Hot Topics in Public Health presented by USC Professors Rima Habre, ScD and Tracy Bastain, PhD
This webinar covers:
- Understanding fundamental concepts related to environmental health disparities research
- Learning about the MADRES pregnancy cohort and ongoing research
- Understanding how the co-occurrence of environmental exposures and social stressors can affect health risk
- Developing an awareness of cross-cutting dimensions of health disparities, with a lens of the COVID-19 pandemic
Phil Solaria: Also, a copy of the presentation and recording will be available soon. I’m going to pass this over to Dr. Shubha Kumar PhD, MPH to touch on our experience and work within the program. Thank you, Dr. Kumar. Thanks for joining us today.
Dr. Shubha Kumar.: Thank you Phil. Thank you everybody for being here today. It’s a pleasure to have an opportunity to interact with you. So I’ll give you a short little bio about myself and about some more information about the program and then we’ll hand it off to our students and our faculty. So a little bit about myself. I’m the program director for the online MPH program and associate professor in the department. I specialize in global health and completed my MPH quite a while back and really loved particularly program evaluation and understanding what are the impacts of health programs. And that’s where I really chose to focus my research as well as my teaching. Prior to academia I also worked primarily in the NGO sector and helped start up an NGO doing humanitarian work around the world, and worked with various NGOs. And I still do today more of a research capacity. That’s a little bit about me.
Dr. Shubha Kumar.: Now to share a little bit more about that our program. So our online MPH program is housed within the Keck School of Medicine. And the Keck School of Medicine was established in 1885, We’re actually the oldest medical school in Southern California. And we are affiliated with several hospitals and have plenty of research institutes and centers of excellence in various areas related to health and medicine and others. Within the School of Medicine, we are housed in the Department of Population and Public Health Sciences formerly known as Department of Preventive Medicine, we just had a name change a few months ago. And within our department we have six different divisions spanning the key areas of public health, including Disease Prevention and Global Health, Bioinformatics, Biostatistics, Epidemiology, Environmental Health, Health Behavior Research. And we have over 100 faculty who work in this department involved in teaching and doing research in key areas of public health.
Dr. Shubha Kumar.: A little bit about the program itself. As you may have heard, we offer six different concentrations to specialize in. So we have a core curriculum that students complete in public health, kind of the basics of public health before they go on to their specialized areas which would be the concentrations. And in those we have Biostatistics and Epidemiology, Community Health Promotion, GEOHealth which is a unique concentration in collaboration with the Spatial Sciences Institute at USC. And we also have a concentration Global Health, Health Services and Policy and Generalist concentration. The Generalist one is more aimed for folks who already have advanced degrees and want to pick and choose their route in public health while the rest of them are really getting foundations and specific areas of public health.
Dr. Shubha Kumar.: In addition to the core curriculum as well as the concentration courses, students also completed a practicum in the program. And the practicum is essentially like an internship where students would get hands-on experience in public health at an agency of their choosing that’s doing something in public health. And we’ve had students go all over the world or stay in their hometown or even stay at their place of work if they’re doing work related to public health as long as they’re working on a new project or something they don’t do in their nine-to-five. It’s really an opportunity for students to get more experience in this area as well as network with folks working in the field and hopefully take some steps towards future career after graduation.
Dr. Shubha Kumar.: So students have done their practicum in places like small NGO in rural village in Tanzania, all the way to the World Health Organization, working on key policies with L.A. County. We have several students who go to L.A. County Department of Public Health and various counties and cities where they may live. Also working with corporate partners who may be working in public health, so there’s a lot of different opportunities. I think, as you guys all know, public health has really come to the forefront in the past 18 19 months or so with everything that’s happening with the pandemic and so there’s plenty of opportunities, plenty of demand for students and trainees in this area.
Dr. Shubha Kumar.: I will leave it at that in terms of the program. You’re welcome to learn more from our institute advisors. But at this point, I’m going to turn it over to one of our wonderful online MPH students, Sri Ramya Vemulakonda. Sri is currently enrolled as an online MPH student taking the generous concentration in USCC and she is the director of student relations within our USC Master of Public Health Students Association. She attended BLDE University for her Bachelors of Medicine and Bachelor of Surgery where she graduated from the B.M Patil Medical College in India and with clinical experience and she can share a little bit more about herself and her experience in the program before we will turn it over to the faculty.
