Southwest Center on Climate change and Health (NIH P20 abstract)

mPI Ernst (contact PI), Mona Arora, and Joe Hoover

Arid lands are home to one in three people, totaling a population of more than 2 billion spanning the globe. Arid land communities are facing multiple climate change-exacerbated threats impacting health including extreme heat events, wildfires, dust storms, biodiversity loss, emerging pathogens, poor air quality, and drought. The Southwest Center on Resilience for Climate Change and Health (SCORCH) brings together transdisciplinary research groups to conduct team-science projects addressing the health needs of arid lands communities adapting to climate change. The Center’s overarching mission is to improve health equity across the lifespan by enhancing community partnerships and supporting adaptation efforts by Indigenous, Latinx, low-resource urban, and rural communities in the Southwestern United States and globally. Based at the
University of Arizona (UArizona), home of internationally recognized climate science and adaptation researchers and Centers, SCORCH will serve as a foundation for expanding UArizona campus initiatives aiming to increase health research at the intersection of climate change science. The three-year planning phase will be used to identify researchers whose expertise align with climate change and health across UArizona and the region, build transdisciplinary teams, identify priority research areas for community adaptation planning, and implement two research projects to develop our initial Research Focus Group (RFG) themes. Our initial three RFGs build on the expertise of the current SCORCH team members and are purposefully broad to encompass evolving research priorities. These three themes include: 1) Health impacts of extreme weather events; 2) Forecasting and early warning of climate change health outcomes; and 3) Adaptive responses in the built environment. Research Project 1 aligns with RFG 2 and 3, to develop an assessment tool that can predict potential health outcomes of greenspace designs. Research Project 2 aligns with RFG 1 to examine the role of maternal exposure to extreme heat and long-term child health outcomes. Through community engaged activities founded on respect and trust, led by the Community Engagement Core, and novel data visualization services, led by the Integrated Data Visualization Core, we will deepen existing and develop new partnerships with academic and community entities with diverse lived experiences and
knowledge frameworks. The geographic location of SCORCH in the Southwestern United States provides unique research opportunities to support adaptation and resilience efforts of Indigenous, Latinx, low-resource urban, and rural communities in the region as well as addressing the unique circumstances found in borderland areas. The potential international reach of SCORCH enables high-impact climate change and health initiatives
that will translate globally.

Learn more about this multi-disciplinary initiative here: Home | SCORCH (arizona.edu)

AZHEALTHTXT

AZHEALTHTXT is a bilingual information-sharing platform that disseminates timely, expert-curated, health information tailored to the unique needs of Arizonans. Our health messaging specifically aims to target three groups: general Arizona community members, individuals living in rural areas, and healthcare providers.

The purpose of this project is to assist Arizona communities stay up to date on health issues and community resources in their area. We cover content ranging from rental assistance, food and water access, housing, substance use, evolving guidance regarding COVID-19 and other emerging diseases, and more!

AZHEALTHTXT, formerly known as AZCOVIDTXT, was developed in collaboration with the Arizona Center for Rural Health as a component of AHEAD AZ, funded by a health disparities CDC grant. Our team is comprised of staff, faculty, and students across multiple University of Arizona disciplines (i.e., medicine, communication, public health, linguistics, and computer science).

Through prioritizing health equity and considering the social determinants of health, we aim to complete the following goals and objectives:

Learn more about this project here: https://azhealthtxt.arizona.edu/

Vectorborne disease education and messaging evaluation: Developing Standardized Methodologies (CDC PACVEC)

As vectorborne diseases increase in range and intensity, public education is a critical component of prevention and control efforts. Yet public health and vector control agencies often invest in materials and messaging campaigns without a strong evaluation program to measure impact. As part of a project with the CDC Pacific Southwest Regional Center of Excellence in Vector-Borne Diseases we are exploring the extent of messaging throughout Arizona, and developing strategies to assess materials that can be easily duplicated. We are working closely with our public health partners to develop innovative solutions to impact behavior change related to mosquito-borne diseases.

• Specific Aim 1: Conduct an Inventory the educational materials provided by county and state health departments in Arizona, extension and identify current and possible dissemination strategies.

• Specific Aim 2: Assess knowledge change pre and post exposure to current materials and identify dissemination preferences.

• Specific Aim 3: Pilot novel educational materials with non-traditional community liaisons for vector control.

WeHealthNotify Collaboration

Kidenga

Dengue emergence in the Arizona-Sonora Desert Region (NIH R01 Abstract)

Aedes aegypti mosquitoes are the primary vector for dengue, yellow fever and chikungunya.  The vector is present in most urban communities stretching along the U.S.-Mexico border yet dengue transmission has only been noted in two U.S. border communities in Texas, notably Brownsville and Laredo, TX.  While many argue that this is a result of different social factors across the border, this fails to explain the lack of transmission in some communities in northern Mexico, notably Nogales, Sonora.  Nogales is a large urban area on the Mexican side of the border with large vector populations and a constant influx of people from dengue endemic areas yet no local cases have been recorded.  Vector presence alone is not sufficient to cause disease transmission; vectors must also survive long enough to blood feed and become infected, have the parasite develop and feed again, transmitting the virus. 

Climatic influences on the lifespan and behavior of Ae. aegypti may also influence the risk of dengue transmission in this region which lies at the boundary of both virus and vector. Geographic areas such as this, at the edge of the range of disease and vector, are at greatest risk of emergence and reemergence of infectious diseases. We will assess the relative age structure of Ae. aegypti populations in nine cities with varying climates in the southern United States and Sonora, MX by trapping and molecularly determining the ages of adult Ae. aegypti during four mosquito seasons. We expect that cities with extremely dry and hot conditions will have younger Ae. aegypti populations. Cities with reported dengue transmission we expect to have Ae. aegypti that are on average younger when taking their first blood meal than cities without transmission.

