“Most Shocking and Inhumane”: Health Disparities in Reproductive Health
Erica Marsh, M.D., M.S.C.I., Department of Obstetrics and Gynecology, University of Michigan

Erica Marsh, M.D., M.S.C.I., is the S. Jan Behrman Collegiate Professor of Reproductive Medicine and Chief of Reproductive Endocrinology and Infertility at the University of Michigan Medical School, Department of Obstetrics and Gynecology (OBGYN), Associate Director of the Michigan Institute of Clinical and Health Research (MICHR), and Founder and Director of the Health and Reproductive Disparities (onWHARD!) Collaborative. She graduated from Harvard College magna cum laude, and Harvard Medical School, cum laude. She completed her residency at the Integrated OBGYN at Brigham and Women’s Hospital, and Massachusetts General Hospital, and a Reproductive Endocrinology and Infertility fellowship at Feinberg School of Medicine before joining the faculty. In 2016, Marsh joined the University of Michigan.

Marsh’s research is published in the area of fibroids, abnormal uterine bleeding, patient perspectives and health disparities in reproductive health. Her work is funded by National Institute of Child Health and Human Development (NICHD), National Institute on Minority Health and Health Disparities (NIMHD), and Chan Zuckerberg Foundation. Her research interest is Comparative Reproductive Health across populations to understand the challenges of reproductive disorders through a translational lens. She received the Ira and Esther Rosenwaks New Investigator Award from the American Society of Reproductive Medicine and was elected to the American Society of Clinical Investigation. She founded and directed the Northwestern Medicine Scholars Program and Black Faculty Association at Michigan Medicine. She was Director to the Cook County Board of Health and Hospital Services. Her awards include Chicago Urban League STEM Innovator, Northwestern Medical Faculty Foundation Physician Community Service Excellence, and the Martin Luther King Jr. Humanitarian Award. She is the 2012 Community Health Volunteer Specialist of the Year.

Contact Information:
Email: [email protected]
Phone: 734-232-5029
Fax: 734-936-5948
Twitter: @ericamarshmd

In this presentation we will review key definitions in the health equity and justice space, provide an overview of reproductive health disparities in a number of areas including uterine fibroids, infertility, and in vitro fertilization, and share some questions to contemplate in our roles as clinicians, researchers, scientists, and citizens as we work toward equity in health care.

Racial Disparities and Preterm Birth: Elucidation of the Problem and Identification of Potential Solutions
Tracy Manuck, M.D., M.S.C.I., University of North Carolina – Chapel Hill

Tracy Manuck, M.D., M.S.C.I.,is a tenured Professor in the Department of Obstetrics and Gynecology and Medical Director of the Prematurity Prevention Program at the University of North Carolina – Chapel Hill, Division of Maternal-Fetal Medicine, and Perinatal Section Head of the Institute for Environmental Health Solutions. She completed her Maternal-Fetal Medicine Fellowship at University of Utah. She is a two-time award winner of the National March of Dimes award for “Best Research in Prematurity” and served on multiple Society for Maternal Fetal Medicine committees and task forces. She is Chair of the Society for Maternal Fetal Medicine Research Committee and member of American College of Obstetricians and Gynecologists Committee for Clinical Obstetrics. Her clinical expertise includes preterm labor, cervical insufficiency, preterm premature rupture of membranes, and preeclampsia. She specializes in providing care for women at highest risk for preterm birth, including those with multiple previous preterm deliveries and those before fetal viability. She investigates health disparities in preterm birth and perinatal outcomes, including the impact of environmental exposures. She received national awards and is involved with the research education of medical students, residents, fellows, and junior faculty.

Manuck seeks to provide personalized solutions to identify, quantify, and reduce preterm birth risk factors and health disparities lowering risks of adverse pregnancy outcomes. Her NIH grant awards including R01 (R01-MD011609) and K24 (K24-ES031131), and North Carolina grant research collaborations, focus on improving the prediction of which women will deliver preterm, evaluate maternal and fetal genetics, epigenetics, and environmental exposures to predict which women will have favorable pregnancy outcomes despite high risks for maternal and fetal morbidity and mortality. Funding from the UNC Medical Foundation supports providing solutions to the complex and pervasive problem of preterm birth.

Contact Information:
Email: [email protected]
Address: 3010 Old Clinic Building, CB#7516
Chapel Hill, NC 27516
Web Link: www.manuckresearch.org

In this talk, Dr. Manuck will provide an overview of disparities in preterm birth. Key environmental factors that should be considered when performing bench-to-bedside preterm birth disparities research will be reviewed. Dr. Manuck will discuss novel study designs to better elucidate preterm birth disparities and underlying mechanisms, including providing details regarding two of the Manuck Research Group’s ongoing projects, the Path to Prevent Preterm Birth (P3) and Environment, Perinatal Outcomes, and Children’s Health (EPOCH) studies. Finally, Dr. Manuck will review proposed methods to translate cohort studies to tangible solutions.

A Practical Approach to EleVATE Equity in Reproductive Health 
Ebony B. Carter, M.D., M.P.H., Washington University School of Medicine, St. Louis

Ebony Carter, M.D., M.P.H., is a tenured Associate Professor and Chief of the Division of Clinical Research in the Department of Obstetrics and Gynecology at Washington University School of Medicine. She practices Maternal Fetal Medicine and serves as Associate Editor for Equity at Obstetrics & Gynecology (the Green Journal). Her research focuses on group prenatal care, as a tool to promote health equity, and is funded by the Robert Wood Johnson Foundation, National Institutes of Health, and the American Diabetes Association.

