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Journal Article
Benmarhnia, T, Huang J, Wu J, Basu R, Bruckner T.  In Press.   Decomposition Analysis of Black-White Disparities in Birth Outcomes: The Relative Contribution of Air Pollution and Social Factors in California. Environmental Health Perspectives .
Benmarhnia, T, Rey L, Cartier Y, Clary CM, Deguen S, Brousselle A.  2014.  Addressing equity in interventions to reduce air pollution in urban areas: a systematic review. International Journal of Public Health. 59:933-944.   10.1007/s00038-014-0608-0   AbstractWebsite

Integration of equity in evidence-based public health is a great challenge nowadays. In this review we draw attention to the importance of considering equity in air pollution interventions. We also propose further methodological and theoretical challenges when assessing equity in interventions to reduce air pollution and we present opportunities to develop this research area.

Benmarhnia, T, Oulhote Y, Petit C, Lapostolle A, Chauvin P, Zmirou-Navier D, Deguen S.  2014.  Chronic air pollution and social deprivation as modifiers of the association between high temperature and daily mortality. Environmental Health. 13   Artn 5310.1186/1476-069x-13-53   AbstractWebsite

Background: Heat and air pollution are both associated with increases in mortality. However, the interactive effect of temperature and air pollution on mortality remains unsettled. Similarly, the relationship between air pollution, air temperature, and social deprivation has never been explored.Methods: We used daily mortality data from 2004 to 2009, daily mean temperature variables and relative humidity, for Paris, France. Estimates of chronic exposure to air pollution and social deprivation at a small spatial scale were calculated and split into three strata. We developed a stratified Poisson regression models to assess daily temperature and mortality associations, and tested the heterogeneity of the regression coefficients of the different strata. Deaths due to ambient temperature were calculated from attributable fractions and mortality rates were estimated.Results: We found that chronic air pollution exposure and social deprivation are effect modifiers of the association between daily temperature and mortality. We found a potential interactive effect between social deprivation and chronic exposure with regards to air pollution in the mortality-temperature relationship.Conclusion: Our results may have implications in considering chronically polluted areas as vulnerable in heat action plans and in the long-term measures to reduce the burden of heat stress especially in the context of climate change.

Benmarhnia, T, Bailey Z, Kaiser D, Auger N, King N, Kaufman JS.  2016.  A Difference-in-Differences Approach to Assess the Effect of a Heat Action Plan on Heat-Related Mortality, and Differences in Effectiveness According to Sex, Age, and Socioeconomic Status (Montreal, Quebec). Environmental Health Perspectives. 124:1694-1699.   10.1289/EHP203   AbstractWebsite

BACKGROUND: The impact of heat waves on mortality and health inequalities is well documented. Very few studies have assessed the effectiveness of heat action plans (HAPs) on health, and none has used quasi-experimental methods to estimate causal effects of such programs.OBJECTIVES: We developed a quasi-experimental method to estimate the causal effects associated with HAPs that allows the identification of heterogeneity across subpopulations, and to apply this method specifically to the case of the Montreal (Quebec, Canada) HAP.METHODS: A difference-in-differences approach was undertaken using Montreal death registry data for the summers of 2000-2007 to assess the effectiveness of the Montreal HAP, implemented in 2004, on mortality. To study equity in the effect of HAP implementation, we assessed whether the program effects were heterogeneous across sex (male vs. female), age (>= 65 years vs. < 65 years), and neighborhood education levels (first vs. third tertile). We conducted sensitivity analyses to assess the validity of the estimated causal effect of the HAP program.RESULTS: We found evidence that the HAP contributed to reducing mortality on hot days, and that the mortality reduction attributable to the program was greater for elderly people and people living in low-education neighborhoods.CONCLUSION: These findings show promise for programs aimed at reducing the impact of extreme temperatures and health inequities. We propose a new quasi-experimental approach that can be easily applied to evaluate the impact of any program or intervention triggered when daily thresholds are reached.

