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Below is an update of the findings from CARES.  What we have learned so far has been published and the papers are available for everyone to read.  

Impact of air manganese on child neurodevelopment in East Liverpool, Ohio.
Children 7-9 years of age from East Liverpool and its surrounding communities were enrolled the CARES study between March 2013-June 2014. Blood and hair were analyzed for Mn and lead, and serum was analyzed for cotinine. Hair Mn was negatively associated with child IQ scores.

Publication: Haynes EN, Sucharew H, Hilbert TJ, Kuhnell P, Spencer A, Newman NC, Burns R, Wright R, Parsons PJ, Dietrich KN. Impact on air manganese on child neurodevelopment in East Liverpool, Ohio. NeuroToxicology. 2018 Jan; 64: 94-102.

A review of human research about manganese exposure and cognition.
Over 27 studies were reviewed, including those focused on both child and adult manganese exposures.  The majority of the studies demonstrated the negative impacts of manganese on cognition. Several of the studies showed that both high and low levels of manganese are associated with reduced cognitive abilities in children.

Publication: Vollet K, Haynes EN, Dietrich KN.  Manganese Exposure and Cognition Across the Lifespan: Contemporary Review and Argument for Biphasic Dose-Response Health Effects. Current Environmental Health Reports. 2016 Dec; 3(4):392-404.

Community Engagement and Data Disclosure in Environmental Health Research (PDF)
Airborne manganese (Mn) concentrations in East Liverpool, Ohio, were reported to be 30 times higher than the reference concentration, which led to an academic–community research partnership to address community concern about Mn exposure, particularly among children. Children and their families were recruited to participate in a pilot study. Samples of blood and hair were collected from the children and analyzed for metals. DD mechanisms were developed using an iterative approach between community and academic partners. 

Publication: Haynes EN, Elam S, Burns R, Spencer A, Yancey E, Kuhnell P, Alden J, Walton M,  Reynolds V, Newman N, Wright RO, Parsons PJ, Praamsma ML, Palmer CD, Dietrich KN.  Community Engagement and Data Disclosure in Environmental Health Research.  Environmental Health Perspectives. 2016 Feb; 124(2): A24-A27.

Secondhand tobacco smoke exposure negatively affected children's ability to coordinate movements.
The same group of children completed testing regarding some of their physical abilities. Exposure to secondhand tobacco smoke was measured by levels of cotinine (an indicator that the child has been exposed to nicotine through second hand smoke).  Higher levels of cotinine were associated with reduced abilities in children’s eye-hand coordination, control of small movements, balance, and strength.

Publication: Yeramaneni S, Dietrich KN, Yolton K, Parsons PJ, Aldous KM, Haynes EN. Secondhand Tobacco Smoke Exposure and Neuromotor Function in Rural Children. The Journal of Pediatrics. 2015; 167(2):253-9.e1.

Children with higher manganese exposure had poorer balance.
A group of 55 children who were part of CARES from Marietta completed balance testing.  Poorer balance was found in those living closer to the ferromanganese refinery, having higher levels of manganese in hair or blood, and having elevated levels of lead in blood.

Publication:  Rugless F, Bhattacharya  A, Succop P, Dietrich KN, Alden J, Kuhnell P, Cox C, Wright R, Parsons PJ, Praamsma ML, Dalmer CD, Wittberg R, Haynes EN. Chronic manganese exposure and postural balance in Children living near a ferromanganese refinery in southeastern Ohio.  Neurotoxicology and Teratology. 2014;41:71-9.

Children living and attending school nearer the manganese refinery had higher levels of manganese in their personal air samples.

A group of 38 children who participated in CARES from Marietta wore personal air monitors for two days. These children and their families recorded the child’s location during the two day sampling period.  Residential and school distance from the ferromanganese refinery (weighted by time spent at each) was associated with levels of manganese in children’s air.

Publication: Haynes EN, Ryan P, Chen A, Brown D, Roda S, Kuhnell P, Wittberg D, Terrell M, Reponen T. Assessment of personal exposure to manganese in children living near a ferromanganese refinery. The Science of the Total Environment. 2012; 427-428:19-25.

Effect of Chronic Low Level Manganese Exposure on Postural Balance: A Pilot Study of Residents in Southern Ohio.

Developing a Bidirectional Academic-Community Partnership with an Appalachian American Community for Environmental Health Research and Risk Communication.

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