Environmental Health[JOURNAL]
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200 papers
Urinary fluoride and dental fluorosis in relation to kidney and liver function in adolescents and young adults in the United States.
Khan D, Mattia A, Wang Z … +1 more , Malin AJ
Environ Health · 2025 Oct · PMID 41174754 · Full text
BACKGROUND: Higher fluoride in plasma has been associated with lower eGFR among adolescents in the National Health and Nutrition Examination Survey (NHANES); however, whether fluoride exposure may contribute to decreased...
BACKGROUND: Higher fluoride in plasma has been associated with lower eGFR among adolescents in the National Health and Nutrition Examination Survey (NHANES); however, whether fluoride exposure may contribute to decreased kidney function or fluoride may accumulate in plasma from lower kidney filtration could not be parsed. We examined the presence of dental fluorosis (DF; reflecting chronic fluoride exposure during tooth development) among adolescents and young adults and urinary fluoride (UF) levels among adolescents in relation to kidney and liver parameters in the United States (US). METHODS: Participants were 1,031 adolescents (aged 12–19 years) and 734 young adults (aged 20–29 years) from NHANES 2015–2016. DF was derived from Dean’s Fluorosis Index (DFI), and defined as any DFI score indicating very mild, mild, moderate, or severe fluorosis, while scores of normal and questionable were categorized as no fluorosis. Kidney or liver function parameters included estimated glomerular filtration rate (eGFR), serum uric acid, the urinary albumin to creatinine ratio, blood urea nitrogen (BUN), gamma glutamate transferase, aspartate aminotransferase, alkaline phosphatase, alanine aminotransferase, and albumin. We conducted survey-weighted linear regression adjusted for covariates to examine associations between fluoride exposure and kidney or liver function. RESULTS: Adolescent participants were 15 years old and adults were 24 years old on average. The median (IQR) UF concentration among adolescents was 0.48 (0.48) mg/L. Approximately 74% of adolescents and 70% of adults had DF with varying degrees of severity (ranging from very mild to severe). Each 1 mg/L increase in UF was associated with an approximately 5 mL/min/1.73 m² lower eGFR among adolescents (B = -4.73, 95% CI: -8.35, -1.12, p = 0.010). Higher UF was also associated with higher serum uric acid (mg/dl) (B = 0.17, 95% CI: 0.01, 0.33, p = 0.040) among adolescents. DF was associated with lower eGFR among adolescents (B = -3.72, 95% CI: -7.10, -0.33, p = 0.031) and adults (B = -3.90, 95% CI: -6.49, -1.31, p = 0.003). In addition, having DF was negatively associated with BUN among adolescents (B = -0.83, 95% CI: -1.44, -0.22, p = 0.007). No other significant associations were observed for liver markers. CONCLUSION: Chronic fluoride exposure during tooth development and recent fluoride exposure in adolescence are cross-sectionally associated with a lower rate of kidney filtration among adolescents and young adults in the US. Prospective US-based studies are needed to determine whether these associations are causal.
Global burden of lung cancer attributable to occupational asbestos exposure: 1990 to 2021.
Huang Q, Cheng Y, Lei R … +4 more , Chen Z, Gu W, Hemminki K, Chen T
Environ Health · 2025 Oct · PMID 41168773 · Full text
BACKGROUND: Asbestos is a well-established occupational carcinogen, with strong evidence linking its exposure to lung cancer. Despite increasing awareness of its health risks, asbestos continues to be used in many countr...
BACKGROUND: Asbestos is a well-established occupational carcinogen, with strong evidence linking its exposure to lung cancer. Despite increasing awareness of its health risks, asbestos continues to be used in many countries. We aimed to evaluate the global burden of lung cancer attributable to occupational asbestos exposure and to analyze its epidemiological patterns across time and by regions, sex, and age. METHODS: We utilized lung cancer data from the Global Burden of Disease (GBD) 2021 database, including information on new cases, deaths, and disability-adjusted life-years (DALYs), along with their age-standardized rates by gender and age groups. Temporal trends were examined using Joinpoint regression models with 95% confidence intervals (CIs). The timeline data on global asbestos bans were retrieved from the International Ban Asbestos Secretariat. RESULTS: We observed, approximately 25 years after the complete ban on asbestos use, a declining trend for lung cancer incidence, as well as for mortality and DALYs due to asbestos exposure. In 2021, occupational asbestos exposure accounted for 9.4% of global lung cancer deaths and 7.2% of DALYs. Between 1990 and 2021, the number of asbestos-related lung cancer deaths increased from 0.13 million to 0.19 million, while DALYs rose from 2.58 million to 3.34 million. The highest deaths and DALYs were observed in regions with high Socio-demographic Index (SDI), though the most rapid increases occurred in lower SDI regions. Over time, lung cancer burden shifted towards older populations, especially those aged over 70. CONCLUSIONS: We found, for the first time, that a complete ban on asbestos with a lag time of 25 years could effectively reduce lung cancer incidence along with asbestos-related deaths and DALYs. These findings underscore the urgent need for a complete ban on asbestos (especially chrysotile).
Occupational exposure to formaldehyde and risk of lymphoma subtypes: results of a multicentre Italian case-control study.
Cocco P, Meloni F, Trobbiani C … +15 more , Miligi L, Ferrante D, Padoan M, Ferri GM, Gambelunghe A, Muzi G, Magnani C, Palmas A, Piras G, Piro S, Zucca M, Ennas MG, Zanotti R, Scarpa A, De Matteis S
Environ Health · 2025 Oct · PMID 41146278 · Full text
BACKGROUND: The International Agency for Research on Cancer classifies formaldehyde as a human carcinogen, with sufficient evidence for nasopharyngeal cancer and leukaemia. However, the association with lymphoma subtypes...
