The primary route of exposure to methylmercury (MeHg), a known developmental neurotoxicant, is from ingestion of seafood. Since 2004, women of reproductive age in the U.S. have been urged to eat fish and shellfish as part of a healthy diet while selecting species that contain lower levels MeHg. Yet few studies have examined trends in MeHg exposure and fish consumption over time in this group of women with respect to their geographical location in the U.S.

Researchers from Oregon State and Louisiana State Universities convened a diverse gathering of leaders of Gulf Coast regional nongovernmental organizations, regulatory agencies, residents, and researchers to examine events following environmental disasters. The overall goals of the workshop were to develop unique findings from participant experiences that could be beneficial and to offer specific recommendations for the improvement of response, recovery, and resilience in future disasters. We examined three topics related to enhancing resilience to environmental disasters: rapid response for characterizing exposure; recovery and the role of the citizen scientist; and increased resilience with community participation. The participants shared their experiences and recommended solutions including increased training for citizen scientists, expanded use of innovative sampling technologies, and greater sharing of environmental conditions and information among stakeholders and agencies postevent. The recommendations will improve future response and recovery efforts, and should strengthen communities by supporting key theoretical attributes of resilience.

Fish provide a valuable source of beneficial nutrients and are an excellent source of low fat protein. However, fish are also the primary source of methylmercury exposure in humans. Selenium often co-occurs with mercury and there is some evidence that selenium can protect against mercury toxicity yet States issue fish consumption advisories based solely on the risks that methylmercury pose to human health. Recently, it has been suggested the selenium: mercury molar ratio be considered in risk management. In order for agencies to utilize the ratio to set consumption guidelines, it is important to evaluate the variability in selenium and mercury in different fish species. We examined 10 different freshwater fish species found within the Columbia River Basin in order to determine the inter- and intra-specific variability in the selenium: mercury molar ratios and the selenium health benefit values. We found significant variation in selenium: mercury molar ratios. The mean molar ratios for each species were all above 1:1, ranging from 3.42:1 in Walleye to 27.2:1 in Chinook salmon. There was a positive correlation between both mercury and selenium with length for each fish species apart from yellow perch and rainbow trout. All species had health benefit values greater than 2. We observed considerable variability in selenium: mercury molar ratios within fish species collected in the Columbia River Basin. Although incorporating selenium: mercury molar ratios into fish consumption holds the potential for refining advisories and assessing the risk of methylmercury exposure, the current understanding of how these ratios apply is insufficient, and further understanding of drivers of variability in the ratios is needed.

One expectation of community-based participatory research (CBPR) is participant access to study results. However, reporting experimental data produced by studies involving biological measurements in the absence of clinical relevance can be challenging to scientists and participants. We applied best practices in data sharing to report the results of a study designed to explore polycyclic aromatic hydrocarbons absorption, metabolism, and excretion following consumption of traditionally smoked salmon by members of the Confederated Tribes of the Umatilla Indian Reservation (CTUIR). A dietary exposure study was developed, in which nine Tribal members consumed 50g of traditionally smoked salmon and provided repeated urine samples over 24 hours. During recruitment, participants requested access to their data following analysis. Disclosing data is an important element of CBPR and must be treated with the same rigor as that given to the data analysis. The field of data disclosure is relatively new, but when handled correctly can improve education within the community, reduce distrust, and enhance environmental health literacy. Using the results from this study, we suggest mechanisms for sharing data with a Tribal community.

