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    Our Pediatric Environmental Exposure Study (PEES) is a 400 child case-control study that is evaluating associations between environmental exposures and biomarkers of oxidative stress and whether or not these biomarkers will better predict risk of severe/uncontrolled childhood asthma compared to parental report of exposure alone (previous NIEHS R21 and CCTST KL2). Exposures include diesel exhaust particle and second hand tobacco smoke exposures, as well as obesity levels. Biomarkers of inflammation and antioxidant status, genetic and socioeconomic factors, and DNA methylation patterns are being considered. Collaborators for the initial phase of the study included Dr. Lisa Martin in the Division of Molecular Genetics, Drs. Gurjit Khurana Hershey, Jocelyn Biagini Myers and Hong Ji in the Division of Asthma Research, Dr. Patrick Ryan in the Division of Biostatistics and Epidemiology, Dr. Tianying Wu in the Department of Environmental Health at UC. Phase 2 of the study began in Fall 2014 and will focus on IL17A/IL13 synergy in more severe asthmatics (difficult to treat asthma) compared to mild/moderate and allergic controls. Collaborators include Dr. Ian Lewkowich in the Division of Immunobiology (PI of NHLBI grant that is funding this project), Dr. Jocelyn Biagini Myers, Gurjit Khurana Hershey and Uma Sivaprasad in the Division of Asthma Research. PEES participants <19 years old will be asked to return. Additional participants will be invited from the Asthma Center's Difficult to Treat Clinic and from the Greater Cincinnati Pediatric Repository.

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    As her preliminary data in PEES revealed strong associations between health outcomes, biomarkers of oxidative stress and socioeconomic factors, we have partnered with Cincinnati’s CoreChange, a grassroots advocacy group, and Seven Hills Neighborhood Houses Center, a full service social service agency and community center in the West End of Cincinnati, to expand our research into the community using a community-based participatory research (CBPR) approach. To this end, we have utilized a $25K gift to implement a community-based research registry, needs assessments using a child-centered PhotoVoice approach and adult focus groups and begin a summer peer health COACH (Coaching on Achieving Community Health) program. To support the Seven Hills Center and buttress research efforts, we have partnered with numerous colleges across the University of Cincinnati to form “Ucore7H”. Ucore7H partners include Dr. Gwendolyn Yip-Ono – Community Philanthropist, Dr. Victor Garcia Division of Pediatric Surgery and co-founder of CoreChange, Mr. Michael Sharp - director for UC’s Center for Service Learning and Civic Engagement, Dr. Liam Ream in the UC’s Division of Professional Practice, Dr. Gisela Esco - UC’s Vice Provost for Assessment and Student Learning and Dr. Tina Whalen – vice dean of the School of Allied Health and many others.


    Youth frequently face acute and chronic stressors that cause mental, physical and/or emotional strain and ultimately contribute to poor health outcomes. In contrast, some youth face a number of stressors as they develop and yet still live healthy, productive lives despite the stress.  Indeed, resilience or the ability to cope and succeed in the face of significant difficulties can protect youth from the negative effects of their environments. Internal, external and existential factors interact and lead to resilience. To identify potentially hidden strategies of resilience, the Resilient Kids [Pilot] Study is using both rigorous quantitative psychosocial-biological and qualitative methodologies to measure shared and distinct mental and physical/built aspects of stress and resilience in distinct low-income or vulnerable youth identified through established partnerships with urban African American, Latino immigrant, and rural Appalachian populations. Associations between validated scales of stress and resilience with several biological markers contributing to an allostatic load index is being evaluated and will define nominal stress response groups (high perceived stress/low allostatic load, high perceived stress/low load, low perceived stress/high load, low perceived stress/low load). A subset analysis in the African American youth will evaluate the role of stress on DNA methylation patterns in children with asthma compared to controls. Finally, using the nominal stress groups, youth will be selected to describe their personal experiences with stress, resilience, and health in visual narratives. These narratives will help researchers to better understand the context of stress and resilience in youth living in three diverse communities. Resilient Kids is funded by an American Psychological Foundation in collaboration with Farrah Jaquez (PI: UC Department of Psychology) and Lisa Vaughn (Cincinnati Children's Emergency Medicine). The asthma subset analysis is funded by a Center for Environmental Genetics grant (CEG; PI – Butsch Kovacic) in collaboration with Drs. Hong Ji and Jocelyn Biagini Myers (Asthma Research). 


    As low income families also experience low literacy, we have evaluated associations between low literacy and asthma control in PEES children ages 4 to 11 years. As an extension of this project, we are collaborating with clinicians targeting low-income and low-literacy caregivers of hospitalized asthmatic children to develop unique multimedia discharge materials that will improve use and sharing of asthma action plans, improve correct use of asthma inhalers and increase asthma control (funding from previous Schroth Foundation grant). Partners include Dr. Carolyn Kercsmar the director of Asthma Center and co-director of the Division of Pulmonology Medicine, Dr. Jeffrey Simmons in Division of General and Community Pediatrics, Dr. Lisa Vaughn in the Division of Emergency Medicine, and Dr. Michael Seid in the Division of Pulmonary Medicine.


    We are currently enrolling for our longitudinal epidemiological study seeking to evaluate environmental and sexual exposure to human papillomavirus (HPV) in families with children diagnosed with Fanconi anemia (current NHLBI R01 and foundation grants). Individuals with Fanconi anemia are genetically vulnerable to squamous head and neck cancers previously shown to be positively associated with HPV. Our team is testing for oral HPV DNA, HPV serological markers as well as markers of immune response. In addition, we are collecting urine samples for NMR/metabolomic studies in collaboration with Dr. Susan Wells in the hematology/oncology at Cincinnati Children's. As part of this study, we regularly interact with a community of families associated with the Fanconi Anemia Research Fund, a strong parent led advocacy group focused on the improving the lives of children with Fanconi anemia, to design, optimize and disseminate the findings from our study. Other collaborators include Dr. Stella Davies, Dr. Parinda Mehta, and Dr. Kasiani Myers all in the Blood Marrow Transplantation Program at Cincinnati Children's, Dr. Darron Brown, director of the Indiana University Center for Vaccine Research, Dr. Rachel Winer at the University of Washington and Dr. Denise Galloway at the Fred Hutchinson Cancer Research Center.

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