BACKGROUND: The International Agency for Research on Cancer classifies formaldehyde as a human carcinogen, with sufficient evidence for nasopharyngeal cancer and leukaemia. However, the association with lymphoma subtypes has been less thoroughly investigated. We explored this link in an Italian multicentre case-control study. METHODS: A total of 867 incident lymphoma cases, histologically confirmed using the WHO classification, and 774 controls participated in the study. Occupational experts classified the probability, frequency, and intensity of exposure to formaldehyde for each study subject based on detailed questionnaire data and literature information. We used unconditional regression analysis to model the risk of lymphoma and its main subgroups and subtypes associated with different formaldehyde exposure metrics, adjusting for age, gender, education, and study centre. RESULTS: Ever exposure to formaldehyde was not associated with risk of all lymphomas combined, the non-Hodgkin lymphoma (NHL) and B-cell lymphoma (BCL) subgroups, or the most prevalent BCL subtypes, but multiple myeloma (MM) (OR = 2.0, 95% CI 1.19–3.31). MM risk also showed consistent upward trends with all the exposure metrics (p for trend ranging 0.005–0.034). Hodgkin’s lymphoma risk was also elevated in the top categories of intensity, duration, and cumulative exposure, but no significant increasing trends were observed. CONCLUSIONS: Our findings suggest an increased risk of multiple myeloma associated with occupational exposure to formaldehyde. A stronger link was observed for daily exposure lasting 20 years or more. The risk of Hodgkin’s lymphoma was also elevated at high exposure intensities.
Not whether but how: the ethics and Language of reporting back individual results.
Castillo E, Khanna S, Vogel T … +2 more , Herbstman J, Rohlman D
Environ Health · 2025 Oct · PMID 41146215 · Full text
BACKGROUND: The ethical obligation of reporting back research results (RBRR) is established. Yet the ethical dimensions of how RBRR is implemented remain largely unexplored. The Environmental influences on Child Health O...
BACKGROUND: The ethical obligation of reporting back research results (RBRR) is established. Yet the ethical dimensions of how RBRR is implemented remain largely unexplored. The Environmental influences on Child Health Outcomes (ECHO) program has identified logistical challenges in RBRR, citing limited guidance resources as a key obstacle. The objective of this research was to characterize and assess ethical considerations for RBRR: (i) with or without clinical significance; (ii) within a pregnancy cohort, and; (iii) within a study population with diverse cultural and traditional contexts. METHODS: Expert Panelists (n = 20), including exposure scientists, community engagement specialists, public health researchers, clinicians and ethicists convened virtually and completed short surveys to identify ethical considerations regarding how RBRR is conducted. While the original objective was to characterize ethical guidelines for RBRR across three potential outcomes, the Panel identified a need for RBRR harmonization; conflicting and inconsistently applied terminology and definitions prevented the Panel from fully discussing the original topics. RESULTS: Ethical considerations for conducting RBRR were mapped to the principles of bioethics (respect for autonomy, beneficence, nonmaleficence, and justice), with Panelists suggesting that additional ethical frameworks could be used in parallel or as a replacement. However, when considering results with or without clinical significance, the Panel identified a clear need for standardized terminology when describing RBRR, particularly regarding the relevance of results to individual health, behavior, and knowledge. The Panel recommended the following related to RBRR: (i) develop centralized resources; (ii) develop multi-use materials; (iii) ensure clear assignment of RBRR responsibility within research projects; (iv) encourage active engagement of research participants in the RBRR process to foster and maintain trust; (v) recognize community-level harms and benefits; (vi) extend RBRR beyond study completion; and, (vii) establish standardized language. DISCUSSION: The Panel highlighted challenges such as non-standard terminology and difficulty discerning between RBRR with clear health or regulatory standards versus results without established, quantified health relationships. The Panel affirmed all research results, regardless of established health relationships, that benefit participants should be returned. While RBRR guidelines were considered universal, the Panel emphasized the need for nuanced considerations, particularly when working with culturally diverse or pregnant populations. Future work should address ethical considerations regarding RBRR’s responsibilities for depositing data in a public-use repository.
Carcinogenicity of vinyl acetate: evidence from multiple data streams.
Li K, Ricker K, Tsai FC … +7 more , Cheng V, Osborne G, Guha N, Elmore S, Alvarado-Cruz I, Sandy MS, Sun M
Environ Health · 2025 Oct · PMID 41137107 · Full text
BACKGROUND: Vinyl acetate (VA) is a synthetic chemical that can be metabolized to form the carcinogen acetaldehyde (AA). This paper summarizes the key evidence relevant to the evaluation of VA’s carcinogenicity. METHODS:...
BACKGROUND: Vinyl acetate (VA) is a synthetic chemical that can be metabolized to form the carcinogen acetaldehyde (AA). This paper summarizes the key evidence relevant to the evaluation of VA’s carcinogenicity. METHODS: We conducted a literature search and reviewed data relevant to the carcinogenicity of VA using a systematic approach. The literature reviewed included epidemiological studies, animal carcinogenicity studies, pharmacokinetic and metabolism studies, as well as studies relevant to the key characteristics of carcinogens. RESULTS: The body of epidemiological evidence includes several occupational studies with significant limitations and one prospective cohort study that assessed ambient air exposure to VA and breast cancer risk. The evidence from animal carcinogenicity studies is considered strong. VA induced tumors in a number of tissues across different strains of rats and mice in both sexes, via two exposure routes (inhalation and drinking water). Some tumor findings showed dose-related trends and were not limited to site-of-entry tissues. VA’s metabolic link to AA strengthens the evidence by providing biological plausibility: both chemicals induced many of the same DNA adducts, genotoxicity endpoints, and tumor types at many of the same sites. In addition, VA demonstrates three of the ten key characteristics of carcinogens in that it can be metabolically activated to be electrophilic, is genotoxic, and induces cell proliferation. CONCLUSION: Our review of VA’s carcinogenicity shows compelling evidence in animal cancer bioassays with supporting mechanistic data, including the formation of reactive compounds and DNA adducts, evidence of genotoxicity including clastogenicity and DNA damage, and the ability to induce cell proliferation and pre-neoplastic lesions. The metabolic link to AA was an important consideration.