The relative influences of trans-Pacific and regional atmospheric transport on measured concentrations of polycyclic aromatic hydrocarbons (PAHs), PAH derivatives (nitro- (NPAH) and oxy-(OPAH)), organic carbon (OC), and particulate matter (PM) less than 2.5 μm in diameter (PM2.5) were investigated in the Pacific Northwest, U.S. in 2010–2011. Ambient high volume PM2.5 air samples were collected at two sites in the Pacific Northwest: (1.) Mount Bachelor Observatory (MBO) in the Oregon Cascade Range (2763 m above sea level (asl)) and 2.) Confederated Tribes of the Umatilla Indian Reservation (CTUIR) in the Columbia River Gorge (CRG) (954 m asl). At MBO, the 1,8-dinitropyrene concentration was significantly positively correlated with the time a sampled air mass spent over Asia, suggesting that this NPAH may be a good marker for trans-Pacific atmospheric transport. At CTUIR, NOx, CO2, and SO2 emissions from a 585 MW coal fired power plant, in Boardman OR, were found to be significantly positively correlated with PAH, OPAH, NPAH, OC, and PM2.5 concentrations. By comparing the Boardman Plant operational time frames when the plant was operating to when it was shut down, the plant was found to contribute a large percentage of the measured PAH (67%), NPAH (91%), OPAH (54%), PM2.5 (39%), and OC (38%) concentrations at CTUIR and the CRG prior to Spring 2011 and likely masked trans-Pacific atmospheric transport events to the CRG. Upgrades installed to the Boardman Plant in the spring of 2011 dramatically reduced the plant's contribution to PAH and OPAH concentrations (by ∼72% and ∼40%, respectively) at CTUIR and the CRG, but not NPAH, PM2.5 or OC concentrations.

A method was developed for the measurement of 19 parent PAHs (PAHs) and 34 hydroxylated PAHs (OH-PAHs) in urine and personal air samples of particulate matter less than 2.5 μm in diameter (PM₂.₅) using GC-MS and validated using NIST SRM 3672 (Organic Contaminants in Smoker's Urine) and SRM 3673 (Organic Contaminants in Nonsmoker's Urine). The method was used to measure PAHs and OH-PAHs in urine and personal PM₂.₅ samples collected from the operators of two different fish smoking facilities (tipi and smoke shed) burning two different wood types (alder and apple) on the Confederated Tribes of Umatilla Indian Reservation (CTUIR) while they smoked salmon. Urine samples were spiked with β-glucuronidase/arylsulfatase to hydrolyze the conjugates of OH-PAHs and the PAHs and OH-PAHs were extracted using Plexa and C18 solid phases, in series. The 34 OH-PAHs were derivatized using MTBSTFA, and the mixture was measured by GC-MS. The personal PM₂.₅ samples were extracted using pressurized liquid extraction, derivatized with MTBSTFA and analyzed by GC-MS for PAHs and OH-PAHs. Fourteen isotopically labeled surrogates were added to accurately quantify PAHs and OH-PAHs in the urine and PM₂.₅ samples and three isotopically labeled internal standards were used to calculate the recovery of the surrogates. Estimated detection limits in urine ranged from 6.0 to 181 pg/ml for OH-PAHs and from 3.0 to 90 pg/ml for PAHs, and, in PM₂.₅, they ranged from 5.2 to 155 pg/m(3) for OH-PAHs and from 2.5 to 77 pg/m(3) for PAHs. The results showed an increase in OH-PAH concentrations in urine after 6h of fish smoking and an increase in PAH concentrations in air within each smoking facility. In general, the PAH exposure in the smoke shed was higher than in the tipi and the PAH exposure from burning apple wood was higher than burning alder.

