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Human Biomonitoring for Environmental Chemicals 2 U.S. and International Biomonitoring Efforts Human monitoring of occupational exposures was conducted beginning in the 1890s through a variety of blood lead monitoring programs (Sexton et al. 2004). Population-based biomonitoring is more recent and has been implemented at various levels within the United States (both federally and among states) and internationally. Only with the recent advent of the National Health and Nutrition Examination Survey (NHANES) have population-based biomonitoring1 studies expanded on measurements of lead, cadmium, and cotinine in clinical specimens (Burke and Sexton 1995). With the additional exposure surveillance data provided by NHANES and a variety of international biomonitoring efforts, regulators now have an improved understanding of how widespread some chemical exposures are in the general population. Biomonitoring data will improve our understanding of population and individual exposures to chemicals and will help regulatory agencies to set priorities for toxicologic and environmental-health research. Litt et al. (2004) noted that “new technologies in biomonitoring have the potential to transform the nation’s capacity to track exposure to pollutants and understand their impacts on health.” Current biomonitoring efforts can be categorized as survey projects and research projects. The objective of survey projects typically is to advance public health by producing information about the prevalence of exposure to environmental toxicants based on periodic monitoring (European 1 As stated in Chapter 1, biomonitoring in the context of this report is focused on biomarkers of exposure, that is, it is limited to the early stages in the process: internal dose, biologically effective dose, and early biologic effect.
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Human Biomonitoring for Environmental Chemicals Commission 2004; Knudsen 2004, as cited in ECETOC 2005). Research projects typically are hypothesis-driven and geared to the collection of data to link health outcomes causally to exposures (ECETOC 2005). Selected historical and current U.S. and international large-scale, population-based efforts to monitor environmental toxicants in human tissues are summarized below. Also included is a brief discussion of biomonitoring by private organizations and laboratories. This chapter is meant not to be a comprehensive summary of biomonitoring efforts but to provide context on the history of biomonitoring and on current and planned efforts in the field. This overview illustrates the diversity in current biomonitoring efforts, particularly with respect to study population size and analytes measured. Because of the differences in biomonitoring studies, including the type of studies conducted, when the studies were performed, and the various applications for the biomarkers, the committee explicitly did not address the duration of the biomonitoring studies or their respective costs in this chapter. HUMAN BIOMONITORING IN THE UNITED STATES Population-based biomonitoring programs in the United States have been in place since the late 1960s and have evolved substantially (see Figure 2-1). Such initial efforts as the National Human Monitoring Program, administered by the U.S. Environmental Protection Agency (EPA), and NHANES, administered by the Centers for Disease Control and Prevention (CDC), monitored for only a few chemicals, primarily pesticides and metals. Later efforts, including the National Human Exposure Assessment Survey (NHEXAS) and NHANES (1999-2000), began monitoring for many more chemicals. In addition to monitoring for a greater variety of chemicals, some studies (NHEXAS and the Agricultural Health Study) began to include environmental sampling to quantify personal exposure better. Although the larger population-based efforts (such as NHANES) have not been able to incorporate environmental monitoring, they have been instrumental in collecting background information on exposure to upwards of 140 chemicals. In the future, the National Children’s Study (NCS), if funded, would have the potential to collect biomonitoring data and link them to environmental monitoring data. CDC has been a major player in funding both state and national biomonitoring programs. NHANES and the National Reports on Human Exposure to Environmental Chemicals have provided regulators with a comprehensive overview of exposures in the general population to selected chemicals. Improvements in analytic techniques for sampling, including lower detection limits, will probably change how biomonitoring data are used. It
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Human Biomonitoring for Environmental Chemicals FIGURE 2-1 Timeline of major U.S. biomonitoring efforts.
