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Kim BF, Lupolt SN, Santo RE, Bachman G, Zhu X, Yang T, Fukagawa NK, Richardson ML, Green C, Phillips KM, Nachman KE. Nutrients and non-essential metals in darkibor kale grown at urban and rural farms: A pilot study. PLoS One 2024; 19:e0296840. [PMID: 38625852 PMCID: PMC11020932 DOI: 10.1371/journal.pone.0296840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/20/2023] [Indexed: 04/18/2024] Open
Abstract
Kale is a nutrient-dense leafy vegetable associated with wide-ranging health benefits. It is tolerant of drought and temperature fluctuations, and could thus serve an increasingly important role in providing a safe and nutritious food supply during the climate crisis, while kale's ease of cultivation and ability to be grown in a wide range of soils make it a good fit for urban agriculture. In this pilot study we explored potential differences between kale grown at urban versus rural farms. We planted kale seedlings (Darkibor variety) at three urban and four rural farms in and around Baltimore City, Maryland, instructed farmers to cultivate them using their usual growing practices, harvested the kale from fields and points of distribution, and analyzed it for concentrations of carotenoids, vitamins C and K1, ten nutritional elements, and eight non-essential metals. Although sample sizes for some analyses were in some cases too small to produce statistically significant results, we identified potentially meaningful differences in concentrations of several components between urban and rural kale samples. Compared to urban samples, mean concentrations of carotenoids and vitamins were 22-38% higher in rural field samples. By contrast, mean concentrations for eight nutritional elements were higher in urban field samples by as much as 413% for iron. Compared to rural field samples, mean concentrations of nine non-essential metals were higher in urban samples, although lead and cadmium concentrations for all samples were below public health guidelines. Some urban-rural differences were more pronounced than those identified in prior research. For six elements, variance within urban and rural farms was greater than variance between urban and rural farms, suggesting urbanicity may not be the primary driver of some observed differences. For some nutrients, mean concentrations were higher than upper ranges reported in prior estimates, suggesting kale may have the potential to be more nutrient-dense than previously estimated. The nutritive and metals composition of this important crop, and the factors that influence it, merit continued investigation given its growing popularity.
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Affiliation(s)
- Brent F. Kim
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sara N. Lupolt
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Raychel E. Santo
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Grace Bachman
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Xudong Zhu
- US Department of Agriculture, Food Quality Laboratory, Agricultural Research Service, Beltsville, Maryland, United States of America
| | - Tianbao Yang
- US Department of Agriculture, Food Quality Laboratory, Agricultural Research Service, Beltsville, Maryland, United States of America
| | - Naomi K. Fukagawa
- US Department of Agriculture, Beltsville Human Nutrition Research Center, Agricultural Research Service, Beltsville, Maryland, United States of America
| | - Matthew L. Richardson
- Center for Urban Research, Engagement and Scholarship, University of the District of Columbia, Washington, DC, United States of America
| | - Carrie Green
- US Department of Agriculture, Adaptive Cropping Systems Laboratory, Agricultural Research Service, Beltsville, Maryland, United States of America
| | - Katherine M. Phillips
- Department of Biochemistry, College of Agriculture and Life Sciences, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Keeve E. Nachman
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Chiger AA, Nachman KE. Invited Perspective: Advancing Cumulative Approaches in Regulatory Decision Making. Environ Health Perspect 2024; 132:31303. [PMID: 38445890 PMCID: PMC10916614 DOI: 10.1289/ehp14610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Andrea A. Chiger
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Keeve E. Nachman
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA
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Brueck CL, Xin X, Lupolt SN, Kim BF, Santo RE, Lyu Q, Williams AJ, Nachman KE, Prasse C. (Non)targeted Chemical Analysis and Risk Assessment of Organic Contaminants in Darkibor Kale Grown at Rural and Urban Farms. Environ Sci Technol 2024; 58:3690-3701. [PMID: 38350027 DOI: 10.1021/acs.est.3c09106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
This study investigated the presence and human hazards associated with pesticides and other anthropogenic chemicals identified in kale grown in urban and rural environments. Pesticides and related compounds (i.e., surfactants and metabolites) in kale samples were evaluated using a nontargeted data acquisition for targeted analysis method which utilized a pesticide mixture containing >1,000 compounds for suspect screening and quantification. We modeled population-level exposures and assessed noncancer hazards to DEET, piperonyl butoxide, prometon, secbumeton, terbumeton, and spinosyn A using nationally representative estimates of kale consumption across life stages in the US. Our findings indicate even sensitive populations (e.g., pregnant women and children) are not likely to experience hazards from these select compounds were they to consume kale from this study. However, a strictly nontargeted chemical analytical approach identified a total of 1,822 features across all samples, and principal component analysis revealed that the kale chemical composition may have been impacted by agricultural growing practices and environmental factors. Confidence level 2 compounds that were ≥5 times more abundant in the urban samples than in rural samples (p < 0.05) included chemicals categorized as "flavoring and nutrients" and "surfactants" in the EPA's Chemicals and Products Database. Using the US-EPA's Cheminformatics Hazard Module, we identified that many of the nontarget compounds have predicted toxicity scores of "very high" for several end points related to human health. These aspects would have been overlooked using traditional targeted analysis methods, although more information is needed to ascertain whether the compounds identified through nontargeted analysis are of environmental or human health concern. As such, our approach enabled the identification of potentially hazardous compounds that, based on their hazard assessment score, merit follow-up investigations.
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Affiliation(s)
- Christopher L Brueck
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland 21205, United States
| | - Xiaoyue Xin
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland 21205, United States
| | - Sara N Lupolt
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland 21205, United States
- Risk Sciences and Public Policy Institute, Johns Hopkins University, Baltimore, Maryland 21205, United States
- Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland 21202, United States
| | - Brent F Kim
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland 21205, United States
- Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland 21202, United States
| | - Raychel E Santo
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland 21205, United States
- Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland 21202, United States
| | - Qinfan Lyu
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland 21205, United States
| | - Antony J Williams
- Center for Computational Toxicology and Exposure, Office of Research and Development, U.S. Environmental Protection Agency, Washington, North Carolina 27711, United States
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland 21205, United States
- Risk Sciences and Public Policy Institute, Johns Hopkins University, Baltimore, Maryland 21205, United States
- Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland 21202, United States
| | - Carsten Prasse
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland 21205, United States
- Risk Sciences and Public Policy Institute, Johns Hopkins University, Baltimore, Maryland 21205, United States
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Stapleton GS, Innes GK, Nachman KE, Casey JA, Patton AN, Price LB, Tartof SY, Davis MF. Assessing the difference in contamination of retail meat with multidrug-resistant bacteria using for-consumer package label claims that indicate on-farm antibiotic use practices- United States, 2016-2019. J Expo Sci Environ Epidemiol 2024:10.1038/s41370-024-00649-y. [PMID: 38374423 DOI: 10.1038/s41370-024-00649-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Antibiotic use in food-producing animals can select for antibiotic resistance in bacteria that can be transmitted to people through contamination of food products during meat processing. Contamination resulting in foodborne illness contributes to adverse health outcomes. Some livestock producers have implemented antibiotic use reduction strategies marketed to consumers on regulated retail meat packaging labels ("label claims"). OBJECTIVE We investigated whether retail meat label claims were associated with isolation of multidrug-resistant organisms (MDROs, resistant to ≥3 classes of antibiotics) from U.S. meat samples. METHODS We utilized retail meat data from the U.S. Food and Drug Administration National Antimicrobial Resistance Monitoring System (NARMS) collected during 2016-2019 for bacterial contamination of chicken breast, ground turkey, ground beef, and pork chops. We used modified Poisson regression models to compare the prevalence of MDRO contamination among meat samples with any antibiotic restriction label claims versus those without such claims (i.e., conventionally produced). RESULTS In NARMS, 62,338 meat samples were evaluated for bacterial growth from 2016-2019. Of these, 24,446 (39%) samples had label claims that indicated antibiotic use was restricted during animal production. MDROs were isolated from 2252 (4%) meat samples, of which 71% (n = 1591) were conventionally produced, and 29% (n = 661) had antibiotic restriction label claims. Compared with conventional samples, meat with antibiotic restriction label claims had a statistically lower prevalence of MDROs (adjusted prevalence ratio: 0.66; 95% CI: 0.61, 0.73). This relationship was consistent for the outcome of any bacterial growth. IMPACT This repeated cross-sectional analysis of a nationally representative retail meat surveillance database in the United States supports that retail meats labeled with antibiotic restriction claims were less likely to be contaminated with MDROs compared with retail meat without such claims during 2016-2019. These findings indicate the potential for the public to become exposed to bacterial pathogens via retail meat and emphasizes a possibility that consumers could reduce their exposure to environmental reservoirs of foodborne pathogens that are resistant to antibiotics.
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Affiliation(s)
- G Sean Stapleton
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Gabriel K Innes
- Yuma Center for Excellence in Desert Agriculture, Yuma, AZ, USA
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joan A Casey
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
| | - Andrew N Patton
- Geospatial Analysis Lab, University of San Francisco, Harney Science Center, San Francisco, CA, USA
| | - Lance B Price
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Sara Y Tartof
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Meghan F Davis
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Molecular and Comparative Pathobiology & Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Quaade S, Casey JA, Nachman KE, Tartof SY, Ho DE. Limitations of Reporting Requirements under California's Livestock Antimicrobial Restriction Law. Environ Health Perspect 2024; 132:25001. [PMID: 38415616 PMCID: PMC10901107 DOI: 10.1289/ehp13702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Antimicrobial use in livestock production is considered a key contributor to growing antimicrobial resistance in bacteria. In 2015, California became the first state to enact restrictions on routine antimicrobial use in livestock production via Senate Bill 27 (SB27). SB27 further required the California Department of Food and Agriculture (CDFA) to collect and disseminate data on antimicrobial use in livestock production. OBJECTIVE The goal of this report is to assess whether CDFA's data release allows us to evaluate how antimicrobial use changed after the implementation of SB27. METHODS We combine the CDFA data with feed drug concentration ranges from the Code of Federal Regulation to evaluate the spread of plausible antimicrobial use trends. We also estimate antimicrobial consumption rates using data from the National Agricultural Statistical Service (NASS) and compare these to changes in medicated feed production reported by the CDFA. DISCUSSION We show that CDFA's reported data are insufficient to reliably estimate whether antimicrobial usage has increased or decreased, most notably because no information is provided about the mass of antimicrobials approved for use or medicated feed drug concentrations. After incorporating additional external data on feed drug concentrations, one can at best provide uninformative bounds on the effect of SB27. We find some evidence that antimicrobial use has decreased by incorporating data on national sales of antimicrobials for food-producing animals, but the weakness of this inference underlines the need for improved data collection and dissemination, especially as other states seek to implement similar policies. We provide recommendations on how to improve reporting and data collection under SB27. https://doi.org/10.1289/EHP13702.
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Affiliation(s)
- Sebastian Quaade
- Stanford Law School, Stanford University, Stanford, California, USA
| | - Joan A Casey
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Keeve E Nachman
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Center for a Livable Future, Baltimore, Maryland, USA
- Johns Hopkins Risk Sciences and Public Policy Institute, Baltimore, Maryland, USA
| | - Sara Y Tartof
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Daniel E Ho
- Stanford Law School, Stanford University, Stanford, California, USA
- Department of Computer Science, Stanford University, Stanford, California, USA
- Department of Political Science, Stanford University, Stanford, California, USA
- Stanford Institute for Human-Centered Artificial Intelligence, Stanford University, Stanford, California, USA
- Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
- Regulation, Evaluation, and Governance Lab, Stanford University, Stanford, California, USA
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Innes GK, Patton AN, Nachman KE, Casey JA, Stapleton GS, Abraham AG, Price LB, Tartof SY, Davis MF. Distance and destination of retail meat alter multidrug resistant contamination in the United States food system. Sci Rep 2023; 13:21024. [PMID: 38030674 PMCID: PMC10687246 DOI: 10.1038/s41598-023-48197-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023] Open
Abstract
Antibiotic-resistant infections are a global concern, especially those caused by multidrug-resistant (MDR) bacteria, defined as those resistant to more than three drug classes. The animal agriculture industry contributes to the antimicrobial resistant foodborne illness burden via contaminated retail meat. In the United States, retail meat is shipped across the country. Therefore, understanding geospatial factors that influence MDR bacterial contamination is vital to protect consumers and inform interventions. Using data available from the United States Food and Drug Administration's National Antimicrobial Resistance Monitoring System (NARMS), we describe retail meat shipping distances using processor and retailer locations and investigated this distance as a risk factor for MDR bacteria meat contamination using log-binomial regression. Meat samples collected during 2012-2014 totaled 11,243, of which 4791 (42.61%) were contaminated with bacteria and 835 (17.43%) of those bacteria were MDR. All examined geospatial factors were associated with MDR bacteria meat contamination. After adjustment for year and meat type, we found higher prevalence of MDR contamination among meat processed in the south (relative adjusted prevalence ratio [aPR] 1.35; 95% CI 1.06-1.73 when compared to the next-highest region), sold in Maryland (aPR 1.12; 95% CI 0.95-1.32 when compared to the next-highest state), and shipped from 194 to 469 miles (aPR 1.59; 95% CI 1.31-1.94 when compared to meats that traveled < 194 miles). However, sensitivity analyses revealed that New York sold the meat with the highest prevalence of MDR Salmonella contamination (4.84%). In this secondary analysis of NARMS data, both geographic location where products were sold and the shipping distance were associated with microbial contamination on retail meat.
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Affiliation(s)
- Gabriel K Innes
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Yuma Center for Excellence in Desert Agriculture, Yuma, AZ, USA.
| | - Andrew N Patton
- University of San Francisco Geospatial Analysis Lab, San Francisco, CA, USA
| | - Keeve E Nachman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joan A Casey
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - G Sean Stapleton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alison G Abraham
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Ophthalmology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Lance B Price
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Sara Y Tartof
- Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Meghan F Davis
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Tehrani MW, Fortner EC, Robinson ES, Chiger AA, Sheu R, Werden BS, Gigot C, Yacovitch T, Van Bramer S, Burke T, Koehler K, Nachman KE, Rule AM, DeCarlo PF. Characterizing metals in particulate pollution in communities at the fenceline of heavy industry: combining mobile monitoring and size-resolved filter measurements. Environ Sci Process Impacts 2023; 25:1491-1504. [PMID: 37584085 PMCID: PMC10510330 DOI: 10.1039/d3em00142c] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
Exposures to metals from industrial emissions can pose important health risks. The Chester-Trainer-Marcus Hook area of southeastern Pennsylvania is home to multiple petrochemical plants, a refinery, and a waste incinerator, most abutting socio-economically disadvantaged residential communities. Existing information on fenceline community exposures is based on monitoring data with low temporal and spatial resolution and EPA models that incorporate industry self-reporting. During a 3 week sampling campaign in September 2021, size-resolved particulate matter (PM) metals concentrations were obtained at a fixed site in Chester and on-line mobile aerosol measurements were conducted around Chester-Trainer-Marcus Hook. Fixed-site arsenic, lead, antimony, cobalt, and manganese concentrations in total PM were higher (p < 0.001) than EPA model estimates, and arsenic, lead, and cadmium were predominantly observed in fine PM (<2.5 μm), the PM fraction which can penetrate deeply into the lungs. Hazard index analysis suggests adverse effects are not expected from exposures at the observed levels; however, additional chemical exposures, PM size fraction, and non-chemical stressors should be considered in future studies for accurate assessment of risk. Fixed-site MOUDI and nearby mobile aerosol measurements were moderately correlated (r ≥ 0.5) for aluminum, potassium and selenium. Source apportionment analyses suggested the presence of four major emissions sources (sea salt, mineral dust, general combustion, and non-exhaust vehicle emissions) in the study area. Elevated levels of combustion-related elements of health concern (e.g., arsenic, cadmium, antimony, and vanadium) were observed near the waste incinerator and other industrial facilities by mobile monitoring, as well as in residential-zoned areas in Chester. These results suggest potential co-exposures to harmful atmospheric metal/metalloids in communities surrounding the Chester-Trainer-Marcus Hook industrial area at levels that may exceed previous estimates from EPA modeling.
