Blood lead concentrations and children's behavioral and emotional problems: a cohort study

How does formal and informal industry contribute to lead exposure? A narrative review from Vietnam, Uruguay, and Malaysia

INTRODUCTION

Lead industries are one of the major sources of environmental pollution and can affect human through different activities, including industrial processes, metal plating, mining, battery recycling, etc. Although different studies have documented the various sources of lead exposure, studies highlighting different types of industries as sources of environmental contamination are limited. Therefore, this narrative review aims to focus mainly on lead industries as significant sources of environmental and human contamination.

CONTENT

Based on the keywords searched in bibliographic databases we found 44 relevant articles that provided information on lead present in soil, water, and blood or all components among participants living near high-risk areas. We presented three case scenarios to highlight how lead industries have affected the health of citizens in Vietnam, Uruguay, and Malaysia.

SUMMARY AND OUTLOOK

Factories conducting mining, e-waste processing, used lead-acid battery recycling, electronic repair, and toxic waste sites were the primary industries for lead exposure. Our study has shown lead exposure due to industrial activities in Vietnam, Uruguay, Malaysia and calls for attention to the gaps in strategic and epidemiologic efforts to understand sources of environmental exposure to lead fully. Developing strategies and guidelines to regulate industrial activities, finding alternatives to reduce lead toxicity and exposure, and empowering the public through various community awareness programs can play a crucial role in controlling exposure to lead.

Prenatal antibiotics exposure and preschoolers' internalizing and externalizing problems: A biomonitoring-based prospective birth cohort study

BACKGROUND

Biomonitoring-based epidemiological studies on prenatal antibiotic exposure and behavioral problems in preschoolers are lacking. The present study aimed to investigate the relationship between prenatal antibiotic exposure and internalizing and externalizing problems in preschoolers.

METHODS

Data from 2449 mother-child pairs were analyzed. Urine samples were repeatedly collected across three trimesters, and 43 antibiotics and 2 metabolites were measured, including preferred as veterinary antibiotics (PVAs), VAs, preferred as human antibiotics and human antibiotics. Preschoolers' internalizing and externalizing problems were evaluated by the Achenbach Child Behavior Checklist. Poisson regression models with generalized estimating equations were used to estimate risk ratios (RRs) and 95 % confidence intervals (CIs) for preschoolers' internalizing, externalizing and total problems across tertiles of antibiotic concentrations during three periods of pregnancy, and performed several subgroup analyses.

RESULTS

First-trimester urinary oxytetracycline (RR = 1.69, 95%CI: 1.20, 2.39, P-FDR = 0.011), tetracycline (RR = 1.91, 95%CI: 1.36, 2.68, P-FDR < 0.001), doxycycline (RR = 1.66, 95%CI: 1.28, 2.17, P-FDR < 0.001) and PVAs (RR = 1.79, 95%CI: 1.29, 2.48, P-FDR < 0.001) concentrations in the highest tertile were related to an elevated risk of internalizing problems compared with concentrations in the lowest tertile. First-trimester urinary doxycycline concentrations in the third tertile were also associated with an increased risk of externalizing problems compared with the first tertile (RR = 2.00, 95%CI: 1.28, 3.15, P-FDR = 0.042). Compared with concentrations in the lowest tertile, first-trimester urinary doxycycline (RR = 1.63, 95%CI: 1.19, 2.22, P-FDR = 0.028) and PVAs (RR = 1.67, 95%CI: 1.14, 2.43, P-FDR = 0.047) concentrations in the middle tertile were related to an increased risk of total problems. Furthermore, the type of main caregiver and children's outdoor activities time modified the relationships between specific prenatal antibiotic exposure and preschoolers' behavioral problems.

CONCLUSIONS

Exposure to specific antibiotics during the first trimester may be related to an increased risk of internalizing and externalizing problems in preschoolers.

Pb2+-Selective Nanoemulsion-Integrated Single-Entity Electrochemistry for Ultrasensitive Sensing of Blood Lead

Unequivocally, Pb2+ as a harmful substance damaging children's brain and nerve systems, thereby causing behavior and learning disabilities, should be detected much lower than the elevated blood lead for children, 240 nM, endorsed by US CDC considering the unknown neurotoxic effects, yet the ultralow detection limit up to sub-ppb level remains a challenge due to the intrinsically insufficient sensitivity in the current analytical techniques. Here, we present nanoemulsion (NE)-integrated single-entity electrochemistry (NI-SEE) toward ultrasensitive sensing of blood lead using Pb-ion-selective ionophores inside a NE, i.e., Pb2+-selective NE. Through the high thermodynamic selectivity between Pb2+ and Pb-ionophore IV, and the extremely large partition coefficient for the Pb2+-Pb-ionophore complex inside NEs, we modulate the selectivity and sensitivity of NI-SEE for Pb2+ sensing up to an unprecedentedly low detection limit, 20 ppt in aqueous solutions, and lower limit of quantitation, 40 ppb in blood serums. This observation is supported by molecular dynamics simulations, which clearly corroborate intermolecular interactions, e.g., H-bonding and π*-n, between the aromatic rings of Pb-ionophore and lone pair electrons of oxygen in dioctyl sebacate (DOS), plasticizers of NEs, subsequently enhancing the current intensity in NI-SEE. Moreover, the highly sensitive sensing of Pb2+ is enabled by the appropriate suppression of hydroxyl radical formation during NI-SEE under a cathodic potential applied to a Pt electrode. Overall, the experimentally demonstrated NI-SEE approach and the results position our new sensing technology as potential sensors for practical environmental and biomedical applications as well as a platform to interrogate the stoichiometry of target ion-ionophore recognition inside a NE as nanoreactors.

Impact of in utero airborne lead exposure on long-run adult socio-economic outcomes: A population analysis using U.S. survey and administrative data

As a neurotoxin, early exposure to lead has long been assumed to affect socioeconomic outcomes well into adulthood. However, the empirical literature documenting such effects has been limited. This study documents the long-term effects of in utero exposure to air lead on adult socio-economic outcomes, including real earnings, disabilities, employment, public assistance, and education, using US survey and administrative data. Specifically, we match individuals in the 2000 US Decennial Census and 2001-2014 American Community Surveys to average lead concentrations in the individual's birth county during his/her 9 months in utero. We then estimate the effects of shocks to airborne lead conditional on observable characteristics, county fixed effects, county-specific time trends, and month-year fixed effects. We find a 0.5 μg/m3 decrease in air lead, representing the average 1975-85 change resulting from the passage of the U.S. Clean Air Act, is associated with an increase in earnings of 3.5%, or a present value, at birth, of $21,400 in lifetime earnings. Decomposing this effect, we find greater exposure to lead in utero is associated with an increase in disabilities in adulthood, an increase in receiving public assistance, and a decrease in employment. Looking at effects by sex, long-term effects for girls seem to fall on participation in the formal labor market, whereas for boys it appears to fall more on hours worked. This is the first study to document such long-term effects from lead using US data. We estimate the present value in 2020, from all earnings impacts from 1975 forward, to be $4.23 Trillion using a discount rate of 3%. In 2020 alone, the benefits are $252 B, or about 1.2% of GDP. Thus, our estimates imply the Clean Air Act's lead phase out is still returning a national dividend of over 1% every year.

Chronic Pb Exposure Induces Anxiety and Depression-like Behaviors in Mice via Excitatory Neuronal Hyperexcitability in Ventral Hippocampal Dentate Gyrus

Lead (Pb) is a widespread neurotoxic pollutant. Pb exposure is associated with mood disorders, with no well-established neural mechanisms elucidated. In the present study, we aimed to investigate whether excitatory neurons in the dentate gyrus subregion of the ventral hippocampus (vDG) played a key role in Pb-induced anxiety and depression-like behaviors. C57BL/6 mice were exposed to 100 ppm Pb starting on day 1 of pregnancy until experiments were performed using the offspring. Behavioral studies suggested that chronic Pb exposure triggered anxiety and depression-like behaviors. A combination of electrophysiological, optogenetic, and immunohistochemistry experiments was conducted. Results showed that Pb exposure resulted in excitatory neuronal hyperexcitability in vDG and that the behavioral deficits caused by Pb exposure could be rescued by inhibition of excitatory neuronal activity. Moreover, it was found that the action potential (AP) threshold of excitatory neurons was decreased by electrophysiological recordings. Our study demonstrates a significant role for excitatory neurons in vDG in Pb-induced anxiety and depression-like behaviors in mice, which is likely a result of decreased AP threshold. These outcomes can serve as an important basis for understanding mechanisms of anxiety and depression under environmental Pb exposure and help in the design of therapeutic strategies.

Developmental Pb exposure increases AD risk via altered intracellular Ca2+ homeostasis in hiPSC-derived cortical neurons

Exposure to environmental chemicals such as lead (Pb) during vulnerable developmental periods can result in adverse health outcomes later in life. Human cohort studies have demonstrated associations between developmental Pb exposure and Alzheimer's disease (AD) onset in later life which were further corroborated by findings from animal studies. The molecular pathway linking developmental Pb exposure and increased AD risk, however, remains elusive. In this work, we used human iPSC-derived cortical neurons as a model system to study the effects of Pb exposure on AD-like pathogenesis in human cortical neurons. We exposed neural progenitor cells derived from human iPSC to 0, 15, and 50 ppb Pb for 48 h, removed Pb-containing medium, and further differentiated them into cortical neurons. Immunofluorescence, Western blotting, RNA-sequencing, ELISA, and FRET reporter cell lines were used to determine changes in AD-like pathogenesis in differentiated cortical neurons. Exposing neural progenitor cells to low-dose Pb, mimicking a developmental exposure, can result in altered neurite morphology. Differentiated neurons exhibit altered calcium homeostasis, synaptic plasticity, and epigenetic landscape along with elevated AD-like pathogenesis markers, including phosphorylated tau, tau aggregates, and Aβ42/40. Collectively, our findings provide an evidence base for Ca dysregulation caused by developmental Pb exposure as a plausible molecular mechanism accounting for increased AD risk in populations with developmental Pb exposure.

