Environmental Health Disparities Webinar

Uploaded by TheNIEHS on 24.10.2012

Symma Finn: Good afternoon and welcome to the Partnerships for Environmental Public Health Webinar,
entitled Environmental Health Disparities. My name is Symma Finn, and I'm a Program Administrator at
the National Institute of Environmental Health Sciences, Division of Extramural Research and
Training. I will be the Moderator for today's session, but I wanted to acknowledge the Coordinator
of the Partnerships for Environmental Public Health Program, Liam O'Fallon, for organizing this
session today. I'm very pleased to introduce our presenters for today -- Dr. Peggy Reynolds and Dr.
Thu Quach of the Cancer Prevention Institute of California, Wig Zamore of the Somerville
Transportation Equity Partnership, and Dr. Christina Fuller of Georgia State University. The first
presentation will be given by Drs. Reynolds and Quach. Dr. Reynolds is a Senior Research Scientist
at the Cancer Prevention Institute of California. Her primary research interests have focused on
social and environmental influences in the etiology of cancer. She has conducted a number of
occupational epidemiology studies, including a study of malignant melanoma among Lawrence Livermore
Laboratory employees, cancer incidents among California teachers, and cancer incidents among flight
attendants. Dr. Reynolds was a co-investigator for a multicenter study that has become one of the
most influential human health studies on the risk of lung cancer from secondhand smoke. The landmark
publications from this study have figured prominently in national and international assessments of
secondhand smoke as a cause of lung cancer in nonsmokers and have provided some of the critical
underpinnings for the dramatic changes in public policy over the last decade regarding regulating
smoking in the workplace. She's one of the founding members of the California Teachers Study, a
large, ongoing prospective study of 133,479 women, established in 1995. Within this cohort study
she's examining air pollution, secondhand smoke, and persistent organic pollutants in relation to
cancer risk. Dr. Quach's primary research interest has focused on immigrant populations and the
environmental, occupational and sociocultural factors that may influence their health. She has
conducted a number of studies focusing on occupational exposure, health and safety in nail salon
workers, many of whom are Vietnamese immigrants. Her research in this area has influenced local,
state and national policies and has helped to promote workplace change. In addition to her role as
Research Scientist at the Cancer Prevention Institute of California, Dr. Quach is the Research
Director of Asian Health Services, a community health center in Oakland, California's Chinatown,
serving low income patients, many whom are Asian immigrants and Pacific Islanders. She has a strong
commitment to community-based participatory research and has worked with different advocacy,
environmental, and community-based organizations to leverage public health goals that promote the
health and wellbeing of underserved populations. Dr. Reynolds and Quach?
Peggy Reynolds: Well, thank you for
the opportunity to talk about our work on this morning's webinar. I will start out by giving a very
brief project overview, then turn it over to Thu to give a little more detail about that, some
information about results of this project, and a word or two about conclusions and next steps.
Starting with project overview, this was designed as a community-based participatory research
project with the objective to identify and characterize neighborhood level environmental hazards and
health barriers for Vietnamese population in California. I should say that this was funded as one of
the Challenge Grants from NIEHS to address the challenge area of health disparities and in response
to the challenge topic, building trust between researchers through capacity building and
environmental public health. As such, our primary purpose was to develop strong partnerships between
researchers and community members to promote environmental public health. So, as I mentioned, the
target population was Vietnamese Americans with a special emphasis on hair and nail salon workers
because this really was designed to build upon ongoing work around promoting worker health and
safety in the nail and hair care sector. We targeted four areas of California, bringing up the map
now, these were areas with high density of Vietnamese populations. If you're familiar with
California you may know about Little Saigon in Orange County and the very high density in these
populations in Santa Clara and Alameda County. What may seem unusual to you is the inclusion of
Marin County, not necessarily known for environmental health disparities, but as we learned in the
process of working with our community partners, it's actually an area of there's an area of
Marin County that is very densely populated by immigrant populations and where there are a number of
environmental justice issues at play. So the partnership really came under the umbrella of our
ongoing work as part of the healthy nail salon collaborative and a close partnership between CPIC
and Asian Health Services in Oakland. Asian Health Services actually integrates and incorporated
participation from several [CDOs] in California representing each of the four geographic areas of
interest which, in turn, recruited community members to participate in this project. And so the
project was designed to be somewhat iterative, certainly circular. We began with the community with
focus groups to identify specific concerns, moved that on into the community audit, which we'll
discuss with you in a little more detail. We trained community members. Together we selected audit
areas, conducted the survey. And then we conducted a series of debriefings, along with our partners,
the community auditors, who then joined us to circle back to the general community to present
community forums in each of the four areas of study. As part of Phase I, we conducted 16 focus
groups with Vietnamese community members. We conducted them in each of the four regions of interest
and different age groups. We wanted to get input and insights from youth, from the elderly, and in
general from adults in the community. There were a total of 94 participants across those groups. As
part of the focus group process, we used topic guides to elicit information about community
perceived economic, environmental, social and built environmental stressors, as well as health
access barriers, and to really get a flavor of what the participants thought about environmental
concerns and health. Phase two, and the primary activity for this project, was the community audit.
