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. 2025 Jan 13;20(1):e0312660.
doi: 10.1371/journal.pone.0312660. eCollection 2025.

Rural Roads to cognitive Resilience (RRR): A prospective cohort study protocol

Lilah M Besser  1 , Lisa Wiese  2 , Diane J Cook  3 , Janet Holt  2 , Sheryl Magzamen  4 , Bryan Minor  3 , Diana Mitsova  5 , Juyoung Park  6 , Olivia Sablan  7 , Madeleine Tourelle  1 , Christine Williams  2
Affiliations

Rural Roads to cognitive Resilience (RRR): A prospective cohort study protocol

Lilah M Besser et al. PLoS One. .

Abstract

Background: Ambient air pollution, detrimental built and social environments, social isolation (SI), low socioeconomic status (SES), and rural (versus urban) residence have been associated with cognitive decline and risk of Alzheimer's disease and related dementias (ADRD). Research is needed to investigate the influence of ambient air pollution and built and social environments on SI and cognitive decline among rural, disadvantaged, ethnic minority communities. To address this gap, this cohort study will recruit an ethnoracially diverse, rural Florida sample in geographic proximity to seasonal agricultural burning. We will (1) examine contributions of smoke-related fine particulate matter (PM2.5) exposures to SI and cognitive function; (2) determine effects of built and social environments on SI and cognitive function; and (3) contextualize SI and cognitive function among residents from different ethnoracial groups during burn and non-burn seasons.

Methods: We will recruit 1,087 community-dwelling, dementia-free, ≥45-year-olds from five communities in Florida's Lake Okeechobee region. Over 36 months, participants will complete baseline visits to collect demographics, health history, and health measurements (e.g., blood pressure, body mass index) and 6-month follow-ups assessing cognitive function and social isolation at each visit. A subsample of 120 participants representative of each community will wear smartwatches to collect sensor data (e.g., heart rate) and daily routine and predefined activities (e.g., GPS-captured travel, frequent destinations) over two months. Ecological momentary assessments (EMA) (e.g., whether smoke has bothered participant in last 30 minutes) will occur over two months during agricultural burning and non-burning months. PurpleAir monitors (36 total) will be installed in each community to continuously monitor outdoor PM2.5 levels.

Discussion: We expect to identify individual- and community-level factors that increase the risk for SI and cognitive decline in a vulnerable rural population.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Florida communities included in the study.
* Exact locations/census block groups included will depend on recruitment. Map image is the intellectual property of Esri and is used herein under license. Copyright © 2020 Esri and its licensors. All rights reserved.
Fig 2
Fig 2. Variation in neighborhood percentage of Hispanic residents by community.
* Exact locations/census block groups included will depend on recruitment. Map image is the intellectual property of Esri and is used herein under license. Copyright © 2020 Esri and its licensors. All rights reserved.
Fig 3
Fig 3. Variation in neighborhood percentage of Black/African American residents by community.
* Exact locations/census block groups included will depend on recruitment. Map image is the intellectual property of Esri and is used herein under license. Copyright © 2020 Esri and its licensors. All rights reserved.
Fig 4
Fig 4. Variation in Area Deprivation Index (neighborhood socioeconomic status) by community.
* Exact locations/census block groups included will depend on recruitment. Map image is the intellectual property of Esri and is used herein under license. Copyright © 2020 Esri and its licensors. All rights reserved.
Fig 5
Fig 5. Conceptual model.
See this image and copyright information in PMC

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