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A communication strategy was developed by The Consortium to Perform Human Biomonitoring on a European Scale (COPHES), as part of its objectives to develop a framework and protocols to enable the collection of comparable human biomonitoring data throughout Europe. The framework and protocols were tested in the pilot study DEMOCOPHES (Demonstration of a study to Coordinate and Perform Human biomonitoring on a European Scale). The aims of the communication strategy were to raise awareness of human biomonitoring, encourage participation in the study and to communicate the study results and their public health significance. It identified the audiences and key messages, documented the procedure for dissemination of results and was updated as the project progressed. A communication plan listed the tools and materials such as press releases, flyers, recruitment letters and information leaflets required for each audience with a time frame for releasing them. Public insight research was used to evaluate the recruitment material, and the feedback was used to improve the documents. Dissemination of results was coordinated in a step by step approach by the participating countries within DEMOCOPHES, taking into account specific national messages according to the needs of each country. Participants received individual results, unless they refused to be informed, along with guidance on what the results meant. The aggregate results and policy recommendations were then communicated to the general public and stakeholders, followed by dissemination at European level. Several lessons were learnt that may assist other future human biomonitoring studies. Recruitment took longer than anticipated and so social scientists, to help with community engagement, should be part of the research team from the start. As a European study, involving multiple countries, additional considerations were needed for the numerous organisations, different languages, cultures, policies and priorities. Therefore, communication documents should be seen as templates with essential information clearly indicated and the option for each country to tailor the material to reflect these differences. Future studies should consider setting up multidisciplinary networks of medical professionals and communication experts, and holding training workshops to discuss the interpretation of results and risk communication. Publicity and wide dissemination of the results helped to raise awareness of human biomonitoring to the general public, policy makers and other key stakeholders. Effective and timely communication, at all stages of a study, is essential if the potential of human biomonitoring research to improve public health is to be realised. [ABSTRACT FROM AUTHOR]

Phthalates, bisphenol A (BPA) and triclosan (TCS) are detectable in the vast majority of people. Most humans are continuously exposed to these chemicals due to their presence in food or in everyday consumer products. The measurement of these compounds in family members may help to explore the impact of major lifestyle factors on exposure. Mothers and (young) children are especially interesting to study, as they mostly share considerable parts of daily life together. Phthalate metabolites, bisphenol A (BPA) and triclosan (TCS) were measured in first morning void urine, collected in mother-child pairs (n = 129) on the same day. The mothers (27-45y) and their children (6-11y) were recruited in the Brussels agglomeration and rural areas of Belgium in the context of the European COPHES-DEMOCOPHES human biomonitoring project. Face-to-face questionnaires gathered information on major exposure sources and lifestyle factors. Exposure determinants were assessed by multiple linear regression analysis. The investigated compounds were detectable in nearly all mothers (92.8–100%) and all children (95.2–100%). The range (P 90 vs. P 10) of differences in urinary concentrations within each age group was for most compounds around 10–20 fold, and was very high for TCS up to 35 and 350-fold in children and mothers respectively. Some participants exceeded the tolerable daily intake guidelines as far as they were available from the European Food Safety Authority (EFSA). Overall, for BPA, the urinary concentrations were similar among both age groups. Most urinary phthalate metabolites were higher in children compared to the mothers, except for monoethyl phthalate (MEP). TCS levels were generally higher in the mothers. Despite the difference in mothers' and children's urinary concentrations, the creatinine-corrected levels were correlated for all biomarkers (Spearman rank r = 0.32 to 0.66, p < 0.001). Furthermore, for phthalates, similar home and lifestyle factors were associated with the urinary concentrations in both age groups: home renovation during last two years or redecoration during the last year for di-ethyl phthalate (DEP); PVC in home for di-n-butyl phthalate (DnBP), di-iso-butyl phthalate (DiBP) and butyl benzyl phthalate (BBzP), and personal care products use for DiBP and DnBP. Based on questionnaire information on general food type consumption patterns, the exposure variability could not be explained. However, comparing the phthalate intake from the current study with earlier assessed Belgian food intake calculations for both ages, food in general was estimated to be the major intake source for di-ethyl hexyl phthalate (DEHP), with diminishing importance for BBzP, DiBP and DnBP. Our results confirm, that children and their mothers, sharing diets and home environments, also share exposure in common consumer products related chemicals. By collecting morning urine levels on the same day, and using basic questionnaires, suspected exposure routes could be unraveled. Phthalates (BBzP, DEP, DnBP, DiBP, DEHP) and phenols (BPA, TCS) exposure takes place via food and/or everyday consumer products. These compounds were detected in nearly all morning urine samples collected in Belgian mother-child pairs sharing home environments. The levels were clearly correlated among both age groups. Personal care products use, housing and/or food intake were the main determinants of exposure associated with the urinary levels. Image 1 • Phthalates, BPA and TCS were measurable in urine of nearly all mother-child pairs. • Analysing morning urine of family members facilitated exploring common exposure patterns. • All urinary levels, especially TCS and MEP were highly variable within both age groups. • Sharing home environments implies sharing exposure in consumer product chemicals. [ABSTRACT FROM AUTHOR]

