Enhancing community preparedness: an inventory and analysis of disaster citizen science activities.

BACKGROUND: Disaster citizen science, or the use of scientific principles and methods by "non-professional" scientists or volunteers, may be a promising way to enhance public health emergency preparedness (PHEP) and build community resilience. However, little research has focused on understanding this emerging field and its implications for PHEP. To address research gaps, this paper: (1) assesses the state of disaster citizen science by developing an inventory of disaster citizen science projects; (2) identifies different models of disaster citizen science; and (3) assesses their relevance for PHEP. METHODS: We searched the English-language peer-reviewed and grey literature for disaster citizen science projects with no time period specified. Following searches, a team of three reviewers applied inclusion/exclusion criteria that defined eligible disasters and citizen science activities. Reviewers extracted the following elements from each project: project name and description; lead and partner entities; geographic setting; start and end dates; type of disaster; disaster phase; citizen science model; and technologies used. RESULTS: A final set of 209 projects, covering the time period 1953-2017, were included in the inventory. Projects were classified across five citizen science models: distributed or volunteer sensing (n = 19; 9%); contributory (n = 98; 47%); distributed intelligence (n = 52; 25%); collaborative research (n = 32; 15%); and collegial research (n = 8; 4%). Overall, projects were conducted across all disaster phases and most frequently for earthquakes, floods, and hurricanes. Although activities occurred globally, 40% of projects were set in the U.S. Academic, government, technology, and advocacy organizations were the most prevalent lead entities. Although a range of technologies were used, 77% of projects (n = 161) required an internet-connected device. These characteristics varied across citizen science models revealing important implications for applications of disaster citizen science, enhancement of disaster response capabilities, and sustainability of activities over time. CONCLUSIONS: By increasing engagement in research, disaster citizen science may empower communities to take collective action, improve system response capabilities, and generate relevant data to mitigate adverse health impacts. The project inventory established a baseline for future research to capitalize on opportunities, address limitations, and help disaster citizen science achieve its potential.

Association Between Long-term Exposure to Ambient Air Pollution and Change in Quantitatively Assessed Emphysema and Lung Function.

Importance: While air pollutants at historical levels have been associated with cardiovascular and respiratory diseases, it is not known whether exposure to contemporary air pollutant concentrations is associated with progression of emphysema. Objective: To assess the longitudinal association of ambient ozone (O3), fine particulate matter (PM2.5), oxides of nitrogen (NOx), and black carbon exposure with change in percent emphysema assessed via computed tomographic (CT) imaging and lung function. Design, Setting, and Participants: This cohort study included participants from the Multi-Ethnic Study of Atherosclerosis (MESA) Air and Lung Studies conducted in 6 metropolitan regions of the United States, which included 6814 adults aged 45 to 84 years recruited between July 2000 and August 2002, and an additional 257 participants recruited from February 2005 to May 2007, with follow-up through November 2018. Exposures: Residence-specific air pollutant concentrations (O3, PM2.5, NOx, and black carbon) were estimated by validated spatiotemporal models incorporating cohort-specific monitoring, determined from 1999 through the end of follow-up. Main Outcomes and Measures: Percent emphysema, defined as the percent of lung pixels less than -950 Hounsfield units, was assessed up to 5 times per participant via cardiac CT scan (2000-2007) and equivalent regions on lung CT scans (2010-2018). Spirometry was performed up to 3 times per participant (2004-2018). Results: Among 7071 study participants (mean [range] age at recruitment, 60 [45-84] years; 3330 [47.1%] were men), 5780 were assigned outdoor residential air pollution concentrations in the year of their baseline examination and during the follow-up period and had at least 1 follow-up CT scan, and 2772 had at least 1 follow-up spirometric assessment, over a median of 10 years. Median percent emphysema was 3% at baseline and increased a mean of 0.58 percentage points per 10 years. Mean ambient concentrations of PM2.5 and NOx, but not O3, decreased substantially during follow-up. Ambient concentrations of O3, PM2.5, NOx, and black carbon at study baseline were significantly associated with greater increases in percent emphysema per 10 years (O3: 0.13 per 3 parts per billion [95% CI, 0.03-0.24]; PM2.5: 0.11 per 2 µg/m3 [95% CI, 0.03-0.19]; NOx: 0.06 per 10 parts per billion [95% CI, 0.01-0.12]; black carbon: 0.10 per 0.2 µg/m3 [95% CI, 0.01-0.18]). Ambient O3 and NOx concentrations, but not PM2.5 concentrations, during follow-up were also significantly associated with greater increases in percent emphysema. Ambient O3 concentrations, but not other pollutants, at baseline and during follow-up were significantly associated with a greater decline in forced expiratory volume in 1 second per 10 years (baseline: 13.41 mL per 3 parts per billion [95% CI, 0.7-26.1]; follow-up: 18.15 mL per 3 parts per billion [95% CI, 1.59-34.71]). Conclusions and Relevance: In this cohort study conducted between 2000 and 2018 in 6 US metropolitan regions, long-term exposure to ambient air pollutants was significantly associated with increasing emphysema assessed quantitatively using CT imaging and lung function.

