2017 Progress Report: Center for Research on Environmental and Social Stressors in Housing across the Life Course

EPA Grant Number: R836156
Center: Disparities in Exposure and Health Effects of Multiple Environmental Stressors Across the Life Course
Center Director: Laden, Francine
Title: Center for Research on Environmental and Social Stressors in Housing across the Life Course
Investigators: Laden, Francine , Adamkiewicz, Gary , Fabian, Maria Patricia , Lane, Kevin J , Levy, Jonathan , Scammell, Madeleine Kangsen , Zanobetti, Antonella
Current Investigators: Laden, Francine , Adamkiewicz, Gary , Fabian, Maria Patricia , Levy, Jonathan , Scammell, Madeleine Kangsen , Sprengler, John D , Zanobetti, Antonella
Institution: Harvard T.H. Chan School of Public Health , Boston University
EPA Project Officer: Callan, Richard
Project Period: July 1, 2015 through June 30, 2020
Project Period Covered by this Report: July 1, 2016 through June 30,2017
Project Amount: $1,500,000
RFA: NIH/EPA Centers of Excellence on Environmental Health Disparities Research (2015) RFA Text |  Recipients Lists
Research Category: Health


Environmental health disparities (EHDs) are based on a combination of factors, including sociodemographic and spatial patterns of exposures to chemical and non-chemical stressors. While this phenomenon is well recognized, the methods to characterize and ultimately mitigate EHDs have been lacking. Few epidemiological studies have characterized disparities in health effects associated with simultaneous exposure to multiple chemical stressors or confounding/effect modification by a complex mixture of nonchemical stressors. In our Center, we are conducting innovative interdisciplinary and multidisciplinary studies spanning epidemiology, exposure science, risk assessment, and quantitative disparities analysis, with strong community engagement. We are examining multiple health outcomes across the life course, operating within our Center’s targeted low-income communities (Chelsea and Dorchester) as well as across the Commonwealth of Massachusetts (MA). Our projects are synergistic and interdependent, ensuring meaningful collective insights into EHDs. Our Center’s project and core aims are:
Project 1, Multi-Exposure Epidemiology Across the Life Course: 1) develop innovative methods to estimate health effects associated with multiple chemical stressor exposures, accounting for large numbers of potential confounders and interactions; 2) estimate the complex interactions of exposures to multiple chemical stressors with non-chemical stressors and social determinants of health disparities on birth outcomes, growth rates, and cardiovascular mortality; and 3) identify epigenetic profiles associated with air pollution exposures, non-chemical stressors and social determinants of health disparities that modify them.
Project 2, Exposure Disparities Related to Resident Behavior and Housing Characteristics: 1) use portable, real-time monitoring devices to estimate indoor exposures to multiple chemical stressors, noise, and thermal comfort in our target communities; 2) determine how resident behaviors and housing characteristics affect indoor-outdoor associations of chemical and non-chemical stressors; and 3) use community-based crowdsourcing approaches to assess housing and household characteristics to develop season-specific determinants that predict ventilation characteristics.
Project 3, Cumulative Risk and Geospatial Health Disparities Related to Chemical and Non-Chemical Stressor Exposures: 1) characterize disparities in exposure to chemical and non-chemical stressors across MA; 2) develop and evaluate multivariable chemical and non-chemical stressor constructs to better characterize exposures hypothesized to be related to EHDs; and 3) develop models of cumulative risk for multiple health outcomes across the life course in our two target communities, including quantified health benefits and changes in EHDs associated with simulated interventions.
Community Engagement Core (CEC): 1) design, implement, and evaluate training for community residents to participate in research conducted as part of Project 2; 2) evaluate and inform Project 3 chemical and nonchemical stressor constructs, stressor exposure models, and microdata simulation constraint variables; and 3) develop culturally appropriate educational materials that translate the aims and findings of research from Projects 1, 2, and 3 to improve environmental health literacy while reducing risk.
Pilot Project Program: 1) support EHD research in new and emerging topic areas within the two target communities; 2) support the application of methods and approaches to address EHDs across a wide range of underserved communities in the United States; and 3) provide seed funding that allows junior investigators the chance to maximize opportunities for independent funding.
Administrative Core: 1) provide the overall administrative infrastructure necessary to coordinate activities among projects and to facilitate interactions with EPA, NIH, and other Centers; 2) monitor the productivity and resources of the Center and its subcomponents to ensure that stated goals and objectives are met; 3) assemble advisory committees, organize regular meetings, and ensure implementation of recommendations; 4) provide mentoring and career development opportunities for the Center’s Career Development Investigators; 5) connect Center investigators with the wider EHD communities at Harvard and Boston University; and 6) provide platforms for disseminating research findings.

