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Cited by 291Water Treatment and DisinfectionCarcinogens and Genotoxicity AssessmentToxic Organic Pollutants Impact

Overview of Disinfection By-products and Associated Health Effects

Open access
Villanueva, Cristina M., Cordier, Sylvaine, Font-Ribera, Laia, Salas, Lucas A., Levallois, Patrick·2015·Current Environmental Health Reports
DOI 10.1007/s40572-014-0032-x
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Abstract

The presence of chemical compounds formed as disinfection by-products (DBPs) is widespread in developed countries, and virtually whole populations are exposed to these chemicals through ingestion, inhalation, or dermal absorption from drinking water and swimming pools. Epidemiological evidence has shown a consistent association between long-term exposure to trihalomethanes and the risk of bladder cancer, although the causal nature of the association is not conclusive. Evidence concerning other cancer sites is insufficient or mixed. Numerous studies have evaluated reproductive implications, including sperm quality, time to pregnancy, menstrual cycle, and pregnancy outcomes such as fetal loss, fetal growth, preterm delivery, and congenital malformation. The body of evidence suggests only minor effects from high exposure during pregnancy on fetal growth indices such as small for gestational age (SGA) at birth. Populations highly exposed to swimming pools such as pool workers and professional swimmers show a higher prevalence of respiratory symptoms and asthma, respectively, although the direction of the association, and thus causality, is not clear among professional swimmers. The risk of asthma, wheezing, eczema, and other respiratory outcomes among children attending swimming pools has been the object of extensive research. Early studies suggested a positive association, while subsequent larger studies found no correlations or showed a protective association. Future research should develop methods to evaluate the effects of the DBP mixture and the interaction with personal characteristics (e.g., genetics, lifestyle), clarify the association between swimming pools and respiratory health, evaluate the occurrence of DBPs in low- and middle-income countries, and evaluate outcomes suggested by animal studies that have not been considered in epidemiological investigations.

Integrity signals

Registry

Crossref · 10.1007/s40572-014-0032-x

Cites

98 of 98 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

22 of 74 cited sources checked · 12 supported · 2 flagged · accuracy not yet measured

  • Premisecitation

    Studies in Germany, Spain, the UK, and the Netherlands found no association between swimming pool attendance and respiratory symptoms among children.

    “However, studies in other European countries such as Germany [91], Spain [92,93], the UK [94•], and the Netherlands [95], have found no association between swimming pool attendance and respiratory symptoms among children.”
    Quote in the paperNot a substantial claim2 of 4 sources checked
    • cites [91] Schoefer Y, Zutavern A, Brockow I, et al. Health risks of early swimming pool attendance. Int J Hyg Environ Health. 2008;211(3–4):367–73. source
    • cites [92] Font-Ribera L, Kogevinas M, Zock JP, et al. Swimming pool attendance and risk of asthma and allergic symptoms in children. Eur Respir J. 2009;34(6):1304–10. source

      For the Spanish study, the Discussion states that pool attendance was associated with slightly fewer upper and lower respiratory tract symptoms, rather than no association. The Results also report a lower prevalence of current asthma among children currently attending pools (OR 0.46, 95% CI 0.25–0.83) and less rhinitis with longer attendance. This paper does not provide the findings for the other countries cited in the sentence. (LLM, conf=0.86)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [93] Font-Ribera L, Villanueva CM, Gracia-Lavedan E, et al. Indoor swimming pool attendance and respiratory and dermal health in schoolchildren—HITEA Catalonia. Respir Med. 2014;108(7):1056–9. source
    • cites [94•]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Premisecitation

    The bladder has been the most frequently evaluated cancer site, including two meta-analyses and two pooled analyses.

