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Fang F, Quach B, Lawrence KG, van Dongen J, Marks JA, Lundgren S, Lin M, Odintsova VV, Costeira R, Xu Z, Zhou L, Mandal M, Xia Y, Vink JM, Bierut LJ, Ollikainen M, Taylor JA, Bell JT, Kaprio J, Boomsma DI, Xu K, Sandler DP, Hancock DB, Johnson EO. Trans-ancestry epigenome-wide association meta-analysis of DNA methylation with lifetime cannabis use. Mol Psychiatry 2024; 29:124-133. [PMID: 37935791 PMCID: PMC11078760 DOI: 10.1038/s41380-023-02310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023]
Abstract
Cannabis is widely used worldwide, yet its links to health outcomes are not fully understood. DNA methylation can serve as a mediator to link environmental exposures to health outcomes. We conducted an epigenome-wide association study (EWAS) of peripheral blood-based DNA methylation and lifetime cannabis use (ever vs. never) in a meta-analysis including 9436 participants (7795 European and 1641 African ancestry) from seven cohorts. Accounting for effects of cigarette smoking, our trans-ancestry EWAS meta-analysis revealed four CpG sites significantly associated with lifetime cannabis use at a false discovery rate of 0.05 ( p < 5.85 × 10 - 7 ) : cg22572071 near gene ADGRF1, cg15280358 in ADAM12, cg00813162 in ACTN1, and cg01101459 near LINC01132. Additionally, our EWAS analysis in participants who never smoked cigarettes identified another epigenome-wide significant CpG site, cg14237301 annotated to APOBR. We used a leave-one-out approach to evaluate methylation scores constructed as a weighted sum of the significant CpGs. The best model can explain 3.79% of the variance in lifetime cannabis use. These findings unravel the DNA methylation changes associated with lifetime cannabis use that are independent of cigarette smoking and may serve as a starting point for further research on the mechanisms through which cannabis exposure impacts health outcomes.
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Affiliation(s)
- Fang Fang
- GenOmics and Translational Research Center, RTI International, Research Triangle Park, NC, USA.
| | - Bryan Quach
- GenOmics and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Kaitlyn G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Jenny van Dongen
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jesse A Marks
- GenOmics and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Sara Lundgren
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Mingkuan Lin
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
| | - Veronika V Odintsova
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ricardo Costeira
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Zongli Xu
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Linran Zhou
- GenOmics and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Meisha Mandal
- GenOmics and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Yujing Xia
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Jacqueline M Vink
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Laura J Bierut
- Department of Psychiatry, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
| | - Miina Ollikainen
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Jack A Taylor
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Jordana T Bell
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ke Xu
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Dana B Hancock
- GenOmics and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Eric O Johnson
- GenOmics and Translational Research Center, RTI International, Research Triangle Park, NC, USA
- Fellow Program, RTI International, Research Triangle Park, NC, USA
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Chen D, Lawrence KG, Sandler DP. Nontraditional Occupational Exposures to Crude Oil Combustion Disasters and Respiratory Disease Risk: A Narrative Review of Literature. Curr Allergy Asthma Rep 2023; 23:299-311. [PMID: 37166706 PMCID: PMC10330790 DOI: 10.1007/s11882-023-01078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE OF REVIEW Burning of petroleum products has been consistently associated with adverse respiratory health effects. Combustion of crude oil, specifically, produces toxic byproducts, but there have been relatively few studies of health effects. Burning of crude oil is increasingly employed as a means of mitigating environmental disasters despite the potential health risks to workers involved in clean-up efforts. Here, we review epidemiological studies of respiratory effects following unique crude oil burning events to (1) characterize respiratory health effects from this nontraditional occupational exposure and (2) identify approaches used to characterize exposures that could be applied to future disaster-related studies. RECENT FINDINGS We searched PubMed and EMBASE for references from inception to January 30, 2023. We also manually screened references cited in eligible articles. We identified 14 eligible publications. Our review suggests that exposure to crude oil combustion has adverse respiratory effects, including reduced lung function and increased occurrence of respiratory symptoms and disease. However, the evidence is inconsistent, and quality of data varied across studies. While some studies used quantitative, modeled exposure estimates, most used self-reported proxies of exposure. Although disasters involving crude oil combustion are relatively rare, limited evidence suggests that some worker populations may be at risk for respiratory effects from burning exposures in disaster settings. Future studies that use improved exposure assessment methods (e.g., personal monitors, remote sensing data) may help further quantify the respiratory risk from crude oil burning exposures.
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Affiliation(s)
- Dazhe Chen
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Kaitlyn G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
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3
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Lawrence KG, Niehoff NM, Keil AP, Braxton Jackson W, Christenbury K, Stewart PA, Stenzel MR, Huynh TB, Groth CP, Ramachandran G, Banerjee S, Pratt GC, Curry MD, Engel LS, Sandler DP. Associations between airborne crude oil chemicals and symptom-based asthma. ENVIRONMENT INTERNATIONAL 2022; 167:107433. [PMID: 35921771 PMCID: PMC9378681 DOI: 10.1016/j.envint.2022.107433] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
RATIONALE The 2010 Deepwater Horizon (DWH) oil spill response and cleanup (OSRC) workers were exposed to airborne total hydrocarbons (THC), benzene, toluene, ethylbenzene, o-, m-, and p-xylenes and n-hexane (BTEX-H) from crude oil and PM2.5 from burning/flaring oil and natural gas. Little is known about asthma risk among oil spill cleanup workers. OBJECTIVES We assessed the relationship between asthma and several oil spill-related exposures including job classes, THC, individual BTEX-H chemicals, the BTEX-H mixture, and PM2.5 using data from the Gulf Long-Term Follow-up (GuLF) Study, a prospective cohort of 24,937 cleanup workers and 7,671 nonworkers following the DWH disaster. METHODS Our analysis largely focused on the 19,018 workers without asthma before the spill who had complete exposure, outcome, and covariate information. We defined incident asthma 1-3 years following exposure using both self-reported wheeze and self-reported physician diagnosis of asthma. THC and BTEX-H were assigned to participants based on measurement data and work histories, while PM2.5 used modeled estimates. We used modified Poisson regression to estimate risk ratios (RR) and 95% confidence intervals (CIs) for associations between spill-related exposures and asthma and a quantile-based g-computation approach to explore the joint effect of the BTEX-H mixture on asthma risk. RESULTS OSRC workers had greater asthma risk than nonworkers (RR: 1.60, 95% CI: 1.38, 1.85). Higher estimated THC exposure levels were associated with increased risk in an exposure-dependent manner (linear trend test p < 0.0001). Asthma risk also increased with increasing exposure to individual BTEX-H chemicals and the chemical mixture: A simultaneous quartile increase in the BTEX-H mixture was associated with an increased asthma risk of 1.45 (95% CI: 1.35,1.55). With fewer cases, associations were less apparent for physician-diagnosed asthma alone. CONCLUSIONS THC and BTEX-H were associated with increased asthma risk defined using wheeze symptoms as well as a physician diagnosis.
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Affiliation(s)
- Kaitlyn G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Nicole M Niehoff
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Alexander P Keil
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA; Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - W Braxton Jackson
- Social and Scientific Systems Inc, a DLH Holdings company, Durham, NC, USA
| | - Kate Christenbury
- Social and Scientific Systems Inc, a DLH Holdings company, Durham, NC, USA
| | | | - Mark R Stenzel
- Exposure Assessment Applications, LLC, Arlington, VA, USA
| | - Tran B Huynh
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Caroline P Groth
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, WV, USA
| | - Gurumurthy Ramachandran
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sudipto Banerjee
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Gregory C Pratt
- Division of Environmental Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Matthew D Curry
- Social and Scientific Systems Inc, a DLH Holdings company, Durham, NC, USA
| | - Lawrence S Engel
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA; Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA.
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Jardel HV, Engel LS, Lawrence KG, Stewart PA, Stenzel MR, Curry MD, Kwok RK, Sandler DP. The association between oil spill cleanup-related total hydrocarbon exposure and diabetes. ENVIRONMENTAL RESEARCH 2022; 212:113591. [PMID: 35661735 PMCID: PMC9267393 DOI: 10.1016/j.envres.2022.113591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/21/2022] [Accepted: 05/29/2022] [Indexed: 05/23/2023]
Abstract
BACKGROUND Although evidence suggests relationships between some crude oil components and glycemic dysregulation, no studies have examined oil spill-related chemical exposures in relation to type 2 diabetes mellitus (DM) risk. This study examined the relationship between total hydrocarbon (THC) exposure among workers involved in the 2010 Deepwater Horizon (DWH) oil spill and risk of DM up to 6 years afterward. METHODS Participants comprised 2660 oil-spill cleanup or response workers in the prospective GuLF Study who completed a clinical exam and had no self-reported DM diagnosis prior to the spill. Maximum THC exposure was estimated with a job-exposure matrix based on interview data and personal measurements taken during cleanup operations. We defined incident DM by self-reported physician diagnosis of DM, antidiabetic medication use, or a measured hemoglobin A1c value ≥ 6.5%. We used log binomial regression to estimate risk ratios (RRs) for DM across ordinal categories of THC exposure. The fully adjusted model controlled for age, sex, race/ethnicity, education, employment status, and health insurance status. We also stratified on clinical body mass index categories. RESULTS We observed an exposure-response relationship between maximum daily ordinal THC exposure level and incident DM, especially among overweight participants. RRs among overweight participants were 0.99 (95% CI: 0.37, 2.69), 1.46 (95% CI: 0.54, 3.92), and 2.11 (95% CI: 0.78, 5.74) for exposure categories 0.30-0.99 ppm, 1.00-2.99 ppm, and ≥3.00 ppm, respectively (ptrend = 0.03). CONCLUSION We observed suggestively increasing DM risk with increasing THC exposure level among overweight participants, but not among normal weight or obese participants.
