In Puerto Rico, the preterm birth rate is 17.7% of live births. At 50% above the U.S. average, it is the highest rate of any U.S. jurisdiction, below only Malawi (18.1%) globally. Puerto Rico also has 16 active Superfund sites and 200+ hazardous waste sites. Our investigations suggest that the increase in preterm birth rates in Puerto Rico cannot be explained by changes in obstetric practices and that there is sufficient evidence that exposure to hazardous chemicals contributes to preterm birth. Risk of exposure to contamination is high as many of these sites are unlined landfills that overlie karst aquifers. These aquifers present highly susceptible pathways for exposure to contamination and in fact there is extensive evidence of groundwater contamination. Established in 2010, the Puerto Rico Testsite for Exploring Contamination Threats Center (PROTECT) uses a holistic system of research, training and stakeholder engagement to study the fate, transport, exposure, health impact and remediation of contaminants, with particular attention to chlorinated solvents and phthalates commonly found at Superfund sites, as both suspect and model agents in the high preterm birth rates in Puerto Rico. PROTECT's new Community Engagement Core (Core F) will leverage the infrastructure and relationships developed in the center's first three years of funding through the Human Subjects and Sampling Core (Core C) and its research projects to serve as the main vehicle for interaction with community stakeholders in Puerto Rico. PROTECT's approach emphasizes bidirectional engagement with two groups of stakeholders: 1) women participating in the PROTECT study cohort (480 women as of March 2013);and 2) the broader group of residents in the areas where PROTECT's groundwater study is being conducted. Core C has established strong relationships with study participants as well as with service providers and a wide range of relevant community social actors, including staff and clinicians at community health centers and private clinics, social work and nursing staff, and community groups. Building on this foundation, Core F will develop a strong bidirectional communication strategy that will emphasize report-back of research findings to stakeholders, informed by stakeholders'priorities, needs and concerns. Core F will also focus on capacity-building for participants and their community organizations, and the development of resources for early childhood development through intervention supports for preterm children born to the participants. Core F activities will help provide appropriate ethical communication to participants via an innovative report-back process, enable participants to be more fully included in the research process, improve study recruitment and retention rates, offer lay perspectives and information, build capacity of participants and their community organizations, and lay the groundwork for additional community-based participatory research proposals.

Public Health Relevance

The Community Engagement core provides bidirectional and ethical communication between the research projects and community to facilitate much-needed research and community engagement on environmental contamination in Puerto Rico and environmental and other contributors to preterm birth. Knowledge gained through this research will inform effective public health strategies for preventing preterm births in Puerto Rico and the U.S., and strategies to reduce exposures to environmental contaminants among pregnant women.

National Institute of Health (NIH)
National Institute of Environmental Health Sciences (NIEHS)
Hazardous Substances Basic Research Grants Program (NIEHS) (P42)
Project #
Application #
Study Section
Special Emphasis Panel (ZES1-LKB-K (S))
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Northeastern University
United States
Zip Code
Ferguson, Kelly K; Cantonwine, David E; McElrath, Thomas F et al. (2016) Repeated measures analysis of associations between urinary bisphenol-A concentrations and biomarkers of inflammation and oxidative stress in pregnancy. Reprod Toxicol 66:93-98
Li, Dan; Zeng, Siyu; He, Miao et al. (2016) Water Disinfection Byproducts Induce Antibiotic Resistance-Role of Environmental Pollutants in Resistance Phenomena. Environ Sci Technol 50:3193-201
Ferguson, Kelly K; Meeker, John D; Cantonwine, David E et al. (2016) Urinary phthalate metabolite and bisphenol A associations with ultrasound and delivery indices of fetal growth. Environ Int 94:531-7
Rajic, Ljiljana; Nazari, Roya; Fallahpour, Noushin et al. (2016) Electrochemical degradation of trichloroethylene in aqueous solution by bipolar graphite electrodes. J Environ Chem Eng 4:197-202
Rajic, Ljiljana; Fallahpour, Noushin; Podlaha, Elizabeth et al. (2016) The influence of cathode material on electrochemical degradation of trichloroethylene in aqueous solution. Chemosphere 147:98-104
McIntosh, Scott; Pérez-Ramos, José; Demment, Margaret M et al. (2016) Development and Implementation of Culturally Tailored Offline Mobile Health Surveys. JMIR Public Health Surveill 2:e28
Watkins, Deborah J; Fortenberry, Gamola Z; Sánchez, Brisa N et al. (2016) Urinary 3-phenoxybenzoic acid (3-PBA) levels among pregnant women in Mexico City: Distribution and relationships with child neurodevelopment. Environ Res 147:307-13
Tan, Wenbing; Zhang, Yuan; He, Xiaosong et al. (2016) Distribution patterns of phthalic acid esters in soil particle-size fractions determine biouptake in soil-cereal crop systems. Sci Rep 6:31987
Johns, Lauren E; Ferguson, Kelly K; Meeker, John D (2016) Relationships Between Urinary Phthalate Metabolite and Bisphenol A Concentrations and Vitamin D Levels in U.S. Adults: National Health and Nutrition Examination Survey (NHANES), 2005-2010. J Clin Endocrinol Metab 101:4062-4069
Shao, Gang; MacNeil, Michael; Yao, Yuanyuan et al. (2016) Porous extraction paddle: a solid phase extraction technique for studying the urine metabolome. Rapid Commun Mass Spectrom :

Showing the most recent 10 out of 116 publications