Environmental Research: Health - IOPscience

Environmental Research: Health - IOPscience
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ISSN:
2752-5309
OPEN ACCESS
Environmental Research: Health
publishes solutions to the challenges intersecting environmental conditions, health, and mental well-being. We welcome a comprehensive range of study designs and approaches from all communities working on improved health outcomes.
Indexed in Web of Science and Scopus.
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The following article is
Open access
Intensifying global heat threatens livability for younger and older adults
L A Parsons
et al
2026
Environ. Res.: Health
015013
View article
, Intensifying global heat threatens livability for younger and older adults
PDF
, Intensifying global heat threatens livability for younger and older adults
Heat exposure presents a growing threat to human health and well-being, particularly for vulnerable populations. Here, we employ a human heat balance model - specifically the human/environmental adaptation and threshold limit model (HEAT-Lim) - to estimate, globally, where ambient temperature and humidity already limit ‘livability’, or the level of physical activity that a person can safely sustain without experiencing an uncontrolled rise in body temperature. Specifically, we use hourly ERA5-Land reanalysis data to assess historical (1950–2024) livability limitations for partially acclimated healthy, younger (age 18–40 years) and older (age >65 years) adults in the shade. We also examine the number of hours/year in which physical activity should be limited to light-to-moderate intensity (e.g., sitting, walking, light housework) to avoid uncontrollable rises in core body temperature. We find, globally, heat-associated livability limitations are on average greatest in high-vulnerability areas. Furthermore, there have been significant increases in livability limitations for both younger and older adults over the last 75 years, with noticeable spikes in El Niño years and in 2024. For younger adults, restrictions to light-to-moderate activity for the highest number of hours are geographically concentrated in moderate- to low-vulnerability countries in South and Southwest Asia. For older adults, restrictions on light-to-moderate activity are widespread in tropical Southwest, South, and Southeast Asia, as well as Sub-Saharan Africa. In the hottest hours of the year, some locations have already experienced ‘unlivable’ conditions (i.e., when no activity is possible to compensate for environmental heat loads). Results highlight that with just over 1 °C of historical global warming, livability limitations are already widespread and growing, particularly for older adults. If warming is not stopped and adaptation measures are not more widely implemented, livability constraints will only expand, particularly as the global population ages.
The following article is
Open access
Air pollution and health impacts of oil & gas production in the United States
Jonathan J Buonocore
et al
2023
Environ. Res.: Health
021006
View article
, Air pollution and health impacts of oil & gas production in the United States
PDF
, Air pollution and health impacts of oil & gas production in the United States
Oil and gas production is one of the largest emitters of methane, a potent greenhouse gas and a significant contributor of air pollution emissions. While research on methane emissions from oil and gas production has grown rapidly, there is comparatively limited information on the distribution of impacts of this sector on air quality and associated health impacts. Understanding the contribution of air quality and health impacts of oil and gas can be useful for designing mitigation strategies. Here we assess air quality and human health impacts associated with ozone, fine particulate matter, and nitrogen dioxide from the oil and gas sector in the US in 2016, and compare this impact with that of the associated methane emissions. We find that air pollution in 2016 from the oil and gas sector in the US resulted in 410 000 asthma exacerbations, 2200 new cases of childhood asthma and 7500 excess deaths, with $77 billion in total health impacts. NO
was the highest contributor to health impacts (37%) followed by ozone (35%), and then PM
2.5
(28%). When monetized, these air quality health impacts of oil and gas production exceeded estimated climate impact costs from methane leakage by a factor of 3. These impacts add to the total life cycle impacts of oil and gas, and represent potential additional health benefits of strategies that reduce consumption of oil and gas. Policies to reduce oil and gas production emissions will lead to additional and significant health benefits from co-pollutant reductions that are not currently quantified or monetized.
The following article is
Open access
Odor, air quality, and well-being: understanding the urban smellscape using crowd-sourced science
Sahil Bhandari
et al
2024
Environ. Res.: Health
035012
View article
, Odor, air quality, and well-being: understanding the urban smellscape using crowd-sourced science
PDF
, Odor, air quality, and well-being: understanding the urban smellscape using crowd-sourced science
Odors are a topic of emerging environmental health interest given their potential links to air quality, health, well-being, and quality of life. However, odors have traditionally been challenging to study given variability in individual sensitivity and perception, atmospheric physico-chemical processes, and emissions of mixtures of odorous contaminants. Here, we explore the potential utility of crowd-sourced odor report data in improving understanding of spatiotemporal patterns of odor experiences and their impacts. We conduct quantitative and qualitative analyses of a 12-month data set from a web application collecting crowd-sourced odor reports, including spatiotemporal information, odor and self-reported impacts description (OSAC: odors, symptoms, actions in response, and suspected causes), and demographics, in Vancouver, Canada. Users report diverse OSAC with strong seasonality and spatial variability. Reported symptoms, ranging from neurological to emotion- and mood-related, highlight the complexity of odor-related health and well-being impacts. Odors can trigger maladaptive actions, where individuals are exposed to other environmental stressors (e.g. heat stress) or curtail healthy behaviors (e.g. exercising outside) to cope with odor impacts. Clustering analysis of OSAC suggests that odor exposures may be linked to health, well-being, and quality of life impacts through complex mechanisms, related not only to the odor experienced but also perceived causes. Spatiotemporal patterns in reports highlight the potential influence of persistent sources (e.g. waste management) and transient events (e.g. accidents). Exploratory multiple linear regression models suggest that monitoring of air quality and meteorology may be insufficient to capture odor issues. Overall, these results suggest that crowd-sourced science incorporating self-reported health and well-being effects and behavioral responses can enrich understanding of the impacts of odorous emissions at large spatiotemporal scales and complement traditional air pollution monitoring.
The following article is
Open access
Extreme heat events increase stroke risk among India’s older adults: evidence from longitudinal ageing study in India
Ayushi Khanduri
et al
2026
Environ. Res.: Health
015015
View article
, Extreme heat events increase stroke risk among India’s older adults: evidence from longitudinal ageing study in India
PDF
, Extreme heat events increase stroke risk among India’s older adults: evidence from longitudinal ageing study in India
The world is getting hotter and older at the same time, and stroke sits at the intersection of these two crises. These factors are predicted to increase in the future. However, epidemiological studies have focused on different countries; research in the Indian context remains limited. To address the gap, the association between stroke and extreme heat days has been investigated among India’s older adults. The association between extreme heat days, i.e. the average of the number of days exceeding the 90th percentile, and self-reported stroke prevalence was analyzed using generalized linear mixed models, with information from the Longitudinal Ageing Study in India. 14,594 individuals aged 45 years and above were involved in this research study. Stratified analysis was performed for gender, residence, education levels, and comorbidities, including diabetes and hypertension. The extreme heat days over the last 12 years are positively associated with stroke. A one-standard-deviation increase in the frequency of extreme heat days was associated with 18% higher odds for stroke (AOR, 1.18; 95% CI, 1.02–1.38). In stratified analysis females (AOR 1.31, 95% CI 1.04–1.66), urban residents (AOR 1.53, 95% CI 1.19–1.97), individuals with no education (AOR 1.31, 95% CI 1.05–1.64), individuals with hypertension (AOR 1.33, 95% CI 1.08–1.63) and diabetes (AOR 1.40, 95% CI 1.08–1.82) had elevated odds for stroke associated with long term exposure to extreme heat days. Our research study focused on the first evidence that long-term exposure to extreme heat days was positively associated with stroke prevalence, leading to fatal cardiovascular disease, in older adults in India.
