New developments in exposure assessment: the impact on the practice of health risk assessment and epidemiological studies

Assessing residential exposure to urban noise using environmental models: does the size of the local living neighborhood matter?

Environmental epidemiological studies rely on the quantification of the exposure level in a surface defined as the subject's exposure area. For residential exposure, this area is often the subject's neighborhood. However, the variability of the size and nature of the neighborhoods makes comparison of the findings across studies difficult. This article examines the impact of the neighborhood's definition on environmental noise exposure levels obtained from four commonly used sampling techniques: address point, façade, buffers, and official zoning. A high-definition noise model, built on a middle-sized French city, has been used to estimate LAeq,24 h exposure in the vicinity of 10,825 residential buildings. Twelve noise exposure indicators have been used to assess inhabitants' exposure. Influence of urban environmental factors was analyzed using multilevel modeling. When the sampled area increases, the average exposure increases (+3.9 dB), whereas the SD decreases (-1.6 dB) (P<0.01). Most of the indicators differ statistically. When comparing indicators from the 50-m and 400-m radius buffers, the assigned LAeq,24 h level varies across buildings from -9.4 to +22.3 dB. This variation is influenced by urban environmental characteristics (P<0.01). On the basis of this study's findings, sampling technique, neighborhood size, and environmental composition should be carefully considered in further exposure studies.

Human health risk assessment with spatial analysis: study of a population chronically exposed to arsenic through drinking water from Argentina

Arsenic (As) is a ubiquitous element widely distributed in the environment. This metalloid has proven carcinogenic action in man. The aim of this work was to assess the health risk related to As exposure through drinking water in an Argentinean population, applying spatial analytical techniques in addition to conventional approaches. The study involved 650 inhabitants from Chaco and Santiago del Estero provinces. Arsenic in drinking water (Asw) and urine (UAs) was measured by hydride generation atomic absorption spectrophotometry. Average daily dose (ADD), hazard quotient (HQ), and carcinogenic risk (CR) were estimated, geo-referenced and integrated with demographical data by a health composite index (HI) applying geographic information system (GIS) analysis. Asw covered a wide range of concentration: from non-detectable (ND) to 2000 μg/L. More than 90% of the population was exposed to As, with UAs levels above the intervention level of 100 μg/g creatinine. GIS analysis described an expected level of exposure lower than the observed, indicating possible additional source/s of exposure to inorganic arsenic. In 68% of the locations, the population had a HQ greater than 1, and the CR ranged between 5·10(-5) and 2,1·10(-2). An environmental exposure area through ADD geo-referencing defined a baseline scenario for space-time risk assessment. The time of residence, the demographic density and the potential health considered outcomes helped characterize the health risk in the region. The geospatial analysis contributed to delimitate and analyze the change tendencies of risk in the region, broadening the scopes of the results for a decision-making process.

The microenvironmental modelling approach to assess children's exposure to air pollution - A review

Exposures to a wide spectrum of air pollutants were associated to several effects on children's health. Exposure assessment can be used to establish where and how air pollutants' exposures occur. However, a realistic estimation of children's exposures to air pollution is usually a great ethics challenge, especially for young children, because they cannot intentionally be exposed to contaminants and according to Helsinki declaration, they are not old enough to make a decision on their participation. Additionally, using adult surrogates introduces bias, since time-space-activity patterns are different from those of children. From all the different available approaches for exposure assessment, the microenvironmental (ME) modelling (indirect approach, where personal exposures are estimated or predicted from microenvironment measurements combined with time-activity data) seemed to be the best to assess children's exposure to air pollution as it takes into account the varying levels of pollution to which an individual is exposed during the course of the day, it is faster and less expensive. Thus, this review aimed to explore the use of the ME modelling approach methodology to assess children's exposure to air pollution. To meet this goal, a total of 152 articles, published since 2002, were identified and titles and abstracts were scanned for relevance. After exclusions, 26 articles were fully reviewed and main characteristics were detailed, namely: (i) study design and outcomes, including location, study population, calendar time, pollutants analysed and purpose; and (ii) data collection, including time-activity patterns (methods of collection, record time and key elements) and pollution measurements (microenvironments, methods of collection and duration and time resolution). The reviewed studies were from different parts of the world, confirming the worldwide application, and mostly cross-sectional. Longitudinal studies were also found enhancing the applicability of this approach. The application of this methodology on children is different from that on adults because of data collection, namely the methods used for collecting time-activity patterns must be different and the time-activity patterns are itself different, which leads to select different microenvironments to the data collection of pollutants' concentrations. The most used methods to gather information on time-activity patterns were questionnaires and diaries, and the main microenvironments considered were home and school (indoors and outdoors). Although the ME modelling approach in studies to assess children's exposure to air pollution is highly encouraged, a validation process is needed, due to the uncertainties associated with the application of this approach.

Including exposure variability in the life cycle impact assessment of indoor chemical emissions: the case of metal degreasing

The present paper describes a method that accounts for variation in indoor chemical exposure settings and accompanying human toxicity in life cycle assessment (LCA). Metal degreasing with dichloromethane was used as a case study to show method in practice. We compared the human toxicity related to the degreasing of 1m(2) of metal surface in different exposure scenarios for industrial workers, professional users outside industrial settings, and home consumers. The fraction of the chemical emission that is taken in by exposed individuals (i.e. the intake fraction) was estimated on the basis of operational conditions (e.g. exposure duration), and protective measures (e.g. local exhaust ventilation). The introduction of a time-dependency and a correction for protective measures resulted in reductions in the intake fraction of up to 1.5 orders of magnitude, compared to application of existing, less advanced models. In every exposure scenario, the life cycle impacts for human toxicity were mainly caused by indoor exposure to metal degreaser (>60%). Emissions released outdoors contributed up to 22% of the life cycle impacts for human toxicity, and the production of metal degreaser contributed up to 19%. These findings illustrate that human toxicity from indoor chemical exposure should not be disregarded in LCA case studies. Particularly when protective measures are taken or in the case of a short duration (1h or less), we recommend the use of our exposure scenario-specific approach.

Methods for evaluating temporal trends in noise exposure

OBJECTIVE

Hearing conservation programs have been mandatory in many US industries since 1983. Since then, three program elements (audiometric testing, hearing protection, and training) have been the focus of much research. By comparison, little has been done on noise exposure evaluation.

