Dermal Exposure and Urinary 1-Hydroxypyrene among Asphalt Roofing Workers
Abstract
The primary objective of this study was to identify significant determinants of dermal exposure to polycyclic aromatic compounds (PACs) among asphalt roofing workers and use urinary 1-hydroxyprene (1-OHP) measurements to evaluate the effect of dermal exposure on total absorbed dose. The study population included 26 asphalt roofing workers who performed three primary tasks: tearing off old roofs (tear-off), putting down new roofs (put-down), and operating the kettle at ground level (kettle). During multiple consecutive work shifts (90 workerdays), dermal patch samples were collected from the underside of each worker's wrists and were analyzed for PACs, pyrene, and benzo(a)pyrene (BAP). During the same work week, urine samples were collected at pre-shift, post-shift, and bedtime each day and were analyzed for 1-OHP (205 urine samples). Linear mixed effects models were used to evaluate the dermal measurements for the purpose of identifying important determinants of exposure, and to evaluate urinary 1-OHP measurements for the purpose of identifying important determinants of total absorbed dose. Dermal exposures to PAC, pyrene, and BAP were found to vary significantly by roofing task (tear-off > put-down > kettle) and by the presence of an old coal tar pitch roof (pitch > no pitch). For each of the three analytes, the adjusted mean dermal exposures associated with tear-off (812 ng PAC/cm2, 14.9 ng pyrene/cm2, 4.5 ng BAP/cm2) were approximately four times higher than exposures associated with operating the kettle (181 ng PAC/cm2, 4.1 ng pyrene/cm2, 1.1 ng BAP/cm2). Exposure to coal tar pitch was associated with a 6-fold increase in PAC exposure (p = 0.0005), an 8-fold increase in pyrene exposure (p < 0.0001), and a 35-fold increase in BAP exposure (p < 0.0001). Similarly, urinary 1-OHP levels were found to be significantly higher on days when an old pitch roof was removed, accounting for a 3.7-fold difference at pre-shift (p = 0.01), a 5.0-fold difference at post-shift (p = 0.004), and a 7.2-fold difference at bedtime (p = 0.002). The pyrene measurements obtained during the work shift were found to be strongly correlated with urinary 1-OHP measurements obtained at the end of that shift (r = 0.8, p < 0.001) as well as at bedtime (r = 0.7, p < 0.001). Ultimately, the results of a distributed lag model indicated that dermal exposure during the preceding 40 hours had a statistically significant effect on urinary 1-OHP. The presence of coal tar pitch was the primary determinant of dermal exposure, particularly for exposure to BAP. However, the task-based differences that were observed while controlling for pitch suggest that exposure to asphalt also contributes to dermal exposures. We found that dermal exposure was a significant determinant of total absorbed dose, suggesting that control strategies aimed at reducing occupational exposure to PACs should include an effort to minimize dermal exposure.
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Dermal uptake is a direct route of pollutant contamination.
“These studies all indicate that dermal uptake is a direct route of pollutant contamination (Fig. 1).”
