German Environmental Survey 2014-2017, GerES V

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The UBA is investigating the effects of environmental influences on children and adolescents.

The UBA is investigating the effects of environmental influences on children and adolescents from more than 160 German cities and municipalities.

Source: Christian Schwier / Fotolia.com

Between 2014 and 2017 the Federal Environment Agency is investigating the severity of the effects on children and adolescents in Germany of environmental influences. Selected families are invited to participate in the study in accordance with statistical criteria. Anyone taking part is providing important insights into the health of the younger generation – a study of environmental impacts.

Table of Contents

 

Current study: Spotlight on adolescents

Preparations for the 5th German Environmental Survey (GerES V) of the Federal Environment Agency are currently underway. The UBA is to invite children and adolescents aged 3-17 from more than 160 German cities and municipalities who have participated in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS, wave 2) of the Robert Koch Institute (RKI). The study procedure has already been tested in a pretest with families from Berlin. As an addition to the RKI health study, the UBA is analysing environmental impacts on the young generation. This is allowing conclusions to be drawn on how pollutants and other environmental factors can affect the development and health of children and adolescents. The results also provide information on how individuals can further their own health and avoid environmental health risks. They are also being used as a basis for political decision making for the drafting of legislation to protect people and the environment. The GerES IV was carried out between 2003 and 2006 in collaboration with the RKI.

 

Objectives of the study

The intention behind the GerES V was to use questionnaires plus noise and pollutant analyses to determine the impact of pollution on children and adolescents and to analyse the extent to which environmental factors can affect the health of the young generation. An integral part of all environmental surveys is what is known as human biomonitoring (HBM), in the context of which blood and urine samples taken from the participants are examined for pollutants. As the Federal Environment Agency (UBA) performs environmental surveys in accordance with uniform quality standards and using largely the same methods, changes in pollution impacts can be identified over many years.

In addition to current impacts and their influence on health, the intention behind GerES V is to clarify the following

  • Where individual pollutants come from and which exposure pathways they take on their way from the environment into human beings
  • How environmental impacts on people have changed in recent years and decades
  • What regional differences there are
  • Which reference values can be usefully applied nationwide to assess the exposure of children and adolescents to pollution in a uniform manner
 

Pretest Study

Before the main study can begin, care must be taken to ensure that all the instruments - for example, the questionnaires and the measuring instruments - are working properly. In the preliminary study, also referred to as a “pretest”, the procedure of the 5th environmental survey was tested in 2013 using nearly 40 children and adolescents in Berlin aged between three and seventeen.

The pretest was carried out by the infas Institute for Appllied Social Sciences, the Fraunhofer Institute for Biomedical Engineering (IBMT), BioMath – Applied Statistics and Informatics in Life Sciences and the Institute of Prevention and Occupational Medicine of the DGUV, Institute of the Ruhr University Bochum (IPA) on behalf of UBA.

The information on GerES V featured in the present text applies for the most part to both the pretest and the main study.

 

Selection of participants

The participants in the GerES V come from more than 160 German towns and municipalities. All the children and adolescents invited have previously participated in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS, wave 2) of the Robert Koch Institute (RKI). They were chosen to do so as representatives of their age, for boys and girls and their place of residence as a result of a random process of selection from the registers of residents in the municipalities or towns in question. This ensures that the result of the GerES V is representative, i.e. that it can be applied to all children and adolescents in Germany.

The greater the number of participants in the GerES V, the more meaningful are its results. On request the families are given an evaluation of their test results as a bonus.

The UBA deliberately chose to investigate environmental impacts on children and adolescents. For several reasons the young generation is considered a risk group for adverse health effects arising from the environment:

  • Toddlers like to put things in their mouths, crawl and play on the floor or dig in sandpits. In this way they ingest certain pollutants more intensely than adults.
  • The bodies of adolescents are constantly under development and are thus especially vulnerable.
  • The manner in which pollutants and other environmental influences are processed in the bodies of children and adolescents often differs from that in adults.
  • Children and adolescents are exposed to more pollutants in proportion to their body weight.
 