We ended up training 66 community members to conduct surveys of the neighborhoods where they live,
work, and play. The objectives really were to characterize differences in those neighborhoods and a
host of factors economic, environmental, social, and built environmental stressors and
also to raise the consciousness of participants through the process where they collected data about
their own neighborhoods. As part of that process we identified both work and home areas and areas,
some additional areas that community members identified as being particularly important for their
own communities, and then we selected audit segments based on one of those areas and trying to get a
balance between residential and business areas and just to give you an idea here is an audit map of
selecting the street segments for one of the audit groups in Marin County. And so, with that, I
think I will turn this over to Thu to give you a little more detail about the nature of the
community audit and on some, a few snippets of results. For those of you on the webinar, Thu
actually is pictured here, as the left-hand partner and setting up a community audit survey, so,
Thu Quach: Thanks, Peggy. So, again, I just want to go over what a community audit is and here
we have just pictures of some of our staff, posing in very fashionable orange vests there, that we
also have the community auditors wear for their own safety. But we usually encourage folks to go in
pairs or in groups of three, and what we would ask during for them to do during the audit was
really to do this Photovoice process, where they actually took pictures in the segments where they
were assigned of things that they thought were important or negative. So the first person on the
left would write down, log down what they took and why they thought it was important, whether it was
a positive or a negative. The person in the middle is holding a camera where she or he would take a
picture of something and then also press the GPS button so that we know where the pictures were
taken. And then the third person is actually completing the community audit survey, which we'll go
over in a little bit, and also carrying a black carbon monitor right I think she's carrying it
by the little bag, the blue bag that you see, and that's a really small, real-time sensor that
allows us to detect some of the black carbon. So why black carbon? Black carbon comes from the
burning of fossil fuels, biofuels and biomass. It's caused some health concerns because it's a
really it's a [soot] particulate, but it's really small and can deposit in the lungs, and it's
often an indicator of exposures to diesel exhaust, which has been classified as a toxic air
contaminant, as well as a probable human carcinogen. In California we have I think three stationery
monitors only, that's really doing all this real-time collection, so there's not a lot in terms of
data collected around black carbon even though it's been an emerging concern. In terms of our
community audit survey we actually based it upon an existing audit survey developed for the aging
population from the St. Louis University School of Public Health, but we made some modifications
based on what our findings were from our focus group. Here you see some pictures of the community
audit. We took information around whether it was a residence, what kind of residential areas and
buildings were there. We also took -- we also had them write down food destinations, retail places,
like gas stations, auto repair shops, nail salons, drycleaners, and also recreational facilities.
And then here are some of the audit survey items that came from our focus group. Really there were
some concerns around idling trucks or buses, which really contribute to black carbon levels, so we
had them note that. One of the things that came from the focus group was around neighborhood safety,
and so we had them document things around graffiti, broken cars and glasses, metal bars on windows
of storefronts were really important. And also another thing that came out in some of the regions
was around secondhand smoking, and the high smoking rates in the Vietnamese population. So what we
tried to do is capture things around cigarette and tobacco advertisements, as well as cigarette
butts on the ground. The other thing was around litter, and so a lot of the community members talked
about littering. And so we had them kind of take pictures, as well as document litter that they saw
in the yards, as well as in the street. So what we asked auditors to do during the process? Here is
an example of what a street segment may look like, and you often would have two, possibly three
auditors carrying their survey, as well as a camera. And what we asked them to do is walk down the
street and cross over and just circle back to where they started, really giving them the time to
really observe their surroundings, really take note of things and take pictures before they started
completing their audit survey. And then when they're done with that, we had them walk the middle of
the segment and actually conduct a five-minute car and truck count, so they would count the number
of cars and trucks that pass by in five minutes on one side of the street. Here is a breakdown of
our community auditors by the four regions that we focus on, as well as the number of audit segments
that they conducted and then also the break-down of men and women in our community auditors. We see
a lot more women participating in this. Some brief results for us -- again, the issue around metal
bars on storefronts to indicate some issues around neighborhood safety. Here are some pictures taken
in various areas, including in Oakland. And here is a graph, these are -- we intentionally showed
you the same graph that we presented back at the community forum to get a flavor of what we were
presenting back to the community. You really see here that over 50% of the street segments that were
done in Alameda actually had metal bars on their stores, much less than in the other regions.
Graffiti was another issue, and you see some pictures here taken by our auditors. Here you have the
breakdown of the four counties, again. And you see it's a little higher in Orange County in Santa
Clara and closely in Alameda, and less so in the Marin County area. Cigarette butts, again, showing
some of the concerns over secondhand smoking. Here are some pictures there. And then you see sort of
some of the cigarette butts, and they're somewhat comparable across the four counties, led mostly by
Alameda. Pictures of litter on the streets, some very interesting pictures taken by our auditors, we
had a whole array of pictures that we took of all kinds of litter that they saw in the neighborhoods
where they audited. And you really see, again, that there, you know, in Alameda there's about 70% of
the street segments that they did that actually had litter in it and then closely followed by Orange
County and Santa Clara. I should say that in no way are we suggesting that the neighborhood segments
are representative of the entire county. Again, these segments were selected based on the addresses
of where our auditors live, work, or what they noted were important in their community because we
really wanted them to conduct an audit that they were familiar with and neighborhoods where they
were familiar with. Tobacco ads, this is a picture taken by one of our auditors around some of the
storefronts, with a lot of tobacco ads on it. There wasn't a huge amount, you know, here you see a
scale of zero to 10%, but in Orange County we saw a lot more than in other areas. I should say that
in our focus groups the overriding theme that came out, particularly among our young adults, was
around smoking that's being taken up by some of the young Vietnamese and so it's interesting that we
saw this. Here are the box plots of 5-min car counts and you can see that overall on average they're
about the same number of car counts that we were seeing except in some areas, like in Orange County,
you see as much as 150 over a five-minute count. So on average are the same, but in some regions
there is a lot more traffic. Five-minute truck counts, again, they're similar except Orange County
really does stand out in this one more so than some of the others. Here is a picture of the black
carbon concentrations that were taken, and on average the different counties, the neighborhoods in
each of those counties were similar, not -- but they are usually around 1.0 micrograms per cubic
meter. Interesting enough, we actually show you the state-wide measurements. Again, those are based
on the three stationery monitors that California has for weekdays, and it is below one, suggesting
that when you do these community collected audits, where you're walking, it may have different
numbers than what you would see if you're using some of the existing data collected by the
government. And this really came out as a big theme for us, you know, that as researchers if we came
in relying on those stationery monitors we often may be underestimating the exposures. Another table
showing the four counties, and in parenthesis next to the counties you see the county median levels.
