The environmental "riskscape" and social inequality: implications for explaining maternal and child health disparities.BACKGROUND: Research indicates that the double jeopardy double jeopardy: see jeopardy. double jeopardy In law, the prosecution of a person for an offense for which he or she already has been prosecuted. In U.S. of exposure to environmental hazards combined with place-based stressors is associated with maternal and child health (MCH See Intel Hub Architecture. ) disparities. OBJECTIVE AND DISCUSSION: Our aim is to present evidence that individual-level and place-based psychosocial stressors may compromise host resistance such that environmental pollutants environmental pollutants, n.pl the substances and conditions, including noise, that adversely affect the health and well-being of the people within a community. would have adverse health effects at relatively lower doses, thus partially explaining MCH disparities, particularly poor birth outcomes. Allostatic load The introduction to this article provides insufficient context for those unfamiliar with the subject matter. Please help [ improve the introduction] to meet Wikipedia's layout standards. You can discuss the issue on the talk page. may be a physiologic mechanism behind the moderation of the toxic effect of environmental pollutants by social stressors. We propose a conceptual framework For the concept in aesthetics and art criticism, see . A conceptual framework is used in research to outline possible courses of action or to present a preferred approach to a system analysis project. for holistic approaches to future MCH research that elucidates the interplay of psychosocial stressors and environmental hazards in order to better explain drivers of MCH disparities. CONCLUSION: Given the complexity of the link between environmental factors and MCH disparities, a holistic approach to future MCH research that seeks to untangle the double jeopardy of chronic stressors and environmental hazard exposures could help elucidate how the interplay of these factors shapes persistent racial and economic disparities in MCH. KEY WORDS: birth outcomes, environment, health disparities
Health disparities (also called health inequalities in some countries) refer to gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups. , stress. Environ Health Perspect 114:1150-1153 (2006). doi:10.1289/ehp.8930 available via http://dx.doi.org/ [Online 6 April 2006] ********** A formidable challenge in the field of maternal and child health (MCH) has been explaining the persistent racial and socioeconomic health disparities, particularly in birth outcomes in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. (Singh and Yu 1995). Despite declines in the overall infant mortality (hardware) infant mortality - It is common lore among hackers (and in the electronics industry at large) that the chances of sudden hardware failure drop off exponentially with a machine's time since first use (that is, until the relatively distant time at which enough mechanical , there remains a significant disparity between black and white infant mortality rates infant mortality rate n. The ratio of the number of deaths in the first year of life to the number of live births occurring in the same population during the same period of time. . Nationally, black women are twice as likely as white women to give birth to a very low-birth-weight baby Noun 1. low-birth-weight baby - an infant born weighing less than 5.5 pounds (2500 grams) regardless of gestational age; "a low-birth-weight infant is at risk for developing lack of oxygen during labor" low-birth-weight infant . For preterm preterm /pre·term/ (-term´) before completion of the full term; said of pregnancy or of an infant. pre·term adj. births, although the gap between the two racial groups has narrowed recently, the disparity between the two groups remains large: a 6.7% difference (National Center for Health Statistics National Center for Health Statistics (NCHS) is part of the Centers for Disease Control and Prevention (CDC), which is part of the United States Department of Health and Human Services. NCHS is the United States' principal health statistics agency. 