What You Don’t Know May Hurt You
What You Don’t Know May Hurt You
Most men know by now that good lifestyle choices – such as exercising regularly, eating a healthy diet, not smoking and drinking in moderation – make a big difference in staying healthy. Men may too often ignore these sensible recommendations, but it’s not because they’re not aware of them.
What many don’t realize is that environmental exposures also contribute to major diseases and health concerns that primarily affect men. EWG’s researchers scoured the scientific literature and uncovered troubling data that may come as a surprise. There has been significant research in recent decades showing that chronic conditions such as heart disease, prostate cancer, infertility may be linked to everyday exposures to chemicals in water, consumer products and food.
Additionally, many men don’t know that they’re at a higher risk than women of developing skin cancer and dying from its most fatal form, melanoma. Read EWG’s advice on some of the alarming trends regarding skin cancer, and why men should engage in proper sun safety.
There’s not much you can do about your genetics, but there are lots of ways to reduce exposures to potentially harmful chemicals and other environmental risk factors, so why not follow some of EWG’s tips and increase your chances of living the healthiest and longest life possible?
A 2013 poll conducted for The Associated Press found that 8 of every 10 men said they had always wanted to be fathers or would like to be one someday. There’s a popular misconception that infertility is a woman’s problem, but according to the American Society for Reproductive Medicine, in about 40 percent of infertile couples, the male partner is either the sole or a contributing cause.
The causes of male infertility are complex and varied, but avoiding risks that can impair proper development of a man’s hormone and reproductive systems is first and foremost. In order to impregnate a woman, a man has to be able to produce and ejaculate enough healthy sperm to fertilize her egg, and studies show that several types of toxic chemicals that everyone encounters in daily life can alter sperm and semen in ways that may impair fertility.
Here are some of the ways that you can be exposed to potentially fertility-impairing chemicals and what you can do to avoid them:
1. Chemicals in household dust
Research has shown that dust is likely to contain several chemicals that may affect sperm quality, including flame-retardants, long-banned polychlorinated biphenyls (PCBs) and phthalates. These particles come from everyday household products, the construction materials used in older homes and the outdoor environment. In a number of human epidemiological studies, these contaminants have been associated with lowered sperm counts, poorer sperm movement (motility) and abnormally shaped sperm.
What can you do? Dusting may sound like a funny thing to recommend to guys interested in protecting their sperm, but using a vacuum fitted with a HEPA filter, mopping the floors and dusting with a damp cloth can reduce the amount of dust you’re exposed to and the fertility-impairing chemicals it may carry.
2. Body-care products
Many personal care products contain ingredients that can damage reproductive health. Among them are phthalates, a class of toxic chemicals that aren’t often listed on labels but can lurk under non-specific ingredient “fragrance.” Phthalates are typically used to make plastics more flexible and have been associated with several types of sperm damage, including lower sperm counts, impaired movement and abnormal shape. Lead acetate, an ingredient in some men’s hair dyes, has also been shown to lower sperm quality in animals, even at low to moderate levels.
What can you do? Read the ingredients on your products’ labels. Avoid lead acetate, phthalates and any product with the generic word “fragrance” and find safer alternatives using EWG’s Skin Deep Cosmetics Database: www.ewg.org/skindeep/.
3. Plastic containers
Food containers, water bottles and the plastic ware you use for storing leftovers can contain chemicals such as phthalates and bisphenol A (BPA), which can leach into food and water. Much like phthalates, BPA has been shown to affect sperm in various ways, including lowering sperm counts, decreasing sperm vitality and impairing sperm movement.
What can you do? Use glass kitchenware instead of plastic. Reuse glass jars for storing food. If you have to use plastic containers, avoid those with recycling codes #3 (may contain BPA) and #7 (may contain phthalates).
4. Canned food
Metal cans are often lined with the endocrine-disrupting chemical BPA, which may contaminate the food inside. In addition to its associations with sperm quality, studies have shown that BPA may also affect a man’s sex drive. Scientists at the Kaiser Permanente Research Institute found that BPA-exposed workers were more likely to have diminished sexual drive, erectile and ejaculation difficulty and decreased satisfaction with their sex lives.
What can you do? Reduce consumption of food packaged in cans and buy and cook fresh ingredients. Instead of canned soup, try making your own with fresh vegetables, meat, broth and spices. Some BPA-free canned food is also available, so look for those labels on store shelves. For more BPA tips, visit: https://www.ewg.org/bpa/.
5. Cell phone radiation
The question of whether cell phone radiation may be harmful remains controversial, but there are now more than 10 studies suggesting that it can affect sperm quality. Both laboratory and real-world tests have shown that cell phone radiation can affect sperm count, movement, structure, appearance and viability, and it may also even damage DNA. With those findings, it’s better to be safe than sorry.
What can you do? You don’t need to stop using your cell phone to protect your sperm. Since radiation levels decline sharply with distance, just keeping your phone out of your front pocket and away from your genitals will reduce your exposure tremendously. Carry your phone in your back pocket or in a bag or briefcase if you carry one. For more tips on reducing your cell phone radiation exposure, visit: www.ewg.org/cellphone-radiation/.
A number of studies have found elevated rates of infertility among farm workers and agricultural communities exposed to high amounts of pesticides. Other researchers have found associations between pesticides such as atrazine and diazinon and poorer sperm quality, sperm abnormalities and impaired movement.
