Exposure Assessment Methods Research Articles

Environmental Risk Factors for Childhood Acute Lymphoblastic Leukemia: An Umbrella Review.

Simple SummaryLeukemia is the most common type of cancer among children worldwide. The aim of this umbrella review was to provide an evidence-based summary of epidemiological studies on environmental risk factors and the risk of childhood acute lymphoblastic leukemia (ALL), by exposure window. Second aim was to assess the prevalence in the German population which determines the relevance on population level. Only low doses of ionizing radiation in early childhood and maternal exposure to general pesticides during pregnancy showed convincing evidence of an association with childhood ALL. Other risk factors vary in level of association. The results of this umbrella review should be interpreted with caution; as the evidence are mostly from case-control studies, where selection and recall bias are potential concerns.Leukemia is the most common type of cancer among children and adolescents worldwide. The aim of this umbrella review was (1) to provide a synthesis of the environmental risk factors for the onset of childhood acute lymphoblastic leukemia (ALL) by exposure window, (2) evaluate their strength of evidence and magnitude of risk, and as an example (3) estimate the prevalence in the German population, which determines the relevance at the population level. Relevant systematic reviews and pooled analyses were identified and retrieved through PubMed, Web of Science databases and lists of references. Only two risk factors (low doses of ionizing radiation in early childhood and general pesticide exposure during maternal preconception/pregnancy) were convincingly associated with childhood ALL. Other risk factors including extremely low frequency electromagnetic field (ELF-MF), living in proximity to nuclear facilities, petroleum, benzene, solvent, and domestic paint exposure during early childhood, all showed some level of evidence of association. Maternal consumption of coffee (high consumption/>2 cups/day) and cola (high consumption) during pregnancy, paternal smoking during the pregnancy of the index child, maternal intake of fertility treatment, high birth weight (≥4000 g) and caesarean delivery were also found to have some level of evidence of association. Maternal folic acid and vitamins intake, breastfeeding (≥6 months) and day-care attendance, were inversely associated with childhood ALL with some evidence. The results of this umbrella review should be interpreted with caution; as the evidence stems almost exclusively from case-control studies, where selection and recall bias are potential concerns, and whether the empirically observed association reflect causal relationships remains an open question. Hence, improved exposure assessment methods including accurate and reliable measurement, probing questions and better interview techniques are required to establish causative risk factors of childhood leukemia, which is needed for the ultimate goal of primary prevention.

A simulation-based stereological correction method for assessment of volumetric liberation and surface exposure of ore particles

• A simulation-based stereological correction method was developed. • First, a database of liberation distributions is established by simulation. • Then, 3D liberation is estimated from 2D liberation, with reference to the database. • Volumetric liberation and surface exposure bias can be corrected. In assessment of the volumetric liberation and surface exposure of ore particles, two-dimensional (2D) analysis, such as the widely used scanning electron microscope and energy dispersive X-ray (SEM/EDX)-based analysis, results in stereological bias with respect to the three-dimensional (3D) reality. Thus, a simulation-based stereological correction method for accurate assessment of volumetric liberation and surface exposure was developed. The method utilizes a pre-established database of numerically simulated binary particles to estimate 3D composition (or exposure) distributions only from measurable 2D composition (or exposure) distributions. Among the notable features of the method are the relatively small amount of 2D-distribution input data required, and the rapidity of the analysis. Experimental validation, and ex-post analysis of previously published research results, showed high estimation accuracy for various types of particles (including actual ore samples) examined in previous studies. In addition, the method is suitable for post analysis of SEM/EDX-based particle sectional liberation analysis.

The Exposome Approach in Allergies and Lung Diseases: Is It Time to Define a Preconception Exposome?

Emerging research suggests environmental exposures before conception may adversely affect allergies and lung diseases in future generations. Most studies are limited as they have focused on single exposures, not considering that these diseases have a multifactorial origin in which environmental and lifestyle factors are likely to interact. Traditional exposure assessment methods fail to capture the interactions among environmental exposures and their impact on fundamental biological processes, as well as individual and temporal factors. A valid estimation of exposure preconception is difficult since the human reproductive cycle spans decades and the access to germ cells is limited. The exposome is defined as the cumulative measure of external exposures on an organism (external exposome), and the associated biological responses (endogenous exposome) throughout the lifespan, from conception and onwards. An exposome approach implies a targeted or agnostic analysis of the concurrent and temporal multiple exposures, and may, together with recent technological advances, improve the assessment of the environmental contributors to health and disease. This review describes the current knowledge on preconception environmental exposures as related to respiratory health outcomes in offspring. We discuss the usefulness and feasibility of using an exposome approach in this research, advocating for the preconception exposure window to become included in the exposome concept.

