Chapter 9
Health effects
associated with lifestyle,
diet and exposure to PTS
9.1. Health risk factors
Chapter 9
9.1. Health risk factors
9.1.1. Tobacco smoking and alcohol intake
Tobacco smoking is found to be one of most common
adverse habits practiced among the indigenous popu-
lation, and is most prevalent in the Chukchi AO. The
dietary and lifestyle survey found that almost 96% of
the total adult indigenous population regularly con-
sumes alcoholic drinks, at least once a month. As
expected, vodka appears to be the preferred alcoholic
drink throughout the Russian Arctic (Table 9.1.).
Table 9.1. Self reported smoking habits and alcohol consumption:
About two thirds of the adult indigenous respondents
proportion of respondents giving a positive answer (Yes) to questions.
(74% of men and 42% of women), reported consum-
ing only vodka or vodka-like strong drinks.
Unfortunately, the original questionnaire used in the
dietary survey did not provide the option of specifying
consumption of homemade alcoholic drinks, which
are illegal to produce. However, the average consump-
tion of such beverages is estimated to range from 11
litres per year in communities in Taymir to 50 litres per
year among indigenous communities in Chukotka.
From the 2003 targeted survey, it was concluded that
homemade alcoholic drinks are often consumed as a
raw (rather than distilled) brew that may well be highly
Table 9.2. Prevalence of lifetime adverse outcomes of pregnancies (%), by reported
contaminated by POPs (see Chapter 6).
alcohol consumption. 1 calculated as ethanol equivalent; 2 includes spontaneous
abortions, stillbirths, ectopic pregnancies
Alcohol intake in quantities amounting to 3 litres of
ethanol per year by indigenous women, has been demon-
strated to cause a number of adverse reproductive health
effects; such as low birth weight, reduced gestational age
of neonates, stillbirth and birth defects (Table 9.2).
In contrast, the smoking of tobacco does not seem to
present a severe risk factor with respect to reproductive
and developmental disorders in indigenous women
and their infants. A statistically positive but moderate
correlation has been found only for a reduction in the
gestational age of newborns of smokers (Table 9.3).
In the meantime, the prevalence of some chronic dis-
eases, and specifically, pulmonary diseases, appears to
Table 9.3. Prevalence of lifetime adverse outcomes of pregnancies (%), by reported
show a close correlation with reported intensity of
smoking habits.
tobacco smoking, illustrating the already well known
dose-response relationship between the two traits
(Table 9.4). A greater prevalence in reported liver dis-
ease is also associated with smoking intensity.
9.1.2. General well being and other social factors
9.1.2.1. Low family income and level of education
It is commonly accepted that poverty and unemploy-
ment are two very important risk factors, which can com-
promise human health. The global trend is for a change
in the nutritional patterns of less-favoured groups in the
population, leading to lower animal protein, and higher
fat consumption. In contrast, indigenous people of the
North with low monetary incomes become more reliant
on local food, and in particular fish and wild (marine)
Table 9.4. Prevalence of chronic diseases (%), by reported
animals, which are generally more readily available to
smoking intensity.
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Chapter 9
9.1. Health risk factors
them than marketed foodstuffs. Since local fish and
In order to minimize possible misclassifications of
marine mammals in many Arctic areas are significantly
occupations, all pregnant respondents were divided
more contaminated by POPs than imported foodstuffs,
into three groups. The first group included women
for those unable to purchase market products, the total
involved in animal farming and herding (outdoors);
burden of PTS is clearly elevated. Thus, poverty can be,
the second group included maintenance and service
and often is, a predisposing risk factor in the exposure
workers (indoors); and the third group, technicians,
of indigenous people in the Arctic to PTS (Table 9.5).
hospital and school personnel, fur/leather handling
Family income and the educational level of pregnant
and workers involved with handcrafts (again indoors).
women, in general, both show negative correlations with
PTS blood concentrations. This points to the probable
The groups with the highest exposure to POPs, (except
impact of poverty and poor awareness regarding risks to
for PCBs), were found to be the indoor occupational
health, on families in less favorable circumstances with
groups, who have potentially experienced a
respect to both income and educational attainment.
longer/higher exposure to household chemicals than
outdoor workers ( Table 9.7).
