I
                       Baltimore
      Integrated Environmental Management
                         Project

                    Phase II Report
                       Indoor Air
EPA
230/
1987.3
c.2
   Regulatory Integration Division
    Office of Policy Analysis
Office of Policy, Planning, and Evaluation
 U.S. Environmental Protection Agency


      •t   1987

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.S. Environ-.,' ••
         Room 7
401 M  Street,
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                       Baltimore-


      Integrated Environmental Management Project

                    Phase II Report:


                       Indoor Air

                        Prepared
                           by

                  David Filbert, Ch ief

            Bureau of Air Quality Management

Baltimore County Department of Environmental Protection
                and Resource Management

                    Roberta Grossman

       (formerly) Regulatory Integration Division

          U.S. Environmental Protection Agency
                          1987


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                           Preface
     This  report was prepared under the auspices  of  the Baltimore
Integrated Environmental Management Project (IEMP).  The Baltimore
IEMP is  a  collaborative  effort  of  the  State  of Maryland,  Anne
Arundel and  Baltimore  Counties,  the  City of  Baltimore, and  the
U.S. Environmental  Protection Agency.   EPA initiated  the  project
as part of  its  pursuit of new approaches to environmental  manage-
ment and policy. The purpose of the IEMP is to use  an integrated
approach to  identify and assess  environmental  issues  that  concern
managers,  to set priorities  for  taking  action  on  them,   and  to
analyze appropriate  approaches to managing them.

     The Baltimore  IEMP represents  the  second  of  four geographic
projects that  EPA  initiated  across  the  country.  The  Baltimore
area was chosen, not because it  has a significant toxics problem,
but because  EPA and  local officials wanted to  explore  better ways
to identify, assess,  and manage  the  human  health risks of environ-
mental pollutants in the area.  Other lEMPs include  Philadelphia,
Santa Clara  County,  and Denver.

     The decision-making structure  of  the  Baltimore IEMP consisted
of two committees,  which  also served as  the* means for  State  and
local participation:   the Management  Committee and  the  Technical
Advisory Committee.   The Management Committee  with members  repre-
senting Baltimore City,  Baltimore County,  Anne  Arundel County,  and
the State, managed the  IEMP  and set its overall policy  directions.
The Technical  Advisory  Committee  composed of  technical managers
from the  City  of Baltimore,  the two counties,  and the  State,  as
well as  representatives  from  the  Maryland  Regional  Planning
Council and  the academic community,  recommended  issues  to  study,
advised the  MC  on  the  technical  and  scientific  aspects   of  the
project,  and  oversaw  and  commented  on  all  EPA  and  consultant
work.  EPA   provided  administrative,  technical,   and  analytical
support.

     The Baltimore  IEMP examined five  environmental  issues:   air
toxics, Baltimore Harbor,  indoor air  pollution,   abatement  of  the
hazards from lead paint,  and potential contamination of  ground-
water from  underground tanks.   For  further information on  these
reports or other IEMP studies, contact the Regulatory  Integration
Division,  the  Office of  Policy  Analysis  (PM-220),  in the  Office
of Policy,  Planning,  and Evaluation,  U.S.   Environmental  Protec-
tion Agency, Washington,  D.C. 20460.

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                         ACKNOWLEDGMENTS
     Numerous  individuals contributed  their  time  and  effort  to
the preparation  of  this  report.

                   Indoor Air  Pollution Work  Group


{Catherine Farrell,  M.D. , MPH,  Chief,  Division  of  Environmental
  Disease Control,  Maryland Department of  Environment

David Filbert, Chief, Bureau of Air  Quality  Management,  Baltimore
  County Department of Environmental  Protection and Resource
  Managemen t   (Cha irman)

Joseph Abey, Chief, Air  Quality Control  Section,  Anne Arundel
  County Department of Health

Charles Billings, Ph.D., (formerly) Associate  Professor,  Environ-
  mental Health  Engineering, School of  Hygiene and  Public  Health,
  Johns Hopkins  University

Elkins W. Dahle, Jr., P.E., Director,  Bureau of Industrial Hygiene
  Baltimore City Department of Health

Roberta Grossman, (formerly) Regulatory  Integration Division,  U.S.
  EPA

Allan B. Heaver, Director, Baltimore Building  Owners  and Managers
  Assoc iation

Thomas A. King,  P.E., Manager, Environmental Systems  Department,
  Mueller Associates, Inc.

      Members of the Baltimore IEMP Management Committee

J. James Dieter, Special Assistant to  the  Director, Department of
  Environmental  Protection and Resource Management, Baltimore
  County

Max Eisenberg, Assistant Secretary for Toxics, Environmental
  Science,  and Health, Department of the Environment, State of
  Maryland

Robert Perciasepe,  (formerly) Assistant  Director, Department of
  Planning,  City of Baltimore

Claude Vannoy, Assistant to the County Executive  for  Land Use,
  Anne Arundel County
                               11

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      Members of the Baltimore  IEMP Technical Advisory  Committee


Jared L. Cohon, Vice Provost for Research,  and  Professor  of  Geographic
  and Environmental Engineering, Johns  Hopkins  University (Chairman
  Technical Advisory Committee)

Don Andrew, Administrator, Engineering  &  Enforcement  Programs,  Depart-
  ment of the Environment, State of Maryland
                                         i>

Philip Clayton, Manager, Cooperative Clean  Water Program, Regional
  Planning Council

Emery Cleaves, Deputy Director, Maryland  Geological Survey

Ralph Cullison, Baltimore City  Department of Public Works, City of
  Baltimore

N. Singh Dhillon, Director, Environmental Health, Anne Arundel  County
  Health Department

Tom Ervin, Environmental Planner, Anne Arundel  County Office  of
  Planning and Zoning

Katherine Parrell , M.D. MPH, Chief, Division of Environmental Disease
  Control, Office of Environmental Programs, State of Maryland

David Filbert, Director of Air  Pollution  Control, Baltimore  County
  Department of Environmental Protection  and Resource Management

Frank Hoot, Assistant Commissioner, Environmental Health, Baltimore
  City Health Department (Chairman, Human Health Subcommittee)

Sam Martin, Consultant, vice Chairman of  TAC

Janice Outen, Supervisor of Water Quality,  Baltimore  County  Depart-
  ment of Environmental Protection and  Resource Management

Colin Thacker, Special Assistant to the Director, Baltimore  County
  Department of Environmental Protection  and Resource Management

Bill Wolinski, Water Quality Coordinator, Baltimore City  Water  Qual-
  ity Management Office
                                  111

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                   Support  Staff and  Resource Persons
Roberta  Grossman,  (formerly)  U.S.  EPA  Regulatory Integration Division

Bruce W.  Jacobs, C.I.H.,  (formerly)  Environmental Toxicologist, Office
   Office  of  Environmental  Programs,  Maryland Department of Environment

John Shumaker,  Program Supervisor, Bureau of Air Quality Management
   Baltimore  County  Department  of  Environmental  Protection and Resource
   Management

Melissa Wieland, Environmental Technician, Environmental Programs
   Unit, Baltimore Gas  and  Electric Company

Charles  Courtney, Chief Air Pollution  Control,  Baltimore City Depart-
ment of  Ffealth

Jeffrey M. Paull, M.S., MPA,  Environmental Toxicologist, Science and
   Health  Advisory Group, Maryland  Department of  the  Environment


             Staff of U.S.  Environmental  Protection Agency


Daniel Beardsley, Director, Regulatory Integration Division

Arthur Koines,  Chief,  Geographic Studies  Branch

John Chamberlin, Site  Director, Baltimore  IEMP

Andrew Manale,  Senior Analyst,  IEMP

Catherine Tunis, Policy Analyst, IEMP

Ellen Tohn,  Policy Analyst, IEMP
                                   iv

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                        Table of Contents
Preface	•	i

Acknowledgments	it

Table of Contents	v

List of Tables and Appendices	vi

Executive Summary	vii

Introduction	1

Background on Indoor Air Pollution 	3

     Health Hazards  	3
     Current Regulatory and Government Activities....	4

The Evaluation Process	 5

     Step !:__ Select the Pollutants for Further Study	5
     Step 2:  Develop and Review Background Information	6
               Documents on Each Pollutant
     Step 3:  Summarize the Background.Information Documents..?
     Step 4:  Develop Criteria for Evaluating the  Pollutants..?
     Step 5:  Apply  the Rating Criteria to the Pollutants	9
     Step 6:  Identify Potential Programs	13
     Step 7:  Develop Criteria for Evaluating the  Potential
               Programs	16
     Step 8:  Apply  the Criteria to the Potential  Programs....19
     Step 9:  Set Priorities for Implementing the  Programs.... 22

Conclusions and Recommendations	23

     Program Recommendations for Passive  Smoking	24
     Program Recommendations for Radon	24
     Some Observations on the Evaluation  Methodology	24


References	26
Appendix 1
Appendix 2
Appendix 3
Appendix 4a

Appendix 4b
Appendix 5a

Appendix 5b

Appendix 6
Indoor Air Pollution Questionnaire
Compilation of Questionnaire Data
Background Information Document Summaries
"Toxicology," an article by Thomas J. Haley, P.D.
(in part)
Justification for the Pollutant Rating Scores
Passive Smoking:  Justification for Ratings of
Potential Programs
Radon:  Justification for Ratings of Potential
Programs
Pollutant/Programs Overview Chart

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             LIST OF TABLES AND EXHIBIT
Exhibit 1    Indoor Air Pollution Work Group  	  3
Table   1    Pollutant Rating Scores	10
Table   2    Results of Pollutant Ranking	11
Table   3    Program Criteria Ratings - Passive  Smoking	20
Table   4    Program Criteria Ratings - Radon  	21
                                VI

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                        EXECUTIVE SUMMARY

     In recent  years numerous  studies  have  shown that  indoor
concentrations of  many  pollutants can  reach levels that  exceed
outdoor air quality  standards.   Since many people spend up to 90
percent of their  time indoors, these concentrations may present
a significant public health hazard.

     The Baltimore  Integrated  Environmental Management  Project
(IEMP) conducted a Phase  I  study  to  identify major environmental
issues for further  study.  Indoor Air Pollution  was one of five
issues selected for  analysis  in Phase  II.   The  Indoor  Air Pollu-
tion Work Group was established to determine:

     0  which indoor  air  pollutants  in the Baltimore  area should
        be assigned  the highest priority  for further  evaluation;
        and

     0  which programs, if  necessary, could most effectively and
        efficiently reduce exposure to those pollutants.

     Using professional judgment  and very limited national  and
local data, we began by selecting several indoor pollutants con-
sidered to be prime candidates for evaluation: asbestos, chlordane,
chloroform, formaldehyde,  lead,  (later  assigned  to another work
group for consideration), products of  combustion, radon, tobacco
smoke (passive  smoking),  and  volatile  organic  compounds  (VOC).
We then prepared a  comprehensive  background information document
for each pollutant.   Each document  included a general discussion
of the pollutant,  its sources, factors leading to exposures, health
effects, control strategies, and ongoing control/assessment activ-
ities along with a more specific discussion of information relevant
to the Baltimore area.  These documents  are available  separately
from this report, as Baltimore IEMP Indoor Air Pollution Phase II
Study;  Support Documents 1987.

     We rated and ranked each pollutant using four  criteria:  the
population potentially exposed  to the  pollutant, the  pollutant's
potential health effects, how government  agencies and  interested
organizations perceive the  pollutant's risks,  and the  public's
concern over the pollutant.  We concluded that:

     0  of the  nine  pollutants  we considered,  passive  smoking,
        radon, and asbestos are of greatest concern;

     o  chlordane  and formaldehyde  are  of  least concern;  and

     o  combustion products, chloroform,  and other VOCs fall some-
        where in between.
                               vn

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     We Identified and evaluated potential programs for assessing
or controlling  the  highest-priority  pollutants.   As  an  initial
step, we used a  fifth  criterion—current activity to control the
problem—to evaluate the priority pollutants.  We found significant
efforts already under way to control asbestos.  Therefore, we fo-
cused our efforts on passive smoking and  radon.  We rated  various
control and assessment programs, using the five criteria of cost,
time frame, acceptability  to  the public,  legal  considerations,
and political sensitivity.   As  a result, we recommended  the follow-
ing programs for dealing with these problems:

     0  passive smoking

        — stop-smoking clinics, self-help programs
        — public education
        -- smoking policies in  government and  nongovernment build-
           ings

     0  radon

        — education  of  the  public  and  government  officials
        — conduct  of  a  State or  local survey  to  establish  a
           profile of the radon problem  in the area.

     As a  conseguence  of  this  oroject,  we engaged  in extensive
communication with  individuals representing  a  large  number  of
agencies and organizations  concerned with  indoor  air pollution.
This laid  a  foundation for  continued  cooperation.   The agencies
and organizations that participated in  the study  should  explore
ways to capitalize on and make formal this informal communication
network.

     The results of  the  Indoor Air Pollution study  should offer
useful guidance  and  background  for  the formulation  of  further
studies and control  programs.   However,  these  results cannot be
considered definitive.

     The lack, of data on measured indoor concentrations and expo-
sures in the Baltimore area, and the lack of resources  to generate
such data, rendered  a  more  comprehensive  evaluation  impossible.
As a  result,  the Phase  II  work  was  based on  readily available
national information and on the collective experiences, expertise,
and professional judgement of the work group members.

     The Baltimore data base on indoor concentrations and exposures
should improve in the  near  future.   EPA's Office  of Research and
Development is conducting  a project in the  Baltimore Area called
the Total  Exposure  Assessment  Methodology  (TEAM).   This  project
is collecting data  on personal exposures to indoor  and  outdoor
toxic air pollution.   It should prove  to be a valuable source of
specific, local data for  further consideration of which pollutants
in the area are of most concern.  The data from this project should
be available in 1988.
                                Vlll

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INTRODUCTION

     In the  summer  of 1983, the  Environmental  Protection Agency
(EPA) initiated  the Baltimore  Integrated  Environmental  Manage-
ment Project  (IEMP).   The project's objectives  were to identify
and assess  the  significance  of  environmental  problems   in  the
Baltimore area,  to  set  priorities  for taking  action on those
problems, and  to  select  appropriate  approaches to  manage them.

     The project involved representatives of the State of Maryland,
the City of  Baltimore, and Baltimore  and  Anne  Arundel Counties.
The lEMP's  Management  Committee  (MC)  and  Technical  Advisory
Committee (TAG) served as the vehicles for State and local parti-
cipation.  Charged with managing the IEMP,  the four members of the
MC derived their  authority from  the  highest-level  policy-making
bodies within  the three  local  jurisdictions and the State.  The
fifteen-member TAC  was composed  of  technical managers  from the
three local jurisdictions and the State, as well  as representatives
from the Baltimore Area Regional  Planning Council and the academic
community.  Besides providing technical and scientific advice to
the MC, the TAC members served as liaisons to other policy makers
in the  local  agencies.  EPA served  as staff to both committees
and provided  technical,  analytic, and  administrative  support to
the project.

     The Baltimore  IEMP  consisted  of  two phases.  In Phase I, we
identified 32 environmental issues for  further study and developed
a process for setting priorities among them.*   We  selected five
issues for study  in Phase II:   indoor air  pollution,  toxic air
pollution, the Baltimore  Harbor,  underground storage  tanks,  and
multimedia metals.

     For this Phase II study, the TAC established a work group on
indoor air pollution (see Exhibit  1).   The  work group's objectives
were to develop a method  for  identifying  and evaluating both (1)
indoor pollutants of  concern in the Baltimore  area,  so we could
set priorities for dealing with them, and (2) programs for reducing
exposures to them.  Because of  a  lack  of  available data on human
exposure to indoor pollutants in the Baltimore area and a lack of
resources to generate new data,  we relied heavily on our own pro-
fessional judgment.    Thus,  the  expertise  and experience  of the
members of the work group were critical  to the success of the study.
  * For a  complete discussion of the  Baltimore  IEMP and Phase I
    activities, see the Baltimore Integrated Environmental Manage-
    ment Project:  Phase I Report,  May 1987,  U.S. EPA Office of
    Policy Analysis PM-220.

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                            Exhibit I

                  Indoor Air Pollution Work Group
David Filbert (Chairman), Chief, Bureau of Air Quality Management,
     Baltimore County Department of Environmental Protection
     and Resource Management

Charles Billings, Ph.D., (formerly) Associate Professor, Environ-
     mental Health Engineering, School of Hygiene and Public Health,
     Johns Hopkins University

Katherine P. Farrell, M.D., MPH, Chief, Division of Environmental
     Disease Control, Maryland Department of Environment

Elkins W. Dahle, Jr., P.E., Director, Bureau of Industrial Hygiene,
     Baltimore City Department of Health

Joseph Abey, Chief, Air Quality Control Section, Anne Arundel
     County Department of Health

Allan B. Heaver, Director, Baltimore Building Owners and Managers
     Association

Jack R. Lodge, Senior Engineer, Environmental Programs Unit,
     Baltimore Gas and Electric Company

Arthur I. Nieberding, P.E., Project Manager, Mueller Associates,
Inc.

