Reconstruction of silica exposure in the North Carolina dusty trades

The current occupational standard for quartz exposure is largely drawn from studies of the granite workers at Barre, Vermont. Since 1935, the North Carolina Dusty Trades program has accumulated data on work-place environmental conditions, occupational history and health status for persons exposed to silica in a broad range of mineral industries, including granite dimension stone. The environmental data have been collected with Greenburg-Smith and midget impingers and the respirable mass dust sampler. A procedure is presented to combine the results of these sampling methods and estimate exposure at the various jobs at each dusty trades plant. From an individual's occupational history, the environmental exposure estimates are used to formulate personal lifetime exposure summaries. The results of this procedure in the North Carolina granite industry compared well with historical data from Vermont granite sheds.     

Validation of a questionnaire and microenvironmental model for estimating past exposures to ozone

Epidemiology studies of the health effects associated with chronic exposure to ozone are constrained by a lack of validated exposure assessment methods that account for activity patterns and building ventilation, two potentially important predictors of ozone exposure. A pilot study was conducted to evaluate the impact of these parameters on an exposure model, to evaluate how reliably they can be reconstructed, and how this reliability affects estimates of past exposures to ozone. Fourteen subjects completed time-activity diaries and wore personal passive monitors during summer 1996 and reconstructed their activities 1 year later in a questionnaire. These data were used in a microenvironmental exposure model and the results were compared to measured personal exposure. A model using activity patterns, building ventilation, and location-specific ambient ozone data produced mean exposure estimates 18.9 +/- 1.5 ppb ozone greater than personal measurements. A simpler model that omitted variation in indoor ventilation produced exposure estimates 5.0 +/- 1.3 ppb ozone greater than mean measured exposures. The questionnaire was a reliable survey method for reconstructing past activity patterns. However, detailed histories of building ventilation may not be required to reconstruct reliably past exposures to ozone. The simple model was more precise and more practical for implementation in large epidemiological studies of health effects related to chronic exposure to ambient ozone.     

Historical perspective on approaches to estimation of inhalation risk by air sampling.

Epidemiological investigation involving historical cohorts requires reconstruction of individual cohort member exposures during the period of study. However, past approaches to exposure assessment by industrial hygienists were characterized by different professional expectations for air sampling, and different orientations for evaluation of air sampling results. The activity designated as "exposure assessment" today was not seriously undertaken prior to the late 1970s. It is important to understand the methodologies utilized in earlier years to assess the quality of workplace air because assumptions of exposure during those years are critically dependent on the utilization of shortterm air sampling results obtained by methods which differ from those employed today. This paper reviews the approaches and methodologies utilized in the United States during the 1930-1980 period to measure airborne concentrations of suspended particulate matter and gaseous contaminants. Specific examples are used to illustrate the obstacles encountered when translating these usually limited data into cumulative exposure indices utilized in testing the hypothesis of a dose-response relationship in epidemiological investigations. The misuse of these data results in exposure misclassification and obscuration of any dose-response relationship(s). Selected options for validation of earlier exposures and for increasing or decreasing confidence in recognized incomplete earlier exposure information are discussed. The problems identified and explored in this presentation are inevitable in dealing with available historical occupational exposure data. They will persist for years and demand attention if the information associated with these incomplete data sets is to be defensibly utilized.     

A comparison and critique of historical and current exposure assessment methods for beryllium: implications for evaluating risk of chronic beryllium disease

The primary beryllium industry has generated a large amount of data on airborne beryllium concentrations that has been used to characterize exposure by task-specific activities, job category, individual worker, and processing area using a variety of methods. These methods have included high-volume breathing zone sampling, high-volume process sampling, high- and low-volume respirable and area sampling, real-time monitoring, and personal sampling. Many of the beryllium studies have used these air sampling methods to assess inhalation exposure and chronic beryllium disease (CBD) risk to beryllium; however, available data do not show a consistent dose-response relationship between airborne concentrations of beryllium and the incidence of CBD. In this article, we describe the air sampling and exposure assessment methods that have been used, review the studies that have estimated worker exposures, discuss the uncertainties associated with the level of beryllium for which these studies have reported an increased risk of CBD, and identify future investigative exposure assessment strategies. Our evaluation indicated that studies of beryllium workers are often not directly comparable because they (1) used a variety of exposure assessment methods that are not necessarily representative of individual worker exposures, (2) rarely considered respirator use, and (3) have not evaluated changes in work practices. It appears that the current exposure metric for beryllium, total beryllium mass, may not be an appropriate measurement to predict the risk of CBD. Other exposure metrics such as mass of respirable particles, chemical form, and particle surface chemistry may be more related to the prevalence of CBD than total mass of airborne beryllium mass. In addition, assessing beryllium exposure by all routes of exposure (e.g., inhalation, dermal uptake, and ingestion) rather than only inhalation exposure in future studies may prove useful.     

