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Background. Despite the importance of baseline health data for evidence-informed decision-making, these data are rarely available for displaced populations. At the height of the European refugee crisis, most of those seeking asylum in Europe were from regions with high prevalences of communicable and non-communicable diseases. To create an epidemiologic profile for refugees in mainland Grecian refugee camps, this study assessed the prevalence of 11 communicable and non-communicable diseases among refugees utilizing Médecins du Monde (MdM) in-camp clinics. Methods. The prevalences of selected diseases among individuals utilizing MdM services were determined from data collected at mainland Grecian refugee camps clinics from April 2016 - July 2017. Overall and age-specific prevalences were reported. Differences in disease burden among refugees from the largest sending countries - Afghanistan and Syria - were compared using prevalence ratios and 95% confidence intervals. Patterns in results were compared with disease burden estimates in sending countries and with findings from comparable settings. Results. Respiratory tract infections (RTIs) were the most prevalent outcome. Among RTIs, upper RTIs were most common, with a prevalence of nearly 40%; throughout the study period, over 46% of children under 18 years had at least one upper RTI consultation. Musculoskeletal conditions (3.64%), were the most prevalent non-communicable outcome, followed by hypertension (2.21%) and asthma (1.28%). Afghans were 31.68% more likely than Syrians to have a consultation for at least one condition (PR: 1.32; 95% CI: 1.25, 1.39). The prevalence of RTIs was comparable to sending countries, but there was a comparatively lower burden of other conditions among refugees than literature estimates from sending countries. Conclusion. Refugees utilizing MdM clinics in camps had higher burdens of communicable diseases - predominantly RTIs - relative to non-communicable diseases. Non-communicable disease burdens were comparatively lower than reported prevalences from in-country populations. These findings can be attributed to a range of considerations including differences in demographic profiles between sending countries and refugee populations and missed opportunities for utilizing clinical care. Based on these data, displaced populations have considerable health needs. Further investment is needed to capture the health profiles of displaced populations to support evidence-informed decision-making processes in humanitarian emergency responses.

The utilization of Incident Command Systems (ICS) and Emergency Operations Centers (EOCs) in public health emergency and disaster response are cornerstones of the capabilities prescribed for Public Health Emergency Preparedness (PHEP). To assess the use of ICS and EOCs by public health agencies during the COVID-19 response, we conducted a content analysis of online materials available from 62 health departments funded by the Centers for Disease Control and Prevention for PHEP. Bivariate associations between evidence of ICS utilization in COVID response were assessed using relative risk regression. Risk ratios (RR) and 95% confidence intervals (95% CI) were reported. 58% (36 of 62) of PHEP grantees had accessible information regarding the use of ICS in COVID-19 public health response. PHEP grantees with online information about PHEP, Hospital Preparedness Program linkages, public health seats at state or jurisdictional EOCs, exercises, and ICS generally were more likely to have COVID-specific ICS information. COVID-19 has placed significant strain on the operational response capacity of public health agencies. Given that this is the most significant event in which PHEP Capabilities have been tested, both in terms of geographic spread and duration, assessment of both preparedness and response capacities is critical for recognizing strengths and addressing shortcomings to improve PHEP operations in future incidents.

Objectives: We aimed to evaluate the association of testosterone deficiency with inflammation and how long-term testosterone therapy affects inflammation biomarkers over time. Methods: We conducted a 2-component study. First, we conducted a cross-sectional study using the recently released 2015-2016 National Health and Nutrition Examination Survey (NHANES) data to examine the association between testosterone deficiency and inflammation biomarkers including high sensitivity C-reactive protein (hsCRP), liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the US general population. Then we conducted a longitudinal study to investigate the longitudinal effect of testosterone therapy on inflammation biomarkers and the risk of cardiovascular events, using data from 776 hypogonadal men based on a registry study in Germany with up to 11 years’ follow-up. Results: The adjusted odds ratios (ORs) describing the associations between testosterone deficiency and hsCRP ≥ 3mg/L, ALT > 40U/L, and AST > 40U/L were 1.81 ( P-value < 0.001), 1.46 ( P-value = 0.009), and 0.99 ( P-value = 0.971), respectively. In the control group, CRP, ALT, and AST levels increased by 0.003 (95%CI: −0.001, 0.007) mg/L, 0.157 U/L (95%CI: 0.145, 0.170), and 0.147 (95%CI: 0.136, 0.159) U/L per month, while in the treatment group, CRP, ALT, and AST levels decreased by 0.05 (95%CI: −0.055, −0.046) mg/L, 0.142 U/L (95%CI: −0.154, −0.130), and 0.148 (95%CI: −0.158, −0.137) U/L per month. Conclusion: Testosterone deficiency was associated with an increased level of inflammation; long-term testosterone therapy alleviated inflammation among hypogonadal men, which may contribute to the reduced cardiovascular risk. Future large trials are warranted to confirm our observational study findings.

