2019 Grantee Highlights

Cheyenne Grabiec – Addressing Environmental Health Concerns of Tribal Communities in the Southwest

December 20, 2019

NIEHS has long supported grantees who work on community-engaged research, environmental education, and tribal issues. Cheyenne Grabiec, an enrolled member of the Navajo Nation, has combined all of these elements early in his career, working on NIEHS-supported environmental health projects at the University of Arizona (UA), first as an undergraduate intern and now as a program coordinator.

While an undergraduate student, Grabiec saw IngriQue Salt, a UA tribal liaison, talk about the Environmental Health Sciences Transformative Research Undergraduate Experience (EHS-TRUE) internship program. Cheyenne says that while he never saw himself working in the field of environmental health, he drew a connection between the state of the environment back home on the Navajo Nation and mental health, so he decided to apply to the program. Later, as an intern in that program, he worked under NIEHS-funded researcher Marti Lindsey, Ph.D., head of the Southwest Environmental Health Sciences Center’s Community Engagement Core. Grabiec planned and managed outreach events with tribal communities to address their environmental health concerns – asthma and air quality were major topics of interest. He also coordinated science cafes, community-based events where scientists hold discussions with community members and where youth are given the opportunity to engage in hands on-activities to learn more about environmental health sciences. He also was on an intertribal team that developed the 2019 Tribal Forum, where tribal leaders and professionals discussed environmental health issues with UA faculty and grad students.

As one outcome of his internship, Grabiec led the development of an Indigenous Inquiry Framework, which guides investigators in designing and implementing projects in collaboration with tribal partners that respect tribal self-determination and put indigenous cultures, traditions, and epistemologies at the center of research. The idea stemmed from his work with researchers who had little to no experience collaborating with tribal communities and seeing their need for a framework for engaging in respectful project development with tribal partners. The framework is being used by interns working on tribal-related projects to assure strong collaboration and a focus on the needs of tribal partners. Lindsey says, “I am very impressed with his ability to translate the collaborative engagement model into a framework for indigenous research practice.”

After graduating in December 2018, Grabiec served as the managing editor of the fourth volume of Indigenous Stewards, a magazine that focuses on the connection between indigenous communities and environmental health. He collaborated with the magazine’s advisory board, assigned articles, and put together the final product, which is broadly disseminated at tribal events and activities and which is an official publication of the University of Arizona. “He has a strong vision of what the magazine can accomplish and how to meld different ideas into a publication I am proud of,” said Lindsey.

In the summers of 2018 and 2019, he participated in Diné College’s Summer Research Enhancement Program, a public health internship in which he served as a teaching assistant and conducted in-depth research on childhood asthma on the Navajo Nation through an NIH-funded UA project.

Grabiec has now returned to the University of Arizona as a program coordinator under Dr. Lindsey. He is working on an air quality and asthma project with a tribe in the Southwest to measure the rate of childhood asthma. According to Grabiec, preliminary data put the asthma rate at 24% – more than double Arizona’s statewide average. The project is now trying to reach more of the tribe’s youth to conduct additional screening and to provide air-quality education.

Grabiec envisions a future in law and tribal government. He is currently enrolled as a master’s student in indigenous peoples law and plans to apply to a J.D. program. Afterwards, he would like to return to the Navajo Nation and put his legal skills to use, perhaps working in the Nation’s Peacemaking Program, an alternative to Anglo-American jurisprudence that relies on restorative justice and traditional Diné wisdom and practices.

Luis Olmedo – Combating Pollution with Community Air Monitoring

November 13, 2019

As executive director of Comité Cívico del Valle, Inc., a community-based environmental justice nonprofit, Luis Olmedo strives to provide health services and research, and promote environmental justice in the Imperial and Coachella Valleys in California.

Olmedo grew up and currently lives near the US-Mexico border, in the Imperial Valley, where traffic and intense agricultural production contribute to poor air quality. The conditions in the Imperial Valley motivated him to find solutions to improve the environment and community health. Comité Cívico addresses the causes of pollution, like traffic at the border, dust storms, and agricultural burning.

“What kind of human beings and neighbors would we be if we ignored the issues that are consequential to the wellbeing of the people who live in our neighborhoods and communities,” asked Olmedo.

Through countless collaborations and funding from the National Institute of Environmental Health Sciences (NIEHS), Comité Cívico works to improve air quality and mitigate health disparities.

Annual Conference Sets NIEHS Project in Motion

When he began working for Comité Cívico in the early 2000s, Olmedo networked with government agencies, academia, and underserved community members to find ways to address community concerns. The collaborations led to the first Environmental Justice Summit in 2007, which highlighted environmental issues in the disadvantaged community. The conference didn’t touch on environmental health specifically, however.

During the second year of the summit, Olmedo took attendees on a bus tour of the Imperial Valley to help them understand the community’s concerns.

“I remember the day we took the tour, there was agricultural burning,” said Olmedo. “It was a cloud of smoke—it looked like a mushroom in the sky. Seeing the smoke in the sky like that helped us realize this was certainly something to be concerned about.”

The bus tour led to a conversation with partners about increasing awareness of air quality issues. Olmedo began working with Paul English, Ph.D., of Tracking California (formerly California Environmental Health Tracking Program), an organization that protects community health by making environmental health data readily available. Together they shifted the conference’s emphasis to environmental health.

As a result of information shared at the summit, community members started speaking up on air quality issues and explaining why the current government air quality monitors didn’t address their needs.

“The summit helped us inform the public about air quality monitoring and enabled the community to take control of their own destiny,” said Olmedo.

Community Members Prove Instrumental in Air Monitoring

Particulate matter (PM) pollution in Imperial County often exceeds the California health safety standard. Historically, the area has the highest rates of emergency room or urgent care visits and hospitalizations for school children with asthma. Tools like air quality monitors can help reduce visits by letting people know when to stay inside.

After the summit, Olmedo and English initiated an NIEHS-funded project called the Imperial County Community Air Monitoring Project. The team installed 40 PM monitors around the county to create a network called Identifying Violations Affecting Neighborhoods (IVAN).

“Through the monitoring network, people are aware of where they might be exposed to poor air quality,” said Olmedo. “As a result, they can adjust their activities to improve their own health.”

Community members played a role in the project, by selecting the location of air quality monitors, helping create outreach materials, disseminating information to schools, and sharing data with local officials to inform health-protective decisions.

“The relationship between myself, the community members, and scientists came together well for the project,” said Olmedo. “Throughout the process, the scientists remained confident that the community could contribute successfully to this project.”

Ripple Effects of NIEHS Grants

Implementation of IVAN in Imperial County showed the wider community that the organization had the capacity to do important work. In 2018, the California Air Resources Board (CARB) awarded the organization, along with 25 others, a Community Air Grant.

The air grants are awarded through a provision of a 2017 state assembly bill that directs attention toward disadvantaged communities impacted by air pollution.

