&EPA
United States
Environmental Protection
Agency
National institute
on Minority Health
and Health Disparities
EPA/600/R-17/402
The Pilot EPA-NIMHD Centers of Excellence
on Environment and Health Disparities
A Summary of Accomplishments
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Disclaimer
The research described in this document has been funded wholly by the U.S. Environmental
Protection Agency (EPA) under the Science To Achieve Results (STAR) grants prog ram.The infor-
mation provided does not necessarily reflect the views of the Agency, and no official endorse-
ment should be inferred. Mention of trade names or commercial products does not constitute
endorsement or recommendation by EPA for use.The information presented in this summary
report is intended to provide the reader with insights about the progress and scientific achieve-
ments of STAR research grants.The report lists the grantees whose research is discussed, and
indicates where more detailed peer-reviewed scientific information can be found.This report
is not sufficiently detailed nor is it intended to be used directly for environmental assessments
or decision making. Readers with these interests should instead consult the peer-reviewed
publications produced by the STAR grants and conduct necessary data quality evaluations as
required for their assessments.
EPA provided funding support for the Pilot Environmental Health Disparities (EHD) Centers,
which were managed and administered by the National Institutes of Health's National Institute
on Minority Health and Health Disparities (NIMHD).
EPA and/or its contractor have received permission to use the images within this document.
Prepared for
U.S. Environmental Protection Agency
Office of Research and Development
National Center for Environmental Research
Washington, DC 20460
Prepared by
ICF International, Inc.
9300 Lee Highway
Fairfax, Virginia 22031
Under EPA Contract No. EP-C-14-001
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Acknowledgements
Foremost, I would like to acknowledge the crucial role of the EPA-NIMHD Pilot EHD
Center Directors, their investigators, and students for their leadership in pioneering
the scientific, educational, and community-based advancements to the topic of
environment and health disparities research. Their timely response and cooperation
to the call for input for this report is greatly appreciated, as it could not have been
possible without their great effort and assistance. I would also like to express much
gratitude to Nishadi Rajapakse at NIH/NIMHD, for her collaborative support throughout
the life of the centers and her contribution to development of this report.
Special thanks and appreciation go to EPA technical reviewers: Andrew Geller, Jim
Quackenboss, Cynthia McOliver, and NicolleTulve for their thoughtful editorial
comments and perspectives on the draft report. Many thanks to the EPA National
Center for Environmental Research (NCER) Senior Managers for their guidance and
direction, and to the CommunicationsTeam for their timely assistance with fine-tuning
the report. Last, but not least, a heart-felt thank you to Nica Louie for her dedicated
oversight of the support contract for this report and for her infinite source of ideas and
inspiration.
Sincerely,
Maggie Breville,
Health Research Program Manager, EPA
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 3
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TABLE OF CONTENTS
8
Introduction
Executive Summary
Background and Origin of the Pilot
EPA-NIMHD Centers
11
Disparities in Environmental
Health Outcomes
26
Center uses environment and health
disparities research data infrastructures to
investigate disparities in cancer outcomes. 26
Is there a relationship between mental
health and diabetes? 28
Complex Factors in Environment
& Health Disparities 30
19
Accomplishments &
Impacts of the Pilot
EPA-NIMHD EHD
Centers
20 Research &
Tools Development
IDENTIFYING ENVIRONMENT &
HEALTH DISPARITIES 21
Disparities in Environmental Exposure 22
Characterizing exposures to traffic-related
air pollution in urban neighborhoods. 22
Investigating and reducing young
American Indians'exposures to
tobacco smoke. 24
Assessing the impact of neighborhood
features on cardiovascular risk disparities. 30
Investigating the interplay between health
disparities and social characteristics
within Hispanic populations. 33
DEVELOPING SOLUTIONS TO
ENVIRONMENT & HEALTH DISPARITIES 37
Collaboration with local community
organization evaluated innovative
approach to reducing school children's
exposures to air pollution. 37
Center research informs intervention to
protect against DNA damage caused by
arsenic and uranium exposure. 40
COLLECTING & SYNTHESIZING
ENVIRONMENTAL HEALTH DISPARITY
DATA 42
Transdisciplinary team seeks answers to
complex health disparity questions. 42
Building New York City communities'
capacity to reduce health disparities. 45
4 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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48 Community
Outreach &
Engagement
COLLABORATIONS TO INFORM POLICY
Influencing state legislation to protect
children's health.
EMPOWERING COMMUNITIES TO
ADDRESS HEALTH DISPARITY ISSUES
The FIESTAS project: Empowering
women to tackle food insecurity.
The Community Block Assessment
Project: Community involvement in
data collection and analysis.
EXPANDING RELATIONSHIPS AND
EDUCATING COMMUNITIES
Center uses environmental health disparity
data to develop community resources.
Public participatory geographic information
systems help residents be more engaged in
local environmental decision-making.
PROVIDING DIRECT COMMUNITY BENEFIT
Improving health and safety in American
Indian community homes and businesses.
LIST OF COMMUNITY PARTNERS
65 Education &
Training
INVOLVING STUDENTS IN PILOT EHD
RESEARCH AND OUTREACH
49
INCORPORATING EHD RESEARCH
INTO CURRICULA
49
TRAINING COMMUNITY MEMBERS AND
PROFESSIONALS ON EHD ISSUES
51
PUBLICATIONS
53 SHARING EHD RESEARCH ACROSS THE WORLD
75
MOVING FORWARD
INVESTIGATORS COMMENTS ON THE
RESEARCH OF THE PILOT EHD CENTERS
CURRENT EHD RESEARCH EFFORTS
60 REFERENCES
61 APPENDIX A. PILOT EPA-NIHMD EHD
CENTER PUBLICATIONS
The EPA-NIMHD Pilo'
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List of Acronyms
AI/NA
American Indian/Native American
COEHDR
Center of Excellence on Health
Disparities Research
AlHce
American Industrial Hygiene
Conference & Exposition
COPD
Chronic Obstructive Pulmonary
Disease
ARC
Action for the Retired Community
DNA
Deoxyribonucleic Acid
BC
Black Carbon
EH
Environmental Health
CAICH
Center for American Indian
Community Health
EHD
Environment and Health
Disparities
CAIHD
Center for Integrative Approaches
to Health Disparities
EJ
Environmental Justice
CBPR
Community-Based Participatory
Research
E J RADAR
ENAR
Environmental Justice Radar
Eastern North American Region
CCE-SPHERE
Coordinating Center of
Excellence in the Social
EPA
Environmental Protection Agency
Promotion of Health Equity in
Research & Education
ETS
Environmental Tobacco Smoke
CEDREC
Center of Excellence in
Disparities Research and
GIS
Geographic Information Systems
Community Engagement
GPA
Grade Point Averages
CEED
Center for Excellence in
Eliminating Disparities
HDEF
Health Disparity Environmental
Factors
CHF
Congestive Heart Failure
HDRCOE
Health Disparities Research
Center of Excellence
CIAHD
Center for Integrative Approaches
to Health Disparities
HHDRC
Hispanic Health Disparities
Research Center
COE
Centers of Excellence
HI PA A
Health Insurance Portability and
Accountability Act
6 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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HIV/AIDS Human Immunodeficiency
Virus/Acquired
Immunodeficiency Syndrome
HPV Human Papillomavirus
IRB Institutional Review Board
ISEE International Society for
Environmental Epidemiology
JHS Jackson Heart Study
LVEF Lower Ventricular Ejection
Fraction
LVMI Left-Ventricular Mass Index
MESA Multi-Ethnic Study of
Atherosclerosis
NATA National AirToxics Assessment
NCER National Center for
Environmental Research
NIEHS National Institute of
Environmental Health Sciences
NIH National Institutes of Health
NIMHD National Institute on Minority
Health and Health Disparities
NM CARES HD New Mexico Center for
Advancement of Research,
Engagement, and Science on
Health Disparities
NOCEMHD Northern Manhattan Center of
Excellence in Minority Health
and Health Disparities
NOMEM Northern Manhattan Study of
Metabolism and Mind
ORD Office of Research and
Development
PI Principal Investigator
PM Particulate Matter
PNC Particle Number Concentration
PPB Parts Per Billion
SDOH Social Determinants of Health
SES Socioeconomic Status
SHC Sustainable and Healthy
Communities
STAR Science To Achieve Results
UIC University of Illinois at Chicago
UNM University of New Mexico
UTEP University of Texas at El Paso
UV Ultraviolet
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 7
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Introduction
Executive Summary 9
Background and Origin of the Pilot
EPA-NIMHD EHD Centers 11
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Executive Summary
Minorities arid economically-disadvaritaged
communities continue to bear a disproportionate
burden of the exposures to environmental stressors
that are associated with adverse health outcomes.1
Federal efforts to alleviate such health disparities
began in the early 1990s, The focus of this report is
the collaboration between the U.S. Environmental
Protection Agency (EPA) and the National Institute of
Health's (NIH's) National Institute on Minority Health
and Health Disparities (NIMHD), which supports
these federal efforts.
Since 2002, the NIMHD Exploratory Centers of
Excellence (COE) have sought to reduce health
disparities in several priority diseases and conditions,
including cardiovascular disease, stroke, cancer,
diabetes, HIV/AIDS, infant mortality, mental health,
obesity, and other conditions that disproportionately
affect health disparity populations. In 2011, EPA
and NIMHD partnered to establish environment
and health disparities research centers. In a joint
effort, the two agencies issued a limited funding
opportunity competition within the existing NIMHD
COE network, which already focused on efforts to
reduce and ultimately eliminate health disparities,
to solicit project amendments that would focus
on social and environmental determinants of
health and solutions to reduce these disparities in
disproportionately impacted populations.2
The competitive supplemental awards process
resulted in the establishment of 10 new pilot
Centers of Excellence on Environment and Health
Disparities research, which are also referred to as the
Pilot EPA-NIMHD EHD Centers or Pilot EHD Centers.
New environmental cores were added to centers
at Columbia University, Georgia State University,
University of Kansas Medical Center, the University
of Illinois at Chicago, Meharry Medical College,
University of Michigan, the University of New Mexico,
University of South Carolina, University of Texas at
El Paso, and Cornell University Weill Cornell Medical
College,3
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 9
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The 10 centers were funded for a total of $7,5
million for a period of up to two years per award.
EPA transferred the funds to NIMHD, which
provided administrative and scientific oversight
of the additional environmental cores along with
their monitoring of the other projects and cores at
those centers.Through this partnership, enhanced
support for addressing social and environmental
determinants of health was proposed to have an
even greater impact on reducing disproportionate
adverse health burden and empower communities
to become more involved in social justice issues
and promote healthy environments.
The research conducted at the centers in the two
years of their existence has produced findings that
have advanced the field of environmental health
disparities. The centers have focused on research
and tools development, community outreach
and engagement, as well as education and
training. They have conducted research to identify
environmental health disparities, develop solutions
to these disparities, and collect and synthesize
disparity data.
Pilot EHD Center research staff have engaged with
their communities in order to form collaborations
to inform evidence-based policies, involve the
communities in the research process to empower
sustainable solutions, and develop community
education resources. The Pilot EHD Centers
supported the education and training of over
a hundred students and junior professionals,
who used center research in their theses and
dissertations and incorporated EHD research and
topics into their university's curriculum.
The centers also trained community members,
and other individuals on topics related to EHDs.
They have presented EHD research results and
findings at over 50 conferences, meetings,
and workshops around the world. Pilot EHD
Center researchers and their students have also
published their work in over 60 peer-reviewed
journals.These centers concluded their research
in 2014.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Background and Origin of the
Pilot EPA-NIMHD EHD Centers
Environmental stressors have a major impact on
human and environmental health, Nearly one-fourth
of the global burden of disease may be attributed
to environmental factors.4 Social and economic
disparities cause many health problems and are very
costly to our society.5
The conditions where people are born, grow, live,
work, and age shape their health and well-being
over their life course. These conditions, commonly
referred to as "social determinants of health,"
influence health outcomes and include such factors
as access to affordable healthy food, clean water,
green space, safe housing, clean air, and supportive
social networks. Social determinants of health are, in
turn, shaped by wider forces, including economics,
social policies, politics, and personal and community
beliefs and value systems.6
The unequal distribution of these conditions and
their determinants across various populations is
increasingly understood as a significant contributor
to persistent and pervasive health disparities.Thus,
environmental influences are not limited to physical,
chemical, or biological agents and natural amenities,
but also include social and economic stressors,
institutional processes, and resiliency factors.
A growing social awareness of these disparities since
the early 1990s has led to the coining of the term
Environmental Justice, or EJ, which EPA now defines
as "the fair treatment and meaningful involvement
of all people regardless of race, color, national
origin, or income with respect to the development,
implementation and enforcement of environmental
laws, regulations, and policies."7
EPA works to achieve its mission to protect human
health and the environment through a variety of
actions and decisions, including regulatory activities,
scientific research, outreach, and education. The
scientific arm of EPA, the Office of Research and
Development (ORD), supports six research programs
that identify the most pressing environmental health
and ecological research needs of the nation.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 11
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In 1995, EPA created the Science To Achieve Results,
or STAR Program, its primary competitive extramural
grants program. Managed by the National Center for
Environmental Research (NCER), one of ORD's national
centers, the STAR Program's goal is to stimulate and
support scientific and engineering research that
advances EPA's mission to protect human health and
the environment. It is a competitive, peer-reviewed,
extramural research program that provides access
to the nation's best scientists and engineers in
academic and other nonprofit research institutions.
STAR funds research on the environmental and
public health effects of air quality, environmental
changes, water quality and quantity, hazardous waste,
toxic substances, and pesticides. STAR has provided
funding support to top researchers in the nation
to identify and solve environmental problems and
provide scientific leadership to protect our planet
and our health.8 The competitive, peer-reviewed
grants supported by the STAR Program range in focus
across various scientific and technical environmental
disciplines, and often incorporate successful models
of community engagement.
The National Institute on Minority Health and Health
Disparities (NIMHD) is one of 27 institutes and centers
of the National Institutes of Health (NIH). NIMHD's
work supports millions of Americans burdened by
disparities in health status and healthcare delivery,
including race and ethnic minority groups, rural
populations, and other populations, including those
with low socioeconomic status.9 Mandated by the
Minority Health and Health Disparities Research
and Education Act of 2000 (P.L. 106-525), the NIMHD
Centers of Excellence (COE) Program has supported
development of the infrastructure, capacity, and
intellectual expertise in health disparities through
establishment of centers within colleges and
universities.
