Health Remedies as a Source of Lead, Mercury, and Arsenic Exposure, New York City, 2010-2019.

Objectives. To describe the types of health remedies collected during poisoning investigations in New York City over a 10-year period that were found to contain high levels of lead, mercury, or arsenic. Methods. Between 2010 and 2019, the New York City Department of Health and Mental Hygiene collected 584 samples of health remedies during poisoning investigations and store surveys for lead, mercury, or arsenic analysis. Results. There was a significant association between blood lead levels and estimated cumulative daily lead exposures among adult users of rasa shastra Ayurvedic medications. Also, average blood lead levels among adult rasa shastra users were significantly higher than levels among those using other types of non-Ayurvedic health remedies. Conclusions. Rasa shastra Ayurvedic medications can contain very high levels of lead, mercury, and arsenic. This underscores the importance of screening for lead, mercury, and arsenic exposures within at-risk populations. Public Health Implications. The general ease of accessibility to rasa shastra medications raises concerns. There is a need for systemic change that results in primary prevention, that is, removal of the source through policy development and regulatory enforcement in the country of origin. (Am J Public Health. 2022;112(S7):S730-S740. https://doi.org/10.2105/AJPH.2022.306906).

Cardiovascular Disease & Cancer Risk Among South Asians: Impact of Sociocultural Influences on Lifestyle and Behavior.

A comprehensive literature review revealed cultural beliefs, societal obligations, and gender roles within the South Asian community to be indirect contributors to the health of South Asian immigrants (SAIs). Health professionals need to increase their work with SAI communities to change less beneficial cultural elements such as misconceptions about health and exercise, and lack of communication when using alternative medicines. Community engaged efforts and continuing medical education are both needed to improve the health of the South Asian immigrant population in a culturally appropriate manner.

A Spoonful of Lead: A 10-Year Look at Spices as a Potential Source of Lead Exposure.

CONTEXT: While lead-based paint and occupational lead hazards remain the primary sources of lead exposures among New York City's lead-poisoned children and men, respectively, these are not the only possible lead sources. Certain consumer products are often implicated. Between 2008 and 2017, the New York City Department of Health and Mental Hygiene tested more than 3000 samples of consumer products during lead poisoning case investigations and surveys of local stores, and of these, spices were the most frequently tested (almost 40% of the samples). OBJECTIVES: To describe spice samples-types, origin, lead concentrations, and the implication of findings for public health programs and global food safety regulations. DESIGN: Descriptive study of lead contamination in spices systematically collected as part of lead poisoning investigations. SETTING AND PARTICIPANTS: A total of 1496 samples of more than 50 spices from 41 countries were collected during investigations of lead poisoning cases among New York City children and adults and local store surveys. RESULTS: More than 50% of the spice samples had detectable lead, and more than 30% had lead concentrations greater than 2 ppm. Average lead content in the spices was significantly higher for spices purchased abroad than in the United States. The highest concentrations of lead were found in spices purchased in the countries Georgia, Bangladesh, Pakistan, Nepal, and Morocco. CONCLUSIONS: Certain commonly used spices, particularly those purchased abroad in Georgia, Bangladesh, Pakistan, Nepal, and Morocco, can have very high lead levels, which can contribute to lead body burden. This underscores the need to develop comprehensive interventions that educate consumers and initiate intergovernmental efforts for stricter global food regulations.

Tracking Declines in Mercury Exposure in the New York City Adult Population, 2004-2014.