Again, they were close to one, however, when we started zooming into certain neighborhoods you will
see that certain neighborhoods actually had peak concentrations that were 10 times, often even more
than what we were reading from the county really, again, underscoring this issue around variation in
terms of black carbon exposure. And we definitely don't want to forget the positives that were
really noted by our auditors. Here you have some pictures taken in Marin about showing the diversity
in the neighborhood, faith communities, water, this is like open where people often like to exercise
around [inaudible] and a lot of greeneries in there, a library, taken by one of our auditors,
Kaiser, a healthcare place for them. And trashcans really suggest the sort of promotion of not
littering. And Laney College, which is one of the community colleges there. Our auditors'
experience, which was really key for us in all of this, was they really expressed that they were
proud to be a part of the project and to have contributed to research that benefits the community.
They really -- they told us they had a lot of fun doing it, going out there and exercising while
they're taking note of their neighborhoods, but it really provided them with an opportunity to meet
new people and to make friends, really the social network type of theme. After the project, auditors
thought that they were more aware of their environment, you know, and this really came out in the
focus groups when we first started asking them questions around environmental health and there were
a lot of the participants were saying, well, we really don't think about it that much. But as the
themes started coming out around traffic and trash and pollution the question was really raised, and
they started asking a lot more questions, both in terms of the focus group, as well as the community
audit process. And the auditors who were recent immigrants who participated really enjoyed this
because they felt like they could meet new people and get to know their community. Many of them said
they would love to participate again. One thing we were really happy about was they felt this
ownership of the data and the project. Oftentimes we will look at the data from each of the regions
and realize, oh, well, maybe we should collect more data because this one seems a little bit high
and we just want to make sure about it. And when we brought this up to the community based agencies
and the auditors themselves they would often volunteer to do this, really indicating this
ownership and wanting to have really good data to present back to the community. When it came to
presenting at the community forums many of them volunteered to co-present with our team, as well as
with the community organizations. And a number of them have asked, well, what's next? You know,
we've started doing this, we want to do more, so we're in discussions about future projects that
have community engagement in it. Conclusions, really around this issue of community collected data,
highlighting neighborhood level aesthetics, neighborhood safety, litter, traffic, sidewalk
conditions and air quality as major community concerns. The community auditors really helped to
identify contributing factors to environmental hazards. During the debriefing sessions we would show
them, oh, well, here's a neighborhood where we really saw some high concentrations of black carbon,
and they would tell us, well, that's interesting because that's where a lot of the school buses come
or that's where we have a lot of idling trucks. The same thing around graffiti, like, well, what
would be reasons why there would be graffiti? They really offered these explanations around, you
know, feelings around gangs and, or feelings around youth really feeling displaced and wanting to
have a place of belonging. So we really looked to them to explain a lot of the data that we saw. We
saw differences between community collected snapshot data and government monitoring data and which
can help us -- which can help inform us on future research that we do, and it really provides the
community with data that can be used to address local environmental concerns. There's already been
discussions about bringing it to their local council to address things like sidewalk conditions and
all that. So, you know, we really are encouraging them to use this data. And it really helps to
build positive relationships with the project participants, as well as our community partners. Next
steps, we actually have been really busy. We've actually submitted several papers, one led by our
community partner around community engagement process. And we'll continue to work on a few others.
We also are finalizing our fact sheets that we're going to be giving to our community agencies.
We'll pass it around to the community so that we really are honoring this idea that whatever we find
we really report back to the community. And we're in discussions for applying for future grants that
utilize a similar method of community engagement and focusing on environmental public health
actions. And in the last minute I really do want to give a shout out to our different community
based organizations that were a part of this project, that they really were at the helm of this in
engaging the community. I think some of them are on the call, and again I just want to acknowledge
them for all their hard work put forth and continued partnership in all of this.
Symma Finn: Well, thank you, Dr. Reynolds and Dr. Quach.
The first question that we did receive asks what is the
environmental health disparity? How did your research study address environmental health disparity
in the communities you studied?
Thu Quach: You know, that's an interesting question. I think that
when we started engaging in this it really was this issue, particularly with the Asian American,
Pacific Islander community in terms of often we go out to address these huge environmental
disparities that it seems like, oh, it's very obvious that there is something. But what's come up
is, well, what happens when we're not sure? No one is really out there monitoring if there are
disparities, and this project really gets that fact. We were looking into some of the enclave areas
where the Vietnamese populations live, and we wanted them to be able to collect the data and
identify if there are disparities. And in the results that we saw we saw that there definitely are
some differences in the black carbon levels for certain neighborhoods. We're looking more and more
into that, but we definitely found some differences, depending on certain neighborhoods in terms of
air quality.
