Project 1: HEAL Study

PM 2.5In the Health Effects Across the Life course (HEAL) study (Project 1), we are assessing environmental health disparities (EHDs) across the life course, with four unique study populations in the Commonwealth of Massachusetts (MA), utilizing health outcomes data spanning from birth to death. Specifically, the Massachusetts Birth Registry (MBR) of more than 600,000 births includes data on birth weight, small for gestational age, and preterm births from 2000 to 2012. Medical records from the Children’s Health Watch (CHW) Boston study site contain longitudinal information on growth throughout early childhood for approximately 6,000 caregiver-children (0–4 years) dyads enrolled at Boston Medical Center’s emergency department or acute clinics from 2005 to 2014. The Massachusetts Department of Public Health has data on cause-specific mortality for all deaths (more than 600,000, over 200,000 cardiovascular) from 2000 to 2012. Lastly, the Coronary Artery Risk Development in Young Adults Study (CARDIA) collected genome-wide methylation data for 800 racially diverse adults at two time points 5 years apart.

In HEAL, we use these data sources and novel statistical methods to estimate health effects associated with chemical stressors or proxies assessed at the individual residence level:

  • black carbon (BC)
  • fine particulate matter (PM5)
  • nitrogen dioxide (NO2)
  • traffic density
  • distance to roadways

We are then examining effect modification by non-chemical stressors, also at the individual residence level, including daily temperatures, noise, green space, and the built environment (neighborhood walkability), along with stressor constructs derived in CRESSH: MAP-EHD related to housing, the neighborhood environment, material hardship, and sociodemographics. This study will identify key factors that can be targeted to mitigate environmentally driven health disparities and is the first of its kind to characterize the impact of chemical and non-chemical stressors on health outcomes at particularly susceptible time points of the life course.


1) Develop innovative statistical methods to estimate health effects associated with a large number of exposures (chemical stressors), accounting for multiple potential confounders and interactions.

2) Examine the association between chemical stressors and environmental health disparities across the lifespan and effect modification by non-chemical stressors and social determinants.

3) Identify epigenetic profiles associated with air pollution exposures in the CARDIA study. Identify which non-chemical stressors and social determinants of health disparities modify these profiles.

Contact: Antonella Zanobetti, Project Lead: