[Is there an Association between Prevention Campaign Knowledge and Sun Protection Behaviour of Parents for their Children? Results of a Parent Survey]

AIM

The aims of this study are to assess prevalence of awareness of sun protection campaigns among parents in Bavaria, Germany, to analyse the impact of sociodemographic factors on campaign knowledge and the association between parental campaign knowledge and sun protection behaviour in their children.

METHODS

A cross-sectional survey was undertaken in 2010-2011 in Bavaria, Germany, with parents of 4,579 children aged 5-6 years (response rate 61%).

RESULTS

Prevalence of knowledge of sun protection campaigns is 13% among parents in Germany and independent of sociodemographic factors. Ignorance of sun protection campaigns is associated with inadequate sun protection behaviour in children independent of sociodemographic and exposure characteristics.

CONCLUSION

Awareness of sun protection campaigns is low among parents. Knowledge of adequate sun protection behaviour should be further increased at the population level in Germany independently of sociodemographic status.

Organophosphate flame retardants and plasticizers in the air and dust in German daycare centers and human biomonitoring in visiting children (LUPE 3)

Organophosphate (OP) flame retardants and plasticizers are chemicals that have been used in large quantities in diverse consumer and building-related products for decades. In the present study, OPs were measured in paired indoor air and dust samples from 63 daycare centers in Germany. Moreover, the urine of 312 children between 22 and 80 months old who attend these facilities was analyzed for the presence of eight OP metabolites. Tri-(2-butoxyethyl)-phosphate (TBEP), tris-(2-chloroisopropyl) phosphate (TCPP), and tri-n-butyl-phosphate (TnBP) were present in low concentrations in indoor air, with median values of 49 ng/m(3), 2.7 ng/m(3), and 2.2 ng/m(3), respectively. In dust, median values of 225 mg/kg for TBEP, 2.7 mg/kg for TCPP, 1.1mg/kg for diphenyl(2-ethylhexyl) phosphate, and 0.5mg/kg for tri-phenyl-phosphate (TPhP) were found. In the urine samples, the metabolites di-phenyl-phosphate, di-n-butyl-phosphate, and di-(2-butoxyethyl)-phosphate had median values (95th percentiles) of 0.8 μg/l (4.0 μg/l), 0.2 μg/l (0.9 μg/l), and 2.0 μg/l (10.7 μg/l), respectively. A significant correlation was found between the dust and air samples in the levels of TnBP, tris(2-chloroethyl) phosphate (TCEP), and TBEP. For TCEP and TBEP, significant correlations were also observed between the levels in dust and the respective metabolite levels in urine. For TCEP, there was also a significant correlation between the concentration in indoor air and metabolite levels in urine. Based on the 95th percentile in dust and air in our study and data from residences in a previously published study, the daily intake of the most abundant OP (TBEP) is high (i.e., 3.2 μg/kg b.w.). This level is approximately 6.4% of the reference dose (RfD) established by the NSF, U.S.A. Overall, our study shows that daycare centers are indoor environments that contribute to OP exposure.

Polybrominated diphenyl ethers (PBDEs), hexabromocyclododecane (HBCD) and "novel" brominated flame retardants in house dust in Germany

Brominated flame retardants (BFRs) are used in a wide variety of products such as electronic devices, upholstery and carpets and in insulation boards. The study presented here aimed to quantify the amounts of BFRs in house dust in Germany. For this purpose 20 residences' dust samples were collected from vacuum cleaner bags and analysed with LC-MS/MS and simultaneously with GC/MS. Using GC/MS, the median (95th percentile) concentrations of PBDEs (sum of tetra- to hepta-congeners), BDE 209, Σ-HBCD (sum of three congeners), and decabromodiphenylethane (DBDPE) were 42ng/g (230ng/g), 950ng/g (3426ng/g), 335ng/g (1545ng/g), and 146ng/g (1059ng/g), respectively. Using LC-MS/MS some "novel" flame retardants were found in median concentrations of 343ng/g (bis(2-ethyl-1-hexyl)tetrabromophthalate, TBPH), and 28ng/g (tetrabromobisphenol A, TBBPA). Whilst 1,2-bis-(2,4,6-tribromophenoxy)ethane (BTBPE) and 2-ethyl-1-hexyl-2,3,4,5-tetrabromobenzoate (EH-TBB) could not be detected. Based on these measurements an exposure assessment for the sum of tetra- to heptabrominated congeners, BDE 209, and Σ-HBCD resulted in a "high" daily intake for toddlers (based on 95th percentiles) of 1.2ng/kg b.w., 0.69ng/kg b.w., and 8.9ng/kg b.w., respectively. For TBPH the "high" intake was calculated at 4.1ng/kg b.w. and for DBDPE at 5.3ng/kg b.w. A clear tendency was observed to apply "novel" BFRs in Germany. Moreover, the results suggest that the recent exposure to PBDEs and HBCD via house dust in Germany is well below the levels that are associated with health effects. For the "novel" brominated flame retardants such an assessment is not possible due to limited toxicological information.

Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers

Despite the recent popularity of e-cigarettes, to date only limited data is available on their safety for both users and secondhand smokers. The present study reports a comprehensive inner and outer exposure assessment of e-cigarette emissions in terms of particulate matter (PM), particle number concentrations (PNC), volatile organic compounds (VOC), polycyclic aromatic hydrocarbons (PAH), carbonyls, and metals. In six vaping sessions nine volunteers consumed e-cigarettes with and without nicotine in a thoroughly ventilated room for two hours. We analyzed the levels of e-cigarette pollutants in indoor air and monitored effects on FeNO release and urinary metabolite profile of the subjects. For comparison, the components of the e-cigarette solutions (liquids) were additionally analyzed. During the vaping sessions substantial amounts of 1,2-propanediol, glycerine and nicotine were found in the gas-phase, as well as high concentrations of PM2.5 (mean 197 μg/m(3)). The concentration of putative carcinogenic PAH in indoor air increased by 20% to 147 ng/m(3), and aluminum showed a 2.4-fold increase. PNC ranged from 48,620 to 88,386 particles/cm(3) (median), with peaks at diameters 24-36 nm. FeNO increased in 7 of 9 individuals. The nicotine content of the liquids varied and was 1.2-fold higher than claimed by the manufacturer. Our data confirm that e-cigarettes are not emission-free and their pollutants could be of health concern for users and secondhand smokers. In particular, ultrafine particles formed from supersaturated 1,2-propanediol vapor can be deposited in the lung, and aerosolized nicotine seems capable of increasing the release of the inflammatory signaling molecule NO upon inhalation. In view of consumer safety, e-cigarettes and nicotine liquids should be officially regulated and labeled with appropriate warnings of potential health effects, particularly of toxicity risk in children.

Phthalates in German daycare centers: occurrence in air and dust and the excretion of their metabolites by children (LUPE 3)

Phthalates have been used for decades in large quantities, leading to the ubiquitous exposure of the population. In an investigation of 63 German daycare centers, indoor air and dust samples were analyzed for the presence of 10 phthalate diesters. Moreover, 10 primary and secondary phthalate metabolites were quantified in urine samples from 663 children attending these facilities. In addition, the urine specimens of 150 children were collected after the weekend and before they went to daycare centers. Di-isobutyl phthalate (DiBP), dibutyl phthalate (DnBP), and di-2-ethylhexyl phthalate (DEHP) were found in the indoor air, with median values of 468, 227, and 194ng/m(3), respectively. In the dust, median values of 888mg/kg for DEHP and 302mg/kg for di-isononyl phthalate (DiNP) were observed. DnBP and DiBP were together responsible for 55% of the total phthalate concentration in the indoor air, whereas DEHP and DiNP were responsible for 70% and 24% of the total phthalate concentration in the dust. Median concentrations in the urine specimens were 44.7μg/l for the DiBP monoester, 32.4μg/l for the DnBP monoester, and 16.5μg/l and 17.9μg/l for the two secondary DEHP metabolites. For some phthalates, we observed significant correlations between their concentrations in the indoor air and dust and their corresponding metabolites in the urine specimens using bivariate analyses. In multivariate analyses, the concentrations in dust were not associated with urinary metabolite excretion after controlling for the concentrations in the indoor air. The total daily "high" intake levels based on the 95th percentiles calculated from the biomonitoring data were 14.1μg/kg b.w. for DiNP and 11.9μg/kg b.w. for DEHP. Compared with tolerable daily intake (TDI) values, our "high" intake was 62% of the TDI value for DiBP, 49% for DnBP, 24% for DEHP, and 9% for DiNP. For DiBP, the total daily intake exceeded the TDI value for 2.4% of the individuals. Using a cumulative risk-assessment approach for the sum of DEHP, DnBP, and DiBP, 20% of the children had concentrations exceeding the hazard index of one. Therefore, a further reduction of the phthalate exposure of children is needed.

