Environmental justice burden and Black-White disparities in spontaneous preterm birth in Harris County, Texas.

Introduction: Given limited evidence of previous studies, we evaluated the role of environmental justice (EJ) burden (i.e., a neighborhood characterized by both increased environmental burden and socioeconomic deprivation) in Black-White disparities in spontaneous preterm birth (sPTB) in Harris County, Texas and compared results that evaluated neighborhood-level socioeconomic deprivation alone. Methods: We conducted a retrospective analysis using PeriBank, a database and biospecimen repository of gravidae giving birth at two hospitals in the Texas Medical Center. We included 3,703 non-Hispanic Black and 5,475 non-Hispanic white gravidae who were U.S.-born, delivered from August 2011-December 2020, and resided in Harris County, TX. We used data from the U.S. EPA EJScreen to characterize the EJ burden of participant's zip code of residence from fine particulate matter (PM2.5), ozone, and proximity to National Priorities List (NPL) sites and calculated zip-code level Area Deprivation Index (ADI). We assessed the contribution of neighborhood-level variables to the Black-White disparity in sPTB by evaluating attenuation of the odds ratio (OR) representing the effect of race in multivariable logistic regression models, controlling for individual-level characteristics. We also conducted race-stratified analyses between each neighborhood variable and sPTB. Exposure indices were treated as continuous variables; in stratified models, ORs and 95% Confidence Intervals (CIs) are presented per 10-unit increase in the neighborhood variable. Results: Accounting for individual-level variables, Black gravidae had 79% higher odds of sPTB than white gravidae (OR = 1.79, 95%CI = 1.32, 2.44); the disparity was moderately attenuated when accounting for EJ burden or ADI (ORs ranged from 1.58 to 1.69). Though we observed no association between any of the EJ burden indices and sPTB among white gravidae, we found increased risks among Black gravidae, with ORs of similar magnitude for each EJ variable. For example, Black gravidae experienced 17% increased odds of sPTB associated with a 10-unit increase in the EJ burden index for PM2.5 (OR = 1.17, 95%CI = 0.97, 1.40). No racial differences were observed in the association of ADI with sPTB. Discussion: Though we observed limited evidence of the contribution of living in EJ neighborhoods to the Black-White disparity in sPTB, our study suggests living in an EJ neighborhood may differentially impact Black and white gravidae.

Effects of newly developed chemotherapy regimens, comorbidities, chemotherapy-related toxicities on the changing patterns of the leading causes of death in elderly patients with colorectal cancer.

BACKGROUND: Abundant evidences have shown that newly developed chemotherapy regimens improved 5-year survival rate of colorectal cancer (CRC) patients over the past two decades. However, their impact on risk of death from leading causes among elderly patients is still poorly understood. PATIENTS AND METHODS: A retrospective cohort study of 69 718 elderly CRC patients with their first primary tumors in 1992-2009, identified from the 12 areas of Surveillance, Epidemiology, and End Results-Medicare linked database with their Medicare claims up to 2010. Multivariate Cox regression models were used to assess the effect of newly developed chemotherapy regimens, comorbidities, and chemotherapy related toxicities on cause-specific death and their temporal patterns among elderly CRC patients. RESULTS: The leading causes of death among CRC patients were CRC, circulation disorders, and secondary cancers, which accounted for 51.4%, 25%, and 4.6% of all-cause death, respectively. Patients diagnosed in more recent diagnostic time periods were significantly less likely to die of CRC [period 2: 5-year hazard ratio = 0.94, 95% confidence interval (CI) 0.90-0.97; period 3: 0.86, 0.83-0.90], circulation disorders (period 2: 0.94, 0.88-1.00; period 3: 0.80, 0.75-0.87), and more likely to die of secondary cancer (period 3: 1.42, 1.20-1.68) compared with those diagnosed in period 1. Charlson comorbidities index and the selected pre-existing comorbidities were significantly associated with increased 5-year risk of death from all three leading causes. Both hematological and gastric toxicity were associated with reduced risk of death from CRC and circulation disorders. The association between diagnostic time period and risk reduction in death from CRC depended on chemotherapy treatment (P < 0.0001). Subgroup analyses showed that the chemotherapy-dependent significant risk reduction was seen in patients with stage II-III CRC, patients without comorbidities, and patients without toxicities (P < 0.0001 for all). CONCLUSION: The newly developed chemotherapy regimens were associated with the decreased risk of mortality from CRC.

