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Fry KL, Taylor MP. Peppered with lead: An environmental forensics approach to identify the source of rising blood lead levels. ENVIRONMENTAL RESEARCH 2024; 252:118832. [PMID: 38579992 DOI: 10.1016/j.envres.2024.118832] [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: 02/17/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024]
Abstract
Despite the phase-out of lead-based products, lead contamination can still present a contemporary risk to public health. In situations where elevated blood lead cannot be attributed to common sources, detailed environmental investigation is needed to identify more elusive sources and manage harmful exposure pathways. We apply a forensics approach to assess common and elusive sources of lead in the home environment of two individuals with fluctuating blood lead levels in Sydney, Australia. Using multiple analytical lines of evidence (portable X-Ray Fluorescence spectrometry (pXRF), inductively coupled-plasma mass spectrometry (ICP-MS), lead isotopic compositional analysis (PbIC) and haematological assessment) a pewter pepper grinder containing lead (>6000 mg/kg; 70% bioavailable) was identified as a potential source. After removing the pepper grinder from the home, the couple's blood lead decreased to below the Australian intervention level of 5 μg/dL within a year (Person A: from 12.5 μg/dL in August 2020 to 4.4 μg/dL in March 2022; and Person B: 15.4 μg/dL in August 2020 to 2.1 μg/dL in July 2021). This case study demonstrates how environmental science investigations can play a crucial role in supporting people to take evidence-based action to improve their health.
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Affiliation(s)
- K L Fry
- School of Natural Sciences, Faculty of Science and Engineering, Macquarie University, North Ryde, New South Wales, 2109, Australia; Environment Protection Authority Victoria, EPA Science, Centre for Applied Sciences, Ernest Jones Drive, Macleod, Victoria, 3085, Australia
| | - M P Taylor
- School of Natural Sciences, Faculty of Science and Engineering, Macquarie University, North Ryde, New South Wales, 2109, Australia; Environment Protection Authority Victoria, EPA Science, Centre for Applied Sciences, Ernest Jones Drive, Macleod, Victoria, 3085, Australia.
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2
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Forsyth JE, Akhalaia K, Jintcharadze M, Nash E, Sharov P, Temnikova A, Elmera C. Reductions in spice lead levels in the republic of Georgia: 2020-2022. ENVIRONMENTAL RESEARCH 2024; 250:118504. [PMID: 38367836 DOI: 10.1016/j.envres.2024.118504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
Spice adulteration using yellow lead chromate-based pigments has been documented as a growing global health concern. Spices from the Republic of Georgia with extremely high levels of lead, up to an order of magnitude higher than any other spices worldwide, have been implicated as sources of child lead poisoning. The objectives of this study were to 1) evaluate lead concentrations in spices sampled across the country of Georgia between 2020 and 2022, and 2) assess factors associated with spice adulteration, specifically the role of spice quality and regulatory enforcement. Spice samples were collected from 29 cities nationwide. The most populous cities were selected in each administrative region as well as those of importance to the spice supply chain. Sampling was carried out at the largest spice bazaars in each city. The regions of Adjara and Imereti were the focus of qualitative interviews conducted in 2021 with key businesspeople selling spices with very high and low levels of lead. The same cities and bazaars were visited at each of three sampling periods between 2020 and 2022. In total, 765 spice samples were collected. Lead concentrations in spices decreased over time, with a maximum of 14,233 μg/g in 2020 down to 36 μg/g in the final sampling round of 2022. A logistic regression determined that sampling round, region and spice type were associated with elevated lead in samples. Samples from Adjara and those containing marigold had the highest lead levels. Interviews with eighteen prominent spice vendors revealed difficulties sourcing sufficient quantities of high quality, brightly colored marigold, and concerns about adulteration. Interviews with two authorities from the National Food Authority highlighted the increased attention on regulating lead in spices since 2018. Continued monitoring and periodic regulatory enforcement may adequately disincentivize further adulteration with lead chromate in the spice industry in Georgia.
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Affiliation(s)
- Jenna E Forsyth
- School of Medicine, Stanford University, Stanford, CA, USA; Stanford King Center on Global Development, Stanford, CA, USA.
| | | | | | | | - Petr Sharov
- Environmental Health and Pollution Management Institute, Tblisi, Georgia
| | - Alena Temnikova
- Environmental Health and Pollution Management Institute, Tblisi, Georgia
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Sargsyan A, Nash E, Binkhorst G, Forsyth JE, Jones B, Sanchez Ibarra G, Berg S, McCartor A, Fuller R, Bose-O'Reilly S. Rapid Market Screening to assess lead concentrations in consumer products across 25 low- and middle-income countries. Sci Rep 2024; 14:9713. [PMID: 38678115 PMCID: PMC11055946 DOI: 10.1038/s41598-024-59519-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
Lead exposure can have serious consequences for health and development. The neurological and behavioral effects of lead are considered irreversible. Young children are particularly vulnerable to lead poisoning. In 2020, Pure Earth and UNICEF estimated that one in three children had elevated blood lead levels above 5 µg/dL. The sources of lead exposure vary around the world and can range from household products, such as spices or foodware, to environmental pollution from nearby industries. The aim of this study was to analyze common products from markets in low- and middle-income countries (LMICs) for their lead content to determine whether they are plausible sources of exposure. In 25 LMICs, the research teams systematically collected consumer products (metal foodware, ceramics, cosmetics, paints, toys, spices and other foods). The items were analyzed on site for detectable lead above 2 ppm using an X-ray fluorescence analyzer. For quality control purposes, a subset of the samples was analyzed in the USA using inductively coupled plasma mass spectrometry. The lead concentrations of the individual product types were compared with established regulatory thresholds. Out of 5007 analyzed products, threshold values (TV) were surpassed in 51% for metal foodware (TV 100 ppm), 45% for ceramics (TV 100 ppm), and 41% for paints (TV 90 ppm). Sources of exposure in LMICs can be diverse, and consumers in LMICs lack adequate protection from preventable sources of lead exposure. Rapid Market Screening is an innovative, simple, and useful tool to identify risky products that could be sources of lead exposure.
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Affiliation(s)
- Aelita Sargsyan
- Pure Earth, 475 Riverside Drive, New York, NY, 10115, USA
- Doctoral Program in Pollution, Toxicology and Environmental Health, Faculty of Biological Sciences, University of Valencia, c/Dr. Moliner, 50, Burjassot, 46100, Valencia, Spain
| | - Emily Nash
- Pure Earth, 475 Riverside Drive, New York, NY, 10115, USA
| | | | - Jenna E Forsyth
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Barbara Jones
- Cardinal Resources, Inc., 4410 Broadway Blvd., Monroeville, PA, 15146, USA
| | | | - Sarah Berg
- Pure Earth, 475 Riverside Drive, New York, NY, 10115, USA
| | | | - Richard Fuller
- Pure Earth, 475 Riverside Drive, New York, NY, 10115, USA
| | - Stephan Bose-O'Reilly
- Pure Earth, 475 Riverside Drive, New York, NY, 10115, USA.
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 5, 80336, Munich, Germany.
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4
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Tan SW, Cohen SG, Wilson MA, Johnson TP, Ivers JA. Lead Poisoning From Home-Prepared Indian Spices in 3 Families. Clin Pediatr (Phila) 2023; 62:824-829. [PMID: 36660959 DOI: 10.1177/00099228221150158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Spice consumption, along with other environmental factors, can contribute to pediatric lead poisoning. Although public health efforts have increased awareness of contamination of spices, false assumptions regarding the safety of home-prepared spices have emerged. Here, we present the clinical features, family beliefs, and environmental toxicology of 3 spice-associated pediatric lead poisoning cases.
