Trihalomethane Exposure Research Articles

Bayesian Methods for the Cross-Design Synthesis of Epidemiological and Toxicological Evidence

Summary Systematic review and synthesis (meta-analysis) methods are now increasingly used in many areas of health care research. We investigate the potential usefulness of these methods for combining human and animal data in human health risk assessment of exposure to environmental chemicals. Currently, risk assessments are often based on narrative review and expert judgment, but systematic review and formal synthesis methods offer a more transparent and rigorous approach. The method is illustrated by using the example of trihalomethane exposure and its possible association with low birth weight. A systematic literature review identified 13 relevant studies (five epidemiological and eight toxicological). Study-specific dose–response slope estimates were obtained for each of the studies and synthesized by using Bayesian meta-analysis models. Sensitivity analyses of the results obtained to the assumptions made suggest that some assumptions are critical. It is concluded that systematic review methods should be used in the synthesis of evidence for environmental standard setting, that meta-analysis will often be a valuable approach in these contexts and that sensitivity analyses are an important component of the approach whether or not formal synthesis methods (such as systematic review and meta-analysis) are used.

Multi-route trihalomethane exposure in households using municipal tap water treated with chlorine or ozone–chlorine

In Korea, data for multi-route trihalomethane (THM) exposure in households using municipal tap water treated with ozone–chlorine or chlorine are unavailable or very limited. Accordingly, the present study was designed to obtain those data by measurements of the THM concentrations in the tap water and indoor and outdoor air in the two types of households, along with an estimation of THM exposure from water ingestion, showering, and the inhalation of indoor air. Chloroform was the most abundant THM in all three media, yet no bromoform was detected in any sample. Similar to previous findings, the winter chloroform concentration in tap water treated with chlorine (22.1 μg/l, median) was significantly higher than that in the tap water treated with ozone–chlorine (16.8 μg/l, median). However, the summer water chloroform concentrations and summer and winter water concentrations of the other two THMs (bromodichloromethane and dibromochloromethane) exhibited no significant difference between the chlorine and ozone–chlorine-treated water. It was suggested that the effects of the water parameters including biochemical oxygen demand of raw water entering water treatment plants should be considered when evaluating the advantage of ozone–chlorine disinfection for THM formation over chlorine disinfection. The indoor air THM concentration trend was also consistent with the water concentration trend. The indoor to outdoor air concentration ratios were comparable with previous studies. The THM exposure estimates from water ingestion, showering, and the inhalation of apartment indoor air when not in the shower suggested that, for residents living in the surveyed households, their exposure to THMs in the home was mostly associated with their household water uses. The THM exposure estimates from tap water ingestion were similar to those from showering.

MATERNAL EXPOSURE TO WATER DISINFECTION BY-PRODUCTS AND ADVERSE BIRTH, NEONATAL AND EARLY CHILDHOOD OUTCOMES

ISEE-238 Aim: This study forms part of a PhD designed to test the hypothesis that there is a positive association between adverse birth, neonatal and early childhood outcomes and disinfection by-product (DBP) exposure. This registry-based prevalence study specifically explores the association between birth defects and residence in areas supplied with public drinking water containing high trihalomethane (THM) levels. Background: DBPs, which are produced during the disinfection of public water supplies, have been implicated as risk factors for adverse reproductive outcomes. In comparison to other states of Australia, Western Australia (WA) has a higher prevalence of birth defects, and it has been hypothesised that environmental influences (such as variable water quality) may be important in the etiology of these disorders. The water supply to the main metropolitan area, Perth, is known to contain high levels of organic precursor molecules (e.g. fulvic and humic acid from soils) that react with chemical disinfectants to produce DBPs, including trihalomethanes (THMs). Routine water sampling has confirmed that THM levels are high in the residential water supplies for a number of suburbs, with levels often exceeding 100 micrograms/L (considered a high level in some studies). Methods: The numbers of birth defects by suburb were identified for the years 2002–2003 through the Western Australia Birth Defects Registry. This registry has a high degree of completeness and accuracy for birth defects occurring in the Perth metropolitan area. To estimate the DBP exposure in the study population, we obtained recent THM data from several Perth suburbs, recorded during routine surveillance and monitoring. Suburbs were classified as high or low THM exposure, with high THM defined as concentrations exceeding 100 microgams/L. The analysis included calculation of the relative risk of birth defects per woman of reproductive age, resident in areas with high versus low THM levels. Results: Our preliminary data indicate that women of reproductive age, resident in confirmed high THM suburbs are 26% more likely to have a child with a birth defect compared to those resident in the largest low THM suburb. This possible relationship between THM and birth defects requires further investigation.

