2024 Pilot Project Awardees: Environmental Health

Title:  Indoor Air Pollution and Cardiac Autonomic Function in Persons Living with HIV

Abstract:  Today persons living with HIV(PLWH) face an increasing prevalence of age-related comorbidities. Both chronic respiratory and cardiovascular diseases are now significant contributors to morbidity among PLWH. There is a need to identify disease pathways that have the potential to impact multi-disease morbidity in today’s aging HIV population. To date there is limited data on the impacts of the indoor environment on both cardiovascular and respiratory health in PLWH.

The Study of HIV Infection in the Etiology of Lung Disease (SHIELD) is an ongoing cohort of individuals with or at-risk for HIV. SHIELD was recently funded to describe the contribution of the environment to respiratory morbidity among PLWH. The robust infrastructure of SHIELD allows for further investigation of multi-morbidity and cardiovascular effects in a high-risk population often overlooked in environmental health research. Our hypothesis is that PLWH represent a population that is uniquely susceptible to the cardiovascular health effects of air pollution exposure.

The study will leverage an innovative approach to capturing data on heart rate variability(HRV), a marker of cardiac autonomic function tied closely to cardiovascular health and mortality risk, to address this hypothesis. The project will deploy a wearable ECG sensor in 20 participants, capturing HRV with enhanced temporal resolution. This will provide preliminary data describing how short-term changes in pollutant exposure impact HRV and cardiovascular health. This pilot tests an innovative approach that can be deployed in clinical practice and also scaled to larger studies focused on the impact of indoor air pollution on multi-disease morbidity in HIV.

Email:  sraju3@jhmi.edu

Title:  Shore Power and AiR Quality (SPARQ) in Baltimore

Abstract:  Children living in neighborhoods near the Port of Baltimore are exposed to particulate matter (PM) and other air pollution emitted from cargo and passenger vessels, sources that are poorly regulated and whose emissions are challenging to quantify. 

Exposure risk is highest when vessels are near land or docked in the port, and passenger cruise vessels typically remain docked in port with diesel generators running to power their onboard systems while loading and unloading passengers and supplies. Many cargo and passenger ports around the world have updated their dockside infrastructure to provide shore power, that is electrical connections that docked ships can plug into in order to power their systems without the need for diesel generators, but these facilities are lacking in the Port of Baltimore. 

Therefore, the purpose of this study is to quantify the amount of fine PM pollution attributable to docked passenger cruise vessels in the Port of Baltimore and to model improvements to air quality if shore power was made available. We will use fine spatiotemporal estimates of PM concentrations from a network of low-cost air quality monitors already in place throughout the Baltimore region along with meteorological data to model PM pollution attributable to docked cruise vessels’ positions as identified through U.S. Coast Guard marine transponder data. 

The valuable information this study will supply should provide evidence of the potential health benefits to nearby communities if the Baltimore Port Administration joined many other ports in upgrading their facilities to provide shore power to docked passenger vessels.

Email:  kaune1@jhu.edu

Title:  Evaluating Environmental and Occupational Exposures to Respiratory Toxicants among Chilean Agricultural Workers in the METALES Study

Abstract:  Agricultural workers experience disproportionate occupational exposures to numerous respiratory toxicants, including complex mixtures of pesticides and semi-volatile organic compounds like polycyclic aromatic hydrocarbons (PAHs). Intensification of global agricultural production has relied heavily on the use of toxic agrochemicals, elevating exposure among agricultural workers and surrounding communities. 

Since the 1990s, applications of the herbicide glyphosate have steadily risen, especially with the advent of genetically engineered “Roundup Ready” crops, prompting a nearly 15-fold increase in global glyphosate use. Simultaneously, exposure to PAHs, emitted from biomass and fossil fuel combustion, remains a significant threat to respiratory health in Latin America, where the prevalence of household wood burning indoors remains high. Nevertheless, regional biomonitoring efforts are scant, limiting scientific understanding of how chemical mixtures contribute to the excess respiratory disease. 

The present study employs silicone wristbands as a novel method to simultaneously assess exposure to multiple classes of chemicals in a nested cross-sectional pilot study of 43 workers from Molina, Chile, an urban area surrounded by agriculture. Specifically, this proposal seeks to determine the utility of silicone wristbands for assessing environmental risk factors compared to urinary biomonitoring in a largely understudied rural, agricultural community that may be associated with respiratory diseases and other chronic diseases. Observed pesticide and PAH exposure levels will also be utilized to estimate cumulative risk of adverse respiratory effects. This study aims to report back results via effective and accessible communication of results to participants to begin mitigating harmful exposures in a vulnerable working community.

