The Michigan Center for the Environment and Children's Health (MCECH) has had many accomplishments that are contributing to the science, practice and policy efforts related to the field of children's environmental health.  A number of these specific results are described in more detail throughout this website.  Also, given that we are in the early stages of analyzing the data collected as part of the Center's activities, additional findings are forthcoming.  Overall, the Center has had an impact in the following areas:

• enhanced knowledge and understanding of the social and physical environmental factors associated with childhood asthma;
• improved knowledge about asthma and environmental triggers, and access to resources to reduce those triggers for the children and families enrolled in the intervention;
• enhanced knowledge and understanding of community-based participatory approaches to research and intervention design, implementation and evaluation;
• increased validity, quality and relevance of the interventions and research due to the active involvement of community partners in all aspects of the process;
• increased recognition of and support for the use of community-based participatory approaches to research and public health practice;
• increased involvement of communities of color in the research and intervention process, communities that have been historically excluded from such involvement; and
• enhanced training opportunities at the masters, doctoral, and post-doctoral levels in the conduct of interdisciplinary, community-based participatory research focused on children's environmental health.

Given the complexity of the research questions being asked, the comprehensiveness of the interventions being conducted, and the commitment to and benefits of working in partnership with communities, academia, and health practitioners, the Center funding mechanism has allowed us to pull together a diverse interdisciplinary team that has created the intellectual synergy required to conduct this research.  Each of the research core projects draw upon data collected and methods used across the projects, resulting in a richer, more expansive knowledge and experiential base from which the research and interventions are conducted, than would be possible with a single individual funded grant.  Furthermore, the impact of the Center has been enhanced through collaborations with other Children's Centers (e.g., through shared protocols, questionnaires, and data analysis methods).  A more in-depth examination of some of the specific accomplishments of the Center follows.

IMPACT ON THE FIELD

The exposure assessment core and intervention core that have been integrated to form the Community Action Against Asthma (CAAA) project are filling important knowledge gaps and helping to redirect the scientific agenda for the field in several ways.  Much of what has been learned and/or accomplished through MCECH will be of particular value to the upcoming national Children's Health Study, given the similarities of assessing multiple exposures to children's health in a longitudinal fashion.  A description is provided below of specific examples of the impact of the Center.

Development of innovative methods to find (and to assist) children with undiagnosed and undertreated asthma.
The strategy employed by our Center involved the distribution of validated screening questionnaires to a large population-based sample of urban elementary school children.  Among slightly more than 3000 returned questionnaires, we were able to identify more than 100 children with responses consistent with moderate to severe persistent asthma who had not received a diagnosis of asthma by a health-care provider (this represents just over 30 percent of all children with moderate to severe asthma who returned questionnaires).  In addition, even among those children who had been given a diagnosis of asthma, lack of integration into the medical care system and resulting significant undertreatment of asthma was very frequent.  As an example, more than 50 percent of those children with moderate to severe asthma did not report daily use of a controller medication.  The methods used to successfully contact the families of children with asthma and encourage returned questionnaires included working with the schools to mail questionnaires to home addresses, distribution of questionnaires in schools, and presentations about the effort in a large variety of community fora by persons with strong roots in these communities.

This kind of approach to the identification of children with asthma has a number of advantages over the more "traditional" approach of identification through health-care providers and services.  These advantages include the ability:  to develop true, population-based estimates of asthma prevalence without the selection biases inherent in identifying only those children interacting with the health-care system; to identify and enroll children with undiagnosed asthma as participants in epidemiologic and intervention studies; and to offer such children direct assistance on strategies to control their asthma.

Innovative air sampling instrumentation.
Indoor air sampling systems were designed and fabricated at the University of Michigan Air Quality Laboratory (UMAQL) (Keeler et al. 2002).  These pump systems utilize linear free-piston vacuum pumps, needle valves, and timers to provide accurately regulated air flow for PM sample collection.  Acoustically insulated wood cases, designed for operation in the classroom and home environments, house the pumps thus minimizing pump noise during sampling periods.  Special attention was given to details such as noise and size of the equipment through close communication with our community partners and participating families.

