Health Impact Assessment Research Articles

Incorporating community perspectives in health impact assessment: A toolbox

Large infrastructure projects, such as mining and renewable energy projects, can affect the health of surrounding communities by changing the natural, physical and social environment. While there is limited understanding of potential health impacts of such projects on local populations in general, there is a particular need for community-driven and equity-oriented approaches to predict and manage such impacts.To assess health impacts as perceived by vulnerable communities affected by large infrastructure projects in sub-Saharan Africa, we present here a suite of qualitative data collection tools, which are complementary to the existing health impact assessment (HIA) tools. At the core of the toolbox are guides to conduct (i) transect walks to qualitatively map and systematically select study communities and (ii) participatory focus group discussions to explore perceived impacts on the wider determinant of health and related health implications from the perspective of the affected communities. This methodology was developed as part of a qualitative study evaluating perceived health impacts in local communities in industrial mining settings in East and West Africa.These flexible and intuitive tools produced reliable and comparable findings across different countries and contexts, suggesting that the tools can be applied in a broad range of large infrastructure project settings. The methodology, with its particular potential for translating qualitative research rapidly into visual outputs, is a promising addition to the existing, mainly quantitative HIA toolbox. Strengthening HIA driven by local communities can ultimately contribute to achieving the health-related targets of the Sustainable Development Goals (SDGs).

Public health and economic impact assessment of PM2.5 from open biomass burning over countries in mainland Southeast Asia during the smog episode

PM2.5 is considered the principal air pollutant caused by open biomass burning (OBB) in Mainland Southeast Asia (MSEA) and significant adverse health effects and economic burdens. The goals of this work are to conduct a literature review on relative measures of the effect associated with the exposure to OBB emission in MSEA, to analyze the impact of OBB emission on PM2.5 concentration in MSEA using the dispersion model, and to estimate the public health and economic impacts associated with the exposure to PM2.5 from OBB on regional and national scales using Environmental Benefits Mapping and Analysis Program during a smog episode. This work found that OBB was the largest emission source in MSEA, contributing 57% to the PM2.5 concentrations, with the substantial OBB impact was found in Northern Laos and Eastern Myanmar. As a result, the exposure to PM2.5 from OBB was estimated to contribute a substantial number of deaths regarding all-cause (78,276 cases - 95% CI: 62,915–92,629), respiratory disease (6,716 cases – 95% CI: 3,639–9,482), and cardiovascular disease (1,076 cases – 95% CI: 490-1,615). The economic impact was estimated at 23.28 billion (95% CI: 18.69–27.57), 1.90 billion (95% CI: 0.88–2.40), and 0.44 billion (95% CI: 0.20–0.67) USD, respectively. OBB emission caused the greatest public health and economic impact in Myanmar, while the smallest impact was found in Cambodia. Our study provides policymakers with quantitative estimates of the OBB impacts so that they can develop appropriate control measures at the regional and national levels in MSEA.

Mortality Burden due to Exposure to Outdoor Fine Particulate Matter in Hanoi, Vietnam: Health Impact Assessment.

Objective: This study reports the mortality burden due to PM2.5 exposure among adults (age >25) living in Hanoi in 2017. Methods: We applied a health impact assessment methodology with the global exposure mortality model and a PM2.5 map with 3 × 3 km resolution derived from multiple data sources. Results: The annual average PM2.5 concentration for each grid ranged from 22.1 to 37.2 µg/m³. The district average concentration values ranged from 26.9 to 37.2 µg/m³, which means that none of the 30 districts had annual average values below the Vietnam Ambient National Standard of 25 µg/m3. Using the Vietnam Ambient National Standard as the reference standard, we estimated that 2,696 deaths (95% CI: 2,225 to 3,158) per year were attributable to exposure to elevated PM2.5 concentrations in Hanoi. Using the Interim Target 4 value of 10 µg/m3 as the reference standard, the number of excess deaths attributable to elevated PM2.5 exposure was 4,760 (95% CI: 3,958–5,534). Conclusion: A significant proportion of deaths in Hanoi could be avoided by reducing air pollution concentrations to a level consistent with the Vietnam Ambient National Standard.

