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Industrial Health 2003, 41, 320–326
Original Article
Plasma Cortisol Levels and Workers Exposed to Urban
Pollutants
Francesco TOMEI1*, Maria Valeria ROSATI1, Manuela CIARROCCA1,
Tiziana Paola BACCOLO1, Monica GABALLO1, Tiziana CACIARI1 and Enrico TOMAO2
1 University of Rome “La Sapienza”, Department of Occupational Medicine, Viale Regina Elena 336, 00161 2 Center for Aeromedical Evaluation and Occupational Medicine IML, ITAF, Rome, Italy Received January 28, 2003 and accepted August 4, 2003 Abstract: Studies on animals and human subjects have proposed that urban pollutants may cause
alterations of cortisol levels. The aim of this study is to evaluate whether police officers exposed to
urban pollutants and possible psycho-social stressors could be at risk for alterations on plasma
cortisol levels compared to a control group. Plasma cortisol levels were determined in 302 police
officers with outdoor activity and administrative workers with indoor activity. The subjects were
subdivided into three groups: “A” (non-smokers and non-drinkers), “B” (smokers), and “C” group
(drinkers). In male and female subjects of “A” and “C” groups and in female subjects of “B” group
the mean cortisol values were significantly higher in police officers compared to controls. The authors
hypothesise an effect on plasma cortisol levels in police officers exposed to chemical, physical and
possible psycho-social stressors.
Key words: Cortisol, Urban pollutants, Police officers, Stressors, Outdoor activity
Introduction
unleaded petrol had been introduced, a mixed regime existed in Italy at the time of this study (use of leaded and unleaded Studies on animals and human subjects have suggested petrol). Moreover, it is probable that anti-detonation additives that urban pollutants may cause an increase of cortisol levels: containing manganese are present in fuels. The use of benzene and toluene1), carbon monoxide2–4), and manganese5).
unleaded petrol is the cause for the increase of benzene in On the contrary, lead6) and zinc7) may cause a decrease of this hormone. Beside these physical agents such as noise8–11), In the period March–April 2001, the Municipality of the vibrations12) and psycho-social stressors13–15) could modify city in question monitored concentrations of PM10 (particulate matter 10 micrometers in diameter and smaller), The class of workers examined in this study were employees considered inhalable, in fixed stations located in districts of the Municipal Police of a big Italian city, for whom we with different intensities of traffic, registering mean monthly have already studied the environmental and biological levels values respectively of 60 µg/m3, 45 µg/m3 and 30 µg/m3 in of some urban pollutants16–19). Exposure dosage to benzene a Municipal park (http://www.comune.roma.it).
was (mean 7 hours) 10.7 µg/m3 for police officers but about The purpose of this study is to evaluate whether police three times lower (3.6 µg/m3) in controls16, 18). Though officers exposed to urban pollutants and possible psycho- social stressors could be at risk for alterations on cortisol *Correspondence: Prof. Francesco Tomei, Via Monte delle Gioie no. 13, levels compared with a control group.
00199 Rome, ITALYPhone: +39-0686203350, +39-0649912541Fax: +39-0686203178, +39-0649912554 Materials and Methods
Table 1. Main characteristics of police officers and controls of both
sexes belonging to “A” (non smokers-non drinkers), “B” (smokers),
and “C” groups (drinkers)
The research was carried out on a working population of 1000 Municipal Police employees. For admission to the study, all workers completed a questionnaire in the presence of a physician to identify non-occupational confounding factors, which contained the following points: sex, age, working life, duties performed and daily working time, recent use (and for six months previous to the taking of blood samples) of medicines, extra occupational exposure to paints, solvents, and pesticides, cigarette smoking habit (mean number of cigarettes smoked, years of subjection to the habit) and daily intake of alcohol (wine, beer, spirits).
In order to avoid the influence of confounding factors, subjects who regularly made use of oral contraceptives20, 21), subjects who referred continual exposure to solvents, paints and pesticides22, 23) and subjects that referred drinking and smoking habit at the same time were excluded from the study.
Subjects who referred to habitual consumption of spirits were Thus, 210 police officers (mean age 45.3 years, SD 7.5, min 32–max 62; mean working life 12.5 years, SD 7.1, min 2–max 33) and 183 controls (mean age 45.4 years, SD 7.2, min 31–max 62; mean working life 7.8 years, SD 4.7, min 2–max 26) were excluded from the study.
We divided all the remaining subjects (n° 607) into police officers and control subjects. The police officers exposed to urban pollutants worked on parking control, control of passages, and control of crossroads or roads with heavy traffic. The subjects doing indoor activities of an of glasses of wine or beer drunk daily (mean, SD, administrative and bureaucratic nature, at lesser level of exposure, were used as control group.
In “A” group including in the study 69 police officers All the police officers and controls worked for seven hours (37 men, 32 women) and 69 controls (37 men, 32 women) a day (daily working time from 8.30 AM to 3.30 PM) at least five days a week. No differences in working schedules In “B” group including in the study 23 police officers (11 (such as start time of work), no shift workers and/or night men, 12 women) and 23 controls (11 men, 12 women) (Table Smoking habit and drinking habit were evaluated separately In “C” group including 59 police officers (41 men, 18 to evaluate hormonal effects of tobacco smoke24, 25) and women) and 59 controls (41 men, 18 women) (Table 1).
alcohol consumption25) on plasma cortisol levels.