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Affiliation(s)
- Shirlee W Tan
- Department of Public Health - Seattle & King County, Seattle, WA, USA
| | - Sharon G Cohen
- Department of Public Health - Seattle & King County, Seattle, WA, USA
| | - Matt A Wilson
- Department of Public Health - Seattle & King County, Seattle, WA, USA
| | - Tory P Johnson
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jessica A Ivers
- Department of Pediatrics, Polyclinic, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
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Nigra AE, Lieberman-Cribbin W, Bostick BC, Chillrud SN, Carrión D. Geospatial Assessment of Racial/Ethnic Composition, Social Vulnerability, and Lead Water Service Lines in New York City. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:87015. [PMID: 37646509 PMCID: PMC10467360 DOI: 10.1289/ehp12276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The state of New York expects to receive $ 115 million in 2022 alone from the U.S. Infrastructure Investment and Jobs Act to support the replacement of lead water service lines. OBJECTIVES Our objective was to determine the number and proportion of potential lead water service lines across New York City (NYC) and to evaluate the association between census tract-level racial/ethnic composition, housing vulnerability, and child lead exposure vulnerability with service line type (Potential Lead, Unknown) for n = 2,083 NYC tracts. METHODS We conducted a descriptive analysis assessing water service line material recorded in the NYC Department of Environmental Protection's Lead Service Line Location Coordinates database. We used conditional autoregressive Bayesian Poisson models to assess the relative risk [RR; median posterior estimates, and 95% credible interval (CrI)] of service line type per 20% higher proportion of residents in a given racial/ethnic group and per higher housing vulnerability and child lead exposure vulnerability index scores corresponding to the interquartile range. We also evaluated the associations in flexible natural cubic spline models. RESULTS Out of 854,672 residential service line records, 136,891 (16.0%) were Potential Lead, and 227,443 (26.6%) were Unknown. In fully adjusted models, higher proportions of Hispanic/Latino residents and higher child lead exposure vulnerability were associated with Potential Lead service lines in flexible spline models and linear models [RR = 1.15 (95% CrI: 1.11, 1.21) and RR = 1.11 (95% CrI: 1.02, 1.20), respectively]. Associations were modified by borough; Potential Lead service lines were associated with higher proportions of non-Hispanic White and non-Hispanic Asian residents in the Bronx and Manhattan, and with higher proportions of non-Hispanic Black residents in Queens. DISCUSSION NYC has a high number of Potential Lead and Unknown water service lines. Communities with a high proportion of Hispanic/Latino residents and those with children who are already highly vulnerable to lead exposures from numerous sources are disproportionately impacted by Potential Lead service lines. These findings can inform equitable service line replacement across New York state and NYC. https://doi.org/10.1289/EHP12276.
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Affiliation(s)
- Anne E. Nigra
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Wil Lieberman-Cribbin
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Benjamín C. Bostick
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, New York, USA
| | - Steven N. Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, New York, USA
| | - Daniel Carrión
- Department of Environmental Health Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
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Forsyth JE, Baker M, Nurunnahar S, Islam S, Islam MS, Islam T, Plambeck E, Winch PJ, Mistree D, Luby SP, Rahman M. Food safety policy enforcement and associated actions reduce turmeric lead chromate adulteration across Bangladesh. ENVIRONMENTAL RESEARCH 2023:116328. [PMID: 37286126 DOI: 10.1016/j.envres.2023.116328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/09/2023]
Abstract
Turmeric adulterated with lead chromate pigment has been previously identified as a primary source of lead exposure in Bangladesh. This study assesses the impact of a multi-faceted intervention between 2017 and 2021 to reduce lead-tainted turmeric in Bangladesh. The intervention involved: i) disseminating findings from scientific studies via news media that identified turmeric as a source of lead poisoning, ii) educating consumers and businesspeople about the risks of lead chromate in turmeric via public notices and face-to-face meetings, and iii) collaborating with the Bangladesh Food Safety Authority to utilize a rapid lead detection technology to enforce policy disallowing turmeric adulteration. Before and after the intervention, evidence of lead chromate turmeric adulteration was assessed at the nation's largest turmeric wholesale market and at turmeric polishing mills across the country. Blood lead levels of workers at two mills were also assessed. Forty-seven interviews were conducted with consumers, businesspeople, and government officials to assess changes in supply, demand, and regulatory capacity. The proportion of market turmeric samples containing detectable lead decreased from 47% pre-intervention in 2019 to 0% in 2021 (n = 631, p < 0.0001). The proportion of mills with direct evidence of lead chromate adulteration (pigment on-site) decreased from 30% pre-intervention in 2017 to 0% in 2021 (n = 33, p < 0.0001). Blood lead levels dropped a median of 30% (IQR: 21-43%), while the 90th percentile dropped 49% from 18.2 μg/dL to 9.2 μg/dL 16 months after the intervention (n = 15, p = 0.033). Media attention, credible information, rapid lead detection tools and swift government action to enforce penalties all contributed to the intervention's success. Subsequent efforts should evaluate if this is an example of an effective intervention that can be replicated to reduce lead chromate adulteration of spices globally.
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Affiliation(s)
- Jenna E Forsyth
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA.
| | - Musa Baker
- Environmental Interventions Unit, Infectious Diseases Division, Icddr,b, Dhaka, 1212, Bangladesh
| | - Syeda Nurunnahar
- Environmental Interventions Unit, Infectious Diseases Division, Icddr,b, Dhaka, 1212, Bangladesh
| | - Shariful Islam
- Environmental Interventions Unit, Infectious Diseases Division, Icddr,b, Dhaka, 1212, Bangladesh; School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | - M Saiful Islam
- Environmental Interventions Unit, Infectious Diseases Division, Icddr,b, Dhaka, 1212, Bangladesh
| | - Tauhidul Islam
- Environmental Interventions Unit, Infectious Diseases Division, Icddr,b, Dhaka, 1212, Bangladesh
| | - Erica Plambeck
- Graduate School of Business, Stanford University, Stanford, CA, USA
| | - Peter J Winch
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Dinsha Mistree
- Hoover Institution and School of Law, Stanford University, Stanford, CA, USA
| | - Stephen P Luby
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, Icddr,b, Dhaka, 1212, Bangladesh
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7
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Alex-Oni K, Sedlar S, Hore P. Why we need a national repository of consumer product lead surveillance data. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:157-159. [PMID: 36750746 PMCID: PMC10005932 DOI: 10.1038/s41370-023-00525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Kolapo Alex-Oni
- Bureau of Environmental Disease and Injury Prevention, New York City Department of Health and Mental Hygiene, 125 Worth Street, CN34C, New York, NY, USA.
| | - Slavenka Sedlar
- Bureau of Environmental Disease and Injury Prevention, New York City Department of Health and Mental Hygiene, 125 Worth Street, CN34C, New York, NY, USA
| | - Paromita Hore
- Bureau of Environmental Disease and Injury Prevention, New York City Department of Health and Mental Hygiene, 125 Worth Street, CN34C, New York, NY, USA.
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8
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Angelon-Gaetz KA, Segule MN, Wilson M. Lead Levels in Spices From Market Basket and Home Lead Investigation Samples in North Carolina. Public Health Rep 2023; 138:91-96. [PMID: 35060792 PMCID: PMC9730183 DOI: 10.1177/00333549211066152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Lead investigators in North Carolina found evidence that contaminated spices may contribute to children's elevated blood lead levels. We compared lead levels in samples of spices and other consumable products by country of purchase to inform consumer safety interventions and regulations. METHODS From February 1, 2011, through October 22, 2020, North Carolina lead investigators sampled spices and other consumable products from 103 homes of children with confirmed elevated blood lead levels. In 2017, the study team purchased 50 products frequently sampled during lead investigations, as a "market basket" sample, from local stores in or near Raleigh, North Carolina. The State Laboratory of Public Health analyzed 423 product samples using mass spectrometry. We extracted environmental sample results from lead investigations from the North Carolina Electronic Lead Surveillance System. RESULTS The median market basket lead result was 0.07 mg/kg (SD = 0.17); the maximum lead result was 0.88 mg/kg. The median home lead investigation sample result was 0.26 mg/kg (SD = 489.44); the maximum lead result was 6504.00 mg/kg in turmeric purchased in India. Among all samples, products purchased in India had more than triple the median lead levels (0.71 mg/kg) of those purchased in the United States (0.19 mg/kg). CONCLUSIONS Purchasing spices in the United States is an action that consumers can take that may reduce their lead poisoning risk. Regulatory agencies should consider a lead limit of <1 mg/kg as attainable for spices sold in US stores and for ingredients of any foods that may be consumed by children.