Symma Finn: Thank you so much for that answer. We do have another question -- how can
you compare communities when areas surveyed were not representative? Were there other more rigorous
comparisons that you can make?
Peggy Reynolds: You know, I will just start that off and then hand it
over to Thu. I think keeping in mind that the objective of this project really was to engage
partnerships with Vietnamese communities to better characterize the neighborhoods in which these
people lived and worked, that clearly, for instance, in the Marin Vietnamese community, which has
lots of new immigrant groups, including a very large Latino population, the characteristics of those
neighborhoods are not representative of the characteristics of neighborhoods in Marin County in
general. So we were really trying to start from a grassroots, ground up level in terms of people
characterizing their own neighborhoods. So, yes, it may not be representative of all of the
neighborhoods of Vietnamese communities in California or all, certainly not of all communities in
California, but this is part of some ongoing grassroots work that we have been doing with this
population. You want to add anything?
Thu Quach: Yes, and I think here you really have to build up,
you know, to ask a question of whether it's representative or not? I think we really wanted to
engage some communities to start exploring what environmental concerns they had and to really give
them some of the tools to begin to collect their own data. This really gave us the opportunity to
develop a tool that they can use again and again, along with some of the black carbon monitors. So
we're not looking to be representative, we're looking into engaging the community to address some of
the concerns that they may have.
Peggy Reynolds: I might just add, again, that on the disparities
issue, one of the issues that our group has been very engaged in studying are -- is the
heterogeneity of Asian groups, and we have many in California, and so that there are a number of
disparities that are really unrecognized because Asians tend to be lumped into a single category and
then we don't really pay attention to some of the individual subgroup issues. And so this was an
attempt to work with one particular Asian ethnicity that actually does have a number of certainly
occupational risks in terms of some of the predominant occupations, but also some adverse
neighborhood exposures, as well.
Symma Finn: Well, okay. Well, thank you. We have several additional
questions. We'll ask one more now and we'll save the other question for the end of the session. So
our next question is did the community members collect GPS, GIS data on where the measurements were
taken and could they be put into a map, so that they could be put into a map?
Thu Quach: Yes, we had
all that information, and they have been put in a map. Actually, when we went back and presented it
we presented it in a map form for them so they can really see where they went and pictures that went
along with it, pictures that they took, as well, aerial pictures of the neighborhood.
Peggy Reynolds: And part of that objective of that mapping
really was from the epidemiologic perspective,
then compare some of the observations from these audit surveys to other data that are available, for
instance, traffic density data that's available for some of these street segments.
Symma Finn: Well, thank you so much, Dr. Reynolds and Dr. Quach
for the interesting presentation and for the answers.
We will revisit the last question we had received, again, later in the session. But at this time I'd
like to introduce the speakers for our second presentation -- Mr. Wig Zamore and Dr. Christina
Fuller. Mr. Zamore has a master's in real estate development from the Massachusetts Institute of
Technology's Department of Urban Studies and Planning. He focuses on the continuum of issues that
revolve around urban economic development, regional transportation, environmental quality and local
public health, in short, sustainable development. In Somerville, Massachusetts he has been an
advocate for dense transit oriented development and a leader in successful campaigns for a new
subway stop and two new light rail branches. In 2007 and 2008 after reviewing excess heart attack
and lung cancer mortality patterns in Massachusetts
Mr. Zamore initiated and helped manage pilot-scale
near-highway pollution studies with Environmental Health and Engineering, and with Aerodyne
Research Incorporated. About the same time, he and other members of the Somerville Transportation
Equity Partnership approached Doug Brugge of Tufts Medical School seeking collaborative community
based research opportunities. Mr. Zamore has helped design and steer the Tufts-based Community
Assessment of Freeway Exposure and Health, the CAFEH Study. Dr. Fuller is a Postdoctoral Research
Associate in the Institute of Public Health at Georgia State University. Her research interests
include characterization of pollution exposure, environmental epidemiology, environmental justice,
and community engaged research. Her current research is in the area of traffic related air
pollution, specifically ultrafine particles and its effect on biomarkers of cardiovascular disease.
Dr. Fuller has worked as an Environmental Engineer in Chicago and as an advocate for environmental
justice in New York City. She earned her bachelor's degree in environmental engineering from the
Northwestern University and master's and doctoral degrees in environmental health from the Harvard
School of Public Health. Mr. Zamore and Dr. Fuller?
