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1.  Ciguatera Incidence in the US Virgin Islands Has Not Increased over a 30-Year Time Period Despite Rising Seawater Temperatures 
Ciguatera fish poisoning is the most common marine food poisoning worldwide. It has been hypothesized that increasing seawater temperature will result in increasing ciguatera incidence. In St. Thomas, US Virgin Islands, we performed an island-wide telephone survey (N = 807) and a medical record review of diagnosed ciguatera cases at the emergency department of the sole hospital and compared these data with comparable data sources collected in 1980. Annual incidence from both recent data sources remained high (12 per 1,000 among adults in the telephone survey). However, the combined data sources suggest that incidence has declined by 20% or more or remained stable over 30 years, whereas seawater temperatures were increasing. Illness was associated with lower education levels, higher levels of fish consumption, and having previous episodes of ciguatera; population shifts from 1980 to 2010 in these factors could explain an incidence decline of approximately 3 per 1,000, obscuring effects from rising seawater temperature.
PMCID: PMC3752756  PMID: 23400575
2.  Dietary patterns are associated with dietary recommendations but have limited relationship to body mass index in the Communities Advancing the Studies of Tribal Nations Across the Lifespan (CoASTAL) cohort 
Public health nutrition  2012;15(10):1948-1958.
Traditional food systems in indigenous groups have historically had health promoting benefits. The objectives of this study were to determine if a traditional dietary pattern of Pacific Northwest Tribal Nations (PNwT) could be derived using reduced rank regression (RRR) and if the pattern would be associated with lower body mass index (BMI) and current Dietary Reference Intakes (DRI).
The baseline data from the Communities Advancing the Studies of Tribal Nations Across the Lifespan (CoASTAL) cohort were used to derive dietary patterns for the total sample and those with plausibly reported energy intakes.
Pacific Northwest Coast of Washington State, United States.
Adult PNwT members of the CoASTAL cohort with lab-measured weight and height and up to 4 days of dietary records (n=418).
A traditional dietary pattern did not evolve from the analysis. Moderate consumption of a sweet drinks dietary pattern was associated with a lower BMI while higher consumption of a vegetarian based dietary pattern was associated with higher BMI. The highest consumers of the vegetarian based dietary pattern were almost 6 times more likely to meet the recommendations for dietary fiber.
Distinct dietary patterns were found. Further exploration is needed to confirm whether the lack of finding a traditional pattern is due to methodology or the loss of a traditional dietary pattern among this population. Longitudinal assessment of the CoASTAL cohort’s dietary patterns needs to continue.
PMCID: PMC3746549  PMID: 22348238
dietary patterns; reduced rank regression; Native American adults; BMI
3.  The Early Psychological Impacts of the Deepwater Horizon Oil Spill on Florida and Alabama Communities 
Environmental Health Perspectives  2011;119(6):838-843.
Although public concern has focused on the environmental impact of the Deepwater Horizon oil spill, the public health impact on a broad range of coastal communities is minimally known.
We sought to determine the acute level of distress (depression, anxiety), mechanisms of adjustment (coping, resilience), and perceived risk in a community indirectly impacted by the oil spill and to identify the extent to which economic loss may explain these factors.
Using a community-based participatory model, we performed standardized assessments of psychological distress (mood, anxiety), coping, resilience, neurocognition, and perceived risk on residents of fishing communities who were indirectly impacted (n = 71, Franklin County, Florida) or directly exposed (n = 23, Baldwin County, Alabama) to coastal oil. We also compared findings for participants who reported income stability (n = 47) versus spill-related income loss (n = 47).
We found no significant differences between community groups in terms of psychological distress, adjustment, neurocognition, or environmental worry. Residents of both communities displayed clinically significant depression and anxiety. Relative to those with stable incomes, participants with spill-related income loss had significantly worse scores on tension/anxiety, depression, fatigue, confusion, and total mood disturbance scales; had higher rates of depression; were less resilient; and were more likely to use behavioral disengagement as a coping strategy.
Current estimates of human health impacts associated with the oil spill may underestimate the psychological impact in Gulf Coast communities that did not experience direct exposure to oil. Income loss after the spill may have a greater psychological health impact than the presence of oil on the immediately adjacent shoreline.
PMCID: PMC3114820  PMID: 21330230
disasters; environmental epidemiology; occupational health; petroleum products; risk perception
4.  Evaluation of dietary assessment tools used to assess the diet of adults participating in the Communities Advancing the Studies of Tribal Nations Across the Lifespan (CoASTAL) cohort 
Accurate assessment of dietary intake is essential for researchers and public health practitioners to make advancements in health. This is especially important in Native Americans who display disease prevalence rates that are dramatically higher than the general U.S. population.
The objective of this study was to evaluate three dietary assessment tools: 1) dietary records, 2) a food frequency questionnaire (FFQ), and 3) a shellfish assessment survey (SAS) among Native American adults from the Communities Advancing Studies of Tribal Nations Across the Lifespan (CoASTAL) cohort.
CoASTAL was comprised of randomly selected individuals from three tribal registries of Pacific Northwest Tribal Nations. This cross-sectional study used data from the baseline of CoASTAL and was restricted to the non-pregnant adults (18+ yr) who completed the SAS (n=500), a FFQ (n=518), dietary records (n=444), weight measures (n=493), and height measures (n=496). Paired t-tests, Pearson correlation coefficients, and percent agreement were used to evaluate the dietary records and the FFQ with and without accounting for plausibility of reported energy intake (rEI). Sensitivity and specificity as well as Spearman correlation coefficients were used to evaluate the SAS and the FFQ compared to dietary records.
Statistically significant correlations between the FFQ and dietary records for selected nutrients were not the same by gender. Accounting for plausibility of rEI for the dietary records and the FFQ improved the strength of the correlations for percent energy from protein, energy from carbohydrate, and calcium for both men and women. In addition, significant associations between rEI (dietary records and FFQ) and weight were more apparent when using only rEI considered plausible. The SAS was found to similarly assess shellfish consumption in comparison to the FFQ.
These results support the benefit of multiple measures of diet, including regional and culturally specific surveys, especially among Native Americans. Accounting for plausibility of rEI may ensure more accurate estimations of dietary intakes.
PMCID: PMC3090645  PMID: 20102829
Native Americans; dietary assessment; convergent validation; shellfish
5.  Occupational Exposure to Pfiesteria Species in Estuarine Waters Is Not a Risk Factor for Illness 
Environmental Health Perspectives  2006;114(7):1038-1043.
Exposure to the dinoflagellate Pfiesteria has, under certain circumstances, been associated with deficits in human learning and memory. However, uncertainties remain about the health risk of chronic, low-level exposures (as seen among occupationally exposed commercial fishermen), particularly in light of studies suggesting that Pfiesteria strains are widespread in the estuarine environment in the U.S. mid-Atlantic region.
We selected an initial cohort of 152 persons, including 123 persons with regular, occupational exposure to the Chesapeake Bay; 107 of the cohort members were followed for the full four summer “seasons” of the study. Cohort members were questioned biweekly about symptoms, and data were collected about the areas of the bay in which they worked. These latter data were matched with data on the presence or absence of Pfiesteria in each area, based on polymerase chain reaction analysis of > 3,500 water samples. Cohort members underwent neuropsychological testing at the beginning and end of each summer season.
No correlation was found between work in an area where Pfiesteria was identified and specific symptomatology or changes on neuropsychological tests.
Although high-level or outbreak-associated exposure to Pfiesteria species (or specific strains within a species) may have an effect on health, routine occupational exposure to estuarine environments in which these organisms are present does not appear to pose a significant health risk.
PMCID: PMC1513342  PMID: 16835056
commercial fishermen; dinoflagellates; environmental toxins; neuropsychological testing; occupational health

Results 1-5 (5)