Never smoker lung cancer risks from exposure to particulate tobacco smoke

The average particulate environmental tobacco smoke (ETS) exposure of never and current smokers and the average lung cancer mortality rate for current smokers is estimated from empirical data. These estimates are used in a linear downward extrapolation of the lung cancer risk/mg of particulate ETS exposure for current smokers to calculate the average lung cancer risk for never smokers and the number of never smoker lung cancer deaths (LCD) in the U.S. in 1980 from exposure to particulate ETS. The estimated average daily inhaled particulate ETS exposure for never smokers is 0.62 mg/day for men and 0.28 mg/day for women. The average never smoker is estimated to retain 11% of the inhaled exposure, for a daily retained exposure of 0.07 mg for men and 0.03 mg for women. Other estimates are: a daily retained exposure for current smokers of 310 mg for men and 249 mg for women, a smoking-attributable lung cancer risk for current smokers in 1980 of 284 LCD/100,000 men and 121 LCD/100,000 women, and an annual retained-exposure lung cancer risk for never smokers of 0.64 LCD/100,000 men and 0.015 LCD/100,000 women. These risks and exposures estimate 12 lung cancer deaths among never smokers from exposure to particulate ETS: 8 among the 11.96 million male never smokers and 4 among the 28.85 million female never smokers in the U.S. in 1980. Conversely, between 655 and 3,610 never smoker lung cancer deaths are estimated from methods based on the average lung cancer risk observed in epidemiological studies of exposure to ETS. Three possible reasons for the discrepancy between the exposure and risk-based estimates are discussed: the excess risks observed in epidemiological studies are due to bias, the relationship between exposure and risk is supralinear, or sidestream tobacco smoke is substantially more carcinogenic than an equivalent exposure to mainstream smoke.     

Comparison of intake of nicotine from environmental tobacco smoke between nose and mouth breathers

Two experiments were carried out in order to investigate nicotine intake through passive smoking. In the first study, carboxyhemoglobin (COHb) and serum cotinine were found to increase to a similar extent in seven subjects breathing through the nose only and in another seven subjects breathing through the mouth only during exposure to environmental tobacco smoke. Similarly, no significant difference was found in urinary excretion of nicotine and cotinine over a period of 72 hours, although nicotine and cotinine excretion tended to be slightly higher after inhalation through the nose only. In the second study, nicotine was measured in four subjects who held mainstream or sidestream smoke in the mouth without inhaling. Cotinine levels in serum and amounts of nicotine and cotinine excreted in the urine were low compared with those measured in the breathing study. Nicotine from sidestream smoke, however, is more effectively absorbed by the oral mucosa than nicotine from mainstream smoke. The data suggest that nicotine intake from passive smoking largely takes place in the bronchial tree and that nicotine absorption via the nasal or the oral mucosa is only of minor significance.     

Levels of household particulate matter and environmental tobacco smoke exposure in the first year of life for a cohort at risk for asthma in urban Syracuse, NY

The Syracuse, NY, AUDIT (Assessment of Urban Dwellings for Indoor Toxics) study was designed to quantify asthma agent levels in the inner-city homes of a birth cohort whose mothers had a diagnosis of asthma. Risk of exposure to particulate matter (PM), particle number and tobacco smoke was assessed in 103 infants' homes. Repeat measurements were made in 44% of the homes. Infants also were examined on a quarterly basis during the first year of life to monitor their respiratory health and urine cotinine levels. Overall geometric mean (GM) values for PM(2.5) of 21.2 μg/m(3) and for PM(10) of 31.8 μg/m(3) were recorded in homes at visit 1. GM values for PM(2.5) and PM(10) in smoking homes were higher at 26.3 and 37.7 μg/m(3), while values in non-smoking homes were 12.7 and 21.2 μg/m(3) respectively. Fifty-four percent of mothers (55/103) smoked at some point in pregnancy (39% smoked throughout pregnancy). Environmental tobacco smoke (ETS) exposure occurred in 68% of homes during the infants' first year. Significant to this study was the size- and time-resolved monitoring of PM at 140 home visits and the classification of PM count data. PM number counts ranged from continuously low levels (little indoor activity) to continuously high counts (constant indoor activity), and recorded apparent instances of prolonged repeated cigarette smoking. Wheezing in the first year of life was recorded for 38% of the infants (39/103). Adjusted logistic regression modeling demonstrated that elevated levels of indoor PM(2.5) (≥ 15 μg/m(3)) were a significant risk factor for infant wheezing after controlling for infant gender, mothers' age and education level, season of home visit and presence of carpeting (OR 4.21; 95% CI 1.36-13.03; p=0.013). An elevated level of the nicotine metabolite cotinine in infant urine also was associated with infant wheezing after adjusting for infant gender, mothers' age and education level (OR 5.10; 95% CI 0.96-27.24; p=0.057). ETS exposure was pervasive in the AUDIT cohort and a risk for developing infants in this urban population.     

