The Birth and Beyond (BABY) study: protocol for a birth cohort study investigating the social and environmental determinants of pregnancy-related outcomes in Black American families.

INTRODUCTION: In the USA, Black birthing people and infants experience disproportionately worse pregnancy-related health outcomes. The causes for these disparities are unknown, but evidence suggests that they are likely socially and environmentally based. Efforts to identify the determinants of these racial disparities are urgently needed to elucidate the highest priority targets for intervention. The Birth and Beyond (BABY) study evaluates how micro-level (eg, interpersonal and family) and macro-level (eg, neighbourhood and environmental) risk and resiliency factors transact to shape birth person-infant health, and underlying psychobiological mechanisms. METHODS AND ANALYSIS: The BABY study will follow 350 Black families (birthing parents, non-birthing parents and infants) from pregnancy through the first postpartum year, with research visits during pregnancy and at infant ages 6 and 12 months. Research visits comprise a combination of interview about a range of recent and life course stress and resiliency exposures and supports, psychophysiological (sympathetic, parasympathetic and adrenocortical) assessment and behavioural observations of parent-infant coregulatory behaviours. Spatial analyses are completed by mapping parent current and past residential addresses onto archival public data (eg, about neighbourhood quality and racial segregation). Finally, EMRs are abstracted for information about birthing parent relevant medical history, pregnancy conditions and infant birth outcomes. Analyses will evaluate the risk and resiliency mechanisms that contribute to pregnancy and birth-related outcomes for Black birthing people and their infants, and the protective role of individual, familial, cultural, and community supports. ETHICS AND DISSEMINATION: The BABY study has been approved by the Institutional Review Board at Albany Medical Centre. The study team consulted with local organisations and groups comprised of stakeholders and community leaders and continues to do so throughout the study. Research results will be disseminated with the scientific and local community as appropriate.

Adult Exposures to Toxic Trace Elements as Measured in Nails along the Interoceanic Highway in the Peruvian Amazon.

Deforestation, artisanal and small-scale gold mining (ASGM), and the rapid development related to highway expansion cause opportunities for toxic trace element exposure in the Amazon region of Madre de Dios (MDD), Peru, one of the most biologically diverse places in the world. The objective of this study was to assess the exposure to arsenic, cadmium, lead, and mercury among adults in Madre de Dios. In total, 418 adult (18+ years) participants in the Investigacion de Migracion, Ambiente, y Salud (IMAS) (Migration, Environment, and Health Study) participated in this study. Consent, survey data, and biospecimens were collected between August and November 2014. Nail elements were measured by inductively coupled plasma sector field mass spectrometry. Differences by selected individual and household characteristics and local land uses were tested using one-way ANOVAs and linear mixed models. Adults in ASGM-affected areas had higher nail arsenic and nail cadmium than their non-ASGM counterparts. Higher household fish consumption was positively associated with nail mercury and nail lead. The results indicate that adult exposure to arsenic, cadmium, lead, and mercury is heterogeneous across Madre de Dios, and the exposures related to ASGM communities and fish consumption suggest that exposures from artisanal and small-scale mining are environmentally widespread. Further investigation is warranted to ascertain potential health impacts.

A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs. OBJECTIVE: The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. METHODS: A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences. RESULTS: Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys. CONCLUSIONS: This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method.

Toxic elements in follicular fluid adversely influence the likelihood of pregnancy and live birth in women undergoing IVF.

