Building a children's health and environment research agenda in Alberta, Canada: A multi-stakeholder engagement process

As new environmental exposures are continuously identified, environmental influences on health are of growing concern. Knowledge regarding the impacts of environmental exposures is constantly evolving and is often incomplete. In this paper, we describe a multi-phased, multi-stakeholder engagement initiative involving diverse stakeholders with an interest in building a children's environmental health research agenda which would link with and support local practices and policies. The intent of this initiative was to identify priority research issues, themes and questions by implementing a tested Research Planning Model that encompassed the engagement of diverse stakeholders. Here, we describe the model application, which was specifically focused on children's health and the environment. A key component of the model was the ongoing stakeholder engagement process. This included two stakeholder forums, during which participants identified three main research themes (social determinants of health, environmental exposures and knowledge translation) and a short list of research questions. Other key components of the model included the development of a Global Sounding Board of key stakeholders, an Advisory Board and a Scientific Panel with mandates to review and prioritise the research questions. In our case, the Advisory Board and Scientific Panel prioritised questions that focused on environmental exposures related to children's respiratory outcomes. The stakeholder engagement described here is an evolving process with frequent changes of context, sustained by the commitment and dedication of the Children's Environment and Health Research planning team and the Advisory Board. In this article, we share the engagement process, outcomes, successes, challenges and lessons learned from this ongoing experience. Keywordsstakeholder engagement, children's health, environmental health, health researc

Children\u27s Health in Latin America: The Influence of Environmental Exposures

Background:Chronic diseases are increasing among children in Latin America. Objective and Methods:To examine environmental risk factors for chronic disease in LatinAmerican children and to develop a strategic initiative for control of these exposures, the WorldHealth Organization (WHO) including the Pan American Health Organization (PAHO), the Collegium Ramazzini, and Latin American scientists reviewed regional and relevant global data. Findings: Industrial development and urbanization are proceeding rapidly in Latin America and environmental pollution has become widespread. Environmental threats to children\u27s health include traditional hazards such as indoor air pollution and drinking water contamination; as well as the newer hazards of urban air pollution; toxic chemicals such as lead, asbestos, mercury,arsenic, and pesticides;hazardous and electronic waste;and climate change. The mix of traditional and modern hazards varies greatly across and within countries reflecting industrialization, urbanization and socioeconomic forces. Conclusions: To control environmental threats to children\u27s health in Latin America, WHO, including PAHO will focus on the most highly prevalent and serious hazards - indoor and outdoor air pollution, water pollution, and toxic chemicals. Strategies for controlling these hazards include developing tracking data on regional trends in children\u27s environmental health(CEH); building a network of Collaborating Centres; promoting biomedical research in CEH;building regional capacity; supporting development of evidence-based prevention policies; studying the economic costs of chronic diseases in children; and developing platforms for dialogue with relevant stakeholders.

Interdisciplinary-driven hypotheses on spatial associations of mixtures of industrial air pollutants with adverse birth outcomes

Background: Adverse birth outcomes (ABO) such as prematurity and small for gestational age confer a high risk of mortality and morbidity. ABO have been linked to air pollution; however, relationships with mixtures of industrial emissions are poorly understood. The exploration of relationships between ABO and mixtures is complex when hundreds of chemicals are analyzed simultaneously, requiring the use of novel approaches. Objective: We aimed to generate robust hypotheses spatially linking mixtures and the occurrence of ABO using a spatial data mining algorithm and subsequent geographical and statistical analysis. The spatial data mining approach aimed to reduce data dimensionality and efficiently identify spatial associations between multiple chemicals and ABO. Methods: We discovered co-location patterns of mixtures and ABO in Alberta, Canada (2006–2012). An ad-hoc spatial data mining algorithm allowed the extraction of primary co-location patterns of 136 chemicals released into the air by 6279 industrial facilities (National Pollutant Release Inventory), wind-patterns from 182 stations, and 333,247 singleton live births at the maternal postal code at delivery (Alberta Perinatal Health Program), from which we identified cases of preterm birth, small for gestational age, and low birth weight at term. We selected secondary patterns using a lift ratio metric from ABO and non-ABO impacted by the same mixture. The relevance of the secondary patterns was estimated using logistic models (adjusted by socioeconomic status and ABO-related maternal factors) and a geographic-based assignment of maternal exposure to the mixtures as calculated by kernel density. Results: From 136 chemicals and three ABO, spatial data mining identified 1700 primary patterns from which five secondary patterns of three-chemical mixtures, including particulate matter, methyl-ethyl-ketone, xylene, carbon monoxide, 2-butoxyethanol, and n-butyl alcohol, were subsequently analyzed. The significance of the associations (odds ratio > 1) between the five mixtures and ABO provided statistical support for a new set of hypotheses. Conclusion: This study demonstrated that, in complex research settings, spatial data mining followed by pattern selection and geographic and statistical analyses can catalyze future research on associations between air pollutant mixtures and adverse birth outcomes

Unintentional Tobacco Smoke Exposure in Children

Secondhand smoke (SHS) exposure increases the prevalence and severity of sinopulmonary diseases in children. The primary source of SHS exposure in children is through adults who live in the same house; however, the level of exposure may vary based on the adult smoking habits at home. This prospective cross-sectional study in Alberta, Canada, investigated the relationship between self-reported caregiver smoking, location, outdoor temperature and children’s’ urine cotinine: creatinine ratio (CCR), a marker of nicotine metabolism. Participants aged 0–9 were recruited from the Child Health Clinics at the Misericordia Community Hospital in Edmonton, Alberta, from 8 January to 24 February 2016 and 30 June to 18 August 2016. Participant CCR levels were compared to caregiver-reported smoking location and environmental factors such as temperature and season. Of the 233 participants who reported smoking status, 21% reported smoking, in keeping with local smoking rates. More participants smoked indoors during the winter than the summer; however, some families limited indoor smoking to a garage. Of the 133 parent–child dyads who provided smoking information and a child urine sample, 18 had an elevated cotinine:creatinine ratio, suggestive of significant tobacco smoke exposure, 15 of whom were from homes that reported smoking. Age < 1 year and number of cigarettes smoked in the home weekly were risks for significant exposure while season, outdoor temperature and smoking location in the home did not reach significance. Smokers should be counseled to protect children, particularly infants, from exposure by limiting the number of cigarettes smoked and isolating smoking to outside the home. Segregated areas such as a garage may provide a useful harm mitigation strategy for indoor smokers, provided the garage does not share ventilation or is not in close proximity to high-traffic areas of the home