    “The bladder has been the most frequently evaluated cancer site, including two meta-analyses [49,50] and two pooled analyses [40, 51•].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [49] King W. Epidemiological studies of disinfection by-products and cancer risk. In: Craun GF, Hauchman FS, Robinson DE, editors. Microbiological pathogens and disinfection by-products in drinking water: health effects and management of risks. Washington, DC: ILSI Press; 2001. p. 243–54.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [50] Villanueva CM, Fernandez F, Malats N, et al. Meta-analysis of studies on individual consumption of chlorinated drinking water and bladder cancer. J Epidemiol Community Health. 2003;57(3):166–73. source
    • cites [40, 51•]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Premisecitation

    Villanueva et al. (2003) meta-analysis showed a combined relative risk of 1.6 (95% CI 1.2-2.2) in men and 1.4 (95% CI 0.6-3.6) in women for more than 40 years of exposure to chlorinated water.

    “A meta-analysis by Villanueva et al. (2003) of six case-control and two cohort studies showed a combined relative risk of 1.6 (95 % CI,1.2-2.2) in men and 1.4 (95 % CI 0.6-3.6) in women for more than 40 years of exposure to chlorinated water.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Villanueva et al. (2003) source
  • Premisecitation

    Cantor et al. (2010) indicated an increased risk of bladder cancer in participants with certain polymorphisms of genes coding for enzymes involved in the metabolism of DBPs and other xenobiotics.

    “In particular, the results of a study by Cantor et al. (2010) indicated an increased risk of bladder cancer in participants with certain polymorphisms of genes coding for enzymes involved in the metabolism of DBPs [17] and of other xenobiotics [54].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Cantor et al. (2010) source
    • cites [17] Cantor KP, Villanueva CM, Silverman DT, et al. Polymorphisms in GSTT1, GSTZ1, and CYP2E1, disinfection by-products, and risk of bladder cancer in Spain. Environ Health Perspect. 2010;118(11):1545–50. source
    • cites [54] Bull R. Toxicological evaluation of experimental data that informs the magnitude of cancer risk from DBPs. In: Hrudey SE, Charrois JW, editors. Disinfection by-products and human health. London: IWA Publishing; 2012. p. 179–212.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Premisecitation

    No association with hypospadias was found in the meta-analysis of four studies.

    “No association with hypospadias was found in this meta-analysis (four studies).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [77] Nieuwenhuijsen MJ, Martinez D, Grellier J, et al. Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses. Environ Health Perspect. 2009;117(10):1486–93. source

      The Results state that the hypospadias meta-analysis found no statistically significant association with chlorinated water or TTHM levels. The passages in our copy do not establish that the meta-analysis included four studies, so that detail remains unsupported. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • May combine two claims. 29
  • Classified as probably not a substantial claim. 10

  • May combine two claims.

    Premisecitation

    Studies have suggested a negative impact of DBP exposure on normal sperm morphology and sperm concentration, but not on motility percentage, after adjusting for confounders.

    “Studies have suggested a negative impact of DBP exposure on normal sperm morphology [58] and on sperm concentration [59], but not on motility percentage, after adjusting for confounders [60].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [58] Fenster L, Waller K, Windham G, et al. Trihalomethane levels in home tap water and semen quality. Epidemiology. 2003;14(6):650–8. source
    • cites [59] Luben TJ, Olshan AF, Herring AH, et al. The healthy men study: an evaluation of exposure to disinfection by-products in tap water and sperm quality. Environ Health Perspect. 2007;115(8):1169–76. source

      Citation [60] is attached to the claim about motility percentage after adjustment, not to the morphology or concentration claims cited separately. The Methods (Semen collection and analyses; page unavailable) state that motility was not included in the statistical analysis because it was unreliable for shipped semen. This study therefore cannot support an adjusted finding of no effect on motility percentage. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [60] Xie SH, Li YF, Tan YF, et al. Urinary trichloroacetic acid levels and semen quality: a hospital-based cross-sectional study in Wuhan, China. Environ Res. 2011;111(2):295–300. source

  • May combine two claims.

    Premisecitation

    Urine trichloroacetic acid has been proposed as a valid biomarker of ingested DBPs because its half-life is longer than consecutive exposure events and reaches steady levels correlating with levels ingested through drinking water.

