Evaluation of the health risk associated with exposure to chloroform in indoor swimming pools

Drinking Water Source, Chlorinated Water, and Colorectal Cancer: A Matched Case-Control Study in Ethiopia

BACKGROUND

There is no study conducted on the association between disinfection byproducts (DBPs) in chlorinated drinking water and colorectal cancer (CRC) in Ethiopia. Therefore, this study aimed to determine the relation between chlorine based DBPs in drinking water and CRC in Addis Ababa, Ethiopia.

METHODS

A facility based matched case control study was conducted involving 224 cases and 448 population controls from June 2020 to May 2021. Cases were defined as histologically confirmed CRC cases. Cases were matched with controls by residence, age, and sex using frequency and individual matching. Geocoding of cases, health facility, and georeferencing of controls were carried out. Data was collected using a pretested structured questionnaire. Pearson Chi square and Fisher's exact tests were employed to assess associations. Stratified analysis was used to detect confounding factors and effect modification. A multivariable conditional logistic regression was used to identify risk factors of CRC.

RESULTS

Of 214 CRC cases, 148 (69.2%) used chlorinated water whereas out of 428 controls 161 (37.6%) used chlorinated water. In the final regression model, drinking chlorinated surface water (adjusted matched odds ratio [adjusted mOR] = 2.6; 95% CI 1.7-4.0), history of swimming (adjusted mOR = 2.4; 95% CI 1.4-4.1), years at the place of current residence (adjusted mOR = 1.5; 95% CI 1.1-2.2), hot tap water use for showering (adjusted mOR; 3.8 = 95% CI 2.5-5.9) were significantly associated with CRC. The stratified analysis confirmed that smoking and meat ingestion were not effect modifiers and confounders.

CONCLUSION

Drinking chlorinated water for extended years is a significant risk factor for CRC in Addis Ababa, Ethiopia. In addition, hot tap water use for showering, and swimming history are risk factors for CRC. This information is essential to design integrated interventions that consider chlorination by-products and exposure routes toward the prevention and control of CRC in Ethiopia. Initiating alternative methods to chlorine disinfection of drinking water is also essential.

Human exposure to air contaminants in sports environments

The aim of this review was to investigate human exposure to relevant indoor air contaminants, predictors affecting the levels, and the means to reduce the harmful exposure in indoor sports facilities. Our study revealed that the contaminants of primary concern are the following: particulate matter in indoor climbing, golf, and horse riding facilities; carbon dioxide and particulate matter in fitness centers, gymnasiums, and sports halls; Staphylococci on gymnasium surfaces; nitrogen dioxide and carbon monoxide in ice hockey arenas; carbon monoxide, nitrogen oxide(s), and particulate matter in motor sports arenas; and disinfection by-products in indoor chlorinated swimming pools. Means to reduce human exposure to indoor contaminants include the following: adequate mechanical ventilation with filters, suitable cleaning practices, a limited number of occupants in fitness centers and gymnasiums, the use of electric resurfacers instead of the engine powered resurfacers in ice hockey arenas, carefully regulated chlorine and temperature levels in indoor swimming pools, properly ventilated pools, and good personal hygiene. Because of the large number of susceptible people in these facilities, as well as all active people having an increased respiratory rate and airflow velocity, strict air quality requirements in indoor sports facilities should be maintained.

Regulation, formation, exposure, and treatment of disinfection by-products (DBPs) in swimming pool waters: A critical review

The microbial safety of swimming pool waters (SPWs) becomes increasingly important with the popularity of swimming activities. Disinfection aiming at killing microbes in SPWs produces disinfection by-products (DBPs), which has attracted considerable public attentions due to their high frequency of occurrence, considerable concentrations and potent toxicity. We reviewed the latest research progress within the last four decades on the regulation, formation, exposure, and treatment of DBPs in the context of SPWs. This paper specifically discussed DBP regulations in different regions, formation mechanisms related with disinfectants, precursors and other various conditions, human exposure assessment reflected by biomarkers or epidemiological evidence, and the control and treatment of DBPs. Compared to drinking water with natural organic matter as the main organic precursor of DBPs, the additional human inputs (i.e., body fluids and personal care products) to SPWs make the water matrix more complicated and lead to the formation of more types and greater concentrations of DBPs. Dermal absorption and inhalation are two main exposure pathways for trihalomethanes while ingestion for haloacetic acids, reflected by DBP occurrence in human matrices including exhaled air, urine, blood, and plasma. Studies show that membrane filtration, advanced oxidation processes, biodegradation, thermal degradation, chemical reduction, and some hybrid processes are the potential DBP treatment technologies. The removal efficiency, possible mechanisms and future challenges of these DBP treatment methods are summarized in this review, which may facilitate their full-scale applications and provide potential directions for further research extension.

