Grantee Research Project Results
2017 Progress Report: Comparing Urban and Rural Effects of Poverty on COPD (CURE COPD)
EPA Grant Number: R836150Center: Comparing Urban and Rural Effects of Poverty on COPD
Center Director: Hansel, Nadia
Title: Comparing Urban and Rural Effects of Poverty on COPD (CURE COPD)
Investigators: Hansel, Nadia , Matsui, Elizabeth C. , Rand, Cynthia , Koehler, Kirsten , McCormack, Meredith , Maisonet, Mildred , Putcha, Nirupama
Current Investigators: Hansel, Nadia , Matsui, Elizabeth C. , McCormack, Meredith , Rand, Cynthia , Koehler, Kirsten
Institution: The Johns Hopkins University , East Tennessee State University
Current Institution: The Johns Hopkins University
EPA Project Officer: Callan, Richard
Project Period: July 1, 2015 through June 30, 2020 (Extended to June 30, 2022)
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: Human Health
Objective:
The goal of the Program is to fully understand the complex interplay between poverty, air pollutants, obesity, and diet in two independent low-income urban and rural cohorts. In particular, Project 1 (Obesity and adverse dietary patterns as susceptibility factors to pollutant exposure in urban chronic obstructive pulmonary disease [COPD]), through an observational study, will focus on low-income adults in an urban setting, aiming to determine whether elevated fat mass and body composition, and adverse diet patterns increase susceptibility to indoor pollution in low income adults with COPD. Project 2 (Indoor air pollution and COPD in rural Appalachia) will investigate the role of indoor air quality on respiratory health of residents of rural Appalachia.
Progress Summary:
Project 1
To date, we have telephone screened 259 potential participants, of which 79 participants have been eligible according to the phone screener. The primary reasons for telephone screener failure were related to the selected catchment area (62%), which includes low-income census blocks, and current smoker status (20%) Currently, from the 79 participants eligible based on telephone screen, 18 are awaiting their clinic screening visit, 11 have declined to participate, and 50 participants have signed a consent form, of which 27 qualified to be enrolled in the study. Enrolled subjects have completed screening questionnaires, and spirometry testing, in order to confirm our case definition based upon GOLD guidelines that classifies the Severity of Airflow Limitation in COPD (Based on Post-Bronchodilator FEV1) in patients with FEV1/FVC < 0.70 as:
- GOLD 2: Moderate 50% ≤ FEV1 < 80% predicted
- GOLD 3: Severe 30% ≤ FEV1 < 50% predicted
- GOLD 4: Very Severe FEV1 < 30% predicted
From the 27 enrolled participants, 10 have completed their baseline clinic and home visit to assess indoor air quality (PM, nitrogen dioxide, and air nicotine); 9 have completed their 3 month follow-up visit; and 9 have completed their 6 month follow-up visit.
The ancillary study is led by Dr. Laura Paulin (K23ES025781) and was introduced to the urban population to better understand how mucociliary clearance and mucus properties add to poor outcomes and disease progression in COPD following exposure to indoor air pollution. To date, 17 participants have signed the consent form for this ancillary study.
Currently, we have two field research coordinators, one research assistant, one environmental technician, one database manager, and a research supervisor to support and help supervise and standardize the research procedures. As a rule, Dr. Hansel routinely directs extensive staff trainings ranging from how to provide participants with relevant information and instructions during each home and clinical visit, to consisting methods.
Currently, a training is being developed on utilizing “teach back” methods where participants are asked to repeat back, or “teach back” in their own words, all of the information they were given during the informed consent. This method is one way to ensure the staff that participants have fully understood the information within the consent. New training topics are determined during the weekly staff meetings where PIs listen to staff and gauge the areas that may need strengthening; weekly staff meetings are held throughout the course of the study. Additional staff cross trainings have recently taken shape within the Data Core on ways to develop forms for data collection in the REDCap website (includes design of questionnaires, labeling of variables and coding schemes, setting up and exporting data). All data forms have been piloted based on staff input and modified as needed. In addition, the Data Core assisted in designing a secure web-based portal of the screening questionnaire and the monthly telephone exacerbation forms for the study. To ensure that all staff members are handling their duties and procedures from the same perspective, a comprehensive manual of operations (MOP) has been developed and updated to reflect amendments to the study procedures; this MOP is an additional training resource for staff to utilize.
