Pregnant women and their offspring are vulnerable to the adverse effects of environmental and psychosocial stressors, individually and in combination. Here, we review the literature on how air pollution and metal exposures may interact with structural and individual-level stressors (including poverty and stressful life events) to impact perinatal and child outcomes. The adverse associations between air pollution and metal exposures and adverse infant and child health outcomes are often exacerbated by co-exposure to psychosocial stressors. Although studies vary by geography, study population, pollutants, stressors, and outcomes considered, the effects of environmental exposures and psychosocial stressors on early health outcomes are sometimes stronger when considered in combination than individually. Environmental and psychosocial stressors are often examined separately, even though their co-occurrence is widespread. The evidence that combined associations are often stronger raises critical issues around environmental justice and protection of vulnerable populations.

Combined Impacts of Prenatal Environmental Exposures and Psychosocial Stress on Offspring Health: Air Pollution and Metals.

In this article, I describe my ongoing bioethnographic collaboration with a multidisciplinary team of exposure scientists in environmental engineering and health. First, I explain how and why integrating ethnography and number-based disciplines is such a complex, time-consuming, and worthwhile process, when ethnography produces a kind of excessive “big data” that is not easily enumerated. Then I describe three of our current bioethnographic projects that seek to make better numbers about how (1) neighborhoods, (2) water distribution, and (3) employment and chemical exposures shape bodily processes in a highly unequal world. To conclude, I reflect on how we might harness ethnographic excess for making better numbers and thus better knowledge, and also how bioethnographic collaboration inevitably transforms ethnography even as we insist on its excess. [collaboration, methodology, ethnography, big data, biomedical science] RESUMEN En este artículo, describo mi colaboración bioetnográfica en curso con un equipo multidisciplinario de científicos sobre exposición en ingeniera ambiental y salud. Primero, explico cómo y por qué el integrar etnografía y disciplinas basadas en números es un proceso tan complejo, consumidor de tiempo y útil, cuando la etnografía produce una clase de “big data” excesiva que no es enumerada fácilmente. Luego describo tres de nuestros proyectos bioetnográficos actuales que buscan hacer mejores números acerca de cómo (1) vecindarios, (2) distribución de agua, y (3) empleo y exposiciones químicas impactan los procesos corporales en un mundo altamente desigual. Para concluir, reflexiono sobre cómo podríamos aprovechar el exceso etnográfico para hacer mejores números y así un mejor conocimiento, y también cómo la colaboración bioetnográfica transforma inevitablemente la etnografía aun cuando insistimos en su exceso. [colaboración, metodología, etnografía, big data, ciencia biomédica] “Y ou know too much! Ethnography is big data!” Brisa, the biostatistician, buried her face in her hands, partly in jest and partly in frustration. She and I are two of many researchers working together as part of a longitudinal birth-cohort study in Mexico City called Early Life Exposures in Mexico to ENvironmental Toxicants (ELEMENT). Brisa’s comment crystallized the challenges of understanding and navigating the relationship between ethnography and research methods that generate numerical data. Before I arrived in Brisa’s office that afternoon, I had been at a meeting with other ELEMENT teammembers discussing a hypothesis about the effects of chemical exposure AMERICAN ANTHROPOLOGIST, Vol. 00, No. 0, pp. 1–15, ISSN 0002-7294, online ISSN 1548-1433. © 2021 by the American Anthropological Association. All rights reserved. DOI: 10.1111/aman.13560 on menopause among study participants. In my mind the hypothesis was flawed because it presumed that the experience of menopause was everywhere the same. To prove my point to Brisa, I rattled off detail after detail about how radically different the participants’ lives are from those of the researchers. As a biostatistician, Brisa routinely works with data sets of millions, but my exhaustive ethnographic knowledge about the lives of a small subset of participants was just “too much.” She voiced a concern I had heard from other team members: ethnography is excessive and unruly in its comprehensiveness, especially because its findings are not 2 American Anthropologist • Vol. 00, No. 0 • xxxx 2021 easily quantified or standardized. Over time, though, these colleagues have come to tell me they value the ethnographic excess I bring to our collaboration. Initially they expected that I would offer ethnographic perspectives on numbers they had already made. Now we were trying to make numbers together, which means we were fundamentally reworking the ways we all make knowledge. This collaboration is an example of what I call bioethnography, a method my team and I have been developing since 2012 in order to make knowledge about dynamic and situated bodily processes in a highly unequal world (Roberts and Sanz 2017). Bioethnography seeks to generate integrated biomedical and ethnographic knowledgewithout separating natural from cultural processes. It insists that intensive ethnographic engagement drive questions from the start, instead of being retrospectively applied to numerical data already collected. Although ethnography is not well suited for making numbers on its own, it can be understood as a kind of “big data” that, in the long run, can be used to ask questions that produce better numbers and better knowledge. On its own can, ethnography can bring valuable insights to bear on complex problems, like the relationship of inequality to health, but because numbers drive policy, they have specific authoritative power for making reality. Thus, bioethnography harnesses ethnographic excess to make better numbers, numbers better situated within the reality they purport to represent. My point, of course, is that ethnographic “excess” is not excessive at all. Knowledge that combines numerical data with ethnographic insight has the potential to identify and dislodge conditions that perpetuate inequality and ill health. In this article, I divide my discussion into two parts. In part 1, “Bioethnographic Collaboration,” I narrate how I came to work with ELEMENT and lay out the principles of bioethnography as we have developed it so far. In part 2, “Making Better Numbers,” I describe three areas of collaborative investigation—neighborhoods, water quality, and aging—to illustrate the complexities and advantages of integrating critical ethnographic approaches and numbers-based disciplines. In each case, I describe numbers we have made, or could make together, that require ethnographic big data to know the world better. PART 1—BIOETHNOGRAPHIC COLLABORATION Bioethnography In l993, a team of Mexican and US environmental health researchers established the ELEMENT project with the objective of understanding the effects of early-life nutrition and exposure to toxicants (such as lead and phenols) (Perng and al 2020). Since 1993, ELEMENT project researchers have collected and analyzed biological samples from about 1,600 participants (800 mother-child pairs) recruited through publicly funded clinics in Mexico City (Afeiche et al. 2011;Hu et al. 2006).ELEMENT’s epidemiological findings have been detailed in over one hundred publications and have influenced policy decisions about lead and fluoride exposure, especially in the United States.Collection of additional biomarkers of toxicant exposure and molecular and other outcomes is scheduled to occur over the next years. Like many longitudinal birth-cohort studies, ELEMENT maintains a bank of participants’ biological samples (which include blood, urine, hair, toenails, breast milk, and teeth) and questionnaire data, which allows reanalysis of samples in response to newly arising questions.1 Over the years, the project has expanded to include study of new toxins (e.g., BPAs, mercury, and fluoride) and new health concerns (e.g., obesity, menopause, sleep) that can be studied through both newly collected data and the retrospective analysis of stored samples (Bashash 2017), using new frameworks, such as epigenetics, by which researchers link toxicant exposure to changes in gene expression that might affect health outcomes. In 2012, I began conversations with the ELEMENT project PI, Karen Peterson, about conducting ethnographic observations among study participants and ELEMENT team members. Collaborating with ELEMENT would offer me the opportunity to deploy insights from feminist and other science and technology studies (STS), as well as from Latin American studies, for understanding phenomena as always relational, contingent, constructed, and enacted through practice (Latour 2010; Mol 2002; Murphy 2013; Stepan 1991; Wade 1993; Weismantel 1995). Following Donna Haraway, I wanted to study dynamic bodily conditions as situated within specific ecological niches (Fuentes 2018) and acknowledge that scientific knowledge is always situated, as it is produced in relation to these conditions (Haraway 1991). I saw ethnography as crucial for documenting phenomena and also for making them. In particular, I wanted to deploy approaches from feminist medical anthropology and STS like Margaret Lock’s situated biologies framework (Lock and Nguyen 2010) and Anne Fausto-Sterling’s call for dynamic and developmental systems approaches (Fausto-Sterling 2005) to make better knowledge about the relationship between health and inequality. Thus, instead of combining objects of inquiry (biology and culture), I conceived of bioethnography as combining two different methods for knowing the world (Mol 2002, 153)—ethnographic observation and biochemical sampling—in order to ask and answer research questions that could not be addressed through either method alone. This methodological focus involves exploring how our data collection and analysis might be shaped if we suspended the nature/culture binary. Thus, blood lead levels and household organization, body mass index (BMI), class hierarchy, hospitality, international trade agreements, and biostatistical and coded ethnographic data are designated as neither nature nor culture. Instead, in bioethnographic collaboration, researchers would ask questions about bodily and environmental conditions together,while continuing to use different methods to discover how these phenomena are produced. Roberts • Bioethnographic Collaboration 3 Asking better questions would allow us to produce better data, leading to better and more comprehensive knowledge. The life scientists would hopefully come to understand biological processes as always dynamic and situated, and I would have to become willing to stand by the numerical knowledge we produced together. Initially these aims were mine, not ELEMENT’s. ELEMENT researchers thought my work might provide social con

Making Better Numbers through Bioethnographic Collaboration

Background Epidemiologic and animal-based studies have raised concern over the potential impact of fluoride exposure on neurobehavioral development as manifested by lower IQ and deficits in attention. To date, no prospective epidemiologic studies have examined the effects of prenatal fluoride exposure on behavioral outcomes using fluoride biomarkers and sensitive measures of attention. Objective We aimed to examine the association between prenatal fluoride exposure and symptoms associated with attention-deficit/hyperactivity disorder (ADHD). Method 213 Mexican mother-children pairs of the Early Life Exposures to Environmental Toxicants (ELEMENT) birth cohort study had available maternal urinary samples during pregnancy and child assessments of ADHD-like behaviors at age 6–12. We measured urinary fluoride levels adjusted for creatinine (MUF cr ) in spot urine samples collected during pregnancy. The Conners' Rating Scales-Revised (CRS-R) was completed by mothers, and the Conners' Continuous Performance Test (CPT-II) was administered to the children. Results Mean MUF cr was 0.85 mg/L (SD = 0.33) and the Interquartile Range (IQR) was 0.46 mg/L. In multivariable adjusted models using gamma regression, a 0.5 mg/L higher MUF cr (approximately one IQR higher) corresponded with significantly higher scores on the CRS-R for DSM-IV Inattention (2.84 points, 95% CI: 0.84, 4.84) and DSM-IV ADHD Total Index (2.38 points, 95% CI: 0.42, 4.34), as well as the following symptom scales: Cognitive Problems and Inattention (2.54 points, 95% CI: 0.44, 4.63) and ADHD Index (2.47 points; 95% CI: 0.43, 4.50). The shape of the associations suggested a possible celling effect of the exposure. No significant associations were found with outcomes on the CPT-II or on symptom scales assessing hyperactivity. Conclusion Higher levels of fluoride exposure during pregnancy were associated with global measures of ADHD and more symptoms of inattention as measured by the CRS-R in the offspring.

Prenatal fluoride exposure and attention deficit hyperactivity disorder (ADHD) symptoms in children at 6–12 years of age in Mexico City

Mercury drives microbial community assembly and ecosystem multifunctionality across a Hg contamination gradient in rice paddies.

Health repercussions of environmental exposure to lead: Methylation perspective

Purpose The Early Life Exposure in Mexico to ENvironmental Toxicants (ELEMENT) Project is a mother–child pregnancy and birth cohort originally initiated in the mid-1990s to explore: (1) whether enhanced mobilisation of lead from maternal bone stores during pregnancy poses a risk to fetal and subsequent offspring neurodevelopment; and (2) whether maternal calcium supplementation during pregnancy and lactation can suppress bone lead mobilisation and mitigate the adverse effects of lead exposure on offspring health and development. Through utilisation of carefully archived biospecimens to measure other prenatal exposures, banking of DNA and rigorous measurement of a diverse array of outcomes, ELEMENT has since evolved into a major resource for research on early life exposures and developmental outcomes. Participants n=1643 mother–child pairs sequentially recruited (between 1994 and 2003) during pregnancy or at delivery from maternity hospitals in Mexico City, Mexico. Findings to date Maternal bone (eg, patella, tibia) is an endogenous source for fetal lead exposure due to mobilisation of stored lead into circulation during pregnancy and lactation, leading to increased risk of miscarriage, low birth weight and smaller head circumference, and transfer of lead into breastmilk. Daily supplementation with 1200 mg of elemental calcium during pregnancy and lactation reduces lead resorption from maternal bone and thereby, levels of circulating lead. Beyond perinatal outcomes, early life exposure to lead is associated with neurocognitive deficits, behavioural disorders, higher blood pressure and lower weight in offspring during childhood. Some of these relationships were modified by dietary factors; genetic polymorphisms specific for iron, folate and lipid metabolism; and timing of exposure. Research has also expanded to include findings published on other toxicants such as those associated with personal care products and plastics (eg, phthalates, bisphenol A), other metals (eg, mercury, manganese, cadmium), pesticides (organophosphates) and fluoride; other biomarkers (eg, toxicant levels in plasma, hair and teeth); other outcomes (eg, sexual maturation, metabolic syndrome, dental caries); and identification of novel mechanisms via epigenetic and metabolomics profiling. Future plans As the ELEMENT mothers and children age, we plan to (1) continue studying the long-term consequences of toxicant exposure during the perinatal period on adolescent and young adult outcomes as well as outcomes related to the original ELEMENT mothers, such as their metabolic and bone health during perimenopause; and (2) follow the third generation of participants (children of the children) to study intergenerational effects of in utero exposures. Trial registration number NCT00558623.

https://bmjopen.bmj.com/content/bmjopen/9/8/e030427.full.pdf

Early Life Exposure in Mexico to ENvironmental Toxicants (ELEMENT) Project


 Purpose: To determine whether the use of G-CSF during the first-line therapy of nSCLC influences the effectiveness of anti-PD1/PD-L1 drugs (aPD1-i) used in subsequent therapies.Methods: We designed a single-center, observational, retrospective study with nSCLC patients treated with aPD1-i (nivolumab, pembrolizumab, or atezolizumab) after primary platinum-based chemotherapy in southern Spain. The primary endpoints were overall survival (OS) and progression free survival (PFS). The results were assessed using the Kaplan-Meier method for G-CSF-use.Results: We enrolled 79 patients (91% male) with a mean age of 66.7 years. Nivolumab, atezolizumab, and pembrolizumab were used in 55.7%, 25.3%, and 19.0% of the patients, respectively. G-CSF was administered to 19 patients. The median treatment duration was 4.1 months (95%CI: 2.3-5.8). Overall survival (OS) and progression free survival (PFS) were 7.3 (95%CI: 3.4-11.3) and 4.4 months (95%CI: 2.3-6.5), respectively. The median OS was 15.8 months (95%CI: 1.2-30.3) in G-CSF-treated patients and 5.3 months (95%CI: 2.3-8.3) in the non-treated group (p=0.186). Higher OS was observed in all subgroups.Conclusions: The effectiveness of aPD1-i in previously treated nSCLC patients was higher in the G-CSF-treated group than in the non-treated group, although the difference was statistically insignificant. These results may contribute to improving the effectiveness of anti-PD1/PD-L1 drugs, although confirmatory prospective studies are required.

/pdf/prognostic-role-of-filgrastim-in-the-effectiveness-of-pd-1-80jbchni.pdf

Prognostic role of filgrastim in the effectiveness of PD-1/PD-L1 inhibitors in previously treated patients with non-small cell lung cancer

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Early Life Exposure in Mexico to ENvironmental Toxicants (ELEMENT) Project

Prognostic role of filgrastim in the effectiveness of PD-1/PD-L1 inhibitors in previously treated patients with non-small cell lung cancer