Workgroup report: Biomonitoring study design, interpretation, and communication--lessons learned and path forward

Bisphenols in indoor dust: A comprehensive review of global distribution, exposure risks, transformation, and biomonitoring

Bisphenols (BPs) are pervasive environmental contaminants extensively found in indoor environments worldwide. Despite their ubiquitous presence and potential health risks, there remains a notable gap in the comprehensive reviews focusing on BPs in indoor dust. Existing literature often addresses specific aspects such as exposure pathways, transformation products, or biomonitoring techniques, but lacks a consolidated, in-depth review encompassing all these facets. This review provides a comprehensive overview of the global distribution of BPs, emphasizing their prevalence in diverse indoor settings ranging from households and workplaces to public areas. Variations in BP concentrations across these environments are explored, influenced by factors such as industrial activities, consumer product usage patterns, and geographical location. Exposure assessments highlight ingestion, inhalation, and dermal contact as primary pathways for BP exposure, with ingestion being particularly significant for vulnerable groups such as infants and young children. Studies consistently reveal higher concentrations of BPs in urban indoor dust compared to rural settings, reflecting the impact of urbanization and intensive consumer practices. Moreover, BPs from mobile sources like vehicles contribute significantly to overall human exposure, further complicating exposure assessments. The review also delves into the transformation of BPs within indoor environments, emphasizing the diverse roles of physical, chemical, and biological processes in generating various transformation products (TPs). These TPs can exhibit heightened toxicity compared to their parent compounds, necessitating deeper investigations into their environmental fate and potential health implications. Critical examination of biomonitoring techniques for BPs and their metabolites underscores the importance of non-invasive sampling methods, offering ethical advantages and practicality in assessing human exposure levels. The emerging use of bioindicators, encompassing plants, animals, and innovative approaches like spider webs, presents promising avenues for effectively monitoring environmental contamination.

HBM4EU chromates study - Reflection and lessons learnt from designing and undertaking a collaborative European biomonitoring study on occupational exposure to hexavalent chromium

The EU human biomonitoring initiative, HBM4EU, aims to co-ordinate and advance human biomonitoring (HBM) across Europe. As part of HBM4EU, we presented a protocol for a multicentre study to characterize occupational exposure to hexavalent chromium (Cr(VI)) in nine European countries (HBM4EU chromates study). This study intended to collect data on current occupational exposure and to test new indicators for chromium (Cr) biomonitoring (Cr(VI) in exhaled breath condensate and Cr in red blood cells), in addition to traditional urinary total Cr analyses. Also, data from occupational hygiene samples and biomarkers of early biological effects, including genetic and epigenetic effects, was obtained, complementing the biomonitoring information. Data collection and analysis was completed, with the project findings being made separately available. As HBM4EU prepares to embark on further European wide biomonitoring studies, we considered it important to reflect on the experiences gained through our harmonised approach. Several practical aspects are highlighted for improvement in future studies, e.g., more thorough/earlier training on the implementation of standard operating procedures for field researchers, training on the use of the data entry template, as well as improved company communications. The HBM4EU chromates study team considered that the study had successfully demonstrated the feasibility of conducting a harmonised multicentre investigation able to achieve the research aims and objectives. This was largely attributable to the engaged multidisciplinary network, committed to deliver clearly understood goals. Such networks take time and investment to develop, but are priceless in terms of their ability to deliver and facilitate knowledge sharing and collaboration.

A Phased Approach for preparation and organization of human biomonitoring studies

BACKGROUND

Human biomonitoring (HBM) studies like other epidemiological studies are costly and time-consuming. They require the administration of questionnaires and collection of biological samples, putting substantial burden on the participants which may result in low participation rates. The growing importance of HBM studies in epidemiology, exposure assessment and risk assessment underline the importance of optimizing study planning, designing and implementation thus minimizing the above-mentioned difficulties.

METHODS

Based on frameworks from survey design and fieldwork preparation of the European Joint Program HBM4EU, the German Environment Surveys and the COPHES/DEMOCOPHES twin projects combined with elements of project management strategies, a Phased Approach has been developed, introducing a step-by-step guideline for the development of epidemiological studies.

