Geisinger Center for Health Research and the Johns Hopkins Bloomberg School of Public Health joined together to form the Environmental Health Institute (EHI) in 2007. The mission of the EHI is to understand how land use, the built environment, energy production and use, food systems and water systems may impact human health in central and northeast Pennsylvania. Such knowledge can be used not only to improve the health of Geisinger Health System patients, but also to understand how to develop and promote healthy and sustainable communities.
Brian Schwartz, MD, MS, professor, Johns Hopkins Bloomberg School of Public Health; senior investigator, Geisinger Center for Health Research, serves as director of the EHI.
Why does Geisinger Health System have an Environmental Health Institute? Because…
- Geisinger is a leader in personalized medicine, integrating genomics into health systems. It is increasingly understood that our genes interact with exposures around us to cause disease. It has been said that, for many diseases, "…genes load the gun, but environmental exposures pull the trigger."
- Community circumstances can affect health. Many chronic diseases have lifestyle factors such as diet, physical activity and stress, that can be influenced by the communities in which we live.
- Community circumstances can enable or constrain the influence of healthcare. For example, diabetes care provided by the health system may be less effective in communities that constrain our ability to eat healthy or walk more.
- Our region has many old and emerging environmental conditions that could affect health. These include, for example, abandoned coal mines, Marcellus shale development and large-scale animal feeding operations that add antibiotics to animal feeds.
- New approaches to personalized medicine require that the health system consider and care for patients in the context of the communities in which they live.
Initiatives & Projects
The Built Environment & Obesity
We are evaluating the relation of the food, land use, physical activity and social environments, measured as features of communities, with body mass index by studying more than 160,000 children with a Geisinger primary care provider. We have funding from the National Institutes of Health as part of the Johns Hopkins systems-oriented childhood obesity center. This new center has three research projects, one of which is centered at Geisinger, and is applying mathematical modeling methods often used in engineering, such as complex dynamic systems and agent-based models, to the obesity epidemic in the region. In phase two of this work, we will complete more detailed measurements in both children and communities.
- Nau C, Ellis H, Huang H, Schwartz BS, Hirsch A, Bailey-Davis L, Kress AM, Pollak J, Glass TA. Exploring the forest instead of the trees: An innovative method for defining obesogenic and obesoprotective environments. Health & Place. 2015 Sep 30;35:136-46.
- Nau C, Schwartz BS, Bandeen-Roche K, Liu A, Pollak J, Hirsch A, Bailey-Davis L, Glass TA.Community socioeconomic deprivation and obesity trajectories in children using electronic health records.Obesity (Silver Spring). 2015 Jan;23(1):207-12.
- Schwartz BS, Bailey-Davis L, Bandeen-Roche K, Pollak J, Hirsch AG, Nau C, Liu AY, Glass TA. Attention deficit disorder, stimulant use, and childhood body mass index trajectory. Pediatrics 2014, April 133(4), 688-76.
- Schwartz BS, Stewart WF, Godby S, Pollak J, DeWalle J, Larson SL, Mercer DG, Glass TA. Body mass index and the built and social environments in children and adolescents using electronic health records. Am J Prev Med 2011; 41: e17-28.
- Feng J, Glass TA, Curriero FC, Stewart WF, Schwartz BS. The built environment and obesity: a systematic review of the epidemiologic evidence. Health & Place 2010; 16: 175-90.
Abandoned Coal Mine Lands, Community Health & Diabetes
There is increasing concern in the public health community about living in communities with what has been termed chronic environmental contamination. Ann Liu, a doctoral student at the Johns Hopkins Bloomberg School of Public Health, completed her thesis research on the community and individual-level impacts of coal abandoned mine lands (AMLs).
Her first paper, that found that the greater the burden of AMLs in communities, the higher the community socioeconomic deprivation, was published in the peer-reviewed journal ISRN Public Health. Her second paper found that higher AML burden was associated with worse diabetes early in the disease course and worse progression over time in 28,000 Geisinger diabetic patients using hemoglobin A1c levels, a biomarker of diabetes severity and control.
