Innovative Strategies for Addressing Climate-Related Health Challenges Symposium

Community perceptions of CKDu in an endemic area of Costa Rica: It has a huge impact and it is alarming - almost 1 to 2 people per house with kidney disease.*

Authors: Anna Strasma, Ashley Perez-Araya, Francini Obregon-Perez, Andrea Corrales-Vargas, Christina Wyatt, Marvin Gonz·lez-Quiroz , Jennifer Crowe

Introduction: Chronic kidney disease of unknown etiology (CKDu) disproportionately affects young male agricultural workers in Central America. It has been called the "black lung of climate change" due to heat being a major risk factor. This mixed methods cross-sectional study seeks to address a gap in the literature by describing the lived experiences and perceptions of CKDu among residents of several affected communities in a highly endemic region of Costa Rica.

Methods: We conducted 19 semi-structured interviews and 2 focus groups of 7 to 8 participants. Surveys was completed by all participants. Verbal responses were transcribed and coded using Dedoose software with both deductive and inductive approaches. We performed thematic analysis Survey responses were analyzed with descriptive statistics in R software.

Results: Of the 37 participants, 57% were male, median age was 56, and the median highest education level was primary school. The most common occupations were homemakers (n=9) and agricultural workers (n=7). The most common causes of CKD reported were insufficient water intake (n=29), arsenic (n=22), and agrochemicals (n=22). In the interviews and focus groups, key themes emerged including the high prevalence of CKD in their community that impacts the emotional, relational, and economic dimensions of individuals, families, and the communities. For example, participants reported isolation experienced by those with CKDu, the significant burden placed on families when a member is afflicted, and a sense of fear of CKDu. Many reported that CKDu is linked to agricultural work, and they experience tension between the need to work to support their families and the risk of worsening their health.

*Oral Presentation

Conclusions: CKDu has immense consequences on all aspects of life for the affected individual, family, community, region, and nation. There is an urgent need for continued research, increased health education, improved socioeconomic conditions, and increased occupational opportunities for people living in vulnerable communities.

Using accelerometer ambient light sensor data to quantify children’s outdoor time  *

Cody D. Neshteruk, Erik A. Willis, Keying Chen, Derek Hales

Purpose: Develop guidelines for processing accelerometer-derived light sensor data to quantify childrenís outdoor time.

Methods: Data were from 1073 children ages 3-5 years who participated in two cluster randomized controlled trials in early care and education centers (ECE). Both trials collected ActiGraph GT3X+ acceleration and light sensor lux data, with children wearing the device on the hip in one and on the wrist in the other. Full-day ECE observations with timestamped indoor and outdoor periods were also collected. Accelerometer and observation data were merged with hourly historical weather data to examine how weather conditions influenced lux readings. Lux value cutoffs distinguishing indoor/outdoor classifications were identified by examining percent agreement (%agree), Kappa, sensitivity + specificity (SENSPC), and false positive (FP) and false negative (FN) rates. Area under the curve (AUC) and error estimates for minutes of outside time were also computed. All analyses were stratified by placement (hip vs. wrist).

Results: In total, there were 556,543 minutes of observation and matched accelerometer lux data, with 13% classified as outside time. Optimal cutoffs for hip worn devices was 37 lux and 223 lux for wrist worn. These cutoffs for hip/wrist wear resulted in good agreement: AUC (0.886; 0.946), %agree (92.9%; 96.7%); kappa (0.678, 0.832), SENSPC (1.677; 1.832), and low balanced FP/FN rates (1.64%; 3.56%). For both hip and wrist placements, lux and observation derived estimates of outdoor time were similar. Lux values diminished slightly with increasing cloud covering and decreasing temperature, but weather conditions did not affect identified cutoffs.

Conclusions: Findings show differences in lux cutoffs to determine indoor and outdoor time in young children based on wear placement. With growing evidence of the impact of climate change and outdoor time on youth health and well-being, these results can guide future research on accurately classifying outdoor exposure.

