Public health experts and climate researchers convene to address communication challenges related to wildfire smoke

As Central Washington became choked with wildfire smoke last summer, Dr. Mark Larson grew so concerned about air quality measures in Kittitas County that he couldn’t sleep for 10 days.
As the health officer for Kittitas County, Larson felt it was his duty to recommend canceling outdoor activities. But as a 20-year community resident, he also knew that the Kittitas Rodeo was right around the corner—a nationally known event that can bring in more than $8 million to the local economy in a single weekend.
Canceling the rodeo would have devastating consequences for his community—a threat made explicit by a public official who asked about replacing Larson with a health officer who would OK the event.
“I’d become the least popular person in Kittitas County,” Larson said.

Our new normal

Smoke in the western parts of North America is getting worse. That was the clear message from Amy Snover, director of the University of Washington Climate Impacts Group (CIG) during a recent symposium on communicating about the health risks of wildfire smoke.
By the 2080s, the median annual area burned in the Northwest could more than double compared to rates of burn experienced between 1916 and 2006, according to Snover. Wildfires and smoke events are becoming our new normal, but we’re not prepared for the impacts.
The symposium was hosted at the UW by the Collaborative on Extreme Event Resilience (CEER) with support from CIG and the UW Department of Environmental & Occupational Health Sciences.
Other sponsors included the UW Program on Climate Change, the Interdisciplinary Center for Exposures, Diseases, Genomics and Environment, the Center for Health and the Global Environment and the Northwest Climate Adaptation Science Center.

Getting the word out

DEOHS Lecturer Nicole Errett
Larson shared his experience as part of a public health practitioner panel on challenges in the field. The smoke cleared from Kittitas County just in time for the 2018 rodeo, and Larson kept his job. But his dilemma as health officer speaks volumes about our future challenges.
Other presenters told related stories—about agricultural communities in the Methow Valley where it’s not safe to be outside when crops are ready for harvest; about tribal children who aren’t able to participate in the harvest of traditional foods; about public schools facing closures when aging buildings can’t stay cool without opening the windows.
From a public health perspective, we face big questions:
  • What messages will support the health of impacted communities?
  • How do we decide what to tell people when the science on health impacts—particularly on mental health—from smoke events is lacking?
  • How do we get messages out to communities that vary widely in terms of language, culture and effective communication channels?
  • Whose responsibility is it to take leadership on messaging?
  • How do we weigh health risks against economic or spiritual risks?
While there are no easy answers, participants agreed that the best answers will come from within impacted communities themselves, shared through forums like the symposium.

A first step

DEOHS Lecturer Tania Busch Isaksen
Drs. Nicole Errett and Tania Busch Isaksen, DEOHS lecturers and co-founders of CEER, planned the smoke symposium with colleague Dr. Heidi Roop of CIG and their students.
“We wanted to start a discussion about the ways that the UW’s resources and expertise could be used to help meet the needs of our public health partners as they grapple with this emerging public health challenge,” Busch Isaksen said.
Errett sees the event as a first step. “We’ll use the discussions we had at the symposium to springboard new collaborations aimed at tackling wildfire smoke risks to improve the health of Washington communities.”

EDGE engagement project lifts moods in the smoke-choked Methow Valley

Typically, summer in the Methow Valley is a time to hike, bike, camp, river raft, mountain climb, attend outdoor arts festivals, and otherwise enjoy the spectacular natural setting.

Lately, things are different. Wildfire season has hit the Methow Valley hard the last five years, causing hazardous smoke conditions that can persist for weeks on end, often making residents feel trapped and isolated.

Teenagers in Twisp, WA find fun and relief from smoke-filled air as part of an EDGE-led community engagement effort. Photo by Kelly Edwards.

Recommendations from public health agencies are commonly limited to staying inside and wearing masks, but those messages aren’t always helpful for people who have been losing whole weeks of summer, cooped up inside. For farmers and agricultural workers who need to harvest, and carpenters who must complete essential outdoor projects before snow falls, staying indoors or leaving the area is not an option. And yet going outside with masks can add to the feeling of apocalypse.

Kelly Edwards, Director of Engagement with the University of Washington Interdisciplinary Center for Exposures, Diseases, Genomics and Environment, wanted to create a different type of public engagement activity, one that would bring community members together in a fun and positive way while providing information to support good day-to-day decision-making.

A girl decorates her mask at the Twisp farmers market. Photo: Kelly Edwards 

The outreach she envisioned would complement the Methow Valley Clean Air Project (MVCAP), which placed Purple Air monitors throughout the Valley to provide residents with timely, highly localized air quality reports that support daily decisions like whether or not to go for a run and, if so, where.

To help create the right messages, Edwards partnered with two local community members—Anthony Twig Wheeler, an international leader in somatic therapy and Robin Baire, a clinical herbalist. Wheeler makes regular appearances on KTRT, the local radio station, to talk about managing stress during wildfire season. Baire specializes in teas and tinctures that can combat the inflammatory response triggered by smoke exposure.

A volunteer with the Methow Valley Clean Air Project. Photo by Kelly Edwards. 

Together with community health expert Rachel Levi and Amanda Durkin, an undergraduate intern in the Department of Environmental and Occupational Health Sciences who works with Dr. Nicole Errett and MVCAP, Edwards, Wheeler, and Baire set up a booth at the Twisp Farmer’s Market last Saturday where they emphasized support for the body’s natural defenses. Wheeler set up comfortable chairs for people to sit in and talk, Baire provided samples of tea and anti-inflammatory tinctures, and Edwards and Durkin passed out air masks provided by the EDGE Center, encouraging people to color on them with non-toxic markers.

“We wanted to give people the right kind of masks,” says Edwards, “but we also wanted them to make them their own. Adding color made them more fun to wear and also kept people from looking like they were sick.” The masks were rated N95 which means they filter out the tiny particulates that pose a health risk. But unlike masks provided by other public health agencies, they also had an air-exchange pocket at the nose that made exhalation easier and kept internal temperatures more comfortable.

The mask activity drew people from age three to 86. Along with the masks, Kelly distributed a handout designed to be accessible to an elementary school audience with simple messages about what’s in smoke and how you can take care of yourself until it passes. The booth also demonstrated simple DIY home air filters that improve indoor air quality. Taping a furnace filter with a MERV rating of 10 or higher to a regular box fan helps remove PM2.5 that infiltrates everything, including our homes.

Methow Valley Clean Air Ambassadors help community members track the highs and lows of air quality in the Methow Valley over the fire season. 

The positive, action-oriented activity was well-received by a community hit hard by smoke for the last five summers. Edwards says that one of the biggest insights from the engagement activity was recognizing the benefit of framing simple, helpful information in a positive way. One elder community member pointed to the last suggestion “Remind yourself that you’re OK and the smoke will go away again,” and said, “This is what I really needed to hear today.”

Edwards and crew will be back at the Twisp Farmer’s Market for Labor Day weekend and plan to do more stress-less activities this weekend at a community dance party organized by the local radio station KTRT and Wheeler. Along with Elizabeth Walker of the MVCAP, the UW EDGE Center plans to further develop, test, and disseminate positive and nuanced public health messaging around smoke preparedness and disaster response.

Getting their hands on science

High school teachers try out a science experiment during a UW workshop. Photo: Sarah Fish
From sun exposure to vaping, this teacher training program pioneered by DEOHS is changing how high school students learn about health and the environment.*

Sure, you can lecture teenagers about the dangers of sun exposure. You can tell them that skin cancer is the most common cancer in the United States. But if you really want the message to hit home, let them discover it for themselves.
That’s the premise behind a pioneering environmental-health education program developed by the UW Center for Exposures, Diseases, Genomics & Environment (EDGE) and a group of Washington high school teachers. EDGE is part of the UW Department of Environmental & Occupational Health Sciences (DEOHS).
The ATHENA program—it stands for the Academy for Teaching about Health and Environment Associations—has changed how health and science are taught across the state since it launched under a different name more than 20 years ago.
“We are reaching students in non-science classes and getting them to think about the intricate connections between human health, the health of the environment and the choices we make as individuals and society,” said Jon Sharpe, DEOHS instruction support specialist who helped start the program.

Learning by doing

A sun simulator replicates UV light. Photo: Sarah Fish.
Teachers say the emphasis on hands-on science and topics relevant to today’s teens gets students excited about health careers and changes how they think about their choices as consumers.
EDGE staff work with high school teachers across Washington to develop classroom kits that teach students about the nutritional differences between natural and artificial sweeteners, the health effects of vaping and other environmental health topics.
“Kids like to get their hands on something tactile,” said Marilyn Hair, former community outreach specialist with EDGE who worked with teachers to develop the kits.

A sun-baked experiment

In the sun exposure experiment, high school students place colorless beads, made of special material that reacts to ultraviolet light, inside a clear plastic box and smear lotion or sunscreen on the clear lid. Other beads are placed in a box with nothing applied to the lid.
Then students make predictions: What will happen to the beads when the boxes are exposed to sunlight?
The approach itself is backed by science: A recent study from the University of Chicago found that students who physically experience scientific concepts understand them more deeply and do better on tests.

Adopted by 33 school districts

Beads used in the sun exposure experiment. Photo: courtesy of Lisa Hayward Watts.
The kits are now part of the health curriculum and family and consumer sciences classes in 33 school districts across Washington.
“The ATHENA curriculum hits on a lot of cylinders,” explained Lindzee Alvarez, a health teacher at Interlake High School in Bellevue and one of ATHENA’s first participants. “Students bring home resonant concepts to their families about relevant topics and can link to things they are learning about in other classes.”
Lessons and activities developed for the ATHENA program are now part of the Bellevue School District health curriculum taught across all of the district’s high schools, thanks to efforts by Alvarez and others to promote the materials.

Making science relevant

Alvarez and other ATHENA participants convened at the UW last month to document the program’s impact, revisit program goals and discuss ways to measure its future effectiveness.
While the original idea was to expose middle- and high-school science teachers to the expertise of UW science researchers, ATHENA now also supports teachers developing and piloting new environmental health-focused lessons and activities, Sharpe said.
“When we first started doing outreach to schools, there was a sense that we really needed to get students to do lab-based experiments so we could nurture future environmental health scientists,” Sharpe said.
Today, “there’s a new emphasis on really big, interdisciplinary problems like climate change, the built environment and health disparities—problems that will require all sorts of expertise to tackle in the coming years.”

*This article first appeared on the University of Washington Department of Environmental and Occupational Health Sciences blog "Health & Saftey Matters."

EDGE Scientists Argue for Updating Food Safety Regulations

In the United States, we usually feel confident that food we bring home from the grocery store is safe. Its quality and safety are monitored by the U.S. Department of Agriculture and the U.S. Environmental Protection Agency for pesticide residues and by the U.S. Food and Drug Administration (FDA) for food additives and contaminants after all.

       Few of us realize that the rules governing FDA regulation of food safety date back to the 1950s and allow additives that are “generally recognized as safe” (GRAS) to be exempted from adequate testing. This GRAS loophole results in an insufficient assurance of food safety because, among other things, it allows the use of thousands of food additives that have not been thoroughly tested for toxicity—a fact that concerns Associate Professor Dr. Sheela Sathyanarayana and her colleagues at The American Academy of Pediatrics.
Dr. Sheela Sathyanarayana is the Co-Director of the EDGE Center’s Developmental & Reproductive Disorders Collaborative Research Team. Photo by UW Medicine. 
       Dr. Sathyanarayana is an expert on the effects of endocrine-disrupting chemicals on child development and also the Co-Director of the EDGE Center’s Developmental & Reproductive Disorders Collaborative Research Team. Recently she co-authored a technical report and a policy statement in the scientific journal Pediatrics, together with EDGE toxicology Ph.D. graduate student Rachel Shaffer, and Associate Professor Leonardo Trasande of the New York University School of Medicine, urging Congress to change the guidelines so that the FDA can collect more data about food additives.
Dr. Rachel Shaffer is an EDGE Ph.D. student in UW's toxicology program. Photo by Jeremy Shaffer. 
       In their technical report, Sathyanarayana and Shaffer point out that very few of the chemicals used in food and food packaging in the U.S. have been tested for reproductive toxicology (only 263 out of 3941 chemicals listed on the FDA “Substances Added to Food” website) and even fewer for developmental toxicology (only two of the same 3941). Children are particularly susceptible to the damaging effects of endocrine disruptors because 1. they eat and drink more relative to their size; 2. their systems for metabolizing and detoxifying chemicals are not as well developed; and 3. their bodies are going through critical hormone-dependent developmental stages, the disruption of which can cause irreversible damage and persistent adverse health effects later in life.

       Several categories of compounds are of particular concern to pediatricians. These include the bisphenols and phthalates used to in plastic food containers and manufacturing equipment; the perfluoroalkyl chemicals used in grease-proof paper and paperboard; the perchlorates used in food packaging; and the nitrates and nitrites used as preservatives and color-enhancers, particularly in meat. Growing evidence suggests that these compounds are associated with a range of health problems from obesity and cancer to disruptions in hormone systems and reproductive and neurological development.
       The report also includes steps individuals can take to minimize their exposure, including buying more fresh or frozen fruits and vegetables and fewer processed meats; avoiding microwaving in plastic containers and wrapping when possible; and using alternatives to plastics such as glass or stainless steel.
       Despite these recommendations, Sathyanarayana and Shaffer emphasize that the purpose of these articles is to encourage better federal regulation. “Our real goal here is to prompt policy change. The burden should not be placed on individuals or families; instead, we need stronger national policies to ensure that direct and indirect food additives are not harmful,” said Shaffer. Sathyanarayana adds “We did this story because most people don’t know that chemicals can be added to their foods without adequate safety/toxicity data.”
       Access to the full technical report is available here and the policy statement here.

Kidney-On-A-Chip In Space: With support from the EDGE Center, a UW team prepares to send their revolutionary simulation kidney into space

Most drugs a person takes will ultimately be cleared from their body into urine by their kidneys. The role of these hard-working organs in drug clearance makes them particularly susceptible to the toxic effects of certain medications. Unfortunately, unlike livers, kidneys can’t regenerate. That’s bad in part because, once they start to fail, they limit the ability of a patient to process drugs—complicating treatment for a range of diseases, including kidney disease.  
In the past, a medical researcher who wanted to test the effects of a new drug on the kidneys might have applied the drug to cultured kidney cells on a plate. Regrettably, that test wouldn’t model what happens in the body very well because it wouldn’t replicate blood flow. A more expensive and ethically complicated option would be to conduct tests on animals.  However, animals are not always predictive of human responses.

Fortunately, a recent breakthrough by a team co-led by EDGE members, Edward Kelly, and Jonathan Himmelfarb, with colleague Catherine Yeung, gives researchers a new option—kidney-on-a-chip. While it might sound like some kind of British hors-d'oeuvres, kidney-on-a-chip is actually a revolutionary new device that functions as a normal kidney, allowing researchers to test drugs as well as xenobiotics in a much more natural laboratory model.
The genius of kidney-on-a-chip is that it incorporates flow to mimic normal kidney function. A tubule of kidney cells are enclosed inside a plastic case through which drugs can be passed in a system that closely replicates a working kidney. Researchers can apply experimental drugs to kidney-on-a-chip with a syringe, pushing medications through the system—even multiple medications at once—without the need for gravity.  
Kelly and Himmelfarb are already using kidney-on-a-chip to compare the toxicity of antibiotics and herbal products on the kidney to compare the effects of different doses. By detecting harmful effects with the chip, they’re able to optimize treatment options for patients while reducing the need for human and animal testing. In the future, they hope to use the chips not only to improve treatment and prevention of disease but also to develop cures.

As exciting as the chip advance has been for kidney research, it’s about to get better. Thanks to recent federal grants from the National Institutes of Health’s National Center for Advancing Translational Science and NASA’s Center for the Advancement of Science in Space, kidney-on-a-chip is preparing for its first cosmic voyage—to the International Space Station.
Why send kidney-on-a-chip to space? Because there’s so much to learn. First of all, microgravity will speed up processes related to the development of kidney disease, so that problems that take decades to develop on Earth could appear within weeks or months in space. This will potentially give researchers rare insights into the long-term effects of drug treatment.
Second, studying kidney-on-a-chip in space can provide important insights into the medical complications associated with weightlessness. Bone loss is one problem that plagues astronauts. Kidneys make the active form of vitamin D that keeps bones healthy, so it’s important to understand how that function occurs in a weightless environment.
Cells have never been sent to space like this. This experiment will allow scientists to probe the long-term effects of a lower-gravity environment on a human organ. What the team learns will dramatically improve our understanding of issues like potential medical challenges for Mar’s first colonists. As Yeung explains it, “This is experimental in the truest sense of the word, which is incredibly exciting.”

Kidney-on-a-chip project co-lead, Edward Kelly, is an Associate Professor in the University of Washington (UW)’s School of Pharmacy and directs the EDGE microphysiological systems unit. Co-lead, Jonathan Himmelfarb, holds an Endowed Chair in Kidney Research at the UW School of Medicine, directs the Kidney Research Institute, and co-leads the EDGE Collaborative Research Team (CRT) on Hepatic, Renal and GI Diseases. Terrance Kavanagh, EDGE Science Director, and Elaine Faustman, co-lead of the EDGE Developmental and Reproductive Disorders CRT, co-direct a predictive toxicology group that supported the development of kidney-on-a-chip and continues to support the use of this technology for environmental health research.

UW EDGE’s Catherine Karr featured in The Lancet for her work to address disparities in environmental health

Catherine Karr, Director of EDGE’s Clinical and Translational Sciences Unit, helps a participant in the Home Air in Agriculture; Pediatric Intervention Study (HAPI) use a device to measure airway inflammation at the Yakima Valley Farm Workers Clinic in Toppenish, WA. Photo credit: Lisa Younglove.
A recent profile in The Lancet describes Dr. Catherine Karr, Director of EDGE’s Clinical and Translational Sciences Unit, as “the best of a new breed of physician-scientists that are patient-centered, community-centered, and justice-centered.” The quote comes from Ruth Etzel, Director of the US Environmental Protection Agency’s Office of Children’s Health Protection.

Karr’s research focuses on the ways in which a child’s environment affects their long-term health and development and the disparities that characterize those impacts. Specifically, she has investigated the role of environmental contaminants in the health of children with asthma in Latino farmworker children living in Washington State’s Yakima Valley. Her work brought attention to the role of crop production, emissions from industrial-scale dairy production, and smoke from winter wood stove use in worsening asthma. Currently, she’s studying whether a combination of asthma education and the use of indoor portable air cleaners can improve children’s health.

Karr also leads NEXTGENNS, a project to address wood smoke with the Yakama Nation community and she is involved in the National Institute of Health’s Environmental Influences on Child Health Outcomes (ECHO) consortium. The goal of ECHO is to understand the effects of early life environmental influences, including chemicals and stress, on subsequent child health and development. One of these influences is exposure to lead, a topic of which Karr is an expert, and about which she was recently interviewed by KIRO 7 as part of a story about high levels of lead found in Washington schools.

Another theme that runs throughout Karr’s work is her emphasis on outreach. As she points out in The Lancet profile, “We are still not very good at communicating the pay-off of healthy environments on population health to key decision makers in government. Doctors also need to know more about the role of environment in their patient's health. It is both part of prevention and sometimes cure.”

Karr holds a masters degree in toxicology, a medical degree, and a Ph.D. in epidemiology. She is currently a Professor of Pediatrics and Environmental and Occupational Health Sciences at the University of Washington as well as Director of the NW Pediatric Environmental Health Specialty Unit. Read the full profile of Karr in The Lancet here.

UW EDGE Center co-organizes a trans-disciplinary workshop to discuss the future of local fisheries

By Victoria Pinheiro, Nereus Program Strategic Communications Lead, original story published here.

Nereus Program Policy Director Yoshi Ota, and Swinomish tribal elder Larry Campbell converse during a Fish and Future breakout session. Photo Credit: Colby K. Neal.
On April 3rd, 2018, tribal representatives, students, and academics gathered to discuss a pressing issue for coastal indigenous communities of the Pacific Northwest: the future of the fish they’ve relied on since time immemorial. Climate change, pollution, and toxic algae blooms are threatening the survival of salmon and shellfisheries relied upon by both the Native American tribes in Washington State and First Nations in British Columbia. These fisheries represent significant nutritional and economic value to both peoples, and they also have deep running cultural importance. All three aspects were considered during the gathering entitled Fish and Future held at the University of Washington’s wǝɫǝbʔaltxʷ (“Intellectual House” in the Luhshootseed language). The building was inspired by the traditional Long Houses of the Coastal Salish people, with lofty cedar walls and beams overlaid with indigenous artwork. Traditional song and drumming filled the space as Willard Bill Jr, Cultural Director of the Muckleshoot Tribe and his son, Justice Bill, delivered a welcome prayer to commence the meeting. The words, music, and setting created an unrivaled sense of place and purpose. “We are here,” Bill told us, referring to the Indigenous People of the Pacific Northwest. “We are alive and strong. We are from here – we’ve never been from anywhere else.”

Justice Bill and his father, Cultural Director of the Muckleshoot Tribe Willard Bill Jr., lead welcome prayer to commence the meeting. Photo Credit: Colby K. Neal
The environmental threats to the fisheries relied upon by 37 million coastal indigenous populations are born from the actions of developed nations, making food sovereignty for these groups a pressing issue of global equity. “Forty-one percent of First Nations people in BC experience food insecurity,” explained Dr. Laurie Chan. “Ninety-one percent of people surveyed want to eat more traditional food but simply don’t have access to it any longer. This is an issue for a number of reasons; one being because diets are healthier when more traditional food is eaten than market food.” And conditions are likely to get worse, Chan explained. “Under the influence of climate change, projections show a considerable decline of fish stocks along the coast of British Colombia. This could result in a decrease of healthy food and essential nutrient intake and also has a negative impact on the well being of the people’s culture.” In other words, this isn’t just a loss of nutrients; it’s a loss of heritage.

Dr. Sara Jo Breslow of the University of Washington's Center for Creative Conservation led workshop participants in an interactive reading from her play The Last Best Place which was created using transcripts from interviews with local farmers, scientists, and tribal members. Photo Credit: Colby K. Neal
The format of the gathering was innovated to inspire and generate creative thinking about what needs to be done. Academic talks and presentations were interspersed with a film screening of Colby K. Neal’s Broken Fish and an interactive reading from The Last Best Place, a play about salmon, people, and habitat by Dr. Sara Jo Breslow. Breslow’s play arranges the words of tribal members, farmers and scientists taken down during anthropological interviews to tell the story of the human-salmon ecosystem in the Pacific Northwest. She gathered eleven members of the audience around a table and handed them each a script. “But there are days when I wonder, if all what they really want, is control over what you do? Or do they really want to save fish?… And you know, you might not understand this, but my family’s been here for 110 years. That’s a long time. This land is my heritage and I intend to pass it on to my grandchildren,” read one participant, speaking the words of a farmer frustrated by restoration regulations. “It staggers me that someone could say that to, say, members of an Indian tribe,” replied another participant, speaking the words of a tribal staff person. “That, you know, to – to whom one hundred and ten years is not even a blink of an eye.” Participants were able to experience the perspective of the character they played, regardless of how different it was from their own, and speak the words of another human with feeling and empathy.

The morning’s proceedings inspired a generative planning session in the afternoon. Participants proposed creating a task force to align ongoing efforts, and to integrate Indigenous and western-based sciences to develop strategic adaptation and action plans. “When we take inquiry back to the tribal community, we get history, community, and culture along with the research objective,” said Swinomish tribal elder Larry Campbell. The meeting ended on a note of progress and excitement about new plans and initiatives inspired by the day’s dialogue. “All of the organizations here presumably started with a first meeting,” said Dr. Elaine Faustman. “I know this meeting will be the start of something new for many of you.”