Non-Chemical Stressors and Cumulative Risk Assessment: An Overview of Current Initiatives and Potential Air Pollutant Interactions
2. What Is Cumulative Risk Assessment?
3. Vulnerability in the Context of Cumulative Risk Assessment
3.1. Susceptibility and Sensitivity (Vulnerability Related to Biological Characteristics)
3.2. Differential Exposure (Vulnerability Related to an Increased Chemical Burden)
3.3. Differential Preparedness and Recovery (Vulnerabilities Related to Social Environment and Behavior)
4. Cumulative Risk Assessment and the Traditional Risk Assessment Paradigm
4.1. Hazard Identification
4.1.1. Physical and Biological Stressors
4.1.2. Social Stressors
4.2. Exposure Assessment
4.4. Risk Characterization
4.5. Risk Management
5. Non-Chemical Stressors and Air Pollution Exposures
5.1. Animal Studies Examining the Cumulative Effects of Exposure to Chemical and Non-Chemical Stressors
5.2. Epidemiological Studies Examining the Cumulative Effects of Exposure to Air Pollutants and Non-Chemical Stressors
18.104.22.168. Short-term Studies
22.214.171.124. Long-term Studies
126.96.36.199. Cardiovascular Effects
188.8.131.52. Neurological Effects
184.108.40.206. Asthma and Other Respiratory Health Effects
220.127.116.11. Limitations Associated with the Use of Epidemiological Data
6. Research Needs and Conclusions
- Identification of the elements of low SES that have the most significant impact on disease (e.g., to what relative extent does poor nutrition vs. psychosocial stress vs. lack of quality healthcare play a role in disease), investigated on a disease-specific basis.
- Metrics to describe degrees of psychosocial stress and other key biological effects of non-chemical stressors, specifically expressing non-chemicals stressors in manner where “dose”-response relationships can be explored.
- Correlations between gross measures of exposure (e.g., the presence of a landfill) and actual chemical exposure in a population.
- Biomarkers that are reliable indicators of the cumulative effects of chemical and non-chemical stresses.
- Correlations between stress induced in animals and psychosocial stress in humans, specifically whether these animal stress models are applicable to human conditions.
- Quantification of the interactions between non-chemical stressors and chemicals and their relative role in health outcomes. Specifically, how dose-response curves change with combined exposures to chemical and non-chemical stressors.
- Epidemiological evaluations specifically designed to explore the relative contribution of chemicals and non-chemical stressors in disease outcomes, and, specifically, how observations relate to dose-response relationships.
- Focused efforts to better “link” research on dose-response relationships to observations gleaned from epidemiological evaluations.
References and Notes
- Risk Assessment Guidance for Superfund (RAGS). Volume I: Human Health Evaluation Manual (Part A) (Interim Final); NTIS PB90-155581, EPA-540/1-89-002; US EPA, Office of Emergency and Remedial Response: Washington, DC, USA, 1989.
- Alexeeff, G; Faust, J; Meehan, L; Milanes, C; Randles, K; Zeise, L. Cumulative Impacts: Building a Scientific Foundation (Public Review Draft); California Environmental Protection Agency, California Office of Environmental Health Hazard Assessment: California, CA, USA, 2010. [Google Scholar]
- Strategies for Addressing Environment Environmental Impacts in Environmental Justice Communities; Cumulative Impacts Subcommittee, Environmental Justice Advisory Council: Trenton, NJ, USA, 2009.
- Ensuring Risk Reduction in Communities with Multiple Stressors: Environmental Justice and Cumulative Risks/Impacts; National Environmental Justice Advisory Council, Cumulative Risks/Impacts Work Group: Washington, DC, USA, 2004.
- A Preliminary Screening Method to Estimate Cumulative Environmental Impacts; New Jersey Department of Environmental Protection: Trenton, NJ, USA, 2009.
- Science and Decisions: Advancing Risk Assessment [The Silver Book]; Committee on Improving Risk Analysis Approaches, National Research Council, National Academies Press: Washington, DC, USA, 2009.
- Levy, JI. Is epidemiology the key to cumulative risk assessment? Risk Anal 2008, 28, 1507–1513. [Google Scholar]
- Litonjua, AA; Carey, VJ; Weiss, ST; Gold, DR. Race, socioeconomic factors, and area of residence are associated with asthma prevalence. Pediatr. Pulmonol 1999, 28, 394–401. [Google Scholar]
- Smedley, BD; Stith, AY; Nelson, AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care; Institute of Medicine (IOM), Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Board on Health Sciences Policy, National Academies Press: Washington, DC, USA, 2003. [Google Scholar]
- Nzerue, CM; Demissachew, H; Tucker, JK. Race and kidney disease: Role of social and environmental factors. J. Natl. Med. Assoc 2002, 94, 28S–38S. [Google Scholar]
- Schulz, A; Northridge, ME. Social determinants of health: implications for environmental health promotion. Health Educ. Behav 2004, 31, 455–471. [Google Scholar]
- Ward, E; Jemal, A; Cokkinides, V; Singh, GK; Cardinez, C; Ghafoor, A; Thun, M. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J. Clin 2004, 54, 78–93. [Google Scholar]
- Gee, GC; Payne-Sturges, DC. Environmental health disparities: A framework integrating psychosocial and environmental concepts. Environ. Health Perspect 2004, 112, 1645–1653. [Google Scholar]
- Framework for Cumulative Risk Assessment; EPA/630/P-02/001F; US EPA, Risk Assessment Forum: Washington, DC, USA, 2003.