Lead pollution-related health of children in China: Disparity, challenge, and policy

Lead (Pb) is a neurotoxic metal, and no level of lead exposure is safe for children. China has still experienced problems on child lead poisoning even though the Chinese government has phased out leaded gasoline since 2000. The underlying problem affecting the lead pollution-related health of children in China remains to be comprehensively investigated. It is found that although the significant decline of BLLs, as the Geometric Mean (GM), from 91.40 μg/L^GM in 2001 to 37.52 μg/L^GM in 2018 is observed, the average BLLs of children are still above 50 μg/L or more [average 59.70 (60.50-65.02, 95 % CI) μg/L^GM] after phasing out leaded gasoline since 2000 in China. Lead exposure causes 29.67 MID per 1000 children with a loss of 98.23 (59.40-146.21, 95 % CI) DALYs per 1000 in China, which is greater than the levels reported from the Western Pacific Region and other low- and middle-income countries. A significant correlation is observed between the number of child crimes (NoCCs) and the outcomes of long-term lead exposure for children in China. Although the disparities in BLLs in China are strongly influenced by unequal distributions of potential multi-lead related sources (soil lead, PM2.5 lead, dust lead), unbalance development of local industrialization and economies, as well as incorrect health care for younger children, the notable emissions from coal combustion (CC) and non-ferrous metals (NMS) exploitation dominate the crucial sources of low-level lead exposure to children after phasing out leaded gasoline in China currently. Faced with the unequal and disparate distribution of BLLs in China, the big bottleneck is to decrease the BLLs exertions of 36-45 μg/L in the next few decades. The Chinese government needs to make more efforts on developing more strict guidelines, implementing more policy strategies on prevention and management of blood Pb poisoning, and monitoring the nationwide changes in children's BLLs continuously.

Firearm-related lead exposure and pediatric lead levels in Massachusetts: A decade of evidence (2010-2019)

The US has more firearms than any other country in the world and uses lead ammunition almost exclusively. Lead exposure is a significant public health concern and children are at the greatest risk given their exposure to take-home lead. Firearm-related take-home lead exposure may be one of the greatest influences on elevated pediatric blood lead levels. For this ecological and spatial investigation of the relationship between firearm licensure rates as a proxy for firearm-related lead exposure and prevalence of children with blood lead levels ≥5 μg/dL in 351 cities/towns in Massachusetts, we used 10 years of data (2010-2019). We examined this relationship against other known contributors to pediatric lead exposure including old housing stock (lead paint/dust), occupations, and lead in water. Pediatric blood lead levels were positively correlated with licensure, poverty, and certain occupations and negatively correlated with lead in water and police or firefighter employment. Firearm licensure was a major significant predictor of pediatric blood lead alone (β = 0.13; 95% CI, 0.10, 0.17) and across all regression models. The final model predicted over half the variation in pediatric blood lead (Adjusted R2 = 0.51). Negative binomial analysis found cities/towns with more firearms had higher pediatric blood lead levels (highest quartile fully adjusted prevalence ratio ((aPR) = 1.18; 95% CI, 1.09, 1.30) with a significant increase in pediatric blood lead per increase in firearms (p < 0.001). There were no significant spatial effects, suggesting that although there could be other factors impacting elevated pediatric blood lead, they are unlikely to influence spatial associations. Our paper provides compelling evidence of a potential and dangerous link between lead ammunition and child blood lead levels and is the first to do so using multiple years' worth of data. More research is required to substantiate this relationship on the individual-level and into prevention/mitigation.

Association between lower-level of environmental lead exposure and reactive and proactive aggression in youth: Sex differences

Lead exposure during childhood has been associated with a variety of negative outcomes, including antisocial/aggressive behavior. However, different subtypes of antisocial behavior have been found to have different neurobiological correlates, and it is unclear whether lead exposure is related to specific subtypes of aggressive behavior. The objective of the study was to examine relationships between childhood blood lead levels (BLL) and proactive and reactive aggression. Further, given prior findings of sex differences in the effects of lead exposure, we examine whether there are sex differences in these relationships. In a sample of 818 youth (47.2% girls) ages 10-13 in China, we assessed BLL and administered the Reactive Proactive Aggression Questionnaire. Results show that BLLs were associated with reactive, but not proactive aggression. There was a significant interaction between BLL and sex in predicting aggression; boys with higher BLL scored higher in both proactive and reactive aggression than boys with lower BLL, but these differences were not present for girls. These findings suggest that lead exposure may have broad effects on antisocial behavior, but that boys may be more susceptible than girls. These findings may provide insights to identifying protective factors that could be potential targets for intervention.

Heavy Metal(loid) Body Burden in Environmentally Exposed Children With and Without Internalizing Behavior Problems

The prevalence of internalizing behavior disorders in children is increasing. Reasons for increasing anxiety and depression include several factors with a less studied consideration being the potential neurotoxic effects of environmental exposures. One group at risk for environmental exposures is children living near coal-burning power plants with coal ash storage facilities. Multivariate logistic regression was used to assess the relationship between metal(loid) exposures and internalizing behaviors in children aged 6-14 years. Metal(loid)s in nail samples were determined by Proton-Induced X-ray Emission and internalizing behavior problems were obtained from the parent ratings on the Child Behavior Checklist. Results indicated that concentrations of metal(loid)s in nails differ between children with internalizing behaviors and without internalizing behaviors. Logistic regression models suggested that exposure to zinc and imputed zirconium were associated with internalizing behaviors in children. However, when a sex-metal(loid) interaction term was included, none of the metal(loid)s were associated with internalizing behaviors indicating a role of sex differences in neurotoxicity with zinc and copper showing effects only for males. In all models, greater exposure to traffic was associated with internalizing behaviors. Zinc has previously been shown to increase risk for mental health problems, while zirconium has received less attention. Out findings indicate that environmental exposures of zinc and zirconium deserve further attention in studies of childhood internalizing disorders.

Prenatal lead (Pb) exposure is associated with differential placental DNA methylation and hydroxymethylation in a human population

Prenatal lead (Pb) exposure is associated with adverse developmental outcomes and to epigenetic alterations such as DNA methylation and hydroxymethylation in animal models and in newborn blood. Given the importance of the placenta in foetal development, we sought to examine how prenatal Pb exposure was associated with differential placental DNA methylation and hydroxymethylation and to identify affected biological pathways linked to developmental outcomes. Maternal (n = 167) and infant (n = 172) toenail and placenta (n = 115) samples for prenatal Pb exposure were obtained from participants in a US birth cohort, and methylation and hydroxymethylation data were quantified using the Illumina Infinium MethylationEPIC BeadChip. An epigenome-wide association study was applied to identify differential methylation and hydroxymethylation associated with Pb exposure. Biological functions of the Pb-associated genes were determined by overrepresentation analysis through ConsensusPathDB. Prenatal Pb quantified from maternal toenail, infant toenail, and placenta was associated with 480, 27, and 2 differentially methylated sites (q < 0.05), respectively, with both increases and decreases associated with exposure. Alternatively, we identified 2, 1, and 14 differentially hydroxymethylated site(s) associated with maternal toenail, infant toenail, and placental Pb, respectively, with most showing increases in hydroxymethylation with exposure. Significantly overrepresented pathways amongst genes associated with differential methylation and hydroxymethylation (q < 0.10) included mechanisms pertaining to nervous system and organ development, calcium transport and regulation, and signalling activities. Our results suggest that both methylation and hydroxymethylation in the placenta can be variable based on Pb exposure and that the pathways impacted could affect placental function.

Exposure to coal ash and depression in children aged 6-14 years old

BACKGROUND

When coal is burned for energy, coal ash, a hazardous waste product, is generated. Throughout the world, over 1 billion tons of coal ash is produced yearly. In the United States, over 78 million tons of coal ash was produced in 2019. Fly ash, the main component of coal ash contains neurotoxic metal (loid)s that may affect children's neurodevelopment and mental health. The objective of this study was to investigate the association between fly ash and depressive problems in children aged 6-14 years old.

METHODS

Children and their parents/guardians were recruited from 2015 to 2020. Tobit regression and logistic regression were used to assess the association between coal fly ash and depressive problems. To determine fly ash presence, Scanning Electron Microscopy was conducted on polycarbonate filters containing PM10 from the homes of the study participants. Depressive problems in children were measured using the Depressive Problems DSM and withdrawn/depressed syndromic problem scales of the Child Behavior Checklist.

RESULTS

In covariate-adjusted Tobit regression models, children with fly ash on the filter had higher scores on the DSM Depressive Problems (3.13 points; 95% CI = 0.39, 5.88) compared with children who did not have fly ash on the filter. Logistic regression supported these findings.