Trade, intellectual property, and the public health bearing

ABSTRACT The objective of this article is to describe the current fracture between global trade and public health priorities, as well as examine opportunities for harmonisation. A literature review of public health, global trade, and intellectual property articles describes several issues with recommendations. Currently, there is mixed quality of research and a lack of health impact assessments to accompany the global trade agenda. Human rights concepts continue in debate as flexibilities to trade laws remain without organised surveillance or evaluation. There are specific, relevant recommendations to implement a trade agenda inclusive of public health leadership. Recent trade and intellctual property advances in public health collaborations should be supported and continued. Trade groups should produce impact assessments before decisions on policies are made, with quality to the research. Lastly, a global research and development treaty should be an open, accessed path.

A hybrid satellite and land use regression model of source-specific PM2.5 and PM2.5 constituents

Although PM2.5 mass varies in source and composition over time and space, most health effects assessment have made the inherent assumption that all PM2.5 mass has the same health implications, irrespective of composition. Nationwide estimates of source-specific PM2.5 mass and constituents at local-scale would allow for epidemiological studies and health effects assessments that consider the variability in PM2.5 characteristics in their health impact assessments. In response, we developed US models of annual exposures at the census tract level for five major PM2.5 sources (traffic, soil, coal, oil, and biomass combustion) and six trace elements (elemental carbon, sulfur, silicon, selenium, nickel, and non-soil potassium) for 2001 through 2014. We employed Absolute Factor Analysis (APCA) to derive the source-specific PM2.5 impacts at monitoring stations. Random forest algorithms that incorporated predictors derived from satellite, chemical transport model, and census tract resolution land-use data on traffic, meteorology, and emissions, which were rigorously tested by 10-fold cross-validation (CV), were then employed to estimate elemental and source-specific PM2.5 levels at non-monitoring site census-tracts over the study years. Model performances were moderate to good, with CV R2 ranging from 0.41 to 0.95. For PM2.5 sources, the highest CV R2 was attained for traffic PM2.5 (CV R2 = 0.73), followed by coal (CV R2 = 0.65), oil (CV R2 = 0.62), soil (CV R2 = 0.60), and biomass (CV R2 = 0.41). Among constituents, the CV was highest for sulfur (CV R2 = 0.95). Our analyses provided highly resolved spatial estimates of annual elemental and source-specific PM2.5 concentrations at the census-tract level, for 2001 through 2014. This dataset offers exposure estimates in support of future nationwide long-term health effects studies of source-specific PM2.5 mass and constituents, enabling epidemiological research that addresses the fact that not all particles are the same.

Vehicular Traffic in Urban Areas: Health Burden and Influence of Sustainable Urban Planning and Mobility

Vehicular traffic is one of the major sources of air pollution in European cities. This work aims to understand which characteristics of the urban environment could influence mobility-related air pollution, quantify the health impacts of exposure to traffic-derived PM2.5 and NO2 concentrations, and assess the potential health benefits expected from traffic interventions. The health benefits modeled are intended to provide a set of comparable data to support decision-makers and encourage informed decision-making to design healthier cities. Targeting a large geographical coverage, 12 European cities from 9 countries were comparatively assessed in terms of mean daily traffic volume/area, the number of public transport stops/area, and the percentage of green and outdoor leisure areas, among other urban indicators. This was implemented using an open-source data mining tool, which was seen as a useful engine to identify potential strategies to improve air quality. The comparison of urban indicators in the selected cities evidenced two trends: (a) cities with the most heterogeneous distribution of public transport stops, as an indicator of poor accessibility, are also those with the lowest proportion of km dedicated to cycleways and footways, highlighting the need in these cities for more sustainable mobility management; and (b) the percentage of green and outdoor leisure areas may influence the share of journeys by bicycle, pointing out that promoting the perception of green routes is relevant to enhance the potential of active transport modes. Socioeconomic factors can be key determinants of the urban indicators and would need further consideration. For the health impact assessment (HIA), two baseline scenarios were evaluated and compared. One is based on mean annual traffic contributions to PM2.5 concentrations in each target city (ranging between 1.9 and 13 µg/m3), obtained from the literature, and the second is grounded on mean annual NO2 concentrations at all available traffic and urban background stations within each city (17.2–83.5 µg/m3), obtained from the European Environment Agency database. The intervention scenarios modeled were designed based on traffic mitigation strategies in the literature, and set to ranges of 6–50% in traffic-derived PM2.5 concentrations and of 4–12.5% in NO2 concentrations. These scenarios could result in only a 1.7% (0.6–4%) reduction in premature mortality due to exposure to traffic-derived PM2.5, and 1.0% (0.4–2%) due to exposure to NO2, as the mean for all the cities. This suggests that more ambitious pollution abatement strategies should be targeted.