What can you do? Buy organic food as much as possible. Can’t always find it or afford it? Use EWG’s Shopper’s Guide to Pesticides and Produce to find fruits and vegetables that have the lowest pesticide residues: https://www.ewg.org/foodnews/. If you live in an agricultural community, check to see if pesticides have been detected in your water supply and purchase the appropriate water filter by using EWG’s Water Filter Buying Guide: https://www.ewg.org/report/ewgs-water-filter-buying-guide/.
The prostate gland secretes the majority of seminal fluid, and cancers of the prostate are common in developed countries. It is the most common cancer among American men, according to the Centers for Disease Control and Prevention. Lung cancer kills more men, but there are almost twice as many prostate cancer cases.
The causes of prostate cancer are unknown, but medical experts and researchers have identified many risk factors, including age, ethnicity, family history and obesity. A growing body of evidence is beginning to show that prostate cancer might be associated with environmental exposures as well.
Here are some key findings in recent decades linking chemical exposures and prostate cancer, and how you can reduce your risks:
1. Cadmium in tobacco
Tobacco leaves accumulate high levels of the heavy metal cadmium, and according to the Centers for Disease Control and Prevention, people who smoke have twice as much cadmium exposure. Cadmium has been associated with an increased risk of prostate cancer in human epidemiological studies. In laboratory studies, cadmium produced prostatic lesions in animals.
What can you do? Quitting smoking not only lowers your risk of lung cancer, respiratory and heart disease, it will also reduce your exposure to cadmium, potentially lowering your risk of prostate cancer.
Many occupational studies have shown that farmers who mix and apply pesticides on their crops have a much higher risk of developing prostate cancer. These large epidemiological studies have implicated a variety of organophosphate and organochlorine pesticides and herbicides, including malathion, 2,4-D, and carbaryl, that are still used in crop and at-home applications today.
What can you do? Buy organic food as much as possible. Can’t always find it or afford it? Use EWG’s Shopper’s Guide to Pesticides and Produce to find fruits and vegetables that have the lowest pesticide residues: www.ewg.org/foodnews/. You may also want to avoid applying pesticides at home.
3. PCBs in animal fat
Polychlorinated biphenyls (PCBs), once used in a variety of industrial and commercial applications, have been linked to a number of health effects. Despite being banned more than three decades ago, they persist in the environment and people are still very much exposed to them. In human epidemiological studies, prostate cancer risk and mortality have been associated with heavy PCB exposure.
What can you do? PCBs typically accumulate in animal fatty tissues, especially in fish, and according to the federal Agency for Toxic Substances and Disease Registry, most people are exposed through contaminated food. To reduce your exposure, choose leaner meats and low-fat or fat-free dairy products. A well-balanced diet with more fruits and vegetables will also reduce your exposure to any one dietary source of PCBs.
4. Bisphenol A (BPA)
A number of animal studies have shown that even at low exposures, BPA affects rat prostates, causing DNA damage and development of precancerous lesions. One study using human prostate cell lines has also shown DNA damage. The notorious endocrine-disrupting compound has also been shown to interfere with prostate cancer treatment in humans. Why this happens is not clear, but some prostate cancer therapies rely on mechanisms that block male androgen hormones. BPA, which has activity similar to the female hormone estrogen, may potentially interfere with these therapies by acting directly on prostate cells.
What can you do? Use glass kitchenware instead of plastic. Reuse old bottles and glass jars for storing food. If you have to use plastic containers, buy BPA-free and avoid those with recycling code #7, which may contain BPA. Since BPA is also common in the linings of canned food, look for cans that say they are BPA-free or choose fresh food over canned. For more tips, check out: www.ewg.org/bpa/.
Cardiovascular disease is the leading cause of death in American men, accounting for about 25 percent of all deaths, according to the latest statistical data from the Centers for Disease Control and Prevention. Consider that the next leading cause of death among men (at 24 percent) is all types of cancer together, heart disease is a major killer.
While many men are probably familiar with common risk factors for heart disease such as age, family history, smoking, poor diet, high blood pressure (hypertension) and high blood cholesterol, fewer are aware of mounting science linking increased cholesterol levels and heart disease to chemical exposures.
Here are some of the recent findings:
1. Fish high in mercury
Men with heart disease or at risk of it are encouraged to eat fish because the omega 3 fatty acids they contain reduce the risk of heart attacks and stroke. However, some seafood contains high amounts of mercury. Research suggests that mercury exposure may be associated with cardiovascular disease, including high blood pressure and an elevated risk of heart attacks.
What can you do? In order to take advantage of the benefits of fish consumption without the mercury risks, avoid seafood with the highest levels of mercury, such as shark, swordfish and tuna steaks. Fish with lots of heart-healthy fatty acids and low mercury include wild salmon and farmed trout.
2. Teflon chemicals
Non-stick coated cookware, certain kinds of food packaging and stain-resistant coatings are often made from compounds called perfluorochemicals. The most notorious and well studied of these is a chemical called perfluorooctanoic acid, or PFOA, which was once used to make Teflon among other common products. Epidemiological studies involving people exposed either on the job or from contaminated drinking water have linked PFOA to increased cholesterol levels. While PFOA is in the process of being phased out, it may be present in older products, and concerns have been raised that replacement perfluorochemicals may have similar health effects.
What can you do? Use cast iron, glass or other uncoated cookware instead of non-stick pans. Make your own popcorn instead of using the microwave variety. Skip the stain resistant coatings, if possible, when buying carpets, furniture and clothing.
3. Rice-based products
Two recent reports by the federal Food and Drug Administration and Consumer Reports magazine found that many rice products have high levels of inorganic arsenic. Not only is arsenic a carcinogen, it may also be associated with increased blood pressure, according to epidemiological studies of populations that have high arsenic exposures. While rice isn’t the only source of arsenic in people’s diets, the levels in rice can be significant.