Sri Ramya: Thank you Dr. Shubha Kumar. Hello professors, colleagues and fellow classmates. It gives me great pleasure to host this Hot Topics Public Health webinar sponsored by USC online MPH program and your Master of Public Health Student Association. A little bit about myself. I’m in my second year of the online MPH program at USC with a Generalist Concentration. I earned my MBBS degree from India I am a foreign medical graduate. I currently serve as the director of online student relations for the Master of Public Health Students Association. Professionally, I work as a clinical research coordinator at Rush University Medical Center Chicago, working with leading researchers on women’s health topics. My goal has always been to improve health services for women and underserved populations in my community, meaningfully, to the field of public health. I also volunteer from time to time at Lurie Children’s Hospital of Chicago. I aspire to implement the skills and knowledge gained to the program to serve The U.S. community in a long lasting impactful way.
Sri Ramya: So I have the honor of introducing two rock stars of environmental health, professor Tracy Bastian and professor Rima Habre. I’m currently taking their classes. Professor Bastain is teaching MPH students on various environmental health topics. Having done her undergraduate at Princeton and MPH at Johns Hopkins, and finishing her doctoral and postdoctoral studies at our very own USC. She joins USC as a professor as well as the project administrator of the Children’s Environmental Health center and Southern California Environmental Health Sciences Center. She has about 35 research obligations, multiple citations, and is currently involved in a large scale population studies in children and adolescents of more than 20 years SoCal Children’s Health study as well as a new cohort of pregnant women and infants in the Margaret Center for Environmental Health Disparities. Her research interests include understanding the role of environmental exposures in early life and during critical periods of development on long road, neurological development, asthma, obesity, and metabolic outcomes and childhood growth trajectories.
Sri Ramya: Professor Rima Habre is also an associate professor at an Environmental Health and Spatial Sciences Department. She graduated from the American University of Beirut with a bachelor’s in Environmental Health and completed a Master’s in Environmental Health and received Doctor of Science in Environmental Health with a concentration and Exposure Science from our T.H. Chan School of Public Health. She has 106 publication, multiple citations and currently working on research on air pollution mixtures and social stresses on the health of vulnerable populations across the life course. She is also the NIEHS young investigator award winner in 2017 and Penrose Award best combination of the qualities of scholarship character and leadership winner. Without further ado, I’d like to introduce professor Tracy Baskin and Rima Habre and kick off the webinar on Environmental Health Disparities and MADRES.
Dr. Tracy Bastain: Well, thank you so much Sri and the rest of the program for that nice introduction. We are very excited today to show some of our work in our Module Center of Excellence in Environmental Health Disparities Research. Today, Dr. Habre and I will cover several topics. After attending today’s webinar you should have an understanding of some fundamental concepts related to Environmental Health Disparities Research. In addition, we will tell you about the MADRES pregnancy cohort and ongoing research in our center. You will have a deeper understanding of how the co-occurrence of environmental exposures and social stressors can affect health risks. Finally, we hope you will develop an awareness of cross-cutting dimensions of health disparities with a lens of the COVID 19 pandemic.
Dr. Tracy Bastain: Environmental health disparities exist when communities are exposed to a combination of environmental factors, such as Core Air or water quality, and social inequities such as little access to health care, lower socioeconomic positions and cultural influences. These disparities are often referred to as a double jeopardy of being disproportionately exposed to environmental exposures and having an increased vulnerability to their effects. These disparities often occur along racial and ethnic lines due to decades of structural racism and discrimination, as well as unjust zoning for housing and discriminatory environmental policies. The field of environmental justice seeks to combat these disparities by advocating for the fair treatment and meaningful involvement of all people, regardless of race, nationality or income.
Dr. Tracy Bastain: When we were beginning this work, we noticed that in Los Angeles, the burden of environmental exposures and childhood obesity were not evenly distributed across all demographic groups. The figure here on the left, shows prevalence rates of childhood obesity at age four from the first decade of the 2000s in L.A. County. The figure shows that the prevalence of early childhood obesity was highest in LatinX populations, and continue to increase in Los Angeles. Whereas Black, White and Asian populations did not see this alarming increasing trend. The figure on the right comes from data from the Office of Environmental Health Hazards Assessment in California. This figure shows that one in three Hispanic or LatinX persons live in one of the 20% most environmentally and economically disadvantaged census tracts in California, compared to at the bottom only one in 14 white individuals.
Dr. Tracy Bastain: The Modern Center for Environmental Health Disparities was founded in 2015 and focuses on how environmental exposures, population level, vulnerabilities and individual level stressors interact to affect maternal and child health outcomes like childhood obesity. The Moderate Center established the moderate pregnancy cohort. A cohort of approximately 900 mother and child pairs from health disparity populations in Los Angeles who predominantly live in environmentally burdened communities. Research projects focused on both mother and child are nested within the cohort and are supported by an administrative structure and supporting cores. The center also supports a strong community engagement programs focused on increasing environmental health literacy among community residents. An innovative internship program for first generation undergraduate students, and the pilot projects program for underrepresented early stage investigators are both central to the center’s mission.