DESIGN

Temporal trends in time weighted average (TWA) exposures and the fraction of measurements exceeding 85 dBA were evaluated by facility, by exposure group within facility, and by individual worker within facility.

STUDY SAMPLE

A large dataset (> 10 000 measurements over 20 years) from eight facilities operated by a multinational aluminum manufacturing company was studied.

RESULTS

Overall, exposures declined across locations over the study period. Several facilities demonstrated substantial reductions in exposure, and the results of mean noise levels and exceedance fractions generally showed good agreement. The results of analyses at the individual level diverged with analyses by facility and exposure group within facility, suggesting that individual-level analyses, while challenging, may provide important information not available from coarser levels of analysis.

CONCLUSIONS

Validated metrics are needed to allow for assessment of temporal trends in noise exposure. Such metrics will improve our ability to characterize, in a standardized manner, efforts to reduce noise-induced hearing loss.

Epidemiologic tools to study the influence of environmental factors on fecundity and pregnancy-related outcomes

Adverse pregnancy outcomes entail a large health burden for the mother and offspring; a part of it might be avoided by better understanding the role of environmental factors in their etiology. Our aims were to review the assessment tools to characterize fecundity troubles and pregnancy-related outcomes in human populations and their sensitivity to environmental factors. For each outcome, we reviewed the possible study designs, main sources of bias, and their suggested cures. In terms of study design, for most pregnancy outcomes, cohorts with recruitment early during or even before pregnancy allow efficient characterization of pregnancy-related events, time-varying confounders, and in utero exposures that may impact birth outcomes and child health. Studies on congenital anomalies require specific designs, assessment of anomalies in medical pregnancy terminations, and, for congenital anomalies diagnosed postnatally, follow-up during several months after birth. Statistical analyses should take into account environmental exposures during the relevant time windows; survival models are an appropriate approach for fecundity, fetal loss, and gestational duration/preterm delivery. Analysis of gestational duration could distinguish pregnancies according to delivery induction (and possibly pregnancy-related conditions). In conclusion, careful design and analysis are required to better characterize environmental effects on human reproduction.

Public health risk assessment associated with heavy metal and arsenic exposure near an abandoned mine (Kirki, Greece)

The 'Agios Philippos' lead-zinc mine in the Kirki region (NE Greece) is now closed, but its legacy of heavy metal contamination remains at the site. At present, management of the contaminated land is of major concern. The area is in a reclamation process and requires immediate remediation action, whereas human risks need to be carefully evaluated. In order to assess these risks, samples from around the mine were collected and analyzed and a scenario involving the oral, dermal, and inhaled doses of arsenic and heavy metals was formulated. A Monte Carlo approach was undertaken, in order to model the average daily dose and quantify the corresponding hazard index and cancer risk. A toxicological risk was associated with samples collected in the vicinity of the mine (floatation, mine tailings) and a pronounced carcinogenic risk for arsenic was evident at the broader occupational/environmental setting. These findings urge for immediate rehabilitation actions that will mitigate population exposures and promote long-term environmental safety in the area.

Pilot task-based assessment of noise levels among firefighters

PURPOSE

Over one million American firefighters are routinely exposed to various occupational hazards agents. While efforts have been made to identify and reduce some causes of injuries and illnesses among firefighters, relatively little has been done to evaluate and understand occupational noise exposures in this group. The purpose of this pilot study was to apply a task-based noise exposure assessment methodology to firefighting operations to evaluate potential noise exposure sources, and to use collected task-based noise levels to create noise exposure estimates for evaluation of risk of noise-induced hearing loss by comparison to the 8-hr and 24-hr recommended exposure limits (RELs) for noise of 85 and 80.3 dBA, respectively.

METHODS

Task-based noise exposures (n=100 measurements) were measured in three different fire departments (a rural department in Southeast Michigan and suburban and urban departments in Northern California). These levels were then combined with time-at-task information collected from firefighters to estimate 8-hr noise exposures for the rural and suburban fire departments (n=6 estimates for each department). Data from 24-hr dosimetry measurements and crude self-reported activity categories from the urban fire department (n=4 measurements) were used to create 24-hr exposure estimates to evaluate the bias associated with the task-based estimates.

RESULTS

Task-based noise levels were found to range from 82-109 dBA, with the highest levels resulting from use of saws and pneumatic chisels. Some short (e.g., 30 min) sequences of common tasks were found to result in nearly an entire allowable daily exposure. The majority of estimated 8-hr and 24-hr exposures exceeded the relevant recommended exposure limit. Predicted 24-hr exposures showed substantial imprecision in some cases, suggesting the need for increased task specificity.

CONCLUSIONS

The results indicate potential for overexposure to noise from a variety of firefighting tasks and equipment, and suggest a need for further exposure characterization and additional hearing loss prevention efforts.

RELEVANCE TO INDUSTRY

Firefighters may be at risk of noise-induced hearing loss, which can affect their fitness for duty and ability to respond effectively to emergencies. The results of this study suggest that additional efforts at hearing loss prevention among firefighters are warranted.

A comparison of population air pollution exposure estimation techniques with personal exposure estimates in a pregnant cohort

There is increasing evidence of the harmful effects for mother and fetus of maternal exposure to air pollutants. Most studies use large retrospective birth outcome datasets and make a best estimate of personal exposure (PE) during pregnancy periods. We compared estimates of personal NOx and NO2 exposure of pregnant women in the North West of England with exposure estimates derived using different modelling techniques. A cohort of 85 pregnant women was recruited from Manchester and Blackpool. Participants completed a time-activity log and questionnaire at 13-22 weeks gestation and were provided with personal Ogawa samplers to measure their NOx/NO2 exposure. PE was compared to monthly averages, the nearest stationary monitor to the participants' home, weighted average of the closest monitor to home and work location, proximity to major roads, as well as to background modelled concentrations (DEFRA), inverse distance weighting (IDW), ordinary kriging (OK), and a land use regression model with and without temporal adjustment. PE was most strongly correlated with monthly adjusted DEFRA (NO2r = 0.61, NOxr = 0.60), OK and IDW (NO2r = 0.60; NOxr = 0.62) concentrations. Correlations were stronger in Blackpool than in Manchester. Where there is evidence for high temporal variability in exposure, methods of exposure estimation which focus solely on spatial methods should be adjusted temporally, with an improvement in estimation expected to be better with increased temporal variability.