Monte-Carlo and multi-exposure assessment for the derivation of criteria for disinfection byproducts and volatile organic compounds in drinking water: Allocation factors and liter-equivalents per day

The probability distributions of total potential doses of disinfection byproducts and volatile organic compounds via ingestion, inhalation, and dermal exposure were estimated with Monte Carlo simulations, after conducting physiologically based pharmacokinetic model simulations to takes into account the differences in availability between the three exposures. If the criterion that the 95th percentile estimate equals the TDI (tolerable daily intake) is regarded as protecting the majority of a population, the drinking water criteria would be 140 (trichloromethane), 66 (bromodichloromethane), 157 (dibromochloromethane), 203 (tribromomethane), 140 (dichloroacetic acid), 78 (trichloroacetic acid), 6.55 (trichloroethylene, TCE), and 22 μg/L (perchloroethylene). The TCE criterion was lower than the Japanese Drinking Water Quality Standard (10 μg/L). The latter would allow the intake of 20% of the population to exceed the TDI. Indirect inhalation via evaporation from water, especially in bathrooms, was the major route of exposure to compounds other than haloacetic acids (HAAs) and accounted for 1.2-9 liter-equivalents/day for the median-exposure subpopulation. The ingestion of food was a major indirect route of exposure to HAAs. Contributions of direct water intake were not very different for trihalomethanes (30-45% of TDIs) and HAAs (45-52% of TDIs).

Occurrence and formation of disinfection by-products in the swimming pool environment: A critical review

Disinfection of water for human use is essential to protect against microbial disease; however, disinfection also leads to formation of disinfection by-products (DBPs), some of which are of health concern. From a chemical perspective, swimming pools are a complex matrix, with continual addition of a wide range of natural and anthropogenic chemicals via filling waters, disinfectant addition, pharmaceuticals and personal care products and human body excretions. Natural organic matter, trace amounts of DBPs and chlorine or chloramines may be introduced by the filling water, which is commonly disinfected distributed drinking water. Chlorine and/or bromine is continually introduced via the addition of chemical disinfectants to the pool. Human body excretions (sweat, urine and saliva) and pharmaceuticals and personal care products (sunscreens, cosmetics, hair products and lotions) are introduced by swimmers. High addition of disinfectant leads to a high formation of DBPs from reaction of some of the chemicals with the disinfectant. Swimming pool air is also of concern as volatile DBPs partition into the air above the pool. The presence of bromine leads to the formation of a wide range of bromo- and bromo/chloro-DBPs, and Br-DBPs are more toxic than their chlorinated analogues. This is particularly important for seawater-filled pools or pools using a bromine-based disinfectant. This review summarises chemical contaminants and DBPs in swimming pool waters, as well as in the air above pools. Factors that have been found to affect DBP formation in pools are discussed. The impact of the swimming pool environment on human health is reviewed.

Assessment of air and water contamination by disinfection by-products at 41 indoor swimming pools

