Effects of Behavioral, Clinical, and Policy Interventions in Reducing Human Exposure to Bisphenols and Phthalates: A Scoping Review

Abstract

Background: There is growing interest in evidence-based interventions, programs, and policies to mitigate exposures to bisphenols and phthalates and in using implementation science frameworks to evaluate hypotheses regarding the importance of specific approaches to individual or household behavior change or institutions adopting interventions. Objectives: This scoping review aimed to identify, categorize, and summarize the effects of behavioral, clinical, and policy interventions focused on exposure to the most widely used and studied bisphenols [bisphenol A (BPA), bisphenol S (BPS), and bisphenol F (BPF)] and phthalates with an implementation science lens. Methods: A comprehensive search of all individual behavior, clinical, and policy interventions to reduce exposure to bisphenols and phthalates was conducted using PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar. We included studies published between January 2000 and November 2022. Two reviewers screened references in CADIMA, then extracted data (population characteristics, intervention design, chemicals assessed, and outcomes) for studies meeting inclusion criteria for the present review. Results: A total of 58 interventions met the inclusion criteria. We classified interventions as dietary ( ), clinical ( ), policy ( ), and those falling outside of these three categories as “other” ( ). Most interventions (81%, 47/58) demonstrated a decrease in exposure to bisphenols and/or phthalates, with policy level interventions having the largest magnitude of effect. Discussion: Studies evaluating policy interventions that targeted the reduction of phthalates and BPA in goods and packaging showed widespread, long-term impact on decreasing exposure to bisphenols and phthalates. Clinical interventions removing bisphenol and phthalate materials from medical devices and equipment showed overall reductions in exposure biomarkers. Dietary interventions tended to lower exposure with the greatest magnitude of effect in trials where fresh foods were provided to participants. The lower exposure reductions observed in pragmatic nutrition education trials and the lack of diversity (sociodemographic backgrounds) present limitations for generalizability to all populations. https://doi.org/10.1289/EHP11760

Invited Perspective: Why Systematic Reviews, Scoping Reviews, and Evidence-to-Decision Frameworks Are Critical for Transparent, Consistent, Equitable, and Science-Based Decision-Making in Environmental Health

“…conducted a systematic scoping review to examine the efficacy of various exposure-reduction interventions for two classes of toxic chemicals: phthalates and bisphenols. 13 Several members of the phthalate and bisphenol chemical classes, which have been detected in nearly 100% of people living in the United States, 14 , 15 are associated with serious and irreversible health harms, including reproductive and developmental toxicity. 8 , 16 – 18 Because of the known or suspected toxicity of these chemicals and their widespread exposure in the human population, international, federal, and state agencies have implemented policies over the past several decades to mitigate human exposures, especially for susceptible subpopulations, such as infants, children, and pregnant people.…”