
Exploring Social, Economic and Environmental Determinants of Health

BTC 20 IS THE 20TH YEAR OF BREAK THE CYCLE!
BREAK THE CYCLE OF
CHILDREN'S ENVIRONMENTAL HEALTH DISPARITIES
20th ANNUAL PROGRAM
A Program of
Break the Cycle of Health Disparities, Inc.

BTC 20 SYMPOSIUM:
CUMULATIVE IMPACTS
Our 2024-2025 20th Annual Break the Cycle of Children’s Environmental Health Disparities Symposium will be on the theme of Cumulative Impacts.
Since the inception of our Annual Break the Cycle program 20 years ago, we have cultivated the interest of students to develop projects to examine the impact of social, economic, and environmental determinants of health on children who grow up in circumstances of social and economic disadvantage.
To date we have had over 200 student projects completed, presented and published that have illustrated the relationships between the lived experiences of vulnerable children and adverse health outcomes.
While the content of each student project demonstrated how to Break the Cycle at any point to reduce children’s health disparities, the accumulated findings from the collection of projects, revealed the relevance of the ecological model embedded in the Cycle of Health Disparities diagram.
The model conceptualized in the Cycle diagram implies an intergenerational perpetuation of the adverse experiences with associated adverse health outcomes, so, breaking the cycle becomes not only an immediate and time-limited interruption, but one that has significant and even profound, long term beneficial consequences.
Furthermore, examining the elements in the framework of the Cycle diagram will reveal the multiple and cumulative factors that result in adverse health outcomes, clearly stated in the Environmental Impact section as a combination of Increased Toxins and Increased Stress as the mediators of the Health Risk Factors, which are likewise, not always found in isolation, but more often than not, manifest as associated co-morbidities that are interactive and synergistic, with cumulative adverse outcomes (see diagram below).