Since 2002, the NIMHD Exploratory COEs have sought
to reduce health disparities in several priority diseases
and conditions, including cardiovascular disease,
stroke, cancer, diabetes, HIV/AIDS, infant mortality,
mental health, obesity, and other conditions that
disproportionately affect health disparity populations.
They have supported over 80 COEs in 31 states, the
District of Columbia, Puerto Rico, and the U.S. Virgin
Islands in majority institutions, medical schools,
Historically Black Colleges and Universities, Hispanic
Serving Institutions, tribal colleges, and liberal
arts colleges. The COEs have conducted research
independently or in formal partnership with one
or more institutional partners; provided research
training opportunities to students, researchers and
junior faculty from health disparity populations; and
engaged in health promotion, and health information
dissemination activities through established
partnerships with community-based organizations.10
In response to the growing EJ awareness, Executive
Order 12898 was issued in 1994, requiring all federal
agencies to work toward ending the disproportionate
exposures of minority and low-income communities
to many environmental hazards.11 While much has
been accomplished since the early 1990s, minority
and economically disadvantaged populations
continue to bear a disproportionate share of
environmental exposures and related illnesses.11
Concern for inequity is based not only on their
potentially higher levels of exposure to environmental
hazards, but also on the synergistic effect of exposure
to multiple environmental hazards and social stressors
like poverty, psychosocial stress, and discrimination.
12 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Today, environmental health and health disparities
researchers blend biological and social science
approaches with traditional environmental science
methods. For example, interdisciplinary approaches
and collaboration with sociologists, psychologists,
and social epidemiologists must examine the joint
effects of social and environmental stressors.
The Federal Healthy People 2020 initiative, the 10-year
national health agenda for the American population,
also set the elimination of health disparities and
achieving health equity as a top national priority.
The succeeding Healthy People 2030 initiative will
set new science-based national objectives for health
promotion and disease prevention in 2030.12
EPA, along with the NIH and other federal and
academic collaborators held two workshops; one
in 2005 and another in 2010, to explore options for
connecting social and environmental factors, for
measuring and tracking environment and health
disparities, and for strengthening EJ research and
decision making. Several critical issues and factors
emerged from these gatherings: 1) stronger funding
support is needed for community-based participatory
research in environment and health disparities,
2) race/ethnicity and socio-economic position
need to be included in environment and health
disparities research, and 3) models to elucidate the
interrelationships between social, physical, and built
environment should continue to be developed and
empirically tested.13
Key factors that likely contribute to higher burdens
of environmental exposure and risk affecting race/
ethnicity and low-income communities include,
proximity to sources of environmental hazards;
unique exposure pathways; multiple cumulative
impacts; susceptibility and vulnerability; vulnerable
physical infrastructure; diminished capacity
to participate in decision-making; and chronic
psychosocial stress.14
1994
Executive Order 12898 is issued to
end disproportionate environmental
exposures of minority and low-income
populations.
Figure 1. Timeline of
the Pilot EPA-NIMHD
EHD Center Research
2002
NIMHD establishes the
Exploratory Centers of
Excellence on Health
Disparities program.
2005
EPA & partners
hold a technical
workshop on social
factors and EHD.
2010
EPA & partners hold
a symposium on
strengthening EJ
decision-making.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Existing programs established independently by
EPA and NIMHD have fostered collaboration across
disciplines and enabled multidisciplinary teams
of community and academic experts from diverse
backgrounds to conduct research and training
in environment and health disparities. With the
common goal of addressing the social determinants
of health affecting disproportionately impacted
populations across the nation, and fueled by the
1994 Executive Order, the EPA-NIMHD collaboration
seemed to be a natural, almost inevitable union,
leading to the signing of a memorandum of
understanding and an inter-agency agreement by
the two organizations in 2011.
Through this partnership, they would support
the establishment of transdisciplinary networks
of excellence in health disparities research that
would engage in the complex interaction of
biological, social, and environmental determinants
of population health. This research partnership
was a significant effort toward advancing scientific
understanding of disease etiology for environmental
related diseases. It also supported the development
of innovative tools and methods to assess exposure,
cumulative health effects and disproportionate
health risks and impacts, and then increased
understanding of population vulnerability.
Figure 1 depicts a timeline of the major events
surrounding the partnership.
Under this agreement, EPA transferred a total of $7.5
million to NIMHD, which managed and administered
the Pilot EHD Centers.The competitive supplemen-
tal awards process resulted in the establishment of
ten (10) awards to the EPA-NIMHD Pilot Centers of
Excellence on Environment and Health Disparities
research, also known as the Pilot EHD Centers.The
centers were funded for a period of up to two years
per award. Figure 2 shows the locations of the 10
Pilot EHD Centers. A brief description of each center
is also provided below.
2011
EPA & NIMHD signed Memorandum
of Understanding to form
partnership,and Inter-Agency
Agreement to support EHD research.
2011
EPA & NIMHD issued a limited
solicitation among the NIMHD COEs
for environmental core additions to
the existing centers.
2012
The 10 Pilot EHD Centers
were competitively
awarded.
2014
The 10 Pilot EHD Centers
concluded their research and
submitted final technical
reports.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Figure 2. Pilot EPA-NIMHD Centers of Excellence on
Environment and Health Disparities Research
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The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
-------
<;&? Columbia University
IN THE CITY OF NEW YORK
Northern Manhattan Center of Excellence
in Minority Health and Health Disparities
(NOCEMHD) - Columbia University - New York,
NY - Jose Luchsinger, PI
NOCEMHD examined how social determinants of
health modified the effect of interventions and
exposures of interest on specific health outcomes
in a clinical trial and a cohort study, respectively.
The center sought to determine the influence of
Health Disparity Environmental Factors (HDEF) on
health outcomes, such as cardiovascular conditions
and mental health. Researchers also explored
how HDEF modify responses to community-
based interventions at the national, state, city,
neighborhood, and individual levels.
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|\l J CENTER
The University af Kansas
Central Plains Center for American Indian
Community Health (CAICH) - The University
of Kansas Medical Center - Kansas City, KS -
Christine Daley, PI
CAICH, also known as GreeNation, used
community-based participatory research methods
to understand how to address health disparities
faced by the American Indian/Native American
(AI/NA) population, which includes such conditions
as asthma, obesity, and diabetes. Researchers
explored the state of housing conditions in AI/NA
communities and how community members could
be linked to programs that would help to solve
their problems. Research also explored the extent
of AI/NA exposure to environmental tobacco
smoke (ETS) and how to address this health
concern.
4
GeorgiaState
University.
Center of Excellence on Health Disparities
Research (COEHDR) - Georgia State University
- Atlanta, GA - Michael Eriksen, PI
COEHDR focused on identifying the syndemic
burden on populations experiencing health
disparities in urban Atlanta (syndemic refers
to the aggregation and interaction of two or
more diseases in a population that tend to
develop under conditions of health disparity).
Investigators explored how research and
mitigation activities could be strengthened and
expanded.
MEHARRY*
MEDICAL COLLEGE
Health Disparities Research Center of Excellence
(HDRCOE) - Meharry Medical College -
Nashville, TN - Paul Juarez, PI
The HDRCOE, with local communities in Alabama,
Arkansas, Georgia, Indiana, Kentucky, Louisiana,
Mississippi, North Carolina, South Carolina,
Tennessee, and Virginia, focused on the built, social,
and policy environments.The center's overall goal
was to expand the capacity of health services
researchers and other biomedical scientists to use
a transdisciplinary systems approach to study the
environmental context of health disparities.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
-------
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Hispanic Health Disparities Research Center
(HHDRC) - The University of Texas at El Paso -
El Paso, TX - Elias Provencio-Vasquez, PI
HHDRC sought to advance the understanding of
the interrelationships between environmental
and social determinants of health disparities,
particularly within heterogeneous Hispanic
populations. Through a commitment to
transdisciplinary research, the center utilized
this knowledge to influence policy change,
public health practice and community-based
interventions to reduce disparities.
Weill Cornell
"@f Medicine
Center of Excellence in Disparities Research and
Community Engagement (CEDREC) - Cornell
University, Weill Cornell Medical College - New
York, NY - Carla Boutin-Foster, PI
CEDREC was a community-academic collaboration,
which brought together a multi-disciplinary team
to address environmental health issues through
education, research and policy. The Environmental
Health Disparities Research Core (EH Core) gave
CEDREC the capacity to collaboratively examine
environmental factors that drive health disparities
and develop innovative and transdisciplinary
solutions.
A
"Disparities in the environment demand a holistic approach to understand all
risks as an organic unit Environmental health research requires comprehensive
and multidisciplinary resources to eliminate health disparities and to enhance
health for all."
- Dr. Michael Eriksen, Director, COEHDR, Georgia State University
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Accomplishments
& Impacts of the
Pilot EPA-NIMHD
EH D Centers
The Pilot EPA-NIMHD EHD Centers have broadly impacted the
field of health disparities research by advancing cutting-edge
research in several critical areas. Specifically, the centers focused
their efforts on (1) researching health disparities and potential
solutions for reducing them, (2) engaging communities to
ensure that research findings are translated into action, and (3)
educating community members and training the next generation
of health disparities researchers. This section highlights impacts
that the centers have made in each of these fields.
Research & Tools Development 20
Community Outreach & Engagement 48
Education&Training 65
-------
® RESEARCH & TOOLS
DEVELOPMENT
Tackling environment and health disparities requires an interdisciplinary and multi-faceted
research approach.The Pilot EPA-NIMHD EHD Centers conducted innovative research to identify
such disparities, developed solutions to mitigate or eliminate the problems identified in their
research, and built tools and data infrastructures to advance future environmental health
disparities research.
IDENTIFYING ENVIRONMENT & DEVELOPING SOLUTIONS TO
HEALTH DISPARITIES 21 ENVIRONMENT & HEALTH DISPARITIES 37
Disparities in Environmental Exposure
Characterizing exposures to traffic-related air
pollution in urban neighborhoods.
Investigating and reducing young American
Indians' exposures to tobacco smoke.
Disparities in Environmental
Health Outcomes
Center uses environment and health
disparities research data infrastructures to
investigate disparities in cancer outcomes.
Is there a relationship between mental
health and diabetes?
Collaboration with local community
organization evaluated innovative approach
to reducing school children's exposures
to air pollution.
Center research informs intervention to
protect against DNA damage caused by
arsenic and uranium exposure.
COLLECTING & SYNTHESIZING
ENVIRONMENTAL HEALTH DISPARITY
DATA 42
Transdisciplinary team seeks answers to
complex health disparity questions.
Complex Factors in Environment & Building New York City communities'
Health Disparities capacity to reduce health disparities.
Assessing the impact of neighborhood
features on cardiovascular risk disparities.
Investigating the interplay between health
disparities and social characteristics
within Hispanic populations.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
-------
Ni
NJ
-
(
II
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Identifying
Environment
& Health
Disparities
The centers investigated important and unique
questions related to disparities in exposure,
outcomes, and the relationships between the two.
For example, is dementia and cognitive decline
more common in Hispanic populations? Are high
poverty areas exposed to more traffic-related air
pollution? Why do tribal college students show
higher rates of smoking than non-tribal students?
Is there a Hispanic Health Paradox in air pollution
sensitivity?
ii.
The greatest opportunity
[of the center] is to complete exposure
pathways that address real world
conditions. Completed exposure
pathways identify the source of
exposures in the environment, how
the chemical or non-chemical stressor
gets under the skin, biomarkers of
exposure, biomarkers of disease,
disease phenotype, clinical diagnosis,
and population-level disparities."
- Dr. Paul D. Juarez, Director
HDRCOE, Meharry Medical College
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 21
-------
Disparities in
Environmental
Exposure
burdens of pollution. Center researchers estimated
community exposures to traffic-related air pollution in
diverse Atlanta neighborhoods, where public housing
community members reside.
samples for lead
Collected and analyzed
300 soil and road dust
Presented research results
to, and collaborated
with, community-based
organizations. Engaged in
citizen science research.
Centers conducted research on how and why
different populations experience disparities in
exposures to pollutants and other environmental
hazards, and identified geographic areas and sub-
populations at highest risk for those exposures.
Characterizing exposures to traffic-related
air pollution in urban neighborhoods
Center of Excellence on Health Disparities Research
(COEHDR) at Georgia State University
The Center of Excellence on Health Disparities Research
at Georgia State University investigated environmental
contributors to urban health disparities, such as air
and water pollution and the potential for unequal
RESEARCH IN ACTION AT COEHDR
Installed 26 air monitoring stations that
measured nitrogen dioxide in 4 census
tracts in Atlanta.
They installed monitors to detect nitrogen dioxide in
the air over a two-week period in four census tracts
with varying proportions of low-socioeconomic status
(SES) residents. Nitrogen dioxide primarily gets in the
air from the burning of fuel. Long exposures to elevated
air concentrations of nitrogen dioxide may contribute
to the development of asthma and potentially increase
susceptibility to respiratory infections.15 It is also
a precursor to hazardous ozone.16 The measured
nitrogen dioxide concentrations ranged from 7 to
21 parts per billion. Geospatial analysis revealed that
higher concentrations were directly related to highway
proximity.15 Results also suggested that air pollution
exposure varies across poverty levels, with high
poverty areas experiencing significantly higher levels of
air pollution than lower poverty areas.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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The center also collected soil and road dust samples
in Sacramento, California, and analyzed them for
lead. Sources of lead in dust include lead-based paint
degradation and the particulates from leaded gasoline
before it was banned. Lead in dust is a concern for
children's health—young children are particularly
susceptible to the health effects of lead and are more
likely to be exposed because of hand-to-mouth
behaviors.The collected samples were used to generate
spatial distributions of lead concentrations, which
can then be used to predict areas of elevated lead
concentrations.
The center's work is an important step toward
addressing environment and health disparities.
Stakeholders and decision makers can use such
information to better understand exposures and take
appropriate action.16 For example, center researchers
are using this knowledge and their expertise to work
with the Federal Highway Administration to identify
tools and opportunities to address environmental
health in transportation projects.They are developing
the basis for including a health disparities assessment
in the protocols for reviewing proposed transportation
projects in the U.S.