Vulnerability to the Cardiovascular Effects of Ambient Heat in Six US Cities: Results from the Multi-Ethnic Study of Atherosclerosis (MESA).

BACKGROUND: With climate change, temperatures are increasing. Heat-associated health events disproportionately affect certain subpopulations. However, prior research has often lacked information on individual-level health and air conditioning and neighborhood stressors/protections. OBJECTIVES: To assess whether (1) heat (2-day mean temperature above local 75th percentiles) is associated with increased heart rate and decreased blood pressure, controlling for age, time, season, daily ozone, and daily particulate matter (PM2.5) and (2) associations differ by antihypertensive medication use, renal function, fasting glucose, emotional support, air conditioning ownership and use, normalized difference vegetation index, neighborhood safety, and residence- specific oxides of nitrogen and PM2.5. METHODS: Health and behavioral characteristics were obtained repeatedly on participants of the Multi-Ethnic Study of Atherosclerosis in six US sites (2000-2010). These were linked with airport temperature, air quality, and satellite- and survey-derived neighborhood characteristics. We used a fixed-effects design, regressing health outcomes on linear temperature splines with knots at the 75th percentiles, interaction terms for each characteristic, and adjustment for month of year, age, PM2.5, and ozone. RESULTS: Overall, heat was not associated with heart rate. However, for a 2°C increase in heat, systolic blood pressure decreased by 1.1 mmHg (95% CI = -1.6, -0.6) and diastolic blood pressure by 0.3 mmHg (95% CI = -0.6, -0.1). Among nonusers of antihypertensive medications, heat-associated decreases in SBP were 2.1 mmHg greater among individuals with central air conditioning versus those without. Confidence intervals around the remaining modifiers were wide after multiple-comparisons corrections or sensitivity analyses. CONCLUSIONS: Outdoor heat is associated with decreasing blood pressure, and cardiovascular vulnerability may vary primarily by ownership of central air conditioning.

Relationship among environmental quality variables, housing variables, and residential needs: a secondary analysis of the relationship among indoor, outdoor, and personal air (RIOPA) concentrations database.

