Association of spontaneous abortion and other reproductive effects with work in the semiconductor industry

Biomonitoring of Exposures to Solvents and Metals in Electronics Manufacturing Facilities in Batam, Indonesia

Concerns about chemical exposure in the electronics manufacturing industry have long been recognized, but data are lacking in Southeast Asia. We conducted a study in Batam, Indonesia, to evaluate chemical exposures in electronics facilities, using participatory research and biological monitoring approaches. A convenience sample of 36 workers (28 exposed, 8 controls) was recruited, and urine samples were collected before and after shifts. Five solvents (acetone, methyl ethyl ketone, toluene, benzene, and xylenes) were found in 46%-97% of samples, and seven metals (arsenic, cadmium, cobalt, tin, antimony, lead, and vanadium) were detected in 60%-100% of samples. Biological monitoring and participatory research appeared to be useful in assessing workers' exposure when workplace air monitoring is not feasible due to a lack of cooperation from the employer. Several logistical challenges need to be addressed in future biomonitoring studies of electronics workers in Asia in factories where employers are reluctant to track workers' exposure and health.

The Dobbs Decision and the Future of Occupational Health in the US

Access to abortion care has a profound impact on women's ability to participate in the workforce. In the US, restrictions on abortion care have waxed and waned over the years, including periods when abortion was broadly permitted across the nation for most pregnant people for a substantial proportion of pregnancy and times when restrictions varied across states, including states where abortion is banned for nearly all reasons. Additionally, access to abortion care has always been a reproductive justice issue, with some people more able to access this care than others even when it is structurally available. In June 2022, the US Supreme Court handed down the Dobbs v. Jackson Women's Health Organization, returning to states the ability to determine restrictions on abortion, including near-total bans on abortion. In this anthology, ten experts share their perspectives on what the Dobbs decision means for the future, how it will exacerbate existing, well-researched issues, and likely also create new challenges needing investigation. Some contributions are focused on research directions, some focus on implications for organizations, and most include both. All contributions share relevant occupational health literature and describe the effects of the Dobbs decision in context.

Two Semiconductor Companies' Financial Support Compensation (FSC) Programs for Semiconductor Workers with Suspected Work-Related Diseases (WRDs)

This study described two companies’ financial compensation programs for semiconductor workers with suspected work-related diseases (WRDs) and discussed the major related issues. The key contents of the programs found on the websites opened by two semiconductor companies (Samsung and SK Hynix) were cited. In order to select the suspected WRDs for the FSC, all available epidemiologic studies related to health problems conducted in the semiconductor industry were reviewed. Most program contents are similar, although the amount of financial compensation and a few types of disease available for compensation differ between the companies. The group of cancer, rare disease, childhood rare disease among children born to semiconductor workers (hereafter selected diseases among offspring), and fetal loss, including spontaneous abortion (SAB) and stillbirth, were considered for compensation. An employment duration of longer than one year on a semiconductor production line is required for FSC for cancer or rare disease. The FSC for SAB and offspring disease require a period of employment longer than one month, either before three months prior to conception or between conception and childbirth. The maximum amount of compensation per type of cancer and rare disease was fixed based on the medical treatment fee. The FSC programs of the two companies have been operated successfully to date. These programs are arguably considered to contribute to resolving the conflict between companies and workers with WRDs.

Semiconductor Work and Adverse Pregnancy Outcomes Associated with Male Workers: A Retrospective Cohort Study

OBJECTIVES

A hazardous work environment in semiconductor factories is a threat to the workers' health. Semiconductor manufacturing characteristically requires young workers, and reproductive toxicity is an important issue. Studies investigating reproductive toxicity among individuals working in the semiconductor manufacturing industry have primarily focused on outcomes in women. Information on the reproductive health of male semiconductor factory workers is limited. This study aimed to evaluate the association between workplace exposures among male workers in a Korean semiconductor company and adverse pregnancy outcomes.

