Environmental Determinants Of Health Research Articles

Environmental health and human health-unifying strategies, conceptual framework and green prescriptions: a review

The intricate relationship between environmental conditions and human health is increasingly acknowledged as a critical area of public health research. As global challenges such as climate change, urbanization, and biodiversity loss become more pronounced, understanding the connections between these environmental factors and health outcomes is essential for developing effective public health strategies. This analysis delves into the complex interactions that exist between environmental influences and health, emphasizing the urgent need for integrated approaches that simultaneously promote ecological sustainability and enhance community well-being. Environmental degradation has significant implications for human health, with many deaths linked to preventable environmental health risks. These risks encompass a wide range of issues, including air and water pollution, exposure to hazardous substances, and the impacts of climate change, all of which disproportionately affect vulnerable populations. A conceptual framework is proposed to elucidate the multifaceted connections between environmental exposures, health determinants, and health outcomes, enabling a clearer understanding of how these elements interrelate. Cohesive strategies, such as the one health approach, advocate for collaboration across various sectors, including public health, veterinary health, and environmental management, to address the shared challenges of health and environmental degradation. Additionally, the principles of planetary health highlight the interdependence of ecosystems and human well-being, underscoring the need for sustainable management of natural resources to safeguard health outcomes. This article also explores the concept of "green prescriptions," which involve recommending nature-based interventions to enhance physical, mental, and social well-being. These prescriptions have demonstrated effectiveness in promoting health while fostering a sense of environmental stewardship. By synthesizing current evidence and successful case studies, this review emphasizes the significance of adopting a holistic perspective that integrates environmental considerations into healthcare practices. Ultimately, fostering collaboration among various stakeholders will contribute to the development of resilient communities that are better equipped to navigate the intertwined challenges of health and environmental sustainability.

Spike and Slab Regression for Nonstationary Gaussian Linear Mixed Effects Modeling of Rapid Disease Progression

ABSTRACTSelect measures of social and environmental determinants of health (referred to as “geomarkers”), predict rapid lung function decline in cystic fibrosis (CF), defined as a prolonged decline relative to patient and/or center‐level norms. The extent to which hyper‐localization, defined as increasing the spatiotemporal precision of geomarkers, aids in prediction of rapid lung decline remains unclear. Linear mixed effects (LME) models with specialized covariance functions have been used for predicting rapid lung function decline, but there are few options to properly incorporate spatial correlation into the covariance functions while inducing simultaneous variable selection. Our innovative Bayesian model uses a spike and slab prior for simultaneous variable selection and offers additional advantages when coupled with nonstationary Gaussian LME modeling. This model also incorporates spatial correlation through an additional random effect term that accounts for spatial correlation based on ZIP code distances. We validated the model with simulations and applied it to real CF data from a Midwestern CF Center. We demonstrate how a combination of demographic, clinical, and geomarker variables can be selected as optimal predictors using Bayesian false discovery rate controlling rule. Our results indicate that incorporating spatiotemporal effects and geomarkers into this novel Bayesian stochastic LME model enhances the dynamic prediction of rapid CF disease progression.

Health promotion at local level in Portugal: is childhood obesity a concern in municipal programs?

Abstract Health promotion programs targeted at distinct health outcomes such as childhood obesity, at local level are increasingly used worldwide. There is a need to better understand the role of local governments (municipalities) as key public health promoters namely in the prevention of obesity in children. This study aims to provide some input regarding this issue in Portugal. In order to achieve this goal, health enhancing programs promoted by Portuguese municipalities in which children could participate were identified. The search of such programs was limited to the municipalities that were part of the Portuguese Network of Healthy Municipalities in 2021 (N = 57). A subsequent document analysis was conducted to describe how municipalities conceptualized children’s health by retrieving information on which topics the programs were focused on, or acted upon, and identify which socio-ecological model levels of health determinants were addressed (or not) by each program. The 77 identified programs were promoted by 30 municipalities and only 11 programs addressed childhood obesity. Most programs focused on the individual health determinants (N = 27) and provided limited information overall, which hindered a more in-depth analysis. The findings suggest that Portuguese municipalities seem to disregard their potential as public health promoters. Childhood obesity is a major public health concern at national level, as reflected in the National Health Plans, but not perceived as such locally. Municipalities are the closest government entities to the population, and it is their responsibility to ensure the population’s quality of life, by addressing the social and environmental determinants of health. Hence, municipalities should instill health concerns in all their actions/interventions, taking in consideration the most recent evidence, specifically in the case of childhood obesity. Key messages • This study findings suggest that, despite childhood obesity being a major public health concern at national level, as reflected in the National Health Plans, it is not perceived as such locally. • There is a need to better understand the role of municipalities as key public health promoters considering they are responsible to intervene on the social and environmental determinants of health.