Validation of an asthma questionnaire for use in healthcare workers.

BACKGROUND: Previous studies have described increased occurrence of asthma among healthcare workers, but to our knowledge there are no validated survey questionnaires with which to study this occupational group. AIMS: To develop, validate, and refine a new survey instrument on asthma for use in epidemiological studies of healthcare workers. METHODS: An initial draft questionnaire, designed by a multidisciplinary team, used previously validated questions where possible; the occupational exposure section was developed by updating health services specific chemical lists through hospital walk-through surveys and review of material safety data sheets. A cross-sectional validation study was conducted in 118 non-smoking subjects, who also underwent bronchial challenge testing, an interview with an industrial hygienist, and measurement of specific IgE antibodies to common aeroallergens. RESULTS: The final version consisted of 43 main questions in four sections. Time to completion of the questionnaire ranged from 13 to 25 minutes. Test-retest reliability of asthma and allergy items ranged from 75% to 94%, and internal consistency for these items was excellent (Cronbach's alpha > or = 0.86). Against methacholine challenge, an eight item combination of asthma related symptoms had a sensitivity of 71% and specificity of 70%; against a physician diagnosis of asthma, this same combination showed a sensitivity of 79% and specificity of 98%. Agreement between self-reported exposures and industrial hygienist review was similar to previous studies and only moderate, indicating the need to incorporate more reliable methods of exposure assessment. Against the aerollergen panel, the best combinations of sensitivity and specificity were obtained for a history of allergies to dust, dust mite, and animals. CONCLUSIONS: Initial evaluation of this new questionnaire indicates good validity and reliability, and further field testing and cross-validation in a larger healthcare worker population is in progress. The need for development of more reliable occupational exposure assessment methods that go beyond self-report is underscored.

Assessing spatial fluctuations, temporal variability, and measurement error in estimated levels of disinfection by-products in tap water: implications for exposure assessment.

AIMS: To assess spatial fluctuations, temporal variability, and errors due to sampling and analysis in levels of disinfection by-products in routine monitoring tap water samples and in water samples collected in households within the same distribution system for an exposure assessment study. METHODS: Mixed effects models were applied to quantify seasonal effects and the degree to which trihalomethane (THM) levels vary among households or locations relative to variation over time within seasons for any given location. In a separate analysis, the proportion of total variation due to measurement error arising from sampling and analysis was also quantified. RESULTS: THM levels were higher in the summer relative to other seasons. Differences in the relative magnitude of the intra- and inter-household components of variation were observed between the two sets of THM measurements, with a greater proportion of the variation due to differences within seasons for the routine monitoring data and a greater proportion of the variation due to differences across locations for the exposure assessment study data. Such differences likely arose due to differences in the strategies used to select sites for sampling and in the time periods over which the data were collected. With the exception of bromodichloromethane, measurement errors due to sampling and analysis contributed a small proportion of the total variation in THM levels. CONCLUSIONS: The utility of routine monitoring data in assigning exposure in epidemiological studies is limited because such data may not represent the magnitude of spatial variability in levels of disinfection by-products across the distribution system. Measurement error contributes a relatively small proportion to the total variation in THM levels, which suggests that gathering a greater number of samples over time with fewer replicates collected at each sampling location is more efficient and would likely yield improved estimates of household exposure.

Heterogeneity in sources of exposure variability among groups of workers exposed to inorganic mercury.

