Assessment of airborne exposure to trihalomethanes from tap water in residential showers and baths

Comparison of Trihalomethane exposure assessment metrics in epidemiologic analyses of reproductive and developmental outcomes

BACKGROUND

Researchers have developed exposure assessment metrics for disinfection by-products (DBPs) utilizing drinking water monitoring data and accounting for spatial and temporal variability, water consumption, and showering and bathing time with an expectation of decreasing exposure misclassification compared to the use of measured concentrations at public water supply (PWS) monitoring locations alone.

OBJECTIVE

We used exposure data collected for a previous study of DBPs to evaluate how different sources of information impact trihalomethane (THM) exposure estimates.

METHODS

We compared gestational exposure estimates to THMs based on water utility monitoring data alone, statistical imputation of daily concentrations to incorporate temporal variability, and personal water consumption and use (bathing and showering). We used Spearman correlation coefficients and ranked kappa statistics to compare exposure classifications.

RESULTS

Exposure estimates based on measured or imputed daily THM concentrations, self-reported consumption, or bathing and showering differed substantially from estimates based solely on concentrations from PWS quarterly monitoring reports. Ranked exposure classifications, high to low quartiles or deciles, were generally consistent across each exposure metric (i.e., a subject with "high" exposure based on measured or imputed THM concentrations generally remained in the "high" category across exposure metrics.) The measured concentrations and imputed daily (i.e., spline regression) concentrations were highly correlated (r = 0.98). The weighted kappa statistics comparing exposure estimates using different exposure metrics ranged from 0.27 to 0.89, with the highest values for the ingestion + bathing/showering metrics compared to metrics for bathing/showering only (0.76 and 0.89). Bathing and showering contributed the most to "total" THM exposure estimates.

IMPACT STATEMENT

We compare exposure metrics capturing temporal variability and multiple estimates of personal THM exposure with THM concentrations from PWS monitoring data. Our results show exposure estimates based on imputed daily concentrations accounting for temporal variability were very similar to the measured THM concentrations. We observed low agreement between imputed daily concentrations and ingestion-based estimates. Considering additional routes of exposure (e.g., inhalation and dermal) slightly increased agreement with the measured PWS exposure estimate in this population. Overall, the comparison of exposure assessment metrics allows researchers to understand the added value of additional data collection for future epidemiologic analyses of DBPs.

Assessment of indirect inhalation exposure to formaldehyde evaporated from water

Volatilization volumes and health risks associated with indirect inhalation exposure to formaldehyde evaporated from water have not been investigated quantitatively. We experimentally investigated formaldehyde volatility, compared with chloroform volatility, predicted formaldehyde inhalation exposure concentrations in Japanese bathrooms, and then re-evaluated drinking water quality standards. Although the Henry's law constant of formaldehyde is 1/10⁴ that of chloroform, with a 30-min exposure period, the formaldehyde non-equilibrium partition coefficient (K'_d) was 1/500th the chloroform value because of formaldehyde's faster volatilization rate. We used this ratio to estimate the cumulative probability distribution of formaldehyde concentrations in bathroom air. For a formaldehyde concentration in water of ≤2.6 mg/L-water (WHO tolerable concentration), the probability that the incremental formaldehyde concentration due to volatilization would exceed 100 μg/m³-air (WHO indoor air quality guideline) was low. However, major sources of formaldehyde in indoor air are building materials and furniture. We therefore calculated the allowable concentration in water by allocating a small percentage of the indoor air guideline value to indirect inhalation exposure via volatilization from tap water. With an allocation factor of 20% (10%), the allowable concentration was 0.52 (0.26) mg/L-water. These concentrations are similar to the Health Canada guideline concentration but they are 3-6 times the Japanese water quality standard.

Multi-route - Multi-pathway exposure to trihalomethanes and associated cumulative health risks with response and dose addition

Cumulative health risk estimation for exposure to mixtures is a current issue, which would present a useful tool for environmental and public health management. Cumulative risks were estimated with response and dose addition methods for individual multi-route - multi-pathway exposure to trihalomethanes and associated carcinogenic toxic risks in Izmir, Turkey. Exposure levels were estimated for ingestion, dermal, and inhalation routes using measured tap water and bottled water THM concentrations. Drinking, showering, hand and dish washing were the considered pathways. THM concentrations in air during the showering were modeled with two-resistance theory using tap water concentration data. The estimated carcinogenic risk levels for ingestion route were in the range of safe (<10^-6) to low priority (<10^-4), for dermal route all were in the safe zone (<10^-6), and for inhalation route were in the range of safe to high priority (>10^-4) zones, indicating ingestion and inhalation routes were of similar significance ahead of dermal exposure. Cumulative carcinogenic risks of THM compounds were estimated using simple (response) addition and dose addition using cumulative relative potency factor (CRPF) methods. CRPF method estimated the risks at lower levels compared to the simple addition, which originated from the use two different risk factor values for the index chemical in the method. Cumulative chronic-toxic risks were also assessed, rendering below the threshold risk levels for all routes. This study showed that multi-route - multi-pathway exposure assessment and cumulative risk assessment should together be considered for better environmental and public health management.

