Associations between mercury exposure with blood pressure and lipid levels: A cross-sectional study of dental professionals.

Mercury (Hg) exposure is a public health problem worldwide that is now being addressed through the Minamata Convention on Mercury. Fish containing methylmercury and dental amalgam containing elemental Hg are the major sources of exposure for most populations. There is some evidence that methylmercury impacts cardiovascular and metabolic health, primarily in populations with high exposure levels. Studies of elemental Hg and these outcomes are relatively rare. We aimed to examine associations between Hg exposure (both elemental and methylmercury) and blood pressure, as well as cholesterol and triglyceride levels. In 2012, we recruited dental professionals attending the Health Screening Program at the American Dental Association (ADA) Annual Session in California. Total Hg levels in hair and blood samples were analyzed as indicators of methylmercury exposure and in urine as an indicator of primarily elemental Hg exposure (n = 386; mean ± sd age 55 ± 11 years). We measured blood pressure (systolic and diastolic) and lipid profiles (total cholesterol, high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol [LDL] and triglycerides). The geometric means (geometric standard deviations) for blood, hair, and urine Hg were 3.64 (2.39) µg/L, 0.60 (2.91) µg/g, and 1.30 (2.44) µg/L, respectively. For every one µg/L increase in specific gravity-adjusted urine Hg, LDL increased by 2.31 mg/dL (95% CI = 0.09, 4.54), in linear regression adjusting for BMI, race, sex, polyunsaturated fatty acid intake from fish consumption, smoking status, and use of cholesterol-lowering medication. No significant associations between Hg biomarkers and blood pressure or hair or blood Hg with lipid levels were observed. Results suggest that elemental Hg exposure may influence LDL concentrations in adults with low-level exposure, and this relationship merits further study in other populations.

A Collaborative Approach to Address Racism in a Community-Academic Partnership.

The HERCULES Exposome Research Center at Emory University uses an exposome approach to study the environment's effect on health and community well-being. HERCULES is guided by a Stakeholder Advisory Board (SAB) that includes representatives of neighborhoods, nonprofit organizations, government agencies, and academic institutions in the Atlanta metropolitan region. This region (and the SAB) has a large proportion of Black residents, many of whom live in areas experiencing environmental injustices. Historic and current racial injustices in Atlanta and public health research made it imperative to initiate dialogue and implement actions to address racism and power dynamics that may impact research and partnerships between affected communities and our institution.After initial discussion, the HERCULES Community Engagement Core and SAB members formed a workgroup to develop an internal anti-racism process. The workgroup drafted an Anti-Racism Commitment, hosted a Racism and Equity Dialogue Series, and initiated a strategic planning process to implement the resulting recommendations, which fell into the following categories: anti-racist guidance/policies and recommendations for research, community engagement, and the department. Center leadership and the SAB were engaged throughout the iterative process.This deliberate and ongoing process allows HERCULES to identify and begin implementing action items that go beyond a written proclamation to address racialized power imbalances and systemic inequities. HERCULES is committed to working collaboratively to earn community trust while addressing systemic issues, recognizing that these are essential to forming research partnerships that address health inequities.

Parenting and Lead Mitigation at Home: A Multifaceted Community Partnership Model Promoting Parent Engagement in Lead Exposure Prevention.

Young children are at high risk of lead poisoning, which can damage early cognitive and behavioral development and have long-lasting impacts. Home environments are persistent sources of exposure for children in urban, low-income settings. Community-academic partnerships are essential for public health intervention strategies addressing residential household lead exposure, yet community organization staff and home visitors often experience strain and burnout. We describe Parenting and Lead Mitigation at Home, a multifaceted partnership project to (a) develop and implement a community-based, peer-delivered education program for parents of young children in neighborhoods at risk for home lead exposure and (b) support the home visitors delivering programming. We developed, delivered, and initially evaluated Lead 101, a lead-exposure prevention curriculum informed by the Community Organizing and Family Issues (COFI) model. The goals were to educate parents around lead exposure risks and empower parents to reduce their child's risk. We developed a novel Reflective Practice pilot curriculum designed to provide emotional support to peer educators and community organization staff who delivered home-based programming. We trained 11 peer educators who delivered Lead 101 to 62 families. We pilot-tested the Reflective Practice curriculum with five community organization staff. The implementation process and pilot evaluation data suggest increased parent knowledge and self-efficacy regarding mitigation of home-based lead hazards, and high satisfaction with reflective practice. Using this model to develop multifaceted partnerships among universities, community-based organizations, and focal communities may facilitate community-engaged program development for families and systematic support for individuals working directly with families, thereby indirectly promoting child health and well-being.