Dr. Tracy Bastain: Training the next generation and increasing diversity in the scientific workforce is a key component of our center. The Center of Internship Program for Undergraduates from under represented groups, provides opportunities for students to join moderates research and community engagement teams. That’s far 18 First generation college student interns have been trained in the joint program and have gone on to graduate school or employment in public health fields, including even joining our own staff team and after graduation. Working with diverse communities requires strong community base and clinical partnerships, as well as a participant centered approach. Our staff are hired from participants communities, which ensures that the staff are able to establish trust and strong relationships based on shared culture and language. A fundamental aspect of our research in community engagement efforts is that our research is conducted with diverse populations and not on diverse populations. The needs of communities and participants come first in our work.
Dr. Tracy Bastain: The Community Engagement Program has centered its efforts on building community environmental health literacy, by conducting workshops with community residents and developing infographics like the ones you see here on this slide. These pictures highlight a workshop training on how to use low cost air monitors to understand air quality and community residents neighborhoods. Another workshop, originally developed by one of the undergraduate interns, focuses on teaching residents how to make and use less toxic cleaning products in their homes. Hundreds of community residents have participated in these workshops. In the first five years of our centers work, we focus on understanding the role of environmental exposures and stress during pregnancy, and maternal and child health outcomes related to obesity and weight gain and weight retention for the first year after birth. We have expanded the study now and we are following both mothers and children through five years after birth and we are investigating the role of these exposures on a variety of health outcomes in both mother and child.
Dr. Tracy Bastain: You may wonder why we focus on pregnancy. Well based on the Developmental Origins of Health and Disease or DOHaD Hypothesis. The period of fetal development is a vulnerable window of exposure for childhood health outcomes. Also because pregnancy is a period of dynamic biological and hormonal fluctuations that are designed to support fetal development, we hypothesize that the prenatal period may also increase maternal susceptibility to these toxic exposures. The author arching goal for the moderate study is to understand the effects of prenatal environmental factors and social stressors on maternal and child health outcomes among low income predominantly Hispanic families in urban Los Angeles who experience high burden of exposure as well as adverse health outcomes.
Dr. Tracy Bastain: The MADRES study is a prospective pregnancy cohort study, which means that enrollment starts in pregnancy and we follow mothers and babies to measure exposures and health outcomes. We partnered with community health centers dedicated to medically underserved populations in order to recruit study participants. Our inclusion criteria were quite broad. Women needed to be less than 30 weeks gestation the time of enrollment, over 18 years old, HIV negative, they had to be able to consent, not or incarcerated and they needed to be only carrying one baby. This was our candy land style map, which is really just meant to give you an idea of all the touch points we have with our participants. Starting in the pregnancy period, shown here in pink, through the first year of life in blue and finally from years two to five in green.
Dr. Tracy Bastain: About 75% of our study participants are Hispanic or LatinX, about 10% are non Hispanic Black, 8% are Non-Hispanic White, with a handful of other groups represented in our cohort. Our families come from very low income households, with over 40% having an annual household income of less than $30,000 per year. And many of our mothers are not aware of their family income levels. Over 50% of our study participants have at most a 12th grade education and about 50% were employed during the pregnancy when they enrolled. So much our original motivation for the center. Our current center research projects focus on the prenatal period as a period of vulnerability for environmental and social stress exposures on longer term mental health, I’m sorry, maternal health outcomes like depression, and cardiovascular disease. We are also investigating the effects of these exposures on biological pathways like inflammation, neuroendocrine function, lipid homeostasis, coagulation and endothelial dysfunction in an aggregated measure called allostatic load, as well as some of these pathways might mediate the effects of the environmental exposures on the health outcomes. And now going to pass the presentation to Dr. Habre.
Dr. Rima Habre: Thank you so much Dr. Bastain and thank you Sri for that lovely introduction and to you all for attending and to the organizers for inviting us to talk to you about MADRES and our work on Environmental Health Disparities Research. And so, I’m going to show you just a few maps and visuals about our data and our cohorts, and to try to shed light on some initiatives that we put together when COVID hits. Because as you all might be aware or might be thinking that environmental health disparities and health inequities overall do affect marginalized populations in a lot of different ways. And not just in terms of environmental exposures. And so, this slide here you see in the map shows you the neighborhoods on the map. So these are colored from very dark pink to red to lighter colors. This is in LA, urban Los Angeles in California. And those darkest neighborhoods that you see are the ones where we have the highest recruitment of these pregnant women from.