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Affiliation(s)
- H V Jardel
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - L S Engel
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC, USA
| | - K G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC, USA
| | - P A Stewart
- Stewart Exposure Assessments, LLC North Arlington, Virginia, USA
| | - M R Stenzel
- Exposure Assessment Applications LLC Arlington, Virginia, USA
| | - M D Curry
- Social and Scientific Systems, Inc., a DLH Holding Company Durham, NC, USA
| | - R K Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC, USA; Office of the Director, National Institute of Environmental Health Sciences, NIH, DHHS, Bethesda, MD, USA
| | - D P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC, USA
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Kwok RK, Jackson WB, Curry MD, Stewart PA, McGrath JA, Stenzel M, Huynh TB, Groth CP, Ramachandran G, Banerjee S, Pratt GC, Miller AK, Zhang X, Engel LS, Sandler DP. Association of Deepwater Horizon Oil Spill Response and Cleanup Work With Risk of Developing Hypertension. JAMA Netw Open 2022; 5:e220108. [PMID: 35195699 PMCID: PMC8867245 DOI: 10.1001/jamanetworkopen.2022.0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
IMPORTANCE Exposure to hydrocarbons, fine particulate matter (PM2.5), and other chemicals from the April 20, 2010, Deepwater Horizon disaster may be associated with increased blood pressure and newly detected hypertension among oil spill response and cleanup workers. OBJECTIVE To determine whether participation in cleanup activities following the disaster was associated with increased risk of developing hypertension. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted via telephone interviews and in-person home exams. Participants were 6846 adults who had worked on the oil spill cleanup (workers) and 1505 others who had completed required safety training but did not do cleanup work (nonworkers). Eligible participants did not have diagnosed hypertension at the time of the oil spill. Statistical analyses were performed from June 2018 to December 2021. EXPOSURES Engagement in cleanup activities following the Deepwater Horizon oil spill disaster, job classes, quintiles of cumulative total hydrocarbons exposure level, potential exposure to burning or flaring oil, and estimated PM2.5 were examined. MAIN OUTCOMES AND MEASURES Systolic and diastolic blood pressure measurements were collected during home exams from 2011 to 2013 using automated oscillometric monitors. Newly detected hypertension was defined as antihypertensive medication use or elevated blood pressure since the spill. Log binomial regression was used to calculate prevalence ratios (PR) and 95% CIs for associations between cleanup exposures and hypertension. Multivariable linear regression was used to estimate exposure effects on continuous blood pressure levels. RESULTS Of 8351 participants included in this study, 6484 (77.6%) were male, 517 (6.2%) were Hispanic, 2859 (34.2%) were non-Hispanic Black, and 4418 (52.9%) were non-Hispanic White; the mean (SD) age was 41.9 (12.5) years at enrollment. Among workers, the prevalence of newly detected hypertension was elevated in all quintiles (Q) of cumulative total hydrocarbons above the first quintile (PR for Q3, 1.29 [95% CI, 1.13-1.46], PR for Q4, 1.25 [95% CI, 1.10-1.43], and PR for Q5, 1.31 [95% CI, 1.15-1.50]). Both exposure to burning and/or flaring oil and gas (PR, 1.16 [95% CI, 1.02-1.33]) and PM2.5 from burning (PR, 1.26 [95% CI, 0.89-1.71]) for the highest exposure category were associated with increased risk of newly detected hypertension, as were several types of oil spill work including cleanup on water (PR, 1.34 [95% CI, 1.08-1.66]) and response work (PR, 1.51 [95% CI, 1.20-1.90]). CONCLUSIONS AND RELEVANCE Oil spill exposures were associated with newly detected hypertension after the Deepwater Horizon disaster. These findings suggest that blood pressure screening should be considered for workers with occupational hydrocarbon exposures.
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Affiliation(s)
- Richard K. Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
- Office of the Director, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - W. Braxton Jackson
- Social & Scientific Systems, Inc, a DLH holdings company, Durham, North Carolina
| | | | | | - John A. McGrath
- Social & Scientific Systems, Inc, a DLH holdings company, Durham, North Carolina
| | - Mark Stenzel
- Exposure Assessment Applications, LLC, Arlington, Virginia
| | - Tran B. Huynh
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Caroline P. Groth
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown
| | - Gurumurthy Ramachandran
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Sudipto Banerjee
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles
| | - Gregory C. Pratt
- Division of Environmental Health, School of Public Health, University of Minnesota, Minneapolis
| | - Aubrey K. Miller
- Office of the Director, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Xian Zhang
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Lawrence S. Engel
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
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Chen D, Lawrence KG, Pratt GC, Stenzel MR, Stewart PA, Groth CP, Banerjee S, Christenbury K, Curry MD, Jackson WB, Kwok RK, Blair A, Engel LS, Sandler DP. Fine Particulate Matter and Lung Function among Burning-Exposed Deepwater Horizon Oil Spill Workers. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:27001. [PMID: 35103485 PMCID: PMC8805798 DOI: 10.1289/ehp8930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 11/01/2021] [Accepted: 01/03/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND During the 2010 Deepwater Horizon (DWH) disaster, controlled burning was conducted to remove oil from the water. Workers near combustion sites were potentially exposed to increased fine particulate matter [with aerodynamic diameter ≤2.5μm (PM2.5)] levels. Exposure to PM2.5 has been linked to decreased lung function, but to our knowledge, no study has examined exposure encountered in an oil spill cleanup. OBJECTIVE We investigated the association between estimated PM2.5 only from burning/flaring of oil/gas and lung function measured 1-3 y after the DWH disaster. METHODS We included workers who participated in response and cleanup activities on the water during the DWH disaster and had lung function measured at a subsequent home visit (n=2,316). PM2.5 concentrations were estimated using a Gaussian plume dispersion model and linked to work histories via a job-exposure matrix. We evaluated forced expiratory volume in 1 s (FEV1; milliliters), forced vital capacity (FVC; milliliters), and their ratio (FEV1/FVC; %) in relation to average and cumulative daily maximum exposures using multivariable linear regressions. RESULTS We observed significant exposure-response trends associating higher cumulative daily maximum PM2.5 exposure with lower FEV1 (p-trend=0.04) and FEV1/FVC (p-trend=0.01). In comparison with the referent group (workers not involved in or near the burning), those with higher cumulative exposures had lower FEV1 [-166.8mL, 95% confidence interval (CI): -337.3, 3.7] and FEV1/FVC (-1.7, 95% CI: -3.6, 0.2). We also saw nonsignificant reductions in FVC (high vs. referent: -120.9, 95% CI: -319.4, 77.6; p-trend=0.36). Similar associations were seen for average daily maximum PM2.5 exposure. Inverse associations were also observed in analyses stratified by smoking and time from exposure to spirometry and when we restricted to workers without prespill lung disease. CONCLUSIONS Among oil spill workers, exposure to PM2.5 specifically from controlled burning of oil/gas was associated with significantly lower FEV1 and FEV1/FVC when compared with workers not involved in burning. https://doi.org/10.1289/EHP8930.
