Please cite this article in press as: Ha, M., et al., Korean Environmental Health Survey in Children and Adolescents (KorEHS-C): Survey design and pilot study results on selected exposure biomarkers. Int. J. Hyg. Environ. Health (2013), http://dx.doi.org/10.1016/j.ijheh.2013.06.001 ARTICLE IN PRESS G Model IJHEH-12697; No. of Pages 11 International Journal of Hygiene and Environmental Health xxx (2013) xxx–xxx Contents lists available at SciVerse ScienceDirect International Journal of Hygiene and Environmental Health journa l h om epage: www.elsevier.com/locate/ijheh Korean Environmental Health Survey in Children and Adolescents (KorEHS-C): Survey design and pilot study results on selected exposure biomarkers Mina Ha a,∗ , Ho-Jang Kwon a , Jong-Han Leem b , Hwan-Cheol Kim b , Kee Jae Lee c , Inho Park d , Young-Wook Lim e , Jong-Hyeon Lee f , Yeni Kim g , Ju-Hee Seo h , Soo-Jong Hong h , Youn-Hee Choi i , Jeesuk Yu j , Jeongseon Kim k , Seung-Do Yu l , Bo-Eun Lee l a Department of Preventive Medicine, Dankook University College of Medicine, Dandae-ro 119, Cheonan, Korea b Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, Korea c Department of Information Statistics, College of Natural Science, Korean National Open University, Seoul, Korea d Department of Statistics, College of Natural Science, Pukyong National University, Busan, Korea e Institute for Environmental Research, Yonsei University, Seoul, Korea f Institute of Environmental Safety and Protection, NeoEnBiz Co., Bucheon, Korea g Department of Adolescent Psychiatry, National Center for Child and Adolescent Psychiatry, Seoul National Hospital, Seoul, Korea h Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea i Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea j Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea k Cancer Epidemiology Branch, National Cancer Center, Goyang, Korea l Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea a r t i c l e i n f o Article history: Received 14 September 2012 Received in revised form 27 May 2013 Accepted 4 June 2013 Keywords: Environmental Health Survey Children and adolescents Framework Sampling strategy Human biomonitoring Pilot study a b s t r a c t For the first nationwide representative survey on the environmental health of children and adolescents in Korea, we designed the Korean Environmental Health Survey in Children and Adolescents (KorEHS-C) as a two-phase survey and planned a sampling strategy that would represent the whole population of Korean children and adolescents, based on the school unit for the 6-19 years age group and the household unit for the 5 years or less age group. A pilot study for 351 children and adolescents aged 6 to 19 years in elementary, middle, and high school of two cities was performed to validate several measurement methods and tools, as well as to test their feasibility, and to elaborate the protocols used throughout the survey process. Selected exposure biomarkers, i.e., lead, mercury, cadmium in blood, and bisphenol A, metabolites of diethylhexyl phthalate and di-n-butyl phthalate and cotinine in urine were analyzed. We found that the levels of blood mercury (Median: 1.7 ug/L) and cadmium (Median: 0.30 ug/L) were much higher than those of subjects in Germany and the US, while metabolites of phthalates and bisphenol A showed similar levels and tendencies by age; the highest levels of phthalate metabolites and bisphenol A occurred in the youngest group of children. Specific investigations to elucidate the exposure pathways of major environmental exposure need to be conducted, and the KorEHS-C should cover as many potential environmental hazards as possible. © 2013 Elsevier GmbH. All rights reserved. Introduction Children and adolescents are biologically vulnerable and the priority population for an environmental health policy. Although biomonitoring projects to establish an environmental health pol- icy, based on national environmental health indices using national ∗ Corresponding author at: Department of Preventive Medicine, Dankook Univer- sity College of Medicine, Dandae-ro 119, Cheonan, Chungnam, Korea, 330-714. E-mail address: minaha@dku.edu (M. Ha). monitoring data, have been performed in many countries (Angerer et al., 2012; Joas et al., 2012; Kolossa-Gehring et al., 2012; Haines and Murray, 2012; Calafat, 2012), including South Korea (Lee et al., 2012), there has been limited information for children and adolescents in South Korea. The project initiated by the Min- istry of Environment, Korea, “Children’s Health and Environmental Research (CHEER)” (2005∼2010) (Ha et al., 2009), was a longitudi- nal cohort study repeatedly followed to examine the relationship between environmental exposure and health, and it allowed us to see the exposure status and prevalence of environment-related diseases and their trends in children nationwide. The limitation, 1438-4639/$ – see front matter © 2013 Elsevier GmbH. All rights reserved. http://dx.doi.org/10.1016/j.ijheh.2013.06.001