Bayesian Networks as a screening tool for exposure assessment

A tiered approach to contamination exposure assessment is currently adopted in many countries. Increasing the site-specific information in exposure assessments is generally recommended when guideline values for contaminants in soil are exceeded. This work details a Bayesian Network (BN) approach to developing a site-specific environmental exposure assessment that focuses on the simple mapping and assessment of assumptions and the effect of new data on assessment outcomes. The BN approach was applied to a floodplain system in New South Wales, Australia, where site-specific information about elevated antimony (Sb) concentrations and distribution in soils was available. Guidelines for exposure assessment in Australia are used as a template for this site, although the approach is generic. The BN-based assessment used an iterative approach starting with limited soil Sb data (41 samples ranging from 0 to 18 mg kg-(1) Sb) and extending the model with more detailed Sb data (145 samples ranging from 0 to 40 mg kg-(1) Sb). The analyses identified dominant exposure pathways and assessed the sensitivity of these pathways to changes in assumptions and the level of site-specific information available. In particular, there was a 10.8% probability of exceeding the tolerable daily intake of Sb in the case study when the limited soil Sb data was used, which increased to 26.2% with the more detailed sampling regime. There was also a 47% decrease in the probability of overexposure to Sb when the dermal bioavailability of arsenic (a similar metalloid) was used as a surrogate measure instead of a default bioavailability of 100%. We conclude that the BN approach to soil exposure assessment has merit both in the context of Australian and international soil exposure assessments.

A review of exposure assessment methods in epidemiological studies on incinerators

Incineration is a common technology for waste disposal, and there is public concern for the health impact deriving from incinerators. Poor exposure assessment has been claimed as one of the main causes of inconsistency in the epidemiological literature. We reviewed 41 studies on incinerators published between 1984 and January 2013 and classified them on the basis of exposure assessment approach. Moreover, we performed a simulation study to explore how the different exposure metrics may influence the exposure levels used in epidemiological studies. 19 studies used linear distance as a measure of exposure to incinerators, 11 studies atmospheric dispersion models, and the remaining 11 studies a qualitative variable such as presence/absence of the source. All reviewed studies utilized residence as a proxy for population exposure, although residence location was evaluated with different precision (e.g., municipality, census block, or exact address). Only one study reconstructed temporal variability in exposure. Our simulation study showed a notable degree of exposure misclassification caused by the use of distance compared to dispersion modelling. We suggest that future studies (i) make full use of pollution dispersion models; (ii) localize population on a fine-scale; and (iii) explicitly account for the presence of potential environmental and socioeconomic confounding.

Environmental exposure assessment in European birth cohorts: results from the ENRIECO project

Environmental exposures during pregnancy and early life may have adverse health effects. Single birth cohort studies often lack statistical power to tease out such effects reliably. To improve the use of existing data and to facilitate collaboration among these studies, an inventory of the environmental exposure and health data in these studies was made as part of the ENRIECO (Environmental Health Risks in European Birth Cohorts) project. The focus with regard to exposure was on outdoor air pollution, water contamination, allergens and biological organisms, metals, pesticides, smoking and second hand tobacco smoke (SHS), persistent organic pollutants (POPs), noise, radiation, and occupational exposures. The review lists methods and data on environmental exposures in 37 European birth cohort studies. Most data is currently available for smoking and SHS (N=37 cohorts), occupational exposures (N=33), outdoor air pollution, and allergens and microbial agents (N=27). Exposure modeling is increasingly used for long-term air pollution exposure assessment; biomonitoring is used for assessment of exposure to metals, POPs and other chemicals; and environmental monitoring for house dust mite exposure assessment. Collaborative analyses with data from several birth cohorts have already been performed successfully for outdoor air pollution, water contamination, allergens, biological contaminants, molds, POPs and SHS. Key success factors for collaborative analyses are common definitions of main exposure and health variables. Our review emphasizes that such common definitions need ideally be arrived at in the study design phase. However, careful comparison of methods used in existing studies also offers excellent opportunities for collaborative analyses. Investigators can use this review to evaluate the potential for future collaborative analyses with respect to data availability and methods used in the different cohorts and to identify potential partners for a specific research question.

Proximity to mining industry and cancer mortality

Mining installations are releasing toxic substances into the environment which could pose a health problem to populations in their vicinity. We sought to investigate whether there might be excess cancer-related mortality in populations residing in towns lying in the vicinity of Spanish mining industries governed by the Integrated Pollution Prevention and Control Directive, and the European Pollutant Release and Transfer Register Regulation, according to the type of extraction method used. An ecologic study was designed to examine municipal mortality due to 32 types of cancer, across the period 1997 through 2006. Population exposure to pollution was estimated on the basis of distance from town of residence to pollution source. Poisson regression models, using the Bayesian conditional autoregressive model proposed by Besag, York and Molliè and Integrated Nested Laplace Approximations for Bayesian inference, were used: to analyze risk of dying from cancer in a 5-kilometer zone around mining installations; effect of type of industrial activity; and to conduct individual analyses within a 50-kilometer radius of each installation. Excess mortality (relative risk, 95% credible interval) of colorectal cancer (1.097, 1.041-1.157), lung cancer (1.066, 1.009-1.126) specifically related with proximity to opencast coal mining, bladder cancer (1.106, 1.016-1.203) and leukemia (1.093, 1.003-1.191) related with other opencast mining installations, was detected among the overall population in the vicinity of mining installations. Other tumors also associated in the stratified analysis by type of mine, were: thyroid, gallbladder and liver cancers (underground coal installations); brain cancer (opencast coal mining); stomach cancer (coal and other opencast mining installations); and myeloma (underground mining installations). The results suggested an association between risk of dying due to digestive, respiratory, hematologic and thyroid cancers and proximity to Spanish mining industries. These associations were dependent on the type of mine.

Risk of cancer mortality in spanish towns lying in the vicinity of pollutant industries

Spatial aggregation of different industrial facilities leads to simultaneous release of pollutant emissions. Our objective is to study cancer mortality risk associated with residence in the vicinity of pollutant factories. We used data on industries for year 2007 (3458 facilities). For the 8,098 Spanish towns, we defined a factor with 4 levels based on the number of factories in a radius of 2.5 km from the centroid of each town (industrial factor). We also used data of land cover use to approximate the percentage of municipal land used for industrial activities in each Spanish town (land-used variable). For both variables we fitted Poisson models with random terms to account for spatial variation. We estimated risk trends related with increasing number of factories or percentage of land used for industrial activities. We studied 33 cancer causes. For the industrial factor, 11 causes showed trend associated with increasing factor level. For the land use variable, 8 causes showed statistically significant risks. Almost all tumours related to the digestive system and the respiratory system showed increased risks. Thus mortality by these tumours could be associated to residence in towns nearby industrial areas with positive trend linked to increasing levels of industrial activity.