2003). Here we discuss the interplay of environmental hazards with place-based and individual-level psychosocial stressors and its implications for MCH research. Although a strong body of literature has shed much light on the individual-level factors (e.g., health behaviors, inter-pregnancy interval, and access to adequate health care) (Hessol et al. 1998; Hummer 1993; Rawlings et al. 1995; Starfield et al. 1991) and placed-based drivers of MCH disparities (e.g., neighborhood poverty, relative income inequality, poor housing, and segregation) (Buka et al. 2002; Guest et al. 1998; Huynh et al. 2005; Laveist 1993; Matteson et al. 1998; Morenoff 2003; O'Campo et al. 1997; Shenassa et al. 2004), there has been little cross-pollination between this field and the research investigating links between environmental hazard exposures and birth outcomes (Parker et al. 2005; Ritz and Yu 1999; Ritz et al. 2000; Sadler et al. 1999; Whyatt et al. 2004; Wilhelm and Ritz 2003). Place-based stressors are biologically relevant components of the human environment and can function independently of individual-level stressors to determine health (Diez-Roux 1998; Shenassa 2001). These place-based factors can influence birth outcomes in three ways: a) by affecting birth outcomes directly (Huynh et al. 2005; Rich-Edwards and Grizzard 2005); b) by increasing exposures to environmental hazards, such as air pollutants (Parker et al. 2005; Woodruff et al. 2003); and c) by enhancing susceptibility to the toxic effects of contaminant contaminant /con·tam·i·nant/ (kon-tam´in-int) something that causes contamination. contaminant something that causes contamination. exposures (Ponce et al. 2005). This third pathway concerning the interaction of place-based stressors with environmental hazards points toward the next generation of studies to understand the combined effects of environmental and psychosocial drivers of MCH disparities. We first discuss the confluence of place-based psychosocial stressors and environmental hazard exposures and its implications for future research on MCH disparities with a focus on birth outcomes. We then propose a possible physiologic link between place-based stressors and environmental hazards in ways that may enhance susceptibility to toxics. We conclude by outlining a conceptual framework for future MCH research. Social Inequality and Environmental Health Disparities Wide-ranging political, socioeconomic, and discriminatory forces coupled with spatial patterns of industrialization industrialization Process of converting to a socioeconomic order in which industry is dominant. The changes that took place in Britain during the Industrial Revolution of the late 18th and 19th century led the way for the early industrializing nations of western Europe and and development have segregated people of color Noun 1. people of color - a race with skin pigmentation different from the white race (especially Blacks) people of colour, colour, color race - people who are believed to belong to the same genetic stock; "some biologists doubt that there are important , particularly African Americans, into communities with some of the highest indices of urban poverty and material deprivation (Morello-Frosch and Jesdale 2006; Schultz et al. 2002; Williams and Collins 2004). Researchers and policy makers concerned about environmental justice argue that communities of color not of the white race; - commonly meaning, esp. in the United States, of negro blood, pure or mixed. See also: Color and the poor face a higher frequency and magnitude of exposures to environmental as well as psychosocial stressors [Institute of Medicine (IOM IOM See: Index and Option Market ) 1999; O'Neill et al. 2003]. Concern has centered on the limited science related to the cumulative impact of multiple exposures to environmental hazards and the potential vulnerability of poor communities to their toxic effects [National Environmental Justice Advisory Council (NEJAC NEJAC National Environmental Justice Advisory Council ) 2004]. This combination and potential interaction of elevated environmental hazard exposures, on the one hand, and socioeconomic stressors, on the other, have been described as a form of "double jeopardy" (IOM 1999). Understanding the MCH implications of these "geographies of exposure and susceptibility" (Jerrett and Finkelstein 2005) or "riskscapes" (Morello-Frosch et al. 2001) requires consideration of the timing of exposure to psychosocial stressors as well as environmental hazards during the life course (e.g., during the prenatal years, infancy, adolescence, or adulthood) and socioeconomic, political, cultural, and gender dynamics. For example, the lack of child care for agricultural workers often forces families, mostly mothers, to take their children to the fields while they work, thereby increasing young children's exposures to pesticides (Natural Resources Defense Council The Natural Resources Defense Council (NRDC) is a New York City-based, non-profit non-partisan international environmental advocacy group, with offices in Washington, D.C., San Francisco, Los Angeles, Chicago, and Beijing. Founded in 1970, NRDC today has 1. 