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Affiliation(s)
- Kim A. Angelon-Gaetz
- Occupational and Environmental Epidemiology Branch, Epidemiology Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Marjorie N. Segule
- Occupational and Environmental Epidemiology Branch, Epidemiology Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | - Molly Wilson
- Occupational and Environmental Epidemiology Branch, Epidemiology Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
- Public Health & Biology Program, Meredith College, Raleigh, NC, USA
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Lopez A, Nicolini CM, Aeppli M, Luby SP, Fendorf S, Forsyth JE. Assessing Analytical Methods for the Rapid Detection of Lead Adulteration in the Global Spice Market. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:16996-17006. [PMID: 36343212 PMCID: PMC9730856 DOI: 10.1021/acs.est.2c03241] [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: 05/05/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 06/09/2023]
Abstract
Lead adulteration of spices, primarily via Pb chromate compounds, has been documented globally as a growing public health concern. Currently, Pb detection in spices relies primarily on expensive and time-consuming laboratory analyses. Advancing rapid Pb detection methods, inclusive of their accuracy and precision, would improve field assessments by food safety inspectors, stakeholders, and the public in the hope of reducing Pb exposure risks at its source. Here, we present two field procedures for Pb detection: portable X-ray fluorescence analysis (pXRF) and a simple colorimetric test. We assess their efficacy to detect Pb and its chemical form in seven spice types, including powders, spice-salt mixtures, and dried roots, compared to the proven laboratory technique, inductively coupled plasma mass spectrometry (ICP-MS). Lead concentrations measured using pXRF and ICP-MS were within 5% of each other for spice powders and 24% for dried roots. By pXRF, spice samples were analyzed within collection plastic bags without preparation, resulting in a detection limit of 2 mg Pb/kg for spice powders, which is comparable to national food standards. The colorimetric test utilized here targets hexavalent chromium, making the method selective to Pb chromate adulteration assuming that this is its dominant source in spices. Color development, and thus detection, was observed when Pb concentrations exceeded approximately 5-70 mg/kg in dried turmeric roots and 1000 mg/kg in spice powders; however, it was ineffective for the spice-salt mixture. We show that pXRF analysis and a colorimetric assay provide information that may improve field decisions about Pb adulteration in a range of spice types, helping to minimize Pb exposure.
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Affiliation(s)
- Alandra
M. Lopez
- Earth
System Science Department, Stanford University, Stanford, California 94305, United States
| | - Carla M. Nicolini
- Earth
System Science Department, Stanford University, Stanford, California 94305, United States
| | - Meret Aeppli
- Earth
System Science Department, Stanford University, Stanford, California 94305, United States
| | - Stephen P. Luby
- Woods
Institute for the Environment, Stanford
University, Stanford, California 94305, United States
| | - Scott Fendorf
- Earth
System Science Department, Stanford University, Stanford, California 94305, United States
- Woods
Institute for the Environment, Stanford
University, Stanford, California 94305, United States
| | - Jenna E. Forsyth
- Woods
Institute for the Environment, Stanford
University, Stanford, California 94305, United States
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Laycock A, Chenery S, Marchant E, Crabbe H, Saei A, Ruadze E, Watts M, Leonardi GS, Marczylo T. The Use of Pb Isotope Ratios to Determine Environmental Sources of High Blood Pb Concentrations in Children: A Feasibility Study in Georgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15007. [PMID: 36429725 PMCID: PMC9690981 DOI: 10.3390/ijerph192215007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
The incidence of lead (Pb) poisoning in children in Georgia has been identified as a major health concern, with a recent national survey identifying that 41% of children aged 2-7 years had blood lead concentrations (BLCs) greater than the blood lead reference value (BLRV) of ≥5 µg dL-1. This study collected samples of blood, spices, paint, soil, dust, flour, tea, toys, milk, and water from 36 households in Georgia where a child had previously been identified as having a BLC > BLRV. The Pb concentrations of these samples were determined and compared to Georgian reference values. Samples from 3 households were analysed for their Pb isotope composition. The Pb isotope composition of the environmental and blood samples were compared to identify the most likely source(s) of Pb exposure. This approach identified that some spice and dust samples were the likely sources of Pb in the blood in these cases. Importantly, some soil, paint, and dust sources with high Pb concentrations could be discounted as contributing to blood Pb based on their distinct isotope composition. The data presented demonstrate the significant contribution that Pb surveillance and Pb isotope ratio analyses can make to managing Pb exposure in regions where high BLCs are identified.
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Affiliation(s)
- Adam Laycock
- UK Health Security Agency, Chemical, Radiation and Environmental Hazards Directorate, Harwell Campus, Chilton OX11 0RQ, UK
| | - Simon Chenery
- British Geological Survey, Kingsley Durham Centre, Keyworth, Nottingham NG12 5GG, UK
| | - Elizabeth Marchant
- UK Health Security Agency, Chemical, Radiation and Environmental Hazards Directorate, Harwell Campus, Chilton OX11 0RQ, UK
| | - Helen Crabbe
- UK Health Security Agency, Chemical, Radiation and Environmental Hazards Directorate, Harwell Campus, Chilton OX11 0RQ, UK
| | - Ayoub Saei
- UK Health Security Agency, Colindale, London NW9 5EQ, UK
| | - Ekaterine Ruadze
- The National Center for Disease Control and Public Health, #99 Kakheti Highway, Tbilisi 0198, Georgia
| | - Michael Watts
- British Geological Survey, Kingsley Durham Centre, Keyworth, Nottingham NG12 5GG, UK
| | - Giovanni S. Leonardi
- UK Health Security Agency, Chemical, Radiation and Environmental Hazards Directorate, Harwell Campus, Chilton OX11 0RQ, UK
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Tim Marczylo
- UK Health Security Agency, Chemical, Radiation and Environmental Hazards Directorate, Harwell Campus, Chilton OX11 0RQ, UK
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Shaffer RM, Forsyth JE, Ferraro G, Till C, Carlson LM, Hester K, Haddock A, Strawbridge J, Lanfear CC, Hu H, Kirrane E. Lead exposure and antisocial behavior: A systematic review protocol. ENVIRONMENT INTERNATIONAL 2022; 168:107438. [PMID: 35994796 DOI: 10.1016/j.envint.2022.107438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Lead exposure remains highly prevalent worldwide despite decades of research highlighting its link to numerous adverse health outcomes. In addition to well-documented effects on cognition, there is growing evidence of an association with antisocial behavior, including aggression, conduct problems, and crime. An updated systematic review on this topic, incorporating study evaluation and a developmental perspective on the outcome, can advance the state of the science on lead and inform global policy interventions to reduce exposure. OBJECTIVES We aim to evaluate the link between lead exposure and antisocial behavior. This association will be investigated via a systematic review of human epidemiological and experimental nonhuman mammalian studies. METHODS The systematic review protocol presented in this publication is informed by recommendations for the conduct of systematic reviews in toxicology and environmental health research (COSTER) and follows the study evaluation approach put forth by the U.S. EPA Integrated Risk Information System (IRIS) program. DATA SOURCES We will search the following electronic databases for relevant literature: PubMed, BIOSIS and Web of Science. Search results will be stored in EPA's Health and Environmental Research Online (HERO) database. STUDY ELIGIBILITY AND CRITERIA Eligible human epidemiological studies will include those evaluating any population exposed to lead at any lifestage via ingestion or inhalation exposure and considering an outcome of antisocial behavior based on any of the following criteria: psychiatric diagnoses (e.g., oppositional defiant disorder (ODD), conduct disorder (CD), disruptive behavior disorders (DBD)); violation of social norms (e.g., delinquency, criminality); and aggression. Eligible experimental animal studies will include those evaluating nonhuman mammalian studies exposed to lead via ingestion, inhalation, or injection exposure during any lifestage. The following outcomes will be considered relevant: aggression; antisocial behavior; and altered fear, anxiety, and stress response. STUDY APPRAISAL AND SYNTHESIS METHODS Screening will be conducted with assistance from an artificial intelligence application. Two independent reviewers for each data stream (human, animal) will screen studies with highest predicted relevance against pre-specified inclusion criteria at the title/abstract and full-text level. Study evaluation will be conducted using methods adapted from the U.S. EPA IRIS program. After data extraction, we will conduct a narrative review and quantitative meta-analysis on the human epidemiological studies as well as a narrative review of the experimental animal studies. We will evaluate the strength of each evidence stream separately and then will develop a summary evidence integration statement based on inference across evidence streams.
