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1.
Geohealth ; 8(6): e2024GH001045, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38895173

RESUMEN

Lead exposure has blighted communities across the United States (and the globe), with much of the burden resting on lower income communities, and communities of color. On 17 January 2024, the US Environmental Protection Agency (USEPA) lowered the recommended screening level of lead in residential soils from 400 to 200 parts per million. Our analysis of tens of thousands of citizen-science collected soil samples from cities and communities around the US indicates that nearly one quarter of households may contain soil lead that exceed the new screening level. Extrapolating across the nation, that equates to nearly 30 million households needing to mitigate potential soil lead hazards, at a potential total cost of 290 billion to $1.2 trillion. We do not think this type of mitigation is feasible at the massive scale required and we have instead focused on a more immediate, far cheaper strategy: capping current soils with clean soils and/or mulch. At a fraction of the cost and labor of disruptive conventional soil mitigation, it yields immediate and potentially life-changing benefits for those living in these environments.

2.
J Sci Food Agric ; 2024 Mar 28.
Artículo en Inglés | MEDLINE | ID: mdl-38545920

RESUMEN

BACKGROUND: This study investigated per- and polyfluoroalkyl substances (PFASs) in 53 fruit and vegetable samples collected from a local wholesale and retail market in Sydney and a local supermarket in Newcastle. As there is limited information about PFAS levels in vegetables on the market, this study aimed to fill this gap and assess potential risks for humans through consumption of these vegetables. METHODS: QuEChERS extraction - a solid-phase extraction method, a portmanteau word formed from 'quick, easy, cheap, effective, rugged and safe' - followed by enhanced matrix removal-lipid cleaning and liquid chromatography-tandem mass spectrometry analysis were used to detect 30 PFASs in vegetables. RESULTS: PFOA was detected in 7 out of the 53 samples, with concentrations of 0.038-1.996 ng g-1 fresh weight; PFOS was detected in 2 samples only, with concentrations ranging from 0.132 to 0.911 ng g-1 fresh weight. PFHxS was not detected in any sample in this study. PFOA and PFOS concentrations measured in vegetables in this study constituted daily intake of 2.03 ng kg-1 body weight (BW) and 1.98 ng kg-1 BW, respectively, according to recommended daily vegetable intake and BW data from the Australian Bureau of Statistics. The most sensitive population group is girls of 4-8 years of age. These estimated exposure levels represent up to 1.3% of the tolerable daily intake for PFOA (160 ng kg-1 BW) and 9.9% for PFOS (20 ng kg-1 BW) according to Food Standards Australia New Zealand. Consumption of the vegetables from the study locations poses a marginal risk to human health. © 2024 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

4.
Geohealth ; 7(9): e2023GH000936, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37736250

RESUMEN

Climate change has significantly enhanced dangerous heat events. Many of our institutions are ill-prepared to provide science-informed and rapid interventions to confront this. The GeoHealth community is working to bring science, public health, and medical professionals closer together to grapple with the challenges posed by extreme heat.

5.
Geohealth ; 7(7): e2023GH000829, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-37496883

RESUMEN

Recent research applied the United States Environmental Protection Agency's Chemical Speciation Network and Interagency Monitoring of Protected Visual Environments monitoring stations and observed that mean concentrations of atmospheric lead (Pb) in highly segregated counties are a factor of 5 higher than in well-integrated counties and argument is made that regulation of existing airborne Pb emissions will reduce children's Pb exposure. We argue that one of the main sources of children's current Pb exposure is from resuspension of legacy Pb in soil dust and that the racial disparity of Pb exposure is associated with Pb-contaminated community soils.

