Patterns of water use and exposure to trihalomethanes among children in Spain

doi:10.1016/j.envres.2010.05.008

Environmental Research

Volume 110, Issue 6, August 2010, Pages 571-579

https://doi.org/10.1016/j.envres.2010.05.008 Get rights and content

Abstract

Few studies characterizing trihalomethane (THM) exposure or examining potential health effects were conducted in children. The present study describes patterns of water use in children as a source of THM exposure, and estimates the daily THM uptake and the relative contribution of each pathway of exposure.

A cross-sectional population-based study was conducted in children 9–12 years of age in Sabadell, Catalonia, Spain (N=2037). We collected individual information on ingestion, frequency and duration of showering, bathing and swimming, source of drinking water, age, sex and parental education. Chloroform, dibromochloroform, bromodichloroform and bromoform in tap, bottled and swimming pool water were measured. The daily chloroform and brominated THM uptakes were estimated combining environmental levels with individual water activities using algorithms reported in the literature.

Among the studied group, 80% of children drank bottled water and 20% regularly attended swimming pools. Mean THM concentration in bottled, tap and chlorinated pool water were, respectively, 0.3, 117 and 92 μg/L. Brominated THM predominated in the tap water (84% of total THM) and chloroform predominated in the swimming pool (84% of total THM). Children attending swimming pools had four times higher THM uptake compared to non-swimmers (p-value<0.05). Showering was the main pathway of exposure for non-swimmers. Girls and children with low parental education had a higher THM uptake (p-value<0.05) as they reported taking longer showers and more frequent baths.

In conclusion, total and specific THM uptake varied considerably with the personal water uses among children. As drinking water was mainly bottled and bathing was infrequent, showering and swimming in pools were the main pathways of THM exposure. Specific water uses among children slightly differed by sociodemographic characteristics.

Introduction

Chlorine is the chemical most extensively used for disinfection in tap water and swimming pools. Disinfection by-products (DBPs) are undesired substances formed by the reaction of the disinfectant with organic and inorganic matter. Trihalomethanes (THMs, chloroform, bromodichloroform, dibromochloroform and bromoform) are the most common by-products of chlorination in both tap and swimming pool water. Traditionally, they have been used as markers of total DBP levels. THMs are highly volatile and skin permeable compounds. Besides ingestion, they can also be taken up by inhalation and dermal absorption through showering, bathing or pool swimming (Gordon et al., 2006). Hence, individual exposure to DBPs depends both on the DBP levels in water and individual behavior.

Trihalomethanes and other DBPs are genotoxic and carcinogenic in experimental models. In epidemiological studies, lifetime THM concentration in tap water has been consistently associated with increased bladder cancer risk in adults (Villanueva et al., 2004). Risk of other cancer sites such as colorectal (Nieuwenhuijsen et al., 2009), pancreatic (Do et al., 2005) or leukemia (Kasim et al., 2006) has also been examined in adults and have shown inconsistent results. The exposure to THM during pregnancy and the risk of adverse reproductive outcomes is also a topic of current research (Nieuwenhuijsen et al., 2009). Although children are a susceptible population to environmental pollutants, only two studies have assessed cancer risk related to THM exposure in childhood, specifically leukemia, finding inconsistent results (Infante-Rivard et al., 2001, Infante-Rivard et al., 2002). These studies used THM levels in tap water as the marker of exposure ignoring differences in individual water use, probably leading to exposure misclassification and therefore attenuation in risk estimates (Armstrong, 1998). In fact, the inability to accurately assess exposure has been one of the major shortcomings of epidemiological studies of DBPs in drinking water (Arbuckle et al., 2002). An international workshop on DBPs highlighted the need for evaluating differences in population activity patterns by age, in order to help estimate past activities in epidemiologic studies (Arbuckle et al., 2002). So far, patterns of water use among children and exposure to THMs or other DBPs during childhood or adolescence have not been described.

Accordingly, the aims of the present study are to (1) describe the patterns of water use in children as a source of THM exposure; (2) estimate the THM uptake combining the personal water use with environmental data; and (3) evaluate the relative contribution of each pathway to the total THM uptake.

Section snippets

Study design and population

In June 2006 a cross-sectional population-based study in the municipality of Sabadell (Spain; about 200,000 inhabitants) was conducted among children in the 4th, 5th and 6th grades of primary school (9–12 years old). We measured THM levels in tap, bottled and swimming pool water of the municipality and collected individual data on water related activities through a questionnaire. Drinking water is supplied by one company, and water originates to one surface water source. Chlorine is the main

Results

The patterns of water use in the study population are shown in Table 2. Most children drank bottled water (80%) and 20% attended swimming pools at least once a month during school terms. For 96% of these pool attendants, this was in a chlorinated pool; the remaining used a brominated pool. Some water related activities differed by sex or parental educational level. Bottled water consumption decreased with increase in parental educational level. Girls compared to boys and children with low

Discussion

The individual patterns of water use resulted in highly different THM uptake among children from a single municipality. Those who regularly attended swimming pools showed the highest THM uptake, while showering was the main pathway of exposure for non-swimmers. Girls compared to boys and children with lower parental education had higher THM uptake as they reported longer showers and more frequent baths.

Bottled water consumption was high (80% of the children), similar to the adult population in

Acknowledgments

We thank Lourdes Arjona for her contribution in the fieldwork, Esther Gracia for her contribution in the plot design, Esther Marco for the laboratory work and Dave MacFarlane for the English revision.

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^☆: Funding resources: This work has been funded by the Spanish Ministry of Education and Science, Plan Nacional Grant SAF2005-07643-C03-01, Spanish Health Ministry Grant (FIS) CP06/00341 and GRACCIE Consolider Ingenio Project CSD2007-00067. Laia Font-Ribera has a predoctoral fellowship by the Spanish Health Ministry, FI06/00651. Cristina M. Villanueva has a contract funded by the Instituto de Salud Carlos III, Spanish Ministry of Health and Consumption (CP06/00341).

^☆☆: Ethics committee approval: Attached herewith there is a copy of the study approval from the Ethics Committee of the Research Center (IMIM-IMAS).

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Patterns of water use and exposure to trihalomethanes among children in Spain☆,☆☆

Abstract

Introduction

Section snippets

Study design and population

Results

Discussion

Acknowledgments

J. Chromatogr. A

Int. J. Hyg. Environ. Health

J. Environ. Sci. (China

Toxicol. Appl. Pharmacol

Environ. Res

Gac. Sanit

Assessing exposure in epidemiologic studies to disinfection by-products in drinking water: report from an international workshop

Environ. Health Perspect.

Effect of measurement error on epidemiological studies of environmental and occupational exposures

Occup. Environ. Med.

Household exposures to drinking water disinfection by-products: whole blood trihalomethane levels

J. Expo. Anal. Environ. Epidemiol.

Assessing the exposure of pregnant women to drinking water disinfection byproducts

Epidemiology

Chlorination disinfection by-products and pancreatic cancer risk

Environ. Health Perspect.

Predictors of use and consumption of public drinking water among pregnant women

J. Expo. Sci. Environ. Epidemiol

Changes in breath trihalomethane levels resulting from household water-use activities

Environ. Health Perspect.

Drinking water contaminants and childhood leukemia

Epidemiology