Carol F. Kwiatkowski’s research while affiliated with University of California, Berkeley and other places


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Publications (31)


Participation flow chart.
Readiness to change by sex (n = 432).
Number of participants responding to pre- and post-test “Readiness to Change” questions (n = 172).
Pre-post changes in “Readiness to Change” for participants who completed post-test surveys (n = 172).
Challenges to reducing exposure to harmful chemicals.

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A Personalized Intervention to Increase Environmental Health Literacy and Readiness to Change in a Northern Nevada Population: Effects of Environmental Chemical Exposure Report-Back
  • Article
  • Full-text available

July 2024

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47 Reads

International Journal of Environmental Research and Public Health (IJERPH)

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Carol F. Kwiatkowski

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[...]

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Jenna Hua

Background: Interventions are needed to help people reduce exposure to harmful chemicals from everyday products and lifestyle habits. Report-back of individual exposures is a potential pathway to increasing environmental health literacy (EHL) and readiness to reduce exposures. Objectives: Our objective was to determine if report-back of endocrine-disrupting chemicals (EDCs) can reduce EDC exposure, increase EHL, and increase readiness to change (i.e., to implement EDC exposure-reduction behaviors). Methods: Participants in the Healthy Nevada Project completed EHL and readiness-to-change surveys before (n = 424) and after (n = 174) a report-back intervention. Participants used mail-in kits to measure urinary biomarkers of EDCs. The report-back of results included urinary levels, information about health effects, sources of exposure, and personalized recommendations to reduce exposure. Results: EHL was generally very high at baseline, especially for questions related to the general pollution. For questions related to chemical exposures, responses varied across several demographics. Statistically reliable improvements in EHL responses were seen after report-back. For readiness to change, 72% were already or planning to change their behaviors. Post-intervention, women increased their readiness (p = 0.053), while men decreased (p = 0.007). When asked what challenges they faced in reducing exposure, 79% cited not knowing what to do. This dropped to 35% after report-back. Participants with higher propylparaben were younger (p = 0.03) and women and participants who rated themselves in better health had higher levels of some phthalates (p = 0.02–0.003 and p = 0.001–0.003, respectively). After report-back, monobutyl phthalate decreased among the 48 participants who had valid urine tests before and after the intervention (p < 0.001). Conclusions: The report-back intervention was successful as evidenced by increased EHL behaviors, increased readiness to change among women, and a decrease in monobutyl phthalate. An EHL questionnaire more sensitive to chemical exposures would help differentiate high and low literacy. Future research will focus on understanding why men decreased their readiness to change and how the intervention can be improved for all participants.

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Public Health Risks of PFAS-Related Immunotoxicity Are Real

March 2024

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129 Reads

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9 Citations

Current Environmental Health Reports

Purpose of Review The discovery of per- and polyfluoroalkyl substances (PFAS) in the environment and humans worldwide has ignited scientific research, government inquiry, and public concern over numerous adverse health effects associated with PFAS exposure. In this review, we discuss the use of PFAS immunotoxicity data in regulatory and clinical decision-making contexts and question whether recent efforts adequately account for PFAS immunotoxicity in public health decision-making. Recent Findings Government and academic reviews confirm the strongest human evidence for PFAS immunotoxicity is reduced antibody production in response to vaccinations, particularly for tetanus and diphtheria. However, recent events, such as the economic analysis supporting the proposed national primary drinking water regulations and clinical monitoring recommendations, indicate a failure to adequately incorporate these data into regulatory and clinical decisions. Summary To be more protective of public health, we recommend using all relevant immunotoxicity data to inform current and future PFAS-related chemical risk assessment and regulation. Biological measures of immune system effects, such as reduced antibody levels in response to vaccination, should be used as valid and informative markers of health outcomes and risks associated with PFAS exposure. Routine toxicity testing should be expanded to include immunotoxicity evaluations in adult and developing organisms. In addition, clinical recommendations for PFAS-exposed individuals and communities should be revisited and strengthened to provide guidance on incorporating immune system monitoring and other actions that can be taken to protect against adverse health outcomes.