From The impact of airborne pollution on skin (2019) · cites this paper as [21]
Cites
Cancer risk from occupational and environmental exposure to polycyclic aromatic hydrocarbons
Boffetta, P., Jourenkova, N., & Gustavsson, P. (1997) · Cancer Causes & Control · doi:10.1023/a:1018465507029 · Cited by 1,039 · see citing works
The Distributed Lag between Air Pollution and Daily Deaths
Schwartz, J. D. (2000) · Epidemiology · doi:10.1097/00001648-200005000-00016 · Cited by 614 · see citing works
Cancer risk in asphalt workers and roofers: Review and meta‐analysis of epidemiologic studies
Partanen, T., & Boffetta, P. (1994) · American Journal of Industrial Medicine · doi:10.1002/ajim.4700260602 · Cited by 194 · see citing works
VanRooij, J. G., Bodelier-Bade, M. M., & Jongeneelen, F. J. (1993) · Occupational and Environmental Medicine · doi:10.1136/oem.50.7.623 · Cited by 190 · see citing works
Inhalation and Dermal Exposure among Asphalt Paving Workers
McClean, M. D., Rinehart, R. D., NGO, L., Eisen, E. A., Kelsey, K. T., & Herrick, R. F. (2004) · The Annals of Occupational Hygiene · doi:10.1093/annhyg/meh062 · Cited by 132 · see citing works
Self-citationBoffetta, P., Burstyn, I., Partanen, T. J., Kromhout, H., Svane, O., Langård, S., Järvholm, B., Frentzel‐Beyme, R., Kauppinen, T. P., Stücker, I., et al. (2002) · American Journal of Industrial Medicine · doi:10.1002/ajim.10182 · Cited by 110 · see citing works
Urinary 1-Hydroxypyrene and Polycyclic Aromatic Hydrocarbon Exposure Among Asphalt Paving Workers
McClean, M. D., Rinehart, R. D., Ngo, L. H., Eisen, E. A., Kelsey, K. T., Wiencke, J. K., & Herrick, R. F. (2004) · The Annals of Occupational Hygiene · doi:10.1093/annhyg/meh044 · Cited by 106 · see citing works
Self-citationMixed Models for Assessing Correlation in the Presence of Replication
Hamlett, A., RYAN, L. M., Serrano-Trespalacios, P., & Wolfinger, R. D. (2003) · Journal of the Air & Waste Management Association · doi:10.1080/10473289.2003.10466174 · Cited by 102 · see citing works
van Rooij, J. G. M., Lieshout, E. M. V., Bodelier-Bade, M. M., & JONGENEELEN, F. J. (1993) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.1322 · Cited by 86 · see citing works
Toraason, M. A., Hayden, C. S., Marlow, D., Rinehart, R. D., Mathias, P. I., Werren, D. M., DeBord, D. G., & Reid, T. M. (2001) · International Archives of Occupational and Environmental Health · doi:10.1007/s004200100238 · Cited by 85 · see citing works
Self-citationTime Series for the Analysis of Pulmonary Health Data
Pope, C. A., & Schwartz, J. D. (1996) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm/154.6_pt_2.s229 · Cited by 82 · see citing works
Machado, M. (1993) · Fundamental and Applied Toxicology · doi:10.1006/faat.1993.1125 · Cited by 76 · see citing works
Proportionate mortality among unionized roofers and waterproofers
Stern, F. B., Ruder, A. M., & Chen, G. (2000) · American Journal of Industrial Medicine · doi:10.1002/(sici)1097-0274(200005)37:5 · Cited by 64 · see citing works
Boogaard, P. J., & van Sittert, N. J. (1995) · The Science of The Total Environment · doi:10.1016/0048-9697(95)04481-f · Cited by 56 · see citing works
Moen, B. E., Nilsson, R., Nordlinder, R. G., Øvrebø, S., Bleie, K., Skorve, A. H., & Hollund, B. E. (1996) · Occupational and Environmental Medicine · doi:10.1136/oem.53.10.692 · Cited by 49 · see citing works
