Evaluating Mixtures of Urinary Phthalate Metabolites and Serum Per-/Polyfluoroalkyl Substances in Relation to Adolescent Hair Cortisol: The HOME Study.

Results of toxicological studies indicate that phthalates and per-/polyfluoroalkyl substances (PFAS), 2 classes of endocrine-disrupting chemicals, may alter the functioning of the hypothalamic-pituitary-adrenocortical (HPA) axis. We evaluated the associations of urinary phthalate metabolites and serum PFAS during gestation and childhood with adolescent hair cortisol concentrations (pg/mg hair) at age 12 years, an integrative marker of HPA axis activity (n = 205 mother-child pairs; Cincinnati, Ohio; enrolled 2003-2006). We used quantile-based g-computation to estimate associations between mixtures of urinary phthalate metabolites or serum PFAS and hair cortisol. We also examined whether associations of individual phthalate metabolites or PFAS with cortisol varied by the timing of exposure. We found that a 1-quartile increase in all childhood phthalate metabolites was associated with 35% higher adolescent hair cortisol (phthalate mixture ψ = 0.13; 95% confidence interval: 0.03, 0.22); these associations were driven by monoethyl phthalate, monoisobutyl phthalate, and monobenzyl phthalate. We did not find evidence that phthalate metabolites during gestation or serum PFAS mixtures were related to adolescent hair cortisol concentrations. We found suggestive evidence that higher childhood concentrations of individual PFAS were related to higher and lower adolescent hair cortisol concentrations. Our results suggest that phthalate exposure during childhood may contribute to higher levels of chronic HPA axis activity.

Per- and polyfluoroalkyl substances and bone mineral content in early adolescence: Modification by diet and physical activity.

BACKGROUND: Per- and polyfluoroalkyl substance (PFAS) exposures may negatively impact bone mineral accrual, but little is known about potential mitigators of this relation. We assessed whether associations of PFAS and their mixture with bone mineral content (BMC) in adolescence were modified by diet and physical activity. METHODS: We included 197 adolescents enrolled in a prospective pregnancy and birth cohort in Cincinnati, Ohio (2003-2006). At age 12 years, we collected serum for PFAS measurements and used dual-energy x-ray absorptiometry to measure BMC. We calculated dietary calcium intake and Health Eating Index (HEI) scores from repeated 24-h dietary recalls, physical activity scores using the Physical Activity Questionnaire for Older Children (PAQ-C), and average moderate to vigorous physical activity (MVPA) based on accelerometry. We estimated covariate-adjusted differences in BMC z-scores per interquartile range (IQR) increase of individual PFAS concentrations using linear regression and per simultaneous IQR increase in all four PFAS using g-computation. We evaluated effect measure modification (EMM) using interaction terms between each modifier and PFAS. RESULTS: Higher serum perfluorooctanoic acid, perfluorooctanesulfonic acid, and perfluorononanoic acid concentrations and the PFAS mixture were associated with lower BMC z-scores. An IQR increase in all PFAS was associated with a 0.27 (-0.54, 0.01) lower distal radius BMC z-score. Associations with lower BMC were generally stronger among adolescents classified as < median for calcium intake, HEI scores, or MVPA compared to those ≥ median. The difference in distal radius BMC z-score per IQR increase in all PFAS was -0.38 (-0.72, -0.04) for those with

Use of Electronic Ecological Momentary Assessment Methodologies in Physical Activity, Sedentary Behavior, and Sleep Research in Young Adults: Systematic Review.

