Global, Environmental, and Occupational Health

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Prior to May 2024, previously known as the Maryland Institute for Applied Environmental Health.

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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, Edith
Distressed 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.
Adoption, reach, and implementation of a cancer education intervention in African American churches
(Springer Nature, 2017-03-14) Santos, Sherie Lou Zara; Tagai, Erin K.; Scheirer, Mary Ann; Bowie, Janice; Haider, Muhiuddin; Slade, Jimmie; Wang, Min Qi; Holt, Cheryl L.
Use of technology is increasing in health promotion and has continued growth potential in intervention research. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this paper reports on the adoption, reach, and implementation of Project HEAL (Health through Early Awareness and Learning)—a community-based implementation trial of a cancer educational intervention in 14 African American churches. We compare adoption, reach, and implementation at the organizational and participant level for churches in which lay peer community health advisors (CHAs) were trained using traditional classroom didactic methods compared with a new online system. Fifteen churches were randomized to one of two study groups in which two CHAs per church were trained through either classroom (“Traditional”; n = 16 CHAs in 8 churches) or web-based (“Technology”; n = 14 CHAs in 7 churches) training methods. Once trained and certified, all CHAs conducted a series of three group educational workshops in their churches on cancer early detection (breast, prostate, and colorectal). Adoption, reach, and implementation were assessed using multiple data sources including church-level data, participant engagement in the workshops, and study staff observations of CHA performance. The project had a 41% overall adoption rate at the church level. In terms of reach, a total of 375 participants enrolled in Project HEAL—226 participants in the Traditional group (43% reach) and 149 in the Technology group (21% reach; p < .10). Implementation was evaluated in terms of adherence, dosage, and quality. All churches fully completed the three workshops; however, the Traditional churches took somewhat longer (M = 84 days) to complete the workshop series than churches in the Technology group (M = 64 days). Other implementation outcomes were comparable between both the Traditional and Technology groups (p > .05). Overall, the Project HEAL intervention had reasonable adoption, though reach could have been better. Implementation was strong across both study groups, suggesting the promise of using web-based methods to disseminate and implement evidence-based interventions in faith-based settings and other areas where community health educators work to eliminate health disparities.
AIR QUALITY ASSESSMENT OF RESIDENTIAL EXPOSURE TO PARTICULATE MATTER AND VOLATILE ORGANIC COMPOUNDS NEAR A CONCRETE BLOCK PLANT AND TRAFFIC IN BLADENSBURG, MARYLAND
(2018) Ezeugoh, Rosemary Ifeoma; Wilson, Sacoby M; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Ambient air pollution from stationary sources, industrial traffic, and commuter traffic can negatively impact air quality and human health. Ernest Maier, a concrete block plant located in Bladensburg, Maryland wants to expand to include a concrete batching plant on the same property. This expansion could further degrade air quality and impact the health of vulnerable residents. Air quality monitoring were conducted in the community at five personal sites using the Airbeam and Atmotube, which are wearable, real-time sensors that can measure PM2.5 and VOCs respectively. Sampling and traffic counts were conducted in thirty minutes’ periods to capture morning on-peak, afternoon off-peak and evening on-peak periods. Pearson’s correlation revealed that a weak correlation among the PM2.5 and VOC concentrations observed between the different sites and some of the values were found to be statistically significant. ANOVA analysis showed that the PM2.5 levels were significantly different at the different sites (p-value 0.001).
Alcohol exposure in preterm infants in neonatal isolettes
(2013) Braun, Rebecca Marie; Sapkota, Amir; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Preterm infants admitted to the NICU may spend up to 12 weeks in isolettes (incubators with controlled air temperature and humidity). Infants receive frequent contact with health-care professionals who use alcohol-based hygiene products. Ethanol is a known developmental neurotoxicant, and inhalation may have long-term effects on infant neurodevelopment. This study assessed alcohol concentration in isolette air after inserting hands cleaned with hand sanitizer, and effects of longer hand rubbing before insertion into the isolette. Each exposure consisted of two squirts (1.5 ± 0.1mL) of hand sanitizer, and hands rubbed for 10 or 20 seconds before insertion into isolettes. Air samples were collected by photoionization detector and breathalyzer. Average ethanol peaks were 387.04ppm (10s) and 104.36ppm (20s). Ethanol levels peaked within 1min, dissipated within 5min, and returned to background within 15 - 20min. Alcohol exposure from ethanol based hand sanitizer may be decreased significantly with longer duration of hand rubbing.
Antibiotic Concentrations and the Composition of Bacterial Communities in Municipal Wastewater and Reclaimed Water
(2016) Kulkarni, Prachi; Sapkota, Amy R; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Before reclaimed water is used more widely within the current United States (U.S.) wastewater treatment infrastructure, it is important to examine the potential public health impacts of this emerging, alternative freshwater resource. My dissertation evaluated antibiotic concentrations and the composition of bacterial communities in conventionally treated municipal wastewater and resulting reclaimed water. I also evaluated the efficacy of a point-of-use filtration system in reducing antimicrobials present in reclaimed water. My objectives were to: 1) Assess the fate of antibiotics and; 2) Characterize the total bacterial community structure of differentially treated wastewater, and reclaimed water that has undergone on-site treatment and storage; and 3) Evaluate zero-valent iron (ZVI)-biosand filtration as a potential point-of use treatment technology for the reduction of antimicrobials from conventionally treated reclaimed water. I extracted nine antibiotics and total genomic deoxyribonucleic acid (DNA) from differentially treated wastewater and reclaimed water samples from two Mid-Atlantic and two Midwest WWTPs, and one associated Mid-Atlantic spray irrigation site. I quantified the presence of antibiotics using high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), and characterized total bacterial community structure using 16S rRNA gene sequencing. I also used HPLC-MS/MS to quantify the reduction of thirteen antimicrobials from conventionally treated reclaimed water after ZVI-biosand filtration. Statistical analyses included the Kruskal Wallis test, paired Wilcoxon signed-rank test, and differential abundance using normalization achieved by cumulative sum scaling. Activated sludge treatment used at all four WWTPs resulted in the reduction of some antibiotics and the increase of genera containing potentially pathogenic bacteria (Mycobacterium and Legionella). Treatment plant chlorination and spray irrigation site ultraviolet radiation (UV) treatment and open-air storage reduced the concentration of azithromycin and increased the relative abundance of Mycobacterium. ZVI-biosand filtration achieved significant reductions in azithromycin, ciprofloxacin, erythromycin, linezolid, oxolinic acid, pipemidic acid, penicillin and vancomycin. This research provided additional scientific evidence that activated sludge treatment and chlorination alone may not be sufficient for the removal of antimicrobials and potentially pathogenic bacteria from municipal wastewater and resulting reclaimed water. However, ZVI-biosand filtration may be an efficient reuse site technology for the reduction of antimicrobials from conventionally treated reclaimed water.
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.