9.1.3. Self assessment of environmental pollution
On the basis of data presented in Tables 9.8. and 9.9,
air pollution is of little concern to indigenous people.
The majority of people still believe that the Arctic is the
least polluted, and most pristine area in the world,
although this judgment may be based on inadequate
public awareness of their local environmental situa-
tion. Women, as expected, are far more concerned
about pollution than men.
Table 9.5. Spearman correlation coefficient for PTS blood concentrations and family
monetary income, and total duration of education, in the group of pregnant
indigenous women.
The most pronounced effect of low family income, is to
promote the consumption of local sources of food fats
which appear to be a major source of PTS exposure for
indigenous populations residing in coastal communi-
ties (Table 9.6). The lowest level of fat intake was
recorded for the indigenous population residing in the
location of the Pechora River, where the main type of
local food consumed are fresh water fish species which
are generally low in fat.
9.1.2.2. Occupation
It was clear from the questionnaire study, that many
indigenous people, and especially women, found diffi-
culty in specifying their occupation; as the employment
Table 9.7. Proportion of pregnant women (%) with higher PTS blood concentra
infrastructure in Arctic areas is often not well-developed.
tions, classified by occupation group.
Although most women residing in indigenous commu-
nities reported some form of employment, job descrip-
9.1.4. Indoor exposure to PTS
tions and job tasks described, as well as monthly incomes
It is important to emphasize that the questionnaire
earned, indicate a fairly wide difference between formal
study has, for the first time, provided overt epidemio-
occupations and the work actually undertaken.
logical evidence of widespread, non-agricultural use of
Table 9.6.
Mean fat consumption
(grams per day) and
monetary income (monthly
income calculated in Russian
roubles) by indigenous
women.
169
9.1. Health risk factors
Chapter 9
A large proportion of indigenous people surveyed (23
45%) reported routine use and sometimes domestic
production, of materials containing lead (such as
paint, ammunition, fishing equipment, etc.)
(Table 9.11). This information suggests that more effort
should be given to evaluating local sources of exposure,
and caution applied in approaching the evaluation of
risks associated with the global transport of PTS.
Table 9.8. Expressed concern over air pollution (women). Question: What is your
feeling about the quality of ambient air in your settlement?
Table 9.9. Expressed concern over air pollution (men). Question: What is your
feeling about the quality of ambient air in your settlement?
highly toxic substances in areas of the Arctic. Indoor
and occupational sources of PTS exposure are likely to
be a significant underlying contributor to the higher
blood concentrations of persistent contaminants found
Table 9.11. Use of materials containing lead. Proportion of respondents given
in the arctic indigenous populations of Russia. Thus,
a positive answer (Yes) to questions.
for instance, almost half of the respondents in the
Chukchi AO and Kola peninsula (Table 9.10) reported
the regular use of a number of highly toxic substances
against insects and rodents. The majority of those
chemicals have not been properly labeled and their use
is practically uncontrolled (see Chapter 4, Table 4.34).
It was discovered, that at least some of these substances
(most of which were imported from China) contain sig-
nificant amount of POPs such as PCBs, DDT and HCH.
Table 9.12. Consumption of local food (Question: Do you regularly consume
The most contaminated substance, proved to be an
local foods?).
insecticide named "Medifox super". This has been in
widespread use since the early 1990's for general house-
hold use, as well as being applied to human skin and
hair, especially of children, for the treatment of skin
parasites such as itch-mites and lice. Considering the
official reported prevalence of pediculosis and scabies,
which affect from 11% to 35% of the total population
resident in arctic indigenous communities, it is clear
that the use of such insecticides could pose a significant
risk of human exposure to POPs.
Table 9.13. Proportion of respondents (%) reporting consumption
of local foods.
