Making the invisible visible: results of a community-led health survey following PFAS contamination of drinking water in Merrimack, New Hampshire

Perinatal exposure to PFOS and sustained high-fat diet promote neurodevelopmental disorders via genomic reprogramming of pathways associated with neuromotor development

Perfluorooctanesulfonic acid (PFOS) is a neurotoxic widespread organic contaminant which affects several brain functions including memory, motor coordination and social activity. PFOS has the ability to traverse the placenta and the blood brain barrier (BBB) and cause weight gain in female mice. It's also known that obesity and consumption of a high fat diet have negative effects on the brain, impairs cognition and increases the risk for the development of dementia. The combination effect of developmental exposure to PFOS and the intake of a high-fat diet (HFD) has not been explored. This study investigates the effect of PFOS and /or HFD on weight gain, behavior and transcriptomic and proteomic analysis of adult brain mice. We found that female mice exposed to PFOS alone showed an increase in weight, while HFD expectedly increased body weight. The combination of HFD and PFOS exacerbated generalized behavior such as time spent in the center and rearing, while PFOS alone impacted the distance travelled. These results suggest that PFOS exposure may promote hyperactivity. The combination of PFOS and HFD alter social behavior such as rearing and withdrawal. Although HFD interfered with memory retrieval, biomarkers of dementia did not change except for total Tau and phosphorylated Tau. Tau was impacted by either or both PFOS exposure and HFD. Consistent with behavioral observations, global cerebral transcriptomic analysis showed that PFOS exposure affects calcium signaling, MAPK pathways, ion transmembrane transport, and developmental processes. The combination of HFD with PFOS enhances the effect of PFOS in the brain and affects pathways related to ER stress, axon guidance and extension, and neural migration. Proteomic analysis showed that HFD enhances the impact of PFOS on inflammatory pathways, regulation of cell migration and proliferation, and MAPK signaling pathways. Overall, these data show that PFOS combined with HFD may reprogram the genome and modulate neuromotor development and may promote symptoms linked to attention deficit-hyperactivity disorders (ADHD) and autism spectrum disorders (ASD). Future work will be needed to confirm these connections.

Popular Health, Environmental and Occupational Surveillance: an integrative literature review

The objective is to identify concepts, experiences, methods, and techniques in Popular Health, Environmental and Occupational Surveillance (VPSAT). This is an integrative review that used the descriptors: Community Participation, Public Health Surveillance, Environmental Health, and Occupational Health, using five databases: Virtual Health Library, EBSCOhost, Embase, Scopus and Web of Science. The review selected 15 studies, based on the inclusion criteria: surveillance experiences with community protagonism; and exclusion criteria: research without primary data and developed only by the health service. The theoretical and methodological bases of the studies were identified as citizen science, popular education, and environmental justice; experiences such as participatory mapping and monitoring; methods such as action research, 'do-it-yourself', and community-based research; and techniques such as "Photovoice" and Community Journal. Low-income urban communities, indigenous peoples, young individuals, and workers stand out as the protagonists. The recognition of the VPSAT as an important source of data and intervention by public health systems and academia contributes to making health surveillance more dialogic and effective.

Cancer Epidemiology in the Northeastern United States (2013-2017)

We tested the hypotheses that adult cancer incidence and mortality in the Northeast region and in Northern New England (NNE) were different than the rest of the United States, and described other related cancer metrics and risk factor prevalence. Using national, publicly available cancer registry data, we compared cancer incidence and mortality in the Northeast region with the United States and NNE with the United States overall and by race/ethnicity, using age-standardized cancer incidence and rate ratios (RR). Compared with the United States, age-adjusted cancer incidence in adults of all races combined was higher in the Northeast (RR, 1.07; 95% confidence interval [CI] 1.07-1.08) and in NNE (RR 1.06; CI 1.05-1.07). However compared with the United States, mortality was lower in the Northeast (RR, 0.98; CI 0.98-0.98) but higher in NNE (RR, 1.05; CI 1.03-1.06). Mortality in NNE was higher than the United States for cancers of the brain (RR, 1.16; CI 1.07-1.26), uterus (RR, 1.32; CI 1.14-1.52), esophagus (RR, 1.36; CI 1.26-1.47), lung (RR, 1.12; CI 1.09-1.15), bladder (RR, 1.23; CI 1.14-1.33), and melanoma (RR, 1.13; CI 1.01-1.27). Significantly higher overall cancer incidence was seen in the Northeast than the United States in all race/ethnicity subgroups except Native American/Alaska Natives (RR, 0.68; CI 0.64-0.72). In conclusion, NNE has higher cancer incidence and mortality than the United States, a pattern that contrasts with the Northeast region, which has lower cancer mortality overall than the United States despite higher incidence.

Significance

These findings highlight the need to identify the causes of higher cancer incidence in the Northeast and the excess cancer mortality in NNE.

Perfluoroalkyl Substances (PFAS) Affect Inflammation in Lung Cells and Tissues

Adverse lung outcomes from exposure to per-and polyfluoroalkyl substances (PFAS) are known; however, the mechanism of action is poorly understood. To explore this, human bronchial epithelial cells were grown and exposed to varied concentrations of short-chain (perfluorobutanoic acid, perflurobutane sulfonic acid and GenX) or long-chain (PFOA and perfluorooctane sulfonic acid (PFOS)) PFAS, alone or in a mixture to identify cytotoxic concentrations. Non-cytotoxic concentrations of PFAS from this experiment were selected to assess NLRP3 inflammasome activation and priming. We found that PFOA and PFOS alone or in a mixture primed and activated the inflammasome compared with vehicle control. Atomic force microscopy showed that PFOA but not PFOS significantly altered the membrane properties of cells. RNA sequencing was performed on the lungs of mice that had consumed PFOA in drinking water for 14 weeks. Wild type (WT), PPARα knock-out (KO) and humanized PPARα (KI) were exposed to PFOA. We found that multiple inflammation- and immune-related genes were affected. Taken together, our study demonstrated that PFAS exposure could alter lung biology in a significant manner and may contribute to asthma/airway hyper-responsiveness.

Adsorption properties and mechanism of zinc acrylic carbon nanosphere aggregates for perfluorooctanoic acid from aqueous solution

This study found that the cross-linkable zinc acrylic nanosphere aggregates (NAs) as precursors were successfully prepared by a simple one-step synthesis route, and Zn,O dopped-carbon nanocomposites were obtained through temperature-controllable engineering, which showed excellent adsorption capacities for perfluorooctanoic acid (PFOA). A series of experiments were performed to investigate and compare carbon materials for the efficient removal of PFOA. The maximum adsorption capacities of PFOA absorbed on carbon nanospheres aggregates (CNAs) were calculated by the Langmuir (360.98 mg/g) and Sips models (309.65 mg/g). The kinetic model indicated there was chemical adsorption and physical adsorption in the adsorption process. Van der Waals force and electrostatic interactions might be the dominant mechanism of the adsorption process. Additionally, pore-filling also played a role in the adsorption process. Furthermore, the adsorption efficiency was still above 90% after five cycles. The selective adsorption ability was tested through various pollutants (metal ions and dye solutions) absorbed by the CNAs. Our results proved that carbon nanosphere aggregates (CNAs) are expected to be outstanding adsorption materials for the decontamination of PFOA from wastewater.

Pediatric Cancer By Race, Ethnicity and Region in the United States

BACKGROUND

In a 2018 descriptive study, cancer incidence in children (age 0-19) in diagnosis years 2003 to 2014 was reported as being highest in New Hampshire and in the Northeast region.

METHODS

Using the Cancer in North America (CiNA) analytic file, we tested the hypotheses that incidence rates in the Northeast were higher than those in other regions of the United States either overall or by race/ethnicity group, and that rates in New Hampshire were higher than the Northeast region as a whole.

RESULTS

In 2003 to 2014, pediatric cancer incidence was significantly higher in the Northeast than other regions of the United States overall and among non-Hispanic Whites and Blacks, but not among Hispanics and other racial minorities. However, there was no significant variability in incidence in the states within the Northeast overall or by race/ethnicity subgroup. Overall, statistically significantly higher incidence was seen in the Northeast for lymphomas [RR, 1.15; 99% confidence interval (CI), 1.10-1.19], central nervous system neoplasms (RR, 1.12; 99% CI, 1.07-1.16), and neuroblastoma (RR, 1.13; 99% CI, 1.05-1.21).

CONCLUSIONS

Pediatric cancer incidence is statistically significantly higher in the Northeast than in the rest of the United States, but within the Northeast, states have comparable incidence. Differences in cancer subtypes by ethnicity merit further investigation.

IMPACT

Our analyses clarify and extend previous reports by statistically confirming the hypothesis that the Northeast has the highest pediatric cancer rates in the country, by providing similar comparisons stratified by race/ethnicity, and by assessing variability within the Northeast.

Adsorption of perfluorooctanoic acid from water by pH-modulated Brönsted acid and base sites in mesoporous hafnium oxide ceramics

Per- and polyfluoroalkyl substances (PFAS) are increasingly appearing in drinking water sources globally. Our work focuses specifically on the adsorption of the legacy perfluorooctanoic acid (PFOA) using mesoporous hafnium oxide (MHO) ceramic synthesized via a sol-gel process. Experiments were performed at varying pH to determine the effect of surface charge on adsorption capacity of PFOA by MHO, and to postulate adsorption behavior. At pH 2.3, the adsorption capacity of PFOA on MHO was 20.9 mg/g, whereas at a higher pH of 6.3, it was much lower at 9.2 mg/g. This was due to increased coulombic attractions at lower pH between the positively charged conjugate acid active sites on MHO surface and negatively charged deprotonated PFOA anion in solution. After adsorption, the solid MHO was regenerated via calcination, reducing the amount of toxic solid waste to be disposed since the adsorbent is regenerated, and the PFOA is completely removed.

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The adsorption capacity of PFOA by MHO was determined to be 20.9 mg/g at pH 2.3

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As pH increased, the adsorption capacity of MHO decreased due to Coulombic repulsions

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MHO could be regenerated via calcination to limit the amount of toxic waste produced

Environmental Health Literacy as Knowing, Feeling, and Believing: Analyzing Linkages between Race, Ethnicity, and Socioeconomic Status and Willingness to Engage in Protective Behaviors against Health Threats

This study investigates the relationships between environmental health literacy, the characteristics of people (race, ethnicity, and socioeconomic status) associated with health disparities, and people’s willingness to engage in protective behaviors against environmental health threats. Environmental health literacy is a framework for capturing the continuum between the knowledge of environmental impacts on public health, and the skills and decisions needed to take health-protective actions. We pay particular attention to three dimensions of environmental health literacy: factual knowledge (knowing the facts), knowledge sufficiency (feeling ready to decide what to do), and response efficacy (believing that protective behaviors work). In June 2020, we collected survey data from North Carolina residents on two topics: the viral infection COVID-19 and industrial contaminants called per- and polyfluoroalkyl substances (PFAS). We used their responses to test stepwise regression models with willingness to engage in protective behaviors as a dependent variable and other characteristics as independent variables, including environmental health literacy. For both topics, our results indicated that no disparities emerged according to socioeconomic factors (level of education, household income, or renting one’s residence). We observed disparities in willingness according to race, comparing Black to White participants, but not when comparing White to American Indian, Alaska Native, Asian, Native Hawaiian, or Pacific Islander participants nor Hispanic to non-Hispanic participants. The disparities in willingness between Black and White participants persisted until we introduced the variables of environmental health literacy, when the difference between these groups was no longer significant in the final regression models. The findings suggest that focusing on environmental health literacy could bridge a gap in willingness to protect oneself based on factors such as race/ethnicity and socioeconomic status, which have been identified in the environmental health literature as resulting in health disparities.

Drinking Water Quality and Public Health in the Kathmandu Valley, Nepal: Coliform Bacteria, Chemical Contaminants, and Health Status of Consumers

