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Rochester JR, Kwiatkowski CF, Neveux I, Dabe S, Hatcher KM, Lathrop MK, Daza EJ, Eskenazi B, Grzymski JJ, Hua J. A Personalized Intervention to Increase Environmental Health Literacy and Readiness to Change in a Northern Nevada Population: Effects of Environmental Chemical Exposure Report-Back. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:905. [PMID: 39063482 PMCID: PMC11277309 DOI: 10.3390/ijerph21070905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Interventions are needed to help people reduce exposure to harmful chemicals from everyday products and lifestyle habits. Report-back of individual exposures is a potential pathway to increasing environmental health literacy (EHL) and readiness to reduce exposures. OBJECTIVES Our objective was to determine if report-back of endocrine-disrupting chemicals (EDCs) can reduce EDC exposure, increase EHL, and increase readiness to change (i.e., to implement EDC exposure-reduction behaviors). METHODS Participants in the Healthy Nevada Project completed EHL and readiness-to-change surveys before (n = 424) and after (n = 174) a report-back intervention. Participants used mail-in kits to measure urinary biomarkers of EDCs. The report-back of results included urinary levels, information about health effects, sources of exposure, and personalized recommendations to reduce exposure. RESULTS EHL was generally very high at baseline, especially for questions related to the general pollution. For questions related to chemical exposures, responses varied across several demographics. Statistically reliable improvements in EHL responses were seen after report-back. For readiness to change, 72% were already or planning to change their behaviors. Post-intervention, women increased their readiness (p = 0.053), while men decreased (p = 0.007). When asked what challenges they faced in reducing exposure, 79% cited not knowing what to do. This dropped to 35% after report-back. Participants with higher propylparaben were younger (p = 0.03) and women and participants who rated themselves in better health had higher levels of some phthalates (p = 0.02-0.003 and p = 0.001-0.003, respectively). After report-back, monobutyl phthalate decreased among the 48 participants who had valid urine tests before and after the intervention (p < 0.001). CONCLUSIONS The report-back intervention was successful as evidenced by increased EHL behaviors, increased readiness to change among women, and a decrease in monobutyl phthalate. An EHL questionnaire more sensitive to chemical exposures would help differentiate high and low literacy. Future research will focus on understanding why men decreased their readiness to change and how the intervention can be improved for all participants.
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Affiliation(s)
- Johanna R. Rochester
- Million Marker Wellness, Inc., Berkeley, CA 94704, USA; (J.R.R.); (C.F.K.); (K.M.H.); (M.K.L.); (E.J.D.); (B.E.)
| | - Carol F. Kwiatkowski
- Million Marker Wellness, Inc., Berkeley, CA 94704, USA; (J.R.R.); (C.F.K.); (K.M.H.); (M.K.L.); (E.J.D.); (B.E.)
| | - Iva Neveux
- Healthy Nevada Project, Renown Health, Reno, NV 89557, USA; (I.N.); (S.D.); (J.J.G.)
- Department of Internal Medicine, University of Nevada, Reno, NV 89557, USA
| | - Shaun Dabe
- Healthy Nevada Project, Renown Health, Reno, NV 89557, USA; (I.N.); (S.D.); (J.J.G.)
| | - Katherine M. Hatcher
- Million Marker Wellness, Inc., Berkeley, CA 94704, USA; (J.R.R.); (C.F.K.); (K.M.H.); (M.K.L.); (E.J.D.); (B.E.)
| | - Michael Kupec Lathrop
- Million Marker Wellness, Inc., Berkeley, CA 94704, USA; (J.R.R.); (C.F.K.); (K.M.H.); (M.K.L.); (E.J.D.); (B.E.)
| | - Eric J. Daza
- Million Marker Wellness, Inc., Berkeley, CA 94704, USA; (J.R.R.); (C.F.K.); (K.M.H.); (M.K.L.); (E.J.D.); (B.E.)
| | - Brenda Eskenazi
- Million Marker Wellness, Inc., Berkeley, CA 94704, USA; (J.R.R.); (C.F.K.); (K.M.H.); (M.K.L.); (E.J.D.); (B.E.)
| | - Joseph J. Grzymski
- Healthy Nevada Project, Renown Health, Reno, NV 89557, USA; (I.N.); (S.D.); (J.J.G.)
- Department of Internal Medicine, University of Nevada, Reno, NV 89557, USA
| | - Jenna Hua
- Million Marker Wellness, Inc., Berkeley, CA 94704, USA; (J.R.R.); (C.F.K.); (K.M.H.); (M.K.L.); (E.J.D.); (B.E.)
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Korfmacher KS, Brody JG. Moving Forward with Reporting Back Individual Environmental Health Research Results. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:125002. [PMID: 38095662 PMCID: PMC10720702 DOI: 10.1289/ehp12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 09/06/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND The practice of reporting back individual results to participants in environmental health research has evolved significantly over the past 20 years. Research findings support the potential of report-back to enhance the ethics, quality, and impact of environmental health research. Nonetheless, implementation of environmental health report-back practices is not yet routine. OBJECTIVES We propose a framework for institutionalizing appropriate report-back to participants of their individual results across the environmental health research enterprise. We provide a brief overview of the rationales for report-back, social science research on report-back experiences over the past two decades, and recent efforts to synthesize guidance in this field. We also describe barriers to be addressed in moving toward widespread implementation of report-back. DISCUSSION Report-back of individual results is increasingly recognized as an ethical responsibility and essential component of impactful environmental health research. Experience shows that when personal results are returned with appropriate contextual information, report-back can increase environmental health literacy, promote individual actions, and enhance engagement in policy change. Therefore, report-back can promote environmental justice and reduce disparities in access to science. Despite this evidence base, report-back is not widely implemented. We recommend the collaborative development of guidelines, training, and resources to build capacity for appropriate report-back to study participants across the environmental health research enterprise, and we identify research priorities to advance the field. Development of tools and shared infrastructure for report-back holds promise for reducing barriers while ensuring high-quality personalized reports. Disseminating successful case studies could also advance excellence. We recommend including diverse scientific disciplines, community partners, representatives of study populations, clinicians, institutional review boards (IRBs), legal experts, public health professionals, and government officials in further developing this critical aspect of environmental health research. https://doi.org/10.1289/EHP12463.
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Menegatto M, Zamperini A. Health and Psychological Concerns of Communities Affected by Per- and Poly-Fluoroalkyl Substances: The Case of Residents Living in the Orange Area of the Veneto Region. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7056. [PMID: 37998286 PMCID: PMC10671329 DOI: 10.3390/ijerph20227056] [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: 09/10/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023]
Abstract
Residents of an extensive area of the Veneto Region (Italy) face one of the largest technological disasters due to per- and polyfluoroalkyl substances (PFAS). On the basis of a risk gradient of contamination, the affected territories were divided into 4 areas: Red (of maximum exposure, where a human biomonitoring programme (HBM) was activated), Orange, Yellow, and Green. This article presents a case study of residents who live in the Orange Area, the second area in terms of contamination, excluded from the HBM. Semi-structured interviews were conducted with 17 residents engaged in promoting a legal procedure to exercise their right to know. Grounded theory and a thematic analysis method were used. Overall, the findings revealed that experiencing contamination causes a negative psychosocial impact on the residents' lives; difficulty accessing information; living with uncertainty, caused by the lack of institutional and health support and medical consultation; a sense of abandonment; difficulty managing preventive and protective actions; and the deterioration of relationships, on the basis of the social comparison with residents of the Red Area, to whom HBM was granted and where the concept of health ostracism has emerged. This study demonstrated that biomonitoring may help reduce discomfort in the case of contamination by informing people of their chemical exposure.
