How common is hip pain among older adults? Results from the Third National Health and Nutrition Examination Survey

OBJECTIVE: To determine the incidence of self-reported significant hip pain using a nationally representative sample of older adults in the United States. STUDY DESIGN: Subjects were interviewed to determine their leisure time physical activity levels and whether they experienced severe hip pain. Sampling weights were calculated to account for unequal selection probabilities. The impact of race, age, and physical activity status was examined as influential factors affecting hip pain. POPULATION: We interviewed 6596 adults aged 60 years and older as part of the third National Health and Nutrition Examination Survey (NHANES III). OUTCOME MEASURED: We measured the prevalence of hip pain. RESULTS: A total of 14.3% of participants aged 60 years and older reported significant hip pain on most days over the past 6 weeks. Men reported hip pain less frequently than women. Age did not influence self-reported hip pain in men. The lowest prevalence of hip pain was found in women aged 60 to 70 years. Sixteen percent of non-Hispanic white women reported hip pain, compared with 14.8% of black women and 19.3% of Mexican American women. Among non-Hispanic white men, 12.4% reported hip pain, a proportion no different from that of their black and Mexican American male counterparts. Among older US adults, 18.4% of those who had not participated in leisure time physical activity during the previous month reported severe hip pain; 12.6% of those who did engage in physical activity reported hip pain. CONCLUSIONS: Self-reported hip pain has increased since NHANES I (1971-1975). Further studies are needed to identify individuals at highest risk for severe hip pain and to identify optimal treatment of hip pain.     

Socioeconomic status and dyslipidemia in Korean adults: The 2008–2010 Korea National Health and Nutrition Examination Survey

Objective

This study investigated the relationship between socioeconomic status (SES) and dyslipidemia and various parameters of dyslipidemia among Korean adults.

Methods

Data from the 2008–2010 Korea National Health and Nutrition Examination Survey were used in this study. A total of 19,041 Korean adults greater than 19 years old participated in the study. The SES was assessed by monthly household income and education level. The relationship of SES to the risk of dyslipidemia was assessed with multivariate logistic regression analysis after adjusting for potential confounders.

Results

The prevalence of dyslipidemia was 37.4% among Korean adults. In men, household income level was positively associated with prevalence and risks of several parameters of dyslipidemia, and education level had positive associations with the risks of dyslipidemia and parameters of dyslipidemia. However, low SES was linked to increased prevalence and risks of dyslipidemia (P for trend < 0.05) and parameters of dyslipidemia in women.

Conclusions

Socioeconomic disparities in dyslipidemia were found in the Korean population. Also, there were gender differences in the relationship between SES and dyslipidemia. These disparities should be considered when performing risk calculations and screening for dyslipidemia, which will ultimately help prevent cardiovascular disease.     

Temporal Trends in Phthalate Exposures: Findings from the National Health and Nutrition Examination Survey, 2001–2010

Background: Phthalates are ubiquitous environmental contaminants. Because of potential adverse effects on human health, butylbenzyl phthalate [BBzP; metabolite, monobenzyl phthalate (MBzP)], di-n-butyl phthalate [DnBP; metabolite, mono-n-butyl phthalate (MnBP)], and di(2-ethylhexyl) phthalate (DEHP) are being replaced by substitutes including other phthalates; however, little is known about consequent trends in population-level exposures.Objective: We examined temporal trends in urinary concentrations of phthalate metabolites in the general U.S. population and whether trends vary by sociodemographic characteristics.Methods: We combined data on 11 phthalate metabolites for 11,071 participants from five cycles of the National Health and Nutrition Examination Survey (2001–2010). Percent changes and least square geometric means (LSGMs) were calculated from multivariate regression models.Results: LSGM concentrations of monoethyl phthalate, MnBP, MBzP, and ΣDEHP metabolites decreased between 2001–2002 and 2009–2010 [percent change (95% CI): –42% (–49, –34); –17% (–23, –9); –32% (–39, –23) and –37% (–46, –26), respectively]. In contrast, LSGM concentrations of monoisobutyl phthalate, mono(3-carboxypropyl) phthalate (MCPP), monocarboxyoctyl phthalate, and monocarboxynonyl phthalate (MCNP) increased over the study period [percent change (95% CI): 206% (178, 236); 25% (8, 45); 149% (102, 207); and 15% (1, 30), respectively]. Trends varied by subpopulations for certain phthalates. For example, LSGM concentrations of ΣDEHP metabolites, MCPP, and MCNP were higher in children than adults, but the gap between groups narrowed over time (p_interaction < 0.01).Conclusions: Exposure of the U.S. population to phthalates has changed in the last decade. Data gaps make it difficult to explain trends, but legislative activity and advocacy campaigns by nongovernmental organizations may play a role in changing trends.Citation: Zota AZ, Calafat AM, Woodruff TJ. 2014. Temporal trends in phthalate exposures: findings from the National Health and Nutrition Examination Survey, 2001–2010. Environ Health Perspect 122:235–241; http://dx.doi.org/10.1289/ehp.1306681     

