M Alicia Overstreet Galeano's research while affiliated with Duke University and other places

Recent studies suggest that exposure to mold in damp buildings is an important environmental risk factor for childhood respiratory illness. One potential source of a damp home, is crawl space construction. A poorly constructed crawl space not only presents the possibility of contributing to a 'damp' home but can also become a reservoir for fungal growth. Fungal levels in the livable indoor environment have been characterized in other studies, but little has been done to assess the potential for mold growth in the crawl space. This study examines the potential for mold growth and subsequent transmission from the crawl space into the home environment. In this study, we assessed mold contamination levels within crawl spaces from 238 study homes in North Carolina. We determined whether air leakage from the heating, ventilation, and air conditioning (HVAC) system and associated ductwork, transmitted viable mold spores from the crawl space into the living spaces within the home. The results indicate that 19% of the homes demonstrated transmission of mold spores from the crawl space into the indoor environment, 45% of the homes displayed no transmission, and 36% of the homes were indeterminate. The results support the hypothesis that the HVAC system can serve as a conduit for the transmission of mold spores from the crawl space to the indoor environment of a home. This transmission likely affects children's health, given the significant amount of time they spend in the home environment. For low-income families, the HVAC system may contribute an additional source of childhood exposure and highlights the importance of the assessment of indoor environmental hazards.

Extensive research shows that blacks, those of low socioeconomic status, and other disadvantaged groups continue to exhibit poorer school performance compared with middle and upper-class whites in the United States' educational system. Environmental exposures may contribute to the observed achievement gap. In particular, childhood lead exposure has been linked to a number of adverse cognitive outcomes. In previous work, we demonstrated a relationship between early childhood lead exposure and end-of-grade (EOG) test scores on a limited dataset. In this analysis, data from the North Carolina Childhood Lead Poisoning Prevention Program surveillance registry were linked to educational outcomes available through the North Carolina Education Research Data Center for all 100 counties in NC. Our objectives were to confirm the earlier study results in a larger population-level database, determine whether there are differences in the impact of lead across the EOG distribution, and elucidate the impact of cumulative childhood social and environmental stress on educational outcomes. Multivariate and quantile regression techniques were employed. We find that early childhood lead exposure is associated with lower performance on reading EOG test scores in a clear dose-response pattern, with the effects increasingly more pronounced in moving from the high end to the low end of the test score distribution. Parental educational attainment and family poverty status also affect EOG test scores, in a similar dose-response fashion, with the effects again most pronounced at the low end of the EOG test score distribution. The effects of environmental and social stressors (especially as they stretch out the lower tail of the EOG distribution) demonstrate the particular vulnerabilities of socioeconomically and environmentally disadvantaged children. Given the higher average lead exposure experienced by African American children in the United States, lead does in fact explain part of the achievement gap.

Preventive approaches to childhood lead poisoning are critical for addressing this longstanding environmental health concern. Moreover, increasing evidence of cognitive effects of blood lead levels < 10 microg/dL highlights the need for improved exposure prevention interventions. Geographic information system-based childhood lead exposure risk models, especially if executed at highly resolved spatial scales, can help identify children most at risk of lead exposure, as well as prioritize and direct housing and health-protective intervention programs. However, developing highly resolved spatial data requires labor-and time-intensive geocoding and analytical processes. In this study we evaluated the benefit of increased effort spent geocoding in terms of improved performance of lead exposure risk models. We constructed three childhood lead exposure risk models based on established methods but using different levels of geocoded data from blood lead surveillance, county tax assessors, and the 2000 U.S. Census for 18 counties in North Carolina. We used the results to predict lead exposure risk levels mapped at the individual tax parcel unit. The models performed well enough to identify high-risk areas for targeted intervention, even with a relatively low level of effort on geocoding. This study demonstrates the feasibility of widespread replication of highly spatially resolved childhood lead exposure risk models. The models guide resource-constrained local health and housing departments and community-based organizations on how best to expend their efforts in preventing and mitigating lead exposure risk in their communities.

