Human Biomonitoring of Environmental
Chemicals
Measuring chemicals in human tissues is the "gold standard"
far assessing people' s exposure to pollution
Ken Sexton, Larry L. Needham and James L. Pirkle
W hat chemicals in you.r daily rou-
tine should you be most con-
cerned about? The volatile organic
compounds from yow: carpet? The ex-
haust fumes on the road to work? The
pesticide residues in the apple in yom
lunch? Most of usare exposed to low
levels of thousands of toxic chemicals
every day. How can a person-or a na-
tion-decide which substances should
be controlled most rigorously?
One strategy is to go a.fter the largest
sources of pollution. This approach cer-
tainly makes sense wh.en those pollu-
tants have obvious and widespread
consequences, such as warming the
globe, causing algal blooms, eroding the
ozone layer or killing off wildli.fe. But
far protectinghuman heal th, this strate-
gy does not serve so well, because the
link between a gíven compound and its
biological effects can be d ifficult to
gauge. For epidemiologists to correlate
environmental pollutants with health
problems, they need to know who has
been exposed and at what leve!.
This knowledge is exceptionally dif-
ficu lt to gain when there is a lag be-
tween exposme and the manifestation
of illness. fo such cases, the data are
seldom-i.f ever-sufficient to deter-
Ke11 Sexton is a projessor of enoironmentalsci-
ences al the U11iuersity of TexasSchoolof Public
Hen/111, Broumsuille Regiono! Ca111p11s, and pas!
presiden! of tite International Socieh¡ of Exposure
A11nlysis ({SEA). Larry L. Needham is Chie]of the
Orgn11ic Annlyticnl Toxicology Branch in theNo-
rionn! Center for Enuiroumenml Health of tite
Centers for Disease Control n11rl Preueution
(COC) and the curren/ /SEA president,james L.
Pirkle is the Deputy Director for Scieucc al the
CDC's E11viro11me11tnl Health Laborntory. Sex-
ton's ndrlress is University of Texas Schoolof P11b-
lic Henlth, Broumsuille Regionn!Cn111p11s, RAHC
B11ildí11g, 80 Fort Brow11, Broumsuiíle, TX 78520.
Internet: ksexto11@utb.erlu
© 2004 Sigma Xi, The Scienti.fic Researcb Society Reproduction
38 American Scientist, Volume 92
work to discover ali kinds of details,
mine the precise agent, the details of sure also requires complex detective
contad and the full extent of the affect-
ed population. Complicating matters, i:ncluding the chemical identity (far ex-
the scientific understanding of the a mple, the pesticide chlorpyrifos),
mechanisms of ~xposme, such as how source (nea.rby agricultu.ral use), medí-
various compou:nds are carried through um of transport (groundwater) and
the air and changed along the way, is route (drinkingcontaminated well wa-
often incomplete. As a result, epidemi- ter). Scientists must consider this infor-
ologists often fin.d it dillicult to estab- mation on exposure against the back-
lish cause-and-eHect relationships for ground of people's activity patterns,
environ.mentally induced sicknesses, eating and drinkinghabits,and lifestyle,
Without reliable information some pol- and they must also evaluate the influ-
luta n ts may be unfairly blamed, where- ence of other chemicals in the air,water,
as others exert their dire effects without beverages, food, dust and soil. Overall,
challenge. Fortunately,there is hope: a this is a daunting challenge.
method of accurately measuri:ng not Historically; those scientists who un-
only contact with, but also absorption dertook such a cornplex task have re-
of toxic chemicals from, the environ- lied on indirect methods: questíon-
rnent-human biomonitoring. naires, diaries, interviews, centralized
monitoring of communítyair or water,
Is Itin Me? and a record of broad activity patterns
Ea.ch person's risk of developing an en- among the population. But the results
vironmentallyrelated clisease, such as were often d isappoin ting. Although
cancer, resuJts from a unique combi:na- these circumstantial approaches have
tion of exposure,genes, age, sex, nutrí- the advantages of practicality and .fru-
tion and li.festyle. Science doesn't fully gality, they can also introduce substan-
understa.nd how these variables inter- tial uncertaintyinto resulting exposure
act, but exposure is dearly a key fac- estimates. This shortcoming multiplies
tor. Thus, a fundamental goal of envi- the potential for a fundamental error-
ronmental health policy is to prevent classifying a person as "not exposed"
(or at least reduce) people taking in when he or she has been or vice versa.
chernicals that lead to any of the five A second approach, the d:i.rect mea-
Ds-disconúort, dyshmction, disabili- surement of an individual's enviren-
ty, disease or death. ment, is sometimes a possibility-forex-
Exposure to an environmental ample, a person might carry a portable
chemical is mínimally defined as con- monitor to record contact with aírborne
tact with the skü1, mouth or nostrils-a chemicals. Although this technique oí-
meanü1g that includes breathing, eat- fers an unequivocal record of chemical
ing a:nd drinking. For the purposes of contact, it is technologically in.feasible
assessing risk, the most important at- or prohibitively expensive to measure
tributes of exposure are magnitude most pollutants this way. Also, although
(what is the concentration?), duration such monitors document exposure,they
(how long does contact last?), frequen- tell nothing about the person's uptake
cy (how often do exposures occur?) of these airborne chemicals-how
and timing (at what age do exposmes much truly gets into his or her body;
occur?).The calcuJation of actual expo- which is, of course, the most relevant
with permission only. Co11tact penns@arnsci.org.
 Bettmann/Corbis
Figure 1. In July 1945, DDT was widely (and mistakenly) hailed as a progressive measure to eradicate dísease-bearing mosquitoes without pos-
ing a risk to human health. In this photo from a beach on Long Island, New York, a new insecticide-spraying machine is tested as beachgoers
play in the mis t. Although this chemical contad is obvious, many other sources of environmental chemical exposure are more difficult to iden-
tify. Human biomonitoring examines people's blood and urine to evaluate actual levels of more than a hundred substances.

