Grantee Research Project Results
2020 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, 2019 through June 30,2020
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:
Since our last report, the Center has made progress toward the primary research aim to increase understanding of the role of indoor air pollution on COPD health disparities identified in two different low-income US communities: an urban community (Baltimore City) and a rural community (Appalachian region). The Center has also made progress on the secondary aim of understanding the role of obesity and poor dietary intake as factors that are common in low-income communities and may increase susceptibility to indoor pollution exposure.
The Center Cores functioned well in support of these aims. The Administrative Core has continued to provide governance and coordination for the overall Center. Even as faculty and staff have shifted to working from home during the COVID pandemic, mentoring of clinical and post doc fellows has continued, as have efforts to share data and encourage collaboration and promote scientific interactions with invited internal and external guest speakers. The Environmental Core has provided specialized sampling methodology expertise supporting the projects, carried out exposure assessment activities, data collection and developed the home visit protocol modifications needed to perform environmental sample collection protocols safely after the COVID outbreak. The Data Management Core has continued to conduct data quality management for all data, and provided preliminary analysis, some of which was presented during the 2020 EHD retreat. The DMC helped our investigative team to publish 22 new manuscripts. Six (06) new abstracts were submitted to the ATS-2020 Congress (currently under preparation), and additional 07 papers are under peer-review. The Community Engagement Core developed a new virtual learning program in response to the Covid-19 pandemic, where Johns Hopkins University students and staff share information about the novel coronavirus with school kids K-12 student awareness about the science of COVID-19 and the public health response. Based on our novel Lung Health Ambassador Program (LHAP), the virtual program allows us to reach a greater and broader audience than we had previously been able
For Projects 1 and 2, University guidelines and have meant that we stopped enrolling participants during the Coronavirus pandemic. In light of this, we have implemented remote pre-screening options and developed a list of eligible candidates to enroll beginning in January 2021. We have adapted equipment and protocols to be contactless and have ordered user friendly devices for deployment in participant homes. Further, we have used this time to analyze stored biospecimens and environmental samples.
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 Title: Obesity and adverse dietary patterns as susceptibility factors to pollutant exposure in urban COPD
To date, we have telephone screened 849 potential eligible participants, of which 359 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 42%) the other cause for phone screen failures is current smoker status, which is 14% of the total number of phone screen fails. Currently, from the 359 participants eligible based on telephone screening, 71 have declined to participate for various reasons, while 33 were no longer eligible. Of the 221 participants that signed a consent form, 106 were qualified to actively take part in the study based on our clinical screening criteria (exhaled carbon monoxide, pre and post spirometry).
All 106 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 106 enrolled and eligible, 91 have completed their baseline clinic and home visit to assess the indoor air quality (PM, nitrogen dioxide and air nicotine), 82 have completed their 6 month follow-up.
To date, participants enrolled were 47% black, 58% female, and had an average of age of 65 years. 15.3% of the enrolled participants did not finish high school, 64% reported a yearly income lower than $30,000, and 29% report some degree of food insecurity based on the Household Food Insecurity Score.
Participants have a mean BMI of 32.4 (57% 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 89 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 (EPA +DHA) intake (0.35±0.42g) and a high omega-6 intake (16.4±9.8g) 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 Virtual Meeting on November, 2020.
In addition to the parent study, there are three new ancillary studies adding to a six new studies total.
For Dr. Laura Paulin’s career development award (K23ES025781), we have completed data collection for 53 out of 60 participants into this ancillary study to date. Dr. Corrine Hanson’s ancillary study has started to analyze the first 10 stool samples collected, and a total of 65 stools samples are available as part of the gut microbiome sub-study. Dr. Nirupama Putcha has finalized data collection for 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 data analysis is currently ongoing suggesting that allergen sensitization alone may confer higher risks for exacerbations, and sensitization with exposure status are important factors to consider, therefore highlighting how the home environment may greatly impact risk for outcomes in COPD. A manuscript from part of this work is now in preparation.
In addition, 1) Dr. Ashraf Fawzy is planning an ancillary study on the role of air pollution and platelet activation (NRSA and K23 awardee); he is measuring 3 markers of platelet activation to determine associations with indoor air pollution and respiratory outcomes; 2) Dr. Vickram Tejani is exploring the macrophage black carbon as a marker of COPD worst clinical outcomes; and 3) Dr. Lesliam Quiroz is looking for the association between Phthalates (measured in urine samples) and COPD morbidity.
Interim data analysis (see data core section in Overall Report) led to data supporting the role of omega-3 consumption in COPD outcomes, therefore in February 2019, we initiated a feasibility pilot of a dietary intervention (food voucher program + dietary counseling) to increase Omega-3 intake. We have completed this pilot study randomizing 20 participants (10 intervention group and 10 control group). At 4 weeks, intervention group reported a 4-fold increase in high-omega-3 rich fish and seafood intake (p=0.002); 43% increase in plasma EPA+DHA levels compared to control. This highlight the potential role of dietary approaches as a novel approach to improve respiratory disease management.