Antibiotic-resistant bacteria in wastewater and potential human exposure through wastewater reuse
(2013) Goldstein, Rachel Elizabeth Rosenberg; Sapkota, Amy R.; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
As community-acquired antibiotic-resistant bacterial infections occur with increasing frequency, it is important to identify possible environmental reservoirs for these organisms. My dissertation evaluated the presence of antibiotic-resistant bacteria in U.S. wastewater intended for reuse and the related public health implications. My objectives were to: 1) Evaluate wastewater from four U.S. wastewater treatment plants (WWTPs) for the presence of methicillin-resistant Staphylococcus aureus (MRSA); 2) Evaluate the occurrence of vancomycin-resistant enterococci (VRE) at four U.S. WWTPs from which treated wastewater is reused; and 3) Determine and compare MRSA, methicillin-susceptible S. aureus (MSSA), VRE, and vancomcyin-susceptible enterococci (VSE) colonization among American reclaimed water spray irrigators and controls. Between 2009 and 2010, 44 wastewater samples were collected from four WWTPs, two in the Mid-Atlantic and two in the Midwest regions of the U.S. I analyzed samples for MRSA and VRE using standard membrane filtration. For the third objective, I collected 94 nasal and dermal swabs from 19 spray irrigators and 24 controls and analyzed them for MRSA, MSSA, VRE, and VSE. I confirmed all isolates and performed antimicrobial susceptibility testing by microbroth dilution. Statistical analyses included two-sample proportion tests and logistic regression. MRSA and VRE were detected at all WWTPs. The percentage of MRSA-positive samples and concentration of VRE decreased as treatment progressed. Neither MRSA nor VRE were identified in tertiary-treated samples, but I identified both in an un-chlorinated effluent sample. No MRSA or VRE were detected in nasal or dermal samples from spray irrigators or controls. MSSA and VSE were detected in 26% and 11% of spray irrigators and 29% and 0% of controls, respectively. The odds of MSSA, MDR MSSA, and either MSSA or VSE colonization were not significantly different between the spray irrigators and controls. My dissertation includes the first reports of MRSA at U.S. WWTPs and VRE at WWTPs whose effluent is intended for reuse. This is also the first U.S. evaluation of occupational exposure to antibiotic-resistant bacteria in reclaimed water. My findings provide additional scientific evidence that antibiotic-resistant bacteria can survive secondary-treated wastewater and may cause increased risks for infection among individuals exposed to reclaimed water.
Antimicrobial Resistance of Enterococci in Surface and Recycled Water in the Mid-Atlantic
(2018) Patterson, Rebecca; Micallef, Shirley A; Payne-Sturges, Devon C; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Increasing demands for agricultural water require identification of alternative water sources. Enterococcus species can exhibit antimicrobial resistance and transfer resistance traits to other bacterial taxa, including human pathogens. This study evaluated the distribution and antimicrobial resistance of Enterococcus faecalis and E. faecium in surface and recycled waters. In all, 365 isolates from 129 water samples collected over one year were identified by species, and 95 were selected for antimicrobial susceptibility testing. Season, water type, temperature and salinity were statistically significantly associated with species probability, and season with antimicrobial resistance of E. faecalis. 1.3% of E. faecalis and 5.0% E. faecium were pan-susceptible but 100% were susceptible to ampicillin, vancomycin, daptomycin and linezolid. Multidrug resistance was detected in 16% of E. faecalis and 70% of E. faecium isolates. Enterococcus was ubiquitous in water and exhibited resistance to multiple antimicrobials, but resistance to antimicrobials of last resort for enterococcal infections was non-existent.
Assessing the Presence of Antibiotic-Resistant Enterococcus in Reclaimed Water Used for Spray Irrigation
(2013) Carey, Stephanie Ann; Sapkota, Amy R; Turner, Paul; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Reclaiming wastewater is increasing in the US to combat dwindling freshwater supplies. This water potentially contains pathogenic bacteria; therefore, we evaluated the occurrence, concentration, and antimicrobial susceptibilities of Enterococcus spp.--an important opportunistic pathogen that remains a leading cause of nosocomial infections--in reclaimed water used for spray irrigation (SI). A total of 48 wastewater effluent and SI samples were collected in 2009 and 2010 from the Mid-Atlantic and Midwest regions of the US. Enterococci were isolated using membrane filtration, confirmed using biochemical tests and PCR, and tested for antimicrobial susceptibility using the Sensititre® dilution system. We detected total enterococci and vancomycin-resistant enterococci (VRE) in 68% (27/40) and 8% (3/40), respectively, of all SI samples. VRE and vancomycin-intermediate enterococci (VIE) represented 2% (1/41) and 10% (4/41), respectively, of the total enterococci recovered from all SI sites. Our findings show that SI workers may be exposed to enterococci during spray irrigation activities.
