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Estill CF, Mayer AC, Chen IC, Slone J, LaGuardia MJ, Jayatilaka N, Ospina M, Sjodin A, Calafat AM. Biomarkers of Organophosphate and Polybrominated Diphenyl Ether (PBDE) Flame Retardants of American Workers and Associations with Inhalation and Dermal Exposures. Environ Sci Technol 2024. [PMID: 38701378 DOI: 10.1021/acs.est.3c09342] [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] [Indexed: 05/05/2024]
Abstract
This study evaluated workers' exposures to flame retardants, including polybrominated diphenyl ethers (PBDEs), organophosphate esters (OPEs), and other brominated flame retardants (BFRs), in various industries. The study aimed to characterize OPE metabolite urinary concentrations and PBDE serum concentrations among workers from different industries, compare these concentrations between industries and the general population, and evaluate the likely route of exposure (dermal or inhalation). The results showed that workers from chemical manufacturing had significantly higher (p <0.05) urinary concentrations of OPE metabolites compared to other industries. Spray polyurethane foam workers had significantly higher (p <0.05) urinary concentrations of bis(1-chloro-2-propyl) phosphate (BCPP) compared to other industries. Electronic scrap workers had higher serum concentrations of certain PBDE congeners compared to the general population. Correlations were observed between hand wipe samples and air samples containing specific flame-retardant parent chemicals and urinary metabolite concentrations for some industries, suggesting both dermal absorption and inhalation as primary routes of exposure for OPEs. Overall, this study provides insights into occupational exposure to flame retardants in different industries and highlights the need for further research on emerging flame retardants and exposure reduction interventions.
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Affiliation(s)
- Cheryl Fairfield Estill
- National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio 45226, United States
| | - Alexander C Mayer
- National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio 45226, United States
| | - I-Chen Chen
- National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio 45226, United States
| | - Jonathan Slone
- RCS Corporation, Charlotte, North Carolina 27277, United States
| | - Mark J LaGuardia
- Virginia Institute of Marine Science, College of William & Mary, Gloucester Point, Virginia 23062, United States
| | - Nayana Jayatilaka
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Maria Ospina
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Andreas Sjodin
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
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Chang VC, Ospina M, Xie S, Andreotti G, Parks CG, Liu D, Madrigal JM, Ward MH, Rothman N, Silverman DT, Sandler DP, Friesen MC, Beane Freeman LE, Calafat AM, Hofmann JN. Urinary biomonitoring of glyphosate exposure among male farmers and nonfarmers in the Biomarkers of Exposure and Effect in Agriculture (BEEA) study. Environ Int 2024; 187:108644. [PMID: 38636272 DOI: 10.1016/j.envint.2024.108644] [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: 02/01/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
Glyphosate is the most widely applied herbicide worldwide. Glyphosate biomonitoring data are limited for agricultural settings. We measured urinary glyphosate concentrations and assessed exposure determinants in the Biomarkers of Exposure and Effect in Agriculture (BEEA) study. We selected four groups of BEEA participants based on self-reported pesticide exposure: recently exposed farmers with occupational glyphosate use in the last 7 days (n = 98), farmers with high lifetime glyphosate use (>80th percentile) but no use in the last 7 days (n = 70), farming controls with minimal lifetime use (n = 100), and nonfarming controls with no occupational pesticide exposures and no recent home/garden glyphosate use (n = 100). Glyphosate was quantified in first morning void urine using ion chromatography isotope-dilution tandem mass spectrometry. We estimated associations between urinary glyphosate concentrations and potential determinants using multivariable linear regression. Glyphosate was detected (≥0.2 µg/L) in urine of most farmers with recent (91 %) and high lifetime (93 %) use, as well as farming (88 %) and nonfarming (81 %) controls; geometric mean concentrations were 0.89, 0.59, 0.46, and 0.39 µg/L (0.79, 0.51, 0.42, and 0.37 µg/g creatinine), respectively. Compared with both control groups, urinary glyphosate concentrations were significantly elevated among recently exposed farmers (P < 0.0001), particularly those who used glyphosate in the previous day [vs. nonfarming controls; geometric mean ratio (GMR) = 5.46; 95 % confidence interval (CI): 3.75, 7.93]. Concentrations among high lifetime exposed farmers were also elevated (P < 0.01 vs. nonfarming controls). Among recently exposed farmers, glyphosate concentrations were higher among those not wearing gloves when applying glyphosate (GMR = 1.91; 95 % CI: 1.17, 3.11), not wearing long-sleeved shirts when mixing/loading glyphosate (GMR = 2.00; 95 % CI: 1.04, 3.86), applying glyphosate exclusively using broadcast/boom sprayers (vs. hand sprayer only; GMR = 1.70; 95 % CI: 1.00, 2.92), and applying glyphosate to crops (vs. non-crop; GMR = 1.72; 95 % CI: 1.04, 2.84). Both farmers and nonfarmers are exposed to glyphosate, with recency of occupational glyphosate use being the strongest determinant of urinary glyphosate concentrations. Continued biomonitoring of glyphosate in various settings is warranted.
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Affiliation(s)
- Vicky C Chang
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shuai Xie
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gabriella Andreotti
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine G Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA
| | - Danping Liu
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jessica M Madrigal
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mary H Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nathaniel Rothman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Debra T Silverman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA
| | - Melissa C Friesen
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laura E Beane Freeman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan N Hofmann
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Curl CL, Hyland C, Spivak M, Sheppard L, Lanphear B, Antoniou MN, Ospina M, Calafat AM. The Effect of Pesticide Spray Season and Residential Proximity to Agriculture on Glyphosate Exposure among Pregnant People in Southern Idaho, 2021. Environ Health Perspect 2023; 131:127001. [PMID: 38054699 PMCID: PMC10699167 DOI: 10.1289/ehp12768] [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] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 09/20/2023] [Accepted: 10/17/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Glyphosate is one of the most heavily used pesticides in the world, but little is known about sources of glyphosate exposure in pregnant people living in agricultural regions. OBJECTIVE Our objective was to evaluate glyphosate exposure during pregnancy in relation to residential proximity to agriculture as well as agricultural spray season. METHODS We quantified glyphosate concentrations in 453 urine samples collected biweekly from a cohort of 40 pregnant people in southern Idaho from February through December 2021. We estimated each participant's glyphosate exposure as the geometric mean (GM) of glyphosate concentrations measured in all samples (average n = 11 samples/participant), as well as the GM of samples collected during the pesticide "spray season" (defined as those collected 1 May-15 August; average n = 5 samples/participant) and the "nonspray season" (defined as those collected before 1 May or after 15 August; average n = 6 samples/participant). We defined participants who resided < 0.5 km from an actively cultivated agriculture field to live "near fields" and those residing ≥ 0.5 km from an agricultural field to live "far from fields" (n = 22 and 18, respectively). RESULTS Among participants living near fields, urinary glyphosate was detected more frequently and at significantly increased GM concentrations during the spray season in comparison with the nonspray season (81% vs. 55%; 0.228 μ g / L vs. 0.150 μ g / L , p < 0.001 ). In contrast, among participants who lived far from fields, neither glyphosate detection frequency nor GMs differed in the spray vs nonspray season (66% vs. 64%; 0.154 μ g / L vs. 0.165 μ g / L , p = 0.45 ). Concentrations did not differ by residential proximity to fields during the nonspray season (0.154 μ g / L vs. 0.165 μ g / L , for near vs. far, p = 0.53 ). DISCUSSION Pregnant people living near agriculture fields had significantly increased urinary glyphosate concentrations during the agricultural spray season than during the nonspray season. They also had significantly higher urinary glyphosate concentrations during the spray season than those who lived far from agricultural fields at any time of year, but concentrations did not differ during the nonspray season. These findings suggest that agricultural glyphosate spray is a source of exposure for people living near fields. https://doi.org/10.1289/EHP12768.
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Affiliation(s)
- Cynthia L. Curl
- School of Public and Population Health, Boise State University, Boise, Idaho, USA
| | - Carly Hyland
- School of Public and Population Health, Boise State University, Boise, Idaho, USA
- Division of Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA, USA
- Division of Agriculture and National Resources, University of California, Berkeley, CA, USA
| | - Meredith Spivak
- School of Public and Population Health, Boise State University, Boise, Idaho, USA
| | - Lianne Sheppard
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Bruce Lanphear
- Simon Fraser University, Vancouver, British Columbia, Canada
| | - Michael N. Antoniou
- Gene Expression and Therapy Group, Department of Medical and Molecular Genetics, King’s College London, London, UK
- Life Sciences and Medicine, Guy’s Hospital, London, UK
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Wambua D, Roman W, Vidanage I, Vidal M, Calafat AM, Ospina M. Online solid phase extraction high-performance liquid chromatography - Isotope dilution - Tandem mass spectrometry quantification of organophosphate pesticides, synthetic pyrethroids, and selected herbicide metabolites in human urine. Chemosphere 2023; 340:139863. [PMID: 37598954 PMCID: PMC10530585 DOI: 10.1016/j.chemosphere.2023.139863] [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] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/22/2023]
Abstract
Analytical methods to quantify pesticide biomarkers in human population studies are critical for exposure assessment given the widespread use of pesticides for pest and weed control and their potential for affecting human health. We developed a method to quantify, in 0.2 mL of urine, concentrations of 10 pesticide biomarkers: four organophosphate insecticide metabolites (3,5,6-trichloro-2-pyridinol (TCPy), 2-isopropyl-6-methyl-4-pyrimidinol, para-nitrophenol, malathion dicarboxylic acid); five synthetic pyrethroid insecticide metabolites (4-fluoro-3-phenoxybenzoic acid, 3-phenoxybenzoic acid, cis and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (DCCA), cis-3-(2,2-dibromovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid); and the herbicide 2,4-dichlorophenoxyacetic acid. he method is based on enzymatic hydrolysis of conjugated urinary metabolites, extraction and pre-concentration of the deconjugated metabolites using automated online solid-phase extraction, and separation and quantification using liquid chromatography-isotope dilution tandem mass spectrometry. Depending on the analyte, method detection limits were 0.1-0.6 ng/mL; mean accuracy, calculated as spike recoveries, was 91-102%, and total precision, given as percent variation coefficient, was 5.9-11.5%. Percent differences associated with three freeze-thaw cycles, 24-h benchtop storage, and short-term processed sample stability were <14%. Method suitability was assessed by recurring successful participation in external quality assessment schemes and by analyzing samples from subjects with suspected exposure to pesticides (n = 40) or who self-reported consuming an organic diet (n = 50). Interquartile ranges were considerably lower for people consuming an organic diet than for those potentially exposed for cis-DCCA (0.37 ng/mL vs 0.75 ng/mL), trans-DCCA (0.88 ng/mL vs 1.78 ng/mL) and TCPy (1.81 ng/mL vs 2.48 ng/mL). This method requires one-fifth of the sample used in our previous method and is suitable for assessing background exposures to select pesticides in large human populations and for studies with limited sample volumes.
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Affiliation(s)
- Dickson Wambua
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA, 30341, USA.
| | - William Roman
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA, 30341, USA
| | - Isuru Vidanage
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA, 30341, USA
| | - Meghan Vidal
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA, 30341, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA, 30341, USA
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA, 30341, USA
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Bommarito PA, Friedman A, Welch BM, Cantonwine DE, Ospina M, Calafat AM, Meeker JD, McElrath TF, Ferguson KK. Temporal trends and predictors of gestational exposure to organophosphate ester flame retardants and plasticizers. Environ Int 2023; 180:108194. [PMID: 37708814 PMCID: PMC10591987 DOI: 10.1016/j.envint.2023.108194] [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] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Organophosphate esters (OPEs), used as flame retardants and plasticizers, are chemicals of concern for maternal and infant health. Prior studies examining temporal trends and predictors of OPE exposure are primarily limited by small sample sizes. OBJECTIVES Characterize temporal trends and predictors of OPE exposure biomarkers. METHODS We determined urinary concentrations of eight biomarkers of OPE exposure at three timepoints during pregnancy for participants in the LIFECODES Fetal Growth Study (n = 900), a nested case-cohort recruited between 2007 and 2018. We examined biomarker concentrations, their variability during pregnancy, and temporal trends over the study period. In addition, we identified sociodemographic and pregnancy characteristics associated with biomarker concentrations. Analyses were conducted using both the within-subject pregnancy geometric means and biomarker concentrations measured at individual study visits. RESULTS Five OPE biomarkers were detected in at least 60% of the study participants. Biomarkers were not strongly correlated with one another and intraclass correlation coefficients, measuring within-subject variability during pregnancy, ranged from 0.27 to 0.51. Biomarkers exhibited varying temporal trends across study years. For example, bis(1-chloro-2-propyl) phosphate (BCIPP) increased monotonically, whereas bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) and diphenyl phosphate (DPHP), displayed non-monotonic trends with concentrations that peaked between 2011 and 2014. We observed associations between sociodemographic characteristics and OPE biomarkers. In general, concentrations of most OPE biomarkers were higher among participants from racial and ethnic minority populations, participants who were younger, had higher pre-pregnancy body mass index (BMI), and less than a college degree. We observed consistent results using either averaged or visit-specific biomarker concentrations. SIGNIFICANCE We observed widespread exposure to several OPEs and OPE biomarkers displayed varying temporal trends in pregnant people from 2007 to 2018. Concentrations of most OPE biomarkers varied according to sociodemographic factors, suggesting higher burdens of exposure among participants with higher pre-pregnancy BMI, those belonging to racial and ethnic minority populations, and lower educational attainment.
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Affiliation(s)
- P A Bommarito
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, 111 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
| | - A Friedman
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, 111 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
| | - B M Welch
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, 111 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA; School of Public Health, University of Nevada, Reno, Reno, NV, USA
| | - D E Cantonwine
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street Boston, MA 02115, USA
| | - M Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - A M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - J D Meeker
- Department of Environmental Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - T F McElrath
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street Boston, MA 02115, USA
| | - K K Ferguson
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, 111 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA.
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Yang W, Braun JM, Vuong AM, Percy Z, Xu Y, Xie C, Deka R, Calafat AM, Ospina M, Yolton K, Cecil KM, Lanphear BP, Chen A. Patterns of urinary organophosphate ester metabolite trajectories in children: the HOME Study. J Expo Sci Environ Epidemiol 2023:10.1038/s41370-023-00605-2. [PMID: 37777668 PMCID: PMC10988284 DOI: 10.1038/s41370-023-00605-2] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/03/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Organophosphate esters (OPEs) have replaced flame retardant polybrominated diphenyl ethers as flame retardants in consumer products, but few longitudinal studies have characterized childhood OPE exposure. OBJECTIVE We aimed to examine the exposure pattern of urinary OPE metabolites in children. METHODS We quantified three urinary OPE metabolites five times in children (1, 2, 3, 5, 8 years) from 312 mother-child pairs in the Health Outcomes and Measures of the Environment (HOME) Study, a prospective pregnancy and birth cohort in Cincinnati, Ohio, USA. We examined the associations of average maternal OPE metabolite concentrations with OPE metabolite concentrations in childhood, characterized childhood OPE trajectories with latent class growth analysis (LCGA), and examined factors related to trajectory membership. RESULTS Bis(2-chloroethyl) phosphate (BCEP) had the lowest median concentrations over time (0.66-0.97 mg/L) while the median concentrations of bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) increased with age (1.44-3.80 mg/L). The median concentrations of diphenyl phosphate (DPHP) fluctuated between 1.96 and 2.69 mg/L. Intraclass correlation coefficients for urinary metabolites measured at five time points indicated high variability within individuals (0.13-0.24). Average maternal urinary BCEP and BDCIPP were associated with concentrations in early childhood. Maternal education, the birth year of the child, and having a carpet in the main activity room were associated with BCEP and BDCIPP trajectory while none of the factors were associated with DPHP trajectory. SIGNIFICANCE The trajectory analysis showed different patterns of urinary OPE metabolite concentrations, suggesting the need to collect multiple samples to adequately reflect OPE exposure. IMPACT STATEMENT In this well-established cohort, we evaluated the patterns of urinary OPE metabolites in children ages 1-8 years. The number of repeated measures over childhood has not been achieved in prior studies. Our results suggested the high variability of urinary OPE metabolites within individuals. Maternal metabolite concentrations during pregnancy were related to child concentrations at ages 1-3 years. BCEP, BDCIPP, and DPHP demonstrated different trajectories in children, which suggests that multiple samples may be required to capture OPE exposure patterns in childhood.