Automated samplers for ambient PM collection, although ideally suited to fixed-site outdoor air monitoring efforts tend to be prohibitively large, costly, and immobile for indoor home and personal exposure monitoring.  To circumvent these problems, customized manual sampling techniques were developed for CAAA that allow these types of exposure monitoring to be conducted.  Because it is necessary to utilize different sampling systems and approaches to quantify PM levels in each of the micro-environments (i.e., indoor, outdoor, personal), a sampler methods comparison was performed to characterize any inherent differences in sampler performance for PM collection (Dvonch et al. 2000).  This information is essential to the research community because different sampler inlets and monitors are used in each of the micro-environments sampled within urban areas (Keeler et al. 2002).

Field and statistical methods to generate and evaluate reliable daily repeated measures of pulmonary function.
The introduction of digital hand-held peak flow monitors able to automatically record date, time, peak expiratory flow, and FEV1 has substantially improved the validity and reliability of pulmonary function data collected without the benefit of direct observation and coaching by health-care personnel.  Nevertheless, frequently in past studies of children using such monitors, the obtained data has been felt to be of such great variability and poor reliability as to be unusable for analyses investigating relationships between environmental factors and fluctuations in health status.  One major difficulty with this type of data, is that, while the maximum possible peak flow and FEV1 at any given point in time is the desired endpoint, participants may easily produce spuriously high values by improper technique.  Our study has included the collection of morning and evening expiratory maneuver results among more than 200 children over two and half years during eleven seasonal 14 day periods.  We have developed innovative field, as well as statistical, methods to improve the validity and usefulness of this data.  Field strategies have included: extensive training and retraining each season in proper technique of the participating children and parents; the introduction of digital peak flow meters which record and indicate to the participant technique and length of blow errors; having participating children complete most morning blows at school while been observed and coached by study personnel; and having children perform expiratory maneuvers using the peak flow meters while at school immediately followed by coached expiratory maneuvers using all ATS criteria on a portable spirometer.  Innovative statistical methods used have included: comparison of coefficients of variation between expiratory maneuvers with and without error messages, and with or without setting a maximum allowable value as a percent of predicted to be considered non-spurious; and comparison to results from extensive coached and observed spirometry data to determine a reliable "personal best" benchmark.  The latter approach was possible in a very similar study, that builds upon the work of CAAA, carried out in Durban, South Africa which used the same peak flow meters.  In the Durban study, baseline spirometry, methacholine challenge testing, and post bronchodilator values were obtained allowing estimation of the individual's "personal best" values for peak flow and FEV1.  The performance of various strategies to identify non-spurious values in the Detroit data could then be validated against the performance of these strategies in the Durban data when measured against spirometry-generated values.

Comprehensive simultaneous evaluation of the physiochemical and psychosocial factors for asthma aggravation.
Aggravation of asthma reflected in increased symptoms, poor pulmonary function, and increased health-care utilization and medication use, has been associated both with ambient air pollutants, indoor contaminants including allergens, measures of socioeconomic status, and various measures of stress.  Few studies have attempted to comprehensively evaluate physical and chemical triggers in both the outdoor and indoor environment, and at the same time psychosocial risk and mitigating factors.  CAAA has employed such a comprehensive strategy so that we are able to evaluate independently physiochemical and psychosocial risk factors as well as any synergistic effects.  Physiochemical measures of exposure have included ambient, indoor (homes and schools), and personal sampling of PM10 and PM2.5; ambient ozone; concentrations of common allergens in household dust; and indoor vapor phase nicotine as a marker of tobacco smoke.  In addition, risk factors within homes have been evaluated through household walkthroughs, and neighborhood risk factors have been evaluated by similar systematic assessment of hazards.  Psychosocial factors evaluated have included caregiver's perception of individual level factors such as social support, and exposure to daily hassles and chronic stressors, and caregiver's perception of more neighborhood and contextual factors, such as social capital, neighborhood participation, neighborhood violence, and physical environmental risks.  Complex regression models are being constructed to examine the joint effects of exposures in these various domains.  Our experience in comprehensive simultaneous evaluation of the physiochemical and psychosocial factors for asthma aggravation will be extremely valuable for the upcoming Children's Health Study which is seeking to examine similar factors in a broader framework.

