Graduation Date

Summer 8-12-2022

Document Type


Degree Name

Doctor of Philosophy (PhD)


Environmental Health, Occupational Health, and Toxicology

First Advisor

Dr. Jesse E. Bell

Second Advisor

Dr. Eleanor G. Rogan, Ph.D.

Third Advisor

Dr. Jill A. Poole, MD

Fourth Advisor

Dr. Yeongjin Gwon, Ph.D.

MeSH Headings

climate change, heat waves, air pollution, pollen, mold


Human exposure to environmental hazards is associated with a variety of preventable adverse health outcomes. As the environmental health risks result from the complex interaction between hazard, exposure, and susceptibility, these exposure-outcome associations are heterogeneous across the population. Improving environmental health literacy by advocating evidence-based environmental risk communication could play a role in reinforcing protective behavior against environmental hazards. The use of public health surveillance systems to assess the exposure-response associations is one of the effective ways to quantify the environmental health risks. However, there are several gaps in effectively quantifying environmental health risks. This dissertation aims to address a few gaps in the context of climate change, heat waves, and air pollution, using public health surveillance systems.

This dissertation quantified the acute and direct health outcomes associated with environmental exposures (outdoor temperature and air quality) using syndromic surveillance and health care utilization databases. The environmental exposures in this dissertation are ascertained using ambient measurements. We followed intermittent time series (controlled and uncontrolled) design to assess the exposure-outcome associations to minimize potential systematic bias. We applied this strategy in three use cases: 1. Climate change, 2. Heat waves, and 3. Air pollution.

In the first use case, we quantified the rate of heat-related illness (HRI) morbidity risk attributable to current and future climate change. Following this, the second use case compared the sensitivity of heat wave definitions that could be effective in minimizing HRI emergency department visits. The third use case estimated the joint association between ambient air pollutant mixtures and pediatric asthma exacerbations. Additionally, in the third use case, we identified specific air pollutants that contributed to higher weights associated with pediatric asthma exacerbations. The findings from this dissertation using public health surveillance systems are aimed to support environmental health literacy among communities and public health policy change. Our results do not imply causal relationships due to the study design and unmeasured biases that influenced our results. Further studies that consider confounding due to susceptibility factors and robust exposure measurements are needed to advocate to build a strong case for environmental health policy changes.

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