1 00:00:06,795 --> 00:00:08,564 >> GOOD AFTERNOON, EVERYBODY. 2 00:00:08,564 --> 00:00:11,533 WELCOME TO THE NIH DIRECTOR'S 3 00:00:11,533 --> 00:00:12,201 LECTURE. 4 00:00:12,201 --> 00:00:13,602 IT'S MY PLEASURE TODAY -- MY 5 00:00:13,602 --> 00:00:15,771 NAME IS DARRELL, I'M THE 6 00:00:15,771 --> 00:00:17,739 SCIENTIFIC DIRECTOR AT NIEHS. 7 00:00:17,739 --> 00:00:19,475 IT'S MY PLEASURE TO INTRODUCE 8 00:00:19,475 --> 00:00:20,909 DR. KELLEY FERGUSON AS THE 9 00:00:20,909 --> 00:00:21,777 SPEAKER. 10 00:00:21,777 --> 00:00:23,979 DR. FERGUSON RECEIVED HER 11 00:00:23,979 --> 00:00:25,747 MPH DEGREE IN OCCUPATIONAL AND 12 00:00:25,747 --> 00:00:28,917 ENVIRONMENTAL EPIDEMIOLOGY IN 13 00:00:28,917 --> 00:00:29,351 2011. 14 00:00:29,351 --> 00:00:30,919 AND HER PH.D. IN ENVIRONMENTAL 15 00:00:30,919 --> 00:00:31,954 HEALTH SCIENCES FROM UNIVERSITY 16 00:00:31,954 --> 00:00:36,058 OF MICHIGAN PUBLIC HEALTH SCHOOL 17 00:00:36,058 --> 00:00:37,626 IN 2014. 18 00:00:37,626 --> 00:00:40,262 SHE JOINED OUR EPIDEMIOLOGY 19 00:00:40,262 --> 00:00:41,864 BRANCH AS A TENURE TRACK 20 00:00:41,864 --> 00:00:43,165 INVESTIGATOR IN 2016. 21 00:00:43,165 --> 00:00:44,833 SHE'S A LEADER IN HER FIELD. 22 00:00:44,833 --> 00:00:48,437 HER SCIENCE FOCUSES PRIMARILY ON 23 00:00:48,437 --> 00:00:49,972 ENVIRONMENTAL CHEMICAL EXPOSURES 24 00:00:49,972 --> 00:00:51,940 AND BOTH PERINATAL AND EARLY 25 00:00:51,940 --> 00:00:54,610 LIFE HEALTH OUTCOMES, AND SHE'S 26 00:00:54,610 --> 00:00:55,644 MADE MAJOR CONTRIBUTIONS TO THE 27 00:00:55,644 --> 00:00:58,180 UNDERSTANDING OF HOW EXPOSURES 28 00:00:58,180 --> 00:01:02,417 TO PHTHALATE PLASTICIZERS WHICH 29 00:01:02,417 --> 00:01:03,652 ARE UBIQUITOUS IN THE 30 00:01:03,652 --> 00:01:04,419 ENVIRONMENT IMPACT PREGNANCY AND 31 00:01:04,419 --> 00:01:05,921 THE DEVELOPMENT OF THE FETUS AND 32 00:01:05,921 --> 00:01:06,688 THE CHILD. 33 00:01:06,688 --> 00:01:08,056 TODAY SHE'LL TALK ABOUT SOME OF 34 00:01:08,056 --> 00:01:10,092 HER RECENT WORK IN THE 35 00:01:10,092 --> 00:01:11,960 RELATIONSHIP BETWEEN PHTHALATE 36 00:01:11,960 --> 00:01:14,496 EXPOSURE AND PRETERM BIRTH, WORK 37 00:01:14,496 --> 00:01:15,497 RECENTLY PUBLISHED IN 38 00:01:15,497 --> 00:01:17,733 > JAMA 39 00:01:17,733 --> 00:01:18,934 PEDIATRICS IN 2022. 40 00:01:18,934 --> 00:01:20,669 THIS WAS A CULMINATION OF HER 41 00:01:20,669 --> 00:01:22,271 EFFORTS TO ESTABLISH A LARGE 42 00:01:22,271 --> 00:01:23,005 CONSORTIUM OF ENVIRONMENTAL 43 00:01:23,005 --> 00:01:24,873 HEALTH COHORTS. 44 00:01:24,873 --> 00:01:27,142 DR. FERGUSON HAS PUBLISHED OVER 45 00:01:27,142 --> 00:01:28,477 140 PEER REVIEWED MANUSCRIPTS, 46 00:01:28,477 --> 00:01:29,778 MANY OF WHICH HAVE APPEARED IN 47 00:01:29,778 --> 00:01:31,747 THE TOP JOURNALS IN HER FIELD. 48 00:01:31,747 --> 00:01:33,482 SHE'S ALSO BEEN RECOGNIZED BY 49 00:01:33,482 --> 00:01:37,219 NUMEROUS AWARDS, INCLUDING THE 50 00:01:37,219 --> 00:01:38,120 GILLETTE OUTSTANDING YOUNG 51 00:01:38,120 --> 00:01:40,622 INVESTIGATOR AWARD IN 2020, AND 52 00:01:40,622 --> 00:01:43,258 ONE OF THE 20 PIONEERS UNDER 40 53 00:01:43,258 --> 00:01:45,627 IN ENVIRONMENTAL PUBLIC HEALTH 54 00:01:45,627 --> 00:01:46,862 IN 2017. 55 00:01:46,862 --> 00:01:49,164 AT NIEHS, SHE IS AN OUTSTANDING 56 00:01:49,164 --> 00:01:52,968 MENTOR WHO HAS SUCCESSFULLY LED 57 00:01:52,968 --> 00:01:54,069 NUMEROUS TRAINEES TO TENURE 58 00:01:54,069 --> 00:01:56,138 TRACK POSITIONS IN ACADEMIA AND 59 00:01:56,138 --> 00:02:04,680 ALSO THEIR RECEIPT OF K99/R OH 60 00:02:04,680 --> 00:02:05,414 K99/R00 AWARDS. 61 00:02:05,414 --> 00:02:08,150 SHE'S RECEIVED NIH TENURE ABOUT 62 00:02:08,150 --> 00:02:10,485 A YEAR AND A HALF AGO, IN 2022. 63 00:02:10,485 --> 00:02:12,254 SO THE TITLE OF HER TALK TODAY 64 00:02:12,254 --> 00:02:16,358 IS PHTHALATE EXPOSURE IN PRETERM 65 00:02:16,358 --> 00:02:17,793 BIRTH, FINDING FROM A POOLED 66 00:02:17,793 --> 00:02:19,695 STUDY OF 16 U.S. COHORTS. 67 00:02:19,695 --> 00:02:25,033 DR. FERGUSON. 68 00:02:25,033 --> 00:02:27,536 >> THANK YOU SO MUCH FOR THAT 69 00:02:27,536 --> 00:02:28,370 INTRODUCTION, DARRELL, AND THANK 70 00:02:28,370 --> 00:02:29,538 YOU SO MUCH FOR THE INVITATION 71 00:02:29,538 --> 00:02:30,505 TO BE HERE TODAY. 72 00:02:30,505 --> 00:02:32,975 IT'S REALLY AN HONOR TO BE HERE 73 00:02:32,975 --> 00:02:34,343 ON MAIN CAMPUS AND TO BE ABLE TO 74 00:02:34,343 --> 00:02:35,744 SHARE SOME OF THIS WORK WITH 75 00:02:35,744 --> 00:02:37,245 YOU. 76 00:02:37,245 --> 00:02:38,780 SO AS DARRELL SAID, THE TITLE OF 77 00:02:38,780 --> 00:02:40,816 MY TALK TODAY IS PHTHALATES IN 78 00:02:40,816 --> 00:02:42,517 PRETERM BIRTH, A POOLED ANALYSIS 79 00:02:42,517 --> 00:02:43,819 OF 16 U.S. COHORTS, AND I'M 80 00:02:43,819 --> 00:02:44,820 GOING TO TALK ABOUT THE EFFORTS 81 00:02:44,820 --> 00:02:49,524 THAT I LED TO CREATE A 82 00:02:49,524 --> 00:02:50,258 CONSORTIUM TO INVESTIGATE THIS 83 00:02:50,258 --> 00:02:51,727 IMPORTANT RESEARCH QUESTION. 84 00:02:51,727 --> 00:02:53,895 I WANTED TO START OFF WITH AN 85 00:02:53,895 --> 00:02:55,163 OVERVIEW OF MY RESEARCH GROUP 86 00:02:55,163 --> 00:02:57,165 AND WHAT WE DO AT NIEHS. 87 00:02:57,165 --> 00:02:59,601 MY OVERARCHING OBJECTIVE IS TO 88 00:02:59,601 --> 00:03:01,570 IMPROVE THE UNDERSTANDING OF HOW 89 00:03:01,570 --> 00:03:03,972 THE ENVIRONMENT IMPACTS 90 00:03:03,972 --> 00:03:06,141 PREGNANCY AND CHILDHOOD HEALTH. 91 00:03:06,141 --> 00:03:08,977 I STUDY ENVIRONMENTAL CHEMICAL 92 00:03:08,977 --> 00:03:10,612 EXPOSURES, PARTICULARLY 93 00:03:10,612 --> 00:03:13,015 NON-PERSISTENT CHEMICAL EXPOS 94 00:03:13,015 --> 00:03:14,082 EXPOSURES, HOW THEY INFLUENCE 95 00:03:14,082 --> 00:03:15,217 PREGNANCY AND CHILD HEALTH, AND 96 00:03:15,217 --> 00:03:18,620 THE ROLE OF OXIDATIVE STRESS AND 97 00:03:18,620 --> 00:03:20,022 INFLAMMATION AS POTENTIAL 98 00:03:20,022 --> 00:03:20,889 MECHANISMS MEDIATING THOSE 99 00:03:20,889 --> 00:03:21,790 RELATIONSHIPS. 100 00:03:21,790 --> 00:03:22,791 MY OVERARCHING HYPOTHESIS IS 101 00:03:22,791 --> 00:03:25,193 THAT THE ENVIRONMENTAL CHEMICAL 102 00:03:25,193 --> 00:03:27,129 EXPOSURES THAT WE EXPERIENCE 103 00:03:27,129 --> 00:03:28,897 DAILY ADVERSELY IMPACT PREGNANCY 104 00:03:28,897 --> 00:03:30,332 AND CHILD HEALTH OUTCOMES AND 105 00:03:30,332 --> 00:03:31,733 THAT OXIDATIVE STRESS AND 106 00:03:31,733 --> 00:03:33,268 INFLAMMATION PLAY A PIVOTAL ROLE 107 00:03:33,268 --> 00:03:35,671 IN THOSE RELATIONSHIPS. 108 00:03:35,671 --> 00:03:36,905 SO THE OUTLINE FOR MY TALK 109 00:03:36,905 --> 00:03:38,540 TODAY, I'M GOING TO START WITH 110 00:03:38,540 --> 00:03:39,841 PHTHALATE EXPOSURE, HOW DO I 111 00:03:39,841 --> 00:03:41,243 PRONOUNCE IT AND WHY SHOULD I 112 00:03:41,243 --> 00:03:42,678 CARE, THEN I'M GOING TO MOVE ON 113 00:03:42,678 --> 00:03:43,745 TO DESCRIBING THIS POOLED STUDY 114 00:03:43,745 --> 00:03:45,280 OF PHTHALATE EXPOSURE IN PRETERM 115 00:03:45,280 --> 00:03:47,516 BIRTH IN WHICH WE'VE ADDRESSED 116 00:03:47,516 --> 00:03:48,250 THREE PRIMARY RESEARCH 117 00:03:48,250 --> 00:03:48,884 QUESTIONS. 118 00:03:48,884 --> 00:03:50,419 FIRST, WHAT IS THE ASSOCIATION 119 00:03:50,419 --> 00:03:52,387 BETWEEN PHTHALATE EXPOSURE AND 120 00:03:52,387 --> 00:03:53,155 PRETERM BIRTH? 121 00:03:53,155 --> 00:03:55,457 SECOND, ARE THERE KEY PERIODS OF 122 00:03:55,457 --> 00:03:56,792 SUSCEPTIBILITY TO A PHTHALATE 123 00:03:56,792 --> 00:03:58,627 EXPOSURE FOR THIS RELATIONSHIP? 124 00:03:58,627 --> 00:04:00,629 AND THIRD, HOW DO EXPOSURES TO 125 00:04:00,629 --> 00:04:02,230 PHTHALATES DIFFER BY RACE AND 126 00:04:02,230 --> 00:04:03,498 ETHNICITY, AND COULD THESE 127 00:04:03,498 --> 00:04:04,633 DIFFERENCES CONTRIBUTE TO THE 128 00:04:04,633 --> 00:04:06,068 DISPARITIES THAT WE 129 00:04:06,068 --> 00:04:07,169 SIMULTANEOUSLY OBSERVE IN RATES 130 00:04:07,169 --> 00:04:09,137 OF PRETERM BIRTH. 131 00:04:09,137 --> 00:04:10,639 I'LL TIE UP WITH SOME MESSAGES 132 00:04:10,639 --> 00:04:11,540 ABOUT THE PUBLIC HEALTH IMPACT 133 00:04:11,540 --> 00:04:13,842 OF MY FINDINGS. 134 00:04:13,842 --> 00:04:15,177 SO PHTHALATE EXPOSURE. 135 00:04:15,177 --> 00:04:16,478 THESE ARE KNOWN AS THE 136 00:04:16,478 --> 00:04:17,813 EVERYWHERE CHEMICALS. 137 00:04:17,813 --> 00:04:20,615 THEY'RE FOUND IN OUR ENVIRONMENT 138 00:04:20,615 --> 00:04:20,949 UBIQUITOUSLY. 139 00:04:20,949 --> 00:04:23,151 THESE ARE SLIGHTLY DIFFERENT 140 00:04:23,151 --> 00:04:25,320 THAN THE FOREVER CHEMICALS, LIKE 141 00:04:25,320 --> 00:04:27,089 PFAS. 142 00:04:27,089 --> 00:04:28,256 THEY'RE METABOLIZED QUICKLY IN 143 00:04:28,256 --> 00:04:30,592 OUR BODIES, BUT NEVERTHELESS, 144 00:04:30,592 --> 00:04:31,893 WE'RE EXPOSED TO THEM CONSTANTLY 145 00:04:31,893 --> 00:04:32,761 ON A DAILY BASIS. 146 00:04:32,761 --> 00:04:33,962 THEY'RE USED IN PLASTICS BECAUSE 147 00:04:33,962 --> 00:04:36,064 THEY CAN INCREASE FLEXIBILITY 148 00:04:36,064 --> 00:04:37,699 AND DURABILITY OF THE PLASTICS 149 00:04:37,699 --> 00:04:39,101 THAT THEY'RE ADDED TO, AND 150 00:04:39,101 --> 00:04:40,001 THEY'RE CHEAP. 151 00:04:40,001 --> 00:04:41,536 SO WHEN YOU'RE LOOKING AT THE 152 00:04:41,536 --> 00:04:42,838 RECYCLING SYMBOLS ON YOUR 153 00:04:42,838 --> 00:04:43,605 PRODUCTS, PHTHALATES ARE 154 00:04:43,605 --> 00:04:44,473 CONTAINED IN THOSE THAT ARE 155 00:04:44,473 --> 00:04:46,775 LABELED WITH THE 3. 156 00:04:46,775 --> 00:04:48,076 IN PERSONAL CARE PRODUCTS, 157 00:04:48,076 --> 00:04:49,611 THEY'RE ALSO USED AS SOLVENTS 158 00:04:49,611 --> 00:04:51,780 FOR OTHER COMPOUNDS LIKE 159 00:04:51,780 --> 00:04:52,214 FRAGRANCES. 160 00:04:52,214 --> 00:04:53,882 SO THEY'RE FOUND UBIQUITOUSLY IN 161 00:04:53,882 --> 00:04:55,517 THE ENVIRONMENT IN FOOD AND 162 00:04:55,517 --> 00:04:56,485 BEVERAGES, PERSONAL CARE 163 00:04:56,485 --> 00:04:58,153 PRODUCTS AND MANY OTHER 164 00:04:58,153 --> 00:05:00,188 MATERIALS AND WE'RE CONSTANTLY 165 00:05:00,188 --> 00:05:00,989 EXPOSED TO THEM. 166 00:05:00,989 --> 00:05:02,190 I'M GOING TO TALK A LITTLE BIT 167 00:05:02,190 --> 00:05:03,759 MORE ABOUT SOME OF THE KEY 168 00:05:03,759 --> 00:05:05,127 EXPOSURE PATHWAYS FOR 169 00:05:05,127 --> 00:05:05,694 PHTHALATES. 170 00:05:05,694 --> 00:05:08,430 PROBABLY THE MOST IMPORTANT IS 171 00:05:08,430 --> 00:05:09,064 INGESTION. 172 00:05:09,064 --> 00:05:10,298 PHTHALATES MAKE THEIR WAY INTO 173 00:05:10,298 --> 00:05:12,167 FOOD THROUGH THE ENVIRONMENT, SO 174 00:05:12,167 --> 00:05:14,236 PHTHALATES CAN BE FOUND IN SOIL, 175 00:05:14,236 --> 00:05:14,770 WATER AND AIR. 176 00:05:14,770 --> 00:05:16,104 THEY CAN MAKE THEIR WAY DIRECTLY 177 00:05:16,104 --> 00:05:18,607 INTO THE FOOD A THAT WAY. 178 00:05:18,607 --> 00:05:20,675 THEY'RE INVOLVED IN PROCESSING 179 00:05:20,675 --> 00:05:23,745 MATERIALS, SO THEY CAN INTERACT 180 00:05:23,745 --> 00:05:24,813 WITH FOOD THROUGH THAT AND 181 00:05:24,813 --> 00:05:26,047 THEY'RE ALSO IN PLASTIC 182 00:05:26,047 --> 00:05:26,782 PACKAGING OF FOODS. 183 00:05:26,782 --> 00:05:27,783 ONCE THEY MAKE THEIR WAY INTO 184 00:05:27,783 --> 00:05:29,217 THE BODY, THEY ARE READILY 185 00:05:29,217 --> 00:05:30,552 ABSORBED THROUGH THE DIGESTIVE 186 00:05:30,552 --> 00:05:33,822 TRACT INTO THE BLOODSTREAM. 187 00:05:33,822 --> 00:05:34,923 "CONSUMER REPORTS" RECENTLY DID 188 00:05:34,923 --> 00:05:37,325 A KIND OF MARKET BASKET SURVEY 189 00:05:37,325 --> 00:05:39,728 EXAMINING LEVELS OF PHTHALATES 190 00:05:39,728 --> 00:05:44,966 AS WELL AS BUSINESS PH BISPHENOD 191 00:05:44,966 --> 00:05:46,368 DETECTION OF PHTHALATES IN 192 00:05:46,368 --> 00:05:48,136 ALMOST ALL OF THE FOODS THAT 193 00:05:48,136 --> 00:05:49,871 THEY ANALYZED. 194 00:05:49,871 --> 00:05:53,275 THE ONE EXCEPTION WAS I THINK 195 00:05:53,275 --> 00:06:01,016 POLAR SPRING SELL THE SELTZER W. 196 00:06:01,016 --> 00:06:02,918 I WANTED TO HIGHLIGHT THIS 197 00:06:02,918 --> 00:06:03,885 PARTICULAR EXPOSURE SOURCE. 198 00:06:03,885 --> 00:06:05,520 ONE OF THE HIGHEST LEVELS OF 199 00:06:05,520 --> 00:06:06,822 EXPOSURE THAT THEY OBSERVED IN 200 00:06:06,822 --> 00:06:07,923 THEIR SURVEY WAS IN PREPARED 201 00:06:07,923 --> 00:06:08,890 MEALS. 202 00:06:08,890 --> 00:06:13,395 SO THESE ARE THINGS LIKE FREEZER 203 00:06:13,395 --> 00:06:15,130 PIZZAS, PREPARED SOUP AND PASTAS 204 00:06:15,130 --> 00:06:16,998 THAT ARE IN CANS AND OTHER 205 00:06:16,998 --> 00:06:17,299 CONTAINERS. 206 00:06:17,299 --> 00:06:18,667 AND THE HIGHEST CONCENTRATION 207 00:06:18,667 --> 00:06:22,170 THAT THEY OBSERVED WAS IN 208 00:06:22,170 --> 00:06:23,572 ANNIE'S ORGANIC CHEESY RAVIOLI 209 00:06:23,572 --> 00:06:24,206 IN A CAN. 210 00:06:24,206 --> 00:06:26,308 I THOUGHT THIS WAS A LITTLE 211 00:06:26,308 --> 00:06:28,310 IRONIC SINCE A COUPLE YEARS AGO 212 00:06:28,310 --> 00:06:29,678 ANNIE'S PLEDGED TO PURGE THIS 213 00:06:29,678 --> 00:06:31,112 CLASS OF CHEMICALS FROM THEIR 214 00:06:31,112 --> 00:06:32,447 FOODS BUT IT KIND OF SHOWS YOU 215 00:06:32,447 --> 00:06:34,049 THE DIFFICULTY IN ADDRESSING 216 00:06:34,049 --> 00:06:35,150 THIS EXPOSURE WHEN IT COMES TO 217 00:06:35,150 --> 00:06:37,118 OUR FOOD SUPPLY. 218 00:06:37,118 --> 00:06:38,486 ANOTHER PRIMARY ROUTE OF 219 00:06:38,486 --> 00:06:39,754 PHTHALATE EXPOSURE IS THROUGH 220 00:06:39,754 --> 00:06:41,056 DERMAL ABSORPTION. 221 00:06:41,056 --> 00:06:42,691 PHTHALATES ARE USED AS ADDITIVES 222 00:06:42,691 --> 00:06:45,393 IN MANY PERSONAL CARE PRODUCTS. 223 00:06:45,393 --> 00:06:46,995 THINGS LIKE PERFUMES, SKIN 224 00:06:46,995 --> 00:06:48,496 TONERS, LOTIONS AND CREAMS, 225 00:06:48,496 --> 00:06:50,465 LIPSTICK, HAIR PRODUCTS, NAIL 226 00:06:50,465 --> 00:06:51,466 POLISH, THEY'RE ALSO FOUND IN A 227 00:06:51,466 --> 00:06:53,101 LOT OF FEMININE CARE PRODUCTS. 228 00:06:53,101 --> 00:06:54,302 SO THIS PLOT ON THE RIGHT IS 229 00:06:54,302 --> 00:06:56,571 FROM A RECENT PAPER WHERE THEY 230 00:06:56,571 --> 00:06:58,039 ANALYZED PHTHALATES IN DIFFERENT 231 00:06:58,039 --> 00:06:59,241 FEMININE CARE PRODUCTS, 232 00:06:59,241 --> 00:07:01,076 INCLUDING PADS, PANTY LINERS, 233 00:07:01,076 --> 00:07:03,845 TAMPONS AND WIPES AND FOUND 234 00:07:03,845 --> 00:07:05,113 DETECTABLE LEVELS IN MANY OF THE 235 00:07:05,113 --> 00:07:06,915 PRODUCTS THAT THEY ANALYZED. 236 00:07:06,915 --> 00:07:08,216 PHTHALATES ARE READILY ABSORBED 237 00:07:08,216 --> 00:07:10,051 THROUGH THE SKIN THROUGH CONTACT 238 00:07:10,051 --> 00:07:14,322 WITH THESE MATERIALS. 239 00:07:14,322 --> 00:07:16,391 IN ADDITION, INHALATION IS AN 240 00:07:16,391 --> 00:07:17,926 IMPORTANT EXPOSURE PATHWAY. 241 00:07:17,926 --> 00:07:20,762 SO PHTHALATES ARE USED AS 242 00:07:20,762 --> 00:07:22,063 PLASTICIZERS IN POLLLY VINYL 243 00:07:22,063 --> 00:07:23,265 CHLORIDE PLASTIC WHICH ARE 244 00:07:23,265 --> 00:07:24,799 INCLUDED IN A LOT OF HOUSEHOLD 245 00:07:24,799 --> 00:07:26,368 MATERIALS SUCH AT VINYL FLOORS 246 00:07:26,368 --> 00:07:27,102 AND SHOWER CURTAINS. 247 00:07:27,102 --> 00:07:29,304 THEY'RE NOT COVALENTLY BOUND TO 248 00:07:29,304 --> 00:07:30,305 THESE MATERIALS SO THEY'RE 249 00:07:30,305 --> 00:07:31,606 EASILY RELEASED INTO THE AIR AND 250 00:07:31,606 --> 00:07:33,475 THEY CAN BE COMMONLY DETECTED IN 251 00:07:33,475 --> 00:07:36,077 HOUSE DUST. 252 00:07:36,077 --> 00:07:37,646 ONCE PHTHALATES MAKE THEIR WAY 253 00:07:37,646 --> 00:07:39,481 INTO THE HUMAN BODY, THEY HAVE 254 00:07:39,481 --> 00:07:41,549 SHORT HALF LIVES, ON THE COURSE 255 00:07:41,549 --> 00:07:42,984 OF 12 TO 48 HOURS. 256 00:07:42,984 --> 00:07:44,619 AFTER WHICH THEY'RE EXCRETED 257 00:07:44,619 --> 00:07:46,821 PRIMARILY IN THE URINE. 258 00:07:46,821 --> 00:07:49,190 BECAUSE OF THIS SHORT HALF-LIFE, 259 00:07:49,190 --> 00:07:50,392 MEASURING CONCENTRATIONS OF 260 00:07:50,392 --> 00:07:52,694 PHTHALATE METABOLITES IN A 261 00:07:52,694 --> 00:07:53,895 SINGLE SAMPLE IS NOT A GREAT 262 00:07:53,895 --> 00:07:55,030 ESTIMATE OF EXPOSURE. 263 00:07:55,030 --> 00:07:57,866 THE GOLD STANDARD IS TO MEASURE 264 00:07:57,866 --> 00:08:01,770 CONCENTRATIONS IN REPEATEDLY 265 00:08:01,770 --> 00:08:02,771 COLLECTED URINE SAMPLES. 266 00:08:02,771 --> 00:08:05,507 DESPITE THE RAPID ELIMINATION OF 267 00:08:05,507 --> 00:08:06,942 PHTHALATES FROM THE BODY, WE 268 00:08:06,942 --> 00:08:08,343 HAVE UNIVERSAL DETECTION IN 269 00:08:08,343 --> 00:08:09,878 URINE SAMPLES FROM HUMAN 270 00:08:09,878 --> 00:08:11,012 POPULATIONS WORLDWIDE, INCLUDING 271 00:08:11,012 --> 00:08:11,713 PREGNANT PEOPLE. 272 00:08:11,713 --> 00:08:13,815 I WANTED TO GIVE YOU A COUPLE OF 273 00:08:13,815 --> 00:08:15,550 EXAMPLES OF THE PHTHALATES THAT 274 00:08:15,550 --> 00:08:16,117 WE ANALYZE. 275 00:08:16,117 --> 00:08:17,319 SO TRADITIONALLY WHEN WE'RE 276 00:08:17,319 --> 00:08:19,187 DOING A STUDY ON PHTHALATES, 277 00:08:19,187 --> 00:08:21,256 WE'LL MEASURE METABOLITES, 278 00:08:21,256 --> 00:08:24,759 MEASURE MAYBE 10 OR 20 PHTHALATE 279 00:08:24,759 --> 00:08:25,427 METABOLITES IN THE SAMPLE. 280 00:08:25,427 --> 00:08:26,594 THERE'S A COUPLE I'M GOING TO 281 00:08:26,594 --> 00:08:27,829 EMPHASIZE TODAY SO I WANTED TO 282 00:08:27,829 --> 00:08:30,098 INTRODUCE YOU TO THEM BRIEFLY. 283 00:08:30,098 --> 00:08:33,301 ONE IS DI-2ETH ILL HEX ILL 284 00:08:33,301 --> 00:08:34,602 PHTHALATE, OR DEHP. 285 00:08:34,602 --> 00:08:36,671 THIS IS A PHTHALATE THAT HAS 286 00:08:36,671 --> 00:08:38,206 BEEN STUDIED PROBABLY THE 287 00:08:38,206 --> 00:08:39,574 LONGEST AND IS THOUGHT TO BE ONE 288 00:08:39,574 --> 00:08:40,942 OF THE MORE TOXIC PHTHALATES. 289 00:08:40,942 --> 00:08:45,747 IT'S USED PRIMARILY TO SOFTEN 290 00:08:45,747 --> 00:08:47,615 PLASTICS AND IN THE BODY IT'S 291 00:08:47,615 --> 00:08:48,583 METABOLIZED INTO THESE FOUR 292 00:08:48,583 --> 00:08:49,150 COMPOUNDS. 293 00:08:49,150 --> 00:08:51,319 WE ANALYZE CONCENTRATIONS OF 294 00:08:51,319 --> 00:08:52,754 THOSE METABOLITES IN URINE AND 295 00:08:52,754 --> 00:08:55,690 I'M GOING TO PRESENT THEM AS A 296 00:08:55,690 --> 00:08:57,092 SUMMED MEASURE BECAUSE THEY ALL 297 00:08:57,092 --> 00:08:58,560 REPRESENT EXPO TOUR TO THE 298 00:08:58,560 --> 00:08:59,861 PARENT COMPOUND DEHP. 299 00:08:59,861 --> 00:09:01,696 ON THIS PLOT, I'M SHOWING 300 00:09:01,696 --> 00:09:02,998 URINARY CONCENTRATIONS OF THE 301 00:09:02,998 --> 00:09:06,634 SUMMED DEHP METABOLITES IN THE 302 00:09:06,634 --> 00:09:08,036 NATIONAL HEALTH AND NUTRITION 303 00:09:08,036 --> 00:09:09,070 EXAMINATION SURVEY IN THE GREY 304 00:09:09,070 --> 00:09:10,372 BARS, AND IN A PREGNANT 305 00:09:10,372 --> 00:09:12,674 POPULATION THAT I STUDY IN THE 306 00:09:12,674 --> 00:09:15,944 YELLOW DOTS. 307 00:09:15,944 --> 00:09:17,445 YOU CAN SEE EXPOSURE TO THESE 308 00:09:17,445 --> 00:09:18,947 COMPOUNDS HAS BEEN DECREASING 309 00:09:18,947 --> 00:09:21,549 OVER TIME, STARTING FROM 2007 TO 310 00:09:21,549 --> 00:09:23,918 2008 TO 2017 TO 2018. 311 00:09:23,918 --> 00:09:25,787 BUT DESPITE THIS DECREASE IN 312 00:09:25,787 --> 00:09:27,088 EXPOSURE, WE'RE STILL ABLE TO 313 00:09:27,088 --> 00:09:29,290 DETECT THESE METABOLITES IN 314 00:09:29,290 --> 00:09:32,227 PREGNANT POPULATIONS. 315 00:09:32,227 --> 00:09:33,261 ANOTHER COUPLE OF COMPOUNDS THAT 316 00:09:33,261 --> 00:09:35,063 I'M GOING TO TALK ABOUT A LOT 317 00:09:35,063 --> 00:09:38,700 ARE DI-N AND DI-ISOBUTYL 318 00:09:38,700 --> 00:09:39,467 PHTHALATE. 319 00:09:39,467 --> 00:09:40,435 THESE ARE USED IN BOTH PERSONAL 320 00:09:40,435 --> 00:09:42,737 CARE PRODUCTS AND PLASTICS SO 321 00:09:42,737 --> 00:09:46,341 THEY HAVE A MORE WIDE VARIETY OF 322 00:09:46,341 --> 00:09:47,909 APPLICATIONS AND THEY'RE 323 00:09:47,909 --> 00:09:50,311 METABOLIZED INTO MBP AND MIBP 324 00:09:50,311 --> 00:09:51,146 RESPECTIVELY. 325 00:09:51,146 --> 00:09:52,680 EXPOSURE HAS BEEN DECREASING AS 326 00:09:52,680 --> 00:09:54,082 WELL BUT IT'S A LITTLE BIT MORE 327 00:09:54,082 --> 00:09:54,983 CONSTANT OVER TIME COMPARED TO 328 00:09:54,983 --> 00:09:59,788 WHAT WE SEE FOR DEHP. 329 00:09:59,788 --> 00:10:01,089 PHTHALATES HAVE KNOWN TOXICITY. 330 00:10:01,089 --> 00:10:04,492 SO THE PRIMARY TOXICITY THAT HAS 331 00:10:04,492 --> 00:10:07,429 BEEN EVALUATED IN ANIMAL AS WELL 332 00:10:07,429 --> 00:10:09,898 AS IN VITRO STUDIES IS THEIR 333 00:10:09,898 --> 00:10:11,166 ENDOCRINE DISRUPTING ACTIVITY 334 00:10:11,166 --> 00:10:14,235 AND THEY'RE KNOWN TO BE 335 00:10:14,235 --> 00:10:15,303 ANTIANDROGENIC. 336 00:10:15,303 --> 00:10:16,204 ADDITIONALLY THEY HAVE BEEN 337 00:10:16,204 --> 00:10:23,645 SHOWN TO ACTIVATE -- ESSENTIALLY 338 00:10:23,645 --> 00:10:24,946 INVOLVED IN THE EARLY INITIATION 339 00:10:24,946 --> 00:10:27,549 OF LABOR. 340 00:10:27,549 --> 00:10:28,783 IN EARLY CASE CONTROLLED STUDIES 341 00:10:28,783 --> 00:10:30,618 OF PHTHALATE EXPOSURE AND 342 00:10:30,618 --> 00:10:31,486 PRETERM BIRTH SHOW THAT 343 00:10:31,486 --> 00:10:32,487 INDIVIDUALS WITH HIGHER 344 00:10:32,487 --> 00:10:33,888 EXPOSURES WERE MORE LIKELY TO 345 00:10:33,888 --> 00:10:36,758 DELIVER PRETERM. 346 00:10:36,758 --> 00:10:40,261 THIS WORK IN THE EARLY 2000s 347 00:10:40,261 --> 00:10:41,563 LED THE ESTABLISHMENT OF THIS 348 00:10:41,563 --> 00:10:42,764 HYPOTHESIS THAT PRENATAL 349 00:10:42,764 --> 00:10:44,966 EXPOSURE TO PHTHALATES CREATES 350 00:10:44,966 --> 00:10:49,003 AN ENVIRONMENT OF INTRAUTERINE 351 00:10:49,003 --> 00:10:50,972 INFLAMMATION WHICH CAN 352 00:10:50,972 --> 00:10:51,606 PRECIPITATE PRETERM BIRTH. 353 00:10:51,606 --> 00:10:52,841 BECAUSE OF THIS HYPOTHESIS, I 354 00:10:52,841 --> 00:10:54,275 STARTED MY DISSERTATION WORK AT 355 00:10:54,275 --> 00:10:55,043 THE UNIVERSITY OF MICHIGAN. 356 00:10:55,043 --> 00:10:57,879 IN THAT WORK, I WORKED WITH THE 357 00:10:57,879 --> 00:10:58,947 LIFECODES PREGNANCY COHORT BASED 358 00:10:58,947 --> 00:11:01,683 OUT OF THE BOSTON AREA AND 359 00:11:01,683 --> 00:11:04,752 INCLUDES PREGNANT WOMEN 360 00:11:04,752 --> 00:11:06,054 RECRUITED FROM 2006 TO 2008. 361 00:11:06,054 --> 00:11:08,690 IN THIS PROSPECTIVE COHORT, WE 362 00:11:08,690 --> 00:11:11,326 SELECTED 130 CASES OF PRETERM 363 00:11:11,326 --> 00:11:14,162 BIRTH AS WELL AS 350 CONTROLS 364 00:11:14,162 --> 00:11:16,698 AND ANALYZED THE URINE SAMPLES 365 00:11:16,698 --> 00:11:18,099 COLLECTED DURING PREGNANCY FOR 366 00:11:18,099 --> 00:11:19,100 PHTHALATE METABOLITE 367 00:11:19,100 --> 00:11:20,368 CONCENTRATIONS IN SAMPLES FROM 368 00:11:20,368 --> 00:11:21,369 THREE DIFFERENT STUDY VISITS. 369 00:11:21,369 --> 00:11:23,138 AS I SAID EARLIER, ANALYZING 370 00:11:23,138 --> 00:11:24,472 CONCENTRATIONS IN A SICKLE 371 00:11:24,472 --> 00:11:26,074 SAMPLE IS LIMITED, SO THIS STUDY 372 00:11:26,074 --> 00:11:27,842 REALLY IMPROVED ON EXPOSURE 373 00:11:27,842 --> 00:11:30,044 ASSESSMENT IN THE FIELD BY 374 00:11:30,044 --> 00:11:31,112 ANALYZING CONCENTRATIONS AT 375 00:11:31,112 --> 00:11:33,548 MULTIPLE TIME POINTS. 376 00:11:33,548 --> 00:11:34,782 WE EXAMINED ASSOCIATIONS WITH 377 00:11:34,782 --> 00:11:36,951 ODDS RATIOS OF PRETERM BIRTH AND 378 00:11:36,951 --> 00:11:38,887 OBSERVED THAT MBP AS WELL AS THE 379 00:11:38,887 --> 00:11:41,389 SUMMED DEHP METABOLITES WERE 380 00:11:41,389 --> 00:11:42,390 ASSOCIATED WITH AN INCREASED 381 00:11:42,390 --> 00:11:46,427 ODDS OF PREMATURITY. 382 00:11:46,427 --> 00:11:48,596 SINCE COMING TO NIEHS, I'VE 383 00:11:48,596 --> 00:11:50,265 REPLICATED THIS FINDING IN OTHER 384 00:11:50,265 --> 00:11:51,566 COHORTS AS WELL. 385 00:11:51,566 --> 00:11:54,869 WITHIN THE TIDE STUDY FROM 2010 386 00:11:54,869 --> 00:11:56,938 TO 2012, EXAMINED ASSOCIATIONS 387 00:11:56,938 --> 00:11:59,340 IN A POPULATION OF ABOUT 630 388 00:11:59,340 --> 00:12:01,476 CONTROLS AND 60 PRETERM BIRTHS, 389 00:12:01,476 --> 00:12:04,145 AND AGAIN, WE ANALYZED 390 00:12:04,145 --> 00:12:05,813 PHTHALATES AND METABOLITE 391 00:12:05,813 --> 00:12:06,781 PLEASURES FROM THREE STUDY 392 00:12:06,781 --> 00:12:07,115 VISITS. 393 00:12:07,115 --> 00:12:09,317 IN THIS STUDY WE ALSO OBSERVED 394 00:12:09,317 --> 00:12:13,221 ASSOCIATIONS BETWEEN MBP AND DHP 395 00:12:13,221 --> 00:12:14,722 METABOLITES IN PRETERM BIRTH AS 396 00:12:14,722 --> 00:12:16,057 WELL AS MIBP ALTHOUGH THE 397 00:12:16,057 --> 00:12:17,492 ASSOCIATIONS WERE A LITTLE BIT 398 00:12:17,492 --> 00:12:18,793 LESS PRECISE BECAUSE WE HAD A 399 00:12:18,793 --> 00:12:20,161 SMALLER NUMBER OF CASES COMPARED 400 00:12:20,161 --> 00:12:21,329 TO THE LIFECODES STUDY. 401 00:12:21,329 --> 00:12:22,197 BUT IT WAS INTERESTING TO US 402 00:12:22,197 --> 00:12:23,731 THAT THE EFFECT SIZES WERE VERY 403 00:12:23,731 --> 00:12:26,034 SIMILAR TO WHAT WE OBSERVED IN 404 00:12:26,034 --> 00:12:28,870 LIFECODES. 405 00:12:28,870 --> 00:12:30,605 ADDITIONALLY, I EXAMINED THIS 406 00:12:30,605 --> 00:12:31,639 ASSOCIATION IN THE PROTECT 407 00:12:31,639 --> 00:12:32,874 COHORT, WHICH IS THE PUERTO RICO 408 00:12:32,874 --> 00:12:34,342 TEST SITE FOR EXPLORING 409 00:12:34,342 --> 00:12:35,410 CONTAMINATION THREATS, AND THIS 410 00:12:35,410 --> 00:12:38,513 IS A SUPERFUND RESEARCH PROGRAM 411 00:12:38,513 --> 00:12:40,014 STUDY BASED IN PUERTO RICO. 412 00:12:40,014 --> 00:12:41,916 THIS STUDY INCLUDED PARTICIPANTS 413 00:12:41,916 --> 00:12:45,153 FROM 2011 TO 2017, AND HAD A 414 00:12:45,153 --> 00:12:47,021 SAMPLE SIZE OF ABOUT A THOUSAND. 415 00:12:47,021 --> 00:12:50,325 AND THIS STUDY, WE ALSO OBSERVED 416 00:12:50,325 --> 00:12:52,293 ASSOCIATIONS BETWEEN MBP AND 417 00:12:52,293 --> 00:12:53,027 MIBP IN PRETERM BIRTH. 418 00:12:53,027 --> 00:12:54,662 WE DID NOT OBSERVE ASSOCIATIONS 419 00:12:54,662 --> 00:12:56,397 WITH DEHP METABOLITES IN THE 420 00:12:56,397 --> 00:12:59,500 STUDY POPULATION, BUT NOTABLY, 421 00:12:59,500 --> 00:13:00,568 EXPOSURE LEVELS WERE 422 00:13:00,568 --> 00:13:01,936 SIGNIFICANTLY LOWER THAN WHAT WE 423 00:13:01,936 --> 00:13:03,004 OBSERVED IN THE OTHER STUDIES 424 00:13:03,004 --> 00:13:06,374 THAT I PRESENTED ON. 425 00:13:06,374 --> 00:13:07,709 SO THOSE ARE THE STUDIES THAT I 426 00:13:07,709 --> 00:13:08,243 WORKED IN. 427 00:13:08,243 --> 00:13:09,611 THESE ARE SOME OF THE OTHER 428 00:13:09,611 --> 00:13:12,080 STUDIES UP UNTIL 2021 THAT ALSO 429 00:13:12,080 --> 00:13:13,481 EXAMINED ASSOCIATIONS BETWEEN 430 00:13:13,481 --> 00:13:15,450 PHTHALATE EXPOSURE IN PREGNANCY 431 00:13:15,450 --> 00:13:16,784 AND GESTATIONAL AGE AT DELIVERY. 432 00:13:16,784 --> 00:13:18,620 AND I WANT TO POINT OUT A COUPLE 433 00:13:18,620 --> 00:13:19,520 OF CHARACTERISTICS OF THESE 434 00:13:19,520 --> 00:13:21,623 STUDIES. 435 00:13:21,623 --> 00:13:22,924 FIRST, MOST OF THEM HAD A VERY 436 00:13:22,924 --> 00:13:24,792 SMALL NUMBER OF PRETERM BIRTHS. 437 00:13:24,792 --> 00:13:26,327 THE LARGEST THAT WAS INCLUDED 438 00:13:26,327 --> 00:13:29,097 WAS A STUDY WITH 134 PRETERM 439 00:13:29,097 --> 00:13:29,797 BIRTHS. 440 00:13:29,797 --> 00:13:32,867 SOME OF THEM DIDN'T REPORT ON 441 00:13:32,867 --> 00:13:34,602 NUMBER OF PRETERM BIRTHS AT ALL. 442 00:13:34,602 --> 00:13:35,937 SECOND, MOST OF THESE STUDIES 443 00:13:35,937 --> 00:13:37,972 RELY ON EXPOSURE ASSESSMENT IN A 444 00:13:37,972 --> 00:13:39,407 SINGLE SPOT URINE SAMPLE, WHICH 445 00:13:39,407 --> 00:13:42,243 AS I SAID HAS ITS LIMITATIONS. 446 00:13:42,243 --> 00:13:43,778 AND FINALLY, THE RESULTS FROM 447 00:13:43,778 --> 00:13:45,913 THESE STUDIES ARE FAR FROM 448 00:13:45,913 --> 00:13:46,414 CONCLUSIVE. 449 00:13:46,414 --> 00:13:48,016 IN THIS TABLE, I'M SHOWING YOU 450 00:13:48,016 --> 00:13:49,584 THE PHTHALATE METABOLITES THAT 451 00:13:49,584 --> 00:13:50,918 WERE ASSOCIATED WITH EITHER 452 00:13:50,918 --> 00:13:53,421 LONGER GESTATIONAL DURATION OR 453 00:13:53,421 --> 00:13:54,455 SHORTER GESTATIONAL DURATION, 454 00:13:54,455 --> 00:13:55,723 AND YOU CAN SEE IT'S KIND OF 455 00:13:55,723 --> 00:13:58,426 MIXED IN BOTH DIRECTIONS, AND AN 456 00:13:58,426 --> 00:13:59,861 EMPTY CELL INDICATES NULL 457 00:13:59,861 --> 00:14:00,328 FINDINGS. 458 00:14:00,328 --> 00:14:01,462 THERE'S A LOT OF NULL FINDINGS 459 00:14:01,462 --> 00:14:05,333 IN THE FIELD AS WELL. 460 00:14:05,333 --> 00:14:07,201 NEVERTHELESS, WE BELIEVE THERE'S 461 00:14:07,201 --> 00:14:08,202 BIOLOGIC PLAUSIBILITY FOR 462 00:14:08,202 --> 00:14:09,704 RELATIONSHIP BETWEEN PHTHALATE 463 00:14:09,704 --> 00:14:10,605 EXPOSURE AND PRETERM BIRTH AND 464 00:14:10,605 --> 00:14:12,106 THE PRIMARY MECHANISM THAT WE 465 00:14:12,106 --> 00:14:14,208 SUSPECT TO BE INVOLVED IN 466 00:14:14,208 --> 00:14:15,276 OXIDATIVE STRESS AND 467 00:14:15,276 --> 00:14:16,611 INFLAMMATION IN PREGNANCY. 468 00:14:16,611 --> 00:14:17,712 IN VITRO STUDIES SHOW THE 469 00:14:17,712 --> 00:14:19,781 CAPACITY OF PHTHALATES TO CAUSE 470 00:14:19,781 --> 00:14:21,516 OXIDATIVE STRESS AND 471 00:14:21,516 --> 00:14:22,984 INFLAMMATION AND PHTHALATES HAVE 472 00:14:22,984 --> 00:14:24,319 BEEN ASSOCIATED WITH OXIDATIVE 473 00:14:24,319 --> 00:14:25,687 STRESS AND INFLAMMATION 474 00:14:25,687 --> 00:14:27,522 BIOMARKERS IN PREGNANT WOMEN. 475 00:14:27,522 --> 00:14:29,290 FINALLY, OXIDATIVE STRESS AND 476 00:14:29,290 --> 00:14:31,059 INFLAMMATION PATHWAYS ARE WELL 477 00:14:31,059 --> 00:14:32,694 ESTABLISHED MECHANISMS THAT LEAD 478 00:14:32,694 --> 00:14:33,127 TO PRETERM BIRTH. 479 00:14:33,127 --> 00:14:34,762 IN THE LIFECODES STUDY THAT I 480 00:14:34,762 --> 00:14:36,497 MENTIONED EARLIER, WE 481 00:14:36,497 --> 00:14:37,298 INVESTIGATED ASSOCIATIONS 482 00:14:37,298 --> 00:14:38,466 BETWEEN PHTHALATE METABOLITES 483 00:14:38,466 --> 00:14:41,536 AND THE OXIDATIVE STRESS 484 00:14:41,536 --> 00:14:44,105 BIOMARKER 8 ICE TOE 485 00:14:44,105 --> 00:14:45,139 PROSTAGLANDIN A2 ALPHA. 486 00:14:45,139 --> 00:14:46,908 IN THAT STUDY WE FOUND THIS 487 00:14:46,908 --> 00:14:47,875 MARKER WAS ASSOCIATED WITH 488 00:14:47,875 --> 00:14:49,210 PRETERM BIRTH AND ALSO WITH 489 00:14:49,210 --> 00:14:52,213 PHTHALATE EXPOSURE AND THAT IT 490 00:14:52,213 --> 00:14:54,782 STA TIS TI LICK MEDIATED THE 491 00:14:54,782 --> 00:14:55,750 ASSOCIATION BETWEEN PHTHALATE 492 00:14:55,750 --> 00:14:56,651 EXPOSURE AND PRETERM BIRTH. 493 00:14:56,651 --> 00:14:57,952 SINCE THAT TIME WE'RE EXPANDING 494 00:14:57,952 --> 00:15:02,857 ON OUR INVESTIGATION OF THIS 495 00:15:02,857 --> 00:15:05,059 OXYLIPIN TO STUDY OTHERS. 496 00:15:05,059 --> 00:15:07,362 SO 8 ISOPROSTAGLANDIN IS 497 00:15:07,362 --> 00:15:08,363 PRODUCED NON-ENZYMATICALLY BUT 498 00:15:08,363 --> 00:15:11,499 THERE ARE MANY OTHERS PRODUCED 499 00:15:11,499 --> 00:15:13,901 ENZYMATICALLY FROM FATTY ACIDS 500 00:15:13,901 --> 00:15:14,869 THROUGH SPECIFIC ENZYMATIC 501 00:15:14,869 --> 00:15:15,470 PATHWAYS. 502 00:15:15,470 --> 00:15:17,105 SO WE'RE STUDYING HOW CHEMICAL 503 00:15:17,105 --> 00:15:18,639 EXPOSURES ARE RELATED TO THESE 504 00:15:18,639 --> 00:15:19,807 MORE SPECIFIC UPSTREAM 505 00:15:19,807 --> 00:15:22,143 REGULATORS OF INFLAMMATION. 