Integrating psychosocial stress into children’s molecular epidemiology research: An investigation of flame retardants, telomeres and neuroendocrine development

Background & Objectives: This dissertation is comprised of two independent projects that seek to answer the research questions outlined in Aims 1 and 2. The first project is focused on measuring exposure to polybrominated diphenyl ethers (PBDE) throughout the early lifecourse, as well as investigating how exposure at different developmental periods relates to neuroendocrine endpoints. PBDEs are flame retardant chemicals that were used extensively in furniture and furnishings sold throughout the United States until their phase-out in 2004. Human exposure occurs primarily through incidental ingestion of PBDE-contaminated dust present in the indoor environment. The second project aimed to characterize telomere dynamics in maternal-child pairs and to evaluate associations between telomere dynamics and indicators of stress and stressful conditions. Telomeres are non-coding nucleotide repeats located at chromosome ends; they serve several functions, such as buffering against loss of important protein coding DNA regions during cell division. Both projects are focused on exposure-response relationships during early life and a central theme throughout this dissertation relates to the intersection of date, time and age in longitudinal cohort studies. Finally, the third aim seeks to integrate findings from Projects I and II and is focused on investigating whether telomere dynamics can be used as a biological indictor of stress in epidemiological research examining associations between low-level environmental chemical exposures and neurodevelopmental endpoints. Methods: Both projects were conducted using data and samples collected as part of the Columbia Center for Children’s Environmental Health (CCCEH) Mothers and Newborns study. In Project I, PBDEs were measured by the Centers for Disease Control and Prevention (CDC) using gas chromatography-mass spectrometry (GC-MS) in plasma samples collected repeatedly between birth and age 9 years. We examined determinants of 1) prenatal exposure to PBDEs (Chapter 2), and 2) trajectories of PBDE exposure over childhood, which we estimated using latent class growth analysis (LCGA) (Chapter 3). We also examined PBDE trajectories in relation to performance on tests of visual, verbal and working memory among early adolescents (Chapter 4) and investigated associations between prenatal exposure to PBDEs and thyroid hormone parameters, which were measured by radioimmunoassay in plasma samples collected at multiple ages (Chapter 5). In Project II, we used monochrome multiplex quantitative polymerase chain reaction (MMqPCR) to measure relative leukocyte telomere length (rLTL) in samples collected from mothers and newborns (umbilical cord blood) at the child’s delivery and from children at ages 2, 3, 5, 7 and 9-years (Chapter 6). We aimed to characterize rLTL dynamics over early life, examine the correlation between paired maternal-newborn rLTL, and examine associations between rLTL with measures of financial strain, perceived stress and maternal distress. Results: In Project I, we detected PBDEs in over 80% of cord blood samples and in multivariable models, sociodemographic and lifestyle factors explained 12% of cord blood PBDE variability. The largest determinant of exposure was ethnicity, with Dominican newborns having lower exposure compared to African American newborns, likely due to the reduced amount of time Dominican mothers had spent in the United States when they gave birth to the study child. Across postnatal life (2000 to 2013), PBDE concentrations in child blood decreased by approximately 12% per year, suggesting that exposure has continually declined since the PBDE phase-out in 2004. Trajectory analyses revealed several unique patterns of PBDE exposure over the early lifecourse, with the majority of children characterized by exposure that was persistently low or that peaked during toddler years. Smaller groups of children were characterized by exposure that was highest during the prenatal period and decreased after birth or by a pattern of high exposure during toddler years that remained elevated into middle childhood. We identified several important predictors of childhood PBDE exposure patterns, including modifiable factors, such as cleaning behaviors. In relation to neurodevelopmental outcomes, we found that children with sustained high exposure to PBDEs scored approximately 5-8 points lower on tests of visual memory. Associations between prenatal exposure and working memory significantly varied by sex, with inverse associations (approximately 8 points lower) observed only among girls. Children with PBDE plasma concentrations that peaked during toddler years performed better on verbal domains, however, these associations were significant only among children breastfed for more than 12 weeks. Finally, in relation to thyroid hormone levels, children with BDE-47 concentrations in the third and fourth quartiles of the exposure distribution (versus first quartile) had significantly lower TSH and free T4 levels, respectively. We did not detect associations between BDE-47 and total T4 levels; likewise, we did not detect associations between other pentaBDE congeners and any thyroid parameter. In Project II, we found that maternal-newborn rLTL in paired samples was moderately correlated and that maternal rLTL at delivery explained 8% of the variability (R2) in newborn rLTL. In relation to measures of hardship, perceived stress and demoralization, we found an inverse, albeit not statistically significant, association between maternal perceived stress and newborn rLTL. We did not detect an association with maternal rLTL, nor did we detect associations between material hardship or demoralization and maternal or newborn rLTL. When examining rLTL in child blood samples collected between birth and age 9 years, we observed a U-shaped pattern characterized by rapid shortening of rLTL between birth and 2 years, followed by gradual lengthening between ages 3 and 9 years. It remains unresolved whether this pattern reflects a true biological phenomenon or if it is an artifact of measurement error introduced by analytic or pre-analytic conditions. Conclusions: Despite the phase-out of PBDEs in 2004, exposure among children residing in New York City remained nearly ubiquitous through 2013, however, concentrations did decline over time. Our finding of several PBDE trajectories suggests that, despite the relatively long half-lives of PBDEs, a single measure may not accurately reflect exposure throughout childhood. Our findings of reduced scores on tests of working and visual memory during the prenatal and postnatal periods, respectively, support a growing body of literature linking early life PBDE exposure to disrupted neurodevelopment. The results of our analysis examining thyroid hormone disruption during childhood revealed a pattern consistent with hypothalamic or pituitary-level disruption during prenatal programming of the thyroid regulatory system. This is the first study to examine prenatal PBDE exposure in relation to childhood thyroid hormone levels, therefore, it is important that this finding is replicated by future research. Our finding of an inverse association between newborn rLTL and maternal perceived stress is consistent with results from previous research and suggests that the developing fetus may be sensitive to maternal stress perception during pregnancy, however, additional research is needed to more fully understand the mechanisms through which this transmission occurs. Our finding of increasing telomere length between toddler years and middle childhood is unexpected and raises questions about the suitability of the qPCR assay for analyzing telomere length in archived samples. Additional analyses are needed to determine whether the observed patterns reflect true biological changes or relate to measurement error introduced during sample processing, storage or analysis. Given these outstanding issues, we were ultimately unable to draw conclusions about the usefulness of telomere dynamics as a stress-sensitive biomarker

