Using Emerging Science and Technologies to Address Persistent and Future Environmental Challenges - Science For Environmental Protection: The Road Ahead - page 48

the National Research Council (NRC) report Science and Decisions: Advancing
Risk Assessment recommended that EPA increase the role of epidemiology, sur-
veillance, and biomonitoring to support cumulative risk assessment (NRC
2009). The most successful and current epidemiologic studies leverage multiple
resources and use highly collaborative and multidisciplinary approaches (Semi-
nara et al. 2007; Baker and Nieuwenhuijsen 2008). In the United States, a num-
ber of high-quality prospective cohort studies funded mostly by the National
Institutes of Health have followed millions of people and have collected bio-
specimen repositories (blood, urine, nails, and DNA) and sociodemographic,
genetic, medical, and lifestyle information (Seminara et al. 2007; Willett et al.
2007; NHLBI 2011). Major prospective cohort studies have also been under-
taken in other countries (Riboli et al. 2002; Ahsan et al. 2006; Elliott and Peak-
man 2008).
With some exceptions, current prospective cohort studies generally lack
information on environmental exposures. EPA can contribute to closing this gap
by, for instance, adding high-quality environmental measures to studies that
already have good followup and outcome measures. Examples of collaborations
in which EPA plays a critical role are the Agricultural Health Study (NIH 2012),
the Multiethnic Study of Atherosclerosis and Air Pollution (MESA Air) (Uni-
versity of Washington 2011), and the National Children's Study (NRC/IOM
2008). In the National Children's Study, the linkage of monitoring data on toxi-
cants in air, water, food, and ecosystems to individual participant data has al-
ready been explored in depth in Queens, New York, one of the Vanguard Na-
tional Children's Study sites (Lioy et al. 2009). Budgetary and implementation
challenges for the National Children's Study will require innovative strategies
for recruitment, examination, and followup without compromising the quality of
the science (Kaiser 2012).
Alternatively, EPA could add followup and outcome measures to studies
that have good measures of exposure, although this is likely to be more time-
consuming and expensive. At a minimum, EPA should ensure that environ-
mental indicators, including country-wide air-monitoring and water-monitoring
data, meet quality and accessibility criteria, for example, through a public data-
access system. The indicators can then be merged with individual and commu-
nity-level data in population-based studies by using geographic and temporal
criteria. Biomonitoring and modeling approaches to predict exposure and dose
and other advances in exposure science—including the exposome (Weis et al.
2005; Sheldon and Cohen Hubal 2009; Rappaport and Smith 2010; Lioy and
Rappaport 2011), -omic technologies, and complex systems approaches (Diez
Roux 2011)—could be incorporated into the prospective studies. By building
expertise and leadership in exposure assessment and by working in collaboration
with other national and international efforts, EPA can play a principal role in the
incorporation of environmental exposures into prospective cohort studies and
thus contribute to the discovery of major environmental determinants, dose-
response relationships, mechanistic pathways, and gene-environment interac-
tions for chronic diseases in human studies.