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Affiliation(s)
- Weili Yang
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Zana Percy
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Changchun Xie
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ranjan Deka
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Ospina
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kimberly Yolton
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kim M Cecil
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Child and Family Research Institute, BC Children's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
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Hyland C, Spivak M, Sheppard L, Lanphear BP, Antoniou M, Ospina M, Calafat AM, Curl CL. Urinary Glyphosate Concentrations among Pregnant Participants in a Randomized, Crossover Trial of Organic and Conventional Diets. Environ Health Perspect 2023; 131:77005. [PMID: 37493357 PMCID: PMC10370340 DOI: 10.1289/ehp12155] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Consumption of an organic diet reduces exposure to a range of agricultural pesticides. Only three studies have examined the effect of an organic diet intervention on exposure to the herbicide glyphosate, the most heavily used agricultural chemical in the world. Despite its widespread use, the primary sources of glyphosate exposure in humans are poorly understood. OBJECTIVE Our objective was to examine the effect of an organic diet intervention on urinary glyphosate concentrations among pregnant individuals. METHODS We conducted a 2-wk randomized crossover trial in which 39 pregnant participants living near (≤ 0.5 km ) and far (> 0.5 km ) from agricultural fields received a 1-wk supply of conventional groceries and 1 wk of organic groceries, randomized to order. We collected daily first morning void urine samples and analyzed composite samples from each week for glyphosate. We examined differences in urinary glyphosate concentrations between the conventional week and the organic week among all participants and stratified by residential proximity to an agricultural field. RESULTS Median specific gravity-adjusted glyphosate concentrations were 0.19 μ g / L and 0.16 μ g / L during the conventional and organic weeks, respectively. We observed modest decreases in urinary glyphosate concentrations from the conventional to organic week among far-field participants, but no difference among near-field participants. In secondary analyses excluding participants who did not meet a priori criteria of compliance with the intervention, we observed significant decreases in urinary glyphosate concentrations, particularly among far-field participants (p < 0.01 - 0.02 , depending on exclusion criteria). DISCUSSION This trial is the first to examine the effect of an organic diet intervention on glyphosate among people living near and far from agricultural fields. Our results suggest that diet is an important contributor to glyphosate exposure in people living > 0.5 km from agricultural fields; for people living near crops, agriculture may be a dominant exposure source during the pesticide spray season. https://doi.org/10.1289/EHP12155.
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Affiliation(s)
- Carly Hyland
- School of Public and Population Health, Boise State University, Boise, Idaho, USA
- Division of Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Meredith Spivak
- School of Public and Population Health, Boise State University, Boise, Idaho, USA
| | - Lianne Sheppard
- School of Public Health, University of Washington, Seattle, Washington, USA
| | | | - Michael Antoniou
- Gene Expression and Therapy Group, King’s College London, Faculty of Life Sciences & Medicine, Department of Medical and Molecular Genetics, Guy’s Hospital, London, UK
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cynthia L. Curl
- School of Public and Population Health, Boise State University, Boise, Idaho, USA
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Bliznashka L, Roy A, Christiani DC, Calafat AM, Ospina M, Diao N, Mazumdar M, Jaacks LM. Pregnancy pesticide exposure and child development in low- and middle-income countries: A prospective analysis of a birth cohort in rural Bangladesh and meta-analysis. PLoS One 2023; 18:e0287089. [PMID: 37294794 PMCID: PMC10256216 DOI: 10.1371/journal.pone.0287089] [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: 01/29/2023] [Accepted: 05/30/2023] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Despite considerable evidence on a negative association between pregnancy pesticide exposure and child development in high-income countries, evidence from low- and middle-income countries (LMICs) is limited. Therefore, we assessed associations between pregnancy pesticide exposure and child development in rural Bangladesh and summarised existing literature in a systematic review and meta-analysis. METHODS We used data from 284 mother-child pairs participating in a birth cohort established in 2008. Eight urinary pesticide biomarkers were quantified in early pregnancy (mean gestational age 11.6±2.9 weeks) as an index of pesticide exposure. The Bayley Scales of Infant and Toddler Development, Third Edition were administered at 20-40 months of age. Associations between creatinine-adjusted urinary pesticide biomarker concentrations and child development scores were estimated using multivariable generalised linear models. We searched ten databases up to November 2021 to identify prospective studies on pregnancy pesticide exposure and child development conducted in LMICs. We used a random-effects model to pool similar studies, including our original analysis. The systematic review was pre-registered with PROSPERO: CRD42021292919. RESULTS In the Bangladesh cohort, pregnancy 2-isopropyl-4-methyl-6-hydroxypyrimidine (IMPY) concentrations were inversely associated with motor development (-0.66 points [95% CI -1.23, -0.09]). Pregnancy 3,5,6-trichloro-2-pyridinol (TCPY) concentrations were inversely associated with cognitive development, but the association was small: -0.02 points (-0.04, 0.01). We observed no associations between 4-nitrophenol and 3-phenoxybenzoic acid (3-PBA) concentrations and child development. The systematic review included 13 studies from four LMICs. After pooling our results with one other study, we found consistent evidence that pregnancy 3-PBA concentrations were not associated with cognitive, language, or motor development. CONCLUSION Evidence suggests that pregnancy exposure to some organophosphate pesticides is negatively associated with child development. Interventions to reduce in-utero pesticide exposure in LMICs may help protect child development.
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Affiliation(s)
- Lilia Bliznashka
- Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, DC, United States of America
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Scotland, United Kingdom
| | - Aditi Roy
- Center for Environmental Health, Public Health Foundation of India, New Delhi, India
| | - David C. Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Antonia M. Calafat
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Maria Ospina
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Nancy Diao
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Maitreyi Mazumdar
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Neurology, Boston Children’s Hospital, Boston, MA, United States of America
| | - Lindsay M. Jaacks
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Scotland, United Kingdom
- Center for Environmental Health, Public Health Foundation of India, New Delhi, India
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9
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Percy Z, Chen A, Sucharew H, Yang W, Vuong AM, Braun JM, Lanphear B, Ospina M, Calafat AM, Cecil KM, Xu Y, Yolton K. Early-life exposure to a mixture of organophosphate esters and child behavior. Int J Hyg Environ Health 2023; 250:114162. [PMID: 36989997 PMCID: PMC10149607 DOI: 10.1016/j.ijheh.2023.114162] [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: 12/05/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Organophosphate esters (OPEs), widely used as flame retardants and plasticizers for commercial and residential purposes, are suspected of being neurotoxic. We aimed to assess exposure to an OPE mixture in early life and its relationship to parent-reported child behavior. We measured urinary concentrations of three OPE metabolites, bis-2-chloroethyl phosphate (BCEP), bis(1,3-dichloro-2-propyl) phosphate (BDCIPP), and diphenyl phosphate (DPHP), at pregnancy (16 and 26 weeks of gestation and delivery) and postnatal time points (ages 1, 2, 3, and 5 years) in the Health Outcomes and Measures of the Environment Study, a longitudinal pregnancy and birth cohort in Cincinnati, Ohio, USA (enrolled 2003-2006, n = 219). We used latent variable analysis in structural equations models and quantile g-computation to investigate associations of a mixture of the three OPE metabolites with parent-reported child behaviors at 3 and 8 years, measured using the Behavioral Assessment System for Children, Second Edition. Higher log-transformed urinary OPE latent variable values at 16 weeks were associated with fewer externalizing problem behaviors (ß = -5.74; 95% CI = -11.24, -0.24) and fewer overall behavioral problems at age 3 years (ß = -5.26; 95% CI = -10.33, -0.19), whereas having higher OPEs at delivery was associated with poorer overall behavioral problems at age 3 years (ß = 2.87; 95% CI = 0.13, 5.61). OPE latent variable values at 16 weeks, 26 weeks, and delivery were not associated with child behavior at 8 years. However, higher OPE latent variable values at 3 years were associated with fewer externalizing behaviors at 8 years (ß = -2.62; 95% CI = -5.13, -0.12). The quantile g-computation estimates had directions largely consistent with the latent variable analysis results. Pregnancy and postnatal urinary OPE metabolite mixtures were associated with child internalizing, externalizing, and overall negative behaviors at 3 and 8 years, but we did not identify a consistent pattern in terms of the direction of the effects or a particularly sensitive time point.
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Affiliation(s)
- Zana Percy
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, USA.
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Heidi Sucharew
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Weili Yang
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Bruce Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Maria Ospina
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kim M Cecil
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kimberly Yolton
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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10
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Werthmann DW, Rabito FA, Adamkiewicz G, Reponen T, Calafat AM, Ospina M, Chew GL. Pesticide exposure and asthma morbidity in children residing in urban, multi-family housing. J Expo Sci Environ Epidemiol 2023:10.1038/s41370-023-00524-2. [PMID: 36765101 PMCID: PMC10412724 DOI: 10.1038/s41370-023-00524-2] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Children are potentially more susceptible to the adverse effects of pesticides due to more sensitive organ systems and lower capacity to metabolize and eliminate chemicals compared to adults. The health risks are particularly concerning children with asthma, living in low-income neighborhoods in multi-family housing because of their impaired respiratory health, and factors associated with low-income, multi-family environments. OBJECTIVE To assess the association between pesticide exposure and asthma morbidity among children 7-12 years residing in low-income, multi-family housing. METHODS The concentrations of seven urinary pesticide biomarkers: 3,5,6-trichloro-2-pyridinol (TCPy), 2-isopropyl-4-methyl-6-hydroxypyrimidine, para-nitrophenol (PNP), 3-phenoxybenzoic acid (3-PBA), 4-fluoro-3-phenoxybenzoic acid, trans-3-(2,2-dichlorovinyl)-2,2-dimethyl-cyclopropane-1-carboxylic acid, and 2,4-dichlorophenoxyacetic acid (2,4-D) were measured. Children (n = 162) were followed for one year with three measures of pesticides biomarkers. Associations between individual biomarkers and asthma attack, asthma related health care utilization, and fraction of exhaled nitric oxide (FeNO), adjusting for demographic and household factors were examined with Generalized Estimating Equations (GEE). Weighted Quantile Sum (WQS) regression was used to examine the effect of pesticide mixture on asthma attacks and asthma-related health care utilization (HCU). RESULTS In adjusted GEE models, positive non-significant associations were found between PNP and HCU (adjusted Odds Ratio(aOR):2.05 95% CI:0.76-5.52) and null associations for 3-PBA and HCU (aOR:1.07 95% CI: 0.88-1.29). Higher concentrations of PNP and 2,4-D were associated with significantly lower FeNO levels (PNP: -17.4%; 2,4-D:-19.74%). The mixture was positively associated with HCU in unadjusted (OR: 1.56 97.5% CI: 1.08-2.27) but not significant in adjusted models (aOR: 1.40 97.5% CI: .86-2.29). The non-specific pyrethroid biomarker 3-PBA at baseline contributed the greatest weight to the index (45%). SIGNIFICANCE There were non-significant associations between pesticide biomarkers and respiratory outcomes in children with asthma. There was a suggestive association between urinary pesticide biomarkers and HCU. Further studies with larger sample sizes could help to confirm these findings. IMPACT STATEMENT Pesticide exposure among children in the urban environment is ubiquitous and there is a dearth of information on the impact of low-level chronic exposure in vulnerable populations. This study suggested that pesticide exposure at concentrations below the national average may not affect asthma morbidity in children. However, different biomarkers of pesticides showed different effects, but the mixture suggested increasing pesticide exposure results in asthma related HCU. The results may show that children with asthma may be at risk for negative health outcomes due to pesticides and the need to further examine this relationship.
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Affiliation(s)
- Derek W Werthmann
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Felicia A Rabito
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Tiina Reponen
- University of Cincinnati, Department of Environmental and Public Health Sciences, Cincinnati, OH, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ginger L Chew
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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11
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Yang W, Braun JM, Vuong AM, Percy Z, Xu Y, Xie C, Deka R, Calafat AM, Ospina M, Burris HH, Yolton K, Cecil KM, Lanphear BP, Chen A. Gestational exposure to organophosphate esters and infant anthropometric measures in the first 4 weeks after birth. Sci Total Environ 2023; 857:159322. [PMID: 36220473 PMCID: PMC9883112 DOI: 10.1016/j.scitotenv.2022.159322] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Few studies have examined whether gestational exposure to organophosphate esters (OPEs), widely used chemicals with potential endocrine-disrupting potency and developmental toxicity, is associated with impaired infant growth. METHODS We analyzed data from 329 mother-infant pairs in the Health Outcomes and Measures of the Environment (HOME) Study (2003-2006, Cincinnati, Ohio, USA). We quantified concentrations of four OPE metabolites in maternal urine collected at 16 and 26 weeks of gestation, and at delivery. We calculated z-scores using 2006 World Health Organization (WHO) child growth standards for the 4-week anthropometric measures (weight, length, and head circumference), the ponderal index, and weekly growth rates. We used multiple informant models to examine window-specific associations between individual OPE metabolites and anthropometric outcomes. We further modeled OPEs as a mixture for window-specific associations with 4-week anthropometric outcomes using mean field variational Bayesian inference procedure for lagged kernel machine regression (MFVB-LKMR). We stratified the models by infant sex. RESULTS Diphenyl phosphate (DPHP) in mothers at 16 weeks, and bis(2-chloroethyl) phosphate (BCEP) and bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) at delivery were positively associated with z-scores of weight, length, and head circumference in all infants at 4 weeks of age. After stratifying by infant sex, positive associations were only observed in males for DPHP at 16 weeks and BCEP at delivery and in females for BDCIPP at delivery. Negative associations not present in all infants were observed in males for di-n-butyl phosphate (DNBP) at 26 weeks of gestation with weight z-score and DPHP at delivery with head circumference z-score. Results were generally similar using MFVB-LKMR models with more conservative 95 % credible intervals. We did not identify consistent associations of gestational OPE metabolite concentrations with the ponderal index and weekly growth rates. CONCLUSION In this cohort, exposure to OPEs during gestation was associated with altered infant anthropometry at 4 weeks after birth.
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Affiliation(s)
- Weili Yang
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Zana Percy
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Changchun Xie
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ranjan Deka
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Ospina
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heather H Burris
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kimberly Yolton
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kim M Cecil
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Child and Family Research Institute, BC Children's Hospital, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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12
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Chang VC, Andreotti G, Ospina M, Parks CG, Liu D, Shearer JJ, Rothman N, Silverman DT, Sandler DP, Calafat AM, Beane Freeman LE, Hofmann JN. Glyphosate Exposure and Urinary Oxidative Stress Biomarkers in the Agricultural Health Study. J Natl Cancer Inst 2023; 115:394-404. [PMID: 36629488 PMCID: PMC10086635 DOI: 10.1093/jnci/djac242] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/03/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Glyphosate is the most widely applied herbicide worldwide, and its use has been associated with increased risks of certain hematopoietic cancers in epidemiologic studies. Animal and in vitro experiments suggest that glyphosate may induce oxidative stress, a key characteristic of carcinogens; however, evidence in human populations remains scarce. We investigated associations between glyphosate exposure and urinary oxidative stress biomarkers in the Biomarkers of Exposure and Effect in Agriculture study, a molecular epidemiologic subcohort in the Agricultural Health Study. METHODS This analysis included 268 male farmers selected based on self-reported recent and lifetime occupational glyphosate use and 100 age- and geography-matched male non-farmers. Concentrations of glyphosate and oxidative stress biomarkers (8-hydroxy-2'-deoxyguanosine [8-OHdG], 8-iso-prostaglandin-F2α [8-isoprostane], and malondialdehyde [MDA]) were quantified in first-morning-void urine. We performed multivariable linear regression to evaluate associations of urinary glyphosate and self-reported glyphosate use with each oxidative stress biomarker. RESULTS Urinary glyphosate concentrations were positively associated with levels of 8-OHdG (highest vs. lowest glyphosate quartile; geometric mean ratio [GMR]=1.15, 95% confidence interval [CI]=1.03-1.28, Ptrend=.02) and MDA (GMR = 1.20, 95% CI = 1.03-1.40, Ptrend=.06) overall. Among farmers reporting recent glyphosate use (last 7 days), use in the previous day was also associated with significantly increased 8-OHdG and MDA levels. Compared with non-farmers, we observed elevated 8-isoprostane levels among farmers with recent, high past 12-month, or high lifetime glyphosate use. CONCLUSIONS Our findings contribute to the weight of evidence supporting an association between glyphosate exposure and oxidative stress in humans and may inform evaluations of the carcinogenic potential of this herbicide.
