1. SUSTAINABLE & HEALTHY COMMUNITIES RESEARCH PROGRAM The Science To Achieve Results (STAR) 2009 RFA Understanding the Role of Nonchemical Stressors and Developing Analytic Methods for Cumulative Risk Assessments (www.epa.gov/ncer/cra) Maggie Breville (National Center for Environmental Research) Exposure to different combinations of environmental stressors can contribute to increased risk for negative health consequences. Extensive studies show associations between disadvantaged communities and suboptimal health. Stressful social environments may also make a population that is already subject to chemical stressors even more sensitive to unhealthy environment exposures. However, it is the general practice of governmental agencies/policy makers to focus on one environmental contaminant at a time. For example, EPA traditionally has used the risk assessment paradigm to assess exposures and risks to single chemicals. Epidemiological studies are becoming very important and receiving greater emphasis in CRA as an approach to assessing the relative contribution of different stressors, and potential interactions between chemical and social stressors. This research addresses two challenges facing cumulative risk assessments (CRAs): a) the ability to successfully evaluate the combined effects of nonchemical and chemical stressors; and b) the need for statistical and other analytical techniques that will enable the analysis of disparate types of data. A total of 7 grants were awarded under this RFA. They will likely close by 2018. Purpose/Utility of Research Expected Research Products Journals, Articles & Reports Exposure & Psychosocial Stress Research Community Federal, State & Local Government Decision Makers General Public Jane Clougherty, University of Pittsburg/Peggy Shepard, West Harlem Environmental Action (WE ACT for Environmental Justice) - Community Stressors and Susceptibility to Air Pollution in Urban Asthma – This research is conducted within a psychosocial stress framework, with the hypothesis that social stressor exposures, individual perceptions of stressors, and the resulting stress response create adverse health outcomes. To examine the independent and joint effects of social stressors and air pollution on childhood asthma hospitalizations, the researchers leveraged fine-scale pollution data from the New York City Community Air Survey (NYCCAS). Deborah Cory-Slechta, University of Rochester School of Medicine and Dentistry/Katrina Korfmacher, University of Rochester Medical Center - Combined Effects of Metals and Stress on Central Nervous System Function - This project tests the hypothesis that non-chemical and chemical stressors that act on the same biological systems or substrates, or that produce common adverse outcomes will have the potential to produce additive or greater effects when they co-occur as risk factors. It is based on prior studies demonstrating synergistic and potentiated central nervous system effects in response to combined exposures to (Pb) and stress. The studies extend observations of Pb and stress to two other neurotoxic metals (methylmercury (MeHg) and arsenic (As)). Robert Laumbach, Rutgers Robert Wood Johnson Medical School/Molly Greenberg, Iron bound Community Corporation - The Effects of Stress and Traffic Pollutants on Childhood Asthma in an Urban Community - Stress and asthma have long been linked by patients and clinicians, despite the fact that stress hormones protect against asthma. The goal of this clinically focused study is to understand how traffic-related pollution affects children with asthma. The hypothesis was that chronic stress downregulates protective acute stress responses. Traffic pollution exacerbates asthma via pulmonary inflammation and airway obstruction, leading to clinical asthma exacerbation. Jonathan Levy, Boston University School of Public Health/Robert French, NorthStar Learning Centers - Effects-Based CRA in a Low-Income Urban Community Near a Superfund Site - This study evaluates cumulative risks from chemical and nonchemical exposures associated with attention deficit hyperactivity disorder (ADHD)-like behavior and high blood pressure in the low-income community of New Bedford, Massachusetts. The study attempts to address exposure modeling and health outcome modeling challenges. Stephen Linder, University of Texas Science Center at Houston - Analytical Strategies for Assessing Cumulative Effects of Chemical and Nonchemical Stressors - The researchers analyzed survey data collected in 2005 to examine the relative influence of social, physical and chemical stressors on health in a city in Texas, with an emphasis on decomposing relation­ ships among variables of interest to CRA into a set of well-defined structural relationships. Effects were modeled using latent- factor structural equations and maximum likelihood estimation. Madeleine Scammel, Boston University School of Public Health/Roseann Bongiovanni, Chelsea Collaborative - New Methods for Analysis of Cumulative Risk in Urban Populations - To facilitate this study, the researchers developed a guide for conducting community interviews, which included a number of considerations important to CRA (e.g., demographics, social and neighborhood factors, ethnic identity, environmental factors, health and health care status, life stressors). Interview questions were developed with input from a number of community organizations and surveys (e.g., Behavioral Risk Factor Surveillance Survey). Elaine Symanski, University of Texas School of Public Health/Maria Jimenez, University of Texas School of Public Health - Hypertension in Mexican-Americans: Assessing Disparities in Air Pollution Risks - The incidence of hypertension, a key risk factor for cardiovascular diseases (CVD), has been growing in the United States (U.S.) and CVD remains the leading cause of death among the U.S. Hispanic population. This research examines the combined effect of air pollution and psychosocial stress on hypertension among individuals of Mexican origin. Researchers will develop and apply new statistical methods for evaluating the combined effects of environmental and psychosocial stressors on hypertension. STAR CRA G RANTEES & C OMMUNITY P ARTNERS  Statistical and computational tools, models and approaches for analyzing disparate types of data required for cumulative risk assessments.  Generation of data evaluating the effects of multiple chemical and nonchemical stressors.  A greater understanding of the combined effects of nonchemical and chemical stressors and the development of statistical and computational tools, models, and approaches for analyzing the disparate types of data required by cumulative risk assessments.  A greater understanding of the biological impact of psychosocial stress and its interaction with chemical exposures, including mechanisms of action and the resulting health consequences. This may consider exposure influences, such as sequence and timing. It might also consider life-stage.  Active engagement of community and other stakeholders in cumulative risk research.  Communication of research findings with communities to promote and improve health.  Original peer-reviewed articles, papers and synthesis reports. Intended End Users 1. US EPA STAR grant #RD-83457601-01 (PI: JE Clougherty) 2014 Proceedings of the EPA Workshop on Interactions Between Social Stress and Environmental Hazards 2014 Proceedings of the EPA Workshop on Interactions Between Social Stress and Environmental Hazards 2014 Cumulative Risk Webinar Series: What We Learned Cumulative Risk Assessment Toolbox: Methods and Approaches for the Practitioner Cumulative Risk Assessment Toolbox: Methods and Approaches for the Practitioner U.S. EPA Authority to Use Cumulative Risk Assessments in Environmental Decision-Making U.S. EPA Authority to Use Cumulative Risk Assessments in Environmental Decision-Making CRA RFA Timeline 2009 STAR CRA Grants Awarded 2012 CRA Progress Review 2012-2013 Cumulative Risk Webinar Series Synthesis Report 2013 CRA Progress Review 2014 Progress Review Meeting Summary Report 2012 Workshop on Interactions Between Social Stressors and Environmental Hazards Webinar 2012 CRA Cumulative Risk Assessment Webinar Series 2013 CRA Cumulative Risk Assessment Webinar Series