*Oral Presentation

External environmental determinants of cardiometabolic disease: An integrated framework of pathomechanisms, multi-level healthcare delivery, person characteristics, and life course perspective*

David J. Press, Luke Parsons, Rebecca Fillipo, Dana Pasquale, Sudha Raman, Elizabeth Macias Rojo, Lesley Curtis, M. Alan Brookhart, Catherine Staton, Hayden Bosworth

Background: External environmental exposures, particularly high temperatures and air pollution, contribute to adverse cardiometabolic disease outcomes through complex pathways. While previous studies have examined specific mechanisms linking external environmental exposures to cardiometabolic disease outcomes, no comprehensive framework has integrated the full complexity of pathomechanisms with multi-level healthcare delivery and person characteristics.

Methods: We developed a conceptual framework synthesizing current evidence on external environmental exposures, pathomechanisms, and cardiometabolic disease outcomes. The framework incorporates both direct pathways through physiological mechanisms and indirect pathways through person-, provider-, and system-level mediators, moderators, and confounders. We applied a life course perspective to examine how structural inequities create and perpetuate health disparities in external environmental exposures and cardiometabolic disease outcomes. 

Results: The framework identifies shared pathomechanisms between high temperatures and air pollution exposure (including endothelial dysfunction, systemic inflammation, and oxidative stress) as well as exposure-specific pathways. These relationships are mediated, moderated, and confounded by multi-level person characteristics (individual and clinical characteristics as well as contextual factors) and multi-level healthcare delivery characteristics (policy context, health system context, and provider factors). The life course perspective reveals how both inherent characteristics (e.g., age, pre-existing conditions) and systematically imposed circumstances (e.g., residential segregation, workplace hazards) contribute to health disparities among susceptible, historically marginalized, and vulnerable populations.

Conclusion: This integrated framework advances understanding of how external environmental exposures affect cardiometabolic disease outcomes through complex multi-level pathways including mediation and moderation by patient characteristics and healthcare delivery. We highlight biological mechanisms and structural inequities underlying the complex association between the external environment and cardiometabolic disease.  Future research and policy efforts must prioritize culturally competent, community-engaged solutions to reduce the disproportionate burden of external environmental exposures among affected populations.

*Oral Presentation

Heat Stress Exposure, Resource Saving, and Cognitive Decline Among Older Adults in China

Jiaowei Gong, Andrew Zhai, Simiao Chen

Previous studies have provided abundant evidence for the adverse impacts of extreme temperature exposure on human health, whereas the policy-interactive effects in the temperatureñhealth nexus are underexplored. In particular, a potential trade-off between climate adaptation behaviors and resource conservation policies exists globally. By combining weather data from the Chinese Academy of Sciences, resource conservation targets from local governments, and individual-level survey data from the China Health and Retirement Longitudinal Study, we investigate the interactive effect of extreme heat exposure (>90?) and resource-saving stringency on the cognitive functioning of older adults. Our findings show that energy and water conservation significantly amplify the negative impacts of heat stress exposure on cognitive performance among older adults in urban China. Furthermore, the amplifying effect of resource conservation policies is more pronounced among individuals aged 65 and above, women, and those with rural hukou, and it also exhibits distinct temporal dynamics. Efforts to balance human behavior and resource conservation policies are needed to minimize the health costs of climate adaptation and to alleviate health inequalities across different demographic groups.

Investigating Genetic Susceptibility to Ozone Exposure

Jean Chung, Tenley Weil, Anastasiya Birukova, Aaron Vose, Claudia Salazar, Robert M. Tighe

Background: Ozone (O3) is a criterion air pollutant, highly recognized cause of environmental lung injury, and increases cardiopulmonary morbidity and mortality. Our research aims to define novel genetic susceptibility factors to O3. We assessed single nucleotide polymorphisms (SNPs) in key genes implicated in O3-induced lung inflammation and injury: Alox15, Alox5, Cxcr3, Cxcl10, and Cd163.

