Exposure Reduction Resources
This is a compilation of key publications and resources from a detailed scan of exposure control resources. Please note that it is not an exhaustive list. Reference to certain organizations does not represent a recommendation or endorsement by CAREX Canada.
Both Occupational and Environmental Exposures - General
1. Cancer Care Ontario (CCO). Prevention System Quality Index: Monitoring Ontario’s efforts in cancer prevention (2016) (PDF)
- Identifies opportunities to reduce exposure and implement cancer prevention initiatives in Ontario; includes ultraviolet radiation, environmental carcinogens (radon, particulate matter), and occupational carcinogens (asbestos, diesel engine exhaust, formaldehyde, and nickel).
2. Espina C, Porta M, Schüz J, Aguado IH, Percival RV, Dora C, Slevin T, Guzman JR, Meredith T, Landrigan PJ, Neira M. "Environmental and occupational Interventions for primary prevention of cancer: A cross-sectoral policy framework." Environ Health Perspect 2013;121(4):420-426.
- A systematic review of policy approaches and effective interventions currently available for the primary prevention of cancer. Key interventions include the precautionary principle, ALARA (as low as reasonably achievable), chemical bans, economic policies across multiple sectors, the occupational exposure control hierarchy, individual level interventions, and “health in all policies”.
3. World Health Organization (WHO). Primary prevention of cancer through mitigation of environmental and occupational determinants (2011) (PDF)
- Provides examples of legislation, regulations, and policies for eliminating or reducing exposure to carcinogens, as well as examples of control measures in the workplace.
4. Canadian Strategy for Cancer Control. Prevention of occupational and environmental cancers in Canada: A best practices review and recommendations (2006) (PDF)
- Explores Canadian and international best practices for cancer control in key areas, including surveillance, information disclosure and labeling, community education and action, worker education and action, non-governmental organization activities, employer/industry reduction of carcinogens, and government interventions.
Environmental Exposures - General
1. Dunn G, Bakker K, Harris L. "Drinking water quality guidelines across Canadian provinces and territories: Jurisdictional variation in the context of decentralized water governance." Int J Environ Res Public Health 2014;11(5):4634-4651.
- Presents the first comprehensive review and analysis of the uptake of the Canadian Drinking Water Quality Guidelines (CDWQG) across Canada’s 13 provinces and territories,and makes recommendations for further research to address the high degree of variability in drinking water management and oversight capacity between urban and rural areas in Canada.
2. Hubaux R, Becker-Santos DD, Enfield KSS, Lam S, Lam WL, Martinez VD. "Arsenic, asbestos and radon: emerging players in lung tumorigenesis." Environ Health 2012;11:89.
- Provides a comprehensive review of arsenic-, asbestos-, and radon-induced molecular mechanisms responsible for genetic and epigenetic alterations in lung cancer, as well as a summary of some of the prevention and management strategies related to these environmental hazards.
3. Reuben S. Reducing environmental cancer risk: What we can do now (2010) (PDF)
- Includes various policy, research, and program recommendations for carcinogen exposure reduction, such as adopting the precautionary approach, improving how regulations are promulgated and enforced, and including advocates in developing research and policy agendas.
4. World Health Organization (WHO). Preventing disease through healthy environments: Action is needed on chemicals of major public health concern (2010) (PDF)
- Provides a brief overview of exposure reduction interventions for various chemicals including air pollution, arsenic, asbestos, benzene, cadmium, and dioxin and dioxin-like substances (including PCBs).
5. Hyndman B, Cancer Care Ontario. Strategies for the reduction and control of environmental carcinogens in Canada: What’s happening? What’s missing? (2005) (PDF)
- Reviews the strategies utilized by governments, industry, researchers, and advocacy groups to reduce or eliminate carcinogen exposures, including surveillance, right-to-know measures, public education initiatives, reductions of carcinogens at the source, and legislative/regulatory measures.
Environmental Exposures - Specific Carcinogens - Arsenic
1. World Health Organization (WHO). Preventing disease through healthy environments (2010) (PDF)
- Includes a brief overview of risk mitigation recommendations to reduce the intake of arsenic from drinking water and food.
2. Health Canada. Guidelines for Canadian drinking water quality: Guideline technical document (Arsenic) (2006) (PDF)
- Includes an overview of water treatment technologies at municipal and residential levels to reduce exposure to arsenic in drinking water.
3. Nachman et al. ”Opportunities and challenges for dietary arsenic intervention.” Environ Health Perspect 2018;126(8): 84503.
