Scholars@Duke
Mercedes A Bravo

Mercedes A Bravo

Assistant Research Professor of Global Health
Duke Global Health Institute

Selected Publications

Spatial Variability in Relationships between Early Childhood Lead Exposure and Standardized Test Scores in Fourth Grade North Carolina Public School Students (2013-2016).

Journal Article Environmental health perspectives · September 2024 BackgroundExposure to lead during childhood is detrimental to children's health. The extent to which the association between lead exposure and elementary school academic outcomes varies across geography is not known.ObjectiveEstimate asso ... Full text Cite

The Association between Long-term PM2.5 Exposure and Risk for Pancreatic Cancer: An Application of Social Informatics.

Journal Article American journal of epidemiology · August 2024 There is a profound need to identify modifiable risk factors to screen and prevent pancreatic cancer. Air pollution, including fine particulate matter (PM2.5), is increasingly recognized as a risk factor for cancer. We conducted a case-control study using ... Full text Cite

Prepubertal exposure to polycyclic aromatic hydrocarbons are associated with early pubertal development onset in boys: A longitudinal study.

Journal Article Journal of hazardous materials · May 2024 ObjectiveTo investigate the effects of polycyclic aromatic hydrocarbons(PAHs) on puberty in boys.Methods695 subjects were selected from four primary schools in Chongqing, China. 675 urine samples from these boys were collected four PAH me ... Full text Cite

Identifying High-Risk ZIP Codes for Childhood Lead Exposure: A Statewide ZCTA-Level Priority List for North Carolina.

Journal Article North Carolina medical journal · March 2024 BackgroundResearch has consistently shown that there is no safe blood lead level (BLL) for children. Despite progress in lead poisoning prevention, lead exposure remains a persistent threat to the health and neurological development of children. T ... Full text Cite

Weekly prenatal PM2.5 and NO2 exposures in preterm, early term, and full term infants: Decrements in birth weight and critical windows of susceptibility.

Journal Article Environmental research · January 2024 BackgroundPrevious studies have observed associations between birth weight and prenatal air pollution exposure, but there is not consensus on timing of critical windows of susceptibility.ObjectiveWe estimated the difference in birth weigh ... Full text Cite

Uncertainty Reduction and Environmental Justice in Air Pollution Epidemiology: The Importance of Minority Representation.

Journal Article GeoHealth · October 2023 Ambient air pollution is an increasing threat to society, with rising numbers of adverse outcomes and exposure inequalities worldwide. Reducing uncertainty in health outcomes models and exposure disparity studies is therefore essential to develop policies ... Full text Cite

Segregation and Childhood Blood Lead Levels in North Carolina.

Journal Article Pediatrics · September 2023 Background and objectivesUsing a local measure of racial residential segregation, estimate the association between racial residential segregation and childhood blood lead levels between the early 1990s and 2015 in North Carolina.MethodsTh ... Full text Cite

Characteristics and Outcomes of Patients Discharged Directly Home From the Pediatric Intensive Care Unit.

Journal Article Journal of intensive care medicine · August 2023 Introduction: Patients admitted to the pediatric intensive care unit (PICU) typically transfer to an acute care floor prior to discharge (ACD). Various circumstances, including rapid clinical improvement, technology dependence, or capacity constrain ... Full text Cite

Long-term air pollution exposure and markers of cardiometabolic health in the National Longitudinal Study of Adolescent to Adult Health (Add Health).

Journal Article Environment international · July 2023 BackgroundAir pollution exposure is associated with cardiovascular morbidity and mortality. Although exposure to air pollution early in life may represent a critical window for development of cardiovascular disease risk factors, few studies have e ... Full text Cite

Assessing community-level exposure to social vulnerability and isolation: spatial patterning and urban-rural differences.

Journal Article Journal of exposure science & environmental epidemiology · March 2023 BackgroundEnvironmental health disparity research involves the use of metrics to assess exposure to community-level vulnerabilities or inequities. While numerous vulnerability indices have been developed, there is no agreement on standardization o ... Full text Cite

Polycyclic aromatic hydrocarbons are associated with later puberty in girls: A longitudinal study.

