The launched the first-of-its-kind project in 2018 in partnership with The Nature Conservancy, Washington University in St. Louis, Hyphae Design Laboratory and others to study whether and how living among more densely greened surroundings contributes to better heart health. The design of the study closely mirrors clinical trials which test whether medical treatments are effective. The team applied the treatment – the addition of large trees and shrubs – to some participants’ neighborhoods but not to others. They then compared residents’ health data to see how the addition of the trees affected their health.

“The Green Heart Louisville Project is an excellent example of how our university’s innovative and collaborative researchers are working to improve lives in our community and far beyond,” UofL President Kim Schatzel said. “Trees are beautiful, but these results show that the trees around us are also beneficial to individual and community health. Through this and many other projects, the Envirome Institute is improving health at the community level, not just for individuals, but for everyone living in a neighborhood.”

To understand the state of community’s health at the start of the study, researchers took blood, urine, hair and nail samples and documented health data from 745 people living in a four-square-mile area of south Louisville. The researchers also took detailed measurements of tree coverage and levels of air pollution in the area.

Following this baseline data collection, the Envirome Institute worked with The Nature Conservancy and a host of local partners and contractors to plant more than 8,000 large trees and shrubs in designated neighborhoods within the project area. Those living in the greened area were considered the treated population and the results obtained from this population were compared with residents of adjacent neighborhoods, where the project team did not plant any trees.

After the plantings, the research team reassessed residents’ health. They found that those living in the greened area had 13-20% lower levels of a biomarker of general inflammation, a measure called high-sensitivity C-reactive protein (hsCRP) than those living in the areas that did not receive any new trees or shrubs. Higher levels of hsCRP are strongly associated with a risk of cardiovascular disease and are an even stronger indicator of heart attack than cholesterol levels. Higher CRP levels also indicate a higher risk of diabetes and certain cancers.

A reduction of hsCRP by this percentage corresponds to nearly 10-15% reduction in the risk of heart attacks, cancer or dying from any disease.

“These results from the Green Heart Louisville Project indicate that trees contribute more to our lives than beauty and shade. They can improve the health of the people living around them,” said Aruni Bhatnagar, director of the Envirome Institute and UofL professor of medicine. “Although several previous studies have found an association between living in areas of high surrounding greenness and health, this is the first study to show that a deliberate increase in greenness in the neighborhood can improve health. With these results and additional studies that we hope to report soon, we are closer to understanding the impact of local tree cover on residents’ health. This finding will bolster the push to increase urban greenspaces.”

As more is known about the health impacts of increased tree cover, increased greening in cities may emerge as a key method to improve public health.

“Most of us��intuitively understand that nature is good for our health. But scientific research testing, verifying and��evaluating this connection is rare,” said Katharine��Hayhoe, chief scientist of The Nature Conservancy.��“These recent findings from the Green Heart Project build the scientific case for��the powerful connections between the health of our planet and the health of all of us.”

Earlier in August, the Green Heart Louisville Project was awarded an additional $4.6 million in funding from the National Institute of Environmental Health Sciences to support continued research over the next five years.

These findings were presented by Daniel Riggs, UofL assistant professor of environmental medicine, at the in Santiago, Chile on Aug. 26.

STUDY DETAILS

This study is part of the Green Heart Louisville Project, ongoing research to discover how trees and shrubs affect people’s health.

The neighborhood

The project involved a four-square-mile area of South Louisville straddling the Watterson Expressway, including the Taylor-Berry, Jacobs, Hazelwood, Oakdale, Wilder Park and Beechmont neighborhoods. The project team planted trees and shrubs in a central portion of the project area that included Wyandotte Park, which served as the treated area. They planted no trees in the outer areas of the project area. [SEE MAP]

The people

Researchers enlisted 745 people living in the project area to participate in the project’s ongoing health study. At enrollment, participants were between 25 and 75 years old, 60% female, 77% white and 50% had household income below $50,000 per year. They live in the planted intervention area as well as outside it.

