Korean Environmental Health Survey in Children and Adolescents (KorEHS-C): Survey design and pilot study results on selected exposure biomarkers

For the first nationwide representative survey on the environmental health of children and adolescents in Korea, we designed the Korean Environmental Health Survey in Children and Adolescents (KorEHS-C) as a two-phase survey and planned a sampling strategy that would represent the whole population of Korean children and adolescents, based on the school unit for the 6-19 years age group and the household unit for the 5 years or less age group. A pilot study for 351 children and adolescents aged 6 to 19 years in elementary, middle, and high school of two cities was performed to validate several measurement methods and tools, as well as to test their feasibility, and to elaborate the protocols used throughout the survey process. Selected exposure biomarkers, i.e., lead, mercury, cadmium in blood, and bisphenol A, metabolites of diethylhexyl phthalate and di-n-butyl phthalate and cotinine in urine were analyzed. We found that the levels of blood mercury (Median: 1.7 ug/L) and cadmium (Median: 0.30 ug/L) were much higher than those of subjects in Germany and the US, while metabolites of phthalates and bisphenol A showed similar levels and tendencies by age; the highest levels of phthalate metabolites and bisphenol A occurred in the youngest group of children. Specific investigations to elucidate the exposure pathways of major environmental exposure need to be conducted, and the KorEHS-C should cover as many potential environmental hazards as possible.