Berit Bakke

Uses of and Exposure to Trichloroethylene in U.S. Industry: A Systematic Literature Review

This article describes a systematic review of the industrial hygiene literature for uses of trichloroethylene (TCE) in industry for the exposure assessment of two population-based case control studies of brain cancer in the United States. Papers and reports that address uses of and exposures to TCE were identified from MEDLINE, TOXLINE, NIOSHTIC, the NIOSH Health Hazard Evaluation database (keywords: chlorinated solvents and trichloroethylene), and in other reviews. This search was complemented by reviewing the reference lists from the identified literature. The collected information was systematized by the Standard Industrial Classification (SIC) system, and measurement data reported in the literature were summarized in a database. TCE use was extensive from the early 1920s through the 1970s mainly as a degreasing agent in metal-fabricating operations. After the 1970s it became less popular because of environmental concerns. TCE historically has had a multitude of uses in many other industries, e.g., dry cleaning, textile, electronics, leather, and rubber. Also, many products like adhesives, drugs, paints, inks, and various industrial products have contained TCE. It was banned as a food additive and in cosmetics in 1977. The arithmetic mean (AM) of the measurements across all industries and decades was 38.2 ppm. The highest personal and area air levels were reported in vapor degreasing (AM of 44.6 ppm). Most TCE measurements were performed in the 1950s, 1970s, and 1980s. The data described here could be used by exposure assessors as is to identify the presence and approximate levels of exposure. Using the same information as a basis should increase the reliability of the assessments, making it easier to compare both the exposure assessment methods and the epidemiologic results across different studies.

Cumulative exposure to dust causes accelerated decline in lung function in tunnel workers

OBJECTIVES To examine whether underground construction workers exposed to tunnelling pollutants over a follow up period of 8 years have an increased risk of decline in lung function and respiratory symptoms compared with reference subjects working outside the tunnel atmosphere, and relate the findings to job groups and cumulative exposure to dust and gases. METHODS 96 Tunnel workers and a reference group of 249 other heavy construction workers were examined in 1991 and re-examined in 1999. Exposure measurements were carried out to estimate personal cumulative exposure to total dust, respirable dust, α-quartz, oil mist, and nitrogen dioxide. The subjects answered a questionnaire on respiratory symptoms and smoking habits, performed spirometry, and had chest radiographs taken. Radiological signs of silicosis were evaluated (International Labour Organisation (ILO) classification). Atopy was determined by a multiple radioallergosorbent test (RAST). RESULTS The mean exposure to respirable dust and α-quartz in tunnel workers varied from 1.2–3.6 mg/m3 (respirable dust) and 0.019–0.044 mg/m3 (α-quartz) depending on job task performed. Decrease in forced expiratory volume in 1 second (FEV1) was associated with cumulative exposure to respirable dust (p<0.001) and α-quartz (p=0.02). The multiple regression model predicted that in a worker 40 years of age, the annual decrease in FEV1 would be 25 ml in a non-exposed non-smoker, 35 ml in a non-exposed smoker, and 50–63 ml in a non-smoking tunnel worker (depending on job). Compared with the reference group the odds ratio for the occurrence of new respiratory symptoms during the follow up period was increased in the tunnel workers and associated with cumulative exposure to respirable dust. CONCLUSIONS Cumulative exposures to respirable dust and α-quartz are the most important risk factors for airflow limitation in underground heavy construction workers, and cumulative exposure to respirable dust is the most important risk factor for respiratory symptoms. The finding of accelerated decline in lung function in tunnel workers suggests that better control of exposures is needed.

