Health Research in the Wake of Disasters: Challenges and Opportunities for Sensor Science.

BACKGROUND: Disaster events adversely affect the health of millions of individuals each year. They create exposure to physical, chemical, biological, and psychosocial hazards while simultaneously exploiting community and individual-level vulnerabilities that allow such exposures to exert harm. Since 2013, the National Institute of Environmental Health Sciences (NIEHS) has led the development of the Disaster Research Response (DR2) program and infrastructure; however, research exploring the nature and effects of disasters on human health is lacking. One reason for this research gap is the challenge of developing and deploying cost-effective sensors for exposure assessment during disaster events. OBJECTIVES: The objective of this commentary is to synergize the consensus findings and recommendations from a panel of experts on sensor science in support of DR2. METHODS: The NIEHS convened the workshop, "Getting Smart about Sensors for Disaster Response Research" on 28 and 29 July 2021 to discuss current gaps and recommendations for moving the field forward. The workshop invited full discussion from multiple viewpoints, with the goal of identifying recommendations and opportunities for further development of this area of research. The panel of experts included leaders in engineering, epidemiology, social and physical sciences, and community engagement, many of whom had firsthand experience with DR2. DISCUSSION: The primary finding of this workshop is that exposure science in support of DR2 is severely lacking. We highlight unique barriers to DR2, such as the need for time-sensitive exposure data, the chaos and logistical challenges that ensue from a disaster event, and the lack of a robust market for sensor technologies in support of environmental health science. We highlight a need for sensor technologies that are more scalable, reliable, and versatile than those currently available to the research community. We also recommend that the environmental health community renew efforts in support of DR2 facilitation, collaboration, and preparedness. https://doi.org/10.1289/EHP12270.

Addressing institutional and community barriers to development and implementation of community-engaged research through competency-based academic and community training.

Introduction: The National Center for Advancing Translational Sciences (NCATS) focuses on reducing barriers to effective translational research that rapidly translates science to clinical and community interventions to improve individual and community health. Community-Engaged Research (CEnR) plays a crucial role in this process by bridging gaps between research and practice. It effectively generates bi-directional knowledge and communication by engaging patients and communities throughout the translation research process. Skills development, however, is critical to enable investigators and communities to establish successful partnerships in research. While there are many independent CEnR education programs nationally, few curricula are mapped to identified domains and competencies. Assessment of current community engagement educational frameworks and competencies: We located three comprehensive efforts to identify CEnR domains and competencies that we aligned to inform development of our curriculum, which we then mapped to these competencies. The first, undertaken by the NCATS Joint Workgroup on Researcher Training and Education and Community Capacity Building (JWG) was developed to assess training opportunities for academic researchers and community partners to increase their capacity to meaningfully engage collaborators in translational research. The JWG identified curricula, resources, tools, strategies, and models for innovative training programs and community engagement in all stages of research. It also conducted a gap analysis of deficiencies in available resources. Using Competency Mapping, they developed a framework for curriculum mapping that included eight domains, each with two to five competencies of knowledge, attitudes, and skills. The second aligned community-engaged research competencies with online training resources across the CTSA consortium, while the third was focused on Dissemination and Implementation training. Actionable recommendations: Further informed by a conceptual model to advance health equity, we have adapted and integrated these components into a set of modules designed to educate and empower investigators, trainees, students, and community partners to engage in effective CEnR. Discussion: This curriculum fills an important gap in our workforce development and helps to meet needs of our community partners. Following program evaluation and validation, we will offer the curriculum for use and further evaluation by other groups interested in using or adapting it for their own programming.

Polycyclic aromatic hydrocarbons (PAHs) cycling and fates in Galveston Bay, Texas, USA.

The cycling and fate of polycyclic aromatic hydrocarbons (PAHs) is not well understood in estuarine systems. It is critical now more than ever given the increased ecosystem pressures on these critical coastal habitats. A budget of PAHs and cycling has been created for Galveston Bay (Texas) in the northwestern Gulf of Mexico, an estuary surrounded by 30-50% of the US capacity of oil refineries and chemical industry. We estimate that approximately 3 to 4 mt per year of pyrogenic PAHs are introduced to Galveston Bay via gaseous exchange from the atmosphere (ca. 2 mt/year) in addition to numerous spills of petrogenic PAHs from oil and gas operations (ca. 1.0 to 1.9 mt/year). PAHs are cycled through and stored in the biota, and ca. 20 to 30% of the total (0.8 to 1.5 mt per year) are estimated to be buried in the sediments. Oysters concentrate PAHs to levels above their surroundings (water and sediments) and contain substantially greater concentrations than other fish catch (shrimp, blue crabs and fin fish). Smaller organisms (infaunal invertebrates, phytoplankton and zooplankton) might also retain a significant fraction of the total, but direct evidence for this is lacking. The amount of PAHs delivered to humans in seafood, based on reported landings, is trivially small compared to the total inputs, sediment accumulation and other possible fates (metabolic remineralization, export in tides, etc.), which remain poorly known. The generally higher concentrations in biota from Galveston Bay compared to other coastal habitats can be attributed to both intermittent spills of gas and oil and the bay's close proximity to high production of pyrogenic PAHs within the urban industrial complex of the city of Houston as well as periodic flood events that transport PAHs from land surfaces to the Bay.