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Affiliation(s)
| | - Adriano Zamperini
- FISPPA Department, University of Padova, Via Venezia 14, 35131 Padova, Italy
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Samon SM, Barton M, Anderson K, Oluyomi A, Bondy M, Armstrong G, Rohlman D. Integrating participant feedback and concerns to improve community and individual level chemical exposure assessment reports. BMC Public Health 2023; 23:1732. [PMID: 37674147 PMCID: PMC10481616 DOI: 10.1186/s12889-023-16661-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND As exposure assessment has shifted towards community-engaged research there has been an increasing trend towards reporting results to participants. Reports aim to increase environmental health literacy, but this can be challenging due to the many unknowns regarding chemical exposure and human health effects. This includes when reports encompass a wide-range of chemicals, limited reference or health standards exist for those chemicals, and/or incompatibility of data generated from exposure assessment tools with published reference values (e.g., comparing a wristband concentration to an oral reference dose). METHODS Houston Hurricane Harvey Health (Houston-3H) participants wore silicone wristbands that were analyzed for 1,530 organic compounds at two time-points surrounding Hurricane Harvey. Three focus groups were conducted in separate neighborhoods in the Houston metropolitan area to evaluate response to prototype community and individual level report-backs. Participants (n = 31) evaluated prototype drafts using Likert scales and discussion prompts. Focus groups were audio-recorded, and transcripts were analyzed using a qualitative data analysis program for common themes, and quantitative data (ranking, Likert scales) were statistically analyzed. RESULTS Four main themes emerged from analysis of the transcripts: (1) views on the report layout; (2) expression of concern over how chemicals might impact their individual or community health; (3) participants emotional response towards the researchers; and (4) participants ability to comprehend and evaluate environmental health information. Evaluation of the report and key concerns differed across the three focus groups. However, there was agreement amongst the focus groups about the desire to obtain personal exposure results despite the uncertainty of what the participant results meant. CONCLUSIONS The report-back of research results (RBRR) for community and individual level exposure assessment data should keep the following key principles in mind: materials should be accessible (language level, data visualization options, graph literacy), identify known information vs unknown (e.g., provide context for what exposure assessment data means, acknowledge lack of current health standards or guidelines), recognize and respect community knowledge and history, and set participant expectations for what they can expect from the report.
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Affiliation(s)
- Samantha M Samon
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, OR, USA
| | - Michael Barton
- Pacific Northwest Center for Translational Environmental Health Research, Oregon State University, Corvallis, OR, USA
| | - Kim Anderson
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, OR, USA
| | - Abiodun Oluyomi
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
| | - Melissa Bondy
- Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Georgina Armstrong
- Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Diana Rohlman
- College of Health, Weniger Hall 223, 103 SW Memorial Place, Corvallis, OR, 97331, USA.
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Safarlou CW, Jongsma KR, Vermeulen R, Bredenoord AL. The ethical aspects of exposome research: a systematic review. EXPOSOME 2023; 3:osad004. [PMID: 37745046 PMCID: PMC7615114 DOI: 10.1093/exposome/osad004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
In recent years, exposome research has been put forward as the next frontier for the study of human health and disease. Exposome research entails the analysis of the totality of environmental exposures and their corresponding biological responses within the human body. Increasingly, this is operationalized by big-data approaches to map the effects of internal as well as external exposures using smart sensors and multiomics technologies. However, the ethical implications of exposome research are still only rarely discussed in the literature. Therefore, we conducted a systematic review of the academic literature regarding both the exposome and underlying research fields and approaches, to map the ethical aspects that are relevant to exposome research. We identify five ethical themes that are prominent in ethics discussions: the goals of exposome research, its standards, its tools, how it relates to study participants, and the consequences of its products. Furthermore, we provide a number of general principles for how future ethics research can best make use of our comprehensive overview of the ethical aspects of exposome research. Lastly, we highlight three aspects of exposome research that are most in need of ethical reflection: the actionability of its findings, the epidemiological or clinical norms applicable to exposome research, and the meaning and action-implications of bias.
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Affiliation(s)
- Caspar W. Safarlou
- Department of Global Public Health and Bioethics, Julius Center for
Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The
Netherlands
| | - Karin R. Jongsma
- Department of Global Public Health and Bioethics, Julius Center for
Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The
Netherlands
| | - Roel Vermeulen
- Department of Global Public Health and Bioethics, Julius Center for
Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The
Netherlands
- Department of Population Health Sciences, Utrecht University,
Utrecht, The Netherlands
| | - Annelien L. Bredenoord
- Department of Global Public Health and Bioethics, Julius Center for
Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The
Netherlands
- Erasmus School of Philosophy, Erasmus University Rotterdam,
Rotterdam, The Netherlands
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Van Horne YO, Alcala CS, Peltier RE, Quintana PJE, Seto E, Gonzales M, Johnston JE, Montoya LD, Quirós-Alcalá L, Beamer PI. An applied environmental justice framework for exposure science. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:1-11. [PMID: 35260805 PMCID: PMC8902490 DOI: 10.1038/s41370-022-00422-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 05/28/2023]
Abstract
On the 30th anniversary of the Principles of Environmental Justice established at the First National People of Color Environmental Leadership Summit in 1991 (Principles of Environmental Justice), we continue to call for these principles to be more widely adopted. We propose an environmental justice framework for exposure science to be implemented by all researchers. This framework should be the standard and not an afterthought or trend dismissed by those who believe that science should not be politicized. Most notably, this framework should be centered on the community it seeks to serve. Researchers should meet with community members and stakeholders to learn more about the community, involve them in the research process, collectively determine the environmental exposure issues of highest concern for the community, and develop sustainable interventions and implementation strategies to address them. Incorporating community "funds of knowledge" will also inform the study design by incorporating the knowledge about the issue that community members have based on their lived experiences. Institutional and funding agency funds should also be directed to supporting community needs both during the "active" research phase and at the conclusion of the research, such as mechanisms for dissemination, capacity building, and engagement with policymakers. This multidirectional framework for exposure science will increase the sustainability of the research and its impact for long-term success.