Email:  mdesan11@jhu.edu; gtore1@jhu.edu

Title:  The Salon Wellness Coalition:  Establishing key alliances for effective outreach in underserved and  underrepresented workers in salon settings to address women and children's health. 

Abstract:  Hairdressers remain an understudied and underrepresented population in environmental health research despite continued exposures to mixtures of EDCs of concern and potential exposure and health disparities. EDC exposures in hairdressers can also impact children’s health. Many hairdressers work during critical windows of susceptibility, including the preconception and prenatal periods, where EDC exposures could negatively impact fertility, birth outcomes, and children’s long-term health. Community partners and hairdressers in our community-engaged pilot work have voiced significant concerns related to women and children’s health across the life course. Many are concerned about reproductive disorders and reported adverse birth outcomes. Higher prevalence of various adverse pregnancy-related outcomes among hairdressers compared to office workers also raise concerns and support the need for larger studies to address exposures in this overburdened workforce.  

In addition to these concerns, our work has revealed participant reluctance to participate in research. Building trust in the salon/hairdresser community is paramount to inform exposure mitigation strategies and epidemiologic studies that aim to improve women and children’s health. To successfully engage and recruit hairdressers in future research studies, we propose to develop novel initiatives to build community trust and identify effective outreach strategies. We will also identify best practices for dissemination of environmental and respiratory health information with a focus on women and children’s health in this community. Initiatives developed will serve as a template for engagement with this underserved community and can be leveraged to inform effective outreach and dissemination approaches for improving women and children’s environmental health in underserved communities.

Email:  lquiros@jhu.edu

Title:  Indoor Air Pollution and COVID-19 in Multigenerational Households on the Cheyenne River Sioux Tribe COVID-19 Wayakta He? Study

Abstract:  American Indian Tribal members experience an increased burden from infectious agents such as SARS-CoV-2. Families were hit particularly hard by COVID-19 pandemic, a concern for the CRST, where many people on live in large multigenerational family units. We are concerned about the combination of indoor air exposures to contaminants from environmental tobacco smoke (ETS) and nitrogen dioxide (NO2), which are very common exposures in this community and can exacerbate upper respiratory infections. In 2021, the CRST was awarded the NIH R21 titled “CRST COVID-19 Wayakta He?” (Are you on guard against COVID-19?) due to this, all samples have been collected and all air measurements have been analyzed. 

Unfortunately, the grant expired before community outreach and involvement could begin. The goal of this research is to understand how indoor air pollution due to ETS and NO2 within multigenerational households on the CRST impacts COVID-19. We aim to complete analysis for this study by understanding how indoor air exposures impact COVID-19 among households and disseminating information to participants and relevant community stakeholders on the CRST. 

Email:  atiller2@jh.edu

Title:  Advancing Children's Environmental Health Communication Through an Online Interactive Doodle 

Abstract:  We propose to create educational assets for a webpage including a minigame in the style of a Google Doodle for an Advancing Communication and Education Pilot Project. Aims of the project include:

1. Increasing user engagement on the BREATHE Center Dashboard
2. Providing another method of information delivery on the BREATHE Center Dashboard to accommodate different users
3. Building assets to share on social media to promote the BREATHE Center Dashboard as well as to provide education on children’s environmental health topics

The game will be created in conjunction with BREATHE Center experts. During development, we will run several rounds of usability testing with the community to ensure that the game is usable and appropriate for our target audience. We hope to release the game and social media posts in October, in concordance with Children’s Environmental Health Day. At the end of the project, we will also run a test comparing learning and engagement between the game versus online text and images to gain insight into how community users interact with online media and how to further spread important messages on environmental health.  

Email:  jday19@jhmi.edu

Title:  Leveraging Electronic Patient Portals for Delivery of Asynchronous Asthma Education Following Asthma Exacerbation

Abstract:  Significance/Innovation: Asthma is one of the most common chronic conditions of childhood, with a particularly high disease burden among children from low-income communities. Parental and patient understanding of disease is essential for mitigating symptoms. However, many barriers exist to obtaining high-quality education particularly for resource limited families. To our knowledge limited research exists on the use of an existing patient portal for delivery of standardized disease specific asthma education post exacerbation. 

Relevance to Children’s Environmental Health: Asthma severity and symptom management is intertwined with a child’s environment. In fact, environmental pollutants and allergens are among the most common causes of uncontrolled symptoms and repeated exacerbations. Therefore, a major piece of our asthma education efforts will center around identification of environmental triggers and taking steps to reduce their impact. 

