Established in 2010, the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) Superfund Research Center (SRC) uses a holistic system of research, training and stakeholder engagement to study the fate, transport, exposure, health impact and remediation of contaminant mixtures, aimed at reducing preterm birth (PTB) and other adverse pregnancy outcomes (APOs). Rates of PTB and infant mortality in Puerto Rico (PR) are among the highest among all U.S. states and territories. After reaching 20% in 2008, the PTB rate in PR has decreased to 11.4% in 2017, yet continues to be among the highest globally Evidence exists that exposure to Superfund chemicals contributes to APOs. Contamination is extensive in PR: there are 18 Superfund sites, and evidence of contamination of the drinking water is extensive. There are also extreme events (hurricanes, flooding) that may result in elevated exposures to environmental pollution. The Community Engagement Core (CEC), working closely with the Human Subjects and Sampling Core (HSSC), the Research Translation Coordinator, and the research projects, is the main vehicle for interaction with community stakeholders in PR. PROTECT?s approach emphasizes bidirectional engagement with two groups of stakeholders: 1) women participating in the PROTECT study cohort (1,457 participants with 1280 completed pregnancies as of October 2018 with the goal of adding another 1000); and 2) the broader group of residents in the areas where PROTECT?s groundwater study is being conducted, including collaborators at the Community Health Centers (CHCs) and clinics that serve as study sites. The CEC?s continual connection with the HSSC has produced strong relationships with study participants, staff and clinicians at CHCs and private clinics, health educators, social work and nursing staff, and community groups. Building on this foundation, the CEC will continue its strong bidirectional communication strategy, which includes meetings and focus groups with participants and clinical staff, distribution of extensive educational materials on reproductive and child health, and report-back of research findings to stakeholders, informed by stakeholder priorities, needs, and concerns. Inspired by participant feedback, we will continue to implement a new interactive cell phone-based app that allows individualized report-back to participants. This innovation will: more fully include participants in the research process, improve study recruitment/retention, provide individual exposure reduction information, and lay the groundwork for community-based participatory research projects. We will work extensively on exposure reduction by providing detailed suggested actions in the app, and by working with Project 4 (Remediation) to test project-developed water filters. The CEC?s central role in providing water filters and emergency supplies post-hurricane has made PROTECT even more trusted, and we will continue to provide emergency preparedness training/support. We will continue work on capacity-building for participants, health care providers, and their organizations, as well as develop resources for maternal and child health.

Public Health Relevance

The Community Engagement core provides bidirectional and ethical communication between the research projects/support cores and community, to facilitate much-needed understanding about environmental contamination in Puerto Rico as well as other contributors to preterm birth and other adverse pregnancy outcomes. Knowledge gained through this work will inform effective public health strategies for preventing those adverse outcomes in Puerto Rico and the U.S., as well as strategies to reduce exposures to environmental contaminants among pregnant women.

National Institute of Health (NIH)
National Institute of Environmental Health Sciences (NIEHS)
Hazardous Substances Basic Research Grants Program (NIEHS) (P42)
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Special Emphasis Panel (ZES1)
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Northeastern University
United States
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