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Affiliation(s)
- Mina W Tehrani
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Ellis S Robinson
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea A Chiger
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Roger Sheu
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Carolyn Gigot
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Thomas Burke
- Risk Sciences and Public Policy Institute, Johns Hopkins University, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Peter F DeCarlo
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins University, Baltimore, MD, USA
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Ku JH, Bruxvoort KJ, Salas SB, Varley CD, Casey JA, Raphael E, Robinson SC, Nachman KE, Lewin BJ, Contreras R, Wei RX, Pomichowski ME, Takhar HS, Tartof SY. Multidrug Resistance of Escherichia coli From Outpatient Uncomplicated Urinary Tract Infections in a Large United States Integrated Healthcare Organization. Open Forum Infect Dis 2023; 10:ofad287. [PMID: 37426945 PMCID: PMC10326677 DOI: 10.1093/ofid/ofad287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/19/2023] [Indexed: 07/11/2023] Open
Abstract
Background Urinary tract infections (UTIs) cause significant disease and economic burden. Uncomplicated UTIs (uUTIs) occur in otherwise healthy individuals without underlying structural abnormalities, with uropathogenic Escherichia coli (UPEC) accounting for 80% of cases. With recent transitions in healthcare toward virtual visits, data on multidrug resistance (MDR) (resistant to ≥3 antibiotic classes) by care setting are needed to inform empiric treatment decision making. Methods We evaluated UPEC resistance over time by care setting (in-person vs virtual), in adults who received outpatient care for uUTI at Kaiser Permanente Southern California between January 2016 and December 2021. Results We included 174 185 individuals who had ≥1 UPEC uUTI (233 974 isolates) (92% female, 46% Hispanic, mean age 52 years [standard deviation 20]). Overall, prevalence of UPEC MDR decreased during the study period (13% to 12%) both in virtual and in-person settings (P for trend <.001). Resistance to penicillins overall (29%), coresistance to penicillins and trimethoprim-sulfamethoxazole (TMP-SMX) (12%), and MDR involving the 2 plus ≥1 antibiotic class were common (10%). Resistance to 1, 2, 3, and 4 antibiotic classes was found in 19%, 18%, 8%, and 4% of isolates, respectively; 1% were resistant to ≥5 antibiotic classes, and 50% were resistant to none. Similar resistance patterns were observed over time and by care setting. Conclusions We observed a slight decrease in both class-specific antimicrobial resistance and MDR of UPEC overall, most commonly involving penicillins and TMP-SMX. Resistance patterns were consistent over time and similar in both in-person and virtual settings. Virtual healthcare may expand access to UTI care.
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Affiliation(s)
- Jennifer H Ku
- Correspondence: Jennifer H. Ku, PhD, MPH, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101 ()
| | - Katia J Bruxvoort
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - S Bianca Salas
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Cara D Varley
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Oregon Health & Science University-Portland State University, School of Public Health, Portland, Oregon, USA
| | - Joan A Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Eva Raphael
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sarah C Robinson
- Center for Health Systems Research, Sutter Health, Walnut Creek, California, USA
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bruno J Lewin
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Kaiser Permanente Southern California and Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Richard Contreras
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Rong X Wei
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Magdalena E Pomichowski
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Harpreet S Takhar
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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9
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Lupolt SN, Newmeyer MN, Lyu Q, Prasse C, Nachman KE. Optimization of a method for collecting infant and toddler urine for non-target analysis using cotton pads and commercially available disposable diapers. J Expo Sci Environ Epidemiol 2023:10.1038/s41370-023-00553-x. [PMID: 37149702 DOI: 10.1038/s41370-023-00553-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Urine is an abundant and useful medium for measuring biomarkers related to chemical exposures in infants and children. Identification of novel biomarkers is greatly enhanced with non-targeted analysis (NTA), a powerful methodology for broad chemical analysis of environmental and biological specimens. However, collecting urine in non-toilet trained children presents many challenges, and contamination from specimen collection can impact NTA results. OBJECTIVES We optimized a caregiver-driven method for collecting urine from infants and children using cotton pads and commercially available disposable diapers for NTA and demonstrate its applicability to various children biomonitoring studies. METHODS Experiments were first performed to evaluate the effects of processing method (i.e., centrifuge vs. syringe), storage temperature, and diaper brand on recovery of urine absorbed to cotton pads. Caregivers of 11 children (<2 years) used and retained diapers (with cotton pads) to collect their child's urine for 24 h. Specimens were analyzed via a NTA method implementing an exclusion list of ions related to contamination from collection materials. RESULTS Centrifuging cotton pads through a small-pore membrane, compared to a manual syringe method, and storing diapers at 4 °C, compared to room temperature, resulted in larger volumes of recovered sample. This method was successfully implemented to recover urine from cotton pads collected in the field; between 5-9 diapers were collected per child in 24 h, and the total mean volume of urine recovered was 44.7 (range 26.7-71.1) mL. NTA yielded a list of compounds present in urine and/or stool that may hold promise as biomarkers of chemical exposures from a variety of sources. IMPACT STATEMENT Infant and children urine is a valuable matrix for studies of the early life exposome, in that numerous biological markers of exposure and outcome can be derived from a single analysis. Depending on the nature of the exposure study, it may be the case that a simple collection method that can be facilitated by caregivers of young children is desirable, especially when time-integrated samples or large volumes of urine are needed. We describe the process for development and results of an optimized method for urine collection and analysis using commercially available diapers and non-target analysis.
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Affiliation(s)
- Sara N Lupolt
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew N Newmeyer
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Qinfan Lyu
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carsten Prasse
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Keeve E Nachman
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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10
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Casey JA, Tartof SY, Davis MF, Nachman KE, Price L, Liu C, Yu K, Gupta V, Innes GK, Tseng HF, Do V, Pressman AR, Rudolph KE. Impact of a Statewide Livestock Antibiotic Use Policy on Resistance in Human Urine Escherichia coli Isolates: A Synthetic Control Analysis. Environ Health Perspect 2023; 131:27007. [PMID: 36821707 PMCID: PMC9945560 DOI: 10.1289/ehp11221] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND On 1 January 2018, California implemented Senate Bill 27 (SB27), banning, for the first time in the United States, routine preventive use of antibiotics in food-animal production and any antibiotic use without a veterinarian's prescription. OBJECTIVES Our objective was to assess whether SB27 was associated with decreased antimicrobial resistance among E. coli isolated from human urine. METHODS We used U.S. nationwide monthly state-level data from BD Insights Research Database (Becton, Dickinson, and Co.) spanning 1 January 2013 to 30 June 2021 on antibiotic-resistance patterns of 30-d nonduplicate E. coli isolated from urine. Tested antibiotic classes included aminoglycosides, extended-spectrum cephalosporins (ESC), fluoroquinolones, and tetracyclines. Counts of tested and not-susceptible (resistant and intermediate, hereafter resistant) urine isolates were available by sex, age group (<65, 65+ year), month, and state. We applied a synthetic control approach to estimate the causal effect of SB27 on resistance patterns. Our approach created a synthetic California based on a composite of other states without the policy change and contrasted its counterfactual postpolicy trends with the observed postpolicy trends in California. FINDINGS We included 7.1 million E. coli urine isolates, 90% among women, across 33 states. From 2013 to 2017, the median (interquartile range) resistance percentages in California were 11.9% (7.4, 17.6), 13.8% (5.8, 20.0), 24.6% (9.6, 36.4), 7.9% (2.1, 13.1), for aminoglycosides, ESC, fluoroquinolones, and tetracyclines, respectively. SB27 was associated with a 7.1% reduction in ESC resistance (p-value for joint null: <0.01), but no change in resistance to aminoglycosides, fluoroquinolones, or tetracyclines. DISCUSSION Further research is needed to determine the role of SB27 in the observed reduction in ESC resistance E. coli in human populations, particularly as additional states implement similar legislation. https://doi.org/10.1289/EHP11221.
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Affiliation(s)
- Joan A. Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Sara Y. Tartof
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Meghan F. Davis
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Molecular and Comparative Pathobiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Keeve E. Nachman
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lance Price
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Cindy Liu
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Kalvin Yu
- Medical and Scientific Affairs, Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Vikas Gupta
- Medical and Scientific Affairs, Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Gabriel K. Innes
- Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, Yuma, Arizona, USA
| | - Hung Fu Tseng
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Vivian Do
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Alice R. Pressman
- Center for Health Systems Research, Sutter Health, Walnut Creek, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Kara E. Rudolph
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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11
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Maffini MV, Rayasam SDG, Axelrad DA, Birnbaum LS, Cooper C, Franjevic S, MacRoy PM, Nachman KE, Patisaul HB, Rodgers KM, Rossi MS, Schettler T, Solomon GM, Woodruff TJ. Advancing the science on chemical classes. Environ Health 2023; 21:120. [PMID: 36635752 PMCID: PMC9835214 DOI: 10.1186/s12940-022-00919-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Hazard identification, risk assessment, regulatory, and policy activity are usually conducted on a chemical-by-chemical basis. Grouping chemicals into categories or classes is an underutilized approach that could make risk assessment and management of chemicals more efficient for regulators. OBJECTIVE AND METHODS While there are some available methods and regulatory frameworks that include the grouping of chemicals (e.g.,same molecular mechanism or similar chemical structure) there has not been a comprehensive evaluation of these different approaches nor a recommended course of action to better consider chemical classes in decision-making. This manuscript: 1) reviews current national and international approaches to grouping; 2) describes how groups could be defined based on the decision context (e.g., hazard/risk assessment, restrictions, prioritization, product development) and scientific considerations (e.g., intrinsic physical-chemical properties); 3) discusses advantages of developing a decision tree approach for grouping; 4) uses ortho-phthalates as a case study to identify and organize frameworks that could be used across agencies; and 5) discusses opportunities to advance the class concept within various regulatory decision-making scenarios. RESULTS Structural similarity was the most common grouping approach for risk assessment among regulatory agencies (national and state level) and non-regulatory organizations, albeit with some variations in its definition. Toxicity to the same target organ or to the same biological function was also used in a few cases. The phthalates case study showed that a decision tree approach for grouping should include questions about uses regulated by other agencies to encourage more efficient, coherent, and protective chemical risk management. DISCUSSION AND CONCLUSION Our evaluation of how classes of chemicals are defined and used identified commonalities and differences based on regulatory frameworks, risk assessments, and business strategies. We also identified that using a class-based approach could result in a more efficient process to reduce exposures to multiple hazardous chemicals and, ultimately, reduce health risks. We concluded that, in the absence of a prescribed method, a decision tree approach could facilitate the selection of chemicals belonging to a pre-defined class (e.g., chemicals with endocrine-disrupting activity; organohalogen flame retardants [OFR]) based on the decision-making context (e.g., regulatory risk management).
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Affiliation(s)
| | - Swati D G Rayasam
- Department of Obstetrics, Program on Reproductive Health and the Environment, Gynecology and Reproductive Sciences, University of California, Box 0132, 490 Illinois Street, Floor 10, San Francisco, CA, 94143, USA
| | | | - Linda S Birnbaum
- Scientist Emeritus and Former Director, National Institutes of Environmental Health Sciences and National Toxicology Program, Research Triangle Park, NC, USA
- Scholar in Residence, Duke University, Durham, NC, USA
| | - Courtney Cooper
- Department of Obstetrics, Program on Reproductive Health and the Environment, Gynecology and Reproductive Sciences, University of California, Box 0132, 490 Illinois Street, Floor 10, San Francisco, CA, 94143, USA
| | | | | | - Keeve E Nachman
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Risk Sciences and Public Policy Institute Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Heather B Patisaul
- Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
| | | | | | - Ted Schettler
- Science and Environmental Health Network, Ames, Iowa, USA
| | - Gina M Solomon
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Public Health Institute, Oakland, CA, USA
| | - Tracey J Woodruff
- Department of Obstetrics, Program on Reproductive Health and the Environment, Gynecology and Reproductive Sciences, University of California, Box 0132, 490 Illinois Street, Floor 10, San Francisco, CA, 94143, USA
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12
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Woodruff TJ, Rayasam SDG, Axelrad DA, Koman PD, Chartres N, Bennett DH, Birnbaum LS, Brown P, Carignan CC, Cooper C, Cranor CF, Diamond ML, Franjevic S, Gartner EC, Hattis D, Hauser R, Heiger-Bernays W, Joglekar R, Lam J, Levy JI, MacRoy PM, Maffini MV, Marquez EC, Morello-Frosch R, Nachman KE, Nielsen GH, Oksas C, Abrahamsson DP, Patisaul HB, Patton S, Robinson JF, Rodgers KM, Rossi MS, Rudel RA, Sass JB, Sathyanarayana S, Schettler T, Shaffer RM, Shamasunder B, Shepard PM, Shrader-Frechette K, Solomon GM, Subra WA, Vandenberg LN, Varshavsky JR, White RF, Zarker K, Zeise L. A science-based agenda for health-protective chemical assessments and decisions: overview and consensus statement. Environ Health 2023; 21:132. [PMID: 36635734 PMCID: PMC9835243 DOI: 10.1186/s12940-022-00930-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 06/17/2023]
Abstract
The manufacture and production of industrial chemicals continues to increase, with hundreds of thousands of chemicals and chemical mixtures used worldwide, leading to widespread population exposures and resultant health impacts. Low-wealth communities and communities of color often bear disproportionate burdens of exposure and impact; all compounded by regulatory delays to the detriment of public health. Multiple authoritative bodies and scientific consensus groups have called for actions to prevent harmful exposures via improved policy approaches. We worked across multiple disciplines to develop consensus recommendations for health-protective, scientific approaches to reduce harmful chemical exposures, which can be applied to current US policies governing industrial chemicals and environmental pollutants. This consensus identifies five principles and scientific recommendations for improving how agencies like the US Environmental Protection Agency (EPA) approach and conduct hazard and risk assessment and risk management analyses: (1) the financial burden of data generation for any given chemical on (or to be introduced to) the market should be on the chemical producers that benefit from their production and use; (2) lack of data does not equate to lack of hazard, exposure, or risk; (3) populations at greater risk, including those that are more susceptible or more highly exposed, must be better identified and protected to account for their real-world risks; (4) hazard and risk assessments should not assume existence of a "safe" or "no-risk" level of chemical exposure in the diverse general population; and (5) hazard and risk assessments must evaluate and account for financial conflicts of interest in the body of evidence. While many of these recommendations focus specifically on the EPA, they are general principles for environmental health that could be adopted by any agency or entity engaged in exposure, hazard, and risk assessment. We also detail recommendations for four priority areas in companion papers (exposure assessment methods, human variability assessment, methods for quantifying non-cancer health outcomes, and a framework for defining chemical classes). These recommendations constitute key steps for improved evidence-based environmental health decision-making and public health protection.