Project 2 Title: Indoor air pollution and COPD in rural Appalachia
To ensure we meet our enrollment goal, this past year we established a second location within Appalachian region. Our second location is the George W. Comstock Center for Public Health Research and Prevention (the JHU Comstock Center) in Hagerstown, Maryland. Johns Hopkins University’s Comstock Center has a well-established relationship with the residents of Washington County and surrounding Appalachia region.
Enrollment of study participants and data collection up to date:
Items Number of Individuals
Screened for eligibility 306
Consented 170
Enrolled 60
Baseline home visit completed 55
3 months home visit completed 55
6 months home visit completed 52
Participants enrolled were mostly white (98%), 58% male, and had an average age of 71.7 years and a mean BMI of 30.7 (51% obese). 26% of the enrolled participants did not finish high school, 44% reported a yearly income lower than $30,000 representing a relatively low-income population with COPD.
Food Frequency Questionnaires have been completed and analyzed on 43 participants at baseline. Participants consumed in average a low omega-3 (EPA +DHA) intake (0.28±0.30g) and a high omega-6 intake (15.7±7.1g) 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 Virtual Meeting in November, 2020.
The study team continues to actively seek opportunities for community outreach and education. In addition to activities in East Tennessee, the team has expanded to reach rural areas of Maryland. In July 2019, Dr. Galiatsatos received a Chest Foundation Award to support expansion of the Lung Health Ambassador Program to rural areas, focused on Maryland. As a result, we have been delivered the curriculum to thirteen schools and community centers in St. Mary’s and Calvert Counties. Expansion is underway to online curriculum delivery in order to reach a broader audience. The outreach activities in partnership with the Comstock Center focus on COPD and environmental health education. These activities focus on Washington, Alleghany, and Garrett counties.
In addition to the parent study, one ancillary study was added. Dr. Sarath Raju planned a NIEHS F32 sub-study to understand the impact of household heating practices and solid fuels on respiratory morbidity. To date, we have completed data collection for 22 participants into this ancillary study.
Future Activities:
Project 1 Title: Obesity and adverse dietary patterns as susceptibility factors to pollutant exposure in urban COPD
During the next reporting period (NCE), we plan to finalize the participant recruitment (reaching the 120 enrolled goal), and finalize data collection. Unfortunately because of the COVID pandemic and subsequent limitations to clinical research studies, we had to stop recruitment for our study, but we have just received IRB approval to resume research in-person study visits. We have identified 15 potential candidates and will bring them to complete their screening visit during the next months. In addition, we have implemented remote pre-screening options (ie: Trial Facts, which is a website-based recruitment tool which has been recently approved for our IRB) to develop an additional list of eligible candidates. To accomplish our study goals, all our active participants are having visits conducted by phone.
Additional plans for the next year include follow-up of COPD participants, QC of the data collected and data analysis and manuscript preparation. 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 (ie: preliminary data analysis has led to data supporting the role of omega-3 consumption in COPD outcomes).
Project 2 Title: Indoor air pollution and COPD in rural Appalachia
We plan to carry out the following tasks during the next reporting period: During the next reporting period, we plan to complete enrollment of the goal of 100 participants. This will include participants from a second cohort recruited from Western Maryland in addition to those who have completed data collection from East Tennessee. Our second location is the George W. Comstock Center for Public Health Research and Prevention (the JHU Comstock Center) in Hagerstown, Maryland. Johns Hopkins University’s Comstock Center has a well-established relationship with the residents of Washington County and surrounding areas. Clinic and environmental training sessions were performed with Comstock staff in 2019, prior to pausing research activities due to COVID 19. We plan to complete enrollment goal of 50 participants with a modified contactless protocol to meet the goal of 100 total for project 2 in the upcoming year.
We will continue data analysis and begin manuscript preparation. In addition, hope to identify educational materials on household air pollution that can be adopted or adapted for regional use; and develop and evaluate a online platforms for dissemination of information on household air pollution risks.
Journal Articles: 35 Displayed | Download in RIS Format
Other center views: | All 49 publications | 35 publications in selected types | All 35 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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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. |
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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. |
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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 |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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Hanson C, Brigham E. Maternal nutrition and child respiratory outcomes:paradigms of lung health and disease. Eur Respir J |
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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 . |
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Supplemental Keywords:
indoor air pollution, COPD, obesity, diet, rural, urbanRelevant Websites:
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
- 2019 Progress Report
- 2018 Progress Report
- 2017 Progress Report
- 2016 Progress Report
- Original Abstract
35 journal articles for this center