Traffic-related air pollution exposure at birth and risk of childhood leukemia: results from the GEOCAP-Birth case-control study.
Danjou AMN, Lafontaine A, Jacquemin B … +5 more , Vienneau D, de Hoogh K, Faure L, Clavel J, Goujon S
Environ Health · 2025 Oct · PMID 41126183 · Full text
BACKGROUND: Air pollution, in particular due to traffic, is suspected of increasing the risk of childhood acute leukemia (AL), most of the evidence coming from epidemiological studies and literature reviews that focused...
BACKGROUND: Air pollution, in particular due to traffic, is suspected of increasing the risk of childhood acute leukemia (AL), most of the evidence coming from epidemiological studies and literature reviews that focused on the time around diagnosis. Using data on the national scale, we tested the hypothesis that prenatal exposure to traffic-related air pollution increases the risk of childhood AL. METHODS: This case–control study included 581 cases of acute lymphoblastic leukemia (ALL) and 136 cases of acute myeloid leukemia (AML), registered in the French national registry of childhood cancer and born and diagnosed between 2010 and 2015, and 11,908 controls. Exposure indicators were evaluated at the addresses at birth and included major road length in 500 m buffers, and modeled exposures of nitrogen dioxide (NO2), fine particulate matter (PM2.5) and black carbon (BC). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression models. Exposures were considered in categories using tertiles’ cut offs or continuously for increments of ½ interquartile range. RESULTS: Both ALL and AML risks increased with PM2.5 exposure (OR ALL = 1.14, 95%CI = 1.08–1.20 and OR AML = 1.12, 95%CI = 1.00–1.25 for an increment of 2 µg/m3, respectively). The risk of ALL was associated with BC exposure in urban units of < 5,000 inhabitants and of 5,000–99,999 inhabitants (OR = 1.90, 95%CI = 1.22–2.97 and OR = 1.58, 95%CI = 1.16–2.17 for an increment of 0.5 10–5/m, respectively), and not in more urban municipalities. An elevated OR for AML was observed for NO2 exposure (OR = 1.4, 95%CI = 0.9–2.1 for the highest versus lowest category). There was no association with the length of major roads. CONCLUSION: The results support a role of exposure to air pollution at time of birth in the risk of childhood AL.
The evolution of an epidemic: age-period-cohort modelling of mesothelioma in Casale Monferrato, 1990-2021, with projections to 2042.
Giraldo M, Zugna D, Migliore E … +2 more , Ramos-Bonilla JP, Maule M
Environ Health · 2025 Oct · PMID 41121262 · Full text
BACKGROUND: In Italy, the area of Casale Monferrato in the Piedmont Region has experienced a high burden of malignant mesothelioma (MM) due to environmental contamination from Eternit, the country's largest asbestos-ceme...
BACKGROUND: In Italy, the area of Casale Monferrato in the Piedmont Region has experienced a high burden of malignant mesothelioma (MM) due to environmental contamination from Eternit, the country's largest asbestos-cement plant, which operated from 1907 to 1986. The severity of the health impact led to the area's designation as a Site of National Interest (SIN) for environmental and health concerns. Despite the 1992 asbestos ban, the MM epidemic persists, driven by the disease's long latency. Using data from the Piedmont Malignant Mesothelioma Registry (RMM), we describe MM trends in Casale Monferrato's SIN from 1990 to 2021 and project future incidence through 2042 using Age-Period-Cohort (APC) models. METHODS: Incidence rates (1990-2021) were estimated as smooth functions of age and calendar time using APC models with restricted cubic splines. Projections through 2042 were made using three approaches: (1) spline-unrestricted, (2) spline-restricted, and (3) constraint-based approach. Performance was evaluated by predicting 2010-2021 rates using data up to 2010 and comparing predicted to observed cases. Sensitivity to the number and position of spline knots was assessed. RESULTS: Between 1990 and 2021, 1,282 pleural MM cases (731 men, 551 women) aged 35-96 were recorded in the Casale Monferrato SIN. Occupational exposure was reported in 61% of men and 21% of women. Non-occupational exposures, including environmental and familial exposures, were common in women (58%) than in men (22%). Incidence increased with age up to 85-90 years, and with birth cohort up to 1945 (154 and 105 per 100,000 in men and women, respectively), then declined. Rates increased over time by period until the mid-2010s and began to decrease thereafter. All approaches projected a slow but steady decline, with case numbers by 2035 returning to early 1990s levels. By 2042, incidence is estimated at 31 per 100,000 in men (8 cases) and 34 per 100,000 in women (9 cases). CONCLUSIONS: The three approaches yielded consistent results, predicting extinction of the MM epidemic curve around mid-century. However, the health burden will persist over the next two decades, highlighting the need for sustained environmental health surveillance.
Chlordecone exposure in women and time to pregnancy: the Timoun cohort study in Guadeloupe, French West Indies.