ACCOMPLISHMENTS & IMPACTS
Q
Examined the association between
traffic-related air pollutants and key
socio-economic and demographic
measures (e.g., poverty and proximity
to freeways and railroads) from
communities in Atlanta.
Q
Collected and analyzed air and dust
monitoring data, and shared results
with community members.
Developed methods for review of
Q
transportation-related disparities
to incorporate health disparity
assessments in transportation
projects.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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investigating and reducing young AI/NA
students' exposures to tobacco smoke
Center for American Indian Community Health (CAICH)
at the University of Kansas Medical Center
American Indians have the highest cigarette smoking
rates of any race or ethnic group in the US.17 Despite
warning labels and other tribal health intervention
efforts, their smoking prevalence has not decreased at
the same rate as it has for non-minority populations.18
The health concerns for this community extend to
nonsmokers—family members or friends nearby—
who might be exposed to secondhand smoke.
Secondhand smoke—also known as environmental
tobacco smoke or ETS—is a complex mixture of
smoke given off by the burning of tobacco products
and the smoke exhaled by smokers. EPA estimates
that exposure to secondhand smoke causes
approximately 3,000 lung cancer deaths per year in
nonsmokers.19
Nearly 35 percent of tribal college students were
smoking when they were surveyed.18
24 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Exposure to secondhand smoke has also been shown
in a number of studies to increase the risk of heart
disease and stroke.19 The Center for American Indian
Community Health (CAICH) at the University of Kansas
Medical Center gathered data needed to design more
effective health interventions for AI/NA communities.
They surveyed over 1,200 tribal college students
and found that 34.7 percent smoked. The mean age
for participants'first cigarette was 14 years old.18
Researchers mapped and compared the availability
and marketing of tobacco products, as well as
accessibility of healthy foods and activities, at two
universities in Lawrence, Kansas (University of Kansas
and Haskell Indian Nations University).
Students at both universities had wide availability of
tobacco products and were exposed to significant
tobacco marketing.18 Students at the University
of Kansas, a public university, had a wider range
of options for healthy foods and activities than
students at Haskell Indian Nations University, which
is solely attended by enrolled or official members
of recognized AI/NA tribes of the U.S.19 Finally, the
CAICH team conducted focus groups with students to
gauge the students' understanding of and preferences
for tobacco policies on campus.
11
On average, tribal students
who smoked tried their first
cigarette when they were 14
years old.18
With this knowledge, the center has tailored
interventions to promote healthy behaviors for tribal
students in Lawrence, Kansas. Investigators presented
baseline data at multiple national conferences and
meetings. The results are being used to develop
strategies to address the current disparities in
smoking among AI/NA college students.20
ACCOMPLISHMENTS & IMPACTS
Q
Examined demographic, cultural,
and environmental characteristics of
smoking and quitting among AI/NA
communities.
Q
Surveyed more than 1,200 tribal
college students about their
tobacco use, exposure to ETS,
contact with tobacco marketing
and products, and other health-
related behaviors.
Q
Informed development of
culturally-tailored smoking
cessation and prevention
and other healthy behavior
programs for AI/NA college
students.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Disparities in
Environmental Health
Outcomes
The prevalence of diseases and other adverse health
outcomes vary dramatically across age, sex, ethnicity,
income level, and other population characteristics.
The Pilot EPA-NIMHD EHD Centers worked to identify
and understand why these disparities exist.
Disease prevalence, such as heart disease, cancer,
and dementia, are reportedly higher in minority and
in the disadvantaged groups.22 The centers explored
pioneering and creative solutions to the disparities
they observed, such as using trees and bushes
to reduce exposure to traffic-related air pollution
(Center of Excellence on Health Disparities Research,
Georgia State University), or using zinc supplements
to alleviate the damage inflicted on DNA from
concurrent exposure to ultraviolet light, arsenic,
and uranium (New Mexico Center for Advancement
of Research, Engagement, & Science on Health
Disparities, University of New Mexico).
Center uses environment and health
disparities research data infrastructures to
investigate disparities in cancer outcomes
Center for Excellence in Eliminating Disparities (CEED) at
the University of Illinois at Chicago
Researchers at the Center for Excellence in Eliminating
Disparities (CEED) at the University of Illinois
at Chicago (UIC) gathered data and developed
data infrastructures to assist researchers and
students nationwide with analyzing and utilizing
environmental health disparities data. Compiling
and organizing dissimilar data from a wide variety
of sources is an enormous task and is often a major
obstacle for environment and health disparities
research projects. As a result of this effort, CEED
researchers identified several important disparities in
cancer outcomes related to race and SES.
CEED acquired 3.7 million data records from the
Cook County (Illinois) Assessor's Office containing
anonymized attributes of Cook County residents
and properties, including age, type, class, assessed
values of land and buildings, zoning (e.g., grocery
stores and gas stations), and other variables.21 The
center also used data from EPA, U.S. Census American
Community Survey, Health Resources and Services
Administration, and Illinois Department of Public
Health to gather information on cancer incidence,
environmental hazards, access to healthcare facilities,
and other factors.21
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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High percent
poverty and high
percent non-point
source cancer risk
Low percent
poverty and low
percent non-point
source cancer risk
Not significant
Figure 3. Poverty
and non-point
source cancer risks
in Cook County,
linois
Utilizing this set of data, researchers investigated how
cancer-related outcomes vary across race and SES in
Cook County, Illinois. In a study of women diagnosed
with epithelial ovarian cancer, women with lower
SES were more likely than women with a high SES to
have three markers of aggressive ovarian cancer: 1)
tumors that are of a higher grade, 2) tumors that are
late-stage, and 3) tumors that remain after surgical
attempts to remove them. In another study CEED
researchers examined, then considered associations
between the spatial distributions of race, SES,
environmental cancer risks, and cancer rates in census
tracts around Chicago. To make comparisons across
census tracts, researchers mapped the percentage
of specific sociodemographic characteristics (African
American, Hispanic, and low SES) in each tract.
They also mapped the 2011 National AirToxics
Assessment (NATA) total cancer risk (based on
emissions data), as well as cancer incidence rates
for each tract. CEED's analysis revealed the spatial
relationships between all of these factors; for example,
census tracts with a high percent of the population
in poverty also had a high percent of the population's
non-point cancer risks (and vice versa, see Figure
3).23 By utilizing these novel methodologies and
comprehensive data infrastructures, this exploratory
research has opened the door for future investigation
into these health disparities.
FINDINGS
Underprivileged women
are more likely to have
ovarian cancer tumors
that:
Are high-grade.
Have progressed to a later
stage (e.g., moved to other
parts of the body).
Are considered to be sub-
optimally removed after
surgery.22
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 27
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Is there a relationship between mental
health and diabetes?
Northern Manhattan Center of Excellence in Minority
Health and Health Disparities (NOCEMHD) at
Columbia University Medical Center
As part of the Northern Manhattan Study of
Metabolism and Mind (NOMEM) cohort, researchers
at the Northern Manhattan Center of Excellence in
Minority Health and Health Disparities (NOCEMHD)
at Columbia University Medical Center, NY, gathered
data on 600 Hispanic men and women, aged
55-64 years, to study the relationship between
diabetes and mental health.24 NOMEM revealed
that over two thirds of middle-aged Hispanics in
Northern Manhattan are overweight or obese and
have pre-diabetes or diabetes.25 Additionally, the
Columbia University Center discovered that pre-
diabetes and diabetes are strongly associated with
worse cognitive performance in multiple domains
assessing verbal memory and dementia (Selective
Reminding Test) as well as executive function (Color
Trails Test).25
In 2012,21 million people in the U.S. had diabetes,
which was the seventh leading cause of death
in 2010.26 Diabetes is associated with serious
health problems, including heart disease, stroke,
blindness, kidney failure, limb amputation, and
death.26 Diabetes has also been implicated as a risk
factor for dementia, along with smoking, obesity,
hypertension, and high cholesterol.27 Dementia is
most commonly brought on by Alzheimer's disease,
a degenerative brain disease, and is characterized
by difficulties with memory, language, problem-
solving, and other cognitive skills.27 5.5 million
Americans have been diagnosed with Alzheimer's
dementia, and this number is predicted to rapidly
escalate over the coming years as the baby boomer
generation ages.27
2 out of 3 middle-aged
Hispanics in Northern
Manhattan have pre-
diabetes or diabetes.24
28 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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ACCOMPLISHMENTS & IMPACTS
Q
Gathered data on over 600 Hispanic men and women in
Northern Manhattan.
Q
Provided additional support for the relationship
between diabetes and dementia in a population
disproportionately affected by both diseases."
Significant disparities exist across race and ethnicity
in the prevalence of diabetes and dementia. Older
African-Americans are twice as likely as older
Caucasians to have Alzheimer's or other dementias,
and older Hispanics are about 1.5 times as likely.2712.8
percent of Hispanics and 13.2 percent of non-Hispanic
African Americans aged 20 years or older have been
diagnosed with diabetes, compared to 7.6 percent of
non-Hispanic Caucasians.26
While there have been previous studies on the
relationship between diabetes and dementia,
they have had several limitations: an older sample
population, a lack of data on participants' mid-life
cognitive ability (prior to a dementia diagnosis), and
a failure to assess participants' pre-diabetes status.24,26
The researchers at NOCEMHD sought to address
those limitations and provide a strong analysis of the
relationship between diabetes and dementia.
Pre-diabetes, diabetes, and normal glucose
tolerance were assessed by examining participants'
clinical history and measuring participants'levels of
hemoglobin A1c (a stable measure of blood sugar
over the past 3 months). Several tests were used
to assess memory, executive abilities, and overall
cognitive performance.24 The results showed that
hemoglobin levels and diabetes were both related
to worse performance on memory tests, and
pre-diabetes was associated with worse executive
abilities.24
Given the vast number of Americans affected by
diabetes, and the debilitating impact of dementia
and other diseases related to cognitive decline,
it is important to understand the risk factors for
each. NOCEMHD's research provides extraordinary
evidence of the relationship between the two
diseases and continues to develop solutions and
encourage lifestyle changes (e.g., regular physical
activity and a healthy diet) to address them.27
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 29
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Complex Factors in
Environment & Health
Disparities
Research into the causes and impacts of
environmental health disparities is not complete
without a critical analysis of the complex relationship
between individual risk factors. Several of the Pilot
EHD Centers explored these interactions to deepen
their understanding of the disparities in their
communities.
To ensure a broad and long-lasting impact, the
centers collected and synthesized data in a format
that has aided further research for themselves and
other researchers'work across the country. Thousands
of data records on community and neighborhood
attributes, individual characteristics, environmental
exposures, health outcomes, and other factors
were gathered and integrated into databases that
support mapping websites, conceptual frameworks,
community profiles, and additional tools.
Assessing the impact of neighborhood
features on cardiovascular risk disparities
Center for Integrative Approaches to Health Disparities
(CIAHD) at the University of Michigan
Heart disease was the leading cause of death in
2008 for people of most race and ethnic groups in
the U.S., including African Americans, Hispanics, and
Caucasians.28
Heart disease costs the U.S.
about $207 billion each year,
including the cost of health
care services, medications,
and lost productivity.29
30 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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The Center for Integrative Approaches to Health
Disparities (CIAI-ID) at the University of Michigan
used the cardiovascular disease and neighborhood
characteristics information from MESA and the
Jackson Heart Study, combined with state-of-the-
art spatial modeling, to identify environmental risk
factors for cardiovascular health. Neighborhood
data included air pollution concentrations,
sociodemographic characteristics, locations of
resources (e.g., food, physical activity resources, social
engagements, and walking destinations), food and
cigarette prices, and information about conditions
of the social environment (e.g., neighborhood social
cohesion, violence, and neighborhood problems)
Results revealed important environmental and
social factors that may contribute to disparities
in cardiovascular health. For example, CIAHD
investigated whether changes in neighborhood
characteristics after moving to a new home were
linked to changes in walking for transportation, for
leisure, or for reduction in body mass index in adults.
The analysis found that moving to areas with higher
walkability (e.g., higher street connectivity) was
associated with an increase in transport walking as
well as a decrease in body mass index.31
The researchers also sought to better understand
spatial inequities in exposure to air pollution and
the extent that other neighborhood factors modify
the impact of air pollution on health. To do this,
they estimated associations of neighborhood- and
individual-level SES with estimates of residential
ambient air pollution concentrations.
NIH has funded large-scale observational studies
to investigate the causes of cardiovascular disease
among diverse study populations. Two of these
studies are the Multi-Ethnic Study of Atherosclerosis
(MESA) and the Jackson Heart Study.30 MESA
studies 6,000 African American, Asian, Hispanic,
and Caucasian adults from six field locations across
the country. The Jackson Heart Study studies 5,306
African American adults from urban and rural counties
in Jackson, Mississippi. These studies are generating
a wealth of data critical to identifying risk factors and
prevention approaches.31
collected from 2000 to 2012. With this large combined
dataset, CIAHD also investigated the variability of
disease risk and healthy behaviors within ethnic
groups.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 31
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Researchers found that air pollutant concentrations
were more strongly associated with neighborhood
SES than individual SES. Considering the entire
study population, the average concentration of
fine particulate matter (PM) and nitrogen oxides
decreased with increasing neighborhood SES.
However, this did not hold true for every city.
For example, they observed higher air pollution
concentration in high-SES neighborhoods in New
York.33
CIAHD also evaluated the modifying interactions
between social disadvantage or psychosocial
adversity and air pollution on two cardiovascular
outcomes that indicate long-term cardiac stress.
Greater left-ventricular mass index (LVMI) and lower
ejection fraction (LVEF) of the heart are predictors
of cardiovascular disease. As concentrations of fine
particulate matter (PM) increased, LVMI decreased,
while LVEF increased. Both cardiovascular measures
increased as concentrations of nitrogen oxide
and nitrogen dioxide increased as well. CIAHD
researchers found fine particulate matter was
not related to the SES index; however, as PM
concentrations increased, psychosocial adversity
index scores decreased. Generally, CIAHD did not
find consistent evidence of interactions between air
pollution and SES, psychological adversity, or any
measure of race/ethnicity segregation with respect
to either of the cardiovascular outcomes they
evaluated.34
ClAHD's spatial analysis of large, high-quality health
and environmental data improved understanding of
cardiovascular disease risk factors among minorities.