‘HepGenç’: A youth festival to promote health and well-being via films, photography, music, and arts

Abstract Background The ‘Lifelong Health’ framework of WHO emphasizes that investing in health during young ages fosters better health and higher quality of life in later years. When working with and for youth, using innovative and participatory approaches have become more important for effective health communication, especially in an era of increased environmental stimuli, digitalization, and decreased attention span for many young people, who are less attracted with traditional/ didactic health education and communication methods. Objectives This paper aims to share practical experiences of a multidisciplinary team of professionals with backgrounds in public health, psychiatry, communication, music, and arts, in collaboration with young people to organize a series of youth health festivals in different cities of Turkiye to promote youth health literacy and access to health care, with a special focus on mental health and well-being. Results HepGenc (ForeverYoung) Festivals are organized by academics and youth from different universities in Turkiye, in collaboration with NGOs and local municipalities of cities, where the events take place. These events encourage young people to think about health and well-being, including social and environmental determinants of health via short films, photography, music, and arts. The series of festivals use creative workshops to introduce different health and well-being topics to youth, who may not always find these issues ‘attractive.’ Social and mental health, including resilience and ability to adapt are also addressed, which help young participants to build a holistic and comprehensive look on health and its determinants. Conclusions Organizing health-focused festivals using films, photography, music, and arts encourages young people to be creative and productive, while raising their awareness on healthy lifestyles and healthy cities, and how they can be agents of positive change. Key messages • Using films, music, and arts help with greater engagement of young people and facilitates their learning, as well as their creativity and productivity. • Collaboration of health, communication, and arts professionals strengthens health communication/ education programs, with additional beneficial outcomes for all disciplines including shared learning.

2.X.1. Sleep Health Disparities across the life-course: from research to public health policy

Abstract Poor sleep health is a recognized common problem across the life cycle, globally. Factors that contribute to this problem include the demands of a “Western” lifestyle (urgency, productivity), economic stressors, social and environmental determinants of health, and global crises including international conflicts, political tensions, and climate change. There is a growing consensus that optimizing sleep health should be a public health priority because poor sleep patterns are a modifiable risk factor for myriad health outcomes, such as cardiovascular disease, diabetes, cancer, cognitive decline, mental illness, and early mortality. In Canada, a nationwide sleep consortium funded by the Canadian Institutes of Health Research (CIHR) was recently formed with a mandate to generate new knowledge that will inform clinical practice and support public health initiatives to deliver resources where they are most needed. The proposed workshop organized by the Chronic Disease EPH section will start with a general overview of the impact of sleep health disparities across the life-course, from childhood to older age, as well as discuss evidence-based public health approaches to promote sleep hygiene and mitigate the risk of adverse health outcomes, including chronic disease (Saverio Stranges). It will be followed by three presentations to address the root causes of sleep health disparities and their impact on chronic disease (Dayna Johnson); participatory research with families and care providers on infant sleep intervention development (Elizabeth Keys), and strategies to address common sleep disorders among middle-aged and older adults (Tetyana Kendzerska). Key messages • Sleep health disparities are a neglected public health issue. • Optimizing sleep health is both a clinical and public health priority, as sleep patterns represent a modifiable risk factor for a range of adverse health outcomes.