Carter earned her undergraduate degree in human biology with honors from Stanford University, a Master of Public Health in health policy from the University of Michigan, and her medical degree from Duke University. She completed her residency in Obstetrics and Gynecology at the Harvard integrated program at Brigham and Women’s/Massachusetts General Hospitals and fellowship training in Maternal Fetal Medicine at Washington University School of Medicine.

Contact Information:
Email: [email protected]
Office Phone: 314-362-8895

We will explore a solution-driven approach to promote parity in reproductive health outcomes based on the work of the Elevating Voices, Addressing Depression, Toxic Stress and Equity (EleVATE) Collaborative. EleVATE Group Prenatal Care was designed by Black women for Black women and birthing people. The intervention is grounded in trauma-informed care, dismantling racism, group dynamics, and embeds a behavioral health intervention in routine prenatal care.

Resources

• Advancing Positive Change Forward Through Ferguson Toolkit: https://drive.google.com/file/d/1xMUXqfOBvJDIegMk1JJ_O0bEH-fP8na_/view
• Continuum on Becoming an Anti-Racist Multicultural Organization: https://philanos.org/resources/Documents/Conference%202020/Pre-Read%20PDFs/Continuum_AntiRacist.pdf
• EleVATE Women - A paradigm shift to address racial inequities in perinatal healthcare: https://pubmed.ncbi.nlm.nih.gov/33306974/

Measures of Structural Racism and their Association with Reproductive Health Inequities
Maeve Wallace, Ph.D., M.P.H., Tulane University, School of Public Health and Tropical Medicine

Maeve Wallace, Ph.D., M.P.H., is a reproductive epidemiologist. Her research interests focus on the social, structural, and policy determinants of maternal and child health and health inequities including structural racism, violence, health policy, and human rights. Her current work seeks to understand the reasons underlying persistent racial inequities in maternal and infant mortality in New Orleans, across the state of Louisiana, and nationwide. She is Associate Director of the Mary Amelia Center for Women's Health Equity Research and is actively involved in collaboration with local and national community-based organizations and governmental agencies on efforts to improve maternal and child health and advance health equity.

Contact Information:
Email: [email protected]
Office Phone: 504-988-7305
Web Link: https://sph.tulane.edu/sbps/maeve-wallace

Black and other pregnant people of color in the U.S. continue to experience vast inequities in maternal and child health outcomes, including preterm birth, infant and maternal mortality. A large body of research finds that such inequities are not explained by individual-level differences in socioeconomic position, health behaviors, or access to health care. Instead, their persistence arises from the macro-level features and functions of our society that dictate the distribution of power and resources across people and places. Increasingly emergent research has sought to quantify measures of structural racism – the totality of ways in which racial discrimination is embedded across mutually reinforcing societal systems – and other macro-level indicators of inequality for the purposes of empirically evaluating their association with population health inequities.

This presentation will provide an overview of various measures of structural racism used in population health research and summarize research findings related to its harmful impact on maternal and child health outcomes and inequities. It will include recommendations for future extensions in this area of research.

The Intersection of Environmental Justice and Women’s Health: A Translational Epidemiologic Approach to Improve Health Equity
Tamarra James-Todd, Ph.D., M.P.H., Harvard T.H. Chan School of Public Health, Harvard University

Tamarra James-Todd, Ph.D., is an environmental reproductive epidemiologist researching environmental chemicals on women’s cardiometabolic health across the reproductive life course. A past Building Interdisciplinary Careers in Women’s Health (BIRCWH) K12 Scholar, she directs the Environmental Reproductive Justice (ERJ) Lab, which investigates and improves adverse environmental exposure and reproductive health disparities. Her work particularly focuses on the importance of pregnancy as a sensitive window of environmental chemical exposures. She is the Principal Investigator of two NIEHS funded R01 grants, focusing on endocrine disrupting chemicals and adverse maternal health outcomes during pregnancy, postpartum, and mid-life in the Environmental Reproductive and Glucose Outcomes (ERGO) study and Project Viva. She serves as the Principal Investigator for the Community Engagement Core of the Metals and Metal Mixtures: Cognitive Aging, Remediation, and Exposure Sources (MEMCARE) P42 Superfund Research Center. In addition, she runs interventions to improve environmental health literacy in the lay community, as well as among health care professionals. She is also the Director of the Organics Core for the Harvard Chan NIEHS Center, where she launched the Environmental Justice Bootcamp in collaboration with two other NIEHS-funded P30 Centers. She has had the honor of serving on two National Academies of Sciences, Engineering, and Medicine committees and the March of Dimes Environmental Justice Working Group.

Contact Information:
Email: [email protected]
(please CC Marlee Quinn at [email protected])

In this talk, Dr. James-Todd will present epidemiologic studies evaluating the evidence for racial/ethnic disparities in both environmental chemical exposures and women’s reproductive health outcomes across the life course. She will provide an environmental justice framework and strategies for employing epidemiologic tools to address issues of environmental and reproductive health disparities. Dr. James-Todd will provide epidemiologic examples using research focused on endocrine disrupting chemical exposures and their sources as it relates to puberty, pregnancy, and menopause associated outcomes. She will also discuss mediation analysis and other types of analytic methods as tools to address environmental health disparities research questions. Dr. James-Todd will highlight socio-cultural and policy-related drivers of environmental reproductive health disparities as a strategy to improve health equity.