Methods: In a Duke IRB approved study, healthy non-smoking individuals without cardiorespiratory disease underwent acute laboratory exposure to filtered air (FA) and O3 (200 ppb) for 2.25h on two separate study visits followed at ~21h by bronchoscopy with bronchoalveolar lavage (BAL). DNA was extracted from blood samples and genotyped to detect polymorphisms using TaqMan Real-Time PCR. Albumin levels in the BAL fluid were measured by ELISA. BAL cytokines (i.e. IFN-y, IL-1b, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-17, and TNF-a) were measured by mesoscale. All statistics were done using Graphpad Prism 10 software. To normalize individual baseline differences, changes after O3 exposure were expressed as a fold change (O3/FA).

Results: There was a significant association between the Alox15 T/T and T/C genotype and increased albumin BAL and IL-4 levels for SNP rs7217186 T>C (p-value = 0.0277, 0.0084 for albumin and IL-4 respectively) and Alox15 G/G and G/A genotype for SNP rs269112 G>A (p-value = 0.0078, 0.0093 for albumin and IL-4 respectively). No significant differences or trends observed between polymorphisms for other genes with respect to albumin or other cytokines.

Conclusions: Our data suggests that ALOX15 may regulate O3-induced lung injury, as evidenced by increased BAL albumin and IL-4 levels in individuals expressing the major alleles of two key SNPs, when compared to minor allele expression. Assessing genetic risk factors that regulate ozone induced changes in lung function can help identify populations who would benefit the most from targeted prevention and development of novel treatments.

Community-based solutions for chronic disease management during natural disasters: A systematic review

Aditi Iyer, Justine Po, Arthur Bookstein

Despite rapid increases in both the burden of chronic disease and climate change-driven extreme weather events globally, the need to jointly address these crises remains largely overlooked. Chronic diseases require ongoing and often specialized care, which natural disasters disrupt by increasing physiological stressors and disrupting access to healthcare facilities, food, shelter and medications. Community-based solutions can mitigate these health risks, especially in low-resource settings and among historically underserved populations. This systematic review aimed to identify key recommendations for community-based interventions that aid with chronic disease management during extreme weather events. A comprehensive search strategy was used to yield 43 eligible studies from 266 search results from Embase, PubMed and Google Scholar. Articles were included if they discussed chronic diseases, community-based solutions and natural disasters and excluded if they were not English-language and/or not published in a peer-reviewed journal. Articles were assessed and selected using PRISMA guidelines, and their quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools. The final sample of studies represented 19 countries and consisted of 6 quantitative, 32 qualitative and 5 mixed-method studies. Minimal quantitative data was a key limitation of this review and topic, which requires further research. From the selected studies, a narrative synthesis approach was used to derive 11 themes of solutions that were sorted into 4 categories: pre-disaster, post-disaster, during disaster or all stages. Findings represent a synthesis of experience-based, effective strategies that can drive critically needed grassroots initiatives at the demand of increased climate crises.

The Inequitable Threat of Wildfires

Parker Ince

Introduction: An initial analysis of wildfire effects on community health reveal an overwhelmingly disproportionate effect on those already burdened by systemic health inequities.

Background: Large-scale wildfires have become one of the most dramatic manifestations of the effects of climate change. In some areas, they have become a predictable, seasonal occurrence. In other areas, wildfires are becoming a terrifying new threat. As wildfires become not just an aberration, but a regular event for millions of Americans, we need to develop action plans to address the public health fallout from these events. Despite headlines showing physical, structural devastation in affluent communities, the long-term effects of wildfires accentuate pre-existing, systemic health burdens on the most disadvantaged groups in society. Agencies need to assess which populations are most at-risk.

Methods: Use publicly-available data to analyze which areas are most vulnerable to long-term health effects of wildfires. Data includes US Census, ACS, and CDC Wonder resources, among others. Descriptive models and rudimentary predictive models were then deployed to demonstrate possible policy interventions. Using advanced analytical software with AI/ML modeling capabilities, the most important health indicators were assessed according to relevant geographical areas, and risk scores were assigned to different communities. A predictive model was then developed at a basic level to demonstrate the potential impact of targeted policy interventions.