A 10 ml sample of venous blood was taken from each We subdivided the police officers and the control subjects worker at 8 in the morning, before they had eaten. Samples into three groups as follows: the “A” group included non- were kept in the workplace in a refrigerator at –4°C until smokers and non-drinkers; the “B” group included smokers; they were transferred (by means of a container and at the the “C” group included drinkers.
same temperature) to the laboratory, where they were Police officers belonging to the “A”, “B” and “C” groups immediately centrifuged and the serum was stored at –20°C were matched with control subjects by sex, age and working life (mean, SD, distribution) (Table1); the police officers in All the workers included in the study underwent RIA groups “B” and “C” were matched with controls respectively (radioimmunoassay) dosage of cortisol on the venous blood: also by the number of cigarettes smoked daily and the number the normal values of the test were the ones applied in our Table 2. Mean (SD) plasma cortisol values and number of police officers and
controls of both sexes belonging to “A” (non smokers-non drinkers), “B”
(smokers), and “C” groups (drinkers)
*P<0.05= with respect to controls. **P>0.05=with respect to controls.
laboratory, 50–250 ng/ml for both sexes (cortisol values at The laboratory did not know which samples came from In “A” group mean cortisol values were significantly higher the group of police officers and which from the control group, in police officers compared with the control group both in although both the physicians and the technicians knew how men and in women (respectively P=0.004, P=0.034) (Table 2). Into this group police officers and control subjects of All of the subjects consented to their personal details being both sexes with cortisol values outside the lower normal available, declaring that they had been made aware that this limit of our laboratory were not present. The number of data is ranked as “sensitive information”, and consented that male police officers with cortisol values outside the higher the data arising from the research protocol should be treated normal limit of our laboratory was not significant compared in an anonymous and collective way, with scientific methods to controls (respectively 3 police officers and 1 control).
and for scientific purposes in accordance with the principles The number of female police officers with cortisol values outside the higher normal limit of our laboratory were not significant compared to control subjects (respectively 1 police officers and 0 controls). The distributions of the cortisol Statistical analysis of the data was based on the calculation values in male and female police officers and control subjects of the mean, standard deviation, distribution, range and belonging to “A” group are shown respectively in Fig. 1 frequency according to the nature of the single variables.
The differences between the means were compared using In male police officers belonging to “B” group mean Student’s t Test for the unpaired data. Analyses of the variance cortisol values were not significant compared to controls (ANOVA) were done to compare the means between three (Table 2); in female subjects of the same group mean cortisol groups. The frequencies of the single variables were values were significantly higher in police officers compared compared using the chi-square test with Yates’ correction.
with control group (P=0.012) (Table 2). The number of The differences were considered significant when the P values male and female police officers and control subjects with were <0.05. The statistical analysis was done using the cortisol values outside the lower and higher normal limit of statistical program Solo-BMDP™ Statistical Software.
our laboratory were not present. The distribution of thecortisol values in female police officers and control subjects belonging to “B” group was significant (P=0.027). On the Industrial Health 2003, 41, 320–326
Fig. 1. Distribution of cortisol values (ng/ml) in police officers and
Fig. 2. Distribution of cortisol values (ng/ml) in police officers and
controls of male sex belonging to “A” group.
controls of female sex belonging to “A” group.
contrary the distribution of the cortisol values in male police officers and control subjects belonging to “B” group was In this study, to avoid the influence of diurnal rhythms of In the “C” group mean cortisol values were significantly the cortisol venous blood samples of all subjects higher in police officers compared to controls both in male included in the study were taken at 8 AM. In fact we and female subjects (respectively P=0.000; P=0.024) (Table considered the normal range of cortisol at 8 AM (50-250 2). The number of male and female police officers and controls with cortisol values outside the lower normal limit all the police officers and controls worked for seven of our laboratory were not present. The number of male hours a day (daily working time from 8.30 AM to 3.30 PM) police officers with cortisol values outside the higher normal at least five days a week. No differences in working schedules limit of our laboratory was not significant compared to (such as start time of work), no shift workers and/or night controls (respectively 6 police officers and 0 controls). The number of female police officers with cortisol values outside The fact that the differences between the means for exposed the higher normal limit of our laboratory was not significant workers and controls is significant suggests they may be of compared to controls (respectively 4 police officers and 0 some clinical relevance even when the mean is “numerically” controls). The distribution of the cortisol values in male and female police officers and control subjects belonging Non significant results achieved for mean and distribution to “C” group was significant (respectively P=0.005, P=0.024).
of cortisol values in male subjects belonging “B” group could No significant differences were from the analyses of the be due to the low number of subjects observed (Table 1).
variance (ANOVA) between mean cortisol values in police Our results confirm that the cigarette smoking habit can increase significantly plasma cortisol concentrations as happens in police officers of female sex belonging to the Discussion
smokers group (“B”). Tobacco smoke contains at least 3800xenobiotics, including nicotine which is considered a Considering that the subjects with the main confounding psychoactive compound. These effects are probably mediated factors were excluded from the study, and that the subjects via activation of central cholinergic receptors24). Clinical investigated were matched by sex, age and working life, studies, using a cigarette smoking as the source of nicotine, the data suggest the possibility that occupational exposure have shown the release of large but variable amounts of to urban pollutants in police officers could have an influence Data resulting from group “C” (drinker subjects) shown a significant increase of plasma cortisol levels in police Lead remains still an important urban pollutant despite officers compared to controls of both sexes. Studies on the gradual abolition in Italy of fuels containing lead the animals and human subjects have found that alcohol ingestion principal emission source of that metal in urban areas.
activates the autonomic nervous system and the Exposure to lead determined in workers, compared to control hypothalamic-pituitary-adrenal axis with increase of cortisol groups, a decrease in plasmatic cortisol levels6).
In human subjects Brandao-Neto et al. (1990) detected The action mechanisms of chemical and physical agents, an acute inhibitory effect of zinc on cortisol secretion during present also as urban pollutants and able to modify cortisol levels, are still uncertain. Studies on animals and human One can suppose that besides agents of chemical nature, subjects have led to the hypothesis that exposure to chemical noise and vibration also could cause alterations in plasma and physical agents could increase1–5) or decrease6, 7, 12) cortisol cortisol. In subjects exposed to noise plasma cortisol levels levels probably in relation to the doses, modality and time showed a brief significant increase during the exposure period8). Our previous researches revealed that exposure of Benzene and toluene possess neurotoxic and immunotoxic about 15 minutes to noise of intensity between 105 and 108 effects. Studies on laboratory animals exposed to benzene dBA, with maximum intensity of frequencies between 2000 and toluene reported an increase of plasma cortisol levels and 4000 Hz is able to provoke a significant increase in probably through an excitatory effect on hypothalamic- plasma levels of cortisol compared with values measured pituitary-adrenocortical axis (HPA-axis)1). It is well known before and after acoustic stimulation10). In workers exposed that personal exposure to benzene, toluene and other aromatic to the low frequency of noise were found increased cortisol hydrocarbons from direct exposure to traffic fumes, as salivary levels11). On the contrary, Fruhstorfer and co-workers experienced by some categories of outdoor workers, such (1988) have evaluated industrial noise exposure effects on as police officers, may be considered higher than personal the release of pituitary hormones in human subjects: it has exposure of indoor workers (particularly in our cities)26).
been impossible to ascertain a noise stress influence on For this reason in our previous researches we have studied cortisol secreting models27). In subjects exposed to vibrations exposure dosage to benzene, toluene and other aromatic has been showed a reduction in plasma cortisol levels12).
hydrocarbons in Municipal Police employees of the city in It has been demonstrated that psycho-social stressors alter question. Time weighted average (TWA) exposure to benzene cortisol levels13, 14). It is well know that police officers are a (mean 10.7 and 3.6 µg/m3, respectively) and to toluene (mean working population exposed to stress28). The constant 40.7 and 13.5 µg/m3, respectively) was significantly higher attention required of police officers in a noisy, polluted, badly among police officers than among indoor workers16–19). Since lit and at times chaotic environment such as the street, requires previous studies have already measured the environmental constant application. Contact with the public, difficult and biological levels in our working population and it is conditions (illegality, tickets, arguments, accidents, injuries) well known that police officers’s exposure dosage is certainly doesn’t make the job easy or healthy. Therefore, significantly higher than controls, we didn’t repeat the stress for Municipal Police constables may be due to relations with citizens, exposure to criminal events or to the necessity From studies carried out on laboratory animals exposed to maintain high levels of performance in various contexts.
to carbon monoxide (CO), plasma levels of cortisol and In a previous study we have analysed subjective stress in adrenocorticotropic (ACTH) hormone were increased Municipal Police employees. To this end, we administered probably through a direct stimulation of central nervous the Rapid Stress Assessment scale (RSA): total RSA score system by hypoxia of tissues2, 3). In human CO exposure were found to be significantly higher in police officers produced significant activation of the HPA axis, as measured compared to controls29). These data induce to suppose that with plasma cortisol4). Our current research have revealed a cumulative effect may exist for different stressors able to an increase in plasma ACTH in police officers exposed to determine high or low plasma cortisol concentrations.
urban pollutants compared with control subjects.
Moreover, the result obtained in smokers (B group) and Alessio et al. (1989) found cortisol and prolactin (PRL) drinkers (C group) police officers compared with controls, levels significantly higher in workers exposed to low doses make one hypothesise an interactive effect of the diverse of manganese5). Our current research have showed an environmental and psycho-social stressors for the diverse increase in plasma PRL in police officers exposed to urban life-styles (such as smoking habit and drinking habit).
Industrial Health 2003, 41, 320–326
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Industrial Health 2003, 41, 320–326

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