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Kaufman JD. Invited Perspective: A Critical Part of a Real-World Environmental Health Trial Is to Demonstrate That the Intervention Reduced Exposure. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:91304. [PMID: 36112540 PMCID: PMC9480976 DOI: 10.1289/ehp11697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/02/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Joel D. Kaufman
- Environmental Health Perspectives, National Institute of Environmental Health Sciences, National Institutes of Health, U.S. Department of Health and Human Services, Research Triangle Park, North Carolina, USA
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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2
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Checkley W, Hossen S, Rosa G, Thompson LM, McCracken JP, Diaz-Artiga A, Balakrishnan K, Simkovich SM, Underhill LJ, Nicolaou L, Hartinger SM, Davila-Roman VG, Kirby MA, Clasen TF, Rosenthal J, Peel JL. Facing the Realities of Pragmatic Design Choices in Environmental Health Studies: Experiences from the Household Air Pollution Intervention Network Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3790. [PMID: 35409475 PMCID: PMC8997769 DOI: 10.3390/ijerph19073790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Abstract
Objective: Household Air Pollution Intervention Network (HAPIN) investigators tested a complex, non-pharmacological intervention in four low- and middle-income countries as a strategy to mitigate household air pollution and improve health outcomes across the lifespan. Intervention households received a liquefied petroleum gas (LPG) stove, continuous fuel delivery and regular behavioral reinforcements for 18 months, whereas controls were asked to continue with usual cooking practices. While HAPIN was designed as an explanatory trial to test the efficacy of the intervention on four primary outcomes, it introduced several pragmatic aspects in its design and conduct that resemble real-life conditions. We surveyed HAPIN investigators and asked them to rank what aspects of the design and conduct they considered were more pragmatic than explanatory. Methods: We used the revised Pragmatic Explanatory Continuum Indicator Summary (PRECIS-2) to survey investigators on the degree of pragmatism in nine domains of trial design and conduct using a five-point Likert rank scale from very explanatory (1) to very pragmatic (5). We invited 103 investigators. Participants were given educational material on PRECIS-2, including presentations, papers and examples that described the use and implementation of PRECIS-2. Results: Thirty-five investigators (mean age 42 years, 51% female) participated in the survey. Overall, only 17% ranked all domains as very explanatory, with an average (±SD) rank of 3.2 ± 1.4 across domains. Fewer than 20% of investigators ranked eligibility, recruitment or setting as very explanatory. In contrast, ≥50% of investigators ranked the trial organization, delivery and adherence of the intervention and follow-up as very/rather explanatory whereas ≤17% ranked them as rather/very pragmatic. Finally, <25% of investigators ranked the relevance of outcomes to participants and analysis as very/rather explanatory whereas ≥50% ranked then as rather/very pragmatic. In-country partners were more likely to rank domains as pragmatic when compared to investigators working in central coordination (average rank 3.2 vs. 2.8, respectively; Wilcoxon rank-sum p < 0.001). Conclusion: HAPIN investigators did not consider their efficacy trial to be rather/very explanatory and reported that some aspects of the design and conduct were executed under real-world conditions; however, they also did not consider the trial to be overly pragmatic. Our analysis underscores the importance of using standardized tools such as PRECIS-2 to guide early discussions among investigators in the design of environmental health trials attempting to measure efficacy.
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Affiliation(s)
- William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (L.J.U.); (L.N.)
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (L.J.U.); (L.N.)
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Ghislaine Rosa
- Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine and Hygiene, London WC1E 7HT, UK;
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30332, USA;
| | - John P. McCracken
- Epidemiology and Biostatistics Department, University of Georgia, Athens, GA 30606, USA;
| | - Anaite Diaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala;
| | - Kalpana Balakrishnan
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai 600116, India;
| | - Suzanne M. Simkovich
- Division of Healthcare Delivery Research, Medstar Health Research Institute, Hyattsville, MD 20782, USA;
- Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington, DC 20007, USA
| | - Lindsay J. Underhill
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (L.J.U.); (L.N.)
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Laura Nicolaou
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (S.H.); (L.J.U.); (L.N.)
