Environmental factor – June 2022: The impact of the environment on women’s health inequalities focus of the seminar

Differences in women’s health affected by exposure, socio-economic factors and racial differences were the focus of the “Environmental Impact on Women’s Health Differences and Reproductive Health”, a NIEHS virtual seminar held from 27 to 28 April

Researchers, community partners and scientists from across the country described how environmental stressors can affect maternal and fetal health outcomes and assessed the role of racial and ethnic differences in exposure. They also discussed how to build authentic partnerships in disproportionately affected communities and identified gaps and potential next steps in advancing disparities in environmental health and women’s reproductive health research.

Compared to white women, black women in the United States have a disproportionately higher pregnancy and childbirth mortality rate, according to participants. Black women are more likely to be uninsured and face greater financial barriers to care and are less likely to have access to prenatal care. Attendees also noted that environmental exposure may increase differences in preventable conditions such as type 2 diabetes and cardiovascular disease.

The NIEHS Faculty of Environmental Health and Environmental Justice (EHD-EJ) sponsored the event, the second in a series of two. The first seminar, held last December, focused on addressing environmental racism through community partnerships.

Left, event organizers Darlene Dixon, DVM, PhD, from the Mechanical Toxicology Branch of the National Toxicology Program’s NIEHS Division, and Melissa Smar, PhD, from the Population Health Branch of the Part-Time Research and Training Division, are two by the co-heads of the EHD-EJ faculty with over 70 members. (Photo courtesy of Steve McCaw / NIEHS)

“The most shocking and inhuman”

Of all the forms of inequality, health injustice is the most shocking and inhumane, “said Martin Luther King Jr., more than five decades ago. Erika E. Marsh, Ph.D.from the University of Michigan, shared this quote as part of his presentation on differences in reproductive health.

Erika E. Marsh, Ph.D. A professor of obstetrics and gynecology at the University of Michigan School of Medicine and head of the Department of Reproductive Endocrinology and Infertility, Marsh specializes in infertility and uterine fibroids, among other areas of study. (Photo courtesy of Erica Marsh)

“When we talk about inequality, we are really talking about equal access to opportunities,” she said. “It is fair when we are really careful and personalize tools that identify and address the inequalities that exist in the beginning.

Marsh noted that economic stability, neighborhood and physical environment, education and access to nutritious food lead to health outcomes and intersect with race. Race is also a social and structural component of health as well as ethnicity. They are important in medicine because they may be relevant to the diagnosis a doctor can make on a patient, according to Marsh.

For example, endometriosis, a disease in which uterine tissue grows outside the uterus, was described in the mid-20th century as a disease of higher-income white women. Other women who have arrived in the emergency department are more likely to be diagnosed with pelvic inflammatory disease.

The experience of racism and the resulting chronic stress leads to a variety of health outcomes and ultimately inequalities, from deaths from COVID-19 to uterine fibroids, Marsh said.

“Race and racism are factors that affect care,” she told those present.

Epidemiology and improved health justice

Risk factors for negative health outcomes in disadvantaged groups are more numerous than in other groups, according to the NIEHS Fellow Tamara James-Todd, Ph.D.from Harvard TH Chan School of Public Health.

Tamara James-Todd, Ph.D. James-Todd is an Associate Professor of Reproductive and Perinatal Epidemiology at Harvard TH Chan School of Public Health. He is also an associate epidemiologist at the Brigham Department of Women’s Health and Women’s Hospital. (Photo courtesy of Tamara James-Todd)

“The question is really what can we do about it?” she said. “Why do they have a greater burden of disease?”

Asking this question is key to building trust and developing sustainable interventions that affect policy, stimulate social change and improve health, she said.

Factors such as historical redness (practice of discriminatory mortgage practices), redness of retailers, food insecurity, home and gender roles, air and noise pollution, beauty standards and types of work can lead to environmental exposure which affects health.

Endocrine disrupting chemicals – including pesticides, plasticizers and flame retardants – have also been linked to adverse health outcomes for women, ranging from infertility to premature birth, according to James Todd. Her lab is investigating whether higher exposure to these chemicals creates differences in health outcomes.

