Wendy McKelvey

A biomonitoring study of lead, cadmium, and mercury in the blood of New York city adults.

Objectives We assessed the extent of exposure to lead, cadmium, and mercury in the New York City (NYC) adult population. Methods We measured blood metal concentrations in a representative sample of 1,811 NYC residents as part of the NYC Health and Nutrition Examination Survey, 2004. Results The geometric mean blood mercury concentration was 2.73 μg/L [95% confidence interval (CI), 2.58–2.89]; blood lead concentration was 1.79 μg/dL (95% CI, 1.73–1.86); and blood cadmium concentration was 0.77 μg/L (95% CI, 0.75–0.80). Mercury levels were more than three times that of national levels. An estimated 24.8% (95% CI, 22.2–27.7%) of the NYC adult population had blood mercury concentration at or above the 5 μg/L New York State reportable level. Across racial/ethnic groups, the NYC Asian population, and the foreign-born Chinese in particular, had the highest concentrations of all three metals. Mercury levels were elevated 39% in the highest relative to the lowest income group (95% CI, 21–58%). Blood mercury concentrations in adults who reported consuming fish or shellfish 20 times or more in the last 30 days were 3.7 times the levels in those who reported no consumption (95% CI, 3.0–4.6); frequency of consumption explained some of the elevation in Asians and other subgroups. Conclusions Higher than national blood mercury exposure in NYC adults indicates a need to educate New Yorkers about how to choose fish and seafood to maximize health benefits while minimizing potential risks from exposure to mercury. Local biomonitoring can provide valuable information about environmental exposures.

Asthma Diagnosed after 11 September 2001 among Rescue and Recovery Workers: Findings from the World Trade Center Health Registry

Background Studies have consistently documented declines in respiratory health after 11 September 2001 (9/11) among surviving first responders and other World Trade Center (WTC) rescue, recovery, and clean-up workers. Objectives The goal of this study was to describe the risk of newly diagnosed asthma among WTC site workers and volunteers and to characterize its association with WTC site exposures. Methods We analyzed 2003–2004 interview data from the World Trade Center Health Registry for workers who did not have asthma before 9/11 (n = 25,748), estimating the risk of newly diagnosed asthma and its associations with WTC work history, including mask or respirator use. Results Newly diagnosed asthma was reported by 926 workers (3.6%). Earlier arrival and longer duration of work were significant risk factors, with independent dose responses (p < 0.001), as were exposure to the dust cloud and pile work. Among workers who arrived on 11 September, longer delays in the initial use of masks or respirators were associated with increased risk of asthma; adjusted odds ratios ranged from 1.63 [95% confidence interval (CI), 1.03–2.56) for 1 day of delay to 3.44 (95% CI, 1.43–8.25) for 16–40 weeks delay. Conclusions The rate of self-reported newly diagnosed asthma was high in the study population and significantly associated with increased exposure to the WTC disaster site. Although we could not distinguish appropriate respiratory protection from inappropriate, we observed a moderate protective effect of mask or respirator use. The findings underscore the need for adequate and timely distribution of appropriate protective equipment and the enforcement of its use when other methods of controlling respiratory exposures are not feasible.

Population-Based Inorganic Mercury Biomonitoring and the Identification of Skin Care Products as a Source of Exposure in New York City