The metal cadmium (Cd) is a widespread environmental pollutant with documented adverse effects on the kidneys and bones from long-term environmental exposure, but with insufficiently elucidated public health consequences such as risk of cardiovascular disease, hormone-related cancer in adults and developmental effects in children. This study is the first pan-European human biomonitoring project that succeeded in performing harmonized measurements of Cd in urine in a comparable way in mother–child couples from 16 European countries. The aim of the study was to evaluate the overall Cd exposure and significant determinants of Cd exposure. A study population of 1632 women (24–52 years of age), and 1689 children (5–12 years of age), from 32 rural and urban areas, was examined within a core period of 6 months in 2011–2012. Women were stratified as smokers and non-smokers. As expected, smoking mothers had higher geometric mean (gm) urinary cadmium (UCd; 0.24 µg/g crea; n =360) than non-smoking mothers (gm 0.18 µg/g crea; n =1272; p <0.0001), and children had lower UCd (gm 0.065 µg/g crea; n =1689) than their mothers at the country level. Non-smoking women exposed to environmental tobacco smoke (ETS) at home had 14% (95% CI 1–28%) higher UCd than those who were not exposed to ETS at home ( p =0.04). No influence of ETS at home or other places on UCd levels was detected in children. Smoking women with primary education as the highest educational level of the household had 48% (95% CI 18–86%) higher UCd than those with tertiary education ( p =0.0008). The same observation was seen in non-smoking women and in children; however they were not statistically significant. In children, living in a rural area was associated with 7% (95% CI 1–13%) higher UCd ( p =0.03) compared to living in an urban area. Children, 9–12 years had 7% (95% CI 1–13%) higher UCd ( p =0.04) than children 5–8 years. About 1% of the mothers, and 0.06% of the children, exceeded the tolerable weekly intake (TWI) appointed by EFSA, corresponding to 1.0 µg Cd/g crea in urine. Poland had the highest UCd in comparison between the 16 countries, while Denmark had the lowest. Whether the differences between countries are related to differences in the degree of environmental Cd contamination or to differences in lifestyle, socioeconomic status or dietary patterns is not clear. [ABSTRACT FROM AUTHOR]

Human biomonitoring (HBM) is an effective tool for assessing actual exposure to chemicals that takes into account all routes of intake. Although hair analysis is considered to be an optimal biomarker for assessing mercury exposure, the lack of harmonization as regards sampling and analytical procedures has often limited the comparison of data at national and international level. The European-funded projects COPHES and DEMOCOPHES developed and tested a harmonized European approach to Human Biomonitoring in response to the European Environment and Health Action Plan. Herein we describe the quality assurance program (QAP) for assessing mercury levels in hair samples from more than 1800 mother–child pairs recruited in 17 European countries. To ensure the comparability of the results, standard operating procedures (SOPs) for sampling and for mercury analysis were drafted and distributed to participating laboratories. Training sessions were organized for field workers and four external quality-assessment exercises (ICI/EQUAS), followed by the corresponding web conferences, were organized between March 2011 and February 2012. ICI/EQUAS used native hair samples at two mercury concentration ranges (0.20–0.71 and 0.80–1.63) per exercise. The results revealed relative standard deviations of 7.87–13.55% and 4.04–11.31% for the low and high mercury concentration ranges, respectively. A total of 16 out of 18 participating laboratories the QAP requirements and were allowed to analyze samples from the DEMOCOPHES pilot study. Web conferences after each ICI/EQUAS revealed this to be a new and effective tool for improving analytical performance and increasing capacity building. The procedure developed and tested in COPHES/DEMOCOPHES would be optimal for application on a global scale as regards implementation of the Minamata Convention on Mercury. [ABSTRACT FROM AUTHOR]