Dr. Rima Habre: So we partner with four different clinics, and that has changed a little bit over time. But by doing that, we are basically recruiting the population generally that lives within urban Los Angeles. So you see East L.A., Downtown, Central, South Central L.A. are some of the highest recruitment neighborhoods in MADRES. And these are like Dr. Bastain described predominantly Hispanic and lower income women, but not exclusively of course. And so, there’s a link down here that you can see to what we call a story map that we put together, describing a little bit more about the data and the neighborhoods that are MADRES participants come from. Please feel free to explore that.
Dr. Rima Habre: But just to tell you a little bit more about these neighborhoods. So if you start on the left, looking at the map on the left, this shows you the racial ethnic distribution in LA. And so, there are these very dark pink boundaries that are drawing basically lines around the MADRES neighborhoods where we have at least five participants. And the colors underneath to show you the predominance category, meaning what racial ethnic group is predominant in that neighborhood. And the green shows that most of these MADRES neighborhoods are Hispanic or Latino neighborhoods. And the yellow is mostly African American or black communities. So as you can see MADRES’ neighborhoods are very much Hispanic, Latino and African American. The map on the right overlays what is known as The 1939 Redlining Zones or the Discriminatory Housing Policies that were in place back in the 30s and 40s that basically outlines neighborhoods that were deemed high risk or not recommended to invest in where people who were actually mostly African American and Hispanic and disadvantage communities were not given equal or fair treatment in terms of being able to buy land, to start businesses. A lot of toxic land uses perhaps are placed there.
Dr. Rima Habre: So as you can see, in the map, I our MADRES’ neighborhoods also overlap with a lot of those very dark red or yellow zones that were the most basically redlined or labeled high risk with discriminatory practices back then. And the issue is that even though this wasn’t actually too long ago but the effects of those discriminatory policies has remained over time, and has left to assume these very strong spatial patterns in what we’re calling this double jeopardy that Dr. Bastain explained before. So in the map that you see here, it has some census data. The top panel is mainly demographic characteristics and the bottom panel is some of the social risk factors that we think about such as poverty and high rent burden, maybe for college graduation rates. And you see that the patterns in these maps do not seem random. They’re very specially drawn, and the larger demographic characteristics seem to mimic or imitate those social stressors or risk factors. And so, that goes to tell you how these systemic and persistent discriminatory practices have led to very strongly entrenched spatial patterns in this risk factors, not just from environmental exposures, but also from social stressors.
Dr. Rima Habre: And they call these place-based or neighborhood level generally. And these are some of the things that you might be involved with if you were to pursue a [inaudible 00:25:50] health track. But it basically paints the picture of this very uneven burden of environmental exposures and susceptibility in low income, marginalized groups and populations.
Dr. Rima Habre: So this is what we’re trying to study in MADRES. And just to paint that picture a little bit clearer. So the map you see here, the colors corresponds to what is called the Cumulative Impact Score from a tool that Dr. Bastain, introduced before called the CalEnviroScreen. The CalEnviroScreen was put together by the OEHHA or Office of Environmental Health Hazard Assessment, I believe, from the California EPA. And it’s a screening tool, it’s meant to shed light on environmental justice issues in the state of California and provide some ranking or scoring of a variety of environmental risk factors but also socials risk factors. And so, the overall score was from zero to 100. And again, in the map, you see that the MADRES neighborhoods fall in those darkest pink to read colors, the highest percentiles of this cumulative impact score. Meaning the most environmentally burdened but also the most vulnerable in terms of population susceptibility criteria.
Dr. Rima Habre: And the plots on the right shows you the distribution of that data in the MADRES neighborhood. So again, you see a very high pollution burden score, even higher population susceptibility or characteristics score, and then the cumulative impacts takes both of these things together into consideration. So in a lot of our studies, we’re actually assigning this data to where our participants live. And we look at these measures as predictors of some of the adverse health outcomes that we’re all interested in. Another key part of this when we think about place based exposures and neighborhood level factors, is that where we live matters. And if you think of that, at a very basic level, at a very intuitive level, you can probably relate to that idea, right? And so, where you live not only dictates maybe the environmental exposures that you’re getting, it also dictates how habitable your neighborhood might be, how safe, how walkable, how easy it is for you to get access to healthy and food options, to different types of services.