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Affiliation(s)
- Tracey J Woodruff
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 490 Illinois Street, Floor 10, Box 0132, San Francisco, CA, 94143, USA.
| | - Swati D G Rayasam
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 490 Illinois Street, Floor 10, Box 0132, San Francisco, CA, 94143, USA
| | | | - Patricia D Koman
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Chartres
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 490 Illinois Street, Floor 10, Box 0132, San Francisco, CA, 94143, USA
| | - Deborah H Bennett
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Linda S Birnbaum
- National Institutes of Environmental Health Sciences and National Toxicology Program, Research Triangle Park, NC, USA
- Duke University, Durham, NC, USA
| | - Phil Brown
- Social Science Environmental Health Research Institute, Northeastern University, Boston, MA, USA
| | - Courtney C Carignan
- Department of Food Science and Human Nutrition, Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI, USA
| | - Courtney Cooper
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 490 Illinois Street, Floor 10, Box 0132, San Francisco, CA, 94143, USA
| | - Carl F Cranor
- Department of Philosophy, University of California, Riverside, Riverside, CA, USA
- Environmental Toxicology Graduate Program, College of Natural and Agricultural Sciences, University of California, Riverside, Riverside, CA, USA
| | - Miriam L Diamond
- Department of Earth Sciences, University of Toronto, Toronto, ON, Canada
- School of the Environment, University of Toronto, Toronto, ON, Canada
| | | | | | - Dale Hattis
- The George Perkins Marsh Institute, Clark University, Worcester, MA, USA
| | - Russ Hauser
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Wendy Heiger-Bernays
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | | | - Juleen Lam
- Department of Public Health, California State University, East Bay, Hayward, CA, USA
| | - Jonathan I Levy
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | | | | | | | - Rachel Morello-Frosch
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Department of Environmental Science, Policy and Management, University of California, Berkeley, Berkeley, CA, USA
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Greylin H Nielsen
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Catherine Oksas
- School of Medicine, University of California, San Francisco, CA, USA
| | - Dimitri Panagopoulos Abrahamsson
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 490 Illinois Street, Floor 10, Box 0132, San Francisco, CA, 94143, USA
| | - Heather B Patisaul
- Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
| | | | - Joshua F Robinson
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 490 Illinois Street, Floor 10, Box 0132, San Francisco, CA, 94143, USA
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Department of Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Ted Schettler
- Science and Environmental Health Network, Ames, IA, USA
| | - Rachel M Shaffer
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, USA
| | - Bhavna Shamasunder
- Department of Urban & Environmental Policy and Public Health, Occidental College, Los Angeles, CA, USA
| | | | - Kristin Shrader-Frechette
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA
- Department of Philosophy, University of Notre Dame, Notre Dame, IN, USA
| | - Gina M Solomon
- School of Medicine, University of California, San Francisco, CA, USA
- Public Health Institute, Oakland, CA, USA
| | - Wilma A Subra
- Louisiana Environmental Action Network, Baton Rouge, LA, USA
| | - Laura N Vandenberg
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts, Amherst, Amherst, MA, USA
| | - Julia R Varshavsky
- Department of Health Sciences, Northeastern University, Boston, MA, USA
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, USA
| | - Roberta F White
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Ken Zarker
- Washington State Department of Ecology, Olympia, WA, USA
| | - Lauren Zeise
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
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Lupolt SN, Agnew J, Ramachandran G, Burke TA, Kennedy RD, Nachman KE. A qualitative characterization of meso-activity factors to estimate soil exposure for agricultural workers. J Expo Sci Environ Epidemiol 2023; 33:140-154. [PMID: 36253407 PMCID: PMC9849121 DOI: 10.1038/s41370-022-00484-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Agricultural workers' exposure to soil contaminants is not well characterized. Activity pattern data are a useful exposure assessment tool to estimate extent of soil contact, though existing data do not sufficiently capture the range and magnitude of soil contact in the agricultural context. OBJECTIVE We introduce meso-activity, or specific tasks, to improve traditional activity pattern methodology. We propose a conceptual framework to organize the factors that may modify soil exposure and impact soil contact estimates within each meso-activity in agriculture. We build upon models from the US EPA to demonstrate an application of this framework to dose estimation. METHODS We conducted in-depth interviews with sixteen fruit and vegetable growers in Maryland to characterize factors that influence soil exposure in agriculture. For illustrative purposes, we demonstrate the application of the framework to translate our qualitative data into quantitative estimates of soil contact using US EPA models for ingestion and dermal exposure. RESULTS Growers discussed six tasks, or meso-activities, involving interaction with soil and described ten factors that may impact the frequency, duration and intensity of soil contact. We organized these factors into four categories (i.e., Environmental, Activity, Timing and Receptor; EAT-R) and developed a framework to improve agricultural exposure estimation and guide future research. Using information from the interviews, we estimated average daily doses for several agricultural exposure scenarios. We demonstrated how the integration of EAT-R qualitative factors into quantitative tools for exposure assessment produce more rigorous estimates of exposure that better capture the true variability in agricultural work. SIGNIFICANCE Our study demonstrates how a meso-activity-centered framework can be used to refine estimates of exposure for agricultural workers. This framework will support the improvement of indirect exposure assessment tools (e.g., surveys and questionnaires) and inform more comprehensive and appropriate direct observation approaches to derive quantitative estimations of soil exposure. IMPACT STATEMENT We propose a novel classification of activity pattern data that links macro and micro-activities through the quantification and characterization of meso-activities and demonstrate how the application of our qualitative framework improves soil exposure estimation for agricultural workers. These methodological advances may inform a more rigorous approach to the evaluation of pesticide and other chemical and biological exposures incurred by persons engaged in the cultivation of agricultural commodities in soil.
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Affiliation(s)
- Sara N Lupolt
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jacqueline Agnew
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gurumurthy Ramachandran
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas A Burke
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ryan David Kennedy
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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14
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Lupolt SN, Santo RE, Kim BF, Burke TA, Nachman KE. Urban Soil Safety Policies: The Next Frontier for Mitigating Lead Exposures and Promoting Sustainable Food Production. Geohealth 2022; 6:e2022GH000615. [PMID: 36176572 PMCID: PMC9473349 DOI: 10.1029/2022gh000615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/03/2022] [Revised: 08/16/2022] [Indexed: 06/16/2023]
Abstract
Urban soils bear the persistent legacy of leaded gasoline and past industrial practices. Soil safety policies (SSPs) are an important public health tool with the potential to inform, identify, and mitigate potential health risks faced by urban growers, but little is known about how these policies may protect growers from exposures to lead and other soil contaminants. We reviewed and evaluated 43 urban agriculture (UA) policies in 40 US cities pertaining to soil safety. About half of these cities had a least one SSP that offered recommendations or provided services for soil testing. Eight cities had at least one SSP containing a requirement pertaining to any topic (e.g., soil testing, a specific best practice for growing). We found notable inconsistencies across SSPs for "acceptable" levels of lead in soils and the activities and behaviors recommended at each level. We specify research needed to inform revisions to US Environmental Protection Agency guidance for lead in soils specific to UA. We conclude with a series of recommendations to guide the development or revision of SSPs.
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Affiliation(s)
- Sara N. Lupolt
- Department of Environmental Health and EngineeringJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Center for a Livable FutureJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Risk Sciences and Public Policy InstituteJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Raychel E. Santo
- Department of Environmental Health and EngineeringJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Center for a Livable FutureJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Brent F. Kim
- Department of Environmental Health and EngineeringJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Center for a Livable FutureJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Thomas A. Burke
- Risk Sciences and Public Policy InstituteJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Keeve E. Nachman
- Department of Environmental Health and EngineeringJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Center for a Livable FutureJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Risk Sciences and Public Policy InstituteJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
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Wallinga D, Smit LAM, Davis MF, Casey JA, Nachman KE. A Review of the Effectiveness of Current US Policies on Antimicrobial Use in Meat and Poultry Production. Curr Environ Health Rep 2022; 9:339-354. [PMID: 35477845 PMCID: PMC9090690 DOI: 10.1007/s40572-022-00351-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Industrial food animal production accounts for most animal-source protein consumed in the USA. These operations rely on an array of external inputs, which can include antimicrobials of medical importance. The use of these drugs in this context has been the subject of public health debate for decades because their widespread use contributes to the selection for and proliferation of drug-resistant bacteria and their genetic determinants. Here, we describe legislative and regulatory efforts, at different levels of governance in the USA, to curtail food animal consumption of medically important antimicrobials. RECENT FINDINGS The features and relative success of the US efforts are examined alongside those of selected member states (Denmark and the Netherlands) of the European Union. Evaluation of efforts at all levels of US governance was complicated by shortcomings in prescribed data collection; nevertheless, available information suggests deficiencies in policy implementation and enforcement compromise the effectiveness of interventions pursued to date. The political will, robust systems for collecting and integrating data on antimicrobial consumption and use, and cross-sectoral collaboration that have been integral to the success of efforts in Denmark and The Netherlands have been notably absent in the USA, especially at the federal level.
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Affiliation(s)
- David Wallinga
- Natural Resources Defense Council, San Francisco, CA, 94104, USA
| | - Lidwien A M Smit
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Meghan F Davis
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room W-7007, Baltimore, MD, 21205, USA
- Department of Molecular and Comparative Pathobiology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Joan A Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, 10034, USA
| | - Keeve E Nachman
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room W-7007, Baltimore, MD, 21205, USA.
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21202, USA.
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
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16
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Lupolt SN, Agnew J, Burke TA, Kennedy RD, Nachman KE. Key considerations for assessing soil ingestion exposures among agricultural workers. J Expo Sci Environ Epidemiol 2022; 32:481-492. [PMID: 34079062 PMCID: PMC8170865 DOI: 10.1038/s41370-021-00339-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND Soil ingestion is a critical, yet poorly characterized route of exposure to contaminants, particularly for agricultural workers who have frequent, direct contact with soil. OBJECTIVE This qualitative investigation aims to identify and characterize key considerations for translating agricultural workers' soil ingestion experiences into recommendations to improve traditional exposure science tools for estimating soil ingestion. METHODS We conducted qualitative in-depth interviews with 16 fruit and vegetable growers in Maryland to characterize their behaviors and concerns regarding soil contact in order to characterize the nature of soil ingestion in the agricultural context. RESULTS We identified and discussed four emergent themes: (1) variability in growers' descriptions of soil and dust, (2) variability in growers' soil contact, (3) growers' concerns regarding soil contact, (4) growers' practices to modify soil contact. We also identified environmental and behavioral factors and six specific agricultural tasks that may impact soil ingestion rates. SIGNIFICANCE Our investigation fills an important gap in occupational exposure science methodology by providing four key considerations that should be integrated into indirect measurement tools for estimating soil ingestion rates in the agricultural context. Specifically, a task-based framework may provide a structure for future investigations of soil contact that may be useful in other populations.
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Affiliation(s)
- Sara N Lupolt
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jacqueline Agnew
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas A Burke
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ryan David Kennedy
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keeve E Nachman
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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McPartland J, Shaffer RM, Fox MA, Nachman KE, Burke TA, Denison RA. Charting a Path Forward: Assessing the Science of Chemical Risk Evaluations under the Toxic Substances Control Act in the Context of Recent National Academies Recommendations. Environ Health Perspect 2022; 130:25003. [PMID: 35195451 PMCID: PMC8865089 DOI: 10.1289/ehp9649] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND In 2016, Congress enacted the Frank R. Lautenberg Chemical Safety for the 21st Century Act ("the Lautenberg Act"), which made major revisions to the main U.S. chemical safety law, the 1976 Toxic Substances Control Act (TSCA). Among other reforms, the Lautenberg Act mandates that the U.S. Environmental Protection Agency (U.S. EPA) conduct comprehensive risk evaluations of chemicals in commerce. The U.S. EPA recently finalized the first set of such chemical risk evaluations. OBJECTIVES We examine the first 10 TSCA risk evaluations in relation to risk science recommendations from the National Academies to determine consistency with these recommendations and to identify opportunities to improve future TSCA risk evaluations by further implementing these key approaches and methods. DISCUSSION Our review of the first set of TSCA risk evaluations identified substantial deviations from best practices in risk assessment, including overly narrow problem formulations and scopes; insufficient characterization of uncertainty in the evidence; inadequate consideration of population variability; lack of consideration of background exposures, combined exposures, and cumulative risk; divergent approaches to dose-response assessment for carcinogens and noncarcinogens; and a flawed approach to systematic review. We believe these deviations result in underestimation of population exposures and health risks. We are hopeful that the agency can use these insights and have provided suggestions to produce chemical risk evaluations aligned with the intent and requirements of the Lautenberg Act and the best available science to better protect health and the environment-including the health of those most vulnerable to chemical exposures. https://doi.org/10.1289/EHP9649.
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Affiliation(s)
| | - Rachel M. Shaffer
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Mary A. Fox
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keeve E. Nachman
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thomas A. Burke
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Innes GK, Markos A, Dalton KR, Gould CA, Nachman KE, Fanzo J, Barnhill A, Frattaroli S, Davis MF. How animal agriculture stakeholders define, perceive, and are impacted by antimicrobial resistance: challenging the Wellcome Trust's Reframing Resistance principles. Agric Human Values 2021; 38:893-909. [PMID: 34776605 PMCID: PMC8588841 DOI: 10.1007/s10460-021-10197-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 05/22/2023]
Abstract
Humans, animals, and the environment face a universal crisis: antimicrobial resistance (AR). Addressing AR and its multi-disciplinary causes across many sectors including in human and veterinary medicine remains underdeveloped. One barrier to AR efforts is an inconsistent process to incorporate the plenitude of stakeholders about what AR is and how to stifle its development and spread-especially stakeholders from the animal agriculture sector, one of the largest purchasers of antimicrobial drugs. In 2019, The Wellcome Trust released Reframing Resistance: How to communicate about antimicrobial resistance effectively (Reframing Resistance), which proposed the need to establish a consistent and harmonized messaging effort that describes the AR crisis and its global implications for health and wellbeing across all stakeholders. Yet, Reframing Resistance does not specifically engage the animal agriculture community. This study investigates the gap between two principles recommended by Reframing Resistance and animal agriculture stakeholders. For this analysis, the research group conducted 31 semi-structured interviews with a diverse group of United States animal agriculture stakeholders. Participants reported attitudes, beliefs, and practices about a variety of issues, including how they defined AR and what entities the AR crisis impacts most. Exploration of Reframing Resistance's Principle 2, "explain the fundamentals succinctly" and Principle 3, "emphasis that this is universal issue; it can affect anyone, including you" reveals disagreement in both the fundamentals of AR and consensus of "who" the AR crisis impacts. Principle 2 may do better to acknowledge that animal agriculture stakeholders espouse a complex array of perspectives that cannot be summed up in a single perspective or principle. As a primary tool to combat AR, behavior change must be accomplished first through outreach to stakeholder groups and understanding their perspectives.
