Publications

Environ Epidemiol. 2025 Jun 13;9(4):e399. doi: 10.1097/EE9.0000000000000399. eCollection 2025 Aug.

ABSTRACT

BACKGROUND: Non-nutritive suck (NNS) is a measure of neurofunction sensitive to environmental exposures in utero. This study aimed to evaluate the relationship between gestational phenol exposure and NNS patterning.

METHODS: Mother-infant pairs from two diverse prospective cohorts were enrolled in the Environmental influences on Child Health Outcomes Program. Phenols were measured in prenatal maternal urine samples and adjusted for specific gravity. NNS was sampled in 1-8-week-old infants using a custom pacifier for ~5 minutes. Associations of 11 phenols and triclocarban with 5 NNS outcomes were assessed individually and as a mixture using generalized linear models adjusted for cohort, child sex and assessment age, and maternal age and education.

RESULTS: Altogether, 215 mother-infant pairs were included. Bisphenol-F was related to a lower NNS frequency. Triclosan was associated with a higher NNS frequency. Propylparaben, 2,4-dichlorophenol, and 2,5-dichlorophenol were associated with lower NNS amplitude. Benzophenone-3, 2,4-dichlorophenol, and 2,5-dichlorophenol were related to more NNS bursts/minute. Propylparaben was associated with more NNS cycles/bursts. Seven phenols were included in mixture analyses: 2,4-dichlorophenol, 2,5-dichlorophenol, benzophenone-3, bisphenol-A, bisphenol-S, methylparaben, and propylparaben. Both Bayesian kernel machine regression and quantile g-computation showed that higher concentrations of the mixture were associated with lower amplitude but more bursts/minute and cycles/burst. Propylparaben was important in the overall mixture effect on amplitude, whereas benzophenone-3 was important in the relationship with bursts/minute.

CONCLUSIONS: Gestational phenol exposure is linked to altered NNS patterning in neonates. Future work should further investigate phenol mixture effects, potential mechanisms, and the association of altered NNS with neurodevelopment.

PMID:40525131 | PMC:PMC12169973 | DOI:10.1097/EE9.0000000000000399

Sci Total Environ. 2025 Jun 16;990:179887. doi: 10.1016/j.scitotenv.2025.179887. Online ahead of print.

ABSTRACT

In rural areas of Low- and Middle-Income Countries, children are regularly exposed to pesticides through various environmental, para-occupational, and occupational pathways, often connected to family-based agricultural activities. Work and living spaces are commonly intertwined, increasing the likelihood of unintentional pesticide exposure among children, including before birth. This commentary explores how such wide-spread exposures to these pervasive chemicals occur – even before birth, and affect critical aspects of child health and development through life. Using the history of Zeca, a child living in rural Brazil whose asthma worsens due to pesticide applications near his home, this discussion paper illustrates how this critical issue is deeply embedded in daily life in many agricultural communities. However, these risks are frequently overlooked in clinical assessments, health surveillance, and policy responses. We discuss how broader structural conditions contribute to children’s exposure to pesticides, including poverty, lack of healthcare access, weak surveillance or enforcement of occupational and environmental protections, and the chemical colonialism. These patterns reflect entrenched social and environmental injustices that disproportionately affect rural children. Thus, we call for a coordinated and systemic response involving stronger regulation, enhanced health surveillance and management, support for safer and more sustainable agricultural practices, and the inclusion of rural communities in decision-making processes. The protection of children from harmful pesticide exposure must be recognized as a public health priority and a matter of social and environmental justice.

PMID:40527261 | DOI:10.1016/j.scitotenv.2025.179887

West J Nurs Res. 2025 Jun 16:1939459251341832. doi: 10.1177/01939459251341832. Online ahead of print.

ABSTRACT

BACKGROUND: Shift work, a nonstandard work arrangement, is increasingly popular in the hospitality industry to meet consumer demands and boost productivity. However, its effects on the health and well-being of hotel workers in the United States remains underexplored.

OBJECTIVE: We aimed to explore the effects of shift work on mental health, sleep, and chronic fatigue among hotel workers.

METHODS: We collaborated with a community advisory board to develop a survey and recruit participants. Individuals aged 18 years or older, working in hotels in a Midwest state, completed surveys online or on paper. Data analysis included descriptive statistics, linear and logistic regression, and stepwise moderation to examine the impact of work schedules on chronic sleep problems, fatigue, and mental health outcomes.

RESULTS: Data from 518 participants were analyzed. The majority identified as white and female, with an average age of 32.05 years. Most were employed in housekeeping or front desk positions. Regression analyses showed that those working nonstandard hours were significantly more likely to report chronic fatigue and screen positive for posttraumatic stress disorder. Paid overtime was significantly associated with decreased symptoms of depression and anxiety. Significant interactions by job type were also observed, with front desk workers reporting increased depression with more overtime compared to other job types.

CONCLUSION: These findings address a crucial gap in understanding shift work’s impact on US hotel workers’ health and well-being. Future longitudinal studies should explore shift work’s effects on sleep, fatigue, and mental health. Tailored interventions and policies may mitigate the adverse effects of shift work.

PMID:40521775 | DOI:10.1177/01939459251341832

Environ Health Perspect. 2025 Jun 11. doi: 10.1289/EHP15223. Online ahead of print.

ABSTRACT

BACKGROUND: Extreme heat risk assessments often rely on epidemiologic studies that used the nearest available outdoor airport temperatures (OATs) rather than individually-experienced temperatures (IETs) and frequently lack key individual-level determinants of exposure, including occupation, housing, and air conditioning. This hampers efforts to characterize heat burden inequities and guide interventions for vulnerable populations.

OBJECTIVES: We developed an approach to estimate individual and subgroup-specific health impacts from modeled IETs before and during extreme heat events for three U.S. cities: Atlanta, Georgia (hot-humid), Detroit, Michigan (temperate), and Phoenix, Arizona (hot-dry).

METHODS: IET profiles were estimated using modeled parcel-linked population microdata, housing-specific indoor temperatures from building energy models, ambient temperatures from urban-scale climate models, and time activity patterns from surveys. We linked each IET profile to daily OATs, then fit mixed-effects regressions to predict “equivalent” OATs (eOATs), based on IET, housing, and demographics. We assigned risk ratios (RRs) from existing literature on all-cause mortality, all-cause emergency department (ED) visits, and preterm births to each person-day’s eOAT and estimated 5-day-extreme-heat absolute risks (ARs) by age-race-income-occupation subgroup.

RESULTS: The eOATs, RRs, and ARs differed between people due to variability in IETs and baseline health outcome incidence rates. All-cause mortality RRs ranges were 1.00-1.16 (Atlanta), 1.01-7.08 (Detroit), and 1.00-6.38 (Phoenix). All-cause-mortality ARs ranged 0.01-32 (Atlanta), 0.01-1,100 (Detroit), and 0.01-950 (Phoenix) per 100,000 persons. ED visit ARs ranges were 0.2-270 (Atlanta) and 0.04-6,200 (Phoenix) per 100,000 persons. Heat mortality ARs were higher among older adults and, only in Detroit, in young, Black, outdoor workers (median = 6.6 per 100,000) compared to young, non-Black, higher-income, indoor workers (median = 0.3 per 100,000).

DISCUSSION: When IETs can be estimated or directly measured, person-specific eOATs can be used to estimate the subgroup-specific heat-health burdens that would be experienced without adaptive behaviors. This approach could be adapted for other contexts to inform climate preparedness and justice policies. https://doi.org/10.1289/EHP15223.

PMID:40497792 | DOI:10.1289/EHP15223

J Nutr. 2025 Jun 4:S0022-3166(25)00328-1. doi: 10.1016/j.tjnut.2025.05.045. Online ahead of print.

ABSTRACT

BACKGROUND: Lifestyle changes during adolescence can impact dietary habits and, subsequently, exposure to heavy metals. We aimed to evaluate the associations between food group intakes and metal exposures in a cohort of adolescents.

METHODS: This study included 416 adolescents from Mexico City aged 10-18. Sociodemographic information at birth and repeated measurements of diet, anthropometry, and metal exposures were collected over two visits 3.5 ± 0.40 years apart (n=514). Food groups (n=31) were created based on the characteristics of 119 food frequency questionnaire items and metal dietary sources. Linear mixed-effects models were used to evaluate the associations between food group intake and exposure to blood lead, urinary arsenic, and urinary cadmium for the overall population (main models) and stratified by sex. Models were adjusted for age, sex (main models), maternal age, socioeconomic status, and specific gravity (only for urinary metals).

RESULTS: Fruit intake in girls (2.63% [95% CI: 0.22, 5.10], and candy in boys (2.13% [95% CI: 0.40, 3.88]) and in the whole population (1.38% [95% CI: 0.16, 2.61]) were associated with higher blood lead levels. Additionally, leafy greens intake was associated with higher blood lead (10.75% [95% CI: -0.01, 22.66]). Chicken intake in girls was associated with 5.95% (95% CI: 0.38, 11.84) higher urinary cadmium. Similarly, the intake of homemade sugar-sweetened beverages in girls (4.42% [35% CI: 0.13, 8.89]), and in the whole population (4.14% [95% CI: 1.42, 6.94]), was associated with higher urinary cadmium. Moreover, the intake of fish and seafood groups was positively associated with blood lead, urinary arsenic, and urinary cadmium.