Convergence of body mass index of immigrants to the Canadian-born population: evidence from the National Population Health Survey (1994–2006)

Recent immigrants typically have better physical health than the native born population. However, this ‘healthy immigrant effect’ tends to gradually wane over time, with increasing length of residence in the host country. To assess whether the body mass index (BMI) of different immigrant groups converged to the Canadian population’s levels, we estimated 12-year trajectories of changes in BMI (accounting for socio-demographic changes). Using data from seven longitudinal waves of the National Population Health Survey (1994 through 2006), we compared the changes in BMI (kg/m²) among three groups: white immigrants, non-white immigrants and Canadian born, aged 18–54 at baseline. We applied linear random effects models to evaluate these BMI separately in 2,504 males and 2,960 females. BMI increased in Canadian born, white immigrants, and non-white immigrants over the 12-year period. However, non-white immigrants (males and females) had a lower mean BMI than Canadian born individuals during this period [Males: −2.27, 95% Confidence interval (CI) −3.02 to −1.53; Females: −1.84, 95% CI −2.79 to −0.90]. In contrast, the mean BMI in white male immigrants and Canadian born individuals were similar (−0.32, 95% CI −0.91 to 0.27). Even after adjusting for time since immigration, non-white immigrants had lower BMI than white immigrants. White male immigrants were the only sub-group to converge to the BMI of the Canadian born population. These results indicate that the loss of ‘healthy immigrant effect’ with regard to convergence of BMI to Canadian levels may not be experienced equally by all immigrants in Canada.     

Prevalence and Associated Factors of Tinnitus: Data From the Korean National Health and Nutrition Examination Survey 2009–2011

Background

Tinnitus is a common condition and frequently can be annoying to affected individuals. We investigated the prevalence and associated factors for tinnitus in South Korea using the data from the Korea National Health and Nutrition Examination Surveys (KNHANES) during 2009–2011.

Methods

KNHANES is a cross-sectional survey of the civilian, non-institutionalized population of South Korea (n = 21 893). A field survey team that included an otolaryngologist moved with a mobile examination unit and performed interviews and physical examinations.

Results

Among the population over 12 years of age, the prevalence of any tinnitus was 19.7% (95% CI 18.8%–20.6%). Tinnitus was more prevalent in women, and the prevalence rate increased with age (P < 0.001). Among those with any tinnitus, 29.3% (95% CI 27.3%–31.3%) experienced annoying tinnitus that affected daily life. Annoying tinnitus also increased with age (P < 0.001), but no sex difference was demonstrated (P = 0.25). In participants aged 40 years or older, age, quality of life, depressive mood, hearing loss, feeling of dizziness, and rhinitis were associated with any tinnitus (P < 0.05). Age, hearing loss, history of cardiovascular disease, and stress were associated with annoying tinnitus (P < 0.05).

Conclusions

Tinnitus is a common condition, and a large population suffers from annoying tinnitus in South Korea. Public understanding of associated factors might contribute to better management of tinnitus.Key words: tinnitus, epidemiology, associated factor, South Korea     

Selecting Adequate Exposure Biomarkers of Diisononyl and Diisodecyl Phthalates: Data from the 2005–2006 National Health and Nutrition Examination Survey

Background

High-molecular-weight phthalates, such as diisononyl phthalate (DINP) and diisodecyl phthalate (DIDP), are used primarily as polyvinyl chloride plasticizers.

Objectives

We assessed exposure to DINP and DIDP in a representative sample of persons ≥ 6 years of age in the U.S. general population from the 2005–2006 National Health and Nutrition Examination Survey (NHANES).

Methods

We analyzed 2,548 urine samples by using online solid-phase extraction coupled to isotope dilution high-performance liquid chromatography–tandem mass spectrometry.

