Gregory D. Kearney

Studying the effects of polycyclic aromatic hydrocarbons on peripheral arterial disease in the United States

PURPOSE Polycyclic aromatic hydrocarbons are a group of prevalent pollutants which are produced by incomplete combustion of organic materials such as coal, fuel, tobacco smoking and food cooking. The associations between exposures to polycyclic aromatic hydrocarbons (PAHs) and peripheral arterial disease (PAD) have not been well studied. METHODS We used the 2001-2004 National Health and Nutrition Examination Survey (NHANES) to investigate the associations between eight monohydroxy urinary metabolites of four PAHs and PAD. RESULTS In a logistic regression model, subjects within the middle and highest tertiles of fluorene metabolites, 2-hydroxyfluorene (2-FLUO) and 3-hydroxyfluorene (3-FLUO), and phenanthrene metabolites, 1-hydroxyphenanthrene (1-PHEN) and 2-hydroxyphenanthrene (2-PHEN), had significantly higher prevalence of PAD as compared to subjects within the lowest tertile after adjusting for cigarette smoking, diabetes mellitus and other covariates (For 2-FLUO, the 3rd tertile: OR=2.22, 95% CI=1.13-4.37, p for trend=0.02; For 3-FLUO, the 3rd tertile: OR=2.36, 95% CI: 1.16-4.77, p for trend=0.02; For 1-PHEN, the 3rd tertile: OR=1.84, 95% CI: 1.01-3.37, p for trend=0.04; For 2-PHEN, the 3rd tertile: OR=1.76, 95% CI: 1.07-2.88, p for trend=0.03). CONCLUSIONS Our findings suggest that exposure to PAHs may increase the risk of PAD. Further studies are necessary to explore the associations between PAHs and PAD.

Sun Safety Among Farmers and Farmworkers: A Review

ABSTRACT Farmers and farmworkers face increased risks of skin cancer from exposure to solar ultraviolet radiation (UVR) when working outdoors. The objective of this study was to evaluate the evidence from behavioral and intervention studies from the peer-reviewed studies related to sun safety among farmers and farmworkers and identify any gaps in the literature. A comprehensive review was conducted between 1990 and 2013; 22 studies were identified related to behavior and health interventions of sun safety among these targeted groups. The inconsistency of data collection methods makes it difficult to estimate with accuracy any overall meaningful results of behavior. However, from the studies reviewed, farmers and farmworkers most frequently reported wearing some type of hat (23.6%–100%) as a primary method of protection from the sun when working outdoors. Female farmers were more likely than male farmers to use sunscreen and engage in indoor tanning behavior. All sun safety educational interventions studies reviewed reported positive increases in behavioral change. To a large degree, adequate sun protection is lacking and varies geographically among farmers. Although targeted education is key to making improvements on sun protection behavior, aggressive attempts have to be made. Studies related to farmworkers, sun safety behavior, and skin cancer are scarce and more research is needed in this area.

Associations between exposure to polycyclic aromatic hydrocarbons and glucose homeostasis as well as metabolic syndrome in nondiabetic adults.

PURPOSE Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental toxic compounds formed from incomplete combustion of carbon-containing materials, cigarette smoking, and food cooking. The genotoxic effects of PAHs have been widely studied. However, their nongenotoxic effects such as their impacts on glucose and metabolic homeostasis have not been well examined. METHODS We used the National Health and Nutritional Examination Survey (NHANES) 2001-2008 to investigate the associations between eight monohydroxy urinary metabolites of four PAHs and glucose homeostasis as well as metabolic syndrome in 1,878 nondiabetic participants aged 18 years or older. RESULTS In linear regression models, increased level of 2-PHEN was significantly associated with increased insulin resistance (β coefficient 0.05 ± 0.02), and increased concentrations of 3-FLUO (β coefficient -0.02 ± 0.01) were significantly associated with decreased β-cell function (all p<0.05) after controlling for selected covariates. In addition, increased concentrations of 2-FLUO (OR=1.25, 95% CI: 1.04-1.51), 1-PHEN (OR=1.36, 95% CI: 1.09-1.70), and 2-PHEN (OR: 1.49, 95% CI: 1.22-1.83) were significantly associated with a higher prevalence of the metabolic syndrome after adjusting for covariates. Consistent results were observed in the subgroup analysis among nonsmokers. CONCLUSIONS Our findings suggest that environmental exposure to PAHs independent of cigarette smoking is associated with insulin resistance, β-cell dysfunction, and increased prevalence of metabolic syndrome.

