Air toxics and health risks in California: the public health implications of outdoor concentrations

Autism spectrum disorders in relation to distribution of hazardous air pollutants in the san francisco bay area

OBJECTIVE

To explore possible associations between autism spectrum disorders (ASD) and environmental exposures, we linked the California autism surveillance system to estimated hazardous air pollutant (HAP) concentrations compiled by the U.S. Environmental Protection Agency.

METHODS

Subjects included 284 children with ASD and 657 controls, born in 1994 in the San Francisco Bay area. We assigned exposure level by census tract of birth residence for 19 chemicals we identified as potential neurotoxicants, developmental toxicants, and/or endocrine disruptors from the 1996 HAPs database. Because concentrations of many of these were highly correlated, we combined the chemicals into mechanistic and structural groups, calculating summary index scores. We calculated ASD risk in the upper quartiles of these group scores or individual chemical concentrations compared with below the median, adjusting for demographic factors.

RESULTS

The adjusted odds ratios (AORs) were elevated by 50% in the top quartile of chlorinated solvents and heavy metals [95% confidence intervals (CIs) , 1.1-2.1], but not for aromatic solvents. Adjusting for these three groups simultaneously led to decreased risks for the solvents and increased risk for metals (AORs for metals: fourth quartile = 1.7 ; 95% CI, 1.0-3.0 ; third quartile = 1.95 ; 95% CI, 1.2-3.1) . The individual compounds that contributed most to these associations included mercury, cadmium, nickel, trichloroethylene, and vinyl chloride.

CONCLUSIONS

Our results suggest a potential association between autism and estimated metal concentrations, and possibly solvents, in ambient air around the birth residence, requiring confirmation and more refined exposure assessment in future studies.

Separate and unequal: residential segregation and estimated cancer risks associated with ambient air toxics in U.S. metropolitan areas

This study examines links between racial residential segregation and estimated ambient air toxics exposures and their associated cancer risks using modeled concentration estimates from the U.S. Environmental Protection Agency's National Air Toxics Assessment. We combined pollutant concentration estimates with potencies to calculate cancer risks by census tract for 309 metropolitan areas in the United States. This information was combined with socioeconomic status (SES) measures from the 1990 Census. Estimated cancer risks associated with ambient air toxics were highest in tracts located in metropolitan areas that were highly segregated. Disparities between racial/ethnic groups were also wider in more segregated metropolitan areas. Multivariate modeling showed that, after controlling for tract-level SES measures, increasing segregation amplified the cancer risks associated with ambient air toxics for all racial groups combined [highly segregated areas: relative cancer risk (RCR) = 1.04; 95% confidence interval (CI), 1.01-107; extremely segregated areas: RCR = 1.32; 95% CI, 1.28-1.36]. This segregation effect was strongest for Hispanics (highly segregated areas: RCR = 1.09; 95% CI, 1.01-1.17; extremely segregated areas: RCR = 1.74; 95% CI, 1.61-1.88) and weaker among whites (highly segregated areas: RCR = 1.04; 95% CI, 1.01-1.08; extremely segregated areas: RCR = 1.28; 95% CI, 1.24-1.33), African Americans (highly segregated areas: RCR = 1.09; 95% CI, 0.98-1.21; extremely segregated areas: RCR = 1.38; 95% CI, 1.24-1.53), and Asians (highly segregated areas: RCR = 1.10; 95% CI, 0.97-1.24; extremely segregated areas: RCR = 1.32; 95% CI, 1.16-1.51). Results suggest that disparities associated with ambient air toxics are affected by segregation and that these exposures may have health significance for populations across racial lines.

Socioeconomic and racial disparities in cancer risk from air toxics in Maryland

We linked risk estimates from the U.S. Environmental Protection Agency's National Air Toxics Assessment (NATA) to racial and socioeconomic characteristics of census tracts in Maryland (2000 Census) to evaluate disparities in estimated cancer risk from exposure to air toxics by emission source category. In Maryland, the average estimated cancer risk across census tracts was highest from on-road sources (50% of total risk from nonbackground sources), followed by nonroad (25%), area (23%), and major sources (< 1%). Census tracts in the highest quartile defined by the fraction of African-American residents were three times more likely to be high risk (> 90th percentile of risk) than those in the lowest quartile (95% confidence interval, 2.0-5.0). Conversely, risk decreased as the proportion of whites increased (p < 0.001). Census tracts in the lowest quartile of socioeconomic position, as measured by various indicators, were 10-100 times more likely to be high risk than those in the highest quartile. We observed substantial risk disparities for on-road, area, and nonroad sources by socioeconomic measure and on-road and area sources by race. There was considerably less evidence of risk disparities from major source emissions. We found a statistically significant interaction between race and income, suggesting a stronger relationship between race and risk at lower incomes. This research demonstrates the utility of NATA for assessing regional environmental justice, identifies an environmental justice concern in Maryland, and suggests that on-road sources may be appropriate targets for policies intended to reduce the disproportionate environmental health burden among economically disadvantaged and minority populations.

Children's exposure to volatile organic compounds as determined by longitudinal measurements in blood

Blood concentrations of 11 volatile organic compounds (VOCs) were measured up to four times over 2 years in a probability sample of more than 150 children from two poor, minority neighborhoods in Minneapolis, Minnesota. Blood levels of benzene, carbon tetrachloride, trichloroethene, and m-/p-xylene were comparable with those measured in selected adults from the Third National Health and Nutrition Examination Survey (NHANES III), whereas concentrations of ethylbenzene, tetrachloroethylene, toluene, 1,1,1-trichloroethane, and o-xylene were two or more times lower in the children. Blood levels of styrene were more than twice as high, and for about 10% of the children 1,4-dichlorobenzene levels were greater than or equal to 10 times higher compared with NHANES III subjects. We observed strong statistical associations between numerous pairwise combinations of individual VOCs in blood (e.g., benzene and m-/p-xylene, m-/p-xylene and o-xylene, 1,1,1-trichloroethane and m-/p-xylene, and 1,1,1-trichloroethane and trichloroethene). Between-child variability was higher than within-child variability for 1,4-dichlorobenzene and tetrachloroethylene. Between- and within-child variability were approximately the same for ethylbenzene and 1,1,1-trichloroethane, and between-child was lower than within-child variability for the other seven compounds. Two-day, integrated personal air measurements explained almost 79% of the variance in blood levels for 1,4-dichlorobenzene and approximately 20% for tetrachloroethylene, toluene, m-/p-xylene, and o-xylene. Personal air measurements explained much less of the variance (between 0.5 and 8%) for trichloroethene, styrene, benzene, and ethylbenzene. We observed no significant statistical associations between total urinary cotinine (a biomarker for exposure to environmental tobacco smoke) and blood VOC concentrations. For siblings living in the same household, we found strong statistical associations between measured blood VOC concentrations.

Relationship of Indoor, Outdoor and Personal Air (RIOPA) study: study design, methods and quality assurance/control results

The Relationship of Indoor, Outdoor and Personal Air (RIOPA) Study was undertaken to evaluate the contribution of outdoor sources of air toxics, as defined in the 1990 Clean Air Act Amendments, to indoor concentrations and personal exposures. The concentrations of 18 volatile organic compounds (VOCs), 17 carbonyl compounds, and fine particulate matter mass (PM(2.5)) were measured using 48-h outdoor, indoor and personal air samples collected simultaneously. PM2.5 mass, as well as several component species (elemental carbon, organic carbon, polyaromatic hydrocarbons and elemental analysis) were also measured; only PM(2.5) mass is reported here. Questionnaires were administered to characterize homes, neighborhoods and personal activities that might affect exposures. The air exchange rate was also measured in each home. Homes in close proximity (<0.5 km) to sources of air toxics were preferentially (2:1) selected for sampling. Approximately 100 non-smoking households in each of Elizabeth, NJ, Houston, TX, and Los Angeles, CA were sampled (100, 105, and 105 respectively) with second visits performed at 84, 93, and 81 homes in each city, respectively. VOC samples were collected at all homes, carbonyls at 90% and PM(2.5) at 60% of the homes. Personal samples were collected from nonsmoking adults and a portion of children living in the target homes. This manuscript provides the RIOPA study design and quality control and assurance data. The results from the RIOPA study can potentially provide information on the influence of ambient sources on indoor air concentrations and exposure for many air toxics and will furnish an opportunity to evaluate exposure models for these compounds.

Ambient air pollution: health hazards to children

Ambient (outdoor) air pollution is now recognized as an important problem, both nationally and worldwide. Our scientific understanding of the spectrum of health effects of air pollution has increased, and numerous studies are finding important health effects from air pollution at levels once considered safe. Children and infants are among the most susceptible to many of the air pollutants. In addition to associations between air pollution and respiratory symptoms, asthma exacerbations, and asthma hospitalizations, recent studies have found links between air pollution and preterm birth, infant mortality, deficits in lung growth, and possibly, development of asthma. This policy statement summarizes the recent literature linking ambient air pollution to adverse health outcomes in children and includes a perspective on the current regulatory process. The statement provides advice to pediatricians on how to integrate issues regarding air quality and health into patient education and children's environmental health advocacy and concludes with recommendations to the government on promotion of effective air-pollution policies to ensure protection of children's health.

Health risk communication using comparative risk analyses

The ability to communicate effectively the degree or magnitude of public exposures or health risks is essential for risk assessors and risk managers. Various guidelines exist for communicating environmental and public health risks, including recommended approaches for putting risk data into proper context. Although it remains unclear as to which approach is the most useful or appropriate under different circumstances, risk comparisons are a popular choice for conveying the significance of or providing a better perspective on a particular chemical exposure or health risk. In this paper, several different types of risk comparisons are described that are frequently used in the private and public sectors, and these are illustrated using a variety of examples from the literature. These approaches include: (1) intrachemical comparisons, (2) interchemical comparisons, (3) comparisons to background levels of risk, (4) comparisons to theoretical risks or safety levels, and (5) comparisons to other actions or activities. The primary purpose of this paper is to summarize and briefly discuss the advantages and limitations of these risk communication approaches. The evolving field of risk communication is also discussed, including ongoing research on public risk perceptions and alternative methods for communicating risk magnitudes and data uncertainties.

A human health assessment of hazardous air pollutants in Portland, OR

Ambient air samples collected from five monitoring sites in Portland, OR during July 1999 to August 2000 were analyzed for 43 hazardous air pollutants (HAP). HAP concentrations were compared to carcinogenic and non-carcinogenic benchmark levels. Carcinogenic benchmark concentrations were set at a risk level of one-in-one-million (1x10(-6)). Hazard ratios of 1.0 were used when comparing HAP concentrations to non-carcinogenic benchmarks. Emission sources (point, area, and mobile) were identified and a cumulative cancer risk and total hazard index were calculated for HAPs exceeding these health benchmark levels. Seventeen HAPs exceeded a cancer risk level of 1x10(-6) at all five monitoring sites. Nineteen HAPs exceeded this level at one or more site. Carbon tetrachloride, 1,3-butadiene, formaldehyde, and 1,1,2,2-tetrachloroethane contributed more than 50% to the upper-bound lifetime cumulative cancer risk of 2.47x10(-4). Acrolein was the only non-carcinogenic HAP with hazard ratios that exceeded 1.0 at all five sites. Mobile sources contributed the greatest percentage (68%) of HAP emissions. Additional monitoring and health assessments for HAPs in Portland, OR are warranted, including addressing issues that may have overestimated or underestimated risks in this study. Abatement strategies for HAPs that exceeded health benchmarks should be implemented to reduce potential adverse health risks.

Residential proximity to agricultural pesticide use and incidence of breast cancer in the California Teachers Study cohort

We examined the association between residential proximity to agricultural pesticide use and breast cancer incidence among members of the California Teachers Study cohort, a large study of professional school employees with extensive information on breast cancer risk factors, followed for cancer incidence since 1995. We identified 1552 invasive breast cancer cases, diagnosed between 1996 and 1999, among 114,835 cohort members. We used California Pesticide Use Reporting data to select pesticides for analysis based on use volume, carcinogenic potential, and exposure potential; a Geographic Information System was used to estimate pesticide applications within a half-mile radius of subjects' residences. We applied Cox proportional hazard models to estimate hazard rate ratios (HR) for selected pesticides, adjusting for age, race, and socioeconomic status. We saw no association between residential proximity to recent agricultural pesticide use and invasive breast cancer incidence. HR estimates for the highest compared to the lowest exposure categories for groups of agents were as follows: probable or likely carcinogens (1.07, 95% confidence interval (CI): 0.86-1.32), possible or suggestive carcinogens (1.06, 95% CI: 0.87-1.29), mammary carcinogens (1.15, 95% CI: 0.90-1.48), and endocrine disruptors (1.03, 95% CI: 0.86-1.25). HR estimates for other groups and individual pesticides did not differ from unity, nor was there a trend for any groupings of or individual pesticides examined. Stratifying by menopausal status or family history of breast cancer did not substantially affect our results. Our analyses suggest that breast cancer incidence is not elevated in areas of recent, high agricultural pesticide use in California.

Risk assessment of exposure to volatile organic compounds in different indoor environments

The lifetime cancer risks of exposure of cooks and food service workers, office workers, housewives, and schoolchildren in Hong Kong to volatile organic compounds (VOCs) in their respective indoor premises during normal indoor activities were assessed. The estimated cancer risk for housewives was the highest, and the second-highest lifetime cancer risk to VOC exposure was for the groups of food service and office workers. Within a certain group of the population, the lifetime cancer risk of the home living room was one to two orders of magnitude higher than that in other indoor environments. The estimated lifetime risks of food service workers were about two times that of office workers. Furthermore, the cancer risks of working in kitchen environments were approximately two times higher than the risks arising from studying in air-conditioned classrooms. The bus riders had higher average lifetime cancer risks than those travelling by Mass Transit Railway. For all target groups of people, the findings of this study show that the exposures to VOCs may lead to lifetime risks higher than 1 x 10(-6). Seven indoor environments were selected for the measurement of human exposure and the estimation of the corresponding lifetime cancer risks. The lifetime risks with 8-h average daily exposures to individual VOCs in individual environments were compared. People in a smoking home had the highest cancer risk, while students in an air-conditioned classroom had the lowest risk of cancer. Benzene accounted for about or more than 40% of the lifetime cancer risks for each category of indoor environment. Nonsmoking and smoking residences in Hong Kong had cancer risks associated with 8-h exposures of benzene above 1.8 x 10(-5) and 8.0 x 10(-5), respectively. The cancer risks associated with 1,1-dichloroethene, chloroform, methylene chloride, trichloroethene, and tetrachloroethene became more significant at selected homes and restaurants. Higher lifetime cancer risks due to exposure to styrene were only observed in the administrative and printing offices and air-conditioned classrooms. Higher lifetime cancer risks related to chloroform exposures were observed at the restaurant and the canteen.

Risk assessment of formaldehyde in typical office buildings in Taiwan

Our study conducts a series of investigations in five office buildings chosen according to the types of construction, ventilation, and building age. Formaldehyde was measured by continuous photoacoustic Multi-Gas monitor Type 1302 (Brüel & Kjaer). The 8-h average concentrations in working hours were used to estimate the lifetime cancer probability (LCP) and chronic non-carcinogenic hazard index (HI). The carcinogenic effect of formaldehyde estimate by LCP (70 years old) is about 2.06 x 10(-4) to 1.75 x 10(-3) after adjusting their working time. The levels of risk are 100-1000 times of the acceptable carcinogenic risk. A similar trend is observed for the levels of HI calculated. Many studies have suggested that exposure to high levels of formaldehyde may cause nasal cancer and other health effects. Therefore, promoting the labeling system for low emission materials to protect consumers from exposure to excessive emissions and helping the industry to develop low emission materials is evidently urgent and deserves greater efforts.

The cost-effectiveness of life-saving interventions in Japan. Do chemical regulations cost too much?

This paper compares the cost-effectiveness of life-saving interventions in Japan, based on information collected from the health, safety and environmental literature. More than 50 life-saving interventions are analyzed. Cost-effectiveness is defined as the cost per life-year saved or as the cost per quality-adjusted life-year saved. Finding a large cost-effectiveness disparity between chemical controls and health care intervention, we raise the question of whether chemical regulations cost society too much. We point out the limitations of this study and propose a way to improve the incorporation of morbidity effects in cost-effectiveness analysis.

Single pollutant versus surrogate measure approaches: do single pollutant risk assessments underestimate the impact of air pollution on lung cancer risk?

Cancer risk as a result of air pollution may be quantified by different approaches. We compared the sum of unit risk based effects of single pollutants with an epidemiology-based method by using PM(10) as a surrogate of the total air pollution. The excess rate for lung cancer cases attributable to an increase of 10 microg/m3 in average PM(10) exposure was estimated from available cohort studies. Applying the epidemiology-based risk method to the air pollution situation in the Basel area (Switzerland) resulted in 13.3 (95% CI = 6.9-19.8) excess lung cancer cases per 100,000 person years. This estimate was considerably higher than the unit risk-based estimate yielding 1.1 (range, 0.45-2.8) cancer cases per 100,000 person years. We discuss these discrepancies in light of inherent differences between approaches in toxicology and epidemiology.

Risk characterization: principles and practice

In the field of risk assessment, characterizing the nature and magnitude of human health or environmental risks is arguably the most important step in the analytical process. In this step, data on the dose-response relationship of an agent are integrated with estimates of the degree of exposure in a population to characterize the likelihood and severity of risk. Although the purpose of risk characterizations is to make sense of the available data and describe what they mean to a broad audience, this step is often given insufficient attention in health risk evaluations. Too often, characterizations fail to interpret or summarize risk information in a meaningful way, or they present single numerical estimates of risk without an adequate discussion of the uncertainties inherent in key exposure parameters or the dose-response assessment, model assumptions, or analytical limitations. Consequently, many users of risk information have misinterpreted the findings of a risk assessment or have false impressions about the degree of accuracy (or the confidence of the scientist) in reported risk estimates. In this article we collected and integrated the published literature on conducting and reporting risk characterizations to provide a broad, yet comprehensive, analysis of the risk characterization process as practiced in the United States and some other countries. Specifically, the following eight topics are addressed: (1) objective of risk characterization, (2) guidance documents on risk characterization, (3) key components of risk characterizations, (4) toxicity criteria for evaluating health risks, (5) descriptors used to characterize health risks, (6) methods for quantifying human health risks, (7) key uncertainties in risk characterizations, and (8) the risk decision-making process. A brief discussion is also provided on international aspects of risk characterization. A number of examples are presented that illustrate key concepts, and citations are provided for approximately 100 of the most relevant papers.

Discrimination and the Political Economy of Environmental Inequality

Over the last decade there has been a surge in academic and scientific inquiry into disparities in environmental hazards among diverse communities. Much of the evidence points to a general pattern of disproportionate exposures to toxics among communities of color and the poor, with racial differences often persisting across economic strata. Although results have implications for the politics of environmental decisionmaking, most of these analyses are limited to illustrating how inequities in exposures and health risks are spread across the landscape, while shedding little light on their origins or the reasons for their persistence. Previous attempts to theorize the causes of environmental inequality have focused on procedural justice in the regulatory arena, emphasizing civil rights jurisprudence and social theories on individual and institutional discrimination. Although these approaches offer insights into the epistemology of environmental inequality, they fail adequately to account for the political economy of discrimination relating to industrial location behavior and racialized labor markets. By integrating relevant social and legal theories with a spatialized economic critique, this paper formulates a more supple theory of environmental discrimination. How the political economy of place shapes distributions of people and pollution and ultimately gives rise to environmental inequality are revealed by exploring the following factors: historical patterns of industrial development and racialized labor markets; suburbanization and segregation; and economic restructuring. This multidisciplinary approach to theorizing the dynamic of environmental discrimination provides a new framework for future policymaking and community organizing to address environmental and economic justice. Implications of this broader framework for policy and politics are discussed in the conclusion.