Progress Summary:

The Center’s Administrative Core continued to coordinate monthly Executive Committee Meetings, which include manuscript tracking, project updates, and general administrative discussions. We have also developed protocols for paper ideas to be proposed to the Executive Committee and for co-authors to be determined. The manuscript tracking process allows us to both evaluate regular progress on scientific manuscripts and to determine whether the appropriate collaborators are included. Also, given substantial interest among external investigators in the themes and datasets within CRESSH, we added a regular opportunity for external investigators to propose collaborative project ideas. We have had multiple such presentations and collaborative grants are under development (including a K award, a diversity supplement, and multiple R03 and R01 applications). We have also invited guests to discuss relevant scientific content.
Members of the Internal Steering Committee (ISC) attended their second meeting on July 21, 2016. The meeting was facilitated by co-directors Laden and Levy and included a presentation by project/core leaders about updates and a discussion with ISC members to gather feedback and insight.
The External Advisory Board (EAB) is comprised of three research based members (Marie O’Neill, University of Michigan; John Durant, Tufts University; Devon Payne-Sturges, University of Maryland) and two community based members (Juan Vega, Assistant Secretary for Communities and Programs within the Department of Housing and Economic Development in Chelsea MA; and David Queeley, Codman Square Neighborhood Development Corporation’s Eco-Innovation District Director in Dorchester MA). Members of the EAB attended their first meeting on June 15, 2016. The meeting included detailed project/core introductions and updates, followed by high-level discussion questions and feedback from EAB members. A joint ISC and EAB meeting was scheduled for June 8, 2017.
 All IRB related paperwork is complete across all three projects.
Project 1: Health Effects Across the Life course (HEAL) study
We focused most effort on Aim 2. For births from 2001-2013 in Massachusetts, we began exploring the relationship between exposure to greenness (measured by satellite-based mean Normalized-Difference-Vegetation-Index (NDVI)) and birth weight while accounting for individual level confounders as well as other neighborhood factors. We are observing a positive association between maternal exposure to greenness during pregnancy and infant birth weight. Next steps are to incorporate social stressors and air pollution.
We have started to work on the association between neighborhood greenness and mortality, and whether or not this association is modified by environmental exposures (temperature and PM2.5) or social stressors. PM2.5 and temperature exposure assessment are based on a hybrid satellite-based model incorporating daily remote sensing data at 1x1 km spatial resolution. Neighborhood greenness is assessed using NDVI. We have started to link the database with variables developed in Project 3, including the Racial Residential Segregation Scale (white vs. the subject’s race) and the Economic Residential Segregation Scale (extreme high vs. extreme low income), calculated per census block group and averaged over zip codes.
We have begun work preparing the datasets for the growth curve analyses using the Boston Children’s HealthWatch (CHW) data. We recently linked electronic health record (EHR) data that have complete coverage from birth throughout childhood (11 years of age) for the 5,694 enrollees, with the earliest birth in 2003. We are also working on developing the most appropriate statistical method to examine the growth curve in relation to chemical/non-chemical stressors, individual characteristics, and effect modifiers.
In work leveraging our modeling infrastructure, we published a paper where we found a statistically significant association between long-term PM2.5 exposure and death in seven southeastern U.S. states during 2000–2013. This association was modified by individual-level factors, neighborhood-level variables, temperature, and chemical composition. We also published a study that focused on the effect of temperature on sudden infant death syndrome (SIDS) and on defining which kids are more susceptible in 210 U.S. cities from 1972 to 2006. We found that temperature increases were associated with an elevated risk of SIDS in the summer, particularly among infants who were Black, 3 months and older, and living in the Midwest and surrounding northern regions. This work provides a strong foundation for our Massachusetts-specific work on birth outcomes.
More work was done on the proposed new statistical method in Aim 1. The final paper was submitted and is under review.
Project 2: Home-based Observation Monitoring Exposure (HOME) study
Sensor selection, device calibration, sampling box construction, QA/QC procedures, and device use protocols have been completed. The final sampling box (Environmental Multipollutant Monitoring Assembly, aka ‘EMMA’) contains measurement devices for PM2.5, NO2, NO, CO2, CO, temperature, relative humidity and noise. In addition, VOC measurements were added to the project and are being collected separate from the sampling box.
All study materials and tool development were completed and translated (Spanish). Data collection protocols and extensive training materials were completed. Qualtrics tools were developed and in use for field data collection (iPads) and data storage/management. Two outdoor locations were established in Chelsea to place air monitors that collect the same real-time measure in use for indoor sampling. Pre-field sampling checks were completed prior to summer data collection, including calibrating gas sensors and co-located sensors in the lab and field. Post-field sampling checks were completed between summer and winter sampling, including recalibration of gas sensors with co-located sensors in the lab and check for sensor drift.