The following article is
Open access
Moving toward a more human-oriented analysis of urban heat: examining differences of heat exposure intensity at busy commuting locations
Peter C Ibsen
et al
2026
Environ. Res.: Health
015016
View article
, Moving toward a more human-oriented analysis of urban heat: examining differences of heat exposure intensity at busy commuting locations
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, Moving toward a more human-oriented analysis of urban heat: examining differences of heat exposure intensity at busy commuting locations
Examining urban thermal environments has become a critical area of research spanning epidemiology, urban planning, and ecology. While traditional metrics like air temperature (
air
) and satellite-derived surface temperature dominate urban heat studies, these measures often fail to reflect how people actually experience thermal exposure intensity. More human-oriented metrics, such as mean radiant temperature (MRT), and the wet bulb globe temperature (WBGT), better capture this lived experience, particularly at locations where people are likely to encounter outdoor heat, such as bus stops. Human demographics further complicate heat exposure, as access to cooling resources like trees and greenspaces can vary by neighborhood income. Our study addresses these complications by collecting thermal data across 60 commuting locations in Denver, Colorado in the summer. We evaluate (1) the extent to which more human-oriented metrics capture thermal exposure compared to
air
and LST, and (2) how heat exposure varies by neighborhood income levels. We observed that bus stops in low-income neighborhoods had an MRT increase 2.8 °C compared wealthier neighborhoods, and that income-driven differences in MRT and WBGT strongly depended on bus stop aspect. After accounting for solar orientation, differences in MRT increased to as much as 6.3 °C at north-facing stops. Our results suggest tree canopy shade explains some observed heat exposure patterns, with south facing bus stops seeing a MRT and WBGT decrease of 0.42 °C and 0.11 °C from a percent increase in tree canopy. Interestingly, depending on bus stop aspect, nearby buildings can increase MRT and WBGT (facing east), or decrease MRT and WBGT (facing south) If planners aim to address this issue, consideration of bus stops, and land covers configuration may help.
The following article is
Open access
Characterizing household air pollutant concentrations associated with an electrification program in the rural San Joaquin Valley
Michael Johnson
et al
2026
Environ. Res.: Health
025002
View article
, Characterizing household air pollutant concentrations associated with an electrification program in the rural San Joaquin Valley
PDF
, Characterizing household air pollutant concentrations associated with an electrification program in the rural San Joaquin Valley
Indoor nitrogen dioxide (NO
) and fine particulate matter (PM
2.5
) are concerns in U.S. households, especially those that cook using gas or propane stoves. Exposures to these and other indoor pollutants are linked to a variety of adverse health outcomes, including asthma morbidity, that disproportionately affect low-income households. We conducted a cross-sectional study of 138 homes in four low-income rural communities in California’s San Joaquin Valley, comparing air pollutant concentrations between households that participated in a state electrification program and households using propane or natural gas for cooking. In each home, pollutants were monitored for approximately one month using personal air monitors and for 48 h using reference-grade instruments. Median 48-h average indoor NO
concentrations were 63% lower in electric stove homes (electric: 6.0 ppb, gas: 16.0 ppb,
< 0.001). No electric stove homes had 48-h indoor NO
concentrations exceeding the California annual guideline of 30 ppb, while 17% of gas homes did. Additionally, no electric stove homes had 1-h rolling-average NO
concentrations exceeding the 100-ppb level deemed unhealthy for sensitive groups by the U.S. Environmental Protection Agency, whereas 41% of gas homes exceeded this threshold. PM
2.5
concentrations were similar across groups, indicating that cooking-related emissions from food were the dominant contributor to PM
2.5
mass concentrations rather than particles generated from gas combustion. Our evaluation of monitoring durations showed that two to four days of NO
data and one week of PM
2.5
data provided reliable estimates of longer-term averages, suggesting that shorter campaigns may yield robust estimates of indoor air quality. These results support the provision of electric cooking technologies as a strategy to address air quality-related health risks in rural, low-income communities and provide new evidence from an understudied population that can inform future indoor air quality research and energy transition policies.
The following article is
Open access
Sanitary sewer overflows, household sewage backups, and antibiotic-resistant bacteria: the new frontier of environmental health risks and disasters
Marccus D Hendricks and Rachel E Rosenberg Goldstein 2025
Environ. Res.: Health
013001
View article
, Sanitary sewer overflows, household sewage backups, and antibiotic-resistant bacteria: the new frontier of environmental health risks and disasters
PDF
, Sanitary sewer overflows, household sewage backups, and antibiotic-resistant bacteria: the new frontier of environmental health risks and disasters
Untreated sewage discharges leading to environmental contamination are increasingly common in communities across the globe. The cause of these discharges ranges from sewer lines in disrepair, blockages, and in the era of more extreme wet weather events, the infiltration of stormwater into the system during heavy downpours. Regardless of the driver of these events, the aftermath results in raw sewage spilling into local waterways, city streets, and commercial and residential structures. Historical research in public health has thoroughly documented the connection between exposure to untreated sewage and waterborne disease. Recent research has detected antibiotic-resistant bacteria at wastewater treatment facilities at a time when deaths by antibiotic-resistant infections are on the rise. However, no research has explored the exposure pathways of antibiotic-resistant bacteria during sanitary sewer overflows and household-level sewage backups. In this commentary, we aim to introduce this new frontier of environmental health risks and disasters. To do this, we describe the history of modern sanitation and sewer infrastructure with a particular focus on wastewater infrastructure in the U.S. We also explore emerging risks and current methods for identifying antibiotic-resistant bacteria in the environment. We end with future directions for interdisciplinary scholarship at the nexus of urban planning, engineering, and public health by introducing the Water Emergency Team (WET) Project. WET is a community-based multi-method effort to identify environmental risks in the aftermath of household backups through (1) residential surveys, (2) indoor visual inspections, (3) environmental sampling, and (4) laboratory processing and reporting. Our hope is that by introducing this comprehensive approach to environmental risks analysis, other scholars will join us in this effort and ultimately towards addressing this grand challenge of our time.
The following article is
Open access
Outside in: the relationship between indoor and outdoor particulate air quality during wildfire smoke events in western US cities
Katelyn O’Dell
et al
2023
Environ. Res.: Health
015003
View article
, Outside in: the relationship between indoor and outdoor particulate air quality during wildfire smoke events in western US cities
PDF
, Outside in: the relationship between indoor and outdoor particulate air quality during wildfire smoke events in western US cities
Previous research on the health and air quality impacts of wildfire smoke has largely focused on the impact of smoke on outdoor air quality; however, many people spend a majority of their time indoors. The quality of indoor air on smoke-impacted days is largely unknown. In this analysis, we use publicly available data from an existing large network of low-cost indoor and outdoor fine particulate matter (PM
2.5
) monitors to quantify the relationship between indoor and outdoor particulate air quality on smoke-impacted days in 2020 across the western United States (US). We also investigate possible regional and socioeconomic trends in this relationship for regions surrounding six major cities in the western US. We find indoor PM
2.5
concentrations are 82% or 4.2
g m
−3
(median across all western US indoor monitors for the year 2020; interquartile range, IQR: 2.0–7.2
g m
−3
) higher on smoke-impacted days compared to smoke-free days. Indoor/outdoor PM
2.5
ratios show variability by region, particularly on smoke-free days. However, we find the ratio of indoor/outdoor PM
2.5
is less than 1 (i.e. indoor concentrations lower than outdoor) at nearly all indoor-outdoor monitor pairs on smoke-impacted days. Although typically lower than outdoor concentrations on smoke-impacted days, we find that on heavily smoke-impacted days (outdoor PM
2.5
> 55
g m
−3
), indoor PM
2.5
concentrations can exceed the 35
g m
−3
24 h outdoor standard set by the US Environmental Protection Agency. Further, total daily-mean indoor PM
2.5
concentrations increase by 2.1
g m
−3
with every 10
g m
−3
increase in daily-mean outdoor PM
2.5.
(median of statistically significant linear regression slopes across all western US monitor pairs; IQR: 1.0–4.3
g m
−3
) on smoke-impacted days. These results show that for indoor environments in the western US included in our analysis, remaining indoors during smoke events is currently an effective, but limited, strategy to reduce PM
2.5
exposure.
