EPA-650/1-74-001
July  1973
Environmental Health  Effects Research Series

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                                          EPA-650/1-74-001
           THE  USE  OF PANELISTS
AS  SUBSTITUTES FOR  TAXICAB  DRIVERS
    IN  CARBON MONOXIDE EXPOSURE
                          by

                  A. Walter Hoover, M. D.
                and Robert M. Albrecht, M. D.

             Division of Environmental Health Sciences
                   School of Public Health
                    Columbia University
                  New York, N. Y. 10032
                  Contract No. CPA 22-69-97
                 Program Element No. 1AA005


               EPA Project Officer: J.H.Knelson
                  Human Studies Laboratory
             National Environmental Research Center
           Research Triangle Park, North Carolina 27711
                      Prepared for

            COORDINATING RESEARCH COUNCIL, INC .
                  30 ROCKEFELLER PLAZA
                  NEW YORK, N.Y. 10020
                 Project No. CAMP-8-68(l-68)

                         and

            OFFICE OF RESEARCH AND DEVELOPMENT
           U.S. ENVIRONMENTAL PROTECTION AGENCY
                  WASHINGTON, D.C.  20460

                       July 1973

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This report has been reviewed by the Environmental Protection Agency
and approved for publication.  Approval does not signify that the
contents necessarily reflect the views and policies of the Agency,
nor does mention of trade names or commercial products constitute
endorsement or recommendation for use.
                                  11

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       Acknowledgments

The authors express their appreciation
for the dedicated interest and efforts of
the Division of Environmental Health
Sciences' staff, who obtained the samples,
performed the  laboratory analyses, and
provided constructive  suggestions at every
stage.  These persons included Mr. Richard
Hanauer, Mrs.  Elaine Nelson, and Mrs.
Maria Graham.
               ill

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               TABLE  OF CONTENTS



Methodology	    page    1

Results	            5

Discussion	           11

Conclusions	           14

References	           15

Appendix A  - "Tables and Figures"	           17

Appendix B  - "Statistical Correlation of Aveolar
             Air Carbon Monoxide Concentrations
             and Carboxyhemoglobin using Spear-
             man Rank Correlation Test"	        27

Appendix C  - "Data on COHb by Finger Prick
             and Alveolar Air COi'	        29
                          V

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                             REPORT

                                on

      The Use of Panelists as Substitutes for Taacicab Drivers in
                    Carbon Monoxide Exposure Studies

            CRC-APRAC Project No. CAPM-8-68 (1-68)
                              Summary


      Analyses of breath and limited blood samples from 30 pairs of taxi

drivers and panelists who drove in New York City traffic fo r 8 hours on two

consecutive days indicated that both panelists and drivers attained similar

COHb (blood carboxyhemoglobin) levels.  This was true for both smokers and

non-smokers though smokers had significantly higher concentrations of COHb

than non-smokers.  There was no consistent difference between the first and

second day of driving in the levels  of alveolar carbon monoxide.
                              Methodology

Background

      Data for this study were collected between June 27, 1969 and November

15, 1970.  There were four objectives:

      a)      To determine whether panelists attain concentrations of

             COHb (blood carboxyhemoglobin) similar to those attained

             by taxicab drivers with equal exposure.


      b)      To determine if the levels of COHb for smokers differed
             from those of non-smokers.

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2.
         c)    To determine the relationship between concentrations of
               carbon monoxide (CO) inside an automobile and the levels
               of COHb.

         d)    To compare the levels of COHb in blood obtained by finger
               prick with the level of carbon monoxide in the expired alveolar
               air after 20 seconds of breath holding.
  The Subjects

         Sixty individuals were divided into 30 pairs,  each pair consisting of a

  taxicab driver and a panelist.  Half of the pairs were current cigarette smokers

  while the other half had never smoked tobacco in any form or had not smoked

  within the previous year.  The smoking history is described in table I.  All

  were  males, and pairs were matched by age within 6 years with the exception

  of 2 pairs.  (See table II).

         Before the study,  subjects  received  a complete  physical examination

  that included a chest x-ray,  electrocardiogram,  test of 1-second  forced

  expiratory volume, hemoglobin test,  and other indicators of physical con-

  dition.  Prospective subjects with  evidence  of pulmonary disease,  cardiac

  disease, blood dyscrasias, or any other disease that might affect normal cardio-

  pulmonary physiology were excluded from the study. In addition,  subjects who

  were  considered incapable of properly providing samples of expired alveolar

  air were excluded to  facilitate the  study.