This knowledge is critical for the identification
of approaches to reduce both the risk and high
prevalence of cardiovascular disease in the U.S.
ACCOMPLISHMENTS & IMPACTS
Q
Combined data from large, diverse
studies of cardiovascular risk with
neighborhood information to
identify environmental risk and
benefit factors.
Q
Published one of the first studies
to examine joint associations
between social and psychosocial
factors, particularly race/ethnicity
residential segregation, and air
pollution with certain measures
of cardiovascular outcomes.
Q
Identified the importance of
examining associations present
in specific geographic regions
and specific population samples
before deciding how to account
for SES in health disparities
research.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Investigating the interplay between health
disparities and social characteristics within
Hispanic populations
Hispanic Health Disparities Research Center
(HHDRC) at the University of Texas at El Paso
(UTEP)
Historically, health disparities research has tended
to rely on traditional categorizations of race
and ethnicity (e.g., Hispanic, African American,
Caucasian).This simplification assumes uniformity
within a minority population when it is likely that
other factors among an ethnic group affect health,
such as differences in language proficiency, SES, and
culture.The Hispanic Health Disparities Research
Center (HHDRC) at the University ofTexas at El Paso
(UTEP) aimed to clarify how race or ethnic status
interacts with other social factors to contribute
to environmental risks and health outcomes for
Hispanic populations in El Paso,Texas.
HHDRC surveyed parents of 4th and 5th graders in
the El Paso Independent School District to examine
the prevalence of respiratory health problems
among children, social variables associated with
respiratory health outcomes, school performance,
and access to health care.35
HHDRC researchers gathered and analyzed El Paso
air quality monitoring data for nitrogen dioxide and
inhalable particles, including PM that is less than
10 microns in diameter and ultrafine particles (or
particles that are less than 0.1 microns in diameter).
"The Environmental Health
Research Lab created via this
NIMHD-EPA Center... focuses on
how interactions between the
physical and social environment
affect the development of chronic
illnesses among vulnerable
populations"
- Dr. Bibiana Mancera, Investigator
HHDRC, University ofTexas at El Paso
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Results from the survey revealed that the students
had high rates of asthma (17 percent of respondents)
and allergies/hay fever (51 percent).35 They also
identified environmental exposures and social
characteristics that were strongly associated with
children's respiratory health outcomes.
Many factors such as gender, obesity, caretaker's
language proficiency, prenatal tobacco smoke
exposure, higher levels of PM, Hispanic ethnicity, and
being born in El Paso were identified as potential
variables contributing to increased odds of respiratory
health problems.35'3637
The Hispanic subpopulation is of particular interest,
as some studies have shown that Hispanic immigrants
in the U.S. have the same or better health outcomes
compared to non-Hispanic Caucasians, despite higher
poverty rates, less education, and lower access to
health care.42 This observation, called the "Hispanic
health paradox," had not been studied until HHDRC's
work. HHDRC conducted one of the first studies to
consider how Hispanic ethnicity interacts with other
social characteristics (e.g., age, sex, race, insurance
status) to influence the relationship between air
pollution and respiratory and cardiovascular health
effects.43
FINDINGS
HHDRC also investigated associations
between air pollutants and other
chemicals and school performance.
Their findings included the following:
Higher levels of residential air toxics were
statistically significantly associated with
lower grade point averages (GPA) even
after controlling for additional variables
such as economic deprivation, maternal
education, teenage motherhood, race,
maternal language proficiency, and
children's gender/age.38 (See In the News).
Q,
Subjective health status and higher levels
of residential air toxics, combined, were
also statistically significantly associated
with lower GPA.39
Q,
Higher levels of school-based hazardous
air pollution were associated with lower
GPA.40
Residential concentrations of metabolic
disrupters (chemicals that interfere
with human endocrine and metabolic
functioning) were statistically significantly
associated with lower GPA.41
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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IN THE
NEWS
The following are
example media
reports on one of the
HHDRC studies.(Clark-
Reyna, Grineski, and
Collins 2016).38
~
m
Environmental Health News
"Bad air means lower grade point averages in Texas"
July 24, 2015
Scientific American
"Dirty air correlates with lower grades in Texas
schoolchildren"
July 24, 2015
Texas Standard, public radio program
"New study links pollution with low GPAs"
July 29, 2015
Mother Jones
"Kids who breathe more pollution have lower grades"
September 5,2015
HHDRC compiled and analyzed data on daily asthma,
Chronic Obstructive Pulmonary Disease (COPD), and
congestive heart failure (CHF) hospital admissions
in El Paso.Their results revealed that Hispanics were
at greater risk for fine PM-associated asthma, COPD,
and CHF hospital admissions as compared to non-
Hispanic Caucasians and non-Hispanics of other
races. Conversely, Hispanics were at lower risk for
nitrogen dioxide-related asthma, COPD, and CHF
admissions as compared to non-Hispanic Caucasians
and non-Hispanics of other races. In terms of other
social characteristics, researchers found that the risk
of fine PM-associated asthma was higher for children
and Hispanics on Medicare (compared to elderly
and private insurance, respectively), while the risk of
PM-associated CHF was higher for Hispanics on private
insurance (compared to all other insurance types).44
These results provide some evidence of a Hispanic
health paradox for nitrogen dioxide-related
sensitivity, but not for fine PM-related sensitivity,
and underscore the necessity of additional research
to understand the mechanisms behind these
relationships.This work represents a significant
contribution to understanding the Hispanic health
paradox in air pollution epidemiology.
HHDRC researchers also identified persistent
disparities in access to healthcare that were
dependent on generational status. In contrast to
previous studies that assumed that individuals
assimilate into U.S. culture by the third generation,
HHDRC examined fourth generations and higher.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 35
-------
They determined that the higher immigrant
generations continue to have better access to care.
However, they also identified greater persistence
of barriers in access to healthcare than previously
reported,45
With a better understanding of disparities of
health and exposure among Hispanics, especially
children, HHDRC has worked collaboratively with
40 stakeholders from environmental, public health,
social justice, and educational organizations in
order to facilitate the translation of environmental
health disparities research into policy, public health
practice, and community-based engagement. HHDRC
researchers engaged professionals from state and
local agencies, as well as private environmental health
organizations, in stakeholder meetings and surveys
in 2013 that asked about important environmental
health issues and key research needs. HHDRC
researchers also hosted a 2-day conference in 2014
titled Environmental Health Disparities on the U.S.-
Mexican Border, which brought together academics
from El Paso, Las Cruces, and Ciudad Juarez,
community stakeholders and service providers,
national experts in EHDs and EJ, and representatives
from national-level funding agencies.
ACCOMPLISHMENTS & IMPACTS
Q
Surveyed more than
1,800 parents in El
Paso to gather health
and social information
for their 4th and 5th
grade children.
Q
Conducted one of the
first studies examining
the role of social factors
in modifying associations
between air pollution and
respiratory/cardiovascular
outcomes.
Q
Found an association
between Texas children's
exposure to air pollution
and a measure of school
performance (i.e., grade
point average).
Q
Revealed new
considerations
about the role of
air pollution in
predicting geographic
inequalities in health
outcomes.
36 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Developing Solutions to
Environment & Health Disparities
While it is critical that the Pilot EPA-NIMHD EHD
Centers of Excellence research the existence
and drivers of environmental health disparities,
determining practical and effective solutions to these
disparities was an equally important facet of their
work.
Collaboration with local community
organization evaluated innovative approach
to reducing school children's exposures to air
pollution
Center of Excellence on Health Disparities Research at
Georgia State University
Exposure to air pollutants emitted by cars and
trucks is a major concern for schools located in close
proximity to major roadways. Long-term exposure
to traffic-related air pollution can lead to asthma
onset and exacerbation, decrements in lung function,
and other health effects in children.46 This is a
nationwide problem—in 2005-2006, an assessment
of the proximity of U.S. schools to major roadways
found that 6.4 million children attended a school
located 250 meters or closer to a major roadway.47
The assessment also found that schools serving
predominantly African American students were
18 percent more likely to be located near a major
roadway, and schools with the majority of students
eligible for free or reduced price meals (a proxy for
income levels) were also more likely to be near a
roadway.47
6.4 million children
a LLCi iucu a :>l.i iuui
located 250 meters
or closer to a major
roadway.47
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Figure 4. Images taken during
the vegetative barrier study
Image A shows a section of the barrier during time of
lower leaf area index. Image B shows a section of the
barrier during a time of higher leaf area index. Image
C shows the camera the investigators used to take
photos to calculate the leaf area index values. Image
D shows photos used to calculate leaf area index
values.46
Given the magnitude of this issue, the associated
inequalities, and the lack of technologies and policies
to completely eliminate traffic-related air emissions,
efforts to reduce the amount of traffic-related air
pollution near schools are vital, Novel, inexpensive,
and simple methods to address this nationwide
concern would be even better.
The Center of Excellence on Health Disparities
Research at Georgia State collaborated with local
community group Mothers & Others for Clean Air to
test a strategy to reduce schools'traffic-related air
pollution exposures using trees and bushes, referred
to as "vegetative barriers."48 Vegetative barriers, if
designed and implemented properly, have been
shown to effectively improve air quality in urban
environments45
Over a one-year period the researchers measured
total particle number concentrations (PNC) and
black carbon (BC) concentrations at a Georgia middle
school next to a major highway with a vegetative
barrier in the middle. Taking advantage of the natural
changes in vegetative cover that occur throughout
the fall, winter, and spring months, the researchers
tested the effect of the vegetative barrier on air
pollution concentrations.
Figure 5.
Study site and
monitoring
transects46
Clasuoom
Tranwct - p
Parking Lot
Transect -p
Weathtr Station
laun*: "Irudfy Slur" Goagi# forth, 20! 1. CWe^mhrr 2t. Xfl6
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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They observed consistent decreases in BC
concentrations with increased distance from the
highway, but not in PNC. Furthermore, at either
distance, BC concentrations were highest during
the winter months when vegetative cover was
the lowest. Additionally, time of year, hour of day,
downwind conditions, temperature, and relative
humidity were all found to be significant predictors
of pollutant concentrations.46
Because the study considered both distance
and vegetation together, the center results were
unable to show a definitive benefit of vegetation
alone in reducing air pollution exposures.
However, the trend indicates that additional
investigations into this solution would be
worthwhile.
Vegetative barriers have the potential to be a low-
cost, sustainable, and simple method to reduce school
childrens'exposures to air pollution associated with
road traffic.
V
ACCOMPLISHMENTS & IMPACTS
1 \
Q
Q
Q
Collaborated with a community-
Engaged school teachers
Helped to build capacity for
based organization to monitor
and students in air pollution
researching environmental
the impacts of air pollution near
monitoring and installation of
contributors to urban health
schools.
vegetative barriers.
disparities.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Center Research informs intervention to
protect against DNA damage caused by
arsenic and uranium exposure
New Mexico Center for Advancement of Research,
Engagement, & Science on Health Disparities (NM CARES
HD) at the University of New Mexico
In one of the first studies of its kind, the New Mexico
Center for Advancement of Research, Engagement,
& Science on Health Disparities (NM CARES HD) at
the University of New Mexico proposed an easy-to-
implement intervention of zinc supplementation
to protect against arsenic and uranium toxicity.
NM CARES HD's research contributed to the
understanding of the physiological mechanisms of
heavy metals exposures, such as arsenic and uranium,
and how they combine with ultraviolet light exposure
to cause DNA damage.
40 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
Exposure to heavy metals is a concern in settings
where the population relies on natural resources, as
is common in many Native American communities.
Health disparities in heavy metals exposure have
been observed within Native American lands
proximate to abandoned uranium mines throughout
the western U.S. In previous studies, researchers
established that low levels of arsenic in drinking
water (as low as 10 ppb) disrupts DNA repair
mechanisms.49
While these low levels are not cytotoxic, arsenic
depletes zinc from target proteins, which leads to an
increase in DNA damage after exposure to ultraviolet
light.38 Researchers also suggest that uranium may
lead to similar zinc-based DNA repair disruption.50 If
so, over-the-counter dietary zinc supplementation
could mitigate the DNA damage and protect against
uranium toxicity.
-------
Examining these effects in the Navajo Birth Cohort
Study, researchers at NM CARES HD found preliminary
indications that an over-the-counter, preconception
zinc supplement was associated with decreased DNA
damage after ultraviolet co-exposure with arsenic and
uranium.51 The research also demonstrated that zinc
supplementation can mitigate or reverse the effects
of arsenic on a particular enzyme's (PARP-1) activity
and ultraviolet light-induced DNA damage in human
cell and mouse models.
ACCOMPLISHMENTS & IMPACTS
Q
Researchers at NM CARES HD
discovered that prenatal zinc
supplementation taken before
pregnancy decreased the amount
of UV-driven DNA damage after
exposure to uranium and arsenic.
Q
This was one of the first studies
to investigate the mechanisms of
uranium-dependent DNA repair
deficiency.
Q
The research informs an easily-
implemented intervention
to decrease DNA damage
caused by arsenic and uranium
exposure.
"The outcomes from the UNM CARES HD Center Program
Environmental Supplement provided the scientific underpinnings
to design and implement a mechanism-based intervention,
sympathetic to Native American holistic views, using zinc
supplementation to alleviate toxicity associated with mine waste
metal exposures. A successful low-cost, easily implemented
intervention could have broad public health implications
- Dr. Laurie Hudson, Investigator, UNM CARES HD, University of New Mexico
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Collecting & Synthes z ng
Envfronment and Health
Disparity Data
The Pilot EPA-NIIV1HD EHD Centers gathered
enormous amounts of data and built infrastructures
to store, synthesize, and analyze that data for
use by researchers across the country for future
environmental and health disparity research.The
data will ensure that the work conducted under this
grants program have long-lasting and far-reaching
impacts on the people affected by environmental
health disparities.
Transdisciplinary team seeks answers to
complex health disparity questions
Health Disparities Research Center of Excellence
(HDRCOE) at Meharry Medical College
Why are some individuals more susceptible to
health problems than others? The reasons are
not simple. Health status is a result of incredibly
complex interactions and variability among genetics,
age, nutrition, exposures to hazards, lifestyle,
behaviors, and socioeconomic variables over one's
42 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
-------
lifetime. Understanding lifetime exposures and
interactions will make it easier to find health
interventions that work.
