Grantee Research Project Results
2019 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. , McCormack, Meredith , Rand, Cynthia , Koehler, Kirsten
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, 2018 through June 30,2019
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:
Project 1
Title: Obesity and adverse dietary patterns as susceptibility factors to pollutant exposure in urban COPD
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 through an observational study, will focus on low-income adults in an urban setting, aiming to determine whether elevated fat mass and body composition, adverse diet patterns increase susceptibility to indoor pollution in low income adults with COPD.
Project 2
Title: Indoor air pollution and COPD in rural Appalachia
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 2 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 569 potential eligible participants, of which 250 were eligible according to the phone screener The main reasons for telephone screener failure are related to out of catchment area (the percentage of screen failures due to catchment is 54%) the other cause for phone screen failures is current smoker status, which is 21% of the total number of phone screen fails. Currently, from the 237 participants eligible based on telephone screening, 47 have declined to participate for various reasons, while 21 were no longer eligible. Of the 156 participants that have signed a consent form, 79 are qualified to actively take part in the study based on our clinical screening criteria (exhaled carbon monoxide, pre and post spirometry) .
All 79 enrolled subjects have completed screening questionnaires, exhaled carbon monoxide (eCO) and spirometry testing in order to confirm our case definition, which is based upon GOLD guidelines (http://goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS.pdf). From the 79 enrolled and eligible, 69 have completed their baseline clinic and home visit to assess the indoor air quality (PM, nitrogen dioxide and air nicotine), 56 have completed their 3 month follow-up visit and 55 have completed their 6 month follow-up.
Items Number of Individuals
| Screened for eligibility | 569 |
| Consented | 156 |
| Enrolled & Eligible | 79 |
| Baseline home visit completed | 69 |
| 3 months home visit completed | 56 |
| 6 months home visit completed | 55 |
To date, participants enrolled were 55.6% black, 57% female, and had an average of age of 67 years. 15.3% of the enrolled participants did not finish high school, 65.3% reported a yearly income lower than $30,000, and 33% report some degree of food insecurity based on the Household Food Insecurity Score.
Participants have a mean BMI of 32.6 (60% obese), and the correlation between BMI and body fat percentage obtained through Densitometry (DEXA) assessment was moderate- high (0.72, p<0.001).
Food Frequency Questionnaires have been completed and analyzed on 68 participants at baseline and during each follow-up clinic visit. Participant’s mean total calorie intake was 2236 kcal and they consumed in average a low omega-3 intake (0.5±1.3g) and a high omega-6 intake (19.4±16.4g) suggestive trends towards unhealthy diets.
We have performed preliminary data analysis and results are described in the overall Annual Center Progress Report, Part A Research Project/Core’s Activities (Core C: Data Management Core). These results were also shared at the Environmental Health Disparities Centers Grant Meeting in Baltimore, MD on January 24-25, 2019.
Since the last reporting period, we have added, promoted existing, and replaced through attrition, several staff members to the research team to continue the work and help supervise the conduct of the research. Dr. Hansel encourages ongoing training of the staff and field workers, throughout the study.
In addition to the parent study, there are three ancillaries. For Dr. Laura Paulin’s career development award (K23ES025781), we have included new data collection instruments and enrolled 22 out of 60 participants into this ancillary study to date.
Corrine Hanson’s ancillary study has started to analyze the first 10 stool samples collected as part of the microbiome sub-study.
Dr. Nirupama Putcha is continuing work on her K23 funded by the NIH. The goal of her work is to understand whether allergic sensitization with environmental exposure is associated with worse outcomes in COPD. Her project is nested within the work of CURE COPD, and the progress she has made is reflective of the formidable support of the CURE study.
She has recruited 154 of the 160 planned participants and has completed some preliminary analysis of dust data from the first 90 participants of the study. Preliminary cross-sectional analysis of these data suggests that though allergen sensitization alone may not confer higher risks for exacerbations, but sensitization with exposure status are important to consider and that the home environment may greatly impact risk for outcomes in COPD. A manuscript from part of this work is now in preparation.
Project 2
During the past year, we have continued to have weekly meetings in the form of phone calls or WebEx. We have completed staff training and have conducted retraining for new staff and to ensure adherence to the protocol and collection of high quality data. We have begun enrolling participants and have completed follow-up visits.