This study was aimed at assessing the profiles (occurrence and speciation) of disinfection by-product (DBP) contamination in air and water of a group of 41 public indoor swimming pools in Québec (Canada). The contaminants measured in the water included the traditional DBPs [i.e., four trihalomethanes (THMs), six haloacetic acids (HAAs)] but also several emergent DBPs [i.e., halonitriles, halonitromethanes, haloketones and nitrosodimethylamine (NDMA)]. Those measured in the air comprised THMs and chloramines (CAMs). Overall, extremely variable DBP levels were found from one pool to another (both quantitatively and in terms of speciation). For instance, in water, among the four THMs, chloroform was usually the most abundant compound (37.9±25.7µg/L). Nevertheless, the sum of the three other brominated THMs represented more than 25% of total THMs at almost half the facilities visited (19 cases). In 13 of them, the levels of brominated THMs (66±24.2µg/L) even greatly outweighed the levels of chloroform (15.2±6.31µg/L). Much higher levels of HAAs (294.8±157.6µg/L) were observed, with a consistent preponderance of brominated HAAs in the swimming pools with more brominated THMs. NDMA levels which were measured in a subset of 8 pools ranged between 2.8ng/L and 105ng/L. With respect to air, chloroform was still the most abundant THM globally (119.4±74.2µg/m(3)) but significant levels of brominated THMs were also observed in various cases, particularly in the previously evoked group of 13 swimming pools with preponderant levels of brominated THMs in water. CAM levels (0.23±0.15mg/m(3)) varied highly, ranging from not detected to 0.56mg/m(3). Overall, the levels were generally relatively high compared to current guidelines or reference values from several countries, and they point to a relatively atypical presence of brominated compounds, and to significant levels of emergent DBPs for which health risk is less documented.

Influence of physical activity in the intake of trihalomethanes in indoor swimming pools

This study describes the relationship between physical activity and intake of trihalomethanes (THMs), namely chloroform (CHCl3), bromodichloromethane (CHCl2Br), dibromochloromethane (CHClBr2) and bromoform (CHBr3), in individuals exposed in two indoor swimming pools which used different disinfection agents, chlorine (Cl-SP) and bromine (Br-SP). CHCl3 and CHBr3 were the dominant compounds in air and water of the Cl-SP and Br-SP, respectively. Physical exercise was assessed from distance swum and energy expenditure. The changes in exhaled breath concentrations of these compounds were measured from the differences after and before physical activity. A clear dependence between distance swum or energy expenditure and exhaled breath THM concentrations was observed. The statistically significant relationships involved higher THM concentrations at higher distances swum. However, air concentration was the major factor determining the CHCl3 and CHCl2Br intake in swimmers whereas distance swum was the main factor for CHBr3 intake. These two causes of THM incorporation into swimmers concurrently intensify the concentrations of these compounds into exhaled breath and pointed to inhalation as primary mechanism for THM uptake. Furthermore, the rates of THM incorporation were proportionally higher as higher was the degree of bromination of the THM species. This trend suggested that air-water partition mechanisms in the pulmonary system determined higher retention of the THM compounds with lower Henry's Law volatility constants than those of higher constant values. Inhalation is therefore the primary mechanisms for THM exposure of swimmers in indoor buildings.

Chemical contaminants in swimming pools: Occurrence, implications and control

A range of trace chemical contaminants have been reported to occur in swimming pools. Current disinfection practices and monitoring of swimming pool water quality are aimed at preventing the spread of microbial infections and diseases. However, disinfection by-products (DBPs) are formed when the disinfectants used react with organic and inorganic matter in the pool. Additional chemicals may be present in swimming pools originating from anthropogenic sources (bodily excretions, lotions, cosmetics, etc.) or from the source water used where trace chemicals may already be present. DBPs have been the most widely investigated trace chemical contaminants, including trihalomethanes (THMs), haloacetic acids (HAAs), halobenzoquinones (HBQs), haloacetonitriles (HANs), halonitromethanes (HNMs), N-nitrosamines, nitrite, nitrates and chloramines. The presence and concentrations of these chemical contaminants are dependent upon several factors including the types of pools, types of disinfectants used, disinfectant dosages, bather loads, temperature and pH of swimming pool waters. Chemical constituents of personal care products (PCPs) such as parabens and ultraviolet (UV) filters from sunscreens have also been reported. By-products from reactions of these chemicals with disinfectants and UV irradiation have been reported and some may be more toxic than their parent compounds. There is evidence to suggest that exposure to some of these chemicals may lead to health risks. This paper provides a detailed review of various chemical contaminants reported in swimming pools. The concentrations of chemicals present in swimming pools may also provide an alternative indicator to swimming pool water quality, providing insights to contamination sources. Alternative treatment methods such as activated carbon filtration and advanced oxidation processes may be beneficial in improving swimming pool water quality.

