Objectives

• Conduct NJ’s first population-based surveillance study using a multistage, cluster, random sampling approach to recruit 500 residents (ages 6 and up) stratified by demographic subdomains across NJ.
• Collect health and nutritional status information from participants.
• Determine body burdens of select environmental contaminants (see below for list) in recruited residents.  
• Establish database for 1) estimating prevalence(s) of health status in NJ population, 2) assessing environmental contaminant levels in NJ population that will be directly compared with national or international levels from other population studies, and 3) serving as a baseline for biomonitoring studies within the state that are currently being conducted or will be planned for the future.

Summary of approaches

• NJ’s 2,010 census tracts (CTs) were grouped into 12 regional areas, with six areas being randomly selected for the first year of campaign. Within each area, 4 CTs will be randomly selected and 100 households (HHs) will be randomly selected in series. The selected HHs will be contacted, interviewed, screened, and recruited to participate in NJHANES. The following year-long campaign will be repeated for the remaining 6 regional areas. An estimated 4800 HHs will be selected through this approach, and 500 participants will be recruited to complete the NJHANES within the scheduled two-year period.
• Questionnaires will be administered to collect a variety of information, including 1) demographics, 2) socioeconomic status, 3) personal behaviors, 4) physical activities, 5) housing characteristics, 6) health insurance, 7) health conditions, 8) dietary recall, and 9) exposures that are associated with environmental contaminants listed below.
• Body weight, height, heart rate, and blood pressure will be measured with portable devices by trained field staff.
• Specimens (~10 mL blood and ~30 mL urine) will be collected from each participant to determine environmental contaminant levels, including 1) metals in blood and urine, 2) per- and polyfluoroalkyl substances (PFAS) in serum, 3) polychlorinated biphenyls (PCBs) in serum, 4) polybrominated diphenyl ethers (PBDEs) in serum, 5) organochlorine pesticides (OCPs) in serum, 6) volatile organic compound (VOC) metabolites in urine, 7) polycyclic aromatic hydrocarbon (PAH) metabolites in urine, and 8) nicotine metabolites in serum.       Urine specific gravity and creatinine and serum lipids will be measured for corrections during the data analysis stage.
  No other testing will be conducted on the samples other than those listed above.
• Analyzed results will be reported back to study participants, if desired, according to the Clinical Laboratory Information Amendment (CLIA) and the Health Insurance Portability and Accountability Act (HIPPA) guidelines. Results communication will include environmental contaminant levels and data interpretation for an elevated individual result compared to the US population level. In certain case, direct contact may be warranted for outreach or retesting purposes. All participants will receive educational materials with factsheets and ways to minimize environmental exposures in daily life.
• Weights for individual sample persons will be developed and used throughout the implementation of NJHANES to adjust for 1) unequal probabilities at each selection stage, 2) varying response/recruitment rates, 3) nonresponse in selected HHs and deselection in responded HHs, 4) decline or missing data in physical exam and lab analysis results, and 5) poststratification for compensating inequalities between the sample population and the target population.   Individual results are private and will not be published.

Objectives

• Evaluate the transferability and adaptability of NJ Biomonitoring’s prenatal screening model developed for Newark to other NJ cities with high-risk subpopulations.
• Offer blood screening for lead (Pb) and mercury (Hg) to participating hospitals’ prenatal population mimicking the Newark model.
• Provide materials to families to educate them on how to protect themselves from Pb and Hg.
• Provide medical and/or environmental interventions as appropriate through program partners to expectant mothers who have elevated levels of Pb and/or Hg.

Summary of approaches

• Recruit hospitals in high-priority cities to work with NJ Biomonitoring to expand the Prenatal Screening Program.
• Work with national and local stakeholders to address gaps in clinical responses, follow up protocols, and policies related to toxic metals exposure.
• Working with program partners, collect blood samples from expectant mothers at their first prenatal visit and cord blood at birth to test for Pb and Hg.
• Monitor intervention and/or remediation actions conducted by our partners in response to elevated Pb and/or Hg levels.
• Evaluate challenges of adapting established model to new cities and hospitals.
• Compare exposure trends between participating hospitals’ patient populations throughout NJ.

Objectives

• Develop analytical methods to accurately and precisely quantify polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), and metals in dried blood spots (DBS) on paper cards.
• Evaluate if DBS from deidentified remnant paper cards previously used for screening disorders in NJ newborns can be a reliable screening tool for prenatal environmental exposure.
• Investigate correlations between metals, PCBs, OCPs and Autism Spectrum Disorder (ASD)-related biomarkers using data previously collected from the DBS cards.