- Describes challenges related to reducing dietary arsenic exposure and shares a framework for shorter-term interventions that employs a field-to-plate food supply chain model to identify monitoring, intervention, and communication opportunities.
Environmental Exposures - Specific Carcinogens - Asbestos
1. WorkSafeBC. Asbestos awareness for homeowners (2017)
- Provides health and safety resources on asbestos hazards during home renovations or demolitions, including sources of asbestos in the home, testing and removal guidelines, and how to prevent exposure.
2. Health Canada. Health risks of asbestos (2016)
- Summarizes sources of asbestos exposure, how to reduce the risk of exposure in the home and when doing car maintenance, and Government of Canada regulations.
Environmental Exposures - Specific Carcinogens - Pesticides
1. HealthLink BC. Tips for reducing pesticide exposure in your home (2017)
- This website provides information about using pesticides in your home safely, and tips for preventing the need for domestic pesticide use in the first place.
2. United States Environmental Protection Agency (US EPA). Citizen's guide to pest control and pesticide safety (2017) (PDF)
- A visual guide on safely using pesticides in your community and how to reduce your exposure.
3. Health Canada. Bedbugs: How do I get rid of them? (2015)
- Bedbugs are a growing nuisance in Canada and can be difficult eradicate from your home, resulting in people resorting to domestic pesticide usage. The Government of Canada provides some useful information about treating bedbugs safely and effectively.
4. Health Canada. Pesticides and food (2013)
- Health Canada provides information about food safety, organic produce, Canadian regulations on pesticide use, and how they determine their “Maximum Residue Limits” for pesticides on food. A PDF is available.
Environmental Exposures - Specific Carcinogens - Radon
1. Canadian Environmental Law Association. Radon in indoor air: A review of policy and law in Canada (2014) (PDF)
- The CELA report makes 14 recommendations for addressing radon risks and filling gaps in research, policy, and law.
2. CHNET-Works! Fireside Chat: Housing Interventions and Respiratory Health (2013)
- This pre-recorded webinar explores scientific and policy issues related to residential housing quality and respiratory health, including case study examples on improving housing and other interventions.
3. Health Canada. Radon – Reduction guide for Canadians (2013)
- Provides information on testing for radon in Canadian homes and summarizes a number of exposure reduction methods including active soil depressurization.
4. Sandel M, Baeder A, Bradman A, Hughes J, Mitchell C, Shaughnessy R, Takaro TK, Jacobs DE. "Housing interventions and control of health-related chemical agents: A review of the evidence." J Public Health Manag Practic 2010;16(5):S24-S33.
- Includes an evaluation of housing interventions that affect health outcomes associated with exposure to chemical agents, including carcinogens radon and benzene.
5. World Health Organization (WHO). WHO handbook on indoor radon: a public health perspective (2009) (PDF)
- Provides an overview of radon prevention and mitigation actions, including key elements for a successful national radon program and prevention strategies for new and existing buildings.
6. National Collaborating Centre for Environmental Health. Effective interventions to reduce indoor radon levels (2008) (PDF)
- Summarizes common radon reduction interventions for existing homes and their relative effectiveness.
Environmental Exposures - Specific Carcinogens - Solar UV Radiation
1. The Community Guide. What works fact sheet: Skin cancer prevention (2014) (PDF)
- Includes systematic reviews of interventions aimed at preventing skin cancer, including education and policy approaches (ex. primary schools, worksites), interventions targeting children’s parents and caregivers, and community-wide interventions (ex. mass media campaigns, community-wide programs).
Environmental Exposures - Specific Carcinogens - Traffic-Related Air Pollution
1. Metro Vancouver. Reducing exposure to traffic emissions (2013) (PDF)
- Identifies strategies for mitigating exposure to traffic-related air pollutants in the Lower Fraser Valley with special consideration of vulnerable populations.
2. Brauer M, Reynolds C, Hystad P. Traffic-related air pollution and health: A Canadian perspective on scientific evidence and potential exposure-mitigation strategies (2012) (PDF)
- Describes four categories of exposure-mitigation options for TRAP: Land-use planning and transportation management; reduction of vehicle emissions; modification of existing structures; and encouraging behavior change. Real-world implementation of policies and actions – within Canada and internationally – are examined.
3. Henschel S, Atkinson R, Zeka A, Le Tertre A, Analitis A, Katsouyanni K, Chanel O, Pascal M, Forsberg B, Medina S, Goodman PG. "Air pollution interventions and their impact on public health." Int J Public Health 2012;57(5):757-768.