Dr. Rima Habre: And so, what we do in MADRES is for all our participants we build these very highly resolved daily residential timeline. So that’s the plot you see on the left here. And the X-Axis is just calendar time from when we started the study. And the Y-Axis is all the different participants. And I think we’re up to like 800 or 900 right now. And so, the highlighted blue dots are the dates of birth or when all these babies are born. And you can see this very beautiful progression over time with enrollment. That is really a massive effort that Dr. Bastain needs to get the scores together, right? But we take all these birth dates and we go back in time to cover the pregnancy period, that’s a somewhat dark red or orange you see in this plot, we go even earlier than that into the preconception period. And then of course, we keep building these forward in time to follow up the babies and their moms to the latest time point that we have.
Dr. Rima Habre: The reason we do this is for every day of every child’s life. We want to know where they have lived. So we take that address location and we geocode it. We put it on a map and that allows us to basically link up a lot of different data sets that help us characterize these neighborhoods that they live in. So we can learn a lot more about environmental exposures, mainly air pollution that we do a lot of work on, but also a lot of neighborhood level stressors. The other big advantage of doing this work is that it helps us overcome some of the strong limitations that usually can be found in epidemiological studies.
Dr. Rima Habre: So the plot on the right tells you a little bit more about that. So in reality people move, people don’t stay at the same residence all the time. And so, what we’ve done with this timeline is that we can also capture all residential mobility. And so, you see the X-Axis is basically weeks relative to the birth date of the baby. And there’s a vertical purple line that’s assigned at birth. And then the red color shows you the number of moves that are happening in the MADRES data in the pregnancy period, and then right after delivery as the baby grows. So what that tells you, and maybe something you didn’t appreciate before, is that there’s actually a lot of moving happening. Maybe that’s intuitive because when you have a pregnancy and a baby, the family is growing. But also maybe certain people are at higher risk of moving to more risky neighborhoods, they can’t afford it or if there are other issues that are compounding this.
Dr. Rima Habre: So just to bring it all together. The reason we do this is so we can understand what people are exposed to at a very high resolution over time, and to also account for any movement that is happening in space. So that we really understand the influence of where we live on health. So this plot, it’s a little bit busy, and it’s work that I did with my wonderful post-doc, Miriam Girguis who is now in a different job leading research. And so, the map you see here is based on some early work in probably half of the cohort, back then. It shows you different residential locations of our participants and their colored by different clusters. So clusters are basically groups that we have determined are very similar to each other and basically very different from each other.
Dr. Rima Habre: So for example, the points in blue that you see there are a cluster A here that we call Near Toxics. What we’ve done is we’ve generated, in GIS and using these Geo Health types of methods, we’ve generated data on about 94 different characteristics of these neighborhoods. All the way from chemical pollution, to the built environment, to social factors, demographic factors and so on. And so, what we see, for example, are some multivariate patterns in this profile. And so, we were able to tell from the data that there were at least four different clusters in these neighborhoods. And this is a small region mind you, relative to that The U.S. This is all within LA.
Dr. Rima Habre: So we so saw that the orange dots, for example, were very different from the green dots, from the blue dots, from the purple dots. And the way we could do this is because we assigned all this different data and did some multivariate analysis. But basically what we learned was that the blue dots were disadvantaged neighborhoods that had a lot of industrial pollution and we’re very close to what we call toxic or hazards. Whereas the green dots were also disadvantaged neighborhoods, also had high unemployment rates and poverty, but they were more exposed to traffic pollution and they happen to be food deserts. The blue dots actually had more food assistance facilities. So even though those two, for example, clusters were right next to each other, the experiences of the women living within them are very different in terms of what affects their health. And similarly, we saw different patterns for those orange and purple dots. And we’re doing this again to understand that cumulative burden of a lot of these different characteristics on health because we’re thinking about health disparities statistically.
Dr. Rima Habre: Okay. So, talking about health disparities when the pandemic hits, of course, everyone was affected. But then we were quickly starting to realize and see, perhaps not surprisingly that our same communities that we worry about in terms of health inequities. We’re also facing the biggest burden or threat from COVID-19 in terms of case rates, and mortality, and not having access to the same level of testing or vaccination but also not having the same luxuries that other communities might have in terms of being able to work from home or stay safe et cetera. This story was actually featuring work done in Oregon Public Health Department, which one of your own students or your own colleagues in this program actually graduated from the MPH was leading the efforts in terms of responding to COVID-19. So I’m very proud to show you this because it features one of our very own, and it shows you how incredibly important the work you can do following an MPH is.