[The occurrence of plasticisers (phthalates) in communal facilities under special consideration of results from LUPE 3]

Children are a very susceptible subgroup of the general population and therefore health authorities have a special interest to prevent them from health hazards. In a study of 3 German Bundesländer the indoor air and dust samples of altogether 63 German daycare centres were analysed for the presence of phthalate diesters in 2011/12 (LUPE 3 study). Inhalable dust and gas phases were collected with a glass fibre filter and polyurethane foam over approximately 6 h while children were attending these facilities. Settled dust was collected by vacuuming the floor of the room using an ALK dust sampler. Indoor air and dust were analysed using a GC/MS system. Median values in the dust samples were 888 mg/kg for di-2-ethylhexyl phthalate (DEHP), 302 mg/kg for diisononyl phthalate (DiNP), 34 mg/kg for diisodecyl phthalate (DiDP), 21 mg/kg for di-n-butyl phthalate (DnBP), and 20 mg/kg for diisobutyl phthalate (DiBP). For DEHP and DiNP maximum values of 10,086 mg/kg and 7,091 mg/kg were observed, respectively. DEHP and DiNP were responsible for 70% and 24% of the total phthalate concentration in the dust. In indoor air phthalates are found mainly in the particulate phase of the filters. Only the more volatile phthalates dimethyl phthalate and diethyl phthalate were found also in the gas phase. The median values in the indoor air were 470 ng/m³ for DiBP, 230 ng/m³ for DnBP, 190 ng/m³ for DEHP, and 100 ng/m³ for DiNP. DnBP and DiBP were together responsible for 55% of the total phthalate concentration in the indoor air. Overall, our study showed that the concentrations of phthalates in indoor air of daycare centers are slightly higher and in dust samples lower compared with schools.

Organochlorine compounds, nitro musks and perfluorinated substances in breast milk - results from Bavarian Monitoring of Breast Milk 2007/8

The aim of the Bavarian Monitoring of Breast Milk (BAMBI) project was to examine 10 organochlorine pesticides (OPs), 3 nitro musks, 6 indicator polychlorinated biphenyls (PCBs), 7 polychlorinated dibenzo-p-dioxins (PCDDs), 10 polychlorinated dibenzofurans (PCDFs), 12 dioxin-like PCBs (dl-PCBs) and several perfluorinated alkyl compounds in breast milk samples. A total of 516 breast milk samples were collected from seven regions in Bavaria and were analyzed by means of GC/ECD, GC/HRMS, and LC/MS-MS. Concerning the OPs, only hexachlorobenzene and a metabolite of DDT, 1,1-dichloro-2,2-bis(4-chlorophenyl) ethylene (p,p'-DDE), could be quantified in all samples (median: 16 ngg(-1) lipid and 63 ngg(-1) lipid, respectively). Median concentrations of 150 ngg(-1) lipid (range: 3-1900 ngg(-1) lipid) were found for the sum of the indicator PCBs. The concentrations of the PCDDs/PCDFs and the dl-PCBs ranged from 0.8 to 15.1 (median 5.7) pg WHO-TEQ1998g(-1) lipid and from 1.5 to 18.9 pg (median 6.4) WHO-TEQ1998 g(-1) lipid, respectively. The median perfluorooctane sulfonate concentration was 0.05 μgL(-1) (range: <0.02-0.26 μgL), while the other PFCs were observed only in a subset of samples. On the basis of the median and 95th percentile concentration, "medium" and "high" intake levels were estimated for a 3-month-old exclusively breastfed infant. In particular, "medium" and "high" intake levels were calculated of 69 and 133 pg WHO1998 TEQ kg(-1) b.w. for PCDDs/PCDFs, 8 and 21 ngkg(-1) b.w. for dl-PCBs, and 6 and 25 ngkg(-1) b.w. for perfluorooctane sulfonate, respectively. The calculated intake for perfluorinated substances is clearly below the tolerable daily intake (TDI), while the established TDI values are still clearly exceeded for PCDDs/PCDFs and dl-PCBs.