CONCLUSION

Coal ash is one of the largest waste streams in the U.S, but it is not classified as a hazardous waste by the Environmental Protection Agency. To our knowledge, no studies have assessed the impact of coal ash on children's mental health. This study highlights the need for further research into the effects of coal ash exposure on children's mental health, and improved regulations on release and storage of coal ash.

Longitudinal association of early childhood lead exposure and adolescent heart rate variability: influence of parental education

Lead exposure has been shown to dysregulate physiological stress responses. However, few studies have investigated the effect of lead exposure on later heart rate variability (HRV), an indicator of a stress response, in large samples of children. Furthermore, the interaction between social environmental factors and lead exposure in childhood, which commonly co-occur, remains understudied. This study examined relationships between childhood lead exposure and early adolescent physiological stress responses at different levels of parental education. Participants were 406 children from Jintan, China. Blood lead levels (BLLs) and parental education data were collected at 3-5 years of age, and HRV outcomes assessed at 12 years via frequency domain measures (LF/HF ratio) collected during an induced stress test. Results show a significant interaction between parental education and BLLs at 3-5 years. This relationship was found to be most consistent for the interaction between BLLs and mother's years of education for both the planning (β = 0.12, p = 0.046) and speaking (β = 0.11, p = 0.043) phase of the stress task, suggesting that increasing years of mother's education may enhance the deleterious influence of lead exposure on the HRV frequency measure, LF/HF ratio. This research highlights the complexity in lead exposure induced outcomes.

Early childhood lead exposure and adolescent heart rate variability: A longitudinal cohort study

Lead is a known neurotoxicant with many detrimental health effects, including neurocognitive deficits and cardiovascular and metabolic disorders. However, few studies have tested the association between lead exposure and the physiological stress response, which in and of itself may act as a precursor to and/or underlying mechanism of detrimental health outcomes. The purpose of this study was to examine the influence of early childhood and early adolescent low-level lead exposure on early adolescent heart rate variability, a widely-used measure of physiological stress. Participants were 408 children from Jintan, China for whom blood lead levels were measured between 3 and 5 years (early childhood) and again at 12 years (early adolescence). Heart rate variability was assessed at 12 years while participants underwent an induced stress task utilizing the ratio of low to high frequency (LF/HF) ECG measures. Mean blood lead levels in the cohort were 6.63 mcg/dl and 3.10 mcg/dl at 3-5 years and 12 years, respectively. Blood lead levels at 3-5 years of age (β 0.06, p = 0.027), but not at age 12 (β -0.05, p = 0.465), were significantly associated with LF/HF measures while controlling for multiple sociodemographic variables, potentially reflecting a dysregulated stress response with a shift towards sympathetic dominance. These findings suggest that early childhood lead exposure may have a detrimental influence on early adolescent autonomic responses to acute stress, which holds implications for cardiovascular health and overall growth and development.

Early-Life Pb Exposure Might Exert Synapse-Toxic Effects Via Inhibiting Synapse-Associated Membrane Protein 2 (VAMP2) Mediated by Upregulation of miR-34b

Background: Early-life Pb exposure can cause behavioral and cognitive problems and induce symptoms of hyperactivity, impulsivity, and inattention in children. Studies showed that blood lead levels were highly correlated with neuropsychiatric disorders, and effects of neurotoxicity might persist and affect the incidence of neurodegenerative diseases, for example Alzheimer’s disease (AD). Objective: To explore possible mechanisms of developmental Pb-induced neuropsychiatric dysfunctions. Methods: Children were divided into low blood lead level (BLL) group (0–50.00μg/L) and high BLL group (>  50.00μg/L) and blood samples were collected. miRNA array was used to testify miRNA expression landscape between two groups. Correlation analysis and real-time PCR were applied to find miRNAs that altered in Pb and neuropsychiatric diseases. Animal models and cell experiments were used to confirm the effect of miRNAs in response to Pb, and siRNA and luciferase experiments were conducted to examine their effect on neural functions. Results: miRNA array data and correlation analysis showed that miR-34b was the most relevant miRNA among Pb neurotoxicity and neuropsychiatric disorders, and synapse-associated membrane protein 2 (VAMP2) was the target gene regulating synapse function. In vivo and in vitro studies showed Pb exposure injured rats’ cognitive abilities and induced upregulation of miR-34b and downregulation of VAMP2, resulting in decreases of hippocampal synaptic vesicles. Blockage of miR-34b mitigated Pb’s effects on VAMP2 in vitro. Conclusion: Early-life Pb exposure might exert synapse-toxic effects via inhibiting VAMP2 mediated by upregulation of miR-34b and shed a light on the underlying relationship between Pb neurotoxicity and developmental neuropsychiatric disorders.

Characteristics and sources of Pb exposure via household dust from the urban area of Shanghai, China

Household dust has been considered as an important pathway for children's environmental Pb exposure. Shanghai was one of the first cities in China that removed Pb from petrol and has been shown in our previous study to have the lowest childhood blood Pb levels in China. This study therefore examines household dust Pb (Pb^HD) in Shanghai in order to determine the extent and exposure risks of Pb^HD. Household vacuum cleaner dust samples (n = 40) were collected and analyzed for total Pb concentration, bio-accessible Pb concentration and Pb isotopic compositions (Pb^IC). The mean concentration of Pb^HD was 195 mg/kg, which is between 7 and 10 times the Pb concentration of background soil samples from Shanghai. Among the investigated homes, those living in neighborhoods with lower average estate prices have higher dust Pb exposure risks for children. Bio-accessibility of Pb in household dust ranged between 53 and 91%, with a mean value of 71%. Analysis of Pb^IC of household dust samples (²⁰⁸Pb/²⁰⁶Pb: 2.1096 ± 0.0054; ²⁰⁷Pb/²⁰⁶Pb: 0.8648 ± 0.0025) are a close match to Pb^IC of coal combustion and solid waste incineration and fit well with those of outdoor air Pb^IC and urban surface soil Pb^IC of Shanghai. The study shows that children living in Shanghai are subject to Pb^HD exposure, with children living in the homes with lower average price having increased susceptibility to Pb^HD exposure. The data indicate that Pb^HD is derived primarily from contemporary coal combustion and solid waste incineration rather than common legacy Pb sources (e.g., Pb petrol and paint). Practices including closing doors and windows on days with poor air quality or high wind and preventing shoe wearing inside homes will aid in minimizing outdoor surface soil and ambient particulate intrusion indoors.

Blood lead levels mediate the relationship between social adversity and child externalizing behavior

BACKGROUND/AIMS

The association between social adversity and externalizing behavioral problems in children is well-documented. What is much less researched are biological mechanisms that may mediate such relationships. This study examines the hypothesis that low blood lead mediates the relationship between social adversity and child externalizing behavior problems.

METHODS

In this cross-sectional study, participants were 131 children aged 11-12 years (mean = 11.90) from Philadelphia, US. A venous fasting blood sample was taken and analyzed for blood lead levels. A social adversity index was calculated based on 10 total indicators derived from a psychosocial interview of the parent and official neighborhood data, while child behavior outcomes (internalizing and externalizing behavior) were assessed using both parent-report and child self-report.

RESULTS

The mean blood lead level was 2.20 μg/dL. Both relatively higher blood lead levels and higher social adversity scores were associated with higher levels of parent-reported and child self-reported externalizing behaviors. Additionally, blood lead mediated the relationship between social adversity and child-reported externalizing behavior (Indirect effect: B = 0.03, 95% CI: 0.004, 0.09) and partially mediated the relationship between social adversity and parent-reported externalizing behavior (Indirect Effect: B = 0.03, 95% CI: 0.01, 0.07).

CONCLUSION

To our knowledge, this study is the first to suggest that blood lead levels play a mediating role in the relationship between externalizing behavior problems and social adversity. Findings have potentially important implications for public health and environmental regulation as well as understanding biological mechanisms that link social inequality with health outcomes, especially in youth from low-income, urban areas.

Parental Lead Exposure Promotes Neurobehavioral Disorders and Hepatic Dysfunction in Mouse Offspring

Lead (Pb) induces neurotoxicity in both children and adults. Children are more vulnerable to Pb toxicity than adults. Little is known about the effects of Pb on the mental health of the children who are prenatally exposed. Therefore, we designed an animal experiment to compare the adverse effects of Pb on neurobehavioral and hepatic functions between Pb-exposed (Pb mice) and parental Pb-exposed (P-Pb mice) group mice. Mice were treated with Pb-acetate (10 mg/kg bodyweight/day) via drinking water. Male mice from unexposed parents treated with Pb for 90 days were defined as Pb mice, whereas male mice from Pb-exposed parents treated with Pb for further 90 days were defined as P-Pb mice. Anxiety-like behavior and spatial memory and learning were assessed by elevated plus maze and Morris water maze. Serum hepatic enzyme activities and butyrylcholinesterase activity were measured by an analyzer. P-Pb mice displayed increased anxiety-like behavior and memory and learning impairments compared to Pb mice. BChE activity was significantly decreased in P-Pb mice compared to Pb mice. Pb levels in the brains of P-Pb mice were significantly higher than those of Pb mice. The activities of serum hepatic enzymes of P-Pb mice were also higher than those of Pb mice. Additionally, histopathology data revealed that hepatic tissue injury was more pronounced in P-Pb mice than in Pb mice. Thus, the results suggest that persistent exposure to Pb from fetus to adult causes more severe neurobehavioral changes and hepatic toxicities than adult exposure only.

