Project Summary Air pollution represents a major public health threat in India, affecting a quarter of the country’s population at extreme levels. The evidence on health impacts of air pollution, which mainly comes from high income countries, is not transferable to LMICs like India with complex urban environments and high pollution levels. The proposal entitled “1/2-GEOHealth Health Effects of Selected Environmental Exposomes Across the Life CourSe (HEALS)-India” builds on the research and infrastructure established in the ongoing (to be completed on 7/30/2021), Air pollution and Health GEOHealth Program. In the current proposal we aim to extend our exposure assessments to include a range of air pollutants: particulate matter with aerodynamic diameter <2.5m (PM2.5), nitrogen dioxide (NO2) and ozone (O3), and extremes of temperature to assess the exposomes at fine spatiotemporal resolutions across different locations in India (Delhi, Chennai, Sonipat, Vizag, Pune, Hyderabad and Bikaner). Additionally, we will evaluate the composition of PM2.5 in these locations and measure real time exposures in a subset of the participants. These exposomes will be related to a range of chronic non- communicable diseases across the life course using inter-digitating cohorts. This will be achieved by leveraging existing pregnancy, children, adult, and older adult cohorts across India. This will help us systematically assess the vulnerable populations across pregnancy, infancy, childhood, adolescence, adult and older adult groups. We will also address how environmental exposomes interact with gender, socio-economic status, rural-urban settings, and pre-existing illnesses in impacting the health outcomes. Further, we will replicate the findings from our epigenome-wide scan (from the ongoing study) in larger set of samples to validate DNA methylation profiles associated with incident myocardial infarction and explore if these epigenetic mechanisms mediate the effect of exposomes on myocardial infarction. Through this joint application, we will accelerate scientific infrastructure development, enhance research training to support research needed to characterize the relationship between environmental exposomes and health outcomes across the lifespan in India. The study will be led by Dr. Prabhakaran from CCDC and Dr. Reddy from PHFI and Dr. Schwartz and Dr. Sieber from HSPH, who will be assisted by the: 1) External Advisory Committee; 2) Administrative Oversight Committee; 3) Training Oversight Committee; 4) Program coordination personnel at HSPH and CCDC; and 5) Supervisory teams for individual trainees (Indian & HSPH mentors). The proposed study findings will identify the policy reforms needed to address the growing burden of air pollution and protect the large at-risk population. The training of the Indian scientists in the linked U2R in the area of environmental health will build capacity to undertake relevant studies and apply for future grants to address the threat from adverse environmental exposures in India.

Project Narrative The current proposal titled, “1/2-GEOHealth Health Effects of Selected Environmental Exposomes Across the Life CourSe (HEALS)-India”, aims to study effect of environmental exposomes: PM2.5, NO2, O3, and extremes of temperature, on multiple health outcomes using a modified life course approach to inform policy interventions.