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Williams PL, Karalius B, Patel K, Aschengrau A, Chakhtoura N, Enriquez N, Moye J, Garvie PA, Monte D, Seage GR, Zorrilla C, Mussi-Pinhata MM. Fetal growth assessed via ultrasound in relation to maternal HIV infection status and antiretroviral regimens. AIDS 2024; 38:567-577. [PMID: 37991521 PMCID: PMC10922527 DOI: 10.1097/qad.0000000000003796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To evaluate effects of maternal HIV and antiretroviral treatment (ART) on intrauterine fetal growth. DESIGN Prospective cohort studies of HIV and ZIKA infection among women living with HIV (WLHIV) and women not living with HIV (WNLHIV) conducted in Brazil and the US from 2016 to 2020. METHODS We evaluated fetal growth via repeated ultrasounds and calculated z scores for fetal growth measures using Intergrowth-21st standards among women with singleton pregnancies. Adjusted linear mixed models were fit for each fetal growth z score by HIV status. Among WLHIV, we compared fetal growth z scores by the most common maternal ART regimens, stratified by timing of ART initiation. RESULTS We included 166 WLHIV and 705 WNLHIV; none had Zika infection. The z scores were similar for WLHIV and WNLHIV for femur length (latest third trimester median = 1.08) and estimated fetal weight (median ≈0.60); adjusted mean differences in fetal weight z scores by HIV status were less than 0.1 throughout gestation. Other fetal growth measurements were lower for WLHIV than WNLHIV early in gestation but increased more rapidly over gestation. Among WLHIV not on ART at conception, adjusted mean z scores were generally similar across regimens initiated during pregnancy but somewhat lower for atazanavir-based regimens for biparietal diameter compared with efavirenz-based or raltegravir-based regimens. Among WLHIV on ART at conception, mean z scores were similar across ART regimens. CONCLUSION Within our cohorts, fetal growth was lower in WLHIV than WNLHIV early in gestation but similar by the end of gestation, which is reassuring. Among WLHIV, fetal growth measures were generally similar across ART regimens evaluated.
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Affiliation(s)
- Paige L Williams
- Center for Biostatistics in AIDS Research
- Department of Biostatistics
- Department of Epidemiology, Harvard T. H. Chan School of Public Health
| | - Brad Karalius
- Department of Epidemiology, Harvard T. H. Chan School of Public Health
| | - Kunjal Patel
- Center for Biostatistics in AIDS Research
- Department of Epidemiology, Harvard T. H. Chan School of Public Health
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Nahida Chakhtoura
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | | | - Jack Moye
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Patricia A Garvie
- Research Department, Children's Diagnostic & Treatment Center, Fort Lauderdale, FL
| | | | - George R Seage
- Department of Epidemiology, Harvard T. H. Chan School of Public Health
| | | | - Marisa M Mussi-Pinhata
- Research Department, Children's Diagnostic & Treatment Center, Fort Lauderdale, FL
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Aschengrau A, Winter MR, Shea MG. Association between resilience promotion factors during childhood and risk of drug use disorder during adulthood. Addict Subst Abus (Middlet) 2023; 2:1-10. [PMID: 37427318 PMCID: PMC10326717 DOI: 10.46439/addiction.2.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Few studies have been conducted on the relationship between "outside-residing" resilience characteristics and the risk of developing drug use disorder later in life. These characteristics include responsive and caring parenting, household routines involving regular family meals and bedtime routines, social support from peers, participation in organized activities, and religious service attendance. We quantified the association between these resilience promotion factors during childhood and the risk of developing criteria for drug use disorder during adulthood using data from a retrospective cohort study of 618 adults born in Massachusetts during 1969-1983, including those with adverse childhood experiences (ACEs). Self-administered questionnaires gathered information on criteria for drug use disorder, ACEs, and family and community resilience promotion factors. Compared to individuals with "low" numbers of resilience promotion factors, 30% (95% CI: 0.5-0.9) and 50% reductions (95% CI: 0.4-0.8) in the risk of developing one or more criteria for drug use disorder were observed among those with "moderate" and "high" numbers of resilience factors, respectively (p value for trend=0.003). Overall, family factors were associated with greater risk reductions than comparable numbers of community factors. Among individuals with ACEs, a "high" number of family factors but not community factors were associated with a reduction in risk (RR:0.6, 95% CI:0.4-1.0 for family factors, RR:1.0, 95% CI:0.5-1.8 for community factors). These results suggest that the risk of developing criteria for drug use disorder decreases in a dose-response fashion according to the number of "outside-residing" resilience promotion factors during childhood, and that family factors are associated with greater risk reductions than community factors, particularly among individuals with ACEs. Coordinated prevention efforts at the family and community level are recommended to reduce the risk of this important societal problem.
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Affiliation(s)
- Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, Boston MA 02118, USA
| | - Margaret G. Shea
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, Boston MA 02118, USA
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Rodriguez E, Peer K, Fruh V, James K, Williams A, de Figueiredo Veiga A, Winter MR, Shea A, Aschengrau A, Lane KJ, Mahalingaiah S. Digital Global Recruitment for Women’s Health Research: Cross-sectional Study. JMIR Form Res 2022; 6:e39046. [PMID: 35969168 PMCID: PMC9520381 DOI: 10.2196/39046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background
With the increased popularity of mobile menstrual tracking apps and boosted Facebook posts, there is a unique opportunity to recruit research study participants from across the globe via these modalities to evaluate women’s health. However, no studies to date have assessed the feasibility of using these recruitment sources for epidemiological research on ovulation and menstruation.
Objective
The objective of this study was to assess the feasibility of recruiting a diverse sample of women to an epidemiological study of ovulation and menstruation (OM) health (OM Global Health Study) using digital recruitment sources. The feasibility and diversity were assessed via click and participation rates, geographic location, BMI, smoking status, and other demographic information.
Methods
Participants were actively recruited via in-app messages using the menstrual tracking app Clue (BioWink GmbH) and a boosted Facebook post by DivaCup (Diva International Inc.). Other passive recruitment methods also took place throughout the recruitment period (eg, email communications, blogs, other social media). The proportion of participants who visited the study website after viewing and clicking the hypertext link (click rates) in the in-app messages and boosted Facebook post and the proportion of participants who completed the surveys per the number of completed consent and eligibility screeners (participation rates) were used to quantify the success of recruiting participants to the study website and study survey completion, respectively. Survey completion was defined as finishing the pregnancy and birth history section of the OM Global Health Study questionnaire.
Results
The recruitment period was from February 27, 2018, through January 24, 2020. In-app messages and the boosted Facebook post were seen by 104,000 and 21,400 people, respectively. Overall, 215 participants started the OM Global Health Study survey, of which 140 (65.1%), 39 (18.1%), and 36 (16.8%) participants were recruited via the app, the boosted Facebook post, and other passive recruitment methods, respectively. The click rate via the app was 18.9% (19,700 clicks/104,000 ad views) and 1.6% via the boosted Facebook post (340 clicks/21,400 ad views.) The overall participation rate was 44.6% (198/444), and the average participant age was 21.8 (SD 6.1) years. In terms of geographic and racial/ethnic diversity, 91 (44.2%) of the participants resided outside the United States and 147 (70.7%) identified as non-Hispanic White. In-app recruitment produced the most geographically diverse stream, with 44 (32.8%) of the 134 participants in Europe, 77 (57.5%) in North America, and 13 (9.8%) in other parts of the world. Both human error and nonhuman procedural breakdowns occurred during the recruitment process, including a computer programming error related to age eligibility and a hacking attempt by an internet bot.
Conclusions
In-app messages using the menstrual tracking app Clue were the most successful method for recruiting participants from many geographic regions and producing the greatest numbers of started and completed surveys. This study demonstrates the utility of digital recruitment to enroll participants from diverse geographic locations and provides some lessons to avoid technical recruitment errors in future digital recruitment strategies for epidemiological research.
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Affiliation(s)
- Erika Rodriguez
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Komal Peer
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Victoria Fruh
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Kaitlyn James
- Deborah Kelly Center for Outcomes Research, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
| | - Anna Williams
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| | | | - Michael R Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, United States
| | | | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Shruthi Mahalingaiah
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
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Abstract
BACKGROUND Polycystic ovary morphology (PCOM) is an ultrasonographic finding that can be present in women with ovulatory disorder and oligomenorrhea due to hypothalamic, pituitary, and ovarian dysfunction. While air pollution has emerged as a possible disrupter of hormone homeostasis, limited research has been conducted on the association between air pollution and PCOM. METHODS We conducted a longitudinal cohort study using electronic medical records data of 5,492 women with normal ovaries at the first ultrasound that underwent a repeated pelvic ultrasound examination during the study period (2004-2016) at Boston Medical Center. Machine learning text algorithms classified PCOM by ultrasound. We used geocoded home address to determine the ambient annual average PM2.5 exposures and categorized into tertiles of exposure. We used Cox Proportional Hazards models on complete data (n = 3,994), adjusting for covariates, and additionally stratified by race/ethnicity and body mass index (BMI). RESULTS Cumulative exposure to PM2.5 during the study ranged from 4.9 to 17.5 µg/m3 (mean = 10.0 μg/m3). On average, women were 31 years old and 58% were Black/African American. Hazard ratios and 95% confidence intervals (CI) comparing the second and third PM2.5 exposure tertile vs. the reference tertile were 1.12 (0.88, 1.43) and 0.89 (0.62, 1.28), respectively. No appreciable differences were observed across race/ethnicity. Among women with BMI ≥ 30 kg/m2, we observed weak inverse associations with PCOM for the second (HR: 0.93, 95% CI: 0.66, 1.33) and third tertiles (HR: 0.89, 95% CI: 0.50, 1.57). CONCLUSIONS In this study of reproductive-aged women, we observed little association between PM2.5 concentrations and PCOM incidence. No dose response relationships were observed nor were estimates appreciably different across race/ethnicity within this clinically sourced cohort.
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Affiliation(s)
- Victoria Fruh
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jay Jojo Cheng
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 702 West Johnson Street, Madison, WI, USA
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114-2696, USA
| | - Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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Doran CR, Aschengrau A. Prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water and sleep quality in adulthood: a retrospective cohort study. Environ Health 2022; 21:15. [PMID: 35033085 PMCID: PMC8760772 DOI: 10.1186/s12940-021-00819-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Communities in Cape Cod, Massachusetts were exposed to tetrachloroethylene (PCE) through contaminated drinking water from 1969 to 1983. PCE exposure during adulthood has well-established neurotoxic effects; however, long-term impacts stemming from early life exposure, especially adverse effects on sleep quality, are not well understood. METHODS The present analysis was based on data from the Cape Cod Health Study, a retrospective cohort study of the long-term neurotoxic impacts of early-life exposure to PCE-contaminated drinking water. Exposure to PCE-contaminated water was estimated using a validated leaching and transport model. Measures of sleep quality were obtained from self-administered questionnaires. Generalized estimating equations were used to generate risk ratios and 95% confidence intervals to estimate the association between early-life PCE exposure and sleep quality among 604 participants. RESULTS Compared to unexposed participants, any PCE exposure during early life was associated with 1.57 times the risk of reporting breathing pauses during sleep (95% CI 0.92-2.68). Low-level exposure to PCE was associated with 1.50 times the risk of reporting sleep apnea or other sleep disorders (95% CI 0.78-2.89), while high levels of exposure had comparable risk compared to no exposure (RR = 0.94, 95% CI 0.50-1.79). Weak or no associations were observed for other sleep quality outcomes. In stratified analyses participants with mental illness and/or substance use disorder had increased risk ratios for short sleep duration associated with PCE exposure. CONCLUSION These findings suggest that early-life exposure to PCE may be associated with a moderate increase in the risk of reporting breathing pauses during sleep in adulthood and that a history of mental illness and/or substance use disorder may exacerbate the risk of short sleep duration.
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Affiliation(s)
- Charlotte R Doran
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot 328 east, Boston, MA, 02118, USA
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot 328 east, Boston, MA, 02118, USA.