A sensitivity analysis of bias in relative risk estimates due to disinfection by-product exposure misclassification.

We conducted a sensitivity analysis of relative risk estimates using local area mean disinfection by-product exposures. We used Monte Carlo simulations to generate data representing 100 towns, each with 100 births (n=10,000). Each town was assigned a mean total trihalomethane (TTHM) exposure value (mean=45, SD=28) based on a variable number of sampling locations (range 2-10). True maternal TTHM exposure was randomly assigned from a lognormal distribution using that town's true mean value. We compared the effect of a 20 microg/l increase in TTHM exposure on the risk of small-for-gestational age infancy using the true maternal exposure compared to various weighting measures of the town mean exposures. The exposure metrics included: (1) unweighted town mean, (2) town mean weighted by the inverse variance of the town mean, (3) town mean weighted by the inverse standard deviation of the town mean, (4) town mean weighted by 1-(standard deviation of sites per town/mean across all towns), and (5) a randomly selected value from one of the sites within the town of residence. To estimate the magnitude of misclassification bias from using the town mean concentrations, we compared the true exposure odds ratios (1.00, 1.20, 1.50, and 2.00) to the mean exposure odds ratios from the five exposure scenarios. Misclassification bias from the use of unweighted town mean exposures ranged from 19 to 39%, increasing in proportion to the size of the true effect estimates. Weighted town mean TTHM exposures were less biased than the unweighted estimates of maternal exposure, with bias ranging from 0 to 23%. The weighted town mean analyses showed that attenuation of the true effect of DBP exposure was diminished when town mean concentrations with large variability were downweighted. We observed a trade-off between bias and precision in the weighted exposure analyses, with the least biased effects estimates having the widest confidence intervals. Effect attenuation due to intrasystem variability was most evident in absolute and relative terms for larger odds ratios.

A retrospective cohort study of trihalomethane exposure through drinking water and cancer mortality in northern Italy

A few epidemiologic studies have suggested that consumption of drinking water with high trihalomethane content increases the risk of cancer. We investigated the mortality of a cohort of 5144 residents in Guastalla, northern Italy, who were supplied tap water with high chloroform and trihalomethane content between 1965 and 1987. Using death rates of a nearby community as reference rates, the standardized mortality ratio from all cancers between 1987 and 1999 was slightly increased for both males (1.2, 95% confidence interval 1.1–1.4) and females (1.1, 95% confidence interval 1.0–1.3). This was mainly due to a higher mortality from stomach, liver, lung, prostate and bladder cancer in males and from stomach, pancreas, breast and ovarian cancer and lymphocytic leukemia in females. We also noted excess mortality from melanoma in both males and females. Overall, our findings were consistent with an association between trihalomethane exposure and increased cancer risk at some sites. However, the point estimates were statistically imprecise, due to the limited number of deaths for some site-specific cancers. In addition, we were unable to rule out the possibility of confounding due to smoking and other life-style factors with regard to some of the excess rates.

The effect of disinfection by-products and mutagenic activity on birth weight and gestational duration.

