# Publications

Mramba RP. Nutritional Status of Children as an Indicator of Bushmeat Utilization in Western Serengeti. Norwegian University of Science and Technology Department of Biology [Internet]. 2011. Publisher's VersionAbstract

Serengeti ecosystem supports great number of large mammals ranging from grazers, browsers and carnivores. Some of these animals migrate between seasonal water sources and grasslands. The human population in the western boundary of the park is currently high and increases at the rate of 4% per annum. Majority of local communities are subsistence farmers who derive their needs such as bush meat from the park. The purpose of the study was to test if bush meat utilization contributes to nutritional improvement of local communities around Serengeti National Park. Three villages were selected at random along a gradient of distance from Serengeti National Park and Lake Victoria and a control village from Dodoma Region in Tanzania. One hundred households were selected at random from each village and interviewed. Weight and height of children aged 3 to 12 years from the selected households were measured. Anthropometric data were analyzed by WHO AntrhoPlus software while questionnaires were analyzed by SPSS for windows version 18. The results revealed significant differences in the number of undernourished children from the villages which were in western Serengeti compared to the control village. Consumption of bushmeat was significantly higher in the villages which were close to the park compared to the village which was further away from the park. Fish consumption was higher than bushmeat in the village which was close to both park and Lake Victoria and negatively correlated with bushmeat meals, while consumption of livestock meat was higher in the control village. No significant relationship between nutritional status of children and number of bushmeat meals observed, but there was a negative relationship between nutritional status and distance from the park/lake and the price of bushmeat. The study also revealed significant relationship between level of education of the parent and the body mass index of the children.

Lowe M. Obesity and climate change mitigation in Australia: overview and analysis of policies with co-benefits. Aust N Z J Public Health [Internet]. 2014;38 (1) :19-24. Publisher's VersionAbstract

OBJECTIVE: To provide an overview of the shared structural causes of obesity and climate change, and analyse policies that could be implemented in Australia to both equitably reduce obesity rates and contribute to mitigating climate change. METHODS: Informed by the political economy of health theoretical framework, a review was conducted of the literature on the shared causes of, and solutions to, obesity and climate change. Policies with potential co-benefits for climate change and obesity were then analysed based upon their feasibility and capacity to reduce greenhouse gas emissions and equitably reduce obesity rates in Australia. RESULTS: Policies with potential co-benefits fit within three broad categories: those to replace car use with low-emissions, active modes of transport; those to improve diets and reduce emissions from the food system; and macro-level economic policies to reduce the over-consumption of food and fossil fuel energy. CONCLUSION: Given the complex causes of both problems, it is argued that a full spectrum of complementary strategies across different sectors should be utilised. IMPLICATIONS: Such an approach would have significant public health, social and environmental benefits.

Wells NM, Lekies KS. Nature and the Life Course: Pathways from Childhood Nature Experiences to Adult Environmentalism. Children, Youth, and Environments. 2006;16 :1-24.Abstract

Model testing of US urban adult interview data and cross-validation procedures using structural equation modeling suggest that childhood participation with nature may set an individual on a trajectory toward adult environmentalism, i.e., positive attitudes and behaviors relating to the environment. This summary is not an official abstract. Users should refer to the original published version of the material for the full abstract

Haase H, Rink L. Multiple impacts of zinc on immune function. Metallonomics [Internet]. 2014;6 :1175-1180. Publisher's VersionAbstract

Even though zinc is essential for virtually all processes in the human body, observations during zinc deficiency indicate that the absence of this trace element most severely affects the immune response. Numerous investigations of the cellular and molecular requirements for zinc in the immune system have indicated that there is not just one single function of zinc underlying this essentiality. In fact, there is a wide range of different roles of zinc in immunity. This review summarizes the recent developments in three of the major fields: the role of zinc as a second messenger in signal transduction, the importance of zinc for immune cell function, and the competition for zinc between the host and the pathogen, a concept known as nutritional immunity.

