Indirect exposures: the significance of bystanders at work and at home

Our plain-English summary of Indirect exposures: the significance of bystanders at work and at home, by P. Grandjean, E. Bach (American Industrial Hygiene Association Journal, 1986).

The study

• Authors: P. Grandjean, E. Bach
• Journal: American Industrial Hygiene Association Journal
• Published: 1986;47(12):819-24
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001141).

Abstract

Indirect exposures of adjacent workers occur at work, and family members may be exposed to hazardous substances that are carried home. The significance of such hazard dissemination has been evaluated in studies dealing mostly with asbestos and lead. The general lessons learned from this evidence would suggest that indirect exposures may occur much more commonly than suspected. Thus, improved primary prevention at the workplace also should be aimed at limiting the extent of indirect exposures. In addition, this factor should be taken into account in occupational history-taking and in epidemiological studies.

In plain English

This 1986 article was a review. The authors looked at studies, including some of their own from Denmark, on 'indirect exposures'. These are exposures of people working near a hazardous job (bystanders) and of family members exposed to substances carried home. Most evidence concerned lead and asbestos. In one reviewed London study of 76 mesothelioma cases, nine patients were relatives of asbestos workers, five of them wives. A case-referent study of 52 women with malignant mesothelioma found that 10 had a husband and/or father in an asbestos-related job, compared with one referent. A study of household contacts of amosite asbestos workers found pleural and/or parenchymal abnormalities in 35% of 669 people examined. Five of 550 deaths among household contacts were from malignant mesothelioma. The authors' own Danish study of 12 pairs of lead workers' socks found gram amounts of lead could be carried home in one pair. The authors noted that the household-exposure studies were generally cross-sectional, making exposure-response relationships difficult to evaluate. They concluded that indirect exposures may well be more widespread than the published evidence shows.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of published studies (including the authors' own Danish studies) on indirect exposures at work and at home
• Who was studied: Studies of bystanders at workplaces (for example shipyards) and of household members of exposed workers, mostly concerning lead and asbestos. The authors' own studies involved Danish lead workers and their 3 to 6-year-old children.
• Exposure: Indirect (bystander and household) exposure to asbestos, lead, beryllium and other substances, including dust carried home on work clothes. One reviewed asbestos study involved amosite asbestos workers.
• Main results:
  • Reviewed study (Harries, UK Naval Dockyards): 12 non-asbestos occupations were listed among asbestosis patients seen in one year
  • Reviewed studies: asbestos-related disease in shipyard workers occurred at similar prevalence rates whether exposure was direct or indirect
  • Reviewed London study: of 76 mesothelioma cases over 50 years, nine patients were relatives of asbestos workers. Five were wives, possibly exposed from shaking and washing the husband's work clothes.
  • Reviewed case-referent study of 52 female cases of malignant mesothelioma: 10 cases had a husband and/or father in an asbestos-related occupation, compared with one referent
  • Reviewed study of household contacts of amosite asbestos workers: pleural and/or parenchymal abnormalities in 35% of 669 individuals examined
  • Same reviewed study: of 550 deaths among household contacts, five were due to malignant mesothelioma
  • Reviewed study: radiologic evidence of asbestosis in 11% of 274 wives of shipyard workers
  • Reviewed Japanese study: pleural plaques in seven out of 40 wives of shipyard workers
  • Authors' own Danish study: 4 of 84 children of lead workers had unusually high blood lead levels of 20-29 μg/100 mL
  • Authors' own study of 12 pairs of socks from lead workers: gram amounts of lead may be carried home in a single pair of socks
• The authors' conclusion: The authors concluded that indirect exposures at work and at home may be more widespread than the scattered literature suggests. They said this should be taken into account in workplace prevention, in epidemiological studies and in taking occupational histories.
• Limitations the authors state:
  • The household-exposure studies reviewed were generally cross-sectional, so an exposure-response relationship is difficult to evaluate
  • The available evidence on indirect exposures at work has probably detected only the most obvious examples

Topics

Medical terms in this study, explained in our Lexicon: Occupational History.

Related studies

• Mesothelioma: you do not have to work for it — E.J. Ampleford, J. Ohar (2007)
• Use of direct versus indirect preparation data for assessing risk associated with airborne exposures at asbestos-contaminated sites — M.P. Goldade, W.P. O'Brien (2014)
• Evaluation of bystander exposures to asbestos in occupational settings: a review of the literature and application of a simple eddy diffusion model — E.P. Donovan, B.L. Donovan, et al. (2011)
• Assessment of airborne exposures and health in flooded homes undergoing renovation — K.A. Hoppe, N. Metwali, et al. (2012)
• Children's health in Latin America: the influence of environmental exposures — A. Laborde, F. Tomasina, et al. (2015)
• Exposures estimates of the Wittenoom mining workforce and town residents - Implications associated with risk estimation for persons exposed to asbestiform riebeckite — A.J. Rogers (2018)

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