Determinants of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans in house dust samples from four areas of the United States.

Determinants of levels of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/F) in dust in U.S. homes are not well characterized. We conducted a pilot study to evaluate the relationship between concentrations of PCDD/F in house dust and residential proximity to known sources, including industrial facilities and traffic. Samples from vacuum bag dust from homes of 40 residents of Detroit, Los Angeles, Seattle, or Iowa who participated in a population-based case-control study of non-Hodgkin lymphoma conducted in 1998-2000 were analyzed using high resolution gas chromatography/high resolution mass spectrometry for 7 PCDD and 10 PCDF congeners considered toxic by the U.S. Environmental Protection Agency (EPA). Locations of 10 types of PCDD/F-emitting facilities were obtained from the EPA; however only 4 types were located near study homes (non-hazardous waste cement kilns, coal-fired power plants, sewage sludge incinerators, and medical waste incinerators). Relationships between concentrations of each PCDD/F and proximity to industrial facilities, freight routes, and major roads were evaluated using separate multivariate regression models for each congener. The median (inter-quartile range [IQR]) toxic equivalence (TEQ) concentration of these congeners in the house dust was 20.3 pg/g (IQR=14.3, 32.7). Homes within 3 or 5 km of a cement kiln had 2 to 9-fold higher concentrations of 5 PCDD and 5 PCDF (p<0.1 in each model). Proximity to freight routes and major roads was associated with elevated concentrations of 1 PCDD and 8 PCDF. Higher concentrations of certain PCDD/F in homes near cement kilns, freight routes, and major roads suggest that these outdoor sources are contributing to indoor environmental exposures. Further study of the contribution of these sources and other facility types to total PCDD/F exposure in a larger number of homes is warranted.

Effects of varying temporal scale on spatial models of mortality patterns attributed to pediatric diarrhea.

Public health data is often highly aggregated in time and space. The consequences of temporal aggregation for modeling in support of policy decisions have largely been overlooked. We examine the effects of changing temporal scale on spatial regression models of pediatric diarrhea mortality patterns, mortality rates and mortality peak timing, in Mexico. We compare annual and decadal level univariate models that incorporate known risk factors. Based on normalized sums of squared differences we compare between annual and decadal coefficients for variables that were significant in decadal models. We observed that spurious relationships might be created through aggregating time scales; obscuring interannual variation and resulting in inflated model diagnostics. In fact, variable selection and coefficient values can vary with changing temporal aggregation. Some variables that were significant at the decadal level were not significant at the annual level. Implications of such aggregation should be part of risk communication to policy makers.

Residential proximity to industrial facilities and risk of non-Hodgkin lymphoma.

Industrial pollution has been suspected as a cause of non-Hodgkin lymphoma (NHL), based on associations with chemical exposures in occupational studies. We conducted a case-control study of NHL in four SEER regions of the United States, in which residential locations of 864 cases and 684 controls during the 10 years before recruitment were used to characterize proximity to industrial facilities reporting chemical releases to the Environmental Protection Agency's Toxics Release Inventory (TRI). For each of 15 types of industry (by 2-digit SIC code), we evaluated the risk of NHL associated with having lived within 2 miles of a facility, the distance to the nearest facility (miles categories of < or =0.5, >0.5-1.0, >1.0-2.0, >2 [referent]), and the duration of residence within 2miles (years categories of 10, 1-9, 0 [referent]), using logistic regression. Increased risk of NHL was observed in relation to lumber and wood products facilities (SIC 24) for the shortest distance of residential proximity (< or =0.5 mile: odds ratio [OR]=2.2, 95% confidence interval [CI]: 0.4-11.8) or the longest duration (10 years: OR=1.9, 95% CI: 0.8-4.8); the association with lumber facilities was more apparent for diffuse large B-cell lymphoma (lived within 2 miles: OR=1.7, 95% CI: 1.0-3.0) than for follicular lymphoma (OR=1.1, 95% CI: 0.5-2.2). We also observed elevated ORs for the chemical (SIC 28, 10 years: OR=1.5, 95% CI: 1.1-2.0), petroleum (SIC 29, 10 years: OR=1.9, 95% CI: 1.0-3.6), rubber/miscellaneous plastics products (SIC 30, < or =0.5mile: OR=2.7, 95% CI: 1.0-7.4), and primary metal (SIC 33, lived within 2miles: OR=1.3, 95% CI: 1.0-1.6) industries; however, patterns of risk were inconsistent between distance and duration metrics. This study does not provide strong evidence that living near manufacturing industries increases NHL risk. However, future studies designed to include greater numbers of persons living near specific types of industries, along with fate-transport modeling of chemical releases, would be informative.