Problem substances

In the context of the GerES V, drinking water, urine, house dust and air samples are examined and tested for pollutants. The UBA looks especially for substances which are known or presumed to be harmful to health under certain circumstances. These include, for instance:

  • Substances which can interfere with the metabolism. Some phthalates, which are added as plasticisers to PVC, are for example suspected of having a similar effect as hormones
  • Neurotoxins, such as mercury, which enter into the oceans through pollution and are absorbed by marine animals such as fish
  • Solvents from paints or pesticides, which can, for example, irritate mucous membranes, what are known as pyrrolidones
  • Noise, which can, for instance, cause sleep disorders with adverse health consequences 
  • Potentially carcinogenic substances like some polycyclic aromatic hydrocarbons (PAHs). Traces of these are to be found, for example, in petrol and can accumulate in household dust on busy roads 
 

Home visit

Anyone volunteering for the GerES V is visited at home at a previously agreed time. In order to provide an overview of possible sources of pollution, all participants are interviewed about their lifestyles, food preferences or hobbies. In addition

  • The UBA asks the families to fill out a questionnaire on their child's health
  • The morning urine of all participating children and adolescents is analysed, alongside a drinking water sample and, in selected households, the contents of a vacuum cleaner bag.
  • The staff measure the level of noise at the child’s window.
  • If the families agree, various devices (passive samplers) are left in the residence for seven days to measure chemicals or suspended particulates in the air.

Analysis in the GerES V

What urine, noise measurement and other investigations can tell us.

  • Overview

    The UBA researchers use the morning urine to determine, among other things, the exposure of the children and adolescents to plasticisers, polycyclic aromatic hydrocarbons (PAHs), metals, parabens, certain pesticides, pyrrolidones, and active and passive smoking (cotinine). Some of the aforementioned substances have a similar effect to hormones and can encourage the development of cancer or trigger allergies.

  • Plasticisers in urine

    The spotlight here is on phthalates and their substitutes. They are used as plasticisers in PVC and can be found, for instance, in toys, food packaging films, floor coverings, hoses, seals or carpeted floors. Some phthalates have hormone-like properties and are classified as detrimental to reproduction.

    Phthalates break down quickly in the body, with the result that the degradation products, known as metabolites, can be found in the urine. In the 5th environmental survey the UBA is determining the quantities of metabolites from more than ten phthalates and phthalate substitutes. These include: DEHP (Di(2-ethylhexyl)-phthalate), DnBP (di-n-butyl phthalate), DiBP (di-iso-butyl phthalate), BBzP (butyl benzyl phthalate), DEP (diethyl phthalate), (di-iso-nonyl phthalate) DiNP, DIDP (di-iso-decyl phthalate), DMP (di-methyl phthalate), DnPeP (di-n-pentyl phthalate), DnOP (di-n-octyl phthalate), DChP (di-cyclo-hexyl phthalate), DPHP (di-propy-heptyl phthalate) and DINCH (di-iso-nonyl-cyclohexane 1.2-dicarboxylat).

  • PAH in urine

    Polycyclic aromatic hydrocarbons (PAH) are created when organic material, such as wood, coal, or oil, fails to combust fully. They also occur in used motor oils, tar and soot. Many PAH are carcinogenic, can damage genetic material or jeopardise reproductive capacity. There is evidence that children react more sensitively to PAH than adults.

    PAH are detected in the urine through the concentration of metabolites of 1-Hydroxypyrene, 1-Hydroxypheanthrene, 2-Hydroxyphenanthrene, 3-Hydroxyphenanthrene and 4-Hydroxyphenanthrene.

  • Cotinine in urine

    Smoking, and with it second-hand smoke (SHS), is still widespread in Germany. Because nicotine can no longer be detected after only a short time (half-life of 2 hours), exposure to smoking or SHS is determined by the presence of cotinine, a nicotine breakdown product. Cotinine can be found in the urine one or two days after contact with nicotine (half-life of approximately 20 hours); this takes a little longer in the case of non-smokers and children.