Objectives The objective of this study was to characterize the changes in timeliness and completeness of disease case reporting in Texas in response to an increasing number of foodborne illnesses and high-consequence infectious disease investigations and the Texas Department of State Health Services’ new state-funded epidemiologist (SFE) program. Methods We extracted electronic disease case reporting data on 42 conditions from 2012 through 2016 in all local health department (LHD) jurisdictions. We analyzed data on median time for processing reports and percentage of complete reports across time and between SFE and non-SFE jurisdictions using Mann–Whitney t tests and z scores. Results The median time of processing improved from 13 days to 10 days from 2012 to 2016, and the percentage of disease case reports that were complete improved from 19.6% to 27.7%. Most reports were for foodborne illnesses; both timeliness (11 to 7 days) and completeness (20.9% to 23.5%) improved for these reports. Conclusions Disease reporting improvements in timeliness and completeness were associated with the SFE program and its enhancement of epidemiologic capacity. SFEs were shown to improve surveillance metrics in LHDs, even in jurisdictions with a high volume of case reports. Adding epidemiologist positions in LHDs produces a tangible outcome of improved disease surveillance.

This study examines what visitors to urban parks in Houston, TX, know about environmental health risks resulting from Hurricane Harvey, a category 4 storm that made landfall in August 2017 and dropped over 60 in. of rain in 8 days making it the most significant rainfall event in US history. Interviews were conducted with adult Houstonians using purposive sampling. In total, 27 interviews were conducted with 36 different participants. Interviews were audio-recorded, transcribed verbatim, and analyzed qualitatively using a phronetic iterative approach. This study found that park visitors lack sufficient knowledge about environmental health risks, yet they have strong desires to learn more about such risks. In particular, participants have clear opinions on what the content of the messages (i.e., concise, manageable, not fear-inducing) should be and how they would like to receive the information (i.e., conveniently accessible, from trusted local sources). Implications for health campaign interventions utilizing uncertainty theories are discussed.

Low baseline testosterone level has been associated with the development of risk factors for cardiovascular disease such as insulin resistance and obesity. In addition to the absolute testosterone level, remarkable changes in testosterone level may have an acute effect on cardiovascular disease development and progression, which has been rarely investigated. In this study, we used a clinical dataset of 376 hypogonadal men whose testosterone levels were measured every six months for up to 11 years from a registry study in Germany, and conducted survival analyses to investigate the effect of testosterone changes since the last visit (time-varying) on the risk of cardiovascular events. Given the potential discrepancies in comorbidity conditions among patients with prior cardiovascular events and those without, all the analyses were stratified by patients' prior cardiovascular event status. We found the effects were not different among patients with prior cardiovascular events and those without. Regardless of patients' prior cardiovascular event status, patients with larger testosterone declines (≥3.12 nmol/L, 90

To understand the role public health students play in response to COVID-19 despite cuts in funding for graduate student emergency response programs (GSERPs), we reviewed the websites of the Association of Schools and Programs of Public Health, Council on Education in Public Health, and individual schools and programs to identify student participation in COVID-19 response activities. Thirty schools and programs of public health are supporting public health agencies in response to COVID-19, primarily through the provision of surge capacity (n = 20, 66.7%), contact tracing (n = 19, 63.3%), and training (n = 11, 36.7%). The opportunity to participate in formal and informal applied public health experiences like practica, service-learning, and field placements can benefit both public health students and agency partners. Although recent publications have identified gaps in academic public health response to COVID-19, in part due to the cessation of funding for workforce development and other university-based programs in public health preparedness, schools and programs of public health continue to support public health agencies. Future funding should explicitly link public health students to applied public health activities in ways that can be measured to document impacts on public health emergency response and the future public health workforce.