Researchers collected participants’ blood, urine, nail and hair samples and health information before and after planting the trees and shrubs in the “treatment” area.

The trees

Between 2019 and 2022, the Green Heart Project planted 8,425 evergreen trees and shrubs of 42 different species from five different families and 630 deciduous trees. Evergreens were pine, cypress, yew, holly and magnolia. Deciduous trees were mainly dogwood, oak and serviceberry.

Project team members and BrightView Landscape maintain the trees to promote their survival, growth and sustained impact.

The data

High-sensitivity C-reactive protein (hsCRP) is a blood test that measures general inflammation in the body. After the planting, people living in the areas where trees and shrubs were added had 13-20% lower hsCRP levels compared with those living in the areas that did not receive greening from the project.

Inflammation as measured by hsCRP , including stroke, heart attack and coronary artery disease. Previous studies have shown that hsCRP increases with age. The change in hsCRP seen in individuals living in the planted areas was similar to the difference between typical levels in a 42-year-old compared with a 33-year-old.

This difference also is similar to the difference between people who exercise regularly and those who do not. Finally, the decrease in hsCRP levels with planting corresponds to a nearly 10-15% reduction in the risk of heart attacks, cancer or dying from any disease.

Funding

A $3 million grant from the National Institute of Environmental Health Sciences supported the health evaluation of community participants and an additional $4.6 million was recently awarded for continuing this research. These grants bring the total investment by the institute to more than $8 million. The Nature Conservancy provided over $8.7 million in funding to support tree planting and maintenance, project management and other key project needs. The project has had an additional $3 million in support from local donors. Recently, $4.6 million in funding was awarded from the NIEHS for continued research over the next five years.

Collaborators and community partners

Collaborators for this project include the University of Louisville, Washington University in St. Louis, , , the United States Forest Service, and other partners.

Community organizations and resident involvement are vital to the success of this ongoing work to learn the health effects of urban greening. The team is grateful to the residents participating in the health study and those who have allowed tree planting on their property.

Watch a video about the research:

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View pictures from the Aug. 27 research results announcement on .

Watch the full Aug. 27 research results announcement on .

Researchers in UofL’s surveyed more than 700 people on a broad spectrum of psychological well-being factors and at the same time, tested the participants’ cardiovascular disease risk factors, including cholesterol levels, blood pressure, triglyceride levels and arterial stiffness, which is associated with the progression of heart disease. They found that participants who scored higher on the well-being survey also had lower levels of cardiovascular disease risk factors.

One of the strongest findings in the study, which was published in the , was that well-being moderated the association between age and arterial stiffness. While study participants with the lowest well-being scores were more likely to have increased arterial stiffness with age, there was no association between age and arterial stiffness for those with high levels of well-being.

Previous studies have showed a correlation between optimism and happiness and lower risk of cardiovascular health events. The survey for this study took a broader approach to assess psychological well-being, said Alison McLeish, associate professor of clinical psychology at UofL and first author of this study.

“In addition to happiness and optimism, overall well-being includes something we call flourishing. It’s when you’re doing things in your work or in your personal life that use your personal strengths and in which you’re striving to reach a goal,” McLeish said. “It might not always bring you happiness in the moment, but there’s an outcome that is exciting and brings you joy and a sense of accomplishment.”

The study’s authors suggested that health care providers may want to incorporate psychological well-being evaluation when assessing cardiovascular risk and recommend well-being interventions to mitigate the effects of age-related decline in cardiovascular health.

Rachel Keith, UofL associate professor of medicine and co-author who coordinated cardiovascular health assessments for the study, said that having an additional option to reduce heart disease that does not involve medication is appealing.

“When clinicians address heart health without medications we typically think about diet, exercise and tobacco cessation. Given that cardiovascular disease is so prevalent in our society, incorporating new and novel approaches that address risk, such as assessing and educating on ways to improve psychological well-being, may provide exciting opportunities to increase health, especially in an aging population,” Keith said.

