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Jedrychowski WA, Majewska R, Spengler JD, Camann D, Roen EL, Perera FP. Prenatal exposure to fine particles and polycyclic aromatic hydrocarbons and birth outcomes: a two-pollutant approach. Int Arch Occup Environ Health 2017; 90:255-264. [PMID: 28168423 PMCID: PMC5360842 DOI: 10.1007/s00420-016-1192-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 12/23/2016] [Indexed: 10/31/2022]
Abstract
BACKGROUND Previous epidemiologic studies have considered the effects of individual air pollutants on birth outcomes, whereas a multiple-pollutant approach is more relevant to public health policy. OBJECTIVES The present study compared the observed effect sizes of prenatal fine particulate matter (PM2.5) and polycyclic aromatic hydrocarbons (PAH) (a component of PM2.5) exposures on birth outcome deficits, assessed by the single vs. two-pollutant approaches. METHODS The study sample included 455 term infants born in Krakow to non-smoking mothers, among whom personal exposures to PM2.5 and PAH were monitored in the second trimester of pregnancy. The exposure effect estimates (unstandardized and standardized regression coefficients) on birth outcomes were determined using multivariable linear regression models, accounting for relevant covariates. RESULTS In the single-pollutant approach, each pollutant was inversely associated with all birth outcomes. The effect size of prenatal PAH exposure on birth weight and length was twice that of PM2.5, in terms of standardized coefficients. In the two-pollutant approach, the negative effect of PM2.5 on birth weight and length, adjusted for PAH exposure, lost its significance. The standardized effect of PAH on birth weight was 10-fold stronger (β = -0.20, p = 0.004) than that estimated for PM2.5 (β = -0.02, p = 0.757). CONCLUSION The results provide evidence that PAH had a greater impact on several measures of fetal development, especially birth weight, than PM2.5. Though in the single-pollutant models PM2.5 had a significant impact on birth outcomes, this effect appears to be mediated by PAH.
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Affiliation(s)
- W A Jedrychowski
- Former Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Renata Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 7, Kopernika Street, Krakow, Poland.
| | - J D Spengler
- Department of Environmental Health, School of Public Health, Harvard University, Boston, MA, USA
| | - David Camann
- Department of Analytical and Environmental Chemistry, Southwest Research Institute, San Antonio, TX, USA
| | - E L Roen
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - F P Perera
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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Roen EL, Wang Y, Calafat AM, Wang S, Margolis A, Herbstman J, Hoepner LA, Rauh V, Perera FP. Bisphenol A exposure and behavioral problems among inner city children at 7-9 years of age. Environ Res 2015; 142:739-45. [PMID: 25724466 PMCID: PMC4545741 DOI: 10.1016/j.envres.2015.01.014] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/14/2015] [Accepted: 01/16/2015] [Indexed: 05/22/2023]
Abstract
BACKGROUND Bisphenol A (BPA) is a ubiquitous endocrine disrupting compound. Several experimental and epidemiological studies suggest that gestational BPA exposure can lead to neurodevelopmental and behavioral problems in early-life, but results have been inconsistent. We previously reported that prenatal BPA exposure may affect child behavior and differently among boys and girls at ages 3-5 years. OBJECTIVES We investigated the association of prenatal and early childhood BPA exposure with behavioral outcomes in 7-9 year old minority children and hypothesized that we would observe the same sex-specific pattern observed at earlier ages. METHODS African-American and Dominican women enrolled in an inner-city prospective cohort study and their children were followed from mother's pregnancy through children's age 7-9 years. Women during the third trimester of pregnancy and children at ages 3 and 5 years provided spot urine samples. BPA exposure was categorized by tertiles of BPA urinary concentrations. The Child Behavioral Checklist (CBCL) was administered at ages 7 and 9 to assess multiple child behavior domains. Associations between behavior and prenatal (maternal) BPA concentrations and behavior and postnatal (child) BPA concentration were assessed via Poisson regression in models stratified by sex. These models accounted for potential confounders including prenatal or postnatal urinary BPA concentrations, child age at CBCL assessment, ethnicity, gestational age, maternal intelligence, maternal education and demoralization, quality of child's home environment, prenatal environmental tobacco smoke exposure, and prenatal mono-n-butyl phthalate concentration. RESULTS The direction of the associations differed between boys and girls. Among boys (n=115), high prenatal BPA concentration (upper tertile vs. lower two tertiles) was associated with increased internalizing (β=0.41, p<0.0001) and externalizing composite scores (β=0.40, p<0.0001) and with their corresponding individual syndrome scales. There was a general decrease in scores among girls that was significant for the internalizing composite score (β=-0.17, p=0.04) (n=135). After accounting for possible selection bias, the results remained consistent for boys. Conversely, high postnatal BPA concentration was associated with increased behaviors on both the internalizing composite (β=0.30, p=0.0002) and externalizing composite scores (β=0.33, p<0.0001) and individual subscores in girls but fewer symptoms in boys. These results remained significant in girls after accounting for selection bias. CONCLUSION These results suggest BPA exposure may affect childhood behavioral outcomes in a sex-specific manner and differently depending on timing of exposure.
