PROJECT ABSTRACT – Component: Research Project 2 As heatwaves and extreme weather events increase, populations in arid lands and urban heat-promoting landscapes may be at increased risk for heat-related illnesses. Although recent evidence suggests a strong association between heatwaves during pregnancy with preterm births and birth outcomes, the downstream effects on childhood neurodevelopment remain unexplored. Animal and cellular models show that temperature has profound effects on systems that regulate neurological functioning. Cross-sectional studies suggest heat stress induces lethargy and exhaustion, and may worsen symptoms of attention deficit hyperactivity disorder (ADHD). Prospectively, simulated heatwaves in pregnant mice induce neurological damage and oxidative stress, alter placental development, and diminish head size. In human studies, and in our pilot data of >700,000 births in Arizona, heatwaves during pregnancy are associated with lower Apgar score, which is a metric of health at birth and associated with later neurological functioning (including ADHD). However, despite this evidence, investigations of heatwaves and later neurodevelopment remain absent from the literature. Thus, in alignment with the mission of the Southwest Center on Resilience for Climate Change and Health (SCORCH), we propose to leverage the unique resources at the University of Arizona and use three decades of extant, population-based Medicaid and birth certificates data to investigate associations of temperature exposures during pregnancy on infant health and childhood neurodevelopment (Apgar score and ADHD) over three decades (1992-2022) in the state of Arizona. We will adopt a research-to-action framework and work with our Community Engagement Core to communicate findings on heat, neurodevelopment, and infant health, to community groups, public health agencies, and municipalities. Due to the urgent nature of climate change response, we additionally recognize the critical importance of promoting climate change resiliency by evaluating whether the built environment and policy may modify these climate-health relationships. Co-I Dr. Ladd Keith has consolidated municipal policy into a heat resiliency scorecard at the census-tract level, called the Plan Integration for Resiliency Scorecard (PIRS) for Heat, which is publicly available in select cities. Several other climate resiliency factors (e.g., transit routes, cooling centers, tree canopy, housing type) are potentially important modifiers of heat and health, although these data exist in disparate sources, at different timelines, and disparate resolutions. Together with the Integrated Data Visualization Core (IDVC), we will consolidate, link to health outcomes, and publish this data that will span multiple decades with >1million observations. This will facilitate broad data usage and accelerate critical research by other investigators on how climate change mitigation and the built environment promote climate resiliency. This proposal will additionally serve as a showcase for SCORCH-supported analyses that integrate protected health data with public data that will be available via online dashboards built by the Integrated Data Visualization Core.