Comité Cívico is now collaborating with other awardees, with the hope of installing more PM monitors and developing a low-cost methane sensor. Methane comes from vehicle exhaust and farms, and is often found in disadvantaged communities, like Imperial County. It can lead to health problems, such as making it harder to breathe.

“Methane is a proxy of other harmful contaminants that we can’t detect – the methane sensor will let us know if there are other possible contaminants in the air,” said Olmedo. “Low cost sensors give us the ability to reach communities that we may not be able to otherwise.”

Olmedo recently hosted the tenth annual Environmental Health Leadership Summit, which has continued to grow. The California governor who approved the bill to improve air quality has helped the summit gain traction. At this year’s summit Olmedo continued the conversation about binational air quality issues between the United States and Mexico.

Jamie San Andres – Combating Exposures in Vulnerable Populations

October 7, 2019

Jamie San Andres began her career organizing campaigns to protect the health of farmworkers and their families by limiting the use of the most toxic pesticides. She grew up in California’s San Joaquin Valley, home to a large farming industry that relies heavily on pesticide use.

“I witnessed firsthand how communities are affected by exposure to pesticides and harmful contaminants,” she said. “Living there for over 10 years shaped my perspective on how marginalized communities experience not just poverty, but also racism and environmental health issues.”

Today, San Andres works as a project coordinator for the Safe & Just Cleaners Research and Action Campaign at Make the Road New York, the largest community-based Latino immigrant organization in New York City. Make the Road New York represents members of the working class who perform a wide variety of jobs, from household cleaners to restaurant servers.

“This position branches both my interests in researching how environmental health impacts low-income immigrant communities and in organizing campaigns to address issues important to these communities,” said San Andres. “We work to improve our members’ lives through community organizing, policy reform, education, and providing legal services.”

Using Academic Research to Address Household Cleaners' Concerns

San Andres works closely with NIEHS grantee Sherry Baron, M.D., who leads the Safe & Just Cleaners campaign as a partnership between the Queens College Barry Commoner Center for Health & the Environment, the Icahn School of Medicine at Mount Sinai, and Make the Road New York.

The group is conducting a survey of 400 household cleaning workers about the cleaning products they use, work practices, knowledge and attitudes about potential hazards, and personal health problems. The group will also measure participants’ exposure to chemicals found in their cleaning products. San Andres and other project leaders will use this information to develop a campaign focused on helping household cleaning workers better understand their environmental health and how to protect themselves from harmful exposures.

“The goal is not just to understand how domestic cleaners have already been affected, but also how to prevent future health problems,” said San Andres. “I really believe in not just conducting research to help understand problems but also thinking about how to improve the lives of the community.”

Building Equitable Partnerships With Vulnerable Communities

To better meet the needs of domestic cleaners, San Andres helps the campaign host a committee meeting each month to retrieve input from the cleaning workers themselves. During the meetings, the workers discuss their goals for the partnership and how researchers can help them meet their objectives, empowering them to take control of their lives.

“I am not a domestic cleaner and I don’t know those realities the way they know them,” said San Andres. “They are experts of their own lives, and so I have a responsibility to hear from them what they would like to see and do.”

San Andres believes fostering strong and equitable research-community partnerships is critical for a project’s success. She makes sure cleaning workers have an equal role in the development and implementation of the Safe & Just Cleaners campaign.

“Community organizations have a larger role than just identifying members to participate in research at the beginning of the study,” she said. “They also act as a bridge to facilitate interactions between the members and the researchers throughout the study. Researchers also have a responsibility to go beyond the bench and continue to interact with participants and invest in their lives.”

Improving Lives Through Academic-Community Collaborations

Looking forward, San Andres will continue to work toward reducing exposures and improving the environmental health of vulnerable communities. She believes the key to improvement is developing strong academic-community collaborations.

“I really love being that bridge between the academic world and the community,” said San Andres. “By combining research and community organizing to increase awareness about how marginalized communities are experiencing environmental health issues, we can improve the lives of vulnerable populations in the U.S. and abroad,” she said.

Esther Min – Academic-Community Collaborations to Address Environmental Justice in Washington State

September 6, 2019

Esther Min, discovered her passion for environmental justice in 2014 while pursuing her M.P.H. and working with community organizations focused on providing access to clean drinking water during one of the worst droughts on record in California.

“People’s water bills were skyrocketing, wells were drying up, families were driving miles away to buy bottled water,” said Min. “I saw the need for meaningful partnerships to empower and amplify community voices while finding real solutions to the problems that matter most to them.”

Now working toward her Ph.D. at the University of Washington (UW), Min continues to foster partnerships between academic researchers and communities through two community-driven environmental justice projects – the Home Air in Agriculture: Pediatric Intervention Trial (HAPI) and the Washington Environmental Health Disparities Map Project. Unlike traditional scientific research, the community identifies research questions and priorities that will address their specific needs.

"Communities reach out to us as scientists looking for solution-driven research to provide data and scientific justification for their calls for action,” said Min. “To me, the most rewarding part is seeing evidence-based research applied to solve real world problems.”

HAPI: Addressing Community Concerns Through Research

Min is part of a research team led by Catherine Karr, M.D., Ph.D., that works with El Proyecto Bienestar to improve the health of children living in the Yakima Valley of Washington State, where intense agricultural production impacts air quality in the region. The team is investigating how air quality in the home influences respiratory symptoms in Latino children with asthma.

The team provided high efficiency particulate air cleaners (HEPAs) and measured indoor air quality before and after to study improvements. They also measured asthma symptoms and educated families about managing asthma.

“This project is really important to me because we’re going beyond just identifying problems in the community,” said Min. “We go the extra step to identify solutions that can make a difference for children’s health.”

Building Partnerships to Address Health Disparities

The second project Min is particularly passionate about is the Washington Environmental Health Disparities Map Project. This interactive tool ranks environmental health risks for communities throughout Washington state based on exposure to diesel emissions, proximity to hazardous waste facilities, and lead risk in housing, for example. The combined risk factor scores help to highlight health inequities between communities.

Min explained that the project began when Front and Centered, a statewide environmental justice group, approached UW researchers with the idea of developing the map. The partnership grew to include various government agencies and regional air quality management groups and included input from communities gathered through listening sessions.

“I’m really proud of our successful partnership,” Min said. “We started without a stable funding resource, but we had a lot of passionate people coming together to address a need. We hope this map will provide information on environmental health disparities in Washington that decision makers can use to address them.”

Teaching Environmental Justice to the Next Generation

As she nears the end of her Ph.D., program, Min looks to the future. She hopes to continue working in a university setting where she can teach undergraduate students, particularly about the importance of community partnerships.

“I didn’t learn about environmental justice or community engaged research until later in my training,” she said. “I think it’s so important to expose students to this early so they understand these important issues within our communities and how research should be strongly rooted in addressing community needs.”

