Abstract
Objective
Environmental chemicals are widely found in food and personal care products and may have adverse effects on fetal development. Our aim was to examine women’s attitudes about these chemicals and ask whether they try to limit their exposure during pregnancy.
Study design
A multi-center cohort of women in the first trimester of pregnancy completed questionnaires including items on attitudes and behaviors related to environmental chemicals. Multivariable logistic regression models were used to examine: (1) whether sociodemographic variables predict environmental health attitudes and behaviors; and (2) whether women’s attitudes about environmental chemicals affect their lifestyle behaviors, particularly diet and personal care product use.
Results
Of the 894 subjects, approximately 60% strongly agreed that environmental chemicals are dangerous and 25% strongly felt they were impossible to avoid. Adjusting for covariates, educated women were more likely to believe that environmental chemicals are dangerous (OR 1.74, 95% CI 1.13, 2.66), and that belief, in turn, was associated with a number of healthy behaviors including choosing organic foods, foods in safe plastics, and chemical-free personal care products, and limiting fast food intake. Younger women were more likely to believe environmental chemicals are impossible to avoid (OR 1.04, 95% CI 1.00, 1.08).
Conclusions
Women’s attitudes about environmental chemicals may impact their choices during pregnancy. Overcoming a lack of concern about environmental chemicals, particularly among certain sociodemographic groups, is important for the success of clinical or public health prevention measures.
Keywords: Environmental chemicals, Pregnancy, Attitudes, Behaviors
1. Introduction
In 2013, several of the leading professional organizations of obstetricians and fertility specialists issued statements acknowledging that environmental chemicals present significant reproductive health risks and calling for the clinical community to integrate environmental health awareness and assessment as a routine part of preconception and prenatal care [1,2]. These statements emphasized that exposure to environmental chemicals like phthalates, bisphenol A (BPA), and pesticides may be of particular concern during pregnancy [3–6]. For some chemicals like phthalates, all populations of pregnant women studied in the U.S., Europe, and Asia have measurable levels, indicating the potential magnitude of the issue [7–11]. Nevertheless, it remains unclear whether these concerns have reached pregnant women and if so, whether they take any measures to avoid such exposures [12].
Thus far, most research on this question has focused on fish consumption advisories aimed at limiting exposure to methylmercury, a developmental neurotoxin. Women’s awareness of mercury’s toxicity and the consumption advisories were strongly related to geographic and sociodemographic factors [13–15]. Even among women aware of the advisories, however, only a minority reduced their fish consumption accordingly during pregnancy [15], and in one study, awareness of advisories was not associated with hair mercury levels among sport fish consumers [16]. These results suggest: (1) that women’s awareness of the risks of chemicals and their motivation to make behavioral changes during pregnancy are two important challenges to reducing exposures; and (2) any clinical or public health measures to increase environmental health awareness and reduce exposures must consider sociodemographic variation.
As the fish consumption literature suggests, diet is an important, potentially modifiable source of chemical exposures. Diet is a major source of exposure not only to methylmercury, but to pesticides, BPA, and phthalates, among other chemicals [17–21]. Personal care product (PCP) use is a second significant, potentially modifiable, source of chemical exposure. Many PCPs contain environmental chemicals as inert ingredients [22] and PCP use patterns are associated with urinary concentrations of phthalate metabolites, phenols, and parabens [23–26]. By limiting product use, forgoing certain products (such as nail polish), or choosing “chemical-free” formulations, women may be able to limit their exposures. In a recent study of pregnant Old Order Mennonites, a population with very low PCP use (including no cosmetics), phthalate metabolite levels were far lower than in the general U.S. population [20].
Thus there is reason to believe that women may be able to reduce their exposure to certain environmental chemicals through their lifestyle choices, and that the recommendations provided for clinicians in the recent statement on exposure to toxic environmental agents may be useful in this respect [1]. In order to successfully translate those recommendations into behavioral changes, however, we need to better understand the extent to which women are concerned about environmental chemicals, whether they make lifestyle choices accordingly, and whether sociodemographic factors (such as race, education, and age) contribute to these attitudes and behaviors. Here we investigate these questions in a large cohort of women in their first trimester of pregnancy.