Although urban community food gardens have the capacity to strengthen and support neighborhoods in need, the benefits of such operations must be considered in tandem with the potential risks associated with urban environmental contamination. Therefore, research is needed to characterize existing community gardens in urban areas. In the present study, a survey of Houston, TX, community gardeners (N = 20) was conducted to better understand their risk-based knowledge and perceptions, current gardening practices, and willingness to implement risk mitigation measures. Soil samples collected from the beds (N = 22) and surrounding grounds (N = 24) of existing community garden sites in Houston, TX, were screened for trace and heavy metals using X-ray fluorescence spectrometry. The survey indicated that community gardeners had few concerns with regard to potential soilborne hazards and were generally willing to use diverse strategies to reduce potential hazards related to garden soil contamination. Ground and garden bed soil collected from community gardens were found to have excess concentrations of arsenic compared to federal health screening limits. The information provided here provides insight into possible discordance between community gardening risk perception and contamination risk that could be addressed through outreach, engagement, and remediation approaches.

Unprecedented inland precipitation and catastrophic flooding associated with Hurricane Harvey potentially redistributed contaminants from industrial sites and transportation infrastructure to recreational areas that make up networks of green infrastructure, creeks, and waterways used for flood control throughout the Greater Houston Area. Sediment samples were collected in parks located near the Buffalo Bayou watershed 1 week after Hurricane Harvey made landfall and again 7 weeks later. Total concentrations of the U.S. Environmental Protection Agency's (EPA's) 16 priority polycyclic aromatic hydrocarbons (PAHs) were measured in each sample at both time points. Diagnostic ratios were calculated to improve understanding of potential sources of PAHs after flooding. Diagnostic ratios suggest vehicular traffic to be a potential source for PAHs in parks. Although the concentrations of PAHs in all samples were below EPA actionable levels, given that no background values were available for comparison, it is difficult to quantify the impact flooding from Hurricane Harvey had on PAH concentrations in Houston parks. However, given the high frequency of flooding in Houston, and the concentration of industrial facilities and transportation infrastructure adjacent to recreation areas, these data demonstrate that PAHs were still present after unprecedented flooding. This study may also serve as a baseline for future efforts to understand the environmental health impacts of disasters.

Polycyclic aromatic hydrocarbons (PAHs) are environmental contaminants associated with adverse human health outcomes. Environmental justice neighborhoods experience disproportionate environmental health risks. Hurricane Harvey made landfall on August 25, 2017, bringing record rainfall and catastrophic flooding to Houston, Texas, redistributing PAHs in residential soil. We aimed to describe PAH distributions in soil in the Manchester neighborhood of Houston, TX, and identify their potential sources. Soil samples were collected from 24 residential addresses and analyzed for 16 priority PAH concentrations using an accelerated solvent extractor. PAH distribution and source determination were conducted using spatial analysis and isomer ratios. All sample sites detected PAHs in soil, with the total mass ranging from 0.75 to 69.9 ng/g, which were predominantly four-ring structured PAHs. Total PAH concentrations were highest on the northeastern border of the neighborhood, whereas lower overall concentrations of PAHs were found on the southwestern border, at the highest elevation in the watershed. The ratio indeno[1,2,3-cd]pyrene (IP) to indeno[1,2,3-cd]pyrene plus benzo[ghi]perylene indicated vehicular combustion as the primary source in 19 of 23 samples. After heavy rainfall from Hurricane Harvey in the Manchester neighborhood, PAHs in soil were unevenly distributed throughout the neighborhood, with an accumulation of PAHs in the northeastern edges. Using isomer ratios and spatial analysis, the likely source of PAHs is from use of transportation infrastructure.

Background Although increases in the prevalence of mental distress have been reported after natural disasters, less is known about the role the environment may play in mitigating posttraumatic stress disorder (PTSD) in hurricane-impacted communities. Aim This study aims to investigate the extent to which concentration and perceived quality of neighborhood greenness are associated with lower levels of PTSD, along with potential mechanisms through which these effects occur. Methods We conducted a cross-sectional survey of individuals (N=272) from 30 Houston neighborhoods that were affected during Hurricane Harvey. Perceived quality of neighborhood green space was measured using a scale adapted from the Neighborhood Open Space (NOS) scale, and concentration of greenness was measured objectively using the normalized difference vegetation index (NDVI). Probable PTSD was measured using the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and hurricane-related distress using the Impact of Event Scale (IES-R). Generalized linear mixed models were used to fit individual models. Based on the results, structural equation models were employed to test direct and indirect pathways simultaneously. Models were adjusted for neighborhood- and individual-level confounders. Results Greater perceived quality of neighborhood green space was significantly associated with lower likelihoods of probable PTSD and hurricane-related distress. The effects of perceived green space quality on hurricane-related distress were mediated by higher levels of emotional resilience. Social cohesion, although significantly correlated with PTSD and distress, did not mediate the effect of perceived green space quality on either. Neighborhood NDVI was significantly associated with hurricane-related distress, but not with PTSD. Conclusion We conclude that living in neighborhoods with greater perceived quality of green space was associated with lower levels of post-hurricane distress, with mediation especially through the emotional resilience pathway. These findings suggest that in disaster recovery policy frameworks, more attention should be paid to the benefits of high-quality neighborhood green infrastructure.