Social-Structural Determinants of Environmental Exposures and Uterine Fibroid Outcomes Among Systematically Marginalized Populations
Ami Zota, Sc.D., M.S., George Washington University Milken Institute School of Public Health

George Washington University Milken Institute School of Public Health

Ami Zota, Sc.D., M.S., is an associate professor at the Department of Environmental & Occupational Health at the George Washington University Milken Institute School of Public Health and an incoming associate professor in the Department of Environmental Health Sciences at Columbia University Mailman School of Public Health (starting June 2022). Her work seeks to secure environmental justice and improve health equity through science, advocacy, communication, and training next generation scientists. Her current research examines how social-structural factors, such as racism, classism, and sexism, shape beauty product use, environmental chemical exposures, and health inequities in women across the life course. Zota is equally committed to science communication. Her work has been featured in high-impact media publications including the Washington Post, USA Today, and The Atlantic, and has helped shape health and safety standards for consumer product chemicals. Zota is also active in multiple efforts to increase diversity, equity, and inclusion in the scientific enterprise. She is the founder and director of the Agents of Change in Environmental Justice, a nationwide program that empowers emerging leaders from historically excluded backgrounds in science and academia to reimagine solutions for a just and healthy planet. In 2017, Zota was recognized as a Pioneer under 40 in Environmental Public Health by the Collaborative on Health and the Environment.

Contact Information:
Email: [email protected]

The public health burden of uterine leiomyomas (fibroids) in the U.S. is immense, with an annual estimated cost of up to $34 billion. These hormonally responsive smooth muscle tumors can substantially burden the millions of women they affect. Fibroid tumors are associated with pelvic pain, heavy bleeding, and infertility. Black women are disproportionately burdened by fibroids. They experience a higher risk of fibroids, an earlier age of onset, and more severe symptoms than non-Black women. However, critical empirical gaps exist in explaining racial disparities in the development and progression of fibroids. There remains a major void in empirical data linking life course social structural stressors to fibroid risk factors, morbidity, and response to medical treatment. Moreover, intersectionality. a critical theoretical framework that asserts that multiple marginalized social positions (e.g., race, gender) and processes (e.g., racism, sexism, classism) intersect to reflect privilege and inequality, has not been integrated broadly into the study of reproductive health. This presentation will discuss the core tenets of intersectionality and its relevance to inequities in environmental exposures and women’s health outcomes.

The presentation will feature three cases that highlight different measures of social-structural stressors. The first case study will discuss how natural hair discrimination, a form of intersectional discrimination experienced by Black women, influences the use of potentially harmful personal care products. The second case study will focus on the association of adverse childhood events, including sexual abuse, fibroid symptom severity, and symptom-related quality of life among a diverse sample of women undergoing hysterectomies for fibroid treatment. The third case study will use qualitative data to illustrate how fibroid management decisions among Black women are influenced by a range of factors including contemporary and historical medical racism.

Resources

• IMPACT Study Instagram account: @harvard_chan_impact_study
• Environmental Reproductive Justice (ERJ) Lab website: https://projects.iq.harvard.edu/james-toddlab

The MIEHR Center: Unraveling Environmental Health Disparities among Mothers and their Children
Elaine Symanski, Ph.D., Baylor College of Medicine

Baylor College of Medicine

Elaine Symanski, Ph.D., is a Professor in the Center for Precision Environmental Health and Department of Medicine at Baylor College of Medicine where she directs the Program in Population and Environmental Health Disparities. She earned her M.S.P.H. and Ph.D. from the University of North Carolina at Chapel Hill. With training in environmental sciences and epidemiology, Symanski’s expertise is in evaluating environmental health risks in over-burdened populations. She is Director of a NIMHD/NIEHS/NICHD P50 Center of Excellence on Environmental Health Disparities Research, the Maternal and Infant Environmental Health Riskscape (MIEHR) Center, which is focused on elucidating the role of myriad factors in the built, social, and physical environments that contribute to disparities in adverse outcomes among pregnant women and their children. Symanski also serves as Deputy Director of a NIEHS P30 Environmental Health Sciences Core Center, the Gulf Coast Center for Precision Environmental Health. She recently participated in SARS CoV-2 seroprevalence investigations with the Houston Health Department and Harris County Public Health. Symanski is currently serving as a sub-group co-chair of an International Agency for Research on Cancer (IARC) Working Group, Cobalt metal (without tungsten carbide or other metal alloys) and cobalt (II) salts; Trivalent and pentavalent antimony; and Weapons-grade tungsten (with nickel and cobalt) alloy, volume 131. Symanski is also co-directing in Spring 2022 the inaugural offering of a medical school course entitled: Environmental Health: What Every Physician Should Know.