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Aschengrau A, Mussi-Pinhata MM, Moye J, Chakhtoura N, Patel K, Williams PL, Karalius B, Garvie PA, Monte D, Whalen F, Lebov J, Seage GR. An International Prospective Cohort Study of HIV and Zika in Infants and Pregnancy (HIV ZIP): Study Protocol. Front Glob Womens Health 2021; 2:574327. [PMID: 34816174 PMCID: PMC8594009 DOI: 10.3389/fgwh.2021.574327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Zika virus (ZIKV) infection may adversely affect pregnancies of women living with HIV (WLHIV). Because no study to date has focused on maternal and child effects of HIV and ZIKV co-infection in pregnant women, we undertook the International Prospective Cohort Study of HIV and Zika in Infants and Pregnancy (HIV ZIP). The aims of this two-phase study of pregnant women and their infants are to compare the incidence of ZIKV infection among pregnant women with and without HIV infection and to determine the risk of adverse maternal and child outcomes associated with ZIKV/HIV co-infection at clinical sites in Brazil, Puerto Rico, and the continental United States. Phase I was designed to enroll pregnant women/infant pairs who were: (1) infected with HIV only, (2) infected with ZIKV only, (3) infected with HIV and ZIKV, and (4) not infected with either HIV or ZIKV. A key goal of this phase was to assess the feasibility of enrolling 200 women/infant pairs within a year, with a target of 150 WLHIV, 50 HIV-uninfected women, and a minimum of 20 who were co-infected with HIV and ZIKV. If the feasibility of Phase I proved successful, Phase II would enroll up to 1,800 additional pregnant women/infant pairs to the same four groups. Enrolled women in both phases were to be followed throughout their pregnancy and up to 6 weeks post-partum. Infants were also to be followed for 1 year after birth. To date, Phase 1 data collection and follow-up have been completed. Delineation of possible harmful effects of HIV/ZIKV co-infection will allow the formulation of standard-of-care recommendations to minimize adverse effects but enable the continuation of preventive HIV therapy. Furthermore, while the prospective HIV ZIP study was developed before the COVID pandemic, it is especially relevant today since it can be easily adapted to provide critically important information on the impact of COVID-19 infection or other still unrecognized new agents among pregnant women and their offspring worldwide.
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Affiliation(s)
- Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Marisa M Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - John Moye
- Maternal Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Nahida Chakhtoura
- Maternal Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Kunjal Patel
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Paige L Williams
- Departments of Biostatistics and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Brad Karalius
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Patricia A Garvie
- Research Department, Children's Diagnostic and Treatment Center, Fort Lauderdale, FL, United States
| | | | | | - Jill Lebov
- Research Triangle Institute International, Research Triangle Park, NC, United States
| | - George R Seage
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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Butler L, Gallagher L, Winter M, Fabian MP, Wesselink A, Aschengrau A. Residential proximity to roadways and placental-associated stillbirth: a case-control study. Int J Environ Health Res 2021; 31:465-474. [PMID: 31587563 PMCID: PMC7131873 DOI: 10.1080/09603123.2019.1673882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/25/2019] [Indexed: 06/10/2023]
Abstract
We conducted a retrospective case-control study of 1,097 women in Massachusetts and Rhode Island, USA, to examine the association between stillbirth related to placental abruption or placental insufficiency and maternal exposure to traffic-related air pollution. We utilized distance to nearest roadway proximity metrics as a proxy for traffic-related air pollution exposure. No meaningful increase in the overall odds of placental-associated stillbirths was observed (adjusted OR: 1.1, 95% CI: 0.5-2.8). However, mothers living within 50 m of a roadway had a 60% increased odds of experiencing a stillbirth related to placental abruption compared to mothers living greater than 200 m away. This suggestive finding was imprecise due to the small case number in the highest exposure category (95% CI: 0.6-4.0). Future studies of placental abruption with more precise exposure assessments are warranted.
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Affiliation(s)
- Lindsey Butler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Lisa Gallagher
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - M. Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Amelia Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
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Stallings TL, Riefkohl Lisci A, McCray NL, Weiner DE, Kaufman JS, Aschengrau A, Ma Y, LaValley MP, Ramírez-Rubio O, Jose Amador J, López-Pilarte D, Laws RL, Winter M, McSorley VE, Brooks DR, Applebaum KM. Dysuria, heat stress, and muscle injury among Nicaraguan sugarcane workers at risk for Mesoamerican nephropathy. Scand J Work Environ Health 2021; 47:377-386. [PMID: 34003295 PMCID: PMC8259701 DOI: 10.5271/sjweh.3963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objectives: Nicaraguan sugarcane workers, particularly cane cutters, have an elevated prevalence of chronic kidney disease of unknown origin, also referred to as Mesoamerican nephropathy (MeN). The pathogenesis of MeN may include recurrent heat stress, crystalluria, and muscle injury with subsequent kidney injury. Yet, studies examining the frequency of such events in long-term, longitudinal studies are limited. Methods: Using employment and medical data for male workers at a Nicaraguan sugarcane company, we classified months of active work as either work as a cane cutter or other sugarcane job and determined occurrence of dysuria, heat events and muscle events. Work months and events occurred January 1997 to June 2010. Associations between cane cutting and each outcome were analyzed using logistic regression based on generalized estimating equations for repeated events, controlling for age. Results: Among 242 workers with 7257 active work months, 19.5% of person-months were as a cane cutter. There were 160, 21, and 16 episodes of dysuria, heat events, and muscle events, respectively. Compared with work months in other jobs, cane cutting was associated with an elevated odds of dysuria [odds ratio 2.40 (95% confidence interval 1.56–3.68)]. The number of heat and muscle events by cane cutter and other job were limited. Conclusions: Working as a cane cutter compared with other jobs in the sugarcane industry was associated with increased dysuria, supporting the hypothesis that cane cutters are at increased risk of events suspected of inducing or presaging clinically evident kidney injury.
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Affiliation(s)
- Tiffany L Stallings
- The George Washington University, Milken Institute School of Public Health, Department of Environmental and Occupational Health, 950 New Hampshire Ave., NW, Suite 400, Washington, DC 20052, USA.
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Friedman A, Shea M, Winter MR, Saitz R, Aschengrau A. Prenatal and early childhood exposure to tetrachloroethylene (PCE) and non-medical use of prescription drugs: A retrospective cohort study in Cape Cod, MA. Environ Res 2021; 196:110384. [PMID: 33129864 DOI: 10.1016/j.envres.2020.110384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Between 1968 and 1983, public drinking water supplies of Cape Cod, Massachusetts were contaminated with the chlorinated solvent tetrachloroethylene (PCE). We previously found an affinity for risk-taking behaviors, including the use of illicit drugs, following prenatal and early childhood exposure to PCE. Using newly collected data, we investigated the risk of non-medical use of prescription drugs (NMUPD) following prenatal and early childhood PCE exposure. METHODS Participants were identified from a retrospective cohort study ("Cape Cod Health Study") via cross-matching birth certificates and water system data. The original self-administered questionnaire gathered data on demographics, work and medical history, and alcohol and illicit drug use from 618 individuals (363 exposed and 255 unexposed). The follow-up survey added questions on non-medical use of prescription pain relievers, tranquilizers, stimulants and sedatives. A validated leaching and transport model was used to estimate exposure to PCE exposure in drinking water. RESULTS There was a wide distribution of cumulative prenatal and early childhood PCE exposure levels (range: 0.04 g-3722.2 g). PCE exposed subjects had a 1.92-fold increase in risk of any non-medical use of prescription drugs [Adjusted RR: 1.92, (95% CI: 1.31, 2.83)]. Furthermore, the association followed a dose-response relationship where the risk of NMUPD was higher for those exposed to PCE levels greater than or equal the median level versus those exposed to levels less than the median [Adjusted RR: 2.05 (95% CI: 1.34, 3.15) vs. 1.83 (95% CI: 1.20, 2.79) (p-value for trend < 0.01)]. Additionally, we found moderate increases in risk by level of non-medical use (any non-medical use, non-medical use of 1 or more categories of prescription drugs, or 2+ categories) as well as by category of drug for pain relivers, stimulants and tranquilizers. CONCLUSION We found that prenatal and early childhood exposure to PCE was associated with a moderate increase in the risk of NMUPD. Exposed subjects had dose-related increased risks of NMUPD of pain relievers, tranquilizers, and stimulants. This study has a number of limitations and is the first to report this association. Additional longitudinal studies of populations exposed to PCE during early life should be conducted to examine its long-term neurotoxic effects.
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Affiliation(s)
- Alexa Friedman
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
| | - Margaret Shea
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA.
| | - Michael R Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA.
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
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Aschengrau A. In Memoriam: George R. Seage III, 1957-2021. Epidemiology 2021; 32:313-314. [PMID: 37681512 PMCID: PMC8011508 DOI: 10.1097/ede.0000000000001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Mahalingaiah S, Cheng JJ, Winter MR, Rodriguez E, Fruh V, Williams A, Nguyen M, Madhavan R, Karanja P, MacRae J, Konanki SC, Lane KJ, Aschengrau A. Multimodal Recruitment to Study Ovulation and Menstruation Health: Internet-Based Survey Pilot Study. J Med Internet Res 2021; 23:e24716. [PMID: 33861203 PMCID: PMC8087968 DOI: 10.2196/24716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/30/2020] [Accepted: 03/11/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Multimodal recruitment strategies are a novel way to increase diversity in research populations. However, these methods have not been previously applied to understanding the prevalence of menstrual disorders such as polycystic ovary syndrome. OBJECTIVE The purpose of this study was to test the feasibility of recruiting a diverse cohort to complete a web-based survey on ovulation and menstruation health. METHODS We conducted the Ovulation and Menstruation Health Pilot Study using a REDCap web-based survey platform. We recruited 200 women from a clinical population, a community fair, and the internet. RESULTS We recruited 438 women over 29 weeks between September 2017 and March 2018. After consent and eligibility determination, 345 enrolled, 278 started (clinic: n=43; community fair: n=61; internet: n=174), and 247 completed (clinic: n=28; community fair: n=60; internet: n=159) the survey. Among all participants, the median age was 25.0 (SD 6.0) years, mean BMI was 26.1 kg/m2 (SD 6.6), 79.7% (216/271) had a college degree or higher, and 14.6% (37/254) reported a physician diagnosis of polycystic ovary syndrome. Race and ethnicity distributions were 64.7% (176/272) White, 11.8% (32/272) Black/African American, 7.7% (21/272) Latina/Hispanic, and 5.9% (16/272) Asian individuals; 9.9% (27/272) reported more than one race or ethnicity. The highest enrollment of Black/African American individuals was in clinic (17/42, 40.5%) compared to 1.6% (1/61) in the community fair and 8.3% (14/169) using the internet. Survey completion rates were highest among those who were recruited from the internet (159/174, 91.4%) and community fairs (60/61, 98.4%) compared to those recruited in clinic (28/43, 65.1%). CONCLUSIONS Multimodal recruitment achieved target recruitment in a short time period and established a racially diverse cohort to study ovulation and menstruation health. There were greater enrollment and completion rates among those recruited via the internet and community fair.
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Affiliation(s)
- Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States.,Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - J Jojo Cheng
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States.,Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, United States
| | - Michael R Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, United States
| | - Erika Rodriguez
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States.,Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States
| | - Victoria Fruh
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Anna Williams
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States
| | - MyMy Nguyen
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States
| | - Rashmi Madhavan
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States
| | - Pascaline Karanja
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States
| | - Jill MacRae
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States
| | - Sai Charan Konanki
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
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12
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Aschengrau A, Grippo A, Winter MR. Influence of Family and Community Socioeconomic Status on the Risk of Adolescent Drug Use. Subst Use Misuse 2021; 56:577-587. [PMID: 33719860 DOI: 10.1080/10826084.2021.1883660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Adolescent drug use increases the risk of mental, physical and social problems later in life and so it is important to understand its complex etiology that likely includes socioeconomic status (SES). We undertook the present analysis using data from a population-based retrospective cohort study to examine the influence of family and community SES in relation to adolescent drug use. We hypothesized that lower levels of community and parental SES would increase the risk of use and that there would be stronger associations for the more proximate family-level factors. Methods: We used self-administered questionnaires (N=1,402) to obtain information on use of marijuana, inhalants, heroin, cocaine/crack, psychedelics/hallucinogens, Ritalin without a prescription, and club drugs during adolescence. Family SES was gathered from birth certificate data on maternal educational level and paternal occupation. Community SES characteristics at birth, age 10 and age 18 were obtained from the US Census Bureau. Results: An increased risk of adolescent drug use was associated with lower maternal education, non-white collar occupations among fathers, and lower community median income, and poverty and unemployment levels at age 18. The strongest associations were seen for the use of multiple drugs (Risk Ratio (RR): 1.7, 95% CI: 1.4-2.2), inhalants (RR: 2.5, 95% CI: 1.5-2.2), crack/cocaine (RR: 2.8, 95% CI: 1.7-4.5), psychedelics/hallucinogens (RR: 1.8, 95% CI: 1.4-2.4), and club/designer drugs (RR: 1.8, 95% CI: 1.2-2.7) among adolescents whose mothers had only a high school education. Conclusions: These results suggest that use of certain drugs during adolescence is associated with both family and community SES measures. However, maternal education appears to have the greatest influence on use, suggesting that a multi-level approach that engages mothers is needed to prevent adolescent drug use.
