Marietta Community Actively 

Researching Exposure Study (CARES)

Erin N. Haynes, DrPH, MS

Assistant Professor

Division of Epidemiology and Biostatistics

College of Medicine

University of Cincinnati

513-558-5327

Erin.Haynes@uc.edu www.eh.uc.edu/cares
Acknowledgements University of Cincinnati

Kim Dietrich, PhD

Amit Bhattacharya, PhD

Paul Succop, PhD

Tina Reponen, PhD

Pat Ryan, PhD, CCHMC

Staff

Cyndy Cox

Jody Alden

Pierce Kuhnell

Megan Parin

Students

Pam Heckel, PhD

Fedoria Rugless

Funding: 

Marietta CARES funding is provided by the National 

Institute of Environmental Health Science 

(1R01 ES016531-01).

Marietta 

College

Mary Barnas, PhD

David Brown, PhD

Clinic Team: 

Ashley Schaad

Philip LeMaster

Mark Jackson

Andy Guimond

Kristin Lutes

Home Sampling Team:

John St. Marie

Velvet Tranchina

Russelita Young

Derek Hennen

Callie Lyons

Diana Hackenberg

Anthony Derotto

Ryan Ellis

Corin Bonnett

Marietta, & Cambridge, 

Communities

Caroline Beidler, Marietta

Arthur Wittberg, PhD Marietta

Dawn Wittberg, Marietta

Rusty Roberts, Cambridge

Community Advisory Board
Marietta, OH/Parkersburg, WV

N = 300

Cambridge, OH

N = 100

Home Environmental Sampling

- Interior Dust

- Exterior Dust

- Water

Ambient Air Sampling

-PM2.5 6 days/week

-4 weeks/season

Personal Air Sampling

N = 40

Neuropsychological Assessment

-Child IQ (WISC-IV)

-BASC-2

-CVLT-C

-Standardized Achievement Test

Neuromotor Assessment

-Grooved Pegboard

-Fingertapping

-Postural Balance

Home Environmental Sampling

- Interior Dust

- Exterior Dust

- Water

Ambient Air Sampling

-PM2.5 6 days/week

-1 week/season

Neuropsychological Assessment

-Child IQ

-BASC-2

-CVLT-C

-Standardized Achievement Test

Neuromotor Assessment

-Grooved Pegboard

-Fingertapping

-Postural Balance

Biological Measures

Whole Blood: Pb, Mn, Cd, Hg Serum: Fe, transferrin and whole blood CBC; 

Hair: Mn; Tooth: Mn (prenatal and postnatal)

Toe Nails

Exposure Assessment Biomarkers

Study Cohort

7-9 year 

old children

N = 400

Health Assessment
Harvard-type PM2.5 impactor

– Marietta: 

• 6 days/week every week 

• 2 years

• 271 total samples

– Cambridge: 

• 6 days/week 1 week/season

• 2 years

• 25 total samples

Stationary Air Sampling
Cambridge Air Sampling
Cambridge Air Sampling

Marietta Air Sampling
Cambridge Air Sampling

Marietta Air Sampling

Mn Air Concentration (ng/m3)

Mean (SD) Range

Marietta

18.13 

(18.73) <DL - 102.99

Cambridge

4.26 

(3.56) <DL - 15.01
Cambridge Air Sampling

Marietta Air Sampling Mn Air Concentration 

(ng/m3)

Mean

(SD) Range

Marietta

18.13 

(18.73)

<DL -

102.99

Cambridge

4.26 

(3.56)

<DL -

15.01

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

1999200020012002200320042005200620072008200920102011
Personal Air Sampling

• Recruited from CARES participants 

from non-smoking households

• Personal Modular Impactor, PM2.5

sampler worn/nearby for 48hr. 

• 38 children have complete data

• Conducted over two Spring seasons
Haynes et al., Sci of Total Environ 2010

•90% of the child’s time was 

spent either at Home (70%) 

or School (20%)

TWD= (Time@Home*Distance) + (Time @School*Distance)

Total Sampling Time
Stationary Air Mn, TWD, and Wind Speed were Significantly 

Associated with Personal Air Mn Concentration

Variable

Parameter 

Estimate t-value

95% C.I.

p-value

Intercept 2.84 2.07 0.04 – 5.64 0.05

Log Stationary Mn (ng/m3) 0.51 0.24 0.3 – 0.99 0.04*

Time Weighted Distance 

(km) -0.075 -2.45

-0.13 - -0.01

0.02*

Wind Index -0.32 -0.85 -1.07 – 0.44 0.40

Wind Speed (km/hr) -0.44 -2.21 -0.18 - -0.01 0.03*

Average Precipitation (cm) -0.44 -1.73 -0.96 – 0.08 0.09

Age -0.004 -0.02 -0.35 – 0.34 0.98

Gender -0.03 -0.11 -0.58 – 0.52 0.91
Personal Air Mn Concentration was slightly related to 

Blood Mn Concentration, but this relationship was 

not statistically significant

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Log personal air Mn (ng/cubic meter)

5

7

9

11

13

15

Blood Mn (microg/L)
Quantifying Postural Balance/Sway

Model ACS-110, Advanced Mechanical Technology Inc. (AMTI), Watertown, 

MA

Mean Sway Length (SL)

Center of Pressure

Total distance traveled by 

Center of Pressure

Area enclosed inside the 

perimeter outlined by the C of P 

movement pattern 

Total distance traveled by 

Center of Pressure

Mean Sway Area (SA)
Control

Eyes Open Firm Surface 

-3.5

-2.5

-1.5

-0.5

0.5

1.5

2.5

3.5

-3.5 -2.5 -1.5 -0.5 0.5 1.5 2.5 3.5

Stabilogram

Postural Balance is Sensitive Measure for Motor Function

• Exclusion Criteria:

• Consumption of alcohol in 

last 24 hours

• History of.... – Meniere’s disease

– Multiple sclerosis

– Parkinson’s disease

– Legal Blindness

– Stroke

– Seizures

– Ear Infection within 2 weeks of testing

• Difficulty standing unaided 

for at least 1 minute

• Pain and discomfort from 

standing 3 minutes
Stabilograms of 

Study Participants

Control

Eyes Open Firm Surface 

-3.5

-2.5

-1.5

-0.5

0.5

1.5

2.5

3.5

-3.5 -2.5 -1.5 -0.5 0.5 1.5 2.5 3.5

Marietta Subject

Eye Open Firm Surface

-3.5

-2.5

-1.5

-0.5

0.5

1.5

2.5

3.5

-3.5 -2.5 -1.5 -0.5 0.5 1.5 2.5 3.5

Eyes Open on Firm 

Surface


Residential Location of Pilot Study Balance Participants 

with 2006 Mn AERMOD Concentrations
TRI Mn Emissions from EMI

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
CARES Preliminary Results, 

Unpublished

Standardized Achievement Test Scores Decrease 

10-16 points for ever log Mn Hair Increase
Postural Balance Assessment in CARES

Bhattacharya, A. et al. Neurotoxicology and Teratology. (2006).

Bhattacharya, A. et al. Environmental Health Perspectives. (1990).

Hair Mn is Significantly Associated with Nearly 

Every Balance Testing Condition
CARES Marietta Balance Participants Residential 

Locations With Respect to AERMOD 2006

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

1999200020012002200320042005200620072008200920102011