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Petti E, Schiffman J, Oh H, Karcher NR. Evidence for Environmental Risk Factors and Cumulative Stress Linking Racial/Ethnic Identity and Psychotic-Like Experiences in ABCD Study Data. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00311-3. [PMID: 38852932 DOI: 10.1016/j.jaac.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 04/14/2024] [Accepted: 05/31/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE Previous work has found increased endorsement of psychotic-like experiences (PLEs) among marginalized racial and ethnic groups. According to social determinants frameworks, marginalized groups are at increased risk for exposure to socio-environmental risk factors, including systemic factors (eg, poverty and poor housing conditions) and social stressors (eg, discrimination). We examine the extent to which environmental risk factors and stress account for associations between racial/ethnic groups with PLEs. METHOD Analyses included 11,876 young adolescents 9 to 10 years of age from the Adolescent Brain Cognitive Development (ABCD) study. Mediation models assessed whether stress at 1-year follow-up indirectly linked baseline environmental risk to later distressing PLEs at 2-year follow-up. Serial mediation models examined whether environmental risk and stress indirectly accounted for variation among racial/ethnic groups in self-reported distressing PLEs. RESULTS Through principal component and mediation analyses, we found evidence that the link between environmental risk (eg, poverty and exposure to crime) and distressing PLEs was mediated by stress. There was also evidence that higher endorsement of distressing PLEs within the Black and Hispanic groups was serially mediated by greater environmental risk and greater stress. CONCLUSION The analyses provide evidence that the associations between marginalized racial and ethnic identities with the endorsement of PLEs partially reflects the sequelae of systemic socio-environmental factors. Findings suggest the potential for intervening upon environmental risk factors to target the reduction of cumulative stress over time, which may in turn buffer against the development of PLEs. PLAIN LANGUAGE SUMMARY Using longitudinal data from 11,876 young adolescents aged 9-10 from the Adolescent Brain Cognitive Development (ABCD) study, this study examined environmental (e.g., poverty) and stress-related factors (e.g., experiences of discrimination, childhood adversity) that are associated with psychotic-like experiences, and whether these factors explain racial/ethnic differences in psychotic-like experiences. The authors found evidence that the association between these environmental risk factors and psychotic-like experiences is partially explained by cumulative stress, and that differences in psychotic-like experiences across racial/ethnic groups were accounted for by both environmental risk factors and stress. Results highlight that systemic factors may explain higher levels of psychotic-like experiences among historically marginalized racial/ethnic groups. Findings suggest the potential for intervening upon modifiable risk factors to buffer against stress, and in turn, the development of psychotic-like experiences over time. DIVERSITY INCLUSION STATEMENT We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way.
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Affiliation(s)
- Emily Petti
- University of California, Irvine, California.
| | | | - Hans Oh
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, California
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Huynh BQ, Chin ET, Kiang MV. Estimated Childhood Lead Exposure From Drinking Water in Chicago. JAMA Pediatr 2024; 178:473-479. [PMID: 38497944 PMCID: PMC10949143 DOI: 10.1001/jamapediatrics.2024.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/12/2024] [Indexed: 03/19/2024]
Abstract
Importance There is no level of lead in drinking water considered to be safe, yet lead service lines are still commonly used in water systems across the US. Objective To identify the extent of lead-contaminated drinking water in Chicago, Illinois, and model its impact on children younger than 6 years. Design, Setting, and Participants For this cross-sectional study, a retrospective assessment was performed of lead exposure based on household tests collected from January 2016 to September 2023. Tests were obtained from households in Chicago that registered for a free self-administered testing service for lead exposure. Machine learning and microsimulation were used to estimate citywide childhood lead exposure. Exposure Lead-contaminated drinking water, measured in parts per billion. Main Outcomes and Measures Number of children younger than 6 years exposed to lead-contaminated water. Results A total of 38 385 household lead tests were collected. An estimated 68% (95% uncertainty interval, 66%-69%) of children younger than 6 years were exposed to lead-contaminated water, corresponding to 129 000 children (95% uncertainty interval, 128 000-131 000 children). Ten-percentage-point increases in block-level Black and Hispanic populations were associated with 3% (95% CI, 2%-3%) and 6% (95% CI, 5%-7%) decreases in odds of being tested for lead and 4% (95% CI, 3%-6%) and 11% (95% CI, 10%-13%) increases in having lead-contaminated drinking water, respectively. Conclusions and Relevance These findings indicate that childhood lead exposure is widespread in Chicago, and racial inequities are present in both testing rates and exposure levels. Machine learning may assist in preliminary screening for lead exposure, and efforts to remediate the effects of environmental racism should involve improving outreach for and access to lead testing services.
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Affiliation(s)
- Benjamin Q. Huynh
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth T. Chin
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mathew V. Kiang
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California
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Park SK, Wang X, Lee S, Hu H. Do we underestimate risk of cardiovascular mortality due to lead exposure? THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 923:171511. [PMID: 38453073 DOI: 10.1016/j.scitotenv.2024.171511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/21/2023] [Accepted: 03/03/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Studies using data from the National Health and Nutrition Examination Survey-III (NHANES-III) have demonstrated significant prospective associations between blood lead levels and increased mortality. Bone lead represents cumulative lead burden and thus is a better biomarker for assessing chronic impacts, but its in vivo assessment requires special K-x-ray fluorescence (KXRF) instrumentation. Our team recently developed an algorithm predicting bone lead levels from a combination of blood lead levels, age and other socioeconomic and behavioral variables. We examined the associations of our algorithm-estimated bone lead levels and mortality in NHANES-III. METHODS We included 11,628 adults followed up to December 31, 2019. Estimated tibia lead and patella lead levels were calculated using our prediction algorithms. We used survey-weighted Cox proportional hazards models to compute hazard ratios (HRs) and 95 % confidence intervals (CIs). RESULTS During the median follow-up of 26.8 years, 4900 participants died (mortality rate = 1398 per 100,000 adults/year). Geometric means (95 % CIs) of blood lead, predicted tibia lead, and predicted patella lead were 2.69 μg/dL (2.54, 2.84), 6.73 μg/g (6.22, 7.25), and 16.3 μg/g (15.9, 16.8), respectively. The associations for all-cause mortality were similar between blood lead and bone lead. However, the associations for cardiovascular mortality were much greater with predicted bone lead markers compared to blood lead: for comparing participants at the 90th vs. 10th percentiles of exposure, HR = 3.32 (95 % CI: 1.93-5.73) for tibia lead, 2.42 (1.56-3.76) for patella lead, 1.63 (1.25-2.14) for blood lead. The population attributable fractions for cardiovascular disease mortality if everyone's lead concentrations were declined to the 10th percentiles were 45.8 % (95 % CI: 28.1-59.4) for tibia lead, 33.1 % (18.1-45.8) for patella lead, and 22.8 % (10.4-33.8) for blood lead. CONCLUSIONS These findings suggest that risk assessment for cardiovascular mortality based on blood lead levels may underestimate the true mortality risk of lead exposure.
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Affiliation(s)
- Sung Kyun Park
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MA, USA; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MA, USA.
| | - Xin Wang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MA, USA
| | - Seulbi Lee
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MA, USA
| | - Howard Hu
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MA, USA; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Balza J, Bikomeye JC, Flynn KE. Effectiveness of educational interventions for the prevention of lead poisoning in children: a systematic review. REVIEWS ON ENVIRONMENTAL HEALTH 2024; 0:reveh-2023-0108. [PMID: 38421442 DOI: 10.1515/reveh-2023-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Childhood exposure to lead has severe health consequences including long-term physical, behavioral, and learning problems. Lead poisoning often occurs in the home and persists as a form of environmental injustice, disparately impacting certain children based on factors such as socioeconomic status, immigration status, and race. Because abatement is costly, many prevention programs rely on educational interventions. We conducted a systematic review to assess the effectiveness of educational interventions on reducing blood lead levels (BLL) in children. CONTENT Following PRISMA-P guidelines, a librarian-guided search strategy incorporated database-specific subject headings and keywords related to lead poisoning and education, and encompassed four databases: Ovid MEDLINE, Scopus, Web of Science Core Collection and CINAHL. Two reviewers screened the results for those that met inclusion criteria (original research, study population of children under 18 years, inclusion of an educational intervention, outcome of BLL). SUMMARY AND OUTLOOK We screened the titles of 2,062 non-duplicate studies, the abstracts of 78 studies, and full texts of 23 articles, resulting in 17 articles that met eligibility criteria. Thirteen studies used multi-pronged interventions, which precluded comprehensive assessment of the effectiveness of the educational component. Interventions that had success in lowering BLL included some notable elements: longevity of intervention, consideration of culture and ethnicity; use of a community or home-based approach; and provision of supplies or assistance with cleaning. Of the four of studies that used solely educational interventions, three were successful in reducing BLL. Among the 12 studies that used a control group, six found their interventions to be successful in reducing BLL. This review found that educational interventions, either alone or as part of a multi-pronged approach, do not consistently reduce BLL in children. However, educational interventions may decrease severity of lead poisoning in children when more robust interventions are not feasible.
