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Integrating Earth Observations and Socioeconomic Data to Address Health, Equity, and Environmental Justice

Access to reliable data about the characteristics of populations is a crucial component of decision making, policy development, and the assessment of progress towards strategic goals. Social determinants of health provide insight into the status of social and economic conditions within populations that have profound effects on public health, equity, and vulnerability. International frameworks such as the Sustainable Development Goals (SDGs) fundamentally focus on equality, but to efficiently address targets and indicators, socioeconomic data and Earth observations must be integrated to help identify populations most vulnerable to the impacts of climate change, natural disasters, health disparities, and poor policy planning. The ability to identify vulnerable populations with data analysis has the potential to empower community stakeholders with spatial awareness needed to inform decision-making that addresses equity and environmental justice issues within their communities. The EPA defines environmental justice (EJ) as “the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation and enforcement of environmental laws, regulations and policies.” NASA’s Earth Science Division (ESD) recognizes the benefits that Earth observations with NASA satellites create by equipping individuals with the knowledge to address community challenges. NASA’s Socioeconomic Data and Applications Center (SEDAC) supports the integration of socioeconomic and Earth science data as an “informational gateway.” This integration of data is advancing health, equity, and environmental justice initiatives.

Natasha Johnson-Griffin↗

Conscientious vaccination exemptions in kindergarten to eighth-grade children across Texas schools from 2012 to 2018: A regression analysis

Background: As conscientious vaccination exemption (CVE) percentages rise across the United States, so does the risk and occurrence of outbreaks of vaccine-preventable diseases such as measles. In the state of Texas, the median CVE percentage across school systems more than doubled between 2012 and 2018. During this period, the proportion of schools surpassing a CVE percentage of 3% rose from 2% to 6% for public schools, 20% to 26% for private schools, and 17% to 22% for charter schools. The aim of this study was to investigate this phenomenon at a fine scale. Methods and findings: Here, we use beta regression models to study the socioeconomic and geographic drivers of CVE trends in Texas. Using annual counts of CVEs at the school system level from the 2012–2013 to the 2017–2018 school year, we identified county-level predictors of median CVE percentage among public, private, and charter schools, the proportion of schools below a high-risk threshold for vaccination coverage, and five-year trends in CVEs. Since the 2012–2013 school year, CVE percentages have increased in 41 out of 46 counties in the top 10 metropolitan areas of Texas. We find that 77.6% of the variation in CVE percentages across metropolitan counties is explained by median income, the proportion of the population that holds a bachelor's degree, the proportion of the population that self-reports as ethnically white, the proportion of the population that is English speaking, and the proportion of the population that is under the age of five years old. Across the 10 top metropolitan areas in Texas, counties vary considerably in the proportion of school systems reporting CVE percentages above 3%. Sixty-six percent of that variation is explained by the proportion of the population that holds a bachelor’s degree and the proportion of the population affiliated with a religious congregation. Three of the largest metropolitan areas—Austin, Dallas–Fort Worth, and Houston—are potential vaccination exemption "hotspots," with over 13% of local school systems above this risk threshold. The major limitations of this study are inconsistent school-system-level CVE reporting during the study period and a lack of geographic and socioeconomic data for individual private schools. Conclusions: In this study, we have identified high-risk communities that are typically obscured in county-level risk assessments and found that public schools, like private schools, are exhibiting predictable increases in vaccination exemption percentages. As public health agencies confront the reemerging threat of measles and other vaccine-preventable diseases, findings such as ours can guide targeted interventions and surveillance within schools, cities, counties, and sociodemographic subgroups.