Kristjanson P, Radeny M, Baltenweck I, Ogutu J, Notenbaert A. Livelihood mapping and poverty correlates at a meso-level in Kenya. Food Policy [Internet]. Submitted;30 :568-583. Publisher's VersionAbstract
We identify and map critical spatial factors grouped into natural, human, social, financial and physical capital assets, which largely determine livelihood options, strategies and welfare of agro-pastoral communities in a semi-arid district of southern Kenya. Our approach builds upon new, relatively high-resolution spatial poverty data and refines participatory land-use mapping methods, making
valuable information on natural and social resource availability and access useful for policy makers. While most poverty analyses focus on the household, we employ quantitative spatial data analysis methods to examine the spatial correlates of meso-, or community-level poverty incidence. The results
suggest that variables influencing poverty levels in this district include pasture potential, livestock density, distance to a major town, road density, access to education, access to security, soil fertility and agricultural potential. Because of the participatory research process taken, these results are already feeding into both local- and national-level policy processes aimed at reducing poverty in Kenya.
Myers SS, Phillips RS, Davis RB, Cherkin DC, Legedza A, Kaptchuk TJ, Hrbek A, Buring JE, Post D, Connelly MT, et al. Patient Expectations as Predictors of Outcome In Patients with Acute Low Back Pain. JGIM: Journal of General Internal Medicine [Internet]. 2008;23 :148-153. Publisher's VersionAbstract

#### BACKGROUND:

Few studies have evaluated the association between patient expectations for recovery and clinical outcomes, and no study has evaluated whether asking patients to choose their therapy modifies such an association.

#### OBJECTIVE:

To evaluate the association between patients' expectations and functional recovery in patients with acute low back pain (LBP), and to determine whether that association is affected by giving patients choice of therapy.

#### DESIGN AND PARTICIPANTS:

A secondary analysis of a randomized controlled trial comparing usual care alone to usual care plus choice of chiropractic, acupuncture, or massage in 444 adults with acute LBP, lasting less than 21 days.

#### MEASUREMENTS AND MAIN RESULTS:

Primary outcome was functional disability (Roland score) at 5 and 12 weeks. Patients' general expectations for improvement were associated with improvement in functional status (beta = 0.96, 95% CI = 0.56, 1.36). A 1-point increase in general expectations was associated with a 0.96-point improvement in Roland score. The association of expectation with outcome was 2-3 times greater in the usual care group than the choice group. However, these differences did not reach statistical significance.

#### CONCLUSIONS:

In patients with acute LBP, higher expectations for recovery are associated with greater functional improvement. Eliciting patient expectations for improvement may be a simple way to identify patients with the highest (or lowest) likelihood of experiencing functional improvement. Incorporating questions about patient expectations in future trials may clarify the role of this important correlate of clinical outcomes.

Almada AA, Golden CD, Osofsky SA, Myers SS. A case for Planetary Health/Geohealth. GeoHealth [Internet]. 2017;1 (2) :75-78. Publisher's VersionAbstract

Concern has been spreading across scientific disciplines that the pervasive human transformation of Earth's natural systems is an urgent threat to human health. The simultaneous emergence of “GeoHealth” and “Planetary Health” signals recognition that developing a new relationship between humanity and our natural systems is becoming an urgent global health priority—if we are to prevent a backsliding from the past century's great public health gains. Achieving meaningful progress will require collaboration across a broad swath of scientific disciplines as well as with policy makers, natural resource managers, members of faith communities, and movement builders around the world in order to build a rigorous evidence base of scientific understanding as the foundation for more robust policy and resource management decisions that incorporate both environmental and human health outcomes.

Moore AF, Spaulding NE, Bohleber P, Handley MJ, Hoffman H, Korotkikh EV, Kurbatov AV, Loveluck CP, Sneed SB, McCormick M, et al. Next generation ice core technology reveals true minimum natural levels of lead (Pb) in the atmosphere: insights from the Black Death. GeoHealth [Internet]. 2017;1 (2). Publisher's VersionAbstract
Fiorella KJ, Milner EM, Salmen CR, Hickey MD, Omollo DO, Odhiambo A, Mattah B, Bukusi EA, Fernald LCH, Brashares JS. Human health alters the sustainability of fishing practices in East Africa. PNAS [Internet]. 2017;114 (16) :4171-4176. Publisher's VersionAbstract