Distribution of petrogenic polycyclic aromatic hydrocarbons (PAHs) in seafood following Deepwater Horizon oil spill.

A community-based participatory research was utilized to address the coastal community's concern regarding Deepwater Horizon oil contamination of seafood. Therefore, we analyzed polycyclic aromatic hydrocarbons (PAHs), major toxic constituents of crude oil, in the seafood collected from gulf coast (Louisiana, Alabama and Mississippi) during December 2011-February 2014. PAHs were extracted from edible part of shrimp, oysters, and crabs by the QuEChERS/dsPE procedure and analyzed by gas chromatography-mass spectrometry. The total PAHs data were further analyzed using the General Linear Mixed Model procedure of the SAS (Version 9.3, SAS Institute, Inc., Cary, NC) statistical software. Brown shrimp showed statistically significant differences in PAHs levels with respect to time and locations while white shrimp showed differences at various time points. PAHs levels in oyster and crab samples were not statistically different at the Type I error of 0.05. Overall, the PAHs levels are far below FDA levels of concern for human consumption.

The utility of a system dynamics approach for understanding cumulative health risk from exposure to environmental hazards.

The potential of system dynamics modeling to advance our understanding of cumulative risk in the service of optimal health is discussed. The focus is on exploring system dynamics modeling as a systems science methodology that can provide a framework for examining the complexity of real-world social and environmental exposures among populations-particularly those exposed to multiple disparate sources of risk. The discussion also examines how system dynamics modeling can engage a diverse body of key stakeholders throughout the modeling process, promoting the collective assessment of assumptions and systematic gathering of critical data. Though not a panacea, system dynamics modeling provides a promising methodology to complement traditional research methods in understanding cumulative health effects from exposure to multiple environmental and social stressors.

Implications of the GC-HARMS Fishermen's Citizen Science Network: Issues Raised, Lessons Learned, and Next Steps for the Network and Citizen Science.

This paper is intended to complement our extended documentation and analysis of the activities of the Gulf Coast Health Alliance: Health Risks related to the Macondo Spill project Community Outreach and Dissemination Core entitled, "Building and maintaining a citizen science network with fishermen and fishing communities after the Deepwater Horizon oil disaster using a Community-Based Participatory Research (CBPR) approach." We discuss nuances of CBPR practice, including trust-building, clarification of stakeholder expectations, balancing timelines and agendas, cultural fluency, and the importance of regional history-political-economic context, regulatory practices, and cultural life-ways-in creating social dynamics that overarch and underpin the entire process. We examine the unique role of knowledge-making hybrid structures like the project's Fishermen's citizen science network and compare/contrast this structure with other models of participatory science or deliberation. Finally, we reiterate the importance of environmental health literacy efforts, summarize project outcomes, and offer thoughts on the future roles of collaborative efforts among communities and institutional science in environmental public health.

Studying the Human Health and Ecological Impacts of the Deepwater Horizon Oil Spill Disaster (Part 2): Introduction to This Special Issue of New Solutions.

This introduction to the special issue continues an examination of the Gulf Coast Health Alliance: Health Risks Related to the Macondo Spill (GC-HARMS) project that began in New Solutions 28:3. GC-HARMS was part of a National Institute of Environmental Health Sciences-funded Gulf-wide consortium that created regional community-university research partnerships addressing health impacts from the oil spill exposures. Findings from this program enhanced regional preparedness and reinforced existing disaster-response networks. This special issue of New Solutions includes an article exploring the outcomes and implications of using a community-based participatory research-citizen science approach in implementing the project's exposure assessment/population health study and another article that describes analytic processes used to characterize toxicity of petrogenic Polycyclic Aromatic Hydrocarbons which provided data used to develop the project's risk message. Finally, this issue includes three Movement Voices interviews from individuals and nonprofits that served as GC-HARMS community hubs during the project.