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Affiliation(s)
- Joanna Balza
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jean C Bikomeye
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Coulton C, Richter FGC, Cho Y, Park J, Jeon J, Fischer RL. Making the case for lead safe housing: Downstream effects of lead exposure on outcomes for children and youth. Health Place 2023; 84:103118. [PMID: 37839260 DOI: 10.1016/j.healthplace.2023.103118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/11/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023]
Abstract
Lead based paint is a predominate source of lead exposure in children, which has a documented negative effect on their health and development. Despite public health efforts, the housing stock in disinvested neighborhoods in many cities continues to present significant risk of childhood lead exposure. In this article, we describe how a multi-agency integrated data system was used to document the impact of lead exposure on indicators of child and youth development as recorded in educational and human service systems. By tracking administrative data for two cohorts of Cleveland, Ohio children from birth to early adulthood and using rigorous matching methods to reduce confounders when comparing those with and without elevated blood lead levels, we document negative effects on developmental, behavioral and socio-economic outcomes due to early childhood lead exposure. The magnitude of disparities between individuals who had elevated blood lead levels (≥5 μg/dL) in early childhood, compared to their matched counterparts, is in the ranges of 20-40%. The analysis is framed by clarifying the context, assumptions and limitations associated with the use of administrative data. This type of information has been useful in illuminating the burden of lead exposure for children, families and youth serving agencies and engaging public officials, landlords and residents in initiatives to bring housing up to lead safe standards.
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Affiliation(s)
- Claudia Coulton
- Center on Poverty and Community Development, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, USA.
| | - Francisca García-Cobián Richter
- Center on Poverty and Community Development, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, USA
| | - Youngmin Cho
- Center on Poverty and Community Development, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, USA; Ewha Womans University, 52 Ewhayeod! ae-gil, Daehyeon-dong, Seodaemun-gu, Seoul, South Korea
| | - Jiho Park
- Center on Poverty and Community Development, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, USA
| | - Jeesoo Jeon
- Center on Poverty and Community Development, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, USA
| | - Robert L Fischer
- Center on Poverty and Community Development, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, USA
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Talayero MJ, Robbins CR, Smith ER, Santos-Burgoa C. The association between lead exposure and crime: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002177. [PMID: 37527230 PMCID: PMC10393136 DOI: 10.1371/journal.pgph.0002177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/21/2023] [Indexed: 08/03/2023]
Abstract
Prior research has demonstrated an association between lead exposure and criminal behavior at the population-level, however studies exploring the effect of lead exposure on criminal behavior at the individual-level have not been reviewed systematically. The intent of this study is to complete a systematic review of all studies assessing individual-level exposures to lead and the outcomes of crime and antisocial behavior traits. We included peer reviewed studies that were published prior to August 2022 and were classified as cohort, cross-sectional, or case-control. Studies measuring the outcomes of crime, delinquency, violence, or aggression were included. The following databases were searched using a standardized search strategy: ProQuest Environmental Science Database, PubMed, ToxNet and the Public Affairs Information Service (PAIS). Seventeen manuscripts met our inclusion criteria. Blood lead was measured in 12 studies, bone lead in 3 studies, and dentine lead levels in 2 studies. This systematic review identified a wide range of diverse outcomes between exposure to lead at multiple windows of development and later delinquent, criminal and antisocial behavior. A review of all potential confounding variables included within each study was made, with inclusion of relevant confounders into the risk of bias tool. There is limited data at the individual level on the effects of prenatal, childhood, and adolescent lead exposure and later criminal behavior and more evidence is necessary to evaluate the magnitude of the associations seen in this review. Our review, in conjunction with the available biological evidence, suggests that an excess risk for criminal behavior in adulthood exists when an individual is exposed to lead in utero or in the early years of childhood. The authors report no conflict of interest and no funding source. Clinical trial registration: PROSPERO ID: CRD42021268379.
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Affiliation(s)
- Maria Jose Talayero
- Department of Environmental and Occupational Health, The George Washington University, Washington, DC, United States of America
| | - C Rebecca Robbins
- Department of Environmental and Occupational Health, The George Washington University, Washington, DC, United States of America
| | - Emily R Smith
- Department of Global Health, The George Washington University, Washington, DC, United States of America
| | - Carlos Santos-Burgoa
- Department of Global Health, The George Washington University, Washington, DC, United States of America
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Kim N, Anneser E, Chu MT, Nguyen KH, Stopka TJ, Corlin L. Household conditions, COVID-19, and equity: Insight from two nationally representative surveys. RESEARCH SQUARE 2023:rs.3.rs-3129530. [PMID: 37461724 PMCID: PMC10350171 DOI: 10.21203/rs.3.rs-3129530/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background With people across the United States spending increased time at home since the emergence of COVID-19, housing characteristics may have an even greater impact on health. Therefore, we assessed associations between household conditions and COVID-19 experiences. Methods We used data from two nationally representative surveys: the Tufts Equity Study (TES; n = 1449 in 2021; n = 1831 in 2022) and the Household Pulse Survey (HPS; n = 147,380 in 2021; n = 62,826 in 2022). In the TES, housing conditions were characterized by heating/cooling methods; smoking inside the home; visible water damage/mold; age of housing unit; and self-reported concern about various environmental factors. In TES and HPS, household size was assessed. Accounting for sampling weights, we examined associations between each housing exposure and COVID-19 outcomes (diagnosis, vaccination) using separate logistic regression models with covariates selected based on an evidence-based directed acyclic graph. Results Having had COVID-19 was more likely among people who reported poor physical housing condition (odds ratio [OR] = 2.32; 95% confidence interval [CI] = 1.17-4.59; 2021), visible water damage or mold/musty smells (OR = 1.50; 95% CI = 1.10-2.03; 2022), and larger household size (5+ versus 1-2 people; OR = 1.53, 95% CI = 1.34-1.75, HPS 2022). COVID-19 vaccination was less likely among participants who reported smoke exposure inside the home (OR = 0.53; 95% CI = 0.31-0.90; 2022), poor water quality (OR = 0.42; 95% CI = 0.21-0.85; 2021), noise from industrial activity/construction (OR = 0.44; 95% CI = 0.19-0.99; 2022), and larger household size (OR = 0.57; 95% CI = 0.46-0.71; HPS 2022). Vaccination was also positively associated with poor indoor air quality (OR = 1.96; 95% CI = 1.02-3.72; 2022) and poor physical housing condition (OR = 2.27; 95% CI = 1.01-5.13; 2022). Certain heating/cooling sources were associated with COVID-19 outcomes. Conclusions Our study found poor housing conditions associated with increased COVID-19 burden, which may be driven by systemic disparities in housing, healthcare, and financial access to resources during the COVID-19 pandemic.
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Balza JS, Bikomeye JC, Beyer KMM, Rublee C, Flynn KE. Elevated blood lead levels of refugee children in the United States: a systematic review of recent literature (2011-2021). REVIEWS ON ENVIRONMENTAL HEALTH 2023; 38:361-383. [PMID: 35443103 DOI: 10.1515/reveh-2022-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/28/2022] [Indexed: 06/02/2023]
Abstract
Lead is an environmental hazard; even small elevations in blood lead level can cause serious negative health effects in children, including irreversible impacts such as learning difficulties, attention disorders, and behavioral issues. Previous research has shown that some groups are at higher risk for lead poisoning including racial/ethnic minorities, those with low economic status, and immigrants, especially refugees. This systematic review explores recent literature studying disparities in lead poisoning in refugee children. Search terms were chosen with the assistance of a medical librarian, and two independent reviewers assessed articles using a PICOS criteria (Population, Intervention, Comparison, Outcome, Study Design) following the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRIMSA-P) guidelines, a set of evidence-based minimum standards for reporting in systematic reviews. 321 article titles were reviewed, 61 abstracts screened, and 17 methods sections reviewed, ultimately including 13 studies. The studies found a high prevalence of elevated blood lead level among refugee populations when compared to reference populations. Both pre-migration and post-migration factors were identified as contributors to the disparity, and associations were identified between elevated blood lead levels and factors such as country of origin, age, and other health variables. Health providers and resettlement workers should be aware of these disparities and related factors. Testing, care, education and consistent follow-up should be provided.