Dr. Rima Habre: And so, when COVID heads, we basically started to think about, “Well how can we communicate or disseminate more information that would help our participants deal with COVID, Know what to do, find the information they need?” And this was really the impetus of the group that tried to put together this StoryMaps. And so, StoryMaps are basically like web pages that includes a lot of geographic information or maps. Like a blog page, I would say. And so, the link is here, and you’re welcome to visit it anytime and look at the data. But we as a group decided to think together about what information do we need to disseminate. And so, we incorporated a lot of these GeoSpatial datasets. But we also added in information on where to find vaccine sites, where to find testing sites. And we were reporting some of the COVID data itself.
Dr. Rima Habre: And so, sadly but that’s the reality of health disparities, is these maps are actually from the StoryMaps that we put together but way back in time, during the peak of the pandemic, I would say, like maybe three to four months in. And so, again you see these big pink boundaries of where our MADRES neighborhoods are. And they would fall or coincide with where the highest case counts for COVID-19 were occurring and also the highest case rate. So I invite you to look at the StoryMaps to see the remaining pieces of information that we’ve provided in there. But also Dr. Bastain and colleagues in MADRES led efforts to develop the survey to basically check in with our participants and see what they’re experiencing. And not surprisingly, we saw that about three quarters of participants reported at least one income in their household was reduced, either by losing a job or having hours reduced. And this is data from back then. It might not reflect current signs, but it’s important because it was during the pandemic or the early days of the pandemic.
Dr. Rima Habre: Also, about half of our participants reported that either their job or their partners put them at higher risk of COVID-19. So they couldn’t get the same protections, let’s say, that anyone else might. They reported feedings discrimination and social isolation on the rise and most of them reported getting less physical exercise, and eating more often to cope with stress. So of course, these are all very influential in terms of the stressors and the mental health and the metabolic health impacts that we are worried about in MADRES. And so, Dr. Jill Johnson leads our community engagement core and her team puts together these amazing infographics and sources of information both in English and in Spanish.
Dr. Rima Habre: And here, we’re just showing you some of them, but I’m sure if you go on the MADRES’s website or our website, you can see more. But she basically took it upon herself and her team to translate a lot of the key information that people need in terms of what to do if someone in your home got COVID, how to take care of them and stay safe and keep your family safe, how to clean and disinfect your home during COVID and basically how to keep Your home and family safe. And of course people don’t always have the luxury to move to a different place or even different rooms within the same house. So this was very key and timely information.
Dr. Rima Habre: I’m going to spend the next few minutes showing you a different variety or flavor of work that we do in MADRES as well. Which is getting more at the personal level. So all the methods and analysis you showed you so far are what we call at the population level. They’re looking at neighborhoods, and neighborhoods are very reflective of what people experience. But we can get way more personal to really understand what people are exposed to in their personal breathing space when it comes to air pollution. We’ll just be very quick visuals to give you an idea. But basically, in some of our sub-studies that are a bit more intensive in terms of the data collection, we use a variety of different air pollution monitors, what we call Personal Exposure Monitoring. And this is really my area of expertise and my field.
Dr. Rima Habre: And so, for example, the device you see on the top, it’s called a microPEM. And we use that to measure minute level PM 2.5 concentrations or air pollution concentrations in the breathing zone of our participants. And we do that over a four day period of time repeatedly over the pregnancy. But also in the plots you see on the right, we use a different setup to collect particles on filters also in the breathing zone of the pregnant woman. So she wears these devices in a purse that you can see here on the plot in the picture. And it’s collecting these air samples from right around the shoulder area to collect these particles on filters that we can then analyze for chemistry and try to understand what are those sources of pollution that these women are breathing. And so, we pair all these designs with very detailed GPS data either by apps that we’ve developed, or that we use that are commercially available.
Dr. Rima Habre: But basically what we do with some of our students in spatial sciences, and this again gives you a bit of a flavor of GeoHealth is that we use these very high resolution GPS tracks to try to understand environmental exposures within actual activity spaces. So meaning instead of… So the plot on the left here, you see is worked by Li, which is a nice paper he published reviewing his methods if you’re interested. And the work on the right is by Yan Xu, my PhD students in spatial sciences. So they’re showing that instead of using the typical residential neighborhood approach where you might be where someone lives and draw a circle around that, we can actually use the GPS track itself to follow people along in terms of where they’ve been and understand exposures within those spaces. And we can also give a lot more weight, that’s the kernel density plots you see at the bottom there, to the places where they spent the most time in. So we do all this to minimize error in our assessments and to really understand what people are exposed to.
