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Pomazal R, Malecki K, Stanton N, Shelton B, Lange M, Irving R, Meiman J, Remucal CK, Cochran A, Schultz AA. Determinants of per- and polyfluoroalkyl substances (PFAS) exposure among Wisconsin residents. ENVIRONMENTAL RESEARCH 2024; 254:119131. [PMID: 38759771 DOI: 10.1016/j.envres.2024.119131] [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: 03/14/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) include thousands of manufactured compounds with growing public health concerns due to their potential for widespread human exposure and adverse health outcomes. While PFAS contamination remains a significant concern, especially from ingestion of contaminated food and water, determinants of the variability in PFAS exposure among regional and statewide populations in the United States remains unclear. OBJECTIVES The objective of this study was to leverage The Survey of the Health of Wisconsin (SHOW), the only statewide representative cohort in the US, to assess and characterize the variability of PFAS exposure in a general population. METHODS This study sample included a sub-sample of 605 adult participants from the 2014-2016 tri-annual statewide representative sample. Geometric means for PFOS, PFOA, PFNA, PFHxS, PFPeS, PFHpA, and a summed measure of 38 analyzed serum PFAS were presented by demographic, diet, behavioral, and residential characteristics. Multivariate linear regression was used to determine significant predictors of serum PFAS after adjustment. RESULTS Overall, higher serum concentrations of long-chain PFAS were observed compared with short-chain PFAS. Older adults, males, and non-Hispanic White individuals had higher serum PFAS compared to younger adults, females, and non-White individuals. Eating caught fish in the past year was associated with elevated levels of several PFAS. DISCUSSION This is among the first studies to characterize serum PFAS among a representative statewide sample in Wisconsin. Both short- and long-chain serum PFAS were detectable for six prominent PFAS. Age and consumption of great lakes fish were the most significant predictors of serum PFAS. State-level PFAS biomonitoring is important for identifying high risk populations and informing state public health standards and interventions, especially among those not living near known contamination sites.
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Affiliation(s)
- Rachel Pomazal
- University of Wisconsin-Madison, Department of Population Health Sciences, Madison, WI, USA
| | - Kristen Malecki
- Division of Environmental and Occupational Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL, USA
| | - Noel Stanton
- Wisconsin State Lab of Hygiene, Madison, WI, USA
| | | | - Meshel Lange
- Wisconsin State Lab of Hygiene, Madison, WI, USA
| | - Roy Irving
- Wisconsin Department of Health Services Madison, WI, USA
| | | | - Christina K Remucal
- University of Wisconsin-Madison, Department of Civil and Environmental Engineering, Madison, WI, USA
| | - Amy Cochran
- University of Wisconsin-Madison, Department of Population Health Sciences, Madison, WI, USA
| | - Amy A Schultz
- University of Wisconsin-Madison, Department of Population Health Sciences, Madison, WI, USA.
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Wilson RJ, Suh YP, Dursun I, Li X, da Costa Souza F, Grodzki AC, Cui JY, Lehmler HJ, Lein PJ. Developmental exposure to the Fox River PCB mixture modulates behavior in juvenile mice. Neurotoxicology 2024; 103:146-161. [PMID: 38885884 DOI: 10.1016/j.neuro.2024.06.008] [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: 03/24/2024] [Revised: 05/13/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
Developmental exposures to PCBs are implicated in the etiology of neurodevelopmental disorders (NDDs). This observation is concerning given the continued presence of PCBs in the human environment and the increasing incidence of NDDs. Previous studies reported that developmental exposure to legacy commercial PCB mixtures (Aroclors) or single PCB congeners found in Aroclors caused NDD-relevant behavioral phenotypes in animal models. However, the PCB congener profile in contemporary human samples is dissimilar to that of the legacy Aroclors, raising the question of whether human-relevant PCB mixtures similarly interfere with normal brain development. To address this question, we assessed the developmental neurotoxicity of the Fox River Mixture (FRM), which was designed to mimic the congener profile identified in fish from the PCB-contaminated Fox River that constitute a primary protein source in the diet of surrounding communities. Adult female C57BL/6 J mouse dams (8-10 weeks old) were exposed to vehicle (peanut oil) or FRM at 0.1, 1.0, or 6.0 mg/kg/d in their diet throughout gestation and lactation, and neurodevelopmental outcomes were assessed in their pups. Ultrasonic vocalizations (USVs) and measures of general development were quantified at postnatal day (P) 7, while performance in the spontaneous alternation task and the 3-chambered social approach/social novelty task was assessed on P35. Triiodothyronine (T3) and thyroxine (T4) were quantified in serum collected from the dams when pups were weaned and from pups on P28 and P35. Developmental exposure to FRM did not alter pup weight or body temperature on P7, but USVs were significantly decreased in litters exposed to FRM at 0.1 or 6.0 mg/kg/d in the maternal diet. FRM also impaired male and female pups' performance in the social novelty task. Compared to sex-matched vehicles, significantly decreased social novelty was observed in male and female pups in the 0.1 and 6.0 mg/kg/d dose groups. FRM did not alter performance in the spontaneous alternation or social approach tasks. FRM increased serum T3 levels but decreased serum T4 levels in P28 male pups in the 1.0 and 6.0 mg/kg/d dose groups. In P35 female pups and dams, serum T3 levels decreased in the 6.0 mg/kg/d dose group while T4 levels were not altered. Collectively, these findings suggest that FRM interferes with the development of social communication and social novelty, but not memory, supporting the hypothesis that contemporary PCB exposures pose a risk to the developing brain. FRM had sex, age, and dose-dependent effects on serum thyroid hormone levels that overlapped but did not perfectly align with the FRM effects on behavioral outcomes. These observations suggest that changes in thyroid hormone levels are not likely the major factor underlying the behavioral deficits observed in FRM-exposed animals.
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Affiliation(s)
- Rebecca J Wilson
- Department of Molecular Biosciences, University of California Davis, Davis, CA, USA
| | - Youjun P Suh
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Ilknur Dursun
- Department of Molecular Biosciences, University of California Davis, Davis, CA, USA; Istinye University, School of Medicine, Department of Physiology, Istanbul 34396, Turkey
| | - Xueshu Li
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA
| | | | - Ana Cristina Grodzki
- Department of Molecular Biosciences, University of California Davis, Davis, CA, USA
| | - Julia Y Cui
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Hans-Joachim Lehmler
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA
| | - Pamela J Lein
- Department of Molecular Biosciences, University of California Davis, Davis, CA, USA.
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Holder C, Cohen Hubal EA, Luh J, Lee MG, Melnyk LJ, Thomas K. Systematic evidence mapping of potential correlates of exposure for per- and poly-fluoroalkyl substances (PFAS) based on measured occurrence in biomatrices and surveys of dietary consumption and product use. Int J Hyg Environ Health 2024; 259:114384. [PMID: 38735219 DOI: 10.1016/j.ijheh.2024.114384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/05/2024] [Accepted: 04/21/2024] [Indexed: 05/14/2024]
Abstract
Per- and poly-fluoroalkyl substances (PFAS) are widely observed in environmental media and often are found in indoor environments as well as personal-care and consumer products. Humans may be exposed through water, food, indoor dust, air, and the use of PFAS-containing products. Information about relationships between PFAS exposure sources and pathways and the amounts found in human biomatrices can inform source-contribution assessments and provide targets for exposure reduction. This work collected and collated evidence for correlates of PFAS human exposure as measured through sampling of biomatrices and surveys of dietary consumption and use of consumer products and articles. A systematic evidence mapping approach was applied to perform a literature search, conduct title-abstract and full-text screening, and to extract primary data into a comprehensive database for 16 PFAS. Parameters of interest included: sampling dates and locations, cohort descriptors, PFAS measured in a human biomatrix, information about food consumption in 11 categories, use of products/articles in 11 categories, and reported correlation values (and their statistical strength). The literature search and screening process yielded 103 studies with information for correlates of PFAS exposures. Detailed data were extracted and compiled on measures of PFAS correlations between biomatrix concentrations and dietary consumption and other product/article use. A majority of studies (61/103; 59%) were published after 2015 with few (8/103; 8%) prior to 2010. Studies were most abundant for dietary correlates (n = 94) with fewer publications reporting correlate assessments for product use (n = 56), while some examined both. PFOA and PFOS were assessed in almost all studies, followed by PFHxS, PFNA, and PFDA which were included in >50% of the studies. No relevant studies included PFNS or PFPeS. Among the 94 studies of dietary correlates, significant correlations were reported in 83% of the studies for one or more PFAS. The significant dietary correlations most commonly were for seafood, meats/eggs, and cereals/grains/pulses. Among the 56 studies of product/article correlates, significant correlations were reported in 70% of the studies. The significant product/article correlations most commonly were for smoking/tobacco, cosmetics/toiletries, non-stick cookware, and carpet/flooring/furniture and housing. Six of 11 product/article categories included five or fewer studies, including food containers and stain- and water-resistant products. Significant dietary and product/article correlations most commonly were positive. Some studies found a mix of positive and negative correlations depending on the PFAS, specific correlate, and specific response level, particularly for fats/oils, dairy consumption, food containers, and cosmetics/toiletries. Most of the significant findings for cereals/grains/pulses were negative correlations. Substantial evidence was found for correlations between dietary intake and biomatrix levels for several PFAS in multiple food groups. Studies examining product/article use relationships were relatively sparse, except for smoking/tobacco, and would benefit from additional research. The resulting database can inform further assessments of dietary and product use exposure relationships and can inform new research to better understand PFAS source-to-exposure relationships. The search strategy should be extended and implemented to support living evidence review in this rapidly advancing area.
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Affiliation(s)
| | - Elaine A Cohen Hubal
- U.S. EPA, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, USA, 27711.
| | | | | | - Lisa Jo Melnyk
- U.S. EPA, Office of Research and Development, Center for Public Health and Environmental Assessment, Cincinnati, OH, 45268, USA.
| | - Kent Thomas
- U.S. EPA, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, USA, 27711.