Retrospective descriptive secondary analyses of data from relationships of indoor, outdoor, and personal air (RIOPA) study homes (in Houston, Texas; Los Angeles County, California; and, Elizabeth, New Jersey May 1999-February 2001) were conducted. Data included air exchange rates, associations between indoor and outdoor temperature and humidity, and calculated apparent temperature and humidex. Analyses examined if study homes provided optimum thermal comfort for residents during both heating and cooling seasons when compared to current American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) Standards 62/62.1 and 55. Results suggested outdoor temperature, humidex, and apparent temperature during the cooling season potentially served as indicators of indoor personal exposure to parameters of thermal comfort. Outdoor temperatures, humidex, and apparent temperature during the cooling season had statistically significant predictive abilities in predicting indoor temperature. During the heating season, only humidex in Texas and combined data across study states were statistically significant, but with weaker to moderate predicative ability. The high degree of correlation between outdoor and indoor environmental variables provided support for the validity of epidemiologic studies of weather relying on temporal comparisons. Results indicated most RIOPA study residents experienced thermal comfort; however, many values indicated how several residents may have experienced some discomfort depending on clothing and indoor activities. With climate change, increases in temperature are expected, with more days of extreme heat and humidity and, potentially harsher, longer winters. Homes being built or modernized should be created with the appropriate guidelines to provide comfort for residents daily and in extreme weather events.

Temperature, ozone, and mortality in urban and non-urban counties in the northeastern United States.

BACKGROUND: Most health effects studies of ozone and temperature have been performed in urban areas, due to the available monitoring data. We used observed and interpolated data to examine temperature, ozone, and mortality in 91 urban and non-urban counties. METHODS: Ozone measurements were extracted from the Environmental Protection Agency's Air Quality System. Meteorological data were supplied by the National Center for Atmospheric Research. Observed data were spatially interpolated to county centroids. Daily internal-cause mortality counts were obtained from the National Center for Health Statistics (1988-1999). A two-stage Bayesian hierarchical model was used to estimate each county's increase in mortality risk from temperature and ozone. We examined county-level associations according to population density and compared urban (≥1,000 persons/mile(2)) to non-urban (<1,000 persons/mile(2)) counties. Finally, we examined county-level characteristics that could explain variation in associations by county. RESULTS: A 10 ppb increase in ozone was associated with a 0.45% increase in mortality (95% PI: 0.08, 0.83) in urban counties, while this same increase in ozone was associated with a 0.73% increase (95% PI: 0.19, 1.26) in non-urban counties. An increase in temperature from 70°F to 90°F (21.2°C 32.2°C) was associated with a 8.88% increase in mortality (95% PI: 7.38, 10.41) in urban counties and a 8.08% increase (95% PI: 6.16, 10.05) in non-urban counties. County characteristics, such as population density, percentage of families living in poverty, and percentage of elderly residents, partially explained the variation in county-level associations. CONCLUSIONS: While most prior studies of ozone and temperature have been performed in urban areas, the impacts in non-urban areas are significant, and, for ozone, potentially greater. The health risks of increasing temperature and air pollution brought on by climate change are not limited to urban areas.

Air Pollution and Blood Pressure: Evidence From Indonesia.

Indonesia faces significant air quality issues due to multiple emissions sources, including rapid urbanization and peatland fires associated with agricultural land management. Limited prior research has estimated the episodic shock of intense fires on morbidity and mortality in Indonesia but has largely ignored the impact of poor air quality throughout the year on biomarkers of cardiovascular disease risk. We conducted a cross-sectional study of the association between particulate matter less than 2.5 microns in diameter (PM2.5) and blood pressure. Blood pressure measurements were obtained from the fifth wave of the Indonesian Family Life Survey (IFLS5), an ongoing population-based socioeconomic and health survey. We used the GEOS-Chem chemical transport model to simulate daily PM2.5 concentrations at 0.5° × 0.625° resolution across the IFLS domain. We assessed the association between PM2.5 and diastolic and systolic blood pressure, using mixed effects models with random intercepts for regency/municipality and household and adjusted for individual covariates. An interquartile range increase in monthly PM2.5 exposure was associated with a 0.234 (95% CI: 0.003, 0.464) higher diastolic blood pressure, with a greater association seen in participants age 65 and over (1.16 [95% CI: 0.24, 2.08]). For the same exposure metric, there was a 1.90 (95% CI: 0.43, 3.37) higher systolic blood pressure in participants 65 and older. Our assessment of fire-specific PM2.5 yielded null results, potentially due to the timing and locations of health data collection. To our knowledge, this is the first study to provide evidence for an association between PM2.5 and blood pressure in Indonesia.

