Leila W. Jackson

Use of hair dyes, hematopoietic neoplasms, and lymphomas : A literature review. I. Leukemias and myelodysplastic syndromes

Abstract We review published epidemiologic studies on personal use of hair dyes and leukemias and myelodysplastic syndromes (MDS). A subsequent article will review studies on lymphomas and multiple myeloma. A computerized literature search for the years 1966 through 1996 was completed using MEDLINE. Data were extracted using a standardized form that recorded study design, study population, type of cases, comparison group, sources of data on personal exposure to hair dyes, method of data collection, type of exposure data collected, covariates, and results. The above search identified 13 epidemiologic studies on the possible association between personal use of hair dyes and leukemias and MDS. although there are some reports of positive associations, overall the evidence linking personal use of hair dyes to various leukemia and MDS subgroups is weak. One cannot definitively rule out an association, however, because of the methodologic limitations, such as small numbers of exposed cases and lack of detailed exposure information. Any further research would need much better assessment of hair dye use, including product type, color frequency, duration, and changes in use over time, and adequate statistical power.

Use of Hair Dyes, Hematopoietic Neoplasms, and Lymphomas: A Literature Review. II. Lymphomas and Multiple Myeloma

Abstract We review studies on hair dyes and lymphomas and multiple myeloma (MM). A computerized literature search for the years 1966 through 1996 was conducted. Data were extracted using a standardized form that recorded study design, study population, type of cases, comparison group, sources of data on personal exposure to hair dyes, method of data collection, type of exposure data collected, covariates, and results. This review identified 10 epidemiologic studies published in the English literature that examined personal use of hair dyes and lymphomas or MM. These studies include three evaluations of Hodgkins disease, five of non-Hodgkins lymphoma (NHL), two of lymphomas with type not specified, and six of MM. For Hodgkin s disease, one case-control study reported some positive associations with use of permanent hair dyes, whereas two cohort studies found no associations with ever use of hair dyes. For NHL and MM, several evaluations suggest associations with use of permanent dyes, particularly with duration, frequency, age at first use, and dark colors. However, these associations are not consistent within and between studies. For lymphomas with type not specified, one study was superseded by a more recent report with NHL specific data and a second study was limited by small numbers of exposed subjects. At this time, it is not possible to determine if the inconsistent associations between permanent hair dyes and NHL and MM reflect sampling variability or differences in methods between studies. Because an appreciable fraction of the population has potential exposure to permanent hair dyes, elucidation of such issues may be warranted with studies that include adequate numbers of exposed subjects and that elicit information on personal use of hair dyes over time.

FREQUENCY OF POLICY RECOMMENDATIONS IN EPIDEMIOLOGIC PUBLICATIONS

OBJECTIVES The purpose of this study was to determine the frequency and character of policy statements in epidemiologic reports. METHODS The first author followed a standardized protocol and reviewed a random sample of articles selected from the American Journal of Epidemiology, Annals of Epidemiology, and Epidemiology. The second author reviewed all articles with policy statements and a 10% sample without such statements. RESULTS Overall, 23.8% of the articles contained policy statements. Annals of Epidemiology and the American Journal of Epidemiology had similar frequencies of articles with policy statements (30% and 26.7%, respectively), while Epidemiology evidenced the lowest frequency (8.3%). The majority of policy statements (55%) pertained to public health practice; 27.5% involved clinical practice, and the remainder (17.5%) focused on corporate policies, regulatory actions, or undefined arenas. The frequency of policy statements differed according to first authors affiliation, type of publication, area of research, research design, and study population. CONCLUSIONS Although a minority of publications included policy statements, the inclusion of a statement seemed to be influenced by specific study characteristics.

Decline in urinary bisphenol A concentrations in the United States.