CUMULATIVE IMPACTS
When examining the social, economic, and environmental factors that impact health, it is readily apparent that they do not operate in isolation, but within an ecological framework where disproportionate exposures to pollution and environmental degradation are intimately intertwined with social, emotional, economic, cultural, geographic, and political realities.
When viewed in this relational totality, and in the conceptual Cycle of Health Disparities framework, it is clear that the interactions between the multiple social, economic and environmental determinants of adverse health outcomes are indeed cumulative.
ATSDR defines Cumulative impacts
as the total harm to human health that occurs from the combination of environmental burdens such as pollution and poor environmental conditions, pre-existing health conditions, and social factors such as access to quality healthcare.
EPA defines Cumulative Impacts
as the totality of exposures to combinations of chemical and non-chemical stressors and their effects on health, well-being, and quality of life outcomes.
Chemical stressors
are defined as exogenous environmental compounds. Chemical stressors change or damage living organisms or ecosystems and are released into the environment by waste, emissions, pesticide use, or uses of formulated compounds like pharmaceuticals.
NON-Chemical stressors
are factors found in the built, natural, and social environments including physical factors such as noise, temperature, and humidity and psychosocial factors.
Stressors
are defined as any physical, chemical, social, or biological entity that can induce a change (either positive or negative) in health, well-being, and quality of life.
Chemical and non-chemical stressors can arise from the built, natural, and social environments, which can be collectively referred to as the total environment.
The Built Environment
refers to the artificially constructed surroundings that provide the setting for human activity.
The Natural Environment
encompasses all living and non-living things naturally occurring on Earth.
The Social Environment
includes not only social interactions but factors such as the economy, community, home, school/daycare, demographics, safety, and welfare.
Activities, behaviors, and lifestyle considerations, as well as systems inherent biological factors with genetic and epigenetic elements, interact with the stressors to influence health, well-being, and quality of life.
Health disparities are caused or exacerbated by exposures to environmental pollution and environmental degradation that are disproportionately experienced by disadvantaged and overburdened individuals and communities.
Thus, health disparities are not necessarily related to single agents, but rather to systems challenges produced by the interaction of environmental pollutants with the social and economic factors, resulting in a cumulative adverse impact on the health and wellbeing of vulnerable children.
Our Symposium on Cumulative Impacts will provide context and background on this phenomenon and demonstrate how this operates in our society, and how our understanding and appreciation of the factors that result in the cumulative impact and adverse health outcomes can stimulate creative strategies to Break the Cycle of Children’s Environmental Health Disparities and build a brighter future for all children that will ultimately benefit our society at large.
ATSDR. (2022). Environmental Justice Index Fact Sheet. Retrieved from atsdr.cdc.gov/placeandhealth/eji/docs/eji_fact_sheet.pdf
CAL EPA 2010. Cumulative Impacts: Building a Scientific Foundation.
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Chicago DPH 2023. Chicago Cumulative Impact Assessment – 2023 Summary Report
Coleman, LW, 2021. Cumulative Impact Ordinances Address Environmental Justice. EHS
Daily Advisor
https://ehsdailyadvisor.blr.com/2021/06/cumulative-impactordinances-address-environmental-justice/
DHHS Healthy People 2030, U.S. Department of Health and Human Services, Office of
Disease Prevention and Health Promotion. Retrieved June 10, 2024, from
https://health.gov/healthypeople/objectives-and-data/social-determinants-health
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summaries. https://health.gov/healthypeople/priority-areas/social-determinantshealth/literature-summaries
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EPA. Cumulative Impacts Research: Recommendations for EPA’s Office of Research and Development. U.S. Environmental Protection Agency, Washington, D.C., EPA/600/R-22/014a, 2022.
EPA 2023b. EPA Legal Tools to Advance Environmental Justice: Cumulative Impacts Addendum.
https://www.epa.gov/ogc/epa-legal-tools-advance-environmental-justice
Lee, C. 2021. Confronting disproportionate impacts and systemic racism in environmental
policy. Environmental Law Reporter 51: 10207-10225.
McHale, CM, Osborne, G, Morello-Frosch, R, Salmon, AG, Sandy, MS, Solomon, S, Zhang, L,
Smith, MT, Zeise, L 2018. Assessing health risks from multiple environmental
stressors: Moving from G×E to I×E. Mutation Research/Reviews in Mutation
Research, Volume 775, 2018, Pages 11-20, ISSN 1383-5742,
https://doi.org/10.1016/j.mrrev.2017.11.003.
Morello-Frosch, R., Zuk, M., Jerrett, M., Shamasunder, B., & Kyle, A. D. (2011). Understanding
the cumulative impacts of inequalities in environmental health: implications for
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Environmental Justice and Cumulative Risks/Impacts. Retrieved from
epa.gov/sites/production/files/2015-02/documents/nejac-cum-risk-rpt-122104.pdf
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Nilsen, F. M., Ruiz, J. D., & Tulve, N. S. 2020b. A meta-analysis of stressors from the total
environment associated with children’s general cognitive ability. International Journal
of Environmental Research and Public Health, 17(15), 5451.
Nilsen FM, Frank J, Tulve NS 2020c. A Systematic Review and Meta-Analysis Investigating the
Relationship between Exposures to Chemical and Non-Chemical Stressors during
Prenatal Development and Childhood Externalizing Behaviors. Int J Environ Res
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Ruiz, J. D. C., Quackenboss, J. J., & Tulve, N. S. (2016). Contributions of a child’s built, natural,
and social environments to their general cognitive ability: A systematic scoping
review. PloS one, 11(2), e0147741.
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Torso, K., A. Walts, T. Davis, R. Dee, S. Jastrow, AND D. Lobdell. Exploring Cumulative
Environmental Impacts on Native American and Alaska Native Community Health
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2023.
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Day 1 Program : April 28, 2025
9:00 AM
Welcome
Abby Mutic PhD, MSN, CNM
Director, Southeast Pediatric Environment Health Specialty Unit
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta
.
9:10 AM
Introduction to Break the Cycle
Leslie Rubin, MD
Director, Break the Cycle Program
Morehouse School of Medicine, Atlanta GA
.
9:30
The Effect of Prematurity on Early Academic Readiness and Successful Education Outcomes
Student: Chloe Brink
-
Mentor: Dr. Michael Msall
University of Chicago
9:50 AM
Sprouting Readers Program and its impact on Nutritional Knowledge for children living in Food Desserts
Kevin Li, Eva Li, Mica Einhorn, Janet Ma
-
Mentor: Joan Wilson
Emory University
10:10 AM
A Youth-Centered Approach to Addressing Poor Air Quality Near a School in Washington Heights, New York City
Nina Flores, Celia Cacho, Jayden Reynoso and Juniesky Rodriguez
-
Mentor: Stephanie Lovinsky-Desir
Columbia University
10:30 AM
HEALTH BREAK
30 Minutes
-
.
11:00 AM
PFAS and Cardiovascular Health in at-risk Youth
Jennifer Arzu
-
Mentor: Joseph M. Braun
Brown University
11:20 AM
Evaluating the Effects of Utility Water Access on Waterborne Diseases in Children in Appalachian Tennessee
Priscilla Owusu-Mensa
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Mentor: Md Rasheduzzaman
East Tennessee State University
11:40 AM
The socioecology of emerging and existing infections in U.S. children—Impact on child health and wellness in the period post-global pandemic
Lilly Immergluck, MD, MS, FAAP
KEYNOTE SPEAKER
.
12:10 PM
LUNCH BREAK
90 MINUTES
Break for Lunch
.
1:30 PM
Lead Screening Rate Disparities in New York City Children
Shahed Mohamed
-
Mentor: Hannah Thompson
Icahn School of Medicine at Mount Sinai
1:50 PM
Bridging the Gap: Climate Change, Water Quality, and Child Health in Flint, Michigan
Dionna LaTrice Brown
-
Mentor: Robert Wahl
Michigan State University
2:10 PM
Extreme Heat and Adverse Birth Outcomes in Rural Communities in Texas and Arkansas
Tyson Murray
-
Mentor: Kevin Lanza
University of Texas Health Science Center at Houston
2:30 PM
HEALTH BREAK
30 MINUTES
Take a break
.
3:00 PM
Access to Healthcare, Neighborhood Violence, and Socioeconomic Status & the Association with Children’s Physical, Mental, and Behavioral Health
Fiza Patel
-
Mentor: Lester M. Arguelles, MS, PHD, Laurel Berman PhD
University of Illinois at Chicago
3:20 PM
Understanding Students’ Perspectives on Environmental Health in an EJ community
Crystal Stephens
-
Mentor: Amy Hutson Chatham
The University of Alabama at Birmingham
3:40 PM
Photovoice project in Wyandanch to highlight environmental challenges and create a sense of advocacy that allows communities to advocate for change
Oluwapelumi J Soyemi, MPH
-
Mentor: Cappy Collins
Docs for Tots
4:00 PM
How do we achieve health equity for children in 2025?
David Wood MD MPH
KEYNOTE SPEAKER
.
4:30 PM
CONCLUSION
Leslie Rubin, MD
Director, Break the Cycle Program
Morehouse School of Medicine, Atlanta GA
.
5:00 PM
POSTER SESSION
Emory University's
Nell Hodgson Woodruff
School of Nursing
5-7PM
.



