Kirsten S. Almberg

Atrazine and nitrate in drinking water and the risk of preterm delivery and low birth weight in four Midwestern states

Background Atrazine and nitrate are common contaminants in water, and there is limited evidence that they are associated with adverse birth outcomes. The objective of this study was to examine whether atrazine and nitrate in water are associated with an increased risk of preterm delivery (PTD) and term low birth weight (LBW). Methods The study included a total of 134,258 singletons births born between January 1, 2004 and December 31, 2008 from 46 counties in four Midwestern states with public water systems that were included in the U.S. Environmental Protection Agency (EPA)’s atrazine monitoring program (AMP). Counties with a population of >300,000 were eliminated from the analyses in order to avoid confounding by urbanicity. Monthly childs sex, race and Hispanic ethnicity specific data were obtained from the states for estimating rates of PTD (<37 weeks) and very preterm (VPTD, <32 weeks), term LBW (<2.5 kg among infants born at term) and very low birth weight (VLBW, <1.5 kg). The rates were linked with county specific monthly estimates of the concentration of atrazine and nitrate in finished water. Multivariable negative binomial models were fitted to examine the association between the exposures and the adverse birth outcomes. Models were fitted with varying restrictions on the percentage of private well usage in the counties in order to limit the degree of exposure misclassification. Results Estimated water concentrations of atrazine (mean=0.42 ppb) and nitrate (mean=0.95 ppm) were generally low. Neither contaminant was associated with an increased risk of term LBW. Atrazine exposure was associated with a significant increased rate of PTD when well use was restricted to 10% and the exposure was averaged over 4–6 months prior to birth (Rate Ratio for 1 ppm increase [RR1 ppm]=1.08, 95%CI=1.05,1.11) or over 9 months prior to birth (RR1 ppm=1.10, 95%CI=1.01,1.20). Atrazine exposure was also associated with an increased rate of VPTD when when well use was restricted to 10% and the exposure was averaged over 7–9 months prior to birth (RR1 ppm=1.19, 95%CI=1.04,1.36). Exposure to nitrate was significantly associated with an increased rate of VPTD (RR1 ppm=1.08, 95%CI=1.02,1.15) and VLBW (RR1 ppm=1.17, 95%CI=1.08,1.25) when well use was restricted to 20% and the exposure was averaged over 9 months prior to birth. Conclusion The positive and negative findings from our study need to be interpreted cautiously given its ecologic design, and limitations in the data for the exposures and other risk factors. Nonetheless, our findings do raise concerns about the potential adverse effects of these common water contaminants on human development and health, and the adequacy of current regulatory standards. Further studies of these issues are needed with individual level outcome data and more refined estimates of exposure. HighlightsAtrazine was associated with PTD in areas with low well use.Nitrate was associated with very VPTD and very VLBW in areas of low well use.A strong interaction was observed between atrazine and nitrate for PTD.These associations were evident at concentrations below the current EPA standards.Our findings should be viewed as exploratory and require confirmation.

A study of adverse birth outcomes and agricultural land use practices in Missouri

BACKGROUND Missouri is an agriculturally intensive state, primarily growing corn and soybeans with additional rice and cotton farming in some southeastern counties. Communities located in close proximity to pesticide-treated fields are known to have increased exposure to pesticides and may be at increased risk of adverse birth outcomes. The study aims were to assess the relationship between county-level measures of crop-specific agricultural production and adverse birth outcomes in Missouri and to evaluate the most appropriate statistical methodologies for doing so. METHODS Potential associations between county level data on the densities of particular crops and low birth weight and preterm births were examined in Missouri between 2004-2006. Covariates considered as potential confounders and effect modifiers included gender, maternal race/ethnicity, maternal age at delivery, maternal smoking, access to prenatal care, quarter of birth, county median household income, and population density. These data were analyzed using both standard Poisson regression models as well as models allowing for temporal and spatial correlation of the data. RESULTS There was no evidence of an association between corn, soybean, or wheat densities with low birth weight or preterm births. Significant positive associations between both rice and cotton density were observed with both low birth weight and preterm births. Model results were consistent using Poisson and alternative models accounting for spatial and temporal variability. CONCLUSIONS The associations of rice and cotton with low birth weight and preterm births warrant further investigation. Study limitations include the ecological study design and limited available covariate information.