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Affiliation(s)
- Vicky C Chang
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gabriella Andreotti
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maria Ospina
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine G Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA
| | - Danping Liu
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joseph J Shearer
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nathaniel Rothman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Debra T Silverman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laura E Beane Freeman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan N Hofmann
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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13
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Proctor SP, Nguyen VT, Hebert AA, Taylor KM, McClung HL, Heaton KJ, Ospina M, Calafat AM. Individual-level permethrin exposure biomarkers in U.S. army soldiers: comparison of two treatment formulations for military uniforms. J Expo Sci Environ Epidemiol 2023; 33:132-139. [PMID: 35999257 PMCID: PMC10140735 DOI: 10.1038/s41370-022-00466-1] [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] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Evidence suggests that wearing permethrin-treated military uniforms is not associated with current adverse health conditions. However, exposure through this route results in permethrin biomarker concentrations considerably higher than those in the U.S. POPULATION The U.S. Army is exploring different methods of uniform treatment that reduce exposure while maintaining effective protection from insect vector-borne diseases. OBJECTIVE To compare permethrin exposure when wearing two types of permethrin-treated military uniforms. METHODS Eight male soldiers participated in a 32-day crossover design study to compare permethrin exposure when wearing the current Army uniform (CurrU) and a uniform with a new applied fabric treatment (NewU). Each soldier wore the uniforms for designated 8 h/day time periods over 3 consecutive days separated by a 'wash-out' week of no exposure. Permethrin exposure was assessed from the urinary concentrations of 3-phenoxybenzoic acid (3-PBA) and of the sum of cis- and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (∑DCCA). Estimated dose was determined based on ∑DCCA concentrations. RESULTS Permethrin exposure biomarkers were 21% (3-PBA, p = 0.025) and 35% (∑DCCA, p < 0.001) lower when wearing the NewU compared to the CurrU; the dose was 33% lower (p = 0.05). SIGNIFICANCE Findings suggest the new treatment reduces human permethrin exposure biomarkers resulting from wearing-treated military uniforms.
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Affiliation(s)
- Susan P Proctor
- Military Performance Division, United States Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA, USA.
- VA Boston Healthcare System, Research Service, 180 South Huntington Avenue, Boston, MA, USA.
| | - V T Nguyen
- Military Performance Division, United States Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA, USA
| | - Ashley A Hebert
- Military Performance Division, United States Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA, USA
| | - Kathryn M Taylor
- Military Performance Division, United States Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA, USA
| | - Holly L McClung
- Military Performance Division, United States Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA, USA
| | - Kristin J Heaton
- Military Performance Division, United States Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA, USA
| | - Maria Ospina
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, 4770 Buford Hwy, Atlanta, GA, USA
| | - Antonia M Calafat
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, 4770 Buford Hwy, Atlanta, GA, USA
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14
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Yang W, Braun JM, Vuong AM, Percy Z, Xu Y, Xie C, Deka R, Calafat AM, Ospina M, Burris HH, Yolton K, Cecil KM, Lanphear BP, Chen A. Associations of gestational exposure to organophosphate esters with gestational age and neonatal anthropometric measures: The HOME study. Environ Pollut 2023; 316:120516. [PMID: 36341822 PMCID: PMC9884151 DOI: 10.1016/j.envpol.2022.120516] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Organophosphate esters (OPEs) are developmental toxicants in experimental studies of animals, but limited evidence is available in humans. We included 340 mother-infant pairs in the Health Outcomes and Measures of the Environment (HOME) Study (Cincinnati, Ohio, USA) for the analysis. We evaluated gestational exposure to OPEs with gestation age at birth and newborn anthropometric measures. We quantified four OPE urinary metabolites at 16 weeks and 26 weeks of gestation. We extracted gestational age at birth, newborn weight, length, and head circumference from the chart review. We calculated z-scores for these anthropometric measures and the ponderal index. We used multiple informant models to examine the associations between repeated OPE measurements and the outcomes. We used modified Poisson regression to estimate the association of gestational exposure to OPEs with preterm birth. We also explored effect modification by infant sex and the potential mediation effect by the highest maternal blood pressure and glucose levels. We found that bis(2-chloroethyl) phosphate (BCEP) at 16 weeks and diphenyl phosphate at 26 weeks of pregnancy were positively associated with gestational age and inversely associated with preterm birth. In female newborns, BCEP at 16 weeks was inversely related to birth weight and length z-scores. In male newborns, we observed negative associations of 26-week di-n-butyl phosphate with the ponderal index at birth. No mediation by the highest maternal blood pressure or glucose levels during pregnancy was identified. In this cohort, gestational exposure to some OPEs was associated with gestational age, preterm birth, and neonatal anthropometric measures. Certain associations tended to be window- and infant sex-specific.
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Affiliation(s)
- Weili Yang
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Zana Percy
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Changchun Xie
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ranjan Deka
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Ospina
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heather H Burris
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kimberly Yolton
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kim M Cecil
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Child and Family Research Institute, BC Children's Hospital, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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15
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Kuiper JR, Vuong AM, Lanphear BP, Calafat AM, Ospina M, Cecil KM, Xu Y, Yolton K, Kalkwarf HJ, Braun JM, Chen A, Buckley JP. Early life organophosphate ester exposures and bone health at age 12 years: The Health Outcomes and Measures of the Environment (HOME) Study. Sci Total Environ 2022; 851:158246. [PMID: 36030851 PMCID: PMC9606835 DOI: 10.1016/j.scitotenv.2022.158246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/14/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND No human studies have evaluated early life organophosphate ester (OPE) exposures with bone health outcomes, despite evidence of osteotoxicity. OBJECTIVES We assessed associations of urinary OPE metabolites measured across early life with areal bone mineral density (aBMD) and bone mineral content (BMC) at age 12 years. METHODS Among 223 mother-child dyads enrolled in the Health Outcomes and Measures of the Environment (HOME) Study, we quantified concentrations of bis-2-chloroethyl phosphate (BCEP), bis-(1,3-dichloro-2-propyl) (BDCIPP), di-n-butyl phosphate (DnBP), and diphenyl phosphate (DPHP) in urine collected from mothers during pregnancy and children at ages 1, 2, 3, 5, and 8 years. At age 12 years, we performed dual energy x-ray absorptiometry and calculated aBMD and BMC z-scores at six skeletal sites. We estimated overall and sex-stratified BMD/BMC z-score differences per interquartile range (IQR) increase in OPE concentrations at multiple exposure timepoints: gestation (average) and 1-3 (average), 5, and 8 years. RESULTS In adjusted models, overall associations of BCEP and BDCIPP with total hip and 1/3rd distal radius aBMD and BMC varied significantly by exposure timepoint, as did BDCIPP with whole body aBMD. For example, differences (95 % CI) in total hip aBMD z-score per IQR increase in BDCIPP were 0.33 (0.01, 0.64), -0.10 (-0.34, 0.14), -0.18 (-0.40, 0.05), and 0.14 (-0.09, 0.38) for concentrations during gestation and at 1-3, 5, and 8 years, respectively. Overall DnBP and DPHP associations were generally null at all timepoints. We observed sex-specific associations for some timepoints and skeletal sites. For example, an IQR increase in 8-year DPHP was associated with a 0.21 (0.05, 0.38) greater total hip aBMD z-score among females but -0.19 (-0.43, 0.05) lower z-score among males. DISCUSSION Early life OPE exposures may be associated with sex- and exposure period-dependent alterations in early adolescent bone mineral accrual and strength.
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Affiliation(s)
- Jordan R Kuiper
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kim M Cecil
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Heidi J Kalkwarf
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jessie P Buckley
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Percy Z, Chen A, Yang W, Braun JM, Lanphear B, Ospina M, Calafat AM, Xie C, Cecil KM, Vuong AM, Xu Y, Yolton K. Childhood urinary organophosphate esters and cognitive abilities in a longitudinal cohort study. Environ Res 2022; 215:114265. [PMID: 36103927 PMCID: PMC9968469 DOI: 10.1016/j.envres.2022.114265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/05/2022] [Revised: 08/12/2022] [Accepted: 08/31/2022] [Indexed: 06/13/2023]
Abstract
The use of organophosphate esters (OPEs) as flame retardants, which has increased over the past two decades, raises concerns that OPEs may be harmful to humans, especially children. Animal studies and some human studies have reported that OPEs may adversely impact brain development, but few human studies evaluated OPE exposure during early childhood and neurodevelopmental outcomes. We aimed to fill this knowledge gap with the present study on urinary OPE metabolite concentrations at ages 1-5 years and cognitive abilities at 8 years. We used data of 223 children from the Health Outcomes and Measures of the Environment (HOME) Study, a prospective pregnancy and birth cohort in Cincinnati, Ohio. The point estimates for bis-2-chloroethyl-phosphate (BCEP) and bis(1,3-dichloro-2-propyl)-phosphate (BDCIPP) in association with IQ tended to be small and positive, while the point estimates for diphenyl-phosphate (DPHP) were small and negative, with 95% CIs including the null. However, we did find that socioeconomic status (SES) variables modified associations between OPEs and child IQ, with adverse OPE-IQ associations being stronger in socioeconomically disadvantaged children than in others. We identified an additional 1- to 2-point decrease in Full Scale IQ for every log-unit increase in BDCIPP, BCEP, and DPHP among those with lower maternal education, non-white race, lower income, or living in more deprived neighborhoods. We observed similar results for the Perceptual Reasoning, Verbal Comprehension, and Working Memory Index Scores. We suspect that there is residual confounding related to socioeconomic disadvantage, which was not captured with the available SES variables typically used in epidemiologic studies.
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Affiliation(s)
- Zana Percy
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Weili Yang
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Bruce Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Maria Ospina
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Changchung Xie
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Kim M Cecil
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kimberly Yolton
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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17
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Ospina M, Schütze A, Morales-Agudelo P, Vidal M, Wong LY, Calafat AM. Exposure to glyphosate in the United States: Data from the 2013-2014 National Health and Nutrition Examination Survey. Environ Int 2022; 170:107620. [PMID: 36368224 DOI: 10.1016/j.envint.2022.107620] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Exposure to glyphosate, the most used herbicide in the United States, is not well characterized. We assessed glyphosate exposure in a representative sample of the U.S. population ≥ 6 years from the 2013-2014 National Health and Nutrition Examination Survey. METHODS We quantified glyphosate in urine (N = 2,310) by ion chromatography isotope-dilution tandem mass spectrometry. We conducted univariate analysis using log-transformed creatinine-corrected glyphosate concentrations with demographic and lifestyle covariates we hypothesized could affect glyphosate exposure based on published data including race/ethnicity, sex, age group, family income to poverty ratio, fasting time, sample collection season, consumption of food categories (including cereal consumption) and having used weed killer products. We used multiple logistic regression to examine the likelihood of glyphosate concentrations being above the 95th percentile and age-stratified multiple linear regression to evaluate associations between glyphosate concentrations and statistically significant covariates from the univariate analysis: race/ethnicity, sex, age group, fasting time, cereal consumption, soft drink consumption, sample collection season, and urinary creatinine. RESULTS Glyphosate weighted detection frequency was 81.2 % (median (interquartile range): 0.392 (0.263-0.656) μg/L; 0.450 (0.266-0.753) μg/g creatinine). Glyphosate concentration decreased from age 6-11 until age 20-59 and increased at 60+ years in univariate analyses. Children/adolescents and adults who fasted > 8 h had significantly lower model-adjusted geometric means (0.43 (0.37-0.51) μg/L and 0.37 (0.33-0.39) μg/L) than those fasting ≤ 8 h (0.51 (0.46-0.56) μg/L and 0.44 (0.41-0.48) μg/L), respectively. The likelihood (odds ratio (95 % CI)) of glyphosate concentrations being > 95th percentile was 1.94 (1.06-3.54) times higher in people who fasted ≤ 8 h than people fasting > 8 h (P = 0.0318). CONCLUSIONS These first nationally representative data suggest that over four-fifths of the U.S. general population ≥ 6 years experienced recent exposure to glyphosate. Variation in glyphosate concentration by food consumption habits may reflect diet or lifestyle differences.
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Affiliation(s)
- Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA 30341, USA.
| | - Andre Schütze
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA 30341, USA
| | - Pilar Morales-Agudelo
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA 30341, USA
| | - Meghan Vidal
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA 30341, USA
| | - Lee-Yang Wong
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA 30341, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA 30341, USA
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18
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Yang W, Braun JM, Vuong AM, Percy Z, Xu Y, Xie C, Deka R, Calafat AM, Ospina M, Yolton K, Cecil KM, Lanphear BP, Chen A. Maternal urinary organophosphate ester metabolite concentrations and glucose tolerance during pregnancy: The HOME Study. Int J Hyg Environ Health 2022; 245:114026. [PMID: 36029741 PMCID: PMC10127082 DOI: 10.1016/j.ijheh.2022.114026] [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: 03/22/2022] [Revised: 07/22/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Endocrine-disrupting chemicals may alter glucose homeostasis, especially during pregnancy. Biomonitoring studies suggest ubiquitous human exposure to organophosphate esters (OPEs), chemicals with endocrine-disrupting capabilities. Few studies have examined the association between maternal exposure to OPEs and blood glucose during pregnancy. METHODS With data from 301 pregnant women in the Health Outcomes and Measures of the Environment (HOME) Study, a prospective pregnancy and birth cohort in Cincinnati, Ohio, USA, we examined whether OPE concentrations were associated with changes in blood glucose. We quantified four OPE metabolites in maternal spot urine samples collected at 16- and 26-weeks pregnancy. We extracted results from the glucose challenge test (GCT) and oral glucose tolerance test (OGTT) via medical chart review. Women with GCT ≥ 140 mg/dL or any abnormal values in OGTT (≥ 95 mg/dL fasting glucose, ≥ 180 mg/dL 1-h glucose, ≥ 155 mg/dL 2-h glucose, ≥ 140 mg/dL 3-h glucose) were defined as having elevated glucose levels. We used linear regression and Bayesian Kernel Machine Regression (BKMR) to estimate the associations of individual OPE metabolites and OPE mixtures with blood glucose levels during pregnancy. We used modified Poisson regression to estimate the associations of OPE metabolite concentrations with elevated glucose levels. We further examined effect measure modification by maternal characteristics (age, pre-pregnancy body mass index [BMI], and race/ethnicity). RESULTS Diphenyl phosphate (DPHP) had the highest geometric mean concentration of the urinary OPE metabolites (1.83 μg/L at 16 weeks, 1.24 μg/L at 26 weeks). Thirty women (10.0%) had elevated glucose levels. Individual OPE metabolites or their mixtures were not significantly associated with continuous GCT results. We did not observe effect measure modification by maternal age, pre-pregnancy BMI categories, or race/ethnicity. Compared with women in the 1st tertile of average DPHP of 16- and 26 weeks of pregnancy, women in the 3rd tertile tended to have a reduced risk of elevated glucose levels (RR = 0.41, 95% CI = 0.16-1.06, p for trend = 0.06). CONCLUSION In this cohort, maternal urinary OPE metabolite concentrations were weakly associated with blood glucose levels during pregnancy.