Mercury is a toxic metal that can be measured in human blood and urine. Population-based biomonitoring from 2004 guided New York City (NYC) Department of Health and Mental Hygiene (DOHMH) efforts to reduce exposures by educating the public about risks and benefits of fish consumption-a predominant source of exposure in the general population-and removing mercury-containing skin-lightening creams and other consumer products from the marketplace. We describe changes in exposures over the past decade in relation to these local public health actions and in the context of national changes by comparing mercury concentrations measured in blood (1201 specimens) and urine (1408 specimens) from the NYC Health and Nutrition Examination Survey (NYC HANES) 2013-2014 with measurements from NYC HANES 2004 and National Health and Nutrition Examination Surveys (NHANES) 2003-2004 and 2013-2014. We found that NYC adult blood and urine geometric mean mercury concentrations decreased 46% and 45%, respectively. Adult New Yorkers with blood mercury concentration ≥ 5 µg/L (the New York State reportable level) declined from 24.8% (95% CL = 22.2%, 27.7%) to 12.0% (95% CL = 10.1%, 14.3%). The decline in blood mercury in NYC was greater than the national decline, while the decline in urine mercury was similar. As in 2004, Asian New Yorkers had higher blood mercury concentrations than other racial/ethnic groups. Foreign-born adults of East or Southeast Asian origin had the highest prevalence of reportable levels (29.7%; 95% CL = 21.0%, 40.1%) across sociodemographic groups, and Asians generally were the most frequent fish consumers, eating on average 11 fish meals in the past month compared with 7 among other groups (p < 0.001). Fish consumption patterns were similar over time, and fish continues to be consumed more frequently in NYC than nationwide (24.7% of NYC adults ate fish ten or more times in the past 30 days vs. 14.7% nationally, p < 0.001). The findings are consistent with the hypothesis that blood mercury levels have declined in part because of local and national efforts to promote consumption of lower mercury fish. Local NYC efforts may have accelerated the reduction in exposure. Having "silver-colored fillings" on five or more teeth was associated with the highest 95th percentile for urine mercury (4.06 µg/L; 95% CL = 3.1, 5.9). An estimated 5.5% of the adult population (95% CL = 4.3%, 7.0%) reported using a skin-lightening cream in the past 30 days, but there was little evidence that use was associated with elevated urine mercury in 2013-14.

Declines in adult blood lead levels in New York City compared with the United States, 2004-2014.

OBJECTIVES: To assess changes in lead exposure in the New York City (NYC) adult population over a 10-year period and to contrast changes with national estimates, overall, and by socio-demographics and smoking status. METHODS: We used measurements of blood lead levels (BLLs) from NYC resident adults who participated in the NYC Health and Nutrition Examination Surveys (HANES) in 2004 and 2013-2014. We compared estimates of geometric means (GM), 95th percentiles, and prevalence of BLL ≥ 5 µg/dL overall and by subgroups over time, with adults who participated in the National HANES (NHANES) 2001-2004 and 2011-2014. RESULTS: The GM BLLs among NYC adults declined from 1.79 µg/dL in 2004 to 1.13 µg/dL in 2013-2014 (P < .0001). The declines over this period ranged from 30.1% to 43.2% across socio-demographic groups and smoking status (P < .0001 for all comparisons), and were slightly greater than declines observed nationally. The drop in prevalence of elevated BLLs (≥ 5 µg/dL) was also greater in NYC (4.8-0.5%), compared with NHANES (3.8-2.0%). By 2013-2014, NYC adults with lower annual family income (< $20,000) no longer had higher GM BLLs relative to those with higher incomes (≥ $75,000), a disparity improvement not observed nationally. Likewise, GM BLLs and 95th percentiles for non-Hispanic black adults in NYC were lower than GM BLLs for non-Hispanic white adults. Non-Hispanic Asian adults had the highest GM BLLs compared with other racial/ethnic groups, both in NYC in 2013-14 and nationally in 2011-2014 (1.37 µg/dL, P = .1048 and 1.22 µg/dL, P = .0004, respectively). CONCLUSION: The lessening of disparity in lead exposure across income groups and decreasing exposure at the high end of the distribution among non-Hispanic black and Asian adults in NYC suggest that regulatory and outreach efforts have effectively targeted these higher exposure risk groups. However, Asian adults still had the highest average BLL, suggesting a need for enhanced outreach to this group. Local surveillance remains an important tool to monitor BLLs of local populations and to inform initiatives to reduce exposures in those at highest risk.

Blood Lead Levels and Potential Risk Factors for Lead Exposures Among South Asians in New York City.

