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Health risk assessment of exposure to benzene, toluene, ethylbenzene, and

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Article in Human and Ecological Risk Assessment · January 2023

DOI: 10.1080/10807039.2023.2167193

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Health risk assessment of exposure to benzene,

toluene, ethylbenzene, and xylene (BTEX) in a
composite manufacturing plant: Monte-Carlo
simulations

Amir Hossein Khoshakhlagh, Masoud Askari Majdabadi, Saeid Yazdanirad &

Lars Carlsen

To cite this article: Amir Hossein Khoshakhlagh, Masoud Askari Majdabadi, Saeid Yazdanirad
& Lars Carlsen (2023): Health risk assessment of exposure to benzene, toluene, ethylbenzene,
and xylene (BTEX) in a composite manufacturing plant: Monte-Carlo simulations, Human and
Ecological Risk Assessment: An International Journal, DOI: 10.1080/10807039.2023.2167193

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HUMAN AND ECOLOGICAL RISK ASSESSMENT: AN INTERNATIONAL JOURNAL
https://doi.org/10.1080/10807039.2023.2167193

Health risk assessment of exposure to benzene, toluene,

ethylbenzene, and xylene (BTEX) in a composite
manufacturing plant: Monte-Carlo simulations
Amir Hossein Khoshakhlagha , Masoud Askari Majdabadib,
Saeid Yazdaniradc,d , and Lars Carlsene
a
Department of Occupational Health, School of Health, Kashan University of Medical Sciences, Kashan,
Iran; bDepartment of Occupational Health, School of Public Health, Tehran University of Medical
Sciences, Tehran, Iran; cSocial Determinants of Health Research Center, Shahrekord University of
Medical Sciences, Shahrekord, Iran; dSchool of Health, Shahrekord University of Medical Sciences,
Shahrekord, Iran; eAwareness Center, Roskilde, Denmark

ABSTRACT ARTICLE HISTORY

This study aimed to assess the possible non-cancer and cancer risks Received 30 September 2022
associated with BTEX in a composite manufacturing plant for the first Revised manuscript
time. Air samples of BTEX were gathered from the breathing zone of Accepted 7 January 2023
participants based on the method of NIOSH 1501 using an adsorbent
KEYWORDS
tube containing activated coconut charcoal and a pump at the recom- BTEX; carcinogenic and
mended flow rate between 50 and 200 milliliters per min. After the non-carcinogenic risks;
preparation, the samples were analyzed using GC mass spectrometry. occupational exposure; air
To evaluate the non-cancer and cancer risks of the pollutants, the pollution; composite
method proposed by the United States environmental protection
agency (USEPA) was applied. The mean concentrations of BTEX were
found lower than the threshold limit values (TLV). The non-carcino-
genic risk values of benzene, ethylbenzene, and xylene were found to
be 46.00, 6.96, and 22.4 times, respectively, higher than the threshold
levels set by the US EPA. Whereas the risk of toluene was lower than
the acceptable limit. Moreover, the results point to a specific risk of
cancer for the workers exposed to benzene and ethylbenzene in this
industry, indicating a potential for 1.66 and 1.91 additional cases per
100 workers exposed to benzene and ethylbenzene, respectively.

Introduction
Benzene, toluene, ethylbenzene, and xylene (BTEX) are compounds with health effects.
That is found in both the external environment (Carlsen et al. 2018) and the occupational
environment (Carlsen et al. 2018, Martins et al. 2019). Inhalation exposure to benzene,
toluene, ethylbenzene, and xylene (BTEX) is one of the most ubiquitous harmful agents in
workplaces (Bolden et al. 2015). Benzene, toluene, ethylbenzene, and xylene (BTEX) are
the most common volatile compounds (VOCs) (Rad et al. 2014). Prolonged exposure to
BTEX may cause serious health effects (Yousefian et al. 2018). The results of toxicological
studies have shown that all compounds of BTEX are neurotoxins, hepatotoxins, and

