Climate Variability / Change and the Risks for Under-Studied Adverse Health Outcomes Project Summary / Abstract Climate change affects the environment and increases the frequency and intensity of extreme weather events. Thus, its public health impact could be substantial. Many uncertainties remain in understanding the relationship between climate factors and health, however. Major gaps include the relative paucity of research on morbidity outcomes, lack of a composite index to measure the joint effects of individual meteorological factors, little data on the assessment of the public health burden, and few translational studies to directly apply local research findings into public health practice. Our proposed study will fill these gaps by evaluating both the independent and joint effects of various meteorological factors on some under-studied outcomes and translating our findings into a climate-health surveillance system and into public communication/education. Biologically-plausible but under-studied health outcomes, including tick-borne and water/food-borne diseases, adverse birth outcomes, and cold-related diseases will be examined in relation to extreme weather conditions, climate variability, special weather events, and the season-modifying effect of individual climate factors including temperature, humidity, air pressure, and wind in New York State (NYS). The Spatial Synoptic Classification II system, a composite weather index derived from five meteorological variables, will also be used to assess the impact of joint effects on these outcomes as well as other more commonly studied outcomes such as respiratory, cardiovascular, renal and heat-related disease. Potential confounders such as socio-demographic factors and maternal/infant characteristics will be controlled and the interactive effects between climate factors and air pollutants will be assessed. We will also try to determine if vulnerable populations such as the elderly, infants, minorities, people living below the poverty level, pregnant women, inner-city residents, or people with pre-existing chronic diseases are disproportionately affected by climate extremes or variability. For all outcomes except adverse birth outcomes, the case-crossover design or time- series analysis will be used to control for time-varying variables, and a two-stage Bayesian Hierarchical model will be used to assess regional effects as well as state-wide effects after controlling for regional differences (the case-control design will be used to study the birth outcomes). This study represents a unique effort to assess weather effects on some important but under-studied health endpoints, evaluating the joint effects of climate factors, and integrating local findings and data into the ongoing Environmental Public Health Tracking (EPHT) system and public health education. This effort will improve our understanding of how climate factors jointly affect health as an air system, identify weather-sensitive diseases and populations, and identify the most hazardous weather factors. Our multi-disciplinary research team will use data already collected and geo- coded through ongoing NYS projects, readily available environmental and health data sets, and an established EPHT system to ensure the proposed study is feasible, efficient, and sustainable. PUBLIC HEALTH RELEVANCE: Climate Variability / Change and the Risks for Under-Studied Adverse Health Outcomes Narrative The proposed study will help us understand how weather factors, both individually, and jointly as a climate system, affect human health. It will be the first study or one of the few studies to assess some important but under-studied health outcomes including vector-borne diseases, water/food-borne diseases, adverse birth outcomes, and cold-related diseases. The findings from this study will be integrated into the current Environmental and Public Health Tracking Program in New York State to develop a climate-health surveillance system and guide the state environmental and health agencies to plan intervention strategies and preparedness programs.