Abby Mutic, Ph.D., M.S.N., C.N.M. and Nathan Mutic, M.S., M.A.T., M.Ed. – Innovating Environmental Health Communication

April 30, 2025

In this highlight, we speak with Abby Mutic, Ph.D., M.S.N., C.N.M., and Nathan Mutic, M.S., M.A.T., M.Ed., both at Emory University, about their shared commitment to ensuring that research is communicated effectively so that people can make informed decisions.

“Over the years, we have featured individuals and their contributions to environmental public health. It is not often that we get to spotlight a family working together to advance this field,” said NIEHS Health Specialist Liam O’Fallon, M.A.

After meeting during graduate school at Vanderbilt University, Abby and Nathan married and began careers in healthcare and education — Abby as a nurse midwife and Nathan as a high school biology and chemistry teacher. While caring for patients, Abby became interested in how the environment affects pregnancy and health outcomes for mothers and their children.

“Many of the women coming to the clinic worked in farming or factories and had concerns about their exposures and whether those exposures were safe for their pregnancies, their health, and their families’ health,” Abby said. “I became really interested in answering those questions.”

Collaborating in the Field

When Abby started at Emory, she continued supporting farm workers, joining the Girasoles Research Program. The program, led by Linda McCauley, Ph.D., R.N., focuses on occupational and environmental health concerns of Florida farm workers, a group with an increased risk for heat-related illnesses.

“As nurse researchers leading the Girasoles study, we were able to connect biometrics, like blood sugar and kidney function, with how workers felt as temperatures change through the day,” said Abby. “We broke down complex information into clear terms, making it easier for research participants to understand the health impacts.”

During summer break from the teaching year, Nathan joined Abby in the field in Florida to help with data collection. Together, they developed a protocol to help researchers share health data with participants. It was during this trip that he discovered a new interest in environmental health.

“My teaching background prepared me to quickly evaluate where someone’s knowledge is and how to build on that knowledge to share information,” said Nathan.

Harnessing Social Media

Nathan shifted from teaching to supporting the Southeast Pediatric Environmental Health Specialty Unit (PEHSU) and the Emory Children’s Environmental Health Center (CEHC). There, he became passionate about clear scientific communication among scientists, clinicians, and communities tackling children’s environmental health.

After a meeting between the PEHSU and CEHC networks, Nathan and collaborators at the University of Illinois Urbana-Champaign and the University of Southern California launched a national social media campaign about children’s environmental health with funding from an NIEHS administrative supplement. The campaign, which built on findings from the 2017 NIEHS/EPA Children’s Environmental Health and Disease Prevention Research Centers Impact Report, allowed organizations in the PEHSU and CEHC networks to tailor posts for their own audience.

“The campaign was only possible because of the collaboration and leadership from each center,” said Nathan.

Nathan found that shared goals and authentic relationships with community groups — like translating environmental health research findings into practical information for reducing exposures to smoke, allergens, and other pollutants — lay the groundwork for effective engagement. While no longer at the PEHSU, Nathan carries those values into his current role as the Assistant Dean of Research Operations at the Nell Hodgson Woodruff School of Nursing at Emory University.

Advancing environmental health communication

Abby now serves as the director of the Southeast PEHSU and is a professor at the Nell Hodgson Woodruff School of Nursing at Emory University. She collaborates with experts in nursing, toxicology, education, and other fields to turn complex environmental health data into clear, actionable information that directly benefits communities.

Like Nathan, Abby centers her work around community voices.

“It’s really important that my research is relevant to what folks in the community are most concerned about with their kids and their pregnancies,” she said.

Abby also collaborates with Sun Joo Grace Ahn, Ph.D., of the University of Georgia, on a virtual immersive experience that simulates asthma triggers in a home setting, helping participants understand how to improve indoor air quality. The project is supported by the NIEHS-funded Center for Children’s Health Assessment, Research, Translation and Combating Environmental Racism (CHARTER), which is directed by Linda McCauley, Ph.D., R.N.

“Talking about environmental health can feel overwhelming if people think they can’t change their environment,” said Abby. “Our simulation empowers people to reduce their air pollution exposure.”