6.
Environ Pollut ; 327: 121531, 2023 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-37004861

RESUMEN

Many urban waterways with older stormwater drainage systems receive a significant amount of untreated or poorly treated waste from Combined Sewer Outflow (CSO) systems during precipitation events. The input of effluent waste from CSO to urban water streams during storm events often leads to elevated fecal coliform, specifically Escherichia Coli (E. Coli) in these waterways. The aim of the study is to examine fecal coliform concentration, water chemistry, and water quality parameters to better understand spatio-temporal patterns of fecal coliform associated with CSO events in three waterways from Indianapolis, Indiana (USA). The waterways are Pleasant Run Creek (PRW), Fall Creek (FC) and White River (WR). The sampling occurred biweekly over one year for PRW, nine months for FC, and an intense (∼every three days) sub-analysis of the presumed peak period of fecal coliform growth (July) for WR. All PRW and FC sampling sites significantly exceeded the EPA contact standard limit of 200 CFU/100 mL for fecal coliform concentrations during the sampling period. We found no relationship between fecal coliform levels and the number or density of CSO outfalls above a given site. The most significant predictors of increased fecal coliform concentrations were precipitation on the sampling day and cumulative degree days. The most significant predictors of decreased fecal coliform were maximum precipitation during the ten-day window prior to sampling and median discharge during a three-day window prior to sampling. These findings suggest a push-pull balance within the system where CSO activation and seasonal gradients replenish and promote fecal coliform growth. At the same time, large hydrologic events act to flush and dilute fecal coliform concentrations. The results from this study help us to better understand how different drivers influence fecal coliform growth and how this information can be potentially used to predict and remediate the conditions of urban water streams.


Asunto(s)
Monitoreo del Ambiente , Calidad del Agua , Monitoreo del Ambiente/métodos , Escherichia coli , Microbiología del Agua , Heces , Ríos/química , Aguas del Alcantarillado
7.
Environ Sci Pollut Res Int ; 30(19): 57178-57187, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-36897455

RESUMEN

Albeit slow and not without its challenges, lead (Pb) emissions and sources in the United States (U.S.) have decreased immensely over the past several decades. Despite the prevalence of childhood Pb poisoning throughout the twentieth century, most U.S. children born in the last two decades are significantly better off than their predecessors in regard to Pb exposure. However, this is not equal across demographic groups and challenges remain. Modern atmospheric emissions of Pb in the U.S. are nearly negligible since the banning of leaded gasoline in vehicles and regulatory controls on Pb smelting plants and refineries. This is evident in the rapid decrease of atmospheric Pb concentrations across the U.S. over the last four decades. One of the most significant remaining contributors to air Pb is aviation gasoline (avgas), which is minor compared to former Pb emissions. However, continual exposure risks to Pb exist in older homes and urban centers, where leaded paint and/or historically contaminated soils + dusts can still harm children. Thus, while effective in eliminating nearly all primary sources of Pb in the environment, the slow rate of U.S. Pb regulation has led to legacy sources of Pb in the environment. More proactive planning, communication, and research of commonly used emerging contaminants of concern that can persist in the environment long after their initial use (i.e., PFAS) should be prioritized so that the same mistakes are not made again.


Asunto(s)
Aviación , Plomo , Niño , Estados Unidos , Humanos , Anciano , Gasolina , Contaminación Ambiental , Polvo , Monitoreo del Ambiente
8.
Artículo en Inglés | MEDLINE | ID: mdl-36767298

RESUMEN

The negative health impacts of air pollution are well documented. Not as well-documented, however, is how particulate matter varies at the hyper-local scale, and the role that proximal sources play in influencing neighborhood-scale patterns. We examined PM2.5 variations in one airshed within Indianapolis (Indianapolis, IN, USA) by utilizing data from 25 active PurpleAir (PA) sensors involving citizen scientists who hosted all but one unit (the control), as well as one EPA monitor. PA sensors report live measurements of PM2.5 on a crowd sourced map. After calibrating the data utilizing relative humidity and testing it against a mobile air-quality unit and an EPA monitor, we analyzed PM2.5 with meteorological data, tree canopy coverage, land use, and various census variables. Greater proximal tree canopy coverage was related to lower PM2.5 concentrations, which translates to greater health benefits. A 1% increase in tree canopy at the census tract level, a boundary delineated by the US Census Bureau, results in a ~0.12 µg/m3 decrease in PM2.5, and a 1% increase in "heavy industry" results in a 0.07 µg/m3 increase in PM2.5 concentrations. Although the overall results from these 25 sites are within the annual ranges established by the EPA, they reveal substantial variations that reinforce the value of hyper-local sensing technologies as a powerful surveillance tool.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Material Particulado/análisis , Contaminantes Atmosféricos/análisis , Contaminación del Aire/análisis , Características de la Residencia , Monitoreo del Ambiente/métodos
9.
Environ Pollut ; 319: 121039, 2023 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-36627044