Social and environmental determinants of sleep health disparities

Abstract Sleep is not equitable. Historically minoritized individuals have a high prevalence of sleep disorders and adverse sleep health. Research supports that social determinants of health are contributing to sleep health inequities. Further, sleep is socially patterned. Neighborhoods with high rates of crime, violence, disadvantage, pollution, inopportune light exposure, and noise, where historically minoritized individuals are most likely to live are associated with adverse sleep health and sleep disorders. Social determinants including discrimination, racism, socioeconomic status, lack of access to care are associated with adverse sleep health, particularly among minoritized individuals. While there is an abundance of evidence identifying risk factors for adverse sleep health, evidence also supports factors that promote healthy sleep. A small but growing literature supports that neighborhood social environment is associated with healthy sleep and may be avenue for addressing sleep disparities. Dr. Johnson will present epidemiologic data on the social and environmental determinants of adverse sleep health using a socioecological framework and discuss the mechanisms by which these factors are contributing to sleep disparities. The goal is to identify these factors, and how they can be utilized to address sleep health disparities.

How are the three environmental threats challenging health systems’ resilience?

Abstract Background Known avoidable environmental risks cause about one quarter of all deaths and disease burden worldwide, amounting to at least a steady 13 million deaths each year. Indeed, diseases caused by the environment weigh heavily on health systems. These not only harm directly human health increasing the burden of disease but also potentiate other threats, by acting as drivers (e.g. pandemics, antimicrobial resistance). In addition, the increased burden due to these environmental threats also put in risk the capacity of health systems to adapt to the new healthcare needs and to provide a proper answer to the diseases caused by other health determinants. Methods Based on a review of the literature, the presentation addresses the question of potential options in public health climate action at the interface of environmental sustainability and health systems sustainability and resilience. It identifies possible priority areas in order to guarantee environmental and healthcare sustainability. Results Approaches that focus on treatment of individual diseases rather than improvement of environmental determinants of health will be insufficient to tackle the triple environmental crises of climate change, biodiversity loss and pollution. Single-determinant approaches are unlikely to achieve expected improvements, given the complex interaction of environmental factors. Conclusions Approaches that are more integrated are required to address the root causes of disease and guarantee health systems sustainability, which are often defined by policies in key sectors other than health, such as the environment. Multi-sectoral actions are needed to prevent and mitigate the threats to human health from the ongoing and interconnected environmental crises of climate change, biodiversity loss and pollution, contributing to a Planetary Health perspective on health systems’ resilience.

Environmentally sustainable person-centred care: Occupational therapy students' attitudes, perceptions and self-perceived preparedness for practice.

Climate change threatens the environments in which person-centred occupational therapy occurs. Environmental sustainability is directly linked with the health and wellbeing of current and future generations, presenting occupational therapists with a unique advocacy and activist role. As practitioners of the future, there is an urgent need to understand students' attitudes, perceptions of, and self-perceived preparedness for, dealing with environmental determinants of health and intergenerational occupational and climate justice. A cross-sectional exploratory descriptive survey collected United Kingdom (UK) based allied health professional students' attitudes, perceptions, and self-perceived preparedness for advocating for environmental sustainability in the context of person-centred care. The survey was distributed to 48 gatekeepers in UK institutions with approved allied health professional training programmes (44 offered occupational therapy); 62 occupational therapy students responded. Descriptive and non-parametric inferential statistics were used to analyse quantitative data. Text and short answers were analysed qualitatively via inductive content analysis. The study was co-designed and implemented with MSc (pre-registration) occupational therapy students. Participants (94%) expressed concerns for climate change, with 84% feeling responsible for addressing environmental sustainability in health care. While 64.5% identified climate justice as a top priority, a perceived challenge emerged between person-centred care and sustainability, with only 18% of participants feeling prepared for environmental sustainability in occupational therapy practice. Participants requested education on personal and professional sustainability practices, as well as collective action. Sharing personal climate change experiences, advocating with family and friends, and facilitating connections for collective action were highlighted as potentially transformative educational tools in this area. Occupational therapy curricula should address environmental sustainability through pragmatic, critical, and ethical lenses to enhance students' preparedness for this advocacy and activist role. Reflection and continuous professional development for environmentally sustainable practices is recommended. Occupational therapists believe that it is important to support people to participate in occupations that matter to them. However, the activities that some people choose to participate in may have negative effects on the environment and the planet. It is important to ensure that when occupational therapists support people in their choices of activities, this does not lead to unequal access to healthy and meaningful occupations of others, now or in the future. That is because occupational therapists also have a responsibility to prevent occupational injustice. Occupational therapy students are the professionals of the future, so it is important to include them in research about this topic. They need to develop skills that allow them to simultaneously make sure that they are delivering person-centred care, which is not environmentally detrimental and that does not lead to occupational injustice. Making sure that occupational therapists provide person-centred care while also managing risks of occupational injustice may be seen as a profession-specific dilemma. In this study, occupational therapy students in the UK completed a survey about their feelings, views, and readiness for managing this dilemma. Results showed that most respondents are concerned about climate change, but do not feel that their occupational therapy education sufficiently prepared them to practise in an environmentally sustainable way. They were asked to propose ideas for addressing this issue, and the article discusses how occupational therapy curricula might be changed in accordance.

