2007 Progress Report: Growing Up Healthy in East Harlem (Community-Based Participatory Research)

EPA Grant Number: R831711C001
Subproject: this is subproject number 001 , established and managed by the Center Director under grant R831711
(EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).

Center: Mount Sinai Center for Children’s Health and the Environment
Center Director: Wolff, Mary S.
Title: Growing Up Healthy in East Harlem (Community-Based Participatory Research)
Investigators: Brenner, Barbara
Current Investigators: Brenner, Barbara , Galvez, Maida , Teitelbaum, Susan , Wolff, Mary S.
Institution: Mount Sinai School of Medicine
EPA Project Officer: Callan, Richard
Project Period: November 1, 2003 through October 31, 2008 (Extended to October 31, 2010)
Project Period Covered by this Report: November 1, 2006 through October 31,2007
RFA: Centers for Children's Environmental Health and Disease Prevention Research (2003) RFA Text |  Recipients Lists
Research Category: Children's Health , Health Effects , Health

Objective:

We are concluding the final year of a three year longitudinal study to broadly examine environmental factors that influence children’s diets and physical activity levels and that impact childhoof growth and development including neighborhood factors in the urban built environment and gene environment interactions including exposure to chemicals found in every day products.

East Harlem children are at risk for a number of childhood conditions including obesity and asthma. In our study population obesity is epidemic; 40% of girls and 50% of boys ages 6-8 years old (n=323) all of whom live in East Harlem, New York City have a body mass index equal to or greater than the 85th percentile for age and gender as compared to national norms. Asthma prevalence/severity is being collected and as a result of funding through this project, additional data collection will include information on obesity related conditions including diabetes risk factors, coronary vascular disease risk factors and characteristics associated metabolic syndrome phenomenon.

Specific Aims 2003-2008:

  1. To characterize the urban built environment of East Harlem using geocoded information on locations of food stores, fast-food outlets, playgrounds and parks.
  2. To characterize diets in a population of East Harlem children, ages 6-8 years at the time of entry and follow them to specifically assess their consumption of fast foods, “junk” foods from vending machines, and phytoestrogens from fresh foods through standardized dietary recall instruments.
  3. To characterize these children’s levels of physical activity, their use of parks and playgrounds, and their participation in sports and other organized youth activities through a structured recall questionnaire.
  4. To characterize these children’s exposures to EDs using: 1) urinary biomarkers to assess exposures to phthalates and bisphenol A; (2) dietary recall to estimate phytoestrogen consumption; (3) recall history to identify use of personal care products; and (4) a household inventory to assess products in the home that may contain EDs. Through tasks 3 and 4 in this objective, a questionnaire will be created to assess children’s exposures to ED-containing products. The same data collection instrument will then be used in both this study and Project 2.
  5. To examine relationships between obesity in the children of East Harlem and (1) diet; (2) physical activity; (3) structural factors in the urban built environment; and (4) ED exposures.
  6. To use the data and insights gained in this Project, in the future, (not within the scope of this grant, to devise evidence based strategies for obesity prevention and health promotion in East Harlem children.

In addition, we plan to serve two methodological aims 2003-2008:

  1. To evaluate the intra-and inter-person variability of exposure to phthalates and bisphenol A through serial measurements of urinary biomarkers in children to determine the optimal urine sample collection protocol (i.e., # of samples, frequency of sample collection) for characterizing ED exposure in children.
  2. To evaluate relationships between children’s measured levels of bisphenol A and phthalates and: (1) diet; (2) reported use of personal care products that may contain EDs; and (3) exposures to products identified through household inventory.

Progress Summary:

Methods

This study has enrolled 323, boys and girls ages 6-8 year old residing in East Harlem who are being followed annually over three years. An annual in-person, interviewer administered visit includes collection of(1) anthropometry (measured height, weight and percent body fat via use of a Tanita bioimpedance scale and RJL device); (2) family demographics; (3) characteristics related to diet, physical activity and product use, (4) neighborhood information about resource utilization by children in East Harlem as well as concerns about existing resources which are potential environmental determinants of diet and physical activity and (5) biologic specimen collection (urine collected for environmental exposure analysis, specifically phenols and phthalates).

At baseline, to quantify diet, parent/legal guardians were asked to complete four 24-hour dietary recalls and one physical activity monitoring via pedometer. Children were given a pedometer that provides objective measurements of physical activity over one week’s duration during the study. At the two subsequent follow-up visits, anthropometry is re-assessed, pertinent information such as medical history is updated, dietary history, physical activity measurement, and a urine specimen is collected. Each participant’s address is geocoded for use with the East Harlem Geographic Information System (GIS).

