Qiuda Zheng

Wastewater-based epidemiology (WBE) and the closely related practice of wastewater-based surveillance (WBS) have moved from specialized environmental monitoring approaches to increasingly important components of public health surveillance

Nicotine and its related biomarkers are increasingly recognized as important wastewater-derived indicators of human exposure and tobacco consumption; however, their occurrence and application for environmental surveillance remain limited in rapidly urbanizing tropical regions. Wastewater-based epidemiology (WBE) provides a powerful approach for assessing population-level exposure by quantifying human-excreted chemical biomarkers in wastewater. Here, we report the first application of WBE to investigate nicotine-related biomarkers in Bangkok, Thailand, a tropical megacity characterized by complex urban dynamics and population mobility. Influent samples from five major wastewater treatment plants were collected twice weekly from February to October 2025 and analyzed for nicotine, its major metabolites, and the tobacco-specific biomarker anabasine. Nicotine-related biomarkers were consistently detected across all wastewater catchments, demonstrating the widespread occurrence of tobacco-associated chemical markers in urban wastewater. The biomarker profile was dominated by human metabolites, including trans-3′-hydroxycotinine and cotinine, followed by nicotine, while anabasine provided source-specific evidence of tobacco-derived nicotine inputs. Estimated nicotine consumption averaged 517.4 ± 164.1 mg/1000 people/day and showed a moderate positive association with cigarette sales data (Spearman’s rₛ = 0.517), supporting the reliability of wastewater-derived biomarkers for community-scale assessment. This proof-of-concept study highlights the value of wastewater monitoring as an environmental surveillance platform for tracking chemical exposure patterns in urban populations and supporting evidence-based strategies toward Sustainable Development Goal 3 (Good Health and Well-Being).

(1) Background: Metabolic disorders, including hypertension, hyperlipidemia, and hyperglycemia (HHH), rank at the top of the disease burden in China. However, population-level assessment of pharmacological treatment remains limited by the lack of scalable metrics for monitoring medication use and outcomes. (2) Methods: We pioneered the use of standardized combined “HHH” medication usage—encompassing antihypertensive, antidiabetic, and lipid-lowering agents—as an integrated proxy for evaluating interventions for cardiovascular diseases and diabetes. Leveraging wastewater-based epidemiology (WBE), we quantified HHH medication loads (mg/d/1000 persons) across 30 prefectures covering all regions in China, and mapped the associated geographical disparities using independent t-tests. Associations with environmental, socioeconomic, demographic, social service, and health-related behavioral and lifestyle factors were further examined via correlation analysis. (3) Results: Our findings confirmed a pronounced north–south gradient in HHH medication uses (the mean standardized loads in the north were approximately twice as high as those in the south, p < 0.05). Furthermore, aging, sex ratio, nicotine consumption, obesity rate, the comprehensive Air Quality Index (AQI), precipitation and the Urban Wellness and Healthcare Index were identified as the top seven influencing factors (|r| values ranging from 0.37 to 0.71, all p < 0.05). (4) Conclusions: As a comprehensive national-scale analysis of multi-drug use for HHH via WBE, this study provides valuable insights into national multi-disease pharmacological treatment, offering evidence-based support for refining clinical prescribing guidelines and rationalizing the allocation of healthcare resources.

Objectives:Accurate measurement of tobacco, nicotine and cannabis use and exposure during pregnancy is essential for research and clinical care, yet existing perinatal surveillance relies on simplified self‑report that inadequately captures exposure patterns. Biological assays provide objective measurement but are invasive, costly, limited to short detection windows, and impractical for repeated or population‑level use. This study aimed to develop and internally validate the Nicotine, Tobacco and Cannabis Use and Exposure (NOTICE) assessment as a low‑burden, non‑biological behavioural tool for use and exposure during pregnancy.Study Design and Setting:In a longitudinal cohort of Australian First Nations pregnant women, repeated NOTICE assessments were collected across pregnancy alongside exhaled carbon monoxide, saliva cotinine, and urinary free cotinine and total 11-Nor-9-carboxy-Δ⁹-tetrahydrocannabinol (THC‑COOH), with and without creatinine correction. Weekly self‑use and exposure scores were combined into a weighted, standardised composite score. Discriminative validity relative to biochemical reference standards was assessed using receiver operating characteristic analysis. Area under the curve (AUC) estimates with bias‑corrected and accelerated bootstrap confidence intervals clustered by participant were calculated. Population‑averaged associations were examined using generalised estimating equations.Results:The composite NOTICE score demonstrated very high discrimination for tobacco and nicotine exposure relative to creatinine‑corrected cotinine ≥5 ng/mg cr (AUC = 0.99; 95% CI 0.98–1.00) and high discrimination for cannabis exposure relative to creatinine‑corrected THC‑COOH ≥80 ng/mg cr (AUC = 0.92; 95% CI 0.83–1.00). Discrimination was stable across alternative biomarker thresholds and consistently superior to exposure‑only measures. Weekly scores demonstrated better discriminative performance than daily scores.Conclusion:NOTICE is a low-burden behavioural assessment that demonstrates strong criterion-based alignment with established biochemical reference standards for measuring tobacco, nicotine and cannabis use and exposure during pregnancy. By integrating active use and environmental exposure across products and timeframes, the tool supports repeated measurement and surveillance of exposure patterns in settings where routine biological testing is impractical.What is new?Key findingsThis study shows that a structured, non‑biological behavioural measurement framework for assessing tobacco, nicotine and cannabis use and exposure in pregnancy can demonstrate high discriminative validity relative to established biochemical reference standards, including urinary cotinine, THC‑COOH and exhaled carbon monoxide.What this adds to what is knownReliable measurement of tobacco, nicotine and cannabis exposure is fundamental to understanding and addressing pregnancy‑related risk, yet existing perinatal surveillance relies on simplified self‑report that inadequately captures exposure patterns. NOTICE enables comprehensive, structured point‑of‑care measurement of use, environmental exposure, temporal variability and context, providing a low‑burden approach that aligns closely with biochemical markers without the logistical, ethical and financial constraints of routine biological specimen collection.What is the implication, what should change now?Incorporation of the NOTICE assessment into research and clinical practice offers a scalable, sta