Background Mercury is a toxic metal that has been used for centuries as a constituent of medicines and other items. Objective We assessed exposure to inorganic mercury in the adult population of New York City (NYC). Methods We measured mercury concentrations in spot urine specimens from a representative sample of 1,840 adult New Yorkers in the 2004 NYC Health and Nutrition Examination Survey. Cases with urine concentrations ≥ 20 μg/L were followed up with a telephone or in-person interview that asked about potential sources of exposure, including ritualistic/cultural practices, skin care products, mercury spills, herbal medicine products, and fish. Results Geometric mean urine mercury concentration in NYC was higher for Caribbean-born blacks [1.39 μg/L; 95% confidence interval (CI), 1.14–1.70] and Dominicans (1.04 μg/L; 95% CI, 0.82–1.33) than for non-Hispanic whites (0.67 μg/L; 95% CI, 0.60–0.75) or other racial/ethnic groups. It was also higher among those who reported at least 20 fish meals in the past 30 days (1.02 μg/L; 95% CI, 0.83–1.25) than among those who reported no fish meals (0.50 μg/L; 95% CI, 0.41–0.61). We observed the highest 95th percentile of exposure (21.18 μg/L; 95% CI, 7.25–51.29) among Dominican women. Mercury-containing skin-lightening creams were a source of exposure among those most highly exposed, and we subsequently identified 12 imported products containing illegal levels of mercury in NYC stores. Conclusion Population-based biomonitoring identified a previously unrecognized source of exposure to inorganic mercury among NYC residents. In response, the NYC Health Department embargoed products and notified store owners and the public that skin-lightening creams and other skin care products that contain mercury are dangerous and illegal. Although exposure to inorganic mercury is not a widespread problem in NYC, users of these products may be at risk of health effects from exposure.

Characterization of residential pest control products used in inner city communities in New York City

The Columbia Center for Childrens Environmental Health (CCCEH) previously reported widespread residential insecticide use in urban communities in New York City. Research suggests that pyrethroids are replacing organophosphates (OPs) in response to 2000–2001 US EPA pesticide regulations restricting OP use. A systematic assessment of active ingredients used for residential pest control is lacking. We queried a database of pesticide applications reported by licensed applicators between 1999 and 2005 and surveyed pest control products available in 145 stores within 29 zip codes in the CCCEH catchment area including Northern Manhattan and the South Bronx. Pyrethroids, pyrethrins, piperonyl butoxide, and hydramethylnon were the most common insecticide active ingredients reported as used by licensed pesticide applicators within the 29 zip codes of the CCCEH catchment area between 1999 and 2005. Use of certain pyrethroids and some non-spray insecticides such as fipronil and boric acid increased significantly by year (logistic regression, OR>1.0, P<0.05), whereas use of OPs, including chlorpyrifos and diazinon decreased significantly by year (logistic regression, OR<1.0, P<0.05). Among pesticide applicators, the most commonly applied active ingredients were formulated as spray applications. With 145 stores in the catchment area, 120 (82.5%) carried at least one insecticide. Spray cans were most common (114/120 stores, 95%); gels were least common (31/120 stores, 25.8%). Among spray formulations, pyrethroid insecticides were the most common pesticide class and permethrin, a pyrethroid, was the most common individual active ingredient. In 2007, one store carried a product containing chlorpyrifos and one store carried a product containing diazinon. This survey suggests that certain pyrethroids and non-spray insecticides replaced OPs for pest control in this area. Chlorpyrifos and diazinon have nearly been eliminated from products marketed for residential pest control.

Population-Based Biomonitoring of Exposure to Organophosphate and Pyrethroid Pesticides in New York City