Firearm licenses associated with elevated pediatric blood lead levels in Massachusetts

OBJECTIVE

To determine the association between firearm-related lead exposure and pediatric blood lead levels.

METHODS

Using data available through the Massachusetts Departments of Public Health and Criminal Justice Information Services, we examined the association between active class A firearm licenses in a community with the prevalence of elevated blood lead levels in children aged 0-4. Correlational and hierarchical multiple regression analyses were conducted with potential confounders and other exposures such as lead paint, lead in water, presence of firing ranges, and social, economic, and occupational variables.

RESULTS

Data from 351 Massachusetts sub-counties were examined. Sub-counties with higher rates of firearm licensure also report higher rates of lead exposure among children. Children in the highest quartile communities were 2.16 times more likely to have elevated BLLs when compared to their peers in the lower quartiles. A one standard deviation change in firearm licensure percentage was found to reflect a 0.96% increase in elevated pediatric blood lead levels. Regression analyses demonstrated that the inclusion of firearm licensure significantly improved the prediction of pediatric BLL. Models were adjusted for percent of a population employed in construction, agriculture, forestry, fishing, hunting, and mining, income distribution, and potential lead paint exposure, which were found to be the primary predictors of elevated pediatric blood lead levels.

DISCUSSION

Firearm use and ownership remains one of the least researched areas in the public health sphere. While the risks of childhood lead exposure are widely understood, including the mechanisms of firearm-related lead exposure and tracking, to date no research has extensively examined it in children and on the community level. Our findings indicate a dire need for continued research on the risks associated with firearm use, ownership, and lead exposure.

Novel Application of Machine Learning Algorithms and Model-Agnostic Methods to Identify Factors Influencing Childhood Blood Lead Levels

Blood lead (Pb) poisoning remains a global concern, particularly for children in their early developmental years. Broken Hill is Australia's oldest operating silver-zinc-lead mine. In this study, we utilized recent advances in machine learning to assess multiple algorithms and identify the most optimal model for predicting childhood blood Pb levels (BLL) using Broken Hill children's (<5 years of age) data (n = 23,749) from 1991 to 2015, combined with demographic, socio-economic, and environmental influencing factors. We applied model-agnostic methods to interpret the most optimal model, investigating different environmental and human factors influencing childhood BLL. Algorithm assessment showed that stacked ensemble, a method for automatically and optimally combining multiple prediction algorithms, enhanced predictive performance by 1.1% with respect to mean absolute error (p < 0.01) and 2.6% for root-mean-squared error (p < 0.01) compared to the best performing constituent algorithm (random forest). By interpreting the model, the following information was acquired: children had higher BLL if they resided within 1.0 km to the central mine area or 1.37 km to the railroad; year of testing had the greatest interactive strength with all other factors; BLL increased faster in Aboriginal than in non-Aboriginal children at 9-10 and 12-18 months of age. This "stacked ensemble + model-agnostic interpretation" framework achieved both prediction accuracy and model interpretability, identifying previously unconnected variables associated with elevated childhood BLL, offering a marked advantage over previous works. Thus, this approach has a clear value and potential for application to other environmental health issues.

Bayesian variable selection for understanding mixtures in environmental exposures

Social and environmental stressors are crucial factors in child development. However, there exists a multitude of measurable social and environmental factors-the effects of which may be cumulative, interactive, or null. Using a comprehensive cohort of children in North Carolina, we study the impact of social and environmental variables on 4th end-of-grade exam scores in reading and mathematics. To identify the essential factors that predict these educational outcomes, we design new tools for Bayesian linear variable selection using decision analysis. We extract a predictive optimal subset of explanatory variables by coupling a loss function with a novel model-based penalization scheme, which leads to coherent Bayesian decision analysis and empirically improves variable selection, estimation, and prediction on simulated data. The Bayesian linear model propagates uncertainty quantification to all predictive evaluations, which is important for interpretable and robust model comparisons. These predictive comparisons are conducted out-of-sample with a customized approximation algorithm that avoids computationally intensive model refitting. We apply our variable selection techniques to identify the joint collection of social and environmental stressors-and their interactions-that offer clear and quantifiable improvements in prediction of reading and mathematics exam scores.

From Florence to fossil fuels: Nursing has always been about environmental health

BACKGROUND

Since its founding, professional nursing has applied an environmental lens to healing.

METHODS

This CANS 2020 Keynote article describes the history of nursing environmental science and nurses important contributions to the US Environmental Justice Movement. Starting with Florence Nightingale's Notes on Nursing, which established Environmental Theory, the paper introduces key figures throughout nursing history who have studied and advocated for environmental health and justice.

FINDINGS

The paper emphasizes that nursing has always been about environmental health and that, regardless of specialty or practice setting, all nurses are called to incorporate environmental science and translation into their research and practice.

CONCLUSION

This call to action is especially critical today in the context of urgent issues like climate change, environmental racism and racial health disparities, emerging infectious diseases like COVID-19, and chemical exposures in the home and workplace (among others).

Early Childhood Co-Sleeping Predicts Behavior Problems in Preadolescence: A Prospective Cohort Study

OBJECTIVE/BACKGROUND

Co-sleeping is common practice around the globe. The relationship between early childhood co-sleeping and adolescent behavior problems remains uncertain. We aim to identify whether early childhood co-sleeping can predict behavior problems in preadolescence.

PARTICIPANTS

A cohort of 1,656 Chinese preschool children were followed up in adolescence.

METHODS

Prospective cohort study design involving two waves of data collection from the China Jintan Cohort (1,656 children aged 3-5 years). Co-sleeping history was collected at 3-5-years-old via parent-reported questionnaire at wave I data collection. Behavior problems were measured twice in childhood and preadolescence, respectively. Adolescent behavior problems were measured by integrating data from self-report, parent-report and teacher-report using the Achenbach System of Empirically Based Assessment. Predictions were assessed using the general linear model with mixed effects on the inverse probability weight propensity-matched sample.

RESULTS

1,656 children comprising 55.6% boys aged 4.9 ± 0.6 were initially enrolled in the first wave of data collection. In the second wave of data collection, 1,274 children were 10.99 ± 0.74 (76.9%) aged 10-13 years were retained. Early childhood co-sleeping is significantly associated with increased behavior problems in childhood (Odds Ratio [OR] 1.22-2.06, ps<0.03) and preadolescence (OR 1.40-2.27, ps<0.02). Moreover, co-sleeping history significantly predicted multiscale increase in internal (OR 1.63-2.61, ps<0.02) and external behavior problems in adolescence.

CONCLUSIONS

Early childhood co-sleeping is associated with multiple behavioral problems reported by parents, teachers, and children themselves. Early childhood co-sleeping predicts preadolescent internalizing and externalizing behavior after controlling for baseline behavior problems.

Early Low-Level Arsenic Exposure Impacts Post-Synaptic Hippocampal Function in Juvenile Mice

Arsenic is a well-established carcinogen known to increase mortality, but its effects on the central nervous system are less well understood. Epidemiological studies suggest that early life exposure is associated with learning deficits and behavioral changes. Studies in arsenic-exposed rodents have begun to shed light on potential mechanistic underpinnings, including changes in synaptic transmission and plasticity. However, previous studies relied on extended exposure into adulthood, and little is known about the effect of arsenic exposure in early development. Here, we studied the effects of early developmental arsenic exposure in juvenile mice on synaptic transmission and plasticity in the hippocampus. C57BL/6J females were exposed to arsenic (0, 50 ppb, 36 ppm) via drinking water two weeks prior to mating, with continued exposure throughout gestation and parturition. Electrophysiological recordings were then performed on juvenile offspring prior to weaning. In this paradigm, the offspring are exposed to arsenic indirectly, via the mother. We found that high (36 ppm) and relatively low (50 ppb) arsenic exposure both decreased basal synaptic transmission. A compensatory increase in pre-synaptic vesicular release was only observed in the high-exposure group. These results suggest that indirect, ecologically relevant arsenic exposure in early development impacts hippocampal synaptic transmission and plasticity that could underlie learning deficits reported in epidemiological studies.

Longitudinal bidirectional association between sleep and behavior problems at age 6 and 11 years

BACKGROUND

Although a growing number of longitudinal studies have found that sleep problems precede behavior problems, few have examined potential bidirectional relationships longitudinally. The present study examined prospective associations between sleep problems and internalizing, externalizing, and attention problems over the course of childhood.

METHODS

Participants included 775 children from the China Jintan Cohort Study. Sleep problems were rated by mothers at ages six and 11.5, as well as self-reported by children at age 11.5. Behavior problems were rated by mothers and teachers at ages six and 11.5, and self-reported by children at age 11.5.

RESULTS

At age six, 15.0% of children were reported to have sleep problems as rated by mothers. At age 11, this prevalence was 12% as rated by mothers and 20% as rated by youth. Bidirectional relationships between sleep problems and behavior problems were observed. Mother-reported sleep problems at age six were predictive of self-reported internalizing and attention problems at age 11.5, even after controlling for baseline behavioral problems. At age six, teacher-reported externalizing, internalizing, and attention problems, and mother-rated internalizing and externalizing problems were all related to sleep problems at age 11.5, even after controlling for baseline sleep problems. Other sociodemographic covariates including child sex, age, and parental education were controlled for.