1999). Many of these pesticides are known neurotoxicants and carcinogens Carcinogens Substances in the environment that cause cancer, presumably by inducing mutations, with prolonged exposure. Mentioned in: Colon Cancer, Rectal Cancer , and the potential long-term effects of childhood and prenatal exposures are just being explored and understood (Berkowitz et al. 2004; Castorina et al. 2003; Eskenazi et al. 2004; Gladen et al. 2003; Perera et al. 2003; Torres-Arreola et al. 2003; Whyatt et al. 2004; Young et al. 2005). Similarly, neighborhood-level factors associated with racial residential segregation may affect health by influencing access to affordable markets with fresh fruits and vegetables and access to health services health services Managed care The benefits covered under a health contract (Diez-Roux 1997; Morland et al. 2002). Women without access to adequate prenatal care prenatal care, n the health care provided the mother and fetus before childbirth. , for example, are likely to have compromised nutritional status nutritional status, n the assessment of the state of nourishment of a patient or subject. , which in turn can heighten the impact of lead exposure both in utero in utero (in u´ter-o) [L.] within the uterus. in u·ter·o adj. In the uterus. in utero adv. and during early childhood (Lee et al. 2005; Zierold 2004). State of the Evidence Research on birth outcomes points to the validity of integrating social with environmental health riskscapes in future MCH research (Gee and Payne-Sturges 2004; Morenoff 2003; O'Campo et al. 1997). Evidence shows a consistent relationship between residence in poverty-stricken (Collins et al. 1997; O'Campo et al. 1997; Papacek et al. 2002), segregated (Guest et al. 1998; Laveist 1993) neighborhoods and poor birth outcomes. Moreover, preliminary work suggests substantial racial and ethnic disparities in environmental hazards exposures (Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. 2005; IOM 1999; Morello-Frosch 2002; NEJAC 2004), including during pregnancy (Woodruff et al. 2003), and studies have begun to link pollutant exposures and negative birth and developmental outcomes (Dejmek et al. 1999; Ritz and Yu 1999; Ritz et al. 2000, 2002). One recent study of individual factors, pollutant exposures, and neighborhood measures of socioeconomic hardship (Ponce et al. 2005) found that preterm birth risk was affected by the interaction of residential traffic-related air pollution exposure and measures of neighborhood economic hardship. Distilling the results of this diverse body of MCH research reveals two critical paths for future inquiry. The first is the direct health effects of hazardous social and physical environments to which communities of color and the poor are disproportionately exposed. To date, MCH studies have emphasized this first line of inquiry by analyzing the effects of individual and place-based socioeconomic status socioeconomic status, n the position of an individual on a socio-economic scale that measures such factors as education, income, type of occupation, place of residence, and in some populations, ethnicity and religion. (SES) stressors, on one hand, or by assessing the effect of individual factors and environmental hazards, on the other. The second line of inquiry, as outlined below, examines all of these factors in an integrated fashion by exploring how the multilevel mul·ti·lev·el adj. Having several levels: a multilevel parking garage. Adj. 1. multilevel - of a building having more than one level interplay and possible interaction of psychosocial stressors with environmental hazards may shape disparities in birth outcomes. For example, previous pollutant exposures may enhance susceptibility to the toxic effects of current pollutant exposures, particularly if the body's defense mechanisms and ability to recover or detoxify de·tox·i·fy v. 1. To counteract or destroy the toxic properties of a substance. 