Health effects of exposure to chlorination by-products in swimming pools

Concerns have been raised regarding the potential negative effects on human health of water disinfectants used in swimming pools. Among the disinfection options, the approaches using chlorine-based products have been typically preferred. Chlorine readily reacts with natural organic matter that are introduced in the water mainly through the bathers, leading to the formation of potentially harmful chlorination by-products (CBPs). The formation of CBPs is of particular concern since some have been epidemiologically associated with the development of various clinical manifestations. The higher the concentration of volatile CBPs in the water, the higher their concentration in the air above the pool, and different routes of exposure to chemicals in swimming pools (water ingestion, skin absorption, and inhalation) contribute to the individual exposome. Some CBPs may affect the respiratory and skin health of those who stay indoor for long periods, such as swimming instructors, pool staff, and competitive swimmers. Whether those who use chlorinated pools as customers, particularly children, may also be affected has been a matter of debate. In this article, we discuss the current evidence regarding the health effects of both acute and chronic exposures in different populations (work-related exposures, intensive sports, and recreational attendance) and identify the main recommendations and unmet needs for research in this area.

Degradation in chlorinated water of the UV filter 4-tert-butyl-4'-methoxydibenzoylmethane present in commercial sunscreens

4-tert-Butyl-4'-methoxydibenzoylmethane (BMDM) is a widely used ultraviolet A filter. In this work, we have studied the effect of chlorine and dissolved organic matter (DOM) concentrations on the stability of UV filter (BMDM) present in two commercial sunscreen cream formulations in water. An experimental design was used to assess the effect of the two experimental factors on the degradation of BMDM. Higher concentrations of chlorine lead to higher degradation percentages of BMDM and higher concentrations of DOM inhibit its degradation. Moreover, a mono and a dichloro derivate of BMDM were identified as by-products.

Relationship between nine haloacetic acids with total organic halogens in different experimental conditions

The effects of pH and bromide ion concentration on the formation of nine haloacetic acids (HAAs) and total organic halogens (TOX) in chlorinated drinking water have been evaluated. In an extensive study, the relationships of nine HAAs with TOX have been investigated. Honesty Significant Differences test (HSD) and ANOVA tests were used for the statistical analyses. The study determined the concentration range of nine HAAs as of a percentage of TOX at varying experimental conditions. Statistical analyses showed that the parameters pH and Br had significant effects on the formation of nine HAAs and TOX. This study also showed that brominated and mixed species of HAAs would be dominant in the presence of high bromide ion concentration which contributes a high percentage of the TOX. The results of this study could be used to set up a maximum contaminant level of TOX as a water quality standard for chlorination by-products.

Design issues in small-area studies of environment and health

BACKGROUND

Small-area studies are part of the tradition of spatial epidemiology, which is concerned with the analysis of geographic patterns of disease with respect to environmental, demographic, socioeconomic, and other factors. We focus on etiologic research, where the aim is to make inferences about spatially varying environmental factors influencing the risk of disease.

METHODS AND RESULTS

We illustrate the approach through three exemplars: a) magnetic fields from overhead electric power lines and the occurrence of childhood leukemia, which illustrates the use of geographic information systems to focus on areas with high exposure prevalence; b) drinking-water disinfection by-products and reproductive outcomes, taking advantage of large between- to within-area variability in exposures from the water supply; and c) chronic exposure to air pollutants and cardiorespiratory health, where issues of socioeconomic confounding are particularly important.

DISCUSSION

The small-area epidemiologic approach assigns exposure estimates to individuals based on location of residence or other geographic variables such as workplace or school. In this way, large populations can be studied, increasing the ability to investigate rare exposures or rare diseases. The approach is most effective when there is well-defined exposure variation across geographic units, limited within-area variation, and good control for potential confounding across areas.

CONCLUSIONS

In conjunction with traditional individual-based approaches, small-area studies offer a valuable addition to the armamentarium of the environmental epidemiologist. Modeling of exposure patterns coupled with collection of individual-level data on subsamples of the population should lead to improved risk estimates (i.e., less potential for bias) and help strengthen etiologic inference.

Total fluid and water consumption and the joint effect of exposure to disinfection by-products on risk of bladder cancer

BACKGROUND

Findings on water and total fluid intake and bladder cancer are inconsistent; this may, in part, be due to different levels of carcinogens in drinking water. High levels of arsenic and chlorinated by-products in drinking water have been associated with elevated bladder cancer risk in most studies. A pooled analysis based on six case-control studies observed a positive association between tap water and bladder cancer but none for nontap fluid intake, suggesting that contaminants in tap water may be responsible for the excess risk.

OBJECTIVES

We examined the association between total fluid and water consumption and bladder cancer risk, as well as the interaction between water intake and trihalomethane (THM) exposure, in a large case-control study in Spain.

METHODS

A total of 397 bladder cancer cases and 664 matched controls were available for this analysis. Odds ratios (OR) were estimated using unconditional logistic regression, controlling for potential confounders.

RESULTS

Total fluid intake was associated with a decrease in bladder cancer risk [OR = 0.62; 95% confidence interval (CI), 0.40-0.95 for highest vs. lowest quintile comparison]. A significant inverse association was observed for water intake (for > 1,399 vs. < 400 mL/day, OR = 0.47; 95% CI, 0.33-0.66; p for trend < 0.0001), but not for other individual beverages. The inverse association between water intake and bladder cancer persisted within each level of THM exposure; we found no statistical interaction (p for interaction = 0.13).

CONCLUSION

Findings from this study suggest that water intake is inversely associated with bladder cancer risk, regardless of THM exposure level.

Chlorination disinfection by-products and pancreatic cancer risk

Chlorination disinfection by-products (CDBPs) are produced during the treatment of water with chlorine to remove bacterial contamination. CDBPs have been associated with an increased risk of bladder cancer. There is also some evidence that they may increase the risk of pancreatic cancer. We report results from a population-based case-control study of 486 incident cases of pancreatic cancer and 3,596 age- and sex-matched controls. Exposure to chlorination by-products was estimated by linking lifetime residential histories to two different databases containing information on CDBP levels in municipal water supplies. Logistic regression analysis found no evidence of increased pancreatic cancer risk at higher CDBP concentrations (all odds ratios < 1.3). Null findings were also obtained assuming a latency period for pancreatic cancer induction of 3, 8, or 13 years.