Has the Volume-Based Drug Purchasing Approach Achieved Equilibrium among Various Stakeholders? Evidence from China.

Volume-based drug purchasing by China’s health insurance system currently represents the largest group purchasing organization worldwide. After exchanging the market that accounted for nearly half of the volume of the healthcare system for the ultra-low-price supply of limited drugs, what are the effects on patient and funding burdens, drug accessibility, and clinical efficacy? We aimed to verify the effectiveness of the policy, explore the reasons behind the problem and identify regulatory priorities and collaborative measures. We used literature and reported data from 2019 to 2021 to conduct a stakeholder analysis and health impact assessment, presenting the benefit and risk share for various dimensions. The analysis method was a multidimensional scaling model, which visualized problematic associations. Seventy-nine papers (61 publications and 18 other resources) were included in the study, with 22 effects and 36 problems identified. The results indicated favorable affordability and poor accessibility of drugs, as well as high risk of reduced drug quality and drug-use rationality. The drug-use demand of patients was guaranteed; the prescription rights of doctors regarding clinical drug use were limited; unreasonable evaluation indicators limited the transformation of public hospitals to value- and service-oriented organizations; the sustainability of health insurance funds and policy promotion were at risk; and innovation by pharmaceutical companies was accelerated. The problems associated with high co-occurrence frequencies were divided into the following clusters: cost control, drug accessibility, system rationality, policy fairness, drug quality, and moral hazards. These findings suggested that China has achieved short-term success in reducing the burden on patients and reducing fund expenditure. However, there were still deficiencies in guaranteed supply, quality control, and efficacy tracking. The study offers critical lessons for China and other low- and middle-income countries.

Practical Opportunities to Improve the Impact of Health Risk Assessment on Environmental and Public Health Decisions

Following alerts about the diminishing role of health risk assessment (HRA) in informing public health decisions, this study examines specific HRA topics with the aim of identifying possible solutions for addressing this compelling situation. The study administered a survey among different groups of stakeholders involved in HRA or decision-making, or both. The responses show various understandings of HRA in the decision-making context—including confusion with the health impact assessment (HIA)—and confirm recurring foundational issues within the risk analysis field that contribute to the growth of inconsistency in the HRA praxis. This inconsistency lowers the effectiveness of HRA to perform its primary purpose of informing public health decisions. Opportunities for improving this situation come at the beginning of the assessment process, where greater attention should be given to defining the assessment and decision-making contexts. Both must reflect the concerns and expectations of the stakeholders regarding the needs and purpose of an HRA on one side, and the methodological and procedural topics relevant for the decision case at hand on the other. The HRA process should end with a decision follow-up step with targeted auditing and the participation of stakeholders to measure its success.

Impact of road traffic noise on annoyance and preventable mortality in European cities: A health impact assessment.