CONTACT Saeid Yazdianirad saeedyazdanirad@gmail.com Social Determinants of Health Research Center,

Shahrekord University of Medical Sciences, Shahrekord, Iran.
ß 2023 Taylor & Francis Group, LLC
2 A. H. KHOSHAKHLAGH ET AL.

irritants (Kuranchie et al. 2019). Also, these compounds cause significant cognitive and
behavioral effects among exposed persons (Santiago et al. 2014). Significant pulmonary
impairments have also been reported due to exposure to BTEX (Moradkhani et al. 2022).
Other non-carcinogenic effects due to exposure to BTEX on human health include aller-
gies, heart disease, liver disorders, and kidney disorders (Thurston et al. 2016). In addition
to the non-carcinogenic consequences, the BTEX compounds benzene and ethylbenzene
are associated with carcinogenicity, whereas studies on xylenes are partly inconclusive
whereas carcinogenicity of toluene is generally not supported by human and animal stud-
ies (Chaudhary and Kumar 2012). Hence, benzene has been categorized as a group 1 A
carcinogen and ethylbenzene as a group 2B (Chaudhary and Kumar 2012). The results of
the epidemiological studies indicate that chronic exposure to benzene and ethylbenzene
increases the risk of leukemia, aplastic anemia, cancer of the blood-forming organs, and
lung cancer (Janitz et al. 2017, Seifi et al. 2019, Partovi et al. 2018).
Given to stated effects, exposure to BTEX, particularly through inhalation, is one of
the major health concerns in workplaces (Yimrungruang et al. 2008). For regulatory
purposes, risk assessment is required to increase awareness of human health by predict-
ing the adverse health effects in working environments (Gao et al. 2004). Based on the
definition of the national research council (NRC), risk assessment is the “determination
of the potentially harmful health effects due to human exposures to hazards in the
environment (Ramırez et al. 2012). Therefore, risk assessment is an essential tool for
predicting the adverse health effects of exposure to chemical compounds that can be
used in studies to evaluate the effects of various substances. Risk assessment comprises
four steps, including hazard identification, dose-response assessment, exposure assess-
ment, and risk determination (Cai et al. 2018). In this technique, the risk is computed
by a combination of exposure and dose-response data on chemical substances. Personal
exposure can be estimated by direct measurement of the specific air pollutants in the
breathing zone of a worker, as one of the most reliable ways (Nieuwenhuijsen et al.
2006). Dose-response data also can be extracted from the United States environmental
protection agency (USEPA) (Barnes and Dourson 1988). After computing the score of
risk, the probability of adverse health effects is determined.
Several studies have evaluated cancer and non-cancer risks of airborne BTEX in dif-
ferent working environments. Hosseini et al. investigated the cancer risk of exposure to
benzene in two rubber tire manufacturing plants and concluded that there was an
unacceptable risk (Hosseini et al. 2014). Rostami et al. examined health risk exposure to
BTEX in printing and copying centers. The results of this study showed that the non-
caner and cancer risks of these compounds were higher than the limits recommended
by the environmental protection agency (EPA) (Rostami et al. 2021). Borhani et al. eval-
uated health risk assessment BTEX in the production of insulation bituminous and con-
cluded that occupational exposure of workers at bituminous production units to
benzene and toluene compounds might increase the risk of health effects for them
(Borhani and Noorpoor 2017). Watchalayann studied the health risk of volatile organic
compounds among workers at the gas service station. The results of this study indicated
that benzene may be the most important cause of both cancer and noncancer risk
(Yimrungruang et al. 2008). Composite manufacturing plants are typically workplaces
where workers potentially may be exposed to high concentrations of BTEX due to the
 HUMAN AND ECOLOGICAL RISK ASSESSMENT: AN INTERNATIONAL JOURNAL 3

use of resins and paints in the production process (Belouadah et al. 2020). Further, the
use of various organic compounds as well as solvents at elevated temperatures constitute
a major source of BTEX (Moridzadeh et al. 2020). The health risk of BTEX exposure in
the composite industry has not previously been investigated. The present study focuses
for the first time on the possible non–cancer and cancer risks associated with BTEX in
a composite manufacturing plant in the center of Iran.

