A 10-year study of factors associated with alcohol treatment use and non-use in a U.S. population sample.

BACKGROUND: This study seeks to identify changes in perceived barriers to alcohol treatment and predictors of treatment use between 1991-92 and 2001-02, to potentially help understand reported reductions in treatment use at this time. Social, economic, and health trends during these 10 years provide a context for the study. METHODS: Subjects were Whites, Blacks, and Hispanics. The data were from the National Longitudinal Alcohol Epidemiologic Survey (NLAES) and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We conducted two analyses that compared the surveys on: (1) perceived treatment barriers for subjects who thought they should get help for their drinking, and (2) variables predicting past-year treatment use in an alcohol use disorder subsample using a multi-group multivariate regression model. RESULTS: In the first analysis, those barriers that reflected negative beliefs and fears about seeking treatment as well as perceptions about the lack of need for treatment were more prevalent in 2001-02. The second analysis showed that survey year moderated the relationship between public insurance coverage and treatment use. This relationship was not statistically significant in 1991-92 but was significant and positive in 2001-02, although the effect of this change on treatment use was small. CONCLUSIONS: Use of alcohol treatment in the U.S. may be affected by a number of factors, such as trends in public knowledge about treatment, social pressures to reduce drinking, and changes in the public financing of treatment.

Effects of socioeconomic status and health care access on low levels of human papillomavirus vaccination among Spanish-speaking Hispanics in California.

Little is known about the effect of language preference, socioeconomic status, and health care access on human papillomavirus (HPV) vaccination. We examined these factors in Hispanic parents of daughters aged 11 to 17 years in California (n = 1090). Spanish-speaking parents were less likely to have their daughters vaccinated than were English speakers (odds ratio [OR] = 0.55; 95% confidence interval [CI] = 0.31, 0.98). Adding income and access to multivariate analyses made language nonsignificant (OR = 0.68; 95% CI = 0.35, 1.29). This confirms that health care use is associated with language via income and access. Low-income Hispanics, who lack access, need information about free HPV vaccination programs.

Alcohol availability and neighborhood poverty and their relationship to binge drinking and related problems among drinkers in committed relationships.

The authors examined the relationship of alcohol outlet density (AOD) and neighborhood poverty with binge drinking and alcohol-related problems among drinkers in married and cohabitating relationships and assessed whether these associations differed across sex. A U.S. national population couples survey was linked to U.S. Census data on AOD and neighborhood poverty. The 1,784 current drinkers in the survey reported on their binge drinking, alcohol-related problems, and other covariates. AOD was defined as the number of alcohol outlets per 10,000 persons and was obtained at the zip code level. Neighborhood poverty was defined as having a low (<20%) or high (≥20%) proportion of residents living in poverty at the census tract level. We used logistic regression for survey data to estimate odds ratios and 95% confidence intervals and tested for differences of associations by sex. Associations of neighborhood poverty with binge drinking were stronger for male than for female drinkers. The association of neighborhood poverty with alcohol-related problems was also stronger for men than for women. We observed no relationships between AOD and binge drinking or alcohol-related problems in this couples survey. Efforts to reduce binge drinking or alcohol-related problems among partners in committed relationships may have the greatest impact if targeted to male drinkers living in high-poverty neighborhoods. Binge drinking and alcohol-related problems, as well as residence in an impoverished neighborhood are risk factors for intimate partner violence (IPV) and other relationship conflicts.

Hexabromocyclododecane (HBCD) stereoisomers in U.S. food from Dallas, Texas.