The Health Disparities Research Center of
Excellence (HDRCOE) at Meharry Medical College
in Nashville,Tennessee tackled this complexity
with a multidisciplinary team of experts in public
health, medicine, mathematics, geography, urban
planning, and social sciences.They developed
a public health "exposome"framework and
gathered data to assess relationships between
environment, personal health, and population
level disparities.52,53 The framework organizes the
integration of environmental exposures across
a person's entire life. It addresses exposures
to hazards, personal attributes, stressors,
community attributes, and moderating factors
to assess the ways critical life stages might be
affected, from molecular to population levels.
HDRCOE used the framework to aggregate health
outcome data with thousands of sources of
environmental exposures. From this framework,
a publicly available database was developed to
allow tracking and analysis of environmental health
data over time, place, and space. Users can create
interactive maps, tables, and charts at local levels (e.g.,
by county) where available.
The framework and database provide tremendous
opportunities to integrate, manipulate, and analyze
variables from a wide range of scientific disciplines to
allow for the examination of complex social problems
such as health disparities.53 These achievements
strengthen the evidence base for health disparities
research, practice, policy, community engagement,
and research training.
WHAT IS THE "EXPOSOME?"
The "exposome" is defined as the cumulative
measure of all exposures during an individual's
lifetime and how those exposures relate to health.52
These exposures or factors can be organized into
three categories, illustrated here with examples.The
concept of the exposome is important because it
captures non-genetic factors that determine health.54
Internal factors such
as hormones, body
type, physical activity,
and age.
** i i It
SS ¦ m
n
Specific external factors
such as radiation, pathogens,
pollutants, and diet.
t
r
General external factors
such as education,
financial status, and
psychological stress.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
-------
Jf
environmental health exposures
and their interactions.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
"As important as... sequencing
of the human genome was,
sequencing the public health
exposome is likely to have a much
greater impact. Completing
exposure pathways over the life
course will provide us with greater
opportunities to target personal
and public health interventions with
tailored\ data driven initiatives."
- Paul D.Juarez, Director
HDRCOE, Meharry Medical College
¦m \
Q
Strengthened the evidence base
for disparities research practice,
policy, community engagement,
and research training.
ACCOMPLISHMENTS & IMPACTS
Q
Pioneered the concept of a public
health exposome framework that
encompassed a lifetime analysis
approach to understanding
Q
Developed a large repository of
environmental health disparities
data that can be used by
researchers across the nation.
-------
Building New York City communities' capacity
to reduce health disparities
Center of Excellence in Disparities Research and
Community Engagement (CEDREC) at Weill Cornell
Medical College
The Center of Excellence in Disparities Research
and Community Engagement (CEDREC) at Weill
Cornell Medical College compiled environmental
health information for the communities of color and
investigated new ways to engage with hard-to-reach
populations in these communities.
The largely African-American communities of the
South Bronx and Harlem have among the highest
cardiovascular disease and cancer death rates in
New York City, and one in three residents live in
poverty.55,56 To effectively disseminate research
findings and solutions and build community capacity
for change to reduce cardiovascular disease and
cancer risks, CEDREC sought to communicate health
information and find research partners from within
communities at a high risk of cardiovascular disease
or cancer. For example, one effort involved using local
barbershops to recruit older African-American men
for blood pressure and colorectal cancer screening.
Additionally, the center developed HeartSmarts,
a faith-based cardiovascular disease prevention
initiative developed in partnership with a hospital.
"Community engagement in research ensures that researchers understand
community priorities, promote culturally-responsive research, while
simultaneously enhancing a community's capacity to address its own health
needs and health disparities issues."
- Dr. Carla Boutin-Foster, Director, CEDREC, Weill Cornell Medical College
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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They contacted faith-based organizations with
the assistance of an established ecumenical
group (Brooklyn District Public Health Office
Advisory group) and used a train-the-trainer
approach to develop lay health ambassadors in
these organizations. These ambassadors then
communicated information to members of their
congregation.
CEDREC partnered closely with a number of
local organizations to improve data collection
and transfer of information and benefits to the
community.These community partners included
Youth Ministries for Peace and Justice, Mothers on
the Move, Families United for Racial and Economic
Equality, Good Old Lower East Side, and the Chinese
Progress Association. The center researched
and developed comprehensive community
environmental health profiles and shared the
information with local partners.57
46 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
-------
These profiles mapped New York City Department
of Health data and community partner catchment
areas to describe a number of community
characteristics, including:
Socioeconomic and demographic indicators
(e.g., ethnicity, income levels, housing, census,
and employment data)
Condition of the natural and built environments
Land use
Transportation
Air quality (indoor and outdoor)
Water quality
Soil contamination
Emissions from vehicles, industry, and power
plants
Use of pesticides
Food safety and systems
Schools
Open spaces
Waste removal and disposal
Availability of health care services, including
outreach and services by government agencies,
hospitals and medical facilities, and first
responders
Ecological data on land use changes and
flooding risk
In collaboration with the New York City Department
of Health and Mental Hygiene, the center overlaid
health statistics data onto the community profiles.
The research team provided the five community
partners with access to these data-rich profiles
that serve as a valuable resource in examining
environmental factors that drive health disparities
and in developing innovative and transdisciplinary
solutions.The research contributed to achieving
the goals of the NIH strategic plan to reduce and
ultimately eliminate health disparities.
ACCOMPLISHMENTS & IMPACTS
Q
Applied a participatory approach
where community partners were
engaged throughout the study and
provided benefits to researchers
and the community.
Q
Created new collaborations that
informed novel community-
based programs.
Q
Accelerated the
dissemination of
cardiovascular disease and
cancer health information
and research findings that
supported community
capacity for change.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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COMMUNITY
OUTREACH &
ENGAGEMENT
Partnering with and educating communities impacted by environment and health disparities bridges the
gap between research and implementation. Many of the Pilot EPA-NIMHD Centers of Excellence focused
on increasing community outreach and engagement activities with communities impacted by health
disparities. Through these activities, the centers successfully empowered communities, informed policy,
strengthened community networks, educated community members and organizations, and provided services
to communities that directly addressed health disparity concerns. The centers worked to initiate and expand
relationships between communities, health organizations, researchers, health practitioners, and policy makers
in order to:
COLLABORATIONS TO INFORM
POLICY
49
Influencing state legislation to protect children's
health
EMPOWERING COMMUNITIES TO
ADDRESS HEALTH DISPARITIES
ISSUES 51
Photovoice Project: Tool for aiding communities in
identifying EHD issues
The FIESTAS Project: Empowering women to tackle
food insecurity
The Community Block Assessment Project:
Community involvement in data collection and
analysis
EXPANDING RELATIONSHIPS AND
EDUCATING COMMUNITIES 58
Center uses environmental health disparity
data to develop community resources.
Public participatory geographic information
system help enhances residents' engagement in
local environmental decision-making.
PROVIDING DIRECT COMMUNITY
BENEFIT 61
Improving health and safety in American
Indian community homes and businesses.
LIST OF COMMUNITY
PARTNERS
63
The centers'work is exemplary of community outreach and
engagement that both enhances awareness of local health
disparity issues among community members and stakeholders,
while simultaneously educating community leaders.
48 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
-------
Collaborations to
Inform Policy
The Pilot EHD Centers provided evidence-based
research, which aids in producing public policy
built on their scientific findings. Such research
findings and interventions that prevent or
mitigate certain exposures are important
considerations when writing new legislation to
protect public health. EPA-NIMHD EHD Center
investigators inform this process by developing
research partnerships and collaborations, and
sharing their research findings with local, state,
and national lawmakers.
Influencing state legislation to protect
children's health
New Mexico Center for Advancement of Research,
Engagement, & Science on Health Disparities (NM
CARES HD) at the University of New Mexico
The New Mexico Center for Advancement of
Research, Engagement, & Science on Health
Disparities (NM CARES HD) has identified,
initiated, and advanced partnerships with health
organizations, which helped influence state
legislation to address public health concerns. NM
CARES HD organized a multi-stakeholder team
that worked on children's asthma and secondhand
smoke as a significant health disparity indicator in
the state of New Mexico.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 49
-------
ACCOMPLISHMENTS &
IMPACTS
Additionally, NM CARES HD initiated partnerships
with the New Mexico Coalition on Asthma,
American Lung Association (local chapter),
American Thoracic Association, New Mexico
Thoracic Society, UNM Pulmonary and Fierce
Pride.This expanded collaboration allowed for the
identification of gaps to inform policy, research,
and practice and the achievement of further public
health advancements. Together, they identified
pediatric exposure to secondhand smoke in
vehicles as a particular concern.
In response to the strength of this collaborative
effort fostered by NM CARES HD, the New Mexico
State Legislature, in 2015, introduced a law
prohibiting smoking in vehicles when children are
present in an effort to protect children's health by
reducing their exposure to secondhand smoke.60
Q
Collaborations between the New Mexico
Center for Advancement of Research,
Engagement, & Science on Health Disparities
(NM CARES HD) and numerous health
organizations played an important role in the
introduction of a house bill by the New Mexico
State Legislation to protect children from
exposure to secondhand smoke in vehicles in
New Mexico. The bill prohibited smoking in
vehicles if minors are present.60
Why is secondhand
smoke a children's health
concern?
Children have no control over their environment,
including where and when the adults in their life
choose to smoke. Secondhand smoke is a complex
mixture containing about 70 carcinogenic chemicals.
Multiple adverse health effects have been associated
with childhood exposure to secondhand smoke,
including respiratory illness and health effects in
adulthood (e.g., cancer and cardiovascular health).58
The I PA NI.V.I ID Pilot Centers of Excellence on Environmental Health Disparities
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Empowering
Communities to
Address Health
Disparity Issues
The importance of creating enduring, long-term,
beneficial change in communities and individuals
cannot be understated. Projects and research
initiatives come and go, but the people remain. It is
essential to determine the methods and strategies
that are most effective at providing communities with
the education and tools they need to continuously
improve their lives.
Through community-based participatory research
projects, the Pilot EHD Centers involved community
members in planning and implementing
interventions and public health strategies to
address health disparity issues. Initiatives, such
as holding community meetings and involving
community members in data collection and
analysis, gave these communities the resources and
sense of empowerment necessary for sustainable
improvement of their environments.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
51
-------
Photovoice Project: Tool for aiding
communities in identifying EHD issues
Coordinating Center of Excellence in the Social
Promotion of Health Equity in Research, Research
Education and Training, and Community Engagement
and Outreach, University of South Carolina
Residents of Orangeburg County, South Carolina,
share concerns about environmental health
disparities, especially in HIV, HPV, cervical cancer, and
head and neck cancers that affect the community. In
response to community concerns, the University of
South Carolina developed a tool to learn more about
perceptions of the environment and health. The tool,
called Photovoice, uses photography to document
perceptions of local environmental hazards,
pollution sources, and potential impact on health
among community members.
"This is where I live. There is a foul odor, smell,
mosquitoes in this sitting water, and I am concerned
about the water,"
- Resident of Orangeburg County, SC
Photovoice was designed for community leaders to
use when discussing and developing policy at the
local level.The goal is that it will be used to guide
discussions about how the environment affects
health and to inform local policy action to address
environmental health disparities.
A sample of adult residents were recruited to
participate in the implementation of Photovoice.
Participants took photos and wrote descriptions
that tell a story about how the environment affects
health. Photos depict both positive and negative
perceptions of the environment and health. In
collaboration with Community Action Board Inc. and
community leaders, the research board reviewed
photos and descriptions. Seven themes emerged
from the photos: Recreation and Leisure; Food
Access; Hazards and Pollution; Health, Human, and
Social Services; Economic Issues; Beautification; and
Accommodation and Accessibility.
Above is an example PhotoVoice entry by a community
member. Photovoice has empowered community
members to take action and notice environmental
health concerns, become active in educating others
about environmental health issues, and practice health
lifestyles.The Environmental Health Core will continue
to collaborate with stakeholders and residents of
Orangeburg County to improve health and reduce
health disparities.59
Resident perceptions of environment
and health fell into seven themes:
• Recreation and Leisure
• Food Access
• Hazards and Pollution
• Health, Human, and Social Services
• Economic Issues
• Beautification
• Accommodation and Accessibility
52 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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The FIESTAS project; Empowering women to
tackle food insecurity
New Mexico Center for Advancement of Research,
Engagement, and Science on Health Disparities (NM
CARES HD) at the University of New Mexico
What is food insecurity?
FIESTAS was a two-year project run by the New
Mexico Center for Advancement of Research,
Engagement, and Science on Health Disparities
(NM CARES HD) at the University of New Mexico,
which focused on improving food security in Santa
Barbara-Martineztown, Albuquerque, New Mexico.
The goal of the project was to understand the
communities everyday experiences in relation to
food, create opportunities for community members
to develop supportive social relationships, obtain
useful information about available food and health
resources, and envision strategies that could improve
nutrition and strengthen social networks in the
neighborhood.
Food insecurity is when the availability of
nutritionally adequate and safe foods, or the
ability to acquire acceptable foods in socially
acceptable ways, is limited or uncertain.49
NM CARES HD researchers found that families in
Santa Barbara-Martineztown experienced food
insecurity rates twice the state average;
1 in 3 families had trouble feeding their families,
compared to 1 in 6 in the rest of the nation. They
also found that availability and quality of food
was lower in Santa Barbara-Martineztown than
in other areas of the country.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 53
-------
Researchers conducted a food security survey,
assessed the neighborhood food environment,
and interviewed local community members about
their struggles and strategies for dealing with food
insecurity.
The results of these inquiries revealed serious food
insecurity issues in this community. While the impacts
of food insecurity on physical health are concerning,
the stress and despair reported by individuals affected
by food insecurity are equally disturbing. Women, in
particular, experienced significant distress related to
issues of food insecurity. Most concerning, women felt
alone in their struggle, embarrassed about seeking
support or counsel from their fellow community
members, even though most members of their
community were also experiencing the same issues.
With a deeper understanding of the issues plaguing
this community, NM CARES HD researchers worked
with community members to conceptualize and
implement strategies to improve food access, food
security, and nutrition. Throughout the project, the
research team engaged the community by holding
community board meetings and other FIESTAS
events for the community members to develop
solutions. The purpose of the events was to prepare
and share meals, discuss community issues, develop
and write interview questions, and interpret survey
and assessment findings.The researchers continue
to actively involve the community in developing
solutions.