Materials and methods

The data for the study were collected on all workers of a composite industry (29 sub-
jects) in 2022, where the production process and raw materials were surveyed with the
help of local experts from the plan to identify sites associated with possible exposure to
BTEX. Workers participated in this study voluntarily. All of them were asked to fill out
the consent form developed by the medical ethics committee, and written informed
consent was obtained from them.

Sampling site description

There are four units in this plant, consisting of resin making, production, grating, and
assembling. In the resin-making unit, raw materials, including resin, calcium, aluminum
carbonate powder, and paint are mixed and transferred to the next unit. In the production
unit, glass fibers are combined to prepare resin in the Paltrogen device and transmitted to
the part of the curing process (Jafarpour et al. 2008). In grating, glass fibers are passed
through the mesh plates and the resin material is poured on it followed by baking at a
temperature 85
C. Leading to the final composite product eventually the product is cut to
the desired size in the assembling unit and transported to the warehouse for packaging.
One of the probable resources of exposure to BTEX is the use of resins and paints in the
process. Moreover, heating the material containing the solvent can increase the emission
of BTEX vapors in the air of workplaces. At the composite factory, two persons were
working in resin making, eight persons in the production unit, eight persons in the grating
unit, and eleven in assembling all of them were studied.

Air sampling and exposure assessment

Sampling method
Air samples of BTEX were obtained from the breathing zone of the participating work-
ers based on the NIOSH 1501 method (Tulashie et al. 2016). Sampling was carried out
during the shift work in winter time by an adsorbent tube containing activated coconut
charcoal (front (100 mg) and rear (50 mg)) produced by SKC (Dehghani et al. 2018).
The adsorbent tubes were placed on the workers’ collars within the breathing zone and
the air was passed through it using a pump at the recommended flow rate between 50
to 200 milliliters per min (Dehghani et al. 2018). Sampling was performed by a personal
sampling pump of model AirChek TOUCH (5–5000 mL min1, SKC, Inc.). Initially, a
pretest was conducted to determine the breakthrough volume. Three samples were col-
lected from the breathing zone of each subject to cover the whole work shift. The
4 A. H. KHOSHAKHLAGH ET AL.

sampling time of each sample was adjusted to between 50 and 90 min. Following the
sampling, the adsorbent tubes were sealed with plastic caps and transferred into a cool
box for preventing sample leakage (Dehghani et al. 2018).

Sample preparation and analysis

In the laboratory, the single adsorbent tubes were broken and the contaminants were
chemically desorbed using 1 ml of carbon disulfide in extraction vials to complete extrac-
tion (60 min). Subsequently, 1 ll of the extract was injected into Gas chromatography-
Mass spectrometric (GC-MS) (GC: 7890; MS: 5975, Agilent Technologies, CA, USA) using
a syringe. Helium (flow rate of 1 ml/min) was used as carrier gas (Dehghani et al. 2018).
In addition to the authentic samples, a series of blank samples were analyzed to eliminate
errors during the analytical steps, i.e., sampling, transmitting, and preparing (Dehghani
et al. 2018).

Quality assurance/quality control (QC/QA)

The samples (field and bank) were placed in a cold box with ice packs (4
C) after sam-
pling and during transfer to the laboratory. In the laboratory also, those were kept in a
refrigerator at the temperature of 4
C until analysis. The research procedure was used to
analyze blank samples. For this purpose, the blank samples were opened at the sampling
site and then their ends were capped, transported, and analyzed to similar be to the main
samples. In addition, carbon disulfide (CS2), as the extraction solvent, was injected into
GC-MS three times and was analyzed. After that, the limit of detection (LOD) was speci-
fied (LOD ¼ 3.3  (standard deviation (SD) of the blanks/slope of the calibration curve))
(Desimoni and Brunetti 2015). Also, a pre-set concentration of BTEX was provided and
entered into the adsorbents (charcoal tubes). Then, the steps of extraction and analysis
were conducted like the samples, and the recovery percentage was computed three times.
The mean recovery percentage for BTEX was equal to 91 ± 12%.