information. for assessing health risk. first applied about 130 years ago when dose, or sometimes the body burden)
Fortunately, technological advances in doctors monitored the amount of sali- has considerable value for estimati.ng
biomedicine and analytical chemistry cyluric acid in the urine of rheumatics the risk to health. Today, it is relatively
now make it possible to get exactly this who were bei.ng treated with large dos- affordable to measure the absorbed
information. Biomonitoring measures es of salicylic acid (the precursor of as- doses for hundreds of chemicals by
the actual levels of suspected enviren- pirin). Andas early as the 1890s, factory looking for bioma.rkers of exposure in
mental chemicals in humantissues and workers who were exposed to lead had accessiblehuman tissues and fluids, in-
fluids. This third approachhas come to their blood and urine screened to fore- cluding saliva, semen, urine, sputum,
be the "gold standard"for assessing ex- stall the elevated levels that produced hair, feces, breast milk and fingemails
posure to chemicals. acutelead poisoni.ng. (all of which can be collected readily),
These investigators soon learned and blood, lung tissue, bone marrow,
Blood (and Urine) Will Tell that the degree of contact with a sub- follicular fluid, adipose tissue and
Biomonitoringis not new. lt has its roots stance doesn't necessarily determine blood vessels (which require incursion
in the analysis of biologicalsamples for the biologically relevant exposure to into the body). Although procedures to
rnarkers for various pharmaceutical that chemical. As a result, this measure collect any of the first set would, tech-
cornpounds and occupational chemi- didn't help much in predicting the nically, be considered "noninvasive,"
cals, efforts that sought to prevent the risks of lead poisoni.ng. However,they in fact, that categorization rests on cul-
harmful accumulation of dangerous did find that the amount of a com- tural, psychological a.nd social factors.
substances. Although it had a different pou.nd that crosses the body's bound- So obtaining the right material can
name at the time, the general idea was aries (called the intemal or absorbed sometimes be awkward. Fortunately

