Research Polychlorinated Biphenyl (PCB) Exposure and Diabetes: Results from the Anniston Community Health Survey Allen E. Silverstone,1 Paula F. Rosenbaum,1 Ruth S. Weinstock,1,2 Scott M. Bartell,3 Herman R. Foushee,4 Christie Shelton,5 and Marian Pavuk,6 for the Anniston Environmental Health Research Consortium* 1State University of New York Upstate Medical University, Syracuse, New York, USA; 2Department of Veterans Affairs Medical Center, Syracuse, New York, USA; 3University of California–Irvine, Irvine, California, USA; 4University of Alabama–Birmingham, Birmingham, Alabama, USA; 5Jacksonville State University, College of Nursing and Health Sciences, Jacksonville, Alabama, USA; 6Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, USA Background : Polychlorinated biphenyls (PCBs) manufactured in Anniston, Alabama, from 1929 to 1971 caused significant environmental contamination. hTe Anniston population remains one of the most highly exposed in the world. o Bjectivs : Reports of increased diabetes in PCB-exposed populations led us to examine possible associations in Anniston residents. Methods : Volunteers (n = 774) from a cross-sectional study of randomly selected households and adults who completed the Anniston Community Health Survey also underwent measurements of height, weight, fasting glucose, lipid, and PCB congener levels and verification of medications. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the relationships between PCBs and diabetes, adjusting for diabetes risk factors. Participants with prediabetes were excluded from the logistic regression analyses. r tluse : Participants were 47% African American, 70% female, with a mean age of 54.8 years. hTe prevalence of diabetes was 27% in the study population, corresponding to an estimated prevalence of 16% for Anniston overall; the PCB body burden of 35 major congeners ranged from 0.11 to 170.42 ppb, wet weight. hTe adjusted OR comparing the prevalence of diabetes in the fifth versus first quintile of serum PCB was 2.78 (95% CI: 1.00, 7.73), with similar associations estimated for second through fourth quintiles. In participants < 55 years of age, the adjusted OR for diabetes for the highest versus lowest quintile was 4.78 (95% CI: 1.11, 20.6), whereas in those ≥ 55 years of age, we observed no significant associations with PCBs. Elevated diabetes prevalence was observed with a 1 SD increase in log PCB levels in women (OR = 1.52; 95% CI: 1.01, 2.28); a decreased prevalence was observed in men (OR = 0.68; 95% CI: 0.33, 1.41). c onclusion : We observed significant associations between elevated PCB levels and diabetes mostly due to associations in women and in individuals < 55 years of age. k ey w ords : diabetes, epidemiology, polychlorinated biphenyls (PCBs), POPs. Environ Health Perspect 120:727–732 (2012). http://dx.doi.org/10.1289/ehp.1104247 [Online 14 February 2012] Diabetes incidence is increasing worldwide. Increasing obesity and sedentary lifestyle are major risk factors, but other environmental factors may also be important. Toxicants such as polychlorinated biphenyls (PCBs) and dioxins are postulated to play a role, based on data from the National Health and Nutrition Examination Survey (NHANES) (Lee et al. 2006, 2007) and studies from the Slovak Republic (Langer et al. 2002; Radikova et al. 2004), Sweden (Lee et al. 2011a), Japan (Tanaka et al. 2011; Uemura et al. 2008), Taiwan (Wang et al. 2008), and the United States (Codru et al. 2007; Lee et al. 2010, 2011b; Persky et al. 2011; Turyk et al. 2009a, 2009b; Vasiliu et al. 2006), but the results are inconsistent. In addition, commentaries (Jones et al. 2008; Porta 2006) have emphasized the need for additional research. PCBs were produced in Anniston, Alabama, from 1929 to 1971 in a plant that was purchased by the Monsanto Corporation in 1935. Large amounts of PCB-containing waste discharged during pro- duction were revealed during litigation in Anniston (Grunwald 2002), with widespread contamination of soil, sediment, and air still found in the late 1990s [Agency for Toxic Substances and Disease Registry (ATSDR) 2000]. Evaluation of PCB levels in sera from adults in Anniston collected from 1996 to 1999 in smaller nonsystematic studies, or as a part of litigation, indicated that this was one of the most highly exposed communities in the world (ATSDR 2000; Hansen et al. 2003). In 2003, the ATSDR awarded fund- ing to the Anniston Environmental Health Research Consortium (AEHRC) to conduct a health survey in Anniston adults. In this study, we examined the prevalence of diabetes in this population and the association of their serum PCB levels with diabetes. Methods Study population. The Anniston Community Health Survey employed a two-stage sampling procedure in which 3,320 households were randomly selected from a commercial list of all residential sites within the city limits. Addresses in west Anniston, the location of the former PCB manufacturing facility, were over- sampled. All sampled addresses were visited Environmental Health Perspectives • volume 120 | number 5 | May 2012 by study staff: 489 were found to be vacant or nonresidential, and residents of 890 could not be contacted after multiple attempts. Contact was made with a member of each of the remaining 1,823 targeted households, and 713 declined to participate. Among the remaining 1,110 consenting households, an adult > 18 years of age was randomly selected for survey completion, resulting in an overall participation rate of 61% (1,110/1,823). The study was reviewed and approved by the University of Alabama–Birmingham’s Institutional Review Board, and all participants provided written informed consent. Data collection. The Anniston Community Health Survey included a 45-page question- naire developed by the AEHRC. Demographic information, medical and family history, and health behaviors were recorded. The survey was administered by trained interviewers at Address correspondence to A.E. Silverstone, Department of Microbiology and Immunology, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY 13210 USA. Telephone: (315) 464-5871. Fax: (315) 464-4417. E-mail: silversa@ upstate.edu *Other Consortium Steering Committee members: S. Baker (community representative), D.O. Carpenter [State University of New York (SUNY) Albany], J. Cash [formerly of Jacksonville State University (JSU)], H. Frumkin [formerly of the Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR)], R. Johnson (University of Alabama–Tuscaloosa), M. Lavender (formerly at JSU), M. Michael [University of Alabama–Birmingham (UAB)], K. Moysich (Roswell Park Cancer Institute), J. Olson (SUNY Buffalo), and A. Percy (UAB). The efforts of the staff of the the Anniston Environmental Health Research Consortium, espe- cially T. Pass, were essential to gathering data and sera from study participants. We thank P. Wolf (UAB) for help in acquiring the survey data and W. Turner, A. Sjödin, L. Needham (deceased), and D. Patterson (formerly) of the Division of Laboratory Sciences of the National Center for Environmental Health, CDC) for the analyses of polychlorinated biphenyls and chlorinated pesticides. This work was funded by grant U50/ATU473215 from the Agency for Toxic Substances and Disease Registry (C. Shelton, principal investigator) and the Anniston Environmental Health Consortium, Polychlorinated Biphenyls Exposure and Adverse Health Effects in Anniston, AL. The authors declare they have no actual or potential competing financial interests. Received 21 July 2011; accepted 14 February 2012. 727