BACKGROUND: Recent technological advances allow for the repeated sampling of real-time data in natural settings using electronic ecological momentary assessment (eEMA). These advances are particularly meaningful for investigating physical activity, sedentary behavior, and sleep in young adults who are in a critical life stage for the development of healthy lifestyle behaviors. OBJECTIVE: This study aims to describe the use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults. METHODS: The PubMed, CINAHL, PsycINFO, Embase, and Web of Science electronic databases were searched through August 2022. Inclusion criteria were use of eEMA; sample of young adults aged 18 to 25 years; at least 1 measurement of physical activity, sedentary behavior, or sleep; English language; and a peer-reviewed report of original research. Study reports were excluded if they were abstracts, protocols, or reviews. The risk of bias assessment was conducted using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Screening, data extraction, and risk of bias assessments were conducted by independent authors, with discrepancies resolved by consensus. Descriptive statistics and narrative synthesis were used to identify overarching patterns within the following categories guided by the Checklist for Reporting Ecological Momentary Assessments Studies: study characteristics, outcomes and measures, eEMA procedures, and compliance. RESULTS: The search resulted in 1221 citations with a final sample of 37 reports describing 35 unique studies. Most reports (28/37, 76%) were published in the last 5 years (2017-2022), used observational designs (35/37, 95%), consisted of samples of college students or apprentices (28/35, 80%), and were conducted in the United States (22/37, 60%). The sample sizes ranged from 14 to 1584 young adults. Physical activity was measured more frequently (28/37, 76%) than sleep (16/37, 43%) or sedentary behavior (4/37, 11%). Of the 37 studies, 11 (30%) reports included 2 movement behaviors and no reports included 3 movement behaviors. eEMA was frequently used to measure potential correlates of movement behaviors, such as emotional states or feelings (25/37, 68%), cognitive processes (7/37, 19%), and contextual factors (9/37, 24%). There was wide variability in the implementation and reporting of eEMA procedures, measures, missing data, analysis, and compliance. CONCLUSIONS: The use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults has greatly increased in recent years; however, reports continue to lack standardized reporting of features unique to the eEMA methodology. Additional areas in need of future research include the use of eEMA with more diverse populations and the incorporation of all 3 movement behaviors within a 24-hour period. The findings are intended to assist investigators in the design, implementation, and reporting of physical activity, sedentary behavior, and sleep research using eEMA in young adults. TRIAL REGISTRATION: PROSPERO CRD42021279156; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021279156.

Urinary Cadmium and Incident Heart Failure: A Case-Cohort Analysis Among Never-Smokers in Denmark.

BACKGROUND: Epidemiologic studies suggest cadmium exposure is associated with cardiovascular disease risk, including heart failure. However, prior findings may be influenced by tobacco smoking, a dominant source of cadmium exposure and risk factor for heart failure. The present study leverages up to 20 years of follow-up in the Danish Diet, Cancer and Health cohort to examine the relationship between urinary cadmium and incident heart failure among people who never smoked. METHODS: Between 1993 and 1997, 19,394 never-smoking participants (ages 50-64 years) enrolled and provided a urine sample. From this sample, we randomly selected a subcohort of 600 men and 600 women and identified 958 incident heart failure cases occurring between baseline and 2015. Using a case-cohort approach, we estimated adjusted hazard ratios (aHR) for heart failure in Cox proportional hazards models with age as the time scale. RESULTS: Participants had relatively low concentrations of urinary cadmium, as expected for never smokers (median = 0.20; 25th, 75th = 0.13, 0.32 µg cadmium/g creatinine). In adjusted models, we found that higher urinary cadmium was associated with a higher rate of incident heart failure overall (aHR = 1.1 per interquartile range difference [95% CI = 1.0, 1.2). In sex-stratified analyses, the association seemed restricted to men (aHR = 1.5 [95% CI = 1.2, 1.9]). CONCLUSIONS: In this cohort of people who never smoked tobacco, environmental cadmium was positively associated with incident heart failure, especially among men.

Exposure to coal ash and depression in children aged 6-14 years old.