Background: The population health implications of the growing burden of trauma-related mortality may be influenced by access to health insurance coverage, and demographic characteristics such as race and ethnicity. We investigated the effects of health insurance status and race/ethnicity on the risk of mortality among trauma victims in Texas.Methods: Using Texas trauma registry data from 2014 - 2016, we categorized health insurance coverage into private, public, and uninsured, and categorized patients with serious injuries into Non-Hispanic Whites, Non-Hispanic Blacks, Hispanics Any-Race, and Others. Multivariate logistic regression was used to estimate the effects of health insurance status and race/ethnicity on mortality, controlling for age, gender, severity of the trauma, cause of trauma, presence of comorbid conditions, trauma center designation, presence of a traumatic brain injury (TBI), and severity of a TBI. Results: From January 1, 2014, to December 31, 2016, there were 415,159 trauma cases in Texas; 8,827 (2.1%) were fatal. Among patients with at least a moderate injury, 24, 606 (17.4%) were uninsured, and 98, 237 (69.4%) identified as Non-Hispanic White. In the multivariate analysis, Hispanics of any race and Non-Hispanic Blacks had higher adjusted odds of trauma mortality compared to Non-Hispanic Whites [ORHispanics= 1.25: 95% CI (1.16 – 1.36)] [ORBlacks= 2.11: 95% CI (1.87 – 2.37)]. Similarly, compared to privately insured, uninsured patients had 86% higher odds of trauma-related death [OR= 1.86: 95% CI (1.66 – 2.05)]. The effects of lack of health insurance on trauma mortality varied across race/ethnicity of the victims; uninsured Non-Hispanic Blacks had disproportionately higher adjusted odds of trauma mortality than uninsured Whites. Conclusion: Using Texas trauma registry data, we found significant disparities in trauma-related mortality risk based on race/ethnicity and health insurance coverage. The identification of trauma mortality inequalities could inform the design and implementation of future public health interventions.

Harris County, Texas, is home to thousands of documented sources of environmental pollution. It is also highly vulnerable to impacts from natural hazards, including floods. Building on the Toxics Mobility Inventory (TMI), this article discusses how the authors developed a Toxics Mobility Vulnerability Index (TMVI) and applied it to Harris County to assess potential exposure risks to residents from the transfer of toxic materials during flood events. The TMI concept was operationalized and standardized by combining multiple spatial data sets to simultaneously evaluate various factors in the weather hazards—extant toxics—social vulnerability nexus (e.g., floodplain area, industrial land use, social vulnerability measures). Findings indicated hot spots of vulnerability to hazard-induced toxics transfer concentrated in Northeast Houston US Census tracts in Harris County. The main drivers of increased risk in these areas include the proportion of the area that is impervious surface, consistently high social vulnerabilities, and poor health. However, the most vulnerable areas also have overlapping exposure to both industrial land use and floodplains. Assessing the contribution of a set of industrial land use, social vulnerability, natural hazard, emergency response, and topography variables in a single index on the same spatial scale (e.g., US Census tract) provides detailed information for policy makers tasked with mitigating risk. Applying tools such as the TMVI to highly vulnerable urban and coastal locations may help identify changes needed for preparedness and mitigation planning and highlight areas where limited resources for investment- and policy-related remediation should be focused, both before and after disasters.