In another study, funded by the National Heart, Lung, and Blood Institute and CHARTER, Abby works with early learning centers in the Atlanta area to measure indoor air exposure using silicone wrist bands worn by pre-K students. Her goal is to study how these pollutants affect children and if they can communicate respiratory symptoms to their parents.

“Building strong relationships with teachers was key to ensuring student learning and play was not interrupted by the study procedures and to build trust with caregivers,” Abby said.

Although they no longer work side by side, Abby and Nathan continue to support each other’s contributions to communicating environmental health to researchers and communities alike.

“I’m thrilled to see growing attention on translating environmental health research for communities,” Abby said. “Identifying how to effectively communicate this data is a science in itself, and communities benefit when we make environmental health information clear and meaningful.”

Mary Crocker M.D. – Protecting Kids From Wildfire Smoke: How Research Informs Practice

April 29, 2025

As a young doctor at Seattle Children’s Hospital, Mary Crocker, M.D., faced a clinical challenge from an unanticipated source: wildfire smoke. Her patients were presenting with exacerbated asthma symptoms from exposure to smoke, and when parents asked how to best protect their children, Crocker wasn’t always sure what to tell them. 

“It was frustrating that I didn’t have great advice to share with them because I didn’t learn about wildfire smoke in medical school,” she said. “That’s when I decided I needed to do more.” 

As she read about wildfire smoke and children’s health, Crocker realized there were few evidence-based interventions to protect children at risk of exposure. She was inspired to develop these interventions, but she needed more time for research. 

Crocker then joined the University of Washington Pediatric and Reproductive Environmental Health Scholars (PREHS) program. The NIEHS-funded program provides pediatricians with protected time to develop their research capacity, conduct community-engaged research, and translate research findings into clinical interventions.

Perks of PREHS

Before PREHS, Crocker had some research training through a fellowship with the National Institutes of Health Fogarty International Center. Through a Peru-based project, she examined the health effects of indoor air pollution from burning wood for fuel. 

“One of the outcomes we studied was pneumonia in children,” said Crocker. “That was my first opportunity to conduct environmental health research, and it coincided with my interests in lung health.” 

She credits her Fogarty fellowship and a career development award from Seattle Children’s Hospital as steppingstones to PREHS. According to Crocker, PREHS classes in environmental epidemiology, qualitative research methods, and data analysis significantly improved her research skills. 

“PREHS course work has strengthened my ability to design rigorous studies, understand data analysis, and interpret results,” she explained. 

Crocker added that the biggest perk of PREHS is mentorship. Her primary mentor, Catherine Karr, M.D., Ph.D., has helped Crocker tap into resources she didn’t know existed, like funding opportunities through NIEHS or research support through different academic departments. 

“I think PREHS will benefit me for a long time,” said Crocker. “I’m able to take what I learn from my research and use it in clinical practice. I can share my findings with patients and say, ‘This is what I found, and here are some things that are helpful.’”

Wildfire Smoke and Children's Respiratory Health

Through PREHS, she has become confident giving advice to families on how to reduce their exposure to wildfire smoke – informed by her work summarizing how wildfire smoke influences respiratory health for the estimated 7.4 million children exposed annually, 700,000 of which have asthma. 

“The number one thing I tell families is to know your air quality,” Crocker said. “I show them how to check the air quality index on apps and websites and tell them what actions need to be taken at different thresholds.” 

Protective measures Crocker recommends include staying inside if possible, wearing an N95 mask if going outside, ensuring smoke cannot enter the home, and installing a home air filter to remove smoke pollution. 

“For some children, wildfire smoke exposure may trigger mild respiratory symptoms, like nasal secretions or coughing,” Crocker explained. “But for others, it can be more severe, like wheezing, coughing, and shortness of breath that can lead to hospitalization and be life-threatening.” 

However, to effectively prevent wildfire smoke exposure, physicians need to know when to step in and what to tell their patients. For Crocker, this was a challenge when she first started at Seattle Children’s Hospital, and she was curious if other doctors had a similar experience. To find out, she conducted a survey of pediatric pulmonary providers in Washington state. 