Linking housing, socio-demographic, environmental and mental health data at scale

Mental disorders are a growing problem worldwide, putting pressure on healthcare systems and wider society. Anxiety and depression are estimated to cost the global economy US$1 trillion per year, yet only 2% of global median government healthcare expenditure goes towards mental health. There is growing evidence linking housing, socio-economic status and local environmental conditions with mental health inequalities. The aim of this paper is to link several open-access datasets at the local area level (N = 32,844) for England to clinical mental health metrics and describe initial statistical findings. Two mental health metrics were used: Small Area Mental Health Index (SAMHI) and diagnosed depression prevalence. To demonstrate the utility of the longitudinal mental health data, changes in depression prevalence were investigated over two study periods (2011–19, i.e. austerity; and 2019–22, i.e. COVID-19). These data were linked to housing data (energy efficiency, floor area, year built, type and tenure) from Energy Performance Certificates (EPCs); socio-demographic data (age, sex, income and education deprivation, household size) from administrative records; and local environment data (winter temperature, air pollution and access to green space). The linked dataset provides a useful resource with which to investigate the social and environmental determinants of mental health. Practice relevance Initial observations of the data revealed a non-linear relationship between home energy efficiency (EPC band) and the mental health metrics, with depression prevalence higher in local areas where the mode EPC bands were C and D, compared with B and E. Researchers can further investigate this relationship using the dataset through robust statistical analysis, adjusting for confounding variables. National and local governments may use the dataset to help allocate resources to prevent and treat mental health conditions. Practitioners can map and interrogate the data to describe their local areas and make preliminary conclusions about the relationships between the built environment and mental health. This preliminary analysis of the data demonstrated a gradient in SAMHI and depression prevalence with income and employment deprivation at the local area level.

Creating a learning health system to include environmental determinants of health: The GroundsWell experience.

Policies aiming to prevent ill health and reduce health inequalities need to consider the full complexity of health systems, including environmental determinants. A learning health system that incorporates environmental factors needs healthcare, social care and non-health data linkage at individual and small-area levels. Our objective was to establish privacy-preserving household record linkage for England to ensure person-level data remain secure and private when linked with data from households or the wider environment. A stakeholder workshop with participants from our regional health board, together with the regional data processor, and the national data provider. The workshop discussed the risks and benefits of household linkages. This group then co-designed actionable dataflows between national and local data controllers and processors. A process was defined whereby the Personal Demographics Service, which includes the addresses of all patients of the National Health Service (NHS) in England, was used to match patients to a home identifier, for the time they are recorded as living at that address. Discussions with NHS England resulted in secure and quality-assured data linkages and a plan to flow these pseudonymised data onwards into regional health boards. Methods were established, including the generation of matching algorithms, transfer processes and information governance approvals. Our collaboration accelerated the development of a new data governance application, facilitating future public health intervention evaluations. These activities have established a secure method for protecting the privacy of NHS patients in England, while allowing linkage of wider environmental data. This enables local health systems to learn from their data and improve health by optimizing non-health factors. Proportionate governance of health and linked non-health data is practical in England for incorporating key environmental factors into a learning health system.

Objective and subjective accounts of urban exposures for epidemiological research on mental health. Measurement and analysis

The interest in the impact of urban environmental exposures (UrbEEs) on mental health has greatly increased in the last two decades. Researchers have tended to measure said exposures either via...

Profiles of cardiometabolic risk and acculturation indicators among South Asians in the US: latent class analysis of the MASALA study.