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Affiliation(s)
- Rachel M Shaffer
- US Environmental Protection Agency, Center for Public Health and Environmental Assessment, Washington, DC, and Research Triangle Park, NC, United States
| | - Jenna E Forsyth
- Stanford University, Woods Institute for the Environment, Stanford, CA, United States
| | - Greg Ferraro
- North Carolina State University, Raleigh, NC, United States
| | | | - Laura M Carlson
- US Environmental Protection Agency, Center for Public Health and Environmental Assessment, Washington, DC, and Research Triangle Park, NC, United States
| | - Kirstin Hester
- US Environmental Protection Agency, Center for Public Health and Environmental Assessment, Washington, DC, and Research Triangle Park, NC, United States
| | - Amanda Haddock
- US Environmental Protection Agency, Center for Public Health and Environmental Assessment, Washington, DC, and Research Triangle Park, NC, United States
| | - Jenna Strawbridge
- Oak Ridge Associated Universities, US Environmental Protection Agency, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States
| | - Charles C Lanfear
- Nuffield College, University of Oxford, Oxford, England, United Kingdom
| | - Howard Hu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ellen Kirrane
- US Environmental Protection Agency, Center for Public Health and Environmental Assessment, Washington, DC, and Research Triangle Park, NC, United States.
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Bramwell L, Morton J, Harding AH, Lin N, Entwistle J. Determinants of blood and saliva lead concentrations in adult gardeners on urban agricultural sites. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2022; 44:3493-3513. [PMID: 34622415 PMCID: PMC9522656 DOI: 10.1007/s10653-021-01095-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
Soil Pb concentrations at urban agriculture sites (UAS) commonly exceed recommended safe levels. There is a lack of evidence regarding uptake of Pb by gardeners using such sites for food crops. Our study aimed to elucidate whether gardening in soil with raised Pb levels results in Pb body burdens of concern to health, and to assess confounding factors influencing Pb body burden. Our cross-sectional case study measured Pb in saliva and blood of UAS gardeners (n = 43), soil and produce samples from their UAS, and home tap water. Blood and saliva Pb concentrations were compared with those from non-UAS gardener controls (n = 29). A health risk threshold of 5 µg dL-1 blood Pb level (BLL) was selected in keeping with international guidance. Detailed surveys investigated individuals' anthropometrics and potential Pb exposures from diet, and historic and everyday activities. Saliva was not found to be a suitable biomarker of adult Pb exposure in this context. Predictors of higher BLLs were being older, being male and eating more root vegetables and shrub fruit. Eating more green vegetables predicted a lower BLL, suggesting a protective effect against Pb uptake. UAS gardeners' BLLs (geometric mean 1.53; range 0.6-4.1 µg dL-1) were not significantly higher (p = 0.39) than the control group (geometric mean 1.43; range 0.7-2.9 µg dL-1). All BLLs were below 5 µg dL-1 except one resulting from occupational exposure. Having paired the UAS gardeners with closely matched controls, we found Pb in UAS soils (with range 62-1300 mg kg-1from common urban sources) unlikely to pose an additional risk to adult health compared to their neighbours who did not access UAS. As such, other Pb sources may be the dominant factor controlling BLL.
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Affiliation(s)
- Lindsay Bramwell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX Tyne and Wear UK
- Present Address: Department of Geography and Environmental Sciences, Northumbria University, Ellison Building, Newcastle Upon Tyne, NE1 8ST Tyne and Wear UK
| | - Jackie Morton
- Health and Safety Executive Science and Research Centre, Buxton, SK17 9JN Derbyshire UK
| | - Anne-Helen Harding
- Health and Safety Executive Science and Research Centre, Buxton, SK17 9JN Derbyshire UK
| | - Nan Lin
- Department of Mathematics, Physics and Electrical Engineering, Northumbria University, Ellison Building, Newcastle Upon Tyne, NE1 8ST Tyne and Wear UK
| | - Jane Entwistle
- Present Address: Department of Geography and Environmental Sciences, Northumbria University, Ellison Building, Newcastle Upon Tyne, NE1 8ST Tyne and Wear UK
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13
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Hore P, Alex-Oni K, Sedlar S, Patel K, Saper RB. Health Remedies as a Source of Lead, Mercury, and Arsenic Exposure, New York City, 2010-2019. Am J Public Health 2022; 112:S730-S740. [PMID: 36179284 PMCID: PMC9528658 DOI: 10.2105/ajph.2022.306906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 09/03/2023]
Abstract
Objectives. To describe the types of health remedies collected during poisoning investigations in New York City over a 10-year period that were found to contain high levels of lead, mercury, or arsenic. Methods. Between 2010 and 2019, the New York City Department of Health and Mental Hygiene collected 584 samples of health remedies during poisoning investigations and store surveys for lead, mercury, or arsenic analysis. Results. There was a significant association between blood lead levels and estimated cumulative daily lead exposures among adult users of rasa shastra Ayurvedic medications. Also, average blood lead levels among adult rasa shastra users were significantly higher than levels among those using other types of non-Ayurvedic health remedies. Conclusions. Rasa shastra Ayurvedic medications can contain very high levels of lead, mercury, and arsenic. This underscores the importance of screening for lead, mercury, and arsenic exposures within at-risk populations. Public Health Implications. The general ease of accessibility to rasa shastra medications raises concerns. There is a need for systemic change that results in primary prevention, that is, removal of the source through policy development and regulatory enforcement in the country of origin. (Am J Public Health. 2022;112(S7):S730-S740. https://doi.org/10.2105/AJPH.2022.306906).