BACKGROUND: Hexabromocyclododecane (HBCD) is a brominated flame retardant used in polystyrene foams in thermal insulation and electrical equipment. The HBCD commercial mixture consists mainly of α, ß, and γ stereoisomers. Health concerns of HBCD exposure include alterations in immune and reproductive systems, neurotoxic effects, and endocrine disruption. Stereoisomer-specific levels of HBCD have not been measured previously in U.S. food. OBJECTIVES: We measured HBCD stereoisomer levels in U.S. foods from Dallas, Texas, supermarkets. METHODS: Convenience samples of commonly consumed foods were purchased from supermarkets in Dallas in 2009-2010. Food samples included a wide variety of lipid-rich foods: fish, peanut butter, poultry, pork, and beef. Thirty-six individual food samples were collected in 2010 and analyzed for α-, ß-, and γ-HBCD stereoisomers using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Ten pooled food samples previously collected in 2009 for a study of total HBCD levels using gas chromatography-mass spectrometry (GC-MS), were reanalyzed for α-, ß-, and γ-HBCD stereoisomers using LC-MS/MS. RESULTS: Of the 36 measured individual foods, 15 (42%) had detectable levels of HBCD. Median (ranges) of α- and γ-HBCD concentrations were 0.003 (< 0.005-1.307) and 0.005 (< 0.010-0.143) ng/g wet weight (ww), respectively; ß-HBCD was present in three samples with a median (range) of 0.003 (< 0.005-0.019) ng/g ww. Median levels (range) for α-, ß-, and γ-HBCD, in pooled samples were 0.077 (0.010-0.310), 0.008 (< 0.002-0.070), and 0.024 (0.012-0.170) ng/g ww, respectively. CONCLUSIONS: α-HBCD was detected most frequently and at highest concentrations, followed by γ-, and then ß-HBCD, in food samples from Dallas, Texas. Food may be a substantial contributor to the elevated α-HBCD levels observed in humans. These data suggest that larger and more representative sampling should be conducted.

Polyfluoroalkyl compounds in Texas children from birth through 12 years of age.

BACKGROUND: For > 50 years, polyfluoroalkyl compounds (PFCs) have been used worldwide, mainly as surfactants and emulsifiers, and human exposure to some PFCs is widespread. OBJECTIVES: Our goal was to report PFC serum concentrations from a convenience sample of Dallas, Texas, children from birth to < 13 years of age, and to examine age and sex differences in PFC concentrations. METHODS: We analyzed 300 serum samples collected in 2009 for eight PFCs by online solid phase extraction-high performance liquid chromatography-isotope dilution-tandem mass spectrometry. RESULTS: Perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) were detected in > 92% of participants; the other PFCs measured were detected less frequently. Overall median concentrations of PFOS (4.1 ng/mL) were higher than those for PFOA (2.85 ng/mL), PFNA (1.2 ng/mL), and PFHxS (1.2 ng/mL). For PFOS, PFOA, PFNA, and PFHxS, we found no significant differences (p < 0.05) by sex, significantly increasing concentrations for all four chemicals by age, and significantly positive correlations between all four compounds. CONCLUSIONS: We found no significant differences in the serum concentrations of PFOS, PFOA, PFNA, and PFHxS by sex, but increasing concentrations with age. Our results suggest that these 300 Texas children from birth through 12 years of age continued to be exposed to several PFCs in late 2009, years after changes in production of some PFCs in the United States.

Hispanic Americans Baseline Alcohol Survey (HABLAS): effects of container size adjustments on estimates of alcohol consumption across Hispanic national groups.

OBJECTIVE: This study was conducted to examine discrepancies in alcohol consumption estimates between a self-reported standard quantity-frequency measure and an adjusted version based on respondents' typically used container size. METHOD: Using a multistage cluster sample design, 5,224 Hispanic individuals 18 years of age and older were selected from the household population in five metropolitan areas of the United States: Miami, New York, Philadelphia, Houston, and Los Angeles. The survey-weighted response rate was 76%. Personal interviews lasting an average of 1 hour were conducted in respondents' homes in either English or Spanish. RESULTS: The overall effect of container adjustment was to increase estimates of ethanol consumption by 68% for women (range across Hispanic groups: 17%-99%) and 30% for men (range: 14%-42%). With the exception of female Cuban American, Mexican American, and South/Central American beer drinkers and male Cuban American wine drinkers, all percentage differences between unadjusted and container-adjusted estimates were positive. Second, container adjustments produced the largest change for volume of distilled spirits, followed by wine and beer. Container size adjustments generally produced larger percentage increases in consumption estimates for the higher volume drinkers, especially the upper tertile of female drinkers. CONCLUSIONS: Self-reported alcohol consumption based on standard drinks underreports consumption when compared with reports based on the amount of alcohol poured into commonly used containers.

Does flying present a threat of polybrominated diphenyl ether exposure?