RESULTS

The Phased Approach splits the process of developing a study into six phases: Phase 0 (Scoping and Planning): All aspects that are necessary to conduct a study are compiled and put on the agenda for decision-making. Phase 1 (Preparation and Testing): Instruments (e.g. questionnaires), materials (e.g. guidelines, information), and ethics and data management issues, needing thorough preparation and testing before a study can start. Phase 2 (Initiation): Organization and acquisition of necessary equipment and engaging and training personnel. Phase 3 (Implementation): All procedures that require temporal proximity to the start date of fieldwork, such as obtaining contact information of invitees. Phase 4 (Fieldwork and Analysis): Involvement of participants and chemical analysis of the collected samples. Phase 5 (Results and Evaluation): Final procedures leading to closure of the project, such as providing and communicating results.

CONCLUSIONS

The separation of the planning and conduct of human biomonitoring studies into different phases creates the basis for a structured procedure and facilitates a step-by-step approach reducing costs, warranting high participation rates and increasing quality of conduct. Emphasis is put on a comprehensive scoping phase ensuring high quality of the study design, which is indispensable for reliable results.

Trace element levels in blood and associated factors in adults living in the metropolitan area of São Paulo, Brazil

This study evaluated blood arsenic (As), cadmium (Cd), lead (Pb), mercury (Hg), copper (Cu) and manganese (Mn) levels in a group of residents (n=374) in the metropolitan area of São Paulo (MASP) and investigated the association between trace element levels in blood and sociodemographic and lifestyle factors. Trace elements were measured in specimens by inductively coupled plasma mass spectrometry (ICP-MS). Geometric means were 3.6μg/L, 0.13μg/L, 23.9μg/L, 1.4μg/L, 999μg/L, and 12.5μg/L for As, Cd, Pb, Hg, Cu, and Mn, respectively. As, Pb and Hg levels were associated with education level. Men presented higher blood lead levels (PbB) and lower blood copper levels (CuB) than women. Fish consumption was primarily related to increased blood Hg levels (HgB). Smokers exhibited 1.8 times more blood cadmium levels (CdB) than non-smokers. Only 4% of the study samples exceeded the Pb reference values for the MASP population, and 12% had Hg levels higher than the German HBM-I value (5μg/L for adults).The study group showed slightly higher exposure to As, Hg and Mn and lower Cd than those of European and North American studies.

On the long-term effects of methyl isocyanate on cell-mediated immunity in Bhopal gas-exposed long-term survivors and their offspring

Methyl isocyanate (MIC) is a toxic industrial chemical that is documented as a potent respiratory toxicant. We investigated cell-mediated immunity (CMI) in the MIC-exposed long-term survivors and their offspring born after the Bhopal gas-leak tragedy in 1984. Several earlier reports show inconsistency in the assessment of immunological effects of MIC on the human population. In these studies, important factors including lifestyle attributes were overlooked. We incorporated these factors also in our study of the basic cell-mediated immune function in the Bhopal MIC-affected population. Twenty-seven years after exposure, we assessed the circulating T-lymphocyte frequency using E-Rosette assay. A total of 46 MIC-exposed healthy long-term survivors and their offspring were studied vis-a-vis parallel gender–age group-matched unexposed controls from Bhopal and various other regions of India. The influence of several lifestyle variabilities (smoking, alcohol intake, and tobacco chewing) on T-lymphocyte frequency was also taken into consideration. Our observations suggest that Erythrocyte-Rosette-forming cell (E-RFC) distribution frequency is largely insignificant in the MIC-affected population as compared to controls ( p > 0.05). In the MIC-affected tobacco chewers, there was a trend of suppression in CMI (relative decrease = 10.3%) as compared to nonchewers. Overall, our results show negligible long-term effect of MIC on CMI measured in terms of E-RFC frequency. These observations are not in agreement with earlier findings that immunosuppressive effects of MIC exposure persist in the T-cells of the affected population. However, atypical lymphocytes were frequently observed as E-RFC in the exposed females when compared to all other subgroups. Hematopoietic disorders (atypical lymphocytosis) in the MIC-affected population along with previous reports on the cytogenetic and humoral immune system linking cancer risk and chronic obstructive pulmonary disease (COPD) are important.