Min plans to maintain her focus on community-driven, solution-oriented research throughout her career. By creating new partnerships and strengthening those she’s already formed, Min will continue to address health disparities and improve the lives of communities she works with.

Meredith McCormack, M.D. M.H.S. - Creating Strong Community Partnerships to Address Environmental Health Disparities

July 17, 2019

Meredith McCormack, M.D. M.H.S., is passionate about reducing health disparities and improving the respiratory health of high-risk populations. As an associate professor of medicine in the Division of Pulmonary and Critical Care at the Johns Hopkins University School of Medicine and Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health, McCormack is examining the effects of environmental exposures on respiratory diseases in low income urban and rural populations.

During her residency at Thomas Jefferson University Hospital, McCormack became interested in smoking-related lung disease. She pursued training and completed a Pulmonary and Critical Care fellowship at John’s Hopkins, where she had an opportunity to join investigators from the Center for Childhood Asthma in the Urban Environment (CCAUE).

“At the CCAUE I was immediately immersed in ongoing research with a multidisciplinary team of investigators. It gave me the opportunity to work with environmental health scientists, biostatisticians, pediatricians, and allergists who each had unique expertise that contributed to my development as an investigator,” said McCormack.

Today, McCormack is a project leader at CCAUE.

Understanding Asthma Health Disparities Among Children

Funded by NIEHS and the U.S. Environmental Protection Agency (EPA), CCAUE is one of thirteen Children’s Environmental Health and Disease Prevention Research Centers in the United States. Their research focuses on studying how exposure to air pollutants and allergens are associated with asthma-related illnesses in low-income minority children.

McCormack’s research has demonstrated the association between air pollution in homes of Baltimore children and asthma. These studies also demonstrated a significant association between indoor air pollution with asthma symptoms and rescue medication use.

More recent studies from McCormack and her team have found that obese children with asthma have a greater respiratory response to indoor air pollution versus children with normal weight. Their findings support the idea that obesity may increase a child’s susceptibility to poor air quality.

Empowering Youth Through Education

The CCAUE team has initiated a Lung Health Ambassadors Program to help students understand how air pollution impacts lung health and asthma. Through the program, McCormack encourages medical community members to engage with Baltimore students through a series of fun and interactive sessions on lung health and risk factors for lung disease.

The program teaches elementary and middle school children about air quality, asthma, and smoking and how the environment can impact their health.

“This program has been a great way to empower young people to be ambassadors of lung health in their communities by sharing what they know with other students, their families, and community,” noted McCormack.

COPD Health Disparities in Rural and Urban Communities

McCormack and her team have also investigated the role of indoor air pollution, obesity, and poor diet in contributing to chronic obstructive pulmonary disease (COPD) in rural Appalachia and urban Baltimore through the Comparing Urban and Rural Effects of Poverty in Chronic Obstructive Pulmonary Disease (CURE COPD) Center. The CURE COPD Center is funded by EPA and the National Institute on Minority Health and Health Disparities.

McCormack’s research in Appalachia demonstrated that rural residence and various indicators of poverty are significant risk factors for COPD. In fact, the risk of COPD in rural poor communities was twice that of the national average. An additional risk factor for COPD in these communities was burning coal indoors to heat their homes.

In Baltimore communities, they found that temperature was associated with an increase in respiratory symptoms and the need for rescue medications. They also found that the effect of indoor air pollution was exaggerated on higher heat days. Taken together, these findings suggest there is an interactive effect of heat and indoor air pollution on individuals with COPD.

Similar to their findings in children, these studies suggested that obesity tends to worsen COPD symptoms and exaggerate the harmful effect of indoor pollution on adults with COPD.

Training Future Scientific Leaders

McCormack and her research team have fostered a unique partnership with the Appalachia community. They have engaged in research with local students and faculty from East Tennessee State University. This collaborative relationship has enabled investigators to acquire expertise beyond their own research group.

McCormack accredits grants from the CURE COPD Center and CCAUE for providing the resources to build this foundation for collaboration and providing opportunities for junior investigators and trainees. The support for these programs has led to the formation of the BREATHE Center (Bridging Research, Lung Health, and the Environment).

“The co-funding by NIEHS and the EPA has provided the foundation for junior investigators and trainees to receive a multi-disciplinary training experience,” said McCormack. “The Center grants have played an important role in my own career development and training, so one of the most exciting parts of my job is getting to help mentor the next generation of scientific leaders.”

Community-Based Interventions

According to McCormack, integrating community outreach and engagement is not only rewarding, it is critical to moving research forward and making a real difference for the people who are impacted by air pollution.

“Both CURE COPD Center and CCAUE have community engagement cores, which is really important for connecting our research with the communities involved in our studies,” she said. “It’s critical that we translate our findings back to the communities who are donating their time and energy to participate in our research or are supporting our work in other ways. By telling them about our findings and communicating how our findings can be used, we are helping to empower them to take action to protect their health.”

McCormack and CCAUE investigators have conducted studies that have found that the use of portable air purifiers reduced asthma morbidity among Baltimore City children. She is currently conducting an air purifier intervention study to investigate differences in pollution susceptibility between overweight and normal weight children. Their team is also concluding a study which examines the effect of an air cleaner intervention on adults with COPD.

In addition to working to prevent diseases like COPD, McCormack and her team strive to build upon and enhance quality of life for the communities they work with.

“A key aspect of our work is trying to improve the lives of people that already have respiratory disease. For example, people who live in rural areas have unique challenges accessing healthcare. We want to shed light on these unique challenges and make improvements because enhancing quality of life can have long-term positive impacts on individual and community health”, said McCormack.

Moving forward, McCormack hopes to continue developing new interventions to reduce harmful environmental exposures. These household and community-based interventions can be implemented to reverse the trajectory of worsening health disparities as among those with COPD and asthma in the highest risk populations. These interventions include improving indoor air quality in homes, schools and community centers by removing sources of air pollution such as secondhand smoke and sources of nitrogen dioxide such as gas- wood- oil- kerosene- and coal-burning appliances.

Paul Laurienti, M.D., Ph.D. - Addressing Health Disparities of Farmworkers and their Families

June 12, 2019

Paul Laurienti, M.D., Ph.D., uses advanced imaging and analysis techniques to study structures within the brain and personal exposure data to explore and understand links between pesticide exposure and brain development.

“I’m interested in looking beyond what part of the brain turns on or off with a particular task, and thinking about how parts interact with each other to control how we perceive things or how we think,” said Laurienti.

As the Director of the Laboratory for Complex Brain Networks (LCBN) at Wake Forest School of Medicine, Laurienti leads an interdisciplinary group of scientists, graduate students, and staff to study the brain as an integrated system. The LCBN was established in 2009 by Laurienti and Jonathan Burdette, M.D., to expand a new field in brain research called network science. Network science is an analysis method for investigating the human brain in terms of a network of interconnected components. “Network science has been a valuable tool for us to assess brain structure and function. We’ve been able to analyze brain networks under different conditions, including environmental exposures and alcohol use disorder.”