Health risk assessment

There are different methods to assess the health risk of pollutants. Some of these tools
include air pollution health risk assessment (AP-HRA) (Hassan Bhat et al. 2021), chemical
risk management self-assessment model (Chem-SAM) (Karimi Zeverdegani et al. 2016),
University of Wollongong (UOW) risk assessment (Karimi Zeverdegani et al. 2016), semi-
quantitative risk assessment method (SQRA) (Karimi Zeverdegani et al. 2016), and non-
cancer and cancer health risk assessment method presented by US EPA (Tong et al. 2018).
Among these tools, only the method suggested by US EPA only can evaluate the risk of
carcinogenesis and non-carcinogenesis effect separately. This method is a comprehensive
technique, which quantitatively assesses risk and focuses on health effects due to exposure
to chemicals. This method, as a valid technique, has been widely used in previous studies
for assessing cancer and non-cancer risks in various work environments (Borhani and
Noorpoor 2017, Dehghani et al. 2018, Sadeghi-Yarandi et al. 2020, Harati et al. 2016,
Tunsaringkarn et al. 2012, Cheng et al. 2022, Chaiklieng et al. 2019). Hence, the EPA
method was selected to evaluate the non-cancer and cancer risks of the pollutants.
 HUMAN AND ECOLOGICAL RISK ASSESSMENT: AN INTERNATIONAL JOURNAL 5

Non-cancer health risk assessment using the US EPA method

To evaluate the non-cancer risk of the pollutants, the method proposed by the United
States environmental protection agency (USEPA) was applied, leading to a hazard quo-
tient (HQ) computed as the ratio between exposure to the pollutant (EC, mg/m3) and
its reference dose for non-carcinogenic effects (RfC), i.e., the maximum acceptable dose
for daily exposure (mg/m3):
HQ ¼ EC=RfC (1)
EC was calculated by the following equation (Tong et al. 2018):
EC ¼ ðC  ET  ED  EFÞ=AT (2)
where C is the concentration of pollutant (mg/m3); other variables are presented in
Table 1.
HQ equal to and less than 1 shows the absence of non-carcinogenic health effects
and HQ more than 1 revealed the presence of non-carcinogenic health effects (Sadeghi-
Yarandi et al. 2020).

Cancer health risk assessment using the US EPA method

To examine the cancer risk of the pollutants, the US environmental protection agency
(USEPA) method and its database (the integrated risk information system (IRIS)) was
applied, leading to the lifetime cancer risk (LCR) index. The value of the index was esti-
mated using Equation 3.
LCR ¼ CDI  SF (3)
where SF is the cancer slope factor (kg. day/mg) and CDI is chronic daily intake
(mg/kg/day). SF was extracted from the database of the IRIS (Vallero 2016, 2019). CDI
was also computed using equation 4 (Tong et al. 2018).
C  IR  ED  EF
CDI ¼ (4)
BW  AT
where C is the concentration of pollutant (mg/m3); other variables are presented in
Table 1.

Table 1. Variables used in non-carcinogenic and carcinogenic risk assessment.

Variable Description Value United Reference
C Concentration of pollutants – mg m-3 Sampling
IR Inhalation rate, adult 16 m3 day 1 EPA 2011
ET Exposure time 8–12 Hours day-1 Questionnaire
EF Exposure frequency 290–310 days years-1 Questionnaire
ED Exposure duration 28–32 years Questionnaire
BW Body weight 58–105 kg Questionnaire
RfC Reference concentration 0.03 for benzene mg m-3 IRIS
from inhalation 5.00 for toluene
1.00 for ethyl benzene
0.10 for xylene
AT Average lifetime 9000 Days (2009)
216000 Hours
SF Slope factor 0.029 for benzene (mg/kg-day)-1 IRIS
0.0087 for ethyl benzene
6 A. H. KHOSHAKHLAGH ET AL.

