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From 1980 to 2017, a fluorochemical manufacturing facility discharged wastewater containing poorly understood per- and polyfluoroalkyl substances (PFAS) to the Cape Fear River, the primary drinking water source for Wilmington, North Carolina, residents. Those PFAS included several fluoroethers including HFPO-DA also known as GenX. Little is known about the bioaccumulation potential of these fluoroethers. We determined levels of fluoroethers and legacy PFAS in serum samples from Wilmington residents. In November 2017 and May 2018, we enrolled 344 Wilmington residents of age into the GenX Exposure Study and collected blood samples. Repeated blood samples were collected from 44 participants 6 months after enrollment. We analyzed serum for 10 fluoroethers and 10 legacy PFAS using liquid chromatography-high-resolution mass spectrometry. Participants' ages ranged from 6 to 86 y, and they lived in the lower Cape Fear Region for 20 y on average (standard deviation: 16 y). Six fluoroethers were detected in serum; Nafion by-product 2, PFO4DA, and PFO5DoA were detected in of participants. PFO3OA and NVHOS were infrequently detected. Hydro-EVE was present in a subset of samples, but we could not quantify it. GenX was not detected above our analytical method reporting limit ( ). In participants with repeated samples, the median decrease in fluoroether levels ranged from 28% for PFO5DoA to 65% for PFO4DA in 6 months due to wastewater discharge control. Four legacy PFAS (PFHxS, PFOA, PFOS, PFNA) were detected in most ( ) participants; these levels were higher than U.S. national levels for the 2015-2016 National Health and Nutrition Examination Survey. The sum concentration of fluoroethers contributed 24% to participants' total serum PFAS (median: ). Poorly understood fluoroethers released into the Cape Fear River by a fluorochemical manufacturing facility were detected in blood samples from Wilmington, North Carolina, residents. Health implications of exposure to these novel PFAS have not been well characterized. https://doi.org/10.1289/EHP6837.

Background Advocates for environmental justice, local, state, and national public health officials, exposure scientists, need broad-based health indices to identify vulnerable communities. Longitudinal studies show that perception of current health status predicts subsequent mortality, suggesting that self-reported health (SRH) may be useful in screening-level community assessments. This paper evaluates whether SRH is an appropriate surrogate indicator of health status by evaluating relationships between SRH and sociodemographic, lifestyle, and health care factors as well as serological indicators of nutrition, health risk, and environmental exposures. Methods Data were combined from the 2003–2006 National Health and Nutrition Examination Surveys for 1372 nonsmoking 20–50 year olds. Ordinal and binary logistic regression was used to estimate odds ratios and 95 % confidence intervals of reporting poorer health based on measures of nutrition, health condition, environmental contaminants, and sociodemographic, health care, and lifestyle factors. Results Poorer SRH was associated with several serological measures of nutrition, health condition, and biomarkers of toluene, cadmium, lead, and mercury exposure. Race/ethnicity, income, education, access to health care, food security, exercise, poor mental and physical health, prescription drug use, and multiple health outcome measures (e.g., diabetes, thyroid problems, asthma) were also associated with poorer SRH. Conclusion Based on the many significant associations between SRH and serological assays of health risk, sociodemographic measures, health care access and utilization, and lifestyle factors, SRH appears to be a useful health indicator with potential relevance for screening level community-based health and environmental studies.

Authors discovered a mass interference in calibration standards analyzed by liquid chromatography-high-resolution mass spectrometry that resulted in underestimation of serum concentrations for perfluoro-3,5,7,9,ll-pentaoxadodecanoic acid [PF05DoA; DTXSID50723994] in the published manuscript. Since the original analyses, authors acquired an authentic analytical standard for PF05DoA and reanalyzed a subset of the serum samples. [...]references to \"total PFAS\" were changed to \"summed PFAS,\" which is a more accurate representation of the methods used. [...]Table S9 was added to report the summary statistics of the erroneous PF05DoA data for reference.

Coal-fired power plants (CFPPs) are major contributors of air pollution globally. In 2002, North Carolina adopted regulation that required CFPPs to substantially reduce their sulfur dioxide (SO2) emissions by 2013 – resulting in measurable decreases of ambient SO2 across the state between 2003 and 2015. Air pollution research suggests an association between ambient SO2 and adverse birth outcomes. Preterm birth (PTB) is an important risk factor for neonatal mortality and associated with childhood and adulthood morbidities as well as high healthcare costs. PTB is also experienced differentially by race and ethnicity, with non-Hispanic Black mothers experiencing a higher prevalence of it compared to non-Hispanic white mothers. This dissertation investigated maternal gestational exposures to coal-fired power plant-related air pollution and their associations with preterm birth using vital birth records from North Carolina during 2003-2015. Specifically, this project 1) characterized NC’s energy generation profile for the past two decades including reductions in emissions from two criteria air pollutants, 2) leveraged a policy intervention to investigate source-specific changes in emissions and associations with PTB, and 3) evaluated ambient SO2 – an air pollutant primarily emitted by CFPPs – exposure during gestation and its association with PTB. Between 2000-2008 in NC, approximately 60% of electric power was generated by CFPPs. Since then, NC’s electric power generation has transformed from predominate dependence on coal to approximately equal dependence on natural gas and nuclear power (each at ~30%), with coal close behind (~25%). Despite the stark drop in reliance on CFPPs for energy in NC, and subsequent drop in emissions, CFPPs still contribute ~60% of SO2 air pollution as of 2017. In Aim 2, we estimated that the absolute prevalence of PTB decreased by 1.3% (95% CI: -2.5, -0.2) due to installation of scrubbers and decreased by 0.6% (95% CI: -1.8, 0.5) due to coal unit retirements at the nearby CFPPs. Within a 5-<10 mile buffer, for CFPPs that installed SO2 scrubbers, the absolute prevalence of PTB decreased for non-Hispanic Asian mothers and non-Hispanic white mothers by 8% (95% CI: -13.9, -2.3) and 1.9% (95% CI: -3.3, -0.4), respectively, compared to those within the 10-<15 mile buffer. Our findings were imprecise and generally null among women living within 0-<5 miles, compared to those 10-<15 miles away, regardless of the intervention type. For Aim 3, across gestational exposure windows, the results for our adjusted single-pollutant and adjusted multi-pollutant models showed a direct association between SO2 and PTB as well as for moderate PTB and late PTB. The effect estimates were largest for the entire pregnancy and the third trimester. This dissertation research comes at a time when the United States government is grappling with whether to move away from or reinvest in coal for electricity generation.