Increased risk of obstructive pulmonary disease in tunnel workers

BACKGROUND Tunnel workers are exposed to gases and particles from blasting and diesel exhausts. The aim of this study was to assess the occurrence of respiratory symptoms and airflow limitation in tunnel workers and to relate these findings to years of exposure. METHODS Two hundred and twelve tunnel workers and a reference group of 205 other heavy construction workers participated in a cross sectional investigation. Exposure measurements were carried out to demonstrate the difference in exposure between the two occupational groups. Spirometric tests and a questionnaire on respiratory symptoms and smoking habits were applied. Atopy was determined by a multiple radioallergosorbent test (RAST). Radiological signs of silicosis were evaluated. Respiratory symptoms and lung function were studied in relation to years of exposure and adjusted for smoking habits and atopy. RESULTS Compared with the reference subjects the tunnel workers had a significant decrease in forced vital capacity (FVC) % predicted and forced expiratory volume in one second (FEV1) % predicted when related to years of exposure. Adjusted FEV1 decreased by 17 ml for each year of tunnel work exposure compared with 0.5 ml in outdoor heavy construction workers. The tunnel workers also reported significantly higher occurrence of respiratory symptoms. The prevalence of chronic obstructive pulmonary disease (COPD) was 14% in the tunnel workers compared with 8% in the reference subjects. CONCLUSION Exposure to dust and gases from diesel exhaust, blasting, drilling and rock transport in tunnel work enhances the risk for accelerated decline in FEV1, respiratory symptoms, and COPD in tunnel workers compared with other heavy construction workers.

A Case-Control Study of Occupational Exposure to Trichloroethylene and Non-Hodgkin Lymphoma

Background Previous epidemiologic findings suggest an association between exposure to trichloroethylene (TCE), a chlorinated solvent primarily used for vapor degreasing of metal parts, and non-Hodgkin lymphoma (NHL). Objectives We investigated the association between occupational TCE exposure and NHL within a population-based case–control study using detailed exposure assessment methods. Methods Cases (n = 1,189; 76% participation rate) and controls (n = 982; 52% participation rate) provided information on their occupational histories and, for selected occupations, on possible workplace exposure to TCE using job-specific interview modules. An industrial hygienist assessed potential TCE exposure based on this information and a review of the TCE industrial hygiene literature. We computed odds ratios (ORs) and 95% confidence intervals (CIs) relating NHL and different metrics of estimated TCE exposure, categorized using tertiles among exposed controls, with unexposed subjects as the reference group. Results We observed associations with NHL for the highest tertiles of estimated average weekly exposure (23 exposed cases; OR = 2.5; 95% CI, 1.1–6.1) and cumulative exposure (24 exposed cases; OR = 2.3; 95% CI, 1.0–5.0) to TCE. Tests for trend with these metrics surpassed or approached statistical significance (p-value for trend = 0.02 and 0.08, respectively); however, we did not observe dose–response relationships across the exposure levels. Overall, neither duration nor intensity of exposure was associated with NHL, although we observed an association with the lowest tertile of exposure duration (OR = 2.1; 95% CI, 1.0–4.7). Conclusions Our findings offer additional support for an association between high levels of exposure to TCE and increased risk of NHL. However, we cannot rule out the possibility of confounding from other chlorinated solvents used for vapor degreasing and note that our exposure assessment methods have not been validated.

Gas and dust exposure in underground construction is associated with signs of airway inflammation

Exposure to gases and dust may induce airway inflammation. It was hypothesized that heavy construction workers who had been exposed to dust and gases in underground construction work for 1 yr, would have early signs of upper and lower airway inflammation, as compared to outdoor workers. A study group comprising 29 nonsmoking underground concrete workers (mean +/- SD age 44+/-12 yrs), and a reference group of 26 outdoor concrete workers (39+/-12 yrs) were examined by acoustic rhinometry, nasal and exhaled nitric oxide spirometry and a questionnaire on respiratory symptoms. Exposure measurements were carried out. The underground workers had higher exposure to total and respirable dust, alpha-quartz and nitrogen dioxide than the references (p<0.001). The occurrence of respiratory symptoms was higher in the underground workers than in the references (p<0.05). Exhaled nitric oxide (NO) (geometric mean+/-SEM) was higher in the underground workers than in the references (8.4+/-1.09 versus 5.6+/-1.07 parts per billion (ppb), p = 0.001), whereas spirometric values were comparable. The underground workers had smaller nasal cross-sectional area and volume than the references, and more pronounced increases after decongestion (p<0.001). To conclude the exposure in underground construction may cause nasal mucosal swelling and increased levels of exhaled nitric oxide, indicating signs of upper and lower airway inflammation.

Dust and gas exposure in tunnel construction work.

