Environmental and Social Determinants of Health Group

National Institute Of Environmental Health Sciences

Investigators

Linked publications, trials & patents

Abstract

My research program continues to investigate factors in the physical and social environment believed to affect chronic disease conditions related to cardiometabolic health. Capable of informing health promotion and disease prevention efforts, our novel research is grounded in the socioecological framework and postulates that environmental (e.g., temperature) and social conditions (e.g., job strain), including interpersonal relationships (e.g., household dysfunction), can influence individual-level behaviors (e.g., sleep) and other risk factors that impact health. As an example of original research regarding environmental exposures in relation to sleep health, we investigated the relationship between indoor bedroom allergen exposure and sleep outcomes using data from the National Health and Nutrition Examination Survey. Elevated pet allergens were associated with trouble sleeping among Hispanic/Latino individuals, and fungal allergens were linked to sleep disorders and increased sleep medication use, especially among women and individuals with moderate socioeconomic status. Moreover, our literature review on artificial light at night (ALAN) exposure synthesized findings from 2000 to 2024, identifying associations with Type 2 diabetes mellitus (T2DM) and the role of sleep, physical activity, and dietary behaviors as mediators. We emphasized the need for future research to consider light characteristics like timing, wavelength, and individual sensitivity. Additionally, I contributed to an American Thoracic Society workshop and resulting report that highlighted the negative impact of environmental hazards on respiratory and sleep health, recommending multi-level intervention strategies. I also contributed to a consensus statement with a multidisciplinary panel where we highlighted the heterogeneity of obstructive sleep apnea and treatment responses. We called for future research that incorporates life course and holistic perspectives, aligning with the priorities of the U.S. Department of Health and Human Services. Using National Health Interview Survey data, we found that neighborhood walkability was associated with sleep health in that places to relax and pedestrian access were associated with better sleep health, while unsafe walking conditions were associated with worse sleep health. We also found – in the NIEHS-funded Sister Study – that closer proximity to greenspace was generally associated with better sleep health; however, women living in lower-income neighborhoods in closer versus further proximity to greenspace reported poorer sleep. This research program has also illuminated how various social determinants of health (SDOH) are associated with sleep health. First, we investigated occupational factors in relation to cardiovascular outcomes. Results showed that compared to adults working in professional/management positions, adults working in laborer positions were less likely to have ideal cardiovascular health – a composite measure defined as never/former smoking; recommended body mass index; meeting physical activity and sleep duration recommendations; and no prior diagnosis of dyslipidemia, hypertension, or diabetes/pre-diabetes. Additionally, the relationship between laborer occupation and lower cardiovascular health was stronger among adults aged 50 years and older than adults younger than 50 years old. We also studied how a range of addressable social stressors were cumulatively associated with sleep health among Black women using data from the NIEHS-funded Study of Environment, Lifestyle and Fibroids. Multiple stressors were associated with poorer sleep health, which can inform future interventions. In a methodological, original research study using Sister Study data, we evaluated – due to prior research revealing differences in reporting behaviors – the reliability of self-reported versus objectively measured BMI across educational and racial along with ethnic groups. Despite some variation in measurement error that was higher among Black and Latina women with higher educational attainment compared to White women and women with lower educational attainment, we found strong agreement in BMI classification, supporting the validity of self-reported data in this cohort. These data can inform future studies. Furthermore, we published two book chapters – one that summarizes the environmental determinants of sleep health and one that discusses sleep as a modifiable, essential pillar of health as touted by lifestyle medicine. Moreover, aligned with the NIEHS critical research area of emphasis related to environmental health disparities (as described in the 2025-2029 strategic plan), my group published a commentary to help guide environmental health disparities scientific inquiry. We emphasized the systematic inclusion of "why" questions in environmental epidemiology that help identify fundamental determinants/causes. This perspective promotes deeper, more actionable science that centers solution-building and trust with communities—shifting the field from observational to transformative approaches that address environmental health disparities. We have employed this framework in our aforementioned investigations. In summary, the research published from this research group collectively highlight the importance of addressing environmental conditions and social determinants of health to improve sleep and subsequent cardiovascular health. The findings also underscore the need for additional research and targeted interventions that promote salubrious environments in hopes of improving both sleep health and cardiovascular health.