Wig Zamore: This is Wig Zamore, and I'm going to
give the first half of this presentation and then hand it off to Christina for the second half. I'm
happy to be included today. I think I'm the civilian representative. So our project is called CAFEH,
Community Assessment of Freeway Exposures and Health, and it's organized around Interstate 93 and
investigates highway pollution gradients and neighborhood cardiovascular health at various distances
from the highway. The second slide shows Interstate 93 going through Somerville, with Boston in the
background, and our largest public housing project on the right. Our funders are lower left. We
greatly appreciate the support of NIEHS. And on the right are partners in the project, with a few of
the field team members in the center bottom. Next, I thought I would show you the different field
years. We had three field years in this five-year project, of which we have about a half year left
to do a final analyses. So lower left you can see Somerville, which is my community, and Interstate
93 and the various distances of study, of participants. Lower right are second year in Dorchester
and South Boston. Top right Chinatown and downtown Boston. And top left Malden, which we used as a
background population for the Chinatown year of study. This is the only -- these slides here are
just a reminder that air pollution affects more than just air and more than just people. And now a
little bit on the study design. On the left lower we have a very well-equipped mobile laboratory,
with both particle and gas instruments, and we'll be creating an ultrafine particle model that will
give values per hour for every participant for each field year and then a detailed prime activity
analysis that came out of surveys. We have lead biomarkers from clinics, including C-reactive
protein, and it will all be put through a structural equation model in the hopes that we can get a
lot more significance than would come out of a simple proximity analysis. To go through how the
community came up with this project, because it originated in Somerville and then extended to Tufts,
and Tufts' longstanding other community partners. We focused, first, actually on economic
development in a community that's mostly residential and lacks jobs and tax base. That led us to
focus on regional transportation capacity and supply and that, in turn, led us to look at air
quality and public health as levers in the public debates. So here's Somerville, top left in gray,
only four square miles. We pretty much had no clean light rail or subway transportation, but through
advocacy of the last decade we have gotten the State to commit to a billion dollars of new subway
and light rail transit. The orange T-stop is in Assembly Square, which is an area we focus on for
economic development. The two green lines are the first new light rail projects in Massachusetts in
a generation, and the subway stop is also the first in a generation. I'm going to talk a little bit
more about the economic development, but that's it for the transportation. So this area, Assembly
Square, was largely industrial, had a big Ford plant and largely underutilized. And the bottom, I've
tipped the orientation 90 degrees to show on the left the original developer's preference, which was
largely for waterfront parking lots and big box stores, and on the right the community preference
for dense mixed use, mixed income housing and a lot of job diversity, as well. And we had quite a
battle, but ended up with a nice settlement about six years ago, that involved taking 50,000
vehicles per day out of what was projected to be 100,000 vehicles per day to and from this area. Had
a large cash commitment from the developers to transit. And, also, at the community's desire ended
up with dense mixed use plan for 10 million square feet, a little bit upside down from traditional
NIMBY. And this is the picture of three urban multistory mixed use blocks underway this year and
also the T-stop, which is underway. All of those will be open in two years. Now to go to the
environmental health and air quality, we started to realize that we had a real issue, that it wasn't
just a political lever. And so we started to look at the literature and also to do some pilot
studies of our own. And to go quickly, of course, Yifang Zhu's seminal 2002 work showing that
primary pollution gradients from highways did not really relate to PM 2.5 and regional standards.
A nice paper by Gail Hagler out of EPA's Mobile Labs Group, showing zero correlation between PM
2.5, PM 10, and ultrafine particles, meaning to us that there was no protection afforded by those
max standards. And then the first ultrafine model world, we're aware of which is in Stockholm, done by
Gidhagan. And to move on to some of the seminal health studies, we again looked at Stockholm and the
Nyberg lung cancer study, which showed that all the statistical significance from air pollution in
Stockholm connected with lung cancer was coming from mobile sources and it was all coming from the
top 10% of exposure, it wasn't coming from an inter-quartile range. A similar study in Oslo, which
I'm not showing. Then Mike Jarrett's nice study of Toronto, where proximity alone was not
statistically significant but he got a pretty good association of cardiovascular mortality, and NO2
as a mobile marker, and again a much higher relative risk for people closest to the pollution
sources. And then finally a great series of studies in Vancouver by Gan and Brauer, where they
found a 450,000 population, a very high cardiovascular mortality among the people who lived within
50 meters of the highway, somewhat less for a study of multi-pollutant ranges within the City, that
multi-pollutant study had black carbon and nitrogen oxides completely eliminating PM 2.5 association
with mortality within the City. Just to stay on housing for a second, these are pictures on the left
of Eastern Massachusetts major affordable housing projects and on the right of highway pollution
hazards marked by 50 or 100,000 vehicles per day. What you see is that the maps are identical. Our
affordable housing is pretty much going in the highest hazard locations, at least in Eastern
Massachusetts from an air pollution point of view. C-reactive active proteins, an important marker
for us. It's a little study by Hertel and Barbara Hoffman in Germany, showing sub chronic 21, 28
days and a little bit less statistical significance for ultrafine particle number count and CRP but
not a statistical association with PM 2.5 or PM 10 in that study. Similar, but more complex study
from Ralph Delfino with senior citizens in California, again, showing a CRP connected with mobile
markers, although more black carbon in this case and primary organic carbon from mobile sources.