Proximity to wood industries and respiratory symptoms in children: a sensitivity analysis

Increased prevalence of respiratory and irritation symptoms was found in children who live near a large wood industrial park. Proximity to the wood industries was used as indicator of exposure. This study describes a sensitivity analysis for the results of the survey. All the children (3-14 years) living in the area were surveyed through a parental questionnaire (n=3854) and their addresses were geocoded. The distances from each child's home and school to the closest industry were combined, weighted and used as an indicator of exposure. A sensitivity analysis was performed to check 1) the robustness of the results to the choice of weights used for defining the exposure indicator, 2) the effect of outliers on risk estimates and 3) the sensitivity on the functional form used for modeling the dose-response function. The choice of the weights did not influence the association between proximity to the industries and respiratory symptoms. Excluding the subjects who lived far away from the industries showed that in a radius of 5km from the industries the study did not had enough power to estimate a gradient in the dose-response function. Besides, results were sensitive to the choice of the functional form used for modeling the minimum distance. The sensitivity analyses confirmed the overall increasing trend of respiratory symptoms with proximity to the industries and pointed out that all the assumptions made for defining a proxy of exposure need to be carefully checked.

Evaluation and comparison of three exposure assessment techniques

This study was conducted to verify the performance of a recently developed subjective rating (SR) exposure assessment technique and to compare estimates made using this and two other techniques (trade mean, or TM, and task-based, or TB, approaches) to measured exposures. Subjects (n = 68) each completed three full-shift noise measurements over 4 months. Individual measured mean exposures were created by averaging each subject's repeated measurements, and TM, TB, and SR estimates were created using noise levels from worksites external to the current study. The bias, precision, accuracy, and absolute agreement of estimates created using the three techniques were evaluated by comparing estimated exposures with measured exposures. Trade mean estimates showed little bias, while neither the TM nor the SR techniques produced unbiased estimates, and the SR estimates showed the greatest bias of the three techniques. Accuracy was essentially equivalent among the three techniques. All three techniques showed poor agreement with measured exposures and were not highly correlated with each other. Estimates from the SR technique generally performed similarly to the TM and TB techniques. Methods to incorporate information from each technique into exposure estimates should be explored.

Prostate cancer and industrial pollution Risk around putative focus in a multi-source scenario

BACKGROUND

Prostate cancer is the second most common type of cancer among men but its aetiology is still largely unknown. Different studies have proposed several risk factors such as ethnic origin, age, genetic factors, hormonal factors, diet and insulin-like growth factor, but the spatial distribution of the disease suggests that other environmental factors are involved. This paper studies the spatial distribution of prostate cancer mortality in an industrialized area using distances from each of a number of industrial facilities as indirect measures of exposure to industrial pollution.

MATERIALS AND METHODS

We studied the Gran Bilbao area (Spain) with a population of 791,519 inhabitants distributed in 657 census tracts. There were 20 industrial facilities within the area, 8 of them in the central axis of the region. We analysed prostate cancer mortality during the period 1996-2003. There were 883 deaths giving a crude rate of 14 per 100,000 inhabitants. We extended the standard Poisson regression model by the inclusion of a multiplicative non-linear function to model the effect of distance from an industrial facility. The function's shape combined an elevated risk close to the source with a neutral effect at large distance. We also included socio-demographic covariates in the model to control potential confounding.

RESULTS

We aggregated the industrial facilities by sector: metal, mineral, chemical and other activities. Results relating to metal industries showed a significantly elevated risk by a factor of approximately 1.4 in the immediate vicinity, decaying with distance to a value of 1.08 at 12km. The remaining sectors did not show a statistically significant excess of risk at the source.

DISCUSSION

Notwithstanding the limitations of this kind of study, we found evidence of association between the spatial distribution of prostate cancer mortality aggregated by census tracts and proximity to metal industrial facilities located within the area, after adjusting for socio-demographic characteristics at municipality level.

The weight method: a new screening method for estimating pesticide deposition from knapsack sprayers in developing countries

Investigations of occupational and environmental risk caused by the use of agrochemicals have received considerable interest over the last decades. And yet, in developing countries, the lack of staff and analytical equipment as well the costs of chemical analyses make it difficult, if not impossible, to monitor pesticide contamination and residues in humans, air, water, and soils. A new and simple method is presented here for estimation of pesticide deposition in humans and soil after application. The estimate is derived on the basis of water mass balance measured in a given number of high absorbent papers under low evaporative conditions and unsaturated atmosphere. The method is presented as a suitable, rapid, low cost screening tool, complementary to toxicological tests, to assess occupational and environmental exposure caused by knapsack sprayers, where there is a lack of analytical instruments. This new method, called the "weight method", was tested to obtain drift deposition on the neighbouring field and the clothes of the applicator after spraying water with a knapsack sprayer in one of the largest areas of potato production in Colombia. The results were confirmed by experimental data using a tracer and the same set up used for the weight method. The weight method was able to explain 86% of the airborne drift and deposition variance.

Health impact assessment of a reduction in ambient PM(2.5) levels in Spain

BACKGROUND

Health effects linked to exposure to high air pollutant levels have been described in depth, and many recent epidemiologic studies have also consistently reported positive associations between exposure to air pollutants at low concentrations (particularly PM(2.5)) and adverse health outcomes.

OBJECTIVE

To estimate the number of avoidable deaths associated with reducing PM(2.5) levels in Spain.