Communication in a Human biomonitoring study: Focus group work, public engagement and lessons learnt in 17 European countries

A communication strategy was developed by The Consortium to Perform Human Biomonitoring on a European Scale (COPHES), as part of its objectives to develop a framework and protocols to enable the collection of comparable human biomonitoring data throughout Europe. The framework and protocols were tested in the pilot study DEMOCOPHES (Demonstration of a study to Coordinate and Perform Human biomonitoring on a European Scale). The aims of the communication strategy were to raise awareness of human biomonitoring, encourage participation in the study and to communicate the study results and their public health significance. It identified the audiences and key messages, documented the procedure for dissemination of results and was updated as the project progressed. A communication plan listed the tools and materials such as press releases, flyers, recruitment letters and information leaflets required for each audience with a time frame for releasing them. Public insight research was used to evaluate the recruitment material, and the feedback was used to improve the documents. Dissemination of results was coordinated in a step by step approach by the participating countries within DEMOCOPHES, taking into account specific national messages according to the needs of each country. Participants received individual results, unless they refused to be informed, along with guidance on what the results meant. The aggregate results and policy recommendations were then communicated to the general public and stakeholders, followed by dissemination at European level. Several lessons were learnt that may assist other future human biomonitoring studies. Recruitment took longer than anticipated and so social scientists, to help with community engagement, should be part of the research team from the start. As a European study, involving multiple countries, additional considerations were needed for the numerous organisations, different languages, cultures, policies and priorities. Therefore, communication documents should be seen as templates with essential information clearly indicated and the option for each country to tailor the material to reflect these differences. Future studies should consider setting up multidisciplinary networks of medical professionals and communication experts, and holding training workshops to discuss the interpretation of results and risk communication. Publicity and wide dissemination of the results helped to raise awareness of human biomonitoring to the general public, policy makers and other key stakeholders. Effective and timely communication, at all stages of a study, is essential if the potential of human biomonitoring research to improve public health is to be realised.

The One Health Perspective in Trace Elements Biomonitoring

Health risks in both animals and humans are associated with chronic exposures to levels of trace elements (TE) eliciting toxic and/or antinutritional effects, including excess exposures to some essential elements. Interferences with essential TE may also lead to secondary nutritional deficiencies and/or imbalances. Although research is still required, biomarkers of exposure, including bioavailability, for TE are established tools for human biomonitoring that can also be applied to animal surveillance. Biomarkers of effect as well as, where available, of susceptibility and bioavailability are necessary to understand whether an ongoing exposure may pose a current or future health concern. In the field of animal health the use of biomarkers is less developed and less widespread than in human health; however, under a One Health perspective, animal biomonitoring can provide important information on the interfaces among humans, animals, and the environment, supporting the prevention and management of health risks. Therefore, a transfer of knowledge from human biomonitoring to farm or free-ranging animals is critical in a risk assessment framework from farm to humans. Advantages and critical aspects in designing and conducting integrative biomonitoring activities in humans and animals were critically reviewed focusing on biomarkers of exposure, effect, susceptibility, and bioavailability for toxic and essential TE. Highlighted aspects include TE metabolism, bioaccessibility, and interactions. Farm or free-ranging animals may provide noninvasive matrices suitable for evaluating animal welfare, environmental stressors, food safety, and potential risks for human health, as proposed by the interdisciplinary concept of One Health.

Hair analysis in health assessment

BACKGROUND

Hair analysis is used for estimation of the nutritional status of individuals. In the present work, a systematic review on the relation between the mineral composition of hair and the physical or mental disorders is discussed. Detailed information of examined populations, methods of sample preparations and analytical techniques are presented.

METHODS

A systematic literature search in four electronic databases Scopus, PubMed, Web of Science and Medline (from 1997 to 2012/01/31) for English language articles was performed. In addition, a reference list and manual search was undertaken.

RESULTS

The following number of studies was included: 66. Most of the authors reported that there exists a correlation between deficiency or excess of some elements in hair and occurrence of some diseases, such as: autism, cancer, hypertension, myocardial infarction, kidney disease and diabetes mellitus. However, not all results were consistent.