506 00:15:22,143 --> 00:15:25,079 THIS IS A FIGURE FROM AN 507 00:15:25,079 --> 00:15:27,081 EXPLORATORY EARLY STUDY WHERE WE 508 00:15:27,081 --> 00:15:28,449 EXAMINED PHTHALATE METABOLITES 509 00:15:28,449 --> 00:15:29,684 AS WELL AS OTHER CHEMICALS THAT 510 00:15:29,684 --> 00:15:31,719 ARE FOUND IN PERSONAL CARE 511 00:15:31,719 --> 00:15:33,921 PRODUCTS IN PLASTICS, AND 512 00:15:33,921 --> 00:15:36,124 EXAMINED ASSOCIATION WITH PLASMA 513 00:15:36,124 --> 00:15:39,060 MARKERS OF OXYLIPINS FROM 514 00:15:39,060 --> 00:15:41,362 DIFFERENT PARENT FAT FATTY ACIDO 515 00:15:41,362 --> 00:15:45,299 LIN LAKE ACID, AROCK DONG ACID, 516 00:15:45,299 --> 00:15:47,068 DH AMOUNT AND EPA THROUGH 517 00:15:47,068 --> 00:15:52,073 SPECIFIC ENZYMATIC PATHWAYS. 518 00:15:52,073 --> 00:15:54,308 WE OBSERVED SOME INTERESTING 519 00:15:54,308 --> 00:15:55,376 ASSOCIATIONS IN THIS PRELIMINARY 520 00:15:55,376 --> 00:15:55,643 STUDY. 521 00:15:55,643 --> 00:16:04,185 FOR EXAMPLE, BETWEEN SOME OF THE 522 00:16:04,185 --> 00:16:09,190 PHTHALATE METABOLITES AND THE 523 00:16:09,190 --> 00:16:11,159 EPOMES AND DIOMES. 524 00:16:11,159 --> 00:16:12,727 SO THIS IS SOME OF THE 525 00:16:12,727 --> 00:16:13,461 MECHANISTIC WORK WE'RE 526 00:16:13,461 --> 00:16:14,896 CONTINUING TO INVESTIGATE 527 00:16:14,896 --> 00:16:15,997 INDEPENDENTLY OF THE STUDY I'M 528 00:16:15,997 --> 00:16:18,599 PRESENTING TODAY. 529 00:16:18,599 --> 00:16:21,102 SO THIS BRINGS ME TO THE POOLED 530 00:16:21,102 --> 00:16:22,336 STUDY. 531 00:16:22,336 --> 00:16:25,506 WE SAW THIS KIND OF AMBIGUITY IN 532 00:16:25,506 --> 00:16:28,142 THE EPIDEMIOLOGIC LITERATURE BUT 533 00:16:28,142 --> 00:16:30,845 WE HAVE STRONG PLAUSIBILITY, SO 534 00:16:30,845 --> 00:16:32,480 I ESTABLISHED THIS POOLED 535 00:16:32,480 --> 00:16:34,916 CONSORTIUM OF 16 U.S. COHORTS TO 536 00:16:34,916 --> 00:16:35,917 ADDRESS THREE PRIMARY RESEARCH 537 00:16:35,917 --> 00:16:38,419 QUESTIONS. 538 00:16:38,419 --> 00:16:39,387 FIRST WHAT IS THE ASSOCIATION 539 00:16:39,387 --> 00:16:40,888 BETWEEN PHTHALATE EXPOSURE AND 540 00:16:40,888 --> 00:16:41,756 PRETERM BIRTH. 541 00:16:41,756 --> 00:16:43,391 SECOND, ARE THERE PERIODS OF 542 00:16:43,391 --> 00:16:44,592 SUSCEPTIBILITY TO PHTHALATE 543 00:16:44,592 --> 00:16:48,229 EXPOSURE DURING PREGNANCY. 544 00:16:48,229 --> 00:16:50,298 AND THIRD, HOW DO EXPOSURES TO 545 00:16:50,298 --> 00:16:51,499 PHTHALATES DIFFER BY RACE AND 546 00:16:51,499 --> 00:16:52,567 ETHNICITY AND COULD THESE 547 00:16:52,567 --> 00:16:53,301 DIFFERENCES CONTRIBUTE TO THE 548 00:16:53,301 --> 00:16:54,235 CONCURRENT DISPARITIES THAT WE 549 00:16:54,235 --> 00:16:55,536 OBSERVE IN RATES OF PRETERM 550 00:16:55,536 --> 00:16:58,706 BIRTH. 551 00:16:58,706 --> 00:17:01,576 TO START OFF, WE PERFORMED A 552 00:17:01,576 --> 00:17:02,510 SYSTEMATIC REVIEW TO IDENTIFY 553 00:17:02,510 --> 00:17:04,512 U.S. STUDIES WITH PRENATAL 554 00:17:04,512 --> 00:17:06,180 URINARY PHTHALATE METABOLITE 555 00:17:06,180 --> 00:17:06,514 MEASUREMENTS. 556 00:17:06,514 --> 00:17:08,783 WE IDENTIFIED 21 UNIQUE 557 00:17:08,783 --> 00:17:11,085 PROSPECTIVE STUDIES. 558 00:17:11,085 --> 00:17:12,854 FIVE OF THESE WERE EXCLUDED 559 00:17:12,854 --> 00:17:14,255 EITHER DUE TO SMALL SAMPLE SIZE 560 00:17:14,255 --> 00:17:15,490 OR THERE WAS ONE CORE HORT THAT 561 00:17:15,490 --> 00:17:16,991 DID NOT RESPOND. 562 00:17:16,991 --> 00:17:18,226 SO OUR FINAL SAMPLE SIZE FOR 563 00:17:18,226 --> 00:17:19,961 THIS STUDY INCLUDED 16 U.S. 564 00:17:19,961 --> 00:17:22,730 COHORTS WITH OVER 6,000 565 00:17:22,730 --> 00:17:24,765 PARTICIPANTS AND 538 CASES OF 566 00:17:24,765 --> 00:17:27,068 PRETERM BIRTH. 567 00:17:27,068 --> 00:17:28,469 THE NAMES OF THE STUDIES AND THE 568 00:17:28,469 --> 00:17:32,907 SAMPLE SIZES ARE SHOWN HERE. 569 00:17:32,907 --> 00:17:34,709 PARTICIPANTS WERE RECRUITED FROM 570 00:17:34,709 --> 00:17:35,877 ACROSS THE U.S. AND FROM PUERTO 571 00:17:35,877 --> 00:17:36,110 RICO. 572 00:17:36,110 --> 00:17:38,012 10 OF THE 16 STUDIES RECRUITED 573 00:17:38,012 --> 00:17:39,413 PARTICIPANTS IN THE FIRST HALF 574 00:17:39,413 --> 00:17:41,582 OF PREGNANCY AND THE DELIVERIES 575 00:17:41,582 --> 00:17:42,383 OCCURRED ACROSS THREE DECADES 576 00:17:42,383 --> 00:17:45,887 STARTING IN THE 80s. 577 00:17:45,887 --> 00:17:48,222 IN TERMS OF EXPOSURE ASSESSMENT, 578 00:17:48,222 --> 00:17:50,124 WE INCLUDED 11 PHTHALATE 579 00:17:50,124 --> 00:17:50,892 METABOLITES LISTED HERE THAT 580 00:17:50,892 --> 00:17:52,527 WERE MEASURED IN 10 OR MORE OF 581 00:17:52,527 --> 00:17:53,427 THE COHORTS. 582 00:17:53,427 --> 00:17:55,563 AND FOR MOST STUDIES, PHTHALATE 583 00:17:55,563 --> 00:17:57,999 METABOLITES WERE ANALYZED AT THE 584 00:17:57,999 --> 00:17:58,666 CENTERS FOR DISEASE CONTROL AND 585 00:17:58,666 --> 00:18:03,037 PREVENTION. 586 00:18:03,037 --> 00:18:04,405 PHTHALATE METABOLITE 587 00:18:04,405 --> 00:18:05,339 CONCENTRATIONS WERE CORRECTED 588 00:18:05,339 --> 00:18:07,275 FOR URINE DILUTION AND AFTER 589 00:18:07,275 --> 00:18:09,143 THAT, REPEATED MEASUREMENTS 590 00:18:09,143 --> 00:18:10,745 WITHIN PARTICIPANT WERE AVERAGE. 591 00:18:10,745 --> 00:18:12,113 SO FOR SOME PARTICIPANTS IN THIS 592 00:18:12,113 --> 00:18:13,548 STUDY, WE HAD A SINGLE SPOT 593 00:18:13,548 --> 00:18:14,949 URINE SAMPLE IN WHICH WE 594 00:18:14,949 --> 00:18:16,250 ANALYZED PHTHALATES, BUT FOR 595 00:18:16,250 --> 00:18:17,885 SOME PARTICIPANTS, WE HAD MORE 596 00:18:17,885 --> 00:18:18,886 THAN ONE. 597 00:18:18,886 --> 00:18:21,455 AND SO TO REDUCE THOSE INTO A 598 00:18:21,455 --> 00:18:23,824 SINGLE EXPOSURE METRIC FOR 599 00:18:23,824 --> 00:18:25,459 PARTICIPANT, WE CREATED A 600 00:18:25,459 --> 00:18:26,227 GEOMETRIC AVERAGE. 601 00:18:26,227 --> 00:18:27,528 THIS PIE CHART IS SHOWING YOU 602 00:18:27,528 --> 00:18:29,063 THE NUMBER OR PROPORTION OF 603 00:18:29,063 --> 00:18:30,097 PARTICIPANTS FOR WHICH WE HAD 604 00:18:30,097 --> 00:18:31,465 ONE MEASUREMENT INCLUDED IN THE 605 00:18:31,465 --> 00:18:33,401 AVERAGE VERSUS TWO, THREE OR 606 00:18:33,401 --> 00:18:36,637 FOUR OR MORE. 607 00:18:36,637 --> 00:18:38,372 FOR OUT COME ASSESSMENT, 608 00:18:38,372 --> 00:18:39,774 GESTATIONAL AGE AT DELIVERY WAS 609 00:18:39,774 --> 00:18:41,542 ESTIMATED BY SELF-REPORTED LAST 610 00:18:41,542 --> 00:18:43,277 MENSTRUAL PERIOD, EARLY 611 00:18:43,277 --> 00:18:44,378 PREGNANCY ULTRASOUND OR SOME 612 00:18:44,378 --> 00:18:46,013 COMBINATION THERE. 613 00:18:46,013 --> 00:18:47,782 AND PRETERM BIRTH WAS DEFINED AS 614 00:18:47,782 --> 00:18:48,883 DELIVERY BEFORE 37 WEEKS 615 00:18:48,883 --> 00:18:49,650 GESTATION. 616 00:18:49,650 --> 00:18:52,119 AND WE HAD A TOTAL OF 538 617 00:18:52,119 --> 00:18:55,423 PRETERM BIRTHS. 618 00:18:55,423 --> 00:18:56,824 THE COVARIATES THAT WE INCLUDED 619 00:18:56,824 --> 00:18:58,159 IN THE STUDY WERE A LITTLE BIT 620 00:18:58,159 --> 00:18:59,260 LIMITED BECAUSE WE HAD TO 621 00:18:59,260 --> 00:19:00,561 HARMONIZE THEM ACROSS ALL 16 622 00:19:00,561 --> 00:19:01,128 COHORTS. 623 00:19:01,128 --> 00:19:03,831 BUT THEY INCLUDED COHORT, 624 00:19:03,831 --> 00:19:07,835 MATERNAL AGE, RACE/ETHNICITY, 625 00:19:07,835 --> 00:19:09,403 EDUCATION LEVEL AND PREPREGNANCY 626 00:19:09,403 --> 00:19:10,504 BODY MASS INDEX. 627 00:19:10,504 --> 00:19:11,939 I WANTED TO BRIEFLY SHOW YOU THE 628 00:19:11,939 --> 00:19:13,708 DISTRIBUTION OF PARTICIPANT 629 00:19:13,708 --> 00:19:14,442 RACE/ETHNICITY IN THE POOLED 630 00:19:14,442 --> 00:19:15,876 STUDY BECAUSE WE DID HAVE A 631 00:19:15,876 --> 00:19:17,411 DIVERSE COHORT HERE. 632 00:19:17,411 --> 00:19:18,546 ABOUT 44% OF THE PARTICIPANTS 633 00:19:18,546 --> 00:19:20,481 WERE NON-HISPANIC WHITE. 634 00:19:20,481 --> 00:19:22,850 13% WERE NON-HISPANIC BLACK. 635 00:19:22,850 --> 00:19:25,386 38% WERE HISPANIC OR LATINA. 636 00:19:25,386 --> 00:19:28,022 3% WERE ASIAN PACIFIC ISLANDER, 637 00:19:28,022 --> 00:19:30,324 AND 2% REPORTED AS OTHER OR FROM 638 00:19:30,324 --> 00:19:31,659 OTHER GROUPS THAT HAD SMALL 639 00:19:31,659 --> 00:19:33,160 SAMPLE SIZES THAT WERE COMBINED 640 00:19:33,160 --> 00:19:36,230 BECAUSE OF THAT ISSUE. 641 00:19:36,230 --> 00:19:38,833 SO TO ADDRESS THE FIRST RESEARCH 642 00:19:38,833 --> 00:19:40,167 QUESTION, WHAT IS THE 643 00:19:40,167 --> 00:19:41,369 ASSOCIATION BETWEEN PHTHALATE 644 00:19:41,369 --> 00:19:42,670 EXPOSURE AND PRETERM BIRTH, I'M 645 00:19:42,670 --> 00:19:44,572 GOING TO KIND OF SKIP RIGHT TO 646 00:19:44,572 --> 00:19:46,273 THE RESULTS, AND I WANT TO 647 00:19:46,273 --> 00:19:47,141 HIGHLIGHT THAT THIS WORK WAS 648 00:19:47,141 --> 00:19:48,909 DONE BY A FORMER POSTDOCTORAL 649 00:19:48,909 --> 00:19:51,212 FELLOW IN MY GROUP, DR. BARRETT 650 00:19:51,212 --> 00:19:52,613 WELCH, WHO IS NOW AN ASSISTANT 651 00:19:52,613 --> 00:19:54,281 PROFESSOR AT THE UNIVERSITY OF 652 00:19:54,281 --> 00:19:56,017 NEVADA-RENO. 653 00:19:56,017 --> 00:19:57,852 WE OBSERVED FOR THESE NINE 654 00:19:57,852 --> 00:19:58,953 DIFFERENT PHTHALATE METABOLITES 655 00:19:58,953 --> 00:20:03,324 THAT THE METABOLITES MIBP, MECPP 656 00:20:03,324 --> 00:20:05,092 AND MCPP WERE ASSOCIATED WITH AN 657 00:20:05,092 --> 00:20:06,527 INCREASED ODDS OF PRETERM BIRTH 658 00:20:06,527 --> 00:20:08,696 IN OUR ADJUSTED MODELS. 659 00:20:08,696 --> 00:20:11,666 AND MECPP IS ONE OF THE DEHP 660 00:20:11,666 --> 00:20:12,633 METABOLITES THAT I MENTIONED 661 00:20:12,633 --> 00:20:16,237 EARLIER. 662 00:20:16,237 --> 00:20:17,672 FOLLOWING OUR PRIMARY ANALYSIS, 663 00:20:17,672 --> 00:20:19,473 WE WANTED TO PERFORM A MIXTURES 664 00:20:19,473 --> 00:20:20,508 ANALYSIS AS WELL. 665 00:20:20,508 --> 00:20:22,576 THE MOTIVATION FOR THIS IS THAT 666 00:20:22,576 --> 00:20:24,045 PREGNANT WOMEN ARE EXPOSED TO 667 00:20:24,045 --> 00:20:25,479 MANY PHTHALATES SIMULTANEOUSLY, 668 00:20:25,479 --> 00:20:26,547 NOT JUST ONE AT A TIME. 669 00:20:26,547 --> 00:20:28,516 SO THE JOINT EFFECT OF THE 670 00:20:28,516 --> 00:20:30,484 MIXTURE MAY ACTUALLY BE MORE 671 00:20:30,484 --> 00:20:32,386 REALISTIC FOR ESTIMATING AN OUT 672 00:20:32,386 --> 00:20:34,188 COME EFFECT THAN INDIVIDUAL 673 00:20:34,188 --> 00:20:35,723 EFFECT ESTIMATES. 674 00:20:35,723 --> 00:20:37,591 TO ADDRESS THE JOINT EFFECTIVE 675 00:20:37,591 --> 00:20:39,093 PHTHALATE EXPOSURE WITHIN OUR 676 00:20:39,093 --> 00:20:41,195 MIXTURE, WE APPLIED A G 677 00:20:41,195 --> 00:20:43,264 COMPUTATION METHOD, ESTIMATING 678 00:20:43,264 --> 00:20:44,699 THE PROBABILITY OF PRETERM BIRTH 679 00:20:44,699 --> 00:20:45,800 FOLLOWING A HYPOTHETICAL 680 00:20:45,800 --> 00:20:46,867 INTERVENTION TO REDUCE 681 00:20:46,867 --> 00:20:48,202 CONCENTRATIONS OF ALL EXPOSURES 682 00:20:48,202 --> 00:20:49,270 IN THE MIXTURE. 683 00:20:49,270 --> 00:20:50,705 AND THIS APPLICATION WAS 684 00:20:50,705 --> 00:20:53,541 DEVELOPED FOR THIS STUDY BY ALEX 685 00:20:53,541 --> 00:20:55,409 KEILL, WHO IS MY COLLABORATOR AT 686 00:20:55,409 --> 00:20:56,610 NCI. 687 00:20:56,610 --> 00:20:58,446 SO HERE WE'RE SHOWING THE JOINT 688 00:20:58,446 --> 00:21:00,247 EFFECT OF ALL OF THE PHTHALATE 689 00:21:00,247 --> 00:21:02,083 METABOLITES WITHIN THE MIXTURE. 690 00:21:02,083 --> 00:21:03,818 WE APPLIED THE G COMPUTATION TO 691 00:21:03,818 --> 00:21:05,352 THE MOST COMMONLY MEASURED 692 00:21:05,352 --> 00:21:06,587 PHTHALATE METABOLITES, AND WHAT 693 00:21:06,587 --> 00:21:08,622 I'M SHOWING YOU ARE THE 694 00:21:08,622 --> 00:21:10,491 ESTIMATED REDUCTION IN PRETERM 695 00:21:10,491 --> 00:21:14,328 BIRTHS FOR HEIG HYPOTHETICAL 696 00:21:14,328 --> 00:21:15,696 INTERVENTIONS RANGING FROM A 0% 697 00:21:15,696 --> 00:21:17,965 REDUCTION IN OVERALL PHTHALATE 698 00:21:17,965 --> 00:21:19,567 EXPOSURE AS THE REFERENCE UP TO 699 00:21:19,567 --> 00:21:20,768 90% REDUCTION IN PHTHALATE 700 00:21:20,768 --> 00:21:21,035 EXPOSURE. 701 00:21:21,035 --> 00:21:22,837 AND I JUST HIGHLIGHTED HERE THE 702 00:21:22,837 --> 00:21:24,939 EFFECT OF REDUCING THE EXPOSURE 703 00:21:24,939 --> 00:21:26,707 MIXTURE BY 50%, WHICH I THINK IS 704 00:21:26,707 --> 00:21:29,777 A FEASIBLE HYPOTHETICAL 705 00:21:29,777 --> 00:21:30,077 REDUCTION. 706 00:21:30,077 --> 00:21:31,946 AND WHAT WE OBSERVED WITH THIS 707 00:21:31,946 --> 00:21:34,248 REDUCTION IS THAT WE WOULD -- BY 708 00:21:34,248 --> 00:21:35,783 REDUCING THE PHTHALATE MIXTURE 709 00:21:35,783 --> 00:21:38,753 BY ABOUT 50%, WE WOULD EXPECT TO 710 00:21:38,753 --> 00:21:40,254 PREVENT ROUGHLY 11 PRETERM 711 00:21:40,254 --> 00:21:45,826 BIRTHS PER 1,000 LIVE BIRTHS. 712 00:21:45,826 --> 00:21:47,461 SO IN CONCLUSION, I WANT TO 713 00:21:47,461 --> 00:21:48,896 EMPHASIZE THE CONSEQUENCES AT 714 00:21:48,896 --> 00:21:49,864 THE POPULATION LEVEL. 715 00:21:49,864 --> 00:21:51,766 DESPITE THE MODEST EFFECT SIZES 716 00:21:51,766 --> 00:21:54,468 THAT WE OBSERVED IN THIS 717 00:21:54,468 --> 00:21:56,437 ANALYSIS, ODDS RATIOS RANGING 718 00:21:56,437 --> 00:21:58,939 FROM 1.4 TO 1.6, THE HEALTH 719 00:21:58,939 --> 00:22:00,341 CONSEQUENCES ON A POPULATION 720 00:22:00,341 --> 00:22:02,209 SCALE COULD BE SUBSTANTIAL GIVEN 721 00:22:02,209 --> 00:22:03,644 THE WIDESPREAD NATURE OF 722 00:22:03,644 --> 00:22:04,779 PHTHALATE EXPOSURE AND THE HIGH 723 00:22:04,779 --> 00:22:06,480 RATES OF PRETERM BIRTH THAT WE 724 00:22:06,480 --> 00:22:09,350 EXPERIENCE IN THE U.S. 725 00:22:09,350 --> 00:22:10,885 ADDITIONALLY, WE OBSERVED A 726 00:22:10,885 --> 00:22:12,253 SIGNIFICANT IMPACT OF REDUCTIONS 727 00:22:12,253 --> 00:22:14,488 IN THE EXPOSURE MIXTURE. 728 00:22:14,488 --> 00:22:16,056 SO ADDITIONAL MEASURES TO 729 00:22:16,056 --> 00:22:18,292 MITIGATE EXPOSURE TO PHTHALATES 730 00:22:18,292 --> 00:22:20,060 AS A CLASS OF CHEMICALS COULD 731 00:22:20,060 --> 00:22:21,595 HELP TO REDUCE PRETERM BIRTH 732 00:22:21,595 --> 00:22:22,596 RATES. 733 00:22:22,596 --> 00:22:24,231 I ALSO WANT TO GIVE A SHOUT OUT 734 00:22:24,231 --> 00:22:26,200 TO A RECENT STUDY THAT JUST CAME 735 00:22:26,200 --> 00:22:27,601 OUT TWO DAYS AGO, SO I ADDED IN 736 00:22:27,601 --> 00:22:29,603 THIS SLIDE LAST NIGHT, THAT'S 737 00:22:29,603 --> 00:22:31,005 HOT OFF THE PRESS FROM THE 738 00:22:31,005 --> 00:22:32,740 ENVIRONMENTAL INFLUENCES ON 739 00:22:32,740 --> 00:22:34,175 CHILD HEALTH OUTCOME STUDY. 740 00:22:34,175 --> 00:22:37,211 THIS IS A CONSORTIUM STUDY THAT 741 00:22:37,211 --> 00:22:38,879 INCLUDES CHILD FOLLOW-UP. 742 00:22:38,879 --> 00:22:41,081 IN THIS STUDY, THEY POOLED DATA 743 00:22:41,081 --> 00:22:45,119 FROM 13 COHORTS, INCLUDING 5,000 744 00:22:45,119 --> 00:22:47,855 BIRTHS AS WELL AS 394 PRETERM 745 00:22:47,855 --> 00:22:49,390 BIRTHS, AND SOME OF THE COHORTS 746 00:22:49,390 --> 00:22:50,624 DID OVERLAP WITH THOSE INCLUDED 747 00:22:50,624 --> 00:22:52,760 IN OUR POOLED STUDY. 748 00:22:52,760 --> 00:22:54,195 BUT IMPORTANTLY, THEY HAD SOME 749 00:22:54,195 --> 00:22:56,831 MORE RECENT DATA COLLECTION, 750 00:22:56,831 --> 00:22:58,499 INCLUDING RECRUITMENT OF 751 00:22:58,499 --> 00:23:00,434 PARTICIPANTS UP UNTIL 2022, WHEN 752 00:23:00,434 --> 00:23:01,969 THEY WERE ABLE TO ANALYZE 753 00:23:01,969 --> 00:23:02,269 SAMPLES. 754 00:23:02,269 --> 00:23:03,504 SO THEY WERE ABLE TO CAPTURE 755 00:23:03,504 --> 00:23:05,873 SOME OF THE MORE RECENT 756 00:23:05,873 --> 00:23:06,340 EXPOSURES AS WELL. 757 00:23:06,340 --> 00:23:07,741 IN THIS STUDY, THEY OBSERVED 758 00:23:07,741 --> 00:23:10,044 THAT METABOLITES OF DEHP AND ITS 759 00:23:10,044 --> 00:23:12,146 REPLACEMENTS INCLUDING DNOP WERE 760 00:23:12,146 --> 00:23:13,581 ASSOCIATED WITH INCREASED ODDS 761 00:23:13,581 --> 00:23:14,748 OF PRETERM BIRTH. 