Symposium on Cumulative Impacts
Tuesday April 29, 2025
8.00am – 1pm
8:00 am
Leslie Rubin MD
Welcome and Introduction
8:10 am
Andrew Geller PhD
Advancing Consideration of Cumulative Impacts
8:40am
Jeremy Sarnat ScD
Environmental Health, Exposomics and what Einstein Got Wrong
9.10am
Take a break
HEALTH BREAK
9:30 am
Stephanie Eick PhD MPH
Cumulative impacts of environmental chemicals and social stressors on maternal-child health
9.50 am
Amy Sharma PhD
Working with South Fulton and South DeKalb Counties in Atlanta to document impacts and empower communities for change
10.10am
Shoshanna Kasle DrPH
Neighborhood Conditions and Cumulative Impact on Communities
10:30AM
Andrew Geller PhD
Charge to Workshop Groups
10:40 am
-
Health Break and Breakout Workgroups
11.30 am
Report back and discussion
Workgroup Reports
11:50 AM
Leslie Rubin MD
Conclusion and Ideas for Future
12:00 PM
-
ADJOURN
Conference and Symposium Speakers
Lilly Immergluck, MD, MS, FAAP
The socioecology of emerging and existing infections in U.S. children—Impact on child health and wellness in the period post-global pandemic