Assessing Inhalation Exposures Associated with Contamination Events in Water Distribution Systems

When a water distribution system (WDS) is contaminated, short-term inhalation exposures to airborne contaminants could occur as the result of domestic water use. The most important domestic sources of such exposures are likely to be showering and the use of aerosol-producing humidifiers, i.e., ultrasonic and impeller (cool-mist) units. A framework is presented for assessing the potential effects of short-term, system-wide inhalation exposures that could result from such activities during a contamination event. This framework utilizes available statistical models for showering frequency and duration, available exposure models for showering and humidifier use, and experimental results on both aerosol generation and the volatilization of chemicals during showering. New models for the times when showering occurs are developed using time-use data for the United States. Given a lack of similar models for how humidifiers are used, or the information needed to develop them, an analysis of the sensitivity of results to assumptions concerning humidifier use is presented. The framework is applied using network models for three actual WDSs. Simple models are developed for estimating upper bounds on the potential effects of system-wide inhalation exposures associated with showering and humidifier use. From a system-wide, population perspective, showering could result in significant inhalation doses of volatile chemical contaminants, and humidifier use could result in significant inhalation doses of microbial contaminants during a contamination event. From a system-wide perspective, showering is unlikely to be associated with significant doses of microbial contaminants. Given the potential importance of humidifiers as a source of airborne contaminants during a contamination event, an improved understanding of the nature of humidifier use is warranted.

Very volatile organic compounds: an understudied class of indoor air pollutants

Very volatile organic compounds (VVOCs), as categorized by the WHO, are an important subgroup of indoor pollutants and cover a wide spectrum of chemical substances. Some VVOCs are components of products commonly used indoors, some result from chemical reactions and some are reactive precursors of secondary products. Nevertheless, there is still no clear and internationally accepted definition of VVOCs. Current approaches are based on the boiling point, and the saturation vapor pressure or refer to analytical procedures. A significant problem is that many airborne VVOCs cannot be routinely analyzed by the usually applied technique of sampling on Tenax TA® followed by thermal desorption GC/MS or by DNPH-sampling/HPLC/UV. Some VVOCs are therefore often neglected in indoor-related studies. However, VVOCs are of high significance for indoor air quality assessment and there is need for their broader consideration in measurement campaigns and material emission testing.

Development and application of a human PBPK model for bromodichloromethane to investigate the impacts of multi-route exposure

As a result of its presence in water as a volatile disinfection byproduct, bromodichloromethane (BDCM), which is mutagenic, poses a potential health risk from exposure via oral, dermal and inhalation routes. We developed a refined human physiologically based pharmacokinetic (PBPK) model for BDCM (including new chemical-specific human parameters) to evaluate the impact of BDCM exposure during showering and bathing on important measures of internal dose compared with oral exposure. The refined model adequately predicted data from the published literature for oral, dermal and bathing/showering exposures. A liter equivalency approach (L-eq) was used to estimate BDCM concentration in a liter of water consumed by the oral route that would be required to produce the same internal dose of BDCM resulting from a 20-min bath or a 10-min shower in water containing 10 µg l(-1) BDCM. The oral liter equivalent concentrations for the bathing scenario were 605, 803 and 5 µg l(-1) BDCM for maximum venous blood concentration (Cmax), the area under the curve (AUCv) and the amount metabolized in the liver per hour (MBDCM), respectively. For a 10-min showering exposure, the oral L-eq concentrations were 282, 312 and 2.1 µg l(-1) for Cmax, AUC and MBDCM, respectively. These results demonstrate large contributions of dermal and inhalation exposure routes to the internal dose of parent chemical reaching the systemic circulation, which could be transformed to mutagenic metabolites in extrahepatic target tissues. Thus, consideration of the contribution of multiple routes of exposure when evaluating risks from water-borne BDCM is needed, and this refined human model will facilitate improved assessment of internal doses from real-world exposures. Published 2015. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

Household cleaning activities as noningestion exposure determinants of urinary trihalomethanes