Comparison of methods for assessment of children exposure to air pollution: dispersion model, ambient monitoring, and personal samplers

Comparison of methods for assessment of children exposure to air pollution: dispersion model, ambient monitoring, and personal samplers

Enhancing the use of exposure science across EU chemical policies as part of the European Exposure Science Strategy 2020–2030

BackgroundA scientific framework on exposure science will boost the multiuse of exposure knowledge across EU chemicals-related policies and improve risk assessment, risk management and communication across EU safety, security and sustainability domains.ObjectiveTo stimulate public and private actors to align and strengthen the cross-policy adoption of exposure assessment data, methods and tools across EU legislation.MethodsBy mapping and analysing the EU regulatory landscape making use of exposure information, policy and research challenges and key areas of action are identified and translated into opportunities enhancing policy and scientific efficiency.ResultsIdentified key areas of actions are to develop a common scientific exposure assessment framework, supported by baseline acceptance criteria and a shared knowledge base enhancing exchangeability and acceptability of exposure knowledge within and across EU chemicals-related policies. Furthermore, such framework will improve communication and management across EU chemical safety, security and sustainability policies comprising sourcing, manufacturing and global trade of goods and waste management. In support of building such a common framework and its effective use in policy and industry, exposure science innovation needs to be better embedded along the whole policymaking cycle, and be integrated into companies’ safety and sustainability management systems. This will help to systemically improve regulatory risk management practices.SignificanceThis paper constitutes an important step towards the implementation of the EU Green Deal and its underlying policy strategies, such as the Chemicals Strategy for Sustainability.

4.B. Workshop: Data collection during COVID-19 pandemic and its policy impacts

The workshop has the aims to review practices for reliable and robust data collection during disaster such as the COVID-19 pandemic and to develop implementation practices. Study conduct is even more necessary in times of crises and at the same time more challenging. We review existing practices by bringing together three aspects of study conduct in times of crises: 1) experiences with sampling methods, 2) experiences with exposure assessment and 3) development of evidence based policy guidelines. First, experiences with different sampling approaches to collect longitudinal data on in a multicentre study during the COVID19 pandemic are presented (Felix Sisenop). Second, exposure assessment methods in different cultural traditions are presented and reflected (Edvaldo Begotaraj). Third, the challenge of rapid evidence based policy development will be reviewed (Marija Jakubauskiene). It will be shown, how data gathered in an international consortium can have impact on a national level through policy advisory. Ensuring the ability to provide robust and reliable data on psychosocial and mental health service responses to crises is an important step for emergency preparedness. The lessons learnt will be discussed with workshop participants.Key messages Rapid study conduct is necessary in times of crises.Methods of rapid study conduct need further development.

Burden of invasive group B Streptococcus disease in non-pregnant adults: A systematic review and meta-analysis.