BACKGROUND:Poorly ventilated combustion stoves and pollutants emitted from combustion stoves increase the risk of acute lower respiratory illnesses (ALRI) in children living in developing countries but few studies have examined these issues in developed countries. Our objective is to investigate behaviors related to gas stove use, namely using them for heat and without ventilation, on the odds of pneumonia and cough in U.S. children.METHODS:The National Health and Nutrition Examination Survey (1988-1994) was used to identify children < 5 years who lived in homes with a gas stove and whose parents provided information on their behaviors when operating their gas stoves and data on pneumonia (N = 3,289) and cough (N = 3,127). Multivariate logistic regression models were used to examine the association between each respiratory outcome and using a gas stove for heat or without ventilation, as well as, the joint effect of both behaviors.RESULTS:The adjusted odds of parental-reported pneumonia (adjusted odds ratio [aOR] = 2.08, 95% confidence interval [CI]: 1.08, 4.03) and cough (aOR = 1.66, 95% CI: 1.14, 2.43) were higher among children who lived in homes where gas stoves were used for heat compared to those who lived in homes where gas stoves were only used for cooking. The odds of pneumonia (aOR = 1.76, 95% CI: 1.04, 2.98), but not cough (aOR = 1.23, 95% CI: 0.87, 1.75), was higher among those children whose parents did not report using ventilation when operating gas stoves compared to those who did use ventilation. When considering the joint association of both stove operating conditions, only children whose parents reported using gas stoves for heat without ventilation had significantly higher odds of pneumonia (aOR = 3.06, 95% CI: 1.32, 7.09) and coughing (aOR = 2.07, 95% CI: 1.29, 3.30) after adjusting for other risk factors.CONCLUSIONS:Using gas stoves for heat without ventilation was associated with higher odds of pneumonia and cough among U.S. children less than five years old who live in homes with a gas stove. More research is needed to determine if emissions from gas stoves ventilation infrastructure, or modifiable behaviors contribute to respiratory infections in children.

Although surfers have high incidental exposure to marine waters, no studies have investigated if surfer risk behaviors (such as surfing during advisories, near an outfall, during a rain event, or use of personal protective equipment) increase or decrease the risk of acquiring waterborne illnesses. We used a web-based survey to assess the association between risk-based behaviors and self-reported illnesses among Pacific Northwest surfers. Commonly reported illnesses include: ear infection or discharge (38%), sore throat or a cough (28%), diarrhea (16%), fever (10.5%), and vomiting (7%). Surfing often during rain events was associated with an increased likelihood of diarrhea (OR = 2.7; 95% CI: 1.4-5.47), sore throat (OR = 1.26; 95% CI: 1.01-2.05), and ear infection (OR = 1.39; 95% CI: 1.01-2.32). Surfing during a health advisory was associated with increased likelihood of diarrhea (OR = 1.94; 95% CI: 1.03-4.64) and sore throat (OR = 2.32; 95% CI: 1.23-4.40). Other behaviors associated with increased illnesses include body surfing, surfing near an outfall, frequency of surfing, and use of ear plugs. Approximately 40% of surfers were unaware if they had surfed during an active health advisory and 29% knowingly surfed during advisories, suggesting the need to engage this population about potential harm and behaviors that may increase health risk.

Few studies have been published on the excretion rates of parent polycyclic aromatic hydrocarbons (PAHs) and hydroxy-polycyclic aromatic hydrocarbons (OH-PAHs) following oral exposure. This study investigated the metabolism and excretion rates of 4 parent PAHs and 10 OH-PAHs after the consumption of smoked salmon. Nine members of the Confederated Tribes of the Umatilla Indian Reservation consumed 50g of traditionally smoked salmon with breakfast and five urine samples were collected during the following 24h. The concentrations of OH-PAHs increased from 43.9μg/g creatinine for 2-OH-Nap to 349ng/g creatinine for 1-OH-Pyr, 3 to 6h post-consumption. Despite volunteers following a restricted diet, there appeared to be a secondary source of naphthalene and fluorene, which led to excretion efficiencies greater than 100%. For the parent PAHs that were detected in urine, the excretion efficiencies ranged from 13% for phenanthrene (and its metabolite) to 240% for naphthalene (and its metabolites). The half-lives for PAHs ranged from 1.4h for retene to 3.3h for pyrene. The half-lives for OH-PAHs were higher and ranged from 1.7h for 9-OH-fluorene to 7.0h for 3-OH-fluorene. The concentrations of most parent PAHs, and their metabolites, returned to the background levels 24h post-consumption.