2. Materials and methods
2.1 Overview of recruitment and relevant study activities
From 2010 to 2012, women were recruited into The Infant Development and the Environment Study (TIDES) from obstetrical clinics affiliated with academic medical centers in four U.S. cities: Minneapolis, MN; Rochester, NY; San Francisco, CA; and Seattle, WA. Study personnel attended obstetrical clinics and approached potentially eligible women in examination rooms. Eligibility criteria included: less than 13 weeks pregnant, singleton pregnancy, English-speaking (or Spanish-speaking at the CA center), age 18 or over, no serious threat to the pregnancy, and plans to deliver at a study hospital. The institutional review boards at all institutions approved TIDES prior to study implementation and all subjects signed informed consent.
Participants completed a questionnaire in each trimester, usually at home through a secure, internet-based portal (with an alternative paper-and-pencil option). The questionnaires included items on demographics as well as factors potentially influencing exposures during pregnancy. Women received $10 for each prenatal questionnaire completed. The data for the current analyses come exclusively from the first-trimester questionnaire. In total, 969 women enrolled and 894 women (92%) provided first-trimester questionnaire data. Seventy consented women dropped out before completing the first questionnaire, while four women did not provide first-trimester questionnaire data but completed other study activities and remained in the study.
2.2 Demographic data
For these analyses, married women were grouped with women who reported “living as married”, while separated, divorced, and single women were grouped together. Ethnicity was dichotomized as Hispanic or non-Hispanic and race was dichotomized as black or not black. Age was reported to the nearest year and yearly household income was grouped into four categories ranging from <$15,000 to >$75,000. Education was dichotomized as graduated college or more versus less than college.
2.3 Environmental health attitudes
Subjects answered two questions on general attitudes about environmental health and chemicals on a 5-point scale (strongly agree, agree, neither agree nor disagree, disagree, strongly disagree). These questions were developed de novo because we know of no validated questionnaire on environmental health awareness and attitudes. The first question asked the extent to which they agreed that “Chemicals in the environment can pose health risks” and the second asked the extent to which they agreed that “Chemicals in the environment are in so many things that it’s impossible to avoid them.” After reviewing the distribution of responses, for both questions, we dichotomized to women who responded “strongly agree” versus all other respondents.
2.4 Environmental health behaviors
Subjects reported on health behaviors during pregnancy, including diet and PCP use. Dietary questions included items on frequency of choosing organic and chemical-free foods and foods in safe plastics (always, usually, sometimes, rarely, never). For each of these, women who responded “always/usually” were compared to all other respondents. Women also reported frequency of fast food consumption during pregnancy, were dichotomized into less than two times per week versus two or more times per week. For PCP use, subjects were first asked how often they try to make sure that the PCPs they buy are organic, ecofriendly, chemical-free, or environmentally friendly, and based on the distribution of responses, subjects were dichotomized as “always/usually/sometimes” versus “rarely/never”. They were asked how many days in the previous week they had applied any one of 25 specific PCPs including nail polish and perfume. Based on their responses, we created three variables: (1) used nail polish within previous week (yes/no); (2) used perfume within previous week (yes/no); and (3) total number of types of PCPs used in the previous week. We then defined women in the highest quartile of PCP use (22 or more different products used) as high PCP users while women who used fewer than 22 different products per week were defined as lower PCP users.
2.5 National Health and Nutrition Examination Survey (NHANES)
To assess the generalizability of our results, we compared the TIDES cohort to that of 721 pregnant women participating in the National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of health in the U.S. population. For this comparison, we pooled the datasets of three distinct NHANES cycles: 2001–2002, 2003–2004, and 2005–2006 cycles [27,28].
2.6 Statistical analyses
We first examined descriptive statistics for all variables and examined subject characteristics by study center. We examined correlations among sociodemographic variables (age, marital status, employment status, race, ethnicity, income, and education level). Because income was strongly correlated with age, marital status, and education level, it was not included in fully adjusted models. We then performed bivariate analyses (crude logistic regressions, t-tests, and chi-square tests) looking at whether these sociodemographic variables predicted environmental health attitudes and behaviors. Any sociodemographic variable that was associated with environmental health attitudes or behaviors at an alpha level of ≤0.15 was included in subsequent multivariable models. These included: race, marital status, age, education level, and study center.