BACKGROUND: When coal is burned for energy, coal ash, a hazardous waste product, is generated. Throughout the world, over 1 billion tons of coal ash is produced yearly. In the United States, over 78 million tons of coal ash was produced in 2019. Fly ash, the main component of coal ash contains neurotoxic metal (loid)s that may affect children's neurodevelopment and mental health. The objective of this study was to investigate the association between fly ash and depressive problems in children aged 6-14 years old. METHODS: Children and their parents/guardians were recruited from 2015 to 2020. Tobit regression and logistic regression were used to assess the association between coal fly ash and depressive problems. To determine fly ash presence, Scanning Electron Microscopy was conducted on polycarbonate filters containing PM10 from the homes of the study participants. Depressive problems in children were measured using the Depressive Problems DSM and withdrawn/depressed syndromic problem scales of the Child Behavior Checklist. RESULTS: In covariate-adjusted Tobit regression models, children with fly ash on the filter had higher scores on the DSM Depressive Problems (3.13 points; 95% CI = 0.39, 5.88) compared with children who did not have fly ash on the filter. Logistic regression supported these findings. CONCLUSION: Coal ash is one of the largest waste streams in the U.S, but it is not classified as a hazardous waste by the Environmental Protection Agency. To our knowledge, no studies have assessed the impact of coal ash on children's mental health. This study highlights the need for further research into the effects of coal ash exposure on children's mental health, and improved regulations on release and storage of coal ash.

Physical activity modifies the relation between gestational perfluorooctanoic acid exposure and adolescent cardiometabolic risk.

OBJECTIVE: Exposure to per- and polyfluoroalkyl substances (PFAS) - endocrine disrupting chemicals - may increase cardiometabolic risk. We evaluated whether adolescent lifestyle factors modified associations between gestational PFAS exposure and cardiometabolic risk using a prospective cohort study. METHODS: In 166 mother-child pairs (HOME Study), we measured concentrations of four PFAS in maternal serum collected during pregnancy. When children were age 12 years, we calculated cardiometabolic risk scores from visceral adiposity area, blood pressure, and fasting serum biomarkers. We assessed adolescent physical activity and Healthy Eating Index scores using the Physical Activity Questionnaire for Older Children (PAQ-C), actigraphy, and 24-h diet recalls. Using multivariable linear regression and weighted quantile sum regression, we examined whether physical activity or diet modified covariate-adjusted associations of PFAS and their mixture with cardiometabolic risk scores. RESULTS: Physical activity modified associations between perfluorooctanoic acid (PFOA) and cardiometabolic risk scores. Each doubling of PFOA was associated with worse cardiometabolic risk scores among children with PAQ-C scores < median (ß:1.4; 95% CI:0.5, 2.2, n = 82), but not among those with PAQ-C scores ≥ median (ß: 0.2; 95% CI: 1.2, 0.7, n = 84) (interaction p-value = 0.01). Associations were most prominent for insulin resistance, leptin-adiponectin ratio, and visceral fat area. We observed results suggesting that physical activity modified the association of PFAS mixture with cardiometabolic risk scores, insulin resistance, and visceral fat area (interaction p-values = 0.17, 0.07, and 0.10, respectively); however, the 95% CIs of the interaction terms included the null value. We observed similar, but attenuated patterns for PFOA and actigraphy-based measures of physical activity. Diet did not modify any associations. Physical activity or diet did not modify associations for other PFAS. CONCLUSIONS: Childhood physical activity modified associations of prenatal serum PFOA concentrations with children's cardiometabolic risk in this cohort, indicating that lifestyle interventions may ameliorate the adverse effects of PFOA exposure.

Perceptions of electronic cigarettes among ethno-culturally diverse Latino adults in four US urban centers.