www.a.mericanscientist.org 2004 Ja.nuary-February 39

 natural compounds in the body such
exposure assessment as proteins.
Choosing the appropriate tíssue or
toxicant 1 toxicant 2 fluid for biological monitoring is based
primarily on the chemical and physical
properties of the chemical of interest
and, in sorne cases, the time interval
emission since the 1ast exposure. For exarnple,
source sorne chemicals including dioxins,
polychlorinatedbiphenylsand organo-
chlorine pesti.cides have long biological
residence times in the body (months or
years) because they are sequestered in
fatty tissues. They are thus saíd to be
fat-loving or, to use the proper term,
lipophilic. By contrast, other chemicals
pathway such as organophosphate pesticides
and volatile organíc compounds, which

J
potential
dose
1 a much longer period (years) than does
absorption barrier
interna!
dose
adverse
effect
Figure 2. Which toxicant is more dangerous? Because of lile múltiple steps through whlch an en-
vironmental chemical rnust pass before it becomes a potential health threat, the answer is not al-
ways clear, Here, toxicant 1is more abundant in the environment, butthe specific properties of the
chemical may mean that it poses less medical risk than another compound. Different methods of
exposure assessment can evaluate each of these steps, but biomarker analysis, which measures in-
terna} doses of specific substances, provides the most relevant informatíon for human health.
for those of us in the biomonitoring for the presence of bíological markers
field, it's never necessary to collect ali of exposure-generally the targeted
of those samples-blood and urine are chemical, its primary metabolites or
typically sufficient. These are analyzed the products of its reaction with certain
don't accumulate in fats (being lipo-
phobic), have relativelyshort biological
residence times (hours or days) and
tend to be metabolized rapidly and ex-
creted in the urine,
The time since the last exposure can
also play a key role in determíníng the
best biological specimen for analysis.
For example, a persistentchemical, such
as a dioxin, remains present in blood for
a nonpersistent compound such as ben-
zene (hours), but dioxin does not form
signilicant urinary metabolites,whereas
benzene does. For these reasons, persis-
tent chemicalsare typically measured in
blood, and nonpersistent chemicals are
measured in urine (as soon after expo-
sure as possible),although they can also
be detected in blood soon after expo-
sure if the analytical methods are suffi-
ciently sensitive-and they usually are.
Specialists can now detect extremely
low levels-parts-per-billionp , arts-per-
b:illion, even parts-per-quadrillion-of
multiple markers using a relatívely
small sample, say, 10 milliliters or less.
Clearly, the sensitivity of the analysís
is important in choosíng what to mea-
sure-but it's not everything. Other is-
sues must be considered before the re-
sults can be considered meaningful.
Well before attempting to discern trace
amoun.ts of target chemicals, an inves-
tigator should be able to answer three
broad questions: How is the rneasure-
ment related to the magnitude, dura-
tion, freguency and timing of expo-
sure? How do subsequent processes
within the body-such as absorption,
distribution, metabolism and excre-
tion-in.fluence the targeted biomark-
er? And is this particular marker spe-
cinc for a certain chernical or does it
indicate an entire class of substances?

40 American Scientist, Volwne 92

 Because the science underpinning food soil/dust water
human biomonitoring has improved
signilicantly in recent years, these ques-
tions are now easier to answer. The o~~:.~:ol '""'\ lovlol'}""')~''
vi
health
rapíd advancement in knowledge of
what the body does to chemicals that
are inhaled, ingested or absorbed lifestyle -------.::::~ ~
through the skin has led to better inter- ~ ~ . ~ predicted
mathem~ttcal ,,... Jevel of toxican!
pretation of the range of concentrations
for various biomarkers. And the num- P~::::i-G--~----~--,mo~de~hng
ber of testable compounds has in- predisposition
creased dramatically:Se.nsitive and spe-
lung, infestine and
/·.,. t·-7 L
.
in people

cific biomarkers are available for many

environmental chemicals, including skinabsorption rates excreten
metaJs, dioxins,furans, polychlorinated metabollsm accumulatlon
biphenyls, pesticidas, volatiJe organic
compounds,phthalates,phytoestrogens Figure 3. Traditional estimates of hu.man exposure have to account for many variables, in·
and environmental tobacco smoke. As cluding sorne that demand assumptions about factors that are pootly understood. The result is
research continues, the list will surely often uncertain.
conti.nue to grow.