Assessment of environmental tobacco smoke and respirable suspended particle exposures for nonsmokers in Hong Kong using personal monitoring

One hundred and ninety-four randomly selected nonsmoking subjects collected air samples in their breathing zone by wearing personal monitors for 24 h. The study was centered in Hong Kong, and comprised housewives in one group, primarily for assessing exposures in the home, and office workers in a second group to assess the contribution of the workplace to overall exposure. Samples collected were analysed for respirable suspended particles (RSP), nicotine, 3-ethenylpyridine, and environmental tobacco smoke (ETS) particles using ultraviolet absorbance (UVPM), fluorescence (FPM), and solanesol measurements (SolPM). Saliva cotinine analyses were also undertaken to confirm the nonsmoking status of the subjects and to investigate their correlation with ETS exposure measurements. Approximately 6% of the subjects in Hong Kong misclassified their nonsmoking status. Median time-weighted average (TWA) RSP concentrations varied from 43 to 54 μg m⁻³ with no significant differences detected between any of the groups investigated. Office workers who lived and worked with smokers were exposed to 2.6 μg m⁻³ ETS particles (SolPM) and 0.44 μg m⁻³ nicotine, based on median TWA concentrations. Median concentrations of ETS particles and nicotine were below the limits of quantification for housewives living with smokers and were not significantly different from those for housewives living with nonsmokers. It would therefore be unreliable in Hong Kong to use a smoking spouse as a marker for assessing health risks related to ETS exposure. The office workers in this study were significantly more exposed to ETS than housewives from either smoking or nonsmoking homes, and the workplace was estimated to contribute over 33% of the annual exposure to ETS particles and nicotine. Exposure estimates suggest that the most highly exposed office workers in this study receive between 11 and 50 cigarette equivalents per year, based upon upper decile levels for ETS particles and nicotine, respectively.     

Seasonal assessment of environmental tobacco smoke and respirable suspended particle exposures for nonsmokers in Bremen using personal monitoring

The study was designed to determine seasonal differences in personal exposures to respirable suspended particles (RSP) and environmental tobacco smoke (ETS) for nonsmokers in Bremen, Germany. The subjects were office workers, either living and working in smoking locations or living and working in nonsmoking locations. One hundred and twenty four randomly selected nonsmoking subjects collected air samples close to their breathing zone by wearing personal monitors for 24 h or, in some cases, for 7-day periods during the winter of 1999. The investigation was repeated in the summer with 126 subjects, comprised of as many of the studied winter population (89 subjects) as possible. Saliva cotinine analyses were undertaken to verify the nonsmoking status of the subjects. Subjects wore one personal monitor while at work and one while away from the workplace on weekdays, and a third monitor at the weekend. Collected air samples were analysed for RSP, nicotine, 3-ethenylpyridine (3-EP) and ETS particles. The latter were estimated using ultraviolet absorbance (UVPM), fluorescence (FPM) and solanesol (SolPM) measurements. ETS exposure was consistently higher in the winter than in the summer, this pattern being particularly evident for subjects both living and working with smokers. The highest median 24-h time weighted average (TWA) concentrations of ETS particles (SolPM, 25 microg m(-3)) and nicotine (1.3 microg m(-3)) were recorded for subjects performing weekday monitoring during the winter. These were significantly higher than equivalent levels of ETS particles (SolPM, 2.4 microg m(-3)) and nicotine (0.26 microg m(-3)) determined during the summer. There were no appreciable differences between winter and summer percent workplace contributions to median TWA ETS particle and nicotine weekday concentrations, the workplace in Bremen, in general, contributing between 35% and 61% of reported median concentrations. Workers, on average, spent one-third of their time at work during a weekday, indicating that concentrations were either comparable or higher in the workplace than in the home and other locations outside the workplace. Median 24-h weekend ETS particle and nicotine concentrations for smoking locations were not significantly different from equivalent weekday levels during the winter, but were significantly lower during the summer. Based upon median 24-h TWA SolPM and nicotine concentrations for the winter, extrapolated to 1 year's ETS exposure, those subjects both living and working in smoking locations (the most highly exposed group) would potentially inhale 13 cigarette equivalents/year (CEs/y). However, based on a similar extrapolation of summer measurements, the same group of subjects would potentially inhale between 1.3 and 1.9 CEs/y. The most highly exposed subjects in this study, based upon 90th percentile concentrations for those both living and working in smoking locations during the winter, would potentially inhale up to 67 CEs/y in the winter and up to 22 CEs/y in the summer. This clearly demonstrates that seasonal effects should be taken into account in the design and interpretation of ETS exposure studies. Air sampling over a 7-day period was shown to be technically feasible, and subsequent RSP, ETS particle and nicotine levels determined by 7-day monitoring were not found to be significantly different from equivalent levels determined by 24-h monitoring. However, the longer sampling period resulted in the collection of an increased quantity of analytes, which improved the limits of quantitation (LOQ) and allowed a more accurate determination of low level ETS exposure. This was reflected by a reduced percentage of data falling below the LOQ for 7-day monitoring compared with 24-h monitoring. The use of a liquid chromatographic method with tandem mass spectrometric detection for saliva cotinine measurement afforded a greatly improved LOQ and greater accuracy at low concentrations compared with the radioimmunoassay (RIA) method used in previous studies by these authors. In this study, 17 subjects out of 180 tested (9.4%) were found to have saliva cotinine levels exceeding the selected threshold of 25 ng ml(-1) used to discriminate between smokers and nonsmokers.     

Monitoring of firefighters exposure to smoke during fire experiments in Portugal

Forest fires represent a serious threat to public security in Europe due to the large burned area. Moreover, smoke pollution due to forest fire events is an important public health issue for the communities directly affected, and particularly for the personnel involved in firefighting operations. Aiming to contribute to the scientific knowledge concerning firefighters exposure to forest fires smoke, data of individual exposure to carbon monoxide, nitrogen dioxide, volatile organic compounds, and particulate matter were obtained during experimental field fires for a group of 10 firefighters equipped with portable “in continuum” measuring devices. Measured values are very high exceeding the Occupational Exposure Standard limits, in particular for peak limit thresholds. These are the first measurements and analysis of firefighter's individual exposure to toxic gases and particles in fire smoke experiments in Europe. However, they already indicate that urgent measures to avoid these levels of exposure are needed.     

Assessment of air quality in Turin by personal monitoring of nonsmokers for respirable suspended particles and environmental tobacco smoke

Exposure to respirable suspended particles (RSP), environmental tobacco smoke (ETS) particles, nicotine, and 3-ethenylpyridine (3-EP) was assessed in Turin for 188 subjects during February and March 1995. Personal monitors were worn over a 24-h period, each subject providing a saliva sample for cotinine analysis both prior to and following the monitoring period. Comprehensive lifestyle questionnaires were also completed before and after the 24-h monitoring period. The study comprised housewives in one group, primarily for assessing exposures in the home, and office workers in a second group to assess exposures in the workplace. A single personal monitor was worn by each participating housewife, while employed subjects wore one monitor at work and a separate monitor at home and elsewhere. Based on median 24-h time-weighted average exposures, the most highly exposed subjects to RSP, ETS particles, nicotine, and 3-EP were office workers living with smokers and employed in locations where smoking was allowed. Annualised exposures for nonsmokers living and working in smoking environments indicate that the home contribution to RSP is between 3 and 4 times that obtained from the workplace. Similarly nicotine and ETS particle contributions from the home are, respectively, 4 and 7 times more than those obtained from the workplace. Subjects living and working with smokers had the highest median saliva cotinine levels of 1.7 ng mL⁻¹. Using a cut off level of 25 ng mL⁻¹, up to 6.5% of subjects were found to have misreported themselves as nonsmokers.     

Environmental tobacco smoke: The use of mathematical models to predict health effects

The mathematical model used by Repace and Lowrey to arrive at the quantitative estimate of five lung cancer deaths per year 100, 000 persons exposed to ETS is questioned based on data from published international studies. A challenge of the Repace and Lowrey calculations is necessary to allay the concern which has arisen from the uncritical acceptance of the preliminary accusative estimates.     