OBJECTIVE: The aim of this study was to examine perceptions including knowledge, attitudes, and beliefs about e-cigarettes among ethno-culturally diverse Latino adults living in the US, a rapidly growing minority group for which we know little about their e-cigarette perceptions. DESIGN: A total of 25 focus groups with Latinos (n = 180; ages 18-64 years) were conducted in 2014. E-cigarettes users and non-users were recruited via purposive sampling techniques. Participants completed brief questionnaires on sociodemographic factors and tobacco use. Focus group discussions were conducted in English and Spanish, audio-recorded, and transcribed. Data were analyzed using thematic analysis procedures. RESULTS: Participants were of diverse Latino backgrounds. Over one-third (35%) reported current cigarette smoking and 8% reported current e-cigarette or hookah use. Nonsmokers reported experimenting with e-cigarettes and hookah during social occasions. Participants' perceptions towards e-cigarettes were generally formed in comparison to conventional cigarettes. Perceived benefits of using e-cigarettes included their utility as a smoking cessation aid, higher social acceptability, and lower harm compared to conventional cigarettes. Negative perceptions of e-cigarettes included lower overall satisfaction compared to conventional cigarettes and high content of toxins. Socio-cultural factors (e.g. gender roles, familismo, and simpatía) also influenced perceptions of e-cigarette of study participants. CONCLUSIONS: Overall, Latino adults knew relatively little about the potential health risks associated with e-cigarette use. The limited knowledge about and misinformation of e-cigarettes among this rapidly growing minority group have important public health implications. Findings may inform culturally tailored health communication campaigns, which are much needed among underserved US Latino populations in light of low effectiveness of tobacco control and regulatory efforts.

Nail Samples of Children Living near Coal Ash Storage Facilities Suggest Fly Ash Exposure and Elevated Concentrations of Metal(loid)s.

Children who live near coal-fired power plants are exposed to coal fly ash, which is stored in landfills and surface impoundments near residential communities. Fly ash has the potential to be released as fugitive dust. Using data collected from 263 children living within 10 miles of coal ash storage facilities in Jefferson and Bullitt Counties, Kentucky, USA, we quantified the elements found in nail samples. Furthermore, using principal component analysis (PCA), we investigated whether metal(loid)s that are predominately found in fly ash loaded together to indicate potential exposure to fly ash. Concentrations of several neurotoxic metal(loid)s, such as chromium, manganese, and zinc, were higher than concentrations reported in other studies of both healthy and environmentally exposed children. From PCA, it was determined that iron, aluminum, and silicon in fly ash were found to load together in the nails of children living near coal ash storage facilities. These metal(loid)s were also highly correlated with each other. Last, results of geospatial analyses partially validated our hypothesis that children's proximity to power plants was associated with elevated levels of concentrations of fly ash metal(loid)s in nails. Taken together, nail samples may be a powerful tool in detecting exposure to fly ash.

Urinary cadmium and stroke - a case-cohort study in Danish never-smokers.

BACKGROUND: and Purpose: Cadmium has been associated with risk of cardiovascular events, including stroke. Human cadmium exposure occurs primarily through diet and tobacco smoke. Recent cohort studies have found an association with stroke, but residual confounding from smoking, could not be ruled out. We therefore conducted a case-cohort study to evaluate whether cadmium is associated with stroke in never-smokers. METHODS: The Danish Diet Cancer and Health cohort consists of Danes 50-64 years old, recruited in 1993-1997. From never-smoking cohort members without previous cancer or stroke we sampled a sub-cohort of 1200 persons. We also identified all (n = 534) cases in the cohort with a validated stroke diagnosis between baseline and 2009. We quantified cadmium and creatinine concentrations from baseline urine samples and used cadmium per creatinine as our main exposure metric. We used Cox proportional hazards models to estimate hazard ratios (HRs) with age as time scale and adjusting for BMI, education and urinary cotinine with and without stratification by sex. RESULTS: The median urinary cadmium concentration was 0.21 µg cadmium/g creatinine in cases and 0.19 µg/g in the sub-cohort. The majority (83%) of stroke cases were diagnosed with ischemic stroke. The HR for stroke in the highest quartile of exposure (median 0.44 µg/g creatinine) was 1.11 (95% CI: 0.79-1.54) compared with the lowest quartile (median 0.10 µg/g creatinine). The HR per inter quartile range (IQR, 0.19 µg/g creatinine) was 1.02 (95% CI: 0.92-1.12). Among men, the HR per IQR higher levels of cadmium (0.16 µg/g creatinine) was 1.18 (95% CI: 0.92-1.52), and 1.00 (95% CI: 0.89-1.12) among women. Adjusting for creatinine or using osmolality instead of creatinine standardization generally attenuated observed relationships. CONCLUSIONS: Our results do not support that low levels of cadmium exposure among never-smokers are strongly associated with risk of stroke, although results varied somewhat by sex and method of accounting for urinary dilution.

