{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T14:36:53Z","timestamp":1770820613094,"version":"3.50.1"},"reference-count":52,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2014,4,22]],"date-time":"2014-04-22T00:00:00Z","timestamp":1398124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Lead (Pb) and methyl mercury (MeHg) are well established neurodevelopmental toxicants (NDTs), but joint exposure to chemical and nonchemical (e.g., maternal stress) stressors has rarely been considered. We characterized exposure to Pb, MeHg and  a measure of physiological dysregulation associated with chronic stress and examined race\/ethnicity as a predictor of joint NDT exposure. Using data from the 2003\u22122004 NHANES, potential chronic stress exposure was estimated using allostatic load (AL),  a quantitative measure of physiological dysregulation. A Hazard Index was calculated for joint exposure to Pb and MeHg (HINDT). Logistic regression was used to assess the relationship between an indicator of elevated joint NDT exposures (HINDT &gt; 1) and race\/ethnicity. The multivariate model was stratified by AL groups to examine effect measure modification. African American (adjusted odds ratio [OR] [95% confidence interval] = 2.2 [1.4, 3.3]) and Mexican American (1.4 [0.7, 2.6]) women were more likely to have an HINDT &gt; 1 compared to Caucasian women. Chronic stress was identified as an effect measure modifier with the largest ORs among women with high AL scores (African Americans = 4.3 [2.0, 9.5]; Mexican Americans = 4.2 [1.3, 14.1]). Chronic stress was found to modify the association between elevated joint NDT exposure and race\/ethnicity, highlighting the importance of evaluating chemical and nonchemical stressor exposures leading to a common endpoint.<\/jats:p>","DOI":"10.3390\/ijerph110404384","type":"journal-article","created":{"date-parts":[[2014,4,22]],"date-time":"2014-04-22T12:18:37Z","timestamp":1398169117000},"page":"4384-4401","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Joint Exposure to Chemical and Nonchemical Neurodevelopmental Stressors in U.S. Women of Reproductive Age in NHANES"],"prefix":"10.3390","volume":"11","author":[{"given":"Amanda","family":"Evans","sequence":"first","affiliation":[{"name":"Oak Ridge Institute for Science and Education (ORISE), U.S. Environmental Protection Agency (EPA), Office of Research and Development, National Center for Environmental Assessment, Cincinnati, OH 45268, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glenn","family":"Rice","sequence":"additional","affiliation":[{"name":"EPA, Office of Research and Development, National Center for Environmental Assessment, Cincinnati, OH 45268, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Teuschler","sequence":"additional","affiliation":[{"name":"Linda Teuschler and Associates, St. Petersburg, FL 33707, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Wright","sequence":"additional","affiliation":[{"name":"EPA, Office of Research and Development, National Center for Environmental Assessment, Cincinnati, OH 45268, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2014,4,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.envres.2013.03.003","article-title":"In utero exposure to environmental lead and manganese and neurodevelopment at 2 years of age","volume":"123","author":"Lin","year":"2013","journal-title":"Environ. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.envint.2010.04.007","article-title":"Metal exposures in an inner-city neonatal population","volume":"36","author":"Jones","year":"2010","journal-title":"Environ. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1289\/ehp.7688","article-title":"Low-level environmental lead exposure and children\u2019s intellectual function: An international pooled analysis","volume":"113","author":"Lanphear","year":"2005","journal-title":"Environ. Health Persp."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.ntt.2012.06.001","article-title":"Neurobehavioral deficits at age 7 years associated with prenatal exposure to toxicants from maternal seafood diet","volume":"34","author":"Grandjean","year":"2012","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.envres.2012.10.005","article-title":"Multiple environmental chemical exposures to lead, mercury and polychlorinated biphenyls among childbearing-aged women (NHANES 1999\u20132004): Body burden and risk factors","volume":"121","author":"Thompson","year":"2013","journal-title":"Environ. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.ntt.2010.09.004","article-title":"Prenatal exposure to lead and cognitive deficit in 7- and 14-year-old children in the presence of concomitant exposure to similar molar concentration of methylmercury","volume":"33","author":"Yorifuji","year":"2011","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1016\/j.biopsych.2010.01.002","article-title":"Maternal prenatal cortisol and infant cognitive development: Moderation by infant\u2013mother attachment","volume":"67","author":"Bergman","year":"2010","journal-title":"Biol. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e376","DOI":"10.1542\/peds.2007-3608","article-title":"Trends in blood lead levels and blood lead testing among US children aged 1 to 5 years, 1988\u20132004","volume":"123","author":"Jones","year":"2009","journal-title":"Pediatrics"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"826","DOI":"10.2105\/AJPH.2004.060749","article-title":"\u201cWeathering\u201d and age patterns of allostatic load scores among blacks and whites in the United States","volume":"96","author":"Geronimus","year":"2006","journal-title":"Am. J. Public Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1289\/ehp.0901115","article-title":"Interaction of stress, lead burden, and age on cognition in older men: The VA Normative Aging Study","volume":"118","author":"Peters","year":"2010","journal-title":"Environ. Health Persp."