Variability of chlorination by-product occurrence in water of indoor and outdoor swimming pools

Swimming is one of the most popular aquatic activities. Just like natural water, public pool water may contain microbiological and chemical contaminants. The purpose of this study was to study the presence of chemical contaminants in swimming pools, in particular the presence of disinfection by-products (DBPs) such as trihalomethanes (THMs), haloacetic acids (HAAs) and inorganic chloramines (CAMi). Fifty-four outdoor and indoor swimming pools were investigated over a period of one year (monthly or bi-weekly sampling, according to the type of pool) for the occurrence of DBPs. The results showed that DBP levels in swimming pools were greater than DBP levels found in drinking water, especially for HAAs. Measured concentrations of THMs (97.9 vs 63.7 μg/L in average) and HAAs (807.6 vs 412.9 μg/L in average) were higher in outdoor pools, whereas measured concentrations of CAMi (0.1 vs 0.8 mg/L in average) were higher in indoor pools. Moreover, outdoor pools with heated water contained more DBPs than unheated pools. Finally, there was significant variability in tTHM, HAA9 and CAMi levels in pools supplied by the same municipal drinking water network, suggesting that individual pool characteristics (number of swimmers) and management strategies play a major role in DBP formation.

Occurrence and spatial and temporal variations of disinfection by-products in the water and air of two indoor swimming pools

In order to improve disinfection by-product (DBP) exposure assessment, this study was designed to document both water and air levels of these chemical contaminants in two indoor swimming pools and to analyze their within-day and day-to-day variations in both of them. Intensive sampling was carried out during two one-week campaigns to measure trihalomethanes (THMs) and chloramines (CAMs) in water and air, and haloacetic acids (HAAs) in water several times daily. Water samples were systematically collected at three locations in each pool and air samples were collected at various heights around the pool and in other rooms (e.g., changing room) in the buildings. In addition, the ability of various models to predict air concentrations from water was tested using this database. No clear trends, but actual variations of contamination levels, appeared for both water and air according to the sampling locations and times. Likewise, the available models resulted in realistic but imprecise estimates of air contamination levels from water. This study supports the recommendation that suitable minimal air and water sampling should be carried out in swimming pools to assess exposure to DBPs.

Trihalomethane exposures in indoor swimming pools: a level III fugacity model

The potential for generation of disinfection byproducts (DBPs) in swimming pools is high due to the concentrations of chlorine required to maintain adequate disinfection, and the presence of organics introduced by the swimmers. Health Canada set guidelines for trihalomethanes (THMs) in drinking water; however, no such guideline exists for swimming pool waters. Exposure occurs through ingestion, inhalation and dermal contact in swimming pools. In this research, a multimedia model is developed to evaluate exposure concentrations of THMs in the air and water of an indoor swimming pool. THM water concentration data were obtained from 15 indoor swimming pool facilities in Quebec (Canada). A level III fugacity model is used to estimate inhalation, dermal contact and ingestion exposure doses. The results of the proposed model will be useful to perform a human health risk assessment and develop risk management strategies including developing health-based guidelines for disinfection practices and the design of ventilation system for indoor swimming pools.

Analysis of trihalomethanes in water and air from indoor swimming pools using HS-SPME/GC/ECD

Headspace solid phase microextraction (HS-SPME) with further quantification by gas chromatography and electron capture detector (GC/ECD) was used to analyze trihalomethanes (THMs) in water and air from indoor swimming pools (ISPs). High correlation coefficients were obtained for the calibration lines in water with detection limits of 0.2 μg/L for trichloromethane (TCM) and bromodichloromethane (BDCM), 0.1 μg/L for dibromochloromethane (DBCM) and 0.5 μg/L for tribromomethane (TBM). Coefficients of variation values were 5-10% for repeatability and 15-25% for reproducibility. In air analysis, high correlation coefficients were also obtained for the calibration lines with detection limits of 2.5 μg/m(3) for TCM and BDCM and 1.25 μg/m(3) for DBCM and TBM. Repeatability and reproducibility coefficients of variation were the same as in water analysis. Analytical results from a survey in four Portuguese ISPs showed that the mean concentration of total trihalomethanes (TTHMs) in water ranged from 22±2 to 577±58 μg/L. In the lack of European specific regulation for THMs in water from ISPs and taking into consideration that ingestion is a form of exposure, TTHMs' values were compared with European drinking water maximum contamination level (100 μg/L, Directive 98/83/CE). From the reported TTHMs mean concentration values in ISPs' water, 40% exceeded that value. TTHMs values determined in the air (T = 30°C) ranged from 98±10 to 1225±123 μg/m(3) and from 51±5 μg/m(3)to 519±52 μg/m(3)at 5 and 150 cm above the water surface, respectively. As expected, swimmers are more exposed to high concentrations of THMs than lifeguards. As there is no European specific regulation for THMs in ISPs' air, the highest TCM values were compared with maximum values reported in the literature for ISPs (1630 μg/m(3)) and with the inhalation exposure limit (10,000 μg/m(3)) established for TCM by European occupational legislation (Directive 2000/39/CE).