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Affiliation(s)
- Gabriel K. Innes
- Environmental Health and Engineering, John Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Agnes Markos
- Environmental Health and Engineering, John Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Kathryn R. Dalton
- Environmental Health and Engineering, John Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Caitlin A. Gould
- Environmental Health and Engineering, John Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
- Environmental Health and Engineering, 1305 Delafield Pl NW, Washington, DC 20011, USA
| | - Keeve E. Nachman
- Environmental Health and Engineering, John Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Jessica Fanzo
- John Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205, USA
- Berman Institute of Bioethics, Nitze School of Advanced International Studies (SAIS) and Bloomberg School of Public Health, Johns Hopkins University, 1717 Massachusetts Ave NW 730, Washington, DC 20036, USA
| | - Anne Barnhill
- John Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205, USA
| | - Shannon Frattaroli
- Environmental Health and Engineering, John Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
| | - Meghan F. Davis
- Environmental Health and Engineering, John Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
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de Pee S, Hardinsyah R, Jalal F, Kim BF, Semba RD, Deptford A, Fanzo JC, Ramsing R, Nachman KE, McKenzie S, Bloem MW. Balancing a sustained pursuit of nutrition, health, affordability and climate goals: exploring the case of Indonesia. Am J Clin Nutr 2021; 114:1686-1697. [PMID: 34477830 PMCID: PMC8574631 DOI: 10.1093/ajcn/nqab258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 07/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To guide the transformation of food systems to provide for healthy and sustainable diets, countries need to assess their current diet and food supply in comparison to nutrition, health, affordability, and environmental goals. OBJECTIVES We sought to compare Indonesia's food utilization to diets optimized for nutritional value and cost and to diets that are increasingly plant-based in order to meet further health and environmental goals, including the EAT-Lancet planetary health diet, to explore whether multiple goals could be achieved simultaneously. METHODS We compared 13 dietary scenarios (2 current, 7 optimized, 3 increasingly plant-based, 1 EAT-Lancet) for nutrient content, cost, greenhouse gas emissions (GHGe), and water footprints, using the FAO food balance sheet, Indonesia Household Income and Expenditure Survey household food expenditure, food composition, life cycle assessment, food losses, and trade data. RESULTS The diversity of modeled scenarios was higher than that of current consumption, reflecting nutritional deficiencies underlying Indonesia's burden of different forms of malnutrition. Nutrient intake targets were met best by nutrient- and cost-optimized diets, followed by the EAT-Lancet diet. Those diets also had high GHGe, although less than 40% of a scenario in which Indonesia would adopt a typical high-income country's diet. Only the low food chain diet had a GHGe below the 2050 target set by the EAT-Lancet commission. Its nutrient content was comparable to that of a no-dairy diet, slightly above those of fish-and-poultry and current diets, and somewhat below those of the EAT-Lancet diets. To meet nutrient needs, some animal-source foods had to be included. Costs of all except the optimized diets were above the current national average food expenditure. No scenario met all goals simultaneously. CONCLUSIONS Indonesia's consumption of rice and unhealthy foods should decrease; food production, trade, and processing should prioritize diversification, (bio)fortification, and limiting environmental impacts; and consumer and institutional demands for healthy, nutritious, and sustainable foods should be stimulated. More granular data and tools are required to develop and assess more detailed scenarios to achieve multiple goals simultaneously.
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Affiliation(s)
- Saskia de Pee
- United Nations World Food Programme, Rome, Italy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | | | - Brent F Kim
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Richard D Semba
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy Deptford
- United Nations World Food Programme, Rome, Italy
| | - Jessica C Fanzo
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Rebecca Ramsing
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keeve E Nachman
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Risk Sciences and Public Policy Institute, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shawn McKenzie
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Martin W Bloem
- Center for Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lupolt SN, Santo RE, Kim BF, Green C, Codling E, Rule AM, Chen R, Scheckel KG, Strauss M, Cocke A, Little NG, Rupp VC, Viqueira R, Illuminati J, Epp Schmidt A, Nachman KE. The Safe Urban Harvests Study: A Community-Driven Cross-Sectional Assessment of Metals in Soil, Irrigation Water, and Produce from Urban Farms and Gardens in Baltimore, Maryland. Environ Health Perspect 2021; 129:117004. [PMID: 34766834 PMCID: PMC8589016 DOI: 10.1289/ehp9431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Emerging evidence suggests social, health, environmental, and economic benefits of urban agriculture (UA). However, limited work has characterized the risks from metal contaminant exposures faced by urban growers and consumers of urban-grown produce. OBJECTIVES We aimed to answer community-driven questions about the safety of UA and the consumption of urban-grown produce by measuring concentrations of nine metals in the soil, irrigation water, and urban-grown produce across urban farms and gardens in Baltimore, Maryland. METHODS We measured concentrations of 6 nonessential [arsenic (As), barium (Ba), cadmium (Cd), chromium (Cr), lead (Pb), nickel (Ni)] and three essential [copper (Cu), manganese (Mn), zinc (Zn)] metals in soil, irrigation water, and 13 types of urban-grown produce collected from 104 UA sites. We compared measured concentrations to existing public health guidelines and analyzed relationships between urban soil and produce concentrations. In the absence of guidelines for metals in produce, we compared metals concentrations in urban-grown produce with those in produce purchased from farmers markets and grocery stores (both conventionally grown and U.S. Department of Agriculture-certified organic). RESULTS Mean concentrations of all measured metals in irrigation water were below public health guidelines. Mean concentrations of nonessential metals in growing area soils were below public health guidelines for Ba, Cd, Pb, and Ni and at or below background for As and Cr. Though we observed a few statistically significant differences in concentrations between urban and nonurban produce items for some combinations, no consistent or discernable patterns emerged. DISCUSSION Screening soils for heavy metals is a critical best practice for urban growers. Given limitations in existing public health guidelines for metals in soil, irrigation water, and produce, additional exposure assessment is necessary to quantify potential human health risks associated with exposure to nonessential metals when engaging in UA and consuming urban-grown produce. Conversely, the potential health benefits of consuming essential metals in urban-grown produce also merit further research. https://doi.org/10.1289/EHP9431.
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Affiliation(s)
- Sara N. Lupolt
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Raychel E. Santo
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brent F. Kim
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carrie Green
- Environmental Microbial and Food Safety Laboratory, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland, USA
| | - Eton Codling
- Adaptive Cropping Systems Laboratory, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland, USA
| | - Ana M. Rule
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rui Chen
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kirk G. Scheckel
- Land and Materials Management Division, National Risk Management Research Laboratory, U.S. Environmental Protection Agency, Cincinnati, Ohio, USA
| | | | - Abby Cocke
- Baltimore Office of Sustainability, Baltimore, Maryland, USA
| | - Neith G. Little
- Baltimore City Office, University of Maryland Extension, Baltimore, Maryland, USA
| | | | - Rachel Viqueira
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jotham Illuminati
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Audrey Epp Schmidt
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keeve E. Nachman
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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21
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Overbey KN, Hamra GB, Nachman KE, Rock C, Schwab KJ. Quantitative microbial risk assessment of human norovirus infection in environmental service workers due to healthcare-associated fomites. J Hosp Infect 2021; 117:52-64. [PMID: 34403766 PMCID: PMC8978295 DOI: 10.1016/j.jhin.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Healthcare-associated norovirus outbreaks place a large burden on healthcare staff. Environmental service workers (ESWs), however, remain understudied despite high contact with potentially contaminated surfaces. Understanding the magnitude of the risk of norovirus infection in healthcare ESWs can protect workers and improve infection control. AIM This study simulated the risk of norovirus infection for unprotected ESWs after a single fomite contact, assuming no disinfection or protective equipment, in norovirus-positive patient rooms. In addition, the risk of secondary surface transmission from norovirus-exposed ESWs was simulated. METHODS A quantitative microbial risk assessment employing two-dimensional Monte Carlo simulation with parameters extracted from the literature was used to estimate norovirus infection from multiple fomite contact scenarios defined by: norovirus source (patient vomit/diarrhoea), location (bathroom/patient room) and target outcome (ESW/secondary illness). FINDINGS Unprotected ESWs have a maximum estimated risk of norovirus infection of 33% (1:3) for a single fomite contact in a room where a norovirus-positive patient had a diarrhoeal event. Patient vomit events lead to fomite contact risk estimates that are four orders of magnitude lower than those for diarrhoeal events. The estimated risk of secondary illness from touching a common surface is as high as 25% (1:4) after single fomite exposure following a diarrhoeal event. CONCLUSIONS A single fomite contact may lead to sizable risk of norovirus infection in ESWs if personal protective equipment and disinfection are not used appropriately. ESWs can also transfer virus to secondary surfaces, initiating further infections. Interventions are needed to reduce fomite transfer of norovirus, and protect patients and staff from nosocomial infections.
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Affiliation(s)
- K N Overbey
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G B Hamra
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C Rock
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, MD, USA
| | - K J Schwab
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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22
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Innes GK, Nachman KE, Abraham AG, Casey JA, Patton AN, Price LB, Tartof SY, Davis MF. Contamination of Retail Meat Samples with Multidrug-Resistant Organisms in Relation to Organic and Conventional Production and Processing: A Cross-Sectional Analysis of Data from the United States National Antimicrobial Resistance Monitoring System, 2012-2017. Environ Health Perspect 2021; 129:57004. [PMID: 33978452 PMCID: PMC8114881 DOI: 10.1289/ehp7327] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND During food animal production, animals are exposed to, colonized by, and sometimes infected with bacteria that may contaminate animal products with susceptible and multidrug-resistant organisms (MDRO). The United States' Organic Foods Production Act resulted in decreased antibiotic use in some animal production operations. Some studies have reported that decreased antibiotic use is associated with reduced MDRO on meat. OBJECTIVES The aim of this study was to investigate associations of meat production and processing methods with MDRO and overall bacterial contamination of retail meats. METHODS Bacterial contamination data from 2012 to 2017 for chicken breast, ground beef, ground turkey, and pork chops were downloaded from the National Antimicrobial Resistance Monitoring System. Poisson regression models with robust variance were used to estimate associations with MDRO contamination and any contamination (adjusted for year and meat type) overall, and according to bacteria genus (Salmonella, Campylobacter, Enterococcus, Escherichia coli) and meat type. RESULTS A total of 39,349 retail meat samples were linked to 216 conventional, 123 split (conventional and organic), and three organic processing facilities. MDRO contamination was similar in conventionally produced meats processed at split vs. conventional facilities but was significantly lower in organically produced meats processed at split facilities [adjusted prevalance ratio (aPR)=0.43; 95% CI: 0.30, 0.63]. Meat processed by split vs. conventional processors had higher or similar MDRO contamination for all tested bacterial genera except Campylobacter (aPR=0.29; 95% CI: 0.13, 0.64). The prevalence of any contamination was lower in samples processed at split vs. conventional facilities for aggregated samples (aPR=0.70; 95% CI: 0.68, 0.73) and all meat types and bacterial genera. DISCUSSION Organically produced and processed retail meat samples had a significantly lower prevalence of MDRO than conventionally produced and processed samples had, whereas meat from split processors had a lower prevalence of any contamination than samples from conventional processors had. Additional studies are needed to confirm findings and clarify specific production and processing practices that might explain them. https://doi.org/10.1289/EHP7327.
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Affiliation(s)
- Gabriel K. Innes
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keeve E. Nachman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alison G. Abraham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, School of Public Health University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Joan A. Casey
- Mailman School of Public Heath, Columbia University, New York, New York, USA
| | - Andrew N. Patton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lance B. Price
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Sara Y. Tartof
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Meghan F. Davis
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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23
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Spaur M, Davis BJK, Kivitz S, DePaola A, Bowers JC, Curriero FC, Nachman KE. A systematic review of post-harvest interventions for Vibrio parahaemolyticus in raw oysters. Sci Total Environ 2020; 745:140795. [PMID: 32731065 DOI: 10.1016/j.scitotenv.2020.140795] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Non-cholera Vibrio bacteria are a major cause of foodborne illness in the United States. Raw oysters are commonly implicated in gastroenteritis caused by pathogenic Vibrio parahaemolyticus. In response to outbreaks in 1997-1998, the US Food and Drug Administration developed a nation-wide quantitative microbial risk assessment (QMRA) of V. parahaemolyticus in raw oysters in 2005. The QMRA identified information gaps that new research may address. Incidence of sporadic V. parahaemolyticus illness has recently increased and, as oyster consumption increases and sea temperatures rise, V. parahaemolyticus outbreaks may become more frequent, posing health concerns. Updated and region-specific QMRAs will improve the accuracy and precision of risk of infection estimates. OBJECTIVES We identify research to support an updated QMRA of V. parahaemolyticus from oysters harvested in Chesapeake Bay and Puget Sound, focusing on observational and experimental research on post-harvest practices (PHPs) published from 2004 to 2019. METHODS A predefined search strategy was applied to PubMed, Embase, Scopus, Science.gov, NAL Agricola, and Google Scholar. Study eligibility criteria were defined using a population, intervention, comparator, and outcome statement. Reviewers independently coded abstracts for inclusion/exclusion using predefined criteria. Data were extracted and study quality and relevance evaluated based on published guidance for food safety risk assessments. Findings were synthesized using a weight of evidence approach. RESULTS Of 12,174 articles retrieved, 93 were included for full-text review. Twenty-seven studies were found to be high quality and high relevance, including studies on cold storage, high hydrostatic pressure, depuration, and disinfectant, and other PHPs. High hydrostatic pressure consistently emerged as the most effective PHP in reducing abundance of V. parahaemolyticus. DISCUSSION Limitations of the knowledge base and review approach involve the type and quantity of data reported. Future research should focus on PHPs for which few or no high quality and high relevance studies exist, such as irradiation and relaying.
