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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Start date: 2020End date: 2024

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    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.
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    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.
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    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.
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    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.
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    Experiential Graduate Course Prepares Transdisciplinary Future Leaders to Innovate at the Food-Energy-Water Nexus
    (MDPI, 2021-01-29) Murray, Rianna Teresa; Marbach-Ad, Gili; McKee, Kelsey; Sapkota, Amy Rebecca
    Food, energy and water (FEW) systems are critically stressed worldwide. These challenges require transformative science, engineering and policy solutions. However, cross-cutting solutions can only arise through transdisciplinary training of our future science and policy leaders. The University of Maryland Global STEWARDS National Science Foundation Research Traineeship seeks to meet these needs. This study assessed a foundational component of the program: a novel, experiential course focused on transdisciplinary training and communication skills. We drew on data from the first two offerings of the course and utilized a mixed-method, multi-informant evaluation that included validated pre–post surveys, individual interviews and focus groups. Paired Mann–Whitney–Wilcoxon tests were used to compare pre- and post-means. After the course, students reported improvements in their ability to identify strengths and weaknesses of multiple FEW nexus disciplines; articulate interplays between FEW systems at multiple scales; explain to peers the most important aspects of their research; and collaborate with scientists outside their field. Students also reported improvements in their oral and written communication skills, along with their ability to critically review others’ work. Our findings demonstrate that this graduate course can serve as an effective model to develop transdisciplinary researchers and communicators through cutting edge, experiential curricular approaches.
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    Global Population Exposed to Extreme Events in the 150 Most Populated Cities of the World: Implications for Public Health
    (MDPI, 2021-02-01) Li, Linze; Jiang, Chengsheng; Murtugudde, Raghu; Liang, Xin-Zhong; Sapkota, Amir
    Climate change driven increases in the frequency of extreme heat events (EHE) and extreme precipitation events (EPE) are contributing to both infectious and non-infectious disease burden, particularly in urban city centers. While the share of urban populations continues to grow, a comprehensive assessment of populations impacted by these threats is lacking. Using data from weather stations, climate models, and urban population growth during 1980–2017, here, we show that the concurrent rise in the frequency of EHE, EPE, and urban populations has resulted in over 500% increases in individuals exposed to EHE and EPE in the 150 most populated cities of the world. Since most of the population increases over the next several decades are projected to take place in city centers within low- and middle-income countries, skillful early warnings and community specific response strategies are urgently needed to minimize public health impacts and associated costs to the global economy.
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    Framing Environmental Health Decision-Making: The Struggle over Cumulative Impacts Policy
    (MDPI, 2021-04-09) Payne-Sturges, Devon C.; Sangaramoorthy, Thurka; Mittmann, Helen
    Little progress has been made to advance U.S. federal policy responses to growing scientific findings about cumulative environmental health impacts and risks, which also show that many low income and racial and ethnic minority populations bear a disproportionate share of multiple environmental burdens. Recent scholarship points to a “standard narrative” by which policy makers rationalize their slow efforts on environmental justice because of perceived lack of data and analytical tools. Using a social constructivist approach, ethnographic research methods, and content analysis, we examined the social context of policy challenges related to cumulative risks and impacts in the state of Maryland between 2014 and 2016. We identified three frames about cumulative impacts as a health issue through which conflicts over such policy reforms materialize and are sustained: (a) perceptions of evidence, (b) interpretations of social justice, and (c) expectations of authoritative bodies. Our findings illustrate that policy impasse over cumulative impacts is highly dependent on how policy-relevant actors come to frame issues around legislating cumulative impacts, rather than the “standard narrative” of external constraints. Frame analysis may provide us with more robust understandings of policy processes to address cumulative risks and impacts and the social forces that create health policy change.
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    Development and Limitations of Exposure Biomarkers to Dietary Contaminants Mycotoxins
    (MDPI, 2021-04-28) Turner, Paul C.; Snyder, Jessica A.