The following article is
Open access
Beating the heat in a low-income urban community of color: a qualitative study of coping strategies, barriers, and solutions
Saket Malhotra
et al
2025
Environ. Res.: Health
045002
View article
, Beating the heat in a low-income urban community of color: a qualitative study of coping strategies, barriers, and solutions
PDF
, Beating the heat in a low-income urban community of color: a qualitative study of coping strategies, barriers, and solutions
Residents of low-income urban communities of color, such as New Haven, Connecticut’s Dwight neighborhood, are disproportionately impacted by ambient heat. In this qualitative study, we conducted five focus groups with Dwight residents to explore health impacts of heat, coping mechanisms, barriers to staying cool, and potential solutions. Participants reported a range of adverse physical and mental health impacts from heat and stressed that persons with pre-existing medical conditions, the elderly, children, unhoused people, and menopausal women are especially vulnerable. Strategies to cope with heat included home air conditioning (AC), fans, showers, not using stoves, wearing fewer clothes, and leaving the home for air-conditioned spaces. Barriers to staying cool identified by participants included Dwight being hotter than other New Haven neighborhoods, not having home AC or the high cost of using home AC, impediments to implementing cooling strategies as renters, lack of knowledge of or lack of access to cooling centers and public pools, living on an upper floor, being unhoused, workplace heat exposure, and poor communication about and difficulty in accessing energy and cooling assistance programs. Participants suggested the need for more trees and green spaces, recreational water spaces, shaded bus stop shelters, accessible cooling centers, programs for renters to make home cooling more accessible and affordable, and wellness checks on the elderly during heat waves. Some participants also expressed concerns about staying warm in the winter. Participants spoke of collective action, especially to protect vulnerable groups. In summary, Dwight residents recognized that they live in an urban heat island, reported using a range of coping strategies, expressed concern for vulnerable groups, and identified barriers to keeping cool, along with a variety of solutions. To implement solutions, state and municipal public investment and innovative mandates and incentives for landlords, spurred on by collective action by residents, are needed.
The following article is
Open access
Climate change and nursing research: a scoping review
Claire A Richards
et al
2025
Environ. Res.: Health
042001
View article
, Climate change and nursing research: a scoping review
PDF
, Climate change and nursing research: a scoping review
This scoping review maps nurse scientists’ contributions to climate change and health research, including work about Indigenous Peoples, and identifies gaps and future opportunities. A review was conducted and reported using the PRISMA extension for scoping reviews, including a systematized literature search. Eligible articles were English-language studies published between 2018–2023, in nursing journals or by nursing faculty, and related to climate change or associated extreme weather events. Abstracted data included: Year, Focus (e.g. multiple hazards, sustainability), Outcomes, Social Determinants of Health, Sample Population/Setting, Study Design, Study Location, and Field of Journal. Studies were categorized by the countries’ Sustainable Development Index (SDI) to evaluate equity in representation. Two reviewers screened the first 30 abstracts for consistency. Remaining articles were screened independently, with discrepancies resolved through discussion. Overall, 202 articles were included, with 159 reporting primary research. Publications on climate change increased over time, with 66% on climate hazards, 29% on broader climate change or sustainability themes, and 5% on other topics. Nearly half (42%) were conducted in countries with low SDI scores (<0.250). Adults and healthcare providers were the most frequent populations sampled, with few studies of communities, work, or school settings. Nearly half were observational studies (44%), followed by qualitative inquiry (22%), with little interventional or community-engaged research. Few (4%) focused on Indigenous health and 42% addressed at least one social determinant of health. Physical health, mental health, and risk management were the most common outcomes; few examined systems of power in adjusting to climate change. We found many opportunities to strengthen and increase nursing research on climate change, including by emphasizing local and global factors shaping climate vulnerability, engaging diverse ways of knowing, centring Indigenous knowledges, studying sustainability and a just energy transition, and pursuing solutions-oriented, transformative research across more diverse populations and settings.
The following article is
Open access
Targeted emission reductions in the Boston metropolitan region: assessing health and equity outcomes across vehicle classes and source regions
Laura Buckley
et al
2026
Environ. Res.: Health
025004
View article
, Targeted emission reductions in the Boston metropolitan region: assessing health and equity outcomes across vehicle classes and source regions
PDF
, Targeted emission reductions in the Boston metropolitan region: assessing health and equity outcomes across vehicle classes and source regions
Vehicle electrification is a key component of many climate action plans. However, its benefits and impacts vary by implementation location and strategy. Given limited governmental resources, understanding how targeting emission reductions in specific sources and regions affects overall outcomes is important for effective planning. This study examines how place-specific emission reductions in different vehicle classes across regions of the Boston metropolitan area influence pollutant exposures, health benefits, and related inequities. Using the Community Multiscale Air Quality model, we analyzed PM
2.5
, NO
, and O
concentration sensitivities to on-road vehicle emissions at 1.33 km × 1.33 km resolution. We integrated the air pollutant estimates with area-level health data to assess the benefits and impacts of changing on-road vehicle emissions from five vehicle classes (light-duty autos; light-duty, medium-duty, and heavy-duty trucks (HDTs); and buses) across six inner core and suburban source regions within the metropolitan area. We modeled emission reduction scenarios to evaluate effects on all-cause mortality, adult asthma emergency department visits, and health inequities among racial and ethnic groups. Our analysis revealed tradeoffs between total health benefits and reductions in health inequities. Emission reductions from larger suburban fleets led to greater overall health benefits but primarily benefited non-Hispanic white communities, which, on average, had lower exposure and health burdens at baseline. Targeting HDTs in inner core regions maximized health benefits and reduced inequities when considered per vehicle. NO
was identified as the primary driver of health impacts and inequities. This study provides policymakers with insights for assessing climate action plans and vehicle electrification policies. We highlight the importance of considering multiple pollutants and using high-resolution health data. This framework helps evaluate strategies balancing overall health benefits with reductions in health inequities, offering valuable guidance for resource-constrained environments.
The following article is
Open access
Air pollution and publications: historic and emerging trends in research topics—a bibliometric study
Karl Kilbo Edlund
et al
2026
Environ. Res.: Health
025003
View article
, Air pollution and publications: historic and emerging trends in research topics—a bibliometric study
PDF
, Air pollution and publications: historic and emerging trends in research topics—a bibliometric study
The scientific literature on air pollution and its health effects has grown steadily over the last half a century. In this study, we apply text analysis, clustering, and natural language analysis to uncover emerging research themes and remaining knowledge gaps. We used publication data made public through PubMed to analyse long-term and recent research trends focusing on the health impacts of air pollution. We identified research themes by analysing trends in medical subject headings terms and performed a quantitative text analysis of article titles and abstracts. We used natural language analysis to identify topic clusters in the literature. Emerging research themes included the use of low-cost exposure sensors and satellite-based exposure assessment, increasing exposure assessment related to wood smoke, while, relatively, interest was decreasing in traffic and occupational airborne exposures. There was increasing interest for mitigation strategies, possibly indicating a shift from regulations to interventions. Emerging health outcomes examined included kidney diseases, neurological and mental disorders, diabetes, pregnancy and neonatal outcomes, and fertility. Knowledge gaps identified included the health effects of airborne microplastics, volatile organic compounds, and hydrocarbons, and the relation between air pollutants and liver, bone and autoinflammatory diseases. We found improved reporting of study design in titles and abstracts and increasing numbers of meta-analyses and systematic reviews. This bibliometric assessment showed that air pollution health research is a maturing research field, while it also highlighted important knowledge gaps. Our results are valuable for guiding future research as well as providing directions for future policy development.
The following article is
Open access
Characterizing household air pollutant concentrations associated with an electrification program in the rural San Joaquin Valley
Michael Johnson
et al
2026
Environ. Res.: Health
025002
View article
, Characterizing household air pollutant concentrations associated with an electrification program in the rural San Joaquin Valley
PDF
, Characterizing household air pollutant concentrations associated with an electrification program in the rural San Joaquin Valley
Indoor nitrogen dioxide (NO
) and fine particulate matter (PM
2.5
) are concerns in U.S. households, especially those that cook using gas or propane stoves. Exposures to these and other indoor pollutants are linked to a variety of adverse health outcomes, including asthma morbidity, that disproportionately affect low-income households. We conducted a cross-sectional study of 138 homes in four low-income rural communities in California’s San Joaquin Valley, comparing air pollutant concentrations between households that participated in a state electrification program and households using propane or natural gas for cooking. In each home, pollutants were monitored for approximately one month using personal air monitors and for 48 h using reference-grade instruments. Median 48-h average indoor NO
concentrations were 63% lower in electric stove homes (electric: 6.0 ppb, gas: 16.0 ppb,
< 0.001). No electric stove homes had 48-h indoor NO
concentrations exceeding the California annual guideline of 30 ppb, while 17% of gas homes did. Additionally, no electric stove homes had 1-h rolling-average NO
concentrations exceeding the 100-ppb level deemed unhealthy for sensitive groups by the U.S. Environmental Protection Agency, whereas 41% of gas homes exceeded this threshold. PM
2.5
concentrations were similar across groups, indicating that cooking-related emissions from food were the dominant contributor to PM
2.5
mass concentrations rather than particles generated from gas combustion. Our evaluation of monitoring durations showed that two to four days of NO
data and one week of PM
2.5
data provided reliable estimates of longer-term averages, suggesting that shorter campaigns may yield robust estimates of indoor air quality. These results support the provision of electric cooking technologies as a strategy to address air quality-related health risks in rural, low-income communities and provide new evidence from an understudied population that can inform future indoor air quality research and energy transition policies.