Ben-Fares M, Monfort C, Kadhel P … +8 more , Costet N, Rouget F, Michineau L, Thomé JP, Cordier S, Multigner L, Warembourg C, Garlantézec R
Environ Health · 2025 Oct · PMID 41102688 · Full text
BACKGROUND: Chlordecone is a persistent organochlorine insecticide that was widely used to control banana root borer in the French West Indies until 1993. Animal studies have reported an impact of chlordecone exposure on...
BACKGROUND: Chlordecone is a persistent organochlorine insecticide that was widely used to control banana root borer in the French West Indies until 1993. Animal studies have reported an impact of chlordecone exposure on female fertility, but no data are available for humans. Here, we investigated the association between chlordecone exposure in women and time to pregnancy (TTP). METHODS: We included 668 pregnant women from the Timoun mother-child cohort study performed in Guadeloupe between 2004 and 2007. TTP was measured with a questionnaire at the inclusion visit. Chlordecone concentrations in maternal blood samples were determined at the time of delivery. A discrete-time Cox model was used to estimate fecundability odds ratios (fOR) and their 95% confidence intervals (95% CIs), with adjustment for potential confounders. Sensitivity analyses were performed by modifying the study population and censoring criteria. RESULTS: Chlordecone was detected in 91% of the study population, with a median concentration of 0.3 µg/L (IQR: 0.1–0.7). The third and fourth quartiles of chlordecone exposure were associated with significantly lower fecundability (fORa [95% CI] = 0.76 [0.58, 0.99]; fORa [95% CI] = 0.72 [0.55, 0.95], respectively). A significant dose-dependent relationship was observed between chlordecone exposure and TTP (p-trend = 0.01). Similar results were observed in all sensitivity analyses except that for primiparous women. CONCLUSION: Our study supports the hypothesis that chlordecone affects the fertility of women and is therefore a public health concern in widely contaminated areas, such as the French West Indies.
Thyroid disrupting effects of exposure to sunscreens: in vitro and in vivo evidence of the impact of organic UV-filters.
Greco A, Franchi E, Denegri M … +4 more , Ambrosino S, Magri F, Coperchini F, Rotondi M
Environ Health · 2025 Oct · PMID 41102674 · Full text
BACKGROUND: Ultraviolet radiation (UVR), primarily from sunlight, is a natural component of environmental exposure and can cause genomic damage, photoaging, and skin cancer. Sunscreens containing UV-filters are widely us...
BACKGROUND: Ultraviolet radiation (UVR), primarily from sunlight, is a natural component of environmental exposure and can cause genomic damage, photoaging, and skin cancer. Sunscreens containing UV-filters are widely used to prevent these effects and are also found in many personal care products. Despite their protective role, concerns have emerged regarding the accumulation of UV-filters in the environment and human matrices, along with their ability to act as endocrine disruptors, which main target include also thyroid hormone regulation. METHODOLOGY: This narrative review was performed through a systematic search of PubMed (Medline), Embase, and the Cochrane Library. Global legislations were reviewed from institutional websites and official databases of major international agencies. MAIN BODY: Various studies have shown that several UV-filters are detectable in human tissues, blood, urine, breast milk, and fetal circulation, suggesting systemic absorption and long-term exposure. Experimental evidence indicates that some UV-filters may affect hormone regulation by interacting with nuclear receptors, particularly those involved in thyroid function. Thyroid hormones are crucial for development, metabolism, and neurological function, mainly during critical life stages such as pregnancy and infancy. Disruption of thyroid hormone homeostasis may result in long-lasting adverse effects. While previous research has mainly focused on estrogenic and androgenic effects, increasing evidence highlights the need to assess thyroid-specific endpoints. This review summarizes current in vitro and in vivo findings on the potential thyroid-disrupting effects of UV-filters. CONCLUSION: A better understanding of how UV-filters may interfere with thyroid hormone regulation is essential for evaluating their safety and informing regulatory decisions. Given the global variability in regulatory frameworks, this issue is particularly relevant for risk assessment and the development of safer and more sustainable alternatives in cosmetic formulations. Future research and awareness campaigns should focus on chronic exposure, mainly on vulnerable populations.
Anthroposomics: integrating anthropological methods into exposome research.
Hardon A, Téllez-Rojo MM, Anastario M … +8 more , Tan ML, Alcala CS, Echague PA, Kuritzky A, Gordon TR, Boudart Z, Sandoval MR, Roberts EFS
Environ Health · 2025 Oct · PMID 41088221 · Full text
BACKGROUND: Exposome research seeks to understand how cumulative environmental exposures across the life course shape health outcomes. Most studies however, adopt a unidirectional, top-down model, conceptualizing individ...
BACKGROUND: Exposome research seeks to understand how cumulative environmental exposures across the life course shape health outcomes. Most studies however, adopt a unidirectional, top-down model, conceptualizing individuals as passive recipients of exposure, which overlooks the social, cultural, and behavioral dynamics through which people engage with their environments and thus underestimates the human agency of those exposed in mitigating exposures. MAIN BODY : To address this gap, we introduce the concept of the anthroposome: the full range of micro-ecological practices through which individuals and communities sense, interpret, avoid, and manage environmental exposures in daily life. Drawing on anthropological theory and focusing on ethnographic methods, we outline five discovery-based approaches for integrating lived experience and social complexity into exposome science. These methods highlight how everyday practices influence exposure pathways and reveal context-specific risk management strategies conventional exposure researchers may miss. Capturing bidirectional human–environment interactions, anthroposomics repositions populations suffering from exposure as active agents who participate in shaping their exposure landscapes. CONCLUSION: Anthroposomics expands the exposome paradigm by integrating ethnographic methods into exposome research, enhancing the paradigm's relevance, effectiveness, and equity. Anthroposomics offers a foundation for preventive, community-responsive, justice-oriented environmental health interventions and policy.