Descriptive Statistics for Study and Communication Variables, All Studies (n = 273)
Impact of Study and Communication Variables on Altmetric Score, All Studies (n = 273)
Impact of Study and Communication Variables on Altmetric Score, Significant Studies with Press Release (n = 16)
Effective communications strategies to increase the impact of environmental health research

July 2023

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74 Reads

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1 Citation

Environmental Health

Background Per- and polyfluoroalkyl substances (PFAS) are the subject of a growing body of research with the potential to positively impact public and ecological health. However, to effect positive change, findings must be communicated beyond the scientific community. Objective We sought to (a) evaluate the relationships between communications strategy, media attention, and scholarly citations of PFAS research and (b) offer guidance for researchers and communications professionals who would like to publicize future work and increase its impact. Methods We analyzed 273 peer-reviewed epidemiological studies on PFAS human health impacts with publication years 2018–2020, as collected by a pre-existing database. We investigated whether a press release was issued, open-access status, abstract and press release readability, timing of publication and press release distribution, journal impact factor, study type and sample size, statistical significance of finding(s), number of scholarly citations, and the Altmetric Attention Score (a measure of media attention). Discussion Of papers reporting a statistically significant association with health harm, those with a press release received 20 times more media attention (as assessed by Altmetric scores) than those that did not. However, only 6.2% of all papers and 7.8% of significant papers issued one. Among papers with a press release, media attention was positively correlated with better abstract and press release readability and speed in issuing the press release. Scholarly citations were positively correlated with media attention, presence of a press release, and open-access status. Conclusion Most papers with significant findings on PFAS are published without a press release and receive little or no media attention. This reduces the likelihood that important research is reaching the public and decisionmakers who can translate science into action. Issuing a press release and receiving media attention also appear to increase scholarly citations. We provide recommendations for authors to increase the reach and impact of future papers.


Quaternary Ammonium Compounds: A Chemical Class of Emerging Concern

May 2023

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347 Reads

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92 Citations

Environmental Science and Technology

Quaternary ammonium compounds (QACs), a large class of chemicals that includes high production volume substances, have been used for decades as antimicrobials, preservatives, and antistatic agents and for other functions in cleaning, disinfecting, personal care products, and durable consumer goods. QAC use has accelerated in response to the COVID-19 pandemic and the banning of 19 antimicrobials from several personal care products by the US Food and Drug Administration in 2016. Studies conducted before and after the onset of the pandemic indicate increased human exposure to QACs. Environmental releases of these chemicals have also increased. Emerging information on adverse environmental and human health impacts of QACs is motivating a reconsideration of the risks and benefits across the life cycle of their production, use, and disposal. This work presents a critical review of the literature and scientific perspective developed by a multidisciplinary, multi-institutional team of authors from academia, governmental, and nonprofit organizations. The review evaluates currently available information on the ecological and human health profile of QACs and identifies multiple areas of potential concern. Adverse ecological effects include acute and chronic toxicity to susceptible aquatic organisms, with concentrations of some QACs approaching levels of concern. Suspected or known adverse health outcomes include dermal and respiratory effects, developmental and reproductive toxicity, disruption of metabolic function such as lipid homeostasis, and impairment of mitochondrial function. QACs' role in antimicrobial resistance has also been demonstrated. In the US regulatory system, how a QAC is managed depends on how it is used, for example in pesticides or personal care products. This can result in the same QACs receiving different degrees of scrutiny depending on the use and the agency regulating it. Further, the US Environmental Protection Agency's current method of grouping QACs based on structure, first proposed in 1988, is insufficient to address the wide range of QAC chemistries, potential toxicities, and exposure scenarios. Consequently, exposures to common mixtures of QACs and from multiple sources remain largely unassessed. Some restrictions on the use of QACs have been implemented in the US and elsewhere, primarily focused on personal care products. Assessing the risks posed by QACs is hampered by their vast structural diversity and a lack of quantitative data on exposure and toxicity for the majority of these compounds. This review identifies important data gaps and provides research and policy recommendations for preserving the utility of QAC chemistries while also seeking to limit adverse environmental and human health effects.