Project 2:
During this period, the East Tennessee State University (ETSU) team has identified nine potential participants that qualify based on prescreening criteria and residential address. Two consent forms have been signed and clinic screening visits scheduled. Also during this reporting period, we have upheld the weekly teleconferences that gave the Johns Hopkins University (JHU) and ETSU investigators and staff the opportunity to discuss study progress. On May 23-26, 2017, research staff, PIs and Co-Is traveled from JHU to ETSU for a multi-day training on all aspects of fieldwork, including recruitment, health data collection, and environmental assessments. This was followed by additional training of ETSU staff, which took take place at JHU from May 30 through June 2, 2017 when the ETSU staff completed the National Institute for Occupational Safety and Health (NIOSH) course in Baltimore on administration of spirometry. The JHU trainings also included clinical trainings and clinical observations and assessments as well as opportunities to discuss operational issues and to review the study protocol. During the JHU visit the investigators (McCormack, Hansel, Koehler and Maisonet) lead discussions regarding the start of collaborative papers and possibly conducting research in additional rural areas, including Appalachia tribal areas.
Another critical development that took place during this award period was incorporating feedback from the local community via the Community Advisory Board (CAB) into the study protocol. Insights provided by CAB members brought to our attention the need to address participants’ access to health care and other household exposures not previously considered. Based on input on the CAB members, we made changes to the protocol and added the use of a personal activity monitor, the assessment of household ammonia concentrations, and a questionnaire assessing access to health care. As a result of interaction with CAB members, the ETSU study team were invited to speak about household air pollution at several events and participated in related meetings and groups, which presented additional opportunities to gauge stakeholders' knowledge on household air pollution and approaches to reduce such exposures. This information is being used to identify vulnerable groups and plan for the development of educational materials for diverse audiences in the upcoming year. Outreach efforts areas are outlined below:
- July 2016 to present Tennessee Healthy Homes Partnership – member
- November 2016 Senior Center, Kingsport, TN – speaker
- November 2016 Better Breathers Club, Kingsport, TN – speaker
- February 2017 Carter Country Health Council, Elizabethton, TN – speaker
- March 2017 School Nurse Training @ Indian Path Medical Center, Kingsport, TN – speaker
- March 2017 Happy Valley High School Health Fair, Elizabethton, TN – participant
- March 2017 East Tennessee State University Maternal and Child Health Interdisciplinary
Symposium, Johnson City, TN – speaker - March 2017 Johnson County Health Council, Mountain City, TN – speaker
- April 2017 Meeting: Valuating the Health, Social, and Building Systems Resilience Benefits of
Weatherizing Affordable Multifamily Housing: A Facilitation of Cross-Sector
Dialogues, Knoxville, TN – participant
A web page about the study was created on the ETSU College of Public Health website and can be viewed at http://www.etsu.edu/cph/respiratory.php. The study also has been covered by the Johnson City Press. The article is available at http://jcweb.libercus.net/Health-Care/2016/09/18/ETSU-part-of-National-Center-of-Excellence-on-Environmental-Health-Disparities-Research.html?ci=stream&lp=1&p=1.
Future Activities:
Future Activities for Project 1:
During the next reporting period we plan to continue with participant recruitment, the follow-up of COPD participants enrolled, and data collection. To accomplish our study goals, we are in the process of hiring additional coordinators to focus only on recruitment; this will allow us to progress rapidly with the recruitment plan over the next reporting period. We also have included additional recruitment materials including a newspaper ad, radio ad, and bus stop ad. Our study was selected by The Johns Hopkins Institute for Clinical and Translational Research (ICTR) and approved by the Johns Hopkins Medicine Institutional Review Board (IRB) as one of the first Johns Hopkins studies to pilot a new approach to invite JHU patients to participate in research studies. This new approach is through the JHU EPIC electronic medical record (EMR) MyChart’s patient portal that will send research study invitations to JHU patients who have agreed to receive study invitations based on inclusion criteria characteristics noted in their EMR that are in line with our research study, all potential participants can opt out of receiving the automated My Chart recruitment study invitation messages at any time.
Future Activities for Project 2:
During the next reporting period we plan to enroll about 33 participants within the ETSU catchment area during the next reporting period. Data quality and study progress will be assessed and reported on a weekly basis and preliminary data analysis will be done. Weekly calls will continue to take place between the ETSU and JHU teams, to discuss study progress and any issues. The ETSU team will continue to engage with members of the CAB and other stakeholders, identify opportunities for outreach and education on household air pollution, and identify educational materials on household air pollution that can be adopted or adapted for regional use. In addition, we will explore the use of social media for dissemination of information on household air pollution risks.
Projected study timeline:
- In year 3, of the calendar years 2017-2018, our focus will remain on screening, enrollment, participant follow-up, and data management and data collection.