Rather than designing and implementing solutions
for the community, researchers gave community
members the tools and knowledge to create
change themselves. Community meetings served as
opportunities for women to strengthen relationships
with fellow community members, increase their
knowledge of available local resources, and gain
an understanding that they were not alone in their
struggles.60
FIESTAS identified how food insecurity intersected with everyday
experiences for women in Santa Barbara-Martineztown. "Women
struggle with the experience of food insecurity in a variety of physically
and emotionally challenging ways. Women... connect shame, fear, family
conflict, the potential for child abuse, feelings of failure, having to sell
beloved family pets, the risk of becoming homeless, not knowing where
to turn for help, and actual physical distress... with food insecurity"
- Dr. Janet Page-Reeves, Investigator, NM CARES HD, University of New Mexico
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Researchers found that women who participated
in the FIESTAS project reported that they felt
personally empowered by the experience, giving
them a new sense of possibility for themselves and
the community. By providing a structured space for
open dialogue between community members and
educating them about available tools and resources,
NM CARES HD researchers created a sense of
empowerment in Santa Barbara-Martineztown that
will enable long-lasting beneficial change brought
about by its own members.
"The vision emerging from [FIESTAS]
is contributing to a new sense of
possibility for the community and
for women individually in their own
lives."
- Dr. Janet Page-Reeves, Investigator
NM CARES HD, University of New Mexico
ACCOMPLISHMENTS & IMPACTS
Q
Connected individuals struggling with food
insecurity to fellow members of their community
experiencing the same hardships removed
feelings of shame and embarrassment, and
empowered them to work on solutions to improve
food security and nutrition.
Q
Empowered women in the community to formulate
and apply strategies to improve food security
and nutrition for themselves and others in their
community, including the following:
1. Women's supper club,
2. Bulk-buying initiative,
3. Walking group,
4. Multidimensional grocery store pilot,
5. Community kitchen, and
6. Community garden.60
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 55
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The Community Block Assessment Project:
Community involvement in data collection
and analysis
Coordinating Center of Excellence in the Social
Promotion of Health Equity in Research, Research
Education and Training, and Community Engagement
and Outreach (CCE-SPHERE) at the University of South
Carolina
To thoroughly understand how ecological features
of the environment act as primary drivers of
health and disease in a community, researchers
must have a complete picture of the distribution
of positive and negative features in the area of
study.The Coordinating Center of Excellence in
the Social Promotion of Health Equity in Research,
Research Education and Training, and Community
Engagement and Outreach (CCE-SPHERE) undertook
such an assessment of the ecological features in
North Charleston and Orangeburg County, South
Carolina.The CCE-SPHERE felt it was pertinent to
involve community members with the collection and
interpretation of community data.
-------
What are pathogenic and salutogenic features?
Pathogenic features increase the negative effect
of environmental hazards on community health
and well-being.
Salutogenic features act as buffers and help
to mitigate and/or moderate the effects of
stressors on the health of individuals and
communities.61
Examples: Psychosocial stressors (i.e., racism,
crime, and violence), pawn shops, liquor stores,
poor sewer, water, and road infrastructure, and
traditional environmental pollutants such as
landfills and Superfund sites.
Examples: Good housing stock, parks, green
space, recreational facilities, supermarkets, and
social service organizations.
CCE-SPHERE researchers used a Community Block
Assessment methodology to assess pathogenic
and salutogenic features of the two communities.
They recruited and trained over 30 members
of the Charleston and Orangeburg counties to
become"block raters,"who then went out into their
communities and collected data on the physical and
social features of over 100 blocks. Data collected
included, the physical layout of the block face, types
of structures, adult and youth activity, and physical
and social order, were used to calculate descriptive
statistics for each study block and to create maps of
the communities with pathogenic and salutogenic
features overlaid. The researchers reviewed the
findings with the community surveyors and held
evaluation sessions to discuss the block assessment
methodology and the utility of the maps.
The results of the Community Block Assessment
revealed important characteristics about these
counties and enabled comparisons between the
two. Data gathered from the study are intended to
inform community-based organizations'planning
and community development initiatives to address
environment and health disparities at the local
level. On a broader scale, researchers evaluated the
success of involving community members in the data
collection process.
Results showed that community participants
felt empowered by the experience. They were
more confident in recognizing features in their
communities that contribute to health, and felt that
the data they gathered would be extremely useful in
helping them to advocate and change policies in their
neighborhoods.62
ACCOMPLISHMENT &
IMPACT
Q
Empowered community members to recognize
positive and negative features in their
communities related to environmental health,
and taught them to understand how that
information can be used to effect real change.
/
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 57
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Expanding Relationships and
Educating Communities
Researchers at the Pilot EPA-NIMHD Centers of Excellence engage with local organizations and citizens to
empower them to take individual actions that will improve public health and decrease environment and health
disparities within their community. These types of community-level interventions have a direct impact and are
most effective at reaching those in most need.
58 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Center uses environmental health disparity
data to develop community resources
Center of Excellence in Eliminating Disparities at the
University of Illinois at Chicago (UIC)
As part of their Environment Core, the Center of
Excellence in Eliminating Disparities at the University of
Illinois at Chicago (UIC) gathered and analyzed health
disparities research data for Chicago from a variety of
sources, for use by their own and other researchers
across the country In addition, they took the important
step of making this data accessible and directly useful to
the local community
Center researchers worked with the UIC Urban Data
Visualization Lab, dedicated to data visualization and
geographic mapping, to develop websites for direct
community benefit.62 The UIC Center developed
prototype websites to share results of this work. For
example, the researchers developed a prototype
website to provide healthcare access information
to wider Cook County residents. This website listed
locations of Federally Qualified Health Centers, local
and state public health clinics, and community health
Centers.63
The UIC Center provided consultation to the Chicago
Consortium for Community Engagement, which
is a network of academic institutions engaged in
community research, to encourage Chicago citizens
to participate in and access local health research.
The UIC Center assisted with development of a
Chicago Community Research Map website—an
interactive map of the 77 Chicago community areas,
which is searchable by geography, research topic, and
investigator.64 Center researchers have also provided
support to the Illinois Breast and Cervical Cancer
Program and to the state of Illinois'Affordable Care
Training to help identify effective ways to reach those
most in need.
ACCOMPLISHMENTS & IMPACTS
Q
Developed website
that provided health
care information for
the disadvantaged and
uninsured in the state
of Illinois.
Q
Consulted for the
Chicago Consortium for
Community Engagement
that created relevant,
accessible, and effective
programs to increase
Chicago communities' use
of health research.
Q
Funded the Beating Breast
Cancer Program that
collaborated with other
agencies in Chicago to
help navigate uninsured
women to obtain
screening mammograms
after an Illinois health
program had to reduce
efforts when faced with
state budget cuts.
Q
Provided expertise
to and worked with
Illinois state agencies
to conduct an
evaluation of an Illinois
health program to
look at effective ways
to reach those in most
need.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Public participatory geographic information
systems help residents be more engaged in
local environmental decision-making
Environmental Health Core at the University of South
Carolina
Members of communities in Orangeburg and
North Charleston, South Carolina, expressed
concerns about environmental stressors. Their
concerns included industrial pollution sources,
goods movement activity, soil contamination,
indoor pollution, and health disparities related to
cardiovascular disease, asthma, cancer, diabetes,
stroke, and birth outcomes.65 The Environmental
Health Core at the University of South Carolina
conducted research and tool development
responsive to these concerns.
A number of stressors are present throughout the
region. Some of the stressors identified include
environmental stressors- such as brownfields,
leaking underground storage tanks, air toxics,
Community issue profiles can be generated by the
tool. The tool and information provide communities
with "issue profiles" of cumulative risk information.
This information helps communities identify
individual-level potential "hot spots," vulnerable
subpopulations, and allows them to prioritize or
manage risk issues.67
and facilities reporting releases of toxic substances
tracked by EPA'sToxic Release Inventory, while
others include social stressors, such as segregation
and socioeconomic status disparities. The center
developed the Environmental Justice Radar
(EJRADAR) tool to improve community access to
relevant exposure and risk-related information
for these stressors.66 This tool allows community
members to map study data and visualize burden
and exposure disparity data. The tool includes hazard,
pollution, socioeconomic, and sociodemographic
data; allows data queries to be performed; and offers
the capability to upload photos of environmental
stressors.67
ACCOMPLISHMENTS & IMPACTS
\
Q
Developed EJRADAR tool, which allowed
0
Held two in-person trainings at the 2013
community-level mapping of research, hazard,
Charleston Area Environmental Justice Conference
pollution, and sociodemographic data, and
and Community Summit to share information on
the ability to upload community photos of
EJRADAR. Provided interactive demonstrations of
environmental stressors.
the tool.
60 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Provide Direct
Community Benefit
Thorough and groundbreaking research is essential
to improve the lives of families and communities
affected by environment and health disparities, but
the benefits are often delayed. Researchers at the Pilot
EPA-NIMHD Centers of Excellence strive to achieve
more immediate and direct positive impacts on their
communities.They perform local-level research,
engage local organizations, raise awareness, and
directly implement community-level initiatives.
improving health and safety in AI/NA
community homes and businesses
Center for American Indian Community Health (CAICH)
at the University of Kansas Medical Center
The Center for American Indian Community Health
(CAICH) at the University of Kansas provided healthy
home assessments and environmental health
education to local AI/NA communities.These services
assisted vulnerable populations at tribal facilities and
schools on multiple reservations in Kansas and South
Dakota.
"We identified problems in over half
of the homes and facilities assessed,
many that required simple solutions
by home owners/renters. If larger
problems are found, we help people
into programs that assist with
the cost of renovations or other
solutions. We received numerous
comments from community
members about how much
these assessments helped them,
particularly from individuals in
whose homes we found gas leaks."
- Dr. Christine Daley, Director
CAICH, Kansas Medical Center
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 61
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With the assistance of Masters of Public Health
students who were fully trained in EPA's Healthy
Homes guidelines, the center provided 72
assessments for AI/NA homeowners, home renters,
and business owners.59 They collected samples to
examine allergens such as dust and mold, potential
safety hazards, as well as air flow and quality.
CAICH identified potential hazards and problems
in more than half of the assessed sites. Many of the
issues could be resolved with simple solutions, such
as installing smoke and carbon monoxide detectors
or providing fire extinguishers and allergen-free
cleaning supplies. When larger or more complex
problems were found, such as widespread mold,
the center provided referrals to programs that
assist with renovations and other solutions. The
assessments served as opportunities for community
members to improve home safety and to expand
their knowledge on potential hazards around
their living environments.The center received
numerous positive comments about how helpful the
assessments were, especially from individuals whose
homes were found to have gas leaks.
Education plays a critical role in addressing
environmental health issues. The center has
developed and presented educational materials
to 240 community members about home safety
and how to maintain a healthy home, 30 facility
maintenance personnel about building safety,
and 30 health care providers about asthma and
improving the home environment of patients.69
University of Kansas
Center researchers
conduct a Healthy
Homes assessment
ACCOMPLISHMENTS & IMPACTS
1 \
Q
Q
Q
Performed 72 healthy home
identified gas leaks in some of the
Raised awareness of potential
assessments that identified ways to
assessed homes—information
hazards in home environments
improve home safety and residents'
that helped avert potentially
and provided the tools and
health.
serious threats to life and
knowledge to properly address
property.
environmental issues around them.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Research staff leveraged
local organizations'
community knowledge
and connections to help
ensure that the centers
addressed the critical
needs specific to that
population.
List of Community Partners
The Pilot EPA-NIMHD EHD Centers engaged directly with community partners when conducting their research.
Research staff leveraged local organizations'community knowledge and connections to help ensure that the
centers addressed the critical needs specific to that population.The following organizations partnered with Pilot
EHD Centers researchers.
Community Organizations
Fierce Pride
Mothers on the Move
Navajo Nation
New Mexico Coalition on Asthma
Proctor Creek Stewardship Council
Santa Barbara-Martineztown Community
Learning Center
Youth Ministries for Peace and Justice
Federal, State, and Local Governments
Fulton County Department of Health and Wellness
Georgia Department of Public Health
Illinois Department of Public Health
Metropolitan Nashville Public Schools
New York City Department of Health
Pan-American Health Organization
Shelby County Health Department
South Carolina Commission for Minority Affairs
South Carolina Department of Health and
Environmental Control
South Carolina Network for the Elimination of
Health Disparities
South Carolina Rural Health Research Center
Tennessee Department of Health
Tennessee Department ofTransportation
U.S. Centers for Disease Control and Prevention
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 63
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Health Associations and Hospitals
Associations for Schools and Programs of
Public Health
Border Epidemiology and Environmental
Health Center
Children's Mercy Hospital
National Environmental Health Association
Non-Profit Organizations
Action for the Retired Community (ARC) Fort
Washington Senior Center
Alianza Dominicana
Alzheimer's Association
American Indian Arts and Crafts Association
American Lung Association
American Thoracic Association
Charleston Community Research to Action Board
Chattahoochee Riverkeepers
Chinese Progress Association
Eco-Action
English Avenue Neighborhood Association
Familias Unidas de Chamizal
Families United for Racial and Economic Equality
Federal Reserve Bank
Good Old Lower East Side
GreenLaw
Low Country Alliance for Model Communities
Metropolitan Chicago Breast Cancer Task Force
Mothers and Others for Clean Air
New Mexico Thoracic Society
Riverstone Senior Life Services
The Conservation Fund
Walk/Bike Nashville
West Atlanta Watershed Alliance
Research Groups and Studies
Charleston Area Pollution Prevention Partnership
Design for Health
Healthy Cities Collaborative
Navajo Birth Cohort Study
The Jackson Heart Study
The Multi-Ethnic Study of Atherosclerosis
Colleges and Universities
Allen University
Benedict College
Claflin University
Emory University School of Medicine
Emory University School of Public Health
Haskell Indian Nations University
Jackson State University
Morris College
Northern New Mexico College
Northwestern University
Pratt Institute
Rush University
Spelman College
University of Chicago
University of Maryland
University of Mississippi Medical Center
University of New Mexico Health Sciences Center
University of Pittsburgh Graduate School of Public
Health Center for Minority Health
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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EDUCATION &
TRAINING
The Pilot EPA-NIMHD Centers of Excellence supported the education and training of students, professionals,
and the communities they served in several ways: involving students in their research and community
outreach, training professionals and community members on topics related to EHDs, incorporating EHD
research and topics into their university's curriculum, and sharing EHD research at meetings, workshops, and
conferences around the world.