“We asked about different components of wildfire smoke and how to manage it in a clinical setting, and we identified many opportunities for improvement,” said Crocker. “For example, most providers knew what the air quality index was, but not all were familiar with how it is calculated. Also, not all providers felt confident helping families prevent exposure.” 

To bridge this gap, Crocker has taken a more active role in pediatric resident training, developing lesson plans for how physicians can address wildfire smoke. She also supports the use of interactive lectures, case studies, and perhaps most importantly, pediatric board exam questions focused on wildfire smoke.

Centering Community

Prior to PREHS, Crocker collaborated with the Public Health Seattle and King County Asthma Program, which pairs environmental home inspections with education to support families of children with asthma. 

As a PREHS scholar, Crocker has continued working with her local public health department to make the services available to more families. She developed a protocol for virtual home visits, taking into consideration concerns identified by families of children with asthma. 

According to Crocker, interventions like this new protocol would not be effective unless informed through community-engaged research. 

“Engaging communities in research is essential,” explained Crocker. “We can do research about communities very easily, but if you want to make a difference and improve health, you need to listen to the individual voices within that community.”

James Stafford, Ph.D. and Michael Rountree, Ph.D. – An Education in Epigenetics: Improving Students’ Environmental Health Knowledge

April 17, 2025

What do a rust-colored fungus and a furry creature with horns have in common? Both are being used to teach students how the environment affects human health. The fictional character and fungus are components of two educational tools – an online game and a laboratory kit – developed by small business Nzumbe, Inc. with funding from NIEHS.

"We want to teach people how their environment impacts their epigenome in ways that can improve or harm human health,” said Nzumbe’s president, James Stafford, Ph.D.

Exposures to chemical compounds can lead to epigenetic changes, which can determine which genes are turned on or off. Although many epigenetic modifications are part of normal development and aging, environmental factors may cause epigenetic changes that lead to a range of health conditions, including autoimmune diseases, neurodevelopmental disorders, and cancers.

From Therapeutics to Teaching Tools

“Nzumbe was initially focused on developing epigenetic therapies for cancer and other diseases, but we have shifted gears to creating educational products,” said Stafford. “NIEHS funding was instrumental in broadening our company’s mission to include education.” 

Founded in 2012 by Stafford, Tommy Pham, M.B.A., and Mitch Turker, Ph.D., Nzumbe quickly brought on epigenetics expert Michael Rountree, Ph.D., as chief scientific officer. Rountree’s expertise with the fungus Neurospora crassa – commonly called red bread mold – was key to some of the company’s initial endeavors to develop disease treatments. 

“The Neurospora fungus has the same epigenetic marks as humans,” he said. “This is especially useful when trying to better understand human diseases triggered by epigenetic changes.” 

Now, with funding from two NIEHS small business grants, the Nzumbe team is developing a laboratory kit for undergraduate students that uses the N. crassa model to demonstrate how environmental exposures can alter gene expression.

Experimenting With Fungus

To develop the laboratory activity, the team created a modified N. crassa strain engineered with an epigenetic reporter gene that restricts growth. The reporter gene is highly responsive to environmental exposures, allowing students to test how an array of environmental factors may alter fungal growth through the epigenome. 

“The Neurospora model is simple, safe, and inexpensive, which makes it an ideal system to teach about environmental epigenetics in the classroom or at home,” said Rountree. 

First, teachers use educational modules developed by Nzumbe to teach about epigenetics, including how environmental exposures can influence gene expression. Then, students apply these concepts in the lab. For example, by changing the fungus’s environment, such as temperature or nutrient source, the students may partially or fully reactivate the epigenetic reporter – allowing the fungus to resume growth.

“The advantage of using this reporter gene is that it provides the students with an outcome that is easy to observe and measure – in this case, growth rate – based on the expression level of the reporter gene,” said Rountree.

Gaming Gene Expression

The Nzumbe team also created an online game called EpiMon. 

“Games make learning more interactive, engaging, and fun,” said Stafford. “We wanted to lean into these attributes to teach students how lifestyle choices and environmental exposures can impact health.” 