CONCLUSIONS

Findings provide further support for the reciprocal relationship between sleep problems and behavior problems. Early interventions that target both types of problems may be especially effective in preventing this aggravating health-behavior cycle.

Exposure to a mixture of metals and growth indicators in 6-11-year-old children from the 2013-16 NHANES

Lead (Pb), mercury (Hg) and fluoride (F) exposure during childhood is of concern owing to their toxicity. Also, evidence suggests that high and low exposure levels to manganese (Mn) and selenium (Se) during this vulnerable period are associated with an increased risk of adverse health effects. A reduced growth is associated with high Pb and F exposure; however, little is known about their impact on children's body size, and there is a lack of consensus on the effects of Hg, Mn, and Se exposure on children's anthropometric measures. This is particularly true for childhood metal co-exposures at levels relevant to the general population. We investigated the joint effects of exposure to a metal mixture (Pb, Mn, Hg, and Se in blood and F in plasma) on 6-11-year-old US children's anthropometry (n = 1,634). Median F, Pb, Mn, Hg, and Se concentrations were 0.3 μmol/L, 0.5 μg/dL, 10.2 μg/L, 0.3 μg/L, and 178.0 μg/L, respectively. The joint effects of the five metals were modeled using Bayesian kernel machine and linear regressions. Pb and Mn showed opposite directions of associations with all outcome measured, where Pb was inversely associated with anthropometry. For body mass index and waist circumference, the effect estimates for Pb and Mn appeared stronger at high and low concentrations of the other metals of the mixture, respectively. Our findings suggest that metal co-exposures may influence children's body mass and linear growth indicators, and that such relations may differ by the exposure levels of the components of the metal mixture.

Environmental exposures and sleep outcomes: A review of evidence, potential mechanisms, and implications

Environmental exposures and poor sleep outcomes are known to have consequential effects on human health. This integrative review first seeks to present and synthesize existing literature investigating the relationship between exposure to various environmental factors and sleep health. We then present potential mechanisms of action as well as implications for policy and future research for each environmental exposure. Broadly, although studies are still emerging, empirical evidence has begun to show a positive association between adverse effects of heavy metal, noise pollution, light pollution, second-hand smoke, and air pollution exposures and various sleep problems. Specifically, these negative sleep outcomes range from subjective sleep manifestations, such as general sleep quality, sleep duration, daytime dysfunction, and daytime sleepiness, as well as objective sleep measures, including difficulties with sleep onset and maintenance, sleep stage or circadian rhythm interference, sleep arousal, REM activity, and sleep disordered breathing. However, the association between light exposure and sleep is less clear. Potential toxicological mechanisms are thought to include the direct effect of various environmental toxicants on the nervous, respiratory, and cardiovascular systems, oxidative stress, and inflammation. Nevertheless, future research is required to tease out the exact pathways of action to explain the associations between each environmental factor and sleep, to inform possible therapies to negate the detrimental effects, and to increase efforts in decreasing exposure to these harmful environmental factors to improve health.

Identifying sensitive windows of airborne lead exposure associated with behavioral outcomes at age 12

Despite the precipitous decline of airborne lead concentrations following the removal of lead in gasoline, lead is still detectable in ambient air in most urban areas. Few studies, however, have examined the health effects of contemporary airborne lead concentrations in children.

METHODS

We estimated monthly air lead exposure among 263 children (Cincinnati Childhood Allergy and Air Pollution Study; Cincinnati, OH; 2001-2005) using temporally scaled predictions from a validated land use model and assessed neurobehavioral outcomes at age 12 years using the parent-completed Behavioral Assessment System for Children, 2nd edition. We used distributed lag models to estimate the effect of airborne lead exposure on behavioral outcomes while adjusting for potential confounding by maternal education, community-level deprivation, blood lead concentrations, greenspace, and traffic related air pollution.

RESULTS

We identified sensitive windows during mid- and late childhood for increased anxiety and atypicality scores, whereas sensitive windows for increased aggression and attention problems were identified immediately following birth. The strongest effect was at age 12, where a 1 ng/m3 increase in airborne lead exposure was associated with a 3.1-point (95% confidence interval: 0.4, 5.7) increase in anxiety scores. No sensitive windows were identified for depression, somatization, conduct problems, hyperactivity, or withdrawal behaviors.

CONCLUSIONS

We observed associations between exposure to airborne lead concentrations and poor behavioral outcomes at concentrations 10 times lower than the National Ambient Air Quality Standards set by the US Environmental Protection Agency.

Elevated lead levels in relation to low serum neuropeptide Y and adverse behavioral effects in preschool children with e-waste exposure

As a neurotoxicant, lead (Pb) primarily affects central nervous system, and particularly impacts developing brain. This study explores the associations of blood Pb level and children's behavioral health. A total of 213 preschool children aged 3-7 years old were recruited from Guiyu (the e-waste-exposed area) and Haojiang (the reference area). The behavioral health of children was assessed using the 'behavioral symptoms' subscale of the Strengths and Difficulties Questionnaire (SDQ). Results showed that there was a significant difference in percent of children categorized as "at risk" between Guiyu (48.2%) and Haojiang (13.9%) (p < 0.001). The blood Pb level of children in Guiyu was significantly higher than those in Haojiang (median: 5.19 μg/dL vs. 3.42 μg/dL, p < 0.001). The serum Neuropeptide Y (NPY) was significantly lower in Guiyu children than those in Haojiang. Spearman correlation analyses demonstrated that blood Pb levels was negatively correlated with NPY (r_s = -0.25, p < 0.001), but positively correlated with behavioral symptom scores; while serum NPY levels were negatively associated with behavioral symptom scores. Behavioral symptom scores were higher in children with blood Pb level ≥5.00 μg/dL (high) than those with blood Pb level < 5.00 μg/dL (low). After adjusting for confounding factors, children with lower NPY levels were at higher risk of having behavioral difficulties. In conclusion, Pb exposure in e-waste-exposed areas may lead to decrease in serum NPY and increase in the risk of children's behavioral problems. In addition, NPY may mediate the association between Pb exposure and behavioral difficulties.

Residential surrounding greenness and self-reported symptoms of anxiety and depression in adolescents

BACKGROUND

Evidence on the relationship between exposure to greenness and adolescent mental health is limited. The purpose of this study was to examine the association between greenness throughout childhood and mental health at age 12 years.

METHODS

We assessed greenness using the satellite-based measure of Normalized Difference Vegetation Index (NDVI) within 200m, 400m, and 800m of home address at birth, age 12 years, and across childhood (averaged for each year from birth to age 12) among the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) cohort. Self-reported symptoms of anxiety and depression were assessed at age 12 years using the Spence Children's Anxiety Scale (SCAS) and Children's Depression Inventory 2 (CDI 2), respectively. Associations were estimated using linear regression, adjusting for covariates including traffic-related air pollution, neurological hazard exposure, blood lead level, household income, and community deprivation.

RESULTS

In adjusted models, NDVI was largely not associated with self-reported anxiety and depression symptoms, except for the SCAS separation anxiety subscale at 400m and 800m (0.1 unit increase mean NDVI 400m: β = -0.97, 95% CI: -1.86, -0.07; 800m: β = -1.33, 95% CI: -2.32, -0.34).

CONCLUSION

While we found no direct relationship between greenness and overall symptoms of anxiety and depression in adolescents upon adjustment for relevant covariates at the 200m distance, greenness may lesson symptoms of separation anxiety within 400m and 800m distance from the home address at age 12 years. Future research should examine mechanisms for these relationships at the community- and individual-level.

Blood lead and mercury levels are associated with low resting heart rate in community adolescent boys

While the neurotoxic effects of heavy metals at even low levels have been well-studied, few studies have examined the cardiovascular effects of heavy metals on resting heart rate and these have focused on adult populations. The present study aimed to examine the association between low-level environmental lead and mercury exposure and resting heart rate in community adolescents. As part of the China Jintan Cohort Study, 532 adolescents aged 12 years (SD = 0.6) were tested for blood levels of lead (BLL) and mercury (BML) and resting heart rate (RHR). Generalized linear models were conducted to test the relationship between BLL and BML and RHR, controlling for children's sex, age, and socioeconomic status. Analyses were clustered at the preschool level when the children were recruited to adjust for standard error. The mean (SD) BLL and BML were 3.14 (SD = 1.19) μg/dL and 1.26 (SD = 0.68) μg/L at age 12 years, respectively. After adjusting for confounders, we found a significant interaction between BML and BLL in predicting RHR in boys (B = -1.27, SE = 0.49, p < 0.01, n = 289). We created BLL and BML groups in boys based on median cut-offs. Boys in the High BLL/High BML group had significantly lower RHR (mean = 84.22 beats per minute [bpm], SD = 8.77, n = 61) than boys in the Low BLL/Low BML group (mean = 89.03 bpm, SD = 10.75, n = 69; p < 0.05). BML and BLL did not interact to predict RHR in girls (B = -0.18, SE = 0.88, p > 0.05, n = 242). Combined high BLL and BML were associated with low RHR in community adolescent boys. Low RHR is an indication of chronic under-arousal and has been implicated in psychopathology, particularly for externalizing behavior. Our findings may stimulate further communication and research in this area.