Respiratory effects of household exposures to tobacco smoke and gas cooking on nonsmokers

The records of 708 nonsmoking white adult residents of Washington County, MD, who had participated in two of respiratory symptoms were analyzed to evaluate the effects of exposure at home to two potential sources of indoor air pollution: cigarette smoking by other household members, and use of gas as a cooking fuel. After adjustment for the effects of age, sex, socioeconomic level, occupational exposure to dust, and years of residence in household, the presence of one or more smokers in the household was only suggestively associated with a higher frequency of chronic phlegm and impaired ventilatory function defined as FEV₁ < 80% predicted. The use for cooking was associated with a significantly increased frequency of chronic cough and a significantly greater percentage with impaired ventilatory function as measured both by FEV₁ < 80% predicted and by FEV₁/FVC < 70%.     

Urinary methyl tert-butyl ether and benzene as biomarkers of exposure to urban traffic

Methyl tert-butyl ether (MTBE) and benzene are added to gasoline to improve the combustion process and are found in the urban environment as a consequence of vehicular traffic. Herein we evaluate urinary MTBE (MTBE-U) and benzene (BEN-U) as biomarkers of exposure to urban traffic. Milan urban policemen (130 total) were investigated in May, July, October, and December for a total of 171 work shifts. Personal exposure to airborne benzene and carbon monoxide (CO), and atmospheric data, were measured during the work shift, while personal characteristics were collected by a questionnaire. A time/activity diary was completed by each subject during the work shift. Spot urine samples were obtained for the determination of MTBE-U and BEN-U. Median personal exposure to CO and airborne benzene were 3.3 mg/m(3) and 9.6 μg/m(3), respectively; median urinary levels in end-of-shift (ES) samples were 147 ng/L (MTBE-U) and 207 ng/L (BEN-U). The time spent on traffic duty at crossing was about 40% of work time. Multiple linear regression models, taking into account within-subject correlations, were applied to investigate the role of urban pollution, atmospheric conditions, job variables and personal characteristics on the level of biomarkers. MTBE-U was influenced by the month of sampling and positively correlated to the time spent in traffic guarding, CO exposure and atmospheric pressure, while negatively correlated to wind speed (R(2) for total model 0.63, P<0.001). BEN-U was influenced by the month and smoking habit, and positively correlated to urinary creatinine; moreover, an interaction between CO and smoking was found (R(2)=0.62, P<0.001). These results suggest that MTBE-U is a reliable marker for assessing urban traffic exposure, while BEN-U is determined mainly by personal characteristics.     

Diet monitoring for assessment of human exposure to environmental pollutants

Daily intake of lead, cadmium, aluminium, radiocaesium, DDT and metabolites, and lindane in the whole-day food rations collected in hospital canteens in Kraków, ?ód?, Olsztyn and Poznań in winters of 1993-1994, 1995 and 1996 were determined. The diets contained almost 40 microg of cadmium, corresponding to 70% of PTWI, and compared to the levels recognised as safe (ADI or PTWI) small amounts of the other contaminants. The highest content of Pb, Cd, Al and lindane was determined in the diets collected in Kraków, that of radiocaesium in ?ód?, and DDT level was the highest in Poznań. The whole-day food rations from Olsztyn, situated in a region called "green lungs of Poland", were not statistically less contaminated than the diets from the other towns. The Pb and radiocaesium levels decreased significantly with time.     

Contribution of (222)Rn-bearing water to the occupational exposure in thermal baths

The present study investigates the short- and long-term effects of radon ((222)Rn) released from water on the progeny exposure in a thermal spa. For the purposes of this work, the Polichnitos spa was used as a case study. The bathroom was supplied with water containing 110-210 kBq m(-3) of (222)Rn. The (222)Rn concentration in air and the short-lived (222)Rn progenies in attached and unattached form were monitored into the bathroom and the surrounding premises. The equilibrium factor (F-factor) and the unattached fraction were estimated. The results of this study show that water flow during bath filling is by far the dominant mechanism by which (222)Rn is released in the air of the bathroom. The progeny exposure was correlated linearly with the (222)Rn concentration in the entering water. The annual effective dose received by a worker was found to be below the lower limit value of 3 mSv recommended by ICRP 65. The dose limit was exceeded only for water containing more than 300 kBq m(-3).     