Preliminary Data

We have characterized the prevalence of childhood obesity and asthma in an inner city, minority population, collected dietary recalls and pedometer data at baseline and mapped neighborhood resources including East Harlem food stores, restaurants, play spaces and community gardens. We also collected survey data on how frequently East Harlem families utilize resources in their community and concerns families have, such as safety concerns that keep children inside apartments rather than outdoors in active play time.

Urine specimens for biomarker data were collected for phthalates and phenols. We completed comparisons of the urine results from a temporality pilot study with product-use question responses Past week use of several personal care products (e.g., shampoo, hair gel, and body moisturizer) was significantly associated with higher concentrations of several metabolites of di-2-ethylhexyl phthalate (DEHP). Reported use of sunscreen was significantly associated with higher concentrations of benzophenone-3 (BP-3), an ultraviolet filter. Reported use of potential sources of bisphenol-A (BPA) exposure (e.g., hard plastics) did not predict BPA concentrations. From these data we compiled a preliminary list of products to test for phthalates from East Harlem stores. Products tested included those that were most frequently reported in the product use questionnaire. In this small, preliminary test of a sample of products, the levels of phthalates were negligible.

We have examined the relationships between asthma and measures of adiposity in a cross-sectional analysis of the children at baseline. These findings corroborate previous reports that BMI is associated with asthma, but provide new and unique information, that more precise measures of adiposity are also associated with asthma. However, these measures offer little additional information above that provided by BMI, in cross-sectional data; we will examine adiposity measures as prospective predictors of asthma during the next year as the followup data becomes available.

The pilot study that has been completed on intraindividual reproducibility of urinary biomarkers among 35 children over 6 months has provided critically important information on stability of child exposure to environmental endocrine disruptors. Most of the 19 biomarkers measured are fairly stable over a 6-12 month period. Children’s body burdens of new-age EDs are high, with maximum levels >3000 μg/L of at least one analyte and median levels >100 μg/L for most of the phthalate, phytoestrogen, and phenol families of EDs. Children’s usage patterns of EDs are being determined through a “product-use” questionnaire.

Data analysis of urinary phthalate metabolites in relation to body size characteristics is under way and an abstract is being submitted for ISEE 2008. In preliminary analysis, using baseline data, the age/race/ethnicity adjusted geometric mean concentration for metabolites of diethyl, dibutyl and dibutylbenzyl phthalates were greater among girls who were in the highest quartile of bmi, bmi percentile, weight, waist and hip circumference when compared to girls in the lower 3 quartiles of these body size characteristics. A similar finding using the NHANES 2001-2002 cross-sectional data was recently reported for men.

Cross-sectional investigation of baseline urinary phthalate biomarker concentrations revealed an increased age/race/ethnicity adjusted prevalence of asthma-related symptoms associated with higher levels of the dibutyl phthalate metabolites as well as higher levels of bisphenol A. These relationships remained after adjustment for BMI. Associations between DEHP exposure and respiratory problems have been reported in the literature; however, we find only a suggestion of an association in our study population. We expect that longitudinal analysis of the data, when it becomes available, will clarify these potential associations.

Key Study Findings on Role of the Neighborhood on Childhood Obesity in East Harlem, NY:

  • Inequities in food store availability exist by race/ethnicity in East Harlem.
    • 100% of African American Census blocks had neither supermarkets nor grocery stores.
    • AA Census blocks were less likely to have convenience stores as compared to Racially mixed Census blocks while Latino Census blocks were more likely to have convenience stores, specialty food stores, full service restaurants and fast food restaurants.
  • East Harlem children have easy access to unhealthy foods:
    • 45% live on a block with a bodega/convenience store
    • 60% live on a block with fast food stores
    • In contrast, more than 75% of the 323 children lived in Census blocks with no grocery stores, specialty stores, or restaurants.
  • The presence of bodegas on the same block as a child’s home was associated with a higher BMI-percentile.
    • children (n=176) living on a block with one or more bodegas (range 1-6) were more likely to have a BMI-percentile in the top tertile (prevalence ratio1.20, 95% CI 1.00-1.45), compared with children having no bodegas (n=147).
    • No associations were seen with BMI-percentile and number of grocery stores, specialty stores, restaurants or fast food restaurants on a child’s Census block.