[The impact of migration background on children's secondhand smoke exposure. A cross-sectional study within the health monitoring units (GME) in Bavaria, Germany]

AIM OF THE STUDY

Differences in children's secondhand smoke (SHS) exposure were examined by migration-specific characteristics, socioeconomic factors and living conditions, as well as with regard to the parents SHS knowledge and SHS attitudes.

STUDY POPULATION AND METHODS

Data from 5,336 pre-school children (29% migrants) were collected in a cross-sectional study in 2008/2009 in Germany through parental questionnaire (response rate: 61%). Using multiple logistic regression, the association of migration background and children's SHS exposure was analysed.

RESULTS

Children with a migration background are at an increased risk of SHS exposure in their homes. Multivariate analyses show that adjusting for socioeconomic factors and parental knowledge of how to protect their children from SHS reduces the estimates of migration background significantly. Compared to children without migration background, the chance of SHS exposure for children with migration background is still increased (OR [95% CI]: 1.57 [1.23-2.01]). Children of Turkish-speaking families, compared to children from German-speaking families, are most often burdened by SHS (3.05 [2.18-4.26]).

CONCLUSION

Migrant-sensitive tobacco prevention in selected risk groups is necessary to provide support for creating smoke-free homes for children.

Occurrence of chlorinated paraffins in house dust samples from Bavaria, Germany

Levels and distribution of chlorinated paraffins were studied in randomly taken house dust samples (<63 μm) from the greater area of Munich, Germany. Quantification of short- (SCCPs, C(10)-C(13)) and medium-chain chlorinated paraffins (MCCPs, C(14)-C(16)) were performed using gas chromatography electron capture negative ion mass spectrometry (GC-ECNI-MS). Concentrations of MCCPs in private household samples varied between 9 μg/g and 892 μg/g, and exceeded levels of SCCPs, which were in the range of 4-27 μg/g. Two dust samples from a public building contained up to 2050 μg/g SCCPs but no MCCPs. Among MCCPs, chlorinated tetradecanes were major components with a proportion of almost 50%. Among SCCPs, chlorinated dodecanes were usually present at higher concentrations than the congeners of any C10, C11, and C13 chains. The results indicate that particularly MCCPs may be present in relatively high concentrations in house dusts.

Exposure of German residents to ethylene and propylene glycol ethers in general and after cleaning scenarios

Glycol ethers are a class of semi-volatile substances used as solvents in a variety of consumer products like cleaning agents, paints, cosmetics as well as chemical intermediates. We determined 11 metabolites of ethylene and propylene glycol ethers in 44 urine samples of German residents (background level study) and in urine samples of individuals after exposure to glycol ethers during cleaning activities (exposure study). In the study on the background exposure, methoxyacetic acid and phenoxyacetic acid (PhAA) could be detected in each urine sample with median (95th percentile) values of 0.11 mgL(-1) (0.30 mgL(-1)) and 0.80 mgL(-1) (23.6 mgL(-1)), respectively. The other metabolites were found in a limited number of samples or in none. In the exposure study, 5-8 rooms were cleaned with a cleaner containing ethylene glycol monobutyl ether (EGBE), propylene glycol monobutyl ether (PGBE), or ethylene glycol monopropyl ether (EGPE). During cleaning the mean levels in the indoor air were 7.5 mgm(-3) (EGBE), 3.0 mgm(-3) (PGBE), and 3.3 mgm(-3) (EGPE), respectively. The related metabolite levels analysed in the urine of the residents of the rooms at the day of cleaning were 2.4 mgL(-1) for butoxyacetic acid, 0.06 mgL(-1) for 2-butoxypropionic acid, and 2.3 mgL(-1) for n-propoxyacetic acid. Overall, our study indicates that the exposure of the population to glycol ethers is generally low, with the exception of PhAA. Moreover, the results of the cleaning scenarios demonstrate that the use of indoor cleaning agents containing glycol ethers can lead to a detectable internal exposure of residents.

