Project 2: Environmental Health Disparities in Rural Appalachia: The impact of air pollution, obesity and diet on COPD morbidity.

慢性阻塞性肺疾病(COPD)是美国第三大死因。 贫困是COPD患病率和发病率增加的一个风险因素。虽然吸烟是其中一个原因 COPD在穷人中的增加，还有其他可能导致健康差距的暴露，以及 使穷人面临更大的风险，包括空气污染、肥胖和不良饮食模式。虽然很棒 在全球范围内确定慢性阻塞性肺病负担的努力已确定室内生物量是一种致病环境因素 暴露和国际努力制定有针对性的干预措施，以降低慢性阻塞性肺病的患病率和发病率 尽管慢性阻塞性肺病仍在继续，但人们对美国贫困农村地区的慢性阻塞性肺病问题关注相对较少。 阿巴拉契亚中南部代表着美国最不利的地区之一。 是农村地区，其特点是收入低、受教育程度低和地理上与世隔绝，这些因素与 身体不好。虽然直接评估该地区室内空气质量的研究相对较少，但初步工作 我们小组的研究表明，室内燃烧燃料的现象很普遍，家庭的室内氮气含量较高 二氧化氮(NO2)和颗粒物(PM)，甚至超过城市环境的典型浓度。住在 阿巴拉契亚地区还会增加肥胖和不良饮食模式的风险，这些因素可能会 对污染物影响的敏感性。南方的肥胖率最高，类似于城市食物 在沙漠中，阿巴拉契亚的农村地区有食物沙漠，这增加了不良饮食模式的可能性。我们自己的工作 在巴尔的摩，城市增加了新的文献，即身体质量可能有助于对空气的易感性 污染，然而，不良饮食模式的作用可能在这种对空气污染的易感性增加中发挥作用 仍然不为人知。在设计干预措施以减少健康差距和改善 农村高危人群的呼吸健康是为了查明该地区室内空气污染的来源，并 确定对COPD易感人群的呼吸健康影响的风险。 项目2建立了能力，并汇集了来自约翰·霍普金斯大学和 东田纳西州立大学了解环境驱动的健康差距在农村、低收入 人口。我们将对100名患有慢性阻塞性肺疾病的吸烟者进行纵向队列研究，包括一周 在基线、3个月和6个月时进行家庭环境监测和同时进行健康结果评估， 目标有以下几点。1)测量和确定曾经吸烟者的家庭空气污染源 阿巴拉契亚地区的慢性阻塞性肺病患者。2)评估室内空气污染暴露对呼吸道发病率的影响 阿巴拉契亚地区患有慢性阻塞性肺病的前吸烟者。3)探索体重和饮食的独立影响 摄入量对呼吸道健康的易感性。项目2是对项目1的补充，有助于治愈COPD 该计划的总体目标是通过定义空气污染、肥胖和 在阿巴拉契亚农村，不利的饮食(在穷人中增加的危险因素)会导致COPD发病率。

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States (U.S.). and poverty is a risk factor for increased COPD prevalence and morbidity. While cigarette smoking is one reason that COPD is increased among the poor, there are other exposures that likely contribute to health disparities and put poor individuals at increased risk, including air pollution, obesity, and adverse dietary patterns. While great efforts to determine the burden of COPD worldwide have identified indoor biomass as a causative environmental exposure and international efforts to develop targeted interventions to reduce COPD prevalence and morbidity are ongoing, there has been relatively little attention to the problem of COPD in poor, rural regions in the U.S. South Central Appalachia represents one of the most disadvantaged regions in the U.S. Most of Appalachia is rural and characterized by low income, limited education and geographic isolation, factors associated with poor health. While relatively few studies have directly assessed indoor air quality in this region, preliminary work by our group suggests that indoor burning of fuels is prevalent and that homes have elevated indoor nitrogen dioxide (NO2) and particulate matter (PM), even exceeding concentrations typical of urban settings. Living in Appalachia also increases the risk for obesity and adverse dietary patterns, factors that may enhance susceptibility to pollutant effects. The South has the highest prevalence of obesity and, analogous to urban food deserts, rural Appalachia has food deserts that enhance the likelihood of adverse dietary patterns. Our own work in Baltimore City has added to the emerging literature that body mass may contribute to susceptibility to air pollution, yet the role of adverse dietary patterns may play a role in this enhanced susceptibility to air pollution remains unknown. A critical next step in designing interventions to reduce heath disparities and improve the respiratory health of high-risk rural populations is to identify the sources of indoor air pollution in this region and determine the risk for respiratory health effects among susceptible individuals with COPD. Project 2 builds capacity and brings together a multidisciplinary team of investigators from Johns Hopkins and East Tennessee State University to understand environmentally driven health disparities in a rural, low-income population. We will conduct a longitudinal cohort study of 100 former smokers with COPD, including one week of home environmental monitoring and simultaneous health outcomes assessment at baseline, 3 and 6 months, with the following aims. 1) To measure and determine sources of household air pollution among former smokers with COPD in Appalachia. 2) To estimate the effect of indoor air pollution exposure on respiratory morbidity among former smokers with COPD in Appalachia. 3) To explore independent effects of body mass and dietary intake on susceptibility to respiratory health. Project 2 complements Project 1 and contributes to CURE COPD Program's overall goal of reducing health disparities by defining the contribution of air pollution, obesity, and adverse diet (risk factors that are increased among the poor) to COPD morbidity in rural Appalachia.