CONCLUSIONS

Most of the authors concluded that the profile of hair mineral imbalance might be useful as a diagnostic tool for the early diagnosis of many diseases. However, it seems that there is a need to standardize sample preparation procedures, in particular washing and mineralization methods.

Community exposure following a drip-application of chloropicrin

OBJECTIVES

To evaluate illnesses resulting from community exposure to chloropicrin on October 5, 2005, in the agricultural community of Salinas, California.

METHODS

A cross-sectional interview survey was conducted of 142 households downwind from the application site in neighborhoods that were sources of emergency calls. A total of 439 residents of the 142 households in affected neighborhoods and 1 emergency responder were interviewed. The authors assessed exposure to chloropicrin resulting from the application using a public domain air pollution dispersion model, the Industrial Source Complex 3 (ISC3).

RESULTS

A total of 440 subjects were represented in the interviews, including 324 (73.6%) who reported symptoms possibly or probably related to chloropicrin exposure. Ocular symptoms were present in 302 (93.2%) of the symptomatic cases. Nonocular (usually systemic or respiratory) symptoms occurred in 170 cases (52.5%), but occurred significantly more frequently in residents who lived within 0.46 miles of the application site. Air-modeling showed a plume of chloropicrin in the affected neighborhoods, with estimated 1-h TWA (time-weighted average) air concentrations between 0.15 and 0.025 ppm.

CONCLUSIONS

Ocular, respiratory, and systemic symptoms on the evening of October 5, 2005, corresponded to a plume of chloropicrin, with estimated concentrations as high as 0.15 ppm, in the community of Salinas, California. Cases occurred between 0.36 and 2.89 miles from the application site. Use of irritant agricultural fumigants near residential neighborhoods can produce a risk of illness for distances more than 2 miles from the site of application. Air modeling is useful for evaluating the relationship between possible exposures and community symptoms.

Developing a biomonitoring educational pamphlet for potential participants in a breast milk biomonitoring study

Over the past decade, biomonitoring research initiatives in the United States have increased because of growing concern over the accumulation of environmental chemicals in the human body. One matrix that has become a viable biological sample for estimating human exposure to environmental chemicals is breast milk. However, breast milk biomonitoring research can induce anxiety and confusion about breastfeeding if communication is lacking between researchers, community partners, and participants. To bridge this communication gap, an informative, reassuring 8-page pamphlet was developed to educate community partners and potential participants about research on 1 class of environmental chemicals-polybrominated diphenyl ethers. Not only did the pamphlet assist in participant recruitment, but it forged positive relationships with valuable community partners.

A new spin on research translation: the Boston Consensus Conference on Human Biomonitoring

BACKGROUND

Translating research to make it more understandable and effective (research translation) has been declared a priority in environmental health but does not always include communication to the public or residents of communities affected by environmental hazards. Their unique perspectives are also commonly missing from discussions about science and technology policy. The consensus conference process, developed in Denmark, offers a way to address this gap.

OBJECTIVES

The Boston Consensus Conference on Human Biomonitoring, held in Boston, Massachusetts, in the fall of 2006, was designed to educate and elicit input from 15 Boston-area residents on the scientifically complex topic of human biomonitoring for environmental chemicals. This lay panel considered the many ethical, legal, and scientific issues surrounding biomonitoring and prepared a report expressing their views.

DISCUSSION

The lay panel's findings provide a distinct and important voice on the expanding use of biomonitoring. In some cases, such as a call for opt-in reporting of biomonitoring results to study participants, they mirror recommendations raised elsewhere. Other conclusions have not been heard previously, including the recommendation that an individual's results should be statutorily exempted from the medical record unless permission is granted, and the opportunity to use biomonitoring data to stimulate green chemistry.

CONCLUSION

The consensus conference model addresses both aspects of a broader conception of research translation: engaging the public in scientific questions, and bringing their unique perspectives to bear on public health research, practice, and policy. In this specific application, a lay panel's recommendations on biomonitoring surveillance, communication, and ethics have practical implications for the conduct of biomonitoring studies and surveillance programs.