Streptococcus agalactiae or group B Streptococcus (GBS) has emerged as an important cause of invasive disease in adults, particularly among the elderly and those with underlying comorbidities. Traditionally, it was recognised as an opportunistic pathogen colonising and causing disease in pregnant women, neonates, and young infants. Reasons for the upsurge of invasive GBS (iGBS) among the elderly remain unclear, although it has been related to risk factors such as underlying chronic diseases, immunosenescence, impaired inflammatory response, and spread of virulent clones. Antibiotics are successfully as treatment or prophylaxis against iGBS. Several candidate vaccines against iGBS are under development. To conduct a systematic review of the current literature on invasive GBS in order to determine disease incidence and case fatality ratio (CFR) among non-pregnant adults. Additionally, information on risk factors, clinical presentation, serotype distribution, and antimicrobial resistance was also retrieved. Between January and June 2020, electronic searches were conducted in relevant databases: MEDLINE, EMBASE, Global Health, and SCOPUS. Studies were included in the systematic review if they met the inclusion/exclusion criteria. The authors assessed the selected studies for relevance, risk of bias, outcome measures, and heterogeneity. Meta-analyses on incidence and CFR were conducted after evaluating the quality of methods for assessment of exposure and outcomes. Pooled estimates of iGBS incidence in non-pregnant adults 15 years and older were 2.86 cases per 100.000 population (95% CI, 1.68-4.34). Incidence rates in older adults were substantially higher, 9.13 (95%CI, 3.53-17.22) and 19.40 (95%CI, 16.26-22.81) per 100.000 population ≥50 and ≥ 65 years old, respectively. Incidence rates ranged from 0.40 (95% CI, 0.30-0.60) in Africa to 5.90 cases per 100.000 population (95% CI, 4.30-7.70) in North America. The overall CFR was and 9.98% (95% CI, 8.47-11.58). CFR was highest in Africa at 22.09% (95% CI, 12.31-33.57). Serotype V was the most prevalent serotype globally and in North America accounting for 43.48% (n = 12926) and 46,72% (n = 12184) of cases, respectively. Serotype Ia was the second and serotype III was more prevalent in Europe (25.0%) and Asia (29.5%). Comorbidities were frequent among non-pregnant adult iGBS cases. Antimicrobial resistance against different antibiotics (i.e., penicillin, erythromycin) is increasing over time. This systematic review revealed that iGBS in non-pregnant adults has risen in the last few years and has become a serious public health threat especially in older adults with underlying conditions. Given the current serotype distribution, vaccines including serotypes predominant among non-pregnant adults (i.e., serotypes V, Ia, II, and III) in their formulation are needed to provide breadth of protection. Continued surveillance monitoring potential changes in serotype distribution and antimicrobial resistance patterns are warranted to inform public health interventions.

Ambient and household PM2.5 pollution and adverse perinatal outcomes: A meta-regression and analysis of attributable global burden for 204 countries and territories.

BackgroundParticulate matter <2.5 micrometer (PM2.5) is associated with adverse perinatal outcomes, but the impact on disease burden mediated by this pathway has not previously been included in the Global Burden of Disease (GBD), Mortality, Injuries, and Risk Factors studies. We estimated the global burden of low birth weight (LBW) and preterm birth (PTB) and impacts on reduced birth weight and gestational age (GA), attributable to ambient and household PM2.5 pollution in 2019.Methods and findingsWe searched PubMed, Embase, and Web of Science for peer-reviewed articles in English. Study quality was assessed using 2 tools: (1) Agency for Healthcare Research and Quality checklist; and (2) National Institute of Environmental Health Sciences (NIEHS) risk of bias questions. We conducted a meta-regression (MR) to quantify the risk of PM2.5 on birth weight and GA. The MR, based on a systematic review (SR) of articles published through April 4, 2021, and resulting uncertainty intervals (UIs) accounted for unexplained between-study heterogeneity. Separate nonlinear relationships relating exposure to risk were generated for each outcome and applied in the burden estimation.The MR included 44, 40, and 40 birth weight, LBW, and PTB studies, respectively. Majority of the studies were of retrospective cohort design and primarily from North America, Europe, and Australia. A few recent studies were from China, India, sub-Saharan Africa, and South America. Pooled estimates indicated 22 grams (95% UI: 12, 32) lower birth weight, 11% greater risk of LBW (1.11, 95% UI: 1.07, 1.16), and 12% greater risk of PTB (1.12, 95% UI: 1.06, 1.19), per 10 μg/m3 increment in ambient PM2.5. We estimated a global population–weighted mean lowering of 89 grams (95% UI: 88, 89) of birth weight and 3.4 weeks (95% UI: 3.4, 3.4) of GA in 2019, attributable to total PM2.5. Globally, an estimated 15.6% (95% UI: 15.6, 15.7) of all LBW and 35.7% (95% UI: 35.6, 35.9) of all PTB infants were attributable to total PM2.5, equivalent to 2,761,720 (95% UI: 2,746,713 to 2,776,722) and 5,870,103 (95% UI: 5,848,046 to 5,892,166) infants in 2019, respectively. About one-third of the total PM2.5 burden for LBW and PTB could be attributable to ambient exposure, with household air pollution (HAP) dominating in low-income countries. The findings should be viewed in light of some limitations such as heterogeneity between studies including size, exposure levels, exposure assessment method, and adjustment for confounding. Furthermore, studies did not separate the direct effect of PM2.5 on birth weight from that mediated through GA. As a consequence, the pooled risk estimates in the MR and likewise the global burden may have been underestimated.ConclusionsAmbient and household PM2.5 were associated with reduced birth weight and GA, which are, in turn, associated with neonatal and infant mortality, particularly in low- and middle-income countries.