- Concepts, Methods and Data Sources for Cumulative Health Risk Assessment of Multiple Chemicals, Exposures and Effects: A Resource Document; EPA/600/R-06/013F; US EPA, Office of Research and Development, National Center for Environmental Assessment: Cincinnati, OH, USA, 2007.
- Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). Public Law 96-510, 1980; US Congress,. 11 December 1980.
- A Review of the Reference Dose and Reference Concentration Processes (Final); EPA/630-P-02/002F; US EPA, Risk Assessment Forum, Reference Dose/Reference Concentration (RfD/RfC) Technical Panel: Washington, DC, USA, 2002.
- Food Quality Protection Act. Public Law 104-170, 1996; US Congress,. 3 August 1996.
- Preliminary Cumulative Risk Assessment of the Organophosphorus Pesticides; US EPA, Office of Pesticide Programs: Washington, DC, USA, 2001.
- Preliminary OP Cumulative Risk Assessment (Part I); US EPA: Washington, DC, USA, 2002; pp. I.A 1–I.A 3.
- A Set of Scientific Issues Being Considered by the Environmental Protection Agency Regarding: Evaluation of the Common Mechanism of Action of the Pyrethroid Pesticides; SAP Minutes No. 2009-07. Proceedings of FIFRA Scientific Advisory Panel (SAP) Meeting, US Environmental Protection Agency Conference Center, Arlington, VA, USA, 16–17 June 2009.
- National Air Toxics Assessments. US EPA Technology Transfer Network Air Toxics Web Site. Available online: http://www.epa.gov/ttn/atw/natamain (accessed on 17 December 2010).
- National-Scale Air Toxics Assessment for 1996: Estimated Emissions, Concentrations and Risk Technical Fact Sheet; US EPA, Office of Air Quality Planning and Standards: Research Triangle Park, NC, USA, 2002.
- US EPA. National-Scale Air Toxics Assessment for 1999: Estimated Emissions, Concentrations and Risk (Technical Fact Sheet). Available online: http://www.epa.gov/ttn/atw/nata1999/natafinalfact.html (accessed on 31 January 2011).
- US EPA. National-Scale Air Toxics Assessment for 2002—Fact Sheet. Available online: http://www.epa.gov/ttn/atw/nata2002/factsheet.html (accessed on 31 January 2011).
- O’Neill, MS; Jerrett, M; Kawachi, I; Levy, JI; Cohen, AJ; Gouveia, N; Wilkinson, P; Fletcher, T; Cifuentes, L; Schwartz, J. Health, wealth, and air pollution: advancing theory and methods. Environ. Health Perspect 2003, 111, 1861–1870. [Google Scholar]
- Wright, RJ; Subramanian, SV. Advancing a multilevel framework for epidemiologic research on asthma disparities. Chest 2007, 132, 757S–769S. [Google Scholar]
- Wright, RJ; Suglia, SF; Levy, J; Fortun, K; Shields, A; Subramanian, SV; Wright, R. Transdisciplinary research strategies for understanding socially patterned disease: the asthma coalition on community, environment, and social stress (ACCESS) project as a case study. Cien. Saude Colet 2008, 13, 1729–1742. [Google Scholar]
- Clean Air Amendments of 1970. Public Law 91-604, 1970; US Congress,. 31 December 1970.
- Pope, CA; Dockery, DW. Health effects of fine particulate air pollution: Lines that connect. J. Air Waste Manage. Assoc 2006, 56, 709–742. [Google Scholar]
- Integrated Science Assessment for Particulate Matter (Final); EPA/600/R-08/139F; US EPA, Office of Research and Development, National Center for Environmental Assessment—RTP Division: Research Triangle Park, NC, USA, 2009.
- Integrated Science Assessment for Carbon Monoxide; EPA/600/R- 09/019F; US EPA, National Center for Environmental Assessment—RTP Division: Research Triangle Park, NC, USA, 2010.
- Air Quality Criteria for Ozone and Related Photochemical Oxidants (Volume I of III); EPA 600/R-05/004aF; US EPA, National Center for Environmental Assessment—RTP Division: Research Triangle Park, NC, USA, 2006.
- Air Quality Criteria for Lead Volumes I and II (Final); EPA/600/R-5/144aF,; US EPA, National Center for Environmental Assessment: Research Triangle Park, NC, USA, 2006.
- Integrated Science Assessment for Sulfur Oxides—Health Criteria; EPA/600/R-08/047F; US EPA, Office of Research and Development: Research Triangle Park, NC, USA, 2008.
- Integrated Science Assessment for Oxides of Nitrogen; EPA/600/R-08/071; US EPA, National Center for Environmental Assessment—RTP Division: Research Triangle Park, NC, USA, 2008.
- Burin, GJ; Saunders, DR. Addressing human variability in risk assessment—the robustness of the intraspecies uncertainty factor. Regul. Toxicol. Pharmacol 1999, 30, 209–216. [Google Scholar]
- Dourson, M; Charnley, G; Scheuplein, R. Differential sensitivity of children and adults to chemical toxicity. ii. risk and regulation. Regul. Toxicol. Pharmacol 2002, 35, 448–467. [Google Scholar]
- DeFur, PL; Evans, GW; Cohen Hubal, EA; Kyle, AD; Morello-Frosch, RA; Williams, DR. Vulnerability as a function of individual and group resources in cumulative risk assessment. Environ. Health Perspect 2007, 115, 817–824. [Google Scholar]
- Morello-Frosch, R; Shenassa, ED. The environmental “riskscape” and social inequality: Implications for explaining maternal and child health disparities. Environ. Health Perspect 2006, 114, 1150–1153. [Google Scholar]
- Field-Deployable Tools for Quantifying Exposures to Psychosocial Stress and to Addictive Substances for Studies of Health and Disease; National Institutes of Health, Genes and Environmental Initiative Exposure Biology Program, NIH Presentation: Bethesda, MD, USA, 2006.