Exposure to bushfire smoke during prescribed burns and wildfires: firefighters' exposure risks and options

Firefighters are exposed to known health-damaging air pollutants present in bushfire smoke and poorly managed exposure can result in serious health issues. A better understanding of exposure levels and the major factors influencing exposures is crucial for the development of mitigation strategies to minimise exposure risks and adverse health impacts. This study monitored air toxics within the breathing zone of firefighters at prescribed burns and at wildfires in Australia. The results showed that exposure levels were highly variable, with higher exposures (sometimes exceeding occupational exposure standards) associated with particular work tasks (such as patrol and suppression) and with certain burn conditions. The majority of firefighter's exposures were at low and moderate levels (~60%), however considerable attention should be given to the high (~30%) and very high (6%) exposure risk situations for which acute and chronic health risks are very likely and for which control strategies should be developed and implemented to minimise health risks.     

Human exposure to environmental pollutants after a tire landfill fire in Spain: Health risks

In May 2016, a fire occurred in one of the largest landfills in Europe (Seseña, Toledo, Spain), where 70,000–90,000 tons of tires had been illegally accumulated for > 15 years. Because of the proximity of population nuclei and the duration of the episode (> 20 days), we conducted a preliminary human health risk assessment study just after the tire fire. Samples of air and soil were collected in 3 areas surrounding the landfill (El Quiñón, at only 500 m, and Seseña Nuevo and Seseña Viejo, both at 4 km), as well as in background sites. In addition, samples of crops (barley, wheat, cabbage and lettuce) were also obtained from local farmers. The concentrations of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs) and a number of trace elements (As, Cd, Co, Cr, Cu, Hg, Mn, Ni, Pb, Sb, Sn, Tl, and V) were analyzed in all the samples. The concentrations of all the target pollutants, excepting PAHs, were relatively similar at the different sampling zones, irrespective of the distance to the landfill. In turn, a significant increase of PAHs was noted near the tire landfill, with air levels up to 6-times higher than those found at 4 km (134 vs. 19.5–22.7 ng/m³). Similarly, PAH concentrations in lettuce were relatively higher than those typically found in monitoring programs of food safety. Because of the increase of airborne PAHs, cancer risks due to exposure to environmental pollutants for the population living at El Quiñón, near the landfill, were between 3- and 5-times higher than those estimated for the inhabitants of Seseña. After this preliminary study, further investigations, focused only on PAHs, but more extensive in terms of number of samples, should be conducted to assure that PAHs have been progressively degraded through time.     

The ecological relevance of current approaches for environmental protection from exposure to ionising radiation

This paper discusses the current approaches to environmental protection from ionising radiation from an ecological perspective, highlighting the need to understand fully what we are trying to protect. Ecologically relevant endpoints for environmental protection are discussed along with the need to integrate protection from ionising radiation with the approaches adopted for non-radioactive contaminants. A possible integrated assessment approach is outlined.     

Tobacco smoke increases the risk of otitis media among Greenlandic Inuit children while exposure to organochlorines remain insignificant

BackgroundPrenatal exposure to environmental levels of organochlorines (OCs) has been demonstrated to have immunotoxic effects in humans. We investigated the relationship between prenatal exposure to OCs and the occurrence of otitis media (OM) among Inuit children in Greenland.MethodsWe estimated the concentration of 14 PCB congeners and 11 pesticides in maternal and cord blood samples and in breast milk in a population-based cohort of 400 mother–child pairs. At follow-up, we examined the children's ears and used their medical records to assess the OM occurrence and severity. Multivariate regression analyses were used with adjustments for passive smoking, crowding, dietary habits, parent's educational level, breast feeding and the use of child-care.ResultsThe children were 4–10 years of age at follow-up and 223 (85%) participated. We found no association between prenatal OC exposure and the development of OM. Factors associated with the child's hazard of OM during the first 4 years of life were: mother's history of OM (HR 1.70, 95% CI 1.11–2.59, p = 0.01); mother's smoking habits: current (HR 2.47, 95% CI 1.45–4.21, p < 0.01) and previous (HR 2.00, 95% CI 1.19–3.36, p < 0.01); number of smokers in the home (HR 1.17, 95% CI 1.05–1.31, p < 0.01). After adjustment mothers' smoking habits remained significant.ConclusionWe found no relationship between high levels of prenatal exposure of OCs and occurrence of OM. Passive smoking was found as the strongest environmental risk factor for the development of OM.Interventions to reduce passive smoke in children's environment are needed.     

