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Wilson NJ, Friedman E, Kennedy K, Manolakos PT, Reierson L, Roberts A, Simon S. Using exterior housing conditions to predict elevated pediatric blood lead levels. ENVIRONMENTAL RESEARCH 2023; 218:114944. [PMID: 36473524 DOI: 10.1016/j.envres.2022.114944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/06/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Housing-based lead paint dust is the most common source of lead exposure for US-born children. Although year of housing construction is a critical indicator of the lead hazard to US children, not all housing of the same age poses the same risk to children. Additional information about housing condition is required to differentiate the housing-based lead risk at the parcel level. This study aimed to identify and assess a method for gathering and using observations of exterior housing conditions to identify active housing-based lead hazards at the parcel level. We used a dataset of pediatric blood lead observations (sample years 2000-2013, ages 6-72 months, n = 6,589) to assess associations between observations of exterior housing conditions and housing-based lead risk. We used graphical and Lasso regression methods to estimate the likelihood of an elevated blood lead observation (≥3.5 μg/dL). Our methods estimate a monotonic increase in the likelihood of an elevated blood lead observation as housing conditions deteriorate with the largest changes associated with homes in the greatest disrepair. Additionally we estimate that age of home construction works in consort with housing conditions to amplify risks among those houses built before 1952. Our analysis indicates that a survey of external housing conditions can be used in combination with age of housing in the identification process, at the parcel level, of homes that pose a housing-based lead hazard to children.
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Affiliation(s)
- Neal J Wilson
- Research Associate, Center of Economic Information, Department of Economics, University of Missouri-Kansas City, Kansas City, MO, USA.
| | - Elizabeth Friedman
- Medical Director of Environmental Health Program, Department of Pediatrics, Children's Mercy, Kansas City, Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| | - Kevin Kennedy
- Director of Environmental Health Program, Children's Mercy, Kansas City, MO, USA.
| | - Panayiotis T Manolakos
- Director, Center of Economic Information, Department of Economics, University of Missouri-Kansas City, Kansas City, MO, USA.
| | - Lori Reierson
- Research Compliance Coordinator, Children's Mercy, Kansas City, MO, USA.
| | - Amy Roberts
- Program Manager, Childhood Lead Poisoning Prevention and Healthy Homes Program, Kansas City Missouri Health Department, Kansas City, MO, USA.
| | - Steve Simon
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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Cushing AM, Khan MA, Kysh L, Brakefield WS, Ammar N, Liberman DB, Wilson J, Shaban-Nejad A, Espinoza J. Geospatial data in pediatric asthma in the United States: a scoping review protocol. JBI Evid Synth 2022; 20:2790-2798. [PMID: 36081367 PMCID: PMC9669090 DOI: 10.11124/jbies-21-00284] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify and describe the literature on the use of geospatial data in pediatric asthma research. INTRODUCTION Asthma is one of the most common pediatric chronic diseases in the United States, disproportionately affecting low-income patients. Asthma exacerbations may be triggered by local environmental factors, such as air pollution or exposure to indoor allergens. Geographic information systems are increasingly recognized as tools that use geospatial data to enhance understanding of the link between environmental exposure, social determinants of health, and clinical outcomes. Geospatial data in pediatric asthma may help inform risk factors for asthma severity, and guide targeted clinical and social interventions. INCLUSION CRITERIA This review will consider studies that utilize geospatial data in the evaluation of pediatric patients with asthma, ages 2 to 18 years, in the United States. Mixed samples of adults and children will also be considered. Geospatial data will include any external non-clinical geographic-based data source that uses a patient's environment or context. METHODS The following databases will be searched: PubMed, Embase, Cochrane CENTRAL, CINAHL, ERIC, Web of Science, and IEEE. Gray literature will be searched in DBLP, the US Environmental Protection Agency, Google Scholar, Google search, and a hand search of recent abstracts from relevant conferences. Articles published in English, Spanish, and French from 2010 to the present will be included. Study screening and selection will be performed independently by 2 reviewers. Data extraction will be performed by a trained research team member following pilot testing.
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Affiliation(s)
- Anna M. Cushing
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Masrur A. Khan
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Lynn Kysh
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Whitney S. Brakefield
- Bredesen Center for Data Science and Engineering, University of Tennessee, Knoxville, TN, United States
- Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nariman Ammar
- Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Danica B. Liberman
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - John Wilson
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, United States
| | - Arash Shaban-Nejad
- Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Juan Espinoza
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Romer Present PS, Berg K, Snow M, Richardson K. Detecting New Sources of Childhood Environmental Lead Exposure Using a Statistical Surveillance System, 2015-2019. Am J Public Health 2022; 112:S715-S722. [PMID: 36179295 PMCID: PMC9528648 DOI: 10.2105/ajph.2022.307009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 09/03/2023]
Abstract
Objectives. To design and implement a statistical surveillance system to prospectively identify potential clusters of elevated blood lead levels (EBLLs) in children younger than 6 years in the Denver, Colorado, metro area. Methods. We evaluated the ability of 2 independent statistical surveillance methods to detect synthetic clusters of EBLLs in Denver between 2015 and 2019. Results. Together, the statistical surveillance methods took an average of 9 months to detect the synthetic clusters. This is faster than similar real-world clusters that have been reported in the past. The system was relatively unaffected by changes in the testing rate and to the blood lead reference value. Conclusions. The adequate design of a statistical surveillance system can help increase the rate at which clusters of EBLLs are detected in Denver, but doing so requires an accurate model of the spatial distribution of EBLLs. Earlier detection of clusters can help guide more effective public health interventions at the local level. (Am J Public Health. 2022;112(S7):S715-S722. https://doi.org/10.2105/AJPH.2022.307009).
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Affiliation(s)
- Paul S Romer Present
- All authors are with the Toxicology and Environmental Epidemiology Office, Colorado Department of Public Health and Environment, Denver
| | - Kevin Berg
- All authors are with the Toxicology and Environmental Epidemiology Office, Colorado Department of Public Health and Environment, Denver
| | - Megan Snow
- All authors are with the Toxicology and Environmental Epidemiology Office, Colorado Department of Public Health and Environment, Denver
| | - Kristy Richardson
- All authors are with the Toxicology and Environmental Epidemiology Office, Colorado Department of Public Health and Environment, Denver
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Zartarian V, Poulakos A, Garrison VH, Spalt N, Tornero-Velez R, Xue J, Egan K, Courtney J. Lead Data Mapping to Prioritize US Locations for Whole-of-Government Exposure Prevention Efforts: State of the Science, Federal Collaborations, and Remaining Challenges. Am J Public Health 2022; 112:S658-S669. [PMID: 36179290 PMCID: PMC9528653 DOI: 10.2105/ajph.2022.307051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 09/03/2023]
Abstract
For this state-of-science overview of geospatial approaches for identifying US communities with high lead-exposure risk, we compiled and summarized public data and national maps of lead indices and models, environmental lead indicators, and children's blood lead surveillance data. Currently available indices and models are primarily constructed from housing-age and sociodemographic data; differing methods, variables, data, weighting schemes, and geographic scales yield maps with different exposure risk profiles. Environmental lead indicators are available (e.g., air, drinking water, dust, soil) at different spatial scales, but key gaps remain. Blood lead level data have limitations as testing, reporting, and completeness vary across states. Mapping tools and approaches developed by federal agencies and other groups for different purposes present an opportunity for greater collaboration. Maps, data visualization tools, and analyses that synthesize available geospatial efforts can be evaluated and improved with local knowledge and blood lead data to refine identification of high-risk locations for prioritizing prevention efforts and targeting risk-reduction strategies. Remaining challenges are discussed along with a work-in-progress systematic approach for cross-agency data integration, toward advancing "whole-of-government" public health protection from lead exposures. (Am J Public Health. 2022;112(S7):S658-S669. https://doi.org/10.2105/AJPH.2022.307051).