LCR greater than 104 is considered a definite risk, LCR between 104 and 105 as a
probable risk, LCR between 105 and 106 as a possible risk, and LCR less than 106 as
negligible risk (Zhang et al. 2018).

Monte-Carlo simulation and sensitivity analysis

There are some uncertainties in the issue of human health, which can lead to the loss of
important information and the creation of unrealistic and incorrect decisions. Monte Carlo
simulation (MCS), ad a probabilistic and statistical-mathematical approach, applies random
sampling of each parameter for investigating uncertainty and thereby decreasing this uncer-
tainty. To describe the uncertainty degree of the output variable, statistical indicators are
determined and their distribution function was identified. The general structure, as a com-
bination of simulations, is used for determining uncertainty by the Monte Carlo method.

Statistical analysis
Descriptive analyses were performed in Microsoft Excel software and the figures were
drawn in this software. For Monte Carlo simulation (MCS) in this study, Crystal Ball
software (version 11.1.2.4, Oracle, Inc., USA) was applied. The computations were per-
formed by 1,000 iterations, and the results were obtained with a confidence degree
between 1 and 99% (Badeenezhad et al. 2019). Probability distributions and percentiles
related to the non-cancer and cancer risk of exposure to the pollutants were obtained
by this software. Moreover, sensitivity analysis for non-cancer and cancer risk assess-
ment of exposure to the pollutants was conducted in this software.

Results
The concentration of measured vapors
Figure 1 shows the concentration of BTEX in the breathing zone of the workers participat-
ing in this study. The mean/minimum/maximum values (mg/m3) of the exposure to ben-
zene, toluene, ethylbenzene, and xylene were found to be 1.52/0.09/4.72, 2.33/0.01/7.50,
4.52/0.02/18.36, and 1.93/0.04/6.95, respectively. According to the American Conference of
Governmental Industrial Hygienists (ACGIH), the threshold limit values (TLVs) for

Figure 1. The concentration of BTEX in the breathing zone of the workers.

 HUMAN AND ECOLOGICAL RISK ASSESSMENT: AN INTERNATIONAL JOURNAL 7

exposure to benzene, toluene, ethylbenzene, and xylene are 1.60 mg/m3 (0.5 ppm),
75.37 mg/m3 (20 ppm), 86.84 mg/m3 (20 ppm), and 434.19 mg/m3 (100 ppm), respectively
(Values 2021). According to the Occupational Safety and Health Administration (OSHA),
permissible exposure limits (PELs) for exposure to benzene, toluene, ethylbenzene, and
xylene are 3.19 mg/m3 (1 ppm), 37.69 mg/m3 (10 ppm), 21.71 mg/m3 (5 ppm), and
434.19 mg/m3 (100 ppm), respectively. According to the recommended exposure limits
(RELs) established by National Institute for Occupational Safety & Health (NIOSH) for
exposure to benzene, toluene, ethylbenzene, and xylene are 0.32 mg/m3 (0.1 ppm),
376.85 mg/m3 (100 ppm), 434.19 mg/m3 (100 ppm), and 434.19 mg/m3 (100 ppm), respect-
ively (Kuranchie et al. 2019). Given that the allowable limits have been recommended for
8 h of work per day and 5 days of work per week, the amount of TLV-TWA was corrected
using the Scala brief model if the work duration was more than 40 h per week (Values
2021). Figure 2 visualizes the comparison of mean exposure values and allowable limits.

Figure 2. Comparison of mean exposure values and allowable limits.