Impact of plastic-related chemicals on emotional and behavioral health in children from Poland.
Polańska K, Jankowska A, Bury D … +7 more , Moos RK, Pälmke C, Jerzyńska J, Jurewicz J, Bose-O'Reilly S, Koch HM, Garí M
Environ Health · 2025 Oct · PMID 41088118 · Full text
BACKGROUND: Exposure to phthalates and non-phthalate plasticizers as well as bisphenols may be relevant to the development of behavioural symptoms in childhood with sex-specific effects, although the results of existing...
BACKGROUND: Exposure to phthalates and non-phthalate plasticizers as well as bisphenols may be relevant to the development of behavioural symptoms in childhood with sex-specific effects, although the results of existing studies are not consistent. The aim of the study was to evaluate the cross-sectional association between childhood exposure to these compounds and behavioral outcomes in the REPRO_PL cohort (Poland). METHODS: Behavioral assessments were performed at the age of 7-9 years by parents using the Strengths and Difficulties Questionnaire (SDQ). HPLC-MS/MS was used for the quantification of BPA and 21 phthalate metabolites corresponding to 11 phthalate compounds (n = 400) and their replacement alternatives BPF, BPS, three metabolites of diethylhexyl terephthalate (DEHTP) and three metabolites of di-isononyl-cyclohexane-1,2-dicarboxylate (DINCH) (n = 150). Multivariable linear regression models accounting for sex-specific effects as well as sex-adjusted models were applied, using both separate models for each metabolite (or sum of metabolites) and joint models. In addition, mixtures models adjusted by the three chemical groups studied were also performed. RESULTS: Median concentrations of several phthalate metabolites and bisphenols were of 42 µg/L (MEP), 4.5 µg/L (MMP), 3.5 µg/L (ΣDiDP), 2 µg/L (BPA) and 1 µg/L (BPF). For ΣDEHTP and ΣDINCH, the median concentrations were 35 µg/L and 3.1 µg/L, respectively. Exposure to phthalates was related to behavioral problems in girls, and bisphenols and DEHTP in boys. Among girls, DiBP was associated with mental health problems (total difficulties: β = 4.84; 95% CI 0.72;8.96, emotional: β = 2.14; 95% CI 0.33;4.0, hyperactivity/inattention: β = 2.52; 95% CI 0.55;4.49, externalizing behavior: (β = 2.95; 95% CI 0.36;5.53) and DiDP with hyperactivity/inattention scores (β = 2.46; 95% CI 0.30;4.63). BPF was associated with emotional problems and internalizing behavior among boys in both main and sensitivity models (main model: β = 1.03; 95% CI -0.16;2.21 and β = 1.71; 95% CI -0.14;3.56 respectively). CONCLUSIONS: This study shows that children's exposure to several replacement compounds of BPA and phthalates, such as BPF and DEHTP, are associated with adverse effects on school-age children's behavior, with a divergent sex-specific effect. In any case, mixture models did not provide any further insight on the aforementioned cross-sectional associations and further methodological approaches are needed to explore adverse neurodevelopmental outcomes in children and teenagers.
Exposure to consecutive extreme ozone-heatwave events and neurological disorders: a retrospective cohort study in Nanjing, China.
Ren H, Xia Y, Zhuang T … +9 more , Li Y, Chen Y, Huang W, Jiang P, Tang X, Han S, Cui Y, Shen J, Ji M
Environ Health · 2025 Oct · PMID 41074155 · Full text
OBJECTIVES: In the context of global warming and escalating urbanization, occurrences of extreme ozone (EO) and heatwave (HW) events are increasingly frequent. However, studies on the impact of consecutive extreme ozone...
OBJECTIVES: In the context of global warming and escalating urbanization, occurrences of extreme ozone (EO) and heatwave (HW) events are increasingly frequent. However, studies on the impact of consecutive extreme ozone and heatwave (EO-HW) events on hospitalizations for neurological disorders (ND) and related economic burdens remains limited. Our study aimed to explore the impacts of these events on ND hospitalizations, length of stay, and related costs, with a specific focus on quantifying the impacts of consecutive extreme events of varying durations. METHODS: Time-series analysis was performed to investigate the relationships between consecutive O and HW events of varying durations and the number of hospitalizations, length of stay, and hospitalization costs for ND, employing a quasi-Poisson distributed‑lag non‑linear model (DLNM). In addition, we further identified potential high-risk groups by age and gender stratification. RESULTS: Exposure to EO-HW events were associated with an increased risk of hospitalization for ND, with this risk persisting from lag 1 day (1.097, 95% CI: 1.005,1.198) to lag 4 days (1.071, 95% CI: 1.004,1.139). Significant associations were particularly evident in male (highest RR value 1.092, 95% CI: 1.016,1.173) and aged < 65 years (highest RR value 1.124, 95% CI: 1.008,1.254). Furthermore, exposure to EO-HW events were found to result in longer length of stay and higher hospitalization costs compared to exposure to HW events alone. CONCLUSIONS: Consecutive EO-HW events significantly increase the risk of hospitalization and the economic burden of ND. Local authorities should consider incorporating early warning information and public health interventions for consecutive extreme weather into existing early warning systems. Neglecting to do so will likely result in higher associated illness rates and economic burdens.
Correction: Maternal and fetal exposures to fluoride during mid-gestation among pregnant women in northern California.