Background: Organophosphates and pyrethroids are the most common classes of insecticides used in the United States. Widespread use of these compounds to control building infestations in New York City (NYC) may have caused higher exposure than in less-urban settings. Objectives: The objectives of our study were to estimate pesticide exposure reference values for NYC and identify demographic and behavioral characteristics that predict exposures. Methods: The NYC Health and Nutrition Examination Survey was a population-based, cross-sectional study conducted in 2004 among adults ≥ 20 years of age. It measured urinary concentrations of organophosphate metabolites [dimethylphosphate (DMP), dimethylthiophosphate (DMTP), dimethyldithiophosphate, diethylphosphate, diethylthiophosphate, and diethyldithiophosphate] in 883 participants, and pyrethroid metabolites [3-phenoxybenzoic acid (3-PBA), trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (trans-DCCA), 4-fluoro-3-phenoxybenzoic acid, and cis-3-(2,2-dibromovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid] in 1,452 participants. We used multivariable linear regression to estimate least-squares geometric mean total dialkylphospate (ΣDAP) and 3-PBA concentrations across categories of predictors. Results: The dimethyl organophosphate metabolites had the highest 95th percentile concentrations (87.4 μg/L and 74.7 μg/L for DMP and DMTP, respectively). The highest 95th percentiles among pyrethroid metabolites were measured for 3-PBA and trans-DCCA (5.23 μg/L and 5.94 μg/L, respectively). Concentrations of ΣDAP increased with increasing age, non-Hispanic white or black compared with Hispanic race/ethnicity, professional pesticide use, and increasing frequency of fruit consumption; they decreased with non-green vegetable consumption. Absolute differences in geometric mean urinary 3-PBA concentrations across categories of predictors were too small to be meaningful. Conclusion: Estimates of exposure to pyrethroids and dimethyl organophosphates were higher in NYC than in the United States overall, underscoring the importance of considering pest and pesticide burdens in cities when formulating pesticide use regulations. Citation: McKelvey W, Jacobson JB, Kass D, Barr DB, Davis M, Calafat AM, Aldous KM. 2013. Population-based biomonitoring of exposure to organophosphate and pyrethroid pesticides in New York City. Environ Health Perspect 121:1349–1356; http://dx.doi.org/10.1289/ehp.1206015

Effectiveness of an Integrated Pest Management Intervention in Controlling Cockroaches, Mice, and Allergens in New York City Public Housing

Background Cockroaches and mice, which are common in urban homes, are sources of allergens capable of triggering asthma symptoms. Traditional pest control involves the use of scheduled applications of pesticides by professionals as well as pesticide use by residents. In contrast, integrated pest management (IPM) involves sanitation, building maintenance, and limited use of least toxic pesticides. Objectives We implemented and evaluated IPM compared with traditional practice for its impact on pests, allergens, pesticide use, and resident satisfaction in a large urban public housing authority. Methods We assigned IPM or control status to 13 buildings in five housing developments, and evaluated conditions at baseline, 3 months, and 6 months in 280 apartments in Brooklyn and Manhattan, in New York City (New York). We measured cockroach and mouse populations, collected cockroach and mouse urinary protein allergens in dust, and interviewed residents. All statistical models controlled for baseline levels of pests or allergens. Results Compared with controls, apartments receiving IPM had significantly lower counts of cockroaches at 3 months and greater success in reducing or sustaining low counts of cockroaches at both 3 and 6 months. IPM was associated with lower cockroach allergen levels in kitchens at 3 months and in beds and kitchens at 6 months. Pesticide use was reduced in IPM relative to control apartments. Residents of IPM apartments also rated building services more positively. Conclusions In contrast to previous IPM studies, which involved extensive cleaning, repeat visits, and often extensive resident education, we found that an easily replicable single IPM visit was more effective than the regular application of pesticides alone in managing pests and their consequences.

Impact of a Letter-Grade Program on Restaurant Sanitary Conditions and Diner Behavior in New York City

OBJECTIVES We evaluated the impact of the New York City restaurant letter-grading program on restaurant hygiene, food safety practices, and public awareness. METHODS We analyzed data from 43,448 restaurants inspected between 2007 and 2013 to measure changes in inspection score and violation citations since program launch in July 2010. We used binomial regression to assess probability of scoring 0 to 13 points (A-range score). Two population-based random-digit-dial telephone surveys assessed public perceptions of the program. RESULTS After we controlled for repeated restaurant observations, season of inspection, and chain restaurant status, the probability of scoring 0 to 13 points on an unannounced inspection increased 35% (95% confidence interval [CI]=31%, 40%) 3 years after compared with 3 years before grading. There were notable improvements in compliance with some specific requirements, including having a certified kitchen manager on site and being pest-free. More than 91% (95% CI=88%, 94%) of New Yorkers approved of the program and 88% (95% CI=85%, 92%) considered grades in dining decisions in 2012. CONCLUSIONS Restaurant letter grading in New York City has resulted in improved sanitary conditions on unannounced inspection, suggesting that the program is an effective regulatory tool.

