Factors associated with per- and polyfluoroalkyl substances (PFAS) serum concentrations in residents of New Hanover County, North Carolina: The GenX exposure study.

In 2017, people living in New Hanover County, North Carolina, learned that for ∼40 years they were unknowingly exposed to per- and polyfluoroalkyl substances (PFAS) through drinking water sourced by the Cape Fear River. Using data from the GenX Exposure Study, which measured serum PFAS levels in county residents, we aimed to understand questionnaire-measured factors associated with serum PFAS levels. Because most residents were served by the same municipal water source, we focused on surrogate factors of drinking water exposure that may contribute to variability in PFAS levels. Our analysis included 335 participants aged 6 and older. We included seven chemicals detected in ≥75% of the study population: four well-studied perfluoroalkyl acids (PFOA, PFOS, PFNA, PFHxS) and three understudied fluoroethers (Nafion byproduct 2, PFO4DA, PFO5DoA). For each PFAS, we evaluated associations of variables with serum PFAS levels adjusting for key demographic characteristics. Additionally, we developed predictive models for each PFAS. We used years of residence in the lower Cape Fear Region as a surrogate for water consumption. Duration of drinking water exposure was associated with higher serum levels of all seven PFAS. Drinking municipal water treated by home filters or other sources of water (non-city) were associated with lower PFAS concentrations for all seven PFAS compared to drinking municipal water without additional filtration. Males had higher levels of well-studied PFAS, but there was no difference for fluoroethers. For six PFAS, the predictive models explained ≥30% of the variance in serum PFAS levels. While some factors were significantly associated with levels of individual PFAS, their relative importance to overall prediction was low, such as microwave popcorn consumption. Consistently, water consumption-related variables were important for both the association and predictive investigations. These analyses provide additional evidence that drinking water is a primary source for serum PFAS concentrations among New Hanover County residents.

Short-term exposure to air pollution and infant mortality: A systematic review and meta-analysis.

BACKGROUND AND AIM: Infant mortality is a widely reported indicator of population health and a leading public health concern. In this systematic review and meta-analysis, we review the available literature for epidemiologic evidence of the association between short-term air pollution exposure and infant mortality. METHODS: Relevant publications were identified through PubMed and Web of Science databases using comprehensive search terms and screened using predefined inclusion/exclusion criteria. We extracted data from included studies and applied a systematic rubric for evaluating study quality across domains including participant selection, outcome, exposure, confounding, analysis, selective reporting, sensitivity, and overall quality. We performed meta-analyses, using both fixed and random-effect methods, and estimated pooled odds ratios (ORs) and 95 % confidence intervals (95%CI) for pollutants (nitrogen dioxide (NO2), sulfur dioxide (SO2), coarse particulate matter (PM10), fine particulate matter (PM2.5), ozone (O3), carbon monoxide (CO)) and infant mortality, neonatal mortality, or postneonatal mortality. RESULTS: Our search returned 549 studies. We excluded 490 studies in the abstract screening phase and an additional 37 studies in the full text screening phase, leaving 22 studies for inclusion. Among these 22 studies, 14 included effect estimates for PM10, 13 for O3, 11 for both NO2 and CO, 8 for SO2, and 3 for PM2.5. We did not calculate a pooled OR for PM2.5 due to the limited number of studies available and demonstrated heterogeneity in the effect estimates. The pooled ORs (95%CI) with the greatest magnitudes were for a 10-ppb increase in SO2 or NO2 concentration in the days before death (1.07 [95%CI: 1.02, 1.12], 1.04 [95%CI: 1.01, 1.08], respectively). The pooled OR for PM10 was 1.02 (95%CI: 1.00, 1.03), and the pooled ORs for CO and O3 were 1.01 (95%CI: 1.00, 1.02) and 0.99 (95%CI: 0.97, 1.01). CONCLUSIONS: Increased exposure to SO2, NO2, PM10, or CO is associated with infant mortality across studies.

Sulfur dioxide reduction at coal-fired power plants in North Carolina and associations with preterm birth among surrounding residents.