Summer data collection ran June–October 2016 and 41 participants were completed (total of 82 visits). The second round of data collection for participants ran November 2016-May 2017 and 31 additional new participants were completed (total of 62 visits) and 36 summer participants completed their second season of data collection (72 visits).
The HOME study team meets biweekly with the CEC and Chelsea community partners to discuss recruitment planning. The HOME study team also meets internally as needed to discuss any data collection concerns, decisions and next steps. In addition to attendance at some of our monthly Executive Committee members, our Dorchester community partners have participated in two project planning meeting including discussions about pre-determined categories (housing types and demographics) for recruitment, establishing partnerships and study timeline.
Project 3: Mapping SpAtial Patterns in Environmental Health Disparities (MAP-EHD) study
In Year 2, we added to the spatial databases started in Year 1, including meteorology, parcel & housing data, NDVI, thermal satellite data, and LiDAR (Light Detection and Ranging, which gives high-resolution information on building heights). Using the extensive geographical database, we started developing constructs that will be evaluated for disparities across Massachusetts, or will be tested as risk factors/modifiers in Project 1. Constructs include: Infiltration–measure of home leakiness; Food access–measure of access to healthy food retailers; Social stressors–measures of social economic disadvantage, racial isolation, immigrant concentration, and foreign born change; Surface temperature–LUR model of surface temperature for multiple urban areas; and Environmental quality–cumulative measure of environmental burden due to proximity to industry, contaminated soil and water, etc. Infiltration is estimated at the parcel level, surface temperature is estimated at 90 ft. resolution, and other constructs above are estimated at the block group level across Massachusetts. The infiltration, food access, and social stressor constructs have been completed, and surface temperature and environmental quality are in progress. Scientific manuscripts are being drafted for each of the stressor construct categories.
We conducted analyses to measure 1) trends in disparities in air pollution exposure (PM2.5 and NO2) over 10 years, and 2) disparities in infiltration constructs. All core analyses have been completed, and one manuscript has been submitted for publication with a second in preparation.
We designed and implemented a winter photo survey in Chelsea to characterize resident behavior related to modifiers of environmental exposures, in conjunction with community partners. Numerous homes in Chelsea were photographed using a vehicle-mounted camera, with key questions including presence of air conditioning and open windows to be answered by those examining the photos.
Finally, with pilot data (n = 100) from CHW (linked to electronic health records), we tested geocoding algorithms and with the BU Data Coordinating Center developed SAS code to clean addresses for geocoding the full dataset. This preliminary work provides the foundation for the forthcoming HEAL analyses.
Community Engagement Core
The environmental justice group associated with our prior partner has incorporated as its own organization, so CRESSH is now partnered with GreenRoots in Chelsea. The CEC, the HOME Study, and GreenRoots have recruited a diverse sample of study participants in Chelsea. The CEC also organized a meeting for HOME Study staff and GreenRoots to meet with the Director of the City of Chelsea Inspectional Services Department to discuss how to recognize and respond to imminent housing-related hazards encountered in the field. So far, this has not been necessary. The CEC coordinated a meeting with HOME Study investigators and Health Resources in Action (HRiA) to begin developing a recruitment and fieldwork plan for Dorchester (to begin in Summer 2017) and is coordinating meetings with pilot project recipients to get input from the community on the conduct of the pilot grants.
The CEC also manages CRESSH’s website and Twitter account to communicate CRESSH news with followers and engage the public via social media. We have created a resource sheet of housing-related resources (inspectional services, safety, maintenance, etc.) in Chelsea to hand out during our home visits. To maintain engagement with participants in between sampling periods, we sent out postcards that updated participants on the progress of the HOME Study. The CEC is also preparing report-back materials that will be used to inform participants of the sampling results from their individual homes and their community.
Pilot Project Program
A request for Pilot Project Applications was posted on the CRESSH website and sent by email in August 2016 to all Center investigators at BUSPH and HSPH, CEC partners, and all JPB Environmental Health Fellows. Three proposals were received and processed for review, with multiple additional inquiries that are expected to result in future proposals. The final award decisions were made: 1) A Multilevel Perspective to Understand Individual and Environmental Stressors on Sleep by Dr. Dayna Johnson and 2) Assessing the Role of Occupation on Home Exposures in a Disadvantaged Community by Dr. Diana Ceballos. Work is in progress on both of these pilot grants.
The center website (www.cressh.org) went live in April 2016. The website facilitates internal and external communication and includes information about the center research projects and cores, investigators and staff, community partners, upcoming events and related reading. In the last year, updates have included: HOME study recruitment documents for Chelsea (English and Spanish), the call for pilot proposals, a view of our Twitter feed (@CRESSH_Mass, launched in November 2016), a private password protected tab for investigators, and a new quarterly newsletter (first issue published in Winter 2017) that reports updates on each project and core, conferences, presentations, publications, and community partner news.

