Book Review

Topics in Environmental Epidemiology

Edited by Kyle Steenland and David A Savitz
New York: Oxford University Press, 1997; 363 pp;
ISBN 0-19-509564-2; $70.95 (CAN)

This book is about environmental epidemiology, which it defines as the epidemiology of the health consequences of exposures that are involuntary and that occur in the general environment, including air, water, diet or soil. It is often difficult to differentiate between environmental epidemiology and occupational epidemiology. As clarified in an example given in the introductory chapter, community exposure to lead from a plant is an issue of environmental epidemiology, whereas worker exposure to lead in the plant is a problem of occupational epidemiology; study design and methods for these two populations would be different.

There are 15 chapters in the book, including the introduction and conclusion, 2 chapters on methodology (design and analysis, and meta-analysis and risk assessment) and 11 chapters on various current issues in environmental epidemiology: diet and food contaminants; chlorinated hydrocarbons and infectious agents in water; particulates, nitrogen dioxide and ozone in air; effects of environmental tobacco smoke; radon; electromagnetic fields; and lead.

As the name of the book suggests, it is on "topics in environmental epidemiology." One would therefore not expect the methodology chapters to be complete and comprehensive. For example, the design and analysis chapter only describes three areas that are uniquely important in environmental epidemiology: ecologic studies, cluster analysis and misclassification of exposure. This chapter, however, presents more problems than solutions, leaving one to wonder about the value of environmental epidemiologic studies. The chapter on meta-analysis and risk assessment, on the other hand, is definitely more positive. It has solid step-by-step examples to guide the readers through the calculations. To understand the mathematics in the two methodology chapters, however, basic knowledge at the introductory epidemiology level is required.

The current issues in environmental epidemiology are well covered in the rest of the book. Comprehensive overviews of each issue, with abundant references, provide readers with good starting points to look into the wealth of literature on these issues. The book also provides a generous supply of summary tables on various previous studies. Examples include food-borne epidemics, chemicals in drinking water, infectious agents in drinking water, infectious agents in recreational water, particulates and mortality, particulates and hospital usage, particulates and respiratory diseases, particulates and lung function, nitrogen dioxide and respiratory diseases, ozone and lung function, passive smoking and respiratory diseases, passive smoking and middle ear diseases, passive smoking and childhood asthma, passive smoking and sudden infant death syndrome, passive smoking and lung cancer, passive smoking and heart disease, radon and lung cancer, and lead and blood pressure.

If one is interested in an overview of environmental epidemiology, the last chapter, "Future Trends in Environmental Epidemiology," written by the editors, is definitely worth reading. It provides an overall synthesis of our identified environmental problems, a summary of what environmental epidemiologists have achieved to date, methodological problems in studies and a look at the future.

Overall rating: 7 out of 10

Strengths:
Good review of up-to-date studies on
various environmental health issues
Nice summary tables of environmental epidemiologic studies
Large amount of references on each topic

Weaknesses:
Could have expanded its methodological section beyond the current two chapters to cover a wider range of methodological issues

Audience:
Epidemiologists who are interested in environmental health problems

Bernard Choi
Associate Professor, University of Toronto
Adjunct Professor, University of Ottawa
and Chief Epidemiologist
Bureau of Cardio-Respiratory Diseases and Diabetes
Laboratory Centre for Disease Control
Health Canada
Tunney's Pasture, AL: 0602D
Ottawa, Ontario  K1A 0L2