Mercury and polychlorinated biphenyls in Asian market fish: a response to results from mercury biomonitoring in New York City.

In 2004, the New York City (NYC) Health and Nutrition Examination Survey measured the highest blood mercury levels in Asian and foreign-born Chinese demographic groups. Fish consumption was the strongest predictor of exposure. The survey did not inquire about consumption of individual species, and subsequent visits to fish markets serving the Asian community suggested that many popular species lack contaminant data. Our objective was to supplement existing information on contaminants in commercial fish by collecting data on species present in markets serving the Asian community. We measured total mercury and the sum of 101 polychlorinated biphenyl (PCB) congeners in 282 individual specimens of 19 species or products from retail fish markets in Chinese neighborhoods in NYC. Species were selected based on their volume in the market, and an absence or insufficiency of national data on mercury levels. PCBs were measured because they are also contaminants of concern. All measurements were made on a wet weight basis on whole fillets (with skin) or products (drained of liquid). Mean mercury levels ranged from below the limit of detection (0.004microg/g) in tilapia to 0.229microg/g in tilefish. The highest mercury level (1.150microg/g) was measured in a tilefish specimen, and mercury levels in tilefish increased with the specimen size. Mean PCB levels ranged from 1ng/g in red snapper to 98ng/g in buffalo carp. The highest PCB levels were measured in a buffalo carp (469ng/g) and a yellow croaker (495ng/g). Species-specific differences in PCB levels accounted for only 6.3% of total variability, in contrast with 39.2% for mercury. Although we did not measure high mean mercury levels in the species we sampled, frequent consumption of fish with low to moderate levels can also elevate blood mercury. The data we collected can be used to guide fish consumption in Asian communities. However, risk-benefit trade-offs also need to be considered.

Using tracking infrastructure to support public health programs, policies, and emergency response in New York City.

OBJECTIVE To describe how the New York City (NYC) Tracking Program has used nationally mandated Secure Portal infrastructure and staff analytical expertise to support programs and inform policy. SETTING The NYC Health Department assesses, investigates, and acts on a wide range of environmental concerns to protect the health of New Yorkers. DESIGN Specific examples of highly effective policies or initiatives that relied on the NYC Tracking Program are described, including restaurant sanitary grade posting, rat indexing, converting boilers to cleaner-burning fuels, reducing exposure to mercury from fish and contaminated products, and responding to Superstorm Sandy. CONCLUSIONS The NYC Tracking Program supports the Health Department in using inspectional, administrative, and health data to guide operations. Tracking has also allowed internal and external partners to use these data to guide policy development.

Declines in adult blood lead levels in New York City compared with the United States, 2004–2014

Objectives To assess changes in lead exposure in the New York City (NYC) adult population over a 10‐year period and to contrast changes with national estimates, overall, and by socio‐demographics and smoking status. Methods We used measurements of blood lead levels (BLLs) from NYC resident adults who participated in the NYC Health and Nutrition Examination Surveys (HANES) in 2004 and 2013–2014. We compared estimates of geometric means (GM), 95th percentiles, and prevalence of BLL ≥ 5 &mgr;g/dL overall and by subgroups over time, with adults who participated in the National HANES (NHANES) 2001–2004 and 2011–2014. Results The GM BLLs among NYC adults declined from 1.79 &mgr;g/dL in 2004 to 1.13 &mgr;g/dL in 2013–2014 (P < .0001). The declines over this period ranged from 30.1% to 43.2% across socio‐demographic groups and smoking status (P < .0001 for all comparisons), and were slightly greater than declines observed nationally. The drop in prevalence of elevated BLLs (≥ 5 &mgr;g/dL) was also greater in NYC (4.8–0.5%), compared with NHANES (3.8–2.0%). By 2013–2014, NYC adults with lower annual family income (<