title: Assessment of exposure in an international study on cancer risks among pulp, paper, and paper product workers.
abstract: A data management system and a department-exposure matrix (PAPDEM) was designed and constructed to facilitate exposure assessment for a large multinational study on cancer risks among pulp, paper, and paper product workers. Exposure to 25 major agents was described by prevalence, P (i.e., proportion of the exposed, classified %-range), and level, L (i.e., annual mean concentration at work, classified). Some agents could be assessed only in qualitative terms. The assessment was specific to mill, work department, agent, and time period. The results of industrial hygiene measurements, information from detailed company questionnaires, and the professional judgments of the assessment team were the cornerstones of the assessment. Validity and consistency of the assessment were aimed at by setting default values for P and L prior to the assessment, accurately defining agents and exposure classes, dividing assessment work by subindustry, working in pairs, testing interrater agreement, and finalizing the estimates in a meeting. In spite of these precautions, good agreement between different assessors was difficult to reach. Exposure to chemical agents turned out to be widespread and complex with frequent multiple exposures. A computer-assisted exposure assessment system such as PAPDEM may save time and facilitate assessment in large epidemiological studies requiring complicated exposure assessment procedures. It also provides a good documentation of exposure assignments, which may be useful in the interpretation of the results and in future updates of the study.
authors.affiliation: Finnish Institute of Occupational Health, Topeliuksenkatu 41aA, FIN 00250 Helsinki, Finland. tkau@occuphealth.fi
authors.forename: Timo
authors.initials: T
authors.lastname: Kauppinen
authors.forename: Kay
authors.initials: K
authors.lastname: Teschke
authors.forename: George
authors.initials: G
authors.lastname: Astrakianakis
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Didier
authors.initials: D
authors.lastname: Colin
authors.forename: Anya
authors.initials: A
authors.lastname: Keefe
authors.forename: Kari
authors.initials: K
authors.lastname: Korhonen
authors.forename: Tuula
authors.initials: T
authors.lastname: Liukkonen
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Nicol
authors.forename: Brian
authors.initials: B
authors.lastname: Pannett
authors.forename: Håkan
authors.initials: H
authors.lastname: Westberg
mesh_terms: D016021:Epidemiologic Studies; D006801:Humans; D007221:Industry; D007256:Information Systems; D007391:International Cooperation; D009369:Neoplasms / Q000209:etiology*; D016273:Occupational Exposure; D010209:Paper; D018570:Risk Assessment