Epidemiologic studies of electric and magnetic fields and cancer: strategies for extending knowledge.

Epidemiologic research concerning electric and magnetic fields in relation to cancer has focused on the potential etiologic roles of residential exposure on childhood cancer and occupational exposure on adult leukemia and brain cancer. Future residential studies must concentrate on exposure assessment that is enhanced by developing models of historical exposure, assessment of the relation between magnetic fields and wire codes, and consideration of alternate exposure indices. Study design issues deserving attention include possible biases in random digit dialing control selection, consideration of the temporal course of exposure and disease, and acquisition of the necessary information to assess the potential value of ecologic studies. Highest priorities are comprehensive evaluation of exposure patterns and sources and examination of the sociology and geography of residential wire codes. Future occupational studies should also concentrate on improved exposure assessment with increased attention to nonutility worker populations and development of historical exposure indicators that are superior to job titles alone. Potential carcinogens in the workplace that could act as confounders need to be more carefully examined. The temporal relation between exposure and disease and possible effect modification by other workplace agents should be incorporated into future studies. The most pressing need is for measurement of exposure patterns in a variety of worker populations and performance of traditional epidemiologic evaluations of cancer occurrence. The principal source of bias toward the null is nondifferential misclassification of exposure with improvements expected to enhance any true etiologic association that is present. Biases away from the null might include biased control selection in residential studies and chemical carcinogens acting as confounders in occupational studies

Selection of reproductive health end points for environmental risk assessment.

In addition to the challenges inherent in environmental health risk assessment, the study of reproductive health requires thorough consideration of the very definition of reproductive risk. Researchers have yet to determine which end points need to be considered to comprehensively evaluate a community's reproductive health. Several scientific issues should be considered in the selection of end points: the severity of the outcomes, with a trade-off between clinical severity and statistical or biological sensitivity; the relative sensitivity of different outcomes to environmental agents; the interrelationship among adverse outcomes; the baseline frequency of the adverse outcome; evidence from reproductive toxicology; and specificity of reproductive effects from the environmental agent. Simultaneously, practical concerns should be addressed: frequency of occurrence of an event and consequent statistical power to evaluate changes; frequency of prerequisites (e.g., pregnancy) that are necessary to be at risk; time and money resource requirements for measuring the outcome; amenability of the end point to retrospective measurement; and burden of measurement on the population being studied. In this article, we discuss these scientific and practical considerations and recommend that reproductive risk assessment include measures of fecundability (menstrual function, time to pregnancy), fetal loss (clinically recognized miscarriage), and infant health (birth weight, gestational age). Additional methodological research is needed to refine the array of reproductive health measures that need to be examined as a consequence of environmental exposures

Pregnancy-induced hypertension in North Carolina, 1988 and 1989.

INTRODUCTION: Pregnancy-induced hypertension (PIH) is a highly prevalent pregnancy complication with adverse effects on maternal and infant health. Epidemiologic research concerning its etiology is limited. METHODS: Birth records from North Carolina for the period 1988 through 1989 included an indication of the presence of PIH. The risk of PIH was examined in relation to several maternal characteristics and exposures, including reproductive history, demographic characteristics, and tobacco use during pregnancy. Risk ratio estimates, adjusted for confounders, were calculated contrasting PIH among exposed vs unexposed women. RESULTS: The overall risk of PIH was 43.1 per 1000 births, with multiple pregnancies, nulliparity, and advanced maternal age associated with markedly increased risks. Tobacco use was inversely associated with PIH, and Blacks and Whites were at virtually equal risk. CONCLUSIONS: Problems in diagnosis and classification impede research in this area, with birth certificates limited in quality and breadth of information. Nonetheless, several patterns emerged that are worthy of further epidemiologic evaluation using more sophisticated designs

Parental occupation and childhood cancer: review of epidemiologic studies.

Parental occupational exposures might affect childhood cancer in the offspring through genetic changes in the ovum or sperm or through transplacental carcinogenesis. The 24 published epidemiologic studies of this association have all used case-control designs, with controls generally selected from birth certificates or from general population sampling. Occupational exposures were inferred from job titles on birth certificates or through interviews. A large number of occupation-cancer associations have been reported, many of which were not addressed or not confirmed in other studies. Several associations have been found with consistency: paternal exposures in hydrocarbon-associated occupations, the petroleum and chemical industries, and especially paint exposures have been associated with brain cancer; paint exposures have also been linked to leukemias. Maternal exposures have received much less attention, but studies have yielded strongly suggestive results linking a variety of occupational exposures to leukemia and brain cancer. The primary limitations in this literature are the inaccuracy inherent in assigning exposure based on job title alone and imprecision due to limited study size. Although no etiologic associations have been firmly established by these studies, the public health concerns and suggestive data warrant continued research

Pesticides and childhood cancers.

To evaluate the possible association between pesticides and the risk of childhood cancers, epidemiologic studies published between 1970 and 1996 were critically reviewed. Thirty-one studies investigated whether occupational or residential exposure to pesticides by either parents or children was related to increased risk of childhood cancer. In general, the reported relative risk estimates were modest. Risk estimates appeared to be stronger when pesticide exposure was measured in more detail. Frequent occupational exposure to pesticides or home pesticide use was more strongly associated with both childhood leukemia and brain cancer than either professional exterminations or the use of garden pesticides. Occupational pesticide exposure was also associated with increased risk of Wilms' tumor, Ewing's sarcoma, and germ cell tumors. Residence on a farm, a proxy for pesticide exposure, was associated with increased risk of a number of childhood cancers. Although increased risk of some childhood cancers in association with pesticide exposure is suggested by multiple studies, methodological limitations common to many studies restrict conclusions; these include indirect exposure classification, small sample size, and potential biases in control selection. Opportunities for methodologic improvement in future studies of pesticides and childhood cancers are described

