State Hygienic Lab receives CDC funding for new statewide biomonitoring program

A new project led by the State Hygienic Lab will analyze the presence of environmental hazards in well water and households across the state.

The award, which includes $728,016 in funding for the first year of the project, is one of six projects funded by the Centers for Disease Control (CDC) for statewide biomonitoring programs.

CPH Contributors to Biomonitoring Program


  • Bill Field, professor of occupational and environmental health, and Wei Bao, assistant professor of epidemiology, will serve as co-investigators of the CDC-funded grant entitled Iowa Environmental Hazard Exposure Assessment through Biomonitoring Surveillance.
  • Funding of the grant builds, in part, on the work of the Iowa Institute of Public Health Research and Policy’s Neonicotinoid Collaboratory led by Field and furthers one of the primary goals of the collaboratory: “to develop an expandable network of collaborators and stakeholders to facilitate surveillance, research, education, and future policy development to identify and understand human exposure and health risks from neonicotinoid insecticides.”
  • The new grant also builds on Bao’s previous research on toxic metals and endocrine disruptors supported by seed funds from the College of Public Health’s New Faculty Research Award, the UI Environmental Health Sciences Research Center (EHSRC), and the UI Center for Health Effects of Environmental Contamination (CHEEC).
  • Hans-Joachim Lehmler, professor of occupational and environmental health, and Paul Romitti, professor of epidemiology, serve on the advisory board for this grant.
  • Darrin Thompson, doctoral fellow in occupational and environmental health, will be involved in the surveillance of neonicotinoid insecticides. Thompson also serves as the associate director of CHEEC.
  • Buyun Liu, postdoctoral research scholar in epidemiology, will be involved in data analysis of the surveillance project. She is the principal investigator of bisphenols-related pilot grants from the EHSRC.

Biomonitoring is the direct measurement of environmental chemicals in people’s blood and urine, indicating the amount of chemical that actually enters the body from all environmental sources. Iowa’s new biomonitoring program will examine three hazard categories: naturally occurring contaminants, agricultural chemicals, and industrial chemicals.

“Biomonitoring data can inform important public health decisions,” said Susie Dai, environmental lab director at the State Hygienic Lab. “By launching a new statewide biomonitoring program, we will be better positioned to access exposures of concern in Iowa communities and identify at-risk populations.”

The first of two studies that Dai’s team will conduct will measure the presence of naturally occurring contaminants such as metals, industrial chemicals such as endocrine disruptors, and neonicotinoid insecticides in well water, and in individuals who drink well water, in rural areas of the state.

Neonicotinoids are used as insecticides to treat crops such as corn and soybeans, and to control fleas and lice in livestock and pets. Previous research has demonstrated that neonicotinoids are harmful to bumblebees, and potentially other pollinators.

The second study will measure levels of the endocrine disruptor Bisphenol A (BPA) and substitutes in pregnant women in the state. BPA is often used as a base material to produce polycarbonate plastic, and previous studies have indicated that it is a potential disruptor of the endocrine systems in humans and animals. Substitutes such as bisphenol S and bisphenol F are often used in “BPA-free” products, and the effects on pregnancy are largely unknown. “Studying the levels of BPA and substitutes in a high-risk population presents a unique opportunity to assess Iowan’s exposure risks,” said Dai.

“The expanded biomonitoring program in Iowa will enable the State Hygienic Laboratory and the local public health departments to provide accurate and high-quality data that can inform state and local decision-makers,” said Michael Pentella, director of the State Hygienic Laboratory. “The funds will also be used to provide important training to laboratory staff members and local public health professionals.”

The project is a collaboration between the State Hygienic Lab with the Iowa Department of Public Health, the University of Iowa Hospitals and Clinics, University of Iowa College of Public Health, Center for Health Effects of Environmental Contamination, Iowa Poison Center, Iowa Criminal Investigation Lab, and ten local health departments.

A version of this story was originally published by the UI Office of the Vice President for Research.

Lessons from Flint

The researcher who revealed the Flint water crisis talks about speaking up, respecting science, and moving forward.

portrait of Mona Hanna-AttishaFlint, Michigan, was once the embodiment of the American dream. The birthplace of General Motors, the city offered the promise of living wages, good schools, accessible health care, and pension plans.

But by 2015, that dream had become as murky as the drinking water running from the city’s taps. That’s the year that Mona Hanna-Attisha — a pediatrician and professor at Michigan State University — released the results of a pivotal study proving Flint’s children were being exposed to dangerous amounts of lead in their water. Today, the crisis serves as a case study in governmental failure, and Hanna-Attisha — who rallied aid for Flint with her advocacy — continues her crusade to hold the powerful accountable, serve as a voice for working-class families, and lead the effort to rebuild the city’s once flourishing dream.