Velma B. Rector, Associate Director, Program Development, American
     Lung Association of Maryland

Thomas A. King, P.E., Manager, Environmental Systems Department,
     Mueller Associates, Inc.

               Support Staff and Resource Persons

Roberta Grossman, U.S. EPA Regulatory Integration Division

Bruce W. Jacobs, C.I.H., Environmental Toxicologist, Office of
  Environmental Programs, Maryland Department of Environment

John Shumaker, Program Supervisor, Bureau of Air Quality Manage-
  ment, Baltimore County Department of Environmental Protection
  and Resource Management

Melissa Wieland, Environmental Technician, Environmental Programs
  Unit, Baltimore Gas and Electric Company

Charles Courtney, Chief, Air Pollution Control, Baltimore City De-
  partment of Health

Jeffrey M. Paull, M.S., MPA, Environmental Toxicologist, Science and
  Health Advisory Group, Maryland Department of Environment

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     Comprised initially of three members of  the TAG,  the work group
added a representative from Anne  Arundel County to provide represen-
tation of  all  three jurisdictions  in  the  study area.   We invited
additional members  on  the  basis  of  their  experience and expertise
in such areas as building codes and construction methods, air quality
management within  buildings,  particular  pollutant]characteristics,
health concerns,  control  options  and  strategies,' and  public edu-
cation.  Several  outside  individuals  provided  special  expertise
and technical assistance.   The  final membership  is listed in Table
1.

     Our primary  focus  was on developing  a  method  for identifying
and ranking  pollutants  of  concern  and for  evaluating  and setting
priorities for  programs to reduce  exposures to  them.   For that
reason, this report is  not a comprehensive  analysis  of indoor air
pollution  in the  Baltimore  area.  It does  present  some conclusions
on certain pollutants and programs for addressing them.

     Before describing  the  Phase II method  for  evaluating  indoor
air pollutants,  we  will  briefly  discuss   the  hazards  from  these
pollutants and the  current  regulatory and government activities for
controlling them.

BACKGROUND ON INDOOR AIR POLLUTION

     During the  past two   decades,  considerable amounts  of  time
and money  have  been spent  on controlling  emissions  of pollutants
into the  outdoor  (ambient)  air.   However,   many  people  spend  as
much as  90  percent of  their time  indoors.  [1]  The  people  most
susceptible to  the  risks   from   air  pollutants—the elderly,  the
sick, and  the  very young—spend  almost  100  percent  of their time
indoors.  [2]  Thus,  even   with   significant  success   in  reducing
ambient concentrations  of   air pollutants,  human exposure to some
pollutants may remain high.

Health Hazards

     The public and the  scientific community have become  increasingly
aware of and concerned  about  the potential hazards  from indoor air
pollutants.  Numerous  studies   nationwide  have  established  that
indoor concentrations  of  some   pollutants can  reach  levels  that
exceed outdoor standards for these pollutants.  Efforts to conserve
energy through improved  insulation  of  homes and  the  use of certain
building materials  and  consumer  products  may have  exacerbated the
magnitude and severity of this public health  problem.

     The spectrum  of  indoor air  pollutants includes  chemical, bio-
logical, and physical agents, some of which are known and potential
human carcinogens.   Some  contaminants  enter indoor  environments
through ventilation systems or by infiltration, while others emanate
from indoor sources.

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     Adverse reactions  to  poor indoor  air quality  generally fall
into three categories:   (a)  feelings of  discomfort {e.g., thermal
discomfort, unpleasant  odors,  lack  of  air  movement)?  (b)  acute
(short-term) health  effects   (e.g.,   mucous  membrane  irritation,
allergic reactions,  skin  rash,  headaches,  nausea, fatigue);  and
(c) chronic (long-term)  health effects  (e.g., respiratory disease,
chemical sensitivity,  repressed immune system  response,  malignan-
cy) .  [3] The acute  effects  usually  manifest themselves immediate-
ly.  In  contrast,  some chronic environmental diseases  may not be-
come evident for ten years  or more.   Thus,  the occupants of a "sick"
building may unknowingly be subjecting themselves to some irrevers-
ible health hazards.   Therefore,  much  of  the concern  about indoor
air quality  focuses  on  the  long-term health effects  from indoor
exposures.

Current Regulatory and Government Activities

     The Clean  Air  Act  authorizes  EPA as the  lead agency  in the
federal government for controlling ambient air pollution.  "Ambient
air" has generally  been defined  as  the  air  outside residences or
buildings to  which  the  general  public  has  access. [4]  While the
Occupational Safety  and  Health Administration  is  responsible for
safeguarding industrial  indoor environments,  no one federal agency
has jurisdiction  over  nonindustrial  indoor  environments.   Thus,
nonindustrial indoor air pollution has received very little federal
attention to date.   To  fill  this void,  the  Government Accounting
Office has  recommended that Congress  amend  the  Clean Air  Act to
give EPA the lead responsibility in this area. [6]

     In 1986 Congress  passed the  "Radon Gas and Indoor Air Quality
Research Act" as  Title IV of  the Superfund  Amendments. [5]   Title
IV directs EPA  to establish  a  radon  and indoor air quality program
to assess  the  extent  of the  problem, to  coordinate  research and
development, and to  recommend  appropriate  action to Congress with-
in two years of the act's passage.

     In an  interim  report released  in April 1987,  EPA  announced
that it  is  adopting  a  dual  approach   to  indoor  air  pollution
control because of  the complexity of the  problem.   Agency efforts
will concentrate on  eliminating the pollutants  and their sources,
as well  as  on  developing  regulations  or  guidance to  change how
buildings function.[7]

      Other federal  agencies  that have statutory responsibilities
related to indoor  air quality are the Department of Energy,  which
is responsible  for  energy  conservation  programs  affecting  resi-
dences and new  buildings;  the  Consumer Product  Safety Commission,
which is responsible  for ensuring the  safety of consumer products;
the Department of Housing and  Urban Development, which  sets federal
standards and regulations for  buildings and building materials; and
the Federal  Trade  Commission,  which is   responsible  for ensuring
truth in advertising.

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           local  agencies have  been more  active  than  federal
           ling  with  indoor  air  guality problems, especially
           f\ /•»'i^4i»»rfane«'  *—r^r\/^ov*no  an/1  /•*• f\-rn r\ 1 a "i r* 4" e  a !•% m i 4*  i M ol /"\ /*\ •"*
     State and  local  agencies have  been more active  than federal
agencies in dealing  with  indoor  air  quality problems, especially
            tg  to  citizens'  concerns  and  complaints  about  indoor
            >n   r11  a  naf-ir\r»ai  cm-trow  chowoH hh^f  32  states have
agencies in  dealing  with  indoor air  quality problems,  especially
in  responding  to  citizens'  concerns  and complaints  about  indoor
air pollution.  [3] A  national  survey  showed that  32 states  have
a program—or  at  least a staff person—responsible  for  investigat-
ing exposures  to  indoor  air pollutants.  [8]  Some of  the  states
active in indoor air quality are California,  Massachusetts,
Minnesota, New  York, New Jersey, Texas, Washington, and  Wisconsin.
However, for  the  most part, many  agencies  lack  the  funding  and
expertise to deal  effectively with  indoor  air quality  issues.   They
also are severely  limited by a  lack  of clearly defined  standards,
regulations, and responsibility.

THE EVALUATION  PROCESS

     The work  group developed   a   process  to  examine  indoor  air
pollutants, to  rate their  relative   importance,  and  to  identify
programs to reduce exposures  and/or provide  for further  assessment
where deemed necessary.  The process consist  of  nine steps:

     Step 1:  Select pollutants for further study.

     Step 2:   Develop  and  review background  informantion documents
              on each  pollutant.

     Step 3:  Summarize the background  information  documents.

     Step 4:   Identify  criteria  for  evaluating  the pollutants.

     Step 5:  Apply the rating criteria to the pollutants.

     Step 6:  Identify potential programs.

     Step 7:  Develop  criteria for  evaluating  the potential
              programs.

     Step 8:  Apply the criteria to the potential programs.

     Step 9:   Set  priorities for   implementation of the programs.

Step 1;  Select Pollutants for Further  Study

     Using information from nationwide studies and  our own collec-
tive experience,  we  selected  the  following  potential   pollutants
and indoor  air  pollution problems  for   possible   further   study;
aeroallergens
aeropathogens
asbestos
                                        odors
                                        radon
                                        products of combustion

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     benzene
     chlordane
     chloroform
     electromagnetic/microwaves
     formaldehyde
     lead
                             other pesticides
                             specific symptoms of unknown orgin
                             tobacco smoke
                             ventilation
                             volatile organic compounds
                                  (VOCs)
     We then designed and completed a questionnaire to help charac-
terize the  nature  and  extent of  the  indoor  air pollution issue  in
the study area  (see Appendix  1).*   Based on  work group responses
to the questionnaire  and our professional judgment,  we decided  to
focus thie study on a  select group  of pollutants,  rather  than  on
"nonpollutant"  issues,  such as  ventilation  and  specific symptoms
of unknown  origin.   Thus,  we  selected the  following 9 pollutants
for further study:
     asbestos
     chlordane
     chloroform
     formaldehyde
     lead
                                products of combustion
                                radon
                                tobacco smoke
                                VOCs
     We decided  to  examine  these pollutants  only  in  residential
buildings and  in public,  commercial/institutional  buildings,  in-
cluding the  nonindustrial  work  place.   We  ruled  out  a  study of
the health effects of  air  pollutants in the industrial work place,
since these effects have been  the  subject of considerable observa-
tion, evaluation, and control since  the early 1900s.

Step2;  Develop and Review Background
Information Documents on Each Pollutant
     ,._ ..~~,, developed a background information document on each of
the pollutants selected  for  further study.  These documents helped
            y*S  *" s~i "1 *n 4- -1 r -r f\.  1 nt«t ^-i «<* 4- *s *•»*•• s*v  *"k £• *% —> *~* W»  V* ,f. "1T^*t-*»-i.4-  —i -MI tA -! s*3 *-vvt t 4 £ T »
We next
us assess the  relative
posure, health
assessment activities,  and  data
area.
                    importance  of each  pollutant  and identify
                                 document  contains  a general
                                                        to ex-
us assess cne  relative  importance  or eacn  pollutant  ana 3
potential control  strategies.    Each  document  contains  a
discussion of  the  pollutant,  its  sources,   factors  leading
posure, health  effects,  control  strategies, known  control
                             strategies,  known  control and/or
                             specific  to  the  Baltimore study
     This was the most  time-intensive step of the evaluation process.
It involved identifying sources of information, interviewing, collec-
ting and presenting  the information accurately,  and  reviewing  it.
We also obtained  outside  review.   (Outside reviewers are listed on
each document.  The  complete documents  are in the separate volume,
Baltimore IEMP Indoor Air Pollution Study:   Support Documents 1987.)
Taking this  time  was  essential,  however,  to  make  sure  that  the
*The same questionnaire was also  completed  by several other organ-
izations as part of Step 4 of the process.  Appendix  2 contains the
compilation of all questionnaire responses.
                              -6-

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evaluation process was  based on the most  complete,  accurate and
reliable information then available.

     A problem in performing  this  step was the difficulty we had
keeping the documents up  to  date.   Activity dates and the status
of projects,  reports,  and  regulatory actions  were  constantly
changing.  To deal  with  this problem, we  established  a cut-off
date for collecting and reviewing'the  information for each pollu-
tant.  (However, we did update them to the extent possible, after
completing the Phase II study.)

Step 3;  Summarize the Background Information Documents

     After completing  the background  information documents,  we
summarized them  in  a  brief, usable   format,  (see Appendix  3).
Each summary  contained the  key  information  on  which  the  rest
of the  process  would  depend:  the  pollutant's  health  effects,
the population  potentially  exposed to  the  pollutant,  ongoing
activities to  control  or assess  the  pollutant, and  available
techniques for controlling it.

Step 4;  Develop Criteria for Evaluating the Pollutants

     To determine  the  relative  significance  of each  pollutant
to indoor  air pollution  in  the  study  area,  we developed  the
following five criteria:

       °  Population in the study area potentiallyexposed to the
          pollutant.   We  based  this criterion on  our assessment
          of the  nature  and  prevalence  of the  sources  of  the
          pollutant relative  to the  population  distribution  in
          the study area.

       °  Known acute or chronic healtheffects.   We  based  our
          evaluation of this factor  on determinations  reported
          by EPA, the  National  Academy  of Sciences,  the Inter-
          national Agency  for Research on Cancer, the  Consumer
          Product Safety Commission, and other established scien-
          tific and research organizations.  The  health effects
          are based on data generated from  laboratory and epidemi-
          ological studies.  In  addition, our rating of each pol-
          lutant for this  factor encompasses our judgement of like-
          ly indoor concentrations  and the risk  associated  with
          them.

       0  Agencies*  and organizations'  perceptions of the impor-
          tance of each pollutant.  Although this is a subjective
          factor, we thought it was  important to consider the pro-
          fessional opinions of  the agencies  represented by work
          group members and  of 'other  organizations in  the study
          area involved with  indoor air  pollution.   To rate this
          criterion,  we used the findings and  experiences  from
          actual field  investigations  in the  study  area, as well
          as national information and research results.

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     °  Public's perception of the health risks of the pollut-
        ants .

        We rated  this  criterion according  to the  numbers  and
        types of public complaints  and  requests for assistance
        the agencies  and  organizations  received,  as well  as
        public responses to informational and educational
        campaigns (e.g., TV or radio program responses).

     0  Current activity level.  The  gauge for  this  criterion
        was the number of ongoing local and national activities
        and programs aimed  at regulating,  controlling,  or  as-
        sessing potential exposures to  indoor  air pollutants.
        Examples of these  activities are  the State of Maryland's
        regulations governing  the removal  and encapsulation of
        asbestos, federal research on exposures to VOCs, legis-
        lation to  require  training  for  commercial  pesticide
        applicators, and public  information programs  on radon.
        We obtained  this  information  from local  and national
        agencies and organizations.

     There are no existing data on exposures to indoor air pol-
lutants in the Baltimore study  area.   Consequently the  work group
selected these criteria as surrogate measures  for exposure data.
In the professional judgement of the work group, they represent
the factors  of concern  in  evaluating  indoor  air pollutants.
While the criteria for  population potentially  exposed and health
effects bring some quantitative and  scientific input to the pro-
cess, the remaining three criteria  are largely subjective.   To
expand our information base for the  agency,  organization,  and
public perceptions criterion,  we sent the indoor air pollution
questionnaire, which we  in  the work  group initially  completed
under Step 1, to numerous other agencies and organizations within
the study area.   (The  questionnaire  responses  are compiled in
Appendix 2.)
ria:
     We established the following scales for each of the crite-
     Population Potentially Exposed

     1     Less than or equal to 10,000
     2     10,001 - 50,000
     3     50,001  - 250,000
     4     250,001 - 1,000,000
     5     Greater than 1,000,000

     Health Effects

     0     No toxicity (no toxic effects)
     1     Slight toxicity
     2     Moderate toxicity
     2.5   Probable carcinogen (or carcinogenicity in question/
           controversy)
     3  .. - Severe toxicity or known carcinogen

                            -8-

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     Agency/Organization Perception of Health Threat
       1
       2
       3
Low
Medium
High
     Public Concern
       1
       2
       3
Low
Medium
High
     Current Activity Level
       0
       1
       2
       3
None
Low
Medium
High
     We based  the  health  effects   scale   on a  ranking  system
devised by  Thomas  J.  Haley.  [9]  Although  Dr.  Haley's  system
doesn't distinguish between probable and known carcinogens,
we thought  that  probable  carcinogens  present   a  greater  haz-
ard than  the  number  2  ranking  suggests.   Therefore,  we  estab-
lished the  2.5  ranking.    (Dr.  Haley's  ranking  system is  des-
cribed in Appendix 4a.)

     Note that  the  scales  assigned  to  the  criteria  are  both
arbitrary and "ordinal"—i.e., the scores only indicate an
ordering and  not  differences  in  the  evaluation.   Thus,  for
example, a  pollutant  that was assigned  a  3  for health  effects
is not  necessarily  three   times  more  important than  a  pollu-
tant that scored a 1 on that criterion.

Step 5;  Apply the Rating Criteria to the Pollutants

     Having selected  and  defined the  criteria,  we  next  applied
them and  rated  the  pollutants   under   consideration.   At  this
point, we  eliminated lead  from  the  process because the  Multi-
media Metals  Work Group  would be evaluating  all routes  of ex-
posure to  lead  in  its  Phase  II  work,  with  a particular  empha-
sis on home abatement procedures.

