Interrater reliability of the Patient Education Materials Assessment Tool (PEMAT).

OBJECTIVE: To assess the interrater reliability (IRR) and usability of the Patient Education Materials Assessment Tool (PEMAT) and the relationship between PEMAT scores and readability levels. METHODS: One hundred ten materials (80 print, 30 audiovisual) were evaluated, each by two raters, using the PEMAT. IRR was calculated using Gwet's AC1 and summarized across items in each PEMAT domain (understandability and actionability) and by material type. A survey was conducted to solicit raters' experience using the PEMAT. Readability of each material was assessed using the SMOG Index. RESULTS: The median IRR was 0.92 for understandability and 0.93 for actionability across all relevant items, indicating good IRR. Eight PEMAT items had Gwet's AC1 values less than 0.81. PEMAT and SMOG Index scores were inversely correlated, with a Spearman's rho of -0.20 (p=0.081) for understandability and -0.15 (p=0.194) for actionability. While 92% of raters agreed the PEMAT was easy to use, survey results suggested specific items for clarification. CONCLUSION: While the PEMAT demonstrates moderate to excellent IRR overall, amendments to items with lower IRR may increase the usefulness of the tool. PRACTICE IMPLICATIONS: The PEMAT is a useful supplement to reading level alone in the assessment of educational materials.

Combined effects of prenatal polycyclic aromatic hydrocarbons and material hardship on child IQ.

IMPORTANCE: Polycyclic aromatic hydrocarbons are common carcinogenic and neurotoxic urban air pollutants. Toxic exposures, including air pollution, are disproportionately high in communities of color and frequently co-occur with chronic economic deprivation. OBJECTIVES: We examined whether the association between child IQ and prenatal exposure to polycyclic aromatic hydrocarbons differed between groups of children whose mothers reported high vs. low material hardship during their pregnancy and through child age 5. We tested statistical interactions between hardships and polycyclic aromatic hydrocarbons, as measured by DNA adducts in cord blood, to determine whether material hardship exacerbated the association between adducts and IQ scores. DESIGN: Prospective cohort. Participants were recruited from 1998 to 2006 and followed from gestation through age 7 years. SETTING: Urban community (New York City) PARTICIPANTS: A community-based sample of 276 minority urban youth EXPOSURE MEASURE: Polycyclic aromatic hydrocarbon-DNA adducts in cord blood as an individual biomarker of prenatal polycyclic aromatic hydrocarbon exposure. Maternal material hardship self-reported prenatally and at multiple timepoints through early childhood. MAIN OUTCOME MEASURE: Child IQ at 7 years assessed using the Wechsler Intelligence Scale for Children. RESULTS: Significant inverse effects of high cord PAH-DNA adducts on full scale IQ, perceptual reasoning and working memory scores were observed in the groups whose mothers reported a high level of material hardship during pregnancy or recurring high hardship into the child's early years, and not in those without reported high hardship. Significant interactions were observed between high cord adducts and prenatal hardship on working memory scores (ß = -8.07, 95% CI (-14.48, -1.66)) and between high cord adducts and recurrent material hardship (ß = -9.82, 95% CI (-16.22, -3.42)). CONCLUSION: The findings add to other evidence that socioeconomic disadvantage can increase the adverse effects of toxic physical "stressors" like air pollutants. Observed associations between high cord adducts and reduced IQ were significant only among the group of children whose mothers reported high material hardship. These results indicate the need for a multifaceted approach to prevention.

Predictors and consequences of global DNA methylation in cord blood and at three years.

DNA methylation changes have been implicated in many common chronic diseases leading to the hypothesis that environmental and age-related DNA methylation changes within individuals are involved in disease etiology. Few studies have examined DNA methylation changes within an individual over time and all of these studies have been conducted in adults. Here, we aim to characterize how global DNA methylation changes from birth to age three within a longitudinal birth cohort study and to determine whether there are consistent predictors of DNA methylation levels measured three years apart. We measured global DNA methylation in the same children at birth (cord blood) and again at three years of age among 165 children, using an immunoassay. We found that on average, DNA methylation was significantly higher in blood at age 3-years than in cord blood (p<0.01). However, for any individual child, the difference was less than would be expected by chance. We found that pre-pregnancy BMI was negatively predictive of both cord and three-year DNA methylation, even after statistical adjustment to account for the correlation between cord blood and three-year DNA methylation. The biologic implications of small changes in global DNA methylation are unknown. However, the observation that global DNA methylation levels persist within an individual from birth to age three supports the belief that factors that influence global DNA methylation, including pre-pregnancy BMI, may confer long-term effects.