Maternal occupational exposure to endocrine-disrupting chemicals during pregnancy and semen parameters in adulthood: results of a nationwide cross-sectional study among Swiss conscripts

Study question Is there a relationship between maternal occupational exposure to endocrine-disrupting chemicals (EDCs) during pregnancy and the semen quality of their sons? Summary answer Our results suggest an association between maternal occupational exposure to potential EDCs, especially to pesticides, phthalates and heavy metals, and a decrease in several semen parameters. What is known already Sexual differentiation, development and proper functioning of the reproductive system are largely dependent on steroid hormones. Although there is some animal evidence, studies on maternal exposure to EDCs during pregnancy and its effect on the semen quality of sons are scarce and none have focused on maternal occupational exposure. Study design, size, duration A cross-sectional study aiming to evaluate semen quality was carried out among Swiss conscripts aged 18 to 22 years between 2005 and 2017. Participants/materials, setting, methods Conscript and parent questionnaires were completed prior to the collection of a semen sample. Semen parameters were categorised according to the guidelines of the World Health Organization (WHO). Data on maternal employment during pregnancy were provided by the parent questionnaire. Maternal occupational exposure to potential EDC categories was defined using a job-exposure matrix (JEM). Logistic regressions were used to analyse the relationship between maternal occupational exposure to EDCs and each semen parameter adjusted for potential confounding factors. Results are presented using odds ratios and 95% confidence intervals. Main results and the role of chance In total, 1,737 conscripts provided a conscript and parent questionnaire, as well as a semen sample; among these 1,045 of their mothers worked during pregnancy. Our study suggests an association between occupational exposure of mothers during pregnancy to potential EDCs and low semen volume and total sperm count, particularly for exposure to pesticides (OR 2.07, 95% CI 1.11-3.86 and OR 2.14, 95% CI 1.05-4.35), phthalates (OR 1.92, 95% CI 1.10-3.37 and OR 1.89, 95% CI 1.01-3.55), and heavy metals (OR 2.02, 95% CI 1.14-3.60 and OR 2.29, 95% CI 1.21-4.35). Maternal occupational exposure to heavy metals was additionally associated with a low sperm concentration (OR 1.89, 95% CI 1.06-3.37). Limitations, reasons for caution Several limitations should be noted, such as the indirect method for maternal occupational exposure assessment during the pregnancy (JEM) and the cross-sectional design of the study. Wider implications of the findings Our observations reinforce the need to inform pregnant women of potential hazards during pregnancy that could impair their child's fertility. Additional studies are needed to confirm the involvement of EDCs. Study funding/competing interest(s) This work was supported by the Swiss Centre for Applied Human Toxicology: SCAHT and the 'Fondation privee des Hopitaux Universitaires de Geneve'. The collection of human biological material used for this study was supported by the FABER Foundation, the Swiss National Science Foundation (SNSF): NFP 50 'Endocrine Disruptors: Relevance to Humans, Animals and Ecosystems', the Medical Services of the Swiss Army (DDPS) and Medisupport. The authors declare they have no competing financial interests. Trial registration number N/A.

Defining the Scope of Exposome Studies and Research Needs from a Multidisciplinary Perspective.

The concept of the exposome was introduced over 15 years ago to reflect the important role that the environment exerts on health and disease. While originally viewed as a call-to-arms to develop more comprehensive exposure assessment methods applicable at the individual level and throughout the life course, the scope of the exposome has now expanded to include the associated biological response. In order to explore these concepts, a workshop was hosted by the Gunma University Initiative for Advanced Research (GIAR, Japan) to discuss the scope of exposomics from an international and multidisciplinary perspective. This Global Perspective is a summary of the discussions with emphasis on (1) top-down, bottom-up, and functional approaches to exposomics, (2) the need for integration and standardization of LC- and GC-based high-resolution mass spectrometry methods for untargeted exposome analyses, (3) the design of an exposomics study, (4) the requirement for open science workflows including mass spectral libraries and public databases, (5) the necessity for large investments in mass spectrometry infrastructure in order to sequence the exposome, and (6) the role of the exposome in precision medicine and nutrition to create personalized environmental exposure profiles. Recommendations are made on key issues to encourage continued advancement and cooperation in exposomics.

Exploring Methods for Surveillance of Occupational Exposure from Additive Manufacturing in Four Different Industrial Facilities.