Journal Article Sci Total Environ · November 10, 2022 The objective of this study is to explore associations between PAH exposures and puberty timing in girls. Beginning in May 2014, 734 girls age 7.2-11.8 years in Chongqing, China, were enrolled in a prospective cohort study. They were followed up every 6 mo ... Full text Link to item Cite

Disparities in air quality downscaler model uncertainty across socioeconomic and demographic indicators in North Carolina.

Journal Article Environmental research · September 2022 Studies increasingly use output from the Environmental Protection Agency's Fused Air Quality Surface Downscaler ("downscaler") model, which provides spatial predictions of daily concentrations of fine particulate matter (PM2.5) and ozone (O ... Full text Cite

Information entropy tradeoffs for efficient uncertainty reduction in estimates of air pollution mortality.

Journal Article Environmental research · September 2022 Implementing effective policy to protect human health from the adverse effects of air pollution, such as premature mortality, requires reducing the uncertainty in health outcomes models. Here we present a novel method to reduce mortality uncertainty by inc ... Full text Cite

Racial residential segregation shapes the relationship between early childhood lead exposure and fourth-grade standardized test scores.

Journal Article Proceedings of the National Academy of Sciences of the United States of America · August 2022 Racial/ethnic disparities in academic performance may result from a confluence of adverse exposures that arise from structural racism and accrue to specific subpopulations. This study investigates childhood lead exposure, racial residential segregation, an ... Full text Cite

Where Is Air Quality Improving, and Who Benefits? A Study of PM2.5 and Ozone Over 15 Years.

Journal Article American journal of epidemiology · June 2022 In the United States, concentrations of criteria air pollutants have declined in recent decades. Questions remain regarding whether improvements in air quality are equitably distributed across subpopulations. We assessed spatial variability and temporal tr ... Full text Cite

A longitudinal study of exposure to fine particulate matter during pregnancy, small-for-gestational age births, and birthweight percentile for gestational age in a statewide birth cohort.

Journal Article Environmental health : a global access science source · January 2022 BackgroundPrevious studies observed associations between prenatal exposure to fine particulate matter (≤ 2.5 μm; PM2.5) and small-for-gestational-age (SGA) birth and lower birthweight percentile for gestational age. Few, if any, studies ... Full text Cite

Bayesian variable selection for understanding mixtures in environmental exposures.

Journal Article Statistics in medicine · September 2021 Social and environmental stressors are crucial factors in child development. However, there exists a multitude of measurable social and environmental factors-the effects of which may be cumulative, interactive, or null. Using a comprehensive cohort of chil ... Full text Cite

Assessing Disparity Using Measures of Racial and Educational Isolation.

Journal Article International journal of environmental research and public health · September 2021 We develop a local, spatial measure of educational isolation (EI) and characterize the relationship between EI and our previously developed measure of racial isolation (RI). EI measures the extent to which non-college educated individuals are exposed prima ... Full text Cite

Effects of accumulated environmental, social and host exposures on early childhood educational outcomes.

Journal Article Environmental research · July 2021 BackgroundPersistent disparities in academic performance may result from a confluence of adverse exposures accruing disproportionately to specific subpopulations.ObjectiveOur overarching objective was to investigate how multiple exposures ... Full text Cite

Geosocial Factors Associated With Adherence to Statin Medications.

Journal Article The Annals of pharmacotherapy · December 2020 BackgroundIndividual patient characteristics, social determinants, and geographic access may be associated with patients engaging in appropriate health behaviors.ObjectiveTo assess the relationship between statin adherence, geographic acc ... Full text Cite

Characteristics of the built environment and spatial patterning of type 2 diabetes in the urban core of Durham, North Carolina.

Journal Article Journal of epidemiology and community health · April 2019 BackgroundFew studies examine relationships between built environment (BE) and type 2 diabetes mellitus (T2DM) using spatial models, investigate BE domains apart from food environment or physical activity resources or conduct sensitivity analysis ... Full text Cite

Residential Racial Isolation and Spatial Patterning of Hypertension in Durham, North Carolina.

Journal Article Prev Chronic Dis · March 28, 2019 INTRODUCTION: Neighborhood characteristics such as racial segregation may be associated with hypertension, but studies have not examined these relationships using spatial models appropriate for geographically patterned health outcomes. The objectives of ou ... Full text Link to item Cite

People, place and pollution: Investigating relationships between air quality perceptions, health concerns, exposure, and individual- and area-level characteristics.