The following article is
Open access
‘Bad water just means bad health’: identifying barriers and promoters of safe drinking water in rural Eastern North Carolina
Lindsay B Savelli
et al
2026
Environ. Res.: Health
025001
View article
, ‘Bad water just means bad health’: identifying barriers and promoters of safe drinking water in rural Eastern North Carolina
PDF
, ‘Bad water just means bad health’: identifying barriers and promoters of safe drinking water in rural Eastern North Carolina
Millions of North Carolina (NC) residents rely on private wells as their primary drinking water source, which are not subjected to the same frequency and extent of testing as state and federally regulated public water systems. In Sampson County, NC, a key county in Eastern NC for industrial animal agriculture, waste disposal, and biomass production, surface and groundwater that feed private wells may be particularly susceptible to contamination. To better understand the barriers and promoters of accessing safe drinking water in this region, we conducted interviews with 23 residents, technical experts, non-profit advocates, researchers, utilities staff, and local and state government affiliates. Employing rapid qualitative analysis, several key themes were identified across participants regarding their perception of what constitutes safe, high-quality drinking water, and the barriers and promoters to achieving it. As barriers, participants reflected on financial barriers, proximity to hazards, discrimination, mistrust in government agencies and industries, knowledge and informational gaps, and procedural and administrative barriers. Effective promoters highlighted by participants included effective staff and partnerships, community-engaged research and education, and proactive management of resources. Responses across participant groups reflect the complexities of decision-making processes involved for maintaining private and public water infrastructure. Additionally, changes in federal and state funding priorities may impede or facilitate action. However, enhanced understanding of drinking water challenges and taking action on effective strategies can support expansion of public water services for residents who wish to connect and increase access to affordable well water testing, maintenance, and remediation resources for private well users. This pilot study demonstrates the importance of engaging multiple interest holders for developing sustainable and affordable community-centered approaches to improve drinking water quality for rural residents.
The following article is
Open access
Coalition building and citizen science for radon risk reduction
Stacy R Stanifer
et al
2026
Environ. Res.: Health
015017
View article
, Coalition building and citizen science for radon risk reduction
PDF
, Coalition building and citizen science for radon risk reduction
We evaluated the implementation of local coalitions led in partnership with citizen scientists, community-based organizations, and public libraries in four rural communities to lower exposure to radon in the home. The objectives were to (1) describe the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) of four radon coalitions, and (2) compare RE-AIM factors among citizen scientists who participated in the coalitions and those who did not. A larger community-engaged research project embedded coalition building using a citizen science approach. Three of the four coalitions focused on health and wellness more broadly (18–34 members); one focused solely on radon (10 members). Coalition membership and activities varied from marketing a radon detector Library Loan Program, community events, and in-library tabling events to working with government officials to sign National Radon Action Month proclamations. We used mixed methods to evaluate coalition-building using the RE-AIM framework. The coalitions were most likely to reach local health departments, hospitals, and schools. Although these partners were highly supportive, they provided few to no resources. Four in 10 citizen scientists were at least moderately involved in the coalition regardless of whether they had high home radon. Citizen scientists reported low awareness of both how frequently radon received local media attention and how favorably radon awareness, testing, and mitigation was portrayed in local media, particularly among those uninvolved in the coalition. Citizen scientists involved in the coalition had the most experience disseminating scientific information on radon and educating the public. The coalitions fostered radon mitigation as 82% of library loan participants with high radon were likely to hire a radon mitigation professional, and all said financial assistance would help them mitigate. Multi-issue health coalitions that engage citizen scientists and partner with public libraries can increase radon testing and build demand for mitigation in rural areas.
The following article is
Open access
Association between prenatal and early childhood exposure to air pollution and cognitive development in children: a systematic review
Viviane Valdes
et al
2026
Environ. Res.: Health
012002
View article
, Association between prenatal and early childhood exposure to air pollution and cognitive development in children: a systematic review
PDF
, Association between prenatal and early childhood exposure to air pollution and cognitive development in children: a systematic review
Air pollution exposure is associated with numerous adverse health outcomes, yet its relationship with child cognitive development is relatively underexamined. This systematic review characterized the association between prenatal and/or early postnatal (<2 years) exposure to ambient/indoor air pollutants and cognitive development outcomes through early childhood (<5 years). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, EMBASE, PsycInfo, Web of Science, and Latin American Caribbean Health Sciences Literature database searches were conducted on three occasions from November 2020 to September 2025. Eligibility criteria included studies reporting on prenatal or postnatal exposures to six criteria air pollutants (as individual pollutants or mixtures) and cognition (cognitive functioning broadly or domain-specific scores) in children <5 years. The Office of Health Assessment and Translation Risk of Bias Rating Tool was used. Of 4,986 initial results, 49 studies met our inclusion criteria. The most consistent evidence was found for fine particulate matter (PM
2.5
) and lead (Pb), where more than 70% of studies found statistically significant associations with lower cognitive scores. Moderate evidence (50%–70% significance) was found for PM less than 10
ms in diameter (PM
10
) and nitrogen dioxide (NO
). Limited evidence (<50% significance) was found for ozone (O₃), carbon monoxide (CO), and sulfur dioxide (SO
), which frequently demonstrated null associations with cognitive scores. Among studies examining exposure timing effects, findings were heterogeneous but indicated that both the prenatal and early postnatal periods may include sensitive periods of vulnerability. Higher prenatal and early postnatal exposure to air pollutants was associated with lower cognitive scores across cognitive domains in early childhood in over 60% of studies. Future research is needed to determine if there are more narrow windows of heightened vulnerability to pollutant exposures within this period. These findings highlight the need for program and policy-level interventions that reduce children’s exposure to air pollutants globally.
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Open access
Co-occurring climate hazards and compound health effects in California: a scoping review
Rachel Connolly
et al
2026
Environ. Res.: Health
012001
View article
, Co-occurring climate hazards and compound health effects in California: a scoping review
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, Co-occurring climate hazards and compound health effects in California: a scoping review
Compound climate events capture the overlap of multiple climate hazards in space, time, or both, which can amplify adverse health outcomes. Despite a strong commitment to climate policy and action, the state of California faces a broad array of these compound climate hazards, and existing adaptation approaches do not yet consider a compound framework for exposures. California is also home to a diverse population with many underserved communities that are particularly vulnerable to the effects of climate events. This scoping review is the first to comprehensively synthesize existing evidence on compound climate exposures and health in California, analyzing exposures co-occurring in the same place at the same time. We searched the Web of Science and PubMed databases and identified 20 articles analyzing the compound effects of climate stressors including heat, air pollution, wildfire smoke, meteorology, and microclimate factors such as green space. The strongest evidence emerged for the co-occurring effects of heat and air pollution—including wildfire smoke—on various health outcomes, including mortality, hospitalizations, and birth outcomes. Several studies also demonstrated spatial variability in these compounded effects at the neighborhood scale. We found heterogeneity in both exposure assessment techniques for characterizing climate extremes, as well as methods to evaluate effects on the additive or multiplicative scale, limiting comparability across studies. Several studies analyzed equity impacts, providing limited evidence that disadvantaged populations are disproportionately vulnerable to compound health effects. Key gaps remain, however, in evaluating the full extent of environmental justice implications, as well as regional effects. Despite these limitations, current evidence underscores the urgency of preparing California populations, particularly vulnerable communities, with resilience strategies to reduce risks from increasingly frequent and severe co-exposures during compound climate events.