Future Activities:

In the next year, the Administrative Core will: 1) Continue to provide the overall administrative infrastructure necessary to coordinate activities, 2) Monitor productivity and resources of the Center and its subcomponents, 3) Continue to assemble and coordinate ISC and EAB meetings, 4) Provide mentoring and career development opportunities for the Center’s CDIs and other early-stage investigators, and 5) Continue to connect Center investigators and activities with various related efforts at both universities.
Project 1 will: 1) Finalize some of the analysis on birth data and air pollution/greenness, 2) Examine birth data in relation to social stressors, 3) Continue the mortality analysis with NDVI, pollution and other chemical and non-chemical stressors, and 4) Start the growth curve analysis in CHW.
Project 2 will: 1) Complete data collection, analysis, and initial manuscript preparation for Chelsea, 2) Continue work with the CEC and HRiA to recruit Dorchester participants, 3) Complete both summer and winter data collection for all Dorchester participants, 4) Progress with Dorchester data management.
Project 3 will: 1) Continue adding to the geographical database, 2) Continue disparities analyses for housing, social and environmental factors, 3) Expand photo survey and construct regression models predicting resident behavior and 4) Start building synthetic population data for Chelsea and Dorchester.
CEC will: 1) Complete recruitment and sampling in Chelsea and Dorchester, 2) Continue working with our community partners to keep the Chelsea and Dorchester communities engaged and provide necessary resources regarding health disparities in housing, 3) Develop partnerships to disseminate our research in Dorchester, 4) Prepare individual report back data for Chelsea residents (PM2.5 & NO2) and coordinate community meeting to present and discuss findings, and 5) Develop materials to share all research products with researchers and communities.
Pilot Program will: 1) Monitor progress from Year 2 awarded pilot and 2) Repeat the call for proposals and selection of top applicants.