Temperature, myocardial infarction, and mortality: effect modification by individual- and area-level characteristics.

BACKGROUND: Although several studies have examined associations between temperature and cardiovascular-disease-related mortality, fewer have investigated the association between temperature and the development of acute myocardial infarction (MI). Moreover, little is known about who is most susceptible to the effects of temperature. METHODS: We analyzed data from the Worcester Heart Attack Study, a community-wide investigation of acute MI in residents of the Worcester (MA) metropolitan area. We used a case-crossover approach to examine the association of apparent temperature with acute MI occurrence and with all-cause in-hospital and postdischarge mortality. We examined effect modification by sociodemographic characteristics, medical history, clinical complications, and physical environment. RESULTS: A decrease in an interquartile range in apparent temperature was associated with an increased risk of acute MI on the same day (hazard ratio = 1.15 [95% confidence interval = 1.01-1.31]). Extreme cold during the 2 days prior was associated with an increased risk of acute MI (1.36 [1.07-1.74]). Extreme heat during the 2 days prior was also associated with an increased risk of mortality (1.44 [1.06-1.96]). Persons living in areas with greater poverty were more susceptible to heat. CONCLUSIONS: Exposure to cold increased the risk of acute MI, and exposure to heat increased the risk of dying after an acute MI. Local area vulnerability should be accounted for as cities prepare to adapt to weather fluctuations as a result of climate change.

Examining the Cross-sectional Association Between Neighborhood Conditions, Discrimination, and Telomere Length in a Predominantly African American Sample.

Disproportionate exposure to adverse neighborhood conditions and greater discrimination may contribute to health disparities among African Americans (AAs). We examined whether adverse neighborhood conditions, alone or in conjunction with discrimination, associate with shorter leukocyte telomere length among a predominantly AA cohort. The sample included 200 residents from two low-income neighborhoods (96% AA; mean age = 67 years). Perceived neighborhood conditions and discrimination were surveyed in 2018, and objective neighborhood conditions (total crime rate, neighborhood walkability, ambient air pollution (PM2.5, black carbon)) were collected in 2017/2018. Relative telomere length (T/S; ratio of telomeric DNA to a single-gene copy) was assessed from blood samples. Linear regression models estimated the main effects of each neighborhood condition and discrimination and their interactions on the T/S ratio. Less walkable neighborhoods were associated with shorter telomeres. Higher air pollution (PM2.5) was associated with shorter telomeres among those experiencing greater discrimination. Findings highlight the importance of understanding the intersecting influences of historic and contemporary sources of systemic racism and how they contribute to accelerated aging among adults.

Air pollution and DNA methylation: interaction by psychological factors in the VA Normative Aging Study.

DNA methylation is a potential pathway linking air pollution to disease. Studies indicate that psychological functioning modifies the association between pollution and morbidity. The authors estimated the association of DNA methylation with ambient particulate matter less than 2.5 µm in diameter (PM(2.5)) and black carbon, using mixed models. DNA methylation of the inducible nitric oxide synthase gene, iNOS, and the glucocorticoid receptor gene, GCR, was measured by quantitative polymerase chain reaction pyrosequencing of 1,377 blood samples from 699 elderly male participants in the VA Normative Aging Study (1999-2009). The authors also investigated whether this association was modified by psychological factors including optimism or pessimism, anxiety, and depression. iNOS methylation was decreased after acute exposure to both black carbon and PM(2.5). A 1-µg/m(3) increase in exposure to black carbon in the 4 hours preceding the clinical examination was associated with a 0.9% decrease in 5-methylcytosine (95% CI: 0.4, 1.4) in iNOS, and a 10-µg/m(3) increase in exposure to PM(2.5) was associated with a 0.6% decrease in 5-methylcytosine (95% CI: 0.03, 1.1) in iNOS. Participants with low optimism and high anxiety had associations that were 3-4 times larger than those with high optimism or low anxiety. GCR methylation was not associated with particulate air pollution exposure.