A Bayesian population PBPK model for multiroute chloroform exposure

A Bayesian hierarchical model was developed to estimate the parameters in a physiologically based pharmacokinetic (PBPK) model for chloroform using prior information and biomarker data from different exposure pathways. In particular, the model provides a quantitative description of the changes in physiological parameters associated with hot-water bath and showering scenarios. Through Bayesian inference, uncertainties in the PBPK parameters were reduced from the prior distributions. Prediction of biomarker data with the calibrated PBPK model was improved by the calibration. The posterior results indicate that blood flow rates varied under two different exposure scenarios, with a two-fold increase of the skin's blood flow rate predicted in the hot-bath scenario. This result highlights the importance of considering scenario-specific parameters in PBPK modeling. To demonstrate the application of a probability approach in toxicological assessment, results from the posterior distributions from this calibrated model were used to predict target tissue dose based on the rate of chloroform metabolized in liver. This study demonstrates the use of the Bayesian approach to optimize PBPK model parameters for typical household exposure scenarios.

The good, the bad, and the volatile: can we have both healthy pools and healthy people?

Swimming is a healthful activity that comes with increased risk of exposure to pathogenic microorganisms and disinfection agents/byproducts.

Chloroform in indoor swimming-pool air: monitoring and modeling coupled with the effects of environmental conditions and occupant activities

Human exposure to chloroform in indoor swimming pools has been recognized as a potential health concern. Although environmental monitoring is a useful technique to investigate chloroform concentrations in indoor swimming-pool air, in practice, the interpretations of measured data would inevitably run into difficulties due to the complex interactions among the numerous variables, including environmental conditions and occupant activities. Considering of the relevant variables of environmental conditions and occupant activities, a mathematical model was first proposed to predict the chloroform concentration in indoor swimming-pool air. The developed model provides a straightforward, conceptually simple way to predict the indoor air chloroform concentration by calculating the mass flux, J, and the Péclet number, Pe, and by using a heuristic value of the indoor airflow recycle ratio, R. The good agreement between model simulation and measured data demonstrates the feasibility of using the presented model for indoor air quality management, operational guidelines and health-related risk assessment.

Predictors of personal air concentrations of chloroform among US adults in NHANES 1999-2000

Volunteer studies suggest that showering/bathing with chlorinated tap water contributes to daily chloroform inhalation exposure for the majority of US adults. We used data from the 1999-2000 US National Health and Nutrition Examination Survey (NHANES) and weighted multiple linear regression to test the hypothesis that personal exposure microevents such as showering or spending time at a swimming pool would be significantly associated with chloroform levels in 2-3 day personal air samples. The NHANES data show that eight of 10 US adults are exposed to detectable levels of chloroform. Median (1.13 microg/m(3)), upper percentile (95th, 12.05 microg/m(3)), and cancer risk estimates were similar to those from recent US regional studies. Significant predictors of log personal air chloroform in our model (R(2)=0.34) included age, chloroform concentrations in home tap water, having no windows open at home during the sampling period, visiting a swimming pool during the sampling period, living in a mobile home/trailer or apartment versus living in a single family (detached) home, and being Non-Hispanic Black versus Non-Hispanic White, although the race/ethnicity estimates appear influenced by several outlying observations. Reported showering activity was not a significant predictor of personal air chloroform, possibly due to the wording of the NHANES shower question. The NHANES measurements likely underestimate true inhalation exposures since subjects did not wear sampling badges while showering or swimming, and because of potential undersampling by the passive monitors. Research is needed to quantify the potential difference.

