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How was research for this document conducted? Who participated?

margauxf

“Since asthma surveillance data were not available at the census tract level for most of Louisiana, we estimated asthma burden using the inpatient discharge data available through LDH.”  (4)

“Case counts are not provided for CTs with a 2018 population of less than 800 to safeguard privacy.” (4)

“To minimize the need for suppression, inpatient discharge data was aggregated for the three most recent years available (2017–2019) and average annual crude rates were calculated for cases where asthma (ICD-10 code J45) was the primary diagnosis, as well as where asthma was any diagnosis.” (4)

“Spearman’s Rank Correlation was utilized to analyze the correlation between various social and environmental vulnerability factors, COVID-19 incidence, and the measures of asthma risk by CT.” (4)

 

“This was performed by first ranking the values in each dataset using RANK.AVG function in MS Excel 2016, followed by applying the PEARSON function to compare two datasets. Significance was set at alpha less than 0.05 (α < 0.05), with degrees of freedom (df) equal to two less than the total number of data points represented in both datasets” (4)

The research team works for the Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health in Baton Rouge. Team members included Arundhati Bakshi; Shanon Soileau; Collete Stewart; Kate Friedman; Collete Maser; Alexis Williams; Kathleen Aubin; and Alicia Van Doren. 

How are the links between environmental conditions and health articulated?

margauxf

“Currently, much of the environmental focus of the pandemic remains on PM2.5 levels; however, we noted that higher levels of ozone was consistently associated with higher incidence rates of COVID-19, and it was the only environmental factor that appeared to have an additive effect over SVI on COVID-19 incidence (Fig 1).” (11)

“Specifically, our data show a moderately strong positive correlation between SVI due to minority status/language barrier and three health data variables: asthma hospitalization; estimated asthma prevalence; and cumulative COVID-19 incidence at 3 months (Table 2). Interestingly, SVI measures were either negatively or not significantly correlated COVID-19 incidence at the 9-and 12-month time points, indicating that social vulnerability factors may have played a greater role in COVID-19 spread early in the pandemic, but may have been of diminishing importance as the pandemic wore on (Fig 1 and Table 2).” (9)

Bakshi A, Van Doren A, Maser C, Aubin K, Stewart C, Soileau S, et al. (2022) Identifying Louisiana communities at the crossroads of environmental and social vulnerability, COVID-19, and asthma. PLoS ONE 17(2): e0264336. https:// doi.org/10.1371/journal.pone.0264336. 

What forms of evidence and expertise are used in the document?

margauxf

This document uses data resources from the Center for Disease Control/Agency for Toxic Substances and Disease Registry (CDC/ATSDR), the Environmental Protection Agency (EPA), and the Louisiana Department of Health (LDH).

These data resources include the Social Vulnerability Index (2018 - CDC/ATSDR), the NATA Respiratory Hazard Index (EPA 2014), PM2.5level (average annual concentration in ug/m3, EPA 2016), ozone level (summer seasonal average of daily maximum 8-hour concentration in air in parts per billion, EPA 2016), indoor mold concerns reported to IEQES program (average annual number of calls, LDH 2017-2019), cumulative COVID-19 incidence rate at 3-, 6-, 9- and 12-month increments (LDH March 2020 - March 2021), asthma hospitalization (average annual crude rate, where asthma was a primary diagnosis among hospitalization cases, LDH 2017-2019), and estimated asthma prevalence (average annual crude rate, where asthma was any diagnosis among hospitalization cases, LDH 2017-2019).