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Human Biomonitoring for Environmental Chemicals also appears that there may be more focus on state and local monitoring through federal funding (the CDC National Biomonitoring Program, NBP) and legislated efforts (as in California and Minnesota). And the monitoring of chemicals in children could be a priority if the NCS is funded. A majority of U.S. biomonitoring efforts measure such analytes as heavy metals, pesticides, cotinine, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), polychlorinated dibenzodioxins, phthalates, and volatile organic compounds (VOCs). Future population-based studies (such as NHANES) will include such chemicals as perfluorinated compounds, polybrominated diphenyl ethers (PBDEs), and perchlorate, on which little exposure information is available. The National Human Monitoring Program and the National Human Adipose Tissue Survey EPA has been involved in a number of biomonitoring efforts, including the National Human Adipose Tissue Survey (NHATS). One of the earliest biomonitoring efforts was the National Human Monitoring Program (NHMP). NHMP was established in 1967 by the U.S. Public Health Service to study pesticide exposures in the population. A primary component of NHMP was the NHATS. NHATS, inherited by EPA in 1970, measured pesticides in human adipose tissue to identify chemicals to which a representative sample of the U.S. population was being exposed and to set priorities for reducing risk posed to at-risk groups (NRC 1991). Since its inception, NHATS has collected nearly 12,000 samples of human tissue, primarily from cadavers and some from patients, and provided adequate data to document the extent of exposure of the U.S. population to over 130 pesticides (NRC 1991). In 1990, the National Research Council Committee on National Monitoring of Human Tissues reviewed and evaluated the uses and effectiveness of NHMP (NRC 1991). In its review, the committee noted that NHATS was effective in documenting a “widespread and significant prevalence of pesticide residues in the general population” and showed “that reductions in use of PCBs, DDT, and dieldrin have been followed by a decline in measured concentrations of these compounds” (NRC 1991). The committee’s review of the program, with its discussion of the need for improved monitoring, was the impetus for the development of NHEXAS. The National Human Exposure Assessment Survey NHEXAS was established in 1993, as a follow on to NHATS, to evaluate comprehensive human exposure to multiple chemicals on a community and regional scale (EPA 2005). NHEXAS expanded on NHATS by moni-
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Human Biomonitoring for Environmental Chemicals toring chemicals (including lead, other metals, pesticides, and organic chemicals) in blood and urine and by surveying personal exposures to chemicals through environmental sampling of air, water, and soil and dust and personal monitoring of air, food and beverages, and uptake (EPA 2005; NRC 1991). Three pilot surveys were conducted: in Arizona, in Maryland, and in a sample population of people in Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin (EPA 2005). NHEXAS measured 46 chemicals in about 460 people (NRC 1991). An EPA Science Advisory Board (SAB) report reviewing NHEXAS noted that among the major strengths of its design were that it was possible to “track many of the exposure pathways back to sources of exposure and [that it] provides a sound scientific basis for exposure and risk reduction” (EPA SAB 1999). The SAB report also recommended that NHEXAS be linked with NHANES data. Other current federal efforts that incorporate biomonitoring include the National Institute of Environmental Health Sciences (NIEHS)-U.S. EPA Centers for Children’s Environmental Health and Disease Prevention Research, the NIEHS Superfund Basic Research Program, and CDC’s NHANES and the Reports on Human Exposure to Environmental Chemicals. NHANES remains the largest and most comprehensive effort to study chemicals in the U.S. population. If funded, future national biomonitoring efforts would include the NCS, a longitudinal study of children from when they are in utero to the age of 21 years that would incorporate regular biomonitoring for environmental chemicals. CDC’s NHANES and the Reports on Human Exposure to Environmental Chemicals, the NIEHS-EPA Centers for Children’s Environmental Health and Disease Prevention Research, and the NCS are highlighted below. Details on other federal programs, including NIEHS’s Superfund Basic Research Program, are presented in Table 2-1. National Institute of Environmental Health Sciences-Environmental Protection Agency Centers for Children’s Environmental Health and Disease Prevention Research The NIEHS-EPA Centers for Children’s Environmental Health and Disease Prevention Research conduct an array of observational studies of environmental-related diseases in children. The program, initiated in 1998, was designed to study environmental exposures of infants and young children, link the exposures to health effects, and develop intervention strategies for reducing the exposures. Funded in two phases, the program includes 12 centers (Kimmel et al. 2005; Landrigan and Tamburlini 2005). Each center has a unique and varied research focus and includes studies of respiratory diseases, childhood learning issues, and developmental disabilities, among others (Kimmel et al. 2005).