STUDY QUESTION: Are follicular fluid (FF), arsenic (As), mercury (Hg), cadmium (Cd) and lead (Pb) concentrations associated with IVF outcomes among women undergoing IVF? SUMMARY ANSWER: There was a non-linear association between higher FF Hg concentration and a lower likelihood of biochemical pregnancy and live birth. Higher FF Pb concentration was also associated with a lower probability of live birth. WHAT IS KNOWN ALREADY: Previous research suggests that toxic elements may affect fertility among couples conceiving with and without assistance. However, the results have been inconsistent, possibly related in part to exposure misclassification. Very few studies have used ovarian FF to measure toxic elements, as it requires an invasive collection procedure, yet it may offer a more accurate estimate of a biologically effective dose than blood or urine. STUDY DESIGN SIZE DURATION: This is a prospective study of 56 women undergoing IVF, from October 2015 to June 2017. FF was collected for analysis on the day of oocyte retrieval. PARTICIPANTS/MATERIALS SETTING METHODS: As, Cd, Hg and Pb were determined in 197 FF specimens, using inductively coupled plasma tandem mass spectrometry. FF glutathione peroxidase, glutathione reductase, total glutathione-S-transferase, superoxide dismutase, arylesterase and paraoxonase (PON1p) activities were measured using kinetic enzyme assays. MAIN RESULTS AND THE ROLE OF CHANCE: Non-linear associations were detected, in which the probabilities of biochemical pregnancy (P = 0.05) and live birth (P = 0.05) were lower in association with FF Hg greater than ∼0.51 µg/l Hg, adjusted for age, race, cigarette smoking and recent seafood consumption. Higher FF Pb was also associated with a lower likelihood of live birth (relative risk (RR) = 0.68, 95% CI: 0.46, 1.00; P = 0.05). We also found a suggestive, although imprecise, antagonizing mediating effect of PON1p activity on the association between FF Pb and live birth (-28.3%; 95% CI: -358%, 270%). LIMITATIONS REASONS FOR CAUTION: The results should be interpreted judiciously given the limited sample size and difficulty accounting for correlated data in generalized additive models and mediation analyses. Additionally, women undergoing IVF are highly selected with respect to age and socioeconomic status, and so the generalizability of the results may be limited. WIDER IMPLICATIONS OF THE FINDINGS: Overall, the results suggest that FF Hg was associated with a lower likelihood of biochemical pregnancy and live birth, with a potential threshold effect, and that higher FF Pb was associated with a lower probability of live birth. These results may help to guide clinical recommendations for limiting the exposure of patients to Hg and Pb and ultimately improve IVF success rates. STUDY FUNDING/COMPETING INTERESTS: This work was funded in part by the National Institute of Environmental Health Sciences (NIEHS), grant number 1R56ES023886-01, to the University at Albany (M.S.B.), and in part by the National Institute of Environmental Health Sciences (NIEHS), grant number 1U2CES026542-01, to the Wadsworth Center (P.J.P.). The authors declare no competing interests. TRIAL REGISTRATION NUMBER: N/A.

Prenatal Exposure to Favorable Social and Environmental Neighborhood Conditions Is Associated with Healthy Pregnancy and Infant Outcomes.

Neighborhood and individual level risks commonly co-occur for pregnant women and may cumulatively contribute to birth outcomes. Moreover, the relationship between favorable social and environmental neighborhood conditions and perinatal outcomes has been understudied. This study considered the accumulated impact of prenatal exposure to positive neighborhood social, environmental, and educational conditions in relation to maternal health during pregnancy and birth size outcomes. In a prospective study of a multi-ethnic and socioeconomically diverse cohort (n = 239) of pregnant women and their infants, neighborhoods were characterized by the Child Opportunity Index (COI), a census-tract composite indicator representing favorable social, environmental, and educational community conditions. Adjusted generalized estimating equations showed that favorable neighborhood conditions promoted the growth of longer and heavier infant bodies, and reduced the risk of intrauterine growth restriction. The associations were stronger for female versus male infants, though not significantly different. Moreover, COI was associated with better maternal mental health and diet during pregnancy; diet significantly mediated the association between COI and birth size outcomes. This study underscores the importance of considering the accumulated benefit of neighborhood assets for maternal and infant health. Interventions that capitalizes on the full range of contextual assets in which mothers live may promote pregnancy health and fetal growth.

Residential Proximity to Biorefinery Sources of Air Pollution and Respiratory Diseases in New York State.

