Degree Name

DrPH (Doctor of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

Liang Wang

Committee Members

Ying Liu, Hadii M. Mamudu, Robert P. Pack


First, this study examined the association of perfluorinated chemicals with 1) cardio-metabolic health outcomes and 2) the association of phthalates with cardiometabolic health outcomes, and 3) cardio-metabolic health outcomes while assessing the possibility of additive interactions between perfluorinated chemicals (PFCs) and phthalates. Second, association with markers of chronic inflammation and oxidative stress were explored. Finally, this study examined the association of these chemicals with estrogenic cancers- Breast cancer, prostate cancer, uterine cancer and ovarian cancer.

Using data from the National Health and Nutrition Examination Survey (NHANES), logistic regression models were used to investigate the relationship between PFCs and the cardio-metabolic health outcomes adjusting for covariates. An interaction term between PFCs and phthalates was added to the main effect model to assess the possibility of effect modification. Generalized linear models were used to examine associations between PFCs and inflammatory and oxidative stress markers per unit increase in exposure to PFCs while adjusting for covariates. Binomial logistic regression was used in investigating the association between quartiles of PFCs and presence or absence of cancer while also adjusting for covariates. Discriminant analysis was used to assess the correlation between individual PFCs compounds and individual cancer categories.

Perfluorononanoic acid (PFNA) was associated with increased odds of central obesity in females, odds ratio (OR): 1.10; 95% confidence interval (CI): (1.01, 1.21). Perfluorohexane sulfonic acid (PFHS), Perfluorononanoic acid (PFNA), Perfluorooctanoic acid (PFOA), Perfluorooctane sulfonic acid (PFOS), and Perfluorodecanoic acid (PFDE) were all significantly associated with lymphocyte counts. Beta (95% CI); 0.03(0.02,0.05), 0.04(0.02,0.05), 0.05(0.03, 0.07), 0.04(0.03,0.05), 0.03(0.01,0.04) and with serum iron 0.07(0.05,0.09), 0.04(0.02,0.07), 0.10(0.07,0.12), 0.05(0.03,0.07), 0.04(0.02,0.06) and serum albumin 0.02(0.02,0.02), 0.02(0.02,0.03), 0.03(0.03,0.04), 0.02(0.02, 0.023), 0.01 (0.01, 0.05). Only PFHS, PFNA, PFOA and PFOS were associated with serum total bilirubin 0.04(0.03,0.05), 0.02(0.00,0.03), 0.06(0.04,0.08), 0.03(0.02,0.05). PFCs studied were associated with increased odds of breast, prostate, uterine and ovarian cancers, p

Document Type

Dissertation - embargo


Copyright by the authors.

Available for download on Wednesday, June 01, 2022