Finally, we fitted two sets of multivariable logistic regression models. The first set examined whether sociodemographic variables predicted the two environmental health attitude variables described in section 2.3. The second set examined whether the two environmental health attitude variables predicted the three dietary and the four personal care products use behaviors described in section 2.4. We performed two sensitivity analyses: one excluding women from the sociodemographically different Rochester, NY study center; and the second including income in the fully adjusted models. All analyses were conducted in SAS Version 9.2 (SAS Institute Inc., Cary, NC, USA) and all p-values reported are two-tailed, with an alpha level of p=0.05.
3. Results
The TIDES subjects were 31.3 years of age on average, married, and were predominantly non-Hispanic and Caucasian. They were similar to pregnant NHANES participants in terms of age, race, marital status and employment, but tended to be more highly educated and with higher income. Fifty-nine percent of subjects strongly agreed that chemicals in the environment are dangerous and 25% strongly agreed that chemicals in the environment are impossible to avoid (Table 1). Women who agreed that chemicals in the environment are dangerous were more likely to say they were also impossible to avoid than women who did not feel that environmental chemicals are dangerous (χ21=26.5, p<0.0001; not shown). Adjusting for other sociodemographic variables, only education level predicted strong agreement that chemicals in the environment are dangerous (OR 1.74, 95% CI 1.13, 2.66; Table 2) and only age predicted strong agreement that chemicals in the environment are impossible to avoid (OR 1.04, 95% CI 1.00, 1.08).
Table 1.
Characteristics of the TIDES study population compared to NHANES (2001–2006) and in relation to attitudes about environmental health and chemicals (n=894).
| Characteristic | NHANES (2001–2006)†*; N (%) N=721 |
TIDESa N (%) N=894 |
N (%) who strongly agree that chemicals in the environment are dangerous N=524 (59) |
N (%) who strongly agree that chemicals in the environment are impossible to avoid N=222 (25) |
|---|---|---|---|---|
| Age | ||||
| <20 | 0 | 37 (4) | 10 (27) | 4 (11) |
| 20–24 | 211 (29) | 115 (13) | 49 (43) | 14 (12) |
| 25–29 | 254 (33) | 208 (23) | 111 (53) | 54 (26) |
| 30–34 | 176 (24) | 303 (34) | 191 (63) | 81 (27) |
| 35–39 | 75 (12) | 188 (21) | 135 (72) | 54 (29) |
| 40+ | 5 (8) | 43 (5) | 28 (65) | 15 (35) |
| p-value†† | 0.008 | 0.05 | ||
| Race/ethnicity | ||||
| Non-Hispanic black | 102 (15) | 104 (13) | 50 (48) | 19 (18) |
| Hispanic | 218 (18) | 78 (9) | 42 (53) | 19 (18) |
| Non-Hispanic white/other | 401 (67) | 644 (78) | 385 (62) | 154 (25) |
| p-value** | 0.01 | 0.19 | ||
| Marital status | ||||
| Married/ Living as married | 598 (81) | 722 (82) | 456 (63) | 195 (27) |
| Separated/divorced/single | 123 (19) | 155(18) | 64 (41) | 26 (17) |
| p-value** | <0.0001 | 0.003 | ||
| Education | ||||
| High school or less | 181 (20) | 125 (14) | 42 (34) | 16 (13) |
| Some college | 132 (16) | 113 (13) | 59 (52) | 23 (20) |
| Graduated college | 216 (32) | 275 (31) | 164 (60) | 64 (23) |
| Some graduate work/graduate degree | 192 (33) | 364 (42) | 255 (70) | 117 (32) |
| p-value†† | <0.0001 | <0.0001 | ||
| Employed | ||||
| Yes | 407 (65) | 639 (73) | 385 (60) | 162 (25) |
| No | 314 (35) | 242 (27) | 138 (57) | 60 (25) |
| p-value** | 0.38 | 0.86 | ||
| Household income | ||||
| <$15,000 per year | 101 (12) | 127 (15) | 62 (49) | 24 (19) |
| $15,000--$45,000 per year | 263 (33) | 165 (19) | 87 (53) | 24 (15) |
| $45,001--$$75,000 per year | 185 (28) | 157 (18) | 95 (61) | 38 (24) |
| >$75,000 per year | 172 (26) | 409 (48) | 271 (66) | 130 (32) |
| p-value†† | 0.0007 | <0.0001 | ||
| Study Center | ||||
| San Francisco, CA | 222 (25) | 152 (68) | 67 (30) | |
| Minneapolis, MN | 231 (26) | 138 (60) | 61 (26) | |
| Rochester, NY | N.A. | 249 (28) | 113 (45) | 42 (17) |
| Seattle, WA | 192 (21) | 121 (63) | 52 (27) | |
| p-value** | <0.0001 | 0.005 |
Percentages may not add up to 100 due to rounding or questions left blank.