Estimation of respirable dust exposure among coal miners in South Africa

The use of retrospective occupational hygiene data for epidemiologic studies is useful in determining exposure-outcome relationships, but the potential for exposure misclassification is high. Although dust sampling in the South African coal industry has been a legal requirement for several decades, these historical data are not readily adequate for estimating past exposures. This study describes the respirable coal mine dust levels in three South African coal mines over time. Each of the participating mining operations had well-documented dust sampling information that was used to describe historical trends in dust exposure. Investigator-collected personal dust samples were taken using standardized techniques from the face, backbye (underground jobs not at the coal face), and surface from 50 miners at each mine, repeated over three sampling cycles. Job histories and exposure information was obtained from a sample of 684 current miners and 188 ex-miners. Linear models were developed to estimate the exposure levels associated with work in each mine, exposure zone, and over time using a combination of operator-collected historical data and investigator-collected samples. The estimated levels were then combined with work history information to calculate cumulative exposure metrics for the miner cohort. The mean historical and investigator-collected respirable dust levels were within international norms and South African standards. Silica content of the dust samples was also below the 5% regulatory action level. Mean respirable dust concentrations at the face, based on investigator-collected samples, were 0.9 mg/m(3), 1.3 mg/m(3), and 1.9 mg/m(3) at Mines 1, 2, and 3, respectively. The operator-collected samples showed considerable variability across exposure zones, mines, and time, with the annual means at the face ranging from 0.4 mg/m(3) to 2.9 mg/m(3). Statistically significant findings were found between operator- and investigator-collected dust samples. Model-based arithmetic mean dust estimates at the face were 1.2 mg/m(3), 2.0 mg/m(3), and 0.9 mg/m(3) for Mines 1, 2, and 3, respectively. Using these levels, the mean cumulative exposure for the cohort was 56.8 mg-years/m(3). Current miners had a mean cumulative exposure of 66.5 mg-years/m(3), compared with ex-miners of 26.8 mg-years/m(3). Improvements in dust management or the use of different sampling equipment could account for the significant differences seen between operator- and investigator-collected data. Regression modeling for estimating mean dust levels over time using combined historical and investigator-collected data seems a reasonable method and useful in constructing models to describe cumulative exposures in a cohort of current and ex-miners.     

Past occupational exposure to airborne manganese in a manganese alloy plant

A retrospective exposure assessment of a group of manganese (Mn) alloy workers was performed in conjunction with a 2004 follow-up study, 14 years after cessation of exposure, to evaluate the long-term effects of occupational Mn exposure on neurobehavioral functions. The ferro- and silico-Mn alloy plant opened in 1973 and closed in 1991. The airborne total Mn (TMn) exposures for job groupings were established using personal sampling data from a 1991 industrial hygiene survey. Historical short-term total dust (TDust) data were used to estimate past TDust exposure for job groupings and plant areas. Relationships between Mn content and TDust from the 1991 survey, supported by sparse historical data, were used to estimate TMn content in the historical TDust data. Results showed past personal TDust exposure levels much higher than those found in 1991. Changes in TDust levels and corresponding TMn levels were a function of changes in ventilation, work practices, and operations, not of product (ferro- or silico-Mn). Relationships between TMn and respirable Mn (RMn) from area sampling in 1991 were used to estimate RMn exposure for the job groups. Work histories for 112 workers were developed from payroll records, questionnaires, and interviews and combined with Mn exposure estimates to develop cumulative exposure indices (CEIs). The TMn CEI ranged from 0.27 mg/m(3)x years to 100.24 mg/m(3)x years, with an AM of 24.40 mg/m(3)x years and a GM of 14.06 mg/m(3)x years. The RMn CEI had an AM of 2.95 mg/m(3)x years and a GM of 1.78 mg/m(3)x years with a range of 0.05-12.03 mg/m(3)x years. Overall average TMn exposure intensity, the TMn CEI divided by time worked in years for each worker, had an AM of 1.6 mg Mn/m(3), a GM of 1.0 mg Mn/m(3), range 0.02-6.2 6 mg Mn/m(3). The results of the 2004 follow-up study showed several concentration-response relationships between TMn CEI and neurobehavioral outcomes, which suggest that increase in cumulative TMn exposure level has long-term consequences on the nervous system.     