9.1.5. Diet
Clearly, the Russian Arctic population is highly
dependent on local foods (Table 9.12 and 9.13).
Table 9.10. Use of insecticides/pesticides and other chemicals. Proportion of those
Practically all the indigenous population in the project
giving a positive answer (Yes).
pilot areas reported dependence on traditional local
170
Chapter 9
9.2. Health effects associated with exposure to PTS
food in their diet. The high consumption of marine
mammal meat and fat by the indigenous population of
9.2.2. Blood concentrations of PTS: Variation
coastal Chukotka, is of particular note (Table 9.14).
POP concentrations in serum are known to vary due a
number of individual factors, e.g. age, diet, parity etc.
This study has shown that the most pronounced differ-
ences are associated with gender and age. Thus, men
older than 40 years of age showed a 1.3-fold increase in
concentrations of total PCBs, DDT and HCH, compared
to younger men living in the same communities
(Figure 9.1). The differences between the two age
Table 9.14. Consumption of marine mammal meat and blubber by indigenous
groups in indigenous women are found to be greater
coastal population (in Uelen).
than between men, with up to a 2-fold increase in POP
concentrations occurring in older women. Pregnant
women showed the lowest serum concentrations for a
9.2. Health effects associated with exposure to PTS
number of organochlorines, such as HCB, total
toxaphenes, and, to a lesser extent, the sums of PCBs
9.2.1. Self evaluation of health status
and DDT. A possible explanation for this phenomenon
With the exception of the TAO population, most respon-
is that pregnant women, in accordance with medical rec-
dents believe that they are in good health. However,
ommendations, are often admitted to delivery depart-
between 28 to 60% also reported that they had been told
ments 34 weeks prior to the expected date of birth, in
by a doctor that they might have a chronic disease (Table
9.15). However, the prevalence of health complaints
made by native people is generally lower than that
observed in non-indigenous arctic populations of the
same age (6279%) (Kovalev et al., 2000). Given the
extremely low life expectancy in Arctic indigenous popu-
lations (see Chapter 2), the low prevalence of reported
health problems is likely to relate to lack of awareness
regarding existing or developing health problems.
Table 9.15. Self reported health problems.
Table 9.16. Relationship between concentration (geometric means; ng/g lipid)
of POPs in serum and parity.
Table 9.17.
Relationship between
concentration (geometric
means; µg/L) of metals
in blood and parity.
Figure 9.1. Concentrations (geometric means, ng/g lipid weight) of OCs in blood
of indigenous people by age.
171
9.2. Health effects associated with exposure to PTS
Chapter 9
Table 9.18.
Spearmen correlation
coefficients between
concentrations of selected
PTS in blood of pregnant
indigenous women.
Table 9.19. Spearmen correlation coefficients between concentrations of selected PTS in blood of women of the general indigenous population.
Table 9.20.
Spearmen correlation
coefficients between
concentrations of selected
PTS in blood in adult
indigenous men.
172
Chapter 9
9.2. Health effects associated with exposure to PTS
order to receive proper health care. This includes spe-
between concentrations of individual POPs in blood
cial nourishment, which is completely based on import-
are generally not very close. The majority of r-values
ed foodstuffs. A further issue to be taken into considera-
range from 0.2 to 0.6. For inorganic contaminants,
tion, is that the group of pregnant women are
only the Pb-Cd pair shows a moderate association.
representative of the whole study area, rather than of
specific communities. Therefore, the possibility of some
9.2.3. Health effects associated
inter-community variation cannot be ruled out.