Results

We detected monocarboxyisooctyl phthalate (MCOP), a metabolite of DINP, and monocarboxyisononyl phthalate (MCNP), a metabolite of DIDP, in 95.2% and 89.9% of the samples, respectively. We detected monoisononyl phthalate (MNP), a minor metabolite of DINP, much less frequently (12.9%) and at concentration ranges (> 0.8 μg/L–148.1 μg/L) much lower than MCOP (> 0.7 μg/L– 4,961 μg/L). Adjusted geometric mean concentrations of MCOP and MCNP were significantly higher (p < 0.01) among children than among adolescents and adults.

Conclusions

The general U.S. population, including children, was exposed to DINP and DIDP. In previous NHANES cycles, the occurrence of human exposure to DINP by using MNP as the sole urinary biomarker has been underestimated, thus illustrating the importance of selecting the most adequate biomarkers for exposure assessment.     

Allostatic Load in Foreign-Born and US-Born Blacks: Evidence From the 2001–2010 National Health and Nutrition Examination Survey

Objectives. We tested whether the immigrant health advantage applies to non-Hispanic Black immigrants and examined whether nativity-based differences in allostatic load exist among non-Hispanic Blacks.Methods. We used pooled data from the 2001–2010 National Health and Nutrition Examination Survey to compare allostatic load scores for US-born (n = 2745) and foreign-born (n = 152) Black adults. We used multivariate logistic regression techniques to assess the association between nativity and high allostatic load scores, controlling for gender, age, health behaviors, and socioeconomic status.Results. For foreign-born Blacks, length of stay and age were powerful predictors of allostatic load scores. For older US-born Blacks and those who were widowed, divorced, or separated, the risk of high allostatic load was greater.Conclusions. Foreign-born Blacks have a health advantage in allostatic load. Further research is needed that underscores a deeper understanding of the mechanisms driving this health differential to create programs that target these populations differently.There is growing interest in improving population health because Healthy People 2020 and the Patient Protection and Affordable Care Act include important provisions to reduce health disparities.1,2 Recent research suggests that certain racial/ethnic groups in the United States, particularly non-Hispanic Blacks, have higher rates of morbidity and all-cause mortality than do Whites. However, non-Hispanic Blacks are a heterogeneous group that includes a growing population of immigrants from a variety of countries and cultural backgrounds. Recent estimates suggest the foreign-born segment of the Black population has almost tripled over the past 3 decades—with the majority migrating from the Caribbean and Africa—and represents roughly 8% of the Black population.3,4 Despite this marked increase, little is known about the health of foreign-born Blacks.Previous research suggests that Caribbean and African immigrants differ from their US-born counterparts in various physical5–8 and mental health indicators.9 Some research suggests that foreign-born Blacks have better health outcomes than do US-born Blacks because of the healthy immigrant effect.10,11 The healthy immigrant effect posits that immigrants have healthier lifestyles in their home countries, are among the healthiest from their home country, and are the group most willing and able to endure the stressors associated with immigration, therefore placing them at a health advantage. However, the health advantage declines with increased time spent in the United States, as immigrants adapt to the US sociocultural environment.10 Research suggests Caribbean and African immigrants have worse health over time because they have higher levels of psychological stress related to immigration and adjusting to new sociocultural environments.9 Additionally, the impact of exposure to racism in the United States may be particularly stressful for immigrants from regions of the world where they were a demographic majority.8,9To measure the deleterious effects of stress on the body, the concept of allostatic load has been introduced as a unique approach to understanding the underlying biological processes that might explain health vulnerability. Allostatic load accounts for the cumulative impact of physiological responses to acute, chronic, or long-term psychosocial stressors generated by social conditions that continuously activate hormonal responses to stressful conditions. Prolonged activation of these physiological systems is thought to place persons at risk for the development for both physical and mental disorders.12,13 The literature on allostatic load suggests that overexposure to adverse conditions while adapting to US culture can create a buildup of stressors endemic to the immigrant experience, particularly for immigrants of color.Some studies document the deleterious effects for foreign-born populations of psychosocial stress on the body and dysregulation of physiological systems known to protect the individual from disease.14 Much of this research has focused on Hispanics, partly because they are one of the largest immigrant ethnic groups, there is available survey data, and there is scientific interest in the Hispanic health paradox.15,16 This paradox—that Hispanics exhibit better health outcomes than do non-Hispanic Whites despite their lower than expected socioeconomic status—has been challenged in various studies in which time in the United States has been shown to be the predictor that is most associated with health declines.17 Kaestner et al.18 found that with increased time in the United States, the probability of having a high allostatic load score increased for foreign-born Mexicans. Peek et al.19 reported that among foreign-born Mexicans, those who had lived in the United States for more than 10 years were more likely to have high allostatic load scores. In this way, allostatic load offers a viable reason for the health decline among immigrants but has not been extensively studied in foreign-born Black populations.The only study to investigate the association between allostatic load and chronic health conditions for a population of Latinos that can identify themselves as Black or of African descent20 found that increasing allostatic load scores were significantly associated with abdominal obesity, hypertension, diabetes, self-reported cardiovascular disease, and arthritis for Puerto Ricans.21 However, to our knowledge, no study has examined the relationship between nativity and allostatic load among US- and foreign-born Blacks. Testing this hypothesis will provide knowledge about whether allostatic load operates in a similar way for this understudied population as evidenced in the Latino immigrant literature. We used the 2001–2010 National Health and Nutrition Examination Survey (NHANES)—one of the largest surveys designed to assess the health and nutritional status of adults residing in the United States—to examine nativity-based differentials in allostatic load. On the basis of previous research on immigrant health, we expected to observe a health advantage in allostatic load for foreign-born over US-born Blacks similar to what has been documented in studies focused on Mexican-born individuals.     