59 BASIC BIOLOGICAL SCIENCES↗

New Particle Formation and Growth in the Houston Atmosphere During TRACER (Final Report)

From 2020-2025, researchers from UC Irvine, UC Riverside, and Colorado State University collaborated on a Department of Energy-funded project to understand how airborne particles form and grow in urban atmospheres, conducting an intensive field campaign in Houston, Texas during summer 2022. Using advanced instruments to measure gas-phase chemicals, particle composition, and a specialized chamber to study particle growth, the team discovered that sulfur-containing compounds from industrial and power plant emissions are the dominant driver of new particle formation in Houston, with particles typically forming locally in the city and growing as air moves away in the urban plume. The research revealed an important methodological insight: measurements from fixed ground stations can be misleading when interpreting how particles actually evolve as air masses move, which has significant implications for how scientists worldwide interpret atmospheric observations. These findings improve understanding of urban air quality and help reduce uncertainties in climate models, since these particles play critical roles in cloud formation and Earth's radiation balance, while also providing detailed information about ultrafine particle composition relevant to public health. The project trained three doctoral students, developed enhanced computer models for urban particle formation, and made all data publicly available through the DOE Atmospheric Radiation Measurement data archive for use by the broader scientific community.

54 ENVIRONMENTAL SCIENCES↗

Knowing the unknown: The underestimation of monkeypox cases. Insights and implications from an integrative review of the literature

Monkeypox is an emerging zoonotic disease caused by the monkeypox virus, which is an infectious agent belonging to the genus Orthopoxvirus. Currently, commencing from the end of April 2022, an outbreak of monkeypox is ongoing, with more than 43,000 cases reported as of 23 August 2022, involving 99 countries and territories across all the six World Health Organization (WHO) regions. On 23 July 2022, the Director-General of the WHO declared monkeypox a global public health emergency of international concern (PHEIC), since the outbreak represents an extraordinary, unusual, and unexpected event that poses a significant risk for international spread, requiring an immediate, coordinated international response. However, the real magnitude of the burden of disease could be masked by failures in ascertainment and under-detection. As such, underestimation affects the efficiency and reliability of surveillance and notification systems and compromises the possibility of making informed and evidence-based policy decisions in terms of the adoption and implementation of ad hoc adequate preventive measures. In this review, synthesizing 53 papers, we summarize the determinants of the underestimation of sexually transmitted diseases, in general, and, in particular, monkeypox, in terms of all their various components and dimensions (under-ascertainment, underreporting, under-detection, under-diagnosis, misdiagnosis/misclassification, and under-notification).

59 BASIC BIOLOGICAL SCIENCES↗

Anthropogenic-Induced Drought: Escalating Mental Health Crises and Environmental Inequities

This study investigates the relationship between the Great Salt Lake (GSL) decline and air quality, focusing on PM2.5 concentrations and their impacts on public health. As the GSL continues to shrink, it has become a significant source of dust emissions, posing serious health and environmental risks to the surrounding areas. There search examines how diminishing water levels in the GSL, driven by climate change, agricultural water use, and urban development, affect local populations' mental health. Adopting an interdisciplinary approach, the study considers the long-term effects of air quality on mental health in relation to inorganic particulate matter, gaseous pollutants, and social vulnerability.

Maheshwari Neelam↗

Centers for Disease Control and Prevention (CDC) Radiation Hazard Scale (Expanded Data Product Feedback Report)

During radiation emergencies, it is important to communicate clearly as radiation risks are often unfamiliar to many members of the general public and emergency responders, including public health workers. To partially address this issue, the Centers for Disease Control and Prevention (CDC) developed the Radiation Hazard Scale to communicate radiation risk to the general public, community leaders, and decision makers. The simple numeric scale does not require a background in radiation physics or health effects and can be used to assist people in understanding their risk and motivate protective action compliance. Lawrence Livermore National Laboratory has assisted the US Department of Energy National Nuclear Security Administration and the CDC in the development of Radiation Hazard Scale data products. This report documents the feedback received from Federal response officials on an expanded data product set. This expanded set accounts for the effects of building protection on radiation exposure and allows for the comparison between different response actions, including sheltering in place, based on the LLNL developed Regional Shelter Analysis methodology.