with PTS blood concentrations
Parity (more precisely the number of breast fed chil-
9.2.3.1. Reproductive and developmental effects
dren) also needs to be considered as a factor capable of
9.2.3.1.1. Main associations between exposure and effects
reducing POP serum concentrations (Tables 9.16 and
A number of experimental findings suggest that expo-
9.17). As previously mentioned, between 68% to 94%
sure to PTS is associated with reproductive health
of indigenous infants are breast fed for a period longer
effects. Epidemiological evidence of this, however, is
than 6 months and almost a half of them for over one
very limited. A basic statistical analysis of recorded
year. Those women having more than one child, but
adverse outcomes of pregnancy in indigenous women,
less than 4 children, showed significantly lower con-
and their current PTS blood concentrations, has
centrations of HCB, DDE and PCBs. The relative
shown that there is a statistically significant, but rela-
increase seen in POP levels of mothers having 4 or
tively low association (RR-value from 2.05 to 2.77)
more children, is likely to reflect the age-dependency
between the prevalence of premature births and blood
effect in POP levels, mentioned above, which is poten-
concentrations of lead exceeding 30 µg/L, cadmium
tially greater in this group of women.
exceeding 1.0 µg/L and PCBs (as Arochlor 1260)
exceeding 5.0 µg/L (Table 9.21). In addition, the iden-
Most of the organic contaminants show positive corre-
tical concentrations of PCBs and Cd measured in both
lations to each other, whilst for inorganic contami-
maternal and cord blood are found to correlate with
nants this is not the case (Tables 9.189.20). For preg-
reduced birth weight of newborns (either below 2500 g
nant women a closer relationship is found between
or 3000 g), at a similar level of statistical significance
total PCBs and HCB (neither of which are pesticides),
(Table 9.22).
and which presumably have one or more common
exposure routes. Organochlorine pesticides are also
There have been four reported cases of serious struc-
positively correlated to each other.
tural malformation and six stillbirths in the study group
of pregnant indigenous women. The geometric means
The correlation pattern obtained from statistical analy-
of concentrations of total PCBs, DDTs and Hg in the
sis of PTS blood concentrations for the general indige-
maternal blood found in these adverse cases, proved to
nous population appears differ slightly from that
be 1.72.0 times higher than in women where there
observed in pregnant women. In fact, relationships
were no reported adverse outcomes (Table 9.23).
Table 9.21. Prevalence of preterm pregnancy and concentrations of PTS
Table 9.22. Prevalence of low birth weight newborns and concentrations
in blood of indigenous women.
of PTS in cord blood.
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9.2. Health effects associated with exposure to PTS
Chapter 9
Table 9.23.
Concentrations (geometric
mean; µg/L) of PTS in blood
of indigenous women
reporting stillbirths and
structural malformations.
Table 9.24.
Concentrations (geometric
mean; µg/L) of PTS in blood
of indigenous women report
ing lifetime spontaneous
abortions.
Table 9.25. Prevalence of low birth weight newborns (%) and concentrations
Table 9.26. Prevalence of premature births (%) and concentrations (µg/L) of total
(µg/L) of total PCB in maternal serum.
PCB in maternal serum.
Some weak associations were also found between the
9.2.3.1.2. Dose response relationships
prevalence of lifetime spontaneous abortions and the
Dose-response relationships for reproductive health
level of blood concentrations of PCBs and HCHs in
effects observed in the entire group of pregnant
pregnant indigenous women of the Kola Peninsula and
women can be demonstrated by a more detailed
the Nenets AO, whereas for the Chukchi AO group of
breakdown of PTS blood concentrations (Tables 9.25
pregnant women, the prevalence of spontaneous abor-
and 9.26). It is clear that total PCB serum concentra-
tions is closely associated with blood concentrations of
tions in maternal serum above the level of 2.0 µg/L,
total Hg (Table 9.24). Unfortunately, the study proto-
seem to be capable of affecting both the birth weight
col did not allow for the separation of organic and inor-
and gestational age of newborns; whereas the preva-
ganic mercury compounds, which are known to have
lence of fatal outcomes of pregnancy increase signifi-
very different toxic profiles including that of reproduc-
cantly at higher levels of PCB exposure, above
tive toxicity.
4.0 µg/L (Table 9.27).