Development of sophisticated statistical methods.
The Center provides an unique opportunity for biostatisticians to collaborate and interact with investigators in an interdisciplinary research team.  This opportunity encourages biostatisticians to understand different disciplines in order to develop a comprehensive data analysis plan.  It stimulates discussions and developments of sophisticated statistical methods to reflect the interdisciplinary nature of the research and to account for the features of the data subject to many dimensions.  The scope of the research in the Center has generated many statistical challenges for biostatisticians and presented them with emerging statistical issues on study design and data analysis that require developing novel statistical methods.  Examples include estimating individual air pollution exposures; handling dropouts and movers; handling various types of missing data; accounting for the longitudinal nature of the data; developing comprehensive measures for medication use and asthma severity.  These developments will advance statistical, methodological research in environmental and children's health.

Successfully engaging community partners in the design, implementation and evaluation of the research.
In recent years, many federal agencies and foundations have called for more community involvement in the design and implementation of research activities.  The research design and implementation of our Center's research components have been directed by a Steering Committee comprised of both academic and community partners with strong participation in decision-making by all members of the Steering Committee.  The Steering Committee has adopted and adheres to a set of community-based participatory research (CBPR) principles that emphasize the active involvement of community members in all aspects of the research and intervention, aimed at benefiting the community.  The community involvement has greatly enhanced the study, particularly in the field techniques.  In addition, the use of a CBPR approach has enhanced the relevance, content, and quality of the data collected.  For example, the questions included on the survey questionnaire were revised and improved by the Steering Committee to be more relevant and understandable to the respondents.  At the Steering Committee's advice, we also hired and trained community members as interviewers who were more easily able to develop rapport and obtain quality data.  Furthermore, the lessons learned by our Center in engaging community members in environmental health research (Parker et al., under review) will contribute greatly to the gaps in knowledge of how to engage community members in environmental health research and more broadly, all prevention research.  This knowledge will also be extremely valuable for the upcoming Children's Health Study.

Implementation of a multi-faceted household intervention.
Another major accomplishment of the intervention component has been the successful implementation of a household/family intervention by lay health workers.  Although the final intervention data results are not yet available, the intervention component has had numerous implementation successes.  For example, the project has shown that lay health workers can be trained to implement Integrated Pest Management (IPM) activities in households.  This implementation finding has two major implications for interventions attempting to utilize Integrated Pest Management techniques in urban homes.  First, it appears that using trained lay health workers from the community to implement the Integrated Pest Management activities enhances the research participants' willingness to undertake IPM activities.  Second, using lay health workers is an economical approach for public health programs as compared to having to rely on professional exterminators.  The results of the process evaluation have also identified the following accomplishments:  increased knowledge among family members about asthma and methods for reducing asthma symptoms; increased access to materials and resources needed to reduce asthma symptoms; behavior changes and modifications to reduce environmental triggers (e.g., removing carpeting, eliminating pests such as cockroaches, using improved housekeeping methods, and quitting smoking indoors or completely) (Williams 2001).

Development of a novel murine model of asthma.
This Center grant has allowed the development of a novel murine model of asthma.  Working with the community health partners in the City of Detroit, we were able to collect house dust which was used for immunization and challenge of mice (Kim et al. 2001).  This is an important new model which can be used to elucidate the pathogenesis of asthma.  Two critical components for this new model are the presence of multiple stimulants and the low levels of the stimulants.  Most previous models of asthma have used only a single molecule which is chemically well-characterized.  In contrast, most patients with asthma are exposed to multiple stimulants from their environment.  By collecting house dust and using this house dust for the sensitization and challenge phase, we are able to more closely mimic environmental conditions.  The second additional strong feature of this model is the extremely low levels of allergenic substances which we use.  As a specific example, we use one million fold less allergen compared to amounts typically used for most mouse models of asthma.  We believe this makes the model much more clinically relevant since the concentrations of the allergens which are used are similar to those found in the environment.

