Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation: meeting report

Identification of risks of endocrine-disrupting chemicals: overview of existing practices and steps ahead Report of a meeting in Bonn, Germany 7-8 July 2014 Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation Meeting report Abstract Since 2017, the WHO Regional Office for Europe, supported by international experts, has been developing a screening tool for assessment of risks to human health from combined exposure to multiple chemical pollutants in indoor air in public settings for children. The first expert consultation, held on 3–4 December 2018 in Bonn, Germany, agreed on lists of priority chemicals and adverse effect endpoints to be considered in the tool. The second consultation took place in Bonn, Germany, on 23–24 September 2019 and was called to finalize the methodological approach and to agree on collection of the relevant toxicological information. Other topics included the selection of sampling sites; methods for sampling and analysis of chemicals of concern in indoor air in public settings for children; and, an educational course for health-care and public-health professionals on indoor air pollution and children’s health. Exposure assessment was discussed alongside the sampling strategy. The main outcomes of the consultation were approaches to the assessment of exposure and handling of toxicological information for the calculation of risks. KEYWORDS: RISK ASSESSMENT HAZARDOUS SUBSTANCES AIR POLLUTION, INDOOR ENVIRONMENTAL EXPOSURE Document number: WHO/EURO:2020-4205-43964-61964 © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). 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Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation iii Contents Acknowledgements ................................................................................................................... iv Abbreviations ............................................................................................................................. v Introduction ................................................................................................................................ 1 Assessment of children’s exposure to chemicals in indoor air in public settings (schools, kindergartens, day-care centres) ................................................................................................. 2 Calculation of exposure ....................................................................................................................... 2 Selection of sampling sites .................................................................................................................. 3 Methods for sampling and analysis of chemicals in indoor air ........................................................... 3 Management of toxicological information for assessment of risks of combined exposure to multiple chemicals in indoor air ................................................................................................. 4 A methodological approach to the tool’s development .............................................................. 5 Building capacity among public-health professionals: an educational course on chemical pollution of indoor air and its risk for children’s health............................................................. 6 Working group session ............................................................................................................... 7 Group 1. Management of toxicological information, grouping of chemicals and methodological approach .............................................................................................................................................. 7 Group 2. Methods for sampling and analysis of chemicals ................................................................. 8 Group 3. Selection of sampling sites ................................................................................................... 8 Group 4. Educational course on chemical pollution of indoor air and its risk for children’s health ... 8 Conclusions and next steps ........................................................................................................ 9 References ................................................................................................................................ 11 Annex 1. Programme ................................................................................................................ 13 Annex 2. List of participants .................................................................................................... 15 Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation iv Acknowledgements The WHO Regional Office for Europe gratefully acknowledges the financial support of the German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety. Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation v Abbreviations ANSES French Agency for Food, Environmental and Occupational Health and Safety BMD benchmark dose C&L Inventory Classification and Labelling Inventory ECHA European Chemicals Agency EN European normative IARC International Agency for Research on Cancer ISO International Organization for Standardization LOAEL lowest-observed-adverse-effect level NOAEL no-observed-adverse-effect level PAH polycyclic aromatic hydrocarbon PM particulate matter POD point of departure PODI point of departure index REACH Registration, Evaluation, Authorization and Restriction of Chemicals SINPHONIE Schools Indoor Pollution and Health Observatory Network in Europe STOT Specific Target Organ Toxicity SVOC semi-volatile organic compound VOC volatile organic compound WHO ECEH WHO European Centre for Environment and Health Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 1 Introduction In line with priorities of the Parma and Ostrava declarations on environment and health (1,2), the WHO Regional Office for Europe is addressing combined exposures to pollutants in indoor air to improve risk assessment and minimize the effects of hazardous chemicals on children in the places where they live, learn and play. To facilitate assessment of risks from combined exposure, the WHO European Centre for Environment and Health (ECEH) is developing a screening tool (further – a tool) to support assessment of the risks to children from indoor air pollutants in public settings such as schools, kindergartens and day-care centres, focusing on selected chemicals and health endpoints. This is consistent with the relatively greater exposure of children than adults, based on physiological considerations and behavioural factors, and increasing evidence of health effects in children associated with indoor and outdoor air pollution (3). The first expert consultation took place on 3–4 December 2018 in Bonn, Germany (4). There, experts discussed the general approach to the development of the tool, which is envisaged to comprise a database of supporting toxicological information for selected chemicals and a spreadsheet to calculate risk of combined exposures based on specified decision rules. The WHO framework for the assessment of risk of combined exposure to multiple chemicals was considered an appropriate construct for the tool. Experts agreed on the lists of priority chemicals and adverse effect endpoints for consideration in the further development of the tool, and reached consensus on an approach to the collection of toxicological information. Discussions of sampling site selection, sampling and analysis of the most common chemicals in indoor air, and an educational course for public-health and health-care professionals resulted in recommendations on finalizing the relevant documents. The second expert consultation was organized in Bonn, Germany, on 23–24 September 2019 to finalize the methodological approach and agree on the information needed to make progress on the tool’s development. The main objectives were to:  agree upon the approach to assessing children’s exposure to chemicals in the tool;  review recommendations on the selection of sampling sites, sampling and analysis of chemicals in indoor air, and the document describing a methodological approach to the tool’s development;  examine the educational course for public-health and health-care professionals on chemical pollution of indoor air and its risk for children’s health; and  discuss next steps towards completing and piloting the tool. The consultation was attended by 17 experts from 14 countries (see Annex 2 for the list of participants). Ms Sani Dimitroulopoulou, Principal Environmental Public Health Scientist at Public Health England, United Kingdom, chaired the meeting. Ms Bilge Danyeli was the rapporteur. Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 2 Ms Francesca Racioppi, Head of WHO ECEH, opened the consultation. She highlighted that WHO has prioritized environmental health within school settings. To this end, it is of great importance to understand the risks to which children are exposed and to raise awareness of the links between the environment, health and educational attainment. Ms Dorota Jarosinska, Programme Manager for Living and Working Environments at WHO ECEH, emphasized the importance of this meeting not only for engaging in methodological discussions but also for ensuring that the tool and associated documentation are clear and communicative to the target audience. The documents prepared for the second consultations were built on the outcomes of the first expert consultation (4). The draft document describing the methodological approach to the tool’s development, an overview of methods for sampling and analysis of the most common chemicals in indoor air, recommendations on the selection of sampling sites and an educational course for public-health and