- Reviews a collection of published intervention studies with particular focus on studies assessing both improvements in air quality and associated health effects.
Occupational Exposures - General
1. Canadian Centre for Occupational Health and Safety (CCOHS). Hazard control (2018)
- Provides an overview of hazard control in the workplace, including elimination controls, substitution, engineering controls, administrative controls, and personal protective equipment.
2. Cancer Care Ontario (CCO), Occupational Cancer Research Centre (OCRC). Burden of occupational cancer in Ontario: Major workplace carcinogens and prevention of exposure (2017)
- Summarizes the burden of occupational cancer and exposure prevention recommendations for policy and workplaces for the most common occupational carcinogens in Ontario, including solar radiation, asbestos, diesel engine exhaust, silica, and many more.
3. National Institute for Occupational Safety and Health (NIOSH). Engineering controls database (2015)
- The Engineering Controls Database provides information on effective engineering controls that can protect workers by eliminating or reducing hazardous conditions. The database can be searched by occupation or work process, and contains previously published material authored by NIOSH researchers.
4. Cancer Council Australia. Occupational cancers: Effective interventions (2015)
- Summarizes effective interventions for occupational cancers, including the use of research, monitoring and surveillance, primary prevention strategies, partnerships between sectors, integrated health protection and health promotion programs, and legislation to improve policy.
5. Blair A, Hohenadel K, Demers P, Marrett L, Straif K. "Prevention of Occupationally Induced Cancer." In: Miller A (eds) Epidemiologic Studies in Cancer Prevention and Screening. Springer, New York, USA, 2013:33-43.
- Summarizes approaches to control occupational risk factors such as the hierarchy of hazard control, ALARA (as low as reasonably achievable), and legislation; explains the challenges of studying the effectiveness of exposure interventions; and provides some examples of successful workplace exposure controls.
6. Stewart JH. "Occupational hygiene: Control of exposures through intervention. " In: Stellman JK (eds) Encyclopedia of Occupational Health and Safety. International Labor Organization, Geneva, CH, 2011.
- Provides a general summary of hazard control interventions, including engineering controls, administrative controls, and personal protective equipment, as well as an overview of factors to consider when selecting an intervention.
7. Lazovish D, Parker DL, Brosseau LM, Milton FT, Dugan SK, Pan W, Hock L. "Effectiveness of a worksite intervention to reduce an occupational exposure: The Minnesota Wood Dust Study." Am J Public Health 2002;92(9):1498-1505.
- A case study exploring a worksite intervention that, despite not substantially reducing wood dust concentrations, highlights the complexity of undertaking intervention research in an occupational setting and reveals key considerations for future occupational interventions.
8. Brosseau LM, Parker DL, Lazovich D, Milton T, Dugan S. "Designing intervention effectiveness studies for occupational health and safety: The Minnesota Wood Dust Study." Am J Ind Med 2002;41(1):54-61.
- Highlights the use of the PRECEDE-PROCEED model as a framework for designing occupational interventions.
Occupational Exposures - Specific Carcinogens - Antineoplastic Agents
1. BC Cancer Agency. Pharmacy practice standards for hazardous drugs (2016)
- Summarizes safe handling practice standards and recommendations for hazardous drugs in pharmacy settings.
2. Canadian Association of Provincial Cancer Agencies. Oral cancer drug therapy safe use and safe handling guidelines (2015) (PDF)
- Presents guidelines focused on the safe use and safe handling of oral cancer drug therapy.
3. WorkSafeBC. Best practices for the safe handling of hazardous drugs (2015)
- Outlines best practices to minimize worker exposure to hazardous drugs; includes task-specific guidelines for a variety of work settings.
4. National Institute for Occupational Safety and Health (NIOSH). Medical surveillance for healthcare workers exposed to hazardous drugs (2012) (PDF)
- Summarizes the elements of a worker medical surveillance program (as part of a comprehensive approach to reducing exposure).
5. National Institute for Occupational Safety and Health (NIOSH). Safe handling of hazardous drugs for veterinary healthcare workers. (2010) (PDF)
- Summarizes safe handling practice standards and recommendations for hazardous drugs in veterinary settings.
6. National Institute for Occupational Safety and Health (NIOSH). NIOSH Alert: Preventing occupational exposure to antineoplastic and other hazardous drugs in healthcare settings (2004) (PDF)
- Presents best practices to minimize worker exposure to hazardous drugs in healthcare settings.