Previous epidemiological studies linking drinking water total trihalomethanes (THM) with pregnancy disorders or bladder cancer have not accounted for specific household cleaning activities that could enhance THM exposures. We examined the relation between household cleaning activities (washing dishes/clothes, mopping, toilet cleaning, and washing windows/surfaces) and urinary THM concentrations accounting for water sources, uses, and demographics. A cross-sectional study (n = 326) was conducted during the summer in Nicosia, Cyprus, linking household addresses to the geocoded public water pipe network, individual household tap water, and urinary THM measurements. Household tap water THM concentrations ranged between 3-129 μg L(-1), while the median (Q1, Q3) creatinine-adjusted urinary THM concentration in females (669 ng g(-1) (353, 1377)) was significantly (p < 0.001) higher than that in males (399 ng g(-1), (256, 681)). Exposure assessment, based on THM exposure equivalency units, showed that hand dishwashing, mopping, and toilet cleaning significantly (p < 0.001) increased urinary THM levels. The effect of dishwashing by females ≥36 y of age remained significant, even after adjusting for potential confounders. No significant (p > 0.05) association was observed between ingestion-based THM exposure equivalency units and urinary THM. Noningestion routes of THM exposures during performance of routine household cleaning activities were shown for the first time to exert a major influence on urinary THM levels. It is warranted that future pregnancy-birth cohorts include monitoring of noningestion household THM exposures in their study design.

Occurrence of disinfection by-products in tap water distribution systems and their associated health risk

The concentrations of trihalomethanes (THMs), including chloroform, bromodichloromethane, dibromochloromethane, and bromoform, and haloacetic acids (HAAs; monochloroacetic acid, monobromoacetic acid, dibromoacetic acid, dichloroacetic acid, and trichloroacetic acid) were measured in tap waters passing through water distribution systems of six water treatment plants in Seoul, Korea, and their associated health risks from exposure to THMs through ingestion, dermal contact, and inhalation were estimated using a probabilistic approach. The concentration ranges for total THMs and HAA5 were 3.9-53.5 and <LOD-49.5 μg/L, respectively. Among DBPs, chloroform, bromodichloromethane, dichloroacetic acid, and trichloroacetic acid were the most frequently detected. Spatial and seasonal variations in concentrations of THMs and HAAs in the six water distribution systems were significant (P < 0.001).The mean lifetime cancer risks through ingestion, dermal contact, and inhalation during showering ranged as 7.23-10.06 × 10(-6), 2.19-3.63 × 10(-6), and 5.22-7.35 × 10(-5), respectively. The major exposure route to THMs was inhalation during showering. Sensitivity analysis showed that shower time and shower frequency had a great impact on the lifetime cancer risk by the exposure to THMs in tap water.

Comparison of trihalomethanes in tap water and blood: a case study in the United States

BACKGROUND

Epidemiological studies have used various measures to characterize trihalomethane (THM) exposures, but the relationship of these indicators to exposure biomarkers remains unclear.

OBJECTIVES

We examined temporal and spatial variability in baseline blood THM concentrations and assessed the relationship between these concentrations and several exposure indicators (tap water concentration, water-use activities, multiroute exposure metrics).

METHODS

We measured water-use activity and THM concentrations in blood and residential tap water from 150 postpartum women from three U.S. locations.

RESULTS

Blood ΣTHM [sum of chloroform (TCM), bromodichloromethane (BDCM), dibromo-chloromethane (DBCM), and bromoform (TBM)] concentrations varied by site and season. As expected based on variable tap water concentrations and toxicokinetic properties, the proportion of brominated species (BDCM, DBCM, and TBM) in blood varied by site (site 1, 24%; site 2, 29%; site 3, 57%) but varied less markedly than in tap water (site 1, 35%; site 2, 75%; site 3, 68%). The blood-water ΣTHM Spearman rank correlation coefficient was 0.36, with correlations higher for individual brominated species (BDCM, 0.62; DBCM, 0.53; TBM, 0.54) than for TCM (0.37). Noningestion water activities contributed more to the total exposure metric than did ingestion, but tap water THM concentrations were more predictive of blood THM levels than were metrics that incorporated water use.

CONCLUSIONS

Spatial and temporal variability in THM concentrations was greater in water than in blood. We found consistent blood-water correlations across season and site for BDCM and DBCM, and multivariate regression results suggest that water THM concentrations may be an adequate surro-gate for baseline blood levels.

Hazard assessment of chemical air contaminants measured in residences

Identifying air pollutants that pose a potential hazard indoors can facilitate exposure mitigation. In this study, we compiled summary results from 77 published studies reporting measurements of chemical pollutants in residences in the United States and in countries with similar lifestyles. These data were used to calculate representative mid-range and upper-bound concentrations relevant to chronic exposures for 267 pollutants and representative peak concentrations relevant to acute exposures for five activity-associated pollutants. Representative concentrations are compared to available chronic and acute health standards for 97 pollutants. Fifteen pollutants appear to exceed chronic health standards in a large fraction of homes. Nine other pollutants are identified as potential chronic health hazards in a substantial minority of homes, and an additional nine are identified as potential hazards in a very small percentage of homes. Nine pollutants are identified as priority hazards based on the robustness of measured concentration data and the fraction of residences that appear to be impacted: acetaldehyde; acrolein; benzene; 1,3-butadiene; 1,4-dichlorobenzene; formaldehyde; naphthalene; nitrogen dioxide; and PM(2.5). Activity-based emissions are shown to pose potential acute health hazards for PM(2.5), formaldehyde, CO, chloroform, and NO(2).