     We first  assigned  each  pollutant  a   numerical  rating  for
each of the five criteria.    Table  1 shows  the  assigned  scores.
Appendix 4b  explains our   reasoning  for  the pollutant  scores.
Next, to  rank the pollutants  in  order of  relative  priority,  we
assigned each  pollutant  two  numerical  scores by  combining  the
rating criteria as follows:

     1.   (Population  Potentially  Exposed)  x  (Health  Effects)

     2.   (Public Concern) + (Agency and Organization Perceptions)

We reserved  the  current  activity  level criterion  for a later
secondary ranking.  Table 2 shows the results of^this^ pollutant
scoring and ranking.                                   '""""•*--

                             -9-

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                                         Table 1

                                 Pollutant Rating  Scores
Pollutant
Chlordane
Formaldehyde
TOCs
Radon
Combustion
Products
Passive
Smoking
Asbestos
Chloroform
Population
Potentially
Exposed
3
3
5
4
5
5
4
5
Health
Effects
2.5
2.5
1
3
2
2.5
3
2.5
Public
Concern
1
1
1
3
1
2
3
1
Agency /Organizat ion
Perception of Health
Threat
1
1
2
3
2
2
3
1
Current
Activity
Level
1
2
1
2
2
2
3
1
Population Potentially Exposed

1  Less than 10,000
2  10,001 - 50,000
3  50,001 - 250,000
4  250,001 - 1,000,000
5  Greater than 1,000,000
               Health Effects

               0  No Toxicity
               1  Slight Toxicity
               2  Moderate Toxicity
               2.5  Probable Carcinogen
               3  Severe Toxicity or Known Carcinogen
Public Concern

1  Low
2  Medium
3  High
Agency/Organization
	Perception

1  Low
2  Medium
3  High
   Current
Activity Level

0  None
1  Low
2  Medium
3  High
                                      -10-

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                                       Table 2

                             Results of Pollutant Ranking
Pollutant
Chlordane
Formaldehyde
VDCs
Radon
Combustion
Products
Passive
Smoking
Asbestos
Chloroform
(Population x Health Effects)
3 x 2.5 = 7.5
3 x 2.5 = 7.5
5x1 = 5
4 x 3 = 12
5 x 2 = 10
5 x 2.5 = 12.5
4 x 3 = 12
5 x 2.5 = 12.5
(Public Concern +
Agency and Org Perception)
1 + 1 = 2
1 + 1 = 2
1 + 2 = 3
3 + 3 = 6
1 + 2 = 3
2 + 2 = 4
3 + 3 = 6
1 + 1 = 2
Based on the above ratings, the pollutants are ordered as follows:
(Population x Health Effects)

 Passive 9moking        12.5
 Chloroform             12.5
 Randon                 12
 Asbestos               12

 Combustion Products    10
 Chlordane               7.5
 Formaldehyde            7.5

 VDCs                    5
(Public Concern + Agency and Org. Perception)

 Radon                      6
 Asbestos                   6
 Passive Smoking            4
 VDCs                       3
 Combustion Products        3

 Chlordane                  2
 Formaldehyde               2
 Chloroform              f  2
                                    -11-

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Looking at the results of the ranking under each of the two
factors we concluded that:

     0  passive smoking,  radon, and asbestos are the highest-
        priority pollutants;
     0  chlordane and  formaldehyde are the lowest-priority
        pollutants and

     0  combustion products, VOCs,  and  chloroform fait some-
        where in the middle.

     Our ranking of the pollutants does not state, nor is it
intended to imply, that passive smoking is  first and formal-
dehyde is eighth.   It  only  shows the relative positions of
the pollutants when we examined  potential  exposure to them
(population potentially exposed,  health effects), and Balti-
more's local  perception  of  the  indoor  air pollution issue
(public concern, agency/organization perception).

     Considering population potentially  exposed and health
effects, chloroform is a relatively high-priority polluant.
Because of the disparity between this ranking and the rela-
tively low ranking  for perception, we  thought that chloro-
form should  be  ranked  somewhere  between  the  highest  and
lowest priorities.   We  also  based our  decision  on  the
following reasons:

     0  Chloroform monitoring  recently  conducted at indoor
        swimming pools and  spas  in Baltimore County showed
        measured concentrations  well  below   the  threshold
        values established  by the  American   Conference  of
        Governmental Industrial  Hygienists.   (See  Appendix
        5 of the chloroform background information document),
        Since the formation of the  chloroform is enhanced at
        indoor pools and  spas by heating  and agitation of
        the water,  and by the addition  of chlorine disin-
        fectants, we  reasoned that finding  significantly
        higher concentrations in residences would be unlike-
        ly.

     0  Calculation  of  indoor  chloroform  levels  in  the
        Baltimore study  area  using  an  indoor  air  quality
        model suggests that ingesting  and  inhaling  chloro-
        form may be of equal importance  in human exposures.
        (See Appendix 3 of the chloroform background infor-
        mation document.)

     Monitoring conducted during EPA's Total  Exposure Assess-
ment .Methodology  (TEAM)  study  in Baltimore County  included
measurement of indoor  chloroform concentrations in several
private residences.  The  results of these measurements, to be
available in 1988, may provide a clearer picture of the re-
lative significance of chloroform as an indoor air pollutant
in the study area.
                                -12-

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     Current Activity Level

     Having established  the  relative  importance of  the  pollut-
ants for  further consideration,  we next  used  the  criterion  of
current activity  level  to conduct  a  secondary  ranking.   We se-
lected this  criterion to  help an  agency  or organization  with
limited resources, focus   on  the  pollutants  for  which there  is
little ongoing activity and  on which  the limited resources would
best be concentrated.

     We applied this criterion to the highest-priority pollutants
identified by the  first  ranking scheme:  asbestos,  passive smok-
ing, and radon.  As shown in Table 1,  asbestos is rated as "high"
with a score of 3, while passive smoking  and radon are both scored
as "medium." Thus, we eliminated  asbestos from further consider-
ation at this point because  numerous  programs  were  already being
conducted in this area.  We  felt  our  effort  would be better con-
centrated on radon and passive smoking.

Step 6;_  Identify Potential Programs

     For passive  smoking  and  radon,  we  next  created a  list  of
potential programs  and activities  that  would  reduce  exposures
and/or further  assess the  pollutant,  as appropriate.   Nothing
was "off-limits"  at this  point;  we  were  generating a  working
list and did not want to eliminate any possibilities prematurely.

     We drew our initial  lists  of potential  programs from the
Control Techniques/Technologies  section  contained  in the  back-
ground information documents.  (Appendix 3 summarizes this infor-
mation.) We  then expanded  each list  with  suggestions   made  by
work group members.

     We designed  the  pollutant overview chart,   which proved  to
be a  very helpful  tool   in  generating  the  program  lists.   The
chart helps ensure  that  no  potential  programs  for  a particular
pollutant are  overlooked.   As we  completed our initial  program
lists, we entered them  into  the  chart under the  general  program-
matic categories of:

     o   public education
     o   pollutant assessment
     o   increased enforcement of existing regulations
     o   new regulations/codes
     o   economic incentives
     o   product controls/standards
     o   interagency information/communication
     o   indoor air pollution standards
     o   technical control
     o   research
       Once completed, this chart  allowed  us to identify program
  gaps and duplications.   For  example, the  absence  of a program
                                -13-

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for a particular pollutant under the general category of "assess-
ment" could trigger a reconsideration  of  the  need for a monitor-
ing program for  that  pollutant.  The  chart could  also indicate
which potential  programs  would affect more than one pollutant-—
e.g., public education may  be a pertinent program for all pollu-
tants.  (Appendix 6 shows the overview  chart completed for passive
smoking and radon.)

     Potential Programs for Passive Smoking

     We identified the following potential programs for reducing
exposures to passive smoking:

     1.  Create a public education program.   This  program  would
point out  the  adverse  health  effects associated  with exposure
of nonsmokers  to  the  sidestream  smoke  from  burning  tobacco
products.  The program  would  reduce the  source  of  exposures by
encouraging smokers to  refrain from smoking  in  the  presence of
nonsmokers or, ideally, to quit smoking.

     2.  Establish smoking policies in government and nongovern-
ment buildings.  Government agencies and  other organizations can
establish nonsmoking policies in their  public buildings and office
buildings.  The program can  also include  efforts to educate, en-
courage, and  offer guidance  to  private  entities   to  establish
similar policies in their facilities.

     3.  Increase enforcement of building codes and standards and
existing smoking regulations.  As  we  noted  in  the  background
information document on  passive smoking,   several  regulations in
effect in  the  study area restrict  smoking in  certain  areas and
types of buildings.  These regulations would benefit  from increased
enforcement efforts.  In addition,  increased enforcement of venti-
lation, air exchange, and similar  requirements in building codes
will reduce  levels  of  tobacco smoke in  indoor  environments.

     4.  Pass state and/or local laws  restricting smoking.  State
and local authorities can pass legislation  to restrict or prohibit
smoking in areas to which the general public has access.

     5.  Sponsor smoking cessation programs.  Such methods as
stop-smoking clinics,  self-help sessions, and  hypnosis sessions
can reduce the number  of smokers and,  therefore, the risks from
passive smoking.

     6.  Offer funding for the expenses of stop-smoking programs.
As part of their health care  insurance  packages,  agencies and
organizations can provide some  form  of coverage for the expenses
of stop-smoking  programs.   They can do  this  in  conjuction with
or in place  of agency-sponsored stop-smoking  methods.   Coverage
might include  paying the full  cost  or part  of  the  cost before
employees start  the  program,  or  reimbursing  employees  after
they successfully  complete   the program  and   after a  specified
smoke-free probation period.

                           -14-

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     7.  Increase state c igarette exc ise taxes .

     Potential Programs for Radon

     We identified the  following potential programs  for assessing
and/or reducing exposures to radon:
     1.  Offer a j>u b I i c edu ca t i on^ pjr gg r^m f^ r th e gene ra l_pu bli .c,_
developers, and builders.  The  program would  provide  information
in the following areas:
     2.
 issue.
the health effects of radon
the nature of radon, its entry into hones, and mitiga-
ive and preventive techniques
identification of potential radon problem areas (to
the extent that limited available data allow)
encouragement for individual homeowner testing for radon
awareness of developers and builders of potential radon
problem areas and building techniques for mitigation
and prevention

Educate elected and government officials about theradon
Government authorities  can be  educated about  the  health
 effects of radon,  its nature  and characteristics,  areas of  the
 nation where   where  serious problems  exist,  the  potential  for
 problems in  the  Baltimore  area,  and  the  need  for  definitive
 survey and testing data.   Officials  can  be  encouraged  to provide
 for assessment activities.

     3.  Conduct a state- and/or locally funded radon survey of
 homes.  State and  local  government agencies  can survey  homes  to
 generate a comprehensive data  base and  identify areas  that  have
 or could have elevated radon levels.

     4.  Conduct a state- and/or locally funded radon survey of
 schools.  If  available resources  for  a radon survey  of  homes  are
 limited, attention  can be  focused  initially on  schools,  where
 young children spend much of their time.

     5.  Provide free jradqn  testing for citizens.   Agencies can
 provide free  radon tests for citizens  upon  request.   For example,
 they can provide free  monitors for citizens  to  use,  or  can  send
 state or local  personnel to citizens' homes with  testing  equip-
 ment.  The test  results would  add to  the  current data  base,  but
 would not  be  , as  comprehensive as  a  carefully  designed  survey.

     6.  Conduct an epidemiological study  to determine  the health
 effects from  radon in the area.
                               -15-

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     Note that the lists of potential programs for passive smoking
and radon have different emphases.  Those for passive smoking focus
on activities  that  reduce potential  exposures,  while  those  for
radon focus more on surveys,  testing,  and  further study.  Radon is
a significant problem in many parts of the U.S.  (see  the background
information document) , but this is not yet determined to be the case
in the Baltimore  study area due  to  a paucity of  test data (see
radon summary  in Appendix #3).  Therefore, the programs for radon
address the immediate need for more testing and monitoring.  Pas-
sive smoke, on the  other hand,  is unarguably a pervasive problem
in the Baltimore  study  area  to  which  the  entire  nonsmoking popu-
lation is  potentially   exposed  (see  passive  smoking  summary  in
Appendix #3).  The program list, therefore, focuses  immediately on
reducing potential exposures.

Step 7;  Develop Criteria for Evaluating the Potential Programs

     We next  identified the following  five criteria  to use  to
evaluate the feasibility of each of the programs:

     0  cost
     0  time frame
     0  legal  considerations
     0  acceptability
     0  political sensitivity

Following are  definitions, rating  schemes,  and brief discussions
of each of the criteria.

     Cost

     The costs we considered were  costs  to the  consumer (general
public) and/or the  provider  (agencies,  nongovernmental  organiza-
tions), incurred when putting the program in place.  Examples are
costs for materials  (pamphlets, brochures),  and  public education
costs (TV or radio time).

     It is difficult to  put  a dollar  figure  on  the  potential
programs because the ultimate cost is very much influenced by the
other criteria.  For example, a program that the  public considers
unacceptable may  take  more  time and  effort  to implement  than  a
program that the public generally embraces.  Therefore, we defined
the cost factor  for agencies and  organizations  in  terms  of  the
anticipated level of  funding that would  be  necessary  within  the
context of budget levels—i.e., new budget allocations, transfer
of resources,  or  adequacy of  existing  resources.    We  rated  the
cost to the  general public according  to  the relative  levels  of
time, effort,  and money required.

     High:     For government agencies and nongovernmental organi-
               zations (includes advocacy groups,  professional
               organizations such as The American  Lung Association
              of Maryland),  the  program  requires a specific budget
               authorization and/or other resources  (staffing,
              equipment, etc).
                               -16-

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            For the general public, the program requires a signif-
            icant outlay of  time,  personal  effort, and/or money.

     Medium:  For government agencies and nongovernmental organi-
              zations, the program  requires the  transfer  or re-
              assignment of  resources  to  the  program,  and/or  a
              change in program priorities.

              For the generaljgublic, the  program  requires  the
              commitment of  time  and  personal  effort,  and/or  a
              moderate outlay of money.

     Low:     For government agencies and nongovernmental organji-
              zaj: ions, the  program  can  operate  with  existing
              budget and personnel.

              For the general public, the program requires little
              time, personal  effort,  or personal  expenditures.

     Time Frame

     We interpreted this criterion  as the length  of  time  needed
for starting up this program and for continued effort, if needed.
However, because of  the  interdependence  of all the  criteria,  we
also considered other factors.  For example, a program that needs
a new budget allocation or  that  is politically sensitive is likely
to take longer to  implement.  We  based the  following time  ranges
on our  own  opinions and experiences,  within  the  context  of the
criteria.

     Long         >5 years
     Medium      2-5 years
     Acceptability

     Legal Considerations

     This factor is relatively straightforward.  It considers what
would be required from a legal standpoint to implement the programs.
Public education programs,  for  instance,  would  not be subject to
regualtions, codes, or other possible  legal  constraints.  On the
other hand, a program requiring testing of  indoor air in homes would
require new legislation.   The  rating  define  the  relative  level
of potential legal requirements and issues.

     High:     The program requires new legislation or regulations,

     Medium:   The program requires union negotiations or some pos-
               sible revisions of  existing regulations

     Low:      The program requires signing -an Executive Order,
               making minor  modifications  to  the  Code,  and/or
               adopting internal policy.

     Minimal:   Minimal or known legal considerations.
                               -17-

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     Acceptability

     This criterion is simultaneously the most difficult to predict
and one of  the most critical of  the  criteria.   Implementing the
majority of  the  indoor  air  programs  proposed  will  affect  both
the public  and private sectors  in  a  way  they  have  rarely  been
touched before.  These programs  are  not dealing with traditional
sources of  air  pollution—i.e.,  an  industrial  or  commercial
source with  pollutants coming  from  a  stack.   Rather,  they are
attempting  to  control  sources of  pollution that are found inside
people's homes,  places  of  work,  private  businesses,  and  in
leisure spaces, such  as  theaters, restaurants,  and other public
places.

     Control strategies  for  industrial  smokestacks  are  gene-
rally considered by the  public  to  be  acceptable  and,  in  fact,
very desirable  in  many instances.  On  the other hand,  the  pub-
lic may perceive  control strategies  or regulations  for sources
found inside private residences or businesses as being intrusive.

     Therefore, "acceptability"  becomes  a  very  important consid-
eration.  A program projected  to be largely unacceptable to the
constituencies will  require considerable   effort   to  implement.
Conversely, a  program  that  is widely  embraced  will  have  a  much
greater opportunity  for  succeeding.    It  will   require  less  time
and cost to implement than will  a  program  that  is unacceptable
to the  majority  of  the  constituencies.   For  these  reasons,  we
have developed the following rating system.

