Validation of a Blood-Based Protein Biomarker Panel for a Risk Assessment of Lethal Lung Cancer in the Physicians' Health Study.

This study aimed to assess a four-marker protein panel (4MP)'s performance, including the precursor form of surfactant protein B, cancer antigen 125, carcinoembryonic antigen, and cytokeratin-19, for predicting lung cancer in a cohort enriched with never- and ever-smokers. Blinded pre-diagnostic plasma samples collected within 2 years prior to a lung cancer diagnosis from 25 cases and 100 sex-, age-, and smoking-matched controls were obtained from the Physicians' Health Study (PHS). The 4MP yielded AUC performance estimates of 0.76 (95% CI: 0.61-0.92) and 0.69 (95% CI: 0.56-0.82) for predicting lung cancer within one year and within two years of diagnosis, respectively. When stratifying into ever-smokers and never-smokers, the 4MP had respective AUCs of 0.77 (95% CI: 0.63-0.92) and 0.72 (95% CI: 0.17-1.00) for a 1-year risk of lung cancer. The AUCs of the 4MP for predicting metastatic lung cancer within one year and two years of the blood draw were 0.95 (95% CI: 0.87-1.00) and 0.78 (95% CI: 0.62-0.94), respectively. Our findings indicate that a blood-based biomarker panel may be useful in identifying ever- and never-smokers at high risk of a diagnosis of lung cancer within one-to-two years.

Socioeconomic Status at Birth and Breast Tissue Composition in Adolescence and Adulthood.

BACKGROUND: Socioeconomic status (SES) at birth is associated with breast cancer risk. Whether this association is driven by changes in breast tissue composition (BTC) prior to adulthood remains unclear. METHODS: We used multivariable linear regression models to examine whether SES at birth is associated with BTC in adolescence and adulthood using data from a New York City cohort of daughters (n = 165, 11-20 years) and mothers (n = 160, 29-55 years). We used maternal-reported data on daughters' household income and maternal education at birth, analyzed individually and in combination (SES index). Women also reported their own mothers' education at birth. We used optical spectroscopy to evaluate BTC measures that positively (water content, collagen content, optical index) and negatively (lipid content) correlate with mammographic breast density, a recognized breast cancer risk factor. RESULTS: Being in the highest versus lowest category of the SES index was associated with lower lipid content [ßadjusted (ßadj) = -0.80; 95% confidence interval (CI), -1.30 to -0.31] and higher collagen content (ßadj = 0.54; 95% CI, 0.09-0.99) in adolescence. In women with a body mass index (BMI) <30 kg/m2, higher maternal education at birth (≥ vs. < high school degree) was associated with lower lipid content (ßadj = -0.57; 95% CI, -0.97 to -0.17), higher water content (ßadj = 0.70; 95% CI, 0.26-1.14), and higher optical index (ßadj = 0.53; 95% CI, 0.10-0.95). CONCLUSIONS: This study supports that SES at birth is associated with BTC in adolescence and adulthood, although the latter association may depend on adult BMI. IMPACT: Further research is needed to identify the socially patterned early life factors influencing BTC.

Assessment of the health benefits to children of a transportation climate policy in New York City.

BACKGROUND: Assessments of health and environmental effects of clean air and climate policies have revealed substantial health benefits due to reductions in air pollution, but have included few pediatric outcomes or assessed benefits at the neighborhood level. OBJECTIVES: We estimated benefits across a suite of child health outcomes in 42 New York City (NYC) neighborhoods under the proposed regional Transportation and Climate Initiative. We also estimated their distribution across racial/ethnic and socioeconomic groups. METHODS: We estimated changes in ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2) concentrations associated with on-road emissions under nine different predefined cap-and-invest scenarios. Health outcomes, including selected adverse birth, respiratory, and neurodevelopmental outcomes, were estimated using a program similar to the U.S. EPA BenMAP program. We stratified the associated monetized benefits across racial/ethnic and socioeconomic groups. RESULTS: The benefits varied widely over the different cap-and-investment scenarios. For a 25% reduction in carbon emissions from 2022 to 2032 and a strategy prioritizing public transit investments, NYC would have an estimated 48 fewer medical visits for childhood asthma, 13,000 avoided asthma exacerbations not requiring medical visits, 640 fewer respiratory illnesses unrelated to asthma, and 9 avoided adverse birth outcomes (infant mortality, preterm birth, and term low birth weight) annually, starting in 2032. The total estimated annual avoided costs are $22 million. City-wide, Black and Hispanic children would experience 1.7 times the health benefits per capita than White and Non-Hispanic White children, respectively. Under the same scenario, neighborhoods experiencing the highest poverty rates in NYC would experience about 2.5 times the health benefits per capita than the lowest poverty neighborhoods. CONCLUSION: A cap-and-invest strategy to reduce carbon emissions from the transportation sector could provide substantial health and monetized benefits to children in NYC through reductions in criteria pollutant concentrations, with greater benefits among Black and Hispanic children.

Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts.

Preterm birth occurs at excessively high and disparate rates in the United States. In 2016, the National Institutes of Health (NIH) launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate the influence of early life exposures on child health. Extant data from the ECHO cohorts provides the opportunity to examine racial and geographic variation in effects of individual- and neighborhood-level markers of socioeconomic status (SES) on gestational age at birth. The objective of this study was to examine the association between individual-level (maternal education) and neighborhood-level markers of SES and gestational age at birth, stratifying by maternal race/ethnicity, and whether any such associations are modified by US geographic region. Twenty-six ECHO cohorts representing 25,526 mother-infant pairs contributed to this disseminated meta-analysis that investigated the effect of maternal prenatal level of education (high school diploma, GED, or less; some college, associate's degree, vocational or technical training [reference category]; bachelor's degree, graduate school, or professional degree) and neighborhood-level markers of SES (census tract [CT] urbanicity, percentage of black population in CT, percentage of population below the federal poverty level in CT) on gestational age at birth (categorized as preterm, early term, full term [the reference category], late, and post term) according to maternal race/ethnicity and US region. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Cohort-specific results were meta-analyzed using a random effects model. For women overall, a bachelor's degree or above, compared with some college, was associated with a significantly decreased odds of preterm birth (aOR 0.72; 95% CI: 0.61-0.86), whereas a high school education or less was associated with an increased odds of early term birth (aOR 1.10, 95% CI: 1.00-1.21). When stratifying by maternal race/ethnicity, there were no significant associations between maternal education and gestational age at birth among women of racial/ethnic groups other than non-Hispanic white. Among non-Hispanic white women, a bachelor's degree or above was likewise associated with a significantly decreased odds of preterm birth (aOR 0.74 (95% CI: 0.58, 0.94) as well as a decreased odds of early term birth (aOR 0.84 (95% CI: 0.74, 0.95). The association between maternal education and gestational age at birth varied according to US region, with higher levels of maternal education associated with a significantly decreased odds of preterm birth in the Midwest and South but not in the Northeast and West. Non-Hispanic white women residing in rural compared to urban CTs had an increased odds of preterm birth; the ability to detect associations between neighborhood-level measures of SES and gestational age for other race/ethnic groups was limited due to small sample sizes within select strata. Interventions that promote higher educational attainment among women of reproductive age could contribute to a reduction in preterm birth, particularly in the US South and Midwest. Further individual-level analyses engaging a diverse set of cohorts are needed to disentangle the complex interrelationships among maternal education, neighborhood-level factors, exposures across the life course, and gestational age at birth outcomes by maternal race/ethnicity and US geography.

Impact of housing instability on child behavior at age 7.

Housing instability is a thought to be a major influence on children's healthy growth and development. However, little is known about the factors that influence housing instability, limiting the identification of effective interventions. The goals of this study were to 1) explore factors, including material hardship, satisfaction with living conditions and housing disrepair, that predict housing instability (total number of moves that a child experienced in the first seven years); and 2) examine the relationship between housing instability and child behavior at age 7, measured by the Child Behavior Checklist. We analyzed these associations among children enrolled in the Columbia Center for Children's Environmental Health (CCCEH) Mothers and Newborns study. In our analysis, we found that housing disrepair predicted residential change after 3 years of age, but not before. Persistent material hardship over the seven-year time period from pregnancy through age 7 was associated with increased number of moves. Children who experienced more than three moves in the first 7 years had significantly more thought- and attention-related problems compared to children who experienced less than 3 moves over the same time period. Children who experienced more than 3 moves also had higher total and internalizing problem behavior scores, although these differences were not statistically significant. We conclude that housing instability is significantly associated with problem behavior in early childhood and that interventions to reduce socioeconomic strain may have the greatest impact in breaking the cycle of children's environmental health disparities related to housing instability.

Pollution from Fossil-Fuel Combustion is the Leading Environmental Threat to Global Pediatric Health and Equity: Solutions Exist.

Fossil-fuel combustion by-products are the world's most significant threat to children's health and future and are major contributors to global inequality and environmental injustice. The emissions include a myriad of toxic air pollutants and carbon dioxide (CO2), which is the most important human-produced climate-altering greenhouse gas. Synergies between air pollution and climate change can magnify the harm to children. Impacts include impairment of cognitive and behavioral development, respiratory illness, and other chronic diseases-all of which may be "seeded" in utero and affect health and functioning immediately and over the life course. By impairing children's health, ability to learn, and potential to contribute to society, pollution and climate change cause children to become less resilient and the communities they live in to become less equitable. The developing fetus and young child are disproportionately affected by these exposures because of their immature defense mechanisms and rapid development, especially those in low- and middle-income countries where poverty and lack of resources compound the effects. No country is spared, however: even high-income countries, especially low-income communities and communities of color within them, are experiencing impacts of fossil fuel-related pollution, climate change and resultant widening inequality and environmental injustice. Global pediatric health is at a tipping point, with catastrophic consequences in the absence of bold action. Fortunately, technologies and interventions are at hand to reduce and prevent pollution and climate change, with large economic benefits documented or predicted. All cultures and communities share a concern for the health and well-being of present and future children: this shared value provides a politically powerful lever for action. The purpose of this commentary is to briefly review the data on the health impacts of fossil-fuel pollution, highlighting the neurodevelopmental impacts, and to briefly describe available means to achieve a low-carbon economy, and some examples of interventions that have benefited health and the economy.

Science as an early driver of policy: child labor reform in the early Progressive Era, 1870-1900.

Scientific evidence is an increasingly important driver of social and environmental policy concerning child health. This trend began earlier than generally recognized. The child labor reform movement of the Gilded Age and early Progressive Era reflected not only moral and economic forces but also the dramatic advances during the later decades of the 19th century in scientific knowledge concerning children's biological and psychological vulnerability to environmental and psychosocial stressors. The growing importance of scientific information in shaping policy concerning children's health between 1870 and 1900 is illustrated by the events leading up to and following the New York State Child Labor Law of 1886. Child labor reform during this period was a critical step in the development of a science-based as well as a value-driven movement to protect children's environmental health and well-being that continues today.

Prenatal exposure to airborne polycyclic aromatic hydrocarbons and IQ: estimated benefit of pollution reduction.

Outdoor air pollution, largely from fossil fuel burning, is a major cause of morbidity and mortality in the United States, costing billions of dollars every year in health care and loss of productivity. The developing fetus and young child are especially vulnerable to neurotoxicants, such as polycyclic aromatic hydrocarbons (PAH) released to ambient air by combustion of fossil fuel and other organic material. Low-income populations are disproportionately exposed to air pollution. On the basis of the results of a prospective cohort study in a low-income population in New York City (NYC) that found a significant inverse association between child IQ and prenatal exposure to airborne PAH, we estimated the increase in IQ and related lifetime earnings in a low-income urban population as a result of a hypothesized modest reduction of ambient PAH concentrations in NYC of 0.25 ng/m(3). For reference, the current estimated annual mean PAH concentration is ~1 ng/m(3). Restricting to NYC Medicaid births and using a 5 per cent discount rate, we estimated the gain in lifetime earnings due to IQ increase for a single year cohort to be US$215 million (best estimate). Using much more conservative assumptions, the estimate was $43 million. This analysis suggests that a modest reduction in ambient concentrations of PAH is associated with substantial economic benefits to children.