  • Creatinine in urine

    Creatinine is not a pollutant, but is made in muscle and nerve cells by the body itself. The amount of creatinine secreted indicates how strongly the urine is diluted. The value is used to classify the relative exposure to other substances.

  • Metals in urine

    Small quantities of some metals, such as zinc or copper, are vitally important for the human body. Others can cause harm, even in small doses, if they enter the body. Examples of these are cadmium and some precious metals such as gold, platinum, and palladium. The metals or their ions penetrate into the organism, for example, through the ingestion of food or via dental implants, and accumulate there over time. The degree of contamination in the body is determined directly from the urine.

    Mercury in urine
    This metal occurs naturally in the environment but is also used in industry. Thermometers used to be manufactured with mercury; today it features, among other places, in energy saving lamps. Mercury vapour may escape when they break. We ingest organic mercury, for example, when we eat sea food. As was shown by the DEMOCOPHES study in 2011, the exposure to organic mercury is relatively low in Germany in comparison to other EU member states. The amount of metallic and inorganic mercury absorbed can be analysed directly by means of urine or blood samples.

    Arsenic in urine
    The semi-metal arsenic is absorbed through the digestive tract and can accumulate in muscles, bones, kidneys or lungs. Exposure is measured directly in urine.

  • Parabens in urine

    These compounds are used as a preservatives and are found, among other places, in cosmetic products such as creams or shampoos; some may also be used in medicines and foodstuffs. Animal tests have shown that some parabens act like hormones. They are detected directly in urine.

  • Organophosphates in urine

    These compounds are among the most important agricultural pesticides and are absorbed primarily via residues on food. Organophosphates can inhibit an enzyme of the nervous system and trigger cramps - right through to respiratory arrest.

    In the 5th environmental survey the UBA is analysing the urine of the subjects for at least five metabolites of organophosphates: dimethylphosphate (DMP), dimethyl thiophosphate (DMTP), dimethyl dithiophosphate (DMDTP), diethylphosphate (DEP), diethylthiophosphate (DETP) and diethyl dithiophosphate (DEDTP).

  • Pyrrolidones in urine

    The pyrrolidones NMP (N-methyl-2-Pyrrolidone) and NEP (N-ethyl-2-Pyrrolidone) are used as solvents in pesticides and found in automotive coatings, paint removers, coating agents for parquet floors and non-stick coatings. NMP has been classified as mutagenic or reprotoxic and is therefore increasingly being replaced by NEP. This latter is still not classified as reprotoxic.

    NMP and NEP are broken down in the body to form metabolites. Quantities of the NMP metabolites of 5-hydroxy-N-methyl-2-pyrrolidone (5-HNMP) and 2-hydroxy-N-methylsuccinimid (2-HMSI) and the NEP metabolite of 5-hydroxy-N-ethyl-2-pyrrolidone (5-HNEP) and 2-hydroxy-N-ethylsuccinimid (2-HESI) are found in urine.

  • Mercaptobenzothiazole in urine

    Mercaptobenzothiazole (MBT) is what is known as a vulcanisation accelerator and is used in the manufacture of rubber. MBT is contained, for example, in air mattresses, rubber gloves, bathing caps or toys and balloons. In some people MBT may trigger a contact allergy, that is, an uncomfortable inflammation of the skin. Exposure to MBT is determined directly in urine.

  • Overview

    Drinking water is among the most effectively monitored foodstuffs in Germany and must meet the same safety criteria as bottled drinking water. And yet, substances that do not belong in it can escape via pipes into the water. The longer water remains in the pipe - experts speak of stagnant water - the greater in general terms is the contamination. In the 5th environment survey, UBA is investigating the drinking water from the households visited for metals and organic substances.

  • Metals in drinking water

    In GerES IV from 2003 to 2006 the scientists found mainly copper, nickel and lead in stagnant water. In the 5th environment survey the content of these metals is determined in stagnant water which has been standing for two to four hours in the pipe and in fresh tap water.