Patterns of 1-hydroxypyrene excretion in volunteers exposed to pyrene by the dermal route
Viau, C. J., & Vyskočil, A. (1995) · The Science of The Total Environment · doi:10.1016/0048-9697(95)04495-m · Cited by 44 · see citing works
Quinlan, R. (1995) · The Annals of Occupational Hygiene · doi:10.1016/0003-4878(95)00004-x · Cited by 26 · see citing works
Biological Versus Ambient Exposure Monitoring of Creosote Facility Workers
Borak, J. B., Sirianni, G., Cohen, H. J., Chemerynski, S., & JONGENEELEN, F. J. (2002) · Journal of Occupational and Environmental Medicine · doi:10.1097/00043764-200204000-00011 · Cited by 23 · see citing works
A carcinogenic bioassay of certain roofing materials
Emmett, E. A., Bingham, E., & Barkley, W. E. (1981) · American Journal of Industrial Medicine · doi:10.1002/ajim.4700020110 · Cited by 17 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Biological impact of environmental polycyclic aromatic hydrocarbons (ePAHs) as endocrine disruptors
Zhang, Y., Dong, S., Wang, H., Tao, S., & Kiyama, R. (2016) · Environmental Pollution · doi:10.1016/j.envpol.2016.03.050 · Cited by 362 · see citing works
The impact of airborne pollution on skin
Araviiskaia, E., Berardesca, E., Bieber, T., Gontijo, G., Sanchez Viera, M., Marrot, L., Chuberre, B., & Dreno, B. (2019) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.15583 · Cited by 214 · see citing works
Lipid Peroxidation and Its Toxicological Implications
Nam, T. G. (2011) · Toxicological Research · doi:10.5487/tr.2011.27.1.001 · Cited by 144 · see citing works
Oxidative contribution of air pollution to extrinsic skin ageing
Fussell, J. C., & Kelly, F. J. (2019) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2019.11.038 · Cited by 85 · see citing works
Exposure to phthalates and correlations with phthalates in dust and air in South China homes
Huang, C. X., Zhang, Y., Liu, L., Wang, F., & Guo, Y. (2021) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2021.146806 · Cited by 59 · see citing works
A Case–Control Study of Lung Cancer Nested in a Cohort of European Asphalt Workers
Olsson, A. C., Kromhout, H., Agostini, M., Hansen, J., Lassen, C. F., Johansen, C., Kjærheim, K., Langård, S., Stücker, I., Ahrens, W., et al. (2010) · Environmental Health Perspectives · doi:10.1289/ehp.0901800 · Cited by 58 · see citing works
Skin disease after occupational dermal exposure to coal tar: a review of the scientific literature
Moustafa, G., Xanthopoulou, E., Riza, E., & Linos, A. (2015) · International Journal of Dermatology · doi:10.1111/ijd.12903 · Cited by 46 · see citing works
Dermal exposure to polycyclic aromatic hydrocarbons in asphalt workers
Fustinoni, S., Campo, L., Cirla, P. E., Martinotti, I., Buratti, M., Longhi, O., Foà, V., & Bertazzi, P. (2010) · Occupational and Environmental Medicine · doi:10.1136/oem.2009.050344 · Cited by 43 · see citing works
Evaluation of a tape-stripping technique for measuring dermal exposure to pyrene and benzo(a)pyrene
Kammer, R., Tinnerberg, H., & Eriksson, K. (2011) · Journal of Environmental Monitoring · doi:10.1039/c1em10245a · Cited by 38 · see citing works
Ratelle, M., Khoury, C., Adlard, B., & Laird, B. D. (2020) · Environmental Research · doi:10.1016/j.envres.2020.109112 · Cited by 37 · see citing works
Urinary 1-hydroxypyrene and Skin Contamination in Firefighters Deployed to the Fort McMurray Fire