An Assessment of Exposure to Pollution by Recreational Users of The Anacostia Watershed: Project Recreate
(2013) Murray, Rianna Teresa; Wilson, Sacoby; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
The Anacostia River, a tributary of the Chesapeake Bay, is highly contaminated with raw sewage, heavy metals, oil and grease, trash, pathogens, excessive sediments and organic chemicals. Many people use this river on a regular basis for recreational purposes, including kayaking, canoeing, rowing and sport fishing. The contaminants in the river potentially pose threats to human health for recreational users. While there has been some study of the exposure to subsistence fishers in this region there is currently little information available on the risks faced by recreational users. This work gathered pilot data on recreational users with the purpose of assessing any associated exposure risks to contaminants. The high levels of contamination in the Anacostia River and the popularity of recreation makes this an important public health issue. This study is the first to combine an evaluation of risk and risk perception for the recreational population of the Anacostia River.
Assessment of Zero-Valent Iron Capabilities to Reduce Food-borne Pathogens via Filtration and Residual Activities in Irrigation Water
(2017) Bradshaw, Rhodel; Sapkota, Ph.D., Amy R; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Inadequate disinfection of contaminated freshwater that is used to irrigate food crops that are eaten raw can result in foodborne illnesses. Therefore, in this study we assessed the efficacy of a low-cost, water treatment technology, zero-valent iron (ZVI), in reducing microbiological contamination of synthetic irrigation water. Specifically, we compared the capabilities of a ZVI-sand filter versus a sand filter in reducing levels of Salmonella Newport MDD314 and E. coli TVS 353 through filtration or residual disinfection. Our data showed that ZVI-sand filtration was more effective than sand filtration alone in reducing levels of both of these microorganisms. Our results also showed that, after filtration, there seemed to be no residual disinfection capabilities associated with either the ZVI-sand system or the sand system alone. Our findings suggest that ZVI-sand filtration can effectively reduce microbial contaminants in irrigation water; however, there seem to be no residual disinfection capabilities after filtration.
Association between community socioeconomic factors, animal feeding operations, and campylobacteriosis incidence rates: Foodborne Diseases Active Surveillance Network (FoodNet), 2004–2010
(Springer Nature, 2016-07-22) Rosenberg Goldstein, Rachel E.; Cruz-Cano, Raul; Jiang, Chengsheng; Palmer, Amanda; Blythe, David; Ryan, Patricia; Hogan, Brenna; White, Benjamin; Dunn, John R.; Libby, Tanya; Tobin-D’Angelo, Melissa; Huang, Jennifer Y.; McGuire, Suzanne; Scherzinger, Karen; Ting Lee, Mei-Ling; Sapkota, Amy R.
Campylobacter is a leading cause of foodborne illness in the United States. Campylobacter infections have been associated with individual risk factors, such as the consumption of poultry and raw milk. Recently, a Maryland-based study identified community socioeconomic and environmental factors that are also associated with campylobacteriosis rates. However, no previous studies have evaluated the association between community risk factors and campylobacteriosis rates across multiple U.S. states. We obtained Campylobacter case data (2004–2010; n = 40,768) from the Foodborne Diseases Active Surveillance Network (FoodNet) and socioeconomic and environmental data from the 2010 Census of Population and Housing, the 2011 American Community Survey, and the 2007 U.S. Census of Agriculture. We linked data by zip code and derived incidence rate ratios using negative binomial regression models. Community socioeconomic and environmental factors were associated with both lower and higher campylobacteriosis rates. Zip codes with higher percentages of African Americans had lower rates of campylobacteriosis (incidence rate ratio [IRR]) = 0.972; 95 % confidence interval (CI) = 0.970,0.974). In Georgia, Maryland, and Tennessee, three leading broiler chicken producing states, zip codes with broiler operations had incidence rates that were 22 % (IRR = 1.22; 95 % CI = 1.03,1.43), 16 % (IRR = 1.16; 95 % CI = 0.99,1.37), and 35 % (IRR = 1.35; 95 % CI = 1.18,1.53) higher, respectively, than those of zip codes without broiler operations. In Minnesota and New York FoodNet counties, two top dairy producing areas, zip codes with dairy operations had significantly higher campylobacteriosis incidence rates (IRR = 1.37; 95 % CI = 1.22, 1.55; IRR = 1.19; 95 % CI = 1.04,1.36). Community socioeconomic and environmental factors are important to consider when evaluating the relationship between possible risk factors and Campylobacter infection.