Residents of Nepal’s Kathmandu Valley draw drinking water from tube wells, dug wells, and stone spouts, all of which have been reported to have serious water quality issues. In this study, we analyzed drinking water samples from 35 tube wells, dug wells, stone spouts, and municipal tap water for bacterial and chemical contaminants, including total and fecal coliform, aluminum, arsenic, barium, beryllium, boron, cadmium, cobalt, chromium, copper, fluoride, iron, mercury, manganese, molybdenum, nickel, lead, antimony, selenium, thallium, uranium, vanadium, and zinc. We also asked a sampling of households who used these specific water sources to rate the taste of their water, list any waterborne diseases they were aware of, and share basic health information about household members. This survey provided us with information from 146 households and 603 individuals. We found widespread bacterial contamination of water sources, with 94% of sources having detectable total or fecal coliform. Nepal Drinking Water Quality Standards and World Health Organization (WHO) Drinking-Water Guidelines or health-based values were exceeded for aluminum (max = 0.53 mg/L), arsenic (max = 0.071 mg/L), iron (max = 7.22 mg/L), and manganese (max = 3.229 mg/L). The distribution of water sources with high arsenic, iron, and manganese appeared to be associated with floodplain deposits. Mixed effects logistic regression models were used to examine the interactions between social factors and water contaminants and their effects on household members’ health. Consumers of water sources with both high and low concentrations of manganese were less likely to have a positive attitude towards school than those whose water sources had moderate concentrations of manganese. Social factors, especially education, played a large role in predicting individual health outcomes. Household taste ratings of drinking water were not correlated with iron or manganese concentrations, suggesting that WHO’s reliance on aesthetic criteria for these contaminants instead of formal drinking-water guidelines may not be sufficient to protect public health.

A Statistical Approach for Identifying Private Wells Susceptible to Perfluoroalkyl Substances (PFAS) Contamination

Drinking water concentrations of per- and polyfluoroalkyl substances (PFAS) exceed provisional guidelines for millions of Americans. Data on private well PFAS concentrations are limited in many regions and monitoring initiatives are costly and time-consuming. Here we examine modeling approaches for predicting private wells likely to have detectable PFAS concentrations that could be used to prioritize monitoring initiatives. We used nationally available data on PFAS sources, and geologic, hydrologic and soil properties that affect PFAS transport as predictors and trained and evaluated models using PFAS data (n~2300 wells) collected by the state of New Hampshire between 2014 and 2017. Models were developed for the five most frequently detected PFAS: perfluoropentanoate, perfluorohexanoate, perfluoroheptanoate, perfluorooctanoate, and perfluorooctane sulfonate. Classification random forest models that allow non-linearity in interactions among predictors performed the best (area under the receiver operating characteristics curve: 0.74 - 0.86). Point sources such as the plastics/rubber and textile industries accounted for the highest contribution to accuracy. Groundwater recharge, precipitation, soil sand content, and hydraulic conductivity were secondary predictors. Our study demonstrates the utility of machine learning models for predicting PFAS in private wells and the classification random forest model based on nationally available predictors is readily extendable to other regions.

Per and polyfluoroalkyl substances scientific literature review: water exposure, impact on human health, and implications for regulatory reform

Among other emerging contaminants in water, per and polyfluoroalkyl substances (PFASs) have garnered international attention from the scientific community on a global scale. Some countries, such as the United States, have found that PFASs are present in humans on a wide scale. Although two PFASs have been widely studied-Perfluorooctanoic acid and Perfluorooctanesulfonic acid-many more PFASs are being created by industry and are either not known, not studied, or both. The objective of this literature review on PFASs is to give an overview of the information available about PFASs related to human exposure. The information from this literature review on the exposure of humans to PFASs through drinking water and the lack of many conventional drinking water treatment systems' ability to remove PFASs (particularly short-chain PFASs) suggests that current regulatory limits are insufficient to adequately protect humans. This is especially true for particularly vulnerable populations such as infants, young children, and developing children (pubescent). The gaps in the current knowledge and in current regulatory approaches could have long-term effects on human health.

Monitoring Analysis of Perfluoroalkyl Substances and F-53B in Bottled Water, Tea and Juice Samples by LC-MS/MS

