Public Awareness and Risk Perceptions of Endocrine Disrupting Chemicals: A Qualitative Study

Perceptions and awareness of endocrine disruptors among mothers in Serbia and health implications

Endocrine-disrupting chemicals are significant contributors to various detrimental conditions, mechanistically disrupting the endocrine system and causing adverse health effects. Mounting evidence suggests they can induce multigenerational and transgenerational effects, yet awareness among individuals remain insufficient. This study aimed to assess the knowledge, attitudes and ways of informing mothers in Serbia about endocrine disruptors based on information from 190 women in Serbia. The research was conducted using a survey consisting of multiple-choice questions comprising: the first part aimed to collect sociodemographic data, the second part related to knowledge and attitudes about endocrine disruptors, and the third part focused on the sources of information about endocrine disruptors. Cronbach's alpha was used to check for scale reliability, and Pearson correlation was used to test the relations between interval variables. ANOVA was employed to test for group differences. The results indicated that mothers in Serbia do not have adequate knowledge about endocrine disruptors (potential sources, categories of substances and alternatives) nor confidence in their ability to mitigate exposure to endocrine disruptors. Also, the estimation of the health risks of exposure to endocrine disruptors was perceived as high, and the mothers thought that they should get additional information about endocrine disruptors before pregnancy. Although with several limitations (i.e. mothers were recruited among those with higher education and mainly from urban areas), the study results highlight the necessity for enhanced maternal education in Serbia regarding endocrine disruptors. Health professionals are deemed most suitable for providing this education, given the respondents' high level of trust in them.

Awareness and Knowledge of Endocrine-Disrupting Chemicals Among Pregnant Women and New Mothers: A Cross-Sectional Survey Study

BACKGROUND/OBJECTIVES

Endocrine-disrupting chemicals (EDCs) are exogenous substances that interfere with hormone regulation, leading to adverse health outcomes. Despite the wide use of EDCs in daily products like plastics, personal care items, and food packaging, public awareness remains low. Pregnant women and new mothers are particularly vulnerable, as exposure to EDCs during early life stages can have long-term health impacts. This cross-sectional, questionnaire-based study aimed to assess the awareness of EDCs among pregnant women and new mothers at a maternity hospital.

METHODS

This cross-sectional study was conducted in a tertiary care hospital between January and August 2022. A questionnaire based on the Mutualités Libres/AIM 2020 survey was used to assess awareness of EDCs among pregnant and postpartum women. The original survey was adapted culturally and linguistically for the Turkish population through translation and expert review. The questionnaire included sections on sociodemographics, habits, knowledge, information sources, healthcare, readiness for change, expectations, and attitudes.

RESULTS

The results showed that 59.2% of participants were unfamiliar with EDCs, and many lacked awareness of the associated health risks, including cancers, infertility, and developmental disorders in children. A significant portion of respondents had never heard of bisphenol A (BPA) or phthalates, while awareness of parabens was relatively higher.

CONCLUSIONS

The study concluded that increasing awareness of EDCs is essential for fostering informed avoidance behaviors, especially in vulnerable populations like pregnant women and new mothers. Public health campaigns and healthcare provider involvement are crucial for enhancing awareness and reducing the health risks associated with EDCs.

Main factors influencing the perceived health risk of endocrine-disrupting chemicals: A systematic literature review

Endocrine-disrupting chemicals (EDCs) are linked to rising health issues such as infertility, childhood obesity, and asthma. While some research exists on health risk perceptions of EDCs, a comprehensive understanding across different populations and contexts is needed. We performed a systematic literature review, examining 45 articles published between 1985 and 2023, focusing on both the risk perception of EDCs as a whole as well as individual EDCs found in the environment (e.g., pesticides, bisphenol A, and phthalates). We identified four major categories of factors influencing EDC risk perception: sociodemographic factors (with age, gender, race, and education as significant determinants), family-related factors (highlighting increased concerns in households with children), cognitive factors (indicating that increased EDC knowledge generally led to increased risk perception), and psychosocial factors (with trust in institutions, worldviews, and health-related concerns as primary determinants). This review highlights the complex nature of EDC risk perception, shaped by sociodemographic, family, cognitive, and psychosocial factors, essential for policymakers in crafting educational and communication strategies. Future research should expand to cover more EDCs, use representative samples, and explore the influence of psychosocial factors on risk perception more deeply.