OBJECTIVE: To investigate possible exposure to polybrominated diphenyl ethers (PBDEs) in US professional airline workers. METHODS: We recruited 30 healthy US professional airline workers who lived in the Dallas, Texas, area to test their blood PBDE levels. We examined the relationship between hours worked in an airplane and total PBDE blood levels. RESULTS: Total PBDE blood levels from the 30 volunteers were unremarkable despite minor elevations of certain congeners in a few volunteers. No statistically significant correlations were noted between hours in airplanes in the past 1 or 5 years and levels of individual brominated diphenyl ethers congeners or total PBDEs. CONCLUSIONS: We hypothesized that elevated PBDE levels in commercial aviation workers could be found associated with time spent in airliners. Our findings do not support such an association.

Bisphenol A (BPA) in U.S. food.

Bisphenol A (BPA) is a chemical used for lining metal cans and in polycarbonate plastics, such as baby bottles. In rodents, BPA is associated with early sexual maturation, altered behavior, and effects on prostate and mammary glands. In humans, BPA is associated with cardiovascular disease, diabetes, and male sexual dysfunction in exposed workers. Food is a major exposure source. We know of no studies reporting BPA in U.S. fresh food, canned food, and food in plastic packaging in peer reviewed journals. We measured BPA levels in 105 fresh and canned foods, foods sold in plastic packaging, and in cat and dog foods in cans and plastic packaging. We detected BPA in 63 of 105 samples, including fresh turkey, canned green beans, and canned infant formula. Ninety-three of these samples were triplicates which had similar detected levels. Detected levels ranged from 0.23 to 65.0 ng/g ww and were not associated with type of food or packaging but did vary with pH. BPA levels were higher for foods of pH 5 compared to more acidic and alkaline foods. Detected levels were comparable to those found by others. Further research is indicated to determine BPA levels in U.S. food in larger, representative sampling.

Dietary intake is associated with phthalate body burden in a nationally representative sample.

BACKGROUND: Phthalates are compounds that are used in a wide range of consumer products. However, the contribution of dietary intake to phthalate exposure has not been well defined. OBJECTIVE: The objective of this study was to assess the contribution of different food types to phthalate exposure. Phthalates are chemicals of concern because of the high levels measured in people and the environment, as well as the demonstrated toxicity in animal studies and limited epidemiological studies. Previous research, although limited, has suggested that phthalates contaminate food in various countries. METHODS: We conducted an exploratory analysis of data collected as part of the 2003-2004 National Health and Nutrition Examination Survey (NHANES). Associations between dietary intake (assessed by a 24-hr dietary recall) for a range of food types (meat, poultry, fish, fruit, vegetable, and dairy) and phthalate metabolites measured in urine were analyzed using multiple linear regression modeling. RESULTS: We found that metabolites of di-(2-ethylhexyl) phthalate (DEHP) and high-molecular-weight phthalate metabolites were associated with the consumption of poultry. Monoethyl phthalate, the metabolite of diethyl phthalate (DEP), was associated with vegetable consumption, specifically tomato and potato consumption. DISCUSSION: These results, combined with results from previous studies, suggest that diet is an important route of intake for phthalates. Further research is needed to determine the sources of food contamination with these toxic chemicals and to describe the levels of contamination of U.S. food in a large, representative U.S. sample.

Polybrominated diphenyl ether levels in foodstuffs collected from three locations from the United States.

OBJECTIVES: The objectives of this study were to provide updated measurements of PBDEs in US food, to estimate possible difference in levels from differing geographical regions, and to provide an improved estimate of current dietary intake. METHODS: Thirty matched food samples for a total of 90 samples were collected from each of three cities (Los Angeles, California; Dallas, Texas; and Albany, New York) and were analyzed for 13 polybrominated diphenyl ether congeners (BDE 28, 47, 49, 66, 85, 99, 100, 138, 153, 154, 183, 203, and 209). Dietary intake of PBDEs was estimated by food type, age, and sex. RESULTS: In this pilot study, we did not note a statistically significant difference in total PBDE levels in food collected from the three locations. The median total PBDE levels (estimating non-detected values as half of the detection limit) in meat, dairy, eggs, and fish were 267 pg/g wet weight (ww) (range 102-3156 pg/g ww), 176 pg/g ww (range 41-954 pg/g ww), 637 pg/g ww (range 193-932 pg/g ww), and 243 pg/g ww (range 36-2161 pg/g ww). PBDE intake from food was estimated to range from 2.7 ng/kg/day for children 2 through 5 years of age to 0.8 ng/kg/day for women aged 60 years and older. This compares closely with our previous study where the intake estimate was 2.7 ng/kg/day for children 2 through 5 years of age and 0.9 ng/kg/day for women aged 60 years and older. CONCLUSION: We did not find a decrease of PBDEs in food since our previous studies which we expected to find due to the declining use of PBDEs in the USA. These findings could be consistent with food contamination from depot sources of PBDEs. A larger, more representative sampling of the US food supply is indicated based on our findings.