  • Organic substances in drinking water

    Organic substances enter drinking water, for example, from plastic pipes, rubber seals and coatings. GC-MA screening in accordance with prEN 15768 is used to determine the quantities involved in such incursions and what types of organic pollutant are common in drinking water.

  • Overview

    The analysis of the vacuum cleaner bag can be used to record the content of plasticisers and flame retardants in household dust. The pollutants can be absorbed via the lungs or the gastrointestinal tract. Children usually have a higher risk of exposure than adults because they often put things in their mouth and breathe faster. Children also often crawl on the ground, and are therefore assumed to incorporate.

  • Plasticisers and flame retardants in the vacuum cleaner bag

    Of all the plasticisers, DEHP (Di(2-ethyl hexyl) phthalate) is the most notorious. It acts as a hormone and can affect fertility, which is why it can no longer be used in children's toys.

    In the laboratory UBA examines the content of phthalates (plasticisers) and their substitutes in house dust. Another test determines the extent of contamination of the dust with flame retardants, which find their way into house dust from such sources as electronic devices, upholstered furniture and carpets.

  • Overview

    Walls, floors, cupboards and pieces of clothing continuously emit chemicals into the indoor air. In the 5th environment survey UBA is looking for volatile organic compounds (VOC) and carbonyls. High concentrations of VOC can cause sick-building syndrome. This disease pattern, recognised by the World Health Organization (WHO), manifests inter alia in headaches, allergies and sleep disorders. Carbonyls can irritate the mucous membranes and are in some cases carcinogenic.

  • Volatile organic compounds (VOCs) in the air

    In the 5th German Environment Survey the VOC are collected for seven days in a passive collector (PERKIN ELMER (PE)) inside and outside the child’s room. Thermo-desorption procedures and gas chromatography mass spectrometry are used by the researchers to determine the concentrations of C6-C16 alkanes, C9 - C14 alkanes, α-pinene, naphthalene, toluene, styrene, phenol, benzyl alcohol, cyclic dimethylsiloxanes D3-D6, some glycol or glycol ethers and glycol ester compounds, TVOC and benzaldehyde, Hexanal, 2-furaldehyde diethyl and formaldehyde.

  • Formaldehyde and other carbonyls in the air

    The content of indoor air is analysed for 15 carbonyls, including formaldehyde and longer-chain aldehydes and ketones. They are found, for example, in particle board, cork flooring, linoleum and some paints.

    For the analysis, passive samplers (SKC UMEx-100) are installed for seven days inside and outside the child’s room. They collect all pollutants containing carbonyl groups and transform them by means of a reaction with dinitrophenylhydrazines (DNPH) into heavy hydrazones. The concentration of the individual substances is determined using high-pressure liquid chromatography (HPLC).

  • Overview

    Particulate matter refers to small airborne particles of below 10 microns in diameter. The smaller the particles, the deeper they penetrate into the lung, making it difficult or impossible to cough them up. Ultrafine particles even make it into the bloodstream via the alveoli.

    Air measurements inside and outside the residences indicate the exposure of the inhabitants to particulate matter, polycyclic aromatic hydrocarbons (PAH) and ultra-fine particles. UBA also analyses the response of the immune system to different dust particles.

  • Particulate matter in the indoor environment and outdoor air

    UBA places small filter devices (mini volume samplers (mini VS)) in the subjects’ living room for seven days to collect particles of no more than 2.5 microns in diameter from the air. This is done with what is known as an impactor preseparator (with a PM 2.5 nozzle and a glass fibre filter with a diameter of 25 millimetres and material density GF10). At the same time the participating families keep a journal in which they document when they vacuum or ventilate the apartment or clean animal cages. For comparison, the particulate concentration outside the residence is measured as well.

  • PAH analysis of particulate matter indoors

    Heavy metals or partially carcinogenic polycyclic aromatic hydrocarbons (PAHs) can accumulate on the surface of the dust particles. The GerES V also tests the dust collected for the particulate matter analysis for its PAH content.

  • Ultra-fine particles in the indoor environment

    Airborne particles smaller than 0.1 micrometres can penetrate into the bloodstream via the alveoli. This can, for instance, cause inflammation in the lungs or damage the cardiovascular system.