2. To remove the effects of poison from something, such as the blood. 3. have been compromised through prior exposures to harmful agents. Similarly, exposure to place-based psychosocial stressors, such as persistent poverty, material deprivation, and a lack of services, may lead to chronic stress, which can weaken the body's defense systems (Cohen cohen or kohen (Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male. 1999; McEwen 1998). Physiologic Mechanisms The concept of allostasis provides a framework for measuring the physiologic manifestations of chronic psychosocial and environmental stressors. Allostasis refers to the ability of the body's stress-response systems to regulate internal physiology in response to psychosocial or physical stressors. The related concept of allostatic load refers to the cumulative physiologic degradation, over the life course, that can result from chronic stress exposure, and the accompanying long-term shift that occurs in the body's homeostatic homeostatic pertaining to homeostasis. functions, with harmful consequences (Geronimus 1992; McEwen 1998; Seeman et al. 1997). The physiologic effect of prolonged stressors can exact a toll on the body that is caused by chronic activation of biologic systems, such as the hypothalamic-pituitary-adrenal axis hypothalamic-pituitary-adrenal axis A tightly-linked, interdependent endocrine unit which, with the systemic sympathetic and adrenomedullary systems, comprises a major peripheral limb of the stress system, the main function of which is to maintain basal and , which releases hormones (e.g., glucocorticoids Glucocorticoids Any of a group of hormones (like cortisone) that influence many body functions and are widely used in medicine, such as for treatment of rheumatoid arthritis inflammation. ) that can have several metabolic and psychological effects, including the mobilization of energy reserves and suppression of the immune system immune system Cells, cell products, organs, and structures of the body involved in the detection and destruction of foreign invaders, such as bacteria, viruses, and cancer cells. Immunity is based on the system's ability to launch a defense against such invaders. (Seeman et al. 1997; Sterling and Eyer 1988). Chronic activation of this system can lead to "wear and tear" on major organ systems (McEwen 1998). The mechanism of allostatic load provides a potential pathway by which place-based stressors can modify the toxic effect of environmental hazard exposures to produce disparate patterns of birth outcomes between and within populations. This is also in line with the concept of "weathering" proposed by Geronimus and others, suggesting that chronic stress associated with the combined effects of poverty, racial discrimination, and material deprivation causes the health of African-American mothers to deteriorate particularly rapidly, leading to poorer birth outcomes with increased age (Collins and Williams 1999; Geronimus 1992). The biomechanics of stress and allostasis can be considered a possible mediator of the heightened susceptibility to the adverse effects of pollution exposures observed among people with low SES. A Framework for Future Research The framework in Figure 1 suggests how area-level and individual-level stressors and buffers may combine to shape environmental hazard exposures, affect individual allostatic load, and in turn enhance susceptibility to the toxic effects of pollution exposures. At the bottom of Figure 1 is a variation of the exposure-health outcome continuum that outlines how environmental toxins might cause disease (National Research Council 1991). Traditionally, the exposure-health outcome continuum includes the emission of a contaminant from an indoor source such as smoking or an outdoor source such as an industrial facility, through human exposure via various media (e.g., air), and the occurrence of an adverse health outcome (e.g., low birth weight). The framework depicted in Figure 1 implies that the presence of an environmental contaminant must first lead to human exposure and then overcome the body's defense systems to have an adverse health effect. The internal dose may not have an adverse health effect until it achieves a biologically effective dose that depends on rates of bioaccumulation bi·o·ac·cu·mu·la·tion