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Aker A, Nguyen V, Ayotte P, Ricard S, Lemire M. Characterizing Important Dietary Exposure Sources of Perfluoroalkyl Acids in Inuit Youth and Adults in Nunavik Using a Feature Selection Tool. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:47014. [PMID: 38683744 PMCID: PMC11057678 DOI: 10.1289/ehp13556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/26/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Previous studies have identified the consumption of country foods (hunted/harvested foods from the land) as the primary exposure source of perfluoroalkyl acids (PFAA) in Arctic communities. However, identifying the specific foods associated with PFAA exposures is complicated due to correlation between country foods that are commonly consumed together. METHODS We used venous blood sample data and food frequency questionnaire data from the Qanuilirpitaa? ("How are we now?") 2017 (Q2017) survey of Inuit individuals ≥ 16 y of age residing in Nunavik (n = 1,193 ). Adaptive elastic net, a machine learning technique, identified the most important food items for predicting PFAA biomarker levels while accounting for the correlation among the food items. We used generalized linear regression models to quantify the association between the most predictive food items and six plasma PFAA biomarker levels. The estimates were converted to percent changes in a specific PFAA biomarker level per standard deviation increase in the consumption of a food item. Models were also stratified by food type (market or country foods). RESULTS Perfluorooctanesulfonic acid (PFOS), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA) were associated with frequent consumption of beluga misirak (rendered fat) [14.6%; 95% confidence interval (CI): 10.3%, 18.9%; 14.6% (95% CI: 10.1%, 19.0%)], seal liver [9.3% (95% CI: 5.0%, 13.7%); 8.1% (95% CI: 3.5%, 12.6%)], and suuvalik (fish roe mixed with berries and fat) [6.0% (95% CI: 1.3%, 10.7%); 7.5% (95% CI: 2.7%, 12.3%)]. Beluga misirak was also associated with higher concentrations of perfluorohexanesulphonic acid (PFHxS) and perfluorononanoic acid (PFNA), albeit with lower percentage changes. PFHxS, perfluorooctanoic acid (PFOA), and PFNA followed some similar patterns, with higher levels associated with frequent consumption of ptarmigan [6.1% (95% CI: 3.2%, 9.0%); 5.1% (95% CI: 1.1%, 9.1%); 5.4% (95% CI: 1.8%, 9.0%)]. Among market foods, frequent consumption of processed meat and popcorn was consistently associated with lower PFAA exposure. CONCLUSIONS Our study identifies specific food items contributing to environmental contaminant exposure in Indigenous or small communities relying on local subsistence foods using adaptive elastic net to prioritize responses from a complex food frequency questionnaire. In Nunavik, higher PFAA biomarker levels were primarily related to increased consumption of country foods, particularly beluga misirak, seal liver, suuvalik, and ptarmigan. Our results support policies regulating PFAA production and use to limit the contamination of Arctic species through long-range transport. https://doi.org/10.1289/EHP13556.
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Affiliation(s)
- Amira Aker
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - Vy Nguyen
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- University of Michigan School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Pierre Ayotte
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
- Centre de Toxicologie du Québec, Institut National de Santé Publique du Québec, Québec, Canada
| | - Sylvie Ricard
- Nunavik Regional Board of Health and Social Services, Kuujjuaq, Québec, Canada
| | - Mélanie Lemire
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
- Institut de biologie intégrative et des systèmes (IBIS), Université Laval, Québec, Québec, Canada
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Bedi M, Sapozhnikova Y, Taylor RB, Ng C. Per- and polyfluoroalkyl substances (PFAS) measured in seafood from a cross-section of retail stores in the United States. JOURNAL OF HAZARDOUS MATERIALS 2023; 459:132062. [PMID: 37480610 DOI: 10.1016/j.jhazmat.2023.132062] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/05/2023] [Accepted: 07/12/2023] [Indexed: 07/24/2023]
Abstract
Seafood is a dominant source of human exposure to per- and polyfluoroalkyl substances (PFAS). Existing studies on foodborne PFAS exposure have focused on only a subset of these compounds. Here, we conducted a pilot study to screen 33 PFAS in 46 seafood samples from a cross-section of national and local stores in the US. Low levels of 8 PFAS were measured in 74% of the samples, predominated by PFHxS (59%). Total PFAS ranged between 0.12 and 20 ng/g; highest levels were measured in Estonia-sourced smelt. The highest median levels were of PFOA (0.84 ng/g) with elevated concentrations found in Chinese clams (2.4 ng/g), which exceeds the EU established maximum limits (MLs). Measured levels of PFHxS, PFOA, and PFNA also exceeded MLs in 24%, 7%, and 5% of the samples, respectively. For average consumption levels, exposures were below the EU established tolerable weekly intakes (TWIs). However, for more frequent consumption of flounder, catfish, and cod, exposures exceeded regulations, which warrants identifying vulnerable high seafood consuming populations. Accidental PFBS cross contamination from sample storage bags resulted in 100% detection in samples, highlighting the problem with post-purchase food handling practices such as storage and cooking that could also have a substantial impact on human exposure, potentially in larger amounts than the (sea)food itself.
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Affiliation(s)
- Megha Bedi
- Department of Civil & Environmental Engineering, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Yelena Sapozhnikova
- USDA, Agricultural Research Service, Eastern Regional Research Center, 600 East Mermaid Lane, Wyndmoor, PA, 19038, USA
| | - Raegyn B Taylor
- USDA, Agricultural Research Service, Eastern Regional Research Center, 600 East Mermaid Lane, Wyndmoor, PA, 19038, USA
| | - Carla Ng
- Department of Civil & Environmental Engineering, University of Pittsburgh, Pittsburgh, PA 15261, USA; Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Barbo N, Stoiber T, Naidenko OV, Andrews DQ. Locally caught freshwater fish across the United States are likely a significant source of exposure to PFOS and other perfluorinated compounds. ENVIRONMENTAL RESEARCH 2023; 220:115165. [PMID: 36584847 DOI: 10.1016/j.envres.2022.115165] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Per- and polyfluoroalkyl substances, or PFAS, gained significant public and regulatory attention due to widespread contamination and health harms associated with exposure. Ingestion of PFAS from contaminated food and water results in the accumulation of PFAS in the body and is considered a key route of human exposure. Here we calculate the potential contribution of PFOS from consumption of locally caught freshwater fish to serum levels. We analyzed data for over 500 composite samples of fish fillets collected across the United States from 2013 to 2015 under the U.S. EPA's monitoring programs, the National Rivers and Streams Assessment and the Great Lakes Human Health Fish Fillet Tissue Study. The two datasets indicate that an individual's consumption of freshwater fish is potentially a significant source of exposure to perfluorinated compounds. The median level of total targeted PFAS in fish fillets from rivers and streams across the United States was 9,500 ng/kg, with a median level of 11,800 ng/kg in the Great Lakes. PFOS was the largest contributor to total PFAS levels, averaging 74% of the total. The median levels of total detected PFAS in freshwater fish across the United States were 278 times higher than levels in commercially relevant fish tested by the U.S. Food and Drug Administration in 2019-2022. Exposure assessment suggests that a single serving of freshwater fish per year with the median level of PFAS as detected by the U.S. EPA monitoring programs translates into a significant increase of PFOS levels in blood serum. The exposure to chemical pollutants in freshwater fish across the United States is a case of environmental injustice that especially affects communities that depend on fishing for sustenance and for traditional cultural practices. Identifying and reducing sources of PFAS exposure is an urgent public health priority.
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Affiliation(s)
- Nadia Barbo
- Duke University, Nicholas School of the Environment, Grainger Hall, Circuit Drive, Box 90328, Durham, NC, 27708, USA
| | - Tasha Stoiber
- Environmental Working Group, 1250 I Street NW, Suite 1000, Washington, DC, 20005, USA
| | - Olga V Naidenko
- Environmental Working Group, 1250 I Street NW, Suite 1000, Washington, DC, 20005, USA
| | - David Q Andrews
- Environmental Working Group, 1250 I Street NW, Suite 1000, Washington, DC, 20005, USA.
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Kim JH, Moon N, Lee JW, Mehdi Q, Yun MH, Moon HB. Time-course trend and influencing factors for per- and polyfluoroalkyl substances in the breast milk of Korean mothers. CHEMOSPHERE 2023; 310:136688. [PMID: 36202376 DOI: 10.1016/j.chemosphere.2022.136688] [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: 03/02/2022] [Revised: 09/01/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Many studies have reported that neonates and infants are exposed to several per- and polyfluoroalkyl substances (PFASs) via breastfeeding; however, these studies have had small sample sizes. This study aimed to determine the concentrations and time-course trend of PFASs in breast milk and identify influencing factors governing PFAS concentrations. Between July and September (2018), 207 low-risk primiparous women were recruited from a lactation counseling clinic in Korea and their breast milk samples were tested for 14 PFASs, including four perfluoroalkyl sulfonic acids. A questionnaire survey, comprising 84 questions covering the women's demographic, obstetrical, dietary, lifestyle, behavioral, and neonatal information, was conducted to investigate associations. Twelve of the 14 PFASs were detectable in breast milk samples. Perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorodecanoic acid were detected in 100% of the samples, followed by perfluorohexanesulfonic acid (detection rate: 87%), perfluorononanoic acid (87%), and perfluorohexanoic acid (73%); the median concentrations were 0.05, 0.10, 0.031, 0.007, and 0.033 ng/mL, respectively. The PFAS concentrations in breast milk measured in our study were higher than those reported in other studies or countries. In 12 years, from 2007 to 18, the mean concentration of PFOA in breast milk increased by approximately three times (278%). The major factors associated with PFAS concentrations in the bivariate association analysis were body mass index; living area (non-metropolitan); neonatal age; and frequency of fish, ice cream, and canned food consumption. In the multiple regression model, fish consumption significantly influenced the PFOS concentrations in breast milk (β = 0.88, p = 0.033). Frequently, fish consumption has been analyzed as the main dietary factor related to PFOS concentration. Our findings suggest the need for a comprehensive cohort study on PFAS exposure and its association with infant health.