    “Urine trichloroacetic acid has been proposed as a valid biomarker of ingested DBPs, as its halflife is longer than consecutive exposure events, reaching steady levels that correlate with levels ingested through drinking water [44].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [44] Bader EL, Hrudey SE, Froese KL. Urinary excretion half-life of trichloroacetic acid as a biomarker of exposure to chlorinated drinking water disinfection by-products. Occup Environ Med. 2004;61(8):715–6. source

  • May combine two claims.

    Premisecitation

    Exceptions to the overall lack of SGA increase were noted in areas with high concentrations of THMs (≥80 μg/L) in tap water, in cases with high uptake via showering, and in susceptible populations such as newborns carrying a genetic variant of the CYP2E1 gene.

    “Exceptions, however, were noted in areas with high concentrations of THMs (≥80 μg/L) in tap water [71, 73•], in cases with high uptake via showering [74•], and in susceptible populations, such as newborns carrying a genetic variant of the CYP2E1 gene [70].”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [71, 73•]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [74•]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [70] Infante-Rivard C. Drinking water contaminants, gene polymorphisms, and fetal growth. Environ Health Perspect. 2004;112(11):1213–6. source

  • May combine two claims.

    Premisecitation

    Meta-analyses of 15 studies on DBP exposure and birth defects reflected an overall 17% increase (3-34%) in all congenital anomalies and an increased risk of ventricular septal defect based on five and three studies, respectively.

    “Meta-analyses of available studies (n=15) on the relationship between DBP exposure and various birth defects have reflected an overall 17 % increase (334 %) in all congenital anomalies and, more specifically, an increased risk of ventricular septal defect, based on five and three studies, respectively.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [77] Nieuwenhuijsen MJ, Martinez D, Grellier J, et al. Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses. Environ Health Perspect. 2009;117(10):1486–93. source

  • May combine two claims.

    Premisecitation

    A cross-sectional study in China measuring urine TCAA in approximately 2,000 men showed a negative correlation between markers of sperm quality and urine TCAA levels, but no dose-response association.

    “In China, a cross-sectional study that measured urine TCAA in approximately 2,000 men visiting a reproduction center showed a negative correlation between markers of sperm quality and urine TCAA levels, but no dose-response association was observed [62].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [62] Zeng Q, Wang YX, Xie SH, et al. Drinking-water disinfection by-products and semen quality: a cross-sectional study in China. Environ Health Perspect. 2014;122(7):741–6. source

  • May combine two claims.

    Premisecitation

    Epidemiological studies have described a higher prevalence of certain respiratory symptoms among pool workers, but have reported no chronic effects.

    “Epidemiological studies have described a higher prevalence of certain respiratory symptoms among pool workers, but have reported no chronic effects [84].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [84] Villanueva CM, Font-Ribera L. Health impact of disinfection by-products in swimming pools. Ann Ist Super Sanita. 2012;48(4):387–96. source

      The Occupational exposure section reports a higher prevalence of nasal symptoms and other respiratory symptoms among pool workers. Two studies found no increase in bronchial hyperreactivity, but the section also reports a higher prevalence of asthma in one study and three cases of occupational asthma. Thus, the categorical claim that studies reported no chronic effects is not supported. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Evidence on DBP occurrence levels is scarce in low- and middle-income countries.

    “There is also a need to evaluate occurrence levels in low-and middle-income countries, where evidence is scarce.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The evidence implicating DBP exposure during pregnancy does not show a consistent association with pregnancy outcomes, with the exception of a slight correlation with fetal growth-related outcomes.

    “The evidence implicating DBP exposure during pregnancy does not show a consistent association with pregnancy outcomes, with the exception of a slight correlation with fetal growth-related outcomes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    The presence of chemical compounds formed as disinfection by-products (DBPs) is widespread in developed countries, and virtually whole populations are exposed to these chemicals through ingestion, inhalation, or dermal absorption from drinking water and swimming pools.