3D printing, a type of additive manufacturing (AM), is a rapidly expanding field. Some adverse health effects have been associated with exposure to printing emissions, which makes occupational exposure studies important. There is a lack of exposure studies, particularly from printing methods other than material extrusion (ME). The presented study aimed to evaluate measurement methods for exposure assessment in AM environments and to measure exposure and emissions from four different printing methods [powder bed fusion (PBF), material extrusion (ME), material jetting (MJ), and vat photopolymerization] in industry. Structured exposure diaries and volatile organic compound (VOC) sensors were used over a 5-day working week. Personal and stationary VOC samples and real-time particle measurements were taken for 1 day per facility. Personal inhalable and respirable dust samples were taken during PBF and MJ AM. The use of structured exposure diaries in combination with measurement data revealed that comparatively little time is spent on actual printing and the main exposure comes from post-processing tasks. VOC and particle instruments that log for a longer period are a useful tool as they facilitate the identification of work tasks with high emissions, highlight the importance of ventilation and give a more gathered view of variations in exposure. No alarming levels of VOCs or dust were detected during print nor post-processing in these facilities as adequate preventive measures were installed. As there are a few studies reporting negative health effects, it is still important to keep the exposure as low as reasonable.

Feasibility and acceptability of monitoring personal air pollution exposure with sensors for asthma self-management

BackgroundExposure to fine particulate matter (PM2.5) increases the risk of asthma exacerbations, and thus, monitoring personal exposure to PM2.5 may aid in disease self-management. Low-cost, portable air pollution sensors offer a convenient way to measure personal pollution exposure directly and may improve personalized monitoring compared with traditional methods that rely on stationary monitoring stations. We aimed to understand whether adults with asthma would be willing to use personal sensors to monitor their exposure to air pollution and to assess the feasibility of using sensors to measure real-time PM2.5 exposure.MethodsWe conducted semi-structured interviews with 15 adults with asthma to understand their willingness to use a personal pollution sensor and their privacy preferences with regard to sensor data. Student research assistants used HabitatMap AirBeam devices to take PM2.5 measurements at 1-s intervals while walking in Philadelphia neighborhoods in May–August 2018. AirBeam PM2.5 measurements were compared to concurrent measurements taken by three nearby regulatory monitors.ResultsAll interview participants stated that they would use a personal air pollution sensor, though the consensus was that devices should be small (watch- or palm-sized) and light. Patients were generally unconcerned about privacy or sharing their GPS location, with only two stating they would not share their GPS location under any circumstances. PM2.5 measurements were taken using AirBeam sensors on 34 walks that extended through five Philadelphia neighborhoods. The range of sensor PM2.5 measurements was 0.6–97.6 μg/mL (mean 6.8 μg/mL), compared to 0–22.6 μg/mL (mean 9.0 μg/mL) measured by nearby regulatory monitors. Compared to stationary measurements, which were only available as 1-h integrated averages at discrete monitoring sites, sensor measurements permitted characterization of fine-scale fluctuations in PM2.5 levels over time and space.ConclusionsPatients were generally interested in using sensors to monitor their personal exposure to PM2.5 and willing to share personal sensor data with health care providers and researchers. Compared to traditional methods of personal exposure assessment, sensors captured personalized air quality information at higher spatiotemporal resolution. Improvements to currently available sensors, including more reliable Bluetooth connectivity, increased portability, and longer battery life would facilitate their use in a general patient population.

Variability in the association between long-term exposure to ambient air pollution and mortality by exposure assessment method and covariate adjustment: A census-based country-wide cohort study

