Convergence of multiple exposures during pregnancy: Effect of wildfires and maternal stressors on birth outcomes among Alaskan women

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PROJECT SUMMARY (ABSTRACT) The research objective of this K01 is to understand how wildfire smoke (WFS) exposure and other maternal stressors converge and contribute to preterm birth differentially across socio-demographic groups. Prematurity is a major determinant of newborn death and disability. There are substantial disparities in the U.S. where the rate of preterm births among American Indian/Alaska Native women is 26% higher than the rate among all U.S. mothers. The research will consist of three Specific Aims. (Aim 1): Evaluate the association between exposure of pregnant women in Alaska to WFS and preterm birth. We hypothesize that maternal WFS exposure is associated with adverse birth outcomes, particularly when exposed at critical developmental windows during gestation. We will develop a historical, spatially explicit WFS layer using the NOAA HYSPLIT model. We will combine model output with Alaskan birth records from 2000-2020 (n=220,000) to estimate associations between WFS exposure and birth outcomes, controlling for maternal smoking, age, parity, and pre-pregnancy co- morbidities. (Aim 2): Assess effect modification of the relationship between WFS exposure and adverse birth outcomes by maternal characteristics, access to healthcare, and geographic remoteness. We will utilize information from birth records to conduct stratified analyses. We hypothesize that maternal socio-demographic characteristics modify the relation between WFS exposure and birth outcomes. (Aim 3): Test the combined effect of stressful life events during pregnancy and WFS exposure on preterm birth. Using a subset of our sample included in the Pregnancy Risk Assessment Monitoring System (PRAMS), we will include measures of stress by domain (e.g. financial, relationship) and number of stressful life events as interaction variables with WFS exposure. The candidate is a tenure-track Assistant Professor of Environmental Health at the University of Alaska-Anchorage with training in epidemiology, biostatistics, ecology methods, and GIS. Her short-term career goals are to expand her research on wildfire epidemiology, and to develop a research program to understand how health disparities in Alaska contribute to the health impacts of climate change. Her long-term career goal is to lead an applied research group that conducts rigorous, community-responsive research. This career award will support her training in health disparities and mixed methods research, qualitative analysis, advanced statistical methods, and integration of health equity into adaptation planning. Her department/mentor team have expertise in environmental epidemiology, biostatistics, air quality modeling, and translational research, and her campus offers many opportunities to support junior faculty. These experiences and resources will support the work proposed here, as well as future interdisciplinary research on environmental justice issues. This proposal supports the NIMHD mission to improve minority health and reduce health disparities by strengthening rigorous quantitative and qualitative methods to enable analysis on small populations and developing methodologies for incorporating and using geographic identifiers in health disparities research to promote place-based research.