Conclusion: Building community resilience to the effects of wildfires dovetails into the type of work we already need to be conducting, but now is lent more urgency in the communities most vulnerable to wildfires. Eventually, zip code-level data needs to be integrated into advanced analytical systems for public health agencies, and combined with geospatial analysis to develop targeted interventions. 

Under the Weather: Triaging Climate Change in Pediatric Graduate Medical Education

Sophia Gauthier MD MS, Lauren Gambill MD MPA, Sanyukta Desai MD, Matthew Wilkinson MD MPH, Elizabeth Matsui MD MHS

Background: The American Academy of Pediatrics declared global climate change a major threat to child health in 2015. In 2019, the American Medical Association passed a resolution advocating for the inclusion of climate change at all levels of medical training, however there remains a paucity in climate change and health curricula for pediatric graduate medical trainees.

Methods: We launched a novel curriculum on climate change and pediatric health at a single pediatric academic center. Pediatric residents listened to a pre-work podcast, then participated in a one-hour interactive clinical case-based learning session. We evaluated pre-and post-course knowledge and attitudes using pre- and post-surveys, and also examined course satisfaction. Additionally, residents were invited to participate in a focus group.

Results: Of the 66 participating residents, 39 completed both the pre- and post-course surveys. Only 26% of them had previous education in climate change. In the post-course survey, 92% of residents expressed satisfaction with the course, 85% agreed that the material should be mandatorily incorporated into residency training, and 100% agreed that they learned new material that was relevant to their clinical practice. Residents demonstrated a significant increase in knowledge scores from a pre-course mean of 9.8 points to post-course mean of 11.6 points (p = 0.003), and significant attitudinal changes in confidence on educating patients on climate change and health as well as perceived importance of this material in medical education. Four residents participated in the focus group and gave examples on how they incorporated material into their clinical practice.

Conclusion: This curriculum contributes to an educational gap. As a pilot study, our confidence in the results is constrained. However, we are encouraged that many pediatric residents expressed course satisfaction and demonstrated educational knowledge gains. Future work should focus on understanding ways in which climate education can affect clinical practice.

Climate change and pregnancy: extreme heat’s impact on the placenta health and birth outcomes.

Liping Feng and Junjie Yao

Background: Pregnancy increases vulnerability to extreme heat, with risks like low birth weight, stillbirth, and fetal growth restriction (FGR). These influence pregnancy outcomes and have lasting effects on both the mother and child. Despite growing attention, gaps remain in understanding susceptibility periods, heat thresholds, and biological pathways of heat-related complications. Heat exposure disrupts circulation and lowers blood flow to organs, but its impact on fetal blood supply through the placenta is unclear. We aim to uncover mechanisms linking heat exposure to pregnancy complications, focusing on placental dysfunction.

Methods: Pregnant mice (2-month-old) were divided into a heating group (40∞C, 50% humidity for 2-h daily) and a control group (25∞C, 50% humidity) from E0.5 to E18.5. Tissues and data were collected at E13.5 and E16.5. We developed high-speed functional photoacoustic microscopy (PAM), allowing us to observe dynamic changes in blood perfusion and oxygenation at the single-vessel level. Using PAM, we quantified the morphology of placenta vasculature (e.g., vessel density, diameter, volume), oxygenation, and blood flow speed before and after heating at 40∞C for 1-h at E7.5, 10.5, 13.5, 16.5, and 18.5.

Results: No maternal mortality occurred. However, we noted pregnancy loss in 3 out of 20 dams, placental insufficiency and abnormalities, FGR, and fetal death within the 40∞C group. Placental insufficiency indicates that the placenta cannot deliver enough oxygen and nutrients to the fetus, aligning with our PAM observation of heat-induced placental hypoxia. The hypoxia biomarker HIF1-alpha was significantly upregulated in heat-exposed placentas. Interestingly, our data suggest variations in maternal cardiac output and placental blood flow at different stages of pregnancy. Moreover, the expression of sFlt-1, a vascular endothelial growth factor antagonist, was significantly upregulated in heat-exposed placentas, consistent with abnormal placental angiogenesis.

Conclusion: Extreme heat exposure during pregnancy induced placental hypoxia and insufficiency, ultimately, FGR and fetal death.