Cherry, N., Aklilu, Y.-A., Beach, J. R., Britz‐McKibbin, P., Elbourne, R., Galarneau, J.-M. F., Gill, B., Kinniburgh, D. W., & Zhang, X. (2019) · Annals of Work Exposures and Health · doi:10.1093/annweh/wxz006 · Cited by 35 · see citing works
Siddens, L. K., Bunde, K. L., Harper, T. A., McQuistan, T. J., Löhr, C. V., Bramer, L., Waters, K. M., Tilton, S. C., Krueger, S. K., Williams, D. E., et al. (2015) · Toxicology and Applied Pharmacology · doi:10.1016/j.taap.2015.05.019 · Cited by 34 · see citing works
Assessing cancer hazards of bitumen emissions – a case study for complex petroleum substances
Kriech, A. J., Schreiner, C. A., Osborn, L. V., & Riley, A. J. (2017) · Critical Reviews in Toxicology · doi:10.1080/10408444.2017.1391170 · Cited by 34 · see citing works
Cancer Risk Associated With Exposure to Bitumen and Bitumen Fumes
Mundt, K. A., Dell, L. D., Crawford, L., Sax, S. N., & Boffetta, P. (2017) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000001202 · Cited by 34 · see citing works
Pesch, B., Lotz, A., Kendzia, B., Schindler, B. K., Welge, P., Marczyński, B., Rihs, H., Raulf, M., Angerer, J., & Brüning, T. (2011) · Archives of Toxicology · doi:10.1007/s00204-011-0680-7 · Cited by 32 · see citing works
Cavallari, J. M., Zwack, L. M., Lange, C. R., Herrick, R. F., & McClean, M. D. (2012) · The Annals of Occupational Hygiene · doi:10.1093/annhyg/mer107 · Cited by 32 · see citing works
Self-citationExposure to bitumen fumes and genotoxic effects on Turkish asphalt workers
Karaman, A., & Pirim, İ. (2009) · Clinical Toxicology · doi:10.1080/15563650902817393 · Cited by 32 · see citing works
Campo, L., Fustinoni, S., Consonni, D., Pavanello, S., Kapka‐Skrzypczak, L., Siwińska, E., Mielżyńska, D., & Bertazzi, P. A. (2013) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2013.06.005 · Cited by 31 · see citing works
Serdar, B., Lee, D. J., & Dou, Z. (2012) · BMJ Open · doi:10.1136/bmjopen-2012-001318 · Cited by 30 · see citing works
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Fostinelli, J., Madeo, E., Toraldo, E., Sarnico, M., Luzzana, G., Tomasi, C., & Palma, G. D. (2018) · Toxicology Letters · doi:10.1016/j.toxlet.2018.06.005 · Cited by 25 · see citing works
Kriech, A. J., Osborn, L. V., SNAWDER, J. E., Olsen, L. D., Herrick, R. F., Cavallari, J. M., McClean, M. D., & Blackburn, G. R. (2011) · Polycyclic aromatic compounds · doi:10.1080/10406638.2011.586398 · Cited by 20 · see citing works
Self-citationFayerweather, W. E. (2007) · Journal of Occupational and Environmental Hygiene · doi:10.1080/15459620701335035 · Cited by 19 · see citing works
Rhomberg, L. R., Mayfield, D. B., Goodman, J. E., Butler, E. L., Nascarella, M. A., & Williams, D. R. (2015) · Critical Reviews in Toxicology · doi:10.3109/10408444.2015.1094450 · Cited by 15 · see citing works
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Khan, A., Ahsan, A., Farooq, M. A., Naveed, M., & Li, H. (2020) · Emerging contaminants and associated treatment technologies · doi:10.1007/978-3-030-45923-9_19 · Cited by 15 · see citing works
Persoons, R., Roseau, L., Petit, P., Hograindleur, C., Montlevier, S., Marquès, M., Ottoni, G., & Maı̂tre, A. (2020) · Toxicology Letters · doi:10.1016/j.toxlet.2020.01.025 · Cited by 13 · see citing works
Bunn, T. L., Liu, Y., Lee, K., Robertson, M., & Yu, L. (2009) · American Journal of Industrial Medicine · doi:10.1002/ajim.20773 · Cited by 13 · see citing works