Enrollment of study participants and data collection up to date:
Enrollment of study participants and data collection since June 2018.
Items Number of Individuals
| Screened for eligibility | 276 |
| Consented | 83 |
| Enrolled | 50 |
| Baseline home visit completed | 44 |
| 3 months home visit completed | 41 |
| 6 months home visit completed | 36 |
Participants enrolled were all white, 60% male, and had an average age of 73.6 years and a mean BMI of 30.7 (45% obese). 26% of the enrolled participants did not finish high school, 40% reported a yearly income lower than $30,000 representing a relatively low-income population with COPD.
The study team continues to actively seek opportunities for community outreach and education. As a result, we have been invited to speak and/or distribute educational materials about household air pollution and ways to minimize it at different events (11 events during the last year).
Drs. Maisonet and McCormack attended the Environmental Health Disparities Centers Grant Meeting in Baltimore, MD on January 24-25, 2019. Dr. McCormack attended the NIH meeting, “COPD and Rural Health: A Dialogue on the National Action Plan” on March 19th.
Dr. McCormack presented “Implementation of a panel exposure and health study in a rural setting” at the International Society of Environmental Epidemiology, Ottawa, Canada in August 2018. She spoke at National Rural Health Institute Rural COPD Stakeholder Meeting in Washington, DC about “Independent Risks for COPD” on February 6, 2019. She will be co-chairing the symposium, “ Rurality in COPD: Defining the problem and deploying novel care delivery approaches ” at the American Thoracic Society Meeting in May 2019 .
Future Activities:
Project 1
During the next reporting period, we plan to finalize the participant recruitment (reaching the 120 enrolled goal), and continue the follow-up of COPD participants enrolled, and data collection.
To accomplish our study goals, we have increased the number of staff dedicated to these activities, reviewed training materials, and increased the frequency of screening visits available in the clinic schedule. We have also increased placement of recruitment materials including in newspapers advertisements.
We have had some success recruiting through the Johns Hopkins Community Physicians (JHCP) and will continue to acquire updated lists of diagnosed COPD patients from this source. We did not find a good return using Baltimore Research (https://www.baltimoreresearch.com/) the national recruiting research service which tracks over 150 medical conditions including COPD, BMI and income and have discontinued that as a recruitment source. Additional plans for the next year include follow-up of COPD participants, QC of the data collected and data analysis and manuscript preparation. Already, interim data analysis (see data core section in Overall Report) supports the hypotheses of the aims of the project as proposed in the original application.
Already preliminary data analysis has led to data supporting the role of omega-3 consumption in COPD outcomes and has led to the work of pulmonary fellow, Abigail Koch, to receive a fundable score on her NRSA submission. In addition, in February we initiated a feasibility pilot of a dietary intervention to increase Omega-3 intake. So far we have completed intervention in two participants (goal is 20).
Project 2
We plan to carry out the following tasks during the next reporting period:
During the next reporting period, we plan to continue with participant recruitment, follow up of COPD participants enrolled, and data collection. We will continue preliminary analysis and begin manuscript preparation. In addition, we plan to increase the number and type of outreach and education activities held; identify educational materials on household air pollution that can be adopted or adapted for Regional use; and develop and evaluate a social media platform 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 |
|---|
| Type | Citation | ||
|---|---|---|---|
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit Exit |
|
|
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) |
Exit |
|
|
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) |
Exit Exit Exit |
|
|
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) |
Exit |
|
|
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) |
Exit Exit |
|
|
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) |
Exit Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
|
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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. |
R836150 (2020) |
|
|
|
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) |
|
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
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) |
Exit |
|
|
Hanson C, Brigham E. Maternal nutrition and child respiratory outcomes:paradigms of lung health and disease. Eur Respir J |
R836150 (2020) |
Exit |
|
|
Swarr D, Putcha N, Zacharias W. “PIK” ing Out New Epigenetic Markers in Lung Disease. Am J Respir Crit Care Med . |
R836150 (2020) |
Exit |
Supplemental Keywords:
air pollution, obesity, COPD, diet, urban, indoor air pollution, COPD, obesity, diet, rural.Relevant Websites:
ETSU - Household Air Pollution and COPD Study 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
- 2018 Progress Report
- 2017 Progress Report
- 2016 Progress Report
- Original Abstract
36 journal articles for this center