Road traffic is the main source of environmental noise in European cities and one of the main environmental risks to health and wellbeing. In this study we aimed to provide an in-depth assessment of available road traffic noise data and to estimate population exposure and health impacts for cities in Europe. We conducted the analysis for 724 cities and 25 greater cities in 25 European countries. We retrieved road traffic strategic noise maps delivered under the Environmental Noise Directive (END) or available from local sources. We assessed noise exposure using the 24hday-evening-night noise level indicator (Lden) starting at exposure levels of 55dB Lden - based on data availability - for the adult population aged 20 and over (n=123,966,346). For the adults exposed to noise levels above 55dB Lden we estimated the health impacts of compliance with the World Health Organization (WHO) recommendation of 53dB Lden. Two primary health outcomes were assessed: high noise annoyance and Ischemic Heart Disease (IHD), using mortality from IHD causes as indicator. Exposure Response Functions (ERFs) relating road traffic noise exposure to annoyance and IHD mortality were retrieved from the literature. Uncertainties in input parameters were propagated using Monte Carlo simulations to obtain point estimates and empirical 95% Confidence Intervals (CIs). Lastly, the noise maps were categorized as high, moderate and low quality following a qualitative approach. Strategic noise map data was delivered in three distinct formats (i.e. raster, polygon or polyline) and had distinct noise ranges and levels of categorization. The majority of noise maps (i.e. 83.2%) were considered of moderate or low quality. Based on the data provided, almost 60 million adults were exposed to road traffic noise levels above 55dB Lden, equating to a median of 42% (Interquartile Range (IQR): 31.8-64.8) of the adult population across the analysed cities. We estimated that approximately 11 million adults were highly annoyed by road traffic noise and that 3608 deaths from IHD (95% CI: 843-6266) could be prevented annually with compliance of the WHO recommendation. The proportion of highly annoyed adults by city had a median value of 7.6% (IQR: 5.6-11.8) across the analysed cities, while the number preventable deaths had a median of 2.2 deaths per 100,000 population (IQR: 1.4-3.1). Based on the provided strategic noise maps a considerable number of adults in European cities are exposed to road traffic noise levels harmful for health. Efforts to standardize the strategic noise maps and to increase noise and disease data availability at the city level are needed. These would allow for a more accurate and comprehensive assessment of the health impacts and further help local governments to address the adverse health effects of road traffic noise.

Economic change and population health: lessons learnt from an umbrella review on the Great Recession

ObjectivesWorldwide, the COVID-19 pandemic triggered the sharpest economic downturn since the Great Recession. To prepare for future crises and to preserve public health, we conduct an overview of systematic reviews...

Health impact assessment of quarrying in some parts of southwestern Nigeria

Health impact assessment of quarrying in some parts of southwestern Nigeria

Strategic environmental assessment (SEA) process for business, economics, management, and eco-tourism, towards sustainable development

Industry 4.0 protocol for SEA process is helpful for the sustainable business, economics, management and business, economics, management, and eco-tourism development. The SEA treaty protocol pertains to federal and official Government procedures that help make much earlier decisions than the EIA process. Therefore, it is a key tool for sustainable development. The objective of the study is to conceptualize the SEA process for the business, economics, management, and eco-tourism scientific sector based on fifteen sustainable detailed project reports. The design of the study is cross-sectional. Environmental Health Impact Assessment (EHIA) process has been conducted for China nuclear power plant/ IGCAR Nuclear Power plant at Kalpakkam, India to consider the safety and health impacts to mitigate psychological health loadings on workers and nearby residents. The significance of the research work is mainly confirmatory SEA process for achieving sustainable business, economics, management, and eco-tourism for Industry 4.0. Keywords: Assessment; business; economics; environment; eco-tourism; sustainability.