Monitoring analysis of 14 per- and polyfluoroalkyl substances (PFAS), 9-chlorohexadecafluoro-3-oxanonane-1-sulfonate (F-53B) and dodecafluoro-3H-4,8-dioxanonanoate (ADONA) in bottled drinking water, tea and juice samples was performed using LC coupled with tandem mass spectrometry (LC-MS/MS) and solid-phase extraction (SPE). In the electrospray negative ion mode, the limit of detection and limit of quantification (LOQ) values were 0.1 to 0.8 ng/mL and 0.2 to 1.6 ng/mL, respectively. The calibration curves were linear from LOQ to 50 ng/mL (r² > 0.999). The SPE procedure (Presep PFC-II) was utilized for sample preparation and recovery rates for three standards (35, 70 and 140 ng/L) were 80.4-118.8% with relative standard deviation (RSD) ≤ 0.6%. Using the developed method, various samples (n = 54) from Japanese markets were investigated for PFAS and F-53B contamination, and values below the LOQ were observed. It is concluded that for monitoring products in the Japanese market, our method represents a significant improvement over complex techniques for the quantification of PFAS and related compounds from various foods.

A Fuzzy Cognitive Map method for integrated and participatory water governance and indicators affecting drinking water supplies

Drinking water governance is challenging with different perceptions and priorities among stakeholders in different countries. To make provision for drinking water protection in agricultural areas, governance systems need to be mapped for bottlenecks to be identified and solutions highlighted. To address this a system thinking approach was used in an explanatory network analysis of Fuzzy Cognitive Maps (FCM) that were created during face to face interviews with stakeholder representative groups (individuals, policy developers, researchers, and regulators). Two exercises were designed and facilitated to obtain stakeholder maps on A) the water governance framework from stakeholders' own perspective with a ranking of actors in terms of their perceived importance and B) a list of importance factors and how these were connected for the provision of good drinking water quality supplies in agricultural areas. Causal relationships were subsequently drawn around each subject allowing mapping. A graph theory Hierarchy Index (h) approach examined if stakeholder groups preferred top down hierarchical governance or a more inclusive democratic governance approach. Finally, an auto-associative neural network method was deployed on group maps for examination during steady-state conditions for three scenarios to be explored i.e. changing "Farmers knowledge", "best management practice (BMP) uptake" and "Farmers behaviour and belief" to the highest level of influence and seeing how the system reacted. Results of Exercise A showed that all stakeholder representative groups had a different perception of the water governance framework. Most stakeholder groups had a democratic point of view regarding water governance structures and the ranking and importance of the actors within the framework. Results of Exercise B demonstrated that most of the groups have similar opinions regarding the highest ranked factors affecting drinking water quality and the possible environmental ecological policy options. In this second exercise, only one representative group showed a democratic outlook whereas all others had a hierarchal outlook. Scenario testing of policy options enabled bottlenecks and possible solutions to be identified. By boosting "Farmers behaviour and belief" to the highest possible level, resulted in a large increase in other factors - a scenario where farmers could benefit from the outcome. This would be achieved by enhancing farmers' willingness and intention to participate and implement BMPs. Better results would be achieved if farmers believed in the method and could benefit from the outcome. Also keeping "Farmers knowledge" at the highest point had a positive influence on the other factors. This can be achieved by enhancing farmers training and knowledge transfer by local and national actors. This method is widely applicable and should be considered for more integrated and participatory approaches to drinking water governance.

Exploring Community Psychosocial Stress Related to Per- and Poly-Fluoroalkyl Substances (PFAS) Contamination: Lessons Learned from a Qualitative Study

The purpose of this study was to qualitatively explore the per- and poly-fluoroalkyl substances (PFAS) exposure experience and associated stressors, to inform public health efforts to support psychosocial health and resilience in affected communities. Semi-structured interviews (n = 9) were conducted from July-September 2019 with community members and state public health department representatives from areas with PFAS-contaminated drinking water. Thematic analysis was completed and themes were described and summarized. Reported stressors included health concerns and uncertainty, institutional delegitimization and associated distrust, and financial burdens. Interviewees provided several strategies to reduce stress and promote stress coping capacity and resilience, including showing empathy and validating the normalcy of experiencing stress; building trust through visible action and sustained community engagement; providing information and actionable guidance; discussing stress carefully; fostering stress coping capacity and resilience with opportunities to build social capital and restore agency; and building capacity among government agencies and health care providers to address psychosocial stress. While communities affected by PFAS contamination will face unavoidable stressors, positive interactions with government responders and health care providers may help reduce negative stress. More research on how best to integrate community psychosocial health and stress coping and resilience concepts into the public health response to environmental contamination could be helpful in addressing these stressors.