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BACKGROUND: Humans are exposed to complex mixtures of phthalate chemicals from a range of consumer products. Previous studies have reported significant associations between individual phthalate metabolites and pregnancy outcomes, but mixtures research is limited. OBJECTIVES: We used the Puerto Rico Testsite for Exploring Contamination Threats longitudinal pregnancy cohort to investigate associations between phthalate metabolite mixtures and pregnancy outcomes. METHODS: Women (n=462 carrying females, n=540 carrying males) provided up to three urine samples throughout gestation (median 18, 22, and 26 wk), which were analyzed for 13 phthalate metabolites. Pregnancy outcomes including preterm birth (PTB), spontaneous PTB, small and large for gestational age (SGA, LGA), birth weight z-score, and gestational age at delivery were abstracted from medical records. Environmental risk scores (ERS) were calculated as a weighted linear combination of the phthalates from ridge regression and adaptive elastic net, which are variable selection methods to handle correlated predictors. Birth outcomes were regressed on continuous ERS. We assessed gestational average and visit-specific ERS and stratified all analyses by fetal sex. Finally, we used Bayesian kernel machine regression (BKMR) to explore nonlinear associations and interactions between metabolites. RESULTS: Differences in metabolite weights from ridge and elastic net were apparent between birth outcomes and between fetal sexes. An interquartile range increase in gestational average phthalate ERS was associated with increased odds of PTB [male odds ratio (OR)=1.56; 95% confidence interval (CI): 1.08, 2.27; female OR=1.91; 95% CI: 1.23, 2.98], spontaneous PTB (male OR=2.32; 95% CI: 1.46, 3.68; female OR=2.00; 95% CI: 1.04, 3.82), and reduced gestational age at birth (male ß=-0.39 wk, 95% CI: -0.62, -0.15; female ß=-0.29 wk, 95% CI: -0.52, -0.05). Analyses by study visit suggested that exposure at â¼22 wk (range 20-24 wk) was driving those associations. Bivariate plots from BKMR analysis revealed some nonlinear associations and metabolite interactions that were different between fetal sexes. DISCUSSION: These results suggest that exposure to phthalate mixtures was associated with increased risk of early delivery and highlight the need to study mixtures by fetal sex. We also identified various metabolites displaying nonlinear relationships with measures of birth weight. https://doi.org/10.1289/EHP8990.
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Poluentes Ambientais , Ácidos Ftálicos , Nascimento Prematuro , Teorema de Bayes , Biomarcadores , Coorte de Nascimento , Peso ao Nascer , Poluentes Ambientais/urina , Feminino , Humanos , Recém-Nascido , Masculino , Ácidos Ftálicos/urina , Gravidez , Nascimento Prematuro/induzido quimicamente , Nascimento Prematuro/epidemiologia , Porto Rico/epidemiologiaRESUMO
CONTEXT: Phthalates are endocrine-disrupting chemicals that may be associated with adverse birth outcomes. Dysregulation of maternal endocrine homeostasis could be a possible biological pathway between phthalates and birth outcomes. OBJECTIVE: Examine associations between 19 maternal urinary phthalate or phthalate replacement metabolites and 9 serum hormones measured over two time points during pregnancy. DESIGN: Longitudinal study conducted in the PROTECT pregnancy cohort. SETTING: Puerto Rico. PATIENTS: Six hundred seventy-seven women in the first trimester of pregnancy. MAIN OUTCOME MEASURES SERUM: CRH, estriol, SHBG, progesterone, TSH, total T3, free T4, total T4, and testosterone. RESULTS: T3 was significantly associated with most metabolites. CRH was inversely associated with mono carboxyisononyl phthalate [MCNP; percent change (%Δ), -4.08; 95% CI, -7.24, -0.804], mono-3-carboxypropyl phthalate (MCPP; %Δ, -5.25; 95% CI, -8.26, -2.14), mono-2-ethyl-5-carboxypentyl phthalate (MECPP; %Δ, -18.4; 95% CI, -30.4, -4.37), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP; %Δ, -13.4; 95% CI, -22.7, -2.92), and mono-2-ethyl-5-oxohexyl phthalate (MEOHP; %Δ, -12.7; 95% CI, -22.2, -2.20). Positive associations were found between numerous phthalate metabolites and free T4, T4, and the T3/T4 ratio. Testosterone was positively associated with mono hydroxybutyl phthalate (MHBP; %Δ, 4.71; 95% CI, 0.27, 9.35) and inversely associated with monoethyl phthalate (MEP; %Δ, -14.5; 95% CI, -24.3, -3.42), and relationships with MCNP and mono carboxyisooctyl phthalate (MCOP) were significantly modified by study visit. Finally, an inverse association was found between mono-2-ethyl-5-hydrohexyl terephthalate (MEHHTP), a terephthalate metabolite, and progesterone at visit 3 only (%Δ, -13.1; 95% CI, -22.3, -2.75). CONCLUSIONS: These results indicate that exposure to phthalates may differentially impact the maternal endocrine system at different points during pregnancy, and that exposures to phthalate replacement chemicals may be particularly important to consider in future human health studies.