Despite advances in healthcare, persistent racial/ethnic inequalities remain a barrier to improving maternal and child health in Houston, a city plagued by environmental justice and equity problems and a microcosm for exposures in the physical, social, and built environments, i.e., the environmental riskscape. Houston is also among the most racially and economically diverse cities in the U.S. Because the city has no zoning laws, many industrial facilities and waste sites are located within poor neighborhoods and neighborhoods of color – as a legacy of historic redlining practices. Consequently, exposures to chemical and non-chemical stressors are heightened among health disparity populations, leading to growing concerns about the health of Houston’s mothers and children. The overarching goal of the Maternal and Infant Environmental Health Riskscape (MIEHR) Research Center is to elucidate the contributions of the environmental riskscape to health disparities in Black and White pregnant women and infants in the greater Houston area. To achieve this goal, we are assembling a cohort of mother-infant dyads from three major obstetric hospitals in the Texas Medical Center to: 1) Assess associations between the mixture of metals and non-chemical stressors, including stress, discrimination, and impacts of disasters with preterm birth and 2) Interrogate maternal biological [e.g., circulating cell-free RNA (cfRNA)] and chemical [PAHs and metal] exposures, as well as features of the social and built environments, to develop disparities-aware classifiers for preterm birth. Identifying the role of combined exposures to chemical and non-chemical stressors and developing predictive classifiers that rely on attributes of individual- and place-level stressors will yield actionable findings that will inform interventions to mitigate disparities and improve the health and well-being of women and their children.

Communities’ Observations to Inform Environmental Health Research in Northeastern British Columbia, Canada 
Élyse Caron-Beaudoin, Ph.D., University of Toronto Scarborough

University of Toronto Scarborough

Élyse Caron-Beaudoin, Ph.D., is an Assistant Professor in environmental health at the University of Toronto in Canada. Her research focuses on the development of transdisciplinary community-based research projects to assess the impacts of environmental pollutants on health by combining information from multiple levels of biological organization. Caron-Beaudoin’s lab uses an innovative participatory approach combining toxicology, molecular biology, community-based research, exposure assessment, epidemiology, and environmental health. Caron-Beaudoin holds a Ph.D. in biology with a specialization in toxicology from the Institute national de la recherche scientifique (INRS; in English, National Institute of Scientific Research) Armand-Frappier Institute in Laval, Quebec. From 2018 to 2020, she was a Canadian Institutes of Health Research-funded postdoctoral fellow at the Université de Montreal. During her fellowship, Caron-Beaudoin investigated the associations between density and proximity to unconventional natural gas wells and birth outcomes in Northeastern British Columbia. She is currently leading a study on exposure to contaminants associated with unconventional natural gas wells during pregnancy.

Contact Information:
Email: [email protected]
Web Link: https://www.elysecaronbeaudoin.com/

Anthropogenic pressures lead to rapid and significant changes in the environment, posing a threat to public health. Several studies confirm that some communities are disproportionately affected by environmental changes. Many of these communities have expressed concerns about the potential health effects of changes in their environment, but few have received support and guidance from researchers in implementing research projects based on their concerns. Our lab highlights community knowledge as a valuable source of information to explore the relationships between environmental factors and health. Most of our lab’s research concerns the potential health impacts of unconventional natural gas operations. To extract natural gas, the industry uses a technique called hydraulic fracturing, which typically involves the drilling of wells and the injection of a large volume of fracking fluid (water, sand, and various chemicals) to fracture the rock formation, freeing the trapped natural gas. Northeastern British Columbia (Canada) sits on an important source of natural gas with approximately 30,000 wells drilled so far. Some chemicals used or associated with hydraulic fracturing may contaminate the soil by accidental spills, leaks, or during disposal of wastewaters. Unconventional natural gas operations can release volatile organic compounds and trace elements naturally occurring in the rock formation. Many of these chemicals are known or suspected reproductive and development toxicants, carcinogens, endocrine disruptors, and respiratory irritants.

During this workshop, Dr. Caron-Beaudoin will present her research regarding the gestational exposure to contaminants associated with unconventional natural gas operations and maternal and birth outcomes in Northeastern British Columbia.

Investigating the Interplay between Environmental and Social Stressors on Maternal Reproductive Health
Carrie Breton, Sc.D., Keck School of Medicine of University of Southern California

Keck School of Medicine of the University of Southern California

Carrie Breton, Sc.D., is Professor of Preventive Medicine at the Keck School of Medicine of the University of Southern California (USC) and is Director of the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) Center for Environmental Health Disparities. She also co-directs the USC program site for the Environmental Influences on Child Health Outcomes (ECHO) national NIH program. Breton’s work addresses the interplay between genetics, epigenetics, and susceptibility to environmental exposures such as air pollution and tobacco smoke on health outcomes in children. Her work in the MADRES Center examines whether pre- and postpartum environmental exposures, coupled with exposures to psychosocial and built environment stressors, affect maternal and child cardiometabolic health outcomes, including perturbed infant growth trajectories and increased childhood obesity risk. Her work in ECHO takes a multigenerational life course approach to studying the contribution of the environment to the developmental origins of childhood and emerging adult respiratory and metabolic health. She has conducted several other studies investigating how environmental exposures alter epigenetic profiles in newborns and young children, and what roles those changes play in underlying disease risk.