South Asians (SA) represent the fastest growing US immigrant group, and previous studies have indicated that they face disproportionately high burden of cardiometabolic disease. Cardiometabolic disease manifests as a syndemic or synergistic epidemic encompassing multiple disease clusters influenced by biological, social, and psychological factors stemming from the acculturative process. This process may exacerbate morbidity within immigrant subgroups. Our aim was to identify cardiometabolic risk profiles among SA using indicators of acculturation. We conducted a latent class analysis on data from the Mediators of Atherosclerosis in South Asians Living in America study (N=771). A composite cardiometabolic disease outcome was constructed using prevalent hypertension, type 2 diabetes, and body mass index. Acculturation indicators included years living in the US, English language proficiency, dietary behaviors, preservation of cultural traditions, social and neighborhood support, maintenance of social relationships (i.e., friendships), and experiences of discrimination, along with proxies of acculturative stress (i.e., depressive symptomology, trait anxiety and anger). Social and environmental determinants of health, health behaviors, religiosity and spirituality served as covariates to further assess latent class membership. Four cardiometabolic risk profiles emerged: (1) lowest risk [73.8% of sample] characterized by high integration into both SA and US cultures; (2) the modest risk [13.4% of sample], exhibiting elevated levels of mental health distress and experiences of discrimination, and distancing themselves from both cultures; and the (3) moderate risk [8.9% of sample] and (4) highest risk [3.9% of sample], demonstrating greater assimilation into US culture. Compared to the lowest risk profile: the modest risk profile was associated with low-income and conflicting attitudes about religion/spirituality, while the moderate risk profile was characterized by lower income and educational attainment with positive behaviors and attitudes toward religion/spirituality. Findings expand our understanding of immigrant cardiometabolic health as a syndemic issue wherein multiple co-occurring and interacting processes synergize to produce negative outcomes in already at-risk subpopulations. Furthermore, acculturation emerges as a crucial factor in understanding health disparities among immigrant and refugee groups in the US.

Environmental Determinants of Health—Time to Redefine the Social History?

Environmental Determinants of Health—Time to Redefine the Social History?

SOCIAL AND ENVIRONMENTAL FACTORS DETERMINING THE HEALTH STATE OF YOUTH STUDENTS IN UKRAINE

One of the bases of sustainable development of mankind is the health of the young generation. The priority of this issue is especially important in the perspective of European integration processes in Ukraine. Youth is an important component of the human resource that every state should take care of. Preserving, restoring and improving the psycho-physiological condition of young people is the key to the survival and further progress of mankind. The purpose of our research is to analyze the importance of individual factors and their combinations that can affect the health of students. Analysis, synthesis and modeling methods were used to study the state of research. The results of our research were carried out with the help of empirical methods: pedagogical observation, questionnaires, interviews, testing, the method of experimental evaluations. Mathematical statistics methods were used to process the research results. This study explores the social and environmental factors affecting the health of university students in Ukraine, emphasizing the importance of promoting a healthy lifestyle among youth. The research highlights the role of education in shaping health culture, noting gaps in the current system's approach to instilling necessary attitudes toward health. The study draws on data from student health assessments and reveals a high prevalence of chronic diseases, especially among students from radiation-contaminated areas. The investigation further examines the genetic and immunological markers influencing students' health, finding that prolonged stress, radiation exposure, and physical inactivity significantly impact immune responses. Additionally, the research explores the link between thyroid and lipid metabolism issues and students' exposure to ionizing radiation. The findings suggest that moderate physical activity and immunomodulators may help mitigate stress-induced immunosuppression. The study concludes that addressing these social and environmental health determinants is critical for improving the well-being of Ukrainian youth and calls for tailored physical education programs and preventive health measures.

The Impact of Environmental Health Determinants in Surgical Oncology.

Environmental determinants of health refer to external factors in our surroundings that influence health outcomes. It is estimated that healthier environments could prevent almost one-quarter of the global burden of disease. Additionally, environmental factors, including lifestyle factors, air pollution, chemical exposures, and natural exposures, are responsible for a significant incidence of cancers and premature cancer deaths. Minority populations, low-income populations, children, and older adults are at increased risk for oncologic risks secondary to environmental factors.

Precision prevention in occupational health: a conceptual analysis and development of a unified understanding and an integrative framework.

Precision prevention implements highly precise, tailored health interventions for individuals by directly addressing personal and environmental determinants of health. However, precision prevention does not yet appear to be fully established in occupational health. There are numerous understandings and conceptual approaches, but these have not yet been systematically presented or synthesized. Therefore, this conceptual analysis aims to propose a unified understanding and develop an integrative conceptual framework for precision prevention in occupational health. Firstly, to systematically present definitions and frameworks of precision prevention in occupational health, six international databases were searched for studies published between January 2010 and January 2024 that used the term precision prevention or its synonyms in the context of occupational health. Secondly, a qualitative content analysis was conducted to analyze the existing definitions and propose a unified understanding. Thirdly, based on the identified frameworks, a multi-stage exploratory development process was applied to develop and propose an integrative conceptual framework for precision prevention in occupational health. After screening 3,681 articles, 154 publications were reviewed, wherein 29 definitions of precision prevention and 64 different frameworks were found, which can be summarized in eight higher-order categories. The qualitative content analysis revealed seven themes and illustrated many different wordings. The proposed unified understanding of precision prevention in occupational health takes up the identified themes. It includes, among other things, a contrast to a "one-size-fits-all approach" with a risk- and resource-oriented data collection and innovative data analytics with profiling to provide and improve tailored interventions. The developed and proposed integrative conceptual framework comprises three overarching stages: (1) data generation, (2) data management lifecycle and (3) interventions (development, implementation and adaptation). Although there are already numerous studies on precision prevention in occupational health, this conceptual analysis offers, for the first time, a proposal for a unified understanding and an integrative conceptual framework. However, the proposed unified understanding and the developed integrative conceptual framework should only be seen as an initial proposal that should be critically discussed and further developed to expand and strengthen both research on precision prevention in occupational health and its practical application in the workplace.

The Kids’ Environment and Health Cohort: a novel administrative data resource for research on the environmental determinants of child health in England

Objective and ApproachThe environment in and around children’s homes and schools can influence their health and educational outcomes. Better understanding of how these potentially modifiable environmental risk factors can affect children is crucial in enabling the creation of healthier and more equitable places. We aim to establish the Kids’ Environment and Health Cohort, a research-ready, de-identified, national longitudinal birth cohort of approximately 11 million children born in England from 2006 to 2023, updated annually. The cohort will link vital statistics, census, health, education, and environmental data, via unique property identifiers from longitudinal health service address records for children and their mothers during pregnancy. Data on environmental exposures around schools will be linked to the cohort via education records. The cohort will be held and accessed in a secure research environment at the Office for National Statistics (ONS). All geographical identifiers will be encrypted and stored separately from the main cohort by the ONS to ensure privacy and security. ResultsWe have received ethics approval and have agreed the legal bases for establishing the cohort. We are now setting up data sharing agreements with each data provider. Delivery of the cohort is scheduled for late 2025. ConclusionThe Kid’s Environment and Health Cohort will support policy-relevant research in exploring associations between environmental factors and children's health and educational outcomes, and assessing the effectiveness of policy interventions. It will also support interdisciplinary collaboration, guiding evidence-based decision-making for environmental, planning, and public health policies aimed at promoting children’s health and well-being.

Social and Environmental Determinants of Health and Cardio-Kidney-Metabolic Syndrome–Related Mortality