Dr. Rima Habre: There are so many more analysis that I can show you from this data. But just for the sake of time, I’m going to keep it very brief and also show you that with this very dense GPS data. So the plot you see on the left. This is from a lot of different people, of course, we can’t show you anything more sensitive than that. But if you think of that bottom piece of that cube, the flat part on the bottom as the map with latitude and longitude, once you start looking at the frequency of certain locations appearing in the data, then you start understanding that these are places where people spend a lot more time in. Usually homes, or work locations or parents and families. And then we can start to connect these state locations with the trips that happened between them as people move around. So what we’re really doing is we’re trying to understand mobility patterns and relate that to personal exposure to air pollution. And so, just from analyzing this data and one of our sets studies, that is a plot you see on the right there shows us basically the context, the type of place that these stays are occurring.
Dr. Rima Habre: So, the vertical axis is the origin of any given trip. And the horizontal axis or the X-Axis is the destination, and pedestrian trips are in blue, and vehicular trips are in red. So overall, we see in this population of pregnant women in MADRES, that there’s about three times more vehicular trips and pedestrian trips overall. And that most of these pedestrian trips, the walking, is happening within commercial and services locations, or between them, and very little pedestrian trips or walking is happening at parks and open spaces. And that’s potentially a problem for L.A. and something that we can intervene on or share with the city officials to shed light on the need for a nicer, bigger, better, safer, cleaner parks and open spaces. That’s what you see at the very bottom right hand corner. Okay, so with that, I hope you’ve given you a nice overview of some of the work that’s happening in MADRES and some of the issues that we think about when it comes to health disparities, especially environmental health disparities.
Dr. Rima Habre: Obviously, the center is very big. And this plot shows you all the different project leads involved. So Dr. Bastain is the director of the center with Dr. Carrie Breton. Dr. Shahreh Farzan leads project two. I lead project three and what we call the Exposure Assessment Core. Dr. Jill Johnston leads the Community Engagement Core. Dr. Claudia Toledo-Corral leads Investigator Development Core. And we all have different expertise in different areas obviously. But we’re also a very great team. And we are leading a lot of different sub studies and research questions within MADRES. So, I’m sure everyone is always happy to talk to you depending on your interest, please feel free to reach out. So with that, I believe I’m turning it over to Phil. Thank you all for your attention. And we’re happy to answer questions. Thanks.
Phil Solaria: Thank you. Thank you to all our presenters Shubha, Sri, Rima and Tracy for sharing all that… Just wonderful information on the program and your experiences. Next, I really wanted to just take some time to go over any questions that anyone might have. We did receive a few already. So, if you have any questions, take advantage of this opportunity, please be sure to share them in our Q&A box so I can make sure that we are able to address those and we’ll get to as many as we can. We did have one question already come up. And the question could be for anyone maybe Shubha, or Sri, but it says, “What research opportunities are available for online students?”
Dr. Shubha Kumar.: Sure. I’m happy to take a stab at it and then Sri and faculty please respond if you’d like to. But in generally speaking, we have a lot of research opportunities because our department faculty are doing a lot of excellent research. And so, there’s opportunities for students to get involved whether those students are on campus or online. We send out postings pretty much all the time about this research opportunity or that one, through our learning management system. So you’ll probably get, on a daily basis, advertisements for opportunities to do research with the faculty whether it’s for your practicum or whether it’s just a side job that you may do or volunteer activity. There’s plenty of opportunities. Sri I don’t know if you want to comment on that.
Sri Ramya: Yeah sure. So, like Dr. Shubha Kumar said, there are opportunities that are being posted. But as like working professionals in the online program, there will be voluntary opportunities or practicum opportunities in whichever. They’re usually postings in multiple concentrations. I’ve seen a few in health promotion, in literacy and also community health promotion, and biostatistics. So that those are all great opportunities in terms. This also made me aware regarding opportunities and then my Environmental Health. So yeah.
Dr. Tracy Bastain: I can maybe just add to what Dr. Kumar and Sri just said, I currently have two online MPH students who are working with me on one on a research project and one on their practicum to actually do some translation of materials or I should say engagement and translation, not Spanish translation back to the study participants. So I think there are a lot of faculty in our department who now participate and work with students directly in their practicum and or capstone projects. So I think depends on interests of the students and interests of the faculty and availability of projects. But there are lots of opportunities.
Phil Solaria: Fantastic, thank you. We have another question here. Again, it could be open for maybe the one of the professors. “Are there any interventions or health programs that the MADRE study participants are offered ie WIC or would that intervene with analysis? Thank you.”