Sexual Minority Health Disparities in Adult Men and Women in the United States: National Health and Nutrition Examination Survey, 2001–2010

Objectives. We used nationally representative data to investigate health disparities associated with sexual minority status among adults in the United States.Methods. We analyzed data from 11 114 adults who participated in the 2001 to 2010 waves of the National Health and Nutrition Examination Survey. Using multiple logistic regressions, we examined the prevalence of HIV, sexually transmitted infections, mental health problems, cigarette smoking, and alcohol and illicit drug use in sexual minorities and heterosexual adults.Results. After adjusting for sociodemographic characteristics, sexual minority men had greater odds of mental health problems, testing positive for HIV and herpes simplex virus type 2 and self-reported gonorrhea and chlamydia. Sexual minority women had greater odds of mental health problems, testing positive for hepatitis C, smoking, heavy drinking, and illicit drug use.Conclusions. Numerous health disparities continue to face sexual minority men and women in the United States. Notably, health disparities persisted beyond the role of sociodemographic factors, including access to insurance and primary care, suggesting that further research is warranted to identify the determinants of health inequity for sexual minorities.A recently published and widely cited report by the Institute of Medicine called for the greater prioritization of research on the health of sexual minorities (i.e., individuals who identify as lesbian, gay, bisexual, or nonheterosexual) in the United States.1 Although this seminal review demonstrated that much progress has been made in documenting sexual minority health disparities and elucidating their determinants, the Institute of Medicine committee noted a number of critical research challenges. For example, most empirical literature that examines sexual minority health has been conducted using convenience samples and local studies. To inform, implement, and achieve coordinated public health responses at the national level, the report recommended increased attention to and investigation of the health of sexual minority populations from nationally representative data.Despite the paucity of population-based sexual minority research, accumulated data from nonprobability samples provide evidence of health disparities between sexual minority and heterosexual populations in the United States. For example, sentinel surveillance data reported by the Centers for Disease Control and Prevention illustrated that the rates of chlamydia, gonorrhea, herpes, and genital warts infections have increased in previous years, with gay, bisexual, and other men who have sex with men experiencing the largest spike in cases.2 Recent data also indicated that human papillomavirus (HPV) infections account for most incident and prevalent sexually transmitted infections (STIs) for both men and women in the United States.3 In addition to the established increased risk of STIs and HIV among sexual minority men,1,4,5 observational studies have also demonstrated higher rates of STIs among women who have sex with women compared with women who have sex with men only.6–8 Notably, gender differences in STIs have also been observed among samples of heterosexual adults. Although most studies suggest that men have a higher incidence of most STIs than women,9,10 1 study found that women were more likely to have herpes simplex virus type 2 (HSV-2) compared with men.11 As such, it stands to reason that there may be important differences in STI rates by both sexual orientation and biological gender.An increased risk of mental health problems, hazardous alcohol use, and illicit drug use among sexual minority populations has also been found in previous research. Studies using probability sampling have documented disparities by sexual minority status in the prevalence of psychiatric disorders,12–15 tobacco use,16 drug use,17 health care access,17,18 violence and victimization,17 and chronic disease risk, including cardiovascular risk, asthma, and obesity.19,20 With few exceptions, a limited number of population-based health studies have explicitly examined variability within sexual minority populations, as many single-state or single-wave population studies lack sufficient sample size to examine differences by key sociodemographics such as gender.17To examine sexual minority health disparities at the national level, we analyzed data from the 2001 to 2010 waves of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of civilian, noninstitutionalized populations in the United States.21 Given the accumulating evidence for variability in health outcomes within sexual minority populations, we sought to describe trends separately for sexual minority men and sexual minority women compared with their heterosexual counterparts. Specifically, our aims were to utilize the NHANES to (1) investigate the prevalence of 5 of the most commonly reported STIs—gonorrhea, chlamydia, HSV-2, HIV, and HPV (as measured by reports of genital warts)—using a combination of biomarker and self-reported data; (2) assess prevalence of mental health and health behaviors, including number of poor mental health days, smoking, heavy drinking, and illicit drug use; and (3) examine disparities in health indicators between sexual minority men versus heterosexual men and sexual minority women versus heterosexual women.     

