Locke, Robert

Arts and Sciences



Peru - Role of micronutrient deficiencies in asthma.

Ambient air pollution is an important contributor to pulmonary disease in densely populated urban areas worldwide. Asthma incidence is increasing in low- and middle-income countries, particularly in Latin America, which has the youngest and fastest growing population of the American hemisphere. Recent publications from in vitro and animal studies, as well as some population studies, strongly suggest that traffic-related ambient air pollution may result in a reprogramming of the epigenome, as part of the environmental stress response against reactive-oxygen-species-mediated activation of the oxidative stress pathway. Micronutrients deficiencies (i.e., vitamin D and folate) are also known to affect both asthma prevalence and severity. The mechanisms underlying the effects of environmental exposures and micronutrient deficiencies on asthma are unclear but are likely to involve epigenetics. This project provides a unique opportunity to examine the interaction effects of ambient pollution and micronutrient levels on asthmatic children from Peru, a population with one of the highest prevalences of asthma in the world, which is truly unique. Our integrated, multidisciplinary design will also provide us with the opportunity to study the relationship between micronutrient deficiencies and epigenetics. Finally, we expect the results of our study will contribute to the improvement of the health of children with asthma. By providing a more accurate and specific assessment of the role micronutrients contribute to asthma induced by air pollution, we can better assess which patients would benefit from supplementation. This proposal seeks to study interaction effects between micronutrients and 1) particulate matter, and 2) epigenetic programming on longitudinal asthma symptoms.

My 10-week experience this past summer in Lima, Peru was an experience that opened my eyes to many cultural, health and social matters that in turn have greatly widened my perspective of the world. The GHEFP grant afforded me the invaluable opportunity to delve into real-world research that upon completion will likely produce important and influential findings and most importantly improve the quality of life of people in Lima and around the world.

Over the last 3 months I have had the privilege of designing and coordinating a study on childhood asthma and the effects of secondhand smoke from step one. Coming into this placement I had a limited amount of public health research experience but with the support of my co-workers in Peru I was able to mesh together public health specific and general professional skills to not only produce a successful project but to come away a much more well-rounded future professional with a greater appreciation for the world around me- an appreciation that will serve me well as I pursue a career abroad- hopefully in diplomacy or global health.

Peru is a country that is still in the process of developing in many regards including healthcare infrastructure. A lot of hospitals are old, worn down and provide inadequate services if patients can even afford them to begin with. These issues highlight the need for preventative measures to keep Peruvians out of hospitals and healthy before the possibility of having to walk through the front door of a hospital. This was one of the areas in which I felt I was making an impact by continuing to promote a proactive approach to health through education and collaboration. While I am half-Colombian and accustomed to life in South America interacting with patients on a regular basis using technical medical terms was a challenge that forced me to get out of my comfort zone and in the end helped me make immense strides in my overall ability to communicate in Spanish. I am now even prouder and feel a greater connection to my heritage and hope to use this new drive and better understanding to be more effective when working not only in Latin America but around the world. I feel more driven and comfortable when interacting with people and wish to travel around more of the world in a career that while currently undefined will allow me to immerse myself in different cultures with a common goal for social change.

My summer global health experience has not only taught me how formal Public Health research is conducted from start to finish but also has afforded me the opportunity to learn more about the world I live in. By providing me the means to go abroad and explore the field of global health in a way I never have before, the GHEFP grant has fueled a passion to immerse myself in new experiences and perspectives and to strive towards I a career and life centered around being an educated global citizen. I would like to thank the Johns Hopkins Center for Global Health for this opportunity that exceeded my expectations and provided me insights and memories that will last a lifetime. 


Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

March 2019



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