    A condensation particle counter (CPC) is set up in the child’s room for an hour to determine the content of ultra-fine particles there. It counts all particles between 1 and 0.01 micrometres in size. The concentration ranges from 0 up to 100,000 particles per cubic centimetre of air (P/cm3). The measurements are taken with closed windows and doors after a period set aside to allow the larger dust particles to settle.

  • Potential effects of dust particles in the indoor environment

    Particulate matter promotes pulmonary and cardiovascular disease. Why exactly this is the case is still not sufficiently clear.

    In the 5th environment survey UBA collects different-sized particles using ultra-small filter devices on Teflon filters and freezes them at minus 20 degrees Celsius. In the laboratory, researchers use cell cultures to ascertain how human lung cells or white blood cells (immune cells) react to the particulate matter. Inflammatory reactions are recorded using the ELISA procedure or a FACS analysis.

  • Overview

    When interiors are affected by mould, health risks arise. Mould spores can penetrate into the lungs, causing irritation and allergies. The rooms are at the same time often contaminated with bacterial toxins.

    The UBA records the total number of spores in the indoor and outdoor air and takes an indoor air sample with a gelatine filter and a tedlar bag plus a floor dust sample. Exposure to house dust mites is also recorded. These too can trigger allergies.

  • Indoor air sample (total number of spores)

    Small sampling devices are set up for 30 minutes in the child’s room to determine the total number of mould spores in the air. The measurement is carried out according to ISO 16000-20.

  • Outdoor air sample (total number of spores)

    Because the indoor concentration of mould spores is affected by the contamination of the outdoor air, the UBA takes a sample for comparison in front of the house as well.

  • Indoor air gelatin filter

    At the same time the researchers use a gelatin filter to collect mould spores in the child’s room to add to the total spore count. In the laboratory, these are distributed over a culture medium. A specific real-time PCR determines the concentration of moulds and actinobacteria. Here, as in the total spore count, a sample is taken in front of the house.

  • Floor dust sample

    Mould fungus can also be found in household dust. It is for this reason that the scientists vacuum five square metres of floor in the child’s room using special attachments. The concentration of mould fungus and bacteria is then determined by a real time PCR.

  • Myco- and endotoxins

    In addition to mould toxins (mycotoxins), UBA also measures the content of endotoxins originating from bacteria in the dust and air. The air is passed through a TENAX tube, where the toxins are collected.

  • Indoor air sample

    In children's rooms in which more than half a square metre is infested with mould, the UBA carries out an additional test: This air is locked in a so-called tedlar bag. In the laboratory, scientists pass the air over cell cultures. In this way they check, for example, how immune cells react to the substances contained in the air.

  • Bed dust sample

    House dust mites frequently cause more allergic reactions than mould. These arachnids prefer to make their home in mattresses or upholstered furniture. In the 5th environmental survey UBA vacuums the beds of the participants with a special cleaner in accordance with uniform specifications. An analysis is then performed to determine how many allergens - substances triggering allergic reactions - were to be found in the beds.

  • Overview

    A level of background noise that is persistently too high is detrimental to well-being and health. Children and adolescents are also affected and, when affected by noise pollution, tend among other things to develop increased blood pressure. Loud music through headphones or at concerts and discos is suspected of causing damage to the ear. However, the exact conditions in which noise becomes harmful to health remain to be conclusively determined.

  • Noise measurement

    The average noise exposure is determined for 15 to 20 minutes on the window ledge of an open window or on the balcony. The scientists document the position of the child’s or adolescent’s room in relation to the road, record the road type and ask questions to establish how the residents rate the noise level in the home. Questions are also asked to ascertain how intensively the children and adolescents listen to music on portable players or go to concerts or discos and how they experience the volume levels.

    In general a noise level outside the home of no more than 40 dB(A) at night and 50 dB(A) during the day is currently assessed as harmless. At higher values there is a gradual decrease in well-being. The risk of damage to health increases with the volume.