MATERIALS AND METHODS

For exposure assessment, we used the US Environmental Protection Agency's Community Multiscale Air Quality model to simulate air pollution levels with a spatial resolution of 18×18 km(2). Two different scenarios were compared, namely, a baseline 2004 scenario based on Spain's National Emissions Inventory and a projected 2011 scenario in which a reduction in PM(2.5) was estimated on the basis of the benefits that might be attained if specific air quality policies were implemented. Using an 18×18 km(2) grid, air pollution data were estimated for the entire Iberian Peninsula, the Balearic Islands, Ceuta and Melilla. For these strata, crude all-cause mortality rates (ICD-10: A00-Y98) were then calculated for the over-30 and 25-74 age groups, taking into account the 2004 population figures corresponding to these same age groups, selected in accordance with the concentration-response functions (Pope CA 3rd, Burnett RT, Thun MJ, Calle EE, Krewski D, Ito K et al. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 2002; 287:1132-41; Laden F, Schwartz J, Speizer FE, Dockery DW. Reduction in fine particulate air pollution and mortality: extended follow-up of the Harvard Six Cities study. Am J Respir Crit Care Med 2006; 173:667-72.). Health impacts were assessed using the Environmental Benefits Mapping and Analysis Program (BenMAP).

RESULTS

Air quality improvement was defined as an average annual reduction of 0.7 μg/m(3) in PM(2.5) levels. Using long-term health impact assessment analysis, we estimated that 1720 (673-2760) all-cause deaths (6 per 100,000 population) in the over-30 age group and 1450 (780-2108) all-cause deaths (5 per 100,000 population) in the 25-74 age group could be prevented annually.

CONCLUSIONS

The results showed the potential benefits in general mortality which could be expected if pollution control policies were successfully implemented by 2011. A specifically adapted BenMAP could be used as a tool for estimating health impacts associated with changes in air pollution in Spain.

Cancer risk assessment after exposure from natural radionuclides in soil using Monte Carlo techniques

PURPOSE

The purpose of this paper is to assess fatal cancer risk after external and internal (inhalation and ingestion) exposure from natural radionuclides in soil like (238)U, (232)Th, (40)K, and (226)Ra on the territory of Bela Crkva, Serbia. Although receiving doses are low from sources like natural radionuclides in soil, because of stochastic effects of ionizing radiation, risk for developing cancer exists and can be quantified.

METHODS

Concentrations of radionuclides from 80 soil samples are measured using HPGe detector. Fatal cancer risk is assessed from calculated ambient dose rate in the target organs of body due to external and internal exposure. Monte Carlo simulations are used to obtain conversion factors which are required to calculate absorbed dose rate in target organs.

RESULTS AND DISCUSSION

Assessed cancer risk for (238)U in the case of both inhalation and ingestion exposure is from 1.11 × 10(-6) to 24 × 10(-6) for minimal and maximal activity in soil samples, from 1.02 × 10(-6) to 23.3 × 10(-6) for exposure to (226)Ra, from 1.89 × 10(-6) to 50.3 × 10(-6) for exposure to (232)Th, and from 0.265 × 10(-6) to 9.83 × 10(-6) for exposure to (40)K. Overall risk from (40)K as external and internal source is from 0.8 × 10(-6) to 31.9 × 10(-6). Calculated cancer risks from both inhalation and ingestion exposure could be related to all tissues that are on the way of distribution of particles within the body but especially to deposition sites in the body.

CONCLUSION

Assessed risks for fatal cancer development from inhaled and ingested natural radionuclides originating in soil are not increased.

Just who is at risk? The ethics of environmental regulation

The willingness to view risk as part of daily life has vanished. A risk-averse mindset among environmental regulators engenders confusion between the ethics of intention and the ethics of consequence, leading to the elevation of the precautionary principle with unintended and often unfortunate outcomes. Environmental risk assessment is conservative, but the actual level of conservatism cannot be determined. High-end exposure assumptions and current toxicity criteria from the USEPA, based on linear extrapolation for carcinogens and default uncertainty factors for systemic toxicants, obscure the degree of conservatism in risk assessments. Ideally, one could choose a percentile of the target population to include within environmental standards, but this choice is complicated by the food, pharmaceutical and advertising industries, whose activities, inadvertent or not, often promote maladaptive and unhealthy lifestyle choices. There has lately been much discussion about background exposures and disease processes and their potential to increase the risk from environmental chemicals. Should these background exposures or disease processes, especially those associated with maladaptive individual choices, be included as part of a regulatory risk evaluation? A significant ethical question is whether environmental regulation should protect those pursuing a self-destructive lifestyle that may add to or synergize with otherwise innocuous environmental exposures. Choosing a target percentile of protection would provide an increased level of transparency and the flexibility to choose a higher or lower percentile if such a choice is warranted. Transparency and flexibility will lead to more responsive environmental regulation that balances protection of public health and the stewardship of societal resources.

How should environmental exposure risk be assessed? A comparison of four methods for exposure assessment of air pollutions

Methods commonly used to assess the environmental exposure risk at a location (e.g., proximity models) are usually based on different assumptions, leading to conflicting results and recommendations in epidemiological studies. In this case study, a comparative evaluation of the accuracy levels associated with four commonly used exposure risk estimate models [i.e., traditional proximity model (TPM), emission weighted proximity model (EWPM), the American Meteorological Society/EPA regulatory model (AERMOD), and ordinary kriging interpolation (OKI)] were conducted. Results show that at the annual and the monthly scales, the normalized exposure risk values simulated by AERMOD and EWPM have higher accuracy levels than the simulations from the TPM and OKI methods. However, AERMOD has higher accuracy than that of the EWPM, and this was attributed to the differences of input data. EWPM provided the most accurate simulations when analysts have access to only point emission source data. The results also indicate that the accuracies of the exposure risks simulated by AERMOD and EWPM can be influenced by factors such as the modeling extent, the distance settings, and so forth.

Retrospective exposure assessment to airborne asbestos among power industry workers

Background

A method of individually assessing former exposure to asbestos fibres is a precondition of risk-differentiated health surveillance. The main aims of our study were to assess former levels of airborne asbestos exposure in the power industry in Germany and to propose a basic strategy for health surveillance and the early detection of asbestos related diseases.

Methods

Between March 2002 and the end of 2006, we conducted a retrospective questionnaire based survey of occupational tasks and exposures with airborne asbestos fibres in a cohort of 8632 formerly asbestos exposed power industry workers. The data on exposure and occupation were entered into a specially designed computer programme, based on ambient monitoring of airborne asbestos fibre concentrations. The cumulative asbestos exposure was expressed as the product of the eight-hour time weighted average and the total duration of exposure in fibre years (fibres/cubic centimetre-years).