- Tucker, P. Report of the Expert Panel Workshop on the Psychological Responses to Hazardous Substances; US Department of Health and Human Services, Agency for Toxic Substances and Disease Registry (ATSDR): Atlanta, GA, USA, 1999. [Google Scholar]
- Bacigalupe, G; Fujiwara, T; Selk, S; Woo, M. Community violence as psychosocial stressor: the case of childhood asthma in Boston. Psychology 2010, 1, 27–34. [Google Scholar]
- EPA Research and Development: Risk Paradigm. US EPA, Office of Research and Development. Available online: http://www.epa.gov/ord/htm/risk.htm (accessed on 17 May 2010).
- Risk Assessment in the Federal Government: Managing the Process; NRC, Committee on the Institutional Means for Assessment of Risks to Public Health: Washington, DC, USA, 1983.
- Menzie, CA; MacDonell, MM; Mumtaz, M. A phased approach for assessing combined effects from multiple stressors. Environ. Health Perspect 2007, 115, 807–816. [Google Scholar]
- Chen, WC; McKone, TE. Chronic health risks from aggregate exposures to ionizing radiation and chemicals: Scientific basis for an assessment framework. Risk Anal 2001, 21, 25–42. [Google Scholar]
- Prasher, D; Morata, T; Campo, P; Fechter, L; Johnson, AC; Lund, SP; Pawlas, K; Starck, J; Sliwinska-Kowalska, M; Sulkowski, W. NoiseChem: An European commission research project on the effects of exposure to noise and industrial chemicals on hearing and balance. Noise Health 2002, 4, 41–48. [Google Scholar]
- Biosolids Applied to Land: Advancing Standards and Practices; National Research Council, Committee on Toxicants and Pathogens in Biosolids Applied to Land, National Academies Press: Washington, DC, USA, 2002.
- CADDIS: The Causal Analysis/Diagnosis Decision Information System; US EPA. Available online: http://www.epa.gov/caddis (accessed on 17 December 2010).
- Ben-Shlomo, Y; Kuh, D. A life course approach to chronic disease epidemiology: Conceptual models, empirical challenges and interdisciplinary perspectives. Int. J. Epidemiol 2002, 31, 285–293. [Google Scholar]
- Adler, NE; Ostrove, JM. Socioeconomic status and health: What we know and what we don’t. Ann. NY Acad. Sci 1999, 896, 3–15. [Google Scholar]
- Social Determinants of Health: The Solid Facts, 2nd ed; Wilkinson, R; Marmot, M (Eds.) World Health Organization: Copenhagen, Denmark, 2003.
- Barzyk, TM; Conlon, KC; Chahine, T; Hammond, DM; Zartarian, VG; Schultz, BD. Tools available to communities for conducting cumulative exposure and risk assessments. J. Expo. Sci. Environ. Epidemiol 2010, 20, 371–384. [Google Scholar]
- Zartarian, VG; Schultz, BD. The EPA’s human exposure research program for assessing cumulative risk in communities. J. Expo. Sci. Environ. Epidemiol 2010, 20, 351–358. [Google Scholar]
- Ryan, PB; Burke, TA; Cohen Hubal, EA; Cura, JJ; McKone, TE. Using biomarkers to inform cumulative risk assessment. Environ. Health Perspect 2007, 115, 833–840. [Google Scholar]
- Centers for Disease Control and Prevention (CDC). Interpreting and Managing Blood Lead Levels <10 μg/dL in Children and Reducing Childhood Exposures to Lead: Recommendations of CDC’s Advisory Committee on Childhood Lead Poisoning Prevention. MMWR 2007, 56, (No. RR-8),. 1–16. [Google Scholar]
- Al Zabadi, H; Ferrari, L; Laurent, AM; Tiberguent, A; Pris, C; Zmirou-Navier, D. Biomonitoring of complex occupational exposures to carcinogens: the case of sewage workers in Paris. BMC Cancer 2008, 8, 67. [Google Scholar]
- Györffy, E; Anna, L; Kovacs, K; Rudnai, P; Schoket, B. Correlation between biomarkers of human exposure to genotoxins with focus on carcinogen–DNA adducts. Mutagenesis 2008, 73, 1–18. [Google Scholar]
- Sram, RJ; Binkova, B. Molecular epidemiology studies on occupational and environmental exposure to mutagens and carcinogens, 1997–1999. Environ. Health Perspect 2000, 108, 57–70. [Google Scholar]
- Franco, SS; Nardocci, AC; Gunther, WM. PAH biomarkers for human health risk assessment: A review of the state-of-the-art. Cad. Saude Publica 2008, 24, S569–S580. [Google Scholar]
- McEwen, BS. Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators. Eur. J. Pharmacol 2008, 583, 174–185. [Google Scholar]
- Dowd, JB; Simanek, AM; Aiello, AE. Socio-Economic status, cortisol and allostatic load: A review of the literature. Int. J. Epidemiol 2009, 38, 1297–1309. [Google Scholar]
- Seeman, T; Epel, E; Gruenewald, T; Karlamanga, A; McEwen, BS. Socio-Economic differentials in peripheral biology: Cumulative allostatic load. Ann. NY Acad. Sci 2010, 1186, 223–239. [Google Scholar]
- Supplementary Guidance for Conducting Health Risk Assessment of Chemical Mixtures; EPA/630/R-00/002; US EPA, Risk Assessment Forum: Washington, DC, USA, 2000.