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Human Biomonitoring for Environmental Chemicals TABLE 2-1 Examples of Current U.S. and International Biomonitoring Efforts Agency/Organization/State Biomonitoring Program United States National Institute of Environmental Health Sciences-Environmental Protection Agency Centers for Children’s Environmental Health and Disease Prevention Research Twelve centers established to conduct observational studies of environmental exposures of children. Centers are collecting a variety of human tissue and samples, including urine, breast milk, peripheral blood, cord blood, meconium, vernix, saliva, hair, placental tissue (Eskenazi et al. 2005). Centers for Disease Control and Prevention—National Health and Nutrition Examination Surveys (NHANES); National Reports on Human Exposure to Environmental Chemicals Provides continuing assessment of U.S. population’s exposure to environmental chemicals using biomonitoring data from NHANES. First National Report on Human Exposure to Environmental Chemicals (First Report) was issued in March 2001. Second Report, released in January 2003, presents biomonitoring exposure data on 116 environmental chemicals for noninstitutionalized, civilian U.S. population in 1999-2000. Third report was released in July 2005 and includes data on 148 chemicals (CDC 2005). Centers for Disease Control and Prevention—State funding through National Biomonitoring Program (see discussion of state biomonitoring efforts below) In 2001, CDC’s Environmental Health Laboratory launched planning grant program (National Biomonitoring Program) to support biomonitoring capacity building for state public-health laboratories (CDC 2005). Agency for Toxic Substances and Disease Registry (ATSDR) ATSDR conducts site-specific exposure investigations, many of which use biomonitoring to assess individual exposures. For example, ATSDR’s Great Lakes Human Health Effects Research Program works to characterize exposure to persistent contaminants via consumption of Great Lakes fish, to investigate potential adverse health effects, and to identify vulnerable subpopulations. Exemplary biomonitoring-based investigations include effects of Great Lakes fish consumption on body burdens of dioxins, furans, and PCBs (Anderson et al. 1998; Falk et al. 1999) on motor functioning in ageing fish-eaters (Schantz et al. 1999), on reproduction-related endpoints (Persky et al. 2001; Karmaus et al. 2002; Buck et al. 2003), and on behavior and memory (Schantz et al. 2001; Stewart et al. 2003). Vulnerable populations studied under this program include Native Americans (Dellinger et al. 1996; Fitzgerald et al. 1999), neonates (Lonky et al. 1996; Stewart et al. 2000), and the aged (Schantz et al. 1999, 2001).
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Human Biomonitoring for Environmental Chemicals Chemicals Measured Mercury, lead, cotinine, pesticides, phthalates, PAHs, PAH-DNA adducts, allergens, endotoxin, antioxidant micronutrients, cytokines, immunoglobulin E, cholinesterase, thyroid hormones, DNA polymorphisms Lead, cadmium, mercury, cobalt, uranium, antimony, barium, beryllium, cesium, molybdenum, platinum, thallium, tungsten, organochlorine pesticides, organophosphorus insecticides (dialkyl phosphate metabolites), (specific metabolites), pyrethroid pesticides, other pesticides (2-isopropoyxyphenol, carbofuranphenol), herbicides, phthalates, phytoestrogens, polycyclic aromatic hydrocarbons, polychlorinated dibenzo-p-dioxins and dibenzofurans, polychlorinated biphenyls, tobacco smoke
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Human Biomonitoring for Environmental Chemicals Agency/Organization/State Biomonitoring Program National Institute of Environmental Health Sciences Superfund Basic Research Program Funds peer-reviewed research in 19 university programs encompassing 70 collaborating institutions (including number of biomonitoring programs) (NIEHS 2005). For example, the Universities of North Carolina, Chapel Hill (UNC) and California, Berkeley (UCB) are conducting studies to develop and validate biomarkers of exposure to benzene and arsenic with which to investigate exposure response relationships in humans. Agricultural Health Study Large prospective cohort study, conducted in North Carolina and Iowa, to assess current and past agricultural exposures using interviews and environmental and biologic monitoring. Evaluating relationship between pesticide exposure and the development of specific cancers (Alavanja et al. 1996; Agricultural Health Study 2005). Farm Family Exposure Study (FFES) FFES was designed to study pesticide exposures of farm families by measuring urinary pesticides in applier, spouse, children (Farm Family Exposure Study 2005). California California Department of Health Services Environmental Health Laboratory Branch developed California Biomonitoring Plan under 2-year grant from CDC (APHL 2004). Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin Biomonitoring consortium of five Upper Midwest states. States plan to share biomonitoring data and samples on toxicants (CDC 2005). New Hampshire Developing public-health laboratory capacity to biomonitor for arsenic, mercury, phthalates, polybrominated diphenyl ethers; and planning pilot studies to estimate body burden of environmental toxicants using newly developed biomonitoring analytic methods (CDC 2005). New York Developing capacity to monitor for polyaromatic hydrocarbons (PAHs) in urine, polybrominated diphenyl ethers (PBDEs) in serum, organochlorine pesticides in serum, volatile organic compounds (VOCs) in blood, cotinine in saliva, trace elements in blood and urine, inorganic mercury in blood; and to generate data on exposure to persistent organic pollutants (CDC 2005).
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Human Biomonitoring for Environmental Chemicals Chemicals Measured Pesticides Pesticides (glyphosate, 2,4-D, 3,5,6-trichloro-2-pyridinol (chlorpyrifos)) Organochlorines (DDT), organophophorus dialkyl phosphate metabolites, pyrethroids, PCBs, PBDEs, phthalates, lead, mercury Asbestos, nitrates and nitrites, persistent organic pollutants, selenium Arsenic, mercury, phthalates, polybrominated diphenyl ethers PAHs, PBDEs, organochlorine pesticides, VOCs, cotinine, trace elements, inorganic mercury
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Human Biomonitoring for Environmental Chemicals Agency/Organization/State Biomonitoring Program Pennsylvania Currently funding biomonitoring and environmental-health tracking efforts, including studies of people living in the vicinity of coal-burning power plants. Washington Efforts to enhance environmental monitoring and analyses of mercury and polychlorinated biphenyls, as well as other persistent toxicants. Rocky Mountain Biomonitoring Consortium (RMBC) RMBC includes Arizona, Colorado, Montana, New Mexico, Utah, and Wyoming in efforts to implement and expand regional laboratory-based biomonitoring program. Program will assess extent of exposure to environmental toxicants, including collecting data on background exposures (CDC 2005). American Chemistry Council Long-Range Research Initiative (LRI) LRI has signed a memorandum of understanding with EPA for joint grant solicitations to fund projects to identify methods and approaches for future population studies requiring exposure information, for studies that characterize exposure factors that are related to high-end exposures, and to interpret biomonitoring data in relation to the exposure data. Some current projects are: “(1) comparing biomonitoring data to exposure data in an attempt to better interpret ethylene oxide DNA adducts (i.e., ethylene oxide bound to DNA) and urine and blood levels of benzene metabolites, respectively, (2) studying the relationship between exposure to phthalates and urinary biomarkers in rats and then modeling this relationship for humans, (3) developing and applying more advanced statistical models to characterize relationships between exposures and biomonitoring data, and (4) evaluating biomarkers of in utero exposures to background levels of environmental contaminants” (LRI 2005). Canada Canadian Health Measures Survey Beginning in 2006, Statistics Canada will initiate a national survey of 5,000 people to collect data on health status and biological measurements to assess exposures to environmental chemicals, including lead and mercury. The surveys are currently in development and collection of data is expected to begin in the fall of 2006, with results released in 2009 (Statistics Canada 2006).