Associations between Prenatal Exposure to Black Carbon and Memory Domains in Urban Children: Modification by Sex and Prenatal Stress

Background Whether fetal neurodevelopment is disrupted by traffic-related air pollution is uncertain. Animal studies suggest that chemical and non-chemical stressors interact to impact neurodevelopment, and that this association is further modified by sex. Objectives To examine associations between prenatal traffic-related black carbon exposure, prenatal stress, and sex with children’s memory and learning. Methods Analyses included N = 258 mother-child dyads enrolled in a Boston, Massachusetts pregnancy cohort. Black carbon exposure was estimated using a validated spatiotemporal land-use regression model. Prenatal stress was measured using the Crisis in Family Systems-Revised survey of negative life events. The Wide Range Assessment of Memory and Learning (WRAML2) was administered at age 6 years; outcomes included the General Memory Index and its component indices [Verbal, Visual, and Attention Concentration]. Relationships between black carbon and WRAML2 index scores were examined using multivariable-adjusted linear regression including effect modification by stress and sex. Results Mothers were primarily minorities (60% Hispanic, 26% Black); 67% had ≤12 years of education. The main effect for black carbon was not significant for any WRAML2 index; however, in stratified analyses, among boys with high exposure to prenatal stress, Attention Concentration Index scores were on average 9.5 points lower for those with high compared to low prenatal black carbon exposure (P3-way interaction = 0.04). Conclusion The associations between prenatal exposure to black carbon and stress with children’s memory scores were stronger in boys than in girls. Studies assessing complex interactions may more fully characterize health risks and, in particular, identify vulnerable subgroups

Racial and Geographic Variation in Effects of Maternal Education and Neighborhood-Level Measures of Socioeconomic Status on Gestational Age at Birth: Findings From the ECHO Cohorts

