Global, Environmental, and Occupational Health
Permanent URI for this communityhttp://hdl.handle.net/1903/10067
Prior to May 2024, previously known as the Maryland Institute for Applied Environmental Health.
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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 Engaging a Chemical Disaster Community: Lessons from Graniteville(MDPI, 2014-05-27) Abara, Winston; Wilson, Sacoby; Vena, John; Sanders, Louisiana; Bevington, Tina; Culley, Joan M.; Annang, Lucy; Dalemarre, Laura; Svendsen, ErikCommunity engagement remains a primary objective of public health practice. While this approach has been adopted with success in response to many community health issues, it is rarely adopted in chemical disaster response. Empirical research suggests that management of chemical disasters focuses on the emergency response with almost no community engagement for long-term recovery. Graniteville, an unincorporated and medically underserved community in South Carolina was the site of one of the largest chlorine exposures by a general US population. Following the immediate response, we sought community participation and partnered with community stakeholders and representatives in order to address community-identified health and environmental concerns. Subsequently, we engaged the community through regular town hall meetings, harnessing community capacity, forming coalitions with existing local assets like churches, schools, health centers, and businesses, and hosting community-wide events like health picnics and screenings. Information obtained from these events through discussions, interviews, and surveys facilitated focused public health service which eventually transitioned to community-driven public health research. Specific outcomes of the community engagement efforts and steps taken to ensure sustainability of these efforts and outcomes will be discussed.Item Occupational Exposure to Staphylococcus aureus and Enterococcus spp. among Spray Irrigation Workers Using Reclaimed Water(MDPI, 2014-04-17) Rosenberg Goldstein, Rachel E.; Micallef, Shirley A.; Gibbs, Shawn G.; He, Xin; George, Ashish; Sapkota, Amir; Joseph, Sam W.; Sapkota, Amy R.As reclaimed water use expands, it is important to evaluate potential occupational health risks from exposure to this alternative water source. We compared odds of colonization with methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible S. aureus (MSSA), vancomycin-resistant enterococci (VRE), and vancomycin-susceptible enterococci (VSE) between spray irrigation workers using reclaimed water and office worker controls. Nasal and dermal swabs from 19 spray irrigation workers and 24 office worker controls were collected and analyzed for MRSA, MSSA, VRE, and VSE. Isolates were confirmed using standard biochemical tests and polymerase chain reaction assays. Antimicrobial susceptibility testing was performed by Sensititre® microbroth dilution. Data were analyzed by two-sample proportion, chi-square, Fisher’s exact tests, and logistic regression. No MRSA or VRE were detected in any samples. MSSA was detected in 26% and 29% of spray irrigators and controls, respectively. VSE was detected in 11% and 0% of spray irrigation workers and controls, respectively. The adjusted odds of MSSA, multidrug-resistant MSSA, and either MSSA or VSE colonization were greater among spray irrigation workers, however results were not statistically significant. Future studies with larger sample sizes are needed to further evaluate this relationship.Item A Critical Review of an Authentic and Transformative Environmental Justice and Health Community — University Partnership(MDPI, 2014-12-11) Wilson, Sacoby; Campbell, Dayna; Dalemarre, Laura; Fraser-Rahim, Herb; Williams, EdithDistressed neighborhoods in North Charleston (SC, USA) are impacted by the cumulative effects of multiple environmental hazards and expansion of the Port of Charleston. The Low Country Alliance for Model Communities (LAMC) built an environmental justice partnership to address local concerns. This case study examines the process of building and sustaining a successful transformative and authentic community-university partnership. We apply the framework established by Community-Campus Partnerships for Health (CCPH), focusing on four of the nine principles of Good Practice of Community Campus Partnerships.Item Antibiotic Concentrations Decrease during Wastewater Treatment but Persist at Low Levels in Reclaimed Water(MDPI, 2017-06-21) Kulkarni, Prachi; Olson, Nathan D.; Raspanti, Greg A.; Rosenberg Goldstein, Rachel E.; Gibbs, Shawn G.; Sapkota, Amir; Sapkota, Amy R.Reclaimed water has emerged as a potential irrigation solution to freshwater shortages. However, limited data exist on the persistence of