Refinement of an asthma screening questionnaire.
We have refined a screening questionnaire (Joseph et al. 1999) that can be successfully completed by families and validly identify children with known or probable asthma as well as classify their asthma according to the NAEPP levels of asthma severity.  This same screening questionnaire has been successfully used as well in Durban, South Africa. In this setting, involving substantial pollution levels from major oil refineries and other industries near a primary school, categorization of asthma severity by the screening questionnaire has successfully identified which children experience pollutant exposure related to fluctuations in asthma health status, i.e., children classified as having moderate to severe asthma demonstrated by far the largest, most statistically significant, and consistent pollutant related effects.

Development and refinement of methods to assess environmental context.
We have also developed and/or refined two methods to measure environmental context the household walkthrough and the neighborhood checklist.  The household observational walkthrough instrument we are using to measure the environmental context of the home was adapted from instruments previously used in the Seattle Healthy Homes project (Krieger et al. 2000) and the HEAL project (Brook et al. 2001).  One unique contribution of MCECH is in the exploration of scoring of the walkthrough instrument.  While previous uses of a household walkthrough have resulted in individual risk items being examined, we are currently exploring construction of aggregated scores for different environmental dimensions of the home as well as an overall home score.  Construction of valid methods for aggregated household risk scores will be useful in both future environmental research and in everyday assessment of housing quality.  Building on earlier instruments (Greenberg and Schneider 1996; Perkins et al. 1990), the neighborhood checklist instrument was developed specifically for this project and consists of an observational checklist of neighborhood environmental stressors (e.g., litter, illegal dumping, abandoned houses and/or vehicles, abandoned factories) that can be administered by community members.  This instrument can assist in collecting research data on the neighborhood context of a child's environmental threats. In addition, as demonstrated by one of our community checklist raters, the process of being trained and collecting the data can serve as a catalyst for neighborhood action for reduction of environmental threats by those community members who are serving as neighborhood checklist raters.

Innovative strategies for recruitment and retention.
The Center, through the input of our community partners, has also developed some innovative strategies for recruitment and retention of participants in the study activities.  For example, early on in the project, the community partners challenged the academic partners about some of their suggestions for getting responses to our screening questionnaire. When the academic partners responded that the suggestions were based on research in the social sciences around questionnaire response rates, the community partners asked if that research was undertaken in Detroit, Michigan.  When the academic partners said no, the community partners asked that we set up a mini-study on recruitment incentives to explore which option would be most successful.  The finding was that a $5 gift certificate to a local shoe store mailed to the respondent was the most successful.  Other recruitment and retention techniques employed by the Center included a newsletter, birthday cards, community-based events (such as having a "fair" at a local community-based organization for children in the study to come and be skin-tested), gift certificates and data feedback.  Due to these efforts, the intervention and exposure components have lost only 13 of the 330 original children to refusal to participate, though there have been losses due to the children moving from the study area and no longer being eligible for the study.

Successfully identifying and training new investigators.
One of the many strengths of our Center has been the ability to successfully identify and train a number of new investigators to work in the field of children's environmental health.  Two postdoctoral new investigators who were initially funded by the Center grant have played critical, central roles as Research Scientists on the Center grant projects.  Working closely with Center Co-director Gerald Keeler, Ph.D., Timothy Dvonch, Ph.D has played a leading role in all aspects of the exposure assessment this has included development of new unique instrumentation, field methods for data collection, data analysis, and writing of manuscripts.  Toby Lewis, M.D., is a pediatric pulmonologist who has played a major role in the development and conduct of the intervention and in the collection, interpretation, and data analysis of health-related information.  She has taken a leading role in writing manuscripts concerning both epidemiologic and intervention aspects of the study.  These are two young, talented scientists with tremendous promise who have been attracted to children's environmental health as their lifelong area of work because of the existence of our Center.

