<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Archiving and Interchange DTD v1.0 20120330//EN" "JATS-archivearticle1.dtd">
<article xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" article-type="research-article"><?properties manuscript?><front><journal-meta><journal-id journal-id-type="nlm-journal-id">100898843</journal-id><journal-id journal-id-type="pubmed-jr-id">21835</journal-id><journal-id journal-id-type="nlm-ta">Int J Hyg Environ Health</journal-id><journal-id journal-id-type="iso-abbrev">Int J Hyg Environ Health</journal-id><journal-title-group><journal-title>International journal of hygiene and environmental health</journal-title></journal-title-group><issn pub-type="ppub">1438-4639</issn><issn pub-type="epub">1618-131X</issn></journal-meta><article-meta><article-id pub-id-type="pmid">31257185</article-id><article-id pub-id-type="pmc">6705116</article-id><article-id pub-id-type="doi">10.1016/j.ijheh.2019.06.007</article-id><article-id pub-id-type="manuscript">HHSPA1045579</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Biomonitoring of mercury and persistent organic pollutants in Michigan urban anglers and association with fish consumption</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Wattigney</surname><given-names>Wendy A.</given-names></name><xref rid="CR1" ref-type="corresp">*</xref></contrib><contrib contrib-type="author"><name><surname>Irvin-Barnwell</surname><given-names>Elizabeth</given-names></name></contrib><contrib contrib-type="author"><name><surname>Li</surname><given-names>Zheng</given-names></name></contrib><contrib contrib-type="author"><name><surname>Ragin-Wilson</surname><given-names>Angela</given-names></name></contrib><aff id="A1">Division of Toxicology and Human Health Science, Agency for Toxic Substances and Disease Registry, 4770 Buford Highway Atlanta, GA, 30341, United States</aff></contrib-group><author-notes><corresp id="CR1"><label>*</label>Corresponding author. ATSDR, Division of Toxicology and Human Health Sciences, 4770, Buford Hwy., NE, MS-F58, Atlanta, GA, 30341, United States. <email>WWattigney@cdc.gov</email> (W.A. Wattigney).</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>9</day><month>8</month><year>2019</year></pub-date><pub-date pub-type="epub"><day>27</day><month>6</month><year>2019</year></pub-date><pub-date pub-type="ppub"><month>7</month><year>2019</year></pub-date><pub-date pub-type="pmc-release"><day>22</day><month>8</month><year>2019</year></pub-date><volume>222</volume><issue>6</issue><fpage>936</fpage><lpage>944</lpage><!--elocation-id from pubmed: 10.1016/j.ijheh.2019.06.007--><abstract id="ABS1"><p id="P1">The 32-mile Detroit River and surrounding tributaries have been designated as a Great Lakes Area of Concern due to pollution from decades of municipal and industrial discharges, sewer overflows and urban development. Key pollutants in fish samples from the Detroit River include mercury, polychlorinated biphenyls (PCBs), dichlorodiphenyldichloroethylene (DDE), dioxins and furans. A biomonitoring study was conducted to assess exposures to these persistent toxic substances in Detroit urban shoreline anglers who may be at high exposure risk due to consumption of locally caught fish. Using a modified venue-based sampling approach, 287 adult shoreline anglers along the Detroit River were recruited and participated in the program. Study participants provided blood and urine specimens and completed a questionnaire following informed consent. We examined percentile estimates for total blood mercury, PCBs, DDE, and dioxin-like total toxic equivalency (TEQ) concentrations among study participants. Multiple linear regression was used to identify important predictors of contaminant concentrations. Participants consumed a median of 64 Detroit River caught fish meals in the past year. The Detroit urban anglers&#x02019; median total blood mercury concentrations was 3.2 times higher than that for the general adult U.S. population. PCB concentrations among the Detroit anglers aged 18&#x02013;39 years were higher than the U.S. population of the same race/ethnicity. Elevated levels of DDE and total TEQ concentrations were not observed in the cohort. Eating more locally caught fish was associated with higher total blood mercury and serum PCB concentrations. The biomonitoring data served to inform public health officials and help guide environmental public health actions to reduce harmful exposures.</p></abstract><kwd-group><kwd>Mercury</kwd><kwd>Persistent organic pollutants (POPs)</kwd><kwd>Polychlorinated biphenyls (PCBs)</kwd><kwd>Dichlorodiphenyldichloroethylene (DDE)</kwd><kwd>Dioxin-like total toxic equivalency</kwd><kwd>Great lakes</kwd><kwd>Fish consumption</kwd><kwd>Fish advisories</kwd></kwd-group></article-meta></front><body><sec id="S1"><label>1.</label><title>Introduction</title><p id="P2">Environmental contaminants have long been a problem in the Great Lakes basin. Over the past century, discharge of toxic chemicals from industrial, municipal, and non-point sources resulted in high concentrations of contaminants that persist in the sediments of lakes, streams, rivers and harbors (<xref rid="R2" ref-type="bibr">Adriaens et al., 2002</xref>). Despite efforts to reduce toxic discharges, legacy contaminants pose potential risks to aquatic organisms, wildlife, and humans. As a result, legacy pollutants, including mercury, polychlorinated biphenyls (PCBs), dichloro-diphenyl-trichloroethane (DDT), dioxins, and furans, are routinely monitored in fish and wildlife throughout the Great Lakes and surrounding areas (<xref rid="R29" ref-type="bibr">Gewurtz et al., 2011</xref>; <xref rid="R1" ref-type="bibr">MDEQ, 2014</xref>; <xref rid="R24" ref-type="bibr">EPA, 2017a</xref>; <xref rid="R52" ref-type="bibr">NOAA, 2017</xref>).</p><p id="P3">Great Lakes waterways have many beneficial uses, such as catching and eating local fish and wildlife and recreational water activities. The U.S.-Canada Great Lakes Water Quality Agreement defines Areas of Concern (AOC) as environmentally degraded geographic areas with restricted beneficial uses due to contamination. (<xref rid="R22" ref-type="bibr">EPA, 2012</xref>). The Detroit River, a 32-mile connecting channel linking Lake St. Clair and the upper Great Lakes to Lake Erie, is a binational AOC. The land use in Detroit is primarily industrial and urban development. The city of Detroit&#x02019;s water and sewer system, as well as 700 square miles of land in Michigan and Ontario, drain into the Detroit River. PCBs, mercury, and dioxins are the primary cause of fish consumption advisories for the Detroit River and connecting waters (<xref rid="R1" ref-type="bibr">MDEQ, 2014</xref>). While the Detroit River is contaminated, it also supports a large population of urban anglers, many of whom are low-income and fish for sustenance as well as recreation (<xref rid="R36" ref-type="bibr">Kalkirtz et al., 2008</xref>; <xref rid="R1" ref-type="bibr">MDEQ, 2014</xref>). Fish advisories are issued by the state to warn anglers that some species of fish from the Detroit River are highly contaminated and should not be eaten in any amount (catfish, carp), and others should be eaten only occasionally (bass, perch). Despite fish advisories, including signs posted at shoreline venues, previous studies found that shoreline anglers in this area frequently eat fish species containing high contaminant levels (<xref rid="R30" ref-type="bibr">Groetsch and Manente, 2010</xref>; <xref rid="R36" ref-type="bibr">Kalkirtz et al., 2008</xref>). As such, shoreline anglers in Detroit are at high risk of exposure to contaminants in the waterways.</p><p id="P4">The U.S. Environmental Protection Agency (EPA) and other federal and state agencies have worked extensively to restore the AOCs on the U.S. side of the Great Lakes basin. The Great Lakes Restoration Initiative (GLRI), established in 2010 and led by the U.S. EPA, is providing resources to accelerate efforts to remediate and restore the Great Lakes and surrounding areas. GLRI activities include accelerating the cleanup of AOCs, combating invasive species, and protecting water-sheds from polluted run-off (<xref rid="R25" ref-type="bibr">EPA, 2017b</xref>). As part of GLRI, the Agency for Toxic Substances and Disease Registry (ATSDR) established the Biomonitoring of Great Lakes Populations (BGLP) program to assess human exposure to toxic chemicals among susceptible populations (<xref rid="R71" ref-type="bibr">Wattigney et al., 2017</xref>). As part of the BGLP program, the Michigan Department of Health and Human Services (MDHHS) conducted a biomonitoring study targeting urban anglers. The study aimed to: (1) evaluate body burden levels of persistent toxic substances in Detroit urban (shoreline) anglers who are at high risk of exposure to persistent toxic contaminants due to regular consumption of fish from the Detroit River; and (2) assess potential exposure sources, particularly consumption of locally caught fish. The MDHHS used the biomonitoring information to guide public health actions to protect this community within their jurisdiction. This report presents total blood mercury, predominant PCBs, dichlorodiphenyldichloroethylene (DDE, a metabolite of DDT), and dioxin-like total toxic equivalency (TEQ) concentrations in Detroit urban anglers, and an assessment of potential exposure sources with a focus on locally caught fish consumption.</p></sec><sec id="S2"><label>2.</label><title>Material and methods</title><sec id="S3"><label>2.1.</label><title>Participant recruitment and clinic visit</title><p id="P5">All study activities were approved by the federal Office of Management and Budget (Control Number 0923&#x02013;0044) and the MDHHS Institutional Review Board. The program development and design, including sampling method, are described in more detail elsewhere (<xref rid="R72" ref-type="bibr">Wattigney et al., 2019</xref>). In brief, participants were recruited using a modified venue-based sampling method (<xref rid="R39" ref-type="bibr">Mackellar et al., 1996</xref>). Following a predetermined venue-day-time (VDT) schedule, anglers at shoreline fishing locations (venues) along the Detroit River were administered screening interviews to determine eligibility and willingness to participate in this study. Eligible anglers included respondents aged 18 years and older who ate at least two meals per month of fish from the Detroit River. MDHHS program staff conducted follow-up phone calls with randomly selected eligible VDT respondents to further confirm eligibility and schedule clinic appointments for the study.</p><p id="P6">Study clinics were held from June through December 2013 at church facilities and community centers located near the shoreline fishing locations. At the clinic visit, study staff obtained written informed consent, administered a questionnaire, measured participants&#x02019; height, weight and blood pressure, and collected blood and urine samples. At the end of the clinic visit, participants received remuneration for their time and &#x0201c;Eat Safe Fish&#x0201d; guidelines (<xref rid="R42" ref-type="bibr">MDHHS, 2018a</xref>; <xref rid="R43" ref-type="bibr">MDHHS, 2018b</xref>). An interview questionnaire was administered to collect information on personal behaviors (e.g., consumption of locally caught fish, occupation, and hobbies) that could be a source of exposure to the target analytes and characteristics (e.g., gender, age, race/ethnicity) that could affect levels of the target analytes in participants&#x02019; blood. In addition to eating contaminated fish, other potential sources of exposure to mercury or PCBs include some occupations or hobbies such as working with commercial electrical equipment or electronic assembly, certain recycling materials, automotive manufacturers, and chemical manufacturers (<xref rid="R8" ref-type="bibr">ATSDR, 2014</xref>; <xref rid="R51" ref-type="bibr">NIOSH, 2018</xref>). The core questionnaire domains were demographics, residential history, job history, hobbies, smoking history, recreational activities in local waterways, women&#x02019;s reproductive history, and dietary intake with a focus on fish consumption. Fish consumption questions included the number of years over their lifetime the respondent has eaten fish from local waters. Participants were then asked to identify species of caught fish eaten at least 5 times in their lifetime, and to recall the location and number of times each location/species was eaten in the past year. Similar questions were asked for wild birds and animals, and home-raised or home-grown food. Visual aids were used to assist in referral to specific waterways, fish species and animals. The interview also collected information on the frequency of commercially purchased fish eaten in the past year for specific species or species groupings.</p></sec><sec id="S4"><label>2.2.</label><title>Laboratory analysis</title><p id="P7">The MDHHS Analytical Chemistry Section performed laboratory analysis of mercury, DDT/DDE, and 97 PCB congeners (1, 3, 8, 11, 16, 17, 18, 22, 25, 26, 27, 28, 31, 32, 33, 37, 40, 42, 44, 45, 47, 48, 49, 52, 56, 60, 63, 64, 66/95, 70, 71, 74, 77, 81, 82, 83, 84, 87, 90, 91, 92, 95, 97, 99, 100, 101, 105, 110, 114, 118, 123, 126, 128, 130, 132, 134, 135, 136, 137, 138/163, 141, 144, 146, 149, 151, 153, 156, 157, 158, 160, 167, 170, 171, 172, 174, 175, 177, 178, 179, 180, 182, 183, 185, 187, 189, 190, 193, 194, 195, 196/203, 198, 199, 200, 201, 205, 206, 207). Mercury was measured in whole blood by inductively coupled plasma-mass spectrometry (ICP-MS) (<xref rid="R60" ref-type="bibr">Rodushkin et al., 1999</xref>; <xref rid="R47" ref-type="bibr">NCEH, 2004</xref>). PCBs and DDT/DDE were measured using gas chromatography with electron capture detection (GC-ECD) using an in-house method adapted from previous publications (<xref rid="R12" ref-type="bibr">Burse et al., 1990</xref>; <xref rid="R46" ref-type="bibr">Najam et al., 1999</xref>). Briefly, lipid separation was performed using Florisil column chromatography with 60&#x02013;100 mesh pesticide residue grade packing. Further fractionation was accomplished by 3% deactivated Silica Gel. All fractions were concentrated to 1.0 mL and analyzed by GC-ECD (<xref rid="R12" ref-type="bibr">Burse et al., 1990</xref>; <xref rid="R46" ref-type="bibr">Najam et al., 1999</xref>). In accordance with program requirements, the MDHHS laboratory provided documentation of Clinical Laboratory Improvement Amendments (CLIA) certification, participated in appropriate external proficiency testing programs, provided proficiency testing results, and provided standard operating procedures for all analytical methods including detailed quality control and quality assurance procedures.</p><p id="P8">Dioxins, furans, coplanar PCBs (congeners 77, 81, 126, 169), total cholesterol and triglycerides were measured by the Centers for Disease Control and Prevention (CDC) National Center for Environmental Health (NCEH) Laboratories. Polychlorinated dibenzo-p-dioxins (PCDDs), dibenzofurans (PCDFs), and non-ortho-substituted or co-planar polychlorinated biphenyls (co-PCBs) were measured in serum by high-resolution gas chromatography/isotope-dilution high-resolution mass spectrometry (HRGC/ID-HRMS) using a previously published method (<xref rid="R65" ref-type="bibr">Sjodin et al., 2004</xref>). PCBs, DDE, and total TEQ serum concentrations are lipid-adjusted and presented as per gram of total lipid. These compounds are lipophilic and concentrate in the body&#x02019;s lipid stores, including the lipid in serum. Serum total lipids was provided by the NCEH laboratories using the enzymatic summation formula: total lipids = (2.27*total cholesterol) + triglycerides + 62.31 (<xref rid="R57" ref-type="bibr">Phillips et al., 1989</xref>; <xref rid="R10" ref-type="bibr">Bernert et al., 2007</xref>; <xref rid="R55" ref-type="bibr">Patterson et al., 2009</xref>). A summary of the analytes and limits of detection are provided in <xref rid="SD1" ref-type="supplementary-material">Supplemental Table 1</xref>.</p></sec><sec id="S5"><label>2.3.</label><title>Data analysis</title><p id="P9">Data were analyzed using the statistical software package SAS Version 9.3 (<xref rid="R63" ref-type="bibr">SAS Institute Inc., 2011</xref>). Descriptive statistics are presented to describe characteristics among all study participants. Percentile estimates and distribution-free 95% confidence interval (CI) estimates for chemical concentrations were calculated using the SAS&#x000ae; Univariate procedure. Percentile estimates and 95% CIs for all study participants are presented for total blood mercury, DDE, total TEQ, PCB 153 and 180 (the two most dominant PCB congeners in this study with 92% or more detects), and the sum of PCB congeners (&#x02211;PCBs) with a 60% or more detection rate (PCBs 138/163, 153, 170, 180, 187, 194 and 199). The median and 95% CI for the &#x02211;PCBs are also presented by age group and for non-Hispanic blacks (80% of study participants). TEQ values were calculated based on WHO 2005 toxic equivalency factors (<xref rid="R69" ref-type="bibr">Van den Berg, 2006</xref>) for PCDDs, PCDFs, co-PCBs, and mono-ortho-substituted PCBs as described elsewhere (<xref rid="R54" ref-type="bibr">Patterson et al., 2008</xref>, <xref rid="R55" ref-type="bibr">2009</xref>).</p><p id="P10">Percentile estimates are compared to the National Health and Nutrition Examination Survey (NHANES) survey results that represent the background exposure of the U.S. population to environmental chemicals (<xref rid="R50" ref-type="bibr">NCHS, 2017</xref>). National-level biomonitoring data provide reference values to be able to identify comparatively high levels of exposure (<xref rid="R13" ref-type="bibr">Calafat et al., 2012</xref>; <xref rid="R62" ref-type="bibr">Saravanabhavan et al., 2017</xref>). Consistent with NHANES analysis, chemical measurements for the angler specimens below the limit of detection (LOD) were assigned a value equal to the LOD divided by the square root of 2 (<xref rid="R49" ref-type="bibr">NCHS, 2010</xref>). We used the most recent NHANES data available for adults aged 20 years and older for comparison. Total blood mercury in this study was compared to the NHANES 2013&#x02013;2014 survey (<xref rid="R48" ref-type="bibr">NCEH, 2017</xref>). For POPs, individual results were only available for NHANES 2003&#x02013;2004, while a weighted pooled-sample design was implemented in NHANES 2009&#x02013;2010 with a published pooled-sample methodology to estimate point estimates with CIs (<xref rid="R15" ref-type="bibr">Caudill, 2012</xref>; <xref rid="R16" ref-type="bibr">Caudill, 2015</xref>). We used NHANES 2009&#x02013;2010 pooled sample estimates for PCB and DDE comparisons (unpublished data). Total TEQ estimates were compared to NHANES 2003&#x02013;2004 percentiles reported by <xref rid="R55" ref-type="bibr">Patterson et al. (2009)</xref>.</p><p id="P11">In addition to descriptive analyses, biomarker data were analyzed to determine the relationship between contaminant levels and potential exposure sources. The main exposure of interest was locally caught fish consumption. For modeling potential confounders and covariates, random values from a uniform distribution between zero and the LOD were substituted for biomarker concentrations less than the LOD (<xref rid="R59" ref-type="bibr">Rocque and Winker, 2004</xref>). In a preliminary set of analyses, we used multivariate analysis of variance and regression models to identify participant characteristics other than fish consumption associated with each biomarker. Questionnaire items related to history of selected occupations (yes/no) and history of selected hobbies (yes/no) were explored as other potential exposure sources to the contaminants of interest.</p><p id="P12">Potential covariates included age, gender, race/ethnicity (non-Hispanic black, non-Hispanic white, other), years residing in the Detroit area, body mass index (BMI) (&#x0003c; 25 kg/m<sup>2</sup>-normal, 25 to &#x0003c; 30- over-weight, and &#x02265;30 - obese), educational attainment (high school graduate or more, less than high school graduate), annual family income (less than $50 K, $50 K or more), use of fish oil supplements (yes/no), use of herbal supplements (yes/no), recreational activities in local waterways in past year (yes/no), current smoker (yes/no), history of selected occupations (yes/no), history of selected hobbies (yes/no), consumption of fish or shellfish within the past week, number of store/restaurant fish meals in the past year, and wild game consumption. Study variables that were associated with the biomarker (p &#x0003c; 0.05) in the preliminary analysis were included in the multiple linear regression model to evaluate the association between each biomarker and locally caught fish meals. Race was included as two &#x0201c;dummy&#x0201d; variables using non-Hispanic whites as the referent (non-Hispanic Blacks and &#x0201c;Other&#x0201d;). For locally caught fish, species and location-specific data were summed into a single variable to represent the number of meals in the past year. Likewise, species-specific data were summed for purchased fish. Serum-based biomarkers were lipid standardized and covariate-adjusted using logarithm to base 10 (log<sub>10</sub>) total lipids as a covariate in the regression models (<xref rid="R53" ref-type="bibr">O&#x02019;Brien et al., 2017</xref>). In addition, we log<sub>10</sub>-transformed bio-markers and number of fish meals to help normalize extreme values. Tests for normality and regression model diagnostics did not indicate a need for non-linear analysis. &#x0201c;The multiple imputation (MI) procedure in SAS&#x000ae; was used to impute 5 iterations of binary values for the 32 missing values for annual family income (less than $50 K, $50 K or more). The Markov Chain Monte Carlo algorithm produced imputed values that were set to 0 or 1 based on the distribution of non-missing values. The three missing values for race/ethnicity were coded as non-Hispanic black.</p></sec></sec><sec id="S6"><label>3.</label><title>Results</title><p id="P13">Detailed recruitment results are presented elsewhere (<xref rid="R72" ref-type="bibr">Wattigney et al., 2019</xref>). In brief, during 439 shoreline venue-day-time visits, interview teams successfully administered eligibility questionnaires to 2,660 anglers. Of the 817 anglers initially determined to be eligible, the program recruited 287 participants. Reasons for non-participation included unable to contact, found to be ineligible via recontact phone interview, and refusals. The participants were primarily male (80.8%), 40&#x02013;59 years old (57.8%) and reported being Black or African American of non-Hispanic origin (79.6%). The majority of participants had been living in the Detroit area for 21 years or longer (86.3%), tended to have a BMI of 30 kg/m<sup>2</sup> or more (48.4%), were current cigarette smokers (50.2%), achieved a high school diploma or higher level of education (81.7%), and indicated an income of less than $25,000 (43.5%) (<xref rid="T1" ref-type="table">Table 1</xref>).</p><p id="P14"><xref rid="T2" ref-type="table">Table 2</xref> presents a summary of questionnaire interview responses to exposure related items. Participants were asked about specific jobs they had. The targeted jobs included pesticide application, recycling, lead paint removal, chemical manufacturing, and battery manufacturing. The most frequent jobs performed in the past are &#x0201c;worked for an automobile manufacturing company&#x0201d; (44.9%) which overlaps with participants who &#x0201c;worked in a foundry, a smelter, a welding facility or steel mill&#x0201d; (36.1%). Only a small percentage of Detroit urban anglers reported having performed the other specified job categories, ranging from 4.2% for &#x0201c;worked for a battery manufacturing or recycling company&#x0201d; to 19.4% who had &#x0201c;been a maintenance worker in any type of heavy industry.&#x0201d; Participants were also asked about specific hobbies with potential for chemical exposure that they or someone in the home may do. The hobbies more frequently reported by participants are gardening or farming (54.9%), painting or glazing (37.3%), woodworking (20.7%), and electronic assembly (15.7%). A fish oil or omega 3 oil supplement was taken by 15% of participants. Swimming-related activities in Detroit area waterways in the past year was reported by 13.6% of participants.</p><p id="P15">In the past year, study participants consumed a median of 64 meals of fish caught from the Detroit River with an interquartile range of 26&#x02013;155 meals. The median number of purchased fish meals in the past year was 28 with an interquartile range of 12&#x02013;65 meals. Few Detroit urban anglers reported eating hunted wild birds or animals. Eating wild game such as deer, raccoon, rabbit, squirrel, or porcupine from the Detroit River AOC in the last 12 months was reported by 11.5% of participants.</p><p id="P16">Information on eating locally caught fish was gathered through a series of questions that identified species-specific and area-specific data (Detroit River and other local areas). Of the 281 participants who provided detailed frequency of caught fish consumption, 255 (90.7%) reported eating white bass caught from the Detroit River with a median of 20 meals in the past year (<xref rid="SD3" ref-type="supplementary-material">Supplemental Table 2</xref>). Other frequently consumed species included yellow perch (60.1%), smallmouth bass (55.2%), white perch (55.2%), rock bass (53.7%), walleye (51.6%), largemouth bass (49.1%), and catfish (45.2%). Data collected on fish purchased from a grocery store or restaurant included species and species groupings (<xref rid="SD4" ref-type="supplementary-material">Supplemental Table 3</xref>). In total, 267 study participants reported eating purchased fish or shellfish with a median of 31 meals in the past year. Canned tuna and &#x0201c;Group A&#x0201d; (cod, haddock, herring, freshwater perch, ocean perch, pollock, scallops, shrimp, or tilapia), were the most frequently consumed fish/shellfish (84.3% of participants). Fifty-one percent of participants ate catfish from a store or restaurant with a median of 6 meals in the past year (<xref rid="SD4" ref-type="supplementary-material">Supplemental Table 3</xref>). These frequently eaten store bought fish are in the lowest mercury advisory grouping with a guideline of a combined 8 meals per month (<xref rid="R43" ref-type="bibr">MDHHS, 2018b</xref>).</p><p id="P17">Of the 287 study participants, 275 blood specimens were collected with 273 aliquots sufficient for total blood mercury analysis. The demographic characteristics of study participants with blood specimens are similar to all participants. Total blood mercury was detected in 93% of the 273 samples. Based on comparisons to NHANES percentiles, the Detroit urban anglers&#x02019; total blood mercury concentrations were 2.4&#x02013;3.2 times higher than the general U.S. adult population (<xref rid="F1" ref-type="fig">Fig. 1</xref>). Twenty-three percent of Detroit urban anglers had a total blood mercury concentration above the NHANES 95th percentile (~5 &#x003bc;g/L). Less than 10 Detroit urban anglers had blood mercury levels above the MDHHS &#x02018;action level&#x02019; of 15 &#x003bc;g/L for early reporting and follow-up.</p><p id="P18">DDE and 97 PCB congeners were analyzed in 275 specimens by the MDHHS laboratory. DDE was detected in 96% of the Detroit urban angler samples, and levels were about 25% and 47% lower than the NHANES 2009/10 50th and 95th percentile, respectively (<xref rid="T3" ref-type="table">Table 3</xref>). PCB concentrations in the Detroit urban angler cohort are higher than NHANES percentiles, as exemplified by &#x02211;PCB and the two most abundant PCB congeners in the study, i.e., PCBs 153 and 180 (<xref rid="T3" ref-type="table">Table 3</xref>). Overall, the &#x02211;PCB concentrations in Detroit urban anglers is 3.0 and 1.8 times higher than NHANES 2009/10 levels at the 50<sup>th</sup> and 95th percentiles, respectively (<xref rid="F2" ref-type="fig">Fig. 2</xref>). Since 80% of the study participants were non-Hispanic blacks, we also compared our study with NHANES by race. As shown in <xref rid="F2" ref-type="fig">Fig. 2</xref>, when median &#x02211;PCB comparisons were restricted to non-Hispanic blacks, Detroit urban anglers and NHANES had similar concentrations for the age group 60 years or older, while angler&#x02019;s median &#x02211;PCB concentrations were 2.5 times and 1.6 times those of the U.S. non-Hispanic black population for 20&#x02013;39 years and 40&#x02013;59 years age groups, respectively. Sample sizes were too small within age groups to support 95th percentile estimates &#x02013; i.e., by definition, only three measures are above the 95th percentiles for age groups 18&#x02013;39 years and 60 years or older. Twenty-seven percent of Detroit urban anglers aged 20&#x02013;39 years, 30% of anglers aged 40&#x02013;59 years and 16% of anglers aged 60 years or older had &#x02211;PCB concentrations above the NHANES 95th percentile for similar aged non-Hispanic blacks.</p><p id="P19">The sample size for statistical analysis of dioxins, furans, and coplanar PCBs is 248, as 25 specimen results were not reported due to quality control issues. Total TEQ concentrations in the Detroit urban angler cohort are shown in <xref rid="T4" ref-type="table">Table 4</xref>. For TEQ estimates, we report the 90<sup>th</sup> and 95th percentile, because the detection frequency was less than 40% for some congeners included in the calculation. The 50<sup>th</sup> percentile is likely to be biased when the percentage of results below the detection limit is near or above 50% (<xref rid="R17" ref-type="bibr">Caudill et al., 2007</xref>). Total TEQ concentrations in the Detroit urban angler cohort were similar to the NHANES comparisons. The individual congeners contributing to total TEQ and their potency value (toxic equivalency factor, TEF), detection rate, 50<sup>th</sup> percentile, and 95th percentile are presented in <xref rid="SD2" ref-type="supplementary-material">Supplemental Table 4</xref>.</p><p id="P20"><xref rid="T5" ref-type="table">Table 5</xref> presents the multivariate regression analyses results for mercury, DDE and &#x02211;PCB. For the regression analysis, we combined species and location-specific fish consumption data into a single variable to represent the number of meals in the past year for locally caught fish and purchased fish, respectively. Because 91% of the study participants reported eating white bass with a median of 20 meals in the past year, and white bass is one of the most highly contaminated fish from the Detroit River, separate predictor models for individual species or fish species grouping was not plausible. Age, race/ethnicity, annual income of at least $50 k, eaten fish or shellfish in the past week, and number of Detroit River fish eaten in the past year were identified as predictors (p &#x0003c; 0.05) for total blood mercury levels. Total blood mercury increased with age, the number of Detroit River fish meals consumed in the past year, and having eaten fish or shellfish in the past week. Total blood mercury was also higher among the small number of participants whose race/ethnicity was classified as &#x02018;Other&#x02019; than non-Hispanic black or non-Hispanic white. The total R<sup>2</sup> for these factors in explaining total blood mercury levels was 0.12 with fish consumption contributing to about half of the explained variation. Lipid-adjusted serum DDE was mostly predicted by increasing age (28% explained variation) and higher in those with race/ethnicity classified as &#x02018;Other.