Understanding feedbacks between human and environmental health is critical for the millions who cope with recurrent illness and rely directly on natural resources for sustenance. Although studies have examined how environmental degradation exacerbates infectious disease, the effects of human health on our use of the environment remains unexplored. Human illness is often tacitly assumed to reduce human impacts on the environment. By this logic, ill people reduce the time and effort that they put into extractive livelihoods and, thereby, their impact on natural resources. We followed 303 households living on Lake Victoria, Kenya over four time points to examine how illness influenced fishing. Using fixed effect conditional logit models to control for individual-level and time-invariant factors, we analyzed the effect of illness on fishing effort and methods. Illness among individuals who listed fishing as their primary occupation affected their participation in fishing. However, among active fishers, we found limited evidence that illness reduced fishing effort. Instead, ill fishers shifted their fishing methods. When ill, fishers were more likely to use methods that were illegal, destructive, and concentrated in inshore areas but required less travel and energy. Ill fishers were also less likely to fish using legal methods that are physically demanding, require travel to deep waters, and are considered more sustainable. By altering the physical capacity and outlook of fishers, human illness shifted their effort, their engagement with natural resources, and the sustainability of their actions. These findings show a previously unexplored pathway through which poor human health may negatively impact the environment.

Ingegnoli V, Giglio E. Complex environmental alterations damages human body defence system: a new bio-systemic way of investigation. WSEAS Transactions on Environment and Development [Internet]. 2017;13 :170-180. Publisher's VersionAbstract
Few studies focus on environment in its biological dimension, relating territorial/landscape alteration and human health, beyond pollution impact. The growing importance of risk factors in medicine and the new ecological advancements in Landscape Bionomics impose to deepen these studies. The landscape is a living entity, in which man and territory form a complex biological level of life organization. So, a landscape must be investigated in its physiology and behaviour by the discipline of Landscape Bionomics. This to check “if”, “how” and “how much” landscape alterations could reflect on human health, independently form pollution. First evidences of a clear correlation subsist, concerning an increase of mortality rate within Milan hinterland (Italy). The Landscape dysfunctions are correlated with the increase of mortality rate MR. All the environmental alterations are registered as ‘stressors’ by a basilar ethological alarm process. So, bionomic landscape dysfunctions may attempt our health bringing to an excess of cortisol, which reduces our hormonal, immune and nervous system defences. This enlarges the W.H.O. estimation of the environmental MR and the importance of applications impose a true effort in landscape rehabilitation.
Oanh NTK, Leelasakultum K. Mapping exposure to particulate pollution during severe haze episode using improved MODIS AOT-PM10 regression model with synoptic meteorology classification. GeoHealth [Internet]. 2017. Publisher's VersionAbstract
Severe smoke haze from biomass burning is frequently observed in Northern Thailand during dry months of February–April. Sparsely located monitoring stations operated in this vast mountainous region could not provide sufficient particulate matter (PM) data for exposure risk assessment. Satellite aerosol optical thickness (AOT) data could be used, but their reliable relationship with ground-based PM data should be first established. This study aimed to improve the regression model between PM10 and Moderate Resolution Imaging Spectroradiometer AOT with consideration of synoptic patterns to better assess the exposure risk in the area. Among four synoptic patterns, each representing the totality of meteorology governing Northern Thailand on a given day, most severe haze days belonged to pattern 2 that featured conditions of clear sky, stagnant air, and high PM10 levels. AOT-24 h PM10 regression model for pattern 2 had coefficient of determination improved to 0.51 from 0.39 of combined case. Daily exposure maps to PM10 in most severe haze period of February–April 2007 were produced for Chiangmai, the largest and most populated province in Northern Thailand. Regression model for pattern 2 was used to convert 24 h PM10 ranges of modified risk scale to corresponding AOT ranges, and the mapping was done using spatially continuous AOT values. The highest exposure risk to PM10 was shown in urban populated areas. Larger numbers of forest fire hot spots and more calm winds were observed on the days of higher exposure risk. Early warning and adequate health care plan are necessary to reduce exposure risk to future haze episodes in the area.
Galvani AP, Bauch CT, Anand M, Singer BH, Levin SA. Human–environment interactions in population and ecosystem health. PNAS [Internet]. 2016;113 (51) :14502–14506. Publisher's VersionAbstract

As the global human population continues to grow, so too does our impact on the environment. The ingenuity with which our species has harnessed natural resources to fulfill our needs is dazzling. Even as we tighten our grip on the environment, however, the escalating extent of anthropogenic actions destabilizes long-standing ecological balances (12). The dangers of mining, refining, and fossil fuel consumption now extend beyond occupational or proximate risks to global climate change (3). Among a plethora of environmental problems, extreme climate events are intensifying (45). Storms, droughts, and floods cause direct destruction, but also have pervasive repercussions on food security, infectious disease transmission, and economic stability that take their toll for many years. For example, within weeks of the catastrophic wind and flood damage from the 2016 Hurricane Matthew in Haiti, there was a dramatic surge in cholera, among other devastating repercussions (67). In a world where 1% of the population possesses 50% of the wealth (8), those worst affected by extreme climatic events and the aftermath are also the least able to rebound.