8 A. H. KHOSHAKHLAGH ET AL.

Non-carcinogenic risk assessment

Table 2 represents the statistical values of HQ for BTEX as a heat map. The results
showed that the values of hazard quotient (95th percentile) of calculated HQ for ben-
zene (46.00), ethylbenzene (6.96), and xylene (22.4) were all above 1, whereas for tolu-
ene (0.59) was below 1. Figure 3 depicts the probability distributions and percentiles
related to the non-cancer risk of exposure to BTEX. The values of non-cancer risk
(HQ) due to exposure to benzene, toluene, ethylbenzene, and xylene for 10% of the
population were equal to 5.54, 2.18  102, 1.62  101, and 9.96  101, respectively.
The values for 90% of the population were estimated at 3.80  101, 4.38  101, 4.52,
and 1.69  101, respectively in agreement with potential adverse health effects due to
exposure to benzene > xylene > ethylbenzene for composite production workers.

Table 2. Statistical values of HQ values for BTEX as a heat map.

Parameter Benzene Toluene Ethyl benzene Xylene
Minimum 2.53 1.08  10-2 2.06  10-2 4.31  10-1
Maximum 7.65  101 2.24 2.77 9.48
Mean 1.91  101 1.95  10-1 1.90 7.55
Median 1.59  101 1.31  10-1 9.16  10-1 5.31
Standard deviation 1.33 2.20  10-2 2.94  10-1 8.30  10-1
95th 4.60  101 5.94  10-1 6.96 2.24  101
Good Moderate Serious

Figure 3. Probability distributions and percentiles related to the non-cancer risk of exposure to (a)
benzene, (b) toluene, (c) ethylbenzene, and (d) xylene.
 HUMAN AND ECOLOGICAL RISK ASSESSMENT: AN INTERNATIONAL JOURNAL 9

Figure 4 shows the sensitivity analysis related to the non-cancer risk assessment of
exposure to BTEX demonstrating the importance of exposure concentration (C) >
exposure time (ET) > exposure duration (ED) > exposure frequency (EF).

Carcinogenic risk assessment

Table 3 shows the statistical values of LCR for benzene and ethylbenzene as a heat map.
The estimated LCRs for benzene and ethylbenzene were both higher than 104 (note
that only data for benzene and toluene are given as the SF for ethylbenzene and xylene
is not available) pointing to a definite cancer risk for workers exposed to benzene and
ethylbenzene in the studied company. Hence, the risk values of benzene and ethylben-
zene were found 16600 and 19100 times, respectively, higher than the threshold risk
level (106) set by the US EPA. Further, the data revealed that 1.66 and 1.91 additional
cases per 100 workers exposed to benzene and ethylbenzene, respectively, can be
expected. Figure 5 displays the probability distributions and percentiles for cancer risk
due to exposure to benzene and ethylbenzene. The values of lifetime cancer risk (LCR)
due to exposure to benzene and ethylbenzene for 10% of the workers were 2.61  103
and 8.40  103, respectively. These values for 90% of the workers were computed by
1.66  102 and 1.91  102, respectively clearly showing the potential carcinogenicity
risk to workers in composite production. Sensitivity analysis revealed the variables with

Figure 4. Sensitivity analysis related to non-cancer risk assessment of exposure to (a) benzene, (b)
toluene, (c) ethylbenzene, and (d) xylene.

Table 3. Statistical values of LCR for benzene and ethylbenzene as a heat map.
Parameter Benzene Ethyl benzene
Mean 8.77  10-3 8.29  10-3
Median 7.39  10-3 4.38  10-3
Standard deviation 6.20  10-4 1.31  10-4
10th 2.61  10-3 8.40  10-4
90th 1.66  10-2 1.91  10-2
Negligible risk Possible risk Probable risk Definite risk
10 A. H. KHOSHAKHLAGH ET AL.

Figure 5. Probability distributions and percentiles related to the cancer risk of exposure to (a) ben-
zene and (b) ethylbenzene.

the highest effect on estimated cancer risk (Figure 6), disclosing that exposure concen-
tration (C) > exposure duration (ED) > exposure frequency (EF) whereas the body
weight (BW) had a negative sensitivity.