  Materials and^Methods

         With his panelist  seated beside him, each driver drove through heavily

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travelled streets in Manhattan and Brooklyn for two successive days.  All

drivers used the same automobile,  a rented 1969 Dodge Dart Sedan.   It was

not air conditioned, and subjects were permitted to open and  close the car

windows freely.

       A member of the study team accompanied the test vehicle,  and he

collected ambient air and alveolar air  specimens while seated in the back

seat.   The driving schedule extended from 8:00 a.m. to 5:00  p.m.  with a

coffee break around 10:00 a.m. and lunch from noon  to 1:00 p.m.  After

their  dinner, subjects were requested  to return for a final alveolar air

specimen at 8:00 p.m.  Tests -were scheduled as follows:



       Hours            Alveolar Air        Ambient Air

                                                  X
                                                  X
                                                  X
                                                  X

                                                  X
                                                  X
                                                  X
                                                  X

                                                  X*

       *Ambient levels in the laboratory where the specimens were  obtained.
         Range was constant bet-ween 5-10 parts per million CO.


       Breath  and air samples were collected in bags of aluminum foil covered

by polyester film and equipped with valved closures.  When filled,  the bags were

shown to lose less  than 10% of their volume after three days,  and they withstood

shipping.
0800
0900
1000
1100
1200
1300
1400
1500
1600
1700
2000
X

X

X


X

X
X

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4.
          To provide a breath sample,  a  subject exhaled completely and then





   inhaled rapidly.  After holding his breath for 20 seconds while being timed





   by a stop-watch, he discarded the  first  1400 cc. of breath and the remaining





   portion was collected and analyzed.  Ambient air was pumped into  a 7-liter





   bag over a 15-minute period.  Alveolar and ambient air specimens were an-





   alyzed on the  same day using a Hilger  and Watts Infra-Red Gas Analyzer,





   type S. C. /L. C.  This is a single-range instrument with a linear response





   and a range -- for the purpose of this  study -- of 0-200 ppm  of carbon mon-





   oxide.  Carbon dioxide and water vapor are removed prior to analysis by a





   drying tube containing soda lime and magnesium perchlorate.





          While  driving,  smokers were allowed to smoke at will except when





   specimens were taken. Since the opening of windows would affect  panelists





   and drivers equally, it was not considered to affect the comparability of





   carbon monoxide levels between panelists and drivers.  The number and time





   of cigarettes smoked would affect COHb but the study was  designed to measure





   the comparability of carbon monoxide in smoking panelists and drivers rather





   than the possible reasons for differences in carbon monoxide levels.







   Determination of Carboxyhemoglobin





          Determination  of carboxyhemoglobin levels were made by analyzing





   finger-prick blood and  using a procedure that was a slight modification of





   one described  by B. T.  Commins  and P. J. Lawther (1).  About 0. 025 ml.  of





   blood from a finger prick was dissolved in 25 ml.  of 0. 04% ammonia solution.





   This solution was divided in  half, and oxygen was  bubbled  through  one half to





   convert any carboxyhemoglobin into oxyhemoglobin.  The spectra of the two

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                                                                          5.


halves was then compared in a spectrophotometer.  The difference between the

spectra was used to estimate the carboxyhemoglobin content of the blood and

was compared with the difference between the spectra of pure oxyhemoglobin

and pure carboxyhemoglobin samples of the  same blood.   The formula for the

percent of carboxyhemoglobin was:

                               _h_
                      % COHb =  h0


Where h =  optical height above the mean of the absorbances at 414 mu (b) and

426 mu (c) with  a peak at 420 mu (a).  A value was obtained by h = 2 - (b+x)/2.

h  was obtained by  the same procedure from the two pure samples.


                                 Results
Ambient Air Concentrations of Carbon Monoxide

       As described in Table 3,  the carbon monoxide levels varied from 2 ppm

to 48 ppm.  The average reading for each hour, however, varied from a mini-

mum of 16. 1 ppm of carbon monoxide at  1000 to 23. 7 ppm. at 1500.  Comparing

the carbon monoxide levels in the cars  of non-smokers to smokers,  the averages

were the same at 1100 and the maximum  difference between averages occurred

at 1500 when levels in non-smokers' air  reached an average of 3. 7 ppm higher.

       These concentrations are generally similar to those  recorded by Jaffe

(2) for the commuter  exposure in New York City.  Using an automatic infra-red

analyzer and 20-30 minute integrated samples, he found the following concen-

trations in the "Center City" in 1966 and  1967:

                            Maximum:   52 and 48 ppm
                            Average:     32 and 27 ppm
                            Minimum:   14 and 9  ppm
       Values in 14 other American cities:  8 to 70 ppm

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6.
         Johnson,  Dworetzky and Heller (3) recorded carbon monoxide levels





   continuously within a trailer parked in midtown Manhattan during 1967.   The





   median hourly concentration on week days was 12-13 ppm.  Colucci and Begeman





   (4) found median hourly averages of 7. 5 and 10. 5  ppm on week days at two sites





   in midtown Manhattan during 1962-64.