Lowering Urinary Phthalate Metabolite Concentrations among Children by Reducing Contaminated Dust in Housing Units: A Randomized Controlled Trial and Observational Study.

Dust in homes can contain phthalates that may adversely affect child development, but whether residential interventions and dust removal can prevent children's exposure to phthalates is unknown. We quantified the influence of a residential lead hazard intervention and dust control on children's urinary phthalate metabolite concentrations. Between 2003 and 2006, The Health Outcomes and Measures of the Environment (HOME) Study randomized 355 pregnant women to receive an intervention to reduce either residential lead or injury hazards before delivery. We quantified eight urinary phthalate metabolites from 288 children at ages 1, 2, or 3 years (680 observations). During yearly home visits, we assessed dust accumulation in housing units. Children in the lead intervention group had 11-12% lower concentrations of the sum of di(2-ethylhexyl) phthalate metabolites, monocarboxyoctyl phthalate, and monocarboxynonyl phthalate compared to the injury intervention group. Monoethyl phthalate concentrations did not differ by group. In observational analyses, children living in housing units that appeared clean had 12-17% lower concentrations of these phthalate metabolites and monobenzyl phthalate, compared to children living in housing units with more dust accumulation. Features of this lead hazard intervention and measures to control dust may reduce children's exposure to phthalates found in building materials and household furnishings.

Recruitment strategies and challenges: Lessons learned from a coal ash and children's health study.

The purpose of this paper is to describe the approaches and recruitment strategies of a study focused on the impact of coal fly ash on neurobehavioral performance among children living in proximity to coal-burning power plants. Challenges encountered with each recruitment approach are highlighted as well as solutions used to overcome those challenges and ultimately enroll children and one of their parents or guardians. To ensure participants were distributed throughout the study area, geographical information systems were used to guide recruitment and achieve the target sample size (N = 300). Several approaches were employed to recruit the number of needed participants, including "shoe leather" or door-to-door recruitment, placement of flyers and brochures in public spaces, mailings to targeted addresses, media announcements, and local government outreach. Since September 2015, 265 participants have been enrolled in the study using a combination of the described recruitment approaches. Even with a well-designed plan, it is important to re-examine strategies at every step to maximize recruitment efforts. Researcher flexibility in adapting to new strategies is vital in facilitating recruitment efforts, and the recruitment of participants in the study remains a dynamic and evolving process.

Community views about the health and exposure of children living near a coal ash storage site.

Coal ash, a waste product generated from burning coal, is composed of small particles comprised of highly toxic elements. Coal ash particles contain heavy metals such as arsenic, lead, and mercury, as well as polyaromatic hydrocarbons and radioactive elements. Most coal ash is stored in landfills and ponds, often located in close proximity to low income communities. Currently, there are no federal regulations governing the storage and transport of coal ash; however the Environmental Protection Agency proposed a coal ash rule in 2010, which could designate coal ash as a hazardous waste. This is the first article to assess community impact from coal ash storage, by exploring parents' perceptions of their children's health and its relationship to chronic exposure to coal ash. This was a community-based study involving four neighborhoods adjacent to a large coal ash storage facility. Focus groups were conducted with community members and the transcripts were analyzed to identify themes regarding children's health, children's exposure to coal ash, and behaviors done to protect children from exposure. The majority of parents (85 %) reported that their children suffered from health conditions; specifically respiratory and emotional and behavioral disorders. Parents highlighted ways in which their children were exposed to coal ash, although many felt they were constantly exposed just by living in the area. Parents felt strongly that exposure to coal ash from the landfill is affecting the health and well-being of their children. Some parents attempted protective behaviors, but most parents felt helpless in reducing children's exposure.