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Affiliation(s)
- Ju Hee Kim
- College of Nursing Science, Kyung Hee University, Seoul 02447, South Korea
| | - Nalae Moon
- College of Nursing Science, Kyung Hee University, Seoul 02447, South Korea
| | - Jae-Won Lee
- Department of Marine Science and Convergence Technology, College of Science and Convergence Technology, Hanyang University, Ansan 15588, South Korea
| | - Qaim Mehdi
- Department of Marine Science and Convergence Technology, College of Science and Convergence Technology, Hanyang University, Ansan 15588, South Korea
| | - Myoung-Hee Yun
- Moyusarang Lactation Consultant Clinic, 13590, Seongnam, South Korea
| | - Hyo-Bang Moon
- Department of Marine Science and Convergence Technology, College of Science and Convergence Technology, Hanyang University, Ansan 15588, South Korea.
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He X, Raymond M, LaHue N, Tomasallo C, Anderson H, Meiman J. Fish consumption and advisory awareness in the Great Lakes basin. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 827:153974. [PMID: 35218843 DOI: 10.1016/j.scitotenv.2022.153974] [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: 11/22/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Fish is a dietary staple in the United States. Risk of exposure to persistent contaminants through fish consumption is a significant health concern. Great Lakes basin states, along with the US Environmental Protection Agency and the Great Lakes Consortium for Fish Consumption Advisories, have developed and continuously updated fish consumption advisories specifically for the Great Lakes basin residents. OBJECTIVES To characterize Great Lakes basin residents' fish consumption and advisory awareness, we conducted a point-in-time survey to describe fish consumption habits and awareness of state and EPA/FDA fish advisories. METHODS We used a randomized, address-based sampling approach to recruit respondents from the eight Great Lakes basin states. Weighted survey analysis procedures were used to estimate population prevalence of fish consumption habits, state and EPA/FDA advisory awareness, and demographic and background characteristics. Logistic regression models were used to assess the associations between demographic and background factors and fish consumption and awareness of advisories, respectively. RESULTS About 92% of respondents, representing an estimated 61 million adults, reported eating fish in the last 12 months. About 64% of respondents only consumed commercial fish, and an estimated 5 million fish consumers exceeded the EPA/FDA recommended limit for fish meals. Minorities were more likely to exceed the EPA/FDA recommended limit. About half of the respondents were aware of state or EPA/FDA advisories; however, minorities and women were less aware of the EPA/FDA advisory. After adjusting for demographic characteristics, sportfish consumption was significantly associated with state advisory awareness; commercial fish consumption was significantly associated with EPA/FDA awareness. DISCUSSION Most respondents only consumed commercial fish, but an estimated 18.6 million adults consumed sportfish. While half of the fish consumers were aware of state or EPA/FDA advisories, minorities and women continue to be less aware of fish advisories. Improved outreach strategies are needed to inform them about safe fish-consumption guidelines.
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Affiliation(s)
- Xiaofei He
- Wisconsin Department of Health Services, Bureau of Environmental and Occupational Health, 1 West Wilson, Madison, WI 53703, United States of America
| | - Michelle Raymond
- Wisconsin Department of Health Services, Bureau of Environmental and Occupational Health, 1 West Wilson, Madison, WI 53703, United States of America
| | - Nathaniel LaHue
- Wisconsin Department of Health Services, Bureau of Environmental and Occupational Health, 1 West Wilson, Madison, WI 53703, United States of America
| | - Carrie Tomasallo
- Wisconsin Department of Health Services, Bureau of Environmental and Occupational Health, 1 West Wilson, Madison, WI 53703, United States of America
| | - Henry Anderson
- University of Wisconsin Madison, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, United States of America
| | - Jonathan Meiman
- Wisconsin Department of Health Services, Bureau of Environmental and Occupational Health, 1 West Wilson, Madison, WI 53703, United States of America.
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Malecki KMC, Nikodemova M, Schultz AA, LeCaire TJ, Bersch AJ, Cadmus-Bertram L, Engelman CD, Hagen E, McCulley L, Palta M, Rodriguez A, Sethi AK, Walsh MC, Nieto FJ, Peppard PE. The Survey of the Health of Wisconsin (SHOW) Program: An Infrastructure for Advancing Population Health. Front Public Health 2022; 10:818777. [PMID: 35433595 PMCID: PMC9008403 DOI: 10.3389/fpubh.2022.818777] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The Survey of the Health of Wisconsin (SHOW) was established in 2008 by the University of Wisconsin (UW) School of Medicine and Public Health (SMPH) with the goals of (1) providing a timely and accurate picture of the health of the state residents; and (2) serving as an agile resource infrastructure for ancillary studies. Today, the SHOW program continues to serve as a unique and vital population health research infrastructure for advancing public health. Methods SHOW currently includes 5,846 adult and 980 minor participants recruited between 2008 and 2019 in four primary waves. WAVE I (2008–2013) includes annual statewide representative samples of 3,380 adults ages 21 to 74 years. WAVE II (2014–2016) is a triannual statewide sample of 1,957 adults (age ≥18 years) and 645 children (age 0–17). WAVE III (2017) consists of follow-up of 725 adults from the WAVE I and baseline surveys of 222 children in selected households. WAVEs II and III include stool samples collected as part of an ancillary study in a subset of 784 individuals. WAVE IV consists of 517 adults and 113 children recruited from traditionally under-represented populations in biomedical research including African Americans and Hispanics in Milwaukee, Wisconsin. Findings to Date The SHOW resource provides unique spatially granular and timely data to examine the intersectionality of multiple social determinants and population health. SHOW includes a large biorepository and extensive health data collected in a geographically diverse urban and rural population. Over 60 studies have been published covering a broad range of topics including, urban and rural disparities in cardio-metabolic disease and cancer, objective physical activity, sleep, green-space and mental health, transcriptomics, the gut microbiome, antibiotic resistance, air pollution, concentrated animal feeding operations and heavy metal exposures. Discussion The SHOW cohort and resource is available for continued follow-up and ancillary studies including longitudinal public health monitoring, translational biomedical research, environmental health, aging, microbiome and COVID-19 research.
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Affiliation(s)
- Kristen M C Malecki
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Maria Nikodemova
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Amy A Schultz
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Tamara J LeCaire
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States.,School of Medicine and Public Health, Wisconsin Alzheimer's Institute, University of Wisconsin, Madison, WI, United States
| | - Andrew J Bersch
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Lisa Cadmus-Bertram
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States.,Department of Kinesiology, School of Education, University of Wisconsin, Madison, WI, United States
| | - Corinne D Engelman
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Erika Hagen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Laura McCulley
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Mari Palta
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Allison Rodriguez
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Ajay K Sethi
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Matt C Walsh
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - F Javier Nieto
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States.,School of Medicine and Public Health, Wisconsin Alzheimer's Institute, University of Wisconsin, Madison, WI, United States.,College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Paul E Peppard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
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10
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Wattigney WA, Savadatti SS, Liu M, Pavuk M, Lewis-Michl E, Kannan K, Wang W, Spliethoff H, Marquez-Bravo L, Hwang SA. Biomonitoring of per- and polyfluoroalkyl substances in minority angler communities in central New York State. ENVIRONMENTAL RESEARCH 2022; 204:112309. [PMID: 34728236 PMCID: PMC8715741 DOI: 10.1016/j.envres.2021.112309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/18/2021] [Accepted: 10/27/2021] [Indexed: 05/25/2023]
Abstract
Onondaga Lake in central New York State was listed as a Superfund site in 1994 due to industrial disposal of pollutants. A biomonitoring program was conducted to assess exposure to over 70 legacy contaminants and contaminants of emerging concern in populations disproportionately at risk for exposure residing near Onondaga Lake and to educate these communities on how to reduce exposures. The populations of focus were refugees from Burma and Bhutan and low-income, primarily African American, anglers (urban anglers). These communities consume locally caught fish for economic as well as cultural reasons and therefore may be at higher risk of exposure. This study focuses on assessment of exposure to per- and polyfluoroalkyl substances (PFAS) and associations with local fish consumption. Using respondent driven sampling, 311 refugees and 89 urban anglers were enrolled in the study. Following informed consent, study participants provided blood and urine specimens and completed a questionnaire. Percentiles of locally caught fish meals in the past 12 months by race/ethnicity groups showed that the Burmese participants of Karen ethnicity were the highest consumers, with a median of 135 meals compared to 103 meals for the other Burmese participants, 70 meals for the urban anglers, and 44 meals for the Bhutanese participants. Compared to the National Health and Nutrition Examination Survey (NHANES) 2015-16 sample of the general U.S. population, the Karen participants had markedly elevated perfluorooctane sulfonic acid (PFOS) and perfluorodecanoic acid (PFDA) levels with median serum concentrations 9.5 times greater (41.6 ng/mL vs. 4.4 ng/mL) and 26.9 times greater (2.69 ng/mL vs. 0.10 ng/mL), respectively; the other Burmese participants had moderately elevated levels of PFOS and PFDA with median serum concentrations 3.0 times greater (13.3 ng/mL vs. 4.4 ng/mL) and 7.3 greater times greater (0.73 ng/mL vs. 0.10 ng/mL), respectively; and, PFAS levels were not elevated in the Bhutanese or urban angler cohorts. Male gender was consistently the strongest predictor of PFAS exposure among all study cohorts. A positive association between local fish consumption was indicated only for PFOS among urban anglers. An association between local fish consumption and PFAS was not statistically significant among the refugee cohorts, perhaps due to the lack of 'lower-end' exposure or exposure variability. Community events were held by the program staff to present the biomonitoring results and distribute community outreach materials with visual aids specific for the study populations to promote safe fish eating.