Bohra, T, Benmarhnia T, McKinnon B, Kaufman JS.  In Press.  ecomposing educational inequalities in child mortality: a temporal trend analysis of access to Water and Sanitation in Peru. American Journal of Tropical Medicine and Hygiene.
Zunzunegui, MV, Belanger E, Benmarhnia T, Gobbo M, Otero A, Beland F, Zunzunegui F, Ribera-Casado JM.  2017.  Financial fraud and health: the case of Spain. Gaceta Sanitaria. 31:313-319.   10.1016/j.gaceta.2016.12.012   AbstractWebsite

Objective: To examine whether financial fraud is associated with poor health sleeping problems and poor quality of life. Methods: Pilot study (n = 188) conducted in 2015-2016 in Madrid and Leon (Spain) by recruiting subjects affected by two types of fraud (preferred shares and foreign currency mortgages) using venue-based sampling. Information on the monetary value of each case of fraud; the dates when subjects became aware of being swindled, lodged legal claim and received financial compensation were collected. Intergroup comparisons of the prevalence of poor physical and mental health, sleep and quality of life were carried according to type of fraud and the 2011-2012 National Health Survey. Results: In this conventional sample, victims of financial fraud had poorer health, more mental health and sleeping problems, and poorer quality of life than comparable populations of a similar age. Those who had received financial compensation for preferred share losses had better health and quality of life than those who had not been compensated and those who had taken out foreign currency mortgages. Conclusion: The results suggest that financial fraud is detrimental to health. Further research should examine the mechanisms through which financial fraud impacts health. If our results are confirmed psychological and medical care should be provided, in addition to financial compensation. (C) 2017 SESPAS. Published by Elsevier Espatia, S.L.U.

Benmarhnia, T, Dionna PA, Tchouaket E, Fansi A, Brousselle A.  In Press.  How effective does a Healthy Lifestyle Habits Promotion Strategy need to be to make it cost-neutral. IJPH.
Delpla, I, Benmarhnia T, Lebel A, Levallois P, Rodriguez MJ.  2015.  Investigating social inequalities in exposure to drinking water contaminants in rural areas. Environmental Pollution. 207:88-96.   10.1016/j.envpol.2015.08.046   AbstractWebsite

Few studies have assessed social inequalities in exposure to drinking water contaminants. This study explores this issue in 593 rural municipalities of Quebec, Canada. Quartiles of an ecological composite deprivation index were used as a proxy of socioeconomic status. Total trihalomethanes (TTHMs) and lead were chosen as proxies of chemical drinking water quality. The results show that the majority of deprived rural municipalities apply no treatment to their water (26%) or use a basic treatment (51%), whereas a relative majority of the wealthiest municipalities (40%) use advanced treatment. The proportion of municipalities having important lead (>5 mu g/L) levels is highest in most deprived municipalities. Moreover, most deprived municipalities have a higher risk of high tap lead levels (RR = 1.33; 95% Cl: 1.30, 1.36). Conversely, most deprived municipalities have a lower risk of high TTHMs levels (RR = 0.78; 95%CI: 0.69, 0.86). These findings suggest an environmental inequality in drinking water contaminants distribution in rural municipalities. (C) 2015 Elsevier Ltd. All rights reserved.

Beck, F, Richard JB, Deutsch A, Benmarhnia T, Pirard P, Roudier C, Peretti-Watel P.  2013.  Knowledge about radon and its associated risk perception in France. Cancer Radiotherapie. 17:744-749.   10.1016/j.canrad.2013.06.044   AbstractWebsite

Purpose. - Radon exposure is a major environmental risk in health. It remains badly known by the general population. It is the second cause of lung cancer, after tobacco smoking. The aim of this cross-sectional general population survey was to describe radon exposure risk knowledge and the socioeconomic factors related to this knowledge.Materials and methods. - The Cancer Barometer survey 2010 questioned the French population about its knowledge of radon as such and as health risk factor. This survey was a two-stage random sampling with computer-assisted telephone interview that was performed from April 3, 2010 to August 7, 2010 on a sample of 3,359 people aged 15 to 75 years old.Results. - Among people aged 15 to 75 years old, only one in five knows that radon is a natural gas coming from the ground. This knowledge is more frequent among people living in an area that is directly concerned by radon, among men and increases with age, with the level of education and the level of income. Radon risk remains still widely underestimated by the general public, including in areas concerned by this risk. When people were confronted with radon exposure, few intended to remedy by improving their home.Conclusion. - The success of prevention initiatives implies the support and the collaboration of various national and local actors. To improve their impact for the prevention of lung cancers, it could be more effective to couple these actions with prevention messages on tobacco. (C) 2013 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