- We estimate it will take 3 years to collect household air monitoring data (three 1-week air quality measurements per household x 100 households). Considering the number of air monitors available and distance between households in Northeast Tennessee we estimate participants household measures will be completed on the first quarter of 2020. The 9-months phone call should be completed by the second semester of 2020.
- We will continue identifying opportunities for outreach and education on household air pollution.
- Engagement with members of the CAB and other stakeholders will continue.
- Identification of educational materials on household air pollution that can be adopted or adapted for Regional use.
- We will explore the use of social media for dissemination of information on household air pollution risks.
Journal Articles: 36 Displayed | Download in RIS Format
Other center views: | All 50 publications | 36 publications in selected types | All 36 journal articles |
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Belli AJ, Bose S, Aggarwal N, DaSilva C, Thapa S, Grammer L, Paulin LM, Hansel NN. Indoor particulate matter exposure is associated with increased black carbon content in airway macrophages of former smokers with COPD. Environmental Research 2016;150:398-402. |
R836150 (2017) R836150 (2019) R836150 (2020) R836152 (2019) R836152 (2020) |
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Galiatsatos P, Kineza C, Hwang S, Pietri J, Brigham E, Putcha N, Rand CS, McCormack M, Hansel NN. Neighbourhood characteristics and health outcomes:evaluating the association between socioeconomic status, tobacco store density and health outcomes in Baltimore City. Tobacco Control 2018;27(e1):e19-e24. |
R836150 (2018) R836150 (2020) R836152 (2018) R836152 (2019) R836152 (2020) |
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Kemper T, Woo H, Belz D, Fawzy A, Lorisio W, Eakin M, Putcha N, McCormack M, Brigham E, Hanson C, Koch A, Hansel N. Higher Plasma Omega-3 Levels are Associated With Improved Exacerbation Risk and Respiratory-Specific Quality of Life in COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2024;11(9):293-302 |
R836150 (Final) |
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Lambert AA, Putcha N, Drummond MB, Boriek AM, Hanania NA, Kim V, Kinney GL, McDonald MN, Brigham EP, Wise RA, McCormack MC, Hansel NN, COPDGene Investigators. Obesity is associated with increased morbidity in moderate to severe COPD. Chest 2017;151(1):68-77. |
R836150 (2017) R836150 (2019) R836150 (2020) R836152 (2019) R836152 (2020) |
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Lemoine C, Brigham E, Woo H, Koch A, Hanson C, Hoffman E, Putcha N, McCormack M, Hansel N. Relationship between Omega-3 and Omega-6 Fatty Acid Intake and Chronic Obstructive Pulmonary Disease Morbidity. ANNALS OF THE AMERICAN THORACIC SOCIETY 2020;17(3):379-383. |
R836150 (2021) |
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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. |
R836150 (2019) R836150 (2020) R836152 (2018) R836152 (2019) R836152 (2020) R836156 (2018) R836156 (2019) R836156 (2020) |
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McCormack MC, Belli AJ, Waugh D, Matsui EC, Peng RD, Williams DL, Paulin L, Saha A, Aloe CM, Diette GB, Breysse PN, Hansel NN. Respiratory effects of indoor heat and the interaction with air pollution in chronic obstructive pulmonary disease. Annals of the American Thoracic Society 2016;13(12):2125-2131. |
R836150 (2019) R836150 (2020) R836152 (2018) R836152 (2019) R836152 (2020) |
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McCormack MC, Paulin LM, Gummerson CE, Peng RD, Diette GB, Hansel NN. Colder temperature is associated with increased COPD morbidity. European Respiratory Journal 2017;49(6):1601501. |
R836150 (2018) R836150 (2019) R836150 (2020) R836152 (2019) R836152 (2020) |
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McCormack M, Balsubramanian A, Wise R, Keet C, Matsui E, Peng R. Reply by McCormack et al. to Townsend and Cowl, and to Miller et al. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE 2022;206(6):795-796. |
R836150 (2021) |
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Moughames E, Galiatsatos P, Woo H, Romero-Rivero K, Raju S, Hoffman E, Ortega V, Parekh T, Krishnan J, Drummond M, Buhr R, Comellas A, Couper D, Paine R, Paulin L, Putcha N, Hansel N. Disparities in access to food and chronic obstructive pulmonary disease (COPD)-related outcomes:a cross-sectional analysis. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE 2021;21(1):139. |