Blood cadmium concentrations in Korean adolescents: From the Korea National Health and Nutrition Examination Survey 2010–2013

Objective

To assess blood cadmium levels in Korean adolescents with respect to demographic and lifestyle factors.

Vitamin D status and elevated red cell distribution width in community-dwelling adults: Results from the National Health and Nutrition Examination Survey 2001–2006

Objectives

Elevated red cell distribution width (RDW) is associated with morbidity and mortality in community-dwelling individuals. Although RDW is traditionally used to diagnose anemia, it may also be a marker of systemic inflammation. Since vitamin D is a potent modulator of inflammatory cytokines our goal was to investigate whether 25-hydroxyvitamin D levels (25OHD) are associated with RDW in non-hospitalized adults.

Design

To investigate this association, we conducted a cross-sectional study. Stepwise multivariable linear and logistic regression models were used to assess the independent association of 25OHD with RDW. Elevated RDW was defined as >14.5%.

Setting

Nationwide sample of non-hospitalized adults within the United States.

Participants

Individuals from the National Health and Nutrition Examination Survey from 2001-2006.

Results

15,162 individuals comprised the analytic cohort. Mean 25OHD was 24.9 ng/mL (SE 0.4) and the prevalence of elevated RDW was 6.3%. Linear regression analysis, controlling for age, sex, race, mean corpuscular volume, albumin, and neutropenia, demonstrated that 25OHD was inversely associated with RDW (β=-0.01; 95%CI -0.01 to -0.01). Logistic regression analysis, controlling for the same covariates, also demonstrated an inverse association of 25OHD with elevated RDW (OR 0.96; 95%CI 0.94-0.99). Individuals with 25OHD <30 ng/mL were more likely to have elevated RDW (OR 1.65; 95%CI 1.13-2.40) compared to those individuals with levels ≥30ng/mL.

Conclusions

In a nationwide sample of non-hospitalized adults within the United States, low 25OHD was associated with increased likelihood of elevated RDW. Further studies are needed to determine whether optimizing vitamin D status can reduce the prevalence of elevated RDW, and thereby reduce morbidity and mortality in the general population.

     

Family Consumer Behaviors,Adolescent Prediabetes and Diabetes in the National Health and Nutrition Examination Survey (2007–2010)

Background: Prediabetes or diabetes (characterized by hemoglobin A1c [HbA1c] levels ≥ 5.7 gm%) has been associated with numerous long-term complications. Family consumer behaviors are important risk factors that lead to impaired glucose tolerance or diabetes. However, few studies have studied the association between the family consumer environment and prediabetes and diabetes in adolescents.

Objective: The aim of this study was to examine the association between family consumer behaviors (healthy food availability and supermarket spending) and adolescent prediabetes and diabetes (ClinicalTrials.gov identifier #NCT03136289.)

