The Impact of Combined Exposure to Metals and Per- and Polyfluoroalkyl Substances on Stress, Cardiovascular Disease Risk and Mortality

PROJECT SUMMARY
The health and life outcomes of individuals are intertwined with the context in which they grow and live. The
totality of exposures one experiences affects health in the short term and throughout the life course.
Environmental exposure to multiple contaminants can increase stress levels in individuals and neighborhoods
with psychosocial stressors such as crime, drug, and alcohol misuse, and violence also taking a toll on
individual and neighborhood wellbeing. In addition, the availability, organization, and quality of local
institutions and infrastructure all affect health in the short and long term.
Individuals are vulnerable to simultaneous exposure to an array of environmental and psychosocial stressors.
Exposure to environmental pollutants such as lead (Pb), cadmium (Cd), mercury (Hg), perfluorooctane
sulfonic acid (PFOS), and perfluorinated alkylated substances (PFOA) are independently associated with
adverse health outcomes, but little is known about their combined effect on individual and neighborhood
stress, cardiovascular disease (CVD) risk and CVD mortality.
Exploring how diverse environmental pollutants combine to cause adverse health outcomes for individuals and
neighborhoods is critical for promoting healthier longer lives among populations in the United States.
Contextualized in the life course theory, our study seeks to close the gap in the literature on exposure to
multiple contaminants to understand the combined effect of Pb, Cd, Hg, PFOS, and PFOA on (a) allostatic load,
a measure of chronic individual stress, (b) Cumulative census track risk of psychosocial stress (CCRPS), a
measure of neighborhood stress, CVD risk and CVD mortality. We hypothesize that multiple environmental
exposures will increase individual and neighborhood level stress, CVD risk, CVD mortality.
It is critical to understand the extent to which the combined effect of Pb, Cd, Hg, PFOS, and PFOA affect the
outcomes in this study. Specifically, study results can be addressed through interventions for the most at risk to
limit combinations of exposures to these contaminants. Study findings will produce modified data analytical
techniques for modeling the combined effects of exposures while accounting for survey data design. In addition
to its implications on health, this project, we will attract and train students, especially those from historically
excluded student populations i.e., Black and Hispanic, to conduct research in environmental epidemiology and
data analytics. In sum, the proposed research project will enhance the current understanding of the impact of
multiple environmental pollutants on individual and neighborhood stress, CVD risk and mortality; this will
expand the research capacity at North Carolina Agricultural and Technical State University, the nation’s largest
HBCU, which is perfectly aligned with the goals of the SuRE program.