Many exposure assessment strategies rely on the occupational group as the unit of analysis in which workers are classified on the basis of job title, location, or on other characteristics related to the workplace or the job. Although statistical methods that combine exposure data collected on workers from different occupational groups are more efficient, the underlying assumption that the degree of variation over time and among workers is the same for all groups has yet to be fully investigated. Given the utility of different modeling approaches when assessing exposures, we investigated assumptions of homogeneity of variance within and between workers using both random- and mixed-effects models. In our study of four groups of workers exposed to inorganic mercury (Hg) at a chloralkali plant, there was no evidence of significant heterogeneity in the levels of variation over time or between workers for air Hg levels. For the biological monitoring data, however, our findings indicate that groups did not share common levels of variability and that it was not appropriate to pool the data and obtain single estimates of the within- and between-worker variance components. Classification of job group as a random or fixed effect had no effect on the results and yielded the same conclusions when the models were compared. To illustrate effects related to the proper specification of a model, the likelihood of exceeding certain levels (which is a function of the parameters of the underlying distribution of the natural log-transformed exposures) was evaluated using the results obtained from the different models. Although the probability that workers' mean exposures exceeded occupational exposure limits for air, urine and blood Hg was generally low (<10%) for all groups except maintenance workers, the estimated values sometimes varied depending upon the particular model that was applied. Given the growing use of random- and mixed-effects models that combine data across occupational groups, additional studies are warranted to evaluate whether it is reasonable to assume common variances and covariances among measurements collected on workers from different groups.

Prenatal exposure to pesticides: a feasibility study among migrant and seasonal farmworkers.

BACKGROUND: Migrant and seasonal farmworkers have a high potential for pesticide exposures, yet are rarely included in epidemiologic studies. This study examined the feasibility of assessing prenatal exposures to pesticides and other compounds in pregnant Hispanic farmworkers. METHODS: Nine women completed a survey about work experiences during pregnancy. Maternal urine, cord blood, and placenta samples were obtained at delivery for analysis of 51 analytes, including 6 phenoxy acid or triazine herbicides, 21 organochlorine insecticides, 10 PCBs, and 14 volatile organic compounds. RESULTS: Seven of 51 analytes were found in the biological samples. DDE, DDT, dichlorbenzene, toluene, trimethylbenzene, and endosulfan sulfate were detected in cord blood samples, and 2,4-D in urine from one or more women. CONCLUSIONS: We documented the feasibility of following farmworkers to assess in utero exposure to pesticides and other contaminants, and demonstrated exposure to these compounds. Difficulties in measuring pesticides with short half lives were noted.

Inter- and intra-individual sources of variation in levels of urinary styrene metabolites.

OBJECTIVE: Given the paucity of studies that have examined variability in biological measures of exposure to workplace contaminants, we quantified the intra- and inter-individual sources of variation in urinary levels of mandelic acid (MA) and phenylglyoxylic acid (PGA) among workers exposed to styrene. A secondary objective was to examine effects of job task and the timing of sampling during the workweek on the variation in workers' urinary styrene metabolite levels. METHODS: As part of routine biological monitoring, a total of 1,714 measurements of MA and PGA collected from 331 workers between 1985 and 1999 from eight reinforced-plastics plants were abstracted from laboratory reports. To evaluate sources of variation in levels of urinary styrene metabolites, we applied random-effects models. The influence of job task and day of sampling on metabolite levels was examined using mixed-effects models. RESULTS: PGA levels were characterized by less variation than levels of MA, as were metabolite levels expressed in terms of urinary creatinine concentration. The relative magnitude of the inter-individual to the intra-individual source of variation was generally higher for post-shift urine samples than for pre-shift urine samples. As expected, urinary metabolite levels were highest for laminators and for samples collected at the latter end of the workweek. Owing to the effects of variation from day-to-day, estimates of workers' exposures that rely on single measurements would generally perform poorly in a regression analysis designed to examine effects resulting from chronic exposure. However, the bias in an observed slope coefficient would be diminished if a second or third urine sample were collected. CONCLUSIONS: Quantification of the intra- and inter-individual sources of variation provides useful information that can be used to design optimal sampling strategies, which would allow for the collection of sufficient data to estimate workers' exposures reliably when evaluating health risks associated with occupational contaminants.