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Affiliation(s)
- Wendy A Wattigney
- Agency for Toxic Substances and Disease Registry, Office of Community Health and Hazard Assessment, 4770 Buford Highway, Atlanta, GA, 30341, United States.
| | - Sanghamitra S Savadatti
- New York State Department of Health, Center for Environmental Health, Division of Environmental Health Assessment, Empire State Plaza-Corning Tower, Albany, NY, 12237, United States; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Albany, NY, 12144, United States
| | - Ming Liu
- New York State Department of Health, Center for Environmental Health, Division of Environmental Health Assessment, Empire State Plaza-Corning Tower, Albany, NY, 12237, United States
| | - Marian Pavuk
- Agency for Toxic Substances and Disease Registry, Office of Community Health and Hazard Assessment, 4770 Buford Highway, Atlanta, GA, 30341, United States
| | - Elizabeth Lewis-Michl
- New York State Department of Health, Center for Environmental Health, Division of Environmental Health Assessment, Empire State Plaza-Corning Tower, Albany, NY, 12237, United States
| | - Kurunthachalam Kannan
- New York State Department of Health, Wadsworth Center, Division of Environmental Health Sciences, Empire State Plaza, Albany, NY, 12201, United States; Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, NY, 10016, United States
| | - Wei Wang
- New York State Department of Health, Wadsworth Center, Division of Environmental Health Sciences, Empire State Plaza, Albany, NY, 12201, United States
| | - Henry Spliethoff
- New York State Department of Health, Center for Environmental Health, Division of Environmental Health Assessment, Empire State Plaza-Corning Tower, Albany, NY, 12237, United States
| | - Lydia Marquez-Bravo
- New York State Department of Health, Center for Environmental Health, Division of Environmental Health Assessment, Empire State Plaza-Corning Tower, Albany, NY, 12237, United States
| | - Syni-An Hwang
- New York State Department of Health, Center for Environmental Health, Division of Environmental Health Assessment, Empire State Plaza-Corning Tower, Albany, NY, 12237, United States; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Albany, NY, 12144, United States
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11
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Hsu WH, Zheng Y, Savadatti SS, Liu M, Lewis-Michl EL, Aldous KM, Parsons PJ, Kannan K, Rej R, Wang W, Palmer CD, Wattigney WA, Irvin-Barnwell E, Hwang SA. Biomonitoring of exposure to Great Lakes contaminants among licensed anglers and Burmese refugees in Western New York: Toxic metals and persistent organic pollutants, 2010-2015. Int J Hyg Environ Health 2022; 240:113918. [PMID: 35016143 DOI: 10.1016/j.ijheh.2022.113918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/31/2021] [Accepted: 01/02/2022] [Indexed: 12/20/2022]
Abstract
Between 2010 and 2015, the New York State Department of Health (NYSDOH) conducted a biomonitoring program to gather exposure data on Great Lakes contaminants among licensed anglers and Burmese refugees living in western New York who ate locally caught fish. Four hundred and nine adult licensed anglers and 206 adult Burmese refugees participated in this program. Participants provided blood and urine samples and completed a detailed questionnaire. Herein, we present blood metal levels (cadmium, lead, and total mercury) and serum persistent organic pollutant concentrations [polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), dichlorodiphenyldichloroethylene (DDE), and trans-nonachlor]. Multiple linear regression was applied to investigate the associations between analyte concentrations and indicators of fish consumption (locally caught fish meals, store-bought fish meals, and consuming fish/shellfish in the past week). Licensed anglers consumed a median of 16 locally caught fish meals and 22 store-bought fish meals while Burmese refugees consumed a median of 106 locally caught fish meals and 104 store-bought fish/shellfish meals in the past year. Compared to the general U.S. adult population, licensed anglers had higher blood lead and mercury levels; and Burmese refuges had higher blood cadmium, lead, and mercury, and higher serum DDE levels. Eating more locally caught fish was associated with higher blood lead, blood mercury, and serum ∑PCBs concentrations among licensed anglers. Licensed anglers and Burmese refugees who reported fish/shellfish consumption in the past week had elevated blood mercury levels compared with those who reported no consumption. Among licensed anglers, eating more store-bought fish meals was also associated with higher blood mercury levels. As part of the program, NYSDOH staff provided fish advisory outreach and education to all participants on ways to reduce their exposures, make healthier choices of fish to eat, and waters to fish from. Overall, our findings on exposure levels and fish consumption provide information to support the development and implementation of exposure reduction public health actions.
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Affiliation(s)
- Wan-Hsiang Hsu
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, 12237, USA; Department of Health Policy, Management and Behavior, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA.
| | - Yue Zheng
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, 12237, USA
| | - Sanghamitra S Savadatti
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, 12237, USA; Department of Epidemiology and Biostatistics, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
| | - Ming Liu
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, 12237, USA
| | - Elizabeth L Lewis-Michl
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, 12237, USA
| | - Kenneth M Aldous
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA; Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
| | - Patrick J Parsons
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA; Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
| | - Kurunthachalam Kannan
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA; Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
| | - Robert Rej
- Division of Translational Medicine, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA; Department of Biomedical Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
| | - Wei Wang
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA
| | - Christopher D Palmer
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA; Department of Environmental Health Sciences, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
| | - Wendy A Wattigney
- Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease Registry, Atlanta, GA, 30341, USA
| | - Elizabeth Irvin-Barnwell
- Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease Registry, Atlanta, GA, 30341, USA
| | - Syni-An Hwang
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, 12237, USA; Department of Epidemiology and Biostatistics, School of Public Health, The University at Albany, State University of New York, Albany, NY, 12144, USA
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12
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Wattigney WA, Irvin-Barnwell E, Li Z, Ragin-Wilson A. Biomonitoring of toxic metals, organochlorine pesticides, and polybrominated biphenyl 153 in Michigan urban anglers. ENVIRONMENTAL RESEARCH 2022; 203:111851. [PMID: 34384752 PMCID: PMC8711253 DOI: 10.1016/j.envres.2021.111851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/07/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
The 32-mile Detroit River and surrounding tributaries have been designated as a Great Lakes Area of Concern due to pollution from decades of municipal and industrial discharges, sewer overflows and urban development. The Agency for Toxic Substances and Disease Registry and the Michigan Department of Health and Human Services conducted a biomonitoring study to assess exposures to persistent toxic substances in Detroit urban shoreline anglers who may be at high exposure risk due to consumption of locally caught fish. Using a modified venue-based sampling approach, 287 adult shoreline anglers along the Detroit River were recruited and participated in the program. Study participants provided blood and urine specimens and completed a questionnaire interview. In this report, we examine percentile estimates for blood lead, blood manganese, urine arsenic, urine mercury, urine cadmium, organochlorine pesticides in serum (mirex, hexachlorobenzene, chlordane), and serum polybrominated biphenyl 153 (PBB 153) concentrations among study participants. Multiple linear regression was used to identify predictors of contaminant concentrations. The Detroit urban anglers' blood lead concentrations were 2 times higher than the general adult U.S. population (median (95% CI): 2.9 μg/dL (1.8-2.3) vs. 0.94 μg/dL (0.90-0.98)). PBB 153 levels were 1.8 times higher than the general adult U.S. population at the 95th percentile (95th percentile, 95% CI: 62.7 ng/g of lipid, 53.2-75.2 vs. 34.6 ng/g of lipid, 12.8-66.8). Percentile estimates of the other study pollutants were similar to background levels found in the general U.S. population. Eating more locally caught fish was not associated with increased body burdens for any of the contaminants examined in this report. Higher blood lead was associated with increased age, male sex, current smoking, residing in a home built before 1960, an annual income less than $25,000, and a work history of lead paint removal. Evidence of PBB exposure in our study cohort likely reflects the continued effect of a widespread contamination of livestock feed in 1973 among Michigan's lower peninsula population. These study results help determine if the pollutants examined warrant further consideration in subsequent population-based biomonitoring of frequent consumers of fish from the Detroit River and surrounding waterways. The biomonitoring data from this study also served to inform public health officials regarding the potential need for environmental public health actions to reduce harmful exposures.
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Affiliation(s)
- Wendy A Wattigney
- Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway, Atlanta, GA, 30341, United States.
| | - Elizabeth Irvin-Barnwell
- Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway, Atlanta, GA, 30341, United States
| | - Zheng Li
- Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway, Atlanta, GA, 30341, United States
| | - Angela Ragin-Wilson
- Office of Associate Director, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway, Atlanta, GA, 30341, United States
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13
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Liu M, Nordstrom M, Forand S, Lewis-Michl E, Wattigney WA, Kannan K, Wang W, Irvin-Barnwell E, Hwang SA. Assessing exposures to per- and polyfluoroalkyl substances in two populations of Great Lakes Basin fish consumers in Western New York State. Int J Hyg Environ Health 2021; 240:113902. [PMID: 34915281 DOI: 10.1016/j.ijheh.2021.113902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fish and other seafood are an important dietary source of per- and polyfluoroalkyl substances (PFAS) exposure in many areas of the world, and PFAS were found to be pervasive in fish from the Great Lakes area. Few studies, however, have examined the associations between Great Lakes Basin fish consumption and PFAS exposure. Many licensed anglers and Burmese refugees and immigrants residing in western New York State consume fish caught from the Great Lakes and surrounding waters, raising their risk of exposure to environmental contaminants including PFAS. The aims of this study were to: 1) present the PFAS exposure profile of the licensed anglers and Burmese refugees and 2) examine the associations between serum PFAS levels and local fish consumption. METHODS Licensed anglers (n = 397) and Burmese participants (n = 199) provided blood samples and completed a detailed questionnaire in 2013. We measured 12 PFAS in serum. Multiple linear regression was used to assess associations between serum PFAS concentrations and self-reported consumption of fish from Great Lakes waters. RESULTS Licensed anglers and Burmese participants reported consuming a median of 16 (IQR: 6-36) and 88 (IQR: 44-132) meals of locally caught fish in the year before sample collection, respectively (data for Burmese group restricted to 10 months of the year). Five PFAS were detected in almost all study participants (PFOS, PFOA, PFHxS, PFNA and PFDA; 97.5-100%). PFOS had the highest median serum concentration in licensed anglers (11.6 ng/mL) and the Burmese (35.6 ng/mL), approximately two and six times that of the U.S. general population, respectively. Serum levels of other PFAS in both groups were generally low and comparable to those in the general U.S. POPULATION Among licensed anglers, Great Lakes Basin fish meals over the past year were positively associated with serum PFOS (P < 0.0001), PFDA (P < 0.0001), PFHxS (P = 0.01), and PFNA (P = 0.02) and the number of years consuming locally caught fish was positively associated with serum PFOS (P = 0.01) and PFDA (P = 0.01) levels. In the Burmese group, consuming Great Lakes Basin fish more than three times a week in the past summer was positively associated with serum PFOS (P = 0.004) and PFDA (P = 0.02) among the Burmese of non-Karen ethnicity, but not among those of Karen ethnicity, suggesting potential ethnic differences in PFAS exposure. CONCLUSIONS Great Lakes Basin fish consumption was associated with an increase in blood concentrations of some PFAS, and especially of PFOS, among licensed anglers and Burmese refugees and immigrants in western New York State. In the Burmese population, there may be other important PFAS exposure routes related to residential history and ethnicity. Continued outreach efforts to increase fish advisory awareness and reduce exposure to contaminants are needed among these populations.