RESUMEN

Lead (Pb) contamination continues to contribute to world-wide morbidity in all countries, particularly low- and middle-income countries. Despite its continued widespread adverse effects on global populations, particularly children, accurate prediction of elevated household dust Pb and the potential implications of simple, low-cost household interventions at national and global scales have been lacking. A global dataset (∼40 countries, n = 1951) of community sourced household dust samples were used to predict whether indoor dust was elevated in Pb, expanding on recent work in the United States (U.S.). Binned housing age category alone was a significant (p < 0.01) predictor of elevated dust Pb, but only generated effective predictive accuracy for England and Australia (sensitivity of ∼80%), similar to previous results in the U.S. This likely reflects comparable Pb pollution legacies between these three countries, particularly with residential Pb paint. The heterogeneity associated with Pb pollution at a global scale complicates the predictive accuracy of our model, which is lower for countries outside England, the U.S., and Australia. This is likely due to differing environmental Pb regulations, sources, and the paucity of dust samples available outside of these three countries. In England, the U.S., and Australia, simple, low-cost household intervention strategies such as vacuuming and wet mopping could conservatively save 70 billion USD within a four-year period based on our model. Globally, up to 1.68 trillion USD could be saved with improved predictive modeling and primary intervention to reduce harmful exposure to Pb dust sources.


Asunto(s)
Contaminación del Aire Interior , Plomo , Niño , Humanos , Plomo/análisis , Exposición a Riesgos Ambientales/análisis , Monitoreo del Ambiente/métodos , Polvo/análisis , Contaminación del Aire Interior/análisis
10.
Environ Sci Pollut Res Int ; 30(2): 4269-4277, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35971050

RESUMEN

Heavy metal contamination in urban environments, particularly lead (Pb) pollution, is a health hazard both to humans and ecological systems. Despite wide recognition of urban metal pollution in many cities, there is still relatively limited research regarding heavy metal distribution and transport at the household-scale between soils and indoor dusts-the most important scale for actual human interaction and exposure. Thus, using community-scientist-generated samples in Indianapolis, IN (USA), we applied bulk chemistry, Pb isotopes, and scanning electron microscopy (SEM) to illustrate how detailed analytical techniques can aid in interpretation of Pb pollution distribution at the household-scale. Our techniques provide definitive evidence for Pb paint sourcing in some homes, while others may be polluted with Pb from past industrial/vehicular sources. SEM revealed anthropogenic particles suggestive of Pb paint and the widespread occurrence of Fe-rich metal anthropogenic spherules across all homes, indicative of pollutant transport processes. The variability of Pb pollution at the household scale evident in just four homes is a testament to the heterogeneity and complexity of urban pollution. Future urban pollution research efforts would do well to utilize these more detailed analytical methods on community-sourced samples to gain better insight into where the Pb came from and how it currently exists in the environment. However, these methods should be applied after large-scale pollution screening techniques such as portable X-ray fluorescence (XRF), with more detailed analytical techniques focused on areas where bulk chemistry alone cannot pinpoint dominant pollution mechanisms and where community scientists can also give important metadata to support geochemical interpretations.


Asunto(s)
Contaminantes Ambientales , Metales Pesados , Contaminantes del Suelo , Humanos , Monitoreo del Ambiente/métodos , Plomo , Contaminación Ambiental , Contaminantes Ambientales/análisis , Metales Pesados/análisis , Ciudades , Suelo , Medición de Riesgo , Contaminantes del Suelo/análisis , China
11.
Neurotoxicol Teratol ; 95: 107149, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36539102

