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Panagis Galiatsatos, M.D. – Bridging the Gap between Health Care Providers and Residents in Baltimore

May 9, 2017

Panagis Galiatsatos, M.D.

Panagis Galiatsatos, M.D., works with medical professionals and community groups to reduce health disparities and improve health and wellness in Baltimore residents.
(Photo courtesy of Panagis Galiatsatos)

Panagis Galiatsatos, M.D., a pulmonary and critical care fellow at Johns Hopkins University School of Medicine, studies how environmental exposures and health disparities impact people with lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma. He also encourages academic medical community members to engage with residents of Baltimore through a program that integrates health education, policy, and community empowerment to mitigate health disparities. “The biggest concern is knowledge. People often receive a lot of misinformation, so one of our goals is to not only raise awareness, but to help people separate myth from fact,” said Galiatsatos.

Addressing Health Disparities in Baltimore

An extension of the NIEHS/EPA co-funded Center for Childhood Asthma in the Urban Environment , Galiatsatos is conducting research with the Comparing Urban and Rural Effects of Poverty on COPD (CURE COPD) Center at Johns Hopkins University. The research, comparing communities in urban Baltimore and rural Appalachia, aims to examine how the interaction of obesity, diet, and air pollution increase the susceptibility to COPD in low-income homes. Since indoor air pollution has been shown to be higher in low-income households, and because both communities suffer disproportionate prevalence and morbidity from COPD, obesity, and poor diet, the Center is working to understand the complex interactive effects underlying health disparities in these communities.

In Baltimore, Galiatsatos and his team are exploring obesity and dietary patterns as susceptibility factors to pollutant exposure in low-income adults with COPD. In addition, based on the observation that pollutant concentrations are higher in the homes of smokers, they are working to understand how smoking behaviors or attitudes of residents in public housing units, and accessibility of tobacco products contribute to high levels of indoor air pollution.

“One of the primary questions we’re thinking about at the CURE COPD Center is how researchers can provide culturally sensitive findings to stakeholders, promote engagement with community members, and build capacity in environmental health literacy and risk prevention,” said Galiatsatos.

The information collected by the Center will be used to inform practical targeted interventions to improve COPD health in this high-risk population. In addition, the team is involved in a variety of health promotion activities to address the environmental health disparities of indoor air pollution in low income populations. These include educating people about making healthier choices and communicating with local clinical professionals and policy makers to further protect the health of these impacted communities. Galiatsatos is also collaborating with counselors, physicians, and religious leaders to implement community outreach programs that promote good health practices.

Promoting Community Empowerment through Health Education

Galiatsatos is the co-director and co-founder of the medical education partnership Medicine for the Greater Good (MGG), established in 2013 at the Johns Hopkins Bayview Medical Center.

Panagis Galiatsatos, M.D. speaking

Galiatsatos speaks at a local church about the influence of lifestyle factors on environmental and human health.
(Photo courtesy of Panagis Galiatsatos)

Aimed at promoting wellness and partnerships beyond the hospital walls, this program creates medical education workshops where MGG volunteers work with schools, churches, and community centers to promote good health practices in the community. The MGG program has completed more than 32 workshops and facilitated over 282 projects that bring health professionals into the community to facilitate discussions about diseases, diet, and exercise, among others. The projects have involved more than 80 medical residents and other students in health professions who worked with over 1000 people in Baltimore communities.

By encouraging physicians to take preventive care to the community and collaborate with local partners, the MGG program is helping to address health disparities in Baltimore. For example, the Caring for a Neighborhood project focuses on access to healthy food, asthma awareness, and mentorship. B’More Asthma Free  helps parents overcome barriers to asthma care, and educates families on asthma symptoms, treatments, and environmental factors that can make the disease worse.

Through community engagement, Galiatsatos hopes to use health education to mitigate health disparities in low income populations in Baltimore. Moving forward, Galiatsatos hopes to expand community-based outreach programs like MGG and to use the information acquired from these programs to communicate with decision makers to improve health and address health disparities

Madeleine Scammell, D.Sc., Connecting Local Environmental Health Concerns to Scientific Research

Madeleine Scammell

Scammell has developed and maintained successful research relationships between community groups and scientists.
(Photo courtesy of Photo courtesy of BU School of Public Health)

Madeleine Scammell, D.Sc., a recent recipient of the competitive NIEHS Outstanding New Environmental Health Science award, is committed to helping communities understand and address the effects of environmental hazards on human health. As an assistant professor at the Boston University (BU) School of Public Health, Scammell has developed and maintained strong partnerships with organizations in the Northeast to provide technical assistance to communities faced with environmental health concerns.