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Affiliation(s)
- Ming Liu
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Empire State Plaza-Corning Tower, Room 1203, Albany, NY, 12237, United States.
| | - Monica Nordstrom
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Empire State Plaza-Corning Tower, Room 1203, Albany, NY, 12237, United States
| | - Steven Forand
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Empire State Plaza-Corning Tower, Room 1203, Albany, NY, 12237, United States
| | - Elizabeth Lewis-Michl
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Empire State Plaza-Corning Tower, Room 1203, Albany, NY, 12237, United States
| | - Wendy A Wattigney
- Agency for Toxic Substances and Disease Registry, Division of Toxicology and Human Health Science, 4770 Buford Highway, Atlanta, GA, 30341, United States
| | - Kurunthachalam Kannan
- New York State Department of Health, Wadsworth Center, Empire State Plaza, Albany, NY, 12201, United States; New York University School of Medicine, Department of Pediatrics and Department of Environmental Medicine, New York, NY, 10016, United States
| | - Wei Wang
- New York State Department of Health, Wadsworth Center, Empire State Plaza, Albany, NY, 12201, United States
| | - Elizabeth Irvin-Barnwell
- Agency for Toxic Substances and Disease Registry, Division of Toxicology and Human Health Science, 4770 Buford Highway, Atlanta, GA, 30341, United States
| | - Syni-An Hwang
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Empire State Plaza-Corning Tower, Room 1203, Albany, NY, 12237, United States; University at Albany, School of Public Health, Department of Epidemiology & Biostatistics, One University Place, Rensselaer, NY, 12144, United States
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14
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Dungar BM, Schupbach CD, Jacobson JR, Kopf PG. Adrenal Corticosteroid Perturbation by the Endocrine Disruptor BDE-47 in a Human Adrenocortical Cell Line and Male Rats. Endocrinology 2021; 162:6346795. [PMID: 34370853 PMCID: PMC8402933 DOI: 10.1210/endocr/bqab160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Indexed: 01/04/2023]
Abstract
Polybrominated diphenyl ethers (PBDEs) have been previously shown to alter various endocrine biosynthetic pathways. Growing epidemiological evidence suggests that PBDEs alter cardiovascular function. The goal of this study was to examine the effects of BDE-47 on adrenal corticosteroid pathways that play vital roles in cardiovascular homeostasis and pathophysiology. The effect of BDE-47 on aldosterone and cortisol secretion was characterized in a human adrenocortical cell line. HAC15 cells were exposed to various concentrations of BDE-47 (1 nM to 100 μM). Cell viability, corticosteroid secretion, gene expression of enzymes involved in corticosteroid synthesis, and metabolic activity was examined. Additionally, Sprague Dawley male rats were orally exposed to BDE-47 (10 or 100 µg/kg), 5 days per week for 16 weeks. Organ weights and plasma corticosteroid levels were measured. In HAC15 cells, basal and stimulated aldosterone and cortisol secretion was significantly increased by BDE-47. Gene expression of several enzymes involved in corticosteroid synthesis and mitochondrial metabolism also increased. In Sprague Dawley rats, adrenal but not heart, kidney, or liver weights, were significantly increased in BDE-47 treatment groups. Plasma corticosterone levels were significantly increased in the 100 µg BDE-47/kg treatment group. No change in plasma aldosterone levels were observed with BDE-47 exposure. These data indicate that BDE-47 disrupts the regulation of corticosteroid secretion and provides further evidence that PBDEs are potential endocrine disruptors. Future studies will determine the underlying molecular mechanism of altered corticosteroid production and examine whether these alterations result in underlying cardiovascular disease in our rodent model of 16-week BDE-47 exposure.
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Affiliation(s)
- Benjamin M Dungar
- Department of Pharmacology, College of Graduate Studies, Midwestern University, Downers Grove, IL 60515, USA
| | - Chad D Schupbach
- Department of Pharmacology, College of Graduate Studies, Midwestern University, Downers Grove, IL 60515, USA
| | - Jessie R Jacobson
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL 60515, USA
| | - Phillip G Kopf
- Department of Pharmacology, College of Graduate Studies, Midwestern University, Downers Grove, IL 60515, USA
- Correspondence: Phillip G. Kopf, PhD, Department of Pharmacology, Midwestern University, 555 31st Street, Downers Grove, IL 60515, USA.
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15
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Marushka L, Hu X, Batal M, Tikhonov C, Sadik T, Schwartz H, Ing A, Fediuk K, Chan HM. The relationship between dietary exposure to persistent organic pollutants from fish consumption and type 2 diabetes among First Nations in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:168-182. [PMID: 34181231 PMCID: PMC8239090 DOI: 10.17269/s41997-021-00484-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We previously examined the associations between dietary dichlorodiphenyldichloroethylene (DDE) and polychlorinated biphenyls (PCBs) intake from fish consumption and type 2 diabetes (T2D) prevalence in Ontario and Manitoba. This study aims to further explore the relationship in a regionally representative sample of First Nations adults living on-reserve across Canada. METHODS Dietary, health and lifestyle data collected by the cross-sectional First Nations Food, Nutrition and Environment Study (2008-2018) were analyzed. This participatory study included 6091 First Nations adult participants who answered questions on T2D. The consumption of locally caught fish was estimated with a food frequency questionnaire. A total of 551 samples from 96 fish species were collected and analyzed for the presence of DDE and PCBs. The associations between fish and dietary DDE/PCBs intake with self-reported T2D were investigated using multiple logistic regression models adjusted for confounders. RESULTS Dietary exposure to DDE (>2.11 ng/kg/bw) and PCBs (>1.47 ng/kg/bw) vs no exposure was positively associated with T2D with ORs of 2.33 (95% CI: 1.24-4.35) for DDE and 1.43 (95% CI: 1.01-3.59) for PCBs. The associations were stronger among females (DDE OR = 3.11 (1.41-6.88); PCBs OR = 1.76 (1.10-3.65)) and older individuals (DDE OR = 2.64 (1.12-6.20); PCBs OR = 1.44 (1.01-3.91)) as compared with males and younger participants. Also, significant dose-response relationships were found for fish consumption in females only. CONCLUSION This study confirms our previous findings that dietary DDE/PCBs exposure may increase the risk of T2D. The effect of DDE/PCBs from fish consumption is driven by geographical differences in DDE/PCBs concentrations in fish and by the amount of fish consumed, and is more prominent in females than in males.
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Affiliation(s)
- Lesya Marushka
- Environmental Public Health Division, First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, ON, Canada
| | - Xuefeng Hu
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Malek Batal
- Département de Nutrition, Faculté de Médecine, Pavillon Liliane de Stewart, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
- Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-sud-de-l'Île-de-Montréal (CReSP), 7101 avenue du Parc, Montréal, QC, H3N 1X7, Canada
| | - Constantine Tikhonov
- Environmental Public Health Division, First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, ON, Canada
| | - Tonio Sadik
- Assembly of First Nations, 55 Metcalfe Street, Suite 1600, Ottawa, ON, K1P 6L5, Canada
| | - Harold Schwartz
- Environmental Public Health Division, First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, ON, Canada
| | - Amy Ing
- Département de Nutrition, Faculté de Médecine, Pavillon Liliane de Stewart, Université de Montréal, C.P. 6128, succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
| | - Karen Fediuk
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Hing Man Chan
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada.
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16
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Malecki KM, Nikodemova M, Schultz AA, LeCaire TJ, Bersch AJ, Cadmus-Bertram L, Engelman CD, Hagen E, Palta M, Sethi AK, Walsh MC, Nieto FJ, Peppard PE. The Survey of the Health of Wisconsin (SHOW) Program: An infrastructure for Advancing Population Health Sciences. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.15.21253478. [PMID: 33851173 PMCID: PMC8043470 DOI: 10.1101/2021.03.15.21253478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE The Survey of the Health of Wisconsin (SHOW) was established in 2008 by the University of Wisconsin (UW) School of Medicine and Public Health (SMPH) with the goals of 1) providing a timely and accurate picture of the health of the state residents; and 2) serving as an agile resource infrastructure for ancillary studies. Today SHOW continues to serve as a vital population health research infrastructure. PARTICIPANTS SHOW currently includes 5,846 adult and 980 minor participants recruited between 2008-2019 in four primary waves. WAVE I (2008-2013) includes annual statewide representative samples of 3,380 adults ages 21 to 74 years. WAVE II (2014-2016) is a triannual statewide sample of 1957 adults (age ≥18 years) and 645 children. WAVE III (2017) consists of follow-up of 725 adults from the WAVE I and baseline surveys of 222 children in selected households. WAVEs II and III include stool samples collected as part of an ancillary study in a subset of 784 individuals. WAVE IV consist of 517 adults and 113 children recruited from traditionally under-represented populations in biomedical research including African Americans and Hispanics in Milwaukee county, WI. FINDINGS TO DATE The SHOW provides extensive data to examine the intersectionality of multiple social determinants and population health. SHOW includes a large biorepository and extensive health data collected in a geographically diverse urban and rural population. Over 60 studies have been published covering a broad range of topics including, urban and rural disparities in cardio-metabolic disease and cancer, objective physical activity, sleep, green-space and mental health, transcriptomics, the gut microbiome, antibiotic resistance, air pollution, concentrated animal feeding operations and heavy metal exposures. FUTURE PLANS The SHOW cohort is available for continued longitudinal follow-up and ancillary studies including genetic, multi-omic and translational environmental health, aging, microbiome and COVID-19 research. ARTICLE SUMMARY Strengths and limitations: The Survey of the Health of Wisconsin (SHOW) is an infrastructure to advance population health sciences including biological sample collection and broader data on individual and neighborhood social and environmental determinants of health.The extensive data from diverse urban and rural populations offers a unique study sample to compare how socio-economic gradients shape health outcomes in different contexts.The objective health data supports novel interdisciplinary research initiatives and is especially suited for research in causes and consequences of environmental exposures (physical, chemical, social) across the life course on cardiometabolic health, immunity, and aging related conditions.The extensive biorepository supports novel omics research into common biological mechanisms underlying numerous complex chronic conditions including inflammation, oxidative stress, metabolomics, and epigenetic modulation.Ancillary studies, such as the Wisconsin Microbiome Study, have expanded the utility of the study to examine human susceptibility to environmental exposures and opportunities for investigations of the role of microbiome in health and disease.Long-standing partnerships and recent participation among traditionally under-represented populations in biomedical research offer numerous opportunities to support community-driven health equity work.No biological samples were collected among children.The statewide sampling frame may limit generalizability to other regions in the United States.