The association of long-term exposure to PM2.5 on all-cause mortality in the Nurses’ Health Study and the impact of measurement-error correction
(Springer Nature, 2015-05-01) Hart, Jaime E; Liao, Xiaomei; Hong, Biling; Puett, Robin C; Yanosky, Jeff D; Suh, Helen; Kioumourtzoglou, Marianthi-Anna; Spiegelman, Donna; Laden, Francine
Long-term exposure to particulate matter less than 2.5 μm in diameter (PM2.5) has been consistently associated with risk of all-cause mortality. The methods used to assess exposure, such as area averages, nearest monitor values, land use regressions, and spatio-temporal models in these studies are subject to measurement error. However, to date, no study has attempted to incorporate adjustment for measurement error into a long-term study of the effects of air pollution on mortality. We followed 108,767 members of the Nurses’ Health Study (NHS) 2000–2006 and identified all deaths. Biennial mailed questionnaires provided a detailed residential address history and updated information on potential confounders. Time-varying average PM2.5 in the previous 12-months was assigned based on residential address and was predicted from either spatio-temporal prediction models or as concentrations measured at the nearest USEPA monitor. Information on the relationships of personal exposure to PM2.5 of ambient origin with spatio-temporal predicted and nearest monitor PM2.5 was available from five previous validation studies. Time-varying Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95 percent confidence intervals (95%CI) for each 10 μg/m3 increase in PM2.5. Risk-set regression calibration was used to adjust estimates for measurement error. Increasing exposure to PM2.5 was associated with an increased risk of mortality, and results were similar regardless of the method chosen for exposure assessment. Specifically, the multivariable adjusted HRs for each 10 μg/m3 increase in 12-month average PM2.5 from spatio-temporal prediction models were 1.13 (95%CI:1.05, 1.22) and 1.12 (95%CI:1.05, 1.21) for concentrations at the nearest EPA monitoring location. Adjustment for measurement error increased the magnitude of the HRs 4-10% and led to wider CIs (HR = 1.18; 95%CI: 1.02, 1.36 for each 10 μg/m3 increase in PM2.5 from the spatio-temporal models and HR = 1.22; 95%CI: 1.02, 1.45 from the nearest monitor estimates). These findings support the large body of literature on the adverse effects of PM2.5, and suggest that adjustment for measurement error be considered in future studies where possible.
Autism Spectrum Disorder and Hazardous Air Pollutants in the U.S. and Maryland
(2010) Trousdale, Kristie; Dabney, Betty J; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
The prevalence of Autism Spectrum Disorder (ASD) diagnoses in the United States has increased dramatically over the past 20 years, fueling investigations into possible environmental triggers for the disorder. Exposures to pesticides, persistent pollutants, prescription medications, and heavy metals through various routes have been examined, but very few studies have examined the potential role of chronic inhalation of hazardous air pollutants (HAPs) in the etiology of ASD. This thesis was designed to examine possible relationships between HAPs and ASD prevalence on a statewide level for the U.S., with sub-analyses on a finer, countywide level within the state of Maryland. Findings suggest consistent, positive associations between ASD prevalence and HAPs at the statewide level for the U.S. The findings do not persist at the county level in the Maryland sub-analyses. These results reinforce the concept of ASD as a spectrum of phenotypes best explained through multifactorial etiological models.