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Affiliation(s)
- Weili Yang
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Zana Percy
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Changchun Xie
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ranjan Deka
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Ospina
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kimberly Yolton
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kim M Cecil
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Child and Family Research Institute, BC Children's Hospital, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
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19
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Bliznashka L, Diao N, Christiani D, Calafat A, Ospina M, Mazumdar M, Hasan MOSI, Wright R, Quamruzzaman Q, Jaacks L. Prenatal Pesticide Exposure Is Associated With Lower Cognitive, Language, and Motor Development Scores in Children 20–40 Months of Age Rural Bangladesh. Curr Dev Nutr 2022. [PMCID: PMC9193688 DOI: 10.1093/cdn/nzac060.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives Pesticides are an often-overlooked dietary exposure, especially in low- and middle-income countries (LMICs). Evidence from high-income settings indicates that pesticide exposure during pregnancy can adversely affect early childhood development (ECD). However, evidence from LMICs is limited. Our objective was to quantify the associations between prenatal pesticide exposure and ECD in rural Bangladesh. Methods We used data from 284 mother-child pairs participating in a birth cohort established in 2008. Eight pesticide biomarkers were assessed in urine collected in early pregnancy (<16 weeks' gestation). Urinary pesticide biomarkers capture all exposure routes. In our sample, 0% of women and 23% of their husbands were employed in agriculture, and indoor residual spraying is rare in this part of Bangladesh. Thus, we hypothesised that the primary pesticide exposure route was dietary intake. ECD was assessed at 20–40 months of age using the Bayley Scales of Infant and Toddler Development, Third Edition. Associations between creatinine-adjusted pesticide levels and child development raw scores were estimated using multivariable generalised linear models. Results 3,5,6-trichloro-2-pyridinol (TCPY) and 4-nitrophenol, metabolites of frequently used organophosphates, were detected in 98% and 100% of women, respectively. The metabolites 3-phenoxybenzoic acid (3-PBA, a pyrethroid metabolite) and 2-isopropyl-4-methyl-6-hydroxypyrimidine (IMPY, an organophosphate metabolite) were detected in 19.8% and 16.1% of women, respectively. Higher IMPY concentrations were associated with lower language (−0.67 points [95% CI −1.31, −0.04]) and motor development (−0.40 points [95% CI −0.71, −0.09]). Higher TCPY concentrations were associated with lower cognitive development, though the association was small: −0.01 points (95% CI −0.02, 0.00). We observed no associations between 4-nitrophenol and 3-PBA and child development. Conclusions Exposure to organophosphates, which are acetylcholinesterase inhibitors, in early pregnancy may adversely affect ECD. Interventions to reduce children's pesticide exposure in LMICs are needed. Funding Sources Funding was provided by UK Research and Innovation, (removed to allow blinded review), and the National Institutes of Health (NIEHS).
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Affiliation(s)
- Lilia Bliznashka
- Global Academy of Agriculture and Food Security, University of Edinburgh
| | - Nancy Diao
- Harvard T.H. Chan School of Public Health
| | | | | | | | | | | | | | | | - Lindsay Jaacks
- Global Academy of Agriculture and Food Security, University of Edinburgh
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20
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Skomal AE, Zhang J, Yang K, Yen J, Tu X, Suarez-Torres J, Lopez-Paredes D, Calafat AM, Ospina M, Martinez D, Suarez-Lopez JR. Concurrent urinary organophosphate metabolites and acetylcholinesterase activity in Ecuadorian adolescents. Environ Res 2022; 207:112163. [PMID: 34627797 PMCID: PMC9138777 DOI: 10.1016/j.envres.2021.112163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/01/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Organophosphates are insecticides that inhibit the enzymatic activity of acetylcholinesterase (AChE). Because of this, AChE is considered a physiological marker of organophosphate exposure in agricultural settings. However, limited research exists on the associations between urinary organophosphate metabolites and AChE activity in children. METHODS This study included 526 participants from 2 exams (April and July-October 2016) of ages 12-17 years living in agricultural communities in Ecuador. AChE activity was measured at both examinations, and organophosphate metabolites, including para-nitrophenol (PNP), 3,5,6-trichloro-2-pyridinol (TCPy), and malathion dicarboxylic acid (MDA) were measured in urine collected in July-October. We used generalized estimating equation generalized linear model (GEEGLM), adjusting for hemoglobin, creatinine, and other demographic and anthropometric covariates, to estimate associations of urinary metabolite concentrations with AChE activity (July-October) and AChE% change between April and July-October. RESULTS The mean (SD) of AChE and AChE% change (April vs July-October) were 3.67 U/mL (0.54) and -2.5% (15.4%), respectively. AChE activity was inversely associated with PNP concentration, whereas AChE% change was inversely associated with PNP and MDA. There was evidence of a threshold: difference was only significant above the 80th percentile of PNP concentration (AChE difference per SD increase of metabolite = -0.12 U/mL [95%CI: 0.20, -0.04]). Likewise, associations with AChE% change were significant only above the 80th percentile of TCPy (AChE % change per SD increase of metabolite = -1.38% [95%CI: 2.43%, -0.32%]) and PNP -2.47% [95%CI: 4.45%, -0.50%]). PNP concentration at ≥80th percentile was associated with elevated ORs for low AChE activity of 2.9 (95% CI: 1.5, 5.7) and for AChE inhibition of ≤ -10% of 3.7 (95% CI: 1.4, 9.8). CONCLUSIONS Urinary organophosphate metabolites, including PNP, TCPy and MDA, particularly at concentrations above the 80th percentile, were associated with lower AChE activity among adolescents. These findings bring attention to the value of using multiple constructs of pesticide exposure in epidemiologic studies.
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Affiliation(s)
- Ana E Skomal
- School of Medicine, University of California-San Diego, La Jolla, CA, USA
| | - Jasen Zhang
- Herbert Wertheim School of Public Health, University of California-San Diego, La Jolla, CA, USA
| | - Kun Yang
- School of Medicine, University of California-San Diego, La Jolla, CA, USA
| | - Jessica Yen
- School of Medicine, University of California-San Diego, La Jolla, CA, USA
| | - Xin Tu
- School of Medicine, University of California-San Diego, La Jolla, CA, USA
| | | | | | - Antonia M Calafat
- National Center for Environmental Health, Division of Laboratory Sciences of the Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Ospina
- National Center for Environmental Health, Division of Laboratory Sciences of the Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jose R Suarez-Lopez
- Herbert Wertheim School of Public Health, University of California-San Diego, La Jolla, CA, USA.
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21
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Yang W, Braun JM, Vuong AM, Percy Z, Xu Y, Xie C, Deka R, Calafat AM, Ospina M, Werner E, Yolton K, Cecil KM, Lanphear BP, Chen A. Maternal urinary OPE metabolite concentrations and blood pressure during pregnancy: The HOME study. Environ Res 2022; 207:112220. [PMID: 34656632 PMCID: PMC8810616 DOI: 10.1016/j.envres.2021.112220] [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] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Few studies have examined the association between maternal exposure to organophosphate esters (OPEs) and systolic/diastolic blood pressure (SBP/DBP) during pregnancy. METHODS We analyzed data from 346 women with a singleton live birth in the HOME Study, a prospective birth cohort in Cincinnati, Ohio, USA. We quantified four OPE metabolites in maternal spot urine samples collected at 16 and 26 weeks pregnancy, standardized by specific gravity. We calculated intraclass correlation coefficients (ICCs). We extracted the first two recorded BP measurements (<20 weeks), the two highest recorded BP measurements (≥20 weeks), and diagnoses of hypertensive disorders of pregnancy (HDP) via chart review. Women with two BP measurements ≥140/90 mmHg or HDP noted in the chart at ≥20 weeks pregnancy were defined as HDP cases. We used linear mixed models and modified Poisson regression with covariate adjustment to estimate associations between OPE concentrations as continuous variables or in tertiles with maternal BP and HDP. RESULTS ICCs of OPEs were 0.17-0.45. Diphenyl phosphate (DPHP) had the highest geometric mean concentration among OPE metabolites. Increasing the average bis(2-chloroethyl) phosphate (BCEP) concentrations were positively associated with two highest recorded DBP ≥20 weeks pregnancy. Compared with women in the 1st DPHP tertile, women in the 3rd tertile at 16 weeks pregnancy had 1.72 mmHg (95% CI: -0.01, 3.46) higher DBP <20 weeks pregnancy, and women in the 3rd tertile of the average DPHP concentrations had 2.25 mmHg (95% CI: 0.25, 4.25) higher DBP ≥20 weeks pregnancy. 33 women (9.5%) were identified with HDP. Di-n-butyl phosphate (DNBP) concentrations at 16 weeks were positively associated with HDP, with borderline significance (RR = 2.98, 95% CI 0.97-9.15). Other OPE metabolites were not significantly associated with HDP. CONCLUSION Maternal urinary BCEP and DPHP concentrations were associated with increased BP during pregnancy. Maternal urinary DNBP concentrations were associated with HDP, with borderline significance.
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Affiliation(s)
- Weili Yang
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Zana Percy
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Changchun Xie
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ranjan Deka
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Ospina
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erika Werner
- Department of Epidemiology, Brown University, Providence, RI, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kimberly Yolton
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kim M Cecil
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Child and Family Research Institute, BC Children's Hospital, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA.
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22
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Wise CF, Hammel SC, Herkert NJ, Ospina M, Calafat AM, Breen M, Stapleton HM. Comparative Assessment of Pesticide Exposures in Domestic Dogs and Their Owners Using Silicone Passive Samplers and Biomonitoring. Environ Sci Technol 2022; 56:1149-1161. [PMID: 34964617 PMCID: PMC10150270 DOI: 10.1021/acs.est.1c06819] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Indexed: 05/03/2023]
Abstract
Pesticides are used extensively in residential settings for lawn maintenance and in homes to control household pests including application directly on pets to deter fleas and ticks. Pesticides are commonly detected in the home environment where people and pets can be subject to chronic exposure. Due to increased interest in using companion animals as sentinels for human environmental health studies, we conducted a comparative pesticide exposure assessment in 30 people and their pet dogs to determine how well silicone wristbands and silicone dog tags can predict urinary pesticide biomarkers of exposure. Using targeted gas chromatography-mass spectrometry analyses, we quantified eight pesticides in silicone samplers and used a suspect screening approach for additional pesticides. Urine samples were analyzed for 15 pesticide metabolite biomarkers. Several pesticides were detected in >70% of silicone samplers including permethrin, N,N-diethyl-meta-toluamide (DEET), and chlorpyrifos. Significant and positive correlations were observed between silicone sampler levels of permethrin and DEET with their corresponding urinary metabolites (rs = 0.50-0.96, p < 0.05) in both species. Significantly higher levels of fipronil were observed in silicone samplers from participants who reported using flea and tick products containing fipronil on their dog. This study suggests that people and their dogs have similar pesticide exposures in a home environment.
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Affiliation(s)
- Catherine F Wise
- Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States
| | - Stephanie C Hammel
- Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States
| | - Nicholas J Herkert
- Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MSS103-2, Atlanta, Georgia 30341, United States
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MSS103-2, Atlanta, Georgia 30341, United States
| | - Matthew Breen
- Duke Cancer Institute, Durham, North Carolina 27710, United States
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, North Carolina 27607, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina 27607, United States
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina 27607, United States
| | - Heather M Stapleton
- Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States
- Duke Cancer Institute, Durham, North Carolina 27710, United States
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23
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Percy Z, Vuong AM, Xu Y, Xie C, Ospina M, Calafat AM, Lanphear BP, Braun JM, Cecil KM, Dietrich KN, Chen A, Yolton K. Prenatal exposure to a mixture of organophosphate esters and intelligence among 8-year-old children of the HOME Study. Neurotoxicology 2021; 87:149-155. [PMID: 34582899 DOI: 10.1016/j.neuro.2021.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 05/10/2021] [Revised: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 01/02/2023]
Abstract
Many environmental chemicals are being identified as suspected neurotoxicants based on the findings of both experimental and epidemiological studies. Organophosphate esters (OPEs), which are among the chemicals that have replaced neurotoxic polybrominated diphenyl ethers (PBDEs) after 2004, have also become an important public health topic as evidence regarding their potential for early-life neurotoxicity is growing. In 233 mother child pairs from Cincinnati, OH, we measured concentrations of the OPE metabolites bis(1,3-dichloro-2-propyl) phosphate (BDCIPP), bis-2-chloroethyl phosphate (BCEP), diphenyl phosphate (DPHP), and di-n-butyl phosphate (DNBP) in the urine of pregnant women at 16 and 26 weeks gestation and at delivery. At age 8 years, we assessed children's cognition using the Wechsler Intelligence Scale for Children-IV. In models adjusted for maternal race, income, body mass index, and IQ, maternal urinary BCEP was associated with a modest increase in child full-scale IQ (ß: 0.81 per a ln-unit BCEP increase; 95 % CI: 0.00, 1.61) while other OPEs were not associated with changes in full-scale IQ or any IQ subscales. Maternal serum PBDE concentrations did not confound the relationships between urinary OPE metabolites and child IQ. Using Bayesian kernel machine regression, we did not find that concentrations of a mixture of OPE metabolites during gestation was associated with any child cognition measures. The results of this study are not consistent with other published work, and a larger sample size would be beneficial to explore potential associations more fully. Therefore, additional studies are necessary to continue studying prenatal OPE exposure and child neurodevelopment and behavior.
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Affiliation(s)
- Zana Percy
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Changchun Xie
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Maria Ospina
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, United States
| | - Kim M Cecil
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, United States; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Kim N Dietrich
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kimberly Yolton
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, United States; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
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24
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Percy Z, Vuong AM, Xu Y, Xie C, Ospina M, Calafat AM, Hoofnagle A, Lanphear BP, Braun JM, Cecil KM, Dietrich KN, Yolton K, Chen A. Maternal Urinary Organophosphate Esters and Alterations in Maternal and Neonatal Thyroid Hormones. Am J Epidemiol 2021; 190:1793-1802. [PMID: 33778842 DOI: 10.1093/aje/kwab086] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/23/2022] Open
Abstract
Production of organophosphate esters (OPEs), which represent a major flame-retardant class present in consumer goods, has increased over the past 2 decades. Experimental studies suggest that OPEs may be associated with thyroid hormone disruption, but few human studies have examined this association. We quantified OPE metabolites in the urine of 298 pregnant women from Cincinnati, Ohio, in the Health Outcomes and Measures of the Environment Study (enrolled 2003-2006) at 3 time points (16 and 26 weeks' gestation, and at delivery), and thyroid hormones in 16-week maternal and newborn cord sera. Urinary bis(1,3-dichloro-2-propyl)-phosphate concentrations were generally associated with decreased triiodothyronine and thyroxine levels and increased thyroid-stimulating hormone levels in maternal and newborn thyroid hormones in quartile dose-response analyses and multiple informant models. There was weaker evidence for thyroid hormone alterations in association with diphenyl-phosphate and di-n-butyl-phosphate. Bis-2-chloroethyl-phosphate was not associated with alterations in thyroid hormones in any analyses. We did not observe any evidence of effect modification by infant sex. These results suggest that gestational exposure to some OPEs may influence maternal and neonatal thyroid function, although replication in other cohorts is needed.
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25
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Mayer AC, Fent KW, Chen IC, Sammons D, Toennis C, Robertson S, Kerber S, Horn GP, Smith DL, Calafat AM, Ospina M, Sjodin A. Characterizing exposures to flame retardants, dioxins, and furans among firefighters responding to controlled residential fires. Int J Hyg Environ Health 2021; 236:113782. [PMID: 34119852 PMCID: PMC8325627 DOI: 10.1016/j.ijheh.2021.113782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/03/2021] [Revised: 05/10/2021] [Accepted: 05/31/2021] [Indexed: 01/14/2023]
Abstract
Firefighters may encounter items containing flame retardants (FRs), including organophosphate flame retardants (OPFRs) and polybrominated diphenyl ethers (PBDEs), during structure fires. This study utilized biological monitoring to characterize FR exposures in 36 firefighters assigned to interior, exterior, and overhaul job assignments, before and after responding to controlled residential fire scenarios. Firefighters provided four urine samples (pre-fire and 3-h, 6-h, and 12-h post-fire) and two serum samples (pre-fire and approximately 23-h post-fire). Urine samples were analyzed for OPFR metabolites, while serum samples were analyzed for PBDEs, brominated and chlorinated furans, and chlorinated dioxins. Urinary concentrations of diphenyl phosphate (DPhP), a metabolite of triphenyl phosphate (TPhP), bis(1,3-dichloro-2-propyl) phosphate (BDCPP), a metabolite of tris(1,3-dichloro-2-propyl) phosphate (TDCPP), and bis(2-chloroethyl) phosphate (BCEtP), a metabolite of tris(2-chloroethyl) phosphate (TCEP), increased from pre-fire to 3-hr and 6-hr post-fire collection, but only the DPhP increase was statistically significant at a 0.05 level. The 3-hr and 6-hr post-fire concentrations of DPhP and BDCPP, as well as the pre-fire concentration of BDCPP, were statistically significantly higher than general population levels. BDCPP pre-fire concentrations were statistically significantly higher in firefighters who previously participated in a scenario (within the past 12 days) than those who were responding to their first scenario as part of the study. Similarly, firefighters previously assigned to interior job assignments had higher pre-fire concentrations of BDCPP than those previously assigned to exterior job assignments. Pre-fire serum concentrations of 2,3,4,7,8-pentachlorodibenzofuran (23478-PeCDF), a known human carcinogen, were also statistically significantly above the general population levels. Of the PBDEs quantified, only decabromodiphenyl ether (BDE-209) pre- and post-fire serum concentrations were statistically significantly higher than the general population. These results suggest firefighters absorbed certain FRs while responding to fire scenarios.