METHODS

Based on the data from the 2015 Semiconductor Health Survey (SHS), which evaluated the workplace exposures, pregnancy outcomes, and general health of 21 969 employees of the semiconductor industry in South Korea, we included 3868 male workers with 7504 pregnancy outcomes identified by self-reports for this retrospective cohort study. Data regarding the pregnancy outcomes, order of pregnancy, and the years of the outcomes were collected via the SHS questionnaire. Adverse pregnancy outcomes were defined as preterm labor, spontaneous abortion, and stillbirth. Workplace exposures were classified as fabrication, assembly, others, lab, and office work (reference group). A generalized estimating equations model including repeated events of individuals and producing relative risk (RR) and 95% confidence interval (CI) was used to estimate the association between workplace exposure and adverse pregnancy outcomes. Analyses were adjusted for work location, spouse's employment in semiconductor production work, educational level, marital status, risky alcohol drinking, smoking status, body mass index, order of pregnancy, and age and year of pregnancy outcome, which were based on a priori decisions.

RESULTS

The adjusted risk for adverse outcomes was higher [RR (95% CI): 1.47 (1.04, 2.07)] among assembly process workers compared with the office workers. Adjusted risks for adverse outcomes among workers in assembly and fabrication, whose spouses also worked in semiconductor production, were 1.60 (95% CI: 1.04, 2.46) and 1.74 (95% CI: 1.18, 2.57) times higher, respectively, compared with the office workers with spouses not working in semiconductor production.

CONCLUSIONS

Based on these findings, semiconductor work might be considered a risk factor for reproductive toxicity among male workers, especially for those whose spouses have the same job.

Semiconductor Work and the Risk of Spontaneous Abortion: A Systematic Review and Meta-Analysis

(1) Background: In the semiconductor industry, female workers were identified as having an increased risk of spontaneous abortion (SA). To date, the association between semiconductor work and SA is controversial. We aimed to assess the association between semiconductor work and specific processes and SA, in the semiconductor industry. (2) Methods: A literature search was conducted using databases such as PubMed, Embase, Cochrane library, and other core databases, from the date of inception of these databases to 31 July 2019. Studies that identified SA risk in female workers in the semiconductor industry were included. (3) Results: We identified 529 studies, of which six studies were included in the meta-analysis. During 1980–1993, the risk of SA in fabrication (Fab) workers was significantly higher than non-Fab workers (RR, 1.29; 95% CI, 1.05–1.57). Photolithography workers had a higher SA risk than non-process and office workers (RR, 1.41; 95% CI, 1.13–1.77). (4) Conclusion: Meta-analysis indicates a statistically significant association between Fab-work and SA. Specific process and chemical exposure meta-analyses need to be interpreted carefully considering bias. Because of the rapid change in the semiconductor industry, it is necessary to conduct an elaborate cohort study taking into consideration the current working environment.

Reproductive Hazards Still Persist in the Microelectronics Industry: Increased Risk of Spontaneous Abortion and Menstrual Aberration among Female Workers in the Microelectronics Industry in South Korea

OBJECTIVES

Despite the global expansion of supply chains and changes to the production process, few studies since the mid-1990 s and 2000s have examined reproductive risks of the microelectronics industry; we examined the reproductive risks among female microelectronics workers in South Korea.

METHODS

Based on claim data from the National Health Insurance (2008-2012), we estimated age-specific rates of spontaneous abortion (SAB) and menstrual aberration (MA) among women aged 20 to 39 years. We compared data between microelectronics workers and three different control groups: economically inactive women, the working population as a whole, and workers employed in the bank industry. For an effect measure, age-stratified relative risks (RRs) were estimated.

RESULTS

Female workers in the microelectronics industry showed significantly higher risk for SAB and MA compared to control groups. The RRs for SAB with reference to economically inactive women, working population, and bank workers in their twenties were 1.57, 1.40, and 1.37, respectively, and the RRs for MA among females in their twenties were 1.54, 1.38, and 1.48, respectively. For women in their thirties, RRs for SAB were 1.58, 1.67, and 1.13, and those for MA were 1.25, 1.35, and 1.23 compared to the three control populations, respectively. All RRs were statistically significant at a level of 0.05, except for the SAB case comparison with bank workers in their thirties.