Personal exposures to dust and gases were measured among 189 underground construction workers who were divided into seven occupational groups performing similar tasks in similar working conditions: drill and blast crew; shaft-drilling crew; tunnel-boring machine crew; shotcreting operators; support workers; concrete workers; and electricians. Outdoor tunnel workers were included as a low-exposed reference group. The highest geometric mean (GM) exposures to total dust (6-7 mg/m3) and respirable dust (2-3 mg/m3) were found for the shotcreters, shaft drillers, and tunnel-boring machine workers. Shaft drillers and tunnel-boring machine workers also had the highest GM exposures to respirable alpha-quartz (0.3-0.4 mg/m3), which exceeded the Norwegian occupational exposure limit (OEL) of 0.1 mg/m3. Shaft drillers had the highest exposure to oil mists (GM=1.4 mg/m3), which was generated mainly from pneumatic drilling. For other groups, exposure to oil mist from diesel exhaust and spraying of oil onto concrete forms resulted in exposures of 0.1-0.5 mg/m3. Exposure to nitrogen dioxide was similar across all groups (GM=0.4-0.9 ppm), except for shaft drillers and tunnel-boring machine workers, who had lower exposures. High short-term exposures (>10 ppm), however, occurred when workers were passing through the blasting cloud.

Cumulative exposure to dust and gases as determinants of lung function decline in tunnel construction workers

Aims: To study the relation between lung function decrease and cumulative exposure to dust and gases in tunnel construction workers. Methods: A total of 651 male construction workers (drill and blast workers, tunnel concrete workers, shotcreting operators, and tunnel boring machine workers) were followed up by spirometric measurements in 1989–2002 for an average of six years. Outdoor concrete workers, foremen, and engineers served as a low exposed referent population. Results: The between worker component of variability was considerably reduced within the job groups compared to the whole population, suggesting that the workers within job groups had similar exposure levels. The annual decrease in FEV1 in low-exposed non-smoking workers was 21 ml and 24 ml in low-exposed ever smokers. The annual decrease in FEV1 in tunnel construction workers was 20–31 ml higher than the low exposed workers depending on job group for both non-smokers and ever smokers. After adjustment for age and observation time, cumulative exposure to nitrogen dioxide showed the strongest association with a decrease in FEV1 in both non-smokers, and ever smokers. Conclusion: Cumulative exposure to nitrogen dioxide appeared to be a major risk factor for lung function decreases in these tunnel construction workers, although other agents may have contributed to the observed effect. Contact with blasting fumes should be avoided, diesel exhaust emissions should be reduced, and respiratory devices should be used to protect workers against dust and nitrogen dioxide exposure.

Exposure to Fibres, Crystalline Silica, Silicon Carbide and Sulphur Dioxide in the Norwegian Silicon Carbide Industry

Objectives: The aim of this study was to assess personal exposure to fibres, crystalline silica, silicon carbide (SiC) and sulphur dioxide in the Norwegian SiC industry. Methods: Approximately 720 fibre samples, 720 respirable dust samples and 1400 total dust samples were collected from randomly chosen workers from the furnace, processing and maintenance departments in all three Norwegian SiC plants. The respirable dust samples were analysed for quartz, cristobalite and non-fibrous SiC content. Approximately 240 sulphur dioxide samples were collected from workers in the furnace department. Results: The sorting operators from all plants, control room and cleaning operators in Plant A and charger, charger/mix and payloader operators in Plant C had a geometric mean (GM) of fibre exposure above the Norwegian occupational exposure limit (OEL) (0.1 fibre cm−3). The cleaner operators in Plant A had the highest GM exposure to respirable quartz (20 μg m−3). The charger/mix operators in Plant C had the highest GM exposure to respirable cristobalite (38 μg m−3) and the refinery crusher operators in Plant A had the highest GM exposure to non-fibrous SiC (0.65 mg m−3). Exposure to the crystalline silica and non-fibrous SiC was generally low and between 0.4 and 2.1% of the measurements exceeded the OELs. The cleaner operators in Plant A had the highest GM exposure to respirable dust (1.3 mg m−3) and total dust (21 mg m−3). GM exposures for respirable dust above the Norwegian SiC industry-specific OEL of 0.5 mg m−3 were also found for refinery crusher operators in all plants and mix, charger, charger/mix and sorting operators in Plant C. Only 4% of the total dust measurements exceeded the OEL for nuisance dust of (10 mg m−3). Exposure to sulphur dioxide was generally low. However, peaks in the range of 10–100 p.p.m. were observed for control room and crane operators in Plants A and B and for charger and charger/mix operators in Plant C. Conclusion: Workers in the SiC industry are exposed to a mixture of several agents including SiC fibres, quartz, cristobalite, non-fibrous SiC and sulphur dioxide. Exposure levels were generally below the current Norwegian OELs; however, high exposure to fibres and respirable dust still occurs in the furnace department.

