The publication "Higher Education Leadership for Democracy, Sustainability, and Social Justice" emerged from a global forum organized by the Council of Europe, the International Consortium for Higher Education, Civic Responsibility and Democracy, the Organization of American States, and the International Association of Universities at Dublin City University in June 2022. It addresses the challenges of Covid-19, which have exposed and contributed to the fragility of democracy, the deepening of extreme inequities, and the rise of populist anti-intellectualism. The book emphasizes the interconnectedness of democracy, sustainability, and social justice, asserting that higher education must not only generate knowledge but also influence individual and societal behavior. It argues that higher education institutions are uniquely positioned to understand history, drive innovation, and create a knowledge project for the broader social good. The book underscores the importance of leadership in higher education and its role in promoting democracy, sustainability, and social justice.

In Part III of the book, we contributed the chapter: Generational Environmental Justice in Climate Change and Sustainability Education.  In it, we present our experience with training programs and their impact in providing education and mentoring to the next generation of professionals in environmental medicine.  We demonstrate that these programs are important because they address a fundamental issue that is not often openly discussed: young people will bear the brunt of climate change, thus signifying a generational environmental injustice.  This unfairness must be acknowledged by earlier generations who have not done enough to prevent the upcoming calamity of climate change, knowing that it will affect future generations. We must provide young people with every tool necessary to fight this generational environmental injustice. 

Citation: Claudio L, Rodriguez-Baez R. (2023) Generational environmental justice in climate change and sustainability education. In: Higher Education Leadership for Democracy, Sustainability and Social Justice. Sjur Bergan, Ira Harkavy and Ronaldo Munck (eds) Council of Europe Higher Education, Series No. 26. ISBN 978-92-871-9373-5

Our study looked at how different factors affect the quality of life related to health among adults in Puerto Rico in 2019. Puerto Rico, a territory of the United States, faces many problems like poverty, a weak healthcare system, poor infrastructure, financial crisis, and the risk of natural disasters exacerbated by climate change. These issues impact the health and well-being of its people, but there hasn't been much research on this.

We used data from a large survey (4,944 adults) to understand how factors like age, income, and health conditions are linked to health-related quality of life, a standardized metric used by the Centers for Disease Control and Prevention. Not surprisingly, the data showed that having chronic health conditions, being older, and having a lower income were all linked to worse health-related quality of life. Specifically, as people had more chronic health conditions, they reported worse overall health, more physical and mental health problems, and more limitations in their daily activities. Interestingly, while older age was generally linked to poorer health-related quality of life, younger people reported more mental health issues.

The study's findings are concerning because they show that the health-related quality of life in Puerto Rico hasn't improved since the last time it was measured. The situation might be getting worse due to the decline in healthcare services following natural disasters and the national economic crisis. The research suggests that there should be specific programs and continuous monitoring to help those who are most at risk, like people with chronic and mental health conditions, the elderly, and those with low income, to improve health equality in Puerto Rico.

Citation: Frontera-Escudero, I., Bartolomei, J.A., Rodríguez-Putnam, A. Claudio, L.  Sociodemographic and health risk factors associated with health-related quality of life among adults living in Puerto Rico in 2019: a cross-sectional study. BMC Public Health 23, 2150 (2023). https://doi.org/10.1186/s12889-023-17115-3

SUMMARY: Misinformation has real-world implications on population health in today's fast-changing pandemic environment. Traditionally, professional middlemen such as reporters and formal media outlets were placed between information creators and the public. We no longer have these intermediates, allowing disinformation to spread. Public health information is frequently not customized to the needs of those most at risk, exacerbating health inequities and increasing suspicion and skepticism.
While public health authorities sometimes employ community-based organizations (CBOs) for outreach activities, they lose opportunities to actively engage them in all phases of the Health Communication Cycle. Fighting the infodemic requires many steps, including understanding what information is required, producing suitable and relevant messages, and sharing these messages in ways that are tailored to the recipients. Community-based organizations are already trustworthy bodies thoroughly engaged in the communities they serve and can help counteract disinformation. As a result of their unique and intangible characteristics and inroads in the communities they serve, CBOs are ideally positioned to play an active part in the health communication cycle, encouraging health equality. Thus, to successfully communicate and fight against health misinformation, particularly in groups with deep-seated mistrust or inadequate health literacy, we must incorporate and engage CBOs in all parts of health communication. 
In this new opinion paper, co-written by our research team and our  community partners, we provide background to support engaging CBOs in addressing health literacy and ehealth equity.

The COVID-19 epidemic has swamped healthcare systems globally, especially in communities of color with high prevalence of pre-existing conditions. Many state governments and healthcare organizations responded by expanding telemedicine capabilities and developing illness tracking smartphone apps. Based on our observations, many state-sponsored eHealth technologies did not involve community participation, thereby contributing to the growing digital health inequities. We propose that as the use of eHealth tools grows, more emphasis be paid to their equitable distribution, accessibility, and use. We offer our experience engaging in a Community Advisory Board working on the dissemination of the COVID Alert NY mobile app to show the relevance of public participation in app development. We also offer suggestions for involving community members in the app development process. We argue that involving communities in the app creation process enhances buy-in, trust, and utilization of digital technology in communities where it is most needed.

