Lee · Environment international 2018 · non-randomized crossover intervention study · n=54

Bisphenol A exposure through receipt handling and its association with insulin resistance among female cashiers.

Cited 48 times in the scientific literature.

Level 3 - non-randomized controlled study

Non-randomized self-controlled before-after intervention trial with cross-sectional biomarker association

PubMed 29778011 · doi:10.1016/j.envint.2018.05.013 · record verified 2026-08-26

What was done

Fifty-four female cashiers from seven retail supermarkets in Korea participated in a two-week study. Participants worked without gloves during the first week and with gloves during the second week. Pre-shift and post-shift urine samples were collected on the first two consecutive days of each week to measure urinary bisphenol A (BPA) concentrations alongside metabolic syndrome biomarkers.

What was found

Without gloves, cashiers showed approximately a two-fold increase in urinary BPA concentrations after their work shift. When wearing gloves, post-shift urinary BPA concentrations showed no change compared to pre-shift levels. Higher urinary BPA concentrations were associated with higher levels of fasting insulin and insulin resistance, though exact numerical estimates, confidence intervals, and p-values were not reported in the abstract.

Why it matters

This study demonstrates that handling thermal paper receipts contributes substantially to occupational BPA burden in cashiers, and that wearing gloves is a simple, effective protective measure.

Limits

The study had a small sample size (n = 54) confined to female workers in one supermarket chain. The intervention was not randomized or counterbalanced (fixed order of weeks). Dietary and other non-occupational BPA sources were not controlled for in the abstract description, and numerical effect sizes for metabolic outcomes were omitted.

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