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Vandenberg LN, Rayasam SDG, Axelrad DA, Bennett DH, Brown P, Carignan CC, Chartres N, Diamond ML, Joglekar R, Shamasunder B, Shrader-Frechette K, Subra WA, Zarker K, Woodruff TJ. Addressing systemic problems with exposure assessments to protect the public's health. Environ Health 2023; 21:121. [PMID: 36635700 PMCID: PMC9835264 DOI: 10.1186/s12940-022-00917-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Understanding, characterizing, and quantifying human exposures to environmental chemicals is critical to protect public health. Exposure assessments are key to determining risks to the general population and for specific subpopulations given that exposures differ between groups. Exposure data are also important for understanding where interventions, including public policies, should be targeted and the extent to which interventions have been successful. In this review, we aim to show how inadequacies in exposure assessments conducted by polluting industries or regulatory agencies have led to downplaying or disregarding exposure concerns raised by communities; that underestimates of exposure can lead regulatory agencies to conclude that unacceptable risks are, instead, acceptable, allowing pollutants to go unregulated; and that researchers, risk assessors, and policy makers need to better understand the issues that have affected exposure assessments and how appropriate use of exposure data can contribute to health-protective decisions. METHODS We describe current approaches used by regulatory agencies to estimate human exposures to environmental chemicals, including approaches to address limitations in exposure data. We then illustrate how some exposure assessments have been used to reach flawed conclusions about environmental chemicals and make recommendations for improvements. RESULTS Exposure data are important for communities, public health advocates, scientists, policy makers, and other groups to understand the extent of environmental exposures in diverse populations. We identify four areas where exposure assessments need to be improved due to systemic sources of error or uncertainty in exposure assessments and illustrate these areas with examples. These include: (1) an inability of regulatory agencies to keep pace with the increasing number of chemicals registered for use or assess their exposures, as well as complications added by use of 'confidential business information' which reduce available exposure data; (2) the failure to keep assessments up-to-date; (3) how inadequate assumptions about human behaviors and co-exposures contribute to underestimates of exposure; and (4) that insufficient models of toxicokinetics similarly affect exposure estimates. CONCLUSION We identified key issues that impact capacity to conduct scientifically robust exposure assessments. These issues must be addressed with scientific or policy approaches to improve estimates of exposure and protect public health.
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Affiliation(s)
- Laura N Vandenberg
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
| | - Swati D G Rayasam
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | | | - Deborah H Bennett
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Phil Brown
- Social Science Environmental Health Research Institute, Northeastern University, Boston, MA, USA
| | - Courtney C Carignan
- Department of Food Science and Human Nutrition, Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI, USA
| | - Nicholas Chartres
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Miriam L Diamond
- Department of Earth Sciences, University of Toronto, Toronto, ON, Canada
- School of the Environment, University of Toronto, Toronto, ON, Canada
| | - Rashmi Joglekar
- Earthjustice, New York, NY, USA
- Earthjustice, Washington, DC, USA
| | - Bhavna Shamasunder
- Department of Urban & Environmental Policy and Public Health, Occidental College, Los Angeles, CA, USA
| | - Kristin Shrader-Frechette
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA
- Department of Philosophy, University of Notre Dame, Notre Dame, IN, USA
| | - Wilma A Subra
- Louisiana Environmental Action Network, Baton Rouge, LA, USA
| | - Ken Zarker
- Washington State Department of Ecology, Olympia, WA, USA
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
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Ruadze E, Leonardi GS, Saei A, Khonelidze I, Sturua L, Getia V, Crabbe H, Marczylo T, Lauriola P, Gamkrelidze A. Reduction in Blood Lead Concentration in Children across the Republic of Georgia following Interventions to Address Widespread Exceedance of Reference Value in 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211903. [PMID: 34831657 PMCID: PMC8621835 DOI: 10.3390/ijerph182211903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 01/10/2023]
Abstract
In recent years, reports of lead contamination have dramatically increased in Georgia. Given concerns about the exposure of children to lead (Pb), the National Multiple Indicator Cluster Survey (MICS-2018) included a blood sampling component. The results showed that 41% of the children that participated had blood Pb levels (BLL) ≥ 5 µg/dL and that BLL in children living in Western Georgia were higher than those in Eastern regions. In response to these findings, NCDC implemented written and verbal advice to the families of children who participated in the MICS-2018 on how to reduce Pb exposure. From August 2019 onwards, the state program of clinical follow-up was implemented. The design of this study was a longitudinal study. The intervention of interest was the public health advice and medical follow-up, and the outcome was defined as the difference in BLL between the MICS-2018 survey and the state program follow-up. We observed a significant overall reduction in median BLL between MICS-2018 and state program follow-up in both August 2019 and the latest results (until December 2019). However, we did not observe any significant further reduction between August and the most recent BLL results. In the Georgian setting, written and verbal communication targeting individual households, alongside home visits to the most exposed, effectively reduced BLL in children.