Hanna-Attisha visited the UI College of Public Health in March 2019, where she gave two talks and met with students. The college selected her book, What the Eyes Don’t See: A Story of Crisis, Resistance, and Hope in an American City, as its annual collegewide book club title. Hanna-Attisha recently answered a few questions about her work and how Flint is doing today.

How meaningful is it to know your book is being studied at the UI and other universities?

To be able to share this story and have others learn from it in hopes they can do similar work has been absolutely inspiring. In my head when I was writing this book, the audience was students — medical students, public health students, undergrads, and high school students — so they could take up these lessons.

The title of the book, What the Eyes Don’t See, is about the people and places and problems all over that we choose not to see. It’s about the power that we all have within us to open our eyes and to not only be awake and alert, but to act when we see things that aren’t right.

In your book you write that there are Flints everywhere. What do you mean by that?

The story of Flint is what happens when you take away democracy. Flint was an egregious example — the city had lost its democracy and was under the control of emergency management. But it’s not isolated to Flint. Throughout the country, there are people who are pre-dominantly poor and of color who are disproportionately burdened by environmental issues.

It’s the story of crumbling infrastructure and what happens when we disrespect science. It’s a “today” story in terms of the denial of climate change and the regulations that protect our air and water quality. And it’s the story of how everyday people said, “We don’t accept the status quo” and spoke up and made a difference in their community.

Do you remember the moment when the enormity of Flint’s problems hit you?

It happened really early, even before I had any of the data in my hands. In the world of lead, you’re supposed to practice something called primary prevention. The only treatment for lead is prevention. So when you hear about the possibility of lead in the environment, you shouldn’t have definitive proof that it’s in somebody’s body, because by then it’s too late. Fundamentally, it’s using children as detectors of contamination.

When I heard about lead being in the water, from that point on I knew it was serious. Unfortunately, I knew that if I was going to get anyone to pay attention to me, I needed that proof of impact. And that’s what our research showed — that yes, the children did have more lead in their blood. But it didn’t need to get to that point. This crisis should have stopped when that first mom said, “Hey, there’s something wrong with my water.”

How is Flint doing today?

We’ve made tremendous progress. Flint’s pipes are almost completely replaced, which is phenomenal. It’ll be only the third city in the country to have replaced its lead pipes. In terms of children’s issues, where I spend my day, we’ve done amazing work. We’re building a model public health program to mitigate the impact of this crisis and promote the development of children. We have things like new childcare centers, literacy support, school health services, mobile grocery stores, and Medicaid expansion. What we hope to do, and what we already are doing, is share our best practices with other cities where children are suffering from very similar toxicities.

One example is that in our clinic, we give every child a nutrition prescription. It’s an actual prescription for healthy food that they can fill at our farmers’ market. Because of the success of that program, it was included in the U.S. farm bill, so it’s become a national program. That’s one of the ways we hope to share what we’re doing to benefit kids all over.

Out of our darkest hour, Flint has set a path forward and built this model program so that we won’t be remembered for this crisis and terrible tragedy, but be remembered for our recovery.

This story appeared in the spring 2019 issue of InSight. A version of this interview originally appeared in the March 2019 issue of Iowa Magazine.

Photo (c) Mike Naddeo

Flint activist, pediatrician Mona Hanna-Attisha will visit the college March 25

All College of Public Health students, faculty, and staff are invited to join a college-wide reading of What the Eyes Don’t See: A Story of Crisis, Resistance, and Hope in an American City by Mona Hanna-Attisha.  It has been selected by the New York Times Book Review as among the ‘100 Notable Books of 2018.’

The book aligns with the University of Iowa’s spring 2019 theme semester, “American Dream.”

Dr. Hanna-Attisha will visit the College of Public Health in March 2019 for several events.

photo of book cover for What the Eyes Don't SeeMonday, March 25

CPH Spotlight Lecture
12:30 pm | Callaghan Auditorium (N110 CPHB)
Lunch will be served at 11:30 am in the CPHB atrium

Public Lecture
7 pm | Callaghan Auditorium (N110 CPHB)
Free and open to the public

Free Books for CPH Students

CPH students will receive a free copy of the book from their department or program — check with your department for details!

Borrow a Book

CPH faculty and staff are invited to borrow a copy of the book from the college for a two-week period. Email to request a book loan or stop by S173 CPHB to pick up a copy.

About the Book

WHAT THE EYES DON’T SEE  the inspiring story of how Dr. Mona Hanna-Attisha, alongside a team of researchers, parents, friends, and community leaders, discovered that the children of Flint, Michigan, were being exposed to lead in their tap water—and then battled her own government and a brutal backlash to expose that truth to the world. Paced like a scientific thriller, What the Eyes Don’t See reveals how misguided austerity policies, broken democracy, and callous bureaucratic indifference placed an entire city at risk. And at the center of the story is Dr. Mona herself—an immigrant, doctor, scientist, and mother whose family’s activist roots inspired her pursuit of justice.