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Affiliation(s)
- Valerie Zartarian
- Valerie Zartarian, Rogelio Tornero-Velez, and Jianping Xue are with the US Environmental Protection Agency (EPA), Office of Research and Development, Research Triangle Park, NC. Antonios Poulakos is with LinTech Global Inc, Boston, MA (contractor for US EPA Office of Research and Development). Veronica Helms Garrison is with the US Department of Housing and Urban Development (HUD), Office of Policy Development and Research. Nicholas Spalt is with the US Environmental Protection Agency, Office of Enforcement and Compliance Assurance, Washington, DC. Kathryn Egan is with the Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry, Office of Community Health and Hazard Assessment, and the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice, Atlanta. Joseph Courtney is with the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice
| | - Antonios Poulakos
- Valerie Zartarian, Rogelio Tornero-Velez, and Jianping Xue are with the US Environmental Protection Agency (EPA), Office of Research and Development, Research Triangle Park, NC. Antonios Poulakos is with LinTech Global Inc, Boston, MA (contractor for US EPA Office of Research and Development). Veronica Helms Garrison is with the US Department of Housing and Urban Development (HUD), Office of Policy Development and Research. Nicholas Spalt is with the US Environmental Protection Agency, Office of Enforcement and Compliance Assurance, Washington, DC. Kathryn Egan is with the Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry, Office of Community Health and Hazard Assessment, and the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice, Atlanta. Joseph Courtney is with the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice
| | - Veronica Helms Garrison
- Valerie Zartarian, Rogelio Tornero-Velez, and Jianping Xue are with the US Environmental Protection Agency (EPA), Office of Research and Development, Research Triangle Park, NC. Antonios Poulakos is with LinTech Global Inc, Boston, MA (contractor for US EPA Office of Research and Development). Veronica Helms Garrison is with the US Department of Housing and Urban Development (HUD), Office of Policy Development and Research. Nicholas Spalt is with the US Environmental Protection Agency, Office of Enforcement and Compliance Assurance, Washington, DC. Kathryn Egan is with the Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry, Office of Community Health and Hazard Assessment, and the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice, Atlanta. Joseph Courtney is with the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice
| | - Nicholas Spalt
- Valerie Zartarian, Rogelio Tornero-Velez, and Jianping Xue are with the US Environmental Protection Agency (EPA), Office of Research and Development, Research Triangle Park, NC. Antonios Poulakos is with LinTech Global Inc, Boston, MA (contractor for US EPA Office of Research and Development). Veronica Helms Garrison is with the US Department of Housing and Urban Development (HUD), Office of Policy Development and Research. Nicholas Spalt is with the US Environmental Protection Agency, Office of Enforcement and Compliance Assurance, Washington, DC. Kathryn Egan is with the Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry, Office of Community Health and Hazard Assessment, and the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice, Atlanta. Joseph Courtney is with the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice
| | - Rogelio Tornero-Velez
- Valerie Zartarian, Rogelio Tornero-Velez, and Jianping Xue are with the US Environmental Protection Agency (EPA), Office of Research and Development, Research Triangle Park, NC. Antonios Poulakos is with LinTech Global Inc, Boston, MA (contractor for US EPA Office of Research and Development). Veronica Helms Garrison is with the US Department of Housing and Urban Development (HUD), Office of Policy Development and Research. Nicholas Spalt is with the US Environmental Protection Agency, Office of Enforcement and Compliance Assurance, Washington, DC. Kathryn Egan is with the Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry, Office of Community Health and Hazard Assessment, and the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice, Atlanta. Joseph Courtney is with the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice
| | - Jianping Xue
- Valerie Zartarian, Rogelio Tornero-Velez, and Jianping Xue are with the US Environmental Protection Agency (EPA), Office of Research and Development, Research Triangle Park, NC. Antonios Poulakos is with LinTech Global Inc, Boston, MA (contractor for US EPA Office of Research and Development). Veronica Helms Garrison is with the US Department of Housing and Urban Development (HUD), Office of Policy Development and Research. Nicholas Spalt is with the US Environmental Protection Agency, Office of Enforcement and Compliance Assurance, Washington, DC. Kathryn Egan is with the Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry, Office of Community Health and Hazard Assessment, and the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice, Atlanta. Joseph Courtney is with the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice
| | - Kathryn Egan
- Valerie Zartarian, Rogelio Tornero-Velez, and Jianping Xue are with the US Environmental Protection Agency (EPA), Office of Research and Development, Research Triangle Park, NC. Antonios Poulakos is with LinTech Global Inc, Boston, MA (contractor for US EPA Office of Research and Development). Veronica Helms Garrison is with the US Department of Housing and Urban Development (HUD), Office of Policy Development and Research. Nicholas Spalt is with the US Environmental Protection Agency, Office of Enforcement and Compliance Assurance, Washington, DC. Kathryn Egan is with the Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry, Office of Community Health and Hazard Assessment, and the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice, Atlanta. Joseph Courtney is with the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice
| | - Joseph Courtney
- Valerie Zartarian, Rogelio Tornero-Velez, and Jianping Xue are with the US Environmental Protection Agency (EPA), Office of Research and Development, Research Triangle Park, NC. Antonios Poulakos is with LinTech Global Inc, Boston, MA (contractor for US EPA Office of Research and Development). Veronica Helms Garrison is with the US Department of Housing and Urban Development (HUD), Office of Policy Development and Research. Nicholas Spalt is with the US Environmental Protection Agency, Office of Enforcement and Compliance Assurance, Washington, DC. Kathryn Egan is with the Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry, Office of Community Health and Hazard Assessment, and the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice, Atlanta. Joseph Courtney is with the CDC, National Center for Environmental Health, Division of Environmental Health Science and Practice
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Xue J, Zartarian V, Tornero-Velez R, Stanek LW, Poulakos A, Walts A, Triantafillou K, Suero M, Grokhowsky N. A Generalizable Evaluated Approach, Applying Advanced Geospatial Statistical Methods, to Identify High Lead Exposure Locations at Census Tract Scale: Michigan Case Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:77004. [PMID: 35894594 PMCID: PMC9327739 DOI: 10.1289/ehp9705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite great progress in reducing environmental lead (Pb) levels, many children in the United States are still being exposed. OBJECTIVE Our aim was to develop a generalizable approach for systematically identifying, verifying, and analyzing locations with high prevalence of children's elevated blood Pb levels (EBLLs) and to assess available Pb models/indices as surrogates, using a Michigan case study. METHODS We obtained ∼1.9 million BLL test results of children <6 years of age in Michigan from 2006-2016; we then evaluated them for data representativeness by comparing two percentage EBLL (%EBLL) rates (number of children tested with EBLL divided by both number of children tested and total population). We analyzed %EBLLs across census tracts over three time periods and between two EBLL reference values (≥5 vs. ≥10μg/dL) to evaluate consistency. Locations with high %EBLLs were identified by a top 20 percentile method and a Getis-Ord Gi* geospatial cluster "hotspot" analysis. For the locations identified, we analyzed convergences with three available Pb exposure models/indices based on old housing and sociodemographics. RESULTS Analyses of 2014-2016 %EBLL data identified 11 Michigan locations via cluster analysis and 80 additional locations via the top 20 percentile method and their associated census tracts. Data representativeness and consistency were supported by a 0.93 correlation coefficient between the two EBLL rates over 11 y, and a Kappa score of ∼0.8 of %EBLL hotspots across the time periods (2014-2016) and reference values. Many EBLL hotspot locations converge with current Pb exposure models/indices; others diverge, suggesting additional Pb sources for targeted interventions. DISCUSSION This analysis confirmed known Pb hotspot locations and revealed new ones at a finer geographic resolution than previously available, using advanced geospatial statistical methods and mapping/visualization. It also assessed the utility of surrogates in the absence of blood Pb data. This approach could be applied to other states to inform Pb mitigation and prevention efforts. https://doi.org/10.1289/EHP9705.
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Affiliation(s)
- Jianping Xue
- U.S. Environmental Protection Agency (EPA), Office of Research and Development, Research Triangle Park, North Carolina, USA
| | - Valerie Zartarian
- U.S. Environmental Protection Agency (EPA), Office of Research and Development, Research Triangle Park, North Carolina, USA
| | - Rogelio Tornero-Velez
- U.S. Environmental Protection Agency (EPA), Office of Research and Development, Research Triangle Park, North Carolina, USA
| | - Lindsay W. Stanek
- U.S. Environmental Protection Agency (EPA), Office of Research and Development, Research Triangle Park, North Carolina, USA
| | - Antonios Poulakos
- U.S. Environmental Protection Agency (EPA), Office of Research and Development, Research Triangle Park, North Carolina, USA
- LinTech Global, Inc., Boston, Massachusetts, USA
| | - Alan Walts
- U.S. EPA, Region 5, Chicago, Illinois, USA
| | | | | | - Nicholas Grokhowsky
- Oak Ridge Institute for Science and Education, Research Triangle Park, North Carolina, USA
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6
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Ettinger AS. Invited Perspective: Identifying Childhood Lead Exposure Hotspots for Action. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:71301. [PMID: 35894591 PMCID: PMC9327736 DOI: 10.1289/ehp10916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Adrienne S. Ettinger
- Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
- Environmental and Occupational Health Sciences Institute, Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
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Moonga G, Chisola MN, Berger U, Nowak D, Yabe J, Nakata H, Nakayama S, Ishizuka M, Bose-O'Reilly S. Geospatial approach to investigate spatial clustering and hotspots of blood lead levels in children within Kabwe, Zambia. ENVIRONMENTAL RESEARCH 2022; 207:112646. [PMID: 34979123 DOI: 10.1016/j.envres.2021.112646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Communities around Kabwe, Zambia are exposed to lead due to deposits from an old lead (Pb) and zinc (Zn) mining site. Children are particularly more vulnerable than adults, presenting with greatest risk of health complications. They have increased oral uptake due to their hand to mouth activities. Spatial analysis of childhood lead exposure is useful in identifying specific areas with highest risk of pollution. The objective of the current study was to use a geospatial approach to investigate spatial clustering and hotspots of blood lead levels in children within Kabwe. METHODS We analysed existing data on blood lead levels (BLL) for 362 children below the age of 15 from Kabwe town. We used spatial autocorrelation methods involving the global Moran's I and local Getis-Ord Gi*statistic in ArcMap 10.5.1, to test for spatial dependency among the blood lead levels in children using the household geolocations. RESULTS BLL in children from Kabwe are spatially autocorrelated with a Moran's Index of 0.62 (p < 0.001). We found distinct hotspots (mean 51.9 μg/dL) in communities close to the old lead and zinc-mining site, lying on its western side. Whereas coldspots (mean 7 μg/dL) where observed in areas distant to the mine and traced on the eastern side. This pattern suggests a possible association between observed BLL and distance from the abandoned lead and zinc mine, and prevailing winds. CONCLUSION Using geocoded data for households, we found clustering of childhood blood lead and identified distinct hotspot areas with high lead levels for Kabwe town. The geospatial approach used is especially valuable in resource-constrained settings like Zambia, where the precise identification of high risk locations allows for the initiation of targeted remedial and treatment programs.