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Affiliation(s)
- Dazhe Chen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kaitlyn G. Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Gregory C. Pratt
- Division of Environmental Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mark R. Stenzel
- Exposure Assessment Applications, LLC, Arlington, Virginia, USA
| | | | - Caroline P. Groth
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Sudipto Banerjee
- Department of Biostatistics, Fielding School of Public Health, University of California–Los Angeles, Los Angeles, California, USA
| | | | | | | | - Richard K. Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
- Office of the Director, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Aaron Blair
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Lawrence S. Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
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7
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Takeshita R, Bursian SJ, Colegrove KM, Collier TK, Deak K, Dean KM, De Guise S, DiPinto LM, Elferink CJ, Esbaugh AJ, Griffitt RJ, Grosell M, Harr KE, Incardona JP, Kwok RK, Lipton J, Mitchelmore CL, Morris JM, Peters ES, Roberts AP, Rowles TK, Rusiecki JA, Schwacke LH, Smith CR, Wetzel DL, Ziccardi MH, Hall AJ. A review of the toxicology of oil in vertebrates: what we have learned following the Deepwater Horizon oil spill. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2021; 24:355-394. [PMID: 34542016 DOI: 10.1080/10937404.2021.1975182] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In the wake of the Deepwater Horizon (DWH) oil spill, a number of government agencies, academic institutions, consultants, and nonprofit organizations conducted lab- and field-based research to understand the toxic effects of the oil. Lab testing was performed with a variety of fish, birds, turtles, and vertebrate cell lines (as well as invertebrates); field biologists conducted observations on fish, birds, turtles, and marine mammals; and epidemiologists carried out observational studies in humans. Eight years after the spill, scientists and resource managers held a workshop to summarize the similarities and differences in the effects of DWH oil on vertebrate taxa and to identify remaining gaps in our understanding of oil toxicity in wildlife and humans, building upon the cross-taxonomic synthesis initiated during the Natural Resource Damage Assessment. Across the studies, consistency was found in the types of toxic response observed in the different organisms. Impairment of stress responses and adrenal gland function, cardiotoxicity, immune system dysfunction, disruption of blood cells and their function, effects on locomotion, and oxidative damage were observed across taxa. This consistency suggests conservation in the mechanisms of action and disease pathogenesis. From a toxicological perspective, a logical progression of impacts was noted: from molecular and cellular effects that manifest as organ dysfunction, to systemic effects that compromise fitness, growth, reproductive potential, and survival. From a clinical perspective, adverse health effects from DWH oil spill exposure formed a suite of signs/symptomatic responses that at the highest doses/concentrations resulted in multi-organ system failure.
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Affiliation(s)
- Ryan Takeshita
- Conservation Medicine, National Marine Mammal Foundation, San Diego, California, United States
| | - Steven J Bursian
- Department of Animal Science, Michigan State University, East Lansing, Michigan, United States
| | - Kathleen M Colegrove
- College of Veterinary Medicine, Illinois at Urbana-Champaign, Brookfield, Illinois, United States
| | - Tracy K Collier
- Zoological Pathology Program, Huxley College of the Environment, Western Washington University, Bellingham, Washington, United States
| | - Kristina Deak
- College of Marine Sciences, University of South Florida, St. Petersburg, Florida, United States
| | | | - Sylvain De Guise
- Department of Pathobiology and Veterinary Sciences, University of Connecticut, Storrs, Connecticut, United States
| | - Lisa M DiPinto
- Office of Response and Restoration, NOAA, Silver Spring, Maryland, United States
| | - Cornelis J Elferink
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas, United States
| | - Andrew J Esbaugh
- Marine Science Institute, University of Texas at Austin, Port Aransas, Texas, United States
| | - Robert J Griffitt
- Division of Coastal Sciences, School of Ocean Science and Engineering, University of Southern Mississippi, Gulfport, Mississippi, United States
| | - Martin Grosell
- RSMAS, University of Miami, Miami, Florida, United States
| | | | - John P Incardona
- NOAA Environmental Conservation Division, Northwest Fisheries Science Center, Seattle, Washington, United States
| | - Richard K Kwok
- Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, North Carolina, United States
| | | | - Carys L Mitchelmore
- University of Maryland Center of Environmental Science, Chesapeake Biological Laboratory, Solomons, Maryland, United States
| | - Jeffrey M Morris
- Health and Environment Division, Abt Associates, Boulder, Colorado, United States
| | - Edward S Peters
- Department of Epidemiology, LSU School of Public Health, New Orleans, Louisiana, United States
| | - Aaron P Roberts
- Advanced Environmental Research Institute and Department of Biological Sciences, University of North Texas, Denton, Texas, United States
| | - Teresa K Rowles
- NOAA Office of Protected Resources, National Marine Fisheries Service, Silver Spring, Maryland, United States
| | - Jennifer A Rusiecki
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, Maryland, United States
| | - Lori H Schwacke
- Conservation Medicine, National Marine Mammal Foundation, San Diego, California, United States
| | - Cynthia R Smith
- Conservation Medicine, National Marine Mammal Foundation, San Diego, California, United States
| | - Dana L Wetzel
- Environmental Laboratory of Forensics, Mote Marine Laboratory, Sarasota, Florida, United States
| | - Michael H Ziccardi
- School of Veterinary Medicine, One Health Institute, University of California, Davis, California, United States
| | - Ailsa J Hall
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, St Andrews, UK
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Lawrence KG, Werder EJ, Sandler DP. Association of neighborhood deprivation with pulmonary function measures among participants in the Gulf Long-Term Follow-up Study. ENVIRONMENTAL RESEARCH 2021; 202:111704. [PMID: 34280418 PMCID: PMC8578346 DOI: 10.1016/j.envres.2021.111704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Individual-level socioeconomic status (SES) has been shown to be an important determinant of lung function. Neighborhood level SES factors may increase psychological and physiologic stress and may also reflect other exposures that can adversely affect lung function, but few studies have considered neighborhood factors. OBJECTIVE Our aim was to assess the association between neighborhood-level SES and lung function. METHODS We cross-sectionally analyzed 6168 spirometry test results from participants in the Gulf long-term Follow-up Study, a large cohort of adults enrolled following the largest maritime oil spill in US history. Outcomes of interest included the forced expiratory volume in 1 s (FEV1; mL), the forced vital capacity (FVC; mL), and the FEV1/FVC ratio (%). Neighborhood deprivation was measured by linking participant home addresses to an existing Area Deprivation Index (ADI) and categorized into quartiles. Individual-level SES measures were collected at enrollment using a structured questionnaire and included income, educational attainment, and financial strain. We used multilevel regression to estimate associations between ADI quartiles and each lung function measure. RESULTS Greater neighborhood deprivation was associated with lower FEV1: βQ2vsQ1: -30 mL (95% CI: -97, 36), βQ3vsQ1: -70 mL (95% CI: -135, -4) and βQ4vsQ1: -104 mL (95% CI: -171, -36). FVC showed similar patterns of associations with neighborhood deprivation. No associations with the FEV1/FVC ratio were observed. CONCLUSION Neighborhood deprivation, a measure incorporating economic and other stressors, was associated with lower FEV1 and FVC, with magnitudes of associations reaching clinically meaningful levels. The impact of this neighborhood SES measure persisted even after adjustment for individual-level SES factors.
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Affiliation(s)
- Kaitlyn G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Emily J Werder
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA.
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Xu J, Engel LS, Rhoden J, Jackson WB, Kwok RK, Sandler DP. The association between blood metals and hypertension in the GuLF study. ENVIRONMENTAL RESEARCH 2021; 202:111734. [PMID: 34303682 PMCID: PMC8578391 DOI: 10.1016/j.envres.2021.111734] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND Both essential and non-essential metals come from natural and anthropogenic sources. Metals can bioaccumulate in humans and may impact human health, including hypertension. METHODS Blood metal (cadmium, lead, mercury, manganese, and selenium) concentrations were measured at baseline for a sample of participants in the Gulf Long-Term Follow-up (GuLF) Study. The GuLF Study is a prospective cohort study focused on potential health effects following the 2010 Deepwater Horizon oil spill. Hypertension was defined as high systolic (≥140 mm Hg) or diastolic (≥90 mm Hg) blood pressure or taking anti-hypertensive medications. A total of 957 participants who had blood measurement for at least one metal, baseline blood pressure measurements, information on any anti-hypertensive medication use, and relevant covariates were included in this cross-sectional analysis. We used Poisson regression to explore the association between individual blood metal levels and hypertension. Quantile-based g-computation was used to investigate the association between the metal mixture and hypertension. We also explored the association between individual blood metal levels and continuous blood pressure measurements using general linear regression. RESULTS Comparing the highest quartile of blood metals with the lowest (Q4vs1), the hypertension prevalence ratio (PR) was 0.92 (95 % confidence interval (CI) = 0.73,1.15) for cadmium, 0.86 (95%CI = 0.66,1.12) for lead, 0.89 (95%CI = 0.71,1.12) for mercury, 1.00 (95%CI = 0.80,1.26) for selenium, and 1.22 (95%CI = 0.95,1.57) for manganese. We observed some qualitative differences across race and BMI strata although none of these differences were statistically significant. In stratified analyses, the PR (Q4vs1) for mercury was 0.69 (95%CI = 0.53, 0.91) in White participants and 1.29 (95%CI = 0.86,1.92) in Black participants (p for interaction = 0.5). The PR (Q4vs1) for manganese was relatively higher in Black participants (PR = 1.37, 95%CI = 0.92,2.05) than in White participants (PR = 1.15, 95%CI = 0.83,1.60, p for interaction = 0.5), with a suggestive dose-response among Blacks. After stratifying by obesity (BMI ≥30 and < 30), positive associations of of hypertension with cadmium (PR [Q4vs1] = 1.19, 95%CI = 0.91,1.56, p for interaction = 0.5), lead (PR [Q4vs1] = 1.14, 95%CI = 0.84,1.55, p for interaction = 1.0) and manganese (PR = 1.25, 95%CI = 0.93,1.68, p for interaction = 0.8) were observed in participants with BMI≥30, but not in participants with BMI<30. The joint effect of the metal mixture was 0.96 (95%CI = 0.73,1.27). We did not observe clear associations between blood metal levels and continuous blood pressure measurements. CONCLUSION We did not find overall cross-sectional associations between blood cadmium, lead, mercury, selenium levels and hypertension or blood pressure. We found some evidence suggesting that manganese might be positively associated with risk of hypertension. Associations varied somewhat by race and BMI.