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Affiliation(s)
- Paromita Hore
- Paromita Hore, Kolapo Alex-Oni, Slavenka Sedlar and Kari Patel are with the Bureau of Environmental Disease and Injury Prevention, New York City Department of Health and Mental Hygiene, New York. Robert B. Saper is with the Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH
| | - Kolapo Alex-Oni
- Paromita Hore, Kolapo Alex-Oni, Slavenka Sedlar and Kari Patel are with the Bureau of Environmental Disease and Injury Prevention, New York City Department of Health and Mental Hygiene, New York. Robert B. Saper is with the Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH
| | - Slavenka Sedlar
- Paromita Hore, Kolapo Alex-Oni, Slavenka Sedlar and Kari Patel are with the Bureau of Environmental Disease and Injury Prevention, New York City Department of Health and Mental Hygiene, New York. Robert B. Saper is with the Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH
| | - Kari Patel
- Paromita Hore, Kolapo Alex-Oni, Slavenka Sedlar and Kari Patel are with the Bureau of Environmental Disease and Injury Prevention, New York City Department of Health and Mental Hygiene, New York. Robert B. Saper is with the Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH
| | - Robert B Saper
- Paromita Hore, Kolapo Alex-Oni, Slavenka Sedlar and Kari Patel are with the Bureau of Environmental Disease and Injury Prevention, New York City Department of Health and Mental Hygiene, New York. Robert B. Saper is with the Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH
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14
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Becker F, Marcantonio F, Datta S, Wichterich C, Cizmas L, Surber J, Kennedy K, Bowles E. Tracking the source of contaminant lead in children's blood. ENVIRONMENTAL RESEARCH 2022; 212:113307. [PMID: 35447155 DOI: 10.1016/j.envres.2022.113307] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/09/2022] [Accepted: 04/10/2022] [Indexed: 06/14/2023]
Abstract
Pb isotope ratios are used for apportioning the sources of Pb in the blood of children (ages 1-6) screened for high blood Pb levels (>5 μg/dL) surrounding urban areas of Kansas City, MO. We compared Pb isotope ratios measured in the child's blood with those of the most likely sources of Pb in that child's home environment. The environmental sources sampled consisted of topsoils, paints, occupational sources (e.g., oil rig workers' uniforms, mechanics' clothes), indoor air filters, dusts, and dietary sources (e.g., spices). Blood lead levels (BLL) ranged from 2.9 to 12.7 μg/dL in children from the five homes participating in this study. Measurements of 206Pb/204Pb, 207Pb/204Pb and 208Pb/204Pb isotope ratios were made by multi-collector ICP-MS. Comparison of the Pb isotope ratios in home environment samples versus those in the child's blood in each home allowed the identification of possible sources of a child's Pb exposure in three homes. In five homes investigated, children's blood Pb levels were most likely to be derived from dusts inside, and topsoil outside, the homes, or a mixture thereof. In one case, blood Pb was derived from turmeric spice and, in another, the Pb was derived from paint. It is not always possible to directly link high BLLs to the environmental sources collected when Pb isotope ratios of the environmental samples did not overlap with those of the blood.
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Affiliation(s)
- F Becker
- Department of Geology and Geophysics, Texas A&M University, College Station, TX, USA
| | - F Marcantonio
- Department of Geology and Geophysics, Texas A&M University, College Station, TX, USA.
| | - S Datta
- Department of Earth and Planetary Sciences, University of Texas, San Antonio, TX, USA
| | - C Wichterich
- Department of Geology and Geophysics, Texas A&M University, College Station, TX, USA
| | - L Cizmas
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - J Surber
- Department of Geology, Kansas State University, Manhattan, KS, USA
| | - K Kennedy
- Children's Mercy Kansas City Environmental Health Program, Kansas City, MO, USA
| | - E Bowles
- Children's Mercy Kansas City Environmental Health Program, Kansas City, MO, USA
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Swaringen BF, Gawlik E, Kamenov GD, McTigue NE, Cornwell DA, Bonzongo JCJ. Children's exposure to environmental lead: A review of potential sources, blood levels, and methods used to reduce exposure. ENVIRONMENTAL RESEARCH 2022; 204:112025. [PMID: 34508773 DOI: 10.1016/j.envres.2021.112025] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
Lead has been used for thousands of years in different anthropogenic activities thanks to its unique properties that allow for many applications such as the manufacturing of drinking water pipes and its use as additives to gasoline and paint. However, knowledge of the adverse impacts of lead on human health has led to its banning from several of its applications, with the main goal of reducing environmental pollution and protecting human health. Human exposure to lead has been linked to different sources of contamination, resulting in high blood lead levels (BLLs) and adverse health implications, primarily in exposed children. Here, we present a summary of a literature review on potential lead sources affecting blood levels and on the different approaches used to reduce human exposure. The findings show a combination of different research approaches, which include the use of inspectors to identify problematic areas in homes, collection and analysis of environmental samples, different lead detection methods (e.g. smart phone applications to identify the presence of lead and mass spectrometry techniques). Although not always the most effective way to predict BLLs in children, linear and non-linear regression models have been used to link BLLs and environmental lead. However, multiple regressions and complex modelling systems would be ideal, especially when seeking results in support of decision-making processes. Overall, lead remains a pollutant of concern and many children are still exposed to it through environmental and drinking water sources. To reduce exposure to lead through source apportionment methods, recent technological advances using high-precision lead stable isotope ratios measured on multi-collector induced coupled plasma mass spectrometry (MC-ICP-MS) instruments have created a new direction for identifying and then eliminating prevalent lead sources associated with high BLLs.
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Affiliation(s)
- Benjamin F Swaringen
- Dept. of Environmental Engineering Sciences, Engineering School of Sustainable Infrastructures and Environment. University of Florida, Gainesville, FL, 32611, USA
| | - Emory Gawlik
- Dept. of Environmental Engineering Sciences, Engineering School of Sustainable Infrastructures and Environment. University of Florida, Gainesville, FL, 32611, USA
| | - George D Kamenov
- Dept. of Geological Sciences, University of Florida, Gainesville, FL 32611, USA
| | - Nancy E McTigue
- Cornwell Engineering Group, 712 Gum Rock Ct, Newport News, VA 23606, USA
| | - David A Cornwell
- Dept. of Environmental Engineering Sciences, Engineering School of Sustainable Infrastructures and Environment. University of Florida, Gainesville, FL, 32611, USA; Cornwell Engineering Group, 712 Gum Rock Ct, Newport News, VA 23606, USA
| | - Jean-Claude J Bonzongo
- Dept. of Environmental Engineering Sciences, Engineering School of Sustainable Infrastructures and Environment. University of Florida, Gainesville, FL, 32611, USA.
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16
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Levin-Schwartz Y, Cowell W, Leon Hsu HH, Enlow MB, Amarasiriwardena C, Andra SS, Wright RJ, Wright RO. Metal mixtures are associated with increased anxiety during pregnancy. ENVIRONMENTAL RESEARCH 2022; 204:112276. [PMID: 34717944 PMCID: PMC8671328 DOI: 10.1016/j.envres.2021.112276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/29/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Exposure to low-dose toxic metals in the environment is ubiquitous. Several murine studies have shown metals induce anxiety-like behaviors, and mechanistic research supports that metals disrupt neurotransmitter signaling systems implicated in the pathophysiology of anxiety. In this study, we extend prior research by examining joint exposure to six metals in relation to maternal anxiety symptoms during pregnancy. METHODS The sample includes 380 participants enrolled in the PRogramming of Intergenerational Stress Mechanisms (PRISM) pregnancy cohort. Spot urine was collected during pregnancy (mean ± standard deviation: 31.1 ± 6.1 weeks), and concentrations of six metals (barium [Ba], cadmium [Cd], chromium [Cr], cesium [Cs], lead [Pb], antimony [Sb]) were measured by Inductively Coupled Plasma - Mass Spectrometry. Trait anxiety symptoms were measured during pregnancy using a short version of the Spielberger State Trait Anxiety Inventory (STAI-T) and information on covariates was collected by questionnaire. We used weighted quantile sum (WQS) regression as the primary modeling approach to examine metals, treated as a mixture, in relation to higher (≥20) vs. lower anxiety symptoms while adjusting for urinary creatinine and key sociodemographic variables. RESULTS The sample is socioeconomically and racially/ethnically diverse. Urinary metal concentrations were log-normally distributed and 25% of the sample had an STAI-T score ≥20. Joint exposure to metals was associated with elevated anxiety symptoms (ORWQS = 1.56, 95% CI: 1.24, 1.96); Cd (61.8%), Cr (14.7%), and Cs (12.7%) contributed the greatest weight to the mixture effect. CONCLUSION Exposure to metals in the environment may be associated with anxiety symptoms during pregnancy. This is a public health concern, as anxiety disorders are highly prevalent and associated with significant co-morbidities, especially during pregnancy when both the mother and developing fetus are susceptible to adverse health outcomes.