The impact of urban environmental exposures on health: An assessment of the attributable mortality burden in Sao Paulo city, Brazil

BackgroundCurrently, more than half of the global population lives in cities. Contemporary urban planning practices result in environmental risk factors (e.g. air pollution, noise, lack of green space, excess heat) that put health and well-being of city dwellers at risk and contribute to chronic diseases and premature death. Despite a growing body of evidence on adverse health impacts related to current urban and transport planning practices, especially for cities in the Global North, not much is known about associated health impacts in South American cities. Therefore, we estimated the mortality burden attributable to breaching internationally-recommended or locally-preferable exposure levels of urban planning related environmental exposures in Sao Paulo, Brazil. MethodsWe carried out a health impact assessment study, following the comparative risk assessment framework, to assess preventable mortality impacts of breaching exposure recommendations for air pollution, green spaces and temperature at the census tract (CT) level (n = 18,363). We also assessed the distribution thereof by socioeconomic vulnerability. ResultsWe estimated that annually 11,372 (95% CI: 7921; 15,910) attributable deaths could be prevented by complying with recommended exposure levels. The largest proportion of preventable mortality was due to breaching air pollution limits (i.e. 8409 attributable deaths), followed by insufficient green space (i.e. 2593), and excess heat (i.e. 370). Adverse health impacts were larger in CTs of lower socioeconomic vulnerability, due to demographic profile, traffic density and residential area configurations. DiscussionNot complying with the health limits for air pollution, green space and temperature exposures resulted in a considerable preventable mortality burden (i.e. 17% of total expected deaths) in Sao Paulo. This burden can be reduced by improving current urban and transport planning practices.

Comparison of weather station and climate reanalysis data for modelling temperature-related mortality

Epidemiological analyses of health risks associated with non-optimal temperature are traditionally based on ground observations from weather stations that offer limited spatial and temporal coverage. Climate reanalysis represents an alternative option that provide complete spatio-temporal exposure coverage, and yet are to be systematically explored for their suitability in assessing temperature-related health risks at a global scale. Here we provide the first comprehensive analysis over multiple regions to assess the suitability of the most recent generation of reanalysis datasets for health impact assessments and evaluate their comparative performance against traditional station-based data. Our findings show that reanalysis temperature from the last ERA5 products generally compare well to station observations, with similar non-optimal temperature-related risk estimates. However, the analysis offers some indication of lower performance in tropical regions, with a likely underestimation of heat-related excess mortality. Reanalysis data represent a valid alternative source of exposure variables in epidemiological analyses of temperature-related risk.

Health benefits from cleaner vehicles and increased active transportation in Seattle, Washington.

BackgroundClimate mitigation policies that focus on the transportation sector yield near-term health co-benefits that could motivate policy action.ObjectiveWe quantified CO2 emission reductions as well as the air pollution and health benefits of urban transportation policies promoting electric vehicles (EV) and walking and bicycling in Seattle, Washington.MethodsWe compared a business-as-usual scenario projected to 2035 with intervention scenarios in which 35% of gasoline vehicles were switched to EV, and 50% of car trips less than 8 kilometers were replaced by walking or bicycling. We modeled changes in primary traffic-generated oxides of nitrogen (NOx) and fine particulate matter (PM2.5) as well as walking and bicycling activity, CO2 emissions from traffic, and fatal traffic injuries due to the transportation policy scenarios. We estimated the impacts of these changes on annual cases of asthma and premature mortality in the Seattle population.ResultsIncreasing the use of EV, walking, and bicycling is estimated to reduce CO2 emissions by 744 tons/year (30%) and lower annual average concentrations of primary traffic-generated NOx and PM2.5 by 0.32 ppb (13%) and 0.08 μg/m3 (19%), respectively. In Seattle, the lower air pollutant concentrations, greater active transportation, and lower fatal traffic injuries would prevent 13 (95% CI: −1, 28), 49 (95% CI: 19, 71), and 5 (95% CI: 0, 14) premature deaths per year, respectively and 20 (95% CI: 8, 27) cases of asthma per year.SignificanceMoving towards cleaner vehicles and active transportation can reduce CO2 emissions, improve air quality, and population health. The resulting public health benefits provide important motivation for urban climate action plans.Impact statementUsing key components of the health impact assessment framework, we quantify the environmental and health benefits of urban transportation policy scenarios that promote electric vehicle use and replace short car trips with walking and bicycling as compared with a business as usual scenario in 2035. Our findings demonstrate that transportation scenarios promoting cleaner vehicles and active transportation can reduce CO2 emissions, improve air quality, and increase physical activity levels, resulting in significant public health benefits.