PurposeThe purpose of this study is to examine perceived experiences of racial discrimination (perceived discrimination) in health care and its associations with completing standards of care for diabetes management and diabetes control.MethodsThis cross-sectional study included 200 adult American Indian (AI) women with type 2 diabetes from 4 health care facilities located on tribal reservations in the Pacific Northwest. Participants completed a survey, and medical records were abstracted. Logistic regression was completed to assess associations.ResultsSixty-seven percent of AI women reported discrimination during their lifetime of health care. After adjusting for patient characteristics, perceived discrimination was significantly associated with lower rates of dental exam; checks for blood pressure, creatinine, and total cholesterol; and pneumococcal vaccination. The association between perceived discrimination and total number of diabetes services completed was not statistically significant. Perceived discrimination was associated with having A1C values above target levels for diabetes control in unadjusted and adjusted models, but no association was observed for blood pressure or total cholesterol.ConclusionsIn our sample of AI women with diabetes, two-thirds reported experiencing racial discrimination in their health care experience. Those reporting perceived discrimination completed fewer diabetes services and therefore may be at increased risk for comorbidities of diabetes. This finding supports the continued need for culturally responsive health care and programs of diabetes education to recognize perceived discrimination and its potential to impact success in self-management and services utilization.

Given the lack of data on private wells, public health and water quality specialists must explore alternative datasets for understanding associated exposures and health risks. Characterizing agricultural nitrogen inputs would be valuable for identifying areas where well water safety may be compromised. This study incorporated existing methods for estimating nutrient loading at the county level with datasets derived from a state permitting program for confined animal feeding operations and agricultural enterprise budget worksheets to produce a high resolution agricultural nitrogen raster map. This map was combined with data on soil leachability and new well locations. An algorithm was developed to calculate nitrogen loading and leachability within 1,000 meters of each well. Wells with a nonzero nitrogen total linked to soils with high leachability were categorized and displayed on maps communicating well susceptibility across the state of Oregon. Results suggest that 4% of recently drilled wells may be susceptible to nitrate contamination, while areas identified for mitigation are too restrictive to include all susceptible wells. Predicted increases in population density and the steady addition of approximately 3,800 new wells annually may lead to a large number of residents, especially those in rural areas, experiencing long-term exposures to nitrate in drinking water.

Gas stoves emit pollutants that are respiratory irritants. U.S. children under age 6 who live in homes where gas stoves are used for cooking or heating have an increased risk of asthma, wheeze and reduced lung function. Yet few studies have examined whether using ventilation when operating gas stoves is associated with a decrease in the prevalence of respiratory illnesses in this population.

Indigenous cultures perceive the natural environment as an essential link between traditional cultural practices, social connectedness, identity, and health. Many tribal communities face substantial health disparities related to exposure to environmental hazards. Our study used qualitative methods to better understand the Confederated Tribes of the Umatilla Indian Reservation (CTUIR) members' perspectives about their environment and its connections with their health including views on environmental health hazards. Three 90-minute focus group sessions with a total of 27 participants were held to elicit opinions on meanings of health and how the environment interacts with health. A systematic text analysis was used to derive themes across focus groups. Participants expressed a holistic view of health that included environmental, physical, mental, spiritual, and social components. A healthy natural environment was identified as an essential component of a healthy individual and a healthy community. Participants also described many environmental health concerns including second-hand smoke, outdoor smoke, diesel exhaust, mold, pesticides, contaminated natural foods, and toxic wastes from the Hanford nuclear site and methamphetamine labs. Many believe the identified environmental hazards contribute to diseases in their community. The natural environment is an important resource to CTUIR members and plays an integral role in achieving and maintaining health. Knowledge about the values and concerns of the community are useful to the tribal and federal governments, health professionals, environmental health practitioners, and community members who seek to achieve sustainable and healthy rural Native communities.