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Affiliation(s)
- Ekaterine Ruadze
- The National Center for Disease Control and Public Health of Georgia, Tbilisi 0198, Georgia; (I.K.); (L.S.); (V.G.); (A.G.)
- Correspondence:
| | - Giovanni S. Leonardi
- UK Health Security Agency, Radiation, Chemical and Environmental Hazards, Harwell Campus, Didcot OX11 0RQ, UK; (G.S.L.); (H.C.); (T.M.)
- Department of Social and Environmental Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Ayoub Saei
- UK Health Security Agency, Statistics Unit, Department of Statistics, Modelling and Economics, London NW9 5EQ, UK;
| | - Irma Khonelidze
- The National Center for Disease Control and Public Health of Georgia, Tbilisi 0198, Georgia; (I.K.); (L.S.); (V.G.); (A.G.)
| | - Lela Sturua
- The National Center for Disease Control and Public Health of Georgia, Tbilisi 0198, Georgia; (I.K.); (L.S.); (V.G.); (A.G.)
| | - Vladimer Getia
- The National Center for Disease Control and Public Health of Georgia, Tbilisi 0198, Georgia; (I.K.); (L.S.); (V.G.); (A.G.)
| | - Helen Crabbe
- UK Health Security Agency, Radiation, Chemical and Environmental Hazards, Harwell Campus, Didcot OX11 0RQ, UK; (G.S.L.); (H.C.); (T.M.)
| | - Tim Marczylo
- UK Health Security Agency, Radiation, Chemical and Environmental Hazards, Harwell Campus, Didcot OX11 0RQ, UK; (G.S.L.); (H.C.); (T.M.)
| | - Paolo Lauriola
- International Society of Doctors for the Environment-Italy (ISDE-Italy), 42122 Modena, Italy;
| | - Amiran Gamkrelidze
- The National Center for Disease Control and Public Health of Georgia, Tbilisi 0198, Georgia; (I.K.); (L.S.); (V.G.); (A.G.)
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Mielke HW, Gonzales CR, Powell ET, Mielke PW. Environmental and health disparities in residential communities of New Orleans: the need for soil lead intervention to advance primary prevention. ENVIRONMENT INTERNATIONAL 2013; 51:73-81. [PMID: 23201779 DOI: 10.1016/j.envint.2012.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 10/24/2012] [Accepted: 10/30/2012] [Indexed: 05/28/2023]
Abstract
Urban environments are the major sites for human habitation and this study evaluates soil lead (Pb) and blood Pb at the community scale of a U.S. city. There is no safe level of Pb exposure for humans and novel primary Pb prevention strategies are requisite to mitigate children's Pb exposure and health disparities observed in major cities. We produced a rich source of environmental and Pb exposure data for metropolitan New Orleans by combining a large soil Pb database (n=5467) with blood Pb databases (n=55,551 pre-Katrina and 7384 post-Katrina) from the Louisiana Childhood Lead Poisoning Prevention Program (LACLPPP). Reanalysis of pre- and post-Hurricane Katrina soil samples indicates relatively unchanged soil Pb. The objective was to evaluate the New Orleans soil Pb and blood Pb database for basic information about conditions that may merit innovative ways to pursue primary Pb exposure prevention. The city was divided into high (median census tract soil≥100 mg/kg) and low Pb areas (median census tract soil<100mg/kg). Soil and blood Pb concentrations within the high and low Pb areas of New Orleans were analyzed by permutation statistical methods. The high Pb areas are toward the interior of the city where median soil Pb was 367, 313, 1228, and 103 mg/kg, respectively for samples collected at busy streets, residential streets, house sides, and open space locations; the low Pb areas are in outlying neighborhoods of the city where median soil Pb was 64, 46, 32, and 28 mg/kg, respectively for busy streets, residential streets, house sides, and open spaces (P-values<10(-16)). Pre-Katrina children's blood Pb prevalence of ≥5 μg/dL was 58.5% and 24.8% for the high and low Pb areas, respectively compared to post-Katrina prevalence of 29.6% and 7.5%, for high and low Pb areas, respectively. Elevated soil Pb permeates interior areas of the city and children living there generally lack Pb safe areas for outdoor play. Soil Pb medians in outlying areas were safer by factors ranging from 3 to 38 depending on specific location. Patterns of Pb deposition from many decades of accumulation have not been transformed by hastily conducted renovations during the seven year interval since Hurricane Katrina. Low Pb soils available outside of cities can remedy soil Pb contamination within city interiors. Mapping soil Pb provides an overview of deposition characteristics and assists with planning and conducting primary Pb exposure prevention.
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Affiliation(s)
- Howard W Mielke
- Department of Pharmacology, Tulane University School of Medicine, 1430 Tulane Avenue-SL 83, New Orleans, LA 70112-2632, USA.
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