R836150 (2021) |
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Peterson CE, Rauscher GH, Johnson TP, Kirschner CV, Barrett RE, Kim S, Fitzgibbon ML, Joslin CE, Davis FG. The association between neighborhood socioeconomic status and ovarian cancer tumor characteristics. Cancer Causes and Control 2014;25(5):633-637. |
R836150 (2020) NIMHD002 (Final) |
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Tejwani V, Rueda A, Khare P, Zhang C, Le A, Putcha N, D'Alessio F, Alexis N, Hansel N, Fawzy A. Airway and Systemic Prostaglandin E2 Association with COPD Symptoms and Macrophage Phenotype. CHRONIC OBSTRUCTIVE PULMONARY DISEASES - JOURNALF OF THE COPD FOUNDATION 2023;10(2):159-169 |
R836150 (2021) |
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Wu T, Fawzy A, Brigham E, McCormack M, Rosas I, Villareal D, Hanania N. Association of Triglyceride-Glucose Index and Lung Health A Population-Based Study. CHEST 2021;160(3):1026-1034 |
R836150 (2021) R836152 (Final) |
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Younas H, Vieira M, Gu C, Lee R, Shin MK, Berger S, Loube J, Nelson A, Bevans-Fonti S, Zhong Q, D’Alessio FR. Caloric restriction prevents the development of airway hyperresponsiveness in mice on a high fat diet. Scientific reports 2019;9(1):1-9. |
R836150 (2020) R834510 (Final) R836152 (Final) |
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Raju S, Keet CA, Paulin LM, Matsui EC, Peng RD, Hansel NN, McCormack MC. Rural residence and poverty are independent risk factors for chronic obstructive pulmonary disease in the United States. American journal of respiratory and critical care medicine. 2019;199(8):961-969. |
R836150 (2019) R836150 (2020) R836152 (2019) R836152 (2020) |
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Tsou PY, McCormack MC, Matsui EC, Peng RD, Diette GB, Hansel NN, Davis MF. The effect of dog allergen exposure on asthma morbidity among inner‐city children with asthma. Pediatric Allergy and Immunology 2020;31(2):210-3. |
R836150 (2020) R832139 (Final) R834510 (Final) R836152 (Final) |
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Paulin LM, Gassett AJ, Alexis NE, Kirwa K, Kanner RE, Peters S, Krishnan JA, Paine R, Dransfield M, Woodruff PG, Cooper CB. Association of long-term ambient ozone exposure with respiratory morbidity in smokers. JAMA internal medicine 2020;180(1):106-15. |
R836150 (2020) |
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Tarazona-Meza CE, Hanson C, Pollard SL, Rivero KM, Davila RM, Talegawkar S, Rojas C, Rice JL, Checkley W, Hansel NN. Dietary patterns and asthma among Peruvian children and adolescents. BMC pulmonary medicine 2020;20(1):1-9. |
R836150 (2020) |
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Zuidema C, Stebounova LV, Sousan S, Gray A, Stroh O, Thomas G, Peters T, Koehler K. Estimating personal exposures from a multi-hazard sensor network. Journal of exposure science & environmental epidemiology 2020;30(6):1013-22. |
R836150 (2020) |
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Hersh CP, Zacharia S, Chelvan RP, Hayden LP, Mirtar A, Zarei S, Putcha N, COPDGene® Investigators. Immunoglobulin E as a biomarker for the overlap of atopic asthma and chronic obstructive pulmonary disease. Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation 2020;7(1):1. |
R836150 (2020) |
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Koch AL, Brown RH, Woo H, Brooker AC, Paulin LM, Schneider H, Schwartz AR, Diette GB, Wise RA, Hansel NN, Putcha N. Obstructive Sleep Apnea and Airway Dimensions in Chronic Obstructive Pulmonary Disease. Annals of the American Thoracic Society 2020;17(1):116-8. |
R836150 (2020) |
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Galiatsatos P, Gomez E, Lin CT, Illei PB, Shah P, Neptune E. Secondhand smoke from electronic cigarette resulting in hypersensitivity pneumonitis. BMJ Case Reports CP 2020;13(3):e233381. |
R836150 (2020) |
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Ghosh B, Park B, Bhowmik D, Nishida K, Lauver M, Putcha N, Gao P, Ramanathan Jr M, Hansel N, Biswal S, Sidhaye VK. Strong correlation between air-liquid interface cultures and in vivo transcriptomics of nasal brush biopsy. American Journal of Physiology-Lung Cellular and Molecular Physiology 2020;318(5):L1056-62. |
R836150 (2020) |
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Galiatsatos P, Woo H, Paulin LM, Kind A, Putcha N, Gassett AJ, Cooper CB, Dransfield MT, Parekh TM, Oates GR, Barr RG. The Association Between Neighborhood Socioeconomic Disadvantage and Chronic Obstructive Pulmonary Disease. International Journal of Chronic Obstructive Pulmonary Disease 2020;15:981. |