Cost of developmental delay from prenatal exposure to airborne polycyclic aromatic hydrocarbons.

Early life exposure to ambient polycyclic aromatic hydrocarbons (PAHs) can result in developmental delay. The negative health effects of PAHs have been well-documented but the cost of developmental delay due to PAH exposure has not been studied. The Columbia Center for Children's Environmental Health previously has reported the significant effect of prenatal exposure to ambient PAHs on delayed mental development at three years, using the Bayley Scales in a cohort of low-income women and children in New York City (NYC). Here we have used the cohort results to estimate the annual costs of preschool special education services for low-income NYC children with developmental delay due to PAH exposure using the Environmentally Attributable Fraction method. The estimated cost of PAH-exposure-related services is over $13.7 million per year for Medicaid births in NYC. This high cost supports policies to reduce level of PAHs in NYC air.

Assessment of benzo(a)pyrene-equivalent carcinogenicity and mutagenicity of residential indoor versus outdoor polycyclic aromatic hydrocarbons exposing young children in New York City.

The application of benzo(a)pyrene (BaP)-toxic equivalent factor to polycyclic aromatic hydrocarbons (PAH) concentrations can provide a more accurate risk assessment from environmental exposure to PAH. We hypothesized that BaP-equivalent toxicity determined following residential air monitoring among young urban children may vary by season. Residential indoor and outdoor air levels of PAH measured over two-weeks in a cohort of 5-6 year old children (n = 260) in New York City were normalized to the cancer and mutagen potency equivalent factor of BaP (BaP = 1). Data are presented as carcinogenic equivalents (BaP-TEQ) and mutagenic equivalents (BaP-MEQ) for the sum of 8 PAH (Sigma(8)PAH; MW >or= 228) and individual PAH and compared across heating versus nonheating seasons. Results show that heating compared to nonheating season was associated significantly with higher (BaP-TEQ)(Sigma8PAH) and (BaP-MEQ)(Sigma8PAH) both indoors and outdoors (p < 0.001). Outdoor (BaP-TEQ)(Sigma8)(PAH) and (BaP-MEQ)(Sigma8PAH) were significantly higher than the corresponding indoor measures during the heating season (p < 0.01). These findings suggest that at levels encountered in New York City air, especially during the heating season, residential exposure to PAH may pose an increased risk of cancer and mutation.

Air pollution threatens the health of children in China.

CONTEXT: . China's rapid economic development has come at the cost of severe environmental degradation, most notably from coal combustion. Outdoor air pollution is associated with >300000 deaths, 20 million cases of respiratory illness, and a health cost of >500 billion renminbi (>3% of gross domestic product) annually. The young are particularly susceptible to air pollution, yet there has been only limited recognition of its effects on children's health and development. DATA SOURCES/DATA EXTRACTION: To fill this gap, we reviewed relevant published environmental studies, biomedical and molecular/epidemiologic research, and economic and policy analyses. RESULTS: China relies on coal for approximately 70% to 75% of its energy needs, consuming 1.9 billion tons of coal each year. In addition to CO(2), the major greenhouse gas, coal burning in China emits vast quantities of particulate matter, polycyclic aromatic hydrocarbons, sulfur dioxide, arsenic, and mercury. Automobiles emit nitrogen dioxide and benzene in addition to particulate matter and polycyclic aromatic hydrocarbons. Seventy percent of Chinese households burn coal or biomass for cooking and heating, which contaminates indoor air. Adverse effects of combustion-related air pollution include reduced fetal and child growth, pulmonary disease including asthma, developmental impairment, and increased risk of cancer. A prospective molecular epidemiologic study of newborns in Chongqing has demonstrated direct benefits to children's health and development from the elimination of a coal-burning plant. CONCLUSIONS: Recognition of the full health and economic cost of air pollution to Chinese children and the benefits of pollution reduction should spur increased use of renewable energy, energy efficiency, and clean-fuel vehicles. This is a necessary investment for China's future.

Children are likely to suffer most from our fossil fuel addiction.

BACKGROUND: The periods of fetal and child development arguably represent the stages of greatest vulnerability to the dual impacts of fossil fuel combustion: the multiple toxic effects of emitted pollutants (polycyclic aromatic hydrocarbons, particles, sulfur oxides, nitrogen oxides, metals) and the broad health impacts of global climate change attributable in large part to carbon dioxide released by fossil fuel burning. OBJECTIVES: In this commentary I highlight current scientific evidence indicating that the fetus and young child are at heightened risk of developmental impairment, asthma, and cancer from fossil fuel pollutants and from the predicted effects of climate disruption such as heat waves, flooding, infectious disease, malnutrition, and trauma. Increased risk during early development derives from the inherently greater biologic vulnerability of the developing fetus and child and from their long future lifetime, during which early insults can potentially manifest as adult as well as childhood disease. I cite recent reports concluding that reducing dependence on fossil fuel and promoting clean and sustainable energy is economically feasible. DISCUSSION: Although much has been written separately about the toxicity of fossil fuel burning emissions and the effects of climate change on health, these two faces of the problem have not been viewed together with a focus on the developing fetus and child. Adolescence and old age are also periods of vulnerability, but the potential for both immediate and long-term adverse effects is greatest when exposure occurs prenatally or in the early years. CONCLUSIONS: Consideration of the full spectrum of health risks to children from fossil fuel combustion underscores the urgent need for environmental and energy policies to reduce fossil fuel dependence and maximize the health benefits to this susceptible population. We do not have to leave our children a double legacy of ill health and ecologic disaster.

Prenatal exposure to passive smoking and duration of breastfeeding in nonsmoking women: Krakow inner city prospective cohort study.

INTRODUCTION: The relationship between tobacco smoking in pregnancy and breastfeeding is of public health importance. The present birth cohort study provided the opportunity to investigate whether the negative relationship between passive smoking measured by the cotinine concentrations in maternal blood at delivery and breastfeeding in postpartum could also be confirmed in nonsmoking mothers. MATERIALS AND METHODS: The study sample included 441 healthy pregnant women who were recruited in the first and second trimester of pregnancy. Enrollment included only nonsmoking women of the age of 18-35 years with singleton pregnancies, without illicit drug use and free from chronic diseases. After delivery, breastfeeding duration was defined using the answers recorded in the interviews with mothers conducted every 3 months. An infant was considered to be fully breastfed when breast milk was the only source of nourishment. Any breastfeeding was defined as an infant's being fully breastfed or receiving both breast milk and formula, with or without solids. In the statistical analysis only total duration of breastfeeding up to 6 months was considered for both forms of breastfeeding. Subjects were categorized into environmental tobacco smoke (ETS) exposure groups according to maternal blood cotinine level at delivery or self-reported exposure to ETS during pregnancy. RESULTS: The adjusted relative risk of discontinuation of any breastfeeding after infant's first 6 months was more than two times higher (OR = 2.42; 95% CI: 1.42-4.14) in women whose blood cotinine level at delivery was above 75th percentile of cotinine distribution (>0.15 ng/mL); the corresponding risk of discontinuation of full breastfeeding was OR = 1.71; 95% CI: 1.03-2.82. Estimated relative risk of discontinuation of any breastfeeding based on self-reported ETS was also significant but much less marked; the corresponding risk of discontinuation of full breastfeeding was insignificant. CONCLUSION: The results obtained support the hypothesis that ETS may affect breastfeeding duration and support the avoidance of passive smoking as a necessary additional measure for breastfeeding promotion.

Assessment of interactions between PAH exposure and genetic polymorphisms on PAH-DNA adducts in African American, Dominican, and Caucasian mothers and newborns.