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INTRODUCTION: Effective communication skills that foster responsible sexual decisions are known to have the potential to reduce the risky adolescent sexual behavior. It is well understood that maternal communication is a key element in modifying the adolescent sexual behavior. The objective of this qualitative study was to explore if Puerto Rican mothers of adolescent girls have conversations about sexuality with their daughters and the content of such conversations. METHODS: A total of 22 HIV-seropositive mothers and 22 HIV-seronegative mothers were enrolled. Six focus groups were conducted, sessions were transcribed ad-verbum and coded for specific topics. All qualitative analysis was incorporated into Atlas.ti. RESULTS: Participants in both groups had a similar average age (mean=41 years old); but, the HIV-seropositive mothers were more likely single, less educated and unemployed. Regarding having engaged in conversations about sexuality and the topics covered, however, there were no differences revealed among HIV-seropositive mothers and seronegative mothers. In both groups, mothers understood the importance of these conversations, but most said they were difficult and uncomfortable. CONCLUSION: These findings reinforce the importance of communication between mothers and daughters for the prevention of STIs, HIV/AIDS, and teenage pregnancy in minority populations.Interventions are needed for mother and daughter to improve communication skills, communication about sexuality, and addressing prevention.
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OBJECTIVE: HIV felt stigma is a major problem needing to be addressed because of its association with poor treatment adherence, decreases in help-seeking behaviors, high-risk sexual conduct, emotional discomfort, and the reduction of well-being in people with HIV/AIDS (PWHA). The aim of this study was to identify the frequency of felt stigma among PWHA in Puerto Rico. METHODS: A cross-sectional study was conducted with 249 subjects (59% men, 41% women). Participants completed the Puerto Rico Comprehensive Center for HIV Disparities (PR-CCHD) Sociodemographic Questionnaire and the HIV Felt Sigma Scale. RESULTS: 80% of the subjects showed some level of felt stigma. Women showed significantly higher levels of HIV-related felt stigma than did men. Disclosure, negative self-image, and public attitude scores were also higher in women than in men. Sociodemographic variables such as age, marital status, employment status, income, and educational level showed significant associations with felt stigma and its dimensions. CONCLUSION: Results of this study evidence the need to develop culturally sensitive intervention models to reduce the felt-stigma burden in PWHA.
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Emoções , Infecções por HIV/psicologia , Estigma Social , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Porto Rico , Fatores SocioeconômicosRESUMO
OBJECTIVES: The purpose of this paper is to describe the prevalence of school and youth violence in Puerto Rico based on several representative samples surveyed in the Island during the 1990's. BACKGROUND: Reviewing the available data on youth violence is necessary in order to decide the best strategies to follow in developing new ways to prevent and monitor it. METHODS: Three surveys were reviewed in this paper: The Youth Risk Behavior Survey conducted by the Center for Disease Control (1991, 1995, 1997); The Methods for the Epidemiology of Child and Adolescent Mental Disorders Study (1991); and the Youth Survey (1997-98). RESULTS: It was found that the prevalence of reported school violence in Puerto Rico tends to be somewhat lower than the prevalence reported in other sites of the U.S.A. Age and gender has a dramatic influence in the reports of youth violence in Puerto Rico. Male students are three times as likely to carry weapons than females and almost twice as likely to report hurting someone than females. Less than 10% of the male students ages 12-13 report carrying a weapon while fully 30% of those 18 year olds reported carrying a weapon. Being arrested also increases from only 3% in the youngest students surveyed to 10% on the oldest group (18 or older). CONCLUSION: The CDC has recently reported that since the early 90's there has been a decrease in reported school violence in the U.S.A. This analysis of youth surveys replicated a similar tendency for Puerto Rican youngsters. Implications for prevention programs are discussed.