What the Eyes Don’t See is a riveting account of a shameful disaster that became a tale of hope, the story of a city on the ropes that came together to fight for justice, self-determination, and the right to build a better world for their—and all of our—children.

About the Author

portrait of Dr. Mona Hanna-AttishMona Hanna-Attisha, MD, MPH, FAAP, Hurley Children’s Hospital Pediatric Public Health Initiative, an innovative and model public health program in Flint, Michigan. A pediatrician, scientist, and activist, Dr. Hanna-Attisha has testified twice before the United States Congress, was presented the Freedom of Expression Courage Award by PEN America, and named one of Time magazine’s 100 Most Influential People in the World for her role in uncovering the Flint Water Crisis and leading recovery efforts. She has appeared on CNN, MSNBC, BBC and countless other media outlets championing the cause of children in Flint and beyond. She is
founding donor of the Flint Child Health and Development Fund (

Dr. Hanna-Attisha received her bachelor’s and Master of Public Health degrees from the University of  Michigan and her medical degree from Michigan State University College of Human Medicine. She completed her residency at Children’s Hospital of Michigan in Detroit, where she was chief resident. She is currently an associate professor of pediatrics and human development at Michigan State University College of Human Medicine.


Study looks at impact of water, sanitation, and social conditions on birth outcomes in India

photo of a woman collecting water in plastic potsA new study by researchers in the University of Iowa College of Public Health examines the complex relationships between water and sanitation access and social conditions on birth outcomes among women in India.

Globally, preterm birth (PTB) and low infant birth weight (LBW) are leading causes of maternal and child illnesses and death. In low-income countries, the challenges women face to meet their basic water, sanitation, and hygiene (WASH) needs may be a major contributor to adverse health outcomes.

“Many homes in low-income countries have no private drinking water source. Women and girls are tasked with fetching water from outside the home, which can be physically stressful,” says Kelly Baker, assistant professor of occupational and environmental health, who co-authored the study. “In addition, homes often lack private toilet facilities, meaning women must use shared or public latrines or manage their sanitation needs in open spaces.”

A portrait of Kelly Baker, professor in the Department of Occupational and Environmental Health at the University of Iowa College of Public Health.
Kelly Baker

The lack of water and sanitation in the home forces women to navigate challenging, and sometimes personally threatening, social and environmental public conditions to collect water and to find a safe, private place to defecate, bathe, or manage menstruation, leading to psychosocial stress.

“Determining whether WASH-related stress—both physical and psychosocial—affects birth outcomes for women in low- and middle-income countries is critical for understanding whether the global prevalence of preterm birth and low infant birth weight could be reduced by improving the social and environmental conditions in which pregnant women seek clean water and proper sanitation,” says study co-author William Story, assistant professor of community and behavioral health.

For the study, which was published online Oct. 8, 2018, in PLOS ONE, the researchers used data from the India Human Development Survey . The survey asked women about their drinking water source, walking time to that source, time spent fetching water, sanitation (toilet) access, harassment of women and girls, local crime, whether community problems are solved collectively or individually, the amount of conflict within the community, as well as education, household wealth, and other characteristics.

portrait of William Story
William Story

The researchers examined the effect of pre-birth WASH and social conditions on self-reported PTB status and LBW status for 7,926 women who gave birth between 2004/2005 and 2011/2012. Of these women, 14.9 percent experienced premature birth and 15.5 percent delivered a low birth weight baby.

The study found that increased time daily spent fetching household water increased women’s risk of delivering a low birth weight baby. Open defecation and using a shared latrine within a woman’s building or compound were also associated with higher odds of low birth weight and preterm birth, respectively, compared to having a private household toilet.

Harassment of women and girls in the community also was associated with both low birth weight and preterm birth. The data also showed a possible association of local crime with low birth weight.

“This study contributes to the limited evidence related to environmental causes of PTB and LBW by demonstrating that lack of household WASH infrastructure and social factors, like crime and harassment of women and girls, are risk factors for adverse birth outcomes in women in low- and middle-income countries,” the researchers write. “Additionally, the findings suggest that gender norms that sanction harassment of women and girls and place the burden of household water fetching on women are key determinants of vulnerability to PTB and LBW among Indian women.”

Interventions that reduce domestic responsibilities related to water and sanitation and that change social norms related to gender-based harassment may reduce rates of PTB and LBW in India, the authors note.

Additional contributors to the study include Evan Walser-Kuntz and Bridget Zimmerman from the UI Department of Biostatistics. The paper is available online at

The study was funded by a pilot grant from the University of Iowa College of Public Health. Funding for the original IHDS study was provided to the University of Maryland and the National Council of Applied Economic Research, New Delhi, by the National Institutes of Health.