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1289\/ehp.6481","article-title":"Maternal stress modulates the effects of developmental lead exposure","volume":"112","author":"Virgolini","year":"2004","journal-title":"Environ. Health Persp."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.neuro.2010.09.004","article-title":"Interactions of lifetime lead exposure and stress: Behavioral, neurochemical and HPA axis effects","volume":"32","author":"Virgolini","year":"2011","journal-title":"Neurotoxicology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1172\/JCI108467","article-title":"Kinetic analysis of lead metabolism in healthy humans","volume":"58","author":"Rabinowitz","year":"1976","journal-title":"J. Clin. Invest."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1006\/taap.1996.0078","article-title":"Methyl mercury pharmacokinetics in man: A reevaluation","volume":"137","author":"Smith","year":"1996","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Koob, G., Moal, M.L., and Thompson, R. (2010). Encyclopedia of Behavioural Neuroscience, Academic Press.","DOI":"10.1016\/B978-0-08-045396-5.00121-4"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1056\/NEJM199801153380307","article-title":"Protective and damaging effects of stress mediators","volume":"338","author":"McEwen","year":"1998","journal-title":"N. Engl. J. Med."},{"key":"ref_17","unstructured":"Fisher, S., and Reason, J. (1988). Handbook of Life Stress, Cognition and Health, Wiley."},{"key":"ref_18","unstructured":"Centers for Disease Control and Prevention (CDC) (2006). National Health and Nutrition Examination Survey: Public Data General Release File Documentation."},{"key":"ref_19","unstructured":"Centers for Disease Control and Prevention (CDC) (2004). Laboratory Procedure Manual: Lead, Cadmium, and Mercury in Whole Blood."},{"key":"ref_20","unstructured":"U.S. Environmental Protection Agency (2000). Supplementary Guidance for Conducting Health Risk Assessment of Chemical Mixtures."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1289\/ehp.6587","article-title":"Blood organic mercury and dietary mercury intake: National Health and Nutrition Examination Survey, 1999 and 2000","volume":"112","author":"Mahaffey","year":"2004","journal-title":"Environ. Health Persp."},{"key":"ref_22","unstructured":"U.S. Environmental Protection Agency (EPA) (2001). Methylmercury (MeHg) (CASRN 22967-92-6), Integrated Risk Information System (IRIS)."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.earlhumdev.2009.04.006","article-title":"Gender specific differences in neurodevelopmental effects of prenatal exposure to very low-lead levels: The prospective cohort study in three-year olds","volume":"85","author":"Jedrychowski","year":"2009","journal-title":"Early Hum. Dev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1111\/j.1742-7843.2010.00616.x","article-title":"The relationship between blood and serum lead levels in peripartum women and their respective umbilical cords","volume":"107","author":"Amaral","year":"2010","journal-title":"Basic Clin. Pharmacol. Toxicol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1080\/10934520903139829","article-title":"A blood lead benchmark for assessing risks from childhood lead exposure","volume":"44","author":"Carlisle","year":"2009","journal-title":"J. Environ. Sci. Health. A"},{"key":"ref_26","unstructured":"Centers for Disease Control and Prevention (CDC) (2012). What Do Parents Need to Know to Protect. Their Children?."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.neubiorev.2009.10.002","article-title":"Allostatic load biomarkers of chronic stress and impact on health and cognition","volume":"35","author":"Juster","year":"2010","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1089\/jwh.2010.2170","article-title":"Racial and ethnic patterns of allostatic load among adult women in the United States: Findings from the National Health and Nutrition Examination Survey 1999\u20132004","volume":"20","author":"Chyu","year":"2011","journal-title":"J. Womens Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/S0531-5565(03)00099-8","article-title":"Age differences in allostatic load: An index of physiological dysregulation","volume":"38","author":"Crimmins","year":"2003","journal-title":"Exp. Gerontol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1111\/j.1469-8986.2011.01185.x","article-title":"Mediators of the relationship between socioeconomic status and allostatic load in the Chicago Health, Aging, and Social Relations Study (CHASRS)","volume":"48","author":"Hawkley","year":"2011","journal-title":"Psychophysiology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.envres.2010.10.002","article-title":"Calculating summary statistics for population chemical biomonitoring in women of childbearing age with adjustment for age-specific natality","volume":"111","author":"Axelrad","year":"2011","journal-title":"Environ. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1289\/ehp.1103873","article-title":"Increased lead biomarker levels are associated with changes in hormonal response to stress in occupationally exposed male participants","volume":"120","author":"Fortin","year":"2012","journal-title":"Environ. Health Persp."