In addition, one student, Stephanie Farquhar, Ph.D., already has successfully completed her Ph.D. dissertation on neighborhood environmental stressors based entirely on the Center's work.  After successful completion of a post-doctoral fellowship at the University of North Carolina at Chapel Hill, where she continued her work in community-based interventions to improve environmental health, she now holds a faculty position at Portland State University.  Three other Ph.D. candidates, Grant Baldwin who is an employee of ATSDR, and Carl Hill (both students in the Department of Health Behavior and Health Education at the School of Public Health) and Fuyuen Yip, a doctoral student in Environmental Health Sciences, are basing their dissertations on the Center's activities.  All of these doctoral candidates have benefited greatly from the strong interdisciplinary teams of scientists which have joined together through the Center mechanism.  Furthermore, the Center has provided an excellent opportunity to train biostatistics graduate students and master level biostatisticians to develop data analysis and communication skills and experience necessary for interdisciplinary research, which has become more and more important in the modern research environment.  Through the work of the murine model research, the Center has successfully recruited three new investigators into the field of children's environmental health.  One of these investigators has a background in molecular biology and is now actively pursuing the inflammatory process in the mouse model. The second individual is a graduate student who has just begun her Ph.D. thesis.  The third individual is a first-year medical student who is considering a career in academic pathology.

TRANSLATION AND DISSEMINATION

A key accomplishment of our Center is that its work has been translated directly into new scientific approaches and outcomes at an international level.  Specifically, a study of students and teachers at a primary school in Durban, South Africa surrounded by heavy industry including two major petroleum refineries already has been successfully conducted under the leadership of our Center scientists.  This study was modeled on the studies being conducted by our Center, and could never have been successfully completed without the Center's previous work.  The same digital peak flow monitors and the same survey instruments, including screening questionnaires, parent baseline, and child baseline questionnaires used in Detroit also were used in Durban.  At the two locations, similar strategies of examining the relationship between fluctuations in ambient air pollutant levels and fluctuations in measures of health status (symptoms and pulmonary function) have been pursued.  The Durban study, which was of considerably smaller scale, did not include a direct intervention component and used only a single season of intensive data collection as opposed to the Detroit design involving 11 consecutive seasons of intensive data collection.

Much of the data analysis for the Durban study has been completed, and an interim report (available upon request) has been completed and presented to the stakeholders in South Africa.  The findings of the Durban study were dramatic.  Students at the school had strikingly high rates of asthma, including moderate to severe persistent asthma, based on the screening questionnaire results.  Moreover, these findings, as well as the screening questionnaire itself, were validated in part by the results of methacholine challenge testing showing similar high rates of reactive airways disease.  In addition, strong and statistically significant associations were found between prior date of exposures to PM10 and SO2, and the probability of reporting lower respiratory symptoms, as well as increased intraday variability in FEV1 and peak flow (which is a marker of asthma aggravation).

This affiliated study has solidified highly productive collaborative relationships between the University of Michigan investigators and investigators from a number of South African institutions.  This has provided a very successful capacity building experience for these institutions:  a number of investigators at the University of Natal Medical School in Durban have received invaluable training in the conduct of these types of environmental studies, as have investigators at Natal Technikon, a technical University with a strong Department of Environmental Health.  Plans are under way to reproduce similar studies in other parts of South Africa.

As this is the first study to examine the relationship between air contaminants and health outcomes in South Africa, and this is a period of transition in which fundamental decisions are being made about the nature of environmental health laws and enforcement, it is expected that this study will have profound beneficial effects on the future approaches to control ambient air pollution and improvement in children's health in South Africa.  Again, this study could never have been completed without the extensive prior work accomplished by the Center at the University of Michigan.  It is also notable that the Durban study was successful in securing funding from non-governmental organizations, the metropolitan health department, the Medical Research Council (similar to the NIH in the U.S.), several academic institutions, and the involved petroleum refineries.