Polycyclic aromatic hydrocarbons (PAH) are widespread pollutants commonly found in air, food, and drinking water. Benzo[a]pyrene is a well-studied representative PAH found in air from fossil fuel combustion and a transplacental carcinogen experimentally. PAHs bind covalently to DNA to form DNA adducts, an indicator of DNA damage, and an informative biomarker of potential cancer risk. Associations between PAH-DNA adduct levels and both cancer risk and developmental deficits have been seen in previous experimental and epidemiologic studies. Several genes have been shown to play an important role in the metabolic activation or detoxification of PAHs, including the cytochrome P450 genes CYP1A1 and CYP1B1 and the glutathione S-transferase (GST) genes GSTM1, and GSTT2. Genetic variation in these genes could influence susceptibility to adverse effects of PAHs in polluted air. Here, we have explored interactions between prenatal PAH exposure and 17 polymorphisms in these genes (rs2198843, rs1456432, rs4646903, rs4646421, rs2606345, rs7495708, rs2472299, rs162549, rs1056837, rs1056836, rs162560, rs10012, rs2617266, rs2719, rs1622002, rs140194, and gene deletion GSTM1-02) and haplotypes on PAH-DNA adducts in cord blood of 547 newborns and in maternal blood of 806 mothers from three different self-described ethnic groups: African Americans, Dominicans, and Caucasians. PAHs were measured by personal air monitoring of mothers during pregnancy. Significant interactions (p < 0.05) were observed between certain genetic polymorphisms and CYP1A1 haplotype and PAHs in mothers and their newborns in the three ethnic groups. However, with our limited sample size, the current findings are suggestive only, warranting further study.

Traditional physical activity indexes derived from the Harvard alumni activity survey have low construct validity in a lower income, urban population.

The purpose of this study is to investigate the construct validity of the Harvard Alumni Activity Survey (HAAS) in an urban, lower income population. Data were collected from 192 smokers enrolled in an antioxidant micronutrient trial. Activity data were compared to body mass index (BMI), diastolic, and systolic blood pressure. The traditional physical activity index (PAI), using data on stair climbing, walking, and sports, was calculated including and excluding body mass. A new scale, the total weekly activity (TWA) scale, was derived from other questions on the HAAS. The PAI scale calculated with body mass was unassociated with BMI and blood pressure. The PAI scale calculated without body mass was unassociated with BMI and systolic blood pressure but was associated with diastolic blood pressure (Beta = -0.001, p = 0.03). The TWA scale was associated with BMI (Beta = -0.01, p = 0.01), diastolic (Beta = -0.03, p = 0.01), and systolic blood pressure (Beta = -0.04, p = 0.01). A one standard deviation change in the TWA scale is predicted to be equivalent to a change of 0.99 BMI units, 2.97 mmHg of diastolic blood pressure, and 3.96 mmHg of systolic blood pressure. This work suggests that the TWA scale has greater construct validity than the traditional PAI scale in this population.

A bibliometric analysis of scientific production in cancer molecular epidemiology.

OBJECTIVES: The main purpose of this research was to compare the scientific production in the field of cancer molecular epidemiology among countries and to evaluate the publication trend between 1995 and 2004. METHODS: A bibliometric study was carried out searching the PubMed database with a combined search strategy based on the keywords listed in the medical subject headings and a free text search. Only articles from a representative subset of 92 journals--accounting for 80% of papers identified--were selected for the analysis, and the resulting 13,240 abstracts were manually checked according to a list of basic inclusion criteria. The study evaluated the number of publications and the impact factor (mean and sum), absolute and normalized by country population and gross domestic product. RESULTS: A total of 3,842 citations were finally selected for the analysis. Thirty-seven percent came from the European Union (UK, Germany, Italy, France and Sweden ranking at the top), 31.6% from USA and 9.7% from Japan. The highest mean impact factor was reported for Canada (6.3), USA (5.9), Finland (5.8) and UK (5.2). Finland, Sweden and Israel had the best ratio between scientific production and available resources. 'Genetic polymorphism, glutathione transferase, breast neoplasm, risk factors, case-control studies and polymerase chain reaction' were the most used keywords in each of the subgroups evaluated, although inclusion criteria may have privileged studies dealing with exogenous carcinogens. CONCLUSION: Cancer molecular epidemiology is an expanding area attracting an increasing interest. The identification of an operative definition is a necessary condition to give to this discipline a unique scientific identity.

The economic impact of early life environmental tobacco smoke exposure: early intervention for developmental delay.