Evaluating the Performance of Per- and Polyfluoroalkyl Substance Finishes on Upholstery Fabrics

April 2023

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34 Reads

AATCC Journal of Research

Per- and polyfluoroalkyl substances are widely used to provide a hydrophobic and oleophobic barrier in some fabric finishing. Per- and polyfluoroalkyl substances are a class of harmful chemicals that persist in the environment and our bodies. For indoor upholstery, these finishes are used to prevent staining. In this study, we examined the effectiveness of certain per- and polyfluoroalkyl substance finishes on commercial indoor fabrics for liquid repellency and stain performance. Three fabrics, each with an unfinished control, a dip finish, and a foam finish, were tested with coffee and oil-based salad dressing stains, two dwell times, two stain application procedures, and three abrasion conditions. Oil stain severity was affected by fabric type, finish, dwell time, and application procedure, but not abrasion. For water-based coffee stains, only fabric type had an effect. Droplet contact angle tests were also performed, revealing water and oil repellency is quickly lost with abrasion. Of the six per- and polyfluoroalkyl substance-finished fabrics tested, five showed small improvements in stain performance over unfinished fabrics; however, the performance differences between fabric types were much larger than the benefits from finishes. For oil stains, per- and polyfluoroalkyl substance finishes help in ideal conditions when the finish is unabraded, stains are set gently on the fabric, and stains are cleaned quickly. Our results suggest that the use of per- and polyfluoroalkyl substances on indoor furniture can be considerably reduced through intentional material selection to achieve better stain performance in lieu of per- and polyfluoroalkyl substance finishes.


Optimizing Chemicals Management in the United States and Canada through the Essential-Use Approach

January 2023

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125 Reads

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19 Citations

Environmental Science and Technology

Chemicals have improved the functionality and convenience of industrial and consumer products, but sometimes at the expense of human or ecological health. Existing regulatory systems have proven to be inadequate for assessing and managing the tens of thousands of chemicals in commerce. A different approach is urgently needed to minimize ongoing production, use, and exposures to hazardous chemicals. The premise of the essential-use approach is that chemicals of concern should be used only in cases in which their function in specific products is necessary for health, safety, or the functioning of society and when feasible alternatives are unavailable. To optimize the essential-use approach for broader implementation in the United States and Canada, we recommend that governments and businesses (1) identify chemicals of concern for essentiality assessments based on a broad range of hazard traits, going beyond toxicity; (2) expedite decision-making by avoiding unnecessary assessments and strategically asking up to three questions to determine whether the use of the chemical in the product is essential; (3) apply the essential-use approach as early as possible in the process of developing and assessing chemicals; and (4) engage diverse experts in identifying chemical uses and functions, assessing alternatives, and making essentiality determinations and share such information broadly. If optimized and expanded into regulatory systems in the United States and Canada, other policymaking bodies, and businesses, the essential-use approach can improve chemicals management and shift the market toward safer chemistries that benefit human and ecological health.



The PFAS-Tox Database: A systematic evidence map of health studies on 29 per- and polyfluoroalkyl substances

July 2022

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253 Reads

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48 Citations

Environment International

Background ●PFAS (per-and polyfluoroalkyl substances) are a large class of synthetic chemicals widely used in consumer products and industrial processes. The scientific literature on PFAS has increased dramatically in the last decade. Many stakeholders, including regulators, scientists, non-governmental organizations, and concerned individuals could benefit from an efficient way to access the health and toxicological literature related to PFAS. ●Objective ●To create a systematic evidence map of the available peer-reviewed health or toxicological research for 29 PFAS. ●Methods ●A protocol for conducting this systematic evidence map was initially published on Zenodo (Pelch et al. 2019c), then peer reviewed and published in Environment International (Pelch et al. 2019d). PubMed database was searched through January 25, 2021. Studies were screened for inclusion and exclusion according to the Populations, Exposures, Comparators, and Outcomes (PECO) statement. Inclusion criteria were intentionally broad and included any human, animal, and/or in vitro study that investigated exposure to one of the 29 PFAS of interest and a human health or toxicological effect. Selected study details were extracted from included studies as described in the protocol. Study appraisal was not conducted. The included studies and extracted meta-data are freely available in the online, interactive systematic evidence map at https://pfastoxdatabase.org. ●Results ●Over 15,000 studies were retrieved from the PubMed literature searches. After manual screening, 1,067 studies were identified and included as investigating the health or toxicological effect of one or more PFAS of interest. There were 505 human, 385 animal, and 220 in vitro studies. Summary tables of the extracted data and overall observations are included in this report. ●Conclusions ●The PFAS-Tox Database is a useful tool for searching, filtering, and identifying peer reviewed research on the health and toxicological effects of the included PFAS. In this summary of the evidence map we provide examples of data gaps and clusters revealed by the database, with the goal of helping direct future research efforts, facilitate systematic reviews (e.g. on immune effects, mixtures of PFAS, or effects of short chain PFAS), inform regulatory risk assessments, and improve opportunities for cross-disciplinary coordination. We also discuss how this tool supports scientists, regulatory agencies, and other individuals by increasing awareness and access to current evidence regarding the health effects associated with PFAS exposure.