What can you do? The best way to lower your arsenic exposure from rice is to eat a varied diet and try other grains such as quinoa, barley, couscous and wheat. When eating brown rice, boil it with a lot of water, as some evidence suggests that can lower arsenic levels. Find out more at: www.ewg.org/release/reducing-arsenic-your-diet/.
4. Tap water
Two common drinking water contaminants, arsenic and lead, have been linked to high blood pressure in scientific studies. Arsenic is a common, naturally occurring drinking water contaminant, and lead leaches from older, corroding plumbing. Water is not the only way people are exposed to these contaminants, but it can be one of the easiest exposure routes to do something about.
What can you do? A good water filter can reduce levels of arsenic and lead in drinking water, but doing your homework is important since not all filters are created equal. For help finding one that will reduce these contaminants and not break the bank, check out EWG’s Water Filter Buying Guide: www.ewg.org/report/ewgs-water-filter-buying-guide/.
5. Bisphenol A (BPA)
While early research focused on BPA’s potential effects on reproductive health, a number of recent scientific studies have found that adults with higher BPA exposure have more cardiovascular disease risk factors such as high blood pressure, coronary heart disease and peripheral artery disease. BPA has been banned in certain products such as baby bottles and infant formula packaging, but it is still quite common in other consumer products.
What can you do? Use glass dishes to store and heat your leftovers. Reuse old bottles and glass jars for storing food. If you have to use plastic containers, avoid ones with recycling code #7, because they may contain BPA. Since BPA is also common in the linings of canned food, look for cans that say they are BPA-free or choose fresh food instead. For more tips, check out: www.ewg.org/bpa/.
When you think of men’s health risks, skin cancer probably isn’t at the top of the list. But it should be. Skin cancer is incredibly common, and the rates of the deadliest form, melanoma, are rising – for reasons scientists don’t totally understand. Men are more likely than women to be diagnosed with melanoma and much more likely to die of it. Which means that men need to do more to protect themselves from the sun. Here’s what you need to know:
1. Skin cancer is the most common cancer in American men, and the rate of new cases is rising.
More than 2 million Americans develop skin cancer each year. Most cases involve one of two disfiguring but rarely fatal forms – basal and squamous cell carcinomas. The deadliest form of skin cancer, melanoma, is also common, afflicting 24.6 per 100,000 men between 2006 and 2010, according to the federal Centers for Disease Control and Prevention. This makes melanoma the fifth most common cancer among men in the U.S. This hasn’t always been the case. According to the National Cancer Institute, over the past 35 years the rate of new melanoma cases among American adults has tripled. The reason for these trends is elusive, as are strategies for preventing this deadly cancer, but you can control some risk factors.
2. Men are much more likely than women to die of melanoma
Melanoma is significantly more common in men than women: the American Cancer Society estimates that 45,000 new cases of melanoma were diagnosed in U.S. men in 2013, compared to 31,600 in women – about a 42 percent higher incidence. What’s even more dramatic, and troubling, is the difference in deaths. Almost twice as many men die of melanoma every year: 6,280 men vs. 3,200 women in 2013. The mortality rate in men, unfortunately, has only been increasing: from 2.6 deaths per 100,000 in 1975 to 4.1 per 100,000 in 2010. Melanoma is one of only three cancers with a rising mortality rate for men.
3. Skin cancer awareness and prevention is lacking among men
In a recent analysis of government survey data, men were more likely than women to report having being sunburned in the previous year. Furthermore, according to a recent survey by the Skin Cancer Foundation, a shocking 70 percent of men do not know the warning signs of melanoma. More than half of those polled said they were unlikely to ask their doctor for a skin exam. The same survey also found that almost half of the male respondents said they had not used a sunscreen in the past year. And when they did, they most likely did not follow the guidelines for proper use. For instance, almost 80 percent did not know that they should apply a full ounce of sunscreen each time. Moreover, many men believe that one application a day is enough, even though the label directions call for reapplying sunscreen every two hours, and after swimming or excessive sweating.
4. What you should do: Educate yourself about skin cancer, use proper sun protection and get checked out regularly by a dermatologist
The most important steps are to know the warning signs of skin cancer, check your skin regularly for new moles that are tender or growing, and ask your primary care doctor how often you should see a dermatologist. While the exact cause of melanoma is not known, researchers have established that the risk factors include family history, indoor tanning, the number of moles on a person’s skin, having fair skin or freckles, ultraviolet radiation and severe sunburn. You can control three of these risk factors: indoor tanning, exposure to UV radiation and sunburns. Reduce exposure by staying in shaded areas during the hours of most intense sunshine. When working outdoors, the best way to protect yourself is with clothing and hats. For exposed skin, use an effective sunscreen, make sure you apply the recommended amount and reapply as necessary. Don’t rely on sunscreen too much. Many sunscreens don’t protect you from all skin damage caused by UV radiation, and some studies have found that people who rely primarily on sunscreen for protection end up with more sunburns, which are a risk factor for melanoma.
Abdelouahab N, Ainmelk Y, Takser L. 2011. Polybrominated diphenyl ethers and sperm quality. Reproductive toxicology 31(4): 546-550.
Achanzar WE, Diwan BA, Liu J, Quader ST, Webber MM, Waalkes MP. 2001. Cadmium-induced Malignant Transformation of Human Prostate Epithelial Cells. Cancer Research 61: 455-458.
Achanzar WE, Webber MM, Waalkes MP. 2002. Altered apoptotic gene expression and acquired apoptotic resistance in cadmium-transformed human prostate epithelial cells. Prostate 52(3): 236-244.
