Heather Strosnider

Centers for Disease Control and Prevention, Атланта, Michigan, United States

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Publications (11)35.81 Total impact

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    ABSTRACT: Studies on the association between prenatal exposure to fine particulate matter with ≤ 2.5 micrometers in aerodynamic diameter (PM2.5) and term low birth weight (LBW) have resulted in inconsistent findings. Most studies were conducted in snapshots of small geographic areas and no national study exists. We investigated geographic variation in the associations between ambient PM2.5 during pregnancy and term LBW in the contiguous United States (US). 3,389,450 term singleton births in 2002 (37 - 44 weeks gestational age and birth weight of 1,000g - 5,500g) were linked to daily PM2.5 via imputed birth days. We generated average daily PM2.5 during the entire pregnancy and each trimester. Multilevel logistic regression models with county-level random effects were used to evaluate the associations between term LBW and PM2.5 during pregnancy. Without adjusting for covariates, the odds of term LBW increased 2% (OR=1.02; 95% CI: 1.00, 1.03) for every 5 µg/m(3) increase in PM2.5 exposure during the second trimester only, which remained unchanged after adjusting for county-level poverty (OR=1.02; 95% CI: 1.01, 1.04). The odds did change to null after adjusting for individual-level predictors (OR=1.00; 95% CI: 0.99, 1.02). Multilevel analyses, stratified by census division, revealed significant positive associations of term LBW and PM2.5 exposure (during the entire pregnancy or a specific trimester) in three census divisions: Middle Atlantic, East North Central, and West North Central, and significant negative association in the Mountain division. Our study provided additional evidence on the associations between PM2.5 exposure during pregnancy and term LBW from a national perspective. The magnitude and direction of the estimated associations between PM2.5 exposure and term LBW varied by geographic locations in the US.
    Environmental Health Perspectives 06/2015; DOI:10.1289/ehp.1408798 · 7.03 Impact Factor
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    ABSTRACT: Short-term effects of air pollution exposure on respiratory disease mortality are well established. However, few studies have examined the effects of long-term exposure and, among those that have, results are inconsistent. To evaluate long-term association between ambient ozone, fine particulate matter (PM2.5, particles with aerodynamic diameter of 2.5 micrometers or less) and chronic lower respiratory disease (CLRD) mortality in the contiguous United States. We fit Bayesian hierarchical spatial Poisson models, adjusting for five county-level covariates (percent adults aged ≥65 years, poverty, lifetime smoking, obesity, and temperature), with random effects at state and county levels to account for spatial heterogeneity and spatial dependence. We derived county-level average daily exposure levels for ambient ozone and PM2.5 for 2001-2008 from the U.S. Environmental Protection Agency's down-scaled estimates and obtained 2007-2008 CLRD deaths from the National Center for Health Statistics. Exposure to ambient ozone was associated with increased rate of CLRD deaths, with a rate ratio of 1.05 (95% credible interval, 1.01-1.09) per 5-ppb increase in ozone; the association between ambient PM2.5 and CLRD mortality was positive but statistically insignificant (rate ratio 1.068, 95% credible interval, 0.995-1.146). This is the first national study that links air pollution exposure data with CLRD mortality for 3109 contiguous U.S. counties. Ambient ozone may be associated with increased rate of death from CLRD in the contiguous United States.
    American Journal of Respiratory and Critical Care Medicine 05/2015; DOI:10.1164/rccm.201410-1852OC · 11.99 Impact Factor
  • Judith R Qualters, Heather M Strosnider, Rosalyn Bell
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    ABSTRACT: Public health surveillance includes dissemination of data and information to those who need it to take action to prevent or control disease. The concept of data to action is explicit in the mission of the Centers for Disease Control and Prevention's (CDC's) National Environmental Public Health Tracking Program (Tracking Program). The CDC has built a National Environmental Public Health Tracking Network (Tracking Network) to integrate health and environmental data to drive public health action (PHA) to improve communities' health. To assess the utility of the Tracking Program and Tracking Network in environmental public health practice and policy making. We analyzed information on how Tracking (all program components hereafter referred to generally as "Tracking") has been used to drive PHAs within funded states and cities (grantees). Two case studies are presented to highlight Tracking's utility. Analyses included all grantees funded between 2005 and 2013. Twenty-seven states, 3 cities, and the District of Columbia ever received funding. We categorized each PHA reported to determine how grantees became involved, their role, the problems addressed, and the overall action. Tracking grantees reported 178 PHAs from 2006 to 2013. The most common overall action was "provided information in response to concern" (n = 42), followed by "improved a public health program, intervention, or response plan" (n = 35). Tracking's role was most often either to enhance surveillance (24%) or to analyze data (23%). In 47% of PHAs, the underlying problem was a concern about possible elevated rates of a health outcome, a potential exposure, or a potential association between a hazard and a health outcome. PHAs were started by a request for assistance (48%), in response to an emergency (8%), and though routine work by Tracking programs (43%). Our review shows that the data, expertise, technical infrastructure, and other resources of the Tracking Program and Tracking Network are driving state and local PHAs.