CONCLUSIONS

Despite technical innovations and health and safety measures, female workers in microelectronics industry in South Korea have high rates of SAB and MA, suggesting continued exposure to reproductive hazards. Further etiologic studies based on primary data collection and careful surveillance are required to confirm these results.

The health impacts of semiconductor production: an epidemiologic review

BACKGROUND

Despite concerns over the harmful health effects of semiconductor production, epidemiological studies have shown mixed results.

OBJECTIVES

We aim to critically appraise epidemiologic studies to date, and to suggest future research and actions to protect workers in semiconductor industry.

METHODS

Epidemiologic studies were identified through electronic database searches, review of reference lists of relevant published works, and expert consultations, and were narratively reviewed.

RESULTS

Most evidence suggests reproductive risks from fabrication jobs, including spontaneous abortion (SAB), congenital malformation, and reduced fertility. Although chemicals have been suspected as causal agents, knowledge of the likely contribution(s) from specific exposures is still limited. Evidence of cancer risk seems to be equivocal. However, the available studies had serious limitations including healthy worker effects (HWEs), information bias, and insufficient power, all of which are associated with underestimation. Nevertheless, excess risks for non-Hodgkin's lymphoma (NHL), leukemia, brain tumor, and breast cancer were observed.

CONCLUSIONS

Monitoring and innovative research based on international collaboration with a focus on sentinel events are required.

Physical activity, physical exertion, and miscarriage risk in women textile workers in Shanghai, China

BACKGROUND

Strenuous occupational physical activity and physical demands may be risk factors for adverse reproductive outcomes.

METHODS

A retrospective study in the Shanghai, China textile industry study collected women's self-reported reproductive history. Occupational physical activity assessment linked complete work history data to an industry-specific job-exposure matrix. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by multivariate logistic regression for the first pregnancy outcome and utilized generalized estimating equations to consider all pregnancies per woman.

RESULTS

Compared with women employed in sedentary jobs, a reduced risk of miscarriage was found for women working in jobs with either light (OR 0.18, 95% CI: 0.07, 0.50) or medium (OR 0.24, 95% CI: 0.08, 0.66) physical activity during the first pregnancy and over all pregnancies (light OR 0.32, 95% CI: 0.17, 0.61; medium OR 0.43, 95% CI: 0.23, 0.80). Frequent crouching was associated with elevated risk (OR 1.82, 95% CI: 1.14, 2.93; all pregnancies per woman).

CONCLUSIONS

Light/medium occupational physical activity may have reduced miscarriage risk, while specific occupational characteristics such as crouching may have increased risk in this cohort.

Reproductive outcomes among male and female workers at an aluminum smelter

OBJECTIVES

Several adverse pregnancy outcomes were reported among female laboratory workers in a North American aluminum smelter. To determine whether these outcomes were associated with any occupational exposure at the plant, a cross-sectional survey was undertaken.

METHODS

Rates of miscarriage, premature singleton birth, and major congenital anomaly occurring during employment were compared with a reference group comprised of all pregnancies that occurred before employment.

RESULTS

Among female workers, the excess of congenital anomalies among female laboratory workers that defined the initial cluster was observed, but no specific pattern was found.

CONCLUSIONS

On the basis of these analyses, the increase in congenital anomalies could not be attributed to occupational exposures at the smelter nor could potential exposure likely explain the diverse anomalies described.

Epidemiologic evidence of relationships between reproductive and child health outcomes and environmental chemical contaminants

