The Use of Epidemiology in Risk Assessment: Challenges and Opportunities

Christensen, Krista; Christensen, Carol H.; Wright, J. Michael; Galizia, Audrey; Glenn, Barbara; Scott, Cheryl Siegel; Mall, Jennifer K.; Bateson, Thomas F.; Murphy, Patricia A.; Cooper, Glinda S.

doi:10.1080/10807039.2014.967039

Cited by 18 publications

(7 citation statements)

References 81 publications

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“…Quantification of occupational exposure to pesticides is crucial to investigate potential adverse health effects in workers 1 2. As it is often logistically not feasible or too costly to collect human samples (eg, urine, stool) and measure exposure biomarkers over time, algorithms have been developed to calculate pesticide exposure intensity scores 3 4.…”

Section: Introductionmentioning

confidence: 99%

Variability and predictors of weekly pesticide exposure in applicators from organic, sustainable and conventional smallholder farms in Costa Rica

et al. 2019

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ObjectiveEstimates of pesticide exposure among applicators from low- and middle-income countries (LMICs) are scarce, and exposure assessment methods are sometimes costly or logistically unfeasible. We examined the variability in weeklong pesticide exposure among applicators in Costa Rica and its predictors.MethodsWe conducted a cross-sectional survey among 221 pesticide applicators from organic, sustainable and conventional farms in 2016. We administered structured questionnaires to assess pesticide application practices at two time points (4–6 weeks apart). We adapted an existing algorithm to fit the context of smallholders and derive weekly pesticide exposure scores. We used linear mixed-effect models to examine within-worker and between-worker score variability. We then identified sociodemographic and occupational predictors of weekly pesticide exposure scores.ResultsWe observed high within-worker and between-worker variability in weekly pesticide exposures (eg, up to 180-fold and 70-fold differences in average weekly exposures within and between workers, respectively; intraclass correlation coefficient=0.4). Applicators working on conventional and sustainable farms had exposure scores twofold and 1.5-fold higher than those working in organic farms, respectively. Farm workers who received training on pesticide use had weekly pesticide exposure scores of 33% (95% CI 1% to 55%) lower than those who did not receive any training.ConclusionsIn this study of applicators from smallholder farms in Costa Rica, we determined the importance of collecting questionnaire data on self-reported pesticide use repeatedly due to its high variability within workers and absence of application records. Our questionnaire-based exposure algorithm could allow the calculation of semiquantitative estimates of average pesticide exposure for applicators from other LMICs.

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Section: Introductionmentioning

confidence: 99%

Variability and predictors of weekly pesticide exposure in applicators from organic, sustainable and conventional smallholder farms in Costa Rica

et al. 2019

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“…Not only did the North Carolina cohort mentioned above collect multiple milk samples, but researchers also calculated exposures using the amount of milk consumed and length of time breastfeeding, completing what was one of the most comprehensive and complete postnatal exposure assessments in this database. Many studies included duration of breastfeeding in their exposure calculations, but some dichotomized duration data in their analyses (i.e., expressed duration as “≤ some number of weeks or months” or “> some number of weeks or months”), which poses increased risk of misclassification bias (Christensen et al. 2015).…”

Section: Resultsmentioning

confidence: 99%

Infant Dietary Exposures to Environmental Chemicals and Infant/Child Health: A Critical Assessment of the Literature

LaKind¹,

Lehmann

Davis

et al. 2018

Environ Health Perspect

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Background: The benefits of breastfeeding to the infant and mother have been well documented. It is also well known that breast milk contains environmental chemicals, and numerous epidemiological studies have explored relationships between background levels of chemicals in breast milk and health outcomes in infants and children. Objectives: In this paper, we examine epidemiological literature to address the following question: Are infant exposures to background levels of environmental chemicals in breast milk and formula associated with adverse health effects? We critically review this literature a ) to explore whether exposure–outcome associations are observed across studies, and b ) to assess the literature quality. Methods: We reviewed literature identified from electronic literature searches. We explored whether exposure–outcome associations are observed across studies by assessing the quality (using a modified version of a previously published quality assessment tool), consistency, and strengths and weaknesses in the literature. The epidemiological literature included cohorts from several countries and examined infants/children either once or multiple times over weeks to years. Health outcomes included four broad categories: growth and maturation, morbidity, biomarkers, and neurodevelopment. Results: The available literature does not provide conclusive evidence of consistent or clinically relevant health consequences to infants exposed to environmental chemicals in breast milk at background levels. Conclusions: It is clear that more research would better inform our understanding of the potential for health impacts from infant dietary exposures to environmental chemicals. A critical data gap is a lack of research on environmental chemicals in formula and infant/child health outcomes. https://doi.org/10.1289/EHP1954

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“…Non-differential measurement error of exposures will usually bias the results toward the null by lowering precision and therefore reducing the ability to distinguish potential effects between non-exposed and exposed subjects or among different exposure categories. Differential measurement of exposures across the exposure groups will also bias the exposure-outcome relationship, although the direction of the biases is less clear; some examples include observer and recall bias (Blair et al, 2007; Christensen et al, 2014). …”

Section: Overview Of Current Methods (Framework and Tools)mentioning

confidence: 99%

How credible are the study results? Evaluating and applying internal validity tools to literature-based assessments of environmental health hazards

Rooney

Cooper

Jahnke

et al. 2016

Environment International

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Environmental health hazard assessments are routinely relied upon for public health decision-making. The evidence base used in these assessments is typically developed from a collection of diverse sources of information of varying quality. It is critical that literature-based evaluations consider the credibility of individual studies used to reach conclusions through consistent, transparent and accepted methods. Systematic review procedures address study credibility by assessing internal validity or “risk of bias” — the assessment of whether the design and conduct of a study compromised the credibility of the link between exposure/intervention and outcome. This paper describes the commonalities and differences in risk-of-bias methods developed or used by five groups that conduct or provide methodological input for performing environmental health hazard assessments: the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group, the Navigation Guide, the National Toxicology Program’s (NTP) Office of Health Assessment and Translation (OHAT) and Office of the Report on Carcinogens (ORoC), and the Integrated Risk Information System of the U.S. Environmental Protection Agency (EPA-IRIS). Each of these groups have been developing and applying rigorous assessment methods for integrating across a heterogeneous collection of human and animal studies to inform conclusions on potential environmental health hazards. There is substantial consistency across the groups in the consideration of risk-of-bias issues or “domains” for assessing observational human studies. There is a similar overlap in terms of domains addressed for animal studies; however, the groups differ in the relative emphasis placed on different aspects of risk of bias. Future directions for the continued harmonization and improvement of these methods are also discussed.

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The Use of Epidemiology in Risk Assessment: Challenges and Opportunities

Cited by 18 publications

References 81 publications

Variability and predictors of weekly pesticide exposure in applicators from organic, sustainable and conventional smallholder farms in Costa Rica

Variability and predictors of weekly pesticide exposure in applicators from organic, sustainable and conventional smallholder farms in Costa Rica

Infant Dietary Exposures to Environmental Chemicals and Infant/Child Health: A Critical Assessment of the Literature

How credible are the study results? Evaluating and applying internal validity tools to literature-based assessments of environmental health hazards

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