Professor, Department of Pediatrics, Section of Infectious Diseases
University of Chicago
Lilly Immergluck is a pediatrician, infectious disease specialist and physician scientist who studies the impact of antibiotic-resistant infections and vaccine preventable illnesses in children. As a pediatric population health service, clinical, and translational researcher, she has spent over three decades addressing ways to prevent the transmission of infectious diseases which disproportionately impact medically underserved communities. Her focus has largely been on topics tied to prevention of infectious diseases, which disproportionately impact medically underserved communities. She applies spatial statistical models to examine how socioecological conditions, rooted in geographical place and influenced by time, lead to the spread of infection. She has served as principal investigator of numerous clinical, translational and therapeutic trials (including Phases 1-4 vaccine trials), emphasizing ways to include underrepresented populations in clinical research; she currently serves as director of the University of Chicago’s Vaccine Center of Excellence.
David Wood MD MPH
How do we achieve health equity for children in 2025?

Dr. David Wood completed his MD and MPH at UCLA and then pursued a residency in both Pediatrics and Preventive Medicine/Public Health. He has dedicated his professional career to developing, implementing and studying models of care for children and families with economic disadvantage and both physical and intellectual disabilities. He has published over 120 peer-reviewed publications and over 50 reports and book chapters. For over 20 years at UCLA and at the University of Florida, he developed and managed creative outreach programs for homeless children and families. In 2003 he founded and ran for 10 years the JaxHATS transition clinic, which has supports the healthy transition of youth with complex medical conditions and physical and intellectual disabilities. In 2014 he became Chair of Pediatrics at East Tennessee State University where he also ran the adolescent and transition clinical program. He currently directs Global Health Program for the ETSU College of Medicine. His current research focus is interventional research on positive youth development among indigenous Kichua youth in Ecuador.
Shoshanna Kasle DrPH
Neighborhood Conditions and Cumulative Impact on Communities

Shoshanna Kasle, DrPH, is the Director of Strategy and Operations at the International Society of Urban Health. She is a public health professional with a passion for exploring how social drivers, such as access to quality education, safe and affordable housing, childhood poverty, and others, impact the ability for everyone to live healthy lives. Previously, she was Program Director at the City Health Dashboard, leading a team of population health and urban policy experts, epidemiologists, and data scientists to bring 40+ measures of health outcomes, health determinants, and health equity at the city and neighborhood level to over 900 U.S. cities. In this role, she also provided technical assistance to city governments and NGOs to use the data to inform policy and programming and to local communities to advocate for their own health and well-being. She has extensive experience in monitoring and evaluation, data translation, developing cross-sectoral partnerships, leading programs, stakeholder management, and cross-systems strategy to improve health outcomes. Her career has spanned academia, primary care, community development, and impact investing, among other areas of focus. Shoshanna received her DrPH from the Harvard T.H. Chan School of Public Health in May 2018 and her MPH in Health Promotion from Columbia University Mailman School of Public Health in 2012.
Amy Sharma PhD
Working with South Fulton and South DeKalb Counties in Atlanta to document impacts and empower communities for change