It is not well understood if and how various social and environmental determinants of health (SEDoH) are associated with mortality rates related to cardio-kidney-metabolic syndrome (CKM) across the US. To study the magnitude of the association strength of SEDoH with CKM-related mortality at the county level across the US. This cross-sectional, retrospective, population-based study used aggregate county-level data from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) data portal from 2010-2019. Data analysis occurred from September 2023 to January 2024. A total of 7 diverse SEDoH were chosen, including median annual household income, percentage of racial and ethnic minority residents per county, fine particulate air pollution (PM2.5) concentrations, high-school completion rate, primary health care access, food insecurity, and rurality rate. The primary outcome was county-level age-adjusted mortality rate (aaMR) attributable to CKM. The association of county-level CKM-related aaMR with the 7 SEDoH was analyzed using geographically weighted models and the model median coefficients for each covariate studied. Data from 3101 of 3243 counties (95.6%) were analyzed. There was substantial variation in SEDoH between states and counties. The overall pooled median (IQR) aaMR (2010-2019) in the US was 505.5 (441.3-578.9) per 100 000 residents. Most counties in the lower half of the US had rates much higher than the pooled median (eg, Southern US median [IQR] aaMR, 537.3 [466.0-615.9] per 100 000 residents). CKM-related mortality was positively associated with the food insecurity rate (median [IQR] β = 6.78 [2.78-11.56]) and PM2.5 concentrations (median [IQR] β = 5.52 [-11.06 to 19.70]), while it was negatively associated with median annual household income (median [IQR] β = -0.002 [-0.003 to -0.001]), rurality (median [IQR] β = -0.32 [-0.67 to 0.02]), high school completion rate (median [IQR] β = -1.89 [-4.54 to 0.10]), racial and ethnic minority rate (median [IQR] β = -0.66 [-1.85 to 0.89]), and primary health care access rate (median [IQR] β = -0.18 [-0.35 to 0.07]). In this cross-sectional study of county-level data across the US, there were substantial geographical differences in the magnitude of the association of SEDoH with CKM-related aaMR. These findings may provide guidance for deciding local health care policy.

Reconceptualizing and Defining Exposomics within Environmental Health: Expanding the Scope of Health Research.

Exposomics, the study of the exposome, is flourishing, but the field is not well defined. The term "exposome" refers to all environmental influences and associated biological responses throughout the lifespan. However, this definition is very similar to that of the term "environment"-the external elements and conditions that surround and affect the life and development of an organism. Consequently, the exposome seems to be nothing more than a synonym for the environment, and exposomics a synonym for environmental research. As a result, some have rebranded their "standard" environmental health research with the neologistic exposome term, whereas others ignore or seek to abandon the seemingly redundant concept of the exposome. We argue that exposomics needs to sharpen its mission focus to counteract this apparent redundancy. Exposomics should be defined as a research program in environmental health aimed at enabling a comprehensive and discovery-driven approach to identifying environmental determinants of human health. Similar to the aim of the Human Genome Project, exposomics aims to analyze the complete complexity of exposures and their corresponding biological responses. Exposomics' primary premise is that the existence of undiscovered, potentially interconnected, nongenetic (environmental) risk factors for health necessitates a comprehensive discovery-driven analysis approach. We argue that exposomics researchers should adopt our reconceptualization of exposomics and focus on the productiveness and integrity of their research program: its purpose and principles. We suggest that exposomics researchers should coordinate the writing of reviews that assess the program's productiveness and integrity, as well as provide a platform for exposomics researchers to define their vision for the field. https://doi.org/10.1289/EHP14509.

Mapping competency profiles of schools of public health: implications for public health workforce education and training in Israel.

Competency frameworks are essential for analyzing capabilities of Schools of Public Health to adequately prepare public health (PH) professionals to address contemporary challenges. This study maps the competency profiles of PH training programs in Israel using a novel curriculum mapping tool. This study assessed all five Israeli Health Education Institutions (HEIs) offering MPH or Bachelors in Public Health (BPH) degrees across 57 competencies in six domains to determine the extent to which competencies were addressed in the curriculum. The competencies list was based on the Association of Schools of Public Health in the European Region (ASPHER) List of Core Competences for the Public Health Professional, adapted for Israeli HEIs. The core curricula in the four MPH programs addressed 45-84% of all competencies. The BPH program addressed 79% of competencies. In MPH programs, the core curricula addressed most or all competencies in the Methods and the Socioeconomic Determinants of Health domains. Competencies in the domains of Environmental Determinants of Health, Health Policy, Economics & Organization, and Health Promotion and Prevention were less comprehensively addressed in most core curricula. Students' opportunities to broaden their exposure to competencies outside the core curricula were context dependent. The curriculum competencies mapping tool that was developed served to assess both strengths and shortcomings in PH education in Israel. The findings demonstrate a highly variable array of PH curriculum models in Israeli HEIs, as well as overall shortcomings in the Environmental, Health Policy Economics and Organization, and Health Promotion and Prevention domains. This analysis has already led to reassessment of the curriculum, and will continue to guide the next steps to increase the harmonization of PH training curricula and to better meet PH challenges in Israel.