BackgroundAmbient air pollution exposure has been associated with higher mortality risk in numerous studies. We assessed potential variability in the magnitude of this association for non-accidental, cardiovascular disease, respiratory disease, and lung cancer mortality in a country-wide administrative cohort by exposure assessment method and by adjustment for geographic subdivisions. MethodsWe used the Belgian 2001 census linked to population and mortality register including nearly 5.5 million adults aged ≥30 (mean follow-up: 9.97 years). Annual mean concentrations for fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone (O3) were assessed at baseline residential address using two exposure methods; Europe-wide hybrid land use regression (LUR) models [100x100m], and Belgium-wide interpolation-dispersion (RIO-IFDM) models [25x25m]. We used Cox proportional hazards models with age as the underlying time scale and adjusted for various individual and area-level covariates. We further adjusted main models for two different area-levels following the European Nomenclature of Territorial Units for Statistics (NUTS); NUTS-1 (n = 3), or NUTS-3 (n = 43). ResultsWe found no consistent differences between both exposure methods. We observed most robust associations with lung cancer mortality. Hazard Ratios (HRs) per 10 μg/m3 increase for NO2 were 1.060 (95%CI 1.042-1.078) [hybrid LUR] and 1.040 (95%CI 1.022-1.058) [RIO-IFDM]. Associations with non-accidental, respiratory disease and cardiovascular disease mortality were generally null in main models but were enhanced after further adjustment for NUTS-1 or NUTS-3. HRs for non-accidental mortality per 5 μg/m3 increase for PM2.5 for the main model using hybrid LUR exposure were 1.023 (95%CI 1.011-1.035). After including random effects HRs were 1.044 (95%CI 1.033-1.057) [NUTS-1] and 1.076 (95%CI 1.060-1.092) [NUTS-3]. ConclusionLong-term air pollution exposure was associated with higher lung cancer mortality risk but not consistently with the other studied causes. Magnitude of associations varied by adjustment for geographic subdivisions, area-level socio-economic covariates and less by exposure assessment method.

A Review of Exposure Assessment Methods Utilized in Studies of Disinfection Byproducts (DBPs) and Birth Defects

BACKGROUND AND AIM: Epidemiologic studies of disinfection byproducts (DBPs) and birth defects have employed a variety of exposure assessment methods. Because there is 1) no gold standard exposure assessment method for DBPs, and 2) documented variability in exposure based on spatial, temporal, and personal behavior patterns, it is important to compare methods and understand their potential impact on health effect estimates. This question is particularly relevant for studies measuring exposures for developmental outcomes such as birth defects, with a narrow critical window. METHODS: We reviewed epidemiologic studies of DBPs and birth defects published prior to 2021. Information on exposure assessment methods and critical windows of pregnancy captured by exposure assessment was extracted by one author, with quality control by two authors. Data were organized and summarized based on complexity of the method, including their ability to characterize and address temporal or spatial variability and personal water-use patterns. RESULTS:We identified exposure assessment methods utilized in 21 studies of DBPs and birth defects; 6 studies used non-specific DBP indicators, such as water type or disinfection method;17 studies developed spatial, temporal, or spatiotemporal-informed estimates based on data collected by public monitoring systems in conjunction with additional modeling; 7 studies incorporated personal behavior information to help address route-specific exposure; 4 of these incorporated DBP uptake factors. Most studies incorporated 1 or 2 exposure assessment methods, while 5 studies included 3 or more approaches; 14 studies developed exposure estimates based on the critical window for birth defects. CONCLUSIONS:There is heterogeneity in exposure assessment methods among studies of DBPs and birth defects. These methods vary in complexity and capture distinct sources of DBP variation. The choice of metric affects the anticipated magnitude of exposure misclassification. More consistent consideration of spatiotemporal patterns and the critical window of development will improve exposure assessment in future studies. *Abstract does not reflect EPA policy KEYWORDS: Exposures, Exposure assessment, Birth outcomes, Water quality

Systematic Methods to Select and Review Epidemiological Literature on the Health Effects of Long-term Exposure to TRAP

BACKGROUND AND AIM: The health effects of traffic-related air pollution (TRAP) continue to be of important public health interest. Following its well-cited 2010 critical review, HEI appointed a new expert Panel to review the literature on the health effects of long-term exposure to TRAP. METHODS: The Panel followed a systematic protocol they published in Prospero to search the literature, assess study quality, summarize results, and reach conclusions about the body of evidence. An extensive search was conducted of literature published between January 1980 and July 2019 on selected health outcomes (all-cause and cause-specific mortality, respiratory effects, cardiometabolic effects, and adverse birth outcomes). The Panel considered studies both within and outside the near-road environment because traffic contributes to ambient air pollution at neighborhood and urban scales. They developed a framework of exposure to TRAP to guide transparent selection and evaluation of epidemiological studies. Criteria including the pollutant considered, spatial scale, and exposure assessment methods were used to identify studies in which the exposure contrasts were related primarily to traffic emissions. RESULTS:Meta-analyses were performed in cases where three or more studies were identified for the same exposure and health outcome. Conclusions were based on a modified US National Toxicology Program’s Office of Health Assessment and Translation (OHAT) approach and a narrative assessment. The two approaches were considered equally valuable in the Special Report, reflecting the complex issues in determining the level of confidence. CONCLUSIONS:The review is now well underway, and the methods along with lessons learned during their application will be presented. The systematic review will undergo peer-review, and publication is aimed for late 2021. The new review will be an authoritative update of HEI’s most-cited report for use by researchers and policymakers. KEYWORDS: traffic-related air pollution, systematic review, birth outcomes, cardiometabolic effects, respiratory effects, mortality