Amy Sharma, PhD, is the Executive Director of Science for Georgia, a non-profit dedicated to engaging scientists and the community in productive dialogue. Sci4Ga bridges the gap between scientists and the public through training, outreach, and advocating for the responsible use of science in public policy. Her career has spanned across industry, academia, and government. She was VP of Product for Prediko, a start-up that was successfully acquired by United Technologies Corp. She spearheaded the development of the big data vertical at GTRI, was an Assistant Professor in Medical Physics at the University of Western Australia, an Assistant Program Manager for the National Science Foundation, and a AAAS Science and Technology Policy Fellow.Dr Sharma’s PhD is in Biomedical Engineering from Duke University. She enjoys difficult challenges, jobs with overly long titles, communicating scientific and technical ideas to non-scientists, performing science stand-up comedy, sewing, and smoking various foods.
Stephanie Eick, PhD MPH
Cumulative impacts of environmental chemicals and social stressors on maternal-child health

Stephanie Eick is, PhD MPH is an environmental and reproductive epidemiologist. Her research focuses on the health effects of environmental chemical and non-chemical (i.e., psychosocial) stressors during pregnancy. She has a particular interest in chemical mixtures, as well as understanding how non-chemical stressors can amplify the harmful effects of chemicals. She is also interested in biomarkers of stress response, such as oxidative stress and inflammation, and better understanding the biological mechanisms leading to adverse pregnancy and child health outcomes. Her research has been funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute of Environmental Health Sciences (NIEHS). Dr. Eick is also a member of the Scientific Advisory Committee on Chemicals, which provides independent scientific advice, information and recommendation to the United States Environmental Protection Agency (US EPA).
Jeremy Sarnat ScD
Environmental Health, Exposomics and what Einstein Got Wrong

Associate Professor, Rollins School of Public Health and Deputy Director of the HERCULES Exposome Research Center at Emory University
Dr. Sarnat is an air pollution researcher whose work focuses primarily on characterizing exposures to air pollution in various populations, in particular panels of cohorts with elevated exposures to traffic-related air pollution. Much of his research examines how exposure science informs environmental epidemiology; the impact of exposure misclassification and confounding on air pollution epidemiologic findings; and the development and application of molecular levels measures of air pollution exposure and response using novel high resolution metabolomics platforms. Dr. Sarnat is the current Deputy Director of the HERCULES Exposome Research Center and recently dismissed Chair of EPA's Clean Air Scientific Advisory Committee (CASAC). In this talk, he will discuss the field's shift toward a more holistic understanding of environmentally mediated disease.
Andrew Geller PhD
Advancing Consideration of Cumulative Impacts

Andrew Geller recently retired as a Senior Science Advisor in EPA’s Office of Research and Development Andrew was the editor-in-chief of EPA’s Interim Cumulative Impacts Framework and was the primary author of EPA’s Environmental Justice Research Roadmap. As Acting and Deputy Director of ORD’s Sustainable and Healthy Research Program, Andrew incorporated EJ and multimedia assessment into ORD’s research portfolio. His research includes the development of community and tribal decision support tools, the impacts of environmental exposures on older adults, and neurotoxicological assessments of the impacts of environmental exposures on visual development and function. Andrew received his undergraduate degree from the University of Pennsylvania and earned his Masters degree and PhD in Cognition and Perception Psychology at the University of Michigan.
Meet the BTC 20 Trainees
We are inviting students who have poster presentations that address children's environmental health and children's health disparities to apply to present their posters at the
20th Annual Break the Cycle of Children's Environmental Health Disparities Program
Monday April 28 from 5-7pm
at Emory University's Nell Hodgson Woodruff School of Nursing
Getting to the Conference
The Conference, Poster Session, and Symposium
Nell Hodgson Woodruff School of Nursing
1520 Clifton Road Atlanta, GA 30322
Parking
The Michael Street Visitor Parking Deck located at
550 Houston Mill Road, Atlanta 30322
Parking validation will be provided.
More information about getting to Emory can be found here:


Online Attendance
Children who grow up in an environment where their parents are stressed by
job insecurity,
income insecurity,
housing insecurity,
and food insecurity,
and live in an environment where the air they breathe is polluted,
and the food they eat is not nutritious,
and the houses and spaces where they live are ill-kept, crowded and with limited access to greenspace,
and their schools are old and teachers are tired, so their education is less than optimal,
and they have limited access to quality healthcare,
they are more likely to suffer from stress, which cumulatively adversely affects their physical and mental health and well-being, and dims their aspirations for a promising future for themselves and for their children.
This latter scenario can be conceptualized in an intergenerational Cycle of Health Disparities

About the
Break the Cycle Program
Project Guidelines
-
University students from all disciplines are invited to develop projects that creatively address social, economic, and environmental factors that adversely affect the health of children. Students are required to identify a mentor in their university departments to monitor and guide their projects.
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All applications are evaluated based on a focus to the cycle of environmental health disparities, the quality of the proposal, novelty, feasibility, and potential for sustainability. There are a limited number selected for full participation in the program each year.
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During the project period there are monthly conference calls to support the progress of the research projects, share ideas and assure that the project is on track and consistent with the spirit of the Break the Cycle concept.
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At the end of the project period, students are required to present their projects at a conference which will be open to the public and includes a keynote speaker of national stature. Conference date will be April 2024
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Students write papers on their projects which are submitted for publication in an international journal as a monograph of the Break the Cycle projects.
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We look froward to following the careers of the students and to remain in contact to monitor the impact of their participation in the Break the Cycle Program on their academic or professional careers.
The Break the Cycle Program focuses on raising awareness of children's environmental health disparities and on cultivating future leaders.
Desired Outcomes
To inspire students from a variety of academic disciplines to explore the relationship between adverse social, economic and environmental factors and the health and development of children and to creatively generate strategies to address the challenges
To collaborate with an interdisciplinary team of academic leaders from different universities and colleges to creatively examine the broader landscape of this topic
To promote leadership among students
To encourage faculty of our university partners to promote academic interest and social awareness of Children’s Environmental Health Disparities.
Each year, students and faculty from a variety of colleges and universities participate in developing projects that will
Break the Cycle of Children’s Environmental Health Disparities
to promote health equity for all children.
The students present their projects at a national conference and the results are published in international journals.
Since its inception in 2004, Break the Cycle (BTC) has partnered with over 80 university departments across 21 States in the US, as well as from 6 countries in Latin America and 2 countries in Africa, and has supported research for over 200 trainees. Annual BTC trainee projects are published in international journals and a book series on public health. Alumni of the BTC program rate their mentored research experiences highly and many pursue careers related to their Break the Cycle projects.
Environmental Health Disparities
Children who grow up in circumstances of social and economic disadvantage are at greater risk for exposure to adverse environmental factors and are more likely to suffer adverse health and developmental consequences. Break the Cycle supports an interdisciplinary set of student-driven research projects that explore the environmental, economic and social factors that adversely affect children’s health and creatively develop strategies to promote the health of children and, thereby, Break the Cycle of Children’s Environmental Health Disparities.
About the Program
Students are required to work with academic mentors from their respective university programs to submit a proposal on how they would develop a project to Break the Cycle. All proposals will be reviewed, and a limited number will be selected based on relevance to the cycle of environmental health disparities, creativity, feasibility, and strength of the project plan.
Those selected will have the opportunity to work with the Break the Cycle faculty and other students from around the country and internationally, to see the project to completion and present their research results and findings at an annual conference in Atlanta scheduled for the spring of 2025.
There will be monthly conference calls to review projects and provide perspectives and guidance on the projects. During these conference calls, faculty and students will have the opportunity to communicate and collaborate with their counterparts in other disciplines at other universities.
Students will also be required to write a scientific paper on their project which will be published in an international peer-review journal as well as a chapter in a book.
Who Can Apply
Students from all disciplines and training levels are encouraged to apply. This includes undergraduates, graduate students, medical residents, and fellows.