The toxicity of methylmercury (MeHg) in humans is well established and the main source of exposure is via the consumption of large marine fish and mammals. Of particular concern are the potential neurodevelopmental effects of early life exposure to low-levels of MeHg. Therefore, it is important that pregnant women, children and women of childbearing age are, as far as possible, protected from MeHg exposure. Within the European project DEMOCOPHES, we have analyzed mercury (Hg) in hair in 1799 mother–child pairs from 17 European countries using a strictly harmonized protocol for mercury analysis. Parallel, harmonized questionnaires on dietary habits provided information on consumption patterns of fish and marine products. After hierarchical cluster analysis of consumption habits of the mother–child pairs, the DEMOCOPHES cohort can be classified into two branches of approximately similar size: one with high fish consumption (H) and another with low consumption (L). All countries have representatives in both branches, but Belgium, Denmark, Spain, Portugal and Sweden have twice as many or more mother–child pairs in H than in L. For Switzerland, Czech Republic, Hungary, Poland, Romania, Slovenia and Slovakia the situation is the opposite, with more representatives in L than H. There is a strong correlation ( r =0.72) in hair mercury concentration between the mother and child in the same family, which indicates that they have a similar exposure situation. The clustering of mother–child pairs on basis of their fish consumption revealed some interesting patterns. One is that for the same sea fish consumption, other food items of marine origin, like seafood products or shellfish, contribute significantly to the mercury levels in hair. We conclude that additional studies are needed to assess and quantify exposure to mercury from seafood products, in particular. The cluster analysis also showed that 95% of mothers who consume once per week fish only, and no other marine products, have mercury levels 0.55 μg/g. Thus, the 95th percentile of the distribution in this group is only around half the US-EPA recommended threshold of 1 μg/g mercury in hair. Consumption of freshwater fish played a minor role in contributing to mercury exposure in the studied cohort. The DEMOCOPHES data shows that there are significant differences in MeHg exposure across the EU and that exposure is highly correlated with consumption of fish and marine products. Fish and marine products are key components of a healthy human diet and are important both traditionally and culturally in many parts of Europe. Therefore, the communication of the potential risks of mercury exposure needs to be carefully balanced to take into account traditional and cultural values as well as the potential health benefits from fish consumption. European harmonized human biomonitoring programs provide an additional dimension to national HMB programs and can assist national authorities to tailor mitigation and adaptation strategies (dietary advice, risk communication, etc.) to their country’s specific requirements. [ABSTRACT FROM AUTHOR]

Within the European Environment and Health Action Plan an initiative to establish a coherent human biomonitoring approach in Europe was started. The project COPHES ( CO nsortium to P erform H uman biomonitoring on a E uropean S cale ) developed recommendations for a harmonized conduct of a human biomonitoring (HBM) survey which came into action as the pilot study DEMOCOPHES ( DEMO nstration of a study to CO ordinate and P erform H uman biomonitoring on a E uropean S cale). Seventeen European countries conducted a survey with harmonized instruments for, inter alia, recruitment, fieldwork and sampling, in autumn/winter 2011/2012. Based on the countries' experiences of conducting the pilot study, following lessons learnt were compiled: the harmonized fieldwork instruments (basic questionnaire, urine and hair sampling) turned out to be very valuable for future HBM surveys on the European scale. A school approach was favoured by most of the countries to recruit school-aged children according to the established guidelines and country specific experiences. To avoid a low participation rate, intensive communication with the involved institutions and possible participants proved to be necessary. The communication material should also include information on exclusion criteria and offered incentives. Telephone contact to the participants the day before fieldwork during the survey can prevent the forgetting of appointments and first morning urine samples. To achieve comparable results on the European scale, training of interviewers in all issues of recruitment, fieldwork and sampling through information material and training sessions is crucial. A survey involving many European countries needs time for preparation and conduct. Materials for quality control prepared for all steps of recruitment, fieldwork and sampling proved to be important to warrant reliable results. [ABSTRACT FROM AUTHOR]