Applicability of non-invasively collected matrices for human biomonitoring

With its inclusion under Action 3 in the Environment and Health Action Plan 2004-2010 of the European Commission, human biomonitoring is currently receiving an increasing amount of attention from the scientific community as a tool to better quantify human exposure to, and health effects of, environmental stressors. Despite the policy support, however, there are still several issues that restrict the routine application of human biomonitoring data in environmental health impact assessment. One of the main issues is the obvious need to routinely collect human samples for large-scale surveys. Particularly the collection of invasive samples from susceptible populations may suffer from ethical and practical limitations. Children, pregnant women, elderly, or chronically-ill people are among those that would benefit the most from non-invasive, repeated or routine sampling. Therefore, the use of non-invasively collected matrices for human biomonitoring should be promoted as an ethically appropriate, cost-efficient and toxicologically relevant alternative for many biomarkers that are currently determined in invasively collected matrices. This review illustrates that several non-invasively collected matrices are widely used that can be an valuable addition to, or alternative for, invasively collected matrices such as peripheral blood sampling. Moreover, a well-informed choice of matrix can provide an added value for human biomonitoring, as different non-invasively collected matrices can offer opportunities to study additional aspects of exposure to and effects from environmental contaminants, such as repeated sampling, historical overview of exposure, mother-child transfer of substances, or monitoring of substances with short biological half-lives.

Participant experiences in a breastmilk biomonitoring study: a qualitative assessment

BACKGROUND

Biomonitoring studies can provide information about individual and population-wide exposure. However they must be designed in a way that protects the rights and welfare of participants. This descriptive qualitative study was conducted as a follow-up to a breastmilk biomonitoring study. The primary objectives were to assess participants' experiences in the study, including the report-back of individual body burden results, and to determine if participation in the study negatively affected breastfeeding rates or duration.

METHODS

Participants of the Greater Boston PBDE Breastmilk Biomonitoring Study were contacted and asked about their experiences in the study: the impact of study recruitment materials on attitudes towards breastfeeding; if participants had wanted individual biomonitoring results; if the protocol by which individual results were distributed met participants' needs; and the impact of individual results on attitudes towards breastfeeding.

RESULTS

No participants reported reducing the duration of breastfeeding because of the biomonitoring study, but some responses suggested that breastmilk biomonitoring studies have the potential to raise anxieties about breastfeeding. Almost all participants wished to obtain individual results. Although several reported some concern about individual body burden, none reported reducing the duration of breastfeeding because of biomonitoring results. The study literature and report-back method were found to mitigate potential negative impacts.

CONCLUSION

Biomonitoring study design, including clear communication about the benefits of breastfeeding and the manner in which individual results are distributed, can prevent negative impacts of biomonitoring on breastfeeding. Adoption of more specific standards for biomonitoring studies and continued study of risk communication issues related to biomonitoring will help protect participants from harm.

Non-invasive matrices in human biomonitoring: a review

Humans and other living organisms are exposed to a variety of chemical pollutants that are released into the environment as a consequence of anthropogenic activities. Environmental pollutants are incorporated into the organism by different routes and can then be stored and distributed in different tissues, which leads to an internal concentration that can induce different alterations, adverse effects and/or diseases. Control measures should be taken to avoid these effects and human biomonitoring is a very useful tool that can contribute to this aim. Human biomonitoring uses different matrices to measure the target chemicals depending on the chemical, the amount of matrix necessary for the analysis and the detection limit (LOD) of the analytical technique. Blood is the ideal matrix for most chemicals due to its contact with the whole organism and its equilibrium with organs and tissues where chemicals are stored. However, it has an important disadvantage of being an invasive matrix. The development of new methodology and modern analytical techniques has allowed the use of other matrices that are less or non-invasive, such as saliva, urine, meconium, nails, hair, and semen or breast milk. The presence of a chemical in these matrices reflects an exposure, but correlations between levels in non-invasive matrices and blood must be established to ensure that these levels are related to the total body burden. The development of new biomarkers that are measurable in these matrices will improve non-invasive biomonitoring. This paper reviews studies that measure Cd, Pb, Hg, polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), polycyclic aromatic hydrocarbons (PAHs), polybrominated diphenyl ethers (PBDEs), organochlorine pesticides and phthalates in non-invasive matrices, the most used techniques for measurements and what alternative techniques are available.