INVOLVING STUDENTS IN PILOT EHD
CENTERS RESEARCH AND OUTREACH 66
INCORPORATING EHD CENTERS RESEARCH
INTO CURRICULA 68
TRAINING COMMUNITY MEMBERS AND
PROFESSIONALS ON EHD ISSUES 69
PUBLICATIONS
SHARING EHD RESEARCH
AROUND THE WORLD
71
72
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 65
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early career professionals
have been involved in the
research, training, and
community outreach of the
Pilot EHD Centers.
Involving Students
n Pilot EHD Center
Research and Outreach
Students and junior faculty used center research
in their theses and dissertations, participated in
monitoring, assessments, and other hands-on
activities, and benefited from mentorship from center
faculty and investigators, among other types of
involvement.
Students and Junior faculty Involved in Center Activities
Junior faculty
Post-doctoral ~J
ph-D- 14
Master's fffffffffttftfffffffffffffftfffftttffttttttttffttttf 5 2
Undergraduates ffffffffffftfffttftttfttttttffffttttttttfttft 45
66 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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"In our [CAICH] opinion, the greatest
success and greatest impact of this
funding was in training ofourAI/NA
students. AI/NA communities face some
of the greatest disparities in education
of anyone in the U.S., and through this
funding, we were able to make a real
difference for students who are now
working in environmental health and
making a difference in their community."
- Dr. Christine Daley, Director
CAICH, University of Kansas Medical Center
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 67
-------
Incorporating EHD Research
into Curricula
Several of the Pilot EHD Centers developed new courses, concentrations, or seminars at their parent institutions.
These opportunities gave more students a chance to engage in environment and health disparities research and
bring about increased participation in the environmental health workforce by highly-trained scientists, some of
whom are also from underserved populations.
The Center of Excellence on Health Disparities
Research (COEHDR) at Georgia State University
developed an environmental health curriculum and
launched an environmental health concentration in
the Master of Public Health and Ph.D. programs.
The New Mexico Center for Advancement of
Research, Engagement, & Science on Health
Disparities (NM CARES HD) at the University of
New Mexico incorporated environment and health
disparities topics into the University of New Mexico
General Preventive Medicine and Public Health
Residency curriculum.
The Center of Excellence in Disparities Research
and Community Engagement (CEDREC) at Weill
Cornell Medical College in New York broadened
the health disparities track of an established Master
of Science Program in Clinical Epidemiology and
Health Services Research to include an environment
and health disparities seminar series focused on
environmental justice. Each seminar was taught by a
different community partner organization.
The Center for Excellence in Eliminating Disparities
(CEED) at the University of Illinois at Chicago
offers a health disparities research course entitled
Quantitative Methods of Health Disparities Research.
It examines quantitative and qualitative methods of
measuring health disparities and health equity using
local data. The center also developed and introduced
a Social Vulnerability course.
68 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Training Community
Members and Professionals
on EHD Issues
Students were not
the only group that
received education
and training from the
centers; community
members, health
care professionals,
and other individuals
also benefited from
the knowledge they
shared.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 69
-------
Center for American Indian
Community Health (CAICH) -
University of Kansas Medical Center
Educated 240 AI/NA community members
and 30 facilities maintenance workers on
environmental health, focusing on healthy
homes.
Educated 30 health care providers on treating
children with asthma, and educated the parents
of the children about their home environment,
New Mexico Center for Advancement
of Research, Engagement, & Science
on Health Disparities (NM CARES HD) -
University of New Mexico
Trained Navajo Nation Community Health
Representatives on environmental health
research and health disparities.
Delivered a four-part tele-education series
focusing on environmental health, uranium
exposure history and legacy, community-based
studies, and laboratory mechanistic studies to a
tribal college network.
Delivered three tele-health presentations
focused on New Mexico-specific research
on the prevalence of children's secondhand
smoke exposures, risk factors for asthma and
respiratory symptoms, and smoking restrictions
as a means to reduce environmental health risks
for children to clinicians across New Mexico.
Center of Excellence in Disparities
Research and Community
Engagement (CEDREC) - Weill Cornell
Medical College
Helped 23 members of partner community-
based organizations obtain Health Insurance
Portability and Accountability Act (HIPPA) and
Institutional Review Board (IRB) certification.
70 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Publications
Center researchers published their work
in various peer-reviewed journals. A list of
publications is provided in Appendix A, listed in
alphabetical order by author and then by date.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Sharing EHD Research Around the World
The Pilot EPA-NIMHD EHD Centers researchers presented their environment and health disparities research at
more than 50 conferences, meetings, and workshops, both nationally and internationally. Presentations are
listed by year and then by month, beginning with the most recent.
2017
Annual Meeting of the Population Association of
America. Chicago, Illinois (April)
Community Mapping Public Health Hackathon.
Nashville,Tennessee (March)
2015
27th Annual Conference of the International
Society for Environmental Epidemiology (ISEE).
Sao Paolo, Brazil. (August)
Annual Meeting of the American Sociological
Association. Chicago, Illinois (August)
2014
National Institute on Minority Health and Health
Disparities (NIMHD) Grantees'Conference.
National Harbor, Maryland (December)
7th American Association for Cancer Research
Conference on the Science of Cancer Health
Disparities in Racial/Ethnic Minorities and the
Medically Underserved. San Antonio, Texas
(November)
142nd Annual Meeting of the American Public
Health Association. New Orleans, Louisiana
(November)
jOUTH
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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8th Conference on Metal Toxicity and
Carcinogenesis. Albuquerque, New Mexico
(October)
International Society for Environmental
Epidemiology (ISEE) Young Researchers
Conference on Environmental Epidemiology.
Barcelona, Spain (October)
Annual Meeting of the American Sociological
Association. San Francisco, California (August)
Centers for Population Health and Health
Disparities Annual Meeting. Los Angeles,
California (May)
Conference on Addressing Environment, Public
Health and Social Justice. El Paso,Texas (May)
Environmental Health Disparities on the US-
Mexico Border Conference. El Paso, Texas (May)
Water Microbiology Conference. Chapel Hill,
North Carolina (May)
11th International Conference on Urban Health.
Manchester, United Kingdom (March)
74th Annual Meeting of the Society for Applied
Anthropology. Albuquerque, New Mexico (March)
Southwest Social Science Annual Meeting. San
Antonio,Texas (April)
7th Health Disparities Conference, Xavier
University of Louisiana. New Orleans, Louisiana
(March)
Eastern North American Region (ENAR)
International Biometric Society Spring Meeting.
Baltimore, Maryland (March)
20th Annual Meeting of the Society for Research
on Nicotine and Tobacco. Seattle, Washington
(February)
University of New Mexico Environmental
Toxicology Seminar Series. Albuquerque, New
Mexico (January)
2013
6th American Association for Cancer Research
Conference on the Science of Cancer Health
Disparities in Racial/Ethnic Minorities and
the Medically Underserved. Atlanta, Georgia
(December)
Colonias Working Group. El Paso,Texas
(December)
112th Annual Meeting of the American
Anthropological Association. Chicago, Illinois
(November)
141st Annual Meeting of the American Public
Health Association. Boston, Massachusetts
(November)
U.S. EPA Sustainable and Healthy Communities
Research Program (SHCRP) Webinar (November)
Water and Health Conference: Where Science
Meets Policy. Chapel Hill, North Carolina (October)
1 st Annual University of Kansas Medical Center
Women in Medicine and Science Poster Session.
Kansas City, Kansas (September)
Annual Meeting of the American College of
Epidemiology. Louisville, Kentucky (September)
Charleston Area Pollution Prevention Partnership
(CAPs) Environmental Justice and Health
Conference and Community Summit. North
Charleston, South Carolina (September)
15th International Medical Geography
Symposium. East Lansing, Michigan (July)
6th Annual James E. Clyburn Health Disparities
Lecture. Columbia, South Carolina (April)
Annual Meeting of the American Association of
Geographers. Los Angeles, California (April)
New Mexico Public Health Association and the
New Mexico Center for the Advancement of
Research, Engagement & Science on Health
Disparities (NM CARES) Joint Conference.
Albuquerque, New Mexico (April)
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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6th Annual Academic and Health Policy
Conference on Correctional Health. Chicago,
Illinois (March)
76th Annual Meeting of the Midwest Sociological
Society. Chicago, Illinois (March)
Urban Health Disparities Summit: Shaping Action
to Reduce Disparities. Atlanta, Georgia (March)
Annual Minority Health in the Midwest
Conference. Chicago, Illinois (February)
2012
Summit on the Science of Eliminating Health
Disparities. National Harbor, Maryland (December)
111th Annual Meeting of the American
Anthropological Association. San Francisco,
California (November)
6th Annual Urban and Regional Information
Systems Association (URISA) Caribbean
Geographic Information Systems (GIS)
Conference, Montego Bay, Jamaica (November)
Geological Society of America Annual Meeting
and Exposition. Charlotte, North Carolina
(November)
140th Annual Meeting of the American Public
Health Association. San Francisco, California
(October)
7th Conference on Metal Toxicity and
Carcinogenesis. Albuquerque, New Mexico
(October)
NIMHD-EPA Centers of Excellence in Environment
and health disparities. Webinar (October)
North Carolina Environmental Justice Network
Annual Summit. Whitakers, North Carolina
(October)
Southwest Conference on Disability. Albuquerque,
New Mexico (October)
Annual Meeting of the American College of
Epidemiology. Chicago, Illinois (September)
Congressional Black Caucus Environmental
Justice Braintrust: Social Determinants and
Environmental Justice. Washington, DC
(September)
University of New Mexico Biomedical Research
Symposium. Albuquerque, New Mexico (August)
National Conference on Health Statistics.
Washington, DC (August)
National Conference on Tobacco or Health. Kansas
City, Missouri (August)
National Cancer Institute Community Networks
Program Centers Meeting. Bethesda, Maryland
(July)
28th Annual Academy Health Research Meeting.
Orlando, Florida (June)
American Industrial Hygiene Conference &
Exposition (AlHce). Indianapolis, Indiana (June)
International HIVTreatment as Prevention
Workshop. Vancouver, Canada (April)
New Mexico Public Health Association and the
New Mexico Center for the Advancement of
Research, Engagement & Science on Health
Disparities (NM CARES) Joint Conference.
Albuquerque, New Mexico (April)
22nd Annual Association for Environmental
Health and Sciences (AEHS) Foundation
International Conference on Soil, Water, Energy,
and Air. San Diego, California (March)
5th Annual Academic and Health Policy
Conference on Correctional Health. Atlanta,
Georgia (March)
South Atlantic National Research Conference
(SANC). Raleigh, North Carolina (March)
2011
Advancing Hispanics/Chicanos & Native
Americans in Science (SACNAS) National
Conference. San Jose, California (October)
3rd North American Congress of Epidemiology.
Montreal, Canada (June)
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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MOVING
Investigators Comments on the
Research of the Pilot EHD Centers
Current EHD Research Efforts
References
Appendix A. Pilot EPA-NIHMD EHD
Center Publications
89
-------
Investigators Comments
on the Research of the
Plot EHD Centers
The Pilot EHD Center Directors were asked for their thoughts on what the next steps and future
directions for environmental health disparity research should be, as well as what research gaps need
to be addressed, and what opportunities for progress they think exists. They provided the following
statements.
k. A
%
¥
Dr. Jose A. Luchsinger,
Principal Investigator,
NOMCEMi-ID, Columbia
University Medical Center
"There is a need to account for the cumulative net impact of social
determinants of health (SDOH) on health. This is especially relevant
for disparities science, which seeks to explain and mitigate
within- and between-group differences in health in the context of
inequality.
I believe that this is a precious program, I am grateful and
privileged to be part of it, and highly supportive for the
continuation of this line of study."
76 The f'PA NI.V.HD Pilot Centers of Excellence on Environmental Health Disparities
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"Gaps exist in fully evaluating and disentangling the complex ways all
of the economic, social and environmental stressors operate alone and
interact with each other in urban environments. We continue to pursue
research that focuses on distinct mechanisms of how environmental
agents impact health as well as broader ecological perspectives on the
association between the environmental and social determinants of
health. Cumulative environmental risk assessment can provide a frame-
work for examining the role of these stressors on health."
Dr. Michael Eriksen, Principal
Investigator, COEHDR,
Georgia State University
"Unfortunately, in American Indian communities, we are behind
the curve in terms of environmental health research and education.
There are still dramatic environmental issues in Native communi-
ties, particularly on reservations... Both the natural and built envi-
ronments on reservations are problematic and the health
consequences are easily seen. We still do not have a basic under-
standing of natural and built environment issues in these commu-
nities."
Dr. Christine Daley, Principal
Investigator, CAICH, University
of Kansas Medical Center
"Incorporating both spatial and temporal dimensions to data and
analytics that will allow us to analyze the effects of environmental
exposures both at key lifestages and across the life span.
Using computational methods that allow us to apply big data analytics
to complex environmental health issues.
Linking environmental exposure data to health outcome measures.
Support transdisciplinary training of environmental health professions
students.
Completing environmental exposure pathways."
Dr. Paul D. Juarez, Principal
Investigator, HDRCOE,
Meharry Medical College
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 77
-------
Dr. Elizabeth Calhoun, Principal
Investigator, CEED, University of
Illinois at Chicago
"We see comparative research as a good approach to examine dif-
ferent patterns of environmental risk distributions that are affect-
ed by divergent socioeconomic and demographic developments
in cities. Comparative research methods can provide unique in-
sight into how different arrangements and contexts influence the
ways where environmental health disparities take place in cities.
Space and time are two key elements in comparative research.
Contrasting historical trajectories, cultures or policies may con-
tribute to present similar/different outcomes.
Environmental health disparity research could be strengthened by
exploring more organizational, social relations, and local political
dynamics. Our explanatory factors have expanded to include local
organizational arrangement, social capital to deal with their own
issues and draw external resources, changes in work relations, and
gentrification processes."
"There continues to be a need to understand how broadly defined
"environmental'factors interact with each other and with
individual-level factors to affect health.This requires not only
understanding their interrelations but also how they interact."Systems
approaches"are key here.