Summary of approaches

• Acquire 1000-2000 remnant DBS cards from the NJ Newborn Screening Program.
• Analytical methods for PCBs, OCPs, and metals in DBS cards will be modified from established biomonitoring methods used by NJ Biomonitoring to overcome potential challenges such as background contamination, volume constraints on DBS card, and accurate estimates of blood volume from whole blood to dried blood spots.
• A neutral broker will be appointed and used to select remnant DBS cards from the remnant pool, remove any identification from the selected DBS cards, assign a new sample ID to each card, and deliver the de-identified DBS cards with associated deidentified ASD biomarker data to NJ Biomonitoring for testing.

Project 1: Environmental Contaminant Levels in Blood and Urine Specimens from New Jersey Clinical Laboratories and Blood Banks

Objectives

• Determine levels of environmental contaminants in blood and urine among New Jersey residents (20-74 years old) using deidentified remnant clinical laboratory and blood bank specimens. Metals in blood and urine, per- and polyfluoroalkyl substances (PFAS) in serum, and polychlorinated biphenyls (PCBs) in serum were selected for study based on the distribution of these chemicals in NJ and their persistence both in nature and in humans.
• Use newly acquired laboratory capabilities and capacities to establish biomonitoring data for the target analytes based on sex, age, geographic location, and race/ethnicity to screen for differences in exposure levels across the study population.
• Confirm the resilience of the infrastructure built to respond to acute exposure incidents.

Summary of approaches

• Acquire 3,000 deidentified, remnant whole blood samples, 1,000 serum samples, and 1,000 urine samples from NJ residents (20-74 years) collected from blood banks and clinical laboratories.
• Analyze samples for metals, PFAS, and PCBs concentrations.
• Perform statistical analysis to determine the distribution of the target analytes by age, sex, residence location, and race to assess whether our study population, or any subpopulation thereof, exhibits higher levels of these contaminants than the national average.

Accomplishments

• The project and sampling plans were completed through the collaboration between the Public Health and Environmental Laboratories (PHEL) and our partners within the NJ State system and at Rutgers University.
• A total of 2,987 out of 3,000 blood samples collected and were analyzable for cadmium (Cd), lead (Pb), and mercury (Hg).
• A total of 1,007 urine samples were collected and analyzed for Arsenic (As), Barium (Ba), Beryllium (Be), Cd, Pb, Thallium (Tl), and Uranium (U).
• A total of 1,030 serum samples were collected and analyzed for PFAS and PCBs.
• Data analysis was conducted by using the demographic information received to examine the distribution of environmental contaminants. PFAS data showed that PFAS levels observed in this project (PFOA, PFNA, and PFHxS) were higher than the US levels found in NHANES. PCB data indicated serum PCB levels in older subjects continue declining trend suggested from NHANES. Both PFAS and PCB results were published in peer-reviewed scientific journals. Draft journal article for metals is currently in preparation.

Project 2: Assessing PFNA Body Burdens Following Drinking Water Intervention

Objectives

• Determine if individuals residing in communities with PFNA-contaminated drinking water have higher PFNA serum levels than the general population.
• Verify that participant serum levels of PFNA decrease over time following interventions.

Summary of approaches

• Collect blood samples once per year for three consecutive years from ~100 volunteers likely to have been exposed to PFNA-contaminated drinking water.
• Collect tap water from each participating home in the first period of sampling.
• Determine PFNA concentration in serum and water.
• Collect questionnaires from participants asking about potential sources of PFNA exposure.
• Perform statistical analyses to determine whether the PFNA concentrations are higher in the study population than the national levels, and whether the serum level of PFNA in the study participants decreases over time.
• NJDEP provided funds to collect and test dust samples from a select group of participants and from control homes in similar communities not in the PFNA contamination radius.

Accomplishments

• 1^st round of recruitment, sample collection/analysis were completed with 120 subjects in 105 participating homes between Aug. 2017 – Mar. 2018.
• 2^nd round of blood collection/analysis were completed for 107 subjects between Aug. 2018 – Mar. 2019.
• 3^rd round blood collection/analysis were completed for 99 subjects between Aug. 2019 and Mar. 2020.
• The first round of PFNA serum data indicated that the participants’ geometric mean (GM) had 5 times higher levels than national average; however, the other 11 PFAS compounds were not elevated than the US population.
• PFAS analysis in home water and house dust confirmed there were currently no ongoing or additional PFNA sources in the study communities.
• Participant PFNA serum levels are decreasing consistently over the course of this study by an average of 27% over three years.