PRACTICAL IMPLICATIONS

This analysis identifies key chemical contaminants of concern in residential indoor air using a comprehensive and consistent hazard-evaluation protocol. The identification of a succinct group of chemical hazards in indoor air will allow for successful risk ranking and mitigation prioritization for the indoor residential environment. This work also indicates some common household activities that may lead to the acute levels of pollutant exposure and identifies hazardous chemicals for priority removal from consumer products and home furnishings.

New method for determination of trihalomethanes in exhaled breath: applications to swimming pool and bath environments

A method for the estimation of the human intake of trihalomethanes (THMs), namely chloroform, bromodichloromethane, dibromochloromethane and bromoform, during showering and bathing is reported. The method is based on the determination of these compounds in exhaled breath that is collected by solid adsorption on Tenax using a device specifically designed for this purpose. Instrumental measurements were performed by automatic thermal desorption coupled to gas chromatography with electron capture detection. THMs in exhaled breath samples were determined during showering and swimming pool attendance. The levels of these compounds in indoor air and water were also determined as reference for interpretation of the exhaled breath results. The THM concentrations in exhaled breath of the volunteers measured before the exposure experiments showed a close correspondence with the THMs levels in indoor air where the sampler was located. Limits of detection in exhaled breath were dependent on THM analytes and experimental sites. They ranged between 170 and 710 ng m(-3) in the swimming pool studies and between 97 and 460 ng m(-3) in the showering studies. Application of this method to THMs determination during showering and swimming pool activities revealed statistically significant increases in THMs concentrations when comparing exhaled breath before and after exposure.

Probabilistic human health risk assessment for quarterly exposure to high chloroform concentrations in drinking-water distribution network of the Province of Quebec, Canada

Because quarterly concentrations of total trihalomethanes (THM) exceeding the 80 μg/L guideline are often tolerated by the public health authorities of the Province of Quebec (Canada), this study examined whether quarterly episodes of high concentrations of THM may pose a risk to the health of its population. Using Monte Carlo simulations, a probabilistic risk assessment was performed for infants (0-<6 mo), toddlers (6 mo-<5 yr) and adults (≥20 yr). Multiroute exposure including ingestion of drinking water as well as inhalation and dermal exposure while showering or bathing was considered. The resulting absorbed doses were compared to short-term reference values for chloroform, used as surrogate for THM, by calculating risk quotients (RQ). On the basis of THM concentrations values in Quebec's drinking water distribution systems during the months of July to October and exceeding the guideline value (>80 μg/L), the 95th percentile value of RQ were 0.65, 0.46, and 0.24 for infants, toddlers, and adults, respectively. Back-calculation allowed determining that a chloroform concentration of 330 μg/L would result in RQ ≤ 1 for 99% of infants, the subgroup considered the most susceptible among the general population. Overall, this study showed that episodes of high THM concentration encountered in Quebec drinking-water distribution network need not be considered as an immediate health concern for the general population. However, these results should not be interpreted as an authorization to exceed the 80 μg/L standard but rather as a risk management tool for public health authorities.

Exposure to inhaled THM: comparison of continuous and event-specific exposure assessment for epidemiologic purposes

Trihalomethanes (THMs) (chloroform, bromoform, dibromochloromethane, and bromodichloromethane) are the most abundant by-products of chlorination. People are exposed to THMs through ingestion, dermal contact and inhalation. The objective of this study was to compare two methods for assessing THM inhalation: a direct method with personal monitors assessing continuous exposure and an indirect one with microenvironmental sampling and collection of time-activity data during the main event exposures: bathing, showering and swimming. This comparison was conducted to help plan a future epidemiologic study of the effects of THMs on the upper airways of children. 30 children aged from 4 to 10 years were included. They wore a 3M 3520 organic vapor monitor for 7 days. We sampled air in their bathrooms (during baths or showers) and in the indoor swimming pools they visited and recorded their time-activity patterns. We used stainless steel tubes full of Tenax to collect air samples. All analyses were performed with Gas Chromatography and Mass Spectrometry (GC-MS). Chloroform was the THM with the highest concentrations in the air of both bathrooms and indoor swimming pools. Its continuous and event exposure measurements were significantly correlated (r(s)=0.69 p<0.001). Continuous exposures were higher than event exposures, suggesting that the event exposure method does not take into account some influential microenvironments. In an epidemiologic study, this might lead to random exposure misclassification, thus underestimation of the risk, and reduced statistical power. The continuous exposure method was difficult to implement because of its poor acceptability and the fragility of the personal monitors. These two points may also reduce the statistical power of an epidemiologic study. It would be useful to test the advantages and disadvantages of a second sample in the home or of modeling the baseline concentration of THM in the home to improve the event exposure method.

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.