Co-created Products from Community Engaged Climate Resilience Education

Caitlin Reilly, Elizabeth DeMattia, Nicolette Cagle, Grace Hayward, Olivia Hayward, Drew Henriksen, Spence Herrington, Aurora McCullum, Fiona Qu, Kathryn Stevenson, Mia Wang

Ready, Set, Resilience is a collaborative, co-created curriculum designed to foster and connect resilience at the personal, ecological, and community levels, focusing on the intersection of natural disasters, climate anxiety, and personal resilience. The central tenet of this initiative is co-production, achieved through intentional partnerships between public school teachers and resilience practitioners from diverse fields. Thus far, this project has resulted in a variety of products, including professional development workshops, three Kenan Fellowships, classroom support from Duke students, a book of nature fables, an activity booklet with somatic exercises for personal resilience, and a draft set of standards-aligned resilience lesson plans for the classroom.

The project is ongoing, and while mixed-methods data collection is underway, it is important to note that results are emerging gradually through the co-productive process and no formal findings are available at this time. However, early feedback from teachers has been promising, with reports of increased personal empowerment and enhanced student engagement through the curriculum. In particular, teachers have noted how the process of co-creation augments their own sense of resilience, which in turn influences their teaching practices.

Ready, Set, Resilience is active in classrooms in Carteret and Durham counties, supported by Duke students, faculty and staff at the Marine Lab and main campus. Recently, the project was invited by western NC teachers to support classrooms/teachers/students impacted by Hurricane Helene, further demonstrating its adaptability to specific climate-related challenges. This initiative represents a unique approach to building climate resilience, blending culturally-responsive community-based methods with education and practical support for teachers, and highlights the potential for further innovation and collaboration in the field of climate-related health interventions.

Exploring Health, Climate, and Food Security in Intibuc·, Honduras

Molly Fitzpatrick

Introduction: Climate change is among the greatest threats to human health. In Honduras, Indigenous communities face severe consequences from climate change. These communities, reliant on agriculture for their livelihoods, are subsequently experiencing exacerbated food insecurity and deteriorating health. The purpose of this study was to explore the experiences, adaptions and concerns of a Honduran community most impacted by climate change in order to inform community-driven efforts to mitigate these impacts.

Method: A qualitative descriptive design was used to address the research objectives. Participants were recruited using convenience sampling through flyers in a health clinic and by word of mouth in the community of Intibuc·. A local healthcare organization, COMPRIMIL, helped inform the discussion guide and facilitate the research process. Data collection involved semi-structured focus group discussions (X3 with n=17 participants) centered on experiences of community members in the face of the changing climate, particularly as it relates to health and food security. Data are currently being analyzed using inductive content analysis to formulate meaningful categories, themes, and patterns.

Results/Outcomes: Data analysis is ongoing, but the community reports significant changes in their food acquisition strategies over the past decade and heightened vulnerability to climate-related disruptions. Emerging themes highlight challenges in water access, resulting health issues, rising food insecurity, and decreasing crop yields. Lacking the necessary infrastructure for clean water, both for agricultural and health needs, the community has faced particular difficulties in maintaining the health of their children. As annual temperatures increase in Intibuc· and rainy season shortens each year, crop production continues to decline, profoundly impacting food security.

Discussion/Conclusions: This study highlights the impact of climate change in Intibuc·, Honduras. Themes include adaptation challenges, strain on food sources, and increased vulnerability to climate events. Findings underscore the urgent need for future research and community-specific interventions.