&#x02019; The association between DDE and eating locally caught fish was not statistically significant (p = 0.13, &#x0003c; 1% explained variation). Age was the most important predictor of lipid-adjusted serum PCB concentrations, accounting for 42% of the variance in the &#x02211;PCBs. Participants whose race/ethnicity was classified as non-Hispanic black and &#x0201c;Other&#x02019; had higher &#x02211;PCB concentrations than non-Hispanics whites. Eating more meals of locally caught fish was significantly associated with PCB concentrations (p = 0.0002, 2.9% explained variation). Age was the most important predictor of lipid adjusted total TEQ (32% explained variation) and higher in those with race/ethnicity classified as &#x02018;Other.&#x02019; The association between total TEQ and eating locally caught fish was not statistically significant (p = 0.07, &#x0003c; 1% explained variation).</p></sec><sec id="S7"><label>4.</label><title>Discussion</title><p id="P21">The Great Lakes and their tributaries serve as a major navigation system for Canada and the United States to the Atlantic Ocean. Since the Industrial Revolution, it was a common practice to dispose of municipal and industrial waste into these vast waters. The Detroit River is one of many Great Lakes waterways to have persistent toxic substances from industrialization and human activities become concentrated in biota and sediments. These substances progressively bioaccumulate up the aquatic food chain and finally in humans (<xref rid="R5" ref-type="bibr">ATSDR, 1999</xref>; <xref rid="R23" ref-type="bibr">EPA, 2016</xref>). Urban anglers who fish along the shores of the Detroit River may have a disproportionately high risk of exposure to contaminants from eating their catch. Urban shoreline anglers tend to be a low-income minority subset of the Great Lakes angler population, and in many cases rely on the fish in the river as a food resource. Previous studies to assess contaminant levels in vulnerable Great Lakes populations have focused on Native American communities and sport anglers, who fish from boats and tend to be more affluent than shoreline anglers (<xref rid="R4" ref-type="bibr">Anderson et al., 1996</xref>; <xref rid="R31" ref-type="bibr">He et al., 2001</xref>; <xref rid="R11" ref-type="bibr">Bloom et al., 2008</xref>; <xref rid="R20" ref-type="bibr">DeCaprio et al., 2005</xref>; <xref rid="R64" ref-type="bibr">Schaeffer et al., 2006</xref>; <xref rid="R26" ref-type="bibr">Fitzgerald et al., 2004</xref>; <xref rid="R18" ref-type="bibr">Christensen et al., 2016a</xref>,<xref rid="R19" ref-type="bibr">b</xref>). Our study focuses on low-income minority urban shoreline anglers who eat fish from the Detroit River to assess human exposure to contaminants. These results add to our knowledge on exposure to environmental contaminants among potentially high-risk populations in the Great Lakes Basin. The MDCH used this information to improve the Michigan Fish Advisory program and to develop fish advisory outreach materials designed specifically for this subpopulation (<xref rid="R27" ref-type="bibr">Friends of the Detroit River, 2017</xref>; <xref rid="R21" ref-type="bibr">Detroit Free Press, 2017</xref>).</p><p id="P22">The Detroit urban anglers in this study had total blood mercury concentrations are 3.2 and 2.4 times higher than the NHANES 50th and 95th percentile, respectively. In addition, 23% of the study participants had a total blood mercury concentration above the 95th percentile of the adult U.S. population (5 &#x003bc;g/L), indicating higher mercury exposure. The NHANES 95% percentile does not imply a health-based reference level of exposure. Total blood mercury is mainly a measure of methylmercury exposure (<xref rid="R5" ref-type="bibr">ATSDR, 1999</xref>). Methylmercury exposures in the U.S. occur primarily through eating contaminated fish and shellfish (<xref rid="R5" ref-type="bibr">ATSDR, 1999</xref>; <xref rid="R40" ref-type="bibr">Mahaffey, 2004</xref>). Higher consumption of locally caught fish was associated with higher levels of total blood mercury among the Detroit angler cohort. Long-term methylmercury exposure has been associated with harmful neurological effects, which are of particular concern for developing fetuses, infants, and children (<xref rid="R5" ref-type="bibr">ATSDR, 1999</xref>). Recent studies have also shown that methylmercury exposure can increase the risk of cardiovascular disease (<xref rid="R28" ref-type="bibr">Genchi et al., 2017</xref>).</p><p id="P23">PCBs are industrial compounds developed in the late 1920s for an array of commercial uses including electrical applications. Manufacturing of PCBs was banned in the U.S. in 1979, however, PCBs are extremely resistant to degradation, persist in sediment and soils, and are regularly found in our waterways. PCBs have been associated with increased cancer risk, hormone disruption, and diabetes (<xref rid="R6" ref-type="bibr">ATSDR, 2000</xref>; <xref rid="R7" ref-type="bibr">ATSDR, 2011</xref>; <xref rid="R37" ref-type="bibr">Karmus and Zhu, 2004</xref>; <xref rid="R14" ref-type="bibr">Carpenter, 2006</xref>; <xref rid="R67" ref-type="bibr">Turyk et al., 2009</xref>). African-American ethnicity and increasing age have been shown to be related to higher PCB congener levels (<xref rid="R41" ref-type="bibr">McGraw and Waller 2009</xref>; <xref rid="R3" ref-type="bibr">Aminov et al., 2014</xref>; <xref rid="R56" ref-type="bibr">Pavuk et al., 2014</xref>). We found higher PCB concentrations in this study than NHANES 2009/10. Participants in this study are primarily non-Hispanic blacks, therefore, we conducted comparisons by age groups restricted to non-Hispanic blacks. Median PCB concentrations in this study were higher than NHANES 2009/10 for those aged 18&#x02013;39 years and 40&#x02013;59 years but similar among those aged 60 years and older (<xref rid="F1" ref-type="fig">Fig. 1</xref>). NHANES 2-year survey data since 2003/04 have been showing a continuous decline in PCB serum concentrations among adult age groups (<xref rid="R66" ref-type="bibr">Sjodin et al., 2014</xref>). As such, our comparisons likely underestimate potential elevated PCB concentrations among the Detroit urban angler study participants.</p><p id="P24">The detection of high mercury, DDT, and PCB levels in Great Lakes fish in the 1970s evoked interest on human exposure assessment and potential human health effects (<xref rid="R32" ref-type="bibr">Hicks and De Rosa, 2002</xref>). Over decades, studies conducted in the Great Lakes basin have documented elevated mercury, DDT or its metabolite DDE, and PCB levels among angler cohorts in areas of contamination in relation to fish consumption (<xref rid="R20" ref-type="bibr">DeCaprio et al., 2005</xref>; <xref rid="R34" ref-type="bibr">Humphrey et al., 2000</xref>; <xref rid="R35" ref-type="bibr">Johnson et al., 1998</xref>; <xref rid="R64" ref-type="bibr">Schaeffer et al., 2006</xref>). The Michigan Fisheaters Cohort studies initially conducted in the 1970s found highly elevated total blood mercury (36.4 &#x003bc;g/L) among eaters of fish caught in areas of contamination; and, significantly greater DDT and PCBs, an emerging fish contaminant, among fisheaters (<xref rid="R33" ref-type="bibr">Humphrey and Budd, 1996</xref>). Following the ban of DDT and PCBs in the 1970s and 1980s, researchers have found lower body burdens of these chemicals in both frequent and infrequent sport fish eaters (<xref rid="R38" ref-type="bibr">Knobeloch et al., 2009</xref>). Over a 10 year follow-up of Great Lakes charter boat captains from 1994 to 1995 and 2001&#x02013;2005, annual declines in serum DDE and PCB concentrations averaged 4.6% and 3.5%, respectively (<xref rid="R38" ref-type="bibr">Knobeloch et al., 2009</xref>). Despite these declines, studies of frequent sport fish consumers in the Great Lakes areas continue to find higher body burden levels of mercury and PCBs in relation to eating locally caught fish (<xref rid="R18" ref-type="bibr">Christensen et al., 2016a</xref>, <xref rid="R19" ref-type="bibr">2016b</xref>).</p><p id="P25">The Detroit urban anglers consumed a median of 1.2 meals per week of locally caught fish which is less than the 3 or more meals per week used to define high-frequency fish consumers based on results of a national survey (<xref rid="R70" ref-type="bibr">Von Stackelberg et al., 2017</xref>). Contaminants vary greatly, however, among fish species and waterways. White bass, one of the most contaminated fish species in the Detroit River, was eaten by 91% of the study anglers with a median of 20 meals in the past year. Fish advisories in the Detroit area have a guideline of 1&#x02013;2 servings per year for white bass (<xref rid="R45" ref-type="bibr">MDHHS, 2018d</xref>). Our findings of higher body burden levels of mercury and PCBs among Detroit urban anglers along with an association with eating locally caught fish demonstrate higher exposure in an area and a susceptible population that had not been studied before and call for more effective and targeted outreach on safe fish eating practices among susceptible populations in the Great Lakes basin.</p><p id="P26">Fish is known to contain high levels of nutrients, such as omega-3 fatty acid, that are beneficial to human health. Further, sport and subsistence anglers benefit nutritionally and recreationally from fishing in local waters. Therefore, our results and potential implications on fish consumption should be interpreted cautiously. Exposure profiles differ by fishing location and types of fish consumed. Prudent species-location-specific fish consumption choices can help balance the risk &#x00026; benefits of eating locally caught fish (<xref rid="R68" ref-type="bibr">Turyk et al., 2012</xref>). Fish consumption advisories in Michigan are issued by the MDHHS based on levels of contaminants in fish tissue sampled by the Michigan Department of Environmental Quality&#x02019;s (MDEQ) Fish Contaminant Monitoring Program (<xref rid="R1" ref-type="bibr">MDEQ, 2014</xref>). The MDHHS <italic>Michigan Eat Safe Fish Guide</italic> includes local water/area specific consumption advisories for fish species (<xref rid="R44" ref-type="bibr">MDHHS, 2018c</xref>). For the Detroit River and Lake St. Claire area, white bass, catfish, smallmouth bass, and largemouth bass are the most contaminated species with a 1 to 2 servings per year guideline in &#x02018;healthy&#x02019; adults and a &#x0201c;do not consume&#x0201d; guideline for women who are pregnant or plan to become pregnant. In this study, white bass was consumed by 90.7% of the Detroit urban anglers with a median of 20 meals in the last year. Our study findings indicate the need for more effective and targeted health communications on eating less contaminated caught species and store bought fish options among this population. Other frequently consumed species (45%&#x02013;60% of anglers) included yellow perch, smallmouth bass, white perch, rock bass, walleye, largemouth bass, and catfish.</p><p id="P27">Low-income minority anglers in urban areas have been reported to exhibit a general lack of awareness or adherence to fish consumption guidelines (<xref rid="R9" ref-type="bibr">Beehler et al., 2001</xref>). Recent studies of urban anglers in the Great Lakes region have sought to characterize fish consumption patterns, awareness of consumption advisories, and factors that influence fish consumption and response to advisories. Shoreline urban angles tended to rely on perception and experience to direct their fishing practices. Water quality was perceived to be of moderate to high quality, much cleaner than it used to be, based on looks. Culture played a role in the types of fish preferred for meals despite knowledge of potential contaminant levels (<xref rid="R9" ref-type="bibr">Beehler et al., 2001</xref>; <xref rid="R36" ref-type="bibr">Kalkirtz et al., 2008</xref>). These studies highlight the importance of using community-based programs to communicate fish consumption advice for targeted sub-populations of urban anglers. Based on the findings of this study, the MDHHS was able to leverage community resources to help develop and deliver more targeted risk communication on eating fish from the Detroit River. The MDHHS staff developed and distributed brochures, easy to understand 1-page guidelines, and television &#x02018;spots&#x02019; through local organizations such as the Detroit River Keepers and the Detroit Free Press (<xref rid="R27" ref-type="bibr">Friends of the Detroit River, 2017</xref>; <xref rid="R21" ref-type="bibr">Detroit Free Press, 2017</xref>).</p><p id="P28">There were some limitations to this study. First, the large number of anglers interviewed at fishing venues who were not successfully recruited introduced a possibility of bias. Reasons for non-participation include: (1) the angler reported eating less than the eligibility criteria of two or more locally caught fish meals per month; and, (2) the angler refused further participation (<xref rid="R72" ref-type="bibr">Wattigney et al., 2019</xref>). Second, data on fish consumption may be under or over estimated due to recall bias. Thirdly, PCB levels are consistently higher in older cohorts of both frequent and non-frequent fish consumers. The PCB levels in Detroit urban anglers aged 60 years and older is influenced by lifetime fish consumption and other exposures during time periods of peak emissions in conjunction with human metabolic rates (<xref rid="R58" ref-type="bibr">Quinn et al., 2012</xref>). Future studies to monitor trends in the exposure impact due to eating fish from the Great Lakes and surrounding waterways would likely benefit by focusing on younger age groups, e.g. 18&#x02013;50 years (<xref rid="R73" ref-type="bibr">Xue et al., 2014</xref>). Another limitation is that the general population data for DDE, PCBs and total TEQ were collected in an earlier time frame than the Detroit urban angler study. We used NHANES 2009/10 as a referent for DDE, PCBs and NHANES 2003/04 for total TEQ. The comparisons with the reference levels from past years likely underestimated the extent of exposure in this study due to evidence of decreasing temporal trends for these legacy persistent organic pollutants. Average PCB 153 concentrations decreased by 36% in 12&#x02013;19 year olds and 14% in people aged 60 years or older from NHANES 2003/04 through 2007/08 (<xref rid="R66" ref-type="bibr">Sjodin et al., 2014</xref>). Atmospheric deposition and fish tissue surveillance studies in the Great Lakes have also shown decreasing trends from 1992 to 2010 for PCB concentrations (halving times of 14 &#x000b1; 2 years) and DDT (halving time of 8.7 &#x000b1; 0.4 years) (<xref rid="R61" ref-type="bibr">Salamova et al., 2013</xref>). Lastly, it is difficult to assess whether a 1.6, 2 or 3 times higher contaminant concentration compared to NHANES data is meaningful in the context of health effects. These measurements are an indication of exposure and are not associated with disease or adverse health outcomes.