Scammell currently leads the NIEHS BU NIEHS BU Superfund Research Program (SRP) Center  Community Engagement Core (CEC), which aims to increase the awareness and utility of BU SRP Center research for communities living near hazardous waste sites or who are affected by other environmental health hazards. She began her work with the BU CEC as a graduate student and has maintained her commitment to fostering community partnerships and working with nearby residents on environmental health issues.

She also leads the CEC for the Center for Research on Environmental and Social Stressors in Housing Across the Life Course (CRESSH), a partnership between the BU School of Public Health and the Harvard T.H. Chan School of Public Health that studies environmental health disparities in low-income communities and throughout Massachusetts.

Responding to community needs

In her capacity as the BU SRP CEC leader, Scammell works primarily with two community partners, Alternatives for Community and Environment (ACE) and Toxics Action Center, to provide information and to empower residents to reduce their exposures to contaminants.

In one project, Scammell is working with partners to determine ambient exposure to polychlorinated biphenyls (PCBs) experienced by residents living near the New Bedford Harbor Superfund site. Between the 1940s and 1970s, PCBs were improperly disposed of directly into the New Bedford Harbor. Cleanup of the harbor is underway, but residents were concerned that dredging of the harbor sediment to remove contaminants could lead to temporary release of PCBs into the air.

"Through ACE, we learned about these specific community concerns about PCB emissions into the air during the harbor cleanup," said Scammell. "The BU SRP Center didn’t have the capacity to respond to their questions about air quality alone, so we partnered with the SRP Center at the University of Iowa, which specializes in ambient PCB air monitoring. We partnered with them to address the community's concerns."

BU Team eith TAC and ACE

The team from the BU with community partners from Toxics Action Center and ACE.
(Photo courtesy of Photo courtesy of BU SRP)

Scammell, along with BU colleagues, students, and CEC community partners, collaborated with residents to place air quality monitors designed by the Iowa SRP Center throughout the communities surrounding the harbor. The researchers and community members have met numerous times over the last year to share and discuss the results. This included prior to a recent publication by the research team, including Scammell, that reported elevated airborne PCB concentrations in the air surrounding New Bedford Harbor and indicated that PCBs are being released into the air from the water. Air measurements have a very strong signature consistent with the two PCB mixtures used in New Bedford that led to contamination of the harbor.

Providing resources to empower communities

From her experience in community-based research, Scammell worked with colleagues to develop a Health Studies Guide to help community groups think through whether a health study may be useful or necessary in their community in response to environmental concerns, such as drinking water contamination. The guide describes a wide range of health studies and walks through the process of choosing and designing a study.

"Scientists who have worked with community groups for many years to address environmental health problems contributed to this guide, as well as community leaders and organizers," said Scammell. "We include insights from focus groups and interviews with community members as well as our own experiences with studies that did or did not resolve community problems."

Scammell also led the launch of the Health and Environment Assistance Resources (HEAR) database, a tool for linking legal, scientific, and technical experts with community groups who have questions or concerns about environmental issues in their neighborhoods. Today, the HEAR database contains more than 400 experts and has led to partnerships between communities and HEAR experts throughout Massachusetts, Maine, Connecticut, Rhode Island, and Vermont.

Scammell and partners have also produced a variety of factsheets and other resources that may be useful to residents facing environmental and health concerns, available on the BU SRP website.

The importance of the community in scientific research

Scammell and CRESSH co-leader Jon Levy

Scammell and CRESSH co-leader Jon Levy, Sc.D., left, talk with students in the Upward Bound Program at Boston University, a college preparatory program for potential first-generation college and low-income high school students.
(Photo courtesy of Photo courtesy of BU School of Public Health)

"As an undergraduate, the disconnect between University research and nearby public health, environmental, social, and economic challenges was clear," said Scammell. After completing her undergraduate degree, she worked for five years at a non-profit organization whose mission was to democratize science and technology.

"We ran a community research network where we linked researchers with community groups, and vice versa," said Scammell. "That is where I learned about NIEHS and their work on community-based research and environmental justice. This informed my desire to be the type of scientist that works with communities on the questions of most concern to them."

These early experiences provided perspectives that she brought with her to BU. Through her current work, Scammell recognizes that community groups have valuable skills that can facilitate community engaged research. She has learned a lot from their community partners on how to best engage local residents, as well as how to turn science into action. She continues to develop and maintain productive partnerships with local organizations and communities.