RESUMEN

Despite efforts to eradicate sources of environmental lead (Pb), children, predominately in lower socioeconomic areas, are still frequently exposed to unsafe levels of Pb from soils, dust, and water. Human studies suggest that Pb exposure is associated with altered drug consumption in adults; however, there is limited research at comparable exposure levels (blood Pb levels <10 µg/dL). To model how early-life, low-level Pb exposure affects alcohol consumption in adulthood, we exposed postnatal day (PND) 21 C57Bl/6 J mice to either 30 ppm or 0 ppm Lead (IV) Acetate in distilled water until PND 42, and testing began in adulthood. We predicted that mice with early-life Pb exposure would exhibit greater anxiety-like behavior and consume more alcohol in a three-week Drinking-in-the-Dark procedure (20% v/v) and a 24-h two-bottle choice procedure (10% v/v). We also predicted that Pb exposure would decrease whole-brain content of Adenylate Cyclase-5 (AC5), a protein linked to anxiety-like behaviors and alcohol drinking. There was no difference in limited-access binge-like consumption between exposure groups; however, Pb-exposed mice displayed higher two-bottle choice alcohol intake and preference. Furthermore, Pb-exposed mice exhibited greater anxiety-like behaviors in experiments conducted before an alcohol drinking history but not after. Finally, Pb-exposed mice exhibited an upregulation of whole-brain AC5 protein content. However, this difference was not found in the nucleus accumbens, dorsomedial or dorsolateral striatum. These findings conclude that early-life Pb exposure alters voluntary alcohol consumption and whole-brain AC5 protein content in adulthood. Future studies are necessary to further understand the mechanism behind how Pb exposure alters alcohol intake.


Asunto(s)
Consumo de Bebidas Alcohólicas , Plomo , Niño , Humanos , Ratones , Masculino , Femenino , Animales , Plomo/toxicidad , Ratones Endogámicos C57BL , Consumo de Bebidas Alcohólicas/efectos adversos , Etanol/toxicidad , Ansiedad/inducido químicamente
12.
Artículo en Inglés | MEDLINE | ID: mdl-35457527

RESUMEN

(1) Background: Rotavirus and norovirus infections are the primary viral causes of childhood diarrhea. In Ukraine, the diarrhea-linked infant mortality rate is low, but the number of children infected is quite high. This study examined the rates of rotavirus and norovirus infections throughout Ukraine. (2) Methods: Fecal samples for children admitted to hospitals in six Ukrainian cities (Kyiv, Lviv, Sumy, Odesa, Kharkiv, and Uman) were tested for the presence of rotavirus and norovirus. (3) Results: The overall rate of hospitalized children suffering from diarrhea with confirmed presence of rotavirus or norovirus in fecal samples was significant (20.67% and 27.94%, respectively). Samples obtained from children from Lviv had significantly higher rates of the viruses, and Kyiv and Uman had significantly lower rotavirus or norovirus detection levels than expected. (4) Conclusion: Childhood diarrhea impacts Ukraine significantly. The economic and societal effects of the failure to address this public health issue are indicated by the hospitalization rate of children with preventable illnesses. The geographical disparities in Ukraine for child hospitalizations caused by rotavirus and norovirus infections could result from environmental (sanitary factors or water purity issues) or social factors. Further research is needed to completely characterize infant viral infections in Ukraine.


Asunto(s)
Infecciones por Caliciviridae , Enfermedades Intestinales , Norovirus , Infecciones por Rotavirus , Rotavirus , Enfermedad Aguda , Infecciones por Caliciviridae/epidemiología , Niño , Diarrea/epidemiología , Heces , Humanos , Lactante , Infecciones por Rotavirus/epidemiología
13.
Geohealth ; 6(2): e2021GH000525, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35372744

