Human exposure pathways to poly- and perfluoroalkyl substances (PFAS) from indoor media: A systematic review
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Human exposure to per- and polyfluoroalkyl substances (PFAS) has been primarily attributed to contaminated food and drinking water. However, PFAS exposure has also been linked to use of consumer products, yet few studies report relationships between these exposure media and human biomonitoring measurements. A systematic review (SR) is a transparent and rigorous method to evaluate a body of scientific evidence to answer a specific research or policy question. Although widely used in clinical medicine and epidemiology, the development of SR methods that are applicable to exposure science studies is ongoing. This study adapted existing SR methodologies to identify important PFAS exposure pathways from indoor environment media including consumer products, household articles, cleaning products, personal care products, and indoor air and dust. Studies included in the SR report exposure measures from household media paired with occupant PFAS concentrations in blood serum, focusing specifically on eight frequently measured chemical species of PFAS. Machine learning approaches were used during the literature scoping and title/abstract screening to prioritize exposure pathways of interest by automated tagging and to select studies for inclusion using an iterative predictive screening model. The extraction of exposure measurement data and study characteristics from each included study was performed in DistillerSR software. Exposure intake calculations were used to estimate a percentage of occupant serum concentrations that could be attributed to indoor exposure pathways. The exposure assessment methods used in included studies were evaluated using an approach modified from the EPA’s Systematic Review Protocol for IRIS Assessments and the Navigation Guide. Along with providing evidence for an estimated range of indoor exposure media’s contribution to serum PFAS concentrations, this systematic review highlights the limited availability of concordant measurement data from indoor exposure media and participant serum. It also presents innovative SR methodologies for exposure science studies, including the development of exposure pathway-specific search strings for use in artificial intelligence software.