- Hertzberg, RC; MacDonell, MM. Synergy and other ineffective mixture risk definitions. Sci. Total Environ 2002, 288, 31–42. [Google Scholar]
- Teuschler, LK. Deciding which chemical mixtures risk assessment methods work best for what mixtures. Toxicol. Appl. Pharmacol 2007, 223, 139–147. [Google Scholar]
- Cory-Slechta, DA; Virgolini, MB; Rossi-George, A; Thiruchelvam, M; Lisek, R; Weston, D. Lifetime consequences of combined maternal lead and stress. Basic Clin. Pharmacol. Toxicol 2008, 102, 218–227. [Google Scholar]
- Clougherty, JE; Levy, JI; Kubzansky, LD; Ryan, PB; Suglia, SF; Canner, MJ; Wright, RJ. Synergistic effects of traffic-related air pollution and exposure to violence on urban asthma etiology. Environ. Health Perspect 2007, 115, 1140–1146. [Google Scholar]
- Clougherty, JE; Kubzansky, LD. A framework for examining social stress and susceptibility to air pollution in respiratory health. Environ. Health Perspect 2009, 117, 1351–1358. [Google Scholar]
- Wason, SC; Smith, TJ; Evans, JS; Perry, MJ; Levy, JI. Modeling Organophosphate Dose Effects with Other Stressors for Children in an Urban Low-Income Environment. Presented at The Society of Risk Analysis Conference, Baltimore, MD, USA, 6–9 December 2009. Paper T2-D.4..
- Goldstein, DS. Computer models of stress, allostasis, and acute and chronic diseases. Ann. NY Acad. Sci 2008, 1148, 223–231. [Google Scholar]
- Polkowski, R. Environmental Justice Case Study: Toxic Waste in Chester, Pennsylvania. Available online: http://www.umich.edu/~snre492/polk.html (accessed on 31 January 2011).
- Environmental Risk Study for City of Chester, Pennsylvania (Summary Report); US EPA Region III;, Department of Environmental Resources: Cbester, PA, USA, 1995.
- The Environmental Justice Strategic Enforcement Assessment Tool (EJSEAT); US EPA, Office of Enforcement and Compliance Assurance, Environmental Justice. Available online: http://www.epa.gov/compliance/ej/resources/policy/ej-seat.html (accessed on 17 December 2010).
- Community-Focused Exposure and Risk Screening Tool (C-FERST); US EPA, Human Exposure and Atmospheric Sciences. Available online: http://www.epa.gov/heasd/c-ferst/ (accessed on 29 November 2010).
- Fox, MA; Groopman, JD; Burke, TA. Evaluating cumulative risk assessment for environmental justice: A community case study. Environ. Health Perspect 2002, 110, 203–209. [Google Scholar]
- Su, JG; Morello-Frosch, R; Jesdale, BM; Kyle, AD; Shamasunder, B; Jerrett, M. An index for assessing demographic inequalities in cumulative environmental hazards with application to Los Angeles, California. Environ. Sci. Technol 2009, 43, 7626–7634. [Google Scholar]
- Schneider, JS; Lee, MH; Anderson, DW; Zuck, L; Lidsky, TI. Enriched environment during development is protective against lead-induced neurotoxicity. Brain Res 2001, 896, 48–55. [Google Scholar]
- Guilarte, TR; Toscano, CD; McGlothan, JL; Weaver, SA. Environmental enrichment reverses cognitive and molecular deficits induced by developmental lead exposures. Ann. Neurol 2003, 53, 50–56. [Google Scholar]
- Clougherty, JE; Rossi, CA; Lawrence, J; Long, MD; Diaz, EA; Lim, R; McEwen, B; Koutrakis, P; Godleski, JJ. Chronic social stress and susceptibility to concentrated ambient fine particles in rats. Environ. Health Perspect 2010, 118, 769–775. [Google Scholar]
- Kristenson, M; Eriksen, HR; Sluiter, JK; Starke, D; Ursin, H. Psychobiological mechanisms of socioeconomic differences in health. Soc. Sci. Med 2004, 58, 1511–1522. [Google Scholar]
- Dockery, DW; Pope, CA, III; Xu, X; Spengler, JD; Ware, JH; Fay, ME; Ferris, BG, Jr; Speizer, FE. An association between air pollution and mortality in six U.S. cities. N. Engl. J. Med 1993, 329, 1753–1759. [Google Scholar]
- Krewski, D; Burnett, RT; Goldberg, MS; Hoover, K; Siemiatycki, J; Jerrett, M; Abrahamowicz, M; White, WH. Reanalysis of the Harvard Six Cities Study and the American Cancer Society Study of Particulate Air Pollution and Mortality, Part II: Sensitivity Analyses; Health Effects Institute: Cambridge, MA, USA, 2000; pp. 129–293. [Google Scholar]
- Krewski, D; Jerrett, M; Burnett, RT; Ma, R; Hughes, E; Shi, Y; Turner, MC; Pope, A; Thurston, G; Calle, EE; Thun, MJ. Extended Follow-Up and Spatial Analysis of the American Cancer Society Study Linking Particulate Air Pollution and Mortality; HEI Research Report 140; Health Effects Institute: Cambridge, MA, USA, 2009. [Google Scholar]
- Gwynn, RC; Thurston, GD. The burden of air pollution: Impacts among racial minorities. Environ. Health Perspect 2001, 109, 501–506. [Google Scholar]
- Zanobetti, A; Schwartz, J. Race, gender and social status as modifiers of the effects of PM10 on mortality. J. Occup. Environ. Med 2000, 42, 469–474. [Google Scholar]
- Last, JM. A Dictionary of Epidemiology, 4th ed; Oxford University Press: New York, NY, USA, 2001. [Google Scholar]
- Jerrett, M; Burnett, RT; Brook, J; Kanaroglou, P; Giovis, C; Finkelstein, N; Hutchison, B. Do socioeconomic characteristics modify the short term association between air pollution and mortality? Evidence from a zonal time series in Hamilton, Canada. J. Epidemiol. Community Health 2004, 58, 31–40. [Google Scholar]
- Franklin, M; Koutrakis, P; Schwartz, J. The role of particle composition on the association between PM-2.5 and mortality. Epidemiology 2008, 19, 680–689. [Google Scholar]
