BackgroundDecades of improper disposal of uranium-mining wastes on the Navajo Nation has resulted in adverse human and ecological health impacts as well as socio-cultural problems. As the Navajo people become increasingly aware of the contamination problems, there is a need to develop a risk-communication strategy to properly inform tribal members of the extent and severity of the health risks. To be most effective, this strategy needs to blend accepted risk-communication techniques with Navajo perspectives such that the strategy can be used at the community level to inform culturally- and toxicologically-relevant decisions about land and water use as well as mine-waste remediation.ObjectiveThe objective of this study was to develop GIS-based thematic maps as communication tools to clearly identify high risk exposure areas and offer alternatives to minimize public and ecological health impacts.MethodsThematic maps were produced that incorporated data derived from environmental sampling and public health surveys. The maps show the location and quality of unregulated water resources and identify regulated water sources that could be used as alternatives. In addition, the maps show the location of contaminated soil and sediment areas in which disturbance of surface deposits should be avoided. Preliminary feedback was collected from an informal Navajo working group to assess the clarity and efficacy of this proposed communication method.ResultsThe working group found the maps to be both clear and effective, and made suggestions for improvements, such as the addition of more map features. The working group predicted that once the maps are presented to the public, water hauling and soil use behaviors will change, and dialogue with chapter officials will be initiated to accelerate further risk reduction efforts.ImplicationsBecause risk communication is complicated by language barriers, lack of infrastructure, and historical mistrust of non-Navajo researchers, mapping provides an easily interpretable medium that can be objectively viewed by community members and decision makers to evaluate activities that affect toxicant exposures.

Summary More than 1100 abandoned mines, milling sites and waste piles from the uranium mining period are scattered across the Navajo Nation, resulting in exposures to environmental metals, including uranium. The Diné Network for Environmental Health project began in response to concerns regarding the community health effects of these environmental exposures on chronic disease. The paper presents the results of the initial Diné Network for Environmental Health survey of 1304 individuals living on the Navajo Nation. We examine the relationship between uranium mine waste exposure and kidney disease, diabetes and hypertension. These chronic diseases are found at high prevalences in the study population, present major public health risks and have been linked to metals exposures in other studies. We model the exposure–outcome relationship by using a multivariate model for the three binary responses. We implement a Bayesian multivariate t‐model, which has marginal log‐odds ratio parameter interpretations and is computationally efficient. In examining environmental exposures, appropriately adjusting for potential confounders is pivotal to obtaining policy relevant effect estimates. We use Bayesian model averaging to account for uncertainty in the functional form for confounding adjustment within a small set of measured confounders. Using this multivariate framework, we find evidence of associations between these chronic diseases and both historic mining era and legacy mining exposures.

The prevalences of cardiovascular disease (CVD) and type 2 diabetes (T2D) have increased among the Navajo Native American community in recent decades. Oxidized low-density lipoprotein (oxLDL) is a novel CVD biomarker that has never been assessed in the Navajo population. We examined the relationship of oxLDL to conventional CVD and T2D risk factors and biomarkers in a cross-sectional population of Navajo participants. This cross-sectional study included 252 participants from 20 Navajo communities from the Diné Network for Environmental Health Project. Plasma samples were tested for oxLDL levels by a sandwich enzyme-linked immunosorbent assay. Univariate and multivariate analyses were used to determine the relationship of oxLDL and oxidized- to non-oxidized lipoprotein ratios to glycated hemoglobin (HbA1c), C-reactive protein (CRP), interleukin 6 (IL6) and demographic and health variables. Type 2 diabetes, hypertension and obesity are very prevalent in this Navajo population. HbA1c, CRP, body mass index (BMI), high-density lipoprotein, and triglycerides were at levels that may increase risk for CVD and T2D. Median oxLDL level was 47 (36.8–57) U/L. Correlational analysis showed that although oxLDL alone was not associated with HbA1c, oxLDL/HDL, oxLDL/LDL and CRP were significantly associated with HbA1c and glucose. OxLDL, oxLDL/HDL and oxLDL/LDL were significantly associated with CRP. Multivariate analysis showed that triglycerides were a common and strong predictor of oxLDL, oxLDL/HDL and oxLDL/LDL. OxLDL was trended with HbA1c and glucose but did not reach significance, however, HbA1c was an independent predictor of OxLDL/HDL. CRP trended with oxLDL/HDL and was a weak predictor of oxLDL/LDL. This Navajo subset appears to have oxLDL levels comparable to subjects without evidence of CVD reported in other studies. The high prevalence of T2D, hypertension and obesity along with abnormal levels of other biomarkers including HbA1c indicate that the Navajo population has a worsening CVD risk profile.

Members of the Navajo Nation, who possess a high prevalence of cardiometabolic disease, reside near hundreds of local abandoned uranium mines (AUM), which contribute uranium, arsenic and other metals to the soil, water and air. We recently reported that hypertension is associated with mine waste exposures in this population. Inflammation is a major player in the development of numerous vascular ailments. Our previous work establishing that specific transcriptional responses of cultured endothelial cells treated with human serum can reveal relative circulating inflammatory potential in a manner responsive to pollutant exposures, providing a model to assess responses associated with exposure to these waste materials in this population. To investigate a potential link between exposures to AUM and serum inflammatory potential in affected communities, primary human coronary artery endothelial cells were treated for 4 h with serum provided by Navajo study participants (n = 145). Endothelial transcriptional responses of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and chemokine ligand 2 (CCL2) were measured. These transcriptional responses were then linked to AUM exposure metrics, including surface area-weighted AUM proximity and estimated oral intake of metals. AUM proximity strongly predicted endothelial transcriptional responses to serum including CCL2, VCAM-1 and ICAM-1 (P < 0.0001 for each), whereas annual water intakes of arsenic and uranium did not, even after controlling for all major effect modifiers. Inflammatory potential associated with proximity to AUMs, but not oral intake of specific metals, additionally suggests a role for inhalation exposure as a contributor to cardiovascular disease.

Specific autoantibodies were assessed among residents of the Navajo Nation in New Mexico chronically exposed to metal mixtures from uranium mine wastes and in drinking water supplies. Age and the extent of exposure to legacy waste from 100 abandoned uranium mine and mill sites were associated with antibodies to denatured DNA, previously known to be an early indicator of medication-induced autoimmunity. Surprisingly, autoantibodies to native DNA and/or chromatin were also linked to environmental exposure, specifically uranium consumption through drinking water for both men and women, while urinary arsenic was negatively associated with these autoantibodies in women. These findings suggest that contaminants derived from uranium mine waste enhanced development of autoantibodies in some individuals, while arsenic may be globally immunosuppressive with gender-specific effects. Specific autoantibodies may be a sensitive indicator of immune perturbation by environmental toxicants, an adverse effect not considered in current drinking water standards or regulatory risk assessment evaluations.