title: A Review of Health Risks and Pathways for Exposure to Wastewater Use in Agriculture.
abstract: Wastewater is increasingly being used in the agricultural sector to cope with the depletion of freshwater resources as well as water stress linked to changing climate conditions. As wastewater irrigation expands, research focusing on the human health risks is critical because exposure to a range of contaminants must be weighed with the benefits to food security, nutrition and livelihoods.
  
  
  
  The goal of this paper was to review research examining health risks and exposure pathways associated with wastewater irrigation to identify research trends and gaps.
  
  
  
  We conducted a review of the literature and identified a total of 126 studies published from 1995 to 2013. Findings were summarized based on several themes including types of exposure pathways, wastewater contaminants, methodological approaches and the geographical distribution of research.
  
  
  
  Only 23 studies used epidemiological methods, while most research applied alternative methods to estimate risk, such as quantitative risk assessment models or comparisons of crop contamination to established guidelines for wastewater reuse. A geographic breakdown demonstrated a focus on microbiological contaminants in specific regions such as sub-Saharan Africa and Southeast Asia, despite growing chemical risks associated with rapid urbanization and industrialization that may change the types and distribution of wastewater contaminants.
  
  
  
  To provide a more comprehensive understanding of the health risks of wastewater use in agriculture, future research should consider multiple exposure routes, long-term health implications, and increase the range of contaminants studied, particularly in regions heavily dependent on wastewater irrigation.
  
  
  
  Dickin SK, Schuster-Wallace CJ, Qadir M, Pizzacalla K. 2016. A review of health risks and pathways for exposure to wastewater use in agriculture. Environ Health Perspect 124:900-909; http://dx.doi.org/10.1289/ehp.1509995.
authors.affiliation: School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Dickin
authors.forename: Corinne J
authors.initials: CJ
authors.lastname: Schuster-Wallace
authors.forename: Manzoor
authors.initials: M
authors.lastname: Qadir
authors.forename: Katherine
authors.initials: K
authors.lastname: Pizzacalla
mesh_terms: D000383:Agriculture / Q000379:methods*; D057231:Climate Change; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D008962:Models, Theoretical; D018570:Risk Assessment; D014865:Waste Disposal, Fluid / Q000379:methods*; D062065:Wastewater / Q000706:statistics & numerical data*; D014874:Water Pollutants, Chemical
chemical_list: D062065:Wastewater; D014874:Water Pollutants, Chemical
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