Being overburdened and medically underserved: assessment of this double disparity for populations in the state of Maryland
(Springer Nature, 2014-04-04) Wilson, Sacoby; Zhang, Hongmei; Jiang, Chengsheng; Burwell, Kristen; Rehr, Rebecca; Murray, Rianna; Dalemarre, Laura; Naney, Charles
Environmental justice research has shown that many communities of color and low-income persons are differentially burdened by noxious land uses including Toxic Release Inventory (TRI) facilities. However, limited work has been performed to assess how these populations tend to be both overburdened and medically underserved. We explored this “double disparity” for the first time in Maryland. We assessed spatial disparities in the distribution of TRI facilities in Maryland across varying levels of sociodemographic composition using 2010 US Census Health Professional Shortage Area (HPSA) data. Univariate and multivariate regression in addition to geographic information systems (GIS) were used to examine relationships between sociodemographic measures and location of TRI facilities. Buffer analysis was also used to assess spatial disparities. Four buffer categories included: 1) census tracts hosting one or more TRI facilities; 2) tracts located more than 0 and up to 0.5 km from the closest TRI facility; 3) tracts located more than 0.5 km and up to 1 km from a TRI facility; and 4) tracts located more than 1 km and up to 5 km from a TRI facility. We found that tracts with higher proportions of non-white residents and people living in poverty were more likely to be closer to TRI facilities. A significant increase in income was observed with an increase in distance between a census tract and the closest TRI facility. In general, percent non-white was higher in HPSA tracts that host at least one TRI facility than in non-HPSA tracts that host at least one TRI facility. Additionally, percent poverty, unemployment, less than high school education, and homes built pre-1950 were higher in HPSA tracts hosting TRI facilities than in non-HPSA tracts hosting TRI facilities. We found that people of color and low-income groups are differentially burdened by TRI facilities in Maryland. We also found that both low-income groups and persons without a high school education are both overburdened and medically underserved. The results of this study provide insight into how state agencies can better address the double disparity of disproportionate environmental hazards and limited access to health care resources facing vulnerable communities in Maryland.
Both parents matter: a national-scale analysis of parental race/ethnicity, disparities in prenatal PM2.5 exposures and related impacts on birth outcomes
(Springer Nature, 2022-05-06) Payne-Sturges, Devon C.; Puett, Robin; Cory-Slechta, Deborah A.
Most U.S. studies that report racial/ethnic disparities in increased risk of low birth weight associated with air pollution exposures have been conducted in California or northeastern states and/or urban areas, limiting generalizability of study results. Few of these studies have examined maternal racial/ethnic groups other than Non-Hispanic Black, non-Hispanic White and Hispanic, nor have they included paternal race. We aimed to examine the independent effects of PM2.5 on birth weight among a nationally representative sample of U.S. singleton infants and how both maternal and paternal race/ethnicity modify relationships between prenatal PM2.5 exposures and birth outcomes. We used data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS–B), a longitudinal nationally representative cohort of 10,700 U.S. children born in 2001, which we linked to U.S.EPA’s Community Multi-scale Air Quality (CMAQ)-derived predicted daily PM2.5 concentrations at the centroid of each Census Bureau Zip Code Tabulation Area (ZCTA) for maternal residences. We examined relationships between term birthweight (TBW), term low birthweight rate (TLBW) and gestational PM2.5 pollutant using multivariate regression models. Effect modification of air pollution exposures on birth outcomes by maternal and paternal race was evaluated using stratified models. All analyses were conducted with sample weights to provide national-scale estimates. The majority of mothers were White (61%). Fourteen percent of mothers identified as Black, 21% as Hispanic, 3% Asian American and Pacific Islander (AAPI) and 1% American Indian and Alaskan Native (AIAN). Fathers were also racially/ethnically diverse with 55% identified as White Non-Hispanic, 10% as Black Non-Hispanic, 19% as Hispanic, 3% as AAPI and 1% as AIAN. Results from the chi-square and ANOVA tests of significance for racial/ethnic differences indicate disparities in prenatal exposures and birth outcomes by both maternal and paternal race/ethnicity. Prenatal PM2.5 was associated with reduced birthweights during second and third trimester and over the entire gestational period in adjusted regression models, although results did not reach statistical significance. In models stratified by maternal race and paternal race, one unit increase in PM2.5 was statistically significantly associated with lower birthweights among AAPI mothers, -5.6 g (95% CI:-10.3, -1.0 g) and AAPI fathers, -7.6 g (95% CI: -13.1, -2.1 g) during 3rd trimester and among births where father’s race was not reported, -14.2 g (95% CI: -24.0, -4.4 g). These data suggest that paternal characteristics should be used, in addition to maternal characteristics, to describe the risks of adverse birth outcomes. Additionally, our study suggests that serious consideration should be given to investigating environmental and social mechanisms, such as air pollution exposures, as potential contributors to disparities in birth outcomes among AAPI populations.