Translational Impacts of World Trade Center Health Program Research: A Mixed Methods Study.

The World Trade Center (WTC) Health Program (hereafter Program) provides medical monitoring and treatment for its Members: the responders and survivors who were at the WTC and related sites or located within the New York City disaster area during and after the terrorist attacks of September 11, 2001. Scientific research supported by the Program provides an evidence base for the health monitoring and clinical care of Members. In this article, the authors describe the findings and recommendations of a four-year study of the Program's research portfolio and its translational impact. They present results from a mixed methods assessment that integrates (1) a scoping review of nearly 1,000 peer-reviewed publications and thousands of pages of grey literature that reference research related to the health effects of 9/11, (2) stakeholder perspectives gathered through focus groups and interviews, and (3) a review of Program documentation. The study is intended to guide planning by Program leadership as it aims to maximize the impacts of Program research and achieve its goal of translating research into care for those affected by the attacks on 9/11.

Assessing Health and Human Services Needs to Support an Integrated Health in All Policies Plan for Prince George's County, Maryland.

With evolving demographics and a changing health system landscape, the Prince George's County Council, acting as the County Board of Health, is considering its future policy approaches and resource allocations related to health and well-being. To inform this path forward, the authors of this study used primary and secondary data to describe both the health needs of county residents and drivers of health within the county, inclusive of the social, economic, built, natural, and health service environments. This study integrates these findings, an analysis of budget documents, and a review of promising practices from other communities to situate recommendations in a Health in All Policies framework to foster aligned and integrated planning and budgeting across the county to promote health and well-being. Findings from the assessment indicate a shared interest among leaders and residents to embrace a holistic strategy for health and well-being in the county. Inefficient uses of the health care system are identified, highlighting a need to rebalance investments in health care use and drivers of health. Additionally, challenges in navigating health and human services and inequities in drivers of health across communities are noted, signaling broader concerns related to residents' access to health and human services that influence health and well-being outcomes. Recommendations are provided for several paths forward for the county to pursue a more integrated policy approach to influence health and well-being outcomes.

Global Health Impacts for Economic Models of Climate Change: A Systematic Review and Meta-Analysis.

Rationale: Avoiding excess health damages attributable to climate change is a primary motivator for policy interventions to reduce greenhouse gas emissions. However, the health benefits of climate mitigation, as included in the policy assessment process, have been estimated without much input from health experts. Objectives: In accordance with recommendations from the National Academies in a 2017 report on approaches to update the social cost of greenhouse gases (SC-GHG), an expert panel of 26 health researchers and climate economists gathered for a virtual technical workshop in May 2021 to conduct a systematic review and meta-analysis and recommend improvements to the estimation of health impacts in economic-climate models. Methods: Regionally resolved effect estimates of unit increases in temperature on net all-cause mortality risk were generated through random-effects pooling of studies identified through a systematic review. Results: Effect estimates and associated uncertainties varied by global region, but net increases in mortality risk associated with increased average annual temperatures (ranging from 0.1% to 1.1% per 1°C) were estimated for all global regions. Key recommendations for the development and utilization of health damage modules were provided by the expert panel and included the following: not relying on individual methodologies in estimating health damages; incorporating a broader range of cause-specific mortality impacts; improving the climate parameters available in economic models; accounting for socioeconomic trajectories and adaptation factors when estimating health damages; and carefully considering how air pollution impacts should be incorporated in economic-climate models. Conclusions: This work provides an example of how subject-matter experts can work alongside climate economists in making continued improvements to SC-GHG estimates.

Impact of World Trade Center-Related Health Research: An Application of the NIEHS Translational Framework.