Significance

The Mount Sinai Center for Children’s Environmental Health and Disease Prevention Research addresses health conditions of public health importance that are of the highest priority to the East Harlem community-- childhood obesity and asthma. Further exploration of toxic paradigms for health outcomes that too often afflict low income minority children is critical in addressing the health disparities that exist in East Harlem. Information gleaned from this project will provide the blueprint for evidence based prevention and promotion efforts targeting inner city children, their families and the community at large.

This research project addresses important gaps in our knowledge about the role of the environment (both macro-the “Built Environment” and micro- ED exposure) on children’s growth and development, specifically with respect to diet, physical activity and weight change. Baseline data demonstrate that disparities exist by race/ethnicity in the distribution of resources in the community that may influence children’s diet, physical activity and risk for overweight. We have also determined that ED metabolites are good measures of exposure over the 6-12 month time frame. Important sources of exposures to EDs specific to an inner city community will be identified and tested for ED levels. Future analyses will explore the relationship between neighborhood factors and ED exposure to children’s body size, both cross-sectionally and longitudinally. In this way, we will be able to ascertain how both the macro and micro environmental factors influences children’s body size specifically with respect to childhood obesity.

Community Advisory Board

The Growing Up Healthy in East Harlem Community Advisory Board met quarterly in 2007-2008 and addressed the following issues and topics with study investigators: Committee membership/participation throughout the course of the study has been consistent and includes representatives from community health centers, community based agencies serving children and families, community residents representing the local community planning board, the Board of Education,, and parents.

  • Analysis of the East Harlem food environment based on ethnic and racial origin.
  • Exposure Assessment –preliminary measurements of phthalates in commonly used personal care and household cleaning products
  • Correlations between urinary and product concentrations.
  • Preliminary findings on higher exposure levels of DCP2 in the study population in comparison to similar cohorts in California and Ohio. What are the public health implications?
  • Communication of both Group and Individual Study Results to Study Participants(Parents or Guardians), with recommendations to consider literacy levels and language.
  • Activities of the Community Outreach and Translation Core
  • Translation of study results to the broader community through education and media strategies


Journal Articles on this Report : 2 Displayed | Download in RIS Format

Other subproject views: All 91 publications 56 publications in selected types All 51 journal articles
Other center views: All 253 publications 140 publications in selected types All 118 journal articles
Type Citation Sub Project Document Sources
Journal Article Galvez MP, Morland K, Raines C, Kobil J, Siskind J, Godbold J, Brenner B. Race and food store availability in an inner-city neighborhood. Public Health Nutrition 2008;11(6):624-631. R831711 (2005)
R831711 (2007)
R831711 (Final)
R831711C001 (2007)
  • Abstract from PubMed
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  • Abstract: Cambridge Journals-Abstract
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  • Other: Cambridge Journals-Full Text PDF
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  • Journal Article Teitelbaum SL, Britton JA, Calafat AM, Ye X, Silva MJ, Reidy JA, Galvez MP, Brenner BL, Wolff MS. Temporal variability in urinary concentrations of phthalate metabolites, phytoestrogens and phenols among minority children in the United States. Environmental Research 2008;106(2):257-269. R831711 (2007)
    R831711 (Final)
    R831711C001 (2007)
  • Abstract from PubMed
  • Full-text: ScienceDirect-Full Text HTML
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  • Abstract: ScienceDirect-Abstract
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  • Other: ScienceDirect-Full Text PDF
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  • Supplemental Keywords:

    RFA, Health, Scientific Discipline, ENVIRONMENTAL MANAGEMENT, POLLUTANTS/TOXICS, Environmental Chemistry, Health Risk Assessment, Chemicals, Endocrine Disruptors - Environmental Exposure & Risk, endocrine disruptors, Biochemistry, Children's Health, Endocrine Disruptors - Human Health, Risk Assessment, environmental health, childhood development, community-based intervention, endocrine disrupting chemicals, exposure studies, phtalates, Human Health Risk Assessment, childhood obesity, children's vulnerablity, neurodevelopmental toxicity, exposure pathways, children's environmental health

    Progress and Final Reports:

    Original Abstract
  • 2004 Progress Report
  • 2005 Progress Report
  • 2006 Progress Report
  • 2008
  • 2009
  • Final Report

  • Main Center Abstract and Reports:

    R831711    Mount Sinai Center for Children’s Health and the Environment

    Subprojects under this Center: (EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
    R831711C001 Growing Up Healthy in East Harlem (Community-Based Participatory Research)
    R831711C002 Pesticides, Endocrine Disruptors, Childhood Growth and Development (Birth Cohort)
    R831711C003 Genetics of Phthalate and Bisphenol A Risk in Minority Populations (Individual Susceptibility)