Recall and Interviewer Bias in Parental Report of Pediatric Exposure to Aromatic Plant Ingredients in Personal Care Products: Development and Validation of a More Accurate Approach.

Jessie Hawkins,Christy Hires,Lindsey Keenan,Elizabeth Dunne,Chunrong Jia

doi:10.1155/2021/9924621

Abstract

Lavender and tea tree essential oils are traditionally considered to be mild, gentle, and safe for pediatric populations and are ubiquitous in personal care products. Recent case reports have proposed a potential association between exposure to these ingredients and endocrine disruption, but these reports contain misclassification bias. The purpose of this study is to develop a reliable and valid measurement instrument for the accurate classification of exposure to aromatic plant ingredients in personal care products to be used in epidemiological studies. This study tested the Aromatic Plant Ingredients and Child Health Survey (APICHS) for validity and reliability, contrasting it with the current approach used in clinician's offices. The APICHS was found to have exceptional sensitivity and specificity (100% and 92.86%, respectively) with a positive predictive value of 97.22%, far exceeding the sensitivity and specificity of the method currently in use. The APICHS is a valid, reliable tool for accurate classification of exposure to aromatic plant ingredients in personal care products and should be used for the avoidance of misclassification.

Highlights

Lavender and tea tree essential oils are among the most common ingredients in personal care products, especially for children [1, 2]. e oils are traditionally considered to be mild, gentle, and safe for pediatric populations [3,4,5]
Because lavender essential oil and tea tree essential oil are ubiquitous in personal care products, identifying and properly classifying exposure status presents a significant challenge. is challenge poses a barrier to the epidemiological research required to scientifically assess the claims that these essential oils act as endocrine disrupting agents in the developing human body
Objective. e primary purpose of this study is to evaluate the Aromatic Plant Ingredients and Child Health Survey (APICHS) for validity and reliability as a measurement instrument. e purpose of this instrument is to accurately classify children who were exposed to lavender or tea tree essential oil through personal care products and household exposures between the ages of 2 and 15 years old

Summary

Introduction

Lavender and tea tree essential oils are among the most common ingredients in personal care products, especially for children [1, 2]. e oils are traditionally considered to be mild, gentle, and safe for pediatric populations [3,4,5]. To identify historical exposures to these ingredients, many clinicians ask parents during an office visit whether or not their child has used any personal care products which contain lavender or tea tree essential oils. Journal of Environmental and Public Health is approach lacks the scientific rigor required to classify exposure status of a child, due to its failure to address information bias, recall bias and interviewer bias, resulting in misclassification bias [12, 13]. Because some chemical research has proposed a relationship between these two ingredients and endocrine disruption in children, a valid and reliable method of classifying patients as exposed and unexposed is urgently required [7]. E purpose of this instrument is to accurately classify children who were exposed to lavender or tea tree essential oil through personal care products and household exposures between the ages of 2 and 15 years old. E secondary objective of this study is to evaluate the prior approach of parental recall for validity and reliability and determine which approach has greater positive predictive value. is study is reported using the STARD checklist for diagnostic accuracy studies

Methods

Results

Diagnostic Utility

Discussion