Includes pregnant women who participated in the 2001–2002, 2003–2004, or 2005–2006 NHANES cycles.
Percentages are probability weighted and representative of US population.
Chi-squared test.
Bivariate logistic regression.
Table 2.
Multivariable logistic regression analyses and odds ratios for attitudes towards environmental chemicals in relation to sociodemographic factors (n=860)a, b
| Characteristic | Strong agreement that chemicals in the environment are dangerous (n=524, 61%) |
Strong agreement that chemicals in the environment are impossible to avoid (n=222, 26%) |
||||
|---|---|---|---|---|---|---|
| OR | 95% CI | p-value | OR | 95% CI | p-value | |
| Marriedc | 1.39 | (0.86, 2.25) | 0.19 | 1.07 | (0.58, 1.97) | 0.82 |
| Age (continuous) | 1.03 | (1.00, 1.07) | 0.07 | 1.04 | (1.00, 1.08) | 0.04 |
| College degree or mored | 1.74 | (1.13, 2.66) | 0.01 | 1.22 | (0.72, 2.05) | 0.46 |
| Race (non-black)e | 1.41 | (0.83, 2.38) | 0.20 | 1.10 | (0.57, 2.11) | 0.78 |
| NY Centerf | 0.61 | (0.38, 0.99) | 0.05 | 0.80 | (0.46, 1.41) | 0.44 |
| WA Centerf | 0.91 | (0.58, 1.44) | 0.69 | 1.16 | (0.72, 1.87) | 0.55 |
| MN Centerf | 0.73 | (0.47, 1.13) | 0.16 | 1.07 | (0.67, 1.71) | 0.78 |
34 women lacked data on the dependent variables and were thus excluded from these analyses.
Multivariable models adjust for all variables included in the table.
Reference group: unmarried
Reference group: less than a college degree
Reference group: black
Reference group: CA Center
Over 75 percent of subjects reported trying to pursue environmentally healthy behaviors, such as consuming organic foods. However, when asked about specific behaviors, such as making sure that the food and beverages they consume come in safe plastics, far fewer women reported following exposure-reducing behaviors (Table 3). In bivariate analyses, there was extensive variation in environmental health-related dietary behaviors and PCP use in relation to sociodemographic variables (Table 3). In general, women who were older, white, married, highly educated, and with a higher household income were more likely to pursue behaviors that may limit chemical exposures. Adjusting for sociodemographic factors, women who strongly agreed that environmental chemicals are dangerous were more likely to eat organic food (OR 2.25, 95% CI 1.55, 3.29), choose food in safe plastics (OR: 1.43, 95% CI 1.06, 1.94), and buy “eco-friendly” PCPs (OR: 2.80, 95% CI 2.06, 3.80). They were less likely to consume fast food frequently (OR: 0.67, 95% CI 0.46, 0.99). By contrast, women who strongly agreed that chemicals in the environment are impossible to avoid were more likely to eat fast food frequently (OR 1.66, 95% CI 1.06, 2.58). Results were largely the same in our sensitivity analyses (not shown).
Table 3.