Benmarhnia, T, Huang J, Jones C.  In Press.  Lost in Translation: Considering the representation of uncertainty in the presentation of empirical findings in WHO policy statements. International Journal of Health Policy and Management.
Perchoux, C, Nazare JA, Benmarhnia T, Salze P, Feuillet T, Hercberg S, Hess F, Menai M, Weber C, Charreire H, Enaux C, Oppert JM, Simon C.  2017.  Neighborhood educational disparities in active commuting among women: the effect of distance between the place of residence and the place of work/study (an ACTI-Cites study). Bmc Public Health. 17   10.1186/s12889-017-4464-8   AbstractWebsite

Background: Active transportation has been associated with favorable health outcomes. Previous research highlighted the influence of neighborhood educational level on active transportation. However, little is known regarding the effect of commuting distance on social disparities in active commuting. In this regard, women have been poorly studied. The objective of this paper was to evaluate the relationship between neighborhood educational level and active commuting, and to assess whether the commuting distance modifies this relationship in adult women. Methods: This cross-sectional study is based on a subsample of women from the Nutrinet-Sante web-cohort (N = 1169). Binomial, log-binomial and negative binomial regressions were used to assess the associations between neighborhood education level and (i) the likelihood of reporting any active commuting time, and (ii) the share of commuting time made by active transportation modes. Potential effect measure modification of distance to work on the previous associations was assessed both on the additive and the multiplicative scales. Results: Neighborhood education level was positively associated with the probability of reporting any active commuting time (relative risk = 1.774; p < 0.05) and the share of commuting time spent active (relative risk = 1.423; p < 0.05). The impact of neighborhood education was greater at long distances to work for both outcomes. Conclusions: Our results suggest that neighborhood educational disparities in active commuting tend to increase with commuting distance among women. Further research is needed to provide geographically driven guidance for health promotion intervention aiming at reducing disparities in active transportation among socioeconomic groups.

Deguen, S, Petit C, Delbarre A, Kihal W, Padilla C, Benmarhnia T, Lapostolle A, Chauvin P, Zmirou-Navier D.  2015.  Neighbourhood characteristics and long-term air pollution levels modify the association between the short-term nitrogen dioxide concentrations and all-cause mortality in Paris. Plos One. 10   ARTN e013146310.1371/journal.pone.0131463   AbstractWebsite

BackgroundWhile a great number of papers have been published on the short-term effects of air pollution on mortality, few have tried to assess whether this association varies according to the neighbourhood socioeconomic level and long-term ambient air concentrations measured at the place of residence. We explored the effect modification of 1) socioeconomic status, 2) long-term NO2 ambient air concentrations, and 3) both combined, on the association between short-term exposure to NO2 and all-cause mortality in Paris (France).MethodsA time-stratified case-crossover analysis was performed to evaluate the effect of short-term NO2 variations on mortality, based on 79,107 deaths having occurred among subjects aged over 35 years, from 2004 to 2009, in the city of Paris. Simple and double interactions were statistically tested in order to analyse effect modification by neighbourhood characteristics on the association between mortality and short-term NO2 exposure. The data was estimated at the census block scale (n=866).ResultsThe mean of the NO2 concentrations during the five days prior to deaths were associated with an increased risk of all-cause mortality: overall Excess Risk (ER) was 0.94% (95% CI=[0.08;1.80]. A higher risk was revealed for subjects living in the most deprived census blocks in comparison with higher socioeconomic level areas (ER=3.14% (95% CI=[1.4-14.90], p<0.001). Among these deprived census blocks, excess risk was even higher where long-term average NO2 concentrations were above 55.8 mu g/m(3) (the top tercile of distribution): ER=4.84%(95% CI=[1.56;8.24], p for interaction= 0.02).ConclusionOur results show that people living in census blocks characterized by low socioeconomic status are more vulnerable to air pollution episodes. There is also an indication that people living in these disadvantaged census blocks might experience even higher risk following short-term air pollution episodes, when they are also chronically exposed to higher NO2 levels.