Integrative transcriptomic profiling uncovers immune and functional responses to bisphenol a across multiple tissues in male mice

Bisphenol A (BPA), an endocrine-disrupting substance commonly found in plastics and receipts, is associated with adverse effects, including endocrine disorders, reduced fertility, and metabolic issues. To gain insights into its effects on biological systems, we observed the adverse effects of BPA in male Institute of Cancer Research (ICR) mice exposed to BPA at the lowest observed adverse effect level for 6 weeks, in comparison with the control groups. We constructed a comprehensive transcriptome profile using 20 different tissues to analyze the changes in the whole-body systems. This involved employing differential gene expression, tissue-specific gene, and gene co-expression network analyses. The study revealed that BPA exposure led to significant differences in the transcriptome in the thymus, suggesting activation of T-cell differentiation and maturation in response to BPA treatment. Furthermore, various tissues exhibited immune response activation, potentially due to the migration of immune cells from the thymus. BPA exposure also caused immune-related functional changes in the colon, liver, and kidney, as well as abnormal signaling responses in the sperm. The transcriptome analysis serves as a valuable resource for understanding the functional impact of BPA, providing profound insights into the effects of BPA exposure and emphasizing the need for further research on potential associated health risks.

Knowledge and beliefs of endocrine disruptors in pediatrics: all hands on deck!

Endocrine disruptors (ED) are ubiquitous pollutants, possibly implicated in chronic disease. Exposure of vulnerable populations; including neonates, infants and children; must therefore be limited. Informing parents is now a public health challenge. We conducted a quantitative cross-sectional study at the Lyon Mother and child Hospital. We used questionnaires to assess the beliefs and knowledge about ED of parents and pediatric healthcare professionals in the pediatric ward in Lyon, France. A total of 746 questionnaires were completed: 444 for professionals and 302 for parents. The majority of both populations had already heard of ED but only 10% of parents and 5% of professionals felt sufficiently informed. Professionals answered better than parents (73% vs. 60%). The main source of information was similar: media. Only 20% of professionals had read a scientific article about ED and 4% have followed a training. Environmental exposure and EDs is an increasing concern for parents but specific knowledge remains scare for parents and professionals. Specific training is needed.

The Effect of Individual or Study-Wide Report-Back on Knowledge, Concern, and Exposure-Reducing Behaviors Related to Endocrine-Disrupting Chemicals

BACKGROUND

To make informed decisions about endocrine-disrupting chemicals (EDCs), people need functional understanding of exposures and health and an ability to act on their knowledge. The return of biomonitoring results is an opportunity to educate people about EDCs and motivate exposure reduction.

OBJECTIVES

This study investigates environmental health knowledge about EDCs, concerns about health effects, and exposure-reducing behaviors before and after the return of individual-level exposure results or only study-wide results.

METHODS

Women in the Child Health and Development Studies who were biomonitored for 42 EDCs were randomly assigned to receive a report with personal chemical results or only study-wide findings. We interviewed participants before and after report-back about their knowledge and concerns about EDCs and how frequently they performed exposure-related behaviors. We investigated baseline differences by education and race and examined changes after report-back by race and report type.

RESULTS

Participants (n = 135 ) demonstrated general understanding of exposure pathways and health impacts of EDCs. For 9 out of 20 knowledge questions, more than 90% of participants (n ≥ 124 ) gave correct responses at baseline, including for questions about chemicals' persistence in the body and effects of early-life exposure. Most participants held two misconceptions-about chemical safety testing in the United States and what doctors can infer from EDC results-although errors decreased after report-back. Initially, concern was higher for legacy pollutants, but report-back increased concern for consumer product chemicals. After report-back, participants took some actions to reduce exposures, particularly to per- and polyfluoroalkyl substances, and total behavior was associated with knowledge and concern but not race, education, or report type.

DISCUSSION

This study demonstrated that participants had foundational knowledge about EDCs and that report-back further built their environmental health literacy. We conclude that future communications should target misconceptions about chemicals regulation in the United States, because information about regulations is crucial for people to evaluate risks posed by consumer product chemicals and decide whether to engage with public policy. https://doi.org/10.1289/EHP12565.