Neighborhood characteristics as predictors of male to female and female to male partner violence.

This article examines the association between neighborhood characteristics at the census tract-level, couples' perceived neighborhood social cohesion and informal social control, and male-to-female (MFPV) and female-to-male (FMPV) partner violence in the United States. Data come from a second wave of interviews (2000) with a national sample of couples 18 years of age and older who were first interviewed in 1995. The path analysis shows that poverty is associated with perceived social cohesion and perceived social control as hypothesized. However, there is no significant mediation effect for social control or social cohesion on any type of violence. In the path analysis, Black ethnicity is associated with social cohesion, which is associated with MFPV. Intimate partner violence (IPV), as a form of domestic violence, may not be as concentrated in high-poverty neighborhoods as criminal violence. IPV may be more determined by personal and dyadic characteristics than criminal violence.

Reliability of self-reported childhood physical abuse by adults and factors predictive of inconsistent reporting.

Little is known about the reliability of self-reported child physical abuse (CPA) or CPA reporting practices. We estimated reliability and prevalence of self-reported CPA and identified factors predictive of inconsistent CPA reporting among 2,256 participants using surveys administered in 1995 and 2000. Reliability of CPA was fair to moderate (kappa = 0.41). Using a positive report from either survey, the prevalence of moderate (61.8%) and severe (12.0%) CPA was higher than at either survey alone. Compared to consistent reporters of having experienced CPA, inconsistent reporters were less likely to be > or = 30 years old (vs. 18-29) or Black (vs. White) and more likely to have < 12 years of education (vs. 12), have no alcohol-related problems (vs. having problems), or report one type (vs. > or = 2) of CPA. These findings may assist researchers conducting and interpreting studies of CPA.

Reactivity to alcohol assessment measures: an experimental test.

AIMS: Previous research has suggested that alcohol screening and assessment may affect drinking. DESIGN: This study was a randomized test of reactivity to alcohol assessment questionnaires among a group of heavy drinking college students. SETTING AND PARTICIPANTS: A total of 147 university students completed a screening questionnaire and were randomized to either immediate assessment or delayed assessment. The immediate assessment group completed a set of drinking questionnaires at baseline, 3, 6 and 12 months, while the delayed assessment group completed questionnaires only at 12 months. MEASUREMENTS: Primary outcomes included overall volume of drinking, risky drinking and use of risk reduction behaviors. FINDINGS: We found a significant effect of assessment on measures of risky drinking and risk reduction behaviors, but not on overall volume of drinking. Specifically, at 12 months, participants who had previously completed drinking assessments had a lower peak blood alcohol concentration (BAC) (d = -0.373), were more likely to report a low score on the Alcohol Use Disorders Identification Test (AUDIT; odds ratio = 2.55) and tended to use more strategies to moderate their alcohol consumption (d = 0.352). Risk reduction behaviors that were affected tended to be those that limited alcohol consumption, rather than those that minimized consequences. CONCLUSIONS: These results may have implications for the development of brief interventions.

Television viewing and snacking behaviors of fourth- and eighth-grade schoolchildren in Texas.

INTRODUCTION: Child and adolescent overweight is a serious health issue. Both snacking and television watching have been associated with childhood overweight, but the relationships have not been well examined in a multiethnic population. The aim of this study was to examine relationships between weekday television viewing, snack consumption, consumption of foods advertised on television, and overweight status of a multiethnic sample of fourth- and eighth-grade schoolchildren in Texas. METHODS: This study is a secondary analysis of data from the School Physical Activity and Nutrition monitoring system, a validated survey with objective measures of height and weight. The sample of 11,594 children in the fourth and eighth grades was weighted to provide data representative of children in Texas public schools. Children were categorized on the basis of self-reported daily television viewing, snack consumption, and consumption of foods advertised on television. Multiple logistic regression was used to analyze, by grade level, the differences in the prevalence of overweight by category. RESULTS: Television viewing, frequency of snack consumption, and consumption of foods advertised on television were all positively related to one another. In general, both consuming more snacks and foods advertised on television were associated with reduced odds of overweight regardless of the amount of television watched. CONCLUSION: The results suggest that the relationships between weekday snacking behaviors and television viewing in a multiethnic population are complicated. When these behaviors are clustered, overweight status may be related more to the number of snacks consumed than to the amount of television watched. To determine the exact relationship, additional research, especially among Hispanic children, is warranted.