Exposure to air pollution poses a significant risk to children's health. However, there is not currently a full and clear understanding of how many schools in England are in locations with high concentrations of air pollutants, and few studies have examined potential associations between air quality outside schools and socio-economic inequalities. To address these gaps, in this part of our study we used modelled air pollution concentrations, as well as monitoring data, to estimate how many schools in England are co-located with levels of annual mean PM 2.5 that exceed the WHO recommended annual mean limit of 10 μgm−3, and matched school annual mean PM 2.5 concentrations to inequality metrics. We assessed the limitations of our methodology by carrying out a sensitivity analysis using a small patch of high-resolution air pollution data generated using a data extrapolation method. Mapping of modelled annual mean concentrations at school locations indicates that around 7800 schools in England – over a third of schools - are in areas where annual mean PM 2.5 in 2017 exceeded the WHO recommended guideline (10 μgm−3). Currently over 3.3 million pupils are attending these schools. We also found that air pollution outside schools is likely to be compounding existing childhood socio-economic disadvantage. Schools in areas with high annual mean PM 2.5 levels (>12 μgm−3) had a significantly higher median intake of pupils on free school meals (17.8%) compared to schools in low PM 2.5 areas (<6 μgm−3 PM 2.5 , 6.5% on free school meals). Schools in the highest PM 2.5 concentration range had significantly higher ethnic minority pupil proportion (78.3%) compared to schools in the lowest concentration range (6.8%). We also found that in major urban conurbations, ethnically diverse schools with high PM 2.5 concentrations are more likely to be near major roads, and less likely to be near significant greenspace, compared to less ethnically diverse schools in areas with lower PM 2.5 levels. • PM 2.5 concentrations were mapped to school locations in England. • Associations between PM 2.5 around schools and inequality metrics were investigated. • 7801 schools were co-located with annual mean PM 2.5 above WHO recommended limit. • Schools in high PM 2.5 areas were more likely to have disadvantaged pupils on roll. • Ethnically diverse schools also more likely to be co-located with high PM 2.5 [ABSTRACT FROM AUTHOR]

Children are particularly vulnerable to the detrimental health impacts of poor air quality. In the UK, recent initiatives at local council level have focussed on mitigating children's air pollution exposure at school. However, an overview of the available evidence on concentration and exposure in school environments - and a summary of key knowledge gaps - has so far been lacking. To address this, we conducted a review bringing together recent academic and grey literature, relating to air quality in outdoor school environments - including playgrounds, drop-off zones, and the school commute - across high-income countries. We aimed to critically assess, synthesise, and categorise the available literature, to produce recommendations on future research and mitigating actions. Our searches initially identified 883 articles of interest, which were filtered down in screening and appraisal to a final total of 100 for inclusion. Many of the included studies focussed on nitrogen dioxide (NO 2), and particulate matter (PM) in both the coarse and fine fractions, around schools across a range of countries. Some studies also observed ozone (O 3) and volatile organic compounds (VOCs) outside schools. Our review identified evidence that children can encounter pollution peaks on the school journey, at school gates, and in school playgrounds; that nearby traffic is a key determinant of concentrations outside schools; and that factors relating to planning and urban design – such as the type of playground paving, and amount of surrounding green space – can influence school site concentrations. The review also outlines evidence gaps that can be targeted in future research. These include the need for more personal monitoring studies that distinguish between the exposure that takes place indoors and outdoors at school, and a need for a greater number of studies that conduct before-after evaluation of local interventions designed to mitigate children's exposure, such as green barriers and road closures. Finally, our review also proposes some tangible recommendations for policymakers and local leaders. The creation of clean air zones around schools; greening of school grounds; careful selection of new school sites; promotion of active travel to and from school; avoidance of major roads on the school commute; and scheduling of outdoor learning and play away from peak traffic hours, are all advocated by the evidence collated in this review. [ABSTRACT FROM AUTHOR]