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Affiliation(s)
- Yuri Levin-Schwartz
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Whitney Cowell
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Hsiao-Hsien Leon Hsu
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Bosquet Enlow
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Chitra Amarasiriwardena
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Syam S Andra
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rosalind J Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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Brown MJ, Patel P, Nash E, Dikid T, Blanton C, Forsyth JE, Fontaine R, Sharma P, Keith J, Babu B, Vaisakh TP, Azarudeen MJ, Riram B, Shrivastava A. Prevalence of elevated blood lead levels and risk factors among children living in Patna, Bihar, India 2020. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000743. [PMID: 36962532 PMCID: PMC10021519 DOI: 10.1371/journal.pgph.0000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/15/2022] [Indexed: 03/26/2023]
Abstract
Childhood lead exposure remains a key health concern for officials worldwide, contributing some 600,000 new cases of intellectually disabled children annually. Most children affected by high exposure to lead live in low- and middle-income countries. The leaded gasoline phase out in India was completed in 2000. Yet, in 2020, an estimated 275 million children aged 0 to 9 years had blood lead levels (BLLs) ≥ 5 μg/dL known to adversely affect intelligence and behavior. Lead sources reported in India include spices, cookware, paint, traditional medicines and cosmetics, and lead-acid battery recycling and repair. However, their relative contribution has not been characterized. More than 200 lead pollution sites related to battery recycling and repair activities were identified in Bihar and Jharkhand, India. Ninety percent of the recycling sites had soil lead concentrations exceeding the US Environmental Protection Agency's standards. We compared blood and environmental lead levels in two groups of children in Patna, Bihar. Households in proximity to battery recycling operations (Proximal n = 67) versus households distal to these operations (Distal n = 68). The average age of children was 40 months; 46% were female. Overall, the geometric mean (GM) BLL was 11.6 μg/dL. GM BLLs of children in Proximal and Distal households were not significantly different (10.2 μg/dL vs. 13.1 μg/dL respectively; p≤0.07). About 87% children, 56 Proximal and 62 Distal had BLLs ≥5 μg/dl. Lead concentrations in environmental samples were significantly higher in Proximal households (soil mean 9.8 vs. 1.6 μg/ft2; dust mean 52.9 vs. 29.9 μg/ft2 p<0.001; Proximal vs. Distal respectively) whereas concentrations in all spices were higher in Distal households (mean 46.8 vs 134.5 ppm p<0.001; Proximal vs. Distal respectively), and turmeric (mean 59.4 vs. 216.9 ppm Proximal vs. Distal respectively). In multivariate analyses for all children lead in spices and turmeric and number of rooms in the house were significant while for the Proximal group only lead in spices remained in the model. The predictive value of these models was poor. For the Distal group, a model with lead concentration in spices, turmeric and soil and number of rooms in the house was a much better fit. Of the 34 water samples collected, 7 were above the Indian standard of 10 ppb for lead in drinking water (2 in the Proximal area, 5 in the Distal area). Children in Patna, Bihar, India are exposed to multiple sources of lead, with lead levels in house dust and loose, locally sourced spices the most likely to increase blood lead levels. A holistic approach to blood lead testing and source identification and remediation are necessary to prevent lead exposure.
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Affiliation(s)
- M J Brown
- Department of Social and Behavioral Sciences, Harvard Chan School of Public Health, Boston, Massachusetts, United States of America
| | - P Patel
- National Center for Disease Control India, New Delhi, India
| | - E Nash
- Pure Earth, New York, New York, United States of America
| | - T Dikid
- National Center for Disease Control India, New Delhi, India
| | - C Blanton
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - J E Forsyth
- Stanford Woods Institute for the Environment, Stanford University, Stanford, California, United States of America
| | - R Fontaine
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - P Sharma
- Pure Earth, New York, New York, United States of America
| | - J Keith
- Pure Earth, New York, New York, United States of America
| | - B Babu
- National Center for Disease Control India, New Delhi, India
| | - T P Vaisakh
- National Center for Disease Control India, New Delhi, India
| | - M J Azarudeen
- National Center for Disease Control India, New Delhi, India
| | - B Riram
- National Center for Disease Control India, New Delhi, India
| | - A Shrivastava
- National Center for Disease Control India, New Delhi, India
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18
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Okatch H, Pitts E, Ritchey E, Givler K, Kuon M. Readability levels and thematic content analysis of online and printed lead poisoning informational materials. BMC Public Health 2021; 21:1874. [PMID: 34657616 PMCID: PMC8520609 DOI: 10.1186/s12889-021-11944-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lead poisoning prevention efforts include preparing and disseminating informational materials such as brochures and pamphlets to increase awareness of lead poisoning, lead exposures and lead poisoning prevention. However, studies have demonstrated that patient education materials for diseases and health conditions are prepared at a reading level that is higher than the recommended 7th-8th grade reading level. This study, therefore, aims to assess the reading levels of lead poisoning informational materials. METHODS Lead poisoning materials (N = 31) were accessed from three states; Michigan, New York and Pennsylvania. The readability levels of the materials were assessed using the Flesh Kincaid Grade Level readability test. The Kruskal-Wallis test was conducted to determine if the readability levels differed between the materials obtained from the different states. Thematic content analyses were carried out to assess the inclusion of four themes; definition of lead poisoning, risk factors and exposures, testing and referral and prevention covering 12 subtopics. The Wilcoxon rank sum test was used to examine if there was a difference in the number of subtopics by readability level (dichotomized to >8th grade and < 8th grade). RESULTS The median readability level of the informational materials was 6.7 (IQR: 5.1-8.1). However, there was variability in the readability levels of the materials (range 3.5 to 10.6); materials obtained from Michigan had the highest median reading level of 8.1 (IQR: 6.9-9.0) followed by Pennsylvania. Heterogeneity was observed in the content of the materials. Most of the materials (80%) from Michigan focused on water as a source of lead poisoning, whereas materials from New York and Pennsylvania focused on lead-based paint and other sources. The materials prepared at >8th grade reading level contained fewer topics than materials prepared at <8th grade reading level. CONCLUSIONS We find that the materials were often prepared at reading levels lower than the recommended 8th grade reading level. However, there is variability in the reading levels and in the content of the materials. While the materials met the general readability guidelines, they did not necessarily meet the needs of specific groups, especially groups at risk.
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Affiliation(s)
- Harriet Okatch
- Biology Department, Franklin and Marshall College, 415 Harrisburg Avenue, Lancaster, PA, 17603, USA.