Understanding potential health risks associated with biofuel production is critical to sustainably combating energy insecurity and climate change. However, the specific health impacts associated with biorefinery-related emissions are not yet well characterized. We evaluated the relationship between respiratory emergency department (ED) visits (2011-2015) and residential exposure to biorefineries by comparing 15 biorefinery sites to 15 control areas across New York (NY) State. We further examined these associations by biorefinery types (e.g., corn, wood, or soybean), seasons, and lower respiratory disease subtypes. We measured biorefinery exposure using residential proximity in a cross-sectional study and estimation of biorefinery emission via AERMOD-simulated modeling. After controlling for multiple confounders, we consistently found that respiratory ED visit rates among residents living within 10 km of biorefineries were significantly higher (rate ratios (RRs) range from 1.03 to 3.64) than those in control areas across our two types of exposure indices. This relationship held across biorefinery types (higher in corn and soybean biorefineries), seasons (higher in spring and winter), air pollutant types (highest for NO2), and respiratory subtypes (highest for emphysema). Further research is needed to confirm our findings.

CoNaMad-Cohorte de Nacimiento de Madre de Dios/Madre de Dios Birth Cohort to Study Effects of in-utero Trace Metals Exposure in the Southern Peruvian Amazon.

Background: In-utero exposure to mercury and other trace metals pose a significant threat to child health and development, but exposures and health impacts in artisanal and small-scale gold mining (ASGM) environments are poorly defined. Objectives: We describe the CONAMAD study design, a prospective birth cohort consisting of multiparous women (18 and over) living in rural and peri-urban Peruvian Amazon communities exposed to ASGM. Methods: Pregnant women are enrolled from health posts across four zones of Madre de Dios, Peru. Data are collected at enrollment, childbirth, and (planned) 36-48 months. At enrollment, hair samples for mercury assessment, demographic and clinical data are obtained. At birth, we obtain venous and cord blood, placenta, hair, toenails, and saliva. Findings: Two hundred seventy mothers were enrolled at an average 20 weeks gestational age with no differences in maternal characteristics across zones. Two hundred fifteen mothers were successfully followed at birth. We obtained 214 maternal and cord blood samples, 211 maternal and 212 infant hair samples, 212 placenta samples, 210 infant saliva samples, and 214 infant dried blood spots. Data collected will allow for testing our primary hypotheses of maternal malnutrition modifying ratios of cord:maternal blood total mercury (tHg), cord blood:maternal hair tHg, and infant:maternal hair tHg, and whether chemical mixtures (Hg, Pb, Cd) have synergistic effects on infant neurodevelopment. Conclusions: CONAMAD is designed to collect and store samples for future processing and hypothesis testing associated with in-utero mercury exposure and child development. We have completed the exposure assessments and will conduct a follow-up of mothers to evaluate early child development outcomes, including developmental delay and growth. These data offer insights into disease mechanisms, exposure prevention, and policy guidance for countries where ASGM is prevalent.

Variability of essential and non-essential trace elements in the follicular fluid of women undergoing in vitro fertilization (IVF).

Both essential and non-essential elements have been associated with female reproductive function in epidemiologic investigations, including among IVF populations. To date, most investigators have used blood or urine to assess biomarkers of exposure, with few employing ovarian follicular fluid (FF). FF may offer a more direct "snapshot" of the oocyte microenvironment than blood or urine, however previous studies report follicle-to-follicle variability in FF constituents that may contribute to exposure misclassification. Our objectives were to investigate sources of trace element variability, to estimate FF biomarker reliability among women undergoing IVF (n = 34), and to determine the minimum number of follicles required to estimate subject-specific mean concentrations. We measured As, Hg, Cd, Pb, Cu, Mn, Se, and Zn in FF samples using inductively coupled plasma tandem mass spectrometry. Inter-subject (between-women) variability contributed most of the variability in FF element concentrations, with ovarian, follicular, and analytical as smaller sources of variability. The proportion of variability attributable to sources between-follicles differed by age, body mass index (BMI), race, and cigarette smoking for Cu, Se, and Zn, by BMI and cigarette smoking for As, by primary infertility diagnosis for Hg, Cu, Se, and Zn, and by ovarian stimulation protocol for Mn and Se. Four to five individual follicles were sufficient to estimate subject-specific mean Cu, Se, and Zn concentrations, while >14 were necessary for As, Hg, Cd, Pb, and Mn. Overall, our results suggest that FF is a suitable source of biomarkers of As and Hg exposure in ovarian follicles. Although limited in size, our study offers the most comprehensive exploration of biological variation in FF trace elements to date and may provide guidance for future studies of ovarian trace element exposures.