n. The increase in the concentration of a substance, especially a contaminant, in an organism or in the food chain over time. , biotransformation biotransformation /bio·trans·for·ma·tion/ (-trans?for-ma´shun) the series of chemical alterations of a compound (e.g., a drug) occurring within the body, as by enzymatic activity. , elimination, and, most relevant to our discussion, an individual's susceptibility. Animal studies suggest that stress can moderate a response to environmental toxins and other agents. For example, chronic stress may increase the absorption of environmental toxicants into the body through increased respiration, consumption, or perspiration (Gordon 2003). Similarly, allostatic load may amplify susceptibility to the toxic effects of pollutants, leading to adverse birth outcomes. Indeed, stress may alter physiologic functioning, through stress-dependent hormones that can affect in utero development and shift the threshold for toxicity, thereby leading to adverse birth outcomes at lower exposures (Paarlberg et al. 1995). Moreover, the body's biotransformation or detoxification Detoxification Definition Detoxification is one of the more widely used treatments and concepts in alternative medicine. It is based on the principle that illnesses can be caused by the accumulation of toxic substances (toxins) in the body. systems can remove or nullify nul·li·fy tr.v. nul·li·fied, nul·li·fy·ing, nul·li·fies 1. To make null; invalidate. 2. To counteract the force or effectiveness of. toxins, but under conditions of chronic stress, the body's defense system may be impaired, resulting in compromised organ resistance. Finally, illness caused by chronic stress may compromise a sick individual's capacity to cope with environmental hazard exposures (Rios et al. 1993). Conclusion Allostatic load may be a critical physiologic mechanism that explains the excess burden of adverse birth outcomes related to certain pollutants observed among low-SES populations and some communities of color. Maternal immune systems that are shaped by chronic stressors before conception and during pregnancy may enhance particular vulnerabilities to adverse pregnancy outcomes. This is compounded by race- and class-based disparities in exposures to environmental hazards that are driven by the distribution of power, privilege, and economic resources (Morello-Frosch 2002). These environmental health disparities are likely to be moderated by the degree and magnitude of chronic community and individual-level stressors that may be reflected in individuals' allostatic load. Therefore, a holistic approach to future MCH research that seeks to untangle the double jeopardy of chronic stressors and environmental hazard exposures could help elucidate how the interplay of these individual- and community-level factors shape persistent racial and economic disparities in birth outcomes. Most important, for researchers and practitioners concerned about environmental justice, this line of inquiry could suggest new strategies for alleviating systemic drivers of racial and socioeconomic disparities in birth outcomes. REFERENCES Berkowitz GS, Wetmur JG, Birman-Deych E, Obel J, Lapinski RH, Godbold JH, et al. 2004. In utero pesticide exposure, maternal paraoxonase activity, and head circumference. Environ Health Perspect 112:388-391. Buka S, Brennan RT, Rich-Edwards JW, Raudenbush SW, Earls F. 2002. Neighborhood support and the birthweight of urban infants. Am J Epidemiol 157:1-8. Castorina R, Bradman A, McKone TE, Barr DB, Harnly ME, Eskenazi B. 2003. Cumulative organophosphate pesticide organophosphate pesticide A phosphorus-rich organic compound–eg, parathion, that contain a halide which phosphorylates cholinesterase and irreversibly inhibits its activity Management Atropine, pralidoxime exposure and risk assessment among pregnant women living in an agricultural community: a case study from the CHAMACOS CHAMACOS Center for the Health Assessment of Mothers and Children of Salinas cohort. Environ Health Perspect 111:1640-1648. Centers for Disease Control and Prevention. 2005. Third National Report on Human Exposure to Environmental Chemicals. NCEH NCEH National Center for Environmental Health (US CDC) Pub. No. 05-0570. Atlanta, GA:Centers for Disease Control and Prevention, National Center for Environmental Health. Cohen S. 1999. Social status and susceptibility to respiratory infections. Ann NY Acad Sci 896:246-253. Collins C, Williams D. 1999. Segregation and mortality: the deadly effects of racism. Social Forum 14:495-523. Collins JW, Herman AA, David RJ. 1997. Very-low-birthweight infants and income incongruity in·con·gru·i·ty n. pl. in·con·gru·i·ties 1. Lack of congruence. 