Environmental Epidemiology: Study methods and Application

by Dean Baker, Mark J. Nieuwenhuijsen

Overview

Air pollution, water contamination, persistent organic pollutants, pesticides, metals, and radiofrequencies are just some examples of environmental factors that have been linked to adverse health effects such as cancer, respiratory disease and reproductive problems. Environmental epidemiology studies the interaction of disease and these environmental determinants of disease at a population level. Whilst risks associated with environmental exposures are generally small, the exposed population, and hence the population burden of disease, may be large. To detect these small risks, it is therefore essential that related methods and their application are refined. In addition, there is increasing attention on environmental health issues from the public, government, and media, thus raising the profile of envrionmental epidemiology in preventive medicine.

This book describes the methods of environmental epidemiology, with emphasis on good practice. It outlines the basic principles of epidemiology and environmental health, and describes in more detail special environmental epidemiological designs that are rarely described in other textbooks. The principles of health risk assessment and forecasting, as well as the application of study data in these types of study, are explored. Several chapters cover practical issues in the conduct of studies, such as field work and data analyses and its requirements. Ethical issues and the role of environmental epidemiology in policy making are also covered.

Product Details

ISBN-13:	9780198527923
Publisher:	Oxford University Press, USA
Publication date:	08/18/2008
Edition description:	New Edition
Pages:	368
Product dimensions:	6.70(w) x 9.60(h) x 1.00(d)

About the Author

Dean Baker has more than 25 years of research experience in occupational and environmental epidemiology. The primary emphasis of his research has been on community-based epidemiological studies. During the past several years, he has focused on developmental toxicity and children's environmental health. He has conducted several epidemiological research studies examining chronic health effects of gestational and early childhood exposure to heavy metals and organochlorine chemicals. His other area of research has been on the health effects of psychosocial stressors in the workplace and in communities exposed to environmental hazards. In both of these areas, Dr. Baker has made contributions to the epidemiological study design and methods. He was elected 3 times as Secretary-Treasurer of the International Society for Environmental Epidemiology, and was a founding member. He is an active teacher at the university, directing an occupational medicine residency program and supervising graduate students. Mark J Nieuwenhuijsen has been involved in various environmental exposure assessment, epidemiology, and health risk assessment studies in the Netherlands, the UK, Eastern Europe and the US. His interests include the health effects of chlorination by-products in water, traffic related air pollution and metals, specifically in relation to reproductive, respiratory, renal and cancer effects. He has published over a hundred papers. He graduated from Wageningen University, the Netherlands, and went to do a PhD at the National Heart and Lung Institute in London, UK. For his post doc he went to the University of California, Davis, USA after which he took up a faculty position at Imperial College London, UK. In January 2007 he joined the Center for Research in Environmental Epidemiology (CREAL) in Barcelona, Spain as a Research Professor. He is associate editor on the journals 'Occupational and Environmental Medicine' and the 'Journal of Exposure Science and Environmental Epidemiology'.