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Affiliation(s)
- Alexander C Mayer
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA.
| | - Kenneth W Fent
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA
| | - I-Chen Chen
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA
| | - Deborah Sammons
- Health Effects Laboratory Division, NIOSH, CDC, Cincinnati, OH, USA
| | | | | | - Steve Kerber
- Firefighter Safety Research Institute, Underwriters Laboratories, Columbia, MD, USA
| | - Gavin P Horn
- Firefighter Safety Research Institute, Underwriters Laboratories, Columbia, MD, USA; Illinois Fire Service Institute, University of Illinois at Urbana-Champaign, IL, USA
| | - Denise L Smith
- Skidmore College, Saratoga Springs, NY, USA; Illinois Fire Service Institute, University of Illinois at Urbana-Champaign, IL, USA
| | - Antonia M Calafat
- Division of Laboratory Services, National Center for Environmental Health, CDC, Atlanta, GA, USA
| | - Maria Ospina
- Division of Laboratory Services, National Center for Environmental Health, CDC, Atlanta, GA, USA
| | - Andreas Sjodin
- Division of Laboratory Services, National Center for Environmental Health, CDC, Atlanta, GA, USA
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26
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Schütze A, Morales-Agudelo P, Vidal M, Calafat AM, Ospina M. Quantification of glyphosate and other organophosphorus compounds in human urine via ion chromatography isotope dilution tandem mass spectrometry. Chemosphere 2021; 274:129427. [PMID: 33529959 PMCID: PMC8717241 DOI: 10.1016/j.chemosphere.2020.129427] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 10/30/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 05/09/2023]
Abstract
Organophosphorus pesticides are the most used pesticides in the United States. Most organophosphorus pesticides are composed of a phosphate (or phosphorothioate or phosphorodithioate) moiety and a variable organic group. Organophosphorus pesticides are scrutinized by regulatory bodies and agencies because of their toxicity or suspected carcinogenicity. Upon exposure, organophosphorus pesticides and their metabolites eliminate in urine; these urinary biomarkers are useful to evaluate human exposure. We developed a method using stable isotope dilution, ion chromatography tandem mass spectrometry for quantification in urine of 6 O,O-dialkylphosphates, metabolites of organophosphorus insecticides, and glyphosate, the most used herbicide in the United States. With simple and minimal sample preparation, the analytical method is selective and sensitive (limits of detection are 0.2-0.8 μg/L), accurate (>85%) and precise (relative standard deviation <20%), depending on the analyte. To assess the suitability of the method in real exposure scenarios, we analyzed samples collected anonymously from subjects with suspected exposure to pesticides (n = 40) or who had been on an organic diet (n = 50). We detected glyphosate in 80% of subjects reporting an organic diet and in 78% of those with suspected glyphosate exposure; concentrations ranged from <0.2 to 28.6 μg/L. Median concentrations were 0.39 μg/L for the organic diet group and 0.40 μg/L for individuals with suspected exposure. Interestingly, interquartile ranges were considerably higher among those reporting pesticide exposure (0.63 μg/L) than those consuming organic diets (0.42 μg/L). These data suggest that the method meets typical validation benchmark values and is sensitive to investigate background exposures in the general population.
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Affiliation(s)
- Andre Schütze
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA, 30341, USA.
| | - Pilar Morales-Agudelo
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA, 30341, USA
| | - Meghan Vidal
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA, 30341, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA, 30341, USA
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S103-2, Atlanta, GA, 30341, USA
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27
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Werthmann DW, Rabito FA, Stout DM, Tulve NS, Adamkiewicz G, Calafat AM, Ospina M, Chew GL. Pyrethroid exposure among children residing in green versus non-green multi-family, low-income housing. J Expo Sci Environ Epidemiol 2021; 31:549-559. [PMID: 33677471 PMCID: PMC8140995 DOI: 10.1038/s41370-021-00312-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/31/2020] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is growing concern about children's chronic low-level pesticide exposure and its impact on health. Green building practices (e.g., reducing leakage of the thermal and pressure barrier that surrounds the structure, integrated pest management, improved ventilation) have the potential to reduce pesticide exposure. However, the potential impact of living in green housing on children's pesticide exposure is unknown. OBJECTIVE To address this question, a longitudinal study of pyrethroid metabolites (3-phenoxybenzoic acid [3-PBA], 4-fluoro-3-phenoxybenzoic acid [4-F-3-PBA], trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid [trans-DCCA]) in first morning void urine, collected from 68 children from New Orleans, Louisiana residing in green and non-green housing was conducted. METHODS Children were followed for 1 year with three repeated measures of pesticide exposure. Generalized estimating equations examined associations between housing type (green vs. non-green) and urinary pyrethroid metabolite concentrations adjusting for demographic and household factors over the year. RESULTS Ninety-five percent of samples had detectable concentrations of 3-PBA (limit of detection [LOD]: 0.1 μg/L); 8% of 4-F-3-PBA (LOD: 0.1 μg/L), and 12% of trans-DCCA (LOD: 0.6 μg/L). In adjusted models, green housing was not associated with statistically significant differences in children's 3-PBA urinary concentrations compared to non-green housing.
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Affiliation(s)
- Derek W Werthmann
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Felicia A Rabito
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Daniel M Stout
- Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Nicolle S Tulve
- Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Gary Adamkiewicz
- Harvard University, T.H. Chan School of Public Health, Boston, MA, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ginger L Chew
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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28
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Chen A, Ospina M, McRae A, McLane P, Hu XJ, Fielding S, Rosychuk RJ. Characteristics of frequent users of emergency departments in Alberta and Ontario, Canada: an administrative data study. CAN J EMERG MED 2021; 23:206-213. [PMID: 33709355 DOI: 10.1007/s43678-020-00013-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Frequent users to emergency departments (EDs) are a diverse group of patients accounting for a disproportionate number of ED presentations. This study examined sociodemographic and ED visit characteristics of adult high-system users in two Canadian provinces. METHODS Cohorts of high-system users were created for Alberta and Ontario including patients with the top 10% of presentations in the National Ambulatory Care Reporting System (April 2015-March 2016). Controls were random samples of non-high-system user patients. Sociodemographic and ED visits data were used to predict high-system user group membership in a multivariable logistic regression model. RESULTS There were 579,674 high-system users and 2,115,960 controls. High-system users were more likely to be female [odds ratio (OR) = 1.1, 95% confidence interval (CI) 1.1,1.1], older (OR 1.02 per 5 years, 95% CI 1.02,1.02), from the lowest-income quintile (OR 1.8, 95% CI 1.7,1.8), and more rural (OR 1.6, 95% CI 1.6,1.6) than controls. High-system users had a higher proportion of presentations by ambulance (OR 1.1 per 0.25 increase, 95% CI 1.1,1.1) and disposition was admission/transfer (OR 1.1 per 0.25 increase, 95% CI 1.1,1.1), left without being seen (OR 1.1, 95% CI 1.1,1.1), or left against medical advice (OR 1.1, 95% CI 1.1,1.1) more often than controls. CONCLUSION High-system users were more likely to be female, older, live in rural areas and within the lowest-income quintile compared to controls. Their heterogeneity in acuity, comorbid chronic diseases, and limited access to primary care suggests that interventions referring high-system users to primary care may be fruitful in reducing ED utilization by high-system users.
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Affiliation(s)
- Anqi Chen
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 524 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada
| | - Maria Ospina
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Andrew McRae
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Patrick McLane
- Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - X Joan Hu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada
| | - Scott Fielding
- Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Rhonda J Rosychuk
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 524 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada. .,Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada. .,Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada.
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29
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Polisena J, Ospina M, Sanni O, Matenchuk B, Livergant R, Amjad S, Zoric I, Haddad N, Morrison A, Wilson K, Bogoch I, Welch VA. Public health measures to reduce the risk of SARS-CoV-2 transmission in Canada during the early days of the COVID-19 pandemic: a scoping review. BMJ Open 2021; 11:e046177. [PMID: 33687956 PMCID: PMC7944419 DOI: 10.1136/bmjopen-2020-046177] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The main objectives of this study were to synthesise and compare pandemic preparedness strategies issued by the federal and provincial/territorial (P/T) governments in Canada and to assess whether COVID-19 public health (PH) measures were tailored towards priority populations, as defined by relevant social determinants of health. METHODS This scoping review searched federal and P/T websites on daily COVID-19 pandemic preparedness strategies between 30 January and 30 April 2020. The PROGRESS-Plus equity-lens framework was used to define priority populations. All definitions, policies and guidelines of PH strategies implemented by the federal and P/T governments to reduce risk of SARS-CoV-2 transmission were included. PH measures were classified using a modified Public Health Agency of Canada Framework for Canadian Pandemic Influenza Preparedness. RESULTS A total of 722 COVID-19 PH measures were issued during the study period. Of these, home quarantine (voluntary) (n=13.0%; 94/722) and retail/commerce restrictions (10.9%; n=79/722) were the most common measures introduced. Many of the PH orders, including physical distancing, cancellation of mass gatherings, school closures or retail/commerce restrictions began to be introduced after 11 March 2020. Lifting of some of the PH orders in phases to reopen the economy began in April 2020 (6.5%; n=47/722). The majority (68%, n=491/722) of COVID-19 PH announcements were deemed mandatory, while 32% (n=231/722) were recommendations. Several PH measures (28.0%, n=202/722) targeted a variety of groups at risk of socially produced health inequalities, such as age, religion, occupation and migration status. CONCLUSIONS Most PH measures centred on limiting contact between people who were not from the same household. PH measures were evolutionary in nature, reflecting new evidence that emerged throughout the pandemic. Although ~30% of all implemented COVID-19 PH measures were tailored towards priority groups, there were still unintended consequences on these populations.
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Affiliation(s)
- Julie Polisena
- Health Technology Assessment Division, International Federation for Medical and Biological Engineering, Ottawa, Ontario, Canada
| | - Maria Ospina
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Omolara Sanni
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Brittany Matenchuk
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel Livergant
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sana Amjad
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Igor Zoric
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nisrine Haddad
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Andra Morrison
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Isaac Bogoch
- Divisions of General Internal Medicine and Infectious Diseases and Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Vivian A Welch
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Centre for Global Health, Bruyere Research Institute, Ottawa, Ontario, Canada
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30
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Käfferlein HU, Koch HM, Bury D, Wrobel SA, Gilsing HD, Ospina M, Baker SE. Comment on "Urinary Metabolites of Neonicotinoid Insecticides: Levels and Recommendations for Future Biomonitoring Studies in China": Quantification of 5-Hydroxyimidacloprid and Biomonitoring. Environ Sci Technol 2021; 55:2163-2164. [PMID: 33417428 PMCID: PMC10150789 DOI: 10.1021/acs.est.0c03723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Heiko U Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
| | - Holger M Koch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
| | - Daniel Bury
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
| | - Sonja A Wrobel
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
| | - Hans-Detlev Gilsing
- Institute for Thin Film Technology and Microsensoric Technology (IDM), Kantstraße 55, 14513 Teltow, Germany
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F17, Atlanta, Georgia 30341, United States
| | - Samuel E Baker
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F17, Atlanta, Georgia 30341, United States
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31
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Chen A, Fielding S, Hu XJ, McLane P, McRae A, Ospina M, Rosychuk RJ. Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study. BMC Health Serv Res 2020; 20:938. [PMID: 33046071 PMCID: PMC7552544 DOI: 10.1186/s12913-020-05774-6] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/29/2020] [Indexed: 11/16/2022] Open
Abstract
Background This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada. Methods Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages. Results There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91). Conclusions Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.
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Affiliation(s)
- Anqi Chen
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 3-524 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9, Canada
| | - Scott Fielding
- Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, T5J 3E4, Canada
| | - X Joan Hu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada
| | - Patrick McLane
- Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, T5J 3E4, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, T6G 2R7, Canada
| | - Andrew McRae
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, T2N 2T9, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada
| | - Maria Ospina
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Rhonda J Rosychuk
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 3-524 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9, Canada. .,Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada. .,Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, T6G 2G1, Canada.
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López-Gálvez N, Wagoner R, Canales RA, de Zapien J, Calafat AM, Ospina M, Rosales C, Beamer P. Evaluating imidacloprid exposure among grape field male workers using biological and environmental assessment tools: An exploratory study. Int J Hyg Environ Health 2020; 230:113625. [PMID: 32950770 DOI: 10.1016/j.ijheh.2020.113625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/26/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/11/2022]
Abstract
Imidacloprid is a neonicotinoid insecticide commonly injected through agricultural drip irrigation systems to reduce the population of vine mealybugs (P. ficus) in grape farms. There is a growing concern of potential human health effects of imidacloprid, however, there is limited information on the exposure to imidacloprid in farm workers. Imidacloprid exposure was evaluated in this exploratory study of 20 male migrant grape workers sampled five days after imidacloprid was injected in the irrigation system during winter and summer seasons. We administered a questionnaire on work activities, exposure characteristics, and socio-demographics and collected personal air, hand wipe, and spot urine samples. Heat exposure was also assessed. Spearman's correlation coefficients and Wilcoxon rank-sum tests were utilized to evaluate associations and differences in imidacloprid exposures with socio-demographic, occupational, and environmental characteristics. All participants had less than a high school education and about half identified an Indigenous language as their primary language. Although not detected in air samples, imidacloprid was detected in 85% of the hand wipes (median: 0.26: 0.41 μg/wipe, range: 0.05-7.10 μg/wipe). The majority of participants (75%) had detectable urinary concentrations of imidacloprid (median: 0.11 μg/g creatinine, range: 0.05-3.90 μg/g of creatinine), and nearly all (95%) had detectable urinary concentrations of 5-hydroxy-Imidacloprid (5-OH-IMI), a metabolite of imidacloprid (median: 1.28 μg/g creatinine, range: 0.20-27.89 μg/g creatinine). There was a significant correlation (p < 0.001) between imidacloprid in hand wipes and urinary imidacloprid and 5-OH-IMI (rs: 0.67 for imidacloprid and 0.80 for 5-OH-IMI). Hand temperature was significantly and positively correlated (p < 0.05) with imidacloprid concentration on hand wipes (rs: 0.70), and urinary biomarkers (rs: 0.68 for imidacloprid, and 0.60 for 5-OH-IMI) suggesting that working in high temperatures may influence the exposure and absorption of imidacloprid. Thus, research on farm workers would benefit in the future by evaluating imidacloprid exposure in relation to heat stress and other occupational factors.