To accomplish this, Nzumbe scientists worked with software developers to create a game in which students guide their character, called an EpiMon, through a lush fictional world filled with forests, streams, and gardens. As students explore their surroundings, they must make choices – like food harvesting, fishing, cooking, and sleeping – that will determine their character’s environmental exposures, lifespan, and overall health. 

The EpiMon starts out as a blue furry character. These physical traits change depending on the type of food the player chooses to harvest and eat, for example. Collecting too much of an easy to access, but less healthy food may result in an EpiMon with brown fur and red eyes, while investing the time to harvest more nutrient dense food may cause the character to sprout a tail. 

“These physical changes serve as visible cues to help the students understand that the choices they make and environmental exposures they encounter influence how genes are expressed,” said Stafford. 

Players can also send their EpiMon on “quests,” which serve as the game’s formal educational component. In one quest, students answer epigenetics questions to defeat a fire-breathing beast. Completing quests grant advantages, like a UV-blocking balm, to help counter environmental exposures. 

“The rewards are designed to teach students about prevention,” said Stafford. “We want them to know there are steps they can take to reduce exposures that may contribute to poor health.” As a companion to the EpiMon game, Nzumbe worked with education experts to design web-based environmental health modules, covering topics like environmental epigenetics and endocrine-disrupting chemicals.

Expanding Access to Engaging Science Education

The Nzumbe team plans to test the game and laboratory kit in undergraduate science classes, focusing on community colleges or small liberal arts colleges. Once launched, the game can be adapted for middle and high school students by adjusting the educational content. 

“Ultimately, we hope these products will help students understand that our environment impacts our health – and encourage them to make decisions that can prevent or reduce their risk of disease,” said Rountree.

Ayca Erkin-Cakmak, M.D., MPH, and Ana Maria Mora, M.D., Ph.D. – Researchers Trace Health Effects of Early-life Exposure to Pesticides and Other Pollutants

April 10, 2025

Two NIEHS-funded clinicians-turned-researchers have launched a collaborative research project using data from the same epidemiological cohort study where they first met—at the University of California (UC), Berkeley. Ayca Erkin-Cakmak, M.D., MPH, and Ana Maria Mora, M.D., Ph.D., are analyzing data from the 25-year-old CHAMACOS cohort study to investigate the association between early-life exposure to mixtures of persistent organic pollutants and cardiometabolic outcomes in young adulthood. 

They received a pilot award from the NIEHS-funded Environmental Research and Translation for Health (EaRTH) Center at University of California, San Francisco (UCSF), to pursue this offshoot research. Erkin-Cakmak and Mora cut their teeth on epidemiology research in the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) study at UC Berkeley. CHAMACOS means “little children” in Mexican Spanish. 

Brenda Eskenazi, Ph.D., of UC Berkeley started the study of over 600 mother-child pairs in the Salinas Valley, on the central coast of California, in 1999. CHAMACOS has become the longest-running birth cohort study examining how pesticides and other environmental exposures affect the health of children, adolescents, and young adults in an agricultural community. It has also given rise to many spin-off studies, including those by Erkin-Cakmak and Mora. 

CHAMACOS researchers have collected a broad spectrum of data on the cohort’s children, including on physical growth, endocrine system health, lung function, neurodevelopment, and risk-taking behaviors. They have tracked the health effects of pesticides and polybrominated diphenyl ethers (PBDEs)—a class of endocrine-disrupting flame retardants—as well as other chemicals. 

Teaming Up to Meet Research Challenges 

Both doctors were drawn to graduate work with CHAMACOS due to their interest in how chemical exposures affect health and in finding ways to reduce these exposures. Even after Erkin-Cakmak took a position at UCSF and Mora continued as a researcher at UC Berkeley, they both knew the CHAMACOS study’s rich data held the potential for more breakthroughs. So, they decided to join forces. 

“We thought it would be great to combine my expertise on pesticides and other environmental toxicants with Ayca’s knowledge of cardiometabolic outcomes and endocrinology, in general,” Mora related. 

With their current EaRTH Center funding, Mora and Erkin-Cakmak are analyzing CHAMACOS data to investigate links between early-life exposure to persistent organic pollutants, including organochlorine pesticides, and cardiometabolic disorders such as obesity in young adults from the cohort. They hope to expand their project to examine the association between exposure to currently used pesticides, such as glyphosate and neonicotinoids, and these health outcomes. 