- Liu AY, Curriero FC, Glass TA, Stewart WF, Schwartz BS. The contextual influence of coal abandoned mine lands in communities and type 2 diabetes in Pennsylvania. Health and Place 2013 22C: 115-122.
- Schoenthaler AM, Schwartz BS, Wood C, Stewart WF. Patient and physician factors associated with adherence to diabetes medications. Diabetes Educ. 2012 May-Jun;38(3):397-408.
- Liu AY, Curriero FC, Glass TA, Stewart WF, Schwartz BS. Associations of the burden of coal abandoned mine lands with three dimensions of community context in Pennsylvania. ISRN Public Health 2012; Article ID 251201, p 1-11.
Animal Feeding Operations & MRSA
The incidence of methicillin-resistant Staphylococcus aureus (MRSA) in the region has increased dramatically over the past decade, with over 4,000 cases during this period. Recently, community-associated infections (CA-MRSA) have surpassed health care-associated infections (HA-MRSA) in incidence. Joan Casey, a doctoral student at Johns Hopkins, completed her PhD dissertation research on this topic. Our research group made several interesting and novel observations which are summarized in three published, peer-reviewed manuscripts. We found: 1) the incidence of CA-MRSA increased by over 30 percent per year while that of HA-MRSA increased by five percent per year; 2) CA-MRSA cases now exceed HA-MRSA cases; 3) aspects of both the farms on which animals were raised and the crop fields to which manure was applied were associated with increased risk of MRSA infection and 4) certain molecular subtypes not previously associated with these animal operations were associated with human MRSA infections. We are currently investigating whether these animal feeding operations cause other health impacts.
- Casey JA, Shopsin B, Cosgrove SE, Curriero FC, Nachman KE, Rose H, Schwartz BS. Molecular characterization of MRSA infection and association with high-density livestock production in Pennsylvania, USA. Environ Health Perspect 2014 May, 122(5), 464-70.
- Casey JA and Schwartz BS. Swine livestock production as a risk factor for community associated MRSA in Pennsylvania. Alliance for the Prudent Use of Antibiotics (APUA) newsletter. 2013 Dec; 31(3): 9-12.
- Casey JA, Curriero FC, Cosgrove SE, Nachman KE, Schwartz BS. High-density livestock Operations, crop field application of manure, and risk of community-associated methicillin-resistant Staphylococcus aureus infection in Pennsylvania. JAMA Internal Medicine 2013 Sep 13.
- Casey JA, Stewart WF, Cosgrove SE, Pollak J, Schwartz BS. A population-based study of the epidemiology and clinical features of methicillin-resistant Staphylococcus aureus infection in Pennsylvania 2001-2010. Epidemiology & Infection 2013 Jun;141(6):1166-79.
Marcellus Shale & Health Outcomes
The EHI's most recent efforts involve the Marcellus shale. We are developing a number of research studies regarding the potential environmental impacts of unconventional natural gas development (UNGD) in the Marcellus shale, and how these may influence such health issues as asthma, cardiovascular disease and pregnancy outcomes.
Marcellus shale development can influence air, surface water and ground water quality, and we are developing studies to assess the potential health impacts of each of these sources and routes of exposure. We are also involved with Geisinger's larger efforts to launch a variety of Marcellus-related studies. We have obtained well and pipeline data from the state and are entering well completion report data into a geospatial database for use in future epidemiologic studies. We have obtained NIH funding to begin health studies.
The NIH study, Marcellus Shale Development, Respiratory and Reproductive Outcomes in Pennsylvania, will use well and infrastructure data to estimate exposures to all aspects of Marcellus shale development in Pennsylvania. These exposure estimates will then be used to evaluate whether asthma control and pregnancy outcomes are affected by Marcellus shale development by studying 30,000 asthma patients and 22,000 pregnancies in the Geisinger Health System from 2006-13. For more information, see the abstract.
- Casey JA, Savitz DA, Rasmussen SG, Ogburn EL, Pollak J, Mercer DG, Schwartz BS. Unconventional Natural Gas Development and Birth Outcomes in Pennsylvania, USA. Epidemiology. 2015 Sep 30;20:00.