From modeling, measuring, to exposomics - a Roadmap to pesticdovigilance

BACKGROUND AND AIM: Pesticides are often linked to ill health. However, to determine the role of specific pesticides in the causation of diseases detailed high-quality exposure assessment is required. Recently, several advancements have been made in exposure assessment of pesticides varying from improved models to predict residents exposures to the use of large pesticide screens in biological fluids. METHODS: The pesticide assessment toolbox consists currently of worker, bystander and residents exposure models, a diversity of measurement techniques to quantify pesticides in different environmental domains (air, water, dust), and personal measurements through biomonitoring, omics-technologies and wearables. But which techniques can be successfully implemented in which circumstances, and what is the minimal input data needed? RESULTS:In this interactive session we will explore the roadmap towards pesticidovigilance in different populations including vulnerable populations. We will identify and discuss where the methodological and input data gaps are and how these could be overcome. CONCLUSIONS:Given the sustained public concerns around pesticide exposures it is important to facilitate better studies on pesticide and health using diverse study designs and exposure assessment methods. The outcome of this workshop should result in the formulation of the top research priorities in pesticidovigilance. KEYWORDS: Pesticides, Exposure Assessment, Wearables, OMICs, biomonitoring, Modelling

Traffic-related air pollution and breast cancer risk: a systematic review and a meta-analysis of observational studies

BACKGROUND AND AIM: Association of breast cancer risk with air pollution exposure, in particular pollution emitted by traffic exhaust has been investigated but current epidemiological evidence remains inconclusive and methodologies of exposure assessment varied. To systematically review the scientific literature on breast cancer risk and indicators of traffic-related air pollution, e.g. distance from roadways or traffic volume of nearby roadways as well as pollutants from motor vehicle emission and provide meta-analytic estimates of the association between breast cancer and exposure to nitrogen oxides (NOx) and nitrogen dioxides (NO2), the main markers of traffic. METHODS: We systematically reviewed the literature on exposure to traffic-related air pollution and breast cancer risk and conducted a random-effects meta-analysis of observational studies investigating the association between exposure to NO2 and NOx and breast cancer risk. RESULTS:We reviewed six case-control and 11 cohort studies that used different exposure assessment methods and time periods of traffic emissions. While, individual studies provided little evidence of an association between different indicators of traffic-related air pollution and breast cancer risk, the meta-analysis on NO2 (based on three case-control and seven cohort studies) indicated a borderline association (pooled relative risk, RR per 10 µg/m3 of NO2: 1.01; 95% confidence interval, CI: 1.00, 1.03; p=0.03). No significant association between NOx and breast cancer was found on the basis of three cohorts (RR: 1.02; 95%CI: 0.99, 1.05; for an increase of 10 µg/m3 of NOx). CONCLUSIONS:Since traffic is the major contributor to NO2 concentration and is responsible for high concentration observed near busy roads, our findings suggest that traffic-related air pollution is likely to increase breast cancer incidence and to provide additional support for the carcinogenicity of air pollution. KEYWORDS: Breast cancer, epidemiology, air pollution, traffic, nitrogen dioxides, meta-analysis

Personal measurements of radiofrequency electromagnetic field exposure among workers of high, medium and low exposed occupations in Spain

BACKGROUND AND AIM: Novel methods for occupational exposure assessment of radiofrequency (RF) electromagnetic fields are needed to address the lack of quantitative data and reduce limitations of current methods used for epidemiological research. In the framework of an international study, we conducted an innovative measurement campaign of personal occupational RF exposure in multiple occupations in Spain in order to enhance a preliminary RF Job Exposure Matrix (RF-JEM). METHODS: Identification and prioritization of the occupations to be measured were based on exposure levels in the preliminary RF-JEM and expert judgment. Selection of participants was based on reported job titles and sources of RF exposure collected in a screening questionnaire, which was disseminated to potential participants using both broad and targeted approaches. Personal full-shift measurements were conducted following a standardized protocol. Additional data about general and occupational-specific sources of RF exposure during the measured work-shift were captured at the end of each observation day through a “worker diary”. RESULTS:Personal measurements of RF exposure were conducted and workers oversampled in occupations previously categorized as medium (n = 105) and highly-exposed (n = 26). A preliminary overview of the measurement results obtained in the campaign for various jobs as well as an initial comparison with the preliminary RF-JEM will be presented. CONCLUSIONS:We conducted the first stage of an innovative international campaign of personal occupational RF exposure measurements in Spain, gathering exposure data for workers from occupations known to be exposed to high, medium and low levels of exposure to RF fields. Further work to conduct personal measurements in the Netherlands and France will also be performed. KEYWORDS: Exposure assessment, Occupational epidemiology, Occupational exposures