Seasonal variations in the household exposures of Korean housewives to volatile tap water disinfection by-products

This study was conducted to compare housewives' winter and summer exposures to volatile disinfection by-products (DBPs) in chlorinated tap water. A total of 60 households were visited for this purpose: 27 in winter and 33 in summer. Each subject was given a questionnaire regarding general tap water use, household ventilation time, and activities related to water use. Tap water, household air, and exhaled breath samples were also collected during the visits. All of the subjects answered that they consumed tap water after either thermal treatment or purification through filtration systems. A longer ventilation time in winter than in summer resulted in a higher inhalation exposure for housewives during that season. Estimated chronic daily intakes calculated for winter and summer showed that in winter, the greatest risk at home is inhalation exposure while resting at home, whereas in summer, it is showering. In both seasons, the ingestion route can be discounted, because tap water is processed before consumption, eliminating the volatile DBPs. From this study, it is evident that the inhalation of household air while resting at home cannot be ignored in risk assessment. Moreover, the fact that water is normally boiled or filtered before use should also be considered.

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.

Disposition of Bromodichloromethane in Humans Following Oral and Dermal Exposure

Exposure to bromodichloromethane (BDCM), one of the most prevalent disinfection byproducts in drinking water, can occur via ingestion of water and by dermal absorption and inhalation during activities such as bathing and showering. The objectives of this research were to assess BDCM pharmacokinetics in human volunteers exposed percutaneously and orally to (13)C-BDCM and to evaluate factors that could affect disposition of BDCM. Among study subjects, CYP2E1 activity varied fourfold; 20% had the glutathione S-transferase theta 1-1 homozygous null genotype; and body fat ranged from 7 to 22%. Subjects were exposed to (13)C-BDCM in water (target concentration of 36 mug/l) via ingestion and by forearm submersion. Blood was collected for up to 24 h and analyzed for (13)C-BDCM by solid-phase microextraction and high-resolution GC-MS. Urine was collected before and after exposure for mutagenicity determinations in Salmonella. After ingestion (mean dose = 146 ng/kg), blood (13)C-BDCM concentrations peaked and declined rapidly, returning to levels near or below the limit of detection (LOD) within 4 h. The T(max) for the oral exposure ranged from 5 to 30 min, and the C(max) ranged from 0.4 to 4.1 ng/l. After the 1 h dermal exposure (estimated mean dose = 155 ng/kg), blood concentrations of (13)C-BDCM ranged from 39 to 170 ng/l and decreased to levels near or below the LOD by 24 h. Peak postdose urine mutagenicity levels that were at least twice that of the predose mean level occurred in 6 of 10 percutaneously exposed subjects and 3 of 8 orally exposed subjects. These results demonstrate a highly significant contribution of dermal absorption to circulating levels of BDCM and confirm the much lower oral contribution, indicating that water uses involving dermal contact can lead to much greater systemic BDCM doses than water ingestion. These data will facilitate development and validation of physiologically based pharmacokinetic models for BDCM in humans.

Particle size distribution and inhalation dose of shower water under selected operating conditions

Showering produces respirable droplets that may serve to deposit pollutants such as trihalomethane decontamination products, heavy metals, inorganic salts, microbes, or cyanoacterial toxins within the respiratory tract. The extent and importance of this route of indoor exposure depend on the physical characteristics of the aerosol as well as the pollutant profile of the source water. The purpose of this study was to characterize shower-generated aerosols as a function of water flow rate, temperature, and bathroom location. Aerosols were generated within a shower stall containing a mannequin to simulate the presence of a human. Using hot water, the mass median diameter (MMD) of the droplets inside the shower and in the bathroom were 6.3-7.5 um and 5.2-6 microm, respectively. Size was independent of water flow rate. The particle concentration inside the shower ranged from 5 to 14 mg/m3. Aerosols generated using cold water were smaller (2.5-3.1 microm) and concentrations were lower (0.02-0.1 mg/m3) inside the shower stall. No aerosols were detected in the bathroom area when cold water was used. The International Commission on Radiological Protection model was used to estimate water deposition in the respiratory tract. For hot water, total deposition ranged from 11 to 14 mg, depending on water flow rate, with approximately 50% of this deposited in the extrathoracic region during assumed mouth breathing, and greater than 86% when nose breathing was assumed. Alveolar deposition was 6-10% and 0.9% assuming oral and nasal breathing, respectively. The consequences deposition of shower water droplets will depend on the nature and extent of any pollutants in the source water.

