Global, Environmental, and Occupational Health Theses and Dissertations
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Item EXPLORING ENVIRONMENTAL INJUSTICE AND AIR POLLUTION-RELATED HEALTH EFFECTS IN PRINCE GEORGE'S COUNTY, MARYLAND(2024) Ravichandran, Vivek; Wilson, Sacoby M; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Polluting facilities have been historically sited in disadvantaged communities of color, known as environmental justice (EJ) communities, due to limited perceived community resistance and mobilization. There is a plethora of air quality disparity research but a gap persists in ascertaining the health inequities associated with community exposure to air pollutants, such as particulate matter (PM) and black carbon (BC), at the neighborhood resolution. To address this gap in EJ science, this dissertation has four specific aims: (1) Implement the community-based participatory research (CBPR) framework to expand and enhance the community-engaged infrastructure to ensure the success of Aims 2-4; (2) Identify spatiotemporal pollution patterns across the Route 50-Sheriff Road-Kenilworth Ave Quadrant; (3) Determine short-term health impacts associated with community exposure to PM and BC via a panel study involving pulse oximeters to correlate elevated PM and BC levels to blood oxygen saturation (SpO2 levels); and (4) Conduct semi-structured interviews and use NVivo to perform thematic analysis on barriers and motivating factors towards passing EJ legislation. My findings demonstrated that a more diverse and representative community advisory board (CAB) allowed us to successfully conduct research while maintaining trust within the community, and bringing in voices from various demographic groups, including different ethnicities, ages, income levels, and geographic locations. This led to a more comprehensive understanding of the community's concerns, priorities, and needs related to air quality. Additionally, my findings revealed that both PM and BC levels were elevated during morning rush periods. PM levels did not exceed the Environmental Protection Agency (EPA) annual standards, but did exceed the more protective World Health Organization (WHO) guidelines. Robert Gray Elementary School exhibited higher PM levels than the other Quadrant sites. Furthermore, BC levels at Fairmount Heights High School were above the threshold defined in the literature above which cognitive inhibition and poor respiratory outcomes have been observed, highlighting the effect of air pollution exposure on vulnerable life stages in the Quadrant. BC peaks were also observed 10-15x these unofficial health-based thresholds. Using a pulse oximetry panel study, we found previous and concurrent day lagged fine particulate matter (PM2.5) was weakly associated with reductions in SpO2. Using NVivo, we identified 18 parent codes and 27 subcategories from our semi-structured interviews with Maryland policymakers/agency staff. Key barriers were: (1) the lack of strategic EJ plans; (2) limited community engagement particularly from those living in communities impacted by environmental injustice; and (3) interagency and policymaker collaboration exacerbated by a clear partisan divide. These findings provide evidence of previous misclassified exposure assessments from sparse existing regulatory monitors, present strategies for overcoming EJ barriers in the state, and underscore the importance of collaboration, community engagement, and policy reform to address environmental disparities and promote environmental justice.Item ENVIRONMENTAL EXPOSURES AND CHILDREN’S HEALTH(2024) Crnosija, Natalie; Payne-Sturges, Devon C.; Puett, Robin C.; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Climate change-driven physicochemical exposures, like extreme heat, wildfire and hurricanes are increasingly being investigated in the public health literature for their potential association with health outcomes. It is important to investigate children’s health specifically in the context of the exposures, as children’s physiological immaturity can make them uniquely vulnerable to these stressors because of their limited adaptive capacity. This dissertation investigates three distinct epidemiologic questions within this sphere, examining: 1) whether Extreme Heat Event Exposure associates with Kindergarteners’ Reading and Mathematics Performance, 2) whether wildfire smoke exposure affects respiratory/cardiovascular pediatric inpatient hospitalization in Alaska, 2015-2019, and 3) the association between exposure to Hurricane Irma and Internalizing, Externalizing and Total Problem Behaviors Among South Floridian Adolescents. Data for each of these studies was obtained from