Occupational Exposures - Specific Carcinogens - Artificial Ultraviolet Radiation
1. Ontario Ministry of Labour. Control measures: Ultraviolet radiation in the workplace (2009)
- Summarizes measures to help prevent overexposure of workers to ultraviolet radiation, including engineering controls, administrative controls, and personal protection, as well as ways to organize a prevention program.
Occupational Exposures - Specific Carcinogens - Asbestos
1. Canadian Centre for Occupational Health and Safety (CCOHS). Asbestos control strategies for workplaces (2018)
- Provides an overview of the components of an asbestos control program and exposure reduction practices.
2. WorkSafeBC. Safe work practices for handling asbestos (2017)
- Describes the safe methods of handling all types of asbestos-containing materials and discusses suitable work procedures for the removal, enclosure, and encapsulation of friable asbestos materials.
3. Government of Alberta. Alberta Asbestos Abatement Manual (2012) (PDF)
- Describes the principles to follow when selecting the most appropriate techniques for the safe abatement of asbestos-containing materials, as well as information on requirements for worker protection, safe work procedures, and applicable legislation.
4. Hohenadel K, Straif K, Demers P, Blair A. The effectiveness of asbestos-related interventions in reducing rates of lung cancer and mesothelioma: A systematic review (2011) (PDF)
- Summarizes initial results of a systematic review to quantify the effectiveness of asbestos-related interventions in reducing incidence of lung cancer, mesothelioma, and malignancy. Prevention intervention results include hygiene efforts, exposure-control policies, discontinuing use, and government bans.
5. Government of Alberta. Control of asbestos during brake maintenance and repair (2009) (PDF)
- Summarizes guidelines for minimizing asbestos exposure associated with brake maintenance and repair, including exposure reduction during various work tasks and appropriate use of personal protective equipment.
6. World Health Organization (WHO), International Labour Organization. Outline for the development of national programmes for elimination of asbestos-related diseases (2007) (PDF)
- Provides a model for developing a national program to eliminate asbestos-related diseases, which includes preventive strategies for reducing exposure to asbestos and related actions at the national, regional, and enterprise level.
Occupational Exposures - Specific Carcinogens - Benzene
1. Government of Alberta. Benzene at the work site (2010) (PDF)
- Summarizes specific measures for preventing exposure to benzene in the workplace, including substitution, engineering controls, administrative controls, and personal protective equipment.
Occupational Exposures - Specific Carcinogens - Carbon Nanotubes
1. National Institute for Occupational Safety and Health. Occupational Exposure to Carbon Nanotubes and Nanofibres (2013) (PDF)
- Summarizes where workers may be exposed to carbon nanotubes and recommends an exposure limit and control measures for employers and workers.
2. Safe Work Australia. Safe handling and use of carbon nanotubes (2012)
- Describes two approaches to managing the risks from exposure to cabon nanotubes: detailed hazard analysis and exposure assessment, and control banding.
Occupational Exposures - Specific Carcinogens - Diesel Engine Exhaust
1. Occupational Cancer Research Centre (OCRC). Controlling diesel particulate matter in underground mines (2017)
- Summarizes strategies for reducing exposure to diesel engine exhaust in the Ontario mining sector using the Hierarchy of Controls.
2. Safe Work Australia. Guidance for managing the risks of diesel exhaust (2015) (PDF)
- Provides information on how to manage risks associated with exposure to diesel exhaust in the workplace.
3. Occupational Safety and Health Administration (OSHA). Hazard Alert: Diesel exhaust/diesel particulate matter (2013) (PDF)
- Includes examples of engineering and administrative controls for minimizing worker exposure to diesel engine exhaust.
4. Bugarski AD, Janisko SJ, Cauda EG, Noll JD, Mischler SE. Diesel aerosols and gases in underground mines: Guide to exposure assessment and control (2011) (PDF)
- Includes source controls, exposure controls, and administrative controls for reducing exposure to diesel aerosols and gases in underground mines.
Occupational Exposures - Specific Carcinogens - Formaldehyde
1. Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST). Prevention guide: Formaldehyde in the workplace (2006) (PDF)
- Summarizes methods for controlling exposure to formaldehyde in the workplace, including substitution, ventilation, and personal protective equipment, and provides exposure control recommendations by sector of economic activity.
Occupational Exposures - Specific Carcinogens - Lead
1. WorkSafeBC. Safe work practices for handling lead (2017) (PDF)
- Provides information about lead exposure at work and assists employers in developing suitable safe work procedures.