</p><p id="P29">In conclusion, urban anglers in Detroit, Michigan had higher total blood mercury and serum PCB concentrations than the general U.S. population. This subpopulation of mainly low-income minority anglers had an exposure profile associated with eating locally caught fish. Fish from the Detroit River have been found to be contaminated with a multitude of chemicals including heavy metals, PCBs, dioxins, and pesticides. The fish consumption information collected from this study indicate that there may be a need for more effective and targeted health communications on fish advisories among this population. The MDHHS used the results of this biomonitoring study to develop and distribute educational materials specific to the Detroit area to promote safe fish eating practices (<xref rid="R44" ref-type="bibr">MDHHS, 2018c</xref>; <xref rid="R45" ref-type="bibr">MDHHS, 2018d</xref>). The biomonitoring data informed public health officials and helped guide environmental public health action to reduce harmful exposures.</p></sec><sec sec-type="supplementary-material" id="SM1"><title>Supplementary Material</title><supplementary-material content-type="local-data" id="SD1"><label>Supplemental Table 1</label><media xlink:href="NIHMS1045579-supplement-Supplemental_Table_1.docx" orientation="portrait" xlink:type="simple" id="d36e590" position="anchor"/></supplementary-material><supplementary-material content-type="local-data" id="SD2"><label>Supplemental Table 4</label><media xlink:href="NIHMS1045579-supplement-Supplemental_Table_4.docx" orientation="portrait" xlink:type="simple" id="d36e594" position="anchor"/></supplementary-material><supplementary-material content-type="local-data" id="SD3"><label>Supplemntal Table 2</label><media xlink:href="NIHMS1045579-supplement-Supplemntal_Table_2.docx" orientation="portrait" xlink:type="simple" id="d36e598" position="anchor"/></supplementary-material><supplementary-material content-type="local-data" id="SD4"><label>Supplmental Table 3</label><media xlink:href="NIHMS1045579-supplement-Supplmental_Table_3.docx" orientation="portrait" xlink:type="simple" id="d36e602" position="anchor"/></supplementary-material></sec></body><back><ack id="S8"><title>Acknowledgements</title><p id="P30">We thank the study participants. We thank Dr. Linda Dykema, Susan Manente, and the rest of the MDHHS program staff whose hard work led to a successful program. We thank Stephanie Davis, MSPH for assistance during program development. We also thank Samuel P. Caudill, PhD for providing his pre-publication NHANES 2009&#x02013;2010 pooled sample estimates for the persistent organic pollutants. The BGLP-I program was funded by the U.S. Environmental Protection Agency Great Lakes Restoration Initiative under Interagency Agreement numbers DW-75&#x02013;92312301 and DW-75&#x02013;9236101. The Detroit urban angler project was financially supported by Cooperative Agreement #5U61TS000138 from the Agency for Toxic Substances and Disease Registry, United States.</p></ack><fn-group><fn id="FN1"><p id="P31" content-type="publisher-disclaimer">Disclaimer</p><p id="P32" content-type="publisher-disclaimer">The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.</p></fn><fn id="FN2"><p id="P33">Appendix A. Supplementary data</p><p id="P34">Supplementary data to this article can be found online at <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1016/j.ijheh.2019.06.007">https://doi.org/10.1016/j.ijheh.2019.06.007</ext-link>.</p></fn></fn-group><ref-list><title>References</title><ref id="R1"><mixed-citation publication-type="web"><collab>MDEQ</collab>, <year>2014</year>
<source>Michigan department of environmental quality. 2014. Fish contaminant report</source>
<comment><ext-link ext-link-type="uri" xlink:href="http://www.michigan.gov/deq/0,4561,7-135-3313_3681_3686_3728-32393-,00.html">http://www.michigan.gov/deq/0,4561,7-135-3313_3681_3686_3728-32393-,00.html</ext-link>.</comment></mixed-citation></ref><ref id="R2"><mixed-citation publication-type="journal"><name><surname>Adriaens</surname><given-names>P</given-names></name>, <name><surname>Batterman</surname><given-names>S</given-names></name>, <name><surname>Blum</surname><given-names>J</given-names></name>, <name><surname>Hayes</surname><given-names>K</given-names></name>, <name><surname>Meyers</surname><given-names>P</given-names></name>, <name><surname>Weber Jr.</surname><given-names>W</given-names></name>, <year>2002</year>
<source>Great Lakes sediments: contamination, toxicity and beneficial re-use</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="https://www.csu.edu/cerc/researchreports/documents/GreatLakesSedimentsContaminationToxicityBeneficialReUse.pdf">https://www.csu.edu/cerc/researchreports/documents/GreatLakesSedimentsContaminationToxicityBeneficialReUse.pdf</ext-link>.</comment></mixed-citation></ref><ref id="R3"><mixed-citation publication-type="journal"><name><surname>Aminov</surname><given-names>Z</given-names></name>, <name><surname>Haase</surname><given-names>R</given-names></name>, <name><surname>Olson</surname><given-names>JR</given-names></name>, <name><surname>Pavuk</surname><given-names>M</given-names></name>, <name><surname>Carpenter</surname><given-names>DO</given-names></name>, <collab>for the Anniston Environmental Health Research Consortium</collab>, <year>2014</year>
<article-title>Racial differences in levels of serum lipids and effects of exposure to persistent organic pollutants on lipid levels in residents of Anniston</article-title>, <source>Alabama. Environ. Int</source>
<volume>73</volume>, <fpage>216</fpage>&#x02013;<lpage>223</lpage>.<pub-id pub-id-type="pmid">25160080</pub-id></mixed-citation></ref><ref id="R4"><mixed-citation publication-type="journal"><name><surname>Anderson</surname><given-names>HA</given-names></name>, <name><surname>Falk</surname><given-names>C</given-names></name>, <name><surname>Fiore</surname><given-names>B</given-names></name>, <name><surname>Hanrahan</surname><given-names>L</given-names></name>, <name><surname>Humphrey</surname><given-names>HEB</given-names></name>, <name><surname>Kanarek</surname><given-names>M</given-names></name>, <name><surname>Long</surname><given-names>T</given-names></name>, <name><surname>Mortensen</surname><given-names>K</given-names></name>, <name><surname>Shelley</surname><given-names>T</given-names></name>, <name><surname>Sonzogni</surname><given-names>B</given-names></name>, <name><surname>Steele</surname><given-names>G</given-names></name>, <name><surname>Tilden</surname><given-names>J</given-names></name>, <year>1996</year>
<article-title>Consortium for the health assessment of Great lakes sport fish consumption</article-title>. <source>Toxicol. Ind. Health</source>
<volume>12</volume>, <fpage>369</fpage>&#x02013;<lpage>373</lpage>.<pub-id pub-id-type="pmid">8843554</pub-id></mixed-citation></ref><ref id="R5"><mixed-citation publication-type="journal"><collab>ATSDR</collab>, <year>1999</year>
<article-title>Toxicological Profile for Mercury. U.S. Department of Health and Human Services</article-title>. <source>Public Health Service, Agency for Toxic Substances and Disease Registry, Atlanta, GA</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="http://www.atsdr.cdc.gov/toxprofiles/tp46.pdf">http://www.atsdr.cdc.gov/toxprofiles/tp46.pdf</ext-link>.</comment></mixed-citation></ref><ref id="R6"><mixed-citation publication-type="book"><collab>ATSDR</collab>, <year>2000</year>
<chapter-title>Toxicological Profile for Polychlorinated Biphenyls (PCBs)</chapter-title>
<publisher-loc>Atlanta, GA</publisher-loc>: <publisher-name>U.S. Department of Health and Human Services</publisher-name>, <source>Public Health Service. Agency for Toxic Substances and Disease Registry, Atlanta, GA</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="https://www.atsdr.cdc.gov/toxprofiles/tp17.pdf">https://www.atsdr.cdc.gov/toxprofiles/tp17.pdf</ext-link>.</comment></mixed-citation></ref><ref id="R7"><mixed-citation publication-type="journal"><collab>ATSDR</collab>, <year>2011</year>
<article-title>Addendum for Polychlorinated Biphenyls, Supplement to the 2000 Toxicological Profile for Polychlorinated Biphenyls (PCBs)</article-title>. <source>U.S. Department of Health and Human Services, Public Health Service. Agency for Toxic Substances and Disease Registry (ATSDR), Atlanta, GA</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="https://www.atsdr.cdc.gov/toxprofiles/pcbs_addendum.pdf">https://www.atsdr.cdc.gov/toxprofiles/pcbs_addendum.pdf</ext-link>.</comment></mixed-citation></ref><ref id="R8"><mixed-citation publication-type="journal"><collab>ATSDR</collab>, <year>2014</year>
<article-title>Case studies in environmental medicine</article-title>. <source>Polychlorinated biphenyls (PCBs) toxicity</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="https://www.atsdr.cdc.gov/csem/pcb/docs/pcb.pdf">https://www.atsdr.cdc.gov/csem/pcb/docs/pcb.pdf</ext-link>.</comment></mixed-citation></ref><ref id="R9"><mixed-citation publication-type="journal"><name><surname>Beehler</surname><given-names>GP</given-names></name>, <name><surname>McGuinness</surname><given-names>BM</given-names></name>, <name><surname>Vens</surname><given-names>JE</given-names></name>, <year>2001</year>
<article-title>Polluted fish, sources of knowledge, and the perception of risk: contextualizing African American anglers&#x02019; sport fishing practices</article-title>. <source>Hum. Organ</source>
<volume>60</volume>, <fpage>288</fpage>&#x02013;<lpage>297</lpage>.</mixed-citation></ref><ref id="R10"><mixed-citation publication-type="journal"><name><surname>Bernert</surname><given-names>JT</given-names></name>, <name><surname>Turner</surname><given-names>WE</given-names></name>, <name><surname>Patterson</surname><given-names>DG</given-names><suffix>Jr.</suffix></name>, <name><surname>Needham</surname><given-names>LL</given-names></name>, <year>2007</year>
<article-title>Calculation of serum &#x0201c;total lipid&#x0201d; concentrations for the adjustment of persistent organohalogen toxicant measurements in human samples</article-title>. <source>Chemosphere</source>
<volume>68</volume>, <fpage>824</fpage>&#x02013;<lpage>831</lpage>.<pub-id pub-id-type="pmid">17408721</pub-id></mixed-citation></ref><ref id="R11"><mixed-citation publication-type="journal"><name><surname>Bloom</surname><given-names>M</given-names></name>, <name><surname>Spliethoff</surname><given-names>H</given-names></name>, <name><surname>Vena</surname><given-names>J</given-names></name>, <name><surname>Shaver</surname><given-names>S</given-names></name>, <name><surname>Addink</surname><given-names>R</given-names></name>, <name><surname>Eadon</surname><given-names>G</given-names></name>, <year>2008</year>
<article-title>Environmental exposure to PBDEs and thyroid function among New York anglers</article-title>. <source>Environ. Toxicol. Pharmacol</source>
<volume>25</volume>, <fpage>386</fpage>&#x02013;<lpage>392</lpage>.<pub-id pub-id-type="pmid">21783878</pub-id></mixed-citation></ref><ref id="R12"><mixed-citation publication-type="journal"><name><surname>Burse</surname><given-names>VW</given-names></name>, <name><surname>Head</surname><given-names>SL</given-names></name>, <name><surname>Korver</surname><given-names>MP</given-names></name>, <name><surname>McClure</surname><given-names>PC</given-names></name>, <name><surname>Donahue</surname><given-names>JF</given-names></name>, <name><surname>Needham</surname><given-names>LL</given-names></name>, <year>1990</year>
<article-title>Determination of selected organochlorine pesticides and polychlorinated biphenyls in human serum</article-title>. <source>J. Anal. Toxicol</source>
<volume>14</volume>, <fpage>137</fpage>&#x02013;<lpage>141</lpage>.<pub-id pub-id-type="pmid">1695698</pub-id></mixed-citation></ref><ref id="R13"><mixed-citation publication-type="journal"><name><surname>Calafat</surname><given-names>AM</given-names></name>, <year>2012</year>
<article-title>The U.S. National Health and Nutrition Examination Survey and human exposure to environmental chemicals</article-title>. <source>Int. J. Hyg Environ. Health</source>
<volume>215</volume>, <fpage>99</fpage>&#x02013;<lpage>101</lpage>.<pub-id pub-id-type="pmid">21937270</pub-id></mixed-citation></ref><ref id="R14"><mixed-citation publication-type="journal"><name><surname>Carpenter</surname><given-names>DO</given-names></name>, <year>2006</year>
<article-title>Polychlorinated biphenyls (PCBs): routes of exposure and effects on human health</article-title>. <source>Rev. Environ. Health</source>
<volume>21</volume>, <fpage>1</fpage>&#x02013;<lpage>23</lpage>.<pub-id pub-id-type="pmid">16700427</pub-id></mixed-citation></ref><ref id="R15"><mixed-citation publication-type="journal"><name><surname>Caudill</surname><given-names>SP</given-names></name>, <year>2012</year>
<article-title>Use of pooled samples from the national health and nutrition examination survey</article-title>. <source>Stat. Med</source>
<volume>31</volume>, <fpage>3269</fpage>&#x02013;<lpage>3277</lpage>.<pub-id pub-id-type="pmid">22492247</pub-id></mixed-citation></ref><ref id="R16"><mixed-citation publication-type="journal"><name><surname>Caudill</surname><given-names>SP</given-names></name>, <year>2015</year>
<article-title>Confidence interval estimation for pooled-sample biomonitoring from a complex survey design</article-title>. <source>Environ. Int</source>
<volume>85</volume>, <fpage>40</fpage>&#x02013;<lpage>45</lpage>.<pub-id pub-id-type="pmid">26313704</pub-id></mixed-citation></ref><ref id="R17"><mixed-citation publication-type="journal"><name><surname>Caudill</surname><given-names>SP</given-names></name>, <name><surname>Wong</surname><given-names>L-Y</given-names></name>, <name><surname>Turner</surname><given-names>WE</given-names></name>, <name><surname>Lee</surname><given-names>R</given-names></name>, <name><surname>Henderson</surname><given-names>A</given-names></name>, <name><surname>Patterson</surname><given-names>DG</given-names><suffix>Jr.</suffix></name>, <year>2007</year>
<article-title>Percentile estimation using variable censored data</article-title>. <source>Chemosphere</source>
<volume>68</volume>, <fpage>169</fpage>&#x02013;<lpage>180</lpage>.<pub-id pub-id-type="pmid">17267011</pub-id></mixed-citation></ref><ref id="R18"><mixed-citation publication-type="journal"><name><surname>Christensen</surname><given-names>KY</given-names></name>, <name><surname>Raymond</surname><given-names>MR</given-names></name>, <name><surname>Thompson</surname><given-names>BA</given-names></name>, <name><surname>Schrank</surname><given-names>CS</given-names></name>, <name><surname>Williams</surname><given-names>MC</given-names></name>, <name><surname>Anderson</surname><given-names>HA</given-names></name>, <year>2016a</year>
<article-title>Comprehension of fish consumption guidelines among older make anglers in Wisconsin</article-title>. <source>J. Community Health</source>
<volume>41</volume>, <fpage>157</fpage>&#x02013;<lpage>164</lpage>.<pub-id pub-id-type="pmid">26306781</pub-id></mixed-citation></ref><ref id="R19"><mixed-citation publication-type="journal"><name><surname>Christensen</surname><given-names>KY</given-names></name>, <name><surname>Thompson</surname><given-names>BA</given-names></name>, <name><surname>Werner</surname><given-names>M</given-names></name>, <name><surname>Malechi</surname><given-names>K</given-names></name>, <name><surname>Imm</surname><given-names>P</given-names></name>, <name><surname>Anderson</surname><given-names>HA</given-names></name>, <year>2016b</year>
<article-title>Levels of persistent contaminants in relation to fish consumption among older male anglers in Wisconsin</article-title>. <source>Int. J. Hyg Environ. Health</source>