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Affiliation(s)
- Maya Spaur
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Benjamin J K Davis
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America; Spatial Science for Public Health Center, Johns Hopkins University, Baltimore, MD, United States of America; Health Sciences Center for Chemical Regulation and Food Safety, Exponent, Inc., Washington, DC, United States of America
| | - Scott Kivitz
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States of America
| | - Angelo DePaola
- Angelo DePaola Consulting, Coden, AL, United States of America
| | - John C Bowers
- Office of Analytics and Outreach, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD, United States of America
| | - Frank C Curriero
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America; Spatial Science for Public Health Center, Johns Hopkins University, Baltimore, MD, United States of America
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America; Johns Hopkins Risk Sciences and Public Policy Institute, Baltimore, MD, United States of America; Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, MD, United States of America.
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Santo RE, Kim BF, Goldman SE, Dutkiewicz J, Biehl EMB, Bloem MW, Neff RA, Nachman KE. Considering Plant-Based Meat Substitutes and Cell-Based Meats: A Public Health and Food Systems Perspective. Front Sustain Food Syst 2020. [DOI: 10.3389/fsufs.2020.00134] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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25
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Kaltofen M, Nachman KE, Hattis D. Letter concerning: Clewell (2019) incorporation of in vitro metabolism data and physiologically based pharmacokinetic modeling in a risk assessment for chloroprene. Inhal Toxicol 2020; 32:327. [PMID: 32791864 DOI: 10.1080/08958378.2020.1806960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Marco Kaltofen
- Boston Chemical Data Corp., Natick, MA, USA.,Nuclear Science and Engineering Program, Department of Physics, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dale Hattis
- George Perkins Marsh Institute, Clark University, Worcester, MA, USA
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26
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Kim H, Caulfield LE, Rebholz CM, Ramsing R, Nachman KE. Trends in types of protein in US adolescents and children: Results from the National Health and Nutrition Examination Survey 1999-2010. PLoS One 2020; 15:e0230686. [PMID: 32214368 PMCID: PMC7098572 DOI: 10.1371/journal.pone.0230686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/05/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND It is unclear if the intakes of different types of protein have changed over time. OBJECTIVE We delineated trends in types of protein (beef, pork, lamb or goat, chicken, turkey, fish, dairy, eggs, legumes, and nuts and seeds) in US children (2-<12 years) and adolescents (12-19 years) from 1999 to 2010. METHODS We used 6 repeated cross-sectional surveys (National Health and Nutrition Examination Survey 1999-2010, n≥1,665 for children; n≥1,156 for adolescents) to test for linear trends in the intake of types of protein (grams per kilogram of body weight) among children and adolescents, and according to sociodemographic groups and participation in food assistance programs. RESULTS Among children, pork intake (0.76 to 0.51 g/kg) decreased, but chicken (0.98 to 1.28 g/kg), all poultry (1.18 to 1.55 g/kg), egg (0.63 to 0.69 g/kg), and legume (0.35 to 0.54 g/kg) intake increased (all P<0.05). Among adolescents, beef intake decreased (0.92 to 0.67 g/kg) whereas chicken (0.59 to 0.74 g/kg) and all poultry (0.72 to 0.86 g/kg) intake increased from 1999 to 2010 (all P<0.01). Participants of the Women, Infants, and Children (WIC) increased the intake of chicken and dairy (all P<0.05) over time whereas no significant trend was observed for income-eligible non-participants. Fish intake did not change in any age group, and recommended types of protein (poultry, fish, nuts and seeds) declined among children of lower socioeconomic status. CONCLUSIONS Intake of recommended types of protein increased among children, adolescents and WIC participants. However, subgroup analyses suggest socioeconomic disparities.
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Affiliation(s)
- Hyunju Kim
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Laura E. Caulfield
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Casey M. Rebholz
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Rebecca Ramsing
- Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Keeve E. Nachman
- Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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27
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Lam Y, Fry JP, Nachman KE. Applying an environmental public health lens to the industrialization of food animal production in ten low- and middle-income countries. Global Health 2019; 15:40. [PMID: 31196114 PMCID: PMC6567672 DOI: 10.1186/s12992-019-0479-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023] Open
Abstract
Background Industrial food animal production (IFAP) is characterized by dense animal housing, high throughput, specialization, vertical integration, and corporate consolidation. Research in high-income countries has documented impacts on public health, the environment, and animal welfare. IFAP is proliferating in some low- and middle-income countries (LMICs), where increased consumption of animal-source foods has occurred alongside rising incomes and efforts to address undernutrition. However, in these countries IFAP’s negative externalities could be amplified by inadequate infrastructure and resources to document issues and implement controls. Methods Using UN FAOSTAT data, we selected ten LMICs where food animal production is expanding and assessed patterns of IFAP growth. We conducted a mixed methods review to explore factors affecting growth, evidence of impacts, and information gaps; we searched several databases for sources in English, Spanish, and Portuguese. Data were extracted from 450+ sources, comprising peer-reviewed literature, government documents, NGO reports, and news articles. Results In the selected LMICs, not only has livestock production increased, but the nature of expansion appears to have involved industrialized methods, to varying extents based on species and location. Expansion was promoted in some countries by explicit government policies. Animal densities, corporate structure, and pharmaceutical reliance in some areas mirrored conditions found in high-income countries. There were many reported weaknesses in regulation and capacity for enforcement surrounding production and animal welfare. Global trade increasingly influences movement of and access to inputs such as feed. There was a nascent, compelling body of scientific literature documenting IFAP’s negative environmental and public health externalities in some countries. Conclusions LMICs may be attracted to IFAP for economic development and food security, as well as the potential for increasing access to animal-source foods and the role these foods can play in alleviating undernutrition. IFAP, however, is resource intensive. Industrialized production methods likely result in serious negative public health, environmental, and animal welfare impacts in LMICs. To our knowledge, this is the first systematic effort to assess IFAP trends through an environmental public health lens for a relatively large group of LMICs. It contributes to the literature by outlining urgent research priorities aimed at informing national and international decisions about the future of food animal production and efforts to tackle global undernutrition.
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Affiliation(s)
- Yukyan Lam
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, 111 Market Place, Suite 840, Baltimore, MD, 21202, USA
| | - Jillian P Fry
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, 111 Market Place, Suite 840, Baltimore, MD, 21202, USA.,Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Keeve E Nachman
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, 111 Market Place, Suite 840, Baltimore, MD, 21202, USA. .,Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA. .,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA. .,Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., W7007, Baltimore, MD, 21205, USA.
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28
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Jones MR, Tellez-Plaza M, Vaidya D, Grau-Perez M, Post WS, Kaufman JD, Guallar E, Francesconi KA, Goessler W, Nachman KE, Sanchez TR, Navas-Acien A. Ethnic, geographic and dietary differences in arsenic exposure in the multi-ethnic study of atherosclerosis (MESA). J Expo Sci Environ Epidemiol 2019; 29:310-322. [PMID: 29795237 PMCID: PMC6252166 DOI: 10.1038/s41370-018-0042-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/02/2017] [Revised: 10/03/2017] [Accepted: 01/27/2018] [Indexed: 05/18/2023]
Abstract
Differences in residential location as well as race/ethnicity and dietary habits may result in differences in inorganic arsenic (iAs) exposure. We investigated the association of exposure to iAs with race/ethnicity, geography, and dietary intake in a random sample of 310 White, Black, Hispanic, and Chinese adults in the Multi-Ethnic Study of Atherosclerosis from 6 US cities with inorganic and methylated arsenic (ΣAs) measured in urine. Dietary intake was assessed by food-frequency questionnaire. Chinese and Hispanic race/ethnicity was associated with 82% (95% CI: 46%, 126%) and 37% (95% CI: 10%, 70%) higher urine arsenic concentrations, respectively, compared to White participants. No differences were observed for Black participants compared to Whites. Urine arsenic concentrations were higher for participants in Los Angeles, Chicago, and New York compared to other sites. Participants that ate rice ≥2 times/week had 31% higher urine arsenic compared to those that rarely/never consumed rice. Participants that drank wine ≥2 times/week had 23% higher urine arsenic compared to rare/never wine drinkers. Intake of poultry or non-rice grains was not associated with urinary arsenic concentrations. At the low-moderate levels typical of the US population, exposure to iAs differed by race/ethnicity, geographic location, and frequency of rice and wine intake.
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Affiliation(s)
- Miranda R Jones
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Maria Tellez-Plaza
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Institute for Biomedical Research Hospital Clinico de Valencia-INCLIVA, Valencia, Spain
| | - Dhananjay Vaidya
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Maria Grau-Perez
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA
| | - Wendy S Post
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences,School of Public Health, University of Washington, Seattle, WA, USA
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | | | - Keeve E Nachman
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tiffany R Sanchez
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA
| | - Ana Navas-Acien
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health Sciences, Columbia University, New York, NY, USA
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29
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Nachman KE, Punshon T, Rardin L, Signes-Pastor AJ, Murray CJ, Jackson BP, Guerinot ML, Burke TA, Chen CY, Ahsan H, Argos M, Cottingham KL, Cubadda F, Ginsberg GL, Goodale BC, Kurzius-Spencer M, Meharg AA, Miller MD, Nigra AE, Pendergrast CB, Raab A, Reimer K, Scheckel KG, Schwerdtle T, Taylor VF, Tokar EJ, Warczak TM, Karagas MR. Opportunities and Challenges for Dietary Arsenic Intervention. Environ Health Perspect 2018; 126:84503. [PMID: 30235424 PMCID: PMC6375412 DOI: 10.1289/ehp3997] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/16/2018] [Accepted: 07/20/2018] [Indexed: 05/18/2023]
Abstract
The diet is emerging as the dominant source of arsenic exposure for most of the U.S. population. Despite this, limited regulatory efforts have been aimed at mitigating exposure, and the role of diet in arsenic exposure and disease processes remains understudied. In this brief, we discuss the evidence linking dietary arsenic intake to human disease and discuss challenges associated with exposure characterization and efforts to quantify risks. In light of these challenges, and in recognition of the potential longer-term process of establishing regulation, we introduce a framework for shorter-term interventions that employs a field-to-plate food supply chain model to identify monitoring, intervention, and communication opportunities as part of a multisector, multiagency, science-informed, public health systems approach to mitigation of dietary arsenic exposure. Such an approach is dependent on coordination across commodity producers, the food industry, nongovernmental organizations, health professionals, researchers, and the regulatory community. https://doi.org/10.1289/EHP3997.
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Affiliation(s)
- Keeve E Nachman
- Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tracy Punshon
- Department of Biological Sciences, Dartmouth College, Hanover, New Hampshire, USA
- Dartmouth Superfund Research Program, Hanover, New Hampshire, USA
- Dartmouth Children's Environmental Health and Disease Prevention Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Laurie Rardin
- Dartmouth Superfund Research Program, Hanover, New Hampshire, USA
| | - Antonio J Signes-Pastor
- Dartmouth Superfund Research Program, Hanover, New Hampshire, USA
- Dartmouth Children's Environmental Health and Disease Prevention Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Carolyn J Murray
- Dartmouth Children's Environmental Health and Disease Prevention Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Brian P Jackson
- Dartmouth Superfund Research Program, Hanover, New Hampshire, USA
- Department of Earth Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | - Mary Lou Guerinot
- Department of Biological Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | - Thomas A Burke
- Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Celia Y Chen
- Department of Biological Sciences, Dartmouth College, Hanover, New Hampshire, USA
- Dartmouth Superfund Research Program, Hanover, New Hampshire, USA
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Maria Argos
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Kathryn L Cottingham
- Department of Biological Sciences, Dartmouth College, Hanover, New Hampshire, USA
- Dartmouth Children's Environmental Health and Disease Prevention Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Francesco Cubadda
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Gary L Ginsberg
- Yale School of Public Health, 60 College St, New Haven, Connecticut, USA
| | - Britton C Goodale
- Dartmouth Superfund Research Program, Hanover, New Hampshire, USA
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Margaret Kurzius-Spencer
- Department of Pediatrics, College of Medicine, University of Arizona, Tucson, Arizona, USA
- Department of Community, Environment and Policy, Mel & Enid College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Andrew A Meharg
- Institute for Global Food Security, Queen's University Belfast, David Keir Building, Malone Road, Belfast, BT9 5BN, Northern Ireland, UK
| | - Mark D Miller
- Western States Pediatric Environmental Health Specialty Unit, University of California, San Francisco, San Francisco, California, USA
| | - Anne E Nigra
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | | | - Andrea Raab
- Department of Chemistry, University of Aberdeen, Aberdeen, UK
| | - Ken Reimer
- Royal Military College, Kingston, Ontario, Canada
| | - Kirk G Scheckel
- Land and Materials Management Division, National Risk Management Research Laboratory, United States Environmental Protection Agency, Cincinnati, Ohio, USA
| | - Tanja Schwerdtle
- Institute of Nutritional Sciences, University of Potsdam, Germany
| | - Vivien F Taylor
- Dartmouth Superfund Research Program, Hanover, New Hampshire, USA
- Department of Earth Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | - Erik J Tokar
- National Toxicology Program Laboratory, National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Todd M Warczak
- Department of Biological Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | - Margaret R Karagas
- Dartmouth Superfund Research Program, Hanover, New Hampshire, USA
- Dartmouth Children's Environmental Health and Disease Prevention Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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30
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Moon KA, Oberoi S, Barchowsky A, Chen Y, Guallar E, Nachman KE, Rahman M, Sohel N, D'Ippoliti D, Wade TJ, James KA, Farzan SF, Karagas MR, Ahsan H, Navas-Acien A. A dose-response meta-analysis of chronic arsenic exposure and incident cardiovascular disease. Int J Epidemiol 2018; 47:1013. [PMID: 29697784 DOI: 10.1093/ije/dyy073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Nigra AE, Sanchez TR, Nachman KE, Harvey D, Chillrud SN, Graziano JH, Navas-Acien A. The effect of the Environmental Protection Agency maximum contaminant level on arsenic exposure in the USA from 2003 to 2014: an analysis of the National Health and Nutrition Examination Survey (NHANES). Lancet Public Health 2018; 2:e513-e521. [PMID: 29250608 PMCID: PMC5729579 DOI: 10.1016/s2468-2667(17)30195-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background The current US Environmental Protection Agency (EPA) maximum
contaminant level (MCL) for arsenic in public water systems (10
µg/L) took effect in 2006. Arsenic is not federally regulated in
private wells. The impact of the 2006 MCL on arsenic exposure in the US, as
confirmed through biomarkers, is presently unknown. We evaluated national
trends in water arsenic exposure in the US, hypothesizing that urinary
arsenic levels would decrease over time among participants using public
water systems but not among those using well water. We further estimated the
expected number of avoided lung, bladder, and skin cancer cases. Methods We evaluated 14,127 participants in the National Health and Nutrition
Examination Survey (NHANES) 2003–2014 with urinary dimethylarsinate
(DMA) and total arsenic available. To isolate water exposure, we expanded a
residual-based method to remove tobacco and dietary contributions of
arsenic. We applied EPA risk assessment approaches to estimate the expected
annual number of avoided cancer cases comparing arsenic exposure in
2013–2014 vs. 2003–2004. Findings Among public water users, fully adjusted geometric means (GMs) of DMA
decreased from 3.01 µg/L in 2003–2004 to 2.49 µg/L
in 2013–2014 (17% reduction; 95% confidence interval
10%, 24%; p-trend<0.01); no change was observed
among well water users (p-trend= 0.35). Assuming these estimated exposure
reductions will remain similar across a lifetime, we estimate a reduction of
200 to 900 lung and bladder cancer cases per year depending on the approach
used. Interpretation The decline in urinary arsenic among public water but not private
well users in NHANES 2003–2014 indicates that the implementation of
the current MCL has reduced arsenic exposure in the US population. Our study
supports prior work showing that well water users are inadequately protected
against drinking water arsenic, and confirms the critical role of federal
drinking water regulations in reducing toxic exposures and protecting human
health. Funding This work was supported by the National Institute of Environmental
Health Sciences (1R01ES025216, R01ES021367, 5P30ES009089 and P42ES010349).