RESUMEN

Lead (Pb) is a neurotoxicant that particularly harms young children. Urban environments are often plagued with elevated Pb in soils and dusts, posing a health exposure risk from inhalation and ingestion of these contaminated media. Thus, a better understanding of where to prioritize risk screening and intervention is paramount from a public health perspective. We have synthesized a large national data set of Pb concentrations in household dusts from across the United States (U.S.), part of a community science initiative called "DustSafe." Using these results, we have developed a straightforward logistic regression model that correctly predicts whether Pb is elevated (>80 ppm) or low (<80 ppm) in household dusts 75% of the time. Additionally, our model estimated 18% false negatives for elevated Pb, displaying that there was a low probability of elevated Pb in homes being misclassified. Our model uses only variables of approximate housing age and whether there is peeling paint in the interior of the home, illustrating how a simple and successful Pb predictive model can be generated if researchers ask the right screening questions. Scanning electron microscopy supports a common presence of Pb paint in several dust samples with elevated bulk Pb concentrations, which explains the predictive power of housing age and peeling paint in the model. This model was also implemented into an interactive mobile app that aims to increase community-wide participation with Pb household screening. The app will hopefully provide greater awareness of Pb risks and a highly efficient way to begin mitigation.

14.
Geohealth ; 5(12): e2021GH000496, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34938931

RESUMEN

GeoHealth as a research paradigm offers the opportunity to re-evaluate common research engagement models and science training practices. GeoHealth challenges are often wicked problems that require both transdisciplinary approaches and the establishment of intimate and long-term partnerships with a range of community members. We examine four common modes of community engagement and explore how research projects are launched, who has the power in these relationships, and how projects evolve to become truly transformative for everyone involved.

16.
Environ Int ; 155: 106582, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-33940394

RESUMEN

We launched the VegeSafe program in 2013 to assist Australians concerned about exposure to contaminants in their soils and gardens. VegeSafe analyses garden soils provided by citizens for trace metals at our laboratory at little to no cost, with easy-to-follow guidance on any intervention required. The response was overwhelming-Australians submitted 17,256 soils from 3,609 homes, and in turn VegeSafe researchers now have unparalleled household-scale data, providing new insights into urban trace metal contamination. The results are sobering, with 35% of homes, particularly those that are older, painted and located in inner cities having soils above the Australian residential guideline (300 mg/kg) for the neurotoxic trace metal lead (Pb). Exposure pathway, blood Pb concentration and vegetable uptake modelling showed the communities in these locations were most at risk. VegeSafe is transformative: 94% of participants better understood contaminants, 83% felt safer in their home environment and 40% undertook remedial action based on their results. The two-way nature of this program enables education of citizens about environmental contaminants, advances public health, and delivers impactful science.


Asunto(s)
Ciencia Ciudadana , Metales Pesados , Contaminantes del Suelo , Australia , Ciudades , Monitoreo del Ambiente , Jardines , Humanos , Metales Pesados/análisis , Suelo , Contaminantes del Suelo/análisis
17.
J Environ Qual ; 49(1): 163-171, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33016370

RESUMEN

Annual and multiyear records of trace element deposition are difficult to develop using monitoring systems but have proven feasible using plant material in several settings. Here, we used material from several tree species (Populus deltoides W. Bartram ex Marshall, Platanus occidentalis L., and Ginkgo biloba L.) to detect atmospheric deposition of trace elements (Cd, Cu, Pb, and Zn) in six localities along a transect from near-urban to far-urban in southeastern Indianapolis, IN, and one control site. We captured soil (legacy footprint), bark (multiannual record), and leaves (seasonal record) across a broad swath of the urban landscape and using a multi-metal approach. Tree bark, leaf, and proximal soil samples were collected and analyzed for their trace element content. The highest trace metal concentrations occurred at the near-urban sites, with particularly high Cu and Pb values. The highest Zn values were found at one of the far-urban sites, which is located near a large brownfield that was a former coal and coke storage and processing facility. No correlation was found between soil trace element composition and that of bark and leaves, perhaps indicating a disconnect between legacy inputs recorded in soils and current inputs recorded in the biological materials. Overall, the tree species analyzed served well as trace element bioindicators, although less so for G. biloba, and thus this approach is promising for further understanding the role that airborne pollution and deposition play in urban watersheds.