762 00:23:14,748 --> 00:23:16,417 SO WE OBSERVED SOME CONSISTENCY 763 00:23:16,417 --> 00:23:20,554 WITH OUR ANALYSIS WITH THE DEHP 764 00:23:20,554 --> 00:23:21,755 METABOLITE, AND WE ALSO OBSERVED 765 00:23:21,755 --> 00:23:24,291 AN ASSOCIATION BETWEEN MCPP, 766 00:23:24,291 --> 00:23:25,593 WHICH IS A NONSPECIFIC 767 00:23:25,593 --> 00:23:28,996 METABOLITE OF DNOP AND PRETERM 768 00:23:28,996 --> 00:23:31,532 BIRTH SO THERE'S A LOT OF 769 00:23:31,532 --> 00:23:32,466 CONSISTENCY IN OUR RESULTS. 770 00:23:32,466 --> 00:23:33,868 NOW I'M GOING TO MOVE ON TO OUR 771 00:23:33,868 --> 00:23:35,302 SECOND RESEARCH QUESTION. 772 00:23:35,302 --> 00:23:36,937 THIS WAS TO INVESTIGATE ARE 773 00:23:36,937 --> 00:23:38,539 THERE PERIODS OF SUSCEPTIBILITY 774 00:23:38,539 --> 00:23:40,474 TO PHTHALATE EXPOSURE DURING 775 00:23:40,474 --> 00:23:41,275 PREGNANCY? 776 00:23:41,275 --> 00:23:42,743 AND THIS IS WORK THAT WAS DONE 777 00:23:42,743 --> 00:23:44,612 BY ANOTHER FORMER POSTDOCTORAL 778 00:23:44,612 --> 00:23:48,449 FELLOW IN MY GROUP, ALEXA 779 00:23:48,449 --> 00:23:49,516 FRIEDMAN, NOW A SENIOR SCIENTIST 780 00:23:49,516 --> 00:23:51,051 WORKING WITH ENVIRONMENTAL 781 00:23:51,051 --> 00:23:53,153 WORKING GROUP. 782 00:23:53,153 --> 00:23:55,556 THERE ARE THREE MAIN QUESTIONS 783 00:23:55,556 --> 00:23:57,424 THAT WE INTEND TO ADDRESS WHEN 784 00:23:57,424 --> 00:23:59,827 WE ARE ASKING ABOUT PERIODS OF 785 00:23:59,827 --> 00:24:01,128 SUSCEPTIBILITY TO ENVIRONMENTAL 786 00:24:01,128 --> 00:24:02,796 CHEMICAL EXPOSURES. 787 00:24:02,796 --> 00:24:04,665 FIRST, WE WANT TO AID IN THE 788 00:24:04,665 --> 00:24:06,200 UNDERSTANDING OF BIOLOGICAL 789 00:24:06,200 --> 00:24:07,134 MECHANISMS THAT MAY BE 790 00:24:07,134 --> 00:24:09,136 CONNECTING OUR EXPOSURE TO OUR 791 00:24:09,136 --> 00:24:10,137 OUTCOME. 792 00:24:10,137 --> 00:24:11,538 SECOND, WE'RE INTERESTED IN 793 00:24:11,538 --> 00:24:13,807 REDUCING EXPOSURE 794 00:24:13,807 --> 00:24:14,708 MISCLASSIFICATION, SO IF WE'RE 795 00:24:14,708 --> 00:24:15,976 REALLY INTERESTED IN EXPOSURE 796 00:24:15,976 --> 00:24:17,645 THAT OCCURS IN EARLY PREGNANCY 797 00:24:17,645 --> 00:24:19,413 AND WE BELIEVE THAT'S THE 798 00:24:19,413 --> 00:24:21,248 CRITICAL WINDOW FOR EFFECT, 799 00:24:21,248 --> 00:24:22,750 MEASURING EXPOSURE ACROSS THE 800 00:24:22,750 --> 00:24:23,984 ENTIRE DURATION OF PREGNANCY IS 801 00:24:23,984 --> 00:24:25,519 GOING TO HAVE A LOT OF 802 00:24:25,519 --> 00:24:27,388 MISCLASSIFICATION. 803 00:24:27,388 --> 00:24:29,356 THIRD, WE'RE LOOKING FOR THE 804 00:24:29,356 --> 00:24:32,860 POSSIBILITY OF IDENTIFYING 805 00:24:32,860 --> 00:24:33,827 OPPORTUNITIES FOR INTERVENTION. 806 00:24:33,827 --> 00:24:35,529 IS THERE A SPECIFIC TIME DURING 807 00:24:35,529 --> 00:24:37,231 PREGNANCY WHERE WE NEED TO 808 00:24:37,231 --> 00:24:40,935 INTERVENE IN ORDER TO AMELIORATE 809 00:24:40,935 --> 00:24:42,169 THE EFFECTS? 810 00:24:42,169 --> 00:24:43,804 SO IN THIS STUDY, WE HAD THE 811 00:24:43,804 --> 00:24:45,839 ADVANTAGE OF HAVING QUITE A FEW 812 00:24:45,839 --> 00:24:47,308 PHTHALATE METABOLITE 813 00:24:47,308 --> 00:24:48,609 OBSERVATIONS IN EACH TRIMESTER 814 00:24:48,609 --> 00:24:50,044 OF PREGNANCY. 815 00:24:50,044 --> 00:24:53,647 SO ABOUT 2200 IN THE FIRST 816 00:24:53,647 --> 00:24:54,715 TRIMESTER, 3700 IN THE SECOND 817 00:24:54,715 --> 00:24:56,583 TRIMESTER, AND 3200 IN THE THIRD 818 00:24:56,583 --> 00:24:57,885 TRIMESTER. 819 00:24:57,885 --> 00:24:59,887 WE OBSERVED THAT EXPOSURE LEVELS 820 00:24:59,887 --> 00:25:01,522 IN THE STUDY POPULATION WERE 821 00:25:01,522 --> 00:25:03,791 VERY SIMILAR ACROSS TRIMESTERS, 822 00:25:03,791 --> 00:25:06,560 SO THE RESULTS OF THIS ANALYSIS 823 00:25:06,560 --> 00:25:08,829 REALLY POINT TO AN INDIVIDUAL'S 824 00:25:08,829 --> 00:25:09,930 BIOLOGIC SUSCEPTIBILITY TO 825 00:25:09,930 --> 00:25:11,298 EXPOSURE IN THE TRIMESTER, NOT 826 00:25:11,298 --> 00:25:12,666 THE FACT THAT THEY HAVE A 827 00:25:12,666 --> 00:25:14,101 DIFFERENT EXPOSURE LEVEL IN THAT 828 00:25:14,101 --> 00:25:17,471 TRIMESTER. 829 00:25:17,471 --> 00:25:19,006 SO WE HAVE TWO APPROACHES FOR 830 00:25:19,006 --> 00:25:20,107 IDENTIFYING PERIODS OF 831 00:25:20,107 --> 00:25:21,008 SUSCEPTIBILITY. 832 00:25:21,008 --> 00:25:24,244 FIRST, WE SOUGHT TO VISUALIZE 833 00:25:24,244 --> 00:25:26,113 THAT PHTHALATE METABOLITE 834 00:25:26,113 --> 00:25:26,814 CONCENTRATIONS ACROSS PREGNANCY 835 00:25:26,814 --> 00:25:28,082 IN CASES OF PRETERM BIRTH AND 836 00:25:28,082 --> 00:25:30,384 COMPARE THEM TO CONTROLS. 837 00:25:30,384 --> 00:25:32,252 AND SECOND, WE ESTIMATED ODDS 838 00:25:32,252 --> 00:25:33,587 RATIOS OF PRETERM BIRTH IN 839 00:25:33,587 --> 00:25:35,422 ASSOCIATION WITH EXPOSURE FOR 840 00:25:35,422 --> 00:25:36,423 EACH TRIMESTER. 841 00:25:36,423 --> 00:25:40,361 SO STRATIFIED ANALYSIS. 842 00:25:40,361 --> 00:25:41,161 FIRST I'M SHOWING YOU THE 843 00:25:41,161 --> 00:25:43,564 RESULTS FOR THE VISUALIZATION OF 844 00:25:43,564 --> 00:25:44,298 CONCENTRATIONS ACROSS PREGNANCY 845 00:25:44,298 --> 00:25:46,266 AND I'M JUST FOCUSING IN HERE ON 846 00:25:46,266 --> 00:25:49,236 THE METABOLITES OF DEHP. 847 00:25:49,236 --> 00:25:50,971 SO THESE PLOTS ARE SHOWING YOU 848 00:25:50,971 --> 00:25:52,806 THE PREDICTED PHTHALATE 849 00:25:52,806 --> 00:25:53,907 METABOLITE CONCENTRATIONS IN 850 00:25:53,907 --> 00:25:56,210 CASES OF PRETERM BIRTH SHOWN IN 851 00:25:56,210 --> 00:25:57,411 GREEN AND THEY'RE KIND OF THE 852 00:25:57,411 --> 00:26:00,681 HIGHER LINE IN EACH PLOT, AND IN 853 00:26:00,681 --> 00:26:01,982 CONTROLS, WHICH ARE SHOWN IN RED 854 00:26:01,982 --> 00:26:03,884 IN THE LOWER LINE IN EACH PLOT. 855 00:26:03,884 --> 00:26:06,920 WE ALSO INCLUDE 95% CONFIDENCE 856 00:26:06,920 --> 00:26:08,655 INTERVALS FOR THOSE ESTIMATES. 857 00:26:08,655 --> 00:26:11,191 THE Y AXIS IS THE PERCENTILE OF 858 00:26:11,191 --> 00:26:13,160 EXPOSURE, SO THEY'RE KIND OF 859 00:26:13,160 --> 00:26:13,927 STANDARDIZED ACROSS THE 860 00:26:13,927 --> 00:26:16,063 DIFFERENT PHTHALATE METABOLITES. 861 00:26:16,063 --> 00:26:17,865 AND THE X AXIS IS SHOWING YOU 862 00:26:17,865 --> 00:26:19,633 THE GESTATIONAL AGE AT THE TIME 863 00:26:19,633 --> 00:26:21,301 OF METABOLITE MEASUREMENT 864 00:26:21,301 --> 00:26:23,904 RANGING FROM ZERO TO 40 WEEKS 865 00:26:23,904 --> 00:26:24,338 GESTATION. 866 00:26:24,338 --> 00:26:26,874 AND WHAT WE OBSERVED FOR THESE 867 00:26:26,874 --> 00:26:29,043 DEHP METABOLITES IS THAT THE 868 00:26:29,043 --> 00:26:30,010 GREATEST SEPARATION BETWEEN 869 00:26:30,010 --> 00:26:32,112 CASES AND CONTROLS IS OBSERVED 870 00:26:32,112 --> 00:26:33,847 EARLIER IN GESTATION. 871 00:26:33,847 --> 00:26:37,584 SO YOU CAN SEE STARTING AROUND 872 00:26:37,584 --> 00:26:39,853 10 WEEKS, YOU SEE SIGNIFICANT 873 00:26:39,853 --> 00:26:41,488 SEPARATION OF THE CONCENTRATIONS 874 00:26:41,488 --> 00:26:43,390 IN CASES COMPARED TO CONTROLS, 875 00:26:43,390 --> 00:26:45,325 BUT THEY TEND TO BE MORE SIMILAR 876 00:26:45,325 --> 00:26:47,194 TOWARD THE END OF PREGNANCY. 877 00:26:47,194 --> 00:26:48,862 SO THIS HIGHLIGHTS EARLY 878 00:26:48,862 --> 00:26:50,697 PREGNANCY AS A POTENTIALLY 879 00:26:50,697 --> 00:26:53,100 SUSCEPTIBLE WINDOW. 880 00:26:53,100 --> 00:26:54,635 OUR SECOND APPROACH WAS TO 881 00:26:54,635 --> 00:26:56,070 EXAMINE ODDS RATIOS OF PRETERM 882 00:26:56,070 --> 00:26:58,472 BIRTH BY TRIMESTER OF EXPOSURE. 883 00:26:58,472 --> 00:26:59,873 AGAIN, I'M JUST SHOWING YOU THE 884 00:26:59,873 --> 00:27:02,076 RESULTS FOR THE DEHP 885 00:27:02,076 --> 00:27:03,077 METABOLITES, AND I'M SHOWING YOU 886 00:27:03,077 --> 00:27:05,279 THE ODDS RATIOS OF PRETERM BIRTH 887 00:27:05,279 --> 00:27:07,781 WITHIN EACH TRIMESTER. 888 00:27:07,781 --> 00:27:09,550 WE OBSERVED THAT THE ODDS RATIOS 889 00:27:09,550 --> 00:27:11,151 FOR PRETERM WERE GREATEST FOR 890 00:27:11,151 --> 00:27:12,586 THE FIRST AND SECOND TRIMESTERS 891 00:27:12,586 --> 00:27:14,888 FOR THE DEHP METABOLITES. 892 00:27:14,888 --> 00:27:18,459 SO FOR EXAMPLE, LOOKING AT THE 893 00:27:18,459 --> 00:27:19,693 MEHP METABOLITE ALL THE WAY ON 894 00:27:19,693 --> 00:27:21,128 THE LEFT, WE SAW THAT THE EFFECT 895 00:27:21,128 --> 00:27:22,362 ESTIMATES WERE GREATEST IN THE 896 00:27:22,362 --> 00:27:23,730 FIRST AND SECOND TRIMESTER, AND 897 00:27:23,730 --> 00:27:26,800 THE P VALUE FOR HETEROGENEITY 898 00:27:26,800 --> 00:27:28,202 WAS .03, INDICATING THAT THE 899 00:27:28,202 --> 00:27:29,636 EFFECTS ARE SIGNIFICANTLY 900 00:27:29,636 --> 00:27:31,605 DIFFERENT BY TRIMESTER. 901 00:27:31,605 --> 00:27:33,674 WE DIDN'T OBSERVE SIGNIFICANT 902 00:27:33,674 --> 00:27:35,008 HETEROGENEITY FOR THE OTHER 903 00:27:35,008 --> 00:27:37,077 PHTHALATE METABOLITES, BUT WE 904 00:27:37,077 --> 00:27:38,378 DID OBSERVE THAT EFFECT 905 00:27:38,378 --> 00:27:40,047 ESTIMATES TENDED TO BE GREATER 906 00:27:40,047 --> 00:27:41,582 IN ASSOCIATION WITH EXPOSURE 907 00:27:41,582 --> 00:27:45,819 MEASURED IN THE FIRST TRIMESTER. 908 00:27:45,819 --> 00:27:48,455 SO IN CONCLUSION FROM THIS AIM, 909 00:27:48,455 --> 00:27:50,424 EARLY PREGNANCY MAY BE A 910 00:27:50,424 --> 00:27:52,392 SUSCEPTIBLE WINDOW TO DEHP 911 00:27:52,392 --> 00:27:53,627 EXPOSURE FOR THE RELATIONSHIP 912 00:27:53,627 --> 00:27:54,461 WITH PRETERM BIRTH. 913 00:27:54,461 --> 00:27:56,964 WE HAD SOME LIMITATIONS TO THIS 914 00:27:56,964 --> 00:27:58,599 ANALYSIS, NOTABLY NOT ALL 915 00:27:58,599 --> 00:27:59,933 PARTICIPANTS HAD DATA AVAILABLE 916 00:27:59,933 --> 00:28:01,802 IN EACH TRIMESTER. 917 00:28:01,802 --> 00:28:04,071 ONLY ABOUT 600 OUT OF OUR 6,000 918 00:28:04,071 --> 00:28:05,272 PARTICIPANTS HAD DATA AVAILABLE 919 00:28:05,272 --> 00:28:06,607 IN EACH TRIMESTER. 920 00:28:06,607 --> 00:28:08,442 THIS WOULD BE THE IDEAL 921 00:28:08,442 --> 00:28:09,543 ANALYSIS, BUT BECAUSE THAT 922 00:28:09,543 --> 00:28:11,078 SAMPLE SIZE IS SO SMALL, WE 923 00:28:11,078 --> 00:28:12,613 COULDN'T REALLY COMPARE OUR 924 00:28:12,613 --> 00:28:14,181 PRIMARY RESULTS TO AN ANALYSIS 925 00:28:14,181 --> 00:28:16,216 WITHIN THE SUBSET. 926 00:28:16,216 --> 00:28:17,751 SECOND, NOT ALL COHORTS 927 00:28:17,751 --> 00:28:19,186 COLLECTED DATA IN EACH 928 00:28:19,186 --> 00:28:19,820 TRIMESTER. 929 00:28:19,820 --> 00:28:22,589 SO ONLY FIVE OF THE 16 COHORTS 930 00:28:22,589 --> 00:28:24,525 OR 3,000 OUT OF 6,000 931 00:28:24,525 --> 00:28:25,759 PARTICIPANTS HAD DATA COLLECTION 932 00:28:25,759 --> 00:28:27,594 IN EACH TRIMESTER, SO THIS COULD 933 00:28:27,594 --> 00:28:31,198 ALSO CREATE SOME BIAS IN THAT 934 00:28:31,198 --> 00:28:32,966 SOME STUDIES DIDN'T RECRUIT 935 00:28:32,966 --> 00:28:34,268 PEOPLE UNTIL THEY HAD ALREADY 936 00:28:34,268 --> 00:28:36,270 MADE TO THE THIRD TRIMESTER, FOR 937 00:28:36,270 --> 00:28:37,237 EXAMPLE. 938 00:28:37,237 --> 00:28:37,704 OKAY. 939 00:28:37,704 --> 00:28:39,206 NOW I'LL MOVE ON TO MY THIRD 940 00:28:39,206 --> 00:28:40,908 AIM, WHICH WAS HOW DO EXPOSURES 941 00:28:40,908 --> 00:28:42,910 TO PHTHALATE DIFFER BY RACE AND 942 00:28:42,910 --> 00:28:44,211 ETHNICITY, AND COULD THESE 943 00:28:44,211 --> 00:28:45,345 DIFFERENCES CONTRIBUTE TO 944 00:28:45,345 --> 00:28:46,547 DISPARITIES IN RATES OF PRETERM 945 00:28:46,547 --> 00:28:47,214 BIRTH? 946 00:28:47,214 --> 00:28:49,483 AND AGAIN, THIS IS WORK LED BY 947 00:28:49,483 --> 00:28:52,085 MY FORMER POSTDOCTORAL FELLOW 948 00:28:52,085 --> 00:28:54,288 DR. BARRETT WELCH. 949 00:28:54,288 --> 00:28:56,256 SO WE KNOW THAT THERE ARE 950 00:28:56,256 --> 00:28:57,691 DISTINCT RACIAL AND ETHNIC 951 00:28:57,691 --> 00:29:00,994 DISPARITIES IN RATES OF PRETERM 952 00:29:00,994 --> 00:29:02,396 BIRTH IN THE U.S. 953 00:29:02,396 --> 00:29:03,931 PRETERM BIRTH RATES AMONG BLACK 954 00:29:03,931 --> 00:29:06,133 WOMEN IS 50% HIGHER THAN AMONG 955 00:29:06,133 --> 00:29:06,767 ALL OTHERS. 956 00:29:06,767 --> 00:29:07,968 SO IN THIS PLOT HERE, I'M 957 00:29:07,968 --> 00:29:10,604 SHOWING THE RATES OF PRETERM 958 00:29:10,604 --> 00:29:11,905 BIRTH OR THE PERCENTAGE OF LIVE 959 00:29:11,905 --> 00:29:13,974 BIRTHS THAT WERE BORN PRETERM 960 00:29:13,974 --> 00:29:16,176 FROM 2017 TO 2019, AND YOU CAN 961 00:29:16,176 --> 00:29:18,278 SEE THAT HIGHEST RATES ARE 962 00:29:18,278 --> 00:29:20,113 EXPERIENCED AMONG BLACK WOMEN. 963 00:29:20,113 --> 00:29:21,315 WE KNOW THAT THESE DIFFERENCES 964 00:29:21,315 --> 00:29:23,183 ARE NOT DUE TO GENETICS BUT 965 00:29:23,183 --> 00:29:25,252 RATHER TO SOCIAL AND PHYSICAL 966 00:29:25,252 --> 00:29:26,119 ENVIRONMENTAL EXPOSURE 967 00:29:26,119 --> 00:29:27,554 DISPARITIES. 968 00:29:27,554 --> 00:29:28,755 WHICH BRINGS INTO QUESTION THE 969 00:29:28,755 --> 00:29:30,390 ROLE OF ENVIRONMENTAL CHEMICAL 970 00:29:30,390 --> 00:29:33,560 EXPOSURES. 971 00:29:33,560 --> 00:29:35,629 AT THE SAME TIME, THERE ARE 972 00:29:35,629 --> 00:29:37,264 IMPORTANT RACIAL AND ETHNIC 973 00:29:37,264 --> 00:29:39,132 DISPARITIES IN PHTHALATE 974 00:29:39,132 --> 00:29:39,800 EXPOSURES. 975 00:29:39,800 --> 00:29:41,668 EXPOSURES TO PHTHALATES AMONG 976 00:29:41,668 --> 00:29:43,637 OTHER ENVIRONMENTAL CHEMICALS 977 00:29:43,637 --> 00:29:44,371 DISPROPORTIONATELY AFFECT PEOPLE 978 00:29:44,371 --> 00:29:45,806 OF COLOR INCLUDING PREGNANT 979 00:29:45,806 --> 00:29:46,573 WOMEN. 980 00:29:46,573 --> 00:29:48,642 IN THIS PLOT ON THE LEFT, I'M 981 00:29:48,642 --> 00:29:51,044 SHOWING YOU JUST SOME QUICK DATA 982 00:29:51,044 --> 00:29:53,814 ON URINARY MIBP CONCENTRATIONS 983 00:29:53,814 --> 00:29:56,316 BY RACE AND ETHNICITY, AND THE 984 00:29:56,316 --> 00:29:57,851 NATIONAL HEALTH AND NUTRITION 985 00:29:57,851 --> 00:29:59,519 EXAMINATION SURVEY FROM 2001 TO 986 00:29:59,519 --> 00:30:00,654 2012. 987 00:30:00,654 --> 00:30:04,658 AND THIS IS THE GEOMETRIC MEAN 988 00:30:04,658 --> 00:30:05,525 URINARY CONCENTRATION IN EACH OF 989 00:30:05,525 --> 00:30:06,393 THOSE STUDY YEARS. 990 00:30:06,393 --> 00:30:08,362 WHAT YOU CAN SEE CONSISTENTLY IS 991 00:30:08,362 --> 00:30:10,297 THAT NON-HISPANIC WHITE 992 00:30:10,297 --> 00:30:11,331 PARTICIPANTS WHO ARE SHOWN IN 993 00:30:11,331 --> 00:30:12,933 THE GREEN DIAMONDS HAVE THE 994 00:30:12,933 --> 00:30:15,469 LOWEST EXPOSURE LEVELS, AND 995 00:30:15,469 --> 00:30:16,536 MEXICAN-AMERICAN AND 996 00:30:16,536 --> 00:30:17,437 NON-HISPANIC BLACK PARTICIPANTS 997 00:30:17,437 --> 00:30:19,840 HAVE THE HIGHEST EXPOSURE LEVELS 998 00:30:19,840 --> 00:30:21,341 CONSISTENTLY OVER TIME. 999 00:30:21,341 --> 00:30:23,343 AND THIS IS ONE OF THOSE 1000 00:30:23,343 --> 00:30:25,545 PHTHALATE METABOLITES THAT WAS 1001 00:30:25,545 --> 00:30:26,613 MOST CONSISTENTLY LINKED TO 1002 00:30:26,613 --> 00:30:27,848 PRETERM BIRTH IN OUR POOLED 1003 00:30:27,848 --> 00:30:28,582 ANALYSIS. 1004 00:30:28,582 --> 00:30:30,017 THESE DISPARITIES AND EXPOSURE 1005 00:30:30,017 --> 00:30:31,518 CAN BE CONTRIBUTED TO FACTORS 1006 00:30:31,518 --> 00:30:34,154 DRIVEN BY SYSTEMIC AND 1007 00:30:34,154 --> 00:30:35,122 INSTITUTIONALIZED RACISM, SUCH 1008 00:30:35,122 --> 00:30:37,224 AS PERSONAL CARE PRODUCT USE, 1009 00:30:37,224 --> 00:30:39,092 AND FOOD LANDSCAPES IN RACIALLY 1010 00:30:39,092 --> 00:30:42,562 SEGREGATED AREAS. 1011 00:30:42,562 --> 00:30:45,132 THE POOLED STUDY OF PHTHALATE 1012 00:30:45,132 --> 00:30:46,533 EXPOSURE IN PRETERM BIRTH IS 1013 00:30:46,533 --> 00:30:48,502 REALLY UNIQUELY POISED TO 1014 00:30:48,502 --> 00:30:50,270 EXAMINE RACIAL AND ETHNIC 1015 00:30:50,270 --> 00:30:51,505 DIFFERENCES AND EXPOSURE DURING 1016 00:30:51,505 --> 00:30:51,905 PREGNANCY. 1017 00:30:51,905 --> 00:30:55,309 BECAUSE OF ITS LARGE SAMPLE SIZE 1018 00:30:55,309 --> 00:30:55,876 AND DIVERSITY. 