Agent-based modeling of urban exposome interventions: prospects, model architectures, and methodological challenges.

With ever more people living in cities worldwide, it becomes increasingly important to understand and improve the impact of the urban habitat on livability, health behaviors, and health outcomes. However, implementing interventions that tackle the exposome in complex urban systems can be costly and have long-term, sometimes unforeseen, impacts. Hence, it is crucial to assess the health impact, cost-effectiveness, and social distributional impacts of possible urban exposome interventions (UEIs) before implementing them. Spatial agent-based modeling (ABM) can capture complex behavior-environment interactions, exposure dynamics, and social outcomes in a spatial context. This article discusses model architectures and methodological challenges for successfully modeling UEIs using spatial ABM. We review the potential and limitations of the method; model components required to capture active and passive exposure and intervention effects; human-environment interactions and their integration into the macro-level health impact assessment and social costs benefit analysis; and strategies for model calibration. Major challenges for a successful application of ABM to UEI assessment are (1) the design of realistic behavioral models that can capture different types of exposure and that respond to urban interventions, (2) the mismatch between the possible granularity of exposure estimates and the evidence for corresponding exposure-response functions, (3) the scalability issues that emerge when aiming to estimate long-term effects such as health and social impacts based on high-resolution models of human-environment interactions, (4) as well as the data- and computational complexity of calibrating the resulting agent-based model. Although challenges exist, strategies are proposed to improve the implementation of ABM in exposome research.

Application of epidemiological methods in health impact assessment

Health impact assessment (HIA) system has been listed in the Outline of the Healthy China 2030 Plan and the Law of Basic Health Care and Health Promotion of the People's Republic of China, however, the technique guideline of HIA needs to be established and improved. This paper summarizes the applications of different epidemiological methods in HIA and focus on the introduction of the application of ecology model of health social determinants as theory basis in the establishment of HIA system along with the introduction of HIA cases in the world. The applications of epidemiological methods in domestic HIA research are limited. Therefore, appropriate applications of epidemiological methods should be strengthened in HIA guideline and system development, especially the applications of big health data, mobile health techniques, systems epidemiology and implementation science, to facilitate data collection and potential health hazard evaluation and surveillance for HIA, establishment and improvement of HIA system and the implementation of Healthy China Strategy.

Estimation of Surface Ozone Concentration and Health Impact Assessment in China

Within the context of PM2.5 concentrations decreasing annually, ozone concentrations have increased instead of decreased, and ozone has become one of the main pollutants in the warm season in China. Based on the idea of big data association analysis, the extreme gradient boosting (XGBoost) ozone concentration estimation model was constructed and developed to estimate the maximum daily 8 h average ozone concentration (O3_8h) in China in 2019 for human exposure assessment. The model input ground monitoring station data, high-resolution remote-sensing satellite data, meteorological data, emission inventory data, digital elevation model (DEM) data, and population data were used to capture the temporal and spatial variation of O3_8h. In this study, ten-fold cross-validation was used to evaluate the estimation performance of the model (R2=0.871, RMSE=11.7 μg·m-3). Compared to those with the random forest (RF) model and kernel ridge regression (KRR) model, due to the improvement in the algorithm itself and the advancement of parallel processing, the estimation results of the XGBoost model showed higher accuracy (RF:R2=0.864, RMSE=12.387 μg·m-3). The KRR model was as follows:R2=0.582, RMSE=23.1 μg·m-3, and the computational efficiency of the model was significantly improved. At the same time, the level of ozone exposure and the relative risk of death due to chronic obstructive pulmonary disease (COPD) in China's provinces and cities were evaluated. The results showed that the top five number of days exceeding the standard occurred in Shandong Province, Henan Province, Hebei Province, Anhui Province, and the Ningxia Hui Autonomous Region. In terms of exposure intensity, Hebei Province, Shandong Province, Shanxi Province, Tianjin City, and Jiangsu Province ranked the top five in terms of population weighted ozone concentration. In terms of health effects, the relative risk of COPD death showed seasonal changes, with the highest in summer and the lowest in winter.