Jani Ingram, Ph.D. –Addressing Environmental Health Needs of Navajo Nation

February 6, 2017

Jani Ingram testing water samples

Jani Ingram, Ph.D., professor of chemistry and biochemistry at Northern Arizona University (NAU), encourages students and citizens in the Navajo community to collaborate in scientific research that addresses local environmental health concerns. Throughout the years she has made significant contributions in the research of carcinogenic chemicals in the environment, especially uranium, and its impact to the Navajo community.

Uranium Exposure in the Navajo Nation

Jani Ingram testing water samples

Ingram, who is a member of the Navajo Nation, first became interested in studying uranium contamination in the reservation in 2002. Uranium mining was a prominent industry in the southwestern United States, leaving a burden of uranium contamination throughout the region. Sources of uranium exposure include abandoned uranium mines, contaminated structures, and contaminated wells. There are 521 abandoned mines in the reservation, many found to have higher levels of gamma radiation than background levels. Investigating uranium exposure is critical for the Navajo community because a large portion of the population still relies on water from unregulated wells for their consumption, household, and livestock needs. Uranium exposure is known to damage the kidneys and increase the risk of cancer and liver disease.

Given Ingram’s past experience researching chemical contamination with the U.S. Department of Energy, she decided to evaluate the issue of contamination and health impacts in the Navajo lands with a goal of distributing information to tribal leaders to help them assess contamination. As an investigator of the training core at NAU for the Partnership of Native American Cancer Prevention (NACP) and director of the Bridging Native American Students to Bachelor’s Degree (BRIDGES) program, Ingram used her research to provide Native American students the opportunity to experience scientifically challenging research of interest to them and the Navajo community. “My heart and soul is in training students, and I’ve seen how passionate the students get and most importantly how it has encouraged them to continue their studies,” said Ingram.

Ingram is actively involved in creating a system of student empowerment by providing professional development opportunities while engaging the residents and tribal leaders of the Navajo nation. For example, undergraduates can engage in research programs during their first and second year, participate in graduate summer transitional enrichment programs, work with NACP investigators and NAU faculty, and attend seminars, presentations, conferences, and meetings creating a pathway towards a graduate program. “Problems on the reservation are going to be best solved by the Navajo students who help their community by going forward,” said Ingram.

Ingram and the students focused their research on three sites in the Navajo Reservation: Cameron, Blackfalls, and Leupp. They took samples from over 200 water wells, open mine sites, and sheep. In the unregulated wells they found high levels of uranium and arsenic. The results showed that the wells contained arsenic levels 40 percent higher than the EPA drinking water standard of 10 ppb and contained uranium levels 20 percent higher than EPA standard of 30 ppb. In livestock, they found similar uranium levels in the sheep from Leupp and Cameron. In further studies Ingram wants to include sheep off the reservation to have a better comparison group.

The unexpected high levels of arsenic in the water wells has led to a new study of arsenic exposure in water, soil, and livestock. As mutton is a traditional food in the Navajo culture, Ingram’s next steps are to work with the students and community to address the chemical contamination in sheep and to later develop food consumption guidelines in the Navajo community. Tommy Rock, also a featured grantee, is currently working with Ingram in examining uranium exposure and bioaccumulation in sheep near mining sites in the Navajo Nation.

Engaging with the Navajo community to transform her research into policies

Moving forward, Ingram hopes to use the data they have collected to influence behaviors in the community. She wants to apply the “bench to bedside” concept to the people in the Navajo community, which in medical practice refers to applying data from scientific research to patients. In order to assess health impacts through this concept, Ingram and colleagues primarily use the Indigenous Health Indicator, which uses “a holistic approach” by taking into consideration the cultural and social beliefs most important to Native Americans. They have worked closely with the Swinomish tribe, who developed the Indigenous Health Indicator, to discuss their past experience with contamination in their traditional foods and how they overcame and tackled the issue.

Ingram and her colleagues are beginning to speak with different individuals and groups, to acquire further knowledge on the Navajo culture that can be later implemented into the best practices that will help the nation address its health needs. For example, she is collaborating with a political scientist from the Applied Indigenous Studies and Politics & International Affairs programs at NAU, a Navajo doctoral student, and a group of knowledge holders, or “medicine men,” to learn more about how people in the Navajo community would like to approach the issue of arsenic exposure, to then establish the policies based on indigenous knowledge and Navajo law.