Coal-fired power plants (CFPP) are major contributors of air pollution, including the majority of anthropogenic sulfur dioxide (SO2) emissions, which have been associated with preterm birth (PTB). To address a 2002 North Carolina (NC) policy, 14 of the largest NC CFPPs either installed desulfurization equipment (scrubbers) or retired coal units, resulting in substantial reductions of SO2 air emissions. We investigated whether SO2 air emission reduction strategies at CFPPs in NC were associated with changes in prevalence of PTB in nearby communities. Methods: We used US EPA Air Markets Program Data to track SO2 emissions and determine the implementation dates of intervention at CFPPs and geocoded 2003-2015 NC singleton live births. We conducted a difference-in-difference analysis to estimate change in PTB associated with change in SO2 reduction strategies for populations living 0-<4 and 4-<10 miles from CFPPs pre- and postintervention, with a comparison of those living 10-<15 miles from CFPPs. Results: With the spatial-temporal exposure restrictions applied, 42,231 and 41,218 births were within 15 miles of CFPP-scrubbers and CFPP-retired groups, respectively. For residents within 4-<10 miles from a CFPP, we estimated that the absolute prevalence of PTB decreased by -1.5% [95% confidence interval (CI): -2.6, -0.4] associated with scrubber installation and -0.5% (95% CI: -1.6, 0.6) associated with the retirement of coal units at CFPPs. Our findings were imprecise and generally null-to-positive among those living within 0-<4 miles regardless of the intervention type. Conclusions: Results suggest a reduction of PTB among residents 4-<10 miles of the CFPPs that installed scrubbers.

North Carolina's Changing Energy Generation Profile and Reductions in Key Air Pollutants, 2000-2019.

BACKGROUND Coal combustion releases a number of airborne toxins. The North Carolina Clean Smokestacks Act (CSA) of 2002 required North Carolina coal-fired power plants (CFPP) to reduce nitrogen oxides (NOX) emissions by 2009 and sulfur dioxide (SO2) emissions to 2 benchmarks by 2009 and 2013.METHODS We utilized publicly available databases from the Energy Information Administration and the Environmental Protection Agency to characterize North Carolina's electricity generation profile from 2000 until 2019 and evaluate corresponding NOx and SO2 emissions by sector over the same time period.RESULTS Between 2000 and 2008 in North Carolina, approximately 60% of electric power was generated by CFPPs. Since then, North Carolina's electric power generation has transformed from predominant dependence on coal to approximately equal dependence on natural gas and nuclear power (each at ~ 30%), with coal close behind (~ 25%). Renewables have increased, although marginally relative to the rapid increase in natural gas. Despite the stark drop in reliance on CFPPs for energy in North Carolina and subsequent drop in emissions, CFPPs still contribute ~ 60% of SO2 air pollution as of 2017.LIMITATIONS This analysis relies upon electricity generation and emissions data self-reported by utilities and publicly available from federal agenciesCONCLUSION North Carolina's electric utilities met the 2009 and 2013 regulatory benchmarks set by the CSA, which resulted in substantial reductions in SO2 emissions from the fuel combustion electric generation sector. Still, CFPPs remain the primary utility-related and overall anthropogenic contributor of SO2 air pollution in North Carolina.

Measurement of Novel, Drinking Water-Associated PFAS in Blood from Adults and Children in Wilmington, North Carolina.

BACKGROUND: From 1980 to 2017, a fluorochemical manufacturing facility discharged wastewater containing poorly understood per- and polyfluoroalkyl substances (PFAS) to the Cape Fear River, the primary drinking water source for Wilmington, North Carolina, residents. Those PFAS included several fluoroethers including HFPO-DA also known as GenX. Little is known about the bioaccumulation potential of these fluoroethers. OBJECTIVE: We determined levels of fluoroethers and legacy PFAS in serum samples from Wilmington residents. METHODS: In November 2017 and May 2018, we enrolled 344 Wilmington residents ≥6 years of age into the GenX Exposure Study and collected blood samples. Repeated blood samples were collected from 44 participants 6 months after enrollment. We analyzed serum for 10 fluoroethers and 10 legacy PFAS using liquid chromatography-high-resolution mass spectrometry. RESULTS: Participants' ages ranged from 6 to 86 y, and they lived in the lower Cape Fear Region for 20 y on average (standard deviation: 16 y). Six fluoroethers were detected in serum; Nafion by-product 2, PFO4DA, and PFO5DoA were detected in >85% of participants. PFO3OA and NVHOS were infrequently detected. Hydro-EVE was present in a subset of samples, but we could not quantify it. GenX was not detected above our analytical method reporting limit (2 ng/mL). In participants with repeated samples, the median decrease in fluoroether levels ranged from 28% for PFO5DoA to 65% for PFO4DA in 6 months due to wastewater discharge control. Four legacy PFAS (PFHxS, PFOA, PFOS, PFNA) were detected in most (≥97%) participants; these levels were higher than U.S. national levels for the 2015-2016 National Health and Nutrition Examination Survey. The sum concentration of fluoroethers contributed 24% to participants' total serum PFAS (median: 25.3 ng/mL). CONCLUSION: Poorly understood fluoroethers released into the Cape Fear River by a fluorochemical manufacturing facility were detected in blood samples from Wilmington, North Carolina, residents. Health implications of exposure to these novel PFAS have not been well characterized. https://doi.org/10.1289/EHP6837.