BACKGROUND AND OBJECTIVES: Early-life exposure to environmental tobacco smoke (ETS) can result in developmental delay as well as childhood asthma and increased risk of cancer. The high cost of childhood asthma related to ETS exposure has been widely recognized; however, the economic impact of ETS-related developmental delay has been less well understood. METHODS AND RESULTS: The Columbia Center for Children's Environmental Health (CCCEH) has reported adverse effects of prenatal ETS exposure on child development in a cohort of minority women and children in New York City (odds ratio of developmental delay = 2.36; 95% confidence interval 1.22-4.58). Using the environmentally attributable fraction (EAF) approach, we estimated the annual cost of one aspect of ETS-related developmental delay: Early Intervention Services. The estimated cost of these services per year due to ETS exposure is > Dollars 50 million per year for New York City Medicaid births and Dollars 99 million per year for all New York City births. CONCLUSION: The high annual cost of just one aspect of developmental delay due to prenatal exposure to ETS provides further impetus for increased prevention efforts such as educational programs to promote smoke-free homes, additional cigarette taxes, and subsidizing of smoking cessation programs.

Biomarkers in maternal and newborn blood indicate heightened fetal susceptibility to procarcinogenic DNA damage.

Polycyclic aromatic hydrocarbons (PAHs) such as benzo[a]pyrene (BaP) are widespread air contaminants released by transportation vehicles, power generation, and other combustion sources. Experimental evidence indicates that the developing fetus is more susceptible than the adult to carcinogenic effects of PAHs, although laboratory studies in rodents suggest that the dose to fetal tissues is an order of magnitude lower than that to maternal tissues. To assess fetal versus adult susceptibility to PAHs and environmental tobacco smoke (ETS), we compared carcinogen-DNA adducts (a biomarker associated with increased cancer risk) and cotinine (a biomarker of tobacco smoke exposure) in paired blood samples collected from mothers and newborns in New York City. We enrolled 265 nonsmoker African-American and Latina mother-newborn pairs in New York City between 1997 and 2001 (estimated average ambient air BaP concentrations < 0.5 ng/m3). Despite the estimated 10-fold lower fetal dose, mean levels of BaP-DNA adducts as determined by high-performance liquid chromatography-fluorescence were comparable in paired New York City newborn and maternal samples (0.24 adducts per 10(8) nucleotides, 45% of newborns with detectable adducts vs. 0.22 per 10(8) nucleotides, 41% of mothers with detectable adducts). However, by the Wilcoxon signed-rank test, the levels in newborns were higher (p = 0.02). Mean cotinine was higher in newborns than in mothers (1.7 ng/mL, 47% detectable vs. 1.28 ng/mL, 44% detectable). Consistent with our prior study in a Caucasian Polish population, these results indicate increased susceptibility of the fetus to DNA damage and reduced ability to clear ETS constituents. The findings have implications for risk assessment, given the need to protect children as a sensitive subset of the population.

Predictors of personal polycyclic aromatic hydrocarbon exposures among pregnant minority women in New York City.

As part of a multiyear birth-cohort study examining the roles of pre- and postnatal environmental exposures on developmental deficits and asthma among children, we measured personal exposures to polycyclic aromatic hydrocarbons (PAHs) among 348 pregnant women in northern Manhattan and the South Bronx, New York. Nonsmoking African-American or Dominican women were identified and recruited into the study. During the third trimester of pregnancy, each subject wore a personal air monitor for 48 hr to determine exposure levels to nine PAH compounds. In this study, we examined levels of exposures to PAHs and tested for associations with potential predictor variables collected from questionnaires addressing socioeconomic factors and day-to-day activities during pregnancy as well as activities and environmental exposures during the 48-hr monitoring period. Reliable personal monitoring data for women who did not smoke during the monitoring period were available for 344 of 348 subjects. Mean PAH concentrations ranged from 0.06 ng/m3 for dibenz[a,h]anthracene to 4.1 ng/m3 for pyrene; mean benzo[a]pyrene concentration was 0.50 ng/m3. As found in previous studies, concentrations of most PAHs were higher in winter than in summer. Multiple linear regression analysis revealed associations between personal PAH exposures and several questionnaire variables, including time spent outdoors, residential heating, and indoor burning of incense. This is the largest study to date characterizing personal exposures to PAHs, a ubiquitous class of carcinogenic air contaminants in urban environments, and is unique in its focus on pregnant minority women.