     High:     The program is acceptable to the  majority of
              constituencies.

     Medium:  There  is no consensus of opinion on  the  program.

     Low:      This program is unacceptable to the majority of
              constituencies.

     Political Sensitivity

     Political sensitivity  can   be  a  dominant  factor  in  the
feasibility of  a  program.    If  elected  officials  object  to,
or at least do not  support  a particular  program,  the  level  of
effort required  for  implementing  the  program   (e.g.,  obtaining
funding or  legislation) can increase  dramatically.

     High:     The program is a very sensitive issue to elected
                officials.

     Medium:  The  program  is  a  moderately sensitive   issue  to
                elected officials.

     Low:      The program carries very little or no political
                implications.
                              -18-

-------
     The work group's original list of program criteria  included a
specific factor  for  the  effectiveness of the potential programs.
We soon reached  the  conclusion,  however, that definition of such
a criterion and, in fact, the absolute determination of  the effec-
tiveness of a  potential  program  is very difficult to accomplish.
All of the potential programs identified will certainly be effec-
tive in reducing potential exposures,  or  in assessing the problem,
to some degree.   It  is  very difficult, however, to  assess the
effectiveness of a program ahead of  time.   The  absolute effect-
iveness will not be  known until  the program has  been implemented
and evaluated.  Since the Phase II  indoor air pollution study does
not use a quantitative evaluation approach such as  risk assessment,
it is impossible to  make comparisons to see  which programs will
give the highest yield quantitatively.   In addition,  the absence
of exposure data and measured airborne concentration data for the
study area  precludes  a  quantitative  evaluation  of  programs.

     The effectiveness of a particular program is the qualitative
"sum" of the  criteria.   Because  all  of  the  program  criteria are
very dependent upon  one  another,  the relative effectiveness  of
a program  must  be  judged  by considering  all  of the  criteria
together.   Thus,  the  ideal program  under  this evaluation  would
receive the optimal score for each of the primary criteria—i.e.,
low cost,   short  time frame,  minimal legal  considerations,  high     M
acceptability, and minimal  political  sensitivity.  However,  few  .   to
programs,  if any, will match these ideal ratings.   They generally  '   o!
will perform well  for some of the  criteria and  not as well for     H
others.  What  is most effective   for  one agency,  therefore,  may
not be equally effective  for another.  Cost may be  a major obstacle
for one agency and  may  render a program  relatively  ineffective
if implemented, while the  same program may  be very effective for
another agency because cost is not a problem.

     Other Considerations

     Many implications associated  with  the  programs could  have
a significant  bearing  on  their  feasibility.  For example,  pas-
sage of new  legislation,  may result  in difficulties  or  exces-
sive demands  on  resources  from  an  enforcement standpoint,  or  a
public education program may generate  citizen reaction  and in-
quiries that require agency or organization response.  An organi-
zation contemplating the implementation of a program should seri-
ously consider all of the potential implications of that program.

Step 8;  Apply the Criteria tothe Potential Programs

We applied the program criteria to each of the potential programs
previously identified for radon and passive smoking.   The program
ratings for each of  the  criteria  are shown  in  Tables  4  and  5.
Appendices 5a and 5b  contain  the  reasoning  and justification for
the program ratings for passive smoking and radon.


                               -19-

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-------
Step 9;  Set Priorities for Implementing the Programs

     Choosing programs for  implementation  requires making trade-
offs among  the  criteria.   For  example, is  it worth
the cost of  a  program to  increase  its acceptance?
to questions  like  these  will  vary from  person  to
agency to agency.
                                                       increasing
                                                      The  answers
                                                      person  and
     To reach a consensus on implementation priorities, we
started with  the  program  close  to  the  ideal,  progressing  to
programs that diverged to  an  increasing extent  from that ideal.
As with the  pollutant  evaluation  process,  the program evaluation
process is necessarily  subjective,  but the methodology  is help-
ful in structuring and guiding the evaluation.

     Implementation Priorities for Programs to
     Control or Assess Passive Smoking
     For passive smoking,  the
the programs is as follows:
                               relative ranking  for  implementing
     1.  Smoking
cause the
             	cessation seems  close  to the  ideal  program be-
           costs  are  low, the  time  frame  is  short,  the  legal
considerations are minimal,  the  acceptability  is high,  and the
political sensitivity  is  minimal.   In  addition, we  identified
no other  considerations  that  may  detract  from this  program.
     2.
for a  second.
five criteria.
must prepare
program.
erations
ployee
         Public educationand smoking policies in buildings
  tied
of the
               They  both have the  ideal  rating for  four
                 Public  education  has  high  costs,   and  agencies
             to  respond  to  citizen inquiries resulting  from the
          Smoking policies  is  rated as medium  for  legal  consid-
         because of  the  possible  need for negotiations  with em-
       unions  over  the   policies.    In  addition,  agencies  may
have to  address  a   vocal  minority  opposed  to  such  policies.

     3_.a  Increased enforcement  ranked   third,  primarily  due  to
the high costs associated with this approach.
     4.  Increased excise taxes
frame and
                                had a medium  rating  for its time
          a high rating  for  both  legal  considerations and polit-
ical sensitivity.  This  program  is attractive,  however,  because
the increased  revenues   could  be  used   specifically  to  support
smoking cessation clinics.

     5.  Health insurance coverage and passage of state and local
laws ranked  fifth.   Health insurance showed  medium  ratings  for
cost, time frame, acceptability,  and political sensitivity.  Most
important, legislation may be required to mandate insurance cover-
rage.  Passage of state  and  local  laws  showed  high  costs, a long
time frame, high legal considerations,  and  high political sensi-
tivity.  Additionally, if  such laws  are passed, enforcing  them
                                22

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     The above  order  could vary, depending  on an organization's
ratings.   For example/ if! cost is not considered to be important,
public education could be ranked higher.

     Implementation Priorities for
     Programs to -Control or Assess Radon

     The relative  ranking  of  programs  for  radon  is  as  follows:

     1.  Education of officials has  the  ideal rating  for  all of
the criteria.   This  program  could  help  obtain  financial  and
manpower resources for implementing other programs.

     2.  Public education ranked second, primarily because of the
high cost  factor.  Agencies  would  have  to respond to citizen in-
quiries.

     3.  Surveys of homes and schools  ranked  third.   Testing in
schools would have a  medium cost,  and  its  political sensitivity
is rated as  medium.   A  survey of  homes  would have  a  high cost
and a  medium time  frame.    Additionally,  Cor the  home  survey,
agencies would  have  to address the  issue of  confidentiality of
test results.

     4.  Free radon testing  ranked  fourth   because  of  its  high
cost and lack of comprehensiveness.

     5.  Epidemiological study  is  ranked  lowest  because  of  its
high costs and  long  time  frame.    However,   such  a   study  would
be very valuable  in  the long  term by characterizing  the  extent
of adverse health  effects  from  radon and  by providing a  basis
for future regulatory policy and control programs.

CONCLUSIONS AND RECOMMENDATIONS

     The purpose of this study was twofold:  to determine
which indoor air pollutants  in  the  study area  should  be further
evaluated,  and  to  identify and evaluate  potential programs that
could effectively and efficiently reduce exposure to these pollu-
tants.   Using professional  judgement and limited national and local
data, the work group  concluded that the following nine indoor air
pollutants warranted   further  examination:   asbestos,  chlordane,
chloroform, formaldehyde,  lead  (later assigned  to  another  work
group), products of combustion, radon, passive smoking and volatile
organic compounds  (VOC).   The work group   then  collected  and
evaluated extensive  amounts  of  information  on each  pollutant.
This information is presented in full separately from this report
in the volume  Baltimore IEMP Indoor Air Pollutiont Support Docu-
ments;  a summary for each appears in the Appendix 3 of this report.

     The work group then  established  the relative importance among
the nine pollutants  by ranking  them according to  the following
criter-ia:   potential  population exposed,  known or suspected human
health effects,  governmental/interest  group  perception  of  risk,
and public  concern.

                               -23-

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     The work  group  concluded  that  the  pollutants  of  relative
highest concern were  passive  smoking, radon,  and  asbestos;  chlor-
dane and  formaldehyde the lowesb; and chloroform,  combustion pro-
ducts, and VOCs in between.

     The work  group  focused  its  attention  on  the pollutants  of
highest concern.   It  discovered  that  there  were  already  numerous
efforts under way  (e.g., detection and abatement programs) to control
asbestos.  Thus it eliminated this pollutant from further consider-
ation.  For  passive  smoking  and radon,   it  proceeded  to  identify
and evaluate potential programs  for  implementation.   Its recommen-
dations for each are  presented below.

Program Recommendations for Passive Smoking

     Of the seven  potential programs examined  for passive smoking,
government and  nongovernment  agencies should  seriously  consider
the following three programs:

     1.  smoking cessation programs,
     2.  public education programs, and
     3.  smoking  policies in  government  and  nongovernment  build-
         i ngs.

Program Recommendations for Radon

     Because of  the  paucity   of  monitoring  data  on  the  actual
nature and extent  of  the  radon issue  in the Baltimore  study area,
we felt a definite  need for  education and testing to effect  better
assessment and  characterization  of the problem.   All  six programs
considered for  radon,  therefore,  focused  on  further  assessment
activities.  We recommend  the following:


     1.  education of elected and government officials
     2.  public education, and
     3.  a state  or local  survey of  homes  and  schools to establish
         a radon profile of the area.

Some Observations on  the Evaluation Process

     The process relied heavily on qualitative information, subjec-
tive analysis, and  the  consensus of  qualified  professionals. Addi-
tional quantitative data  specific to the study area  would be very
valuable.  The following observations ace made to point out strengths
and weaknesses of the process.

     1.  A very important product of  this study  is  the foundation
established for continued interagency cooperation  and  integration
in the Baltimore  area.  We  identified numerous contacts and estab-
lished .lines of communication.   This groundwork  could  greatly en-
hance a  continuing cooperative  effort in the  area of  indoor air
pollution.  We  recommend  that the agencies and  organizations that
participated should formalize this- communication network.
                                -24-

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     2.  Since the methodology  is  largely. subjectivef the makeup
of the work group is critical.  The members should have extensive
expertise and experience  in  the  area  of indoor air pollution and
should represent appropriate  federal,  state,  and  local agencies,
as well as pertinent nongovernment organizations.   The broad mem-
bership enhanced our  access"to  information;  it also  provided  a
valuable diversity of perspectives during discussion.

     3.  The lack of monitoring data on indoor concentrations for
the study area makes it extremely difficult to project the effec-
tiveness of programs with any certainty.  We wrestled with an ob-
jective, quantitative measure of effectiveness, which would have
been ideal, but  determined that  a  subjective,  consensus approach
was the best possible method available at this time.  As the data
from further research  on indoor air become available,  this will
allow agencies to  develop guantitative  measures  of  program  ef-
fectiveness .

     4.  The overall  process is  very lengthy.  The  collection,
review, and synthesis of  information can  be  very  time consuming.
Once the information  base has been established, however,  use  of
the evaluation criteria  to identify pollutant  and  program prior-
ities proceeds at a reasonable pace.

     5.  Keeping the background  information documents up to date
is difficult and time consuming.  The  status of proposed legisla-
tion and regulations on indoor air pollution is constantly chang-
ing, new research  results  are   rapidly  becoming  available,  and
studies are being initiated regularly.
                               -25-

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REFERENCES
[1]


[2]



[3]




[4]

[5]
     Preston E.  McNall,  Jr., P.E., Ph.D.,  "Indoor Air Quality,"
      ASHRAE Journal, June 1986.

     John  E.  Yocom,  "Indoor-Outdoor  Air  Quality  Relationships.
     A Critical Review,"  Journal of the Air Pollution Control
     Association, May 1982.
     Ken  Sexton,  "Indoor  Air  Quality:   An  OverVlyv/  of  Policy
     and Regulatory  Issues,"  presented  at  the  Air  Pollution
     Control Association Conference, Detroit, Michigan, June
     16-21, 1985.

     40 CFR Part 50.1 (E), revised July 1, 1978.

     Superfund Amendments and  Reauthorization Act of 1966 (PL99-
     499).
[6]  General Accounting Office, "Indoor Air Pollution:  An
     Emerging Health  Problem,"  CED-80-111,  September  24,  1980.

[7]  U.S. EPA, Report to Congress on Indoor Air Pollution and
     Radon Under Title IV Superfund Amendments and Reauthoriza-
     tion Act of 1986, April 1987.

[8]  American Journal of Public Health, vol. 74 (1984).

[9]  Thomas  J.   Haley,   "Toxicology"   in  Dangerous Properties of
     I_nd us t r i a 1 Ma t e r i a Is , 6th  ed.   Part  of  the  "Toxicology"
     section of. this book is attached in Appendix 4a.
                                 -26-

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APPENDICES

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                                                                       Appendix 1
               INTEGRATED ENVIRONMENTAL MANAGEMENT PROJECT (IEMP)

                           Indoor  Air  Pollution  Survey
 AGENCY/ORGANIZATION:
 Name of  Person Completing  the  Survey:_

 Position:
 Telephone  Number:
 Please complete the attached survey and return it by
to:
Please indicate with "N/A" those questions which do not apply to your agency or
organization.
If you have any questions, please call
at
Thank you.

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                   INTEGRATED ENVIRONMENTAL MANAGEMENT PROJECT
          The  State  of  Maryland  (Department  of  Health  and Mental  Hygiene,
Office  of  Environmental  Programs),  the City  of Baltimore,  Baltimore County,
Anne  Arundel County,  and the  U.S.  Environmental Protection  Agency  have joined
together  to undertake  a project  in  the metropolitan  Baltimore region  known
as  the  Integrated Environmental  Management  Project   (IEMP)  The  integrated
approach  to environmental management looks simultaneously at pollution problems
in all  environmental  media,  as opposed to the more traditional medium-by-medium
approach.   Human health risks, ecological impacts, and potential control options
will  be identified and analyzed during the project.

          The  objectives of  the  IEMP are,  tirst,  to  assist State and  local
governments in  addressing  site-specific  environmental  problems;  second,  to
develop  methodologies for  evaluating and  solving problems  in all media;  and
third,  to derive  recommendations for policy and  programs in  the light  of the
study results.

          It is  intended that  the project  be  useful to  EPA policy-makers and
to  public  health  and  environmental  decision  makers within  Maryland  and  the
Baltimore region.  Since it is the State  and  local  officials who must  directly
carry out and who  are most  directly affected by environmental  decisions,  the
priorities  of  the project  and the  environmental  issues  examined will reflect
State and local concerns.

          Phase I  of  the Baltimore  IEMP is completed.   This  portion  consisted
of an evaluation  and diagnosis of  potential problems in  the  study  area  in all
environmental  media.   Six  issues  were  identified  for  possible  further  study
in Phase Two:.  Ambient Air Toxics, Multimedia Metals,  Underground Storage Tanks,
the Harbor,  Trihalomethanes  in  Drinking  Water,  and Indoor Air Pollution.  Workr
groups for  each of the issues have  been  formed  to develop Work Plans for inves-
tigation and analysis of the respective issues.

          The Indoor Air  Pollution  Workgroup has  developed a Work Plan  to learn
more  about   the  indoor  air  quality  in  the  metropolitan Baltimore area.   The
goal  is to investigate  and  support  the implementation  of  possible  programs
to reduce exposure to indoor pollutants and to expand the State and local govern-
ment capabilities to respond to indoor air pollution inquiries.

          In order to begin assessing the  indoor air quality in the  Baltimore
area  the workgroup has developed  a  questionnaire  for agencies and organizations
which are,  or  may be,  involved in indoor air  pollution matters.   The  informa-
tion  collected from  the questionnaire  will  be  included  in an  assessment  of
the nature and extent of indoor air pollution in the Baltimore area.

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 1.   Please describe your  intloor air pollution program or activities:

                                                                 YES

     Formal Program                                               	
     Line Item Budgeted Program                                   	
     Part of Another Program  (e.g. complaint handling)            	
     Provide On Site Investigation                                	
     Provide Sampling/Monitoring                                  	
     Provide Telephone Consultation         .                      	
     Provide Referral Service                                     	
     Other Activities   	       	         	         	 	
                                                                NO
2.  a.
3.  a.
 What  are  the main  indoor  air  pollution  problems  identified  by  persons
 calling your agency/organization?   Please  indicate  the  relative  frequency
 of  occurrences  IN  COLUMN  A  beginning  with  the  most  frequent (1).