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Tommy Rock – Exposing Years of Uranium Water Contamination in a Navajo Community

January 9, 2017

Tommy Rock, a doctoral student at Northern Arizona University, grew up in a small community on the Navajo reservation, where he saw firsthand the effects of uranium mining on his relatives. Navajo lands were mined heavily for uranium from 1944 to 1986, leaving more than 500 abandoned uranium mine sites and elevated levels of radiation in homes and drinking water sources.

“My grandfather was a former uranium mine worker who died from cancer about ten years ago,” said Rock. “I wanted to do something about this problem of uranium contamination, and as I learned more and became involved in research, I realized more communities across the Navajo Nation were also affected.”

After completing a master's degree in sustainable communities from Northern Arizona University in 2008, Rock worked as a research scientist at the University of New Mexico and then as an environmental specialist with the Navajo Nation EPA. He is now pursuing a doctorate in Earth Science and Environmental Sustainability at Northern Arizona University.

Last year, Rock helped discover more than a decade of uranium contamination in the drinking water of the small community of Sanders in eastern Arizona. Sanders lies just outside of the Navajo reservation, and about 80 percent of the community is Navajo.

Uranium in the water supply

Through his work with the Northern Arizona University Center for American Indian Resilience (CAIR), Rock shows community members from Cameron, Arizona, how environmental samples are processed in the lab

Through his work with the Northern Arizona University Center for American Indian Resilience (CAIR), Rock shows community members from Cameron, Arizona, how environmental samples are processed in the lab.
(Photo courtesy of CAIR)

Rock discovered the contamination while working on a project funded by an EPA Environmental Justice Grant. The project involved testing unregulated wells along the Puerco River, a tributary of the Little Colorado River that flows through Sanders. Rock and his colleagues organized a two-day training for the community and hired community workers to conduct the water testing.

"When conducting this training, one of the community members asked us to sample the public water supply,” said Rock. “We did this, and found elevated levels of uranium in the wells along the river as well as in the pubic water sources."

The results, which came back in June of 2015, showed uranium levels at 43 parts per billion, well above the EPA limit of 30 parts per billion. Exposure to uranium in drinking water can lead to bone cancer and impaired kidney function. When Rock and his colleagues looked deeper to figure out how long the contamination had been taking place, they found records indicating elevated levels of uranium as far back as 2003. All the tests from 2009 to 2015 showed elevated levels of uranium in the public water.

“The sad thing was that the community members were not notified about the contamination by the state or the Arizona Windsong Water Company, which supplied the water,” said Rock. “The water company violated the federal Safe Water Drinking Act by not giving reports to their customers.”

The researchers presented their findings at several community meetings, and while people stopped using the public water, they were not seeing any movement by the state or water company to fix the contamination. During one of these meetings, community members asked the researchers to test the well that supplies water to the elementary and middle schools. “We found elevated uranium in this water supply as well,” said Rock. “The school district shut off water fountains in the schools and started hauling in water from another town.”

Igniting Change

Rock worked with Karletta Chief, Ph.D., from the University of Arizona to gather water and sediment samples after the Gold King Mine Spill, which affected many Navajo communities.

Rock worked with Karletta Chief, Ph.D., from the University of Arizona to gather water and sediment samples after the Gold King Mine Spill, which affected many Navajo communities.
(Photo courtesy of Karletta Chief)

It was not until after media coverage of the contamination in April 2016 that the people of Sanders finally saw actions aimed at fixing the problem. After Windsong’s license was not renewed, the new company handling the Sander’s public water system replaced the well that supplies the public water. While some people are using the new water, the entire water system still needs to be upgraded since the water infrastructure is old in the community of Sanders and cannot handle the full pressure from the new waterline.

Although the state isn’t required to notify people of contamination, the Arizona Department of Environmental Quality has changed its policy and will now issue public notices for drinking water violations if the public water system neglects to do so. “I like to think that we helped change this policy,” said Rock. “I am also glad to know I played a part in helping the community of Sanders have better water now than they did before.”

Rock continues to work on his dissertation research, which is examining uranium exposure and bioaccumulation in sheep living around mining sites on Navajo land. By understanding how this traditional indigenous food source accumulates uranium, Rock hopes to develop safe consumption recommendations for tribal members in mining-affected areas. This research project is led by Jani Ingram, Ph.D., of Northern Arizona University, who is funded by the NIEHS through the Native American Research Centers for Health.

After completing his doctoral degree, Rock would like to use his knowledge and experience to help people in other parts of the world. “One day I would like to work for the World Health Organization, so I could help indigenous populations throughout the world find solutions to their contamination problems.”

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