Anenberg SC, Weinberger KR, Roman H, Neumann JE, Crimmins A, Fann N, Martinich J, Kinney PL. Impacts of oak pollen on allergic asthma in the United States and potential influence of future climate change . GeoHealth [Internet]. 2017. Publisher's VersionAbstract

Future climate change is expected to lengthen and intensify pollen seasons in the U.S., potentially increasing incidence of allergic asthma. We developed a proof-of-concept approach for estimating asthma emergency department (ED) visits in the U.S. associated with present-day and climate-induced changes in oak pollen. We estimated oak pollen season length for moderate (Representative Concentration Pathway (RCP) 4.5) and severe climate change scenarios (RCP8.5) through 2090 using five climate models and published relationships between temperature, precipitation, and oak pollen season length. We calculated asthma ED visit counts associated with 1994–2010 average oak pollen concentrations and simulated future oak pollen season length changes using the Environmental Benefits Mapping and Analysis Program, driven by epidemiologically derived concentration-response relationships. Oak pollen was associated with 21,200 (95% confidence interval, 10,000–35,200) asthma ED visits in the Northeast, Southeast, and Midwest U.S. in 2010, with damages valued at $10.4 million. Nearly 70% of these occurred among children age <18 years. Severe climate change could increase oak pollen season length and associated asthma ED visits by 5% and 10% on average in 2050 and 2090, with a marginal net present value through 2090 of$10.4 million (additional to the baseline value of $346.2 million). Moderate versus severe climate change could avoid >50% of the additional oak pollen-related asthma ED visits in 2090. Despite several key uncertainties and limitations, these results suggest that aeroallergens pose a substantial U.S. public health burden, that climate change could increase U.S. allergic disease incidence, and that mitigating climate change may have benefits from avoided pollen-related health impacts. Day DB, Xiang J, Mo J, Li F, Chung M, Gong J, Weschler CJ, Ohman-Strickland PA, Sundell J, Weng W, et al. Association of Ozone Exposure With Cardiorespiratory Pathophysiologic Mechanisms in Healthy Adults. JAMA Internal Medicine [Internet]. 2017. Publisher's VersionAbstract Importance Exposure to ozone has been associated with cardiovascular mortality, but the underlying biological mechanisms are not yet understood. Objective To examine the association between ozone exposure and cardiopulmonary pathophysiologic mechanisms. Design, Setting, and Participants A longitudinal study involving 89 healthy adult participants living on a work campus in Changsha City, China, was conducted from December 1, 2014, to January 31, 2015. This unique quasiexperimental setting allowed for better characterization of air pollutant exposure effects because the participants spent most of their time in controlled indoor environments. Concentrations of indoor and outdoor ozone, along with the copollutants particulate matter, nitrogen dioxide, and sulfur dioxide, were monitored throughout the study period and then combined with time-activity information and filtration conditions of each residence and office to estimate 24-hour and 2-week combined indoor and outdoor mean exposure concentrations. Associations between each exposure measure and outcome measure were analyzed using single-pollutant and 2-pollutant linear mixed models controlling for ambient temperature, secondhand smoke exposure, and personal-level time-varying covariates. Main Outcomes and Measures Biomarkers indicative of inflammation and oxidative stress, arterial stiffness, blood pressure, thrombotic factors, and spirometry were measured at 4 sessions. Results Of the 89 participants, 25 (28%) were women and the mean (SD) age was 31.5 (7.6) years. The 24-hour ozone exposure concentrations ranged from 1.4 to 19.4 parts per billion (ppb), corresponding to outdoor concentrations ranging from 4.3 to 47.9 ppb. Within this range, in models controlling for a second copollutant and other potential confounders, a 10-ppb increase in 24-hour ozone was associated with mean increases of 36.3% (95% CI, 29.9%-43.0%) in the level of platelet activation marker soluble P-selectin, 2.8% (95% CI, 0.6%-5.1%) in diastolic blood pressure, 18.1% (95% CI, 4.5%-33.5%) in pulmonary inflammation markers fractional exhaled nitric oxide, and 31.0% (95% CI, 0.2%-71.1%) in exhaled breath condensate nitrite and nitrate as well as a −9.5% (95% CI, −17.7% to −1.4%) decrease in arterial stiffness marker augmentation index. A 10-ppb increase in 2-week ozone was associated with increases of 61.1% (95% CI, 37.8%-88.2%) in soluble P-selectin level and 126.2% (95% CI, 12.1%-356.2%) in exhaled breath condensate nitrite and nitrate level. Other measured biomarkers, including spirometry, showed no significant associations with either 24-hour ozone or 2-week ozone exposures. Conclusions and Relevance Short-term ozone exposure at levels not associated with lung function changes was associated with platelet activation and blood pressure increases, suggesting a possible mechanism by which ozone may affect cardiovascular health. Gilbert SL, Sivy KJ, Pozzanghera CB, DuBour A, Overduijn K, Smith MM, Zhou J, Little JM, Prugh LR. Socioeconomic Benefits of Large Carnivore Recolonization Through Reduced Wildlife-Vehicle Collisions . Conservation Letters [Internet]. 2017;10 (4) :431-439. Publisher's VersionAbstract The decline of top carnivores has released large herbivore populations around the world, incurring socioeconomic costs such as increased animal–vehicle collisions. Attempts to control overabundant deer in the Eastern United States have largely failed, and deer–vehicle collisions (DVCs) continue to rise at alarming rates. We present the first valuation of an ecosystem service provided by large carnivore recolonization, using DVC reduction by cougars as a case study. Our coupled deer population models and socioeconomic valuations revealed that cougars could reduce deer densities and DVCs by 22% in the Eastern United States, preventing 21,400 human injuries, 155 fatalities, and$2.13 billion in avoided costs within 30 years of establishment. Recently established cougars in South Dakota prevent \$1.1 million in collision costs annually. Large carnivore restoration could provide valuable ecosystem services through such socio-ecological cascades, and these benefits could offset the societal costs of coexistence.