different sources, including the Early Childhood Longitudinal Study—Birth Cohort, hospital administrative data from the Alaska Department of Health and the NIH’s Adolescent Brain Cognitive Development Study. Where appropriate, external data was linked to these datasets as a means of linking exposures to health outcome data. In the first study, we found weak evidence of an association between exposure to lagged extreme heat events and children’s performance on kindergarteners’ mathematics and reading performance. In the second study, we observed a number of nonsignificant, minor associations between wildfire smoke exposure and respiratory and cardiovascular inpatient hospitalization among Alaskan children. In the third study, we observed a number of nonsignificant, minor associations between exposure to Hurricane Irma and internalizing, externalizing and total problem behaviors using data from Baseline and Wave 2 of the ABCD study. In summary, this research indicates the need for larger, more robust samples to investigate children’s health outcomes.Item COMPARISON OF ACRYLAMIDE EXPOSURE BIOMARKERS IN CHILDREN AND ADOLESCENTS USING NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (NHANES) 2003-04 AND 2015-16(2024) Vallejo, Jessica Vasquez; Turner, Paul C; Kadry, Abdel; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Acrylamide (AA) is an important industrial chemical of occupational concern due to its neurotoxicity and probable carcinogenicity; it is also a tobacco burning product and thus contributes to health concerns in smokers. More recently it was discovered to be thermally generated in the cooking of starch-rich foods, creating a potentially wider public health concern. Children and adolescents are a particularly vulnerable group because they consume more acrylamide-rich foods compared to adults. In addition, they are still going through important developmental stages. This study examines AA and its metabolite glycidamide (GA) using hemoglobin adduct biomarkers (HbAA and HbGA respectively) from the U.S. children (6-11) and adolescents’ (12-19) National Health and Nutrition Examination Survey’s 2003-04 (n=2814) and the 2015-16 (n=697). The study investigated changes in exposure over time and examined the contribution of potential modifiers including smoking status, race/ethnicity, poverty-to-income ratio, sex, and age. All HbAA and HbGA are reported as pmoL adduct per gram Hb (pmol/G Hb).Overall, HbAA biomarkers significantly (p<0.0001) declined from 2003-04, GMs (95% CI) (57.9 [55.7, 60.1] pmol/G Hb) versus (42.8 [41.4, 44.2] pmol/G Hb) in 2015-16 for all ages, with similar reductions observed in the individual children and the adolescent groups. Smokers had a higher burden of HbAA biomarkers than non-smokers, and with a significant reduction in numbers of smokers from 2003-04 to 2015-16, this likely contributes to the reduction in overall exposure. When non-smokers only were examined, a significant (p<0.0001) decrease in HbAA was still observed, from 2003-04 GMs (95% CI) (53.4 [52.0, 54.9] pmol/G Hb) versus (41.2 [40.2, 42.2] pmol/G Hb) in 2015-16, suggesting an additional contribution of changes in AA levels in food or frequency of high-risk food consumption. Similar statistically significant reductions were seen for both children and adolescent groups separately. HbGA is a marker of AA biotransformation to GA, which is a more mutagenic metabolite of AA. The ratio is of HbAA:HbGA is a phenotypic marker of mutagenic risk. In non-smokers, there was a significant (p=0.001) difference in the HbAA:HbGA ratio in children GMs (95% CI) (0.8 [0.8, 0.8] pmol/G Hb) at 2003-04 and (0.9 [0.9, 1.0] pmol/G Hb) at 2015-16 versus adolescents (1.0 [1.0, 1.1] pmol/G Hb) at 2003-04 and (1.1 [1.0, 1.2] pmol/G Hb) at 2015-16, respectively, suggesting children may be at greater risk to the mutational effects of AA exposure compared to adolescents. In multivariate regression analysis of non-smokers only, age and race significantly contributed to the HbAA biomarker levels, with higher HbAA in younger age groups and in non-Hispanic black participants, highlighting a disparity in exposure pattern. Overall, AA exposure seems to have reduced from 2003-04 to 2015-16; the reduction is driven by both changes in smoking but also diet. The young and non-Hispanic black participants remain at highest risk of exposure and potential health effects from exposure to AA.Item INVESTIGATING LONG-TERM TRENDS IN VIBRIOSIS SEVERITY AND RISK ASSOCIATED WITH WATER EXPOSURE AND CLIMATE-INDUCED STRESSORS IN THE CHESAPEAKE BAY: A MIXED METHODS STUDY(2023) Morgado, Michele Ewing; Sapkota, Amy R; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The number of outbreaks and