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Affiliation(s)
- Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Alexandra Grippo
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Michael R Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
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Mahalingaiah S, Cosenza C, Cheng JJ, Rodriguez E, Aschengrau A. Cognitive testing of a survey instrument for self-assessed menstrual cycle characteristics and androgen excess. Fertil Res Pract 2020; 6:19. [PMID: 33292647 PMCID: PMC7650203 DOI: 10.1186/s40738-020-00088-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022]
Abstract
Background In large population-based studies, there is a lack of existing survey instruments designed to ascertain menstrual cycle characteristics and androgen excess status including hirsutism, alopecia, and acne. Our objective was to cognitively test a survey instrument for self-assessed menstrual cycle characteristics androgen excess. Methods Questions to assess menstrual characteristics and health were designed using existing surveys and clinical experience. Pictorial self-assessment tools for androgen excess were also developed with an experienced medical illustrator to include the modified Ferrimen-Galway, acne and androgenic alopecia. These were combined into an online survey instrument using REDCap. Of the 219 questions, 120 were selected for cognitive testing to assess question comprehension in a population representative of the future study population. Results Cognitive testing identified questions and concepts not easily comprehended, recalled, or had problematic response choices. Comprehension examples included simplifying the definition for polycystic ovary syndrome and revising questions on historic menstrual regularity and bleeding duration. Recall and answer formation examples include issues with recalling waist size, beverage consumption, and interpretation of questions using symbols (> or <). The survey was revised based on feedback and subsequently used in the Ovulation and Menstruation (OM) Health Pilot study. Conclusion We present a cognitively tested, novel survey instrument to assess menstrual cycle characteristics and androgen excess.
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Affiliation(s)
- Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Building 1 665 Huntington Avenue, Boston, MA, 02115, USA. .,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital , 55 Fruit Street Yawkey 10, Boston, MA, 02114, USA. .,Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Boston, MA, 02118, USA.
| | - Carol Cosenza
- Center for Survey Research, UMass Boston, 100 Morrissey Blvd, Boston, MA, 02125, USA
| | - J Jojo Cheng
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, 53792, USA
| | - Erika Rodriguez
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital , 55 Fruit Street Yawkey 10, Boston, MA, 02114, USA
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA, 02118, USA
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14
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Aschengrau A, Grippo A, Winter MR, Shea MG, White RF, Saitz R. Drug use disorder following early life exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study. Environ Health 2020; 19:99. [PMID: 32943075 PMCID: PMC7495895 DOI: 10.1186/s12940-020-00638-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Many studies of adults with occupational exposure to solvents such as tetrachloroethylene (PCE) have shown adverse effects on cognition, mood and behavioral problems. Much less is known about neurotoxic effects in early life at lower exposure levels seen in community settings. We recently reported that illicit drug use was more frequent among adults from Cape Cod, Massachusetts who were exposed to PCE-contaminated drinking water during gestation and early childhood than their unexposed counterparts. Using newly collected data from this population-based retrospective cohort study, the current analysis examines whether early life PCE exposure is also associated with drug use disorder over the life course. METHODS Three-hundred and sixty-three subjects with prenatal and early childhood PCE exposure and 255 unexposed subjects were studied. These individuals (median age: 40-41 years) completed self-administered questionnaires on the eleven established diagnostic criteria for drug use disorder and confounding variables. A validated leaching and transport model was used to estimate exposure to PCE-contaminated water. RESULTS Overall, 23.3% of subjects reported having at least one criterion for drug use disorder over their lifetime. Early life PCE exposure was associated with a modest increase in the lifetime presence of one or more diagnostic criteria for drug use disorder (adjusted RR: 1.4, 95% CI: 1.0-1.8). Compared to unexposed subjects, PCE-exposed subjects were more likely to report having most diagnostic criteria of drug use disorder, including neglecting major roles due to drug use, physical and psychological problems related to drug use, and giving up activities due to drug use. No dose-response relationships were observed with increasing levels of PCE exposure. CONCLUSIONS These results suggest that exposure to PCE-contaminated drinking water during early life modestly increases the risk of developing diagnostic criteria for drug use disorder later in life. Because this study has several limitations, these findings should be confirmed in follow-up investigations of other exposed populations with more diverse racial and socioeconomic characteristics.
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Affiliation(s)
- Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Alexandra Grippo
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, Boston, MA 02118 USA
| | - Margaret G. Shea
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, Boston, MA 02118 USA
| | - Roberta F. White
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118 USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118 USA
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA USA
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15
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Wesselink AK, Hatch EE, Rothman KJ, Mikkelsen EM, Aschengrau A, Wise LA. Prospective study of cigarette smoking and fecundability. Hum Reprod 2020; 34:558-567. [PMID: 30576495 DOI: 10.1093/humrep/dey372] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/19/2018] [Accepted: 11/28/2018] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION To what extent is cigarette smoking associated with reduced fecundability? SUMMARY ANSWER Current female smokers, particularly those who had smoked ≥10 cigarettes/day for ≥10 years, had lower fecundability than never smokers, but current male smoking and passive smoking in either partner showed little association with reduced fecundability. WHAT IS KNOWN ALREADY Female smoking has been identified as a cause of infertility, yet there has been limited characterization of the dose and duration at which an effect is observed. Results for male active smoking and passive smoking in both partners are less consistent. STUDY DESIGN, SIZE, DURATION We analyzed data from a North American internet-based preconception cohort study of 5473 female and 1411 male pregnancy planners, enrolled from 2013 to 2018. Participants had been attempting conception for ≤6 menstrual cycles at study entry. PARTICIPANTS/MATERIALS, SETTING, METHODS We collected information on active and passive smoking history on baseline questionnaires. Pregnancy was reported on female bi-monthly follow-up questionnaires. We calculated fecundability ratios (FR) and 95% CI using proportional probabilities regression models, adjusted for demographic, behavioral, medical, reproductive and dietary variables. MAIN RESULTS AND THE ROLE OF CHANCE Female current regular smoking (FR = 0.90, 95% CI: 0.77, 1.07), current occasional smoking (FR = 0.88, 95% CI: 0.73, 1.06), and former smoking (FR = 0.89, 95% CI: 0.81, 0.98) were associated with small reductions in fecundability. Results were stronger among women who smoked ≥10 cigarettes/day for ≥10 years (FR = 0.77, 95% CI: 0.53, 1.10). Male current regular and former smoking, and current passive smoking in either partner were not meaningfully associated with reduced fecundability. In utero exposure to ≥10 cigarettes/day among females was associated with reduced fecundability (FR = 0.75, 95% CI: 0.52, 1.06). LIMITATIONS, REASONS FOR CAUTION Numbers of cigarette smokers, particularly within categories of intensity and duration, were small. Under-reporting of smoking may have resulted in non-differential misclassification, and smokers were more likely to be lost to follow-up. WIDER IMPLICATIONS OF THE FINDINGS Given the consistency of our findings with results from previous studies and our observation of a dose-response relation in intensity of smoking, this study supports an association between female cigarette smoking and lower fecundability. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the National Institute of Child Health and Human Development (R01-HD086742, R21-HD072326, R03-HD090315 and T32-HD052458). The authors declare no competing interests.
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Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, MA, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, MA, USA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, MA, USA.,Research Triangle Institute, Durham, NC, USA
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aaruhus University Hospital, Aarhus, Denmark
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, MA, USA
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16
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Lee SY, Cabral HJ, Aschengrau A, Pearce EN. Associations Between Maternal Thyroid Function in Pregnancy and Obstetric and Perinatal Outcomes. J Clin Endocrinol Metab 2020; 105:5678077. [PMID: 31838502 PMCID: PMC7089848 DOI: 10.1210/clinem/dgz275] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/12/2019] [Indexed: 12/21/2022]
Abstract
CONTEXT The effects of maternal subclinical hypothyroidism on pregnancy outcomes are not clear. OBJECTIVE We aimed to assess potential associations between maternal thyrotropin (thyroid-stimulating hormone [TSH]) levels in pregnancy and obstetric and perinatal outcomes. DESIGN Retrospective cohort study. SETTING Tertiary academic medical center. PATIENTS Women aged ≥18 years with a singleton gestation and no known thyroid disease seen for prenatal care at Boston Medical Center from January 1, 2003 through May 22, 2014, and their fetuses and infants were included. MAIN OUTCOME MEASURES Risk ratios of adverse obstetric and perinatal outcomes. RESULTS A total of 8,413 pregnant women (mean age 29.1 years, 15% white, 60% black, 13% Hispanic) and their fetuses and infants (mean gestational age at birth 38.5 weeks, 52% male, mean birth weight 3.2 kg) were included in the analyses. The median (interquartile range) TSH level was 1.06(0.62-1.60) mIU/L, and 130 women (1.6%) had TSH > 4 mIU/L. Maternal TSH levels > 4 mIU/L were associated with increased risks of prematurity (risk ratio [RR] 2.17 [95% confidence interval 1.15-4.07] P = .016) and neonatal respiratory distress syndrome (RDS) (RR 2.83 [95% confidence interval 1.02-7.86] P = .046) compared to TSH levels ≤ 4 mIU/L. Although not statistically significant, TSH levels > 4 mIU/L were also associated with increased RRs for fetal loss, preeclampsia/eclampsia, and low birth weight. TSH levels > 4 mIU/L were not associated with preterm labor, placental abruption, cesarean section, gestational hypertension or diabetes, or neonatal intensive care unit admission. CONCLUSION Maternal serum TSH concentration > 4 mIU/L in pregnancy was associated with approximately 2-fold increased risks of prematurity and RDS in offspring. Elevated TSH was also associated with statistically non-significant increases in the risk of fetal loss, preeclampsia/eclampsia, and low birth weight.
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Affiliation(s)
- Sun Y Lee
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA, US
- Correspondence and Reprint Requests: Sun Y. Lee, MD. Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, 720 Harrison Avenue, Suite 8100, Boston, MA 02118. E-mail:
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, US
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, US
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA, US
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17
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Aschengrau A, Weinberg JM, Janulewicz PA, Romano ME, Gallagher LG, Winter MR, Martin BR, Vieira VM, Webster TF, White RF, Ozonoff DM. Correction to: Occurrence of mental illness following prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study. Environ Health 2020; 19:40. [PMID: 32272944 PMCID: PMC7147003 DOI: 10.1186/s12940-020-00594-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Following publication of the original article [1], the author reported that, because of a programming error, incorrect sentences and incorrect Table 3 has been published. The correct sentences and Table 3 are shown below.