Endocrine-disrupting chemicals (EDCs) and cancer: new perspectives on an old relationship

PURPOSE

Environmental endocrine-disrupting chemicals (EDCs) are a mixture of chemical compounds capable to interfere with endocrine axis at different levels and to which population is daily exposed. This paper aims to review the relationship between EDCs and breast, prostate, testicle, ovary, and thyroid cancer, discussing carcinogenic activity of known EDCs, while evaluating the impact on public health.

METHODS

A literature review regarding EDCs and cancer was carried out with particular interest on meta-analysis and human studies.

RESULTS

The definition of EDCs has been changed through years, and currently there are no common criteria to test new chemicals to clarify their possible carcinogenic activity. Moreover, it is difficult to assess the full impact of human exposure to EDCs because adverse effects develop latently and manifest at different ages, even if preclinical and clinical evidence suggest that developing fetus and neonates are most vulnerable to endocrine disruption.

CONCLUSION

EDCs represent a major environmental and health issue that has a role in cancer development. There are currently some EDCs that can be considered as carcinogenic, like dioxin and cadmium for breast and thyroid cancer; arsenic, asbestos, and dioxin for prostate cancer; and organochlorines/organohalogens for testicular cancer. New evidence supports the role of other EDCs as possible carcinogenic and pregnant women should avoid risk area and exposure. The relationship between EDCs and cancer supports the need for effective prevention policies increasing public awareness.

Awareness Regarding Sex Hormone Disruptors in Everyday Products Among Females of Reproductive Age in Al-Jouf, the Kingdom of Saudi Arabia

Background and objective Endocrine-disrupting chemicals (EDCs) are natural or synthetic molecules that can alter and affect the operations of the hormonal system of an organism. These compounds include plastic consumer products and food containers such as phytoestrogen, which is also naturally present in food. EDCs can be found in the cord blood and maternal blood of pregnant women, as well as colostrum. Hence, they may affect not only the mother but also the offspring. In this study, we aimed to evaluate the awareness among females of reproductive age regarding the nature, source, as well as physiological and psychological burden associated with sex hormones disruptors. Methods A descriptive cross-sectional study was conducted among females between the age of 15-45 years in the Al-Jouf region, Saudi Arabia. A self-administrated questionnaire was used as the data collection tool; it consisted of multiple-choice questions to obtain information on the awareness among the females. In this study, females were classified into those with good knowledge and those with poor knowledge based on their level of knowledge by using a scoring system with a total score of 12. IBM SPSS Statistics version 24 (IBM Corp., Armonk, NY) was used to analyze the collected data. Results The study included 491 females; 6.6% of them had been using soya-containing products for a long time, and 32.5% reported using oatmeal for a long time. The majority (86.2%) did not use any other hormonal therapy. There were significant differences in the knowledge about sex hormone disruptors among the participants, and women with poorer knowledge about sex hormone disruptors were significantly less likely to report the long-time usage of soya-containing food when compared to women with greater knowledge (2.2% vs. 4.2%, p<0.001). The results showed that women with poorer knowledge were also significantly less likely to report the usage of hormonal therapies when compared to women with greater knowledge (6.7% vs. 7.2%, p<0.001), indicating that the usage of these chemicals is higher in women with greater knowledge although they are aware of their effects. Conclusion The study showed that females had good knowledge about the nature and usage of EDCs but poor knowledge about their impact. The knowledge of females was associated with their behavior regarding the usage of such products.

Recent Trends in Multiclass Analysis of Emerging Endocrine Disrupting Contaminants (EDCs) in Drinking Water

Ingestion of water is a major route of human exposure to environmental contaminants. There have been numerous studies exploring the different compounds present in drinking water, with recent attention drawn to a new class of emerging contaminants: endocrine-disrupting compounds (EDCs). EDCs encompass a broad range of physio-chemically diverse compounds; from naturally occurring to manmade. Environmentally, EDCs are found as mixtures containing multiple classes at trace amounts. Human exposure to EDCs, even at low concentrations, is known to lead to adverse health effects. Therefore, the ability to evaluate EDC contamination with a high degree of sensitivity and accuracy is of the utmost importance. This review includes (i) discussion on the perceived and actual risks associated with EDC exposure (ii) regulatory actions that look to limit EDC contamination (iii) analytical methods, including sample preparation, instrumentation and bioassays that have been advanced and employed for multiclass EDC identification and quantitation.