A review on the practical application of human biomonitoring in integrated environmental health impact assessment

Environmental health sciences focus on the link between the presence of contaminants in the environment and their relation with possible adverse health effects. Within this context, human biomonitoring (HBM) data have proven to be a valuable addition to, or have even surpassed, estimates of exposure based on environmental measures. Probably the main achievement of HBM data is that it provides an integrated overview of the pollutant dose any constituent is exposed to and incorporates bioaccumulation, excretion, half-life, and other potentially critical toxicokinetic parameters. In an integrated environmental health impact assessment framework, HBM serves as a pivotal point between environment and health, on the one hand leaning on environmental data to provide information on sources and pathways of exposure, and on the other hand clarifying hypotheses on the relationship between internal dose and prevalence of disease clusters. This study reflects the work performed in the INTARESE project (Integrated Assessment of Health Risk of Environmental Stressors in Europe). Because it was perceived that there was an overall lack of knowledge on the general methodology and potential application of HBM data in integrated environmental health impact assessment, an extensive review of literature was performed on past and current developments, potential, and applicability of HBM within the context of integrated environmental health impact assessment. This study covers three main topics that provide guidance for improved interpretation and application of HBM data: (1) sample collection and storage, (2) sample measurement, and (3) data interpretation. These main issues were discussed for 15 of the most common or relevant (classes of) chemicals. For more detailed information, the reader is pointed to the unabridged review (INTARESE, 2007), and consultation is available through the INTARESE web site (www.intarese.org).

Illnesses associated with chloropicrin use in California agriculture, 1992-2003

With limitations imposed on the use of methyl bromide by international treaty, use of metam-sodium, chloropicrin, and other fumigants have increased; this increase has been accompanied by multiple community illness episodes. In this review we address the California experience of direct or indirect exposures to chloropicrin, after use of this fumigant as an active ingredient in agricultural pest control, from the years 1992-2003. The best available toxicology data demonstrate that, for brief exposures (5-30 sec), eye irritation (or at least "chemesthesis"--detection of exposure by the eye) occurred in 50% of volunteer subjects exposed to 700 ppb of chloropicrin. Of 62 subjects tested, 10-15% (depending upon the site of exposure) failed to detect 1200 ppb of chloropicrin (the highest concentrations tested). For exposures lasting 20 min, the minimum concentration detectable by 50% of the subjects was 75 ppb; the no-observed-effect-level (NOEL) for eye irritation was 50 ppb. Exposures for 1 hr, at 100 and 150 ppb, produced subjective eye irritation in most subjects. Using a standard tenfold uncertainty factor (Extoxnet 2006), an estimated NOEL for a 1-hr exposure to chloropicrin (calculated from the 100 ppb lowest-observed-effect-level) would be 10 ppb. The few monitoring studies conducted for agricultural use of chloropicrin demonstrate that the most sensitive effect to chloropicrin exposure is sensory irritation. The use of chloropicrin for field fumigation presents a difficult problem, both because of the extreme degree to which it is irritating, and because of the very low concentrations that cause such irritation. The cases summarized in this report, especially those resulting from applications that adhere to label and permit standards, suggest that additional mitigation measures are needed to minimize off-site human exposure associated with chloropicrin applications in California. Examination of the previously discussed Pesticide Illness Surveillance Program cases revealed that conducting the applications according to label directions and local permit conditions was not always adequate to prevent off-site exposure or resultant irritation or other symptoms. This suggests that current methods of fumigant containment and/or buffer zone requirements are insufficient under some circumstances.

Human biomonitoring and the INSPIRE directive: spatial data as link for environment and health research

Recently, there has been a rapid gain of interest in the availability, applicability, and integration of different types of spatial data for environment and health issues. The INSPIRE Directive (Directive 2007/2/EC) aims at providing better and easily accessible spatial information in Europe for the formulation and implementation of community policy on the environment by triggering the creation of a European spatial information infrastructure that delivers integrated spatial information services to potential users. Human biomonitoring (HBM) significantly contributes to the already existing data on environment and health because of its specific nature of providing information on the internal dose of chemicals rather than their mere presence in different environmental compartments. However, due to the intrinsic nature of HBM data, a number of issues need to be dealt with if HBM data are to be used to its full capacity in a geographic information systems (GIS) environment and within the INSPIRE directive. The current article highlights some of these issues, and discusses a number of options to improve the geographical relevance of HBM data for their optimal use within the INSPIRE Directive framework. The main aim of this publication is to illustrate that HBM has a significant contribution to make to the INSPIRE Directive, although some kind of data aggregation will be necessary to protect individual privacy. If HBM data wants to have a significant contribution to spatial information used to assist policymaking and on the surveillance or tracking of the direct or indirect impact of such policies, the HBM data need to be compatible with other data collected within the other themes of the INSPIRE Directive.