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Affiliation(s)
- Joanna S Balza
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jean C Bikomeye
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kirsten M M Beyer
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Caitlin Rublee
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Obeng A, Roh T, Aggarwal A, Uyasmasi K, Carrillo G. The contribution of secondhand tobacco smoke to blood lead levels in US children and adolescents: a cross-sectional analysis of NHANES 2015-2018. BMC Public Health 2023; 23:1129. [PMID: 37308859 DOI: 10.1186/s12889-023-16005-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/27/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Lead is a major developmental neurotoxicant in children, and tobacco smoke has been suggested as a source of lead exposure in vulnerable populations. This study evaluates the contribution of secondhand tobacco smoke (SHS) to blood lead levels (BLLs) in children and adolescents. METHODS We analyze data from 2,815 participants aged 6-19 years who participated in the National Health and Nutrition Examination Survey (2015-2018) to investigate the association between serum cotinine levels and BLLs. A multivariate linear regression was conducted to estimate geometric means (GMs) and the ratios of GMs after adjusting for all covariates. RESULTS The geometric means of BLLs in study participants aged 6 - 19 years were 0.46 µg/dl (95% CI 0.44, 0.49). After adjusting for relevant participant characteristics, the geometric means of BLLs were 18% (BLL 0.48 µg/dl, 95% CI 0.45, 0.51) and 29% (BLL 0.52 µg/dl, 95% CI 0.46, 0.59) higher in participants who had intermediate serum cotinine levels (0.03 - 3 ng/mL) and those who had high serum cotinine levels (> 3 ng/mL) respectively, compared to participants who had low serum cotinine levels (BLL 0.41 µg/dl, 95% CI 0.38, 0.43). CONCLUSIONS SHS exposure may be a source of BLLs in US children and adolescents. Efforts to reduce lead exposure in children and adolescents should include strategies to reduce SHS exposure.
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Affiliation(s)
- Alexander Obeng
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, 77843, USA
| | - Taehyun Roh
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, 77843, USA
| | - Anisha Aggarwal
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, 77843, USA
| | - Kido Uyasmasi
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, 77843, USA
| | - Genny Carrillo
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, 77843, USA.
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Wilson NJ, Friedman E, Kennedy K, Manolakos PT, Reierson L, Roberts A, Simon S. Using exterior housing conditions to predict elevated pediatric blood lead levels. ENVIRONMENTAL RESEARCH 2023; 218:114944. [PMID: 36473524 DOI: 10.1016/j.envres.2022.114944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/06/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Housing-based lead paint dust is the most common source of lead exposure for US-born children. Although year of housing construction is a critical indicator of the lead hazard to US children, not all housing of the same age poses the same risk to children. Additional information about housing condition is required to differentiate the housing-based lead risk at the parcel level. This study aimed to identify and assess a method for gathering and using observations of exterior housing conditions to identify active housing-based lead hazards at the parcel level. We used a dataset of pediatric blood lead observations (sample years 2000-2013, ages 6-72 months, n = 6,589) to assess associations between observations of exterior housing conditions and housing-based lead risk. We used graphical and Lasso regression methods to estimate the likelihood of an elevated blood lead observation (≥3.5 μg/dL). Our methods estimate a monotonic increase in the likelihood of an elevated blood lead observation as housing conditions deteriorate with the largest changes associated with homes in the greatest disrepair. Additionally we estimate that age of home construction works in consort with housing conditions to amplify risks among those houses built before 1952. Our analysis indicates that a survey of external housing conditions can be used in combination with age of housing in the identification process, at the parcel level, of homes that pose a housing-based lead hazard to children.
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Affiliation(s)
- Neal J Wilson
- Research Associate, Center of Economic Information, Department of Economics, University of Missouri-Kansas City, Kansas City, MO, USA.
| | - Elizabeth Friedman
- Medical Director of Environmental Health Program, Department of Pediatrics, Children's Mercy, Kansas City, Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| | - Kevin Kennedy
- Director of Environmental Health Program, Children's Mercy, Kansas City, MO, USA.
| | - Panayiotis T Manolakos
- Director, Center of Economic Information, Department of Economics, University of Missouri-Kansas City, Kansas City, MO, USA.
| | - Lori Reierson
- Research Compliance Coordinator, Children's Mercy, Kansas City, MO, USA.
| | - Amy Roberts
- Program Manager, Childhood Lead Poisoning Prevention and Healthy Homes Program, Kansas City Missouri Health Department, Kansas City, MO, USA.
| | - Steve Simon
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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Oliva B, Som K. National-Scale Assessment of Environmental Justice Trends in Public School Proximity to Industrial Lead Sources. ENVIRONMENTAL JUSTICE (PRINT) 2022; 16:10.1089/env.2022.0028. [PMID: 36960345 PMCID: PMC10031512 DOI: 10.1089/env.2022.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Lead poisoning can severely affect neurological development in small children. Communities with environmental justice concerns often face higher levels of lead exposure via multiple routes of exposure. School-aged children can be exposed to lead at their schools through the deposition of lead emissions onto soil over time. METHOD Public school students' demographics in 'proximate schools;' those within 1.5 km of facilities with lead emissions were compared to other schools in their area. The average proximate emissions per student were calculated for different demographic groups in various geographic areas. RESULTS Schools in combined statistical areas within 1.5 km of lead facilities were found to be composed of significantly more Black (22%) and Hispanic (30%) students than other schools in the area (17% and 26% respectively). Meanwhile, schools close to lead sources tended to have smaller proportions of white students (37% in 'proximate schools', but 47% overall. When average emissions around students were calculated for a handful of combined statistical areas, inequality in lead exposure could be seen in almost every geographic area, across income and racial lines. DISCUSSION Students of color consistently faced the highest emissions in every area, though amounts, inequities, and at-risk populations differed throughout the different geographic areas. CONCLUSION The unique history of each location regarding immigration, discrimination, zoning laws, urban sprawl, and industrial past can contribute to this variety in inequities. These findings are not only consistent with environmental justice trends but also highlight other vulnerabilities for students like age and food security.
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Affiliation(s)
- Beatriz Oliva
- ORISE Research Participant, Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Kushal Som
- US Environmental Protection Agency, Region 5, Chicago, IL
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Eneanya ND, Boulware LE, Tsai J, Bruce MA, Ford CL, Harris C, Morales LS, Ryan MJ, Reese PP, Thorpe RJ, Morse M, Walker V, Arogundade FA, Lopes AA, Norris KC. Health inequities and the inappropriate use of race in nephrology. Nat Rev Nephrol 2022; 18:84-94. [PMID: 34750551 PMCID: PMC8574929 DOI: 10.1038/s41581-021-00501-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/13/2022]
Abstract
Chronic kidney disease is an important clinical condition beset with racial and ethnic disparities that are associated with social inequities. Many medical schools and health centres across the USA have raised concerns about the use of race - a socio-political construct that mediates the effect of structural racism - as a fixed, measurable biological variable in the assessment of kidney disease. We discuss the role of race and racism in medicine and outline many of the concerns that have been raised by the medical and social justice communities regarding the use of race in estimated glomerular filtration rate equations, including its relationship with structural racism and racial inequities. Although race can be used to identify populations who experience racism and subsequent differential treatment, ignoring the biological and social heterogeneity within any racial group and inferring innate individual-level attributes is methodologically flawed. Therefore, although more accurate measures for estimating kidney function are under investigation, we support the use of biomarkers for determining estimated glomerular filtration rate without adjustments for race. Clinicians have a duty to recognize and elucidate the nuances of racism and its effects on health and disease. Otherwise, we risk perpetuating historical racist concepts in medicine that exacerbate health inequities and impact marginalized patient populations.
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Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer Tsai
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Marino A Bruce
- Program for Research on Faith, Justice, and Health, Department of Behavioral and Social Sciences, University of Houston College of Medicine, Houston, TX, USA
| | - Chandra L Ford
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Christina Harris
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Leo S Morales
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Michael J Ryan
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle Morse
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Valencia Walker
- Department of Paediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Antonio A Lopes
- Clinical Epidemiology and Evidence-Based Medicine Unit of the Edgard Santos University Hospital and Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil
| | - Keith C Norris
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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13
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Green KA, Bovell-Ammon A, Sandel M. Housing and Neighborhoods as Root Causes of Child Poverty. Acad Pediatr 2021; 21:S194-S199. [PMID: 34740428 DOI: 10.1016/j.acap.2021.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/16/2021] [Accepted: 08/25/2021] [Indexed: 10/19/2022]
Abstract
Understanding how housing inequities among families with children are rooted in structural racism is important for identifying opportunities to engage in ongoing and collective work as pediatricians to lift children out of poverty. This article discusses the complex mechanisms between housing and child and family health outcomes, and offers potential solutions linking housing, health programs, and policy solutions. Beginning with a review of historical antecedents of housing policy and their impact on health inequities, the authors outlines policies and structures directly linked to disproportionate housing instability and inequities in health outcomes among children. This article examines four key domains of housing - affordability, stability, quality, and neighborhood - and their relationship to child and family health. Finally, the authors present multidimensional solutions for advancing health equity.