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Affiliation(s)
- Nicolás López-Gálvez
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. PO 245210, Tucson, AZ, 85724, USA.
| | - Rietta Wagoner
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. PO 245210, Tucson, AZ, 85724, USA
| | - Robert A Canales
- Interdisciplinary Program in Applied Mathematics, University of Arizona, 617 N. Santa Rita Ave. PO Box 210089, Tucson, AZ, 85721, USA
| | - Jill de Zapien
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. PO 245210, Tucson, AZ, 85724, USA
| | - Antonia M Calafat
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, 4770 Buford Hwy, Atlanta, GA, 30341, United States
| | - Maria Ospina
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, 4770 Buford Hwy, Atlanta, GA, 30341, United States
| | - Cecilia Rosales
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. PO 245210, Tucson, AZ, 85724, USA
| | - Paloma Beamer
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. PO 245210, Tucson, AZ, 85724, USA
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Maule AL, Heaton KJ, Cadarette B, Taylor KM, Guerriere KI, Haven CC, Scarpaci MM, Kenefick RW, Ospina M, Calafat AM, Proctor SP. Effect of Environmental Temperature and Humidity on Permethrin Biomarkers of Exposure in U.S. Soldiers Wearing Permethrin-Treated Uniforms. Am J Trop Med Hyg 2020; 102:1455-1462. [PMID: 32228790 DOI: 10.4269/ajtmh.19-0543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Environmental factors, including high temperature and humidity, can influence dermal absorption of chemicals. Soldiers can be dermally exposed to permethrin while wearing permethrin-treated uniforms. This study aimed at examining the effects of high temperature and a combined high temperature and humid environment on permethrin absorption compared with ambient conditions when wearing a permethrin-treated uniform. Twenty-seven male enlisted soldiers wore study-issued permethrin-treated army uniforms for 33 consecutive hours in three different environments: 1) simulated high temperature (35°C, 40% relative humidity [rh]) (n = 10), 2) simulated high temperature and humidity (30°C, 70% rh) (n = 10), and 3) ambient conditions (13°C, 60% rh) (n = 7). Spot urine samples, collected at 21 scheduled time points before, during, and after wearing the study uniforms, were analyzed for permethrin exposure biomarkers (3-phenoxybenzoic acid, cis- and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid) and creatinine. Biomarker concentrations were 60-90% higher in the heat and combined heat/humidity groups (P < 0.001-0.022) than the ambient group. Also, the average daily permethrin dose, calculated 12 hours after removing the treated uniforms, was significantly higher in the heat (P = 0.01) and the heat/humidity (P = 0.03) groups than the ambient group. There were no significant differences in biomarker concentrations or computed average daily dose between the heat and the heat/humidity groups. Both hot and combined hot and humid environmental conditions significantly increased permethrin absorption in soldiers wearing permethrin-treated uniforms.
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Affiliation(s)
- Alexis L Maule
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,United States Army Research Institute of Environmental Medicine, Military Performance Division, Natick, Massashusetts
| | - Kristin J Heaton
- Boston University School of Public Health, Department of Environmental Health, Boston, Massachusetts.,United States Army Research Institute of Environmental Medicine, Military Performance Division, Natick, Massashusetts
| | - Bruce Cadarette
- United States Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, Massachusetts
| | - Kathryn M Taylor
- United States Army Research Institute of Environmental Medicine, Military Performance Division, Natick, Massashusetts
| | - Katelyn I Guerriere
- United States Army Research Institute of Environmental Medicine, Military Performance Division, Natick, Massashusetts
| | - Caitlin C Haven
- United States Army Research Institute of Environmental Medicine, Military Performance Division, Natick, Massashusetts
| | - Matthew M Scarpaci
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,United States Army Research Institute of Environmental Medicine, Military Performance Division, Natick, Massashusetts
| | - Robert W Kenefick
- United States Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, Massachusetts
| | - Maria Ospina
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Atlanta, Georgia
| | - Antonia M Calafat
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Atlanta, Georgia
| | - Susan P Proctor
- United States Army Research Institute of Environmental Medicine, Military Performance Division, Natick, Massashusetts.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,VA Boston Healthcare System, Research Service, Boston, Massachusetts
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Proctor SP, Maule AL, Heaton KJ, Cadarette BS, Guerriere KI, Haven CC, Taylor KM, Scarpaci MM, Ospina M, Calafat AM. Permethrin exposure from wearing fabric-treated military uniforms in high heat conditions under varying wear-time scenarios. J Expo Sci Environ Epidemiol 2020; 30:525-536. [PMID: 30728486 PMCID: PMC7971189 DOI: 10.1038/s41370-019-0120-y] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/04/2018] [Accepted: 12/26/2018] [Indexed: 05/14/2023]
Abstract
This study examined the effect of high-temperature conditions and uniform wear time durations (expeditionary, 33 h continuous wear; garrison, 3 days, 8 h/day wear) on permethrin exposure, assessed by urinary permethrin biomarkers, from wearing post-tailored, factory-treated military uniforms. Four group study sessions took place over separate 11-day periods, involving 33 male Soldiers. Group 1 (n = 10) and Group 2 (n = 8) participants wore a study-issued permethrin-treated Army uniform under high heat environment (35 °C, 40% relative humidity (rh)) and expeditionary and garrison wear-time conditions, respectively. For comparison, Group 3 (n = 7) and Group 4 (n = 8) participants wore study-issued permethrin-treated uniforms in cooler ambient conditions under operational and garrison wear-time conditions, respectively. Urinary biomarkers of permethrin (3-phenoxybenzoic acid, and the sum of cis- and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid) were significantly higher under high temperature compared to ambient conditions, regardless of wear-time situations (Group 1 vs. Group 3; Group 2 vs. Group 4; p < 0.001, for both). Under high-temperature conditions, expeditionary (continuous) compared to garrison wear-time resulted in significantly (p < 0.001) higher urinary biomarker concentrations (Group 1 vs. Group 2). Differences related to wear-time under the ambient conditions (Group 3 vs. Group 4) were not statistically significant. Findings suggest that wearing permethrin-treated clothing in heat conditions results in higher internal dose of permethrin above that observed under ambient conditions.
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Affiliation(s)
- Susan P Proctor
- United States Army Research Institute of Environmental Medicine, Military Performance Division, 10 General Greene Avenue, Natick, MA, USA.
- VA Boston Healthcare System, Research Service, 180 South Huntington Avenue, Boston, MA, USA.
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, USA.
| | - Alexis L Maule
- United States Army Research Institute of Environmental Medicine, Military Performance Division, 10 General Greene Avenue, Natick, MA, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720-A, Rockledge Drive, Suite 100, Bethesda, MD, USA
| | - Kristin J Heaton
- United States Army Research Institute of Environmental Medicine, Military Performance Division, 10 General Greene Avenue, Natick, MA, USA
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, USA
| | - Bruce S Cadarette
- United States Army Research Institute of Environmental Medicine, Military Performance Division, 10 General Greene Avenue, Natick, MA, USA
| | - Katelyn I Guerriere
- United States Army Research Institute of Environmental Medicine, Military Performance Division, 10 General Greene Avenue, Natick, MA, USA
| | - Caitlin C Haven
- United States Army Research Institute of Environmental Medicine, Military Performance Division, 10 General Greene Avenue, Natick, MA, USA
| | - Kathryn M Taylor
- United States Army Research Institute of Environmental Medicine, Military Performance Division, 10 General Greene Avenue, Natick, MA, USA
| | - Matthew M Scarpaci
- United States Army Research Institute of Environmental Medicine, Military Performance Division, 10 General Greene Avenue, Natick, MA, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720-A, Rockledge Drive, Suite 100, Bethesda, MD, USA
| | - Maria Ospina
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, 4770 Buford Hwy, Atlanta, GA, USA
| | - Antonia M Calafat
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, 4770 Buford Hwy, Atlanta, GA, USA
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Percy Z, Vuong AM, Ospina M, Calafat AM, La Guardia MJ, Xu Y, Hale RC, Dietrich KN, Xie C, Lanphear BP, Braun JM, Cecil KM, Yolton K, Chen A. Organophosphate esters in a cohort of pregnant women: Variability and predictors of exposure. Environ Res 2020; 184:109255. [PMID: 32087441 PMCID: PMC7103481 DOI: 10.1016/j.envres.2020.109255] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 11/18/2019] [Revised: 02/04/2020] [Accepted: 02/12/2020] [Indexed: 05/09/2023]
Abstract
Organophosphate esters (OPEs) are a group of chemicals used as flame retardants and plasticizers that replaced polybrominated diphenyl ethers in consumer products such as furniture and electronics. To characterize exposure to OPEs during fetal development, we measured urinary OPE metabolite concentrations in women twice during pregnancy (16 and 26 weeks' gestation) and at delivery (n = 357). We also previously quantified house dust OPE parent compound concentrations at 20 weeks' gestation (n = 317). Diphenyl phosphate (DPHP) had the highest geometric mean urinary concentrations (1.5-2.3 μg/g creatinine), followed by bis(1,3-dichloro-2-propyl) phosphate (BDCIPP; 0.75-0.99 μg/g creatinine), and bis(2-chloroethyl) phosphate (BCEP; 0.72-0.97 μg/g creatinine), while dibutyl phosphate (DNBP) had the lowest concentrations (0.25-0.28 μg/g creatinine). Urinary OPE metabolites were moderately correlated with each other at 26 weeks (rs: 0.23-0.38, p < 0.001) while the correlations at 16 weeks and delivery were slightly weaker. Intra-class correlations for urinary metabolites measured at three time points were poor (0.16-0.34), indicating high variability within individuals. Dust concentrations of OPE parent compounds were associated with BCEP, BDCIPP, and DPHP concentrations in urine at some but not all time points. In linear mixed models of urinary OPE metabolite concentrations, household size was inversely associated with BCEP concentrations, and being non-white was associated with lower BDCIPP and DPHP concentrations. Urine samples collected in the summer had the highest OPE metabolite concentrations. This study highlights the need to collect multiple urine samples during pregnancy to define exposure patterns and investigate potential periods of susceptibility.
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Affiliation(s)
- Zana Percy
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ann M Vuong
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Maria Ospina
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark J La Guardia
- Virginia Institute of Marine Science, William & Mary, Gloucester Point, VA, USA
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert C Hale
- Virginia Institute of Marine Science, William & Mary, Gloucester Point, VA, USA
| | - Kim N Dietrich
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Changchun Xie
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Kim M Cecil
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Aimin Chen
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Cairncross ZF, Chaput KH, McMorris C, Ospina M, Brown HK, Metcalfe A. Roles of the underlying cause of delivery and gestational age on long-term child health. Paediatr Perinat Epidemiol 2020; 34:331-340. [PMID: 32043606 DOI: 10.1111/ppe.12648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/11/2019] [Accepted: 12/25/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical conditions leading to delivery are heterogeneous. However, most studies examining the short- and long-term consequences of birth on child health only consider gestational age at delivery, not the underlying cause. OBJECTIVE To examine the effect of both gestational age at delivery and underlying cause of delivery on child health outcomes. METHODS This population-based retrospective cohort study of singleton infants born in Alberta (April 2004-March 2005) used linked administrative and perinatal data to identify birth subtypes by underlying cause (infection/inflammation (I/I), placental dysfunction (PD), both, or neither), gestational age at delivery, and child health outcomes (neonatal morbidity and mortality, paediatric complex chronic conditions, and neurodevelopmental disorders and disabilities). Poisson regression with robust variance was used to assess differences in the (adjusted) risk ratio (RR) of each outcome by gestational age, and by cause of delivery. The roles of gestational age and cause of delivery were examined using mediation analysis methods. RESULTS A total of 38,192 children were included, with 66.7% experiencing neither I/I nor PD (I/I: 4.0%, PD: 27.5%, both: 1.8%). Infants born preterm had higher risk of all outcomes compared to those born at term and late-term. Infants with exposure to both causes had higher risk of all outcomes (neonatal morbidity, RR 8.96, 95% confidence interval [CI] 7.55, 10.63; paediatric complex chronic conditions, RR 3.94, 95% CI 3.08, 5.05; and neurodevelopmental disorders, RR 1.58, 95% CI 1.37, 1.84). The effect of underlying cause of delivery on child health outcomes was partially explained by gestational age, more in cases involving I/I than in those involving PD alone. CONCLUSIONS Short- and long-term child health outcomes differ by the underlying cause leading to delivery, as well as the gestational age at delivery. Having a clearer prognosis for infants may promote the use of clinical interventions earlier for children at increased risk.
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Affiliation(s)
- Zoe F Cairncross
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Kathleen H Chaput
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Carly McMorris
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Maria Ospina
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
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Ingle ME, Watkins D, Rosario Z, VélezVega CM, Calafat AM, Ospina M, Ferguson KK, Cordero JF, Alshawabkeh A, Meeker JD. An exploratory analysis of urinary organophosphate ester metabolites and oxidative stress among pregnant women in Puerto Rico. Sci Total Environ 2020; 703:134798. [PMID: 31726298 PMCID: PMC6954949 DOI: 10.1016/j.scitotenv.2019.134798] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 06/17/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Organophosphate esters (OPEs) are used as flame retardants and plasticizers. Oxidative stress, the imbalance of reactive oxygen species and antioxidants, measured prenatally has been associated with adverse birth outcomes including preeclampsia and preterm birth. We are the first study to investigate the relationship between OPEs and oxidative stress among pregnant women. METHODS Pregnant women 18-40 yrs. were recruited in Northern Puerto Rico (n = 47) between 2011 and 2015. OPE concentrations of: bis(2-chloroethyl) phosphate (BCEtP), bis(1-chloro-2-propyl) phosphate (BCPP), bis(1,3-dichloro-2-propyl) phosphate (BDCPP), dibutyl phosphate (DNBP), and diphenyl phosphate (DPHP) and biomarkers for oxidative stress, 8-hydroxy-2'-deoxyguanosine (8-OHdG) and 8-isoprostane were measured in urine up to three times during pregnancy. Associations between oxidative stress biomarkers and OPEs were assessed using linear mixed models adjusted for specific gravity, age, BMI, and income. RESULTS Metabolites BCEtP, BDCPP, and DPHP were frequently detected (>97%). OPE metabolite concentrations remained stable over time (Intraclass correlation coefficients (ICCs): 0.51-0.60). Metabolites BCEtP, BCPP, and DPHP were associated with an increase in 8-isoprostane and OHdG. An interquartile range (IQR) increase in BDCPP was associated with a 21% increase in 8-isoprostane (p < 0.01), while and IQR increase in DPHP and BCPP was associated with a 12% increase (p = 0.04, p = 0.08, respectively). IQR increases in BDCPP and DPHP were also associated with an 18 and 19% increase in OHdG, respectively (p < 0.01). CONCLUSION OPE metabolites were frequently detected and our results suggest that exposure to OPEs is associated with higher levels of oxidative stress. Further investigation into these relationships and birth outcomes is warranted.
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Affiliation(s)
- Mary E Ingle
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Deborah Watkins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Zaira Rosario
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067, USA
| | - Carmen M VélezVega
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067, USA
| | - Antonia M Calafat
- Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F17, Atlanta, GA 30341, USA
| | - Maria Ospina
- Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F17, Atlanta, GA 30341, USA
| | - Kelly K Ferguson
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - José F Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Akram Alshawabkeh
- College of Engineering, Northeastern University, 110 Forsyth St, Boston, MA 02115, USA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.
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Ospina M, Osornio-Vargas ÁR, Nielsen CC, Crawford S, Kumar M, Aziz K, Serrano-Lomelin J. Socioeconomic gradients of adverse birth outcomes and related maternal factors in rural and urban Alberta, Canada: a concentration index approach. BMJ Open 2020; 10:e033296. [PMID: 32014876 PMCID: PMC7045252 DOI: 10.1136/bmjopen-2019-033296] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Using a summary measure of health inequalities, this study evaluated the distribution of adverse birth outcomes (ABO) and related maternal risk factors across area-level socioeconomic status (SES) gradients in urban and rural Alberta, Canada. DESIGN Cross-sectional study using a validated perinatal clinical registry and an area-level SES. SETTING The study was conducted in Alberta, Canada. Data about ABO and related maternal risk factors were obtained from the Alberta Perinatal Health Program between 2006 and 2012. An area-level SES index derived from census data (2006) was linked to the postal code at delivery. PARTICIPANTS Women (n=3 30 957) having singleton live births with gestational age ≥22 weeks. PRIMARY AND SECONDARY OUTCOME MEASURES We estimated concentration indexes to assess inequalities across SES gradients in both rural and urban areas (CIdxR and CIdxU, respectively) for spontaneous preterm birth (PTB), small for gestational age (SGA), large for gestational age (LGA), gestational hypertension, gestational diabetes, smoking and substance use during pregnancy and pre-pregnancy weight >91 kg. RESULTS The highest health inequalities disfavouring low SES groups were identified for substance abuse and smoking in rural areas (CIdxR-0.38 and -0.23, respectively). Medium inequalities were identified for LGA (CIdxR-0.08), pre-pregnancy weight >91 kg (CIdxR-0.07), substance use (CIdxU-0.15), smoking (CIdxU-0.14), gestational diabetes (CIdxU-0.10) and SGA (CIdxU-0.07). Low inequalities were identified for PTB (CIdxR-0.05; CIdxU-0.05) and gestational diabetes (CIdxR-0.04). Inequalities disfavouring high SES groups were identified for gestational hypertension (CIdxR+0.04), SGA (CIdxR+0.03) and LGA (CIdxU+0.03). CONCLUSIONS ABO and related maternal risk factors were unequally distributed across the socioeconomic gradient in urban-rural settings, with the greatest concentrations in lower SES groups of rural areas. Future research is needed on underlying mechanisms driving SES gradients in perinatal health across the rural-urban spectrum.
