Measurement issues in environmental epidemiology.

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Abstract
This paper deals with the area of environmental epidemiology involving measurement of exposure and dose, health outcomes, and important confounding and modifying variables (including genotype and psychosocial factors). Using examples, we illustrate strategies for increasing the accuracy of exposure and dose measurement that include dosimetry algorithms, pharmacokinetic models, biologic markers, and use of multiple measures. Some limitations of these methods are described and suggestions are made about where formal evaluation might be helpful. We go on to discuss methods for assessing the inaccuracies in exposure or dose measurements, including sensitivity analysis and validation studies. In relation to measurement of health outcomes, we discuss some definitional issues and cover, among other topics, biologic effect markers and other early indicators of disease. Because measurement error in covariates is also important, we consider the problems in measurement of common confounders and effect modifiers. Finally, we cite some general methodologic research needs.