- Samet, JM; Dominici, F; Curriero, FC; Coursac, I; Zeger, SL. Fine particulate air pollution and mortality in 20 U.S. cities, 1987–1994. N. Engl. J. Med 2000, 343, 1742–1749. [Google Scholar]
- Schwartz, J. Assessing confounding, effect modification, and thresholds in the association between ambient particles and daily deaths. Environ. Health Perspect 2000, 108, 563–568. [Google Scholar]
- O’Neill, MS; Loomis, D; Borja-Aburto, VH. Ozone, area social conditions, and mortality in Mexico City. Environ. Res 2004, 94, 234–242. [Google Scholar]
- Martins, MC; Fatigati, FL; Vespoli, TC; Martins, LC; Pereira, LA; Martins, MA; Saldiva, PH; Braga, AL. Influence of socioeconomic conditions on air pollution adverse health effects in elderly people: an analysis of six regions in São Paulo, Brazil. J. Epidemiol. Community Health 2004, 58, 41–46. [Google Scholar]
- Gouveia, N; Fletcher, T. Time series analysis of air pollution and mortality: effects by cause, age and socioeconomic status. J. Epidemiol. Community Health 2000, 54, 750–755. [Google Scholar]
- Villeneuve, PJ; Burnett, RT; Shi, Y; Krewski, D; Goldberg, MS; Hertzman, C; Chen, Y; Brook, J. A time-series study of air pollution, socioeconomic status, and mortality in Vancouver, Canada. J. Expo. Anal. Environ. Epidemiol 2003, 13, 427–435. [Google Scholar]
- Zeka, A; Zanobetti, A; Schwartz, J. Individual-level modifiers of the effects of particulate matter on daily mortality. Am. J. Epidemiol 2006, 163, 849–859. [Google Scholar]
- Forastiere, F; Stafoggia, M; Tasco, C; Picciotto, S; Agabiti, N; Cesaroni, G; Perucci, CA. Socioeconomic status, particulate air pollution, and daily mortality: Differential exposure or differential susceptibility. Am. J. Ind. Med 2007, 50, 208–216. [Google Scholar]
- Bell, ML; Dominici, F. Effect modification by community characteristics on the short-term effects of ozone exposure and mortality in 98 US communities. Am. J. Epidemiol 2008, 167, 986–997. [Google Scholar]
- Filleul, L; Rondeau, V; Vandentorren, S; Le Moual, N; Cantagrel, A; Annesi-Maesano, I; Charpin, D; Declercq, C; Neukirch, F; Paris, C; et al. Twenty five year mortality and air pollution: results from the French PAARC survey. Occup. Environ. Med 2005, 62, 453–460. [Google Scholar]
- Hoek, G; Brunekreef, B; Goldbohm, S; Fischer, P; van den Brandt, PA. Association between mortality and indicators of traffic-related air pollution in The Netherlands: A cohort study. Lancet 2002, 360, 1203–1209. [Google Scholar]
- Finkelstein, MM; Jerrett, M; DeLuca, P; Finkelstein, N; Verma, DK; Chapman, K; Sears, MR. Relation between income, air pollution and mortality: A cohort study. CMAJ 2003, 108, 57–70. [Google Scholar]
- Finkelstein, MM; Jerrett, M; Sears, MR. Environmental inequality and circulatory disease mortality gradients. J. Epidemiol. Community Health 2005, 59, 481–487. [Google Scholar]
- Dietrich, KN; Succop, PA; Berger, OG; Hammond, PB; Bornschein, RL. Lead exposure and the cognitive development of urban preschool children: The cincinnati lead study cohort at age 4 years. Neurotoxicol. Teratol 1991, 13, 203–211. [Google Scholar]
- Ris, MD; Dietrich, KN; Succop, PA; Berger, OG; Bornschein, RL. Early exposure to lead and neuropsychological outcome in adolescence. J. Int. Neuropsychol. Soc 2004, 10, 261–270. [Google Scholar]
- Tong, S; McMichael, AJ; Baghurst, PA. Interactions between environmental lead exposure and sociodemographic factors on cognitive development. Arch. Environ. Health 2000, 55, 330–335. [Google Scholar]
- Winneke, G; Kraemer, U. Neuropsychological effects of lead in children: Interactions with social background variables. Neuropsychobiology 1984, 11, 195–202. [Google Scholar]
- Bellinger, D; Leviton, A; Waternaux, C; Needleman, H; Rabinowitz, M. Low-Level lead exposure, social class, and infant development. Neurotoxicol. Teratol 1989, 10, 497–503. [Google Scholar]
- Glass, TA; Bandeen-Roche, K; McAtee, M; Bolla, K; Todd, AC; Schwartz, BS. Neighborhood psychosocial hazards and the association of cumulative lead dose with cognitive function in older adults. Am. J. Epidemiol 2009, 169, 683–692. [Google Scholar]
- Peters, JL; Kubansky, L; McNeely, E; Schwartz, J; Spiro, A, III; Sparrow, D; Wright, RO; Nie, H; Hu, H. Stress as a potential modifier of the impact of lead levels on blood pressure: The normative aging study. Environ. Health Perspect 2007, 115, 1154–1159. [Google Scholar]
- Cakmak, S; Dales, RE; Judek, S. Do gender, education, and income modify the effect of air pollution gases on cardiac disease? J. Occup. Environ. Med 2006, 48, 89–94. [Google Scholar]
- Shankardass, K; McConnell, R; Jerrett, M; Milam, J; Richardson, J; Berhane, K. Parental stress increases the effect of traffic-related air pollution on childhood asthma incidence. Proc. Natl. Acad. Sci. USA 2009, 106, 12406–12411. [Google Scholar]
- Cakmak, S; Dales, RE; Judek, S. Respiratory health effects of air pollution gases: Modification by education and income. Arch. Environ. Occup. Health 2006, 61, 5–10. [Google Scholar]
- Lin, M; Chen, Y; Villeneuve, P; Burnett, R; Lemyre, L; Hertzman, C; McGrail, K; Krewski, D. Gaseous air pollutants and asthma hospitalization of children with low household income in Vancouver, British Columbia, Canada. Am. J. Epidemiol 2004, 159, 294–303. [Google Scholar]