Human exposure to fluorotelomer alcohols, perfluorooctane sulfonate and perfluorooctanoate via house dust in Bavaria, Germany

This study aimed at investigating the presence and distribution of fluorotelomer alcohols (FTOHs), perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA) in house dust to evaluate human exposure to these compounds via dust ingestion. 31 house dust samples were collected from Bavaria, Germany and analyzed for 4:2, 6:2, 8:2 and 10:2 FTOH, PFOS and PFOA. PFOA was the dominant compound in 79% of the dust samples, followed by PFOS and 8:2 FTOH, while 4:2 FTOH was not detected in any samples. The total concentration of per- and polyfluorinated compounds (PFCs) varied from 32.2 to 2456 ng/g. In addition, the total ingestion rate for PFCs was 0.4-135 ng/d for adults and 5.1-246 ng/d for toddlers, and the highest 8:2 FTOH-based PFOA intake via indoor dust was 0.24 ng/d for adults and 0.44 ng/d for toddlers. Overall, the results of this study demonstrate that dust ingestion is a minor pathway for human exposure to these PFCs; the PFC ingestion via indoor dust is generally low, and only under a worst scenario high intakes have to be expected for toddlers.

Airborne allergens, endotoxins, and particulate matter in elementary schools, results from Germany (LUPE 2)

Allergic disorders are the most common childhood-related chronic diseases in developed countries. It is essential to assess the exposure, especially in schools, where children spend a large portion of their time. We aimed to investigate allergen and endotoxin levels in the air of schools and to observe seasonal variations of these factors. We evaluated airborne concentrations of house dust mites allergens (Der p 1, Der f 1), cat allergen (Fel d 1), and endotoxin in PM10 in 14 classrooms during the school days in the region of Munich, each over 20 consecutive days and in 1 classroom over the course of a year (at 83 days); we also tested outdoor air close to the schools. Endotoxin levels were quantified using two different analytical methods. In addition, indoor air climate parameters were measured. The median daily indoor CO2 and PM10 concentrations in the classrooms ranged from 423 to 3,135 ppm (median: 1,211 ppm) and 9 to 390 μg/m(3) (median: 127 μg/m(3)), respectively. Fel d 1 in the PM10 samples was the most frequently detected allergen, with levels from 0.02 to 1.15 ng/m(3) in a total of 301 samples (median: 0.19 ng/m(3), 95th percentile: 0.57 ng/m(3)). Der p 1 and Der f 1 were detected in only 51% and 19% of the samples, with 95th percentiles at 0.5 and 0.3 ng/m(3). Endotoxin levels in the PM10 and inhalable dust samples ranged from 0.5 to 84.1 EU/m(3) (median: 15.3 EU/m(3); 95th percentile: 58.2 EU/m(3)) and from 0.03 to 115 EU/m(3) (median: 8.4 EU/m(3); 95th percentile: 27.9 EU/m(3)). Fel d 1 and endotoxin were found in higher levels in the winter months. The results of the two different indoor sampling techniques for endotoxin were statistically significantly correlated. The results of airborne allergens indicate a generally low exposure level in classrooms. With regard to endotoxin, our study showed higher levels in schools compared with residences.

Effect of classroom air quality on students' concentration: results of a cluster-randomized cross-over experimental study

To assess the effect of indoor air quality as indicated by the median carbon dioxide (CO₂) level in the classroom on the concentration performance (CP) of students, a cross-over cluster-randomized experimental study was conducted in 20 classrooms with mechanical ventilation systems. Test conditions 'worse' (median CO₂ level on average 2115 ppm) and 'better' (median CO₂ level on average 1045 ppm) were established by the regulation of the mechanical ventilation system on two days in one week each in every classroom. Concentration performance was quantified in students of grade three and four by the use of the d2-test and its primary parameter 'CP' and secondary parameters 'total number of characters processed' (TN) and 'total number of errors' (TE). 2366 d2-tests from 417 students could be used in analysis. In hierarchical linear regression accounting for repeated measurements, no significant effect of the experimental condition on CP or TN could be observed. However, TE was increased significantly by 1.65 (95% confidence interval 0.42-2.87) in 'worse' compared to 'better' condition. Thus, low air quality in classrooms as indicated by increased CO₂ levels does not reduce overall short-term CP in students, but appears to increase the error rate.