Uyghurturk DA, Goin DE, Martinez-Mier EA … +2 more , Woodruff TJ, DenBesten PK
Environ Health · 2025 Oct · PMID 41068924 · Full text
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The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis.
Mazzoli R, Filippini T, Iamandii I … +5 more , De Pasquale L, Veneri F, Birnbaum LS, Rothman KJ, Vinceti M
Environ Health · 2025 Oct · PMID 41068882 · Full text
BACKGROUND: Fluoride exposure and its effects on human health are controversial and highly debated. While beneficial in preventing dental caries, fluoride has been linked to skeletal and dental fluorosis at high levels,...
BACKGROUND: Fluoride exposure and its effects on human health are controversial and highly debated. While beneficial in preventing dental caries, fluoride has been linked to skeletal and dental fluorosis at high levels, as well as other adverse health endpoints in children and adults. However, the safe range of exposure for bone health remains poorly defined. We used existing literature to quantify the dose-response relation between fluoride exposure and bone health, focusing on fracture risk and bone mineral density (BMD). METHODS: We conducted a systematic review and dose-response meta-analysis by searching literature in online databases (MEDLINE/PubMed, Embase and Web of Science) up to August 26, 2025, and by pooling results of studies examining fluoride exposure and its associations with bone health outcomes, namely fracture risk and BMD. We also conducted stratified analyses by sex, age, and fracture site. This study is registered in PROSPERO (CRD42022321899). RESULTS: We included 37 studies published between 1945 and 2024. 10 pertained to bone density only; 19 to bone fractures only; and eight to both outcomes. We found a non-linear, positive relation between fluoride exposure and fracture risk, with an indication of an approximate threshold around 1.5 mg/L of fluoride in drinking water and a nearly linear increasing fracture risk above that concentration (risk ratios of 1.06, 1.19 and 1.35 at 2.0, 3.0 and 4.0 mg/L, respectively, compared to null exposure). Sex-specific dose-response analyses, available only for fragility fractures, indicated an effect in females but little or nothing in males. The association between fluoride and BMD was inconsistent, showing opposite trends for different bone sites (hip and spine) and amounts of exposure, and by sex. Among females aged over 50 years, an association of drinking water fluoride with fragility fracture risk started as early as around 0.5 mg/L (risk ratio of 1.26 at 1.0 mg/L). CONCLUSIONS: This study indicates increased risk of fractures with fluoride exposure > 1.5 mg/L in drinking water, with an enhanced susceptibility in postmenopausal females. These findings, which appear consistent with those yielded by recent pooled analysis related to other endpoints in children, may be helpful in assessing the risk-benefit profile for fluoride exposure. CLINICAL TRIAL REGISTRATION: not applicable.
First trimester urine glyphosate concentrations and gestational diabetes in nulliparas: a nested case-control study.
Haas DM, Moss K, Faysal H … +3 more , Yee LM, Silver RM, Grobman WA
Environ Health · 2025 Oct · PMID 41057879 · Full text
BACKGROUND: Environmental exposures, such as pesticides, during pregnancy have been associated with several adverse pregnancy outcomes, including miscarriage and shorter gestational length at birth. However, their relati...
BACKGROUND: Environmental exposures, such as pesticides, during pregnancy have been associated with several adverse pregnancy outcomes, including miscarriage and shorter gestational length at birth. However, their relationship with gestational diabetes (GDM) is uncertain. The objective of this study was to analyze first-trimester urinary herbicide concentrations for their associations with GDM. METHODS: This was a nested case-control study analysis of the Nulliparous Pregnancy Outcomes Study- Monitoring Mothers-to-be (nuMoM2b) study. The study included participants at the three midwestern study sites. We analyzed individuals according to whether they developed GDM. Urinary herbicide concentration at the upper quartile was the exposure of interest. To assess the association of first-trimester urine glyphosate and metabolites with GDM, conditional logistic regression was used for matched pairs models. To test whether the association of herbicides with GDM was modified by BMI, an interaction term of herbicide (dichotomous variable) * BMI was included. RESULTS: The 118 cases of nuMoM2b participants with GDM were matched with 118 randomly selected age-matched controls who had no adverse pregnancy outcomes. Participants with GDM were less likely to be Non-Hispanic White (26.3% vs. 40.7%; p = 0.02), had a higher mean BMI (30.7 ± 8.3 vs. 26.1 ± 6.3; p < 0.01), and were less likely to have graduated from college (55.1% vs. 72.0%; p = 0.007). Glyphosate concentrations were above the limit of detection (LOD) in 93.6% of analyzable samples. In the adjusted conditional logistic regression for the matched pairs model, participants with glyphosate in the upper quartile had significantly higher odds of having GDM (odds ratio [OR] 3.27, 95% confidence interval [CI] 1.04-10.3), with the OR of 1.23 (95% CI 1.02-1.47) for the interaction with BMI. Compared to participants with BMI < 25 kg/m, the adjusted odds of GDM for participants with obese BMI (≥ 30 kg/m) was elevated (OR 8.52, 95% CI 1.27-57.2). CONCLUSION: First trimester urinary glyphosate concentrations were associated with development of GDM, and the magnitude of this association increased at higher BMI. TRIAL REGISTRY: NCT01322529.
A nationwide analysis of heat and workplace injuries in the United States.
Alahmad B, Kessler W, Alwadi Y … +3 more , Schwartz J, Wagner GR, Michaels D
Environ Health · 2025 Oct · PMID 41047384 · Full text
BACKGROUND: Exposure to heat leads to physiological and cognitive impairments that increase the risk of workplace injuries. This study estimates the number and proportion of work injuries reported to the United States Oc...