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Stella M. Hartinger
- Latin American Center of Excellence on Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima 15102, Peru;
| | - Victor G. Davila-Roman
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - Miles A. Kirby
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Thomas F. Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Joshua Rosenthal
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA;
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Grajeda LM, Thompson LM, Arriaga W, Canuz E, Omer SB, Sage M, Azziz-Baumgartner E, Bryan JP, McCracken JP. Effectiveness of Gas and Chimney Biomass Stoves for Reducing Household Air Pollution Pregnancy Exposure in Guatemala: Sociodemographic Effect Modifiers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217723. [PMID: 33105825 PMCID: PMC7660060 DOI: 10.3390/ijerph17217723] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 12/18/2022]
Abstract
Household air pollution (HAP) due to solid fuel use during pregnancy is associated with adverse birth outcomes. The real-life effectiveness of clean cooking interventions has been disappointing overall yet variable, but the sociodemographic determinants are not well described. We measured personal 24-h PM2.5 (particulate matter <2.5 µm in aerodynamic diameter) thrice in pregnant women (n = 218) gravimetrically with Teflon filter, impactor, and personal pump setups. To estimate the effectiveness of owning chimney and liquefied petroleum gas (LPG) stoves (i.e., proportion of PM2.5 exposure that would be prevented) and to predict subject-specific typical exposures, we used linear mixed-effects models with log (PM2.5) as dependent variable and random intercept for subject. Median (IQR) personal PM2.5 in µg/m3 was 148 (90-249) for open fire, 78 (51-125) for chimney stove, and 55 (34-79) for LPG stoves. Adjusted effectiveness of LPG stoves was greater in women with ≥6 years of education (49% (95% CI: 34, 60)) versus <6 years (26% (95% CI: 5, 42)). In contrast, chimney stove adjusted effectiveness was greater in women with <6 years of education (50% (95% CI: 38, 60)), rural residence (46% (95% CI: 34, 55)) and lowest SES (socio-economic status) quartile (59% (95% CI: 45, 70)) than ≥6 years education (16% (95% CI: 22, 43)), urban (23% (95% CI: -164, 42)) and highest SES quartile (-44% (95% CI: -183, 27)), respectively. A minority of LPG stove owners (12%) and no chimney owner had typical exposure below World Health Organization Air Quality guidelines (35 μg/m3). Although having a cleaner stove alone typically does not lower exposure enough to protect health, understanding sociodemographic determinants of effectiveness may lead to better targeting, implementation, and adoption of interventions.
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Affiliation(s)
- Laura M. Grajeda
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (E.C.); (J.P.M.)
- Correspondence:
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA;
| | - William Arriaga
- Regional Hospital, Ministry of Public Health Social Assistance of Guatemala, Quetzaltenango 09001, Guatemala;
| | - Eduardo Canuz
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (E.C.); (J.P.M.)
| | - Saad B. Omer
- Yale Institute for Global Health, Schools of Public Health & Medicine, Yale University, New Haven, CT 06510, USA;
| | - Michael Sage
- Division of Environmental Hazards and Health Effects, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA;
| | | | - Joe P. Bryan
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA;
- Centers for Disease Control and Prevention, Central American Regional Office, Guatemala City 01015, Guatemala
| | - John P. McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala; (E.C.); (J.P.M.)
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Lai AM, Carter E, Shan M, Ni K, Clark S, Ezzati M, Wiedinmyer C, Yang X, Baumgartner J, Schauer JJ. Chemical composition and source apportionment of ambient, household, and personal exposures to PM 2.5 in communities using biomass stoves in rural China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 646:309-319. [PMID: 30055493 DOI: 10.1016/j.scitotenv.2018.07.322] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/22/2018] [Accepted: 07/23/2018] [Indexed: 05/03/2023]
Abstract
Fine particulate matter (PM2.5) has health effects that may depend on its sources and chemical composition. Few studies have quantified the composition of personal and area PM2.5 in rural settings over the same time period. Yet, this information would shed important light on the sources influencing personal PM2.5 exposures. This study investigated the sources and chemical composition of 40 personal exposure, 40 household, and 36 ambient PM2.5 samples collected in the non-heating and heating seasons in rural southwestern China. Chemical analysis included black carbon (BC), water-soluble components (ions, organic carbon), elements, and organic tracers. Source apportionment was conducted using organic tracer concentrations in a Chemical Mass Balance model. Biomass burning was the largest identified PM2.5 source contributor to household (average, SD: 48 ± 11%) and exposures (31 ± 6%) in both seasons, and ambient PM2.5 in winter (20 ± 4%). Food cooking also contributed to household and personal PM, reaching approximately half of the biomass contributions. Secondary inorganic aerosol was the major identified source in summertime ambient PM2.5 (32 ± 14%), but was present in all samples (summer: 10 ± 3% [household], 13 ± 6% [exposures]; winter: 18 ± 2% [ambient], 7 ± 2% [household], 8 ± 2% [exposures]). Dust concentrations and fractional contribution to total PM2.5 were higher in summer exposure samples (7 ± 4%) than in ambient or household samples (6 ± 1% and 2 ± 1%, respectively). Indoor sources comprised up to one-fifth of ambient PM2.5, and outdoor sources (vehicles, secondary aerosols) contributed up to 15% of household PM2.5. While household sources were the main contributors to PM2.5 exposures in terms of mass, inorganic components of personal exposures differed from household samples. Based on these findings, health-focused initiatives to reduce harmful PM2.5 exposures may consider a coordinated approach to address both indoor and outdoor PM2.5 source contributors.