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Affiliation(s)
| | | | - Megan Sandel
- Department of Pediatrics, Boston Medical Center (M Sandel), Boston, Mass.
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14
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Liu X, Taylor MP, Aelion CM, Dong C. Novel Application of Machine Learning Algorithms and Model-Agnostic Methods to Identify Factors Influencing Childhood Blood Lead Levels. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:13387-13399. [PMID: 34546733 DOI: 10.1021/acs.est.1c01097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
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.
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Affiliation(s)
- Xiaochi Liu
- School of Information Engineering, China University of Geosciences, Beijing 100083, China
- Earth and Environmental Sciences, Faculty of Science and Engineering, Macquarie University, Sydney 2109, New South Wales, Australia
| | - Mark P Taylor
- Earth and Environmental Sciences, Faculty of Science and Engineering, Macquarie University, Sydney 2109, New South Wales, Australia
| | - C Marjorie Aelion
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts, Amherst 01003, Massachusetts, United States
| | - Chenyin Dong
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou 510655, China
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15
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Malavika L, Goyal T, Mitra P, Saikiran G, Sharma S, Sharma P. Risk Factors for Lead Toxicity and its Effect on Neurobehavior in Indian Children. Indian J Clin Biochem 2021; 37:294-302. [DOI: 10.1007/s12291-021-00995-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
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16
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Boyle J, Yeter D, Aschner M, Wheeler DC. Estimated IQ points and lifetime earnings lost to early childhood blood lead levels in the United States. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 778:146307. [PMID: 34030355 DOI: 10.1016/j.scitotenv.2021.146307] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
There is no safe detectable level of lead (Pb) in the blood of children. Blood lead levels (BLLs) at ages 6-24 months ≥2 μg/dL result in lost grade school intelligence quotient (IQ) points at ages 5-10 years. Black children continue to have the highest BLLs in the United States. Therefore, we examined currently undetermined racial/ethnic disparities in anticipated IQ points and associated lifetime earnings lost to early childhood blood lead. We conducted secondary analysis of infants with blood lead (in μg/dL) measured at ages 12-24 months by the cross-sectional National Health and Nutrition Examination Survey (NHANES) during 1999 to 2010. Nationally-representative estimates were produced using weighted simulation model. A total of 1241 infants were included from the NHANES sample (52% male; mean [SD] age, 18.5 [3.5] months; 25% Black [non-Hispanic], 42% Hispanic [any race], 5% Other/Multiracial, and 29% White [non-Hispanic]) after excluding 811 without BLL determinations. For national outcomes, Black infants experienced approximately 46-55% greater average estimated loss of grade school IQ points from blood lead than Hispanic or White infants (-1.78 IQ points vs. -1.15 and -1.21 respectively) with similar disparities in costs to expected lifetime earnings (-$47,116 USD vs. -$30,393 and -$32,356 respectively). Our estimated nationwide costs of IQ points lost to BLLs during this 12-year period totaled $554 billion ($46.2 billion/year), in which blood lead <5 μg/dL accounted for 74% of this total burden. We report two aspects of the substantial national costs attributable to lead exposure in just the second year of life alone, which disproportionately impact predominately African-American Black infants from continuing legacies of environmental racism in lead exposure. Our findings underscore the remarkably high costs from recognized hazards of blood lead even at the lowest levels and the importance of primary prevention regarding childhood lead exposure.
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Affiliation(s)
- Joseph Boyle
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Deniz Yeter
- School of Nursing, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David C Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23284, USA.
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17
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Bravo MA, Miranda ML. Effects of accumulated environmental, social and host exposures on early childhood educational outcomes. ENVIRONMENTAL RESEARCH 2021; 198:111241. [PMID: 33933487 PMCID: PMC8176571 DOI: 10.1016/j.envres.2021.111241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Persistent disparities in academic performance may result from a confluence of adverse exposures accruing disproportionately to specific subpopulations. OBJECTIVE Our overarching objective was to investigate how multiple exposures experienced over time affect early childhood educational outcomes. We were specifically interested in whether there were: racial/ethnic disparities in prevalence of adverse exposures; racial/ethnic disparities in associations observed between adverse exposures and early childhood educational outcomes; and interactions between exposures, suggesting that one exposure augments susceptibility to adverse effects of another exposure. METHODS We link geocoded North Carolina birth data for non-Hispanic white (NHW) and non-Hispanic black (NHB) children to blood lead surveillance data and 4th grade end-of-grade (EOG) standardized test scores (n = 65,151). We construct a local, spatial index of racial isolation (RI) of NHB at the block group level. We fit race-stratified multi-level models of reading and mathematics EOG scores regressed on birthweight percentile for gestational age, blood lead level, maternal smoking, economic disadvantage, and RI, adjusting for maternal- and child-level covariates and median household income. RESULTS There were marked racial/ethnic disparities in prevalence of adverse exposures. Specifically, NHB children were more likely than NHW children to be economically disadvantaged (80% vs. 40%), live in block groups with the highest quintile of RI (46% vs. 5%), have higher blood lead levels (4.6 vs. 3.7 μg/dL), and lower birthweight percentile for gestational age (mean: 39th percentile vs. 51st percentile). NHB children were less likely to have mothers who reported smoking during pregnancy (11% and 22%). We observed associations between key adverse exposures and reading and math EOG scores in 4th grade. Higher birthweight percentile for gestational age was associated with higher EOG scores, while economic disadvantage, maternal smoking, and elevated blood lead levels were associated with lower EOG scores. Associations observed for NHB and NHW children were generally not statistically different from one another, with the exception of neighborhood RI. NHB children residing in block groups in the highest RI quintile had reading and math scores 1.54 (0.74, 2.34) and 1.12 (0.38, 1.87) points lower, respectively, compared to those in the lowest RI quintile; statistically significant decrements in EOG scores associated with RI were not observed for NHW children. We did not find evidence of multiplicative interactions between exposures for NHB or NHW children. DISCUSSION Key adverse host, environmental, and social exposures accrue disproportionately to NHB children. Decrements in test scores associated with key adverse exposures were often but not always larger for NHB children, but were not significantly different from those estimated for NHW children. While we did not observe interactive effects, NHB children on average experience more deleterious combined exposures, resulting in larger decrements to test scores compared to NHW children.
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Affiliation(s)
- Mercedes A Bravo
- Biostatistics and Epidemiology Division, Research Triangle Institute (RTI) International, Durham, NC, USA; Children's Environmental Health Initiative, University of Notre Dame, South Bend, IN, USA.
| | - Marie Lynn Miranda
- Children's Environmental Health Initiative, University of Notre Dame, South Bend, IN, USA; Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, South Bend, IN, USA
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18
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Reja D, Makar M, Visaria A, Karanfilian B, Rustgi V. Blood lead level is associated with advanced liver fibrosis in patients with non-alcoholic fatty liver disease: A nationwide survey (NHANES 2011-2016). Ann Hepatol 2021; 19:404-410. [PMID: 32376236 DOI: 10.1016/j.aohep.2020.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/05/2020] [Accepted: 03/25/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Non-Alcoholic Fatty Liver Disease (NAFLD) is linked to obesity and metabolic syndrome, but increasing evidence also implicates environmental toxins. In this study, we aim to show that in elevated blood Lead levels in NAFLD patients result in worsening liver fibrosis. MATERIALS AND METHODS 30,172 patients from NHANES 2011-2016 met inclusion criteria. 2499 patients ages 20-74 were identified with NAFLD as determined by the Fatty Liver Index score, and 425 with advanced liver fibrosis were identified using the NAFLD Fibrosis Score. Simple linear regression, Student's T-test, and Rao-Scott Chi-Square test was used for continuous and categorical variables. Multivariate regression analysis was used to adjust for confounders to determine odds of Advanced Fibrosis. RESULTS Increased serum Lead level was independently associated with increased risk of Advanced Fibrosis (OR 5.93, 95% CI 2.88-12.24) in the highest Lead quartile (Q4). In subgroup analysis stratified by BMI, a significant association between advanced liver fibrosis and blood Lead levels was consistently present, Q4 (OR 5.78, 95% CI 0.97-33.63) and Q4 (OR 6.04, 95% CI 2.92-12.48) in BMI <30 and >30, respectively. Increased Lead exposure was also evident in patients who were older, less educated, male, and drank alcohol and smoked tobacco. CONCLUSIONS Our findings show that advanced liver fibrosis is up to six times more likely in NAFLD patients with increased Lead exposure.