Asunto(s)
Oligoelementos/análisis , Biomarcadores Ambientales , Monitoreo del Ambiente , Suelo , Árboles
18.
Environ Sci Technol Lett ; 7(10): 760-765, 2020 Oct 13.
Artículo en Inglés | MEDLINE | ID: mdl-37566290

RESUMEN

Quaternary ammonium compounds (QACs or "quats") make up a class of chemicals used as disinfectants in cleaning and other consumer products. While disinfection is recommended for maintaining a safe environment during the COVID-19 pandemic, the increased use of QACs is concerning as exposure to these compounds has been associated with adverse effects on reproductive and respiratory systems. We have determined the occurrence of 19 QACs in residential dust collected before and during the COVID-19 pandemic. QACs were detected in >90% of the samples collected during the pandemic at concentrations ranging from 1.95 to 531 µg/g (n = 40; median of 58.9 µg/g). The total QAC concentrations in these samples were significantly higher than in samples collected before the COVID-19 pandemic (p < 0.05; n = 21; median of 36.3 µg/g). Higher QAC concentrations were found in households that generally disinfected more frequently (p < 0.05). Disinfecting products commonly used in these homes were analyzed, and the QAC profiles in dust and in products were similar, suggesting that these products can be a significant source of QACs. Our findings indicate that indoor exposure to QACs is widespread and has increased during the pandemic.

19.
Artículo en Inglés | MEDLINE | ID: mdl-30029546

RESUMEN

An ambitious citizen science effort in the city of Indianapolis (IN, USA) led to the collection and analysis of a large number of samples at the property scale, facilitating the analysis of differences in soil metal concentrations as a function of property location (i.e., dripline, yard, and street) and location within the city. This effort indicated that dripline soils had substantially higher values of lead and zinc than other soil locations on a given property, and this pattern was heightened in properties nearer the urban core. Soil lead values typically exceeded the levels deemed safe for children's play areas in the United States (<400 ppm), and almost always exceeded safe gardening guidelines (<200 ppm). As a whole, this study identified locations within properties and cities that exhibited the highest exposure risk to children, and also exhibited the power of citizen science to produce data at a spatial scale (i.e., within a property boundary), which is usually impossible to feasibly collect in a typical research study.


Asunto(s)
Monitoreo del Ambiente/métodos , Jardines/estadística & datos numéricos , Plomo/análisis , Contaminantes del Suelo/análisis , Zinc/análisis , Ciudades , Mapeo Geográfico , Humanos , Indiana , Medición de Riesgo
20.
Artículo en Inglés | MEDLINE | ID: mdl-29662032

RESUMEN

Cardiovascular-related clinical markers were evaluated in this cross-sectional study of United States adults (aged ≥ 20) exposed to lead via the National Health and Nutrition Examination Survey 2007-2008 and the 2009-2010 datasets. In four quartiles of exposure-0-2 µg/dL, 2-5 µg/dL, 5-10 µg/dL, and 10 µg/dL and over, clinical and anthropometric markers were evaluated-to examine how the markers manifested in the quartiles. Associations were determined via linear regression. Finally, clinical makers, and how they manifested between exposed and less-exposed occupations, were explored in addition to how duration of exposure altered these clinical markers. In regression analysis, Diastolic Blood Pressure (DBP) and high-density lipoprotein (HDL) cholesterol, were significantly associated with blood lead level (BLL). In the occupational analysis, Systolic Blood Pressure (SBP), DBP, C-reactive protein (CRP), triglycerides, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, showed differences between populations in the exposed and less-exposed occupations. Regarding Agriculture, Forestry & Fishing, the duration of exposure altered SBP, CRP, and LDL cholesterol. With mining, the duration of exposure altered SBP, DBP, triglycerides, and HDL cholesterol, whereas in construction, the duration in occupation altered SBP, triglycerides, and CRP. In conclusion, lead exposure has a profound effect on the cardiovascular system, with potentially adverse outcomes existing at all exposure levels.


Asunto(s)
Contaminantes Ambientales/efectos adversos , Plomo/efectos adversos , Exposición Profesional/efectos adversos , Adulto , Antropometría , Presión Sanguínea/efectos de los fármacos , Proteína C-Reactiva/análisis , Sistema Cardiovascular/efectos de los fármacos , Colesterol/sangre , Estudios Transversales , Femenino , Humanos , Masculino , Encuestas Nutricionales , Triglicéridos/sangre , Estados Unidos/epidemiología , Adulto Joven
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