Leveraging Collaborations to Understand how Pesticides Impact the Brain

In 2013 Laurienti began a collaboration with Thomas Arcury, Ph.D., through the NIEHS ViCTER program. Arcury had been leading an NIEHS-funded research project called Preventing Agricultural Chemical Exposure (PACE) since 1997. The PACE project is a community-based participatory research project focused on Latino farmworkers who are exposed to pesticides.

Laurienti was able to contribute neuroimaging expertise to examine the neurocognitive and behavioral effects pesticide exposure on adult Latino farmworkers. “The ViCTER award is the reason why I am doing my current research. I am a neuroscientist, so before this collaboration I was not involved in pesticide exposure research. The ViCTER program has enabled us to combine unique research perspectives to understand this problem,” said Laurienti.

Laurienti now leads the current phase of the project, PACE5, which is exploring how pesticide exposure is related to brain development and neurocognitive functions among Latino children. This longitudinal study is following children of Latino farmworkers for two years and comparing them to children of nonfarm working Latino parents with comparable socioeconomic status.

In order to measure pesticide exposure in the children, Laurienti teamed up with Kim Anderson, Ph.D., at Oregon State University. Anderson has developed simple wearable silicone wristbands that act as passive sampling devices by capturing personal exposure to thousands of different chemicals. The team will then use behavioral assessments and cutting-edge brain imaging techniques to explore links between pesticide exposure and brain development.

“Ours will be the first study that I can find that utilizes longitudinal measurements of pesticide exposure and advanced brain imaging in children to examine the effects of pesticide exposure,” said Laurienti.

Building Trust and Providing Actionable Results

With the exception of neuroimaging, most of the data collected for Laurienti’s pesticide exposure studies are acquired through the community.

“It has been fascinating to learn how different it is to conduct research out in the environment where the exposures are happening, rather than just in the laboratory,” said Laurienti. “I’ve learned through this process how crucial it is to build trust with community partners who can help engage our participants and identify trusted interviewers and data collectors.”

Laurienti and his research team often share their scientific findings with the community, particularly, to the study participants themselves. By reporting back results, study participants and their families can benefit from his research efforts.

“Providing study participants with our research findings is really rewarding for me. It brings the value of our research back to them and empowers them to take action,” said Laurienti.

Advancing Research Through Data Sharing

A key component of Laurienti’s research moving forward is improving data management and data sharing. In collaboration with Ramon Casanova, Ph.D., Laurienti is trying to transform the way people look at brain networks and how scientists can build on each other’s research.

“Instead of focusing on specific spots in the brain, it will be more like looking at a road map and thinking about the connections between points,” he said. “We’re trying to transform the data from individual points into what we call trajectories and standardize it in a way that will allow us to compare across different studies or populations.”

By sharing these new brain network trajectories, Laurienti hopes that researchers will be able to leverage older studies and compare across different research projects to answer complex questions about how the brain works.

Maida Galvez, M.D. – Empowering Pediatricians to Address Children’s Environmental Health Needs

May 15, 2019

NIEHS-funded researcher, Maida Galvez, M.D., M.P.H., an associate professor of environmental medicine, public health, and pediatrics at Mount Sinai, strives to increase awareness of the link between environmental exposures and health. By forging partnerships and translating science on pediatric environmental health, she is helping clinicians and families take action to protect children’s health.

Galvez was motivated to specialize in children’s environmental health during a seven-year B.S./ M.D. biomedical program at the City University of New York, and through a residency in social pediatrics at the Children’s Hospital at Montefiore in the Bronx. These experiences led her to apply for a competitive fellowship training program in environmental pediatrics at Mount Sinai which involved working on Growing Up Healthy in East Harlem, an NIEHS-funded study led by Mary Wolff, Ph.D. Through these experiences, she saw firsthand how neighborhoods can shape health.

“Seeing connections between substandard housing, poverty, and neighborhood health led me to think about community-level concerns, and how that impacted children’s health,” said Galvez.

Emphasizing Environmental Health in Pediatric Practice

Galvez co-directs the Community Engagement Core (CEC) for the Mount Sinai Transdisciplinary Center for Early Environmental Exposures where she collaborates with an interdiscplinary team of healthcare professionals to identify environmental health concerns and connect vulnerable populations to needed interventions. Her work has focused on serving children from high poverty neighborhoods around New York City, such as East Harlem and the Bronx. Many of the children she serves suffer from health conditions which are known to be related to air quality, housing quality, exposure to certain chemicals, and other factors related to their environment.

“There are many upstream root causes of health conditions in children, and the environment is one of them,” said Galvez. “For the busy clinician, it’s difficult during a 15-minute well child visit to address how the home environment and larger community impacts health.”

To overcome these challenges, Galvez, CEC Co-Director Carol Horowitz, M.D., and the CEC team collaborate with the Region 2 Pediatric Environmental Health Specialty Unit (PEHSU) at Mount Sinai and a newly established statewide network called the New York State Children’s Environmental Health Centers (NYSCEHC). These entities serve as important clinical translational arms for the CEC.

Through PEHSU and NYSCEHC, a team of experts at Mount Sinai work together with social workers, asthma counselors, and allied health professionals to systematically identify environmental causes of health outcomes, especially asthma. They then link families to local community-based organizations that can provide a healthy home intervention. For example, homes with mold concerns may be investigated for water leaks, proper ventilation, and suitable water drainage. After the intervention, relevant information is included in the patient’s Electronic Health Record, ensuring coordinated care and communication among clinicians, community-based organizations, and public health agencies.

“Our team has championed a broader consideration of social determinants of health to include the assessment of the home environment to promote healthy homes,” says Galvez.

Raising the Profile of Environmental Health Needs

Galvez also aims to translate knowledge about environmental health concerns to broader audiences, including the public and the medical community. Through the CEC, she has collaborated with environmental health scientists, clinicians, community organizations, policymakers, and others to develop and disseminate key environmental health messages.

For example, through an NIEHS P30 Administrative Supplement award, the Mount Sinai CEC is working with other CECs across the country to update the American Academy of Pediatrics and Physicians for Social Responsibility’s Prescriptions for Prevention. The Mount Sinai CEC's page also provides a variety of fact sheets, infographics, videos, and other resources about a variety of potentially harmful exposures.

“We seek to shift the way the pediatric practices operate by championing inclusion of environmental health,” said Galvez.

One sign they are already achieving this goal is that recommendations championed by the CEC and partners made it into the most recent version of Bright Futures, a national health promotion and prevention initiative led by the American Academy of Pediatrics.

Expanding the Vision of Children’s Environmental Health

Galvez says a key success for the CEC has been its ability to improve collaboration across diverse fields and expertise.