Discussion
BTEX is emitted into the ambient air from a variety of resources such as petrol, diesel,
vehicular fumes, coal tar, cigarette smoke, paint, resin, etc. (Słomi nska et al. 2014).
Their non-polar and highly lipophilic properties promote absorption and deposition in
internal organs and subcutaneous tissue (Tohon et al. 2015). BTEX has high vapor pres-
sures. That causes them to evaporate easily into the air, especially at increased tempera-
tures (Speight 2015). Collecting air samples in the breathing zone of workers are the
optimal method for elucidating personal exposure to these compounds. Based on the
results, the mean value of benzene exposure was lower than threshold limit values
(TLV) and permissible exposure limits (PELs) but it was higher than recommended
exposure limits (RELs). Also, the mean value of benzene in the inhalation area appeared
close to the TLV. For toluene, ethyl benzene, and xylene, the mean values were lower
than threshold limit values (TLV), permissible exposure limits (PELs), and recom-
mended exposure limits (RELs).
The results of the present study are consistent with the findings of previous studies.
Hence, Dehghani et al. measured BTEX emitted from a coke production unit, demon-
strating that the benzene concentration was higher than the threshold limit values
(TLVs), while toluene, ethylbenzene, and xylene were found in levels lower than the

Figure 6. Sensitivity analysis related to cancer risk assessment of exposure to (a) benzene and (b)
ethylbenzene.
 HUMAN AND ECOLOGICAL RISK ASSESSMENT: AN INTERNATIONAL JOURNAL 11

threshold limit values (TLVs) (Dehghani et al. 2018). Similar results were obtained by
Azari et al. studying the BTEX to petroleum depot workers. The TLV of benzene is
lower than the TLV of toluene, ethylbenzene, and xylene, reflecting the higher toxicity
of the former (Rezazadeh et al. 2012). The results of the present study are consistent
with the findings of previous studies. It may be because the threshold limit value of
benzene compared to toluene, ethylbenzene, and xylene is lower given that this sub-
stance is more dangerous. Thus, WHO 2014 pointed at benzene as a major health con-
cern in Africa, particularly in occupational environments (Kuranchie et al. 2019).
In the production process of composite materials, resins and paints are used at ele-
vated temperatures causing the release of BTEX ambient air (Moridzadeh et al. 2020).
Dehghani et al. (32) investigated BTEX sources in Tehran, concluding that the solvent
and paint sources contributed to nearly 5 and 29 percent of total BTEX concentration,
respectively. The mixed origin source, including plastic manufacturing (39%), leather
industries (28%), and unknown sources (33%), contributed to nearly two-thirds (66%)
of the remaining ambient BTEX (Dehghani et al. 2017). The present study discloses for
the first time the presence of BTEX in ambient air as a result of the production of com-
posite materials.
The non-cancer risk assessment in this study was performed using the hazard quotient
(HQ) based on the measured inhalation exposures. Based on the results, the values of
hazard quotient (95th percentile) for benzene, ethylbenzene, and xylene indicate potential
non-carcinogenic risks even though the exposure values are well below the TLV at least
for toluene, ethylbenzene, and xylene. In agreement with earlier studies exposure to ben-
zene in rubber tire manufacturing workers (33), a coke-making unit of a steel plant
(Chang et al. 2010), and printing and copying centers (Rostami et al. 2021). The possible
adverse health effects of BTEX are summarized in Table 4, the results unambiguously
stressing the importance of taking the potential risks of BTEX seriously.
In a further sensitivity analysis, we looked at the variables with the highest influence
on calculated non-cancer risk. The results of the sensitivity analysis related to the non-
cancer risk assessment of exposure to BTEX demonstrated the importance of exposure
concentration (C) > exposure time (ET) > exposure duration (ED) > exposure fre-
quency (EF). Not surprisingly these data points at a reduction of exposure concentra-
tion significantly will reduce non-cancer risk.
The cancer risk assessment in this study was conducted by the lifetime cancer risk
(LCR) based on the measured inhalation exposures. The results showed that the risk
values of benzene and ethylbenzene were found 16600 and 19100 times, respectively,
higher than the threshold risk level (106) set by the US EPA. Further, the data revealed

Table 4. Adverse health effects of BTEX.