The Center has also disseminated findings and contributed to prevention research in the United States.  CAAA exposure assessment data is fed directly to study participants and community partners, as well as more general community audiences for use in environmental awareness, education, and local policy (Keeler et al. 2002).  Additional examples include the sharing of instruments and field techniques with other ongoing national EPA, NIEHS, NIH and foundation funded projects conducting asthma interventions and/or exposure studies of children to environmental threats.  For example, researchers, community partners, and staff have made over 30 presentations to local, state and national conferences.  Important to note is that in addition to national and international conferences of professional societies, such as the American Thoracic Society, American Public Health Association, Society of Toxicology, American Association for Aerosol Research, European Aerosol Society, and International Society of Exposure Analysis, Center members have presented to local audiences such as the Michigan Department of Environmental Quality Toxicologists, the Detroit Area Asthma Coalition, the Southeast Michigan Environmental Health Conference, and the Southeast Michigan Health Improvement Conference.  The Center has also assisted national agencies such as EPA and NIEHS in their efforts to increase community-based participatory research.  For example, two representatives from the Center's Steering Committee, a community partner and an academic partner, served on the planning committee for EPA's Local Air Toxics national conference, held in Detroit, Michigan in November 2001.  The Center was highlighted in a presentation/site visit, which, in the closing session of the conference, was consistently cited by panelists and audience members as the most valuable learning experience of the conference.  The Center has also engaged media, including television, newspapers, magazines, and web-based health sites to disseminate the Center's research activities, and children's environmental health in general.  Articles and/or segments have appeared in the Detroit Free Press, Detroit News, Detroit Metro Times, Detroit Hour Magazine, and the Detroit area ABC and Fox TV affiliates.

In addition to these translation and dissemination accomplishments, the results from our murine model studies have the potential to be generalizable to other areas of investigation.  For example, we are evaluating the interactions between the innate and adaptive immune system to predict the final outcome of the disease state.  Our findings could serve as a basic underpinning for further understanding of such disease processes as ischemia reperfusion injury, viral infections, and rejection of transplant organs.  We have made specific efforts to communicate our research findings to members of the community, as well as to staff at the State of Michigan.  Formal presentations of the data have been made to these groups on several occasions.

INSTITUTIONAL AND COMMUNITY CAPACITY

Our Center has been viewed very favorably at the University both at the level of the School of Public Health and the School of Medicine, as well as University-wide.  The level of support and enthusiasm for our Center is reflected in the very substantial direct financial support ($700,000) provided by the School of Public Health, School of Medicine, and the Office of the Vice President for Research.  The Center has greatly increased prominence of children's environmental health University wide, and particularly, within several departments including Environmental Health Sciences and Health Behavior and Health Education in the School Public Health and the Department of Pediatrics in the School of Medicine.  A sizable accomplishment has been the exposure and involvement of not only doctoral but also master's level students to the work of the project.  In addition to the 16 masters and doctoral level students who have directly worked with the program, hundreds more students have been exposed to the Center activities through their classes.  For example, the intervention component is now used as the case study in the required program planning/intervention design class for all MPH students (n=55 students a year) in the Health Behavior and Health Education Department.  This automatic exposure to children's environmental health issues for students in the more social and behavioral aspects of public health would not have happened without the presence of this Center.  It is quite clear that if the Center had not come into being to bring together a critical mass of interdisciplinary scientists focused on issues in children's environmental health, the field would have much less prominence at the University of Michigan, and not be nearly as attractive a career path for talented newer scientists.