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Affiliation(s)
- Alexandra M Lai
- Environmental Chemistry and Technology Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Ellison Carter
- Department of Civil and Environmental Engineering, Colorado State University, Fort Collins, CO, USA
| | - Ming Shan
- Department of Building Science, Tsinghua University, Beijing, China
| | - Kun Ni
- Department of Building Science, Tsinghua University, Beijing, China
| | - Sierra Clark
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Majid Ezzati
- School of Public Health, Imperial College London, London, United Kingdom; MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom
| | | | - Xudong Yang
- Department of Building Science, Tsinghua University, Beijing, China
| | - Jill Baumgartner
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - James J Schauer
- Environmental Chemistry and Technology Program, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, Madison, WI, USA.
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5
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Bilsback KR, Eilenberg SR, Good N, Heck L, Johnson M, Kodros JK, Lipsky EM, L'Orange C, Pierce JR, Robinson AL, Subramanian R, Tryner J, Wilson A, Volckens J. The Firepower Sweep Test: A novel approach to cookstove laboratory testing. INDOOR AIR 2018; 28:936-949. [PMID: 30099773 DOI: 10.1111/ina.12497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
Emissions from solid-fuel cookstoves have been linked to indoor and outdoor air pollution, climate forcing, and human disease. Although task-based laboratory protocols, such as the Water Boiling Test (WBT), overestimate the ability of improved stoves to lower emissions, WBT emissions data are commonly used to benchmark cookstove performance, estimate indoor and outdoor air pollution concentrations, estimate impacts of stove intervention projects, and select stoves for large-scale control trials. Multiple-firepower testing has been proposed as an alternative to the WBT and is the basis for a new standardized protocol (ISO 19867-1:2018); however, data are needed to assess the value of this approach. In this work, we (a) developed a Firepower Sweep Test [FST], (b) compared emissions from the FST, WBT, and in-home cooking, and (c) quantified the relationship between firepower and emissions using correlation analysis and linear model selection. Twenty-three stove-fuel combinations were evaluated. The FST reproduced the range of PM2.5 and CO emissions observed in the field, including high emissions events not typically observed under the WBT. Firepower was modestly correlated with emissions, although the relationship varied between stove-fuel combinations. Our results justify incorporating multiple-firepower testing into laboratory-based protocols but demonstrate that firepower alone cannot explain the observed variability in cookstove emissions.
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Affiliation(s)
- Kelsey R Bilsback
- Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado
| | - Sarah R Eilenberg
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Nicholas Good
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
| | - Lauren Heck
- Department of Statistics, Colorado State University, Fort Collins, Colorado
| | | | - John K Kodros
- Department of Atmospheric Science, Colorado State University, Fort Collins, Colorado
| | - Eric M Lipsky
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania
- Department of Mechanical Engineering, Penn State Greater Allegheny, McKeesport, Pennsylvania
| | - Christian L'Orange
- Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado
| | - Jeffrey R Pierce
- Department of Atmospheric Science, Colorado State University, Fort Collins, Colorado
| | - Allen L Robinson
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - R Subramanian
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Jessica Tryner
- Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado
| | - Ander Wilson
- Department of Statistics, Colorado State University, Fort Collins, Colorado
| | - John Volckens
- Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado
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Abstract
Nearly 3 billion people are exposed to household air pollution emitted from inefficient cooking and heating stoves, and almost the entire global population is exposed to detectable levels of outdoor air pollution from traffic, industry, and other sources. Over 3 million people die annually of ischemic heart disease or stroke attributed to air pollution, more than from traditional cardiac risk factors such as obesity, diabetes mellitus, or smoking. Clinicians have a role to play in reducing the burden of pollution-attributable cardiovascular disease. However, there currently exists no clear clinical approach to this problem. Here, we provide a blueprint for an evidence-based clinical approach to assessing and mitigating cardiovascular risk from exposure to air pollution. We begin with a discussion of the global burden of pollution-attributable cardiovascular disease, including a review of the mechanisms by which particulate matter air pollution leads to cardiovascular outcomes. Next, we offer a simple patient-screening tool using known risk factors for pollution exposure. We then discuss approaches to quantifying air pollution exposures and cardiovascular risk, including the development of risk maps for clinical catchment areas. We review a collection of interventions for household and outdoor air pollution, which clinicians can tailor to patients and populations at risk. Finally, we identify future research needed to quantify pollution exposures and validate clinical interventions. Overall, we demonstrate that clinicians can be empowered to mitigate the global burden of cardiovascular disease attributable to air pollution.