- Grineski, SE; Staniswalis, JG; Peng, Y; Atkinson-Palombo, C. Children’s asthma hospitalizations and relative risk due to nitrogen dioxide (NO2): Effect modification by race, ethnicity and insurance status. Environ. Res 2010, 110, 178–188. [Google Scholar]
- Gwynn, RC; Thurston, GD. The burden of air pollution: Impacts among racial minorities. Environ. Health Perspect 2001, 109, 501–506. [Google Scholar]
- Chen, E; Schreier, HM; Strunk, RC; Brauer, M. Chronic traffic-related air pollution and stress interact to predict biologic and clinical outcomes in asthma. Environ. Health Perspect 2008, 116, 970–975. [Google Scholar]
- Adler, NE; Newman, K. Socioeconomic disparities in health: Pathways and policies. Health Aff. (Millwood) 2002, 21, 60–76. [Google Scholar]
- Steenland, K; Henley, J; Calle, E; Thun, M. Individual- and area-level socioeconomic status variables as predictors of mortality in a cohort of 179,383 persons. Am. J. Epidemiol 2004, 159, 1047–1056. [Google Scholar]
- Zanobetti, A; Schwartz, J; Gold, D. Are there sensitive subgroups for the effects of airborne particles? Environ. Health Perspect 2000, 108, 841–845. [Google Scholar]
- Goldberg, MS; Bailar, JC; Burnett, RT; Brook, JR; Tamblyn, R; Bonvalot, Y; Ernst, P; Flegel, KM; Singh, RK; Valois, MF. Identifying Subgroups of the General Population That May Be Susceptible to Short-term Increases in Particulate Air Pollution: A Time-series Study in Montreal, Quebec; HEI Research Report 97; Health Effects Institute: Cambridge, MA, USA, 2000. [Google Scholar]
- Ito, K; Thurston, DG. Daily PM10 mortality/associations: An investigation of at-risk subpopulations. J. Expo. Anal. Environ. Epidemiol 1996, 6, 79–95. [Google Scholar]
- Krewski, D; Burnett, RT; Goldberg, MS; Hoover, BK; Siemiatycki, J; Jerrett, M; Abrahamowicz, M; White, WH. Overview of the reanalysis of the harvard six cities study and American cancer society study of particulate air pollution and mortality. J. Toxicol. Environ. Health 2003, 66, 1507–1551. [Google Scholar]
- Pope, CA; Burnett, RT; Thurston, GD; Thun, MJ; Calle, EE; Krewski, D; Godleski, JJ. Cardiovascular mortality and long-term exposure to particulate air pollution: epidemiological evidence of general pathophysiological pathways of disease. Circulation 2004, 109, 71–77. [Google Scholar]
- Pope, CA; Burnett, RT; Thun, MJ; Calle, EE; Krewski, D; Ito, K; Thurston, GD. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 2002, 287, 1132–1141. [Google Scholar]
- Pope, CA; Thun, MJ; Namboodiri, MM; Dockery, DW; Evans, JS; Speizer, FE; Heath, CW. Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. Am. J. Respir. Crit. Care Med 1995, 151, 669–674. [Google Scholar]
- Laurent, O; Bard, D; Filleul, L; Segala, C. Effect of socioeconomic status on the relationship between atmospheric pollution and mortality. J. Epidemiol. Community Health 2007, 61, 665–675. [Google Scholar]
- Dragano, N; Bobak, M; Wege, N; Peasey, A; Verde, PE; Kubinova, R; Weyers, S; Moebus, S; Mohlenkamp, S; Stang, A; et al. Neighbourhood socioeconomic status and cardiovascular risk factors: A multilevel analysis of nine cities in the Czech Republic and Germany. BMC Public Health 2007, 7, 255. [Google Scholar]
- Harvey, PG; Hamlin, MW; Kumar, R. Blood lead, behavior and intelligence test performance in preschool children. Sci. Total Environ 1984, 40, 45–60. [Google Scholar]
- Lansdown, R; Yule, W; Urbanowicz, MA; Hunter, J. The relationship between blood-lead concentrations, intelligence, attainment and behavior in a school population: The second london study. Int. Arch. Occup. Environ. Health 1986, 57, 225–235. [Google Scholar]
- Tong, IS; Lu, Y. Identification of confounders in the assessment of the relationship between lead exposure and child development. Ann. Epidemiol 2001, 11, 38–45. [Google Scholar]
- Lanphear, BP; Hornung, R; Khoury, J; Yolton, K; Baghurst, P; Bellinger, DC; Canfield, RL; Dietrich, KN; Bornschein, R; Greene, T; et al. Low-Level environmental lead exposure and children’s intellectual function: An international pooled analysis. Environ. Health Perspect 2005, 113, 894–899. [Google Scholar]
- Koller, K; Brown, T; Spurgeon, A; Levy, L. Recent developments in low-level lead exposure and intellectual impairment in children. Environ. Health Perspect 2004, 112, 987–994. [Google Scholar]
- Bellinger, DC. Effect modification in epidemiologic studies of low-level neurotoxicant exposures and health outcomes. Neurotoxicol. Teratol 2000, 22, 133–140. [Google Scholar]
- Evans, GW; Marcynyszyn, LA. Environmental justice, cumulative environmental risk, and health among low- and middle–income children in upstate New York. Am. J. Public Health 2004, 94, 1942–1944. [Google Scholar]
|Criteria air pollutant||Susceptibility factors||Other vulnerability factors||Reference|
|Carbon monoxide||Pre-existing disease|
|Differential exposure/dose (e.g., altitude, exercise, proximity to roads)|
Abuse of medication and other substances
SES (e.g., education and income)
|Particulate matter (PM10 and PM2.5)||Pre-existing disease|
|SES (e.g., education, unemployment, and income)|||
|Differential exposure (e.g., activity level, time spent outdoors; physical activity)|
