# Exploring associations between the Phthalate Environmental Reproductive Health Literacy (PERHL) scale & biomarkers of phthalate exposure: A pilot study

## TL;DR

This pilot study explores how a health literacy scale related to phthalates correlates with actual phthalate exposure levels in a small group of participants.

## Contribution

The study introduces a novel analysis linking environmental health literacy scores with biomarker data for phthalate exposure.

## Key findings

- Higher PERHL scores were generally associated with lower concentrations of DEHP, butyl, and PCP phthalate metabolites.
- A one-point increase in the 'Protective Behavior/Risk Control' subscale was linked to significant decreases in DEHP and butyl metabolite concentrations.

## Abstract

Perinatal exposure to phthalates is associated with adverse health impacts for parents and children. The field of environmental health literacy seeks to measure how environmental health information is conceptualized and used to inform behaviors. We assessed whether scores on the validated Phthalate Environmental Reproductive Health Literacy (PERHL) scale were associated with biomarkers of phthalate exposure.

42 members of the Environmental Reproductive and Glucose Outcomes (ERGO) cohort completed the PERHL scale and provided spot urine samples. Phthalate summary measures for model outcomes were created by calculating molar sums of specific gravity-corrected metabolite concentrations representing exposure to parent phthalate, Di(2-ethylhexyl)phthalate (DEHP), personal care product (PCP)-associated phthalates, and parent butyl-phthalates. Linear regression models were used to estimate the associations of the PERHL scale scores with phthalate summary measures, controlling for educational attainment (college degree or higher vs. no college degree), age (years), and race and ethnicity (non-Hispanic White vs. non-White).

Higher scores on the PERHL Scale and subscales were generally associated with lower ΣDEHP, Σbutyl, and ΣPCP metabolite concentrations. A one-point increase in the ‘Protective Behavior/Risk Control’ subscale score was significantly associated with a −30.3% (95% CI: −50.1, −2.6) decrease in ΣDEHP, and a −30.6% (95% CI: −51.5, −0.63) decrease in Σbutyl metabolite concentrations.