 What  are  the main  indoor  air  pollution  problems  identified  or  confirmed
 by  personnel of your  agency/organization?   Please indicate  the relative
 frequency of occurrences  IN COLUMN  B  beginning with the most frequent  (1).
                                                    COLUMN A
                                                            COLUMN  B
Aeroallergens                               	      	
Aeropathogens                               	      	
Asbestos                                    	      	
Benzene                                     	      	
Chlordane                                   	      	
Chloroform                                  	      	
Electromagnetic/Microwa/es                  	   ,   	
Formaldehyde                                	      	
Lead  (including lead paint)                 	      	
Odors                   .                   	      	
Other Pesticides                            	      	
Products of Incomplete Combustion  (PIC)     	      	
Radon                                      	      	
Specific Symptoms of Unknown Origin         	      	
Tobacco Smoke                               	      	
Ventilation                                 	       	
Volatile Organic Compounds (VOC)            '	      	
OTHER 	      	      	

On the average, how many calls/complaints per month  relating  to indoor air
pollution has your agency received during the past year?

	  Less than 10 per month
	  10-20 per month
	  20-50 per month
	  Greater than 50  per month

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    b.  On the average, what was the total number of calls/complaints per month
        received by your agency/organization during the past year?

        	  calls/complaints per month
    a.  In your opinion, does the number of calls increase dramatically following
        a television or newspaper story or other form of public education regarding
        indoor air pollution?

        	  Yes
        	  No
        	  No Opinion
    b.  If you have observed such an increase, please estimate the percent increase.

        	 % increase

    c.  Can you give an example of such an occurrence? 	
5.  Please identify the sections in your organization where indoor air-pollution
    problems are handled.

    Aeroallergens 	
    Aeropathogens 	

    Asbestos 	

    Benzene
    Chlordane
    Chloroform
    Electromagnetic/Microwaves

    Formaldehyde 	
    Lead (including lead paint)

    Odors
    Other Pesticides
    Products of Incomplete Combustion
    Radon
    Specific Symptoms of Unknown Origin

    Tobacco Smoke 	

    Ventilation 	    	
    Volatile Organic Compounds
    OTHER

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                                       -3-
6.  Of the calls/complaints received:
    a.  For what percentage do you make an on-site investigation?

    b.  What percentage are resolved over the telephone?   (excluding referrals)
        	%
    c.  What percentage are referred to other agencies?
        Please check those agencies/organizations to which calls are referred.
        	  Fire Department
        	  Physicians
        	  Gas and Electric Company
        	  American Lung Association
        	  Occupational Safety and Health
        	  Independent Laboratories or Consultants
        	  Unions
        	  Agencies of the Federal Government 	:	
               Agencies of the State Government
               Agencies of the Local Government
               OTHER
    d.   Please check those agencies/organizations from whom you receive referrals
        regarding indoor air pollution.
        	  Fire Department
        	  Physicians
        	  Gas and Electric Company
        	  American Lung Association
        	  Occupational Safety and Health
        	  Independent Laboratories  or Consultants
        	  Unions                           ' ,
        	  Agencies of the Federal Government     •	
               Agencies of  the State Government
               Agencies  of  the  Local  Government
               OTHER

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                                        -4-
7.  Of the calls/complaints investigated by your agency/organization:
    a.  For what percentage are you able to identify the source of the problem?
    b.  For what percentage are you able to identify a solution?
    c.  For what percentage do you call on expertise outside of your agency/organ-
        ization for assistance in the investigation?
    d.  For what percentage do you find no problems from indoor air pollution?
8.  What do you consider to be your greatest need(s) in the area of indoor air
    pollution capabilities?  (please rank in order of priority)
    	  Manpower
    	  Indoor Air Pollution Line Item Budget Appropriation
    	  Legislation
    	  Enforceable Regulations/Codes
    	  Indoor Air Pollution Standards (non-occupational)
    	  Funding
    	  Equipment
    	  Training
    	  Access to Laboratory
    	  Informational Resources
    	  Organizational Changes Within Your Own Agency/Organization
    	  Institutional Arrangements Outside Your Agency/Organization (Governmental,
            public, academic, etc.)
            OTHER
9.  Would you please provide copies of the following?
    a.  Forms used in relation to indoor air pollution.
    b.  Examples of on-site investigation reports.  (Names, addresses, and other
        confidential information should be deleted.)

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                                       -5-
10.   Do you have any additional comments describing your indoor air  pollution
     activities which the survey did  not cover?

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CHLORDRNE Summary.
Appendix #3
   11/19/86
1.  STATEMENT OF THE PROBLEM;  Improper use and/or applicaticai of chlordane/chlordane
    mixture may expose household residents to airborne concentrations of these
    coitpounds in indoor air.

2.  EXPOSUPE;
    Seminary of Exposure Routes;
    a.  Misapplication by conmercial applicator allowing intrusion of pesticide into
        the home (e.g., accidental piercing of ventilation ducts during application).
    b.  Misuse/misapplication by homeowners and/or noncommercial applicators
        (e.g., using product for other than specified purpose).
    c.  Structural characteristics of building allow intrusion of Chlordane after
        proper application (e.g., cracks in foundation, footings, etc.).

    Population Potentially Fxposured in Efaltimore Study Area:
    a.  Homes/year in Maryland treated with termiticides = 250,000.
    b.  Current U.S. termiticide usage is roughly 70% chlordane or a chlordane/
        heptachlor mixture: 250,000 homes/year  X  70%  =  175,000 homes treated
                                              with chlordane or chlordane mixture.
    c.  Chlordane Use in Baltimore Study Area in 1982 = 76,648 Ibs (22% of Md. use):
          175,000 homes  X  22% = about 3R,500 homes in Baltimore Study Area treated
                                  with chlordane or chlordane mixture.
    d.  Number of people potentially exposed in the Baltimore Study Area = 106,000.
        B. City = 43% households = 38,500 X 43% = 16,555 X 2.7 people/hh = 44,698.5 people
        P. Co. =  37% households = 38,500 X 37% = 14,245 X 2.7 people/hh = 38,461.5 people
        A.A. Co.= 20% households = 38,500 X 20% =  7,700 X 3.0 people/hh = 23,100.0. people
         (Bait. City + Bait. Co. + A. A. Co. =  44,698.5 + 38,461.5 + 23,100 = 106,260.)

    e.  Number of Chlordane misapplications in Md. (reported to Md. Dept. of Agric.) -
           15 cases in past 4 years (9 suspected misapplication cases).
        No. of Chlordane misapplications by homeowner/noncommercial applicators - Unknown.

3.  HEALTH EFFECTS;
    a.  Carcinogenic!ty.
        o  Group B2, FPA Carcinogenic Assessment Guidelines - Probable Human
                     Carcinogen (inadequate human evidence, sufficient animal
                     evidence).
        o  Group 3, IARC - Cannot be classified as carcinogen (inadequate human
                           evidence, limited animal evidence).
    b.  Other Health Effects.
        o Acutely toxic to Central Nervous System
        o Teratogenicity, Reproductive Effects, Mutagenicity - Inconclusive.

4.  CONTROL TECMJIQUES/TECHNDLCIGIFS;
    a.  Mechanical alteration during construction (e.g., avoiding soil/wood contact?
        increase crawlspace ventilation).
    b.  Alternative termiticides (experimental included).
    c.  Pretreatment of new homes (e.g., treat soil before building house).

5.  CURRENT ACTIVITY LEVEL;
    aT  U.S. EPA/OPP - gathering data to restrict Chlordane use to certified applicators.
    b.  Md. Legislation (5/13/86) - Pesticide applicators must undergo training in
        first thirty days of employment (Effective July 1, 1986).
    c.  If EPA does not restrict use to licensed applicators, Md. Dept. of Agriculture
        may attempt to accomplish this.

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FORMALDEHYDE Summary.
11/19/86
1.  STATEMENT OF THE PROBLEM:  Formaldehyde present in building materials,
    insulation, consumer products, etc. can offgas in the indoor environment.

2.  EXPOSURE;
    Stannary of Exposure;
    Pressed wood products containing urea-formaldehyde (UF) resins and
    urea-formaldehyde foam insulation  (UFFI) are the major sources of elevated
    indoor air concentrations.  UFPI use has decreased dramatically since 1982
    (CPSC tan);  main concern, therefore, is UFFI use between 1975-1981.
    Formaldehyde emissions from TJFFI depend upon nature of the product,  age of the
    source, indoor temperature and humidity, and improper installation.
    Formaldehyde emissions from pressed wood products depend on a number of factors,
    e.g., type of product resin content, indoor temperature and humidity, age of
    product, surface area of product relative to indoor air volume (loading rate).

    Population Potentially Exposured in Baltimore Study Area;
    UFFI;  Major building type of concern is residential.  Most concern is with UFFI
      installed between 1975-1981.
      - Since UFFI has declined in use since 1981 (CPSC ban), there is little
        potential for exposure in homes 1-5 years old, or new homes in future.
      - Therefore, potential concern is for homes 5 years old or older (prior to
        CPSC ban).  However, off gassing of formaldehyde decreases with age of the
        product.  There is a significant reduction in formaldehyde levels after
        the first year or two.  therefore, there is little potential for broad
        exposure from past or current use of UFFI.

    Pressed Vtood Products:  Pressed wood products are of concern in all building
      types;  however, it is of more concern in mobile homes due to the greater
      surface area of wood products/indoor air volume of the mobile home.  (There
      were about 5,300 mobile homes in the Baltimore Study Area in 1985.)  It is
      very difficult to characterize exposures in buildings because the sources
      of formaldehyde can be continuously renewed, e.g., new pressed wood furniture
      in an office or new kitchen cabinets in a 30-year old home.

      However, some 1985 national data do give potential exposures to certain
      formaldehyde-containing products used in construction of new single-family
      detached homes:
      - About 11,600 homes were built in 1985 in the Baltimore Study Area,  of which
        about 5,000 were single-family detached homes, 3,600 were single-family
        attached homes, and 3,000 were multi-family homes.

      - Of the 5,000 single-family detached homes;
          24% (about 1200 hones) used both particleboard underlayment and/or
          hardwood plywood wall paneling;
          15% (about 750 homes) used particleboard underlayment flooring; and
          12% (about 600 homes) used hardwood plywood wall paneling.

      - Of the 3,600 single-family attached homes;
          16% (about 580 homes) used particleboard underlayment flooring; and
           6% (about 220 homes) used hardwood plywood wall paneling.

      - Of the 3,000 multi-family homes:
          8.5% (about 250 homes) used particleboard underlayment flooring;  and
          2%   (about 60 homes)  used hardwood plywood wall paneling.

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POFMALDEHYDE
               -2-
      - Nearly all single-family hones (about 8,900 hones) used kitchen cabinets.

      - About 30-40% of new single-family homes (about 2,600 - 3,500 homes) used
        hardwood plywood doors.

      - About 47% of new single-family homes (about 4,100 hones) used
        particleboard closet shelves.

      - The use of particleboard underlayment has the nost significant impact on the
        average concentration in the home.

      - The potential exposed population to formaldehyde in new homes in the Baltimore
        Study Area is:   (11,600 homes, 1985) X (2.8 people/household) = 32,480 people.
        Mobile homes = 5,300 x 2.8 people/household = 14,840 people.
        New Homes (32,480) + Mobile hones (14,840) = 47,320 people.
3.  HEALTH EFFECTS;
    a.  Oarcinogenicity.
Group Bl, Probable Human Carcinogen (CAG) - limited
human evidence, sufficient animal evidence.

    b.  Other Health Effects.
        -  Toxicity:  irritation of the eye, nose and throat at low level exposure.
           Irritant of upper and lower airways and pulmonary effects.
        -  Some evidence as potential animal nutagen.
        -  Not a potential human or animal teratogen.


    CONTROL TEX3!NIC3UES/TEX3M)LOGIES;
    a~IRemoval of formaldehyde-emitting materials, e.g., UEFI.
    b.  Avoid using building products and furnitures with high formaldehyde levels.
    c.  Change UP resin formulation.
    d.  Use substitute resin.
    e.  Post-cure product treatments, e.g., ammonia fumigation, scavenger- and
        non-scavenger-containing barriers.
    f.  Increase building air exchange rate.
    g.  rise of dehumidifier, air cleaners, air conditioning coil.

5.  CURRENT ACTIVITY LEVEL;
    a.  FPA investigating regulatory options for:  fabrics treated with formaldehyde
        resins, and construction materials.
    b.  CPSC recommended working with industry to develop voluntary standards to
        control formaldehyde emissions from pressed wood products and to inform
        appropriate organizations of health effects information.
    c.  CPSC plans to write, in 1987, a booklet for consumers on remedies of
        formaldehyde emissions.
    d.  Several ongoing studies monitoring formaldehyde in mobile and conventional
        housing are being conducted.

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VOLATILE OKGMJIC COMPOUNDS (VOCs) Sumtary.
    STATEMENT OF THE PROBLEM!
11/19/86
    Thousands of chemicals present in household and office products and furnishings
    can Vie released into the indoor air in varying concentrations.  The average
    home contains some 45 aerosol containers, each of which nay contain up to 15
    different VOCs.
2.  EXPOSURE;
    Summary of 'Exposure;
    The primary sources of VDCs in the indoor environment are various products and
    materials which contain a VOC of potential concern.  These products include:
    persona] hygiene and cosmetic products, building materials, cleaning products,
    biocidal treatments, hobby materials, molded household wares, drycleaned
    clothing, refrigerants, aerosol propellents, gasoline, and office products such
    as reproduction solutions.

    VDCs are also present, but to a lesser degree, in the combustion products of
    furnaces, fireplaces, woodstoves, and Verosene heaters.  Other sources include
    the volatilization of organic compounds from drinking water use indoors, and
    intrusion of VOTs indoors from the outdoor air.

    The most significant source is, however, by far the myriad of consumer products
    and materials and their chemical ingredients.

    Two major studies on exposures to volatile organic compounds indoors have revealed
    that:  (1) concentrations indoors are generally higher than the concentrations
    found outdoors;  (2) the sources are numerous, and (3) ranges of concentrations
    vary greatly, often by factors of 10 or 100.  Volatile organic compounds have
    been found in the air inside coimiercial buildings, public buildings, schools,
    office buildings, and hospitals, as well as private homes.

    Population Potentially Exposured in Baltimore Study Area:
    Given the ubiquitous presence of chemical containing products and materials in
    indoor environments, the entire study area population will at one time or another,
    be exposed to volatilized organics in indoor air.  The extent of the exposure will
    depend on several factors, including:  time spent in a particular location,
    presence of certain products and their chemical compositions, extended use of a
    particular product, and characteristics of the environment such as temperature,
    humidity, air exchange rates, etc.

    In 19R7,  the EPA will be conducting a Total Exposure Assessment Methodology (TEAM)
    study in the Baltimore IEMP study area which will shed some guantitative light
    on the exposures of individuals to specific VOCs in the indoor environments.

3.  HEALTH EFFECTS;
    Human health effects of indoor non-occupational exposures to VOCs are not yet
    well understood.  The large number of chemicals found indoors makes it extremely
    difficult to associate health effects with exposures to specific compounds.

    Various compounds found indoors have been associated with headache, irritation
    of eyes,  mucous membranes, and respiratory system, drowsiness,  fatigue,  and
    general malaise.  Occupational exposure studies have documented health effects
    from VOCs including cancer,  mutagenicity,  respiratory ailments, heart disease,
    allergic reactions, and other toxic effects.  In general,  concentrations of '\tOCs
    measured in the non-occupational environment are one or two orders of magnitude
    lower than the Occupational Safety and Health Administration's Permissible

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VOLATILE ORGANIC COMPOUNDS (VDCs)
-2-
    Exposure Limits (PFL) and American Conference of Governmental Industrial
    Hygienists' (AOGIH) Threshold Limit Values (TLV).  The lower levels, however,
    may still be excessive and cause serious health effects, althrough the effects
    of chronic and acute exposures to these lower concentrations are not yet
    generally Icnown.

A.  CONTROL
    a.  Reformulation of consumer products to reduce or eliminate VOC content.

    b.  Removal or sealing of building materials.

5.  CURRENT ACTIVITY LEVEL ;
    a.  CPSC has authority to ban or regulate hazardous substances produced for
        use by consumers.  CPSC actions to date include:
        o  ban of vinyl chloride from hairsprays /aerosols .
        o  ban of carbon tetrachloride in household products.
        o  pending action to require warning label on products containing
           methylene chloride.
        o  warning labels are required on furniture polishes, oven and drain cleaners,
           turpentine, lighter fluid, ethylene glycol, methyl alcohol, solvents,
           kerosene, varsol and other petroleum distillates, perchloroethylene.

    b.  Federal research, coordinated by the Interagency Committee on Indoor Air
        Quality (CIAQ), is being conducted to characterize indoor concentrations
        and sources.