Building and Maintaining a Citizen Science Network With Fishermen and Fishing Communities Post Deepwater Horizon Oil Disaster Using a CBPR Approach.

When the Deepwater Horizon oil rig blew out in 2010, the immediate threats to productive deep water and estuarial fisheries and the region's fishing and energy economies were obvious. Less immediately obvious, but equally unsettling, were risks to human health posed by potential damage to the regional food web. This paper describes grassroots and regional efforts by the Gulf Coast Health Alliance: health risks related to the Macondo Spill Fishermen's Citizen Science Network project. Using a community-based participatory research approach and a citizen science structure, the multiyear project measured exposure to petrogenic polycyclic aromatic hydrocarbons, researched the toxicity of these polycyclic aromatic hydrocarbon compounds, and communicated project findings and seafood consumption guidelines throughout the region (coastal Louisiana, Mississippi, and Alabama). Description/analysis focuses primarily on the process of building a network of working fishermen and developing group environmental health literacy competencies.

Studying the Human Health and Ecological Impacts of the Deep Water Horizon Oil Spill Disaster: Introduction to This Special Issue of New Solutions.

Gulf Coast Health Alliance: Health Risks Related to the Macondo Spill (GC-HARMS) began in 2011 as a component project of the National Institute of Environmental Health Sciences' (NIEHS) Deep Water Horizon (DWH) Research Consortia program. This Gulf-wide consortium created regional community-university research partnerships focused on addressing health impacts resulting from oil spill exposures. Findings from this trans-National Institutes of Health program have helped enhance and refine community disaster preparedness and reinforced local-regional disaster response networks. Focal points of individual projects included the following: effects of multiple stressors on individuals and vulnerable populations, exposure to contaminants associated with crude oil, and mental health impacts. This introduction to New Solutions Special Issue on the GC-HARMS response to the DWH disaster presents an overview of the project's internal structure and relationship to the comprehensive NIEHS consortia response and lists articles and interviews featured currently with brief mention of additional articles slated for the next issue.

The Gulf Coast Health Alliance: Health Risks Related to the Macondo Spill (GC-HARMS) Study: Self-Reported Health Effects.

The Deepwater Horizon (DWH) explosion in 2010 is the largest oil spill (Macondo) in U.S. HISTORY: We focused on gaining an understanding of the physical health and mental health effects attributable to the Macondo oil spill. This is a report of a cross-sectional cohort study (wave 1) to establish 'baseline' findings and meant to provide descriptive information to be used for a multi-wave, longitudinal study. Gulf Coast Health Alliance: health Risks related to the Macondo Spill (GC-HARMS) uses a Community-Based Participatory Research approach, thus including multi-disciplinary, multi-institutional academic partners and representatives of three communities impacted by the spill. Three research sites were selected for human sampling along the Gulf of Mexico coast including two from Mississippi and one from Louisiana, with Galveston, Texas, serving as a comparison site, given that it was not directly impacted by the spill. One hundred participants were selected from each community, representing adults, seniors and children, with approximately equal numbers of males and females in each group. Participants completed initial assessments including completion of a 'baseline' survey and, rigorous physical assessments. Results from wave 1 data collection reported herein reveal changes in self-reported physical health and mental health status following the oil spill, disparities in access to healthcare, and associations between mental health and emotional conditions related to displacement/unemployment. Few environmental health studies have been conducted in communities impacted by significant oil spills. Results imply potential prolonged effects on mental health and community vulnerability.

Ethical issues in patient-centered outcomes research and comparative effectiveness research: a pilot study of community dialogue.

Community bioethics dialogues were held on the topic of patient-centered outcomes research (PCOR) and comparative effectiveness research (CER). Participants were 65 and older and represented either a lower income, African American group (A) or a higher income White group (B). Participants were presented with a variety of background reading and study materials. Meetings were held 2 hr per week for 6 weeks. The groups showed both independence in judgment from the investigators and diversity of opinion between the two groups. Group B addressed more topics than Group A and in some instances explored additional policy nuances. Members of Group A appeared more cognizant of issues of social justice that affect vulnerable populations and appeared leery of approaches that suggested possible disrespect for their own personal experiences. Future plans call for both repeating the dialogue with additional, diverse community groups and repeating community bioethics dialogues on new topics with the same groups.

Evaluating community and campus environmental public health programs.

The National Institute of Environmental Health Sciences' (NIEHS) Partnerships for Environmental Public Health (PEPH) program created the Evaluation Metrics Manual as a tool to help grantees understand how to map out their programs using a logic model, and to identify measures for documenting their achievements in environmental public health research. This article provides an overview of the manual, describing how grantees and community partners contributed to the manual, and how the basic components of a logic model can be used to identify metrics. We illustrate how the approach can be implemented, using a real-world case study from the University of Texas Medical Branch, where researchers worked with community partners to develop a network to address environmental justice issues.