Methods: Data from a nationwide survey conducted by the Centers for Disease Control and Prevention (National Health and Nutrition Examination Survey [NHANES] 2007–2010 data) were used for these analyses. Adolescents aged 12–19 years were selected for this study. Bivariate analyses and logistic regression models assessed the relationship between family consumer behaviors and the prevalence of adolescent prediabetes and diabetes. Multivariable models adjusted for age, gender, ethnicity, physical activity, education, income, and household size.

Results: A total of 2520 adolescents were eligible for this study. Adolescents with healthier household food availability had negative odds (odds ratio [OR] = 0.74, 95% confidence interval [CI], 0.55–1.00), as did higher log supermarket spending (OR = 0.69; 95% CI, 0.57–0.85). Interaction models demonstrated that adolescent females had more negative odds of prediabetes/diabetes for both healthier food availability (OR = 0.79, 95% CI, 0.39–1.29) and for greater log supermarket spending (OR = 0.69, 95% CI, 0.57–0.85).

Conclusion: This study shows that both healthy food availability and an increase in supermarket spending were associated with a decreased adjusted prevalence of prediabetes and diabetes in adolescents, with a greater effect in females. These results suggest the need for policy and dietary interventions targeting the consumer environment.     

Exposure of the U.S. Population to Acrylamide in the National Health and Nutrition Examination Survey 2003–2004

Background

The lifelong exposure of the population to acrylamide has raised concerns about the possible health effects of the chemical. Data on the extent of exposure to acrylamide and its primary metabolite, glycidamide, are needed to aid in the assessment of potential health effects.

Objectives

The aim of this study was to assess human exposure to acrylamide and glycidamide in the general U.S. population through the measurement of hemoglobin adducts of acrylamide (HbAA) and glycidamide (HbGA).

Methods

HbAA and HbGA were measured in 7,166 subjects from the National Health and Nutrition Examination Survey. Stratified HbAA and HbGA data were reported by sex, age groups, race/ethnicity (Mexican American, non-Hispanic black, non-Hispanic white), and smoking status based on serum cotinine levels. Covariate-adjusted geometric means for each demographic group were calculated using multiple regression analysis.

Results

HbAA and HbGA levels ranged from 3 to 910 and from 4 to 756 pmol/g hemoglobin, respectively, with smokers having the highest levels overall. Tobacco smoke exposure in nonsmokers had a small but significant effect on HbAA and HbGA levels. Adjusted geometric mean levels for children 3–11 years of age were higher than for adults ≥ 60 years of age [mean (95% confidence interval): HbAA, 54.5 (49.1–51.5) and HbGA, 73.9 (71.3–76.6) vs. HbAA, 46.2 (44.3–48.2) and HbGA, 41.8 (38.7–45.2)]. Levels were highest in Mexican Americans [HbAA: 54.8 (51.9–57.8), HbGA: 57.9 (53.7–62.5)], whereas non-Hispanic blacks had the lowest HbGA levels [43.5 (41.1–45.9)].

Conclusions

U.S. population levels of acrylamide and glycidamide adducts are described. The high variability among individuals but modest differences between population subgroups suggest that sex, age, and race/ethnicity do not strongly affect acrylamide exposure. Adduct concentration data can be used to estimate relative exposure and to validate intake estimates.     

Per- and polyfluoroalkyl substances in sera from children 3 to 11 years of age participating in the National Health and Nutrition Examination Survey 2013–2014

Several per- and polyfluoroalkyl substances (PFAS) have been measured in U.S. National Health and Nutrition Examination Survey (NHANES) participants 12 years of age and older since 1999–2000, but PFAS data using NHANES individual samples among children younger than 12 years do not exist. To obtain the first nationally representative PFAS exposure data in U.S. children, we quantified serum concentrations of 14 PFAS including perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), in a nationally representative subsample of 639 3–11 year old participants in NHANES 2013–2014. We used on-line solid-phase extraction coupled to isotope dilution-high performance liquid chromatography-tandem mass spectrometry; limits of detection were 0.1 ng/mL for all analytes. We calculated geometric mean concentrations, determined weighted Pearson correlations, and used linear regression to evaluate associations of sex, age (3–5 vs 6–11 years), race/ethnicity (Hispanic vs non-Hispanic), household income, and body mass index with concentrations of PFAS detected in more than 60% of participants. We detected PFOS, PFOA, PFHxS, and PFNA in all children at concentrations similar to those of NHANES 2013–2014 adolescents and adults, suggesting prevalent exposure to these PFAS or their precursors among U.S. 3–11 year old children, most of whom were born after the phase out of PFOS in the United States in 2002. PFAS concentration differences by sex, race/ethnicity, and age suggest lifestyle differences that may impact exposure, and highlight the importance of identifying exposure sources and of studying the environmental fate and transport of PFAS.     