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Human Biomonitoring for Environmental Chemicals Chemicals Measured Heavy metals (lead, arsenic, mercury) Arsenic, cotinine, DDT, dioxins, lead, PBDEs, PCBs, mercury, cholinesterase, trihalomethanes Heavy metals, arsenic speciation, mercury speciation, organophosphates, organochlorine pesticides, VOCs, dichloroethane, trichloroethylene; cotinine, nitrates and nitrites, creosote, PAHs (wood smoke), radionuclides, cyanide, dioxin-furan, disinfection byproducts, perchlorates, phthalate metabolites, thiodiglycol (mustard gas), sarin
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Human Biomonitoring for Environmental Chemicals individual and pooled samples of human milk, the second to include similarly selected participants after a 4-year period (WHO 2005). Germany Germany has comprehensive occupational and population-based biomonitoring programs. The German Environmental Surveys (GerESs) are a multistage probability sample of the German population that include analysis of tissues for traces of environmental chemicals (see Table 2-1 for analytes measured) (Becker et al. 2003). The surveys were conducted in 1985-1986 (GerESI), 1990-1992 (GerESII), and 1998 (GerESIII) and included 4,822 people 18-69 years old (Becker et al. 2003). The most recent survey, GerESIV (2003-2006), will include 1,800 children in 150 sampling locations (GerES 2005). Beginning in 1993, data from the GerES surveys and other epidemiologic and toxicologic studies were used to establish reference values and human biological monitoring (HBM) values (GerES 2005). Reference values “indicate the upper margin of the current background exposure of the general population and [are used] to identify subjects with an increased level of exposure” (Jakubowski and Trzcinka-Ochocka 2005) compared with the background population level. Those values are derived from data on blood, urine, and other tissues collected from population studies (Ewers et al. 1999). Reference values may be derived differently for susceptible groups if physiologic differences are substantial (for example, children vs adults) (Ewers et al. 1999). HBM values are derived from toxicologic and human studies and are health based (Jakubowski and Trzcinka-Ochocka 2005). Two types of HBM values exist: HBM I, “the concentration of an environmental toxin in human biological material below which there is no risk of adverse health effects”; and HBM II, “the concentration above which there is an increased risk of adverse health effects in susceptible individuals in the general population” (Jakubowski and Trzcinka-Ochocka 2005). An HBM I value serves as an alert level, and an HBM II value is an action level at which immediate efforts should be made to reduce exposure and further clinical examination should follow (Ewers et al. 1999). HBM values and reference values have been derived for a number of chemicals, including lead, cadmium, mercury, pentachlorophenol (PCP), and arsenic. Additional examples of European biomonitoring efforts are included in Table 2-1. HUMAN-SPECIMEN BANKING Lee et al. (1995) defined environmental-specimen banking as “a long-term, stable storage of specimens sampled from the physical environment,
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Human Biomonitoring for Environmental Chemicals such as air, water, soil, or sediment samples, or of biological specimens sampled from human, animal, or plant populations.” If collected and stored appropriately, tissues from specimen banks can be used in retrospective and prospective cohort studies (Zenick and Griffith 1995). That allows the testing of hypotheses as the scientific community identifies them after sampling has taken place. Ideally, data provided from stored-specimen banks can be used to “relate levels of environmental contamination to health outcomes via doses” (Holzman 1996). There are a number of large specimen banks and repositories in the United States, administered primarily by federal government. Others are administered by the military, universities, corporations, and nonprofit organizations (NBAC 1999). Similarly, the EU has specimen banks available for research purposes. A few examples from in the United States and EU are described below. In the United States, CDC has been involved in tissue and specimen banking primarily to provide information for use in epidemiologic studies and research programs. Two larger-scale programs include specimens from NHANES and the Agency for Toxic Substances and Disease Registry (ATSDR) Specimen and Data Repository. Regarding storage of tissue resulting from NHANES, serum, plasma, and urine have been collected and stored for future research projects. Specimens from NHANES III and NHANES 1999-2004 are available. Projected uses of the