Project 3: Assessing and Addressing Environmental Exposure of Expectant Women to Lead and Mercury

Objectives

• Identify expectant mothers in NJ who may be at higher risk to lead (Pb) and mercury (Hg) exposure because of geographical or behavioral factors to provide them free blood screening.
• Provide materials to families to educate them on how to protect themselves from Pb and Hg.
• Provide medical/environmental interventions as appropriate through program partners to expectant mothers who have elevated levels of Pb and/or Hg.
• Collect birth outcomes to confirm the effectiveness of prenatal screening and interventions.

Summary of approach

• Working with program partners, collect samples from up to 1,000 NJ expectant mothers potentially exposed to Pb and Hg due to environmental, dietary, or cultural factors.
• Monitor intervention and/or remediation actions conducted by our partners in response to elevated Pb and/or Hg levels.
• Conduct follow-up testing as necessary to confirm that any interventions/abatements were successful in reducing the exposure, and that blood levels are reducing over time.
• Evaluate birth outcomes of babies whose mothers received interventions.

Accomplishments

• NJ Biomonitoring worked closely with leadership at University Hospital (UH) in Newark, NJ and NJ Poison Control to provide this much needed Prenatal Screening Program as standard-of-care to their entire patient population at no cost to the expectant mothers.
• Cord blood is also being collected from all babies at delivery as standard-of-care to make sure that babies whose mothers received prenatal care elsewhere, or no prenatal care at all, are tested and given whatever support they may need.
• Thousands of educational materials in 5 languages (English, French Creole, Polish, Portuguese, and Spanish) have been provided to NJ families and health providers about Pb and Hg exposure and how to protect themselves, with a focus on expectant mothers.
• The Prenatal Screening Program launched in June 2019 and has tested over 5000 patient samples to date and will average 5000 tests per year, far exceeding testing goals.
• Multiple cases where hospitalization and immediate treatment were determined to be in the best interest of the baby have been identified that otherwise would have gone undetected.
• NJ Biomonitoring designed questionnaires and does speciation analysis on Hg to help the program partners identify the sources of exposure with proven results.
• Treatment, consultations, and interventions have successful lowered mothers’ and babies’ blood Pb and Hg levels.
• Exposure trends have been identified in the patient population indicating that Pb at detectable levels was prevalent, but 99% of mothers and babies were below the current CDC health limit; whereas Hg was far more prevalent than anticipated with 10% of the babies being above the established health limit.
• Internal review protocols are being initiated to assist NJDOH and UH leadership in making data-driven public health decisions based on the results from the program.
• NJ Biomonitoring has begun the process of testing the portability and adoptability of the Prenatal Screening Program to other cities.

Peer-reviewed articles:

1. Chang Ho Yu, Bhupendra Patel, Marilou Palencia, and Zhi-Hua (Tina) Fan. “A Sensitive and Accurate Method for the Determination of Perfluoroalkyl and Polyfluoroalkyl Substances (PFASs) in Human Serum Using a High-Performance Liquid Chromatography-Online Solid Phase Extraction-Tandem Mass Spectrometry”. Journal of Chromatography A, 1480, 1-10, 2017.
2. Wang G, Di Bari J, Bind E, Steffens AM et al. “Association Between Maternal Exposure to Lead, Maternal Folate Status, and Intergenerational Risk of Childhood Overweight and Obesity”. JAMA Network Open, 2019;2(10) 1-14. October 2019.
3. Chang Ho Yu, C. David Riker, Shou-en Lu, and Zhi-Hua (Tina) Fan. “Biomonitoring of Emerging Contaminants, Perfluoroalkyl and Polyfluoroalkyl Substances (PFAS), in New Jersey Adults in 2016-2018”. Int J Hyg Environ Health. Jan;223(1):34-44, 2020.
4. Wang G, DiBari J, Bind E, Steffens A, Mukherjee J, Bartell T, Bellinger D, Hong X, Ji Y, Wang M, Wills-Karp M, Cheng T, and Wang X. In utero exposure to mercury and childhood overweight or obesity: counteracting effect of maternal folate status. BMC Medicine. 2019 17:216. November 2019.
5. Songyan Du, Lisa Rodenburg, Norman Patterson, Christopher Chu, C. David Riker, Chang Ho Yu and Zhihua (Tina) Fan.“Serum Concentration of Polychlorinated Biphenyls from New Jersey Biomonitoring Study: 2016-2018”. Chemosphere, 261, 127730, 2020. 
6. Judith Graber, Taylor M. Black, Nimit N. Shah, Alberto J. Caban-Martinez, Shou-en Lu, Troy Brancard, Chang Ho Yu, Mary E. Turyk, Kathleen Black, Michael B. Steinberg, Zhihua Fan, and Jeffrey L. Burgess. Prevalence and Predictors of Per- and Polyfluoroalkyl Substances (PFAS) Serum Levels Among Members of a Suburban US Volunteer Fire Department. International Journal of Environmental Research and Public Health, 18, 3730-3742, 2021.
7. Chang Ho Yu, Clifford P. Weisel, Shahnaz Alimokhtari, Panos Georgopoulos, and Zhihua (Tina) Fan. Biomonitoring: A Tool to Assess PFNA Body Burdens and Evaluate the Effectiveness of Drinking Water Intervention for Communities in New Jersey. International Journal of Hygiene and Environmental Health, 235, 113757, 2021.

Meeting and Conference Presentations 2015

1. Eric Bind. “Biomonitoring and New Jersey” in oral presentation at ASCLS-NJ 2015 Spring Seminar & Expo, East Windsor, NJ. April 16, 2015.
2. Zhi-Hua (Tina) Fan. “New Jersey Biomonitoring Program - New Initiative and Challenges” in oral presentation at 2015 APHL Annual Meeting and Ninth Gov’t Env Lab Conf., Indianapolis, IN, USA from May 18 - 21, 2015.
3.  

2016

1. Z Fan, C Yu, E Bind, C Riker et al. “Development of the Capability and Capacity to Conduct Biomonitoring in New Jersey” in poster presentation at the 26th Annual Conf of ISES, Utrecht, Netherland, October 9-13, 2016.

2017

1. Bind, E. “The Importance of Strong Collaborations and Leveraging Resources” in oral presentation at National Meeting for State Biomonitoring Programs, Ewing NJ. December 5-7, 2017.
2. Zhihua (Tina) Fan. “Success and Challenge of Implementing Surveillance and Investigational Studies” in oral presentation at National Meeting for State Biomonitoring Programs, Ewing, NJ, December 5-7, 2017.
3. Chang Ho Yu. “Improvements for the Determination of Perfluoroalkyl and Polyfluoroalkyl Substances (PFASs) in Human Serum by High-Performance Liquid Chromatography-Online Solid Phase Extraction-Tandem Mass Spectrometry” in oral presentation at 2017 EAS Symposium & Exposition, November 13-15, 2017.
4. S Du, N Patterson, C. Riker. “Measurement of Polychlorinated Biphenyls (PCBs) in Serum by HRGC/ID-HRMS” in poster presentation at 2017 EAS Symposium & Exposition, November 13-15, 2017.
5. Chang Ho Yu. “Community Exposure to Perfluoroalkyl and Polyfluoroalkyl Substances (PFASs), an Emerging Public Health Issue” in oral presentation at 2017 APHL Annual Meeting & Eleventh Gov’t Env Lab Conf, June 11-14, 2017.
6. Eric Bind and Clifford Weisel.  “Assessing Environmental Exposure of Expecting Women in New Jersey to Toxic Metals, PCBs, and PFCs” in poster presentation at 2017 APHL National Meeting & 11^th Gov’t Env Lab Conference, Providence, RI.  June 11-14, 2017.

2018

1. Z Fan, C Yu, E Bind, D Haltmeier et al. “Toxic Metals, PFAS and PCBs in Blood and Urine Specimens Collected from New Jersey Clinical Laboratories and Blood Banks” in poster presentation at ISES-ISEE 2018 Joint Annual Meeting Aug 26-30, 2018 Ottawa, Canada.
2. C Yu, C Weisel, S Alimokhtari, S Minchila et al. “A Community Biomonitoring Study to Assess PFAS Body Burdens from PFNA-Contaminated Drinking Water in New Jersey” in poster presentation of 2018 APHL Annual Meeting & Twelfth Government Environmental Laboratory Conference, June 2018.
3. C Weisel, B Parsa, Z Fan, C Yu et al. “Evaluation of Exposure to Perfluorinated chemicals (PFCs) due to Contamination of Drinking Water in Gloucester County, New Jersey” in poster presentation at ISES-ISEE 2018 Joint Annual Meeting Aug 26-30, 2018 Ottawa, Canada.
4. S Du, N Patterson, C Chu, C. Riker “Serum concentration of Polychlorinated Biphenyls (PCBs) in New Jersey Residence” in poster presentation at APHL annual meeting June 2-5, 2018 Pasadena, CA.
5. Chang Ho Yu, and Zhihua (Tina) Fan. “Biomonitoring – A Useful Tool to Assess Effectiveness of Intervention on Community Exposure to PFNA Contaminated Drinking Water". APHL Lab Matters Winter Issue, 24-25, 2018.
6.  