health-care professionals were prepared, following recommendations from the first consultation. To guide the discussion, invited experts delivered presentations on the agenda topics. These were followed by a detailed discussion of questions raised in the presentations at the plenary and in working groups (see Annex 1 for the programme). The working groups addressed the four main areas of discussion:  Group 1. Management of toxicological information, grouping of chemicals and description of the methodological approach  Group 2. Methods for sampling and analysis of chemicals  Group 3. Selection of sampling sites  Group 4: Educational course on chemical pollution of indoor air and its risk for children’s health. Assessment of children’s exposure to chemicals in indoor air in public settings (schools, kindergartens, day-care centres) Calculation of exposure Three WHO documents guide the calculations and assessment of exposure to chemicals in general and in terms of specific population groups:  WHO human health risk assessment toolkit: chemical hazards (2010) (5)  Environmental Health Criteria 237: Principles for evaluation of health risks in children associated with exposure to chemicals (2006) (6)  Environmental Health Criteria 214: Human exposure assessment (2000) (7). The basic information needed to assess exposure includes the relevant routes and pathways of exposure, the environmental media expected to contain the chemical, and the duration of exposure. Adjustments related to combined or long-term low-dose exposure may be needed. Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 3 Long-term average exposures are considered most relevant for the characterization of risk for developing the tool. Assessment of cancer risk is a special case of long-term exposure for which lifetime average exposure is of interest. In general, the exposure rate is calculated as the concentration of a chemical in an exposure medium multiplied by the rate at which a person inhales or ingests that medium, divided by their representative body weight. Exposure through inhalation is the concentration of a chemical inhaled during a specified exposure period, calculated based on the inhalation rate of a specific population group. The plenary discussion focused on consideration of the duration of exposure and possible simplification of exposure calculations for the purpose of combined exposure assessment within the tool. It yielded the following main conclusions.  The first version of the tool will accept the concept of exposure calculation over 24 h/5 days (one school week) given a potentially equal exposure level in other settings, including households.  The calculation formula for the inhalation pathway of exposure will be adopted in the development of the tool. Selection of sampling sites A questionnaire was developed for the assessment of potential sampling sites to identify places where concentrations of hazardous chemicals are likely to be higher. It was designed for use in schools, kindergartens and day-care centres, and can be completed based on a visual inspection. A set of questions guides the evaluation of factors/sources of pollutants, for which responses are yes or no (scored as 0 or 1). Discussion of the questionnaire continued in the working group session. Methods for sampling and analysis of chemicals in indoor air In preparation for the second expert consultation, the document describing methods for sampling (including both passive and active methods) and analysis of chemicals and the associated database were revised according to the three lists of chemicals agreed during the first consultation (4). The sampling and analysis document outlines practical, commonly used methods that provide adequate quantitative characterization with reasonable detection limit. General considerations for selecting a sampling strategy draw from information in the WHO Regional Office for Europe’s meeting report Methods for monitoring indoor air quality in schools (8), ISO 16000-1. Indoor air – Part 1: General aspects of sampling strategy (9) and the Schools Indoor Pollution and Health Observatory Network in Europe (SINPHONIE) project (10). Discussion in the plenary focused on the prioritization of methods for obtaining reliable results and sampling time. Discussion of specific topics related to the analysis of volatile organic compounds (VOCs) and semi-volatile organic compounds (SVOCs) continued in the working group session. Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 4 The plenary discussion yielded the following conclusions.  The priority of methods in decreasing order are: (i) International Organization for Standardization (ISO) and European normative (EN) methods; (ii) national methods authorized according to national rules; and (iii) methods published in peer-reviewed journals.  Continuous sampling from Monday to Friday (one school week) is recommended, with relevant adjustment of the sampling strategy.  Accredited laboratories and non-accredited laboratories that have successfully passed the intercomparison exercise should be invited to take part in the analysis of samples; their credibility should be confirmed before a survey starts.  Alternative methods can be considered in the absence of certain analytical equipment. For example, the method described in EN 14662-5 for sampling VOCs with passive samplers and solvent desorption can be considered if a laboratory does not have thermal desorption equipment recommended by ISO 16017-2. Management of toxicological information for assessment of risks of combined exposure to multiple chemicals in indoor air After the first consultation, the collection of toxicological information continued with a focus on the updated lists of chemicals and adverse effect endpoints. Information for five adverse effect endpoints (respiratory, cardiovascular, neurological, carcinogenic effects and irritation) was collected for the 19 chemicals included in the list of priority substances, and for 23 highly prioritized compounds from the list of 36 substances that should be included in the tool when possible (the “wish list”) (4). For each substance, reference values for inhalation for critical health endpoints and points of departure (PODs) for the five adverse effect endpoints were searched in relevant databases (WHO indoor air quality guidelines (11), the International Toxicity Estimates for Risk Assessments database (12) and the EU-LCI database (13)) and scientific publications). Chemicals were considered to invoke the adverse effect outcome if a relevant lowest-observed- adverse-effect level (LOAEL) or benchmark dose (BMD) for the effect was identified. If a BMD, LOAEL, no-observed-adverse-effect level (NOAEL), tumorigenic concentration or unit risk was/were identified for inhalation, the substance was included in the database. If only (a) NOAEL value(s) for the highest test concentration was/were identified (no LOAEL or BMD), the substance was not assigned to an adverse effect endpoint group. Identification of chemicals causing respiratory irritation was based on the EU-LCI and Specific Target Organ Toxicity (STOT) SE 3 databases. Thus, if a substance has been categorized as STOT SE 3, it was included. Substances for which any LOAEL for respiratory irritation has been identified were also included. Regarding the classification of eye irritation, Category 1 of the European Classification and Labelling (C&L) Inventory (14) refers to “causes serious eye damage”, Category 2A refers to Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 5 “irritants” and Category 2B refers to “mild irritants”. If a substance has been categorized as Category 1, 2A or 2B in the C&L Inventory, the substance was considered to cause eye irritation assessment. If not categorized as Category 1, 2A or 2B, and if no POD for sensory irritation was available in the database, the substance was not considered to be an irritant. Classifications for skin corrosion/irritation and respiratory/skin sensitization were considered, but were not taken into account. Chemicals were considered carcinogenic if tumorigenic concentrations and unit risk values have been identified, and if the substances have been classified in Group 1 by the International Agency for Research on Cancer (IARC) in consistence with identification of the relevant endpoints based on consideration of observational (that is, largely epidemiological) studies in humans. However, additional discussion is needed to finalize the methodological approach in relation to carcinogenicity risks from chemicals in indoor air. If PODs for non-cancer effects are based on animal data, a point of departure index (PODI) > 100 requires refinement of the assessment or consideration of remedial measures to reduce exposure. If based on human data, a PODI > 10 for any of the effects requires additional refinement or remedial measures. Several questions were flagged for further discussion in the working group. These concerned the approach for the assessment of carcinogenic effects of polycyclic aromatic hydrocarbons (PAHs), the inclusion of particulate matter (PM) in the tool, the approach for the assessment of cancer risk; the approach for the selection of reference values and PODs for the calculation of risk through the tiers, and adequacy of the margin of exposure. Discussion of these and other topics continued in the working group session. A methodological approach to the tool’s development A draft of the document describing a methodological approach to the tool’s development was prepared following this recommendation from experts at the first consultation: “A document describing in detail the basis for the proposed approach to combined exposure assessment in the tool, with assumptions and limitations and guidance on its practical implementation, should be prepared and accompany the tool” (4). The document was structured as follows:  Introduction and objectives  Terminology  Scope, purpose and limitations of the tool  Tiered approach  Chemicals and the basis for their selection  Health endpoints  Description and criteria for selection of tiered toxicological information included in the supporting database. Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 6 The information included in these chapters was outlined briefly. Several questions were flagged for further discussion. These included decisions on addressing combined exposures to multiple chemicals (not necessarily temporal co-exposure) or mixtures (temporal co-exposures); inclusion of the threshold of toxicological concern to enable expansion of the tool to a broader range of data-poor substances at a later stage; an approach to the calculation of risks for carcinogenicity; the possibility of developing additionally criteria for grouping; additional criteria for reference values and/or PODs in the tool; and appropriate filters for the selection of reference values and/or PODs. Discussion of the document describing the methodology of the tool’s development continued in the working group session, which also addressed the collection of toxicological information, formatting of toxicological data and grouping of chemicals for combined exposure assessment. Building capacity among public-health professionals: an educational course on chemical pollution of indoor air and its risk for children’s health The educational course “Chemical pollution of indoor air and its risk for children’s health (with a focus on public settings)” was developed for two main purposes: to train public-health and health-care professionals working at the national level (that is, to train the trainers), and to share information for training/educating public-health professionals at the local level, medical workers such as school nurses and paediatricians, and allied specialists such as teachers. The package consists of the following six modules:  Introduction  Sources of chemical in indoor air  Vulnerability of children  Indoor air pollution and children’s health  Assessment of risk for children’s health from combined exposure to multiple chemicals in indoor air  Risk communication. Discussion of the educational course continued in the working group session. The main outcomes of all working group discussions are summarized in the following session. Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 7 Working group session Group 1. Management of toxicological information, grouping of chemicals and methodological approach Discussion of these issues yielded the following conclusions.  Exclude PM from the assessment of combined exposure, which is necessarily restricted to chemicals. Consider the inclusion of PM as a separate, individual compound.  Accept benzo[a]pyrene as a PAH marker and remove individual PAHs from the list of chemicals for inclusion in the tool. Retain naphthalene due to its presence in gaseous form and inclusion in the WHO guidelines for indoor air quality (15).  Adopt tumorigenic doses for presentation in the database and application in the tool for consistency with the margin-of-exposure approach for non-cancer effects. Check availability or need for conversion of unit risks. Investigate the impact of including priority substances that are classified in IARC Group 1 versus those classified in Group 1 and Group 2. Describe the basis for the selection of IARC Group 1 in the methodology document. Consider the adequate margin of exposure for carcinogens that act via a mutagenic mode of action according to the European Food Safety Authority and the European Chemicals Agency (ECHA) based on human or animal data.  Prioritize WHO reference values for hazard index calculations (Tier 0) followed by most recent values. The tool will be designed to permit uploading of national reference values if available.  For Tier 1, recommend the lowest available NOAEL for both animal and human studies as a default choice for POD selection; if only LOAEL data are available, apply an adjustment factor to the NOAEL using default 3 as suggested by ECHA (14). Provide an option in the tool to override default.  Include three levels of risks calculation (tiers) in the tool: Tier 0 – hazard index as a sum of acceptable/reference concentrations/values based on critical effect endpoints without grouping of chemicals by adverse effects (conservative); Tier 1, Level 1 – hazard index as a sum of critical effect endpoints with grouping by adverse effects; Tier 1, Level 2 – PODI (if the margin of exposure for Tier 1, Level 2 assessment is not sufficient, seek expert advice on next steps).  