Occupational exposure in lung cancer patients: contribution of remote past work.

Occupational exposures have been recognized for a number of years as contributing to disease risk for certain cancers. Although disease risk may be attributed to personal behaviors, such as cigarette smoking, occupational exposure may enhance the risk. Obtaining occupational histories is therefore important to the study of the etiology of cancer. However, the availability of occupational information in the medical record and vital registries can be incomplete or of poor quality and is often restricted to current, most recent, or usual occupation. This article reports the contribution of remote past work, data not ordinarily collected in the medical record, as an exposure source to potential lung carcinogens in a group of lung cancer patients. Twenty-six of the 114 lung cancer patients interviewed (23%) reported remote work consistent with past exposure to lung carcinogens. This occupational risk would have been undetected by usual history-taking methods and highlights the significant limitations of occupational data collection methods by vital registries.     

Determining exposure history in occupational epidemiology]

In epidemiology, it is necessary that exposure indicators have good validity in order to obtain valid results when measuring the risks associated with occupational exposure to environmental noxious agents. However, ensuring the validity of past exposure data is no easy task. Because there are no environmental hygiene measures or representative levels of bioindicators signaling past exposure, self-reports have been used as a source of indirect exposure data. Unfortunately, data on specific agents are commonly poor and need to be complemented with data on the determinants of exposure. The validity of self-reports improves when certain techniques, such as control lists and icons, are employed, and the quality of individual exposure data improves when secondary data on exposure and its conditioning or determining factors are incorporated. Exposure can be determined by means of exposure matrices, assessment by experts, and exposure models, and by using a combination of primary and secondary data on exposure and its conditioning factors. Matrices contain pooled data and can thus lead to errors in classifying individual exposure and to biased risk estimates. Assessment by experts is probably the method with the highest validity, but it can become expensive when studies are large. It is also feasible to use a formal model for assessing perceivable exposures, complemented with expert assessments whenever the results of the model appear to deviate from reality.     

Measurement and analysis of nicotine and other VOCs in indoor air as an indicator of passive smoking

In Finland the Tobacco Act was amended in 1994 to include workplaces. The developed method for estimating passive smoking, or environmental tobacco smoke utilised the widely used measurement of volatile organic compounds in indoor air quality surveys. The method is based on active sorbent sampling, thermal desorption and gas chromatography/mass selective detection (GC/MS) analysis and it has been tested in a chamber and in field conditions. The method can be used simultaneously to measure volatile organic compounds and exposure to tobacco smoke. We recommend nicotine, collected by active sampling, as an indicator for the evaluation of the exposure to environmental tobacco smoke spreading from smoking areas.     

Validation and calibration of a model used to reconstruct historical exposure to polycyclic aromatic hydrocarbons for use in epidemiologic studies

OBJECTIVES: We previously developed a historical reconstruction model to estimate exposure to airborne polycyclic aromatic hydrocarbons (PAHs) from traffic back to 1960 for use in case-control studies of breast cancer risk. Here we report the results of four exercises to validate and calibrate the model. METHODS: Model predictions of benzo[a]pyrene (BaP) concentration in soil and carpet dust were tested against measurements collected at subjects' homes at interview. In addition, predictions of air intake of BaP were compared with blood PAH-DNA adducts. These same soil, carpet, and blood measurements were used for model optimization. In a separate test of the meteorological dispersion part of the model, predictions of hourly concentrations of carbon monoxide from traffic were compared with data collected at a U.S. Environmental Protection Agency monitoring station. RESULTS: The data for soil, PAH-DNA adducts, and carbon monoxide concentrations were all consistent with model predictions. The carpet dust data were inconsistent, suggesting possible spatial confounding with PAH-containing contamination tracked in from outdoors or unmodeled cooking sources. BaP was found proportional to other PAHs in our soil and dust data, making it reasonable to use BaP historical data as a surrogate for other PAHs. Road intersections contributed 40-80% of both total emissions and average exposures, suggesting that the repertoire of simple markers of exposure, such as traffic counts and/or distance to nearest road, needs to be expanded to include distance to nearest intersection.     