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Heatwave characteristics and health impacts: a review of epidemiological evidence and implications for heatwave response plans
Kyriaki Psistaki
et al
2025
Environ. Res.: Health
042003
View article
, Heatwave characteristics and health impacts: a review of epidemiological evidence and implications for heatwave response plans
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, Heatwave characteristics and health impacts: a review of epidemiological evidence and implications for heatwave response plans
Heatwaves are widely recognized as one of the most serious threats to public health, with their specific characteristics largely shaping the relationship between heat exposure and health outcomes. There is evidence that heatwave intensity affects mortality and morbidity, but several studies have shown that duration, timing and sequence of heatwave events are also important. As the frequency and severity of heatwaves continue to rise due to climate change, these factors should be taken into account, to make early warning systems, public health recommendations, and protective interventions for vulnerable populations more sophisticated and responsive. This narrative literature review aims to summarize key insights from key studies to improve understanding of the relationship between heatwave characteristics and public health, and to inform the development and refinement of heatwave response plans. A total of 23 studies were included in the qualitative synthesis and the findings highlight that not all heatwaves have the same impact. There is evidence that both longer and more intense events, as well as those occurring earlier in the season, are frequently linked to higher risks of mortality and morbidity. It is suggested that refined early warning systems that incorporate multiple heatwave characteristics may more accurately reflect health risks and support increased preparedness and the development of more effective and locally tailored response plans. These plans should prioritize early activation of protective measures, targeted interventions and recommendations for those at risk and sustained public engagement throughout the warm season.
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Integrating climate services into health systems for nutrition security: a scoping review
Bianca Carducci
et al
2025
Environ. Res.: Health
042002
View article
, Integrating climate services into health systems for nutrition security: a scoping review
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, Integrating climate services into health systems for nutrition security: a scoping review
Climate information services (CISs) are science-based tools used to inform decision-making in climate-sensitive sectors, such as agriculture, water resources, energy, disaster risk reduction and health. These CISs rely on high-quality climate and weather data in order to predict and prepare for specific extreme weather or climate events such as droughts and floods. Within the health sector, most CISs have been developed to prevent and treat specific infectious diseases or food insecurity; however less is known on how CISs have been used for nutrition programming. We conducted a scoping review of available evidence, on the use of CISs to implement direct and indirect nutrition interventions in health-care and other sectors ahead of extreme weather or climate events. We searched PubMed, Web of Science and Scopus, and grey literature sources for primary studies (observational, intervention, and program evaluations) conducted in low- and middle-income countries from 1 January 2000 to 1 April 2024. We included 48 studies, representing 67 country-level programs. The majority of programs were found in the African region (
= 38), followed by South-East Asian Region (
= 10), Region of the Americas (
= 9), Western Pacific Region (
= 8), Eastern Mediterranean Region (
= 1), and the European Region (
= 1). Most CISs were developed in response to vector-borne diseases (17 countries), droughts (10 countries), floods (9 countries) or multi-hazards (11 countries). The types of nutrition programs deployed were largely outside of the health sector using social protection schemes or vector control including poverty alleviation (
= 49 programs), water, sanitation and hygiene (
= 24 programs), disease prevention (
= 23 programs) or emergency nutrition (
= 19 programs). Few studies evaluated impacts of CISs on the nutritional status of women, children and adolescents affected by climate events. There is urgency and opportunity for better integration of weather and climate information into health systems decision-making and workforce preparedness at local levels to improve both short- and long-term nutrition outcomes.
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Open access
Climate change and nursing research: a scoping review
Claire A Richards
et al
2025
Environ. Res.: Health
042001
View article
, Climate change and nursing research: a scoping review
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, Climate change and nursing research: a scoping review
This scoping review maps nurse scientists’ contributions to climate change and health research, including work about Indigenous Peoples, and identifies gaps and future opportunities. A review was conducted and reported using the PRISMA extension for scoping reviews, including a systematized literature search. Eligible articles were English-language studies published between 2018–2023, in nursing journals or by nursing faculty, and related to climate change or associated extreme weather events. Abstracted data included: Year, Focus (e.g. multiple hazards, sustainability), Outcomes, Social Determinants of Health, Sample Population/Setting, Study Design, Study Location, and Field of Journal. Studies were categorized by the countries’ Sustainable Development Index (SDI) to evaluate equity in representation. Two reviewers screened the first 30 abstracts for consistency. Remaining articles were screened independently, with discrepancies resolved through discussion. Overall, 202 articles were included, with 159 reporting primary research. Publications on climate change increased over time, with 66% on climate hazards, 29% on broader climate change or sustainability themes, and 5% on other topics. Nearly half (42%) were conducted in countries with low SDI scores (<0.250). Adults and healthcare providers were the most frequent populations sampled, with few studies of communities, work, or school settings. Nearly half were observational studies (44%), followed by qualitative inquiry (22%), with little interventional or community-engaged research. Few (4%) focused on Indigenous health and 42% addressed at least one social determinant of health. Physical health, mental health, and risk management were the most common outcomes; few examined systems of power in adjusting to climate change. We found many opportunities to strengthen and increase nursing research on climate change, including by emphasizing local and global factors shaping climate vulnerability, engaging diverse ways of knowing, centring Indigenous knowledges, studying sustainability and a just energy transition, and pursuing solutions-oriented, transformative research across more diverse populations and settings.
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Open access
Prenatal lead exposure and neonatal hearing screening outcomes in newborns from the PIPA cohort project, Rio de Janeiro
Nascimento Waack Braga Villar et al
View accepted manuscript
, Prenatal lead exposure and neonatal hearing screening outcomes in newborns from the PIPA cohort project, Rio de Janeiro
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, Prenatal lead exposure and neonatal hearing screening outcomes in newborns from the PIPA cohort project, Rio de Janeiro
Objective: To investigate the association between prenatal lead (Pb) exposure and Neonatal Hearing Screening (NHS) outcomes. Methods: This cross-sectional study included 434 newborns evaluated at a public university maternity hospital in Rio de Janeiro between 2021 and 2022. The NHS was performed using Transient Evoked Otoacoustic Emissions, analyzing amplitudes at 2, 3, and 4 kHz. Umbilical cord blood Pb concentrations were measured via inductively coupled plasma mass spectrometry (ICP-MS). Participants were categorized as below-median Pb (<0.80 μg/dL) or at/above-median Pb (≥0.80 μg/dL). Results: Median Pb concentration was 0.80 μg/dL. A negative correlation was observed between Pb levels and 4 kHz right-ear amplitudes (r=-0.104, p=0.031). In girls, higher Pb exposure was associated with significantly reduced 4 kHz right-ear amplitudes (p=0.008; d=0.36), which remained significant after multivariable adjustment (p=0.009). Conclusions: Prenatal Pb exposure may impair cochlear function, particularly in girls, even at concentrations below the Centers for Disease Control and Prevention (CDC) reference value (3.5 µg/dL). These findings highlight the need for environmental metal exposure prevention policies.
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Open access
Residential green space, walkability, and cardiometabolic biomarkers in midlife women: a longitudinal cohort study
Desai et al
View accepted manuscript
, Residential green space, walkability, and cardiometabolic biomarkers in midlife women: a longitudinal cohort study
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, Residential green space, walkability, and cardiometabolic biomarkers in midlife women: a longitudinal cohort study
Background Cardiovascular disease remains the leading cause of death among U.S. women. Green spaces and neighborhood features may influence cardiometabolic health by modulating environmental stressors and physical activity. Few longitudinal studies have examined green space, walkability, and cardio-inflammatory biomarkers, particularly in midlife women during the menopausal transition—a period of elevated cardiovascular risk. Methods We analyzed longitudinal data from the multi-ethnic, multi-site U.S. Study of Women’s Health Across the Nation (SWAN) (1999–2017) to examine associations between residential green space, walkability index, and cardio-inflammatory biomarkers across multiple clinical visits. Green space exposure was assessed using the National Land Cover Database (NLCD), with supplemental measures from the Normalized Difference Vegetation Index (NDVI). Exposures, categorized into tertiles, were weighted by 12-month geocoded residential history. Linear mixed-effects models estimated associations with systemic inflammatory, fibrinolytic, and lipid biomarkers, adjusting for socioeconomic, lifestyle, and environmental factors. Interaction analyses tested effect modification, with subgroup effects estimated. Results Medium residential NLCD greenness in 1000m buffer was associated with an 11.5% lower (95% Confidence Interval (CI): -18.6, -8.1%) high-sensitivity C-reactive protein (hs-CRP), along with lower fibrinogen and tissue-plasminogen activator antigen (tPA-ag) levels compared to low greenness tertile, suggesting anti-inflammatory and anticoagulant effects. Higher NDVI greenness showed a similar negative association with hs-CRP (-10.2%, 95% CI: -18.6, -1.1%). Compared to low walkability tertile, medium walkability group was linked to higher low-density lipoprotein (LDL) and total cholesterol (TC). Effect modification analyses indicating lower hs-CRP, higher high-density lipoprotein (HDL), and lower triglycerides (TG), suggested potential biological interactions between green space and women who transitioned to post-menopausal period. Conclusion Findings support green space's role in reducing systemic inflammation while highlighting the complex interplay of walkability, air pollution, and urban factors. Greenness and walkability capture distinct built environmental aspects, underscoring the need for green infrastructure to mitigate gentrification, reduce pollution, and support cardiovascular health.