According to James Todd, different approaches will be needed to reduce disparities in environmental health. Some examples include improving environmental health literacy and understanding the structural factors – the workplace environment, public policy and so on – that can put people at increased risk of exposure.

Differences in reproductive health and the environment

Researchers from more than a dozen institutions presented issues related to women’s reproductive health. In addition to Marsh and James-Todd, the following individuals offered their experiences during the seminar.

  • “Racial and Ethnic Differences in Environmental Exposure and Reproductive Health Outcomes – What We Know and What We Need to Know?” By Michael Bloom, Ph.D. from George Mason University.
  • “Study of the Interaction of Environmental and Social Stressors on Maternal Reproductive Health,” by Carrie Breton, Ph.D., of the University of Southern California.
  • “Community Observations on Environmental Health Research in Northeast British Columbia, Canada,” by Dr. Elise Caron-Bodoin of the University of Toronto Scarborough.
  • A Practical Approach to Improving Reproductive Health Justice, by Ebony Carter, MD, of the University of Washington School of Medicine, St. Louis.
  • “Context Matters: The Mismatch between Animal Models and the Complexity of the Human Environment,” by Deborah Corey-Slechta, Ph.D., of the University of Rochester Medical Center.
  • “Creating Authentic Partnerships between the Columbia Center for the Environment for Children (CCCEH) and Community Youth,” by Julie Herbstman, PhD, of Columbia University, and Jesibel Pimentel and Quincy Wise of CCCEH.
  • “Abandoning Exclusivity for Authentic Collaboration with Communities,” by Tanya Khemet Taiwo, PhD, University of California, Davis, and Janet Robinson Flint, Black Women for Wellness in Los Angeles.
  • “Linking Childhood Adversity and Weight Gain in Women: Insights from a Mouse Model of Postnatal Neglect,” by Analia Loria, PhD, of the University of Kentucky Medical College.
  • “Racial Differences and Premature Birth: Clarifying the Problem and Identifying Potential Solutions,” by Tracy Manak, MD, of the University of North Carolina at Chapel Hill.
  • Engaging the Community in Women’s Environmental Public Health in Puerto Rico: PROTECT Responde, by Dr. Carmen Milagros Veles Vega of the University of Puerto Rico’s Medical Sciences Campus and Maria Isabel Santana, PROTECT team.
  • “The MIEHR Center: Discovering the Differences in Environmental Health among Mothers and Their Children,” by Dr. Elaine Simanski of Baylor College of Medicine.
  • “Measures for structural racism and its relationship to reproductive health inequalities,” said Dr. Maeve Wallace of Tulane University.
  • “Socio-structural determinants of environmental exposure and uterine fibroid outcomes among systematically marginalized populations,” by Ami Zota, Ph.D., George Washington University.

The seminar also included a session entitled “Identifying gaps and next steps in environmental health inequalities and research on women’s reproductive health”. The panelists included the following.

  • Regin Dauthard, MD, Women’s Health Research Service, National Institutes of Health (NIH).
  • Karen Parker, Ph.D., Sexual Minority Research, NIH.
  • Devon Payne-Sturgess, Ph.D., School of Public Health, University of Maryland.
  • Checo Rorie, Ph.D., North Carolina State University of Agriculture and Technology.
  • ClarLynda Williams-DeVane, Ph.D., North Carolina, Department of Health and Human Services, Department of Public Health.
  • Tracy Woodruff, Ph.D., University of California, San Francisco.
  • Tanya Khemet Taiwo, PhD, University of California, Davis, Center for Environmental Health.

Also, the following student presenters of the NIEHS Scholars Connect Program shared their work.

  • Violet Evans, University of North Carolina at Chapel Hill.
  • Amina Hester, University of North Carolina at Chapel Hill.
  • J’ya Hunter, North Carolina State University of Agriculture and Technology.
  • Tana Lewis, North Carolina State University of Agriculture and Technology.
  • Jessica Wu, University of North Carolina at Chapel Hill.

(Susan Kozir is the author of contracts for the NIEHS Communications and Public Relations Office.)

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