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Affiliation(s)
- Emily L Roen
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th St., New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Columbia University, 722W. 168th St., New York, NY 10032, USA
| | - Ya Wang
- Columbia Center for Children's Environmental Health, Columbia University, 722W. 168th St., New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, 722W. 168th St., New York, NY 10032, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F53, Atlanta, GA 30341, USA
| | - Shuang Wang
- Columbia Center for Children's Environmental Health, Columbia University, 722W. 168th St., New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, 722W. 168th St., New York, NY 10032, USA
| | - Amy Margolis
- Columbia Center for Children's Environmental Health, Columbia University, 722W. 168th St., New York, NY 10032, USA; Division of Child & Adolescent Psychiatry and the Center for Developmental Neuropsychiatry, Department of Psychiatry, the New York State Psychiatric Institute and the College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
| | - Julie Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th St., New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Columbia University, 722W. 168th St., New York, NY 10032, USA
| | - Lori A Hoepner
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th St., New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Columbia University, 722W. 168th St., New York, NY 10032, USA
| | - Virginia Rauh
- Columbia Center for Children's Environmental Health, Columbia University, 722W. 168th St., New York, NY 10032, USA; The Heilbrunn Department of Population and Family Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA
| | - Frederica P Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th St., New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Columbia University, 722W. 168th St., New York, NY 10032, USA.
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Genkinger JM, Stigter L, Jedrychowski W, Huang TJ, Wang S, Roen EL, Majewska R, Kieltyka A, Mroz E, Perera FP. Prenatal polycyclic aromatic hydrocarbon (PAH) exposure, antioxidant levels and behavioral development of children ages 6-9. Environ Res 2015; 140:136-44. [PMID: 25863187 PMCID: PMC4492867 DOI: 10.1016/j.envres.2015.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 03/17/2015] [Accepted: 03/19/2015] [Indexed: 05/15/2023]
Abstract
PURPOSE Prenatal polycyclic aromatic hydrocarbon (PAH) exposure has been shown to increase DNA adduct levels and to affect neurodevelopment. Micronutrients may modify the adverse effect of PAH on neurodevelopment. Thus, we examined if micronutrient concentrations modified the association between PAH exposure and neurodevelopmental outcomes. METHODS 151 children from a birth cohort who had micronutrient concentrations measured in cord blood and completed the Child Behavioral Checklist (CBCL), between the ages of 6 and 9 years, were evaluated. Prenatal airborne PAH exposure was measured by personal air monitoring. The betas and 95% CI for the associations of antioxidant concentrations and PAH exposure with each of the outcomes of CBCL raw score and dichotomized standardized T-score (based on clinical cutpoints) were estimated, respectively, by multivariable poisson and logistic models. RESULTS Children below the median for alpha-tocopherol and gamma-tocopherol concentrations, compared to those above, were more likely to have thought problems, aggressive behavior and externalizing problems (p<0.05). Lower carotenoid concentration was associated with more thought problems (MVβ=0.60, p<0.001) and externalizing problems (MVβ=0.13, p<0.05) for the same contrast. No statistically significant associations were observed between retinol concentrations and neurodevelopmental symptoms. Overall, no consistent patterns were observed when we examined the interaction between antioxidants (e.g., alpha-tocopherol) and PAH in relation to CBCL symptoms (e.g., internalizing and externalizing problems, p<0.05). CONCLUSIONS Lower alpha-tocopherol, gamma-tocopherol and carotenoid levels may adversely affect healthy neurodevelopment, even after accounting for PAH exposure. Future research to confirm these findings are warranted given the importance of identifying modifiable factors for reducing harmful PAH effects.