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Affiliation(s)
- Given Moonga
- Institute and Clinic for Occupational-, Social- and Environmental Medicine, LMU University Hospital Munich, Ziemssenstr. 1, D-80336, Munich, Germany; CIH(LMU) Center for International Health, LMU University Hospital, Munich, Germany; Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia; Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT (Private University for Health Sciences, Medical Informatics and Technology), Hall i.T, Austria.
| | - Moses N Chisola
- Department of Geography and Environmental Studies, University of Zambia, Lusaka, Zambia
| | - Ursula Berger
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational-, Social- and Environmental Medicine, LMU University Hospital Munich, Ziemssenstr. 1, D-80336, Munich, Germany
| | - John Yabe
- School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Hokuto Nakata
- Laboratory of Toxicology, Department of Environmental Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Shouta Nakayama
- Laboratory of Toxicology, Department of Environmental Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Mayumi Ishizuka
- Laboratory of Toxicology, Department of Environmental Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Stephan Bose-O'Reilly
- Institute and Clinic for Occupational-, Social- and Environmental Medicine, LMU University Hospital Munich, Ziemssenstr. 1, D-80336, Munich, Germany; Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT (Private University for Health Sciences, Medical Informatics and Technology), Hall i.T, Austria; University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Clinic St. Hedwig, Regensburg, Germany
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8
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El Zahran T, Mostafa H, Hamade H, Al Hariri M, Saab A, Tamim H, Tohme R, Al Hamod DA, Sinno D, Sawaya RD, Kazzi Z. Lead screening in children presenting to three hospitals in Lebanon. Arch Dis Child 2022; 107:251-256. [PMID: 34429329 DOI: 10.1136/archdischild-2021-322012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/10/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lead damages most body organs and its effects are most profound in children. In a study in Beirut in 2003, before banning the leaded gasoline, 79% of the participants showed blood lead levels (BLLs) higher than 5 µg/dL. The prevalence of lead exposure in Lebanon after the ban on leaded gasoline has not been studied. This study assessed the BLL in Lebanese children aged 1-6 years. METHODS This cross-sectional study was conducted in three hospitals in Beirut. The children's BLLs were tested, and their caregiver completed a questionnaire to identify subgroups at risk of exposure. Participants were provided with a WHO brochure highlighting the risks of lead. RESULTS Ninety children with a mean age of 3.5±1.5 years were enrolled in the study and had a mean BLL of 1.1±0.7 µg/dL, with all values being below 5.0 µg/dL, showing a marked decrease in BLL compared with the mean BLL before the ban on leaded gasoline in 2002. Having a father or a mother with a college degree (p=0.01 and p=0.035, respectively) and having a monthly household income greater than $1000 (p=0.021) were associated with significantly lower BLL. Having more rooms at home and residing close to construction sites were associated with a significantly lower BLL (p=0.001 and p=0.026, respectively). Residing in a house aged >40 years and receiving traditional remedies were associated with a significantly higher BLL (p=0.009 and p<0.0001, respectively). CONCLUSION BLLs have declined among Lebanese children and this could be attributed to multiple factors including the ban of leaded gasoline. It would be beneficial to conduct a larger study with a nationally representative sample to better characterise the BLL.
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Affiliation(s)
- Tharwat El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala Mostafa
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Hamade
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Moustafa Al Hariri
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aed Saab
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Biostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rasha Tohme
- Department of Pediatrics, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Dany A Al Hamod
- Department of Pediatrics, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Durriyah Sinno
- Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rasha Dorothy Sawaya
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ziad Kazzi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Wheeler DC, Boyle J, Nelson EJ. Modeling annual elevated blood lead levels among children in Maryland in relation to neighborhood deprivation. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 805:150333. [PMID: 34543794 DOI: 10.1016/j.scitotenv.2021.150333] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
Estimating environmental lead exposure using ecologic risk models is an inexpensive strategy to inform public health departments and to develop location-based intervention strategies such as targeted screening and mitigation. Importantly, studies in this area have not assessed temporal and spatio-temporal lead exposure risk trends. Due to lead abatement efforts and targeted screening efforts, it is anticipated that lead exposure risk has decreased over time. However, it is unknown if decreases have occurred, and if the decreases are evenly distributed across neighborhoods. Thus, the purpose of this study was to examine the association between neighborhood deprivation and risk of elevated blood lead levels (EBLLs) in both temporal and spatio-temporal contexts within the US state of Maryland in 2005-2015. To consider the temporal dimension of lead risk, we used a novel extension of Bayesian index models to estimate time-varying neighborhood deprivation indices along with time-varying index effects. The results showed that overall EBLL proportion decreased over time, from a high of 0.11 in 2006 to a low of 0.02 in 2015. The association between neighborhood deprivation and EBLL risk was positive and significant annually, but generally diminished over time. The most important variables in the neighborhood deprivation index were percent of houses built before 1940 and median household income. In summary, using Bayesian index models that can account for both temporal and spatio-temporal contexts is a promising approach to inform public health efforts to remediate lead and focus testing efforts and may be useful in studies in other geographic areas and times.
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Affiliation(s)
- David C Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States of America.
| | - Joseph Boyle
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Erik J Nelson
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, UT, United States of America
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10
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Marshall AT, McConnell R, Lanphear BP, Thompson WK, Herting MM, Sowell ER. Risk of lead exposure, subcortical brain structure, and cognition in a large cohort of 9- to 10-year-old children. PLoS One 2021; 16:e0258469. [PMID: 34648580 PMCID: PMC8516269 DOI: 10.1371/journal.pone.0258469] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/26/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Lead, a toxic metal, affects cognitive development at the lowest measurable concentrations found in children, but little is known about its direct impact on brain development. Recently, we reported widespread decreases in cortical surface area and volume with increased risks of lead exposure, primarily in children of low-income families. METHODS AND FINDINGS We examined associations of neighborhood-level risk of lead exposure with cognitive test performance and subcortical brain volumes. We also examined whether subcortical structure mediated associations between lead risk and cognitive performance. Our analyses employed a cross-sectional analysis of baseline data from the observational Adolescent Brain Cognitive Development (ABCD) Study. The multi-center ABCD Study used school-based enrollment to recruit a demographically diverse cohort of almost 11,900 9- and 10-year-old children from an initial 22 study sites. The analyzed sample included data from 8,524 typically developing child participants and their parents or caregivers. The primary outcomes and measures were subcortical brain structure, cognitive performance using the National Institutes of Health Toolbox, and geocoded risk of lead exposure. Children who lived in neighborhoods with greater risks of environmental lead exposure exhibited smaller volumes of the mid-anterior (partial correlation coefficient [rp] = -0.040), central (rp = -0.038), and mid-posterior corpus callosum (rp = -0.035). Smaller volumes of these three callosal regions were associated with poorer performance on cognitive tests measuring language and processing speed. The association of lead exposure risk with cognitive performance was partially mediated through callosal volume, particularly the mid-posterior corpus callosum. In contrast, neighborhood-level indicators of disadvantage were not associated with smaller volumes of these brain structures. CONCLUSIONS Environmental factors related to the risk of lead exposure may be associated with certain aspects of cognitive functioning via diminished subcortical brain structure, including the anterior splenium (i.e., mid-posterior corpus callosum).