Exposure and Uptake Biomonitoring

has many ad va:ntages over traditional
methods. For example, bíologícal
samples reveal the integrated effects of
repeated contact. Also, this approach
documents ali routes of expo-
sure-inhalation, absorption through
the ski.n and ingestion, indudíng hand-
to-mouth transfer by children, Such
specimens also reflect the modifyingin-
fluences of physiology, bioavailability
and bioaccumulation,which can mag- environmentor
nify the concentrations of sorne envi- microenvironment
ronmental chernicals enough to raise
them above the detection threshold.
Perhaps most importantly, these tests ~
can help establish correlations between
exposure a:nd subsequent illness in in-
d.ividuals=-which is often the key ob-
servation in proving whether or not a emission
link exists.
A great strength of biomonitoring is
that it provides unequivocal evidence ~
that both exposureand uptake have tak-
en place. In sorne cases these data can
confirm the fíndíngs of traditional expo-
sure estirnates. For example,in 1979,res-
idents of Triana, Alabama, were noti-
fied that .fish from a nearby creek had
forty times more DDT than the allow-
able limit, even though the local DDT
rnanufacmríng plant had been ínactive
since 1971. The annou.ncement was es-
pecially conceming because marrypeo-
ple in that area caught and ate the fish
regularly. In response to this discovery,
the Centers for Dísease Control and
Prevention (CDC) constructed an eval-
cost accuracy
uation based on DDT concentrations in
Figure 4. Exposure to environmental cb.emicals can be assessed in severa! ways. GeneraUy, the
fish and the amount of fish eaten per accuracy and cost vary together. Monitoring emission sources is the least expensive and least
week. This estímate indeed correlated accurate means of determiníng human exposure, whereas biomarker measurement is more
with Ievels of DDT and its metabolites, costly but also highly informa ti ve for that person.

