Background Studies carried out by national and regional authorities have shown high levels of certain pollutants – above limits set by EU regulation - near industrial plants and landfills in Italy. In some of these areas, where the consumption of locally grown foodstuffs is common, there is a real risk of an exposure to persistent organic pollutants (POPs). Persistent Organic Pollutants (POPs) are a group of organic chemicals of anthropogenic origin that are toxic to both humans and wildlife. Because of their physical and chemical properties, POPs are characterised by high environmental and biological persistence. Once released into the environment, they remain intact for years and can be transported over long distances through natural processes involving soil, water, and air, resulting in widespread distribution including in regions where they have never been produced or used. In addition, POPs have the ability to bio-accumulate in organisms and bio-magnify through food webs. They are readily absorbed in fatty tissues of living organisms and reach their highest concentrations at the top of food chains. Diet accounts for over 90% of total exposure to POPs. Fatty foods of animal origin (meat, fish, and dairy products) are the major sources of intake of POPs. Toxic effects of most POPs include cancer and adverse effects on the nervous, reproductive, and immune systems. Some POPs are also known or suspected endocrine disrupters, capable of altering the hormonal system and, as a consequence, damaging the reproductive and immune systems of exposed individuals. Human biomonitoring (HBM) represents the most straightforward and effective approach to assess the extent of exposure of the general population, population groups and individuals to environmental toxins like POPs. HBM provides an integrated measure of the internal dose of pollutants resulting from all exposure routes and sources over time. In spite of this advantage, HBM data are scarce due to ethical and practical problems. Analysis of POPs in biological samples is costly, time-consuming and requires highly sensitive and specific techniques. Moreover, available data are generally of poor comparability because they are obtained from different study designs and expressed in different concentration units. Gathering more consistent POP exposure data via HBM will help create a powerful tool to assess whether ‘overexposure’ is ongoing, or has occurred in the past. Objectives The WOMENBIOPOP project aimed to respond to the increasing demand for information on POP exposure level (from environmental origins). It focused on a subpopulation covering women of reproductive age (20-40 years), whose exposure to POPs was assessed through biomonitoring. Project actions aimed to analyse POP blood concentrations and determine the ‘internal dose’ of selected contaminants resulting from all exposures sources and routes. Areas with different exposure zones were to be identified in nine regions and different monitoring plans would be drawn up, according to the level of industrial activity. At least 50 women, including young mothers, were to be enrolled in each area. A network of local sanitary units and environmental units was planned, under the co-ordination of the ISS and the Italian department of environment. The study was to be selected on the basis of available data on POPs concentrations and carried out in co-operation with sanitary units in charge of enrolment and blood testing. Each participant would sign an informed consent form and compile a questionnaire on exposure and medical history. Answers were to be analysed by epidemiologists. Analytical work would be carried out in line with those used at EU level to allow comparability with studies carried out in other Member States. Since diet accounts for more than 90% of human exposure to POPs, analysis of blood concentration data would take into account dietary habits documented in the questionnaires. Results were to be communicated to the local population through local sanitary units. Results The WOMENBIOPOP project’s studies provided a successful response to the increasing demand for information about the level of human exposure to POPs. Outcomes led to the creation of a national database on environment and health data, establishment of background levels, characterisation of spatial patterns and identification of at-risk populations, as well as examination of changes in POP body concentrations over time. The project is the first example of any such HBM study on POPs in Italy that uses consistent design approaches and application methods. Study approaches, designs and methods employed were fully in line with those used at EU-wide level. This facilitates very good comparability with on-going and future studies carried out in EU Member States. It has also been the first HBM study on POPs involving a network of sanitary units and specialists representing regions at different geographical latitudes, different socio-demographic contexts, and exposure situations. The project approach thus allowed national health authorities to build up for the first time a country-wide database of reliable and comparable data about the ‘internal exposure’ of women of childbearing age. It also provided information to be used to: (i) quantitatively predict in-utero exposure during pregnancy; (ii) monitor the cohort of enrolled babies as to possible health outcomes specifically related to the POPs of interest; (iii) begin to establish nationally representative values for POPs; and (iv) provide a baseline for emerging trends. Analysis of the project’s nation-wide biomonitoring study determined the ‘internal dose’ of selected POPS contaminants for 749 women of childbearing age and 200 babies in six regions in Italy (Trentino Alto Adige, Piemonte, Sicily, Umbria, Lazio and Puglia). The following analyses were assessed: - Non dioxin-like PCBs: nine congeners at greatest abundance, including the six so called ‘indicator’ PCBs; - Dioxin-like PCBs: 12 dioxin-like congeners; - PBDEs: six congeners of major abundance and toxicological significance; - Pesticides: HCB, DDE and beta-HCH; - PCDDs and PCDFs: 17 congeners; and - PFOS and PFOA. A database of more than 45 000 analytical data was produced by the LIFE project. This is considered to be Italy’s widest database on POP concentrations in women of reproductive age. It fills a knowledge gap about POP levels in the general population. Previous data referred only to small population samples and lacked comparability. What’s more, no data at all was available in other regions. Analyses of the study data showed that in general, serum concentrations of POPs were higher in Northern Regions with an industrial history. Women residing in rural areas tended to be exposed to dioxins and pesticides more than women residing in urban areas, and even in the industrial areas considered. While this is quite reasonable for pesticides, the result is quite surprising for dioxins. Lifestyle factors, such as indoor burning of biomass, and agricultural practices, are thought to be responsible for this comparatively higher observed exposure. In addition, POP levels were shown to be highly correlated with age, thus, future HBM should be planned to strictly stratify groups by age. The bifocal/trifocal approach used in the study was also shown to be adequate to detect spatial trends within Regions and may be easily applied in further studies. Useful lessons learned during the project included the importance of using well-tested, fit-for-purpose equipment and integrated time planning for sampling and analysis. Training was applied to help reduce error-rates and increase efficiency. Other project experiences of interest reconfirmed that communication is a critical issue in biomonitoring. In this regard, some problems were encountered linked both to lack of trust in institutions and to difficulties in communicating the notion that POP presence in a human body is not necessarily linked to illness. In addition, experience showed that local decision makers' fears on how to manage public communication matters could represent a problem. In some cases it led to the withdrawal of some Regions from the project (early on) while in others it significantly delayed the organisation of events to communicate the results to local populations in the final phase of the project. Regarding policy, benefits from the project’s methodology relate to its ability to provide homogeneous and reliable data for: evaluating geographical and temporal trends; identifying hot spots in need of national and EU level policy intervention; and informing associated risk management decisions. However, policy makers’ reactions to the study findings differed – ranging from lack of action based on concerns about controlling public health scares in some areas, to proactive measures being launched in other areas through follow-up studies. This new work is expected to involve more in-depth investigations to understand the reasons why some areas of contamination that were identified by the LIFE project (e.g. PBDEs) were above certain thresholds. Results of the new work could lead to stricter controls against environmental pollution and remediation actions may also be needed to improve environmental quality. Further information on the project can be found in the project's layman report and After-LIFE Communication Plan (see "Read more" section).