National Health and Nutrition Examination Survey

Volatile Organic Compounds and Trihalomethanes/MTBE (Whole Blood)

Volatile organic compounds (VOCs) are a large group of chemicals that have been used as solvents, degreasers, and cleaning agents in industry and consumer products. Many of the VOCs were found to contaminate ground water and drinking water sources. Because of human health concerns, these VOCs have been banned or restricted from most uses.

The halogenated solvents are VOCs consisting of a hydrocarbon chain or one hydrocarbon substituted with one or more chlorine or bromine atoms. Most of these chemicals are used as degreasers and solvents in various products such as paint. In the past, 1,1,1-trichloroethane was used as a dry cleaning agent, insect fumigant, and solvent in consumer products. Methylene chloride, perchloroethylene, and trichloroethene are other VOCs that were widely used in the past.

Benzene, toluene, ethylbenzene, xylene, and styrene, collectively referred to as BTEXS, are components of tobacco smoke. Along with 2,5-dimethylfuran, these VOCs are usually detected in the blood of cigarette smokers at higher levels than in non-smokers. Chlorobenzene (monochlorobenzene) and the three dichlorobenzenes are halogenated aromatic hydrocarbons primarily used in industrial and chemical synthetic processes. Chlorobenzene has been used to produce DDT, phenol, and nitrobenzene. The dichlorobenzenes are also chemical intermediates in the synthesis of dyes, pesticides, and other industrial products. 1,4-Dichlorobenzene (para-dichlorobenzene) is used also as a moth repellent and as a deodorizer. Disinfection by-products (DBP), including bromodichloromethane, dibromochloromethane, bromoform, and chloroform are formed when chlorine interacts with natural organic materials found in water. Primary sources of DBPs are chlorinated drinking water and recreational water bodies, such as swimming pools.

The prevalence of disinfection by-products in drinking water supplies has raised concerns about possible adverse health effects from chronic exposure to these potentially carcinogenic compounds. Methyl-tert-butyl ether (MTBE) was used as an additive to replace lead in gasoline, but its use was banned after widespread ground water contamination was discovered.

Inhalation is the most common VOC route of exposure in the general population, including indoor sources such as paints, adhesives, cleaning solutions, and aerosolized insecticide sprays; industries producing these solvents; and contaminated waste disposal sites. Drinking water may contribute to exposure when underground drinking water supplies are contaminated. After they are absorbed in the body, VOCs are rapidly eliminated in exhaled breath, or may be rapidly metabolized and eliminated in the urine.

Participants aged 18 years and older, who met the regular one-half subsample selection criteria, were included in this special subsample. Additionally, to oversample adult smokers, those participants aged 18 years and older, not in the regular one-half subsample, who smoked at least 100 cigarettes in their entire lifetime (SMQ020=1) and now smoke cigarettes every day (SMQ040=1), were also included in this special subsample.

An automated analytical method was developed using capillary gas chromatography (GC) and mass spectrometry (MS) with selected-ion monitoring (SIM) detection and isotope-dilution. This method quantifies levels of individual VOCs and Trihalomethanes (THMs) and MTBE in whole blood to low-parts-per-trillion range. Because non-occupationally exposed individuals have blood VOC concentrations within this range, this method is applicable for determining these quantities and investigating cases of sustained or recent low-level exposure.

Refer to the Laboratory Method Files section for a detailed description of the laboratory methods used.

There were no changes to the lab method, lab equipment, or lab site for this component in the NHANES 2013-2014 cycle.

Volatile Organic Compounds (VOCs) & Trihalomethanes/MTBE (January 2017)

Whole blood samples were processed, stored, and shipped to the Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA for analysis.

Detailed instructions on specimen collection and processing are discussed in the NHANES Laboratory Procedures Manual (LPM). Vials are stored under appropriate refrigerated (2-8°C) conditions until they are shipped to National Center for Environmental Health, for testing.

The NHANES quality assurance and quality control (QA/QC) protocols meet the 1988 Clinical Laboratory Improvement Act mandates. Detailed QA/QC instructions are discussed in the NHANES LPM.

Mobile Examination Centers (MECs)

Laboratory team performance is monitored using several techniques. NCHS and contract consultants use a structured competency assessment evaluation during visits to evaluate both the quality of the laboratory work and the quality-control procedures. Each laboratory staff member is observed for equipment operation, specimen collection and preparation; testing procedures and constructive feedback are given to each staff member. Formal retraining sessions are conducted annually to ensure that required skill levels were maintained.

Analytical Laboratories

NHANES uses several methods to monitor the quality of the analyses performed by the contract laboratories. In the MEC, these methods include performing blind split samples collected during “dry run” sessions. In addition, contract laboratories randomly perform repeat testing on 2% of all specimens.

NCHS developed and distributed a quality control protocol for all CDC and contract laboratories, which outlined the use of Westgard rules (Westgard, et al., 1981) when running NHANES specimens. Progress reports containing any problems encountered during shipping or receipt of specimens, summary statistics for each control pool, QC graphs, instrument calibration, reagents, and any special considerations are submitted to NCHS quarterly. The reports are reviewed for trends or shifts in the data. The laboratories are required to explain any identified areas of concern.

All QC procedures recommended by the manufacturers were followed. Reported results for all assays meet the CDC/NCEH Tobacco and Volatile Branch quality control and quality assurance performance criteria for accuracy and precision, similar to the Westgard rules (Caudill, et al., 2008).

The data were reviewed. Incomplete data or improbable values were sent to the performing laboratory for confirmation.

Refer to the 2013-2014 Laboratory Data Overview for general information on NHANES laboratory data.

Subsample Weights

Whole blood VOCs were measured in a special smoking subsample of participants 18 years and older. Special sample weights are required to analyze these data properly. Specific sample weights for this subsample are included in this data file and should be used when analyzing these data.

Demographic and Other Related Variables

The analysis of NHANES laboratory data must be conducted using the appropriate survey design and demographic variables. The NHANES 2013-2014 Demographics File contains demographic data, health indicators, and other related information collected during household interviews as well as the sample design variables. The recommended procedure for variance estimation requires use of stratum and PSU variables (SDMVSTRA and SDMVPSU, respectively) in the demographic data file.

The Fasting Questionnaire File includes auxiliary information such as fasting status, the length of the fast, and the time of venipuncture.

This laboratory data file can be linked to the other NHANES data files using the unique survey participant identifier (i.e., SEQN).

Detection limits

The detection limits were constant for all of the analytes in the data set. Two variables are provided for each of these analytes. The variable name ending in “LC” (ex., LBD2DFLC) indicates whether the result was below the limit of detection: the value “0” means that the result was at or above the limit of detection, “1” indicates that the result was below the limit of detection. For analytes with analytic results below the lower limit of detection (ex., LBD2DFLC=1), an imputed fill value was placed in the analyte results field. This value is the lower limit of detection divided by square root of 2 (LLOD/sqrt [2]). The other variable prefixed LBX (ex., LBX2DF) provides the analytic result for that analyte.