Environmental Studies 

There are substantial concerns regarding the health impact of environmental exposures in central and northeastern Pennsylvania. Historically, Pennsylvania has been plagued with numerous human-created environmental challenges including abandoned mine acid drainage and other industrial contamination and degradation, farm runoff, deforestation, and more broadly, structural challenges with local zoning ordinances and use of land and waterways. 

In late 2006, the Geisinger Center for Health Research (GCHR) and the Department of Environmental Health Sciences in the Johns Hopkins Bloomberg School of Public Health (JHBSPH) joined together to form the Environmental Health Institute (EHI). The Institute’s Co-directors are Dr. Zhengmin Qian of GCHR and Dr. Brian Schwartz of JHBSPH. A cornerstone of our work is the creation of a comprehensive region wide GIS database and related methods that are suitable for creating exposure indices.  The GIS resource is invaluable for efficiently conducting case-control studies of the relation between health and the environment. 

The EHI bridges the creation of knowledge about health and the environment and translating such knowledge into sustainable solutions.  We define the “environment” broadly, to encompass traditional hazardous exposures (e.g., pesticides, metals, air pollution) and more recent areas of interest in environmental health such as land use, and the health effects of the built and social environments in specific communities.

Physical Activity and the Built and Social Environments

PI: Walter (Buzz) Stewart, PhD, MPH

An obesity epidemic is raging among children in the United States.  Changes in the built environment that influence physical activity and eating behaviors have been implicated.  This study, funded by the Robert Wood Johnson Active Living Research program, will first identify components of the built environment (e.g., land use, sprawl, green spaces) and social environment (e.g., community social disorder, community deprivation) associated with body mass index (BMI) in all children between the ages of 5 and 18 years with a Geisinger Clinic primary care provider (approximately 100,000 children).  This analysis will be used to identify 32 communities along a gradient of risk in the built environment, and then select 15 children per community for more extensive evaluation, including of individual and parental behaviors, and the community, school, and household settings, specifically related to physical activity.  The results will have important policy implications for addressing the obesity epidemic in children and offer suggestions for approaches to community design that may mitigate the risk by increasing physical activity among children. 

Obesity in Children and the Local Food Environment

PI: Brian Schwartz, MD, MS

In a related study of obesity in children, this study will focus on the local food environment (LFE).  As obesity results from an imbalance between calories taken in and calories expended, an important consideration is the role of the LFE.  This study will evaluate body mass index (BMI) in children between 2 and 18 years using the Geisinger Clinic electronic health record (EHR) in relation to the LFE.  The LFE will be defined as the density, diversity, accessibility, and clustering in places (i.e., Census tracts) of full-service restaurants, limited service (i.e., fast food) restaurants, grocery stores, convenience stores, and farmer’s markets and produce stands.  As the LFE is likely to have different influences on BMI at different ages, this study will evaluate relations of the LFE with BMI in different age groupings, to evaluate effect modification.  This study will allow inferences to be made about the importance of the local food environment and offer clues to addressing the childhood obesity epidemic.

Abandoned Mine Lands, Community Health, and Individual Health

PI:Brian Schwartz, MD, MS

Pennsylvania has a long history of coal mining and abandoned coal mine lands (AML) now mar the landscape in 44 of 67 counties in the state.  Over 5,000 documented AML sites covering nearly 184,431 acres and roughly 3,129 miles of waterways tainted with acid mine drainage (AMD) reflect the severe toll on the natural environment.  The Office of Surface Mining (OSM) estimates that approximately 1.65 million people live within a one-mile radius of a Surface Mining Control and Reclamation Act (SMCRA) Priority I or Priority II problem area in Pennsylvania, the highest in the country.  These ubiquitous AMLs pose a potential threat to the health and prosperity of nearby communities in general as well as to individuals exposed to the presence of AML in their neighborhoods, presumably contributing to lower overall community health.  In this study, we will evaluate how the burden of AMLs in places is associated with community health, and then, with risk of cardiovascular and renal diseases in individuals.  The burden of AMLs will be assessed using the RAMLIS database with place-level measures of the density of, diversity of, and accessibility to toxic contamination, aesthetic qualities, physical hazards, and reclamation activities; and community health will be assessed using Census data in three dimensions (social disorganization, physical disorder, economic deprivation).  This study will be the first to evaluate the burden of AMLs in relation to human health, and the results could offer important insights for directing reclamation funding in the future.