1019 00:30:55,876 --> 00:30:57,477 THIS PLOT IS SHOWING TH THE 1020 00:30:57,477 --> 00:30:58,779 DIVERSITY OF OUR POPULATION 1021 00:30:58,779 --> 00:30:59,646 SOMEWHAT DIFFERENTLY THAN THE 1022 00:30:59,646 --> 00:31:00,947 PREVIOUS PIE CHART I SHOWED. 1023 00:31:00,947 --> 00:31:02,516 IT DISPLAYS EACH OF THE COHORTS 1024 00:31:02,516 --> 00:31:04,284 THAT WERE INCLUDED IN OUR STUDY, 1025 00:31:04,284 --> 00:31:06,153 AND THE NUMBER OF PARTICIPANTS 1026 00:31:06,153 --> 00:31:08,188 WHO SELF-REPORTED AS 1027 00:31:08,188 --> 00:31:09,856 NON-HISPANIC WHITE, NON-HISPANIC 1028 00:31:09,856 --> 00:31:11,825 BLACK, HISPANIC LATINA, ASIAN 1029 00:31:11,825 --> 00:31:15,962 PACIFIC ISLANDER OR OTHER. 1030 00:31:15,962 --> 00:31:17,698 OUR FIRST STEP IN THIS STUDY WAS 1031 00:31:17,698 --> 00:31:19,466 TO EXAMINE RACIAL AND ETHNIC 1032 00:31:19,466 --> 00:31:20,901 DISPARITIES IN PHTHALATE 1033 00:31:20,901 --> 00:31:21,335 EXPOSURE. 1034 00:31:21,335 --> 00:31:23,837 AND WE DID THIS BY EXAMINING 1035 00:31:23,837 --> 00:31:25,605 PERCENT DIFFERENCE IN COVARIATE 1036 00:31:25,605 --> 00:31:28,241 ADJUSTED GEOMETRIC MEANS WITHIN 1037 00:31:28,241 --> 00:31:29,776 NON-HISPANIC BLACK, HISPANIC 1038 00:31:29,776 --> 00:31:31,845 LATINA AND ASIAN PACIFIC 1039 00:31:31,845 --> 00:31:33,480 ISLANDER PARTICIPANTS COMPARED 1040 00:31:33,480 --> 00:31:34,014 TO NON-HISPANIC WHITE 1041 00:31:34,014 --> 00:31:35,248 PARTICIPANTS. 1042 00:31:35,248 --> 00:31:36,883 IN NON-HISPANIC WHITE 1043 00:31:36,883 --> 00:31:38,952 PARTICIPANTS WERE SELECTED A 1044 00:31:38,952 --> 00:31:41,621 PRIORI AS THE REFERENCE GROUP AS 1045 00:31:41,621 --> 00:31:43,023 WE EXPECTED THEM TO HAVE THE 1046 00:31:43,023 --> 00:31:45,092 LOWEST EXPOSURE LEVELS, AND 1047 00:31:45,092 --> 00:31:46,460 INDEED THEY DID. 1048 00:31:46,460 --> 00:31:48,495 THESE ESTIMATES ARE ADJUSTED FOR 1049 00:31:48,495 --> 00:31:50,764 MATERNAL AGE, EDUCATION, 1050 00:31:50,764 --> 00:31:54,401 PREPREGNANCY BMI, DELIVERY -- 1051 00:31:54,401 --> 00:31:55,836 AND STUDY, AS THESE ARE 1052 00:31:55,836 --> 00:31:56,737 SOMETIMES FACTORS THAT OTHERS 1053 00:31:56,737 --> 00:32:00,374 MIGHT USE TO KIND OF EXPLAIN WHY 1054 00:32:00,374 --> 00:32:02,509 THE DISPARITIES AND EXPOSURE 1055 00:32:02,509 --> 00:32:03,710 LEVELS EXIST. 1056 00:32:03,710 --> 00:32:06,446 SO THESE DIFFERENCES THAT I'M 1057 00:32:06,446 --> 00:32:08,548 SHOWING YOU EXIST AFTER 1058 00:32:08,548 --> 00:32:09,516 ADJUSTMENT FOR ALL OF THOSE 1059 00:32:09,516 --> 00:32:10,183 FACTORS. 1060 00:32:10,183 --> 00:32:11,618 SO THIS PLOT ON THE RIGHT IS 1061 00:32:11,618 --> 00:32:12,919 SHOWING YOU EACH OF THE 1062 00:32:12,919 --> 00:32:15,322 PHTHALATE METABOLITES THAT WE 1063 00:32:15,322 --> 00:32:16,757 EXAMINED IN THIS STUDY, AND IT'S 1064 00:32:16,757 --> 00:32:18,191 SHOWING YOU THE PERCENT 1065 00:32:18,191 --> 00:32:21,661 DIFFERENCE IN 95% CONFIDENCE 1066 00:32:21,661 --> 00:32:24,731 INTERVALS, IN EXPOSURE LEVELS IN 1067 00:32:24,731 --> 00:32:26,833 EACH OF THESE GROUPS COMPARED TO 1068 00:32:26,833 --> 00:32:27,601 NON-HISPANIC WHITE PARTICIPANTS. 1069 00:32:27,601 --> 00:32:29,336 WHAT YOU CAN SEE STARTING AT THE 1070 00:32:29,336 --> 00:32:30,637 TOP IS THAT THERE ARE MUCH 1071 00:32:30,637 --> 00:32:33,073 HIGHER LEVELS OF EXPOSURE IN 1072 00:32:33,073 --> 00:32:33,940 NON-HISPANIC BLACK PARTICIPANTS 1073 00:32:33,940 --> 00:32:36,042 COMPARED TO NON-HISPANIC WHITE 1074 00:32:36,042 --> 00:32:36,376 PARTICIPANTS. 1075 00:32:36,376 --> 00:32:39,746 WE ALSO OBSERVED MUCH HIGHER 1076 00:32:39,746 --> 00:32:42,716 LEVELS OF EXPOSURE AMONG OUR 1077 00:32:42,716 --> 00:32:44,017 HISPANIC LATINA PARTICIPANTS, 1078 00:32:44,017 --> 00:32:46,887 AND FOR ASIAN PACIFIC ISLANDER 1079 00:32:46,887 --> 00:32:47,988 PARTICIPANTS, EXPOSURE LEVELS 1080 00:32:47,988 --> 00:32:49,322 WERE MORE SIMILAR TO 1081 00:32:49,322 --> 00:32:50,290 NON-HISPANIC WHITE PARTICIPANTS, 1082 00:32:50,290 --> 00:32:53,260 BUT WE DO SEE THAT MBP AND MIBP, 1083 00:32:53,260 --> 00:32:54,694 WHICH ARE SOME OF THE PHTHALATES 1084 00:32:54,694 --> 00:32:55,662 THAT WERE ASSOCIATED WITH 1085 00:32:55,662 --> 00:32:57,631 PRETERM BIRTH IN OUR INITIAL 1086 00:32:57,631 --> 00:32:59,933 ANALYSIS, WERE HIGHER IN ASIAN 1087 00:32:59,933 --> 00:33:01,134 AND PACIFIC ISLANDER 1088 00:33:01,134 --> 00:33:03,437 PARTICIPANTS. 1089 00:33:03,437 --> 00:33:04,871 I KIND OF ALREADY EXPLAINED 1090 00:33:04,871 --> 00:33:06,406 THIS, BUT AGAIN, THE GREATEST 1091 00:33:06,406 --> 00:33:08,041 DIFFERENCES IN EXPOSURE THAT WE 1092 00:33:08,041 --> 00:33:09,176 OBSERVED WERE FOR PHTHALATES 1093 00:33:09,176 --> 00:33:10,377 THAT WERE TYPICALLY FOUND IN 1094 00:33:10,377 --> 00:33:12,446 PERSONAL CARE PRODUCTS. 1095 00:33:12,446 --> 00:33:15,282 SO FOR THESE COMPOUNDS, 1096 00:33:15,282 --> 00:33:16,917 NON-HISPANIC BLACK PARTICIPANTS 1097 00:33:16,917 --> 00:33:19,119 HAD 23 TO 148% HIGHER EXPOSURE 1098 00:33:19,119 --> 00:33:20,454 AFTER ADJUSTING FOR ALL OF THESE 1099 00:33:20,454 --> 00:33:22,189 OTHER FACTORS. 1100 00:33:22,189 --> 00:33:25,492 HISPANIC LATINA PARTICIPANTS HAD 1101 00:33:25,492 --> 00:33:27,561 5 TO 94% HIGHER EXPOSURE LEVELS, 1102 00:33:27,561 --> 00:33:29,996 AND AS I SAID FOR ASIAN PACIFIC 1103 00:33:29,996 --> 00:33:31,097 ISLANDER PARTICIPANTS, THEY HAD 1104 00:33:31,097 --> 00:33:33,500 MORE SIMILAR EXPOSURE LEVELS TO 1105 00:33:33,500 --> 00:33:38,238 NON-HISPANIC WHITE PARTICIPANTS. 1106 00:33:38,238 --> 00:33:39,773 SO WE HAD SEVERAL FOLLOW-UP 1107 00:33:39,773 --> 00:33:44,044 QUESTIONS AFTERR AFTER IDENTIFYS 1108 00:33:44,044 --> 00:33:47,547 DISPARITY EXPOSURE IN OUR POOL 1109 00:33:47,547 --> 00:33:48,381 POPULATION. 1110 00:33:48,381 --> 00:33:49,516 FIRST DO ASSOCIATIONS BETWEEN 1111 00:33:49,516 --> 00:33:50,817 PHTHALATE EXPOSURE AND PRETERM 1112 00:33:50,817 --> 00:33:52,152 BIRTH DIFFER BY MATERNAL RACE 1113 00:33:52,152 --> 00:33:53,253 AND ETHNICITY? 1114 00:33:53,253 --> 00:33:55,622 THIS IS KIND OF A TRADITIONAL 1115 00:33:55,622 --> 00:33:56,957 STRATIFIED EFFECT MODIFICATION 1116 00:33:56,957 --> 00:33:58,158 ANALYSIS, AND KIND OF THE 1117 00:33:58,158 --> 00:33:59,826 JUSTIFICATION FOR THIS ANALYSIS 1118 00:33:59,826 --> 00:34:02,329 IS THAT THERE COULD POSSIBLY BE 1119 00:34:02,329 --> 00:34:03,763 UNMEASURED FACTORS IN OUR STUDY 1120 00:34:03,763 --> 00:34:05,832 THAT ARE ASSOCIATED WITH 1121 00:34:05,832 --> 00:34:07,634 MATERNAL RACE AND ETHNICITY SUCH 1122 00:34:07,634 --> 00:34:09,703 AS PSYCHOSOCIAL STRESS DURING 1123 00:34:09,703 --> 00:34:11,204 PREGNANCY THAT ARE CAUSING SOME 1124 00:34:11,204 --> 00:34:12,639 GROUPS TO BE MORE SUSCEPTIBLE TO 1125 00:34:12,639 --> 00:34:14,074 THE EFFECTS OF PHTHALATE 1126 00:34:14,074 --> 00:34:15,308 EXPOSURE COMPARED TO OTHERS. 1127 00:34:15,308 --> 00:34:17,277 SO IT'S KIND OF THE UNDERLYING 1128 00:34:17,277 --> 00:34:17,711 JUSTIFICATION. 1129 00:34:17,711 --> 00:34:19,779 BUT OUR STATISTICAL APPROACH IS 1130 00:34:19,779 --> 00:34:22,182 TO EXAMINE ASSOCIATIONS BETWEEN 1131 00:34:22,182 --> 00:34:23,950 INDIVIDUAL PHTHALATE METABOLITES 1132 00:34:23,950 --> 00:34:25,285 IN PRETERM BIRTH IN MODELS THAT 1133 00:34:25,285 --> 00:34:27,120 ARE STRATIFIED BY MATERNAL RACE 1134 00:34:27,120 --> 00:34:30,090 AND ETHNICITY. 1135 00:34:30,090 --> 00:34:31,825 HERE ARE THE RESULTS FOR THAT I 1136 00:34:31,825 --> 00:34:32,359 AAL CYST. 1137 00:34:32,359 --> 00:34:33,793 THIS PLOT IS AGAIN SHOWING YOU 1138 00:34:33,793 --> 00:34:35,896 EACH OF THE PHTHALATE MA TAB 1139 00:34:35,896 --> 00:34:39,833 LIGHTS THAT WE EXAMINED AND THE 1140 00:34:39,833 --> 00:34:43,136 ODDS RATIO IN NON-HISPANIC WHITE 1141 00:34:43,136 --> 00:34:44,771 PARTICIPANTS, NON-HISPANIC BLACK 1142 00:34:44,771 --> 00:34:46,106 PARTICIPANTS, AND HISPANIC 1143 00:34:46,106 --> 00:34:47,541 LATINA PARTICIPANTS. 1144 00:34:47,541 --> 00:34:49,376 AND WHAT WE OBSERVED IS THAT FOR 1145 00:34:49,376 --> 00:34:51,278 TWO OF THE FOUR PHTHALATE 1146 00:34:51,278 --> 00:34:53,647 METABOLITES THAT WERE ASSOCIATED 1147 00:34:53,647 --> 00:34:57,651 WITH PRETERM BERM IN BIRTH IN R 1148 00:34:57,651 --> 00:35:01,788 PRIMARY ANALYSES -- FOR MBP THE 1149 00:35:01,788 --> 00:35:03,323 ODDS OF PRETERM BIRTH WERE 1150 00:35:03,323 --> 00:35:04,624 GREATEST AMONG HISPANIC OR 1151 00:35:04,624 --> 00:35:05,659 LATINA PARTICIPANTS. 1152 00:35:05,659 --> 00:35:08,061 AND FOR MIBP, THE ODDS OF 1153 00:35:08,061 --> 00:35:10,063 PRETERM BIRTH WAS GREATEST AMONG 1154 00:35:10,063 --> 00:35:14,534 NON-HISPANIC BLACK PARTICIPANTS. 1155 00:35:14,534 --> 00:35:15,502 OUR SECOND QUESTION IS A LITTLE 1156 00:35:15,502 --> 00:35:16,937 BIT MORE HYPOTHETICAL. 1157 00:35:16,937 --> 00:35:19,539 SO WE ASKED, COULD ELIMINATING 1158 00:35:19,539 --> 00:35:20,674 DISPARITIES IN PHTHALATE 1159 00:35:20,674 --> 00:35:23,043 EXPOSURE THAT EXIST BY RACE AND 1160 00:35:23,043 --> 00:35:24,077 ETHNICITY REDUCE RATES OF 1161 00:35:24,077 --> 00:35:25,378 PRETERM BIRTH? 1162 00:35:25,378 --> 00:35:27,147 OUR APPROACH FOR THIS WAS TO 1163 00:35:27,147 --> 00:35:28,648 APPLY G COMPUTATION TO ESTIMATE 1164 00:35:28,648 --> 00:35:31,284 THE RATES OF PRETERM BIRTH THAT 1165 00:35:31,284 --> 00:35:33,153 WE WOULD HAVE OBSERVED IF 1166 00:35:33,153 --> 00:35:34,287 NON-HISPANIC BLACK PARTICIPANTS 1167 00:35:34,287 --> 00:35:36,122 HAD THE SAME EXPOSURE TO 1168 00:35:36,122 --> 00:35:37,857 PHTHALATES AS NON-HISPANIC WHITE 1169 00:35:37,857 --> 00:35:38,625 PARTICIPANTS. 1170 00:35:38,625 --> 00:35:41,261 AND ALSO FOR HISPANIC LATINA 1171 00:35:41,261 --> 00:35:43,563 PARTICIPANTS. 1172 00:35:43,563 --> 00:35:46,399 SO WE APPLIED THIS HYPOTHETICAL 1173 00:35:46,399 --> 00:35:49,269 INTERVENTION WITH THE CENTRAL 1174 00:35:49,269 --> 00:35:51,271 QUESTION, IF WE COULD ELIMINATE 1175 00:35:51,271 --> 00:35:52,339 DISPARITIES IN PHTHALATE 1176 00:35:52,339 --> 00:35:53,807 EXPOSURE, WOULD IT SIGNIFICANTLY 1177 00:35:53,807 --> 00:35:55,508 IMPACT RATES OF PRETERM BIRTH? 1178 00:35:55,508 --> 00:35:57,477 SO UNDER THE HYPOTHETICAL 1179 00:35:57,477 --> 00:35:59,479 INTERVENTION, WE REDUCE EXPOSURE 1180 00:35:59,479 --> 00:36:01,548 LEVELS FOR EACH OF THE NINE 1181 00:36:01,548 --> 00:36:02,983 PHTHALATE METABOLITES IN OUR 1182 00:36:02,983 --> 00:36:04,951 MIXTURE IN NON-HISPANIC BLACK 1183 00:36:04,951 --> 00:36:06,953 PARTICIPANTS AND HISPANIC LATINA 1184 00:36:06,953 --> 00:36:08,788 PARTICIPANTS TO THE DISTRIBUTION 1185 00:36:08,788 --> 00:36:10,323 THAT WAS OBSERVED IN 1186 00:36:10,323 --> 00:36:11,758 NON-HISPANIC WHITE PARTICIPANTS. 1187 00:36:11,758 --> 00:36:14,394 SO I'M TRYING TO ILLUSTRATE THIS 1188 00:36:14,394 --> 00:36:14,928 HERE ON THE RIGHT. 1189 00:36:14,928 --> 00:36:16,896 SO WHAT YOU CAN SEE ON THE 1190 00:36:16,896 --> 00:36:18,498 BOTTOM IS THE DISTRIBUTION OF 1191 00:36:18,498 --> 00:36:23,136 ONE EXPOSURE BIOMARKER IN OUR 1192 00:36:23,136 --> 00:36:24,671 REFERENCE GROUP, WHICH IS 1193 00:36:24,671 --> 00:36:25,972 NON-HISPANIC WHITE PARTICIPANTS, 1194 00:36:25,972 --> 00:36:27,874 AND YOU SEE THE CURVE THEY 1195 00:36:27,874 --> 00:36:29,009 EXPERIENCE OF THEIR EXPOSURE. 1196 00:36:29,009 --> 00:36:31,645 ON THE TOP IN THE GREEN ON THE 1197 00:36:31,645 --> 00:36:33,613 RIGHT, THAT DISTRIBUTION IS WHAT 1198 00:36:33,613 --> 00:36:36,349 WE OBSERVE IN OUR STUDY 1199 00:36:36,349 --> 00:36:37,217 POPULATION, THE EXPOSURE 1200 00:36:37,217 --> 00:36:39,953 DISTRIBUTION FOR THAT PHTHALATE 1201 00:36:39,953 --> 00:36:41,621 METABOLITE, AMONG, FOR EXAMPLE, 1202 00:36:41,621 --> 00:36:43,156 NON-HISPANIC BLACK PARTICIPANTS. 1203 00:36:43,156 --> 00:36:44,357 THE DISTRIBUTION IS MUCH HIGHER 1204 00:36:44,357 --> 00:36:46,092 THAN WHAT WE OBSERVE FOR 1205 00:36:46,092 --> 00:36:47,694 NON-HISPANIC WHITE PARTICIPANTS. 1206 00:36:47,694 --> 00:36:49,763 SO UNDER THIS HYPOTHETICAL 1207 00:36:49,763 --> 00:36:51,297 INTERVENTION, WE SHIFT THAT 1208 00:36:51,297 --> 00:36:52,699 DISTRIBUTION CURVE TO THE LEFT, 1209 00:36:52,699 --> 00:36:54,567 SO THAT THE MEAN IS EQUIVALENT 1210 00:36:54,567 --> 00:36:57,871 TO THAT THAT'S OBSERVED AMONG 1211 00:36:57,871 --> 00:37:02,142 NON-HISPANIC WHITE PARTICIPANTS. 1212 00:37:02,142 --> 00:37:04,444 AND THEN WE ESTIMATE THE EFFECT 1213 00:37:04,444 --> 00:37:07,514 OF SHIFTING THIS CURVE, THIS 1214 00:37:07,514 --> 00:37:09,149 INTERVENTION ON THE PREDICTED 1215 00:37:09,149 --> 00:37:10,583 PRETERM BIRTH RATES WITHIN EACH 1216 00:37:10,583 --> 00:37:12,886 OF OUR RACIAL AND ETHNIC GROUPS. 1217 00:37:12,886 --> 00:37:15,722 SO IN THIS PLOT, I'M SHOWING YOU 1218 00:37:15,722 --> 00:37:17,057 FIRST NON-HISPANIC WHITE 1219 00:37:17,057 --> 00:37:18,692 PARTICIPANTS WHO EXPERIENCE NO 1220 00:37:18,692 --> 00:37:19,826 INTERVENTION UNDER OUR 1221 00:37:19,826 --> 00:37:21,461 HYPOTHETICAL FRAMEWORK, AND I'M 1222 00:37:21,461 --> 00:37:23,296 SHOWING YOU THE NUMBER OF 1223 00:37:23,296 --> 00:37:25,065 PRETERM BIRTHS PER 1,000 LIVE 1224 00:37:25,065 --> 00:37:27,267 BIRTHS IN THE 95% CONFIDENCE 1225 00:37:27,267 --> 00:37:28,468 INTERVAL IN OUR STUDY 1226 00:37:28,468 --> 00:37:32,172 POPULATION. 1227 00:37:32,172 --> 00:37:33,840 NEXT I'M SHOWING YOU THE 1228 00:37:33,840 --> 00:37:34,808 NON-HISPANIC BLACK PARTICIPANTS, 1229 00:37:34,808 --> 00:37:36,242 AND I'M SHOWING YOU THE NUMBER 1230 00:37:36,242 --> 00:37:38,211 OF PRETERM BIRTHS PER 1,000 LIVE 1231 00:37:38,211 --> 00:37:39,746 BIRTHS BEFORE THE INTERVENTION 1232 00:37:39,746 --> 00:37:42,282 IN THE BLUE CIRCLE AND AFTER THE 1233 00:37:42,282 --> 00:37:43,483 INTERVENTION, IN THE GREY 1234 00:37:43,483 --> 00:37:43,950 TRIANGLE. 1235 00:37:43,950 --> 00:37:46,553 WHAT YOU CAN SEE IS THAT OUR HIP 1236 00:37:46,553 --> 00:37:48,254 THET CAL INTERVENTION REDUCES 1237 00:37:48,254 --> 00:37:50,423 THE PERCENT PRETERM BIRTHS BY 1238 00:37:50,423 --> 00:37:54,260 ABOUT 13%. 1239 00:37:54,260 --> 00:37:56,763 SIMILARLY AMONG HISPANIC LATINA 1240 00:37:56,763 --> 00:37:58,398 PARTICIPANTS, AFTER THE 1241 00:37:58,398 --> 00:38:00,400 INTERVENTION, WE OBSERVE 1242 00:38:00,400 --> 00:38:01,468 DECREASE IN THE NUMBER OF 1243 00:38:01,468 --> 00:38:03,570 PRETERM BIRTHS BY ABOUT 9%. 1244 00:38:03,570 --> 00:38:05,238 NOW WE'RE NOT SAYING HERE THAT 1245 00:38:05,238 --> 00:38:07,841 THIS IS THE ONE FACTOR THAT IS 1246 00:38:07,841 --> 00:38:10,043 CREATING DISPARITIES IN PRETERM 1247 00:38:10,043 --> 00:38:12,345 BIRTH RATES AMONG BLACK AND 1248 00:38:12,345 --> 00:38:14,013 WHITE WOMEN IN THE U.S., BUT 1249 00:38:14,013 --> 00:38:15,882 WE'RE SAYING THAT IT COULD BE A 1250 00:38:15,882 --> 00:38:17,083 POSSIBLE CONTRIBUTOR AND THIS IS 1251 00:38:17,083 --> 00:38:19,719 AN IMPORTANT WAY TO EXAMINE THIS 1252 00:38:19,719 --> 00:38:21,454 DIFFERENCE AND THE CONSEQUENCES 1253 00:38:21,454 --> 00:38:24,524 OF EXPOSURE. 1254 00:38:24,524 --> 00:38:26,860 SO IN CONCLUSION IN REGARDS TO 1255 00:38:26,860 --> 00:38:28,495 EXPOSURE DISPARITY, WE OBSERVED 1256 00:38:28,495 --> 00:38:30,363 THAT NON-HISPANIC BLACK AND 1257 00:38:30,363 --> 00:38:32,499 HISPANIC LATINA PARTICIPANTS HAD 1258 00:38:32,499 --> 00:38:35,301 EXPOSURES THAT WERE AS HIGH AS 1259 00:38:35,301 --> 00:38:37,937 94 TO 148% HIGHER COMPARED TO 1260 00:38:37,937 --> 00:38:39,272 NON-HISPANIC WHITE PARTICIPANTS. 1261 00:38:39,272 --> 00:38:41,474 AND THIS IS AFTER ADJUSTMENT FOR 1262 00:38:41,474 --> 00:38:43,877 FACTORS THAT ARE ASSOCIATED WITH 1263 00:38:43,877 --> 00:38:46,279 BOTH RACE AND ETHNICITY AND WITH 1264 00:38:46,279 --> 00:38:46,646 EXPOSURE. 