Malignant mesothelioma in Australia, 1945-2002

Using register data, time trends in mesothelioma incidence in Australia from 1945 to 2002 were calculated. Incidences are reported by age, sex, anatomic site, and state of notification. Associations with occupational and environmental asbestos exposure histories and lifetime risks in different exposure categories were investigated. Lung-fiber content was measured in a subset of cases. Australia had 7,027 cases from 1945 to 2001, with 488 more in January 2002 through June 2003. Incidence rates for Australia per million population > or = 20 years old (1999) were: male 53.3; female 10.2; total 31.8. Rates have continually increased and are the highest reported national rates in the world. Western Australia had the highest rate (1999 total 47.7), but most cases arose from the two most populous eastern states, New South Wales and Victoria. In 88% of cases (male 90%, female 61%), histories of asbestos exposures were obtained. In 80% of cases with no history of exposure, TEM lung asbestos fiber counts > 200,000 fibers > 2 microm length/g dry lung were obtained, suggesting unrecognized exposure. Australia's high incidence of mesothelioma is related to high past asbestos use, of all fiber types, in a wide variety of settings. The number of cases is expected to be about 18,000 by 2020, with about 11,000 yet to appear.     

利用相似接触组研究低浓度苯接触对工人血液指标的影响

目的　研究不同相似接触组 (SEG)工人的血液指标与苯的接触剂量的关系。方法　研究对象为某鞋厂成型车间的制鞋工人 ,采用观察法和采样法相结合的方法划分SEG ,个体采样泵采集每个SEG中 5个工人呼吸带处接触水平 ,体检收集工人的血样、职业史 ,多元回归分析苯的接触水平对血常规的影响。结果　根据SEG的定义及该车间的实际情况 ,划分为 5个SEG ,除年龄有差异外 ,各SEG工人的工龄、吸烟、饮酒、血常规、主诉症状方面差异无显著性 (P >0 .0 5 ) ;多元回归分析发现 ,外周血白细胞计数随空气中苯浓度的增加而减少 ,两者之间呈负相关 (r=- 0 .36 ,P <0 .0 5 ) ;接苯工龄与红细胞计数也存在负相关 (r =- 0 .2 9,P <0 .0 5 ) ;而红细胞和血小板的计数与苯接触之间没有发现类似的相关关系 (P >0 .0 5 )。结论　SEG研究发现 ,苯的接触剂量与白细胞计数之间存在剂量 -反应关系 ,今后应该通过增加样本量 ,进一步研究低浓度的苯接触对工人外周血液指标的影响。     

Exposure opportunity models for Agent Orange, dioxin, and other military herbicides used in Vietnam, 1961-1971

Nearly 19.5 million gallons of herbicides were sprayed on the Republic of Vietnam between 1961 and 1971 for military purposes. Amounts of spray and patterns of applications are available in an electronic file called HERBS that contains records of 9141 defoliation missions, including detailed coordinates of US Air Force Ranch Hand aircraft flight paths, along with chemical agent and gallonage sprayed. Two classes of models for use in epidemiological and environmental studies that utilize the HERBS data for estimating relative exposure opportunity indices are presented: a discrete "hits" model that counts instances of proximity in time and space to known herbicide applications, and a continuous exposure opportunity index, E4, that takes into account type and amount of herbicide sprayed, distance from spray application, and time interval when exposure may have occurred. Both direct spraying and indirect exposure to herbicide (or dioxin) that may have remained in the local environment are considered, using a conservative first-order model for environmental disappearance. A correction factor for dermal versus respiratory routes of entry has been incorporated. E4 has a log-normal distribution that spans six orders of magnitude, thus providing a substantial amount of discrimination between sprayed and unsprayed areas. The models improve on earlier ones by making full use of the geometry of the HERBS spray flight paths of Ranch Hand aircraft. To the extent possible so many decades after the War, the models have been qualitatively validated by comparison with recent dioxin soil and biota samples from heavily contaminated areas of Vietnam, and quantitatively validated against adipose dioxin obtained in epidemiological studies of Vietnamese. These models are incorporated within a geographic information system (GIS) that may be used, as one would expect, to identify locations such as hamlets, villages, and military installations sprayed by herbicide. In a novel application, the GIS also facilitates quantitative risk assessment in epidemiological and ecological studies by applying the models within a framework of historical reconstruction of exposure history of individuals based upon their location histories.     