CONCLUSIONS: We observed associations between food group intake and metal exposures in a group of Mexican adolescents using repeated measures of both outcomes and exposures. We also found that some of these associations varied by sex.

PMID:40480419 | DOI:10.1016/j.tjnut.2025.05.045

Int J Hyg Environ Health. 2025 Jun 4;268:114599. doi: 10.1016/j.ijheh.2025.114599. Online ahead of print.

ABSTRACT

Phthalates are widely used plasticizers and solvents in a variety of consumer and personal care products, resulting in ubiquitous exposure across the general population. Pregnancy represents a particularly critical window of vulnerability, as prenatal phthalate exposures have been linked to adverse health outcomes, including preterm birth and child developmental problems. While growing evidence highlights potential neurotoxic effects in children, few studies have examined the combined impact of multiple phthalates and newly introduced replacement chemicals. In this study, we included 199 mother-child dyads from the PROTECT birth cohort in Puerto Rico. We assessed prenatal exposure to multiple phthalates and a replacement chemical, di(2-ethylhexyl) terephthalate (DEHTP), by measuring biomarkers in maternal urine samples. Neurodevelopmental outcomes were then evaluated in early childhood (ages 1-3 years) across multiple domains – adaptive, cognitive, communication, motor, and personal-social. We employed a range of mixture modeling approaches-adaptive elastic net (adENET), Bayesian kernel machine regression (BKMR), and quantile g-computation (Q-gcomp). We identified mono(carboxyisononyl) phthalate (MCOP) as a key contributor to poorer neurodevelopmental outcomes and observed an overall adverse trend for the combined mixture. These results provide evidence of additive and mixture effects among multiple phthalates and replacement chemicals, underscoring the need for further research to elucidate the biological mechanisms by which these exposures may collectively influence child neurodevelopment.

PMID:40472722 | DOI:10.1016/j.ijheh.2025.114599

Int J Environ Res Public Health. 2025 May 12;22(5):763. doi: 10.3390/ijerph22050763.

ABSTRACT

Cyanobacterial harmful algal blooms (cyanoHABs) occur worldwide and can cause ingestion and inhalation exposure to microcystin and other potent toxins. This study develops life course exposure measures for cyanobacteria for application in population studies and then associates these measures with the survival of individuals with amyotrophic lateral sclerosis (ALS). The exposure measures utilize an individual’s residence history, date of disease onset, and satellite data from the Cyanobacteria Assessment Network. Residence duration for selected exposure windows referenced to disease onset date was used to weight cyanobacteria concentrations in water bodies within 0.25 to 10 km of each residence. Different concentration metrics, buffer sizes, and exposure windows were evaluated. The 2.5 and 5 km buffers best balanced the likelihood and plausibility of exposure while still resolving exposure contrasts. Over their lifetime, most study participants lived within 5 km of cyanobacteria blooms, and the exposure was associated with up to 0.89 years shorter survival, with significant interactions for individuals reporting swimming, fishing, and private wells. Our findings suggest a new and modifiable risk factor for ALS survival, and a need to confirm exposures and epidemiological findings. These cyanoHAB exposure estimates can facilitate population studies that can discover new relationships with neurodegenerative and other diseases.

PMID:40427878 | PMC:PMC12110991 | DOI:10.3390/ijerph22050763

Arch Dis Child Fetal Neonatal Ed. 2025 May 20:fetalneonatal-2024-328378. doi: 10.1136/archdischild-2024-328378. Online ahead of print.

ABSTRACT

OBJECTIVE: Assess the relationship between applied face mask force and leak during simulated ventilation using different ventilating devices and mask holds.

DESIGN: Randomised cross-over simulation study.

SETTING: Quiet, non-clinical room in children’s hospital.

PARTICIPANTS: Twenty-four experienced neonatal healthcare providers.

INTERVENTIONS: Ventilate a manikin for 2 min per trial, each with three trial conditions: self-inflating bag (SIB) with one-hand hold, T-piece with one-hand hold, T-piece with two-hand hold.

MAIN OUTCOME MEASURES: Applied force (newtons (N)) measured under the head and at four locations on the manikin’s face (nasal bridge, mentum, left and right zygomatic arches), force asymmetry applied to the mask rim, and mask leak.

RESULTS: Under-head force was greatest using the SIB with one-hand hold (mean (SD) 20.53 (5.87) N) and least using the T-piece with one-hand hold (mean (SD) 17.58 (6.11) N). While mask leak was reduced with increasing force, leak-free ventilation was achieved by some participants in all trial conditions with low (<10 N) under-head force. Force asymmetry on the manikin's face was similar using a one-hand hold compared with a two-hand hold. With both holds, forces were greater on the side of the face corresponding to the operator's non-dominant hand.

CONCLUSION: Applied force and leak varied between devices and mask holds. Force asymmetry was present with both mask holds. Leak-free ventilation could be achieved with small forces using either an SIB or T-piece and either mask hold. Force feedback during training may improve the effectiveness and safety of neonatal ventilation.

PMID:40393694 | DOI:10.1136/archdischild-2024-328378

Environ Health Perspect. 2025 Jun;133(6):67019. doi: 10.1289/EHP15305. Epub 2025 Jun 19.

ABSTRACT

BACKGROUND: Quantitative characterization of the health impacts associated with exposure to chemical mixtures has received considerable attention in current environmental and epidemiological studies. With many existing statistical methods and emerging approaches, it is important for practitioners to understand which method is best suited for their inferential goals.

OBJECTIVE: The goal of this paper is to provide empirical simulation-based evidence regarding performance of mixture methods to help guide researchers on selecting the best available methods to address three scientific questions in mixtures analysis: identifying important components of a mixture, identifying interactions among mixture components, and creating a summary score for risk stratification and prediction.

METHODS: We conducted a review and comparison of 11 analytical methods available for use in mixtures research through extensive simulation studies for continuous and binary outcomes. In addition, we carried out an illustrative data analysis using the PROTECT birth cohort from Puerto Rico to examine the associations between exposure to chemical mixtures-metals, polycyclic aromatic hydrocarbons (PAHs), phthalates, and phenols-and birth outcomes.

RESULTS: Our simulation results suggest that the choice of methods depends on the goal of analysis and that there is no clear winner across the board. For selection of important toxicants in the mixtures and for identifying interactions, Elastic net (Enet) by Zou et al., Lasso for Hierarchical Interactions (HierNet) by Bien et al., and selection of nonlinear interactions by a forward stepwise algorithm (SNIF) by Narisetty et al. have the most stable performance across simulation settings. For overall summary or a cumulative measure, we find that using the Super Learner to combine multiple environmental risk scores can lead to improved risk stratification and prediction properties.

CONCLUSIONS: We develop an integrated R package “CompMix” that provides a platform for mixtures analysis where the practitioners can implement a pipeline that includes several approaches for mixtures analysis. Our study offers guidelines for selecting appropriate statistical methods for addressing specific scientific questions related to mixtures research. We identify critical gaps where new and better methods are needed. https://doi.org/10.1289/EHP15305.

PMID:40392783 | PMC:PMC12178341 | DOI:10.1289/EHP15305

Nat Med. 2025 Jun;31(6):1809-1829. doi: 10.1038/s41591-025-03624-8. Epub 2025 Apr 22.

ABSTRACT

Although iron deficiency is well documented, less is known about dietary involvement in symptomatic iron deficiency manifesting in medical conditions. In this study, we quantified the global burden of dietary iron deficiency, focusing on where inadequate dietary iron intake leads to clinical manifestations such as anemia. We analyzed data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to estimate dietary iron deficiency prevalence and disability-adjusted life years (DALYs), stratified by age, sex, geography and socio-demographic index (SDI) across 204 countries. In 2021, global age-standardized prevalence and DALY rates were 16,434.4 (95% uncertainty interval (UI), 16,186.2-16,689.0) and 423.7 (285.3-610.8) per 100,000 population, with rates decreasing by 9.8% (8.1-11.3) and 18.2% (15.4-21.1) from 1990 to 2021. A higher burden was observed in female individual (age-standardized prevalence, 21,334.8 (95% UI, 20,984.8-21,697.4); DALYs, 598.0 (402.6-854.4)) than in male individual ((age-standardized prevalence, 11,684.7 (11,374.6-12,008.8); DALYs, 253.0 (167.3-371.0)). High-SDI countries presented greater improvement, with a 25.7% reduction compared to 11.5% in low-SDI countries. Despite global improvements, dietary iron deficiency remains a major health concern with a global prevalence of 16.7%, particularly affecting female individuals, children and residents in low-SDI countries. Urgent interventions through supplementation, food security measures and fortification initiatives are essential.

PMID:40263631 | DOI:10.1038/s41591-025-03624-8