A. E. Nigra was supported by 5T32ES007322.
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Affiliation(s)
- Anne E Nigra
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Tiffany R Sanchez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David Harvey
- Commissioned Corps Officer of the U.S. Public Health Service, Rockville, MD
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY
| | - Joseph H Graziano
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
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32
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Poulsen MN, Pollak J, Sills DL, Casey JA, Rasmussen SG, Nachman KE, Cosgrove SE, Stewart D, Schwartz BS. Residential proximity to high-density poultry operations associated with campylobacteriosis and infectious diarrhea. Int J Hyg Environ Health 2017; 221:323-333. [PMID: 29268955 DOI: 10.1016/j.ijheh.2017.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 12/31/2022]
Abstract
Poultry carry zoonotic bacteria that can cause gastroenteritis in humans. Environmental transmission of pathogens from poultry operations may increase gastrointestinal infection risk in surrounding communities. To evaluate associations between residential proximity to high-density poultry operations and individual-level diarrheal illnesses, we conducted a nested case-control study among 514,488 patients in Pennsylvania (2006-2015). Using electronic health records, we identified cases of five gastrointestinal outcomes: three pathogen-specific infections, including Escherichia coli (n = 1425), Campylobacter (n = 567), and Salmonella (n = 781); infectious diarrhea (n = 781); and non-specific diarrhea (2012-2015; n = 28,201). We estimated an inverse-distance squared activity metric for poultry operations based on farm and patient addresses. Patients in the second and fourth (versus first) quartiles of the poultry operation activity metric had increased odds of Campylobacter (AOR [CI], Q2: 1.36 [1.01, 1.82]; Q3: 1.38 [0.98, 1.96]; Q4: 1.75 [1.31, 2.33]). Patients in the second, third, and fourth quartiles had increased odds of infectious diarrhea (Q2: 1.76 [1.29, 2.39]; Q3: 1.76 [1.09, 2.85]; Q4: 1.60 [1.12, 2.30]). Stratification revealed stronger relations of fourth quartile and both Campylobacter and infectious diarrhea in townships, the most rural community type in the study geography. Increasing extreme rainfall in the week prior to diagnosis strengthened fourth quartile Campylobacter associations. The poultry operation activity metric was largely unassociated with E. coli, Salmonella, and non-specific diarrhea. Findings suggest high-density poultry operations may be associated with campylobacteriosis and infectious diarrhea in nearby communities, highlighting additional public health concerns of industrial agriculture.
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Affiliation(s)
- Melissa N Poulsen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA.
| | - Jonathan Pollak
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deborah L Sills
- Department of Civil and Environmental Engineering, Bucknell University, Lewisburg, PA, USA
| | - Joan A Casey
- Department of Environmental Science, Policy & Management, University of California, Berkeley, CA, USA
| | - Sara G Rasmussen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sara E Cosgrove
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dalton Stewart
- Department of Civil and Environmental Engineering, Bucknell University, Lewisburg, PA, USA
| | - Brian S Schwartz
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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33
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Moon KA, Oberoi S, Barchowsky A, Chen Y, Guallar E, Nachman KE, Rahman M, Sohel N, D’Ippoliti D, Wade TJ, James KA, Farzan SF, Karagas MR, Ahsan H, Navas-Acien A. A dose-response meta-analysis of chronic arsenic exposure and incident cardiovascular disease. Int J Epidemiol 2017; 46:1924-1939. [PMID: 29040626 PMCID: PMC5837344 DOI: 10.1093/ije/dyx202] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/17/2017] [Accepted: 08/30/2017] [Indexed: 01/08/2023] Open
Abstract
Background Consistent evidence at high levels of water arsenic (≥100 µg/l), and growing evidence at low-moderate levels (<100 µg/l), support a link with cardiovascular disease (CVD). The shape of the dose-response across low-moderate and high levels of arsenic in drinking water is uncertain and critical for risk assessment. Methods We conducted a systematic review of general population epidemiological studies of arsenic and incident clinical CVD (all CVD, coronary heart disease (CHD) and stroke) with three or more exposure categories. In a dose-response meta-analysis, we estimated the pooled association between log-transformed water arsenic (log-linear) and restricted cubic splines of log-transformed water arsenic (non-linear) and the relative risk of each CVD endpoint. Results Twelve studies (pooled N = 408 945) conducted at high (N = 7) and low-moderate (N = 5) levels of water arsenic met inclusion criteria, and 11 studies were included in the meta-analysis. Compared with 10 µg/l, the estimated pooled relative risks [95% confidence interval (CI)] for 20 µg/l water arsenic, based on a log-linear model, were 1.09 (1.03, 1.14) (N = 2) for CVD incidence, 1.07 (1.01, 1.14) (N = 6) for CVD mortality, 1.11 (1.05, 1.17) (N = 4) for CHD incidence, 1.16 (1.07, 1.26) (N = 6) for CHD mortality, 1.08 (0.99, 1.17) (N = 2) for stroke incidence and 1.06 (0.93, 1.20) (N = 6) for stroke mortality. We found no evidence of non-linearity, although these tests had low statistical power. Conclusions Although limited by the small number of studies, this analysis supports quantitatively including CVD in inorganic arsenic risk assessment, and strengthens the evidence for an association between arsenic and CVD across low-moderate to high levels.
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Affiliation(s)
- Katherine A Moon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shilpi Oberoi
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aaron Barchowsky
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yu Chen
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keeve E Nachman
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Nazmul Sohel
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | | | - Timothy J Wade
- United States Environmental Protection Agency, Office of Research and Development, Chapel Hill, NC, USA
| | - Katherine A James
- Department of Family Medicine, University of Colorado, Denver, CO, USA
| | - Shohreh F Farzan
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Ana Navas-Acien
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
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Nachman KE, Lam J, Schinasi LH, Smith TC, Feingold BJ, Casey JA. O'Connor et al. systematic review regarding animal feeding operations and public health: critical flaws may compromise conclusions. Syst Rev 2017; 6:179. [PMID: 28859697 PMCID: PMC5580209 DOI: 10.1186/s13643-017-0575-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/22/2017] [Indexed: 12/27/2022] Open
Abstract
In this comment, we summarize several scientific concerns with the recently published systematic review from O'Connor and colleagues that examined the relationship between proximity to animal-feeding operations and health of individuals in nearby communities. The authors utilized a bias tool not designed for environmental health research, erroneously excluded important studies, and incorrectly interpreted others. As a result, the conclusions drawn in the review misrepresent the evidence from the published literature, limiting its value to policymakers, researchers, and the public.
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Affiliation(s)
- Keeve E Nachman
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, MD, USA. .,Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Suite W7010-E, Baltimore, MD, 21205, USA. .,Johns Hopkins Risk Sciences and Public Policy Institute, Baltimore, MD, USA. .,Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Juleen Lam
- Program on Reproductive Health and the Environment, Department of OB/GYN & RS, University of California, San Francisco, CA, USA
| | - Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.,Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Tara C Smith
- Department of Epidemiology, University of Iowa College of Public Health, 145N. Riverside Drive, Iowa City, IA, USA.,Center for Emerging Infectious Diseases, University of Iowa College of Public Health, Coralville, IA, USA.,Department of Biostatistics, Environmental Health Sciences and Epidemiology, College of Public Health, Kent State University, Kent, OH, USA
| | - Beth J Feingold
- Department of Environmental Health Sciences, University at Albany School of Public Health, State University of New York, Rensselaer, NY, USA
| | - Joan A Casey
- School of Public Health, University of California, Berkeley, CA, USA
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Nigra AE, Nachman KE, Love DC, Grau-Perez M, Navas-Acien A. Poultry Consumption and Arsenic Exposure in the U.S. Population. Environ Health Perspect 2017; 125:370-377. [PMID: 27735790 PMCID: PMC5332189 DOI: 10.1289/ehp351] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/24/2016] [Accepted: 09/19/2016] [Indexed: 05/17/2023]
Abstract
BACKGROUND Arsenicals (roxarsone and nitarsone) used in poultry production likely increase inorganic arsenic (iAs), monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), and roxarsone or nitarsone concentrations in poultry meat. However, the association between poultry intake and exposure to these arsenic species, as reflected in elevated urinary arsenic concentrations, is unknown. OBJECTIVES Our aim was to evaluate the association between 24-hr dietary recall of poultry consumption and arsenic exposure in the U.S. population. We hypothesized first, that poultry intake would be associated with higher urine arsenic concentrations and second, that the association between turkey intake and increased urine arsenic concentrations would be modified by season, reflecting seasonal use of nitarsone. METHODS We evaluated 3,329 participants ≥ 6 years old from the 2003-2010 National Health and Nutrition Examination Survey (NHANES) with urine arsenic available and undetectable urine arsenobetaine levels. Geometric mean ratios (GMR) of urine total arsenic and DMA were compared across increasing levels of poultry intake. RESULTS After adjustment, participants in the highest quartile of poultry consumption had urine total arsenic 1.12 (95% CI: 1.04, 1.22) and DMA 1.13 (95% CI: 1.06, 1.20) times higher than nonconsumers. During the fall/winter, participants in the highest quartile of turkey intake had urine total arsenic and DMA 1.17 (95% CI: 0.99, 1.39; p-trend = 0.02) and 1.13 (95% CI: 0.99, 1.30; p-trend = 0.03) times higher, respectively, than nonconsumers. Consumption of turkey during the past 24 hr was not associated with total arsenic or DMA during the spring/summer. CONCLUSIONS Poultry intake was associated with increased urine total arsenic and DMA in NHANES 2003-2010, reflecting arsenic exposure. Seasonally stratified analyses by poultry type provide strong suggestive evidence that the historical use of arsenic-based poultry drugs contributed to arsenic exposure in the U.S. CITATION Nigra AE, Nachman KE, Love DC, Grau-Perez M, Navas-Acien A. 2017. Poultry consumption and arsenic exposure in the U.S. Environ Health Perspect 125:370-377; http://dx.doi.org/10.1289/EHP351.
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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
- Department of Epidemiology,
- Department of Environmental Health Sciences,
- Address correspondence to A.E. Nigra, Department of Environmental Health Sciences, Columbia Mailman School of Public Health, 722 W. 168th St., 11th Floor, Room 1105, New York, NY 10032 USA. E-mail: , or A. Navas-Acien, Department of Environmental Health Sciences, Columbia Mailman School of Public Health, 722 W. 168th St., 11th Floor, Room 1105, New York, NY 10032 USA. Telephone: 212-342-4712. E-mail:
| | - Keeve E. Nachman
- Department of Environmental Health Sciences,
- Center for a Livable Future, and
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David C. Love
- Department of Environmental Health Sciences,
- Center for a Livable Future, and
| | - Maria Grau-Perez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Environmental Health Sciences,
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Epidemiology,
- Department of Environmental Health Sciences,
- Address correspondence to A.E. Nigra, Department of Environmental Health Sciences, Columbia Mailman School of Public Health, 722 W. 168th St., 11th Floor, Room 1105, New York, NY 10032 USA. E-mail: , or A. Navas-Acien, Department of Environmental Health Sciences, Columbia Mailman School of Public Health, 722 W. 168th St., 11th Floor, Room 1105, New York, NY 10032 USA. Telephone: 212-342-4712. E-mail:
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Nachman KE, Love DC, Baron PA, Nigra AE, Murko M, Raber G, Francesconi KA, Navas-Acien A. Nitarsone, Inorganic Arsenic, and Other Arsenic Species in Turkey Meat: Exposure and Risk Assessment Based on a 2014 U.S. Market Basket Sample. Environ Health Perspect 2017; 125:363-369. [PMID: 27735789 PMCID: PMC5332177 DOI: 10.1289/ehp225] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 07/21/2016] [Accepted: 07/23/2016] [Indexed: 05/03/2023]
Abstract
BACKGROUND Use of nitarsone, an arsenic-based poultry drug, may result in dietary exposures to inorganic arsenic (iAs) and other arsenic species. Nitarsone was withdrawn from the U.S. market in 2015, but its use in other countries may continue. OBJECTIVES We characterized the impact of nitarsone use on arsenic species in turkey meat and arsenic exposures among turkey consumers, and we estimated cancer risk increases from consuming turkey treated with nitarsone before its 2015 U.S. withdrawal. METHODS Turkey from three cities was analyzed for total arsenic, iAs, methylarsonate (MA), dimethylarsinate, and nitarsone, which were compared across label type and month of purchase. Turkey consumption was estimated from NHANES data to estimate daily arsenic exposures for adults and children 4-30 months of age and cancer risks among adult consumers. RESULTS Turkey meat from conventional producers not prohibiting nitarsone use showed increased mean levels of iAs (0.64 μg/kg) and MA (5.27 μg/kg) compared with antibiotic-free and organic meat (0.39 μg/kg and 1.54 μg/kg, respectively) and meat from conventional producers prohibiting nitarsone use (0.33 μg/kg and 0.28 μg/kg, respectively). Samples with measurable nitarsone had the highest mean iAs and MA (0.92 μg/kg and 10.96 μg/kg, respectively). Nitarsone was higher in October samples than in March samples, possibly resulting from increased summer use. Based on mean iAs concentrations in samples from conventional producers with no known policy versus policies prohibiting nitarsone, estimated lifetime daily consumption by an 80-kg adult, and a recently proposed cancer slope factor, we estimated that use of nitarsone by all turkey producers would result in 3.1 additional cases of bladder or lung cancer per 1,000,000 consumers. CONCLUSIONS Nitarsone use can expose turkey consumers to iAs and MA. The results of our study support the U.S. Food and Drug Administration's removal of nitarsone from the U.S. market and further support its removal from the global marketplace. Citation: Nachman KE, Love DC, Baron PA, Nigra AE, Murko M, Raber G, Francesconi KA, Navas-Acien A. 2017. Nitarsone, inorganic arsenic, and other arsenic species in turkey meat: exposure and risk assessment based on a 2014 U.S. market basket sample. Environ Health Perspect 125:363-369; http://dx.doi.org/10.1289/EHP225.