Neurotoxicological evaluation of two disinfection by-products, bromodichloromethane and dibromoacetonitrile, in rats

The Safe Drinking Water Act requires that the U.S. EPA consider noncancer endpoints for the assessment of adverse human health effects of disinfection by-products (DBPs). As an extension of our studies in which we demonstrated neurotoxicity at relatively low levels of dibromo- and dichloroacetic acids, we examined the potential neurotoxicity of other classes of DBPs. Bromodichloromethane (BDCM) and dibromoacetonitrile (DBAN) were administered to male and female F-344 rats via drinking water for 6 months. During exposure, rats were tested for neurobehavioral effects using a functional observational battery and motor activity, followed by perfusion fixation for neuropathological evaluation at the end of exposure. Calculating for chemical loss, fluid consumption, and body weight, average intakes were approximately: 9, 27, and 72mg/(kgday) BDCM, and 5, 12, and 29mg/(kgday) DBAN. Fluid consumption was decreased in most treatment groups, but body weight gain was altered only at the high concentrations. There were few neurobehavioral changes, and these were not considered toxicologically relevant. Of the general observations, there was only minimally decreased body tone in DBAN-treated high-dose males. Treatment-related neuropathological findings were not observed. Lowered fluid consumption was the most sensitive and consistent endpoint in the present studies. Thus, unlike the haloacetic acids, neurotoxicity may not be a concern for toxicity of halomethanes or haloacetonitriles.

Changes in breath trihalomethane levels resulting from household water-use activities

Common household water-use activities such as showering, bathing, drinking, and washing clothes or dishes are potentially important contributors to individual exposure to trihalomethanes (THMs), the major class of disinfection by-products of water treated with chlorine. Previous studies have focused on showering or bathing activities. In this study, we selected 12 common water-use activities and determined which may lead to the greatest THM exposures and result in the greatest increase in the internal dose. Seven subjects performed the various water-use activities in two residences served by water utilities with relatively high and moderate total THM levels. To maintain a consistent exposure environment, the activities, exposure times, air exchange rates, water flows, water temperatures, and extraneous THM emissions to the indoor air were carefully controlled. Water, indoor air, blood, and exhaled-breath samples were collected during each exposure session for each activity, in accordance with a strict, well-defined protocol. Although showering (for 10 min) and bathing (for 14 min), as well as machine washing of clothes and opening mechanical dishwashers at the end of the cycle, resulted in substantial increases in indoor air chloroform concentrations, only showering and bathing caused significant increases in the breath chloroform levels. In the case of bromodichloromethane (BDCM), only bathing yielded a significantly higher air level in relation to the preexposure concentration. For chloroform from showering, strong correlations were observed for indoor air and exhaled breath, blood and exhaled breath, indoor air and blood, and tap water and blood. Only water and breath, and blood and breath were significantly associated for chloroform from bathing. For BDCM, significant correlations were obtained for blood and air, and blood and water from showering. Neither dibromochloromethane nor bromoform gave measurable breath concentrations for any of the activities investigated because of their much lower tap-water concentrations. Future studies will address the effects that changes in these common water-use activities may have on exposure.

Influence of tap water quality and household water use activities on indoor air and internal dose levels of trihalomethanes

Individual exposure to trihalomethanes (THMs) in tap water can occur through ingestion, inhalation, or dermal exposure. Studies indicate that activities associated with inhaled or dermal exposure routes result in a greater increase in blood THM concentration than does ingestion. We measured blood and exhaled air concentrations of THM as biomarkers of exposure to participants conducting 14 common household water use activities, including ingestion of hot and cold tap water beverages, showering, clothes washing, hand washing, bathing, dish washing, and indirect shower exposure. We conducted our study at a single residence in each of two water utility service areas, one with relatively high and the other low total THM in the residence tap water. To maintain a consistent exposure environment for seven participants, we controlled water use activities, exposure time, air exchange, water flow and temperature, and nonstudy THM sources to the indoor air. We collected reference samples for water supply and air (pre-water use activity), as well as tap water and ambient air samples. We collected blood samples before and after each activity and exhaled breath samples at baseline and post-activity. All hot water use activities yielded a 2-fold increase in blood or breath THM concentrations for at least one individual. The greatest observed increase in blood and exhaled breath THM concentration in any participant was due to showering (direct and indirect), bathing, and hand dishwashing. Average increase in blood THM concentration ranged from 57 to 358 pg/mL due to these activities. More research is needed to determine whether acute and frequent exposures to THM at these concentrations have public health implications. Further research is also needed in designing epidemiologic studies that minimize data collection burden yet maximize accuracy in classification of dermal and inhalation THM exposure during hot water use activities.

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.