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Affiliation(s)
- Debashis Reja
- Rutgers Robert Wood Johnson Medical School, Department of Internal Medicine, 1 Robert Wood Johnson Place, New Brunswick, NJ, United States.
| | - Michael Makar
- Rutgers Robert Wood Johnson Medical School, Department of Internal Medicine, 1 Robert Wood Johnson Place, New Brunswick, NJ, United States
| | - Aayush Visaria
- Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, United States
| | - Briette Karanfilian
- Rutgers Robert Wood Johnson Medical School, Department of Internal Medicine, 1 Robert Wood Johnson Place, New Brunswick, NJ, United States
| | - Vinod Rustgi
- Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson School of Medicine, 1 Robert Wood Johnson Place, New Brunswick, New Brunswick, NJ, United States
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19
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Suarez-Lopez JR, Cairns MR, Sripada K, Quiros-Alcala L, Mielke HW, Eskenazi B, Etzel RA, Kordas K. COVID-19 and children's health in the United States: Consideration of physical and social environments during the pandemic. ENVIRONMENTAL RESEARCH 2021; 197:111160. [PMID: 33852915 PMCID: PMC8542993 DOI: 10.1016/j.envres.2021.111160] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/12/2021] [Accepted: 04/07/2021] [Indexed: 05/08/2023]
Abstract
Public health measures necessary to counteract the coronavirus disease 2019 (COVID-19) pandemic have resulted in dramatic changes in the physical and social environments within which children grow and develop. As our understanding of the pathways for viral exposure and associated health outcomes in children evolves, it is critical to consider how changes in the social, cultural, economic, and physical environments resulting from the pandemic could affect the development of children. This review article considers the environments and settings that create the backdrop for children's health in the United States during the COVID-19 pandemic, including current threats to child development that stem from: A) change in exposures to environmental contaminants such as heavy metals, pesticides, disinfectants, air pollution and the built environment; B) changes in food environments resulting from adverse economic repercussion of the pandemic and limited reach of existing safety nets; C) limited access to children's educational and developmental resources; D) changes in the social environments at the individual and household levels, and their interplay with family stressors and mental health; E) social injustice and racism. The environmental changes due to COVID-19 are overlaid onto existing environmental and social disparities. This results in disproportionate effects among children in low-income settings and among populations experiencing the effects of structural racism. This article draws attention to many environments that should be considered in current and future policy responses to protect children's health amid pandemics.
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Affiliation(s)
- Jose R Suarez-Lopez
- Department of Family Medicine and Public Health, and Herbert Wertheim School of Public Health and Human Longevity, University of California San Diego, La Jolla, CA, USA.
| | - Maryann R Cairns
- Department of Anthropology, Dedman College of Humanities and Sciences, Southern Methodist University, Dallas, TX, USA
| | - Kam Sripada
- Centre for Global Health Inequalities Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lesliam Quiros-Alcala
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Howard W Mielke
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health, School of Public Health, University of California, Berkeley, CA, USA
| | - Ruth A Etzel
- Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, 14214, USA
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20
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Dickinson-Copeland CM, Immergluck LC, Britez M, Yan F, Geng R, Edelson M, Kendrick-Allwood SR, Kordas K. Increased Risk of Sub-Clinical Blood Lead Levels in the 20-County Metro Atlanta, Georgia Area-A Laboratory Surveillance-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105163. [PMID: 34068063 PMCID: PMC8152486 DOI: 10.3390/ijerph18105163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/01/2021] [Accepted: 05/02/2021] [Indexed: 01/11/2023]
Abstract
Lead (Pb) is a naturally occurring, highly toxic metal that has adverse effects on children across a range of exposure levels. Limited screening programs leave many children at risk for chronic low-level lead exposure and there is little understanding of what factors may be used to identify children at risk. We characterize the distribution of blood lead levels (BLLs) in children aged 0–72 months and their associations with sociodemographic and area-level variables. Data from the Georgia Department of Public Health’s Healthy Homes for Lead Prevention Program surveillance database was used to describe the distribution of BLLs in children living in the metro Atlanta area from 2010 to 2018. Residential addresses were geocoded, and “Hotspot” analyses were performed to determine if BLLs were spatially clustered. Multilevel regression models were used to identify factors associated with clinical BBLs (≥5 µg/dL) and sub-clinical BLLs (2 to <5 µg/dL). From 2010 to 2018, geographically defined hotspots for both clinical and sub-clinical BLLs diffused from the city-central area of Atlanta into suburban areas. Multilevel regression analysis revealed non-Medicaid insurance, the proportion of renters in a given geographical area, and proportion of individuals with a GED/high school diploma as predictors that distinguish children with BLLs 2 to <5 µg/dL from those with lower (<2 µg/dL) or higher (≥5 µg/dL) BLLs. Over half of the study children had BLLs between 2 and 5 µg/dL, a range that does not currently trigger public health measures but that could result in adverse developmental outcomes if ignored.
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Affiliation(s)
- Carmen M. Dickinson-Copeland
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (L.C.I.); (M.B.)
- Correspondence:
| | - Lilly Cheng Immergluck
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (L.C.I.); (M.B.)
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Maria Britez
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (L.C.I.); (M.B.)
| | - Fengxia Yan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Ruijin Geng
- Pediatric Clinical and Translational Research Unit, Clinical Research Center, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Mike Edelson
- Geographic Information Systems, InterDev, Roswell, GA 30076, USA;
| | - Salathiel R. Kendrick-Allwood
- Department of Pediatrics, Divisions of General Pediatrics & Neonatology, Emory University School of Medicine, Atlanta, GA 30303, USA;
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY 14214, USA;
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21
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Albores-Garcia D, McGlothan JL, Bursac Z, Guilarte TR. Chronic developmental lead exposure increases μ-opiate receptor levels in the adolescent rat brain. Neurotoxicology 2021; 82:119-129. [PMID: 33248188 PMCID: PMC7855666 DOI: 10.1016/j.neuro.2020.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 12/17/2022]
Abstract
Childhood lead (Pb2+) intoxication is a global public health problem best known for producing deficits in learning and poor school performance. Human and preclinical studies have suggested an association between childhood Pb2+ intoxication and proclivity to substance abuse and delinquent behavior. While environmental factors have been implicated in opioid addiction, less is known about the role of exposure to environmental pollutants on the brain opioid system. Opioid receptors are involved in the biological effects of opioids and other drugs of abuse. In this study, we examine the effect of chronic developmental Pb2+ exposure (1500 ppm in the diet) on μ-opioid receptor (MOR) levels in the rat brain using [3H]-d-Ala2-MePhe4-Gly-ol5 enkephalin ([3H]-DAMGO) quantitative receptor autoradiography at different developmental stages (juvenile, early-adolescent, late adolescent and adult) in male and female rats. Our results indicate that chronic developmental Pb2+ exposure increases the levels of [3H]-DAMGO specific binding to MOR in juvenile and early adolescent Pb2+-exposed male and female rat brain with no changes in late-adolescent (PN50) and minor changes in Pb2+-exposed adult male rats (PN120). Specifically, at PN14, Pb2+-exposed males had an increase in MOR binding in the lateral posthalamic nuclei (LPTN), and Pb2+-exposed females had increased MOR binding in LPTN, medial thalamus, and hypothalamus. At PN28, Pb2+-exposed males had increased MOR levels in the striatum, stria medullaris of the thalamus, LPTN, medial thalamus, and basolateral amygdala, while Pb2+-exposed females showed an increase in nucleus accumbens core, LPTN, and medial thalamus. No changes were detected in any brain region of male and female rats at PN50, and at PN120 there was a decrease in MOR binding of Pb2+-exposed males in the medial thalamus. Our findings demonstrate age and gender specific effects of MOR levels in the rat brain as a result of chronic developmental Pb2+ exposure. These results indicate that the major changes in brain MOR levels were during pre-adolescence and early adolescence, a developmental period in which there is higher engagement in reward and drug-seeking behaviors in humans. In summary, we show that chronic exposure to Pb2+, an ubiquitous and well-known environmental contaminant and neurotoxicant, alters MOR levels in brain regions associated with addiction circuits in the adolescent period, these findings have important implications for opioid drug use and abuse.
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Affiliation(s)
- Damaris Albores-Garcia
- Brain, Behavior & the Environment Program, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, United States; Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, United States
| | - Jennifer L McGlothan
- Brain, Behavior & the Environment Program, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, United States; Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, United States
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, United States
| | - Tomás R Guilarte
- Brain, Behavior & the Environment Program, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, United States; Department of Environmental Health Sciences, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, United States.