2. The state or quality of being incongruous. 3. Something incongruous. Noun 1. among African American and white parents in Chicago. Am J Public Health 87:414-417. Dejmek J, Selevan S, Benes I, Solansky I, Sram R. 1999. Fetal growth and maternal exposure to particulate matter during pregnancy. Environ Health Perspect 107:475-480. Diez-Roux A. 1997. Neighborhood environments and coronary heart disease coronary heart disease: see coronary artery disease. coronary heart disease or ischemic heart disease Progressive reduction of blood supply to the heart muscle due to narrowing or blocking of a coronary artery (see atherosclerosis). : a multilevel analysis. Am J Epidemiol 146:48-63. Diez-Roux A. 1998. Bringing context back into epidemiology: variables and fallacies in multilevel analysis. Am J Public Health 88:216-222. Eskenazi B, Harley K, Bradman A, Weltzien E, Jewell NP, Barr DB, et al. 2004. Association of in utero organophosphate pesticide exposure and fetal growth and length of gestation in an agricultural population. Environ Health Perspect 112:1116-1124. Gee G, Payne-Sturges D. 2004. Environmental health disparities: a framework integrating psychosocial and environmental concepts. Environ Health Perspect 1123:1645-1653. Geronimus AT. 1992. The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethn Dis 2:207-221. Gladen BC, Shkiryak-Nyzhnyk ZA, Chyslovska N, Zadorozhnaja TD, Little RE. 2003. Persistent organochlorine or·gan·o·chlo·rine n. Any of various hydrocarbon pesticides, such as DDT, that contain chlorine. compounds and birth weight. Ann Epidemiol 13:151-157. Gordon C. 2003. Role of environmental stress in the physiological response to chemical toxins. Environ Res 92:1-7. Guest AM, Almgren G, Hussey JM. 1998. The ecology of race and socioeconomic distress: infant and working-age mortality in Chicago. Demography 35:23-34. Hessol NA, Fuentes-Afflick E, Bacchetti P. 1998. Risk of low birth weight infants among black and white parents. Obstet Gynecol 92:814-822. Hummer RA. 1993. Racial differences in infant mortality in the U.S.: an examination of social and health determinants. Soc Forces 72:529-554. Huynh M, Parker J, Harper S, Pamuk E, Schoendorf K. 2005. Contextual effect of income inequality on birth outcomes. Int J Epidemiol 34:888-895. IOM. 1999. Toward Environmental Justice: Research, Education, and Health Policy Needs. Washington, DC:Institute of Medicine, Committee on Environmental Justice, Health Sciences Policy Program, Health Sciences Section. Jerrett M, Finkelstein M. 2005. Geographies of risk in studies linking chronic air pollution exposure to health outcomes. J Toxicol Environ Health 68:1207-1242. Laveist TA. 1993. Segregation, poverty, and empowerment: health consequences for African Americans. Milbank Q 71:41-64. Lee M, Chun O, Song W. 2005. Determinants of the blood lead levels of US women of reproductive age. J Am Coll Nutr 24:1-9. Matteson DW, Burr JA, Marshall JR. 1998. Infant mortality: a multi-level analysis of individual and community risk factors. Soc Sci Med 47:1841-1854. McEwen BS. 1998. Protective and damaging effects of stress mediators. N Engl J Med 338:171-179. Morello-Frosch R. 2002. The political economy of environmental discrimination. Environ Plann C Gov Policy 20:477-496. Morello-Frosch R, Jesdale BM. 2006. Separate and unequal: residential segregation and estimated cancer risks associated with ambient air toxics in U.S. metropolitan areas. Environ Health Perspect 114:386-393. Morello-Frosch R, Pastor M, Sadd J. 2001. Environmental justice and southern California's "riskscape": the distribution of air toxics exposures and health risks among diverse communities. Urban Affairs Rev 36:551-578. Morenoff J. 2003. Neighborhood mechanisms and the spatial dynamics of birth weight. Am J Sociol 108:976-1017. Morland K, Wing S, Diez Roux Roux , Pierre Paul Émile 1853-1933. French bacteriologist. His work with the diphtheria bacillus led to the development of antitoxins to neutralize pathogenic toxins. A, Poole C. 2002. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med 22:23-29. National Center for Health Statistics. 