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The SpoTT program rests on several preliminary considerations concerning residents:

  • The emissions from the combustion of municipal solid waste pose the residents living in the area of interest of the plant at potential exposure to a variety of chemical pollutants
  • The literature reports the occurrence of adverse effects in some situations but not in others
  • Given the uncertainty of scientific evidence, disseminating accurate information concerning the area of interest of the WtE plant is important


The results of the SpoTT program will inform risk assessment and related decision-making processes.

SPoTT investigates diseases for which a potential association with waste incineration plant emissions has been reported in scientific literature.

SpoTT conducts multiple lines of activity:

  • Surveillance and epidemiological monitoring of long- and short-term health effects on the residents living in the area of interest of the plant; the information are gleaned from hospital admission, mortality, and birth records
  • Toxicological monitoring using biomarkers of exposure to chemicals sampled from residents living in the area of interest


Short-term effects

Cristiana IvaldiSS Epidemiologia Ambientale, Dipartimento Valutazioni Ambientali di Arpa Piemonte

There are few published studies on the short-term effects of emissions from municipal solid waste (WtE) incineration plants, despite concerns in general population about the immediate effects of exposure to such emissions. In 2013 the SpoTT program started an epidemiological surveillance of short-term effects using the method applied by previous studies on atmospheric pollution ( SpoTT2 will update this study with data from a longer observation period (2013-2023). Main aim is to determine the short-term effects that the WtE plant may have on the health of residents near the plant.

Three approaches are taken:

  • analysis of time trends for emergency room visits by the local population subdivided in a group residing in the area of interest and a control group.
  • comparison of daily trends in mortality or hospital admission for acute cardiovascular and respiratory episodes a few days after peak emission of monitored atmospheric pollutants has been recorded. There is published evidence for an association between these diseases and incineration emissions.
  • analysis of the relationship between daily trends for NO2 and variation in the number of emergency room visits and hospital admissions for the group living in the area of interest and the control group. The analysis will be stratified by age group, with particular focus on children aged 0-14 years.

It are analyzed data from the regional archives of hospital discharge and mortality records.

Short-term effects are defined as the difference between daily trends for health episodes and levels of monitored atmospheric pollutants. The aim is to determine whether the daily trend for levels of atmospheric pollutants is followed 1 to 5 days later by an increase in mortality caused by acute cardiorespiratory and respiratory diseases.

Long-term effects

Cristiana IvaldiSS Epidemiologia Ambientale, Dipartimento Valutazioni Ambientali di Arpa Piemonte

Studies involving the residents living in the area of interest of the municipal solid waste (MSW) incinerator have produced inconclusive results. There is consensus in the international scientific community that exposure to emissions from plants using old technologies is a cause of certain types of tumors (liver, stomach, colorectal, lung, non-Hodgkin’s lymphoma, soft tissue sarcoma), congenital anomalies (especially urinary tract malformation), and premature births.

In light of such evidence, in 2013 the SpoTT program started epidemiological monitoring of long-term effects, i.e., diseases with long latency between exposure and manifestation of the disease. SpoTT2 will continue this line of activity by involving the residents living in the area of interest of the plant.

Main aim is to describe the population’s health describing health events that can be traced to exposure to emissions released by the plant. The medical information for each resident will be retrieved from the regional archives of hospital discharge, mortality, and birth records.

The data collected in the first phase of SpoTT will be updated with the more recent data. Data on reproductive outcome, congenital malformation, hospital admission, and mortality will be analyzed for the period 2003-2022 (10 years before and 10 years after the plant went into operation.

The first 10 years before the plant went into operation constitutes the baseline for determining whether the number of health events increased after the plant went into operation.

The environmental determinants analysed include PM10 and heavy metals; motor vehicle emissions and other sources, particularly industrial emissions, are considered confounding factors.


Giuseppe Salamina SC Servizio Igiene e Sanità Pubblica – ASL Città di Torino;
Enrico ProcopioSC Servizio Igniene eSanità Pubblica – ASL TO3

In collaborazione con: U.O. Esposizione Umana a Contaminanti Ambientali – Dipartimento Ambiente e Salute – Istituo Superiore di Sanità (ref. Elena De Felip); SS Epidemiologia Ambientale, Dipartimento Valutazioni Ambientali di Arpa Piemonte (ref. Cristiana Ivaldi)

The aim of biomonitoring, begun in 2013, is to assess changes in a number of biomarkers of exposure to toxic substances in population groups living near and far from the plant.

The most effective means of measuring exposure to toxic substances in humans is by biomonitoring, because analysis of pollutants or their metabolites in the human body (e.g., blood samples) provides a measure of the real “internal dose” resulting from possible routes and sources of exposure (respiratory, cutaneous, oral).

SpoTT is Italy’s largest, most complete biomonitoring program of residents living in the area of interest of a MSW incineration plant. A cohort of 410 subjects was randomly selected, among residents near the incinerator (exposed group) and residents far from it (control group).

The cohort was monitored before the start-up of the plant and will be followed up one and three years after, with measurements of respiratory function, selected blood and urine parameters including nineteen heavy metals, seventeen congeners of PCDDs/Fs, twelve congeners of DL-PCBs, thirty congeners of NDL-PCBs, eleven OH-PAHs, specific hormones (T3, T4, TSH, cortisol and ACTH) and common health parameters.

Additional information to interpret the clinical test results was obtained via questionnaires investigating the environment, lifestyle, medical history, diet, employment history, and perception of risk.

Local farmers residing in the area of interest were also involved in the study. In the period 2020 through 2023 biomonitoring will be continued in the residents and the farmers living in the area of interest, who had been monitored for changes in exposure to toxic substances, as done in the initial program. This biomonitoring survey is planned for June-July 2023 and constitutes a follow-up at 10 years of plant operation.

The same exams and tests will be performed as in the previous phases, and the same questionnaires administered to control the information on behaviors, lifestyle, employment and clinical history.

A repository for biological samples will be created for conserving the samples for 30 years at the Department of Clinical and Biological Sciences, University of Turin. The database containing the biomonitoring data, at SCaDU, Epidemiology Unit, ASL TO3, will be updated. The results of the toxicological tests will be posted on the SpoTT website as aggregate data (mean of the sample analyzed).

Individual study participant test results will be made available on request. The complexity of the analysis and the quantity of samples for analysis require restitution of all results for a period of 1 year, in particular:

  • Results of standard laboratory parameters and endocrine and respiratory function within a few weeks after sampling
  • Results of heavy metals tests within 6 months after sampling

Results of tests of PAHs, dioxins, and PCBs within 1 year approximately after sampling

SPOTT2 ensures assistance and support to the people involved in all the phases of the program