Epidemiologic studies of disinfection by-products have traditionally focused on total trihalomethane (TTHM) concentration as a surrogate for maternal exposure during pregnancy. We used birth certificate data on 196,000 infants to examine the effect of third-trimester exposures on various indices of fetal development. We examined the effect of town-average concentrations of TTHM and additional exposure metrics in relation to mean birth weight, mean gestational age, small for gestational age (SGA) infancy, and preterm delivery. Trihalomethane data (TTHM, chloroform, and bromodichloromethane) from 1995-1998 were available for 109 towns in Massachusetts. Data from 1997-1998 on haloacetic acid (total haloacetic acids, dichloroacetic acid, and trichloroacetic acid), 3-chloro-4-(dichloromethyl)-5- hydroxy-2(5H)-furanone (MX), and mutagenicity were available for a limited number of towns. We observed reductions in mean birth weight (12-18 g) for maternal trihalomethane exposures > the 90th percentile compared with those < the 50th percentile. Birth weight reductions were detected for chloroform exposures > 20 microg/L and TTHM exposures > 40 microg/L. Elevated trihalomethanes were associated with increases in gestational duration and a reduced risk of preterm delivery. We found evidence of an exposure-response effect of trihalomethanes on risk of SGA, with odds ratios (ORs) ranging from 1.09 to 1.23 for bromodichloromethane exposures > 5 microg/L. Elevated mutagenic activity was associated with SGA [OR = 1.25; 95% confidence interval (CI), 1.04 to 1.51] and mean birth weight (-27 g; 95% CI, -54 to -1). Although smaller in magnitude, our findings are consistent with previous studies reporting associations between trihalomethanes and SGA. These data also suggest a relationship between fetal development indices and mutagenic activity independent of exposure to trihalomethanes, haloacetic acids, and MX.

Disinfection byproducts and bladder cancer: a pooled analysis.

Exposure to disinfection byproducts in drinking water has been associated with an increased risk of bladder cancer. We pooled the primary data from 6 case-control studies of bladder cancer that used trihalomethanes as a marker of disinfection byproducts. Two studies were included from the United States and one each from Canada, France, Italy, and Finland. Inclusion criteria were availability of detailed data on trihalomethane exposure and individual water consumption. The analysis included 2806 cases and 5254 controls, all of whom had measures of known exposure for at least 70% of the exposure window of 40 years before the interview. Cumulative exposure to trihalomethanes was estimated by combining individual year-by-year average trihalomethane level and daily tap water consumption. There was an adjusted odds ratio (OR) of 1.24 in men exposed to an average of more than 1 microg/L (ppb) trihalomethanes compared with those who had lower or no exposure (95% confidence interval [CI] = 1.09-1.41). Estimated relative risks increased with increasing exposure, with an OR of 1.44 (1.20-1.73) for exposure higher than 50 microg/L (ppb). Similar results were found with other indices of trihalomethane exposure. Among women, trihalomethane exposure was not associated with bladder cancer risk (0.95; 0.76-1.20). These findings strengthen the hypothesis that the risk of bladder cancer is increased with long-term exposure to disinfection byproducts at levels currently observed in many industrialized countries.

Trihalomethanes in public water supplies and risk of stillbirth.

The chlorine used to disinfect public drinking water supplies reacts with naturally occurring organic matter to form a number of chemical byproducts. Recent studies have implicated exposure to chlorination byproducts in drinking water, trihalomethanes (THMs), in particular, with intrauterine death. We conducted a population-based case-control study in Nova Scotia and Eastern Ontario, Canada, to examine the effect of exposure to THMs on stillbirth risk. Cases were women who had a stillborn infant, and controls were a random sample of women with live births. Subjects were interviewed, and women with a public water source provided a residential water sample. Risks were examined according to residential THM level in tap water and to a total exposure metric incorporating tap water ingestion, showering, and bathing. We enrolled 112 stillbirth cases and 398 live birth controls. Women with a residential total THM level of 80 or more microg/L had twice the risk of a stillbirth compared with women with no exposure to THMs (adjusted odds ratio [OR] = 2.2; 95% confidence interval [CI] = 1.1-4.4). The highest quintile of total THM exposure using the total exposure metric was associated with an adjusted odds ratio of 2.4 (95% CI = 1.2-4.6) compared with women not exposed to THMs. Similar results were seen for specific THM compounds. A monotonic dose-response relationship was not seen. Our results provide evidence for an increased risk of stillbirth associated with exposure to chlorination byproducts through ingestion and showering and bathing, although there was not a clear dose-response relationship.

