Interpretation of Low to Moderate Relative Risks in Environmental Epidemiologic Studies

Acquavella, John F.; Friedlander, Barry; Ireland, Belinda

doi:10.1146/annurev.pu.15.050194.001143

Cited by 7 publications

(6 citation statements)

References 25 publications

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“…Nine studies (20% ) reported no significant associations between exposures and health effects. There are many possible reasons for insignificance (Roht et al, 1985;Schulman et al, 1993;Acquavella et al, 1994;Nurminen, 1995 ). As examples, the studies suggested the possibility of sampling and measurement bias ( Willis et al, 1993;Garcõ Âa -Rodrõ Âguez et al, 1996;Morris and Knorr, 1996 ), confounding ( Heary et al, 1980;Archer, 1990;Baghurst et al, 1992;Kilburn and Warshaw, 1995;Pope et al, 1995 ) , insufficient sample size and statistical power (Greaves et al, 1981;Matanoski et al, 1981;Brown et al, 1984;Rosenman et al, 1989;Aschengrau et al, 1996 ) , lack of baseline data ( Willis et al, 1993 ) , and residence mobility Pekkanen et al, 1995 ) .…”

Section: Validity Of Residence Location As An Exposure Indicatormentioning

confidence: 99%

Residence location as a measure of environmental exposure: a review of air pollution epidemiology studies

Huang

Batterman

2000

J Expo Sci Environ Epidemiol

161

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Residence location has long been used to indicate environmental exposure in many epidemiological studies. This indicator is easy to establish, requires little exposure or monitoring data, and is potentially applicable to many types of investigations. The validity, accuracy and utility of residence location as an exposure indicator, however, is challenged by current concerns regarding multiple exposure pathways, persistent and toxic contaminants, and cumulative exposures from non -point, mobile and point sources. This paper reviews 45 epidemiological studies that use residence location to identify study populations and estimate air pollution exposures. Thirteen ( 29% ) of the studies determined environmental exposures based on``proximity'' measures, usually the distance from a subject's residence to a pollutant source. Other studies used``zones'' presumed to have equal pollutant levels. Several studies combined zone and proximity approaches. Exposures were quantified using monitoring data in 27 ( 60% ) studies and dispersion modeling in two ( 4% ) studies. Sixteen ( 36% ) studies did not use any environmental data to quantify exposure. A total of 31 ( 69% ) of the studies reported significant associations between health endpoints and the pollutant exposures represented by residence location. In general, comprehensive and systematic approaches to identify and estimate population exposures were not used, and the exposure estimates were therefore deemed likely to have great uncertainty. Unless exposure levels among groups are verified, it cannot be determined whether nonsignificant associations between exposures and health endpoints indicate a lack of measurable health effects, or are merely a result of exposure misclassification. Site -specific and quantitative exposure assessments are needed to better quantify and confirm exposures within such studies, as well as to permit interpretations and comparisons across studies. Journal of Exposure Analysis and Environmental Epidemiology (2000) 10, 66 ± 85.

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Section: Validity Of Residence Location As An Exposure Indicatormentioning

confidence: 99%

Residence location as a measure of environmental exposure: a review of air pollution epidemiology studies

Huang

Batterman

2000

J Expo Sci Environ Epidemiol

161

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“…When general causation between the substance in question and specific adverse health effect(s) has not been firmly established, formal causal analysis using a framework such as the Bradford Hill criteria may be considered [40]. Although not extolled by Hill, evaluation of relative risks (RRs) and confidence intervals are informative in a general causation analysis provided that they are interpreted with concern for bias, confounding, and validity in the underlying studies [41]. It is particularly difficult to assert causality with small-tomoderate RRs, which are unlikely to fulfill Hill's "strength" and "biological gradient" criteria, and competing theories to explain the possible association between exposure and disease should be explored.…”

Section: World Trade Center Health Programmentioning

confidence: 99%

“…It is of some note that the Agency for Toxic Substances and Disease Registry does not consider animal model studies to be sufficient for determining that an exposure results in an adverse human health effect. Within human epidemiological studies themselves, different study designs (i.e., case-control, cohort, ecological, cross-sectional) each have their strengths and weaknesses in contributing to a causation analysis [41]. Characteristics of the adverse human health effect, such as induction and latency periods, should be considered when critically analyzing study designs.…”