New York City's South Asian children and pregnant women have a disproportionate burden of elevated blood lead levels. This study is the first to investigate blood lead levels and risk factors for lead exposures among South Asian New Yorkers. A survey and a finger-stick blood lead test using a portable analyzer were administered to 230 South Asian adults and children. Blood lead levels of 5 µg/dL or higher were found in 20 % of the adults and 15 % of the children, as compared to 5 % of adults and 2.5 % of children citywide. Factors associated with elevated blood lead levels were recent repair work at home, not speaking English, Bangladeshi or Indian ethnicity, and occupational risk factors. Public health professional should be aware that South Asians may be at an increased risk for elevated blood lead levels.

Intervention model for contaminated consumer products: a multifaceted tool for protecting public health.

Lead-based paint and occupational lead hazards remain the primary exposure sources of lead in New York City (NYC) children and men, respectively. Lead poisoning has also been associated with the use of certain consumer products in NYC. The NYC Department of Health and Mental Hygiene developed the Intervention Model for Contaminated Consumer Products, a comprehensive approach to identify and reduce exposure to lead and other hazards in consumer products. The model identifies hazardous consumer products, determines their availability in NYC, enforces on these products, and provides risk communication and public education. Implementation of the model has resulted in removal of thousands of contaminated products from local businesses and continues to raise awareness of these hazardous products.

Pesticide concentrations in maternal and umbilical cord sera and their relation to birth outcomes in a population of pregnant women and newborns in New Jersey.

We evaluated in utero exposures to pesticides by measuring maternal and cord serum biomarkers in a New Jersey cohort of pregnant women and the birth outcomes of their neonates. The study was based on 150 women that underwent an elective cesarean delivery at term in a hospital in central New Jersey. We evaluated the following pesticide compounds in both maternal and umbilical cord sera: chlorpyrifos, diazinon, carbofuran, chlorothalonil, dacthal, metolachlor, trifluralin and diethyl-m-toluamide (DEET). Of these compounds, chlorpyrifos, carbofuran, chlorothalonil, trifluralin, metolachlor and DEET were the pesticides most frequently detected in the serum samples. We found high (> or =75th percentile) metolachlor concentrations in cord blood that were related to birth weight (3605 g in upper quartile vs 3399 g; p=0.05). We also observed an increase in abdominal circumference with increasing cord dichloran concentrations (p=0.031). These observations suggest that in utero exposures to certain pesticides may alter birth outcomes.

Perinatal exposure to perchlorate. thiocyanate, and nitrate in New Jersey mothers and newborns.

Perchlorate is a commonly occurring environmental toxicant that may be transported across the placental barrier by the sodium-iodide symporter (NIS), possibly resulting in both increased perchlorate exposure and decreased iodide uptake by the fetus. Therefore, we measured levels of three physiologically relevant NIS-inhibitors (perchlorate, nitrate, and thiocyanate) and iodide in maternal and fetal fluids collected during cesarean-section surgeries on 150 U.S. women. Geometric means of perchlorate, thiocyanate, and nitrate levels in maternal urine (2.90, 947, and 47900 microg/L, respectively) were similar to previously published results, while urinary iodide levels (1420 microg/L) were significantly higher (p < 0.0001), likely because of prevalent prenatal vitamin use in the study population (74%). Thiocyanate levels were higher in the maternal serum, cord serum, and amniotic fluid of smokers compared to women with environmental tobacco smoke exposure and nonsmokers (p-values of 0.0006, 0.0011, and 0.0026, respectively). Perchlorate was detected in most samples: urine (100%), maternal serum (94%), cord serum (67%), and amniotic fluid (97%). Maternal urinary perchlorate levels were positively correlated with perchlorate levels in amniotic fluid (r = 0.57), indicating that maternal urine perchlorate is an effective biomarker of fetal perchlorate exposure. Maternal serum perchlorate was generally higher than cord serum perchlorate (median ratio 2.4:1 for paired samples), and maternal urine perchlorate was always higher than fetal amniotic fluid perchlorate levels (mean ratio 22:1); conversely, iodide levels were typically higher in fetal fluids compared to maternal fluids. We found no evidence of either disproportionate perchlorate accumulation or lack of iodide in the fetal compartment. In this panel of healthy infants, we found no association between cord blood levels of these anions and newborn weight length, and head circumference.

Phthalates Biomarker Identification and Exposure Estimates in a Population of Pregnant Women.

