Running head: ENVIRONMENTAL EXPOSURE REDUCTION PLAN 1
Carlos Vera, Program Coordinator
Fresno County Department of Public Health
1221 Fulton St,
Fresno, CA 93721
December 29, 2019
Catherine Doyle, MPH, MBA
Department of Health Science and Recreation
One Washington Square
San Jose, CA 95192-0052
Dear Ms. Doyle:
Fresno County is pleased to submit this application to request funding assistance for the
Environmental Exposure Reduction Plan (EERP). Our organization ask for $249,882 to fund the
pilot study that will be used as a model for the later Environmental Exposure Reduction Plan that
will be implemented in the other counties in the Central Valley. This program aims to decrease
incidence rates of asthma and cognitive impairments by holding pesticides and nitrates exposure
education among pregnant Latina women to in Reedley, California. The multifaceted program
intends to create long lasting changes not only through education but also building community
capacity, routinely water and air monitoring, and policy changes to improve resident’s health
outcomes.
In 2016, the Reedley Community Health Needs Assessment indicated asthma as a key priority
area and a root cause for this chronic condition were the environmental pollutants. EERP, will
provide the priority population continuous pesticide and nitrate education that will improve their
self-efficacy on these chemicals leading to lower exposure levels and diminished health
repercussions for their children. The Fresno County Public Health Department has been a
backbone organization for several environmental issues keeping racial and health equity as a
core principal driven to address the most pressing issues in every community. For this purpose,
we request funding to solve the disproportionate health burdens faced by the city of Reedley,
California.
Thank you, Ms. Doyle, we appreciate you looking at our proposal. Hope to hear from you soon.
Contact me at (831) 229-0108 or carlos.vera@fresnocountyca.gov if you have any questions or
need additional information.
Sincerely,
Carlos Vera, Program Coordinator
ENVIRONMENTAL EXPOSURE REDUCTION PLAN 2
Abstract
Asthma and cognitive impairments in the Central Valley are health disparities recognized by the
Fresno, Kings, Tulare, and Madera County as a top four priority area in the community
(Adventist Health, 2016). Toxicants such as pesticides and nitrates which are highly correlated to
causing asthma and cognitive impairments have disproportionately polluted the City of Reedley
as indicated by the number of water quality violations in the past number of years (California
Water Boards, 2017). The Environmental Exposure Reduction Plan (EERP) will provide a
pesticide and nitrate exposure education program to reduce toxicant exposure among pregnant
Latina Women in Reedley, California which shall decreased rates of childhood asthma and
cognitive impairments. The program shall be guided by the Health Belief Model to provide
education and awareness on pesticide/nitrate induced asthma and cognitive impairments, but also
influence the priority population to take actions to reduce their exposure. Although only being a
temporary fix to the situation, the improved self-efficacy will be important to increasing
community capacity for policy and regulation changes of pesticide and nitrate use in the area.
Yet, EERP’s impact to reduce asthma and cognitive impairments will be unknown 4 years from
when participants children are born, the biospecimen collected will be an early indicator for
determining health outcomes. Furthermore, to measure the effectiveness of the education
component of EERP, a brief environmental exposure survey will be administered after the nine-
month period.
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ENVIRONMENTAL EXPOSURE REDUCTION PLAN 3
Problem Statement
Elevated levels of pesticides and nitrates during pregnancy have been found to have a
high association between exposure of chemicals and children developing asthma and cognitive
impairments (Bouchard, et al., 2011; Brender, et al., 2013). Asthma, a chronic respiratory disease
that can cause death, hypoxia, and cognitive impairment is an issue that has increased over the
past 10 years (Caldera‐Alvarado, Khan,DeFina, Pieper, & Brown, 2013). Yet, having all this
research and data, the agriculture industry has continued to pollute the water and air of
approximately 50 million people in the United States (Alavanja, 2009). California’s Central
Valley has been disproportionality effected by higher pesticide and nitrate exposure than other
parts of California, were 63% of the state’s public water system violations have occurred