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Affiliation(s)
- Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA, 02118, USA.
| | - Janice M Weinberg
- Department of Biostatistics, Boston University School of Public Health, Crosstown, 715 Albany Street, Boston, MA, 02118, USA
| | - Patricia A Janulewicz
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA, 02118, USA
| | - Megan E Romano
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA, 02118, USA
- Department of Epidemiology, University of Washington, Box 357236, Seattle, WA, 98195, USA
| | - Lisa G Gallagher
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA, 02118, USA
| | - Michael R Winter
- Data Coordinating Center, Boston University School of Public Health, Crosstown, 715 Albany Street, Boston, MA, 02118, USA
| | - Brett R Martin
- Data Coordinating Center, Boston University School of Public Health, Crosstown, 715 Albany Street, Boston, MA, 02118, USA
| | - Veronica M Vieira
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA, 02118, USA
| | - Thomas F Webster
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA, 02118, USA
| | - Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA
| | - David M Ozonoff
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA, 02118, USA
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Aschengrau A, Winter MR, Gallagher LG, Vieira VM, Butler LJ, Fabian MP, Carwile JL, Wesselink AK, Mahalingaiah S, Janulewicz PA, Weinberg JM, Webster TF, Ozonoff DM. Reproductive and developmental health effects of prenatal exposure to tetrachloroethylene-contaminated drinking water. Environ Sci Process Impacts 2020; 22:555-566. [PMID: 32051987 PMCID: PMC7937243 DOI: 10.1039/c9em00590k] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Tetrachloroethylene (PCE) is a common contaminant in both occupational and community settings. High exposure levels in the workplace have been shown to have adverse impacts on reproduction and development but few epidemiological studies have examined these effects at the lower levels commonly seen in community settings. We were presented with a unique opportunity to examine the reproductive and developmental effects of prenatal exposure to PCE-contaminated drinking water resulting from the installation of vinyl-lined water pipes in Massachusetts and Rhode Island from the late 1960s through 1980. This review describes the methods and findings of two community-based epidemiological studies, places their results in the context of the existing literature, and describes the strengths and challenges of conducting epidemiological research on a historical pollution episode. Our studies found that prenatal exposure to PCE-contaminated drinking water is associated with delayed time-to-pregnancy, and increased risks of placental abruption, stillbirths stemming from placental dysfunction, and certain birth defects. No associations were observed with pregnancy loss, birth weight, and gestational duration. Important strengths of this research included the availability of historical data on the affected water systems, a relatively high exposure prevalence and wide range of exposure levels, and little opportunity for recall bias and confounding. Challenges arose mainly from the retrospective nature of the exposure assessments. This research highlights the importance of considering pregnant women and their developing fetuses when monitoring, regulating, and remediating drinking water contaminants.
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Affiliation(s)
- Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, 710 Albany Street, Boston, MA 02118, USA.
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Wesselink AK, Hatch EE, Rothman KJ, Weuve JL, Aschengrau A, Song RJ, Wise LA. Perceived Stress and Fecundability: A Preconception Cohort Study of North American Couples. Am J Epidemiol 2018; 187:2662-2671. [PMID: 30137198 DOI: 10.1093/aje/kwy186] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/16/2018] [Indexed: 11/14/2022] Open
Abstract
While some epidemiologic studies support the hypothesis that stress can adversely affect fertility, few prospective studies have assessed the association in couples from the general population. We used data from Pregnancy Study Online, a web-based preconception cohort study of pregnancy planners from the United States and Canada (2013-2018), to examine the association between women's and men's perceived stress levels prior to conception and fecundability. Women (aged 21-45 years) and their male partners (aged ≥21 years) who were attempting conception without fertility treatment were eligible. We measured perceived stress using the 10-item Perceived Stress Scale (PSS). We ascertained pregnancy information using bimonthly follow-up questionnaires of female participants. We followed 4,769 couples until self-reported pregnancy, initiation of fertility treatment, loss to follow-up, or 12 menstrual cycles of attempt time, whichever came first. We used proportional probabilities regression models to estimate fecundability ratios and 95% confidence intervals, adjusting for potential confounders. Higher PSS scores among the women were associated with slight reductions in fecundability (comparing PSS scores of ≥25 vs. <10, fecundability ratio = 0.87, 95% confidence interval: 0.74, 1.02). PSS scores among the men were not substantially associated with fecundability.
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Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- RTI International, Research Triangle Park, North Carolina
| | - Jennifer L Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Rebecca J Song
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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20
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Aschengrau A, Gallagher LG, Winter M, Butler L, Patricia Fabian M, Vieira VM. Modeled exposure to tetrachloroethylene-contaminated drinking water and the occurrence of birth defects: a case-control study from Massachusetts and Rhode Island. Environ Health 2018; 17:75. [PMID: 30400949 PMCID: PMC6219161 DOI: 10.1186/s12940-018-0419-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/24/2018] [Indexed: 05/31/2023]
Abstract
BACKGROUND Residents of Massachusetts and Rhode Island were exposed to tetrachloroethylene-contaminated drinking water from 1968 through the early 1990s when it leached from the vinyl lining of asbestos cement water distribution pipes. While occupational exposure to solvents during pregnancy has consistently been linked to an increased risk of certain birth defects, mixed results have been observed for environmental sources of exposure, including contaminated drinking water. The present case-control study was undertaken to examine further the association between prenatal exposure to tetrachloroethylene-contaminated drinking water and the risk of central nervous system defects, oral clefts and hypospadias. METHODS Cases were comprised of live- and stillborn infants delivered between 1968 and 1995 to mothers who resided in 28 Massachusetts and Rhode Island cities and towns with some PCE-contaminated water supplies. Infants with central nervous system defects (N = 268), oral clefts (N = 112) and hypospadias (N = 94) were included. Controls were randomly selected live-born, non-malformed infants who were delivered during the same period and geographic area as cases (N = 771). Vital records and self-administered questionnaires were used to gather identifying information, birth defect diagnoses, and other relevant data. PCE exposure during the first trimester was estimated using water distribution system modeling software that incorporated a leaching and transport model. Prenatal PCE exposure was dichotomized as "high" or "low" exposure at the level corresponding to an estimated average concentration of 40 μg/L, the criterion for remediation when PCE contamination was discovered in 1980. RESULTS Mothers with "high" levels of exposure to PCE-contaminated drinking water during the first trimester (> 40 μg/L) had increased odds of having a child with spina bifida (OR: 2.0, 95% CI: 0.8-5.4), cleft lip with or without cleft palate (OR: 3.8, 95% CI: 1.2-12.3) and hypospadias (OR: 2.1, 95% CI:0.5-8.3). No increases in the odds of other defects were observed in relation to "high" exposure levels. CONCLUSIONS The results of the present study suggest that mothers with "high" PCE exposure levels during the first trimester have increased odds of having a child with spina bifida, cleft lip with or without cleft palate, and hypospadias. These findings support several prior studies that observed an increased risk of selected birth defects following prenatal exposure to solvents in occupational and environmental settings. Even though PCE contamination from vinyl lined pipes was remediated many years ago, it remains a widespread contaminant across the U.S and so environmental regulations must be guided by a precautionary perspective that safeguards pregnant women and their offspring.
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Affiliation(s)
- Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot 3 East, Boston, MA 02118 USA
| | - Lisa G. Gallagher
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot 3 East, Boston, MA 02118 USA
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 715 Albany Street, Fuller-9, Boston, MA 02118 USA
| | - Lindsey Butler
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Talbot 4 West, Boston, MA 02118 USA
| | - M. Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Talbot 4 West, Boston, MA 02118 USA
| | - Veronica M. Vieira
- University of California, Irvine, Program in Public Health, 653 East Peltason Drive, Irvine, CA 92697 USA
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Wesselink AK, Hatch EE, Wise LA, Rothman KJ, Vieira VM, Aschengrau A. Exposure to tetrachloroethylene-contaminated drinking water and time to pregnancy. Environ Res 2018; 167:136-143. [PMID: 30014895 PMCID: PMC6399737 DOI: 10.1016/j.envres.2018.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The synthetic solvent tetrachloroethylene (PCE), commonly used in dry cleaning operations, is a human neurotoxicant and carcinogen. However, its effect on reproduction is poorly understood, as prior studies have been limited to small occupational cohorts. We examined the association between PCE exposure from contamination of the public drinking water supply and time-to-pregnancy (TTP) in a cohort of mothers from Cape Cod, Massachusetts. METHODS The Cape Cod Family Health Study is a retrospective cohort study designed to examine the reproductive and developmental health effects of exposure to PCE-contaminated drinking water. Our analysis included 1565 women who reported 3826 planned pregnancies from 1949 to 1990. Women completed self-administered questionnaires that ascertained TTP for each of her pregnancies, regardless of the outcome, as well as residential history and demographic information. We utilized EPANET water distribution system modeling software and a leaching and transport model to assess PCE exposure for each pregnancy. We used log-binomial regression models to estimate relative risks (RR) and 95% confidence intervals (CI), adjusting for potential confounders. We performed a probabilistic bias analysis to examine the effect of outcome misclassification on our results. RESULTS Any cumulative PCE exposure before pregnancy was associated with a 15% reduction in risk of TTP > 12 months (RR = 0.85, 95% CI: 0.70, 1.03). However, women with the highest average monthly PCE exposure around the time of the pregnancy attempt (≥ 2.5 g) had increased risk of TTP > 12 months (RR = 1.36, 95% CI: 1.06, 1.76). CONCLUSIONS We found little evidence for long-term, cumulative adverse effects of PCE exposure on TTP, but high levels of PCE exposure around the time of the pregnancy attempt were associated with longer TTP. These associations may be underestimated due to the exclusion of unsuccessful pregnancy attempts from our study population, and may be biased by outcome and exposure misclassification given the long-term recall of TTP and use of a leaching and transport model to estimate PCE exposure.
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Affiliation(s)
- Amelia K Wesselink
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA.
| | - Elizabeth E Hatch
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Lauren A Wise
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Kenneth J Rothman
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA; RTI International, Research Triangle Park, NC, USA
| | - Veronica M Vieira
- University of California, Irvine, Program in Public Health, Susan and Henry Samueli College of Health Sciences, Irvine, CA, USA
| | - Ann Aschengrau
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA
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Aschengrau A, Gallagher LG, Winter M, Butler LJ, Patricia Fabian M, Vieira VM. Modeled exposure to tetrachloroethylene-contaminated drinking water and the risk of placenta-related stillbirths: a case-control study from Massachusetts and Rhode Island. Environ Health 2018; 17:58. [PMID: 29970097 PMCID: PMC6029409 DOI: 10.1186/s12940-018-0402-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Residents of Massachusetts and Rhode Island were exposed to tetrachloroethylene (PCE)-contaminated drinking water from 1968 through the early 1990s when the solvent was used to apply a vinyl liner to drinking water mains to address taste and odor problems. Few studies have examined the risk of fetal death among women exposed to solvent-contaminated drinking water. Two previous investigations found moderate increases in the risk of stillbirth among highly exposed women; however, these results were based on a small number of cases. The present case-control study was undertaken to examine further this association with a large number of stillbirths. METHODS Cases were comprised of stillborn infants delivered between 1968 and 1995 to mothers who resided in 28 Massachusetts and Rhode Island cities and towns with some affected water mains (N = 296). Cases were included if the cause of death was placental abruption and/or placental insufficiency. Controls were randomly selected live-born infants who were delivered in the same time period and geographic area (N = 783). Data on confounding variables were gathered from vital records and questionnaires. PCE exposure was estimated using a leaching and transport model integrated into water system software. RESULTS Mothers with any PCE exposure had a 1.7-fold increase in the adjusted odds of placenta-related stillbirth (95% CI: 1.2-2.4). The adjusted odds ratio (OR) increased as a woman's exposure level increased: in comparison to unexposed mothers, ORs were 1.5 (95% CI: 1.0-2.3) for low exposure (> 0-median), 1.7 (95% CI: 1.1-2.5) for moderate exposure (>median-90th percentile) and 1.9 (95% CI: 1.1-3.2) for high exposure (>90th percentile) (p value for trend = 0.02). A similar pattern was observed when PCE exposure was dichotomized at 40 μg/L, the suggested action guideline for remediation (OR = 1.5, 95% CI: 1.1-2.2 and OR = 2.6, 95% CI: 1.4-4.8, respectively, for PCE exposure <=40 μg/L and > 40 μg/L) (p value for trend = .003). CONCLUSIONS We observed a linear dose-dependent increase in the odds of stillbirth due to placental abruption and placental insufficiency with prenatal exposure to PCE contaminated drinking water. Because PCE remains a common drinking water contaminant, these findings highlight the importance of considering pregnant women when monitoring, regulating and remediating drinking water supplies.