Maternal Δ-aminolevulinic acid dehydratase 1-2 genotype enhances fetal lead exposure and increases the susceptibility to the development of cerebral palsy

Limited epidemiologic studies questioned the association between pre- and postnatal lead exposure and the development of cerebral palsy (CP). Moreover, the genotypes of δ-aminolevulinic acid dehydratase (δ-ALAD) in CP patients and their mothers and their association to the blood lead levels (BLLs) were not previously studied. This study aimed to evaluate the association between δ-ALAD gene polymorphism and BLL in cases of CP and their mothers. A case control study was carried out on 23 CP cases and equal number of healthy matched controls. The mothers of the included children were asked to answer a questionnaire involving the baseline clinical and demographic characteristics. Also, questionnaires were done to detect the sources of environmental lead exposure and screen lead exposure during the pregnancy period. BLL, δ-ALAD enzyme activity, and genetic analysis for ALAD G177C were done for each child and his mother. There was significant (p < 0.001) elevation of BLL in CP cases and their mothers that was positively correlated (r = 0.436, p < 0.05). There were progressive decreases in δ-ALAD activity with increasing BLL in both children and mothers (p < 0.05). There were non-significant (p > 0.05) differences between CP and the control group regarding frequency of ALAD G177C genotypes, while there was a significant (p = 0.04) increase in the frequency of ALAD 1-2 (GC) genotype in the mothers of the CP group associated with high BLL and significant decrease in δ-ALAD activity (p < 0.001). The study can indicate the significance of δ-ALAD gene polymorphism in the prenatal exposure to lead and the affection of the developing brain, pointing to the importance of controlling lead in pregnant women especially those with ALAD 1-2 genotype.

A review on fly ash from coal-fired power plants: chemical composition, regulations, and health evidence

Throughout the world, coal is responsible for generating approximately 38% of power. Coal ash, a waste product, generated from the combustion of coal, consists of fly ash, bottom ash, boiler slag, and flue gas desulfurization material. Fly ash, which is the main component of coal ash, is composed of spherical particulate matter with diameters that range from 0.1 μm to >100 μm. Fly ash is predominately composed of silica, aluminum, iron, calcium, and oxygen, but the particles may also contain heavy metals such as arsenic and lead at trace levels. Most nations throughout the world do not consider fly ash a hazardous waste and therefore regulations on its disposal and storage are lacking. Fly ash that is not beneficially reused in products such as concrete is stored in landfills and surface impoundments. Fugitive dust emissions and leaching of metals into groundwater from landfills and surface impoundments may put people at risk for exposure. There are limited epidemiological studies regarding the health effects of fly ash exposure. In this article, the authors provide an overview of fly ash, its chemical composition, the regulations from nations generating the greatest amount of fly ash, and epidemiological evidence regarding the health impacts associated with exposure to fly ash.

A 25-year record of childhood blood lead exposure and its relationship to environmental sources

Broken Hill, the oldest silver (Ag)-zinc (Zn)-lead (Pb) mining community in Australia, has a legacy and ongoing problem of environmental Pb exposure that was identified as early as 1893. To reduce Pb exposure risks, identifying potential exposure pathways and related factors is a critical first step. This study examined blood lead (PbB) levels of children ≤60 months old (n = 24,106 samples), along with Pb concentrations in corresponding soil (n = 10,160 samples), petri-dish dust (n = 106 houses) and ceiling dust (n = 80 houses) over a 25-year period from 1991 to 2015. Regression analysis was used to examine the relationships between environmental Pb sources and children's blood lead (PbB) outcomes. Analysis of the dataset showed Aboriginal children in Broken Hill had a geometric mean PbB of 7.4 μg/dL (95% CI: 6.7-7.4) being significantly higher (p < 0.01) than non-Aboriginal children (PbB 6.2 μg/dL, 95% CI: 6.2-6.3) for all years between 1991 and 2015. Children at the age of 24-36 months had a higher PbB compared with other age groups. Higher PbB levels were also statistically associated with lower socio-economic status and children living in houses built before 1940 (p < 0.01). Blood Pb was also significantly correlated with both soil Pb and indoor petri-dish dust Pb loadings, confirming that these are important pathways for exposure in Broken Hill. A 100 mg/kg increase in soil Pb was associated with a 0.12 μg/dL increase in childhood PbB. In addition, PbB concentrations increased with indoor petri-dish dust Pb loadings (i.e., 0.08 μg/dL per 100 μg/m²/30 days). The 25-year data show that the risk of exposure at ≥ 10 μg/dL was seemingly unavoidable irrespective of residential address (i.e., children of all ages presenting with a ≥10 μg/dL across the whole city area). In terms of moving forward and mitigating harmful early-life Pb exposures, all children aged 24-36 months should be prioritised for feasible and effective intervention practices. Primary intervention must focus on mitigating contemporary ongoing dust emissions from the mining operations and the associated mine-lease areas along with household soil remediation, to help prevent recontamination of homes. Additional practices of dust cleaning using wet mopping and wiping techniques, vacuuming of carpets and furnishings, ongoing monitoring of children and household dust remain important but short-lived abatement strategies. Overall, the key goal should be to eliminate risk by removing contamination in the wider environment as well as in individual homes.

Association between blood lead exposure and mental health in pregnant women: Results from the Japan environment and children's study

OBJECTIVE

Although environmental lead exposure has decreased, several studies have shown that low-level lead exposure can result in adverse psychological symptoms. However, few studies have examined lead neurotoxicity in pregnant women. We investigated the association between lead exposure and psychological symptoms in pregnant women, and between socio-economic status and blood lead levels.

METHODS

Blood lead levels were measured in 17,267 pregnant women in the Japan Environment and Children's Study. Odds ratios (ORs) for high blood lead levels were calculated using multinomial logistic regression. Psychological symptoms were assessed using the Kessler Psychological Distress Scale (K6). ORs for depression (K6 ≥ 13 or ≥5) were calculated using logistic regression with adjustment for potential confounders.

RESULTS

The geometric mean of whole blood lead levels was 0.58 μg/dl (range 0.14-6.75 μg/dl). Higher blood lead levels were associated with older age (OR 1.79, 9 5% confidence interval [CI] 1.46-2.19), unmarried status (OR 1.75, 95 % CI 1.31-2.33), lower household income (OR 1.76, 95 % CI 1.38-2.24), and lower educational attainment (OR 1.34, 95 % CI 1.20-1.48). The percentage of women with K6 scores ≥13 and ≥5 was 3 % and 28.2 %, respectively. There was no significant association between lead exposure and K6 score (K6 ≥ 13: OR 1.00, 95 % CI 0.76-1.32; K6 ≥ 5: OR 0.98, 95 % CI 0.88-1.09).

CONCLUSION

Our results indicate a small but significant association between higher blood lead levels and lower socio-economic status in a population with low blood lead levels, but no association between low-level lead exposure and psychological symptoms.

Study protocol to examine the relationship between environmental exposure to lead and blood lead levels among children from day-care centres in Ekurhuleni Metropolitan Municipality

INTRODUCTION

Lead exposure is toxic to all humans and is very harmful to young children, especially 5-year-olds. Elevated blood lead levels (BLLs) in children have been associated with their daily surrounding environment. This protocol seeks to evaluate the association between environmental lead exposure and BLLs among children in day-care centres, including household and other risk factors.

METHODS AND ANALYSIS

To achieve the objectives of the study, we adopted a cross-sectional analytical design. A portable X-ray fluorescence analyser was used for environmental sampling, and BLLs were determined using the LeadCare II machine among preschool children. Household and other risk factors were assessed using a questionnaire. Random sampling was employed to select day-care centres in the municipality and children in each day-care centre. Data will be analysed using SPSS V. 26.

ETHICS AND DISSEMINATION

Ethical approval and permission were obtained prior to commencement of the study. The researcher intends to publish the results in peer-reviewed journals and also to present a paper at a scientific conference. The study will generate information on environmental lead exposure among vulnerable children (2-5 years), and it will promote public health action to prevent long-term exposure in day-care centres.

Depression, changes in peripheral blood cell count, and changes in selected biochemical parameters related to lead concentration in whole blood (Pb-B) of women in the menopausal period

THE AIM

The aim of this study was to assess the severity of depression, vasomotor symptoms, changes in peripheral blood cell count, and selected biochemical parameters in relation to the concentration of lead in whole blood of women in the perimenopausal period.

METHODS

The study sample consisted of 233 women from the general population of the West Pomeranian Province (Poland) in age between 44-65 years. The intensity of menopausal symptoms was examined using the Blatt-Kupperman Index, and the severity of depression using the Beck Depression Inventory. The following biochemical data were evaluated: concentrations of glucose, triglycerides, HDL, C-reactive protein, glycated haemoglobin, cortisol, insulin, blood cell count, and lead concentration in whole blood (Pb-B).

RESULTS

A whole blood Pb concentration below 5 μg/dl was found in 55 subjects (23.61 %), in 142 women (60.94 %) it ranged from 5 to 10 μg/dl, while in 36 women (15.45 %) was higher than 10 μg/dl. There was a strong positive correlation between Pb concentration in the blood of the examined women and the severity of depressive symptoms (Rs=+0.60, p = 0.001). The lowest mean values for total leukocytes (5.07 ± 1.22 thousand/μl) and neutrophils (2.76 ± 0.86 thousand/μl) were found in women with Pb concentration above 10 μg/dl (p < 0.05). There was a significant negative correlation between the number of total leukocytes (r=-0.45, p = 0.002) and neutrophils (r=-0.50, p = 0.001) and blood Pb concentration. Analysis showed statistically significant differences in glucose concentration (p < 0.05) between groups. Blood glucose was higher in women with Pb-B <5 and between 5-10 μg/dl than in women with Pb-B >10 μg/dl.