Agarwal A, Deepinder F, Sharma RK, Ranga G, Li J. 2008. Effect of cell phone usage on semen analysis in men attending infertility clinic: an observational study. Fertility and Sterility 89(1): 124-128.
Agarwal A, Desai NR, Makker K, Varghese A, Mouradi R, Sabanegh E, Sharma R. 2009. Effects of radiofrequency electromagnetic waves (RF-EMW) from cellular phones on human ejaculated semen: an in vitro pilot study. Fertility and Sterility 92(4): 1318-1325.
Agiesta J. 2013. Poll: Most men aspire to be dads. Available: http://bigstory.ap.org/article/poll-most-men-aspire-be-dads [Accessed July 22, 2013].
Ahmedin J, Siegel R, Xu J, Ward E. Cancer Statistics, 2010. CA: A Cancer Journal for Clinicians 60: 288-296.
Akutsu K, Takatori S, Nozawa S, Yoshiike M, Nakazawa H, Hayakawa K, Makino T, Iwamoto T. 2008. Polybrominated diphenyl ethers in human serum and sperm quality. Bulletin of Environmental Contamination and Toxicology 80(4): 345-350.
Allouche L, Hamadouche M, Touabti A. 2009. Chronic effects of low lead levels on sperm quality, gonadotorpins and testosterone in albino rats. Experimental and Toxicologic Pathology 61(5): 503-520.
American Cancer Society. 2013. Cancer Facts & Figures 2013. Available: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf [Accessed January 30, 2014]
American Society for Reproductive Medicine. 2013. Quick facts about Fertility. Available: http://www.reproductivefacts.org/detail.aspx?id=2322 [Accessed July 22, 2013].
Autier P, Boniol M, Dore JF. 2007. Sunscreen use and increased duration of intentional sun exposure: still a burning issue. International Journal of Cancer 121(1): 1–5.
Band PR, Abanto Z, Bert J, Lang B, Fang R, Gallagher RP, Le ND. 2011. Prostate cancer risk and exposure to pesticides in British Columbia farmers. The Prostate 71(2): 168-183.
Bautista LE, Stein JH, Morgan BJ, Stanton N, Young T, Nieto FJ. 2009. Association of blood and hair mercury with blood pressure and vascular reactivity. WMJ 108(5): 250-252.
Boffetta P, Sällsten G, Garcia-Gómez M, Pompe-Kirn V, Zaridze D, Bulbulyan M, Caballero JD, Ceccarelli F, Kobal AB, Merler E. 2001. Mortality from cardiovascular diseases and exposure to inorganic mercury. Occupational and Environmental Medecine 58(7): 461-466.
Buck Louis GM, Sundaram R, Schisterman EF, Sweeney AM, Lynch CD, Gore-Langton RE, Chen Z, Kim S, Caldwell KL, Barr DB. 2012. Heavy Metals and Couple Fecundity, the LIFE Study. Chemosphere 87(11): 1201-1207.
Bush B, Bennett AH, Snow JT. 1986. Polychlorobiphenyl congeners, p,p'-DDE, and sperm functions in humans. Archives of Environmental Contamination and Toxicology 15(4): 333-341.
Castro B, Sánchez P, Torres JM, Preda O, del Moral RG, Ortega E. 2013. Bisphenol A Exposure during Adulthood Alters Expression of Aromatase and 5α-Reductase Isozymes in Rat Prostate. PLoS One 8(2): e55905.
Centers for Disease Control and Prevention. 2013. Cancer Among Men. Available: http://www.cdc.gov/cancer/dcpc/data/men.htm [Accessed July 24, 2013]
Centers for Disease Control and Prevention. 2013. Leading Causes of Death in Males United States, 2009. Available: http://www.cdc.gov/men/lcod/2009/index.htm. [Accessed July 24, 2013]
Centers for Disease Control and Prevention. 2013. Skin Cancer Trends. Available: http://www.cdc.gov/cancer/skin/statistics/trends.htm [Accessed January 28, 2014]
Centers for Disease Control and Prevention: U.S. Cancer Statistics Working Group. 2013. United States Cancer Statistics: 1999-2010 Incidence and Mortality Web-based Report. Available: http://apps.nccd.cdc.gov/uscs/ [Accessed January 28, 2014]
Costa G, Sartori S, Consonni D. 2009. Thirty years of medical surveillance in perfluorooctanoic acid production workers. Journal of Occupational and Environmental Medicine 51(3): 364-372.
Dallinga JW, Moonen EJ, Dumoulin JC, Evers JL, Geraedts JP, Kleinjans JC. 2002. Decreased human semen quality and organochlorine compounds in blood. Human Reproduction 17(8): 1973-1979.
De Flora S, Micale RT, La Maestra S, Izzotti A, D'Agostini F, Camoirano A, Davoli SA, Troglio MG, Rizzi F, Davalli P, Bettuzzi S. 2011. Upregulation of clusterin in prostate and DNA damage in spermatozoa from bisphenol A-treated rats and formation of DNA adducts in cultured human prostatic cells. Toxicological Sciences 112(1): 45-51.
De Iuliis GN, Newey RJ, King BV, Aitken RJ. 2009. Mobile phone radiation induces reactive oxygen species production and DNA damage in human spermatozoa in vitro. PLoS One 4(7): e6446.
Derouiche S, Warnier M, Mariot P, Gosset P, Mauroy B, Bonnal JL, Slomianny C, Delcourt P, Prevarskaya N, Roudbaraki M. 2013. Bisphenol A stimulates human prostate cancer cell migration via remodelling of calcium signalling. Springerplus 2: 54.