Decreasing immunity to hepatitis A virus infection among US adults: Findings from the National Health and Nutrition Examination Survey (NHANES), 1999–2012

BackgroundThe clinical course of hepatitis A virus (HAV) infection is more severe with increased age. In the United States, surveillance data reported to CDC since 2011 indicate increases in both the absolute number of cases and the mean age of cases. Total antibody to HAV (anti-HAV) is a marker of immunity.MethodsWe analyzed National Health and Nutrition Examination Survey (NHANES) data for anti-HAV from respondents aged ≥2 years collected from 2007 to 2012 and compared with data collected 10 years earlier (1999–2006). For US-born adults aged ≥20 years, we estimated age-adjusted anti-HAV prevalence by demographic and other characteristics, evaluated factors associated with anti-HAV positivity and examined anti-HAV prevalence by decade of birth.ResultsThe prevalence of anti-HAV among adults aged ≥20 years was 24.2% (95% CI 22.5–25.9) during 2007–2012, a significant decline from 29.5% (95% CI 28.0–31.1) during 1999–2006. Prevalence of anti-HAV was consistently lower in 2007–2012 compared to 1999–2006 by all characteristics examined. In 2007–2012, the lowest age-specific prevalence was among adults aged 30–49 years (16.1–17.6%). Factors significantly associated with anti-HAV positivity among adults were older age, Mexican American ethnicity, living below poverty, less education, and not having insurance. By decade of birth, the prevalence of anti-HAV was slightly lower in 2009–2012 than in 1999–2002, except among persons born from 1980 to 1989.ConclusionsNHANES data document very low prevalence of hepatitis A immunity among U.S. adults aged 30–49 years; waning of anti-HAV over time may be minimal. Improving vaccination coverage among susceptible adults should be considered.     

Associations Between Selected Xenobiotics and Antinuclear Antibodies in the National Health and Nutrition Examination Survey, 1999–2004

Background:

Potential associations between background environmental chemical exposures and autoimmunity are understudied.

Objectives:

Our exploratory study investigated exposure to individual environmental chemicals and selected mixtures in relation to the presence of antinuclear antibodies (ANA), a widely used biomarker of autoimmunity, in a representative sample of the U.S. population.

Methods:

This cross-sectional analysis used data on 4,340 participants from the National Health and Nutrition Examination Survey (1999–2004), of whom 14% were ANA positive, to explore associations between ANA and concentrations of dioxins, dibenzofurans, polychlorinated biphenyls, organochlorines, organophosphates, phenols, metals, and other environmental exposures and metabolites measured in participants’ serum, whole blood, or urine. For dioxin-like compounds with toxic equivalency factors, we developed and applied a new statistical approach to study selected mixtures. Lognormal models and censored-data methods produced estimates of chemical associations with ANA in males, nulliparous females, and parous females; these estimates were adjusted for confounders and accommodated concentrations below detectable levels.

Results:

Several associations between chemical concentration and ANA positivity were observed, but only the association in males exposed to triclosan remained statistically significant after correcting for multiple comparisons (mean concentration ratio = 2.8; 95% CI: 1.8, 4.5; p < 0.00001).

Conclusions:

These data suggest that background levels of most xenobiotic exposures typical in the U.S. population are not strongly associated with ANA. Future studies should ideally reduce exposure misclassification by including prospective measurement of the chemicals of concern and should track changes in ANA and other autoantibodies over time.

Citation:

Dinse GE, Jusko TA, Whitt IZ, Co CA, Parks CG, Satoh M, Chan EKL, Rose KM, Walker NJ, Birnbaum LS, Zeldin DC, Weinberg CR, Miller FW. 2016. Associations between selected xenobiotics and antinuclear antibodies in the National Health and Nutrition Examination Survey, 1999–2004. Environ Health Perspect 124:426–436; http://dx.doi.org/10.1289/ehp.1409345     

Relationship between blood cadmium,lead, and serum thyroid measures in US adults – the National Health and Nutrition Examination Survey (NHANES) 2007–2010

Experimental studies have shown that both cadmium (Cd) and lead have potent endocrine disrupting activity. However, studies on whether these heavy metals disrupt thyroid system in humans, especially in general populations with low levels of exposure, are sparse. The study analyzed 6,231 participants aged 20 and older with measurements from 2007–2010 of the National Health and Nutrition Examination Survey (NHANES) to investigate whether whole blood Cd and lead level are associated with serum thyroid hormones measures. Our study suggests that thyroid function may be disrupted by both Cd and lead exposures in the general population and the specific roles of Cd and lead exposure on thyroid axis may differ by sex. However, the mechanisms by which these heavy metals may disrupt thyroid system function in general population needs to be further investigated.     