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Affiliation(s)
- Keeve E. Nachman
- Johns Hopkins Center for a Livable Future,
- Department of Environmental Health Sciences,
- Department of Health Policy and Management,
- Risk Sciences and Public Policy Institute, and
- Address correspondence to K.E. Nachman, 615 N. Wolfe St., W7010-E, Baltimore, MD 21205 USA. Telephone: (410) 502-7578. E-mail:
| | - David C. Love
- Johns Hopkins Center for a Livable Future,
- Department of Environmental Health Sciences,
| | - Patrick A. Baron
- Johns Hopkins Center for a Livable Future,
- Department of Environmental Health Sciences,
| | - Anne E. Nigra
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Manuela Murko
- Institute of Chemistry-Analytical Chemistry, University of Graz, Graz, Austria
| | - Georg Raber
- Institute of Chemistry-Analytical Chemistry, University of Graz, Graz, Austria
| | | | - Ana Navas-Acien
- Department of Environmental Health Sciences,
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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Nachman KE, Ginsberg GL, Miller MD, Murray CJ, Nigra AE, Pendergrast CB. Mitigating dietary arsenic exposure: Current status in the United States and recommendations for an improved path forward. Sci Total Environ 2017; 581-582:221-236. [PMID: 28065543 PMCID: PMC5303536 DOI: 10.1016/j.scitotenv.2016.12.112] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 08/15/2016] [Revised: 12/08/2016] [Accepted: 12/16/2016] [Indexed: 05/19/2023]
Abstract
Inorganic arsenic (iAs) is a well-characterized carcinogen, and recent epidemiologic studies have linked chronic exposures to non-cancer health outcomes, including cardiovascular disease, diabetes, skin lesions and respiratory disorders. Greater vulnerability has been demonstrated with early life exposure for health effects including lung and bladder cancer, immunotoxicity and neurodevelopment. Despite its well-known toxicity, there are important gaps in the regulatory oversight of iAs in food and in risk communication. This paper focuses on the US regulatory framework in relation to iAs in food and beverages. The state of existing regulatory agency toxicological assessments, monitoring efforts, standard setting, intervention policies and risk communication are explored. Regarding the approach for standard setting, risk-based evaluations of iAs in particular foods can be informative but are insufficient to create a numeric criterion, given current uncertainties in iAs toxicology and the degree to which traditional risk targets can be exceeded by dietary exposures. We describe a process for prioritizing dietary exposures for different lifestages and recommend a relative source contribution-based approach to setting criteria for arsenic in prioritized foods. Intervention strategies begin with an appropriately set criterion and a monitoring program that documents the degree to which this target is met for a particular food. This approach will promote improvements in food production to lower iAs contamination for those foods which initially do not meet the criterion. Risk communication improvements are recommended to ensure that the public has reliable information regarding sources and alternative dietary choices. A key recommendation is the consideration of meal frequency advice similar to what is currently done for contaminants in fish. Recent action level determinations by FDA for apple juice and infant rice cereal are evaluated and used as illustrations of how our recommended approach can further the goal of exposure mitigation from key sources of dietary iAs in the US.
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Affiliation(s)
- Keeve E Nachman
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Center for a Livable Future, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | | | - Mark D Miller
- Western States Pediatric Environmental Health Specialty Unit, University of California, San Francisco, CA, USA
| | - Carolyn J Murray
- Dartmouth Children's Environmental Health and Disease Prevention Research Center, Hanover, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Anne E Nigra
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Krishnakumar PK, Qurban MA, Stiboller M, Nachman KE, Joydas TV, Manikandan KP, Mushir SA, Francesconi KA. Arsenic and arsenic species in shellfish and finfish from the western Arabian Gulf and consumer health risk assessment. Sci Total Environ 2016; 566-567:1235-1244. [PMID: 27277209 DOI: 10.1016/j.scitotenv.2016.05.180] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/17/2016] [Accepted: 05/25/2016] [Indexed: 05/03/2023]
Abstract
This study reports the levels of total arsenic and arsenic species in marine biota such as clams (Meretrix meretrix; N=21) and pearl oyster (Pinctada radiata; N=5) collected from nine costal sites in Jan 2014, and cuttlefish (Sepia pharaonis; N=8), shrimp (Penaeus semisulcatus; N=1), and seven commercially important finfish species (N=23) collected during Apr-May 2013 from seven offshore sites in the western Arabian Gulf. Total As and As species such as dimethylarsinic acid (DMA), arsenobetaine (AB), trimethylarsine oxide (TMAO), arsenocholine (AC), tetramethylarsonium ion (Tetra), arsenosugar-glycerol (As-Gly) and inorganic As (iAs) were determined by using ICPMS and HPLC/ICPMS. In bivalves, the total As concentrations ranged from 16 to 118mg/kg dry mass; the toxic iAs fraction contributed on average less than 0.8% of the total As, while the nontoxic AB fraction formed around 58%. Total As concentrations for the remaining seafood (cuttlefish, shrimp and finfish) ranged from 11 to 134mg/kg dry mass and the iAs and AB fractions contributed on average 0.03% and 81% respectively of the total As. There was no significant relationship between the tissue concentrations of total As and iAs in the samples. There was also no significant relationship between As levels in seafood and geographical location or salinity of the waters from which samples were collected. Based on our results, we recommend introducing a maximum permissible level of arsenic in seafood from the Gulf based on iAs content rather than based on total As. Our analyses of cancer risks and non-cancer hazards identified non-negligible risks and the potential for hazards; the greatest risks were identified for expatriate consumers of bivalves and high-end consumers of seafood. Despite this, many uncertainties remain that would be best addressed by further analyses.
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Affiliation(s)
- Periyadan K Krishnakumar
- Center for Environment and Water, Research Institute, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia.
| | - Mohammad A Qurban
- Center for Environment and Water, Research Institute, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
| | - Michael Stiboller
- Institute of Chemistry-Analytical Chemistry, NAWI Graz, University of Graz, A-8010 Graz, Austria
| | - Keeve E Nachman
- Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health Sciences, Baltimore, MD, USA
| | - Thadickal V Joydas
- Center for Environment and Water, Research Institute, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
| | - Karuppasamy P Manikandan
- Center for Environment and Water, Research Institute, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
| | - Shemsi Ahsan Mushir
- Center for Environment and Water, Research Institute, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
| | - Kevin A Francesconi
- Institute of Chemistry-Analytical Chemistry, NAWI Graz, University of Graz, A-8010 Graz, Austria
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Fox MA, Nachman KE, Anderson B, Lam J, Resnick B. Meeting the public health challenge of protecting private wells: Proceedings and recommendations from an expert panel workshop. Sci Total Environ 2016; 554-555:113-8. [PMID: 26950625 DOI: 10.1016/j.scitotenv.2016.02.128] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 12/23/2015] [Revised: 02/02/2016] [Accepted: 02/18/2016] [Indexed: 05/25/2023]
Abstract
Private wells serving fewer than 25 people are federally unregulated, and their users may be exposed to naturally occurring agents of concern such as arsenic and radionuclides, as well as anthropogenic contaminants. The Centers for Disease Control and Prevention's Clean Water for Health Program works to protect private wells and prevent adverse health outcomes for the roughly 15% of Americans who rely on them. To understand current and emerging challenges to the private drinking water supply, an interdisciplinary expert panel workshop on "Future and Emerging Issues for Private Wells" was organized to inform strategic planning for the Clean Water for Health Program. The panel assessed current conditions of ground water as a source for private wells, identified emerging threats, critical gaps in knowledge, and public health needs, and recommended strategies to guide future activities to ensure the safety of private drinking water wells. These strategies addressed topics of broad interest to the environmental public health community including: development of new methods to support citizen science; addressing contaminant mixtures; expanding capacity for well testing; evaluating treatment technologies; building an evidence base on best practices on well owner outreach and stewardship; and research and data needs.
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Affiliation(s)
- Mary A Fox
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 407, Baltimore, MD 21205, USA; Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 429, Baltimore, MD 21205, USA.
| | - Keeve E Nachman
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 407, Baltimore, MD 21205, USA; Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 429, Baltimore, MD 21205, USA; Center for a Livable Future, Johns Hopkins University, 615 North Wolfe Street, Room W7010, Baltimore, MD 21205, USA; Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Breeana Anderson
- Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 429, Baltimore, MD 21205, USA; Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, 725 North Wolfe Street, Baltimore, MD 21205, USA
| | - Juleen Lam
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 407, Baltimore, MD 21205, USA; Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 429, Baltimore, MD 21205, USA; University of California at San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, Mailstop 0132, 550 16th Street, 7th Floor, San Francisco, CA 94143, USA
| | - Beth Resnick
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 407, Baltimore, MD 21205, USA; Office of Public Health Practice and Training, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA
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Fry JP, Love DC, MacDonald GK, West PC, Engstrom PM, Nachman KE, Lawrence RS. Environmental health impacts of feeding crops to farmed fish. Environ Int 2016; 91:201-14. [PMID: 26970884 DOI: 10.1016/j.envint.2016.02.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/22/2016] [Accepted: 02/18/2016] [Indexed: 05/15/2023]
Abstract
Half of the seafood consumed globally now comes from aquaculture, or farmed seafood. Aquaculture therefore plays an increasingly important role in the global food system, the environment, and human health. Traditionally, aquaculture feed has contained high levels of wild fish, which is unsustainable for ocean ecosystems as demand grows. The aquaculture industry is shifting to crop-based feed ingredients, such as soy, to replace wild fish as a feed source and allow for continued industry growth. This shift fundamentally links seafood production to terrestrial agriculture, and multidisciplinary research is needed to understand the ecological and environmental health implications. We provide basic estimates of the agricultural resource use associated with producing the top five crops used in commercial aquaculture feed. Aquaculture's environmental footprint may now include nutrient and pesticide runoff from industrial crop production, and depending on where and how feed crops are produced, could be indirectly linked to associated negative health outcomes. We summarize key environmental health research on health effects associated with exposure to air, water, and soil contaminated by industrial crop production. Our review also finds that changes in the nutritional content of farmed seafood products due to altered feed composition could impact human nutrition. Based on our literature reviews and estimates of resource use, we present a conceptual framework describing the potential links between increasing use of crop-based ingredients in aquaculture and human health. Additional data and geographic sourcing information for crop-based ingredients are needed to fully assess the environmental health implications of this trend. This is especially critical in the context of a food system that is using both aquatic and terrestrial resources at unsustainable rates.
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Affiliation(s)
- Jillian P Fry
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, USA.
| | - David C Love
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Graham K MacDonald
- Department of Geography, McGill University, 805 Sherbrooke Street West, Montreal, Quebec, Canada
| | - Paul C West
- Institute on the Environment (IonE), University of Minnesota, 1954 Buford Avenue, St. Paul, MN, USA
| | - Peder M Engstrom
- Institute on the Environment (IonE), University of Minnesota, 1954 Buford Avenue, St. Paul, MN, USA
| | - Keeve E Nachman
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, USA
| | - Robert S Lawrence
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA
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Kim BF, Nachman KE, Neff RA, Spiker ML, Santo RE. Concerns re: interpretation and translation of findings in Energy use, blue water footprint, and greenhouse gas emissions for current food consumption patterns and dietary recommendations in the US. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s10669-016-9587-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Industrial food animal production (IFAP) is a source of environmental microbial and chemical hazards. A growing body of literature suggests that populations living near these operations and manure-applied crop fields are at elevated risk for several health outcomes. We reviewed the literature published since 2000 and identified four health outcomes consistently and positively associated with living near IFAP: respiratory outcomes, methicillin-resistant Staphylococcus aureus (MRSA), Q fever, and stress/mood. We found moderate evidence of an association of IFAP with quality of life and limited evidence of an association with cognitive impairment, Clostridium difficile, Enterococcus, birth outcomes, and hypertension. Distance-based exposure metrics were used by 17/33 studies reviewed. Future work should investigate exposure through drinking water and must improve exposure assessment with direct environmental sampling, modeling, and high-resolution DNA typing methods. Investigators should not limit study to high-profile pathogens like MRSA but include a broader range of pathogens, as well as other disease outcomes.
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Affiliation(s)
- Joan A Casey
- Robert Wood Johnson Foundation Health and Society Scholars Program, UC San Francisco and UC Berkeley, 50 University Hall, Room 583, Berkeley, CA, 94720-7360, USA,
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Boyle MD, Payne-Sturges DC, Sangaramoorthy T, Wilson S, Nachman KE, Babik K, Jenkins CC, Trowell J, Milton DK, Sapkota A. Hazard Ranking Methodology for Assessing Health Impacts of Unconventional Natural Gas Development and Production: The Maryland Case Study. PLoS One 2016; 11:e0145368. [PMID: 26726918 PMCID: PMC4700999 DOI: 10.1371/journal.pone.0145368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/01/2015] [Indexed: 11/18/2022] Open
Abstract
The recent growth of unconventional natural gas development and production (UNGDP) has outpaced research on the potential health impacts associated with the process. The Maryland Marcellus Shale Public Health Study was conducted to inform the Maryland Marcellus Shale Safe Drilling Initiative Advisory Commission, State legislators and the Governor about potential public health impacts associated with UNGDP so they could make an informed decision that considers the health and well-being of Marylanders. In this paper, we describe an impact assessment and hazard ranking methodology we used to assess the potential public health impacts for eight hazards associated with the UNGDP process. The hazard ranking included seven metrics: 1) presence of vulnerable populations (e.g. children under the age of 5, individuals over the age of 65, surface owners), 2) duration of exposure, 3) frequency of exposure, 4) likelihood of health effects, 5) magnitude/severity of health effects, 6) geographic extent, and 7) effectiveness of setbacks. Overall public health concern was determined by a color-coded ranking system (low, moderately high, and high) that was generated based on the overall sum of the scores for each hazard. We provide three illustrative examples of applying our methodology for air quality and health care infrastructure which were ranked as high concern and for water quality which was ranked moderately high concern. The hazard ranking was a valuable tool that allowed us to systematically evaluate each of the hazards and provide recommendations to minimize the hazards.