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Affiliation(s)
- Kristen M.C. Malecki
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Maria Nikodemova
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Amy A. Schultz
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Tamara J. LeCaire
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
- Wisconsin Alzheimer’s Institute, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Andrew J. Bersch
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Lisa Cadmus-Bertram
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
- Department of Kinesiology, School of Education, University of Wisconsin, Madison
| | - Corinne D. Engelman
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Erika Hagen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Mari Palta
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Ajay K. Sethi
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | | | - F. Javier Nieto
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
- Department of Kinesiology, School of Education, University of Wisconsin, Madison
| | - Paul E. Peppard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
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17
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Baygi SF, Fernando S, Hopke PK, Holsen TM, Crimmins BS. Nontargeted Discovery of Novel Contaminants in the Great Lakes Region: A Comparison of Fish Fillets and Fish Consumers. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:3765-3774. [PMID: 33646760 DOI: 10.1021/acs.est.0c08507] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sport fish fillets and human sera (fish consumers) were collected in the Lake Superior and Lake Michigan basin and screened for novel contaminants using the isotopic profile deconvoluted chromatogram (IPDC) algorithm. The IPDC algorithm was extended beyond traditional Cl/Br filters to detect additional potential bioaccumulative and toxic (PBT) such as perfluoroalkyl substances (PFAS). The IPDC algorithm screened for approximately 13.5 million theoretical molecular formulas. Additional algorithm modules were developed to detect data independent MS/MS fragmentation products and a retention time index calculator using a series of 13C-labeled perfluoroalkyl carboxylic acids (13C-PFCAs). Ten potential compound classes were isolated including six untargeted PFAS, six homologue groups of polyfluorinated carboxylic acids, polyfluorinated telomer alcohols (PoFTOHs), two hydroxylated polychlorobiphenyls, pesticides, herbicides, antifungals, pharmaceuticals, artificial sweeteners, and personal care products with minimal postprocessing efforts. The algorithm isolated 48 ubiquitous PoFTOHs in both fish fillet and serum of fish consumers suggesting a region wide distribution of this class of compounds. The 3, 4, and 7 fluorine substituted PoFTOH were the most abundant congeners in both biological matrices.
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Affiliation(s)
- Sadjad Fakouri Baygi
- Clarkson University, Department of Chemical and Biomolecular Engineering, 8 Clarkson Avenue, Potsdam, New York 13699, United States
| | - Sujan Fernando
- Clarkson University, Center for Air Resources Engineering and Science, 8 Clarkson Avenue, Potsdam, New York 13699, United States
| | - Philip K Hopke
- Clarkson University, Department of Chemical and Biomolecular Engineering, 8 Clarkson Avenue, Potsdam, New York 13699, United States
| | - Thomas M Holsen
- Clarkson University, Center for Air Resources Engineering and Science, 8 Clarkson Avenue, Potsdam, New York 13699, United States
- Clarkson University, Department of Civil and Environmental Engineering, 8 Clarkson Avenue, Potsdam, New York 13699, United States
| | - Bernard S Crimmins
- Clarkson University, Department of Civil and Environmental Engineering, 8 Clarkson Avenue, Potsdam, New York 13699, United States
- AEACS, LLC, New Kensington, Pennsylvania 15068, United States
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18
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Colles A, Bruckers L, Den Hond E, Govarts E, Morrens B, Schettgen T, Buekers J, Coertjens D, Nawrot T, Loots I, Nelen V, De Henauw S, Schoeters G, Baeyens W, van Larebeke N. Perfluorinated substances in the Flemish population (Belgium): Levels and determinants of variability in exposure. CHEMOSPHERE 2020; 242:125250. [PMID: 31896205 DOI: 10.1016/j.chemosphere.2019.125250] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 10/18/2019] [Accepted: 10/27/2019] [Indexed: 05/22/2023]
Abstract
Because of their dirt-, water- and oil-repelling properties, per- and polyfluoroalkyl substances (PFASs) are frequently used in a broad variety of consumer products. They have been detected in human samples worldwide. In Flanders, Belgium, the Flemish Environment and Health Studies (FLEHS) measured the levels of five PFAS biomarkers in four different age groups of the Flemish population and identified determinants of variability in exposure. Cord plasma or peripheric serum samples and questionnaire data were available for 220 mother-newborn pairs (2008-2009), 269 mother-newborn pairs (2013-2014), 199 adolescents (14-15 years old, 2010), 201 adults (20-40 years old, 2008-2009) and 205 adults (50-65 years old, 2014). Measured levels of perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS) and perfluorononanoic acid (PFNA) in Flanders are in the middle or low range compared to concentrations reported in other Western countries. Levels of perfluorobutanesulfonic acid (PFBS) were below the quantification limit in 98%-100% of the samples. Despite decreasing levels in time for PFOS and PFOA, 77% of the adults (2014) had serum levels exceeding HBM-I values of 5 μg/L for PFOS and 2 μg/L for PFOA. Beside age, sex, fish consumption, parity and breastfeeding, the multiple regression models identified additionally consumption of offal and locally grown food, and use of cosmetics as possible exposures and menstruation as a possible route of elimination. Better knowledge on determinants of exposure is essential to lower PFASs exposure.
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Affiliation(s)
- Ann Colles
- VITO - Health, Boeretang 200, 2400, Mol, Belgium.
| | - Liesbeth Bruckers
- Hasselt University, Data Science Institute, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Agoralaan - Gebouw D, 3590, Diepenbeek, Belgium
| | - Elly Den Hond
- Provincial Institute of Hygiene, Kronenburgstraat 45, 2000, Antwerp, Belgium
| | - Eva Govarts
- VITO - Health, Boeretang 200, 2400, Mol, Belgium
| | - Bert Morrens
- University of Antwerp, Department of Sociology, Sint-Jacobstraat 2-4, 2000, Antwerp, Belgium
| | - Thomas Schettgen
- Institut für Arbeits-, Sozial- und Umweltmedizin, Pauwelsstrasse 30, 52074, Aachen, Germany
| | | | - Dries Coertjens
- University of Antwerp, Department of Sociology, Sint-Jacobstraat 2-4, 2000, Antwerp, Belgium
| | - Tim Nawrot
- Hasselt University, Centre of Environmental Sciences, Agoralaan - Gebouw D, 3590, Diepenbeek, Belgium
| | - Ilse Loots
- University of Antwerp, Department of Sociology, Sint-Jacobstraat 2-4, 2000, Antwerp, Belgium
| | - Vera Nelen
- Provincial Institute of Hygiene, Kronenburgstraat 45, 2000, Antwerp, Belgium
| | - Stefaan De Henauw
- University of Ghent, Department of Public Health, C. Heymanslaan 10 - 4K3, 9000, Ghent, Belgium
| | | | - Willy Baeyens
- Vrije Universiteit Brussel (VUB), Department of Analytical, Environmental and Geochemistry (AMGC), Pleinlaan 2, 1050, Brussels, Belgium
| | - Nicolas van Larebeke
- Vrije Universiteit Brussel (VUB), Department of Analytical, Environmental and Geochemistry (AMGC), Pleinlaan 2, 1050, Brussels, Belgium
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19
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Wattigney WA, Irvin-Barnwell E, Li Z, Ragin-Wilson A. Biomonitoring of mercury and persistent organic pollutants in Michigan urban anglers and association with fish consumption. Int J Hyg Environ Health 2019; 222:936-944. [PMID: 31257185 PMCID: PMC6705116 DOI: 10.1016/j.ijheh.2019.06.007] [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: 02/27/2019] [Revised: 06/07/2019] [Accepted: 06/24/2019] [Indexed: 01/29/2023]
Abstract
The 32-mile Detroit River and surrounding tributaries have been designated as a Great Lakes Area of Concern due to pollution from decades of municipal and industrial discharges, sewer overflows and urban development. Key pollutants in fish samples from the Detroit River include mercury, polychlorinated biphenyls (PCBs), dichlorodiphenyldichloroethylene (DDE), dioxins and furans. A biomonitoring study was conducted to assess exposures to these persistent toxic substances in Detroit urban shoreline anglers who may be at high exposure risk due to consumption of locally caught fish. Using a modified venue-based sampling approach, 287 adult shoreline anglers along the Detroit River were recruited and participated in the program. Study participants provided blood and urine specimens and completed a questionnaire following informed consent. We examined percentile estimates for total blood mercury, PCBs, DDE, and dioxin-like total toxic equivalency (TEQ) concentrations among study participants. Multiple linear regression was used to identify important predictors of contaminant concentrations. Participants consumed a median of 64 Detroit River caught fish meals in the past year. The Detroit urban anglers' median total blood mercury concentrations was 3.2 times higher than that for the general adult U.S. population. PCB concentrations among the Detroit anglers aged 18-39 years were higher than the U.S. population of the same race/ethnicity. Elevated levels of DDE and total TEQ concentrations were not observed in the cohort. Eating more locally caught fish was associated with higher total blood mercury and serum PCB concentrations. The biomonitoring data served to inform public health officials and help guide environmental public health actions to reduce harmful exposures.