Individuals can take steps on their own to maximize psychological well-being. McLeish suggested practicing mindfulness activities, for one. This could be seated meditation or intentionally being present in the moment while doing daily tasks such as walking, washing the dishes or even eating. In addition, she suggested what she calls positive psychology interventions.

“Part of that is identifying your strengths and your values so you can start to craft your life and your activities to build on those strengths and utilize them in different ways. You can do activities that use those strengths as a way to feel a sense of accomplishment as well as joy and happiness,” McLeish said.

McLeish said that while more research is needed to determine the extent to which improving well-being will improve cardiovascular disease risk, this study supports the idea that improving mental health can have a positive impact on physical health.

“The absence of disease doesn’t necessarily indicate health or well-being. It just gets you to neutral,” McLeish said. “A lot of times, both clinical psychology as well as medicine are focused on the absence of disease. We are trying to say let’s go a little bit further than that.”

The Envirome Institute has secured a 30-year lease with Louisville Metro Government to use Founders Square as an outdoor laboratory to research innovative ideas in urban greening. Patrick Piuma, director of the Envirome Institute’s Urban Design Studio, will oversee a project to intensely plant Founders Square with native plant and tree species while creating an accessible, inviting and functional public space for anyone to enjoy. The project at Founders Square will build on the Envirome Institute’s groundbreaking work with the , which is examining the scientific link between nature and human health.

“The Trager Micro-Forest Project is a transformative project connecting people with nature, starting in the heart of our city,” said Michael Trager-Kusman. “The members of our family are honored to support learning about the impact of scientifically planned and planted green spaces in the city we love.”

The project will provide an opportunity for UofL researchers in multiple disciplines to work with members of the community and other organizations to track and measure changes in human health and well-being and to study the project’s impact of biodiversity, micro-climates, economic development and public safety. The learning from this project can be used to inform the way city planners integrate nature into urban environments everywhere.

“This is an exceptional project for UofL’s Envirome Institute at the New Vision of Health Campus, and we are delighted to have the Trager family’s generous support as we embark on new fields of inquiry into the impact of the built environment on human health,” said Lori Stewart Gonzalez, interim president of UofL.

“The Envirome Institute is committed to the health and vitality of downtown Louisville, which is why we’re establishing our New Vision of Health Campus downtown at Fifth Street and Muhammad Ali Boulevard,” said Aruni Bhatnagar, director of the Christina Lee Brown Envirome Institute. “The Trager Micro-Forest Project is not simply a beautification project. It is a scientific project, which will be the first of its kind in our region of the country.”

“The Trager Micro-Forest Project and the Envirome Institute’s New Vision of Health campus are catalysts for positive momentum during this pivotal time for downtown Louisville. These initiatives complement our commitment to a sustainable future, a commitment that requires vision and action. We expect these initiatives will spur additional economic development in the area while adding well-planned and maintained green spaces that make our downtown area more attractive for those who live, work and visit there. Thank you to the Trager family for their support of the Envirome Institute’s innovative and forward-thinking project,” said Mayor Greg Fischer.

In the past, Louisville’s downtown was a vibrant hub of activity, from shopping and industry to entertainment and culture. The Trager Micro-Forest Project is intended to excite and engage the community while changing perceptions of downtown and promoting a greener and healthier city.

Initial work on the Trager Micro-Forest Project is already underway. Researchers are analyzing current park usage and taking air and surface temperature measurements in Founders Square and surrounding properties, and they have completed an inventory of the existing trees. This past summer, they used ground-penetrating radar to peer beneath the surface of Founders Square to identify any possible underground obstacles. Community members will be invited to participate in activities on site and provide input into the project over the next few months, with plantings to follow.

The campus will be��both a world-class research center and a nexus for community engagement, spawning citizen scientists and making health equity everyone’s pursuit.��It will consist of two historic buildings on West Muhammad Ali Boulevard totaling 133,000 square feet and an adjacent garden space.

The launch of the New Vision of Health Campus is made possible by a commitment from health advocate Christina Lee Brown of Louisville valued at $47 million by the university. Brown is providing $30 million over 20 years to support the����and is giving rent-free use of the buildings to the university, equating to a $17-million in-kind donation. In a special meeting earlier today, the UofL Board of Trustees approved a lease granting UofL use of the property, which is owned by Brown. The university plans to seek additional partnerships and financial support for the campus and its mission.

“We are incredibly grateful to Mrs. Brown for this generous gift of support and this special space in the heart of the city,” said Lori Stewart Gonzalez, interim president of UofL. “On this new campus, UofL researchers will increase our understanding of the many aspects of our environment that contribute to optimum health for everyone, here and beyond. It embodies our commitment to health equity.”

“To grow from our past and promote long, fulfilling lives, we shouldn’t chase any single cause. We live in a complex, interdependent world where history is our shared legacy and health is our shared aspiration,” Brown said. “By honestly recognizing our common stories, we can frame a new vision of health which unifies us. It can inspire healthier lives, healthier communities and a healthier world.”

�ճ������will include specially designed laboratories and offices for the��that will engage researchers and community members to learn how natural, cultural and personal environments impact health. Institute researchers work with community partners to discover how to build healthier cities, creating insights and models to improve health in Louisville and around the world.

The research will be directed by Aruni Bhatnagar, director of the UofL Envirome Institute, professor of medicine and chief of the UofL Division of Environmental Medicine.

“Our quest is to pursue the new vision that health is a resource that needs to be cultivated through conducive physical and environmental conditions,” Bhatnagar said. “Health is more than the absence of disease. Health is a resilience that helps individuals withstand all forms of stress. We want to move the discussion of health away from disease and instead focus on actively promoting health before disease occurs.”

The UofL Christina Lee Brown Envirome Institute was created in 2018 with a $5-million gift from Brown that charged UofL researchers to take a holistic, multidisciplinary approach to understanding how the human-environment interrelationship affects peoples’ lives and to convert that knowledge to actionable steps to promote human health. This research and the new funding announced today support the university’s grand challenge strategic research priority of “,” an initiative to lead a transformative shift in how we understand, promote and recover health through all stages of life.

Research highlights from the Envirome Institute include the��, documenting the health impacts of living among greater levels of vegetation, the��, tracking the presence and spread of COVID-19 in the community through testing of individuals and wastewater, and research to document the effects of smoking and vaping on health. Bhatnagar is co-director of the American Heart Association’s Tobacco Center for Regulatory Science, and the center’s research was employed as key evidence for ending the sale of flavored vaping products in California. The institute also houses the only NIH Superfund Research Center devoted to studying the effects of superfund chemicals on cardiovascular health, diabetes and obesity.

“This is UofL research that could transform the way we promote well-being by revealing and decoding the factors that affect it,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “We are proud to work with Christina Lee Brown and appreciate her continued support to further this important effort in advancing our health. Together, we will help people here in Louisville and around the world live lives that are not just longer, but healthier and more resilient.”

The gift announced today is the single largest philanthropic gift in the university’s history.

The launch of the New Vision of Health Campus is made possible by a commitment from health advocate Christina Lee Brown of Louisville valued at $47 million by the university. Brown is providing $30 million over 20 years to support the and is giving rent-free use of the buildings to the university, equating to a $17-million in-kind donation. In a special meeting earlier today, the UofL Board of Trustees approved a lease granting UofL use of the property, which is owned by Brown. The university plans to seek additional partnerships and financial support for the campus and its mission.

“We are incredibly grateful to Mrs. Brown for this generous gift of support and this special space in the heart of the city,” said Lori Stewart Gonzalez, interim president of UofL. “On this new campus, UofL researchers will increase our understanding of the many aspects of our environment that contribute to optimum health for everyone, here and beyond. It embodies our commitment to health equity.”