Changes in serum PBB and PCB levels over time among women of varying ages at exposure.

The identification of host factors that are predictors of changes in serum polyhalogenated biphenyl contaminants over time has been a difficult challenge in epidemiologic studies of exposed individuals. Of particular concern are age at exposure, reproductive and lactational histories, and changes in body mass index. Using both cross-sectional and longitudinal approaches, this study examined factors related to high initial serum PBB and PCB levels and changes in these levels over time among women of varying ages at exposure (n=1772; age range<1 to 45 years). In 1973, PBB exposure occurred through consumption of farm products contaminated with PBB added to cattle feed. Exposures to PCBs began in 1941 through PCB-contaminated silo sealant deteriorating into animal feed. The Michigan Department of Public Health began enrolling participants in 1977 and has continued to follow them through annual updates. At enrollment, questionnaires were administered to obtain demographic, lifestyle, and anthropometric measurements, medical/reproductive and occupational histories, and contaminated food consumption patterns. Blood samples were collected for PBB and PCB analysis at enrollment for all participants; additional serum tests were done on a subset of the population during follow-up. Median serum levels at enrollment were 2.0 ppb PBB and 5.0 ppb PCB. A decline in serum PBB level over an interval that ranged from 1 to 146 months (median=31) was observed for 44.6% of the women (median=1.0 ppb), while 12.2% showed an increase (median=1.0 ppb). PCB levels declined in 50.3% of the women (median=3.0 ppb) while 12.2% increased (median=2.0 ppb). Relative to women whose contaminant levels were stable, higher initial serum level was a predictor of decline for both PBB and PCB (OR=1.66, 95% CI 1.52-1.82; OR=3.26, 95% CI 2.58-4.12, respectively); a yearly increase in interval between tests was related to declining PCBs (OR=1.65, 95% CI 1.46-1.87). In addition, age< or =10 years at exposure (OR=1.72, 95% CI 1.03-2.86) and residence on a quarantined farm (OR=1.40, 95- CI 1.03-1.90) were predictors of a decrease in PBBs. Factors related to an increase in PBB levels were age< or =10 years at exposure (OR=0.30, 95% CI 0.10-0.96) and initial PBB level (OR=1.24, 95% CI 1.15-1.33); and for PCBs, high initial level (OR=1.34, 95% CI 1.17-1.53) and body mass index (OR=1.07, 95% CI 1.01-1.13). One or more live births during the interval between tests were not related to changing levels of either contaminant; breastfeeding data were not available for examination. Early age at exposure appears to be an important predictor of changes in serum PBB levels over time.

Mixed-effects models for the evaluation of long-term trends in exposure levels with an example from the nickel industry.

Longitudinal studies play an important role in evaluating the temporal behavior of occupational exposures. The purpose of this paper is to examine certain features of longitudinal data and to present a general conceptual framework by which these features may be taken into account so that statistically valid inferences can be made. Statistical methods that rely on the application of mixed-effects models are proposed for evaluating long-term trends in exposures to workplace contaminants. The mixed-effects model presented herein has fixed effects for trend components and random effects for workers, job groups, buildings and plants. These models differ from conventional techniques in that they accommodate hierarchically structured data and account for the correlation that may arise due to the clustering of measurements based on when and where the data were collected. While primary interest is focused on determining the magnitude of trends in exposure levels over time, the model also provides information about the magnitude of the sources of variation associated with different groupings of workers. Application of the mixed-effects model is illustrated with a large database of shift-long personal exposure measurements collected on workers exposed to nickel aerosols in the nickel-producing industry.