Bivariate analyses examining environmental health-related behaviors during pregnancy in relation to sociodemographic factors (n=894)a,b.
| Dietary Habits during pregnancy; N (%) | Personal Care Product (PCP) use in last week; N (%) | ||||||
|---|---|---|---|---|---|---|---|
| Consume “organic”, “pesticide free” and/or “chemical free” foodsc |
Try to make sure food is in safe plasticc |
Eat fast food 2+ times in a typical week |
Try to buy “eco- friendly”, “chemical- free” PCPsc |
Perfume use (any) |
Nail polish use (any) |
Highest quartile of product use |
|
| 628 (76) | 417 (51) | 201 (23) | 704 (80) | 563 (63) | 506 (57) | 253 (28) | |
| Age | |||||||
| <20 | 11 (44) | 15 (68) | 17 (57) | 15 (50) | 21 (57) | 17 (46) | 8 (21) |
| 20–24 | 52 (57) | 53 (51) | 57 (50) | 80 (70) | 80 (70) | 69 (60) | 27 (23) |
| 25–29 | 129 (66) | 93 (47) | 61 (29) | 156 (75) | 143 (69) | 128 (62) | 59 (28) |
| 30–34 | 238 (82) | 132 (46) | 46 (15) | 254 (84) | 185 (61) | 162 (53) | 93 (31) |
| 35–39 | 166 (91) | 106 (59) | 19 (10) | 167 (89) | 111 (59) | 111 (59) | 54 (29) |
| 40+ | 32 (84) | 18 (49) | 1 (2) | 32 (82) | 23 (53) | 19 (44) | 12 (28) |
| p-value | <0.0001 | 0.64 | <0.0001 | <0.0001 | 0.001 | 0.03 | 0.78 |
| Race/ethnicity | |||||||
| Non-Hispanic black | 42 (51) | 45 (49) | 66 (63) | 67 (64) | 72 (69) | 61 (59) | 23 (22) |
| Hispanic | 49 (66) | 45 (63) | 23 (29) | 62 (78) | 59 (74) | 55 (69) | 25 (31) |
| Non-Hispanic white/other | 528 (82) | 318 (50) | 105 (15) | 560 (83) | 422 (62) | 384 (57) | 203 (30) |
| p-value | <0.0001 | 0.11 | <0.0001 | <0.0001 | 0.06 | 0.11 | 0.24 |
| Marital status | |||||||
| Married/ Living as married | 555 (81) | 351 (51) | 117 (16) | 597 (83) | 452 (63) | 409 (57) | 221 (31) |
| Separated/divorced/single | 69 (53) | 64 (47) | 83 (54) | 103 (66) | 108 (70) | 96 (62) | 32 (21) |
| p-value | <0.0001 | 0.39 | <0.0001 | <0.0001 | 0.46 | 0.22 | 0.007 |
| Education | |||||||
| High school or less | 50 (47) | 59 (57) | 65 (52) | 83 (66) | 87 (70) | 70 (56) | 28 (22) |
| Some college | 59 (62) | 54 (53) | 48 (43) | 79 (70) | 84 (74) | 67 (59) | 25 (22) |
| Graduated college | 202 (78) | 136 (51) | 58 (21) | 234 (85) | 174 (63) | 170 (62) | 77 (28) |
| Some graduate work/graduate degree | 313 (88) | 165 (47) | 28 (8) | 303 (83) | 216 (59) | 197 (54) | 122 (33) |
| p-value | <0.0001 | 0.11 | <0.0001 | <0.0001 | 0.003 | 0.97 | 0.006 |
| Employed | |||||||
| No | 153 (71) | 122 (51) | 77 (32) | 189 (78) | 98 (41) | 64 (26) | 103 (43) |
| Yes | 472 (79) | 291 (46) | 124 (20) | 514 (81) | 250 (39) | 168 (27) | 348 (55) |
| p-value | 0.02 | 0.12 | 0.0003 | 0.42 | 0.46 | 0.29 | 0.08 |
| Household income | |||||||
| <$15,000 per year | 56 (52) | 62 (54) | 64 (50) | 88 (69) | 85 (67) | 74 (58) | 31 (24) |
| $15,000--$45,000 per year | 85 (62) | 70 (48) | 64 (39) | 117 (71) | 114 (69) | 92 (56) | 37 (22) |
| $45,001--$$75,000 per year | 113 (74) | 73 (48) | 26 (17) | 124 (80) | 104 (66) | 94 (60) | 48 (31) |
| >$75,000 per year | 359 (90) | 201 (51) | 38 (9) | 355 (87) | 248 (61) | 236 (58) | 134 (33) |
| p-value | <0.0001 | 0.69 | <0.0001 | <0.0001 | 0.19 | 0.90 | 0.05 |
| Study Center | |||||||
| San Francisco, CA | 207 (95) | 115 (56) | 15 (7) | 197 (90) | 137 (62) | 136 (61) | 80 (36) |
| Minneapolis, MN | 163 (75) | 98 (45) | 50 (22) | 183 (80) | 141 (61) | 134 (58) | 59 (26) |
| Rochester, NY | 110 (53) | 121 (55) | 110 (44) | 173 (70) | 179 (72) | 139 (56) | 61 (25) |
| Seattle, WA | 148 (82) | 83 (46) | 26 (14) | 151 (81) | 106 (55) | 97 (51) | 53 (28) |
| p-value | <0.0001 | 0.05 | <0.0001 | <0.0001 | 0.003 | 0.16 | 0.03 |
Actual n for individual bivariate analyses varies due to questions left blank.