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Affiliation(s)
- Yoshira Ornelas Van Horne
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA.
| | - Cecilia S Alcala
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 17 East 102 Street, New York, NY, 10029, USA
| | - Richard E Peltier
- School of Public Health & Health Sciences, University of Massachusetts Amherst, 686 North Pleasant Street, Room 175, Amherst, MA, 01003, USA
| | - Penelope J E Quintana
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
| | - Edmund Seto
- Department of Environmental & Occupational Health Sciences, School of Public Health, University of Washington, Roosevelt One Building, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98195, USA
| | - Melissa Gonzales
- Department of Internal Medicine, University of New Mexico School of Medicine, MSC10 5550 Epidemiology, Albuquerque, NM, 87111, USA
| | - Jill E Johnston
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90032, USA
| | | | - Lesliam Quirós-Alcalá
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Paloma I Beamer
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N. Martin Ave., Tucson, AZ, 85724, USA
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Oksas C, Brody JG, Brown P, Boronow KE, DeMicco E, Charlesworth A, Juarez M, Geiger S, Schantz SL, Woodruff TJ, Morello-Frosch R, Padula AM. Perspectives of peripartum people on opportunities for personal and collective action to reduce exposure to everyday chemicals: Focus groups to inform exposure report-back. ENVIRONMENTAL RESEARCH 2022; 212:113173. [PMID: 35351450 PMCID: PMC9244766 DOI: 10.1016/j.envres.2022.113173] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/15/2022] [Accepted: 03/22/2022] [Indexed: 05/30/2023]
Abstract
Participants in biomonitoring studies who receive personal exposure reports seek information to reduce exposures. Many chemical exposures are driven by systems-level policies rather than individual actions; therefore, change requires engagement in collective action. Participants' perceptions of collective action and use of report-back to support engagement remain unclear. We conducted virtual focus groups during summer 2020 in a diverse group of peripartum people from cohorts in the Environmental influences on Child Health Outcomes (ECHO) Program (N = 18). We assessed baseline exposure and collective action experience, and report-back preferences. Participants were motivated to protect the health of their families and communities despite significant time and cognitive burdens. They requested time-conscious tactics and accessible information to enable action to reduce individual and collective exposures. Participant input informed the design of digital report-back in the cohorts. This study highlights opportunities to shift responsibility from individuals to policymakers to reduce chemical exposures at the systems level.
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Affiliation(s)
- Catherine Oksas
- University of California San Francisco School of Medicine, San Francisco, CA, USA.
| | | | - Phil Brown
- Department of Sociology and Anthropology and Department of Health Sciences, Northeastern University, Boston, MA, USA.
| | | | - Erin DeMicco
- Program for Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Annemarie Charlesworth
- Program for Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Maribel Juarez
- Program for Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Sarah Geiger
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Susan L Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Tracey J Woodruff
- Program for Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Rachel Morello-Frosch
- School of Public Health and Department of Environmental Science, Policy and Management University of California Berkeley, Berkeley, CA, USA.
| | - Amy M Padula
- Program for Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
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Tomsho KS, Polka E, Chacker S, Queeley D, Alvarez M, Scammell MK, Emmons KM, Rudd RE, Adamkiewicz G. A process for creating data report-back tools to improve equity in environmental health. Environ Health 2022; 21:67. [PMID: 35821055 PMCID: PMC9277935 DOI: 10.1186/s12940-022-00880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although there is increasing interest in reporting results of environmental research efforts back to participants, evidence-based tools have not yet been applied to developed materials to ensure their accessibility in terms of literacy, numeracy, and data visualization demand. Additionally, there is not yet guidance as to how to formally assess the created materials to assure a match with the intended audience. METHODS Relying on formative qualitative research with participants of an indoor air quality study in Dorchester, Massachusetts, we identified means of enhancing accessibility of indoor air quality data report-back materials for participants. Participants (n = 20) engaged in semi-structured interviews in which they described challenges they encountered with scientific and medical materials and outlined written and verbal communication techniques that would help facilitate engagement with and accessibility of environmental health report-back materials. We coupled these insights from participants with best practice guidelines for written materials by operationalizing health literacy tools to produce accessible audience-informed data report-back materials. RESULTS The resulting data report-back materials had a 7th -grade reading level, and between a 4th -8th grade level of overall document complexity. The numeracy skills required to engage with the material were of the lowest demand, and we incorporated best practices for risk communication and facilitating understanding and actionability of the materials. Use of a rigorous assessment tool provides evidence of accessibility and appropriateness of the material for the audience. CONCLUSIONS We outline a process for developing and evaluating environmental health data reports that are tailored to inspire risk-reduction actions, and are demonstrably accessible in terms of their literacy, numeracy, and data visualization demand. Adapting health literacy tools to create and evaluate environmental data report-back materials is a novel and evidence-based means of ensuring their accessibility.
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Affiliation(s)
- Kathryn S. Tomsho
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 02215 Boston, MA USA
| | - Erin Polka
- Department of Environmental Health, Boston University School of Public Health, 02118 Boston, MA USA
| | | | - David Queeley
- Mystic River Watershed Association, 02476 Arlington, MA USA
| | - Marty Alvarez
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 02215 Boston, MA USA
| | - Madeleine K. Scammell
- Department of Environmental Health, Boston University School of Public Health, 02118 Boston, MA USA
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 02115 Boston, MA USA
| | - Rima E. Rudd
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 02115 Boston, MA USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 02215 Boston, MA USA
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Participant Experiences in a Human Biomonitoring Study: Follow-Up Interviews with Participants of the Flemish Environment and Health Study. TOXICS 2021; 9:toxics9040069. [PMID: 33800558 PMCID: PMC8066005 DOI: 10.3390/toxics9040069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
Communicating individual human biomonitoring results to study participants has been the subject of debate for some time. This debate is dominated by ethical considerations from a researchers’ perspective on whether or not to communicate, thereby overlooking more practice-based questions from a participants’ perspective on what and how to communicate. We conducted a small scale follow-up study based on eleven face-to-face interviews with mothers participating in the third cycle of the Flemish Environment and Health Study (FLEHS III 2012–2015) to investigate how they experienced and interpreted individual biomonitoring results. Key findings indicate that respondents were generally satisfied with participating in the biomonitoring study, but the report-back process especially lacked contextualized information and interactive communication options to better comprehend and cope with personal results. These findings also argue in favor of a more tailored approach in which report-back methods, formats and content are diversified according to the type of results and the preferences of participants. A reflexive research practice with active engagement in follow-up research is crucial to improve participants’ understanding and use of personal biomonitoring results.
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10
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Tomsho KS, Schollaert C, Aguilar T, Bongiovanni R, Alvarez M, Scammell MK, Adamkiewicz G. A Mixed Methods Evaluation of Sharing Air Pollution Results with Study Participants via Report-Back Communication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4183. [PMID: 31671859 PMCID: PMC6862165 DOI: 10.3390/ijerph16214183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 11/16/2022]
Abstract
We implemented a concurrent triangulation mixed-methods evaluation of an air pollution data report-back to study participants in Chelsea, Massachusetts. We aimed to determine whether the report-back was effective in the following three ways: engagement, understandability, and actionability for the participants. We also evaluated participants' valuation of the report-back information and process. The evaluation involved both qualitative components, such as ethnographic observation, and quantitative components, such as closed-ended questionnaires and demographic data. The participants who engaged in the report-back process were significantly different from those who did not engage both in terms of their demographics, and in their indoor air pollutant concentrations. Participant understanding generally corresponded with the intended meaning of the research team, suggesting successful data communication. Additionally, many of the participants reported that they were inspired to take action in order to reduce their indoor air pollutant exposure as a result of the report-back process and information provided. These results identify areas of improvement for engagement, particularly regarding populations that may have higher exposures. This work outlines a framework with which to contextualize and evaluate the success of engagement with report-back efforts. Such evaluations can allow research teams to assess whether they are providing information that is equitably useful and actionable for all participants.