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Affiliation(s)
- Meleah D. Boyle
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Devon C. Payne-Sturges
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Thurka Sangaramoorthy
- Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland, College Park, Maryland, United States of America
| | - Sacoby Wilson
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Keeve E. Nachman
- Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kelsey Babik
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Christian C. Jenkins
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Joshua Trowell
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Donald K. Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| | - Amir Sapkota
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
- * E-mail:
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Smith TJS, Wolfson JA, Jiao D, Crupain MJ, Rangan U, Sapkota A, Bleich SN, Nachman KE. Caramel color in soft drinks and exposure to 4-methylimidazole: a quantitative risk assessment. PLoS One 2015; 10:e0118138. [PMID: 25693062 PMCID: PMC4333292 DOI: 10.1371/journal.pone.0118138] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/08/2015] [Indexed: 11/19/2022] Open
Abstract
Caramel color is added to many widely-consumed beverages as a colorant. Consumers of these beverages can be exposed to 4-methylimidazole (4-MEI), a potential carcinogen formed during its manufacture. California's Proposition 65 law requires that beverages containing 4-MEI concentrations corresponding to exposures that pose excess cancer risks > 1 case per 100,000 exposed persons (29 μg 4-MEI/day) carry warning labels. Using ultrahigh-performance liquid chromatography-tandem mass spectrometry, we assessed 4-MEI concentrations in 12 beverages purchased in California and a geographically distant metropolitan area (New York) in which warning labels are not required. In addition, we characterized beverage consumption by age and race/ethnicity (using weighted means calculated from logistic regressions) and assessed 4-MEI exposure and resulting cancer risks and US population cancer burdens attributable to beverage consumption. Data on beverage consumption were obtained from the National Health and Nutrition Examination Survey, dose-response data for 4-MEI were obtained from the California Environmental Protection Agency Office of Environmental Health Hazards Assessment, and data on population characteristics were obtained from the U.S. Census Bureau. Of the 12 beverages, Malta Goya had the highest 4-MEI concentration (915.8 to 963.3μg/L), lifetime average daily dose (LADD - 8.04x10-3 mg/kgBW-day), lifetime excess cancer risk (1.93x10-4) and burden (5,011 cancer cases in the U.S. population over 70 years); Coca-Cola had the lowest value of each (4-MEI: 9.5 to 11.7μg/L; LADD: 1.01x10-4 mg/kgBW-day; risk: 1.92x10-6; and burden: 76 cases). 4-MEI concentrations varied considerably by soda and state/area of purchase, but were generally consistent across lots of the same beverage purchased in the same state/area. Routine consumption of certain beverages can result in 4-MEI exposures > 29 μg/day. State regulatory standards appear to have been effective in reducing exposure to carcinogens in some beverages. Federal regulation of 4-MEI in caramel color may be appropriate.
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Affiliation(s)
- Tyler J. S. Smith
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Julia A. Wolfson
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ding Jiao
- Food Safety and Sustainability Center, Consumer Reports, Yonkers, New York, United States of America
| | - Michael J. Crupain
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland, United States of America
- Food Safety and Sustainability Center, Consumer Reports, Yonkers, New York, United States of America
| | - Urvashi Rangan
- Food Safety and Sustainability Center, Consumer Reports, Yonkers, New York, United States of America
| | - Amir Sapkota
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, United States of America
| | - Sara N. Bleich
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Keeve E. Nachman
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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So AD, Shah TA, Roach S, Ling Chee Y, Nachman KE. An Integrated Systems Approach is Needed to Ensure the Sustainability of Antibiotic Effectiveness for Both Humans and Animals. J Law Med Ethics 2015; 43 Suppl 3:38-45. [PMID: 26243242 DOI: 10.1111/jlme.12273] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The growing demand for animal products and the widespread use of antibiotics in bringing food animals to market have heightened concerns over cross-species transmission of drug resistance. Both the biology and emerging epidemiology strongly support the need for global coordination in stemming the generation and propagation of resistance, and the patchwork of global and country-level regulations still leaves significant gaps. More importantly, discussing such a framework opens the door to taking modular steps towards solving these challenges - for example, beginning among targeted parties rather than all countries, tying accountability to financial and technical support, or taxing antibiotic use in animals to deter low-value usage of these drugs. An international agreement would allow integrating surveillance data collection, monitoring and enforcement, research into antibiotic alternatives and more sustainable approaches to agriculture, technical assistance and capacity building, and financing under the umbrella of a One Health approach.
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Affiliation(s)
- Anthony D So
- Professor of the Practice of Public Policy and Global Health and Director of the Program on Global Health and Technology Access at the Sanford School of Public Policy at Duke University and Duke Global Health Institute in Durham, NC
| | - Tejen A Shah
- Associate in Research at the Program on Global Health and Technology Access at the Sanford School of Public Policy at Duke University and Duke Global Health Institute in Durham, NC
| | - Steven Roach
- Food Safety Program Director at Food Animal Concerns Trust in Chicago, IL
| | - Yoke Ling Chee
- Director of Programmes at the Third World Network in Penang, Malaysia
| | - Keeve E Nachman
- Assistant Professor, Departments of Environmental Health Sciences and Health Policy and Management at Johns Hopkins Bloomberg School of Public Health, and a Program Director at the Johns Hopkins Center for a Livable Future at Johns Hopkins University in Baltimore, MD
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Nadimpalli M, Rinsky JL, Wing S, Hall D, Stewart J, Larsen J, Nachman KE, Love DC, Pierce E, Pisanic N, Strelitz J, Harduar-Morano L, Heaney CD. Persistence of livestock-associated antibiotic-resistant Staphylococcus aureus among industrial hog operation workers in North Carolina over 14 days. Occup Environ Med 2014; 72:90-9. [PMID: 25200855 PMCID: PMC4316926 DOI: 10.1136/oemed-2014-102095] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study aimed to evaluate the persistence of nasal carriage of Staphylococcus aureus, methicillin-resistant S. aureus and multidrug-resistant S. aureus over 14 days of follow-up among industrial hog operation workers in North Carolina. METHODS Workers anticipating at least 24 h away from work were enrolled June-August 2012. Participants self-collected a nasal swab and completed a study journal on the evening of day 1, and each morning and evening on days 2-7 and 14 of the study. S. aureus isolated from nasal swabs were assessed for antibiotic susceptibility, spa type and absence of the scn gene. Livestock association was defined by absence of scn. RESULTS Twenty-two workers provided 327 samples. S. aureus carriage end points did not change with time away from work (mean 49 h; range >0-96 h). Ten workers were persistent and six were intermittent carriers of livestock-associated S. aureus. Six workers were persistent and three intermittent carriers of livestock-associated multidrug-resistant S. aureus. One worker persistently carried livestock-associated methicillin-resistant S. aureus. Six workers were non-carriers of livestock-associated S. aureus. Eighty-two per cent of livestock-associated S. aureus demonstrated resistance to tetracycline. A majority of livestock-associated S. aureus isolates (n=169) were CC398 (68%) while 31% were CC9. No CC398 and one CC9 isolate was detected among scn-positive isolates. CONCLUSIONS Nasal carriage of livestock-associated S. aureus, multidrug-resistant S. aureus and methicillin-resistant S. aureus can persist among industrial hog operation workers over a 14-day period, which included up to 96 h away from work.
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Affiliation(s)
- Maya Nadimpalli
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica L Rinsky
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steve Wing
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Devon Hall
- Rural Empowerment Association for Community Help (REACH), Warsaw, North Carolina, USA
| | - Jill Stewart
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jesper Larsen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Keeve E Nachman
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore Maryland, USA Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dave C Love
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore Maryland, USA Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Pierce
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nora Pisanic
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jean Strelitz
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laurel Harduar-Morano
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher D Heaney
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Baron PA, Love DC, Nachman KE. Pharmaceuticals and personal care products in chicken meat and other food animal products: a market-basket pilot study. Sci Total Environ 2014; 490:296-300. [PMID: 24858227 DOI: 10.1016/j.scitotenv.2014.04.112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/25/2014] [Accepted: 04/26/2014] [Indexed: 06/03/2023]
Abstract
Pharmaceutical drugs are extensively used in industrial food animal production. We examined whether residues of veterinary antibiotics and other pharmaceuticals and personal care products (PPCPs) were detectable in a small market-basket sample of retail chicken (n=39), ground beef (n=3) and milk (n=3) samples. High-performance liquid chromatography and tandem mass spectrometry were used to assess the concentration of 59 PPCPs and their residues in animal products. All samples of ground beef, milk, and 14 chickens were analyzed individually, while an additional 25 chicken samples were pooled and analyzed in groups of five. The majority of PPCPs were not detected in meat and milk samples. Caffeine was detected in two of three milk samples (0.4 ng/mL, 2.0 ng/mL) and in 10 of 19 individual and pooled chicken samples (median: 18.6 ng/g, range: 6.1-28.8 ng/g). Acetaminophen was detected in three of three milk samples (median: 1.5 ng/mL, range: 1.4-2.1 ng/mL). Antibiotics in the tetracycline class were detected in two of three milk samples (median: 1.0 ng/mL, range: 0.1-2.0 ng/mL) and did not exceed regulatory residue tolerances of 300 ng/mL. There are no regulatory residue tolerances for caffeine or acetaminophen in animal products. The acetaminophen detections in milk, however, raise questions about extra-label and unapproved use of pharmaceutical drugs in food animal production, as this drug is not approved for use in lactating dairy cattle or any other type of food animal production. Additional studies are needed to confirm our finding of PPCPs in meat and dairy products.
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Affiliation(s)
- Patrick A Baron
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; Johns Hopkins Center for a Livable Future, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - David C Love
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; Johns Hopkins Center for a Livable Future, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Keeve E Nachman
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; Johns Hopkins Center for a Livable Future, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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Casey JA, Shopsin B, Cosgrove SE, Nachman KE, Curriero FC, Rose HR, Schwartz BS. High-density livestock production and molecularly characterized MRSA infections in Pennsylvania. Environ Health Perspect 2014; 122:464-70. [PMID: 24509131 PMCID: PMC4014753 DOI: 10.1289/ehp.1307370] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 02/06/2014] [Indexed: 05/23/2023]
Abstract
BACKGROUND European studies suggest that living near high-density livestock production increases the risk of sequence type (ST) 398 methicillin-resistant Staphylococcus aureus (MRSA) colonization. To our knowledge, no studies have evaluated associations between livestock production and human infection by other strain types. OBJECTIVES We evaluated associations between MRSA molecular subgroups and high-density livestock production. METHODS We conducted a yearlong 2012 prospective study on a stratified random sample of patients with culture-confirmed MRSA infection; we oversampled patients from the Geisinger Health System with exposure to high-density livestock production in Pennsylvania. Isolates were characterized using S. aureus protein A (spa) typing and detection of Panton-Valentine leukocidin (PVL) and scn genes. We compared patients with one of two specific MRSA strains with patients with all other strains of MRSA isolates, using logistic regression that accounted for the sampling design, for two different exposure models: one based on the location of the animals (livestock model) and the other on crop field application of manure (crop field model). RESULTS Of 196 MRSA isolates, we identified 30 spa types, 47 PVL-negative and 15 scn-negative isolates, and no ST398 MRSA. Compared with quartiles 1-3 combined, the highest quartiles of swine livestock and dairy/veal crop field exposures were positively associated with community-onset-PVL-negative MRSA (CO-PVL-negative MRSA vs. all other MRSA), with adjusted odds ratios of 4.24 (95% CI: 1.60, 11.25) and 4.88 (95% CI: 1.40, 17.00), respectively. The association with CO-PVL-negative MRSA infection increased across quartiles of dairy/veal livestock exposure (trend p = 0.05). CONCLUSIONS Our findings suggest that other MRSA strains, beyond ST398, may be involved in livestock-associated MRSA infection in the United States.
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Affiliation(s)
- Joan A Casey
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Fry JP, Laestadius LI, Grechis C, Nachman KE, Neff RA. Investigating the role of state permitting and agriculture agencies in addressing public health concerns related to industrial food animal production. PLoS One 2014; 9:e89870. [PMID: 24587087 PMCID: PMC3933695 DOI: 10.1371/journal.pone.0089870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/24/2014] [Indexed: 12/26/2022] Open
Abstract
Objectives Industrial food animal production (IFAP) operations adversely impact environmental public health through air, water, and soil contamination. We sought to determine how state permitting and agriculture agencies respond to these public health concerns. Methods We conducted semi-structured qualitative interviews with staff at 12 state agencies in seven states, which were chosen based on high numbers or rapid increase of IFAP operations. The interviews served to gather information regarding agency involvement in regulating IFAP operations, the frequency and type of contacts received about public health concerns, how the agency responds to such contacts, and barriers to additional involvement. Results Permitting and agriculture agencies’ responses to health-based IFAP concerns are constrained by significant barriers including narrow regulations, a lack of public health expertise within the agencies, and limited resources. Conclusions State agencies with jurisdiction over IFAP operations are unable to adequately address relevant public health concerns due to multiple factors. Combining these results with previously published findings on barriers facing local and state health departments in the same states reveals significant gaps between these agencies regarding public health and IFAP. There is a clear need for regulations to protect public health and for public health professionals to provide complementary expertise to agencies responsible for regulating IFAP operations.
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Affiliation(s)
- Jillian P. Fry
- Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Linnea I. Laestadius
- Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland, United States of America
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States of America
| | - Clare Grechis
- Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Keeve E. Nachman
- Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Roni A. Neff
- Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Kim BF, Poulsen MN, Margulies JD, Dix KL, Palmer AM, Nachman KE. Urban community gardeners' knowledge and perceptions of soil contaminant risks. PLoS One 2014; 9:e87913. [PMID: 24516570 PMCID: PMC3916346 DOI: 10.1371/journal.pone.0087913] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 01/01/2014] [Indexed: 11/30/2022] Open
Abstract
Although urban community gardening can offer health, social, environmental, and economic benefits, these benefits must be weighed against the potential health risks stemming from exposure to contaminants such as heavy metals and organic chemicals that may be present in urban soils. Individuals who garden at or eat food grown in contaminated urban garden sites may be at risk of exposure to such contaminants. Gardeners may be unaware of these risks and how to manage them. We used a mixed quantitative/qualitative research approach to characterize urban community gardeners' knowledge and perceptions of risks related to soil contaminant exposure. We conducted surveys with 70 gardeners from 15 community gardens in Baltimore, Maryland, and semi-structured interviews with 18 key informants knowledgeable about community gardening and soil contamination in Baltimore. We identified a range of factors, challenges, and needs related to Baltimore community gardeners' perceptions of risk related to soil contamination, including low levels of concern and inconsistent levels of knowledge about heavy metal and organic chemical contaminants, barriers to investigating a garden site's history and conducting soil tests, limited knowledge of best practices for reducing exposure, and a need for clear and concise information on how best to prevent and manage soil contamination. Key informants discussed various strategies for developing and disseminating educational materials to gardeners. For some challenges, such as barriers to conducting site history and soil tests, some informants recommended city-wide interventions that bypass the need for gardener knowledge altogether.
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Affiliation(s)
- Brent F. Kim
- Johns Hopkins Center for a Livable Future, Baltimore, Maryland, United States of America
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Melissa N. Poulsen
- CLF-Lerner Fellow, Johns Hopkins Center for a Livable Future, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jared D. Margulies
- Johns Hopkins Center for a Livable Future, Baltimore, Maryland, United States of America
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Geography and Environmental Systems, University of Maryland, Baltimore, Maryland, United States of America
| | - Katie L. Dix
- Community Greening Resource Network, Parks & People Foundation, Baltimore, Maryland, United States of America
| | - Anne M. Palmer
- Johns Hopkins Center for a Livable Future, Baltimore, Maryland, United States of America
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Keeve E. Nachman
- Johns Hopkins Center for a Livable Future, Baltimore, Maryland, United States of America
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
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