Long-term trends in exposures to nickel aerosols.

A comprehensive evaluation of temporal changes in exposure to nickel aerosols in the nickel-producing and nickel-using industries was conducted. For various nickel compounds, trends in the geometric mean exposure levels were evaluated on the basis of job group, building, plant, and industrial sector. At each level of classification, approximately two-thirds of the data provided evidence of workplace declines in exposures. Depending on how exposure measurements were aggregated, approximately one-quarter to one-half of the data produced statistically significant trends, with far more exposures declining than increasing over time. Whereas significantly negative linear trends were detected for total nickel exposures in the mining (-7%/yr), smelting (-9%/yr), and refining (-7%/yr) sectors, total nickel exposures in milling showed a significantly positive trend (+4%/yr). When the data were classified at the job group, building, or plant level, the median rate of change in exposure levels was -4, -6, and -3%/yr, respectively. For a subset of the data, effects of various factors related to work environment, process, and nature of the job on trends in exposure levels were evaluated. When such factors were examined simultaneously, the results suggested that the decline in exposures was greater in workplaces with no ventilation system compared with ventilated workplaces, in groups of workers who performed similar rather than diverse tasks, and in North American workplaces compared with workplaces in Europe and Western Australia. These results could be used in the design of prospective sampling protocols and in future retrospective health-effects studies of workers in the nickel industries.

Variability in airborne and biological measures of exposure to mercury in the chloralkali industry: implications for epidemiologic studies.

Exposure assessment is a critical component of epidemiologic studies, and more sophisticated approaches require that variation in exposure be considered. We examined the intra- and interindividual sources of variation in exposure to mercury vapor as measured in air, blood, and urine among four groups of workers during 1990-1997 at a Swedish chloralkali plant. Consistent with the underlying kinetics of mercury in the body, the variability of biological measures was dampened considerably relative to the variation in airborne levels. Owing to the effects of intraindividual variation, estimating workers' exposures from a few measurements can attenuate measures of effect. To examine such effects on studies relating long-term exposure to a continuous health outcome, we evaluated the utility of each exposure measure by comparing the necessary sample sizes required for accurate estimation of a slope coefficient obtained from a regression analysis. No single measure outperformed the others for all groups of workers. However, when workers were evaluated together, creatinine-corrected urinary mercury better discriminated workers' exposures than airborne or blood mercury levels. Thus, pilot studies should be conducted to examine variability in both air and biomonitoring data because quantitative information about the relative magnitude of the intra- and interindividual sources of variation feeds directly into our efforts to design an optimal sampling strategy when evaluating health risks associated with occupational or environmental contaminants.

Comprehensive evaluation of long-term trends in occupational exposure: Part 2. Predictive models for declining exposures.

OBJECTIVES: To explore the effects of various factors related to the industry, the contaminant, and the period and type of sampling on long term declining trends in occupational exposure. METHODS: Linear regression analyses were used to assess the relation between reductions in exposure and geographical location, industrial sector, type of contaminant, type of monitoring, carcinogenic classification, calendar period, duration of sampling, and number of reductions in the threshold limit value during the sampling period. Both univariable and multivariable models were applied. RESULTS: Based on univariable analyses, the findings suggest that exposures declined more rapidly in manufacturing than in mining, more rapidly for aerosol contaminants than for vapours, and more rapidly when biological, rather than airborne, monitoring was conducted. Exposures collected more recently (first year of sampling in 1972 or later) fell more rapidly than exposures first evaluated during earlier periods. Irrespective of when the data were collected, the results also suggest that the longer the duration of sampling the slower the rate of decline. Taken together, we found that characteristics related to the contaminant, the industry, the sampling period, and the type of sampling explained a substantial proportion of the variability for exposures evaluated before 1972 (R2 = 0.78) and for sites evaluated both before and after 1972 (R2 = 0.91), but explained essentially no variation for data gathered exclusively after 1972 (R2 = 0.04). CONCLUSIONS: By identifying factors that have affected the rates of reduction in a consistent fashion, the results should guide investigators in estimating historical levels when studies assessing exposure-response relations are carried out.