   Comparison of Drivers  and  Panelists





         As shown by Figure 1, the average  hourly alveolar air measurements for





   drivers and panelists showed that  carbon  monoxide concentrations for the two





   groups varied almost identically for non-smokers.  For smokers, slight





   differences can be discerned.  This lack of conformity for smokers can be





   attributed to the broad range that carbon monoxide measurements  spanned,





   varying from below 25 ppm  to over 45 ppm.  By contrast, the average carbon





   monoxide readings for non-smokers had a minimum of about 12 ppm and a





   maximum of less than 20.  When each day was investigated separately,  as shown




   in Figure 2, the same general observations could be made.








   Comparison of Smokers and  Non-Smokers





         The striking contrast  in the  study occurred  when smokers,  both drivers





   and panelists, were compared with non-smokers.  As shown in Figure 3,





   smokers consistently exhibited a considerably higher concentration of carbon





   monoxide than non-smokers.  The difference was greater at 5:00 p.m. in the





   case of drivers and at either 3:00  p.m. among panelists,  depending upon





   whether the first or second  day is being considered.  However, the gap already





   existed at 8:00 a.m.  and  remained through 8:00 p.m.  three hours  after driving





   had ceased.

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                                                                            7.
      Interestingly, the level of carbon monoxide in non-smokers at 8:00 a. m.





was slightly lower among panelists than for taxicab drivers.  This raised the





question whether the groups differed in exposure at home or on the way to work.





An occupational effect  could have existed,  but this does not seem likely since





the effects of occupational exposure presumably would have worn off by the





next morning.








Analysis of Variance





      All carbon monoxide readings were averaged by four categories:  (1)





smoking drivers,  (2) non-smoking drivers, (3)  smoking panelists,  and (4)





non-smoking panelists.  When these categories  were averaged, the difference





between drivers and panelists was -2. 9 ppm for smokers and +1. 5 ppm for non-





smokers.  Statistical tests were then performed to see whether a  significant





difference existed between any of the four comparable groups.  Tests were





performed on the log CO concentration, and the model was a three-way in-





complete  analysis of variance.   But the difference between drivers and panelists





on both the smoker  and non-smoker categories  was not statistically significant.







Trend Over Time





      As illustrated by Figure 1, the change in  carbon monoxide levels among





non-smoking drivers during each day was minor.   Among panelists, the





levels rose slightly to peak around  3:00 p.m.  or 5:00 p.m. For smokers,  on





the other hand, the increase was considerable, and the peak occurred at  5:00





p.m.   A consistent difference in alveolar carbon monoxide between the first

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8.
  and second days of driving did not appear to exist.





   Comparison of Ambient Air and Alveolar Air





          To determine the effect of carbon monoxide levels in ambient air upon




   corresponding levels in alveolar air, correlation coefficients were calculated




   using the logarithms of carbon monoxide measurements in ppm for each type




   of air.  Since 60 persons -- either drivers or panelists -- were involved for




   two days,  each correlation was based on 60 pairs of numbers.  Both the





   morning and daily averages of carbon monoxide levels in ambient air were




   used since  it seemed possible that morning values might reveal a time-lag




   relationship.   As shown in Table 5,  however, the data did not confirm this




   hypothesis, and the morning figures did not appear to have any advantage





   over the figures of the entire day.  In general, the  correlation was stronger




   with the 5:00 p.m. alveolar air carbon monoxide  than with the 8:00 p.m. con-





   centrations.  In general, the correlation was higher among non-smokers than




   smokers,  a predictable observation since non-smokers had ambient air as




   their only source.  The maximum correlation coefficients were relatively




   weak: 0. 60 and 0. 55 for non-smoking panelists and drivers  respectively at




   5:00 p.m.




          The only other recorded study comparing  ambient air within a car and





   concentrations  of carbon monoxide by the car's occupants was by Clayton et al




   (5).  Two individuals drove for 8 hours  continuously in a police scout car,




   presumably entirely within Detroit.   One smoked cigars,  and the other did




   not smoke.  The carbon monoxide was monitored continuously, and readings





   were recorded every five minutes.  Using 50 readings, the average value was

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17 ppm and a peak of 120 ppm occurred when the engine was idling.  The





COHb  rose  from 0. 8 to 1. 2% in the non-smoker and 3. 1 to  3. 9% in the smoker.