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Scenario-based modeling for exploring urban cooling pathways: a targeted, health-relevant approach toward just resilience
Giannaros et al
View accepted manuscript
, Scenario-based modeling for exploring urban cooling pathways: a targeted, health-relevant approach toward just resilience
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, Scenario-based modeling for exploring urban cooling pathways: a targeted, health-relevant approach toward just resilience
Mesoscale modeling applications assessing urban-heat-reducing strategies, such as cool roofs, usually assume uniform implementation. While informative at the city scale, this approach offers limited insight into practical deployment and usually does not account for either local needs or existing disparities. In contrast, evaluating spatially and socioeconomically focused interventions within mesoscale modeling frameworks can provide more tangible and just pathways to urban cooling. In this context, the current study employed the Weather Research and Forecasting (WRF) model with explicit urban canopy representation at 400 m spatial resolution to simulate three cool-roof scenarios (white/cool-colored paint, reflective coating, super-cool material) targeting heat-stress relief and health-relevant implications in the vulnerable western suburbs of the Athens Urban Area (AUA), Greece. Simulations were conducted for a nine-day extreme heat wave (28 July–5 August 2021), influenced by varying wind circulations (Etesians and sea breeze), which informed the spatial configuration of the cooling measures. Specifically, the intervention area was positioned within a strategically located industrial zone to facilitate sea-breeze-driven cooling toward the heat-sensitive western AUA. The targeted cool-roof scenarios produced clear atmospheric cooling, with mean daytime near-surface air-temperature reductions in the broader influence zone (West Athens, Central Athens, Piraeus) reaching 0.54 °C under Etesians and 0.73 °C during sea-breeze conditions. Through integration of thermophysiologically grounded epidemiological evidence and demographic data, these physical cooling effects were linked to population-wide heat-stress responses and associated health-beneficial implications, affecting 2.5–20% of West Athens for all considered populations (male and female adults and seniors) and cool-roof strategies when sea breeze prevails. In total, the benefited population comprised 134,661 (white/cool-colored paint) to 197,787 (super-cool material) people, with heat-vulnerable female seniors exhibiting larger numbers than their male counterparts. These outcomes demonstrate how a targeted, health-relevant modeling framework can generate meaningful, needs-based insights to advance just resilience in urban environments.
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Open access
Lessons from the first U.S. school districts with real-time indoor environmental quality (IEQ) sensors in classrooms: benefits, barriers and opportunities
Botana Martinez et al
View accepted manuscript
, Lessons from the first U.S. school districts with real-time indoor environmental quality (IEQ) sensors in classrooms: benefits, barriers and opportunities
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, Lessons from the first U.S. school districts with real-time indoor environmental quality (IEQ) sensors in classrooms: benefits, barriers and opportunities
With aging buildings, rising temperatures, and limited budgets, school districts in the United States need effective strategies to address classroom environmental issues, secure funding for upgrades, and develop climate resilience plans. Collecting real-time indoor environmental quality data in classrooms can support these goals, yet few districts have adopted comprehensive school environmental monitoring, and little is known about the barriers and facilitators to its use. Understanding the value of this approach to ensure good environmental conditions inside schools, the challenges faced by early adopters, and strategies to overcome them will be essential for broader implementation. During the spring of 2025, we interviewed 13 school staff members from 5 public school districts across United States that were early adopters of IEQ monitoring. Discussions covered perceptions of IEQ in their districts, benefits of collecting this data, and barriers and facilitators to implementing sensors and leveraging the data collected. Participants identified many uses for classroom IEQ data, including supporting operations (e.g., simplifying environmental audits, remotely validating complaints, holding mechanical ventilation vendors accountable) and sustainability efforts (e.g., advocating for capital upgrades, monitoring wildfire smoke infiltration, predicting mold growth, ensuring medication safety, and student education). Opinions were mixed on publicly sharing the data. Barriers included database complexity, the need for environmental health and data expertise, high costs, technical challenges, workload, and ethical concerns. Schools addressed these challenges through vendor support, artificial intelligence, and partnerships with academic researchers. Key opportunities for advancing environmental equity in schools involve improving environmental health literacy among staff and leadership and establishing indoor air quality standards. This study highlights lessons learnt from pioneering districts and demonstrates how IEQ monitoring can improve classroom conditions, support operations and funding, and guide climate resilience and sustainability initiatives. The findings offer valuable insights for school districts, governments, and researchers considering installing environmental monitoring in classrooms.
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Open access
Changes in patient characteristics and patterns of visits to emergency departments during an extreme heat event
Paul et al
View accepted manuscript
, Changes in patient characteristics and patterns of visits to emergency departments during an extreme heat event
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, Changes in patient characteristics and patterns of visits to emergency departments during an extreme heat event
Background: An extreme heat event (EHE) occurred in Western North America in late June 2021. Multiple studies in British Columbia, Canada, found significant impacts on mortality from this EHE, with less focus on morbidity to date. This study aims to examine changes in volumes and patterns of emergency department (ED) visits during the EHE. Methods: We compared 33,309 adult ED visits during the EHE with 116,367 visits on the same calendar days of four previous years (2016-2019) for 27 EDs across the province. We used descriptive analyses and conditional logistic regression to assess differences in patient demographics, pre-existing chronic diseases, visit acuity, presenting complaint, and visit outcome. Results: On average, there were 528 (15 %) more daily visits during the EHE than during the baseline, with larger increases among older adults and high acuity visits. Increases were observed in all EDs across the province, but smaller EDs with lower capacity had the largest relative increases. Significant increases in presenting complaints were observed for ear-related, cardiovascular and neurologic conditions, and patients leaving before triage. Among high acuity visits, there was a 15.6% increase for neurologic conditions, primarily due to altered level of consciousness. People with parkinsonism, chronic kidney disease, mood and anxiety disorders, and diabetes were more likely to visit the ED during the EHE. Conclusions: We found substantial changes in patient volumes and cause-specific patterns of ED visits during the 2021 EHE. These results can help inform planning for ED surges, and preparation in community and the broader health system to protect public health.
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Wildfire smoke exposure and emergency department visits in Washington State
Annie Doubleday
et al
2023
Environ. Res.: Health
025006
View article
, Wildfire smoke exposure and emergency department visits in Washington State
PDF
, Wildfire smoke exposure and emergency department visits in Washington State
Wildfires are increasing in prevalence in western North America due to changing climate conditions. A growing number of studies examine the impact of wildfire smoke on morbidity; however, few evaluate these impacts using syndromic surveillance data that cover many emergency departments (EDs). We used syndromic surveillance data to explore the effect of wildfire smoke exposure on all-cause respiratory and cardiovascular ED visits in Washington state. Using a time-stratified case crossover design, we observed an increased odds of asthma visits immediately after and in all five days following initial exposure (lag 0 OR: 1.13; 95% CI: 1.10, 1.17; lag 1–5 ORs all 1.05 or greater with a lower CI of 1.02 or higher), and an increased odds of respiratory visits in all five days following initial exposure (lag 1 OR: 1.02; 95% CI: 1.00, 1.03; lag 2–5 ORs and lower CIs were all at least as large) comparing wildfire smoke to non-wildfire smoke days. We observed mixed results for cardiovascular visits, with evidence of increased odds emerging only several days following initial exposure. We also found increased odds across all visit categories for a 10
g m
−3
increase in smoke-impacted PM
2.5
. In stratified analyses, we observed elevated odds for respiratory visits among ages 19–64, for asthma visits among ages 5–64, and mixed risk estimates for cardiovascular visits by age group. This study provides evidence of an increased risk of respiratory ED visits immediately following initial wildfire smoke exposure, and increased risk of cardiovascular ED visits several days following initial exposure. These increased risks are seen particularly among children and younger to middle-aged adults.