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Affiliation(s)
- Maria Ospina
- Department of Obstetrics and Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Charlene C Nielsen
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Crawford
- Alberta Perinatal Health Program, Alberta Health Services, Calgary, Alberta, Canada
| | - Manoj Kumar
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Khalid Aziz
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jesus Serrano-Lomelin
- Department of Obstetrics and Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Kaur N, Starling AP, Calafat AM, Sjodin A, Clouet-Foraison N, Dolan LM, Imperatore G, Jensen ET, Lawrence JM, Ospina M, Pihoker C, Taylor KW, Turley C, Dabelea D, Jaacks LM. Longitudinal association of biomarkers of pesticide exposure with cardiovascular disease risk factors in youth with diabetes. Environ Res 2020; 181:108916. [PMID: 31761333 PMCID: PMC6982582 DOI: 10.1016/j.envres.2019.108916] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death among individuals with diabetes, but little is known about the role of exposures to environmental chemicals such as pesticides in the early development of CVD risk in this population. OBJECTIVES To describe changes over time in concentrations of pesticide biomarkers among youth with diabetes in the United States and to estimate the longitudinal association between these concentrations and established risk factors for CVD. METHODS Pesticide biomarkers were quantified in urine and serum samples from 87 youth with diabetes participating in the multi-center SEARCH cohort study. Samples were obtained around the time of diagnosis (baseline visit, between 2006 and 2010) and, on average, 5.4 years later (follow-up visit, between 2012 and 2015). We calculated geometric mean (95% CI) pesticide biomarker concentrations. Eight CVD risk factors were measured at these two time points: body mass index (BMI) z-score, HbA1c, insulin sensitivity, fasting C-peptide (FCP), LDL cholesterol, HDL cholesterol, total cholesterol, and triglycerides. Linear regression models were used to estimate the associations between each pesticide biomarker at baseline and each CVD risk factor at follow-up, adjusting for baseline health outcome, elapsed time between baseline and follow up, sex, age, race/ethnicity, and diabetes type. RESULTS Participants were, on average, 14.2 years old at their baseline visit, and most were diagnosed with type 1 diabetes (57.5%). 4-nitrophenol, 3-phenoxybenzoic acid, 2,4-dichlorophenoxyacetic acid (2,4-D), 3,5,6-trichloro-2-pyridinol, 2,2-bis(4-chlorophenyl)-1,1-dichloroethene, and hexachlorobenzene were detected in a majority of participants at both time points. Participants in the highest quartile of 2,4-D and 4-nitrophenol at baseline had HbA1c levels at follow-up that were 1.05 percentage points (95% CI: -0.40, 2.51) and 1.27 percentage points (0.22, 2.75) higher, respectively, than participants in the lowest quartile of these pesticide biomarkers at baseline. These participants also had lower log FCP levels (indicating reduced beta-cell function) compared to participants in the lowest quartile at baseline: beta (95% CI) for log FCP of -0.64 (-1.17, -0.11) for 2,4-D and -0.39 (-0.96, 0.18) for 4-nitrophenol. In other words, participants in the highest quartile of 2,4-D had a 47.3% lower FCP level compared to participants in the lowest quartile, and those in the highest quartile of 4-nitrophenol had a 32.3% lower FCP level than those in the lowest quartile. Participants with trans-nonachlor concentrations in the highest quartile at baseline had HbA1c levels that were 1.45 percentage points (-0.11, 3.01) higher and log FCP levels that were -0.28 (-0.84, 0.28) lower than participants in the lowest quartile at baseline, that is to say, participants in the highest quartile of trans-nonachlor had a 24.4% lower FCP level than those in the lowest quartile. While not all of these results were statistically significant, potentially due to the small same size, clinically, there appears to be quantitative differences. No associations were observed between any pesticide biomarker at baseline with BMI z-score or insulin sensitivity at follow-up. CONCLUSIONS Exposure to select pesticides may be associated with impaired beta-cell function and poorer glycemic control among youth with diabetes.
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Affiliation(s)
- Navdep Kaur
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anne P Starling
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andreas Sjodin
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Noemie Clouet-Foraison
- Northwest Lipid Metabolism and Diabetes Research Laboratory, Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lawrence M Dolan
- Division of Endocrinology, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Maria Ospina
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Kyla W Taylor
- Office of Health Assessment and Translation, National Toxicology Program, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Christine Turley
- Department of Pediatrics, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Craig JA, Ceballos DM, Fruh V, Petropoulos ZE, Allen JG, Calafat AM, Ospina M, Stapleton HM, Hammel S, Gray R, Webster TF. Exposure of Nail Salon Workers to Phthalates, Di(2-ethylhexyl) Terephthalate, and Organophosphate Esters: A Pilot Study. Environ Sci Technol 2019; 53:14630-14637. [PMID: 31736299 PMCID: PMC7192361 DOI: 10.1021/acs.est.9b02474] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Relatively little is known about the exposure of nail technicians to semivolatile organic compounds (SVOCs) in nail salons. We collected preshift and postshift urine samples and silicone wrist bands (SWBs) worn on lapels and wrists from 10 female nail technicians in the Boston area in 2016-17. We analyzed samples for phthalates, phthalate alternatives, and organophosphate esters (OPEs) or their metabolites. Postshift urine concentrations were generally higher than preshift concentrations for SVOC metabolites; the greatest change was for a metabolite of the phthalate alternative di(2-ethylhexyl) terephthalate (DEHTP): mono(2-ethyl-5-carboxypentyl) terephthalate (MECPTP) more than tripled from 11.7 to 36.6 μg/g creatinine. DEHTP biomarkers were higher in our study participants' postshift urine compared to 2015-2016 National Health and Nutrition Examination Survey females. Urinary MECPTP and another DEHTP metabolite were moderately correlated (r = 0.37-0.60) with DEHTP on the SWBs, suggesting occupation as a source of exposure. Our results suggest that nail technicians are occupationally exposed to certain phthalates, phthalate alternatives, and OPEs, with metabolites of DEHTP showing the largest increase across a work day. The detection of several of these SVOCs on SWBs suggests that they can be used as a tool for examining potential occupational exposures to SVOCs among nail salon workers.
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Affiliation(s)
- Jessica A. Craig
- Department of Environmental Health, Boston University School of Public Health, 750 Albany Street, Boston, Massachusetts 02118 United States
- Corresponding Author:
| | - Diana M. Ceballos
- Department of Environmental Health, Boston University School of Public Health, 750 Albany Street, Boston, Massachusetts 02118 United States
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02215, United States
| | - Victoria Fruh
- Department of Environmental Health, Boston University School of Public Health, 750 Albany Street, Boston, Massachusetts 02118 United States
| | - Zoe E. Petropoulos
- Department of Environmental Health, Boston University School of Public Health, 750 Albany Street, Boston, Massachusetts 02118 United States
| | - Joseph G. Allen
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02215, United States
| | - Antonia M. Calafat
- Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Maria Ospina
- Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Heather M. Stapleton
- Nicholas School of the Environment, Duke University; Durham, North Carolina 27708, United States
| | - Stephanie Hammel
- Nicholas School of the Environment, Duke University; Durham, North Carolina 27708, United States
| | - Rebecca Gray
- Department of Environmental Health, Boston University School of Public Health, 750 Albany Street, Boston, Massachusetts 02118 United States
| | - Thomas F. Webster
- Department of Environmental Health, Boston University School of Public Health, 750 Albany Street, Boston, Massachusetts 02118 United States
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Tong V, Corchuelo S, Cates J, Laiton-Donato K, Dollard S, Rico A, Lanzieri T, Acosta J, Ailes E, Rodríguez H, Ricaldi J, González M, Pelaez D, Valencia D, Mercado M, Honein M, Ospina M. Prevalence of congenital CMV infection in Colombia. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Jaacks LM, Diao N, Calafat AM, Ospina M, Mazumdar M, Ibne Hasan MOS, Wright R, Quamruzzaman Q, Christiani DC. Association of prenatal pesticide exposures with adverse pregnancy outcomes and stunting in rural Bangladesh. Environ Int 2019; 133:105243. [PMID: 31675560 PMCID: PMC6863610 DOI: 10.1016/j.envint.2019.105243] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/29/2019] [Accepted: 10/03/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Pesticide exposure during pregnancy is thought to adversely affect fetal growth, which in turn may impact child growth, but results have been inconsistent across studies and few have explored these effects in developing countries. OBJECTIVES To quantify urinary concentrations of pesticide biomarkers in early pregnancy (<16 weeks' gestation), and to estimate the association of these concentrations with preterm birth, low birth weight, small for gestational age, and stunting at ~1 and 2 years of age. METHODS Eight pesticide biomarkers were quantified in urine collected from 289 pregnant women (aged 18-40 years) participating in a birth cohort study in Bangladesh. Anthropometry measurements were conducted on the index child at birth and approximately 1 and 2 years of age. A directed acyclic graph was used to identify minimal sufficient adjustment sets. Log-binomial regression was used to estimate the relative risk (RR) with 95% confidence intervals (CI). RESULTS 3,5,6-trichloro-2-pyridinol (TCPY), a metabolite of chlorpyrifos and chlorpyrifos methyl, and 4-nitrophenol, a metabolite of parathion and methyl parathion, were detected in nearly all women with geometric mean (95% CI) values of 3.17 (2.82-3.56) and 18.66 (17.03-20.46) µg/g creatinine, respectively. 3-phenoxybenzoic acid (3-PBA), a non-specific metabolite of several pyrethroids, and 2-isopropyl-4-methyl-6-hydroxypyrimidine (IMPY), a diazinon metabolite, were detected in 19.8% and 16.1% of women, respectively. The remaining four pesticide biomarkers were detected in <10% of women. Women in the highest quartile of 4-nitrophenol were more than 3 times more likely to deliver preterm than women in the lowest quartile: unadjusted RR (95% CI), 3.57 (1.65, 7.73). Women in the highest quartile of 4-nitrophenol were also at increased risk of having a child born small for gestational age: RR (95% CI) adjusted for household income, maternal education, and maternal total energy and meat intake, 3.81 (1.10, 13.21). Women with detectable concentrations of IMPY were at increased risk of having a child born with low birth weight compared to women with non-detectable concentrations: adjusted RR (95% CI), 2.13 (1.12, 4.08). We observed no association between any of the pesticide biomarkers and stunting at 1 or 2 years of age. DISCUSSION Exposure to the insecticides parathion and diazinon during early pregnancy may increase the risk of adverse birth outcomes.
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Affiliation(s)
- Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Nancy Diao
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Ospina
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maitreyi Mazumdar
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | | | - Robert Wright
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Ingle ME, Watkins D, Rosario Z, Vélez Vega CM, Huerta-Montanez G, Calafat AM, Ospina M, Cordero JF, Alshawabkeh A, Meeker JD. The association of urinary organophosphate ester metabolites and self-reported personal care and household product use among pregnant women in Puerto Rico. Environ Res 2019; 179:108756. [PMID: 31574449 PMCID: PMC6905189 DOI: 10.1016/j.envres.2019.108756] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 04/12/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND Organophosphate esters (OPEs) are widely detected among U.S. pregnant women. OPEs, some of which are present in nail polish, have been associated with adverse reproductive health outcomes. More research is needed to investigate associations with OPEs and personal care products (PCP) use. METHODS Pregnant women (18-40 years) were recruited from two hospitals and five prenatal clinics in Northern Puerto Rico (n = 148 women) between 2011 and 2015. Concentrations of bis(2-chloroethyl) phosphate (BCEtP), bis(1-chloro-2-propyl) phosphate (BCPP), bis(1,3-dichloro-2-propyl) phosphate (BDCPP), di-n-butyl phosphate (DNBP), di-benzyl phosphate (DBzP), di-cresyl phosphate (DCP), DPHP, and 2,3,4,5-tetrabromobenzoic acid (TBBA) were measured twice during pregnancy. Participants completed questionnaires on PCP and household products (HP) use. Associations among products and metabolite concentrations (n = 296 observations) were assessed using linear mixed models. RESULTS BCEtP, BCPP, BDCPP and DPHP were detected frequently (≥77%). Correlations among metabolites (0.16 ≤ r ≤ 0.35) and Intraclass correlation coefficients (ICCs) (0.03 ≤ ICC≤0.34) were weak-to-moderate. Suntan lotion was associated with a 110% increase in BDCPP. DPHP increased with perfume (51%) and nail polish (49%) use. BCPP increased 46% with pesticide use in home. CONCLUSION Biomarkers of OPEs were often detected among pregnant women. Associations with PCP and HP use suggest OPEs may be used in such products, specifically in perfume and nail polish. Further investigation into these products is warranted.
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Affiliation(s)
- Mary E Ingle
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Deborah Watkins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Zaira Rosario
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, PO Box 365067, San Juan, PR, 00936-5067, USA
| | - Carmen M Vélez Vega
- University of Puerto Rico Graduate School of Public Health, UPR Medical Sciences Campus, PO Box 365067, San Juan, PR, 00936-5067, USA
| | | | - Antonia M Calafat
- Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F17, Atlanta, GA, 30341, USA
| | - Maria Ospina
- Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F17, Atlanta, GA, 30341, USA
| | - José F Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Akram Alshawabkeh
- College of Engineering, Northeastern University, 110 Forsyth St, Boston, MA, 02115, USA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.
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Curl CL, Porter J, Penwell I, Phinney R, Ospina M, Calafat AM. Effect of a 24-week randomized trial of an organic produce intervention on pyrethroid and organophosphate pesticide exposure among pregnant women. Environ Int 2019; 132:104957. [PMID: 31324402 PMCID: PMC6754760 DOI: 10.1016/j.envint.2019.104957] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND Introduction of an organic diet can significantly reduce exposure to some classes of pesticides in children and adults, but no long-term trials have been conducted. OBJECTIVES To assess the effect of a long-term (24-week) organic produce intervention on pesticide exposure among pregnant women. METHODS We recruited 20 women from the Idaho Women, Infants, and Children (WIC) program during their first trimester of pregnancy. Eligible women were nonsmokers aged 18-35 years who reported eating exclusively conventionally grown food. We randomly assigned participants to receive weekly deliveries of either organic or conventional fruits and vegetables throughout their second or third trimesters and collected weekly spot urine samples. Urine samples, which were pooled to represent monthly exposures, were analyzed for biomarkers of organophosphate (OP) and pyrethroid insecticides. RESULTS Food diary data demonstrated that 66% of all servings of fruits and vegetables consumed by participants in the "organic produce" group were organic, compared to <3% in the "conventional produce" group. We collected an average of 23 spot samples per participant (461 samples total), which were combined to yield 116 monthly composites. 3-Phenoxybenzoic acid (3-PBA, a non-specific biomarker of several pyrethroids) was detected in 75% of the composite samples, and 3-PBA concentrations were significantly higher in samples collected from women in the conventional produce group compared to the organic produce group (0.95 vs 0.27 μg/L, p = 0.03). Another pyrethroid biomarker, trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid, was detected more frequently in women in the conventional compared to the organic produce groups (16% vs 4%, p = 0.05). In contrast, we observed no statistically significant differences in detection frequency or concentrations for any of the four biomarkers of OP exposure quantified in this trial. DISCUSSION To our knowledge, this is the first long-term organic diet intervention study, and the first to include pregnant women. These results suggest that addition of organic produce to an individual's diet, as compared to conventional produce, significantly reduces exposure to pyrethroid insecticides.