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Affiliation(s)
- Jeanine M Genkinger
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Laura Stigter
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Wieslaw Jedrychowski
- Department of Epidemiology and Preventive Medicine, Jagiellonian University College of Medicine, Krakow, Poland
| | - Tzu-Jung Huang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Shuang Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Emily L Roen
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renata Majewska
- Department of Epidemiology and Preventive Medicine, Jagiellonian University College of Medicine, Krakow, Poland
| | - Agnieszka Kieltyka
- Department of Epidemiology and Preventive Medicine, Jagiellonian University College of Medicine, Krakow, Poland
| | - Elzbieta Mroz
- Department of Epidemiology and Preventive Medicine, Jagiellonian University College of Medicine, Krakow, Poland
| | - Frederica P Perera
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Vishnevetsky J, Tang D, Chang HW, Roen EL, Wang Y, Rauh V, Wang S, Miller RL, Herbstman J, Perera FP. Combined effects of prenatal polycyclic aromatic hydrocarbons and material hardship on child IQ. Neurotoxicol Teratol 2015; 49:74-80. [PMID: 25912623 DOI: 10.1016/j.ntt.2015.04.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 02/20/2015] [Accepted: 04/15/2015] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Polycyclic aromatic hydrocarbons are common carcinogenic and neurotoxic urban air pollutants. Toxic exposures, including air pollution, are disproportionately high in communities of color and frequently co-occur with chronic economic deprivation. OBJECTIVES We examined whether the association between child IQ and prenatal exposure to polycyclic aromatic hydrocarbons differed between groups of children whose mothers reported high vs. low material hardship during their pregnancy and through child age 5. We tested statistical interactions between hardships and polycyclic aromatic hydrocarbons, as measured by DNA adducts in cord blood, to determine whether material hardship exacerbated the association between adducts and IQ scores. DESIGN Prospective cohort. Participants were recruited from 1998 to 2006 and followed from gestation through age 7 years. SETTING Urban community (New York City) PARTICIPANTS A community-based sample of 276 minority urban youth EXPOSURE MEASURE: Polycyclic aromatic hydrocarbon-DNA adducts in cord blood as an individual biomarker of prenatal polycyclic aromatic hydrocarbon exposure. Maternal material hardship self-reported prenatally and at multiple timepoints through early childhood. MAIN OUTCOME MEASURE Child IQ at 7 years assessed using the Wechsler Intelligence Scale for Children. RESULTS Significant inverse effects of high cord PAH-DNA adducts on full scale IQ, perceptual reasoning and working memory scores were observed in the groups whose mothers reported a high level of material hardship during pregnancy or recurring high hardship into the child's early years, and not in those without reported high hardship. Significant interactions were observed between high cord adducts and prenatal hardship on working memory scores (β = -8.07, 95% CI (-14.48, -1.66)) and between high cord adducts and recurrent material hardship (β = -9.82, 95% CI (-16.22, -3.42)). CONCLUSION The findings add to other evidence that socioeconomic disadvantage can increase the adverse effects of toxic physical "stressors" like air pollutants. Observed associations between high cord adducts and reduced IQ were significant only among the group of children whose mothers reported high material hardship. These results indicate the need for a multifaceted approach to prevention.
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Affiliation(s)
- Julia Vishnevetsky
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Deliang Tang
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Hsin-Wen Chang
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Emily L Roen
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Ya Wang
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Virginia Rauh
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; The Heilbrunn Center for Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA
| | - Shuang Wang
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Rachel L Miller
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA; Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA
| | - Julie Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Frederica P Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA.
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Jedrychowski WA, Perera FP, Majewska R, Mrozek-Budzyn D, Mroz E, Roen EL, Sowa A, Jacek R. Depressed height gain of children associated with intrauterine exposure to polycyclic aromatic hydrocarbons (PAH) and heavy metals: the cohort prospective study. Environ Res 2015; 136:141-7. [PMID: 25460630 PMCID: PMC4262637 DOI: 10.1016/j.envres.2014.08.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 08/12/2014] [Accepted: 08/15/2014] [Indexed: 05/20/2023]
Abstract
Fetal exposure to environmental toxicants may program the development of children and have long-lasting health impacts. The study tested the hypothesis that depressed height gain in childhood is associated with prenatal exposure to airborne polycyclic aromatic hydrocarbons (PAH) and heavy metals (lead and mercury). The study sample comprised 379 children born to non-smoking mothers among whom a total of 2011 height measurements were carried out over the 9-year follow-up period. Prenatal airborne PAH exposure was assessed by personal air monitoring of the mother in the second trimester of pregnancy and heavy metals were measured in cord blood. At the age of 3 residential air monitoring was done to evaluate the level of airborne PAH, and at the age 5 the levels of heavy metals were measured in capillary blood. The effect estimates of prenatal PAH exposure on height growth over the follow-up were adjusted in the General Estimated Equation (GEE) models for a wide set of relevant covariates. Prenatal exposure to airborne PAH showed a significant negative association with height growth, which was significantly decreased by 1.1cm at PAH level above 34.7 ng/m(3) (coeff.=-1.07, p=0.040). While prenatal lead exposure was not significantly associated with height restriction, the effect of mercury was inversely related to cord blood mercury concentration above 1.2 μg/L (coeff.=-1.21, p=0.020), The observed negative impact of prenatal PAH exposure on height gain in childhood was mainly mediated by shorter birth length related to maternal PAH exposure during pregnancy. The height gain deficit associated with prenatal mercury exposure was not seen at birth, but the height growth was significantly slower at later age.