Translating biomonitoring data into risk management and policy implementation options for a European Network on Human Biomonitoring

BACKGROUND

The "European Environment & Health Action Plan 2004-2010" originates from the concern of the European Commission on the well-being of individuals and the general population. Through this plan, the Commission has set the objectives to improve the information chain for a better understanding of the link between sources of pollution and health effects, to better identify existing knowledge gaps, and improve policy making and communication strategies. Human biomonitoring (HBM) has been included as one of the tools to achieve these objectives. As HBM directly measures the amount of a chemical substance in a person's body, taking into account often poorly understood processes such as bioaccumulation, excretion, metabolism and the integrative uptake variability through different exposure pathways, HBM data are much more relevant for risk assessment than extrapolations from chemical concentrations in soil, air, and water alone. However, HBM primarily is a stepping stone between environmental and health data, and the final aim should be an integrated and holistic systematic risk assessment paradigm where HBM serves as a pivotal point between environment and health, on the one hand leaning on environmental data to provide detailed information on the sources and pathways of pollutants that enter the human body, and on the other hand clarifying new and existing hypotheses on the relationship between environmental pollutants and the prevalence of diseases. With the large amount of data that is being gathered in the different national survey projects, and which is expected to become available in Europe in the near future through the expected European Pilot Project on HBM, a framework to optimize data interpretation from such survey projects may greatly enhance the usefulness of HBM data for risk managers and policy makers.

RESULTS

This paper outlines an hierarchic approach, based on the stepwise formulation of 4 subsequent steps, that will eventually lead to the formulation of a variety of policy relevant risk reduction options.

CONCLUSION

Although the usefulness of this approach still needs to be tested, and potential fine-tuning of the procedure may be necessary, approaching the policy implications of HBM in an objective framework will prove to be essential.

Societal and ethical issues in human biomonitoring--a view from science studies

BACKGROUND

Human biomonitoring (HBM) has rapidly gained importance. In some epidemiological studies, the measurement and use of biomarkers of exposure, susceptibility and disease have replaced traditional environmental indicators. While in HBM, ethical issues have mostly been addressed in terms of informed consent and confidentiality, this paper maps out a larger array of societal issues from an epistemological perspective, i.e. bringing into focus the conditions of how and what is known in environmental health science.

METHODS

In order to analyse the effects of HBM and the shift towards biomarker research in the assessment of environmental pollution in a broader societal context, selected analytical frameworks of science studies are introduced. To develop the epistemological perspective, concepts from "biomedical platform sociology" and the notion of "epistemic cultures" and "thought styles" are applied to the research infrastructures of HBM. Further, concepts of "biocitizenship" and "civic epistemologies" are drawn upon as analytical tools to discuss the visions and promises of HBM as well as related ethical problematisations.

RESULTS

In human biomonitoring, two different epistemological cultures meet; these are environmental science with for instance pollution surveys and toxicological assessments on the one hand, and analytical epidemiology investigating the association between exposure and disease in probabilistic risk estimation on the other hand. The surveillance of exposure and dose via biomarkers as envisioned in HBM is shifting the site of exposure monitoring to the human body. Establishing an HBM platform faces not only the need to consider individual decision autonomy as an ethics issue, but also larger epistemological and societal questions, such as the mode of evidence demanded in science, policy and regulation.

CONCLUSION

The shift of exposure monitoring towards the biosurveillance of human populations involves fundamental changes in the ways environment, health and disease are conceptualised; this may lead to an individualisation of responsibilities for health risks and preventive action. Attention to the conditions of scientific knowledge generation and to their broader societal context is critical in order to make HBM contribute to environmental justice.