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Affiliation(s)
- Jing Xu
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA; Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Lawrence S Engel
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Joyce Rhoden
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - W Braxton Jackson
- Social & Scientific Systems, Inc., DLH Holdings Company, Durham, NC, USA
| | - Richard K Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA; Office of the Director, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA.
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Lawrence KG, Jackson WB, Ramsey S, Kwok RK, Engel LS, Curry MD, Sandler DP. Spirometry quality predictors in a large multistate prospective study. Respir Med 2021; 188:106618. [PMID: 34571455 DOI: 10.1016/j.rmed.2021.106618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Gulf Long-Term Follow-up (GuLF) Study is a prospective cohort study of health effects associated with oil spill response and clean-up following the 2010 Deepwater Horizon Disaster (DWH). As part of the study, spirometry testing of lung function was carried out in home visits across multiple states. Few studies have described factors associated with spirometry test failure in field-based settings. OBJECTIVE Our objective was to identify what factors, if any, predict test failure among GuLF Study participants who completed spirometry testing in a non-traditional setting. METHODS Trained examiners administered spirometry (May 2011-May 2013) to 10,019 participants living in US Gulf States (LA, MS, TX, AL, FL) using an Easy-on ultrasonic spirometer. We applied American Thoracic Society/European Respiratory Society quality criteria to determine quality test failure and identified factors predictive of failure using both a Stepwise and a LASSO model. We calculated odds ratios and 95% confidence intervals (CIs) for associations of selected factors with test failure. RESULTS Among GuLF Study participants who conducted spirometry, self-reported African American/Black participants (OR: 1.39, 95% CI: 1.23,1.56); men (OR:1.61, 95% CI: 1.41,1.83); and those making less than $20,000 per year (OR: 1.45, 95% CI: 1.26,1.67) were more likely to fail quality testing, while those who were obese were less likely to fail (OR: 0.61, 95% CI: 0.42,0.89). CONCLUSION Field-based studies involving spirometry should identify and account for participant factors that may influence test failure. Coaching that is tailored to those less likely to have experience with spirometry may help reduce test failure rates.
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Affiliation(s)
- Kaitlyn G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - W Braxton Jackson
- Social & Scientific Systems, Inc., a DLH Holding Company, Durham, NC, USA
| | - Steven Ramsey
- Social & Scientific Systems, Inc., a DLH Holding Company, Durham, NC, USA
| | - Richard K Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA; Office of the Director, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Lawrence S Engel
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA; Dept. of Epidemiology, Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Matthew D Curry
- Social & Scientific Systems, Inc., a DLH Holding Company, Durham, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA.
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Hu MD, Lawrence KG, Gall M, Emrich CT, Bodkin MR, Jackson WB, MacNell N, Kwok RK, Engel LS, Sandler DP. Natural hazards and mental health among US Gulf Coast residents. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:842-851. [PMID: 33603095 PMCID: PMC8371064 DOI: 10.1038/s41370-021-00301-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/02/2021] [Accepted: 01/21/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND Individuals affected by disasters are at risk for adverse mental health sequelae. Individuals living in the US Gulf Coast have experienced many recent major disasters, but few studies have explored the cumulative burden of experiencing multiple disasters on mental health. OBJECTIVE The objective of this study was to evaluate the relationship between disaster burden and mental health. METHODS We used data from 9278 Gulf Long-term Follow-up Study participants who completed questionnaires on perceived stress, anxiety, depression, and post-traumatic stress disorder (PTSD) in 2011-2013. We linked 2005-2010 county-level data from the Spatial Hazard Events and Losses Database for the United States, a database of loss-causing events, to participant's home address. Exposure measures included total count of loss events as well as severity quantified as property/crop losses per capita from all hazards. We used multilevel modeling to estimate odds ratios (OR) and 95% confidence intervals (CI) for each exposure-outcome relationship. RESULTS Total count of loss events was positively associated with perceived stress (ORQ4:1.40, 95% CI:1.21-1.61) and was inversely associated with PTSD (ORQ4:0.66, 95% CI:0.45-0.96). Total duration of exposure was also associated with stress (ORQ4:1.16, 95% CI:1.01-1.33) but not with other outcomes. Severity based on cumulative fatalities/injuries was associated with anxiety (ORQ4:1.31, 95% CI:1.05-1.63) and stress (ORQ4:1.34, 95% CI:1.15-1.57), and severity based on cumulative property/crop losses was associated with anxiety (ORQ4:1.42, 95% CI:1.12-1.81), depression (ORQ4:1.22, 95% CI:0.95-1.57) and PTSD (ORQ4:1.99, 95% CI:1.44-2.76).
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Affiliation(s)
- Michael D Hu
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, Durham, NC, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kaitlyn G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, Durham, NC, USA
| | - Melanie Gall
- Center for Emergency Management and Homeland Security, Arizona State University, Phoenix, AZ, USA
| | - Christopher T Emrich
- College of Community Innovation and Education, University of Central Florida, Orlando, FL, USA
| | | | | | | | - Richard K Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, Durham, NC, USA
| | - Lawrence S Engel
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, Durham, NC, USA
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, Durham, NC, USA.
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Hu MD, Lawrence KG, Bodkin MR, Kwok RK, Engel LS, Sandler DP. Neighborhood Deprivation, Obesity, and Diabetes in Residents of the US Gulf Coast. Am J Epidemiol 2021; 190:295-304. [PMID: 33524122 DOI: 10.1093/aje/kwaa206] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
Socioeconomic status has been associated with cardiovascular disease risk factors. However, few studies have examined this relationship among populations in the US Gulf Coast region. We assessed neighborhood deprivation in relation to obesity and diabetes in 9,626 residents participating in the Gulf Long-Term Follow-Up Study (2011-present) who completed a home visit (2011-2013) with height, weight, waist, and hip measurements. Obesity was categorized as body mass index of at least 30, and diabetes was defined by doctor's diagnosis or prescription medication. Participant home addresses were linked to an established Area Deprivation Index and categorized into 4 levels (1 = least deprived). In adjusted, modified Poisson regression models, participants with greatest deprivation were more likely to have obesity compared with those with least deprivation (adjusted prevalence ratio (aPR) = 1.21, 95% confidence interval (CI): 1.08, 1.35), central obesity (aPR = 1.11, 95% CI: 1.04, 1.19), and diabetes (aPR = 1.49, 95% CI: 1.03, 2.14). Repeated analyses among a subgroup of participants (n = 3,016) whose hemoglobin A1C values were measured 3 years later indicated the association with diabetes (defined as diagnosis, medications, or hemoglobin A1C ≥ 6.5) was similar (aPR = 1.46, 95% CI: 1.14, 1.86). Results suggest neighborhood deprivation is associated with obesity and diabetes in a US region with high baseline prevalence.
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Choi B. Developing a Job Exposure Matrix of Work Organization Hazards in the United States: A Review on Methodological Issues and Research Protocol. Saf Health Work 2020; 11:397-404. [PMID: 33329905 PMCID: PMC7728710 DOI: 10.1016/j.shaw.2020.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 11/21/2022] Open
Abstract
Background Most job exposure matrices (JEMs) have been developed for chemical and physical hazards in the United States (US). In addition, the overall validity of most JEMs of work organization hazards using self-reported data in the literature remains to be further tested due to several methodological weaknesses. Methods This paper aims to review important methodological issues with regard to a JEM of work organization hazards using self-report data and to present a research protocol for developing a four-axis (job titles, hazards, sex, and time) JEM of major work organization hazards using the US General Social Survey-Quality of Work-Life (GSS-QWL) data (2002–2018; N = 7,100 workers). Results Five methodological weaknesses in existing JEMs of work organization hazards using self-report data were identified: having only two axes (hazard and occupation), using psychometrically weak items and scales, including scales having little interoccupational variability, unresolved optimal minimum numbers of subjects per occupation, and low accessibility. The methodological weaknesses were successfully addressed in the proposed research protocol. Conclusion The work organization JEM to be developed will significantly facilitate and strengthen occupational epidemiological studies on work organization hazards and major health outcomes, improve national and occupational surveillance of work organization hazards, and promote interventions for a healthy work environment in the US.