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Affiliation(s)
- Andrew T. Marshall
- Children’s Hospital Los Angeles, and the Department of Pediatrics, University of Southern California, Los Angeles, California, United States of America
| | - Rob McConnell
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, United States of America
| | - Bruce P. Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Wesley K. Thompson
- Department of Biostatistics, Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California, United States of America
| | - Megan M. Herting
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, United States of America
| | - Elizabeth R. Sowell
- Children’s Hospital Los Angeles, and the Department of Pediatrics, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
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11
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Nguyen MB. Aligning Partners in Pediatric Health: Using Geographical Information Systems to Plan Community Coalitions. J Prim Care Community Health 2021; 11:2150132720940513. [PMID: 32646267 PMCID: PMC7357009 DOI: 10.1177/2150132720940513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: Compared with adults, children have higher emergency department (ED) utilization for asthma exacerbation. While community coalitions have been shown to prevent ED visits for asthma, there is little guidance on where to best implement these efforts. Geographical information systems (GIS) technology can help in the selection and coordination of potential coalition partners. This report proposes a model to be used by clinicians and child health equity advocates to strategize high-impact community health interventions. The aims were to identify the clusters of ED utilization for pediatric asthma, evaluate sociodemographic features of the population within the clusters, and identify potential primary care and school community partners. Methods: This model uses ED visit data from 450 nonmilitary California hospitals in 2012. We obtained ZIP code–level counts and rates for patients younger than 18 years discharged with a diagnosis code of 493 for asthma conditions from the California Office of Statewide Health Planning and Development’s Open Portal. We applied GIS spatial analysis techniques to identify statistically significant cluster for pediatric asthma ED utilization. We then locate the candidate community partners within these clusters. Results: There were 181 720 ED visits for asthma for all age groups in 2012 with 70 127 visits for children younger than 18 years. The top 3 geographic clusters for ED utilization rates were located in Fresno, Inglewood, and Richmond City, respectively. Spatial analysis maps illustrate the schools located within 0.5– and 1-mile radii of primary care clinics and provide a visual and statistical description of the population within the clusters. Conclusion: This study demonstrates a model to help clinicians understand how GIS can aid in the selection and creation of coalition building. This is a potentially powerful tool in the addressing child health disparities.
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Affiliation(s)
- Margaret B Nguyen
- University of California San Diego, Rady Children's Hospital, San Diego, CA, USA
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12
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Dickinson-Copeland CM, Immergluck LC, Britez M, Yan F, Geng R, Edelson M, Kendrick-Allwood SR, Kordas K. Increased Risk of Sub-Clinical Blood Lead Levels in the 20-County Metro Atlanta, Georgia Area-A Laboratory Surveillance-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105163. [PMID: 34068063 PMCID: PMC8152486 DOI: 10.3390/ijerph18105163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/01/2021] [Accepted: 05/02/2021] [Indexed: 01/11/2023]
Abstract
Lead (Pb) is a naturally occurring, highly toxic metal that has adverse effects on children across a range of exposure levels. Limited screening programs leave many children at risk for chronic low-level lead exposure and there is little understanding of what factors may be used to identify children at risk. We characterize the distribution of blood lead levels (BLLs) in children aged 0–72 months and their associations with sociodemographic and area-level variables. Data from the Georgia Department of Public Health’s Healthy Homes for Lead Prevention Program surveillance database was used to describe the distribution of BLLs in children living in the metro Atlanta area from 2010 to 2018. Residential addresses were geocoded, and “Hotspot” analyses were performed to determine if BLLs were spatially clustered. Multilevel regression models were used to identify factors associated with clinical BBLs (≥5 µg/dL) and sub-clinical BLLs (2 to <5 µg/dL). From 2010 to 2018, geographically defined hotspots for both clinical and sub-clinical BLLs diffused from the city-central area of Atlanta into suburban areas. Multilevel regression analysis revealed non-Medicaid insurance, the proportion of renters in a given geographical area, and proportion of individuals with a GED/high school diploma as predictors that distinguish children with BLLs 2 to <5 µg/dL from those with lower (<2 µg/dL) or higher (≥5 µg/dL) BLLs. Over half of the study children had BLLs between 2 and 5 µg/dL, a range that does not currently trigger public health measures but that could result in adverse developmental outcomes if ignored.
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Affiliation(s)
- Carmen M. Dickinson-Copeland
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (L.C.I.); (M.B.)
- Correspondence:
| | - Lilly Cheng Immergluck
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (L.C.I.); (M.B.)
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Maria Britez
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (L.C.I.); (M.B.)
| | - Fengxia Yan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Ruijin Geng
- Pediatric Clinical and Translational Research Unit, Clinical Research Center, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Mike Edelson
- Geographic Information Systems, InterDev, Roswell, GA 30076, USA;
| | - Salathiel R. Kendrick-Allwood
- Department of Pediatrics, Divisions of General Pediatrics & Neonatology, Emory University School of Medicine, Atlanta, GA 30303, USA;
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY 14214, USA;
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13
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Boonchieng W, Chaiwan J, Shrestha B, Shrestha M, Dede AJ, Boonchieng E. mHealth Technology Translation in a Limited Resources Community-Process, Challenges, and Lessons Learned From a Limited Resources Community of Chiang Mai Province, Thailand. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2021; 9:3700108. [PMID: 33728106 PMCID: PMC7954649 DOI: 10.1109/jtehm.2021.3055069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 02/02/2023]
Abstract
This report aims to provide practical advice about the implementation of a public health monitoring system using both geographic information system technology and mobile health, a term used for healthcare delivery via mobile devices. application amongst household residents and community stakeholders in the limited resource community. A public health monitoring system was implemented in a semi-rural district in Thailand. The challenges encountered during implementation were documented qualitatively in a series of monthly focus group discussions, several community hearings, and many targeted interviews. In addition, lessons learned from the expansion of the program to 75 other districts throughout Thailand were also considered. All challenges proved solvable yielding several key pieces of advice for future project implementation teams. Specifically, communication between team members, anticipating technological challenges, and involvement of community members are critical. The problems encountered in our project were mainly related to the capabilities of the data collectors and technical issues of mobile devices, internet coverage, and the GIS application itself. During the implementation phase, progressive changes needed to be made to the system promptly, in parallel with community team building in order to get the highest public health impact.
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Affiliation(s)
| | - Jintana Chaiwan
- Faculty of Public HealthChiang Mai UniversityChiang Mai50200Thailand
| | - Bijaya Shrestha
- Faculty of Social Sciences and HumanitiesMahidol UniversityNakhon Pathom73170Thailand
| | - Manash Shrestha
- Faculty of Social Sciences and HumanitiesMahidol UniversityNakhon Pathom73170Thailand
| | - Adam J.O. Dede
- Unit of Excellence on Clinical Outcomes Research and Integration, School of Pharmaceutical SciencesUniversity of PhayaoMae Ka56000Thailand
| | - Ekkarat Boonchieng
- Data Science Research CenterDepartment of Computer ScienceFaculty of Science, Chiang Mai UniversityChiang Mai50200Thailand
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14
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Marshall AT, Betts S, Kan EC, McConnell R, Lanphear BP, Sowell ER. Association of lead-exposure risk and family income with childhood brain outcomes. Nat Med 2020; 26:91-97. [PMID: 31932788 PMCID: PMC6980739 DOI: 10.1038/s41591-019-0713-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/22/2019] [Indexed: 02/08/2023]
Abstract
Socioeconomic factors influence brain development and structure, but most studies have overlooked neurotoxic insults that impair development, such as lead exposure. Childhood lead exposure affects cognitive development at the lowest measurable concentrations, but little is known about its impact on brain development during childhood. We examined cross-sectional associations among brain structure, cognition, geocoded measures of the risk of lead exposure and sociodemographic characteristics in 9,712 9- and 10-year-old children. Here we show stronger negative associations of living in high-lead-risk census tracts in children from lower- versus higher-income families. With increasing risk of exposure, children from lower-income families exhibited lower cognitive test scores, smaller cortical volume and smaller cortical surface area. Reducing environmental insults associated with lead-exposure risk might confer greater benefit to children experiencing more environmental adversity, and further understanding of the factors associated with high lead-exposure risk will be critical for improving such outcomes in children.
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Affiliation(s)
- Andrew T Marshall
- Children's Hospital Los Angeles, and the Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Samantha Betts
- Children's Hospital Los Angeles, and the Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Eric C Kan
- Children's Hospital Los Angeles, and the Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Elizabeth R Sowell
- Children's Hospital Los Angeles, and the Department of Pediatrics, University of Southern California, Los Angeles, CA, USA.