Review and implications of IARC monograph 103 outcomes for the asphalt pavement industry
Kriech, A. J., & Osborn, L. V. (2014) · Road Materials and Pavement Design · doi:10.1080/14680629.2013.867893 · Cited by 13 · see citing works
Exposure Assessment for a Nested Case–Control Study of Lung Cancer among European Asphalt Workers
Agostini, M., Ferro, G., Olsson, A. C., Burstyn, I., de Vocht, F., Hansen, J., Lassen, C. F., Johansen, C., Kjærheim, K., Langård, S., et al. (2010) · The Annals of Occupational Hygiene · doi:10.1093/annhyg/meq059 · Cited by 13 · see citing works
A case–control study of asphalt and tar exposure and lung cancer in minorities
McClean, M. D., Kelsey, K. T., Sison, J. D., Quesenberry, C. P., Wrensch, M., & Wiencke, J. K. (2011) · American Journal of Industrial Medicine · doi:10.1002/ajim.21007 · Cited by 11 · see citing works
Self-citationAgostini, M., Fransman, W., de Vocht, F., de Joode, B. V. W., & Kromhout, H. (2011) · The Annals of Occupational Hygiene · doi:10.1093/annhyg/mer026 · Cited by 12 · see citing works
Ololade, I. A., Alabi, B. A., Oladoja, N. A., Ololade, O. O., & Apata, A. O. (2023) · Environmental Monitoring and Assessment · doi:10.1007/s10661-023-11293-8 · Cited by 9 · see citing works
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Rozewski, E., Taqi, O., Fini, E. H., Lewinski, N. A., & Klein‐Seetharaman, J. (2023) · Frontiers in Systems Biology · doi:10.3389/fsysb.2022.928962 · Cited by 9 · see citing works
Galea, K. S., McGonagle, C., Sleeuwenhoek, A., Todd, D., & Jiménez, A. S. (2014) · The Annals of Occupational Hygiene · doi:10.1093/annhyg/meu014 · Cited by 9 · see citing works
Osborn, L. V., SNAWDER, J. E., Olsen, L. D., Kriech, A. J., Cavallari, J. M., Herrick, R. F., McClean, M. D., & Blackburn, G. R. (2011) · Polycyclic aromatic compounds · doi:10.1080/10406638.2011.585369 · Cited by 8 · see citing works
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Myers, S. R., Zamora, R., Ali, Y., Cunningham, C. R., Wright, T. L., & Weeks, J. W. (2008) · Polycyclic aromatic compounds · doi:10.1080/10406630701779434 · Cited by 8 · see citing works
Occupational asphalt is not associated with head and neck cancer
Fogleman, E., Eliot, M., Michaud, D. S., Nelson, H. H., McClean, M. D., Langevin, S. M., & Kelsey, K. T. (2015) · Occupational Medicine · doi:10.1093/occmed/kqv102 · Cited by 7 · see citing works
Self-citationAnttila, P., Heikkilä, P., Mäkelä, M. J., Schlünssen, V., & Priha, E. (2009) · The Annals of Occupational Hygiene · doi:10.1093/annhyg/men082 · Cited by 7 · see citing works
Liljelind, I., Hagenbjörk-Gustafsson, A., & Nilsson, L. O. (2008) · Journal of Environmental Monitoring · doi:10.1039/b810355k · Cited by 6 · see citing works
Prenatal developmental toxicity studies on fumes from oxidised asphalt (OA) in the rat
Boogaard, P. J., Buschmann, J., Fuhst, R., Blümlein, K., Koch, W., Schaudien, D., Schwarz, K., McAlinden, C., Deferme, L., Vaissière, M., et al. (2021) · Reproductive Toxicology · doi:10.1016/j.reprotox.2021.03.003 · Cited by 5 · see citing works
Satoh, M., Suzuki, T., Sakurai, T., Toyama, S., Kamata, Y., Kondo, S., Suga, Y., Tominaga, M., & Takamori, K. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms221910525 · Cited by 4 · see citing works
Petroleum, Coal Tar, and Related Products
Niemeier, R. W. (2012) · Patty's Toxicology · doi:10.1002/0471435139.tox022.pub2 · Cited by 3 · see citing works
