SPECIFIC AIMS: for Proposed Research Study
Overview. The broad aims of this research are to increase multi-disciplinary understanding of the risks at the Agbogbloshie electronic waste site in central Accra, Ghana, and to use study findings to inform evidence-based implementation activities and policy options at the national, regional, and international levels. The specific scientific goals include: 1) characterize work-related, time-varying, job-specific exposures of electronic waste recycling workers at the Agbogbloshie site, and assess biological markers of dose, to metals, organic compounds, and markers of combustion products; 2) provide estimates of potentially increased lifetime, work-exposure-associated cancer risks; and, 3) evaluate associations of exposures with measures of acute and chronic respiratory morbidity in workers. These scientific goals are fully integrated with an overarching goal to rapidly strengthen the capacity of the West African region to address critical environmental and occupational health (EOH) challenges. The proposed Agbogbloshie study is intended to provide a setting for high-quality research training in EOH for doctoral and masters students, postdoctoral fellows, and junior faculty from academic institutions of the several participating countries to accelerate thusly the development of a robust West African EOH hub.
Specific Aim 1. To enroll 132 study participants over a 12-month period: 92 Agbogbloshie waste recycling workers, including at least 40 new hires (an inception cohort), and including at least 52 workers (‘burners’) [note: the first job assignment of many new hires is as a burner] whose primary job responsibility is to manage the burning of electronic equipment, as well as a group of 40 'controls' residing in MadinaZongo, an area of greater Accra more than 10 km from Agbogbloshie many of whose residents are known to be quite similar to the waste workers with respect to age, length of time residing in the greater Accra area (and region of the country from where they moved), socioeconomic position, and religion and culture. Each of the 132 participants will have exposures and health status assessed at three points in time: baseline, at 12 months post-enrollment (estimated minimum n of 100 remaining in the study), and at 24 months post-enrollment (estimated minimum n of 70).
Specific Aim 2. To collect and analyze, at 0-, 12-, and 24-months for each participant, 1) biological samples (blood and urine) for a) metals, b) organic compounds including flame retardants, polycyclic aromatic hydrocarbons (PAHs), dioxin-related compounds, and, 2) personal air monitoring, through a combination of real-time measurements and analysis of size-specific samples collected on filters, including markers of combustion products: PM 2.5 and formaldehyde, as well as quantitative analysis of filter samples for the same suite of organic compounds being evaluated in blood samples, as well as for elemental carbon. The results of biological and filter samples will be used to estimate potentially increased lifetime, work-exposure-associated cancer risks using standard methodologies.
Hypotheses: 2.1) Biomarkers of exposure to both metals and to organic compounds will vary across worker classifications. Specifically, those actively processing electronic waste (especially those primarily doing burning, and, to a lesser extent, those primarily doing dismantling) will have greatest exposures; 2.2) Metal and organic compound exposure biomarker levels will vary over time, even within the same participant. 2.3) Variation in metals exposures can be explained by differences in concentration and bioavailability of metals in soil, dust, food, and water collected from an individuals’ work site and home; 2.4) Variation in organic compound exposures can also be explained by differences in concentration and bioavailability across multiple media, though for those actively processing electronic waste, especially if involved with burning, exposures will be predominantly explained by work activities; 2.5)As compared to the control population, working at the Agbogbloshie site, and, especially, working as a burner on the site, will be associated with significantly increased estimated lifetime cancer risk.
Specific Aim 3. To collect respiratory health status data at 0-, 12-, and 24-months for each participant. Health measures to be assessed: respiratory symptoms, reported frequency of upper and lower respiratory infections, pulmonary function assessed by hand-held spirometer, interference with ability to work or with other activities of daily living, medication use, and, health services utilization.
Specific Aim 3a. To evaluate -- while controlling for covariates such as previous history of respiratory illnesses, gender, age, tobacco use, current or historical use of biomass fuels for cooking in domiciles, potential respiratory hazards at previous or current (among controls) work environments, body mass index, religion, socioeconomic position -- whether working on the Agbogbloshie site, and especially working as a burner on the site, and whether quantified exposures to potential respiratory hazards (PM 2.5, elemental carbon, PAHs) are associated with differences in respiratory health status.
Hypotheses: The covariate-adjusted probability and severity of adverse respiratory conditions or outcomes will be higher: 3a.1) among workers at the Agbogbloshie as compared to the control participants, and, 3a.2) among current burners as compared to those on other jobs at Agbogbloshie, and, 3a.3) among those with higher quantified exposure to potential respiratory hazards. 3a.4) Among those who went from being a burner to a different job at Agbogbloshie over the course of their participation in the study, measures of exposure will be lower and measures of respiratory status will show improvement at the newer job as compared to the job as a burner.