<volume>219</volume>, <fpage>184</fpage>&#x02013;<lpage>194</lpage>.<pub-id pub-id-type="pmid">26614251</pub-id></mixed-citation></ref><ref id="R20"><mixed-citation publication-type="journal"><name><surname>DeCaprio</surname><given-names>AP</given-names></name>, <name><surname>Johnson</surname><given-names>GW</given-names></name>, <name><surname>Tarbellc</surname><given-names>AM</given-names></name>, <name><surname>Carpentera</surname><given-names>DO</given-names></name>, <name><surname>Chiarenzellid</surname><given-names>JR</given-names></name>, <name><surname>Morsee</surname><given-names>GS</given-names></name>, <name><surname>Santiago-Riverae</surname><given-names>AL</given-names></name>, <name><surname>Schymuraf</surname><given-names>MJ</given-names></name>, <collab>Akwesasne Task Force on the Environment</collab>, <year>2005</year>
<article-title>Polychlorinated biphenyl (PCB) exposure assessment by multivariate statistical analysis of serum congener profiles in an adult Native American population</article-title>. <source>Environ. Res</source>
<volume>98</volume>, <fpage>284</fpage>&#x02013;<lpage>302</lpage>.<pub-id pub-id-type="pmid">15910784</pub-id></mixed-citation></ref><ref id="R21"><mixed-citation publication-type="web"><collab>Detroit Free Press</collab>, <year>2017</year>
<source>Study finds frequent Detroit River fish-eaters have elevated blood toxins</source>
<comment><ext-link ext-link-type="uri" xlink:href="http://www.freep.com/videos/news/local/michigan/detroit/2017/04/01/study-finds-frequent-detroit-river-fish-eaters-have-elevated-blood-toxins/99591554/">http://www.freep.com/videos/news/local/michigan/detroit/2017/04/01/study-finds-frequent-detroit-river-fish-eaters-have-elevated-blood-toxins/99591554/</ext-link>.</comment></mixed-citation></ref><ref id="R22"><mixed-citation publication-type="web"><collab>EPA</collab>, <year>2012</year>
<collab>United States environmental protection agency and environment Canada</collab>. <source>The 2012 Great lakes water quality agreement</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="https://binational.net//wp-content/uploads/2014/05/1094_Canada-USA-GLWQA-_e.pdf">https://binational.net//wp-content/uploads/2014/05/1094_Canada-USA-GLWQA-_e.pdf</ext-link>.</comment></mixed-citation></ref><ref id="R23"><mixed-citation publication-type="web"><collab>EPA</collab>, <year>2016</year>
<collab>U.S. Environmental protection agency</collab>. <source>Persistent organic pollutants: a global issue, a global response</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="https://www.epa.gov/international-cooperation/persistent-organic-pollutants-global-issue-global-response">https://www.epa.gov/international-cooperation/persistent-organic-pollutants-global-issue-global-response</ext-link>.</comment></mixed-citation></ref><ref id="R24"><mixed-citation publication-type="web"><collab>EPA</collab>, <year>2017a</year>
<collab>United States environmental protection agency</collab>. <source>Great lakes fish monitoring surveillance program</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="https://www.epa.gov/great-lakes-monitoring/great-lakes-fish-monitoring-surveillance-program-data">https://www.epa.gov/great-lakes-monitoring/great-lakes-fish-monitoring-surveillance-program-data</ext-link>.</comment></mixed-citation></ref><ref id="R25"><mixed-citation publication-type="web"><collab>EPA</collab>, <year>2017b</year>
<collab>U.S. Environmental protection agency (c)</collab>. <source>Great lakes restoration initiative(GLRI)</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="https://www.epa.gov/great-lakes-funding/great-lakes-restoration-initiative-glri">https://www.epa.gov/great-lakes-funding/great-lakes-restoration-initiative-glri</ext-link>.</comment></mixed-citation></ref><ref id="R26"><mixed-citation publication-type="journal"><name><surname>Fitzgerald</surname><given-names>EF</given-names></name>, <name><surname>Hwang</surname><given-names>S</given-names></name>, <name><surname>Langguth</surname><given-names>K</given-names></name>, <name><surname>Cayo</surname><given-names>M</given-names></name>, <name><surname>Yang</surname><given-names>B</given-names></name>, <name><surname>Bush</surname><given-names>B</given-names></name>, <name><surname>Worswick</surname><given-names>P</given-names></name>, <name><surname>Lauzon</surname><given-names>T</given-names></name>, <year>2004</year>
<article-title>Fish consumption and other environmental exposures and their associations with serum PCB concentrations among Mohawk women at Akwesane</article-title>. <source>Environ. Res</source>
<volume>94</volume>, <fpage>160</fpage>&#x02013;<lpage>170</lpage>.<pub-id pub-id-type="pmid">14757379</pub-id></mixed-citation></ref><ref id="R27"><mixed-citation publication-type="web"><collab>Friends of the Detroit River</collab>, <year>2017</year>
<source>Detroit Riverkeeper Program</source>
<comment><ext-link ext-link-type="uri" xlink:href="http://www.detroitriver.org">http://www.detroitriver.org</ext-link>.</comment></mixed-citation></ref><ref id="R28"><mixed-citation publication-type="journal"><name><surname>Genchi</surname><given-names>G</given-names></name>, <name><surname>Sinicropi</surname><given-names>MS</given-names></name>, <name><surname>Carocci</surname><given-names>A</given-names></name>, <name><surname>Lauria</surname><given-names>G</given-names></name>, <name><surname>Catalano</surname><given-names>A</given-names></name>, <year>2017</year>
<article-title>Mercury exposure and heart diseases</article-title>. <source>Int. J. Environ. Res. Public Health</source>
<volume>14</volume>, <fpage>761</fpage>&#x02013;<lpage>762</lpage>.</mixed-citation></ref><ref id="R29"><mixed-citation publication-type="journal"><name><surname>Gewurtz</surname><given-names>SB</given-names></name>, <name><surname>Backus</surname><given-names>SM</given-names></name>, <name><surname>Bhavsar</surname><given-names>SP</given-names></name>, <name><surname>McGoldrick</surname><given-names>DJ</given-names></name>, <name><surname>de Solla</surname><given-names>SR</given-names></name>, <name><surname>Murphy</surname><given-names>EW</given-names></name>, <year>2011</year>
<article-title>Contaminant biomonitoring programs in the Great Lakes: review of approaches and critical factors</article-title>. <source>Environ. Rev</source>
<volume>19</volume>, <fpage>162</fpage>&#x02013;<lpage>184</lpage>.</mixed-citation></ref><ref id="R30"><mixed-citation publication-type="web"><name><surname>Groetsch</surname><given-names>KJ</given-names></name>, <name><surname>Manente</surname><given-names>S</given-names></name>, <year>2010</year>
<source>Case studies of community-based fish consumption advisories at three Michigan Great lakes areas of concern</source> Available at. <comment><ext-link ext-link-type="uri" xlink:href="http://www.michigan.gov/documents/mdch/Michigan_FCA_AOC_rpt_2010__307475_7.pdf">http://www.michigan.gov/documents/mdch/Michigan_FCA_AOC_rpt_2010__307475_7.pdf</ext-link>.</comment></mixed-citation></ref><ref id="R31"><mixed-citation publication-type="journal"><name><surname>He</surname><given-names>JP</given-names></name>, <name><surname>Stein</surname><given-names>AD</given-names></name>, <name><surname>Humphrey</surname><given-names>HE</given-names></name>, <name><surname>Paneth</surname><given-names>N</given-names></name>, <name><surname>Courval</surname><given-names>JM</given-names></name>, <year>2001</year>
<article-title>Time trends in sport-caught Great Lakes fish consumption and serum polychlorinated biphenyl levels among Michigan anglers, 1973&#x02013;1993</article-title>. <source>Environ. Sci. Technol</source>
<volume>35</volume>, <fpage>435</fpage>&#x02013;<lpage>440</lpage>.<pub-id pub-id-type="pmid">11351711</pub-id></mixed-citation></ref><ref id="R32"><mixed-citation publication-type="journal"><name><surname>Hicks</surname><given-names>HE</given-names></name>, <name><surname>De Rosa</surname><given-names>CT</given-names></name>, <year>2002</year>
<article-title>Great Lakes Research &#x02013; important human health findings and their impact on ATSDR&#x02019;s Superfund research program</article-title>. <source>Int. J. Hyg Environ. Health</source>
<volume>205</volume>, <fpage>49</fpage>&#x02013;<lpage>61</lpage>.<pub-id pub-id-type="pmid">12018016</pub-id></mixed-citation></ref><ref id="R33"><mixed-citation publication-type="journal"><name><surname>Humphrey</surname><given-names>HEB</given-names></name>, <name><surname>Budd</surname><given-names>ML</given-names></name>, <year>1996</year>
<article-title>Michigan&#x02019;s fisheaters cohorts: a prospective history of exposure</article-title>. <source>Toxicol. Ind. Health</source>
<volume>12</volume>, <fpage>499</fpage>&#x02013;<lpage>505</lpage>.<pub-id pub-id-type="pmid">8843566</pub-id></mixed-citation></ref><ref id="R34"><mixed-citation publication-type="journal"><name><surname>Humphrey</surname><given-names>HEB</given-names></name>, <name><surname>Gardiner</surname><given-names>JC</given-names></name>, <name><surname>Pandya</surname><given-names>JR</given-names></name>, <name><surname>Sweeney</surname><given-names>AM</given-names></name>, <name><surname>Gasior</surname><given-names>DM</given-names></name>, <name><surname>McCaffrey</surname><given-names>RJ</given-names></name>, <name><surname>Schantz</surname><given-names>SL</given-names></name>, <year>2000</year>
<article-title>PCB congener profile in the serum of humans consuming Great lakes fish</article-title>. <source>Environ. Health Perspect</source>
<volume>108</volume>, <fpage>167</fpage>&#x02013;<lpage>171</lpage>.<pub-id pub-id-type="pmid">10656858</pub-id></mixed-citation></ref><ref id="R35"><mixed-citation publication-type="journal"><name><surname>Johnson</surname><given-names>BL</given-names></name>, <name><surname>Hicks</surname><given-names>HE</given-names></name>, <name><surname>Jones</surname><given-names>DE</given-names></name>, <name><surname>Cibulas</surname><given-names>W</given-names></name>, <name><surname>Wargo</surname><given-names>A</given-names></name>, <name><surname>DeRosa</surname><given-names>CT</given-names></name>, <year>1998</year>
<article-title>Public health implications of persistent toxic substances in the Great Lakes and St. Lawrence Basins</article-title>. <source>J. Great Lakes Res</source>
<volume>24</volume>, <fpage>698</fpage>&#x02013;<lpage>722</lpage>.</mixed-citation></ref><ref id="R36"><mixed-citation publication-type="journal"><name><surname>Kalkirtz</surname><given-names>V</given-names></name>, <name><surname>Martinez</surname><given-names>M</given-names></name>, <name><surname>Teague</surname><given-names>A</given-names></name>, <year>2008</year>
<article-title>Environmental Justice and Fish Consumption Advisories on the Detroit River Area of Concern. A Practicum for Masters of Science</article-title>. <source>University of Michigan, School of Natural Resources and Environment</source>
<comment><ext-link ext-link-type="uri" xlink:href="http://www.miseagrant.umich.edu/downloads/fisheries/detroitriver/Thesis-Environmental-Justice-Study.pdf">http://www.miseagrant.umich.edu/downloads/fisheries/detroitriver/Thesis-Environmental-Justice-Study.pdf</ext-link>.</comment></mixed-citation></ref><ref id="R37"><mixed-citation publication-type="journal"><name><surname>Karmus</surname><given-names>W</given-names></name>, <name><surname>Zhu</surname><given-names>X</given-names></name>, <year>2004</year>
<article-title>Maternal concentration of polychlorinated biphnyls and dichlorodiphenyl dichlorethylene and birth weight in Michigan fish eaters: a cohort study</article-title>. <source>Environ. Health</source>
<volume>3</volume>, <fpage>1</fpage>&#x02013;<lpage>17</lpage>.<pub-id pub-id-type="pmid">14748928</pub-id></mixed-citation></ref><ref id="R38"><mixed-citation publication-type="journal"><name><surname>Knobeloch</surname><given-names>L</given-names></name>, <name><surname>Turyk</surname><given-names>M</given-names></name>, <name><surname>Imm</surname><given-names>P</given-names></name>, <name><surname>Snhrank</surname><given-names>C</given-names></name>, <name><surname>Anderson</surname><given-names>H</given-names></name>, <year>2009</year>
<article-title>Temporal changes in PCB and DDE levels among a cohort of frequent and infrequent consumers of Great Lakes sportfish</article-title>. <source>Environ. Res</source>
<volume>109</volume>, <fpage>66</fpage>&#x02013;<lpage>72</lpage>.<pub-id pub-id-type="pmid">18950754</pub-id></mixed-citation></ref><ref id="R39"><mixed-citation publication-type="journal"><name><surname>Mackellar</surname><given-names>D</given-names></name>, <name><surname>Valleroy</surname><given-names>L</given-names></name>, <name><surname>Karon</surname><given-names>G</given-names></name>, <name><surname>Lemp</surname><given-names>G</given-names></name>, <name><surname>Janssen</surname><given-names>R</given-names></name>, <year>1996</year>
<article-title>The Young Men&#x02019;s Survey: methods for estimating HIV seroprevalence and risk factors among young men who have sex with men</article-title>. <source>Publ. Health Rep</source>
<volume>111</volume>, <fpage>138</fpage>&#x02013;<lpage>144</lpage>.</mixed-citation></ref><ref id="R40"><mixed-citation publication-type="journal"><name><surname>Mahaffey</surname><given-names>KR</given-names></name>, <year>2004</year>
<article-title>Fish and shellfish as dietary sources of methylmercury and the omega-3 fatty acids, eicosahexaaenoic acid and docosahexaenoic acid: risk and benefits</article-title>. <source>Environ. Res</source>
<volume>95</volume>, <fpage>414</fpage>&#x02013;<lpage>428</lpage>.<pub-id pub-id-type="pmid">15220075</pub-id></mixed-citation></ref><ref id="R41"><mixed-citation publication-type="journal"><name><surname>McGraw</surname><given-names>JE</given-names></name>, <name><surname>Waller</surname><given-names>DP</given-names></name>, <year>2009</year>
<article-title>The role of African American Ethnicity and metabolism in sentinel polychlorinated biphenyl congener serum levels</article-title>. <source>Environ. Toxicol. Pharmacol</source>
<volume>27</volume> (<issue>1</issue>), <fpage>54</fpage>&#x02013;<lpage>61</lpage>.<pub-id pub-id-type="pmid">20047000</pub-id></mixed-citation></ref><ref id="R42"><mixed-citation publication-type="web"><collab>MDHHS</collab>, <year>2018a</year>
<collab>Michigan department of human health Services</collab>. <source>Eat safe fish in Michigan</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="http://www.michigan.gov/documents/family_fish_166020_7.pdf">http://www.michigan.gov/documents/family_fish_166020_7.pdf</ext-link>.</comment></mixed-citation></ref><ref id="R43"><mixed-citation publication-type="web"><collab>MDHHS</collab>, <year>2018b</year>
<source>Michigan department of health and human Services buy safe fish brochure</source>
<comment><ext-link ext-link-type="uri" xlink:href="https://www.michigan.gov/documents/mdch/2011-05-26_-_MERCURY_ADVISORY_FLYER_STORE-BOUGHT_FISH__RESTAURANT_WEB_354266_7.pdf">https://www.michigan.gov/documents/mdch/2011-05-26_-_MERCURY_ADVISORY_FLYER_STORE-BOUGHT_FISH__RESTAURANT_WEB_354266_7.pdf</ext-link>.</comment></mixed-citation></ref><ref id="R44"><mixed-citation publication-type="web"><collab>MDHHS</collab>, <year>2018c</year>
<source>Michigan department of human health Services. Choose wisely eat safely</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="http://www.michigan.gov/mdhhs/0,5885,7-339-71548_54783_54784_54785-212826-,00.html">http://www.michigan.gov/mdhhs/0,5885,7-339-71548_54783_54784_54785-212826-,00.html</ext-link>.</comment></mixed-citation></ref><ref id="R45"><mixed-citation publication-type="journal"><collab>MDHHS</collab>, <year>2018d</year>