High temperatures and habitat quality shape fetal loss and birth outcomes in wild baboons

Carmen M. Cromer, Susan C. Alberts

Exposure to extreme heat is associated with increased fetal losses (e.g., Bonell et al. 2024). The mechanisms underlying this phenomenon are of great interest in the context of climate change but are currently poorly understood. Here, we investigated fetal loss in a nonhuman animal model of health and demography, the wild baboons of the Amboseli basin in southern Kenya. Baboons are close relatives of humans, and previous research has positioned this population as a robust mechanistic model of human biological and biosocial processes (Tung et al. 2023). Furthermore, as in humans, exposure to extreme heat in Amboseli baboons predicts increased fetal loss rates (Beehner et al. 2006; Fogel et al. 2023). We extended this result by testing the prediction that exposure to prenatal environmental stressors, including extreme heat, low rainfall (an index of food availability) and degraded habitats, disproportionately affects male fetuses, leading to female-biased live birth ratios. While warmer temperatures in the third trimester of pregnancy are associated with a substantial increase in the log-odds of fetal loss (?=0.1126245, p=0.004), warmer temperatures have no effect on the log-odds of female birth (p=0.6928). On the other hand, poor habitat quality is associated with an increased log-odds of female birth (p=0.017), indicating that a degraded habitat may pose a particular risk for male fetuses. In addition, the youngest and oldest mothers in the dataset have a statistically significantly increased risk of producing a female offspring. This preliminary analysis adds to a developing body of evidence (Wyrwoll 2023) that the impacts of climate change-induced heatwaves are detrimental to fetal health for both sexes, in both human and non-human primates, and paves the way for a more detailed analysis of potential mechanisms underlying this phenomenon.

Towards an Equitable and Inclusive Community Science: An Update from the Center for Collaborative Heat Monitoring

Ashton Merck; Max Cawley; Imani Vincent

Extreme heat is a leading public health threat in the United States (Campbell et al., 2018). Disparities between experiences and burdens of extreme heat events caused by inequitable investment, disenfranchisement, and the painful legacy of exclusionary policy and planning are among the most pressing matters of environmental justice that Americans face today (Manware et al., 2022). Participatory science can help communities gather critical locally-relevant data that can inform resilience planning on heat. At the same time, a common critique of participatory science is that many projects engage communities that are already well-connected and relatively well-resourced. There is a clear and troubling gap between the people who are more likely to participate in citizen science work and those who are most imperiled by heat and other climate risks (Pandya, 2012). Thus, it is essential to develop community science projects with an explicit focus on equity, accessibility, and inclusion to meaningfully broaden individual participation in science while building capacity in communities that are uniquely heat-imperiled.

The Center for Collaborative Heat Monitoring is a NIHHIS Center of Excellence that is focused on community-based heat monitoring to advance equitable heat resilience. The CCHM is a national partnership led by science museums that is based at the Museum of Life and Science in Durham, NC. In this presentation, members of the CCHM (including the Director and Program Manager) will describe how the CCHM is developing a ìscience-to-civicsî model of co-creation of knowledge, which is guided by the principles of informal science education and informed by the latest science in heat modeling and mapping. Critically, this model will also be influenced by the outcomes of partnerships with 30 communities over 3 years; the presentation will briefly describe the 10 communities that were recently selected as 2025 Community Science Partners. The presentation will conclude with key takeaways for researchers as well as possible avenues for collaboration.

Climate & Health Education for Healthcare Professions: An online course developed for the Coursera learning platform.

Trisha Dalapati, Jennifer Lawson, John Lohnes, Brian McAdoo, Denise Nepveaux, Valerie Sabol, Allyson Sutkowi-Hemstreet, AnnMarie Walton

The climate crisis is a health crisis. According to the World Health Organization, ì[c]limate change is the single biggest health threat facing humanity.î The health impacts of climate change are far-reaching, impacting most human physiological systems and mental health. Although climate change amplifies health risks for all people, the climate crisis disproportionately affects vulnerable and marginalized populations.

Healthcare systems are also adversely impacted by climate change, particularly when their ability to deliver care is compromised during and following extreme weather events. Ironically, the healthcare sector itself accounts for 5% of global greenhouse gas emissions and 8-9% of US emissions. Therefore health systems must include emission mitigation along with their preparedness and resilience plans.

It is critical that all healthcare professionals understand the relationships between climate change, environmental sustainability and health and apply this knowledge in their own practices and systems. However, this information is not widely taught in traditional health professions education. Building upon a pilot course to address this gap, an interprofessional team of Duke University faculty members and students developed a Coursera course, ìClimate and Health for Healthcare Professionsî.