Longer term study from Stockholm by Panasevich, pretty good statistical significance with IL-6, as
well as CRP. And then Paul Ridker is one of our team members, but I'm not going to go into this
slide. This is what I kind of use as my back of the envelope for health effects for people living
very close to highways, basically, 50% to 100% higher cardiovascular, heart attack, and lung cancer
mortality, as well as childhood asthma. To move a little bit to a description of the community,
these are the cities that surround -- Boston, Somerville is the densest city in the State, Chelsea
also has a lot of immigrants, and is second densest. I often use these two together in presenting to
people because of the pollution and socioeconomic issues. They're quite similar, one and two, in
density of immigrants, population, multifamily housing, a lot of need for State support per year
because of shortage of jobs. Transit is largely buses and very high mobile pollution. The main
difference being that Somerville also has a great density of college grads at this point who can
contribute some mental energy to some of these issues. As I said, a lot of mobile pollution, and
when you have a lot of mobile pollution and a dense population you tend to get fairly high health
effects on a per square mile basis. So this is a five-year compilation of heart attack and lung
cancer from Massachusetts public data, showing the greatest density of excess deaths in Somerville
and Chelsea. It's not epidemiology, obviously, but it corresponds with the literature and this was
one of the things that spurred us on a little bit. And then just a sample of some of the really good
socioeconomic and segregation work that's been done from a large study by Rachel Morello-Frosch at
Berkeley, looking at all the Census [facts] and air toxics, including diesel. Some of our pilot
studies, we did two pretty, pretty important studies to us. One was the Environmental Health and
Engineering that had some good outcomes from time integrated NO2 as a mobile marker, and then on the
right we were fortunate enough to use Aerodyne Research and their really fabulous equipment set to
look at a typical winter morning rush hour in Somerville. Some of the results, this is from the NO2
study, showing much higher concentrations in mobile pollutants near the highway, as would be
expected. And here's a -- just a graph off the highway center on the left, showing how steep that
time integrated NO2 signal is. And then here a nice paper we got from the Aerodyne work in
Atmospheric Chemistry and Physics, on the right showing especially early morning, very steep
gradients of ultrafine nitrogen oxides and other primary mobile pollutants. So we took these to
Tufts and got together with their community based participatory research group, run by Doug
Brugge. This is a picture of the CAFEH mobile lab and two of the grad students that have worked on
it. On the left is Allison Patton, who has got the arduous task of creating the ultrafine particle
model and that's pretty, pretty well underway. Here is one year of results from 55 representative
days of monitoring. In the center of each of these panels is Interstate 93, and you can see the
gradients in either direction for the full year, top left, by season top right, the colder weather
has stronger primary pollution gradients. On the bottom left is day of week. Sunday we don't have a
lot of sampling. And then bottom right is different times of day. And what you see especially is a
pretty steep drop-off on the right-hand side, which is downwind, left-hand side is more center city
in Somerville. Where we're going from here kind of under the CAFEH umbrella, we have two sibling
studies. We have a sub study that's part of a large Puerto Rican health study, and the sub study is
looking at mobile pollution and cardiovascular outcomes. On the right we have a HUD funded pilot
study of HEPA filter intervention in Mystic Housing residence. It's right next to Interstate 93,
to see if we can lower indoor pollution and cardiovascular inflammatory biomarkers. And then, of
course, on the bottom what remains the hard analytic work from CAFEH, and I think that Christina is
going to talk a little bit about that, namely integrating the ultrafine particle model, the time
activity, and the structural equation model. And, just to show you, we have very detailed time
activities for all of our participants. The red being residential, in the top superfluous fulltime
students for workers, the bottom is more retirees, and also time on highway and that kind of thing.
And two concluding slides. From the community point of view the quandary is that we think the
science is already there, that there's very high relative risk of mortality and morbidity for people
who live and spend a lot of time next to highways, but in the absence of some federal authority
declaring this to be a hazard and getting that message out to both the public and policymakers, it's
going to be very hard outside of some places, like California, with their own science and policy to
really start to design healthy cities. And we all know that cities are among the healthiest places
on earth, but we really should be designing them in ways that will be healthy for a much longer
time. Our infrastructure and our buildings last a long time, and we really can't afford to throw
another generation in the dumpster on these issues. So I'll stop there. Thank you very much.
Symma Finn: Thank you, Dr. -- Mr. Zamore. Dr. Fuller?
Christina Fuller: Thank you, Wig, for starting off
our presentation. I just wanted to highlight more about CAFEH, that being a five-year
cross-sectional study of ultrafine particles near highways and markers of information on blood
pressure, which is cardiovascular health. And Wig and I will both be happy to answer any additional
questions about how the study was structured and how we were able to make it a community based
project at the end, but actually right now I'm going to discuss more about the preliminary results
that we've had. So there are three areas included in the CAFEH study, as Wig mentioned --
Somerville, South Boston, and Dorchester, and Chinatown and Malden. And here are more detailed maps
of the study areas, to which I will be referring in this presentation -- Somerville and South
Boston/Dorchester. If you recall, the final analyses will use modeled hourly ultrafine particle
concentrations as a measure of exposure and a structural equation model of health effects. But
leading up to the full analysis we have examined health effects in our population with exposure
measured in ways commonly used in literature. By this I would mean using central site data to look
at acute exposure and proximity data to look at chronic exposures. And by doing these preliminary
analyses we can elucidate the factors important to consider in our SEM and also to have points of
comparison for the full model. From the Somerville sample of 142 people we looked at acute to sub
acute affects associated with exposure to ultrafine particle concentrations that were measured at a
distant site and located in Boston, about seven kilometers from our study area, which is an exposure
that has been used in past epidemiological studies. And what this shows, on the left-hand side, are
some characteristics of the Somerville population. And on the right-hand side are box plots
showing our exposure measurements, lags of zero, one, and two days, and moving averages of three up
to 28 days. On the Y axis are the percent increases in both [IL-6 and C-reactive protein. And there
are estimates of the affects are for 5,000 particles per cubic centimeter increase in ultrafine
particles, and what you can see is that for IL-6 there's a 50% increase in IL-6 for a three-day moving
average, up to the highest effect estimate which is 91% increase for a 28-day moving average.
