Genee Smith, Msph

While some studies in mice have suggested a possible link between tuberculosis and air pollution, this question has not been studied on a large scale in humans. Previous research suggests that air pollution, by increasing inflammation in the lungs and decreasing the immune system's response, may increase the risk of developing TB. The link between tuberculosis and smoking is also unclear, with some research showing an association and some not finding a connection.

"The results of the study could have global implications and could not have been done without American Lung Association support."

Genee will use an American Lung Association Lung Health Dissertation Award to examine both questions. She will link two major sources of information: electronic medical records from the Kaiser Permanente patient database and air pollution data from the California Air Resources Board (CARB). The study will include records of 3,000 adults with active TB and 6,000 healthy adults without a history of TB, all of whom live in California.

The medical records will tell Ms. which patients have a history of smoking. They will also contain patients' addresses and how long they have lived at that location. She will compare those records with the CARB data to estimate individual-level exposures and their relationship to TB. She will also examine whether the association between air pollution and TB is stronger among smokers than non-smokers.

"California is a natural place to conduct this study, because the state has excellent air pollution data, and Kaiser Permanente, which is based in California, has a huge number of electronic medical records," Ms. says. She is working with Kaiser to develop a model that will take into account where a person lives, and link that information to air pollution data starting 24 months before they were diagnosed with TB. The results of the study could have global implications, since many developing countries have both high rates of TB and severe air pollution, she says.

"Because Kaiser has more than three million people in their database, I would not be able to do this scale of epidemiologic study without the funding provided by the American Lung Association," Ms. Smith says.