Contact Information:
Email: [email protected]

Eliminating disparities in maternal health outcomes is a national priority, especially given the numerous adverse health sequelae. Moreover, pregnancy may be an underappreciated period of susceptibility to environmental exposures and impacts on later maternal health outcomes. Given the lack of data on the relationships between prenatal exposures and stressors with postpartum maternal health, we are currently investigating how exposures such as air pollution affect maternal health outcomes, including complications in pregnancy such as gestational diabetes and thyroid dysfunction, as well as depression and cardiometabolic health in the postpartum period within the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) Center.

Importantly, we are exploring whether different levels of individual or neighborhood level stressors make certain groups of individuals more or less vulnerable to the negative effects of pollutant exposures. In this workshop, we will share recent results investigating the effects of prenatal air pollutants on pregnancy complications and birth outcomes, as well as postpartum maternal health. We highlight that some of the strongest effects on maternal health and birth outcomes are found in participants with the highest levels of perceived stress and who live in neighborhoods experiencing the highest levels of cumulative environmental and social burden.

Racial and Ethnic Disparities in Environmental Exposures and Reproductive Health Outcomes – What Do We Know and What Do We Need to Know?
Michael Bloom, Ph.D., George Mason University

Michael Bloom, Ph.D., is Associate Professor of Global and Community Health at George Mason University, where he teaches graduate level epidemiology and environmental health. He completed a Ph.D. concentrating in environmental epidemiology at the University at Buffalo and postdoctoral training in reproductive epidemiology at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. His research focuses on identifying and characterizing associations between environmental risk factors and human health outcomes in the U.S. and abroad, especially effects on human reproduction and fetal development, and disparate impacts among vulnerable populations. Bloom is the co-Principal Investigator (PI) of the Reproductive Development Study, a prospective investigation of birth outcomes and gestational exposure to environmental pollutants found in personal care products and plastics among a diverse population, and the co-PI of the Study of Metals and Assisted Reproductive Technologies, which investigates the effects of toxic trace elements on reproductive outcomes among diverse couples using in vitro fertilization. Bloom’s work has been supported by the National Institutes of Health and the Fulbright Association.

Contact Information:
Email: [email protected]
Address: George Mason University
Department of Global and Community Health
4400 University Drive, MS 5B7
Fairfax, VA 22030

Women of color experience greater risks of adverse reproductive and fetal developmental outcomes than their white counterparts. Growing research shows that the causal factors driving these reproductive health disparities extend well beyond individual socioeconomic differences but are attributable in large part to the intersection of racist policies in housing, law enforcement, education, and healthcare among others, leading to systematic disadvantages, chronic psychosocial stress, and a disproportionate burden of exposure to reproductive toxicants. The adverse reproductive and fetal developmental effects of women’s exposure to a milieu of chemical and non-chemical stressors may also confer greater lifelong health risks on their offspring and contribute to a vicious intergenerational cycle of health disparity.

Disentangling the intersection of the effects of chemical and non-chemical reproductive stressors on fertility and fetal developmental effects is critically important for eliminating the disparities, yet there are formidable challenges. I will present data-driven examples to illustrate some of the challenges in characterizing the reproductive and fetal developmental risks of women’s exposure to environmental reproductive toxicants and the racial and ethnic disparities in their effects. The examples are intended to foster discussion of the opportunities and strategies for filling the existing data gaps.

Resources

• Caron-Beaudoin, Élyse, et al. "Volatile organic compounds (VOCs) in indoor air and tap water samples in residences of pregnant women living in an area of unconventional natural gas operations: Findings from the EXPERIVA study." Science of The Total Environment 805 (2022): 150242. URL: https://www.sciencedirect.com/science/article/pii/S0048969721053195
• Caron-Beaudoin, Élyse, et al. "Density and proximity to hydraulic fracturing wells and birth outcomes in Northeastern British Columbia, Canada." Journal of Exposure Science & Environmental Epidemiology 31.1 (2021): 53-61. URL: https://www.nature.com/articles/s41370-020-0245-z
• Caron-Beaudoin, E., et al. "Proximity and density to hydraulic fracturing wells, birth outcomes and maternal depression in Northeastern British Columbia, Canada." ISEE Conference Abstracts. Vol. 2020. No. 1. 2020. URL: https://ehp.niehs.nih.gov/doi/abs/10.1289/isee.2020.virtual.P-0311
• Caron-Beaudoin, Élyse, et al. "Urinary and hair concentrations of trace metals in pregnant women from Northeastern British Columbia, Canada: a pilot study." Journal of Exposure Science & Environmental Epidemiology 29.5 (2019): 613-623. URL: https://www.nature.com/articles/s41370-019-0144-3
• Caron-Beaudoin, Élyse, et al. "Gestational exposure to volatile organic compounds (VOCs) in Northeastern British Columbia, Canada: a pilot study." Environment international 110 (2018): 131-138. URL: https://www.sciencedirect.com/science/article/pii/S0160412017310309

Context Matters: The Disconnect Between Animal Models and the Complexity of the Human Environment
Deborah Cory-Slechta, Ph.D., University of Rochester Medical School