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15
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Padula AM, Monk C, Brennan PA, Borders A, Barrett ES, McEvoy C, Foss S, Desai P, Alshawabkeh A, Wurth R, Salafia C, Fichorova R, Varshavsky J, Kress A, Woodruff TJ, Morello-Frosch R. A review of maternal prenatal exposures to environmental chemicals and psychosocial stressors-implications for research on perinatal outcomes in the ECHO program. J Perinatol 2020; 40:10-24. [PMID: 31616048 PMCID: PMC6957228 DOI: 10.1038/s41372-019-0510-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/08/2019] [Accepted: 08/15/2019] [Indexed: 01/18/2023]
Abstract
Exposures to environmental chemicals and psychosocial stressors during pregnancy have been individually associated with adverse perinatal outcomes related to birthweight and gestational age, but are not often considered in combination. We review types of psychosocial stressors and instruments used to assess them and classes of environmental chemical exposures that are known to adversely impact perinatal outcomes, and identify studies relevant studies. We discuss the National Institutes of Health's Environmental influences on Child Health Outcomes (ECHO) program that has combined existing longitudinal cohorts that include more than 50,000 children across the U.S. We describe future opportunities for investigators to use this important new resource for addressing relevant and critical research questions to maternal health. Of the 84 cohorts in ECHO, 38 collected data on environmental chemicals and psychosocial stressors and perinatal outcomes. The diverse ECHO pregnancy cohorts provide capacity to compare regions with distinct place-based environmental and social stressors.
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Affiliation(s)
- Amy M. Padula
- University of California San Francisco, San Francisco, CA
USA
| | | | | | - Ann Borders
- North Shore University Health System, Evanston, IL,
USA
| | | | | | - Sophie Foss
- Columbia University Medical Center, New York, NY, USA
| | - Preeya Desai
- Columbia University Medical Center, New York, NY, USA
| | | | | | | | - Raina Fichorova
- Brigham and Women’s Hospital and Harvard Medical
School, Boston, MA, USA
| | | | - Amii Kress
- Johns Hopkins University, Baltimore, MD, USA
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16
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Garrison A, Khoshnood B, Courtin D, Milet J, Garcia A, Massougbodji A, Ayotte P, Cot M, Bodeau-Livinec F. Blood lead level in infants and subsequent risk of malaria: A prospective cohort study in Benin, Sub-Saharan Africa. PLoS One 2019; 14:e0220023. [PMID: 31318954 PMCID: PMC6638975 DOI: 10.1371/journal.pone.0220023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/08/2019] [Indexed: 11/23/2022] Open
Abstract
Lead and malaria both present significant health risks to children in Sub-Saharan Africa. Previous studies have shown that high blood lead levels in children act as a protective factor against subsequent malaria incidence. The main objective of this study was to investigate associations between blood lead level and malaria outcomes prospectively in Beninese children from 12 to 24 months of age. Two-hundred and four children were assessed for lead at 12 months and closely followed until 24 months for malaria; when symptoms and parasite density were also recorded. Univariate and multivariate negative binomial and linear regression models tested associations between blood lead level quartile and total episodes of malaria (total symptomatic and asymptomatic episodes) and parasite density, respectively. Median blood lead level among children measured at 12 months was 56.50 (4.81-578) μg/L. During the 12-month follow-up, 172 (84.31%) children had at least one malaria episode. Univariate and multivariate negative binomial and linear regressions did not reveal significant associations between blood lead level quartile and malaria outcomes. Iron deficiency was not found to be an effect modifier. Results from this prospective child-cohort study investigating associations between blood lead level and malaria did not confirm results from previous cross-sectional studies. Further research is needed to further explore this relationship and other co-morbidities due to malaria and lead.
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Affiliation(s)
- Amanda Garrison
- INSERM UMR1153 Equipe de recherche en Epidémiologie Obstétricale, Périnatale, et Pédiatrique (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Paris, France
- Sorbonne Universités, UPMC Université Paris 6, Paris, France
- Ecole des Hautes Etudes en Santé Publique (EHESP), Saint Denis, France
| | - Babak Khoshnood
- INSERM UMR1153 Equipe de recherche en Epidémiologie Obstétricale, Périnatale, et Pédiatrique (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Paris, France
| | - David Courtin
- Mère et enfant face aux infections tropicales (MERIT), l’Institut de Recherche pour le Développement (IRD), Université Paris 5, Sorbonne Paris Cité, Paris, France
| | - Jacqueline Milet
- Mère et enfant face aux infections tropicales (MERIT), l’Institut de Recherche pour le Développement (IRD), Université Paris 5, Sorbonne Paris Cité, Paris, France
| | - André Garcia
- Mère et enfant face aux infections tropicales (MERIT), l’Institut de Recherche pour le Développement (IRD), Université Paris 5, Sorbonne Paris Cité, Paris, France
| | | | - Pierre Ayotte
- Institut National de Santé Publique du Québec, Québec City, Canada
| | - Michel Cot
- Mère et enfant face aux infections tropicales (MERIT), l’Institut de Recherche pour le Développement (IRD), Université Paris 5, Sorbonne Paris Cité, Paris, France
| | - Florence Bodeau-Livinec
- INSERM UMR1153 Equipe de recherche en Epidémiologie Obstétricale, Périnatale, et Pédiatrique (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Paris, France
- Ecole des Hautes Etudes en Santé Publique (EHESP), Saint Denis, France
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17
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Wheeler DC, Raman S, Jones RM, Schootman M, Nelson EJ. Bayesian deprivation index models for explaining variation in elevated blood lead levels among children in Maryland. Spat Spatiotemporal Epidemiol 2019; 30:100286. [PMID: 31421801 DOI: 10.1016/j.sste.2019.100286] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/21/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
Lead exposure adversely affects children's health. Exposure in the United States is highest among socioeconomically disadvantaged individuals who disproportionately live in substandard housing. We used Bayesian binomial regression models to estimate a neighborhood deprivation index and its association with elevated blood lead level (EBLL) risk using blood lead level testing data in Maryland census tracts. Our results show the probability of EBLL was spatially structured with high values in Baltimore city and low values in the District of Columbia suburbs and Baltimore suburbs. The association between the neighborhood deprivation index and EBLL risk was statistically significant after accounting for spatial dependence in probability of EBLL. The percent of houses built before 1940, African Americans, and renter occupied housing were the most important variables in the index. Bayesian models provide a flexible one-step approach to modeling risk associated with neighborhood deprivation while accounting for spatially structured and unstructured heterogeneity in risk.
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Affiliation(s)
- David C Wheeler
- Department of Biostatistics, Virginia Commonwealth University, United States.
| | - Shyam Raman
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington, United States
| | - Resa M Jones
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University and Fox Chase Cancer Center, Temple University Health, United States
| | | | - Erik J Nelson
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington, United States
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18
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Njati SY, Maguta MM. Lead-based paints and children's PVC toys are potential sources of domestic lead poisoning - A review. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2019; 249:1091-1105. [PMID: 31146315 DOI: 10.1016/j.envpol.2019.03.062] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 02/21/2019] [Accepted: 03/15/2019] [Indexed: 06/09/2023]
Abstract
Lead (Pb) both in paints and children's Polyvinyl chloride (PVC) toys is a major public health concern which has attracted attention of the international community. Concentrations of Pb both in lead-based paints and children's PVC toys have been assessed through various studies across the globe. Therefore, the purpose of this article was to summarize the results reported in these studies and provide some comprehension on their implications to human health for law enforcement as well as for awareness raising to the general public. Highlights on identified gaps have been provided to pave ways for further research interventions in order to establish comprehensive information on the subject. Regardless of regulatory limits on the content of lead, both in paints and children's PVC toys existing in different countries in the world, some of the reviewed articles have revealed significant levels of lead in these two items far above the permissible limits. High lead levels in paints have been recorded in China (116,200 ppm), Cameroon (500,000 ppm), South Africa (189,000 ppm), Tanzania (120,862.1 ppm), Uganda (150,000 ppm), Thailand (505,716 ppm) and Brazil (170,258.4 ppm) just to mention a few. Lead poisoning cases in children have been reported in several countries including France, Morocco, South Africa and United States. Countries where high levels of lead in children's PVC toys have been recounted include; China (860,000 ppm), South Africa (145,000 ppm), United States (22,550 ppm), Thailand (4,486.11 ppm), Palestine (6,036 ppm) and India (2,104 ppm). Awareness raising among parents is vital to impart them with knowledge on the matter so that they can take strenuous measures to protect their children from lead poisoning emanating from playing with toys and paint dust. Law enforcement on phasing out lead-based paints and control of lead content in children's PVC toys worldwide is also highly recommended.
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Affiliation(s)
- Shukuru Yusufu Njati
- Tanzania Rural and Urban Roads Agency (TARURA), P.O.Box 11042, Dodoma, Tanzania.
| | - Mihayo Musabila Maguta
- Department of Environmental Planning, Institute of Rural Development Planning (IRDP), P. O. Box 138, Dodoma, Tanzania.
