Improving the well-being of mothers, infants, and children is one of the nation’s most pressing public health concerns. It’s so important, in fact, that the U.S. Department of Health and Human Services included maternal, infant, and child health among the priorities of its Healthy People 2020 initiative, alongside cancer, diabetes, and food safety.

Now, Northeastern is at the forefront of solving this challenge, leading a robust interdisciplinary team to bolster health and quality of life for women and their children.

Earlier this month, the university received a four-year, $2.9 million grant from the National Institutes of Health as well as an additional four-year, $2.1 million funding notice from the Environmental Protection Agency to establish the Center for Research on Early Childhood Exposure and Development in Puerto Rico.

Known as CRECE, which is Spanish for “grow,” the center will study how pollutant exposure and psychosocial risk factors impact the health and development of children living on the island’s heavily contaminated northern coast.

Puerto Rico is home to more than 200 hazardous waste sites and particularly high levels of air pollution. Its preterm birth rate is among the highest in the world, climbing from 12 percent in the 1990s to 17 percent today, while the region’s children suffer disproportionately from obesity, autism, and asthma.

“This work will inform future intervention, risk assessment, and policy-setting efforts for both this at-risk population and the U.S. as a whole,” said Akram Alshawabkeh, the grant’s principal investigator and the George A. Snell Professor of Engineering at Northeastern.

The knowledge we gather will make a significant contribution to improving children’s health and reducing the global rate of preterm birth.”
—Akram Alshawabkeh

The synergy between two centers

The research—which dovetails with Northeastern’s focus on solving global challenges in health—will leverage the ongoing work that is being done by university’s Puerto Rico Testsite for Exploring Contamination Threats Center.

Since its founding in 2010, the PROTECT Center has received two grants totaling $23.5 million from the NIH’s National Insti­tute of Envi­ron­mental Health Sci­ences’ Super­fund Research Pro­gram to conduct an inter­dis­ci­pli­nary inves­ti­ga­tion into the com­plex rela­tion­ship between groundwater con­t­a­m­i­na­tion and the island’s extremely high preterm birth rate.

Both centers—which include Northeastern, the University of Michigan, the University of Georgia, and the University of Puerto Rico—are co-directed by Alshawabkeh, a geoenvironmental engineering expert, and Jose F. Cordero, the Patel Distinguished Professor in Public Health at the University of Georgia. The centers also include collaborations with EarthSoft Inc., an environmental data management company, and the Silent Spring Institute, a nonprofit dedicated to breaking the links between environmental chemicals and women’s health.

“CRECE represents a multidisciplinary effort with the potential for tremendous impact on our understanding of how human health is impacted by these chemicals and what can be done to protect exposed children,” said Nadine Aubry, dean of the College of Engineering. “We are proud to have been chosen to lead a second NIEHS center, which is a strong recognition of our leadership in environmental health, and confident that like PROTECT, CRECE will serve as an inspirational model for others seeking to perform interdisciplinary research and help solve the grand challenges of our time.”

The interdisciplinary approach

Over the past five years, the PROTECT team has followed a cohort of 800 pregnant Puerto Rican women through childbirth, exploring whether exposure to commonly found environmental contaminants and chemicals has contributed to the island’s high preterm birth rate.

The findings revealed extensive groundwater contamination and elevated levels of suspect chemicals in the cohort’s participants. They also identified potential mechanisms by which chemicals can stimulate preterm birth, the second leading cause of death worldwide in chil­dren under the age of 5.

The CRECE team will build on this work, tracking from birth to age 4 a cohort of 600 children whose prenatal exposure was documented in the PROTECT study.

The researchers will investigate how exposure to multiple pollutants impacts child health and development as well as how other factors, including socioeconomic status, maternal stress, and preterm birth, might modify the effects of these exposures. Specifically, they will measure pollution levels; conduct mental health assessments; evaluate parental questionnaires; and analyze air, water, and urine samples.

“This study,” Alshawabkeh explained, “will incorporate the totality of the environment to describe how psychosocial, air quality, water quality, product use, and personal exposures contribute to the health and development of children.”

In addition to Alshawabkeh, five Northeastern faculty members will participate in the study.

• Helen Suh, for example, a professor in the Department of Health Sciences with expertise in air pollution’s health effects, will investigate the link between prenatal exposure to air pollution and adverse birth outcomes.
• April Gu, for her part, an associate professor of civil and environmental engineering whose scholarship focuses on biotechnologies and water quality monitoring, will use a “toxicogenomics-based” approach she developed to examine the pathways by which exposure to a mixture of pollutants or particle matter might affect child health and development.
• Phil Brown, the University Distinguished Professor of Sociology and Health Sciences who studies community response to toxic waste-induced disease, will lead the project’s community outreach program.

And they’re not alone. In all, the CRECE team comprises an interdisciplinary group of engineers, environmental epidemiologists, social workers, sociologists, biostatisticians, toxicologists, pediatricians, and communication neuroscientists. “When addressing a global challenge like environmental contamination and human health,” Alshawabkeh explained, “it is crucial to integrate knowledge from a variety of fields, to bring together different expertise in a unified approach.”

Community outreach

The project’s community outreach program will convene residents, researchers, government agencies, and community organizations to improve the communication and practice of children’s environmental health in Puerto Rico.

The plan will include an innovative “report-back” strategy, which Brown designed in collaboration with the Silent Spring Institute to ensure parents of participants receive—and understand—their individual data. It will also include developing environmental health education programs for the island’s residents; expanding relationships with public health communities; and coordinating learning opportunities aimed at building capacity among healthcare professionals.

“We’ve developed a strong relationship with the community,” Alshawabkeh said. “One of our goals is to promote the sharing of knowledge and results across the center and with stakeholders.”