A cross-disciplinary evaluation of evidence for multipollutant effects on cardiovascular disease.

BACKGROUND: The current single-pollutant approach to regulating ambient air pollutants is effective at protecting public health, but efficiencies may be gained by addressing issues in a multipollutant context since multiple pollutants often have common sources and individuals are exposed to more than one pollutant at a time. OBJECTIVE: We performed a cross-disciplinary review of the effects of multipollutant exposures on cardiovascular effects. METHODS: A broad literature search for references including at least two criteria air pollutants (particulate matter [PM], ozone [O3], oxides of nitrogen, sulfur oxides, carbon monoxide) was conducted. References were culled based on scientific discipline then searched for terms related to cardiovascular disease. Most multipollutant epidemiologic and experimental (i.e., controlled human exposure, animal toxicology) studies examined PM and O3 together. DISCUSSION: Epidemiologic and experimental studies provide some evidence for O3 concentration modifying the effect of PM, although PM did not modify O3 risk estimates. Experimental studies of combined exposure to PM and O3 provided evidence for additivity, synergism, and/or antagonism depending on the specific health endpoint. Evidence for other pollutant pairs was more limited. CONCLUSIONS: Overall, the evidence for multipollutant effects was often heterogeneous, and the limited number of studies inhibited making a conclusion about the nature of the relationship between pollutant combinations and cardiovascular disease.

Gender and Racial/Ethnic Disparities: Cumulative Screening of Health Risk Indicators in 20-50 Year Olds in the United States.

This study explored potential gender and racial/ethnic disparities in overall health risk related to 24 health risk indicators selected across six domains: socioeconomic, health status and health care, lifestyle, nutritional, clinical, and environmental. Using the 2003-2006 National Health and Nutrition Examination Surveys (NHANES), it evaluated cross-sectional data for 5,024 adults in the United States. Logistic regression models were developed to estimate prevalence odds ratios (PORs) adjusted for smoking, health insurance status, and age. Analyses evaluated disparities associated with 24 indicator variables of health risk, comparing females to males and four racial/ethnic groups to non-Hispanic Whites. Non-Hispanic Blacks and Mexican Americans were at greater risk for at least 50% of the 24 health risk indicators, including measures of socioeconomic status, health risk behaviors, poor/fair self-reported health status, multiple nutritional and clinical indicators, and blood lead levels. This demonstrates that cumulative health risk is unevenly distributed across racial/ethnic groups. A similarly high percentage (46%) of the risk factors was observed in females. Females as compared to males were more likely to have lower income, lower blood calcium, poor/fair self-reported health, more poor mental health days/month, higher medication usage and hospitalizations, and higher serum levels of some clinical indicators and blood cadmium. This analysis of cumulative health risk is responsive to calls for broader-based, more integrated assessment of health disparities that can help inform community assessments and public health policy.

Factors associated with self-reported health: implications for screening level community-based health and environmental studies.

BACKGROUND: Advocates for environmental justice, local, state, and national public health officials, exposure scientists, need broad-based health indices to identify vulnerable communities. Longitudinal studies show that perception of current health status predicts subsequent mortality, suggesting that self-reported health (SRH) may be useful in screening-level community assessments. This paper evaluates whether SRH is an appropriate surrogate indicator of health status by evaluating relationships between SRH and sociodemographic, lifestyle, and health care factors as well as serological indicators of nutrition, health risk, and environmental exposures. METHODS: Data were combined from the 2003-2006 National Health and Nutrition Examination Surveys for 1372 nonsmoking 20-50 year olds. Ordinal and binary logistic regression was used to estimate odds ratios and 95 % confidence intervals of reporting poorer health based on measures of nutrition, health condition, environmental contaminants, and sociodemographic, health care, and lifestyle factors. RESULTS: Poorer SRH was associated with several serological measures of nutrition, health condition, and biomarkers of toluene, cadmium, lead, and mercury exposure. Race/ethnicity, income, education, access to health care, food security, exercise, poor mental and physical health, prescription drug use, and multiple health outcome measures (e.g., diabetes, thyroid problems, asthma) were also associated with poorer SRH. CONCLUSION: Based on the many significant associations between SRH and serological assays of health risk, sociodemographic measures, health care access and utilization, and lifestyle factors, SRH appears to be a useful health indicator with potential relevance for screening level community-based health and environmental studies.