- .Casey J, Ogburn E, Rasmussen S, Irving J, Pollak J, Locke P, and Schwartz B. (2015). Predictors of Indoor Radon Concentration in Pennsylvania 1989-2013. Environmental Health Perspectives. [Epub ahead of print] 2015 Apr. doi: 10.1289/ehp.1409014.
- Graham J, Irving J, Tang X, Sellers S, Crisp J, Horwitz D, Muehlenbachs L, Krupnick A, Carey D. Increased traffic accident rates associated with shale gas drilling in Pennsylvania. Accident Analysis & Prevention, 2015 Jan. 74: 203-309.
The General Environment & Chronic Rhinosinusitis
We have been studying the epidemiology of chronic rhinosinusitis (CRS) in Geisinger's patients. This is a chronic condition with a significant patient and population disease burden. It has many links to environmental exposures. The EHI at Geisinger Health System, in collaboration with Northwestern University, The University of Chicago and the Johns Hopkins Bloomberg School of Public Health, has been awarded a program project grant (PO1) by the NIH to study the epidemiology, genetics and pathobiology of chronic rhinosinusitis. The collaborative group, collectively known as the Chronic Rhinosinusitis Integrative Studies Program (CRISP), is the only PO1 recipient in the United States studying this common but poorly understood disease. Program project grants are more complex in scope and budget than individual research grants, and are made available to a group of several investigators with differing areas of expertise who wish to collaborate in research by pooling their talents and resources. These resources will fund continued studies examining the genetic, environmental, molecular and immunologic underpinnings of CRS in order to discover new means of treating this disease. Project 1 of the CRISP is focused on the epidemiology of CRS, using both electronic health records and new primary data collection consisting of surveys, sinus CT scans and sinus endoscopy in patients with nasal and sinus symptoms. This will allow us to develop new approaches to understanding the diagnosis, treatment, natural history and risk factors for this common, disabling condition. For more information on the NIH grant, see the abstract.
- Hirsch AG, Yan XS, Sundaresan AS, Tan BK, Schleimer RP, Kern RC, Kennedy TL, Greene JS, Schwartz BS. Five‐year risk of incident disease following a diagnosis of chronic rhinosinusitis. Allergy. 2015 Dec 1;70(12):1613-21.
- Sundaresan AS, Hirsch AG, Storm M, Tan BK, Kennedy TL, Greene JS, Kern RC, Schwartz BS. Occupational and environmental risk factors for chronic rhinosinusitis: a systematic review. International forum of allergy & rhinology 2015 Nov 1 (Vol. 5, No. 11, pp. 996-1003).
- Ference EH, Stubbs V, Lidder AK, Chandra RK, Conley D, Avila PC, Hirsch AG, Min JY, Shintani Smith S, Kern RC, Tan BK. Measurement and comparison of health utility assessments in chronic rhinosinusitis. International forum of allergy & rhinology 2015 Oct 1 (Vol. 5, No. 10, pp. 929-936).
- Lam K, Hirsch AG, Tan BK. The association of premorbid diseases with chronic rhinosinusitis with and without polyps. Current opinion in otolaryngology & head and neck surgery. 2014 Jun;22(3):231.
- Tan BK, Chandra RK, Pollak J, Kato A Conley DB, Peters AT, Grammer LC, Avila PC, Kern RC, Stewart WF, Schwartz BS. Incidence and associated premorbid diagnosis of patients with chronic rhinosinusitis. J Allergy Clinical Immunology 2013 May; 131(5): 1350-60.
- Tan BK, Kern RB, Schleimer RP, Schwartz BS. Chronic rhinosinusitis - the unrecognized epidemic [editorial]. AJRCCM 2013 Dec; 188(11): 1275-7.