54 ENVIRONMENTAL SCIENCES↗

Planetary protection, legal ambiguity and the decision making process for Mars sample return

As scientists and mission planners develop planetary protection requirements for future Mars sample return missions, they must recognize the socio-political context in which decisions about the mission will be made and pay careful attention to public concerns about potential back contamination of Earth. To the extent that planetary protection questions are unresolved or unaddressed at the time of an actual mission, they offer convenient footholds for public challenges in both legal and decision making realms, over which NASA will have little direct control. In this paper, two particular non-scientific areas of special concern are discussed in detail: 1) legal issues and 2) the decision making process. Understanding these areas is critical for addressing legitimate public concerns as well as for fulfilling procedural requirements regardless whether sample return evokes public controversy. Legal issues with the potential to complicate future missions include: procedural review under National Environmental Policy Act (NEPA); uncertainty about institutional control and authority; conflicting regulations and overlapping jurisdictions; questions about international treaty obligations and large scale impacts; uncertanities about the nature of the organism; and constitutional and regulatory concerns about quarantine, public health and safety. In light of these important legal issues, it is critical that NASA consider the role and timing of public involvement in the decision making process as a way of anticipating problem areas and preparing for legitimate public questions and challenges to sample return missions.

NASA Discipline Number 59-10↗

A Taxonomic Classification Approach for Global Spatio-temporal Data

The World Bank, World Health Organization, and other major vendors collectively provide thousands of global time series datasets that focus on issues of the environment, public health, economics, violence, education, and national security. Sorting these data into meaningful information requires the use of data mining techniques to cluster trends into an orderly and manageable number of cases. The World SpatioTemporal Analytics and Mapping (WSTAMP) project database (wstamp.ornl.gov) was developed to spatiotemporally harmonize global vendor data (23,300+ attributes, 200+ locations, 50+ years). Within the WSTAMP analytical environment, Dynamic Time Warping (DTW) has been a highly effective data-driven approach for clustering and mapping these time series into national spatiotemporal behavior maps. Two significant properties have surfaced from this work. First, several recognizable cluster patterns have emerged and persist across a range of locations, attributes, and time frames (e.g., increasing, decreasing, rebounding, peak, oscillating). Secondly, practitioners engaging WSTAMP have noted the explanatory and anticipatory value of these patterns and articulated particular interest in detecting them within the spatiotemporal cube. This need was addressed by shifting DTW-based clustering from an open ended, data-driven implementation to a taxonomic pattern matching approach. This paper presents the method including implementation strategies for visualization and human computer interaction and applies the approach to a sample data set and concludes with next steps.

Stewart, Robert↗

NASA Remote Sensing Data for Epidemiological Studies

In response to the need for improved observations of environmental factors to better understand the links between human health and the environment, NASA has established a new program to significantly improve the utilization of NASA's diverse array of data, information, and observations of the Earth for health applications. This initiative, lead by Goddard Space Flight Center (GSFC) has the following goals: (1) To encourage interdisciplinary research on the relationships between environmental parameters (e.g., rainfall, vegetation) and health, (2) Develop practical early warning systems, (3) Create a unique system for the exchange of Earth science and health data, (4) Provide an investigator field support system for customers and partners, (5) Facilitate a system for observation, identification, and surveillance of parameters relevant to environment and health issues. The NASA Environment and Health Program is conducting several interdisciplinary projects to examine applications of remote sensing data and information to a variety of health issues, including studies on malaria, Rift Valley Fever, St. Louis Encephalitis, Dengue Fever, Ebola, African Dust and health, meningitis, asthma, and filariasis. In addition, the NASA program is creating a user-friendly data system to help provide the public health community with easy and timely access to space-based environmental data for epidemiological studies. This NASA data system is being designed to bring land, atmosphere, water and ocean satellite data/products to users not familiar with satellite data/products, but who are knowledgeable in the Geographic Information Systems (GIS) environment. This paper discusses the most recent results of the interdisciplinary environment-health research projects and provides an analysis of the usefulness of the satellite data to epidemiological studies. In addition, there will be a summary of presently-available NASA Earth science data and a description of how it may be obtained.