Phthalates are known reproductive and developmental toxicants in experimental animals. However, in humans, there are few data on the exposure of pregnant women that can be used to assess the potential developmental exposure experienced by the fetus. We measured several phthalate metabolites in maternal urine, maternal serum, and cord serum samples collected at the time of delivery from 150 pregnant women from central New Jersey. The urinary concentrations of most metabolites were comparable to or less than among the U.S. general population, except for mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), three metabolites of di(2-ethylhexyl) phthalate (DEHP). The median urinary concentrations of MEHHP (109 mug/l) and MEOHP (95.1 mug/l) were more than 5 times their population-based concentrations, whereas the median urinary concentration of MEHP was more than 20 times higher. High concentration of MEHP may indicate a recent exposure to the parent chemical DEHP in the hospital shortly before the collection of the samples. Calculation of daily intakes using the urinary biomarker data reveals that none of the pregnant women tested had integrated exposures to DEHP greater than the Agency for Toxic Substances and Disease Registry's minimal risk levels (MRLs chronic 60, intermediate 100 mug/kg/day). No abnormal birth outcomes (e .g., birth weight, Apgar Score, and gestational age) were noted in those newborns whose mothers had relatively greater exposure to DEHP during the perinatal period than others in this study. Significantly greater concentrations and detection frequencies in maternal urine than in maternal serum and cord serum suggest that the urinary concentrations of the phthalate metabolites may be more reliable biomarkers of exposure than their concentrations in other biological specimens.

Analytical method developed for measurement of dialkylphosphate metabolites in urine collected from children non-occupationally exposed to organophosphate pesticides in an agricultural community in Thailand.

There has been increasing concern in regards to organophosphate (OP) pesticide exposure among farm workers and their families in Thailand's agricultural areas. Therefore, the development of an analytical method for estimating OP pesticide exposure is necessary to allow for monitoring of OP pesticide exposures within these populations. This paper describes an analytical method developed to measure dialkylphosphate (DAP) metabolites in urine. The methods in this study are important in the biological monitoring of OP metabolites in agricultural families in Thailand and can be used as an initial guidance procedure in any environmental toxicological laboratory in Thailand.

Biological monitoring of organophosphate pesticides in preschool children in an agricultural community in Thailand.

Organophosphate pesticide exposures of preschool children in a Thailand agricultural community and reference children living outside the farm area in the same subdistrict were determined. Levels of dialkylphosphate (DAP) metabolites were measured in first-morning-void urine samples. During the dry season (April-May), the farm children excreted significantly higher levels of all DAP metabolites than the reference children did (Mann-Whitney U test, p < 0.05; Wilcoxon signed-rank text, p < 0.05). During the wet season (September-October), DAP metabolite levels were similar in the two groups. Reference children showed no significant difference related to season. Pesticide spraying during the dry season is a likely cause of the farm children's organophosphate exposures.

Children's residential exposure to chlorpyrifos: application of CPPAES field measurements of chlorpyrifos and TCPy within MENTOR/SHEDS-Pesticides model.

The comprehensive individual field-measurements on non-dietary exposure collected in the Children's-Post-Pesticide-Application-Exposure-Study (CPPAES) were used within MENTOR/SHEDS-Pesticides, a physically based stochastic human exposure and dose model. In this application, however, the model was run deterministically. The MENTOR/SHEDS-Pesticides employed the CPPAES as input variables to simulate the exposure and the dose profiles for seven children over a 2-week post-application period following a routine residential and professional indoor crack-and-crevice chlorpyrifos application. The input variables were obtained from a personal activity diary, microenvironmental measurements and personal biomonitoring data obtained from CPPAES samples collected from the individual children and in their homes. Simulation results were compared with CPPAES field measured values obtained from the children's homes to assess the utility of the different microenvironmental data collected in CPPAES, i.e. indicator toys and wipe samplers to estimate aggregate exposures that can be result from one or more exposure pathways and routes. The final analyses of the database involved comparisons of the actual data obtained from the individual biomarker samples of a urinary metabolite of chlorpyrifos (TCPy) and the values predicted by MENTOR/SHEDS-Pesticides using the CPPAES-derived variables. Because duplicate diet samples were not part of the CPPAES study design, SHEDs-Pesticides simulated dose profiles did not account for the dietary route. The research provided more confidence in the types of data that can be used in the inhalation and dermal contact modules of MENTOR/SHEDS-Pesticides to predict the pesticide dose received by a child. It was determined that we still need additional understanding about: (1) the types of activities and durations of activities that result in non-dietary ingestion of pesticides and (2) the influence of dietary exposures on the levels of TCPy found in the urine.