specimens include developing new analytic technologies, identifying new biomarkers, and intramural and extramural research, as approved by CDC (Gunter 1997; NCHS 2005). In 1995, ATSDR funded the CDC-ATSDR Specimen and Data Repository to store over 6 million biologic specimens for use in various research work (Gunter 1997). Numerous specimens are stored in the repository, including serum, cells, and tissues. The repository was designed to handle a large portion of CDC’s biologic specimens (Gunter 1997). The EU, through its Health and Environment Strategy, has stressed the importance of increased funding and capacity in addition to improved coordination among current biobanking activities (European Commission 2004). A number of European countries have established national specimen banks, including Germany and Sweden. The German Environmental Specimen Bank, initiated in 1985, annually samples and archives specimens to determine the effectiveness of environmental regulations and to conduct retrospective monitoring (European Commission 2004). The bank collects six types of human specimens— whole blood, blood plasma, scalp hair, pubic hair, saliva, and 24-hour urine samples from people 20-29 years old in four cities (Münster, Halle/ Saale, Greifswald, and Ulm). Screening is conducted to determine the pres-
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Human Biomonitoring for Environmental Chemicals ence of a variety of metals, PCBs, hexachlorobenzene, PBDEs, phthalates, and PCPs (European Commission 2004). The Swedish Environmental Specimen Bank is a centralized storage bank that has been operational for 20 years. It conducts annual sampling of a variety of environmental and human specimens for use in a number of studies, including retrospective analyses. Regional banks store human blood for use in these studies (European Commission 2004). The European Prospective Investigation into Cancer and Nutrition (EPIC) is the largest study of diet and health in the EU, with over 520,000 participants in 10 European countries. The study, initiated in 1992, collects detailed information and diet and lifestyle factors in addition to blood samples, which are stored for future analyses. The study participants will be followed for the next 10 years to investigate the role of nutrition in the development of chronic disease (IARC 2005). UK Biobank is a long-term human-specimen bank that will be initiated at full scale in 2006, although pilot projects are under way. The project will collect information, including blood (fractioned to plasma or serum) and urine samples, from 500,000 participants 40-69 years old. The study will follow participants over 20-30 years to study progression of chronic diseases. Supporting the efforts described above, the International Society for Biological and Environmental Repositories was founded in 2000 to provide guidance on repository management, disseminate information regarding the effective management of specimen collections, and develop efforts to educate the community about related issues (ISBER 2005). Additional information about biobanking is presented in Table 2-1 and in Chapter 4. GENERAL OBSERVATIONS A review of large-scale biomonitoring programs in the United States and the EU did not reveal substantial differences in the types and number of analytes measured (see Table 2-1 for discussion of examples of studies). Most studies included monitoring of heavy metals (often lead and mercury), pesticides, PAHs, PCBs, dioxins, phthalates, VOCs, and emerging chemicals (perfluorinated compounds and PBDEs). Regarding funding, the Government Accountability Office, in its review of the long-term strategy for monitoring of exposure to chemicals in the United States, noted that, “as compared to the hundreds of millions spent on monitoring contaminants in environmental media, we estimate that $7 million was spent collectively by CDC (including ATSDR) and EPA on their respective human exposure efforts in 1999” (GAO 2000). Although funding for such efforts in the United States has increased with the
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Human Biomonitoring for Environmental Chemicals CDC National Reports on Human Exposure to Environmental Chemicals and NHANES, state biomonitoring efforts have not fared as well. For instance, funding for implementation of state biomonitoring plans has been in place in only three states or regions as of 2004. In addition, although the state planning grants were funded at $5,000,000 and $4,970,500 in FY 2002 and FY 2003, respectively, only $2,650,000 was allotted for implementation (APHL 2004). The NCS, would provide a valuable database of children’s exposures; however, its funding status is currently being debated. The burden of collecting biomonitoring data seems to