Indoor coal ash and school and social competency among children aged 6-14 years.

BACKGROUND: A child's ability to succeed in social interactions and in a school setting are important for their development and growth. Exposure to environmental pollutants has been associated with poorer school performance and fewer social interaction in children. Fly ash, a waste product generated when burning coal for energy, is comprised of small glass spheres with neurotoxic heavy metal(loid)s found to be risk factors for learning and social problems in school. OBJECTIVE: The purpose of this novel study was to assess the association of fly ash in children's homes with school and social competency. METHODS: We recruited children aged 6-14 years old from communities located within 10 miles of two coal-burning power plants. In homes of the participants, fly ash was collected on polycarbonate filters using personal modular impactors. We measured school competency and social competency using the validated Child Behavioral Checklist. Using Tobit and linear regression we investigated the relationship of indoor fly ash with school and social competency. RESULTS: Forty-three percent of children in the study had fly ash in their homes. In covariate-adjusted Tobit models, children with fly ash in their homes scored on average 2.63 (95% CI: -4.98, -0.28) points lower on the school competency scale than peers without ash in their homes. We did not observe that fly ash in homes was related with lower social competency. SIGNIFICANCE: Results from this study suggest that children with fly ash in their homes had poorer performance in the school setting, compared to peers without fly ash in their homes. In the US, coal-fired power plants are being closed, however health concerns about pollution from coal ash storage facilities remains. Findings from this study can provide impetus for creating of public health policy and to highlight the need future research on children's exposure to fly ash. IMPACT: Children's growth and development are impacted by their social interactions and ability to perform in school settings. Environmental pollutants may impact these essential elements of development. Millions of children are exposed to fly ash which is a waste product generated from burning coal. Fly ash, an environmental health threat throughout the world, is comprised of small glass spheres with trace concentrations of neurotoxic metal(loid)s. Findings from this research show that children with fly ash in their homes are significantly more likely to have poorer school performance than children without fly ash in their homes.

Urine antimony and risk of cardiovascular disease - A prospective case-cohort study in Danish Non-Smokers.

BACKGROUND: Limited evidence suggests that antimony induces vascular inflammation and oxidative stress and may play a role in cardiovascular disease (CVD) risk. However, few studies have examined whether environmental antimony from sources other than tobacco smoking is related with CVD risk. The general population may be exposed through air, drinking water, and food that contains antimony from natural and anthropogenic sources, such as mining, coal combustion, and manufacturing. OBJECTIVES: To examine the association of urine antimony with incident acute myocardial infarction (AMI), heart failure, and stroke among people who never smoked tobacco. METHODS: Between 1993 and 1997, the Danish Diet, Cancer and Health (DCH) cohort enrolled participants (ages 50-64 years), including n = 19,394 participants who reported never smoking at baseline. Among these never smokers, we identified incident cases of AMI (N = 809), heart failure (N = 958), and stroke (N = 534) using the Danish National Patient Registry. We also randomly selected a subcohort of 600 men and 600 women. We quantified urine antimony concentrations in samples provided at enrollment. We used modified Cox proportional hazards models to estimate adjusted hazard ratios (HR) for each incident CVD outcome in relation to urine antimony, statistically adjusted for creatinine. We used a separate prospective cohort, the San Luis Valley Diabetes Study (SLVDS), to replicate these results. RESULTS: In the DCH cohort, urine antimony concentrations were positively associated with rates of AMI and heart failure (HR = 1.52; 95%CI = 1.12, 2.08 and HR = 1.58; 95% CI = 1.15, 2.18, respectively, comparing participants in the highest (>0.09 µg/L) with the lowest quartile (<0.02 µg/L) of antimony). In the SLVDS cohort, urinary antimony was positively associated with AMI, but not heart failure. DISCUSSION: Among this sample of Danish people who never smoked, we found that low levels of urine antimony are associated with incident CVD. These results were partially confirmed in a smaller US cohort.