Background: Veterans of the 1991 Gulf War have an increased risk of amyotrophic lateral sclerosis (ALS), but the etiology is unknown. Objectives: This study sought to identify geographic areas with elevated risk for the later development of ALS among military personnel who served in the first Gulf War. Methods: A unified geographic information system (GIS) was constructed to allow analysis of secondary data on troop movements in the 1991 Gulf War theatre in the Persian Gulf region including Iraq, northern Saudi Arabia, and Kuwait. We fit Bayesian Poisson regression models to adjust for potential risk factors, including one relatively discrete environmental exposure, and to identify areas associated with elevated risk of ALS. Results: We found that service in particular locations of the Gulf was associated with an elevated risk for later developing ALS, both before and after adjustment for branch of service and potential of exposure to chemical warfare agents in and around Khamisiyah, Iraq. Conclusions: Specific geographic locations of troop units within the 1991 Gulf War theatre are associated with an increased risk for the subsequent development of ALS among members of those units. The identified spatial locations represent the logical starting points in the search for potential etiologic factors of ALS among Gulf War veterans. Of note, for locations where the relative odds of subsequently developing ALS are among the highest, specific risk factors, whether environmental or occupationally related, have not been identified. The results of spatial models can be used to subsequently look for risk factors that follow the spatial pattern of elevated risk.

Childhood lead poisoning remains a critical environmental health concern. Low-level lead exposure has been linked to decreased performance on standardized IQ tests for school-aged children. In this study we sought to determine whether blood lead levels in early childhood are related to educational achievement in early elementary school as measured by performance on end-of-grade (EOG) testing. Educational testing data for 4th-grade students from the 2000-2004 North Carolina Education Research Data Center were linked to blood lead surveillance data for seven counties in North Carolina and then analyzed using exploratory and multivariate statistical methods. The discernible impact of blood lead levels on EOG testing is demonstrated for early childhood blood lead levels as low as 2 microg/dL. A blood lead level of 5 microg/dL is associated with a decline in EOG reading (and mathematics) scores that is roughly equal to 15% (14%) of the interquartile range, and this impact is very significant in comparison with the effects of covariates typically considered profoundly influential on educational outcomes. Early childhood lead exposures appear to have more impact on performance on the reading than on the mathematics portions of the tests. Our emphasis on population-level analyses of children who are roughly the same age linked to previous (rather than contemporaneous) blood lead levels using achievement (rather than aptitude) outcome complements the important work in this area by previous researchers. Our results suggest that the relationship between blood lead levels and cognitive outcomes are robust across outcome measures and at low levels of lead exposure.

More municipal water treatment plants are using chloramines as a disinfectant in order to reduce carcinogenic by-products. In some instances, this has coincided with an increase in lead levels in drinking water in those systems. Lead in drinking water can be a significant health risk. We sought to test the potential effect of switching to chloramines for disinfection in water treatment systems on childhood blood lead levels using data from Wayne County, located in the central Coastal Plain of North Carolina. We constructed a unified geographic information system (GIS) that links blood lead screening data with age of housing, drinking water source, and census data for 7,270 records. The data were analyzed using both exploratory methods and more formal multivariate techniques. The analysis indicates that the change to chloramine disinfection may lead to an increase in blood lead levels, the impact of which is progressively mitigated in newer housing. Introducing chloramines to reduce carcinogenic by-products may increase exposure to lead in drinking water. Our research provides guidance on adjustments in the local childhood lead poisoning prevention program that should accompany changes in water treatment. As similar research is conducted in other areas, and the underlying environmental chemistry is clarified, water treatment strategies can be optimized across the multiple objectives that municipalities face in providing high quality drinking water to local residents.

State government, university, and local health department (LHD) partners collaborated to build the geographic information system (GIS) capacity of 5 LHDs in North Carolina. Project elements included procuring hardware and software, conducting individualized and group training, developing data layers, guiding the project development process, coordinating participation in technical conferences, providing ongoing project consultation, and evaluating project milestones. The project provided health department personnel with the skills and resources required to use sophisticated information management systems, particularly those that address spatial dimensions of public health practice. This capacity-building project helped LHDs incorporate GIS technology into daily operations, resulting in improved time and cost efficiency. Keys to success included (1) methods training rooted in problems specific to the LHD, (2) required project identification by LHD staff with associated timelines for development, (3) ongoing technical support as staff returned to home offices after training, (4) subgrants to LHDs to ease hardware and software resource constraints, (5) networks of relationships among LHDs and other professional GIS users, and (6) senior LHD leadership who supported the professional development activities being undertaken by staff.