A newly recognized occupational hazard for US electronic recycling facility workers: polybrominated diphenyl ethers.

OBJECTIVE: To describe a newly recognized US occupational health hazard, polybrominated diphenyl ether (PBDE) flame retardant exposure, to US workers at electronics recycling facilities to communicate this information to occupational medicine physicians and related health workers. METHODS: Using PBDE air values reported from a California electronic recycling facility and estimates of US food, air and dust intake, electronic recycling facility workers' PBDE exposure at this facility was estimated using multiple possible scenarios. We compared these estimates to intake estimates for the US general population. Occupational PBDE study findings from China, Sweden, and Norway where elevated environmental or blood PBDE levels were detected in similar workers are reviewed. RESULTS: An approximate 6-fold to 33-fold increase in the electronic recycling facility workers' PBDE exposure was estimated compared with the US general population. CONCLUSION: PBDE exposure in US electronic recycling facilities is a largely unrecognized occupational health hazard. The extent of worker exposure in the US should be better characterized and steps taken to lower levels of PBDEs in the workplace where exposure exists. Health care providers, plant safety professionals, and government agencies can play a role in recognizing the problem and in decreasing worker exposure.

Construct, concurrent and predictive validity of the URICA: data from two multi-site clinical trials.

BACKGROUND: A better understanding of how to measure motivation to change and how it relates to behavior change in patients with drug and alcohol dependence would broaden our understanding of the role of motivation in addiction treatment. METHODS: Two multi-site, randomized clinical trials comparing brief motivational interventions with standard care were conducted in the National Institute on Drug Abuse Clinical Trials Network. Patients with primary drug dependence and alcohol dependence entering outpatient treatment participated in a study of either Motivational Enhancement Therapy (n=431) or Motivational Interviewing (n=423). The construct, concurrent, and predictive validity of two composite measures of motivation to change derived from the University of Rhode Island Change Assessment (URICA): Readiness to Change (RTC) and Committed Action (CA) were evaluated. RESULTS: Confirmatory factor analysis confirmed the a priori factor structure of the URICA. RTC was significantly associated with measures of addiction severity at baseline (r=.12-.52, p<.05). Although statistically significant (p<.01), the correlations between treatment outcomes and RTC were low (r=-.15 and -18). Additional analyses did not support a moderating or mediating effect of motivation on treatment retention or substance use. CONCLUSIONS: The construct validity of the URICA was confirmed separately in a large sample of drug- and alcohol-dependent patients. However, evidence for the predictive validity of composite scores was very limited and there were no moderating or mediating effects of either measure on treatment outcome. Thus, increased motivation to change, as measured by the composite scores of motivation derived from the URICA, does not appear to influence treatment outcome.

Dismantling motivational interviewing and feedback for college drinkers: a randomized clinical trial.

Motivational interviewing (MI) is a counseling style that has been shown to reduce heavy drinking among college students. To date, all studies of MI among college students have used a format that includes a feedback profile delivered in an MI style. This study was a dismantling trial of MI and feedback among heavy-drinking college students. After an initial screen, 279 heavy-drinking students were randomized to (a) Web feedback only, (b) a single MI session without feedback, (c) a single MI session with feedback, or (d) assessment only. At 6 months, MI with feedback significantly reduced drinking, as compared with assessment only (effect size = .54), MI without feedback (effect size = .63), and feedback alone (effect size = .48). Neither MI alone nor feedback alone differed from assessment only. Neither sex, race or ethnicity, nor baseline severity of drinking moderated the effect of the intervention. Norm perceptions mediated the effect of the intervention on drinking. MI with feedback appears to be a robust intervention for reducing drinking and may be mediated by changes in normative perceptions.