1265 00:38:46,646 --> 00:38:48,615 WE ALSO OBSERVED SIGNIFICANT 1266 00:38:48,615 --> 00:38:51,351 EFFECT MODIFICATION WITH LARGER 1267 00:38:51,351 --> 00:38:53,119 MAGNITUDES OF ASSOCIATIONS FOR 1268 00:38:53,119 --> 00:38:55,522 MBP AND MIBP AMONG NON-HISPANIC 1269 00:38:55,522 --> 00:38:57,257 BLACK OR HISPANIC LATINA 1270 00:38:57,257 --> 00:38:58,691 PARTICIPANTS COMPARED TO 1271 00:38:58,691 --> 00:39:00,693 NON-HISPANIC WHITE PARTICIPANTS. 1272 00:39:00,693 --> 00:39:02,862 IN TERMS OF PREVENTING PRETERM 1273 00:39:02,862 --> 00:39:03,863 BIRTH, OUR RESULTS PROVIDE 1274 00:39:03,863 --> 00:39:05,265 EVIDENCE THAT IF THESE GROUPS 1275 00:39:05,265 --> 00:39:07,066 HAD NEARLY EQUAL EXPOSURES 1276 00:39:07,066 --> 00:39:09,235 COMPARED TO NON-HISPANIC WHITE 1277 00:39:09,235 --> 00:39:10,804 PARTICIPANTS, THEN THEY MAY HAVE 1278 00:39:10,804 --> 00:39:13,973 FEWER PRETERM BIRTHS. 1279 00:39:13,973 --> 00:39:15,408 SO NOW I'LL MOVE INTO TALKING 1280 00:39:15,408 --> 00:39:17,777 ABOUT THE PUBLIC HEALTH IMPACT 1281 00:39:17,777 --> 00:39:19,445 BRIEFLY. 1282 00:39:19,445 --> 00:39:20,547 SO THE FIRST QUESTION THAT YOU 1283 00:39:20,547 --> 00:39:21,981 MIGHT ASK AFTER SEEING THIS DATA 1284 00:39:21,981 --> 00:39:23,950 IS, ARE THESE HYPOTHESIZED 1285 00:39:23,950 --> 00:39:25,585 REDUCTIONS WORTH PURSUING? 1286 00:39:25,585 --> 00:39:27,153 WE BELIEVE THE ANSWER IS YES. 1287 00:39:27,153 --> 00:39:29,088 PRETERM BIRTH IS A SIGNIFICANT 1288 00:39:29,088 --> 00:39:30,757 PUBLIC HEALTH PROBLEM IN THE 1289 00:39:30,757 --> 00:39:31,724 U.S. AND ELSEWHERE. 1290 00:39:31,724 --> 00:39:34,627 IT AISK AFFECTS ABOUT 10% OF BIS 1291 00:39:34,627 --> 00:39:36,029 IN THE U.S. AND THERE ARE VERY 1292 00:39:36,029 --> 00:39:38,565 FEW KNOWN AND PREVENTABLE RISK 1293 00:39:38,565 --> 00:39:40,767 FACTORS FOR PRETERM BIRTH. 1294 00:39:40,767 --> 00:39:42,635 THE MOST WELL-KNOWN INCLUDE 1295 00:39:42,635 --> 00:39:44,838 SOCIOECONOMIC STATUS, MATERNAL 1296 00:39:44,838 --> 00:39:46,439 AGE AND PREVIOUS PRETERM BIRTH. 1297 00:39:46,439 --> 00:39:48,341 THESE ARE ALL VERY DIFFICULT 1298 00:39:48,341 --> 00:39:49,309 FACTORS TO INTERVENE UPON. 1299 00:39:49,309 --> 00:39:52,045 IN THE OVERALL POPULATION, 1300 00:39:52,045 --> 00:39:54,514 REDUCING EXPOSURE TO PHTHALATES 1301 00:39:54,514 --> 00:39:56,683 BY EVEN JUST 50% IN OUR STUDY 1302 00:39:56,683 --> 00:39:58,551 RESULTED IN ROUGHLY 10% FEWER 1303 00:39:58,551 --> 00:39:59,452 PRETERM BIRTHS. 1304 00:39:59,452 --> 00:40:02,622 THIS WOULD BE THE EQUIVALENT OF 1305 00:40:02,622 --> 00:40:06,025 ABOUT 386,000 PRETERM BIRTHS IN 1306 00:40:06,025 --> 00:40:06,726 2021. 1307 00:40:06,726 --> 00:40:08,561 FINALLY, REDUCING HIGH PHTHALATE 1308 00:40:08,561 --> 00:40:10,563 EXPOSURES AMONG SYSTEMATICALLY 1309 00:40:10,563 --> 00:40:11,764 MARGINALIZED GROUPS WOULD HELP 1310 00:40:11,764 --> 00:40:13,399 TO REDUCE THE RACIAL DISPARITY 1311 00:40:13,399 --> 00:40:14,601 IN PRETERM BIRTH THAT WE 1312 00:40:14,601 --> 00:40:18,204 EXPERIENCE IN THE U.S. 1313 00:40:18,204 --> 00:40:20,506 A SECOND BIG QUESTION IS, ARE 1314 00:40:20,506 --> 00:40:23,376 THESE HYPOTHESIZED REDUCTIONS IN 1315 00:40:23,376 --> 00:40:24,043 EXPOSURE POSSIBLE? 1316 00:40:24,043 --> 00:40:26,212 WE ALSO THINK THE ANSWER IS YES. 1317 00:40:26,212 --> 00:40:27,480 AND THE INVESTIGATION OF 1318 00:40:27,480 --> 00:40:28,982 EXPOSURE DISPARITIES IN 1319 00:40:28,982 --> 00:40:30,884 PARTICULAR, THE HYPOTHETICAL 1320 00:40:30,884 --> 00:40:32,085 EXPOSURE DISTRIBUTIONS THAT WE 1321 00:40:32,085 --> 00:40:35,054 MODELED IN NON-HISPANIC BLACK 1322 00:40:35,054 --> 00:40:36,823 PARTICIPANTS ALREADY ACTUALLY 1323 00:40:36,823 --> 00:40:39,525 EXIST AMONG NON-HISPANIC WHITE 1324 00:40:39,525 --> 00:40:41,194 PARTICIPANTS, SO IT SHOULD BE 1325 00:40:41,194 --> 00:40:41,461 FEASIBLE. 1326 00:40:41,461 --> 00:40:42,729 IN THE OVERALL POPULATION, 1327 00:40:42,729 --> 00:40:44,697 REDUCTION BY 50% SEEMS FEASIBLE 1328 00:40:44,697 --> 00:40:45,465 AS WELL. 1329 00:40:45,465 --> 00:40:47,800 WE'RE NOT SEEING -- SAYING THAT 1330 00:40:47,800 --> 00:40:48,668 THESE EFFECTS WOULD BE OBSERVED 1331 00:40:48,668 --> 00:40:51,204 IF WE ELIMINATED EXPOSURE. 1332 00:40:51,204 --> 00:40:52,739 WE'RE SAYING IF WE REDUCE THEM 1333 00:40:52,739 --> 00:40:54,274 BY 50%, WE WOULD SEE SIGNIFICANT 1334 00:40:54,274 --> 00:40:56,676 EFFECTS. 1335 00:40:56,676 --> 00:40:58,878 AND THIRD, HOW CAN HYPOTHESIZED 1336 00:40:58,878 --> 00:41:00,013 REDUCTIONS HAPPEN? 1337 00:41:00,013 --> 00:41:01,748 THIS IS GOING TO REQUIRE A 1338 00:41:01,748 --> 00:41:02,515 COMBINED APPROACH. 1339 00:41:02,515 --> 00:41:04,817 SO I TALKED ABOUT THE EXPOSURE 1340 00:41:04,817 --> 00:41:05,618 SOURCES AT THE BEGINNING OF THIS 1341 00:41:05,618 --> 00:41:05,818 TALK. 1342 00:41:05,818 --> 00:41:07,687 THIS IS GOING TO REQUIRE 1343 00:41:07,687 --> 00:41:08,988 TARGETING BOTH PERSONAL CARE 1344 00:41:08,988 --> 00:41:11,658 PRODUCT USE AS WELL AS DIETARY 1345 00:41:11,658 --> 00:41:13,726 SOURCES OF EXPOSURE. 1346 00:41:13,726 --> 00:41:15,628 WE BELIEVE THAT PRIORITIZATION 1347 00:41:15,628 --> 00:41:17,764 OF ACTIONS AT THE POPULATION 1348 00:41:17,764 --> 00:41:20,099 LEVEL INCLUDING LEGISLATIVE 1349 00:41:20,099 --> 00:41:21,301 POLICIES AS WELL AS VOLUNTARY 1350 00:41:21,301 --> 00:41:23,603 MARKET REMOVAL RATHER THAN 1351 00:41:23,603 --> 00:41:25,772 INDIVIDUAL LEVEL CHANGES LIKE 1352 00:41:25,772 --> 00:41:27,974 IMPLEMENTING DIETS IN ORGANIC 1353 00:41:27,974 --> 00:41:30,243 FOOD OR USE OF FRAGRANCE-FREE 1354 00:41:30,243 --> 00:41:31,978 ITEMS ARE GOING TO RESULT IN 1355 00:41:31,978 --> 00:41:33,846 MORE EFFECTIVE CHANGE IN 1356 00:41:33,846 --> 00:41:34,948 PHTHALATE EXPOSURE. 1357 00:41:34,948 --> 00:41:36,849 AND FINALLY, INTERVENTIONS HAVE 1358 00:41:36,849 --> 00:41:38,484 TO ACCOUNT FOR THE 1359 00:41:38,484 --> 00:41:40,420 INTERSECTIONALITY OF RACISM, 1360 00:41:40,420 --> 00:41:43,990 SEXISM AND SOCIAL INEQUITY. 1361 00:41:43,990 --> 00:41:46,626 I THINK IT'S REALLY IMPORTANT TO 1362 00:41:46,626 --> 00:41:48,795 POINT OUT THAT PERSONAL LEVEL 1363 00:41:48,795 --> 00:41:50,563 BEHAVIORAL INTERVENTIONS MAY BE 1364 00:41:50,563 --> 00:41:50,897 INEFFECTIVE. 1365 00:41:50,897 --> 00:41:53,633 SO NOT ONLY ARE WE ALREADY 1366 00:41:53,633 --> 00:41:54,534 BURDENING PREGNANT WOMEN BY 1367 00:41:54,534 --> 00:41:55,568 TELLING THEM SO MANY DIFFERENT 1368 00:41:55,568 --> 00:41:57,737 THINGS THAT THEY NEED TO DO 1369 00:41:57,737 --> 00:41:59,739 DURING GESTATION, THINGS TO 1370 00:41:59,739 --> 00:42:02,308 AVOID AND ET CETERA, ADDING ONE 1371 00:42:02,308 --> 00:42:05,845 MORE TO THE LIST IS TOO MUCH IN 1372 00:42:05,845 --> 00:42:07,947 MY OPINION. 1373 00:42:07,947 --> 00:42:09,582 AND ADDITIONALLY, INDIVIDUAL 1374 00:42:09,582 --> 00:42:10,817 LEVEL CHANGES MAY NOT BE 1375 00:42:10,817 --> 00:42:11,517 EFFECTIVE. 1376 00:42:11,517 --> 00:42:13,886 THERE HAVE BEEN TRIALS TO SEE, 1377 00:42:13,886 --> 00:42:16,222 DOES CONSUMING A DIET IN FRESH 1378 00:42:16,222 --> 00:42:17,957 FOOD REDUCE YOUR PHTHALATE 1379 00:42:17,957 --> 00:42:18,591 EXPOSURE? 1380 00:42:18,591 --> 00:42:20,360 AND SOME OF THEM SHOW SOME 1381 00:42:20,360 --> 00:42:22,362 SUCCESS, BUT OTHERS DO NOT. 1382 00:42:22,362 --> 00:42:24,364 SIMILARLY, TRIALS TO CHANGE 1383 00:42:24,364 --> 00:42:26,232 PERSONAL CARE PRODUCT USE 1384 00:42:26,232 --> 00:42:27,633 PATTERNS, TO USE PRODUCTS THAT 1385 00:42:27,633 --> 00:42:30,269 ARE FRAGRANCE-FREE OR 1386 00:42:30,269 --> 00:42:31,404 PHTHALATE-FREE HAVE SHOWN SOME 1387 00:42:31,404 --> 00:42:32,939 SUCCESS BUT NOT FOR ALL 1388 00:42:32,939 --> 00:42:34,807 PHTHALATE METABOLITES, AND NOT 1389 00:42:34,807 --> 00:42:37,410 CONSISTENTLY ACROSS STUDIES. 1390 00:42:37,410 --> 00:42:38,911 ADDITIONALLY, BY IMPLEMENTING 1391 00:42:38,911 --> 00:42:40,980 PERSONAL LEVEL CHANGES, WE'RE 1392 00:42:40,980 --> 00:42:43,149 REALLY RELYING ON THE 1393 00:42:43,149 --> 00:42:45,118 INDIVIDUAL, AND SUCCESS MAY BE 1394 00:42:45,118 --> 00:42:47,153 DEPENDENT ON ACCESS TO 1395 00:42:47,153 --> 00:42:48,354 PHTHALATE-FREE PRODUCT OR TO 1396 00:42:48,354 --> 00:42:49,322 EDUCATION ABOUT WHAT CHEMICALS 1397 00:42:49,322 --> 00:42:51,090 ARE INCLUDED IN THOSE PRODUCTS. 1398 00:42:51,090 --> 00:42:55,628 SO BY FOCUSING ON PERSONAL LEVEL 1399 00:42:55,628 --> 00:42:57,330 INTERVENTION, WE COULD BE 1400 00:42:57,330 --> 00:42:58,931 PERPETUATING THE INEQUITIES THAT 1401 00:42:58,931 --> 00:42:59,465 ALREADY EXIST. 1402 00:42:59,465 --> 00:43:00,767 THIS FIGURE IS FROM A RECENT 1403 00:43:00,767 --> 00:43:02,335 PAIB IN ENVIRONMENTAL HEALTH 1404 00:43:02,335 --> 00:43:04,971 PERSPECTIVES BY MY COLLABORATOR, 1405 00:43:04,971 --> 00:43:07,573 TAMARA TODD, AND IT INVESTIGATED 1406 00:43:07,573 --> 00:43:11,077 THE RISK OF IDENTIFYING PERSONAL 1407 00:43:11,077 --> 00:43:14,180 CARE PRODUCTS THAT HAD HIGH 1408 00:43:14,180 --> 00:43:18,017 HAZARD SCORES IN BOSTON 1409 00:43:18,017 --> 00:43:18,351 NEIGHBORHOODS. 1410 00:43:18,351 --> 00:43:19,852 WHAT THEY OBSERVED IN THAT STUDY 1411 00:43:19,852 --> 00:43:22,955 IS THAT RETAILERS IN BOSTON 1412 00:43:22,955 --> 00:43:24,957 NEIGHBORHOODS WITH A HIGHER 1413 00:43:24,957 --> 00:43:28,227 PERCENT OF RES NENS OF COLOR 1414 00:43:28,227 --> 00:43:29,429 WERE MORE LIKELY TO SELL 1415 00:43:29,429 --> 00:43:30,363 PRODUCTS WITH HIGH HAZARD 1416 00:43:30,363 --> 00:43:30,797 SCORES. 1417 00:43:30,797 --> 00:43:32,732 SO THIS IS A MAP OF BOSTON, AND 1418 00:43:32,732 --> 00:43:35,735 YOU CAN SEE KIND OF IN THE 1419 00:43:35,735 --> 00:43:37,370 CENTER, NUMBER 1 REPRESENTS 1420 00:43:37,370 --> 00:43:38,771 BEACON HILL AND NUMBER 1421 00:43:38,771 --> 00:43:40,106 4 REPRESENTS THE DOWNTOWN AREA. 1422 00:43:40,106 --> 00:43:42,008 THOSE ARE LIGHTER SHADED AREAS 1423 00:43:42,008 --> 00:43:44,077 COMPARED TO THE OTHER 1424 00:43:44,077 --> 00:43:45,711 NEIGHBORHOODS LIKE DORCHESTER 1425 00:43:45,711 --> 00:43:47,480 AND ROXBURY, WHERE YOU SEE 1426 00:43:47,480 --> 00:43:49,382 DARKER SHADING, WHICH INDICATES 1427 00:43:49,382 --> 00:43:52,318 THAT THEY'RE MORE LIKELY TO 1428 00:43:52,318 --> 00:43:53,686 IDENTIFY PERSONAL CARE PRODUCTS 1429 00:43:53,686 --> 00:43:55,154 ON THE SHELVES THAT HAVE HIGH 1430 00:43:55,154 --> 00:43:56,923 HAZARD SCORES ACCORDING TO THE 1431 00:43:56,923 --> 00:43:57,957 ENVIRONMENTAL WORKING GROUP 1432 00:43:57,957 --> 00:44:01,027 DATABASE. 1433 00:44:01,027 --> 00:44:03,663 SO IN TERMS OF WHAT CAN BE DONE 1434 00:44:03,663 --> 00:44:06,332 OUTSIDE OF THE PERSONAL LEVEL, 1435 00:44:06,332 --> 00:44:09,135 PROJECT TENDR, WHICH IS AN 1436 00:44:09,135 --> 00:44:10,903 ORGANIZATION DEDICATED TO 1437 00:44:10,903 --> 00:44:13,306 ADVOCACY AROUND THE USE OF 1438 00:44:13,306 --> 00:44:15,775 CHEMICALS IN PRODUCTS, PUBLISHED 1439 00:44:15,775 --> 00:44:18,111 THIS PAPER IN 2021 THAT GAVE 1440 00:44:18,111 --> 00:44:19,512 SOME RECOMMENDATIONS FOR 1441 00:44:19,512 --> 00:44:21,647 CRITICAL POLICY REFORMS FOR THE 1442 00:44:21,647 --> 00:44:23,049 REDUCTION OF PHTHALATE EXPOSURE 1443 00:44:23,049 --> 00:44:24,684 FOR THE PROTECTION OF BRAIN 1444 00:44:24,684 --> 00:44:26,119 DEVELOPMENT IN CHILDREN. 1445 00:44:26,119 --> 00:44:27,687 SO THEY HAVE SOME REALLY NICE 1446 00:44:27,687 --> 00:44:30,723 EXAMPLES IN THIS PAPER OF SOME 1447 00:44:30,723 --> 00:44:32,291 PUBLIC HEALTH LEVEL CHANGES THAT 1448 00:44:32,291 --> 00:44:34,360 COULD BE MADE TO REDUCE 1449 00:44:34,360 --> 00:44:35,094 PHTHALATE EXPOSURE. 1450 00:44:35,094 --> 00:44:37,130 SOME CAN OCCUR ON THE FEDERAL 1451 00:44:37,130 --> 00:44:38,364 REGULATORY ACTION LEVEL. 1452 00:44:38,364 --> 00:44:40,166 FOR EXAMPLE, THE U.S. CONSUMER 1453 00:44:40,166 --> 00:44:41,801 PRODUCT SAFETY COMMISSION BANNED 1454 00:44:41,801 --> 00:44:44,103 USE OF EIGHT PHTHALATES IN 1455 00:44:44,103 --> 00:44:45,071 CHILDREN'S TOYS. 1456 00:44:45,071 --> 00:44:47,006 SECOND, ANOTHER EXAMPLE IS THAT 1457 00:44:47,006 --> 00:44:50,710 THE U.S. FDA SET MAXIMUM DEHP 1458 00:44:50,710 --> 00:44:53,346 CONCENTRATIONS IN BOTTLED 1459 00:44:53,346 --> 00:44:54,147 DRINKING WATER AT THE SAME 1460 00:44:54,147 --> 00:44:56,215 CONCENTRATION THAT THE EPA SET 1461 00:44:56,215 --> 00:44:57,550 IN DRINKING WATER. 1462 00:44:57,550 --> 00:44:59,018 THERE CAN ALSO BE VOLUNTARY 1463 00:44:59,018 --> 00:45:00,319 ACTION BY RETAILERS. 1464 00:45:00,319 --> 00:45:06,359 I MENTIONED THE EFFORTS THAT 1465 00:45:06,359 --> 00:45:07,560 ANNIE'S IS TRYING TO IMPLEMENT 1466 00:45:07,560 --> 00:45:08,461 EARLIER IN THE TALK. 1467 00:45:08,461 --> 00:45:09,762 ANOTHER EXAMPLE FROM THIS PAPER 1468 00:45:09,762 --> 00:45:13,900 IS THAT PANERA BREAD HAS 1469 00:45:13,900 --> 00:45:15,234 REPLACED VINYL GLOVES WHICH 1470 00:45:15,234 --> 00:45:20,740 CONTAIN PHTHALATES. 1471 00:45:20,740 --> 00:45:22,275 THESE ARE THINGS I THINK CAN 1472 00:45:22,275 --> 00:45:24,143 TRULY LEAD TO AN EQUITABLE 1473 00:45:24,143 --> 00:45:25,478 REDUCTION IN PHTHALATE EXPOSURE 1474 00:45:25,478 --> 00:45:27,380 IN THE U.S., COMPARED TO 1475 00:45:27,380 --> 00:45:28,648 DEMANDING INDIVIDUALS TO MAKE 1476 00:45:28,648 --> 00:45:30,416 CERTAIN CHANGES IN THEIR 1477 00:45:30,416 --> 00:45:32,318 LIFESTYLES. 1478 00:45:32,318 --> 00:45:33,753 SO WITH THAT, I WANT TO 1479 00:45:33,753 --> 00:45:35,621 ACKNOWLEDGE THE WORK OF MY 1480 00:45:35,621 --> 00:45:38,691 FORMER POSTDOCTORAL FELLOWS, DR. 1481 00:45:38,691 --> 00:45:41,460 AND THE SUPPORT OF ALEX KEILL, 1482 00:45:41,460 --> 00:45:42,995 WHO IS NOW IN THE DIVISION OF 1483 00:45:42,995 --> 00:45:44,330 CANCER EPIDEMIOLOGY AND 1484 00:45:44,330 --> 00:45:46,832 GENETICS, THE NCI, WHO IS MY 1485 00:45:46,832 --> 00:45:47,934 METHODOLOGIST, AND STATISTICIAN 1486 00:45:47,934 --> 00:45:50,369 ON THIS STUDY, AND HAS BEEN 1487 00:45:50,369 --> 00:45:53,105 REALLY HELPFUL IN UNDERSTANDING 1488 00:45:53,105 --> 00:45:54,674 KIND OF THE OUTPUT OF THESE 1489 00:45:54,674 --> 00:45:55,341 ANALYSES. 1490 00:45:55,341 --> 00:45:57,276 AND WE HAVE A LARGE NUMBER OF 1491 00:45:57,276 --> 00:45:58,177 COLLABORATORS WHO ARE IN THE 1492 00:45:58,177 --> 00:46:02,114 WORKING GROUPS FOR EACH OF THESE 1493 00:46:02,114 --> 00:46:03,282 PAPERS AND OTHER COLLABORATORS 1494 00:46:03,282 --> 00:46:04,584 FROM THE POOL STUDY. 1495 00:46:04,584 --> 00:46:06,552 I'M SO THANKFUL TO THEM FOR 1496 00:46:06,552 --> 00:46:07,687 CONTRIBUTING THEIR DATA AND 1497 00:46:07,687 --> 00:46:08,154 THEIR TIME. 1498 00:46:08,154 --> 00:46:10,223 THEY WERE UNCOMPENSATED FOR 1499 00:46:10,223 --> 00:46:11,624 THEIR EFFORTS WORKING WITH ME ON 1500 00:46:11,624 --> 00:46:13,626 THIS STUDY, SO I'M VERY GRATEFUL 1501 00:46:13,626 --> 00:46:15,494 TO THEM AND FOR ME FUNDING FROM 1502 00:46:15,494 --> 00:46:21,934 THE INTRAMURAL RESEARCH PROGRAM. 1503 00:46:21,934 --> 00:46:23,102 WITH THAT, I'LL TAKE ANY 1504 00:46:23,102 --> 00:46:23,436 QUESTIONS. 1505 00:46:23,436 --> 00:46:23,736 THANK YOU. 1506 00:46:23,736 --> 00:46:25,838 [APPLAUSE] 1507 00:46:25,838 --> 00:46:28,808 >> THANK YOU FOR THAT VERY 1508 00:46:28,808 --> 00:46:29,308 INTRIGUING PRESENTATION. 1509 00:46:29,308 --> 00:46:30,243 SO THE PEOPLE IN THE ROOM CAN 1510 00:46:30,243 --> 00:46:32,411 COME TO THE MICROPHONE FOR 1511 00:46:32,411 --> 00:46:33,512 QUESTIONS, AND IF YOU'RE 1512 00:46:33,512 --> 00:46:35,314 LISTENING ON THE VIDEOCAST, YOU 1513 00:46:35,314 --> 00:46:36,816 CAN ENTER YOUR QUESTIONS THERE. 1514 00:46:36,816 --> 00:46:39,885 MAYBE LET ME START WITH ONE 1515 00:46:39,885 --> 00:46:40,886 QUESTION. 1516 00:46:40,886 --> 00:46:43,956 SO YOU MENTIONED THAT THESE 1517 00:46:43,956 --> 00:46:45,324 COMPOUNDS ARE UBIQUITOUSLY 1518 00:46:45,324 --> 00:46:45,625 PRESENT. 