Identifying periods of heightened susceptibility to lead exposure in relation to behavioral problems.

BACKGROUND: Lead exposure is associated with behavioral problems in children, but the age(s) of greatest susceptibility to low-level lead exposure is unknown. OBJECTIVE: We evaluated the association of repeated blood lead concentrations with parent-reported behaviors to identify periods of heightened susceptibility during infancy and childhood (HOME Study; Cincinnati, OH; 2003-2006; n = 244). METHODS: We quantified lead in whole blood samples (ages 1, 2, 3, 4, 5, and 8 years) and assessed behavior using the Behavioral Assessment System for Children-2 (BASC-2; ages 2, 3, 4, 5, and 8 years). We used multiple informant models and modified Poisson regression to estimate covariate-adjusted associations of ln-transformed blood lead concentrations with continuous BASC-2 T-scores and the relative risk of behavior scores classified as at-risk or clinically significant, respectively. RESULTS: We observed trends indicating that higher blood lead concentrations at all ages were adversely associated with scores on behavioral scales. On the Externalizing Problems and Adaptive Skills scales, these associations were strongest for blood lead concentrations at age 8 years (ß = 3.1-point; 95% CI = 0.7, 5.4 and ß = -2.2-point; 95% CI = -4.9, 0.5, respectively) compared with other ages. Overall, higher blood lead concentrations were associated with elevated risk of behavior scores classified as at-risk or clinically significant on the Adaptive Skills, Behavioral Symptom Index, and Externalizing Problems scales. SIGNIFICANCE: Contemporary levels of lead exposure during the first 8 years of life were associated with ADHD-related behaviors, specifically aggression, hyperactivity, and conduct problems. IMPACT STATEMENT: Our results highlight the importance of primary lead prevention across childhood.

Family asthma management in urban children and its association with sleep outcomes.

Asthma symptoms impact children's sleep quality. However, it is unclear how families' daily management of their child's asthma is associated with sleep quality. We examine associations between family asthma management components and sleep duration and quality for urban children (ages 7-9 years). Additionally, we examine these associations by racial/ethnic group. Data were collected as part of a longitudinal study that examined the co-occurrence of asthma, allergic rhinitis, sleep quality, and academic functioning for urban children diagnosed with persistent asthma (N = 196). A semi-structured interview assessed family asthma management practices. Sleep quality data were collected via actigraphy. Our visual depiction of sleep outcomes show that those with higher family asthma management ratings present with longer sleep duration and better sleep quality. Among specific family asthma management components, we found a significant association between children's adherence to asthma medications and number of nighttime awakenings. For non-Latino Black (NLB) children, we found a significant association between environmental control and sleep duration. For urban children with asthma, clinical strategies to enhance overall family asthma management have the potential to support improved sleep quality. Additionally, for NLB children, asthma management interventions that provide environmental control practices may increase sleep duration.

Proximity to coal-fired power plants and neurobehavioral symptoms in children.