Approaches for evaluating the relevance of multiroute exposures in establishing guideline values for drinking water contaminants

In establishing the guideline values for chemical contaminants in drinking water, the contribution of inhalation and dermal routes associated with showering/bathing needs to be evaluated. The present article reviews the current approaches available for evaluating the importance of inhalation and dermal routes of exposure to drinking water contaminants (DWCs) and integrates them within a 2-tier approach. Accordingly, tier 1 would evaluate whether the dermal or inhalation route is likely to contribute to at least 10% of the dose received from ingestion of drinking water (i.e., 0.15 L-equivalent per day based on the daily water intake rate of 1.5 L/day typically used in Health Canada assessments). Based on the route-specific exposure parameters (i.e., area of skin exposed, effective skin permeability coefficient [K(p)], and air to water concentration ratio during use conditions [F(air-water)], breathing rate, duration of contact, and fraction absorbed), it was determined that for DWCs with K(p) less than 0.024 cm/hr and F(air - water) less than 0.0063, the dermal and inhalation routes during showering or bathing are unlikely to contribute significantly to the total dose. For DWCs with K(p) value equal to or greater than 0.025 cm/hr, dermal notation is implied, and as such, tier 2 calculation of L-equivalent associated with dermal exposure needs to be performed. Similarly, for DWCs with F(air-water) greater than 0.00063, inhalation notation is implied, and detailed evaluation of the L-equivalent associated with inhalation exposure (i.e., tier 2) is suggested. In general, data from human volunteer studies, observational measurements, and targeted modeling studies are useful for deriving L-equivalents, reflective of the magnitude of dose received via dermal and inhalation routes relative to the oral route. However, in resource-limited situations, these approaches can be integrated within a 2-tier approach for prioritizing and providing quantitative evaluations of the relevance of dermal and inhalation routes for developing exposure guidelines for DWCs.

Alveolar air and urine analyses as biomarkers of exposure to trihalomethanes in an indoor swimming pool

The exposure of workers and swimmers at an indoor swimming pool to trihalomethanes (THMs) as a consequence of water chlorination was evaluated by analyzing alveolar air and urine samples. Environmental monitoring of THMs in water and ambient air was also performed in order to assess the possible correlation between environmental and biological samples. The sampling was done concurrently, taking the urine and alveolar air samples before and after the work shift for 15 workers and the swimming activity for 12 swimmers. A high THM uptake was observed in alveolar air and urine of subjects exposed, with chloroform being the most abundant THM. Mean chloroform levels in alveolar air and urine before exposure were 4 microg/ m3 and 475 ng/L, respectively. After 2 h of exposure, concentration increases of ca. 8 times in alveolar air and 2 times in urine were observed in workers. After 1 h swimming, the increases found in swimmers were ca. 20 and 3 times in alveolar air and urine, respectively. High increases have also been observed in bromodichloromethane levels. We have obtained excellent correlations between the chloroform concentrations found in the swimming pool ambient air/alveolar air, and between the urine/ alveolar air of the participants after exposure (r > 0.9). In conclusion, alveolar air provides better response sensitivity and shorter reaction time to external exposure than urine, being therefore the most sensitive biomarker.

Reverse dosimetry: interpreting trihalomethanes biomonitoring data using physiologically based pharmacokinetic modeling

Biomonitoring data provide evidence of exposure of environmental chemicals but are not, by themselves, direct measures of exposure. To use biomonitoring data in understanding exposure, physiologically based pharmacokinetic (PBPK) modeling can be used in a reverse dosimetry approach to assess a distribution of exposures possibly associated with specific blood or urine levels of compounds. Reverse dosimetry integrates PBPK modeling with exposure pattern characterization, Monte Carlo analysis, and statistical tools to estimate a distribution of exposures that are consistent with biomonitoring data in a population. The present study used an existing PBPK model for chloroform as a generic framework to develop PBPK models for other trihalomethanes (THMs). Using Monte Carlo sampling techniques, probabilistic information about pharmacokinetics and exposure patterns was included to estimate distributions of THMs concentrations in blood in relation to various exposure patterns in a diverse population. In addition, the possibility of inhibition of hepatic metabolism among THMs was evaluated under the scenarios of household exposure. These studies demonstrated how PBPK modeling can be used as a tool to estimate a population distribution of exposures that could have resulted in particular biomonitoring results. When toxicity level is known, this tool can also be used to estimate proportion of population above levels associated with health risk.