Chemicals of Concern

mtebbe
  • Flame retardant chemicals
    • Migrate off of products and into air/dust
    • Many are endocrine disruptors, interfere with the reproductive system and thyroid
  • Stain repellent chemicals
    • Polyfluorinated alkyl substances (PFASs) or polyfluorinated chemicals (PFCs)
    • Enter air, dust, and drinking water
    • 6 million US residents have blood PFAS concentrations over EPA limit
    • Associated with cancer, thyroid disease, immunotoxicity, reduced immune response to childhood immunizations
  • Phthalates
    • Enter air and dust
    • Associated with asthma and allergies
  • Polychlorinated Biphenyls (PCBs)
    • Environmentally persistent pollutant, endocrine disruptor, and probable carcinogen
    • No longer used, but remain in estimated 25,000 US schools
    • Prenatal exposure may affect height, weight, head circumference, and body size at puberty

Main Argument

mtebbe

The authors structure their argument around three metrics: student health, student thinking, and student performance. They define these as follows:

  • Student health: the overall physical and biological health of a school building occupant.
  • Student thinking: short-term impacts on cognitive function and mental well-being.
  • Student performance: the successful long-term academic performance of students.

Through their review of more than 200 studies, they conclude that there is unambiguous evidence for negative effects of low environmental quality on all three of these metrics. Although it is discussed in less detail, they also reference studies that provide evidence for the improvement of these three metrics when issues with school infrastructure are addressed.

Scale of the Issue Pt. 2

mtebbe

"Millions of K–12 students in America spend several hours a day learning in schools that are more than 50 years old and in need of extensive repair and where children may be exposed to mold, poor ventilation, uncomfortable temperatures, inadequate lighting, and overcrowded, excessively noisy conditions."

Emphasizes the scale of the issue--this is not a Philadelphia or Santa Ana or Azusa problem, it is a national issue for all public schools. Also emphasizes the breadth of the issues--there are so many different forms of environmental hazards in schools.

Unique Effects on Children's Health

mtebbe
  • Ventilation & air quality:
    • Children breathe more air than adults relative to their body size
  • Water quality:
    • Contaminants like lead have greater effects on cognitive development and behavior of children than adults
  • Thermal comfort
    • Current models for thermal comfort are based on adults and do not predict children's comfort levels
    • Children are more susceptible to the effects of heat stress
    • Children's clothing and activity levels (major determinants of thermal comfort) are distinct from adults
  • Lighting and views
    • Children have larger pupils than adults
    • Children have greater light-induced melatonin suppression--their Circadian rhythms are more susceptible to manipulation
  • Noise
    • Children under 15 are more sensitive to difficult listening conditions because they are still developing mature language skills
    • Children need a greater signal-to-noise ratio in order to understand language
    • Memory and attention development are sensitive to chronic noise exposure

External Factors

mtebbe

"We recognize that beyond the four walls of the school building there are many environmental and social contexts that can adversely affect students’ well-being and undermine their academic potential. Inequities persist in the distribution of the social determinants of health, and students bring these influence with them every day when they walk through the doors of their school building."

Environmental injustice can't be an either/or issue of hazards inside or outside schools, it needs to be a both/and issue where hazards in schools are being addressed in conjunction with hazards outside of schools.

Chronic Environmental Hazards

mtebbe

"The chronic impacts of a poor school environment often do not get the same type of attention as cases like these, because the links between building quality and health are subtler and less overt."

"These" is referring to a list of dramatic incidents where students were suddenly exposed to some kind of environmental hazard. This quote captures one of the biggest challenges of environmental justice work--in the many, many cases where it is not visible, it is hard to mobilize support, attention, and emotion because the links aren't flashy. This connects to ideas about slow disasters in Anthro 25A.

National Standards for Environmental Quality in Schools

mtebbe
  • Ventilation:
    • 15 cubic feet of outside air per person or 5 liters per person per second
    • Carbon dioxide concentrations below 1000 ppm
  • Water quality:
  • Thermal health
    • Indoor temperatures between 68 and 77 degrees Fahrenheit
  • Lighting
    • Minimum 350 lux, up to 1000 lux
    • LED instead of fluorescent lighting
  • Noise
    • Maximum background noise: 35 dB
    • Maximum reverbration time: 0.6-0.7 seconds