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Affiliation(s)
- Kathryn S Tomsho
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Claire Schollaert
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Temana Aguilar
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA.
| | | | - Marty Alvarez
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
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Salerno J, Peters ES, Pinney SM, Morain S, Hlaing WM. Untangling the ethical intersection of epidemiology, human subjects research, and public health. Ann Epidemiol 2019; 34:1-5. [PMID: 31005553 PMCID: PMC7370238 DOI: 10.1016/j.annepidem.2019.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/08/2019] [Accepted: 03/15/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Members of the American College of Epidemiology (ACE) Ethics Committee identified current ethics and epidemiology topic areas to consider for further discussion, consultation, teaching opportunities, and conference presentation. This article reflects on the activities of the Committee at the ACE Annual Meeting in New Orleans, Louisiana, September 24-26, 2017. METHODS The overall aim for the Ethics Committee was to engage members of the College and other audiences and highlight the evolution of ethics and epidemiology since the inception of the original Ethics Guidelines published by the ACE Ethics and Standards of Practice Committee in 2000. The Ethics Committee organized a symposium session at the 2017 Annual Meeting of ACE on the ethics of human subjects research as it relates to specialized areas of epidemiology and the intersecting role of public health. This article presents a summary and further discussion of that symposium session. RESULTS Three topic areas were presented: an overview of ethics and epidemiology (E.S.P.), very high biomarker levels in environmental epidemiology research (S.M.P.), and the interface of epidemiology, human subjects research, and public health interventions (S.M.). This article begins by reviewing the foundations of epidemiology and public health and the well-known ethical principles of human subjects research. Then, it considers the ethical considerations in the use of population registry data in epidemiological research, environmental epidemiology, and epidemic surveillance and response. This article may form the basis of teaching of ethics principles related to epidemiology and public health and may serve as a companion piece to the original ACE Ethics Guidelines. CONCLUSIONS Researchers are increasingly faced with ethical considerations in diverse, nontraditional, and specialized areas of epidemiology and public health. This article illustrates these challenges with real-world examples of clinical and population registry data, the study of environmental biomarkers, and Zika virus epidemic; it also reviews relevant ethical principles underpinning these examples and identifies where gaps in knowledge may exist.
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Affiliation(s)
- Jennifer Salerno
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada.
| | - Edward S Peters
- Epidemiology Program, School of Public Health, Louisiana State University, New Orleans
| | - Susan M Pinney
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Stephanie Morain
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | - WayWay M Hlaing
- Division of Epidemiology and Population Sciences, Department of Public Health Sciences, University of Miami, Miami, FL
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Dyke SOM, Saulnier KM, Dupras C, Webster AP, Maschke K, Rothstein M, Siebert R, Walter J, Beck S, Pastinen T, Joly Y. Points-to-consider on the return of results in epigenetic research. Genome Med 2019; 11:31. [PMID: 31122281 PMCID: PMC6533659 DOI: 10.1186/s13073-019-0646-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
As epigenetic studies become more common and lead to new insights into health and disease, the return of individual epigenetic results to research participants, in particular in large-scale epigenomic studies, will be of growing importance. Members of the International Human Epigenome Consortium (IHEC) Bioethics Workgroup considered the potential ethical, legal, and social issues (ELSI) involved in returning epigenetic research results and incidental findings in order to produce a set of 'Points-to-consider' (P-t-C) for the epigenetics research community. These P-t-C draw on existing guidance on the return of genetic research results, while also integrating the IHEC Bioethics Workgroup's ELSI research on and discussion of the issues associated with epigenetic data as well as the experience of a return of results pilot study by the Personal Genome Project UK (PGP-UK). Major challenges include how to determine the clinical validity and actionability of epigenetic results, and considerations related to environmental exposures and epigenetic marks, including circumstances warranting the sharing of results with family members and third parties. Interdisciplinary collaboration and good public communication regarding epigenetic risk will be important to advance the return of results framework for epigenetic science.
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Affiliation(s)
- Stephanie O M Dyke
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, Quebec, H3A 0G1, Canada.
- Montreal Neurological Institute, Faculty of Medicine, McGill University, Montreal, Quebec, H3A 2B4, Canada.
| | - Katie M Saulnier
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, Quebec, H3A 0G1, Canada
| | - Charles Dupras
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, Quebec, H3A 0G1, Canada
| | - Amy P Webster
- UCL Cancer Institute, University College London, London, WC1E 6DD, UK
| | | | - Mark Rothstein
- Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University Medical Center, 89091, Ulm, Germany
| | - Jörn Walter
- Saarland University, 66123, Saarbrücken, Germany
| | - Stephan Beck
- UCL Cancer Institute, University College London, London, WC1E 6DD, UK
| | - Tomi Pastinen
- Department of Human Genetics, McGill University and Genome Quebec Innovation Centre, Montreal, Quebec, H3A 0G1, Canada
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, 64108, USA
| | - Yann Joly
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, Quebec, H3A 0G1, Canada
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Perovich LJ, Ohayon JL, Cousins EM, Morello-Frosch R, Brown P, Adamkiewicz G, Brody JG. Reporting to parents on children's exposures to asthma triggers in low-income and public housing, an interview-based case study of ethics, environmental literacy, individual action, and public health benefits. Environ Health 2018; 17:48. [PMID: 29784007 PMCID: PMC5963109 DOI: 10.1186/s12940-018-0395-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/11/2018] [Indexed: 05/25/2023]
Abstract
BACKGROUND Emerging evidence about the effects of endocrine disruptors on asthma symptoms suggests new opportunities to reduce asthma by changing personal environments. Right-to-know ethics supports returning personal results for these chemicals to participants, so they can make decisions to reduce exposures. Yet researchers and institutional review boards have been reluctant to approve results reports in low-income communities, which are disproportionately affected by asthma. Concerns include limited literacy, lack of resources to reduce exposures, co-occurring stressors, and lack of models for effective reporting. To better understand the ethical and public health implications of returning personal results in low-income communities, we investigated parents' experiences of learning their children's environmental chemical and biomonitoring results in the Green Housing Study of asthma. METHODS The Green Housing Study measured indoor chemical exposures, allergens, and children's asthma symptoms in "green"-renovated public housing and control sites in metro-Boston and Cincinnati in 2011-2013. We developed reports for parents of children in the study, including results for their child and community. We observed community meetings where results were reported, and metro-Boston residents participated in semi-structured interviews in 2015 about their report-back experience. Interviews were systematically coded and analyzed. RESULTS Report-back was positively received, contributed to greater understanding, built trust between researchers and participants, and facilitated action to improve health. Sampling visits and community meetings also contributed to creating a positive study experience for participants. Participants were able to make changes in their homes, such as altering product use and habits that may reduce asthma symptoms, though some faced roadblocks from family members. Participants also gained access to medical resources, though some felt that clinicians were not responsive. Participants wanted larger scale change from government or industry and wanted researchers to leverage study results to achieve change. CONCLUSIONS Report-back on environmental chemical exposures in low-income communities can enhance research benefits by engaging residents with personally relevant information that informs and motivates actions to reduce exposure to asthma triggers. Ethical practices in research should support deliberative report-back in vulnerable communities.