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22
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Bovell-Ammon A, Yentel D, Koprowski M, Wilkinson C, Sandel M. Housing Is Health: A Renewed Call for Federal Housing Investments in Affordable Housing for Families With Children. Acad Pediatr 2021; 21:19-23. [PMID: 32619545 DOI: 10.1016/j.acap.2020.06.141] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Diane Yentel
- National Low Income Housing Coalition (D Yentel, M Koprowski, and C Wilkinson), Washington, DC
| | - Mike Koprowski
- National Low Income Housing Coalition (D Yentel, M Koprowski, and C Wilkinson), Washington, DC
| | - Chantelle Wilkinson
- National Low Income Housing Coalition (D Yentel, M Koprowski, and C Wilkinson), Washington, DC
| | - Megan Sandel
- Boston Medical Center (A Bovell-Ammon and M Sandel), Boston, Mass
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23
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Bantol KEA, Brumberg HL, Shah SI, Javier JR. Perspectives from the Society for Pediatric Research: contaminants of water and children's health: Can we do better? Pediatr Res 2020; 88:535-543. [PMID: 32470969 DOI: 10.1038/s41390-020-0985-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 02/18/2020] [Accepted: 04/29/2020] [Indexed: 01/09/2023]
Abstract
Children are uniquely susceptible to the health consequences of water contamination. In this review, we summarize the existing, robust literature supporting the importance of examining specific water contaminants (i.e., lead, pesticides, nitrates, arsenic, perchlorate) and the routes of contamination in the United States and globally. We also discuss the health effects of exposure to contaminated water and significant disparities related to access to clean water. Lastly, we offer strategies for prevention and intervention-including those focused on the individual patient level-and review the current US policy framework pertaining to regulation of these toxicants. IMPACT: A key message in this article is that exposure to water contaminants have serious and long-lasting consequences on children's health. This review summarizes current existing literature and adds policy recommendations supporting clean water for children. Information from this review has two potential impacts: Guide health professionals in screening and/or treating children's health problems resulting from water contaminant exposure. Guide policy makers in using evidence-based approaches to improve water quality and clean water access.
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Affiliation(s)
- Kamil Evy A Bantol
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Heather L Brumberg
- New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, New York, NY, USA
| | - Shetal I Shah
- New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, New York, NY, USA
| | - Joyce R Javier
- Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Eisenberg A, Seymour E, Hill AB, Akers J. Toxic structures: Speculation and lead exposure in Detroit's single-family rental market. Health Place 2020; 64:102390. [PMID: 32838900 DOI: 10.1016/j.healthplace.2020.102390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/06/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
Foreclosure sales permitted investors to purchase large volumes of low-cost residential properties after the last financial crisis, reshaping patterns of property ownership in low-income housing markets across the US. This study links post-foreclosure property acquisitions by investor landlords to subsequent lead poisoning cases among children under age six living in Detroit, Michigan. We find that the odds of exhibiting elevated blood lead levels (≥5 μg/dL) are higher for children living in investor-owned homes purchased through tax foreclosure sale. These findings highlight the potential for property speculation in post-foreclosure housing markets to exacerbate severe and racialized burdens of excess lead toxicity in low-income communities.
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Affiliation(s)
- Alexa Eisenberg
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Eric Seymour
- Urban Planning, Edward J. Bloustein School of Planning and Public Policy, Rutgers University, 33 Livingston Ave, New Brunswick, NJ 08901, USA.
| | - Alex B Hill
- Chronic Disease and Injury Prevention Manager, Detroit Health Department, 3246 E Jefferson, Detroit, MI, 48207, USA.
| | - Joshua Akers
- Geography and Urban and Regional Studies, University of Michigan-Dearborn, 4901 Evergreen Rd, Dearborn, MI, 48128, USA.
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Dong C, Taylor MP, Gulson B. A 25-year record of childhood blood lead exposure and its relationship to environmental sources. ENVIRONMENTAL RESEARCH 2020; 186:109357. [PMID: 32330765 DOI: 10.1016/j.envres.2020.109357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- Chenyin Dong
- Department of Earth and Environmental Sciences, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, 2109, Australia; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, PR China.
| | - Mark Patrick Taylor
- Department of Earth and Environmental Sciences, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Brian Gulson
- Department of Earth and Environmental Sciences, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, 2109, Australia; CSIRO Land and Water, Lucas Heights, NSW, 2234, Australia
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Yeter D, Banks EC, Aschner M. Disparity in Risk Factor Severity for Early Childhood Blood Lead among Predominantly African-American Black Children: The 1999 to 2010 US NHANES. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1552. [PMID: 32121216 PMCID: PMC7084658 DOI: 10.3390/ijerph17051552] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 11/16/2022]
Abstract
There is no safe detectable level of lead (Pb) in the blood of young children. In the United States, predominantly African-American Black children are exposed to more Pb and present with the highest mean blood lead levels (BLLs). However, racial disparity has not been fully examined within risk factors for early childhood Pb exposure. Therefore, we conducted secondary analysis of blood Pb determinations for 2841 US children at ages 1-5 years with citizenship examined by the cross-sectional 1999 to 2010 National Health and Nutrition Examination Survey (NHANES). The primary measures were racial disparities for continuous BLLs or an elevated BLL (EBLL) ≥5 µg/dL in selected risk factors between non-Hispanic Black children (n = 608) and both non-Hispanic White (n = 1208) or Hispanic (n = 1025) children. Selected risk factors included indoor household smoking, low income or poverty, older housing built before 1978 or 1950, low primary guardian education <12th grade/general education diploma (GED), or younger age between 1 and 3 years. Data were analyzed using a regression model corrected for risk factors and other confounding variables. Overall, Black children had an adjusted +0.83 µg/dL blood Pb (95% CI 0.65 to 1.00, p < 0.001) and a 2.8 times higher odds of having an EBLL ≥5 µg/dL (95% CI 1.9 to 3.9, p < 0.001). When stratified by risk factor group, Black children had an adjusted 0.73 to 1.41 µg/dL more blood Pb (p < 0.001 respectively) and a 1.8 to 5.6 times higher odds of having an EBLL ≥5 µg/dL (p ≤ 0.05 respectively) for every selected risk factor that was tested. For Black children nationwide, one in four residing in pre-1950 housing and one in six living in poverty presented with an EBLL ≥5 µg/dL. In conclusion, significant nationwide racial disparity in blood Pb outcomes persist for predominantly African-American Black children even after correcting for risk factors and other variables. This racial disparity further persists within housing, socio-economic, and age-related risk factors of blood Pb outcomes that are much more severe for Black children.
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Affiliation(s)
- Deniz Yeter
- Independent Researcher, Kansas City, KS 66104, USA
| | | | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
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Mannetje A', Coakley J, Douwes J. Where are we at with lead? Current levels, time trend, and determinants of blood lead in New Zealand children and adults. Int J Hyg Environ Health 2020; 225:113468. [PMID: 32007778 DOI: 10.1016/j.ijheh.2020.113468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Abstract
AIMS A national biomonitoring survey was conducted in 2014-2016, to determine current blood lead levels (BLL) in New Zealand children and adults and identify determinants of BLL. METHODS Blood samples were provided by 191 children (age 5-18) and 304 adults (age 20-65) and analysed for BLL using inductively coupled mass spectroscopy. Linear regression on log-transformed BLL was used to assess associations between BLL and demographic and lifestyle factors collected via questionnaire. RESULTS The geometric mean (GM) BLL was 0.86 μg/dl (95%CI 0.80-0.92) for children and 1.31 μg/dl (1.23-1.39) for adults, representing a 90% reduction in BLL over the past 36 years. For children, shellfish consumption was associated with 20% higher BLL. Adult BLLs were positively associated with age, beer consumption, spirits consumption, having roof water as the home's water supply, and having worked in glass manufacturing. Determinants of reduced BLL were tofu and canned food consumption. For women, menopause was associated with 34% higher BLL. CONCLUSIONS Although significant reductions in New Zealanders' BLL have been achieved in the past decades, this study identified several additional opportunities to reduce further background exposure to lead. In particular, consideration needs to be given to reducing lead levels in New Zealand roof water supplies.