Dr. Tracy Bastain: So I think that’s a really excellent question. This is an epidemiologic study. So, we are predominantly focused on observing what’s happening in the environment that our participants live and work, and studying the outcomes. That being said, we work really closely with our clinical partners. And so, we have a pretty good idea of when some of the women in our studies are experiencing challenges or need help connecting to either healthcare services or, as you mentioned, things like WIC and other social services. So we really have that partnership between our study and the clinical community as well as some other referrals. And that’s how we conduct a study as opposed to us doing the interventions ourselves.
Phil Solaria: Thank you. We do have another question. It looks like it’s directed for Sri, “It seems that you’ve taken advantage obviously of the opportunities USC provides to their students, the networking, the resources, you’re part of MAPSA. So a common question students ask, Recruitment is due, do online students have the same access to campus resources as on the on campus students do?”
Sri Ramya: Yeah. I feel we have access to the same resources. So we have access to library resources including material from Norris Medical Library, we have access to professor’s teaching assistants, and academic advisors. We also have access to career resources and the meetings with career counseling, and for resume building and other career opportunities. So I feel we have equal access to same as on campus students. We are trying to from the student government. We are trying to promote more social events also. But yeah, as working professionals, I think those would be the only thing that’s not as much as on campus students.
Phil Solaria: Thank you, Sri. We do have another question. Well, first a comment, “This is such important work. What is your hope for the impact of the research that you do?”
Dr. Rima Habre: I feel like this is a Dr. Bastain question. But I’m happy to start or do you want to go ahead first?
Dr. Tracy Bastain: Go ahead Dr. Habre. I feel like I’ve dominated the answering. So why don’t you take a step first then I’ll [inaudible 00:54:00]
Dr. Rima Habre: Sure. I mean, that I think, really our hope is that the research would be impactful in terms of providing actionable data to officials, the planners, the health organizations to really make a difference in answering some of these health questions for the outcomes that these women experience. So we have lots of different ways that could happen. But just one example, for example, is that a lot of our clinic partners are worried about using some of these women or some of their own population in terms of follow up after delivery in the postpartum period that we know is a very sensitive time as an very risky time for the mom after she delivers.
Dr. Rima Habre: And so, they’re learning from working with as some of these factors that might contribute to losing people to follow up or what kinds of services they need, or are there periods of time where they might need more [inaudible 00:55:04]and information and support especially as a woman goes through pregnancy and the postpartum period. I feel like there are so many other ways that we hope and work on our research being impactful. And of course, Dr. Johnston needs a lot of that translational aspect with the community engagement work. And I’m sure Dr. Bastain you might want to add to this as well.
Dr. Tracy Bastain: Sure. I mean, I think Dr. Habre definitely touched on some of the key pieces. We really consider this study to be solution oriented. It is observational in nature, as opposed to an intervention, like we talked about a few minutes ago. But it has a lot of implications for helping improve the situation for marginalized communities. Both at a very high global policy level. A lot of research coming out of our group and others at USC has led directly to policy change, in terms of lowering pollution exposures, both in the air and the water, as well as in household products, that’s another area of interest of ours. And it’s at that policy level that the participants contribute their experiences and their data, which will then eventually translate into helping the community is at large, much larger than just the participants.
Dr. Tracy Bastain: But we also feel like impacting our own communities very close with our participant community is equally important. So we are really work to educate our participants on some of the exposures in their lives. I mentioned before that we have a student working with us on report back, or participant translation of the research. And part of the component of this initiative is to actually provide detailed information that’s useful to participants about their own data, their own exposures to environmental toxicants and what they can do about it. So I think that’s all the way from the participant level to the society level, is what the ultimate goal of our work is.
Phil Solaria: Perfect, thank you guys for sharing. It looks like we’re almost out of time. So if we didn’t get to your specific question, we’ll be sure to reach out to you on a one on one situation. We’ll be sure to answer any questions that you might have. So at this time, I really would just like to thank all the presenters. Thank you Shubha, thank you Sri, Tracy and Rima for sharing all this great information and your experiences really doesn’t mean a lot to us. Lastly, we’d like to thank you all again for taking time out of your day to hear more about USC and our Hot Topics in Public Health.
Phil Solaria: As a reminder for next steps, here is my contact information with my email address included. If you have any other questions or if there were any that we did not get to today. We’ll be sure to send you a quick follow up email to get these answered. Thank you all so much. And again, just as a reminder, a copy of this recording and slide presentation will be available in the next following days. Again, thank you for joining us. We hope everyone has a good week. Be safe and have a great rest of the week. Thank you.