The correlation coefficient for ambient carbon monoxide and COHb was not





provided.





Comparison of Finger Prick  Blood and Alveolar Air





      Blood was obtained by finger prick six times a day for the two-day test





from four drivers and their panelists.  Half of the pairs  smoked.  Table 6





illustrates the correlation between COHb and the alveolar air carbon monoxide;





but, because of the small number  of subjects,  additional statistical evaluation





was indicated because a plot  of all values  for alveolar air carbon monoxide and





the simultaneous COHb on a scatter diagram indicated that  the comparison did





not approximate a normal distribution.  The Spearman Rank Correlation Test





was then performed.  When smoking habits were disregarded, an  r of  0. 5531





was found between the carbon monoxide alveolar air and the COHb readings.





A test  of significance gave the T -2 as 6. 26, which indicates statistical sig-





nificance at the 1% level.  The second test using non-smokers resulted in





values of r = 0.4002 (N=48) and Tn-2  = 2. 96  significant at the 1% level.  The





final procedure testing only the values of smokers  resulted in values of r =





0. 0795  (N=43) and Tn_2 = 0. 51 with no statistical significance indicated.





     According to the article, "Post Exposure Relationship of Carbon Mon-





oxide in Blood and Expired  Air"  by J. E. Peterson (6),  "Alveolar  breath





analysis can be used to accurately estimate the percent COHb saturation in





adult white males  provided  the ambient  carbon monixide concentration  is near





zero. "  In our study, a definite difference  appeared to exist between

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10.





    correlations among smokers and non-smokers,  perhaps suggesting that part of




    the ambient air exposure in smokers is the carbon monoxide present in the  res-




    piratory exchange necessary for smoking cigarettes.
                                                                                     *



          Further study has been conducted at the request of the authors by another

                                                                                    *.



    laboratory to correlate measurements between single samples of expired alveolar




    air concentrations of carbon monoxide and single finger prick  blood specimens as




    •well as venous blood  specimens for determination of COHb.  Carbon monoxide




    concentrations of below 2 parts per million were maintained in the ambient




    atmosphere.  The only major variable was the smoking habit of the individual.




    Under no circumstances were non-smokers tested in the same laboratory where




    a smoker had previously been tested.  Subjects  consisted of five adult males




    aged 22, 25, 30 and 34 years with smoking histories of at least two packs daily




    during recent years.   Examinations and medical records indicated no demonstrable




    physical disease. Using the Spearman Rank Correlation, the relationship between




    expired alveolar air carbon monoxide and finger prick COHb determinations was




    found to be r = 0. 568, which indicates no statistical significance.




          Then six 1 -pack-per-day male smokers of ages 22, 22,  35, 44,  38, and




    21 were tested for carbon monoxide concentrations in alveolar air and COHb




    in blood.   Correlations  by the Spearman Rank Test were found to be almost




    identical with the smoking group of the cab drivers in this study.  The r was




    0. 0821 and the T -2  = 6. 84, which gave statistical significance at the 1% level.




    Correlations between the finger prick and the venous blood  methods indicated




    a  correlation coefficient of 0. 87,  which was  considered to be highly significant.

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                                                                             11.
                                Discussion








Use of Panelists as Substitutes for Taxicab Drivers






      In general, this study found that panelists attained concentrations of





COHb similar to those attained by taxicab drivers with equal exposure.  Some





questions remain  though, on some points, such as the generally higher  average





carbon  monoxide readings in alveolar air for panelists in the smoking category.





But to investigate this subject further, more information would have to be ob-





tained.   Contributing factors could be the air-pollution concentrations at the





residence of subjects,  the method of transportation from home to the study  site,





and the  length of time for travel from home to  the site of the study.  Seasoning





(i. e. , long or heavy experience in driving) and age may possibly affect levels





of carbon monoxide in subjects.





      Nelson and Hasselblad (7) examined four taxi drivers and four passengers





at 9:00  a.m.,  11:00 a.m. ,  1:00 p. m.  and 3:00  p. m. on two successive days.





The design paired one non-smoking driver with one non-smoking passenger





and one smoking driver with one smoking passenger.  While no gross differ-





ences between drivers and  passengers were observed,  the sample was ob-





viously  minimal in size.  This  seems to be the only published  study comparing





drivers and passengers.





Smokers vs. Non-Smokers





      There is  abundant evidence that cigarette smoking has a more potent





effect on carbon monoxide concentrations than ambient city air, and the

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12,
   ambient air concentrations in this study were not extraordinary.   But is there


   interaction between smoking and ambient air?  Our data suggest that there may
                                                                                     •*
   be.   The ambient air carbon monoxide has only a small effect alone.  But the

                                                                                    «
   large rise for smokers, as shown in Figure  1, could be due to cigarette smoking   >


   alone, except that the sharp fall between  5:00 p.m.  when driving stopped and


   8:00 p.m. implies  a significant effect of ambient air.   Of  course,  alternative


   explanations for this drop could also be found.