Aims: Develop high-quality asthma education to disseminate via Patient Portal “MyChart” after acute exacerbation. Understand the acceptability of the delivery mechanism and efficacy for improving patient/parent education post exacerbation. 

Research Plan: Collaborate with personnel within EMR to create succinct high yield asthma education that can be distributed after ED visit for asthma exacerbation. Distribute this education to relevant participants. Collect data on what percentage of individuals opens education. Determine acceptability of this delivery mechanism via focus group interviews with 10-15 recipients. Compare rates of follow up and ED visits post exacerbation with a historical control group. 

Translational Plan: Disseminate findings to relevant stakeholders within participating clinics and clinic advisory boards. Present findings locally and nationally to promote adoption. 

Email:  hsparks1@jh.edu

Title:  Leveraging Time-Activity Data to Improve Exposure Estimation and Lung Health Interventions in Environmental Justice Communities 

Abstract:  Children living in communities on the fenceline of petrochemical and other industrial facilities reside in locations where concentrations of air pollutants are frequently elevated compared to the general population. How and where these children spend time, as compared to children in the general population, may further contribute to children’s inhaled doses of air pollutants. Our project aims to collect primary evidence to demonstrate that exposure estimates relying solely on air pollutant concentrations may mischaracterize true inhaled air pollutant doses by ignoring critical differences in how and where people spend time. We aim to collect and use high-resolution time-activity pattern data for children in a fenceline community to develop quantitative adjustment factors for air pollutant exposure estimation. We will administer time-activity surveys to caregivers of children <6 years in a fenceline community on one weekday and one weekend for three seasons. We will compare distributions of time-activity patterns for children in a fenceline community to two other communities and US EPA’s initial National Human Activity Pattern Survey. We will generate age-adjusted average daily inhaled air volumes and quantitative adjustment factors for fenceline communities for use in future risk assessments of children’s exposure to air pollution. Knowledge gained from this study will be communicated to community members with recommendations for low-no cost behavioral modifications to reduce exposure. We will work with regulatory colleagues to integrate the approach demonstrated in this pilot into agency guidance to advance the practice of exposure and cumulative risk assessment to improve and protect children’s environmental health. 

Email:  slupolt1@jhu.edu 

Title:  Assessing the social network structure of high-risk pregnant patients: A novel research method in Obstetrics 

Abstract: Prenatal environmental exposures play a significant role in the development of child respiratory diseases such as asthma. The strength of social networks in the mother, assessed by mapping her immediate connections to others, represents a critical component of the early life exposome. Similar to other non-chemical environmental exposures such as maternal psychosocial stress, social networks may alter fetal programming to increase risks of child respiratory disease. While social networks have been demonstrated to influence other disease outcomes such as obesity and stroke among adults, the contribution of maternal social networks to the development of childhood respiratory disease is unknown. This study hypothesizes that a weak maternal social network may enhance fetal vulnerability and increase the risk of poor neonatal outcomes predisposing towards child asthma. This application proposes a pilot study of 15 women recruited from an ethnically diverse, NYC cohort of pregnant mothers with active asthma, in which relationships between indoor air pollution and dietary exposures and maternal-fetal health are currently under investigation. Features of the pregnant mother’s social network, such as the size and density, will be quantitatively characterized at one time point in gestation. Associations between these characteristics and birth outcomes on the pathway to asthma, including low birth weight and prematurity, will be explored. This work represents a critical opportunity to identify novel environmental factors that influence the risk of respiratory disease among children. Study results will directly inform a subsequent larger study of the longer-term impact of early-life social exposures on child asthma.

Email:  rachel.meislin@mssm.edu 

Title: Contribution of Metal Exposures to Chronic Lung Risks from Use of Electronic Cigarettes 

Abstract: The goal of this research is to understand the contribution of heavy metals inhaled at a young age to long term health outcomes. We will use questionnaire data to assess e-cigarette use, and will analyze metals in urine, blood, and aerosol from user e-cig devices. Enhancing our understanding of excess risk from vaping will inform policy makers on the risks of using e-cigarettes over a lifetime, which can direct public health guidance on youth nicotine use. Heavy metals such as Cr and Ni have been found in e-cigarette aerosols and elevated in user’s blood/urine, but it is unknown how low-level inhalation of metals with exposure patterns like e-cigarettes will affect long-term risk of lung outcomes. Although links between respiratory health effects and metal exposures from ambient air and occupation have already been found, a risk assessment quantitating the excess hazard of exposure to metals from behaviors such as e-cigarette use, has not been done. Our hypothesis is that heavy metal exposure from e-cigarette use will be associated with increased body burden (metals in blood) leading to increased risk of respiratory effects.

Email:  atiller2@jh.edu