Introduction Funding and staff formerly dedicated to routine public health tasks (e.g., responding to communicable and non-communicable diseases, investigating foodborne outbreaks, conducting routine surveillance) and services (e.g., environmental health, substance abuse, maternal-child health) may no longer be available in many public health departments due to the COVID-19 response. The objective of this study was to assess the extent to which staffing for essential public health services has been redirected to the COVID-19 response. Materials and methods This is a cross-sectional study using a survey distributed through the Qualtrics platform. Individuals (N = 298) working in public health across governmental and academic public health departments in the U.S. during the ongoing COVID-19 pandemic response were surveyed. Survey items measured multiple domains including professional experience (i.e., training, years of experience, content expertise, job functions, hours worked), mental and physical health status (i.e., generalized anxiety, depression, burnout), and career plans (i.e., pre-pandemic vs. current career plans). Results The total number of content expertise areas and programmatic functions covered by individual public health workers increased between January and September of 2020, with 26% (73 of 282) of respondents reporting an increase in both. The total number of respondents working in infectious disease and preparedness remained constant, while declines were reported in program evaluation (-36%) and health education (-27%) and increases were reported in disease investigation (+35%). Conclusions The provision of many essential public health functions and tasks have been limited or eliminated while the U.S. public health workforce responds to the COVID-19 pandemic. These findings highlight opportunities for funding and professional development of public health systems, both during and after the COVID-19 response, to help ensure the continuity of essential public health services, staffing sustainability, and preparedness for future public health emergencies in the U.S.

Background. Hurricane Harvey made landfall along the Texas Gulf Coast as a Category 4 hurricane on August 25, 2017, producing unprecedented precipitation that devastated coastal areas. Catastrophic flooding in the City of Houston inundated industrial and residential properties resulting in the displacement and transfer of soil, sediment, and debris and heightening existing environmental justice (EJ) concerns. Objectives. The primary aim of this study was to evaluate the presence, distribution, and potential human health implications of polycyclic aromatic hydrocarbons (PAHs) in a residential neighborhood of Houston, Texas following a major hurricane. Methods. Concentrations of PAHs in 40 soil samples collected from a residential neighborhood in Houston, Texas were measured. Spatial interpolation was applied to determine the distribution of PAHs. Potential human health risks were evaluated by calculating toxicity equivalency quotients (TEQs) and incremental excess lifetime cancer risk (IELCR). Results. Total priority PAH concentrations varied across samples (range: 9.7 × 101 ng/g-1.6 × 104 ng/g; mean: 3.0 × 103 ng/g ± 3.6 × 103 standard deviation). Spatial analysis indicated a variable distribution of PAH constituents and concentrations. The IELCR analysis indicated that nine of the 40 samples were above minimum standards. Conclusions. Findings from this study highlight the need for fine scale soil testing in residential areas as well as the importance of site-specific risk assessment. Competing Interests. The authors declare no competing financial interests.

Comprehensive plans provide an overall vision for a city’s land use and development and influence community health conditions. As part of a community-engaged research project, a Healthy Living and Active Design Scorecard was applied to the comprehensive plan of League City, Texas, to identify health-promoting design and planning strategies. Although the plan scored similarly to published examples, several areas of improvement aligned with priorities from a community health assessment were identified, including improving public transportation and access to exercise and recreation. Future revisions of the plans and neighbourhood scaled designs targeting these issues could improve the health of the community.

While the health impacts of the COVID-19 pandemic on frontline health care workers have been well described, the effects of the COVID-19 response on the U.S. public health workforce, which has been impacted by the prolonged public health response to the pandemic, has not been adequately characterized. A cross-sectional survey of public health professionals was conducted to assess mental and physical health, risk and protective factors for burnout, and short- and long-term career decisions during the pandemic response. The survey was completed online using the Qualtrics survey platform. Descriptive statistics and prevalence ratios (95% confidence intervals) were calculated. Among responses received from 23 August and 11 September 2020, 66.2% of public health workers reported burnout. Those with more work experience (1–4 vs. &lt, 1 years: prevalence ratio (PR) = 1.90, 95% confidence interval (CI) = 1.08−3.36, 5–9 vs. &lt, 1 years: PR = 1.89, CI = 1.07−3.34) or working in academic settings (vs. practice: PR = 1.31, CI = 1.08–1.58) were most likely to report burnout. As of September 2020, 23.6% fewer respondents planned to remain in the U.S. public health workforce for three or more years compared to their retrospectively reported January 2020 plans. A large-scale public health emergency response places unsustainable burdens on an already underfunded and understaffed public health workforce. Pandemic-related burnout threatens the U.S. public health workforce’s future when many challenges related to the ongoing COVID-19 response remain unaddressed.