          Bartlett (8) stressed the point that carbon monoxide from smoking and


   carbon monoxide from ambient air are not additive.  If one has a high level of


   COHb from smoking,  and  exposure to a low level of carbon monoxide in ambient


   air  will not increase the COHb.   But Bartlett adds,  "this conclusion is  modified


   by the fact that smokers' carbon monoxide excretion bet-ween cigarettes is


   slower in a carbon monoxide polluted environment  than in pure air.   Thus,


   their long-term average COHb concentrations are slightly higher in the presence


   of environmental carbon monoxide than in its absence.  "



   Ambient Air and  COHb


          The relationship between ambient carbon monoxide concentration -within


   the  automobile and COHb is positive but weak.  But this correlation is  inherently


   different to ascertain for subjects driving an automobile and is more suitably


   investigated in the  rigidly controlled conditions obtainable in a laboratory


   chamber.  We were not able to operate the infra-red analyzer  in the car becausf


   the  shocks and jolts could not  be  softened sufficiently.  We then used bag

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                                                                            13.
samples integrated over 15 minutes,  taking 8 samples  over the 9-hour day.





In view of the potentially radically different concentrations encountered in





driving, even from one block to another, and the fact that subjects escaped





exposure to high levels of ambient carbon monoxide during the one hour lunch





period, it is not surprising that the correlation was not great.








Alveolar Air, Finger Prick and Venipuncture Blood





      The correlation between carbon monoxide in alveolar air and the COBh





in finger prick blood was -weak.  But a significant correlation can only be





expected -where the ambient air concentrations of carbon monoxide are





relatively low; and,  in this study,  the ambient  carbon monoxide concentrations





were elevated in all collections of expired air with the  exception of the evening





specimen at 8:00 p.m.





      Another explanation  for the insignificant  correlation is technical.   In





any micro method using finger puncture techniques, the possibility of dilution





by tissue juices is always  regarded as a valid technical disclaimer.  Additional





venous  blood  and finger tip comparisons were  conducted by one of the authors





(A.W.H. ),  and the significant correlation (0.82) between COHb as determined





by finger prick and by venous blood methods was obtained for 15 subjects,





seven smokers and eight non-smokers.  Because the test subjects for the





panelist study were in a vehicle, venipuncture  was not  feasible and the micro





finger prick method had to be used.

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14.
                                Conclusions


          The data of this  study indicate that panelists are a satisfactory sub-

    stitute for taxi drivers in field studies of carbon monoxide concentrations.

    Use of alveolar air to  indicate the probable levels of COHb,  however,  did

    not prove to be a viable assumption since CO concentrations in alveolar air

    did not correlate acceptably with COHb under the conditions of this study.

    More satisfactory for  future studies,  the authors believe,  will be  expanded

    application of the finger-prick method.

          This study suggested several  promising areas for future investigation.

    The influence of high levels of ambient carbon monoxide on the validity of

    alveolar  air measurements must be further explored.  Correlation of COHb

    and expired air from heavy smokers should be studied.  And there should be

    a more intensive effort to establish a standardized method for field deter-

    minations of COHb.
                                                  A. Walter Hoover,  M. D.
                                                  Robert M. Albrecht, M. D.

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                                                                             15.
                           References
(1)    Commins,  B. T. and P. J.  Lawther,  "A Sensitive Method for the
      Determination of COHb in a Finger Prick Sample of Blood, "
      British Journal of Industrial Medicine 22 (1965), p. 139-143.

(2)    Jaffe, Lewis S. ,  "Ambient Carbon Monoxide and Its Fate in the
      Atmosphere,"  Journal of the Air Pollution  Control Association
      18 (1968), p. 534-540.

(3)    Johnson, Kenneth  L. ,  L. H.  Dworetzky,  and Austin N. Heller,
      "Carbon Monoxide and Air Pollution  from Automobile Emissions
      in New York City, " Science  160 (1968), p. 67-68.

(4)    Colucci,  Joseph M. and Charles R.   Begeman,  "Carbon Monoxide
      in Detroit,  New York and Los Angeles  Air /'Environmental Science
      and Technology 3  (1969), p.  41-47.

(5)    Clayton,  George D. ,  Warren A. Cook, and  W. G.  Frederick, "A
      Study of the Relationship of Street Level  Carbon Monoxide Concen-
      trations to  Traffic Accidents, "  Traffic Safety  (December I960),
      p. 25-31.