Epidemiologic Studies of Electric and Magnetic Fields and Cancer: Strategies for Extending Knowledge

Epidemiologic research concerning electric and magnetic fields in relation to cancer has focused on the potential etiologic roles of residential exposure on childhood cancer and occupational exposure on adult leukemia and brain cancer. Future residential studies must concentrate on exposure assessment that is enhanced by developing models of historical exposure, assessment of the relation between magnetic fields and wire codes, and consideration of alternate exposure indices. Study design issues deserving attention include possible biases in random digit dialing control selection, consideration of the temporal course of exposure and disease, and acquisition of the necessary information to assess the potential value of ecologic studies. Highest priorities are comprehensive evaluation of exposure patterns and sources and examination of the sociology and geography of residential wire codes. Future occupational studies should also concentrate on improved exposure assessment with increased attention to nonutility worker populations and development of historical exposure indicators that are superior to job titles alone. Potential carcinogens in the workplace that could act as confounders need to be more carefully examined. The temporal relation between exposure and disease and possible effect modification by other workplace agents should be incorporated into future studies. The most pressing need is for measurement of exposure patterns in a variety of worker populations and performance of traditional epidemiologic evaluations of cancer occurrence. The principal source of bias toward the null is nondifferential misclassification of exposure with improvements expected to enhance any true etiologic association that is present. Biases away from the null might include biased control selection in residential studies and chemical carcinogens acting as confounders in occupational studies

Overview of Occupational Exposure to Electric and Magnetic Fields and Cancer: Advancements in Exposure Assessment

For over ten years, there has been concern with the potential for increased risk of cancer among "electrical workers." In contrast to studies of residential exposure to magnetic fields, occupational studies include electric and magnetic field exposures and have much greater variability in field intensity, frequency, and temporal patterns. Studies of leukemia in electrical workers show a moderate consistency, with elevated risk ratios of 1.2 to 2.0 commonly observed. Brain tumors are similarly elevated with some consistency, and three recent studies have suggested increased risk of male breast cancer. Retrospective exposure assessment methods were advanced in recent studies of diverse occupations in a study in central Sweden, which yielded evidence of increased risk of chronic lymphocytic leukemia among men in more highly exposed occupations. A study of telephone workers in New York State incorporated measurements and found some indication of increased leukemia risk only when exposures were based on historical technology. Utility workers in southern California were studied and found not to have increased risks of leukemia and brain cancer based on exposures estimated with measurements. An ongoing study of electric utility workers at five companies in the United States incorporates an extensive measurement protocol. Randomly selected workers within occupational categories wore a time-integrating magnetic-field meter to provide estimates of exposure for the occupational category. We were able to estimate and partition the variance into between-day (the largest contributor), within occupational categories, and between occupational categories. Principal research needs concern optimal levels of worker aggregation for exposure assignment, historical extrapolation, study of diverse work environments, and integration of residential and occupational exposure in the same study

Assessment of water use for estimating exposure to tap water contaminants.

Epidemiological studies examining the association between exposure to tap water contaminants (such as chlorination by-products) and disease outcomes (such as cancer and adverse reproductive outcomes) have been limited by inaccurate exposure assessment. Failure to take into account the variation in beverage and tap water consumption and exposure to volatile contaminants through inhalation and dermal absorption can introduce misclassification in assessing the association between exposure to tap water contaminants and health. To refine exposure assessment of tap water contaminants, we describe in detail the tap water consumption, showering, and bathing habits of pregnant women and their male partners as assessed by a questionnaire and a 3-day water diary. We found good agreement between questionnaire and 3-day water diary values for drinking water intake (Pearson's r = 0.78) and for time spent showering(r = 0.68) and bathing (r = 0.78). Half of the participants consumed tap water on a regular basis with an overall mean +/- 1 standard deviation (SD) of 0. 78 +/- 0.51 l/day. Our results further suggest that full-time employees, compared to women working part-time or less, have more heterogeneous consumption patterns over time. Seventy-nine percent of women and 94% of men took showers for an average of 11.6 +/-4.0 min and 10.4 +/- 4.8 min, respectively. Baths were taken more frequently by women than men (21% vs. 3%) for an average of 22.9 +/-10.1 min and 21.3 +/- 12.4 min, respectively. Thus, these patterns of tap water use should be considered in the design and interpretation of environmental epidemiology studies

Drinking water and pregnancy outcome in central North Carolina: source, amount, and trihalomethane levels.

In spite of the recognition of potentially toxic chemicals in chlorinated drinking water, few studies have evaluated reproductive health consequences of such exposure. Using data from a case-control study of miscarriage, preterm delivery, and low birth weight in central North Carolina, we evaluated risk associated with water source, amount, and trihalomethane (THM) concentration. Water source was not related to any of those pregnancy outcomes, but an increasing amount of ingested water was associated with decreased risks of all three outcomes (odds ratios around 1.5 for 0 glasses per day relative to 1-3 glasses per day, falling to 0.8 for 4+ glasses per day). THM concentration and dose (concentration x amount) were not related to pregnancy outcome, with the possible exception of an increased risk of miscarriage in the highest sextile of THM concentration (adjusted odds ratio = 2.8, 95% confidence interval = 1.1-2.7), which was not part of an overall dose-response gradient. These data do not indicate a strong association between chlorination by-products and adverse pregnancy outcome, but given the limited quality of our exposure assessment and the increased miscarriage risk in the highest exposure group, more refined evaluation is warranted