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Affiliation(s)
- Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot 3 East, Boston, MA 02118 USA
| | - Lisa G. Gallagher
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot 3 East, Boston, MA 02118 USA
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, M921B, Boston, MA 02118 USA
| | - Lindsey J. Butler
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Talbot 4 West, Boston, MA 02118 USA
| | - M. Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Talbot 4 West, Boston, MA 02118 USA
| | - Veronica M. Vieira
- University of California, Irvine, Program in Public Health, 653 East Peltason Drive, Irvine, CA 92697 USA
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Ross CS, Brooks DR, Aschengrau A, Siegel MB, Weinberg J, Shrier LA. Positive and negative affect following marijuana use in naturalistic settings: An ecological momentary assessment study. Addict Behav 2018; 76:61-67. [PMID: 28756041 DOI: 10.1016/j.addbeh.2017.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/30/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
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Lemkin A, Kistin CJ, Cabral HJ, Aschengrau A, Bair-Merritt M. School connectedness and high school graduation among maltreated youth. Child Abuse Negl 2018; 75:130-138. [PMID: 28483290 DOI: 10.1016/j.chiabu.2017.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/14/2017] [Accepted: 04/24/2017] [Indexed: 05/07/2023]
Abstract
Maltreated youth have higher rates of school dropout than their non-maltreated peers. School connectedness is a modifiable predictor of school success. We hypothesized maltreated youth's school connectedness (supportive relationships with adults at school and participation in school clubs) would be positively associated with high school graduation. We included youth with at least one Child Protective Services (CPS) report by age twelve from Longitudinal Studies of Child Abuse and Neglect, a prospective cohort study. Participation in extracurricular activities and adult relationships reported at age 16, high school graduation/General Education Development (GED) status reported at age 18, and demographics were provided by youth and caregivers. Maltreatment data were coded from CPS records. The outcome was graduation/receipt of GED. Multivariable logistic regressions examined the association between school connectedness and graduation/receipt of GED, controlling for confounders. In our sample of 318 maltreated youth, 73.3% graduated. School club was the only activity with a statistically significant association with graduation in bivariate analysis. Having supportive relationships with an adult at school was not significantly associated with graduation, though only 10.7% of youth reported this relationship. Maltreated youth who participated in school clubs had 2.54 times the odds of graduating, adjusted for study site, gender, poverty status, caregiver high school graduation status, and age at first CPS report (95% CI: [1.02, 6.33]). Few maltreated youth reported relationships with adults at school, and additional efforts may be needed to support these vulnerable youth. School club participation may represent an opportunity to modify maltreated youth's risk for school dropout.
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Affiliation(s)
- Allison Lemkin
- Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, 88 East Newton Street, Vose Hall 3, Boston, MA, 02118, USA; Department of Epidemiology, Boston University School of Public Health, 715 Albany St. Talbot Building, Boston, MA, 02118, USA.
| | - Caroline J Kistin
- Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, 88 East Newton Street, Vose Hall 3, Boston, MA, 02118, USA.
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, Boston, MA, 02118, USA.
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St. Talbot Building, Boston, MA, 02118, USA.
| | - Megan Bair-Merritt
- Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, 88 East Newton Street, Vose Hall 3, Boston, MA, 02118, USA.
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25
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Tassiopoulos K, Huo Y, Braun J, Williams PL, Smith R, Aschengrau A, Nichols S, Hazra R, Meyer WA, Knapp K, Deygoo NS, Seage GR, for the Pediatric HIV/AIDS Cohort S. Blood lead levels and neurodevelopmental function in perinatally HIV-exposed, uninfected children in a US-based longitudinal cohort study. AIDS Res Hum Retroviruses 2017; 33:919-928. [PMID: 28322573 DOI: 10.1089/aid.2016.0265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While children's exposure to environmental lead in the U.S. has decreased, areas of elevated levels remain. Because lead exposure is a risk factor for developmental delays, it should be considered when studying neurodevelopmental effects of in-utero antiretroviral medication (ARV) exposure in the growing population of perinatally HIV-exposed, uninfected children (PHEU). We compared blood lead levels (BPb) in PHEU children enrolled in the Surveillance Monitoring of ART Toxicities (SMARTT) Study to U.S. children, assessed associations with neurodevelopment, and explored whether associations between in-utero ARV and neurodevelopment are modified by BPb. METHODS Prevalence of elevated BPb (≥5 µg/dL) at ages 1-2 years was calculated by year and race/ethnicity and compared to that for children in the National Health and Nutrition Examination Survey (NHANES 2002-2010). Associations between elevated BPb and neurodevelopment at 1 and 3 years were assessed. Associations between ARVs (tenofovir disopropil fumarate [TDF]; atazanavir) and neurodevelopment were evaluated within BPb level (≥5 vs. <5 µg/dL). RESULTS Mean BPb in SMARTT decreased from 5.9 to 2.7 µg/dL between 1998-2014; prevalence of elevated BPb decreased from 50% to 4%. Both were consistently higher than in NHANES. Elevated BPb was associated with cognitive delay at age 3 (adjusted odds ratio: 1.64; 95% CI: 0.95, 2.90). At age 1, TDF was associated with delay only among those with elevated BPb. CONCLUSIONS PHEU children more often had elevated BPb than the general U.S. pediatric population. Exposure to environmental lead is one of several factors that may place these children at higher risk for neurodevelopmental delay.
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Affiliation(s)
- Katherine Tassiopoulos
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yanling Huo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Joseph Braun
- Department of Epidemiology, Brown University, Providence, Rhode Island
| | - Paige L. Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Renee Smith
- Department of Pediatrics, University of Illinois, Chicago, Illinois
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego, California
| | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | | | - Katherine Knapp
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nagamah S. Deygoo
- Department of Pediatrics, NYU School of Medicine, New York, New York
| | - George R. Seage
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Stallings TL, Riefkohl A, Ma Y, Weiner DE, Aschengrau A, Kaufman JS, Ramirez-Rubio O, Amador JJ, Lopez D, Laws R, Winter M, McSorley VE, Brooks D, Applebaum KM. Cane Cutting and Dysuria among male Sugarcane Workers in Nicaragua. Ann Epidemiol 2017. [DOI: 10.1016/j.annepidem.2017.07.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gallagher LG, Webster TF, Aschengrau A. Exploring associations between prenatal solvent exposures and teenage drug and alcohol use: a retrospective cohort study. Environ Health 2017; 16:26. [PMID: 28283038 PMCID: PMC5346200 DOI: 10.1186/s12940-017-0232-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Investigating the effects of prenatal and childhood exposures on behavioral health outcomes in adolescence is challenging given the lengthy period between the exposure and outcomes. We conducted a retrospective cohort study in Cape Cod, Massachusetts to evaluate the impact of prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water on the occurrence of risk-taking behaviors as a teenager. An increased occurrence of risk-taking behaviors, particularly illicit drug use, was observed in those highly exposed to PCE. We hypothesized that there may be other sources of prenatal solvent exposure such as maternal consumption of alcoholic beverages during pregnancy which might modify the previously observed associations between PCE and risk-taking behaviors and so we conducted an exploratory analysis using available cohort data. The current report presents the results of these analyses and describes the difficulties in conducting research on long-term behavioral effects of early life exposures. METHODS The exploratory analysis compared a referent group of subjects with no early life exposure to PCE or alcohol (n = 242) to subjects with only alcohol exposure (n = 201), subjects with only PCE exposure (n = 361), and subjects with exposure to both PCE and alcohol (n = 302). Surveys completed by the subject's mother included questions on prenatal alcoholic beverage consumption and available confounding variables such as cigarette smoking and marijuana use. Surveys completed by the subjects included questions on risk-taking behaviors such as alcoholic beverage consumption and illicit drug use as a teenager and available confounding variables. PCE exposure was modeled using a leaching and transport algorithm embedded in water distribution system modeling software that estimated the amount of PCE delivered to a subject's residence during gestation and early childhood. RESULTS Subjects with early life exposure to both PCE and alcohol had an increased risk of using two or more major drugs as a teen (RR = 1.9 (95% CI 1.2, 3.0)) compared to unexposed subjects. Increased risks for only PCE exposure (RR = 1.6 (95% CI 1.0, 2.4) and only alcohol exposure (RR = 1.3 (95% CI 0.7, 2.1)) were also evident but were smaller than the increased risk associated with both exposures. While available confounding variables were controlled, many relevant social risk factors were not obtained due to limitations in the retrospective study design. CONCLUSIONS This exploratory analysis found evidence for an additive effect of early life exposure to PCE and alcohol on the risk of use of multiple illicit drugs as a teenager. Because of numerous limitations in this retrospective study, further research is needed to examine longstanding behavioral effects of early life exposures. To be most informative, this research should involve long-term prospective data collection.
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Affiliation(s)
- Lisa G. Gallagher
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street T3E, Boston, MA 02118 USA
| | - Thomas F. Webster
- Department of Environmental Health, Boston University School of Public Health, Boston, MA USA
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street T3E, Boston, MA 02118 USA
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Butler LJ, Janulewicz PA, Carwile JL, White RF, Winter MR, Aschengrau A. Childhood and adolescent fish consumption and adult neuropsychological performance: An analysis from the Cape Cod Health Study. Neurotoxicol Teratol 2017; 61:47-57. [PMID: 28263856 DOI: 10.1016/j.ntt.2017.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This exploratory analysis examines the relationship between childhood and adolescent fish consumption and adult neuropsychological performance. DESIGN Data from a retrospective cohort study that assessed fish consumption from age 7 to 18years via questionnaire were analyzed. A subset of the population underwent domain-specific neuropsychological assessment. Functions evaluated included omnibus intelligence, academic achievement, language, visuospatial skills, learning and memory, attention and executive function, fine motor coordination, mood, and motivation to perform. SETTING Eight towns in the Cape Cod region of Massachusetts, USA, an area characterized by high fish consumption and an active seafood industry. SUBJECTS A cohort of 1245 subjects was recruited based on Massachusetts birth records from 1969 to 1983. Sixty-five participants from the original cohort underwent neuropsychological testing in adulthood (average age=30years). RESULTS Participant report of consuming fish at least twice per month was associated with better performance on tests of visual learning, memory, and attentional abilities. However, self-report of consuming fish at rates higher than twice per month was not associated with improved abilities. No statistically significant associations were observed between type of fish consumed (e.g., species known to be high in methylmercury content) and test outcomes. CONCLUSIONS The results suggest that moderate fish consumption during childhood and adolescence may be associated with some cognitive benefits and that consumption of fish during this exposure window may potentially influence adult neuropsychological performance. Future prospective studies should take into account this time period of exposure.
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Affiliation(s)
- Lindsey J Butler
- Department of Environmental Health, Boston University School of Public Health, Medical Campus, 715 Albany Street, T4W, Boston, MA 02118, United States; Department of Epidemiology, Boston University School of Public Health, Medical Campus, 715 Albany Street, T4E, Boston, MA 02118, United States.
| | - Patricia A Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Medical Campus, 715 Albany Street, T4W, Boston, MA 02118, United States
| | - Jenny L Carwile
- Department of Epidemiology, Boston University School of Public Health, Medical Campus, 715 Albany Street, T4E, Boston, MA 02118, United States
| | - Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Medical Campus, 715 Albany Street, T4W, Boston, MA 02118, United States
| | - Michael R Winter
- Data Coordinating Center, Boston University, Medical Campus, 85 East Newton Street, M921, Boston, MA 02118, United States
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Medical Campus, 715 Albany Street, T4E, Boston, MA 02118, United States
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Carwile JL, Butler LJ, Janulewicz PA, Winter MR, Aschengrau A. Childhood Fish Consumption and Learning and Behavioral Disorders. Int J Environ Res Public Health 2016; 13:ijerph13111069. [PMID: 27827868 PMCID: PMC5129279 DOI: 10.3390/ijerph13111069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/20/2016] [Accepted: 10/25/2016] [Indexed: 01/27/2023]
Abstract
Fish is a major source of nutrients critical for brain development during early life. The importance of childhood fish consumption is supported by several studies reporting associations of n-3 polyunsaturated fatty acid (n-3 PUFA) supplementation with better behavior and school performance. However, fish may have a different effect than n-3 PUFA alone due to the neurotoxic effects of methylmercury, a frequent contaminant. We investigated associations of childhood fish consumption with learning and behavioral disorders in birth cohort study of the neurotoxic effects of early life exposure to solvent-contaminated drinking water. Childhood (age 7–12 years) fish consumption and learning and behavioral problems were reported in self-administered questionnaires (age 23–41 at questionnaire completion). Fish consumption was not meaningfully associated with repeating a grade, tutoring, attending summer school, special class placement, or low educational attainment. However, participants who ate fish several times a week had an elevated odds of Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (odds ratio: 5.2; 95% confidence interval: 1.5–18) compared to participants who did not eat fish. While these findings generally support the safety of the observed level of fish consumption, the absence of a beneficial effect may be attributed to insufficient fish intake or the choice of relatively low n-3 PUFA fish.