Duty SM, Silva MJ, Barr DB, Brock JW, Ryan L, Chen Z, Herrick RF, Christiani DC, Hauser R. 2003. Phthalate exposure and human semen parameters. Epidemiology 14(3): 269-277.
Duty SM, Singh NP, Silva MJ, Barr DB, Brock JW, Ryan L, Herrick RF, Christiani DC, Hauser R. 2003. The relationship between environmental exposures to phthalates and DNA damage in human sperm using the neutral comet assay. Environmental Health Perspectives 111(9): 1164-1169.
Duty SM, Calafat AM, Silva MJ, Brock JW, Ryan L, Chen Z, Overstreet J, Hauser R. 2004. The relationship between environmental exposure to phthalates and computer-aided sperm analysis motion parameters. Journal of Andrology 25(2): 293-302.
Environmental Working Group. 2013. Skin Cancer on the Rise. Available: https://www.ewg.org/2013sunscreen/skin-cancer-on-the-rise/ [Accessed February 6, 2014]
Fillion M, Mergler D, Sousa Passos CJ, Larribe F, Lemire M, Guimarães JR. 2006. A preliminary study of mercury exposure and blood pressure in the Brazilian Amazon. Environmental Health 5: 29-46.
Fiorim J, Ribeiro Júnior RF, Silveira EA, Padilha AS, Vescovi MV, de Jesus HC, Stefanon I, Salaices M, Vassallo DV. 2011. Low-level lead exposure increases systolic arterial pressure and endothelium-derived vasodilator factors in rat aortas. PLoS One 6(2): e17117.
Fitz-Simon N, Fletcher T, Luster MI, Steenland K, Calafat AM, Kato K, Armstrong B. 2013. Reductions in serum lipids with a 4-year decline in serum perfluorooctanoic acid and perfluorooctanesulfonic acid. Epidemiology 24(4): 569-576.
Frisbee SJ, Shankar A, Knox SS, Steenland K, Savitz DA, Fletcher T, Ducatman AM. 2010. Perfluorooctanoic acid, perfluorooctanesulfonate, and serum lipids in children and adolescents: results from the C8 Health Project. Archives of Pediatrics & Adolescent Medicine 164(9): 860-869.
Glenn BS, Stewart WF, Links JM, Todd AC, Schwartz BS. 2003. The longitudinal association of lead with blood pressure. Epidemiology 14(1): 30-36.
Goncharov A, Rej R, Negoita S, Schymura M, Santiago-Rivera A, Morse G; Akwesasne Task Force on the Environment, Carpenter DO. 2009. Lower serum testosterone associated with elevated polychlorinated biphenyl concentrations in Native American men. Environmental Health Perspectives 117(9): 1454-1460.
Guallar E, Sanz-Gallardo MI, van't Veer P, Bode P, Aro A, Gómez-Aracena J, Kark JD, Riemersma RA, Martín-Moreno JM, Kok FJ; Heavy Metals and Myocardial Infarction Study Group. 2002. Mercury, fish oils, and the risk of myocardial infarction. New England Journal of Medicine 347(22): 1747-1754.
Guha Mazumder D, Purkayastha I, Ghose A, Mistry G, Saha C, Nandy AK, Das A, Majumdar KK. 2012. Hypertension in chronic arsenic exposure: A case control study in West Bengal. Journal of Environmental Science and Health 47(11): 1514-1520.
Hauser R, Altshul L, Chen Z, Ryan L, Overstreet J, Schiff I, Christiani DC. 2002. Environmental organochlorines and semen quality: results of a pilot study. Environmental Health Perspectives 110(3): 229-233.
Hauser R, Chen Z, Pothier L, Ryan L, Altshul L. 2003. The relationship between human semen parameters and environmental exposure to polychlorinated biphenyls and p,p'-DDE. Environmental Health Perspectives 111:1505-1511.
Hauser R, Meeker JD, Duty S, Silva MJ, Calafat AM. 2006. Altered semen quality in relation to urinary concentrations of phthalate monoester and oxidative metabolites. Epidemiology 17(6): 682-691.
Hauser R, Meeker JD, Singh NP, Silva MJ, Ryan L, Duty S, Calafat AM. 2007. DNA damage in human sperm is related to urinary levels of phthalate monoester and oxidative metabolites. Human Reproduction 22(3): 688-695.
Hess-Wilson JK, Webb SL, Daly HK, Leung YK, Boldison J, Comstock CE, Sartor MA, Ho SM, Knudsen KE. 2007. Unique bisphenol A transcriptome in prostate cancer: novel effects on ERbeta expression that correspond to androgen receptor mutation status. Environmental Health Perspectives 115(11): 1646-1653.
Ho SM, Tang WY, Belmonte de Frausto J, Prins GS. 2006. Developmental exposure to estradiol and bisphenol A increases susceptibility to prostate carcinogenesis and epigenetically regulates phosphodiesterase type 4 variant 4. Cancer Research 66(11): 5624-5632.
Hong D, Cho SH, Park SJ, Kim SY, Park SB. 2013. Hair mercury level in smokers and its influence on blood pressure and lipid metabolism. Environmental Toxicology and Pharmacology 36(1): 103-107.
Hossain E, Ota A, Takahashi M, Karnan S, Damdindorj L, Konishi Y, Konishi H, Hosokawa Y. 2013. Arsenic upregulates the expression of angiotensin II Type I receptor in mouse aortic endothelial cells. Toxicology Letters 220(1): 70-75.