The course content is delivered in four learning modules covering: 1) the Planetary Health Education Framework, 2) healthcare systems and climate change 3) climate-informed healthcare and 4) roles and responsibilities of health professionals in addressing climate change. It is available via the Duke Coursera online learning platform to anyone with an internet connection. This course is aimed at practicing health professionals, health professions students and health system administrators, but will be valuable to anyone with an interest in climate change and health. Initially offered for free, it may eventually be available as a for-credit certificate program with hopes of making it required learning for all Duke health professions students and practitioners.

Examining the Community Engagement Research Strategies Used in the Climate Impact on Lung Cancer via Exposure to Radon (CLOVER) Study in North Carolina

Mary Srivastava, BS; Yadurshini Raveendran, MS; Phillip Gibson, MS; Jules Iradukunda, MD; Rashad Rahman, BS; Jeffrey Clark, MD; Amie Koch, DNP; Junfeng Zhang, PhD; Tomi Akinyemiju, PhD

Background: Representation of diverse racial and ethnic groups in clinical research is often hindered by systemic barriers, including mistrust, accessibility issues, and historical discrimination. The CLOVER (Climate Impact on Lung Cancer via Exposure to Radon) study investigates how shifting climate patterns affect radon exposure and lung cancer risk across North Carolina (NC), particularly in communities historically underrepresented in research. Through targeted community engagement, the study seeks to recruit participants from diverse racial, ethnic, and socioeconomic backgrounds.

Methods: The study will recruit 1,000 participants across NC, prioritizing individuals from minority, low socioeconomic status (SES), and rural backgrounds. Using demographic data and radon exposure metrics, high-risk counties are identified for targeted engagement. In partnership with community-based organizations, Tribal communities, non-profits, faith-based organizations, and trained community health ambassadors, we will foster trust and encourage participation in the study through community events and informational sessions.

Results: Barriers and facilitators encountered during participant recruitment will be discussed, with insights into logistical, cultural, and resource challenges. Special attention will be given to recruitment dynamics in Western NC following Hurricane Helene, where post-disaster conditions posed unique obstacles. Strategies that fostered trust and engagement in these areas will be highlighted. Recommendations will be provided to enhance recruitment efforts in communities facing similar challenges in future studies. 

Conclusion: Findings from the CLOVER study will inform best practices for community-based recruitment in diverse and geographically varied areas. This approach enhances community engagement and representation in environmental health research, particularly in regions impacted by climate change.

Examining the Relationship between Extreme Temperature and Youth Health Outcomes: The Role of Neighborhood Disparities in New York City

Keying Chen, Cody Neshteruk, Elizabeth Rojo, Emily D’Agostino

Introduction

Extreme temperatures have been shown to adversely affect cardiovascular and respiratory health which is associated with an increased prevalence of obesity and asthma. In New York City (NYC), extreme temperatures disproportionately impact underserved neighborhoods, primarily due to built environment factors (i.e., poor housing quality, limited green spaces). Within NYC, the prevalence of childhood obesity and poor physical fitness in underserved neighborhoods has increased and childhood asthma rates are higher in low-income, minority neighborhoods. This study aims to examine the relationship between neighborhood disparities in climate change and youth health outcomes, focusing on obesity, physical fitness, and asthma as proxies for cardiovascular and respiratory health. 

Methods

This study will use longitudinal methods to examine the associations between extreme temperature and (1) youth fitness, and (2) childhood obesity and asthma, incorporating a one-year lag between temperature exposure and outcomes. The study will describe temperature variations at the census tract level that are associated with disparities in youth health outcomes. Youth fitness and obesity data will be obtained from the NYC FITNESSGRAM, containing annual health and fitness records of NYC public school students in grades 4-12 from 2006 to 2019. Height, weight and fitness are measured during annual assessments and linked across years by unique identifiers. Obesity will be defined as age- and sex-specific BMI ? 95th percentile. Fitness outcomes will include scores for aerobic capacity, muscular strength, and muscular endurance. Asthma data will be drawn from the Automated Student Health Records (ASHR).  Daily temperature data from the nClimGrid-Daily dataset, developed by the National Centers for Environmental Information, will provide temperature records from 1951 to present.