Arsenic in drinking water and adverse birth outcomes in Ohio

Background Arsenic in drinking water has been associated with adverse reproductive outcomes in areas with high levels of naturally occurring arsenic. Less is known about the reproductive effects of arsenic at lower levels. Objectives This research examined the association between low‐level arsenic in drinking water and small for gestational age (SGA), term low birth weight (term LBW), very low birth weight (VLBW), preterm birth (PTB), and very preterm birth (VPTB) in the state of Ohio. Methods Exposure was defined as the mean annual arsenic concentration in drinking water in each county in Ohio from 2006 to 2008 using Safe Drinking Water Information System data. Birth outcomes were ascertained from the birth certificate records of 428,804 births in Ohio from the same time period. Multivariable generalized estimating equation logistic regression models were used to assess the relationship between arsenic and each birth outcome separately. Sensitivity analyses were performed to examine the roles of private well use and prenatal care utilization in these associations. Results Arsenic in drinking water was associated with increased odds of VLBW (AOR 1.14 per &mgr;g/L increase; 95% CI 1.04, 1.24) and PTB (AOR 1.10; 95% CI 1.06, 1.15) among singleton births in counties where <10% of the population used private wells. No significant association was observed between arsenic and SGA, or VPTB, but a suggestive association was observed between arsenic and term LBW. Conclusions Arsenic in drinking water was positively associated with VLBW and PTB in a population where nearly all (>99%) of the population was exposed under the current maximum contaminant level of 10 &mgr;g/L. Current regulatory standards may not be protective against reproductive effects of prenatal exposure to arsenic. HighlightsWe examined arsenic concentrations in drinking water and birth outcomes in Ohio.Arsenic concentration treated as county‐wide annual average in public water supply.Arsenic concentrations associated with preterm birth.Arsenic concentrations associated with term low birth weight births.Current standards not protective against reproductive effects of arsenic exposure.

Increasing Severity of Pneumoconiosis Among Younger Former US Coal Miners Working Exclusively Under Modern Dust-Control Regulations

Background: Coal workers’ pneumoconiosis (CWP) steadily declined among US miners following dust control regulations in 1970. In 2000, severe forms of this disease reemerged among young miners, and are well described among working—but not former—miners. Methods: Black lung benefits program (BLBP) data (2001 to 2013) were used to estimate respiratory disease burden among former miners including: (1) CWP (simple; advanced CWP, and progressive massive fibrosis [CWP/PMF]); and (2) respiratory impairment (FEV1 percent reference: mild, moderate, ≥moderately-severe). Results: Among 24,686 claimants, 8.5% had advanced CWP/PMF; prevalence was highest among younger (less than or equal to 56 years: 10.8%) and older (greater than 70 years: 8.4%) miners and those who began work after versus before 1970 (8.3% vs. 4.0%). Conclusions: BLBP claims provide potentially useful data for monitoring the burden and severity of coal mine dust lung disease, and assessing efficacy of protective regulations.

High Cigarette and Poly-Tobacco Use Among Workers in a Dusty Industry: New Jersey Quarry Workers.

Objective: Tobacco use is high among US extraction and construction workers, who can also incur occupational dust exposure. Information on different types of tobacco use among quarry/mine workers is sparse. Methods: During mandated training sessions, New Jersey quarry workers were surveyed about their tobacco use. Prevalence was calculated for single and multiple tobacco use by demographic and workplace characteristics; logistic regression was used to assess associations with smoking. Results: Two hundred forty (97.1%) workers completed surveys. Among respondents, 41.7% [95% confidence interval (95% CI) 35.4 to 48.3] currently used any tobacco product of whom 28.1% smoked cigarettes. In multivariate analysis, positive associations with smoking included working as a contractor versus mine employee (odds ratio 2.32, 95% CI 1.01 to 5.36) and a usual job title of maintenance (odds ratio 2.02, 95% CI 0.87 to 4.94). Conclusion: Industry-specific information may be helpful in developing targeted tobacco-cessation programs.

Injury and Illness Data for Illinois Mining Industry Employees, 1990 to 2012.

Objective: This study identifies and evaluates injury types associated with distribution of cause of injuries and compensation among Illinois miners. Methods: Cases were selected from the Illinois Workers’ Compensation database from 1990 to 2012 to determine injury distributions and compensation among miners and non-miners. Logistic models were used to analyze total monetary compensation, temporary total disability (TTD), and permanent partial disability as primary outcomes. Results: The major predictors of total monetary compensation in both miners and non-miners were TTD, permanent partial disability, average weekly wage, and age at the time of filing. Systemic injuries were an additional driver of final monetary compensation among miners. Miners were compensated

Atrazine Contamination of Drinking Water and Adverse Birth Outcomes in Community Water Systems with Elevated Atrazine in Ohio, 2006–2008

618 less (total monetary compensation; confidence interval 95%: −971, −266; P < 0.001), had 2.1 more weeks away from work (TTD; confidence interval 95%: 1.58, 2.63; P < 0.001), and had higher numbers of systemic injuries than non-miners. Conclusions: Systemic injuries are important drivers for TWC in miners in terms of median compensation and TTD.