Particulate matter measurement in South Africa: are the right questions being asked?

BACKGROUND AND AIM: Particulate matter (PM) is a key indicator of air pollution and a significant risk factor for adverse health effects in humans. High PM levels have been observed in industrialized and urban areas in South Africa. Concerns over the health effects of PM2.5 made the South African government to establish the national standard for PM2.5 in 2012. Since then, most studies conducted in South Africa have focused on determining the ambient concentration of PM2.5 and its health impacts. However, PM2.5 is not a self-contained pollutant but a mixture of different compounds including chemical and biological fractions. There is a dearth of studies measuring the relationship between exposure to individual pollutants and the combined effects of multipollutant in PM2.5 and adverse health outcomes in South Africa. Also, little is known about the exact constituents of PM responsible for the observed health effects in South Africa. This paper discusses current PM monitoring and assessment methods in use for air pollution studies in South Africa. METHODS: METHODS: A literature search using various search engines and (or) keywords was done. Articles selected for review were chosen following predefined criteria, to extract and analyze data. RESULTS:The results show that the biological and chemical components of inhalable and respirable PM play a significant role in the burden of health effects attributed to PM. In most studies, PM2.5 levels were measured with fixed ambient monitoring stations on the assumption that levels of PM2.5 recorded by the fixed monitoring station are representative of the total concentration of PM2.5 to which the residents within the study area are exposed. CONCLUSIONS:There is also an overall poor understanding of current novel methods of air quality monitoring and exposure assessment. Efforts geared towards the adoption of novel air quality monitoring and exposure assessment techniques should be instituted in South Africa. KEYWORDS: Particulate matter, Air monitoring, Exposure assessment, South Africa

Interactions of agricultural pesticide use near home during pregnancy and adverse childhood experiences on adolescent neurobehavioral development in the CHAMACOS study

BackgroundStudies have documented independent adverse associations between prenatal and early-life exposure to environmental chemicals and social adversity with child neurodevelopment; however, few have considered these exposures jointly. The objective of this analysis is to examine whether associations of pesticide mixtures and adolescent neurobehavioral development are modified by early-life adversity in the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) cohort. MethodsWe used linear mixed effects Bayesian Hierarchical Models (BHM) to examine the joint effect of applications of 11 agricultural pesticides within 1 km of maternal homes during pregnancy and youth-reported Adverse Childhood Experiences (ACEs) with maternal and youth-reported internalizing behaviors, hyperactivity, and attention problems assessed via the Behavior Assessment for Children (BASC) (mean = 50, standard deviation = 10) at ages 16 and 18 years (n = 458). ResultsThe median (25th-75th percentiles) of ACEs was 1 (0–3); 72.3% of participants had low ACEs (0–2 events) and 27.7% had ACEs (3+ events). Overall, there was little evidence of modification of exposure-outcome associations by ACEs. A two-fold increase in malathion use was associated with increased internalizing behaviors among those with high ACEs from both maternal- (β = 1.9; 95% Credible Interval (CrI): 0.2, 3.7 for high ACEs vs. β = −0.1; 95% CrI: 1.2, 0.9 for low ACEs) and youth-report (β = 2.1; 95% CrI: 0.4, 3.8 for high ACEs vs. β = 0.2; 95% CrI: 0.8, 1.2 for low ACEs). Applications of malathion and dimethoate were also associated with higher youth-reported hyperactivity and/or inattention among those with high ACEs. ConclusionWe observed little evidence of effect modification of agricultural pesticide use near the home during pregnancy and adolescent behavioral problems by child ACEs. Future studies should examine critical windows of susceptibility of exposure to chemical and non-chemical stressors and should consider biomarker-based exposure assessment methods.