Environmental Impacts on Women’s Health Disparities and Reproductive Health
Wednesday & Thursday, April 27 – 28 | Virtual Workshop
- Session 1: Disparities in Maternal and Women’s Health Outcomes by Race and Ethnicity
- Session 2: Indicators and Measures of Structural Racism as Risk Factors of Maternal and Child Health
- Session 3: Beyond Race and Gender: An Intersectional Perspective on Environmental Exposures and Reproductive Health
- Session 4: Modeling Environmental Health Disparities: What’s a Bench Scientist to Do?
- Session 6: Community-Engaged Research: Building Authentic Partnerships in Disproportionately Impacted Communities
Session 1: Disparities in Maternal and Women’s Health Outcomes by Race and Ethnicity
“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
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
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
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.
Session 2: Indicators and Measures of Structural Racism as Risk Factors of Maternal and Child Health
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
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
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
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.
Session 3: Beyond Race and Gender: An Intersectional Perspective on Environmental Exposures and Reproductive Health
The MIEHR Center: Unraveling Environmental Health Disparities among Mothers and their Children
Elaine Symanski, Ph.D., Baylor College of Medicine
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
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
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
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.
Session 4: Modeling Environmental Health Disparities: What’s a Bench Scientist to Do?
Context Matters: The Disconnect Between Animal Models and the Complexity of the Human Environment
Deborah Cory-Slechta, Ph.D., University of Rochester Medical School
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
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.
Session 6: Community-Engaged Research: Building Authentic Partnerships in Disproportionately Impacted Communities
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
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
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)
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.