Human ecology has played an essential role in the spread of mosquito-borne diseases. With standing water as a significant factor contributing to mosquito breeding, artificial containers disposed of as trash&mdash, which are capable of holding standing water&mdash, provide suitable environments for mosquito larvae to develop. The development of these larvae further contributes to the possibility for local transmission of mosquito-borne diseases in urban areas such as Zika virus. One potential solution to address this issue involves leveraging unmanned aerial vehicles that are already systematically becoming more utilized in the field of geospatial technology. With higher pixel resolution in comparison to satellite imagery, as well as having the ability to update spatial data more frequently, we are interested in investigating the feasibility of unmanned aerial vehicles as a potential technology for efficiently mapping potential breeding grounds. Therefore, we conducted a comparative study that evaluated the performance of an unmanned aerial vehicle for identifying artificial containers to that of conventionally utilized GPS receivers. The study was designed to better inform researchers on the current viability of such devices for locating a potential factor (i.e., small form factor artificial containers that can host mosquito breeding grounds) in the local transmission of mosquito-borne diseases. By assessing the performance of an unmanned aerial vehicle against ground-truth global position system technology, we can determine the effectiveness of unmanned aerial vehicles on this problem through our selected metrics of: timeliness, sensitivity, and specificity. For the study, we investigated these effectiveness metrics between the two technologies of interest in surveying a study area: unmanned aerial vehicles (i.e., DJI Phantom 3 Standard) and global position system-based receivers (i.e., Garmin GPSMAP 76Cx and the Garmin GPSMAP 78). We first conducted a design study with nine external participants, who collected 678 waypoint data and 214 aerial images from commercial GPS receivers and UAV, respectively. The participants then processed these data with professional mapping software for visually identifying and spatially marking artificial containers between the aerial imagery and the ground truth GPS data, respectively. From applying statistical methods (i.e., two-tailed, paired t-test) on the participants&rsquo, data for comparing how the two technologies performed against each other, our data analysis revealed that the GPS method performed better than the UAV method for the study task of identifying the target small form factor artificial containers.

Introduction Because of their inability to access adequate medical care, transportation, and nutrition, socially vulnerable populations are at increased risk of health challenges during disasters. This study estimates the association between case counts of coronavirus disease 2019 (COVID-19) infection and social vulnerability in the U.S., identifying counties at increased vulnerability to the pandemic. Methods Using Social Vulnerability Index and COVID-19 case count data, an ordinary least squares regression model was fitted to assess the “global” relationship between COVID-19 case counts and social vulnerability. Local relationships were assessed using a geographically weighted regression model, which is effective in exploring spatial non-stationarity. Results As of May 12, 2020, a total of 1,320,909 people had been diagnosed with COVID-19 in the U.S. Of the counties included in this study (91.5%, 2,844/3,108), the highest case count was recorded in Trousdale, Tennessee (16,525.22 per 100,000) and the lowest in Tehama, California (1.54 per 100,000). At the “global” level, overall Social Vulnerability Index (eβ=1.65, p=0.03) and minority status and language (eβ=6.69, p

Objective To assess associations between state public health agency governance and timing and extent of implementation of social distancing control measures during COVID-19 response. Design State public health agencies were stratified by governance, and data on timing and extent of social distancing were collected from the Institute for Health Metrics and Evaluation. Multinomial logistic regression and time-to-event analyses were conducted to quantify impacts of governance structure on timing and extent of social distancing. Setting State health departments in the United States. Results States operating under centralized public health governance structures enacted social distancing 4 days after decentralized states and had a 73% reduced likelihood of enacting a social distancing policy (hazard ratio = 0.27; 95% CI, 0.08 to 0.86). Conclusion State health department governance structure may have implications on timing and extent of social distancing control measures implemented during a public health emergency.

Objective To determine the association between Medicaid expansion and infant mortality rate (IMR) in the United States. Data sources State-level aggregate data on US IMR, race, and sex were abstracted from the US Center for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research. Study design The association between Medicaid expansion and IMR adjusted for race and sex was assessed with multiple linear regression models using difference-in-differences estimation and Huber-White robust standard errors. Principal findings Difference-in-differences regression found no association between Medicaid expansion status and change in national IMR from 2010 to 2017 (Coef. = 0.04; 95% CI: -0.39, 0.46). However, among Hispanics, the program was found to be associated with reduction in IMR (Diff-in-Diff Coef. = -0.53; 95% CI: -1.02, -0.03). Conclusions Overall, the Affordable Care Act-induced Medicaid expansion was not associated with IMR reduction in expansion states relative to nonexpansion states. However, the program was associated with a significant IMR decline among Hispanics.