Deborah Cory-Slechta, Ph.D., is a Professor of Environmental Medicine and former Dean for Research, Chair of the Department of Environmental Medicine, and PI of the NIEHS Core Center Grant at the University of Rochester Medical School. Her research includes both animal models and human studies focused on the consequences of developmental exposures to environmental chemicals on brain development and behavior and neurodegenerative diseases. One common theme of these studies has been a focus on cumulative risk assessment, including the development of animal models that better simulate human environmental conditions, and epidemiological studies that can better gauge interactions of environmental factors. These efforts have resulted in over 200 peer-reviewed publications. She has served on advisory panels of the NIH, the U.S. Food and Drug Administration (FDA), the U.S. Environmental Protection Agency (EPA), the National Academy of Sciences (NAS), and the Centers for Disease Control and Prevention (CDC), and on the editorial boards of the journals Environmental Health Perspectives, Neurotoxicology, Toxicology, Toxicological Sciences, Toxicology and Applied Pharmacology, and Neurotoxicology and Teratology. She has also served on the U.S. EPA Science Advisory Board and the Board of Scientific Counselors, Agency for Toxic Substances and Disease Registry/CDC. In 2017, she received the Distinguished Neurotoxicologist Award from the Neurotoxicology Specialty Section of the Society of Toxicology and in 2021 was awarded the Distinguished Toxicology Scholar Award from the Society of Toxicology.

Contact Information:
Email: [email protected]
Office Phone: 585-275-7060

Many of the diseases and disorders of widespread prevalence in the human population, and for which cures have been elusive, are deemed ‘complex’ disorders and attributed to multiple environmental and genetic factors. Yet, in general, experimental animal models of chemical exposure effects fail to capture the complexity and context of the human environment, or they focus predominantly on interactions with genetic factors. Our laboratory has attempted to generate more translationally relevant animal models of lead (Pb) exposures, to understand the actual risk to the central nervous system posed by interactions of lead with risk factors with which it shares biological substrates and common adverse outcomes.

These included combinations of developmental Pb exposures with prenatal stress and/or with offspring stress, based on the shared mediation by these risk factors through the hypothalamic-pituitary-adrenal axis and brain mesocorticolimbic systems. Such studies revealed that maternal and/or prenatal stress can enhance Pb neurotoxicity, and even unmask Pb effects not seen in the absence of stress. In some cases, combined Pb exposure and prenatal stress resulted in effects consistent with higher levels of Pb exposure alone. Additionally, Pb neurotoxicity was dramatically influenced by the type of behavioral experience that offspring had previously undergone, resulting in modified epigenetic profiles in the brain. Furthermore, the nature of these interactions was highly sex-dependent. In summary, studies of the neurotoxicity of chemicals such as Pb exposure alone, i.e., in the absence of other pertinent environmental risk factors, may result in misleading information as to exposure levels of concern and mechanisms underlying toxicity.

Linking Adverse Childhood Experiences and Weight Gain in Women: Insights from a Mouse Model of Postnatal Neglect
Analia Loria, Ph.D., University of Kentucky College of Medicine

Analia S. Loria, Ph.D., is an Associate Professor at the Department of Pharmacology and Nutritional Sciences at the University of Kentucky. She earned her bachelor’s degree at the University of Buenos Aires (Argentina) and her Ph.D. at the University of Murcia (Spain), completing her postdoctoral training at the Medical College of Georgia (USA). Loria has a strong background in cardiovascular physiology, biochemistry, and vascular biology of vasoactive peptides. Using mouse and rat models, she investigates the effects of early life stress on cardiovascular and metabolic outcomes. Her postdoctoral work was supported by an American Heart Association Fellowship early on. She was subsequently awarded a K99 from the National Heart, Lung, and Blood Institute focused on the influence of early life stress on renal and vascular function. Since joining the University of Kentucky, Loria has established a laboratory highly focused on the study of cardiovascular function in obesity settings, including the measurement of acute and chronic blood pressure, assessment of vascular function ex vivo, and adipose tissue biology. Loria’s active research program is investigating the sex-specific mechanisms underlying the increased cardiometabolic risk associated with early life stress.

Contact Information:
Email: [email protected]
Phone: 859-218-1414, Lab: 859-218-1395
Web Link: https://pharmns.med.uky.edu/users/alo243

Previously, we have shown that Maternal Separation and Early Weaning (MSEW), a model of early life stress, exacerbates high fat diet (HF)-induced visceral obesity in female offspring compared to normally reared female mice. Here, we investigated the female-specific signature of lipid and kinase pathways in visceral fat when obesity is induced in mice previously exposed to MSEW. Visceral fat was collected to assess lipidomics, transcriptomics, serine/threonine kinase activity, and in vitro lipolysis assay. Female MSEW mice showed increased adiposity and triacylglycerol accumulation (44:2/FA 18:2+NH4 lipids), reduced mitochondrial DNA density, and decreased phosphorylation of seven phosphokinases, despite a similar number of preadipocytes, food intake, and energy expenditure.

Single-cell RNA sequencing in isolated pre- and mature adipocytes showed a ~9-fold downregulation of aquaglyceroporin 3 (Aqp3), a channel responsible for glycerol efflux. Obese MSEW mice displayed high levels of circulating and adrenal-derived aldosterone and visceral adipose tissue-derived corticosterone. As mineralocorticoid receptors (MR) can bind both of these hormones and promote fat cell expansion during obesity, we used the MR blocker spironolactone (100 mg/kg/day, 2 weeks), which normalized the elevated intracellular glycerol levels, and the number of large size adipocytes in MSEW mice compared to controls. This data provides new insights into the dysregulation of adipose tissue in female MSEW mice by identifying possible targets important in adipocyte hypertrophy. Furthermore, our data suggests that MR plays a role in the promotion of adipocyte hypertrophy in female MSEW mice by preventing glycerol release in favor of triglyceride formation and storage.