fall on CDC. Without state and local programs, valuable geographic and temporal differences in exposure cannot be examined. States are better able to target programs to serve the needs of the communities and may be able to incorporate environmental sampling to augment human monitoring data (Needham et al. 2005a). Thus, increased funding for state programs should have a high priority; as stated by the NY Wadsworth Center, a CDC grantee, “significantly higher funding is needed to support larger biomonitoring exposure investigations, ability to respond to new public health issues, and to participate in external collaborations to address emerging problems” (Wadsworth Center, unpublished material,3 September 2003; George Eadon, Wadsworth Center, personal commun., July 26, 2005). An assessment of biomonitoring efforts reveals that the biomonitoring of chemicals in children seems to have a high priority in both the United States and the EU, as evidenced by the sheer number of programs and the aggressive agenda for future monitoring of this population. Other issues include the monitoring of susceptible populations in the United States and Europe. In addition to current population-based biomonitoring programs, future U.S. efforts should include biomonitoring of populations that may be at higher risk of exposure to chemicals. Additional funding for state or local biomonitoring programs may provide an opportunity to evaluate exposure of those populations (for example, state HANES). As discussed in this chapter, because biomonitoring is being conducted on an international level by numerous organizations, and there is much knowledge to be gained from understanding patterns of exposure worldwide, the committee encourages the exchange of biomonitoring information and expertise globally. This includes sharing biomonitoring data, study approaches, and tracking of trends. Such coordination will enhance national and international standardization and validation of biomonitoring techniques and provide for complementary study designs. To this end, the committee encourages the development of such information exchanges be- 3 Derived from New York State Department of Health. 2003. New York State Biomonitoring Program Plan.
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Human Biomonitoring for Environmental Chemicals tween EPA and the Organization for Economic Co-operation and Development (OECD). CONCLUSIONS An assessment of current U.S. and European biomonitoring efforts has yielded the following conclusions: Biomonitoring is rapidly developing in the United States and Europe with comparable types and numbers of analytes being measured. The biomonitoring of chemicals in children appears to have a high priority in both the United States and the European Union. State and local biomonitoring programs have the potential to provide valuable biomonitoring data on the geographic and temporal differences in exposure among populations. Increased funding for such efforts in the United States is needed. RECOMMENDATIONS The committee recommends that additional funding be committed to state-level biomonitoring programs. The committee encourages the sharing of biomonitoring data between the EPA and the OECD to foster international collaboration and develop the field of biomonitoring. REFERENCES ACC (American Chemistry Council). 2002. Long-Range Research Initiative. Research Strategy. American Chemistry Council, Arlington, VA. October 2002 [online]. Available: http://www.uslri.com/documents/cat_25/doc_427.pdf [accessed June 3, 2005]. Agricultural Health Study. 2005. Agricultural Health Study [online]. Available: http://www.aghealth.org/ [accessed Sept. 26, 2005]. Alavanja, M.C., D.P. Sandler, S.B. McMaster, S.H. Zahm, C.J. McDonnell, C.F. Lynch, M. Pennybacker, N. Rothman, M. Dosemeci, A.E. Bond, and A. Blair. 1996. The Agricultural Health Study. Environ. Health Perspect. 104(4):362-369. Albertini, R., M. Bird, N. Doerrer, L. Needham, S. Robison, L. Sheldon, and H. Zenick. In press. The use of biomonitoring data in exposure and human health risk assessment. Environ. Health Perspect. [online]. Available: http://ehp.niehs.nih.gov/docs/2006/9056/abstract.html [accessed Aug. 21, 2006]. Anderson, H.A., C. Falk, L. Hanrahan, J. Olson, V.W. Burse, L. Needham, D. Paschal, D. Patterson, Jr., and R.H. Hill, Jr. 1998. Profiles of Great Lakes critical pollutants: A sentinel analysis of human blood and urine. The Great Lakes Consortium. Environ. Health Perspect. 106(5):279-289. APHL (Association of Public Health Laboratories). 2004. Biomonitoring: Measuring Chemicals in People. May 2004 [online]. Available: http://www.aphl.org/docs/Biomonitoring.pdf [accessed June 3, 2005].
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Representative terms from entire chapter: