Annals of Occupational and Environmental Medicine

Original article

Association between delivery-food consumption frequency and urinary bisphenol concentrations among Korean adults: a nationally representative study (Korean National Environmental Health Survey cycle 5, 2021–2023): Gwisang Park, Hyeyun Lee, Inchul Jeong, Eunhee Ha, Kihun Kim; Ann Occup Environ Med 2026;e37. Published online July 30, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e37 [Accepted]

Abstract PDF: Background
Bisphenol exposure remains a public health concern, particularly as the use of bisphenol analogues such as bisphenol S (BPS) has increased. In the post-pandemic period, delivery-food consumption has become routine in South Korea and may represent an important behavioral pathway for bisphenol exposure. This study examined whether delivery-food consumption in plastic containers is associated with urinary bisphenols among Korean adults.
Methods
This study used adult data from the Korean National Environmental Health Survey (KoNEHS) cycle 5 (2021–2023). Delivery-food consumption frequency (nine categories) was modeled per 1-time-per-month increase. Outcomes were urinary bisphenol A (BPA), BPS, and bisphenol F (BPF). Creatinine-adjusted concentrations were analyzed on the natural log scale using multivariable regression models. Model 1 adjusted for sociodemographic factors, and model 2 additionally adjusted for plastic-related behavioral variables.
Results
Among 4,275 adults with complete bisphenol and urinary creatinine data, delivery-food consumption frequency was positively associated with creatinine-adjusted urinary BPS concentrations (1.49% increase per 1-time-per-month increase; 95% confidence interval [CI]: 0.74–2.24; p < 0.001) after sociodemographic adjustment, whereas associations with BPA (0.32% increase; 95% CI, −0.45 to 1.09; p = 0.416) and BPF (−0.14% change; 95% CI: −1.18 to 0.90; p = 0.787) were not statistically significant. After additional adjustment for plastic-related behavioral variables in model 2, the association remained statistically significant for BPS (1.54%; 95% CI, 0.76–2.33; p < 0.001), whereas the associations with BPA and BPF remained non-significant.
Conclusions
More frequent consumption of delivery foods packaged in plastic containers was independently associated with higher creatinine-adjusted urinary BPS concentrations. Given that common delivery container polymers in Korea are generally bisphenol-free, this association suggests that delivery-related behavior serves as a behavioral surrogate for a bundled exposure scenario. The observed BPS signal may partly reflect cumulative exposure from ancillary materials, such as thermal receipts and labels. Future studies should identify specific delivery-associated sources and migration pathways of bisphenols.

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Review

A work-relatedness assessment in epidemiological case investigation of occupational cancers: II. Practice: an upper urinary tract cancer in a dyer: Kihun Kim, Hyeoncheol Oh, Jungwon Kim; Ann Occup Environ Med 2020;32:e31. Published online September 1, 2020; DOI: https://doi.org/10.35371/aoem.2020.32.e31

Abstract PDF: An epidemiological case investigation of occupational cancer is conducted to determine the causation between the cancer and the worker's job. This review describes the overall process of work-relatedness assessment of the epidemiological case investigation through a case of upper urinary tract cancer (UUTC) in benzidine exposed worker in dyeing industry. Medical referrals, occupational history, material safety data sheet, and working environment monitoring submitted by the Korea Workers' Compensation and Welfare Service were reviewed. We further investigated literatures about the cotton dyeing industry, the domestic law and working environment monitoring reports. Benzidine was listed as an International Agency for Research on Cancer risk factor only for bladder cancer among urinary tract cancers, requiring different logical grounds for establishing causation. A literature review was conducted on the metabolic pathways of benzidine to establish biological plausibility. In addition, several papers were investigated that UUTC and bladder cancer share risk factors to extrapolate the epidemiological studies of bladder cancer. Epidemiologic studies of benzidine and bladder cancer were investigated. The worker is a 71-year-old man and performed dyeing and transporting at several dyeing factories for 29 years. The worker was diagnosed with UUTC based on radiologic and histologic results. It was critical to consider that he worked as a dyer for 3 years. The cancer was diagnosed in 2018, with a latent period of approximately 35 years. The worker performed cotton dyeing, and benzidine-based dye was mainly used. The quantitative exposure level of benzidine was reported from non-detection to 397.4 µg/m³. In biological metabolisms, N-acetylhydroxylamine changes DNA structure of urothelium. As a result of reviewing 4 epidemiological studies, the standardized incidence ratio and standardized mortality ratio were significantly high with 3 years of exposure. Work-relatedness was finally assessed as probable based on biological mechanisms and epidemiological evidence. This review will help solutions for work-relatedness assessment processes.

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Review

A work-relatedness assessment in epidemiological case investigation of occupational cancers: I. Principles: Kihun Kim, Jungwon Kim; Ann Occup Environ Med 2020;32:e30. Published online September 1, 2020; DOI: https://doi.org/10.35371/aoem.2020.32.e30

Abstract PDF

It is important to identify the causal relationship between occupational exposure and the disease in the area of compensation because most cancers have long latent period. This review presents the principles that should be considered when evaluating the work-relatedness. We reviewed reports on occupational cancers published by the International Agency for Research on Cancer, American Conference of Governmental Industrial Hygienists, National Toxicology Program, Environmental Protection Agency, European Union, which are the world's most prestigious organizations. In addition, we reviewed relevant papers and books published in Korea. The process is conducted in the order of cancer diagnosis, exposure assessment for carcinogens, and work-relatedness assessment. The probability of causation is determined stochastically rather than deterministically. There is no absolute standard for accreditation criteria and results may vary according to expert opinions and in each country or organization. Revealing the causal relationship of occupational cancers is a difficult process owing to inconsistency in relevant epidemiological studies, lack of well-established biological mechanisms, loss of objective occupational historical data, and other complexity of individual cases. Causation is unclear in many cases. Nevertheless, the data should be reviewed in detail for each case suspected of work-related cancers, and an assessment should be made through valid and plausible logic and literature evidences.

Citations

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Feasibility of acquiring occupational data from cancer patients’ medical records in Malaysian oncology centres
Nadia Mohamad, Sakshaleni Rajendiran, Nurul Amalina Khairul Hasni, Nik Muhammad Nizam Nik Hassan, Rafiza Shaharudin, Ros Suzanna Ahmad Bustamam, Nolia Luhong Bilang, Mohd Azahadi Omar, Nik Khairol Reza Md Yazin, Rohaida Ismail
BMC Public Health.2025;[Epub] CrossRef
Technetium-99m hand perfusion scintigraphy (Raynaud’s scan) as a method of verification in hand arm vibration syndrome: a review
Taewoong Ha, Hyeoncheol Oh, Jungwon Kim
Annals of Occupational and Environmental Medicine.2022;[Epub] CrossRef

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Research Article

Effects of job stress on symptoms of bipolar spectrum disorder in an electronic parts manufacturing company: Hyeonchoel Oh, Kihun Kim, Taewoong Ha, Jungwon Kim; Ann Occup Environ Med 2020;32:e25. Published online July 13, 2020; DOI: https://doi.org/10.35371/aoem.2020.32.e25

Abstract PDF

Background

Mental illness is known to be caused by genetic, biological, and environmental risk factors. Although previous studies have established the link between mental illness and job stress, most of them are limited to major depression disorder. Therefore, this study examined the relationship between job stress and bipolar spectrum disorder (BSD).

Methods

This is a cross-sectional study based on a survey conducted in April 2017 at an electronic parts manufacturing company in Busan. In a total of 441 workers, the degree of BSD was identified using the Korean version of the Mood Disorder Questionnaire, and the degree of job stress was identified using the Korean Occupational Stress Scale Short Form. This study also identified general characteristics of workers and job-related factors. The χ² test and Fisher's exact test was conducted to determine the differences among the variables, based on BSD. Multiple logistic regression analysis was conducted to determine the influence of independent variables on BSD.

Results

Cross-analysis showed significant differences between the BSD high-risk and low-risk groups regarding age, sex, occupation, smoking, problem drinking, job stress total score, occupational climate, and major depression disorder symptom. In addition, the significant differences between the BSD high-risk and low-risk groups about job stress were observed in terms of job demand, job insecurity, and occupational climate. A multiple logistic regression analysis revealed that the high-risk group in the job stress group had a higher effect on BSD than the low-risk group (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.10–4.88). Among the categories of job stress, high-risk groups in 3 areas—job demand (OR: 2.56, 95% CI: 1.27–5.17), job insecurity (OR: 4.42, 95% CI: 1.19–16.42), and occupational climate (OR: 2.55, 95% CI: 1.29–5.05)—were more likely to have an impact on BSD than the low-risk groups.

Conclusions

This study demonstrated that the high-risk groups of job stress total score, job demand, job insecurity, and occupational climate had a more significant effect on BSD than the low-risk groups. As workers with BSD may have difficulties in their work and personal lives, there is a need to manage job stress to prevention of BSD.

Citations

Citations to this article as recorded by

A Cross‐Sectional Analysis of Social Determinants of Health in Bipolar Disorder: Exploring Gender‐Related Differences
Manuel Gardea‐Resendez, Manuel Fuentes‐Salgado, Francisco Romo‐Nava, Miguel L. Prieto, David J. Bond, Aysegul Ozerdem, Hannah K. Betcher, Katherine M. Moore, Melissa Solares‐Bravo, Mete Ercis, Alessandro Miola, Jorge A. Sanchez‐Ruiz, Marin Veldic, Balwind
Bipolar Disorders.2025; 27(8): 545. CrossRef
Job retention for people with bipolar disorder: A qualitative analysis
Elise Marion‐Paris, Emma Beetlestone, Raphaël Paris, Mouloud Bouhadfane, Antoine Villa, Marie‐Pascale Lehucher‐Michel
Scandinavian Journal of Psychology.2023; 64(2): 171. CrossRef
The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management
Roger S. McIntyre, Martin Alda, Ross J. Baldessarini, Michael Bauer, Michael Berk, Christoph U. Correll, Andrea Fagiolini, Kostas Fountoulakis, Mark A. Frye, Heinz Grunze, Lars V. Kessing, David J. Miklowitz, Gordon Parker, Robert M. Post, Alan C. Swann,
World Psychiatry.2022; 21(3): 364. CrossRef

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