This review summarizes the level of epidemiologic evidence for relationships between prenatal and/or early life exposure to environmental chemical contaminants and fetal, child, and adult health. Discussion focuses on fetal loss, intrauterine growth restriction, preterm birth, birth defects, respiratory and other childhood diseases, neuropsychological deficits, premature or delayed sexual maturation, and certain adult cancers linked to fetal or childhood exposures. Environmental exposures considered here include chemical toxicants in air, water, soil/house dust and foods (including human breast milk), and consumer products. Reports reviewed here included original epidemiologic studies (with at least basic descriptions of methods and results), literature reviews, expert group reports, meta-analyses, and pooled analyses. Levels of evidence for causal relationships were categorized as sufficient, limited, or inadequate according to predefined criteria. There was sufficient epidemiological evidence for causal relationships between several adverse pregnancy or child health outcomes and prenatal or childhood exposure to environmental chemical contaminants. These included prenatal high-level methylmercury (CH(3)Hg) exposure (delayed developmental milestones and cognitive, motor, auditory, and visual deficits), high-level prenatal exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs), and related toxicants (neonatal tooth abnormalities, cognitive and motor deficits), maternal active smoking (delayed conception, preterm birth, fetal growth deficit [FGD] and sudden infant death syndrome [SIDS]) and prenatal environmental tobacco smoke (ETS) exposure (preterm birth), low-level childhood lead exposure (cognitive deficits and renal tubular damage), high-level childhood CH(3)Hg exposure (visual deficits), high-level childhood exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) (chloracne), childhood ETS exposure (SIDS, new-onset asthma, increased asthma severity, lung and middle ear infections, and adult breast and lung cancer), childhood exposure to biomass smoke (lung infections), and childhood exposure to outdoor air pollutants (increased asthma severity). Evidence for some proven relationships came from investigation of relatively small numbers of children with high-dose prenatal or early childhood exposures, e.g., CH(3)Hg poisoning episodes in Japan and Iraq. In contrast, consensus on a causal relationship between incident asthma and ETS exposure came only recently after many studies and prolonged debate. There were many relationships supported by limited epidemiologic evidence, ranging from several studies with fairly consistent findings and evidence of dose-response relationships to those where 20 or more studies provided inconsistent or otherwise less than convincing evidence of an association. The latter included childhood cancer and parental or childhood exposures to pesticides. In most cases, relationships supported by inadequate epidemiologic evidence reflect scarcity of evidence as opposed to strong evidence of no effect. This summary points to three main needs: (1) Where relationships between child health and environmental exposures are supported by sufficient evidence of causal relationships, there is a need for (a) policies and programs to minimize population exposures and (b) population-based biomonitoring to track exposure levels, i.e., through ongoing or periodic surveys with measurements of contaminant levels in blood, urine and other samples. (2) For relationships supported by limited evidence, there is a need for targeted research and policy options ranging from ongoing evaluation of evidence to proactive actions. (3) There is a great need for population-based, multidisciplinary and collaborative research on the many relationships supported by inadequate evidence, as these represent major knowledge gaps. Expert groups faced with evaluating epidemiologic evidence of potential causal relationships repeatedly encounter problems in summarizing the available data. A major driver for undertaking such summaries is the need to compensate for the limited sample sizes of individual epidemiologic studies. Sample size limitations are major obstacles to exploration of prenatal, paternal, and childhood exposures during specific time windows, exposure intensity, exposure-exposure or exposure-gene interactions, and relatively rare health outcomes such as childhood cancer. Such research needs call for investments in research infrastructure, including human resources and methods development (standardized protocols, biomarker research, validated exposure metrics, reference analytic laboratories). These are needed to generate research findings that can be compared and subjected to pooled analyses aimed at knowledge synthesis.

Worker exposure to methanol vapors during cleaning of semiconductor wafers in a manufacturing setting

An exposure simulation was conducted to characterize methanol exposure of workers who cleaned wafers in quality control departments within the semiconductor industry. Short-term (15 min) and long-term (2-4 hr) personal and area samples (at distances of 1 m and 3-6 m from the source) were collected during the 2-day simulation. On the first day, 45 mL of methanol were used per hour by a single worker washing wafers in a 102 m(3) room with a ventilation rate of about 10 air changes per hour (ACH). Virtually all methanol volatilized. To assess exposures under conditions associated with higher productivity, on the second day, two workers cleaned wafers simultaneously, together using methanol at over twice the rate of the first day (95 mL/hr). On this day, the ventilation rate was halved (5 ACH). Personal concentrations on the first day averaged 60 ppm (SD = 46 ppm) and ranged from 10-140 ppm. On the second day, personal concentrations for both workers averaged 118 ppm (SD = 50 ppm; range: 64-270 ppm). Area concentrations measured on the first day at 1 m from the source and throughout the balance of the room averaged 29 ppm (SD = 19 ppm; range: 4-83 ppm) and 18 ppm (SD = 12 ppm; range: 3-42 ppm), respectively. As expected, area concentrations measured on the second day were higher than the first and averaged 73 ppm (SD = 25 ppm; range: 27-140 ppm) at 1 meter and 48 ppm (SD = 13 ppm; range: 21-67 ppm) throughout the balance of the room. The results of this simulation suggest that the use of methanol to clean semiconductor wafers without the use of local exhaust ventilation and with relatively low room ventilation rates is unlikely to result in worker exposures exceeding the current ACGIH(R) threshold limit value of 200 ppm. This study also confirmed prior studies suggesting that when a relatively volatile chemical is located within arm's length (near field), breathing zone concentrations will be about two- to threefold greater than the room concentration when the air exchange rate is 5-10 ACH.