Journal Articles: 7 Displayed | Download in RIS Format

Other center views: All 42 publications 7 publications in selected types All 7 journal articles
Type Citation Sub Project Document Sources
Journal Article Antonelli J, Han B, Cefalu M. A synthetic estimator for the efficacy of clinical trials with all-or-nothing compliance. Statistics in Medicine 2017;36(29):4604-4615. R836156 (2018)
  • Abstract from PubMed
  • Full-text: Harvard University-Full Text PDF
  • Abstract: Wiley-Abstract
  • Journal Article Fong KC, Hart JE, James P. A review of epidemiologic studies on greenness and health: updated literature through 2017. Current Environmental Health Reports 2018;5(1):77-87. R836156 (2018)
  • Full-text from PubMed
  • Abstract from PubMed
  • Associated PubMed link
  • Abstract: Springer-Abstract
  • Other: Digital Science-Abstract
  • Journal Article Jhun I, Mata DA, Nordio F, Lee M, Schwartz J, Zanobetti A. Ambient temperature and sudden infant death syndrome in the United States. Epidemiology 2017;28(5):728-734. R836156 (2017)
    R836156 (2018)
  • Full-text from PubMed
  • Abstract from PubMed
  • Associated PubMed link
  • Full-text: Research Gate-Full Text PDF
  • Abstract: Epidemiology-Abstract
  • Journal Article Levy JI, Quiros-Alcala L, Fabian MP, Basra K, Hansel NN. Established and emerging environmental contributors to disparities in asthma and chronic obstructive pulmonary disease. Current Epidemiology Reports 2018;5(2):114-124. R836156 (2018)
    R836152 (2018)
  • Abstract from PubMed
  • Abstract: Springer-Abstract
  • Other: ResearchGate-Abstract
  • Journal Article Rosofsky A, Levy JI, Zanobetti A, Janulewicz P, Fabian MP. Temporal trends in air pollution exposure inequality in Massachusetts. Environmental Research 2018;161:76-86. R836156 (2018)
  • Abstract from PubMed
  • Full-text: ScienceDirect-Full Text HTML
  • Abstract: ScienceDirect-Abstract
  • Other: ScienceDirect-Full Text PDF
  • Journal Article Wang Y, Shi L, Lee M, Liu P, Di Q, Zanobetti A, Schwartz JD. Long-term exposure to PM2.5 and mortality among older adults in the Southeastern US. Epidemiology 2017;28(2):207-214. R836156 (2017)
    R835872 (2016)
  • Full-text from PubMed
  • Abstract from PubMed
  • Associated PubMed link
  • Abstract: Epidemiology-Abstract
  • Journal Article Zigler CM, Choirat C, Dominici F. Impact of National Ambient Air Quality Standards nonattainment designations on particulate pollution and health. Epidemiology 2018;29(2):165-174. R836156 (2018)
    R835872 (2016)
  • Abstract from PubMed
  • Abstract: Ovid-Abstract
  • Supplemental Keywords:

    fine particulate matter, nitrogen dioxide, air pollution, temperature, housing, cumulative risk, birth weight, mortality

    Relevant Websites:

    Center for Research on Environmental and Social Stressors in Housing Across the Life Course (CRESSH)


    Progress and Final Reports:

    Original Abstract
  • 2016 Progress Report
  • 2018 Progress Report
  • 2019
  • Subprojects under this Center: (EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
    R836156C001 Multi-Exposure Epidemiology across the Life Course
    R836156C002 Exposure Disparities Related to Resident Behavior and Housing Characteristics
    R836156C003 Cumulative Risk and Geospatial Health Disparities Related to Chemical and Non-Chemical Stressor Exposures