1519 00:46:45,625 --> 00:46:48,261 SO WHAT COULD WOMEN WHO ARE 1520 00:46:48,261 --> 00:46:50,096 WANTING TO BECOME PREGNANT OR 1521 00:46:50,096 --> 00:46:51,998 WHO ARE IN THE EARLY STAGES OF 1522 00:46:51,998 --> 00:46:53,332 PREGNANCY AND WANTING TO AVOID 1523 00:46:53,332 --> 00:46:55,134 EXPOSURE, WHAT COULD THEY DO 1524 00:46:55,134 --> 00:46:57,803 OTHER THAN NOT USE PERSONAL CARE 1525 00:46:57,803 --> 00:46:59,405 PRODUCTS AND NOT GO TO PANERA 1526 00:46:59,405 --> 00:47:02,108 BREAD WHEN THEY'RE USING THE 1527 00:47:02,108 --> 00:47:02,708 RIGHT GLOVES? 1528 00:47:02,708 --> 00:47:04,143 >> THAT'S A GOOD QUESTION, AND 1529 00:47:04,143 --> 00:47:06,312 YOU KNOW, I HAVE A LOT OF 1530 00:47:06,312 --> 00:47:07,980 FRIENDS WHO ARE TRYING TO GET 1531 00:47:07,980 --> 00:47:10,816 PREGNANT OR WHO ARE PREGNANT OR 1532 00:47:10,816 --> 00:47:11,550 RECENTLY HAD CHILDREN. 1533 00:47:11,550 --> 00:47:12,652 SO I FREQUENTLY GET THIS 1534 00:47:12,652 --> 00:47:14,053 QUESTION, WHAT CAN I DO. 1535 00:47:14,053 --> 00:47:15,488 AND I TELL MY FRIENDS TO NOT 1536 00:47:15,488 --> 00:47:17,290 STRESS OUT TOO MUCH. 1537 00:47:17,290 --> 00:47:18,924 CHANGING A DIETARY BEHAVIOR, 1538 00:47:18,924 --> 00:47:21,227 CHANGING A PERSONAL CARE PRODUCT 1539 00:47:21,227 --> 00:47:22,695 BEHAVIOR MIGHT POSSIBLY REDUCE 1540 00:47:22,695 --> 00:47:24,497 YOUR EXPOSURE, BUT IT'S NOT 1541 00:47:24,497 --> 00:47:24,930 GUARANTEED. 1542 00:47:24,930 --> 00:47:25,798 THERE'S SO MANY DIFFERENT 1543 00:47:25,798 --> 00:47:27,066 SOURCES OF PHTHALATES IN OUR 1544 00:47:27,066 --> 00:47:28,100 ENVIRONMENT THAT IT'S REALLY 1545 00:47:28,100 --> 00:47:29,969 HARD TO REDUCE YOUR INDIVIDUAL 1546 00:47:29,969 --> 00:47:31,704 LEVEL EXPOSURE. 1547 00:47:31,704 --> 00:47:33,239 AND SO INSTEAD, I THINK WE NEED 1548 00:47:33,239 --> 00:47:34,707 TO THINK MORE ABOUT THE CHANGES 1549 00:47:34,707 --> 00:47:37,777 THAT WE CAN MAKE ON A POPULATION 1550 00:47:37,777 --> 00:47:39,745 LEVEL TO REMOVE OR CHANGE THE 1551 00:47:39,745 --> 00:47:41,747 CHEMICALS THAT WE INCLUDE IN 1552 00:47:41,747 --> 00:47:43,082 PRODUCTS THAT WE'RE COMING INTO 1553 00:47:43,082 --> 00:47:44,483 CONTACT WITH ON A DAILY BASIS. 1554 00:47:44,483 --> 00:47:46,018 >> GREAT. 1555 00:47:46,018 --> 00:47:46,285 DR. OWENS. 1556 00:47:46,285 --> 00:47:47,520 >> HI. 1557 00:47:47,520 --> 00:47:50,156 I ENJOYED YOUR TALK. 1558 00:47:50,156 --> 00:47:53,993 WHAT VALIDATION IS THERE THAT 1559 00:47:53,993 --> 00:47:55,661 THERE'S A 100% CORRELATION 1560 00:47:55,661 --> 00:47:56,862 BETWEEN EXPOSURE AND URINE 1561 00:47:56,862 --> 00:47:57,463 LEVELS? 1562 00:47:57,463 --> 00:48:00,933 >> THAT'S A GOOD QUESTION. 1563 00:48:00,933 --> 00:48:03,502 VALIDATION ON THE CORRELATION 1564 00:48:03,502 --> 00:48:05,338 BETWEEN INTAKE AND URINARY 1565 00:48:05,338 --> 00:48:05,705 CONCENTRATIONS. 1566 00:48:05,705 --> 00:48:06,906 THERE HAVE BEEN STUDIES IN 1567 00:48:06,906 --> 00:48:08,307 HUMANS WHERE THEY'VE 1568 00:48:08,307 --> 00:48:10,009 ADMINISTERED PHTHALATES AND 1569 00:48:10,009 --> 00:48:11,844 EXAMINED THE CONCENTRATIONS IN 1570 00:48:11,844 --> 00:48:13,045 URINE. 1571 00:48:13,045 --> 00:48:15,448 I'M NOT SURE -- IT SOUNDS LIKE 1572 00:48:15,448 --> 00:48:16,682 YOU'RE SOMEONE WHO WORKS WITH 1573 00:48:16,682 --> 00:48:18,651 ANIMAL MODELS, AND THINKING MORE 1574 00:48:18,651 --> 00:48:20,553 FROM THIS PERSPECTIVE. 1575 00:48:20,553 --> 00:48:23,489 >> NO, IT'S JUST THAT -- IT'S 1576 00:48:23,489 --> 00:48:25,925 MORE OF A WORDSMITHING ISSUE. 1577 00:48:25,925 --> 00:48:29,195 YOU KNOW, TO TALK ABOUT 1578 00:48:29,195 --> 00:48:30,796 EXPOSURES WHEN YOU'RE ACTUALLY 1579 00:48:30,796 --> 00:48:31,430 MEASURING URINE AND THERE'S A 1580 00:48:31,430 --> 00:48:34,834 LOT THAT HAPPENS BETWEEN 1581 00:48:34,834 --> 00:48:36,502 SOMETHING TOUCHING YOU AND 1582 00:48:36,502 --> 00:48:37,570 ENDING UP IN YOUR URINE. 1583 00:48:37,570 --> 00:48:39,071 >> RIGHT, RIGHT. 1584 00:48:39,071 --> 00:48:41,474 I THINK THAT THEY'RE ACCURATELY 1585 00:48:41,474 --> 00:48:42,775 CATCHING WHAT MAKES THEIR WAY 1586 00:48:42,775 --> 00:48:44,910 INTO THE HUMAN BODY, IF THAT 1587 00:48:44,910 --> 00:48:45,111 IS -- 1588 00:48:45,111 --> 00:48:46,445 >> OKAY, YES, THAT WAS THE 1589 00:48:46,445 --> 00:48:48,247 QUESTION. 1590 00:48:48,247 --> 00:48:52,685 >> WE HAVE A QUESTION FROM 1591 00:48:52,685 --> 00:48:54,286 MIRANDA BROADNEY ONLINE. 1592 00:48:54,286 --> 00:48:55,488 THE QUESTION IS, YOU MAY COVER 1593 00:48:55,488 --> 00:48:57,022 THIS BUT WHAT DO YOU OR THE 1594 00:48:57,022 --> 00:48:59,258 FIELD KNOW ABOUT DIFFERENTIAL 1595 00:48:59,258 --> 00:49:00,893 PHTHALATE EXPOSURE ACROSS 1596 00:49:00,893 --> 00:49:03,429 COMMUNITIES OF BIRTHING MOTHERS? 1597 00:49:03,429 --> 00:49:06,232 >> THAT'S A GOOD QUESTION. 1598 00:49:06,232 --> 00:49:09,335 THE TERM "COMMUNITY" CAN APPLY 1599 00:49:09,335 --> 00:49:12,538 TO A LOT OF THINGS. 1600 00:49:12,538 --> 00:49:14,273 WE TEND TO STUDY KIND OF 1601 00:49:14,273 --> 00:49:15,408 DIFFERENCES BASED ON THE FACTORS 1602 00:49:15,408 --> 00:49:17,076 THAT WE COLLECT IN OUR STUDY, 1603 00:49:17,076 --> 00:49:19,345 WHICH ARE MORE KIND OF 1604 00:49:19,345 --> 00:49:20,913 DEMOGRAPHIC, YOU KNOW, 1605 00:49:20,913 --> 00:49:24,650 COMMUNITIES BASED ON RACE AND 1606 00:49:24,650 --> 00:49:25,985 ETHNICITY, SOME OF OUR STUDIES 1607 00:49:25,985 --> 00:49:27,286 ARE BASED IN DIFFERENT STATES, 1608 00:49:27,286 --> 00:49:30,723 BUT WE DON'T HAVE A LOT OF 1609 00:49:30,723 --> 00:49:31,657 FOCUSED GEOGRAPHIC INFORMATION 1610 00:49:31,657 --> 00:49:33,259 IN THESE STUDIES. 1611 00:49:33,259 --> 00:49:34,894 THAT'S AN AREA THAT I'VE KIND OF 1612 00:49:34,894 --> 00:49:36,595 BEEN INTERESTED IN. 1613 00:49:36,595 --> 00:49:38,664 ARE THERE NEIGHBORHOOD OR 1614 00:49:38,664 --> 00:49:40,933 TEMPORAL DIFFERENCES IN HOW 1615 00:49:40,933 --> 00:49:43,135 THESE EXPOSURE LEVELS CHANGE? 1616 00:49:43,135 --> 00:49:44,503 I THINK THAT'S A REALLY 1617 00:49:44,503 --> 00:49:45,404 IMPORTANT QUESTION FOR FUTURE 1618 00:49:45,404 --> 00:49:46,705 WORK. 1619 00:49:46,705 --> 00:49:49,442 >> AND WE HAVE A COMMENT ONLINE, 1620 00:49:49,442 --> 00:49:51,110 EXCELLENT LINE OF INVESTIGATION. 1621 00:49:51,110 --> 00:49:51,544 CLEAR PRESENTATION. 1622 00:49:51,544 --> 00:49:53,446 THANK YOU VERY MUCH. 1623 00:49:53,446 --> 00:49:56,682 AND IN THE ROOM? 1624 00:49:56,682 --> 00:49:59,919 >> GREAT BR PRESENTATION, KELLY. 1625 00:49:59,919 --> 00:50:01,120 NICE TO HEAR ABOUT ALL OF YOUR 1626 00:50:01,120 --> 00:50:01,654 WORK TO DATE. 1627 00:50:01,654 --> 00:50:02,455 COUPLE QUESTIONS HERE. 1628 00:50:02,455 --> 00:50:04,356 ONE IS, HAVE YOU CONSIDERED 1629 00:50:04,356 --> 00:50:05,357 LOOKING AT THE INTERACTION OF 1630 00:50:05,357 --> 00:50:07,726 THE PHTHALATE EXPOSURE WITH 1631 00:50:07,726 --> 00:50:10,095 OTHER RISK FACTORS FOR PRETERM 1632 00:50:10,095 --> 00:50:10,296 BIRTH? 1633 00:50:10,296 --> 00:50:12,531 AND MIGHT THE TWO TOGETHER, FOR 1634 00:50:12,531 --> 00:50:15,501 EXAMPLE, GIVE A WORSE PREGNANCY 1635 00:50:15,501 --> 00:50:17,036 OUT COME, EVEN EARLIER GESTATION 1636 00:50:17,036 --> 00:50:19,038 OR WORSE OUTCOMES THE A BIRTH? 1637 00:50:19,038 --> 00:50:20,339 >> THAT'S A REALLY GOOD 1638 00:50:20,339 --> 00:50:20,940 QUESTION. 1639 00:50:20,940 --> 00:50:23,342 IT'S SOMETHING THAT I WAS REALLY 1640 00:50:23,342 --> 00:50:24,310 INTERESTED IN WHEN I FIRST CAME 1641 00:50:24,310 --> 00:50:26,412 TO NIEHS, AND I'VE BEEN A LITTLE 1642 00:50:26,412 --> 00:50:27,913 BIT LIMITED IN ABILITY TO 1643 00:50:27,913 --> 00:50:29,081 INVESTIGATE THAT JUST BECAUSE OF 1644 00:50:29,081 --> 00:50:31,484 THE DATA AVAILABILITY, BUT IN 1645 00:50:31,484 --> 00:50:33,252 THE TIDE STUDY WHICH I MENTIONED 1646 00:50:33,252 --> 00:50:35,554 EARLIER, WE EXAMINED 1647 00:50:35,554 --> 00:50:36,422 ASSOCIATIONS BETWEEN PHTHALATES 1648 00:50:36,422 --> 00:50:37,923 AND PRETERM BIRTH AND OBSERVED 1649 00:50:37,923 --> 00:50:38,791 ASSOCIATIONS WITH SOME OF THE 1650 00:50:38,791 --> 00:50:39,458 SAME COMPOUNDS THAT WE DID IN 1651 00:50:39,458 --> 00:50:40,793 THE POOLED STUDY. 1652 00:50:40,793 --> 00:50:42,228 ALSO IN THAT STUDY, WE HAVE 1653 00:50:42,228 --> 00:50:45,297 MEASURES OF PSYCHOSOCIAL STRESS 1654 00:50:45,297 --> 00:50:46,065 DURING PREGNANCY AND WE KNOW 1655 00:50:46,065 --> 00:50:47,666 THAT CAN BE A RISK FACTOR FOR 1656 00:50:47,666 --> 00:50:48,100 PRETERM BIRTH. 1657 00:50:48,100 --> 00:50:50,069 SO I WAS INTERESTED IN IS THERE 1658 00:50:50,069 --> 00:50:51,670 AN INTERACTION BETWEEN THOSE TWO 1659 00:50:51,670 --> 00:50:53,172 EXPOSURES AND INDEED WE DID FIND 1660 00:50:53,172 --> 00:50:54,306 ONE IN THAT STUDY. 1661 00:50:54,306 --> 00:50:56,509 IT WAS A LIMITED SAMPLE SIZE, 1662 00:50:56,509 --> 00:50:58,744 BUT WE FOUND THAT MOTHERS WHO 1663 00:50:58,744 --> 00:51:00,145 EXPERIENCED STRESSFUL LIFE 1664 00:51:00,145 --> 00:51:01,447 EVENTS DURING PREGNANCY, WHICH 1665 00:51:01,447 --> 00:51:05,317 IS JUST ONE OF MANY DIFFERENT 1666 00:51:05,317 --> 00:51:06,352 PARAMETERIZATIONS OF 1667 00:51:06,352 --> 00:51:08,554 PSYCHOSOCIAL STRESS, THOSE WOMEN 1668 00:51:08,554 --> 00:51:09,388 EXPERIENCED AN ASSOCIATION 1669 00:51:09,388 --> 00:51:11,023 BETWEEN PHTHALATE EXPOSURE AND 1670 00:51:11,023 --> 00:51:12,758 PRETERM BIRTH, WHEREAS THOSE WHO 1671 00:51:12,758 --> 00:51:14,360 HAD NO STRESSFUL LIFE EVENT 1672 00:51:14,360 --> 00:51:15,261 DURING PREGNANCY DID NOT. 1673 00:51:15,261 --> 00:51:16,562 SO IT REALLY SHOWED THAT THERE 1674 00:51:16,562 --> 00:51:19,164 COULD BE SOME SORT OF JOINT 1675 00:51:19,164 --> 00:51:21,000 EFFECT OF STRESS AND PHTHALATE 1676 00:51:21,000 --> 00:51:23,435 EXPOSURE ON PREMATURITY. 1677 00:51:23,435 --> 00:51:25,437 >> AND ANOTHER QUESTION IS ABOUT 1678 00:51:25,437 --> 00:51:28,073 THE METABOLISM OF PHTHALATES AND 1679 00:51:28,073 --> 00:51:31,143 WHETHER THERE ARE ANY GENETIC 1680 00:51:31,143 --> 00:51:32,344 POLYMORPHISMS THAT LEAD TO 1681 00:51:32,344 --> 00:51:33,846 DIFFERENCES IN METABOLISM SUCH 1682 00:51:33,846 --> 00:51:36,115 THAT SOME PEOPLE MAY HAVE 1683 00:51:36,115 --> 00:51:37,550 INCREASED EXPOSURE JUST FROM 1684 00:51:37,550 --> 00:51:39,018 THEIR GENETIC RISKS. 1685 00:51:39,018 --> 00:51:42,021 >> THAT'S A REALLY GOOD QUEST 1686 00:51:42,021 --> 00:51:42,288 QUESTION. 1687 00:51:42,288 --> 00:51:43,756 WHEN I WAS WORKING ON MY 1688 00:51:43,756 --> 00:51:45,925 DISSERTATION WORK, THERE WAS AN 1689 00:51:45,925 --> 00:51:51,830 INTEREST IN LOOKING AT THE DEHP 1690 00:51:51,830 --> 00:51:53,098 METABOLITES, WHICH ARE 1691 00:51:53,098 --> 00:51:56,001 METABOLITES FIRST INTO MEHP AND 1692 00:51:56,001 --> 00:52:00,639 THEN SECOND INTO MEOHP, MEHPP, 1693 00:52:00,639 --> 00:52:02,641 MECPP, THE OXIDIZED METABOLITES. 1694 00:52:02,641 --> 00:52:05,377 SO THERE WAS THE IDEA THAT THIS 1695 00:52:05,377 --> 00:52:08,881 KIND OF THE RATIOS OF THOSE 1696 00:52:08,881 --> 00:52:10,249 METABOLITES COULD BE AN 1697 00:52:10,249 --> 00:52:11,884 INDICATOR OF HOW EFFICIENTLY THE 1698 00:52:11,884 --> 00:52:15,955 INDIVIDUAL IS METABOLIZING DEHP. 1699 00:52:15,955 --> 00:52:18,390 AND SO SEVERAL STUDIES KIND OF 1700 00:52:18,390 --> 00:52:19,825 EXAMINED THE RATIO OF THOSE 1701 00:52:19,825 --> 00:52:21,994 COMPOUNDS AS AN EFFECT MODIFIER 1702 00:52:21,994 --> 00:52:24,496 AND ANALYSES TO SEE IF THERE IS 1703 00:52:24,496 --> 00:52:25,898 MORE EFFICIENT METABOLISM INTO 1704 00:52:25,898 --> 00:52:27,566 THESE OXIDIZED METABOLITES, IS 1705 00:52:27,566 --> 00:52:28,901 THAT POSSIBLY PROTECTIVE OR 1706 00:52:28,901 --> 00:52:30,102 SOMETHING LIKE THAT. 1707 00:52:30,102 --> 00:52:32,104 AND IT WASN'T REALLY FOUND TO BE 1708 00:52:32,104 --> 00:52:33,339 AN IMPORTANT EFFECT MODIFIER IN 1709 00:52:33,339 --> 00:52:35,741 THE PAPERS THAT EXISTED. 1710 00:52:35,741 --> 00:52:39,144 SO IN TERMS OF DOING AN ACTUAL 1711 00:52:39,144 --> 00:52:41,447 GENETIC STUDY AND LOOKING AT 1712 00:52:41,447 --> 00:52:42,381 POLYMORPHISMS IN ASSOCIATION 1713 00:52:42,381 --> 00:52:43,349 WITH EXPOSURE, I'M NOT FAMILIAR 1714 00:52:43,349 --> 00:52:44,116 WITH THAT LITERATURE. 1715 00:52:44,116 --> 00:52:46,218 I DON'T KNOW IF IT EXISTS. 1716 00:52:46,218 --> 00:52:48,687 BUT IT'S A REALLY INTERESTING 1717 00:52:48,687 --> 00:52:49,154 QUESTION. 1718 00:52:49,154 --> 00:52:49,521 >> THANK YOU. 1719 00:52:49,521 --> 00:52:57,096 >> WE HAVE A COMMENT FROM DR 1720 00:52:57,096 --> 00:52:58,998 DR. ELISEO, HE SAYS ONE WAY TO 1721 00:52:58,998 --> 00:53:02,101 LOWER THE RISK FACTOR IS THROUGH 1722 00:53:02,101 --> 00:53:04,069 DIRECTED CACHE ASSISTANCE, WHICH 1723 00:53:04,069 --> 00:53:04,703 WORKS. 1724 00:53:04,703 --> 00:53:05,304 GREAT PRESENTATION. 1725 00:53:05,304 --> 00:53:05,804 >> THANK YOU VERY MUCH. 1726 00:53:05,804 --> 00:53:08,841 APPRECIATE IT. 1727 00:53:08,841 --> 00:53:10,909 >> WE HAVE ANOTHER QUESTION 1728 00:53:10,909 --> 00:53:13,312 ONLINE FROM NOR WHITE. 1729 00:53:13,312 --> 00:53:15,014 REGARDING THE RACIAL 1730 00:53:15,014 --> 00:53:16,548 SOCIOECONOMIC DISPARITY IN 1731 00:53:16,548 --> 00:53:18,317 PERSONAL CARE PRODUCT EXPOSURE, 1732 00:53:18,317 --> 00:53:21,854 IS THE PROBLEM THAT CHEAPER 1733 00:53:21,854 --> 00:53:22,955 PRODUCTS HAVE MORE PHTHALATES OR 1734 00:53:22,955 --> 00:53:24,089 IS THERE A CULTURAL PREFERENCE 1735 00:53:24,089 --> 00:53:25,057 FOR CERTAIN PRODUCTS THAT HAPPEN 1736 00:53:25,057 --> 00:53:27,826 TO HAVE HIGHER THAT WILL LATES 1737 00:53:27,826 --> 00:53:29,561 AND THAT'S THE ISSUE, OR BOTH? 1738 00:53:29,561 --> 00:53:31,997 >> I THINK BOTH IS THE ANSWER. 1739 00:53:31,997 --> 00:53:33,565 THAT'S A REALLY GOOD QUESTION, 1740 00:53:33,565 --> 00:53:37,002 AND SOMETHING THAT MY COLLEAGUE 1741 00:53:37,002 --> 00:53:42,107 AMI SOTA HAS ADDRESSED, THE 1742 00:53:42,107 --> 00:53:42,875 DISCUSSION AROUND CERTAIN 1743 00:53:42,875 --> 00:53:44,043 PERSONAL CARE PRODUCT THAT ARE 1744 00:53:44,043 --> 00:53:45,778 USED MORE BY COMMUNITIES OF 1745 00:53:45,778 --> 00:53:47,413 COLOR TENDING TO HAVE HIGHER 1746 00:53:47,413 --> 00:53:49,581 LEVELS OF SOME OF THESE CHEMICAL 1747 00:53:49,581 --> 00:53:49,848 EXPOSURES. 1748 00:53:49,848 --> 00:53:51,583 SO I THINK IT'S REALLY SOMETHING 1749 00:53:51,583 --> 00:53:53,752 TO PAY ATTENTION TO WHEN WE'RE 1750 00:53:53,752 --> 00:53:55,320 KIND OF INVESTIGATING HOW CAN WE 1751 00:53:55,320 --> 00:53:56,422 REDUCE EXPOSURE LEVELS. 1752 00:53:56,422 --> 00:53:57,823 >> WE HAVE A COUPLE MORE 1753 00:53:57,823 --> 00:53:59,992 QUESTIONS ONLINE. 1754 00:53:59,992 --> 00:54:01,193 ONE FROM STEVEN GILMAN. 1755 00:54:01,193 --> 00:54:03,162 THANK YOU SO MUCH FOR THIS 1756 00:54:03,162 --> 00:54:04,263 REALLY IMPORTANT TALK. 1757 00:54:04,263 --> 00:54:05,731 IT WOULD BE INTERESTING -- I 1758 00:54:05,731 --> 00:54:06,932 WOULD BE INTERESTED IN YOUR 1759 00:54:06,932 --> 00:54:08,367 THOUGHTS ON STUDYING PHTHALATES 1760 00:54:08,367 --> 00:54:10,669 IN THE CONTEXT OF EXPOSOME 1761 00:54:10,669 --> 00:54:11,603 APPROACHES. 1762 00:54:11,603 --> 00:54:12,805 THAT MAY ALSO INCORPORATE OTHER 1763 00:54:12,805 --> 00:54:14,840 TYPES OF CHEMICALS, INCLUDING, 1764 00:54:14,840 --> 00:54:15,708 FOR EXAMPLE, AIR POLLUTION, 1765 00:54:15,708 --> 00:54:17,209 WHICH IS ALSO ASSOCIATED WITH 1766 00:54:17,209 --> 00:54:18,277 PRETERM BIRTH. 1767 00:54:18,277 --> 00:54:19,778 >> YEAH, THAT'S A REALLY 1768 00:54:19,778 --> 00:54:20,879 IMPORTANT KIND OF NEXT STEP THAT 1769 00:54:20,879 --> 00:54:23,649 I'M INTERESTED IN MY RESEARCH 1770 00:54:23,649 --> 00:54:24,416 GROUP AT NIEHS. 