Background: Natural amenities, including pleasant climate, varied topography, and water features, promote health. It is unclear if this relationship differs across a wide range of natural environments and income.

Objective: To consider non-linear relationships between natural amenities, income, and health among adult primary care patients.

Methods: We used survey data from 3,352 adults in 13 states. PROMIS-29® mental and physical health summary scores were the primary outcomes. The natural environment (measured by the USDA Natural Amenities Scale (NAS) at the county level) was the primary predictor. Multilevel models were used to explore the relationships between NAS and health allowing for the possibility of a non-linear relationship. Individual, census-level and practice characteristics were considered as potential confounders. A triple interaction of income (<$30k vs ≥30k) and NAS (<0 vs ≥0) was considered.

Results: In low amenity areas, higher income individuals had improvements in physical (ß=2.0; 95% confidence interval 0.4, 3.6) and mental (1.5; 0.1, 2.9) health with each increase in NAS; there was no relationship for low income individuals. However, in high amenity areas, low income individuals had a decline in physical (-0.2; -0.3, -0.1) and mental (-0.2; -0.4, -0.1) health with each increase in NAS; there was no relationship for high income individuals.

Conclusions: In areas with low natural amenities, increasing amenities are associated with better physical and mental health for higher income individuals but not for lower income individuals. Perhaps higher income individuals have the resources and time to take advantage of the natural resources. However, in areas with high natural amenities, low income individuals have declines in health with more amenities, while there is no impact on higher income individuals. It is unclear what characteristics of the physical, social, and economic environment may be responsible for this phenomenon.

Since March of 2020, COVID-19 has claimed the lives of over 500,00 Americans. In Texas, parks remained mostly open during the pandemic, while other nonessential businesses were closed. Past research has indicated that parks are venues for physical activity (PA) and connection with nature. To better understand how parks were being used during the pandemic, a partnership was formed with Austin Parks Foundation and UTHealth. The team explored four public parks based in Austin, Texas: two in areas with greater economic need and two in economically better-off areas. We aimed to evaluate: 1) the aspects of the park that attracted users; 2) how these parks supported the PA and mental wellbeing of users; and 3) users’ behavioral intentions for future park use.

Qualitative data were collected among 151 adult park users (18 years and older) during December of 2020, using an open-ended survey format. Transcript interviews were manually coded in Microsoft Word and analyzed using thematic content analysis.

Key themes related to current park use were amenities of the park: “trails;” places for PA: “my COVID-19 experience has been [enhanced] with my regular walks;” settings for improved mental well-being: [parks] “relieve stress and anxiety;” and venues for safe social interactions: [I could] “be around people yet distanced.” Parks were considered essential spaces by park users: “the months when [parks] were closed were some of the most challenging.” Recommended enhancements to park amenities such as lighting around trails as well as the addition of social activities would increase future park use. Signage about how to stop the spread of COVID-19 was also mentioned.

Findings from this study indicate that parks are critical spaces for the overall health of park users. Future park use could be increased by adding amenities and engaging park users through community events and other social activities.

Background: Chronic noncommunicable diseases are associated with multiple risks factors and negative outcomes that are long-lasting and difficult to treat. Some populations may be even more at risk because of their seriocomic status, lack of healthcare, and poor work and living conditions and environment. Informal waste pickers are one such group of people that may be suffering from chronic noncommunicable diseases while also not have access to care to help minimize symptoms of the diseases.

Objectives: The aim of this study was to understand the effects noncommunicable diseases in waste pickers, along with perceived associated risks and available treatment for the diseases.

Methods: A qualitative study was conducted, using interviews with 24 waste pickers who worked at Estrutural dumpsite, the second largest open-air dumpsite in the world.

Results: Participants believed their commonly experienced noncommunicable diseases were as a result of working in the open-air dumpsite. Chronic diseases commonly noted in the interviews included hypertension, chronic pain, respiratory disease, diabetes, and kidney problems. Participants discussed self-medication or prescribed medication, used to treat their conditions. Most participants had varying beliefs regarding prevention strategies to reduce disease; novel ideas for prevention focused on religion, fate, and God when discussing outcomes related to illnesses. When answering questions regarding ideal working conditions to help prevent diseases, participants responded by expressing a desire for protective gear, which could help block hazards associated with the dump to help decrease associated diseases.