Community capacity achievements associated with the Center include the following:  1) Ninety-six (96) community members have been trained in environmental health field data collection techniques.  2) Three hundred (300) families have been trained in the importance of indoor and outdoor air quality in asthma-related health and in techniques to reduce environmental triggers to improve asthma-related health.  3) There has been increased value placed by community members on the importance of accurate data collection on environmental threats to health.  This is perhaps best exemplified by one of our community partners who, at the beginning of the project expressed only interest in the intervention component of the Center since, as he expressed it, this was the only aspect of the Center that offered a benefit to the community.  However, in a recent data feedback retreat, this community partner asked intently about the results of the exposure assessment component and pressed the academic partners for more research results as soon as possible, noting that this information was extremely valuable for the community in evaluating several new proposed transportation issues.  4) The community partners on the Steering Committee who, through feedback sessions on the data the Center is collecting, are now better able to understand environmental data and are currently prioritizing and implementing neighborhood and policy advocacy activities around environmental health in the southwest and east side areas of Detroit.

AFFILIATED RESEARCH

As mentioned earlier, we were successful in leveraging additional resources from the University of Michigan ($700,000) when we initially submitted the grant proposal to establish the Center.  Since then, we have been successful in obtaining additional funds that have directly enhanced our research investigations, as well as established collaborative relationships with other researchers that have enabled us to expand upon our research efforts.  These efforts, and the amount and sources of additional funds (where appropriate) are briefly described below.

Community Organizing Network for Environmental Health (CONEH).
This project is directly affiliated with Community Action Against Asthma and aims to reduce exposure to physical environmental and psychosocial environmental stressors associated with asthma severity and exacerbation, and to strengthen protective factors that modify the effects of these stressors on children with asthma, their caregivers, and the neighborhoods and broader community in which they reside.  CONEH is funded by the NIEHS for five years beginning in September, 2000 for $2.4 million dollars.

Air Contaminant Exposures, Acute Symptoms and Disease Aggravation Among Students and Teachers at the Settlers School in South Durban, South Africa.
As described previously, this study was modeled on the studies being conducted by the Center, has been led by Center faculty, and could never have been successfully completed without the Center's previous work.  A wide array of funders have supported this study, including: GroundWork (an NGO); Durban Metropolitan Health Department, South Africa; University of Natal, Durban, South Africa; Technikon Natal, Durban, South Africa; Fogarty International Center, USA; University of Michigan, USA; Medical Research Council of South Africa; ENGEN, a multi-national oil company; and SAFREF, a multi-national oil company.

Effects of Inhaled Urban Air Particulates on Normal and Hypersecretory Airways in Rats.
Dr. Jack R. Harkema, D.V.M., Ph.D., Professor of Pathology at Michigan State University (MSU) is the Principal Investigator of this Health Effects Institute (HEI) funded study.  Dr. Gerald J. Keeler, Ph.D, University of Michigan (UM), School of Public Health is the CO-PI of the interdisciplinary study looking at the mechanisms of cellular damage in animal models of asthma.  The project is specifically designed to:  1) examine the chemical and physical characteristics of PM2.5 and other airborne pollutants in the outdoor air of a local Detroit community with a high incidence of childhood asthma; 2) determine the effects of this community-based PM2.5 on the airway epithelium in normal rats and compromised rats with pre-existing hypersecretory airway diseases (i.e., animal models of allergic airway disease (asthma) and chronic bronchitis); and 3) identify the chemical or physical components of PM2.5 that are responsible for PM2.5-induced airway inflammation and epithelial alterations in these animal models of human airway disease.  MCECH's community-based Center working with the community partners and schools enabled the HEI Study to be conducted at the Maybury Elementary School.  The ongoing community exposure work at the school as part of CAAA provided a foundation and context for the HEI work and findings.

Healthy Environments Partnership (HEP): Social and Physical Environment and Health Disparities.
The major goal of this research is to examine the relationships between socioeconomic status, selected aspects of the physical environment, social stressors and risk of cardiovascular disease among Detroit residents.  This study involves several researchers and community partners who are members of CAAA, and will be using some of the outdoor air quality data collected through the Center.  HEP is funded by the NIEHS for five years beginning in October, 2000 for $3 million dollars.