Percentages may not add up to 100 due to rounding or questions left blank.
Refers to respondents who reported always, usually, or sometimes (as opposed to rarely or never).
4. Comment
We examined pregnant women’s attitudes towards environmental health and chemicals and their associations with dietary behaviors and PCP use. Over half of this well-educated population strongly agreed that environmental chemicals are hazardous and a quarter strongly felt that they are impossible to avoid, which presents a challenge to reducing exposures through individually-motivated behavioral changes. To address these attitudes, future research should examine the extent to which environmental chemical exposure can be avoided or reduced through simple, well-defined changes, rather than complete dietary and lifestyle transformations [17,20,21,29]. When effective strategies like avoiding canned goods are identified [18], they should be widely disseminated, so that women feel empowered to reduce their exposure.
In keeping with the fish consumption and methylmercury literature [15], our results show considerable sociodemographic variation in environmental health-related dietary behaviors. This variation likely reflects both access-related issues (time, money, physical proximity) and differences in awareness and beliefs that dietary intake (beyond basic nutritional requirements) during pregnancy can affect the health of the fetus. This is important from a public health perspective in that attempts to lower chemical exposure through behavioral changes may be more successful in some sociodemographic groups than others and may need to be customized to different populations [17,19,21].
Most women reported trying to make “eco-friendly” PCP choices, but women’s attitudes towards environmental health and chemicals were not associated with their actual PCP use. Women may be unaware of environmental chemicals in PCPs and perceive them to be “safe”. For instance, many women who were concerned about environmental chemicals also used perfume during pregnancy despite the fact that most perfumes likely include phthalates. In the same way that diet has been a recent focus of environmental health interventions, additional research is needed to examine how changing PCP use patterns could lower chemical exposures.
It is worth noting that in our study, educational attainment was a consistent predictor of both concern about the dangers of environmental chemicals and engaging in health behaviors that might reduce exposure. Educated women are likely to have better access to environmental health information, to be better equipped to process that information, and to have more resources to support their lifestyle choices. Given the socioeconomic disparities in many environmental exposures [30,31], providing access to environmental health information and improving environmental health literacy in populations of low socioeconomic status may be particularly important. To this end, clinicians, as a trusted source of information, are in a strong position to educate women on the hazards of environmental chemicals and promote healthy behaviors.
One limitation of the current study is the potential for reporting bias in women’s attitudes towards environmental chemicals and their behaviors. Subjects may have reported attitudes about environmental chemicals that they felt were consistent with the study’s aims. Women may have also over-reported “healthy” behaviors and under-reported “unhealthy” ones. A second limitation is the generalizability of our results. TIDES recruited through first-trimester prenatal care, and thus the cohort does not include women who did not seek early prenatal care, who are typically more likely to forgo healthy behaviors and continue with risky behaviors [32,33]. Although our population is similar to NHANES in many ways, ultimately it is not nationally representative. Unfortunately, in pregnancy cohort studies (particularly those which follow the resulting children, as TIDES will) selection bias is an inherent limitation [34–36]. In particular, minorities tend to be less well represented and less willing to participate in such long-term studies [37]. In the future, therefore, using a one-time assessment may help to reach a more diverse subject population.