List of Chemicals prioritized* by the California Office of Environmental Health Hazard Assessment and included in the systematic evidence map.
Identifying Environmental Factors that Influence Immune Response to SARS-CoV-2: Systematic Evidence Map Protocol

April 2022

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57 Reads

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8 Citations

Environment International

Background Widespread environmental contamination can directly interact with human immune system functions. Environmental effects on the immune system may influence human susceptibility to respiratory infections as well as the severity of infectious diseases, such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Furthermore, the efficacy of vaccines to respiratory diseases may be impacted by environmental exposures through immune perturbations. Given the quick pace of research about COVID-19 and associated risk factors, it is critical to identify and curate the streams of evidence quickly and effectively. Objective We developed this systematic evidence map protocol to identify and organize existing human and animal literature on high-priority environmental chemical classes (Per- and polyfluoroalkyl substances, pesticides, phthalates, quaternary ammonium compounds, and air pollutants) and their potential to influence three key outcomes: (1) susceptibility to respiratory infection, including SARS-CoV-2 (2) severity of the resultant disease progression, and (3) impact on vaccine efficacy. The result of this project will be an online, interactive database which will show what evidence is currently available between involuntary exposures to select environmental chemicals and immune health effects, data gaps that require further research, and data rich areas that may support further analysis. Search and study eligibility We will search PubMed for epidemiological or toxicological literature on select toxicants from each of the chemical classes and each of the three outcomes listed above. Study appraisal and synthesis of methods For each study, two independent reviewers will conduct title and abstract screening as well as full text review for data extraction of study characteristics. Study quality will not be evaluated in this evidence mapping. The main findings from the systematic evidence map will be visualized using a publicly available and interactive database hosted on Tableau Public.


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Citations (27)


... The immune system is a vital defence mechanism, protecting the body against foreign invaders, including pathogens and toxins. However, exposure to certain chemicals can disrupt the delicate balance of immune function, leading to immunotoxic effects that may manifest as heightened susceptibility to infections, autoimmune disorders, allergic reactions, or impaired vaccine responses [5]. Given the intricate interplay between the immune system and overall health, the inclusion of immunotoxicity endpoints in risk assessment is essential for accurately characterizing the potential hazards associated with chemical exposures and safeguarding public health (Fig. 1). ...

Reference:

Discover Toxicology Integrated approaches for immunotoxicity risk assessment: challenges and future directions
Public Health Risks of PFAS-Related Immunotoxicity Are Real

Current Environmental Health Reports

... Akerlof [1] provides a bibliometric analysis to trace the development and convergence of topics within environmental communication, highlighting how the field has evolved and expanded over decades. Fuoco [2] discusses strategies that significantly increase the public and academic impact of environmental health communications, emphasizing the importance of media engagement and open-access publications. Byrnes et al. [3] advocate for an interdisciplinary approach in environmental education, promoting a pedagogy that integrates environmental justice into communication strategies. ...

Effective communications strategies to increase the impact of environmental health research

Environmental Health

... CYP-metabolized general chemicals comprise hundreds of compounds; among them are alkyl dimethyl benzyl ammonium chlorides known also as benzalkonium chlorides (BACs) [60]. The BACs belong to common quaternary ammonium compounds (QACs), which exert cytotoxic effects and are hazardous to human health [61]. Recombinant CYP2D6, CYP4F2, and CYP4F12 have been shown to metabolize substantial part of BACs in human liver microsomes [62]. ...