Exposure assessment in epidemiologic studies of adverse pregnancy outcomes and disinfection byproducts

A major challenge in studies that examine the association between disinfection byproducts in drinking water and pregnancy outcomes is the accurate representation of a subject's exposure. We used household water samples and questionnaire information on water-use behavior to examine several aspects of exposure assessment: (i) the distribution and correlation of specific disinfection byproducts, (ii) spatial distribution system and temporal variation in byproduct levels, and (iii) the contribution of individual water-use behavior. The level of specific trihalomethanes (THMs) and haloacetic acids (HAAs) was determined for 360 household water samples in Eastern Ontario and Nova Scotia. Subjects were interviewed regarding tap water ingestion and showering and bathing practices. In both provinces, total THMs correlated highly with chloroform (correlation coefficient (r) >0.95) and less so with total HAAs (r = 0.74 in Nova Scotia and r = 0.52 in Ontario). The correlation between total THMs and bromodichloromethane was high in Nova Scotia (r = 0.63), but low in Ontario (r = 0.26). The correlation was between THM level in individual household samples, and the mean THM level during the same time period from several distribution system samples was 0.63, while a higher correlation in THM level was observed for samples taken at the same location 1 year apart (r = 0.87). A correlation of 0.73 was found between household THM level and a total exposure measure incorporating ingestion, showering, and bathing behaviors. These results point to the importance of: measurement of different classes of byproducts; household rather than distribution system sampling; and, incorporation of subject behaviors in exposure assessment in epidemiologic studies of disinfection byproducts and adverse pregnancy outcomes.

Exposure of pregnant women to tap water related activities

BACKGROUND

Evidence for an association between exposure of pregnant women to chlorination disinfection by-products and adverse birth outcomes is inconsistent and inconclusive.

AIMS

To evaluate the use of a questionnaire in a population of pregnant women to assess their exposure to water, examine the validity of the questionnaire by a seven day diary, and to obtain a better understanding of the exposure of pregnant women to water in Central London.

METHODS

A total of 147 pregnant women were asked to complete a questionnaire. Information was requested on their exposure to water from cooking and washing up, showering and bathing, food and drink, and swimming. Demographic and socioeconomic information were also recorded. For validation purposes, women were asked to complete a seven day diary at home.

RESULTS

The average exposure duration was 338.5 min/week for cooking and washing up, 172.2 min/week for bathing and showering, and 67.9 min/month for swimming. The total fluid intake was 18.9 l/week of which, on average, 18% was cold tap water; 30% of this tap water was consumed outside the home. The correlation between questionnaire and diary data was generally good to very good, although women tended to overestimate their exposure in the questionnaire compared to the diary.

CONCLUSIONS

Information was obtained on the daily exposure of pregnant women in Central London to chlorinated water at home, work, and elsewhere. The questionnaire was found to be a valid method to assess the exposure of pregnant women to water and the response rate was higher than for diaries.

Trihalomethanes in Public Water Supplies and Risk of Stillbirth

BACKGROUND

The chlorine used to disinfect public drinking water supplies reacts with naturally occurring organic matter to form a number of chemical byproducts. Recent studies have implicated exposure to chlorination byproducts in drinking water, trihalomethanes (THMs), in particular, with intrauterine death.

METHODS

We conducted a population-based case-control study in Nova Scotia and Eastern Ontario, Canada, to examine the effect of exposure to THMs on stillbirth risk. Cases were women who had a stillborn infant, and controls were a random sample of women with live births. Subjects were interviewed, and women with a public water source provided a residential water sample. Risks were examined according to residential THM level in tap water and to a total exposure metric incorporating tap water ingestion, showering, and bathing.

RESULTS

We enrolled 112 stillbirth cases and 398 live birth controls. Women with a residential total THM level of 80 or more microg/L had twice the risk of a stillbirth compared with women with no exposure to THMs (adjusted odds ratio [OR] = 2.2; 95% confidence interval [CI] = 1.1-4.4). The highest quintile of total THM exposure using the total exposure metric was associated with an adjusted odds ratio of 2.4 (95% CI = 1.2-4.6) compared with women not exposed to THMs. Similar results were seen for specific THM compounds. A monotonic dose-response relationship was not seen.

CONCLUSIONS

Our results provide evidence for an increased risk of stillbirth associated with exposure to chlorination byproducts through ingestion and showering and bathing, although there was not a clear dose-response relationship.

Exposures to drinking water chlorination by-products in a Russian city

Exposures to water disinfection by-products (DBPs) via ingestion of drinking water, and dermal absorption and inhalation during showering/bathing were assessed in the city of Cherepovets, Russia, which uses heavy chlorination to disinfect organic-rich surface water. Concentrations of DBPs (mean +/- standard deviation) in tap water were the following: total trihalomethanes (THMs) 205 +/- 70 micrograms/l, five haloacetic acids (HAAs) 150 +/- 30 micrograms/l, and 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (mutagen X or MX) 160 +/- 50 ng/l. Concentrations of THMs and HAAs exceeded the corresponding US standards by a factor of 2.5, while MX concentrations were the highest ever reported. The mutagenic activity of tap water extracts in the Salmonella TA-100 assay was 14,900 net revertants/l. Concentrations of chloroform in breathing zone air in bathrooms during showering were 330 +/- 260 micrograms/m3, shower room air at an industrial plant 2,600 +/- 1,100 micrograms/m3, and bedrooms of local residents 2 +/- 2 micrograms/m3. The mean concentration of chloroform was 3.2 micrograms/m3 in exhaled air samples collected before showering and 110 micrograms/m3 after showering. Data on water ingestion and water use practices in the general population and for pregnant women were collected using questionnaires and diaries. Due to concerns over microbiological safety of water, average daily consumption of non-boiled tap water in pregnant women was only 0.01 l/day, while consumption of boiled tap water was 0.81 l/day. This resulted in low ingestion exposures to volatile THMs. Inhalation and dermal absorption determined total exposures to these compounds. HAAs and MX persist in boiled water and drinks resulting in high ingestion exposures. Several brands of inexpensive home water filters were tested for removal of these compounds. To demonstrate a method of exposure reduction in a sensitive subpopulation, the most efficient filters were given to a group of pregnant women. These women and a control group of pregnant women without filters maintained water ingestion diaries for two weeks. The use of home filters resulted in reduction of exposures to HAAs by a factor of three and a greater reduction in exposures to MX.