The World Trade Center Health Program (WTCHP) has a research mission to identify physical and mental health conditions that may be related to the 9/11 terrorist attacks as well as effective diagnostic procedures and treatments for WTC-related health conditions. The ability of the WTCHP to serve its members and realize positive impacts on all of its stakeholders depends on effective translation of research findings. As part of an ongoing assessment of the translational impact of World Trade Center (WTC)-related research, we applied the National Institute of Environmental Health Sciences (NIEHS) translational framework to two case studies: WTC-related research on post-traumatic stress disorder (PTSD) and cancer. We conducted a review of 9/11 health-related research in the peer-reviewed literature through October 2017, grey literature, and WTCHP program documentation. We mapped peer-reviewed studies in the literature to the NIEHS framework and used WTCHP program documentation and grey literature to find evidence of translation of research into clinical practice and policy. Using the NIEHS framework, we identified numerous translational milestones and bridges, as well as areas of opportunity, within each case study. This application demonstrates the utility of the NIEHS framework for documenting progress toward public health impact and for setting future research goals.

Science Policy to Advance a Climate Change and Health Research Agenda in the United States.

Climate change is thought to be one of the greatest public health threats of the 21st century and there has been a tremendous growth in the published literature describing the health implications of climate change over the last decade. Yet, there remain several critical knowledge gaps in this field. Closing these gaps is crucial to developing effective interventions to minimize the health risks from climate change. In this commentary, we discuss policy trends that have influenced the advancement of climate change and health research in the United States context. We then enumerate specific knowledge gaps that could be addressed by policies to advance scientific research. Finally, we describe tools and methods that have not yet been fully integrated into the field, but hold promise for advancing the science. Prioritizing this advancement offers the potential to improve public health-related policies on climate change.

Health and Social Services in Puerto Rico Before and After Hurricane Maria: Predisaster Conditions, Hurricane Damage, and Themes for Recovery.

"In September 2017, Puerto Rico was struck by two major hurricanes-Irma and Maria-that intensified existing challenges in Puerto Rico's health and social services infrastructure. In the aftermath, the government of Puerto Rico created a long-term recovery plan built on an evidence-based assessment of the damage from the hurricanes and the ongoing needs across Puerto Rico. Development of the recovery plan was supported by the Federal Emergency Management Agency, other federal agencies, local stakeholders, and analysis from the Homeland Security Operational Analysis Center (HSOAC), operated by RAND Corporation under contract with the U.S. Department of Homeland Security. HSOAC research provided the foundation for the 31 courses of action in the recovery plan addressing the health and social services sector. These actions are a mix of social, governmental, fiscal, and economic policies and reforms. This collection of actions presents an opportunity to build a more resilient health and social services infrastructure and regional health care networks to ensure reliable access to services, promote health and well-being, and more efficiently and effectively respond to public health crises and future disasters. The actions span the areas of health care, public health and emergency preparedness, environmental health, mental and behavioral health, and social services. The damage and needs assessment and courses of actions cover four major themes: building system capacity to respond both during disasters and routine times; strengthening the health and social services workforce; strengthening support services for at-need populations; and creating health-promoting communities.

Air pollution, obesity, genes and cellular adhesion molecules.

OBJECTIVES: Particulate matter has been associated with acute cardiovascular outcomes, but our understanding of the mechanism is incomplete. We examined the association between particulate matter and cell adhesion molecules. We also investigated the modifying effect of genotype and phenotype variation to gain insight into the relevant biological pathways for this association. METHODS: We used mixed regression models to examine the association of PM(2.5) (particulate matter < or = 2.5 microm in diameter) and black carbon with serum concentrations of soluble intercellular adhesion molecule (sICAM-1) and soluble vascular cell adhesion molecule (sVCAM-1), markers of endothelial function and inflammation, in a longitudinal study of 809 participants in the Normative Ageing Study (1819 total observations). We also examined whether this association was modified by genotype, obesity or diabetes status. Genes selected for analyses were either related to oxidative stress, endothelial function, lipid metabolism or metal processing. RESULTS: Black carbon during the 2 days prior to blood draw was significantly associated with increased sVCAM-1 (4.5% increase per 1 microg/m(3), 95% CI 1.1 to 8.0). Neither pollutant was associated with sICAM-1. Larger effects of black carbon on sVCAM were seen in subjects with obesity (p=0.007) and who were GSTM1 null (p=0.02). CONCLUSIONS: Black carbon is associated with markers of endothelial function and inflammation. Genes related to oxidative defence may modify this association.

