Associations between Ambient Air Pollution and Adverse Birth Outcomes in Florida

描述(由申请者提供)：我们的长期目标是成为环境流行病学的领军人物，并制定一项研究计划，以提高我们对环境暴露对人类健康的作用的理解。主要的短期研究目标是在佛罗里达大学建立独立和合作的研究议程和项目，重点是环境暴露的流行病学研究，特别是空气污染。这项职业发展计划将提供必要的资源，通过提供更多技术技能培训和正式指导，扩大我对与空气污染有关的健康问题的调查：(1)增进我对空气污染对生殖健康影响的了解；(2)在环境流行病学研究方面获得更多经验，包括研究设计、暴露评估、大型数据集管理技能和统计建模；以及(3)提高成功竞争独立赠款资助所必需的技能，包括科学写作、手稿开发和赠款技能。特别是，这项指导性研究的目标是调查空气污染对胎儿健康的健康影响。在美国和佛罗里达州，早产和低出生体重等不良妊娠结局的发生率不断上升，这是导致儿童和成人死亡和/或发病的主要原因。越来越多的流行病学证据表明，母亲暴露于环境空气污染与不良妊娠结局之间存在关联。然而，研究结果并不一致。这里的目的是评估佛罗里达州环境空气污染和不良妊娠结局之间的关系。这项研究将利用三个相同地理区域和时间段的相关数据集：佛罗里达州出生证明数据、美国人口普查数据和来自分层贝叶斯(HB)时空统计模型的内插空气质量数据，该模型提供了更好的空气污染水平的空间分辨率，以便更准确地评估暴露。在这项研究中，人们将：1)使用基于人口的出生队列来检查空气污染和不良出生结果之间的关系，强调检测暴露的关键窗口和确定影响因素；2)在考虑了社区水平因素(即人口普查区域水平的变量)的混杂影响和/或影响修改后，应用多水平模型来进一步调查这些关联；3)使用时间序列分析来评估空气污染和早产之间的关系；4)制定一项赠款建议，以独立资助开展一项关于空气污染和生殖健康的研究。这项研究专门讨论空气污染对不良妊娠结局的健康影响，最终目的是提供对其病因的洞察，这些原因可以修改，以减少这些主要的生殖健康问题。因此，这项工作对公共卫生具有至关重要的意义，因为不良妊娠结局的比率不断上升，其长期健康后果以及空气污染的无处不在的性质。 与公共健康相关：考虑到不良妊娠结局的增长率和空气污染的无处不在的性质，重要的是要了解空气污染在不良妊娠结局发生中的作用，空气污染是否对胎儿健康产生不利影响，如果考虑到其他社区层面的社会环境因素的混杂影响，这种相关性是否会改变。此外，确定怀孕期间某段时间的胎儿是否对空气污染更敏感，以及具有某些特征的胎儿是否更容易受到空气污染对健康的不利影响，可以帮助我们更好地了解它们之间的因果关系，这反过来又可以引导我们扭转不良生育结局的上升趋势。这项提案寻求使用2004-2005年佛罗里达州出生登记数据、人口普查数据和模拟的空气质量数据来更好地理解这些关系。

DESCRIPTION (provided by applicant): The overarching long-term goal is to be a leading scientist of environmental epidemiology and to develop a program of research that improves our understanding the role of environmental exposures in human health. The primary short-term research objective is to establish an independent and collaborative research agenda and projects at the University of Florida with a major focus on epidemiological research on environmental exposures, particularly on air pollution. This career development plan will provide the necessary resources to expand my inquiry into health problems related to air pollution by providing training in additional technique skills and formal mentorship to: (1) advance my knowledge of the impacts of air pollution on reproductive health; (2) gain further experiences in the conduct of research in environmental epidemiology, including study design, exposure assessment, large dataset management skills and statistical modeling; and (3) advance the skills which are essential for successful competition of independent grant funding, including scientific writing, manuscript development and grantsmanship. In particular, the goal of this mentored research is to investigate the health effects of air pollution on fetal health. The increasing rates of adverse pregnancy outcomes such as preterm delivery and low birth weight, which are major causes of mortality and/or morbidity in childhood and adulthood, have been reported in the USA and in Florida. Growing epidemiological evidence suggests associations between maternal exposure to ambient air pollution and adverse pregnancy outcomes. However, the findings have been inconsistent. The intent here is to evaluate the associations between ambient air pollution and adverse pregnancy outcome in Florida. This study will utilize three related datasets for the same geographic area and time periods: the Florida birth certificate data, US census data and the interpolated air quality data from the Hierarchical Bayesian (HB) space-time statistical model, which provides a better spatial resolution of air pollution levels for more accurately assessing exposure. In this study, one will: 1) use a population-based birth cohort to examine the associations between air pollution and adverse birth outcomes by emphasizing on detection of the critical windows of exposure and identification of the effect modifiers; 2) apply multilevel models to further investigate these associations after considering the confounding effects and/or effect modification of neighborhood level factors (i.e. census tract- level variables); 3) use a time-series analysis to assess the associations between air pollution and preterm births; 4) develop a grant proposal for independent funding to conduct a study on air pollution and reproductive health. This study specifically addresses health effects of air pollution on adverse pregnancy outcomes with the ultimate goal of offering insight into their etiological causes, which can be modifiable in order to reduce these major reproductive health problems. Therefore, this work is of critical public health importance because of the increasing rates of adverse pregnancy outcomes, their long-term health consequences and the omnipresent nature of air pollution. PUBLIC HEALTH RELEVANCE: Considering the increasing rates of adverse pregnancy outcomes and the omnipresent nature of air pollution, it is important to understand the role of air pollution in the development of adverse pregnancy outcomes, whether air pollution has adverse health effects on fetus and whether the associations will change if considering the confounding effects of additional neighborhood-level socially environmental factors. Furthermore, determining whether fetus at certain period of time during pregnancy is more sensitive to air pollution and whether fetus with certain characteristics is more vulnerable to adverse health effects of air pollution can help us better a causal relationship between them, which in turn guides us to reverse the increasing rates of adverse birth outcomes. This proposal seeks to better understand these relationships using 2004-2005 Florida birth registry data, census data and the modeled air quality data.