Progressive Massive Fibrosis Resurgence Identified in U.S. Coal Miners Filing for Black Lung Benefits, 1970–2016

Atrazine, a common water contaminant in the U.S., has been associated with adverse birth outcomes in previous studies. This study aimed to determine if atrazine concentrations in drinking water are associated with adverse birth outcomes including small for gestational age (SGA), term low birth weight (term LBW), very low birth weight (VLBW), preterm birth (PTB), and very preterm birth (VPTB). This study included 14,445 live singleton births from Ohio communities served by 22 water systems enrolled in the U.S. Environmental Protection Agency’s Atrazine Monitoring Program between 2006 and 2008. Mean gestational and trimester-specific atrazine concentrations were calculated. Significantly increased odds of term LBW birth was associated with atrazine exposure over the entire gestational period (OR 1.27, 95% CI 1.10, 1.45), as well as the first (OR 1.20, 95% CI 1.08, 1.34) and second trimesters (OR 1.13, 95% CI 1.07, 1.20) of pregnancy. We observed no evidence of an association between atrazine exposure via drinking water and SGA, VLBW, PTB, or VPTB. Our results suggest that atrazine exposure is associated with reduced birth weight among term infants and that exposure to atrazine in drinking water in early and mid-pregnancy may be most critical for its toxic effects on the fetus.

High exposure mining occupations are associated with obstructive lung disease, National Health Interview Survey (NHIS), 2006-2015

Rationale: There has been a resurgence of progressive massive fibrosis (PMF) in the United States, particularly among central Appalachian miners. Objectives: We characterized the proportion of PMF among former U.S. coal miners applying for Federal Black Lung Program benefits, 1970‐2016. Methods: Data from the U.S. Department of Labor were used to characterize trends in proportion of PMF cases, defined as an approved black lung claim with a determination of PMF, among all miners who filed for federal benefits between January 1, 1970, and December 31, 2016. Joinpoint, logistic, and linear regression models were used to identify changes in the proportion of claimants with PMF over time. Results: There were 4,679 unique PMF cases among claimants for federal black lung benefits between 1970 and 2016, with 2,474 miners determined to have PMF since 1996. The number of PMF cases among Federal Black Lung Program claimants fell from 404 (0.5% of claimants) in 1978 to a low of 18 cases (0.6%) in 1988, and then increased to 353 cases (8.3%) in 2014. The proportion of federal black lung benefits claimants with PMF has been increasing since 1978 (0.06% annual percent change [APC]; 95% confidence interval [CI], 0.05‐0.07%; P < 0.0001), and began increasing at a significantly increased rate after 1996 (0.26% APC; 95% CI, 0.25‐0.28%; P < 0.0001). Most miners with PMF (84%) last mined in West Virginia, Kentucky, Pennsylvania, or Virginia. Since 1970, the proportion of claimants with PMF has increased significantly among miners who last worked in Kentucky (16.6% APC; 95% CI, 16.5‐16.7%), Pennsylvania (4.7% APC; 95% CI, 4.6‐4.8%), Tennessee (16.1% APC; 95% CI, 15.7‐16.4%), West Virginia (16.8% APC; 95% CI, 16.6‐16.9%), and most sharply among miners last working in Virginia (31.5% APC; 95% CI, 31.2‐31.7%), where in 2009, more than 17% of claimants received a PMF determination. The proportion of PMF determinations for the rest of the United States has not exceeded 4%. Conclusions: There has been a resurgence of PMF, particularly in central Appalachian miners. The resurgence of this preventable disease points to the need for improved primary and secondary prevention of dust‐related lung disease in U.S. coal miners.

Linking Compensation and Health Surveillance Data Sets to Improve Knowledge of US Coal Miners’ Health

BACKGROUND The association between mining occupation categories and obstructive lung disease (OLD) has not been well explored in the United States. METHODS National Health Interview Survey (NHIS) data from 2006 to 2015 was used to determine the relationship between mining occupations and diagnosis of chronic bronchitis, emphysema, chronic obstructive pulmonary disease (COPD), and asthma. We classified occupations into low, moderate, high, and very high dust exposure groups. Extraction workers were categorized as very high dust exposure. RESULTS We found 4.5% of miners had chronic bronchitis, 3.3% had emphysema, 6.2% had COPD, and 9.9% had asthma. In fully adjusted models, extraction workers had significantly increased odds of having chronic bronchitis (OR = 2.18 [95%CI: 1.02, 4.64]), emphysema (OR = 7.85 [95%CI: 1.70, 36.27]), and COPD (OR = 2.56 [95%CI: 1.29, 5.12]) compared to lower exposure occupations. CONCLUSIONS Occupation is an important predictor of OLD in the mining industry.