Using biomarkers to inform cumulative risk assessment

Cumulative risk assessment for combinations of environmental and psychosocial stressors: A systematic review

With the growing awareness of stressors, cumulative risk assessment (CRA) has been proposed as a potential method to evaluate possible additive and synergistic effects of multiple stressors on human health, thus informing environmental regulation and protecting public health. However, CRA is still in its exploratory stage due to the lack of generally accepted quantitative approaches. It is an ideal time to summarize the existing progress to guide future research. To this end, a systematic review of the literature on CRA issues dealing with combinations of environmental and psychosocial stressors was conducted in this study. Using typology and bibliometric analysis, the body of knowledge, hot topics, and research gaps in this field were characterized. It was found that research topics and objectives mainly focus on qualitative analysis and community settings; more attention should be paid to the development of quantitative approaches and the inclusion of occupational settings. Further, the roles of air pollution and vulnerability factors in CRA have attracted the most attention. This study concludes with views on future prospects to promote theoretical and practical development in this field; specifically, CRA is a multifaceted topic that requires substantial collaborations with various stakeholders and substantial knowledge from multidisciplinary fields. This study presents an overall review as well as research directions worth investigating in this field, which provides a historical reference for future study. Integr Environ Assess Manag 2024;20:602-615. © 2023 SETAC.

Characterisation of the risk associated with chronic lifetime exposure to mixture of chemical hazards: case study of trace elements

Risk assessment methodology, mostly commonly used, faces the complexity of the environment. Populations are exposed to multiple sources of chemicals throughout life and the chemical mixtures they are exposed change during time (lifestyle factors, regulatory decisions, etc). The risk assessment needs to consider these dynamics and the evolution of the body with age, in order to refine the exposure assessment to chemicals and to predict the health impact of these exposures. This review highlights the latest methodologies developed to improve risk assessment, especially cor heavy metals. The methodologies aim to better describe the chemical toxicokinetic and toxicodynamic as well as the exposure assessment. Human Biomonitoring (HBM) data give great opportunities to link biomarkers of exposure with an adverse effect. Physiologically-Based Toxicokinetic (PBTK) models are more and more used to simulate the evolution of biomarkers in organisms, considering the external exposures and the physiological evolutions. PBTK models may also be used to determine the routes of exposure or to predict the impacts of schemes of exposure. The major limit is the integration of several chemicals in mixture with common adverse effects and the interactions between them.

A systematic review of the toxic effects of a nanopesticide on non-target organisms: Estimation of protective concentrations using a species sensitivity distribution (SSD) approach - The case of atrazine

Nanopesticides, such as nanoencapsulated atrazine (nATZ), have been studied and developed as eco-friendly alternatives to control weeds in fields, requiring lower doses. This review contains a historical and systematic literature review about the toxicity of nATZ to non-target species. In addition, the study establishes protective concentrations for non-target organisms through a species sensitivity distribution (SSD) approach. Through the systematic search, we identified 3197 publications. Of these, 14 studies addressed "(nano)atrazine's toxicity to non-target organisms". Chronological and geographic data on the publication of articles, characterization of nATZ (type of nanocarrier, size, polydispersity index, zeta potential), experimental design (test species, exposure time, measurements, methodology, tested concentrations), and toxic effects are summarized and discussed. The data indicate that cell and algal models do not show sensitivity to nATZ, while many terrestrial and aquatic invertebrates, aquatic vertebrates, microorganisms, and plants have high sensitivity to nAZT. The SSD results indicated that D. similis is the most sensitive species to nATZ, followed by C. elegans, E. crypticus, and P. subcapitata. However, the limitations in terms of the number of species and endpoints available to elaborate the SSD reflect gaps in knowledge of the effects of nATZ on different ecosystems.

Assessment of Preschool Children's Exposure Levels to Organophosphate and Pyrethroid Pesticide: A Human Biomonitoring Study in Two Turkish Provinces

Pesticides are products developed to prevent, destroy, repel or control certain forms of plant or animal life that are considered to be pests. However, now they are one of the critical risk factors threatening the environment, and they create a significant threat to the health of children. Organophosphate (OP) and pyrethroid (PYR) pesticides are widely used in Turkey as well as all over the world. The main focus of this presented study was to analyze the OP and PYR exposure levels in urine samples obtained from 3- to 6-year-old Turkish preschool children who live in the Ankara (n:132) and Mersin (n:54) provinces. In order to measure the concentrations of three nonspecific metabolites of PYR insecticides and four nonspecific and one specific metabolite of OPs, liquid chromatography-tandem mass spectrometry (LC-MS/MS) analyses were performed. The nonspecific PYR metabolite 3-phenoxybenzoic acid (3-PBA) found in 87.1% of samples (n = 162) and the specific OP metabolite 3,5,6-trichloro-2-pyridinol (TCPY) found in 60.2% of samples (n = 112) were the most frequently detected metabolites in all urine samples. The mean concentrations of 3-PBA and TCPY were 0.38 ± 0.8 and 0.11 ± 0.43 ng/g creatinine, respectively. Although due to the large individual variation no statistically significant differences were found between 3-PBA (p = 0.9969) and TCPY (p = 0.6558) urine levels in the two provinces, significant exposure differences were determined both between provinces and within the province in terms of gender. Risk assessment strategies performed in light of our findings do not disclose any proof of a possible health problems related to analyzed pesticide exposure in Turkish children.

Heavy metals and inflammatory, oxidative/antioxidant and DNA damage biomarkers among people living with HIV/AIDS (PLWHA) in Niger Delta, Nigeria

This study evaluated the association of heavy metals (HMs) and effect biomarkers (inflammation, oxidative stress/antioxidant capacity and DNA damage) among people living with HIV/AIDS (PHWHA) in Niger Delta area, Nigeria. Blood levels of lead (BPb), cadmium (BCd), copper (BCu), zinc (BZn), iron (BFe), C-reactive protein (CRP), Interleukin-6 (IL-6), Tumor necrosis factor-α (TNF-α), Interferon-γ (IFN-γ), Malondialdehyde (MDA), Glutathione (GSH) and 8-hydroxy-2-deoxyguanosine (8-OHdG) were determined in a total of 185 participants, 104 HIV-positive and 81 HIV-negative sampled in both Niger Delta and non-Niger Delta regions. BCd (p < 0.001) and BPb (p = 0.139) were higher in HIV-positive subjects compared to HIV-negative controls; on the contrary, BCu, BZn and BFe levels were lower (p < 0.001) in HIV-positive subjects compared to HIV-negative controls. The Niger Delta population had higher levels of heavy metals (p < 0.01) compared to non-Niger Delta residents. CRP and 8-OHdG were higher (p < 0.001) in HIV-positive than in HIV-negative subjects and in Niger-Delta than in non-Niger Delta residents. BCu had significant positive dose-response relationship with CRP (61.9%, p = 0.063) and GSH (1.64%, p = 0.035) levels in HIV-positive subjects, and negative response with MDA levels (26.6%, p < 0.001). Periodic assessment of HMs levels among PLWHA is recommended.

Human health risk assessment for contaminated sites: A retrospective review

Soil contamination is a serious global hazard as contaminants can migrate to the human body through the soil, water, air, and food, threatening human health. Human Health Risk Assessment (HHRA) is a commonly used method for estimating the magnitude and probability of adverse health effects in humans that may be exposed to contaminants in contaminated environmental media in the present or future. Such estimations have improved for decades with various risk assessment frameworks and well-established models. However, the existing literature does not provide a comprehensive overview of the methods and models of HHRA that are needed to grasp the current status of HHRA and future research directions. Thus, this paper aims to systematically review the HHRA approaches and models, particularly those related to contaminated sites from peer-reviewed literature and guidelines. The approaches and models focus on methods used in hazard identification, toxicity databases in dose-response assessment, approaches and fate and transport models in exposure assessment, risk characterization, and uncertainty characterization. The features and applicability of the most commonly used HHRA tools are also described. The future research trend for HHRA for contaminated sites is also forecasted. The transition from animal experiments to new methods in risk identification, the integration and update and sharing of existing toxicity databases, the integration of human biomonitoring into the risk assessment process, and the integration of migration and transformation models and risk assessment are the way forward for risk assessment in the future. This review provides readers with an overall understanding of HHRA and a grasp of its developmental direction.

South American National Contributions to Knowledge of the Effects of Endocrine Disrupting Chemicals in Wild Animals: Current and Future Directions

Human pressure due to industrial and agricultural development has resulted in a biodiversity crisis. Environmental pollution is one of its drivers, including contamination of wildlife by chemicals emitted into the air, soil, and water. Chemicals released into the environment, even at low concentrations, may pose a negative effect on organisms. These chemicals might modify the synthesis, metabolism, and mode of action of hormones. This can lead to failures in reproduction, growth, and development of organisms potentially impacting their fitness. In this review, we focused on assessing the current knowledge on concentrations and possible effects of endocrine disruptor chemicals (metals, persistent organic pollutants, and others) in studies performed in South America, with findings at reproductive and thyroid levels. Our literature search revealed that most studies have focused on measuring the concentrations of compounds that act as endocrine disruptors in animals at the systemic level. However, few studies have evaluated the effects at a reproductive level, while information at thyroid disorders is scarce. Most studies have been conducted in fish by researchers from Brazil, Argentina, Chile, and Colombia. Comparison of results across studies is difficult due to the lack of standardization of units in the reported data. Future studies should prioritize research on emergent contaminants, evaluate effects on native species and the use of current available methods such as the OMICs. Additionally, there is a primary focus on organisms related to aquatic environments, and those inhabiting terrestrial environments are scarce or nonexistent. Finally, we highlight a lack of funding at a national level in the reviewed topic that may influence the observed low scientific productivity in several countries, which is often negatively associated with their percentage of protected areas.

Understanding the combined effects of multiple stressors: A new perspective on a longstanding challenge

Wildlife populations and their habitats are exposed to an expanding diversity and intensity of stressors caused by human activities, within the broader context of natural processes and increasing pressure from climate change. Estimating how these multiple stressors affect individuals, populations, and ecosystems is thus of growing importance. However, their combined effects often cannot be predicted reliably from the individual effects of each stressor, and we lack the mechanistic understanding and analytical tools to predict their joint outcomes. We review the science of multiple stressors and present a conceptual framework that captures and reconciles the variety of existing approaches for assessing combined effects. Specifically, we show that all approaches lie along a spectrum, reflecting increasing assumptions about the mechanisms that regulate the action of single stressors and their combined effects. An emphasis on mechanisms improves analytical precision and predictive power but could introduce bias if the underlying assumptions are incorrect. A purely empirical approach has less risk of bias but requires adequate data on the effects of the full range of anticipated combinations of stressor types and magnitudes. We illustrate how this spectrum can be formalised into specific analytical methods, using an example of North Atlantic right whales feeding on limited prey resources while simultaneously being affected by entanglement in fishing gear. In practice, case-specific management needs and data availability will guide the exploration of the stressor combinations of interest and the selection of a suitable trade-off between precision and bias. We argue that the primary goal for adaptive management should be to identify the most practical and effective ways to remove or reduce specific combinations of stressors, bringing the risk of adverse impacts on populations and ecosystems below acceptable thresholds.

Identification and Characterization of mRNA Biomarkers for Sodium Cyanide Exposure

Biomarkers in exposure assessment are defined as the quantifiable targets that indicate the exposure to hazardous chemicals and their resulting health effect. In this study, we aimed to identify, validate, and characterize the mRNA biomarker that can detect the exposure of sodium cyanide. To identify reliable biomarkers for sodium cyanide exposure, critical criteria were defined for candidate selection: (1) the expression level of mRNA significantly changes in response to sodium thiocyanate treatment in transcriptomics results (fold change > 2.0 or <0.50, adjusted p-value < 0.05); and (2) the mRNA level is significantly modulated by sodium cyanide exposure in both normal human lung cells and rat lung tissue. We identified the following mRNA biomarker candidates: ADCY5, ANGPTL4, CCNG2, CD9, COL1A2, DACT3, GGCX, GRB14, H1F0, HSPA1A, MAF, MAT2A, PPP1R10, and PPP4C. The expression levels of these candidates were commonly downregulated by sodium cyanide exposure both in vitro and in vivo. We functionally characterized the biomarkers and established the impact of sodium cyanide on transcriptomic profiles using in silico approaches. Our results suggest that the biomarkers may contribute to the regulation and degradation of the extracellular matrix, leading to a negative effect on surrounding lung cells.

Molecular toxicology and carcinogenesis of fumonisins: a review

Fumonisins, discovered in 1988 are a group of naturally occurring toxins produced by fusarium pathogenic fungi. Besides their presence in animal feeds, contamination of human foods such as corn, millet, oats, rye, barley, wheat and their products are widespread. Exposure to fumonisins results in species and organ specific toxicities including neurological disorders among equids, pulmonary edema in swine, esophageal cancer in humans and both kidney and liver related toxicities in rodents. This review seeks to consolidate groundbreaking research on the science of fumonisins toxicity, highlight recent progress on fumonisins research, and provide an overview of plausible mechanistic biomarkers for fumonisins exposure assessment.

Electrophysiological responses in Amazonian fish species Bryconops caudomaculatus (Osteichthyes: Characiformes) as biomarkers of xenobiotic toxicity

Sublethal exposures to environmental pollutants may cause changes in physiological parameters. Thus, knowledge of basal physiological rates of the species and the development of methods to quantify these rates are extremely important. Considering the scarcity of cardiac and muscle physiological studies in native Amazonian fish species and that no evaluation of electrophysiological responses by exposure to a stressor has been reported in Bryconops caudomaculatus, the aim of this study was to develop techniques of electromyographic and electrocardiographic recordings of normal responses, during toxicity induction and short-term recovery. A total of 9 animals were used, divided into two groups: control group (n = 4) and treated group (n = 5), with records lasting 5 min. The results showed that the basal electromyographic records indicate that the studied species has a very intense swimming activity, whereas the basal cardiac parameters clearly showed the patterns in P wave tracing, QRS complex, T wave and Q-T and R-R intervals. During exposure to the stressor, muscle activity ceased presenting intense decrease and myorelaxant effect expected. Electrocardiographic responses confirmed cardiotoxicity with intense bradycardia, ventricular bigeminism, prolongation of QRS complex duration and cardiac arrhythmias, indicating cardiac dysfunction. It was concluded that the electrophysiological responses are excellent biomarkers and showed the susceptibility of the species to the tested substance. In addition, the electrocardiogram and the electromyogram are excellent techniques to reflect the degree of environmental stress when organisms are exposed to toxic substances in the environment.

Biomonitoring of non-persistent pesticides in urine from lactating mothers: Exposure and risk assessment

The aim of the present study was to assess the exposure to pesticides in urine from Spanish lactating mothers (n = 116). Six nonspecific (dialkyl phosphates) and 20 specific metabolites of organophosphate pesticides (OPs), herbicides and pyrethroids were analyzed. The most frequently detected biomarkers were diethyl phosphate, p-nitrophenol, 3,5,6-trichloro-2-pyridinol and 3-phenoxybenzoic acid, whose geometric means were 1.9 ng·mL^-1, 0.8 ng·mL^-1, 1.5 ng·mL^-1 and 1.4 ng·mL^-1, respectively. Herbicide metabolites were the least frequently detected biomarkers with detection frequencies between 0% (2,4,5-Trichlorophenoxyacetic acid) and 22% (2,4-Dichlorophenoxyacetic acid). Multiple regression analyses showed that the closeness to a farming activity, the place of residence and the presence of garden/plants at home were some of the most important contributors to urinary levels of pesticide metabolites. Estimated daily intake (EDI), hazard quotient (HQ) and hazard index (HI) were obtained in order to interpret urinary levels of the most frequently detected pesticide metabolites in a risk assessment context. The highest EDIs were obtained for chlorpyrifos (0.40-1.14 μg·kg bw^-1·day^-1) and deltamethrin (0.34-4.73 μg·kg bw^-1·day^-1). The calculated HQ for chlorpyrifos, dimethoate, parathion and deltamethrin ranged from 0.01 to 0.47, and HI for OPs ranged from 0.09 to 0.33 showing that apparently there were low health risks due to the exposure to these pesticides in this group of Spanish breastfeeding women.

Experimental modeling of the acute toxicity and cytogenotoxic fate of composite mixtures of chromate, copper and arsenate oxides associated with CCA preservative using Clarias gariepinus (Burchell 1822)

Concurrent occurrence of chromium (Cr), copper (Cu) and arsenic (As) from chromated copper arsenate (CCA) wood preservative in aquatic ecosystems demands that their joint-actions in eliciting toxic effects be assessed for adequate understanding of the health risk they may pose to biota. Clarias gariepinus was exposed to As₂O₃ , CrO₃ and CuO and their composite mixtures (1:1 and 1:1:1) at various concentrations (0 – 600 mg/L) for 96-h to determine the acute toxicity using OECD (1992) protocol. C. gariepinus was then exposed to sub-lethal concentrations corresponding to 6.25, 12.5, 25.0, 50.0 and 100% of the 96-h LC₅₀ for 7 days to assess the cytogenotoxic effects using piscine micronucleus (MN) test. The 96-h LC₅₀ showed that the metals/metalloid demonstrated differential interactions in a concentration dependent pattern. The 96-h LC₅₀ showed that Cr was the most toxic while Cu and As:Cu were indeterminate (Cr > Cr:Cu > As:Cr > As > As:Cr:Cu > Cu = As:Cu indeterminate). Isobologram and synergistic ratio (SR) models predicted antagonistic interaction between Cu:Cr and As:Cr and synergism between As:Cu in the causation of morbidity and mortality of C. gariepinus. Interaction factor model predicted antagonism as common interactive mechanism among the metal/metalloid mixtures in the induction of MN and abnormal nuclear erythrocytes in C. gariepinus. Predicted interactions among the three metals/ metalloid were largely antagonism and synergism towards the induction of acute toxicity and cytogenotoxicity. The models employed herein may be useful in establishing environmental safe limits for mixtures of metals/metalloids against the induction of acute toxicity and DNA damage in lower aquatic vertebrates.

A multibiomarker approach to evaluate the effect of polyaromatic hydrocarbon exposure on oxidative and genotoxic damage in tandoor workers

We conducted a cohort study of tandoor workers to evaluate the relationship between the biomarkers of oxidative and genotoxic damage and exposure to polyaromatic hydrocarbons. A series of oxidative and genotoxic damage biomarkers, including urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG), malondialdehyde (MDA) content, and tail moment (TM) by comet assay, was studied. A total of 76 tandoor workers and 79 demographically matched healthy individuals as controls were included. Our results showed that the tandoor workers had significantly higher urinary levels of 1-hydroxypyrene, urinary 8-OHdG, MDA content, and TM compared with the control population. The concentration of all these biomarkers increased with age in the control population as well as tandoor workers. In tandoor workers, significant variation in MDA, 8-oxodG (8-oxo-2′-deoxyguanosine) and TM concentration was detected between smokers (5.08 ± 1.72 nmol/mL, 16.01 ± 4.94 ng/mg creatinine, and 5.87 ± 0.98 µm, respectively) and nonsmokers (3.84 ± 0.98 nmol/mL, 13.74 ± 3.60 ng/mg creatinine, and 5.32 ± 0.69 µm, respectively). A similar pattern was obtained for the control population. We did not obtain significant variations for alcoholics and tobacco chewers. A significant increase in all these three biomarkers was observed with the increase in the period of work exposure in tandoor workers. Multivariate regression analysis also revealed that urinary 8-oxodG, MDA, and TM were statistically significantly related to age and period of work exposure. Overall, the present study showed that the exposure to wood smoke in tandoor workers under occupational conditions led to increased DNA damage because of oxidative stress and genotoxicity. These biomarkers, therefore, are good indices to assess oxidative DNA damage in these workers exposed to occupational genotoxicants. It is also necessary to make preventive changes in work conditions and lifestyle, which will help these occupational workers to lead a healthy life.

Ionizing radiation exposure: hazards, prevention, and biomarker screening

Radiation is a form of energy derived from a source that is propagated through material in space. It consists of ionizing radiation or nonionizing radiation. Ionizing radiation is a feature of the environment and an important tool in medical treatment, but it can cause serious damage to organisms. A number of protective measures and standards of protection have been proposed to protect against radiation. There is also a need for biomarkers to rapidly assess individual doses of radiation, which can not only estimate the dose of radiation but also determine its effects on health. Proteomics, genomics, metabolomics, and lipidomics have been widely used in the search for such biomarkers. These topics are discussed in depth in this review.

Preparation and performance features of wristband samplers and considerations for chemical exposure assessment

Wristbands are increasingly used for assessing personal chemical exposures. Unlike some exposure assessment tools, guidelines for wristbands, such as preparation, applicable chemicals, and transport and storage logistics, are lacking. We tested the wristband's capacity to capture and retain 148 chemicals including polychlorinated biphenyls (PCBs), pesticides, flame retardants, polycyclic aromatic hydrocarbons (PAHs), and volatile organic chemicals (VOCs). The chemicals span a wide range of physical-chemical properties, with log octanol-air partitioning coefficients from 2.1 to 13.7. All chemicals were quantitatively and precisely recovered from initial exposures, averaging 102% recovery with relative SD ≤21%. In simulated transport conditions at +30 °C, SVOCs were stable up to 1 month (average: 104%) and VOC levels were unchanged (average: 99%) for 7 days. During long-term storage at -20 °C up to 3 (VOCs) or 6 months (SVOCs), all chemical levels were stable from chemical degradation or diffusional losses, averaging 110%. Applying a paired wristband/active sampler study with human participants, the first estimates of wristband-air partitioning coefficients for PAHs are presented to aid in environmental air concentration estimates. Extrapolation of these stability results to other chemicals within the same physical-chemical parameters is expected to yield similar results. As we better define wristband characteristics, wristbands can be better integrated in exposure science and epidemiological studies.

Developmental neurotoxicity of the organophosphorus insecticide chlorpyrifos: from clinical findings to preclinical models and potential mechanisms

Organophosphorus (OP) insecticides are pest-control agents heavily used worldwide. Unfortunately, they are also well known for the toxic effects that they can trigger in humans. Clinical manifestations of an acute exposure of humans to OP insecticides include a well-defined cholinergic crisis that develops as a result of the irreversible inhibition of acetylcholinesterase (AChE), the enzyme that hydrolyzes the neurotransmitter acetylcholine (ACh). Prolonged exposures to levels of OP insecticides that are insufficient to trigger signs of acute intoxication, which are hereafter referred to as subacute exposures, have also been associated with neurological deficits. In particular, epidemiological studies have reported statistically significant correlations between prenatal subacute exposures to OP insecticides, including chlorpyrifos, and neurological deficits that range from cognitive impairments to tremors in childhood. The primary objectives of this article are: (i) to address the short- and long-term neurological issues that have been associated with acute and subacute exposures of humans to OP insecticides, especially early in life (ii) to discuss the translational relevance of animal models of developmental exposure to OP insecticides, and (iii) to review mechanisms that are likely to contribute to the developmental neurotoxicity of OP insecticides. Most of the discussion will be focused on chlorpyrifos, the top-selling OP insecticide in the United States and throughout the world. These points are critical for the identification and development of safe and effective interventions to counter and/or prevent the neurotoxic effects of these chemicals in the developing brain. This is an article for the special issue XVth International Symposium on Cholinergic Mechanisms.

Causal inference in cumulative risk assessment: The roles of directed acyclic graphs

Cumulative risk assessments (CRAs) address exposures to multiple chemical and nonchemical stressors and often focus on characterization of health risks in vulnerable populations. Evaluating complex exposure-response relationships in CRAs requires the use of formal and rigorous methods for causal inference. Directed acyclic graphs (DAGs) are graphical causal models used to organize and communicate knowledge about the underlying causal structure that generates observable data. Using existing graphical theories for causal inference with DAGs, risk analysts can identify confounders and effect measure modifiers to determine if the available data are both internally valid to obtain unbiased risk estimates and are generalizable to populations of interest. Conditional independencies implied by the structure of a DAG can be used to test assumptions used in a CRA against empirical data in a selected study and can contribute to the evidence evaluations related to specific causal pathways. This can facilitate quantitative use of these data, as well as help identify key research gaps, prioritize data collection activities, and evaluate risk management alternatives. DAGs also enable risk analysts to be explicit about sources of uncertainty and to determine whether a causal effect can be estimated from available data. Using a conceptual model and DAG for a hypothetical community located near a concentrated animal feeding operation (CAFO), we illustrate the advantages of using DAGs for evaluating causality in CRAs. DAGs also can be used in conjunction with weight of evidence (WOE) methodology to improve causal analysis for CRA, which could lead to more effective interventions to reduce population health risks.

An Overview of Literature Topics Related to Current Concepts, Methods, Tools, and Applications for Cumulative Risk Assessment (2007-2016)

Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for CRA over the past decade. Work in both human health and ecological cumulative risk has advanced in two different contexts. The first context is the effects of chemical mixtures that share common modes of action, or that cause common adverse outcomes. In this context two primary models are used for predicting mixture effects, dose addition or response addition. The second context is evaluating the combined effects of chemical and nonchemical (e.g., radiation, biological, nutritional, economic, psychological, habitat alteration, land-use change, global climate change, and natural disasters) stressors. CRA can be adapted to address risk in many contexts, and this adaptability is reflected in the range in disciplinary perspectives in the published literature. This article presents the results of a literature search and discusses a range of selected work with the intention to give a broad overview of relevant topics and provide a starting point for researchers interested in CRA applications.

Evaluation of area contaminated by wood treatment activities: Genetic markers in the environment and in the child population

Wood preservation activities and related compounds are a problem since these areas have major environmental contamination liabilities which compromise the health of the surrounding population and the integrity of ecological processes. The present study evaluated an area influenced by soil contamination arising from the activities of a deactivated wood treatment plant. The presence and effect of mutagenic compounds in environmental samples were used as markers of exposure together with the evaluation biomarkers of genetic damage in children. Organic extracts from samples of public source water and from fine atmospheric particulate matter (PM2.5) were evaluated for mutagenic potential using the Salmonella/microsome assay. Children living in the area surrounding the plant were analyzed for genetic damage assessed by the comet assay in lymphocytes and micronucleus test (MN) in lymphocytes and oral mucosa and compared to a group living in an area outside the preferential quadrant of atmospheric dispersion and in opposition to the drainage at the site. The mutagenic effect and PAHs concentrations found were similar to studies that evaluated intensely occupied urban areas and those under industrial influence. The MN frequencies in lymphocytes and binucleated cells in the oral mucosa were significantly higher in the risk group. No significant differences were observed in the other genetic damage biomarkers evaluated. The presence of pollutants with a mutagenic and carcinogenic effect on the PM2.5 and the increased in some biomarkers indicate that the population is potentially exposed to substances capable of causing adverse health effects and atmospheric airborne is a possible exposure route.

A decade of environmental public health tracking (2002-2012): progress and challenges

BACKGROUND

The creation of the Centers for Disease Control and Prevention Environmental Public Health Tracking Program spawned an invigorating and challenging approach toward implementing the nation's first population-based, environmental disease tracking surveillance system. More than 10 years have passed since its creation and an abundance of peer-reviewed articles have been published spanning a broad variety of public health topics related primarily to the goal of reducing diseases of environmental origin.

OBJECTIVE

To evaluate peer-reviewed literature related to Environmental Public Health Tracking during 2002-2012, recognize major milestones and challenges, and offer recommendations.

DESIGN

A narrative overview was conducted using titles and abstracts of peer-reviewed articles, key word searches, and science-based search engine databases.

MAIN OUTCOMES

Eighty published articles related to "health tracking" were identified and categorized according to 4 crossed-central themes. The Science and Research theme accounted for the majority of published articles, followed by Policy and Practice, Collaborations Among Health and Environmental Programs, and Network Development.

CONCLUSIONS

Overall, progress was reported in the areas of data linkage, data sharing, surveillance methods, and network development. Ongoing challenges included formulating better ways to establish the connections between health and the environment, such as using biomonitoring, public water systems, and private well water data. Recommendations for future efforts include use of data to inform policy and practice and use of electronic health records data for environmental health surveillance.

Cumulative risk assessment lessons learned: a review of case studies and issue papers

Cumulative risk assessments (CRAs) examine potential risks posed by exposure to multiple and sometimes disparate environmental stressors. CRAs are more resource intensive than single chemical assessments, and pose additional challenges and sources of uncertainty. CRAs may examine the impact of several factors on risk, including exposure magnitude and timing, chemical mixture composition, as well as physical, biological, or psychosocial stressors. CRAs are meant to increase the relevance of risk assessments, providing decision makers with information based on real world exposure scenarios that improve the characterization of actual risks and hazards. The U.S. Environmental Protection Agency has evaluated a number of CRAs, performed by or commissioned for the Agency, to seek insight into CRA concepts, methods, and lessons learned. In this article, ten case studies and five issue papers on key CRA topics are examined and a set of lessons learned are identified for CRA implementation. The lessons address the iterative nature of CRAs, importance of considering vulnerability, need for stakeholder engagement, value of a tiered approach, new methods to assess multiroute exposures to chemical mixtures, and the impact of geographical scale on approach and purpose.

Considerations for Using Genetic and Epigenetic Information in Occupational Health Risk Assessment and Standard Setting

Risk assessment forms the basis for both occupational health decision-making and the development of occupational exposure limits (OELs). Although genetic and epigenetic data have not been widely used in risk assessment and ultimately, standard setting, it is possible to envision such uses. A growing body of literature demonstrates that genetic and epigenetic factors condition biological responses to occupational and environmental hazards or serve as targets of them. This presentation addresses the considerations for using genetic and epigenetic information in risk assessments, provides guidance on using this information within the classic risk assessment paradigm, and describes a framework to organize thinking about such uses. The framework is a 4 × 4 matrix involving the risk assessment functions (hazard identification, dose-response modeling, exposure assessment, and risk characterization) on one axis and inherited and acquired genetic and epigenetic data on the other axis. The cells in the matrix identify how genetic and epigenetic data can be used for each risk assessment function. Generally, genetic and epigenetic data might be used as endpoints in hazard identification, as indicators of exposure, as effect modifiers in exposure assessment and dose-response modeling, as descriptors of mode of action, and to characterize toxicity pathways. Vast amounts of genetic and epigenetic data may be generated by high-throughput technologies. These data can be useful for assessing variability and reducing uncertainty in extrapolations, and they may serve as the foundation upon which identification of biological perturbations would lead to a new paradigm of toxicity pathway-based risk assessments.

Considerations for Using Genetic and Epigenetic Information in Occupational Health Risk Assessment and Standard Setting

Risk assessment forms the basis for both occupational health decision-making and the development of occupational exposure limits (OELs). Although genetic and epigenetic data have not been widely used in risk assessment and ultimately, standard setting, it is possible to envision such uses. A growing body of literature demonstrates that genetic and epigenetic factors condition biological responses to occupational and environmental hazards or serve as targets of them. This presentation addresses the considerations for using genetic and epigenetic information in risk assessments, provides guidance on using this information within the classic risk assessment paradigm, and describes a framework to organize thinking about such uses. The framework is a 4 × 4 matrix involving the risk assessment functions (hazard identification, dose-response modeling, exposure assessment, and risk characterization) on one axis and inherited and acquired genetic and epigenetic data on the other axis. The cells in the matrix identify how genetic and epigenetic data can be used for each risk assessment function. Generally, genetic and epigenetic data might be used as endpoints in hazard identification, as indicators of exposure, as effect modifiers in exposure assessment and dose-response modeling, as descriptors of mode of action, and to characterize toxicity pathways. Vast amounts of genetic and epigenetic data may be generated by high-throughput technologies. These data can be useful for assessing variability and reducing uncertainty in extrapolations, and they may serve as the foundation upon which identification of biological perturbations would lead to a new paradigm of toxicity pathway-based risk assessments.

Modeling autism: a systems biology approach

Autism is the fastest growing developmental disorder in the world today. The prevalence of autism in the US has risen from 1 in 2500 in 1970 to 1 in 88 children today. People with autism present with repetitive movements and with social and communication impairments. These impairments can range from mild to profound. The estimated total lifetime societal cost of caring for one individual with autism is $3.2 million US dollars. With the rapid growth in this disorder and the great expense of caring for those with autism, it is imperative for both individuals and society that techniques be developed to model and understand autism. There is increasing evidence that those individuals diagnosed with autism present with highly diverse set of abnormalities affecting multiple systems of the body. To this date, little to no work has been done using a whole body systems biology approach to model the characteristics of this disorder. Identification and modelling of these systems might lead to new and improved treatment protocols, better diagnosis and treatment of the affected systems, which might lead to improved quality of life by themselves, and, in addition, might also help the core symptoms of autism due to the potential interconnections between the brain and nervous system with all these other systems being modeled. This paper first reviews research which shows that autism impacts many systems in the body, including the metabolic, mitochondrial, immunological, gastrointestinal and the neurological. These systems interact in complex and highly interdependent ways. Many of these disturbances have effects in most of the systems of the body. In particular, clinical evidence exists for increased oxidative stress, inflammation, and immune and mitochondrial dysfunction which can affect almost every cell in the body. Three promising research areas are discussed, hierarchical, subgroup analysis and modeling over time. This paper reviews some of the systems disturbed in autism and suggests several systems biology research areas. Autism poses a rich test bed for systems biology modeling techniques.

Pathogenic infection confounds induction of the estrogenic biomarker vitellogenin in rainbow trout

To examine the behavior of the estrogenic biomarker vitellogenin (VTG) under the combined impact of estrogens and pathogens, parasite-infected or noninfected rainbow trout were exposed to two doses of 17β-estradiol (E2). Infected and E2-exposed fish showed significantly lower hepatic VTG mRNA levels than healthy fish. Transcriptome data suggest that this was due to energetic constraints. Reduced responsiveness of the VTG biomarker in parasitized fish might obscure detection of low-level field exposure.

Mercury concentrations in hair from neonatal and juvenile Steller Sea Lions (Eumetopias jubatus): implications based on age and region in this northern Pacific marine sentinel piscivore

Mercury is a global contaminant of concern for the fetus and the neonate of piscivores. Methylmercury, produced within marine ecosystems, is of particular concern as a readily absorbed neurotoxicant transported across the blood brain barrier and transplacentally. In the North Pacific Ocean, Steller sea lions are broadly distributed apex predators and, as such, integrate complex food webs and the associated exposure and possible adverse effects of toxic and infectious agents. Hair, including lanugo, was examined using regional and age groupings to assess mercury concentrations in young Alaskan Steller sea lions. The highest concentrations of mercury occurred in the youngest animals, likely via in utero exposure. Based on the adverse developmental outcomes of methylmercury toxicity this specific cohort is of concern. Regionally, higher concentrations of mercury were observed in the endangered western population of Steller sea lions and mirrored patterns observed in human biomonitoring studies of Alaskan coastal communities. These data have broader implications with respect to human and ecosystem health as Steller sea lions rely on similar prey species and foraging areas as those targeted by commercial fisheries and subsistence users and are therefore valuable sentinels of marine ecosystem health.

Cumulative risk assessment: an overview of methodological approaches for evaluating combined health effects from exposure to multiple environmental stressors

Systematic evaluation of cumulative health risks from the combined effects of multiple environmental stressors is becoming a vital component of risk-based decisions aimed at protecting human populations and communities. This article briefly examines the historical development of cumulative risk assessment as an analytical tool, and discusses current approaches for evaluating cumulative health effects from exposure to both chemical mixtures and combinations of chemical and nonchemical stressors. A comparison of stressor-based and effects-based assessment methods is presented, and the potential value of focusing on viable risk management options to limit the scope of cumulative evaluations is discussed. The ultimate goal of cumulative risk assessment is to provide answers to decision-relevant questions based on organized scientific analysis; even if the answers, at least for the time being, are inexact and uncertain.

Non-chemical stressors and cumulative risk assessment: an overview of current initiatives and potential air pollutant interactions

Regulatory agencies are under increased pressure to consider broader public health concerns that extend to multiple pollutant exposures, multiple exposure pathways, and vulnerable populations. Specifically, cumulative risk assessment initiatives have stressed the importance of considering both chemical and non-chemical stressors, such as socioeconomic status (SES) and related psychosocial stress, in evaluating health risks. The integration of non-chemical stressors into a cumulative risk assessment framework has been largely driven by evidence of health disparities across different segments of society that may also bear a disproportionate risk from chemical exposures. This review will discuss current efforts to advance the field of cumulative risk assessment, highlighting some of the major challenges, discussed within the construct of the traditional risk assessment paradigm. Additionally, we present a summary of studies of potential interactions between social stressors and air pollutants on health as an example of current research that supports the incorporation of non-chemical stressors into risk assessment. The results from these studies, while suggestive of possible interactions, are mixed and hindered by inconsistent application of social stress indicators. Overall, while there have been significant advances, further developments across all of the risk assessment stages (i.e., hazard identification, exposure assessment, dose-response, and risk characterization) are necessary to provide a scientific basis for regulatory actions and effective community interventions, particularly when considering non-chemical stressors. A better understanding of the biological underpinnings of social stress on disease and implications for chemical-based dose-response relationships is needed. Furthermore, when considering non-chemical stressors, an appropriate metric, or series of metrics, for risk characterization is also needed. Cumulative risk assessment research will benefit from coordination of information from several different scientific disciplines, including, for example, toxicology, epidemiology, nutrition, neurotoxicology, and the social sciences.

Review of pesticide urinary biomarker measurements from selected US EPA children's observational exposure studies

Children are exposed to a wide variety of pesticides originating from both outdoor and indoor sources. Several studies were conducted or funded by the EPA over the past decade to investigate children’s exposure to organophosphate and pyrethroid pesticides and the factors that impact their exposures. Urinary metabolite concentration measurements from these studies are consolidated here to identify trends, spatial and temporal patterns, and areas where further research is required. Namely, concentrations of the metabolites of chlorpyrifos (3,5,6-trichloro-2-pyridinol or TCPy), diazinon (2-isopropyl-6-methyl-4-pyrimidinol or IMP), and permethrin (3-phenoxybenzoic acid or 3-PBA) are presented. Information on the kinetic parameters describing absorption and elimination in humans is also presented to aid in interpretation. Metabolite concentrations varied more dramatically across studies for 3-PBA and IMP than for TCPy, with TCPy concentrations about an order of magnitude higher than the 3-PBA concentrations. Temporal variability was high for all metabolites with urinary 3-PBA concentrations slightly more consistent over time than the TCPy concentrations. Urinary biomarker levels provided only limited evidence of applications. The observed relationships between urinary metabolite levels and estimates of pesticide intake may be affected by differences in the contribution of each exposure route to total intake, which may vary with exposure intensity and across individuals.

Integrated exposure assessment of sewage workers to genotoxicants: an urinary biomarker approach and oxidative stress evaluation

BACKGROUND

Sewage workers are exposed to multiple chemicals among which many are suspected genotoxicants. Therefore, they might incur DNA damage and oxidative stress. We aimed to explore integrated urinary biomarkers, assessing the overall urine genotoxicity by in vitro comet and micronucleus assays and measuring urinary 8-oxo-2'-deoxyguanosine.

METHODS

During three consecutive working days, polycyclic aromatic hydrocarbons and volatile organic compounds were sampled in workplace air of 34 sewage and 30 office workers, as indicators of airborne exposure. The last day, subjects collected their 24 hours urine. Genotoxicity of urinary extracts was assessed by comet and micronucleus assays on a HepG2 cell line. Using competitive enzymatic immunoassay we evaluated the 24 hours urinary 8-oxo-2'-deoxyguanosine excretion. Benzo(a)pyrene toxicity equivalent factors and inhalation unit risk for Benzo(a)pyrene and benzene were used to give an estimate of cancer risk levels.

RESULTS

Workplace air concentrations of polycyclic aromatic hydrocarbons (e.g. 23.7 [range 2.4-104.6] ng.m-3 for fluoranthene) and volatile organic compounds (e.g. 19.1 ± 2.9 [standard error] μ.m-3 for benzene) were elevated in sewage compared to office workplaces (P < 0.01) and corresponded to an increased lifetime cancer risk. The urinary extracts of sewage workers showed higher genotoxicity (P < 0.001) than office workers.

CONCLUSIONS

The integrated and non-specific urinary biomarkers of exposure showed that sewage workers experience exposure to mixtures of genotoxicants in the workplace.

Combined toxic exposures and human health: biomarkers of exposure and effect

Procedures for risk assessment of chemical mixtures, combined and cumulative exposures are under development, but the scientific database needs considerable expansion. In particular, there is a lack of knowledge on how to monitor effects of complex exposures, and there are few reviews on biomonitoring complex exposures. In this review we summarize articles in which biomonitoring techniques have been developed and used. Most examples describe techniques for biomonitoring effects which may detect early changes induced by many chemical stressors and which have the potential to accelerate data gathering. Some emphasis is put on endocrine disrupters acting via epigenetic mechanisms and on carcinogens. Solid evidence shows that these groups of chemicals can interact and even produce synergistic effects. They may act during sensitive time windows and biomonitoring their effects in epidemiological studies is a challenging task.

Leveraging Epidemiology to Improve Risk Assessment

The field of environmental public health is at an important crossroad. Our current biomonitoring efforts document widespread exposure to a host of chemicals for which toxicity information is lacking. At the same time, advances in the fields of genomics, proteomics, metabolomics, genetics and epigenetics are yielding volumes of data at a rapid pace. Our ability to detect chemicals in biological and environmental media has far outpaced our ability to interpret their health relevance, and as a result, the environmental risk paradigm, in its current state, is antiquated and ill-equipped to make the best use of these new data. In light of new scientific developments and the pressing need to characterize the public health burdens of chemicals, it is imperative to reinvigorate the use of environmental epidemiology in chemical risk assessment. Two case studies of chemical assessments from the Environmental Protection Agency Integrated Risk Information System database are presented to illustrate opportunities where epidemiologic data could have been used in place of experimental animal data in dose-response assessment, or where different approaches, techniques, or studies could have been employed to better utilize existing epidemiologic evidence. Based on the case studies and what can be learned from recent scientific advances and improved approaches to utilizing human data for dose-response estimation, recommendations are provided for the disciplines of epidemiology and risk assessment for enhancing the role of epidemiologic data in hazard identification and dose-response assessment.

An overview of measurement method tools available to communities for conducting exposure and cumulative risk assessments

Community-based programs for assessing and mitigating environmental risks represent a challenge to participants because each brings a different level of understanding of the issues affecting the community. These programs often require the collaboration of several community sectors, such as community leaders, local governments and researchers. Once the primary concerns, community vulnerabilities and assets are identified, participants plan on how to address immediate actions, rank known risks, collect information to support decision making, set priorities and determine an evaluation process to assess the success of the actions taken. The evaluation process allows the community to develop new action plans based on the results obtained from earlier actions. Tracking the success of the community actions may be as simple as a visual/tangible result (e.g., cleaning a park) or as complex as the collection of specific measurements to track the reduction of toxic pollutants or to determine the presence of a specific contaminant. Recognizing that communities may need to perform measurements to meet their goals, this paper provides an overview of the available measurement methods for several chemicals and biologicals in relevant environmental samples to a community setting. The measurement methods are organized into several categories according to their level of complexity, estimated cost and sources. Community project technical advisors are encouraged to examine the objective(s) of the community to be addressed by a measurement collection effort and the level of confidence that needed for the data to make appropriate decisions. The tables provide a starting point for determining which measurement method may be appropriate for specific community needs.

Tools available to communities for conducting cumulative exposure and risk assessments

This paper summarizes and assesses over 70 tools that could aid with gathering information and taking action on environmental issues related to community-based cumulative risk assessments (CBCRA). Information on tool use, development and research needs, was gathered from websites, documents, and CBCRA program participants and researchers, including 25 project officers who work directly with community groups. The tools were assessed on the basis of information provided by project officers, community members, CBCRA researchers, and by case study applications. Tables summarize key environmental issues and tool features: (1) a listing of CBCRA-related environmental issues of concern to communities; (2) web-based tools that map environmental information; (3) step-by-step guidance documents; (4) databases of environmental information; and (5) computer models that simulate human exposure to chemical stressors. All tools described here are publicly available, with the focus being on tools developed by the US Environmental Protection Agency. These tables provide sources of information to promote risk identification and prioritization beyond risk perception approaches, and could be used by CBCRA participants and researchers. The purpose of this overview is twofold: (1) To present a comprehensive, though not exhaustive, summary of numerous tools that could aid with performing CBCRAs; and (2) To use this toolset as a sample of the current state of CBCRA tools to critically examine their utility and guide research for the development of new and improved tools.

Research needs for community-based risk assessment: findings from a multi-disciplinary workshop

Communities face exposures to multiple environmental toxicants and other non-chemical stressors. In addition, communities have unique activities and norms that influence exposure and vulnerability. Yet, few studies quantitatively consider the role of cumulative exposure and additive impacts. Community-based risk assessment (CBRA) is a new approach for risk assessment that aims to address the cumulative stressors faced by a particular community, while incorporating a community-based participatory research framework. This paper summarizes an Environmental Protection Agency (EPA) sponsored workshop, "Research Needs for Community-Based Risk Assessment." This workshop brought together environmental and public health scientists and practitioners for fostering an innovative discussion about tools, methods, models, and approaches for CBRA. This workshop was organized around three topics: (1) Data and Measurement Methods; (2) The Biological Impact of Non-Chemical Stressors and Interaction with Environmental Exposures; and (3) Statistical and Mathematical Modeling. This report summarizes the workshop discussions, presents identified research needs, and explores future research opportunities in this emerging field.

An emission-weighted proximity model for air pollution exposure assessment

BACKGROUND

Among the most common spatial models for estimating personal exposure are Traditional Proximity Models (TPMs). Though TPMs are straightforward to configure and interpret, they are prone to extensive errors in exposure estimates and do not provide prospective estimates.

METHOD

To resolve these inherent problems with TPMs, we introduce here a novel Emission Weighted Proximity Model (EWPM) to improve the TPM, which takes into consideration the emissions from all sources potentially influencing the receptors. EWPM performance was evaluated by comparing the normalized exposure risk values of sulfur dioxide (SO(2)) calculated by EWPM with those calculated by TPM and monitored observations over a one-year period in two large Texas counties. In order to investigate whether the limitations of TPM in potential exposure risk prediction without recorded incidence can be overcome, we also introduce a hybrid framework, a 'Geo-statistical EWPM'. Geo-statistical EWPM is a synthesis of Ordinary Kriging Geo-statistical interpolation and EWPM. The prediction results are presented as two potential exposure risk prediction maps. The performance of these two exposure maps in predicting individual SO(2) exposure risk was validated with 10 virtual cases in prospective exposure scenarios.

RESULTS

Risk values for EWPM were clearly more agreeable with the observed concentrations than those from TPM. Over the entire study area, the mean SO(2) exposure risk from EWPM was higher relative to TPM (1.00 vs. 0.91). The mean bias of the exposure risk values of 10 virtual cases between EWPM and 'Geo-statistical EWPM' are much smaller than those between TPM and 'Geo-statistical TPM' (5.12 vs. 24.63).

CONCLUSION

EWPM appears to more accurately portray individual exposure relative to TPM. The 'Geo-statistical EWPM' effectively augments the role of the standard proximity model and makes it possible to predict individual risk in future exposure scenarios resulting in adverse health effects from environmental pollution.

Air pollution exposure assessment methods utilized in epidemiological studies

The assessment of personal exposure to air pollution is a critical component of epidemiological studies associating air pollution and health effects. This paper critically reviewed 157 studies over 29 years that utilized one of five categories of exposure methods (proximity, air dispersion, hybrid, human inhalation, and biomarkers). Proximity models were found to be a questionable technique as they assume that closer proximity equates to greater exposure. Inhalation models and biomarker estimates were the most effective in assessing personal exposure, but are often cost prohibitive for large study populations. This review suggests that: (i) factors such as uncertainty, validity, data availability, and transferability related to exposure assessment methods should be considered when selecting a model; and (ii) although an entirely discreet new class of approach is not necessary, significant progress could be made through the development of a 'hybrid' model utilizing the strengths of several existing methods. Future work should systematically evaluate the performance of hybrid models compared to other individual exposure assessment methods utilizing geospatial information technologies (e.g. geographic information systems (GIS) and remote sensing (RS)) to more robustly refine estimates of ambient exposure and quantify the linkages and differences between outdoor, indoor and personal exposure estimates.