BACKGROUND: Coal-fired power plants are a major source of air pollution that can impact children's health. Limited research has explored if proximity to coal-fired power plants contributes to children's neurobehavioral disorders. OBJECTIVE: This community-based study collected primary data to investigate the relationships of residential proximity to power plants and neurobehavioral problems in children. METHODS: 235 participants aged 6-14 years who lived within 10 miles of two power plants were recruited. Exposure to particulate matter ≤10 µm (PM10) was measured in children's homes using personal modular impactors. Neurobehavioral symptoms were assessed using the Child Behavior Checklist (CBCL). Multiple regression models were performed to test the hypothesized associations between proximity/exposure and neurobehavioral symptoms. Geospatial statistical methods were used to map the spatial patterns of exposure and neurobehavioral symptoms. RESULTS: A small proportion of the variations of neurobehavioral problems (social problems, affective problems, and anxiety problems) were explained by the regression models in which distance to power plants, traffic proximity, and neighborhood poverty was statistically associated with the neurobehavioral health outcomes. Statistically significant hot spots of participants who had elevated levels of attention deficit hyperactivity disorder, anxiety, and social problems were observed in the vicinity of the two power plants. SIGNIFICANCE: Results of this study suggest an adverse impact of proximity to power plants on children's neurobehavioral health. Although coal-fired power plants are being phased out in the US, health concern about exposure from coal ash storage facilities remains. Furthermore, other countries in the world are increasing coal use and generating millions of tons of pollutants and coal ash. Findings from this study can inform public health policies to reduce children's risk of neurobehavioral symptoms in relation to proximity to power plants.

Heavy Metal(loid) Body Burden in Environmentally Exposed Children With and Without Internalizing Behavior Problems.

The prevalence of internalizing behavior disorders in children is increasing. Reasons for increasing anxiety and depression include several factors with a less studied consideration being the potential neurotoxic effects of environmental exposures. One group at risk for environmental exposures is children living near coal-burning power plants with coal ash storage facilities. Multivariate logistic regression was used to assess the relationship between metal(loid) exposures and internalizing behaviors in children aged 6-14 years. Metal(loid)s in nail samples were determined by Proton-Induced X-ray Emission and internalizing behavior problems were obtained from the parent ratings on the Child Behavior Checklist. Results indicated that concentrations of metal(loid)s in nails differ between children with internalizing behaviors and without internalizing behaviors. Logistic regression models suggested that exposure to zinc and imputed zirconium were associated with internalizing behaviors in children. However, when a sex-metal(loid) interaction term was included, none of the metal(loid)s were associated with internalizing behaviors indicating a role of sex differences in neurotoxicity with zinc and copper showing effects only for males. In all models, greater exposure to traffic was associated with internalizing behaviors. Zinc has previously been shown to increase risk for mental health problems, while zirconium has received less attention. Out findings indicate that environmental exposures of zinc and zirconium deserve further attention in studies of childhood internalizing disorders.

Urinary phthalate metabolite concentrations and adolescent sleep duration.

Some environmental chemicals, such as phthalates, are capable of disrupting endocrine function related to the development and regulation of sleep patterns. However, the contribution of phthalate exposure to inadequate sleep during adolescence is unknown. We aim to evaluate the association between phthalate exposure and short sleep duration during adolescence. METHODS: We used data from participants 16-17 years of age in the 2005-2010 cycles of the National Health and Nutrition Examination Survey. Participants reported typical sleep duration during weekdays, which we categorized into short sleep duration (less than 8 hours per night) and adequate sleep duration (8 or more hours) based on consensus guidelines. We used weighted logistic regression to evaluate the association between log10-transformed urinary phthalate metabolite concentrations and odds of short sleep duration. RESULTS: An interquartile range increase in di(2-ethylhexyl) phthalate metabolites, monocarboxynonyl phthalate, monocarboxyoctyl phthalate, and mono-isobutyl phthalate was associated with 1.48 (95% confidence interval [95% CI] = 1.02, 2.16), 1.64 (95% CI = 1.17, 2.32), 1.46 (95% CI = 0.99, 2.16), and 1.92 (95% CI = 1.08, 3.43) times the odds of short sleep duration, respectively. Furthermore, we observed monotonic dose-response relations between some phthalate metabolites and odds of short sleep duration. CONCLUSIONS: Our results suggest that higher urinary concentrations of several phthalate metabolites are associated with short sleep duration during adolescence. Understanding the contribution of modifiable environmental factors to inadequate sleep duration is of great public health importance because inadequate sleep can have substantial health implications.