From the Clinic to the Bench 

Erkin-Cakmak earned her pediatric medicine degree in her native Turkey, before realizing she wanted bench research to be part of her career. 

“I wanted to contribute not only to children’s health through care, but also by conducting research to inform the care we provide,” Erkin-Cakmak said. 

She started almost from scratch as a master’s student at UC Berkeley, where she became involved in CHAMACOS research. She then trained at UCSF, where she is now a pediatric endocrinologist and researcher. 

Mora also transitioned from a clinical medicine career to scientific research. After earning her medical doctorate in Costa Rica, she worked for a year as a primary health care practitioner in the Costa Rican Social Security Health System. She discovered her passion—and a pressing need in her community—to understand the health effects of pesticide exposure in vulnerable populations. Costa Rica is a major banana producer, and many residents are affected by the chemicals that banana growers spray on crops. 

“I grew tired of treating people only after they had been diagnosed,” Mora said. “That sparked my interest in identifying and reducing risk factors rather than intervening at the later stages of disease.” 

Study Spinoffs Multiply Positive Impacts 

The CHAMACOS cohort study has informed many new, related studies, often led by community members whom the study has engaged over the years. One example is the CHAMACOS Youth Council, a group of Salinas youth trained in community-based science. The council has provided research feedback and conducted its own studies. 

“These youth were trained to design questionnaires, collect data, and analyze them,” Mora explained. “In some cases, they even met with local decision-makers to discuss the results. It was a very empowering experience for them.” 

The ripple effect of the CHAMACOS cohort extends even further. Mora brought her knowledge and experience from the study to her home country of Costa Rica, where she collaborated with Berna van Wendel de Joode at Universidad Nacional to launch a birth cohort study of mother-child pairs living near banana plantations. Now more than ten years old, the study has uncovered significant adverse health effects associated with pesticide exposure. 

Erkin-Cakmak spoke of trying to make ripples in her networks back in Turkey. 

“I still have conversations with my doctor colleagues who are practicing there,” Erkin-Cakmak said. “I try to communicate what I have been learning about how exposure to pesticides can have lifelong effects on health to my connections there.” 

The Power of Personalized Results 

Erkin-Cakmak and Mora noted that the CHAMACOS study has always prioritized sharing its findings with the Salinas Valley community. The researchers publish a biannual newsletter called “La Semilla” — Spanish for “the seed” — in which they present complex scientific data in an understandable and relevant way to the community. 

Parents and children in the cohort are also invited to an annual community forum, where researchers share individualized study results. Mora has helped host a few of these gatherings, during which CHAMACOS researchers explain to each participant what chemicals they have been exposed to, how their exposures compare to the rest of the study population, and how these exposures may affect their health. 

“We are very mindful of the results we share and the purpose behind them,” Mora explained. “We don’t want to scare people, but to provide guidance on how they can potentially reduce their exposures.” 

For example, Mora pointed out, that the participating parents cannot change their past exposure to organochlorine pesticides, but they can reduce their own and their family’s contact with current-use pesticides, flame retardants, and forever chemicals. 

“I have found people are interested in learning no matter where you are, whether in a meeting [with peers] or when you visit a Salinas clinic and meet with study participants,” Mora noted. “People want to learn how they can improve their health. Once you have given them the information, you’ve put power into their hands.”

Liliana Aguayo, Ph.D. – Helping Families Make Heart-Healthy Choices

March 5, 2025

The culture, relationships, and behaviors that make up a person’s social circle are not always top of mind for environmental health researchers, who often focus on chemical exposures. But Liliana Aguayo, Ph.D., a research assistant professor in the Nell Hodgson Woodruff School of Nursing at Emory University, believes that social factors play a pivotal role in health outcomes, especially for children.

With this in mind, Aguayo, a scholar in the NIEHS-funded Pediatric and Reproductive Environmental Health Southeastern Environmental Exposures and Disparities (PREHS-SEED) program, uses qualitative and quantitative approaches to study the origins of cardiovascular health disparities in children.