Table of Contents

Preface: for whom this book is intended     v
What is environmental epidemiology?   Bert Brunekreef   Dean Baker   Mark Nieuwenhuijsen     1
Introduction     1
Classic environmental epidemiological studies     1
Scope of environmental epidemiology     7
Reasons to embark on studies in environmental epidemiology     8
Environmental epidemiology and related fields     10
Review of environmental health and epidemiological principles   Dean Baker     15
Basic principles of environmental health     15
Review of epidemiological principles     22
Environmental exposure assessment   Mark Nieuwenhuijsen   Bert Brunekreef     41
Introduction     41
Initial considerations of an exposure assessment strategy     41
Source receptor models and pathways and exposure routes     42
Exposure parameters     49
Exposure level and variability     50
Ecological versus individual exposure estimates     52
Exposure classification, measurement or modeling     53
Geographical information systems     60
Validation studies     65
Conclusion     65
Health effects assessment   Dean Baker     73
Concepts of health effects measurement     73
Assessment of health effects     77
Data linkage     89
Methodological issues in health effects assessment     90
Measurement error: consequences and design issues   Ben Armstrong     93
Introduction     93
Describing measurement error     94
The consequences of measurement error in exposure     97
Design issues     105
Error in outcomes     110
Issues not covered in this chapter     110
Study design and methods   Dean Baker     113
Introduction     113
Types of study     114
Strategy in choosing a study design     140
Data analysis   Lianne Sheppard     147
Concepts of data analysis and hypothesis testing     147
Analysis planning     150
Data analysis process     155
Combining study results: meta-analysis of observational studies     165
Finally     168
Special study designs and analyses in environmental epidemiology     171
Introduction   Mark Nieuwenhuijsen      17
Time-series   Klea Katsouyanni   Giota Touloumi     172
Panel studies   Klea Katsouyanni   Giota Touloumi     182
Spatial epidemiology   Lars Jarup   Nicky Best     189
Investigation of disease clusters   Daniel Wartenberg     196
Gene-environment interactions   Valentina Gallo   Paolo Vineis     206
The epidemiology of chemical incidents and natural disasters   Paul Cullinan   Anna Hansell     227
Introduction     227
Study design issues     229
Examples     236
Environmental epidemiology in developing countries   Isabel Romieu   Horacio Riojas Rodriguez     249
Environmental health problems in developing countries     249
Methodological challenges of environmental epidemiology studies in developing countries     252
The impact of local research in promoting prevention and control of environmental threats     262
Practical issues in study implementation   Dean Baker     265
Steps in study implementation     265
Study protocol     266
Ethics review and informed consent     271
Composition of the study team      273
Study organization     276
Study implementation     278
Tools for data management and analysis     287
Stakeholder and participant involvement   Primitivo Rojas   Raymond Neutra     293
Introduction     293
Stakeholder involvement     294
Community based participatory research in environmental health     296
Planning and implementing public participation in studies     297
Dunsmuir case study     300
Ethics and environmental epidemiology   Colin Soskolne     307
Introduction     307
Ethical issues in public health     308
Ethical and legal guidelines for research     311
Scientific integrity, whistleblowers, and victimized colleagues     313
Advocacy and hired guns     314
Confidentiality and privacy     314
Policy of openness and stakeholder engagement     316
Communication with the public     317
Ethics review and informed consent     317
ISEE ethics guidelines     318
Health risk assessment   Nino Kunzli   Laura Perez     319
From environmental epidemiology to public health risk assessment      319
Classical risk assessment framework     320
Types of risk assessments     323
Quantitative methods to derive public health risk     326
Uncertainties and limitations of risk assessment     338
Illustrative risk assessment examples     342
Using integrated assessment to analyze and forecast the future effects of global environmental change   Pim Martens   Maud Huynen     349
Introduction     349
Global environmental changes and their potential health impacts     350
Challenges to population health research     351
Integrated assessment of human health impacts     356
Critical methodological issues in integrated assessment of human health     357
The way ahead     362
The role and limits of epidemiology in policy arguments   Raymond Neutra     365
Introduction     365
Upstream and downstream policies     366
Stakeholders' ethical frameworks drive informational needs and policy preferences     366
A basic policy question     372
What epidemiologists can and cannot bring to the decision tree     373
Alternative framings of the basic policy question     374
Formatting conclusions to accommodate different frameworks      375
The structure of causal reasoning by epidemiologists     376
Conclusion     380
Further Information     383
Index     387

Editorial Reviews

Reviewer: Patrick Thomas O'Shaughnessy, MS, PhD (University of Iowa College of Public Health)
Description: This book describes the application of epidemiological principles needed to discover associations between human health effects and exposure to environmental contaminants. With the use of interesting examples from the scientific literature, this very readable book covers the entire field of environmental epidemiology from the basic principles of epidemiology to an assessment of the societal and policy implications of results obtained from these studies.
Purpose: The editors have solicited the aid of an international group of distinguished epidemiologists for the purpose of combining in one book a description of pertinent epidemiological methods with a variety of examples of how those methods are applied to studies of the environmental effects on human health.
Audience: The editors assume that readers have taken at least an introductory course in epidemiology and therefore do not provide more than an overview of the principles taught in such a course. This book was therefore developed with the more advanced graduate student in mind, although it is written in such a way that it could be easily understood by any interested readers, such as biostatisticians, geneticists, toxicologists, and environmental health practitioners seeking to better understand the application of environmental epidemiological principles regardless of their background in epidemiology.
Features: The book is written in a narrative format with only essential equations and supporting tables and graphs interjected as needed. As such, readers are not given enough detail to properly analyze data obtained from an epidemiological investigation. Rather, a variety of topics such as measurement error, spatial epidemiology, study implementation, and risk assessment are described, which provide a thorough understanding of the many aspects of environmental epidemiology currently conducted by researchers around the world. These topics include the most recent issues under investigation such as molecular epidemiology and the use of geographical information systems (GIS) to better determine spatial associations between health effects and pollutant sources.
Assessment: Although I am not an epidemiologist, as a scientist interested in environmental health issues and the adverse health effects caused by air pollutants in particular, I found this book very interesting. Although this may not seem a detailed or profound statement, it is the ability of a book to maintain a reader's interest and thereby confer the knowledge it imparts that is the ultimate proof of its usefulness.

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