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Affiliation(s)
- Laura J. Perovich
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA USA
- Silent Spring Institute, Newton, MA USA
| | - Jennifer Liss Ohayon
- Silent Spring Institute, Newton, MA USA
- Social Science Environmental Health Research Institute, Northeastern University, Boston, MA USA
| | - Elicia Mayuri Cousins
- Department of Sociology and Anthropology and Social Science Environmental Health Research Institute, Northeastern University, Boston, MA USA
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy and Management and School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Phil Brown
- Social Science Environmental Health Research Institute, Northeastern University, Boston, MA USA
| | - Gary Adamkiewicz
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA USA
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Stubbe DE. Biomarkers in Psychiatry: Communication Opportunities and Obstacles. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2018; 16:183-186. [PMID: 31975915 PMCID: PMC6526848 DOI: 10.1176/appi.focus.20180003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Dorothy E Stubbe
- Dr. Stubbe is associate professor and program director for the Yale University School of Medicine Child Study Center, New Haven, Connecticut
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Turner MC, Nieuwenhuijsen M, Anderson K, Balshaw D, Cui Y, Dunton G, Hoppin JA, Koutrakis P, Jerrett M. Assessing the Exposome with External Measures: Commentary on the State of the Science and Research Recommendations. Annu Rev Public Health 2017; 38:215-239. [PMID: 28384083 PMCID: PMC7161939 DOI: 10.1146/annurev-publhealth-082516-012802] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The exposome comprises all environmental exposures that a person experiences from conception throughout the life course. Here we review the state of the science for assessing external exposures within the exposome. This article reviews (a) categories of exposures that can be assessed externally, (b) the current state of the science in external exposure assessment, (c) current tools available for external exposure assessment, and (d) priority research needs. We describe major scientific and technological advances that inform external assessment of the exposome, including geographic information systems; remote sensing; global positioning system and geolocation technologies; portable and personal sensing, including smartphone-based sensors and assessments; and self-reported questionnaire assessments, which increasingly rely on Internet-based platforms. We also discuss priority research needs related to methodological and technological improvement, data analysis and interpretation, data sharing, and other practical considerations, including improved assessment of exposure variability as well as exposure in multiple, critical life stages.
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Affiliation(s)
- Michelle C Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain; , .,Universitat Pompeu Fabra (UPF), Barcelona 08002, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain.,McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario K1G 3Z7, Canada
| | - Mark Nieuwenhuijsen
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08003, Spain; , .,Universitat Pompeu Fabra (UPF), Barcelona 08002, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain
| | - Kim Anderson
- Department of Environmental and Molecular Toxicology, Oregon State University, Corvallis, Oregon 97331;
| | - David Balshaw
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709; ,
| | - Yuxia Cui
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709; ,
| | - Genevieve Dunton
- Department of Preventive Medicine and Department of Psychology, University of Southern California, Los Angeles, California 90033;
| | - Jane A Hoppin
- Center for Human Health and the Environment, Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina 27695;
| | - Petros Koutrakis
- Department of Environmental Health, Harvard University, Boston, Massachusetts 02115;
| | - Michael Jerrett
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California 94704; .,Department of Environmental Health Science, Fielding School of Public Health, University of California, Los Angeles, California 90095-1772;
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Arcury TA, Wiggins MF, Brooke C, Jensen A, Summers P, Mora DC, Quandt SA. Using "Policy Briefs" to Present Scientific Results of CBPR: Farmworkers in North Carolina. Prog Community Health Partnersh 2017; 11:137-147. [PMID: 28736406 DOI: 10.1353/cpr.2017.0018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Using scientific results to inform policy that improves health and well-being of vulnerable community members is essential to community-based participatory research (CBPR). OBJECTIVES We describe "policy briefs," a mechanism developed to apply the results of CBPR projects with migrant and seasonal farmworkers to policy changes. LESSONS LEARNED Policy briefs are two-page summaries of published research that address a single policy issue using language and graphics to make the science accessible to diverse audiences. Policy brief topics are selected by community advocates, based on collaborative research, and address a specific policy or regulation. Development is an iterative process of discussion with community representatives. Briefs have been used to provide information to advocates, state and national policymakers, and the public. CONCLUSIONS Disseminating CBPR results to address policy is needed. Collaborating with community partners to produce policy briefs ensures that information about concerns and struggles reflects their priorities.
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Domingo JL, García F, Nadal M, Schuhmacher M. Autopsy tissues as biological monitors of human exposure to environmental pollutants. A case study: Concentrations of metals and PCDD/Fs in subjects living near a hazardous waste incinerator. ENVIRONMENTAL RESEARCH 2017; 154:269-274. [PMID: 28110241 DOI: 10.1016/j.envres.2017.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 06/06/2023]
Abstract
Human biomonitoring is of tremendous importance to prevent potential adverse effects derived from human exposure to chemicals. Blood and urine are among the biological monitors more frequently used. However, biological matrices such as breast milk, hair, nails, saliva, feces, teeth, and expired air are also often used. In addition, and focused mainly on long-term exposure, adipose tissue and other human tissues like bone, liver, brain or kidney, are also used as biological monitors of certain substances, especially for long-term biomonitoring. However, for this kind of tissues sampling is always a limiting factor. In this paper, we have examined the role of autopsy tissues as biological monitors of human exposure to environmental pollutants. For it, we have used a case study conducted near a hazardous waste incinerator (HWI) in Catalonia (Spain), in which the concentrations of metals and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), have been periodically determined in autopsy tissues of subjects living in the area under potential influence of the facility. This case study does not show advantages -in comparison to other appropriate biomonitors such as blood- in using autopsy tissues in the monitoring of long-term exposure to metals and PCDD/Fs.
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Affiliation(s)
- José L Domingo
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia, Spain
| | - Francisco García
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia, Spain
| | - Martí Nadal
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia, Spain.
| | - Marta Schuhmacher
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia, Spain
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Ford AR, Scott DN. A Critique of Risk Disclosure as the Solution for Minimizing Toxic Exposures in Pregnancy. New Solut 2017; 27:51-67. [PMID: 28403738 DOI: 10.1177/1048291117697108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The issue of pregnant women's exposures to everyday chemicals and the implications for the health of future children are receiving increased attention in popular media and in the academic press. In response, health profession organizations are developing clinical practice guidelines for warning pregnant women about the risks associated with exposures to certain toxics. We evaluate different sides of a risk-avoidance approach for pregnant women in the context of a hypothetical case study involving phthalates and women who work in nail salons. We consider the ubiquitous nature of low-dose exposures and both the positive aspects and limitations of promoting avoidance measures with respect to phthalate exposures. We conclude that a risk-disclosure approach has both practical limitations and equity dimensions which must be factored in to public health guidelines and messaging and the development of clinical practice guidelines. Upstream solutions including regulatory action on chemicals and heightened attention to environmental justice would result in optimal management of this issue.