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Affiliation(s)
- BongKyoo Choi
- Department of Medicine and Program in Public Health, University of California Irvine, CA, USA.,Center for Work and Health Research, Irvine, CA, USA
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14
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Lawrence KG, Keil AP, Garantziotis S, Umbach DM, Stewart PA, Stenzel MR, McGrath JA, Jackson WB, Kwok RK, Curry MD, Engel LS, Sandler DP. Lung function in oil spill responders 4-6 years after the Deepwater Horizon disaster. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2020; 83:233-248. [PMID: 32249687 PMCID: PMC7837370 DOI: 10.1080/15287394.2020.1745111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Oil spill response and clean-up (OSRC) workers were exposed to hazardous airborne chemicals following the 2010 Deepwater Horizon disaster. The aim of this study was to evaluate lung function in workers 4-6 years following the disaster using a prospective cohort. Participants who completed two spirometry test sessions 1-3 years, and 4-6 years after the spill (N = 1,838) were included and forced expiratory volume in 1 s (FEV1; ml), forced vital capacity (FVC; ml), and ratio (FEV1/FVC; %) determined. Linear mixed models were utilized to estimate relationships between OSRC exposures and lung function 4-6 years after the spill and changes since the prior measurement. Despite suggestive reduced lung function at 1-3 years, at the 4-6-year exam workers with total hydrocarbon (THC) exposure 1-2.99 ppm and ≥3 ppm compared to those with ≤0.29 ppm exhibited higher FEV1 (β: 108 ml, 95% CI: 17, 198) and (β: 118 ml, 95% CI: 5, 232), respectively. Compared with support workers, those in higher exposed jobs displayed greater improvement in FEV1 between visits: cleanup on water (β: 143 ml, 95% CI: 35, 250), operations (β: 132 ml, 95% CI: 30, 234) and response (β: 149 ml, 95% CI: 43, 256). Greater FEV1 improvement was also associated with higher versus the lowest level THC exposure: 1-2.99 ppm (β: 134 ml, 95% CI: 57, 210) and ≥3 ppm (β: 205 ml, 95% CI: 109, 301). Lung function decrements seen shortly after the spill were no longer apparent 4-6 years later, with the greatest improvement among those with the highest exposures.
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Affiliation(s)
- Kaitlyn G. Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Alexander P. Keil
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Stavros Garantziotis
- Clinical Research Unit, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - David M. Umbach
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | | | | | | | | | - Richard K. Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | | | - Lawrence S. Engel
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
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Ferguson A, Solo-Gabriele H, Mena K. Assessment for oil spill chemicals: Current knowledge, data gaps, and uncertainties addressing human physical health risk. MARINE POLLUTION BULLETIN 2020; 150:110746. [PMID: 31910518 DOI: 10.1016/j.marpolbul.2019.110746] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/29/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
Limited models are available to estimate human physical health risks (e.g., probability of outcomes such as lung disease, cancer, skin disease) from exposure to chemicals resulting from oil spills that may occur offshore and later impact coastline spills. An approach is presented to assess physical health risks from oil spills that involves establishing a platform capable of assessing aggregate health risk (via inhalation, ingestion, and dermal exposure routes). Gaps include the need to develop models reflecting oil spill concentration distributions given the influence from environmental, physical, biological and chemical factors. Human activities need to be quantified for different populations including emergency response workers, fishermen, shellfish consumers, and children who play at beaches that may be impacted by oil spills. Work is also needed in developing comprehensive toxicological profiles for the majority of chemicals - including dispersants found in oil spills - and to estimate toxicity from mixtures.
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Affiliation(s)
- Alesia Ferguson
- University of North Carolina Agriculatural and Technical State University (NCAT), Built Environment Department, Greensboro, NC 27411, United States.
| | - Helena Solo-Gabriele
- University of Miami, Department of Civil, Architectural, and Environmental Engineering, Coral Gables, FL 33146, United States.
| | - Kristina Mena
- University of Texas - Houston, School of Public Health, Houston, TX 77030.
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Quist AJL, Rohlman DS, Kwok RK, Stewart PA, Stenzel MR, Blair A, Miller AK, Curry MD, Sandler DP, Engel LS. Deepwater Horizon oil spill exposures and neurobehavioral function in GuLF study participants. ENVIRONMENTAL RESEARCH 2019; 179:108834. [PMID: 31703974 PMCID: PMC6878206 DOI: 10.1016/j.envres.2019.108834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/26/2019] [Accepted: 10/16/2019] [Indexed: 05/04/2023]
Abstract
INTRODUCTION The 2010 Deepwater Horizon (DWH) disaster exposed tens of thousands of oil spill response and cleanup (OSRC) workers to hydrocarbons and other hazardous chemicals. Some hydrocarbons, such as toluene and hexane, have been found to have acute adverse effects on the central nervous system in occupational settings. However, no studies have examined the association between oil spill exposures and neurobehavioral function. METHODS We used data from the Gulf Long-term Follow-up Study, a cohort of adults who worked on the DWH response and cleanup. Total hydrocarbon (THC) exposure attributed to oil spill cleanup work was estimated from a job-exposure matrix linking air measurement data to detailed cleanup work histories. Participants were also categorized into 6 job categories, or OSRC classes, based on their activity with the highest exposure. Neurobehavioral performance was assessed at a clinical exam 4-6 years after the spill. We used multivariable linear regression to evaluate relationships of ordinal THC levels and OSRC classes with 16 neurobehavioral outcomes. RESULTS We found limited evidence of associations between THC levels or OSRC classes and decreased neurobehavioral function, including attention, memory, and executive function. Workers exposed to ≥3 ppm THC scored significantly worse (difference1.0-2.9ppm = -0.39, 95% confidence interval (CI) = -0.74, -0.04) than workers exposed to <0.30 ppm THC for the digit span forward count test. There was also a possible threshold effect above 1 ppm THC for symbol digit test total errors (difference1.0-2.9ppm = -0.56 (95% CI = -1.13, -0.003), difference≥3.0ppm = -0.55 (95% CI = -1.20, 0.10)). Associations appeared to be stronger in men than in women. A summary latency measure suggested an association between more highly exposed jobs (especially support of operations workers) and decreased neurobehavioral function. CONCLUSION OSRC-related exposures were associated with modest decreases in neurobehavioral function, especially attention, memory, and executive function.
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Affiliation(s)
- Arbor J L Quist
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Diane S Rohlman
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Richard K Kwok
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | | | - Mark R Stenzel
- Exposure Assessment Applications LLC, Arlington, VA, USA
| | - Aaron Blair
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Aubrey K Miller
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | | | - Dale P Sandler
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - Lawrence S Engel
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA; National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
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Kwok RK, Miller AK, Gam KB, Curry MD, Ramsey SK, Blair A, Engel LS, Sandler DP. Developing Large-Scale Research in Response to an Oil Spill Disaster: a Case Study. Curr Environ Health Rep 2019; 6:174-187. [PMID: 31376082 PMCID: PMC6699641 DOI: 10.1007/s40572-019-00241-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research conducted in the wake of a disaster can provide information to help mitigate health consequences, support future recovery efforts, and improve resilience. However, a number of barriers have prevented time-sensitive research responses following previous disasters. Furthermore, large-scale disasters present their own special challenges due to the number of people exposed to disaster conditions, the number of groups engaged in disaster response, and the logistical challenges of rapidly planning and implementing a large study. In this case study, we illustrate the challenges in planning and conducting a large-scale post-disaster research study by drawing on our experience in establishing the Gulf Long-term Follow-up (GuLF) Study following the 2010 Deepwater Horizon disaster. We describe considerations in identifying at-risk populations and appropriate comparison groups, garnering support for the study from different stakeholders, obtaining timely scientific and ethics review, measuring and characterizing complex exposures, and addressing evolving community health concerns and unmet medical needs. We also describe the NIH Disaster Research Response (DR2) Program, which provides a suite of resources, including data collection tools, research protocols, institutional review board guidance, and training materials to enable the development and implementation of time-critical studies following disasters and public health emergencies. In describing our experiences related to the GuLF Study and the ongoing efforts through the NIH DR2 Program, we aim to help improve the timeliness, quality, and value of future disaster-related data collection and research studies.
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Affiliation(s)
- Richard K Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), NIH, Research Triangle Park, North Carolina, USA.
| | | | - Kaitlyn B Gam
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), NIH, Research Triangle Park, North Carolina, USA
| | - Matthew D Curry
- Social & Scientific Systems, Inc., Durham, North Carolina, USA
| | - Steven K Ramsey
- Social & Scientific Systems, Inc., Durham, North Carolina, USA
| | - Aaron Blair
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, Maryland, USA
| | - Lawrence S Engel
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), NIH, Research Triangle Park, North Carolina, USA
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), NIH, Research Triangle Park, North Carolina, USA
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Werder EJ, Engel LS, Blair A, Kwok RK, McGrath JA, Sandler DP. Blood BTEX levels and neurologic symptoms in Gulf states residents. ENVIRONMENTAL RESEARCH 2019; 175:100-107. [PMID: 31108353 PMCID: PMC6571161 DOI: 10.1016/j.envres.2019.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 05/12/2023]
Abstract
BACKGROUND The chemicals benzene, toluene, ethylbenzene, and xylenes (BTEX) are neuroactive. Exposures often co-occur because they share common sources. We examined neurologic effects of environmental BTEX exposure among U.S. Gulf coast residents taking into account concomitant exposures. METHODS We measured blood concentrations of BTEX in 690 Gulf state residents. Neurologic symptoms were ascertained via telephone interview. We used log-binomial regression to estimate associations between blood BTEX levels and self-reported neurologic symptoms independently for the presence of any neurologic, central (CNS), or peripheral nervous system (PNS) symptoms. We estimated associations in single chemical models mutually adjusted for co-occurring BTEX and used weighted quantile sum regression to model associations between the combined BTEX mixture and neurologic symptoms. RESULTS Half (49%) of participants reported at least one neurologic symptom. Each BTEX chemical was associated with increased CNS and PNS symptoms in single-chemical models comparing the highest to lowest quartile of exposure. After adjusting for coexposures, benzene was associated with CNS symptoms among all participants (PR = 2.13, 95% CI: 1.27, 3.57) and among nonsmokers (PR = 2.30, 95% CI: 1.35, 3.91). After adjusting for coexposures, associations with toluene were apparent only for reporting multiple PNS symptoms (PR = 2.00, 95% CI: 0.96, 4.16). In mixture analyses, a one-quartile increase in BTEX exposure was associated with neurologic symptoms (OR = 1.47, 95% CI: 1.11, 1.98). The weighted quantile sum index weighted benzene most heavily, which was consistent with single chemical analyses. CONCLUSIONS Increasing blood benzene concentration was associated with increased prevalence of CNS symptoms. In this sample, BTEX-associated neurologic effects are likely driven by exposure to benzene and, to a lesser extent, toluene.
