United States
Environmental Protection
Agency
Health Effects Research
Laboratory
Research Triangle Park NC 27711
v°/EPA
Research and Development
EPA-600/S1-81-004 Mar 1981
Project Summary
Air Pollution and Health
Effects in Children Residing in
Akron, Ohio
Richard A. Mostardi, Nancy R. Woebkenberg, Daniel Ely, Glenn Atwood, Mary
Conlon, Marcia Jarretf, and Meredith Dahlin
The purpose of this study was to
determine the effects of ambient air
pollutants on respiratory function,
incidence, and severity of acute respi-
ratory illness, the nature of pulmonary
epidemiology and trace element ac-
cumulation in fourth, fifth, and sixth
grade children in Akron, Ohio.
Air pollutants were measured at
three locations. These were sulfur
dioxide (SO?), nitrogen dioxide (NO2),
total suspended particulates (TSP),
and from the Hi-vol filters, suspended
sulfates(SO4=) and nitrates (IMO3-).
The filters and bubblers were run on a
daily 24-hour schedule, and chemical
analyses were carried out by Commu-
nity Health Assessment Monitoring
Program (CHAMP) contractors.
All physiological and epidemiologi-
cal data were collected at Seiberling
and Betty Jane grade schools in Akron,
Ohio, both of which are located on the
eastern edge of the city and adjacent
to industrial complexes.
The aerometric results indicate sig-
nificant differences between the an-
nual means for SO2 and NO2 with the
Seiberling School having been exposed
to the higher values.
The questionnaire results indicate
that the Seiberling children report
more wheezing in the chest and short-
ness of breath than the Betty Jane
children. Daily symptoms reported by
the students indicate that the Seiber-
ling children report twice as many
incidences of upper respiratory symp-
toms including rhinitis, cough, and
sore throat.
Trace metal analysis in hair showed
that the Seiberling males have higher
lead levels; both males and females
have higher mercury levels but females
have lower levels of cadmium when
compared to Betty Jane children.
However, none of the trace element
levels can be considered abnormally
high.
Baseline lung function testing did
show that the ratio FEVi/FVC was
significantly lower (p < .1) at the
Seiberling School. For both schools,
there was a decrease in lung function
during the symptomatic phase of an
acute respiratory illness (ARI), and the
tests further indicate that the ARI's in
the Seiberling School were more severe
and/or involved the small airways
more so than the Betty Jane School.
The ARI's were not complete after
nine days with the Seiberling children
showing slower recovery than the
Betty Jane children.
On the basis of available aerometric
information, SO2 in combination with
IMO2 is primarily responsible for the
reduction in lung function tests and
the exacerbations seen in the children
at the Seiberling School.
This Project Summary was develop-
ed by EPA's Health Effects Research
Laboratory, Research Triangle Park,
NC, to announce key findings of the
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research project which is fully docu-
mented in a separate report of the
same title (see Project Report ordering
information at back).
Introduction
Air pollution continues to be a problem
confronting urban and industrial popu-
lations of the world. As the consumption
of energy increases, the amount of
pollutants produced by fossil fuel com-
bustion will continue to increase. Fur-
thermore, there will be a shift from oil
toward coal which will increase total
suspended particulates (TSP) and sulfur
dioxide (SO2). One of the perplexing
problems facing our society is how
much recovery or removal of these pol-
lutants from stack gas is necessary to
protect public health? Such pollutants
have been shown to affect a number of
human organ systems, the most sus-
ceptible being the respiratory system.
There is a large body of evidence that
suggests that air pollutants are associ-
ated with an increased incidence of both
upper and lower respiratory disorders.
Early work by Rosenbaum showed that
urban recruits suffered more respiratory
infections than rural recruits. Work
done in the United States and England
has shown that both severity and inci-
dence of acute respiratory illness (ARI)
are related to high levels of one or more
airborne pollutants.
Ventilatory functions have also been
shown to be affected by air pollutants.
These effects have been shown most
dramatically in children. While many
studies have shown significant losses of
pulmonary function due to pollutant,
others have not. This paradox could be
due to a number of factors including the
level of airborne pollutants, compound-
ing factors such as cigarette smoking
and secondary exposure to irritating
substances, or dust which has not been
controlled in the experimental design.
Of all the industrial emissions S02,
N02, and TSP appear to be particularly
detrimental to the upper and lower
respiratory system and, as such, are of
specific importance. Many studies have
shown strong positive relationships
between one or more of the pollutants to
increased mortality and morbidity.
The purpose of this work is not to
repeat other work, but to incorporate
various data gathering procedures and
facets of other studies into one compre-
hensive work. This study was designed
to examine the morbidity rates of chil-
dren in areas with high and low levels of
air pollution, to determine how illness
affects lung functions, and to carefully
monitor the air pollutants that may be
producing exacerbations.
Experimental Procedure
In the Akron area two schools were
selected for study. The Seiberling Ele-
mentary School is located in the east
section of the city approximately two
miles from the center of downtown and
one-half mile from the closest factory.
The Betty Jane Elementary School is
located two miles east of the Seiberling
School. There were approximately 140
fourth, fifth, and sixth grade children
who volunteered to participate in the
study. Participation was requested
through the parents who were also
asked to fill out and return with the child
an epidemiologicquestionnaire pertain-
ing to acute and chronic respiratory
symptoms.
Pulmonary function tests (PFT) were
carried out on each child using a Warren
E. Collins nine liter recording spiro-
meter. The children were also asked to
fill out a daily diary pertaining to the
incidence of cough, sore throat, runny
nose, eye irritation, and cold. This diary
was used as a surveillance tool to de-
termine when the children were suffer-
ing from acute respiratory illnesses
(ARI).
On days when several symptoms
were checked by a student, the child
was called out of class and examined for
symptom verification. If the child has a
verified ARI, PFT was carried out at least
two different times during the sympto-
matic phase of the disease and every
other day up to nine days asymptomatic.
All of the PFT data which included
forced vital capacity (FVC), forced expir-
atory volume-one second (FEVi), and
maximal midexpiratory flow (MMF)
were corrected to BTPS and adjusted for
age, height, and weight using multiple
linear regression. A 100mg hair sample
was also collected for trace elements,
lead, mercury, arsenic, and cadmium.
Aerometric data were collected on a
daily basis at each school. The 24-hour
period began and ended at 8:00 a.m.
Total suspended paniculate (TSP) were
collected and measured using a hi-
volume sampler and standard techniques
of weighing the filter before and after
the 24-hour exposure.
The N02 and S02 values were deter-
mined using the liquid phase bubbler
train. The bubblers were run on the
same 24-hour period as the hi-volume
samplers.
These schools and the associated air
pollution station were located in a walk-
ing school district. Ninety-five percent
of the students walk to and live within
one mile of the school.
Conclusions
The aerometric data collected at the
station showed significantly higher
levels of S02 and N02 in the Seiberling
area. The annual mean values for S02
were 59.6 /ug/m3 at Seiberling and 18.5
/ug/m3 at Betty Jane. N02 values were
48.6 /ug/m3 and 34.5 /ug/m3, respec-
tively. TSP values were also significantly
different between the schools.
To reinforce these data, the values
from the Seiberling School were com-
pared with data collected by the Akron
Air Pollution Control Board at a site a
quarter mile south of the Seiberling
station. These annual means were not
significantly different.
Comparison of questionnaire re-
sponses between the two showed sig-
nificant differences for cough, wheeze,
and shortness of breath with the Seiber-
ling School having the highest incidence
of each. |
Baseline PFT data did not show any
significant differences except the ratio
FVC/FEVi. This value was consistently
lower at the Seiberling School and has
been shown m previous studies to be
sensitive to airway obstruction.
The daily symptoms were compiled
for each school on a weekly basis and
expressed as a percent of those students
reporting a particular symptom. All of
the symptoms, especially runny nose,
sore throat, and cough were nearly
doubled in percent reporting at the
Seiberling School as compared to Betty
Jane.
The results of the ARI component of
the study was of particular interest. Not
only did the Seiberling students report
twice the incidence of verified ARI but
the severity of the disease was greater
as evidenced by FEVi and MMF during
both the symptomatic and asymptomatic
phases of the ARI indicate that airways
of the Seiberling children were being
compromised to a greater extent than
the Betty Jane children.
Discussion
This work has succeeded in accom-
plishing its design objectives by:
measuring air pollutants within a give
area, 2) measuring a variety of physio-
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logical and epidemiological parameters
within the selected areas, 3) repeating
sampling procedures on the children
under several conditions, and 4) utilizing
a large sample size. It is felt that the
design of this project optimized the
study of the cause and effect relation-
ship between air pollutants and health
effects in children, where in the past
this has not been accomplished.
The aerometric data proved to be an
interesting find within this study design.
The annual average for SO2 at Seiberling
School was about three times the value
recorded at the Betty Jane School, and
that for NO2 was about twice the value
recorded at Betty Jane. Both of these
values are significantly different. Since
these differences occurred within a
geographical area of about 5 square
miles, it provided an excellent opportu-
nity to determine if any physiological
differences exist.
The levels of SO2 are not exceedingly
high, but the annual average value does
approach the Federal secondary annual
standard of 60jug/m3. Available litera-
ture seems to indicate that values of at
least 80 ^g/m3 are effective in pro-
ducing only minor irritations and, most
likely, would not produce any reductions
in pulmonary functions. This same
value of 80 //g/m3 is assumed to be
associated with aggravating chronic
obstructive lung disease (COLD). Base-
line pulmonary function testing done in
this work is in agreement with the above
statements, since no differences were
found in any of the PFT parameters
recorded during asymptomatic condi-
tions. However, reductions were found
in the value FEVi/FVC in the Seiberling
children. This ratio represents that
portion of the vital capacity that can be
forcefully expired within the first second
of a forced expiration. It is quite sensitive
to changes in small airway integrity and,
in the past, it has been a very effective
predictor of small airway disease. This
reduction of the FEVi/FVC ratio is con-
sidered to be a significant find in this
study. As stated before, the levels of
pollutants are not alarmingly high and,
as such, would not be expected to
adversely affect lung functions. How-
ever, in testing these children over a two
year period of time, a reducedFEVi/FVC
ratio was consistently found for children
in the area with the highest pollutant
levels. This particular parameter, when
considered alone, might be overlooked
as a minor effect since the differences
are small, and the levels of statistical
significance are at the 0.1 level of
probability. However, when these data
are coupled with the results of the ARI
work, problems can occur.