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Boronow KE, Susmann HP, Gajos KZ, Rudel RA, Arnold KC, Brown P, Morello-Frosch R, Havas L, Brody JG. DERBI: A Digital Method to Help Researchers Offer "Right-to-Know" Personal Exposure Results. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:A27-A33. [PMID: 28145870 PMCID: PMC5289917 DOI: 10.1289/ehp702] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Researchers and clinicians in environmental health and medicine increasingly show respect for participants and patients by involving them in decision-making. In this context, the return of personal results to study participants is becoming ethical best practice, and many participants now expect to see their data. However, researchers often lack the time and expertise required for report-back, especially as studies measure greater numbers of analytes, including many without clear health guidelines. In this article, our goal is to demonstrate how a prototype digital method, the Digital Exposure Report-Back Interface (DERBI), can reduce practical barriers to high-quality report-back. DERBI uses decision rules to automate the production of personalized summaries of notable results and generates graphs of individual results with comparisons to the study group and benchmark populations. Reports discuss potential sources of chemical exposure, what is known and unknown about health effects, strategies for exposure reduction, and study-wide findings. Researcher tools promote discovery by drawing attention to patterns of high exposure and offer novel ways to increase participant engagement. DERBI reports have been field tested in two studies. Digital methods like DERBI reduce practical barriers to report-back thus enabling researchers to meet their ethical obligations and participants to get knowledge they can use to make informed choices.
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Affiliation(s)
| | | | - Krzysztof Z. Gajos
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, Massachusetts, USA
| | | | - Kenneth C. Arnold
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, Massachusetts, USA
| | - Phil Brown
- Social Science Environmental Health Research Institute, Northeastern University, Boston, Massachusetts, USA
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy and Management and School of Public Health, University of California, Berkeley, California, USA
| | - Laurie Havas
- Child Health and Development Studies Participant Advisory Council, Berkeley, California, USA
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Ohayon JL, Cousins E, Brown P, Morello-Frosch R, Brody JG. Researcher and institutional review board perspectives on the benefits and challenges of reporting back biomonitoring and environmental exposure results. ENVIRONMENTAL RESEARCH 2017; 153:140-149. [PMID: 27960129 PMCID: PMC5412511 DOI: 10.1016/j.envres.2016.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/03/2016] [Accepted: 12/03/2016] [Indexed: 05/25/2023]
Abstract
As the number of personal exposure studies expands and trends favor greater openness and transparency in the health sciences, ethical issues arise around reporting back individual results for contaminants without clear health guidelines. Past research demonstrates that research participants want their results even when the health implications are not known. The experiences of researchers and institutional review boards (IRBs) in studies that have reported personal chemical exposures can provide insights about ethical and practical approaches while also revealing areas of continued uncertainty. We conducted semi-structured interviews with 17 researchers and nine IRB members from seven personal exposure studies across the United States to investigate their experiences and attitudes about the report-back process. Researchers reported multiple benefits of report-back, including increasing retention and recruitment, advancing environmental health literacy, empowering study participants to take actions to reduce exposures, encouraging shifts in government and industry practices, and helping researchers discover sources of exposure through participant consultation. Researchers also reported challenges, including maintaining ongoing contact with participants, adopting protocols for notification of high exposures to chemicals without health guidelines, developing meaningful report-back materials, and resource limitations. IRB members reported concern for potential harm to participants, such as anxiety about personal results and counterproductive behavior changes. In contrast, researchers who have conducted personal report-back in their studies said that participants did not appear overly alarmed and noted that worry can be a positive outcome to motivate action to reduce harmful exposures. While key concerns raised during the early days of report-back have been substantially resolved for scientists with report-back experience, areas of uncertainty remain. These include ethical tensions surrounding the responsibility of researchers to leverage study results and resources to assist participants in policy or community-level actions to reduce chemical exposures, and how to navigate report-back to vulnerable populations.
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Affiliation(s)
| | - Elicia Cousins
- Department of Sociology and Anthropology and Social Science Environmental Health Research Institute, Northeastern University, 360 Huntington Avenue, 310INV, 02115 Boston, MA, USA.
| | - Phil Brown
- Department of Sociology and Anthropology and Social Science Environmental Health Research Institute, Northeastern University, 360 Huntington Avenue, 310INV, 02115 Boston, MA, USA.
| | - Rachel Morello-Frosch
- School of Public Health and Department of Environmental Science, Policy and Management, University of California, Berkeley, 130 Mulford Hall, 94720 Berkeley, CA, USA.
| | - Julia Green Brody
- Silent Spring Institute, 320 Nevada Street, Suite 302, 02460 Newton, MA, USA.
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Barrett JR. After the Research Is Done: Legal Obligations for Participants in Household Exposure Studies. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:A206. [PMID: 27801653 PMCID: PMC5089894 DOI: 10.1289/ehp.124-a206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Goho SA. The Legal Implications of Report Back in Household Exposure Studies. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:1662-1670. [PMID: 27153111 PMCID: PMC5089882 DOI: 10.1289/ehp187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/18/2015] [Accepted: 04/29/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Scientists conducting research into household air or dust pollution must decide whether, when, and how to disclose to study participants their individual results. A variety of considerations factor into this decision, but one factor that has not received attention until now is the possibility that study participants' receipt of their results might create legal duties under environmental, property, landlord-tenant, or other laws. OBJECTIVES This article examines relevant laws and regulations and explores the scope of participants' legal duties and the resulting legal and ethical consequences for researchers. Participants could be required in some situations to disclose the presence of certain chemicals when selling or renting their homes or to frequent visitors. The article discusses hypothetical case studies involving the reporting back of results regarding lead, polychlorinated biphenyls, and phthalates. DISCUSSION The potential legal duties of study participants have both ethical and legal implications for researchers. Issues include whether the legal consequences for participants should affect the decision whether to report back individual results, how researchers should disclose the legal risks to participants during the informed consent process, and whether researchers would be liable to study participants for legal or economic harm arising from reporting study results to them. The review provides recommendations for language that researchers could use in the informed consent process to disclose the legal risks. CONCLUSIONS Researchers should still report back to participants who want to see their results, but they should disclose the risks of obtaining the information as part of the informed consent process. Citation: Goho SA. 2016. The legal implications of report back in household exposure studies. Environ Health Perspect 124:1662-1670; http://dx.doi.org/10.1289/EHP187.