| | - Ebony Pitts
- Biology Department, Franklin and Marshall College, 415 Harrisburg Avenue, Lancaster, PA, 17603, USA
| | - Emily Ritchey
- Biology Department, Franklin and Marshall College, 415 Harrisburg Avenue, Lancaster, PA, 17603, USA
| | - Kylie Givler
- Department of Physical Therapy, University of Delaware, 210 South College Ave, Newark, DE, 19716, USA
| | - Madeline Kuon
- Biology Department, Franklin and Marshall College, 415 Harrisburg Avenue, Lancaster, PA, 17603, USA
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Blood Lead Levels and Subsequence Risk of Malaria in the African Population: A Systematic Review and Meta-Analysis. Trop Med Infect Dis 2021; 6:tropicalmed6030149. [PMID: 34449746 PMCID: PMC8396233 DOI: 10.3390/tropicalmed6030149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/28/2021] [Accepted: 08/05/2021] [Indexed: 12/03/2022] Open
Abstract
Previous epidemiological studies showed that blood lead level (BLL) was associated with malaria infection and severity. Therefore, the present study aimed to qualitatively and quantitatively synthesize the evidence on the association between BLL and risk of malaria infection and severity using the systematic review and meta-analysis approach. Potentially relevant studies were identified from three databases using a combination of search terms. The quality of the included studies was assessed using the checklist for the cross-sectional studies developed by the Joanna Briggs Institute. The qualitative synthesis of the risk or odds of malaria infection in patients with BLL was performed as the outcome of each included study could not be pooled. The pooled mean BLL and prevalence of malaria infection of the included studies was estimated using a random-effect model. The heterogeneity of the outcomes among the included studies was assessed using the Cochran Q test and I2 statistics. The subgroup analysis of the study sites and participants was performed to explore the source(s) of heterogeneity of the outcomes. Publication bias was assessed in the case of more than 10 studies used for pooling of the same outcome. Among 114 potentially relevant studies identified from the databases, 6 eligible studies were included for qualitative and quantitative syntheses. The results showed that the pooled mean BLLs were 7.33 μg/dL in children (95% confidence interval (95%CI), 4.08–10.58; I2, 98.2%), 7.94 μg/dL in children with BLL > 45 mg/dL before chelation (95%CI, 7.87–8.01), 7.41 μg/dL in infants (95%CI, 7.34–7.48 μg/dL), 9.20 μg/dL in children with malaria (95%CI, 9.16–9.24 μg/ dL), and 36.37 μg/dL in pregnant women (95%CI, 34.43–38.31 μg/dL). The prevalence rates of malaria among participants (2381 participants, 803 malaria-positive patients) were 53% in children (95%CI, 50–57%; I2, 99.8%), 24% in children with BLL > 45 mg/dL before chelation (95%CI, 21–27%), 12% in infants (95%CI, 8–18%), and 21% in pregnant women (95%CI, 18–26%). The subgroup analysis of countries demonstrated that the prevalence rates of malaria among participants was 17% in Benin (95%CI, 13–21%; I2, 98.8%) and 36% in Nigeria (95%CI, 10–63%; I2, 99.4%). BLL associated with decreased risk of malaria was demonstrated by two studies conducted in Benin and Nigeria, while BLL associated with increased risk of malaria was demonstrated by a study conducted in Nigeria. BLL was associated with the risk of severe malaria, involving severe neurological features and severe anemia. In conclusion, the present systematic review and meta-analysis determined the current status of the studies on BLL and risk of malaria in African countries. Further studies are needed to investigate the impact of BLL on patients with malaria to help the clinician determine the risk of severity, such as the development of neurological features or severe anemia, among patients exposed to lead.
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Jahir T, Pitchik HO, Rahman M, Sultana J, Shoab AKM, Nurul Huda TM, Byrd KA, Islam MS, Yeasmin F, Baker M, Yeasmin D, Nurunnahar S, Luby SP, Winch PJ, Forsyth JE. Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh. ENVIRONMENTAL RESEARCH 2021; 199:111292. [PMID: 33971132 PMCID: PMC8261827 DOI: 10.1016/j.envres.2021.111292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 06/09/2023]
Abstract
Lead exposure is harmful at any time in life, but pre-natal and early childhood exposures are particularly detrimental to cognitive development. In Bangladesh, multiple household-level lead exposures pose risks, including turmeric adulterated with lead chromate and food storage in lead-soldered cans. We developed and evaluated an intervention to reduce lead exposure among children and their caregivers in rural Bangladesh. We conducted formative research to inform theory-based behavioral recommendations. Lead exposure was one of several topics covered in the multi-component intervention focused on early child development. Community health workers (CHWs) delivered the lead component of the intervention during group sessions with pregnant women and mother-child dyads (<15 months old) in a cluster-randomized trial. We administered household surveys at baseline (control n = 301; intervention n = 320) and 9 months later at endline (control n = 279; intervention n = 239) and calculated adjusted risk and mean differences for primary outcomes. We conducted two qualitative assessments, one after 3 months and a second after 9 months, to examine the feasibility and benefits of the intervention. At endline, the prevalence of lead awareness was 52 percentage points higher in the intervention arm compared to the control (adjusted risk difference: 0.52 [95% CI 0.46 to 0.61]). Safe turmeric consumption and food storage practices were more common in the intervention versus control arm at endline, with adjusted risk differences of 0.22 [0.10 to 0.32] and 0.13 [0.00 to 0.19], respectively. Semi-structured interviews conducted with a subset of participants after the intervention revealed that the perceived benefit of reducing lead exposure was high because of the long-term negative impacts that lead can have on child cognitive development. The study demonstrates that a group-based CHW-led intervention can effectively raise awareness about and motivate lead exposure prevention behaviors in rural Bangladesh. Future efforts should combine similar awareness-raising efforts with longer-term regulatory and structural changes to systematically and sustainably reduce lead exposure.
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Affiliation(s)
- Tania Jahir
- Emerging Infections, Icddr,b, Dhaka, Bangladesh
| | | | | | | | - A K M Shoab
- Emerging Infections, Icddr,b, Dhaka, Bangladesh
| | | | | | - Md Saiful Islam
- Emerging Infections, Icddr,b, Dhaka, Bangladesh; School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | | | - Musa Baker
- Emerging Infections, Icddr,b, Dhaka, Bangladesh
| | | | | | | | - Peter J Winch
- John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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21
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Halonen JI, Erhola M, Furman E, Haahtela T, Jousilahti P, Barouki R, Bergman Å, Billo NE, Fuller R, Haines A, Kogevinas M, Kolossa-Gehring M, Krauze K, Lanki T, Vicente JL, Messerli P, Nieuwenhuijsen M, Paloniemi R, Peters A, Posch KH, Timonen P, Vermeulen R, Virtanen SM, Bousquet J, Antó JM. A call for urgent action to safeguard our planet and our health in line with the helsinki declaration. ENVIRONMENTAL RESEARCH 2021; 193:110600. [PMID: 33307082 DOI: 10.1016/j.envres.2020.110600] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 05/21/2023]
Abstract
In 2015, the Rockefeller Foundation-Lancet Commission launched a report introducing a novel approach called Planetary Health and proposed a concept, a strategy and a course of action. To discuss the concept of Planetary Health in the context of Europe, a conference entitled: "Europe That Protects: Safeguarding Our Planet, Safeguarding Our Health" was held in Helsinki in December 2019. The conference participants concluded with a need for action to support Planetary Health during the 2020s. The Helsinki Declaration emphasizes the urgency to act as scientific evidence shows that human activities are causing climate change, biodiversity loss, land degradation, overuse of natural resources and pollution. They threaten the health and safety of human kind. Global, regional, national, local and individual initiatives are called for and multidisciplinary and multisectorial actions and measures are needed. A framework for an action plan is suggested that can be modified for local needs. Accordingly, a shift from fragmented approaches to policy and practice towards systematic actions will promote human health and health of the planet. Systems thinking will feed into conserving nature and biodiversity, and into halting climate change. The Planetary Health paradigm ‒ the health of human civilization and the state of natural systems on which it depends ‒ must become the driver for all policies.