Results

Data of 7775 (90% of the total) participants working in installations for power generation, power distribution or gas supply could be evaluated. The power generation group (n = 5284) had a mean age of 56 years, were exposed for 20 years and had an average cumulative asbestos exposure of 42 fibre years. The occupational group of "metalworkers" (n = 1600) had the highest mean value of 79 fibre years. The corresponding results for the power distribution group (n = 2491) were a mean age of 45 years, a mean exposure duration of 12 years and an average cumulative asbestos exposure of only 2.5 fibre years. The gas supply workers (n = 512) had a mean age of 54 years and a mean duration of exposure of 15 years.

Conclusions

While the surveyed cohort as a whole was heavily exposed to asbestos dust, the power distribution group had a mean cumulative exposure of only 6% of that found in the power generation group. Based on the presented data, risk-differentiated disease surveillance focusing on metalworkers and electricians from the power generating industry seems justified. That combined with a sensitive examination technique would allow detecting asbestos related diseases early and efficiently.

A model to predict the breathing zone concentrations of particles emitted from surfaces

Activity based sampling (ABS) is typically performed to assess inhalation exposure to particulate contaminants known to have low, heterogeneous concentrations on a surface. Activity based sampling determines the contaminant concentration in a person's breathing zone as they perform a scripted activity, such as raking a specified area of soil, while wearing appropriate sample collection instrumentation. As an alternative approach, a probabilistic model based on aerosol physics and fluid dynamics was developed to predict the breathing zone concentration of a particulate contaminant emitted from a surface during activities of variable intensity. The model predicted the particle emission rate, tracked particle transport to the breathing zone, and calculated the breathing zone concentration for two scenarios. One scenario used an Eulerian model based on a Gaussian concentration distribution to quantify aerosol exposure in the trailing wake of a moving object. The second scenario modeled exposure in a quiescent environment. A Lagrangian model tracked the cumulative number of individual particles entering the breathing zone volume at a particular time. A Monte Carlo simulation calculated the breathing zone concentration probability distribution for each scenario. Both models predicted probability distributions of asbestos breathing zone concentrations that bracketed experimentally measured personal exposure concentrations. Modeled breathing zone concentrations were statistically correlated (p-value < 0.001) with independently collected ABS concentrations. The linear regression slope of 0.70 and intercept of 0.03 were influenced by the quantity of ABS data collected and model parameter input distributions at a site broader than those at other sites.

Use of land surface remotely sensed satellite and airborne data for environmental exposure assessment in cancer research

In recent years, geographic information systems (GIS) have increasingly been used for reconstructing individual-level exposures to environmental contaminants in epidemiological research. Remotely sensed data can be useful in creating space-time models of environmental measures. The primary advantage of using remotely sensed data is that it allows for study at the local scale (e.g., residential level) without requiring expensive, time-consuming monitoring campaigns. The purpose of our study was to identify how land surface remotely sensed data are currently being used to study the relationship between cancer and environmental contaminants, focusing primarily on agricultural chemical exposure assessment applications. We present the results of a comprehensive literature review of epidemiological research where remotely sensed imagery or land cover maps derived from remotely sensed imagery were applied. We also discuss the strengths and limitations of the most commonly used imagery data (aerial photographs and Landsat satellite imagery) and land cover maps.

Availability and comparability of human biomonitoring data across Europe: a case-study on blood-lead levels

Recently, it has become clear that the complexity of environmental health issues requires an approach that takes into account the complexities, interdependencies and uncertainties of the real world. An urgent issue that has surfaced is the need for accurate tools to better describe exposure characterization to environmental chemicals. By including human biomonitoring (HBM) data, a greater precision in exposure and associated risk estimates and more accurate dose-response relationships may be achieved. A restricting issue still is the availability of reliable and comparable HBM data. The aim of the current study was twofold: (1) to find out whether it is practically feasible to collect raw, individual HBM data across Europe; and (2) to evaluate the comparability and use of these HBM data for environmental health impact assessment at a European scale. Blood-lead (B-Pb) was selected as the chemical of choice because of its long history as an environmental pollutant in HBM programs and its known public health relevance. Through literature search and identification of HBM experts across Europe, HBM programs that measured B-Pb were identified and asked to share individual data on age, gender and B-Pb levels. Following this request, more than 20,000 individual data points from 8 European countries were collected. Analysing these data made clear that it is difficult to use disparate data collections because of the inherent variability with respect to the gender and age of participants and calendar-years sampled. When these confounders were taken however, there was no additional variability in B-Pb distributions among different countries. It was concluded that while it is possible to collect HBM data from different sources across Europe, the need to get data from comparable (sub-)populations is essential for appropriate use and interpretation of HBM data for environmental health impact assessment.

Exposure to heavy metals and PCDD/Fs by the population living in the vicinity of a hazardous waste landfill in Catalonia, Spain: health risk assessment

Most fly ashes produced in municipal waste incinerators of Catalonia (Spain) are deposited in a hazardous waste landfill (HWL) placed in Castellolí (Barcelona). This facility means a concern for the population living nearby. In response to this, we performed a probabilistic study focused on assessing human health risks derived from environmental exposure to heavy metals and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) around the HWL. Concentrations of various metals and PCDD/Fs were determined in soil and air samples collected at the HWL, and in 4 locations around it. Health risks were evaluated according to the distance from the sampling locations to the HWL (near and far-sites). In general terms, metal and PCCD/F levels were relatively low in air and soil samples. However, concentrations of PCDD/Fs, as well as those of some metals, were found to be relatively higher in the HWL and Castellolí (the nearest village) samples than in those collected far away, resulting in a slight increase of exposure to those pollutants. Anyhow, the current concentrations of metals and PCDD/Fs suggest that it is highly unlikely that there are any additional non-carcinogenic and carcinogenic risks for the population living near the HWL.

Human Exposure: Indoor and Outdoor

Human exposure to air pollution is highly variable, reflecting the strong spatial and temporal variability of air pollutant concentrations in urban environments. A wide variety of outdoor and indoor sources contribute to acute and chronic exposures to respirable particles, carbon monoxide, nitrogen oxides, sulfur dioxide, ozone, volatile organic compounds and polycyclic aromatic hydrocarbons. Ambient air quality measurements and dispersion model simulations are commonly used to estimate population exposure to air pollutants in cities. In addition, time-activity micro-environmental and other dynamic time-space models can be used to characterise the personal exposure of individuals or population subgroups. People in developed countries typically spend 90% of their time indoors, and impact of indoor sources, such as tobacco smoking, gas cooking, construction and furnishing materials, and household chemicals (e.g. paints, adhesives, cleaning products, etc.), on personal exposure can become dominant. Recent exposure surveys have shown that personal exposure is typically higher than both indoor and outdoor concentrations of traffic-related pollutants such as benzene. In most cases, this is due to peak personal exposures occurring within transient (e.g. commuting) and other highly polluted micro-environments (e.g. petrol stations, garages, etc.). In developing countries, domestic fuel combustion (e.g. biomass burning for cooking and heating) has been identified as a major factor contributing to elevated exposure of the population to respirable particles, carbon monoxide, polycyclic aromatic hydrocarbons, nitrogen oxides and sulfur dioxide.