Lane K, Charles-Guzman K, Wheeler K, Abid Z, Graber N, Matte T. Health Effects of Coastal Storms and Flooding in Urban Areas: A Review and Vulnerability Assessment . Journal of Environmental and Public Health [Internet]. 2013. Publisher's VersionAbstract

Coastal storms can take a devastating toll on the public's health. Urban areas like New York City (NYC) may be particularly at risk, given their dense population, reliance on transportation, energy infrastructure that is vulnerable to flood damage, and high-rise residential housing, which may be hard-hit by power and utility outages. Climate change will exacerbate these risks in the coming decades. Sea levels are rising due to global warming, which will intensify storm surge. These projections make preparing for the health impacts of storms even more important. We conducted a broad review of the health impacts of US coastal storms to inform climate adaptation planning efforts, with a focus on outcomes relevant to NYC and urban coastal areas, and incorporated some lessons learned from recent experience with Superstorm Sandy. Based on the literature, indicators of health vulnerability were selected and mapped within NYC neighborhoods. Preparing for the broad range of anticipated effects of coastal storms and floods may help reduce the public health burden from these events.

Ebenstein A, Fan M, Greenstone M, He G, Zhou M. New evidence on the impact of sustained exposure to air pollution on life expectancy from China’s Huai River Policy. Proceedings of the National Academy of Sciences [Internet]. 2017. Publisher's VersionAbstract

This paper finds that a 10-μg/m3 increase in airborne particulate matter [particulate matter smaller than 10 μm (PM10)] reduces life expectancy by 0.64 years (95% confidence interval = 0.21–1.07). This estimate is derived from quasiexperimental variation in PM10 generated by China’s Huai River Policy, which provides free or heavily subsidized coal for indoor heating during the winter to cities north of the Huai River but not to those to the south. The findings are derived from a regression discontinuity design based on distance from the Huai River, and they are robust to using parametric and nonparametric estimation methods, different kernel types and bandwidth sizes, and adjustment for a rich set of demographic and behavioral covariates. Furthermore, the shorter lifespans are almost entirely caused by elevated rates of cardiorespiratory mortality, suggesting that PM10 is the causal factor. The estimates imply that bringing all of China into compliance with its Class I standards for PM10 would save 3.7 billion life-years.