sporadic illnesses associated with non-cholera Vibrio spp. contaminated seafood and coastal water sources have been increasingly reported across the United States and many other nations, and may continue to rise as a result of ocean warming, adversely impacting public health. However, there are limited data concerning the trends in virulence and antibiotic resistance of these bacterial pathogens outside of Southern U.S. waters, including critical estuarine systems such as the Chesapeake Bay. Moreover, there are few studies that have evaluated longitudinal trends in Vibrio illness (vibriosis) among water users (recreational and commercial) and shellfish consumers in more northern states such as Maryland. To address these knowledge gaps my dissertation research involved 1) a retrospective longitudinal molecular analysis, as well as antimicrobial susceptibility testing, to evaluate changes in V. vulnificus and V. parahaemolyticus antibiotic resistance patterns and virulence factors; and 2) an epidemiological study using publicly-available data to evaluate vibriosis trends. My specific aims were as follows: 1) To evaluate changes in virulence factors among V. vulnificus and V. parahaemolyticus isolates recovered from the Chesapeake Bay between 2009-2022; 2) To evaluate changes to antibiotic susceptibility among V. vulnificus and V. parahaemolyticus isolates recovered from the Chesapeake Bay between 2009-2022; and 3) To evaluate long-term trends in the incidence of severe vibriosis among water users (recreational and commercial) and shellfish consumers in Maryland between 2006-2019. Overall, my results indicate that potentially pathogenic V. vulnificus and V. parahaemolyticus occur across the Chesapeake Bay throughout every season, including at frequencies that may still lead to an increased risk of infection in the fall and possibly early winter. Moreover, the mid and lower sections of the Bay, which include many commercial and recreationally important areas, may harbor a greater risk of severe vibriosis from wound-associated water exposures, given the greater presence of V. vulnificus isolates characterized by clinically-relevant virulence factors. Interestingly, I also found that antibiotic resistance patterns among V. vulnificus and V. parahaemolyticus isolates collected from Tangier Sound in the lower Chesapeake Bay have remained relatively stable since 2009. Notwithstanding, recovered Vibrio spp. isolates exhibited varying levels of resistance and intermediate-resistance to antibiotics used to treat severe vibriosis, underscoring the need for prompt diagnosis and treatment with effective first line antibiotic agents. Finally, my epidemiological analysis revealed that long-term increases in Vibrio infections, notably V. vulnificus wound infections, are occurring in Maryland. This trend, along with increased rates in hospitalizations and average hospital durations, underscore the need to improve public awareness, water monitoring, post-harvest seafood interventions, and environmental forecasting, particularly as our climate warms and creates environmental conditions that support the growth of estuarine vibrios.Item EXAMINATION OF THE ASSOCIATIONS BETWEEN SELECTED PERFLUOROALKYL SUBSTANCES AND THEIR ISOMERS WITH BODY WEIGHT IN ADOLESCENTS USING NHANES 2013-2018(2023) Snyder, Jessica A; Payne-Sturges, Devon; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)0ABSTRACT Title of thesis: EXAMINATION OF THE ASSOCIATIONS BETWEEN SELECTED PERFLUOROALKYL SUBSTANCES AND THEIR ISOMERS WITH BODY WEIGHT IN ADOLESCENTS USING NHANES 2013-2018 Jessica Snyder, Master of Science, 2023 Thesis Directed by: Professor Devon Payne-Sturges Maryland Institute for Applied Environmental Health Perfluoroalkyl substances (PFAS), a class of environmentally persistent chemicals, are suspected of having obesogenic properties, with studies thus far being inconclusive. Few past studies of PFAS toxicity have distinguished between isomer types of each PFAS group during analysis, however. In this thesis, data for non-smoking 14-19 year-olds from three cycles of the National Health and Nutrition Examination Survey was analyzed to identify potential associations in adolescents between bodyweight and two major families of PFAS: perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) and to additionally determine if differentiating between linear and branched isomeric groups of two major PFAS families could better elucidate any associations found. In unadjusted models, weighted linear regression of body mass index (BMI) and serum concentrations of branched, linear, and total PFAS isomer groups, all returned positive associations ranging from β (95% confidence interval) of 