Lung cancer following exposure to chloromethyl methyl ether. An epidemiological study.

A historical prospective epidemiological study was conducted on workers exposed to chloromethyl methyl ether (CMME) containing 0.5% to 4% bis(chloromethyl) ether (BCME) as an impurity. The study period was 1948 to 1972. Follow-up procedures located 98.9% of the cohort, including those separated from the plant. The cause of death was established for 95.3% of the 278 known deceased men. A CMME exposure rating system was established from employees' work histories and recollections of supervisors. This system approximated relative exposure concentrations and duration times. Analysis on an age-specific basis revealed a relative risk of lung cancer 3.8 times higher in 669 exposed vs 1,616 unexposed workers, a significant increase. Although limited by lack of quantitative environmental sampling data, dose-response relationships were established between lung cancer an intensity and/or duration of exposure.     

Methods for estimating population coverage of mass distribution programmes: a review of practices in relation to trachoma control

In the context of trachoma control, population coverage with mass drug administration (MDA) using antibiotics is measured using routine data. Due to the limitations of administrative records as well as the potential for bias from incomplete or incorrect records, a literature review of coverage survey methods applied in neglected tropical disease control programmes and immunisation outreach was conducted to inform the design of coverage surveys for trachoma control. Several methods were identified, including the '30 × 7' survey method for the Expanded Programme on Immunization (EPI 30×7), other cluster random sampling (CRS) methods, lot quality assurance sampling (LQAS), purposive sampling and routine data. When compared against one another, the EPI and other CRS methods produced similar population coverage estimates, whilst LQAS, purposive sampling and use of administrative data did not generate estimates consistent with CRS. In conclusion, CRS methods present a consistent approach for MDA coverage surveys despite different methods of household selection. They merit use until standard guidelines are available. CRS methods should be used to verify population coverage derived from LQAS, purposive sampling methods and administrative reports.     

Reverse dosimetry: interpreting trihalomethanes biomonitoring data using physiologically based pharmacokinetic modeling

Biomonitoring data provide evidence of exposure of environmental chemicals but are not, by themselves, direct measures of exposure. To use biomonitoring data in understanding exposure, physiologically based pharmacokinetic (PBPK) modeling can be used in a reverse dosimetry approach to assess a distribution of exposures possibly associated with specific blood or urine levels of compounds. Reverse dosimetry integrates PBPK modeling with exposure pattern characterization, Monte Carlo analysis, and statistical tools to estimate a distribution of exposures that are consistent with biomonitoring data in a population. The present study used an existing PBPK model for chloroform as a generic framework to develop PBPK models for other trihalomethanes (THMs). Using Monte Carlo sampling techniques, probabilistic information about pharmacokinetics and exposure patterns was included to estimate distributions of THMs concentrations in blood in relation to various exposure patterns in a diverse population. In addition, the possibility of inhibition of hepatic metabolism among THMs was evaluated under the scenarios of household exposure. These studies demonstrated how PBPK modeling can be used as a tool to estimate a population distribution of exposures that could have resulted in particular biomonitoring results. When toxicity level is known, this tool can also be used to estimate proportion of population above levels associated with health risk.     

Use of plant- and period-specific job-exposure matrices in studies on occupational cancer

Job-exposure matrices were constructed and applied in the estimation of past exposures in a case-referent study nested within a cohort of Finnish woodworkers. The objective was to avoid bias in the risk estimates because of a misclassification of exposures. The matrices were constructed separately for each plant under study and each calendar year of follow-up. The level of exposure was incorporated in the matrices, since rather comprehensive data on exposures were available. The individual work histories were converted to exposure histories by a computer program which calculated several exposure indicators (eg, level and dose, with and without allowance for a latency period). The comparison between several indicators was thought to provide additional information for the final evaluation of results. The use of the plant- and period-specific job exposure matrices may be considered in cohort and nested case-referent studies on occupational hazards as an alternative to other procedures used in the estimation of exposures. Specific matrices may find broader applicability along with the increasing availability of detailed hygienic data.     