A merged model of quality improvement and evaluation: maximizing return on investment.

Quality improvement (QI) and evaluation are frequently considered to be alternative approaches for monitoring and assessing program implementation and impact. The emphasis on third-party evaluation, particularly associated with summative evaluation, and the grounding of evaluation in the social and behavioral science contrast with an emphasis on the integration of QI process within programs or organizations and its origins in management science and industrial engineering. Working with a major philanthropic organization in Georgia, we illustrate how a QI model is integrated with evaluation for five asthma prevention and control sites serving poor and underserved communities in rural and urban Georgia. A primary foundation of this merged model of QI and evaluation is a refocusing of the evaluation from an intimidating report card summative evaluation by external evaluators to an internally engaged program focus on developmental evaluation. The benefits of the merged model to both QI and evaluation are discussed. The use of evaluation based logic models can help anchor a QI program in evidence-based practice and provide linkage between process and outputs with the longer term distal outcomes. Merging the QI approach with evaluation has major advantages, particularly related to enhancing the funder's return on investment. We illustrate how a Plan-Do-Study-Act model of QI can (a) be integrated with evaluation based logic models, (b) help refocus emphasis from summative to developmental evaluation, (c) enhance program ownership and engagement in evaluation activities, and (d) increase the role of evaluators in providing technical assistance and support.

Evaluation of Diverse Community Asthma Interventions: Balancing Health Outcomes with Developing Community Capacity for Evidence-Based Program Measurement.

The challenge of evaluating community asthma management programs is complicated by balancing the emphasis on health outcomes with the need to build community process capacity for conducting and monitoring evidence-based programs. The evaluation of a Georgia Childhood Asthma Management Program, a Healthcare Georgia Foundation-supported initiative for multiple diverse programs and settings, provides an example of an approach and the results that address this challenge. A "developmental evaluation" approach was applied, using mixed methods of quantitative and qualitative data collection and analysis, to assess the progress of community asthma prevention programs in building community within the context of: where the community is starting, community-level systems changes, and the community's progress toward becoming more outcome measurement oriented and evidence based. Initial evaluation efforts revealed extensive mobilization of community assets to manage childhood asthma. However, there were minimal planned efforts to assess health outcomes and systems changes, and the lack of a logic model-based program design linking evidence-based practices to outcomes. Following developmental technical assistance within evaluation efforts, all programs developed logic models, linking practices to outcomes with data collection processes to assess progress toward achieving the selected outcomes. This developmental approach across diverse projects and communities, along with a quality improvement benchmarking approach to outcomes, created a focus on health status outcome improvement. Specifically, this approach complemented an emphasis on an improved community process capacity to identify, implement, and monitor evidence-based asthma practices that could be used within each community setting.

Mobile farm clinic outreach to address health conditions among Latino migrant farmworkers in Georgia.

Agricultural labor involves exposure to many occupational hazards, some of which can lead to chronic health conditions. The purpose of this study was to conduct an occupational health needs assessment of illnesses and work-related injuries among a Latino migrant farmworker population (recruited to harvest Vidalia onions) in South Georgia. Study data included survey responses from 100 farmworkers attending mobile farm clinics in 2010 at their worker housing residences, supplemented by medical diagnoses data from the same clinics collected over 3 years (2009-2011) for 1161 farmworkers at six different farms. From the survey, the main health problems reported were hypertension (25%), eye problems (12%), musculoskeletal problems (11%), diabetes (10%), and depression (7%). In multivariate analyses, depression scores were associated with having a history of musculoskeletal problems (p = .002). According to the mobile farm clinic data, the most common medical diagnoses included back pain (11.8%), hypertension (11.4%), musculoskeletal problems (11.3%), gastrointestinal disorders (8.6%), eye problems (7.2%), dermatitis or rash (7.0%), and tinea or fungal skin infections (5.6%). The study identified eye and musculoskeletal problems as the major occupational health conditions for this population of farmworkers.

Brominated flame retardants in offices in Michigan, USA.