C-reactive protein was similar, with the highest effect estimates being a 74% increase for a 28-day
moving average. And although our assessed estimates are larger than previous studies, possibly due
to the imprecision of our measurements, as you can see by the wide confidenc intervals, which is
not surprising based on the modest sample size. We're just using our Somerville population. In CAFEH
we have a rich dataset of personal characteristics, and although it is difficult to see differences
in this modest sample size there are some factors that warrant further exploration in the full SEM
model. There is suggestion that diabetes increases the effect of ultrafine particles on IL-6, as you
can see from the box plot to the left, and also BMI greater than 30 may increase effect estimates of
exposure to CRP and possibly dampen response in IL-6. As we look at longer time periods of exposure,
our longest being 28 days, we become more interested in factors that may change chronic exposure, so
28 days is pretty much a sub acute near chronic exposure. And one chronic exposure factor that we're
interested in is the roadway. So see the highlights annual household income and education, which may
be expected to result in health disparities and has done so in past studies. And so what I
highlighted here are household incomes broken down by this is a highway less than 100 meters, 100 to
400 meters, and greater than 1,000 meters. And our background area, which is greater than 1,000
meters, the populations that have an income less than $16,499 is only 2% of that population,
however, in our 100 to 400 meter group it's 38%, and then 100 meters is actually 15%. When we looked
down at 100,000, you see that there's higher income people in our urban background neighborhood and
fewer percentages at that income level in the nearer to highway locations. Our subsequent analysis
of chronic exposures included both Somerville and Dorchester/South Boston neighborhoods. The
distance for this analysis was broken down into five distance bins, as you can see in the upper
left-hand corner. And this biograph shows CRP and IL-6 levels by distance to highway. All distance
groups had an average CRP exceeding three milligrams per liter, which would be categorized as an
elevated risk, and CRP was highest in the 150 to 250 meter group, followed by the zero to 50, and
250 to 450 meter group. Of particular note is how similar the CRP and IL-6 values are between the 50
and 150 meter group and the urban background. And some of the demographic and health measure
variables were actually similar between those two groups. But what we were really interested in is
how much CRP levels in the exposed distance groups, which we defined as 100 to 400 meters, how they
differ from the urban background. And when we analyzed the data by restricting it to each study area
we discovered that there are some differences. What this map is showing is the percent difference in
CRP levels between each of the exposed distance groups compared to their urban background. And those
percent differences are represented by the color scheme, with light being less than urban
backgrounds, and lightest blue being zero to 50% difference, and up from there. So what we see in
Somerville is that all the distance groups have a percent CRP difference greater than their urban
backgrounds, with the highest difference being between the urban backgrounds and the zero to 50 and
150 to 250 meter groups. But when we look at Dorchester/South Boston we see a very different
picture, where only the zero to 50 and 150 meter groups have a CRP percent difference above the
urban backgrounds, it's a much flatter slope. When we look at IL-6 we see, again, that there's a
difference in the patterns compared to the urban background by study area. For Somerville IL-6 of all
distance categories have positive associations with the two furthest exposed groups contain a
significant percent difference. When we examine the Dorchester/South Boston map we see that the
percent difference is pretty flat across the exposed distance groups but the zero to 50 meter group
contained the largest percent difference compared to the urban background. So we have hypothesized
some potential reasons for these disparate findings between these two study areas. And one of them
is that the urban background comparison group in Dorchester and South Boston has other participants
that live adjacent to Dorchester Avenue, which you can see in the figure to the right, going north
and south, and that is a significant source of ultrafine particles. However, when you look in
Somerville there's a road called Broadway, and there are no study participants that live very close
to that highway. This shows, again, disparities in the chronic effects. So pretty much you look at
the combined associations for IL-6 at the bottom, and CRP at the top, and you can see associations
with distance to the highway compared to the urban background. When you break them out into
Somerville versus South Boston/Dorchester you see that the associations are different depending on
the study area and also depending on other factors, such as the city, how we recruited our sample,
random and convenience, and being on one or the other side of the highway, but those are not quite
as clear. So, in summary, with our key analysis we do see an increasing trend in affects for IL-6 and
CRP, with increasing ultrafine particle concentrations, and that diabetes and BMI may play a factor.
We also see chronic associations, as well, but there is a lot of variation depending on things like
personal characteristics, like BMI, or exposure characteristics, such as time activity. Now I'm
going to turn more to talk about how variability in exposure due to ambient or indoor concentrations
for time activity can change the associations that we find. So if we examine this more, we looked at
data from Somerville and collected particle number concentrations [as our proxy] for ultrafine
particles. So we had instruments monitoring at six sites, they are represented here by BBB, which is
one site, MAC, Mystic Activity Center, is another site, both in the study area. And then a central
distance site, SPH, that's School of Public Health that was in Boston. We did long-term monitoring
there for a year, and then at a selection of 18 homes within Somerville we collected one to two
weeks of monitoring there. So this table shows four models of outdoor residential ultrafine
particles. For the first two lines you see the asterisk represents a percent of increase in
residential outdoor ultrafine particles for a 10% increase in the fixed site ultrafine particles.
Here, this first line, the School of Public Health, that's the distance site & the second line, the
Mystic Activity Center, is the near highway site. So what is shown is that more ultrafine particle
variation at homes in the study area were explained by variation at the near highway sites as
opposed to the central site. And one of the take home points is that near highway populations may be
a vulnerable population. Using only central site data or proximity may not sufficiently capture
these exposure variations for people who live close to highways. In addition, people spend the
majority of their time indoors and it's important to evaluate the representativeness of ambient
concentrations when people spend most of their time indoors. So using our monitored data we looked
at this, as well. And what this shows in a nutshell is that there's evidence that highway ultrafine
particle easily migrates indoors because overall indoor/outdoor ratios were close to one, although
there was significant variation throughout the day and between homes. This is representative of
during warm periods in this community, so that's the only time where we took these measurements. So
next there are several factors that impact the indoor ultrafine particle concentrations, and those
include the outdoor concentrations were the largest predictor of what's indoors, but also other
factors, such air-conditioning, time of day, and meteorology. And what I have here is a time series
plot of data from two houses -- the one on top, which did not have central air-conditioning, and the
one bottom that used central air-conditioning just to illustrate how air-conditioning can modify
infiltration of ambient particles indoors. And to revisit the CAFEH diagram, which we've shown at
the very beginning, of the plan for spacial temporal modeling of ultrafine particle concentrations,
to look at our health effects, we see that each neighborhood is different in population and also in
pollution landscape, which can lead to differences in health effects. And some do not exactly fit
what we may expect to find in terms of demographic information or near highway concentrations.
Central site monitors may not adequately capture exposures present near highways for pollutants with
large [inaudible] variations, which may lead to exposure misclassification. And, therefore, we
conclude that detailed exposure data and knowledge of population characteristics are really
necessary for us to understand fully associations between ultrafine particles and cardiovascular
health and will also give us the ability to highlight some of the underlying health disparities in a
diverse data set. So that's the last slide, and we'd like to, again, acknowledge our funders and
also the CAFEH partners and community participants.
Symma Finn: Thank you so much, Dr. Reynolds. We
do have a question already -- has there been any attempt to use buffer zones or anti-idling
ordinances for trucks in order to improve the air quality in the area?
Wig Zamore: Yes, there is an
anti-idling law in Massachusetts. It's not always upheld, but there have been some interesting
forays by students, junior high school students, high school students, giving out tickets and
bringing awareness to the issue. There's also another group in Boston, which focuses on diesel
pollution, and they've got quite a good campaign going in the City of Boston with regard to
construction equipment, which is another large urban source.
Symma Finn: Thank you. We also have a
question for the first two speakers, Peggy and Thu, that we weren't able to ask earlier -- what
policy change or change in public health do you expect to achieve from the program, what did the
communities request in terms of changing the environmental health of their neighborhoods?
Thu Quach: This is Thu. I first want to say that a lot of the work
that we were doing was very developmental,
that we were just starting off in this. However, when we presented at the different community forums
the community had organized to bring out some of the politicians to show some of this. One of the
issues that Peggy highlighted was what we found in Marin County, was that a lot of the Vietnamese
living there actually lived in an area called, what they call the canal area, and there is a lot of
Vietnamese and Latino population there. And they really brought up issues around air quality, as
well as some of the racial tension. And during the presentation of some of this they had voiced some
of their concerns to some of the policy decision makers at the community forum, so this is just the
beginning of the community getting engaged in issues around environmental health. And so we are
still in discussions around what we want to do next with it.
Peggy Reynolds: I would just add that
it's also very relevant to the very impressive and extensive work that you'd seen in the second
presentation because one of the major concerns in the Alameda County group had to do with traffic
and there is actually concern about creating a new freeway off-ramp in the Chinatown area, which
would even furthermore impact exposures in that area. And so our colleagues at Asian Health Services
have seen this also as a valuable way to collect some both qualitative and quantitative data to
inform the debates that are going on right now on that issue. Do you want to add anything?
Thu Quach: Yes, I think that we're in the process of discussing
with Asian Health Services and some of
their other community allies on providing the audit tool, as well as the black carbon monitors, and
then working with others to secure particulate matter monitors for community members to conduct the
same audits around neighborhoods where they want to put the off-ramp and then the other areas. So we
are continuing to do research and collecting data that would inform some of the work that the
community is doing and organizing around for local policies.
Peggy Reynolds: And, again, many of
these are issues that have been initiated with the community, so in that partnership they have
primary ownership, they're partners in a lot of it.
Symma Finn: Thank you so much for that very
comprehensive answer. We have another question for the second two speakers -- they're asking when
will the Boston study be published?
Wig Zamore: We've probably got about four papers out there in
various pieces. Christina has a recent paper in Atmospheric Environment, and we put the Somerville
year in Atmospheric Environment, as well. I think that our analysis is going to take another half
year, at least, before we can get out some comprehensive conclusions. And, of course, we've got our
fingers crossed that the original hypothesis of getting detailed personal exposure over the course
of a year, plus the time activity and the use of the structural equation model will produce results
that are clearer than the small short pieces that we've put out using kind of more, more traditional
and less accurate methods to date, but we wanted to get going on some things to guide the fuller
analysis. So that's why we've proceeded that way.
Symma Finn: Thank you so much, and thanks to
everyone for participating in today's session. Before we close I'd like to make a few announcements.
Your feedback is very important. After today's webinar please take a moment to fill out the short
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will be on the PEPH Events page as soon as they are available. The Events page is shown here on the
screen. And we really want to thank, once again, to all our presenters for your most interesting
presentations today -- Dr. Peggy Reynolds, Dr. Thu Quach, Mr. Wig Zamore, and Dr. Christina Fuller.
That concludes today's webinar. Thank you, again, for participating.