Benmarhnia, T, Grenier P, Brand A, Fournier M, Deguen S, Smargiassi A.  2015.  Quantifying Vulnerability to Extreme Heat in Time Series Analyses: A Novel Approach Applied to Neighborhood Social Disparities under Climate Change. International Journal of Environmental Research and Public Health. 12:11869-11879.   10.3390/ijerph120911869   AbstractWebsite

Objectives: We propose a novel approach to examine vulnerability in the relationship between heat and years of life lost and apply to neighborhood social disparities in Montreal and Paris. Methods: We used historical data from the summers of 1990 through 2007 for Montreal and from 2004 through 2009 for Paris to estimate daily years of life lost social disparities (DYLLD), summarizing social inequalities across groups. We used Generalized Linear Models to separately estimate relative risks (RR) for DYLLD in association with daily mean temperatures in both cities. We used 30 climate scenarios of daily mean temperature to estimate future temperature distributions (2021-2050). We performed random effect meta-analyses to assess the impact of climate change by climate scenario for each city and compared the impact of climate change for the two cities using a meta-regression analysis. Results: We show that an increase in ambient temperature leads to an increase in social disparities in daily years of life lost. The impact of climate change on DYLLD attributable to temperature was of 2.06 (95% CI: 1.90, 2.25) in Montreal and 1.77 (95% CI: 1.61, 1.94) in Paris. The city explained a difference of 0.31 (95% CI: 0.14, 0.49) on the impact of climate change. Conclusion: We propose a new analytical approach for estimating vulnerability in the relationship between heat and health. Our results suggest that in Paris and Montreal, health disparities related to heat impacts exist today and will increase in the future.

Benmarhnia, T, Auger N, Stanislas V, Lo E, Kaufman JS.  2015.  The relationship between apparent temperature and daily number of live births in Montreal. Maternal and Child Health Journal. 19:2548-2551.   10.1007/s10995-015-1794-y   AbstractWebsite

Temperature is a hypothesized determinant of early delivery, but seasonal and long term trends, delayed effects of temperature, and the influence of extreme cold temperatures have not yet been addressed. We aim to study the influence of apparent temperature on daily number of births, considering lag structures, seasonality and long term trends.We used daily number of births in conjunction with apparent outdoor temperatures between 1981 and 2010 in Montreal. We used Poisson regression combined with a distributed lag nonlinear model to consider non-linear relationships between temperature and daily number of births across specific lag periods.We found that apparent temperature was associated with the daily number of births in Montreal, with a 1-day delay. We found an increase in births on hot days, and decrease on cold days, both offset by a harvesting effect after 4 and 5 days.This study suggests that the number of births is affected by extreme temperatures. Obstetric and perinatal service providers should be prepared for spikes in the number of births caused by extreme temperatures.

Chaix, B, Duncan D, VallĂ©e J, Vernez-Moudon A, Benmarhnia T, Kestens Y.  In Press.  The residential effect fallacy in neighborhood and health studies: formal definition, empirical identification, and correction. Epidemiology.
Benmarhnia, T, Kihal-Talantikite W, Ragettli MS, Deguen S.  2017.  Small-area spatiotemporal analysis of heatwave impacts on elderly mortality in Paris: A cluster analysis approach. Science of the Total Environment. 592:288-294.   10.1016/j.scitotenv.2017.03.102   AbstractWebsite

Background: Heat-waves have a substantial public health burden. Understanding spatial heterogeneity at a fine spatial scale in relation to heat and related mortality is central to target interventions towards vulnerable communities. Objectives: To determine the spatial variability of heat-wave-related mortality risk among elderly in Paris, France at the census block level. We also aimed to assess area-level social and environmental determinants of high mortality risk within Paris. Methods: We used daily mortality data from 2004 to 2009 among people aged >65 at the French census block level within Paris. We used two heat wave days' definitions that were compared to non-heat wave days. A Bernoulli cluster analysis method was applied to identify high risk clusters of mortality during heat waves. We performed random effects meta-regression analyses to investigate factors associated with the magnitude of the mortality risk. Results: The spatial approach revealed a spatial aggregation of death cases during heat wave days. We found that small scale chronic PM10 exposure was associated with a 0.02 (95% CI: 0.001; 0.045) increase of the risk of dying during a heat wave episode. We also found a positive association with the percentage of foreigners and the percentage of labor force, while the proportion of elderly people living in the neighborhoodwas negatively associated. We also found that green space density had a protective effect and inversely that the density of constructed feature increased the risk of dying during a heat wave episode. Conclusion: We showed that a spatial variation in terms of heat-related vulnerability exists within Paris and that it can be explained by some contextual factors. This study can be useful for designing interventions targeting more vulnerable areas and reduce the burden of heat waves. (C) 2017 Elsevier B.V. All rights reserved.