Murine Model Investigation.
The Center team involved in conducting the murine model study has submitted an additional grant to the Sandler Program for Asthma Research and is waiting to hear the status of that proposal.

SUSTAINABILITY

The work of the Center has the potential for sustainable changes in several of the parties involved in the project.  As mentioned earlier, the results of the process evaluation have indicated some changes in the knowledge and behaviors of families enrolled in the intervention.  Upon completion of analysis of the quantitative evaluation data, we will have a better understanding of how widespread and sustainable these changes have been. More visible and sustainable changes have already been observed in the academics involved in the Center, and the community itself.  For the academics, changes have been observed both in interest in environmental health (2 new R01 grants that have been funded for environmental health investigations were submitted by researchers previously not involved in environmental health), and in the participation of academics in interdisciplinary environmental health research.  For community members, changes in their knowledge of and interest and involvement in environmental health issues has been observed in their strong support of and participation in the efforts of the two new environmental health research projects.  For example, as part of the CONEH project affiliated with Community Action Against Asthma, several community partner organizations representing the Steering Committee have been actively involved in the establishment of the "Southeast Collaboration", that has brought together a number of community-based organizations that focus specifically on environmental issues.  The aim of this collaboration is to prioritize environmental concerns related to children's health, and to engage in collective strategies to reduce those environmental stressors.

REFERENCES

Brook, D., Collier, C., Dickey, P., Doyle, J., Duggan, A., Gilbert, S., Krieger, J. et al.  2001.  Master Home Environmentalist Training Manual, 13th edition.  Seattle, WA:  American Lung Association of Washington.

Dvonch, J.T., Marsik, F.J., Keeler, G.J., Robins, T.G., Yip, F.Y., Morishita, M.  2000.  Field comparison of PM2.5 TEOM and PM2.5 manual filter-based measurement methods in urban atmospheres.  Journal of Aerosol Science 31 (suppl 1):  S190-S191.

Greenberg, M., Schneider, D.  1996.  Environmentally Devastated Neighborhoods: Perceptions, Policies and Realities.  New Brunswick, NJ:  Rutgers University Press.

Kim, J., Merry, A.C., Nemzek, J.A., Bolgos, G.L, Siddiqui, J., Remick, D.G.  2001.  Eotaxin represents the principal eosinophil chemoattractant in a novel murine asthma model induced by house dust containing cockroach allergens.  Journal of Immunology 167:  2808-2815.

Joseph, B.L., Foxman, B., Leickly, F.E., Peterson, E., Ownby, D.  1999.  Sensitivity and specificity of asthma definitions and symptoms used in a survey of childhood asthma.  Journal of Asthma 36:  565-573.

Keeler, G.J., Dvonch, J.T., Yip, F.Y., Parker, E.A., Israel, B.A., Marsik, F.J., Morishita, M. et al.  2002.  Assessment of personal and community-level exposures to particulate matter among children with asthma in Detroit, Michigan as part of Community Action Against Asthma (CAAA).  Environmental Health Perspectives 110(suppl 2), in press.

Krieger, J.W., Song, L., Takaro, T.K., Stout, J.  2000.  Asthma and the home environment of low-income urban children:  Preliminary findings from the Seattle-King County healthy homes project.  Journal of Urban Health 77(1):  50-67.

Parker, E.A., Israel, B.A., Keeler, G.J., Lewis, T.C., Ramirez, E., Robins, T.G., Rowe, Z., Williams, M.  Community action against asthma:  Examining the partnership process of a community-based participatory research project.  Submitted to Journal of General Internal Medicine

Perkins, D.D., Florin, P., Rich, R.C., Wandersman, A., Chavis, D.M.  1990.  Participation and the social and physical environment of residential blocks:  Crime and community context.  American Journal of Community Psychology 18(1):  83-115.

Williams, M.  2001.  Community action against asthma:  Evaluation progress report - qualitative data from community environmental specialists.  University of Michigan School of Public Health, internal report.

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Updated January 02, 2003