    Mycotoxins are toxic secondary fungal metabolites that frequently contaminate cereal crops globally, presenting exposure hazards to humans and livestock in many settings. The heterogeneous distribution of mycotoxins in food restricts the usefulness of food sampling and intake estimates for epidemiological studies, making validated exposure biomarkers better tools for informing epidemiological investigations. While biomarkers of exposure have served important roles for understanding the public health impact of mycotoxins such as aflatoxins (AF), the science of biomarkers must continue advancing to allow for better understanding of mycotoxins’ roles in the etiology of disease and the effectiveness of mitigation strategies. This review will discuss mycotoxin biomarker development approaches over several decades for four toxins of significant public health concerns, AFs, fumonisins (FB), deoxynivalenol (DON), and ochratoxin A (OTA). This review will also highlight some knowledge gaps, key needs and potential pitfalls in mycotoxin biomarker interpretation.
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    Laboratory Chamber Evaluation of Flow Air Quality Sensor PM2.5 and PM10 Measurements
    (MDPI, 2022-06-15) Crnosija, Natalie; Zamora, Misti Levy; Rule, Ana M.; Payne-Sturges, Devon
    The emergence of low-cost air quality sensors as viable tools for the monitoring of air quality at population and individual levels necessitates the evaluation of these instruments. The Flow air quality tracker, a product of Plume Labs, is one such sensor. To evaluate these sensors, we assessed 34 of them in a controlled laboratory setting by exposing them to PM10 and PM2.5 and compared the response with Plantower A003 measurements. The overall coefficient of determination (R2) of measured PM2.5 was 0.76 and of PM10 it was 0.73, but the Flows’ accuracy improved after each introduction of incense. Overall, these findings suggest that the Flow can be a useful air quality monitoring tool in air pollution areas with higher concentrations, when incorporated into other monitoring frameworks and when used in aggregate. The broader environmental implications of this work are that it is possible for individuals and groups to monitor their individual exposure to particulate matter pollution.
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    EXAMINATION OF THE ASSOCIATIONS BETWEEN SELECTED PERFLUOROALKYL SUBSTANCES AND THEIR ISOMERS WITH BODY WEIGHT IN ADOLESCENTS USING NHANES 2013-2018
    (2023) Snyder, Jessica A; Payne-Sturges, Devon; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    0ABSTRACT Title of thesis: EXAMINATION OF THE ASSOCIATIONS BETWEEN SELECTED PERFLUOROALKYL SUBSTANCES AND THEIR ISOMERS WITH BODY WEIGHT IN ADOLESCENTS USING NHANES 2013-2018 Jessica Snyder, Master of Science, 2023 Thesis Directed by: Professor Devon Payne-Sturges Maryland Institute for Applied Environmental Health Perfluoroalkyl substances (PFAS), a class of environmentally persistent chemicals, are suspected of having obesogenic properties, with studies thus far being inconclusive. Few past studies of PFAS toxicity have distinguished between isomer types of each PFAS group during analysis, however. In this thesis, data for non-smoking 14-19 year-olds from three cycles of the National Health and Nutrition Examination Survey was analyzed to identify potential associations in adolescents between bodyweight and two major families of PFAS: perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) and to additionally determine if differentiating between linear and branched isomeric groups of two major PFAS families could better elucidate any associations found. In unadjusted models, weighted linear regression of body mass index (BMI) and serum concentrations of branched, linear, and total PFAS isomer groups, all returned positive associations ranging from β (95% confidence interval) of 4.06 (3.44, 4.68) for total PFOS to 12.33 (10.39,14.28) for linear PFOA. When models were adjusted for sex, age, race/ethnic origin and income level, however, only a negative association between BMI and branched PFOS (bPFOS) was found, with β= -1.24 (-2.10, -0.39). Unadjusted weighted logistic regression models of both overweight and obese status resulted in positive associations between obesity and both branched PFOS and total PFOS with odds ratios (95% confidence intervals) of 0.45 (0.27, 0.74) and 0.86 (0.75, 0.99) respectively. After adjusting for potential confounders, the only statistically significant relationship was between branched bPFOS and obesity, with a 56% decrease in the odds of obesity for every unit increase in serum concentration of bPFOS [β =-1.06, adjusted odds ratio= 0.44 (0.26,0.76)]. There was no significant difference between the sexes in any results. The apparent protective effect that bPFOS has against obesity and elevated BMI, notable as a health outcome association in itself, also illustrates that isomeric differentiation is important in studying PFAS, as nPFOS had no statistically significant 1 association by itself while ΣPFOS, used by many studies, did. Thus, the lack of differentiation could mask which PFAS type contributes to any associations discovered.