www.americanscientist.org 2004 [anuary-February 41


figure 5. At its Environmental Health Laboratory, CDC scientists use several types of hígh-
resolution mass spectrometry to analyze human rissue and fluid sampJes. The equipment
shown here is being used to measure dioxin Ievels in a sample of blood serum, (Photog:raph
courtesy of james L. Pirkle.)
DDE and DDD, in the blood of Triana
residents. In a similar story that un-
foJded in the late 1980s, chemical-plant
workers in New Jersey and Missouri
discovered that they had been exposed
to dioxin-contaminated compoundsup
to the early 1970s. They had come into
contact with the dioxin in various
ways-breathing it, swallowíng it and
taking it in through the skin, Despite
the cornplexities of their interaction
with this dangerous substance-and
the time interval since exposme-a
scheme that used occupational records
to calculate the duration of potential
exposure was able to accurateJy estí-
mate interna! doses. This finding was
confírmed by the correla tion. of these
results with the concentration of diox-
ins in their blood.
Havíng information about exposure
and uptake is more than a pro forma de-
tail: There are many cases in which tra-
ditional estimates of exposure (ques-
tionna i res, proximity to sources,
environmental concentrations, con-
structed scenarios) are not correlated
with measured biomarkers. For exam-
ple, from 1962 to 1971, the U.S. Air
Force sprayed the defoliant known as
"Agent Orange" in Vietnam. Many ser-
vice members who participated in that
operation touched or breathed the her-
bicide, potentiallyexposing themselves
42 American Scientist, Yolumc 92
gasoline lead decreased by approxi-
mately 55 percent) there was a parallel
decline in the amount of lead coursing
through the veins of the U.S. popula-
tion .. Overall, average blood concentra-
tions decreased from about 16 to less
than 10 micrograms of Lead per
deciliter of blood. These data demon-
strated the effectiveness of removíng
lead from gasoline, and they were a
dominant factor fil the decision by the
Environmental Protection Agency
(EPA) to remove lead from gasoline
more rapidly-a task that was effec-
tively complete by 1991. Today, the av-
erage blood-lead leve! in the U.S. pop-
ulation is less than 2 micrograms per
deciliter
Exposure Disclosure
The study that revealed the tight con-
nection between the lead in people's gas
tanks and the lead in their blood was
mounted by the CDC, which conducts
the National Health and Nutrition Ex-
amination Surveys (NHANES for
short). Although no envirorunental
chemicals were measured as part of
NHANES l (1971-1975), starting with
to high levels of dioxin. The Air Force NHANES Il (1976-1980), the CDC be-
first estimated the risk to soldiers usíng gan measuring blood lead levels in the
a scenario approach, which included U.S. population, ironically enough, af-
the average dioxin concentration in ter the Food and Drug Admi:n.istration
Agent Orange, the number of gallons voiced concerns about possible expo-
used during a soldier's tour of duty, sures from eat:ing food stored in lead-
and the frequency and duration of po- soldered cans, which turned out to be a
tentiaJ contact based on job description. very minor risk comparad with leaded
Despite a considerable scie:ntific effort gasoline, As part of NHANES Il, the
that went into these predictions, CDC EPA tested for certain persistent pesti-
studies in the late 1980s preved that cides in people's blood and nonpersis-
none of the exposure estimates were tent pesticides or their metabolites in
correlated with the measured blood urine. A fter an eight-year hia tus,
levels of dioxin in at-risk troops. A sub- NHANES lll was conducted in two
sequent investigation of personnel three-year phases from 1988 to 1994. 1n
with the highest dio.xinlevels did iden- that iteration, the CDC measured lead
tify sorne patterns that explained their and cadmium and began testing for co-
increased contact-for example, small- tinine, the major metaboli te of nicotine,
statured enlisted men often climbed in blood. Additionally,the CDC began a
into the chemical tanks to clean out separa.te pilot program to measure new
residual Agent Orange. compounds, testing for trace amounts
A more st:riking example of the val- of 32 volatile organic chemicalsin blood
ue of biomonitoríng carne in the mid- and 12 pesticides or their metabolites in
1970s when the United States elected mine from approxin1ately 1,000 of the
to start phasing out leaded gasoline. NHANES ID participants.
Prior to this decisión, traditional mod- Then carne another long gap in cov-
els had suggested that eliminating lead erage. But thankfully,in 1999, NHANES
in gasolíne would have only a slight ef- became a continuous survey of the
fect on people's uptake of that metal. noninstitutionalized U.S. populatíon.
However, biomonitoríngdata from the Ot is thought that excludb1g members
CDC's Second National Health and of isolated organizations, such as mili-
Nutrition Examinatíon Survey re- tary personnel, college students and
veaJed that from 1976 to 1980 (as un- prisoners, provides a better cross-sec-
leaded fuel was first introduced and tion of America.) In the current design,
 ldentifying priority Recognizing time trendsin
exposures. Out of thousands exposure. Periodic measurement of
of chemicals, which are the most biomarkers in the population shows how body
dangerous? Biomarkers can help set burdens of chemicals vary from season to
priorities for season, year to year and decade to decade.
public health
and regulatory
follow-up.

ldentifyingat-rlsk Establishingreference
populations
. Large biomarker studies ranges for comparison .
can distinguish exposure differences among A blood test shows that you've been
racial, geographic or socioeconomic groups. exposed to sorne chemical. Should you
be worried? Your
doctor can't
tell without data
from people
with little or no
exposure.

Providingintegrated Evaluating exposure

dose measurements. preventionefforts.
Biomarker analysis provides a Our government is entrusted with reducing
direct assay of body burden that people's exposure to environmental
integrates exposure from all sources, chemicals. Do they succeed? Before-and-after
even ones that are hard biomarker tests can tell.
to measure.