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Comportamento do Adolescente , Instituições Acadêmicas/estatística & dados numéricos , Violência/estatística & dados numéricos , Adolescente , Comportamento Agonístico , Alabama/epidemiologia , Connecticut/epidemiologia , Coleta de Dados , Feminino , Armas de Fogo/estatística & dados numéricos , Piromania , Humanos , Delinquência Juvenil/estatística & dados numéricos , Delinquência Juvenil/tendências , Masculino , New York/epidemiologia , Prevalência , Porto Rico , Assunção de Riscos , Problemas Sociais , Violência/legislação & jurisprudência , Violência/prevenção & controle , Violência/tendênciasRESUMO
OBJECTIVE: The objective of this study is to compare the prevalence of several types of sexual behaviors among Puerto Rican adolescents living in New York City and in the Greater San Juan Metropolitan Area of Puerto Rico. BACKGROUND: There is a scarcity of literature about sexual behaviors among Hispanic adolescents. The available literature has several limitations. METHODS: The data for the analysis was collected through personal interviews in two high schools, one in Puerto Rico and the other in New York City as part of multi-site Centers for Disease Control (CDC) study. RESULTS: To test whether the adolescent sexual behavior varied by site and more specifically to determine whether the Puerto Rican youngsters surveyed in New York are more sexually experienced, as measured by a sexual involvement scale, a set-wise hierarchical multiple regression/correlation (MRC) analysis was done. It showed that the sexual involvement behavior of Puerto Rican students in N.Y. was higher that the involvement of students surveyed in Puerto Rico even when controlling by gender, age, mother's education and household composition. CONCLUSION: Variations in the sexual behavior of Puerto Rican adolescents living in two socio-cultural environments (New York City and Greater San Juan in Puerto Rico) were documented. Differences were observed both in the patterns of sexual experiences reported in the two sites in the higher levels of sexual experience reported in the New York sample. The documented differences have important implications for the development of interventions for HIV/STD prevention strategies.
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Humanos , Masculino , Feminino , Adolescente , Comportamento do Adolescente , Comportamento Sexual , Análise de Variância , Centers for Disease Control and Prevention, U.S. , Preservativos , Anticoncepção , Infecções Sexualmente Transmissíveis/prevenção & controle , Educação , Hispânico ou Latino , Infecções por HIV/prevenção & controle , Mães , Cidade de Nova Iorque , Porto Rico , Estados UnidosRESUMO
The purpose of this analysis is to examine the factors associated with intentions to initiate sexual intercourse among a group of female high school students in Puerto Rico. A large metropolitan high school was purposively selected for the study. The mean age of the girls who participated in the study (N = 133) was 16. 13 percent f the surveyed girls reported having had intercourse at some point in their lives. 45 percent indicated when answered that they were sure they would not initiate sex during the next year; 18 percent answered that it probably would not happen; and the others (28 percent) responded with an even 50-50 chance or more that it will probably happen. A multiple regression/correlation analysis showed that the mother's traditional sexual values along with the teen's own conventional behavior, traditional sexual values as well as a perception of conventional behavior by their peers were related to a lower expectation of sex initiation
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Humanos , Feminino , Adolescente , Comportamento Sexual , Fatores Etários , Análise Multivariada , Porto Rico , Inquéritos e QuestionáriosRESUMO
A cross-section of 250 youngsters enrolled in drug treatment programs in Puerto Rico were surveyed in 1991. Even though the surveyed youngsters are not intravenous drug users it was found that they have a high prevalence of behaviors considered by the Centers for Diseases Control as increasing the risk of HIV infection in youth. These behaviors include frequent experimentation with non-IV drugs, early onset of sexual behaviors (mean = 13.5 years) and drug use (mean = 13.8 years), and a high number of sexual partners (mean = 3.13) reported for the year preceding the interview. Infrequent use of contraceptives and condoms and ineffective practices to prevent STD/HIV were also reported. This subgroup of youngsters in drug treatment centers can be defined as a high risk group in need of HIV infection prevention services