Guidelines for the communication of Biomonitoring Equivalents: Report from the Biomonitoring Equivalents Expert Workshop Judy S. LaKind a , Lesa L. Aylward b , Conrad Brunk c , Stephen DiZio d , Michael Dourson e , Daniel A. Goldstein f , Michael E. Kilpatrick g , Daniel Krewski h , Michael J. Bartels i , Hugh A. Barton j , Peter J. Boogaard k , John Lipscomb l , Kannan Krishnan m , Monica Nordberg n , Miles Okino o , Yu-Mei Tan p , Claude Viau m , Janice W. Yager q , Sean M. Hays r, * a LaKind Associates, LLC, 106 Oakdale Avenue, Catonsville, MD 21228, USA b Summit Toxicology, LLP, 6343 Carolyn Drive, Falls Church, VA 22044, USA c Centre for Studies in Religion and Society, University of Victoria, Victoria, BC, Canada V8W 2Y2 d Interstate Technology & Regulatory Council, 8810 Cal Center Drive, Sacramento, CA 95826, USA e Toxicology Excellence for Risk Assessment, 2300 Montana Avenue, No. 409, Cincinnati, OH 45211, USA f Monsanto Company, 800 North Lindbergh Boulevard, St. Louis, MO 63167, USA g Department of Defense, Force Health Protection and Readiness Programs, 5113 Leesburg Pike, Suite 901, Falls Church, VA 22041, USA h University of Ottawa, Institute of Population Health, R Samuel McLaughlin Centre for Population Health Risk Assessment, One Stewart Street, Room 320, Ottawa, Ont., Canada K1N 6N5 i Toxicology Research Laboratory, 1803 Building, The Dow Chemical Company, Midland, MI 48674, USA j National Center for Computational Toxicology, US EPA, B205-1, 109 TW Alexander Dr., Research Triangle Park, NC 27711, USA k Shell International, Shell Health, Carel van Bylandtlaan 30, P.O. Box 162, The Hague 2501AN, The Netherlands l USEPA, 26 W Martin Luther King Drive, MD A 130, Cincinnati, OH 45268, USA m Université de Montréal, Département de santé environnmentale et santé au travail, 2375 Côte Ste Catherine, Montréal, Que., Canada H3T 1A8 n Karolinska Institutet, Institute of Environmental Medicine, SE-171 77 Stockholm, Sweden o US EPA/EDRB, P.O. Box 93478, Las Vegas, NV 89193-3478, USA p The Hamner Institutes for Health Sciences, 6 Davis Drive, P.O. Box 12137, Research Triangle Park, NC 27709-2137, USA q Department of Internal Medicine, Division of Epidemiology, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA r Summit Toxicology, LLP, 165 Valley Road, Lyons, CO 80540, USA article info Article history: Received 15 January 2008 Available online 22 May 2008 Keywords: Biomonitoring Biomonitoring Equivalents Risk communication BEs Transparency Exposure guidance values abstract Biomonitoring Equivalents (BEs) are screening tools for interpreting biomonitoring data. However, the development of BEs brings to the public a relatively novel concept in the field of health risk assessment and presents new challenges for environmental risk communication. This paper provides guidance on methods for conveying information to the general public, the health care community, regulators and other interested parties regarding how chemical-specific BEs are derived, what they mean in terms of health, and the challenges and questions related to interpretation and communication of biomonitoring data. Key communication issues include: (i) developing a definition of the BE that accurately captures the BE concept in lay terms, (ii) how to compare population biomonitoring data to BEs, (iii) interpreting bio- monitoring data that exceed BEs for a specific chemical, (iv) how to best describe the confidence in chem- ical-specific BEs, and (v) key requirements for effective communication with health care professionals. While the risk communication literature specific to biomonitoring is sparse, many of the concepts devel- oped for traditional risk assessments apply, including transparency and discussions of confidence and uncertainty. Communication of BEs will require outreach, education, and development of communication materials specific to several audiences including the lay public and health care providers. Ó 2008 Elsevier Inc. All rights reserved. 1. Introduction The traditional risk assessment paradigm for evaluating health risks associated with exposure to environmental chemi- cals—a four-step process including hazard identification, expo- sure assessment, dose–response evaluation and risk characterization—has been in use for over two decades (NRC, 1983). A large body of literature on risk communication associ- ated with this paradigm is available. Interested parties, including regulators, health care providers, and the general public, have some familiarity with the types of information they obtain when 0273-2300/$ - see front matter Ó 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.yrtph.2008.05.007 * Corresponding author. E-mail address: shays@summittoxicology.com (S.M. Hays). Regulatory Toxicology and Pharmacology 51 (2008) S16–S26 Contents lists available at ScienceDirect Regulatory Toxicology and Pharmacology journal homepage: www.elsevier.com/locate/yrtph