The following article is
Open access
Air pollution and health impacts of oil & gas production in the United States
Jonathan J Buonocore
et al
2023
Environ. Res.: Health
021006
View article
, Air pollution and health impacts of oil & gas production in the United States
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, Air pollution and health impacts of oil & gas production in the United States
Oil and gas production is one of the largest emitters of methane, a potent greenhouse gas and a significant contributor of air pollution emissions. While research on methane emissions from oil and gas production has grown rapidly, there is comparatively limited information on the distribution of impacts of this sector on air quality and associated health impacts. Understanding the contribution of air quality and health impacts of oil and gas can be useful for designing mitigation strategies. Here we assess air quality and human health impacts associated with ozone, fine particulate matter, and nitrogen dioxide from the oil and gas sector in the US in 2016, and compare this impact with that of the associated methane emissions. We find that air pollution in 2016 from the oil and gas sector in the US resulted in 410 000 asthma exacerbations, 2200 new cases of childhood asthma and 7500 excess deaths, with $77 billion in total health impacts. NO
was the highest contributor to health impacts (37%) followed by ozone (35%), and then PM
2.5
(28%). When monetized, these air quality health impacts of oil and gas production exceeded estimated climate impact costs from methane leakage by a factor of 3. These impacts add to the total life cycle impacts of oil and gas, and represent potential additional health benefits of strategies that reduce consumption of oil and gas. Policies to reduce oil and gas production emissions will lead to additional and significant health benefits from co-pollutant reductions that are not currently quantified or monetized.
The following article is
Open access
Outside in: the relationship between indoor and outdoor particulate air quality during wildfire smoke events in western US cities
Katelyn O’Dell
et al
2023
Environ. Res.: Health
015003
View article
, Outside in: the relationship between indoor and outdoor particulate air quality during wildfire smoke events in western US cities
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, Outside in: the relationship between indoor and outdoor particulate air quality during wildfire smoke events in western US cities
Previous research on the health and air quality impacts of wildfire smoke has largely focused on the impact of smoke on outdoor air quality; however, many people spend a majority of their time indoors. The quality of indoor air on smoke-impacted days is largely unknown. In this analysis, we use publicly available data from an existing large network of low-cost indoor and outdoor fine particulate matter (PM
2.5
) monitors to quantify the relationship between indoor and outdoor particulate air quality on smoke-impacted days in 2020 across the western United States (US). We also investigate possible regional and socioeconomic trends in this relationship for regions surrounding six major cities in the western US. We find indoor PM
2.5
concentrations are 82% or 4.2
g m
−3
(median across all western US indoor monitors for the year 2020; interquartile range, IQR: 2.0–7.2
g m
−3
) higher on smoke-impacted days compared to smoke-free days. Indoor/outdoor PM
2.5
ratios show variability by region, particularly on smoke-free days. However, we find the ratio of indoor/outdoor PM
2.5
is less than 1 (i.e. indoor concentrations lower than outdoor) at nearly all indoor-outdoor monitor pairs on smoke-impacted days. Although typically lower than outdoor concentrations on smoke-impacted days, we find that on heavily smoke-impacted days (outdoor PM
2.5
> 55
g m
−3
), indoor PM
2.5
concentrations can exceed the 35
g m
−3
24 h outdoor standard set by the US Environmental Protection Agency. Further, total daily-mean indoor PM
2.5
concentrations increase by 2.1
g m
−3
with every 10
g m
−3
increase in daily-mean outdoor PM
2.5.
(median of statistically significant linear regression slopes across all western US monitor pairs; IQR: 1.0–4.3
g m
−3
) on smoke-impacted days. These results show that for indoor environments in the western US included in our analysis, remaining indoors during smoke events is currently an effective, but limited, strategy to reduce PM
2.5
exposure.
The following article is
Open access
Exploring vulnerability to heat and cold across urban and rural populations in Switzerland
Evan de Schrijver
et al
2023
Environ. Res.: Health
025003
View article
, Exploring vulnerability to heat and cold across urban and rural populations in Switzerland
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, Exploring vulnerability to heat and cold across urban and rural populations in Switzerland
Heat- and cold-related mortality risks are highly variable across different geographies, suggesting a differential distribution of vulnerability factors between and within countries, which could partly be driven by urban-to-rural disparities. Identifying these drivers of risk is crucial to characterize local vulnerability and design tailored public health interventions to improve adaptation of populations to climate change. We aimed to assess how heat- and cold-mortality risks change across urban, peri-urban and rural areas in Switzerland and to identify and compare the factors associated with increased vulnerability within and between different area typologies. We estimated the heat- and cold-related mortality association using the case time-series design and distributed lag non-linear models over daily mean temperature and all-cause mortality series between 1990–2017 in each municipality in Switzerland. Then, through multivariate meta-regression, we derived pooled heat and cold-mortality associations by typology (i.e. urban/rural/peri-urban) and assessed potential vulnerability factors among a wealth of demographic, socioeconomic, topographic, climatic, land use and other environmental data. Urban clusters reported larger pooled heat-related mortality risk (at 99th percentile, vs. temperature of minimum mortality (MMT)) (relative risk = 1.17 (95%CI: 1.10; 1.24), vs peri-urban 1.03 (1.00; 1.06), and rural 1.03 (0.99; 1.08)), but similar cold-mortality risk (at 1st percentile, vs. MMT) (1.35 (1.28; 1.43), vs rural 1.28 (1.14; 1.44) and peri-urban 1.39 (1.27–1.53)) clusters. We found different sets of vulnerability factors explaining the differential risk patterns across typologies. In urban clusters, mainly environmental factors (i.e. PM
2.5
) drove differences in heat-mortality association, while for peri-urban/rural clusters socio-economic variables were also important. For cold, socio-economic variables drove changes in vulnerability across all typologies, while environmental factors and ageing were other important drivers of larger vulnerability in peri-urban/rural clusters, with heterogeneity in the direction of the association. Our findings suggest that urban populations in Switzerland may be more vulnerable to heat, compared to rural locations, and different sets of vulnerability factors may drive these associations in each typology. Thus, future public health adaptation strategies should consider local and more tailored interventions rather than a one-size fits all approach.
The following article is
Open access
Effect modification of the association between fine particulate air pollution during a wildfire event and respiratory health by area-level measures of socio-economic status, race/ethnicity, and smoking prevalence
C E Reid
et al
2023
Environ. Res.: Health
025005
View article
, Effect modification of the association between fine particulate air pollution during a wildfire event and respiratory health by area-level measures of socio-economic status, race/ethnicity, and smoking prevalence
PDF
, Effect modification of the association between fine particulate air pollution during a wildfire event and respiratory health by area-level measures of socio-economic status, race/ethnicity, and smoking prevalence
Fine particulate air pollution (PM
2.5
) is decreasing in most areas of the United States, except for areas most affected by wildfires, where increasing trends in PM
2.5
can be attributed to wildfire smoke. The frequency and duration of large wildfires and the length of the wildfire season have all increased in recent decades, partially due to climate change, and wildfire risk is projected to increase further in many regions including the western United States. Increasingly, empirical evidence suggests differential health effects from air pollution by class and race; however, few studies have investigated such differential health impacts from air pollution during a wildfire event. We investigated differential risk of respiratory health impacts during the 2008 northern California wildfires by a comprehensive list of socio-economic status (SES), race/ethnicity, and smoking prevalence variables. Regardless of SES level across nine measures of SES, we found significant associations between PM
2.5
and asthma hospitalizations and emergency department (ED) visits during these wildfires. Differential respiratory health risk was found by SES for ED visits for chronic obstructive pulmonary disease where the highest risks were in ZIP codes with the lowest SES levels. Findings for differential effects by race/ethnicity were less consistent across health outcomes. We found that ZIP codes with higher prevalence of smokers had greater risk of ED visits for asthma and pneumonia. Our study suggests that public health efforts to decrease exposures to high levels of air pollution during wildfires should focus on lower SES communities.