CONCLUSION

Exposure to Pb may be a factor playing a significant role in the development of depressive symptoms in menopausal women. It may also be associated with glucose metabolism disorders and immunosuppression in women during this period of life.

Interaction of Toxoplasma gondii infection and elevated blood lead levels on children's neurobehavior

A chronic infection caused by Toxoplasma gondii was considered asymptomatic in immunologically healthy humans, but results from animal and epidemiological studies led to a reconsideration of this assumption. The objective of this study was to evaluate the seroprevalence of T. gondii infection and its possible effects on the behavior of school-aged children in Bahia, Brazil. Serum anti-body determinations were performed by Enzyme-linked Immunosorbent Assay (ELISA). Blood lead levels (BLL) were measured by graphite furnace atomic absorption spectrometry (GFAAS). The evaluation of a child's behavior was assessed using the Child Behavior Check List (CBCL). Multivariate models applying logistic regression were used to test the association of chronic T. gondii infection and BLL with behavioral outcomes in children. Seroprevalence for anti-T. gondii IgG antibody was 43.7 % (95 %-CI: 35.8-51.9). Significant associations between chronic T. gondii infection and total behavioral problems (OR = 2.50; 95 %-CI: 1.06-5.88), internalizing spectrum problems (OR = 4.35; 95 %-CI: 1.11-17.14) and rule breaking (OR = 2.61; 95 %-CI: 1.12-6.05) were observed. A possible interaction between toxoplasmosis prevalence and lead exposure was detected. Children with above the median BLL and positive for IgG anti-T. gondii showed a 5.51-fold increase (95 %-CI: 1.75-17.38) in the chance of displaying disobedient behavior. The results suggest that T. gondii infection may be contributing to the high indices of behavioral changes. Moreover, these findings are the first evidence for a possible interaction between chronic T. gondii infection and elevated blood lead levels on children's neurobehavior.

Contemporary blood lead levels of children aged 0-84 months in China: A national cross-sectional study

Despite the global abundance of studies on children's lead (Pb) exposure, the magnitude of Pb exposure among children across China remains unclear, especially for rural areas. In 2000, Pb was removed from petrol, marking a change in the sources of Pb exposure in China. To better understand children's Pb exposure and inform potential approaches to exposure reduction, we conducted a national blood Pb survey of 31,373 children (0-84 months old) from May 2013 to March 2015, using a multi-stage and multi-strata sampling method. Blood lead levels (BLLs) were tested using graphite furnace atomic absorption spectrometry with a detection limit of 1 µg/L. The results show that Chinese children had a contemporary geometric mean (GM) BLL of 26.7 μg/L, with 8.6% of BLLs exceeding 50 µg/L. Boys had higher BLLs (GM 27.2 μg/L) compared to girls (GM: 25.9 μg/L) (p < 0.001). Children at the age of 0-36 months had a lower PbB (GM 25.7 μg/L) level compared with those aged 36-84 months (GM 27.9 μg/L) (p < 0.001). When taking into account sociodemographic factors, a multivariate logistic regression analysis shows that the odds ratios (OR) of having a BLL of 27 µg/dL (i.e., median BLL of this study) or higher were 1.88 (95% CI: 1.76, 2.02) and 1.35 (95% CI: 1.22, 1.49) for homes using coal and biomass fuels, respectively, compared to those using gas or electricity. Meanwhile, children in homes close to roads were more likely to have BLLs exceeding 27 µg/dL (OR: 1.11, 95% CI: 1.03, 1.20). In China, rural children had higher BLLs compared to urban children. As a result of pediatric exposure to Pb, there were approximately 144 million and 36 million IQ points lost for rural children and urban children, respectively, revealing a disparity of Pb exposure between rural and urban areas in China. Cleaner domestic fuels and improved cooking/heating equipment will reduce contemporary Pb exposure in rural areas. In addition, the association between contemporary BLLs and distance away from roads further suggests that resuspension of legacy soil/dust Pb should not be neglected in future remediation programs and household interventions. As a large scale survey, this study provides evidence for revising the reference value of BLL, improving the guideline for clinical and public health management, and implementing interventions to prevent adverse health outcomes associated with low-level Pb exposure in children.

A systematic review and meta-analysis examining the interrelationships between chemical and non-chemical stressors and inherent characteristics in children with ADHD

Children may be more vulnerable to the combined interactions of chemical and non-chemical stressors from their built, natural, and social environments when compared to adults. Attention deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed childhood neurodevelopmental disorder and is considered a major public health issue, as 75% of childhood cases persist into adulthood. ADHD is characterized by developmentally inappropriate levels of hyperactivity, impulsivity, and inattention, with the neurotransmitter serotonin regulating these symptoms. Monoamine oxidase A (MAOA) aids in serotonin uptake and is often implicated in behavioral and emotional disorders, including ADHD. When children are exposed to cigarette smoke, bisphenol A (BPA), or organophosphate pesticides, MAOA activity is inhibited. Non-chemical stressors, such as traumatic childhood experiences, and lifestyle factors, complicate the relationship between genotype and exposures to chemical stressors. But the co-occurrence among outcomes between exposures to chemical stressors, non-chemical stressors, and the low activity MAOA genotype suggest that mental illness in children may be influenced by multiple interacting factors. In this systematic review, we examine the existing literature that combines exposures to chemical and non-chemical stressors (specifically childhood trauma), MAOA characteristics, and ADHD diagnosis to investigate the interrelationships present. We observe that chemical (lead [Pb], phthalates/plasticizers, persistent organic pollutants, and cigarette smoke) exposure is significantly related to ADHD in children. We also observed that existing literature examining the interaction between MAOA, exposures to chemical stressors, and traumatic experiences and their effect on ADHD outcomes is sparse. We recommend that future studies investigating childhood ADHD include chemical and non-chemical stressors and inherent characteristics to gain a holistic understanding of childhood mental health outcomes.

Environmental lead exposure is associated with neurocognitive dysfunction in children with chronic kidney disease

BACKGROUND

Environmental lead exposure is associated with cognitive impairment in healthy children, with deficits seen in intelligence quotient (IQ), attention, and behavior. Neurocognitive dysfunction is also a well-described complication among children with chronic kidney disease (CKD). The objective was to evaluate the association between blood lead levels (BLL) and performance on neurocognitive assessments in a cohort of children with CKD.

METHODS

Cross-sectional study of children with mild to moderate CKD from the Chronic Kidney Disease in Children (CKiD) multicenter prospective cohort study. The primary exposure was BLL. The primary outcome was performance on age-specific neurocognitive assessments evaluating IQ, executive functioning, attention, hyperactivity, and behavior. Multivariable linear regression was used to evaluate the association between BLL and neurocognitive performance, adjusted for key sociodemographic and clinical variables.

RESULTS

A total of 412 subjects were included with median age 15.4 years, median estimated GFR 39 mL/min/1.73², median BLL 1.2 mcg/dL, and median IQ score 99. In multivariable linear regression, higher BLL was associated with significantly lower IQ score (- 2.1 IQ points for every 1-mcg/dL increase in BLL, p = 0.029). Higher BLL was associated with worse scores on the Conners' Continuous Performance Test II Variability T-Score, a measure of inattention (+ 1.8 T-Score points for every 1-mcg/dL increase in BLL, p = 0.033).

CONCLUSIONS

Low-level lead exposure is associated with significantly lower IQ and more inattention in children with CKD, a population already at high risk for neurocognitive dysfunction. Universal screening for elevated BLL should be considered for all children with CKD at age 12-24 months.

Association of low-level blood lead with serum uric acid in U.S. adolescents: a cross-sectional study

BACKGROUND

Uncertainty remains regarding the association between blood lead levels (BLL) and serum uric acid (SUA) with relatively low BLL exposure because of limited data in the adolescent population. We examined the association between BLL and SUA in U.S. adolescents.

METHODS

In this cross-sectional study, 8303 adolescents aged 12-19 years from NHANES 1999-2006 were analyzed. BLL was Ln-transformed for analysis for the skewed distribution. Elevated SUA was defined as ≥5.5 mg/dL. Multivariate linear and multiple logistic regression analyses were performed to evaluate the association of BLL with SUA and elevated SUA. Moreover, a generalized additive model (GAM) and a fitted smoothing curve (penalized spline method) were conducted.

RESULTS

The overall mean BLL was 1.3 μg/dL. Multivariate linear regression analyses showed that LnBLL was independently and positively correlated with SUA level (β = 0.13, 95%CI: 0.09-0.17). Multiple logistic analyses showed that LnBLL was associated with a 24% increased prevalence of elevated SUA (OR = 1.24; 95% CI, 1.11-1.38). Analyses using restricted cubic spline confirmed that the associations of LnBLL with SUA and elevated SUA were linear. Subgroup analyses showed that stronger associations between LnBLL and SUA were detected in adolescents with lower levels of education and estimated glomerular filtration rate (eGFR) (all P for interaction < 0.05).

CONCLUSIONS

BLL was independently and positively correlated with SUA level and elevated SUA among U.S. adolescents, particularly with lower levels of education and eGFR. The data suggest that there is no "safe" threshold level of exposure to lead.