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1039\/c2em10835f","article-title":"Assessment of prenatal mercury exposure in a predominately Caribbean immigrant community in Brooklyn, NY","volume":"14","author":"Geer","year":"2012","journal-title":"J. Environ. Monit."},{"key":"ref_34","unstructured":"Agency for Toxic Substances and Disease Registry (ATSDR) (2006). Interaction Profile for: Chlorpyrifos, Lead, Mercury, and Methylmercury."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1289\/ehp.1205740","article-title":"Evaluation of biomonitoring data from the CDC national exposure report in a risk assessment context: Perspectives across chemicals","volume":"121","author":"Aylward","year":"2013","journal-title":"Environ. Health Persp."},{"key":"ref_36","unstructured":"U.S. Environmental Protection Agency (EPA) (2013). Integrated Risk Information System (IRIS)."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1289\/ehp.9332","article-title":"Vulnerability as a function of individual and group resources in cumulative risk assessment","volume":"115","author":"DeFur","year":"2007","journal-title":"Environ. Health Persp."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1476-069X-11-10","article-title":"Social disparities in exposures to bisphenol A and polyfluoroalkyl chemicals: A cross-sectional study within NHANES 2003\u20132006","volume":"11","author":"Nelson","year":"2012","journal-title":"Environ. Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.2105\/AJPH.2006.091892","article-title":"Hispanic paradox in biological risk profiles","volume":"97","author":"Crimmins","year":"2007","journal-title":"Am. J. Public Health"},{"key":"ref_40","unstructured":"Martin, J., Hamilton, B., Sutton, P., Ventura, S., Menacker, F., and Munson, M. (2005). Births: Final Data for 2003, National Center for Health Statistics."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1093\/aje\/152.9.829","article-title":"Patterns and determinants of blood lead during pregnancy","volume":"152","author":"Schramm","year":"2000","journal-title":"Am. J. Epidemiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1289\/ehp.1002727","article-title":"Environmental chemicals in pregnant women in the United States: NHANES 2003\u20132004","volume":"119","author":"Woodruff","year":"2011","journal-title":"Environ. Health Persp."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/10253890902874913","article-title":"Human models in acute and chronic stress: assessing determinants of individual hypothalamus-pituitary-adrenal axis activity and reactivity","volume":"13","author":"Kudielka","year":"2010","journal-title":"Stress"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1289\/ehp.8930","article-title":"The environmental \u201criskscape\u201d and social inequality: Implications for explaining maternal and child health disparities","volume":"114","author":"Shenassa","year":"2006","journal-title":"Environ. Health Persp."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.annepidem.2013.03.006","article-title":"Allostatic load may not be associated with chronic stress in pregnant women, NHANES 1999\u20132006","volume":"23","author":"Morrison","year":"2013","journal-title":"Ann. Epidemiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s10995-012-1083-y","article-title":"Allostatic load and birth outcomes among white and black women in New Orleans","volume":"17","author":"Wallace","year":"2013","journal-title":"Matern Child Health J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1289\/ehp.9863","article-title":"Synergistic effects of traffic-related air pollution and exposure to violence on urban asthma etiology","volume":"115","author":"Clougherty","year":"2007","journal-title":"Environ. Health Persp."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1289\/ehp.11076","article-title":"Chronic traffic-related air pollution and stress interact to predict biologic and clinical outcomes in asthma","volume":"116","author":"Chen","year":"2008","journal-title":"Environ. Health Persp."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"12406","DOI":"10.1073\/pnas.0812910106","article-title":"Parental stress increases the effect of traffic-related air pollution on vhildhood ssthma incidence","volume":"106","author":"Shankardass","year":"2009","journal-title":"Proc. Natl. Acad. Sci. USA."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1289\/ehp.1104517","article-title":"Black-white blood pressure disparities: Depressive symptoms and differential vulnerability to blood lead","volume":"121","author":"Hicken","year":"2013","journal-title":"Environ. Health Persp."},{"key":"ref_51","unstructured":"Read, S., and Grundy, E. (2012). Allostatic Load\u2014A Challenge to Measure Multisystem Physiological Dysregulation. Pathways Node at NCRM, National Centre for Research Methods."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.exger.2005.03.002","article-title":"A comparative analysis of measurement approaches for physiological dysregulation in an older population","volume":"40","author":"Seplaki","year":"2005","journal-title":"Exp. Gerontol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/11\/4\/4384\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T21:10:32Z","timestamp":1760217032000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/11\/4\/4384"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,4,22]]},"references-count":52,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2014,4]]}},"alternative-id":["ijerph110404384"],"URL":"https:\/\/doi.org\/10.3390\/ijerph110404384","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,4,22]]}}}