SES/racial ethnic factors (e.g., education and income)
Environmental factors (urban vs. rural, ETV, endotoxin exposure)
Physiological states (menopause, pregnancy, lactation)
|SES (e.g., education, life stress, and income)|||
|Sulfur dioxide||Genetic factors|
|SES (e.g., education and income)|
Differential exposure (e.g., activity level, residential location, AC use, time spent outdoors)
|Nitrogen dioxide||Pre-existing disease|
|SES (e.g., education and income)|
Differential exposure (e.g., proximity to roads)
|Selected potential indicators of vulnerability (individual)||Selected potential indicators of vulnerability (community)|
|Susceptibility and sensitivity (biological characteristics)||Inherited diseases/predisposition to disease|
|Mental health (coping skills)|
|Low birth weight|
|Differential exposure (increased chemical burden)||Old, substandard housing||Old, substandard housing|
|Cleanliness/sanitation||Inadequate air flow|
|Home use of pesticides||Increased air pollutant exposure|
|Substandard hygiene||Traffic density|
|Poor ventilation||Proximity to hazardous waste sites|
|Proximity to waste disposal sites|
|Proximity to industrial releases|
|Differential preparedness and recovery (social environment and behavior)||SES||SES|
|Family instability||Crime and violence|
|Personal nutrition||Lack of community resources|
|Smoking||Access to quality health care|
|Drug addiction||Substandard schools|
|Chronic underemployment||Concentration of poverty|
|Other aspects of psychosocial stress||Racial segregation|
|Health care access||Noise|
|Health behaviors||Civil engagement/political empowerment|
|Reproductive events||Social capital|
|Draft CalEPA Cumulative Impacts Assessment ||NJDEP Preliminary Screening Method to Estimate Cumulative Environmental Impacts ||NJDEP Strategies for Addressing Cumulative Impacts in Environmental Justice Communities ||US EPA’s NJSEAT |
|Measures of Sensitive Population and Social Indicators|
|Sensitive Populations||None||Social Determinants||Social Demographic Indicators|
|% of population under age 5||Age of housing||% of population living in poverty|
|% of population over age 65||Proportion of population who are children||% of population counted as minority|
|SES||Proportion of population over age 60||% of population 25 years old and|
|% Non-white residents||Poverty rate||over without a high school diploma|
|Median household income||Median family income||% of population over 65 years of age|
|% of residents living below 2X||Racial and ethnic composition of population||% of population under 5 years of age|
|National Poverty Level||Unemployment rate||% of population of limited English proficiency|
|Some measure of parks/recreational space|
|Measures of Environmental Exposure Burden|
|Exposures||Exposures||Pollution burden||Environmental indictors|
|PM2.5 concentrations||NATA cancer risk||Lead in blood of children age 6 or younger||NATA cancer risk|
|Ozone concentrations||NATA diesel exposure||RCRA sites||NATA non-cancer risk|
|Releases from industrial facilities (TRI data)||Estimated benzene emissions||TRI||NATA non-cancer diesel PM|
|Traffic (all)||US EPA National Priorities List sites||Toxic chemical emissions and transfers from industrial facilities|
|Traffic (trucks)||Power plants|
|Density of major regulated sites||Treatment, storage, and disposal facilities||Population-weighted ozone monitoring data|
|Density of known contaminated sites||Brownfields|
|Density of dry cleaners||Known contaminated sites||Population-weighted PM2.5 monitoring data|
|Density of junkyards||Municipal incinerators|
|Resource recovery landfills|
|Incinerator ash landfills|
|Sewage treatment plants|
|Municipal solid waste landfills|
|Trash transfer stations|
|Environmental effects||Compliance indicators|
|Hazardous waste and cleanup sites||Inspections of major facilities|
|Leaking underground fuel tanks||Violations at major facilities|
|Formal actions at major facilities|
|Facility density based on all facilities in US EPA’s facility registry system|
|Measures of Existing Public Health Problems|
|Public health||Existing health problems||Human health indictors|
|Low birth weight||Total cancer incidence rate||% infant mortality|
|Cancer mortality rate||Total cancer death date||% low birth weight births|
|Asthma hospitalization rate||Asthma: hospitalization rate|
|Asthma: emergency department visits|
|Chronic lower respiratory disease|
|Carbon monoxide poisonings|
|All-cause mortality rate|
|Coronary heart disease rate|
|Low birth weight rate|
|Infant mortality rate|
|Birth defect rate|
|Some measure of violence/crime|
|Availability of preventive services|
|Childhood lead screening rate|
|Total population of census tract|
|Size (area) of census tract|
|Health outcome||Chemical stressor||Non-chemical stressor||Results||Reference|
|Short-term studies||CoH (PM indicator); SO2||SES indicators: unemployment, poverty, education, high manufacturing employment||Effect modification by SES measures; slightly higher relative risks and more significant results across the lag periods tested|||
|PM2.5||SES indicators: household income, poverty, education||Effect modification only significant for household income|||
|PM10 adjusted for O3, SO2, NO2, CO||SES indicators: education, annual income||No effect modification by SES|||