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Affiliation(s)
- Andrea 't Mannetje
- Centre for Public Health Research, Massey University. PO Box 756, Wellington, 6140, New Zealand.
| | - Jonathan Coakley
- Centre for Public Health Research, Massey University. PO Box 756, Wellington, 6140, New Zealand
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University. PO Box 756, Wellington, 6140, New Zealand
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Gagnon-Chauvin A, Bastien K, Saint-Amour D. Environmental toxic agents: The impact of heavy metals and organochlorides on brain development. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:423-442. [PMID: 32958188 DOI: 10.1016/b978-0-444-64150-2.00030-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Exposure to environmental toxicants can have deleterious effects on the development of physical, cognitive, and mental health. Extensive laboratory and clinical studies have demonstrated how the developing brain is uniquely sensitive to toxic agents. This chapter focuses on the main neurologic impairments linked to prenatal and postnatal exposure to lead, methylmercury, and polychlorinated biphenyls, three legacy environmental contaminants whose neurotoxic effects have been extensively studied with respect to cognitive and behavioral development. The main cognitive, emotion regulation, sensory, and motor impairments in association with these contaminants are briefly reviewed, including the underlying neural mechanisms such as neuropathologic damages, brain neurotransmission, and endocrine system alterations. The use of neuroimaging as a novel tool to better understand how the brain is affected by exposure to environmental contaminants is also discussed.
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Affiliation(s)
- Avril Gagnon-Chauvin
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada; Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Kevin Bastien
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada; Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Dave Saint-Amour
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada; Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada.
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Callahan CL, Friesen MC, Locke SJ, Dopart PJ, Stewart PA, Schwartz K, Ruterbusch JJ, Graubard BI, Chow WH, Rothman N, Hofmann JN, Purdue MP. Case-control investigation of occupational lead exposure and kidney cancer. Occup Environ Med 2019; 76:433-440. [PMID: 30760604 PMCID: PMC10364141 DOI: 10.1136/oemed-2018-105327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesLead is a suspected carcinogen that has been inconsistently associated with kidney cancer. To clarify this relationship, we conducted an analysis of occupational lead exposure within a population-based study of kidney cancer using detailed exposure assessment methods.MethodsStudy participants (1217 cases and 1235 controls), enrolled between 2002 and 2007, provided information on their occupational histories and, for selected lead-related occupations, answered questions regarding workplace tasks, and use of protective equipment. Industrial hygienists used this information to develop several estimates of occupational lead exposure, including probability, duration and cumulative exposure. Unconditional logistic regression was used to compute ORs and 95% CIs for different exposure metrics, with unexposed subjects serving as the reference group. Analyses were also conducted stratifying on several factors, including for subjects of European ancestry only, single nucleotide polymorphisms in ALAD (rs1805313, rs1800435, rs8177796, rs2761016), a gene involved in lead toxicokinetics.ResultsIn our study, cumulative occupational lead exposure was not associated with kidney cancer (OR 0.9, 95% CI 0.7 to 1.3 for highest quartile vs unexposed; ptrend=0.80). Other lead exposure metrics were similarly null. We observed no evidence of effect modification for the evaluated ALAD variants (subjects of European ancestry only, 662 cases and 561 controls) and most stratifying factors, although lead exposure was associated with increased risk among never smokers.ConclusionsThe findings of this study do not offer clear support for an association between occupational lead exposure and kidney cancer.
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Sobolewski M, Varma G, Adams B, Anderson DW, Schneider JS, Cory-Slechta DA. Developmental Lead Exposure and Prenatal Stress Result in Sex-Specific Reprograming of Adult Stress Physiology and Epigenetic Profiles in Brain. Toxicol Sci 2018; 163:478-489. [PMID: 29481626 PMCID: PMC5974781 DOI: 10.1093/toxsci/kfy046] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Developmental exposure to lead (Pb) and prenatal stress (PS) both impair cognition, which could derive from their joint targeting of the hypothalamic-pituitary-adrenal axis and the brain mesocorticolimbic (MESO) system, including frontal cortex (FC) and hippocampus (HIPP). Glucocorticoids modulate both FC and HIPP function and associated mediation of cognitive and other behavioral functions. This study sought to determine whether developmental Pb ± PS exposures altered glucocorticoid-related epigenetic profiles in brain MESO regions in offspring of female mice exposed to 0 or 100 ppm Pb acetate drinking water from 2 mos prior to breeding until weaning, with half further exposed to prenatal restraint stress from gestational day 11-18. Overall, changes in females occured in response to Pb exposure. In males, however, Pb-induced neurotoxicity was modulated by PS. Changes in serum corticosterone levels were seen in males, while glucocorticoid receptor changes were seen in both sexes. In contrast, both Pb and PS broadly impacted brain DNA methyltransferases and binding proteins, particularly DNMT1, DNMT3a and methyl-CpG-binding protein 2, with patterns that differed by sex and brain regions. Specifically, in males, effects on FC epigenetic modifiers were primarily influenced by Pb, whereas extensive changes in HIPP were produced by PS. In females, Pb exposure and not PS primarily altered epigenetic modifiers in both FC and HIPP. Collectively, these findings indicate that epigenetic mechanisms may underlie associated neurotoxicity of Pb and of PS, particularly associated cognitive deficits. However, mechanisms by which this may occur will be different in males versus females.
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Affiliation(s)
- Marissa Sobolewski
- Department of Environmental Medicine, University of Rochester School of Medicine, Rochester, New York,To whom correspondence should be addressed at Department of Environmental Medicine, University of Rochester School of Medicine, University of Rochester Medical Center, Box EHSC, Rochester, NY 14642. Fax: 585-256-2591; E-mail:
| | - Garima Varma
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Beth Adams
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David W Anderson
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jay S Schneider
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Deborah A Cory-Slechta
- Department of Environmental Medicine, University of Rochester School of Medicine, Rochester, New York
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Sobolewski M, Conrad K, Marvin E, Allen JL, Cory-Slechta DA. Endocrine active metals, prenatal stress and enhanced neurobehavioral disruption. Horm Behav 2018; 101:36-49. [PMID: 29355495 PMCID: PMC5970043 DOI: 10.1016/j.yhbeh.2018.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/05/2018] [Accepted: 01/14/2018] [Indexed: 11/24/2022]
Abstract
Metals, including lead (Pb), methylmercury (MeHg) and arsenic (As), are long-known developmental neurotoxicants. More recently, environmental context has been recognized to modulate metals toxicity, including nutritional state and stress exposure. Modulation of metal toxicity by stress exposure can occur through shared targeting of endocrine systems, such as the hypothalamic-pituitary-adrenal axis (HPA). Our previous rodent research has identified that prenatal stress (PS) modulates neurotoxicity of two endocrine active metals (EAMs), Pb and MeHg, by altering HPA and CNS systems disrupting behavior. Here, we review this research and further test the hypothesis that prenatal stress modulates metals neurotoxicity by expanding to test the effect of developmental As ± PS exposure. Serum corticosterone and behavior was assessed in offspring of dams exposed to As ± PS. PS increased female offspring serum corticosterone at birth, while developmental As exposure decreased adult serum corticosterone in both sexes. As + PS induced reductions in locomotor activity in females and reduced response rates on a Fixed Interval schedule of reinforcement in males, with the latter suggesting unique learning deficits only in the combined exposure. As-exposed males showed increased time in the open arms of an elevated plus maze and decreased novel object recognition whereas females did not. These data further confirm the hypothesis that combined exposure to chemical (EAMs) and non-chemical (PS) stressors results in enhanced neurobehavioral toxicity. Given that humans are exposed to multiple environmental risk factors that alter endocrine function in development, such models are critical for risk assessment and public health protection, particularly for children.
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Affiliation(s)
- Marissa Sobolewski
- Dept. of Environmental Medicine, University of Rochester School of Medicine, Rochester, NY, United States. marissa:
| | - Katherine Conrad
- Dept. of Environmental Medicine, University of Rochester School of Medicine, Rochester, NY, United States
| | - Elena Marvin
- Dept. of Environmental Medicine, University of Rochester School of Medicine, Rochester, NY, United States
| | - Joshua L Allen
- Dept. of Environmental Medicine, University of Rochester School of Medicine, Rochester, NY, United States
| | - Deborah A Cory-Slechta
- Dept. of Environmental Medicine, University of Rochester School of Medicine, Rochester, NY, United States
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Cowell WJ, Wright RJ. Sex-Specific Effects of Combined Exposure to Chemical and Non-chemical Stressors on Neuroendocrine Development: a Review of Recent Findings and Putative Mechanisms. Curr Environ Health Rep 2018; 4:415-425. [PMID: 29027649 DOI: 10.1007/s40572-017-0165-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Environmental toxicants and psychosocial stressors share many biological substrates and influence overlapping physiological pathways. Increasing evidence indicates stress-induced changes to the maternal milieu may prime rapidly developing physiological systems for disruption by concurrent or subsequent exposure to environmental chemicals. In this review, we highlight putative mechanisms underlying sex-specific susceptibility of the developing neuroendocrine system to the joint effects of stress or stress correlates and environmental toxicants (bisphenol A, alcohol, phthalates, lead, chlorpyrifos, and traffic-related air pollution). RECENT FINDINGS We provide evidence indicating that concurrent or tandem exposure to chemical and non-chemical stressors during windows of rapid development is associated with sex-specific synergistic, potentiated and reversed effects on several neuroendocrine endpoints related to hypothalamic-pituitary-adrenal axis function, sex steroid levels, neurotransmitter circuits, and innate immune function. We additionally identify gaps, such as the role that the endocrine-active placenta plays, in our understanding of these complex interactions. Finally, we discuss future research needs, including the investigation of non-hormonal biomarkers of stress. We demonstrate multiple physiologic systems are impacted by joint exposure to chemical and non-chemical stressors differentially among males and females. Collectively, the results highlight the importance of evaluating sex-specific endpoints when investigating the neuroendocrine system and underscore the need to examine exposure to chemical toxicants within the context of the social environment.