Exogenous and endogenous determinants of blood trihalomethane levels after showering.

BACKGROUND: We previously conducted a study to assess whether household exposures to tap water increased an individual's internal dose of trihalomethanes (THMs). Increases in blood THM levels among subjects who showered or bathed were variable, with increased levels tending to cluster in two groups. OBJECTIVES: Our goal was to assess the importance of personal characteristics, previous exposures, genetic polymorphisms, and environmental exposures in determining THM concentrations in blood after showering. METHODS: One hundred study participants completed a health symptom questionnaire, a 48-hr food and water consumption diary, and took a 10-min shower in a controlled setting. We examined THM levels in blood samples collected at baseline and 10 and 30 min after the shower. We assessed the significance of personal characteristics, previous exposures to THMs, and specific gene polymorphisms in predicting postshower blood THM concentrations. RESULTS: We did not observe the clustering of blood THM concentrations observed in our earlier study. We found that environmental THM concentrations were important predictors of blood THM concentrations immediately after showering. For example, the chloroform concentration in the shower stall air was the most important predictor of blood chloroform levels 10 min after the shower (p < 0.001). Personal characteristics, previous exposures to THMs, and specific polymorphisms in CYP2D6 and GSTT1 genes were significant predictors of both baseline and postshowering blood THM concentrations as well as of changes in THM concentrations associated with showering. CONCLUSION: The inclusion of information about individual physiologic characteristics and environmental measurements would be valuable in future studies to assess human health effects from exposures to THMs in tap water.

Maternal exposure to water disinfection by-products during gestation and risk of hypospadias.

BACKGROUND: The use of chlorine for water disinfection results in the formation of numerous contaminants called disinfection by-products (DBPs), which may be associated with birth defects, including urinary tract defects. METHODS: We used Arkansas birth records (1998-2002) to conduct a population-based case-control study investigating the relationship between hypospadias and two classes of DBPs, trihalomethanes (THM) and haloacetic acids (HAA). We utilised monitoring data, spline regression and geographical information systems (GIS) to link daily concentrations of these DBPs from 263 water utilities to 320 cases and 614 controls. We calculated ORs for hypospadias and exposure to DBPs between 6 and 16 weeks' gestation, and conducted subset analyses for exposure from ingestion, and metrics incorporating consumption, showering and bathing. RESULTS: We found no increase in risk when women in the highest tertiles of exposure were compared to those in the lowest for any DBP. When ingestion alone was used to assess exposure among a subset of 40 cases and 243 controls, the intermediate tertiles of exposure to total THM and the five most common HAA had ORs of 2.11 (95% CI 0.89 to 5.00) and 2.45 (95% CI 1.06 to 5.67), respectively, compared to women with no exposure. When exposure to total THM from consumption, showering and bathing exposures was evaluated, we found an OR of 1.96 (95% CI 0.65 to 6.42) for the highest tertile of exposure and weak evidence of a dose-response relationship. CONCLUSIONS: Our results provide little evidence for a positive relationship between DBP exposure during gestation and an increased risk of hypospadias but emphasise the necessity of including individual-level data when assessing exposure to DBPs.

Identifying public water facilities with low spatial variability of disinfection by-products for epidemiological investigations.