BACKGROUND: Exposure to heat leads to physiological and cognitive impairments that increase the risk of workplace injuries. This study estimates the number and proportion of work injuries reported to the United States Occupational Safety and Health Administration (OSHA) that can be attributed to heat exposure. These estimates contribute to the calculation of the benefits of standards, policies, and programs that reduce workplace exposure to extreme heat. METHODS: We analyzed all 2023 injury cases reported to OSHA's Injury Tracking Application by establishments with 100 or more employees, primarily in high-hazard industries. Each injury was geocoded and matched with high-resolution weather data for the specific injury date. Using a case-crossover design, we compared heat index on each injury day (case) with matched non-injury control days for the same worker. Conditional logistic regression was applied separately for summer-only and year-round periods with a non-linear term for heat index to estimate the odds ratios for injury occurrence. We additionally examined heat-injury patterns by industry sectors and in states with/without workplace heat standards. RESULTS: The odds of work injury increased non-linearly with a rising heat index: the pooled national estimate showed a clear upward trend starting around 85°F and accelerating above 90°F. Our results were consistent across nearly all industry sectors, including those that are predominantly indoors. Using a heat index of 80°F as reference, odds ratios (OR) of injuries at or above 90°F, 100°F and 110°F were 1.03 (95% confidence intervals [CI]: 1.02, 1.04), 1.10 (1.07, 1.13), and 1.20 (1.13, 1.26), respectively. At a heat index of 110°F or higher, the odds increased by 22% in states without occupational heat rules (OR=1.22; 1.15,1.29) versus 9% in states with rules (OR=1.09; 0.84, 1.41), suggesting a protective effect, although confidence intervals overlapped. Overall, we estimate 1.18% (95% empirical CI: 0.92%, 1.45%) of all injuries were attributable to heat exposure on days exceeding a heat index of 70°F. CONCLUSION: Heat exposure increases the overall risk of work injury, an effect consistent across nearly all major industries.
The WHO-commissioned systematic reviews on health effects of radiofrequency radiation provide no assurance of safety.
Melnick RL, Moskowitz JM, Héroux P … +10 more , Mallery-Blythe E, McCredden JE, Herbert M, Hardell L, Philips A, Belpoggi F, Frank JW, Scarato T, Kelley E, International Commission on the Biological Effects of Electromagnetic Fields (ICBE-EMF)
Environ Health · 2025 Oct · PMID 41034851 · Full text
The World Health Organization (WHO) commissioned 12 systematic reviews (SR) and meta-analyses (MA) on health effects of exposure to radiofrequency electromagnetic fields (RF-EMF). The health outcomes selected for those r...
The World Health Organization (WHO) commissioned 12 systematic reviews (SR) and meta-analyses (MA) on health effects of exposure to radiofrequency electromagnetic fields (RF-EMF). The health outcomes selected for those reviews (cancer, electromagnetic hypersensitivity, cognitive impairment, birth outcomes, male fertility, oxidative stress, and heat-related effects) were based on a WHO-conducted international survey. The SR of the studies of cancer in laboratory animal studies was the only one that did not include a MA, because those authors considered it inappropriate due to methodological differences among the available studies, including differences in exposure characteristics (carrier frequency, modulation, polarization), experimental parameters (hours/day of exposure, duration of exposure, exposure systems), and different biological models. MAs in all the other SRs suffered from relatively few primary studies available for each MA (sometimes due to excessive subgrouping), exclusion of relevant studies, weaknesses in many of the included primary studies, lack of a framework for analyzing complex processes such as those involved in cognitive functions, and/or high between-study heterogeneity. Due to serious methodological flaws and weaknesses in the conduct of the reviews and MAs on health effects of RF-EMF exposure, the WHO-commissioned SRs cannot be used as proof of safety of cell phones and other wireless communication devices. However, the animal cancer SR, which was rated as "high certainty of evidence" for heart schwannomas and "moderate certainty of evidence" for brain gliomas, provided quantitative information that could be used to set exposure limits based on reducing cancer risk. The multiple and significant dose-related adverse effects found in the SRs on male fertility and pregnancy and birth outcome should also serve as the basis for policy decisions to lower exposure limits and reduce human reproductive risks. The report of harmful effects (e.g., cancer, reproductive toxicity, etc.) at doses below the adverse health effect threshold claimed by ICNIRP demonstrates that current exposure limits to RF-EMF, which were established by applying arbitrary uncertainty factors to their putative adverse threshold dose, lack scientific credibility.
Relationship of prenatal methylmercury exposure and language/verbal function: a meta-analysis.
Kopylev L, Segal D
Environ Health · 2025 Sep · PMID 41024146 · Full text
BACKGROUND: Developmental neurotoxicity (DNT) is a well-established hazard of methylmercury (MeHg) exposure. Past research on MeHg has highlighted DNT tests of language/verbal function (in particular the Boston naming te...
BACKGROUND: Developmental neurotoxicity (DNT) is a well-established hazard of methylmercury (MeHg) exposure. Past research on MeHg has highlighted DNT tests of language/verbal function (in particular the Boston naming test (BNT)) as an important aspect of MeHg toxicity. METHODS: We conducted a meta-analysis based on a recent systematic review of MeHg neurodevelopmental dose-response cohort studies published 1998-2025 that reported similarly normed tests of language/verbal function. Meta-analyses were based on recent studies using maternal blood biomarkers or cord blood biomarkers converted into maternal blood biomarkers. RESULTS: For the BNT with or without cues, analysis (based on 2 studies (3 populations)) results were adverse, but not statistically significant. For the similarly normed language/verbal tests, decrements were statistically significant [-0.0085 95% (-0.0167; -0.0003) per MeHg µg/L maternal blood (based on eight studies)]. Results of a fill and trim sensitivity analysis were similar in the size of the effect to the original results. The two studies with sex-specific results indicated that boys appeared to be more sensitive to MeHg-related language/verbal function decrements when compared with girls. CONCLUSIONS: Although most of the individual study results of language/verbal function were not statistically significant, the meta-estimate showed a statistically significant decrement in language/verbal function in children due to prenatal MeHg exposure.