Human papillomavirus vaccine uptake among males 11–26 years in United States: Findings from the National Health and Nutrition Examination Survey, 2011–2012

Anogenital human papillomavirus (HPV) infection is the leading sexually transmitted infection in the United States. In October 2011, the quadrivalent HPV vaccine (HPV4) was recommended for males in the U.S. We analyzed a subsample of 11–26 year old (N = 1012) males, from the National Health and Nutritional Examination Survey 2011–2012 dataset, to examine HPV vaccine uptake. The initiation rates in the 11–17 years and the 18–26 years age-groups were 10.7% (95% confidence interval (CI): 8.09–16.6%) and 5.5% (95%CI: 3.1–9.5%) respectively. The corresponding HPV vaccine completion rates were 39.3% (16.7–67.7%) for the 11–17 year old males and 59.1% (37.2–77.6) for the 18–26-year-old males. Despite a slight increase, HPV vaccine uptake remained low among males. These findings can help in HPV vaccination policy in the United States, with a focus on informational messages directed toward young males and their parents in order to increase uptake of HPV vaccine.     

Is obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey

Data from the Third National Health and Nutrition Examination Survey (1988-1994) were used to examine the relation between obesity and depression. Past-month depression was defined using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, and was measured with the Diagnostic Interview Schedule. Obesity was defined as a body mass index (weight (kg)/height (m)2) of 30 or higher. The authors compared risks of depression in obese and normal-weight (body mass index 18.5-24.9) persons. Obesity was associated with past-month depression in women (odds ratio (OR)=1.82, 95% confidence interval (CI): 1.01, 3.3) but was not significantly associated in men (OR=1.73, 95% CI: 0.56, 5.37). When obesity was stratified by severity, heterogeneity in the association with depression was observed. Class 3 (severe) obesity (body mass index > or =40) was associated with past-month depression in unadjusted analyses (OR=4.98, 95% CI: 2.07, 11.99); the association remained strong after results were controlled for age, education, marital status, physician's health rating, dieting for medical reasons, use of psychiatric medicines, cigarette smoking, and use of alcohol, marijuana, and cocaine. These findings suggest that obesity is associated with depression mainly among persons with severe obesity. Prospective studies will be necessary to clarify the obesity-depression relation but await the identification of potential risk factors for depression in the obese.     

Association between Blood Lead and Walking Speed in the National Health and Nutrition Examination Survey (NHANES 1999–2002)

Background: Walking speed is a simple and reliable measure of motor function that is negatively associated with adverse health events in older people, including falls, disability, hospital admissions, and mortality. Lead has adverse affects on human health, particularly on the vascular and neurological systems.Objective: We explored the hypothesis that lead is associated with slower walking speed.Methods: We used U.S. National Health and Nutrition Examination Survey (NHANES) cross-sectional data from 1999–2002. The time to walk 20 ft (walking speed) was measured among 1,795 men and 1,798 women ≥ 50 years of age. The association between walking speed and quintiles of blood lead concentration was estimated separately in men and women using linear regression models adjusted for age, education, ethnicity, alcohol use, smoking status, height, and waist circumference.Results: Mean blood lead concentrations and walking speeds were 2.17 μg/dL and 3.31 ft/sec in women, and 3.18 μg/dL and 3.47 ft/sec in men, respectively. Among women, walking speed decreased with increasing quintiles of blood lead, resulting in an estimated mean value that was 0.11 ft/sec slower (95% CI: –0.19, –0.04; p-trend = 0.005) for women with blood lead concentrations in the highest versus lowest quintile. In contrast, lead was not associated with walking speed in men.Conclusion: Blood lead concentration was associated with decreased walking speed in women, but not in men. Our results contribute to the growing evidence that lead exposure, even at low levels, is detrimental to public health.