<article-title>Michigan department of human health Services</article-title>. <source>Brochure choose wisely eat safely in the Detroit area</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="http://www.michigan.gov/documents/mdch/2009-11-04_-_Eat_Safe_Fish_in_Detroit_300468_7.pdf">http://www.michigan.gov/documents/mdch/2009-11-04_-_Eat_Safe_Fish_in_Detroit_300468_7.pdf</ext-link>.</comment></mixed-citation></ref><ref id="R46"><mixed-citation publication-type="journal"><name><surname>Najam</surname><given-names>AR</given-names></name>, <name><surname>Korver</surname><given-names>MP</given-names></name>, <name><surname>Williams</surname><given-names>CC</given-names></name>, <name><surname>Burse</surname><given-names>VW</given-names></name>, <name><surname>Needham</surname><given-names>LL</given-names></name>, <year>1999</year>
<article-title>Analysis of a mixture of polychlorinated biphenyls and chlorinated pesticides in human serum by column fractionation and dual-column capillary gas chromatography with electron capture detection</article-title>. <source>J. Assoc. Off. Anal. Chem</source>
<volume>82</volume>, <fpage>177</fpage>&#x02013;<lpage>185</lpage>.</mixed-citation></ref><ref id="R47"><mixed-citation publication-type="web"><collab>NCEH</collab>, <year>2004</year>
<collab>National center for environmental health, centers for disease control and prevention</collab>. <source>Laboratory procedure manual, total mercury</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="https://wwwn.cdc.gov/nchs/data/nhanes/2007-008/labmethods/thgihg_e_met_total_mercury.pdf">https://wwwn.cdc.gov/nchs/data/nhanes/2007-008/labmethods/thgihg_e_met_total_mercury.pdf</ext-link>.</comment></mixed-citation></ref><ref id="R48"><mixed-citation publication-type="web"><collab>NCEH</collab>, <year>2017</year>
<source>Fourth National Report on Human Exposure to Environmental Chemicals, Updated Tables, January 2017</source>. <collab>National Center for Environmental Health, Centers for Disease Control and Prevention</collab>, <comment>Atlanta, GA 2017</comment> Available at: <comment><ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov/exposurereport">http://www.cdc.gov/exposurereport</ext-link>.</comment></mixed-citation></ref><ref id="R49"><mixed-citation publication-type="web"><collab>NCHS</collab>, <year>2010</year>
<collab>National center for health statistics</collab>, <source>centers for disease control and prevention, national health and nutrition examination survey, environmental chemical data tutorial. 2017</source>. <comment><ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov/nchs/tutorials/environmental/index.htm">http://www.cdc.gov/nchs/tutorials/environmental/index.htm</ext-link>.</comment></mixed-citation></ref><ref id="R50"><mixed-citation publication-type="web"><collab>NCHS</collab>, <year>2017</year>
<collab>National Center for Health Statistics</collab>. <source>Centers for Disease Control and Prevention, National Health and Nutrition Examination Survey 2017</source>. Available at: <comment><ext-link ext-link-type="uri" xlink:href="https://www.cdc.gov/nchs/nhanes/index.htm">https://www.cdc.gov/nchs/nhanes/index.htm</ext-link>.</comment></mixed-citation></ref><ref id="R51"><mixed-citation publication-type="web"><collab>NIOSH</collab>, <year>2018</year>
<collab>National Institute for occupational safety and health</collab>, <source>centers for disease control and prevention. Mercury</source> Available at: <comment><ext-link ext-link-type="uri" xlink:href="https://www.cdc.gov/niosh/topics/mercury">https://www.cdc.gov/niosh/topics/mercury</ext-link>.</comment></mixed-citation></ref><ref id="R52"><mixed-citation publication-type="web"><collab>NOAA</collab>, <year>2017</year>
<collab>United States department of commerce</collab>, <collab>national oceanic and atmospheric administration</collab>. <source>Great lakes region toxic substances and areas of concern</source>. Available at: <comment><ext-link ext-link-type="uri" xlink:href="http://www.regions.noaa.gov/great-lakes/index.php/great_lakes-restoration-initiative/toxics">http://www.regions.noaa.gov/great-lakes/index.php/great_lakes-restoration-initiative/toxics</ext-link>.</comment></mixed-citation></ref><ref id="R53"><mixed-citation publication-type="journal"><name><surname>O&#x02019;Brien</surname><given-names>KM</given-names></name>, <name><surname>Upson</surname><given-names>K</given-names></name>, <name><surname>Buckley</surname><given-names>JP</given-names></name>, <year>2017</year>
<article-title>Lipid and creatinine adjustment to evaluate health effects of environmental exposure</article-title>. <source>Curr. Envir. Health Rpt</source>
<volume>4</volume>, <fpage>44</fpage>&#x02013;<lpage>50</lpage>.</mixed-citation></ref><ref id="R54"><mixed-citation publication-type="journal"><name><surname>Patterson</surname><given-names>DG</given-names><suffix>Jr.</suffix></name>, <name><surname>Turner</surname><given-names>WE</given-names></name>, <name><surname>Caudill</surname><given-names>SP</given-names></name>, <name><surname>Needham</surname><given-names>LL</given-names></name>, <year>2008</year>
<article-title>Total TEQ reference range (PCDDs, PCDFs, cPCBs, mono-PCBs) for the US population 2001&#x02013;2002</article-title>. <source>Chemosphere</source>
<volume>73</volume>, <fpage>S261</fpage>&#x02013;<lpage>S277</lpage>.<pub-id pub-id-type="pmid">18511103</pub-id></mixed-citation></ref><ref id="R55"><mixed-citation publication-type="journal"><name><surname>Patterson</surname><given-names>DG</given-names></name>, <name><surname>Wong</surname><given-names>LY</given-names></name>, <name><surname>Turner</surname><given-names>WE</given-names></name>, <name><surname>Caudill</surname><given-names>SP</given-names></name>, <name><surname>Dipietro</surname><given-names>ES</given-names></name>, <name><surname>McClure</surname><given-names>PC</given-names></name>, <name><surname>Cash</surname><given-names>TP</given-names></name>, <name><surname>Osterloh</surname><given-names>JD</given-names></name>, <name><surname>Pirkle</surname><given-names>JL</given-names></name>, <name><surname>Sampson</surname><given-names>EJ</given-names></name>, <name><surname>Needham</surname><given-names>LL</given-names></name>, <year>2009</year>
<article-title>Levels in the U.S. population of those persistent organic pollutants (2003&#x02013;2004) included in the Stockholm Convention or in other long-range transboundary air pollution agreements</article-title>. <source>Environ. Sci. Technol</source>
<volume>43</volume>, <fpage>1211</fpage>&#x02013;<lpage>1218</lpage>.<pub-id pub-id-type="pmid">19320182</pub-id></mixed-citation></ref><ref id="R56"><mixed-citation publication-type="journal"><name><surname>Pavuk</surname><given-names>M</given-names></name>, <name><surname>Olson</surname><given-names>JR</given-names></name>, <name><surname>Wattigney</surname><given-names>WA</given-names></name>, <name><surname>Dutton</surname><given-names>ND</given-names></name>, <name><surname>Sjodin</surname><given-names>A</given-names></name>, <name><surname>Shelton</surname><given-names>C</given-names></name>, <name><surname>Turner</surname><given-names>WE</given-names></name>, <name><surname>Bartell</surname><given-names>SM</given-names></name>, <year>2014</year>
<article-title>Predictors of serum polychlorinated biphenyl concentrations in Anniston residents</article-title>. <source>Sci. Total Environ</source>
<volume>496</volume>, <fpage>624</fpage>&#x02013;<lpage>634</lpage>.<pub-id pub-id-type="pmid">25115605</pub-id></mixed-citation></ref><ref id="R57"><mixed-citation publication-type="journal"><name><surname>Phillips</surname><given-names>DL</given-names></name>, <name><surname>Pirkle</surname><given-names>JL</given-names></name>, <name><surname>Burse</surname><given-names>VW</given-names></name>, <name><surname>Bernert</surname><given-names>JT</given-names><suffix>Jr.</suffix></name>, <name><surname>Henderson</surname><given-names>LO</given-names></name>, <name><surname>Needham</surname><given-names>LL</given-names></name>, <year>1989</year>
<article-title>Chlorinated hydrocarbon levels in human serum: effects of fasting and feeding</article-title>. <source>Arch. Environ. Contam. Toxicol</source>
<volume>18</volume>, <fpage>495</fpage>&#x02013;<lpage>500</lpage>.<pub-id pub-id-type="pmid">2505694</pub-id></mixed-citation></ref><ref id="R58"><mixed-citation publication-type="journal"><name><surname>Quinn</surname><given-names>CL</given-names></name>, <name><surname>Wania</surname><given-names>F</given-names></name>, <year>2012</year>
<article-title>Understanding differences in the body burden-age relationship of bioaccumulating contaminants based on population cross sections versus individuals</article-title>. <source>Environ. Health Perspect</source>
<volume>120</volume>, <fpage>554</fpage>&#x02013;<lpage>559</lpage>.<pub-id pub-id-type="pmid">22472302</pub-id></mixed-citation></ref><ref id="R59"><mixed-citation publication-type="journal"><name><surname>Rocque</surname><given-names>DA</given-names></name>, <name><surname>Winker</surname><given-names>K</given-names></name>, <year>2004</year>
<article-title>Biomonitoring of contaminants in birds from two trophic levels in the North Pacific</article-title>. <source>Environ. Toxicol. Chem</source>
<volume>23</volume>, <fpage>759</fpage>&#x02013;<lpage>766</lpage>.<pub-id pub-id-type="pmid">15285370</pub-id></mixed-citation></ref><ref id="R60"><mixed-citation publication-type="journal"><name><surname>Rodushkin</surname><given-names>I</given-names></name>, <name><surname>Odman</surname><given-names>F</given-names></name>, <name><surname>Branth</surname><given-names>S</given-names></name>, <year>1999</year>
<article-title>Multielement analysis of whole blood by high resolution inductively coupled plasma mass spectrometry</article-title>. <source>Fresenius J. Anal. Chem</source>
<volume>364</volume>, <fpage>338</fpage>&#x02013;<lpage>346</lpage>.</mixed-citation></ref><ref id="R61"><mixed-citation publication-type="journal"><name><surname>Salamova</surname><given-names>A</given-names></name>, <name><surname>Pagano</surname><given-names>JJ</given-names></name>, <name><surname>Holsen</surname><given-names>TM</given-names></name>, <name><surname>Hites</surname><given-names>RA</given-names></name>, <year>2013</year>
<article-title>Post-1990 temporal trends of PCBs and organochlorine pesticides in the atmosphere and in fish from Lakes Erie, Michigan, and Superior</article-title>. <source>Environ. Sci. Technol</source>
<volume>27</volume>, <fpage>9109</fpage>&#x02013;<lpage>9114</lpage>.</mixed-citation></ref><ref id="R62"><mixed-citation publication-type="journal"><name><surname>Saravanabhavan</surname><given-names>G</given-names></name>, <name><surname>Werry</surname><given-names>K</given-names></name>, <name><surname>Walker</surname><given-names>M</given-names></name>, <name><surname>Haines</surname><given-names>D</given-names></name>, <name><surname>Malowany</surname><given-names>M</given-names></name>, <name><surname>Khoury</surname><given-names>C</given-names></name>, <year>2017</year>
<source>Human Biomonitoring Reference Values for Meals and Trace Elements in Blood and Urine Derived from the Canadian Health Measures Survey 2007&#x02013;2013</source></mixed-citation></ref><ref id="R63"><mixed-citation publication-type="journal"><collab>SAS Institute Inc</collab>, <year>2011</year>
<source>SAS/STAT&#x000ae; 9.3 User&#x02019;s Guide. SAS Institute Inc, Cary, NC</source></mixed-citation></ref><ref id="R64"><mixed-citation publication-type="journal"><name><surname>Schaeffer</surname><given-names>DJ</given-names></name>, <name><surname>Dellinger</surname><given-names>JA</given-names></name>, <name><surname>Needham</surname><given-names>LL</given-names></name>, <name><surname>Hansen</surname><given-names>LG</given-names></name>, <year>2006</year>
<article-title>Serum PCB profiles in Native Americans from Wisconsin based on region, diet, age, and gender: implications for epidemiology studies</article-title>. <source>Sci. Total Environ</source>
<volume>357</volume>, <fpage>74</fpage>&#x02013;<lpage>87</lpage>.<pub-id pub-id-type="pmid">15935445</pub-id></mixed-citation></ref><ref id="R65"><mixed-citation publication-type="journal"><name><surname>Sjodin</surname><given-names>A</given-names></name>, <name><surname>Jones</surname><given-names>RS</given-names></name>, <name><surname>Lapeza</surname><given-names>CR</given-names></name>, <name><surname>Focant</surname><given-names>JF</given-names></name>, <name><surname>McGahee III</surname><given-names>EE</given-names></name>, <name><surname>Patterson</surname><given-names>DG</given-names></name>, <year>2004</year>
<article-title>Semi-automated high-throughput extraction and cleanup methods for the measurement of polybrominated diphenyl ethers, polybrominated biphenyls, and polychlorinated biphenyls in human serum</article-title>. <source>Anal. Chem</source>
<volume>76</volume>, <fpage>1921</fpage>&#x02013;<lpage>1927</lpage>.<pub-id pub-id-type="pmid">15053652</pub-id></mixed-citation></ref><ref id="R66"><mixed-citation publication-type="journal"><name><surname>Sjodin</surname><given-names>A</given-names></name>, <name><surname>Jones</surname><given-names>RS</given-names></name>, <name><surname>Caudill</surname><given-names>SP</given-names></name>, <name><surname>Wong</surname><given-names>L</given-names></name>, <name><surname>Turner</surname><given-names>WE</given-names></name>, <name><surname>Calafat</surname><given-names>AM</given-names></name>, <year>2014</year>
<article-title>Polybrominated diphenyl ethers, polychlorinated biphenyls, and persistent pesticides in serum from the National Health and Nutrition Examination Survey: 2003&#x02013;2008</article-title>. <source>Environ. Sci. Technol</source>
<volume>48</volume>, <fpage>753</fpage>&#x02013;<lpage>760</lpage>.<pub-id pub-id-type="pmid">24298999</pub-id></mixed-citation></ref><ref id="R67"><mixed-citation publication-type="journal"><name><surname>Turyk</surname><given-names>M</given-names></name>, <name><surname>Anderson</surname><given-names>HA</given-names></name>, <name><surname>Knobeloch</surname><given-names>L</given-names></name>, <name><surname>Imm</surname><given-names>P</given-names></name>, <name><surname>Persky</surname><given-names>VW</given-names></name>, <year>2009</year>
<article-title>Prevalence of diabetes and body burdens of polychlorinated biphenyls, polybrominated biphenyl ethers, and p,p&#x02019;-diphenyldichloroethene in Great Lakes sport fish consumers</article-title>. <source>Chemosphere</source>
<volume>75</volume>, <fpage>674</fpage>&#x02013;<lpage>679</lpage>.<pub-id pub-id-type="pmid">19157498</pub-id></mixed-citation></ref><ref id="R68"><mixed-citation publication-type="journal"><name><surname>Turyk</surname><given-names>ME</given-names></name>, <name><surname>Bhavsar</surname><given-names>SP</given-names></name>, <name><surname>Bowerman</surname><given-names>W</given-names></name>, <name><surname>Boysen</surname><given-names>E</given-names></name>, <name><surname>Clark</surname><given-names>M</given-names></name>, <name><surname>Diamond</surname><given-names>M</given-names></name>, <name><surname>Mergler</surname><given-names>D</given-names></name>, <name><surname>Pantazopoulos</surname><given-names>P</given-names></name>, <name><surname>Schantz</surname><given-names>S</given-names></name>, <name><surname>O&#x02019;Carpener</surname><given-names>DO</given-names></name>, <year>2012</year>
<article-title>Risk and benefits of consumption of Great Lakes fish</article-title>. <source>Environ. Health Perspect</source>