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Affiliation(s)
- Shaun A. Goho
- Emmett Environmental Law and Policy Clinic, Harvard Law School, Harvard University, Cambridge, Massachusetts, USA
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Finn S, Collman G. The Pivotal Role of the Social Sciences in Environmental Health Sciences Research. New Solut 2016; 26:389-411. [PMID: 27605565 DOI: 10.1177/1048291116666485] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Environmental health sciences research seeks to elucidate environmental factors that put human health at risk. A primary aim is to develop strategies to prevent or reduce exposures and disease occurrence. Given this primary focus on prevention, environmental health sciences research focuses on the populations most at risk such as communities of color and/or low socioeconomic status. The National Institute of Environmental Health Sciences research programs incorporate the principles of Community-Based Participatory Research to study health disparities. These programs promote community engagement, culturally appropriate communications with a variety of stakeholders, and consideration of the social determinants of health that interact with environmental factors to increase risk. Multidisciplinary research teams that include social and behavioral scientists are essential to conduct this type of research. This article outlines the history of social and behavioral research funding at National Institute of Environmental Health Sciences and offers examples of National Institute of Environmental Health Sciences-funded projects that exemplify the value of social science to the environmental health sciences.
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Affiliation(s)
- Symma Finn
- 1 National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Gwen Collman
- 1 National Institute of Environmental Health Sciences, Durham, NC, USA
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Ramirez-Andreotta MD, Brody JG, Lothrop N, Loh M, Beamer PI, Brown P. Reporting back environmental exposure data and free choice learning. Environ Health 2016; 15:2. [PMID: 26748908 PMCID: PMC4707004 DOI: 10.1186/s12940-015-0080-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 12/05/2015] [Indexed: 05/07/2023]
Abstract
Reporting data back to study participants is increasingly being integrated into exposure and biomonitoring studies. Informal science learning opportunities are valuable in environmental health literacy efforts and report back efforts are filling an important gap in these efforts. Using the University of Arizona's Metals Exposure Study in Homes, this commentary reflects on how community-engaged exposure assessment studies, partnered with data report back efforts are providing a new informal education setting and stimulating free-choice learning. Participants are capitalizing on participating in research and leveraging their research experience to meet personal and community environmental health literacy goals. Observations from report back activities conducted in a mining community support the idea that reporting back biomonitoring data reinforces free-choice learning and this activity can lead to improvements in environmental health literacy. By linking the field of informal science education to the environmental health literacy concepts, this commentary demonstrates how reporting data back to participants is tapping into what an individual is intrinsically motivated to learn and how these efforts are successfully responding to community-identified education and research needs.
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Affiliation(s)
- Monica D Ramirez-Andreotta
- Department of Soil, Water, and Environmental Science, University of Arizona, 1177 E Fourth Street, Rm. 429, Tucson, Arizona, USA.
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85721, USA.
| | | | - Nathan Lothrop
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85721, USA.
| | - Miranda Loh
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85721, USA.
- Institute of Occupational Medicine, Edinburgh, UK.
| | - Paloma I Beamer
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85721, USA.
| | - Phil Brown
- Department of Sociology and Anthropology and Department of Health Sciences, Northeastern University, Boston, MA, USA.
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Zarate OA, Brody JG, Brown P, Ramirez-Andreotta MD, Perovich L, Matz J. Balancing Benefits and Risks of Immortal Data: Participants' Views of Open Consent in the Personal Genome Project. Hastings Cent Rep 2015; 46:36-45. [PMID: 26678513 DOI: 10.1002/hast.523] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
An individual's health, genetic, or environmental-exposure data, placed in an online repository, creates a valuable shared resource that can accelerate biomedical research and even open opportunities for crowd-sourcing discoveries by members of the public. But these data become "immortalized" in ways that may create lasting risk as well as benefit. Once shared on the Internet, the data are difficult or impossible to redact, and identities may be revealed by a process called data linkage, in which online data sets are matched to each other. Reidentification (re-ID), the process of associating an individual's name with data that were considered deidentified, poses risks such as insurance or employment discrimination, social stigma, and breach of the promises often made in informed-consent documents. At the same time, re-ID poses risks to researchers and indeed to the future of science, should re-ID end up undermining the trust and participation of potential research participants. The ethical challenges of online data sharing are heightened as so-called big data becomes an increasingly important research tool and driver of new research structures. Big data is shifting research to include large numbers of researchers and institutions as well as large numbers of participants providing diverse types of data, so the participants' consent relationship is no longer with a person or even a research institution. In addition, consent is further transformed because big data analysis often begins with descriptive inquiry and generation of a hypothesis, and the research questions cannot be clearly defined at the outset and may be unforeseeable over the long term. In this article, we consider how expanded data sharing poses new challenges, illustrated by genomics and the transition to new models of consent. We draw on the experiences of participants in an open data platform-the Personal Genome Project-to allow study participants to contribute their voices to inform ethical consent practices and protocol reviews for big-data research.
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Pinney SM, Biro FM. Letter to the editor re Morollo-Frosh "Communicating results in post-Belmont era biomonitoring studies". ENVIRONMENTAL RESEARCH 2015; 142:756. [PMID: 26076818 PMCID: PMC5497832 DOI: 10.1016/j.envres.2015.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Susan M Pinney
- Department of Environmental Health University of Cincinnati, College of Medicine, United States.
| | - Frank M Biro
- Department of Pediatrics University of Cincinnati College of Medicine Interim Director of Research Division of Adolescent & Transition Medicine Cincinnati Children's Hospital Medical Center, United States.
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Casteleyn L, Dumez B, Becker K, Kolossa-Gehring M, Den Hond E, Schoeters G, Castaño A, Koch HM, Angerer J, Esteban M, Exley K, Sepai O, Bloemen L, Horvat M, Knudsen LE, Joas A, Joas R, Biot P, Koppen G, Dewolf MC, Katsonouri A, Hadjipanayis A, Cerná M, Krsková A, Schwedler G, Fiddicke U, Nielsen JKS, Jensen JF, Rudnai P, Közepésy S, Mulcahy M, Mannion R, Gutleb AC, Fischer ME, Ligocka D, Jakubowski M, Reis MF, Namorado S, Lupsa IR, Gurzau AE, Halzlova K, Jajcaj M, Mazej D, Tratnik Snoj J, Posada M, López E, Berglund M, Larsson K, Lehmann A, Crettaz P, Aerts D. A pilot study on the feasibility of European harmonized human biomonitoring: Strategies towards a common approach, challenges and opportunities. ENVIRONMENTAL RESEARCH 2015; 141:3-14. [PMID: 25746298 DOI: 10.1016/j.envres.2014.10.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/21/2014] [Accepted: 10/27/2014] [Indexed: 06/04/2023]
Abstract
In 2004 the European Commission and Member States initiated activities towards a harmonized approach for Human Biomonitoring surveys throughout Europe. The main objective was to sustain environmental health policy by building a coherent and sustainable framework and by increasing the comparability of data across countries. A pilot study to test common guidelines for setting up surveys was considered a key step in this process. Through a bottom-up approach that included all stakeholders, a joint study protocol was elaborated. From September 2011 till February 2012, 17 European countries collected data from 1844 mother-child pairs in the frame of DEMOnstration of a study to COordinate and Perform Human Biomonitoring on a European Scale (DEMOCOPHES).(1) Mercury in hair and urinary cadmium and cotinine were selected as biomarkers of exposure covered by sufficient analytical experience. Phthalate metabolites and Bisphenol A in urine were added to take into account increasing public and political awareness for emerging types of contaminants and to test less advanced markers/markers covered by less analytical experience. Extensive efforts towards chemo-analytical comparability were included. The pilot study showed that common approaches can be found in a context of considerable differences with respect to experience and expertize, socio-cultural background, economic situation and national priorities. It also evidenced that comparable Human Biomonitoring results can be obtained in such context. A European network was built, exchanging information, expertize and experiences, and providing training on all aspects of a survey. A key challenge was finding the right balance between a rigid structure allowing maximal comparability and a flexible approach increasing feasibility and capacity building. Next steps in European harmonization in Human Biomonitoring surveys include the establishment of a joint process for prioritization of substances to cover and biomarkers to develop, linking biomonitoring surveys with health examination surveys and with research, and coping with the diverse implementations of EU regulations and international guidelines with respect to ethics and privacy.