Figure 6. When used to establish levels of .human chemical exposure, biomonitoring has six major uses that can help to protect public health,

www.a.mericansc:ientist.o.rg 2004 )anuary-February 43

 110 ~ 70-
(ñ 17 ...J

e:
.Sl 100
:g,
Predicted blood lead 16 -¡;; 60
o(/)
e:
·¡:
"O 90 15 :J'

o
e:
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ro 60 :o ""
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~
~
30 8z o 1 1 1 1 1 1

1975 1976 1977 1978 1979 1980 1981 1965 1970 1975 1980 1985 1990 1995
year year

Figure 7. Leade.d gasolíne began to be phased out in the 1970s. Although the predicted effect on blood lead was minimal, actual Iead exposure
in the U.S. population (measured in micrograms of lead per deciliter of blood) sharply declined between 1976 and 1980, paralleling the changes
in gasoline (left). Blood Jead and gas lead continued to follow nearly identical decreases up to 1990. At the same time, a series of studies on lead
toxicity showed that lower doses could still cause adverse e.ffects, prompting a steady decline in the leve! defi.ning lead poisoning (right),
a new national sample is collected dioxins, furans and polychlorinated norms, epidemiologísts can confirm
every two years. Although sorne other biphenyls; and phytoestrogens. Results the unusual exposure, identify the
studies have focused on specific popu- from the general populationare subdi- souroes and provide continuing health
la tions or on more restricted data, vided by age, gender and ethnicity. care as appropriate. The reference
NHANES is the muy national survey An important feature of the CDC re- ran.ges provide indirect financia! ad-
that includes both a medical examina- port is that it provides reference ranges
700
tion and collection of biological sam- far exposure among the general U.S.
ples from participants. Individuals se- population. If people are concerned fil :g 600
lected for NHANESare representative that they may have been excessively Q) e:
E~ 500

they do not necessarily have high or they can compare their biomarker 1ev- (¡)o 400
unusual exposures. About 5,000 partic- els to those standards. These reference gE E 2 300
Cl Q)
ipants are examined annually from 15 ranges are immensely beneficia! to (/)

locations throughout the country. public-health scientists who must de- 200
cide if certain hígh-exposure groups 100
Reporting For Duty need follow-up action. lf average levels
In March 2001, the CDC released the among the cohort are similar to those ------
National Report on Human Exposure of the general public, then the group's :J' 0.5
e:.¬
to EnvironmentaJ Chemicals,which in- exposure is unlikely to cause unique t1l Cl e: 0.4 Q)

cluded data from 1999 on 27 chemicals. problems. On the other hand, if levels E~ Q)
o e:
A second report was published in Jan- are substantially h.igher than national EºE
uary 2003 that examined 116chemicals Q) ·~ 0.3
Figure 8. One important function of biomon- o o
in samples from 1999-2000. Both stud- a> E
Cl ::l
ies used biomonitoring to provide an itoring is that it can identify specific subpop- Q; 0.2
ulations that may be more vulnerable to ex- (/)
ongoing assessment of exposure to a
posure from a particular chemrcal. For
variety of substances. Although vari- example, p,p'-DDE, a long-lasting metabolite
0.1
ous studies of workplace exposure, for of DDT, is more than twice as high in. Mexi-
example, had raised concerns about can-Americans compared with the general 3.0
the health effects of such chemicals, population. 13y contrast, cotinine levels are
most of them had never befare been the lowest among this group, indicating that
E
rneasured in a representative slice of they have the least ex:posure to envíronmen- ::i~
~ ...J 2.5
the U.S. population. tal tobacco smoke. For both cotinine and lead, 3le:~:g,
The inventory of tested substances in non-hispanic blacks showed the highest lev- t1l "O

the second CDC report includes lead,
mercury, cadmium and other metals:
persistent (organochlorine-based) and
nonpersistent (organophosphate- and
carbamate-based) insecticides, herbi-
cides an.d other pesticides; pest repel-
lents and disinfectants; cotinine; phtha-
lates; polycyclicaromatic hydrocarbons:
els. DDE (in nanograms pe.r gram of lipid) ~~ 2.0
E
and lead (in micrograms per deciliter of
blood serum) data are from the CDC's Sec-
ond National Report on Human Exposure to
Environmental Chemicals, published in 2003.
lnformation on cotinine (in nanograms per
milliliter of blood) is from the third National
Health and Nutrition Examination Survey
(NHANES III), 1988-199L