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Affiliation(s)
- Emily J Werder
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, NC, USA
| | - Lawrence S Engel
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, NC, USA; Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Aaron Blair
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Richard K Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, NC, USA
| | | | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, NC, USA.
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Strelitz J, Sandler DP, Keil AP, Richardson DB, Heiss G, Gammon MD, Kwok RK, Stewart PA, Stenzel MR, Engel LS. Exposure to Total Hydrocarbons During Cleanup of the Deepwater Horizon Oil Spill and Risk of Heart Attack Across 5 Years of Follow-up. Am J Epidemiol 2019; 188:917-927. [PMID: 30698634 DOI: 10.1093/aje/kwz017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/10/2019] [Accepted: 01/16/2019] [Indexed: 11/13/2022] Open
Abstract
Exposure to total hydrocarbons (THC) and volatile organic compounds from air pollution is associated with risk of coronary heart disease. THC exposure from oil spills might be similarly associated, but no research has examined this. We assessed the relationship between THC exposure during the response and cleanup of the Deepwater Horizon oil spill (Gulf of Mexico) and heart attack risk among 24,375 oil spill workers enrolled in the Gulf Long-Term Follow-up Study. There were 312 first heart attacks (self-reported physician-diagnosed myocardial infarction, or fatal coronary heart disease) ascertained during the study period (2010-2016). THC exposures were estimated using a job-exposure matrix incorporating self-reported activities and personal air measurements. We used Cox proportional hazards regression to estimate hazard ratios, with inverse-probability weights to account for confounding and censoring. Maximum THC levels of ≥0.30 parts per million (ppm) were associated with heart attack risk, with a 1.8-fold risk for exposure of ≥3.00 ppm versus <0.30 ppm (hazard ratio = 1.81, 95% confidence interval: 1.11, 2.95). The risk difference for highest versus lowest THC level was 10 excess cases per 1,000 workers. This is the first study of the persistent health impacts of THC exposure during oil spill work, and results support increased protection against oil exposure during cleanup of future spills.
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Affiliation(s)
- Jean Strelitz
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
| | - Alexander P Keil
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David B Richardson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marilie D Gammon
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Richard K Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
| | | | - Mark R Stenzel
- Exposure Assessment Applications, LLC, Arlington, Virginia
| | - Lawrence S Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
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Gam KB, Kwok RK, Engel LS, Curry MD, Stewart PA, Stenzel MR, McGrath JA, Jackson WB, Jensen RL, Keil AP, Lichtveld MY, Miller AK, Sandler DP. Lung Function in Oil Spill Response Workers 1-3 Years After the Deepwater Horizon Disaster. Epidemiology 2019; 29:315-322. [PMID: 29381492 DOI: 10.1097/ede.0000000000000808] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the effects of inhalation exposures on lung function among workers involved in the mitigation of oil spills. Our objective was to determine the relationship between oil spill response work and lung function 1-3 years after the Deepwater Horizon (DWH) disaster. METHODS We evaluated spirometry for 7,775 adults living in the Gulf states who either participated in DWH response efforts (workers) or received safety training but were not hired (nonworkers). At an enrollment interview, we collected detailed work histories including information on potential exposure to dispersants and burning oil/gas. We assessed forced expiratory volume in 1 second (FEV1; mL), forced vital capacity (FVC; mL), and the ratio (FEV1/FVC%) for differences by broad job classes and exposure to dispersants or burning oil/gas using multivariable linear and modified Poisson regression. RESULTS We found no differences between workers and nonworkers. Among workers, we observed a small decrement in FEV1 (Beta, -71 mL; 95% confidence interval [CI], -127 to -14) in decontamination workers compared with support workers. Workers with high potential exposure to burning oil/gas had reduced lung function compared with unexposed workers: FEV1 (Beta, -183 mL; 95% CI, -316 to -49) and FEV1/FVC (Beta, -1.93%; 95% CI, -3.50 to -0.36), and an elevated risk of having a FEV1/FVC in the lowest tertile (prevalence ratio, 1.38; 95% CI, 0.99 to 1.92). CONCLUSIONS While no differences in lung function were found between workers and nonworkers, lung function was reduced among decontamination workers and workers with high exposure to burning oil/gas compared with unexposed workers.
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Strelitz J, Keil AP, Richardson DB, Heiss G, Gammon MD, Kwok RK, Sandler DP, Engel LS. Self-reported myocardial infarction and fatal coronary heart disease among oil spill workers and community members 5 years after Deepwater Horizon. ENVIRONMENTAL RESEARCH 2019; 168:70-79. [PMID: 30278364 PMCID: PMC6263782 DOI: 10.1016/j.envres.2018.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 05/31/2023]
Abstract
BACKGROUND Chemical, physical and psychological stressors due to the 2010 Deepwater Horizon oil spill may impact coronary heart disease (CHD) among exposed populations. Using longitudinal information from two interviews in the Gulf Long Term Follow-up (GuLF) STUDY, we assessed CHD among oil spill workers and community members. OBJECTIVE To assess the associations between duration of oil spill clean-up work, residential proximity to the oil spill, and incidence of self-reported myocardial infarction or fatal CHD. METHODS Among respondents with two GuLF STUDY interviews (n = 21,256), there were 395 first incident heart disease events (self-reported myocardial infarction or fatal CHD) across 5 years. We estimated hazard ratios (HR) and 95% confidence intervals (95%CI) for associations with duration of oil spill clean-up work and residential proximity to the oil spill. To assess potential impacts of non-response, we compared covariate distributions for those who did (n = 21,256) and did not (n = 10,353) complete the second interview and used inverse probability (IP) of censoring weights to correct for potential non-response bias. RESULTS Living in proximity to the oil spill (vs. living further away) was associated with heart disease, with [HR(95%CI) = 1.30(1.01-1.67)] and without [1.29(1.00-1.65)] censoring weights. For work duration, hazard of heart disease appeared to be higher for those who worked > 180 days (vs. 1-30 days), with and without censoring weights [1.43(0.91-2.25) and 1.36(0.88-2.11), respectively]. Associations persisted throughout the 5-year follow-up. CONCLUSIONS Residential proximity to the spill and duration of clean-up work were associated with a suggested 29-43% higher hazard of heart disease events. Associations were robust to censoring.
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Affiliation(s)
- Jean Strelitz
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC 27599, USA.
| | - Alexander P Keil
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC 27599, USA
| | - David B Richardson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC 27599, USA
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC 27599, USA
| | - Marilie D Gammon
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC 27599, USA
| | - Richard K Kwok
- National Institute of Environmental Health Sciences, NIH, DHHS, 111 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Dale P Sandler
- National Institute of Environmental Health Sciences, NIH, DHHS, 111 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Lawrence S Engel
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC 27599, USA; National Institute of Environmental Health Sciences, NIH, DHHS, 111 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
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Gam KB, Engel LS, Kwok RK, Curry MD, Stewart PA, Stenzel MR, McGrath JA, Jackson WB, Lichtveld MY, Sandler DP. Association between Deepwater Horizon oil spill response and cleanup work experiences and lung function. ENVIRONMENT INTERNATIONAL 2018; 121:695-702. [PMID: 30317099 PMCID: PMC6400458 DOI: 10.1016/j.envint.2018.09.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/29/2018] [Accepted: 09/30/2018] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Oil spill response and cleanup (OSRC) workers had potentially stressful experiences during mitigation efforts following the 2010 Deepwater Horizon disaster. Smelling chemicals; skin or clothing contact with oil; heat stress; handling oily plants/wildlife or dead animal recovery; and/or being out of regular work may have posed a risk to worker respiratory health through psychological stress mechanisms. OBJECTIVE To evaluate the association between six potentially stressful oil spill experiences and lung function among OSRC workers 1-3 years following the Deepwater Horizon disaster, while controlling for primary oil spill inhalation hazards and other potential confounders. METHODS Of 6811 GuLF STUDY participants who performed OSRC work and completed a quality spirometry test, 4806 provided information on all exposures and confounders. We carried out complete case analysis and used multiple imputation to assess risk among the larger sample. Potentially stressful work experiences were identified from an earlier study of these workers. The lung function parameters of interest include the forced expiratory volume in 1 s (FEV1, mL), the forced vital capacity (FVC, mL) and the ratio (FEV1/FVC, %). RESULTS On average, participants in the analytic sample completed spirometry tests 1.7 years after the spill. Among workers with at least 2 acceptable FEV1 and FVC curves, workers with jobs that involved oily plants/wildlife or dead animal recovery had lower values for FEV1 (Mean difference: -53 mL, 95% CI: -84, -22), FVC (Mean difference: -45 mL, 95% CI: -81, -9) and FEV1/FVC (Mean difference: -0.44%, 95% CI: -0.80, -0.07) compared to unexposed workers in analyses using multiple imputation. CONCLUSIONS Workers involved in handling oily plants/wildlife or dead animal recovery had lower lung function than unexposed workers after accounting for other OSRC inhalation hazards.