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Affiliation(s)
| | | | - K Becker
- Federal Environment Agency (UBA), Germany
| | | | | | | | - A Castaño
- Instituto de Salud Carlos III, Spain
| | - H M Koch
- Ruhr Universität Bochum, Germany
| | | | - M Esteban
- Instituto de Salud Carlos III, Spain
| | - K Exley
- Public Health England, United Kingdom
| | - O Sepai
- Public Health England, United Kingdom
| | - L Bloemen
- Environmental Health Sciences International, The Netherlands
| | - M Horvat
- Jožef Stefan Institute, Slovenia
| | | | | | | | - P Biot
- Federal Public Service Health, Food chain safety and Environment, Belgium
| | | | - M-C Dewolf
- Hainaut Vigilance Sanitaire (HVS) and Hygiene Publique in Hainaut (HPH), Belgium
| | | | | | - M Cerná
- National Institute of Public Health, Czech Republic
| | - A Krsková
- National Institute of Public Health, Czech Republic
| | | | | | | | | | - P Rudnai
- National Institute of Environmental Health, Hungary
| | - S Közepésy
- National Institute of Environmental Health, Hungary
| | | | | | - A C Gutleb
- Centre de Recherche Public - Gabriel Lippmann, Luxembourg
| | | | - D Ligocka
- Nofer Institute of Occupational Medicine, Poland
| | - M Jakubowski
- Nofer Institute of Occupational Medicine, Poland
| | - M F Reis
- Faculdade de Medicina de Lisboa, Portugal
| | - S Namorado
- Faculdade de Medicina de Lisboa, Portugal
| | - I-R Lupsa
- Environmental Health Center, Romania
| | | | - K Halzlova
- Urad Verejneho Zdravotnictva Slovenskej Republiky, Slovakia
| | - M Jajcaj
- Urad Verejneho Zdravotnictva Slovenskej Republiky, Slovakia
| | - D Mazej
- Jožef Stefan Institute, Slovenia
| | | | - M Posada
- Instituto de Salud Carlos III, Spain
| | - E López
- Instituto de Salud Carlos III, Spain
| | - M Berglund
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - K Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A Lehmann
- Federal Office of Public Health (FOPH), Switzerland
| | - P Crettaz
- Federal Office of Public Health (FOPH), Switzerland
| | - D Aerts
- Federal Public Service Health, Food chain safety and Environment, Belgium
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Saykin AJ, Shen L, Yao X, Kim S, Nho K, Risacher SL, Ramanan VK, Foroud TM, Faber KM, Sarwar N, Munsie LM, Hu X, Soares HD, Potkin SG, Thompson PM, Kauwe JSK, Kaddurah-Daouk R, Green RC, Toga AW, Weiner MW. Genetic studies of quantitative MCI and AD phenotypes in ADNI: Progress, opportunities, and plans. Alzheimers Dement 2015; 11:792-814. [PMID: 26194313 PMCID: PMC4510473 DOI: 10.1016/j.jalz.2015.05.009] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 05/08/2015] [Accepted: 05/08/2015] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Genetic data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) have been crucial in advancing the understanding of Alzheimer's disease (AD) pathophysiology. Here, we provide an update on sample collection, scientific progress and opportunities, conceptual issues, and future plans. METHODS Lymphoblastoid cell lines and DNA and RNA samples from blood have been collected and banked, and data and biosamples have been widely disseminated. To date, APOE genotyping, genome-wide association study (GWAS), and whole exome and whole genome sequencing data have been obtained and disseminated. RESULTS ADNI genetic data have been downloaded thousands of times, and >300 publications have resulted, including reports of large-scale GWAS by consortia to which ADNI contributed. Many of the first applications of quantitative endophenotype association studies used ADNI data, including some of the earliest GWAS and pathway-based studies of biospecimen and imaging biomarkers, as well as memory and other clinical/cognitive variables. Other contributions include some of the first whole exome and whole genome sequencing data sets and reports in healthy controls, mild cognitive impairment, and AD. DISCUSSION Numerous genetic susceptibility and protective markers for AD and disease biomarkers have been identified and replicated using ADNI data and have heavily implicated immune, mitochondrial, cell cycle/fate, and other biological processes. Early sequencing studies suggest that rare and structural variants are likely to account for significant additional phenotypic variation. Longitudinal analyses of transcriptomic, proteomic, metabolomic, and epigenomic changes will also further elucidate dynamic processes underlying preclinical and prodromal stages of disease. Integration of this unique collection of multiomics data within a systems biology framework will help to separate truly informative markers of early disease mechanisms and potential novel therapeutic targets from the vast background of less relevant biological processes. Fortunately, a broad swath of the scientific community has accepted this grand challenge.
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Affiliation(s)
- Andrew J Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Li Shen
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA; Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Xiaohui Yao
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; School of Informatics and Computing, Indiana University, Purdue University - Indianapolis, Indianapolis, IN, USA
| | - Sungeun Kim
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kwangsik Nho
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shannon L Risacher
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Vijay K Ramanan
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tatiana M Foroud
- Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kelley M Faber
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Xiaolan Hu
- Bristol-Myers Squibb, Wallingford, CT, USA
| | | | - Steven G Potkin
- Department of Psychiatry and Human Behavior, University of California - Irvine, Irvine, CA, USA
| | - Paul M Thompson
- Department of Neurology, Keck School of Medicine of USC, University of Southern California, Marina del Rey, CA, USA; Imaging Genetics Center, Keck School of Medicine of USC, University of Southern California, Marina del Rey, CA, USA
| | - John S K Kauwe
- Department of Biology, Brigham Young University, Provo, UT, USA; Department of Neuroscience, Brigham Young University, Provo, UT, USA
| | - Rima Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
| | - Robert C Green
- Partners Center for Personalized Genetic Medicine, Boston, MA, USA; Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute for Neuroimaging and Neuroinformatics, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Michael W Weiner
- Department of Radiology, University of California-San Francisco, San Francisco, CA, USA; Department of Medicine, University of California-San Francisco, San Francisco, CA, USA; Department of Psychiatry, University of California-San Francisco, San Francisco, CA, USA; Center for Imaging of Neurodegenerative Diseases, San Francisco VA Medical Center, San Francisco, CA, USA
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