The following article is
Open access
After the fire: A qualitative study of the role of long-term recovery organizations in addressing rural communities’ post-wildfire needs
Kathleen Moloney
et al
2023
Environ. Res.: Health
021009
View article
, After the fire: A qualitative study of the role of long-term recovery organizations in addressing rural communities’ post-wildfire needs
PDF
, After the fire: A qualitative study of the role of long-term recovery organizations in addressing rural communities’ post-wildfire needs
U.S. wildfire activity has increased over the past several decades, disrupting the systems and infrastructure that support community health and resilience. As the cumulative burden of wildfire damage is projected to increase, understanding an effective community recovery process is critically important. Through qualitative interviews with leaders of long-term recovery organizations (LTROs), a key component of wildfire recovery, we explored barriers and facilitators to LTROs’ ability to support post-wildfire needs among rural communities. Between February-May 2022, we conducted surveys and semi-structured interviews with 18 leaders from six LTROs serving rural communities in Washington, Oregon, and California impacted by wildfires between 2015–2020. The Robert Wood Johnson Foundation’s Culture of Health Framework informed the semi-structured interview guide and
a priori
codebook, to examine LTROs’ ability to address post-wildfire community needs from a health equity perspective. Additional codes were added through an inductive approach, and emerging themes were identified. Our findings indicate that LTROs face many barriers in addressing community needs post-wildfire, including the policies governing access to and the slow arrival of recovery resources, the intertwined nature of community economic health and built environment restoration, and the challenge of forming a functional LTRO structure. However, participants also identified facilitators of LTROs’ work, including the ability of LTROs and their government partners to adapt policies and procedures, and close collaboration with other community organizations. Factors both internal and external to the community and LTROs’ organizational characteristics influence their ability to address community needs, essential to health, post-wildfire. This study’s findings suggest the need for policy improvements to promote more equitable recovery resource access, that economic recovery should be a core LTRO function, and that recovery planning should be incorporated into community disaster preparedness activities. Future research should focus on LTROs’ role in other contexts and in response to other disasters.
The following article is
Open access
Warm-season temperatures and emergency department visits among children with health insurance
Jennifer D Stowell
et al
2023
Environ. Res.: Health
015002
View article
, Warm-season temperatures and emergency department visits among children with health insurance
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, Warm-season temperatures and emergency department visits among children with health insurance
High ambient temperatures have become more likely due to climate change and are linked to higher rates of heat-related illness, respiratory and cardiovascular diseases, mental health disorders, and other diseases. To date, far fewer studies have examined the effects of high temperatures on children versus adults, and studies including children have seldom been conducted on a national scale. Compared to adults, children have behavioral and physiological differences that may give them differential heat vulnerability. We acquired medical claims data from a large database of commercially insured US children aged 0–17 from May to September (warm-season) 2016–2019. Daily maximum ambient temperature and daily mean relative humidity estimates were aggregated to the county level using the Parameter-elevation Relationships on Independent Slopes dataset, and extreme heat was defined as the 95th percentile of the county-specific daily maximum temperature distribution. Using a case-crossover design and temperature lags 0–5 days, we estimated the associations between extreme heat and cause-specific emergency department visits (ED) in children aged <18 years, using the median county-specific daily maximum temperature distribution as the reference. Approximately 1.2 million ED visits in children from 2489 US counties were available during the study period. The 95th percentile of warm-season temperatures ranged from 71 °F to 112 °F (21.7 °C to 44.4 °C). Comparing 95th to the 50th percentile, extreme heat was associated with higher rates of ED visits for heat-related illness; endocrine, nutritional and metabolic diseases; and otitis media and externa, but not for all-cause admissions. Subgroup analyses suggested differences by age, with extreme heat positively associated with heat-related illness for both the 6–12 year (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.16, 1.56) and 13–17 year age groups (OR: 1.55, 95% CI: 1.37, 1.76). Among children with health insurance across the US, days of extreme heat were associated with higher rates of healthcare utilization. These results highlight the importance of individual and population-level actions to protect children and adolescents from extreme heat, particularly in the context of continued climate change.
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Open access
Air quality and health effects of a transition to ammonia–fueled shipping in Singapore
Sagar Rathod
et al
2023
Environ. Res.: Health
041002
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, Air quality and health effects of a transition to ammonia–fueled shipping in Singapore
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, Air quality and health effects of a transition to ammonia–fueled shipping in Singapore
Ammonia has been proposed to replace heavy fuel oil (HFO) in the shipping industry by 2050. When produced with low-carbon electricity, ammonia can reduce greenhouse gas emissions. However, ammonia emissions also contribute to local air pollution via the formation of secondary particulate matter. We estimate the potential ammonia emissions from storage and bunkering operations for shipping in Singapore, a port that accounts for 20% of global bunker fuel sales, and their impacts on air quality and health. Fuel storage and bunkering can increase total gaseous ammonia emissions in Singapore by up to a factor of four and contribute to a 25%–50% increase in ambient PM
2.5
concentration compared to a baseline scenario with HFO, leading to an estimated 210–460 premature mortalities in Singapore (30%–70% higher than the baseline). Proper abatement on storage and bunkering can reduce these emissions and even improve ambient PM
2.5
concentrations compared to the baseline. Overall, while an energy transition from HFO to ammonia in the shipping industry could reduce global greenhouse gas and air pollutant burdens, local policies will be important to avoid negative impacts on the communities living near its supply chain.
The following article is
Open access
Repeat wildfire and smoke experiences shared by four communities in Southern California: local impacts and community needs
Suellen Hopfer
et al
2024
Environ. Res.: Health
035013
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, Repeat wildfire and smoke experiences shared by four communities in Southern California: local impacts and community needs
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, Repeat wildfire and smoke experiences shared by four communities in Southern California: local impacts and community needs
Families in unincorporated communities in Southern California’s Eastern Coachella Valley (ECV) increasingly experience the burden of repeat wildfires and smoke. This study describes their lived wildfire and smoke experiences, health impacts, unique community-level inequities that compound wildfire risk and air quality effects, communication preferences, and resource needs for future wildfire preparedness. A wildfire community vulnerability framework informed the focus group discussion guide, exploring individual, community, and local government level factors that potentially influence community response and mitigation behaviors to repeat wildfire and smoke. Ten focus groups with 118 participants occurred in spring 2023 with four communities in ECV, California. Findings center on narratives of acute wildfire-related experiences, including evacuation and burned trailer homes, acute and chronic self report physical and mental health impacts of wildfires and smoke, daily life disruptions, staying indoors for protection, and local interactions described as a community strength in responding to fires. Participants from unincorporated, low-income, and monolingual Spanish-speaking communities predominantly consisting of farm workers requested greater emergency preparedness and response information, training and education in Spanish, postfire resources, lower trash service fees, increased enforcement of illegal dumping and burning, and use of multimodal and bilingual communication channels for wildfire, smoke, and wind alerts.
The following article is
Open access
Activating health professionals as climate change and health communicators and advocates: a review
Eryn Campbell
et al
2025
Environ. Res.: Health
012002
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, Activating health professionals as climate change and health communicators and advocates: a review
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, Activating health professionals as climate change and health communicators and advocates: a review
Health professionals have a crucial role to play in educating the public and advocating with policymakers about the human health relevance of climate change. Here, we review 93 studies published between the years 2000–2023 on the roles health professionals can play in addressing climate change as a health issue, their knowledge of and concern about the issue, their willingness to engage with the issue, barriers they perceive to that engagement, and strategies to overcome these challenges. Overall, we found health professionals have a growing understanding of and concern about climate change’s impacts on human health and are interested in communicating about the issue and advocating for climate and health solutions. Continued efforts are needed to develop effective programming and resources to help activate, train, and support health professionals as trusted voices on the issue.
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Environmental Publications
Environmental Research Communications
Environmental Research Letters
Environmental Research: Climate
Environmental Research: Ecology
Environmental Research: Energy
Environmental Research: Food Systems
Environmental Research: Health
Environmental Research: Infrastructure and Sustainability
Environmental Research: Water
Journal information
2022-present
Environmental Research: Health
doi: 10.1088/issn.2752-5309
Online ISSN: 2752-5309