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Affiliation(s)
- Kaitlyn B Gam
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States of America; Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
| | - Lawrence S Engel
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States of America; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Richard K Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States of America
| | - Matthew D Curry
- Social & Scientific Systems Inc., Durham, NC, United States of America
| | - Patricia A Stewart
- Stewart Exposure Assessments, LLC, Arlington, VA, United States of America
| | - Mark R Stenzel
- Exposure Assessment Applications, LLC, Arlington, VA, United States of America
| | - John A McGrath
- Social & Scientific Systems Inc., Durham, NC, United States of America
| | - W Braxton Jackson
- Social & Scientific Systems Inc., Durham, NC, United States of America
| | - Maureen Y Lichtveld
- Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States of America.
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Strelitz J, Engel LS, Kwok RK, Miller AK, Blair A, Sandler DP. Deepwater Horizon oil spill exposures and nonfatal myocardial infarction in the GuLF STUDY. Environ Health 2018; 17:69. [PMID: 30144816 PMCID: PMC6109340 DOI: 10.1186/s12940-018-0408-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/19/2018] [Indexed: 05/31/2023]
Abstract
BACKGROUND Workers involved in the response and clean-up of the 2010 Deepwater Horizon oil spill faced possible exposures to crude oil, burning oil, dispersants and other pollutants in addition to physical and emotional stress. These exposures may have increased risk of myocardial infarction (MI) among oil spill workers. METHODS Gulf Long-term Follow-up (GuLF) STUDY participants comprise individuals who either participated in the Deepwater Horizon response efforts or registered for safety training but were not hired. Oil spill-related exposures were assessed during enrollment interviews conducted in 2011-2013. We estimated risk ratios (RR) and 95% confidence intervals for the associations of clean-up work characteristics with self-reported nonfatal MI up to three years post-spill. RESULTS Among 31,109 participants without history of MI prior to the spill, 77% worked on the oil spill. There were 192 self-reported MI during the study period; 151 among workers. Among the full cohort, working on the oil spill clean-up (vs not working on the clean-up) and living in proximity to the oil spill (vs further away) were suggestively associated with a possible increased risk of nonfatal MI [RR: 1.22 (0.86, 1.73) and 1.15 (0.82, 1.60), respectively]. Among oil spill workers, working for > 180 days was associated with MI [RR for > 180 days (vs 1-30 days): 2.05 (1.05, 4.01)], as was stopping working due to heat [RR: 1.99 (1.43, 2.78)]. There were suggestive associations of maximum total hydrocarbon exposure ≥3.00 ppm (vs < 0.30 ppm) [RR: 1.69 (0.90, 3.19)] and working on decontaminating oiled equipment (vs administrative support) [1.72 (0.96, 3.09)] with nonfatal MI. CONCLUSION This is the first study to assess the associations between oil spill exposures and MI. Results suggest that working on the spill for > 180 days and stopping work due to heat increased risk of nonfatal MI. Future research should evaluate whether the observed associations are related to specific chemical exposures or other stressors associated with the spill.
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Affiliation(s)
- Jean Strelitz
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Lawrence S. Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC USA
| | - Richard K. Kwok
- National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC USA
| | - Aubrey K. Miller
- National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC USA
| | - Aaron Blair
- National Cancer Institute, NIH, DHHS, Bethesda, MD USA
| | - Dale P. Sandler
- National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC USA
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Abdalla N, Banerjee S, Ramachandran G, Stenzel M, Stewart PA. Coastline Kriging: A Bayesian Approach. Ann Work Expo Health 2018; 62:818-827. [PMID: 30052748 DOI: 10.1093/annweh/wxy058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 06/02/2018] [Indexed: 11/13/2022] Open
Abstract
Statistical interpolation of chemical concentrations at new locations is an important step in assessing a worker's exposure level. When measurements are available from coastlines, as is the case in coastal clean-up operations in oil spills, one may need a mechanism to carry out spatial interpolation at new locations along the coast. In this article, we present a simple model for analyzing spatial data that is observed over a coastline. We demonstrate four different models using two different representations of the coast using curves. The four models were demonstrated on simulated data and one of them was also demonstrated on a dataset from the GuLF STUDY (Gulf Long-term Follow-up Study). Our contribution here is to offer practicing hygienists and exposure assessors with a simple and easy method to implement Bayesian hierarchical models for analyzing and interpolating coastal chemical concentrations.
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Affiliation(s)
- Nada Abdalla
- Department of Biostatistics, University of California-Los Angeles, Los Angeles, CA, USA
| | - Sudipto Banerjee
- Department of Biostatistics, University of California-Los Angeles, Los Angeles, CA, USA
| | - Gurumurthy Ramachandran
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mark Stenzel
- Stewart Exposure Assessments, LLC, Arlington, VA, USA
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Gam KB, Kwok RK, Engel LS, Curry MD, Stewart PA, Stenzel MR, McGrath JA, Jackson WB, Jensen RL, Lichtveld MY, Miller AK, Sandler DP. Exposure to Oil Spill Chemicals and Lung Function in Deepwater Horizon Disaster Response Workers. J Occup Environ Med 2018; 60:e312-e318. [PMID: 29389810 PMCID: PMC5995629 DOI: 10.1097/jom.0000000000001292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess the relationship between total hydrocarbon (THC) exposures attributed to oil spill clean-up work and lung function 1 to 3 years after the Deepwater Horizon (DWH) disaster. METHODS We used data from the GuLF STUDY, a large cohort of adults who worked on response to the DWH disaster and others who were safety trained but did not work. We analyzed data from 6288 workers with two acceptable spirometry tests. We estimated THC exposure levels with a job exposure matrix. We evaluated lung function using the forced expiratory volume in 1 second (FEV1; mL), the forced vital capacity (FVC; mL), and the FEV1/FVC ratio (%). RESULTS Lung function measures did not differ by THC exposure levels among clean-up workers. CONCLUSION We did not observe an association between THC exposure and lung function among clean-up workers 1 to 3 years following the DWH disaster.
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Affiliation(s)
- Kaitlyn B. Gam
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
- Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Richard K. Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Lawrence S. Engel
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | | | | | - Robert L. Jensen
- Pulmonary Division, University of Utah and Intermountain Medical Center, Salt Lake City, Utah
| | - Maureen Y. Lichtveld
- Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Aubrey K. Miller
- Office of the Director, National Institute of Environmental Health Sciences, Bethesda, Maryland
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
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Chambers D, Reese C, Thornburg L, Sanchez E, Rafson J, Blount B, Ruhl J, De Jesús V. Distinguishing Petroleum (Crude Oil and Fuel) From Smoke Exposure within Populations Based on the Relative Blood Levels of Benzene, Toluene, Ethylbenzene, and Xylenes (BTEX), Styrene and 2,5-Dimethylfuran by Pattern Recognition Using Artificial Neural Networks. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2018; 52:308-316. [PMID: 29216422 PMCID: PMC5750095 DOI: 10.1021/acs.est.7b05128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Studies of exposure to petroleum (crude oil/fuel) often involve monitoring benzene, toluene, ethylbenzene, xylenes (BTEX), and styrene (BTEXS) because of their toxicity and gas-phase prevalence, where exposure is typically by inhalation. However, BTEXS levels in the general U.S. population are primarily from exposure to tobacco smoke, where smokers have blood levels on average up to eight times higher than nonsmokers. This work describes a method using partition theory and artificial neural network (ANN) pattern recognition to classify exposure source based on relative BTEXS and 2,5-dimethylfuran blood levels. A method using surrogate signatures to train the ANN was validated by comparing blood levels among cigarette smokers from the National Health and Nutrition Examination Survey (NHANES) with BTEXS and 2,5-dimethylfuran signatures derived from the smoke of machine-smoked cigarettes. Classification agreement for an ANN model trained with relative VOC levels was up to 99.8% for nonsmokers and 100.0% for smokers. As such, because there is limited blood level data on individuals exposed to crude oil/fuel, only surrogate signatures derived from crude oil and fuel were used for training the ANN. For the 2007-2008 NHANES data, the ANN model assigned 7 out of 1998 specimens (0.35%) and for the 2013-2014 NHANES data 12 out of 2906 specimens (0.41%) to the crude oil/fuel signature category.