The Mediation of Maternal Occupational Skillfulness on Maternal Education and Chinese Preschoolers' Behavior

There is growing evidence supporting the individual associations of maternal occupation and maternal education with children's behavioral outcomes. However, few studies have linked these factors together in a mediation model. The current study is the first to examine the mediating effect of maternal occupational skillfulness on the relationship between the length of maternal education and preschool children's behavioral outcomes in the Chinese context. To assess children's behavior, parents and teachers of 286 preschoolers from the China Jintan Cohort Study completed the Child Behavior Checklist (CBCL) and Caregiver-Teacher Report Form (C-TRF), respectively. Sociodemographic information, such as maternal occupational skillfulness and education level, was also collected. Using PROCESS and kappa statistics, maternal occupational skillfulness was found to mediate the effect of length of maternal education on both internalizing and externalizing behaviors of preschoolers, as rated by parents but not on behaviors as rated by teachers. Such findings can provide insight for counseling psychologists or family therapists in providing mothers, particularly those in low-skill jobs, appropriate advice and strategies for handling job-related stress. Mother-child relationships would consequently improve, which could then minimize the development of children's internalizing and externalizing behaviors. Furthermore, teachers could identify at-risk children and provide early intervention. Our findings also offer insight for policy makers to consider legislation providing financial assistance from the government to low-income mothers. Future replication studies should be conducted in other countries so as to determine whether similar results can be obtained.

Ecogenetics of lead toxicity and its influence on risk assessment

Lead (Pb) toxicity is a public health problem affecting millions worldwide. Advances in 'omic' technology have paved the way to toxico-genomics which is currently revolutionizing the understanding of interindividual variations in susceptibility to Pb toxicity and its functional consequences to exposure. Our objective was to identify, comprehensively analyze, and curate all the potential genetic and epigenetic biomarkers studied to date in relation to Pb toxicity and its association with diseases. We screened a volume of research articles that focused on Pb toxicity and its association with genetic and epigenetic signatures in the perspective of occupational and environmental Pb exposure. Due to wide variations in population size, ethnicity, age-groups, and source of exposure in different studies, researchers continue to be skeptical on the topic of the influence of genetic variations in Pb toxicity. However, surface knowledge of the underlying genetic factors will aid in elucidating the mechanism of action of Pb. Moreover, in recent years, the application of epigenetics in Pb toxicity has become a promising area in toxicology to understand the influence of epigenetic mechanisms such as DNA methylation, chromatin remodeling, and small RNAs for the regulation of genes in response to Pb exposure during early life. Growing evidences of ecogenetic understanding (both genetic and epigenetic processes) in a dose-dependent manner may help uncover the mechanism of action of Pb and in the identification of susceptible groups. Such studies will further help in refining uncertainty factors and in addressing risk assessment of Pb poisoning.

Childhood lead poisoning from domestic products in China: A case study with implications for practice, education, and policy

OBJECTIVE

This study aimed to report three representative childhood lead poisoning cases in China from domestic products exposure and to highlight their critical implications for practice, education, and policy in prevention and treatment of childhood lead poisoning by health care providers, especially public health nurses.

DESIGN AND SAMPLE

Three representative childhood lead poisoning cases occurring in 2017 were collected and analyzed.

RESULTS

The lead exposure sources of three cases were evaluated by experts in the field and determined to be tin pots, home factories for tinfoil, and contamination of folk medicine, respectively. These cases demonstrated that the lack of lead exposure risk assessment, insufficient knowledge of potential lead exposure sources, underdeveloped policy, and regulations were areas for improvement.

CONCLUSIONS

The best strategies for preventing lead poisoning include an appropriate risk assessment of lead exposure, implementation of comprehensive parental health education, conduction of further research by public health providers, and the application of policy strategies by the government. It was determined that public health nurses are at the frontline of prevention of lead poisoning in children.

Blood lead, bone lead and child attention-deficit-hyperactivity-disorder-like behavior

BACKGROUND AND OBJECTIVE

Mounting evidence showed that lead exposure increased the risk of child attention-deficit-hyperactivity disorder (ADHD). Epidemiologic studies have typically used the blood-lead as a biomarker of lead exposure; blood-lead levels mostly reflect recent lead exposure. However, few studies have examined the relationship between bone-lead, a biomarker of cumulative exposure, and ADHD. Therefore, we aimed to compare the associations of bone-lead vs blood-lead levels with child ADHD symptoms and comorbidities.

METHODS

A total of 164 children aged 3-15 years were enrolled during 2014-2015. The Vanderbilt-ADHD-Diagnostic-Parent-Rating Scale (VADPRS) was used to evaluate the children's ADHD symptoms and comorbidities. Children's blood and bone lead concentrations were assessed, the latter using a non-invasive K-X-ray-fluorescence technique. According to blood-lead levels, children were classified into high (blood-lead ≥ 10.0 μg/dL) and low (blood-lead < 10.0 μg/dL) blood-lead groups. According to bone-lead levels, children were classified into high (bone-lead ≥ 2.66 μg/g) and low (bone-lead < 2.66 μg/g) bone-lead groups. We associated blood/bone lead with VADPRS data using multi-variable binary logistic regression models.

RESULTS

Children in the high blood-lead group had higher hyperactivity/impulsivity (P = 0.02) scores than the corresponding low blood-lead group. Children in the high bone-lead group had higher hyperactivity/impulsivity (P = 0.02) and oppositional-defiant-disorder (ODD) (P = 0.03) scores than the corresponding low bone-lead group. After adjusting for relevant confounders, children in the high bone-lead group were more likely to have ODD-behavior than the low group (OR = 6.7, 95%CI: 1.2-36.5). However, no adjusted association was observed between blood-lead and any ADHD-domain score.

CONCLUSION

High levels of cumulative lead exposure in children may be an independent risk factor of ODD-behavior.

Circulatory Levels of Toxic Metals (Aluminum, Cadmium, Mercury, Lead) in Patients with Alzheimer's Disease: A Quantitative Meta-Analysis and Systematic Review

BACKGROUND

Environmental exposure to toxic metals has been postulated to play a role in the pathophysiological processes of Alzheimer's disease (AD). However, the circulatory levels of toxic metals in AD patients are not consistent in previous studies.

OBJECTIVE

To systematically assess levels of toxic metals (aluminum, mercury, cadmium, lead) in the circulation (blood, serum/plasma) of AD patients and controls.

METHODS

PubMed, Web of Science, Science Direct, Cochrane Library, and the China National Knowledge Infrastructure (CNKI) were systematically searched to identify studies published up to January 1, 2017. Meta-analyses were performed using random-effects models and the pooled standardized mean difference (SMD) were reported with 95% confidence intervals (CI).

RESULTS

We identified 17, 7, 8, and 10 studies for aluminum, mercury, cadmium, and lead, respectively. Meta-analyses showed significantly elevated circulatory levels of aluminum (SMD = 1.08, 95% CI: 0.66, 1.50), mercury (SMD = 0.55, 95% CI, 0.15, 0.95), and cadmium (SMD = 0.62, 95% CI: 0.12, 1.11), whereas lower levels of lead (SMD = -0.23, 95% CI: -0.38, -0.07) in AD patients than in controls. Publication bias was only observed for aluminum studies, but the "trim and fill" analysis showed that the publication bias did not alter the direction of the effect. Sensitivity analyses showed no studies from the pooled analysis changed the results.

CONCLUSION

Compared to controls, circulatory levels of aluminum, mercury, and cadmium are significantly higher but the levels of lead were reduced in AD patients. These findings suggest that elevated aluminum, mercury, and cadmium in the circulation, especially in serum may play a role in the progression of AD.

Environmental injustice and childhood lead exposure in peri-urban (ger) areas of Darkhan and Erdenet, Mongolia

BACKGROUND

The ger ("tent city") areas in Mongolia are a product of rapid urbanization and transitional economic development combine with lack of institutional, administrative and financial capacity of governments to cope with the pace. These areas have become traps for inequities in social and environmental services and the associated effects on human health. Disparities in childhood lead exposure in such communities are largely unexplored.

METHODS

We measured the concentrations of lead in blood of children, aged 4-7 years, in Erdenet (Orkhon Province) and Darkhan (Darkhan-Uul Province), the second and third largest cities in Mongolia. A survey instrument was used to gather information on influencing factors on lead exposure and the Strengths and Difficulties Questionnaire (SDQ) was used to assess a spectrum of behavioral problems among the children.

RESULTS

The mean blood lead level (BLL) of children in the two cities was found to be 3.8 ± 2.6 μg/dL (range: < 1.5-17.2 μg/dL) and 27.8% of the children had BLLs ≥5 μg/dL. Average BLL of children in Erdenet (a mining center) was significantly higher than that for children in Darkhan, and there was statistically significant difference between average BLL of children who live in ger district (4.2 ± 2.8 μg/dL) compared to those of children in housing units within the city (3.2 ± 2.4 μg/dL). In spite of the low values, BLLs was significantly associated with a number of effects on the spectrum of behavioral disorders, specifically with the scores for hyperactivity, conduct disorder and pro-social behavior.

CONCLUSIONS

This study shows that childhood lead poisoning is common especially in ger communities of the urban areas of Mongolia. It contributes evidence showing that BLL low as 3.8 μg/dL can selectively activate some effects from a spectrum of likely behavioral disorders in children.