Exposure information in environmental health research: current opportunities and future directions for particulate matter, ozone, and toxic air pollutants

Understanding and quantifying outdoor and indoor sources of human exposure are essential but often not adequately addressed in health effect studies for air pollution. Air pollution epidemiology, risk assessment, health tracking, and accountability assessments are examples of health effect studies that require but often lack adequate exposure information. Recent advances in exposure modeling along with better information on time-activity and exposure factor data provide us with unique opportunities to improve the assignment of exposures for both future and ongoing studies linking air pollution to health impacts. In September 2006, scientists from the US Environmental Protection Agency and the Centers for Disease Control and Prevention along with scientists from the academic community and state health departments convened a symposium on air pollution exposure and health to identify, evaluate, and improve current approaches for linking air pollution exposures to disease. This manuscript presents the key issues, challenges, and recommendations identified by the exposure working group, who used case studies of particulate matter, ozone, and toxic air-pollutant exposure to evaluate health effects for air pollution. One of the overarching lessons of this workshop is that obtaining better exposure information for these different health effect studies requires both goal setting for what is needed and mapping out the transition pathway from current capabilities for meeting these goals. Meeting our long-term goals requires definition of incremental steps that provide useful information for the interim and move us toward our long-term goals. Another overarching theme among the three different pollutants and the different health study approaches is the need for integration among alternate exposure-assessment approaches. For example, different groups may advocate exposure indicators, biomonitoring, mapping methods (GIS), modeling, environmental media monitoring, and/or personal exposure modeling. However, emerging research reveals that the greatest progress comes from integration among two or more of these efforts.

Human biomonitoring data interpretation and ethics; obstacles or surmountable challenges?

The use of human samples to assess environmental exposure and uptake of chemicals is more than an analytical exercise and requires consideration of the utility and interpretation of data as well as due consideration of ethical issues. These aspects are inextricably linked.In 2004 the EC expressed its commitment to the development of a harmonised approach to human biomonitoring (HBM) by including an action in the EU Environment and Health Strategy to develop a Human Biomonitoring Pilot Study. This further underlined the need for interpretation strategies as well as guidance on ethical issues. A workshop held in December 2006 brought together stakeholders from academia, policy makers as well as non-governmental organisations and chemical industry associations to a two day workshop built a mutual understanding of the issues in an open and frank discussion forum. This paper describes the discussion and recommendations from the workshop.The workshop developed key recommendations for a Pan-European HBM Study: 1. A strategy for the interpretation of human biomonitoring data should be developed. 2. The pilot study should include the development of a strategy to integrate health data and environmental monitoring with human biomonitoring data at national and international levels. 3. Communication strategies should be developed when designing the study and evolve as the study continues. 4. Early communication with stakeholders is essential to achieve maximum efficacy of policy developments and facilitate subsequent monitoring. 5. Member states will have to apply individually for project approval from their National Research Ethics Committees. 6. The study population needs to have sufficient information on the way data will be gathered, interpreted and disseminated and how samples will be stored and used in the future (if biobanking) before they can give informed consent. 7. The participants must be given the option of anonymity. This has an impact on follow-up. 8. The pilot study should develop guidelines and best practice for Ethics for pan European studies.In conclusion all participants felt there that there has to be stakeholder involvement in any planned pan-European Human Biomonitoring Study and the format of the workshop was appropriate for such dialogue.

Neurobehavioral toxicology of pyrethroid insecticides in adult animals: a critical review

Pyrethroids are pesticides with high selectivity for insects. In order to identify strengths and gaps in the database for pyrethroid neurobehavioral toxicology, we have critically analyzed the data from peer-reviewed literature. This review includes dose-response data that have been recently generated demonstrating consistent findings for low-dose, acute, oral exposure to pyrethroids in small rodents. All pyrethroids tested (i.e., about twenty compounds), regardless of structure, produce a decrease in motor activity in a variety of test protocols. The range of relative potencies varies more than two orders of magnitude, and thresholds for motor activity were found well below doses that produce overt signs of poisoning. Six compounds (allethrin, permethrin, cis-permethrin, deltamethrin, cypermethrin, and fenvalerate) impair schedule-controlled operant responding, seven compounds (pyrethrum, bifenthrin, S-bioallethrin, permethrin, beta-cyfluthrin, cypermethrin, and deltamethrin) decrease grip strength, and two compounds (deltamethrin and alpha-cypermethrin) produce incoordination using the rotarod. In addition, while compounds lacking an alpha-cyano group (e.g., cismethrin, permethrin, bifenthrin) induce an increase in acoustic-evoked startle response amplitude, cyano compounds (e.g., deltamethrin, cypermethrin, cyfluthrin) produce the opposite outcome. Other endpoints (e.g., tremor intensity, sensory response) have been only occasionally explored. A synthesis of the neurobehavioral evidence relating to the action of pyrethroids indicates that some differences in the experimental findings across compounds are also present in the low-effective dose range. For risk assessment purposes, a strategy that takes into account data from an array of neurobehavioral endpoints is needed to capture the heterogeneity of pyrethroid-induced adverse effects and accurately inform policy decisions.

Vulnerability as a function of individual and group resources in cumulative risk assessment

BACKGROUND

The field of risk assessment has focused on protecting the health of individual people or populations of wildlife from single risks, mostly from chemical exposure. The U.S. Environmental Protection Agency recently began to address multiple risks to communities in the "Framework for Cumulative Risk Assessment" [EPA/630/P02/001F. Washington DC:Risk Assessment Forum, U.S. Environmental Protection Agency (2003)]. Simultaneously, several reports concluded that some individuals and groups are more vulnerable to environmental risks than the general population. However, vulnerability has received little specific attention in the risk assessment literature.

OBJECTIVE

Our objective is to examine the issue of vulnerability in cumulative risk assessment and present a conceptual framework rather than a comprehensive review of the literature. In this article we consider similarities between ecologic and human communities and the factors that make communities vulnerable to environmental risks.

DISCUSSION

The literature provides substantial evidence on single environmental factors and simple conditions that increase vulnerability or reduce resilience for humans and ecologic systems. This observation is especially true for individual people and populations of wildlife. Little research directly addresses the topic of vulnerability in cumulative risk situations, especially at the community level. The community level of organization has not been adequately considered as an end point in either human or ecologic risk assessment. Furthermore, current information on human risk does not completely explain the level of response in cumulative risk conditions. Ecologic risk situations are similarly more complex and unpredictable for cases of cumulative risk.

CONCLUSIONS

Psychosocial conditions and responses are the principal missing element for humans. We propose a model for including psychologic and social factors as an integral component of cumulative risk assessment.