        EPA Office of Toxic Substances is researching the use of consumer products,
        VOC content, and personal exposures.

    c.  Baltimore TEAM study is currently being planned and designed;  sampling
        will be conducted in 19fl7.
        Maryland Department of Health and Mental Pygiene (DHMH) activities include:
        o  investigation of citizen complaints.
        o  enforcement of CPSC actions.
        o  public information and creation in conjunction with CPSC.
        o  research and surveys in conjunction with CPSC.

        American Lung Association of Maryland (ALAM) offers seminars and other forms
        of public education to persons who utilize art materials.

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COMBUSTION PRODUCTS Surrroary.
                                            11/19/86
1.  STATEMFTSTT OF THE PROBLEM;
    Biomass and fossil fuels are burner* indoors for heating, cookinq, and
    recreational purposes.  Combustion at less than optimal conditions produces
    gases and particulate products, including nitrogen oxides, carbon dioxide,
    carbon monoxide, organic and inorganic particulates, and various metals and
    organic vapors.  Inadequate venting of these products results in increased
    indoor concentrations, often substantially higher than outdoor concentrations.

2.  EXPOSURE:
    Summary of Exposure;

    Coiqpound
    Nitrogen Oxides . . .
    Carbon Monoxide . . .

    Carbon Dioxide  . . .
    Respirable Suspended.
      Particulates
    Sulphur dioxide . . .
Source
Natural gas appliances and unvented kerosene heaters.
Gas cooking ranges, ovens, and furnaces? tobacco smoke;
vehicle emissions from attached garages.
Combustion sources; tobacco products; metabolic processes.
Tobacco smoke; gas ovens and furnaces; kerosene heaters;
fireplaces.
Ose of improper or low grade fuels in unvented kerosene
heaters; fuel oil or natural gas appliances. Main source
is infiltration of contaminated outside air.
    Combustion of fossil fuels results in a rich array of organic compounds.  In
    most cases, however, the concentrations of organic compounds from combustion are
    small compared to other indoor sources of such compounds.  Polycyclic Aromatic
    Hydrocarbons (PAHs) are an exception, however, where combustion is the major source.

    A combination o^ combustion sources is often found in the same building or home.
    The concentrations of pollutants found indoors depend on a complex interaction
    of the following factors:
        o  type of appliance, e.g., gas appliances, wood stoves, etc.
        o  fuel quality and type.
        o  combustion conditions, i.e., optimal or poor conditions.
        o  age, physical design, condition and maintenance of the appliances.
        o  air exchange rate in the home or building.
        o  nature and duration of appliance usage.
        o  pollutant generation rate.

    Population Potentially Exposured in Baltimore Study Area;
    The 1984 Baltimore Gas & Klectric Residential Appliance Survey and 1985
    Regional Planning Council household estimates give the following estimates of
    residential combustion appliance usage:
      Appliances
      o  Ranges - Natural Gas
         Ranaes - Bottled Gas
      o  Clothes Dryer - Natural Gas
      o  Hot Water Heater - Natural Gas
         Hot Water Heater - Bottled Gas
         Hot Water Heater - Oil
      o  House Heating - Natural Gas
         House Heating - Bottled Gas
         House Heating - Oil
         Kerosene Heater
         Wood Stove
         Fireplace
            Households in the Baltimore Study Area
               431,998
                26,626
               157,608
               421,928
                13,140
                53,738
               364,724
                 2,737
               201,693
                27,413
                31,609
                66,665

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COMBUSTION PRODUCTS
        -2-
    According to these statistics, of 668,900 households in the Baltimore Study Area:
        o  569,154 households (or 85%) have a combustion device- for primary heating.
        o  488,806 households (or 73%) have a combustion appliance for hot water heating.
        o  157,608 households (or 24%) have a natural gas fired clothes dryer.
        o  458,624 households (or 69%) have a gas fired range.

    If one includes electric appliances, the relative use of fossil or biomass fuels
    fired appliances to the total number of households is:
    Appliance
    Ranges
    Clothes Dryer
    Hot Water Heater
    House Heating*
Percent Using Contoustion Fuel vs Electric
67% (vs 33% electric)
40% (vs 60% electric)
79% (vs 21% electric)
90% (vs 10% electric)
    *This does not include kerosene heaters, wood stove, or fireplaces.
     1?5,687 households have one or more of these devices as a secondary heating
     appliance in addition to a primary gas, oil, or electric furnace.

    Given these statistics, it is apparent that the vast majority of the households
    have at least one combustion appliance which is a potential source of indoor
    air pollutants.  In reality, most household have more than one of these devices.

    In addition:
        o  Of the 668,900 households in the Baltimore Study Area, 549,498 households
           (or 82%) were over 10 years old.
        o  Jurisdiction

           Baltimore City
           Baltimore County
           Anne Arundel County
      Combustion-Fired Primary Heating Systems
      Older than 10 years Old _
      ~
            (or 189,327)
       68%  (or 141,043)
       58%  (or  57,295)
        o  10% of the households in the Baltimore Study Area (or 66,890 households)
           had a person less than 5 years of age.

        o  17% of the households in the Baltimore Study Area (or 100,335 households)
           had a person 65 years of age or older.

    Inasmuch as heating systems require more maintenance to operate optimally
    as they get older, and well over 50% of the heating systans are over 10 years old,
    a large segment of the population is potentially exposed to combustion products
    from an aging furnace. There also is a significant number of especially
    susceptible persons, under 5 years and over 65 years of age, potentially exposed.
3.  HEALTH
        Nitrogen Oxides.  Nitrogen oxides produce immediate short-term effects on
        airway reactivity, resulting in increased vulnerability to other pollutants.
        o  Asthmatics appear to be most susceptible.
        o  Exposed children may be at increased risk of chronic lung disease.
        o  Persons at special risk are those with chronic bronchitis, emphysema,
           asthma, and children under 2 years old.
        o  Nitrogen dioxide affects host defenses against bacterial pulmonary
           infections in animals - relevance to humans not yet established.
        o  One study found association between gas range use and severe cases  of
           chest illness in children before age two.

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                                      -3-
COMBUSTION PRODUCTS
    d.
    e.
    f.
Carbon Monoxide.
o  Carbon Monoxide causes tissue hypoxia brought on by a reduced ability
   of the blood to carry oxygen to body tissues.
o  Asphyxiation occurs at greater than 1800 ppm for 1 hour.
o  Loss of alertness, impaired perception, loss of normal dexterity, re-
   duced learning ability, drowsiness, confusion,  and finally coma and
   death.
o  At relatively low levels, persons with heart problems may be at partic-
   ular risk due to high oxygen demand of the heart.

Carbon Dioxide.
o  Carbon dioxide causes adverse health effects at very high concentrations,
o  Slight elevations in the blood level increases the breathing rate.
o  Health effects in guinea pigs were observed at 3000 ppm.
o  Carbon dioxide is not a significant health effect pollutant from com-
   bustion.
Respirable Suspended Particulates.  Major effects of concern attributed to
particle exposure include:
o  Impairment of respiratory mechanics, and lung functions.
o  Aggravation of existing respiratory and cardiovascular disease.
o  Altered lung defense mechanisms.
o  Carcinogenesis due to polycyclic aromatic hydrocarbons adsorbed on the
   particle surfaces.
o  Increased susceptibility to infectious diseases.

Organic Compounds.
o  Many organic compounds have been identified with cancer, mutagenicity,
   respiratory ailments, heart diseases, and other toxic effects.
o  PAHs carried by particulates are considered to be a cause of lung can-
   cer; risk is assumed to be directly proportional to accumulated exposure.

Sulphur Dioxide.  Sulphur dioxide is an irritant and causes significant
bronchoconstriction in asthmatics.
    CONTROL TECHNIQUES/TECHNOLOGIES;
    a.  Source removal.
    b.  Source use restriction.
    c.  Modification of equipment and factors, e.g., fuels.
    d.  Use of air cleaning devices.
    e.  Ventilation improvements.
    f.  Proper maintenance and operation of sources.
    g.  Combustion efficiency testing.
    CURRENT ACTIVITY LEVEL;
    a.  Consumer Product Safety Commission (CPSC).
        o  Proposed survey that will target high exposure groups.
        o  Study was completed on space heaters; it will be available in Summer 1986.

    b.  Environmental Protection Agency (EPA).
        o  Proposed New Source Performance Standard (NSPS) for woodburning stoves
           is expected by January 1987 and promulgation in 1988.  Effect on indoor
           air quality is unclear.

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                                      -4-
COMBUSTION PRODUCTS
        o  Tennessee Valley Authority (TVA) study found that increased ambient
           fine particulate concentrations result in increased indoor concentra-
           tions; thus, the NSPS for woodburning stoves could reduce indoor par-
           ticulate levels as well as ambient levels.
    c.  Gas Research Institute (GRI).
        O  Study on unvented gas space heaters has been completed; data are being
           analyzed.
       . o  Ongoing study of gas ranges and associated health effects.
        o  Major study of problem of indoor air pollution from gas appliances.
    d.  Other Research.
        o  Federal CIAQ proposing a study on combustion products.
        o  American Society for Testing Materials (ASTM) studying PAHs.
        o  Health Effects Institute (HEI), Cambridge, Mass, is overseeing research
           on health effects of low exposures to carbon monoxide and nitrogen
           dioxide.

    e.  Baltimore Study Area.
        o  Baltimore City has a ban on unvented space heaters (gas and kerosene).
        o  Baltimore County restricts use of unvented kerosene heaters to single-
           family dwellings with owner consent.
        o  Maryland DHMH regulations restrict sulphur in fuel content:
           1.0% by weight for solid fuels and residual oil;  0.3% in distillate oil.

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RADON Summary.                                                         11/19/86
1.  STATEMENT OF THE PROBLEM:
    Radon, a naturally occurring gas produced by radioactive decay of uranium,
    can become dissolved in water or released with soil gas.  Exposure from
    elevated indoor air levels may lead to adverse health effects (lung cancer).

2.  EXPOSURE;
    Summary of Exposure:
    The two primary sources of naturally-occurring radon in buildings are soil
    gas and groundwater;  less significant contributions may come fron building
    materials, outdoor air, and homeheating fuels.  In most situations, the major
    contributor to indoor radon concentrations is from soil and rocks.

    The main mechanism of radon gas transport into the hone is pressure driven
    flow.  The most important pathway into the home is through cracks and other
    openings in the building substructure.  The amount of radon entering the home
    depends on many factors, such as building type and characteristics, soil  .
    factors (e.g., presence of radium, permeability, etc.) and meteorology.

    Population Potentially Exposured in Baltimore Study Area;
    Few data have been received by the Maryland Department of Health and Mental
    Hygiene (DHMH);  as of July 1, 1986, 210 Maryland measurements were available,
    of which 18 measurements were from the Baltimore Study Area:
      Of the 18 measurements, 6 had levels <4 pCi/1; 10 had levels between 4-20
      pCi/1; and 2 had levels between 21 - 50 pCi/1.
    No other data are presently available for the Baltimore Study Area.

    A number of monitoring studies have been conducted in Maryland:
      o  1980 sampling of 58 homes in Mt. Airy area using grab samples.
         Average concentration was 3.8 pCi/1.

      o  1982 sampling of 41 homes in Damascus area using passive activated
         carbon integrating devices.  Average radon concentrations for living
         areas (41 homes) were 3.9 pCi/1 and for basements (37 homes) were 9.6 pCi/1.

      o  1985/1986 sampling of 22 towns in Md. using passive activated carbon devices.
         Wintertime:  31% of homes had >_ 4 pCi/1 in the living area, and
                      51% of homes had _>_ 4 pCi/1 in the basement.
         Summertime:   7% of homes had >_ 4 pCi/1 in the living area, and
                      39% of homes had >_ 4 pCi/1 in the basement.

    Other Md. data include:
      o  Terradex Corporation reported 16 hones tested:
         31% with levels > 4 pCi/1;  the highest reading was > 20 pCi/1.

    Potential exposure in Maryland is unknown.  Many factors are involved:  location
    and condition of the house, seasonal variations, etc.  More will be known after
    Md. DHMH receives more measurements from homes in the Baltimore Study Area and
    after the proposed Md. survey of radon in homes.
3.
4.
HEALTH EFFECTS;
    Carcinogenicity.  The primary site is the lung, due to exposure to alpha
    radiation from inhaled decay products of radon.
    a.
b.  The interaction of exposure to radon with exposure to tobacco smoke may
    result in a disproportionate increase in risk.

COMTROL TECHNIQUES/TECHNOLOGIES;
a.  Prevent radon from entering the home, e.g., seal major radon entry routes,
    prevent radon entry into the home by collecting radon gas at the source
    and ventilating away from the house.

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                                          -2-
        Reroove radon and its decay products from the home through ventilation.
    c.  Remove radon decay products from the home through filtration/ionization,
        e.g., air cleaners. *
    d.  Remove the source of radon, i.e., remove building materials containing radon.

5.  CURRENT ACTIVITY LEVEL;
    a.  Interagency Committee on Indoor Air Quality (CIAQ),  Radon Workgroup.
        This group is primarily responsible for coordinating federal research and
        activities on indoor radon.

    b.  EPA Radon Action Program:
        o  Has developed a quality assurance program to test indoor radon monitoring
           devices for accuracy;
        o  Is developing measurement methods and procedures;
        o  Is supporting demonstrations and evaluations of selected mitigation techniques;
        o  Is developing a training program for federal and state employees on measurement
           diagnosis, and mitigation of radon problems;
        o  Is identifying elevated radon areas through geological and other data;
        o  Is providing state assistance (design of radon surveys, management and
           evaluation of survey data, etc.);
        o  Is preparing various publications;
        o  Is conducting information dissemination programs and evaluation;
        o  Will" conduct a national survey of radon in U.S. homes;  and
        o  Will examine new home design and construction techniques to reduce potential
           exposure.

    c.  KPA Office of Drinking Water Activity.  A Maximum Contaminant Level (MCL) is
        being developed for radon in public drinking water supplies.

    d.  Department of Energy.
        o  Conducting research on radon sources, variability of radon levels,  radon
           entry mechanism into and behavior within buildings,  control techniques/
           mitigation, health effects;
        o  Producing documents on radon;  and
        o  Conducting survey work.

    e.  Other Organizations.  Various activities such as developing and distributing
        information (both to building industry members and the  public),  and collecting
        measurements.

    f.  Baltimore Study Area.
        o  Md. DHMH Division of Radiation Control is collecting data for Maryland;
           Md. Geological Survey will plot these test results to look for unusual
           patterns or clusters of homes in Maryland having elevated levels.
        o  Md. is making available to the public both general information on  radon
           and its health effects, and specific information  on  indoor sampling kits.
        o  Md. State Community Health Programs has requested budget (FY 1988)  for
           a radon survey in Maryland.  If funding is approved,  the survey will
           beqin 7/1/87.
        o  American Lung Association of Md.  (ALAM) is going to  distribute radon
           information to the  public in Maryland.
        *not recommended by EPA due to controversy over effectiveness  for the  fraction
         of radon decay products unattached to airborne particles.

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PASSIVE POKING Suntnary.
               11/19/86
1.  STATEMENT OF TOE PROBLEM;
    Exposure of a nonsmoker to indoor air polluted with sidestream smoke (that
    which comes directly from the burning end of the tobacco product) and exhaled
    mainstream smoke (that which the smoker -inhales directly into the lungs)
    may cause adverse health effects.

2.  EXPOSURE;
    Population Potentially Exposuredin Baltimore Study Area;
    1985 Population Estimate     Total        Adult*
    Baltimore City               760,000      544,300
    Baltimore County             665,200      502,950
    Anne Arundel County          396,300      281,900
              TOTAL            1,821,500    1,329,150

      * An adult is defined here as 20 years and older;
        here as 12 - 19 years old.
     Teenager*
      78,900
      66,900
      45,670
     191,470

a teenager is defined
    National Percentage of U.S. 19R5 Adult Pop. that smoke:  about 31%.
    National Percentage of U.S. 1985 Teenage Boys that smoke:  about 11%
    National Percentage of U.S. 1985 Teenage Girls that smoke: about 13%

    Data provided by Baltimore City Health Dept.: 43% of Baltimore City pop.
    smoke.  Therefore, estimated Baltimore City population that smoke:
         623,200 (adults + teens) X 43% = 267,976 or about 268,000.

    To estimate the number of smokers in Baltimore County and Anne Arundel County,
    the national percentages are used:
        Bait. Co. adult pop. + A. A. Co. adult pop. = 784,850 X 31% = 243,304.
        Bait. Co. teen pop.  + A. A. Co. teen pop.  = 112,570 X 12% =  13,508.
    Therefore, the estimated Baltimore County and Anne Arundel County population
    that smokes:  adults + teens = 256,812 or about 256,800.