Brominated flame retardants (BFRs) are now ubiquitous contaminants with large reservoirs and high concentrations in buildings. Most of the information documenting BFR levels has been obtained in residences, and other environments that can lead to exposure have received relatively little attention, including offices that contain numerous BFR sources and where individuals spend considerable time. The aim of this study is to characterize BFR concentrations, potential emission sources, and migration pathways in office environments. We measure BFR levels in floor dust, indoor air, ventilation filter dust, and carpets in ten commercial and institutional buildings in Michigan, U.S.A. The median concentration of total BDEs in settled dust was 8754 ng g(-1), at the upper range of levels previously reported. Especially elevated levels were found in offices in buildings that contained known or likely BFR sources, e.g., computer servers. A trends analysis in a newly constructed building showed remarkable increases in concentrations of BFRs in settled dust and indoor air, and apparent steady-state levels were reached 5 to 8 months after building completion, a particularly striking finding given that the building was constructed and furnished several years after the voluntary phase-out of the penta- and octa-mixtures. Airborne particulate matter collected in a building's HVAC system filters contained PBDEs, including BDE-209, at levels exceeding the concentration of floor dust. In conjunction with estimates of building air flow rates, filter efficiency and other parameters, mass balance calculations for this building were used to estimate the emission rates and reservoirs of PBDEs. The widespread distribution of BFRs found in offices in both new and old buildings suggests the significance of workplace exposures, the need for controls to minimize human exposure, intra-building migration, and environmental releases of these chemicals, and the need for monitoring in new buildings to confirm the effectiveness of the PBDE phase-out.

Concentrations and emissions of polybrominated diphenyl ethers from U.S. houses and garages.

Concentrations of polybrominated diphenyl ethers (PBDEs) and other brominated flame retardants (BFRs) have been rapidly increasing in fish, birds, sediments, indoor environments, and humans, but emission sources and exposure pathways of these pollutants remain poorly understood. The many BFR-containing materials in buildings constitute a large reservoir of these compounds, and in-use releases from this reservoir may be a significant environmental source. To estimate in-use releases from building materials and contents in residences, we monitored 12 houses and garages in two seasons and combined measurements of BFRs in air and settled dust, air exchange rates, and other information in an approach that utilized the building as a "natural" test chamber. Results were scaled to provide a first estimate of aggregate emission rates from U.S. houses. PBDE releases total about 4 microg h(-1) per house or 20 ng m(-2) h(-1), and U.S. houses and garages collectively release about 4100 kg y(-1). Most of these releases are settled floor dust, but about 20% are released directly to the ambient environment via airborne vapor and particulate matter. These screening-level estimates are subject to considerable uncertainty, but they have an advantage in that they reflect real-world conditions based on mass balance calculations.

VOC and particulate emissions from commercial cigarettes: analysis of 2,5-DMF as an ETS tracer.

Emissions of particulate matter (PM) and a broad suite of target volatile organic compounds (VOCs) in total, main-stream (MS) and side-stream (SS) smoke emissions are measured for six types of commercial cigarettes. The suitability of 2,5-dimethyl furan (DMF) as a tracer for environmental tobacco smoke (ETS) is investigated using laboratory results and a field study of 47 residences. Over 30 VOCs were characterized in cigarette smoke, including several that have not been reported previously. "regular tar", "low tar", menthol, and nonmenthol cigarettes showed only minor differences in PM and VOC emissions. When total emissions are considered, PM emissions averaged 18 +/- 2 mg cigarette(-1) and VOC emissions averaged 3644 +/- 160 mg cigarette(-1). DMF appears to satisfy all requirements for a tracer, namely, uniqueness, detectability, similar emission factors across tobacco products (211 +/- 16 microg cigarette(-1)), consistent proportions to other ETS compounds, and behavior similar to other ETS components in relevant environments. On the basis of field study results, DMF more reliably indicated smoking status than occupant-completed questionnaires, and cigarette smoking was responsible for significant fractions of benzene (50%), styrene (49%), and other VOCs in the smoker's homes.

Quantifying the availability of clay surfaces in soils for adsorption of nitrocyanobenzene and diuron.

Coverage of clay surfaces by soil organic matter (SOM) may limitthe efficacy of the soil mineral fractions for adsorption of organic contaminants and pesticides. Two methods were scrutinized for quantitatively assessing the availability of clay surfaces in a smectitic Webster A-horizon soil for sorption of p-nitrocyanobenzene (p-NCB) and diuron. One method, described previously, involves the summation of independent contributions of SOM and swelling clays to sorption of organic solutes. For this method, several assumptions must be made and/or procedural difficulties overcome in the determination of certain terms in the equation proposed for calculating the fractional availability of mineral surfaces (fa). To alleviate the methodological limitations, we developed an alternative approach for determining fa. Good agreement between fa values was obtained from both methods for p-NCB but not diuron. For p-NCB sorption, fa values varied between 0.55 and 0.71. For diuron sorption, our alternative equation estimated fa values varied between 0.41 and 0.61; the other approach yielded negative values. The results demonstrate that SOM does reduce the availability of clay surfaces, hence, suppressing sorption by the Webster A-horizon soil. Our newly developed method provides more reasonable estimates of the availability of soil-clay surfaces for sorption than an earlier published approach.