Background: Given the time and monetary costs associated with traditional analytical chemistry, there remains a need to rapidly characterize environmental samples for priority analysis, especially within disaster research response (DR2). As PAHs are both ubiquitous and occur as complex mixtures at many National Priority List sites, these compounds are of interest for post-disaster exposures. Objective: This study tests the field application of the KinExA Inline Biosensor in Galveston Bay and the Houston Ship Channel (GB/HSC) and in the Elizabeth River, characterizing the PAH profiles of these region's soils and sediments. To our knowledge, this is the first application of the biosensor to include soils. Methods: The biosensor enables calculation of total free PAHs in porewater (C free), which is confirmed through gas chromatography-mass spectrometry (GC-MS) analysis. To determine potential risk of the collected soils the United States Environmental Protection (USEPA) Agency's Regional Screening Level (RSL) Calculator is used along with the USEPA Region 4 Ecological Screening Values (R4-ESV) and Refined Screening Values (R4-RSV). Results: Based on GC-MS results, all samples had PAH-related hazard indices below 1, indicating low noncarcinogenic risks, but some samples exceeded screening levels for PAH-associated cancer risks. Combining biosensor-based C free with Total Organic Carbon yields predictions highly correlated (r > 0.5) both with total PAH concentrations as well as with hazard indices and cancer risks. Additionally, several individual parent PAH concentrations in both the GB/HSC and Elizabeth River sediments exceeded the R4- ESV and R4-RSV values, indicating a need for follow-up sediment studies. Conclusions: The resulting data support the utility of the biosensor for future DR2 efforts to characterize PAH contamination, enabling preliminary PAH exposure risk screening to aid in prioritization of environmental sample analysis.

Polycyclic aromatic hydrocarbons (PAHs) are a class of >100 chemicals that naturally occur in coal tar, crude oil, and gasoline and can be manufactured as part of dyes, plastics, and pesticides. PAHs are complex environmental toxicants and exposure to them have been linked to adverse health outcomes including cancer, as well as diseases of the skin, liver, and immune system. Residents of the environmental justice neighborhood of Manchester, located on Houston’s East End, are disproportionally exposed to toxic pollutants from both industry and transportation infrastructure. Based on a longstanding community engagement partnership with the research team, neighborhood residents sought to better understand their domestic exposure to PAHs. Particulate wipes were used to collect dust from a marked area within the entryway of randomly selected homes to assess for the presence of PAHs. Nineteen of the 61 PAH analytes, including the Environmental Protection Administration’s 16 priority PAHs and the subgroup of 7 probable human carcinogens, were found in the sampled homes. Residents of the Houston neighborhood of Manchester potentially have significant domestic exposure to PAHs from combustion sources. More research is needed to assess the source of the PAHs and to better understand the potential health impacts of these exposures.

Natural disasters are increasing in frequency and severity worldwide. Associations between individual-level vulnerability to natural disasters and social stratification have been widely de...

As part of the ongoing recovery from catastrophic flooding associated with Hurricanes Harvey and Florence, communities along the U.S. Atlantic and Gulf Coasts must plan for adaptations that integrate resilience into the redevelopment of community spaces. In designing resilient community spaces, particular consideration must be paid to socially vulnerable communities. Community visioning and neighborhood-scaled design is the first step in the development process. However, it can be a hurdle for communities that lack the capacity to conduct and evaluate such work collaboratively. Service-learning projects implemented through university–community partnerships can help communities increase resilience by developing master plans. The products generated through service-learning projects often conclude at the conceptual level, with no evaluation of the feasibility of their implementation. This study examines the use of landscape performance models in evaluating proposed master plan parameters. It is situated in Manchester, a community in Houston that is physically and socially vulnerable to flooding. Findings demonstrate that landscape performance models can objectively evaluate the costs and performance measures of service-learning products rooted in local conditions and community feedback.

In the United States, people of color from low income and working-class backgrounds are at disproportionate risk to pollution and other environmental stressors. These environmental justice communities (EJCs) can also experience increased risk when a natural disaster collides with a preexisting environmental risk. The current research is an exploratory field study that examines perceptions of environmental risk after a natural disaster and how meaningful a public apology would be in three communities. Residents (N = 161) in two EJCs and a community without documented risks reported their environmental concerns and perceptions of public apologies. Overall, EJC residents reported greater concern about chemical hazard exposure than did residents with decreased risk. Furthermore, chemical exposure concerns facilitated public apology meaningfulness within the EJCs, but not in the decreased risk community.