“Our experience with shared learning and cross-fertilization has been phenomenal. We’re bringing partners together that typically haven’t been present in these efforts,” said Galvez. “Our team has made meaningful strides to integrate a greater consideration of the environmental determinants of health into clinical care.” Moving forward, she aims to continue addressing the environmental health needs of families, particularly those that are high risk. “The global vision is that we meaningfully integrate environmental health into the routine medical care of children of all ages, and that healthy environments are prioritized and seen as integral to children’s overall health,” said Galvez.

Related Links

• Environmental Risks to Children: Prioritizing Health Messages in Pediatric Practice
• Transdisciplinary Center on Early Environmental Exposures
• Pediatric Environmental Health Toolkit Training Module
• CDC Healthy Homes Assessment Tools

Courtney Carignan, Ph.D. – Working With Diverse Communities to Explore Environmental Health Impacts

April 19, 2019

Courtney Carignan, Ph.D., knows the importance of community input in environmental health research and has shaped her work to meet the needs and concerns of communities. Carignan, an assistant professor at Michigan State University (MSU), has measured contaminants and assessed health effects for a wide range of populations including infertile couples, pregnant women, infants, new mothers, office workers, gymnasts, and communities exposed to contaminated drinking water.

Responding to Community Concerns

Her work with communities began during her first job out of college coordinating response to trichloroethylene contamination in drinking water in a rural Pennsylvania community.

“I got to know the people in the community and talk with them about their questions and concerns,” Carignan said. “From that experience, I resolved to find a way to better respond to and assist exposed communities.”

Now at MSU, Carignan is working with communities in New England and Michigan to characterize PFAS exposures and understand potential health effects from exposure in drinking water. PFAS are manufactured chemicals used in products for stain and water resistance, as well as in foams for fighting fuel fires. They have contaminated the drinking water of over 6 million Americans including that of several communities near where she is working. After PFAS contamination was discovered in these communities, Carignan started using her research to help answer community questions about the extent of the exposure and how it may be affecting the health of children.

“I’m currently investigating the effects of PFAS from contaminated drinking water on children’s immune systems and helping create an educational resource for exposed communities,” she said. “I’m also providing technical assistance for communities here in Michigan, as well as for the state health department.”

Carignan is part of a new NIEHS Research to Action grant focused on links between PFAS exposure and impaired vaccine response and other effects on the immune system in children, in collaboration with Northeastern University professor Phil Brown, Ph.D., and Laurel Schaider, Ph.D., of the Silent Spring Institute. Working in two communities who have experienced PFAS contamination in their drinking water, the researchers are measuring PFAS and markers of immune response in blood and interviewing community members to document experiences of affected communities. They are also developing an online network with resources for community education and engagement.

Unique Insight Into Gymnast Exposures

Carignan also has an ongoing project focused on assessing and reducing exposures to flame retardants in gymnasts. This work started when she was an NIEHS-funded doctoral student at Boston University under the guidance of Tom Webster, Ph.D., where she worked on a project to examine flame retardant exposures in office workers.

“From that work, I learned that flame retardants were used in polyurethane foam,” Carignan said. “As a former gymnast, I became concerned that flame retardants may be used in the foam of gymnastics training equipment, including the loose foam pit and landing mats.”

Most gyms contain a large pit filled with hundreds of foam polyurethane blocks, which provide a soft landing for gymnasts learning new acrobatic moves. Carignan initiated a small study to examine this potential exposure. She found that female gymnasts in her study, who were training at a collegiate gym in the eastern United States, had four to six and a half times more flame retardants in their blood compared to the general U.S. population. She also found that handwipe samples from the gymnasts after practice contained two to three times more flame retardants than before practice. Extremely high levels of flame retardants in dust, air, and foam from the gym suggested that the foam blocks were an important source of exposure.

Based on these findings, she started thinking about how to reduce exposure for gymnasts and collaborating with gymnasts, gym owners, and suppliers to understand the sources of flame retardants in gyms and ways to reduce exposure. Carignan started the Gymnast Flame Retardant Collaborative to facilitate communication between research scientists, fire safety experts, equipment manufacturers, and the gymnastics community.

“The collaborative provided a mechanism to engage with the gymnastics community,” Carignan said. “By forming a group, we were able to discuss the problem and find ways to solve it together.”

With support from the Toxics Use Reduction Institute at the University of Massachusetts Lowell, Carignan led an Intervention Study to see the changes flame retardant exposure in gymnastics training facilities when foam pits are replaced with flame retardant-free foam. Through this study, in collaboration with several other researchers including Heather Stapleton, Ph.D. an associate professor at Duke University, she observed a five-fold decline in flame retardant exposure for gymnasts. In collaboration with fire safety experts, they were also able to provide a check list for gyms describing how to meet all fire safety requirements and assure fire safety in gyms without the need for flame retardants in the foam.

Investigating Important Exposures in Communities

“My research focus is motivated by concerns of the communities I work with, loved ones who have encountered infertility, and as a woman, parent, and conscientious consumer,” Carignan said. She has also been part of several other studies focused on exposures and health. For example, as part of her postdoctoral work, Carignan worked on an NIH-funded study led by Russ Hauser, M.D., Sc.D., where she discovered an association between organophosphate flame retardants in urine and negative in vitro fertilization (IVF) outcomes in women. Her publication describing these links was chosen as an NIEHS 2017 Paper of the Year.

In support of her innovative approach to research and engagement, Carignan was named as one of 20 Pioneers under 40 in Environmental Public Health by the Collaborative on Health and the Environment. She was chosen for her accomplishments in driving environmental health science in new directions and promoting work that will protect the health of children, families, and communities.

“I’m really proud to be named among colleagues that I admire so much.” Carignan said. “The award helped me feel that the extra effort it takes to translate research into action is valued by the environmental health community.”

Staci Bilbo, Ph.D. — Bridging Basic Research and Clinical Care to Better Understand Autism

March 20, 2019

Staci Bilbo, Ph.D., studies how environmental exposures and the immune system interact in early life to impact brain development. Her research focuses on autism spectrum disorder (ASD), which affects about 1 in 59 children. As a basic scientist, Bilbo and her research team work in a lab using mouse models, but they also partner with clinicians to explore how their basic research may be relevant to understanding and treating ASD.

“I became interested in autism because of the community of parents and clinicians who were recognizing autism in their children and patients and trying to grapple with this disorder that was on the rise,” said Bilbo, who is an associate professor of pediatrics and neuroscience at Harvard Medical School and director of research for the Lurie Center for Autism at Mass General Hospital for Children. In July 2019, she will be returning to Duke University, where she was an assistant professor for nine years, as the Haley Family professor of psychology and neuroscience.

Research Path Leads to Autism and the Environment

Bilbo’s path to ASD research began when she was a graduate student, curious about how the immune system interacts with other important biological systems and functions in the body. She found that factors known to impact the immune system, such as an infection or stress during pregnancy, affected brain development and behavior in offspring.