Nies, E., Brüning, T., Steinhausen, M., Welge, P., Werner, S., Pallapies, D., Bartsch, R., Brinkmann, B., Schriever‐Schwemmer, G., Hartwig, A., et al. (2019) · The MAK-Collection for Occupational Health and Safety · doi:10.1002/3527600418.mb805242d0067 · Cited by 3 · see citing works
Kang, H., & Jeong, S. (2011) · Toxicological Research · doi:10.5487/tr.2011.27.1.015 · Cited by 1 · see citing works
Air pollution and the skin diseases
Rauf, A. U., & Pribadi, A. P. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-16080-6.00003-3 · Cited by 1 · see citing works
Prevention of Occupational Skin Cancer
Adam, K., Soyer, P., & Adam, K. W. J. (2012) · Springer eBooks · doi:10.1007/978-3-642-02035-3_115
Health Risks of Organic Materials used in Construction
Auburtin, G. (2013) · doi:10.1002/9781118616734.ch3
Lung Cancer and Occupational Exposure to Combustion Products
Olsson, A. C. (2010) · Figshare
Ikhtiar-ud-, D. (2013) · HEC National Digital Library
Comparison of Urinary PAHs among Firefighters and Asphalt Pavers
Aquino, T. L., Johnson, G. T., Truncale, T., & Harbison, R. D. (2017) · Occupational Diseases and Environmental Medicine · doi:10.4236/odem.2017.52004
Shen, G. (2014) · Springer theses · doi:10.1007/978-3-642-39762-2_2
Ma, C., Taylor, J. S., & Downham, T. F. (2012) · Springer eBooks · doi:10.1007/978-3-642-02035-3_183
Taylor, J. S., Ma, C., & Downham, T. F. (2018) · Springer eBooks · doi:10.1007/978-3-319-40221-5_183-2
Taylor, J. S., Ma, C., & Downham, T. F. (2019) · Springer eBooks · doi:10.1007/978-3-319-68617-2_183
Coal Tar, Crude Oil, and Derived Products
Ryman-Rasmussen, J. P. (2023) · Patty's Toxicology · doi:10.1002/0471125474.tox022.pub3
Taylor, J. S., Ma, C., & Taylor, J. M. (2025) · Springer eBooks · doi:10.1007/978-3-319-40221-5_183-3
- Authors
- McClean, M. D., Rinehart, R. D., Sapkota, A., Cavallari, J. M., & Herrick, R. F.
- Affiliations
- Boston University (US)
- Occupational Safety & Health Administration (US)
- Centre international de recherche sur le cancer (FR)
- Harvard University (US)
- Venue
- Journal of Occupational and Environmental Hygiene
- Publisher
- Informa UK Limited
- Published
- 2007-05-16
- Volume
- 4
- Issue
- sup1
- Pages
- 118-126
- ISSN
- 1545-9624 (ISSN-L)
- 1545-9632
- OpenAlex
- W2046918720
- Cited by
- 59
- References
- 19
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 4 · 2021: 3 · 2020: 3 · 2019: 5 · 2018: 2 · 2017: 3 · 2016: 1 · 2015: 4 · 2014: 3 · 2013: 3 · 2012: 6
- FWCI
- 3.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Occupational and Environmental Hygiene (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (1 R01 CA 74413-01, R01CA074413)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Toxic Organic Pollutants Impact
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Safety in Workplaces
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
- Keywords
- dermal exposure, polycyclic aromatic compounds, urinary 1-hydroxypyrene, benzo[a]pyrene, pyrene, coal tar pitch, occupational exposure, exposure determinants, urinary biomarkers, occupational health risk assessment, personal protective equipment
- MeSH terms
- Air Pollutants, Occupational, Coal Tar, Construction Materials, Facility Design and Construction, Humans, Hydrocarbons, Male, Polycyclic Aromatic Hydrocarbons, Pyrenes, Skin Absorption, Tobacco Smoke Pollution, Occupational Exposure
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