2003. National Vital Statistics Report. Washington, DC:National Center for Health Statistics. National Research Council. 1991. Human Exposure Assessment for Airborne Pollutants: Advances and Opportunities. Washington, DC:National Academy Press. Natural Resources Defense Council. 1999. Trouble on the Farm: Growing Up with Pesticides in Agricultural Communities. San Francisco:Natural Resources Defense Council. NEJAC. 2004. Ensuring Risk Reduction in Communities with Multiple Stressors: Environmental Justice and Cumulative Risks/Impacts--Draft Report. New Orleans:National Environmental Justice Advisory Council. O'Campo P, Xue X, Wang M-C, Caughy MOB. 1997. Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis. Am J Epidemiol 87:1113-1118. O'Neill MS, Jerrett M, Kawachi I, Levy JI, Cohen AJ, Gouveia N, et al. 2003. Health, wealth, and air pollution: advancing theory and methods. Environ Health Perspect 111:1861-1870. Paarlberg KM, Vingerhoets AJ, Passchier J, Dekker GA, Van Geijn HP. 1995. Psychosocial factors and pregnancy outcome: a review with emphasis on methodological issues. J Psychosom Res 39:563-595. Papacek EM, Collins JW, Schulte NF, Goergen C, Drolet A. 2002. Differing postneonatal mortality postneonatal mortality Public health A standard indicator of health, defined as the number of infant deaths occurring between 28 days and 11 months of life. Cf Infant mortality. rates of African-American and white infants in Chicago: an ecologic study. Matern Child Health J 6:99-105. Parker J, Woodruff T, Basu R, Schoendorf K. 2005. Air pollution and birth weight among term infants in California. Pediatrics 115:121-128. Perera FP, Rauh V, Tsai WY, Kinney P, Camann D, Barr D, et al. 2003. Effects of transplacental transplacental /trans·pla·cen·tal/ (-plah-sen´tal) through the placenta. trans·pla·cen·tal adj. Relating to or involving passage through or across the placenta. exposure to environmental pollutants on birth outcomes in a multiethnic population. Environ Health Perspect 111:201-205. Ponce N, Hoggatt K, Wilhelm M, Ritz B. 2005. Preterm birth: the interaction of traffic-related air pollution with economic hardship in Los Angeles neighborhoods. Am J Epidemiol 162:140-148. Rawlings J, Rawlings V, Read J. 1995. Prevalence of low birth weight and preterm delivery in relation to the interval between pregnancies among white and black women. N Engl J Med 332:69-74. Rich-Edwards JW, Grizzard T. 2005. Psychosocial stress and neuroendocrine neuroendocrine /neu·ro·en·do·crine/ (-en´do-krin) pertaining to neural and endocrine influence, and particularly to the interaction between the nervous and endocrine systems. neu·ro·en·do·crine adj. mechanisms in preterm delivery. Am J Obstet Gynecol 192:S30-S35. Rios R, Poje G, Detels R. 1993. Susceptibility to environmental pollutants among minorities. Toxicol Ind Health 9:797-820. Ritz B, Yu F. 1999. The effect of ambient carbon monoxide carbon monoxide, chemical compound, CO, a colorless, odorless, tasteless, extremely poisonous gas that is less dense than air under ordinary conditions. It is very slightly soluble in water and burns in air with a characteristic blue flame, producing carbon dioxide; on low birth weight among children born in southern California between 1989 and 1993. Environ Health Perspect 107:17-25. Ritz B, Yu F, Chapa G, Fruin S. 2000. Effect of air pollution on preterm birth among children born in southern California between 1989 and 1993. Epidemiology 11:502-511. Ritz B, Yu F, Chapa G, Shaw G, Harris J. 2002. Ambient air pollution and risk of birth defects birth defects, abnormalities in physical or mental structure or function that are present at birth. They range from minor to seriously deforming or life-threatening. A major defect of some type occurs in approximately 3% of all births. in southern California. Am J Epidemiol 155:17-25. Sadler L, Belanger K, Saftlas A, Leaderer B, Hellenbrand K, McSharry J, et al. 1999. Environmental tobacco smoke environmental tobacco smoke (ETS/passive smoke), n the gaseous by-product of burning tobacco products, including but not limited to commercially manufactured cigarettes and cigars; contains toxic elements harmful to the health of adults and children exposure and small-for-gestational-age birth. Am J Epidemiol 150:695-705. Schultz A, Williams D, Israel B, Lempert L. 2002. Racial and spatial relations as fundamental determinants