Nursing scholar expands study of extreme heat on human health

UB faculty member Daniel Jackson Smith has an opening statement that cuts to the heart of any discussion on climate change.

“We all recognize the world is getting hotter, right?” says Smith, who joined the School of Nursing faculty in July as an assistant professor.

“Politically, the idea of climate change is if it’s manmade or not. But when we say it’s getting hotter, that’s not up for debate. And that’s impacting human health.”

That conviction anchors and drives Smith’s research on extreme heat and its effects on human health. Wherever you go, he says, people notice their surroundings are warmer than they remember as kids. It’s almost automatic. So his research — including his most recent grant, a career development K01 from the National Institute of Nursing Research of the National Institutes of Health — carries that self-assurance that climate change and its effect on public health is not a problem that breaks down along the country’s red and blue divide. This is a problem for everyone.

Smith’s newest research study puts that belief into action. “High Heat and Human Health: The Impacts of Heatwaves on Kidney Disease and Data Driven Solutions” aims to explore the link between heat waves and kidney disease hospitalizations. Smith’s team will examine environmental factors such as impervious land use, reduced green space and historical redlining, and find associations among these factors with kidney disease.

“We‘re looking for whatever associations we can find,” he explains. “Patients admitted to hospitals, numbers of diagnoses, co-morbidities. The novel piece is we will be looking at people’s addresses and their neighborhood. Are they living in neighborhoods that were historically redlined, which we know are hotter than neighborhoods that weren’t.

“We’re going to look at neighborhood characteristics, like more concrete, fewer trees. There is some evidence that historically neighborhoods were redlined because they were less desirable places to be, and one of those desirable factors was being cool.”

Using what he calls the “knowledge-to-action theory,” the research will be translated into community-based interventions, while also enhancing Smith’s expertise in reducing environmental health disparities caused by climate change.

The three-year grant, just under $500,000, will incorporate data from about 80,000 individuals from greater metro Philadelphia (near Villanova University, where Smith was previously a faculty member, as well as a nurse practitioner at Prevention Point Philadelphia in the city’s Kensington neighborhood) and greater metro Atlanta (near Emory University, where Smith completed his nursing training, including initial licensure, certification as a primary care nurse practitioner and his PhD).

For Smith, the grant is another step toward expanding his study of the effects of climate change beyond those working outdoors, something he has studied in recent years.

“This grant is trying to take a look at how it’s really not only outdoor workers impacted by climate change, even though they are. But more so, anyone with kidney disease is impacted.”

In other words, it’s not just about those who work outdoors, such as farm workers, or those exposed to high heat in their jobs, like people working in crowded and overheated restaurants.

This is about anyone; it’s not what Smith calls a “niche” study. This is about parents, friends, families — everyone whose kidneys would be affected by extreme heat and reducing environmental health disparities because of climate change.

The project has three aims: two data science aims examining the associations of kidney disease and environment, and one implementation science aim developing interventions that can be used as quickly as possible to reduce the impacts of heat on the kidneys.

For Smith, it all started growing up on a dairy farm in Harmony, North Carolina. He constantly saw the interaction between the environment and humans. He remembers seeing the concept of eutrophication play out in front of him as nutrients started to mix in with water in a pond.

“The overgrowth starts eating up all the oxygen in the water. And then you have this natural organic material where there is no oxygen. All the fish are dying. And over time, the pond will fill in.”

While studying to be a nurse, he started to understand not only how humans impacted the environment, but how the environment impacts human health.

“That narrative flipped for me to the environment’s impact on humans, rather than what humans are doing to the environment,” he says.

He will travel to Guatemala in January to train with his mentor, Emory University professor Lisa Thompson, in implementation science, bringing research back to the community to directly help patients.

“That’s an important part of the study,” Smith says. “It takes 17 years for research findings to be translated into practice. We have to take the research back to the stakeholders — doctors, nurses, nurse practitioners, people running our public health departments. And especially patients.

“How do we start developing interventions that can potentially protect people’s health during periods of heat waves?”