Conclusion

The results of this study will provide insights into the association between extreme temperatures and youth health, and how neighborhood-level temperature variations may contribute to disparities in youth health outcomes among NYC public school students.

Effect of Ambient Temperature on Mortality Risk in Hemodialysis Patients: An Individual-Level Analysis

Karthikeyan K, David Carlson

Climate variability, particularly fluctuations in temperature, could pose potential health risks to vulnerable populations. We recently began a work-in-progress study to examine the effect of ambient temperature on the mortality risk of hemodialysis patients using Electronic Health Records (EHR) from DaVita Clinic spanning 2015 to 2020. Our dataset includes patient mortality information along with state-level care locations for over 238,000 individuals. We integrated this with hourly temperature data from the ERA5-Land database. Since city-level data are unavailable, we use temperature measurements from the most populous city in each state as a proxy.  

We employed Cox Proportional Hazards (CoxPH) models with time-varying covariates to analyze the relationship between daily average temperatures and patient mortality. Our initial analysis focused on all-cause mortality with a cohort of patients who survived the first six months of treatment. Preliminary results reveal a statistically significant association: ambient temperatures are informative on mortality risk among hemodialysis patients (p<.05 on a small subset of the data) and provide informative insights over a risk model trained on EHR alone.

As we move forward, we are looking at nonlinear extensions potentially capture more complex relationship between temperature and mortality, for example, at extremely high or low temperatures. Furthermore, we also plan to examine how temperature effects vary across different baseline risk profiles and how they vary across regions of the country.

Our findings underscore the need to account for environmental factors in the care of hemodialysis patients. This study contributes to a deeper understanding of how climate change may influence patient outcomes, informing public health strategies and clinical practices aimed at enhancing patient resilience in the face of environmental challenges. 

Impact of Climate Anxiety, Brain Fog and Sport Anxiety on Pakistani Athletesí Subjective Performance during Smog.

syed mubashar iqbal shah, yaser nadeem, takreem ahmad umair, shahid imran, shamroz

Purpose: The study aims to explore mental health aspects of smog in one of the most polluted cities [Lahore Pakistan] in the world. The World Health Organization’s air quality standards were surpassed more than 100 times in the Pakistani population as they survive yearly through the fifth season of smog in Lahore (Ali & Kazmi, 2024). The study explores the impact of smog on the sports community.

Methods: This is a cross-sectional correlational quantitative study that took place during smog season, October 2024 till the end December 2024. A sample of 560 adolescents and adults from the Punjab Sports Board was recruited through purposive sampling. Inclusion criteria included sport pentathletes who were well-knowledgeable in the English Language. Pen and paper questionnaires were rotated and responses were coded on IBM SPSS v.25 followed by descriptive and inferential statistics. Informed consent was taken from the participants. The study adheres to the Department of Psychology, Hazara University Pakistan guidelines. Instruments of Climate Anxiety [Clayton &Karazsia, 2020 ] , Sport Anxiety[Smith et al., 1990] , Brain Fog[ Debowska et al., 2024], and Athleteís Subjective Performance [Nahum et al., 2016].

Key Findings: Pearson correlation shows a strong significant association among all variables. Multiple linear regression shows that climate, sports anxiety, and brain negatively impact athlete performance, further stressing pentathlon championships training and demoralizing athletes. MANOVA shows that age and gender have significant main effects.

Relevance to climate-related health challenges: Smog impacts mental health and community intervention for mitigation strategies is important. Training from sports and climate psychologists is required. Nature interventions in the community have to be fostered. Apart from precautionary, pharma logical, and environmental action plans, behavioral intervention on grass-root levels including acceptance, cognitive restructuring through sports, improvement of resilience, and psychological flexibility can help the sports community to survive and perform through the smog.

Date: April 8, 2025

Location: Penn Pavilion, 107 Union Dr, Durham, NC

Time: 9:00 – 3:00

Parking is available at 135 Science Drive, Durham, 27708 (Bryan Center Parking Garage)