Uncertainty in epidemiology and health risk and impact assessment

Environmental epidemiology and health risk and impact assessment have long grappled with problems of uncertainty in data and their relationships. These uncertainties have become more challenging because of the complex, systemic nature of many of the risks. A clear framework defining and quantifying uncertainty is needed. Three dimensions characterise uncertainty: its nature, its location and its level. In terms of its nature, uncertainty can be both intrinsic and extrinsic. The former reflects the effects of complexity, sparseness and nonlinearity; the latter arises through inadequacies in available observational data, measurement methods, sampling regimes and models. Uncertainty occurs in three locations: conceptualizing the problem, analysis and communicating the results. Most attention has been devoted to characterising and quantifying the analysis--a wide range of statistical methods has been developed to estimate analytical uncertainties and model their propagation through the analysis. In complex systemic risks, larger uncertainties may be associated with conceptualization of the problem and communication of the analytical results, both of which depend on the perspective and viewpoint of the observer. These imply using more participatory approaches to investigation, and more qualitative measures of uncertainty, not only to define uncertainty more inclusively and completely, but also to help those involved better understand the nature of the uncertainties and their practical implications.

Air pollution exposure assessment methods utilized in epidemiological studies

The assessment of personal exposure to air pollution is a critical component of epidemiological studies associating air pollution and health effects. This paper critically reviewed 157 studies over 29 years that utilized one of five categories of exposure methods (proximity, air dispersion, hybrid, human inhalation, and biomarkers). Proximity models were found to be a questionable technique as they assume that closer proximity equates to greater exposure. Inhalation models and biomarker estimates were the most effective in assessing personal exposure, but are often cost prohibitive for large study populations. This review suggests that: (i) factors such as uncertainty, validity, data availability, and transferability related to exposure assessment methods should be considered when selecting a model; and (ii) although an entirely discreet new class of approach is not necessary, significant progress could be made through the development of a 'hybrid' model utilizing the strengths of several existing methods. Future work should systematically evaluate the performance of hybrid models compared to other individual exposure assessment methods utilizing geospatial information technologies (e.g. geographic information systems (GIS) and remote sensing (RS)) to more robustly refine estimates of ambient exposure and quantify the linkages and differences between outdoor, indoor and personal exposure estimates.

Study of non-Hodgkin's lymphoma mortality associated with industrial pollution in Spain, using Poisson models

Background

Non-Hodgkin's lymphomas (NHLs) have been linked to proximity to industrial areas, but evidence regarding the health risk posed by residence near pollutant industries is very limited. The European Pollutant Emission Register (EPER) is a public register that furnishes valuable information on industries that release pollutants to air and water, along with their geographical location.

This study sought to explore the relationship between NHL mortality in small areas in Spain and environmental exposure to pollutant emissions from EPER-registered industries, using three Poisson-regression-based mathematical models.

Methods

Observed cases were drawn from mortality registries in Spain for the period 1994–2003. Industries were grouped into the following sectors: energy; metal; mineral; organic chemicals; waste; paper; food; and use of solvents. Populations having an industry within a radius of 1, 1.5, or 2 kilometres from the municipal centroid were deemed to be exposed. Municipalities outside those radii were considered as reference populations.

The relative risks (RRs) associated with proximity to pollutant industries were estimated using the following methods: Poisson Regression; mixed Poisson model with random provincial effect; and spatial autoregressive modelling (BYM model).

Results

Only proximity of paper industries to population centres (>2 km) could be associated with a greater risk of NHL mortality (mixed model: RR:1.24, 95% CI:1.09–1.42; BYM model: RR:1.21, 95% CI:1.01–1.45; Poisson model: RR:1.16, 95% CI:1.06–1.27). Spatial models yielded higher estimates.

Conclusion

The reported association between exposure to air pollution from the paper, pulp and board industry and NHL mortality is independent of the model used. Inclusion of spatial random effects terms in the risk estimate improves the study of associations between environmental exposures and mortality.

The EPER could be of great utility when studying the effects of industrial pollution on the health of the population.

Distributions of personal VOC exposures: a population-based analysis

Information regarding the distribution of volatile organic compound (VOC) concentrations and exposures is scarce, and there have been few, if any, studies using population-based samples from which representative estimates can be derived. This study characterizes distributions of personal exposures to ten different VOCs in the U.S. measured in the 1999--2000 National Health and Nutrition Examination Survey (NHANES). Personal VOC exposures were collected for 669 individuals over 2-3 days, and measurements were weighted to derive national-level statistics. Four common exposure sources were identified using factor analyses: gasoline vapor and vehicle exhaust, methyl tert-butyl ether (MBTE) as a gasoline additive, tap water disinfection products, and household cleaning products. Benzene, toluene, ethyl benzene, xylenes chloroform, and tetrachloroethene were fit to log-normal distributions with reasonably good agreement to observations. 1,4-Dichlorobenzene and trichloroethene were fit to Pareto distributions, and MTBE to Weibull distribution, but agreement was poor. However, distributions that attempt to match all of the VOC exposure data can lead to incorrect conclusions regarding the level and frequency of the higher exposures. Maximum Gumbel distributions gave generally good fits to extrema, however, they could not fully represent the highest exposures of the NHANES measurements. The analysis suggests that complete models for the distribution of VOC exposures require an approach that combines standard and extreme value distributions, and that carefully identifies outliers. This is the first study to provide national-level and representative statistics regarding the VOC exposures, and its results have important implications for risk assessment and probabilistic analyses.

Meeting report: atmospheric pollution and human reproduction

BACKGROUND

There is a growing body of epidemiologic literature reporting associations between atmospheric pollutants and reproductive outcomes, particularly birth weight and gestational duration.

OBJECTIVES

The objectives of our international workshop were to discuss the current evidence, to identify the strengths and weaknesses of published epidemiologic studies, and to suggest future directions for research.