When Bilbo was an assistant professor at Duke University, she began to explore how prenatal exposure to environmental chemicals, like air pollution, and social factors, like stress, interact to influence health outcomes. “There is pretty striking evidence in the literature showing that stress makes individuals more vulnerable to the effects of air pollution,” she explained. She credits Marie Lynn Miranda, Ph.D., who at the time was director of the Duke University Southern Center on Environmentally Driven Disparities in Birth Outcomes, for encouraging her to pursue a research path in environmental health.

Bilbo and colleagues found that mice exposed to both prenatal diesel exhaust and maternal stress had worse ASD-related outcomes compared to mice exposed to stress or diesel exhaust alone. "We see a true synergy in terms of the impact on offspring if we look at outcomes like social behavior deficits or immune system abnormalities. We don't see much with just diesel exposure or stress alone, but we see a lot with the two combined,” explained Bilbo. “This finding has implications for mothers and children living in poorer neighborhoods, where both air pollution and stress levels may be high.”

With a grant from NIEHS, Bilbo and her research team continue to investigate how combined exposure to maternal stress and diesel exhaust during pregnancy may contribute to autism risk by disrupting immune molecules that are critical for normal brain development.

Moving Research Beyond the Lab

Bilbo also partners with clinicians who work with ASD patients at the Lurie Center for Autism, a treatment center for individuals with ASD and other developmental disorders. She was named director of research for the Lurie Center in 2016.

Bilbo teamed up with Lurie Center Director, Christopher McDougle, M.D., to create a unique program that brings together the postdocs and trainees working in her lab with Lurie Center clinicians. The clinical and lab groups meet once a month for a “research exchange” in which the clinicians talk about their specialty and how they care for patients, and lab students present their basic research.

This exchange helps the clinicians contribute to and stay current with the latest research around the biology underlying autism. It also encourages basic scientists to consider how the research they are doing is relevant to ASD patients. Bilbo’s postdocs and trainees also shadow clinicians to meet some of the patients and their families. “For many of my students, this is the first time they have met ASD patients and their families and grasped the clinical relevance of their research.”

Through virtual meetings and travel, Bilbo will maintain her connection with the Lurie Center when she moves to Duke University in July. She also hopes to establish a research exchange program with ASD clinicians and researchers at Duke and will continue working with her research team in Boston through a small satellite lab. “I'm feeling very optimistic because I think this type of collaboration is the way science should be – there's no way we're going to solve a problem like autism by confining it to a single city, place, or lab.”

Brian D. Smith II – Increasing Awareness for a Healthy Detroit

March 8, 2019

Brian Smith, a community relations specialist at the Center for Urban Responses to Environmental Stressors (CURES) at Wayne State University in Detroit, Michigan, helps to raise residents’ awareness of how to protect their health from environmental stressors.

Having grown up in Detroit’s industrial corridor, where residents face serious health threats from air pollution, Smith is not only passionate about raising awareness but also understands the culture and how best to connect with community members. Smith and the CURES team are working in collaboration with community partners to address environmental health concerns in Detroit’s urban landscape, such as poor air quality due to high truck traffic, lead-contaminated soil and water, and abandoned homes and buildings that create an unsafe environment.

Leveraging Community Partnerships to Build Capacity

Smith got his start in community outreach in 2013 when, as a returning combat veteran for the Michigan National Guard, he began work as an AmeriCorps volunteer with Focus: HOPE, a nonprofit in Detroit addressing hunger, poverty, inadequate education, and racial divisiveness.

He was able to leverage the partnerships and skills he built while at Focus: HOPE when he joined CURES in 2015. “I feel really proud that through my work with CURES I’ve been able to continue to give back to Focus: HOPE,” noted Smith. “They were interested in learning about the health impacts of a proposed concrete recycling facility in a neighborhood with high poverty and high asthma rates, and we were able to help address that need.”

Smith worked with CURES researchers and community partners to host an environmental health literacy session to review exposure and health impact data with the residents, who then used this information when they met with the board of zoning.

“Rather than using the term ‘empower,’ I think of this work as helping people to stand in their own power by way of giving them more knowledge and connecting them to community services and resources,” Smith stated.

Bringing Research to Detroiters Through Environmental Health Chats

One way Smith helps to foster collaborations and co-learning experiences for environmental health advocates, healthcare professional, stakeholders, leaders, and researchers is through public forums and mobile environmental health chats.

Smith’s innovative forums and workshops bring environmental health information to the places community members already gather, such as churches, schools, and community centers.

CURES hosts these public forums for 80 to 100 people several times per year. The forums include presentations from researchers on the current science as well as presentations from the Community Advisory Board members or community partners, such as Detroiters Working for Environmental Justice, Ecology Center, Zero Waste Detroit, Detroit Health Department, Breathe Free Detroit, Southwest Detroit Environmental Vision, and provide residents with information and resources. These presentations are recorded so that the information can be accessed at any time. In addition, Smith uses these presentations to host mobile environmental health chats for approximately 80 community members two to three times per year.

Guided Environmental Health Tours

To see Detroit’s environmental health issues up close, Smith provides Environmental Health Tours to nursing students, medical residents, environmental law students, visiting researchers, and community partners. The stops on the tour highlight CURES research interests and areas of concern for the CURES Community Advisory Board, such as petroleum coke exposure in Southwest Detroit, community gardens, and the neighborhood around the trash incinerator.

“One of our stops is the neighborhood I grew up in. When we were on a tour last fall, I knew the driver of the ice-cream truck that drove by because he was the same driver when I was growing up,” Smith noted. “I feel honored to continue to be a steward to my community as well as a conduit to for bi-directional information sharing between CURES and the community.”

Planning for the Future

Smith is currently completing his Master in Urban Planning degree at Wayne State University and will graduate in December. Given the direct relationship between the urban and industrial environment in Detroit and the environmental health disparities in the city, he hopes to bring this unique planning perspective to his work to continue to make a difference to the residents of Detroit.

Read More

• Center for Urban Responses to Environmental Stressors (CURES) at Wayne State University
• CURES Video Raises Awareness of Detroit’s Environmental Health Issues
• CURES Community Engagement

Kim Harley, Ph.D. – Engaging Latino Youth in Environmental Health

February 20, 2019

Kim Harley, Ph.D., reproductive epidemiologist, is passionate about improving environmental health literacy, training, and leadership skills in Latino youth of Salinas, CA.

California’s Salinas Valley is one of the most productive agricultural regions in the nation, with annual revenues exceeding $4 billion per year. According to Harley, more than 9 million pounds of agricultural pesticides are applied to crop fields in the Salinas Valley per year.

An Associate Director of the NIEHS-funded Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS) study, Harley leads projects that utilize community-based participatory research approaches to address pesticide and other environmental exposures experienced by immigrant farmworker women and their children living in the Salinas Valley. In other words, she works with community residents at every stage of the research process -- from defining the research questions to collecting data, analyzing and communicating results and implementing interventions.

