Vaginal douching and racial/ethnic disparities in phthalates exposures among reproductive-aged women: National Health and Nutrition Examination Survey 2001-2004.
Vaginal douching and racial/ethnic disparities in phthalates exposures among reproductive-aged women: National Health and Nutrition Examination Survey 2001-2004.
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DOI：
10.1186/s12940-015-0043-6
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发表时间：
2015-07-15
期刊：
影响因子：
--
通讯作者：
Zota AR
中科院分区：
文献类型：
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作者：
Branch F;Woodruff TJ;Mitro SD;Zota AR
邻苯二甲酸二乙酯（DEP）和邻苯二甲酸二丁酯（DnBP）是消费品中发现的工业化学品，可能会增加对健康产生不良影响的风险。尽管已知使用个人护理/美容产品会导致邻苯二甲酸酯暴露，但之前没有研究将女性卫生用品作为潜在的邻苯二甲酸酯来源。在这项研究中，我们评估了阴道冲洗和其他女性卫生产品是否会增加美国育龄妇女对邻苯二甲酸酯的暴露。我们对739名女性进行了一项横断面研究2001-2004年国家健康和营养调查中的20-49岁妇女，以检查自我报告的女性卫生用品使用情况与（卫生棉条、卫生巾、阴道冲洗液、女性喷雾剂、女性爽身粉，和女性擦拭巾/小毛巾）与尿浓度的邻苯二甲酸单乙酯（MEP）和邻苯二甲酸单正丁酯（MnBP）（分别为DEP和DnBP的代谢物）。在过去的一个月里，黑人女性比白色和墨西哥裔美国女性使用阴道冲洗液、女性喷雾剂、女性爽身粉和湿巾/小毛巾的比例更大，而白色女性比其他种族/族裔群体更有可能使用卫生棉条（p < 0.05）。在过去的一个月里，冲洗与较高浓度的MEP有关，但与MnBP无关。没有其他女性卫生用品与MEP或MnBP显著相关。我们观察到冲洗频率和MEP浓度之间存在剂量反应关系（p趋势< 0.0001）;频繁使用者（≥2次/月）的MEP浓度比非使用者高152.2%（95%置信区间（CI）：（68.2%，278.3%））。我们还检查了阴道冲洗是否介导种族/民族与邻苯二甲酸酯暴露之间的关系。黑人女性的MEP水平比白色女性高48.4%（95%CI：16.8%，88.6%; p = 0.0002）。对冲洗进行调整后，该差异缩小至26.4%（95% CI：-0.9%，61.2%; p = 0.06）。冲洗的中介效应对于黑人与白人之间的差异具有统计学意义（z = 3.71，p < 0.001），但对于墨西哥裔美国人与白人之间的差异则没有统计学意义（z = 1.80，p = 0.07）。阴道冲洗可能会增加DEP暴露，并导致DEP暴露的种族/民族差异。阴道冲洗液中环境化学物质的存在需要进一步检查。
Diethyl phthalate (DEP) and di-n-butyl phthalate (DnBP) are industrial chemicals found in consumer products that may increase risk of adverse health effects. Although use of personal care/beauty products is known to contribute to phthalate exposure, no prior study has examined feminine hygiene products as a potential phthalate source. In this study, we evaluate whether vaginal douching and other feminine hygiene products increase exposure to phthalates among US reproductive-aged women. We conducted a cross-sectional study on 739 women (aged 20–49) from the National Health and Nutrition Examination Survey 2001–2004 to examine the association between self-reported use of feminine hygiene products (tampons, sanitary napkins, vaginal douches, feminine spray, feminine powder, and feminine wipes/towelettes) with urinary concentrations of monoethyl phthalate (MEP) and mono-n-butyl phthalate (MnBP), metabolites of DEP and DnBP, respectively. A greater proportion of black women than white and Mexican American women reported use of vaginal douches, feminine spray, feminine powder, and wipes/towelettes in the past month whereas white women were more likely than other racial/ethnic groups to report use of tampons (p < 0.05). Douching in the past month was associated with higher concentrations of MEP but not MnBP. No other feminine hygiene product was significantly associated with either MEP or MnBP. We observed a dose–response relationship between douching frequency and MEP concentrations (ptrend < 0.0001); frequent users (≥2 times/month) had 152.2 % (95 % confidence intervals (CI): (68.2 %, 278.3 %)) higher MEP concentrations than non-users. We also examined whether vaginal douching mediates the relationship between race/ethnicity and phthalates exposures. Black women had 48.4 % (95 % CI: 16.8 %, 88.6 %; p = 0.0002) higher MEP levels than white women. Adjustment for douching attenuated this difference to 26.4 % (95 % CI:−0.9 %, 61.2 %; p = 0.06). Mediation effects of douching were statistically significant for black-white differences (z = 3.71, p < 0.001) but not for differences between Mexican Americans and whites (z = 1.80, p = 0.07). Vaginal douching may increase exposure to DEP and contribute to racial/ethnic disparities in DEP exposure. The presence of environmental chemicals in vaginal douches warrants further examination.