    Journal of public health management and practice: JPHMP 03/2015; 21 Suppl 2, Environmental Public Health Tracking:S12-S22. DOI:10.1097/PHH.0000000000000175 · 1.47 Impact Factor
  • Heather Strosnider, Ying Zhou, Lina Balluz, Judith Qualters
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    ABSTRACT: Public health agencies at the federal, state, and local level are responsible for implementing actions and policies that address health problems related to environmental hazards. These actions and policies can be informed by integrating or linking data on health, exposure, hazards, and population. The mission of the Centers for Disease Control and Prevention׳s National Environmental Public Health Tracking Program (Tracking Program) is to provide information from a nationwide network of integrated health, environmental hazard, and exposure data that drives actions to improve the health of communities. The Tracking Program and federal, state, and local partners collect, integrate, analyze, and disseminate data and information to inform environmental public health actions. However, many challenges exist regarding the availability and quality of data, the application of appropriate methods and tools to link data, and the state of the science needed to link and analyze health and environmental data. The Tracking Program has collaborated with academia to address key challenges in these areas. The collaboration has improved our understanding of the uses and limitations of available data and methods, expanded the use of existing data and methods, and increased our knowledge about the connections between health and environment. Valuable working relationships have been forged in this process, and together we have identified opportunities and improvements for future collaborations to further advance the science and practice of environmental public health tracking.
    Environmental Research 07/2014; 134. DOI:10.1016/j.envres.2014.04.039 · 3.95 Impact Factor
  • Yongping Hao, Lina Balluz, Heather Strosnider
    2014 Council of State and Territorial Epidemiologists Annual Conference; 06/2014
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    ABSTRACT: Introduction. Although lead paint and leaded gasoline have not been used in the US for thirty years, thousands of US children continue to have blood lead levels (BLLs) of concern. Methods. We investigated the potential association of modeled air lead levels and BLLs ≥ 10 μ g/dL using a large CDC database with BLLs on children aged 0-3 years. Percent of children with BLLs ≥ 10 μ g/dL (2000-2007) by county and proportion of pre-50 housing and SES variables were merged with the US EPA's National Air Toxics Assessment (NATA) modeled air lead data. Results. The proportion with BLL ≥ 10 μ g/dL was 1.24% in the highest air lead counties, and the proportion with BLL ≥ 10 μ g/dL was 0.36% in the lowest air lead counties, resulting in a crude prevalence ratio of 3.4. Further analysis using multivariate negative binomial regression revealed that NATA lead was a significant predictor of % BLL ≥ 10 μ g/dL after controlling for percent pre-l950 housing, percent rural, and percent black. A geospatial regression revealed that air lead, percent older housing, and poverty were all significant predictors of % BLL ≥ 10 μ g/dL. Conclusions. More emphasis should be given to potential sources of ambient air lead near residential areas.
    Journal of Environmental and Public Health 01/2013; 2013:278042. DOI:10.1155/2013/278042
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    ABSTRACT: The U.S. Environmental Protection Agency (EPA) and the U.S. Centers for Disease Control (CDC) co-organized a symposium on "Air Pollution Exposure and Health" at Research Triangle Park, North Carolina on September 19-20, 2006. The symposium brought together health and environmental scientists to discuss the state of the science and the cross-jurisdictional and methodological challenges in conducting air pollution epidemiology, environmental public health tracking and accountability research. The symposium was held over 2 days and consisted of technical presentations and breakout group discussions on each of the three principal themes of this meeting: (1) monitoring and exposure modeling information, (2) health effects data and (3) linkage of air quality and health data for research, tracking and accountability. This paper summarizes the symposium presentations and the conclusions and recommendations developed during the meeting. The accompanying two papers, which appear in this issue of the Journal, provide more in-depth discussion of issues pertinent to obtaining and analyzing air pollution exposure and health information. The symposium succeeded in identifying areas where there are critical gaps of knowledge in existing air pollution exposure and health information and in discovering institutional or programmatic barriers, which impede accessing and linking disparate data sets. Several suggestions and recommendations emerged from this meeting, directed toward (1) improving the utility of air monitoring data for exposure quantification, (2) improving access to and the quality of health data, (3) studying emerging air quality and health issues, (4) exploring improved or novel methods for linking data and (5) developing partnerships, building capacity and facilitating interdisciplinary communication. The meeting was successful in promoting an interdisciplinary dialogue around these issues and in formulating strategies to support these recommended activities. Finally, this symposium subsequently led to strengthening and initiating new partnerships or interactions between the EPA, CDC, States, academia and the research community at large.