PRACTICAL IMPLICATIONS

This study could not confirm that low air quality in classrooms as indicated by increased CO₂ levels reduces short-term concentration performance (CP) in students; however, it appears to affect processing accuracy negatively. To ensure a high level of accuracy, good air quality characterized, for example, by low CO₂ concentration should be maintained in classrooms.

Influence of dietary factors, age and nickel contact dermatitis on nickel excretion

BACKGROUND

Nickel is a frequently detected cause of allergic contact dermatitis. Ingestion of nickel may lead to flares of nickel contact dermatitis.

METHODS

We examined nickel excretion in the urine of 164 female patients with and without nickel contact dermatitis. The associations between age, atopic dermatitis, nickel contact dermatitis and nickel exposure through nutrition (e.g. dietary supplements) and by patch tests were investigated prospectively. Nickel was measured with atomic absorption spectrometry with two different standardized methods.

RESULTS

A nickel detection limit of 0.2 µg/l was exceeded by all samples. The 95th percentiles of urine nickel concentration were 3.77 µg/l (age 18-30 years) and 3.98 µg/l (age 31-46 years). Bivariate analyses pointed to significantly increased nickel excretion with increasing age, ingestion of dietary supplements, drinking of stagnant tap water, and consumption of nickel-rich food. In the multivariate analysis, age and dietary supplements remained significant predictors of high nickel excretion. A non-significant increase in the median concentration of nickel was observed after the administration of conventional nickel patch tests. Patients with atopic eczema showed urine nickel concentrations similar to those in non-atopic controls.

CONCLUSIONS

The 95th percentile of nickel excretion in our study population markedly exceeded the actual reference value of 3 µg/l. Age and consumption of dietary supplements are the most important predictors. The use of stagnant tap water and consumption of nickel-rich food contribute to the total load. These factors should be explicitly mentioned when allergic patients on a low-nickel diet are counselled. In contrast, existing nickel contact sensitization was not more frequent in subjects with higher nickel excretion. Nickel patch testing may cause transient minor systemic nickel exposure. The findings of this study extend our understanding and management of factors associated with nickel allergy.

Determination of phthalic acid diesters in human milk at low ppb levels

Phthalic acid diesters (PAE) are omnipresent in the human environment and food is a major contributor to the overall human exposure towards these chemicals. Due to developmental effects, PAE infants' exposure via human milk has been subjected to a number of analytical studies. These previous studies, however, revealed that normal laboratory blank values are in the range of or even higher than human milk levels due to the presence of PAE in laboratory environments. In order to provide more reliable data on PAE exposure via human milk, the aim of this study was to develop and validate a robust and sensitive analytical method. This should be capable of removing matrix components efficiently and guarantee limits of quantification in the low ppb range. The method development took into account liquid-liquid extraction and selective pressurised fluid extraction (sPFE) as well as chromatography-based clean-up steps. The final method consisted of a liquid-liquid extraction followed by an automated chromatographic clean-up by an sPFE device. After volume reduction the cleaned extracts were analysed by quadrupole GC/MS. Quantification was based on internal standards. An extensive quality assurance and method test programme demonstrated conservatively determined limits of detection and quantification from 0.3 to 10 ng g⁻¹ in human milk, with recoveries of internal standards from 50% to 101%. Thus, the method allowed the quality-assured detection of di-isobutyl phthalate (DiBP), di-n-butyl phthalate (DBP), di-2-ethylhexyl phthalate (DEHP), di-allyl phthalate (DAP), benzylbutyl phthalate (BBP) and di-cyclohexyl phthalate (DcHP) in 30 human milk samples provided by 30 volunteers from southern Germany. DiBP, DBP and DEHP were the most commonly detected PAE, with median levels of 1.0, 0.6 and 2.3 ng g⁻¹, respectively.