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Affiliation(s)
- Wendy A Wattigney
- Division of Toxicology and Human Health Science, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway Atlanta, GA, 30341, United States.
| | - Elizabeth Irvin-Barnwell
- Division of Toxicology and Human Health Science, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway Atlanta, GA, 30341, United States
| | - Zheng Li
- Division of Toxicology and Human Health Science, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway Atlanta, GA, 30341, United States
| | - Angela Ragin-Wilson
- Division of Toxicology and Human Health Science, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway Atlanta, GA, 30341, United States
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20
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Rychlik KA, Sillé FCM. Environmental exposures during pregnancy: Mechanistic effects on immunity. Birth Defects Res 2019; 111:178-196. [PMID: 30708400 DOI: 10.1002/bdr2.1469] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/16/2019] [Indexed: 12/21/2022]
Abstract
In human studies, it is well established that exposures during embryonic and fetal development periods can influence immune health. Coupled with genetic predisposition, these exposures can alter lifetime chronic and infectious disease trajectory, and, ultimately, life expectancy. Fortunately, as research advances, mechanisms governing long-term effects of prenatal exposures are coming to light and providing the opportunity for intervention and risk reduction. For instance, human association studies have provided a foundation for the association of prenatal exposure to particulate matter with early immunosuppression and later allergic disease in the offspring. Only recently, the mechanisms mediating this response have been revealed and there is much we have yet to discover. Although cellular immune response is understood for many exposure scenarios, molecular pathways are still unidentified. This review will provide commentary and synthesis of the current literature regarding environmental exposures during pregnancy and mechanisms determining immune outcomes. Shared mechanistic features and current gaps in the state of the science are identified and discussed. To such purpose, we address exposures by their immune effect type: immunosuppression, autoimmunity, inflammation and tissue damage, hypersensitivity, and general immunomodulation.
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Affiliation(s)
- Kristal A Rychlik
- Department of Environmental Health and Engineering, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Fenna C M Sillé
- Department of Environmental Health and Engineering, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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21
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Wattigney WA, Irvin-Barnwell E, Li Z, Davis SI, Manente S, Maqsood J, Scher D, Messing R, Schuldt N, Hwang SA, Aldous KM, Lewis-Michl EL, Ragin-Wilson A. Biomonitoring programs in Michigan, Minnesota and New York to assess human exposure to Great Lakes contaminants. Int J Hyg Environ Health 2019; 222:125-135. [PMID: 30153973 PMCID: PMC6376966 DOI: 10.1016/j.ijheh.2018.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/14/2018] [Accepted: 08/21/2018] [Indexed: 12/27/2022]
Abstract
Over the past century, industrialization and urban practices have resulted in the contamination of the Great Lakes ecosystem-the world's largest surface freshwater system-that provides drinking water and recreation to more than 40 million residents. In 2010, the Great Lakes Restoration Initiative was launched to accelerate efforts to protect and restore the Great Lakes and surrounding areas. Funded by GLRI, the Agency for Toxic Substances and Disease Registry initiated the Biomonitoring of Great Lakes Populations (BGLP) program. The objective of the program is to assess human exposure to legacy and emerging contaminants in the Great Lakes by measuring the body burden of contaminants in potentially susceptible populations. The BGLP program consists of a series of cross-sectional studies carried out collaboratively with states that are funded through ATSDR. The first BGLP Program (BGLP-I) began in 2010 and was completed in September 2015 through cooperative agreements with state health departments in Michigan, Minnesota, and New York. The three state programs targeted susceptible adult populations living in designated areas of contamination. Contaminants measured in all populations include mercury, lead, mirex, hexachlorobenzene, dichlorodiphenyltrichloroethane, and selected polychlorinated biphenyl congeners. In addition, some chemicals of emerging concern, such as per- and polyfluoroalkyl substances, were measured in several populations. The biomonitoring results helped guide public health actions to mitigate chemical exposures in these vulnerable Great Lakes populations. We provide an overview of the BGLP-I program's study populations, designs, and general methods. This overview provides a lead-in for subsequent manuscripts that present human biomonitoring data for legacy and emerging contaminants in culturally diverse susceptible populations-i.e., shoreline anglers, sport anglers, American Indians, and Burmese immigrants-residing in seven areas of concern.
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Affiliation(s)
- Wendy A Wattigney
- Division of Toxicology and Human Health Science, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway, Atlanta, 30341, GE, United States.
| | - Elizabeth Irvin-Barnwell
- Division of Toxicology and Human Health Science, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway, Atlanta, 30341, GE, United States
| | - Zheng Li
- Division of Toxicology and Human Health Science, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway, Atlanta, 30341, GE, United States
| | - Stephanie I Davis
- Office of Science, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, 30341, GE, United States
| | - Susan Manente
- Division of Environmental Health, Michigan Department of Human Health Services, 333 S. Grand Ave., Lansing, MI 48909, United States
| | - Junaid Maqsood
- Division of Environmental Health, Michigan Department of Human Health Services, 333 S. Grand Ave., Lansing, MI 48909, United States
| | - Deanna Scher
- Division of Environmental Health, Minnesota Department of Health, 625 N. Robert St., St. Paul, Minnesota, 55164-0975, United States
| | - Rita Messing
- Division of Environmental Health, Minnesota Department of Health, 625 N. Robert St., St. Paul, Minnesota, 55164-0975, United States; Retired from Division of Environmental Health, Minnesota Department of Health, United States
| | - Nancy Schuldt
- Fond du Lac Environmental Program, Division of Resource Management, 28 University Road, Cloquet, MN, 55720, United States
| | - Syni-An Hwang
- Bureau of Environmental & Occupational Epidemiology, New York State Department of Health, Empire State Plaza, Corning Tower Room 1203, Albany, NY, 12237, United States
| | - Kenneth M Aldous
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Empire State Plaza, PO Box 509, Albany, NY, 12201, United States
| | - Elizabeth L Lewis-Michl
- Bureau of Environmental & Occupational Epidemiology, New York State Department of Health, Empire State Plaza, Corning Tower Room 1203, Albany, NY, 12237, United States
| | - Angela Ragin-Wilson
- Division of Toxicology and Human Health Science, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway, Atlanta, 30341, GE, United States
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22
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Eagles-Smith CA, Silbergeld EK, Basu N, Bustamante P, Diaz-Barriga F, Hopkins WA, Kidd KA, Nyland JF. Modulators of mercury risk to wildlife and humans in the context of rapid global change. AMBIO 2018; 47:170-197. [PMID: 29388128 PMCID: PMC5794686 DOI: 10.1007/s13280-017-1011-x] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Environmental mercury (Hg) contamination is an urgent global health threat. The complexity of Hg in the environment can hinder accurate determination of ecological and human health risks, particularly within the context of the rapid global changes that are altering many ecological processes, socioeconomic patterns, and other factors like infectious disease incidence, which can affect Hg exposures and health outcomes. However, the success of global Hg-reduction efforts depends on accurate assessments of their effectiveness in reducing health risks. In this paper, we examine the role that key extrinsic and intrinsic drivers play on several aspects of Hg risk to humans and organisms in the environment. We do so within three key domains of ecological and human health risk. First, we examine how extrinsic global change drivers influence pathways of Hg bioaccumulation and biomagnification through food webs. Next, we describe how extrinsic socioeconomic drivers at a global scale, and intrinsic individual-level drivers, influence human Hg exposure. Finally, we address how the adverse health effects of Hg in humans and wildlife are modulated by a range of extrinsic and intrinsic drivers within the context of rapid global change. Incorporating components of these three domains into research and monitoring will facilitate a more holistic understanding of how ecological and societal drivers interact to influence Hg health risks.