(6)    Peterson, J. E., "Post Exposure Relationship of Carbon Monoxide
      in Blood and Expired  Air," Archives of Environmental Health
      (August 1970).

(7)    Nelson, William C. and Victor  Hasselblad,  "Carbon Monoxide Levels
      of Taxidrivers  and Passengers, " Division of Health Effects Research,
      National Air Pollution Control Administration,  Durham, N. C.  mimeo-
      graphed, undated.

(8)    Bartlett, Donald,  J. R. , "Pathophysiology of Exposure to Low
      Concentrations of Carbon Monoxide,"  Archives of Environmental
      Health 16  (1968),  p.  719-727.

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                                                17.
     APPENDIX A
TABLES AND FIGURES

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 TABLE 1
Smoking History
Smoking
Never
Ex-smokers
Currently under 1 pack of cigarettes per day
Currently 1 to 2 packs of cigarettes per day
Currently over 2 packs of cigarettes per day
Total
Drivers
5
10
4
7
4
30
Panelists
7
8
4
9
2
30

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                   TABLE 2
   Age Difference Between Driver and  Panelist










Number of Years                  Number of Pairs




      0-3                              21
                                                              19.

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20.
                                    TABLE 3










                   Ambient Air Concentrations of CO in ppm by




                                   Time of Day
Hour
0800
0900
1000
1100
1300
1400
1500
1600
MINIMUM
8
3
6
4
4
2
6
5
AVERAGE
Non-smokers Smokers
22. 5
20. 6
18.1
21. 7
18. 9
19. 2
23. 7
19. 4
19. 3
18. 8
16.1
21. 7
16. 4
19. 3
20. 0
20. 2
MAXIMUM
41
42
36
48
42
43
44
43

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                                                                 21.
                   TABLE 4







      Average CO Concentrations in ppm by-





                 Time of Day










                 NON-SMOKERS
8:00 A.M.   10:00 A.M.    12 NOON  3:00 P.M.   5:00 P.M.   8:00 P.M.
Drivers,
Drivers,
Day 1
Day 2
Avg. Drivers
Panelists
Panelists
, Day 1
, Day 2
Avg. Panelists

Drivers,
Drivers,

Day 1
Day 2
Avg. Drivers
Panelists
* Panelists
, Day 1
, Day 2
Avg. Panelists
18.
15.
16.5
13.
12.
12. 5

22.
23.
22. 5
29.
23.
26. 0
18.
18.
18. 0
15.
14.
14. 5

29.
26.
27. 5
29.
31.
30. 0
15.
16.
15. 5
14.
16.
15. 0
SMOKERS
30.
23.
26. 5
22.
25.
23. 5
18.
20.
19. 0
16.
21.
18. 5

38.
37.
37. 5
45.
40.
42. 5
17.
21.
19. 0
18.
21.
19. 5

41.
39
40. 0
44.
44.
44. 0
15.
16.
15. 5
14.
15.
14. 5

30.
30
30. 0
33.
36.
34. 5

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22.
                                       TABLE 5
                               Correlation Coefficients
Correlation with:
Avg. all day
Smokers Ambient air CO
Drivers 5PM, CO 0. 38
Drivers 8PM, CO 0. 26
Panelists 5PM, CO 0. 36
Panelists 8PM, CO 0. 45
Non-Smoke rs
Drivers 5PM, CO 0.55
Drivers 8PM, CO 0. 53
Panelists 5PM, CO 0. 60
Panelists 8PM, CO 0. 17
Avg. morning
Ambient air CO
0.40
0. 34
0.29
0.40
0. 51
0.49
0. 56
0.23

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                                                                          23.
                                TABLE 6







                    Correlation of COHb obtained by




                    finger-prick and alveolar air CO










Pair number          Smoker             Driver         Panelist







    1	Yes	,_15	0




    2	Yes	._65	. 08





    3	No	J50	. 54




    4                    No                 .71              .23

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24.
       FIGURE. 1
   45
  I 35
  CL
 UJ 25
 >
 UJ
 O
 o
              AVERAGE CO  READINGS

         FOR SMOKERS  AND  NONSMOKERS

                 BY  TIME OF DAY

            (AVERAGED OVER  2 DAYS)
                  NONSMOKERS
                   .^•*"
  8a.m.

45r-
         10a.m. I2noon   3p.m.  5p.m.
   35
  CL
  a.
ui

LU
 O
 O
   25
    15
                    -•
                     SMOKERS
    8a.m. 10a.m. I2noon   3p.m.  5p.m.
                                   . DRIVERS

                                   ^ PANELISTS
                                    8p.m.
                                 ^PANELISTS


                                 '• DRIVERS
                                    8p.m.