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19
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Daley GM, Abdulla C, Pretorius CJ, Ungerer JPJ. Insidious plumbum. Pathology 2019; 51:449-451. [PMID: 31000170 DOI: 10.1016/j.pathol.2018.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/17/2018] [Accepted: 11/25/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Gemma Maree Daley
- Department of Chemical Pathology, Pathology Queensland Central Laboratory, Brisbane, Qld, Australia.
| | - Cheriya Abdulla
- Department of Paediatrics, Rockhampton Base Hospital, Rockhampton, Qld, Australia
| | - Carel J Pretorius
- Department of Chemical Pathology, Pathology Queensland Central Laboratory, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Jacobus P J Ungerer
- Department of Chemical Pathology, Pathology Queensland Central Laboratory, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
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20
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Castro IE, Larsen DA, Hruska B, Parsons PJ, Palmer CD, Gump BB. Variability in the spatial density of vacant properties contributes to background lead (Pb) exposure in children. ENVIRONMENTAL RESEARCH 2019; 170:463-471. [PMID: 30640080 PMCID: PMC6433169 DOI: 10.1016/j.envres.2018.12.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/17/2018] [Accepted: 12/31/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Heightened blood lead levels (BLL) are associated with cognitive deficiencies and adverse behavioral outcomes. Lead-contaminated house dust is the primary source of exposure in U.S. children, and evidence suggests that even background (low-level) exposure has negative consequences. Identifying sources of background exposure is of great public health significance because of the larger number of children that can be affected. METHODS Blood lead was assessed in a bi-racial sample of children from Syracuse, NY, aged 9-11, using established biomonitoring methods. The spatial density of vacant properties was modelled from publicly available georeferenced datasets. Further, regression models were used to measure the impact of this spatial density variable on children's BLL. RESULTS In a sample of 221 children, with a mean BLL of 1.06 µg/dL (SD = 0.68), results showed increases in spatial density of vacant properties predict increases in median blood-PB levels, b = 0.14 (0.06-0.21), p < .001. This association held true even after accounting for demographic covariates, and age of individual housing. Further analysis showed spatial autocorrelation of the residuals changed from a clustered pattern to a random pattern once the spatial density variable was introduced to the model. DISCUSSION This study is the first to identify a background-lead exposure source using spatial density modelling. As vacant properties deteriorate, lead-contaminated dust likely disperses into the surrounding environment. High-density areas have an accumulation of lead hazards in environmental media, namely soil and dust, putting more children at risk of exposure.
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Affiliation(s)
- Ivan E Castro
- Department of Public Health, Food Studies, and Nutrition, Syracuse University, Syracuse, NY 13204, USA
| | - David A Larsen
- Department of Public Health, Food Studies, and Nutrition, Syracuse University, Syracuse, NY 13204, USA
| | - Bryce Hruska
- Department of Public Health, Food Studies, and Nutrition, Syracuse University, Syracuse, NY 13204, USA
| | - Patrick J Parsons
- Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; Department of Environmental Health Sciences, School of Public Health, University at Albany, Rennselaer, NY 12144, USA
| | - Christopher D Palmer
- Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; Department of Environmental Health Sciences, School of Public Health, University at Albany, Rennselaer, NY 12144, USA
| | - Brooks B Gump
- Department of Public Health, Food Studies, and Nutrition, Syracuse University, Syracuse, NY 13204, USA.
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Daley GM, Pretorius CJ, Ungerer JPJ. Lead Toxicity: an Australian Perspective. Clin Biochem Rev 2018; 39:61-98. [PMID: 30828115 PMCID: PMC6372192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Plumbism refers to the clinical features of lead toxicity, a condition which has been identified and then forgotten in a depressingly cyclical fashion since ancient times. For the past 6000 years antiquarians have described the human use of lead despite the well documented and severe adverse effects of exposure. As the analytical methods of lead measurement bring improved detection capability, it is clear that there is no safe amount of lead in the body. Sadly, we continue to identify affected patients in contemporary Australia, including young children. While there is little evidence that chelation therapy improves outcomes in affected individuals, it is recommended for use in patients with acute encephalopathy or in those with particularly elevated levels. The paucity of evidence supporting active treatment of plumbism highlights the importance of primary prevention, particularly in our most vulnerable.
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Affiliation(s)
- Gemma M Daley
- Department of Chemical Pathology, Pathology Queensland Central Laboratory, University of Queensland, Brisbane, Qld 4006, Australia
| | - Carel J Pretorius
- Department of Chemical Pathology, Pathology Queensland Central Laboratory, University of Queensland, Brisbane, Qld 4006, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Qld 4006, Australia
| | - Jacobus PJ Ungerer
- Department of Chemical Pathology, Pathology Queensland Central Laboratory, University of Queensland, Brisbane, Qld 4006, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Qld 4006, Australia
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El Zahran T, Ralston A, King A, Hindman D, Morgan BW. Elevated lead level from a tobacco source requiring chelation in a 12-year-old child. Clin Toxicol (Phila) 2018; 56:1159-1161. [PMID: 29623731 DOI: 10.1080/15563650.2018.1458990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/06/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022]
Abstract
CONTEXT Across the world, tobacco is used in a variety of forms, including being smoked or added to a "quid" that is then chewed. We report a case of lead poisoning in a child from tobacco imported from Thailand. CASE DETAILS A 12-year-old Thai immigrant boy had a blood lead level (BLL) of 6 mcg/dL on routine testing upon arrival to the United States, but which increased to 72 mcg/dL six months after his arrival. He was asymptomatic with unremarkable workup. At this time his father, mother and two siblings were also found to have elevated BLLs of 53, 16, 22, and 11 mcg/dL, respectively. Water, paint, food and cookware sources tested negative for lead, whereas samples of the father's dried tobacco leaves imported from Thailand contained 36.12 ppm (mcg/g) of lead. The mother admitted that both she and the patient used the tobacco as well. The child was chelated with oral succimer and his BLL decreased. DISCUSSION In our case, the source of the lead exposure was from the tobacco that the patient was chewing. Tobacco is often overlooked as a source of lead exposure, though it has been reported in the literature, both from direct smoking and from chewing, as well as through secondhand smoke. Toxicologists and health care professionals should consider cultural practices when evaluating patients with elevated BLLs.
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Affiliation(s)
- Tharwat El Zahran
- a Emory University School of Medicine , Atlanta , GA , USA
- b Georgia Poison Control , Atlanta , GA , USA
| | - Aaron Ralston
- a Emory University School of Medicine , Atlanta , GA , USA
- b Georgia Poison Control , Atlanta , GA , USA
| | | | - Diane Hindman
- a Emory University School of Medicine , Atlanta , GA , USA
- b Georgia Poison Control , Atlanta , GA , USA
| | - Brent W Morgan
- a Emory University School of Medicine , Atlanta , GA , USA
- b Georgia Poison Control , Atlanta , GA , USA
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Aoki Y, Brody DJ. WIC Participation and Blood Lead Levels among Children 1-5 Years: 2007-2014. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:067011. [PMID: 29961657 PMCID: PMC6084832 DOI: 10.1289/ehp2384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 05/30/2018] [Accepted: 06/03/2018] [Indexed: 05/30/2023]
Abstract
BACKGROUND The CDC recommends a targeted strategy for childhood blood lead screening based on participation in federal programs, such as Medicaid and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Yet, there is scarcity of data on blood lead levels (BLLs) among WIC participants. OBJECTIVE Our objective was to investigate whether children participating in WIC and not enrolled in Medicaid, who have not been targeted in the historical Medicaid-focused screening strategy, have higher BLLs than children in neither of these programs. METHODS The analysis included 3,180 children 1-5 y of age in the National Health and Nutrition Examination Surveys conducted in 2007-2014. Log-binomial regression, which allows direct estimation of prevalence ratios, was used to examine associations between WIC participation (in conjunction with Medicaid enrollment) and having BLLs ≥5 μg/dL with adjustment for age (1-2 vs. 3-5 y). RESULTS The percentage of children participating in "WIC only," "Medicaid only," "both WIC and Medicaid," and "neither" were 18.9%, 10.8%, 25.4%, and 44.9%, respectively. "WIC only," "Medicaid only," and "both WIC and Medicaid" children were more likely to have BLLs ≥5 μg/dL than children who were not enrolled in either program, with adjusted prevalence ratios of 3.29 [95% confidence interval (CI): 1.19, 9.09], 4.56 (95% CI: 2.18, 9.55), and 2.58 (95% CI: 1.18, 5.63). CONCLUSIONS Children participating in WIC but not Medicaid were more likely to have BLLs ≥5 μg/dL than children who were not enrolled in either program. These findings may inform public health recommendations and clinical practice guidelines. https://doi.org/10.1289/EHP2384
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Affiliation(s)
- Yutaka Aoki
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Debra J Brody
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
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Zhao ZH, Zheng G, Wang T, Du KJ, Han X, Luo WJ, Shen XF, Chen JY. Low-level Gestational Lead Exposure Alters Dendritic Spine Plasticity in the Hippocampus and Reduces Learning and Memory in Rats. Sci Rep 2018; 8:3533. [PMID: 29476096 PMCID: PMC5824819 DOI: 10.1038/s41598-018-21521-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 02/05/2018] [Indexed: 11/24/2022] Open
Abstract
Lead (Pb) is known to impair children's cognitive function. It has been previously shown that developmental Pb exposure alters dendritic spine formation in hippocampal pyramidal neurons. However, the underlying mechanism has not yet been defined. In this study, a low-level gestational Pb exposure (GLE) rat model was employed to investigate the impact of Pb on the spine density of the hippocampal pyramidal neurons and its regulatory mechanism. Pb exposure resulted in impaired performance of the rats in the Morris water maze tasks, and in decreased EPSC amplitudes in hippocampal CA3-CA1 regions. With a 3D reconstruction by the Imaris software, the results from Golgi staining showed that the spine density in the CA1 region was reduced in the Pb-exposed rats in a dose-dependent manner. Decreased spine density was also observed in cultured hippocampal neurons following the Pb treatment. Furthermore, the expression level of NLGN1, a postsynaptic protein that mediates synaptogenesis, was significantly decreased following the Pb exposure both in vivo and in vitro. Up-regulation of NLGN1 in cultured primary neurons partially attenuated the impact of Pb on the spine density. Taken together, our resultssuggest that Pb exposure alters spine plasticity in the developing hippocampus by down-regulating NLGN1 protein levels.