BACKGROUND AND AIMS: Epidemiological studies of disinfection by-products (DBPs) and reproductive outcomes have been hampered by misclassification of exposure. In most epidemiological studies conducted to date, all persons living within the boundaries of a water distribution system have been assigned a common exposure value based on facility-wide averages of trihalomethane (THM) concentrations. Since THMs do not develop uniformly throughout a distribution system, assignment of facility-wide averages may be inappropriate. One approach to mitigate this potential for misclassification is to select communities for epidemiological investigations that are served by distribution systems with consistently low spatial variability of THMs. METHODS AND RESULTS: A feasibility study was conducted to develop methods for community selection using the Information Collection Rule (ICR) database, assembled by the US Environmental Protection Agency. The ICR database contains quarterly DBP concentrations collected between 1997 and 1998 from the distribution systems of 198 public water facilities with minimum service populations of 100,000 persons. Facilities with low spatial variation of THMs were identified using two methods; 33 facilities were found with low spatial variability based on one or both methods. Because brominated THMs may be important predictors of risk for adverse reproductive outcomes, sites were categorised into three exposure profiles according to proportion of brominated THM species and average TTHM concentration. The correlation between THMs and haloacetic acids (HAAs) in these facilities was evaluated to see whether selection by total trihalomethanes (TTHMs) corresponds to low spatial variability for HAAs. TTHMs were only moderately correlated with HAAs (r = 0.623). CONCLUSIONS: Results provide a simple method for a priori selection of sites with low spatial variability from state or national public water facility datasets as a means to reduce exposure misclassification in epidemiological studies of DBPs.

Comparison of trihalomethanes in tap water and blood.

Trihalomethane (THM) concentrations in blood and tap water were measured for 50 women living in two locations with different bromide concentrations and disinfectant types. Blood samples were taken from each woman early in the morning prior to any major water-use activity and again immediately after showering. Each residence was sampled for THMs in tap water prior to the woman's shower. Cobb County, GA, tap water exhibited high THM concentrations composed primarily of chloroform. Corpus Christi, TX, tap water exhibited lower THM concentrations with significant proportions of brominated THMs. THMs in tap water and blood were compared using mole fraction speciation, extent of bromine incorporation, and correlation analysis. Results indicated that THMs in the blood rose significantly as a result of showering, that showering shifted the THM distribution in the blood toward that found in the corresponding tap water, and that THMs measured in the blood of women living in the two locations reflected species and concentration differences in their respective tap waters. In general, blood concentrations were not significantly correlated with tap water concentrations. This finding suggests that other factors, in addition to tap water concentrations, may be important in determining THM concentrations in the blood.

DBP formation kinetics in a simulated distribution system.

Little is known about how the growth of halogenated disinfection by-products (DBPs) in drinking water is affected by time spent in a distribution system. Experiments were performed to compare the rate of trihalomethane and haloacetic acid production in a simulated pipe environment to that observed for the same water held in glass bottles. Results showed that although the rate of chlorine consumption in the pipe was much greater than in the bottle, there was no decrease in the amount of haloacetic acids produced and that trihalomethane levels actually increased by an average of 15%. Separate tests confirmed that this increase was due to a reservoir of organic precursor material associated with deposits on the pipe wall. This work suggests that the rate of DBP production in a distribution system will not necessarily be reduced by increased chlorine consumption due to non-DBP producing reactions with deposits on the pipe wall.

Assessing exposure to disinfection by-products in women of reproductive age living in Corpus Christi, Texas, and Cobb county, Georgia: descriptive results and methods.

We conducted a field study in Corpus Christi, Texas, and Cobb County, Georgia, to evaluate exposure measures for disinfection by-products, with special emphasis on trihalomethanes (THMs). Participants were mothers living in either geographic area who had given birth to healthy infants from June 1998 through May 1999. We assessed exposure by sampling blood and water and obtaining information about water use habits and tap water characteristics. Two 10-mL whole blood samples were collected from each participant before and immediately after her shower. Levels of individual THM species (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) were measured in whole blood [parts per trillion (pptr)] and in water samples (parts per billion). In the Corpus Christi water samples, brominated compounds accounted for 71% of the total THM concentration by weight; in Cobb County, chloroform accounted for 88%. Significant differences in blood THM levels were observed between study locations. For example, the median baseline blood level of bromoform was 0.3 pptr and 3.5 pptr for participants in Cobb County and Corpus Christi, respectively (p = 0.0001). Differences were most striking in blood obtained after showering. For bromoform, the median blood levels were 0.5 pptr and 17 pptr for participants in Cobb County and Corpus Christi, respectively (p = 0.0001). These results suggest that blood levels of THM species vary substantially across populations, depending on both water quality characteristics and water use activities. Such variation has important implications for epidemiologic studies of the potential health effects of disinfection by-products.

A geographic information assessment of birth weight and crop production patterns around mother's residence.