Cancer and reproductive risks in the semiconductor industry

Although many reproductive toxicants and carcinogens are used in the manufacture of semiconductor chips, and worrisome findings have been reported, no broad epidemiologic study has been conducted to define possible risks in a comprehensive way. With few exceptions, the American semiconductor industry has not supported access for independent studies. Older technologies are exported to newly industrialized countries as newer technologies are installed in Japan, the United States, and Europe. Thus there is particular concern about the many workers, mostly in countries that are still industrializing, who have jobs that use chemicals, technologies, and equipment that are no longer in use in developed countries. Since most countries lack cancer registries and have inadequate reproductive and cancer reporting mechanisms, industry efforts to control exposures to carcinogens are of particular importance. Government agencies, the courts, industry, publishers, and academia, on occasion, collude to ignore or to downplay the importance of occupational diseases. Examples of how this happens in the semiconductor industry are presented.

Effect of occupational safety measures on micronucleus frequency in semiconductor workers

OBJECTIVES

To examine whether semiconductor workers exposed to complex mixtures of chemical waste show an increase in genotoxic effects, and, if so, whether occupational safety measures protect these workers.

METHODS

To assess chemical exposure in the workplace, air monitoring of boron trifluoride and boron trichloride was performed and urinary concentrations of fluoride were measured. The cytokinesis-block micronucleus test on isolated lymphocytes was used for the detection of genotoxic effects. Two series of monitoring have been performed in order to assess the effect of implemented protection measures.

RESULTS

We found a significantly higher mean frequency of micronuclei in exposed workers than in controls, whereas air monitoring and measurement of urinary fluoride failed to detect chemical exposure of these workers. Twelve years after implementation of protective measures, the mean level of micronuclei in exposed individuals was found to be as low as those from controls.

CONCLUSIONS

These findings indicate that exposed workers in the semiconductor industry may have an increased risk of genotoxic effects from complex mixtures of chemical waste products. The decline of the mean level of micronuclei in exposed workers down to the base level of controls after implementation of protective measures points to the significance of adequate safety standards to protect against chromosomal damage in semiconductor personnel.

Endocrine-disrupting chemicals use distinct mechanisms of action to modulate endocrine system function

The term endocrine-disrupting chemicals is used to define a structurally diverse class of synthetic and natural compounds that possess the ability to alter various components of the endocrine system and potentially induce adverse health effects in exposed individuals and populations. Research on these compounds has revealed that they use a variety of both nuclear receptor-mediated and non-receptor-mediated mechanisms to modulate different components of the endocrine system. This review will describe in vitro and in vivo studies that highlight the spectrum of unique mechanisms of action and biological effects of four endocrine-disrupting chemicals--diethylstilbestrol, genistein, di(n-butyl)phthalate, and methoxyacetic acid--to illustrate the diverse and complex nature of this class of compounds.

