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

项目总结/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程度增加的趋势将持续下去。此外，野火不仅仅是一个 这是一种短期现象;在过去三十年里，火灾季节的持续时间急剧增加。 迄今为止，关于野火对健康影响的研究一直强调呼吸系统健康， 心血管终点。尽管越来越多的文献表明，城市空气污染， 特别是PM2.5，与流产风险增加，出生体重较低，早产， 胎龄和发育条件，如自闭症，很少有研究评估的影响， 野火对美国出生和发育的影响。值得注意的是，这些工作都没有在农村地区进行， 全年都有独特的暴露情况。我们迫切需要了解这些影响， 为社区和个人一级的干预提供信息战略。我们将联合收割机 暴露评估、出生证明、胎儿和婴儿死亡率数据以及电子健康记录（EHR） 量化怀孕期间与野火暴露相关的婴儿风险，并确定 促进复原力。参与者对野火暴露的特定住所估计之间的关联， 2000年至2017年期间，蒙大拿州的总体和三个月的出生结果， 全年发生的事件，都将被调查。具体结果包括出生体重、低出生体重 状态和小于胎龄状态;出生时胎龄和早产状态;新生儿强化 监护室入院;胎儿死亡;和婴儿死亡率。EHR将用于评估野火的影响 在普罗维登斯和社区医疗中心， 2012年至2017年期间的中心医疗保健组织。具体来说，我们将研究野火的影响- 相关PM2.5暴露对2、4和6个月龄时发育里程碑成就的影响。通知 制定有效、实用和可持续的干预措施，我们将研究潜在的影响， 按以下因素修改：个人因素，如母亲教育和家庭收入，以及社区因素 弹性促进资源，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能力， 野火相关的空气污染物暴露的复杂时空建模，并扩大和更多 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育的影响， 资源，赋予这些影响的弹性。最重要的是，它将为未来的干预措施提供信息， 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.