The public health exposome: a population-based, exposure science approach to health disparities research.

The lack of progress in reducing health disparities suggests that new approaches are needed if we are to achieve meaningful, equitable, and lasting reductions. Current scientific paradigms do not adequately capture the complexity of the relationships between environment, personal health and population level disparities. The public health exposome is presented as a universal exposure tracking framework for integrating complex relationships between exogenous and endogenous exposures across the lifespan from conception to death. It uses a social-ecological framework that builds on the exposome paradigm for conceptualizing how exogenous exposures "get under the skin". The public health exposome approach has led our team to develop a taxonomy and bioinformatics infrastructure to integrate health outcomes data with thousands of sources of exogenous exposure, organized in four broad domains: natural, built, social, and policy environments. With the input of a transdisciplinary team, we have borrowed and applied the methods, tools and terms from various disciplines to measure the effects of environmental exposures on personal and population health outcomes and disparities, many of which may not manifest until many years later. As is customary with a paradigm shift, this approach has far reaching implications for research methods and design, analytics, community engagement strategies, and research training.

Environmental Public Health Applications Using Remotely Sensed Data.

We describe a remote sensing and GIS-based study that has three objectives: (1) characterize fine particulate matter (PM2.5), insolation and land surface temperature using NASA satellite observations, EPA ground-level monitor data and North American Land Data Assimilation System (NLDAS) data products on a national scale; (2) link these data with public health data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study to determine whether these environmental risk factors are related to cognitive decline, stroke and other health outcomes; and (3) disseminate the environmental datasets and public health linkage analyses to end users for decision-making through the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) system. This study directly addresses a public health focus of the NASA Applied Sciences Program, utilization of Earth Sciences products, by addressing issues of environmental health to enhance public health decision-making.

Fine particulate matter and incident cognitive impairment in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort.

Studies of the effect of air pollution on cognitive health are often limited to populations living near cities that have air monitoring stations. Little is known about whether the estimates from such studies can be generalized to the U.S. population, or whether the relationship differs between urban and rural areas. To address these questions, we used a satellite-derived estimate of fine particulate matter (PM2.5) concentration to determine whether PM2.5 was associated with incident cognitive impairment in a geographically diverse, biracial US cohort of men and women (n = 20,150). A 1-year mean baseline PM2.5 concentration was estimated for each participant, and cognitive status at the most recent follow-up was assessed over the telephone using the Six-Item Screener (SIS) in a subsample that was cognitively intact at baseline. Logistic regression was used to determine whether PM2.5 was related to the odds of incident cognitive impairment. A 10 µg/m(3) increase in PM2.5 concentration was not reliably associated with an increased odds of incident impairment, after adjusting for temperature, season, incident stroke, and length of follow-up [OR (95% CI): 1.26 (0.97, 1.64)]. The odds ratio was attenuated towards 1 after adding demographic covariates, behavioral factors, and known comorbidities of cognitive impairment. A 10 µg/m(3) increase in PM2.5 concentration was slightly associated with incident impairment in urban areas (1.40 [1.06-1.85]), but this relationship was also attenuated after including additional covariates in the model. Evidence is lacking that the effect of PM2.5 on incident cognitive impairment is robust in a heterogeneous US cohort, even in urban areas.

Estimating ground-level PM(2.5) concentrations in the southeastern U.S. using geographically weighted regression.

Most of currently reported models for predicting PM(2.5) concentrations from satellite retrievals of aerosol optical depth are global methods without considering local variations, which might introduce significant biases into prediction results. In this paper, a geographically weighted regression model was developed to examine the relationship among PM(2.5), aerosol optical depth, meteorological parameters, and land use information. Additionally, two meteorological datasets, North American Regional Reanalysis and North American Land Data Assimilation System, were fitted into the model separately to compare their performances. The study area is centered at the Atlanta Metro area, and data were collected from various sources for the year 2003. The results showed that the mean local R(2) of the models using North American Regional Reanalysis was 0.60 and those using North American Land Data Assimilation System reached 0.61. The root mean squared prediction error showed that the prediction accuracy was 82.7% and 83.0% for North American Regional Reanalysis and North American Land Data Assimilation System in model fitting, respectively, and 69.7% and 72.1% in cross validation. The results indicated that geographically weighted regression combined with aerosol optical depth, meteorological parameters, and land use information as the predictor variables could generate a better fit and achieve high accuracy in PM(2.5) exposure estimation, and North American Land Data Assimilation System could be used as an alternative of North American Regional Reanalysis to provide some of the meteorological fields.

Use of remotely sensed data to evaluate the relationship between living environment and blood pressure.

BACKGROUND: Urbanization has been correlated with hypertension (HTN) in developing countries undergoing rapid economic and environmental transitions. OBJECTIVES: We examined the relationships among living environment (urban, suburban, and rural), day/night land surface temperatures (LST), and blood pressure in selected regions from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Also, the linking of data on blood pressure from REGARDS with National Aeronautics and Space Administration (NASA) science data is relevant to NASA's strategic goals and missions, particularly as a primary focus of the agency's Applied Sciences Program. METHODS: REGARDS is a national cohort of 30,228 people from the 48 contiguous United States with self-reported and measured blood pressure levels. Four metropolitan regions (Philadelphia, PA; Atlanta, GA; Minneapolis, MN; and Chicago, IL) with varying geographic and health characteristics were selected for study. Satellite remotely sensed data were used to characterize the LST and land cover/land use (LCLU) environment for each area. We developed a method for characterizing participants as living in urban, suburban, or rural living environments, using the LCLU data. These data were compiled on a 1-km grid for each region and linked with the REGARDS data via an algorithm using geocoding information. RESULTS: REGARDS participants in urban areas have higher systolic and diastolic blood pressure than do those in suburban or rural areas, and also a higher incidence of HTN. In univariate models, living environment is associated with HTN, but after adjustment for known HTN risk factors, the relationship was no longer present. CONCLUSION: Further study regarding the relationship between HTN and living environment should focus on additional environmental characteristics, such as air pollution. The living environment classification method using remotely sensed data has the potential to facilitate additional research linking environmental variables to public health concerns.