Project 1: Wildfire impacts on birth and developmental outcomes in a rural state

项目摘要/摘要 野火的频率、严重程度和持续时间都在增加。气候变化和现成的燃料来源 确保火灾频率和严重性增加的趋势将持续下去。此外，野火不仅仅是一场 这是一种短期现象；火季的持续时间在过去30年里急剧增加。 到目前为止，关于野火对健康影响的研究一直强调呼吸健康，在较小程度上， 心血管终点。尽管越来越多的文献表明，城市空气污染， 具体地说，PM2.5与流产风险增加、出生体重低、早产、小于 胎龄和发育状况，如自闭症，很少有研究评估 野火对美国出生和发展的影响值得注意的是，这些工作都没有在农村地区进行， 一年四季都有独特的曝光率。迫切需要了解对 为社区和个人层面的干预提供战略信息。我们将把最先进的空气污染物 暴露评估、出生证明和胎儿和婴儿死亡数据，以及电子健康记录(EHR) 量化怀孕期间暴露在野火中对婴儿的风险，并确定 促进韧性。参与者住所特定的野火暴露估计之间的关联， 蒙大拿州2000至2017年间的总体和按三个月分列的出生结果，占暴露的比例 全年发生的，将被调查。具体结果包括出生体重、低出生体重 状态，小于胎龄状态；出生时胎龄和早产状态；新生儿重症 监护病房入院；胎儿死亡；婴儿死亡率。EHR将用于评估野火的影响 《普罗维登斯与社区医学》中蒙大拿州西部出生婴儿的发育暴露 2012至2017年间的医疗保健组织中心。具体来说，我们将调查野火的影响- 2、4、6个月龄发育里程碑成就与PM2.5暴露相关。要通知 开发有效、实用和可持续的干预措施，我们将检查潜在的影响 修改依据：个人因素，如产妇教育和家庭收入，以及社区 促进复原力的资源，包括邻里社会经济地位、社会资本和信息 和沟通能力。拟议研究的成功开展将建设以下能力 与野火相关的空气污染物暴露和扩展等的复杂时空模拟 环境暴露对神经发育影响的综合研究。拟议的项目将， 首次量化野火对农村地区出生和发展的影响，并确定 赋予这些影响韧性的资源。最重要的是，它将为未来的干预提供信息，旨在 减轻这一日益严重的公共卫生威胁的影响。

Project Summary/Abstract Wildfires are increasing in frequency, severity, and duration. Climate change and readily-available fuel sources ensure the trend toward increased fire frequency and severity will persist. Moreover, wildfires are not simply a short-term phenomenon; the duration of fire seasons has increased dramatically over the last three decades.  Research on the health impacts of wildfires has to date emphasized respiratory health and, to a lesser degree, cardiovascular endpoints. Although a growing body of literature has demonstrated that urban air pollution, specifically PM2.5, is linked to increased risk of miscarriage, lower birth weight, prematurity, being small for gestational age, and developmental conditions such as autism, little research has evaluated influence of wildfires on birth and development in the U.S. Of note, none of this work has been performed in rural areas, which have a unique profile of exposures throughout the year. An urgent need exists to understand impacts to inform strategies for community- and individual-level interventions. We will combine state-of-the-art air pollutant exposure assessment, birth certificate and fetal and infant mortality data, and electronic health records (EHR) to quantify the risk to infants associated with wildfire exposures during pregnancy and identify factors that promote resilience. The association between participant residence-specific estimates of wildfire exposure, overall and by trimester, and birth outcomes in Montana between 2000 and 2017, accounting for exposures occurring throughout the year, will be investigated. Specific outcomes include birth weight, low birth weight status, and small for gestational age status; gestational age at birth and preterm birth status; neonatal intensive care unit admission; fetal death; and infant mortality. EHR will be used to evaluate the impact of wildfire exposures on development in infants born in western Montana in the Providence and Community Medical Center health care organizations between 2012 and 2017. Specifically, we will investigate the effect of wildfire- related PM2.5 exposures on developmental milestone achievement at 2, 4, and 6 months of age. To inform the development of efficacious, practical, and sustainable interventions, we will examine potential effect modification by: individual-level factors, such as maternal education and household income, and community resilience promoting resources, including neighborhood socioeconomic status, social capital, and information and communication capacity. The successful conduct of the proposed research will build capacity for sophisticated spatio-temporal modeling of wildfire-associated air pollutant exposure and expanded and more comprehensive studies of neurodevelopmental impacts of environmental exposures. The proposed project will, for the first time, quantify the impacts of wildfires on birth and development in rural areas and determine resources that confer resilience to these effects. Most importantly, it will inform future interventions designed to mitigate the impacts of this ever-growing threat to public health.