Schwarz, L, Benmarhnia T, Laurian L.  2015.  Social Inequalities Related to Hazardous Incinerator Emissions: An Additional Level of Environmental Injustice. Environmental Justice. 8:213-219.   10.1089/env.2015.0022   AbstractWebsite

Environmental justice (EJ) research focuses on disproportionate population exposures to multiple point and non-point pollution sources. The hazardous pollutants released by waste incinerators can contribute to uneven (or unjust) spatial and social distributions of environmental risks. The EJ literature has already revealed that the geographical distribution of incinerators generates distinct social inequalities. In the French context, these inequalities are evident when considering the proportion of unemployed people, the proportion of recent immigrants and the proportion of persons born abroad (each increases the likelihood that a town hosts an incinerator). In this article, we seek to determine whether additional social injustices occur due to disproportionate quantities of incinerator emissions. We collected annual nitrogen oxide (NOx) emissions from all incinerators in France for 2009-2010. We found that incinerators in French municipalities with higher unemployment and higher proportions of immigrants and persons born abroad have higher NOx emission levels, even when controlling for population size and broader regional social and environmental deprivation indices. This indicates that incinerators in France generate higher social inequalities than initially thought, both due to their spatial distribution and to the amount of emissions they release. We recommend that unequal social impacts should be considered in waste management planning, facility siting decisions, and decisions affecting emission controls for existing and possible future incinerators in France.

Juneau, C, Benmarhnia T, Poulin A, Cote S, Potvin L.  2015.  Socioeconomic position during childhood and physical activity during adulthood: a systematic review. International Journal of Public Health. 60:799-813.   10.1007/s00038-015-0710-y   AbstractWebsite

A growing body of evidence links socioeconomic position early in life and physical activity during adulthood. This systematic review aimed to summarize this evidence.Medline and EMBASE were searched for studies that assessed socioeconomic position before age 18 years and physical activity at age a parts per thousand yen18 years. Studies were rated according to three key methodological quality criteria: (1) was childhood socioeconomic position assessed prospectively? (2) Was socioeconomic position during adulthood included in the statistical analysis? (3) Was a validated instrument used to measure of physical activity?Forty-two publications were included. Twenty-six (61.9 %) found a significant association between socioeconomic position early in life and physical activity during adulthood. Twenty-one studies met at least two methodological quality criteria. Among those, the proportion was higher: 15/21 (71.4 %). Associations were of weak to moderate strength, positive for physical activity during leisure time, and negative for transports and work.The bulk of the evidence supports the notion that there is a life course association between socioeconomic position early in life and physical activity during adulthood. Studies using more rigorous methodology supported this conclusion more consistently.

Cartier, Y, Benmarhnia T, Brousselle A.  2015.  Tool for assessing health and equity impacts of interventions modifying air quality in urban environments. Evaluation and Program Planning. 53:1-9.   10.1016/j.evalprogplan.2015.07.004   AbstractWebsite

Background: Urban outdoor air pollution (AP) is a major public health concern but the mechanisms by which interventions impact health and social inequities are rarely assessed. Health and equity impacts of policies and interventions are questioned, but managers and policy agents in various institutional contexts have very few practical tools to help them better orient interventions in sectors other than the health sector. Our objective was to create such a tool to facilitate the assessment of health impacts of urban outdoor AP interventions by non-public health experts.Methods: An iterative process of reviewing the academic literature, brainstorming, and consultation with experts was used to identify the chain of effects of urban outdoor AP and the major modifying factors. To test its applicability, the tool was applied to two interventions, the London Low Emission Zone and the Montreal BIXI public bicycle-sharing program.Results: We identify the chain of effects, six categories of modifying factors: those controlling the source of emissions, the quantity of emissions, concentrations of emitted pollutants, their spatial distribution, personal exposure, and individual vulnerability. Modifiable and non-modifiable factors are also identified. Results are presented in the text but also graphically, as we wanted it to be a practical tool, from pollution sources to emission, exposure, and finally, health effects.Conclusion: The tool represents a practical first step to assessing AP-related interventions for health and equity impacts. Understanding how different factors affect health and equity through air pollution can provide insight to city policymakers pursuing Health in All Policies. (C) 2015 The Authors. Published by Elsevier Ltd.