    “The presence of chemical compounds formed as disinfection by-products (DBPs) is widespread in developed countries, and virtually whole populations are exposed to these chemicals through ingestion, inhalation, or dermal absorption from drinking water and swimming pools.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Early studies suggested a positive association between children attending swimming pools and asthma, wheezing, eczema, and other respiratory outcomes, while subsequent larger studies found no correlations or showed a protective association.

    “Early studies suggested a positive association, while subsequent larger studies found no correlations or showed a protective association.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Populations highly exposed to swimming pools, such as pool workers and professional swimmers, show a higher prevalence of respiratory symptoms and asthma, respectively, although the direction of the association and causality is not clear among professional swimmers.

    “Populations highly exposed to swimming pools such as pool workers and professional swimmers show a higher prevalence of respiratory symptoms and asthma, respectively, although the direction of the association, and thus causality, is not clear among professional swimmers.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    More than 600 DBPs have been identified.

    “with more than 600 DBPs that have been identified [1]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Richardson SD, Plewa MJ, Wagner ED, et al. Occurrence, genotoxicity, and carcinogenicity of regulated and emerging disinfection by-products in drinking water: a review and roadmap for research. Mutat Res. 2007;636(1–3):178–242. source

  • May combine two claims.

    Interpretationnone given

    Epidemiological evidence shows a consistent association between long-term exposure to trihalomethanes and bladder cancer risk, but the causal nature of the association is not conclusive.

    “Epidemiological evidence has shown a consistent association between long-term exposure to trihalomethanes and the risk of bladder cancer, although the causal nature of the association is not conclusive.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Ozone used in combination with chlorine-based disinfectants produces lower volumes of THMs, HAAs, and chlorine-based DBPs, but results in production of aldehydes, ketones, keto aldehydes, carboxylic acids, keto acids, hydroxy acids, alcohols, and esters, and can form bromate when raw water contains bromide.

    “Ozone is used in combination with chlorine-based disinfectants to produce a lower volume of THMs, HAAs, and chlorine-based DBPs, but results in the production of aldehydes, ketones, keto aldehydes, carboxylic acids, keto acids, hydroxy acids, alcohols, and esters, and can also form bromate when the raw water contains bromide [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] von Gunten U. Ozonation of drinking water: part II. Disinfection and by-product formation in presence of bromide, iodide or chlorine. Water Res. 2003;37(7):1469–87. source

  • May combine two claims.

    Premisecitation

    Rahman et al. (2010) integrated three additional case-control studies with poorer designs, did not reject heterogeneity, and estimated a combined RR for highest exposure of 1.3 (95% CI 1.1-1.6).

    “Rahman et al. (2010) integrated three additional case-control studies with poorer designs, did not reject heterogeneity, and were able to estimate a combined RR for highest exposure of 1.3 (95 % CI, 1.1-1.6)[55].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Rahman et al. (2010) source
    • cites [55] Rahman MB, Driscoll T, Cowie C, et al. Disinfection by-products in drinking water and colorectal cancer: a meta-analysis. Int J Epidemiol. 2010;39(3):733–45. source

  • May combine two claims.

    Premisecitation

    Trihalomethanes have been used in epidemiological studies as surrogates of total DBP content, although correlations among specific DBPs are variable.

    “Trihalomethanes have been used in epidemiological studies as surrogates of total DBP content, although correlations among specific DBPs are variable [35].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Villanueva CM, Castano-Vinyals G, Moreno V, et al. Concentrations and correlations of disinfection by-products in municipal drinking water from an exposure assessment perspective. Environ Res. 2012;114:1–11. source

  • May combine two claims.

    Premisecitation

    Animal studies have shown fetotoxic effects, retarded fetal development, spermatotoxicity, delayed sexual maturation, changes in reproductive organs/placenta, and skeletal effects from DBP exposure.