Sidestream tobacco smoke constituents in indoor air modelled in an experimental chamber— Polycyclic aromatic hydrocarbons

Exposure to sidestream tobacco smoke is concerned with constituents in suspension in the indoor atmosphere. The natural dissipation of sidestream tobacco smoke has been investigated in a static atmosphere in a 10 m³ experimental chamber, and the rate of dissipation is expressed as T_0.5, the half-life of residence in the air. Respective T_0.5 of smoke components are calculated from the various sample data points, assuming a kinetic equation of the first-order process. Sidestream smoke has been generated by a smoking machine according to the Coresta standard protocol and then left to age over an 8-hour period, with subsequent sampling at defined time intervals. The experiments have been repeated over five days, and eight data point samples are obtained for each experiment. Besides nicotine, CO, and smoke particulate matter, interest has been focused on polycyclic aromatic hydrocarbons (PAH). The initial concentrations, C₀ for smoke particulate matter and nicotine (gas and particulate phases) are found to be 13.8 mg and 92 μg per cigarette per cubic meter, with T_0.5 being 2.6 and 2.1 hours, respectively. Low molecular-weight PAH have T_0.5 up to 20 hours, explainable only by their high concentrations in the gas phase, while the 3- to 7-ring PAH have T_0.5 of about 2 hours. The contribution of CO to ambient concentration is 91 mg per cigarette per cubic meter. The data can be useful in mathematical modellization studies regarding ventilation or exposure to sidestream smoke.     

A novel model to characterize postnatal exposure to lipophilic environmental toxicants and application in the study of hexachlorobenzene and infant growth

BackgroundInfants are exposed to persistent environmental contaminants through breast milk, yet studies assessing the health effects of postnatal exposure are lacking. Existing postnatal exposure assessment is either too simple (lactation exposure model, LEM) or requires complex physiologically-based pharmacokinetic (PBPK) models.ObjectivesWe present equations for postnatal exposure calculations. We applied these equations to study the effect of hexachlorobenzene (HCB) on infant growth in the two first years of life.MethodsHCB was measured in breast milk samples in 449 mother-child pairs participating in the Norwegian birth cohort study HUMIS. We used these concentrations, mother's weight, height and age, together with child's weight at 8 age points, and proportion of milk consumed each month, to calculate HCB concentrations in the infant over age. We then estimated the association between HCB and infant growth using a linear mixed model.ResultsChildren exposed to HCB via mother's milk reached concentrations 1–5 times higher than the mother. HCB was associated with lower weight gain in the first 2 years (− 33 g per unit HCB and month, 95% CI: − 38, − 27 at 6 months). Associations were stronger during the first 3 months (− 57 g per unit HCB and month, 95% CI: − 67, − 49 at 1 month), indicating a critical window of effect. Our equations gave more precise estimates than the LEM.ConclusionOur equations for postnatal exposure of lipophilic environmental toxicants give better results than the LEM and are easier to implement than the complex PBPK models. HCB exposure, especially during the first three months of life, has a negative effect on infant growth up to 2 years.     

Measuring combined exposure to environmental pressures in urban areas: an air quality and noise pollution assessment approach

This study presents a methodological scheme developed to provide a combined air and noise pollution exposure assessment based on measurements from personal portable monitors. Provided that air and noise pollution are considered in a co-exposure approach, they represent a significant environmental hazard to public health. The methodology is demonstrated for the city of Thessaloniki, Greece. The results of an extensive field campaign are presented and the variations in personal exposure between modes of transport, routes, streets and transport microenvironments are evaluated. Air pollution and noise measurements were performed simultaneously along several commuting routes, during the morning and evening rush hours. Combined exposure to environmental pollutants is highlighted based on the Combined Exposure Factor (CEF) and Combined Dose and Exposure Factor (CDEF). The CDEF takes into account the potential relative uptake of each pollutant by considering the physical activities of each citizen. Rather than viewing environmental pollutants separately for planning and environmental sustainability considerations, the possibility of an easy-to-comprehend co-exposure approach based on these two indices is demonstrated. Furthermore, they provide for the first time a combined exposure assessment to these environmental pollutants for Thessaloniki and in this sense they could be of importance for local public authorities and decision makers. A considerable environmental burden for the citizens of Thessaloniki, especially for VOCs and noise pollution levels is observed. The material herein points out the importance of measuring public health stressors and the necessity of considering urban environmental pollution in a holistic way.