-------
                                            25.
     FIGURE 2
  45
1.35
Q.
  25
LU
o  15
o
          AVERAGE CO READINGS
     FOR  SMOKERS AND NONSMOKERS
               BY TIME OF  DAY
               NONSMOKERS
  8a.m. lOa.m  12 noon
45r
                       3p.m.  5p.m.
1.35
Q.
_i
UJ
  25
O  15
o

                 SMOKERS
    8a.m. lOa.m  12 noon   3p.m  5p.m.
                                      PANELISTS, day I
                                    v. DRIVERS, day 2
                                    *" DRIVERS.day I
                                      PANELISTS,day 2
                                     8p.m.
                                    •>.PANELISTS,day I
                                      PANELISTS, day 2

                                    ^ DRIVERS.day I
                                      DRIVERS, day 2
                                     8p.m.

-------
 26.
     FIGURE 3
  45
I 35
QL
UJ
  25
O  15
o
             AVERAGE CO READINGS
          FOR DRIVERS AND PANELISTS
                 BY  TIME OF  DAY
            ,X DRIVERS
                                      SMOKERS, day I
                                      SMOKERS, day 2
                               ...^NONSMOKERS.dayl
                                  "NONSMOKERS,day2
     8a.m. 10a.m. I2noon

  45r
                     3p.m. 5p.m.
I 35
OL
UJ

UJ
_J

O
o
  25
15
8p.m.
                                   •SMOKERS, day 2
                                    SMOKERS, day I
               PANELISTS
                                    NONSMOKERS,day2
     8a.m. 10a.m. I2noon    3p.m. 5p.m.    8p.m.

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                                                         27.
               APPENDIX B
STATISTICAL CORRELATION OF ALVEOLAR AIR
CARBON MONOXIDE CONCENTRATIONS AND CAR-
BOXYHEMOGLOBIN USING SPEARMAN RANK
CORRELATION TEST

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28.
            Statistical Correlation of Alveolar Air Carbon Monoxide
            Concentration and Carboxyhemoglobin Using Spearman
                          Rank Correlation Test
            All values of the simultaneous  readings  of CO* and COHb* were

    roughly plotted on a scatter diagram.  It was found through observation that

    the  comparison between the two values did not approximate a normal distri-

    bution.  It was,  therefore, decided not to accept  the correlation coefficient

    test since the assumption of normality of distribution must be made  for the

    test to be valid.   Conversion of the CO and COHb values to logarithms still

    left doubt as  to the normalcy of distribution,  although normalcy was  being

    approached.

            Thus, the Spearman  Rank Correlation Test was applied since normal

    distribution of values would not be a  limiting factor.  Three tests were per-

    formed.  The first was to correlate all  CO and COHb readings taken as a

    single group,  without regard to smoking.  The formula for the test was:

                          2
            r = 1 - —-—^2—L      where r  =  correlation,  d =  difference of
                     n3 -n
                                  the ranks, and n = 91.  This gave a value of

    r= 0. 5531.  A test of significance gave t  ,, = 6. 26,  which indicates  a statistical

    significance at the 1%  level.

            The  second test, using non-smokers only, resulted in  values  of

    r =  0. 4002  (n = 48) and tn_2 =2. 96  significant at the 1%  level. The final test

    using only smokers resulted in values of r = 0. 0795 (n = 43) and t  ?=  0. 51,

    showing no statistical  significance.
    #CO concentration is measured in ppm (parts per million) and COHb in
     % (per cent)

-------
                     APPENDIX C
DATA ON COHb BY FINGER PRICK AND ALVEOLAR AIR CO

-------
30.
         Levels of COHb (%) and Alveolar Air CO (ppm) for 4 Panelists
and 4 Drivers
Non- Smokers

Time
Day 1





Day 2






Day 1





Day 2







8 a. m.
10 a.m.
12
3 p. m.
5
8
8 a. m.
10
12
3 p. m.
5
8

8 a. m.
10. 30
12. 30
3. 15
5. 30
8
8 a. m.
10
12
3
5
8
Driver A
% COHb
2. 7
2.2
2.6
4. 3
2.6
1. 5
1. 5
2. 3
5. 3
3. 5
1. 5
. 1
Driver B
2. 2
0
2. 1
3. 5
2. 9
3.6
3.8
3. 0
3.4
3.2
3.0
1. 3