Chlorpyrifos accumulation patterns for child-accessible surfaces and objects and urinary metabolite excretion by children for 2 weeks after crack-and-crevice application.

The Children's Post-Pesticide Application Exposure Study (CPPAES) was conducted to look at the distribution of chlorpyrifos within a home environment for 2 weeks after a routine professional crack-and-crevice application and to determine the amount of the chlorpyrifos that is absorbed by a child living within the home. Ten residential homes with a 2- to 5-year-old child in each were selected for study, and the homes were treated with chlorpyrifos. Pesticide measurements were made from the indoor air, indoor surfaces, and plush toys. In addition, periodic morning urine samples were collected from each of the children throughout the 2-week period. We analyzed the urine samples for 3,5,6-trichloropyridinol, the primary urinary metabolite of chlorpyrifos, and used the results to estimate the children's absorbed dose. Average chlorpyrifos levels in the indoor air and surfaces were 26 (pretreatment)/120 (posttreatment) ng/m3 and 0.48 (pretreatment)/2.8 (posttreatment) ng/cm2, respectively, reaching peak levels between days 0 and 2; subsequently, concentrations decreased throughout the 2-week period. Chlorpyrifos in/on the plush toys ranged from 7.3 to 1,949 ng/toy postapplication, with concentrations increasing throughout the 2-week period, demonstrating a cumulative adsorption/absorption process indoors. The daily amount of chlorpyrifos estimated to be absorbed by the CPPAES children postapplication ranged from 0.04 to 4.8 microg/kg/day. During the 2 weeks after the crack-and-crevice application, there was no significant increase in the amount of chlorpyrifos absorbed by the CPPAES children.

Contributions of children's activities to pesticide hand loadings following residential pesticide application.

The role of children's activities in leading to pesticide exposure was evaluated by comparing pesticide loadings on the hands of children with the activities of the same children observed over a 4-h period. In all, 10 children ranging in age from 24 to 55 months were videotaped on the second day following a routine professional crack and crevice chlorpyrifos application in their homes. Before and following the video session, the children's hands were rinsed in isopropyl alcohol. Thus, only the chlorpyrifos that accumulated on and remained on the child's hands during the videotaping were removed for analysis after the videotaping session. The rinsate was analyzed for chlorpyrifos. The children's behaviors were quantified using virtual tracking device and the frequency and duration of behaviors, the hourly rate of behaviors, and the locations in which behaviors occurred were compared to hand loadings of pesticides. Pesticide hand loadings obtained following the videotaping sessions were associated with pesticide levels on surfaces and toys, but not with air levels. Pesticide loadings obtained following the videotaping sessions were also associated with frequencies, durations, and hourly rates of contact with bottles, and object-to-mouth behaviors, as well as contact duration with upholstered/textured surfaces. The hand loadings were also associated with the number of locations where the children exhibited object-to-mouth behavior and with children's use of house space during the videotaping sessions.

Organophosphate pesticide exposures of traditional and integrated pest management farmers from working air conditions: a case study in Thailand.

Concentrations of organophosphate pesticides, including chlorpyrifos and methyl parathion, were measured in ambient air breathed by farmers in Tambon Bang Rieng, Thailand. An exposure assessment and comparison was made between the levels of pesticide exposure of traditional and integrated pest management (IPM) farmers. Thirty-three air samples were collected during pesticide spraying. Traditional farmers were exposed to higher levels of the pesticide(s), with an average concentration of 0.19 mg/m3, compared with 0.037 mg/m3 for the IPM farmers. It was estimated that a farmer of Tambon Bang Rieng would be exposed to 81-12,261 mg of the organophosphate pesticide(s) via inhalation throughout his or her lifetime. Moreover, traditional farmers absorbed more of pesticide via inhalation than did IPM farmers.