Limitations in the use of potassium dichromate as a blood preservative for the analysis of organohalogenated compounds: two month results.

For analysis of organochlorine contaminants in human tissue, the "gold standard" for preservation, storage, and shipping is usually freezing. However, this method can be difficult, if samples are taken in remote areas, and costly, when the samples must be shipped on dry ice. Therefore, a more simple and cost effective method of preservation is essential for remote field work. Potassium dichromate (K(2)Cr(2)O(7)) has been successfully employed in the preservation of human and cows' milk as well as chicken eggs. Our previous studies described the use of potassium dichromate for preservation of whole blood for analysis of dioxins, dibenzofurans, and PCBs. Potassium dichromate was found to successfully preserve blood at room temperature for 34 d with no significant differences in the measured concentrations of chemical contaminants or blood lipid level when compared to frozen samples. However, in a follow-up study, 3 months and 6 months of potassium dichromate preservation proved inadequate to preserve the samples for organic pollutant analysis. We noted that the lipid portion of the blood in the chemically preserved samples was declining in level or degrading, while the persistent organic pollutants remained intact at the same levels on a whole weight basis. To narrow down the window of efficacy for the use of potassium dichromate to preserve blood samples for analysis, the present study compared chemical preservation to freezing for an intermediate time period, 2 months. Similar to our previous findings at 3 and 6 months, at 2 months significant lipid degradation was observed in the chemically preserved samples. Chemically preserved samples had significantly higher levels of organochlorine contaminants (dioxins, dibenzofurans, and PCBs) when measured on a blood lipid basis but not on a wet weight basis compared to frozen samples. While 2 months of potassium dichromate preservation was not useful for obtaining accurate measure of dioxins, furans, and PCBs on a lipid basis, previous studies found this method of preservation to be useful for at least one month (Schecter, A., Pavuk, M., Päpke, O., Malisch, R., 2004. The use of potassium dichromate and ethyl alcohol as blood preservatives for analysis of organochlorine contaminants. Chemosphere 57, 1-7). However blood stored at -70 degrees C and at 22 degrees C with potassium dichromate gave similar results when expressed on a wet weight basis.

Readiness to change among a group of heavy-drinking college students: correlates of readiness and a comparison of measures.

OBJECTIVE: Although several multi-item scales assess readiness to change alcohol consumption, some researchers have proposed that a small number of single-item rulers may assess readiness nearly as well. PARTICIPANTS: In fall 2006 and spring 2007, the authors assessed 279 participants who reported at least 1 heavy drinking episode in the 2 weeks prior to the survey. METHODS: The authors compared answers from the Readiness to Change Questionnaire with rulers measuring importance and confidence regarding change. RESULTS: Importance correlated strongly with readiness to change, whereas confidence correlated negatively and less strongly with readiness. The validity of the importance ruler as a proxy for readiness was supported by its correlations with several measures of patterns of alcohol use, as well as its precursors and consequences. CONCLUSIONS: Given the strong correlation between the importance ruler and the Readiness to Change score, this method may have practical utility as a brief assessment tool. Adding confidence as a second dimension slightly improved the ability to predict readiness.

Brominated flame retardants in US food.

We and others recently began studying brominated flame retardant levels in various matrices in the US including human milk and other food. This paper reviews the food studies. In our studies, ten to thirteen polybrominated diphenyl ether (PBDE) congeners were measured, usually including BDE 209. All US women's milk samples were contaminated with PBDEs from 6 to 419 ng/g, lipid, orders of magnitude higher than levels reported in European studies, and are the highest reported worldwide. We compared our market basket studies of meat, fish and dairy products with other US food studies of meat and fish. US studies showed somewhat higher levels of PBDEs than reported elsewhere. Fish were most highly contaminated (median 616 pg/g), then meat (median190 pg/g) and dairy products (median 32.2 pg/g). However, unlike some European countries where fish predominates, dietary intake of PBDEs in the US is mostly from meat, then fish and then dairy products. Broiling can decrease the amount of PBDEs per serving. We also measured levels of hexabromocyclododecane (HBCD), another brominated flame retardant, in human milk. The levels are lower than PBDEs, 0.16-1.2 ng/g, similar to European levels, unlike PBDEs where US levels are much higher than European levels.