Community Engagement in Women’s Environmental Public Health in Puerto Rico: PROTECT Responde
Carmen Milagros Velez Vega, Ph.D., M.S.W., University of Puerto Rico Medical Sciences Campus
Maria Isabel Santana, PROTECT

University of Puerto Rico Medical Sciences Campus

Carmen Milagros Vélez Vega, Ph.D., M.S.W., is a Tenured Professor at the University of Puerto Rico. She is active in research on social determinants of maternal and child environmental health and community engagement. She is the Principal Investigator of the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) project, the Center for Research on Early Childhood Exposure and Development in Puerto Rico (CRECE), the international cohort study Zika in Pregnancy and Infant (ZIP), and the Environmental Influences on Child Health Outcomes in Puerto Rico (ECHO-PRO). These projects include a community outreach component that is under the direction of Vélez Vega. She is also the principal investigator of the Community Outreach Component of the Center for Collaborative Research on Health Disparities of the Medical Sciences Campus.

Vélez Vega completed her Ph.D. in Research and Administration of Social Policies from the Graduate School of Social Work, Rio Piedras Campus of the University of Puerto Rico, and also completed a bachelor’s degree in Social Work and a master’s degree in Clinical Social Work from Florida State University. She has extensive experience in community engagement activities and is a member of the Puerto Rican Taskforce on Premature Births. Carmen Vélez Vega is the 2019 recipient of the American Public Health Association (APHA) Helen Rodriguez-Trias Social Justice Award for her work toward social justice for the disadvantaged and underserved women and children in Puerto Rico. Vélez Vega is presently a member of the Environmental Protection Agency’s Children’s Health Protection Advisory Committee (CHPAC).

Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) is a Superfund Research program created in 2010 to study the effects of exposure to contaminants on preterm births and maternal and child health in Puerto Rico. One of PROTECT’s Community Engagement Core objectives is to share with the participants the results of their exposures to chemical and environmental substances during their pregnancy period and strategies to reduce them. During the pandemic, the report back process was affected by social distancing and the closure ordered by the government of Puerto Rico. To generate more accessible and immediate communication with the participants, the PROTECT community engagement team developed a "PROTECT Responde" initiative. The purpose of this initiative was to create an educational campaign developed for digital social media platforms such as Facebook, Youtube, and Instagram to inform participants about possible environmental pollutants and harmful chemicals that can be related to adverse effects on pregnancy in maternal and child health. This campaign, as well as other Community Engagement Core activities, are planned in the context of our Community Advisory Team composed of collaborators in maternal and child health from the participating Federally Qualified Health Centers (FQHCs), Community groups and participants. This team oversees the creation and development of campaign materials and all report back materials and strategies through regular meetings.

The COVID-19 pandemic forced our Community Engagement Core to adapt our implementation strategies, for example translating our printed educational materials to videos, interviews, and infographics through social media platforms, and integrate them into the closed-circuit TV at collaborating FQHCs. The Community Advisory Team were instrumental in reviewing and supporting PROTECT on the development of materials that would answer the needs of our participants and make sure the messages were relevant and understood. The content developed consisted of videos, infographics, and radio segments that educate about PROTECT findings studies of chemicals and environmental pollutants related to preterm birth and other health outcomes. The main aspects to consider in all the creative processes were the importance of cultural humility, sociodemographic characteristics, and adaptation of the scientific content to a general vocabulary. The "PROTECT Responde" initiative is being implemented in health centers and other community settings.

Abandoning Exclusivity for Authentic Collaborations with Communities
Tanya Khemet Taiwo, Ph.D., M.P.H., C.P.M., University of California Davis, Environmental Health Sciences Center
Janette Robinson Flint, Black Women for Wellness, Los Angeles

Tanya Khemet Taiwo, Ph.D., M.P.H., C.P.M., is an assistant professor in the Department of Midwifery and Director of the Master of Arts in Maternal-Child Health Systems program. She also provides midwifery care on a part-time basis at CommuniCare Health Centers, a Federally Qualified Health Center with clinics in urban and rural communities around the Sacramento area. These clinics are committed to the compassionate care of low-income families in a multidisciplinary setting. Taiwo comes from a family tradition of midwives, stretching back at least three generations. Her grandmother and her maternal aunts were midwives practicing in rural Jamaica. She apprenticed with midwives in Seattle, Senegal, and Jamaica.

Taiwo is an epidemiologist whose research examines the role of maternal prenatal stress on child neurodevelopment, and how these stressors interact with environmental exposures. Her concern for environmental exposures affecting pregnant women drives her as co-director of the Community Engagement Core at the UC Davis Environmental Health Sciences Center. She is also a research fellow at The Birth Place Lab at the University of British Columbia. At the Birth Place Lab, she is collaborating on the Giving Voice to Mothers Study, a community-based participatory research project that examines how race, ethnicity, and birthplace affect maternity care in the United States.