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Affiliation(s)
- Jenny L Carwile
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Lindsey J Butler
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Patricia A Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Michael R Winter
- Data Coordinating Center, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
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Hewlett M, Chow E, Aschengrau A, Mahalingaiah S. Prenatal Exposure to Endocrine Disruptors: A Developmental Etiology for Polycystic Ovary Syndrome. Reprod Sci 2016; 24:19-27. [PMID: 27342273 DOI: 10.1177/1933719116654992] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common and complex endocrinopathies among reproductive-age women. Polycystic ovary syndrome is characterized by symptomatology of oligomenorrhea and androgen excess, with or without presence of polycystic ovarian morphology. The etiology of PCOS is multifactorial, including genetic and environmental components. It has been previously established that prenatal androgen exposure results in a PCOS phenotype in experimental animal models and epidemiologic human studies. Investigators hypothesize that prenatal exposure to endocrine-disrupting chemicals (EDCs) may contribute to PCOS development. This review examines the emerging research investigating prenatal exposure to 3 major classes of EDCs-bisphenol A (BPA), phthalates, and androgenic EDCs-and the development of PCOS and/or PCOS-related abnormalities in humans and animal models. Highlights of this review are as follows: (1) In rodent studies, maternal BPA exposure alters postnatal development and sexual maturation;, (2) gestational exposure to dibutyl phthalate and di(2-ethylhexyl)phthalate results in polycystic ovaries and a hormonal profile similar to PCOS; and (3) androgenic EDCs, nicotine and 3,4,4'-trichlorocarbanilide, create a hyperandrogenic fetal environment and may pose a potential concern. In summary, prenatal exposure to EDCs may contribute to the altered fetal programming hypothesis and explain the significant variability in severity and presentation.
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Affiliation(s)
- Meghan Hewlett
- 1 Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Erika Chow
- 1 Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Ann Aschengrau
- 2 Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Shruthi Mahalingaiah
- 1 Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA.,2 Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Mahalingaiah S, Winter MR, Aschengrau A. Association of prenatal and early life exposure to tetrachloroethylene (PCE) with polycystic ovary syndrome and other reproductive disorders in the cape cod health study: A retrospective cohort study. Reprod Toxicol 2016; 65:87-94. [PMID: 27412368 DOI: 10.1016/j.reprotox.2016.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/01/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tetrachloroethylene (PCE) is an organic lipophilic solvent with possible neuroendocrine toxicity. The objective of this study was to determine the association of prenatal and early childhood exposure to PCE-contaminated drinking water and development of adult-onset Polycystic Ovary Syndrome (PCOS), endometriosis, difficulty conceiving and miscarriage. METHODS Five-hundred exposed and 331 unexposed female participants born between 1969 and 1983 completed questionnaires on demographic and lifestyle characteristics, and reproductive disorders. Residential locations from the prenatal period through five years of age were used to estimate early life PCE exposure with water modeling software. RESULTS For any early life exposure to PCE, the adjusted risk ratio for PCOS was 0.9 (95% CI: 0.5-1.6). No statistically significant associations were observed for increasing levels of exposure with PCOS or the other reproductive disorders. CONCLUSION No meaningful associations were found among adult women with early life exposure to PCE-contaminated drinking water and adult-onset reproductive disorders.
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Affiliation(s)
- Shruthi Mahalingaiah
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, 85 E. Concord St., 6th Floor, Boston, MA 02118, USA.
| | - Michael R Winter
- Data Coordinating Center, Boston University School of Public Health, Fuller 9, 715 Albany Street, Boston MA 02118, USA.
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA 02118, USA.
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Mahalingaiah S, Hart JE, Laden F, Farland LV, Hewlett MM, Chavarro J, Aschengrau A, Missmer SA. Adult air pollution exposure and risk of infertility in the Nurses' Health Study II. Hum Reprod 2016; 31:638-47. [PMID: 26724803 DOI: 10.1093/humrep/dev330] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/07/2015] [Indexed: 01/01/2023] Open
Abstract
STUDY QUESTION Is there an association between air pollution exposures and incident infertility? SUMMARY ANSWER Increased exposure to air pollution is associated with an increased incidence of infertility. WHAT IS KNOWN ALREADY Exposures to air pollution have been associated with lower conception and fertility rates. However, the impact of pollution on infertility incidence is unknown. STUDY DESIGN, SIZE, DURATION Prospective cohort study using data collected from 116 430 female nurses from September 1989 to December 2003 as part of the Nurses' Health Study II cohort. PARTICIPANTS/MATERIALS, SETTING, METHODS Infertility was defined by report of attempted conception for ≥12 months without success. Participants were able to report if evaluation was sought and if so, offer multiple clinical indications for infertility. After exclusion, 36 294 members were included in the analysis. Proximity to major roadways and ambient exposures to particulate matter less than 10 microns (PM10), between 2.5 and 10 microns (PM2.5-10), and less than 2.5 microns (PM2.5) were determined for residential addresses for the 36 294 members between the years of 1993 and 2003. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using multivariable adjusted Cox proportional hazard models with time-varying covariates. MAIN RESULTS AND THE ROLE OF CHANCE Over 213 416 person-years, there were 2508 incident reports of infertility. Results for overall infertility were inconsistent across exposure types. We observed a small increased risk for those living closer to compared to farther from a major road, multivariable adjusted HR = 1.11 (CI: 1.02-1.20). This was consistent for those reporting primary or secondary infertility. For women living closer to compared to farther from a major road, for primary infertility HR = 1.05 (CI: 0.94-1.17), while for secondary infertility HR = 1.21 (CI: 1.07-1.36). In addition, the HR for every 10 µg/m(3) increase in cumulative PM2.5-10 among women with primary infertility was 1.10 (CI: 0.96-1.27), and similarly was 1.10 (CI: 0.94-1.28) for those with secondary infertility. LIMITATIONS, REASONS FOR CAUTION Within the 2 year window of infertility diagnosis, we do not have the exact date of diagnosis or the exact timing of the start of attempting conception. As infertility status and subtypes of infertility were prospectively collected biennially, we were unable to tightly examine the timing of exposures on incidence of infertility. In terms of exposure quantification, we used ambient air pollution exposures as a proxy for personal exposures, potentially leading to exposure misclassification. However, several studies suggest that ambient measurements are an acceptable surrogate for individual level exposures in most populations. WIDER IMPLICATIONS OF THE FINDINGS We observed an association between all size fractions of PM exposure, as well as traffic-related air pollution, and incidence of infertility. Of note, the strongest association was observed between cumulative average exposures over the course of follow-up and the risk of infertility, suggesting that chronic exposures may be of greater importance than short-term exposures. STUDY FUNDING/COMPETING INTERESTS The work for this paper was supported by the following: S.M.: Reproductive Scientist Development Program HD000849, and the Building Interdisciplinary Research Careers in Women's Health HD043444, the Boston University CTSI 1UL1TR001430, and a research grant from the Boston University Department of Obstetrics and Gynecology, S.A.M.: R01HD57210 from the National Institute of Child Health and Human Development and the Massachusetts Institute of Technology Center for Environmental Health Sciences Translational Pilot Project Program, R01CA50385 from the National Cancer Institute, J.E.H. and F.L.: 5R01ES017017 from the National Institute for Environmental Health Sciences, 5 P42 ES007381 from the National Institute of Environmental Health at the National Institute of Health. L.V.F.: T32HD060454 in reproductive, perinatal, and pediatric epidemiology from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The Nurses' Health Study II is additionally supported by infrastructure grant UM1CA176726 from the National Cancer Institute, NIH, U.S. Department of Health and Human Services. The authors have no actual or potential competing financial interests to disclose.
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Affiliation(s)
- S Mahalingaiah
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA 02118, USA
| | - J E Hart
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - F Laden
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - L V Farland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - M M Hewlett
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA 02118, USA
| | - J Chavarro
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - A Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - S A Missmer
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Stallings TL, Aschengrau A, Riefkohl A, Rubio OR, Brooks DR, Weiner D, Amador JJ, Lopez D, Kaufman J, Laws R, Winter M, Applebaum KM. Medical Visits Among Nicaraguan Sugarcane Workers: Uncommon UTI Diagnoses and Subclinical Findings. Ann Epidemiol 2015. [DOI: 10.1016/j.annepidem.2015.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hoffman K, Aschengrau A, Webster TF, Bartell SM, Vieira VM. Associations between residence at birth and mental health disorders: a spatial analysis of retrospective cohort data. BMC Public Health 2015; 15:688. [PMID: 26195105 PMCID: PMC4508761 DOI: 10.1186/s12889-015-2011-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health disorders impact approximately one in four US adults. While their causes are likely multifactorial, prior research has linked the risk of certain mental health disorders to prenatal and early childhood environmental exposures, motivating a spatial analysis to determine whether risk varies by birth location. METHODS We investigated the spatial associations between residence at birth and odds of depression, bipolar disorder, and post-traumatic stress disorder (PTSD) in a retrospective cohort (Cape Cod, Massachusetts, 1969-1983) using generalized additive models to simultaneously smooth location and adjust for confounders. Birth location served as a surrogate for prenatal exposure to the combination of social and environmental factors related to the development of mental illness. We predicted crude and adjusted odds ratios (aOR) for each outcome across the study area. The results were mapped to identify areas of increased risk. RESULTS We observed spatial variation in the crude odds ratios of depression that was still present even after accounting for spatial confounding due to geographic differences in the distribution of known risk factors (aOR range: 0.61-3.07, P = 0.03). Similar geographic patterns were seen for the crude odds of PTSD; however, these patterns were no longer present in the adjusted analysis (aOR range: 0.49-1.36, P = 0.79), with family history of mental illness most notably influencing the geographic patterns. Analyses of the odds of bipolar disorder did not show any meaningful spatial variation (aOR range: 0.58-1.17, P = 0.82). CONCLUSION Spatial associations exist between residence at birth and odds of PTSD and depression, but much of this variation can be explained by the geographic distributions of available risk factors. However, these risk factors did not account for all the variation observed with depression, suggesting that other social and environmental factors within our study area need further investigation.
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Affiliation(s)
- Kate Hoffman
- Nicholas School of the Environment, Duke University, Durham, NC, USA.
| | - Ann Aschengrau
- Boston University School of Public Health, Boston, MA, 02118, USA.
| | - Thomas F Webster
- Boston University School of Public Health, Boston, MA, 02118, USA.
| | - Scott M Bartell
- Program in Public Health, University of California, Irvine, 653 E. Peltason Drive, AIRB 2042, Irvine, CA, 92697, USA.
| | - Verónica M Vieira
- Program in Public Health, University of California, Irvine, 653 E. Peltason Drive, AIRB 2042, Irvine, CA, 92697, USA.