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Affiliation(s)
- Michael B Hadley
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (M.B.H.)
| | - Jill Baumgartner
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Quebec, Montreal, Canada (J.B.)
| | - Rajesh Vedanthan
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Quebec, Montreal, Canada (J.B.)
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Carter E, Norris C, Dionisio KL, Balakrishnan K, Checkley W, Clark ML, Ghosh S, Jack DW, Kinney PL, Marshall JD, Naeher LP, Peel JL, Sambandam S, Schauer JJ, Smith KR, Wylie BJ, Baumgartner J. Assessing Exposure to Household Air Pollution: A Systematic Review and Pooled Analysis of Carbon Monoxide as a Surrogate Measure of Particulate Matter. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:076002. [PMID: 28886596 PMCID: PMC5744652 DOI: 10.1289/ehp767] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 05/08/2023]
Abstract
BACKGROUND Household air pollution from solid fuel burning is a leading contributor to disease burden globally. Fine particulate matter (PM2.5) is thought to be responsible for many of these health impacts. A co-pollutant, carbon monoxide (CO) has been widely used as a surrogate measure of PM2.5 in studies of household air pollution. OBJECTIVE The goal was to evaluate the validity of exposure to CO as a surrogate of exposure to PM2.5 in studies of household air pollution and the consistency of the PM2.5-CO relationship across different study settings and conditions. METHODS We conducted a systematic review of studies with exposure and/or cooking area PM2.5 and CO measurements and assembled 2,048 PM2.5 and CO measurements from a subset of studies (18 cooking area studies and 9 personal exposure studies) retained in the systematic review. We conducted pooled multivariate analyses of PM2.5-CO associations, evaluating fuels, urbanicity, season, study, and CO methods as covariates and effect modifiers. RESULTS We retained 61 of 70 studies for review, representing 27 countries. Reported PM2.5-CO correlations (r) were lower for personal exposure (range: 0.22-0.97; median=0.57) than for cooking areas (range: 0.10-0.96; median=0.71). In the pooled analyses of personal exposure and cooking area concentrations, the variation in ln(CO) explained 13% and 48% of the variation in ln(PM2.5), respectively. CONCLUSIONS Our results suggest that exposure to CO is not a consistently valid surrogate measure of exposure to PM2.5. Studies measuring CO exposure as a surrogate measure of PM exposure should conduct local validation studies for different stove/fuel types and seasons. https://doi.org/10.1289/EHP767.
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Affiliation(s)
- Ellison Carter
- Institute on the Environment, University of Minnesota , St. Paul, Minnesota, USA
| | - Christina Norris
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University , Montreal, Quebec, Canada
| | - Kathie L Dionisio
- National Exposure Research Laboratory, U.S. Environmental Protection Agency , Research Triangle Park, North Carolina, USA
| | - Kalpana Balakrishnan
- Department Environmental Health Engineering, Sri Ramachandra University , Porur, Chennai, India
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University , Baltimore, Maryland, USA
- Program in Global Disease Epidemiology and Control, Department of International Heath, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University , Fort Collins, Colorado, USA
| | - Santu Ghosh
- Department Environmental Health Engineering, Sri Ramachandra University , Porur, Chennai, India
| | - Darby W Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University , New York, New York, USA
| | - Patrick L Kinney
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University , New York, New York, USA
| | - Julian D Marshall
- Department of Civil and Environmental Engineering, University of Washington , Seattle, Washington, USA
| | - Luke P Naeher
- Department of Environmental Health Science, College of Public Health, The University of Georgia , Athens, Georgia, USA
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University , Fort Collins, Colorado, USA
| | - Sankar Sambandam
- Department Environmental Health Engineering, Sri Ramachandra University , Porur, Chennai, India
| | - James J Schauer
- Environmental Chemistry & Technology Program, University of Wisconsin-Madison , Madison, Wisconsin, USA
- Department of Civil & Environmental Engineering, University of Wisconsin-Madison , Madison, Wisconsin, USA
| | - Kirk R Smith
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley , Berkeley, California, USA
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts, USA
| | - Jill Baumgartner
- Institute on the Environment, University of Minnesota , St. Paul, Minnesota, USA
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University , Montreal, Quebec, Canada
- Institute for Health and Social Policy, McGill University , Montreal Quebec, Canada
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