Journal Article Environment international · January 2019 An extensive body of research has demonstrated that air pollution exposure is associated with adverse health outcomes. Urban air quality remains a major concern for both public health officials and the general public. In the United States, air quality publ ... Full text Cite

Toll-like Receptor 4 Pathway Polymorphisms Interact with Pollution to Influence Asthma Diagnosis and Severity.

Journal Article Scientific reports · August 2018 Asthma is a common chronic lung disease, the incidence and severity of which may be influenced by gene-environment interactions. Our objective was to examine associations between single nucleotide polymorphisms (SNPs) and combinations of SNPs in the toll-l ... Full text Cite

Residential Racial Isolation and Spatial Patterning of Type 2 Diabetes Mellitus in Durham, North Carolina.

Journal Article American journal of epidemiology · July 2018 Neighborhood characteristics such as racial segregation may be associated with type 2 diabetes mellitus, but studies have not examined these relationships using spatial models appropriate for geographically patterned health outcomes. We constructed a local ... Full text Cite

Airborne Fine Particles and Risk of Hospital Admissions for Understudied Populations: Effects by Urbanicity and Short-Term Cumulative Exposures in 708 U.S. Counties.

Journal Article Environmental health perspectives · April 2017 BackgroundEvidence of health risks associated with ambient airborne fine particles in nonurban populations is extremely limited.ObjectiveWe estimated the risk of hospitalization associated with short-term exposures to particulate matter w ... Full text Cite

Particulate Air Pollution from Wildfires in the Western US under Climate Change.

Journal Article Climatic change · October 2016 Wildfire can impose a direct impact on human health under climate change. While the potential impacts of climate change on wildfires and resulting air pollution have been studied, it is not known who will be most affected by the growing threat of wildfires ... Full text Cite

Racial isolation and exposure to airborne particulate matter and ozone in understudied US populations: Environmental justice applications of downscaled numerical model output.

Journal Article Environment international · July 2016 BackgroundResearchers and policymakers are increasingly focused on combined exposures to social and environmental stressors, especially given how often these stressors tend to co-locate. Such exposures are equally relevant in urban and rural areas ... Full text Cite

Air pollution and mortality in São Paulo, Brazil: Effects of multiple pollutants and analysis of susceptible populations.

Journal Article Journal of exposure science & environmental epidemiology · March 2016 Health impacts of air pollution may differ depending on sex, education, socioeconomic status (SES), location at time of death, and other factors. In São Paulo, Brazil, questions remain regarding roles of individual and community characteristics. We estimat ... Full text Cite

The impact of temperature on mortality in a subtropical city: effects of cold, heat, and heat waves in São Paulo, Brazil.

Journal Article International journal of biometeorology · January 2016 Understanding how weather impacts health is critical, especially under a changing climate; however, relatively few studies have investigated subtropical regions. We examined how mortality in São Paulo, Brazil, is affected by cold, heat, and heat waves over ... Full text Cite

A systematic review of the physical health impacts from non-occupational exposure to wildfire smoke.

Journal Article Environmental research · January 2015 BackgroundClimate change is likely to increase the threat of wildfires, and little is known about how wildfires affect health in exposed communities. A better understanding of the impacts of the resulting air pollution has important public health ... Full text Cite

Air Quality in Lanzhou, a Major Industrial City in China: Characteristics of Air Pollution and Review of Existing Evidence from Air Pollution and Health Studies.

Journal Article Water, air, and soil pollution · October 2014 Air pollution contributes substantially to global health burdens; however, less is known about pollution patterns in China and whether they differ from those elsewhere. We evaluated temporal and spatial heterogeneity of air pollution in Lanzhou, an urban C ... Full text Cite

Comparison of exposure estimation methods for air pollutants: ambient monitoring data and regional air quality simulation.

Journal Article Environmental research · July 2012 Air quality modeling could potentially improve exposure estimates for use in epidemiological studies. We investigated this application of air quality modeling by estimating location-specific (point) and spatially-aggregated (county level) exposure concentr ... Full text Cite

Spatial heterogeneity of PM10 and O3 in São Paulo, Brazil, and implications for human health studies.

Journal Article Journal of the Air & Waste Management Association (1995) · January 2011 Developing exposure estimates is a challenging aspect of investigating the health effects of air pollution. Pollutant levels recorded at centrally located ambient air quality monitors in a community are commonly used as proxies for population exposures. Ho ... Full text Cite