Analysis of in vivo and in vitro DNA strand breaks from trihalomethane exposure

BackgroundEpidemiological studies have linked the consumption of chlorinated surface waters to an increased risk of two major causes of human mortality, colorectal and bladder cancer. Trihalomethanes (THMs) are by-products formed when chlorine is used to disinfect drinking water. The purpose of this study was to examine the ability of the THMs, trichloromethane (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and tribromomethane (TBM), to induce DNA strand breaks (SB) in (1) CCRF-CEM human lymphoblastic leukemia cells, (2) primary rat hepatocytes (PRH) exposed in vitro, and (3) rats exposed by gavage or drinking water.MethodsDNA SB were measured by the DNA alkaline unwinding assay (DAUA). CCRF-CEM cells were exposed to individual THMs for 2 hr. Half of the cells were immediately analyzed for DNA SB and half were transferred into fresh culture medium and incubated for an additional 22 hr before testing for DNA SB. PRH were exposed to individual THMs for 4 hr then assayed for DNA SB. F344/N rats were exposed to individual THMs for 4 hr, 2 weeks, and to BDCM for 5 wk then tested for DNA SB.ResultsCCRF-CEM cells exposed to 5- or 10-mM brominated THMs for 2 hr produced DNA SB. The order of activity was TBM>DBCM>BDCM; TCM was inactive. Following a 22-hr recovery period, all groups had fewer SB except 10-mM DBCM and 1-mM TBM. CCRF-CEM cells were found to be positive for the GSTT1-1 gene, however no activity was detected. No DNA SB, unassociated with cytotoxicity, were observed in PRH or F344/N rats exposed to individual THMs.ConclusionCCRF-CEM cells exposed to the brominated THMs at 5 or 10 mM for 2 hr showed a significant increase in DNA SB when compared to control cells. Additionally, CCRF-CEM cells exposed to DBCM and TBM appeared to have compromised DNA repair capacity as demonstrated by an increased amount of DNA SB at 22 hr following exposure. CCRF-CEM cells were found to be positive for the GSTT1-1 gene, however no activity was detected. No DNA SB were observed in PRH or F344/N rats exposed to individual THMs.

Chlorination by-products in drinking water and menstrual cycle function.

We analyzed data from a prospective study of menstrual cycle function and early pregnancy loss to explore further the effects of trihalomethanes (THM) on reproductive end points. Premenopausal women ((italic)n(/italic) = 403) collected urine samples daily during an average of 5.6 cycles for measurement of steroid metabolites that were used to define menstrual parameters such as cycle and phase length. Women were asked about consumption of various types of water as well as other habits and demographics. A THM level was estimated for each cycle based on residence and quarterly measurements made by water utilities during a 90-day period beginning 60 days before the cycle start date. We found a monotonic decrease in mean cycle length with increasing total THM (TTHM) level; at > 60 microg/L, the adjusted decrement was 1.1 days [95% confidence interval (CI), -1.8 to -0.40], compared with less than or equal to 40 microg/L. This finding was also reflected as a reduced follicular phase length (difference -0.94 day; 95% CI, -1.6 to -0.24). A decrement in cycle and follicular phase length of 0.18 days (95% CI, -0.29 to -0.07) per 10 microg/L unit increase in TTHM concentration was found. There was little association with luteal phase length, menses length, or cycle variability. Examining the individual THMs by quartile, we found the greatest association with chlorodibromomethane or the sum of the brominated compounds. Incorporating tap water consumption showed a similar pattern of reduced cycle length with increasing TTHM exposure. These findings suggest that THM exposure may affect ovarian function and should be confirmed in other studies.

Multipathway risk assessment on disinfection by-products of drinking water in Hong Kong

The lifetime cancer risk and the hazard index of trihalomethanes (THMs) through oral ingestion, dermal absorption, and inhalation exposure from tap water in 19 districts in Hong Kong are estimated. The most dominant THMs are chloroform and bromodichloromethane (BDCM) in Hong Kong tap water. Among the three different pathways, residents have a higher risk of cancer through oral ingestion than through the other two pathways. The lifetime cancer risks through oral ingestion and dermal absorption for BDCM make the highest percentage contribution (59%) to total risks, followed by chloroform (24%). The chloroform and BDCM are at or above the negligible risk level of 10 −6 by a factor of 10 or more in most districts. Among the 19 districts, people living in Sai Kung have the highest risk of cancer due to the THM exposure through the multipathways, mainly because of the exposure to BDCM and dibromochloromethane (DBCM). The total cancer risk analysis indicates that each year approximately 10 out of the seven million Hong Kong residents could get cancer from the daily intake of water.