    “Experimental evidence provided by animal studies has shown fetotoxic effects, retarded fetal development, spermatotoxicity, delayed sexual maturation, changes in reproductive organs/placenta, and skeletal effects [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Tardiff RG, Carson ML, Ginevan ME. Updated weight of evidence for an association between adverse reproductive and developmental effects and exposure to disinfection by-products. Regul Toxicol Pharmacol. 2006;45(2):185–205. source

  • May combine two claims.

    Premisecitation

    Chlorine dioxide is widely used in Italy, leading to lower levels of THMs but higher levels of chlorite and chlorate.

    “Chlorine dioxide is widely used in Italy, leading to lower levels of THMs but higher levels of chlorite and chlorate [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Fantuzzi G, Aggazzotti G, Righi E, et al. Exposure to organic halogen compounds in drinking water of 9 Italian regions: exposure to chlorites, chlorates, trihalomethanes, trichloroethylene and tetrachloroethylene. Ann Ig. 2007;19(4):345–54.

  • May combine two claims.

    Interpretationcitation

    The validity of urine trichloroacetic acid as a biomarker is limited because trichloroacetic acid is a metabolite of other substances and only the ingestion pathway is covered.

    “However, the validity of this method is limited, given that trichloroacetic acid is a metabolite of other substances, and only the ingestion pathway is covered (haloacetic acids are not volatile or skin-permeable) [45].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Savitz DA. Invited commentary: biomarkers of exposure to drinking water disinfection by-products–are we ready yet? Am J Epidemiol. 2012;175(4):276–8. source

  • May combine two claims.

    Premisecitation

    Levels of natural organic matter precursors determine DBP yield, while bromide and iodide concentrations determine formation of brominated and iodinated DBP species.

    “The levels of precursors such as natural organic matter (e.g., humic and fulvic acids) are determinants of the DBP yield, while bromide and iodide concentrations determine the formation of brominated and iodinated DBP species [6,7].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] Kampioti AA, Stephanou EG. The impact of bromide on the formation of neutral and acidic disinfection by-products (DBPs) in Mediterranean chlorinated drinking water. Water Res. 2002;36(10):2596–606. source
    • cites [7] Richardson SD, Fasano F, Ellington JJ, et al. Occurrence and mammalian cell toxicity of iodinated disinfection byproducts in drinking water. Environ Sci Technol. 2008;42(22):8330–8. source

  • May combine two claims.

    Premisecitation

    Several DBPs have been shown to be genotoxic in in vitro assays and carcinogenic in animal experiments.

    “Several disinfection by-products have been shown to be genotoxic in in vitro assays and carcinogenic in animal experiments [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Richardson SD, Plewa MJ, Wagner ED, et al. Occurrence, genotoxicity, and carcinogenicity of regulated and emerging disinfection by-products in drinking water: a review and roadmap for research. Mutat Res. 2007;636(1–3):178–242. source

  • May combine two claims.

    Interpretationnone given

    The consistency in epidemiological findings and the observed dose-response relationship, at least for men, cannot be dismissed.

    “On the other hand, the consistency in epidemiological findings and the observed doseresponse relationship, at least for men, cannot be dismissed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Chlorine reacts with organic matter from swimmers, leading to the formation of DBPs such as nitrosamines or chloramines, apart from trihalomethanes, haloacetic acids, and other DBPs also found in drinking water.

    “It reacts with organic matter from swimmers, leading to the formation of DBPs such as nitrosamines [81] or chloramines, apart from trihalomethanes, haloacetic acids, and other DBPs that are also found in drinking water.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] Walse SS, Mitch WA. Nitrosamine carcinogens also swim in chlorinated pools. Environ Sci Technol. 2008;42(4):1032–7. source

  • May combine two claims.

    Premisecitation

    Several studies have shown a higher prevalence of asthma among swimmers compared to other athletes, but the direction of the association is not clear because swimming is a recommended sport for asthmatics.