Comprehensive evaluation of long-term trends in occupational exposure: Part 1. Description of the database.

OBJECTIVES: To conduct a comprehensive evaluation of long term changes in occupational exposure among a broad cross section of industries worldwide. METHODS: A review of the scientific literature identified studies that reported historical changes in exposure. About 700 sets of data from 119 published and several unpublished sources were compiled. Data were published over a 30 year period in 25 journals that spanned a range of disciplines. For each data set, the average exposure level was compiled for each period and details on the contaminant, the industry and location, changes in the threshold limit value (TLV), as well as the type of sampling method were recorded. Spearman rank correlation coefficients were used to identify monotonic changes in exposure over time and simple linear regression analyses were used to characterise trends in exposure. RESULTS: About 78% of the natural log transformed data showed linear trends towards lower exposure levels whereas 22% indicated increasing trends. (The Spearman rank correlation analyses produced a similar breakdown between exposures monotonically increasing or decreasing over time.) Although the rates of reduction for the data showing downward trends ranged from -1% to -62% per year, most exposures declined at rates between -4% and -14% per year (the interquartile range), with a median value of -8% per year. Exposures seemed to increase at rates that were slightly lower than those of exposures which have declined over time. Data sets that showed downward (versus upward) trends were influenced by several factors including type and carcinogenicity of the contaminant, type of monitoring, historical changes in the threshold limit values (TLVs), and period of sampling. CONCLUSIONS: This review supports the notion that occupational exposures are generally lower today than they were years or decades ago. However, such trends seem to have been affected by factors related to the contaminant, as well as to the period and type of sampling.

Assessment of water use for estimating exposure to tap water contaminants.

Epidemiological studies examining the association between exposure to tap water contaminants (such as chlorination by-products) and disease outcomes (such as cancer and adverse reproductive outcomes) have been limited by inaccurate exposure assessment. Failure to take into account the variation in beverage and tap water consumption and exposure to volatile contaminants through inhalation and dermal absorption can introduce misclassification in assessing the association between exposure to tap water contaminants and health. To refine exposure assessment of tap water contaminants, we describe in detail the tap water consumption, showering, and bathing habits of pregnant women and their male partners as assessed by a questionnaire and a 3-day water diary. We found good agreement between questionnaire and 3-day water diary values for drinking water intake (Pearson's r = 0.78) and for time spent showering(r = 0.68) and bathing (r = 0.78). Half of the participants consumed tap water on a regular basis with an overall mean +/- 1 standard deviation (SD) of 0. 78 +/- 0.51 l/day. Our results further suggest that full-time employees, compared to women working part-time or less, have more heterogeneous consumption patterns over time. Seventy-nine percent of women and 94% of men took showers for an average of 11.6 +/-4.0 min and 10.4 +/- 4.8 min, respectively. Baths were taken more frequently by women than men (21% vs. 3%) for an average of 22.9 +/-10.1 min and 21.3 +/- 12.4 min, respectively. Thus, these patterns of tap water use should be considered in the design and interpretation of environmental epidemiology studies.

Compliance versus risk in assessing occupational exposures.