<volume>120</volume>, <fpage>11</fpage>&#x02013;<lpage>18</lpage>.<pub-id pub-id-type="pmid">21947562</pub-id></mixed-citation></ref><ref id="R69"><mixed-citation publication-type="journal"><name><surname>Van den Berg</surname><given-names>M</given-names></name>, <name><surname>Birnbaum</surname><given-names>L</given-names></name>, <name><surname>Denison</surname><given-names>M</given-names></name>, <etal/>, <year>2006</year>
<article-title>The 2005 World Health Organization re-evaluation of human and mammalian toxic equivalency factors for dioxin and dioxin-like compounds</article-title>. <source>Toxicol. Sci</source>
<volume>93</volume>, <fpage>223</fpage>&#x02013;<lpage>241</lpage>.<pub-id pub-id-type="pmid">16829543</pub-id></mixed-citation></ref><ref id="R70"><mixed-citation publication-type="journal"><name><surname>Von Stackelberg</surname><given-names>K</given-names></name>, <name><surname>Li</surname><given-names>M</given-names></name>, <name><surname>Sunderland</surname><given-names>E</given-names></name>, <year>2017</year>
<article-title>Results of a national survey of high-frequency fish consumers in the United States</article-title>. <source>Environ. Res</source>
<volume>158</volume>, <fpage>126</fpage>&#x02013;<lpage>136</lpage>.<pub-id pub-id-type="pmid">28623747</pub-id></mixed-citation></ref><ref id="R71"><mixed-citation publication-type="journal"><name><surname>Wattigney</surname><given-names>WA</given-names></name>, <name><surname>Li</surname><given-names>ZJ</given-names></name>, <name><surname>Ragin-Wilson</surname><given-names>A</given-names></name>, <article-title>2017. The biomonitoring of Great lakes populations program</article-title>. <source>J. Environ. Health</source>
<volume>79</volume>, <fpage>42</fpage>&#x02013;<lpage>44</lpage>
<year>2017</year>.<pub-id pub-id-type="pmid">28912609</pub-id></mixed-citation></ref><ref id="R72"><mixed-citation publication-type="journal"><name><surname>Wattigney</surname><given-names>WA</given-names></name>, <name><surname>Irvin-Barnwell</surname><given-names>E</given-names></name>, <name><surname>Li</surname><given-names>JZ</given-names></name>, <name><surname>Davis</surname><given-names>S</given-names></name>, <name><surname>Manente</surname><given-names>S</given-names></name>, <name><surname>Maqsood</surname><given-names>J</given-names></name>, <name><surname>Scher</surname><given-names>D</given-names></name>, <name><surname>Messing</surname><given-names>R</given-names></name>, <name><surname>Hwang</surname><given-names>S</given-names></name>, <name><surname>Aldous</surname><given-names>KM</given-names></name>, <name><surname>Lewis-Michl</surname><given-names>EL</given-names></name>, <name><surname>Ragin-Wilson</surname><given-names>A</given-names></name>, <year>2019</year>
<article-title>Biomonitoring programs in Michigan, Minnesota and New York to assess human exposure to Great Lakes contaminants</article-title>. <source>Int. J. Hyg Environ. Health</source>
<volume>222</volume>, <fpage>125</fpage>&#x02013;<lpage>135</lpage>.<pub-id pub-id-type="pmid">30153973</pub-id></mixed-citation></ref><ref id="R73"><mixed-citation publication-type="journal"><name><surname>Xue</surname><given-names>J</given-names></name>, <name><surname>Liu</surname><given-names>SV</given-names></name>, <name><surname>Zartarian</surname><given-names>VG</given-names></name>, <name><surname>Geller</surname><given-names>AM</given-names></name>, <name><surname>Schultz</surname><given-names>BD</given-names></name>, <year>2014</year>
<article-title>Analysis of NHANES measured blood PCBs in the general US population and application of SHEDS model to identify key exposure factors</article-title>. <source>J. Expo. Sci. Environ. Epidemiol</source>
<volume>24</volume>, <fpage>615</fpage>&#x02013;<lpage>621</lpage>.<pub-id pub-id-type="pmid">24424407</pub-id></mixed-citation></ref></ref-list></back><floats-group><fig id="F1" orientation="portrait" position="float"><label>Fig. 1.</label><caption><p id="P35">Selected percentiles for total blood mercury concentration with 95% confidence intervals among Detroit urban anglers, 2013 and NHANES 2013/14.</p></caption><graphic xlink:href="nihms-1045579-f0001"/></fig><fig id="F2" orientation="portrait" position="float"><label>Fig. 2.</label><caption><p id="P36">Median (95% CI) for the Sum of 7 PCB concentrations for Detroit urban anglers, 2013 and NHANES 2009/10.</p></caption><graphic xlink:href="nihms-1045579-f0002"/></fig><table-wrap id="T1" position="float" orientation="portrait"><label>Table 1</label><caption><p id="P37">Selected characteristics of Detroit Urban Anglers Study participants.</p></caption><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/></colgroup><thead><tr><th align="left" valign="middle" rowspan="1" colspan="1">Characteristic (number excluded)<xref rid="TFN1" ref-type="table-fn">*</xref></th><th align="left" valign="middle" rowspan="1" colspan="1">Number (%)</th><th align="left" valign="middle" rowspan="1" colspan="1">Characteristic (number of missing)</th><th align="center" valign="middle" rowspan="1" colspan="1">Number (%)</th></tr></thead><tbody><tr><td align="left" valign="middle" rowspan="1" colspan="1"><bold>Gender by age</bold></td><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1"><bold>BMI - kg/m</bold><sup><bold>2</bold></sup> (2)</td><td align="left" valign="middle" rowspan="1" colspan="1"/></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Female</td><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Normal &#x0003c; 25</td><td align="center" valign="middle" rowspan="1" colspan="1">49 (17.2%)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">18&#x02013;39 years</td><td align="left" valign="middle" rowspan="1" colspan="1">14 (25.5%)</td><td align="left" valign="middle" rowspan="1" colspan="1">Overweight 25&#x02013;29.9</td><td align="center" valign="middle" rowspan="1" colspan="1">98 (34.4%)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">40&#x02013;59 years</td><td align="left" valign="middle" rowspan="1" colspan="1">25 (45.5%)</td><td align="left" valign="middle" rowspan="1" colspan="1">Obese 30+</td><td align="center" valign="middle" rowspan="1" colspan="1">138 (48.4%)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">60&#x02013;79 years</td><td align="left" valign="middle" rowspan="1" colspan="1">16 (29.1%)</td><td align="left" valign="middle" rowspan="1" colspan="1"><bold>Smoking status</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"/></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Male</td><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Never smoked</td><td align="center" valign="middle" rowspan="1" colspan="1">78 (27.2)%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">18&#x02013;39 years</td><td align="left" valign="middle" rowspan="1" colspan="1">38 (16.4%)</td><td align="left" valign="middle" rowspan="1" colspan="1">Former smoker</td><td align="center" valign="middle" rowspan="1" colspan="1">65 (22.6)%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">40&#x02013;59 years</td><td align="left" valign="middle" rowspan="1" colspan="1">141 (60.8%)</td><td align="left" valign="middle" rowspan="1" colspan="1">Current smoker</td><td align="center" valign="middle" rowspan="1" colspan="1">144 (50.2)%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">60&#x02013;79 years</td><td align="left" valign="middle" rowspan="1" colspan="1">53 (22.8%)</td><td align="left" valign="middle" rowspan="1" colspan="1"><bold>Education</bold> (2)</td><td align="center" valign="middle" rowspan="1" colspan="1"/></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"><bold>Race/Ethnicity</bold> (3)</td><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Less than high school graduate</td><td align="center" valign="middle" rowspan="1" colspan="1">52 (18.3%)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">White, non-Hispanic</td><td align="left" valign="middle" rowspan="1" colspan="1">27 (9.5%)</td><td align="left" valign="middle" rowspan="1" colspan="1">High school graduate</td><td align="center" valign="middle" rowspan="1" colspan="1">101 (35.4%)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Black or African American, non- Hispanic</td><td align="left" valign="middle" rowspan="1" colspan="1">226 (79.6%)</td><td align="left" valign="middle" rowspan="1" colspan="1">Some college</td><td align="center" valign="middle" rowspan="1" colspan="1">82 (28.8%)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Other (includes multiracial)</td><td align="left" valign="middle" rowspan="1" colspan="1">31 (10.9%)</td><td align="left" valign="middle" rowspan="1" colspan="1">College degree</td><td align="center" valign="middle" rowspan="1" colspan="1">50 (17.5%)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"><bold>Years residing in Detroit area</bold> (2)</td><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1"><bold>Annual Family Income</bold> (32)</td><td align="center" valign="middle" rowspan="1" colspan="1"/></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">2 years or less</td><td align="left" valign="middle" rowspan="1" colspan="1">&#x0003c; 4%<xref rid="TFN2" ref-type="table-fn">**</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">Less than 25 K</td><td align="center" valign="middle" rowspan="1" colspan="1">111 (43.5%)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">3&#x02013;10 years</td><td align="left" valign="middle" rowspan="1" colspan="1">&#x0003c; 4%<xref rid="TFN2" ref-type="table-fn">**</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">$25 K - less than 50 K</td><td align="center" valign="middle" rowspan="1" colspan="1">77 (30.2%)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">11&#x02013;20 years</td><td align="left" valign="middle" rowspan="1" colspan="1">23 (8.1%)</td><td align="left" valign="middle" rowspan="1" colspan="1">$50 K or more</td><td align="center" valign="middle" rowspan="1" colspan="1">67 (26.3%)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">21 years or more</td><td align="left" valign="middle" rowspan="1" colspan="1">246 (86.3%)</td><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="center" valign="middle" rowspan="1" colspan="1"/></tr></tbody></table><table-wrap-foot><fn id="TFN1"><label>*</label><p id="P38">A response of &#x0201c;don&#x02019;t know&#x0201d; or refusal and missing values.</p></fn><fn id="TFN2"><label>**</label><p id="P39">Percentages that represent 10 or less individuals are suppressed to protect privacy.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T2" position="float" orientation="portrait"><label>Table 2</label><caption><p id="P40">Fish Consumption, work history of selected jobs, selected hobbies, and nutritional supplements with a potential of chemical exposure among Detroit Urban Anglers Study participants (n = 287).</p></caption><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/></colgroup><thead><tr><th align="left" valign="middle" rowspan="1" colspan="1">Response (number excluded)<xref rid="TFN3" ref-type="table-fn">*</xref></th><th align="left" valign="middle" rowspan="1" colspan="1">Percentage, Yes</th></tr></thead><tbody><tr><td align="left" valign="middle" rowspan="1" colspan="1">Ate fish or shell fish within the past week (1)</td><td align="left" valign="middle" rowspan="1" colspan="1">45.5%</td></tr><tr><td colspan="2" align="left" valign="middle" rowspan="1"><bold>As part of a job, have you ever ....</bold></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">applied pesticides that kill insects, fungus, or weeds? (1)</td><td align="left" valign="middle" rowspan="1" colspan="1">16.8%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">worked for a trash or recycling company? (4)</td><td align="left" valign="middle" rowspan="1" colspan="1">15%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">worked in a foundry, a smelter, a welding facility or steel mill? (2)</td><td align="left" valign="middle" rowspan="1" colspan="1">36.1%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">removed lead paint? (14)</td><td align="left" valign="middle" rowspan="1" colspan="1">11.7%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">worked with commercial electrical equipment such as transformers, or capacitors? (3)</td><td align="left" valign="middle" rowspan="1" colspan="1">10.2%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">been a maintenance worker in any type of heavy industry? (4)</td><td align="left" valign="middle" rowspan="1" colspan="1">19.4%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">worked for a battery manufacturing or recycling company? (4)</td><td align="left" valign="middle" rowspan="1" colspan="1">4.2%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">worked for a chemical manufacturing company? (2)</td><td align="left" valign="middle" rowspan="1" colspan="1">9.8%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">worked for an automobile manufacturing company? (2)</td><td align="left" valign="middle" rowspan="1" colspan="1">44.9%</td></tr><tr><td colspan="2" align="left" valign="middle" rowspan="1"><bold>In the past 12 months, hobbies and activities done by either yourself or someone inside your home.</bold></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Dyeing material (1)</td><td align="left" valign="middle" rowspan="1" colspan="1">4.9%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Electronic assembly (1)</td><td align="left" valign="middle" rowspan="1" colspan="1">15.7%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Gardening or farming (1)</td><td align="left" valign="middle" rowspan="1" colspan="1">54.9%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Glass crafting (3)</td><td align="left" valign="middle" rowspan="1" colspan="1">&#x0003c; 4%<xref rid="TFN4" ref-type="table-fn">**</xref></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Leather crafting (1)</td><td align="left" valign="middle" rowspan="1" colspan="1">&#x0003c; 4%<xref rid="TFN4" ref-type="table-fn">**</xref></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Metal working (1)</td><td align="left" valign="middle" rowspan="1" colspan="1">8.7%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Painting or glazing (3)</td><td align="left" valign="middle" rowspan="1" colspan="1">37.3%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Printmaking (2)</td><td align="left" valign="middle" rowspan="1" colspan="1">4.6%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Woodworking (2)</td><td align="left" valign="middle" rowspan="1" colspan="1">20.7%</td></tr><tr><td colspan="2" align="left" valign="middle" rowspan="1"><bold>Other Questionnaire item</bold></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Take fish oil or omega 3 oil supplement (2)</td><td align="left" valign="middle" rowspan="1" colspan="1">14.7%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Take a store-bought herbal supplement (3)</td><td align="left" valign="middle" rowspan="1" colspan="1">9.5%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">In the past 12 months swim in the Detroit River (1)</td><td align="left" valign="middle" rowspan="1" colspan="1">13.6%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Ate locally caught wild game or birds in the past 12 months</td><td align="left" valign="middle" rowspan="1" colspan="1">11.5%</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1"><bold>Median (25</bold>th <bold>and 75</bold>th <bold>percentile)</bold></td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Detroit River caught fish, meals in past 12 months (7)</td><td align="left" valign="middle" rowspan="1" colspan="1">64 (26, 155)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Years eating fish from the Detroit AOC</td><td align="left" valign="middle" rowspan="1" colspan="1">30 (15, 44)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Fish purchased in a restaurant or store, meals in past 12 months (20 people reported none)</td><td align="left" valign="middle" rowspan="1" colspan="1">28 (12, 65)</td></tr></tbody></table><table-wrap-foot><fn id="TFN3"><label>*</label><p id="P41">A response of &#x0201c;don&#x02019;t know&#x0201d; or refusal and missing values.