antibiotics in reclaimed water used for irrigation. Therefore, we examined the fate of nine commonly-used antibiotics (ampicillin, azithromycin, ciprofloxacin, linezolid, oxacillin, oxolinic acid, penicillin G, pipemidic acid, and tetracycline) in differentially treated wastewater and reclaimed water from two U.S. regions. We collected 72 samples from two Mid-Atlantic and two Midwest treatment plants, as well as one Mid-Atlantic spray irrigation site. Antibiotic concentrations were measured using liquid-chromatography- tandem mass spectrometry. Data were analyzed using Mann-Whitney-Wilcoxon tests and Kruskal Wallis tests. Overall, antibiotic concentrations in effluent samples were lower than that of influent samples. Mid-Atlantic plants had similar influent but lower effluent antibiotic concentrations compared to Midwest plants. Azithromycin was detected at the highest concentrations (of all antibiotics) in influent and effluent samples from both regions. For most antibiotics, transport from the treatment plant to the irrigation site resulted in no changes in antibiotic concentrations, and UV treatment at the irrigation site had no effect on antibiotic concentrations in reclaimed water. Our findings show that low-level antibiotic concentrations persist in reclaimed water used for irrigation; however, the public health implications are unclear at this time.Item Prevalence of Microbiological and Chemical Contaminants in Private Drinking Water Wells in Maryland, USA(MDPI, 2018-08-07) Murray, Rianna T.; Rosenberg Goldstein, Rachel E.; Maring, Elisabeth F.; Pee, Daphne G.; Aspinwall, Karen; Wilson, Sacoby M.; Sapkota, Amy R.Although many U.S. homes rely on private wells, few studies have investigated the quality of these water sources. This cross-sectional study evaluated private well water quality in Maryland, and explored possible environmental sources that could impact water quality. Well water samples (n = 118) were collected in four Maryland counties and were analyzed for microbiological and chemical contaminants. Data from the U.S. Census of Agriculture were used to evaluate associations between the presence of animal feeding operations and well water quality at the zip code level using logistic regression. Overall, 43.2% of tested wells did not meet at least one federal health-based drinking water standard. Total coliforms, fecal coliforms, enterococci, and Escherichia coli were detected in 25.4%, 15.3%, 5.1%, and 3.4% of tested wells, respectively. Approximately 26%, 3.4%, and <1% of wells did not meet standards for pH, nitrate-N, and total dissolved solids, respectively. There were no statistically significant associations between the presence of cattle, dairy, broiler, turkey, or aquaculture operations and the detection of fecal indicator bacteria in tested wells. In conclusion, nearly half of tested wells did not meet federal health-based drinking water standards, and additional research is needed to evaluate factors that impact well water quality. However, homeowner education on well water testing and well maintenance could be important for public health.Item Methods for Evaluating the Combined Effects of Chemical and Nonchemical Exposures for Cumulative Environmental Health Risk Assessment(MDPI, 2018-12-10) Payne-Sturges, Devon C.; Scammell, Madeleine K.; Levy, Jonathan I.; Cory-Slechta, Deborah A.; Symanski, Elaine; Carr Shmool, Jessie L.; Laumbach, Robert; Linder, Stephen; Clougherty, Jane E.Cumulative risk assessment (CRA) has been proposed as a means of evaluating possible additive and synergistic effects of multiple chemical, physical and social stressors on human health, with the goal of informing policy and decision-making, and protecting public health. Routine application of CRA to environmental regulatory and policy decision making, however, has been limited due to a perceived lack of appropriate quantitative approaches for assessing combined effects of chemical and nonchemical exposures. Seven research projects, which represented a variety of disciplines, including population health science, laboratory science, social sciences, geography, statistics and mathematics, were funded by the US Environmental Protection Agency (EPA) to help address this knowledge gap. We synthesize key insights from these unique studies to determine the implications for CRA practice and priorities for further research. Our analyses of these seven projects demonstrate that the necessary analytical methods to support CRA are available but are ultimately context-dependent. These projects collectively provided advancements for CRA in the areas of community engagement, characterization of exposures to nonchemical stressors, and assessment of health effects associated with joint exposures to chemical and psychosocial stressors.