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Affiliation(s)
| | - Frederica P Perera
- Columbia Center for Children's Environmental Health, Mailman School Public Health, Columbia University, NY, USA
| | | | | | - Elżbieta Mroz
- Jagiellonian University Medical College, Krakow, Poland
| | - Emily L Roen
- Columbia Center for Children's Environmental Health, Mailman School Public Health, Columbia University, NY, USA
| | - Agata Sowa
- Jagiellonian University Medical College, Krakow, Poland
| | - Ryszard Jacek
- Jagiellonian University Medical College, Krakow, Poland
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Perera FP, Chang HW, Tang D, Roen EL, Herbstman J, Margolis A, Huang TJ, Miller RL, Wang S, Rauh V. Early-life exposure to polycyclic aromatic hydrocarbons and ADHD behavior problems. PLoS One 2014; 9:e111670. [PMID: 25372862 PMCID: PMC4221082 DOI: 10.1371/journal.pone.0111670] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 10/06/2014] [Indexed: 12/25/2022]
Abstract
Importance Polycyclic aromatic hydrocarbons are widespread urban air pollutants from combustion of fossil fuel and other organic material shown previously to be neurotoxic. Objective In a prospective cohort study, we evaluated the relationship between Attention Deficit Hyperactivity Disorder behavior problems and prenatal polycyclic aromatic hydrocarbon exposure, adjusting for postnatal exposure. Materials and Methods Children of nonsmoking African-American and Dominican women in New York City were followed from in utero to 9 years. Prenatal polycyclic aromatic hydrocarbon exposure was estimated by levels of polycyclic aromatic hydrocarbon- DNA adducts in maternal and cord blood collected at delivery. Postnatal exposure was estimated by the concentration of urinary polycyclic aromatic hydrocarbon metabolites at ages 3 or 5. Attention Deficit Hyperactivity Disorder behavior problems were assessed using the Child Behavior Checklist and the Conners Parent Rating Scale- Revised. Results High prenatal adduct exposure, measured by elevated maternal adducts was significantly associated with all Conners Parent Rating Scale-Revised subscales when the raw scores were analyzed continuously (N = 233). After dichotomizing at the threshold for moderately to markedly atypical symptoms, high maternal adducts were significantly associated with the Conners Parent Rating Scale-Revised DSM-IV Inattentive (OR = 5.06, 95% CI [1.43, 17.93]) and DSM-IV Total (OR = 3.37, 95% CI [1.10, 10.34]) subscales. High maternal adducts were positivity associated with the DSM-oriented Attention Deficit/Hyperactivity Problems scale on the Child Behavior Checklist, albeit not significant. In the smaller sample with cord adducts, the associations between outcomes and high cord adduct exposure were not statistically significant (N = 162). Conclusion The results suggest that exposure to polycyclic aromatic hydrocarbons encountered in New York City air may play a role in childhood Attention Deficit Hyperactivity Disorder behavior problems.