To the Editor: Bisphenol A (BPA) is a highvolume production chemical used in polycarbonate plastics and epoxy resins. Human exposure occurs when BPA leaches from packaging into food or water. BPA has been associated with adverse reproductive, cardiometabolic, and behavioral outcomes, resulting in public and scientific concern.1–4 This concern, particularly for children, has led to the production of BPA-free products.2,5 Prior reports noted a possible decrease in urinary BPA after 2003–20043,6; however, more recent data are now available. We assessed time trends, especially among children, using National Health and Nutrition Examination Survey (NHANES) 2003–2010 data. Spot urine samples were obtained in 10,415 persons from four consecutive 2-year NHANES cycles (www.cdc. gov/nchs/nhanes.htm). Urinary BPA was analyzed using high-performance liquid chromatography-tandem mass spectrometry; this method did not change over time. The limit of detection (LOD) was 0.4 ng/ml: LOD/√2 was used for values below LOD (7.0%) (see eTable 1, http:// links.lww.com/EDE/A634). To account for urine dilution, BPA was creatininecorrected (BPAcorr) or adjusted for creatinine in models. We carried out statistical analyses using Stata 11.2 (College Station, TX), accounting for survey design and incorporating appropriate sample weights. Geometric mean BPAcorr levels by year were calculated. We assessed the percentage difference in BPA over time, adjusting for creatinine, age, sex, race/ethnicity, and income, using linear regression models with 2003–2004 as the reference category. To determine when substantial changes in BPA concentrations occurred within the study time frame, we further examined the percentage difference between consecutive survey cycles. Geometric mean BPAcorr was 2.09 μg/g creatinine (95% confidence interval [CI] = 2.02–2.16). BPA concentrations were higher in 2003–2004 compared with later years (eTable 2, h t tp : / / l inks . lww.com/EDE/A634; Fig.). In adjusted models, among 6to 11-year-olds, 12to 19-year-olds, and those 20 years or older, the percentage difference in BPA comparing 2009– 2010 to 2003–2004 was −45 (95% CI = −55 to −32), −40 (−49 to −28), and −20 (−23 to −2), respectively (eTable3, h t tp : / / l inks . lww.com/EDE/A634; Fig.). When comparing each cycle with the previous one, we observed significant decreases from 2003–2004 to 2005–2006 among all age groups and from 2007–2008 to 2009–2010 among 6to 11-year-olds, but a significant increase from 2005–2006 to 2007–2008 among those 20 years or older (eTable 4, http://links.lww.com/EDE/A634). Urinary BPA concentrations declined from 2003 to 2010 among younger children; however, among young people of age 12–19 years and those 20 years or older, there was a decline only from 2003–2004 to 2005–2006. This analysis is consistent with prior reports but includes more recent data and specifically focused on time trends. As has been suggested previously, this decline might represent random variation6; however, it is also plausible that there has been a true reduction in BPA exposure. As early as 2003, public concern about BPA generated advice on how to avoid exposure,7 by changing consumption habits; this has been shown to affect urinary BPA concentrations.8 In addition, removal of BPA from products would reduce exposures. It will be important to continue monitoring BPA concentrations, as additional removal of BPA from products may further reduce body burdens. It is also important to consider what is used as a substitute, to avoid merely replacing one endocrine disruptor with another.5 In conclusion, BPA concentrations have declined among 6to 11-year-olds in recent years, but remain highest in this age group, which may be the most vulnerable to environmental toxicants.1 Additional research should consider the health effects of BPA exposure particularly in the pediatric population, where outcomes—especially those related to obesity and cardiovascular risk—remain relatively understudied.

Spouses of persian gulf war I veterans : Medical evaluation of a U.S. cohort

Ten years after the 1991 Persian Gulf War (GW I), a comprehensive evaluation of a national cohort of deployed veterans (DV) demonstrated a higher prevalence of several medical conditions, in comparison to a similarly identified cohort of nondeployed veterans (NDV). The present study determined the prevalence of medical conditions among nonveteran spouses of these GW I DV and NDV. A cohort of 490 spouses of GW I DV and 537 spouses of GW I NDV underwent comprehensive face-to-face examinations. No significant differences in health were detected except that spouses of DV were less likely to have one or more of a group of six common skin conditions. We conclude that, 10 years after GW I, the general physical health of spouses of GW I DV is similar to that of spouses of NDV.

Pregnancy outcomes among U.S. Gulf War veterans: A population-based survey of 30,000 veterans

Anecdotal reports by veterans of the Persian Gulf War of 1990 have included concern over negative reproductive outcomes, including spontaneous abortions and birth defects. Two previous birth records studies failed to findevidence of an increased risk of defects, but a large population-based study of Gulf War veterans in the United Kingdom did suggest more miscarriages than in a control population. The present health survey examined reproductive outcomes in 15,000 Gulf War veterans and a comparable number of non-Gulf War veterans. The final study group, representing a 70% rate of response to a 16-page health survey, included 11,44] Gulf War veterans and 9476 control subjects. Nearly 30% of survey participants (6043) had index pregnancies. Male Gulf veterans reported more miscarriages and stillbirths than male non-Gulf War veterans, but the difference was statistically significant only for miscarriages. Female Gulf War veterans reported the same effects, but neither was significant. Live-born infants of male Gulf War veterans reportedly had likely birth defects nearly twice as often as control infants (adjusted odds ratio [OR], 1.94; 95% confidence interval [CI], 1.37-2.74), Female Gulf War veterans were nearly 3-fold likelier than control subjects to have a child with a likely birth defect (adjusted OR, 2.97; 95% CI, 1.47-5.99). Adjusted ORs for moderate to severe birth defects were 1.78 for males and 2.80 for females. A small excess of chromosomal defects was reported by Gulf War veterans. This large-scale population-based survey suggests that both male and female Gulf War veterans report significantly higher rates of birth defects in their live-born infants than do military control subjects. In addition, male Gulf War veterans reported significantly more miscarriages.