The ARI data produced several signifi-
cant findings. The first was the number
and severity of the ARI's in the children
at the Seiberling School. A higher
number of children reported ARI's at
Seiberling as compared to Betty Jane.
This fact also corresponded with the
daily symptoms data where a high
incidence of daily symptoms at Seiber-
ling was also found.
In both schools a significant reduction
in FVC, FEVi, and MMF was founded
when compared to baseline values. Of
greater significance, when these differ-
ences were compared from baseline
values between the two schools, the
Seiberling children had a significantly
greater reduction in FEVi and MMF than
the Betty Jane children. Examination of
the PFT data histograms would indicate
that lung functions were slower to
return to the original baseline values,
especially for MMF. MMF was the
parameter most affected by the ARI's. In
the past, this value was used as a
sensitive indicator of changes in small
airway function. From the results of this
study, ARI appears to have had a most
profound effect on the small airways of
the Seiberling children. It seems that
the higher levels of SO2 and NO2 exerted
a low level chronic effect on these
children and produced the reduction in
the ratio FEX/T/FVC. The superimposition
of the ARI produced a compounding of
the exacerbation which reflected itself
in the highly significant reduction of
and MMF values.
A second substantiating find was the
number of reported daily symptoms and
questionnaire responses in the Seiber-
ling children. On a daily percentage
basis, the Seiberling children reported
nearly twice as many upper and lower
respiratory symptoms than the Betty
Jane children. In filling out the ques-
tionnaires, the Seiberling parents re-
ported that their children had more
wheezing and shortness of breath than
their counterparts at the Betty Jane
School.
Selection processes are constantly
occurring in communities with high
levels of air pollution. Those adults with
a chronic respiratory problem are often
advised to leave the area in favor of a
more moderate climate and, preferably,
one with lower levels of air pollutants.
Thus, in studies dealing with adults it
should be determined whether the pop-
ulation being studied is a true cross
section or a selected group which is
resistant to the pollutants and free of
obstructive pulmonary diseases.
In children, this is usually not the case
as they take up residence in the area of
parental employment, and only in cases
of severe pediatric respiratory problems
do parents move the family away. Low
level chronic symptoms or high inci-
dences and an increase in the severity
of ARI's are usually tolerated, overlooked,
assumed to be peculiar to a given child.
However, these subclinical chronic
symptoms associated with air pollution
could well be the forerunner of other
more complicated and debilitating prob-
lems of COLD in adulthood.
The term threshold is one which is
often used in air pollution research.
There are many variations of threshold
as evidenced by the Primary and Sec-
ondary Standards as well as the Pollution
Standard Index. Of primary interest
within the context of this report is the
lowest threshold or the Primary Stan-
dards for SO2 and NO2. The data reported
in this study all point to the fact that the
Primary Standard for both of these
variables are capable of producing low
level pulmonary abnormalities and
therefore are currently too high. The
annual average for S02 that the Seiber-
ling children were exposed to are closer
to the Ohio Standard than the Primary
Standard, but there are still significant
pulmonary problems.
N02 values reported in this work are
much lower than the Primary Standard
and, at this level, there are no health
effects reported in the literature. It is
suggested that the effects could be
synergistic with SO2 and, as such, the
problem deserves serious consideration.
Recommendations
It is recommended that the annual
average for S02 be no higher than 80
fjg/m or, more ideally, be lowered to 60
fjg/m3. In this study the level of N02,
although quite low, does appear to be
affecting the children. This may be
either a synergistic effect with SOa or an
individual effect. On the basis of these
findings it is recommended that the
health effects of N02 be given careful
consideration but the Primary Standard
should not be changed.
i US GOVERNMENT PRINTING OFFICE 1961-757-012/7033
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Richard A Mostardi, Nancy R Woebkenberg, Daniel Ely, Glenn Atwood, Mary
C onion, Marcia Jarrett, and Meredith Dahlin are with the University of Akron,
Akron, OH 44325.
Wilson Riggan is the EPA Project Officer (see below)
The complete report, entitled "Air Pollution and Health Effects in Children
Residing in Akron, Ohio,"(Order No. PB 81-152 498; Cost: $12 50, subject to
change) will be available only from'
National Technical Information Service
5285 Port Royal Road
Springfield, VA 22161
Telephone- 703-487-4650
The EPA Project Officer can be contacted at:
Health Effects Research Laboratory
U S. Environmental Protection Agency
Research Triangle Park, NC 27711
United States
Environmental Protection
Agency
Center for Environmental Research
Information
Cincinnati OH 45268
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Fees Paid
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Protection
Agency
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Penalty for Private Use $300
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