Specific Aim 3b. To investigate interactions between occupational exposures to respiratory hazards at Agbogbloshie and 1) current or historical use of biomass fuels for cooking in domiciles, 2) tobacco use, 3) pre-employment history of diagnosis of, or symptoms consistent with, asthma or tuberculosis, in producing adverse respiratory health effects.
Hypotheses: 3b.1)Those working in Agbogbloshie, and, especially, those working as burners, with 1) a substantial current or historical exposure to biomass fuels used for cooking in domiciles, or, 2) substantial tobacco use, or, 3) pre-employment history of diagnosis of, or symptoms consistent with, asthma or active tuberculosis, will demonstrate higher probability and/or more severe adverse respiratory outcomes associated with their work-related exposures as compared to those in the same jobs without histories of such additional risk factors.
SPECIFIC AIMS for Proposed Research Training
Below are the unified set of research training-related Specific Aims for the linked U01 and U2R grants, slightly modified to reflect the further consolidation of the plans for the proposed central study of Agbogbloshie e-waste workers. The numbering for these specific aims begins with the letter "T" for training to avoid any confusion with the research study specific aims above.
Specific Aim T1. Pursue innovative multidisciplinary scientific research studies with high public health relevance and likely significant policy implications addressing key EOH threats in the informal sectors of participating countries in West Africa. Specific Aim T1A. Finalize key hypotheses and suitable approaches to data collection for studies in three identified regional priority areas, electronic waste, informal gold mining, and transportation-related ambient air pollution. Comment:This specific aim has been fully accomplished for the Agbogbloshiee-waste study as reflected in the research specific aims above and the details presented in the ‘Proposed Research’ section further below in this application. Substantial progress has been made in the planning of pilot studies addressing informal gold mining, addressing transportation-related ambient air pollution, as well as further e-waste comparative studies of Agbogbloshie to other e-waste sites in West Africa, as described for all further below. Specific Aim T1B: Organize the approach to these studies so as to assure the carefully mentored, interactive participation of trainees at various levels (post-docs, doctoral students, etc.) from multiple complementary disciplines in all study stages (conceptualization; design; detailed protocol; data collection, management, and analysis; manuscript preparation, etc.).Comment:A detailed plan of training approach has been settled upon for theAgbogbloshie e-waste study, and is described further below. Planning for training associated with the gold mining, ambient air pollution, and comparative e-waste studies are in formation with the expectation that approaches will be quite similar to the approach for the Agbogbloshiee-waste study.
Specific Aim T2. Increase sustainable capacity to conduct EOH research in West Africa through: Specific Aim T2A. Strengthening of existing, and launching of new, Masters and doctoral EOH research training programs through a combination of: i) sharing of existing curricula; ii) cross-country curriculum development workshops; iii) consultation by faculty from well-established degree programs to new or recently launched programs. Specific Aim T2B. Enhancing training of West African postdoctoral fellows organized into interdisciplinary, inter-country project teams spending 4 months on the UM or McGill campus, followed by 6 months in WA home countries executing research projects in the informal sector. The months at UM/McGill will include:i) mentoring by teams of NA and WA senior scientists; ii) customized courses in the responsible conduct of research, interdisciplinary research, advanced statistical methods, scientific writing, and use of technology and information resources; iii) auditing other relevant courses; iv) presentations on planned research projects. Specific Aim T2C. Implement innovations in mentoring and team-building. A key innovation will be WA senior scientists will reside on the UM/McGill campus for the 1st two months the postdoctoral teams are there. Specific Aim T2D. Offer similar training at UM/McGill for WA doctoral students teams.
Specific Aim T3: Conduct ongoing monitoring and evaluation (M & E) of progress of the grant: using qualitative and quantitative methods and jointly developed metrics, assess: a) successes, and any barriers to progress; b) quantity and quality of research training; c) administrative & management abilities; d) cross-country collaborations; e) academic/governmental collaborations. Make changes in approach and allocation of resources as indicated. Use long-range summative evaluation to monitor participants’: peer reviewed publications, submitted research grant applications, successful grant applications, and career trajectories. Monitor broader impacts on the participating institutions’ research environments, including faculty retention and promotion rates, and overall institutional productivity measures such as mean annual number of peer-review publications and number and size of grants per faculty member.