Prenatal bisphenol a exposure and child behavior in an inner-city cohort.

BACKGROUND: Experimental laboratory evidence suggests that bisphenol A (BPA), an endocrine disruptor, is a neurodevelopmental toxicant. However, there have been limited and inconclusive results with respect to sex-specific BPA effects on child behavior. OBJECTIVE: We examined the association between prenatal BPA exposure and child behavior, adjusting for postnatal BPA exposure and hypothesizing sex-specific effects. METHODS: We followed African-American and Dominican women and their children from pregnancy to child's age 5 years, collecting spot urine samples from the mothers during pregnancy (34 weeks on average) and from children between 3 and 4 years of age to estimate BPA exposure. We assessed child behavior between 3 and 5 years of age using the Child Behavior Checklist (CBCL) and used generalized linear models to test the association between BPA exposure and child behavior, adjusting for potential confounders. RESULTS: The analysis was conducted on 198 children (87 boys and 111 girls). Among boys, high prenatal BPA exposure (highest quartile vs. the lowest three quartiles) was associated with significantly higher CBCL scores (more problems) on Emotionally Reactive [1.62 times greater; 95% confidence interval (CI): 1.13, 2.32] and Aggressive Behavior syndromes (1.29 times greater; 95% CI: 1.09, 1.53). Among girls, higher exposure was associated with lower scores on all syndromes, reaching statistical significance for Anxious/Depressed (0.75 times as high; 95% CI: 0.57, 0.99) and Aggressive Behavior (0.82 times as high; 95% CI: 0.70, 0.97). CONCLUSION: These results suggest that prenatal exposure to BPA may affect child behavior, and differently among boys and girls.

Prenatal polycyclic aromatic hydrocarbon (PAH) exposure and child behavior at age 6-7 years.

BACKGROUND: Airborne polycyclic aromatic hydrocarbons (PAH) are widespread urban air pollutants from fossil fuel burning and other combustion sources. We previously reported that a broad spectrum of combustion-related DNA adducts in cord blood was associated with attention problems at 6-7 years of age in the Columbia Center for Children's Environmental Health (CCCEH) longitudinal cohort study. OBJECTIVES: We evaluated the relationship between behavioral problems and two different measures of prenatal exposure--both specific to PAH--in the same cohort. METHODS: Children of nonsmoking African-American and Dominican women in New York City (NYC) were followed from in utero to 6-7 years. Prenatal PAH exposure was estimated by personal air monitoring of the mothers during pregnancy as well as by the measurement of DNA adducts specific to benzo[a]pyrene (BaP), a representative PAH, in maternal and cord blood. At 6-7 years of age, child behavior was assessed using the Child Behavior Checklist (CBCL) (n = 253). Generalized linear models were used to test the association between prenatal PAH exposure and behavioral outcomes. RESULTS: In multivariate analyses, high prenatal PAH exposure, whether characterized by personal air monitoring (greater than the median of 2.27 ng/m³) or maternal and cord adducts (detectable or higher), was positively associated with symptoms of Anxious/Depressed and Attention Problems (p ≤ 0.05). CONCLUSION: These results provide additional evidence that environmental levels of PAH encountered in NYC air can adversely affect child behavior.

Polycyclic aromatic hydrocarbons-aromatic DNA adducts in cord blood and behavior scores in New York city children.

BACKGROUND: Airborne polycyclic aromatic hydrocarbons (PAH) are widespread urban pollutants that can bind to DNA to form PAH-DNA adducts. Prenatal PAH exposure measured by personal monitoring has been linked to cognitive deficits in childhood in a prospective study conducted by the Columbia Center for Children's Environmental Health. OBJECTIVES: We measured PAH-DNA and other bulky aromatic adducts in umbilical cord white blood cells using the 32P-postlabeling assay to determine the association between this molecular dosimeter and behavioral/attention problems in childhood. METHODS: Children born to nonsmoking African-American and Dominican women residing in New York City (NYC) were followed from in utero to 7-8 years of age. At two time points before 8 years of age (mean ages, 4.8 years and 7 years), child behavior was assessed using the Child Behavior Checklist (CBCL). To estimate and test the association between adducts and behavioral outcomes, both CBCL continuous raw scores and dichotomized T-scores were analyzed. RESULTS: Higher cord adducts were associated with higher symptom scores of Anxious/Depressed at 4.8 years and Attention Problems at 4.8 and 7 years, and with Diagnostic and Statistical Manual of Mental Disorders, 4th edition-oriented Anxiety Problems at 4.8 years. CONCLUSIONS: These results suggest that PAH exposure, measured by DNA adducts, may adversely affect child behavior, potentially affecting school performance.