Despite these limitations, this research is important in that it suggests that even in pregnancy, many women do not try to limit their exposure to chemicals in the environment, either because they don’t think it’s important to or they don’t know how to do so. These attitudes are particularly prevalent among certain groups of women, suggesting the need for strategic public health measures targeting high-risk groups. Alternatively, recognizing how difficult it is to motivate people to make behavioral changes, systems-level changes aimed at reducing use of chemicals in consumer products would be valuable. Future research in this vein is needed to: (1) examine women’s knowledge of sources of environmental chemical exposures; (2) identify their trusted sources of environmental health information; (3) determine whether pregnancy is truly a period during which women are highly amenable to lifestyle changes (including those aimed at lowering chemical exposure), as is widely believed; and (4) determine whether changes made during pregnancy are long-lasting or cease in the post-partum period.
Table 4.
Multivariable logistic regression analyses and odds ratios for pregnancy behaviors in relation to attitudes towards environmental chemicals.a
| nb | Strong agreement that chemicals in the environment are dangerous |
Strong agreement that chemicals in the environment are impossible to avoid |
|||||
|---|---|---|---|---|---|---|---|
| OR | 95% CI | p-value | OR | 95% CI | p-value | ||
| Dietary habits | |||||||
| Always/usually consume “organic”, “pesticide free” and/or “chemical free” foodsc | 801 | 2.25 | (1.55, 3.29) | <0.0001 | 0.94 | (0.60, 1.48) | 0.79 |
| Always/usually try to make sure food is in safe plasticsd | 803 | 1.43 | (1.06, 1.94) | 0.02 | 0.79 | (0.57, 1.10) | 0.17 |
| Eat fast food 2+ times in a typical weeke | 860 | 0.67 | (0.46, 0.99) | 0.04 | 1.66 | (1.06, 2.58) | 0.03 |
| Personal care product (PCP) use | |||||||
| Always/usually buy “ecofriendly”, “chemical-free”, or “environmentally friendly” PCPsf | 859 | 2.80 | (2.06, 3.80) | <0.0001 | 0.89 | (0.64, 1.23) | 0.48 |
| Use perfumeg | 860 | 0.91 | (0.67, 1.23) | 0.55 | 1.01 | (0.73, 1.41) | 0.93 |
| Use nail polishh | 860 | 0.77 | (0.58, 1.04) | 0.09 | 1.08 | (0.78, 1.49) | 0.64 |
| Highest quartile of PCP use in past weeki | 860 | 1.01 | (0.71, 1.43) | 0.96 | 0.95 | (0.66, 1.36) | 0.78 |
Each row represents a separate model of how attitudes predict a pregnancy behavior, adjusting for age, study center, race, employment, education, and marital status.
N varies by model due to “don’t know” or missing values for dependent variable.
Reference group: Sometimes/rarely/never consume “organic”, “pesticide free” and/or “chemical free foods”
Reference group: Sometimes/rarely/never try to make sure food is in safe plastics
Reference group: Eat fast food less than 2 times in a typical week
Reference group: Sometimes/rarely/never try to buy “ecofriendly”, “chemical-free”, or “environmentally friendly” PCPs.
Reference group: no reported perfume use in last week
Reference group: no reported nail polish use in last week
Reference group: bottom three quartiles of PCP use in last week
Acknowledgements
We acknowledge the contributions of the entire TIDES Study Team: Coordinating Center: Fan Liu, Erica Scher; UCSF: Marina Stasenko, Erin Ayash, Melissa Schirmer, Jason Farrell, Mari-Paule Thiet, Laurence Baskin; UMN: Chelsea Georgesen, Heather L. Gray, Brooke J. Rody, Carrie A. Terrell, Kapilmeet Kaur; URMC: Erin Brantley, Heather Fiore, Lynda Kochman, Lauren Parlett, Jessica Marino, Eva Pressman; UW: Kristy Ivicek, Bobbie Salveson, Garry Alcedo.
Financial support
Funding for TIDES was provided by the following grant from the National Institute of Environmental Health Sciences: R01ES016863-04. Funding for the current analysis was provided by K12 ES019852-01.
Footnotes
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Study Locations: Coordinating center: New York, NY; Clinical centers: Minneapolis, MN; Rochester, NY; San Francisco, CA; Seattle, WA.
Disclosure statement
The authors report no conflict of interest.
Contributor Information
Sheela Sathyanarayana, Email: Sheela.sathyanarayana@seattlechildrens.org.
Sarah Janssen, Email: sarah.janssen@ucsf.edu.
Ruby H.N. Nguyen, Email: nguy0082@umn.edu.
References
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