Contact Information:
Email: [email protected]

Janette Robinson Flint and Tanya Khemet Taiwo will draw on their collective decades of experience as reproductive and environmental justice activists and environmental justice researchers to engage participants with proven effective strategies for developing and sustaining equitable and effective partnerships. In this workshop, we will engage participants in critical thinking about the roots of environmental injustice and its impact on women’s health disparities, and how these systems continue to be perpetuated in environmental health policy and research priorities. We will examine where the environmental health community has failed to examine the unique exposures experienced by Black, Indigenous, and women of color – specifically, the exposures to chemical toxins in beauty, personal care, hair, and cleaning products.

This will be followed by a discussion of the importance and value of community engagement and how, when well done, can help close these gaps in knowledge and abandon the standard narrative that compartmentalizes environmental exposures, communities, and life experiences without attending to the social forces that shape these conditions. Participants will gain insights into community participatory research challenges and benefits, and build the skills needed to recognize and avoid performative or ineffective patterns of working with community partners that perpetuate racism, classism, and academic elitism. We will examine how researchers can move from the tendency toward tokenism and further marginalization, to power-sharing and meaningful engagement. Creating sustainable approaches to reduce health burdens requires effective and equitable collaborations of researchers engaged with affected communities and truly multi-disciplinary teams that extend beyond our limited perception of what multi-disciplinary means. In this manner, we can identify optimal targeted solutions, utilize research to build community resilience, improve enforcement measures, increase the environmental health literacy of the public, and empower communities most at risk.

Creating Authentic Partnerships between the Columbia Center for Children’s Environmental Health (CCCEH) and Community Youth
Julie Herbstman, Ph.D., Sc.M., Columbia University, Mailman School of Public Health
Yesibel Pimentel and Quincy L. Wise, Columbia Center for Children’s Environmental Health (CCCEH)

Julie Herbstman, Ph.D, is an environmental and molecular epidemiologist whose research area focuses on the effects of prenatal exposures to environmental pollutants and the molecular mechanisms underlying these associations. She is an Associate Professor in the Environmental Health Sciences Department at the Columbia University Mailman School of Public Health and is the Director of the Columbia Center for Children’s Environmental Health (CCCEH). She has expertise in the design, conduct, and analysis of epidemiologic studies that include biomarker data and directs multiple longitudinal birth cohort studies of children born in New York City. She leads a number of NIH-funded research projects looking at early life to endocrine-disrupting compounds, which frequently elicit sex-specific effects, including polybrominated diphenyl ethers (PBDE), pyrethroid pesticides, polycyclic aromatic hydrocarbons (PAH), phenols (including BPA) and phthalates, and their impact on child health and neurodevelopment as well as maternal health. She is also a Principal Investigator of a cohort grant within the NIH-funded nationwide Environmental Influences on Child Health Outcomes (ECHO) consortium.

Contact Information:
Email: [email protected]

Since 1998, the Columbia Center for Children’s Environmental Health (CCCEH) has been conducting community-based research in Northern Manhattan and the South Bronx neighborhoods of New York City to identify the harmful effects of early life exposure to environmental pollutants on children's health. Community partnerships are the keystone of this research and are instrumental in helping us identify community needs and ensure that our research has measurable and maximal translational impact. Beginning with WeACT for Environmental Justice, which was our original leading partner, we have expanded our collaborations with other community groups and now have 22 active members of our Community Advisory and Stakeholder Board (CASB). In collaboration with these groups, we have been elevating and amplifying the voices of youth within and around the community. Here, we provide an example of an issue (Beauty Justice) around which we extended our collaborations and ultimately our reach by engaging with and supporting our youth-based community members.

Resources

• The Birth Place Lab, University of British Columbia: https://www.birthplacelab.org/
• Black Women for Wellness Environmental Justice Resources: https://www.bwwla.org/environmental-justice/
• Health Babies Bright Futures: https://www.hbbf.org/
• Project TENDR (Targeting Environmental Neurodevelopmental Risks): http://projecttendr.com/

Session 7. Identifying Gaps and Next Steps in Environmental Health Disparities (EHD) and Women’s Reproductive Health Research

Resources

• The NIH Maternal Morbidity & Mortality Web Portal (ORWH): https://orwh.od.nih.gov/mmm-portal
• A Big Boost to Federal Efforts to Reduce and Prevent Maternal Morbidity and Mortality: White House Issues a “Call to Action” (ORWH): https://orwh.od.nih.gov/about/director/messages/big-boost-to-federal-efforts-to-reduce-and-prevent-mmm
• Centers of Excellence on Environmental Health Disparities Research (NIMHD): https://www.nimhd.nih.gov/programs/extramural/coe/environmental.html
• The HHS Office of Climate Change and Health Equity (OASH): https://www.hhs.gov/ocche/index.html
• Climate Change and Health Equity: https://www.hhs.gov/ocche/climate-change-health-equity/index.html
• Environmental Justice: https://www.hhs.gov/environmental-justice/index.html
• 2022 American Association for Cancer Research (AACR) – AACR Cancer Disparities Progress Report: https://cancerprogressreport.aacr.org/disparities/
• 2020 AACR Cancer Disparities Progress Report 2020: https://cancerprogressreport.aacr.org/wp-content/uploads/sites/2/2020/09/AACR_CDPR_2020.pdf
• National Cancer Institute: https://www.cancer.gov/
• American Cancer Society: https://www.cancer.org/