44 American Scientist, Volume 92


vantages too, because distinguishing
cornmon from unusual chemica.l con-
tact helps direct resources to the most-
pertinent exposure situations.
The overa.rching purpose of these re-
ports is to help scientists, physicians
and hea.lth officials to prevent, reduce
and treat environmentally induced ill-
nesses. However, sorne caution must be
exercised in interpreting the find:ings: It
is important to remember that detect-
ing a chemical in a person's blood or
urine does not by itself mean that the
exposure causes disease, Separate sci-
entific studies in anima ls and humans
are required to determine whích levels
are likely to do harrn. Far most chemi-
cals, toxicologists simply don't have
this information.
But even if scie.ntists are not sure of
the overall level of risk, they can make
concrete statements about whether sit-
uations are getting better or worse. The
latest CDC report, in addition to listing
current biomarker levels in the popula-
tion, also highlights sorne interesting
exposure trends gleaned from earlier
NHANES findings. Far example, from
1991 to 1994, 4.4 percent of children be-
tween the ages of one and 6ve had lev-
els of blood lead greater than or equal
to 10 mícrogramsper deciliter, the Fed-
eral action level. By the second collec-
tion period (1999 and 2000), only 2.2
percent of thís age group exceeded this
threshold. 111is decrease suggests that
efforts to reduce lead exposure far chíl-
dren have been successful. [t also serves
as a rerninder that sorne children, in-
cluding those living in homes with
lead-based pai.nt or lead-contaminated
dust, remain at unacceptably high risk.
The last report also indicates a hope-
ful trend in the exposure to enviren-
mental tobacco smoke, as shown by
tests for the biomarker cotinine in the
blood of nonsmokers. Median levels of
cotinine fell more than 70 percent in
roughJy a decade-that is, between the
second (1988 to 1991) and third (1999
and 2000) periods of data collection.
This drop provi.des objective evidence
of reduced exposw-e to environmental
tobacco smoke for the general U.S. pop-
u lation. Nevertheless, the fact that more
than half of American youth continué
to be exposed to environmental tobacco
smoke remains a publíc-health concern.
The CDC plans to release future re-
ports that document their biomonitor-
i.ng efforts every two years. In the next
edition, they will also add the findings
from separate studies of special popu-
www.americanscientist.org
5 -
4 -
r
nonsmokers smokers
e:
o
"i a ~
3
a.
o
3 -
a.
Q)
.,s
o
Q)
Ol 2 - '
!9
e
Ql
~
Q)
a.
-
-
o 1
1
'
ílp~ ,~nnn
1
'
: i
1
1-
'
0.1 1.0 10 100 1000
serum cotinine (ng/mL)
Figure 9. U.S. population clearJy segrega tes into smokers and nonsmokers based on the Jevel of
cotinine in blood. The working threshold for distinguishing the two groups is 10 nanograms
per mililllter of blood serum. Among nonsmokers, the highest valúes of cotinine were found
in children under 12, and they were strongly reflective of the number of smokers in the home.
The data are from NHANES m, 1988-1991.
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Por relevant Web links, consuJt th:is
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issue of American Scientist Onlíne:
the bod y does to the chemical (and vice
versa) must keep pace. If this effort is h lt p· // www.americanscientist org/
successful, a ful] screen of exposure lssueTOC/jssue/521
biomarkers may be a part of every
routine physical exam in the not-
too-distant future.
2004 January-February 45