“There is no one-size-fits-all answer when it comes to better health outcomes for children,” said Aguayo. “For each child, we need to determine the unique factors within their own social environments that are contributing to – or protecting them from – the development of disease.” 

Early Influences

Aguayo’s commitment to studying social factors formed at a young age. Her family frequently visited a small mountain village in Mexico. There, they knew a poor, older woman who had been kicked by her donkey while selling cheese.

Her parents helped the woman get to the hospital where she was treated. In the process, doctors were surprised by her exceptional health. As a woman in her 60s living alone in a rundown shed, they didn’t expect her exam to reveal the health of a 20-year-old.

“We know from the social determinants of health literature that people with a lower socioeconomic status have poorer health compared to those with a higher socioeconomic status,” said Aguayo. “And yet, this lady was so healthy.”

The woman may have benefitted from a healthy diet, strong social network, and daily walking routine, said Aguayo. Her lack of electricity – which could have resulted in an earlier bedtime and more sleep– may have also played a role.

“When I think about my research, I want to disentangle what this lady had been doing since childhood. What can we take from her lifelong experience to make sure that social or economic circumstances don't dictate our destiny in terms of health?” she said.

Getting to the Bottom of Health Differences

Aguayo took a roundabout path to her research position. After receiving a political science degree from Loyola University, she worked as a Spanish translator for a company that administers health-focused questionnaires to families.

There, she witnessed firsthand the role that language and culture play in health evaluation. For example, Spanish-speaking respondents who were asked to order objects by size for a cognition test would often perform poorly on the test. But Aguayo helped her colleagues realize that the word for one of the objects – “elk” – does not translate well into Spanish and is not a familiar concept for most Hispanic families.

Her passion for listening to respondents to understand their unique circumstances and improve health led her to pursue a joint master’s and doctoral degree in public health from the University of Illinois. Afterwards, as a postdoctoral researcher at the American Heart Association and Northwestern University’s Ann & Robert H. Lurie Children’s Hospital, she began to investigate why some children were more prone to poor cardiovascular health than others.

For example, she found that among Black and Hispanic children, those whose mothers had a higher pre-pregnancy body mass index score were at an increased risk of developing obesity in childhood. The finding suggests that interventions aimed at helping mothers achieve a healthy weight before pregnancy may help reduce childhood obesity in these populations.

Serving Communities

As a scholar in the PREHS-SEED program, Aguayo received funding to conduct a large-scale review of studies examining cardiovascular health predictors, outcomes, and mechanisms across the life course. This effort has informed her community-based research aimed at improving child health.

For one project called “Little Hearts,” she partnered with nursing faculty at Universidad Autonoma de San Luis Potosi in Mexico to provide free cardiovascular health assessments to mothers and children through a public kindergarten.

“Many of the mothers haven’t had health care evaluations since their children were born,” said Aguayo. “We identified and referred a few cases of diabetes and high blood pressure for further assessment, evaluated the children's health, and gave the information to the mothers so they can bring it to their pediatricians.”

The team is now using the data to develop an intervention aimed at curbing consumption of added sugars from ultra-processed foods.

For another project, Aguayo works with endocrinologists to develop a dietary intervention to prevent metabolic dysfunction-associated steatotic liver disease (MASLD) among Hispanic children aged 6-9 years in Atlanta. Studies have shown that Hispanic populations have the highest prevalence of MASLD in the U.S. As part of the program, participants and their siblings get access to free cardiovascular and liver health screenings.

Most recently, Aguayo joined an Emory University program that provides health services to farmworker families in Georgia.

“Farmworkers are one of the most vulnerable populations in the U.S., often experiencing dehydration, greater exposure to pesticides, and weather-related injuries,” said Aguayo. “Although they make it possible for us to have fresh foods and vegetables, in many cases they lack access to fresh produce. As a result, they are at greater risk for diabetes, MASLD, and other preventable chronic diseases.”

Aguayo’s long-term goal is to use data from these projects to devise ways to improve heart health. Her participation in the PREHS-SEED program has been paramount to helping her work towards this goal.

“Findings from these different projects and the statistical training and career development support I’ve received have helped me identify key knowledge gaps and how to address them as I move forward in my research career,” she said.