Joensen UN, Frederiksen H, Jensen MB, Lauritsen MP, Olesen IA, Lassen TH, Andersson AM, Jørgensen N. 2012. Phthalate excretion pattern and testicular function: a study of 881 healthy Danish men. Environmental Health Perspectives 120(10): 1397-1403.
Jönsson BA, Richthoff J, Rylander L, Giwercman A, Hagmar L. 2005. Urinary phthalate metabolites and biomarkers of reproductive function in young men. Epidemiology 16(4): 487-493.
Juhler RK, Larsen SB, Meyer O, Jensen ND, Spanò M, Giwercman A, Bonde JP. 1999. Human semen quality in relation to dietary pesticide exposure and organic diet. Archives of Environmental Contamination and Toxicology 37(3): 415-423.
Julin B, Wolk A, Johansson JE, Andersson SO, Andrén O, Akesson A. 2012. Dietary cadmium exposure and prostate cancer incidence: a population-based prospective cohort study. British Journal of Cancer 107(5): 895-900.
Koo HJ, Lee BM. 2004. Estimated exposure to phthalates in cosmetics and risk assessment. Journal of Toxicology and Environmental Health 67(23-24): 1901-1914.
Køster B, Thorgaard C, Philip A, Clemmensen IH. 2010. Prevalence of sunburn and sun-related behaviour in the Danish population: a cross-sectional study. Scandanavian Journal of Public Health 38(5): 548 –52.
Koutros S, Beane Freeman LE, Lubin JH, Heltshe SL, Andreotti G, Barry KH, DellaValle CT, Hoppin JA, Sandler DP, Lynch CF, Blair A, Alavanja MC. 2013. Risk of total and aggressive prostate cancer and pesticide use in the Agricultural Health Study. American Journal of Epidemiology 177(1): 59-74.
Koutros S, Berndt SI, Hughes Barry K, Andreotti G, Hoppin JA, Sandler DP, Yeager M, Burdett LA, Yuenger J, Alavanja MC, Beane Freeman LE. 2013. Genetic susceptibility loci, pesticide exposure and prostate cancer risk. PLoS One 8(4): e58195.
Kunrath J, Gurzau E, Gurzau A, Goessler W, Gelmann ER, Thach TT, McCarty KM, Yeckel CW. 2013. Blood pressure hyperreactivity: an early cardiovascular risk in normotensive men exposed to low-to-moderate inorganic arsenic in drinking water. Journal of Hypertension 31(2): 361-369.
Lang IA, Galloway TS, Scarlett A, Henley WE, Depledge M, Wallace RB, Melzer D. 2008. Association of urinary bisphenol A concentration with medical disorders and laboratory abnormalities in adults. Journal of the American Medical Association 300(11): 1303-1310.
Li D, Zhou Z, Qing D, He Y, Wu T, Miao M, Wang J, Weng X, Ferber JR, Herrinton LJ, Zhu Q, Gao E, Checkoway H, Yuan W. 2010. Occupational exposure to bisphenol-A (BPA) and the risk of self-reported male sexual dysfunction. Human Reproduction 25(2): 519-527.
Li DK, Zhou Z, Miao M, He Y, Qing D, Wu T, Wang J, Weng X, Ferber J, Herrinton LJ, Zhu Q, Gao E, Yuan W. 2010. Relationship between urine bisphenol-A level and declining male sexual function. Journal of Andrology 31(5): 500-506.
Li DK, Zhou Z, Miao M, He Y, Wang J, Ferber J, Herrinton LJ, Gao E, Yuan W. 2011. Urine bisphenol-A (BPA) level in relation to semen quality. Fertility and Sterility 95(2): 625-630.
Li X, Li B, Xi S, Zheng Q, Wang D, Sun G. 2013. Association of urinary monomethylated arsenic concentration and risk of hypertension: a cross-sectional study from arsenic contaminated areas in northwestern China. Environmental Health 12: 37.
Li X, Li B, Xi S, Zheng Q, Lv X, Sun G. 2013. Prolonged environmental exposure of arsenic through drinking water on the risk of hypertension and type 2 diabetes. Environmental Science and Pollution Research International. Advanced online publication. DOI: 10.1007/s11356-013-1768-9
Linos E, Keiser E, Fu T, Colditz G, Chen S, Tang JY. 2011. Hat, shade, long sleeves, or sunscreen? Rethinking US sun protection messages based on their relative effectiveness. Cancer Causes Control 22: 1067–1071.
Liu L, Bao H, Liu F, Zhang J, Shen H. 2012. Phthalates exposure of Chinese reproductive age couples and its effect on male semen quality, a primary study. Environment International 42: 78-83.
Meeker JD, Calafat AM, Hauser R. 2010. Urinary bisphenol A concentrations in relation to serum thyroid and reproductive hormone levels in men from an infertility clinic. Environmental Science and Technology 44(4): 1458-1463.
Meeker JD, Stapleton HM. 2010. House dust concentrations of organophosphate flame retardants in relation to hormone levels and semen quality parameters. Environmental Health Perspectives 118(3): 318-323.
Melzer D, Rice NE, Lewis C, Henley WE, Galloway TS. 2010. Association of urinary bisphenol a concentration with heart disease: evidence from NHANES 2003/06. PLoS One 5(1): e8673.
Melzer D, Osborne NJ, Henley WE, Cipelli R, Young A, Money C, McCormack P, Luben R, Khaw KT, Wareham NJ, Galloway TS. 2012. Urinary bisphenol A concentration and risk of future coronary artery disease in apparently healthy men and women. Circulation 125(12): 1482-1490.