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Affiliation(s)
- Jaana I Halonen
- Finnish Institute for Health and Welfare, Helsinki, Finland.
| | | | - Eeva Furman
- Finnish Environment Institute, Helsinki, Finland
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Finland
| | | | - Robert Barouki
- Université de Paris, Inserm UMR S-1124, 75006, Paris, France
| | - Åke Bergman
- Department of Environmental Science, Stockholm University, Stockholm, Sweden; School of Science and Technology, MTM, Örebro University, Örebro, Sweden
| | - Nils E Billo
- Global Alliance Against Chronic Respiratory Disease Finland, Helsinki, Finland
| | | | - Andrew Haines
- Department of Public Health, Environments and Society and Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Manolis Kogevinas
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Kinga Krauze
- European Regional Centre for Ecohydrology of the Polish Academy of Sciences, Łódź, Poland
| | - Timo Lanki
- Finnish Institute for Health and Welfare, Helsinki, Finland; University of Eastern Finland, Kuopio, Finland
| | | | - Peter Messerli
- Centre for Development and Environment (CDE), University of Bern, Bern, Switzerland; Wyss Academy for Nature, University of Bern, Bern, Switzerland
| | - Mark Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Ludwig-Maximilians Universität München, Germany
| | | | | | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands
| | - Suvi M Virtanen
- Finnish Institute for Health and Welfare, Helsinki, Finland; Faculty of Social Sciences, Unit of Health Sciences, Tampere University; Center for Child Health Research, Tampere University and Tampere University Hospital; and The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Jean Bousquet
- Centre Hospitalier Universitaire de Montpellier, 34295, Montpellier, France; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, 10117, Berlin, Germany; Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, 10178 Berlin, Germany
| | - Josep M Antó
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
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22
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Byers HL, McHenry LJ, Grundl TJ. Increased risk for lead exposure in children through consumption of produce grown in urban soils. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 743:140414. [PMID: 32659566 PMCID: PMC7492482 DOI: 10.1016/j.scitotenv.2020.140414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/14/2020] [Accepted: 06/19/2020] [Indexed: 05/06/2023]
Abstract
Childhood Pb exposure is associated with a multitude of poor health outcomes. In food-insecure areas, growing fresh produce in backyard gardens or on vacant industrial properties is seen as an option for parents. The question arises, could Pb accumulate in consumable tissues of common produce when grown in metals-rich soils at concentrations that would pose a risk to children. This study investigated factors contributing to the accumulation of Pb in consumable tissues of nine common produce crops grown in metals-rich soils from backyard gardens and a former industrial property. Pb in consumable tissues was directly quantified at concentrations less than 1 μg g-1 via X-ray fluorescence (XRF) using protocols specifically developed for use in plant matrices. The accumulation of Pb in prepared raw consumable tissues in three Pb-rich soils was the greatest in modified taproot crops (mean Pb of 11.8 ± 14.6 μg g-1; turnip, beetroot, radish, carrot), with lesser concentrations in fruits (mean Pb of 2.0 ± 3.0 μg g-1; tomato, pepper), and potatoes (mean Pb of 0.7 ± 1.1 μg g-1). An exposure risk evaluation using the USFDA IRL for Pb indicates that consumption of less than 1 g of certain produce grown in this study, including produce grown in garden soils from residential properties, drastically increases the risk of Pb exposure in children. This study further indicates that the proportion of Pb contributed to the daily body burden in children from food is far greater than previously understood, and in all modeled cases, the contribution of Pb from food on a daily basis far outweighs the contribution of Pb from drinking water. For an average child, after addressing over-riding soil/dust impacts, addressing food quality is critical to minimizing Pb exposure.
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Affiliation(s)
- Harris L Byers
- University of Wisconsin Milwaukee, Department of Geosciences, 3209 North Maryland Avenue, Milwaukee, WI 53211, USA
| | - Lindsay J McHenry
- University of Wisconsin Milwaukee, Department of Geosciences, 3209 North Maryland Avenue, Milwaukee, WI 53211, USA
| | - Timothy J Grundl
- University of Wisconsin Milwaukee, Department of Geosciences, 3209 North Maryland Avenue, Milwaukee, WI 53211, USA.
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23
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Howe CG, Claus Henn B, Eckel SP, Farzan SF, Grubbs BH, Chavez TA, Hodes TL, Faham D, Al-Marayati L, Lerner D, Quimby A, Twogood S, Richards MJ, Meeker JD, Bastain TM, Breton CV. Prenatal Metal Mixtures and Birth Weight for Gestational Age in a Predominately Lower-Income Hispanic Pregnancy Cohort in Los Angeles. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:117001. [PMID: 33141601 PMCID: PMC7608819 DOI: 10.1289/ehp7201] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Reduced fetal growth increases the risk for adverse health outcomes. Growing evidence suggests that metal exposures contribute to reduced fetal growth, but little is known about the effects of complex metal mixtures. OBJECTIVES We investigated the impact of a complex mixture of metals on birth weight for gestational age (BW for GA) in the Maternal and Developmental Risks from Environmental and Social Stressors study, a predominately lower-income Hispanic pregnancy cohort in Los Angeles, California. METHODS Cadmium (Cd), cobalt (Co), mercury (Hg), nickel (Ni), molybdenum (Mo), lead (Pb), antimony (Sb), tin (Sn), and thallium (Tl) were measured by inductively coupled plasma mass spectrometry (ICP-MS) in maternal urine samples collected in early pregnancy (median GA: 13.1 wk). Speciated urinary arsenic (As) (inorganic+monomethyl+dimethyl As) was measured by high-performance liquid chromatography coupled to ICP-MS. Primary analyses focused on a mixture of seven metals that have previously been associated individually with fetal growth (i.e., As, Cd, Co, Hg, Ni, Pb, Tl) (n=262). In exploratory analyses, we additionally examined three metals that have been less studied in relation to fetal growth (i.e., Mo, Sb, Sn). Covariate-adjusted Bayesian kernel machine regression was used to investigate metal mixture associations with BW for GA z-scores. RESULTS In primary analyses, Hg and Ni ranked highest as predictors of BW for GA. An inverse linear association was estimated for Hg, whereas a positive association was estimated for Ni at low-to-moderate concentrations. A potential interaction between Hg and Ni was also identified. In our exploratory analysis, Sb ranked highest as a predictor of BW for GA, followed by Hg and Ni. CONCLUSIONS Our findings suggest that in this understudied population, Hg may reduce fetal growth, whereas Ni may promote fetal growth. We also identified Sb as a potential metal of concern for this population, which merits additional investigation. https://doi.org/10.1289/EHP7201.
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Affiliation(s)
- Caitlin G. Howe
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sandrah P. Eckel
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Shohreh F. Farzan
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Brendan H. Grubbs
- Department of Obstetrics and Gynecology, Keck School of Medicine, Los Angeles, California, USA
| | - Thomas A. Chavez
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Tahlia L. Hodes
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Dema Faham
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Laila Al-Marayati
- Department of Obstetrics and Gynecology, Keck School of Medicine, Los Angeles, California, USA
- Eisner Health, Los Angeles, California, USA
| | | | - Alyssa Quimby
- Department of Obstetrics and Gynecology, Keck School of Medicine, Los Angeles, California, USA
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sara Twogood
- Department of Obstetrics and Gynecology, Keck School of Medicine, Los Angeles, California, USA
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Theresa M. Bastain
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Carrie V. Breton
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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24
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Abstract
Background: Human lead (Pb) exposure can result in a number of adverse health outcomes, particularly in children. Objective: An assessment of lead exposure sources was carried out in the Republic of Georgia following a nationally representative survey that found elevated blood lead levels (BLLs) in children. Methods: A range of environmental media were assessed in 25 homes and four bazaars spanning five regions. In total, 682 portable X-Ray Fluorescence measurements were taken, including those from cookware (n = 53); paint (n = 207); soil (n = 91); spices (n = 128); toys (n = 78); and other media (n = 125). In addition, 61 dust wipes and 15 water samples were collected and analyzed. Findings: Exceptionally high lead concentrations were identified in multiple spices. Median lead concentrations in six elevated spices ranged from 4–2,418 times acceptable levels. Median lead concentrations of all other media were within internationally accepted guidelines. The issue appeared to be regional in nature, with western Georgia being the most highly affected. Homes located in Adjara and Guria were 14 times more likely to have lead-adulterated spices than homes in other regions. Conclusions: Further study is required to determine the source of lead contamination in spices. Policy changes are recommended to mitigate potential health impacts. The results of this study contribute to a growing body of evidence that points to adulterated spices as a significant source of human lead exposure.
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