Development and Validation of the Prevention of Toxic Chemicals in the Environment for Children Tool: A Questionnaire for Examining the Community's Knowledge of and Preferences Toward Toxic Chemicals and Children's Brain Development

Early-life exposures to toxic chemicals can adversely impact brain development. Understanding people's knowledge of the impact of toxic chemicals on brain development is critical to reduce widespread exposure to chemicals. Yet it is unknown what people know about risks of toxic chemicals and how to reduce exposures. We developed and validated the questionnaire, PRevention of Toxic chemicals in the Environment for Children Tool (PRoTECT), to examine people's knowledge and attitudes about the influence of toxic chemicals on child development. We used best practices for developing and validating scales. First, we drafted items to assess knowledge of the impact of toxic chemicals on brain development, levels of concern regarding exposures, and preferences for prevention of neurodevelopmental disorders. Second, we received feedback on item clarity from five focus groups consisting of 46 community participants. In addition, 17 experts completed a content validity scale for each item and provided qualitative feedback. We administered the revised 18-item questionnaire to 190 participants of child-bearing age for scale development, and using exploratory factor analysis, we found evidence for a four-factor model of PRoTECT, RMSR = 0.05, of which 16 of the 18 items had adequate content validity with loadings >0.40 on a derived factor. We discuss future directions and applications of PRoTECT.

Interventions on Reducing Exposure to Endocrine Disrupting Chemicals in Human Health Care Context: A Scoping Review

Purpose

Inevitability of exposure to endocrine disrupting chemicals (EDCs) in daily lives of modern society is increasing interests in developing and implementing interventions to prevent or reduce harmful health effects of EDCs in various academic areas. This is a scoping review of intervention studies aimed at reducing exposure to EDCs in the text of human health care.

Methods

Scoping review methodology was used to explore the extent, range, and nature of current literature. A comprehensive systematic search of PubMed, CINAHL, Cochrane, PcycINFO, EMBASE, and RISS was performed for studies published to date. The authors followed Arksey and O'Malley's stages; 1) identification of research questions; 2) identification of relevant studies using a total of six electronic databases; 3) study selection; 4) charting the data; and 5) collation, summarization and reporting of the data.

Results

A total of 2114 articles were retrieved, from which 13 articles were included in the final review. Among the 13 studies, 12 conducted interventions regarding dietary modification or replacement of household or personal goods. The duration of interventions ranged from at least three days to a maximum of six months, including six studies with a period of less than ten days. The participants were all healthy populations, eight of which were for adults, three for children or adolescents, and two for families. Outcome of the interventions were measured through concentration of EDCs in urine or/and house air. The effects of the interventions were inconsistent, with 11 studies showing significant changes of EDC concentration while no significant change was found in two studies.

Conclusion

The results indicate a need for randomized controlled trials, participant-centered studies promoting active participation and practices of subjects, studies specifying subgroups of participants, and studies including families as units in interventions.

Fighting Bisphenol A-Induced Male Infertility: The Power of Antioxidants

Bisphenol A (BPA), a well-known endocrine disruptor present in epoxy resins and polycarbonate plastics, negatively disturbs the male reproductive system affecting male fertility. In vivo studies showed that BPA exposure has deleterious effects on spermatogenesis by disturbing the hypothalamic–pituitary–gonadal axis and inducing oxidative stress in testis. This compound seems to disrupt hormone signalling even at low concentrations, modifying the levels of inhibin B, oestradiol, and testosterone. The adverse effects on seminal parameters are mainly supported by studies based on urinary BPA concentration, showing a negative association between BPA levels and sperm concentration, motility, and sperm DNA damage. Recent studies explored potential approaches to treat or prevent BPA-induced testicular toxicity and male infertility. Since the effect of BPA on testicular cells and spermatozoa is associated with an increased production of reactive oxygen species, most of the pharmacological approaches are based on the use of natural or synthetic antioxidants. In this review, we briefly describe the effects of BPA on male reproductive health and discuss the use of antioxidants to prevent or revert the BPA-induced toxicity and infertility in men.