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Affiliation(s)
- Zai-Hua Zhao
- Department of Occupational and Environmental Health and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, No 169 of West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Gang Zheng
- Department of Occupational and Environmental Health and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, No 169 of West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Tao Wang
- Department of Occupational and Environmental Health and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, No 169 of West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Ke-Jun Du
- Department of Occupational and Environmental Health and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, No 169 of West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Xiao Han
- Department of Occupational and Environmental Health and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, No 169 of West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Wen-Jing Luo
- Department of Occupational and Environmental Health and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, No 169 of West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Xue-Feng Shen
- Department of Occupational and Environmental Health and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, No 169 of West Changle Road, Xi'an, Shaanxi, 710032, China.
| | - Jing-Yuan Chen
- Department of Occupational and Environmental Health and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, No 169 of West Changle Road, Xi'an, Shaanxi, 710032, China.
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Suplee PD, Bloch JR, Hillier A, Herbert T. Using Geographic Information Systems to Visualize Relationships Between Perinatal Outcomes and Neighborhood Characteristics When Planning Community Interventions. J Obstet Gynecol Neonatal Nurs 2018; 47:158-172. [PMID: 29406286 DOI: 10.1016/j.jogn.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe maternal morbidity, birth outcomes, and neighborhood characteristics of urban women from a racially segregated city with the use of a geographic information system (GIS). DESIGN Exploratory neighborhood-level study. Existing birth certificate data were linked and aggregated to neighborhood-level data for spatial analyses. SETTING Southern city in New Jersey. SAMPLE Women and their 7,858 live births that occurred between 2009 and 2013. METHODS Secondary analyses of extant sources were conducted. Maternal health and newborn birth outcomes were geocoded and then aggregated to the neighborhood level for further exploratory spatial analyses through our GIS database. An iterative process was used to generate meaningful visual representations of the data through maps of maternal and infant health in 19 neighborhoods. RESULTS The racial and ethnic residential segregation and neighborhood patterns of associations of adverse birth outcomes with poverty and crime were illustrated in GIS maps. In 43% of the births, women had a documented medical risk. Significantly more preterm births occurred for Black women (p < .01) and women older than 35 years of age (p = .01). The rate of diabetes was greater in Hispanic women, and the rate of pregnancy-related hypertensive disorders was greater in Black women. CONCLUSION Data-driven maps can provide clear evidence of maternal and infant health and health needs based on the neighborhoods where mothers live. This research is important so that maternity care providers can understand contextual factors that affect mothers in their communities and guide the design of interventions.
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Kotey S, Carrico R, Wiemken TL, Furmanek S, Bosson R, Nyantakyi F, VanHeiden S, Mattingly W, Zierold KM. Elevated Blood Lead Levels by Length of Time From Resettlement to Health Screening in Kentucky Refugee Children. Am J Public Health 2017; 108:270-276. [PMID: 29267053 DOI: 10.2105/ajph.2017.304115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine elevated blood lead levels (EBLLs) in refugee children by postrelocation duration with control for several covariates. METHODS We assessed EBLLs (≥ 5µg/dL) between 2012 and 2016 of children younger than 15 years (n = 1950) by the duration of resettlement to health screening by using logistic regression, with control for potential confounders (gender, region of birth, age of housing, and intestinal infestation) in a cross-sectional study. RESULTS Prevalence of EBLLs was 11.2%. Length of time from resettlement to health screening was inversely associated with EBLLs (tertile 2 unadjusted odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.56, 1.12; tertile 3 OR = 0.62; 95% CI = 0.42, 0.90; tertile 2 adjusted odds ratio [AOR] = 0.62; 95% CI = 0.39, 0.97; tertile 3 AOR = 0.57; 95% CI = 0.34, 0.93). There was a significant interaction between intestinal infestation and age of housing (P < .003), indicating significant risk in the joint exposure of intestinal infestation (a pica proxy) and age of house. CONCLUSIONS Elevated blood lead levels were reduced with increasing length of time of resettlement in unadjusted and adjusted models. Improved housing, early education, and effective safe-house inspections may be necessary to address EBLLs in refugees.
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Affiliation(s)
- Stanley Kotey
- Stanley Kotey is with the Department of BioInformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Ruth Carrico, Stephen Furmanek, Rahel Bosson, Sarah VanHeiden, and William Mattingly are with the Department of Medicine, Division of Infectious Diseases, University of Louisville. Timothy Lee Wiemken and Kristina M. Zierold are with the Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville. Florence Nyantakyi is with the Pediatric Society of Ghana, Kumasi, Ghana
| | - Ruth Carrico
- Stanley Kotey is with the Department of BioInformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Ruth Carrico, Stephen Furmanek, Rahel Bosson, Sarah VanHeiden, and William Mattingly are with the Department of Medicine, Division of Infectious Diseases, University of Louisville. Timothy Lee Wiemken and Kristina M. Zierold are with the Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville. Florence Nyantakyi is with the Pediatric Society of Ghana, Kumasi, Ghana
| | - Timothy Lee Wiemken
- Stanley Kotey is with the Department of BioInformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Ruth Carrico, Stephen Furmanek, Rahel Bosson, Sarah VanHeiden, and William Mattingly are with the Department of Medicine, Division of Infectious Diseases, University of Louisville. Timothy Lee Wiemken and Kristina M. Zierold are with the Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville. Florence Nyantakyi is with the Pediatric Society of Ghana, Kumasi, Ghana
| | - Stephen Furmanek
- Stanley Kotey is with the Department of BioInformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Ruth Carrico, Stephen Furmanek, Rahel Bosson, Sarah VanHeiden, and William Mattingly are with the Department of Medicine, Division of Infectious Diseases, University of Louisville. Timothy Lee Wiemken and Kristina M. Zierold are with the Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville. Florence Nyantakyi is with the Pediatric Society of Ghana, Kumasi, Ghana
| | - Rahel Bosson
- Stanley Kotey is with the Department of BioInformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Ruth Carrico, Stephen Furmanek, Rahel Bosson, Sarah VanHeiden, and William Mattingly are with the Department of Medicine, Division of Infectious Diseases, University of Louisville. Timothy Lee Wiemken and Kristina M. Zierold are with the Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville. Florence Nyantakyi is with the Pediatric Society of Ghana, Kumasi, Ghana
| | - Florence Nyantakyi
- Stanley Kotey is with the Department of BioInformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Ruth Carrico, Stephen Furmanek, Rahel Bosson, Sarah VanHeiden, and William Mattingly are with the Department of Medicine, Division of Infectious Diseases, University of Louisville. Timothy Lee Wiemken and Kristina M. Zierold are with the Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville. Florence Nyantakyi is with the Pediatric Society of Ghana, Kumasi, Ghana
| | - Sarah VanHeiden
- Stanley Kotey is with the Department of BioInformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Ruth Carrico, Stephen Furmanek, Rahel Bosson, Sarah VanHeiden, and William Mattingly are with the Department of Medicine, Division of Infectious Diseases, University of Louisville. Timothy Lee Wiemken and Kristina M. Zierold are with the Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville. Florence Nyantakyi is with the Pediatric Society of Ghana, Kumasi, Ghana
| | - William Mattingly
- Stanley Kotey is with the Department of BioInformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Ruth Carrico, Stephen Furmanek, Rahel Bosson, Sarah VanHeiden, and William Mattingly are with the Department of Medicine, Division of Infectious Diseases, University of Louisville. Timothy Lee Wiemken and Kristina M. Zierold are with the Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville. Florence Nyantakyi is with the Pediatric Society of Ghana, Kumasi, Ghana
| | - Kristina M Zierold
- Stanley Kotey is with the Department of BioInformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY. Ruth Carrico, Stephen Furmanek, Rahel Bosson, Sarah VanHeiden, and William Mattingly are with the Department of Medicine, Division of Infectious Diseases, University of Louisville. Timothy Lee Wiemken and Kristina M. Zierold are with the Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville. Florence Nyantakyi is with the Pediatric Society of Ghana, Kumasi, Ghana
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Spatial Surveillance of Childhood Lead Exposure in a Targeted Screening State: An Application of Generalized Additive Models in Denver, Colorado. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 23 Suppl 5 Supplement, Environmental Public Health Tracking:S79-S92. [PMID: 28763391 DOI: 10.1097/phh.0000000000000620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT The targeted nature of Colorado's childhood lead screening program presents several analytical issues that complicate routine epidemiologic surveillance. OBJECTIVES To analyze spatial patterns of childhood lead exposure among children younger than 6 years, identifying areas of increased risk along with associated covariates. METHODS We analyzed a spatial case-control data set of childhood lead poisoning using generalized additive models. Incident cases were represented by the residential locations of children younger than 6 years with confirmed elevated blood lead levels (EBLL) of 5 μg/dL or more recorded between calendar years 2010 and 2014, and controls were sampled from the population at risk. We modeled the effect of spatial location, adjusting for potential spatial confounders. We also adjusted for a number of covariates previously identified in the childhood lead poisoning literature to understand the ecologic-level drivers of spatial variation in risk. MAIN OUTCOME MEASURE(S) Crude and adjusted spatial odds ratios describing the relative frequency of lead poisoning among different locations in Denver, Colorado. RESULTS We found evidence of statistically significant spatial clustering in incident cases of lead poisoning even after adjustment for age, sex, year, season, and spatially smoothed screening rate. Spatial confounder-adjusted odds ratios in the Denver study area ranged from 0.22 to 2.7. Adjusting for additional ecologic-level covariates effectively accounted for the observed spatial variation. We found that ecologic-level indicators of low socioeconomic status, Hispanic ethnicity, Asian race, and older housing age were all positively and significantly associated with an increased EBLL risk. CONCLUSION Housing and socioeconomic factors continue to be the primary ecologic risk factors associated with childhood lead exposure and can be used to predict risk at a fine spatial resolution in the Denver study area. Our analysis demonstrates how other targeted screening states can be proactive about childhood lead surveillance within their major population centers and enhance the spatial specificity of lead mitigation efforts.