Preterm birth occurs at excessively high and disparate rates in the United States. In 2016, the National Institutes of Health (NIH) launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate the influence of early life exposures on child health. Extant data from the ECHO cohorts provides the opportunity to examine racial and geographic variation in effects of individual- and neighborhood-level markers of socioeconomic status (SES) on gestational age at birth. The objective of this study was to examine the association between individual-level (maternal education) and neighborhood-level markers of SES and gestational age at birth, stratifying by maternal race/ethnicity, and whether any such associations are modified by US geographic region. Twenty-six ECHO cohorts representing 25,526 mother-infant pairs contributed to this disseminated meta-analysis that investigated the effect of maternal prenatal level of education (high school diploma, GED, or less; some college, associate\u27s degree, vocational or technical training [reference category]; bachelor\u27s degree, graduate school, or professional degree) and neighborhood-level markers of SES (census tract [CT] urbanicity, percentage of black population in CT, percentage of population below the federal poverty level in CT) on gestational age at birth (categorized as preterm, early term, full term [the reference category], late, and post term) according to maternal race/ethnicity and US region. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Cohort-specific results were meta-analyzed using a random effects model. For women overall, a bachelor\u27s degree or above, compared with some college, was associated with a significantly decreased odds of preterm birth (aOR 0.72; 95% CI: 0.61-0.86), whereas a high school education or less was associated with an increased odds of early term birth (aOR 1.10, 95% CI: 1.00-1.21). When stratifying by maternal race/ethnicity, there were no significant associations between maternal education and gestational age at birth among women of racial/ethnic groups other than non-Hispanic white. Among non-Hispanic white women, a bachelor\u27s degree or above was likewise associated with a significantly decreased odds of preterm birth (aOR 0.74 (95% CI: 0.58, 0.94) as well as a decreased odds of early term birth (aOR 0.84 (95% CI: 0.74, 0.95). The association between maternal education and gestational age at birth varied according to US region, with higher levels of maternal education associated with a significantly decreased odds of preterm birth in the Midwest and South but not in the Northeast and West. Non-Hispanic white women residing in rural compared to urban CTs had an increased odds of preterm birth; the ability to detect associations between neighborhood-level measures of SES and gestational age for other race/ethnic groups was limited due to small sample sizes within select strata. Interventions that promote higher educational attainment among women of reproductive age could contribute to a reduction in preterm birth, particularly in the US South and Midwest. Further individual-level analyses engaging a diverse set of cohorts are needed to disentangle the complex interrelationships among maternal education, neighborhood-level factors, exposures across the life course, and gestational age at birth outcomes by maternal race/ethnicity and US geography

Evidence on the Human Health Effects of Low-Level Methylmercury Exposure

Background: Methylmercury (MeHg) is a known neuro-toxicant. Emerging evidence indicates it may have adverse effects on the neuro-logic and other body systems at common low levels of exposure. Impacts of MeHg exposure could vary by individual susceptibility or be confounded by bene-ficial nutrients in fish containing MeHg. Despite its global relevance, synthesis of the available literature on low-level MeHg exposure has been limited

Prenatal exposure to polybrominated diphenyl ethers and BMI Z-scores from 5 to 14 years

Background Polybrominated diphenyl ethers (PBDEs) are flame-retardant compounds widely used in household products until phase out in 2004. PBDEs are endocrine disruptors and are suggested to influence signaling related to weight control. Prenatal exposures to PBDEs may alter childhood adiposity, yet few studies have examined these associations in human populations. Methods Data were collected from a birth cohort of Dominican and African American mother-child pairs from New York City recruited from 1998 to 2006. PBDE congeners BDE-47, − 99, − 100, and − 153 were measured in cord plasma (ng/μL) and dichotomized into low (80th percentile) exposure categories. Height and weight were collected at ages 5, 7, 9, 11, and an ancillary visit from 8 to 14 years (n = 289). Mixed-effects models with random intercepts for participant were used to assess associations between concentrations of individual PBDE congeners or the PBDE sum and child BMI z-scores (BMIz). To assess associations between PBDEs and the change in BMIz over time, models including interactions between PBDE categories and child age and (child age)2 were fit. Quantile g-computation was used to investigate associations between BMIz and the total PBDE mixture. Models were adjusted for baseline maternal covariates: ethnicity, age, education, parity, partnership status, and receipt of public assistance, and child covariates: child sex and cord cholesterol and triglycerides. Results The prevalence of children with obesity at age 5 was 24.2% and increased to 30% at age 11. Neither cord levels of individual PBDEs nor the total PBDE mixture were associated with overall BMIz in childhood. The changes in BMIz across childhood were not different between children with low or high PBDEs. Results were similar when adjusting for postnatal PBDE exposures. Conclusions Prenatal PBDE exposures were not associated with child growth trajectories in a cohort of Dominican and African American children

Probabilistic Decision Tools for Determining Impacts of Agricultural Development Policy on Household Nutrition

Governments around the world have agreed to end hunger and food insecurity and to improve global nutrition, largely through changes to agriculture and food systems. However, they are faced with a lot of uncertainty when making policy decisions, since any agricultural changes will influence social and biophysical systems, which could yield either positive or negative nutrition outcomes. We outline a holistic probability modeling approach with Bayesian Network (BN) models for nutritional impacts resulting from agricultural development policy. The approach includes the elicitation of expert knowledge for impact model development, including sensitivity analysis and value of information calculations. It aims at a generalizable methodology that can be applied in a wide range of contexts. To showcase this approach, we develop an impact model of Vision 2040, Uganda's development strategy, which, among other objectives, seeks to transform the country's agricultural landscape from traditional systems to large-scale commercial agriculture. Model results suggest that Vision 2040 is likely to have negative outcomes for the rural livelihoods it intends to support; it may have no appreciable influence on household hunger but, by influencing preferences for and access to quality nutritional foods, may increase the prevalence of micronutrient deficiency. The results highlight the trade-offs that must be negotiated when making decisions regarding agriculture for nutrition, and the capacity of BNs to make these trade-offs explicit. The work illustrates the value of BNs for supporting evidence-based agricultural development decisions

Using the Personality Assessment Inventory-Adolescent in Legal Settings

The Personality Assessment Inventory-Adolescent (PAI-A; Morey et al., 2007) is a self-report measure of personality and psychopathology appropriate for use with individuals aged 12–18. It is modeled after the Personality Assessment Inventory (PAI; Morey, 1991), a measure widely used with adults in clinical and legal settings. The PAI-A assesses a variety of features that have utility in legal settings, including validity scales that assess approach to testing, clinical scales measuring common types of psychopathology, and treatment consideration scales that provide indicators of treatment motivation and other factors that may be important for predicting outcomes. The PAI-A has been included in a limited number of research studies and few of those have focused on justice-involved youths. Additionally, because juvenile court records are not typically publicly available, there is limited information about the PAI-A available in case law. This manuscript reviews the properties, strengths, and weaknesses of the PAI-A and its existing literature. Factors for mental health and legal professionals to consider in relation to the admissibility of this measure, questioning and cross-examination, and how the PAI-A may be received in court are also discussed

Prevalence of historical and replacement brominated flame retardant chemicals in New York City homes

Background: Until their phase-out between 2005 and 2013, polybrominated diphenyl ethers (PBDEs) were added to household products including furniture, rugs, and electronics to meet flammability standards. Replacement brominated flame retardant (BFR) chemicals, including 2-ethylhexyl-2,3,4,5- tetrabromobenzoate (TBB) and bis(2-ethylhexyl) 2,3,4,5-tetrabromophthalate (TBPH), which are components of the Firemaster 550® commercial mixture, are now being used to meet some flammability standards in furniture. The objective of this analysis was to evaluate the extent to which mothers and their children living in New York City are exposed to PBDEs, TBB, and TBPH. Methods: We measured PBDEs, TBB, and TBPH using gas chromatography mass spectrometry in dust (n = 25) and handwipe (n = 11) samples collected between 2012 and 2013 from mothers and children living in New York City. We defined dust as enriched if the proportional distribution for a given BFR exceeded two-thirds of the total BFR content. Results: We detected PBDEs and TBPH in 100% of dust and handwipe samples and TBB in 100% of dust samples and 95% of handwipe samples. Dust from approximately two-thirds of households was enriched for either PBDEs (n = 9) or for TBB + TBPH (n = 8). Overall, the median house dust concentration of TBB + TBPH (1318 ng/g dust) was higher than that of ΣPentaBDE (802 ng/g dust) and BDE-209 (1171 ng/g dust). Children generally had higher BFR handwipe concentrations compared to mothers (ΣPentaBDE: 73%, BDE-209: 64%, TBB + TBPH: 55%) and within households, BFR concentrations from paired maternal-child handwipes were highly correlated. Among mothers, we found a significant positive relation between house dust and handwipe BDE-209 and TBB + TBPH concentrations. Conclusion: PBDEs, TBB and TBPH are ubiquitous in house dust and handwipes in a sample of mother-child pairs residing in New York City