    “Several studies have shown a higher prevalence of asthma among swimmers compared to other athletes [85], but the direction of the association is not clear, given that swimming is a recommended sport for asthmatics [85,86].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [85] Goodman M, Hays S. Asthma and swimming: a meta-analysis. J Asthma. 2008;45(8):639–47. source
    • cites [86] Uyan ZS, Carraro S, Piacentini G, et al. Swimming pool, respiratory health, and childhood asthma: should we change our beliefs? Pediatr Pulmonol. 2009;44(1):31–7. source

  • May combine two claims.

    Premisecitation

    A California prospective study suggested an increased risk of spontaneous abortion among women who consumed five or more glasses of cold tap water per day containing ≥75 μg/liter of total THMs, with higher risk when bromodichloromethane was considered.

    “A prospective study conducted in California suggested an increased risk of spontaneous abortion among women who consumed five or more glasses of cold tap water per day containing ≥75 μg/liter of total THMs, with a higher risk when bromodichloromethane was considered [65].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] Waller K, Swan SH, DeLorenze G, et al. Trihalomethanes in drinking water and spontaneous abortion. Epidemiology. 1998;9(2):134–40. source

  • May combine two claims.

    Interpretationreasoning

    Despite a large body of research, there is no clear evidence linking exposure to DBPs and reproductive outcomes, with the exception of a slight association with fetal growth-related outcomes and sporadic associations with some categories of congenital anomalies.

    “In summary, despite a large body of research, there is no clear evidence linking exposure to DBPs and reproductive outcomes, with the exception of a slight association with fetal growth-related outcomes and sporadic associations with some categories of congenital anomalies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Trichloramine is a volatile compound producing a penetrating odor and causing skin irritation, and is present in the air of indoor swimming pools.

    “Trichloramine, a volatile compound producing a penetrating odor and causing skin irritation [82], is present in the air of indoor swimming pools.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [82] Weaver WA, Li J, Wen Y, et al. Volatile disinfection by-product analysis from chlorinated indoor swimming pools. Water Res. 2009;43(13):3308–18. source

  • May combine two claims.

    Interpretationreasoning

    The available body of evidence has identified the bladder as a potential target, but lingering issues prevent definitive conclusions of causality.

    “The available body of evidence has identified some sites, particularly the bladder, as potential targets, but lingering issues prevent definitive conclusions of causality.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Laboratory models may not necessarily contribute to an understanding of acute or chronic effects in humans, who are generally exposed at very low doses.

    “laboratory models may not necessarily contribute to an understanding of acute or chronic effects in humans, who are generally exposed at very low doses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Swimming was associated with increased lung function and a lower prevalence of asthma symptoms, especially among children with pre-existing respiratory conditions.

    “Indeed, swimming was associated with increased lung function and a lower prevalence of asthma symptoms, especially among children with pre-existing respiratory conditions [94•].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [94•]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    The only prospective longitudinal study, among 5,738 British child swimmers, found no increased risk of asthma or any respiratory or allergy symptoms at around 10 years of age.

    “The only prospective longitudinal study was performed among 5,738 British child swimmers, which found no increased risk of asthma or any respiratory or allergy symptoms at around 10 years of age [94•].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [94•]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Current technologies in developed countries allow water treatment that minimizes the formation of DBPs while maintaining microbial safety.

    “current technologies in developed countries allow water treatment that minimizes the formation of DBPs while maintaining microbial safety.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Studies showing null associations between swimming pool attendance and respiratory symptoms were population-based and had larger sample sizes.

    “Studies showing null associations were population-based and had larger sample sizes [91-93, 94•, 95].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [91-93, 94•, 95]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Exposure assessment is a key challenge in epidemiological studies, particularly for long-latency diseases such as cancer.

    “exposure assessment is a key challenge in epidemiological studies, particularly for long-latency diseases such as cancer.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    DBPs may be incorporated through multiple routes (ingestion, inhalation, skin absorption).

    “may be incorporated through multiple routes (ingestion, inhalation, skin absorption)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisenone given

    Disinfection by-products are undesired consequences of disinfection.