Quaternary Ammonium Compounds: A Chemical Class of Emerging Concern

Environmental Science and Technology

... what should be reported and by whom) across plastic and food industry alike is critical for ensuring that these safety and sustainability criteria are being met, in turn these data will facilitate scientific research in identifying and eliminating emerging risks and finding suitable alternatives. The 'essential use' concept and criteria [84] can support systematic decisionmaking to determine which plastics could be removed altogether, which can be substituted for other materials or systems and which plastic chemicals, polymers and products are truly playing essential roles for the safety or functioning of society, and in which contexts. If the role of plastic packaging is to protect UPFs, can we really say they are serving the safety of society? ...

Optimizing Chemicals Management in the United States and Canada through the Essential-Use Approach

Environmental Science and Technology

... Per-and polyfluoroalkyl substances (PFAS) are a large group of manufactured chemicals that are commonly used in consumer and industrial products because of their water-and grease-resistance and surfactant properties [1][2][3]. However, several PFAS have been linked to adverse health outcomes [4][5][6], thus making it paramount to study human exposure to PFAS in order to better understand the risk posed by these chemicals. Because PFAS are often found in consumer products that are used and stored indoors, where people spend the majority of their time [7], it is particularly important to understand the emission of PFAS from consumer products to air, their subsequent fate indoors, and their contributions to PFAS concentrations measured in indoor air [8]. ...

The PFAS-Tox Database: A systematic evidence map of health studies on 29 per- and polyfluoroalkyl substances

Environment International

... EPA's newly released (May 2022) PFAS-150 systematic evidence map is also limited to "studies that could inform human hazard identification," in other words, human epidemiological and mammalian animal bioassays with oral or inhalation routes of exposure (Carlson et al. 2022). In an accompanying invited perspective, we document the similarities and differences between the two tools, PFAS-Tox Database and PFAS-150 (Table 1 in (Pelch and Kwiatkowski 2022)). We note that the narrower PECO statement focused on human and experimental mammalian animal studies used by US EPA in developing PFAS-150 leads to the identification of far fewer studies. ...

Invited Perspective: The Promise of Fit-for-Purpose Systematic Evidence Maps for Supporting Regulatory Health Assessment
  • Citing Article
  • May 2022

Environmental Health Perspectives

... In fact, it is known, in general, that a certain fraction of the population is exposed to environmental-transmitted pathogens that lead to a normal disease pathway and other fraction, usually much larger [21,33], become asymptomatic carriers of microorganisms that can be resistant to antibiotic treatment. As individuals come into contact with a contaminated environment, prolonged exposure to antimicrobial resistance pathogens may weaken or significantly downgrade their overall health status making them more susceptible to severe disease [6,20,30]. ...

Identifying Environmental Factors that Influence Immune Response to SARS-CoV-2: Systematic Evidence Map Protocol

Environment International

... Data for the OPFRs were extracted from the literature reviewed by Patisaul et al. 2021 and annotated to various neurodevelopmental processes, including endocrine disruption, apoptosis/necrosis, glial (astrocytes, oligodendrocytes, microglia) differentiation and function, neuronal differentiation and maturation (ontogeny of neurotransmitters and receptors, neurite morphology, synaptogenesis), and behavior (zebrafish and medaka) (Supplemental Table S2). Several of these processes are currently not covered in the DNT battery. ...

Beyond Cholinesterase Inhibition: Developmental Neurotoxicity of Organophosphate Ester Flame Retardants and Plasticizers
  • Citing Article
  • October 2021

Environmental Health Perspectives

... These U.S. regulations aim to cover a comprehensive range of PFAS in consumer products. Overall, global regulatory trends are shifting towards phasing out or signi cantly restricting PFAS through both substance-speci c and class-based approaches [14]. Comprehensive PFAS regulation limits the intentional use of PFAS as a precautionary measure, prevents the use of regrettable substitutes, and facilitates transition to non-PFAS alternatives. ...

Response to “Comment on Scientific Basis for Managing PFAS as a Chemical Class”
  • Citing Article
  • February 2021

Environmental Science & Technology Letters

... The protocol for this systematic review is registered with PROSPERO (International Prospective Register of Systematic Reviews; ID: CRD42023407689). The COSTER (Conduct of Systematic Reviews in Toxicology and Environmental Health Research) recommendations (Whaley et al., 2020) informed the planning and conduct of the systematic review and the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement (Page et al., 2021) guided the reporting. ...

Recommendations for the conduct of systematic reviews in toxicology and environmental health research (COSTER)

Environment International