of health in Detroit. Milbank Q 80:677-707. Seeman TE, Singer BH, Rowe JW, Horwitz RI, McEwen BS. 1997. Price of adaptation--allostatic load and its health consequences. MacArthur studies of successful aging. Arch Intern Med 157:2259-2268. Shenassa E. 2001. Society, physical health and modern epidemiology. Epidemiology 12:467-470. Shenassa ED, Stubbendick A, Brown MJ. 2004. Social disparities in housing and related pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children. pe·di·at·ric adj. Of or relating to pediatrics. injury: a multilevel study. Am J Public Health 94:633-639. Singh GK, Yu SM. 1995. Infant mortality in the United States: trends, differentials, and projections, 1950 through 2010. Am J Public Health 85:957-964. Starfield B, Shapiro S, Weiss J, Liang K-Y, Ra K, Paige D, et al. 1991. Race, family income, and low birth weight. Am J Epidemiol 134:1167-1174. Sterling P, Eyer J. 1988. Allostasis: a new paradigm New Paradigm In the investing world, a totally new way of doing things that has a huge effect on business. Notes: The word "paradigm" is defined as a pattern or model, and it has been used in science to refer to a theoretical framework. to explain arousal pathology. In: Handbook of Life Stress, Cognition, and Health (Fisher S, Reason JT, eds). Chichester, NY:Wiley, 750. Torres-Arreola L, Berkowitz G, Torres-Sanchez L, Lopez-Cervantes M, Cebrian ME, Uribe M, et al. 2003. Preterm birth in relation to maternal organochlorine serum levels. Ann Epidemiol 13:158-162. Whyatt RM, Rauh V, Barr DB, Camann DE, Andrews HF, Garfinkel R, et al. 2004. Prenatal insecticide exposures and birth weight and length among an urban minority cohort. Environ Health Perspect 112:1125-1132. Wilhelm M, Ritz B. 2003. Residential proximity to traffic and adverse birth outcomes in Los Angeles County, California Los Angeles County is a county in California and is by far the most populous county in the United States. Figures from the U.S. Census Bureau give an estimated 2006 population of 9,948,081 residents,[1] while the California State government's population bureau lists a , 1994-1996. Environ Health Perspect 111:207-216. Williams D, Collins C. 2004. Reparations reparations, payments or other compensation offered as an indemnity for loss or damage. Although the term is used to cover payments made to Holocaust survivors and to Japanese Americans interned during World War II in so-called relocation camps (and used as well to : a viable strategy to address the enigma of African American health. Am Behav Sci 47:977-1000. Woodruff T, Parker J, Kyle A, Schoendorf K. 2003. Disparities in exposure to air pollution during pregnancy. Environ Health Perspect 11:942-946. Young JG, Eskenazi B, Gladstone EA, Bradman A, Pedersen L, Johnson C, et al. 2005. Association between in utero organophosphate pesticide exposure and abnormal reflexes in neonates. Neurotoxicology 26:199-209. Zierold K. 2004. Trends in blood lead levels among children enrolled in the special supplemental nutrition program for women, infants, and children from 1996 to 2000. Am J Public Health 94:1513-1515. Rachel Morello-Frosch (1,2) and Edmond D. Shenassa (2,3) (1) Center for Environmental Studies; (2) Department of Community Health, School of Medicine; and (3) Centers for Behavioral and Preventive Medicine preventive medicine, branch of medicine dealing with the prevention of disease and the maintenance of good health practices. Until recently preventive medicine was largely the domain of the U.S. , Brown University, Providence, Rhode Island  “Providence” redirects here. For other uses, see Providence (disambiguation). Providence is the capital and the most populous city of the U.S. , USA Address correspondence to R. Morello-Frosch, Center for Environmental Studies and Department of Community Health, School of Medicine, Brown University, 135 Angell St., Box 1943, Providence, RI 02912 USA. Telephone: (401) 863-9429. Fax: (401) 863-3503. E-mail: rmf@brown.edu We thank S. Yu for her comments on an earlier version of this manuscript. E.D.S D.S Drainage Structure (flood protection) . was supported by grant R40MC03600-01-00 from the Maternal and Child Health Bureau, Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS . The authors declare they have no competing financial interests. Received 16 December 2005; accepted 6 April 2006. |
|
||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion