Application of the Public Health Exposome Framework to Estimate Phenotypes of Resilience in a Model Ohio African-American Women’s Cohort

  • Patricia Cifuentes
  • John Reichard
  • Wansoo Im
  • Sakima Smith
  • Cynthia Colen
  • Carmen Giurgescu
  • Karen Patricia Williams
  • Shannon Gillespie
  • Paul D. Juarez
  • Darryl B. HoodEmail author


We report integration of the United States Environmental Protection Agency’s (USEPA) United States Environmental Justice Screen (EJSCREEN) database with our Public Health Exposome dataset to interrogate 9232 census blocks to model the complexity of relationships among environmental and socio-demographic variables toward estimating adverse pregnancy outcomes [low birth weight (LBW) and pre-term birth (PTB)] in all Ohio counties. Using a hill-climbing algorithm in R software, we derived a Bayesian network that mapped all controlled associations among all variables available by applying a mapping algorithm. The results revealed 17 environmental and socio-demographic variables that were represented by nodes containing 69 links accounting for a network with 32.85% density and average degree of 9.2 showing the most connected nodes in the center of the model. The model predicts that the socio-economic variables low income, minority, and under age five populations are correlated and associated with the environmental variables; particulate matter (PM2.5) level in air, proximity to risk management facilities, and proximity to direct discharges in water are linked to PTB and LBW in 88 Ohio counties. The methodology used to derive significant associations of chemical and non-chemical stressors linked to PTB and LBW from indices of geo-coded environmental neighborhood deprivation serves as a proxy for design of an African-American women’s cohort to be recruited in Ohio counties from federally qualified community health centers within the 9232 census blocks. The results have implications for the development of severity scores for endo-phenotypes of resilience based on associations and linkages for different chemical and non-chemical stressors that have been shown to moderate cardio-metabolic disease within a population health context.


Particulate matter 2.5 μm United States Environmental Protection Agency United States Environmental Justice Screen Low birth weight Pre-term birth Infant mortality Cardiovascular CV Cardiovascular disease Public participatory geographical information system Toxic release inventory facility 



Particulate matter at 2.5 μm


United States Environmental Protection Agency


United States Environmental Justice Screen


low birth weight


pre-term birth


infant mortality


Stambaugh Elwood


South Side Health Advisory Committee




cardiovascular disease


public participatory geographical information system


toxic release inventory


risk management plan

NPL site

national priorities list site



The authors would like to thank the entire Interdisciplinary Cardio-metabolic Exposome Team (ICE Tea) for critical review and comments. This work was supported, in part, by start-up package received from the Ohio State University College of Public Health and US EPA STAR Award RD83927501 (DBH and PDJ). Support was also from a start-up package received from Meharry Medical College for the Health Disparities Research Center of Excellence (PDJ).

Supplementary material

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Copyright information

© The New York Academy of Medicine 2019

Authors and Affiliations

  • Patricia Cifuentes
    • 1
  • John Reichard
    • 2
  • Wansoo Im
    • 3
  • Sakima Smith
    • 4
  • Cynthia Colen
    • 5
  • Carmen Giurgescu
    • 6
  • Karen Patricia Williams
    • 6
  • Shannon Gillespie
    • 6
  • Paul D. Juarez
    • 3
  • Darryl B. Hood
    • 7
    Email author
  1. 1.Department of Evidence and Intelligence for Action, Information Systems for Health UnitPan American Health OrganizationWashingtonUSA
  2. 2.Department of Environmental Health, Risk Science CenterUniversity of CincinnatiCincinnatiUSA
  3. 3.Department of Family and Community Medicine, School of MedicineMeharry Medical CollegeNashvilleUSA
  4. 4.Division of Endocrinology, Diabetes & MetabolismThe Ohio State University Wexner Medical CenterColumbusUSA
  5. 5.Department of SociologyThe Ohio State UniversityColumbusUSA
  6. 6.Martha S. Pitzer Center for Women, Children, & Youth, College of NursingThe Ohio State UniversityColumbusUSA
  7. 7.Division of Environmental Health Sciences, College of Public HealthThe Ohio State UniversityColumbusUSA

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