    Journal of Exposure Science and Environmental Epidemiology 07/2008; 19(1):19-29. DOI:10.1038/jes.2008.34 · 3.05 Impact Factor
  • Heather Strosnider, Anne Savage Venner
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    ABSTRACT: Decision making for environmental public health practice and policy development is faced with many challenges. A critical need for informed public health decision making is surveillance data. Unfortunately, health and environmental surveillance systems lack the coordination and integration needed to benefit environmental public health decisions. Decision making is also limited by data gaps which exist in both health and environmental systems. The Centers for Disease Control and Prevention's (CDC) National Environmental Public Health Tracking Program (Tracking Program) was created to establish a nationwide network of integrated health and environmental data. The Tracking Program will play a role in environmental public health decision making by filling gaps in data and facilitating the linkage of disparate health and environmental databases. Over the past four years, the Tracking Program has worked to build capacity for environmental public health within state and local agencies. Individual tracking grantees have demonstrated the ability to utilize health and environmental data to inform practices and policies regarding environmental health. By the end of 2008, the Tracking Program will provide nationally consistent information across multiple states which can assist the decision making process for both public health practice and policy development. The program will provide environmental public health information about lead, carbon monoxide, air, water, asthma, acute myocardial infarction, birth defects, cancer, and reproductive outcomes. Over time, the Tracking Program will add new information and continue to build capacity for environmental public health practice and policy development.
    135st APHA Annual Meeting and Exposition 2007; 11/2007
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    ABSTRACT: Consecutive outbreaks of acute aflatoxicosis in Kenya in 2004 and 2005 caused > 150 deaths. In response, the Centers for Disease Control and Prevention and the World Health Organization convened a workgroup of international experts and health officials in Geneva, Switzerland, in July 2005. After discussions concerning what is known about aflatoxins, the workgroup identified gaps in current knowledge about acute and chronic human health effects of aflatoxins, surveillance and food monitoring, analytic methods, and the efficacy of intervention strategies. The workgroup also identified public health strategies that could be integrated with current agricultural approaches to resolve gaps in current knowledge and ultimately reduce morbidity and mortality associated with the consumption of aflatoxin-contaminated food in the developing world. Four issues that warrant immediate attention were identified: a) quantify the human health impacts and the burden of disease due to aflatoxin exposure; b) compile an inventory, evaluate the efficacy, and disseminate results of ongoing intervention strategies; c) develop and augment the disease surveillance, food monitoring, laboratory, and public health response capacity of affected regions; and d) develop a response protocol that can be used in the event of an outbreak of acute aflatoxicosis. This report expands on the workgroup's discussions concerning aflatoxin in developing countries and summarizes the findings.
    Environmental Health Perspectives 12/2006; 114(12):1898-903. DOI:10.1289/ehp.9302 · 7.03 Impact Factor
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    ABSTRACT: To determine if an increased rate of breast cancer in Alaska Native women is related to their consumption of a subsistence diet that may contain p,p'-dichlorodiphenylethylene (DDE) and polychlorinated biphenyls (PCBs). A retrospective case control design. We analyzed banked serum collected between 1981 and 1987 from 126 Alaska Native women, including 63 case women who subsequently developed breast cancer and 63 age-matched control women who remained cancer-free. Serum was analyzed for DDT, DDE, 13 other chlorinated pesticides, and 28 PCB congeners. The geometric mean for p,p'-DDE levels among case women was 8.67 ppb (95% Confidence Interval 7.48, 10.04); among control women, the geometric mean was 7.36 ppb (6.53, 8.30). The geometric mean for total PCB levels among case women was 4.55 ppb (3.61, 5.74) and for control women, the geometric mean was 6.10 ppb (4.73, 7.86). Cancer status and total PCB levels varied across ethnicity (i.e., Eskimo, Aleut, and Indian) but DDE levels were uniform among these ethnic groups. Using conditional logistic regression analysis to adjust for potential confounders (e.g., ethnicity, family history of breast cancer, parity), we found an odds ratio of 1.43 (0.46, 4.47) for the highest tertile of DDE exposure and 0.42 (0.07, 2.38) for the highest tertile of total PCB exposure. Although the results are limited by small sample size and restricted risk factor information, our findings of higher DDE levels, but lower PCB levels among women with breast cancer are consistent with previous research. Our results confirm exposure to organochlorines among Alaska Native women but do not identify these exposures as a significant risk factor for breast cancer.
    International journal of circumpolar health 03/2006; 65(1):18-27. DOI:10.3402/ijch.v65i1.17885 · 1.30 Impact Factor
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    Heather Strosnider