Purpose: Breast and cervical cancer-mortality disparities are prominent among American Indian women. These disparities, in part, may result from patients perceived experiences of discrimination in health care. This report evaluates the impact of perceived discrimination on screening for breast and cervical cancer in a sample of 200 American Indian women with type 2 diabetes.Methods: Data were collected from patient report and medical records. Prevalence of breast and cervical cancer screening were assessed. Unadjusted and adjusted logistic regression analyses were used to assess associations between perceived discrimination, cancer screening status, and patients' health care-seeking behaviors.Findings: Substantial proportions of AI women in our sample were behind the recommended schedules of screening for breast and cervical cancer. Adjusted estimates revealed that perceived discrimination was significantly associated with not being current for clinical breast examination and Pap test, and was close to statistical significance with not being current for mammography. The number of suboptimal health care-seeking behaviors increased with higher mean levels of perceived discrimination.Conclusions: Among AI women, perceived discrimination in health care may negatively influence use of breast and cancer screening services, and health care-seeking behaviors. More research is needed among AIs to examine features of health care systems related to the phenomenon patients perceived experience of discrimination. Copyright (C) 2013 by the Jacobs Institute of Women's Health. Published by Elsevier Inc.

Naphthalene is an important contaminant in indoor and outdoor air. Acute overexposure can have toxic effects, resulting in hemolysis. There have been no studies evaluating the impact of environmental exposure on red blood cell indices. We examined 1- and 2-hydroxynaphthalene urinary metabolites (NAP1 and NAP2) in non-Hispanic White, non-Hispanic Black, and Mexican-American adults in the USA and their relationship with hemoglobin (Hb) and hematocrit (HCT). Using the 2003–2004 National Health and Nutrition Examination Survey data, weighted generalized linear regression analyses were used to examine the association between Hb (in grams per deciliter) and HCT (in percent) with NAP1 and NAP2 (per 100,000 ng/L). Beta coefficients ± SE are reported. NAP1 and NAP2 were highest in non-Hispanic Blacks, followed by non-Hispanic Whites, and lowest in Mexican-American adults. There was a positive association between NAP1 and Hb (0.39 ± 0.11, p = 0.0034) and HCT (1.14 ± 0.28, p = 0.0009) after adjusting for age, gender, race, education, and smoking. Stratified analysis by smoking showed similar results with the association being stronger for smokers (Hb 0.63 ± 0.23, p = 0.02; HCT 1.43 ± 0.79, p = 0.09) than nonsmokers (Hb 0.34 ± 0.14, p = 0.03; HCT 1.08 ± 0.42, p = 0.02). The association was also stronger for non-Hispanic blacks (Hb 0.54 ± 0.20, p = 0.02; HCT 1.43 ± 0.55, p = 0.02) than for non-Hispanic whites (Hb 0.37 ± 0.18, p = 0.06; HCT 1.20 ± 0.51, p = 0.03) and was not significant for Mexican-Americans (Hb 0.30 ± 1.7, p = 0.10; HCT 0.99 ± 0.52, p = 0.08). NAP2 was not significantly associated with Hb or HCT. The observed disparity in NAP1 and NAP2 levels by race/ethnicity is consistent with published literature. The origin of these differences in exposure is unclear but may reflect differences in environmental exposure as well as genetic susceptibility. The positive association between NAP1 with HCT and Hb is an unexpected finding. Further research is needed to understand the possible biological mechanisms or other explanations for this association.

The article provides an overview of methods that can be used to develop exposure scenarios for unique tribal natural resource usage patterns. Exposure scenarios are used to evaluate the degree of environmental contact experienced by people with different patterns of lifestyle activities, such as residence, recreation, or work. In 1994, U.S. President Bill Clinton's Executive Order 12898 recognized that disproportionately high exposures could be incurred by people with traditional subsistence lifestyles because of their more intensive contact with natural resources. Since then, we have developed several tribal exposure scenarios that reflect tribal-specific traditional lifeways. These scenarios are not necessarily intended to capture contemporary resource patterns, but to describe how the resources were used before contamination or degradation, and will be used once again in fully traditional ways after cleanup and restoration. The direct exposure factors for inhalation and soil ingestion rates are the same in each tribal scenario, but the diets are unique to each tribe and its local ecology, natural foods, and traditional practices. Scenarios, in part or in whole, also have other applications, such as developing environmental standards, evaluating disproportionate exposures, developing sampling plans, planning for climate change, or evaluating service flows as part of natural resource damage assessments.

Although it is known that polycyclic aromatic hydrocarbons (PAHs) can be found in smoked meats, little is known about their prevalence in Native American smoked fish. In this work, the effect of traditional Native American fish smoking methods on dietary exposure to PAHs and possible risks to human health has been assessed. Smoking methods considered smoking structure (tipi or shed) and wood type (apple or alder). Neither smoking structure nor wood type accounted for differences in smoked salmon content of 33 PAHs. Carcinogenic and noncarcinogenic PAH loads in traditionally smoked salmon were 40-430 times higher than those measured in commercial products. Dietary exposure to PAHs could result in excess lifetime cancer risks between 1 × 10(-5) and 1 × 10(-4) at a daily consumption rate of 5 g d(-1) and could approach 1 × 10(-2) at 300 g d(-1). Hazard indexes approached 0.005 at 5 g d(-1), or approximately 0.3 at 300 g d(-1). Levels of PAHs present in smoked salmon prepared using traditional Native American methods may pose elevated cancer risks if consumed at high consumption rates over many years.

In 2009, the U.S. Department of Health and Human Services released “The Surgeon General’s Call to Action to Promote Healthy Homes,” which highlights the link between well-water quality and health, and recommends annual testing of private wells for bacteria and chemical contamination.1 Also in 2009, the American Academy of Pediatrics (AAP) released new guidance for private well-water testing to protect children from illnesses associated with exposure to drinking-water contaminants.2 Chief among the new guidelines was the recommendation that water be tested at least annually for nitrate and coliform bacteria. The AAP also recommended that state governments require well testing when a dwelling is sold. California, Colorado, Georgia, Idaho, Indiana, Oregon, Pennsylvania, Washington, and Wisconsin have been identified as having the highest nitrate concentrations in shallow groundwater in the U.S.3 Of This is the first article published as part of a new column in Public Health Reports, Environmental Health. The goal of the column is to emphasize the role that the environment plays in public health. It is appropriate that the column be launched with an article about water-quality surveillance because this topic holds a special place in public health history. In 1854, an outbreak of cholera occurred in London. An obstetrician, Dr. John Snow, tracked down and interviewed individuals with cholera and healthy people, and he hypothesized that a specific well was the source of the outbreak. Dr. Snow is recognized as one of the fathers of epidemiology for this pioneering work. Besides the historical significance, this article by Hoppe et al. presents another important topic in public health—primary prevention. The authors explore whether private well testing prior to real estate transactions could help in state-based surveillance efforts of private wells. They conclude that innovative policy supporting testing could serve an important role in surveillance and help ensure water quality for people moving into homes served by wells. In 1854, Dr. Snow’s research led to the secondary prevention effort of removal of the pump handle from the contaminated well to prevent other people from being exposed. Let’s hope that work such as that described in this article leads to broader policy efforts supporting primary prevention of exposure to contaminated water.

BACKGROUND:When conducting research with American Indian tribes, informed consent beyond conventional institutional review board (IRB) review is needed because of the potential for adverse consequences at a community or governmental level that are unrecognized by academic researchers. OBJECTIVES:In this article, we review sovereignty, research ethics, and data-sharing considerations when doing community-based participatory health-related or natural-resource-related research with American Indian nations and present a model material and data-sharing agreement that meets tribal and university requirements. DISCUSSION:Only tribal nations themselves can identify potential adverse outcomes, and they can do this only if they understand the assumptions and methods of the proposed research. Tribes must be truly equal partners in study design, data collection, interpretation, and publication. Advances in protection of intellectual property rights (IPR) are also applicable to IRB reviews, as are principles of sovereignty and indigenous rights, all of which affect data ownership and control. CONCLUSIONS:Academic researchers engaged in tribal projects should become familiar with all three areas: sovereignty, ethics and informed consent, and IPR. We recommend developing an agreement with tribal partners that reflects both health-related IRB and natural-resource-related IPR considerations.