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Butler L, Janulewicz P, Carwile J, Winter M, White R, Aschengrau A. Childhood and adolescent fish consumption and adult neuropsychological performance: An analysis from the Cape Cod Health Study. Neurotoxicol Teratol 2015. [DOI: 10.1016/j.ntt.2015.04.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aschengrau A, Winter MR, Vieira VM, Webster TF, Janulewicz PA, Gallagher LG, Weinberg J, Ozonoff DM. Long-term health effects of early life exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study. Environ Health 2015; 14:36. [PMID: 25889838 PMCID: PMC4397674 DOI: 10.1186/s12940-015-0021-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/27/2015] [Indexed: 05/26/2023]
Abstract
BACKGROUND While adult exposure to PCE is known to have toxic effects, there is little information on the long-term impact of prenatal and early childhood exposure. We undertook a retrospective cohort study to examine the effects of their early life exposure to PCE-contaminated drinking water. This retrospective cohort study examined whether prenatal and early childhood exposure to PCE-contaminated drinking water influenced the risk of a variety of chronic conditions among adults who were born between 1969 and 1983 in the Cape Cod area of Massachusetts. METHODS Eight hundred and thirty-one participants with prenatal and early childhood PCE exposure and 547 unexposed participants were studied. Individuals completed questionnaires to gather information on demographic characteristics, chronic conditions, and other sources of solvent exposure. The location of residences from birth through 1990 were used to estimate PCE exposure with U.S. EPA's water distribution system modeling software (EPANET) modified to incorporate a leaching and transport model. RESULTS No associations were observed between early life PCE exposure and current occurrence of obesity, diabetes, cardiovascular disease, hypertension, color blindness, near- and far sightedness and dry eyes. In contrast, a 1.8-fold increased risk of cancer (95% CI: 0.8, 4.0) was seen among individuals with any early life exposure. These results were based on 31 participants (23 exposed and 8 unexposed) who reported cancers at a variety of anatomical sites, particularly the cervix. A 1.5-fold increase in the risk of epilepsy (95% CI: 0.6, 3.6, based on 16 exposed and 7 unexposed participants) was also observed among individuals with any early life exposure that was further increased to 1.8 (95% CI: 0.7, 4.6) among those with exposure at or above the sample median. CONCLUSIONS These results suggest that the risk of epilepsy and certain types of cancer such as cervical cancer may be increased among adults who were exposed to PCE-contaminated drinking water exposure during gestation and early childhood. These findings should be interpreted cautiously because of the study limitations and confirmed in follow-up investigations of similarly exposed populations with medically-confirmed diagnoses. This relatively young study population should also be monitored periodically for subsequent changes in disease risk.
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Affiliation(s)
- Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA, 02118, USA.
| | - Michael R Winter
- Data Coordinating Center, Boston University School of Public Health, Crosstown, 715 Albany Street, Boston, MA, 02118, USA.
| | - Veronica M Vieira
- University of California, Irvine, Program in Public Health, 653 East Peltason Dr, Irvine, CA, 92697, USA.
| | - Thomas F Webster
- Department of Environmental Health, Boston University School of Public Health, Talbot 4 W, 715 Albany Street, Boston, MA, 02118, USA.
| | - Patricia A Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Talbot 4 W, 715 Albany Street, Boston, MA, 02118, USA.
| | - Lisa G Gallagher
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA, 02118, USA.
| | - Janice Weinberg
- Department of Biostatistics, Boston University School of Public Health, Crosstown, 715 Albany Street, Boston, MA, 02118, USA.
| | - David M Ozonoff
- Department of Environmental Health, Boston University School of Public Health, Talbot 4 W, 715 Albany Street, Boston, MA, 02118, USA.
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Carwile JL, Mahalingaiah S, Winter MR, Aschengrau A. Prenatal drinking-water exposure to tetrachloroethylene and ischemic placental disease: a retrospective cohort study. Environ Health 2014; 13:72. [PMID: 25270247 PMCID: PMC4183765 DOI: 10.1186/1476-069x-13-72] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/14/2014] [Indexed: 05/05/2023]
Abstract
BACKGROUND Prenatal drinking water exposure to tetrachloroethylene (PCE) has been previously related to intrauterine growth restriction and stillbirth. Pathophysiologic and epidemiologic evidence linking these outcomes to certain other pregnancy complications, including placental abruption, preeclampsia, and small-for-gestational-age (SGA) (i.e., ischemic placental diseases), suggests that PCE exposure may also be associated with these events. We examined whether prenatal exposure to PCE-contaminated drinking water was associated with overall or individual ischemic placental diseases. METHODS Using a retrospective cohort design, we compared 1,091 PCE-exposed and 1,019 unexposed pregnancies from 1,766 Cape Cod, Massachusetts women. Exposure between 1969 and 1990 was estimated using water distribution system modeling software. Data on birth weight and gestational age were obtained from birth certificates; mothers self-reported pregnancy complications. RESULTS Of 2,110 eligible pregnancies, 9% (N = 196) were complicated by ≥1 ischemic placental disease. PCE exposure was not associated with overall ischemic placental disease (for PCE ≥ sample median vs. no exposure, risk ratio (RR): 0.90; 95% confidence interval (CI): 0.65, 1.24), preeclampsia (RR: 0.36; 95% CI: 0.12-1.07), or SGA (RR: 0.98; 95% CI: 0.66-1.45). However, pregnancies with PCE exposure ≥ the sample median had 2.38-times the risk of stillbirth ≥27 weeks gestation (95% CI: 1.01, 5.59), and 1.35-times of the risk of placental abruption (95% CI: 0.68, 2.67) relative to unexposed pregnancies. CONCLUSIONS Prenatal PCE exposure was not associated with overall ischemic placental disease, but may increase risk of stillbirth.
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Affiliation(s)
- Jenny L Carwile
- />Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
| | - Shruthi Mahalingaiah
- />Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA USA
| | - Michael R Winter
- />Data Coordinating Center, Boston University School of Public Health, Boston, MA USA
| | - Ann Aschengrau
- />Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
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Mahalingaiah S, Hart JE, Laden F, Aschengrau A, Missmer SA. Air pollution exposures during adulthood and risk of endometriosis in the Nurses' Health Study II. Environ Health Perspect 2014; 122:58-64. [PMID: 24225723 PMCID: PMC3888567 DOI: 10.1289/ehp.1306627] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 11/08/2013] [Indexed: 05/05/2023]
Abstract
BACKGROUND Particulate matter and proximity to large roadways may promote disease mechanisms, including systemic inflammation, hormonal alteration, and vascular proliferation, that may contribute to the development and severity of endometriosis. OBJECTIVE Our goal was to determine the association of air pollution exposures during adulthood, including distance to road, particulate matter<2.5 μm, between 2.5 and 10 μm, and <10 μm, (PM2.5, PM10-2.5, PM10), and timing of exposure with risk of endometriosis in the Nurses' Health Study II. METHODS Proximity to major roadways and outdoor levels of PM2.5, PM10-2.5, and PM10 were determined for all residential addresses from 1993 to 2007. Multivariable-adjusted time-varying Cox proportional hazard models were used to estimate the relation between these air pollution exposures and endometriosis risk. RESULTS Among 84,060 women, 2,486 incident cases of surgically confirmed endometriosis were identified over 710,230 person-years of follow-up. There was no evidence of an association between endometriosis risk and distance to road or exposure to PM2.5, PM10-2.5, or PM10 averaged over follow-up or during the previous 2- or 4-year period. CONCLUSIONS Traffic and air pollution exposures during adulthood were not associated with incident endometriosis in this cohort of women.
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Affiliation(s)
- Shruthi Mahalingaiah
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
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Mahalingaiah S, Hart J, Laden F, Boynton-Jarrett R, Aschengrau A, Missmer S. Adult air pollution exposure and risk of uterine leiomyomata in the nurses’ health study ii. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vasilakis-Scaramozza C, Aschengrau A, Cabral H, Jick SS. Antidepressant Use During Early Pregnancy and the Risk of Congenital Anomalies. Pharmacotherapy 2013; 33:693-700. [DOI: 10.1002/phar.1211] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Ann Aschengrau
- Department of Epidemiology; Boston University School of Public Health; Boston Massachusetts
| | - Howard Cabral
- Department of Epidemiology; Boston University School of Public Health; Boston Massachusetts
| | - Susan S. Jick
- Boston Collaborative Drug Surveillance Program; Boston University School of Medicine; Lexington Massachusetts
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Janulewicz P, White R, Martin B, Winter M, Weinberg J, Vieira V, Aschengrau A. Adult neuropsychological performance following prenatal and early postnatal exposure to tetrachloroethylene (PCE)-contaminated drinking water. Neurotoxicol Teratol 2013. [DOI: 10.1016/j.ntt.2013.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Janulewicz PA, Killiany RJ, White RF, Martin BM, Winter MR, Weinberg JM, Aschengrau A. Structural Magnetic Resonance Imaging in an adult cohort following prenatal and early postnatal exposure to tetrachloroethylene (PCE)-contaminated drinking water. Neurotoxicol Teratol 2013; 38:13-20. [PMID: 23571160 DOI: 10.1016/j.ntt.2013.03.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 03/21/2013] [Accepted: 03/22/2013] [Indexed: 10/27/2022]
Abstract
This population-based retrospective cohort study examined Structural Magnetic Resonance Imaging (MRI) of the brain in relation to prenatal and early postnatal exposure to tetrachloroethylene (PCE)-contaminated drinking water on Cape Cod, Massachusetts. Subjects were identified through birth records from 1969 through 1983. Exposure was modeled using pipe network information from town water departments, a PCE leaching and transport algorithm, EPANet water flow modeling software, and Geographic Information System (GIS) methodology. Brain imaging was performed on 26 exposed and 16 unexposed subjects. Scans were acquired on a Philips 3T whole body scanner using the ADNI T1-weighted MP-RAGE scan. The scans were processed by FreeSurfer version 4.3.1 software to obtain measurements of specific brain regions. There were no statistically significant differences between exposed and unexposed subjects on the measures of white matter hypointensities (β: 127.5mm(3), 95% CI: -259.1, 1514.0), white matter volumes (e.g. total cerebral white matter: β: 21230.0mm(3), 95% CI: -4512.6, 46971.7) or gray matter volumes (e.g. total cerebral gray matter: β: 11976.0mm(3), 95% CI: -13657.2, 37609.3). The results of this study suggest that exposure to PCE during gestation and early childhood, at the levels observed in this population, is not associated with alterations in the brain structures studied.
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Affiliation(s)
- Patricia A Janulewicz
- Department of Epidemiology, Boston University Schools of Public Health and Medicine, Boston, MA 02118, USA.
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Abstract
STUDY OBJECTIVE To estimate the prevalence of congenital anomalies among the offspring of women exposed and unexposed to antihypertensive drugs during early pregnancy. DESIGN Matched cohort study. DATABASE The United Kingdom's General Practice Research Database. SUBJECTS Women exposed to antihypertensive drugs during early pregnancy and a sample of matched unexposed pregnant women. MEASUREMENTS AND MAIN RESULTS The prevalence of any anomaly among unexposed and exposed women was 23.5 (95% confidence interval [CI] 14.4-38.3) and 20.9 (95% CI 10.0-43.8) per 1000 pregnancies, respectively (relative risk [RR] 0.9, 95% CI 0.4-2.2). The relative risk of limb anomalies among women exposed to β-blockers was 6.4 (95% CI 0.6-70.1). Exposure to angiotensin-converting enzyme (ACE) inhibitors, β-blockers, and calcium channel blockers increased the risk of genital anomalies (RR 3.8, 95% CI 0.9-16.0; RR 2.8, 95% CI 0.7-11.9; RR 1.3, 95% CI 0.1-12.4, respectively). CONCLUSION ACE inhibitors prescribed in the first trimester of pregnancy appeared to increase the risk of congenital anomalies among the offspring of exposed women (RR 2.5, 95% CI 0.5-13.5). These drugs should be avoided in women planning to become pregnant. A marginally increased risk was also found with exposure to β-blockers (RR 1.4, 95% CI 0.6-3.3). These findings are based on small numbers and are not statistically significant.
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Abstract
STUDY OBJECTIVE To estimate the prevalence of congenital anomalies between the offspring of women exposed and unexposed to asthma drugs during early pregnancy. DESIGN Matched cohort study. DATABASE The United Kingdom's General Practice Research Database. PATIENTS Women exposed to asthma drugs during early pregnancy and a sample of matched unexposed pregnant women. MEASUREMENTS AND MAIN RESULTS The prevalence of any anomaly among unexposed and exposed women was 27.8 (95% confidence interval [CI] 25.4-30.6)/1000 pregnancies and 31.3 (95% CI 27.7-35.5)/1000 pregnancies, respectively (relative risk [RR] 1.1 95% CI 1.0-1.3). CONCLUSION Our findings suggest that asthma drugs, overall, do not increase the risk of congenital anomalies in the offspring when taken during the first trimester of pregnancy.