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Galiatsatos P, Follin A, Alghanim F, Sherry M, Sylvester C, Daniel Y, Chanmugam A, Townsend J, Saria S, Kind AJ, Chen E. The Association Between Neighborhood Socioeconomic Disadvantage and Readmissions for Patients Hospitalized With Sepsis. Critical Care Medicine 2020;48(6):808-14. |
R836150 (2020) |
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Raju S, Brigham EP, Paulin LM, Putcha N, Balasubramanian A, Hansel NN, McCormack MC. The Burden of Rural Chronic Obstructive Pulmonary Disease:Analyses from the National Health and Nutrition Examination Survey. American journal of respiratory and critical care medicine 2020;201(4):488-91. |
R836150 (2020) |
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Wu TD, Fawzy A, Kinney GL, Bon J, Neupane M, Tejwani V, Hansel NN, Wise RA, Putcha N, McCormack MC. Metformin use and respiratory outcomes in asthma-COPD overlap. Respiratory research 2021;22(1):1-8. |
R836150 (2021) R836152 (Final) |
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Afshar-Mohajer N, Wu TD, Shade R, Brigham E, Woo H, Wood M, Koehl R, Koehler K, Kirkness J, Hansel NN, Ramchandran G. Obesity, tidal volume, and pulmonary deposition of fine particulate matter in children with asthma. European Respiratory Journal 2022;59(3). |
R836150 (2021) R836152 (Final) |
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Galiatsatos P, Brigham E, Krasnoff R, Rice J, Van Wyck L, Sherry M, Rand CS, Hansel NN, McCormack MC. Association between neighborhood socioeconomic status, tobacco store density and smoking status in pregnant women in an urban area. Preventive Medicine 2020:106107. |
R836150 (2020) |
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Eakin MN, Eckmann T, Dinglas VD, Akinremi AA, Hosey M, Hopkins RO, Needham DM. Association between participant contact attempts and reports of being bothered in a national, longitudinal cohort study of ARDS survivors. Chest 2020 Mar 17. |
R836150 (2020) |
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Sharp M, Brown T, Chen ES, Rand CS, Moller DR, Eakin MN. Association of Medication Adherence and Clinical Outcomes in Sarcoidosis. Chest 2020 Feb 4. |
R836150 (2020) |
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Burkes RM, Ceppe AS, Doerschuk CM, Couper D, Hoffman EA, Comellas AP, Barr RG, Krishnan JA, Cooper C, Labaki WW, Ortega VE. Associations Among 25-Hydroxyvitamin D Levels, Lung Function, and Exacerbation Outcomes in COPD:An Analysis of the SPIROMICS Cohort. Chest 2020 Jan 17. |
R836150 (2020) |
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Balasubramanian A, Kolb TM, Damico RL, Hassoun PM, McCormack MC, Mathai SC. Diffusing Capacity is an Independent Predictor of Outcomes in Pulmonary Hypertension Associated with Chronic Obstructive Pulmonary Disease. Chest 2020 Mar 14. |
R836150 (2020) |
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Tarazona-Meza CE, Nicholson A, Romero KM, Pollard SL, Gálvez-Davila RM, Hansel NN, Checkley W. Household food insecurity is associated with asthma control in Peruvian children living in a resource-poor setting. Journal of Asthma 2019 Aug 26:1-8. |
R836150 (2020) |
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Hanson C, Brigham E. Maternal nutrition and child respiratory outcomes:paradigms of lung health and disease. Eur Respir J |
R836150 (2020) |
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Swarr D, Putcha N, Zacharias W. “PIK” ing Out New Epigenetic Markers in Lung Disease. Am J Respir Crit Care Med . |
R836150 (2020) |
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Supplemental Keywords:
air pollution, obesity, COPD, diet, urban, indoor air pollution, ruralRelevant Websites:
http://www.etsu.edu/cph/respiratory.php Exit
Progress and Final Reports:
Original Abstract Subprojects under this Center: (EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
R836150C001 Obesity and Adverse Dietary Patterns as Susceptibility Factors to Pollutant Exposure in Urban COPD
R836150C002 Environmental Health Disparities in Rural Appalachia: The impact of air pollution, obesity and diet on COPD morbidity
The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.
Project Research Results
- Final Report
- 2021 Progress Report
- 2020 Progress Report
- 2019 Progress Report
- 2018 Progress Report
- 2016 Progress Report
- Original Abstract
36 journal articles for this center