Mixed models and empirical bayes estimation for retrospective exposure assessment of dust exposures in Canadian sawmills

OBJECTIVES: Data on job histories is commonly available from study subjects and worksites, therefore jobs are often used for assigning exposures in historical epidemiological studies. Exposure estimates are often derived by offering jobs as fixed effects in statistical models. An alternative approach would be to offer job as a random effect to obtain empirical Bayes estimates of exposure. This approach is more efficient since it weights exposure estimates according to the within-job and between-job variability and the number of measurements for each job. We assess three models for predicting historical dust exposures of sawmill workers. METHODS: Models were developed using 407 inhalable dust measurements collected from 58 jobs in four sawmills. The first model incorporated all variables as fixed effects; the second added a random term to account for correlation within workers; and the third offered random terms for worker, job and mill (hierarchical model). Empirical Bayes estimates were used to calculate job-specific exposures from the hierarchical model. RESULTS: The fixed effects and random worker mixed models performed nearly identically because there was low within-worker correlation (r = 0.26). The Bayesian exposure predictions from the hierarchical model were slightly more correlated with the observed mill-job arithmetic means than those from the models where jobs were fixed effects (0.74 versus 0.70). CONCLUSIONS: While we observed no large differences in exposure estimates by treating job as a fixed or random effect, treating job as a random effect allowed for job-specific coefficients to be estimated for every job while borrowing strength in the presence of sparse data by assuming that the job means are normally distributed around the group mean. In addition, empirical Bayes job estimates can be used for a posteriori job grouping. The use of this method for retrospective exposure assessment should continue to be examined.     

Estimating historical exposure to silica among mine and pottery workers in the people's Republic of China

A quantitative retrospective exposure assessment method was developed for use in a nested case-control study of lung cancer among mine and pottery workers exposed to silica dust in the People's Republic of China. Exposure assessment was carried out in 20 mines (10 tungsten, 6 iron/copper, and 4 tin) and nine pottery factories. A job title dictionary was developed and used in both the collection of historical exposure information and work histories of 1,668 (316 cases and 1,352 controls) study subjects. Several data abstraction forms were developed to collect historical and current exposure information and employees' work histories, starting in 1950. A retrospective exposure matrix was developed on the basis of facility/job title/calendar year combinations using available historical exposure information and current exposure profiles. Information on the amount of respirable, thoracic, and free silica content in total dust was used in estimating exposure to silica. Starting in 1950, 6,805 historical estimates had been carried out for 14 calendar-year periods. We estimated the average total dust concentration to be 9 mg/M³, with a range from 28 mg/M³ in earlier years to 3 mg/M³ in recent years. Several exposure indices [such as cumulative dust, average dust, cumulative respirable (<5 μ in particle size) and thoracic (<10 μ in particle size) silica dust, average respirable and thoracic silica dust, exposure-weighted duration, and the highest/longest exposure] were calculated for individuals by merging work history and historical exposure matrix for each study subject. We developed these various measures of exposure to allow investigators to compare and contrast different indices of historical exposure to silica. © 1993 Wiley-Liss, Inc.

1 This article is a US Government work and, as such, is in the public domain in the United States of America.

     

Ferruginous body counts in sputum as an index of past exposure to mineral fibres.

Previous work by our group among vermiculite miners exposed to fibrous tremolite demonstrated that asbestos body counts in sputum closely reflected intensity and duration of past exposure. In the present project sputum samples from nearly 600 volunteers from 11 cohorts of workers exposed to asbestos and other mineral fibres were found to contain much lower numbers of asbestos bodies than had been observed in vermiculite workers and these counts did not reliably reflect past levels of exposure. No evidence was found that occupational exposure to man-made mineral fibres led to any ferruginous body formation. Asbestos body counts appeared to differentiate between mesothelioma cases and controls and between levels of radiological asbestosis, but in both comparisons, based on small numbers, the power of discrimination was low. Substantial variation was found both in asbestos body and in macrophage counts in daily sampling of vermiculite workers but it was not sufficient to invalidate comparison between groups for epidemiological study. In individual subjects, however, little reliance can be put on results from a single sputum sample, particularly if negative.