Maynard, Nancy G.↗

State-Specific Prevalence of Inactivity, Self-Rated Health Status, and Severe Joint Pain Among Adults With Arthritis — United States, 2019

Arthritis is associated with joint pain, disability, and physical inactivity, potentially resulting in poor quality of life. The Centers for Disease Control and Prevention analyzed 2019 Behavioral Risk Factor Surveillance System data to estimate state-specific arthritis prevalence and, among adults with arthritis, the prevalence of physical inactivity, fair/poor self-rated health status, and severe joint pain. Among adults with arthritis, age-standardized prevalences of physical inactivity, fair/poor health status, and severe joint pain were high in all states and highest in southeastern states. Increased promotion and use of evidence-based public health interventions for arthritis may improve health-promoting behaviors and health outcomes among adults with arthritis.

59 BASIC BIOLOGICAL SCIENCES↗

Satellites as Sentinels for Environment & Health

Satellites as Sentinels for Environment & Health Remotely-sensed data and observations are providing powerful new tools for addressing human and ecosystem health by enabling improved understanding of the relationships and linkages between health-related environmental parameters and society as well as techniques for early warning of potential health problems. NASA Office of Earth Science Applications Program has established a new initiative to utilize its data, expertise, and observations of the Earth for public health applications. In this initiative, lead by Goddard Space Flight Center, remote sensing, geographic information systems, improved computational capabilities, and interdisciplinary research between the Earth and health science communities are being combined in rich collaborative efforts resulting in more rapid problem-solving, early warning, and prevention in global health issues. This presentation provides a number of recent examples of applications of advanced remote sensing and other technologies to health.and security issues related to the following: infectious and vector-borne diseases; urban, regional and global air pollution; African and Asian airborne dust; heat stress; UV radiation; water-borne disease; extreme weather; contaminant pathways (ocean, atmosphere, ice)

Maynard, Nancy G.↗

Urban environmental health applications of remote sensing

An urban area was studied through the use of the inventory-by-surrogate method rather than by direct interpretation of photographic imagery. Prior uses of remote sensing in urban and public research are examined. The effects of crowding, poor housing conditions, air pollution, and street conditions on public health are considered. Color infrared photography was used to categorize land use features and the grid method was used in photo interpretation analysis. The incidence of shigella and salmonella, hepatitis, meningitis, tuberculosis, myocardial infarction and veneral disease were studied, together with mortality and morbidity rates. Sample census data were randomly collected and validated. The hypothesis that land use and residential quality are associated with and act as an influence upon health and physical well-being was studied and confirmed.

Rush, M.↗

AMIA KDDM Working Group Collaborative Workshop: Enriching Electronic Health Records with Social Determinants of Health to Improve Outcomes and Health Equity

Prior research has demonstrated that social determinants of health (SDoH) are major drivers of health outcomes and contributors to widespread health inequities. It was estimated that, in the United States, SDoH could be responsible for up to 40% of all preventable deaths, significantly higher than the 10-15% for which better medical care is responsible. Public health interventions that target SDoH are instrumental for improving health outcomes and reducing long-standing health inequities. Currently, most mainstream EHR vendors have implemented SDoH screeners in their EHR systems. However, the utility of the screeners is low, rendering patient-level SDoH still widely unavailable in the structured fields. SDoH are sometimes mentioned in free-text clinical notes (e.g., social context section) where natural language processing (NLP) can be applied to extract relevant information. Contextual-level SDoH can be identified from multiple data sources, many of which are publicly available and spatiotemporally linked to EHR data. As such, there is an opportunity for the KDDM research community to create innovative solutions to draw meaningful insights by creating and using rich data with SDoH to improve health outcomes while reducing disparities. In this workshop organized by AMIA Knowledge Discovery and Data Mining Working Group (AMIA KDDM WG), we will invite world-leading experts from academia, national laboratories, and life science industry with varied backgrounds in biomedical informatics, epidemiology, data science, machine learning, natural language processing, and pediatric cardiology to discuss the best practice of capturing, standardizing, and using SDoH information in various applications aiming at improving outcomes and health equity.

He, Zhe↗

How New Mexico Leveraged a COVID-19 Case Forecasting Model to Preemptively Address the Healthcare Needs of the State: Quantitative Analysis

Prior to the COVID-19 pandemic, US hospitals relied on static projections of future trends for long-term planning and were only beginning to consider forecasting methods for short-term planning of staffing and other resources. With the overwhelming burden imposed by COVID-19 on the health care system, an emergent need exists to accurately forecast hospitalization needs within an actionable timeframe. Our goal was to leverage an existing COVID-19 case and death forecasting tool to generate the expected number of concurrent hospitalizations, occupied intensive care unit (ICU) beds, and in-use ventilators 1 day to 4 weeks in the future for New Mexico and each of its five health regions. We developed a probabilistic model that took as input the number of new COVID-19 cases for New Mexico from Los Alamos National Laboratory’s COVID-19 Forecasts Using Fast Evaluations and Estimation tool, and we used the model to estimate the number of new daily hospital admissions 4 weeks into the future based on current statewide hospitalization rates. The model estimated the number of new admissions that would require an ICU bed or use of a ventilator and then projected the individual lengths of hospital stays based on the resource need. By tracking the lengths of stay through time, we captured the projected simultaneous need for inpatient beds, ICU beds, and ventilators. We used a postprocessing method to adjust the forecasts based on the differences between prior forecasts and the subsequent observed data. Thus, we ensured that our forecasts could reflect a dynamically changing situation on the ground. Forecasts made between September 1 and December 9, 2020, showed variable accuracy across time, health care resource needs, and forecast horizon. Forecasts made in October, when new COVID-19 cases were steadily increasing, had an average accuracy error of 20.0%, while the error in forecasts made in September, a month with low COVID-19 activity, was 39.7%. Across health care use categories, state-level forecasts were more accurate than those at the regional level. Although the accuracy declined as the forecast was projected further into the future, the stated uncertainty of the prediction improved. Forecasts were within 5% of their stated uncertainty at the 50% and 90% prediction intervals at the 3- to 4-week forecast horizon for state-level inpatient and ICU needs. However, uncertainty intervals were too narrow for forecasts of state-level ventilator need and all regional health care resource needs. Real-time forecasting of the burden imposed by a spreading infectious disease is a crucial component of decision support during a public health emergency. Our proposed methodology demonstrated utility in providing near-term forecasts, particularly at the state level. This tool can aid other stakeholders as they face COVID-19 population impacts now and in the future.

60 APPLIED LIFE SCIENCES↗

Observations from Space: A Unique Vantage Point for the Study of the Environment and Possible Associations with Disease Occurrence

Health providers/researchers need environmental data to study and understand the geographic, environmental, and meteorological differences in disease. Satellite remote sensing of the environment offers a unique vantage point that can fill in the gaps of environmental, spatial, and temporal data for tracking disease. The field of geospatial health remains in its infancy, and this program will demonstrate the need for collaborations between multi-disciplinary research groups to develop the full potential. NASA will discuss the Public Health Projects developed to work with Grantees and the CDC while providing them with information on opportunities for future collaborations with NASA for future research.

Estes, S.↗

Lessons learned studying design issues for lunar and Mars settlements

In a study of lunar and Mars settlement concepts, an analysis was made of fundamental design assumptions in five technical areas against a model list of occupational and environmental health concerns. The technical areas included the proposed science projects to be supported, habitat and construction issues, closed ecosystem issues, the "MMM" issues (mining, material processing, and manufacturing), and the human elements of physiology, behavior, and mission approach. Four major lessons were learned. First it is possible to relate public health concerns to complex technological development in a proactive design mode, which has the potential for long-term cost savings. Second, it became very apparent that prior to committing any nation or international group to spending the billions to start and complete a lunar settlement, over the next century, that a significantly different approach must be taken from those previously proposed, to solve the closed ecosystem and "MMM" problems. Third, it also appears that the health concerns and technology issues to be addressed for human exploration into space are fundamentally those to be solved for human habitation of the Earth (as a closed ecosystem) in the 21st century. Finally, it is proposed that ecosystem design modeling must develop new tools, based on probabilistic models as a step up from closed circuit models.

Life Support Systems↗

Climate and Health Impacts of US Emissions Reductions Consistent with 2 C

An emissions trajectory for the US consistent with 2 C warming would require marked societal changes, making it crucial to understand the associated benefits. Previous studies have examined technological potentials and implementation costs and public health benefits have been quantified for less-aggressive potential emissions-reduction policies, but researchers have not yet fully explored the multiple benefits of reductions consistent with 2 C. We examine the impacts of such highly ambitious scenarios for clean energy and vehicles. US transportation emissions reductions avoid approx.0.03 C global warming in 2030 (0.15 C in 2100), whereas energy emissions reductions avoid approx.0.05-0.07 C 2030 warming (approx.0.25 C in 2100). Nationally, however, clean energy policies produce climate disbenefits including warmer summers (although these would be eliminated by the remote effects of similar policies if they were undertaken elsewhere). The policies also greatly reduce damaging ambient particulate matter and ozone. By 2030, clean energy policies could prevent approx.175,000 premature deaths, with approx.22,000 (11,000-96,000; 95% confidence) fewer annually thereafter, whereas clean transportation could prevent approx.120,000 premature deaths and approx.14,000 (9,000-52,000) annually thereafter. Near-term national benefits are valued at approx.US$250 billion (140 billion to 1,050billion) per year, which is likely to exceed implementation costs. Including longer-term, worldwide climate impacts, benefits roughly quintuple, becoming approx.5-10 times larger than estimated implementation costs. Achieving the benefits, however, would require both larger and broader emissions reductions than those in current legislation or regulations.

policies↗

System Model Calculations for the Active Trenches of the Low-Level Burial Grounds, Hanford Site, Washington

Two lined trenches (Trench 31 and 34) located within the 200 West Low-Level Burial Ground (LLBG) area of the U.S. Department of Energy’s (DOE) Hanford Site are designated for permanent disposal of low-level radioactive waste (LLW) and mixed low-level radioactive waste (MLLW). In accordance with DOE O 435.1, Radioactive Waste Management, radioactive waste shall be managed and disposed in a manner that is protective of worker, public health and safety, and the environment. DOE O 435.1 requires a site-specific radiological performance assessment (PA) that includes calculations of potential releases and subsequent doses to members of the public for a period of 1,000 years after closure of a low-level waste (LLW) disposal facility. The purpose of this environmental calculation file (ECF) is to document the various dose calculations performed to support DOE’s LLBG PA. The dose assessments are performed to evaluate the potential exposure of an all-pathway representative person to radionuclide contaminants of potential concern (COPCs) that may be released from the LLBG Trenches 31 and 34 to the point of calculation (POC) located at the outer edge of a 100 m buffer zone surrounding the trench boundary. This ECF uses inputs from other ECFs and their associated model package reports (MPRs) supporting the LLBG PA. The five major objectives of this ECF are to present the results of the following: (1) Deterministic dose assessments for both groundwater and atmospheric exposure scenarios; (2) Radon-222 (Rn-222) flux emanating at the surface from the disposed wastes; (3) Uncertainty analyses of the groundwater pathway annual dose due to uncertainty in input parameters; (4) Sensitivity analyses of the input parameters that could potentially impact the fate and transport of the contaminants and doses; (5) Doses arising from inadvertent intruder exposure scenarios.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