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Affiliation(s)
- D.M. Chambers
- Corresponding author: 4770 Buford Hwy., NE, Mail Stop F-47, Atlanta, GA 30341,
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Mental health indicators associated with oil spill response and clean-up: cross-sectional analysis of the GuLF STUDY cohort. LANCET PUBLIC HEALTH 2017; 2:e560-e567. [PMID: 29253441 DOI: 10.1016/s2468-2667(17)30194-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/19/2017] [Accepted: 09/27/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Adverse mental health effects have been reported following oil spills but few studies have identified specific responsible attributes of the clean-up experience. We aimed to analyse the effects of the 2010 Deepwater Horizon (Gulf of Mexico) disaster on the mental health of individuals involved in oil spill response and clean-up. METHODS We used data from the Gulf Long-term Follow-up Study, a cohort of workers and volunteers involved in oil spill clean-up after the Deepwater Horizon disaster. We included 8968 workers (hired after completing training for oil spill response and clean-up) and 2225 non-workers (completed training but were not hired) who completed a Patient Health Questionnaire-8 and four-item Primary Care PTSD Screen to assess for probable depression and post-traumatic stress disorder (PTSD) indicators. Participants were recruited between March 28, 2011, and March 29, 2013. The mental health indicators were assessed at home visits done between May 12, 2011, and May 15, 2013. We used regression models to analyse the effect of potentially stressful job experiences, job type, and total hydrocarbon exposure on mental health indicators. FINDINGS Oil spill response and clean-up work was associated with increased prevalence of depression (prevalence ratio [PR] 1·22, 95% CI 1·08-1·37) and PTSD (PR 1·35, 95% CI 1·07-1·71). Among workers, individuals who reported smelling oil, dispersants, or cleaning chemicals had an elevated prevalence of depression (1·56, 1·37-1·78) and PTSD (2·25, 1·71-2·96). Stopping work because of the heat was also associated with depression (1·37, 1·23-1·53) and PTSD (1·41, 1·15-1·74), as was working as a commercial fisherman before the spill (1·38, 1·21-1·57; and 2·01, 1·58-2·55, respectively). An increase in exposure to total hydrocarbons appeared to be associated with depression and PTSD, but after taking into account oil spill job experiences, only the association between the highest amount of total hydrocarbons and PTSD remained (1·75, 1·11-2·76). INTERPRETATION Oil spill clean-up workers with high amounts of total hydrocarbon exposure or potentially stressful job experiences had an increased prevalence of depression and PTSD. These findings provide evidence that response and clean-up work is associated with adverse psychological effects and suggest the need for mental health services both before and after the event. FUNDING National Institutes of Health (NIH) Common Fund and the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences.
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McGowan CJ, Kwok RK, Engel LS, Stenzel MR, Stewart PA, Sandler DP. Respiratory, Dermal, and Eye Irritation Symptoms Associated with Corexit™ EC9527A/EC9500A following the Deepwater Horizon Oil Spill: Findings from the GuLF STUDY. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:097015. [PMID: 28934097 PMCID: PMC5915187 DOI: 10.1289/ehp1677] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 05/07/2023]
Abstract
BACKGROUND The large quantities of chemical oil dispersants used in the oil spill response and cleanup (OSRC) work following the Deepwater Horizon disaster provide an opportunity to study associations between dispersant exposure (Corexit™ EC9500A or EC9527A) and human health. OBJECTIVES Our objectives were to examine associations between potential exposure to the dispersants and adverse respiratory, dermal, and eye irritation symptoms. METHODS Using data from detailed Gulf Long-term Follow-up ( GuLF) Study enrollment interviews, we determined potential exposure to either dispersant from participant-reported tasks during the OSRC work. Between 27,659 and 29,468 participants provided information on respiratory, dermal, and eye irritation health. We estimated prevalence ratios (PRs) to measure associations with symptoms reported during the OSRC work and at study enrollment, adjusting for potential confounders including airborne total hydrocarbons exposure, use of cleaning chemicals, and participant demographics. RESULTS Potential exposure to either of the dispersants was significantly associated with all health outcomes at the time of the OSRC, with the strongest association for burning in the nose, throat, or lungs [adjusted PR (aPR)=1.61 (95% CI: 1.42, 1.82)], tightness in chest [aPR=1.58 (95% CI: 1.37, 1.81)], and burning eyes [aPR=1.48 (95% CI: 1.35, 1.64). Weaker, but still significant, associations were found between dispersant exposure and symptoms present at enrollment. CONCLUSIONS Potential exposure to Corexit™ EC9527A or EC9500A was associated with a range of health symptoms at the time of the OSRC, as well as at the time of study enrollment, 1-3 y after the spill. https://doi.org/10.1289/EHP1677.
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Affiliation(s)
- Craig J McGowan
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS) , Research Triangle Park, North Carolina, USA
| | - Richard K Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS) , Research Triangle Park, North Carolina, USA
| | - Lawrence S Engel
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS) , Research Triangle Park, North Carolina, USA
- Department of Epidemiology, UNC Gillings School of Global Public Health , Chapel Hill, North Carolina, USA
| | - Mark R Stenzel
- Exposure Assessment Applications, LLC , Arlington, Virginia, USA
| | | | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS) , Research Triangle Park, North Carolina, USA
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Kwok RK, Engel LS, Miller AK, Blair A, Curry MD, Jackson WB, Stewart PA, Stenzel MR, Birnbaum LS, Sandler DP. The GuLF STUDY: A Prospective Study of Persons Involved in the Deepwater Horizon Oil Spill Response and Clean-Up. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:570-578. [PMID: 28362265 PMCID: PMC5382003 DOI: 10.1289/ehp715] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 05/11/2023]
Abstract
BACKGROUND The 2010 Deepwater Horizon disaster led to the largest ever marine oil spill. Individuals who worked on the spill were exposed to toxicants and stressors that could lead to adverse effects. OBJECTIVES The GuLF STUDY was designed to investigate relationships between oil spill exposures and multiple potential physical and mental health effects. METHODS Participants were recruited by telephone from lists of individuals who worked on the oil spill response and clean-up or received safety training. Enrollment interviews between 2011 and 2013 collected information about spill-related activities, demographics, lifestyle, and health. Exposure measurements taken during the oil spill were used with questionnaire responses to characterize oil exposures of participants. Participants from Gulf states completed a home visit in which biological and environmental samples, anthropometric and clinical measurements, and additional health and lifestyle information were collected. Participants are being followed for changes in health status. RESULTS Thirty-two thousand six hundred eight individuals enrolled in the cohort, and 11,193 completed a home visit. Most were young (56.2% ≤ 45 years of age), male (80.8%), lived in a Gulf state (82.3%), and worked at least 1 day on the oil spill (76.5%). Workers were involved in response (18.0%), support operations (17.5%), clean-up on water (17.4%) or land (14.6%), decontamination (14.3%), and administrative support (18.3%). Using an ordinal job exposure matrix, 45% had maximum daily total hydrocarbon exposure levels ≥ 1.0 ppm. CONCLUSIONS The GuLF STUDY provides a unique opportunity to study potential adverse health effects from the Deepwater Horizon oil spill.
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Affiliation(s)
- Richard K. Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina USA
- Address correspondence to R.K. Kwok, Epidemiology Branch, NIEHS, P.O. Box 12233, MD A3-05, 111 T.W. Alexander Dr., Research Triangle Park, NC 27709-2233 USA. Telephone: (919) 627-8892. , or D.P. Sandler, Epidemiology Branch, NIEHS, P.O. Box 12233, MD A3-05, 111 T.W. Alexander Dr., Research Triangle Park, NC 27709-2233 USA. Telephone: (919) 541-4668.
| | - Lawrence S. Engel
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina USA
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Aubrey K. Miller
- Office of the Director, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, USA
| | - Aaron Blair
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, Maryland, USA
| | | | | | | | - Mark R. Stenzel
- Exposure Assessment Applications, LLC, Arlington, Virginia, USA
| | - Linda S. Birnbaum
- Office of the Director, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, USA
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina USA
- Address correspondence to R.K. Kwok, Epidemiology Branch, NIEHS, P.O. Box 12233, MD A3-05, 111 T.W. Alexander Dr., Research Triangle Park, NC 27709-2233 USA. Telephone: (919) 627-8892. , or D.P. Sandler, Epidemiology Branch, NIEHS, P.O. Box 12233, MD A3-05, 111 T.W. Alexander Dr., Research Triangle Park, NC 27709-2233 USA. Telephone: (919) 541-4668.
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Takeshita R, Sullivan L, Smith C, Collier T, Hall A, Brosnan T, Rowles T, Schwacke L. The Deepwater Horizon oil spill marine mammal injury assessment. ENDANGER SPECIES RES 2017. [DOI: 10.3354/esr00808] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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