Date of Award

January 2026

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Nicole Deziel

Abstract

Background: Residential proximity to Superfund sites, major industrial hazardous waste sites in the United States, has been linked to adverse birth outcomes, but results have been inconsistent potentially due to imprecise exposure assessment and ecological designs. We assessed whether maternal residential proximity to NPL Superfund sites is associated with preterm birth (PTB) and low birthweight (LBW) outcomes using individual-level and contaminant-specific Superfund exposure assignments in Pennsylvania, a state with among the highest number of sites. Methods: We conducted a retrospective cohort study using Pennsylvania birth registry data (2003-2020), restricted to birth residences within 50 km of a Superfund site (n=2,205,764). A series of proximity-based metrics were constructed (e.g., residence within 10 km vs >10 km of a Superfund site) using distance from the birth address to site boundaries. We performed logistic regression models separately for PTB and LBW and Superfund exposure, adjusting for maternal age, race, education, parity, use of food assistance programs, and smoking. Stratified analyses by maternal race and site contaminant type (e.g., metals, volatile organic compounds) were conducted. Results: Closer residential proximity to a Superfund site was consistently associated with higher odds of LBW across exposure metrics. For example, living <10 km versus > 10 km of any site was associated with a 4% increase in odds for LBW (OR: 1.04, 95% CI: 1.03-1.05). Associations with PTB were generally non-significant. Residence within 10 km of a site predominantly containing metals yielded higher odds of both PTB and LBW [PTB: OR (95% CI): 1.04 (1.02, 1.06); LBW: OR (95% CI): 1.07 (1.05, 1.09)]. A higher proportion of Black/African American and WIC-participating mothers lived within 10 km of Superfund sites, reflecting environmental injustice patterns; however, no evidence for differential risk was observed in analyses stratified by race. Conclusion: Associations for metal-specific sites suggest contaminant-specific risks and need for improved exposure characterization. Findings from this study highlight the importance of understanding environmental exposure to Superfund sites to prevent adverse birth outcomes and guide remediation. Future research should examine temporal proximity and whether site remediation efforts reduce adverse birth outcomes.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 03/16/2027

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