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Affiliation(s)
| | - Ellen K. Silbergeld
- Johns Hopkin Bloomberg School of Public Health, 615 N. Wolfe Street, E6644, Baltimore, MD 21205 USA
| | - Niladri Basu
- McGill University, 204-CINE Building, Montreal, QC H9X 3V9 Canada
| | - Paco Bustamante
- University of La Rochelle, laboratory of Littoral Environment and Societies, Littoral Environnement et Sociétés (LIENSs), LIENSs UMR 7266 CNRS-Université de La Rochelle, 2 rue Olympe de Gouges, 17000 La Rochelle, France
| | - Fernando Diaz-Barriga
- Center for Applied Research in Environment and Health at, Universidad Autonoma de San Luis Potosi, Avenida Venustiano Carranza No. 2405, Col Lomas los Filtros Código Postal, 78214 San Luis Potosí, SLP Mexico
| | - William A. Hopkins
- Department of Fish and Wildlife Conservation, 310 West Campus Drive Virginia Tech, Cheatham Hall, Room 106 (MC 0321), Blacksburg, VA 24061 USA
| | - Karen A. Kidd
- Department of Biology & School of Geography and Earth Sciences, McMaster University, 1280 Main Street W., Hamilton, ON L8S 4K1 Canada
| | - Jennifer F. Nyland
- Department of Biological Sciences, 1101 Camden Ave, Salisbury, MD 21801 USA
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23
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Mínguez-Alarcón L, Afeiche MC, Williams PL, Arvizu M, Tanrikut C, Amarasiriwardena CJ, Ford JB, Hauser R, Chavarro JE. Hair mercury (Hg) levels, fish consumption and semen parameters among men attending a fertility center. Int J Hyg Environ Health 2017; 221:174-182. [PMID: 29102416 DOI: 10.1016/j.ijheh.2017.10.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/22/2017] [Accepted: 10/24/2017] [Indexed: 12/26/2022]
Abstract
General population exposure to methylmercury (MeHg), the most common organic mercury compound found in the environment, occurs primarily through the consumption of contaminated fish and shellfish. Due to limited studies and lack of consideration of effect modification by fish consumption, it remains uncertain if exposure to mercury affects semen parameters. Thus, we investigated whether hair Hg levels, a biomarker of mercury exposure, were associated with semen parameters among men attending an academic fertility center, and whether this relationship was modified by intake of fish. This analysis included 129 men contributing 243 semen samples who were enrolled in the Environment and Reproductive Health (EARTH) Study between 2005 and 2013, and had data of hair Hg, intake of fish and semen parameters available. Hair Hg levels were assessed using a direct mercury analyzer. Intake of fish was collected using a validated food frequency questionnaire. Semen parameters were analyzed following WHO 2010 evaluation criteria. Generalized linear mixed models with random intercepts accounting for within-man correlations across semen samples were used to evaluate the association of hair Hg levels and semen parameters adjusting for age, BMI, smoking status, abstinence time and alcohol intake. Effect modification by total fish intake (≤1.68 vs. >1.68 servings/week) was tested. The median hair Hg levels of the men was 0.72ppm and ranged from 0.03 to 8.01ppm; almost 30% of the men had hair Hg levels >1ppm. Hair Hg levels were positively related with sperm concentration, total sperm count, and progressive motility, after adjusting for potential confounders and became attenuated after further adjustment for fish intake. Specifically, men in the highest quartile of hair mercury levels had 50%, 46% and 31% higher sperm concentration, total sperm count and progressive motility, respectively, compared to men in the lowest quartile. These associations were stronger among men whose fish intake was above the study population median. Semen volume and normal morphology were unrelated to hair Hg levels. These results confirmed exposure to MeHg through fish intake and showed the important role of diet when exploring the associations between heavy metals and semen parameters among men of couples seeking fertility care. Further research is needed to clarify the complex relationship between fish intake and Hg, and potential effects on male reproductive health, specifically, semen parameters.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Myriam C Afeiche
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Mariel Arvizu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Cigdem Tanrikut
- Department of Urology, Massachusetts General Hospital, Boston, MA, United States; Department of Surgery, Harvard Medical School, Boston, MA, United States
| | - Chitra J Amarasiriwardena
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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24
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Bangma JT, Bowden JA, Brunell AM, Christie I, Finnell B, Guillette MP, Jones M, Lowers RH, Rainwater TR, Reiner JL, Wilkinson PM, Guillette LJ. Perfluorinated alkyl acids in plasma of American alligators (Alligator mississippiensis) from Florida and South Carolina. ENVIRONMENTAL TOXICOLOGY AND CHEMISTRY 2017; 36:917-925. [PMID: 27543836 PMCID: PMC5494598 DOI: 10.1002/etc.3600] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/09/2016] [Accepted: 08/18/2016] [Indexed: 05/21/2023]
Abstract
The present study aimed to quantitate 15 perfluoroalkyl acids (PFAAs) in 125 adult American alligators at 12 sites across the southeastern United States. Of those 15 PFAAs, 9 were detected in 65% to 100% of samples: perfluorooctanoic acid, perfluorononanoic acid, perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnA), perfluorododecanoic acid, perfluorotridecanoic acid (PFTriA), perfluorotetradecanoic acid, perfluorohexanesulfonic acid (PFHxS), and perfluorooctane sulfonate (PFOS). Males (across all sites) showed significantly higher concentrations of 4 PFAAs: PFOS (p = 0.01), PFDA (p = 0.0003), PFUnA (p = 0.021), and PFTriA (p = 0.021). Concentrations of PFOS, PFHxS, and PFDA in plasma were significantly different among the sites in each sex. Alligators at both Merritt Island National Wildlife Refuge (FL, USA) and Kiawah Nature Conservancy (SC, USA) exhibited some of the highest PFOS concentrations (medians of 99.5 ng/g and 55.8 ng/g, respectively) in plasma measured to date in a crocodilian species. A number of positive correlations between PFAAs and snout-vent length were observed in both sexes, suggesting that PFAA body burdens increase with increasing size. In addition, several significant correlations among PFAAs in alligator plasma may suggest conserved sources of PFAAs at each site throughout the greater study area. The present study is the first to report PFAAs in American alligators, to reveal potential PFAA hot spots in Florida and South Carolina, and to provide a contaminant of concern when assessing anthropogenic impacts on ecosystem health. Environ Toxicol Chem 2017;36:917-925. Published 2016 Wiley Periodicals Inc. on behalf of SETAC. This article is a US government work and, as such, is in the public domain in the United States of America.
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Affiliation(s)
- Jacqueline T. Bangma
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John A. Bowden
- Hollings Marine Laboratory, Chemical Sciences Division, National Institute of Standards and Technology, Charleston, South Carolina, USA
| | - Arnold M. Brunell
- Florida Fish and Wildlife Conservation Commission, Eustis, Florida, USA
| | - Ian Christie
- Grice Marine Laboratory, College of Charleston, Charleston, South Carolina, USA
| | | | - Matthew P. Guillette
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Martin Jones
- Department of Mathematics, College of Charleston, Charleston, South Carolina, USA
| | - Russell H. Lowers
- Integrated Mission Support Service, Kennedy Space Center, Titusville, Florida, USA
| | - Thomas R. Rainwater
- Baruch Institute of Coastal Ecology and Forest Science, Clemson University, Georgetown, South Carolina, USA
| | - Jessica L. Reiner
- Hollings Marine Laboratory, Chemical Sciences Division, National Institute of Standards and Technology, Charleston, South Carolina, USA
- Address correspondence to
| | | | - Louis J. Guillette
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
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Wattigney WA, Li Z, Ragin-Wilson A. The Biomonitoring of Great Lakes Populations Program. JOURNAL OF ENVIRONMENTAL HEALTH 2017; 79:42-44. [PMID: 28912609 PMCID: PMC5595369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Wendy A. Wattigney
- Division of Toxicology and Human Health Science, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway, Atlanta, Georgia, 30341, United States
| | - Zheng Li
- Division of Toxicology and Human Health Science, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway, Atlanta, Georgia, 30341, United States
| | - Angela Ragin-Wilson
- Division of Toxicology and Human Health Science, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway, Atlanta, Georgia, 30341, United States
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Gandhi N, Gewurtz SB, Drouillard KG, Kolic T, MacPherson K, Reiner EJ, Bhavsar SP. Polybrominated diphenyl ethers (PBDEs) in Great Lakes fish: Levels, patterns, trends and implications for human exposure. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 576:907-916. [PMID: 27865120 DOI: 10.1016/j.scitotenv.2016.10.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/06/2016] [Accepted: 10/06/2016] [Indexed: 05/27/2023]
Abstract
Levels of polybrominated diphenyl ethers (PBDEs) were measured in edible portions of Great Lakes fish, with the goal of examining patterns/trends and evaluating implications for human exposure. A total of 470 fillets of 18 fish species collected from various parts of the Canadian waters of the Great Lakes between 2006 and 2013 were analyzed for 17 (expanded to 33 in 2009) PBDEs. For a limited number of species, fillet to whole body and fillet to eggs PBDEs were compared to examine pattern and concentration among tissue types. Levels and patterns of PBDEs varied dramatically within and among the 18 fish species. Bottom dwelling Common Carp (and White Sucker) exhibited the highest ∑PBDE levels (27-71ng/g). Lake Trout and Lake Whitefish from Lake Superior had higher levels than those from the other Great Lakes; otherwise the spatial trend was Lake Ontario≫Erie~Huron~Superior. The measured levels would result in restriction on consumption of only Common Carp from the Toronto waterfront area, which is in proximity to the most urbanised region on the Canadian side of the basin. Deca-BDE was the major congener in panfish, while BDE-47 was the major congener in top predators and its contribution to ∑PBDE increased with the contamination. Although ∑PBDE was related to fish length and lipid content when all measurements were pooled, the relationships were variable for individual sampling events (species/location/year). Whole body ∑PBDE for bottom dweller Brown Bullhead and Common Carp were 2.6-4.9 times greater and egg ∑PBDE for four fatty Salmon/Trout species were same to 6.5 times greater than the corresponding fillet concentrations. Levels of major lower brominated PBDEs appear to have declined in fish fillets by 46-74% between 2006/07 and 2012. Although PBDE in existing consumer items will remain in-use for a while, it will likely not result in appreciable accumulation of PBDEs in fish. Based on an overall assessment, regular monitoring of PBDEs in Great Lake fish can be replaced with targeted surveillance and focus can be shifted to other in-use flame retardants.
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Affiliation(s)
- Nilima Gandhi
- University of Windsor, 401 Sunset Avenue, Windsor, ON N9B 3P4, Canada
| | - Sarah B Gewurtz
- University of Windsor, 401 Sunset Avenue, Windsor, ON N9B 3P4, Canada
| | - Ken G Drouillard
- University of Windsor, 401 Sunset Avenue, Windsor, ON N9B 3P4, Canada
| | - Terry Kolic
- Ontario Ministry of the Environment and Climate Change, Toronto, ON M9P 3V6, Canada
| | - Karen MacPherson
- Ontario Ministry of the Environment and Climate Change, Toronto, ON M9P 3V6, Canada
| | - Eric J Reiner
- Ontario Ministry of the Environment and Climate Change, Toronto, ON M9P 3V6, Canada
| | - Satyendra P Bhavsar
- University of Windsor, 401 Sunset Avenue, Windsor, ON N9B 3P4, Canada; Ontario Ministry of the Environment and Climate Change, Toronto, ON M9P 3V6, Canada.
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Zhu P, Ling X, Liu W, Kong L, Yao Y. Simple and fast determination of perfluorinated compounds in Taihu Lake by SPE-UHPLC–MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1031:61-67. [DOI: 10.1016/j.jchromb.2016.07.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/13/2016] [Accepted: 07/17/2016] [Indexed: 02/09/2023]
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Fish Consumption, Levels of Nutrients and Contaminants, and Endocrine-Related Health Outcomes Among Older Male Anglers in Wisconsin. J Occup Environ Med 2016; 58:668-75. [DOI: 10.1097/jom.0000000000000758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Raymond MR, Christensen KY, Thompson BA, Anderson HA. Associations Between Fish Consumption and Contaminant Biomarkers With Cardiovascular Conditions Among Older Male Anglers in Wisconsin. J Occup Environ Med 2016; 58:676-82. [DOI: 10.1097/jom.0000000000000757] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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