DISCUSSION

Participants identified promising exposure assessment tools, including exposure models with fine spatial and temporal resolution that take into account time-activity patterns. More knowledge on factors correlated with exposure to air pollution, such as other environmental pollutants with similar temporal variations, and assessment of nutritional factors possibly influencing birth outcomes would help evaluate importance of residual confounding. Participants proposed a list of points to report in future publications on this topic to facilitate research syntheses. Nested case-control studies analyzed using two-phase statistical techniques and development of cohorts with extensive information on pregnancy behaviors and biological samples are promising study designs. Issues related to the identification of critical exposure windows and potential biological mechanisms through which air pollutants may lead to intrauterine growth restriction and premature birth were reviewed.

CONCLUSIONS

To make progress, this research field needs input from toxicology, exposure assessment, and clinical research, especially to aid in the identification and exposure assessment of feto-toxic agents in ambient air, in the development of early markers of adverse reproductive outcomes, and of relevant biological pathways. In particular, additional research using animal models would help better delineate the biological mechanisms underpinning the associations reported in human studies.

Arsenic cancer risk posed to human health from tilapia consumption in Taiwan

Ingested inorganic arsenic is strongly associated with a wide spectrum of adverse health outcomes. We propose a bioaccumulation and the Weibull model-based epidemiological framework to accurately estimate the reference arsenic intake guideline for tilapia consumption and tilapia-cultured water arsenic concentration based on bioaccumulations of tilapia and gender/age/cancer-specific epidemiological data from the arseniasis-endemic area in Taiwan. Our results show a positive relationship between arsenic exposure and age/gender- and cancer-specific cumulative incidence ratio using Weibull dose-response model. Based on male bladder cancer with an excess lifetime cancer risk of 10(-4), we estimate the reference tilapia inorganic arsenic guideline value to be 0.084 microg g(-1) dry wt based on the suggested daily consumption rate of 120 gd(-1). Our findings show that consumption of tilapia in a blackfoot disease (BFD)-endemic area poses no significant cancer risk (excess cancer risks ranging from 3.4 x 10(-5) to 9.3 x 10(-5)), implying that people in BFD-endemic areas are not readily associated with higher fatalities for bladder cancer exposed from tilapia consumption. We are confident that our model can be easily adapted for other aquaculture species, and encourage risk managers to use the model to evaluate the potential population-level long-term low-dose cancer risks. We conclude that, by integrating the bioaccumulation concept and epidemiological investigation of humans exposed to arsenic, we can provide a scientific basis for risk analysis to enhance risk management strategies.

Inter-rater agreement for a retrospective exposure assessment of asbestos, chromium, nickel and welding fumes in a study of lung cancer and ionizing radiation

A retrospective exposure assessment of asbestos, welding fumes, chromium and nickel (in welding fumes) was conducted at the Portsmouth Naval Shipyard for a nested case-control study of lung cancer risk from external ionizing radiation. These four contaminants were included because of their potential to confound or modify the effect of a lung cancer-radiation relationship. The exposure assessment included three experienced industrial hygienists from the shipyard who independently assessed exposures for 3519 shop/job/time period combinations. A consensus process was used to resolve estimates with large differences. Final exposure estimates were linked to employment histories of the 4388 study subjects to calculate their cumulative exposures. Inter-rater agreement analyses were performed on the original estimates to better understand the estimation process. Although concordance was good to excellent (78-99%) for intensity estimates and excellent (96-99%) for frequency estimates, overall simple kappa statistics indicated only slight agreement beyond chance (kappa < 0.2). Unbalanced distributions of exposure estimates partly contributed to the weak observed overall inter-rater agreement. Pairwise weighted kappa statistics revealed better agreement between two of the three panelists (kappa = 0.19-0.65). The final consensus estimates were similar to the estimates made by these same two panelists. Overall welding fume exposures were fairly stable across time at the shipyard while asbestos exposures were higher in the early years and fell in the mid-1970s. Mean cumulative exposure for all study subjects was 520 fiber-days cc(-1) for asbestos and 1000 mg-days m(-3) for welding fumes. Mean exposure was much lower for nickel (140 microg-days m(-3)) and chromium (45 microg-days m(-3)). Asbestos and welding fume exposure estimates were positively associated with lung cancer in the nested case-control study. The radiation-lung cancer relationship was attenuated by the inclusion of these two confounders. This exposure assessment provided exposure estimates that aided in understanding of the lung cancer-radiation relationship at the shipyard.

Traffic-related atmospheric pollutants levels during pregnancy and offspring's term birth weight: a study relying on a land-use regression exposure model

BACKGROUND

Some studies have suggested that particulate matter (PM) levels during pregnancy may be associated with birth weight. Road traffic is a major source of fine PM (PM with aero-dynamic diameter < 2.5 microm; PM(2.5)).

OBJECTIVE

We determined to characterize the influence of maternal exposure to atmospheric pollutants due to road traffic and urban activities on offspring term birth weight.

METHODS

Women from a birth cohort [the LISA (Influences of Lifestyle Related Factors on the Human Immune System and Development of Allergies in Children) cohort] who delivered a non-premature baby with a birth weight > 2,500 g in Munich metropolitan area were included. We assessed PM(2.5), PM(2.5) absorbance (which depends on the blackness of PM(2.5), a marker of traffic-related air pollution), and nitrogen dioxide levels using a land-use regression model, taking into account the type and length of roads, population density, land coverage around the home address, and temporal variations in pollution during pregnancy. Using Poisson regression, we estimated prevalence ratios (PR) of birth weight < 3,000 g, adjusted for gestational duration, sex, maternal smoking, height, weight, and education.

RESULTS

Exposure was defined for 1,016 births. Taking the lowest quartile of exposure during pregnancy as a reference, the PR of birth weight < 3,000 g associated with the highest quartile was 1.7 for PM(2.5) [95% confidence interval (CI), 1.2-2.7], 1.8 for PM(2.5) absorbance (95% CI, 1.1-2.7), and 1.2 for NO(2) (95% CI, 0.7-1.7). The PR associated with an increase of 1 microg/m(3) in PM(2.5) levels was 1.13 (95% CI, 1.00-1.29).

CONCLUSION

Increases in PM(2.5) levels and PM(2.5) absorbance were associated with decreases in term birth weight. Traffic-related air pollutants may have adverse effects on birth weight.