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Chapter 9
9.2. Health effects associated with exposure to PTS
Among inorganic contaminants, a clear dose-response
increased blood concentrations of Pb, Cd or total
relationship has been found between total mercury
mercury. (Table 9.29). In total, the study group of
concentrations in maternal blood and the prevalence
indigenous newborns showed a higher ratio of
of low birth weight. Other adverse outcomes showed a
males/females (1.32) than the national average
U-shape curve, with a higher lifetime prevalence occur-
(1.06), with this ratio higher even than that found in
ring in the group of women with Hg concentrations
the top `male prevalent' nations such as Korea (1.14)
below 1 µg/L, and with the highest response from the
and China (1.09) (www.globalstat.com), (Figure 9.2).
group with concentrations over 1.4 µg/L (Table 9.28). Interestingly, these reproductive and developmental
effects appear to show a closer association with blood
9.2.3.1.3. Gender dependent health effects
concentrations of the lower chlorinated congeners of
It has been found that the gender of indigenous off-
PCBs, such as 28; 31; 52; 99 and 118 (Figure 9.3). It
spring can be significantly affected by an increase in
was also found that female newborns are at a higher
maternal blood concentrations of lead, Arochlor
risk of low birth weight and premature births than
1260 and total PCBs. Mothers are more likely to have
male newborns. The frequency of these adverse out-
daughters, if their exposure to POPs was relatively
Figure 9.2.
high. This did not appear to be the case, with
Relationship between preg
nancy outcome (male/female
sex ration of newborns) and
total PCB concentrations in
maternal serum.
Figure 9.4.
Relationship between
Table 9.27. Prevalence of fatal outcomes of pregnancy (%) and concentrations
premature births (earlier
(µg/L) of total PCB in maternal serum.
than 37 weeks; %) of male
and female newborn and
total PCB concentrations
in maternal serum.
Figure 9.5.
Relationship between low
birth weight (under 2500g,
%) in male and female
newborn and total PCB
concentrations
in maternal serum.
Table 9.28. Prevalence of lifetime adverse outcome of pregnancies (%)
and concentrations (µg/L) of mercury in blood.
Figure 9.3.
Relationship between
pregnancy outcome
(male/female sex ration of
newborns) and PCB concen
trations in matreial blood
serum (µg/L) for lower (a)
and higher (b) chlorinated
PCBs.
a
b
175
9.2. Health effects associated with exposure to PTS
Chapter 9
comes for female newborns is closely correlated with
In contrast the indigenous women of the same age
total PCB concentrations measured in maternal
showed quite a significant association between the
serum (Figures 9.4 and 9.5).
prevalence of reported chronic diseases and elevated
blood concentrations of some PTS, particularly that of
9.2.3.1.4. Confounding factors
Pb. (Table 9.31).
Unlike tobacco smoking, alcohol abuse has been con-
firmed as a severe reproductive health risk factor, and
thus, might act as a confounder to PTS induced repro-
ductive health effects. In order to rule this out, data for
women who did not report drinking hard liquor, was
analyzed separately by levels of PTS exposure, for
selected pregnancy outcomes.
Lead concentrations of over 30.0 µg/L in maternal blood
and PCB concentrations in serum of over 2.0 µg/L, may
have affected gestational age, as well as the prevalence of
stillbirths and spontaneous abortions, and compound
with alcohol intake. However, it is important to note that
for other contaminants (DDTs, HCHs, toxaphens,
chlordanes) at observed exposure levels had no preva-
lence of reproductive health and developmental effects
for non-drinking women and women who reported
moderate and hard alcohol intake.
9.2.3.2. Prevalence of chronic diseases
The prevalence of reported health problems related to
known chronic diseases among indigenous men over
Table 9.30. Reported chronic diseases and concentrations of PTS in blood
the age of 40, was not found to show a close association
of indigenous men over 40 years of age.
with measured current blood concentrations of PTSs
(Table 9.30). This was possibly due to poor awareness
regarding the manifestations and symptoms of the var-
ious health disorders.
Table 9.31. Reported chronic diseases and concentrations of PTS in blood
of indigenous women over 40 years of age.
Table 9.29. Concentrations (geometric mean) of PTS in maternal blood and gender
of newborns.
176