Drowning in disinfection byproducts? Assessing swimming pool water

Disinfection is mandatory for swimming pools: public pools are usually disinfected by gaseous chlorine or sodium hypochlorite and cartridge filters; home pools typically use stabilized chlorine. These methods produce a variety of disinfection byproducts (DBPs), such as trihalomethanes (THMs), which are regulated carcinogenic DBPs in drinking water that have been detected in the blood and breath of swimmers and of nonswimmers at indoor pools. Also produced are halogenated acetic acids (HAAs) and haloketones, which irritate the eyes, skin, and mucous membranes; trichloramine, which is linked with swimming-pool-associated asthma; and halogenated derivatives of UV sun screens, some of which show endocrine effects. Precursors of DBPs include human body substances, chemicals used in cosmetics and sun screens, and natural organic matter. Analytical research has focused also on the identification of an additional portion of unknown DBPs using gas chromatography (GC)/mass spectrometry (MS) and liquid chromatography (LC)/MS/MS with derivatization. Children swimmers have an increased risk of developing asthma and infections of the respiratory tract and ear. A 1.6-2.0-fold increased risk for bladder cancer has been associated with swimming or showering/bathing with chlorinated water. Bladder cancer risk from THM exposure (all routes combined) was greatest among those with the GSTT1-1 gene. This suggests a mechanism involving distribution of THMs to the bladder by dermal/inhalation exposure and activation there by GSTT1-1 to mutagens. DBPs may be reduced by engineering and behavioral means, such as applying new oxidation and filtration methods, reducing bromide and iodide in the source water, increasing air circulation in indoor pools, and assuring the cleanliness of swimmers. The positive health effects gained by swimming can be increased by reducing the potential adverse health risks.

Development of physiologically based toxicokinetic models for improving the human indoor exposure assessment to water contaminants: trichloroethylene and trihalomethanes

Generally, ingestion is the only route of exposure that is considered in the risk assessment of drinking water contaminants. However, it is well known that a number of these contaminants are volatile and lipophilic and therefore highly susceptible to being absorbed through other routes, mainly inhalation and dermal. The objective of this study was to develop physiologically based human toxicokinetic (PBTK) models for trihalomethanes (THM) and trichloroethylene (TCE) that will facilitate (1) the estimation of internal exposure to these chemicals for various multimedia indoor exposure scenarios, and (2) consideration of the impact of biological variability in the estimation of internal doses. Five PBTK models describing absorption through ingestion, inhalation and skin were developed for these contaminants. Their concentrations in ambient air were estimated from their respective tap water concentrations and their physicochemical characteristics. Algebraic descriptions of the physiological parameters, varying as a function of age, gender and diverse anthropometric parameters, allow the prediction of the influence of interindividual variations on absorbed dose and internal dosimetry. Simulations for various scenarios were done for a typical human (i.e., 70 kg, 1.7 m) as well as for humans of both genders varying in age from 1 to 90 years. Simulations show that ingestion contributes to less than 50% of the total absorbed dose or metabolized dose for all chemicals. This contribution to internal dosimetry, such as maximal venous blood concentrations (Cmax) and the area under the venous blood concentration time curve (AUC), decreases markedly (e.g., as low as 0.9% of Cmax for bromodichloromethane). The importance of this contribution varies mainly as a function of shower duration. Moreover, model simulations indicate that multimedia exposure is more elevated in children than adults (i.e., up to 200% of the adult internal dose). The models developed in this study allow characterization of the influence of the different routes of exposure and an improved estimation of the realistic multimedia exposure to volatile organic chemicals present in drinking water. Hence, such models will greatly improve health risk assessment for these chemicals.