    “Disinfection by-products are undesired consequences of disinfection”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Trihalomethanes have been traditionally used as markers of DBP mixtures.

    “Trihalomethanes have been traditionally used as markers of DBP mixtures”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    DBPs constitute complex mixtures.

    “DBPs constitute complex mixtures”
    Quote in the paperNot a substantial claim
38 of 38

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Several epidemiological studies have investigated health effects of long-term exposure to residential DBPs and all identified an association with increased risk of bladder cancer.

    “Several epidemiological studies have investigated health effects of long-term exposure to residential DBPs and all identified an association with increased risk of bladder cancer.”

    From Effects of exposure to water disinfection by-products in a swimming pool: A metabolome-wide association study (2018) · cites this paper as Villanueva et al., 2015

  • THMs' carcinogenic effects have been confirmed by numerous laboratory animal studies, which show that THMs in drinking water are associated with colorectal tumors, breast cancer, and bladder tumors as a result of nongenetic toxicity.

    “THMs' carcinogenic effects have been confirmed by numerous studies employing laboratory animals, which show that THMs in the drinking water are associated with colorectal tumors, BC, and bladder tumors as a result of nongenetic toxicity [34].”

    From Overview of emerging contaminants and associated human health effects (2015) · cites this paper as [34]

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. King W. Epidemiological studies of disinfection by-products and cancer risk. In: Craun GF, Hauchman FS, Robinson DE, editors. Microbiological pathogens and disinfection by-products in drinking water: health effects and management of risks. Washington, DC: ILSI Press; 2001. p. 243–54.
  2. Hrudey SE. Epidemiological inference and evidence on DBPs and human health. In: Hrudey SE, Charrois JW, editors. Disinfection by-products and human health. London: IWA Publishing; 2012. p. 213–82.
  3. Bull R. Toxicological evaluation of experimental data that informs the magnitude of cancer risk from DBPs. In: Hrudey SE, Charrois JW, editors. Disinfection by-products and human health. London: IWA Publishing; 2012. p. 179–212.
  4. IARC. Trichloroethylene and other chlorinated agents. IARC Monographs on the evaluation of carcinogenic risks to humans, vol. 106. Lyon, France: IARC Scientific publications; 2012.

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Authors
Villanueva, C. M., Cordier, S., Font-Ribera, L., Salas, L. A., & Levallois, P.
Affiliations
  • Barcelona Biomedical Research Park (ES)
  • Inserm (FR)
  • Universitat Pompeu Fabra (ES)
  • Centre hospitalier universitaire de Québec (CA)
Corresponding author
Villanueva, Cristina M.
ORCID
Venue
Current Environmental Health Reports
Publisher
Springer Science and Business Media LLC
Published
2015-01-22
Volume
2
Issue
1
Pages
107-115
ISSN
2196-5412 (ISSN-L)
DOI
10.1007/s40572-014-0032-x
OpenAlex
W1988179669
Cited by
291
References
98
Citations by year
2026: 13 · 2025: 28 · 2024: 28 · 2023: 29 · 2022: 38 · 2021: 34 · 2020: 42 · 2019: 32 · 2018: 18 · 2017: 19 · 2016: 6 · 2015: 2 · 2014: 1 · 2013: 1
FWCI
9.39
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Current Environmental Health Reports (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
Topics
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Water Treatment and Disinfection
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Carcinogens and Genotoxicity Assessment
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Toxic Organic Pollutants Impact
Keywords
disinfection by-products, trihalomethanes, drinking water disinfection, swimming pool water, bladder cancer, reproductive health, fetal growth, asthma, respiratory symptoms, congenital malformations, occupational exposure, professional swimmers, health effects
MeSH terms
Animals, Asthma, Disinfectants, Environmental Exposure, Female, Humans, Male, Neoplasms, Public Health, Respiratory Tract Diseases, Swimming Pools, Trihalomethanes, Drinking Water

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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