Epidemiology of asthma: prevalence and burden of disease.

While clinical guidelines clearly define mechanisms for asthma diagnosis based upon history, lung function testing, symptoms, and physical examination, surveillance for asthma is much less straightforward. Epidemiologists have long debated the best means of assessing the scope and burden of asthma, seeking to reduce the potential for confounding introduced by differential means of diagnosis and even slight differences in surveillance questions, both of which can bias surveillance results such that we over- or undercount cases. This chapter will provide an overview of asthma epidemiology in the USA and internationally, as well as review of the data and findings from the major surveillance systems, a discussion of a networked approach to the science and evaluation of therapeutic treatments using the exemplar of the Inner-City Asthma Network, and assessment of public health implications.

Community-based interventions in asthma.

Community and public health interventions provide potentially powerful means of decreasing morbidity, hospitalizations, emergency room visits, and mortality from asthma. This chapter thus provides an overview of community-based interventions, which have been demonstrated to be effective-and/or ineffective-in reducing the burden of disease, including development of asthma coalitions, interventions for both provider and patient education, environmental controls to reduce exposure to asthma triggers, and institutional policy and systems change. Perhaps most important is the demonstrated effect of integrated, comprehensive approaches to asthma management and control. A multidisciplinary approach spanning T1 through T4 translational research, coupled with public health activities is promising and has already demonstrated success in reducing the burden of disease.

COLLABORATING WITH THE COMMUNITY: THE EXTRA-TERRITORIAL TRANSLATIONAL RESEARCH TEAM.

The purpose of the present study is to suggest a revision of the team science concept to the more inclusive extra-territorial research team (ETRT). Translational thinking is largely marked by the perception of the team as a thing-like structure at the center of the scientific activity. Collaboration accordingly involves bringing external others (e.g., scientists, community members, and clinicians) into the team through limited or dependent participation. We suggest that a promising and innovative way to see the team is as an idea: a schema for assembling and managing relationships among otherwise disparate individuals with vested interests in the problem at hand. Thus, the ETRT can be seen as a process as well as an object. We provide a case study derived from a qualitative analysis of the impact of the logic of translational science on a team assessment of environmental health following an off-coast oil disaster. The ETRT in question displayed the following principles of constructive relationship management: a high sense of adventure given the quick pace and timeliness given the relevance of the oil spill to all team members; regular meetings in the community to avoid the appearance of academic hegemony; open access by lay as well as institutional scientists; integration of emergency management coordinators into the group; and the languages of public health, environmental pharmacology/toxicology and coastal culture seamlessly interwoven in discussion. The ETRT model is an appropriate strategy for mobilizing and integrating the knowledge and skills needed for comprehensive science and service responses, especially during crisis.

Community-Acquired Clostridium Difficile Infection: Awareness and Clinical Implications.

The epidemiology of Clostridium difficile infection (CDI) is changing. CDI, usually depicted as a nosocomial infection in the elderly, is now occurring in community-dwelling persons who are younger and otherwise dissimilar. A more virulent isolate (North American Pulsed Field type 1 (NAP1) associated with increased morbidity and mortality, has been identified. In 2005, similar strains were associated with severe disease in community-dwelling patients at a rate of 7.6/100,000. Screening patients with potential CDI symptoms and implementing preventative measures, including judicious use of antibiotics, can reduce disease burden.

Gender differences in risk behaviors among high school youth.

The US Centers for Disease Control and Prevention's (CDC) Youth Risk Behavior Surveillance System (YRBSS) demonstrates that American youth engage in a wide variety of risky behaviors.(1) The frequency and type of these behaviors often differ by a number of factors, such as socioeconomic status, race, and ethnicity. For example, results of the 2011 YRBSS revealed that white high school students were most likely to have texted or e-mailed while driving or been bullied on school property, while black high school students were most likely to have engaged in risky sexual behaviors, to have been physically inactive, and to be obese.(1) Conversely, Hispanic high school students were most likely to have ridden with a driver who had been drinking alcohol; to have ever used cocaine, inhalants, or ecstasy; and to have failed to use protection to prevent pregnancy during last sexual intercourse.(1) However, it is difficult to discern whether differences in risk-taking behaviors between and among ethnic groups can actually be attributed to differences in group norms, socioeconomic status, or cultural beliefs regarding acceptance or rejection of such behaviors,(1) suggesting a need for more comprehensive regional investigations.