CITATION: 
Araya F, Stingone JA, Claudio L. Inequalities in exposure to ambient air neurotoxicants and disparities in markers of neurodevelopment in children by maternal nativity status. Int J. Environ Res Public Health 2021, 18 (14) 7512   https://doi.org/10.3390/ijerph18147512

SUMMARY: Exposure to hazardous air pollutants (HAPs) varies greatly amongst populations. Inequities in HAP exposure among groups can lead to disparities in neurodevelopmental outcomes in children. Our study's goal was to see if HAP exposure was influenced by maternal nativity, a demographic characteristic generally disregarded in health disparities research. We also looked at whether unequal HAP exposure levels may affect young children's neurodevelopment.
To do this, we used data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a nationally representative sample of children born in 2001 (n = 4750). Early cognitive development was assessed using Bayley's Short Form–Research Edition (BSF–R), a standardized test often used to assess brain development.
We found that participants at age nine months were exposed to ten possibly neurotoxic HAPs in their homes. Using linear regression models, we found that maternal nativity and HAP exposure had a synergistic effect on neurodevelopment. For instance, 32 percent of children born to foreign-born mothers were exposed to high levels of HAPs, compared to 21 percent of children born to U.S.-born moms.
One example of a particular HAP was the air pollutant isophorone, a measure of industrial pollution.  After adjusting for socioeconomic characteristics, both isophorone exposure and maternal nativity status were linked with worse BSF-R mental scores in children. There was no statistically significant interaction between nativity status and isophorone exposure, but the change in mental scores was higher in children of foreign-born mothers than in children of U.S.-born mothers (0.12, vs. 0.03, p = 0.2).
In conclusion, children of foreign-born mothers were more likely than US-born mothers to be exposed to HAPs in the highest levels, showing disparities in pollutant exposure by nativity status within metropolitan populations. Exposures linked to nativity status may harm children's neurodevelopment.

 In a new study we published this week in The Journal of Clinical Investigation, our multidisciplinary team of computer scientists, physicians, and epidemiologists at the Icahn School of Medicine at Mount Sinai developed a novel machine-learning algorithm. We used this new machine learning method to identify previously unknown mixtures of toxic air pollutants that appear to be linked to poor asthma outcomes in children.  
     The issue we addressed with this investigation was that most studies assess the toxicity of pollutants one at a time. But in the real world, people are exposed to mixtures of pollutants that cause different health effects. Gaurav Pandey, PhD, Assistant Professor of Genetics and Genomic Sciences and a senior author of the study, said: "Traditionally, for technical reasons, it has been difficult to study the health effects of more than one toxic at a time. We overcame this by tapping into the power of machine learning algorithms."    
     To do this, we examined early exposure to dozens of pollutants to which 151 children with mild to severe asthma were potentially exposed early in their lives, as measured by the Environmental Protection Agency's National Air Toxics Assessment resource. We developed and applied a novel algorithm, named "Data-driven ExposurE Profile (DEEP) Extraction, to determine the possible ways that each pollutant, alone or in combination with others, could explain asthma outcomes in the children. The algorithm development was led by Yan-Chak Li, MPhil, a bioinformatician, and Hsiao-Hsien Leon Hsu, ScD, Assistant Professor of Environmental Medicine and Public Health. 
     We found that some disease cases could be linked to an individual chemical. One example of an individual chemical showing an effect was the ammonia-scented waterproofing agent trimethylamine, which raised the chances that a child with asthma would spend a night in the hospital.
     Other pollutants could act alone or in mixtures. One example was acrylic acid, a chemical used in plastics, coatings, medical products, and detergents. Exposure to acrylic acid raised the chances that a child would need daily medication. Exposure to acrylic acid combined with other chemicals further increased this possibility, and in addition, it boosted the chances of emergency room visits and overnight hospitalizations among the asthmatic children who participated in the study. (See illustration)  
     In all, 34 individual chemicals were found to be linked to poor asthma outcomes. Importantly, some asthma cases appeared to be linked to mixtures of pollutants that had never been associated with asthma.   
      "As a physician who treats children with asthma, I was struck by how many potential air toxics are not on our radar," said Supinda Bunyavanich, MD, MPH, MPhil, Professor of Pediatrics, and Genetics and Genomic Sciences, and a senior author of the study. "These results changed my view of the heightened risk some children face."  
     "Our study is an example of how machine learning has the potential to alter medical research," said Dr. Pandey. "It is allowing us to understand how a wide variety of environmental factors—or the exposome—influences our health. In the future, we plan to use DEEP and other computer science techniques to tackle environmental factors associated with other complex disorders."  
     This work was supported by the Department of Genetics and Genomic Sciences at Mount Sinai, Scientific Computing at Icahn Mount Sinai, and the National Institutes of Health (AI118833, HG011407, HL147328, OD023337, and ES023515).
Article
Citation: Li, Y.C., Hsu, H.H.L., Chun Y, Chiu PH, Arditi Z, Claudio L, Pandey G, Bunyavanich S. Machine learning-driven identification of early-life air toxic combinations associated with childhood asthma outcomes. Journal of Clinical Investigation, October 5, 2021, DOI: 10.1172/JCI152088