The EHI has developed a regional Marcellus Impact Pilot Program and made five awards totaling $100,000 to principal investigators from six different institutions that will provide research opportunities for nine students. Awards were made to Dr. Steven Rier (Bloomsburg University with United States Geological Survey partners), Dr. Lisa Bailey-Davis (Geisinger Health System), Dr. Jonathan Niles (Susquehanna University) with Dr. Chris Grant (Juniata College), Dr. Melvin Zimmerman and Dr. Peter Petokas (Lycoming College), and Dr. Md. Khalequzzaman (Lock Haven University).
|PI/s and Institution/s||Project Title|
|Dr. Steven Rier, Bloomsburg University (with United States Geological Survey Partners)||Developing biofilm markers for monitoring the impacts of unconventional oil and gas development on stream ecosystems|
|Dr. Baily-Davis, Geisinger Health System||Pennsylvania farmers' perception of agricultural impacts from unconventional natural gas development in the Marcellus Shale|
|Dr. Jonathan Niles, Susquehanna University and Dr. Chris Grant, Juniata College||Assessing potential impacts of unconventional natural gas extractions and mercury concentrations on trophic food webs of unassessed headwater streams|
|Dr. Melvin Zimmerman and Dr. Peter Petokas, Lycoming College||An assessment of eastern hellbender population trajectories and water quality as determinates of watershed health|
|Dr. Md. Khalequzzaman, Lock Haven University||Determination of the sources of turbidity in waterways in the Marcellus Shale gas drilling region|
In the News
Unconventional Natural Gas Development ("Fracking")
Animal Feeding Operations & MRSA
Obesity and ADHD
- Nau C, Ellis H, Huang H, Hirsch A, Bailey-Davis L, Schwartz B, Pollak J, Liu A, Glass TA. What Renders a Community Obesogenic? Using Conditional Random Forests to Characterize a Risk Regime. 47th Annual meeting of the Society for Epidemiologic Research, Seattle, WA (concurrent contributed session), June 2014.
- Nau C, Ellis H, Hong H, Hirsch A, Bailey-Davis L, Schwartz BS, Pollak J, Liu AY, Glass TA. Exploring the forest instead of the trees: an innovative method for defining obesogenic environments. Annual meeting of the Population Association of America, Boston, MA, May 2014.
- Schwartz BS. Ongoing studies on the health effects of unconventional natural gas development. Invited participant in Impact of Unconventional Natural Gas Drilling Operations on the Environment and Public Health, Center of Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, February 2014.
- Nau C, Hirsch A, Bailey-Davis L, Schwartz BS, Pollak J, Liu A, Glass TA. Beyond Single Trees: Random Forests for Characterization of Obesogenic Environments in Children. 31st Annual scientific meeting of The Obesity Society, Atlanta, GA, November 2013.
- Bailey-Davis L, Schwartz BS, Bandeen-Roche K, Hirsh AG, Pollack J, Glass TA. Longitudinal associations of psychotropic medication use with childhood body mass index trajectories. 31st Annual scientific meeting of The Obesity Society, Atlanta, GA, November 2013.
- Schwartz BS. The use of electronic health records systems in 'BIG' environmental epidemiology. American College of Epidemiology Annual Meeting, Louisville, KY, September 2013.
- Casey JA, Curriero FC, Schwartz BS. Residential proximity to high-density livestock farms or manure-applied cropfields and risk of tetracycline-resistant Staphylococcus aureus infection in Pennsylvania, USA, 2005-2010. Joint ISEE, ISES and ISIAQ Environmental Health Conference, Basel, Switzerland, August 2013.
- Nau C, Glass TA, Liu AY, Pollak J, Hirsch A, Bailey-Davis L, Schwartz BS. Community socioeconomic deprivation and obesity trajectories in children using Big Data. 46th Annual Meeting of the Society for Epidemiologic Research, Boston, MA, June 2013.
- Schwartz BS. Doing environmental epidemiology research with electronic health records and Environmental health data streams: health data. In meeting entitled: The Heterogeneity of Environmental Health Data: Fostering Integration to Advance Discovery. For the Standing Committee on Use of Emerging Science for Environmental Health Decisions, National Research Council, Washington, DC, January 2013.