</p></fn><fn id="TFN4"><label>**</label><p id="P42">Percentages that represent 10 or less individuals are suppressed to protect privacy.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T3" position="float" orientation="landscape"><label>Table 3</label><caption><p id="P43">p,p&#x02019;-DDE and select PCB concentrations for Detroit Urban Anglers, 2013 (n = 275) and the adult U.S. population from NHANES 2009/10.</p></caption><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/></colgroup><thead><tr><th align="left" valign="middle" rowspan="1" colspan="1"/><th align="left" valign="middle" rowspan="1" colspan="1">Detroit Urban Anglers</th><th align="left" valign="middle" rowspan="1" colspan="1"/><th align="left" valign="middle" rowspan="1" colspan="1"/><th align="left" valign="middle" rowspan="1" colspan="1">NHANES</th><th align="left" valign="middle" rowspan="1" colspan="1"/><th align="left" valign="middle" rowspan="1" colspan="1"/></tr></thead><tbody><tr><td align="left" valign="middle" rowspan="1" colspan="1"><bold>Biomarker (ng/g lipid)</bold></td><td align="left" valign="middle" rowspan="1" colspan="1"><bold>50th Percentile</bold> (95% CI)</td><td align="left" valign="middle" rowspan="1" colspan="1"><bold>75th Percentile</bold> (95% CI)</td><td align="left" valign="middle" rowspan="1" colspan="1"><bold>95th Percentile</bold> (95% CI)</td><td align="left" valign="middle" rowspan="1" colspan="1"><bold>50th Percentile</bold> (95% CI)</td><td align="left" valign="middle" rowspan="1" colspan="1"><bold>75th Percentile</bold> (95% CI)</td><td align="left" valign="middle" rowspan="1" colspan="1"><bold>95th Percentile</bold> (95% CI)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">p,p&#x02019;-DDE</td><td align="left" valign="middle" rowspan="1" colspan="1">127 (111&#x02013;145)</td><td align="left" valign="middle" rowspan="1" colspan="1">247 (203&#x02013;286)</td><td align="left" valign="middle" rowspan="1" colspan="1">816 (692&#x02013;1394)</td><td align="left" valign="middle" rowspan="1" colspan="1">169 (148&#x02013;192)</td><td align="left" valign="middle" rowspan="1" colspan="1">404 (357&#x02013;459)</td><td align="left" valign="middle" rowspan="1" colspan="1">1531 (1194&#x02013;1962)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">PCB 153</td><td align="left" valign="middle" rowspan="1" colspan="1">48.1 (43.4&#x02013;55.5)</td><td align="left" valign="middle" rowspan="1" colspan="1">90.8 (82.1&#x02013;107)</td><td align="left" valign="middle" rowspan="1" colspan="1">212 (157&#x02013;368)</td><td align="left" valign="middle" rowspan="1" colspan="1">17.1 (15.4&#x02013;19.0)</td><td align="left" valign="middle" rowspan="1" colspan="1">37.7 (33.6&#x02013;42.3)</td><td align="left" valign="middle" rowspan="1" colspan="1">111 (93.3&#x02013;131)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">PCB 180</td><td align="left" valign="middle" rowspan="1" colspan="1">40.5 (35.8&#x02013;46.2)</td><td align="left" valign="middle" rowspan="1" colspan="1">69.8 (59.7&#x02013;84.3)</td><td align="left" valign="middle" rowspan="1" colspan="1">148 (130&#x02013;318)</td><td align="left" valign="middle" rowspan="1" colspan="1">12.7 (11.0&#x02013;14.7)</td><td align="left" valign="middle" rowspan="1" colspan="1">30.2 (26.3&#x02013;34.7)</td><td align="left" valign="middle" rowspan="1" colspan="1">80.9 (70.1&#x02013;93.3)</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Sum of PCBs<xref rid="TFN5" ref-type="table-fn">*</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">170 (150&#x02013;193)</td><td align="left" valign="middle" rowspan="1" colspan="1">317 (272&#x02013;375)</td><td align="left" valign="middle" rowspan="1" colspan="1">639 (544&#x02013;1333)</td><td align="left" valign="middle" rowspan="1" colspan="1">56.7 (49.1&#x02013;65.4)</td><td align="left" valign="middle" rowspan="1" colspan="1">130 (114&#x02013;148)</td><td align="left" valign="middle" rowspan="1" colspan="1">357 (303&#x02013;421)</td></tr></tbody></table><table-wrap-foot><fn id="TFN5"><label>*</label><p id="P44">Criteria for PCBs included is 60% or more detects in the Detroit urban angler study (PCBs 138/163, 153, 170, 180, 187, 194 and 199. The NHANES sum includes PCB 138/<bold>158</bold> (not PCB 138/163).</p></fn></table-wrap-foot></table-wrap><table-wrap id="T4" position="float" orientation="landscape"><label>Table 4</label><caption><p id="P45">Total toxic equivalency (TEQ) values for Detroit Urban Anglers, 2013 (n = 248) and the adult U.S. population from NHANES 2003/04.</p></caption><table frame="hsides" rules="rows"><colgroup span="1"><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/></colgroup><thead><tr><th colspan="6" align="left" valign="middle" rowspan="1">Total toxic equivalency (TEQ) values using 2005 TEFs, in pg/g lipid</th></tr></thead><tbody><tr><td align="left" valign="middle" rowspan="1" colspan="1">Detroit Urban Anglers</td><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Detroit Urban Anglers</td><td align="left" valign="middle" rowspan="1" colspan="1">NHANES</td><td align="left" valign="middle" rowspan="1" colspan="1">Detroit Urban Anglers</td><td align="left" valign="middle" rowspan="1" colspan="1">NHANES</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Sample size</td><td align="left" valign="middle" rowspan="1" colspan="1">90th Percentile (95% CI)</td><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">95th Percentile (95% CI)</td><td align="left" valign="middle" rowspan="1" colspan="1"/></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">TOTAL</td><td align="left" valign="middle" rowspan="1" colspan="1">248</td><td align="left" valign="middle" rowspan="1" colspan="1">31.3 (26.2&#x02013;38.6)</td><td align="left" valign="middle" rowspan="1" colspan="1">32.5 (29.2&#x02013;35.7)</td><td align="left" valign="middle" rowspan="1" colspan="1">40.5 (32.9&#x02013;66.1)</td><td align="left" valign="middle" rowspan="1" colspan="1">39.9 (36.6&#x02013;45.7)</td></tr></tbody></table></table-wrap><table-wrap id="T5" position="float" orientation="landscape"><label>Table 5</label><caption><p id="P46">Results of multivariate regression models built with covariates correlated in preliminary analyses (p &#x0003c; 0.1) with the logarithm of blood mercury, DDE and the &#x02211;PCB concentrations, Detroit urban anglers.</p></caption><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/></colgroup><thead><tr><th align="left" valign="middle" rowspan="1" colspan="1">Biomarker</th><th align="left" valign="middle" rowspan="1" colspan="1">Parameter</th><th align="left" valign="middle" rowspan="1" colspan="1">10<sup>&#x003b2;</sup></th><th align="left" valign="middle" rowspan="1" colspan="1">P-value</th><th align="left" valign="middle" rowspan="1" colspan="1">Partial R<sup>2</sup></th></tr></thead><tbody><tr><td align="left" valign="middle" rowspan="1" colspan="1">Total blood mercury<xref rid="TFN6" ref-type="table-fn">*</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">Age at interview (years)</td><td align="left" valign="middle" rowspan="1" colspan="1">1.0143</td><td align="left" valign="middle" rowspan="1" colspan="1">0.005</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0254</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Non-Hispanic Blacks<xref rid="TFN7" ref-type="table-fn">**</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">1.4880</td><td align="left" valign="middle" rowspan="1" colspan="1">0.052</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0022</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">&#x02018;Other&#x02019; than non-Hispanic White or Black<xref rid="TFN7" ref-type="table-fn">**</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">1.7342</td><td align="left" valign="middle" rowspan="1" colspan="1">0.029</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0139</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Annual family income 50 K or more</td><td align="left" valign="middle" rowspan="1" colspan="1">1.3017</td><td align="left" valign="middle" rowspan="1" colspan="1">0.035</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0155</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Ate fish or shellfish in past week (yes vs no)</td><td align="left" valign="middle" rowspan="1" colspan="1">1.4539</td><td align="left" valign="middle" rowspan="1" colspan="1">0.002</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0442</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Number of Detroit River fish meals in the past year<xref rid="TFN6" ref-type="table-fn">*</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">1.2407</td><td align="left" valign="middle" rowspan="1" colspan="1">0.011</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0217</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Total R<sup>2</sup></td><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">0.1228</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Total DDE, lipid adjusted<xref rid="TFN6" ref-type="table-fn">*</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">Age at interview (years)</td><td align="left" valign="middle" rowspan="1" colspan="1">1.0433</td><td align="left" valign="middle" rowspan="1" colspan="1">&#x0003c; 0.0001</td><td align="left" valign="middle" rowspan="1" colspan="1">0.2785</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Females</td><td align="left" valign="middle" rowspan="1" colspan="1">1.3254</td><td align="left" valign="middle" rowspan="1" colspan="1">0.033</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0123</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Non-Hispanic Blacks<xref rid="TFN7" ref-type="table-fn">**</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">1.3534</td><td align="left" valign="middle" rowspan="1" colspan="1">0.092</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0000</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">&#x02018;Other&#x02019; than non-Hispanic White or Black<xref rid="TFN7" ref-type="table-fn">**</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">1.7123</td><td align="left" valign="middle" rowspan="1" colspan="1">0.018</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0131</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Total lipids<xref rid="TFN7" ref-type="table-fn">**</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">1.2403</td><td align="left" valign="middle" rowspan="1" colspan="1">0.670</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0007</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Number of Detroit River fish meals in the past year<xref rid="TFN6" ref-type="table-fn">*</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">1.138</td><td align="left" valign="middle" rowspan="1" colspan="1">0.133</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0060</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Total R<sup>2</sup></td><td align="left" valign="middle" rowspan="1" colspan="1">0.3107</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Sum of 7 PCBs, lipid adjusted<xref rid="TFN7" ref-type="table-fn">**</xref><sup>,</sup>
<xref rid="TFN8" ref-type="table-fn">***</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">Age at interview (years)</td><td align="left" valign="middle" rowspan="1" colspan="1">1.0536</td><td align="left" valign="middle" rowspan="1" colspan="1">&#x0003c; 0.0001</td><td align="left" valign="middle" rowspan="1" colspan="1">0.4241</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Non-Hispanic Blacks<xref rid="TFN6" ref-type="table-fn">*</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">1.6797</td><td align="left" valign="middle" rowspan="1" colspan="1">0.001</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0008</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">&#x02018;Other&#x02019; than non-Hispanic White or Black<xref rid="TFN6" ref-type="table-fn">*</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">2.3173</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0001</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0314</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Total lipids<xref rid="TFN7" ref-type="table-fn">**</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">0.7073</td><td align="left" valign="middle" rowspan="1" colspan="1">0.424</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0014</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Number of Detroit River fish meals in the past year<xref rid="TFN6" ref-type="table-fn">*</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">1.3425</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0002</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0288</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Total R<sup>2</sup></td><td align="left" valign="middle" rowspan="1" colspan="1">0.4863</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Total TEQ, lipid adjusted<xref rid="TFN7" ref-type="table-fn">**</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">Age at interview (years)</td><td align="left" valign="middle" rowspan="1" colspan="1">1.0683</td><td align="left" valign="middle" rowspan="1" colspan="1">&#x0003c; 0.0001</td><td align="left" valign="middle" rowspan="1" colspan="1">0.3197</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Non-Hispanic Blacks</td><td align="left" valign="middle" rowspan="1" colspan="1">1.2791</td><td align="left" valign="middle" rowspan="1" colspan="1">0.327</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0067</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">&#x02018;Other&#x02019; than non-Hispanic White or Black</td><td align="left" valign="middle" rowspan="1" colspan="1">2.7096</td><td align="left" valign="middle" rowspan="1" colspan="1">0.002</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0234</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Total lipids<xref rid="TFN7" ref-type="table-fn">**</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">1.1003</td><td align="left" valign="middle" rowspan="1" colspan="1">0.893</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0002</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Number of Detroit River fish meals in the past year<xref rid="TFN7" ref-type="table-fn">**</xref></td><td align="left" valign="middle" rowspan="1" colspan="1">1.2548</td><td align="left" valign="middle" rowspan="1" colspan="1">0.073</td><td align="left" valign="middle" rowspan="1" colspan="1">0.0087</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1"/><td align="left" valign="middle" rowspan="1" colspan="1">Total R<sup>2</sup></td><td align="left" valign="middle" rowspan="1" colspan="1">0.3586</td></tr></tbody></table><table-wrap-foot><fn id="TFN6"><label>*</label><p id="P47">Log10 transformed.</p></fn><fn id="TFN7"><label>**</label><p id="P48">Referent is non-Hispanic Whites.</p></fn><fn id="TFN8"><label>***</label><p id="P49">Criteria for PCBs included is 60% or more detects in the Detroit urban angler study (PCBs 138/163, 153, 170, 180, 187, 194 and 199).</p></fn></table-wrap-foot></table-wrap></floats-group></article>