Seafood consumption is associated with higher follicular fluid arsenic (As) and mercury (Hg) concentrations in women undergoing in vitro fertilization (IVF).

Human exposure to non-essential toxic metals such as cadmium (Cd), mercury (Hg), and lead (Pb), and metalloids such as arsenic (As) commonly occurs through diet. Toxic trace element exposures have been reported in association with fertility and fecundity in epidemiologic studies even at low to moderate levels. While most previous studies employed blood and urine biomarkers of exposure, few have assessed toxic trace elements in ovarian follicular fluid (FF), which surrounds the developing oocyte and hence may better reflect concentrations potentially affecting reproductive outcomes. Our objective was to identify dietary predictors of FF toxic trace elements in n = 56 women (mean age: 38.3 years) undergoing in vitro fertilization (IVF) at the University of California at San Francisco. We determined As, Hg, Cd, and Pb in 197 FF specimens, collected on the day of oocyte retrieval, using inductively coupled plasma tandem mass spectrometry. A comprehensive food frequency questionnaire was used to assess the weekly and annual dietary "patterns" of participants. Consumption of specific seafood items and turkey were correlated with individual FF toxic trace elements. We also found that each unit higher seafood consumption in the past week dominated by mollusks, shrimp, and bass was associated with 60% higher FF As (95% confidence interval (CI): 25%, 105%) and FF Hg (95%CI: 7%, 136%) concentrations. Higher annual seafood consumption dominated by urchin, crab, and trout was associated with 16% higher FF As (95%CI: -2%, 38%) and 31% higher FF Hg (95%CI: 7%, 60%) concentrations per unit intake. No associations were noted between diet and Cd and Pb levels in FF. Overall, our results suggest that higher seafood consumption contributes to elevated levels of As and Hg in FF. These findings are consistent with previous IVF studies that assessed toxic trace element exposures in blood and urine. To our knowledge, this is the first study to report that diet might be a source of As, Hg, Cd, and Pb in FF.

Sources of exposure to urinary phthalates among couples undergoing infertility treatment.

Phthalates have been implicated as reproductive toxicants in animal models and in human populations. This study examined associations between potential exposure sources and urinary phthalate metabolite concentrations among women (n = 56) and their male partners (n = 43) undergoing in vitro fertilization (IVF). On the day of oocyte retrieval, participants provided urine samples and completed questionnaires detailing use of personal care products (PCPs), and consumption of medications, foods, and beverages in the preceding 24 h. Urine was analyzed for MEP, MBP, MPP, MHxP, MEHP, MEHHP, MECPP, MiNP, MiDP, MCHP, and MBzP, via liquid chromatography-tandem mass spectrometry. We employed principal component analysis (PCA) to summarize exposure sources and regression models to estimate associations between exposure patterns and urinary phthalate metabolites, adjusted for confounding variables. Among women, application of more body washes and eye creams, and consumption of more supplements, was associated with greater urinary MECPP [relative difference = 1.36 (95% CI: 1.28, 1.45)] and the molar sum of DEHP metabolites, including MEHP, MEHHP, and MECPP [∑DEHP; 1.26 (95% CI: 1.17, 1.34)]. Among men, consumption of more supplements and allergy medications was associated with greater urinary MECPP, MEHHP, and ∑DEHP [relative difference = 1.13 (95% CI: 1.02, 1.23)] concentrations. Identifying differences in sources of phthalate exposure may help clinicians to intervene to reduce exposure as part of a comprehensive strategy to help improve IVF outcomes.

Projecting life-cycle environmental impacts of corn production in the U.S. Midwest under future climate scenarios using a machine learning approach.