Exposure to ethylene glycol monomethyl ether: clinical and cytogenetic findings

Glycol ethers are known reproductive and developmental toxins in laboratory animals, but little is known about their genotoxic effects in humans. In the current article, the authors tested the hypothesis that human in utero exposure to ethylene glycol monomethyl ether (EGME) is associated with the development of specific congenital anomalies and elevated levels of chromosome aberrations. The authors conducted a clinical and cytogenetic evaluation of 41 offspring of 28 females occupationally exposed to EGME for an average duration of 4.6 yr. Six offspring of 5 women who were occupationally exposed to EGME during pregnancy exhibited characteristic dysmorphic features that were not observed in 35 offspring of 23 women who worked in the same facility, but who were not pregnant at the time of exposure. Persistent cytogenetic damage was observed exclusively in all 6 in-utero-exposed offspring, but not in their 12 match non-in-utero-exposed controls. The study characterizes EGME as a human teratogen, as indicated by the prevalence of characteristic dysmorphic features and persistent cytogenetic damage in individuals exposed in utero to this chemical.

Prolonged time to pregnancy in female workers exposed to ethylene glycol ethers in semiconductor manufacturing

BACKGROUND

Previous research on reproductive effects of working in the semiconductor industry is limited and has produced conflicting results.

METHODS

This retrospective cohort study was designed to investigate the risk factors for female fertility in a wafer-manufacturing company of Taiwan in 1997. Waiting time to pregnancy and potential confounders were collected by face-to-face interview. Exposure was assessed by directors and senior engineers in manufacturing, administrative, and safety and health departments according to safety records, personnel records, and job histories from questionnaires, using a tiered exposure-assessment approach. Of a total 842 female workers, 720 (85.5%) participated. There were 292 pregnancies from 173 workers eligible for analysis. Relative fecundability (fecundability ratio, or FR) was calculated using Cox's proportional hazard models to evaluate the effect of occupational exposure to ethylene glycol ethers on female fertility.

RESULTS

Waiting time to pregnancy of female workers in the photolithography area was longer than that of those in the nonfabrication area (FR = 0.77; 95% CI = 0.45-1.32), and those who were potentially exposed to ethylene glycol ethers showed longer time to pregnancy compared with those not exposed (FR = 0.59; 95% CI = 0.37-0.94).

CONCLUSION

This study provides further evidence that ethylene glycol ethers may cause female subfertility.

Toxicity review of ethylene glycol monomethyl ether and its acetate ester

Ethylene glycol monomethyl ether (EGME) and its acetate ester (EGMEA) are highly flammable, colorless, moderately volatile liquids with very good solubility properties. They are used in paints, lacquers, stains, inks and surface coatings, silk-screen printing, photographic and photo lithographic processes, for example, in the semiconductor industry, textile and leather finishing, production of food-contact plastics, and as an antiicing additive in hydraulic fluids and jet fuel. EGME and EGMEA are efficiently absorbed by inhalation as well as via dermal penetration. Dermal absorption may contribute substantially to the total uptake following skin contact with liquids or vapours containing EGME or EGMEA. EGMEA is rapidly converted to EGME in the body and the two substances are equally toxic in animals. Therefore, the two substances should be considered as equally hazardous to man. Effects on peripheral blood, testes, and sperm have been reported at occupational exposure levels ranging between 0.4 and 10 ppm EGME in air, and with additional, possibly substantial, dermal exposure. Severe malformations and disturbed hematopoiesis have been linked with exposure to EGME and EGMEA at unknown, probably high, levels. Embryonic deaths in monkeys and impaired spermatogenesis in rabbits have been reported after daily oral doses of 12 and 25 mg per kg body weight, respectively. In several studies, increased frequency of spontaneous abortions, disturbed menstrual cycle, and subfertility have been demonstrated in women working in the semiconductor industry. The contribution of EGME in relation to other exposure factors in the semiconductor industry is unclear.

Spontaneous abortion in the British semiconductor industry: An HSE investigation. Health and Safety Executive

BACKGROUND

The UK Health and Safety Executive (HSE) conducted a study to examine the risk of spontaneous abortion (SAB) in British female semiconductor industry workers, following reports from the USA which suggested an association between risk of SAB and work in fabrication rooms and/or exposure to ethylene glycol ethers.

METHODS

A nested case-control study based on 2,207 women who had worked at eight manufacturing sites during a 5-year retrospective time frame was established; 36 cases were matched with 80 controls.