Adjust the exposure scenario of the study to a continuous exposure scenario by applying default adjustment factors as recommended by the Registration, Evaluation, Authorization and Restriction of Chemicals (REACH) guidance (16), except for irritation/upper respiratory tract effects (assumed to be concentration based). Scale human PODs and animal PODs to a common basis (100 for interspecies differences and human variability, 10 for human variability) to have a common metric for hazard to enable comparison with exposure for the margin of exposure.  Exclude carbon monoxide and ozone from the list of priority chemicals as they are not high priorities for combined exposure assessment for long-term effects. Consider including di(2-ethylhexyl) phthalate, butyl acetate, 1,2,3-trimethyl benzene and 1,4- Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 8 dichlorobenzene after double-checking the toxicological information available for these chemicals.  Check grouping for respiratory irritation against an additional source, such as the French Agency for Food, Environmental and Occupational Health and Safety (ANSES). Group 2. Methods for sampling and analysis of chemicals Participants revised the technical document prepared for the consultation. They proposed including a sampling strategy and restructuring the document according to agreement on the list of chemicals for inclusion in the tool. Group 3. Selection of sampling sites Participants discussed the approach to evaluating outdoor sources of chemicals (in particular industrial enterprises and car parking places), indoor sources (such as heating systems, building materials and furniture) and the influence of renovations on indoor air pollution. They also addressed issues concerning the labelling of low-emission materials and the definition of rural and urban areas. Discussion resulted in the following recommendations.  Revise the list of industrial sources and parking places and propose an estimation of proximity to them.  Define “rural” and “urban” areas, taking into account existing WHO definitions.  Add options of materials used for floors, ceilings, wall coverings and window frames. Group 4. Educational course on chemical pollution of indoor air and its risk for children’s health Discussion of the content of the educational course yielded the following recommendations for its final revision.  Revise the infographics on children’s health and sources of chemicals (indoor and outdoor) and the list and graphs of industrial and transport sources of chemicals into indoor air.  Prioritize data relevant to the WHO European Region rather than global estimates, and include the most recent data if available.  Double-check the information about health effects on children and reconsider its grouping.  Include more explanatory information on assessment of risk from combined exposure.  Include a recommendation on the development of a risk communication strategy.  Revise key messages to different target groups considering the most recent knowledge about sources of exposure and effectiveness of risk-reduction measures. Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 9 Conclusions and next steps Outcomes of working group discussions were presented and discussed in the plenary. Participants decided on the following next steps.  Consider the inclusion of PM as an individual-compound risk assessment if not covered by the AirQ+ software tool for risk assessment of outdoor air pollution.  Revise toxicological information according to the agreements of the working group if possible, and apply the agreed default adjustment factors for risks calculation.  Prioritize the publication of the educational course after its revision according to the outcomes of the working group discussion, and pilot the course in the trainings planned in Tallinn, Estonia, and Budapest, Hungary, for October 2019.  Include a sampling strategy in the overview of the methods for sampling and analysis and coordinate it with an approach to the assessment of exposure in the tool.  Finalize the document describing the methodological approach to the tool’s development, taking into account the working group discussions.  Include in the tool only those chemicals for which toxicological information is available for assessment of risk from combined exposure at three levels of complexity: hazard index without grouping of chemicals according to health effects; hazard index with grouping of chemicals according to health effects; and PODI.  Consider the inclusion of additional information in the questionnaire for the selection of sampling sites according to working group recommendations.  Continue the discussion of additional issues using available communication channels (email, WebEx, telephone calls).  Consider holding a third consultation to test the software when it is developed. Conclusions of the expert consultation also included lists of chemicals and adverse effect endpoints for final revision for inclusion in the tool, and approaches to the assessment of exposure and management of toxicological information for the calculation of risks. The following list of chemicals was agreed for a final revision taking into account the availability of toxicological information, as stated above, for inclusion in the tool: 1. formaldehyde 2. acetaldehyde 3. benzene 4. ethylbenzene 5. o-xylene 6. m,p-xylenes 7. styrene 8. toluene 9. 1,2,3-trimethylbenzene 10. 1,4-dichlorobenzene 11. butyl acetate 12. limonene 13. -pinene 14. tetrachloroethylene 15. trichloroethylene 16. naphthalene 17. benzo(a)pyrene 18. nitrogen dioxide 19. di-n-butyl phthalate 20. di(2-ethylhexyl) phthalate. Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 10 Bilateral and multilateral discussions and will continue to finalize the document and to develop the software prototype. The meeting closed at 17:30 on 24 September 2019. Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 11 References 1. Parma Declaration on Environment and Health. Copenhagen: WHO Regional Office for Europe; 2010 (http://www.euro.who.int/__data/assets/pdf_file/0011/ 78608/E93618.pdf, accessed 9 December 2019). 2. Ostrava Declaration on Environment and Health. Copenhagen: WHO Regional Office for Europe; 2017 (http://www.euro.who.int/__data/assets/pdf_file/0007/ 341944/OstravaDeclaration_SIGNED.pdf, accessed 9 December 2019). 3. Summary of principles for evaluating health risks in children associated with exposure to chemicals. Geneva: WHO; 2011 (https://www.who.int/ceh/health_risk_ children.pdf, accessed 9 December 2019). 4. Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the first expert consultation. Copenhagen: WHO Regional Office for Europe; 2019 (http://www.euro.who.int/__data/assets/pdf_file/0020/410780/ Indoor-air-pollutants-public-children-first-consulation-report.pdf, accessed 9 December 2019). 5. WHO human health risk assessment toolkit: chemical hazards. Geneva: WHO; 2010 (https://www.who.int/ipcs/methods/harmonization/areas/ra_toolkit/en/, accessed 9 December 2019). 6. Environmental Health Criteria 237: Principles for evaluating health risks in children associated with exposure to chemicals. Geneva: WHO; 2006 (http://www.inchem.org/documents/ehc/ehc/ehc237.pdf, accessed 9 December 2019). 7. Environmental Health Criteria 214: Human exposure assessment. Geneva: WHO; 2000 (https://apps.who.int/iris/handle/10665/42181, accessed 9 December 2019). 8. Methods for monitoring indoor air quality in schools. Copenhagen: WHO Regional Office for Europe; 2011 (http://www.euro.who.int/__data/assets/pdf_file/0011/ 147998/e95417.pdf, accessed 9 December 2019). 9. ISO 16000-1. Indoor air – Part 1: General aspects of sampling strategy. Geneva: International Organization for Standardization; 2004 (https://www.iso.org/obp/ui/ #iso:std:iso:16000:-1:ed-1:v1:en, accessed 9 December 2019). 10. Schools Indoor Pollution and Health Observatory Network in Europe (SINPHONIE), Regional Environmental Center for Central and Eastern Europe. SINPHONIE – Final report. Luxembourg: Publications Office of the European Union; 2014 (https://op.europa.eu/en/publication-detail/-/publication/b1243a1b-317b-422f-b6cf- 645b693b3cdf/language-en, accessed 9 December 2019). 11. WHO guidelines for indoor air quality. Geneva: WHO; 2006 (http://www.euro.who.int/en/health-topics/environment-and-health/air- quality/policy/who-guidelines-for-indoor-air-quality, accessed 9 December 2019 Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 12 12. Toxicology Data Network. TOXNET databases [website]. Bethesda: National Library of Medicine; 2019 (http://toxnet.nlm.nih.gov, accessed 9 December 2019). 13. EU-LCI values [website]. Brussels: European Commission; 2019 (https://ec.europa.eu/growth/sectors/construction/eu-lci/values_en, accessed 9 December 2019). 14. C&L Inventory [website]. Helsinki: European Chemicals Agency; 2019 (https://echa.europa.eu/information-on-chemicals/cl-inventory-database, accessed 9 December 2019). 15. WHO guidelines for indoor air quality. Selected pollutants. Copenhagen: WHO Regional Office for Europe; 2010 (http://www.euro.who.int/__data/assets/pdf_file/0009/128169/e94535.pdf, accessed 9 December 2019). 16. Guidance on REACH [website]. Helsinki: European Chemicals Agency; 2019 (https://echa.europa.eu/guidance-documents/guidance-on-reach, accessed 9 December 2019). Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 13 Annex 1. Programme 23 September 2019 11:30–13:00 Registration 13:00–13:20 Opening of the meeting Ms Dorota Jarosinska, WHO European Centre for Environment and Health (WHO ECEH) Election of Chair Tour de table: self-presentation of meeting participants Adoption of the meeting agenda 13:20–13:40 Update on follow-up activities of the first consultation, and scope and expected outcomes of the second consultation Ms Irina Zastenskaya, WHO ECEH 13:40–15:30 Session 1 Assessment of children’s exposure to chemicals in indoor air in public settings (schools, kindergartens, day-care centres) - an approach to calculating exposure - an update on the selection of sampling sites - an update on the methods for sampling and analysis of chemicals Ms Irina Zastenskaya, WHO ECEH Mr Alexander Gankin, Scientific Practical Centre of Hygiene, Belarus Ms Florentina Villanueva, Research Institute for Combustion and Atmospheric Pollution, Spain Discussion 16:00–17:00 Session 2 Management of toxicological information for assessment of risks of combined exposure to multiple chemicals in indoor air - grouping of toxicological information on points of departure - grouping of chemicals according to their adverse effect endpoints Ms Katleen de Brouwere, VITO, Belgium Discussion 17:00–18:00 Session 3 Methodological approach to the tool’s development: a document accompanying the tool Ms Bette Meek, University of Ottawa, Canada Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 14 18:00 Closure of the day 24 September 2019 9:00–9:30 Wrap-up of the first day 9:30–10:15 Session 4 Building capacity among public health professionals: an educational course on chemical pollution of indoor air and its risk for children’s health Ms Irina Zastenskaya, WHO ECEH Discussion 10:15–13:00 Working group discussions and finalization of working papers 15:00 – 15:30 Working group reports to the plenary Discussion 16:00–16:30 Plenary discussion of the meeting outcomes 16:30–17:00 Next steps and closure of the meeting Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 15 Annex 2. List of participants Temporary advisers Kristina Aidla Chief Specialist Estonian Health Board Environmental Health Paldiski mnt 81 10617 Tallinn Estonia Guillaume Boulanger Deputy Head Air Risks Assessment Unit Department of Risk Assessment French Agency for Food, Environmental and Occupational Health and Safety (ANSES) 14 rue Pierre et Marie Curie 94701 Maisons-Alfort Cedex France Eva Csobod External Environment and Health Expert Regional Environmental Center for Central and Eastern Europe 9–11 Ady Endre Street 2000 Szentendre Hungary Bilge Danyeli 50354 Hürth Germany Katleen De Brouwere Senior Health Researcher VITO Boeretang 200 2400 Mol Belgium Sani Dimitroulopoulou Principal Environmental Public Health Scientist – Indoor Environments, Air Quality and Public Health Centre for Radiation, Chemical and Environmental Hazards Public Health England Harwell Science and Innovation Campus Chilton, Oxfordshire OX11 0RQ United Kingdom Eduardo de Oliveira Fernandes Emeritus Professor Faculty of Engineering University of Porto Rua Dr. Roberto Frias, 400 4200 465 Porto Portugal Marta Gabriel Energy Researcher Institute of Science and Innovation in Mechanical and Industrial Engineering Rua Dr. Roberto Frias, 400 4200-465 Porto Portugal Alexandr Gankine Researcher Scientific Practical Centre of Hygiene Ministry of Health Laboratory of Environmental Factors and Health Risk Analysis 8, Akademicheskaya str. 220012, Minsk Belarus Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 16 M.E. (Bette) Meek Associate Director of Chemical Risk Assessment McLaughlin Centre for Risk Science University of Ottawa 600 Peter-Morand Crescent, Room 216 Ottawa, Ontario K1G 5Z3 Canada Lotte Mollen Health Researcher VITO Boeretang 200 2400 Mol Belgium Pawel Rostkowski Senior Research Scientist Department of Environmental Chemistry Norwegian Institute for Air Research Instituttveien 18 2007 Kjeller Norway Marianne Stranger Senior Researcher Air Quality Measurements – Indoor Air Quality Environmental Risk and Health Unit VITO Boeretang 200 2400 Mol Belgium Tamas Szigeti Head of Air Hygiene Laboratory National Public Health Center Albert Flórián 2-6. 1097 Budapest Hungary Irena Taraskeviciene Head of Public Health Division National Public Health Center Kalvarijų str 153 LT-08221 Vilnius Lithuania Theo Vermeire Senior Risk Assessor for Chemicals National Institute for Public Health and the Environment Centre for the Safety of Substances and Products Antonie van Leeuwenhoeklaan 9 3720BA Bilthoven The Netherlands Florentina Villanueva Castilla La Mancha Science and Technology Park University of Castilla La Mancha Researcher (INCRECYT Program) 13171 Camino de Moledores Ciudad Real Spain Towards a tool for assessment of cumulative risks from indoor air pollutants in public settings for children: the second expert consultation 17 World Health Organization European Centre for Environment and Health Philip Baumann Information Technology Specialist James Creswick Communications Officer Dorota Jarosinska Programme Manager Living and Working Environments Edith Kimotho Programme Assistant Pierpaolo Mudu Technical Officer Living and Working Environments Roman Perez Velasco Technical Officer, Air Quality and Health Living and Working Environments Hanna Yang Technical Officer, Air Quality and Health Living and Working Environments Irina Zastenskaya Technical Officer, Chemical Safety Living and Working Environments The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. 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