Grantee Research Project Results
2021 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 , Diette, Gregory B. , Putcha, Nirupama , Peng, Roger D. , Galiatsatos, Panagis , Raju, Sarath , Fawzy, Ashraf , Eakin, Michelle , Brigham, Emily
Current 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, 2020 through June 30,2021
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 Center’s aim is to increase understanding of the role of indoor air pollution to the COPD health disparities identified in low income settings; we have chosen to focus our studies on the role of indoor air pollution (particulate matter, PM and nitrogen dioxide, NO2) exposures on COPD morbidity in two different low-income US communities: an urban community (Baltimore City) and a rural community (Appalachian region). We also have a specific focus on understanding the role of obesity and poor dietary intake (low anti-oxidant, pro-inflammatory diet) as factors that are common in low-income communities and may increase susceptibility to indoor pollution exposure.
Project 1: 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: 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:
During the previous 12 months of the program award, the Co-Program Directors, Nadia N Hansel, MD MPH and Gregory B. Diette, MD, have maintained a well-trained staff providing essential support to the faculty, students, and researchers with the objectives of the Johns Hopkins University Centers of Excellence on Environmental Health Disparities Research and the Comparing Urban and Rural Effects of Poverty on COPD (CURE COPD).
A central point of focus of the Center has been to cultivate the framework that promotes responsible governance of the Center’s Cores and Projects. During this reporting time, we have applied ongoing quality management, promoted the development of data management, safety management and statistical analysis plans. We have managed cooperative agreements and other dynamic administrative documents including best practice project guidelines and Standard Operating Procedures (SOP), Manual of Procedures (MOP) that facilitate the Center’s scientific integrity. These documents are routinely monitored by key team members, making certain that they are reassessed and up-to-date.
To date, Project 1 has enrolled 115 COPD participants (99 at Baseline). As presented in individual project and environmental core sections, the enrolled subjects represent low-income individuals with moderate to severe COPD with a high prevalence of obesity. In addition, as anticipated, these subjects reside in homes that tend to have indoor pollutant concentrations that are on average, higher than outdoor air and higher than indoor concentrations seen in many indoor home environments.
Project 2. To date, Project 2 has enrolled 124 COPD participants (78 completed baseline visits).Over the past year, we established our second location within Appalachia 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 areas. Clinic and environmental training sessions were performed with Comstock staff in late summer and early Fall 2019. Due to COVID-19, modified, contactless protocols were developed and implemented. We plan to complete enrollment using our modified protocols. Additionally, we have used this time to complete data quality control checks of already collected data, as well as analyze stored biospecimens and environmental samples.
Project 1: Obesity and adverse dietary patterns as susceptibility factors to pollutant exposure in urban COPD
To date, we telephone screened 995 potential eligible participants, of which 399 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 38%), current smoker status, which is 33% of the total number of phone screen fails. Currently, from the 399 participants eligible based on telephone screening, 82 declined to participate for various reasons, while 46 were no longer eligible. Of the 244 participants that signed a consent form, 115 qualified to actively take part in the study based on our clinical screening criteria (exhaled carbon monoxide, pre and post spirometry).
All 115 enrolled subjects 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 115 enrolled and eligible, 99 completed their baseline clinic and home visit to assess the indoor air quality (PM, nitrogen dioxide and air nicotine), 86 completed their 6 month follow-up.
Participants enrolled were 57% black, 57% female, and had an average of age of 66 years. 17.4% of the enrolled participants did not finish high school, 67% reported a yearly income lower than $30,000, and 26% report some degree of food insecurity based on the Household Food Insecurity Score.
Participants have a mean BMI of 32.3 (59.6% obese), and the correlation between BMI and body fat percentage obtained through Densitometry (DEXA) assessment was moderate- high (0.70, p<0.001).
Food Frequency Questionnaires have been completed and analyzed on 95 participants at baseline and during each follow-up clinic visit. Participant’s mean total calorie intake was 2029 kcal and they consumed in average a low omega-3 (EPA +DHA) intake (0.31±0.34g) and a high omega-6 intake (14.6±8.3g) 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.
For Dr. Laura Paulin’s career development award (K23ES025781), we completed data collection for 59 participants into this ancillary study. Participant’s mean expectorated total mucin concentration was 8.43±11.36mg/mL and mean mucus percentage solid was 3.63±2.47. The mean percent mucociliary clearance (MCC) measure through 60 minutes and 90 minutes were 12.4±9.1 and 15.9±10.8 respectively. Preliminary analysis suggests that higher total mucin concentration worsens the adverse association between indoor nitrogen dioxide (NO2) and several COPD severity measures, including COPD assessment test score (CAT), and lung function as measured by FEV1 percent predicted.
In addition to the parent study, there are ancillary studies nested within Project 1.
In addition, 1) Dr. Ashraf Fawzy received a K23 award to look at markers of platelet activation to determine associations with indoor air pollution and respiratory outcomes; 2) Dr. Vickram Tejani investigated the role of macrophage black carbon as a marker of COPD worse clinical outcomes (Tejwani et al. COPD. 2021); and 3) Dr. Lesliam Quiroz and Dr. Daniel Belz are investigating the association between Phthalates (measured in urine samples) and COPD morbidity as part of an NRSA award; 4) Dr. Sarath Raju was recently awarded a K12 award “Understanding the Respiratory Health Effects of Air Pollution among Persons Living with HIV” and received an impact score of 20 on his recently submitted K23 award, entitled “Air Pollution’s Impact on Lung Aging in HIV”.