Climate change is exacerbating environmental pollution from crop production. Spatially and temporally explicit estimates of life-cycle environmental impacts are therefore needed for suggesting location and time relevant environmental mitigations strategies. Emission factors and process-based mechanism models are popular approaches used to estimate life-cycle environmental impacts. However, emission factors are often incapable of describing spatial and temporal heterogeneity of agricultural emissions, whereas process-based mechanistic models, capable of capturing the heterogeneity, tend to be very complicated and time-consuming. Efficient prediction of life-cycle environmental impacts from agricultural production is lacking. This study develops a rapid predictive model to quantify life-cycle global warming (GW) and eutrophication (EU) impacts of corn production using a novel machine learning approach. We used the boosted regression tree (BRT) model to estimate future life-cycle environmental impacts of corn production in U.S. Midwest counties under four emissions scenarios for years 2022-2100. Results from BRT models indicate that the cross-validation (R2) for predicting life cycle GW and EU impacts ranged from 0.78 to 0.82, respectively. Furthermore, results show that future life-cycle GW and EU impacts of corn production will increase in magnitude under all four emissions scenarios, with the highest environmental impacts shown under the high-emissions scenario. Moreover, this study found that changes in precipitation and temperature played a significant role in influencing the spatial heterogeneity in all life-cycle impacts across Midwest counties. The BRT model results indicate that machine learning can be a useful tool for predicting spatially and temporally explicit future life-cycle environmental impacts associated with corn production under different climate scenarios.

Population-based dietary exposure to mercury through fish consumption in the Southern Peruvian Amazon.

BACKGROUND: Mercury exposure related to artisanal and small-scale gold mining (ASGM) has raised environmental and public health concerns globally. Exposure to mercury, a potent neurotoxin that bioaccumulates in fish, is especially of concern to women of childbearing age (WCBA) and children in high-fish consuming populations. In Madre de Dios (MDD), Peru, an Amazon region with naturally occurring mercury and high ASGM activity, there is significant exposure concern among the mainly riverine, fish-consuming communities. The objective of this study was to conduct the first assessment of mercury exposure in a population-based sample of MDD, identify factors associated with elevated levels and compare the relationship between fish consumption and hair total mercury (H-THg) among persons living in ASGM affected and non-ASGM affected watersheds. METHODS: Hair samples and household demographic surveys, including a module on fish consumption, were collected from 723 participants across 46 communities within 10 km of the Interoceanic Highway in MDD, who were previously enrolled in the first population-based study in MDD spanning areas affected and unaffected by ASGM. H-THg concentration (natural log transformed) was evaluated for association with independent demographic variables through multilevel multivariate regression models accounting for clustering among households and communities. Samples from canned fish available at local stores were also tested for total mercury. RESULTS: Fish consumption (diversity and total consumed) varied spatially along the highway. 269 participants (37.2%) had elevated H-THg (>2.2 µg/g; median 1.60 µg/g; mean 2.24 µg/g), including 42.7% of WCBA and 20.0% of children under 5. Overall, H-THg was higher among people living in ASGM-affected areas. H-THg concentrations were strongly associated with fish consumption; however, in the multivariate models, household consumption of high trophic level fish was associated with elevated H-THg only in communities located in the ASGM-impacted watersheds. Similarly, the relationship between living in a household engaged in economic activities of fishing or Brazil nut harvesting was associated with higher H-THg, but only among households in the ASGM-affected area. In the non-ASGM affected areas, we observed a positive relationship between household daily fruit consumption and H-THg that was not observed in ASGM-affected areas. CONCLUSION: Diet, residential location, and occupation are strong predictors of mercury exposure in Madre de Dios, Peru. Canned fish may represent a previously overlooked source of dietary Hg exposure in the region. In accordance with the Minamata Convention on Mercury, the significant environmental health concern of mercury exposure in ASGM areas demands policy and programmatic attention.

Evaluation of Methicillin-Resistant Staphylococcus aureus Carriage and High Livestock Production Areas in North Carolina through Active Case Finding at a Tertiary Care Hospital.