Conclusion: Recyclable collectors were aware of occupational hazards they were exposed and associated chronic noncommunicable diseases but lacked education on the importance of preventive measures and how to obtain and trust on health team to receive adequate treatment to improve their health. The findings of the present study confirm the need to strengthen intersectoral actions to protect and uphold health rights of this vulnerable population.

Background:
Viral gene copies from fecal shedding can be detected in raw sewage while COVID-19 cases are pre- or asymptomatic, prompting health departments to consider wastewater surveillance for early detection of SARS-CoV-2 circulation. This study evaluated the association between wastewater viral concentrations and incident cases across community-sized sewershed catchment areas.

Methods:
Negative binomial models regressed three-, five-, and seven-day rolling averages of daily COVID-19 cases centered on wastewater sample collection date against the log geometric means of SARS-CoV-2 viral concentrations per milliliter for nine sites in Marin County. Sites were categorized by low (<10), medium (11-30), and high (>30) case burden based on peak daily case counts, and category-specific incident rate ratios were pooled using random effects meta-analyses.

Results:
There were 404 samples collected, with a median of 28 samples per site (IQR: 6). For each one-unit increase in the SARS-CoV-2 concentration, three-day rolling average case rates increased 14% (95% CI: 9-20%) among sites with a small case burden (n=5), 32% (95% CI: 14-49%) among sites with a medium burden (n=2), and 88% among sites with the greatest burden (n=2; 95% CI: 75-101%). Similar relationships were observed with five- and seven-day rolling averages.

Conclusions:
This study found a statistically significant, positive relationship between wastewater concentrations and daily case counts that increased in magnitude with increasing daily case burden. Future studies should investigate how this association is impacted by sample quality, length between sampling, and geographic transmission and testing variability. Wastewater surveillance could provide an early warning sign for increasing community COVID-19 transmission and may be exceedingly important in identifying variants of concern with increasing COVID-19 vaccination coverage.

Background

The August 4, 2020 blast in Beirut, Lebanon resulting from the explosion of 2,750 tonnes of ammonium nitrate caused 200 deaths, 6,500 injuries, and 300,000 displaced. Residential and commercial areas were largely destroyed. Cost was estimated at $5 Billion. Chemicals released into the air included: NO_x, NH₃, N₂O, O₃, PM_2.5, and asbestos. We summarized available data to characterize the mismanagement of hazardous material which led to this chemical disaster.

Methods

A comprehensive literature review of the peer-reviewed and grey literature was conducted. Scholarly articles (PubMed, Web of Science, Google scholar), UN reports, social media, news reports, and documentaries published between August 4, 2020 and March 20, 2021 were reviewed. Thematic analysis was carried out to identify the flaws in the management system.

Results

Our review showed that: ammonium nitrate was stored at the port for seven years following the unloading of the cargo of a ship broken at sea in 2013; no one claimed ownership of the cargo; authorities did not discard it in a timely manner; existing guidelines for the storage of chemicals were not implemented; monitoring programs, emergency preparedness, and basic safety measures were lacking.

Discussion

Ammonium nitrate had been a public health threat since its storage. Had regulations for its handling been adopted, the blast would have been avoided. A national call for establishing a transparent monitoring system for the storage of chemicals in the country has triggered the resignation of the government and the shakeup of the existing political system in Lebanon.