Harley has been committed to the CHAMACOS study since it began in 1998, while she was a graduate student at the University of California at Berkley.

“The CHAMACOS study was funded during my M.P.H. and I was really excited about the possibility of working on the study as part of my Ph.D., which is why I applied to the Epidemiology program at Berkeley. I joined Drs. Brenda Eskenazi and Asa Bradman when they were first starting the study,” said Harley.

CHAMACOS is the longest running longitudinal birth cohort study of women and children in a farmworker community, containing years of data characterizing the effects of environmental exposures on children’s neurodevelopment, behavior, and other health outcomes and amassing hundreds of thousands of biospecimens. As research participants transitioned from children into adolescents, new questions and ideas concerning the study arose from Harley and her team. This led to the formation of the study’s youth council.

The CHAMACOS Youth Community Council

In 2010, Harley helped establish the CHAMACOS Youth Council (YC) in collaboration with partners from Clinica de Salud del Valle de Salinas, a local network of community health clinics. This leadership group trains 10 to 15 Latino youth in research design and implementation, promotes environmental health literacy, and engages them in advocacy and outreach.

“Our youth council work started with funding from NIEHS, so we are really proud and grateful to NIEHS for starting and believing in this project,” said Harley.

To date, Harley has worked as the principal investigator to oversee several successful research projects led by the YC, including the Health and Environmental Research in Make-Up of Salinas Adolescents (HERMOSA) Study and the Chamacos of Salinas Evaluating Chemicals in Homes & Agriculture (COSECHA) Study, each of which was 3 years long. The vast majority go on to college. A new cohort of the YC is currently working on a project examining Latina’s exposures to potentially hormone disrupting or carcinogenic chemicals in cleaning products.

Youth Participatory Action Research

According to Harley, youth engagement in participatory science and evaluation requires dedicated research and community partners. These partners assist with strategic planning, devote adequate time for learning and training, revise and critique research design strategies, recruit participants, interpret findings, and translate these findings into actions. Shared decision making is also an integral part of youth research, ranging from initial decisions on the research concept and study design to the final decisions on dissemination and intervention. This process empowers youth researchers to lead, develop ownership and become fully vested in the study.

Youth-engaged participatory science and evaluation also provides positive professional development opportunities for youth, improved self-esteem, as well as exposure to environmental research and institutes of higher education. Often these youth develop research skills and leadership abilities, which empower many to pursue careers in public health and environmental law.

“We are really interested in training the next generation of environmental health leaders in the Salinas farm worker community,” said Harley.

The HERMOSA Study

The first YC-led project Harley oversaw with her community partner, Kimberly Parra, was the HERMOSA study. The study examined 100 Latina adolescent’s exposures to endocrine-disrupting chemicals (EDCs) in cosmetics and beauty products. EDCs are molecules, natural or synthetic, that mimic, block or interfere with the function of hormones in the body.

This three year study, funded by the California Breast Cancer Research Program, was the first to demonstrate that choosing personal care products labeled free of phthalates, parabens, triclosan and benzophenone-3 (BP-3), can significantly reduce personal exposure to some EDCs.

The YC under the direction of Harley, has communicated these scientific findings to both local and national communities through major news broadcasts and educational materials. Efforts by the YC to reduce exposure to EDCs have also included: writing petitions on media platforms, writing letters to CEOs of major drugstore chains, creating DIY beauty recipes, educating policy makers in Sacramento, and presenting scientific data to the California Consumer Product Safety Commission.

The COSECHA Study

In 2016, the YC in collaboration with Harley and community partner, Jose Camacho, conducted the COSECHA Study. This three-year project funded by the California Breast Cancer Research Program, assessed pesticide exposure in Latina adolescents living in Salinas Valley. The YC members collected all data from 100 participants including: residential dust samples, urine samples, GPS coordinates, nearby field crop verification, environment sampling bracelets and questionnaires.

Research findings were analyzed by Harley and her Berkeley colleagues and, with the help of James Nolan, the center’s Community Outreach Coordinator, youth researchers translated scientific discoveries into health education activities, including developing a Radio Novella Series on how to protect oneself and family from pesticides. The series has aired on 10 radio stations throughout the Central Valley, Eastern Washington and Oregon. Youth researchers have also distributed custom made doormats to individuals within the agricultural community, which the research indicated may help reduce pesticide exposures in the home. Each mat was printed with simple tips for reducing take-home pesticide exposures. In addition, youth researchers have co-presented their discoveries at scientific meetings and conferences.

Household Cleaning Products Study

Again as principal investigator, Harley has begun an intervention study with a new cohort of YC members, geared towards understanding and reducing chemical exposure in cleaning products, among Latina moms living in Salinas Valley. Harley anticipates that the results from this study will be available within the next year or two.

Related Resources

• Engaging Youth in Environmental Public Health

Sherry Baron, M.D. – Engaging the Community to Protect the Health of Low-Wage Workers

January 29, 2019

Sherry Baron, M.D., an NIEHS-funded occupational physician and public health researcher, strives to make work practices and workplaces safer, especially for disadvantaged populations. According to Baron, one of every three workers in the United States is a low wage worker and makes less than 12 dollars per hour. These workers are more likely to be exposed to hazards on the job.

Baron initially became interested in worker health during an undergraduate internship with a network of rural community health clinics serving coal miners. Since then, she has made it her life’s work to document the environmental hazards of low-wage workers and develop successful interventions to protect their health.

“I wanted to have a career where I could improve social justice,” Baron said. “I was drawn to occupational health because it was an area of medicine where I could be directly engaged with communities around issues that were important to them.”

Using Community Partnerships to Reach Immigrant Workers

Before becoming a professor of Occupational and Environmental Health at the City University of New York (CUNY), Baron spent 25 years as a researcher at the National Institute of Occupational Safety and Health (NIOSH). She had a distinguished career at NIOSH where she won several awards for her work championing occupational health for low-wage, immigrant workers. She also collaborated with NIEHS and the U.S. Environmental Protection Agency (EPA) on an environmental justice initiative called Partnerships for Communication (1994-2007), which added an occupational justice focus.

Baron also served as the coordinator for the NIOSH Occupational Health Disparities program where she helped to shift the thinking about how best to reach low-wage and immigrant workers. She found that community partnerships were much more effective than the traditional occupational health model of trying to reach low-wage workers through their workplace. “Focusing on the community and developing workplace exposure reduction programs with community partnerships has been very successful in reaching a whole group of workers that we haven’t successfully reached in the past.” Baron stated.

Building Capacity to Protect Workers' Health During Disasters

Baron applied her community-based research approach at CUNY and the Barry Commoner Center for Health and the Environment to explore how environmental exposures at the workplace and in the community can impact health.