4.06 (3.44, 4.68) for total PFOS to 12.33 (10.39,14.28) for linear PFOA. When models were adjusted for sex, age, race/ethnic origin and income level, however, only a negative association between BMI and branched PFOS (bPFOS) was found, with β= -1.24 (-2.10, -0.39). Unadjusted weighted logistic regression models of both overweight and obese status resulted in positive associations between obesity and both branched PFOS and total PFOS with odds ratios (95% confidence intervals) of 0.45 (0.27, 0.74) and 0.86 (0.75, 0.99) respectively. After adjusting for potential confounders, the only statistically significant relationship was between branched bPFOS and obesity, with a 56% decrease in the odds of obesity for every unit increase in serum concentration of bPFOS [β =-1.06, adjusted odds ratio= 0.44 (0.26,0.76)]. There was no significant difference between the sexes in any results. The apparent protective effect that bPFOS has against obesity and elevated BMI, notable as a health outcome association in itself, also illustrates that isomeric differentiation is important in studying PFAS, as nPFOS had no statistically significant 1 association by itself while ΣPFOS, used by many studies, did. Thus, the lack of differentiation could mask which PFAS type contributes to any associations discovered.Item DETERMINING THE IMPACT OF WELL MAINTENANCE, CONDITION, TYPE, AND LOCATION FACTORS ON E. COLI AND TOTAL COLIFORMS IN MARYLAND FARM PRIVATE DRINKING WATER WELLS(2023) Smith, Cameron Nicole; Rosenberg Goldstein, Rachel; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Even with the establishment of the Safe Drinking Water Act in 1974, private wells are still not regulated or monitored for drinking water quality or the presence of contaminants such as total coliform bacteria and Escherichia coli. The presence of microbiological contaminants in private wells poses a public health risk. With Agricultural Agents from the University of Maryland Extension, we collected 67 water samples from Maryland farms with private wells located in seven regions and 19 counties of Maryland. We evaluated water samples for total coliforms and E. coli to understand the risk of contamination for Maryland private well owners. We also analyzed the impact of well factors, location, and climate on the presence of total coliforms and E. coli in well water by analyzing participant survey responses and climate data. Our results found that 39% (26/67) of the well water samples were positive for total coliforms and 10% (7/67) were positive for E. coli. Region (p<0.01), county (p=0.03), previously testing for pH (p<0.01), and ambient temperature (p=0.05) were significant factors impacting total coliform concentration. Region (p<0.01) and precipitation in the last 24 hours of collection (p<0.01) were the only significant factors impacting E. coli concentration. These findings emphasize the importance of well water testing for private well owners.Item Examining Consumer Product Use And Phthalate Exposure Among Vulnerable Populations(2023) Boyle, Meleah; Quirós-Alcalá, Lesliam; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)One in 13 Americans have asthma, and higher rates have been reported among women and Black children.1 In addition, hairdressers who are exposed to chemicals through products used on themselves and their clients frequently report respiratory symptoms and conditions.2–10 Limited studies indicate that chemicals in personal care and consumer products (PCP) may impact respiratory health.11–14 The goal of this dissertation is to describe PCP use and exposures to recognized and suspected respiratory irritants (phthalates) among vulnerable populations who may experience disparate exposures. The aims are to: 1) characterize PCP use among 110 children with asthma, 2) examine associations between PCP use and asthma morbidity among 110 children with asthma, and 3) characterize concentrations and exposure determinants to phthalate metabolites in post-shift urine samples among 23 female hairdressers and 17 female office workers. In aim 1, participants were majority Black (87%), males (56%), and aged 8-11 years (66%). Adolescents (12-17 years) and females reported more frequent use of hair, face, and body products compared to children (8-11 years) and males. Participants used chemical treatments on their hair as young as 4 years and females 11-16 years used feminine wipes, spray, and regular deodorant in the genital area. For aim 2, use of aerosol products, hair products, and nail polish were positively associated with maximal symptom days [number of aerosol products (aOR: 1.36; CI: 1.17, 1.59), hairspray (aOR: 1.63; CI: 1.14, 2.33), perfume (aOR: 1.40; CI: 1.11,1.77); shampoo (aOR: 1.34; CI: 1.05,1.73), hair sheen (aOR: 1.41; CI: 1.00, 2.00), nail polish (aOR: 2.42; CI: 1.72, 3.41)] among children with asthma. For Aim 3, the geometric mean (GM) for monoethyl phthalate (MEP) was 10 times higher among hairdressers (161.4 ng/mL) than office workers (15.3 ng/mL). Hairdressers who provided chemical services had higher GM MEP concentrations than those who did not: texturizing (200.2 vs. 115.4 ng/mL), relaxing (181.6 vs. 92.1 ng/mL), bleaching (182.3 vs. 71.6 ng/mL), hair color (171.9 vs. 83.2 ng/mL), and Brazilian blowout (181.4 vs. 134.6 ng/mL). Hairdressers who provided natural services had lower GM MEP concentrations than those who did not: twists (129.1 vs. 215.8 ng/mL), sister locs/locs (86.0 vs. 241.9 ng/mL), and afros (94.7 vs. 203.9 ng/mL). While larger studies are needed, this dissertation provides new data on PCP use and phthalate exposure among Black children and hairdressers.Item CHARACTERIZING BACTERIAL COMMUNITIES ACROSS DIVERSE TOBACCO PRODUCTS AND DYSBIOSIS IN THE ORAL MICROBIOME RESULTING FROM TOBACCO USE(2022) Chattopadhyay, Suhana; Sapkota, Amy R; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)To evaluate the adverse health effects associated with tobacco smoking, the majority of studies have largely focused on the impact of chemical constituents in tobacco products and less on the impact of microbial contaminants within these products. Similarly, the United States (U.S.) Food and Drug Administration’s (FDA) Family Smoking Prevention and Tobacco Control Act (FSPTCA) requires tobacco manufacturers and importers to test and report on chemical constituents included on their list of harmful and potentially harmful constituents (HPHCs) in tobacco products and tobacco smoke; however, this HPHC list excludes microorganisms. Nevertheless, over the past decade, an increasing number of studies have explored the bacterial microbiome of tobacco products (e.g., cigarettes, little cigars, cigarillos, hookah and smokeless tobacco) and mainstream smoke. These studies have yielded robust data on bacterial diversity and bacterial community composition within individual tobacco product types. However, to date, there are no comparative characterizations of the bacterial microbiome across diverse tobacco products. In particular, there have been no studies that have characterized the metabolically-active (live) bacterial communities across these products; bacterial communities that might be transferred to the user’s oral cavity and cause subsequent adverse health effects. Furthermore, from an oral health perspective, while smoking/using tobacco products causes significant oral dysbiosis (bacterial community disturbances), there is a lack of data on the potential transfer of bacteria from tobacco products to user’s oral cavities or transient temporal changes in the oral microbiome that might result from smoking these tobacco products. Moreover, there are limited data comparing oral microbiome differences between cigarette smokers and smokeless tobacco users. To address these knowledge gaps, my dissertation research involved a comparative analysis of the bacterial microbiome of commercially-available tobacco products and anevaluation of the impacts of tobacco use on the oral microbiome of users. My specific aims were: 1) To evaluate the compositional differences in the bacterial microbiome between conventional tobacco products; 2) To evaluate transient changes in the oral microbiome of cigarette smokers after a single use of a little cigar; and 3) To conduct a comparative characterization of the oral microbiome between cigarette users, smokeless tobacco users, and non-users over time. Overall, I found that each type of conventional tobacco product harbored a significantly different bacterial community, with mentholation and/or flavoring being a significant driver of bacterial community changes. However, across all products the majority of the metabolically-active bacterial community was identified as Pseudomonas, along with members of the phylum Firmicutes, as well as a few pathogenic species previously associated with animal/human respiratory diseases. In analyzing the oral microbiome of cigarette smokers, I found that a singleuse of a little cigar product did not cause transient changes in the oral microbiome. In analyzing longer temporal effects of smoking on the oral microbiome, I found that, even though total bacterial diversity and composition did not change over time, multiple bacterial taxa were significantly different, with regard to their relative abundance, after four months. In addition, I found that dysbiosis of the oral microbiome was dependent on the type of tobacco product used (cigarettes or smokeless