title: Toward Greater Implementation of the Exposome Research Paradigm within Environmental Epidemiology.
abstract: Investigating a single environmental exposure in isolation does not reflect the actual human exposure circumstance nor does it capture the multifactorial etiology of health and disease. The exposome, defined as the totality of environmental exposures from conception onward, may advance our understanding of environmental contributors to disease by more fully assessing the multitude of human exposures across the life course. Implementation into studies of human health has been limited, in part owing to theoretical and practical challenges including a lack of infrastructure to support comprehensive exposure assessment, difficulty in differentiating physiologic variation from environmentally induced changes, and the need for study designs and analytic methods that accommodate specific aspects of the exposome, such as high-dimensional exposure data and multiple windows of susceptibility. Recommendations for greater data sharing and coordination, methods development, and acknowledgment and minimization of multiple types of measurement error are offered to encourage researchers to embark on exposome research to promote the environmental health and well-being of all populations.
authors.affiliation: Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029; email: jeanette.stingone@mssm.edu , susan.teitelbaum@mssm.edu.
authors.forename: Jeanette A
authors.initials: JA
authors.lastname: Stingone
authors.affiliation: Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20817; email: louisg@mail.nih.gov.
authors.forename: Germaine M
authors.initials: GM
authors.lastname: Buck Louis
authors.affiliation: National Institute for Environmental Studies, Tsukuba 305-0053, Japan; email: fabre@nies.go.jp.
authors.forename: Shoji F
authors.initials: SF
authors.lastname: Nakayama
authors.affiliation: Institute for Risk Assessment Sciences, Environmental Epidemiology Division, Utrecht University, Utrecht 3584 CM, Netherlands; email: R.C.H.Vermeulen@uu.nl.
authors.forename: Roel C H
authors.initials: RC
authors.lastname: Vermeulen
authors.affiliation: Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709; email: richard.kwok@nih.gov.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Kwok
authors.affiliation: Exposure, Response, and Technology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709; email: yuxia.cui@nih.gov , balshaw@niehs.nih.gov.
authors.forename: Yuxia
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Exposure, Response, and Technology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709; email: yuxia.cui@nih.gov , balshaw@niehs.nih.gov.
authors.forename: David M
authors.initials: DM
authors.lastname: Balshaw
authors.affiliation: Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029; email: jeanette.stingone@mssm.edu , susan.teitelbaum@mssm.edu.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Teitelbaum
mesh_terms: D004777:Environment; D004781:Environmental Exposure / Q000009:adverse effects*; D004782:Environmental Health; D006801:Humans; D012107:Research Design
keywords: environmental epidemiology; exposome; life-course epidemiology; multiple exposures