Short-term exposure to air pollution and risk of ischemic stroke requiring intravenous thrombolysis: a population-level analysis in Poland from the EP-PARTICLES study.
Święczkowski M, Lip GYH, Kurasz A … +5 more , Jemielita P, Duzinkiewicz M, Januszko T, Dobrzycki S, Kuźma Ł
Environ Health · 2025 Sep · PMID 41024000 · Full text
BACKGROUND: Air pollution is an important non-classical cardiovascular risk factor. Ischemic stroke (IS) is an increasing healthcare challenge, with the ageing population and associated presence of atrial fibrillation wo...
BACKGROUND: Air pollution is an important non-classical cardiovascular risk factor. Ischemic stroke (IS) is an increasing healthcare challenge, with the ageing population and associated presence of atrial fibrillation worldwide. In patients with IS, intravenous thrombolysis (IVT) is an effective treatment method within 4.5 hours from symptoms onset. Our aim was to assess the association between exposure to air pollution and IVT-treated IS, allowing for high temporal precision in exposure assessment. METHODS: We conducted a retrospective population-based cohort study including 5.4 million inhabitants in Eastern Poland in the Years 2011-20. IVT-treated IS patients were enrolled into this study based on ICD-10 and ICD-9 code (I63 with 99.101/99.102/99.103). To ensure high spatial resolution, we used the GEM-AQ model for air quality modeling. Generalized linear mixed model with a Poisson distribution and random intercepts were used to examine municipality-specific associations between short-term exposure to air pollutants and IVT-treated IS. RESULTS: We recorded 96,189 IS cases with a dominance of females (52.5%) and patients 65 years old and over (78.8%). 10,486 (10.9%) patients received IVT treatment. In this group there was lower share of women (51.3% vs. 52.7%, p < 0.001), fewer elderly individuals (76% vs. 79.1%, p < 0.001), and lower in-hospital mortality (13.6% vs. 15.5%, p < 0.001). The rate of IVT use increased significantly from 3.2% in 2011 to 18.3% in 2020 (Kendall's τ = 0.956, p < 0.001). Exposure to benzo(a)pyrene was associated with the highest negative effects, causing 10.3% and 13.5% increase in risk of IVT-treated IS on LAG 0 and LAG 0-6 in the overall population, respectively. There was also an association between increased PM2.5 and IVT-treated incidence across all analyzed populations. Exposure to NO significantly increased the risk of IVT-treated IS only in females. Increases in SO and O levels did not influence IVT-treated incidence. There were no age or sex differences in the effects of air pollution exposure. CONCLUSIONS: Exposure to air pollution might serve as a trigger for IVT-treated IS, exerting a comparable effect across different sexes and age groups. The IVT-treated IS group was characterized by improved survival. Public health efforts should focus on reducing air pollution levels and ensuring rapid access to advanced IS treatment in high-risk, highly polluted areas. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05198492).
The sugar industry's efforts to manipulate research on fluoride effectiveness and toxicity: a ninety-year history.
Neurath C
Environ Health · 2025 Sep · PMID 41016930 · Full text
BACKGROUND: Extensive academic research has documented the tobacco industry's manipulation of science. Recently, scholars have begun examining the sugar industry's use of similar tactics to downplay sugar's role in obesi...
BACKGROUND: Extensive academic research has documented the tobacco industry's manipulation of science. Recently, scholars have begun examining the sugar industry's use of similar tactics to downplay sugar's role in obesity, diabetes, cardiovascular disease, and tooth decay. Archival records show sugar-industry-funded scientists criticized evidence linking sugar to these harms and deflected attention to other risk factors. Sugar's connection to tooth decay has been the most difficult harm for the industry to deny. Evidence is emerging that the industry turned to promoting fluoride as the solution to tooth decay thereby averting calls for reducing sugar consumption. Newly accessible sugar and dental industry documents enable investigation into whether fluoride research was manipulated to deflect from sugar's role in tooth decay, and later to defend fluoride when evidence of fluoride's own harmful effects arose. METHOD: Internal documents from sugar and dental organizations were examined and compared to the published scientific record. The Industries Documents collection at the University of California San Francisco was the main source of records. Analysis was in the context of the current understanding of how vested interests manipulate science to defend their products. RESULTS: Records dating back to the 1930s demonstrate the sugar industry, sometimes in cooperation with dental interests, exaggerated fluoride's effectiveness and downplayed safety concerns. The sugar industry's science manipulation campaign preceded the better-known tobacco industry campaign defending cigarettes. Key leaders of the sugar industry's campaign transferred to the tobacco industry, which then adopted many of the sugar industry's tactics and financed research from some of the same sugar-conflicted scientists. Currently, a prominent safety issue with fluoride is developmental neurotoxicity. Evidence indicates that researchers with undisclosed conflicts of interest with sugar and allied industries produced biased reviews downplaying this risk. CONCLUSION: Recently available records reveal a long history of the sugar industry distorting fluoride science. Many of the sugar industry's tactics were later adopted by the tobacco industry and mirrored by industries involved in asbestos, lead, pesticides, climate change denial, and others. Researchers and policymakers should be aware of the distorted scientific record regarding fluoride effectiveness and toxicity.
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