Applying bioethical principles to human biomonitoring

Bioethical principles are widely used as a normative framework in areas of human research and medical care. In recent years there has been increasing formalization of their use in public health decisions. The "traditional bioethical principles" are applied in this discussion to the important issue human biomonitoring for environmental exposures. They are: (1) Autonomy--Also known as the "respect for humans" principle, people understand their own best interests; (2) Beneficence--"do good" for people; (3) Nonmaleficence--"do no harm"; (4) Justice--fair distribution of benefits and costs (including risks to health) across stakeholders.Some of the points made are: (1) There is not a single generic bioethical analysis applicable to the use of human biomonitoring data, each specific use requires a separate deliberation; (2) Using unidentified, population-based biomonitoring information for risk assessment or population surveillance raises fewer bioethical concerns than personally identified biomonitoring information such as employed in health screening; (3) Companies should proactively apply normative bioethical principles when considering the disposition of products and by-products in the environment and humans; (4) There is a need for more engagement by scholars on the bioethical issues raised by the use of biomarkers of exposure; (5) Though our scientific knowledge of biology will continue to increase, there will always be a role for methods or frameworks to resolve substantive disagreements in the meaning of this data that are matters of belief rather than knowledge.

New biomarkers of occupational exposure to polycyclic aromatic hydrocarbons

Polycyclic aromatic hydrocarbons (PAH) are metabolized in a complex manner. Although biological activity is associated with diol-epoxide formation, phenolic metabolites have predominantly been used in human biomonitoring. In this study monohydroxylated and new metabolites were characterized as biomarkers for occupational PAH exposure. In 97 male workers, personal exposure to 16 airborne PAH compounds was measured during shift. In postshift urine, 1-hydroxypyrene and 1,6- and 1,8-dihydroxypyrene (1-OHP, DiOHP) were determined as metabolites of pyrene (P), and the sum of 1-, 2-, 3-, 4-, and 9-hydroxyphenanthrenes (OHPHE), and PHE-dihydrodiols (PHED) as metabolites of phenanthrene (PHE). The referent group comprised 21 nonsmoking construction workers. Median (interquartile range) shift concentrations of airborne P and PHE were 1.46 (0.62-4.05 microg/m(3)) and 10.9 (3.69-23.77 microg/m(3)), respectively. The corresponding parameters were 3.86 (2.08-7.44) microg/g creatinine (crn) for 1-OHP, 0.66 (0.17-1.65) microg/g crn for DiOHP, 11.44 (5.21-34.76) microg/g crn for OHPHE, and 12.28 (3.3-97.76) microg/g crn for PHED in PAH-exposed workers. The median levels of 1-OHP and OHPHE were 0.09 (0.08-0.17 microg/m(3)) and 0.59 (0.45-1.39 microg/m(3)), respectively, in the referents. PHE correlated significantly with OHPHE and PHED, and P with 1-OHP but not with DiOHP. Under a doubling of PHE, OHPHE increased by a factor of 1.56 and PHED by 1.57. With a doubling of P, 1-OHP rose by 1.31 and DiOHP by 1.27. P is predominantly metabolized into 1-OHP, whereas PHE is metabolized equally into OHPHE and PHED. Thus metabolites of PHE were found as reliable biomarkers for PAH exposure.

Biomonitoring and biomarkers: exposure assessment will never be the same

Using modern analytical technology, it is now possible to measure almost any chemical present in our bodies. The future role of classical exposure assessment will perhaps be marginalized because biomonitoring programs can directly measure the concentration of chemicals that are present in biologic matrices. Although the concentration of chemicals in the environment will continue to be measured and related to exposure parameters, the prioritization of the national environmental agenda will be dictated by biomonitoring. Recent biomonitoring studies have examined the levels of >200 chemicals. Biomonitoring data, by themselves, are not informative in helping consumers understand their individual health risk. A major challenge facing those who conduct biomonitoring programs is how to best communicate the information to the public. In this article, we review benefits and challenges, along with select results from the Centers for Disease Control and Prevention's 2005 National Report on Human Exposure to Environmental Chemicals. We recommend that these data be carefully interpreted, with the goal of establishing baseline exposure information, rather than creating surrogates for conclusions about human health risk.