Assessments of occupational exposures to chemicals are generally based upon the practice of compliance testing in which the probability of compliance is related to the exceedance [gamma, the likelihood that any measurement would exceed an occupational exposure limit (OEL)] and the number of measurements obtained. On the other hand, workers' chronic health risks generally depend upon cumulative lifetime exposures which are not directly related to the probability of compliance. In this paper we define the probability of "overexposure" (theta) as the likelihood that individual risk (a function of cumulative exposure) exceeds the risk inherent in the OEL (a function of the OEL and duration of exposure). We regard theta as a relevant measure of individual risk for chemicals, such as carcinogens, which produce chronic effects after long-term exposures but not necessarily for acutely-toxic substances which can produce effects relatively quickly. We apply a random-effects model to data from 179 groups of workers, exposed to a variety of chemical agents, and obtain parameter estimates for the group mean exposure and the within- and between-worker components of variance. These estimates are then combined with OELs to generate estimates of gamma and theta. We show that compliance testing can significantly underestimate the health risk when sample sizes are small. That is, there can be large probabilities of compliance with typical sample sizes, despite the fact that large proportions of the working population have individual risks greater than the risk inherent in the OEL. We demonstrate further that, because the relationship between theta and gamma depends upon the within- and between-worker components of variance, it cannot be assumed a priori that exceedance is a conservative surrogate for overexposure. Thus, we conclude that assessment practices which focus upon either compliance or exceedance are problematic and recommend that employers evaluate exposures relative to the probabilities of overexposure.

An investigation of multiple biomarkers among workers exposed to styrene and styrene-7,8-oxide.

Investigations of cancer and cytogenetic damage among reinforced-plastics workers have produced contradictory results. In all studies, the focus has been on styrene rather than the carcinogen, styrene-7,8-oxide (SO), traces of which are generated during the manufacturing process. Because styrene is present at very high levels and is metabolized almost exclusively through SO, coexposures to SO have been discounted. This study investigated the relative contributions of airborne styrene and SO and of smoking toward several SO-specific biomarkers (DNA and albumin adducts) and sister chromatid exchanges in the blood of 48 reinforced-plastics workers. Among individual subjects, albumin and DNA adducts as well as sister chromatid exchanges were significantly correlated with styrene exposure. However, among the 20 subjects with measurements to both styrene and SO, albumin adducts were significantly correlated with exposure to SO but not to styrene. Finally, among the 10 job groups, surprisingly strong correlations (0.709 < or = r < or = 0.966) were found between all SO biomarkers and exposure to SO but not to styrene. Calculations suggest that SO was about 2000 times more effective than styrene in producing SO biomarkers. After accounting for the disparate exposures to the two chemicals, a typical worker received 71% of the systemic dose of SO via inhalation; nonetheless, 5 of the 20 subjects received the majority of the SO dose from styrene. Cigarette smoking increased levels of SO-albumin and SO-DNA adducts, suggesting that SO was a constituent of tobacco smoke. We conclude that inhalation of SO should be considered in any interventions to reduce health risks.

An investigation of systematic changes in occupational exposure.

Nonstationary behavior in occupational exposure was examined among a number of job groups from different industries. A change in the mean level of exposure between two survey periods was evaluated by applying mixed-effects models. Overall, differences between surveys were observed in slightly more than one-third of the industries analyzed and in about one-quarter of the total number of comparisons performed. Exposures in the majority of cases decreased in the later survey. Further analyses examined the impact of nonstationary exposures on the estimation of the between- and within-worker components of variance. When changes in the mean exposure level were detected, point estimates of the variance components generated under the mixed model were compared with those estimates obtained under the one-way random-effects model, which assumes that the mean exposure level remains constant over time. The results indicate that the magnitude of the bias in the variance component estimates can be substantial when the misspecified model is applied. It is concluded that, in the absence of changes known to affect exposure, data collected within a year are likely to result in relatively valid inferences about mean and variance parameters using models that assume stationarity; for periods extending beyond a year, systematic changes in exposure are more likely to occur. Thus, exposure assessment strategies should be designed so that sufficient data are collected among groups of workers to investigate systematic changes and to ensure that appropriate statistical models are applied. In this way, occupational hygienists will be able to make reliable inferences about the underlying distribution of exposures pertinent to each occupational group.

Blood lead levels in relation to menopause, smoking, and pregnancy history.