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Bohac GC, Guaqueta D, Cheng DM, Aschengrau A, Hartshorn KL. Disparity in the use of combined modality therapy for rectal cancer in the older adult. J Geriatr Oncol 2012; 4:90-7. [PMID: 24071497 DOI: 10.1016/j.jgo.2012.10.173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 08/10/2012] [Accepted: 10/03/2012] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The standard treatment strategy for patients with rectal adenocarcinoma having T3 or T4 tumors or positive lymph nodes includes concurrent chemoradiation, surgery and chemotherapy. Population based studies show relatively low rates of usage of standard therapy for rectal cancer in the older adult. MATERIALS AND METHODS Two decades of cases of stage II and stage III rectal cancer from two academic teaching hospitals were reviewed. Comparisons were made of subjects ≤70 or ≥71years with regard to initiation and completion of radiation, chemotherapy and surgery. RESULTS Subjects ≥71years of age had significantly lower proportions of surgical resection (84 vs. 94%) and of initiation of all three component of standard therapy (49 vs. 66%) compared to those ≤70years of age. Subjects ≥71years had significantly more co-morbidities; however, the difference in initiation of therapy remained after adjusting for stage, treating hospital, co-morbid status, race or sex in multivariable analysis. The odds for initiation of therapy were reduced by ≈22% in older adults in the adjusted analysis. Among all patients who started therapy only 56% completed it without dose reduction or delay. There were trends to increased completion among those receiving neo-adjuvant vs. post-operative chemoradiation and among those with stage III as opposed to stage II cancer. CONCLUSIONS Our study indicates that a major disparity in the use of standard therapy for rectal cancer in the older adult exists in academic hospital settings. It will be important for oncologists to reconsider increasing the usage of curative therapy in these patients.
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Affiliation(s)
- Gerald C Bohac
- Boston University School of Medicine, Department of Medicine, Boston MA, USA
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Getz KD, Janulewicz PA, Rowe S, Weinberg JM, Winter MR, Martin BR, Vieira VM, White RF, Aschengrau A. Prenatal and early childhood exposure to tetrachloroethylene and adult vision. Environ Health Perspect 2012; 120:1327-32. [PMID: 22784657 PMCID: PMC3440105 DOI: 10.1289/ehp.1103996] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/19/2012] [Indexed: 05/09/2023]
Abstract
BACKGROUND Tetrachloroethylene (PCE; or perchloroethylene) has been implicated in visual impairments among adults with occupational and environmental exposures as well as children born to women with occupational exposure during pregnancy. OBJECTIVES Using a population-based retrospective cohort study, we examined the association between prenatal and early childhood exposure to PCE-contaminated drinking water on Cape Cod, Massachusetts, and deficits in adult color vision and contrast sensitivity. METHODS We estimated the amount of PCE that was delivered to the family residence from participants' gestation through 5 years of age. We administered to this now adult study population vision tests to assess acuity, contrast sensitivity, and color discrimination. RESULTS Participants exposed to higher PCE levels exhibited lower contrast sensitivity at intermediate and high spatial frequencies compared with unexposed participants, although the differences were generally not statistically significant. Exposed participants also exhibited poorer color discrimination than unexposed participants. The difference in mean color confusion indices (CCI) was statistically significant for the Farnsworth test but not Lanthony's D-15d test [Farnsworth CCI mean difference = 0.05, 95% confidence interval (CI): 0.003, 0.10; Lanthony CCI mean difference = 0.07, 95% CI: -0.02, 0.15]. CONCLUSIONS Prenatal and early childhood exposure to PCE-contaminated drinking water may be associated with long-term subclinical visual dysfunction in adulthood, particularly with respect to color discrimination. Further investigation of this association in similarly exposed populations is necessary.
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Affiliation(s)
- Kelly D Getz
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Avery TR, Kleinman KP, Klompas M, Aschengrau A, Huang SS. Reply to Moehring et al. Infect Control Hosp Epidemiol 2012. [DOI: 10.1086/666637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Aschengrau A, Weinberg JM, Janulewicz PA, Romano ME, Gallagher LG, Winter MR, Martin BR, Vieira VM, Webster TF, White RF, Ozonoff DM. Occurrence of mental illness following prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study. Environ Health 2012; 11:2. [PMID: 22264316 PMCID: PMC3292942 DOI: 10.1186/1476-069x-11-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 01/20/2012] [Indexed: 05/09/2023]
Abstract
BACKGROUND While many studies of adults with solvent exposure have shown increased risks of anxiety and depressive disorders, there is little information on the impact of prenatal and early childhood exposure on the subsequent risk of mental illness. This retrospective cohort study examined whether early life exposure to tetrachloroethylene (PCE)-contaminated drinking water influenced the occurrence of depression, bipolar disorder, post-traumatic stress disorder, and schizophrenia among adults from Cape Cod, Massachusetts. METHODS A total of 1,512 subjects born between 1969 and 1983 were studied, including 831 subjects with both prenatal and early childhood PCE exposure and 547 unexposed subjects. Participants completed questionnaires to gather information on mental illnesses, demographic and medical characteristics, other sources of solvent exposure, and residences from birth through 1990. PCE exposure originating from the vinyl-liner of water distribution pipes was assessed using water distribution system modeling software that incorporated a leaching and transport algorithm. RESULTS No meaningful increases in risk ratios (RR) for depression were observed among subjects with prenatal and early childhood exposure (RR: 1.1, 95% CI: 0.9-1.4). However, subjects with prenatal and early childhood exposure had a 1.8-fold increased risk of bipolar disorder (N = 36 exposed cases, 95% CI: 0.9-1.4), a 1.5-fold increased risk post-traumatic stress disorder (N = 47 exposed cases, 95% CI: 0.9-2.5), and a 2.1-fold increased risk of schizophrenia (N = 3 exposed cases, 95% CI: 0.2-20.0). Further increases in the risk ratio were observed for bipolar disorder (N = 18 exposed cases, RR; 2.7, 95% CI: 1.3-5.6) and post-traumatic stress disorder (N = 18 exposed cases, RR: 1.7, 95% CI: 0.9-3.2) among subjects with the highest exposure levels. CONCLUSIONS The results of this study provide evidence against an impact of early life exposure to PCE on the risk of depression. In contrast, the results provide support for an impact of early life exposure on the risk of bipolar disorder and post-traumatic stress disorder. The number of schizophrenia cases was too small to draw reliable conclusions. These findings should be confirmed in investigations of other similarly exposed populations.
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Affiliation(s)
- Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA 02118, USA
| | - Janice M Weinberg
- Department of Biostatistics, Boston University School of Public Health, Crosstown, 715 Albany Street, Boston, MA 02118, USA
| | - Patricia A Janulewicz
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA 02118, USA
| | - Megan E Romano
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA 02118, USA
- Department of Epidemiology, University of Washington, Box 357236, Seattle WA, 98195, USA
| | - Lisa G Gallagher
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA 02118, USA
| | - Michael R Winter
- Data Coordinating Center, Boston University School of Public Health, Crosstown, 715 Albany Street, Boston MA 02118, USA
| | - Brett R Martin
- Data Coordinating Center, Boston University School of Public Health, Crosstown, 715 Albany Street, Boston MA 02118, USA
| | - Veronica M Vieira
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA 02118, USA
| | - Thomas F Webster
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA 02118, USA
| | - Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA 02118, USA
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Boston MA 02118, USA
| | - David M Ozonoff
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA 02118, USA
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Avery TR, Kleinman KP, Klompas M, Aschengrau A, Huang SS. Inclusion of 30-day postdischarge detection triples the incidence of hospital-onset methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2011; 33:114-21. [PMID: 22227979 DOI: 10.1086/663714] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Hospitalized patients are at increased risk for acquisition of methicillin-resistant Staphylococcus aureus (MRSA). As hospital length of stay shortens, hospital-acquired MRSA events may be more likely to be detected after discharge. OBJECTIVE We assessed the impact of attributing MRSA cases discovered within 30 days after discharge to the most recent hospitalization and identified patient characteristics associated with MRSA detection after discharge. DESIGN Retrospective cohort study. SETTING Twenty-seven acute care hospitals in Orange County, California. PARTICIPANTS Adult acute care admissions (2002-2007). METHODS Using a countywide hospital data set containing diagnostic codes with present-on-admission (POA) indicators, we identified the first admission with a MRSA code for each patient. This incident MRSA admission was defined as predischarge-detected (pre-DD) hospital-onset MRSA (HO-MRSA) when MRSA was not POA. If MRSA was POA and a prior admission occurred within 30 days, this prior admission was assigned postdischarge-detected (post-DD) HO-MRSA. We evaluated the impact of including post-DD HO-MRSA in the calculation of hospital HO-MRSA incidence using signed-rank tests and reviewed changes in hospital rankings. We conducted multivariate comparisons of patient characteristics of pre-DD versus post-DD HO-MRSA patients. RESULTS Among 1,217,253 at-risk hospitalizations, the inclusion of post-DD HO-MRSA tripled the median hospital HO-MRSA incidence, from 12.2 to 35.7 cases per 10,000 at-risk admissions (P < .0001). Hospital ranking changed substantially when including post-DD HO-MRSA. Patients with shorter stays were more likely to have post-DD MRSA. CONCLUSIONS On the basis of administrative claims data, the inclusion of post-DD HO-MRSA significantly increased the estimated HO-MRSA incidence and altered hospital rankings. This finding underscores the limitations of single-facility data when deriving HO-MRSA incidence and rank.
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Affiliation(s)
- Taliser R Avery
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts 02215, USA.
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Aschengrau A, Weinberg JM, Janulewicz PA, Romano ME, Gallagher LG, Winter MR, Martin BR, Vieira VM, Webster TF, White RF, Ozonoff DM. Affinity for risky behaviors following prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study. Environ Health 2011; 10:102. [PMID: 22136431 PMCID: PMC3268745 DOI: 10.1186/1476-069x-10-102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 12/02/2011] [Indexed: 05/20/2023]
Abstract
BACKGROUND Many studies of adults with acute and chronic solvent exposure have shown adverse effects on cognition, behavior and mood. No prior study has investigated the long-term impact of prenatal and early childhood exposure to the solvent tetrachloroethylene (PCE) on the affinity for risky behaviors, defined as smoking, drinking or drug use as a teen or adult. OBJECTIVES This retrospective cohort study examined whether early life exposure to PCE-contaminated drinking water influenced the occurrence of cigarette smoking, alcohol consumption, and drug use among adults from Cape Cod, Massachusetts. METHODS Eight hundred and thirty-one subjects with prenatal and early childhood PCE exposure and 547 unexposed subjects were studied. Participants completed questionnaires to gather information on risky behaviors as a teenager and young adult, demographic characteristics, other sources of solvent exposure, and residences from birth through 1990. PCE exposure was estimated using the U.S. EPA's water distribution system modeling software (EPANET) that was modified to incorporate a leaching and transport model to estimate PCE exposures from pipe linings. RESULTS Individuals who were highly exposed to PCE-contaminated drinking water during gestation and early childhood experienced 50-60% increases in the risk of using two or more major illicit drugs as a teenager or as an adult (Relative Risk (RR) for teen use = 1.6, 95% CI: 1.2-2.2; and RR for adult use = 1.5, 95% CI: 1.2-1.9). Specific drugs for which increased risks were observed included crack/cocaine, psychedelics/hallucinogens, club/designer drugs, Ritalin without a prescription, and heroin (RRs:1.4-2.1). Thirty to 60% increases in the risk of certain smoking and drinking behaviors were also seen among highly exposed subjects. CONCLUSIONS The results of this study suggest that risky behaviors, particularly drug use, are more frequent among adults with high PCE exposure levels during gestation and early childhood. These findings should be confirmed in follow-up investigations of other exposed populations.
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Affiliation(s)
- Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA 02118, USA
| | - Janice M Weinberg
- Department of Biostatistics, Boston University School of Public Health, Crosstown, 715 Albany Street, Boston, MA 02118, USA
| | - Patricia A Janulewicz
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA 02118, USA
| | - Megan E Romano
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA 02118, USA
- Department of Epidemiology, University of Washington, Box 357236, Seattle WA, 98195, USA
| | - Lisa G Gallagher
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA 02118, USA
| | - Michael R Winter
- Data Coordinating Center, Boston University School of Public Health, Crosstown, 715 Albany Street, Boston MA 02118, USA
| | - Brett R Martin
- Data Coordinating Center, Boston University School of Public Health, Crosstown, 715 Albany Street, Boston MA 02118, USA
| | - Veronica M Vieira
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA 02118, USA
| | - Thomas F Webster
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA 02118, USA
| | - Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA 02118, USA
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Boston Ma 02118 USA
| | - David M Ozonoff
- Department of Environmental Health, Boston University School of Public Health, Talbot 4W, 715 Albany Street, Boston, MA 02118, USA
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