    Total estimated population in Baltimore Study Area that smokes (excluding pre-
    teen smokers) = 268,000 + 256,800  =  524,800.

    Estimate of Nbnsrookers (potentially exposed to tobacco smoke) in the Baltimore
    Study Area:Total population - Smokers = 1,821,500 - 524,800  =  1,296,700.

3.  HEALTH EFFECTS;
    a.  Carcinogenicity.  Lung cancer and other potential cancer sites.
    b.  Other Health Effects.
        o  Passive smoking may increase symptomatic coronary heart disease and has
           been associated with impaired pulmonary function.
        o  Evidence also exists that physical growth and development deficiencies
           are more likely to occur in children of smokers.

4.  CONTROL TECMNIQUES/TECMTOLCXSIES;
    a~iUse of air cleaning devices.
    b.  Ventilation Improvements.

5.  CURRENT ACTIVITY LEVEL;
    a.  U.S. Department of Health and Human Services.  Clearinghouse to collect
        scientific and legislative information on smoking and disease in order to
        provide worldwide reference standards on which to base public health
        and other programs.

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PASSIVE SMOKING
-2-
    b.  Private Businesses.
        o  In 1986, 36% of U.S. businesses had established smoking policies.
        o  In 1979, 42% of blue collar conpanies had designated smoking areas and
           28% had prohibited smoking completely;  15% of white collar conpanies
           had designated areas for smoking and 11% had prohibited smoking completely.

    c.  Other Organizations.   Other national organizations provide:  legislative
        actions against smoking, public education and awareness,  legal support,
        and clearinghouse for state and local clean indoor air information and
        cigarette excise tax legislation.

    d.  Baltimore Study Area.
        Current Smoking Restrictions;

        o  MD HEALTH & ENV. CODE ANN. Section 11-205 (1982).
           Regulates smoking on premises of hospitals,  nursing homes,  health
           clinics, and physicians' offices.

                                  ********
        o  MD TRANS?. CODE ANN. Section 7-705 (Supp. 1984).
           Prohibits smoking or carrying lighted tobacco products in public mass
           transit bus,  railcar, or transit station.

        o  MD ANN. CODK Article 70, Section 35A (1980).
           Prohibits smoking in intrastate motor bus carrier.

        o  Baltimore County Code Section 18-27,  Smoking on Public Transit  Vehicles
           prohibited (1973).

        o  Anne Arundel County Code Section 17-313.
           Prohibits taxicab  driver from smoking without consent  of the passenger.

                                   ******
        o  MD ANN. Code Article 89, Section 64 (1979).
           Prohibits smoking  on public elevators.

                                   ******
        o  State Fire Prevention Code Section F-310.0,  Smoking Conditions  (1984
           Edition BOCA Fire  Prevention Code).   Prohibits smoking where conditions
           are such as to make smoking a hazard.

        o  Baltimore City Fire Prevention  Code Section  F-310.0> Smoking Conditions
           (1978 Edition BOCA Fire Prevention Code).  Prohibits smoking where
           conditions are such as to make  smoking a  hazard.  This is being updated
           to coincide w/1984 BOCA Fire Prevention Code.

        o  Baltimore County Code Section 28.3,  Precautions against Fire, General
           (1976 Edition of American Insurance Association  (AIA)  Fire  Prevention
           Code).   Prohibits  smoking where conditions are such as to make  smoking
           a hazard.  This is  being updated to coincide with 1984  BOCA  Fire
           Prevention Code.
                                  *******
           Local Organizations;
        o  The Healthy Majority.   Statewide coalition of over  23  health agencies
           and individuals with the goal of supporting the establishment of
           smoking and nonsmoking sections in public places.   1986 legislation

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PASSIVE SMOKING
-3-
           was introduced, which prohibited smoking in retail stores, restaurants,
           and state office buildings.  It did not pass.  In addition to planned
           introduction of legislation at the state level in 1987, they have
           targeted two counties for legislation at the local level.

        o  Mary landers for Nonsrrokers1 Rights, Incorporated, Baltimore, MD.

        o  American Lung Association of MD, Lutherville, MD.
           Programs are concerned with the prevention of onset of cigarette
           smoking and reducing the number of current smokers, as well as increasing
           the number of smoke-free facilities and activities.  Activities include:
           curricula development and comprehensive stroking prevention programs
           in schools; public education; education and referral service for
           medical care providers; cessation clinics and programs; legislative
           support; nonsmoking policy assistance.

        o  Bowie GASP.  Bowie GASP is a local nonprofit voluntary organization,
           involved with public education, legislative activities concerning
           smoking in public places, etc.

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ASBESTOS Summary.
                                                                  11/19/86
 !•  STATEMENT OF THE PROBLEM.
    Asbestos, a group of naturally occurring minerals that separate into fibers,
    is used in many products in the home, public and commercial buildings, and
    schools.  If asbestos fibers are released to the air indoors, they may easily
    be inhaled or swallowed, thus creating a hazard to building occupants.
    Inhalation is the main route of exposure.

 2.  EXPOSURE.
    Summary of Exposure.
    Potential exposure to asbestos depends on:
     o  location of the asbestos-containing material (ACM) in the structure,
        e.g., boiler room vs cafeteria, or in ceiling spaces used as return air
        plenums with high potential for fiber release and distribution.
     o  Type of ACM, e.g., boiler lagging and insulating pipe wrapping vs floor tile.
     o  Physical condition of the material, i.e., friable (easily crumbled or
        reduced to powder by hand pressure) material vs nonfriable material.
     o  potential for contact with the ACM, which may release airborne fibers,
        i.e., areas subject to accidental damage or vandalism (such as high traffic
        halls, utility rooms, etc.) vs located behind solid wall or ceiling.
     o  exterior ambient air levels.
    The most important factor listed above is friability of the ACM.

    Three forms of asbestos are generally found in buildings:
     o  sprayed or troweled-on surfacing materials;
     o  insulation on pipes or boilers, and ducts? and
     o  miscellaneous forms, such as wallboard, ceiling tiles, and floor tiles.
    Materials in the first two categories above can be friable.  Those in the
    third category are nonfriable;  however, any ACM that is damaged during repair
    or renovation may release asbestos fibers.
4.
    Population Potentially Exposured in Baltimore Study Area;
    Government Owned Buildings and Boards of Education Buildings:
                                                               see chart
    Private Buildings:
      Baltimore City
      Baltimore County
      Anne Arundel County
3.  HEALTH EFFECTS.
                      No. of Demolition
                      Permits Reviewed/Yr
                         190

                          50
No. of Renovation
Permits Reviewed/Yr
 1,400-1,500

     Unknown
                                                                       Total
1,590-1,690
about 1,000
   50+
a.  Carcinogenicity.  EPA GAG Group A, Known Carcinogen
    o  Mesothelioma - tumor of cells of membranes covering lungs and other body
                      organs.
    o  Lung and other cancers, such as larynx, pharynx, oral cavity, esophagus,
       stomach, colon, rectum, kidney, and ovary.
    o  Exposure to both asbestos and tobacco smoke can increase the risk of
       developing lung cancer.
b.  other Health Effects.
    o  Asbestosis - irreversible lung scarring;  can be fatal in occupationally
                    exposed persons.
CONTROL TECHNIQUES/TECHNOLOGIES.
a.  Use substitute material,  (new buildings)
b.  Use proper abatement method and techniques, i.e., removal, encapsulation,
    enclosing material, (existing buildings)

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ASBESTOS
—2—
5.  CURREOT ACTIVITY LEVEL.
    a.  Environmental Protection Agency (EPA).
        Programs to address asbestos include: National Emissions Standards for
        Hazardous Air Pollutants (NESHAPs); Asbestos in Schools Program; Technical
        Assistance Program: Contractor Certification;  Asbestos Information and
        Training Centers;  and Worker Protection Rules (during abatement).

        The 1986 Asbestos Hazard Emergency Response Act passed, which will require
        EPA to set standards for identification andabatement of asbestos in
        schools;  require public and private elementary and secondary schools to
        develop management plans describing abatement actions to be undertaken;
        requires states to develop accreditation programs and review the management
        plans prepared by schools,  and requires schools to implement management
        plans and complete them in timely fashion.

        EPA has also proposed a rule under TSCA §6 to prohibit the manufacture,
        importation, and processing of asbestos in certain products and to phase
        out the use of asbestos in all other products.

    b.  Consumer Protection Safety Commission (CPSC).
        o  CPSC banned the use of asbestos in certain consumer products.
        o  CPSC will be drafting enforcement policy to notify the public that labelling
           requirements of the Federal Hazardous Substances Act, §2(p), apply to
           consumer products containing asbestos.
        o  CPSC conducted a Homes Investigation of asbestos in homes in Philadelphia,
           Cleveland, and San Francisco.  61 of 66 (older) homes sampled (bulk
           sampling) were confirmed to contain asbestos.   45 hones will follow up
           with airborne sampling,
        o  CPSC is developing educational information for the consumer (booklet).

    c.  Other Organizations.
        o  White Lung Association provides public education concerning asbestos
           hazards.
        o  American Lung Association performs educational, referral, and legislative
           activities.
        o  Asbestos Information Association represents asbestos manufacturers and
           importers in the U.S. and Canada.
        o  National Asbestos Council is a trade association of abatement contractors.
        o  Safe Building Alliance publishes information (health effects, exposure,
           occurrences of ACM,  technical management action), and performs regulatory
           and legislative monitoring and liaison.

    d.  Baltimore Study Area.
        GOVEPM1EOT OWNED BUILDIN5S.
        a. State of Maryland.  Survey of state owned buildings, with abatement
           performed as necessary with funds allowed.

        b. Baltimore City.
           o  Neighborhood Progress Administration (NPA).   NPA acquires for Baltimore
              City property for demolition, development/renovation purposes.
              Properties must be inspected prior to demolition, renovation,  etc.
           o  Baltimore City Asbestos Task Force.  Purpose - develop a comprehensive
              asbestos management program for government owned buildings, including
              Board of Education facilities.  Performed survey of school system
              and government owned buildings; personnel protection;  maintenance
              workers' training and awareness program.

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ASBESTOS
                                       -3-
c.  Baltimore County.
    o  Asbestos Coordinating Committee.  Purpose - enhance communication
       and coordination among agencies with buildings that contain asbestos.
       Performed survey of government owned buildings.

d.  Anne Arundel County.
    o  Survey of government owned buildings.

BOARDS OF EDUCATION
a.  State of Maryland.
    o  Performed survey of school buildings, with abatement performed as
       necessary with funds allowed.
    o  Developing set of contractor credentials and specifications hired to do
       school inspections.
    o  Developing set of procedures used to conduct school inspections.
    o  Conducts asbestos workshops for school systems personnel.
    o  Collects data from school boards each year on asbestos activity status.

b.  Baltimore City.   (see Government Owned Buildings)
    o  Performed survey of school buildings, with abatement performed as
       necessary with funds allowed.

c.  Baltimore County.
    o  Performed survey of school buildings, with abatement performed as
       necessary with funds allowed.
    o  Provides information updates to school personnel.
       Provides Board personnel with training on asbestos removal.
       Provides oversight of school/government owned building projects.
        o
        o
    d.   Anne Arundel County.
        o  Performed survey of school buildings,  with abatement performed as
           necessary with funds allowed.
        o  Provided training  of in-house  personnel concerning minor abatement jobs.

    e.   Other Organizations.
        o  Private and church schools are independent and responsible for asbestos
           management in their own schools.
        o  Archdiocese of Baltimore has surveyed its member schools; abatement was
           performed as necessary.

    PRIVATE BUCDIHGS
    a.   State of Maryland.
        o  Department of Health and Mental ftygiene (DHMH) - Licensing of businesses
           involved in asbestos project;   asbestos training course certification
           program;  and enforcement  and  support activities.
        o  State Employees Program -  specifies  equipment, procedures,  and type of
           work a State employee can  perform.   Training program established.

    b.   Baltimore City.
        o  Enforces State Air Quality Asbestos  regulations,  with enforcement actions
           taken through the  State.
        o  No local regulations or ordinances specifically address asbestos.
        o  Responds to citizen complaints.
        o  Office of Building Engineer issues demolition/renovation permits;   sites
           are not inspected  prior to issuing the permits.

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ASBESTOS
        o  Baltimore City Health Dept. receives job notices from M3. DFWH;
           if job is significant, City inspectors will monitor the work.
        o  Baltimore City Council Bill 925, Building Code Asbestos Removal, is
           being reviewed for conment;  it would require any structure certified
           free of asbestos before demolition removal or rehabilitation.

        Baltimore County.
        o  Enforces State Air Quality Asbestos regulations.  Enforcement actions
           for NESHAPs projects are taXen by the State DHMH;  enforcement actions
           for Non-NESHAP projects are taken under Baltimore County Code §13-18,
           Health Nuisances.
        o  No local regulations or ordinances specifically address asbestos.
        o  Responds to citizen complaints.
        o  Baltimore County Building Permit Applications (for renovation/razing of
           buildings erected before 1978) are reviewed by Baltimore County Health
           Department as part of the permit review system.  On-site inspection is
           required for all projects, to determine presence of asbestos.  Monitoring
           is performed from beginning of abatement work through to completion/
           reoccupancy, as well as transport and disposal of asbestos waste.
                                                             Inspections and
d.  Anne Arundel County.
    o  Enforces State Air Quality Asbestos regulations;
       enforcement actions are taken by State DHMH.
    o  No local regulations or ordinances specifically address asbestos.
    o  Responds to citizen complaints.
    o  Office of Inspections and Permits issues demolition/renovation permits.
       Sites are not inspected, prior to issuing the permit.
    o  Anne Arundel County receives job notices from M3. DHMH but does not
       routinely inspect these projects.

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CHLOROFORM Summary.
2/24/R7

1.  ffTAtiMEOT OF TOE PROBLEM;   Volatile oroanic compounds have been shown to
    transfer from water to air When heated or aerated.  This is continuous,
    leading to an enrichment of air at the point of use, and diffusion through the
    "House.  In water disinfected with chlorine, trihalomethanes are formed through
    chemical reaction.  tXiring household water use, e.g., showers and washing
    machines, chloroform is volatilized into the indoor air.

2.  EXPOSURE;  Fxposure to indoor airborne concentrations of chloroform can result
    from several sources, such as showers, baths,  dishwashers,  laundry machines,
    and humidifiers.  Airborne chloroform has also been masured at indoor swimming
    pools.

    the concentrations of volatilized chloroform found in indoor air are dependent
    on a number of factors,  including:

      o  frequency and duration of water appliance use
      o  pollutant volatilization rate
      o  home air volume and air recirculation rate
      o  air infiltration and exfiltration rate
      o  air mixing factor
      o  outdoor pollutant concentration
      o  volume of water use
      o  indoor temperature.

    A.  Inhalation from Various Types of Water Uses.

        Research has shown that the fraction of a VOC released  to the air is
        about the same as radon.  The research on radon volatilization has shown
        that *or laundry and dishwshing machines,  the transfer  efficiency can be
        as high as 90%.  Hie comparable figure for showers was  63%,  and for tub
        baths 43%.  Thus, the volatilization of chloroform would take place at
        these same transfer efficiencies.

        Using a single-compartment indoor air quality model and various assumptions
        (e.g.,  daily respiratory volume of 20 m^ and daily water intake from
        0.15L to 2L) exposure from the air route can be as significant as that from
        water ingestion.  It is shown that the relative uptakes ^rom the inhalation
        and ingestion routes point to the possibility of substantial air exposures
        of volatile organic compounds from water use in the home.

        1.  Inhalation from Showers and Tub Baths.  In one study utilizing a
            laboratory bath-shower system, volatilization of chloroform and
            trichloroethylene was found to be greater than 50%.  The air concentrations
            of chloroform were measured for both use of the shower and filling of
            the bath tub, with concentrations during showering  found to be higher.

        ?.  Inhalation from Humidification of the Building.  Humidifiers add
            moisture to interior air From the drinking water supply.  Moisture is
            added by evaporation of water, or disspelling aerosols,  either directly
            into the "home or into furnace duct systems tJiat provide air to the
            home interior.  Chloroform in the water supply is likely to approach
            100% release into the indoor air because of its high volatility.

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CHLOROFOM                                                              -2-

            Exposure to chloroform via home humidifiers is relatively small.
            Using a chloroform concentration of 60 ppb (worst case scenario for
            Baltimore) and several assumptions ("house air volume of ?0,000 cu.
            ft., air infiltration of 20,000 cfm/hr, and humidification rate of
            13 gals/day), the airborne chloroform levels would only be about 2  X
            10 -7 g/m3.

        3.  Inhalation from Indoor Swimming Fbols.  Indoor swimming pools and spas
            are a possible source of airborne chloroform exposure from the use of
            chlorine as a disinfectant in the pool water.