Household water insecurity has serious implications for the health, livelihoods and wellbeing of people around the world. Existing methods to assess the state of household water insecurity focus largely on water quality, quantity or adequacy, source or reliability, and affordability. These methods have significant advantages in terms of their simplicity and comparability, but are widely recognized to oversimplify and underestimate the global burden of household water insecurity. In contrast, a broader definition of household water insecurity should include entitlements and human capabilities, socio-cultural dynamics, and political institutions and processes. This paper proposes a mix of qualitative and quantitative methods that can be widely adopted across cultural, geographic, and demographic contexts to assess hard-to-measure dimensions of household water insecurity. In doing so, it critically evaluates existing methods for assessing household water insecurity and suggests ways in which methodological innovations advance a broader definition of household water insecurity.

Objectives. To assess how health department contextual factors influence perceptions of the 15 Public Health Preparedness Capabilities, developed by the Centers for Disease Control and Prevention (CDC) to provide guidance on organizing preparedness activities. Methods. We conducted an online survey and focus group between September 2015 and May 2016 with directors of preparedness programs in state, metropolitan, and territorial jurisdictions funded by CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreement. The survey collected demographic information and data on contextual factors including leadership, partnerships, organizational structure, resources and structural capacity, and data and evaluation. Results. Seventy-seven percent (48 of 62) of PHEP directors completed the survey and 8 participated in the focus group. Respondents were experienced directors (mean = 10.6 years), and 58% led 7 or more emergency responses. Leadership, partnerships, and access to fiscal and human resources were associated with perception and use of the capabilities. Conclusions. Despite some deficiencies, PHEP awardees believe the capabilities provide useful guidance and a flexible framework for organizing their work. Contextual factors affect perceptions of the capabilities and possibly the effectiveness of their use. Public Health Implications. The capabilities can be used to address challenges in preparedness, including identifying evidence-based practices, developing performance measures, and improving responses.

The National Institute for Environmental Health Sciences has called for targeted efforts to engage underserved youth in environmental education programs that support environmental literacy and contribute to the development of a diverse workforce pipeline for environmental science-related occupations. Evidence suggests that career knowledge among low income and minority youth is more likely to be incompatible with post-secondary educational opportunities than other racial and ethnic groups. One approach to attenuating discordant college and career expectations among underserved youth is building networks for information sharing between secondary and post-secondary students. The purpose of this commentary is to describe the development and implementation of a high school curriculum on environmental science and environmental justice by Texas A&M University in collaboration with community engagement partners, students, and teachers at Furr High School, an innovative XQ Super School in Houston, Texas.

Communities adjacent to concentrated areas of industrial land use (CAILU) are exposed to elevated levels of pollutants during flood disasters. Many CAILU are also characterized by insufficient infrastructure, poor environmental quality, and socially vulnerable populations. Manchester, TX is a marginalized CAILU neighborhood proximate to several petrochemical industrial sites that is prone to frequent flooding. Pollutants from stormwater runoff discharge from industrial land uses into residential areas have created increased toxicant exposures. Working with local organizations, centers/institutes, stakeholders, and residents, public health researchers sampled air, water, indoor dust, and outdoor soil while researchers from landscape architecture and urban planning applied these findings to develop a community-scaled master plan. The plan utilizes land use and built environment changes to increase flood resiliency and decrease exposure to contaminants. Using a combination of models to assess the performance, costs, and benefits of green infrastructure and pollutant load impacts, the master plan is projected to capture 147,456 cubic feet of runoff, and create $331,400 of annual green benefits by reducing air pollution and energy use, providing pollution treatment, increase carbon dioxide sequestration, and improve groundwater replenishment. Simultaneously, there is a 41% decrease across all analyzed pollutants, reducing exposure to and transferal of toxic materials.

Background In the last decade there has been an increase in community-based organizations providing support and educational outreach to populations effected by hazards. Prior research has demonstrated various roles that community social capital can play in both the enhancement of disaster preparedness and the mitigation of physical and mental health impacts following a natural disaster. Methods To assess self-reported health of residents of South Houston, Texas impacted by Hurricane Harvey, attendees of a community event completed a survey that included the 12 item short form health survey version 2 (SF-12v2). Results Although survey participants were older and more likely to be African-American than the overall population of Houston, they had higher mental health composite scores that the national average, with increases in mental wellbeing associated with a longer length of residence in their neighborhood. Conclusions The City of Houston, with highly segregated, socially vulnerable populations at high risk from natural hazards, should consider ways to support community engagement around disaster preparedness, response, and recovery that may build community cohesion and improve post-disaster mental health.