Mendiola J, Jørgensen N, Andersson AM, Calafat AM, Ye X, Redmon JB, Drobnis EZ, Wang C, Sparks A, Thurston SW, Liu F, Swan SH. 2010. Are environmental levels of bisphenol a associated with reproductive function in fertile men? Environmental Health Perspectives 118(9): 1286-1291.
Meyer TE, Coker AL, Sanderson M, Symanski E. 2007. A case-control study of farming and prostate cancer in African-American and Caucasian men. Occupational and Environmental Medicine 64(3): 155-160.
Min JY, Lee KJ, Park JB, Min KB. 2012. Perfluorooctanoic acid exposure is associated with elevated homocysteine and hypertension in US adults. Occupational and Environmental Medicine 69(9): 658-692.
Nakamura K, Yasunaga Y, Ko D, Xu LL, Moul JW, Peehl DM, Srivastava S, Rhim JS. 2002. Cadmium-induced neoplastic transformation of human prostate epithelial cells. International Journal of Oncology 20(3): 543-547.
National Cancer Institute. 2013. SEER Stat Fact Sheets: Melanoma of the Skin and SEER Cancer Statistics Review 1975-2010. Surveillance Epidemiology and End Results. Available: http://seer.cancer.gov/statfacts/html/melan.html and http://seer.cancer.gov/csr/1975_2010/browse_csr.php?section=16&page=sect_16_zfig.01.html [Accessed January 30, 2014]
Nelson JW, Hatch EE, Webster TF. 2010. Exposure to polyfluoroalkyl chemicals and cholesterol, body weight, and insulin resistance in the general U.S. population. Environmental Health Perspectives 118(2): 197-202.
Poręba R, Gać P, Poręba M, Andrzejak R. 2012. Assessment of cardiovascular risk in workers occupationally exposed to lead without clinical presentation of cardiac involvement. Environmental Toxicology and Pharmacology 34(2): 351-357.
Qu W, Ke H, Pi J, Broderick D, French JE, Webber MM, Waalkes MP. 2007. Acquisition of apoptotic resistance in cadmium-transformed human prostate epithelial cells: Bcl-2 overexpression blocks the activation of JNK signal transduction pathway. Environmental Health Perspectives 115(7): 1094- 1100.
Richthoff J, Rylander L, Jönsson BA, Akesson H, Hagmar L, Nilsson-Ehle P, Stridsberg M, Giwercman A. 2003. Serum levels of 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) in relation to markers of reproductive function in young males from the general Swedish population. Environmental Health Perspectives 111(4): 409-413.
Ritchie JM, Vial SL, Fuortes LJ, Guo H, Reedy VE, Smith EM. 2003. Organochlorines and risk of prostate cancer. Journal of Occupational and Environmental Medicine 45(7): 692-702.
Rodvall YE, Wahlgren CF, Ullén HT, Wiklund KE. 2010. Factors related to being sunburnt in 7-year-old children in Sweden. European Journal of Cancer 46(3): 566-572.
Rozati R, Reddy PP, Reddanna P, Mujtaba R. 2002. Role of environmental estrogens in the deterioration of male factor fertility. Fertility and Sterility 78(6): 1187-1194.
Ruder AM, Hein MJ, Hopf NB, Waters MA. 2013. Mortality among 24,865 workers exposed to polychlorinated biphenyls (PCBs) in three electrical capacitor manufacturing plants: A ten-year update. International Journal of Hygeine and Environmental Health. Advanced online publication. DOI: 10.1016/j.ijheh.2013.04.006
Sakr CJ, Leonard RC, Kreckmann KH, Slade MD, Cullen MR. 2007. Longitudinal study of serum lipids and liver enzymes in workers with occupational exposure to ammonium perfluorooctanoate. Journal of Occupational and Environmental Medicine 49(8): 872-879.
Sakr CJ, Kreckmann KH, Green JW, Gillies PJ, Reynolds JL, Leonard RC. 2007. Cross-sectional study of lipids and liver enzymes related to a serum biomarker of exposure (ammonium perfluorooctanoate or APFO) as part of a general health survey in a cohort of occupationally exposed workers. Journal of Occupational and Environmental Medicine 49(1): 1086-1096.
Schecter A, Lorber M, Guo Y, Wu Q, Yun SH, Kannan K, Hommel M, Imran N, Hynan LS, Cheng D, Colacino JA, Birnbaum LS. 2013. Phthalate concentrations and dietary exposure from food purchased in New York State. Environmental Health Perspectives 121(4): 473-479.
Scinicariello F, Abadin HG, Murray HE. 2011. Association of low-level blood lead and blood pressure in NHANES 1999-2006. Environmental Research 111(8): 1249-1257.
Sengupta M, Deb I, Sharma GD, Kar KK. 2013. Human sperm and other seminal constituents in male infertile patients from arsenic and cadmium rich areas of Southern Assam. Systems Biology in Reproductive Medicine. Systems Biology in Reproductive Medicine 59(4): 199-209.
Shankar A, Teppala S. 2012. Urinary bisphenol A and hypertension in a multiethnic sample of US adults. Journal of Environmental and Public Health. Advanced online publication. DOI: 10.1155/2012/481641
Shankar A, Teppala S, Sabanayagam C. 2012. Bisphenol A and peripheral arterial disease: results from the NHANES. Environmental Health Perspectives 120(9): 1297-1300.
Shankar A, Xiao J, Ducatman A. 2012. Perfluorooctanoic acid and cardiovascular disease in US adults. Archives of Internal Medicine 172(18): 1397-1403.