Exposure to Atrazine and Selected Non-Persistent Pesticides among Corn Farmers during a Growing Season

The aim was to develop quantitative estimates of farmers’ pesticide exposure to atrazine and to provide an overview of background levels of selected non-persistent pesticides among corn farmers in a longitudinal molecular epidemiologic study. The study population consisted of 30 Agricultural Health Study farmers from Iowa and 10 non-farming controls. Farmers completed daily and weekly diaries from March to November in 2002 and 2003 on pesticide use and other exposure determinants. Urine samples were collected at 10 time points relative to atrazine application and other farming activities. Pesticide exposure was assessed using urinary metabolites and diaries. The analytical limit of detection (LOD) ranged between 0.1 and 0.2 μg/l for all pesticide analytes except for isazaphos (1.5 μg/l) and diazinon (0.7 μg/l). Farmers had higher geometric mean urinary atrazine mercapturate (AZM) values than controls during planting (1.1 vs <LOD μg/g creatinine; P<0.05). AZM levels among farmers were significantly related to the amount of atrazine applied (P=0.015). Interestingly, farmers had a larger proportion of samples above the LOD than controls even after exclusion of observations with an atrazine application within 7 days before urine collection (38% vs 6%, P<0.0001). A similar pattern was observed for 2,4-D and acetochlor (92% vs 47%, P<0.0001 and 45% vs 4%, P<0.0001, respectively). Urinary AZM levels in farmers were largely driven by recent application of atrazine. Therefore, the amount of atrazine applied is likely to provide valid surrogates of atrazine exposure in epidemiologic studies. Elevated background levels of non-persistent pesticides, especially 2,4-D, indicate importance in epidemiologic studies of capturing pesticide exposures that might not be directly related to the actual application.

Determinants of Dust Exposure in Tunnel Construction Work

In tunnel construction work, dust is generated from rock drilling, rock bolting, grinding, scaling, and transport operations. Other important dust-generating activities are blasting rock and spraying wet concrete on tunnel walls for strength and finishing work. The aim of this study was to identify determinants of dust exposure in tunnel construction work and to propose control measures. Personal exposures to total dust, respirable dust, and alpha-quartz were measured among 209 construction workers who were divided into 8 job groups performing similar tasks: drill and blast workers, shaft drilling workers, tunnel boring machine workers, shotcreting operators, support workers, concrete workers, outdoor concrete workers, and electricians. Information on determinants was obtained from interviewing the workers, observation by the industrial hygienist responsible for the sampling, and the job site superintendent. Multivariate regression models were used to identify determinants associated with the dust exposures within the job groups. The geometric mean exposure to total dust, respirable dust, and alpha-quartz for all tunnel workers was 3.5 mg/m(3) (GSD = 2.6), 1.2 mg/m(3) (GSD = 2.4), and 0.035 mg/m(3) (GSD = 5.0), respectively. A total of 15 percent of the total dust measurements, 5 percent of the respirable dust, and 21 percent of the alpha-quartz exceeded the Norwegian OELs of 10 mg/m(3), 5 mg/m(3), and 0.1 mg/m(3), respectively. Job groups with highest geometric mean total dust exposure were shotcreting operators (6.8 mg/m(3)), tunnel boring machine workers (6.2 mg/m(3)), and shaft drilling workers (6.1 mg/m(3)). The lowest exposed groups to total dust were outdoor concrete workers (1.0 mg/m(3)), electricians (1.4 mg/m(3)), and support workers (1.9 mg/m(3)). Important determinants of exposure were job group, job site, certain tasks (e.g., drilling and scaling), the presence of a cab, and breakthrough of the tunnel. The use of ventilated, closed cabs appeared to be the single most important control measure for lowering exposures.