“To grow from our past and promote long, fulfilling lives, we shouldn’t chase any single cause. We live in a complex, interdependent world where history is our shared legacy and health is our shared aspiration,” Brown said. “By honestly recognizing our common stories, we can frame a new vision of health which unifies us. It can inspire healthier lives, healthier communities and a healthier world.”

The will include specially designed laboratories and offices for the that will engage researchers and community members to learn how natural, cultural and personal environments impact health. Institute researchers work with community partners to discover how to build healthier cities, creating insights and models to improve health in Louisville and around the world.

The research will be directed by Aruni Bhatnagar, director of the UofL Envirome Institute, professor of medicine and chief of the UofL Division of Environmental Medicine.

“Our quest is to pursue the new vision that health is a resource that needs to be cultivated through conducive physical and environmental conditions,” Bhatnagar said. “Health is more than the absence of disease. Health is a resilience that helps individuals withstand all forms of stress. We want to move the discussion of health away from disease and instead focus on actively promoting health before disease occurs.”

The UofL Christina Lee Brown Envirome Institute was created in 2018 with a $5-million gift from Brown that charged UofL researchers to take a holistic, multidisciplinary approach to understanding how the human-environment interrelationship affects peoples’ lives and to convert that knowledge to actionable steps to promote human health. This research and the new funding announced today support the university’s grand challenge strategic research priority of “,” an initiative to lead a transformative shift in how we understand, promote and recover health through all stages of life.

Research highlights from the Envirome Institute include the , documenting the health impacts of living among greater levels of vegetation, the , tracking the presence and spread of COVID-19 in the community through testing of individuals and wastewater, and research to document the effects of smoking and vaping on health. Bhatnagar is co-director of the American Heart Association’s Tobacco Center for Regulatory Science, and the center’s research was employed as key evidence for ending the sale of flavored vaping products in California. The institute also houses the only NIH Superfund Research Center devoted to studying the effects of superfund chemicals on cardiovascular health, diabetes and obesity.

“This is UofL research that could transform the way we promote well-being by revealing and decoding the factors that affect it,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “We are proud to work with Christina Lee Brown and appreciate her continued support to further this important effort in advancing our health. Together, we will help people here in Louisville and around the world live lives that are not just longer, but healthier and more resilient.”

The gift announced today is the single largest philanthropic gift in the university’s history.

UofL Interim President Lori Gonzalez and local officials gathered Friday to announce the effort through Supplies Overseas (SOS), an organization that works with area hospitals and healthcare providers to collect gently/unused medical supplies and send them to those in need.��UofL surgeon Gordon Tobin, a founding board member of SOS, also participated in the announcement.

Former ambassador to the Slovak Republic Tod Sedgwick said his contacts in Ukraine stressed the need for medical supplies. The local organization has collected almost 20 pallets of supplies – worth more than $100,000 — including bandages, defibrillators, and anesthesia and orthopedic supplies, said SOS president Denise Sears.��The organization also is sending personal protective equipment in response to Covid-19 concerns in the region.

SOS has worked with local philanthropist Christina Lee Brown to secure funding for the initiative, and officials from UPS have offered their services to help transport the supplies.

“This is a partnership of many elements of our compassionate community,” Tobin said, noting that the organization was created more than two decades ago by physicians at the UofL Department of Surgery, with early participation by UofL, Jewish and Norton hospitals. “And they continue to supply the needed supplies you see here today.”

Tobin said SOS has shipped more than $60 million in supplies to more than 106 countries around the world.

Gonzalez said UofL’s participation is an example of one of its Cardinal Principles, being a Community of Care. And she thanked those who have pulled the initiative together.

“This is an example of the university and the city stepping up to help those in need,” she said. “To the people of Ukraine, you are in our thoughts. You are in our prayers. And more importantly … we are able to take action to actually give help on the ground.”

People wishing to donate medical supplies can drop them off at the SOS headquarters, 1500 Arlington Avenue in Louisville, or request pick up for larger items.��The first shipment of supplies to Ukraine is expected to leave Louisville early this week.

Over the next six months, the , part of the Department of Urban and Public Affairs, will explore how the city of Louisville can serve as a living laboratory for research, education and experimentation at the Healthful City Design Studio at 429 W. Muhammad Ali Blvd. This temporary pop-up location, an addition to the current UDS location in the Portland neighborhood, offers a space in which community members can dive into issues and opportunities specific to the heart of downtown.

“This is an exciting opportunity to pull together the threads of urban planning and design, public health, equity, ecology, engineering, economics and more to focus on how these overlapping facets of the city can not only solve problems we face now, but also position our downtown and city for the future,” said UDS Director Patrick Piuma. “I believe we have the talented minds throughout our community to examine these aspects of our city, and our hope is to find ways to unlock the creativity needed to become a leader in this space.”

To kick off the pop-up, Piuma, alongside colleague and entrepreneur Sylvanus Hudson, will develop a series of events, workshops, demonstration projects and more to bring together professionals and the local community to explore how the built environment affects health and what it means to be a healthy city. The team will be joined by collaborators from other UofL departments, Louisville Metro Government, the University of Kentucky and related organizations and individuals as the direction of the initiative takes shape.

Early events and activities will be focused on outreach and education, getting people together to share ideas about what a healthy city looks like and collaborative demonstration projects to communicate the importance of cooling urban heat islands, improving air and water quality, planting trees and other vegetation, public safety, welcoming environments and the health benefits of reintroducing nature into urban environments.

“The pandemic has revealed the importance of the built environment on health and how valuable safe and healthy places are in promoting public health and resilience,” said Aruni Bhatnagar, director of the Christina Lee Brown Envirome Institute.

The goal of the effort will be to create a unique urban laboratory for innovation where UofL becomes a stronger partner with the community, public officials and others to develop novel solutions to the challenges our city faces. This initiative is an offshoot of the Downtown Revitalization Team’s Action Plan that calls for making downtown more vibrant, clean, safe and welcoming.

“It is critical for Louisville to invest in its natural and built environments to improve residents’ health, as well as be a competitive city in the 21^st Century,” said Jeff O’Brien, co-chief of Louisville Forward. “We can design our cities to prepare us for the changing climate and improve our health, all while making the city a more vibrant and equitable place.”

The UDS initiative will draw on past programs such as the Sustainable City Series’ public forums that raised awareness of sustainable practices and has led to place-making projects such as and .

The Healthful City Design Studio opens Monday, Nov. 8.

��

In the first study, UofL researchers Aruni Bhatnagar, professor of medicine and director of the Envirome Institute, Ray Yeager and Daniel Riggs, with Carver Coleman and Arden Pope of Brigham Young University and others, analyzed retrospective data from more than 5.5 million cancer patients and survivors from 2003 to 2016. They found that cancer patients in greener counties lived longer than those in counties with less greenness. The protective effects of greenness against cancer mortality were seen with both males and females and individuals of all ages, but were more pronounced at urban locations. Individuals with cancers that were highly survivable – such as breast, prostate and skin cancer – benefitted more from greenness than those with cancers with low survival rates such as brain, esophageal, liver, lung and pancreatic cancer. ����

The study, “,” published in the journal Environment International, evaluated associations between greenness and fine particulate matter in the air on causes of death in a large group of cancer patients and survivors in the United States.

“This is the largest study of the relationship between greenness and cancer mortality, and it provides clear evidence that living in green areas is beneficial to cancer patients,” said Bhatnagar “However, we do not yet understand why greenness protects against cancer mortality. Much more remains to be done to see whether greenness benefits cancer patients by lowering mental stress and anxiety or by reducing the levels of air pollutants or whether some other mechanisms are at play.”

The study also found that cardiopulmonary disease, but not cancer, was associated with higher levels of fine particulate air pollution. Mortality from cardiopulmonary causes – stroke, heart attack or COPD – was not affected by county greenness, except in rural locations.����

Greenness and depression

A second study, led by Kandi Walker and Joy Hart, professors in the UofL Department of Communication, Bhatnagar and other researchers in the Envirome Institute, found that people’s satisfaction with levels of greenness in their neighborhood was associated with lower levels of self-reported depressive symptoms. ��

The researchers surveyed participants about their perceptions of greenness in their neighborhoods and their mental health symptoms and found that those who were more satisfied with the greenness surrounding their homes also reported lower depression symptoms on a health survey, the Patient Health Questionnaire-9.

The 44.5% of survey participants who reported they were satisfied with the level of greenness in their neighborhood collectively scored better on the health questionnaire for depression.

“Given the pervasiveness of depression in the U.S. population, any changes that can reduce depression are essential, particularly those that can affect a large number of people,” Hart said. “The findings of this study suggest that greening interventions that focus on greenness satisfaction may be a strategy to reduce depression in urban populations.”

The study, “,” was published in July in the journal Population Medicine.

South Louisville study participants needed

Participants in the greening satisfaction study were part of the Health, Environment and Action in Louisville (HEAL) study of the Great Heart Project, which is an ongoing assessment of the effects of neighborhood greenness on individual health. Additional participants are needed for the HEAL Study by the end of September. More information is available on the website.

“Together, these studies add weight to the importance of trees, shrubs and other vegetation in urban areas in benefitting and nurturing human health. Accumulation of such evidence strengthens the case that increasing greenness in urban locations can decrease the high rates of non-communicable diseases in cities,” Bhatnagar said. “And since greenness improves health in general, it may also be effective against infectious disease.”

UofL researchers already are testing wastewater to determine whether coronavirus infection exists in different neighborhoods around Jefferson County. This new work goes one step further, with the goal of estimating how many people within those neighborhoods are infected. If virus levels are high in the wastewater, it may be a signal of widespread infection in the community.

“This could revolutionize the way we track and contain pandemics, and not just COVID-19,” said Aruni Bhatnagar, professor of medicine. “It gives us an invaluable tool that could offer a clearer view of where and how the virus spreads.”

Researchers at UofL’s , where Bhatnagar is director, began testing wastewater last year as part of the Co-Immunity Project, a groundbreaking partnership with the to track COVID-19 in Metro Louisville.

As part of that effort, the from 12 sites representing multiple neighborhoods and five water quality treatment centers that aggregate the entire county to the UofL Center for Predictive Medicine for virus analysis.

In this new work, MSD and other community partners will continue collecting wastewater samples over the next six months. After analysis, UofL will also send the results to the CDC’s National Wastewater Surveillance System, which will help inform efforts across the U.S.

As with previous rounds of COVID-19 testing conducted through the Co-Immunity Project, researchers will recruit participants by sending letters to selected households across Jefferson County. They hope to continue to enroll a few thousand people every month and will compare their COVID-19 infection and antibody results with wastewater samples from the same area, with the goal of finding how they correlate.

“The aim of the project is to figure out whether we can estimate how many people in a given area are infected by simply testing the community wastewater,” said Ted Smith, associate professor of medicine and a lead on the wastewater epidemiology project. “Additionally, this is a passive and comparatively low-cost way to monitor community infection and has the additional benefit of being inclusive of all communities in our city and is a promising step to ensuring public health equity.”

Since the beginning of the pandemic, the Co-Immunity Project has conducted ongoing testing and surveys to better understand the spread of the coronavirus and COVID-19. In the past year, UofL researchers have tested more than 12,000 people for COVID-19 infection and antibodies, beginning with frontline health care workers. They also have worked to gauge how local citizens feel about COVID-19 vaccines, with in a recent poll saying they would like to be vaccinated.

“This is critically important work in our fight against COVID-19,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “Our hope is that by working with the CDC, we can develop these new, more efficient tools for tracking pandemics and take a big step in advancing health for all of our community.”

Last year, U.S. Senator Mitch McConnell (R-KY), then-Senate majority leader, negotiated and championed five historic and completely bipartisan COVID-19 rescue packages. In addition to supporting workers and propping up the economy, these relief bills also allocated for COVID-19 testing. McConnell personally called then-U.S. Secretary of Health and Human Services Alex Azar to request that the CDC direct a portion of that funding to UofL’s Co-Immunity Project.

“Our country has responded to this terrible pandemic with innovation and discovery and Kentucky continues to play a major role in beating this virus. I’d like to congratulate Dr. Bhatnagar and UofL’s entire Co-Immunity Project on their groundbreaking study,” McConnell said in a statement. “After hearing about their work, I took this project to the highest levels of the federal government to help accelerate their research with additional federal funding.��As UPS and other Louisville employers are sending safe and effective vaccinations around the country, I’m proud top researchers right here at UofL are pushing the boundaries of knowledge in detection and prevention.”

In February, the researchers asked adults living in Jefferson County their perceptions about the coronavirus vaccine in order to identify potential barriers to vaccine uptake and to better understand vaccine hesitancy. Letters were mailed to 35,999 households across all geographic sectors of the county inviting the recipients to take part in the survey as well as to make an appointment for free testing for COVID-19, also part of the Co-Immunity Project.

“We wanted to better understand which residents had access to the vaccine as well as their attitudes toward the vaccine,” said Aruni Bhatnagar, Ph.D., director of the . “This information would help us improve equity in vaccine availability as well as help us understand the reasons behind vaccine hesitancy in our community. So, we incorporated the survey opportunity into our outreach for random community testing for the virus.”

The survey included questions about whether the person had been vaccinated, where they received most of their information about the vaccine and where they would prefer to be vaccinated. They also had an option to indicate they would not get vaccinated. They also were asked what would make them more likely to be vaccinated and what influenced those who were hesitant to vaccination.

Participants completed the questionnaire on a website that also offered them the opportunity to schedule an appointment for COVID-19 infection and antibody testing. Most of the 1,296 survey participants were age 60 or over (44%), female (61%) and white (84%) and 90.2% reported being unvaccinated.

An overwhelming majority of participants (91%) indicated they would choose to be vaccinated, with slightly lower rates among minority participants. Vaccine-hesitant participants suggested that more evidence of safety and effectiveness or their health provider’s recommendation would increase their likelihood of getting vaccinated. Although vaccines are provided for free, concerns about cost were seen in more than half the participants.

While most vaccine-hesitant participants expressed concern about side effects and safety, followed by not “tested on enough people who are like me,” minority participants expressed these concerns at higher rates and many vaccine participants from all races had concerns about the timeline of vaccine development. Other concerns were related to the efficacy of the vaccines, vaccines in general and government mistrust.

About 3% of white and 8% of minority participants indicated they would never choose vaccination. Minority participants reported they were more likely to choose vaccination with celebrity endorsement, offerings by faith organizations and vaccination requirements. White participants were more likely to choose vaccination if their family and friends or elected officials were vaccinated and with evidence of efficacy.

Most participants would prefer to be vaccinated by their health care provider, followed by a mobile or walk-in clinic, a pharmacy or a hospital. Other sites, such as community organizations, community recreation centers, workplaces or schools were of interest to one-fourth or less of participants. Minority participants were less interested in vaccination at work, pharmacies, libraries and mobile or walk-up clinics and more interested in being vaccinated at food distribution centers or by their health care provider.

Compared with white participants, minority participants were less likely to report knowing how to find out their vaccine eligibility or sign up for a vaccination.

While they acknowledge limitations to the study due to the fact that it was delivered along with the testing invitation and that it required a computer and internet access to complete, the researchers believe analysis of the results will be helpful in increasing access and acceptance of vaccines among different populations.

“Obtaining information on how to get a vaccine continues to be burdensome and solutions to this problem will help with more equitable vaccine distribution,” said Rachel Keith, Ph.D., assistant professor in the UofL Department of Medicine and a lead investigator in the Co-Immunity Project.