Another critical area is policy evaluation and capitalizing on natural ex-
periments to get a better handle on what policies or interventions may
be most successful in creating environmental change that then impacts
health disparities."
Dr. Ana Diez-Roux, Principal
Investigator, CIAHD, University
of Michigan
Dr. Melissa Gonzales, Principal
Investigator, NM CARES HD,
University of New Mexico
"The greatest need is to further develop and refine multi-level
approaches to research design and analytical techniques in en-
vironmental health. These approaches are needed to effectively
understand combined effects of social, biological and environ-
mental determinants to environmental health disparities."
78 The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Dr. Saundra Glover, Principal
Investigator, CCE-SPHERE,
University of South Carolina
"A comprehensive research agenda that combines expertise in
environmental, social and behavioral science, and an expansive
community network to conduct environmental, community-based
participatory and translational research focused on addressing
environmental stressors, particularly in rural/minority communities.
[Additionally, there was a need for] funding to support the training and
development of more underrepresented minority researchers in the
conduct of community-based participatory research in vulnerable and
underserved communities. A final area of emphasis needs to be the
development, implementation, and evaluation of programs to increase
environmental health literacy among minority youth who are from
overburdened communities such as North Charleston, South Carolina,
and empower youth to be more engaged in activities to improve envi-
ronmental health and address local environmental injustice and environ-
mental health disparities."
"Intra-ethnic heterogeneity is an important yet still un-
der-recognized factor in environmental health disparities.
Few scholars are looking at disparities within ethnic groups
(e.g., based on language, nativity, country of origin), which
can be substantial and can be masked in aggregate groups
(e.g., when looking at "Asians" or "Hispanics")."
"A focus on epigenetics."
Dr. Bibiana Mancera, Investigator,
HHDRC, University of Texas at El Paso
"There is a gap in our understanding of how cumulative environmental
determinants contribute to diseases. New disease models need to be devel-
oped that better explicate the interactions between environment and health
while taking into consideration individual factors such as perceived stress,
ethnicity, gender, and comorbidity.
Dr. Carla Boutin-Foster,
Principal Investigator,
CEDREC, Weill Cornell
Medicine College
Environmental health research can benefit from the application of a trans-
lational paradigm that links scientists with community partners. The inte-
gration of scientists will enable specimens from the community to be taken
back to the lab where the physiologic impact of environmental toxins can be
tested. The involvement of community partners can guide the measurement
of mediating factors such as psychosocial and neighborhood level factors.
Key partners were brought together from various sectors and collaboratively
conducted surveys. The EH Core demonstrated the feasibility of engaging
community partners in research initiatives that focused on environmental
health disparities."
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 79
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Current EHD Research
Efforts
The Pilot EPA-NIMHD EHD Centers brought life and
energy to the topic of environment and health
disparities research. They produced a new and
unusual blending of environmental evaluation and
health disparities research that was truly unique and
ground breaking, and that revitalized the faculty,
students, and the impacted communities on which
they focused. The numerous successes and positive
impacts of the Pilot EHD Centers precipitated the
future direction of research on this topic well before
their grants even concluded, setting the foundation
for the next generation of environmental health
disparities research.
The interim research findings of the 10 Pilot EHD
Centers were just coming to light when a new
partnership began to form, setting the foundation
for the next phase of environmental and health
disparities research. In addition, the successes of the
EPA-NIMHD partnership attracted the involvement of
another NIH institute, namely the NIEHS, which joined
in collaboration to produce a new federal partnership
for EHD research. The two NIH institutes (NIMHD and
NIEHS) together contributed $17.5M, and EPA added
an additional $7.5M, to produce a $25M interagency
partnership in 2013.
In October 2014, NIH-EPA partnership issued a new
funding opportunity announcement to establish
the Centers of Excellence on Environmental Health
Disparities Research (P50) to stimulate basic and
applied research on environmental health disparities.
Investigators, in coordination with their community
partners, were encouraged to propose basic,
biological, clinical, epidemiological, behavioral and/
or social scientific investigations of disease conditions
associated with significant morbidity and mortality
in low SES and health-disparate populations, and to
determine whether specific windows of susceptibility
(i.e., life stages associated with enhanced sensitivity)
put individuals in these populations at greater risk of
illness and health disparities.70
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Of particular interest were proposals that
focused on environmentally driven health
disparities integrating etiology, genetics and
diagnosis. Investigators were also encouraged
to conduct studies in geographic areas that
have been understudied for the suite of factors
that contribute to environmental health
disparities; e.g., in inner city or rural and remote
communities, tribal communities (on and off
reservations), migrant communities, and/or
immigrant communities.70
Under the new federal partnership, five new EHD
research centers were competitively awarded
in 2015, and are jointly funded by 5-year grants.
These new grants, named the NIH-EPA Centers of
Excellence on Environmental Health Disparities
research, are managed separately by NIMHD and
NIEHS (through their P50 grants mechanism)
and by EPA (through its STAR grants program).
The centers support research efforts, mentoring,
capacity building, research translation, and
information dissemination, and are designed to
address program-specific research priorities.
The investigators of these centers have proposed
a wide array of research focus for their programs,
ranging from better incorporation of epigenetics
to modeling methods and data analytics, to
enhanced understanding of how multiple factors
interact to influence environmental health
disparities. The new centers and their specific
goals are highlighted below.71
The EPA research manager responsible for
spearheading the EPA-NIMHD partnership
emphasized that it was the collaboration
between EPA and NIMHD that made the Pilot EHD
Centers possible. Modeled after the EPA-NIEHS
Children's Research Centers, the Pilot EPA-NIMHD
centers produced research and knowledge
that is used as scientific evidence to address
environmental justice concerns. These centers
worked with local communities to empower and
engage them to become more informed about
environmental health disparities and the actions
they can take to foster healthier environments.
(D. C. Payne-Sturges, Email Communication,
August 8,2017).
The Pilot EHD Centers were also successful in
helping to empower communities to become
more involved in social justice issues and
promote healthy environments.The NIMHD
Program Director who collaborated with
the EPA to establish the Pilot EHD centers
highlighted the transdisciplinary nature of the
centers and effective use of resources. This
approach supported the centers' use of existing
infrastructure to conduct research allowing them
to understand how environmental, social, and
biological factors contribute to health disparities.
(N. Rajapakse, Email Communication, July 16,
2017).
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 81
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The NIH-EPA Centers of Excellence on
Environmental Health Disparities Research
Disparities in Exposure and Health
Effects of Multiple Environmental
Stressors Across the Life Course
(CRESSH)
Harvard T.H. Chan School of Public Health
and Boston University School of Public Health,
Francine Laden and Jon Levy, Center Directors
Researchers investigate how housing conditions
may affect birth weight, childhood growth
trajectories, and risk of death from cardiovascular
disease, and whether improved urban housing
may benefit health.
Comparing Urban and Rural Effects
of Poverty on COPD (CURE COPD)
The Johns Hopkins University, Nadia Hansel,
Center Director
Investigators compare urban and rural effects of
poverty on chronic obstructive pulmonary disease
(COPD), and the impact of improved dietary intake
on preventing or mitigating disease progression.
\
Center for Indigenous Environmental
Health Research (CIEHR)
University of Arizona, Jeffery Burgess, Center
Director
This center works with indigenous populations to
examine chemical contamination of traditional
foods, water, air, and household environments, and
increase environmental health literacy.
Center for Native American
Environmental Health Equity
Research
University of New Mexico, Johnnye Lewis,
Center Director
This research team examines how contact with
metal mixtures from abandoned mines affects
rural Native American populations through
exposures related to inadequate drinking water
infrastructure, reliance on local foods, and other
uses of local resources to maintain their traditional
lifestyle and culture.
Maternal and Developmental Risks from Environmental and Social
Stressors (MADRES Center)
University of Southern California, Frank Gilliland, Center Director
Investigators study how environmental factors may contribute to childhood obesity
and excessive weight gain during pregnancy in Hispanic and Latino communities.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
-------
The new EHD centers will add their contribution
to the scientific evidence base, informing effective
solutions to environment and health disparities
and forging stronger community partnerships.
The investigators of these centers are expected to
conclude their research and submit final technical
reports beginning in the year 2020.
Given that the causes of health disparities are
multi-factorial and hence require a coordinated
and interdisciplinary approach to eliminate them,
NIMHD currently funds several programs in this
area while continuing to lead the federal effort at
the NIH to stimulate new research.
Many of the current NIMHD funding
opportunities focus on the environment and
its impact on health disparities, for example
research focused on the etiology of health
disparities from a biological point of view in
understanding the chemical and non-chemical
stressors on epigenetics pathways. NIMHD
will continue their work to improve the health
conditions of minority Americans and other
underserved groups experiencing disparities in
health status across their lifespan, and promote
programs aimed at expanding the participation
of underrepresented minorities in all aspects of
biomedical and behavioral research.
"Optimized protection and welfare of public and environmental
health is best achieved through a holistic approach. The Pilot EPA-
NIMHD EHD Centers explored this widely under-studied paradigm.
Their enhanced support for addressing social and environmental
determinants of health promotes a model of enhanced community
engagement that is better poised for reducing disproportionate
adverse health burden, while empowering communities toward
social justice and promoting healthy environments
- Maggie Breville, Health Research Program Manager, ORD/EPA
-------
References
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The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities
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Appendix A: Pilot EPA-NIMHD
EHD Center Publications
(listed alphabetically)
Burwell-Naney, K., Zhang, H., Samantapudi, A., Jiang,
C., Dalemarre, L., Rice, L.,... Wilson, S. (2013).
Spatial disparity in the distribution of superfund
sites in South Carolina: An ecological study.
Environmental Health, 12,96. doi:10.1186/1476-
069X-12-96.
Chavez-Payan, P. (2013). Low birth weight, prenatal
smoking, pest exposure and breastfeeding modify
the effect of acculturation on Hispanic children's
asthma. The University of Texas at El Paso.
Retrieved from http://digitalcommons.utep.edu/
dissertations/AAI1551219/. Accessed September
20,2017.
Chavez-Payan, P., Grineski, S. E., Collins, T. W. (2015).
Early life and environmental risk factors modify
the effect of acculturation on Hispanic children's
asthma. Hispanic Health Care International, 13(3),
119-130. doi:10.1891/1540-4153.13.3.119.
Chen, C. K., Bruce, M., Tyler, L., Brown, C., Garrett, A.,
Goggins, S.,... Skelton, T. (2013). Analysis of an
environmental exposure health questionnaire in a
metropolitan minority population utilizing logistic
regression and Support Vector Machines. Journal
of Health Care for the Poor and Underserved, 24(1
Suppl), 153-171. doi:10.1353/hpu.2013.0046.
Choi, W. S., Nazir, N., Pacheco, C. M., Filippi, M. K.,
Pacheco, J., White Bull, J.,... Daley, C. M. (2016).
Recruitment and baseline characteristics
of American Indian tribal college students
Participating in a Tribal college tobacco and
behavioral survey. Nicotine and Tobacco Research,
18(6), 1488-1493. doi:10.1093/ntr/ntv226.
Collins,T. W., Jimenez, A. M., Grineski, S. E. (2013).
Hispanic health disparities after a flood disaster:
Results of a population-based survey of
individuals experiencing home site damage in El
Paso, Texas. Journal of Immigrant and Minority
Health, 15(2), 415-426. doi:10.1007/s10903-012-
9626-2.
Collins,T. W., Kim,Y. A., Grineski, S. E., Clark-Reyna,
S. (2014). Can economic deprivation protect
health? Paradoxical multilevel effects of poverty
on Hispanic children's wheezing. International
Journal of Environmental Research and
Public Health, 11 (8), 7856-7873. doi:10.3390/
ijerph 110807856.
Cooper, K. L., Dashner, E. J.,Tsosie, R., Cho,Y. M., Lewis,
J., Hudson, L. G. (2016). Inhibition of poly(ADP-
ribose)polymerase-1 and DNA repair by uranium.
Toxicology Applied Pharmacology, 291,13-20.
doi:10.1016/j.taap.2015.11.017.
Coughlin, S. S., Matthews-Juarez, P., Juarez, P. D.,
Melton, C. E., King, M. (2014). Opportunities to
address lung cancer disparities among African
Americans. Cancer Medicine, 3(6), 1467-1476.
doi:10.1002/cam4.348.
Dalemarre, L., Wilson, S., Campbell, D., Fraser-Rahim,
H., Williams, E. (2014). Summary on the Charleston
Pollution Prevention Partnership Environmental
Justice Conference and Summit. Environmental
Justice, 7(3), 81 -86. doi:10.1089/env.2014.0007.
Fuller, C., Carter, D., Hayat, M., Baldauf, R., Watts Hull,
R. (2017). Phenology of a vegetation barrier
and resulting impacts on near-highway particle
number and black carbon concentrations
on a school campus. International Journal of
Environmental Research and Public Health, 14(2),
160. doi:10.3390/ijerph14020160.
Grineski, S., Collins, T., Chakraborty, J., McDonald, Y.
(2013). Environmental health injustice: Exposure
to air toxics and children's respiratory hospital
admissions in El Paso,Texas.The Professional
Geographer, 65(1), 31 -46. doi:10.1080/00330124.2
011.639625.
The EPA-NIMHD Pilot Centers of Excellence on Environmental Health Disparities 89
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Grineski, S. E., Collins, T. W., Chakraborty, J. (2013).
Hispanic heterogeneity and environmental
injustice: Intra-ethnic patterns of exposure to
cancer risks from traffic-related air pollution in
Miami. Population and Environment, 35(1), 26-44.
doi:10.1007/sl 1111-012-0184-2.
Grineski, S. E., Collins, T. W., Chavez-Payan, P., Jimenez,
A. M., Clark-Reyna, S., Gaines, M., Kim, Y. A.
(2014). Social disparities in children's respiratory
health in El Paso,Texas. International Journal of
Environmental Research and Public Health, 11 (3),
2941 -2957. doi:10.3390/ijerph 110302941.
Grineski, S. E., Collins, T. W., Chavez-Payan, P., Jimenez,
A. M., Clark-Reyna, S., Gaines, M., Kim, Y. A.
(2014). Social disparities in children's respiratory
health in El Paso,Texas. International Journal of
Environmental Research and Public Health, 11 (3),
2941 -2957. doi:10.3390/ijerph 110302941.
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