Air pollution-associated changes in biomarkers of diabetes risk.

BACKGROUND: Ambient particulate matter (PM) and nitrogen oxide (NOx) air pollution may be diabetogenic. OBJECTIVE: To examine longitudinal associations of short- and longer-term mean PM ≤10 µm (PM10), PM ≤2.5 µm (PM2.5), and NOx concentrations with five biomarkers of diabetes risk. METHODS: We studied a stratified, random minority oversample of nondiabetic Women's Health Initiative clinical trials participants with biomarkers and geocoded participant address-specific mean air pollution concentrations available at repeated visits (years = 1993-2004; n = 3,915; mean age = 62.7 years; 84% white). We log-transformed the biomarkers, then used multi-level, mixed-effects, longitudinal models weighted for sampling design/attrition and adjusted for sociodemographic, clinical, and meteorological covariates to estimate their associations with air pollutants. RESULTS: Biomarkers exhibited null to suggestively negative associations with short- and longer-term PM10 and NOx concentrations, e.g., -3.1% (-6.1%, 0.1%), lower homeostatic model assessment of insulin resistance per 10 µg/m3 increase in 12-month PM10. A statistically significant interaction by impaired fasting glucose (IFG) at baseline in this analysis indicated potentially adverse effects only among women with versus without IFG, i.e., 1.4% (-3.5%, 6.5%) versus -4.6% (-7.9%, -1.1%), P interaction < 0.05. In contrast, longer-term PM2.5 concentrations were largely but not statistically significantly associated with higher biomarkers. CONCLUSIONS: Low-level short-term PM10 and NOx concentrations may have negligible adverse effects on biomarkers of diabetes risk. Although longer-term mean PM2.5 concentrations showed primarily null associations with these biomarkers, results suggestively indicated that PM2.5 exposure over the range of concentrations experienced in the United States may adversely affect biomarkers of diabetes risk at the population level, as may longer-term mean PM10 concentrations among women with IFG.

Injury and Illness Surveillance of U.S. Agricultural Workers: Assessment of Recommendations and Actions.

Agriculture remains one of America's oldest and most valued industries, but is also one of the most hazardous, with farmworkers experiencing high rates of injuries and illnesses. The National Institute for Occupational Safety and Health's (NIOSH) Agriculture, Forestry and Fishing (AgFF) Program provides leadership to prevent harm to workers in the three named sectors. Since its inception, the AgFF Program has spearheaded numerous surveillance initiatives to understand the magnitude of injuries and illnesses among agricultural worker populations, identify vulnerable groups, and evaluate the effectiveness of intervention measures. In 2012, the program underwent a review from an independent panel convened to evaluate progress in program relevance and impact. While the panel offered a number of recommendations for improving surveillance, it provided little guidance on how to prioritize and achieve the recommendations. In 2015, NIOSH asked the RAND Corporation to assess options for action in response to panel recommendations. The goal of this study is to provide NIOSH with a practical assessment of the feasibility and desirability of carrying out actions to meet surveillance-related panel recommendations, given current AgFF Program resources and priorities. The authors conducted literature reviews and targeted interviews to detail how actions could be implemented and identify barriers to their achievement. For each action, the authors applied criteria relevant to assessing feasibility (costs, partnership engagement, information availability and accessibility, policy barriers, timelines) and desirability (relevance to program priorities, information quality, and impact). Overall, the study identifies a number of actions that balanced both feasibility and desirability for NIOSH to consider as it determines the direction of the AgFF Program.