Trihalomethane exposures from municipal water supplies and selected congenital malformations.

Concerns about potential health effects of trihalomethanes (THMs) have prompted investigations on whether infants whose mothers were periconceptionally exposed to drinking water containing THMs are at greater risk of congenital malformations. We used two large case-control maternal interview studies that were conducted among California deliveries from 1987 through 1991. One study comprised 538 infants/fetuses with neural tube defects (NTDs) and 539 nonmalformed control infants. The second study included an additional 265 infants with NTDs, 207 infants with conotruncal heart defects, 409 infants with orofacial clefts, and 481 control infants. Expert personnel from municipal water companies estimated THM levels for a particular residence and specific periconceptional time period using quarterly monitoring measurements. Estimates were also made for four individual THM levels and for the total THM level. NTD risk in the first study was inversely associated with total THM exposure. Although the second study did not show the same inverse relationship for NTDs, there were no positive associations of NTDs or the other malformations with total THM as estimated from continuous models. Elevated risks were observed for the lowest category of exposure (1-24 ppb), but risks were either not substantially elevated or were imprecise for higher exposure levels. Thus no evidence was observed for an exposure-response relation. Our results do not provide a clear pattern of association between THM exposure and risks of specific congenital malformations. Imprecise exposure measures coupled with a lack of information about other possible sources of THM exposure may have caused associations to be underestimated.

Effect of trihalomethane exposure on fetal development

Aims: To examine the effect of trimester specific and pregnancy average total trihalomethane (TTHM) exposure on infant birth weight, low birth weight, and intrauterine growth retardation in term births, as...

Influence of exposure assessment methods on risk estimates in an epidemiologic study of total trihalomethane exposure and spontaneous abortion.

Trihalomethanes are common contaminants of chlorinated drinking water. Studies of their health effects have been hampered by exposure misclassification, due in part to limitations inherent in using utility sampling records. We used two exposure assessment methods, one based on utility-wide sampling averages, and one based on measurements from the utility sampling site closest to the subject's residence, to reestimate total trihalomethane (TTHM) exposure for 4212 participants in a preexisting study of risk factors for spontaneous abortion (SAB). For both approaches we performed unweighted, weighted, and subset analyses. The weighted and subset analyses were intended to reduce exposure misclassification, and were based on within-utility variance in TTHM measurements for the utility-wide average approach, and the distance between the subject's residence and sampling site for the closest-site approach. In general, the utility-wide average methods produced odds ratios equivalent to or slightly higher than the closest-site methods. Odds ratios obtained using the utility-wide average, but not the closest-site, approach also became progressively stronger in the weighted and subset analyses. A dose-response was seen between SAB and an exposure metric incorporating both TTHM concentration (utility-wide average approach) and personal ingestion, with SAB rates ranging from 8.3% to 13.7% (unweighted), 7.9% to 16.6% (variance weighted), and 6.6% to 23.1% (low-variance subset). Utility-wide average TTHM exposure assessment methods together with variance-based weights and subsets are relatively simple exposure assessment techniques, which may increase the epidemiologic usefulness of utility sampling records.