Simões MR, Ribeiro Júnior RF, Vescovi MV, de Jesus HC, Padilha AS, Stefanon I, Vassallo DV, Salaices M, Fioresi M. 2011. Acute lead exposure increases arterial pressure: role of the renin-angiotensin system. PLoS One 6(4): e18730.
Skin Cancer Foundation. 2012. New survey reveals gender divide surrounding skin cancer awareness and prevention. Available: http://www.skincancer.org/media-and-press/press-release-2012/survey [Accessed January 30, 2014]
Steenland K, Fletcher T, Savitz D. 2008. Status report: Association of perfluorooctanic acid (PFOA) and perfluoroctanesulfonate (PFOS) with lipids among adults in a community with high exposure to (PFOA). The C8 Science Panel. Available: http://www.c8sciencepanel.org/pdfs/Status_Report_C8_and_lipids_Oct2008.pdf
Steenland K, Tinker S, Shankar A, Ducatman A. 2010. Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric acid among adults with elevated community exposure to PFOA. Environmental Health Perspectives 118(2): 229-233.
Swan SH. 2006. Semen quality in fertile US men in relation to geographical area and pesticide exposure. International Journal of Andrology 29(1): 62-68.
Swan SH, Brazil C, Drobnis EZ, Liu F, Kruse RL, Hatch M, Redmon JB, Wang C, Overstreet JW; Study For Future Families Research Group. 2003. Geographic differences in semen quality of fertile U.S. males. Environmental Health Perspectives 111(4): 414-420.
Swan SH, Kruse RL, Liu F, Barr DB, Drobnis EZ, Redmon JB, Wang C, Brazil C, Overstreet JW; Study for Future Families Research Group. 2003. Semen quality in relation to biomarkers of pesticide exposure. Environmental Health Perspectives 111(12): 1478-1484.
Virtanen JK, Voutilainen S, Rissanen TH, Mursu J, Tuomainen TP, Korhonen MJ, Valkonen VP, Seppänen K, Laukkanen JA, Salonen JT. 2005. Mercury, fish oils, and risk of acute coronary events and cardiovascular disease, coronary heart disease, and all-cause mortality in men in eastern Finland. Arteriosclerosis, Thrombosis, and Vascular Biology 25(1): 228-233.
Waalkes MP, Anver M, Diwan BA. 1999. Carcinogenic effects of cadmium in the noble (NBL/Cr) rat: induction of pituitary, testicular, and injection site tumors and intraepithelial proliferative lesions of the dorsolateral prostate. Toxicological Sciences 52(2): 154-161.
Waalkes MP, Rehm S. 1992. Carcinogenicity of oral cadmium in the male Wistar (WF/NCr) rat: effect of chronic dietary zinc deficiency. Fundamental and Applied Toxicology 19(4): 512-520. Toxicological Sciences 52(2): 154-161.
Wang J, Zhang Y, Zhang W, Jin Y, Dai J. 2012. Association of perfluorooctanoic acid with HDL cholesterol and circulating miR-26b and miR-199-3p in workers of a fluorochemical plant and nearby residents. Environmental Science and Technology 46(17): 9274-9281.
Wennberg M, Strömberg U, Bergdahl IA, Jansson JH, Kauhanen J, Norberg M, Salonen JT, Skerfving S, Tuomainen TP, Vessby B, Virtanen JK. 2012. Myocardial infarction in relation to mercury and fatty acids from fish: a risk-benefit analysis based on pooled Finnish and Swedish data in men. The American Journal of Clinical Nutrition 96(4): 706-713.
Wetherill YB, Fisher NL, Staubach A, Danielsen M, de Vere White RW, Knudsen KE. 2005. Xenoestrogen action in prostate cancer: pleiotropic effects dependent on androgen receptor status. Cancer research 65(1): 54-65.
Wetherill YB, Hess-Wilson JK, Comstock CE, Shah SA, Buncher CR, Sallans L, Limbach PA, Schwemberger S, Babcock GF, Knudsen KE. 2006. Bisphenol A facilitates bypass of androgen ablation therapy in prostate cancer. Molecular Cancer Therapeutics 5(12): 3181-3190.
Wetherill YB, Petre CE, Monk KR, Puga A, Knudsen KE. 2002. The xenoestrogen bisphenol A induces inappropriate androgen receptor activation and mitogenesis in prostatic adenocarcinoma cells. Molecular Cancer Therapeutics 1(7): 515-524.
Wirth JJ, Rossano MG, Potter R, Puscheck E, Daly DC, Paneth N, Krawetz SA, Protas BM, Diamond MP. 2008. A pilot study associating urinary concentrations of phthalate metabolites and semen quality. Systems Biology in Reproductive Medicine 54(3): 143-154.
Wu HM, Lin-Tan DT, Wang ML, Huang HY, Lee CL, Wang HS, Soong YK, Lin JL. 2012. Lead level in seminal plasma may affect semen quality for men without occupational exposure to lead. Reproductive Biology and Endocrinology 10: 91.
Zhang C, Mao G, He S, Yang Z, Yang W, Zhang X, Qiu W, Ta N, Cao L, Yang H, Guo X. 2012. Relationship between long-term exposure to low-level arsenic in drinking water and the prevalence of abnormal blood pressure. Journal of Hazardous Materials. Advanced online publication. DOI: 10.1016/j.jhazmat.2012.09.045.
Zhang YH, Zheng LX, Chen BH. 2006. Phthalate exposure and human semen quality in Shanghai: a cross-sectional study. Biomedical and Environmental Sciences 19(3): 205-209.