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Affiliation(s)
- Whitney J Cowell
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA. .,Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 12th Floor, Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA.
| | - Rosalind J Wright
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Grineski SE, Collins TW. Geographic and social disparities in exposure to air neurotoxicants at U.S. public schools. ENVIRONMENTAL RESEARCH 2018; 161:580-587. [PMID: 29245126 PMCID: PMC5760180 DOI: 10.1016/j.envres.2017.11.047] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 05/22/2023]
Abstract
Children are especially vulnerable to the health and developmental impacts of environmental hazards and they spend significant portions of their days at school. Yet there are no national-level studies examining school-level environmental inequalities and few have examined disparate exposure to neurological air toxicants, even though chronic exposure to air pollution impacts children's brain functioning. We paired information about the geographic locations and demographics of each public school in the US with air neurotoxicant exposure estimates pertaining to 24 known neurotoxicants included in the US Environmental Protection Agency's National Air Toxics Assessment. Using bivariate and multivariate statistics, we tested for environmental injustices in air neurotoxicant exposure at 84,969 US public schools. Metropolitan New York City (EPA Region 2) is the geographic region most burdened by air neurotoxicant exposures at schools since one-third of all schools in that region are in the top 10% (at "high risk") for ambient neurotoxicant exposure among all schools nationwide. Students attending "high risk" public schools nationwide are significantly more likely to be eligible for free/reduced price meals, and to be Hispanic, black, or Asian/Pacific Islander (API). They are significantly less likely to be white or of another race. In a multivariate generalized estimating equation controlling for school district effects, schools with greater proportions of Hispanic, black, and API students, schools with higher enrollment, and schools located in more urban (vs. rural) counties face greater risks. Schools serving the youngest students (e.g., pre-kindergarten) have greater levels of risk than schools serving older students. Across all analyses, this study shows that racial/ethnic minority children are bearing the brunt of air neurotoxicant exposures at school, which may be unequally impacting their school performance and future potential.
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Affiliation(s)
- Sara E Grineski
- Department of Sociology, University of Utah, 200 Presidents Circle, Salt Lake City, UT 84112, USA.
| | - Timothy W Collins
- Department of Geography, University of Utah, 200 Presidents Circle, Salt Lake City, UT 84112, USA.
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Associations between lead concentrations and cardiovascular risk factors in U.S. adolescents. Sci Rep 2017; 7:9121. [PMID: 28831128 PMCID: PMC5567237 DOI: 10.1038/s41598-017-09701-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/27/2017] [Indexed: 11/30/2022] Open
Abstract
Little is known regarding the effects of environmental lead exposure on cardiovascular risk factors in the adolescent population. We studied 11,662 subjects included in the National Health and Nutrition Examination Survey (NHANES) 1999–2012. Blood lead levels were analysed for their association with cardiovascular risk factors (CVRF). Regression coefficients (Beta) and 95% confidence intervals (CIs) of blood lead in association with CVRF (e.g., total cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride, fasting glucose, glycohemoglobin, fasting insulin, and blood pressure) were estimated using multivariate and generalized linear regression after adjusting for age, gender, ethnicity, serum cotinine, body mass index (BMI), physical activity, and household income. We identified a strong positive association between blood lead (coefficient = 0.022, 95% CI 0.003, 0.041; P = 0.022) and LDL-cholesterol in adolescents (age 12–19 years). However, no associations with other CVRFs were found in the overall population. In the generalized linear models, participants with the highest lead levels demonstrated a 1.87% (95% CI 0.73%, 3.02%) greater increase in serum LDL-cholesterol (p for trend = 0.031) when compared to participants with the lowest lead levels. These results provide epidemiological evidence that low levels of blood lead are positively associated with LDL-cholesterol in the adolescent population.
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35
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Dhimal M, Karki KB, Aryal KK, Dhimal B, Joshi HD, Puri S, Pandey AR, Dhakal P, Sharma AK, Raya GB, Ansari I, Groneberg DA, Müller R, Kuch U. High blood levels of lead in children aged 6-36 months in Kathmandu Valley, Nepal: A cross-sectional study of associated factors. PLoS One 2017; 12:e0179233. [PMID: 28604801 PMCID: PMC5467890 DOI: 10.1371/journal.pone.0179233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/25/2017] [Indexed: 11/18/2022] Open
Abstract
Young children are at greatest risk of exposure to lead and its effects. Although lead is one of the most widely used elements with known health hazard, there is little data on the blood lead level (BLL) of children in the Kathmandu Valley. Thus, this study aimed to assess factors associated with high BLL in children who were 6–36 months of age and resided in the Kathmandu Valley. In this hospital-based cross-sectional study 6–36 month-old children visiting the Paediatrics Outpatient Department of Tribhuvan University Teaching Hospital, Patan Hospital, and Siddhi Memorial Hospital were enrolled. All three hospitals are located in different areas inside the Kathmandu Valley. Written informed consent was obtained from the parents, and exposure data were collected using a structured questionnaire. Portable Anodic Stripping Voltammetry (ASV) was used to determine BLLs in children. Data were analyzed using SPSS version 16. Of 312 children enrolled in the study, 64.4% had BLLs ≥5μg/dl. A significant association was found between BLL and exposure to enamel paints in the household in the form of painting materials used in different parts of the house like walls, windows and doors (p = 0.001). Furthermore, multivariate analyses showed that BLLs were 4.5 times higher in children playing with dirt and dust (p = 0.006) and that children belonging to the community of lower caste/ethnicity groups had significantly higher BLLs compared to those from the upper caste groups (p = 0.02). Our study demonstrated that children living in households that have used enamel paints, children belonging to lower caste/ethnic groups, and children frequently playing with dirt and dust had significantly higher BLLs. The results of this study highlight the importance of policy decisions to limit environmental lead contamination, and to roll out awareness building measures designed to limit lead exposure and break the poverty cycle associated with chronic lead poisoning.
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Affiliation(s)
- Meghnath Dhimal
- Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal
- * E-mail:
| | | | | | - Bimala Dhimal
- Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal
| | - Hari Datt Joshi
- Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal
| | - Sajan Puri
- Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal
| | - Achyut Raj Pandey
- Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal
| | - Purushotam Dhakal
- Nepal Health Research Council (NHRC), Ramshah Path, Kathmandu, Nepal
| | - Arun Kumar Sharma
- Department of Pediatrics, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Imran Ansari
- Department of Pediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - David A. Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - Ruth Müller
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - Ulrich Kuch
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
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Soil Lead and Children's Blood Lead Disparities in Pre- and Post-Hurricane Katrina New Orleans (USA). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040407. [PMID: 28417939 PMCID: PMC5409608 DOI: 10.3390/ijerph14040407] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/05/2017] [Accepted: 04/08/2017] [Indexed: 12/04/2022]
Abstract
This study appraises New Orleans soil lead and children’s lead exposure before and ten years after Hurricane Katrina flooded the city. Introduction: Early childhood exposure to lead is associated with lifelong and multiple health, learning, and behavioral disorders. Lead exposure is an important factor hindering the long-term resilience and sustainability of communities. Lead exposure disproportionately affects low socioeconomic status of communities. No safe lead exposure is known and the common intervention is not effective. An essential responsibility of health practitioners is to develop an effective primary intervention. Methods: Pre- and post-Hurricane soil lead and children’s blood lead data were matched by census tract communities. Soil lead and blood lead data were described, mapped, blood lead graphed as a function of soil lead, and Multi-Response Permutation Procedures statistics established disparities. Results: Simultaneous decreases occurred in soil lead accompanied by an especially large decline in children’s blood lead 10 years after Hurricane Katrina. Exposure disparities still exist between children living in the interior and outer areas of the city. Conclusions: At the scale of a city, this study demonstrates that decreasing soil lead effectively reduces children’s blood lead. Primary prevention of lead exposure can be accomplished by reducing soil lead in the urban environment.
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