Flooding is a social issue, as much as it is one that affects the built environment. Through the American Institute of Architects (AIA) Design and Health Research Consortium at the University of South Florida, faculty and students partnered with Hillsborough County government to identify mitigation strategies and policies to address flooding and sea-level rise. Taking a transdisciplinary approach to planning is critical for knowledge development and generating solutions that accomplish multiple objectives that consider how different parts of the system are connected. A systems approach toward addressing these complex issues helps identify links between urban design and public health. Project proposals were developed by four design studio research teams comprised of graduate students from six disciplines: public health, architecture, urban design, regional planning, environmental engineering, and structural engineering. Ultimately, each project proposal is structured to be multi-functional and strives to address several issues with singular gestures. The mitigation strategies aim to alleviate ecological and population concerns through urban structural changes to improve conditions across urban environments that directly impact public health. A more resilient community, means a healthy community. Key characteristics of a resilient (and healthy) community will be discussed, including (1) community members who are physically and mentally well; (2) access to health care, healthy foods, and services as needed; (3) community members are self-sufficient and can take care of each other during difficult times; and (4) residents are engaged in the community and connected to each other. Our built environment can foster high levels of social engagement that will build more resilient and integrated communities to reduce the barriers that affect both physical and social vulnerabilities. Discussing the intersect of design and public health proposes a unique opportunity for addressing vulnerabilities across the built environment, ecological systems, economic systems, and social networks.

Z-drugs are prescribed for treating anxiety and sleeping disorders, with known side effects including risk of addiction and substance misuse. Antidepressants are another class of psychotropic drugs used for treating anxiety as well as seasonal and dysthymic depression. Both types of drugs may present a threat to aquatic ecosystems. Misuse and abuse of these medications have escalated over the years, a development that possibly may have been exacerbated by the COVID-19 global pandemic. Wastewater-based epidemiology constitutes a fast, easy, and inexpensive approach to epidemiological surveys for understanding the incidence and frequency of uses of these drugs. This study analyzed wastewater samples from 50 cities across the United States and Mexico during a severe wave of the COVID-19 pandemic from July to September 2020. The goal was to track the occurrence and concentrations in wastewater to estimate drug use rates during the pandemic. Time proportional composite samples of untreated municipal wastewater were analyzed using solid-phase extraction followed by liquid chromatography-tandem mass spectrometry to determine levels of zolpidem, zaleplon, alprazolam, diazepam, nordiazepam, temazepam, clonazepam, lorazepam, ketamine, and select metabolites. Medications were detected in both countries, and an initial risk assessment was performed. This study is among the first to investigate Z-drugs and understand mental health in wastewater in North America.

Background: The effect of air-pollution on health and mortality has been reported before. Nonetheless, there is lack of research on how this effect varies by individuals’ ethnic origin. This study aims to examine the effect of 10-years air-pollution exposure on self-perceived health in five main ethnic groups in the United-Kingdom.

Methods: The 2011 United-Kingdom census microdata with a sample of around 2.5-million individuals aged 16 and above was linked to the yearly 10-year average of NO₂, SO₂, particulate-matter (PM10, PM2.5), and carbon-monoxide pollutants at the council-area level. The association between air-pollution and health by ethnic groups was examined using mixed-effects-generalised-linear models. Models were adjusted for individual socio-demographics.

Results: Poorer health was observed among Pakistani/Bangladeshi (OR: 1.71; 95%CI: 1.69-1.74), Indian (OR: 1.33; 95%CI: 1.31-1.36), and African/Caribbean (OR: 1.06; 95%CI: 1.04-1.07) populations as compared to White-group. Higher concentrations of NO₂ (OR: 1.040; 95%CI=1.021-1.059), SO₂ (OR: 1.065; 95%CI=1.049-1.081) and carbon-monoxide (OR: 1.040; 95%CI=1.024-1.055) were associated with poorer self-perceived health. Poor self-perceived health was aggravated more for ethnic minorities (OR>1; lower end of 95%CI>1), particularly for African/Caribbean populations than the White-group, with increasing concentrations of NO₂, PM10, PM2.5 and carbon-monoxide pollutants. In contrast, SO₂ pollution was associated with better health among ethnic minorities. This finding is likely explained by the residential-context of ethnic minorities: they often live in urban and deprived areas-close to major roads, which increases their exposure to traffic-related (NO₂, PM10, PM2.5 and carbon-monoxide) pollution rather than industrial-related (SO₂) air-pollution.

Conclusion: Using large-scale individual-level data, this study supports the long-term effect of air-pollution on self-perceived health and provides an insight about the mechanisms underlying ethnic inequalities in health in the context of air-pollution. Longitudinal data are needed to further explore how the effect of air-pollution on individuals’ health varies by ethnic origins over time.