Finally, Associate Professor of Medicine, Dr. Nirupama Putcha, has published Home Dust Allergen Exposure is Associated with Outcomes Among Sensitized Individuals with COPD (Putcha et al. AJRCCM 2021). This study, nested within CURE1, demonstrates that allergen exposures are common in COPD and associated with adverse outcomes among those with concomitant allergen sensitization. This work is novel in that it is the first to show that home allergen exposure may impact respiratory health in patients with COPD, regardless of eosinophil levels.
Based on preliminary data supporting the role of omega-3 consumption in COPD outcomes, we have completed a feasibility pilot of a dietary intervention (food voucher program + dietary counseling) to increase Omega-3 intake. The pilot study randomized 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 highlights the potential role of dietary approaches as a novel approach to improve respiratory disease management. Dr Hansel recently received notice of a new R01 award, which will support a full trial of this hypothesis and related aims.
Project 2: Indoor air pollution and COPD in rural Appalachia
To date, Project 2 has enrolled 124 COPD participants (78 completed baseline visits). Over the past year, we continued enrollment at our second location within Appalachia 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 areas. Clinic and environmental training sessions were performed with Comstock staff in late summer and early Fall 2019. Due to COVID-19, modified, contactless protocols were developed and implemented. We plan to complete enrollment using our modified contactless protocol. Additionally, we have used this time to complete data quality control checks of already collected data, as well as analyze stored biospecimens and environmental samples.
Preliminary data on East Tennessee State University (ETSU) cohort is summarized in Table 1 and 2. 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 (see Table 1). Study results demonstrate that indoor air pollution is associated with increased respiratory morbidity among participants with COPD.
| range | N | |||
| 71.55 ± 8.30 | (52.0-91.0) | 56 | ||
| 24 (42.9%) | 56 | |||
White | 55 (98.2%) | 56 | |||
Education | 56 | ||||
High school grad or less | 32 (57.1%) | 56 | |||
Some college | 13 (23.2%) | 56 | |||
College grad or above | 11 (19.6%) | 56 | |||
Annual household Income | |||||
<$30k | 25 (44.6%) | 56 | |||
$30k-$50k | 11 (19.6%) | 56 | |||
$50k-$70k | 6 (10.7%) | 56 | |||
>$70k | 11 (19.6%) | 56 | |||
DK/Refused | 3 (5.4%) | 56 | |||
Insurance | |||||
Plan via employer/union (of self or family member) | 4 (7.1%) | 56 | |||
Plan via self-purchase or family member purchase. | 5 (8.9%) | 56 | |||
Medicare | 36 (64.3%) | 56 | |||
Medicaid or other state program | 5 (8.9%) | 56 | |||
TRICARE, VA, or Military | 6 (10.7%) | 56 | |||
Married | 36 (64.3%) | 56 | |||
BMI | 30.78 ± 8.22 | (16.0-57.6) | 56 | ||
Obese (BMI≥30) | 27 (48.2%) | 56 | |||
Pack-Years | 62.41 ± 38.73 | (15.0-210.0) | 56 |
Table 1. Participant Characteristics, CURE2 baseline (ETSU only)
Effect Estimate | 95% CL | P Value | |
mMRC (>2 vs <2) (OR) | 2.08 | 1.15 to3.74 | 0.015 |
SGRQ Total Score Clinical COPD Questionnaire (CCQ) | 2.05 | 0.86 to 3.25 | 0.001 |
0.13 | 0.04 to 0.22 | 0.006 | |
COPD Assessment Test (CAT) | 0.38 | -0.24 to 0.99 | 0.228 |
Rhinitis Control Assessment Test (RCAT) | -0.54 | -1.21 to 0.13 | 0.113 |
FEV% predicted | 0.08 | -1.13 to1.28 | 0.903 |
Table 2. The Association Between a Two- Fold increase iN PM 2.5 and Markers of COPD Morbidity
Future Activities:
Project 1: Obesity and adverse dietary patterns as susceptibility factors to pollutant exposure in urban COPD
During the next reporting period (NCE), we plan to finalize follow up visits and data collection. To accomplish our study goals the focus for the next reporting period will include:
1. To complete study visits by March, 2022 each of the remaining participants will complete screening, 0-month, 3-month, and 6-month visits as well as monthly exacerbation calls.
2. We anticipate we will have collected and stored urine and blood samples at each of the three time points for study participants. These samples will be sent for analysis in batch.
Additional plans for the next reporting period include QC of the data collected and data analysis and manuscript preparation. Interim data analysis otheses of the aims of the project as proposed in the original application.
Project 2: Indoor air pollution and COPD in rural Appalachia
We plan to carry out the following tasks during the next reporting period: We will complete remaining follow-up visits for participants enrolled at the George W. Comstock Center for Public Health Research and Prevention (the JHU Comstock Center) in Hagerstown, Maryland. We will continue data analysis and begin manuscript preparation. We will continue to develop approaches to provide education and dissemination of results to local communities.
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. |
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. |
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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. |
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. |
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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:
The JHU study website Exit , ETSU study website 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
- 2020 Progress Report
- 2019 Progress Report
- 2018 Progress Report
- 2017 Progress Report
- 2016 Progress Report
- Original Abstract
35 journal articles for this center