For example, she led a research effort following Superstorm Sandy that documented the health impact of that disaster on Latinx workers who provided clean up and reconstruction efforts. (The term Latinx is now used instead of Latino or Latina to be inclusive of all genders.) Baron also designed a community engaged intervention effort to raise the profile of local immigrant community-based organizations in the New York City (NYC) disaster preparedness planning process. This work led to ongoing funding to assist community-based Latinx worker centers in developing their own capacity to conduct effective Spanish-language training to inform workers about their rights to safe workplaces.

Involving the Community to Reduce Exposure to Toxic Cleaners

Baron and her team are in the initial stages of an NIEHS Research to Action project to reduce exposure to toxic cleaning chemical products among low-wage Latinx immigrants. They are partnering with the largest Latinx immigrant community-based organization in NYC, Make the Road New York, to survey Latinx domestic cleaning workers about cleaning product use.

“Community partnerships are incredibly important for good science and for helping build capacity within community-based organizations on issues of environmental sciences.” Baron emphasized. In collaboration with co-principal investigator Homero Harari, Sc.D., researcher and assistant professor at Icahn School of Medicine at Mt. Sinai, the team is not only developing exposure measure methodology, they are also using citizen science and involving community members in the exposure assessment process.

Looking to the future, Baron is excited to find new ways to engage the communities she works with. For example, she plans to continue to build awareness about environmental exposures among communities using citizen science approaches, such as using smart phone applications for workers to document dangerous working conditions.

Read More

• Barry Commoner Center for Health and the Environment
• Reducing Exposure to Toxic Cleaning Chemical Products Among Latino Community Members
• Improving the Health of Immigrant Workers in NYC
• Promoting Safety and Health for In-Home Care Workers

Thomas McKeon – Working With Schools to Address Environmental Health Needs

January 14, 2019

Thomas McKeon, a researcher and academic coordinator at the University of Pennsylvania (Penn), has a longstanding interest in environmental health literacy and community engagement. His work focuses on providing tools and education to protect vulnerable populations, especially children, in Pennsylvania from environmental toxins, such as air pollutants.

McKeon’s passion for environmental health stems from early life experiences. Throughout his childhood, he participated in a nature camp located in Pennington, New Jersey, called The Watershed Institute, first as a participant, and later as a counselor. “The institute placed a strong emphasis on understanding how environmental issues impact human health through direct exploration, such as examining water samples,” says McKeon. “For me, the connection between environmental health and human health has always been quite clear.”

His interest in further exploring this connection lead McKeon to pursue a B.S. in Ecology and Natural Resources at Rutgers University, and later an M.P.H. in Environmental Health at Penn. Now, he works closely with NIEHS grantee Marilyn Howarth, M.D., at the Community Engagement Core (CEC) of Penn’s Center of Excellence in Environmental Toxicology (CEET). Together, they work collaboratively with stakeholders to identify and solve environmental health problems for Pennsylvania communities.

Responding to High Asthma Rates in Schools

Over the past few years, one of the CEC’s key priorities has been addressing the alarmingly high asthma rates in Philadelphia. According to Philadelphia’s 2017 Health of the City report, asthma rates are two to three times higher in the Philadelphia region compared to the rest of Pennsylvania. Studies indicate that high asthma rates are linked to a variety of outdoor air pollutants from auto exhaust, power plants, airports, and oil refineries.

“Children are among the populations most affected by asthma, resulting in missed school days, activity limitation, and hospitalization,” says McKeon. “However, many residents are unaware of actions they can take to keep their children safe.”

In response, McKeon and colleagues worked with the Delaware Valley Regional Planning Commission to design a project to educate staff at early learning centers about how to protect children from poor outdoor air quality. Working together, they developed a 15-minute presentation discussing local asthma prevalence, the relationship of poor outdoor air quality and asthma, and air quality alert resources. They contacted daycare directors, asking to share the free resource with their staff.

“As we began giving the presentation, we got a lot of positive feedback, and daycares started recommending other daycares we should talk with as well,” says McKeon. From 2015 to 2017, they gave the presentation to staff at a total of 45 childcare centers in Philadelphia.

To test their approach, their team administered pre- and post- presentation surveys to measure knowledge gained about outdoor air quality and asthma. Their results show that staffers gained awareness of the U.S. Air Quality Index (EPA’s index for reporting air quality). Additionally, many daycares staffers signed up to receive alerts from AirNow.Gov, and more than half of preschool staffers said they modified daycare activities based upon air quality. For example, daycare centers were more likely to adjust time spent playing outside on code orange or red air quality alert days. “After receiving our training, staffers indicated increased knowledge about air quality and air monitoring resources,” said McKeon. “This gave staffers a sense of empowerment through improved knowledge, and encouraged positive decision-making to protect children at risk for asthma.”

To follow up on this success, their team is looking to create a similar presentation tailored for elderly populations, another group with a high risk of respiratory illness. “We like to take a living, breathing approach with our environmental educational programs, which can be modified according to changing situations and circumstances – and for diverse needs,” says McKeon.

Teaching Environmental Health Through Art

The CEC is also working in Chester City, Pennsylvania, a community just outside of Philadelphia that suffers from disproportionally high rates of asthma, cancer, and other conditions. McKeon and others recently worked with a small group of high school students in the Chester Boys and Girls Club, encouraging them to express their environmental health concerns through art.

The CEC met with students on two occasions. First, McKeon led an environmental health presentation during which they discussed lead, poor air quality, and related concerns in the region. Second, they collaborated to create personalized environmental health patches for a unified quilt.

Their quilt is made of photosensitive imprints and watercolor tiles. The quilt visually emphasizes commonalities shared among all communities, focusing on plants, streams, and open spaces. However, the mosaic of discoloration portrays the impact of environmental influences on health equity.

The CEC entered the quilt, which they titled An Equitable Earth, in the National Academy of Medicine’s nationwide Visualize Health Equity art contest, and it was selected to be featured in a permanent online gallery. “We saw an opportunity to highlight a community suffering from health disparities and environmental health inequities,” said McKeon. “We worked with students to successfully create a project through their active participation, helping young people elevate their own voices.”

Next Steps: Finding Place-Based Answers

Looking forward, McKeon plans to use geocoding and data collection in his work to answer place-based questions and formulate solutions. “This area of focus would be a natural progression from community engagement and community-based participatory research, enabling us to yield more specific exposure information,” said McKeon. “For example, we could better answer questions, like: How is air pollution from traffic impacting asthma rates in specific communities?”

McKeon says CEC’s successes would not be possible without the help of NIEHS. “The institute has played an invaluable role to help us improve environmental health in Pennsylvania’s most vulnerable communities, and I’m delighted to be a part of these efforts,” says McKeon.

Related Resources

• Learn about the U.S. Air Quality Index
• Explore EPA’s Asthma Picture Book – “Why is Coco Orange?”
• Sign up for EPA’s air quality alerts
• Learn about the National Academy of Medicine’s (NAM) Health Equity Project