Induction of micronuclei in wild-type and p53(+/-) transgenic mice by inhaled bromodichloromethane

Bromodichloromethane (BDCM) is commonly present in trace amounts in drinking water as a disinfection by-product. BDCM has been shown to be carcinogenic in mice and rats when given by gavage at relatively high doses. Genotoxic activity as well as induced regenerative cell proliferation may contribute to the carcinogenic potential of BDCM. The purpose of the current studies was to evaluate the ability of BDCM to induce micronuclei (MN) in bone marrow and blood of wild-type and p53(+/-) mice on the C57BL/6 and FVB/N genetic backgrounds using the inhalation route of exposure. Toxicity studies were being conducted in this laboratory with inhaled BDCM to select doses for longer-term cancer bioassays using wild-type and p53(+/-) transgenic mice on different genetic backgrounds. Bone marrow samples from these experiments were evaluated for the induction of MN after 1 and 3 weeks of exposure. Accumulation of MN in the peripheral blood was also evaluated at the 13-week time point of a cancer study with the p53(+/-) mice. For the 1-week time point, male C57BL/6 wild-type and p53(+/-) mice and FVB/N wild-type and p53(+/-) mice were exposed daily for 6h per day for 7 consecutive days to atmospheric BDCM concentrations of 0, 1, 10, 30, 100, or 150 ppm. In a second experiment, mice were exposed daily for 6h per day for 3 weeks to atmospheric BDCM concentrations of 0, 0.5, 1, 3, 10, or 30 ppm. Resulting levels of polychromatic erythrocytes (PCE) containing MN were assessed in the bone marrow. For all of the 1- and 3-week exposure groups, the only statistically significant increase in the percentage of bone marrow PCE cells containing MN was in the 1-week 100 ppm BDCM exposure group in the FVB/N wild-type mice (control 0.26% versus exposed 1.16%). C57BL/6 p53(+/-) mice and FVB/N p53(+/-) mice were exposed daily for 6 h per day for 13 weeks to atmospheric BDCM concentrations of 0, 0.5, 3, 10, or 15 ppm. MN were quantified in samples of peripheral blood. Statistically significant increases in the percentage of peripheral blood NCE cells containing MN were seen at the highest BDCM exposure group of 15 ppm in both the C57BL/6 p53(+/-) strain (control 0.36% versus exposed 0.67%) and the FVB/N p53(+/-) strain (control 0.36% versus exposed 0.86%). These data indicate weak induction of MN by BDCM, but only at high atmospheric concentrations relative to normal environmental exposures and with extended periods of exposure. Although comparisons are difficult because responses were negative or marginal, the p53 genotype or the genetic background did not appear to substantially alter susceptibility to the genotoxic effects of BDCM.

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.

Weight of evidence for an association between adverse reproductive and developmental effects and exposure to disinfection by-products: a critical review

Disinfection by-products (DBP) are a side effect of water chlorination. Some toxicological studies suggest an association between DBP exposure and adverse reproductive and developmental effects. This investigation considered all toxicological and epidemiological evidence for the various effects, outcome by outcome. The weight of evidence demonstrated that no association with DBP exposure exists for over a dozen outcomes including low and very low birth weight, preterm delivery, some specific congenital anomalies, and neonatal death. The analysis found inconsistent or very weak results for all congenital anomalies/birth defects, all central nervous system anomalies, neural tube defects, spontaneous abortion, and stillbirth. The weight of evidence suggested a positive association with DBP exposure for some measure of growth retardation (such as intrauterine growth retardation or small for gestational age) and for urinary tract anomalies. Having catalogued these effects, it should be noted that exposure assessment in the epidemiological studies published to date has been inadequate to definitively demonstrate an association of small magnitude. Exposure to DBP primarily has been based on routine (i.e., quarterly) monitoring of public water supplies for trihalomethanes (THM) matched to maternal residence. In order to determine whether an association exists between adverse reproductive and developmental effects and exposure to DBP, studies must consider the THM concentration and the quantity of the water actually consumed by pregnant women.