Occupational Exposures - Specific Carcinogens - Pesticides
1. Canadian Centre for Occupational Health and Safety (CCOHS). Pesticides (2018)
- A variety of pesticide factsheets are available about using pesticides safely at work, including First Aid, Labels, Health Effects, and Re-Entry Time. The “Pesticides – Working Safely” fact sheet includes sections on proper mixing and application techniques, storage, and clean-up after a spill.
2. National Pesticide Information Centre. Minimizing exposure at work. (2016)
- The NPIC has developed a wide-range of useful factsheets on individual pesticides, as well as an overview on Minimizing Pesticide Exposure at Work.
3. Government of British Columbia. Personal protective equipment for pesticide applicators (2016)
- Detailed information on pesticide labeling, the use of personal protective equipment and clothing, respirators, and cleaning of personal protective equipment
4. The Agricultural Health and Safety Network. Agricultural health and safety resources (2013)
- A variety of educational materials to improve the health and safety of farm families in Saskatchewan and Canada. Their chemical safety materials include factsheets on “Skin Health for Farmers”, “How to Wash Clothing Used While Spraying Agrochemicals”, among many others.
5. Keifer MC. "Effectiveness of interventions in reducing pesticide overexposure and poisonings." Am J Prev Med 2000;18(4):80-90.
- This peer-reviewed article reviewed and evaluated several studies on the efficacy of various methods of pesticide exposure reduction interventions, including changes in application procedures, packaging, mixing, use of personal protective equipment, and biological monitoring.
Occupational Exposures - Specific Carcinogens - Shiftwork
NOTE: Shiftwork represents a complex and interwoven set of exposures with no simple control measures. However, there are interventions that may help to reduce the negative impacts of shiftwork.
1. Canadian Centre for Occupational Health and Safety (CCOHS). Rotational Shiftwork (2018)
- Provides an overview of rotational shiftwork and the improvements that can be made at both the organizational and individual level.
2. National Institute for Occupational Safety and Health (NIOSH). Work schedules: Shiftwork and long hours (2017)
- Provides training materials, guidance documents, publications, and other resources that address demanding work schedules.
Occupational Exposures - Specific Carcinogens - Silica
1. WorkSafeBC. Silica (2017)
- Provides an overview of silica dust exposure, related health effects, and strategies to reduce the risk of exposure.
2. National Institute for Occupational Safety and Health (NIOSH). Best practice engineering control guidelines to control worker exposure to respirable crystalline silica during asphalt pavement milling (2015) (PDF)
- Summarizes best practice engineering controls to reduce respirable crystalline silica exposure during asphalt pavement milling in highway construction.
3. Beaudry C, Dion C, Gérin M, Perrault G, Bégin D, Lavoué J. Construction workers’ exposure to crystalline silica: Literature review and analysis (2013) (PDF)
- Identifies the positions and duties with the highest risk in relation to their crystalline silica exposure level and the various means of controlling exposure, including their effectiveness.
4. Government of Alberta. Crystalline silica at the work site (2009) (PDF)
- Summarizes specific measures for preventing exposure to crystalline silica in the workplace, including silica substitutes in abrasive blasting, engineering controls, administrative controls, and personal protective equipment.
5. Meeker JD, Cooper MR, Lefkowitz D, Susi P. "Engineering control technologies to reduce occupational silica exposures in masonry cutting and tuckpointing." Public Health Rep 2009;124(1):101-111.
- Evaluates the effectiveness of various engineering controls used to reduce crystalline silica exposure in construction.
6. Scholz RC, Slavin TJ, Rowntree K. Control of Silica Exposure in Foundries (2007) (PDF)
- Summarizes engineering controls, work practice controls, and administrative controls for reducing silica exposure in foundries, and provides more detail on process and material handling controls, ventilation of dust sources, and silica exposure control programs.
Occupational Exposures - Specific Carcinogens - Wood dust
1. Canadian Centre for Occupational Health and Safety (CCOHS). Wood dust - Health effects (2017)
- Provides information on workplace exposures wood dust, strategies for controlling exposure, and the recommended respirators.
We’re also in the process of building a list of organizations that either make exposure reduction recommendations or have their own compilations of resources to offer. A few of these organizations include:
Interested in exposure reduction resources for a substance not found in this list? Have you come across some useful resources that you think would add value to our list? Please get in touch with us: firstname.lastname@example.org.