Cloración del agua potable en España y cáncer de vejiga

Drinking water chlorination generates trihalomethanes and other by-products with mutagenic and carcinogenic properties in animal experiments. Epidemiological studies have associated trihalomethanes to an increased risk of bladder cancer. We evaluate trihalomethane levels in four Spanish areas and calculate the bladder cancer risk attributable to this exposure. Trihalomethanes have been analysed in 111 drinking water samples from four Spanish areas using gas chromatography. Water utilities were contacted and information on drinking water consumption in Spain has been collected. We reviewed the epidemiological studies that assess the association between bladder cancer risk and exposure to chlorination by-products. Attributable risk was calculated on the basis of these levels, mortality data per area and risk estimates obtained from the literature. Mediterranean areas present the highest levels of trihalomethanes with 81, 80, 61 and 52 µg/l in Sabadell, Alicante, Barcelona and Manresa respectively. Lower levels are found in Tenerife and Asturias with 7 and 20 µg/l respectively. The bladder cancer attributable risk in high trihalomethane exposure areas may be, on average, around 20%. The trihalomethane levels found are high compared to those of other European Union countries. In the high exposure areas, drinking water chlorination may generate a considerable number of bladder cancer cases. These estimations have to be carefully interpreted and verified with more extensive studies.

Assessment of airborne exposure to trihalomethanes from tap water in residential showers and baths.

This study evaluates airborne concentrations of common trihalomethane (THM) compounds in bathrooms during showering and bathing in homes supplied with chlorinated tap water. Three homes in an urban area were selected, each having three bedrooms, a full bath, and approximately 1,000 square feet of living area. THMs were concurrently measured in tap water and air in the shower/bath enclosure and the bathroom vanity area using Summa canisters. Chloroform (TCM), bromodichloromethane (BDCM), and chlorodibromomethane (CDBM) were quantified using U.S. Environmental Protection Agency (EPA) Method TO-14. Air samples were collected prior to, during, and after the water-use event for 16 shower and 7 bath events. Flow rate and temperature were measured, but not controlled. The increase in average airborne concentration (+/- standard error) during showers (expressed as microg/m3 in shower enclosure or bathroom air per microg/L in water) was 3.3+/-0.4 for TCM, 1.8+/-0.3 for BDCM, and 0.5+/-0.1 for CDBM (n = 12), and during baths was 1.2+/-0.4 for TCM, 0.59+/-0.21 for BDCM, and 0.15+/-0.05 for CDBM (n = 4). The relative contribution of each chemical to the airborne concentrations was consistent for all shower and bath events, with apparent release of TCM > BDCM > CDBM. The results are therefore consistent with their relative concentration in tap water and their vapor pressures. When the shower findings for TCM are normalized for water concentration, flow rate, shower volume, and duration, the average exposure concentrations in these urban residences are about 30% lower than those reported by other investigators using EPA analytical methods. This difference is likely attributable primarily to greater air exchange rates in residential shower/bath stalls compared to more "airtight" laboratory shower chambers. This appears to be the first field study to thoroughly evaluate THM exposures from residential showers and baths, and can be used to validate previously published models of tap water volatile chemical transfer to indoor air.

Relation between Stillbirth and Specific Chlorination By-Products in Public Water Supplies

During water treatment, chlorine reacts with naturally occurring organic matter in surface water to produce a number of by-products. Of the by-products formed, trihalomethanes (THMs) are among the highest in concentration. We conducted a retrospective cohort study to evaluate the relationship between the level of total THM and specific THMs in public water supplies and risk for stillbirth. The cohort was assembled from a population-based perinatal database in the Canadian province of Nova Scotia and consisted of almost 50,000 singleton deliveries between 1988 and 1995. Individual exposures were assigned by linking mother's residence at the time of delivery to the levels of specific THMs monitored in public water supplies. Analysis was conducted for all stillbirths and for cause-of-death categories based on the physiologic process responsible for the fetal death. Total THMs and the specific THMs were each associated with increased stillbirth risk. The strongest association was observed for bromodichloromethane exposure, where risk doubled for those exposed to a level of [greater and equal to] 20 microg/L compared to those exposed to a level &lt; 5 microg/L (relative risk = 1. 98, 95% confidence interval, 1.23-3.49). Relative risk estimates associated with THM exposures were larger for asphyxia-related deaths than for unexplained deaths or for stillbirths overall. These findings suggest a need to consider specific chlorination by-products in relation to stillbirth risk, in particular bromodichloromethane and other by-product correlates. The finding of a stronger effect for asphyxia deaths requires confirmation and research into possible mechanisms.

Relation between stillbirth and specific chlorination by-products in public water supplies.