Compounds Adverse non-carcinogenic health effects
Benzene Damage on the reproductive-, immune-, nervous-, endocrine-, cardiovascular-, and respiratory
systems
Toluene Skin/eye irritant, a ventral nerve system depressant
may cause fatigue, weakness, confusion, headache, dizziness, and insomnia
Ethylbenzene Skin and mucous membrane irritants
may cause acute and chronic damage to the central nervous systems including vertigo,
unconsciousness, tremors, respiratory system
Xylene Eye, skin, and mucous membrane irritants may cause damage to the respiratory-, gastrointestinal-,
musculoskeletal-, nervous- systems, liver, and kidney
12 A. H. KHOSHAKHLAGH ET AL.

that 1.66 and 1.91 additional cases per 100 workers exposed to benzene and ethylben-
zene, respectively, can be expected. The results revealed the potential carcinogenicity
risk to workers in composite production. The cancer risk of exposure to benzene was
higher than exposure to ethylbenzene in agreement with previous studies (39,41). IARC
and USEPA have independently considered benzene as a Group A and Class 1 human
carcinogen, respectively (Edokpolo et al. 2015). Exposure to benzene can increase the
occurrence of acute myeloid leukemia in individuals (Yimrungruang et al. 2008). IARC
has classified ethylbenzene as a possible carcinogen so prolonged exposure to ethylben-
zene may cause cancer in humans (Harati et al. 2016). The importance of controlling
the concentrations and thus the exposure to these compounds in industrial environ-
ments is ubiquitous. Sensitivity analysis revealed the variables with the highest effect on
estimated cancer risk, disclosing that exposure concentration (C) > exposure duration
(ED) > exposure frequency (EF) whereas the body weight (BW) had a negative sensitiv-
ity. As above, these data points to the mandatory decrease of exposure concentration to
reduce the cancer risk.
It should be noted that there are uncertainty and limitations in the health risk assess-
ment in data and analyses. However, uncertainties cannot be avoided and those are
inherent in all scientific studies. The nature of risk assessment is probabilities. The sci-
entific uncertainties associated with such predictive techniques include not only the
uncertainty associated with the available knowledge but also uncertainty related to the
predictive nature of estimates (Medicine et al. 2013). In the present study, it was tied to
the uncertainty of analyses decrease using Monte-Carlo simulation. Therefore, the
results of such studies are a guide for hazard perception and those must not be consid-
ered as criteria for evaluating the definite health effects.

Conclusions
The health risk of exposure to benzene, toluene, ethylbenzene, and xylene (BTEX) in a
composite manufacturing plant has been studied for the first time. The exposure to
BTEX was lower than the prevailing threshold limit values (TLV). However, in all cases
the hazard quotient was found higher than 1; thus, the exposure to benzene, ethylben-
zene, and xylene was higher than the recommended limit, thus, pointing to non-cancer
risks. Furthermore, BTEX possesses potentially significant carcinogenicity effects due to
exposure to benzene and ethylbenzene in process of composite material production.
The main risk factor for both non-cancer and cancer effects is the concentration of
BTEX in ambient air. In sum, it has been demonstrated that the occurrence of cancer
due to exposure to BTEX in the industry of composite materials production is serious
and calls for attention. Hence, it is emphasized that administrative and technical con-
trols such as preparation of general and local ventilation, the enclosure of the produc-
tion process to reduce air born concentrations and the use of personal protective
equipment are implemented.

Acknowledgment
Researchers need to thank all staff members who have participated in this study.
 HUMAN AND ECOLOGICAL RISK ASSESSMENT: AN INTERNATIONAL JOURNAL 13

Disclosure statement
The authors declare that they have no conflict of interest.

ORCID
Amir Hossein Khoshakhlagh http://orcid.org/0000-0002-2265-5054
Saeid Yazdanirad http://orcid.org/0000-0002-5251-6637

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