Postmenopausal bone loss may result in the release of lead stored in bone. This study examined Mexican-American women aged 20 years and older who participated in the Hispanic Health and Nutrition Examination Survey (1982-1984) to assess the influence of menopause, pregnancy history, and smoking on blood lead levels. After adjustment for factors likely to influence blood lead levels and for design effects, the authors confirmed associations with age, income level, education, degree of urbanization, and body mass. Blood lead concentrations were markedly higher among current smokers and postmenopausal women, with these two factors showing separate, roughly additive effects. Gravidity had little impact on blood lead level among premenopausal women. However, among postmenopausal women, never-pregnant women had higher blood lead levels than did those who had ever been pregnant. The largest increase (4.4 micrograms/dl, 95 percent confidence interval 0.95, 7.8) was observed among smokers. In a separate analysis of postmenopausal women, women with recent menopause (4 years or less) had blood lead concentrations 1.4 micrograms/dl higher (95 percent confidence interval 0.20, 2.7) than did those whose menopause occurred more than 4 years previously. This finding, along with an overall slow decline in blood lead levels with each year after menopause, suggests that lead is being mobilized at rates consistent with the patterns of bone loss, placing women with recent menopause at increased risk for higher blood lead levels.

The relationship between environmental monitoring and biological markers in exposure assessment.

The poor quality of traditional assessments of exposure has encouraged epidemiologists to explore biological monitoring in studies of chronic diseases. Yet, despite theoretical advantages, biomarkers have not been widely used in such applications. This article compares the general utility of a biomarker with that of the measurement of exposure per se. Points are illustrated with a longitudinal study of boat workers in which levels of styrene in the breathing zone and in exhaled air were compared to sister chromatid exchanges (SCEs) in peripheral lymphocytes. First, the linear relationship is explored between personal exposure and the levels of a biomarker in the cohort. A good fit to the straight-line relationship reflected by a correlation coefficient which is close to 1, such as observed with styrene in exhaled air (r2 = 0.83), suggests linear kinetics, that the appropriate route of exposure was measured by personal monitoring, small interindividual differences, adequate sample sizes, and a specific biomarker. However, a small correlation coefficient, as observed between SCEs and styrene exposure (r2 = 0.11), indicates that either kinetics were nonlinear or that more complex issues were involved with one or more of these factors. Second, environmental and biologic measurements are compared for use as independent variables in establishing a straight-line relationship between exposure and the health effect. If the ratio of the within-person to the between-person components of variance of the independent variable is large, then significant attenuation results when estimating the slope of the line.(ABSTRACT TRUNCATED AT 250 WORDS)

An investigation of the dependence of exposure variability on the interval between measurements.

Investigations have suggested that owing to the effects of autocorrelation and/or non-stationary behaviour exposure variability increases with the number of days between measurements. This study confirmed such increasing variability with the interval between observations in a collection of occupational data sets after controlling for factors likely to contribute to variability and for sample size. Consecutive shift-long exposure measurements for 53 workers from five different data sets in 123 time series were analysed. When the data were combined a clear increasing trend in the variance was observed with interval, but a breakdown by data set revealed that this trend was present in only two of the five data sets. The effect was further isolated in 30% of the workers who contributed data and in 29% of the total number of time series analysed. Amongst the data where the trend was evident the combination of autocorrelation and non-stationary behavior explained the increase in 64% of the time series. Significant autocorrelation was detected for a small group of workers in only one of the data sets and for a minority of cases amongst workers who contributed more than one time series to the analysis. Thus, autocorrelation of shift-long exposures does not appear to be pervasive and is unlikely to present significant problems when implementing statistically-based sampling strategies. On the other hand, the issue of non-stationarity remains equivocal. Although only a small proportion of time series was found to be non-stationary, the period investigated was short (around 30 days) and it remains to be seen whether the problem is more pronounced over longer time scales.