A landscape approach using remote sensing (RS) and geographic information system (GIS) technologies was developed to identify the proximity of maternal residence to agricultural areas, and the association between crop production patterns around mothers residences and low birth weight was evaluated. Satellite data obtained for Weld County, Colorado, in 1991 and 1993 were digitally processed to generate crop location maps for this study. GIS procedures were then used to determine crop types within 300- and 500-m circular zones around mothers' homes for 125 births that occurred from 1991 to 1993 in the study area. The relationships between different crop patterns around the mothers' residences and the birth weight of babies were investigated while controlling for potential confounding variables. The results indicated that low birth weight was associated with total crop production area within a 300-m buffer zone around mothers' residences (P=0.058). When each of the study crops was considered separately, low birth weight was associated with sugar beet production (P=0.05) and corn production (P=0.1) within both the 300- and the 500-m buffer zones. This RS/GIS approach provides clues to the potential relationships between birth weight and crop production near the residence.

Identifying populations potentially exposed to agricultural pesticides using remote sensing and a Geographic Information System.

Pesticides used in agriculture may cause adverse health effects among the population living near agricultural areas. However, identifying the populations most likely to be exposed is difficult. We conducted a feasibility study to determine whether satellite imagery could be used to reconstruct historical crop patterns. We used historical Farm Service Agency records as a source of ground reference data to classify a late summer 1984 satellite image into crop species in a three-county area in south central Nebraska. Residences from a population-based epidemiologic study of non-Hodgkin lymphoma were located on the crop maps using a geographic information system (GIS). Corn, soybeans, sorghum, and alfalfa were the major crops grown in the study area. Eighty-five percent of residences could be located, and of these 22% had one of the four major crops within 500 m of the residence, an intermediate distance for the range of drift effects from pesticides applied in agriculture. We determined the proximity of residences to specific crop species and calculated crop-specific probabilities of pesticide use based on available data. This feasibility study demonstrated that remote sensing data and historical records on crop location can be used to create historical crop maps. The crop pesticides that were likely to have been applied can be estimated when information about crop-specific pesticide use is available. Using a GIS, zones of potential exposure to agricultural pesticides and proximity measures can be determined for residences in a study.

Exposure to trihalomethanes and adverse pregnancy outcomes.

Exposure during pregnancy to disinfection by-products in drinking water has been hypothesized to lead to several adverse reproductive outcomes. We performed a retrospective cohort study to examine the relation of trihalomethane exposure during the third trimester of pregnancy to low birthweight, term low birthweight, and preterm delivery. We matched Colorado birth certificates from January 1, 1990, through December 31, 1993, to historical water sample data with respect to time and location of maternal residence based on census block groups. After excluding births from all census block groups with no trihalomethane sample data and restricting to singleton white births with 28-42 weeks of completed gestation (>400 gm), we studied 1,893 livebirths within 28 census block groups. We found a weak association of trihalomethane exposure during the third trimester with low birthweight (odds ratio = 2.1 for the highest exposure level; 95% confidence interval = 1.0-4.8); a large increase in risk for term low birthweight at the highest level of exposure (odds ratio = 5.9; 95% confidence interval = 2.0-17.0); and no association between exposure and preterm delivery (odds ratio = 1.0 for the highest exposure level; 95% confidence interval = 0.3-2.8). The small number of adverse outcomes reduced the precision of risk estimates, but these data indicate a potentially important relation between third trimester exposure to trihalomethanes and retarded fetal growth.

Surveillance around hazardous waste sites: geographic information systems and reproductive outcomes.

The purpose of this paper is to discuss the potential for integrating surveillance techniques in reproductive epidemiology with geographic information system technology in order to identify populations at risk around hazardous waste sites. Environmental epidemiologic studies have had problems with estimating or measuring exposures to individuals, and of detecting effects when the exposure is low, but continuous. In addition, exposures around hazardous waste sites are complex and frequently involve chemical mixtures. The birth weight of human babies has been reported to be sensitive to many environmental influences. Birth weight can be analyzed as a continuous variable or as a dichotomous one using the standard cutpoint of 2500 g or less to indicate low birth weight. It has the potential to be a powerful surveillance tool since exposures to the fetus reflect maternal and paternal exposures. The advent of recent environmental regulations pertaining to hazardous waste sites has greatly increased the availability of environmental data for many sites. The major problem with incorporating these data into epidemiologic studies has been with the logistics of data management and analysis. Computer-assisted geographic information systems hold promise in providing capabilities needed to address the data management and analysis requirements for effective epidemiologic studies around to hazardous waste sites.