During water treatment, chlorine reacts with naturally occurring organic matter in surface water to produce a number of by-products. Of the by-products formed, trihalomethanes (THMs) are among the highest in concentration. We conducted a retrospective cohort study to evaluate the relationship between the level of total THM and specific THMs in public water supplies and risk for stillbirth. The cohort was assembled from a population-based perinatal database in the Canadian province of Nova Scotia and consisted of almost 50,000 singleton deliveries between 1988 and 1995. Individual exposures were assigned by linking mother's residence at the time of delivery to the levels of specific THMs monitored in public water supplies. Analysis was conducted for all stillbirths and for cause-of-death categories based on the physiologic process responsible for the fetal death. Total THMs and the specific THMs were each associated with increased stillbirth risk. The strongest association was observed for bromodichloromethane exposure, where risk doubled for those exposed to a level of [greater and equal to] 20 microg/L compared to those exposed to a level < 5 microg/L (relative risk = 1. 98, 95% confidence interval, 1.23-3.49). Relative risk estimates associated with THM exposures were larger for asphyxia-related deaths than for unexplained deaths or for stillbirths overall. These findings suggest a need to consider specific chlorination by-products in relation to stillbirth risk, in particular bromodichloromethane and other by-product correlates. The finding of a stronger effect for asphyxia deaths requires confirmation and research into possible mechanisms.

Inhalation exposure to THMs from drinking water in south Taiwan

Trihalomethanes (THMs) are important disinfection byproducts (DBPs) in drinking water. To understand the magnitude of exposure to THMs for the people in southern Taiwan, models are used to estimate the inhalation exposure associated with drinking water based on raw water quality. Two parts of models are used in this study, one for estimating THM concentration from raw water quality, and one for estimating inhalation exposure to people. Important raw water quality and operational parameters, including TOC, UV254, pH, temperature, chlorine dosage, and water residence time of a major water treatment plant in south Taiwan were collected. An empirical THM formation model was then employed to predict the THM concentration at consumers’ dwellings based on the parameters collected. Differences between the predicted results and experimental data were found to be small, indicating that the model is appropriate. The predicted THM concentration distribution was served as input parameters for the exposure models. Three major scenarios associated with probable inhalation exposure of THMs, including shower, pre- and post-cooking activities, and cooking processes, were considered in the exposure models. The model results show that the mean inhalation exposure of THMs for shower, pre- and post-cooking activities, and cooking processes are 26.4, 1.56, 3.29 μg/day, respectively. The total inhalation exposure (summation of the three scenarios) was found to be comparable with that for direct ingestion, indicating that inhalation is an important pathway for THM exposure from drinking water.

Exposure Estimates to Disinfection By-Products of Chlorinated Drinking Water

Exposure to disinfection by-products (DBPs) of drinking water is multiroute and occurs in households serviced by municipal water treatment facilities that disinfect the water as a necessary step to halt the spread of waterborne infectious diseases. Biomarkers of the two most abundant groups of DBPs of chlorination, exhaled breath levels of trihalomethanes (THMs) and urinary levels of two haloacetic acids, were compared to exposure estimates calculated from in-home tap water concentrations and responses to a questionnaire related to water usage. Background THM breath concentrations were uniformly low. Strong relationships were identified between the THM breath concentrations collected after a shower and both the THM water concentration and the THM exposure from a shower, after adjusting for the postshower delay time in collecting the breath sample. Urinary haloacetic acid excretion rates were not correlated to water concentrations. Urinary trichloroacetic acid excretion rates were correlated with ingestion exposure, and that correlation was stronger in a subset of individuals who consumed beverages primarily within their home where the concentration measurements were made. No correlation was observed between an average 48-hr exposure estimate and the urinary dichloroacetic acid excretion rate, presumably because of its short biological half-life. Valid biomarkers were identified for DBP exposures, but the time between the exposure and sample collection should be considered to account for different metabolic rates among the DBPs. Further, using water concentration as an exposure estimate can introduce misclassification of exposure for DBPs whose primary route is ingestion due to the great variability in the amount of water ingested across a population.