Recent reports from the Netherlands document the emergence of novel multilocus sequence typing (MLST) types (e.g., ST-398) of methicillin-resistant Staphylococcus aureus (MRSA) in livestock, particularly swine. In Eastern North Carolina (NC), one of the densest pig farming areas in the United States, as many as 14% of MRSA isolates from active case finding in our medical center have no matches in a repetitive sequence-based polymerase chain reaction (rep-PCR) library. The current study was designed to determine if these non-matched MRSA (NM-MRSA) were geographically associated with exposure to pig farming in Eastern NC. While residential proximity to farm waste lagoons lacked association with NM-MRSA in a logistic regression model, a spatial cluster was identified in the county with highest pig density. Using MLST, we found a heterogeneous distribution of strain types comprising the NM-MRSA isolates from the most pig dense regions, including ST-5 and ST-398. Our study raises the warning that patients in Eastern NC harbor livestock associated MRSA strains are not easily identifiable by rep-PCR. Future MRSA studies in livestock dense areas in the U.S. should investigate further the role of pig-human interactions.

In urban, but not rural, areas of Madre de Dios, Peru, adoption of a Western diet is inversely associated with selenium intake.

Road development has been a major driver of the transition from traditional to calorie-dense processed 'Western' diets in lower and middle-income countries. The paving of the Interoceanic Highway (IOH) facilitated rapid development to the Madre de Dios (MDD) region in the Peruvian Amazon. As traditional foods such as Brazil nuts and fish are known to be rich in the essential micronutrient selenium, people further along the nutrition transition to a Western diet may have lower selenium (Se) intake. To test this hypothesis, in 2014 the Investigacion de Migracion, Ambiente, y Salud (IMAS Study) (Migration, Environment, and Health Study) collected household surveys from 310 households in 46 communities along the IOH and nails for Se analysis from 418 adults. Principal component analysis of 25 commonly consumed food items identified a factor resembling Western diet, which was used to calculate household Western diet weighted sum factor scores (WSFS). WSFS means were interpolated into a 10 km buffer around the IOH using inverse distance weighting. Western diet adoption was higher in urban compared to rural areas (p < 0.0001), and geographic variation was observed between mining and agricultural areas. Mean nail Se was 730 ng/g, SD 198 ng/g (range: 200-1390 ng/g). Generalized estimating equation (GEE) models assessed the association between food consumption and nail Se. Household chicken consumption was positively associated with Se in rural areas only. Urban/rural status modified the effect of western diet adoption on nail Se, and Se was inversely associated with WSFS in urban areas only. Conclusion: In urban, but not rural, areas of Madre de Dios, Peru, adoption of a Western diet is inversely associated with selenium intake. As the essential micronutrient selenium is a vital part of antioxidant proteins, lower intake could compound the chronic health effects that may result from transition to a calorie-dense diet.

Cancers Disproportionately Affecting the New York State Transgender Population, 1979-2016.

OBJECTIVES: To summarize what is known about cancer among the transgender population in New York State. METHODS: We identified transgender patients diagnosed between 1979 and 2016 in the New York State Cancer Registry using reported sex, text search of the case abstract, and linkage to statewide hospitalization records. RESULTS: We identified 230 transgender patients, including 125 natal males, 48 natal females, and 57 with unknown natal sex. Median age at diagnosis was 47.4 years, compared with 66.0 years for all patients. Transgender patients were more than 2.5 times more likely to use cigarettes than were other cancer patients. Kaposi sarcoma had the highest proportional incidence ratio (71.7). CONCLUSIONS: In New York State, HIV- and human papillomavirus-related cancers disproportionately affect the transgender population. Public Health Implications. To our knowledge, this is the first report of cancer among the transgender population that incorporates more detailed codes that took effect in 2015. Awareness of the differences in transgender cancer incidence from the general population is vital to ensure that necessary preventive care and screenings are accessible and offered appropriately to this population.

O'Connor et al. systematic review regarding animal feeding operations and public health: critical flaws may compromise conclusions.

In this comment, we summarize several scientific concerns with the recently published systematic review from O'Connor and colleagues that examined the relationship between proximity to animal-feeding operations and health of individuals in nearby communities. The authors utilized a bias tool not designed for environmental health research, erroneously excluded important studies, and incorrectly interpreted others. As a result, the conclusions drawn in the review misrepresent the evidence from the published literature, limiting its value to policymakers, researchers, and the public.

Mercury, selenium and fish oils in marine food webs and implications for human health.

Humans who eat fish are exposed to mixtures of healthful nutrients and harmful contaminants that are influenced by environmental and ecological factors. Marine fisheries are composed of a multitude of species with varying life histories, and harvested in oceans, coastal waters and estuaries where environmental and ecological conditions determine fish exposure to both nutrients and contaminants. Many of these nutrients and contaminants are thought to influence similar health outcomes (i.e., neurological, cardiovascular, immunological systems). Therefore, our understanding of the risks and benefits of consuming seafood require balanced assessments of contaminants and nutrients found in fish and shellfish. In this paper, we review some of the reported benefits of fish consumption with a focus on the potential hazards of mercury exposure, and compare the environmental variability of fish oils, selenium and mercury in fish. A major scientific gap identified is that fish tissue concentrations are rarely measured for both contaminants and nutrients across a range of species and geographic regions. Interpreting the implications of seafood for human health will require a better understanding of these multiple exposures, particularly as environmental conditions in the oceans change.

River transport of mercury from artisanal and small-scale gold mining and risks for dietary mercury exposure in Madre de Dios, Peru.

Artisanal and small-scale gold mining (ASGM) is a major contributor to deforestation and the largest anthropogenic source of atmospheric mercury worldwide. Despite significant information on the direct health impacts of mercury to ASGM miners, the impact of mercury contamination on downstream communities has not been well characterized, particularly in Peru's Madre de Dios region. In this area, ASGM has increased significantly since 2000 and has led to substantial political and social controversy. This research examined the spatial distribution and transport of mercury through the Madre de Dios River with distance from ASGM activity. This study also characterized risks for dietary mercury exposure to local residents who depend on fish from the river. River sediment, suspended solids from the water column, and fish samples were collected in 2013 at 62 sites near 17 communities over a 560 km stretch of the Madre de Dios River and its major tributaries. In areas downstream of known ASGM activity, mercury concentrations in sediment, suspended solids, and fish within the Madre de Dios River were elevated relative to locations upstream of mining. Fish tissue mercury concentrations were observed at levels representing a public health threat, with greater than one-third of carnivorous fish exceeding the international health standard of 0.5 mg kg(-1). This study demonstrates that communities located hundreds of kilometers downstream of ASGM activity, including children and indigenous populations who may not be involved in mining, are at risk of dietary mercury exposure that exceed acceptable body burdens. This report represents the first systematic study of the region to aid policy decision-making related to ASGM activities in Peru.

Achieving a healthy zoning policy in Baltimore: results of a health impact assessment of the TransForm Baltimore zoning code rewrite.

OBJECTIVES: The social determinants of health (SDH) include factors apart from genes and biology that affect population health. Zoning is an urban planning tool that influences neighborhood built environments. We describe the methods and results of a health impact assessment (HIA) of a rezoning effort in Baltimore, Maryland, called TransForm Baltimore. We highlight findings specific to physical activity, violent crime, and obesity. METHODS: We conducted a multistage HIA of TransForm Baltimore using HIA practice guidelines. Key informant interviews identified focus areas for the quantitative assessment. A literature review and a zoning code analysis evaluated potential impacts on neighborhood factors including physical activity, violent crime, and obesity. We estimated potential impacts in high- and low-poverty neighborhoods. The findings resulted in recommendations to improve the health-promoting potential of TransForm Baltimore. RESULTS: Mixed-use and transit-oriented development were key goals of TransForm Baltimore. Health impacts identified by stakeholders included walkability and healthy communities. For Baltimore residents, we estimated that (1) the percentage of people living in districts allowing mixed-use and off-premise alcohol outlets would nearly triple, (2) 18% would live in transit-oriented development zones, and (3) all residents would live in districts with new lighting and landscaping guidelines. Limiting the concentration of off-premise alcohol outlets represented an opportunity to address health promotion. CONCLUSIONS: Changes to Baltimore's zoning code could improve population health including decreasing violent crime. HIAs are an important platform for applying SDH to public health practice. This HIA specifically linked municipal zoning policy with promoting healthier neighborhoods.