Hand, foot, and mouth disease (HFMD) is a common childhood infection caused by enteroviruses, which exhibit distinct regional and seasonal epidemiological patterns. Wastewater-based epidemiology is a crucial tool for monitoring population infection dynamics and viral subtype distribution. However, the lack of effective on-site viral detection methods limits timely early warning and effective surveillance of infectious disease outbreaks. This study developed a one-pot RT-RPA/CRISPR-Cas12a assay-based, string-powered flywheel microfluidic chip for the multiplex detection of HFMD viruses in wastewater. First, by leveraging the regulatory effect of heparin sodium on CRISPR/Cas12a activity, a one-pot RT-RPA/CRISPR-Cas12a system was constructed to detect four major subtypes of HFMD virus (EV-A71, CV-A16, CV-A6, and CV-A10). Subsequently, this method was integrated into a pull-wire, flywheel-type, dual-axis centrifugal microfluidic chip, named the Heparin-Inhibited CRISPR-Associated System Chip (HICAS-Chip), enabling integrated enrichment, purification, elution, and multiplexed detection. The HICAS-Chip allowed visual detection of nucleic acids at 10 aM sensitivity within 1 h, corresponding to the sensitivity of the one-pot RT-RPA/CRISPR-Cas12a assay. During a year-long wastewater monitoring program in Guiyang City, China, the HICAS-Chip identified EV-A71 and CV-A10 as the predominant circulating subtypes, with incidence peaks observed in June, November, and December. The wastewater detection results obtained using HICAS-Chip showed high concordance (95.83%) with RT-qPCR assays. This platform provides an efficient portable device for the early detection and continuous monitoring of HFMD epidemic trends by wastewater-based epidemiology.

Estimating substance use in Japan traditionally depends on police seizure records and national self‐reporting surveys, which face substantial challenges due to social stigma. This study applies wastewater‐based epidemiology to overcome these challenges of monitoring illicit drug and legal stimulant use in a Japanese metropolitan area serving ∼1.8 million residents. Influent wastewater samples collected over 4 weeks in 2021 were analyzed for 29 substances. Methamphetamine was the only illicit drug consistently detected (consumption at 17.0 ± 5.1 mg/day/1000 people), reflecting its prevalence in Japan's drug scene and aligning with patterns in other East Asian countries. Ephedrine and pseudoephedrine, known precursors of methamphetamine were detected at high levels, suggesting their common use in legal medicines. Nicotine and methamphetamine consumption remained stable across weekdays and weekends. Higher ephedrine consumption during the lockdown period likely resulted from increased use of Kampo medicines to manage COVID‐19 symptoms. This study provides the first objective evidence of population‐level methamphetamine use in a large urban catchment of Japan, which is relatively low compared to other countries. The findings demonstrate the feasibility of wastewater analysis as a complementary surveillance approach to the existing system, enabling more responsive and evidence‐based drug policy.

Studies of third‐hand exposure to methamphetamine from contaminated properties have focused on dermal and oral exposure but have mostly excluded inhalation. Recent literature highlights the need to consider this previously omitted pathway. In this study, we monitored airborne concentrations in properties most likely contaminated via recreational smoking of methamphetamine. The homogeneity of airborne methamphetamine was assessed, along with the correlation between its levels and those measured on different surfaces or in the subsurface material. Airborne methamphetamine concentrations were also compared ‘before’ and ‘after’ remediation. Our results suggested airborne methamphetamine contributes as an exposure route for properties contaminated by this drug, although this may only be significant in certain situations. The level of airborne methamphetamine was relatively homogenous among rooms of the same property, and there were correlations between air sampling with wipe ( R ² = 0.76) and bulk sampling ( R ² = 0.94), but mainly driven by higher contamination levels. This indicates that air sampling could be used as an additional tool to identify the presence of high methamphetamine contamination. The presence of low levels of airborne methamphetamine after remediation of impacted surfaces is additional evidence that airborne sampling is a sensitive method to detect methamphetamine contamination in properties. Further research is needed to establish the relationship between levels of methamphetamine contamination and specific health risks, which can then be used to determine related policy responses and, if necessary, establish evidence‐based remediation targets.