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Affiliation(s)
- Frederica P. Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- Columbia Center for Children's Environmental Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Hsin-wen Chang
- Columbia Center for Children's Environmental Health, Columbia University, New York, New York, United States of America
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Deliang Tang
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- Columbia Center for Children's Environmental Health, Columbia University, New York, New York, United States of America
| | - Emily L. Roen
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- Columbia Center for Children's Environmental Health, Columbia University, New York, New York, United States of America
| | - Julie Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- Columbia Center for Children's Environmental Health, Columbia University, New York, New York, United States of America
| | - Amy Margolis
- Columbia Center for Children's Environmental Health, Columbia University, New York, New York, United States of America
- Division of Child & Adolescent Psychiatry and the Center for Developmental Neuropsychiatry, Department of Psychiatry, the New York State Psychiatric Institute and the College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Tzu-Jung Huang
- Columbia Center for Children's Environmental Health, Columbia University, New York, New York, United States of America
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Rachel L. Miller
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- Columbia Center for Children's Environmental Health, Columbia University, New York, New York, United States of America
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Shuang Wang
- Columbia Center for Children's Environmental Health, Columbia University, New York, New York, United States of America
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Virginia Rauh
- Columbia Center for Children's Environmental Health, Columbia University, New York, New York, United States of America
- The Heilbrunn Department of Population and Family Health, Columbia University, New York, New York, United States of America
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Roen EL, Copeland GE, Pinagtore NL, Meza R, Soliman AS. Disparities of cancer incidence in Michigan's American Indians: spotlight on breast cancer. Cancer 2014; 120:1847-53. [PMID: 24676851 DOI: 10.1002/cncr.28589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/17/2013] [Accepted: 12/23/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND In American Indians (AIs), cancer is a leading cause of mortality, yet their disease burden is not fully understood due to unaddressed racial misclassification in cancer registries. This study describes cancer trends among AIs in Michigan, focusing on breast cancer, in a linked data set of Indian Health Service (IHS), tribal, and state cancer registry data adjusted for misclassification. METHODS AI status was based on reported race and linkage to IHS data and tribal registries. Data with complete linkage on all incident cancer cases in Michigan from 1995 to 2004 was used to calculate age-standardized incidence estimates for invasive all-site and female breast cancers stratified by racial group. For female breast cancers, stage- and age-specific incidence and percent distributions of early- versus late-stage cancers and age of diagnosis were calculated. RESULTS More than 50% of all AI cases were identified through IHS and/or tribal linkage. In the linked data, AIs had the lowest rates of all-sites and breast cancer. For breast cancers, AI women had a greater late-stage cancer burden and a younger mean age of diagnosis as compared to whites. Although the age-specific rate for whites was greater than for AI women in nearly all age groups, the difference in hazard ratio increased with increasing age. CONCLUSIONS Our state-specific information will help formulate effective, tailored cancer prevention strategies to this population in Michigan. The data linkages used in our study are crucial for generating accurate rates and can be effective in addressing misclassification of the AI population and formulating cancer prevention strategies for AI nationwide.
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Affiliation(s)
- Emily L Roen
- University of Michigan School of Public Health, Ann Arbor, Michigan
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Roen EL, Roubidoux MA, Joe AI, Russell TR, Soliman AS. Adherence to screening mammography among American Indian women of the Northern Plains. Breast Cancer Res Treat 2013; 139:897-905. [PMID: 23749344 PMCID: PMC3760373 DOI: 10.1007/s10549-013-2580-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 05/25/2013] [Indexed: 11/29/2022]
Abstract
Breast cancer is a burden for American Indian (AI) women who have younger age at diagnosis and higher stage of disease. Rural areas also have had less access to screening mammography. An Indian Health Service Mobile Women's Health Unit (MWHU) was implemented to improve mammogram screening of AI women in the Northern Plains. Our purpose was to determine the past adherence to screening mammography at a woman's first presentation to the MWHU for mammogram screening. Date of the most recent prior non-MWHU mammogram was obtained from mammography records. Adherence to screening guidelines was defined as the prior mammogram occurring 1-2 years before the first MWHU visit among women >41 years, and was the main outcome, whereas, age and clinic site were predictors. Adherence was compared with national data of the Breast Cancer Surveillance Consortium (BCSC). Among 1,771 women >41 years, adherence to screening mammography guidelines was 48.01 % among >65 years, 42.05 % among 50-64 years, 33.43 % among 41-49 years, and varied with clinic site (25.23-65.93 %). Age (p < 0.0001) and clinic site (p < 0.0001) were associated with adherence. Overall, adherence to screening mammography guidelines was found in 39.86 % (706/1771) of MWHU women versus 74.34 % (747,095/1,004,943) of BCSC women. The majority (60.14 %) of women at first presentation to the MWHU had not had mammograms in the previous 2 years, lower screening adherence than nationally (25.66 %). Adherence was lowest among women ages 41-49, and varied with clinic site. Findings suggest disparities in mammography screening among these women.
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Affiliation(s)
- Emily L. Roen
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
| | - Marilyn A. Roubidoux
- Division of Breast Imaging, Department of Radiology, University of Michigan Medical School, 2910H Taubman Center, SPC 5326, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Annette I. Joe
- Division of Breast Imaging, Department of Radiology, University of Michigan Medical School, 2910H Taubman Center, SPC 5326, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Tina R. Russell
- Midwest Division, Community Partnerships of South Dakota, American Cancer Society, Inc., Sioux Falls, SD, USA
| | - Amr S. Soliman
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE, USA
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