RESULTS

The overall SAB rate in the industry was 10.0%. (65 SABs/651 pregnancies) The crude odds ratio (OR) for fabrication work was 0.65 (95% CI 0.30-1.40). This was essentially unchanged after adjustment for a range of potential confounding factors in the first 3 months of pregnancy and was reduced to 0.58 (95% CI 0.26-1.30) after adjustment for smoking in the previous 12 months. There were no statistically significantly elevated ORs for any work group or any specific chemical or physical exposure in the industry.

CONCLUSIONS

There is no evidence of an increased risk of SAB in the British semiconductor industry. Am. J. Ind. Med. 36:557-572, 1999. Published 1999 Wiley-Liss, Inc.

Occupational reproductive hazards

Although the causes of many reproductive disorders remain unknown, scientific evidence is accumulating to implicate occupational agents in fertility disorders and adverse pregnancy outcomes. Effective assessment and management of workers exposed to reproductive hazards often involves a team-based approach. By identifying potential reproductive hazards, making appropriate referrals, and by educating and advocating for patients, clinicians can play an important part in safeguarding the reproductive health of workers.

Tiered exposure-assessment strategy in the Semiconductor Health Study

The Semiconductor Health Study included 14 U.S. companies with 82 silicon-based wafer-fabrication rooms and a complex array of processes and chemicals. Its epidemiologic components were a historical examination of spontaneous abortion rates among 902 women, a prospective evaluation of reproductive outcomes in 483 women, and a cross-sectional review of male fertility and of respiratory, ergonomic, neurologic, or gastrointestinal problems among 3,175 men and women. Designing an exposure assessment strategy presented unique problems, and multiple agents had to be evaluated. A three-tiered approach to exposure assessment was developed to reflect increasing specificity of exposures. At the first tier, employees were divided into fabrication and nonfabrication groups. At the second tier, work groups with qualitatively different exposures were determined. At the third tier, intensity of exposures to specific chemical, physical, and ergonomic agents was evaluated. Evaluations were based on worker reports of tasks performed, moderated by fabrication-specific factors observed by study industrial hygienists during site visits.

A model for assessing occupational exposure to extremely low-frequency magnetic fields in fabrication rooms in the Semiconductor Health Study

A model was created to assess occupational exposure to extremely low-frequency magnetic fields (ELF-MF) among semiconductor fabrication-room (fab) workers. This model was based on the assumption that each subject's exposure arose from being near identifiable ELF-MF sources or being in areas with high ELF-MF levels. To assess ELF-MF exposures, the model superimposed subjects' time-activity patterns (patterns of how and where they spent their time) with measurements of magnetic-field levels from devices and work areas. This model, which was validated by personal dosimetry on 192 persons in three fabs, predicted actual time-weighted average exposures with a correlation coefficient of 0.62. The inability of the model to predict individual exposures more accurately was attributed to unforseen sources of elevated ELF-MF (transformers, distribution panels, sources in adjacent rooms) or to errors in subjects' judgments of time spent near devices. These unpredictable errors are intrinsic to the method used to estimate exposure.

Patterns of chemical use and exposure control in the Semiconductor Health Study

Information on chemical use and exposure control between 1986 and 1990 was collected from 14 companies participating in the Semiconductor Health Study. Questionnaires and site visits provided data used to develop exposure categories for three epidemiological studies: prospective, historical, and cross-sectional. Patterns of use of target chemicals were compiled for 82 silicon-wafer fabrication rooms (fabs), including 47 from which subjects were selected for study. Chemical use was examined by operation, year, and epidemiological component. Target agents for epidemiological analyses were present in more than 50% of fabs. Use of these agents was fairly constant from 1986 to 1990, except for a moderate increase in use of propylene glycol monomethyl ether acetate, a solvent being substituted for ethylene-based glycol ethers (EGE) in photoresists. The distribution of personal protective equipment, engineering controls, and other factors potentially affecting employee exposure was also examined. Controls designed to manage processes or high acute toxicity were present in most fabs; their prevalence remained unchanged from 1986 through 1990. Controls designed to reduce exposures to chemicals with low acute toxicity were less widely distributed; their prevalence increased moderately from 1986 to 1990.