Section: World Trade Center Health Programmentioning

confidence: 99%

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The implementation of medical monitoring programs following potentially hazardous exposures: a medico-legal perspective

Vearrier

Greenberg

2017

Clinical Toxicology

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Context: Clinical toxicologists may be called upon to determine the appropriateness of medical monitoring following documented or purported exposures to toxicants in the occupational, environmental, and medical settings. Methods: We searched the MEDLINE database using the Ovid V R search engine for the following terms cross-referenced to the MeSH database: ("occupational exposures" OR "environmental exposures") AND ("physiologic monitoring" OR "population surveillance"). The titles and abstracts of the resulted articles were reviewed for relevance. We expanded our search to include non-peer-reviewed publications and gray literature and resources using the same terms as utilized in the MEDLINE search. There were a total of 48 relevant peer-reviewed and non-peer-reviewed publications. Publications excluded contained no information relevant to medical monitoring following potentially harmful toxicologic exposures, discussed only worker screening/surveillance and/or population biomonitoring, contained redundant information, or were superseded by more recent information.

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“…Where the at-risk population is small to begin with, and the environmental risks are low to moderate, interpreting epidemiological results is limited by lack of power (Acquavella et al, 1994). Moreover, attempts to validate exposure by testing for biomarkers are often frustrated when years have elapsed since the exposure was terminated.…”

Section: Role Of Epidemiological Studiesmentioning

confidence: 99%

Approaches for assessing hazards and risks to workers and the public from contaminated land

Gochfeld

Burger

Friedlander

et al. 2007

Remediation Journal

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Many public agencies and private entities are faced with assessing the risks to humans from contamination on their lands. The United States Department of Energy (US DOE) and Department of Defense are responsible for large holdings of contaminated land and face a long-term and costly challenge to assure sustainable protectiveness. With increasing interest in the conversion of brownfields to productive uses, many former industrial properties must also be assessed to determine compatible future land uses. In the United States, many cleanup plans or actions are based on the Comprehensive Environmental Responsibility, Compensation, and Liability Act, which provides important but incomplete coverage of these issues, although many applications have tried to involve stakeholders at multiple steps. Where there is the potential for exposure to workers, the public, and the environment from either cleanup or leaving residual contamination in place, there is a need for a more comprehensive approach to evaluate and balance the present and future risk(s) from existing contamination, from remediation actions, as well as from postremediation residual contamination.This article focuses on the US DOE, the agency with the largest hazardous waste remediation task in the world. Presented is a framework extending from preliminary assessment, risk assessment and balancing, epidemiology, monitoring, communication, and stakeholder involvement useful for assessing risk to workers and site neighbors. Provided are examples of those who eat fish, meat, or fruit from contaminated habitats. The US DOE's contaminated sites are unique in a number of ways:(1) huge physical footprint size, (2) types of waste (mixed radiation/chemical), and (3) quantities of waste. Proposed future land uses provide goals for remediation, but since some contamination is of a type or magnitude that cannot be cleaned up with existing technology, this in turn constrains future land use options, requiring an iterative approach. The risk approaches must fit a range of future land uses and end-states from leave-in-place to complete cleanup. This will include not only traditional risk methodologies, but also the assessment and surveillance necessary for stewards for long-term monitoring of risk from historic and future exposure to maintain sustainable protective- 29Approaches for Assessing Hazards and Risks to Workers and the Public from Contaminated Land entities to focus on realistic remediation goals constrained by technologic feasibility and costs as well as future land uses and values. At the end of the Cold War in 1989, the United States Department of Energy (US DOE) faced the daunting task of remediating chemical and radioactive waste from weapons production, storage, and testing (US DOE, 1996a). Contaminated soil, lakes, rivers, buildings, tanks, drums, and other containers in various states of repair require study and remediation-or at least containment and maintenance-at great cost (US DOE, 1995). There are at least 100 US DOE waste sites that cannot be cleaned ...

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Interpretation of Low to Moderate Relative Risks in Environmental Epidemiologic Studies

Cited by 7 publications

References 25 publications

Residence location as a measure of environmental exposure: a review of air pollution epidemiology studies

Residence location as a measure of environmental exposure: a review of air pollution epidemiology studies

The implementation of medical monitoring programs following potentially hazardous exposures: a medico-legal perspective

Approaches for assessing hazards and risks to workers and the public from contaminated land

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