2019

1. C Weisel, Z Fan, C Yu, L Chao et al. “Exposure to Perfluoroalkyl Substances (PFAS) due to Contamination of Drinking Water in Gloucester County, New Jersey: Evaluating the Effectiveness of an Intervention through Biomonitoring and Modeling” in poster presentation of 2019 American Public Health Association, November 2019.
2. Eric Bind. “Setting up a Prenatal Lead and Screening and Interventions Program” in oral presentation at 2019 National Biomonitoring Meeting, St. Paul, MN, October 2019.
3. Chang Ho Yu. “Changes of Residents’ PFAS Serum Levels after Interventions of Drinking Water Contaminated with PFNA in NJ Communities” in oral presentation at 2019 National Biomonitoring Meeting, St. Paul, MN, October 2019.
4. Eric Bind. “Reducing Lead and Mercury Exposure “Prenatal/Perinatal Screening and Interventions” in oral presentation at 2019 Population Health Summit, Princeton, NJ, September 2019.
5. Eric Bind. “Fighting a Lead Crisis with Collaborations Lessons and Challenges of Implementing a Prenatal Screening and Intervention Program” in oral presentation at 2019 APHL Annual Meeting & 13th Government Environmental Laboratory Conf, June 2019.
6. A Steffens, E Bind, A Krasley, J Mukherjee et al. “A Cost-Effective Biomonitoring Approach to Identify Vulnerable Subpopulations Using Metals Data” in poster presentation at 2019 APHL Annual Meeting & 13th Government Environmental Laboratory Conf, June 2019.
7. C Yu, C Weisel, P Georgopoulos, S Alimokhtari et al. “A Reduction of PFNA Body Burden from a Community Exposure to PFNA-contaminated Drinking Water in New Jersey after Interventions” in poster presentation at 2019 APHL Annual Meeting & 13th Government Environmental Laboratory Conf, June 2019.
8. S Du, N Patterson, C Chu, C Riker et al. “Serum concentration of Polychlorinated Biphenyls (PCBs) from New Jersey Biomonitoring Study: 2016-1018” in poster presentation at 2019 APHL Annual Meeting.
9. Eric Bind. “Metals Exposure in NJ Through Biomonitoring” in oral presentation at Rutgers University HEO Core, New Brunswick, NJ, May 2019.

2020

1. Eric Bind, Andrew Steffens, Andrew Krasley, Morgan McConico, Douglas Haltmeier, and Zhihua (Tina) Fan. “Reducing Lead & Mercury Exposure in High-Risk Mothers and Babies” in oral presentation at International Society of Exposure Science 2020 Annual Conference.
2. Chang Ho Yu, Clifford Weisel, Panos Georgopoulos, Shahnaz Alimokhtari, Shawn O’Leary, and Zhihua (Tina) Fan. “Assessing PFNA Body Burdens Following Drinking Water Intervention for Communities in New Jersey” in poster presentation at International Society of Exposure Science 2020 Annual Conference.
3. A. M. Steffens, E. P. Bind, A. T. Krasley, M. B. McConico, D. Haltmeier, and Z. Fan. “Standard-of-Care Prenatal Screening for Lead and Mercury: A Case for Early Interventions” in poster presentation at 2020 Association of Public Health Laboratories Annual Meeting.
4. Elisabeth Cook, Chang Ho Yu, Shawn O’Leary, David Riker, Douglas Haltmeier, Eric Bind, Andrew Steffens, Linbin Zhong, Morgan McConico, Songyan Du, Andrew Krasley, Li Qiao, and Zhihua (Tina) Fan. “New Jersey Health and Nutrition Examination Survey (NJHANES)” in poster presentation at 2020 Association of Public Health Laboratories Annual Meeting.
5. Shawn O’Leary, Chang Ho Yu, Eric Bind, Songyan Du, Andrew Steffens, Morgan McConico, Douglas Haltmeier, Zhihua (Tina) Fan. “Method Development for PCBs, OCPs, and Toxic Metals in Dried Blood Spots – Potential Indicators for Early Detection of Autism Spectrum Disorder” in poster presentation at 2020 Association of Public Health Laboratories Annual Meeting.
6. Andrew Steffens, Eric P. Bind, Andrew Krasley, Morgan McConico, Douglas Haltmeier, and Zhihua (Tina) Fan. “Mercury Exposure in Mothers and Babies: The Issues Beyond Testing “ in oral presentation at 2020 APHL Environmental Health Committee Annual Meeting.