A cross-sectional study of musculoskeletal symptoms and risk factors in semiconductor workers

As part of the cross-sectional component of the Semiconductor Health Study, we assessed prevalence of specific musculoskeletal symptoms and their association with possible ergonomic risk factors. A total of 3,175 persons (78% participation rate) from eight manufacturing sites across the U.S. completed a health and work questionnaire. Using logistic regression methods to adjust for nonoccupational factors, we compared musculoskeletal symptom (self report) prevalence among fabrication room (fab) and nonfab workers, among specific work process groups, and among workers exposed to selected ergonomic stressors. Overall, seven of 12 musculoskeletal outcomes were significantly more prevalent among fab workers. Distal upper-extremity symptoms were more common among fab than nonfab workers [relative risk (RR) = 1.44, 95% confidence interval (CI) = 1.26-1.63] and showed a dose-response effect with hours per day spent in the fab; increased risk was associated with frequency of lifting and with use of vacuum wands and projection aligners. Female sex and high somatization index score were associated with increased reporting for all musculoskeletal outcomes.

Historical cohort study of spontaneous abortion among fabrication workers in the Semiconductor Health Study: agent-level analysis

Risk of spontaneous abortion (SAB) was examined in relation to chemical and physical agents in a retrospective study of employees of 14 seminconductor manufacturers: After screening over 6,000 employees, 506 current and 385 former workers were eligible. If a woman had multiple eligible pregnancies, one was selected at random. Telephone interviews provided data on demographics and occupational and other exposures during the first trimester. Two groups of chemicals accounted for the 45% excess risk of SAB among fabrication-room (fab) workers: photoresist and developed solvents (PDS), including glycol ethers, and fluoride compounds used in etching. Women exposed to high levels of both these agents were at greater risk (RR = 3.21, 95% confidence interval [CI] = 1.29-5.96). In fab workers without these exposures, SAB rates were not elevated (adjusted relative risk [RR] = 0.98, 95% CI = 0.55-1.69). An association was seen with workplace stress, which was not limited to women exposed to PDS or fluoride, nor did stress explain the associations between these chemicals and SAB.

Prospectively assessed menstrual cycle characteristics in female wafer-fabrication and nonfabrication semiconductor employees

Women aged 18-44 years in silicon-wafer fabrication-room (fab) jobs and frequency-matched women in nonfab jobs were screened for a prospective study of reproductive health (n = 2,639). Among the 739 (28%) eligible women, 481 (65%) completed a baseline interview; 402 completed at least one menstrual cycle of follow-up with daily diaries and urinary assays to exclude conceptive cycles. Adjusted mean cycle lengths (MCL) did not differ between fab and nonfab women (p = 0.97). Women working in thin film and ion implantation (TFII) had the highest adjusted MCL (34.8 +/- 1.7 days) compared with nonfab workers (32.5 +/- 1.4 days, p = 0.07). Among women working exclusively in one group, TFII women had significantly higher MCL (36.1 +/- 2.04 days) than nonfab women (32.0 +/- 1.38 days, p = 0.017). TFII women were also more likely to have all cycles > 35 days (adjusted relative risk [RR] = 2.45; 95% CI = 0.85-6.06). Variability was assessed by logarithmic transformation of the mean standard deviation (MLSD) in cycle length per woman and adjusted for age and ethnicity (4.5 days for fab vs. 4.0 days for nonfab, p = 0.16). Women working exclusively in TFII or photolithography (PHOTO) had significantly higher adjusted MLSD in cycle length (6.68 +/- 1.28 and 5.72 +/- 1.24 days, respectively) than women in nonfab (4.1 +/- 1.16 days, p = 0.013 and 0.019, respectively). Fab and nonfab women did not differ significantly in mean days of bleeding or risk of having cycles > 35 or < 24 days. However, elevated risks of having cycles < 24 days were seen in supervisor engineers (adjusted RR = 2.46, 95% CI = 1.19-3.63) and PHOTO women (adjusted RR = 1.83, 95% CI = 0.94-2.88).