This application is in response to RFA TW 03-005 entitled """"""""Health, Environment and Economic Development."""""""" Rural-urban migration has risen dramatically in many parts of the developing world, including the Eastern Mediterranean (EM) region, as a result of economic development trends. This has created large informal settlements around maj or urban centers, where poverty, poor housing conditions and lack of services, in combination with environmental risks such as unsafe water, poor sanitation, and air pollution, are thought to have major adverse effects on health and well being. Our long-range goal is to improve the health status of residents living in informal urban settlements in Syria. As a first step in this process, the objective of this proposal is to comprehensively assess the health needs and resources of residents of these settlements, particularly in relation to environmental risks. The rationale for the proposed research is that the collection of standardized data on health status and needs, environmental hazards, and demographic/socioeconomic characteristics of residents, along with objective data on representative exposures and outcomes likely to be of great importance in this population--air quality and respiratory symptoms--will guide the development of effective intervention strategies to alleviate some of the environmental health burdens facing these communities and help to improve overall health. With a multidisciplinary team of public health, environmental science, respiratory medicine, behavioral science, and urban planning researchers with expertise in the EM region, we are well positioned to undertake the proposed research. Once we complete the work proposed in the R21 application, we expect to be prepared to submit an R01 application proposing to develop and test specific intervention strategies. With that introduction, the specific aims are to: (1) Perform comprehensive assessment of health and environmental hazards among residents of informal settlements in Aleppo by conducting formative work and objective measurement of selected indoor air pollutants and respiratory function. (2) Describe the health status and environmental risks of people living in informal settlements in Aleppo, and examine possible associations between exposures and outcomes collected in Aim 1 to assess the health burdens associated with environmental hazards; and (3) Establish local, sustainable environmental health surveillance and research capacity by providing training opportunities and partnering with local and national stakeholders.
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