Added value of combining health examination surveys and human biomonitoring studies

Abstract

Abstract Background In many European countries, parallel to health examination surveys (HES), human biomonitoring (HBM) studies are conducted to monitor chemical exposures of the population. HES and HBM studies use survey based data collection with similarities in sample selection and recruitment, ethics and data protection, collection of data by questionnaire and through biological samples. Methods In the framework of European Human Biomonitoring Initiative (HBM4EU), evaluation of opportunities and potential obstacles related to combining HES and HBM surveys has been conducted. Experiences and expectations of principal investigators (PI) of studies from 19 European countries have been evaluated. Results The most common reasons for omitting an HBM module from a HES were lack of knowledge related to chemical measurements, lack of funding and capacities for chemical analysis. Many PIs feared that adding an HBM module to their survey would increase the participant burden and decrease participation rate. In surveys where these two different modules were already combined, the biggest benefits were seen on use of same infrastructure for recruitment of survey invitees, collection of questionnaire information and biological samples, and additional information on health, resulting more cost-effective data collection with more information on each participant. Combining these two modules had challenges on fitting together needs from the two study objectives. While survey content broadens, balancing participant burden and research interest of both HES and an HBM module is challenging. The amount of collected biological samples such as blood samples is limited. Coordination of the activities between several research groups can be challenging and time consuming. Conclusions Several examples have shown that combining HBM and health surveys is possible and provide several benefits. However, it requires a good preparation and planning and sufficient coordination capacity to be successful. Key messages Combining HES and HBM is possible but requires detailed planning and good collaboration between research groups. Combined HES and HBM studies provide a wide range of information about population health status and its determinants as well as chemicals levels of exposure.