Estimating & comparing greenhouse gas emissions for existing intramuscular COVID-19 vaccines and a novel thermostable oral vaccine.

BackgroundClimate impacts are rarely considered in health impact and economic assessments of public health programs. This study estimates the greenhouse gas (GHG) emissions averted by a novel oral SARS-CoV-2 (COVID-19) vaccine compared with four existing intramuscular vaccines: AstraZeneca's COVISHIELD®, Pfizer/BioNTech's COMIRNATY®, Moderna's mRNA-1273, and Johnson & Johnson's Ad26.COV2.S COVID-19 vaccine.MethodsWe estimated GHG emissions averted for five vaccine modalities across nine countries. GHG emissions averted were derived from differences in cold chain logistics, production of vaccine supplies, and medical waste disposal. Countryspecific data including population coverage and electricity production mix were included in GHG emissions calculations. Results are presented in averted GHG per vaccine course and country level based on modeled vaccination demand.FindingsPer course, an oral vaccine is estimated to avert between 0.007 and 0.024 kgCO2e compared with Johnson & Johnson, 0.013 to 0.048 kgCO2e compared with AstraZeneca, 0.23 to 0.108 kgCO2e compared with Moderna, and 0.134 to 0.466 kgCO2e compared with Pfizer/BioNTech. The total GHG averted varied across countries based upon predicted demand, mix of electrical production, and vaccination strategy with the largest emissions reductions projected for India and the United States.InterpretationOur results demonstrate large potential GHG emissions reductions from the use of oral vs. intramuscular vaccines for mass COVID-19 vaccination programs. Up to 82.25 million kgCO2e could be averted from utilization of an oral vaccine in the United States alone, which is equivalent to eliminating 17,700 automobiles from the road for one year.FundingFunding was provided by Vaxart, Inc. Vaxart, Inc. is currently developing an oral COVID-19 vaccine, the characteristics of which were utilized to define the thermostable oral vaccine discussed in this study. Apart from providing data on the characteristics of the oral vaccine under development, the funders had no influence over the study design, methods, statistical analyses, results, framing of results, decision to submit the manuscript for publication, or choice of journal.

Public Rental Housing and Obesogenic Behaviors among Adults in Hong Kong: Mediator Role of Food and Physical Activity Environment.

Public rental housing (PRH) for low-income families has been shown in several studies to be associated with poor health status and obesity. However, the causes of this health disparity are controversial, and the associations and pathways between PRH and obesogenic behaviors remain unknown. Using cross-sectional survey data of 1977 adults living in Hong Kong (aged or over 18) together with multi-source GIS-based environmental data, we examined the associations between PRH and obesogenic behaviors and the extent to which those associations can be explained by neighborhood food and physical environment. The unhealthy food environment, which relates with infrequent fruit and vegetables consumption, was calculated based on the relative density of fast food restaurants and convenience stores to grocery stores. The physical activity environment, which relates to physical inactivity and prolonged sitting, was assessed in terms of density of sports facilities and street greenery, separately. Regressions and mediation analyses show that PRH was negatively associated with physical inactivity directly and also indirectly via higher sports facilities density; however, PRH was positively associated with unhealthy diet largely directly and positively associated with prolonged sitting indirectly via less street greenery. We advanced the international literature of PRH health impact assessment and its environmental health pathways by providing evidence from the least housing-affordable city in the world. The findings provide planning implications in formulating a healthier PRH community for these low-income PRH households and mitigating health disparities induced by housing type.