CO (ppm)
16
18
21
22
21
18
20
21
19
22
17
12

15
15
12
22
18
35
22
23
23
25
22
21
Panelist A
%COHb
1. 5
7. 5
2.6
1. 8
2.8
2. 9
1. 3
3.6
2.4
2. 2
4. 7
. 1
Panelist B
2.6
2.8
2. 8
2.4
2.8
2.8
1. 1
2. 5
3. 7
3. 1
2. 3
2. 5

CO
10
10
10
20
21
11
11
14
13
18
17
7

16
20
11
16
22
23
14
18
18
19
20
17

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                                                                                         31.
                                Levels of COHb (%_) and Alveolar Air CO (ppm)
V
•4
      Time






for

4 Panelists and 4 Drivers
Smoke
Driver C
% COHb CO (ppm)
8
9
1
2
5
8
8
10
11
2
4
8
a. m.
. 35
1.45
. 30 p.m.


a. m.

. 45
. 30
. 30

6.
8.
11
17
12
12
7.
13.
11.
13.
22.
12.
2
1
. 0
. 8
. 5
. 8
9
1
5
4
0
2
29
41
40
35

36
30
35
23
31
38
23
Driver D
8
10
12
3
5
8
8
12
2
5
8
a. m.
. 45
. 30
. 15


a. m.

. 45


2.
5.
7.
5.
6.
6.
3.
3.
6.
4.
-
0
7
7
5
5
6
3
2
3
6

12
50
50
13
50
45
38
22
32
37
19
rs


Panelist C
%COHb
6.
6.
8.
7.
10.
8.
10.
7.
16.
14.
8.
17.
9
5
6
4
4
9
2
9
2
0
5
3
CO
28
45
15
45
-
31
8
24
32
34
37
44
Panelist D
1.
3.
3.
6.
4.
7.
6.
3.
1.
1.
4.
1
0
1
5
3
8
4
1
7
7
9

33
50
39
50
45
30
10
39
39
19

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32.
                                    TECHNICAL REPORT DATA
                            (Please read Instructions on the reverse before completing)
 1. REPORT NO.
  EPA-650/1-74-001
                                                            3. RECIPIENT'S ACCESSION-NO.
 4. TITLE AND SUBTITLE
   The Use of Panelists  as  Substitutes for Taxi cab
   Drivers in Carbon Monoxide Exposure.
                                                            5. REPORT DATE
                                                              July  1973
             |6. PERFORMING ORGANIZATION CODE
                                                 t

                                                 V
 7. AUTHOR(S)
  A.  Walter Hoover, M.D.  & Robert M. Albrecht,  M.D.
                                                            8. PERFORMING ORGANIZATION REPORT NO.
 |9. PERFORMING ORGANIZATION NAME AND ADDRESS
   Division of Environmental  Health Sciences
   School  of Public Health, Columbia University
   600 West 168th Street
   New York, N.Y. 10032
              10. "PROGRAM ELEMENT NO.

               1A1007 21AFU
              11. CONTRACT/GRANT NO.

                CAMP-8-68(l-68) and
                CPA  22-69-97
 12. SPONSORING AGENCY NAME AND ADDRESS
   Coordinating Research  Council, Inc, 30 Rockefeller
   Plaza, New York, N.Y.   10020  and  The Environmental
   Protection Agency,  Research Triangle Park,  North
   Carolina  27711
              13. TYPE OF REPORT AND PERIOD COVERED
                Final  Report	
             14. SPONSORING AGENCY CODE
 15. SUPPLEMENTARY NOTES
 16. ABSTRACT
        Analyses of  breath and limited blood  samples from 30 pairs  of taxi
   drivers and panelists  who drove in New  York  City traffic for  8  hours on
   two consecutive days  indicated that both panelists and drivers  attained
   similar COHb  (blood carboxyhemoglobin)  levels.   This was true for both
   smokers and non-smokers though smokers  had significantly higher concen-
   trations of COHb  than  non-smokers.  There  was no consistent difference
   between the first and  second day of driving  in the levels of  alveolar
   carbon monoxide.
 17.
                                KEY WORDS AND DOCUMENT ANALYSIS
                  DESCRIPTORS
b.lDENTIFIERS/OPEN ENDED TERMS  |c.  COSATI Field/Group
   carbon monoxide  exposure
   smoking
   driving
   blood carboxyhemoglobin level (COHb)
  CRC-APRAC  Project No.
   CAPM-8-68 (1-68)
Plumonary
  Physiology
Environmental
  Toxicology
 18. DISTRIBUTION STATEMENT
                                               19. SECURITY CLASS (This Report)

                                               	N/A	
                           21. NO. OF PAGES

                               35	
   Unlimited
                                               20. SECURITY CLASS (Thispage)
                                                                          22. PRICE
 EPA Form 2220-1 (9-73)

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