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Affiliation(s)
- Cynthia L Curl
- Department of Community and Environmental Health, Boise State University, Boise, ID, USA.
| | - Jessica Porter
- Department of Community and Environmental Health, Boise State University, Boise, ID, USA
| | - Ian Penwell
- Department of Community and Environmental Health, Boise State University, Boise, ID, USA
| | - Rachel Phinney
- Department of Community and Environmental Health, Boise State University, Boise, ID, USA
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Jayatilaka NK, Restrepo P, Davis Z, Vidal M, Calafat AM, Ospina M. Quantification of 16 urinary biomarkers of exposure to flame retardants, plasticizers, and organophosphate insecticides for biomonitoring studies. Chemosphere 2019; 235:481-491. [PMID: 31272008 PMCID: PMC6960943 DOI: 10.1016/j.chemosphere.2019.06.181] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 03/28/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 05/16/2023]
Abstract
Chlorinated alkyl and non-chlorinated aryl organophosphate flame retardants (OPFRs) and some brominated flame retardants (FR) were introduced as replacements for polybrominated diphenyl ethers (PBDEs) after PBDEs phase-out in 2004 and 2013. Organophosphorous (OP) insecticides are mainly used in agricultural settings since the Food Quality Protection Act of 1996 phased-out most residential uses of OP insecticides in the United States. Urinary metabolites of FRs and OPs are known exposure biomarkers to FRs and OP insecticides, respectively. For large population-based studies, concurrent quantification of these metabolites using a small urine volume is desirable, but until now was not possible. We developed an analytical approach to quantify in 0.2 mL urine 10 FRs and six OP insecticide metabolites: diphenyl phosphate, bis(1,3-dichloro-2-propyl) phosphate, bis(1-chloro-2-propyl) phosphate, bis(2-chloroethyl) phosphate, dicresyl phosphates, dibutyl phosphate, dibenzyl phosphate, 2,3,4,5-tetrabromobenzoic acid, 2-((isopropyl)phenyl)phenyl phosphate, 4-((tert-butyl)phenyl)phenyl phosphate, dimethyl phosphate, diethyl phosphate, dimethyl thiophosphate, dimethyl dithiophosphate, diethyl thiophosphate, and diethyl dithiophosphate. The method relies on enzymatic deconjugation, automated off-line solid phase extraction, high-performance liquid chromatography, and isotope dilution tandem mass spectrometry. Detection limits ranged from 0.05 to 0.5 ng mL-1, accuracy from 89 to 118%, and imprecision was <10%. . This method is the first to quantify simultaneously trace levels of 16 biomarkers of FRs and OP insecticides in only four drops of urine. We confirmed the method suitability for use in large epidemiological studies to assess background and occupational exposures to these classes of environmental pollutants by analyzing 303 samples collected from the general population and a group of firefighters. FR metabolite and DAPs concentrations in the general population group were lower than in the firefighters group, and within the ranges reported in the U.S. general population and other non-occupationally exposed populations.
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Affiliation(s)
- Nayana K Jayatilaka
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS 103-2, Atlanta, GA 30341, USA.
| | - Paula Restrepo
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS 103-2, Atlanta, GA 30341, USA.
| | - Zachary Davis
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS 103-2, Atlanta, GA 30341, USA; CDC Foundation, 600 Peachtree Street NE, Suite 1000, Atlanta, GA 30308, USA.
| | - Meghan Vidal
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS 103-2, Atlanta, GA 30341, USA.
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS 103-2, Atlanta, GA 30341, USA.
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS 103-2, Atlanta, GA 30341, USA.
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Ospina M, Wong LY, Baker SE, Serafim AB, Morales-Agudelo P, Calafat AM. Exposure to neonicotinoid insecticides in the U.S. general population: Data from the 2015-2016 national health and nutrition examination survey. Environ Res 2019; 176:108555. [PMID: 31288196 PMCID: PMC6710140 DOI: 10.1016/j.envres.2019.108555] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 05/18/2023]
Abstract
BACKGROUND Neonicotinoids are used for insect control in agriculture, landscaping, and on household pets. Neonicotinoids have become popular replacements for organophosphate and carbamate insecticides, and use is on the rise. OBJECTIVES To assess human exposure to neonicotinoid insecticides in a representative sample of the U.S. general population 3 years and older from the 2015-2016 National Health and Nutrition Examination Survey (NHANES). METHODS We used online solid-phase extraction coupled to isotope dilution high-performance liquid chromatography-tandem mass spectrometry after enzymatic hydrolysis of conjugates to quantify in 3038 samples the urinary concentrations of six neonicotinoid biomarkers: four parent compounds (acetamiprid, clothianidin, imidacloprid, thiacloprid) and two metabolites (N-desmethyl-acetamiprid, 5-hydroxy-imidacloprid). We calculated distribution percentiles, and used regression models to evaluate associations of various demographic parameters and fasting time with urinary concentrations above the 95th percentile (a value selected to represent higher than average concentrations) of neonicotinoid biomarkers. RESULTS Weighted detection frequencies were 35% (N-desmethyl-acetamiprid), 19.7% (5-hydroxy imidacloprid), 7.7% (clothianidin), 4.3% (imidacloprid), and <0.5% (acetamiprid, thiacloprid). The weighted frequency of having detectable concentrations of at least one of the six biomarkers examined was 49.1%. The 95th percentile concentrations for N-desmethyl-acetamiprid, 5-hydroxy imidacloprid, and clothianidin were 1.29, 1.37, and 0.396 μg/L, respectively. For people who fasted <8 h, regardless of race/ethnicity and sex, 3-5 year old children were more likely to have N-desmethyl-acetamiprid concentrations above the 95th percentile than adolescents (adjusted odds ratio (OR) = 3.12; 95% confidence interval [CI], (0.98-9.98)) and adults (adjusted OR = 4.29; 95% CI, (2.04-9.0)); and children 6-11 years of age were more likely than adults to have N-desmethyl-acetamiprid concentrations above the 95th percentile (adjusted OR = 2.65; 95% CI, (1.2-5.84)). Asians were more likely than non-Asians to have concentrations above the 95th percentile of N-desmethyl-acetamiprid (adjusted OR = 1.94; 95% CI, (1.08-3.49)) and 5-hydroxy-imidacloprid (adjusted OR = 2.25; 95% CI, (1.44-3.51)). Samples collected during the summer were more likely to have metabolite concentrations above the 95th percentile than those collected in the winter (adjusted OR 1.55 for N-desmethyl-acetamiprid, and 2.43 for 5-hydroxy-imidacloprid). CONCLUSIONS The detection of neonicotinoid metabolites more frequently and at much higher concentrations than the corresponding parent compounds suggests that the metabolites may be suitable biomarkers to assess background exposures. About half of the U.S. general population 3 years of age and older was recently exposed to neonicotinoids. Compared to other age ranges and ethnicities, young children and Asians may experience higher exposures. At present, reasons for such differences remain unknown.
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Affiliation(s)
- Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F17, Atlanta, GA, 30341, USA.
| | - Lee-Yang Wong
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F17, Atlanta, GA, 30341, USA
| | - Samuel E Baker
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F17, Atlanta, GA, 30341, USA
| | - Amanda Bishop Serafim
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F17, Atlanta, GA, 30341, USA
| | - Pilar Morales-Agudelo
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F17, Atlanta, GA, 30341, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F17, Atlanta, GA, 30341, USA
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47
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Estill CF, Slone J, Mayer AC, Phillips K, Lu J, Chen IC, Christianson A, Streicher R, La Guardia MJ, Jayatilaka N, Ospina M, Calafat AM. Assessment of spray polyurethane foam worker exposure to organophosphate flame retardants through measures in air, hand wipes, and urine. J Occup Environ Hyg 2019; 16:477-488. [PMID: 31112485 PMCID: PMC6659107 DOI: 10.1080/15459624.2019.1609004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 05/16/2023]
Abstract
Tris(1-chloro-2-propyl) phosphate (TCPP, also referenced as TCIPP), a flame retardant used in spray polyurethane foam insulation, increases cell toxicity and affects fetal development. Spray polyurethane foam workers have the potential to be exposed to TCPP during application. In this study, we determined exposure to TCPP and concentrations of the urinary biomarker bis(1-chloro-2-propyl) phosphate (BCPP) among 29 spray polyurethane foam workers over 2 work days. Work was conducted at residential or commercial facilities using both open-cell (low density) and closed-cell (high density) foam. Study participants provided two personal air samples (Day 1 and Day 2), two hand wipe samples (Pre-shift Day 2 and Post-shift Day 2), and two spot urine samples (Pre-shift Day 1 and Post-shift Day 2). Bulk samples of cured spray foam were also analyzed. Sprayers were found to have significantly higher TCPP geometric mean (GM) concentration in personal air samples (87.1 μg/m3), compared to helpers (30.2 μg/m3; p = 0.025). A statistically significant difference was observed between TCPP pre- and post-shift hand wipe GM concentrations (p = 0.004). Specifically, TCPP GM concentration in post-shift hand wipe samples of helpers (106,000 ng/sample) was significantly greater than pre-shift (27,300 ng/sample; p < 0.001). The GM concentration of the urinary biomarker BCPP (23.8 μg/g creatinine) was notably higher than the adult male general population (0.159 μg/g creatinine, p < 0.001). Urinary BCPP GM concentration increased significantly from Pre-shift Day 1 to Post-shift Day 2 for sprayers (p = 0.013) and helpers (p = 0.009). Among bulk samples, cured open-cell foam had a TCPP GM concentration of 9.23% by weight while closed-cell foam was 1.68%. Overall, post-shift BCPP urine concentrations were observed to be associated with TCPP air and hand wipe concentrations, as well as job position (sprayer vs. helper). Spray polyurethane foam workers should wear personal protective equipment including air-supplied respirators, coveralls, and gloves during application.
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Affiliation(s)
| | | | | | | | - John Lu
- National Institute for Occupational Safety and Health (NIOSH)
| | - I-Chen Chen
- National Institute for Occupational Safety and Health (NIOSH)
| | | | | | | | - Nayana Jayatilaka
- National Center for Environmental Health, Centers for, Disease Control and Prevention
| | - Maria Ospina
- National Center for Environmental Health, Centers for, Disease Control and Prevention
| | - Antonia M. Calafat
- National Center for Environmental Health, Centers for, Disease Control and Prevention
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48
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Black K, MacDonald I, Chambers T, Ospina M. POSTPARTUM MENTAL HEALTH DISORDERS IN INDIGENOUS WOMEN: A SYSTEMATIC REVIEW AND META-ANALYSIS. Journal of Obstetrics and Gynaecology Canada 2019. [DOI: 10.1016/j.jogc.2019.02.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sullivan KM, Poffley A, Funkhouser S, Driver J, Ross J, Ospina M, Calafat AM, Beard CB, White A, Balanay JA, Richards S, Dyer M, Mather TN, Meshnick S. Bioabsorption and effectiveness of long-lasting permethrin-treated uniforms over three months among North Carolina outdoor workers. Parasit Vectors 2019; 12:52. [PMID: 30674346 PMCID: PMC6343280 DOI: 10.1186/s13071-019-3314-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 08/18/2018] [Accepted: 01/13/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Vector-borne diseases are an important cause of morbidity and mortality in the USA. Effective, convenient prevention methods are needed. Long-lasting permethrin-impregnated (LLPI) clothing can prevent tick bites, however, additional information is needed on the real-world effectiveness and safety of this preventative measure. METHODS In this pilot study, we recruited state and county park employees from North Carolina to wear LLPI uniforms for three months during the summer of 2016. We collected spot urine samples for biomonitoring of permethrin metabolites at one week, one month and three months after first use of the LLPI uniform. Following three months of wear, we collected pants and socks and analyzed them for permethrin content and mortality to ticks and mosquitoes. RESULTS Thirteen park employees were included in the analysis. Bioactive amounts of permethrin remained in all clothing swatches tested, although there was great variability. Tick mortality was high, with 78% of pant and 88% of sock swatches having mean knockdown percentages ≥ 85%. In contrast, mosquito mortality was low. Over the study period, the absorbed dosage of permethrin averaged < 4 μg/kg/d of body weight based on measurements of three metabolites. CONCLUSIONS LLPI clothing retained permethrin and bioactivity against ticks after three months of use in real-world conditions. The estimated absorbed dosage of permethrin was well below the U.S. EPA level of concern, suggesting that LLPI clothing can be used safely by outdoor workers for tick bite prevention.
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Affiliation(s)
- Kristin M. Sullivan
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC USA
| | - Alison Poffley
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC USA
| | - Sheana Funkhouser
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC USA
| | - Jeffrey Driver
- Risksciences LLC, Longboat Key, FL and University of South Florida, College of Public Health, Tampa, FL USA
| | - John Ross
- Risksciences LLC, Longboat Key, FL and University of South Florida, College of Public Health, Tampa, FL USA
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Charles B. Beard
- Division of Vector-borne Diseases, Centers for Disease Control and Prevention, Ft. Collins, CO USA
| | - Avian White
- Environmental Health Sciences Program, Department of Health Education and Promotion, East Carolina University, Greenville, NC USA
| | - Jo Anne Balanay
- Environmental Health Sciences Program, Department of Health Education and Promotion, East Carolina University, Greenville, NC USA
| | - Stephanie Richards
- Environmental Health Sciences Program, Department of Health Education and Promotion, East Carolina University, Greenville, NC USA
| | - Megan Dyer
- Center for Vector-Borne Disease, University of Rhode Island, Kingston, RI USA
| | - Thomas N. Mather
- Center for Vector-Borne Disease, University of Rhode Island, Kingston, RI USA
| | - Steven Meshnick
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC USA
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50
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Villa-Roel C, Ospina M, Majumdar SR, Couperthwaite S, Rawe E, Nikel T, Rowe BH. Engaging patients and primary care providers in the design of novel opinion leader based interventions for acute asthma in the emergency department: a mixed methods study. BMC Health Serv Res 2018; 18:789. [PMID: 30340482 PMCID: PMC6194690 DOI: 10.1186/s12913-018-3587-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multifaceted interventions driven by the needs of patients and providers can help move evidence into practice more rapidly. This study engaged both patients and primary care providers (PCPs) to help design novel opinion leader (OL)-based interventions for patients with acute asthma seen in emergency departments (EDs). METHODS A mixed methods design was employed. In phase I, we invited convenience samples of patients with asthma presenting to the ED and PCPs to participate in a survey. Perceptions with respect to: a) an ideal OL-profile for asthma guidance; and b) content, style and delivery methods of OL-based interventions in acute asthma directed from the ED were collected. In phase II, we conducted focus groups to further explore preferences and expectations for such interventions with attention to barriers and facilitators for implementation. RESULTS Overall, 54 patients completed the survey; 39% preferred receiving guidance from a respirologist, 44% during their ED visit and 56% through individual discussions. In addition, 55% expressed interest in having PCP follow-up within a week of ED discharge. A respirologist was identified as the ideal OL-profile by 59% of the 39 responding PCPs. All expressed interest in receiving notification of their patients' ED presentation, most within a week and including diagnosis and ED/post ED-treatment. Personalized, guideline-based, recommendations were considered to be the ideal content by the majority; 39% requested this guidance through a pamphlet faxed to their offices. In the focus groups, patients and PCPs recognized the importance of health professional liaisons in transitions in care; patient anxiety and PCP time constraints were identified as potential barriers for ED-educational information uptake and proper post-ED follow-up, respectively. CONCLUSIONS Engaging patients and PCPs yielded actionable information to tailor OL-based multifaceted interventions for acute asthma in the ED. We identified potential facilitators for the implementation of such interventions (e.g., patient interaction with alternative health care professionals who could facilitate transitions in asthma care between the ED and the primary care setting), and for the provision of post discharge self-management education (e.g., consideration of the first week of ED discharge as a practical time frame for this intervention). Prioritization of identified barriers (e.g., lack of PCP involvement) could be addressed by the identification of potential early adopters in practice environments (e.g., clinicians with special interest in asthma).
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Affiliation(s)
- Cristina Villa-Roel
- Department of Emergency Medicine, University of Alberta, 7-30 University Terrace, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada.
| | - Maria Ospina
- Department of Obstetrics & Gynecology, University of Alberta, 7-30 University Terrace, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada.,School of Public Health, University of Alberta, 7-30 University Terrace, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Sumit R Majumdar
- Departments of Medicine, University of Alberta, 7-30 University Terrace, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Stephanie Couperthwaite
- Department of Emergency Medicine, University of Alberta, 7-30 University Terrace, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Erin Rawe
- Department of Emergency Medicine, University of Alberta, 7-30 University Terrace, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Taylor Nikel
- Department of Emergency Medicine, University of Alberta, 7-30 University Terrace, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, University of Alberta, 7-30 University Terrace, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada.,School of Public Health, University of Alberta, 7-30 University Terrace, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
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