1771 00:54:24,416 --> 00:54:26,518 SO WE KNOW THAT PHTHALATES ARE 1772 00:54:26,518 --> 00:54:27,486 JUST ONE CLASS OF CHEMICALS THAT 1773 00:54:27,486 --> 00:54:31,790 ARE INCLUDED IN PLASTICIZERS AND 1774 00:54:31,790 --> 00:54:32,891 WE'RE SIMULTANEOUSLY EXPOSED TO 1775 00:54:32,891 --> 00:54:34,126 MANY OTHER CHEMICALS THROUGH 1776 00:54:34,126 --> 00:54:35,828 PLASTICS AND OTHER CHEMICALS 1777 00:54:35,828 --> 00:54:36,061 BESIDES. 1778 00:54:36,061 --> 00:54:37,596 SO KIND OF THE JOINT EFFECTS 1779 00:54:37,596 --> 00:54:39,331 THAT WE TALKED ABOUT EARLIER, 1780 00:54:39,331 --> 00:54:40,799 LIKE UNDERSTANDING THE 1781 00:54:40,799 --> 00:54:41,734 COMBINATIONS OF THOSE MULTIPLE 1782 00:54:41,734 --> 00:54:43,535 DIFFERENT CHEMICALS TO PRETERM 1783 00:54:43,535 --> 00:54:44,536 BIRTH IS SOMETHING THAT I'M 1784 00:54:44,536 --> 00:54:46,205 REALLY INTERESTED IN 1785 00:54:46,205 --> 00:54:49,274 UNDERSTANDING, AND ALSO HOW THE 1786 00:54:49,274 --> 00:54:50,509 CORRELATIONS EXIST AMONG THESE 1787 00:54:50,509 --> 00:54:51,143 CHEMICALS. 1788 00:54:51,143 --> 00:54:52,578 SO JUST BECAUSE WE'RE ONLY 1789 00:54:52,578 --> 00:54:53,512 MEASURING PHTHALATES, YOU KNOW, 1790 00:54:53,512 --> 00:54:55,280 THERE COULD BE OTHER CHEMICALS 1791 00:54:55,280 --> 00:54:58,751 THAT ARE ASSOCIATED WITH 1792 00:54:58,751 --> 00:55:00,519 PHTHALATE EXPOSURE THAT ARE ALSO 1793 00:55:00,519 --> 00:55:01,353 CONTRIBUTING TO PRETERM BIRTH 1794 00:55:01,353 --> 00:55:02,788 AND WE NEED TO UNDERSTAND, ARE 1795 00:55:02,788 --> 00:55:04,089 WE INVESTIGATING THE RIGHT 1796 00:55:04,089 --> 00:55:05,724 CHEMICAL EXPOSURE, ARE THERE 1797 00:55:05,724 --> 00:55:06,792 OTHER CHEMICAL EXPOSURES OUT 1798 00:55:06,792 --> 00:55:09,561 THERE THAT NEED MORE ATTENTION. 1799 00:55:09,561 --> 00:55:12,364 >> VERY NICE TALK. 1800 00:55:12,364 --> 00:55:13,866 IN THE DATA YOU PRESENTED IN THE 1801 00:55:13,866 --> 00:55:15,300 CHANGE IN PHTHALATES OVER THE 1802 00:55:15,300 --> 00:55:16,235 TRIMESTERS, IT LOOKED LIKE THERE 1803 00:55:16,235 --> 00:55:17,936 WAS AN INCREASE AROUND WEEK 12 1804 00:55:17,936 --> 00:55:18,570 FOR YOUR CASES. 1805 00:55:18,570 --> 00:55:20,072 DO YOU HAVE AN IDEA ABOUT WHAT 1806 00:55:20,072 --> 00:55:21,940 THAT MIGHT BE, AND DID THAT 1807 00:55:21,940 --> 00:55:23,442 PATTERN HOLD UP THE SAME ACROSS 1808 00:55:23,442 --> 00:55:25,511 RACIAL GROUPS OR DID DIFFERENT 1809 00:55:25,511 --> 00:55:26,612 RACIAL GROUPS HAVE DIFFERENT 1810 00:55:26,612 --> 00:55:28,480 CHANGES OVER TIME DURING THEIR 1811 00:55:28,480 --> 00:55:28,747 PREGNANCY? 1812 00:55:28,747 --> 00:55:30,749 >> THAT'S A REALLY GOOD 1813 00:55:30,749 --> 00:55:31,383 QUESTION. 1814 00:55:31,383 --> 00:55:34,119 I HAVE KIND OF STAYED AWAY FROM 1815 00:55:34,119 --> 00:55:35,988 FOCUSING ON THE WIGGLES IN THOSE 1816 00:55:35,988 --> 00:55:37,689 PLOTS TOO MUCH BECAUSE WE DON'T 1817 00:55:37,689 --> 00:55:39,458 HAVE GREAT REPRESENTATION FROM 1818 00:55:39,458 --> 00:55:41,426 ALL PARTICIPANTS ACROSS EACH OF 1819 00:55:41,426 --> 00:55:42,728 THOSE TIME PERIODS. 1820 00:55:42,728 --> 00:55:44,730 SO SOME OF THE VARIABILITY THAT 1821 00:55:44,730 --> 00:55:46,365 YOU OBSERVE COULD JUST BE DUE TO 1822 00:55:46,365 --> 00:55:48,834 THE FACT THAT ONE COHORT HAS 1823 00:55:48,834 --> 00:55:49,701 DATA AVAILABLE IN THAT AREA. 1824 00:55:49,701 --> 00:55:50,969 SO WE TRIED TO LOOK AT THE 1825 00:55:50,969 --> 00:55:52,070 GENERAL TRENDS AND WHEN DO WE 1826 00:55:52,070 --> 00:55:53,906 TEND TO OBSERVE DIFFERENCES IN 1827 00:55:53,906 --> 00:55:55,741 CASES AND CONTROLS ACROSS 1828 00:55:55,741 --> 00:55:57,142 TRIMESTERS. 1829 00:55:57,142 --> 00:56:00,245 IN TERMS OF WHETHER OR NOT THOSE 1830 00:56:00,245 --> 00:56:02,748 DIFFERENCES SIMILARLY EXIST 1831 00:56:02,748 --> 00:56:04,550 ACROSS RACIAL AND ETHNIC GROUPS, 1832 00:56:04,550 --> 00:56:06,585 WE HAVEN'T EXAMINED THAT IN THE 1833 00:56:06,585 --> 00:56:08,120 PERIODS OF SUSCEPTIBILITY 1834 00:56:08,120 --> 00:56:08,387 ANALYSIS. 1835 00:56:08,387 --> 00:56:10,689 WE DIDN'T HAVE A STRONG REASON 1836 00:56:10,689 --> 00:56:13,458 TO BELIEVE OR TO SUSPECT THAT 1837 00:56:13,458 --> 00:56:14,860 PERIODS OF SUSCEPTIBILITY WOULD 1838 00:56:14,860 --> 00:56:17,696 BE DIFFERENT BY MATERNAL RACE 1839 00:56:17,696 --> 00:56:18,764 AND ETHNICITY, BUT IT IS 1840 00:56:18,764 --> 00:56:19,731 SOMETHING WE COULD EXPLORE. 1841 00:56:19,731 --> 00:56:20,065 GOOD IDEA. 1842 00:56:20,065 --> 00:56:25,037 >> WE HAVE ANOTHER QUESTION FROM 1843 00:56:25,037 --> 00:56:25,938 JONATHAN TALBOT. 1844 00:56:25,938 --> 00:56:27,372 MEDIA COVERAGE ON RECENT STUDIES 1845 00:56:27,372 --> 00:56:29,007 OF PHTHALATES INCLUDES CRITICISM 1846 00:56:29,007 --> 00:56:30,509 OF METHODOLOGIES THAT EXAMINE 1847 00:56:30,509 --> 00:56:31,376 MULTIPLE PHTHALATES TOGETHER. 1848 00:56:31,376 --> 00:56:33,212 IS THIS A LEGITIMATE CONCERN, 1849 00:56:33,212 --> 00:56:34,847 AND IS THERE ANOTHER WAY TO 1850 00:56:34,847 --> 00:56:35,714 ESTABLISH POSSIBLE ASSOCIATION? 1851 00:56:35,714 --> 00:56:37,115 >> YEAH, THAT'S A REALLY GOOD 1852 00:56:37,115 --> 00:56:37,883 QUESTION. 1853 00:56:37,883 --> 00:56:40,185 EXAMINING PHTHALATES TOGETHER IS 1854 00:56:40,185 --> 00:56:42,354 MORE REALISTIC, I BELIEVE, AND 1855 00:56:42,354 --> 00:56:45,624 IT DOES KIND OF REFLECT KIND OF 1856 00:56:45,624 --> 00:56:46,925 WHAT WE'RE GETTING AT, WHICH IS 1857 00:56:46,925 --> 00:56:49,428 THE IMPACT OF AN INTERVENTION TO 1858 00:56:49,428 --> 00:56:50,829 AVOID PHTHALATES GENERALLY, HOW 1859 00:56:50,829 --> 00:56:52,598 WOULD AVOIDING PHTHALATES 1860 00:56:52,598 --> 00:56:53,899 GENERALLY RESULT IN LOWER 1861 00:56:53,899 --> 00:56:59,238 EXPOSURE LEVELS IN A CHA AND A N 1862 00:56:59,238 --> 00:56:59,905 YOUR PREGNANCY OUT COME. 1863 00:56:59,905 --> 00:57:01,540 IN TERMS OF UNDERSTANDING THE 1864 00:57:01,540 --> 00:57:02,274 TOXICITY OF INDIVIDUAL 1865 00:57:02,274 --> 00:57:03,275 COMPOUNDS, I THINK IT'S REALLY 1866 00:57:03,275 --> 00:57:06,278 IMPORTANT THAT EVERY STUDY THAT 1867 00:57:06,278 --> 00:57:07,613 EXAMINES A GROUP OF CHEMICALS OR 1868 00:57:07,613 --> 00:57:09,348 JOINT EFFECT OF KESM KALS NEEDS 1869 00:57:09,348 --> 00:57:11,950 TO HE EXAMINE CHEMICALS ONE AT A 1870 00:57:11,950 --> 00:57:12,251 TIME. 1871 00:57:12,251 --> 00:57:14,987 IN ORDER TO COMBINE DATA ACROSS 1872 00:57:14,987 --> 00:57:17,222 PAPERS IN META-ANALYSIS IN ORDER 1873 00:57:17,222 --> 00:57:18,924 TO FORM RISK ASSESSMENT, IT'S 1874 00:57:18,924 --> 00:57:21,326 REALLY IMPORTANT TO STUDY 1875 00:57:21,326 --> 00:57:21,994 CHEMICALS ONE AT A TIME. 1876 00:57:21,994 --> 00:57:23,528 SO WHILE I THINK IT IS USEFUL TO 1877 00:57:23,528 --> 00:57:24,496 UNDERSTAND THE PUBLIC HEALTH 1878 00:57:24,496 --> 00:57:25,998 IMPACT OF EXAMINING JOINT 1879 00:57:25,998 --> 00:57:27,399 EFFECTS, I THINK FOCUSING ON 1880 00:57:27,399 --> 00:57:29,935 MAKING SURE THAT WE EXAMINE 1881 00:57:29,935 --> 00:57:31,203 CHEMICALS ONE AT A TIME IN OUR 1882 00:57:31,203 --> 00:57:33,338 ANALYSES IS IMPORTANT. 1883 00:57:33,338 --> 00:57:35,540 >> SO I'M JUST CURIOUS, MAYBE 1884 00:57:35,540 --> 00:57:36,541 SPEND A MINUTE OR TWO TALKING 1885 00:57:36,541 --> 00:57:38,076 ABOUT WHERE YOU THINK YOU'RE 1886 00:57:38,076 --> 00:57:39,711 GOING IN THE FUTURE WITH THIS. 1887 00:57:39,711 --> 00:57:41,780 SO WHAT ARE YOUR NEXT STEPS IN 1888 00:57:41,780 --> 00:57:43,282 TERMS OF EITHER THE COMBINED 1889 00:57:43,282 --> 00:57:45,284 COHORT OR OTHERWISE? 1890 00:57:45,284 --> 00:57:46,251 >> THAT'S A GOOD QUESTION. 1891 00:57:46,251 --> 00:57:47,953 SO THERE ARE SOME LIMITATIONS TO 1892 00:57:47,953 --> 00:57:49,388 WORKING IN A POOLED STUDY. 1893 00:57:49,388 --> 00:57:51,123 I THINK THAT THIS HAS BEEN 1894 00:57:51,123 --> 00:57:53,625 REALLY USEFUL FOR IDENTIFYING A 1895 00:57:53,625 --> 00:57:54,960 LARGE NUMBER OF PRETERM BIRTH 1896 00:57:54,960 --> 00:57:55,928 CASES, SOMETHING THAT WE 1897 00:57:55,928 --> 00:57:58,530 COULDN'T GET OUT OF, YOU KNOW, A 1898 00:57:58,530 --> 00:58:01,266 STUDY -- A SINGLE STUDY. 1899 00:58:01,266 --> 00:58:03,669 BUT THE LIMITATIONS ARE KIND OF 1900 00:58:03,669 --> 00:58:05,170 IN THESE OTHER DATA THAT WE'RE 1901 00:58:05,170 --> 00:58:07,372 INTERESTED IN THAT COULD BE 1902 00:58:07,372 --> 00:58:09,641 CO-OCCURRING WITH THE EXPOSURES 1903 00:58:09,641 --> 00:58:10,742 THAT WE'RE MEASURING. 1904 00:58:10,742 --> 00:58:12,878 SO EXPANDING BEYOND LOOKING AT 1905 00:58:12,878 --> 00:58:14,313 PHTHALATES BY THEMSELVES AND 1906 00:58:14,313 --> 00:58:15,180 EXAMINING OTHER CHEMICALS THAT 1907 00:58:15,180 --> 00:58:16,915 ARE FOUND IN PLASTICS IN THE 1908 00:58:16,915 --> 00:58:18,250 ENVIRONMENT AND KIND OF THE 1909 00:58:18,250 --> 00:58:20,752 JOINT EFFECTS OF THESE CHEMICALS 1910 00:58:20,752 --> 00:58:22,054 SIMULTANEOUSLY IS ONE INTEREST 1911 00:58:22,054 --> 00:58:23,322 AREA. 1912 00:58:23,322 --> 00:58:25,190 ALSO MODIFYING EFFECTS OF THINGS 1913 00:58:25,190 --> 00:58:26,491 LIKE PSYCHOSOCIAL STRESSORS. 1914 00:58:26,491 --> 00:58:28,694 I THINK THAT'S REALLY IMPORTANT, 1915 00:58:28,694 --> 00:58:29,761 AND INVESTIGATING THE ROLE OF 1916 00:58:29,761 --> 00:58:30,429 DIET. 1917 00:58:30,429 --> 00:58:32,264 NOBODY BROUGHT IT UP, THAT'S 1918 00:58:32,264 --> 00:58:33,398 USUALLY MY VERY FIRST QUESTION 1919 00:58:33,398 --> 00:58:34,900 WHEN I TALK ABOUT THIS RESEARCH, 1920 00:58:34,900 --> 00:58:36,168 IS THAT PHTHALATE EXPOSURES COME 1921 00:58:36,168 --> 00:58:37,703 FROM THE DIET, AND DIET IS 1922 00:58:37,703 --> 00:58:38,470 IMPORTANT FOR HEALTH. 1923 00:58:38,470 --> 00:58:40,105 SO WHAT IS THE POTENTIAL 1924 00:58:40,105 --> 00:58:41,840 CONFOUNDING ROLE OF DIET IN THIS 1925 00:58:41,840 --> 00:58:42,174 SCENARIO? 1926 00:58:42,174 --> 00:58:44,743 AND WE HAVE EXAMINED DIET IN 1927 00:58:44,743 --> 00:58:47,913 OTHER STUDIES, CALORIC INTAKE, 1928 00:58:47,913 --> 00:58:50,349 AMOUNT OF FRUIT AND VEGETABLE 1929 00:58:50,349 --> 00:58:50,649 INTAKE. 1930 00:58:50,649 --> 00:58:52,818 WE DON'T REALLY SEE A BIG IMPACT 1931 00:58:52,818 --> 00:58:54,486 OF ADJUSTING FOR THOSE FACTORS 1932 00:58:54,486 --> 00:58:57,522 IN OUR ANALYSES, BUT ONE OF THE 1933 00:58:57,522 --> 00:58:58,790 MAIN OR A BIG EXPOSURE SOURCE 1934 00:58:58,790 --> 00:59:00,459 FOR PHTHALATES IS ULTRAPROCESSED 1935 00:59:00,459 --> 00:59:01,426 FOOD. 1936 00:59:01,426 --> 00:59:03,428 AND I THINK THAT THERE NEEDS TO 1937 00:59:03,428 --> 00:59:05,864 BE MORE WORK TO UNDERSTAND HOW 1938 00:59:05,864 --> 00:59:07,866 THAT EXPOSURE SOURCE, 1939 00:59:07,866 --> 00:59:08,734 PARTICULARLY COULD BE 1940 00:59:08,734 --> 00:59:11,336 POTENTIALLY CONFOUNDING THE 1941 00:59:11,336 --> 00:59:12,537 RESULTS THAT WE'RE LOOKING AT. 1942 00:59:12,537 --> 00:59:14,506 SO I'M INTERESTED IN KIND OF 1943 00:59:14,506 --> 00:59:15,640 EXPANDING THE EXPOSURES FROM 1944 00:59:15,640 --> 00:59:16,641 LOOKING AT ONE CLASS OF A 1945 00:59:16,641 --> 00:59:18,610 CHEMICAL TO THE EXPOSOME. 1946 00:59:18,610 --> 00:59:19,845 I'M ALSO INTERESTED IN 1947 00:59:19,845 --> 00:59:22,614 UNDERSTANDING THE BIOLOGY 1948 00:59:22,614 --> 00:59:22,848 FURTHER. 1949 00:59:22,848 --> 00:59:24,182 SO AS I MENTIONED KIND OF 1950 00:59:24,182 --> 00:59:25,050 BRIEFLY, YOU KNOW, WE'RE 1951 00:59:25,050 --> 00:59:27,419 INTERESTED IN UNDERSTANDING 1952 00:59:27,419 --> 00:59:28,620 INFLAMMATION AND OXIDATIVE 1953 00:59:28,620 --> 00:59:30,188 STRESS PATHWAYS IN PREGNANCY 1954 00:59:30,188 --> 00:59:32,024 THAT COULD BE UPREGULATED IN 1955 00:59:32,024 --> 00:59:33,859 RESPONSE TO PHTHALATE AND OTHER 1956 00:59:33,859 --> 00:59:35,027 CHEMICAL EXPOSURES, AND HOW 1957 00:59:35,027 --> 00:59:37,863 THOSE PLAY A ROLE IN PRETERM 1958 00:59:37,863 --> 00:59:38,530 BIRTH. 1959 00:59:38,530 --> 00:59:39,931 SO WE'RE STUDYING THOSE MORE, 1960 00:59:39,931 --> 00:59:44,603 AND THAT KIND OF ALSO INVOLVES 1961 00:59:44,603 --> 00:59:45,303 INVESTIGATING OUR OUT COME IN 1962 00:59:45,303 --> 00:59:45,937 MORE DETAIL. 1963 00:59:45,937 --> 00:59:48,440 SO IN THE STUDY, WE EXAMINED 1964 00:59:48,440 --> 00:59:50,609 PRETERM BIRTH AS DELIVERY BEFORE 1965 00:59:50,609 --> 00:59:51,610 37 WEEKS GESTATION BUT ANY 1966 00:59:51,610 --> 00:59:54,179 CLINICIAN KNOWS THAT THAT IS NOT 1967 00:59:54,179 --> 00:59:55,414 THE BEST OUT COME TO LOOK AT. 1968 00:59:55,414 --> 00:59:57,249 THERE'S EARLIER PRETERM BIRTH 1969 00:59:57,249 --> 01:00:00,652 WHICH HAS WORSE EFFECTS FOR THE 1970 01:00:00,652 --> 01:00:01,620 DEVELOPING CHILD. 1971 01:00:01,620 --> 01:00:02,788 THERE'S ALSO DIFFERENT 1972 01:00:02,788 --> 01:00:03,989 PRESENTATIONS OF PRETERM BIRTH. 1973 01:00:03,989 --> 01:00:05,624 THERE'S A SPONTANEOUS PRETERM 1974 01:00:05,624 --> 01:00:07,192 BIRTH VERSUS ONE THAT IS 1975 01:00:07,192 --> 01:00:08,193 DELIVERED BY THE OBSTETRICIAN 1976 01:00:08,193 --> 01:00:08,994 BECAUSE SOMETHING IS GOING WRONG 1977 01:00:08,994 --> 01:00:12,197 WITH THE FETUS IN UTERO. 1978 01:00:12,197 --> 01:00:13,598 SO KIND OF ISOLATING THESE 1979 01:00:13,598 --> 01:00:15,867 DIFFERENT OUTCOMES MORE 1980 01:00:15,867 --> 01:00:17,002 SPECIFICALLY IS SOMETHING THAT 1981 01:00:17,002 --> 01:00:18,603 I'D LIKE TO FOCUS ON IN THE 1982 01:00:18,603 --> 01:00:18,837 FUTURE. 1983 01:00:18,837 --> 01:00:21,139 >> LAST QUESTION IN THE ONE 1984 01:00:21,139 --> 01:00:23,175 MINUTE WE HAVE LEFT FROM TANYA 1985 01:00:23,175 --> 01:00:23,842 WHITE. 1986 01:00:23,842 --> 01:00:26,144 SOMETIMES WHEN PRODUCTS ARE 1987 01:00:26,144 --> 01:00:27,879 REDUCED IN PRODUCTS -- CHEMICALS 1988 01:00:27,879 --> 01:00:29,247 ARE REDUCED IN PRODUCTS, THEY 1989 01:00:29,247 --> 01:00:30,549 ARE REPLACED BY PRODUCTS THAT 1990 01:00:30,549 --> 01:00:32,084 HAVE NOT BEEN STUDIED OR COULD 1991 01:00:32,084 --> 01:00:32,918 BE POTENTIALLY WORSE. 1992 01:00:32,918 --> 01:00:34,052 IS THIS AN AREA OF CONCERN? 1993 01:00:34,052 --> 01:00:36,021 >> YEAH, THIS IS DEFINITELY A 1994 01:00:36,021 --> 01:00:38,423 HUGE AREA OF CONCERN. 1995 01:00:38,423 --> 01:00:40,892 MY GROUP HAS DONE SOME WORK 1996 01:00:40,892 --> 01:00:43,295 LOOKING AT SOME OF THE PHTHALATE 1997 01:00:43,295 --> 01:00:43,929 REPLACEMENTS AND OTHER COMPOUNDS 1998 01:00:43,929 --> 01:00:46,331 THAT HAVE BEEN USED TO REPLACE 1999 01:00:46,331 --> 01:00:49,401 PRIMARILY DEHP AS A PLASTICIZER, 2000 01:00:49,401 --> 01:00:50,502 BECAUSE THOSE ARE BEING 2001 01:00:50,502 --> 01:00:51,803 INTRODUCED TO THE MARKET AND 2002 01:00:51,803 --> 01:00:52,571 HAVE NOT BEEN STUDIED 2003 01:00:52,571 --> 01:00:53,004 THOROUGHLY. 2004 01:00:53,004 --> 01:00:54,206 SO WE'RE KIND OF FOCUSING ON 2005 01:00:54,206 --> 01:00:55,207 THOSE RIGHT NOW, BUT THERE'S A 2006 01:00:55,207 --> 01:00:57,242 LOT OF OTHER CHEMICALS AS WELL. 2007 01:00:57,242 --> 01:01:00,145 SO SUGGESTING A PHASE-OUT, IF WE 2008 01:01:00,145 --> 01:01:01,613 SEE A TOXIC EFFECT OF A 2009 01:01:01,613 --> 01:01:02,914 CHEMICAL, WE STILL NEED TO 2010 01:01:02,914 --> 01:01:04,549 ADDRESS IT. 2011 01:01:04,549 --> 01:01:06,852 BUT THERE DOES NEED TO BE SOME 2012 01:01:06,852 --> 01:01:07,886 ATTENTION TO KIND OF WHAT'S 2013 01:01:07,886 --> 01:01:08,887 GOING TO COME NEXT. 2014 01:01:08,887 --> 01:01:09,354 >> GREAT. 2015 01:01:09,354 --> 01:01:10,255 SO I THINK WE'RE AT THE TOP OF 2016 01:01:10,255 --> 01:01:12,257 THE HOUR, SO LET'S AGAIN THANK 2017 01:01:12,257 --> 01:01:13,158 DR. FERGUSON FOR A WONDERFUL 2018 01:01:13,158 --> 01:01:13,358 TALK. 2019 01:01:13,358 --> 01:01:14,793 [APPLAUSE] 2020 01:01:14,793 --> 01:01:25,337 >> THANK YOU FOR YOUR ATTENTION.