tobacco), and that tobacco smokers/users’ oral microbiomes harbored a more diverse set of bacterial species when compared to that of non-users. In summary, this work provides a comparative analysis of the total and metabolically-active bacterial microbiome of tobacco products, as well as rich findings regarding the relationship between tobacco use and oral microbiome dysbiosis. These data address major research priorities of the FDA relating to furthering our understanding of the adverse health risksassociated with tobacco smoking. Specifically, my data will add to the current body of knowledge regarding the potential role of tobacco bacterial communities in the development of smoking-related diseases. My data also can be leveraged by tobacco regulatory bodies to make future evidence-based policy changes that help reduce risks associated with microorganisms in tobacco products and protect public health.Item EVALUATING MALARIA AND THE IMPACT OF WATER RESOURCES DEVELOPMENT IN WESTERN ETHIOPIA THROUGH A ONE HEALTH PROSPECTIVE(2022) Mansfield, Tavis; Turner, Paul; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In Ethiopia, the potential to be infected with malaria may increase this decade due to the expected increases in available breeding habitats created by the filling of the Grand Ethiopian Renaissance Dam (GERD) and its reservoir as well as internal displacement and forced migration of tens of thousands of people due to the flooding of local communities by the filling of the GERD’s reservoir and ongoing civil conflict in the Tigray Region of northern Ethiopia. A One Health framework was used in this research along with refugee migration and resettlement information and, risk evaluation tools to assess the potential health effects of the construction and filling of the GERD and its reservoir in Western Ethiopia on the burden of malaria and the human population living in the same area. This thesis shows Anopheles mosquitoes that are the primary vector of malaria are present in Western Ethiopia and present an entomological surveillance tool that can be implemented in the region. The author also considers the human population movement and illustrate the current vulnerabilities of the various groups involved.Item EXPLORING RISK ASSESSMENT METHODS TO EXAMINE NEUROLOGICAL RISK DUE TO AIR TOXIC EXPOSURE IN MINNESOTA(2022) Ezeugoh, Rosemary Ifeoma; Payne-Sturges, Devon; Puett, Robin; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)BackgroundExisting research has investigated the relationships between sociodemographic characteristics and air toxic exposure in the United States. However, a few studies have examined the neurological risk from exposure to air toxics. The purpose of the study was to determine the correlation between sociodemographic variables and neurological risk due to exposure to air toxics. Also, spatial meth-ods were used to understand the distribution of neurological risk and sociodemographic character-istics. Methods Air toxic neurological risk data were obtained from the United States Environmental Protection Agency's National-scale Air Toxics Assessment and sociodemographic data from the 2010-2014 American Community Survey US Census Bureau. The NATA dataset contains 24 neurotoxic air pollutants. The hazard quotient (HQ) for each air pollutant was quantified by calculating the ratio of the inhalation exposure concentration (EC) to the reference concentration (RfC). In addition, the EPA additively models the neurological risks of different pollutants (HQ) to estimate an aggregate neurological risk score (hazard index (HI)) for each census tract. We conducted statistical analysis using R and spatial analysis using ArcGIS 10. Results The mean cumulative neurological risk (HI) from all sources was 0.05, and all HI<1 for all tracts in Minnesota. The range of values for HI is 1 to >1, with >1 being the greatest harm. Percent pov-erty, percent without high school education and percent non-Hispanic white were weakly negative-ly correlated with cumulative neurological risk. In comparison, median household income, percent unemployed, percent non-Hispanic black, percent Hispanic and percent people of color were weak-ly positively correlated with cumulative neurological risk. The choropleth map of cumulative neuro-logical risk showed that individuals in Minneapolis-St. Paul may be disproportionately exposed to air toxics. Conclusions These findings suggest that there may be an unequal distribution of neurotoxic air pollutants, espe-cially in Minneapolis-St. Paul. Study results may inform and target public health efforts at specific locations to eliminate sociodemographic inequalities in exposure to neurotoxic air pollutants.