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.
Climate change, extreme events, and increased risk of salmonellosis: foodborne diseases active surveillance network (FoodNet), 2004-2014
(Springer Nature, 2021-09-18) Morgado, Michele E.; Jiang, Chengsheng; Zambrana, Jordan; Upperman, Crystal Romeo; Mitchell, Clifford; Boyle, Michelle; Sapkota, Amy R.; Sapkota, Amir
Infections with nontyphoidal Salmonella cause an estimated 19,336 hospitalizations each year in the United States. Sources of infection can vary by state and include animal and plant-based foods, as well as environmental reservoirs. Several studies have recognized the importance of increased ambient temperature and precipitation in the spread and persistence of Salmonella in soil and food. However, the impact of extreme weather events on Salmonella infection rates among the most prevalent serovars, has not been fully evaluated across distinct U.S. regions. To address this knowledge gap, we obtained Salmonella case data for S. Enteriditis, S. Typhimurium, S. Newport, and S. Javiana (2004-2014; n = 32,951) from the Foodborne Diseases Active Surveillance Network (FoodNet), and weather data from the National Climatic Data Center (1960-2014). Extreme heat and precipitation events for the study period (2004-2014) were identified using location and calendar day specific 95th percentile thresholds derived using a 30-year baseline (1960-1989). Negative binomial generalized estimating equations were used to evaluate the association between exposure to extreme events and salmonellosis rates. We observed that extreme heat exposure was associated with increased rates of infection with S. Newport in Maryland (Incidence Rate Ratio (IRR): 1.07, 95% Confidence Interval (CI): 1.01, 1.14), and Tennessee (IRR: 1.06, 95% CI: 1.04, 1.09), both FoodNet sites with high densities of animal feeding operations (e.g., broiler chickens and cattle). Extreme precipitation events were also associated with increased rates of S. Javiana infections, by 22% in Connecticut (IRR: 1.22, 95% CI: 1.10, 1.35) and by 5% in Georgia (IRR: 1.05, 95% CI: 1.01, 1.08), respectively. In addition, there was an 11% (IRR: 1.11, 95% CI: 1.04-1.18) increased rate of S. Newport infections in Maryland associated with extreme precipitation events. Overall, our study suggests a stronger association between extreme precipitation events, compared to extreme heat, and salmonellosis across multiple U.S. regions. In addition, the rates of infection with Salmonella serovars that persist in environmental or plant-based reservoirs, such as S. Javiana and S. Newport, appear to be of particular significance regarding increased heat and rainfall events.
Code to reproduce analysis of manuscript: Minimal transmission in an influenza A (H3N2) human challenge-transmission model with exposure events in a controlled environment
(2019-12-10) Bueno de Mesquita, Paul Jacob; Milton, Donald K.
The Community Environmental Health Assessment Workbook: A Guide to Evaluating your Community's Health
(Environmental Law Institute, 2000-12) Payne-Sturges, Devon; Locke, Paul; Keiner, Suellen
This Workbook will help community leaders, local organizers, and citizens groups assess environmental health problems in their neighborhoods and assist them in tackling these problems. It outlines an approach to identifying problems, gathering information, and establishing the community’s priorities for improving the environmental health of its residents. The Workbook is divided into four parts. It is written mainly for the citizen organizer, community leader, or other person who will serve as the project manager and take the lead in organizing the assessment. Part One is a brief introduction and discussion of this Workbook. Part Two discusses the reasons why your community should undertake an environmental health assessment, and outlines the assessment process. Part Three explains the community environmental health assessment process step-by-step, and shows citizens in detail how to conduct an assessment. Part Four suggests possible next steps after a community assessment is completed.