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Title: A review of exposure assessment methods for epidemiological studies of health effects related to industrially contaminated sites
Authors: Hoek, Gerard 
Ranzi, Andrea 
Alimehmeti, Ilir 
Ardeleanu, Elena-Roxana 
Arrebola, Juan P. 
Ávila, Paula 
Candeias, Carla 
Colles, Ann 
Crișan, Gloria Cerasela 
Dack, Sarah 
Demeter, Zoltán 
Fazzo, Lucia 
Fierens, Tine 
Flückiger, Benjamin 
Gaengler, Stephanie 
Hänninen, Otto O. 
Harzia, Hedi 
Hough, Rupert 
Iantovics, Barna Laszlo 
Kalantzi, Olga-Ioanna 
Karakitsios, Spyros P. 
Makris, Konstantinos C. 
Martin-Olmedo, Piedad 
Nechita, Elena 
Nicoli, Thomai 
Orru, Hans 
Pasetto, Roberto 
Pérez-Carrascosa, Francisco Miguel 
Pestana, Diogo 
Rocha, Fernando 
Sarigiannis, Dimosthenis A. 
Teixeira, João Paulo 
Tsadilas, Christos 
Tasic, Visa 
Vaccari, Lorenzo 
Iavarone, Ivano 
De Hoogh, Kees 
Major Field of Science: Medical and Health Sciences
Field Category: Clinical Medicine
Keywords: Industrially contaminated sites;Exposure assessment;Dispersion modelling;Biomonitoring;Epidemiology
Issue Date: 2018
Source: Epidemiologia e Prevenzione, 2018, vol. 42, no. 5-6, pp. 21-36
Volume: 42
Issue: 5-6
Start page: 21
End page: 36
Journal: Epidemiologia e prevenzione 
Abstract: BACKGROUND: this paper is based upon work from COST Action ICSHNet. Health risks related to living close to industrially contaminated sites (ICSs) are a public concern. Toxicology-based risk assessment of single contaminants is the main approach to assess health risks, but epidemiological studies which investigate the relationships between exposure and health directly in the affected population have contributed important evidence. Limitations in exposure assessment have substantially contributed to uncertainty about associations found in epidemiological studies. OBJECTIVES: to examine exposure assessment methods that have been used in epidemiological studies on ICSs and to provide recommendations for improved exposure assessment in epidemiological studies by comparing exposure assessment methods in epidemiological studies and risk assessments. METHODS: after defining the multi-media framework of exposure related to ICSs, we discussed selected multi-media models applied in Europe. We provided an overview of exposure assessment in 54 epidemiological studies from a systematic review of hazardous waste sites; a systematic review of 41 epidemiological studies on incinerators and 52 additional studies on ICSs and health identified for this review. RESULTS: we identified 10 multi-media models used in Europe primarily for risk assessment. Recent models incorporated estimation of internal biomarker levels. Predictions of the models differ particularly for the routes 'indoor air inhalation' and 'vegetable consumption'. Virtually all of the 54 hazardous waste studies used proximity indicators of exposure, based on municipality or zip code of residence (28 studies) or distance to a contaminated site (25 studies). One study used human biomonitoring. In virtually all epidemiological studies, actual land use was ignored. In the 52 additional studies on contaminated sites, proximity indicators were applied in 39 studies, air pollution dispersion modelling in 6 studies, and human biomonitoring in 9 studies. Exposure assessment in epidemiological studies on incinerators included indicators (presence of source in municipality and distance to the incinerator) and air dispersion modelling. Environmental multi-media modelling methods were not applied in any of the three groups of studies. CONCLUSIONS: recommendations for refined exposure assessment in epidemiological studies included the use of more sophisticated exposure metrics instead of simple proximity indicators where feasible, as distance from a source results in misclassification of exposure as it ignores key determinants of environmental fate and transport, source characteristics, land use, and human consumption behaviour. More validation studies using personal exposure or human biomonitoring are needed to assess misclassification of exposure. Exposure assessment should take more advantage of the detailed multi-media exposure assessment procedures developed for risk assessment. The use of indicators can be substantially improved by linking definition of zones of exposure to existing knowledge of extent of dispersion. Studies should incorporate more often land use and individual behaviour.
ISSN: 1120-9763
DOI: 10.19191/EP18.5-6.S1.P021.085
Rights: © Inferenze Scarl
Type: Article
Affiliation : Utrecht University 
Environment and Energy of Emilia-Romagna 
University of Medicine Tirana 
University of Bacǎu 
University of Granada 
CIBER de Epidemiología y Salud Pública 
Virgen de las Nieves University Hospital 
National Laboratory of Energy and Geology 
University of Porto 
University of Aveiro 
Flemish Institute for Technological Research 
Public Health England 
National Public Health Institute 
Italian National Health Institute 
Swiss Tropical and Public Health Institute 
University of Basel 
Cyprus University of Technology 
National Institute for Health and Welfare 
Estonian Health Board 
James Hutton Institute 
University of Târgu Mureş 
University of Aegean 
Aristotle University of Thessaloniki 
HERACLES Research Center on the Exposome and Health 
Escuela Andaluza de Salud Pública 
Hellenic Agricultural Organization 
University of Tartu 
Center for Health Technology and Services Research 
Universidade Nova de Lisboa 
University School for Advanced Study 
Mining and Metallurgy Institute Bor 
University of Modena and Reggio Emilia 
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