Emory-Georgia Clean Air Research & Education (CARE) Program

总结/摘要 在全球范围内，每年有700万人死于室内和环境空气污染的共同影响，其中约94% 低收入和中等收入国家（LMIC）。此外，二手烟（SHS）是一个主要的全球健康问题， 这一问题每年造成约60万人死亡（占死亡率的1%），妇女和儿童受到的影响尤为严重 的SHS。中低收入国家也不成比例地受到SHS及相关发病率和死亡率的影响。共和国 格鲁吉亚（GE）受到空气污染和SHS的显著影响。21%的疾病是由不良环境暴露引起的 在儿童中，疾病负担和死亡占25%，包括30%的疾病负担和14%的死亡。此外，通用电气的死亡率 环境和室内空气污染指数在世界上排名第三。此外， 性别平等在男性中占58%（世界第六高），在女性中占6%，这意味着SHS在性别平等中的重要影响。事实上，42%的 GE成人报告每日SHS暴露。为了强调这些统计数据的影响，GE的2017-2021年国家环境 和健康行动计划表明，解决空气污染是通用电气最突出的公共卫生优先事项之一。 然而，国内研究这种环境危害对环境的影响的能力有限， 健康这项申请，埃默里-格鲁吉亚清洁空气研究和教育（EG-CARE）计划，恰逢 提高研究和政策的优先次序，以减少空气污染和解决非传染性疾病在通用电气，并代表了一个独特的 埃默里大学，通用电气国家疾病控制和公共卫生中心（NCDC）， 通用电气国家环境局（NEA）和第比利斯国立医科大学（TSMU）。各种现有 将利用合作和持续努力，包括福格蒂资助的赠款，以促进无烟空气政策 在通用电气公司（R 01）和加强结核病研究能力在通用电气公司（D43），以及一个NIEHS资助的中心赠款， HERCULES（P30）和NIEHS资助的埃默里T32培训计划。这些努力的主要领导者以及这些努力的主要领导者 各机构将合作实施这一培训计划，其长期目标是提高通用电气的能力， 开展与非传染性疾病和环境健康相关的研究，并最终为政策和实践提供信息，以减少 非传染性疾病本申请的总体目标是开发和实施一个涉及培训的培训计划， 导师制和应用研究机会，以最终实现长期目标。在主题上，EG-CARE将重点关注 关于非传染性疾病和高血压之间的交叉点，特别是空气污染，目标是：1）加强正式的非传染性疾病和高血压培训 机会和体制基础设施，以支持正在进行的研究培训; 2）提供辅导NCD-和EH- 从分子到人口水平的相关研究机会，特别关注空气质量 3）重视研究传播和知识 翻译为政策和实践提供信息。利用上述正在进行的努力，这项建议提出了一个及时， GE高度优先的公共卫生问题，强调其潜在影响。项目团队的独特定位是， 实现这些目标，并在未来5年和长期内加强与非传染性疾病和高血压相关的研究能力。

SUMMARY/ABSTRACT Globally, 7 million deaths are attributable to the joint effects of indoor and ambient air pollution annually, with ~94% occurring in low- and middle-income countries (LMICs). In addition, secondhand smoke (SHS) is a major global health problem, causing ~600,000 deaths (1% of mortality) annually, with women and children being disproportionately affected by SHS. LMICs are also disproportionately impacted by SHS and related morbidity and mortality. The Republic of Georgia (GE) is notably impacted by air pollution and SHS. Adverse environmental exposures cause 21% of disease burden and 25% of deaths, including 30% of disease burden and 14% of deaths among children. Moreover, GE’s mortality index attributed to ambient and indoor air pollution is the 3rd highest in the world. Additionally, the smoking prevalence in GE is 58% in men (6th highest in the world) and 6% in women, implying significant impact of SHS in GE. Indeed, 42% of GE adults report daily SHS exposure. Underscoring the impact of these statistics, GE’s 2017-2021 National Environment and Health Action Plan indicates that addressing air pollution is among the most prominent public health priorities in GE. However, there is limited in-country capacity to conduct research regarding the impact of such environmental hazards on health. This application, the Emory-Georgia Clean Air Research and Education (EG-CARE) program, coincides with increased prioritization of research and policy to reduce air pollution and address NCDs in GE, and represents a uniquely strategic collaboration among Emory University, the GE National Center for Disease Control and Public Health (NCDC), the GE National Environmental Agency (NEA), and Tbilisi State Medical University (TSMU). Various existing collaborations and ongoing efforts will be leveraged, including Fogarty-funded grants to promote smoke-free air policies in GE (an R01) and to enhance TB research capacity in GE (a D43), as well as an NIEHS-funded center grant called HERCULES (a P30) and an NIEHS-funded T32 training program at Emory. Key leaders of these efforts and across these institutions will collaborate to implement this training program, with the long-term goal of enhancing capacity in GE to conduct research related to NCDs and environmental health (EH) and ultimately inform policy and practice to reduce NCDs. The overall objective of this application is to develop and implement a training program involving training, mentorship, and applied research opportunities to ultimately reach the long-term goal. Thematically, EG-CARE will focus on the intersection between NCDs and EH, particularly air pollution, and aim to: 1) enhance formal NCD and EH training opportunities and institutional infrastructure to support ongoing research training; 2) provide mentored NCD- and EH- related research opportunities spanning from the molecular to the population level, with a particular focus on air quality and pollution, to candidates with outstanding potential; and 3) emphasize research dissemination and knowledge translation to inform policy and practice. Leveraging the aforementioned ongoing efforts, this proposal addresses a timely, high-priority public health concern in GE, underscoring its potential impact. The program team is uniquely positioned to address these aims and enhance research capacity related to NCDs and EH in the next 5 years and in the long term.