Benmarhnia, T, Sottile MF, Plante C, Brand A, Casati B, Fournier M, Smargiassi A.  2014.  Variability in Temperature-Related Mortality Projections under Climate Change. Environmental Health Perspectives. 122:1293-1298.   10.1289/ehp.1306954   AbstractWebsite

Background: Most studies that have assessed impacts on mortality of future temperature increases have relied on a small number of simulations and have not addressed the variability and sources of uncertainty in their mortality projections.Objectives: We assessed the variability of temperature projections and dependent future mortality distributions, using a large panel of temperature simulations based on different climate models and emission scenarios.Methods: We used historical data from 1990 through 2007 for Montreal, Quebec, Canada, and Poisson regression models to estimate relative risks (RR) for daily nonaccidental mortality in association with three different daily temperature metrics (mean, minimum, and maximum temperature) during June through August. To estimate future numbers of deaths attributable to ambient temperatures and the uncertainty of the estimates, we used 32 different simulations of daily temperatures for June-August 2020-2037 derived from three global climate models (GCMs) and a Canadian regional climate model with three sets of RRs (one based on the observed historical data, and two on bootstrap samples that generated the 95% CI of the attributable number (AN) of deaths). We then used analysis of covariance to evaluate the influence of the simulation, the projected year, and the sets of RRs used to derive the attributable numbers of deaths.Results: We found that < 1% of the variability in the distributions of simulated temperature for June-August of 2020-2037 was explained by differences among the simulations. Estimated ANs for 2020-2037 ranged from 34 to 174 per summer (i.e., June-August). Most of the variability in mortality projections (38%) was related to the temperature-mortality RR used to estimate the ANs.Conclusions: The choice of the RR estimate for the association between temperature and mortality may be important to reduce uncertainty in mortality projections.

Benmarhnia, T, Deguen S, Kaufman JS, Smargiassi A.  2015.  Vulnerability to heat-related mortality a systematic review, meta-analysis, and meta-regression analysis. Epidemiology. 26:781-793.   10.1097/EDE.0000000000000375   AbstractWebsite

Background: Addressing vulnerability to heat-related mortality is a necessary step in the development of policies dictated by heat action plans. We aimed to provide a systematic assessment of the epidemiologic evidence regarding vulnerability to heat-related mortality.Methods: Studies assessing the association between high ambient temperature or heat waves and mortality among different subgroups and published between January 1980 and August 2014 were selected. Estimates of association for all the included subgroups were extracted. We assessed the presence of heterogeneous effects between subgroups conducting Cochran Q tests. We conducted random effect meta-analyses of ratios of relative risks (RRR) for high ambient temperature studies. We performed random effects meta-regression analyses to investigate factors associated with the magnitude of the RRR.Results: Sixty-one studies were included. Using the Cochran Q test, we consistently found evidence of vulnerability for the elderly ages >85 years. We found a pooled RRR of 0.99 (95% confidence interval [CI] = 0.97, 1.01) for male sex, 1.02 (95% CI = 1.01, 1.03) for age >65 years, 1.04 (95% CI = 1.02, 1.07) for ages >75 years, 1.03 (95% CI = 1.01, 1.05) for low individual socioeconomic status (SES), and 1.01 (95% CI = 0.99, 1.02) for low ecologic SES.Conclusions: We found strongest evidence of heat-related vulnerability for the elderly ages >65 and >75 years and low SES groups (at the individual level). Studies are needed to clarify if other subgroups (e.g., children, people living alone) are also vulnerable to heat to inform public health programs.

Benmarhnia, T, Kaufman JS.  In Press.  When evidence of heat-related vulnerability depends on the contrast measure. International Journal of Biometeorology .