Use of a physiologically based pharmacokinetic model to identify exposures consistent with human biomonitoring data for chloroform

Biomonitoring data provide evidence of human exposure to environmental chemicals by quantifying the chemical or its metabolite in a biological matrix. To better understand the correlation between biomonitoring data and environmental exposure, physiologically based pharmacokinetic (PBPK) modeling can be of use. The objective of this study was to use a combined PBPK model with an exposure model for showering to estimate the intake concentrations of chloroform based on measured blood and exhaled breath concentrations of chloroform. First, the predictive ability of the combined model was evaluated with three published studies describing exhaled breath and blood concentrations in people exposed to chloroform under controlled showering events. Following that, a plausible exposure regimen was defined combining inhalation, ingestion, and dermal exposures associated with residential use of water containing typical concentrations of chloroform to simulate blood and exhaled breath concentrations of chloroform. Simulation results showed that inhalation and dermal exposure could contribute substantially to total chloroform exposure. Next, sensitivity analysis and Monte Carlo analysis were performed to investigate the sources of variability in model output. The variability in exposure conditions (e.g., shower duration) was shown to contribute more than the variability in pharmacokinetics (e.g., body weight) to the predicted variability in blood and exhaled breath concentrations of chloroform. Lastly, the model was used in a reverse dosimetry approach to estimate distributions of exposure consistent with concentrations of chloroform measured in human blood and exhaled breath.

Airborne exposure to trihalomethanes from tap water in homes with refrigeration-type and evaporative cooling systems

This study evaluates airborne concentrations of common trihalomethane compounds (THM) in selected living spaces of homes supplied with chlorinated tap water containing >85 ppb total THM. Three small homes in an arid urban area were selected, each having three bedrooms, a full bath, and approximately 1000 square feet; two homes had standard (refrigeration-type) central air conditioning and the third had a central evaporative cooling system ("swamp cooler"). A high-end water-use pattern was used at each home in this exposure simulation. THM were concurrently measured on 4 separate test days in tap water and air in the bathroom, living room, the bedroom closest to the bathroom, and outside using Summa canisters. Chloroform (trichloromethane, TCM), bromodichloromethane (BDCM), and dibromochloromethane (DBCM) concentrations were quantified using U.S. EPA Method TO-14. The apparent volatilization fraction consistently followed the order: TCM > BDCM > DBCM. Relatively low airborne THM concentrations (similar to outdoors) were found in the living room and bedroom samples for the home with evaporative cooling, while the refrigeration-cooled homes showed significantly higher THM levels (three- to fourfold). This differential remained after normalizing the air concentrations based on estimated THM throughput or water concentrations. These findings indicate that, despite higher throughput of THM-containing water in homes using evaporative coolers, the higher air exchange rates associated with these systems rapidly clears THM to levels similar to ambient outdoor concentrations.

Cancer risk associated with household exposure to chloroform

Chloroform (CHCl3) the trihalomethane most prevalent in drinking water, is a proven animal carcinogen and a suspected human carcinogen. Consequently, standards have been issued by health authorities to limit its concentration in drinking water. These limits are based solely on ingestion, without taking into account inhalation and skin contact. Exposure to CHCl3 was assessed for 18 men (age: mean 38 years; range 23-51) following a 10-min shower in their respective residences located in the Quebec City region (Canada). CHCl3 concentration was measured in alveolar air samples collected before, immediately after, and 15 min and 30 min following the shower. Indoor air and water concentrations were determined concomitantly. Mean CHCl3 concentrations in the air of the shower stall and in water were respectively 147 microg/m3 (SD = 56.2 microg/m3) and 20.1 microg/L (SD = 9.0 microg/L). Water concentrations were comparable to those documented in a large proportion of distribution networks in Canada. The mean increase in alveolar air CHCl3 concentration (deltaCHCIALV) at the end of the shower was 33 microg/m3 (SD = 14.7 microg/m3). A multiple-regression analysis revealed that deltaCHCl3ALV values were only associated with chloroform concentration in air of the shower stall. DeltaCHCl3ALV were described using a physiologically based pharmacokinetic (PBPK) model. This model was then used to estimate concentrations of CHCl3 metabolites bound to liver and kidney macromolecules following a shower, and also according to exposure scenarios that integrate drinking-water ingestion and air inhalation. The concentration predicted in the liver following a worst-case exposure scenario was 0.41 microg CHCl3 equivalents/kg of tissue, some 6,000 times lower than the lowest concentration that did not increase the incidence of hepatic tumors in laboratory animals. Data indicate that for this range of exposure the safety margin appears therefore considerable with respect to the potential carcinogenic effect of household exposure to CHCl3.