To determine how the age of Ae. aegypti population vary over a finer spatial scale, we will sample adults in 150 households in Hermosillo, Mexico; a city with a history of dengue outbreaks. Additionally, we will survey the households for potential social and environmental factors that mediate the relationship between climate and longevity.  We expect to find significant variability across households.  Residences with older mosquitoes will have more vegetation, fewer barriers to mosquito access and indoor resting sites, no competing vector species and no control measures.

From the information gathered in the first two objectives, we will construct a model to predict the likelihood of the expansion of Ae. Aegypti populations that survive long enough to transmit dengue and thus changes in risk of dengue transmission. We expect that models of risk of dengue under climate change scenarios will decrease in areas that surpass a heat and dryness threshold and will increase in populations with increasing moisture. 

Increasing ownership and use of insecticide-treated bednets in western Kenya (NIH R15 Abstract)

Despite dramatic improvements, malaria remains a significant health problem in many regions of the world. As malaria programs move from control to elimination, there is an urgent need to understand barriers to and facilitators of the use of control measures. In this proposal, we focus on the most widely used control measure; bednets in a highland/low transmission and a lowland/high transmission. Our preliminary results indicate that in Kenya roughly 1 in 4 children under 5, the group most vulnerable to malaria, live in households that do not own a bednet. Additionally, even in net owning homes, 1 in 6 children under 5, do not sleep under a net. As Kenya and other programs expand their scope to distribute enough nets to cover all household members, much effort needs to go into understanding the prevalence of and factors related to disuse. The objective of the following proposal is to use qualitative and quantitative methods to determine the prevalence of ownership, misuse and disuse of bednets under field conditions and to identify modifiable risk factors. We will use an ecological approach to assess not only individual level factors that drive bednet ownership and use but the social and environmental context in which these decisions are being made.

Following focus group discussions with community members and key informant interviews with health clinic staff, government vector control staff and village and community leaders, we will conduct a cross-sectional survey that examines 1) perceived susceptibility to malaria 2) perceived severity of malaria 3) perceived benefits of ITN use 4) perceived barriers to ITN use 5) cues to action such as health promotion programs and 6) confidence in the subject’s self-efficacy with regard to obtaining an ITN and its proper use. We will use remotely-sensed images and GIS to determine how these perceptions and practices vary geographically and if they correspond with actual risk as determined through parallel parasite prevalence surveys and pyrethrum spray catches of Anopheles. From the cross-sectional participants we will identify positive deviants, community members who own and use bednets regularly despite experiencing at least 75% of the factors associated with not owning or using a bednet. In-depth interviews will be conducted to determine their solutions and personal motivators that may be used to improve community bednet ownership and compliance.

Our approach is unique in its combination of rich qualitative data and the rigor and generalizability of established epidemiologic methods. Identifying what is already working in a community is more likely to be successfully implemented as a larger intervention. We expect that we will find that individuals who have personal loss due to malaria, have identified solutions to logistical issues with hanging bednets, have a higher perception of risk and who have greater access to household resources will be more likely to own and use a bednet. This research will help drive the development of targeted community-based interventions that should improve ITN ownership and use and ultimately reduce malaria transmission.

Identifying factors associated with vaccine hesitancy in Arizona

Vaccine exemptions are currently an area of intense focus in public health. Universal recommendations for vaccination in the United States have substantially reduced the morbidity and mortality from several diseases (1).  The Institute of Medicine (IOM) recently completed an exhaustive report on the safety of eight recommended vaccines, and concluded that while there can be rare adverse events after vaccination, the benefits of the program far outweigh the risk (2). In the United States, all states and the District of Columbia have laws requiring vaccinations for entry into public schools; however, approximately 20 states allow for parents to waive vaccines based on personal beliefs. The protocol for obtaining these personal belief exemptions (PBEs) varies widely by state (3, 4), and Arizona is one of approximately 10 states with the easiest procedures for obtaining exemptions (5). This is of concern because the ease of obtaining exemptions has been directly associated with increased incidence of pertussis (4, 6) and measles (7). Of note, the rate of vaccine exemptions has tripled in Arizona in the past decade(5), and concurrent with this rise, Tucson experienced a measles outbreak in 2008 that cost over $800,000 to contain (8).

When parents request an exemption from immunizations that would otherwise protect their children from vaccine preventable diseases (VPDs), the repercussions extend to and place a significant risk upon not only on their children but also on the health of other individuals in their communities, particularly in areas where there are geographic clusters of vaccination exemptors (6). Our preliminary data demonstrate that such clusters exist in Arizona, though the reasons for this are unclear. The individuals involved or affected include not only the children of parents who have exempted them based on their own personal beliefs but also include immune-compromised children who were exempted due to medical purposes, as well as children who are too young to be vaccinated (9). Interestingly, children and adults who are immunized are also at risk because vaccines are not 100% efficacious and, while parents may believe that they are exercising their individual freedom and autonomy, by exempting their children from vaccination, they are doing so at the cost of public health by causing an increase in the risk for outbreaks of VPDs (10). Additionally, PBEs are not randomly distributed across Arizona. High clusters of exemptions have been detected in Yavapai and Maricopa Counties. People residing in these communities have a higher risk of outbreaks of VPDs.