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Blood Lead Levels and Risk Factors among Preschool Children in a Lead Polluted Area in Taizhou, China. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4934198. [PMID: 28466011 PMCID: PMC5390650 DOI: 10.1155/2017/4934198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 01/22/2023]
Abstract
Objective. To determine the blood lead levels and identify related risk factors among preschool children in a lead polluted area (Taizhou, China) and provide theoretical support for prevention of lead pollution. Methods. A stratified-clustered-random sampling method was used to determine the survey sample. Blood lead levels were determined by the tungsten atomizer absorption spectrophotometer. Results. A total of 2,018 subjects (average age of 59 months; 1,087 boys and 931 girls) were included. The arithmetic mean, geometric mean, and median blood lead levels of the preschool children were 56.4 μg/L, 48.9 μg/L, and 46 μg/L. A total of 8.8% children had blood lead levels >100 μg/L and 43.9% had blood lead levels >50 μg/L. Mother's education level, father's occupation, decorative tableware, exposure to makeup, and the residential floor were all risk factors for elevated blood lead levels (odds ratios of 1.42, 1.21, 1.11, 1.19, and 1.27, resp.), while hand washing before eating food was a protective factor (odds ratio of 0.88). Conclusions. The blood lead levels of preschool children in Taizhou were higher than in other areas in China and in developed countries. Therefore, policies ensuring lead-based industries are not placed in close proximity to residential areas are required.
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Boutwell BB, Nelson EJ, Emo B, Vaughn MG, Schootman M, Rosenfeld R, Lewis R. The intersection of aggregate-level lead exposure and crime. ENVIRONMENTAL RESEARCH 2016; 148:79-85. [PMID: 27035924 DOI: 10.1016/j.envres.2016.03.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 06/05/2023]
Abstract
CONTEXT Childhood lead exposure has been associated with criminal behavior later in life. The current study aimed to analyze the association between elevated blood lead levels (n=59,645) and crime occurrence (n=90,433) across census tracts within St. Louis, Missouri. DESIGN Longitudinal ecological study. SETTING Saint Louis, Missouri. EXPOSURE MEASURE Blood lead levels. MAIN OUTCOME MEASURE Violent, Non-violent, and total crime at the census tract level. RESULTS Spatial statistical models were used to account for the spatial autocorrelation of the data. Greater lead exposure at the census-tract level was associated with increased violent, non-violent, and total crime. In addition, we examined whether non-additive effects existed in the data by testing for an interaction between lead exposure and concentrated disadvantage. Some evidence of a negative interaction emerged, however, it failed to reach traditional levels of statistical significance (supplementary models, however, revealed a similar negative interaction that was significant). CONCLUSIONS More precise measurements of lead exposure in the aggregate, produced additional evidence that lead is a potent predictor of criminal outcomes.
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Affiliation(s)
- Brian B Boutwell
- School of Social Work, College for Public Health & Social Justice, Saint Louis University, 3550 Lindell Boulevard, St. Louis, MO 63103-1021, United States; Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, United States.
| | - Erik J Nelson
- Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, United States
| | - Brett Emo
- Department of Environmental and Occupational Health, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, United States
| | - Michael G Vaughn
- School of Social Work, College for Public Health & Social Justice, Saint Louis University, 3550 Lindell Boulevard, St. Louis, MO 63103-1021, United States
| | - Mario Schootman
- Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, United States
| | - Richard Rosenfeld
- Department of Criminology and Criminal Justice, University of Missouri-St. Louis, One University Blvd., St. Louis, MO 63121, United States
| | - Roger Lewis
- Department of Environmental and Occupational Health, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, United States
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Gonzales FA, Jones RR, Deardorff J, Windham GC, Hiatt RA, Kushi LH. Neighborhood deprivation, race/ethnicity, and urinary metal concentrations among young girls in California. ENVIRONMENT INTERNATIONAL 2016; 91:29-39. [PMID: 26908165 PMCID: PMC6360017 DOI: 10.1016/j.envint.2016.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/31/2016] [Accepted: 02/02/2016] [Indexed: 05/26/2023]
Abstract
BACKGROUND Although metals can adversely impact children's health, the distribution of exposures to many metals, particularly among vulnerable subpopulations, is not well characterized. OBJECTIVES We sought to determine whether neighborhood deprivation was associated with urinary concentrations of thirteen metals and whether observed relationships varied by race/ethnicity. METHODS We obtained neighborhood characteristics from the 2005-2009 American Community Survey. Demographic information and urine samples from 400 healthy young girls in Northern California were obtained during a clinical visit. Urine samples were analyzed for metals using inductively-coupled plasma-mass spectrometry and levels were corrected for creatinine. We ran analysis of variance and generalized linear regression models to estimate associations of urinary metal concentrations with neighborhood deprivation and race/ethnicity and stratified multivariable models to evaluate possible interactions among predictors on metals concentrations. RESULTS Urinary concentrations of three metals (barium, lead, antimony) varied significantly across neighborhood deprivation quartiles, and four (barium, lead, antimony, tin) varied across race/ethnicity groups. In models adjusted for family income and cotinine, both race/ethnicity (F3,224=4.34, p=0.01) and neighborhood deprivation (F3,224=4.32, p=0.01) were associated with antimony concentrations, but neither were associated with lead, barium, or tin, concentrations. Examining neighborhood deprivation within race/ethnicity groups, barium levels (pinteraction<0.01) decreased with neighborhood deprivation among Hispanic girls (ptrend<0.001) and lead levels (pinteraction=0.06) increased with neighborhood deprivation among Asian girls (ptrend=0.04). CONCLUSIONS Our results indicate that children's vulnerability to some metals varies by neighborhood deprivation quartile and race/ethnicity. These differential distributions of exposures may contribute to environmental health disparities later in life.
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Affiliation(s)
- Felisa A Gonzales
- National Cancer Institute, Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, BG 9609 RM 3E502 MSC 9712, 9609 Medical Center Drive, Rockville, MD 20850-9712, United States.
| | - Rena R Jones
- National Cancer Institute, Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, BG 9609 RM 6E124 MSC 9771, 9609 Medical Center Drive, Rockville, MD 20850-9771, United States.
| | - Julianna Deardorff
- University of California at Berkeley, School of Public Health, Department of Community Health and Human Development, 50 University Hall #7360, Berkeley, CA 94720-7360, United States.
| | - Gayle C Windham
- California Department of Public Health, Environmental Health Investigations Branch, 850 Marina Bay Parkway, Building P, 3rd Floor, Richmond, CA 94804, United States.
| | - Robert A Hiatt
- University of California at San Francisco, Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, Box 0560, San Francisco, CA 94143-0560, United States.
| | - Lawrence H Kushi
- Kaiser Permanente, Division of Research, 2000 Broadway, Oakland, CA 94612, United States.
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