Assessment of Sun Safety Behavior among Farmers Attending a Regional Farm Show in North Carolina

ABSTRACT Background: Due to the nature of working outdoors, many farmers experience high levels of exposure to ultraviolet radiation (UVR) whereby, increasing their risk for skin cancer. The primary goal of this study was to evaluate personal behavior and perception on sun protection among farmers attending a regional farm show in North Carolina. Methods: Farmers (n = 397) were asked to complete a self-administered questionnaire regarding behavior and importance of using personal sun protection (i.e., sunblock, etc.,) when working outdoors. Results: There were 285 (71.8%) male farmers and 79 (19.9%) female farmers with a mean age of 54 years. Overall, the majority of farmers recognized the importance of protecting themselves from the sun, however, actual personal behavior for using proper protection methods ranked low. Farmers with lighter, fairer skin tended to use more sun protection and ranked the importance of sun protection higher when compared to those with skin that was less likely to burn in the sun. Conclusion: The importance of personal sun protection should continue to be stressed to farmers at every available opportunity including farm shows, trainings and through health care providers.

Estimating the Prevalence of Heat-Related Symptoms and Sun Safety–Related Behavior among Latino Farmworkers in Eastern North Carolina

ABSTRACT In hot weather, thermal heat generated by the body, combined with environmental heat from the sun, can lead outdoor workers to experience heat-related stress, severe illness, or even death. The aims of this study were to estimate the prevalence of heat-related symptoms and potential risk factors associated with sun safety–related behavior among Latino farmworkers. Data from interviewer-administered questionnaires were collected from a cross-sectional survey among farmworkers (N = 158) from August to September 2013. Data analysis assessed associations between work activities, sun safety behavior, and the prevalence of heat-related illness (HRI) symptoms among workers. Nearly two thirds (72%) of farmworkers experienced at least one HRI symptom and lacked proper cooling methods when working outdoors. Most workers reported wearing long-sleeved shirts (85%), long pants (98%), and baseball caps (93%). The prevalence of having one HRI symptom was 72% and 27% among workers having three or more HRI symptoms. The majority of farmworkers experience symptoms of HRI and are not provided with proper shade protection when working outdoors. Increased emphasis on administrative controls, particularly educating field supervisors and workers on how to avoid and recognize HRI, should be a priority.

Assessment of Personal Protective Equipment Use Among Farmers in Eastern North Carolina: A Cross-sectional Study

ABSTRACT Agriculture consistently ranks among the top hazardous occupations, accounting for a significant number of injuries and fatalities in the workplace. Eastern North Carolina has a significant number of small, independent, family-run, owned, and operated farms. However, little is known about perception, behavior, training, accessibility, or purchasing personal protective equipment (PPE) for safety among farmers in the region. In this study, telephone interviews were conducted among participating farmers between March and June 2012 (N = 129). Univariate and bivariate analyses were conducted to examine associations between PPE behavior and workplace hazards, health-related concerns, and wearing and purchasing PPE. Findings indicated that personal behavior of wearing hearing protection devices (HPDs) and protection from the sun among farmers was low. However, a relatively high percentage of farmers reported wearing PPE when working with agricultural chemicals. Most farmers received training from agricultural extension offices. The findings indicate that, in general, farmers are well aware of the risks associated with occupational hazards and recognize concern for health and safety protection in the workplace. Transitioning these concerns into preventative action remains a challenge and priority for the agricultural health professional.

Sun protection behaviors among Latino migrant farmworkers in eastern North Carolina.

Objective: Farmworkers are at an increased risk of skin cancer from exposure to excessive amounts of ultraviolet radiation from the sun. The primary objective of this study was to evaluate sun protection behaviors. Methods: A cross-sectional study of Latino farmworkers in eastern North Carolina was conducted using personal interviews followed by a full-body examination for skin cancers (N = 157). Results: Participants were predominately, young, males from Mexico who spent 9 or more hours each work day in the sun. Most reported wearing long sleeved shirts (85.7%) and long pants (98.0%). Few workers rarely used sunscreen (90.8%) or wore sunglasses (87.4%). Skin cancers were not identified among workers. Conclusions: In general, farmworkers lack sufficient information and knowledge about the risks of skin cancer from the sun. Interventions for reducing excessive ultraviolet radiation exposures are warranted.

Safety and Injury Characteristics of Youth Farmworkers in North Carolina: A Pilot Study

ABSTRACT Agriculture is a unique US industry in how youth are involved. Youth employed in agriculture experience high rates of injury, and youth migrant and seasonal farmworkers may be extremely vulnerable. The primary aim for this analysis is to describe the personal characteristics, work characteristics, occupational safety behaviors, and occupational injuries of North Carolina youth farmworkers. This pilot study uses data from interviewer-administered questionnaires with 87 youth farmworkers. Participants included males (62.1%) and females (37.9%), with 26.4% aged 10–13 years, 39.1% 14–15 years, and 34.5% 16–17 years. The majority (78.2%) were born in the United States. Most worked in tobacco (46.0%), sweet potatoes (28.7%), and berries (28.7%). They were paid by the hour (54.0%) and piece rate (55.2%); 21.8% reported a problem getting paid the amount earned. Three quarters wore a hat, and 63.2% wore gloves while working. Five (5.7%) had received pesticide use training in the past year. Over half reported a musculoskeletal injury (54.0%), a traumatic injury (60.9%), or a dermatological injury (72.4%) in the last year. Six of the injuries led to medical treatment, and 10 resulted in missed school or work. Farmworker youth in North Carolina are at times not treated fairly when they work, occupational safety behaviors are limited (increasing exposure to pesticides and other environmental hazards), and they commonly experience injuries. Research on the occupational exposures and health experienced by youth farmworkers is needed to inform policy. Changes in policy are warranted to improve the safety of youth farmworkers.

A population-based study of smoking, serum cotinine and exhaled nitric oxide among asthmatics and a healthy population in the USA

Abstract Background: Fractional concentration of exhaled nitric oxide (FeNO) is recommended by the American Thoracic Society (ATS) as a noninvasive biomarker of airway inflammation. In addition to inflammation, many factors may be associated with FeNO, particularly tobacco exposure; however, only age has been included as an influential factor for children below 12 years. Numerous studies have demonstrated negative associations between tobacco exposure and FeNO levels with self-reported data, but few with an objective assessment of smoking. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2007–2012 were analyzed to examine the association between FeNO and active/passive tobacco. Exposure was assessed by both self-report and serum cotinine levels among 11,160 subjects aged 6–79 years old with asthma, or without any respiratory disease. Results: Study results indicated 28.8% lower FeNO, 95% CI [25.2%, 32.3%] and 38.1% lower FeNO, 95% CI: [28.1, 46.2] was observed among healthy and asthmatic participants with serum cotinine in the highest quartile compared to those in the lowest quartile, respectively. Self-reported smoking status and recent tobacco use were also associated with decreased FeNO. Self-reported passive smoking was significantly associated with a 1.0% decrease in FeNO 95% CI [0.0, 2.0] among asthmatic subjects but not among healthy subjects. Conclusions: Active smoking, whether measured by self-report or serum cotinine, was associated with decreased FeNO levels. In addition to age, increased attention should be given to tobacco exposure when using FeNO as a biomarker in clinical practice. Additional research is needed to establish reference value of FeNO considering the impact of tobacco exposure.

Eastern Carolina Asthma Prevention Program (ECAPP): An Environmental Intervention Study among Rural and Underserved Children with Asthma in Eastern North Carolina:

Objective Asthma is the most common chronic childhood condition affecting 6.3 million (US) children aged less than 18 years. Home-based, multi-component, environmental intervention studies among children with asthma have demonstrated to be effective in reducing asthma symptoms. In this study, a local hospital and university developed an environmental intervention research pilot project, Eastern Carolina Asthma Prevention Program (ECAPP), to evaluate self-reported asthma symptoms, breathing measurements, and number of asthma-related emergency department (ED) visits among low-income, minority children with asthma living in rural, eastern North Carolina. Our goal was to develop a conceptual model and demonstrate any asthma respiratory improvements in children associated with our home-based, environmental intervention. Methods This project used a single cohort, intervention design approach to compare self-reported asthma-related symptoms, breathing tests, and ED visits over a 6 month period between children with asthma in an intervention study group (n = 12) and children with asthma in a control study group (n = 7). The intervention study group received intense asthma education, three home visits, 2 week follow-up telephone calls, and environmental intervention products for reducing asthma triggers in the home. The control group received education at baseline and 2 week calls, but no intervention products. Results At the end of the study period, significant improvements were observed in the intervention group compared with the control group. Overall, the intervention group experienced a 58% (46 ± SD 26.9) reduction in self-reported asthma symptoms; 76% (34 ± SD 29.7) decrease in rescue medicine; 12% (145 ± SD 11.3) increase in controller medicine; 37% decrease in mean exhaled nitric oxide levels and 33% fewer ED asthma-related visits. Conclusion As demonstrated, a combination of efforts appeared effective for improving asthma respiratory symptoms among children in the intervention group. ECAPP is a low cost pilot project that could readily be adapted and expanded into other communities throughout eastern North Carolina. Future efforts could include enhanced partnerships between environmental health professionals at local health departments and pediatric asthma programs at hospitals to carry out ECAPP.