|PM10||SES indicator: education||Evidence of weak effect modification by education|||
|PM10||SES indicators: unemployment, poverty level, education||No effect modification by SES|||
|PM10, O3||SES indicator: sociospatial development index (based on homes with electricity, homes with piped water and drainage, literacy, and indigenous language speakers)||PM10 not associated with mortality; ozone was significantly associated with mortality, but no consistent effect modification observed|||
|PM10||SES indicators: education, income, living in slums||Effect of PM on respiratory mortality was negatively correlated with % college education, % family income > $3,500, living in slums|||
|PM10||SES indicator: composite index||Larger effect in higher SES areas but not statistically significant|||
|TSP, CO, NO2, SO2, O3, PM10, CoH, PM10–2.5||SES indicator: income||Only NO2 was associated with mortality in low income groups|||
|Short-term studies||PM10||SES indicator: education||Larger mortality risk estimates were observed in least-educated for all cause, respiratory, and heart disease-related mortality|||
|PM10||SES indicator: income, index that includes education, occupation, unemployment rate, family size, crowding, home ownership||The PM10-mortality association was greater in lower income and lower SES communities|||
|O3||SES indicator: education, income, unemployment, poverty||Effect modification only for unemployment; higher mortality rates for higher unemployment|||
|Long-term studies||PM2.5, sulfates||SES indicator: education||Significant effects for both PM2.5 and sulfates in least educated|||
|PM2.5, sulfates||SES indicator: education||Patterns are similar to previous study but effect modification is less clear; for ischemic heart disease pattern was reverse (most educated has greatest risk)|||
|TSP, BS, NO2||SES indicator: education||No effect modification by educational attainment|||
|BS||SES indicator: education||No effect modification by educational attainment|||
|TSP, SO2||SES indicator: income||Relative risks were higher for the low household income category|||
|Air pollution index: sum of standardized measures of TSP and SO2||Deprivation index (includes unemployment and education)||No effect modification|||
|Neurological effects||Blood lead||SES indicator: income||Cognitive deficits (Kaufman Assessment Battery) associated with neonatal blood lead only in poorer families|||
|Blood lead||SES indicator: income||No modifying effect of SES on blood lead-learning/IQ association, but observed trend of greater vulnerability in lower SES subgroup|||
|Blood lead||SES indicator: parents’ occupational prestige||Modifying effects by SES were observed for IQ and blood lead, but interaction became non significant when adjusted for other factors (age at testing, iron status, birth weight, etc.)|||
|Blood lead||SES indicator: composite index including education and father’s occupation||Effect modification of lead-related decreased performance in visual-motor integration and choice reaction tests|||
|Blood lead||SES indicators: Hollingshead’s Four-Factor Index of Social Class, a measure of parents’ occupational and educational achievements||Modifying effects by SES were observed for Mental Development Index and blood lead only at ages 18 to 24 months|||
|Bone lead||SES indicators: neighborhood psychosocial hazards (neighborhood violent crimes, 911 calls, etc.)||Psychosocial stress exacerbated effects of lead on 3 of 7 cognitive measures|||
|Cardiovascular Disease||Lead (bone lead)||SES indicators: stress (based on standardized questionnaire and self-reported)||Effects of lead on hypertension were more pronounced in stressed individuals|||
|O3, CO, NO2||SES indicators: education, income||No effect modification by SES on cardiac hospital admissions|||
|Asthma and other respiratory diseases||NO2 (proxy for traffic)||SES indicators: exposure to violence||Elevated risk of developing asthma with increased NO2 exposure only in children with higher exposure to violence|||
|Traffic-related air pollution (Nitrogen Oxides)||SES indicators: parental education, parental stress||High parental stress was associated with higher incidence of traffic-related risk of developing asthma. An increased risk of asthma was also observed for low SES families exposed to air pollution|||
|O3, SO2, NO2||SES indicators: education, income||Greater hospitalizations for respiratory effects in lower education and lower income strata|||
|NO2, SO2, O3, CO||SES indicator: average household income adjusted for household size||Male children had higher asthma hospitalizations in low SES group with exposure to NO2; female children had higher asthma hospitalizations for SO2 in the low-income group. No associations for O3 or CO|||
|NO2||SES indicator: insurance status||Children without insurance had higher risk of asthma admissions than those with private insurance|||
|PM10, O3, sulfates, strong acidity||SES indicator: insurance status||The overall hospital admissions association for both O3 and PM10 was driven by the uninsured minority population|||
|NO2||Life stress||Greater inflammatory markers associated with high stress in low pollution exposure group|||
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