            Bromine is also used *br disinfection in some swimmina pools and spas.
            Therefore, inhalation of bromoform, another trihalomethane, is a
            possible question.

            Exposure depends on the chemical competitions between the bromine and
            chlorine reactions, which are based on a number of factors, including
            the amount o^ chlorine or bromine added to the pool water, the amount
            of chlorine already in the water, water temperature, room volume, air
            circulation, agitation of the water in spa hot tubs, etc.  Exposures,
            therefore, are difficult to characterize.

            One recent study measured chloroform and bromoform concentrations 2 cm
            above the water. surface at indoor swimming pools and spas.  The maximum
            measured concentrations were as follows:
            Pools, Chlorinated only
            Pools, Brominated only
            Pools, Chlorinated and Brominated
            Spas, Chlorinated only
            Spas, Brominated only
            Spas, Chlorinated and Brominated

    B.  Exposures in the Baltimore Study Area.
Chloroform (mg/m-*)  Bromoform (mg/m3)
      .900             .0001
      .013             .051
      .215             .054
      .699             .0001
      .102             .167
      .255             .142
        1.  R&ta Pertaining to the Baltimore Study Area.
                    population in Baltimore City and Baltimore County served by the
               Ashburton and Montebello Filtration Plants:  1,381,500 (100% of
               Baltimore City population and 90% of Baltimore County population.

            o  1980 population in Anne Arundel County served by Anne Arundel County
               public water system or Baltimore City water system:  209, 224
               (about 56% of total population).

            o  1980 population in the Baltimore Study Area potentially exposed to
               chloroform in indoor air:   1,590,724 (PP% of total population).

            Modelling of Potential Exposure in Baltimore Study Area.   Utilizing
            a simplified single compartment indoor air quality model, an estimate
            of the maximum indoor air concentrations resulting from volatilization
            of oroanic chemicals in water can he calculated.  Then, utilizing
            Baltimore Metropolitan data on chloroform in drinking water, the
            relative air and water exposures for a home in the Baltimore area can
            be determined.

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CHDOPOPOFM
                                                                     -3-
            Tfie model hone has the following characteristics:

              o  air volume is 450 nP
              o  air recirculation is 1350 m3/hr
              o  infiltration and exfiltration rates are 33« m^/hr
              o  typical water use is 30 L/hr (family of four)
              o  temperature indoors is 77 degrees P.

            Based on worst case Baltimore metropolitan treated drinking water THM
            •^ata from January 1984 to September 1985, a chloroform concentration
            in water of 60 ppb is used.

            Assuming the pollutant is continuously generated and 100% volatilized,
            the maximum indoor air concentration in the model home is calculated
            to be 0.001 ppm.

            Assuming a respiratory volume of 20 rtP/day for an adult male:

              Daily inhalation exposure = 0.10 ing/day.

            Assuming a daily total water intake" of 2 liters:

              Daily ingestion exposure .= 0.12 ing/day,

            or, assuring a daily tap-water intake of 0.15 liters:

              Daily ingestion exposure = 0.009 ing/day.

            This comparison is based on worst case numbers and a very specifically
            defined home.  The model does confirm, however, that inhalation
            exposure can be as significant as ingestion exposure.
3.  HEALTH Eb'WTTS.
    B.
    C.
Carcinogenicity.  Chloroform is considered to be a Probable Human Carcinogen
by EPA GAG and IARC.  Although it was evaluated by the ingestion route,
and not inhalation, it is believed that the carcinogenic response is not
dependent on the route of exposure to the body.  The main target organs
are the liver and kidney.

Non-Carcinogenic Effects.  Acute exposures to chloroform through inhalation
have demonstrated toxicity to the central nervous system, liver, kidney,
and heart.  Chronic inhalation studies revealed toxicity to the liver,
and kidney and possibly the central nervous system.

Teratogenic and Reproductive Effects.  No data for humans are available.
Inhalation animal tests showed chloroform to be a potential development
toxicant.  There is the potential of causing fetal development delays,
adverse effects in pregnancy maintenance, and lab animal terata.
    D.
Mutagenicity.  No definite conclusion can be reached.
mutagenicity is possible.
Studies show that

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CHLOROFORM

4.  COOTPQL TECHNIQUES AND TECHNOLOGIES.

    A.  Removal of trihalonBthanes by aeration or adsorption.

    B.  Removal of trfhalomethane precursors.

    C.  Use of Disinfectants other than free chlorine.
s.  CURRENT AND FUTURE ACTIVITY LEVEL.

    A.  EPA.

        The FPA Office of Drinking Water is writing criteria documents on
        Disinfectants, including TFMs.  The External Review Draft is expected
        by the end of FY 19P7?  the Final Draft is expected by the end of FY 1988.
        Draft Maximum Contaminant Levels Goal (MCLG) will then be developed,
        based on health effects.

        According to the 1986 amendments of the Safe Drinking Water Act,  Final
        MCLGs and MCLs will be published in the.Federal Register in 1989.

    B.  Baltimore TEAM Study.

        An FPA Total Exposure Assessment Methodology (TEAM) study will be conducted
        in 1987.  Chloroform levels will be measured by personal monitors, indoor
        and outdoor fixed site monitors, breath samples, and water samples.

    C.  Chloroform Monitoring at Swimming Pools.

        The Baltimore County Health Department has conducted a monitoring study at
        indoor swimming pools and spas for both chloroform and bromoform.  Results
        are found in the Appendices to the Chloroform Background Information Document.

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                                                                                 Appendix  #4a
                                             SECTION 1

                                         Toxicology
                                        Thomas J.  Haley, Ph.D.
                                    Honorary Professor of Pharmacology
                               University of Arkansas for the Medical Sciences
                                           Little Rock, Arkansas
            TOXICOLOGY DEFINED
Toxicology is the science of poisons, their effects on the
body, various antidotes for their action, and their detec-
tion  in body fluids and tissues. It  is considered a new
science, even though Hippocrates, the father of medicine,
advised his students on the toxic properties of the drug
Veratnun alba, and Paracelsus, in the sixteenth century,
pointed out that the difference between a therapeutic dose
and a toxic one was only a matter of quantity. The degree
of toxicity of chemicals is shown in the Hodge-Sterner
Table.
Exper. LDto;Dose
per Kilogram of
Body wt
<1.0 mg
1-50 mg
50-500 mg
0.5-5 gm
5-15 gm
>!5gm
Degree of
Toxicity
Dangerously toxic
Seriously toxic
Highly toxic
Moderately toxic
Slightly toxic
Extremely low
toxicity
Probable
Lethal Dose for
a 70 kg Man
A taste
A teaspoonrul
An ounce
A pint
A quart
More than a
quart
   Since all chemicals can be toxic, it is necessary to define
the conditions of an exposure as well as the amount of
chemical involved in an exposure to compare toxicities.
           TOXICITY RATING SYSTEM
 In Section 6, the following system of toxicity rating is
 used to indicate relative hazard:
                    U —unknown
  This rating covers chemicals for which insufficient data
 are available to enable a valid assessment of toxic hazard
 to be  made. Such chemicals usually are in one  of  the
 following categories:
   1. No information has been discovered in the literature,
     and none  is known to the authors.
   2. ijmitod informatioo from •i»»«"«i experiments is
     available,  but it is not possible to relate it to human
     exposure.  The data are mentioned  to indicate to the
     reader that fnjf««i experiments  have been done.
   3. The validity  of published toxicity data was ques-
     tioned by the authors.
             s   None = no toxicity   (0)

  This designation is for chemicals that fall into the fol-
lowing categories:
  1.  Chemicals  that produce no toxic effects under any
     conditions  of normal usage.
  2.  Chemicals that require overwhelming doses to pro-
     duce any toxic effects in humans.

                Low = slight toxicity   (1)

  1.  Acute local Chemicals that on a  single  exposure
     lasting seconds, minutes, or hours cause only slight
     effects on the skin  or mucous membranes or eyes,
     regardless  of the extent of exposure.
  2.  Acute systemic. Chemicals that can enter the body
     by inhalation, ingestion, or dermal contact and pro-
     duce only slight toxic effects, regardless of the dura-
     tion of exposure or following the ingestion of a single
     dose, regardless of the amount absorbed or the extent
     of the exposure.
  3. Chronic local Chemicals that on repeated or contin-
     uous exposure covering days, months, or years cause
     only slight and reversible damage to the skin  or
     mucous membranes. The extent of the exposure can
     be great or small.
  4. Chronic systemic.  Chemicals  that on repeated  or
     continuous exposure covering days, months, or years
     cause slight and usually reversible toxic effects  on
     the skin, mucous membranes, or eyes. The exposure
     can be by  ingestion, inhalation or skin contact and
     may be great or small. Slightly toxic chemicals pro-
     duce changes readily reversible once  the exposure
     ceases with or without medical intervention.
               Mod = moderate toxicity  (2)
   1
   Acute local Chemicals that on a single exposure
   lasting seconds, minutes, or hours produce moderate
   toxicity to the skin, mucous membranes, or eyes.
   The effects can be the result of an intense exposure
   for seconds or a moderate exposure for hours.
2.  Acute systemic. Chemicals mat after being absorbed
   by inhalation,  ingestion, or skin contact produce
   moderate toxicity after a single exposure lasting sec-
   onds, minutes, or hours or after the ingestion of a
   single dose.
3.  Chronic local CTt**nir?** Out on continuous or re-

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a  sicriofii
     petted exposure over days, months, or yean •
     moderate toxicity to the skin, mucous membranes,
     or eyes.
  4. Chronic systemic. Chemicals that on absorption by
     ingestion, inhalation, or skin contact cause moderate
     toxicity after continuous or repeated exposures over
     days, months, or years.

  Under the  moderate classification are chemicals that
can cause reversible or irreversible changes in the human
body not necessarily severe enough to cause serious physi-
cal  impairment or threaten life.

             High = severe toxicity   (3)
  1. Acute local  Chemicals  that on a single exposure
     covering seconds or  minutes can cause injury  to
     the skin, mucous membranes, or eyes of sufficient
     severity  to threaten life, cause permanent physical
     impairment or disfigurement.
  2. Acute systemic. Chemicals that after a single expo-
     sure by  inhalation, ingestion, or skin contact cause
     injury of sufficient severity to fhreaten life. The expo-
     sure may last seconds, minutes, or  hours  or  may
     be a single ingestion.
  3. Chronic local. Chemicals that on continuous or re-
     peated exposures covering days, months, or years
     can cause injury to the skin, mucous membranes,
     or eyes of sufficient .severity to threaten hie or pro-
     duce permanent impairment, disfigurement, or irre-
     versible  change.
  4. Chronic systemic. Chemicals that on continuous or
     repeated exposures by inhalation, ingestion, or der-
     mal contact to small  amounts for days, months, or
     years can produce death or serious physical impair-
     ment.

             TOXICTTY  AND HAZARD
Toxicity is defined as the  ability of a chemical to cause
injury once it reaches a susceptible site in or on the body.
Hazard is defined as the likelihood that a chemical will
cause injury  under circumstances of ordinary use.

                    EXPOSURES
 1.  Acute exposure, which  entails a short duration, means
exposure to chemicals absorbed by inhalation, dermally,
or  by ingestion with the duration of total exposure mea-
sured in seconds, minutes, or hours. As applied to inges-
tion it means a single dose.
   2. Subchronic exposure means  intermediate exposures
between acute and chronic and may be for up to 90 days.
   3. Chronic exposure means exposures of long duration
and as applied to dermal and inhalation covers prolonged
or  repeated  exposures with durations of days,  months,
or  years. With ingestion,  it means repeated doses of the
 chemical for days, months, or years.

                     EFFECTS
It is essential to differentiate between acute and chronic
effects of chemicals and  acute and chronic exposures.
Chronic toxicity mint be related to chrome illness pro.
duced by exposure to chemicals regardless of the duration
of such exposure; even an acute exposure may produce
a chronic illness, i.e., heavy metals and carcinogens. Re-
peated exposure to such chemicals accentuate chronic
illness. On the other hand, exposure to cyanides or sulfides
does not produce  chronic illness but instead produces
acute poisoning and death.
  Toxic effects may be local or systemic, depending on
the area exposed. Local exposure affects the nose, eyes,
mouth, throat, skin, and various parts of the respiratory
and gastrointestinal tracts; absorption does not have to
occur.  With chronic exposure,  however, absorption does
occur,  and the site of damage may  be remote from  the
site of contact. In many cases both local and systemic
damage occurs.


                     DOSAGE
Dosage is  the most  important factor  in  determining
whether a given chemical will produce a toxic effect. There
is a large variation in the toxicity of chemicals, and even
water can cause illness under certain circumstances. For
comparisons of the toxicities of different chemicals,  the
median lethal dose (LOW) is usually used as the yardstick
and is stated as weight of poison per unit body weight
or surface  area. The median  lethal  dose is a statistical
estimate of the amount of .chemical required to kill 50%
of a given population of test  animals. It is useful also
to make a comparison of the susceptibility of various
animal species regardless of size. To be  meaningful,  the
LDM must  specify  the experimental  conditions, route of
administration, species, age, sex.  number of doses, and
the time of the measurement  in  days or weeks. Other
factors may include the route of exposure, i.e., ingestion,
inhalation, or dermal; type of formulation, temperature,
humidity, barometric pressure, physiologic state of the
subject, and the possible interaction between two or more
administered chemicals. This last  factor requires knowl-
edge of body  enzymes that may be stimulated or  de-
pressed, which then causes rapid or delayed elimination
of a given chemical.


                  TOXIC LEVELS
Everyone  is interested in the  highest  level of exposure
to toxic chemicals at which no  deleterious effect is noted.
The American Conference of Governmental  Industrial
Hygienists (ACGIH) has set such levels for human expo-
sure in industry. They are called Threshold Limit Values
(TLV's) and formerly were known as Maximum Allowa-
ble Concentrations (MAC's).  As new information  be-
comes available, they may be  revised  upward or down-
ward,  and  as soon as the information  becomes available
other compounds are added to.the list. The TLV's refer
to air  concentrations of a given  chemical to which an
individual can be repeatedly exposed for 8 hours per day,
5 days per week. Because some individuals can experience
hypersensitivity even at the TLV level, all workers should
be pre-employment tested. Because  the TLV's are time-

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 Justification for the Pollutant Rating Scores.
 FORMALDEHYDE:
Appendix I4b
     12/2/86
 1.   Population Potentially Exposed;   3   (50,001 - 250,000 population).
     Population potentially exposed to formaldehyde in new hones = 11,600 hares (1985)
     X 2.8 people/household = 32,480 people?
     Mobile homes = 5,300 hones X 2.8  people/household = 14,840 people;
     Total =  32,480 + 14,840 = 47,320  people.

     Added to this  figure are those people  in older homes potentially exposed to new .
     formaldehyde-containing products.  This would push the population over into
     Category 3, at a minimum.

 2.   Health Effects;   2.5
     GAG Group Bl Probable  Human  Carcinogen with other toxic effects.
     Some  controversy on carcinogenicity  (EPA Study/ National Cancer Institute -
     Formaldehyde Institute Study).

 3.   Public Concern*;  1  LOW.

 4.   Agency/Org. Perception of Health Threat*;  1  LOW.

 5.   Current  Activity Level;  2   MEDIUM - Federal regulatory and research activities;
                     national monitoring studies;  formaldehyde industry activities;
                      little local activities (local inspections upon complaint).
ASBESTOS;

1.  Population Potentially Exposed;  4  (250,001 - 1,000,000 population)
    At a minimum, school children potentially exposed:
     (1980)  Age 5 - 19;  Baltijnore City -   190,500
                          Baltimore County =  95,900
                          Anne Arundel Co. = 147,300
                                             433,700
    These population figures are in Category 4, + children not exposed and other
    sources of exposure (residential).

2.  Health Effects;  3 -   CAG Group A Known Carcinogen-

3.  Public Concern*:  3  HIGH.

4.  Agency/Org. Perception of Health Threat*;  3  HIGH.

5.  Current Activity Level;-  3  HIGH  - Nfcny federal, state, and local activities.
*  Rankings for Categories (3) Public Concern and (4) Agency/Org. Perception of
   Health Threat  were based on the experience and professional judgement of the
   IAP Workgroup members.

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                                JUSTIFICATION  -2-
COMBUSTION PRODUCTS t

1.  Population Potentially Exposed;  5   (>1,000,000 population)
    70% of population have gas fired range = 458/624  X 2.8 people/household =
    1,284,147.   Population  > 1,000,000  =  Category 5.

2.  Health Effects;  2
    A number of caipounds are involvedr  largely based on N02 effects (adverse
    effects at low concentrations) as well as other pollutants.  Discount effects
    of PAHs as they are a minor part of  the Combustion Products.

3.  Public Concern*;  1  LOW.

4.  Agency/Org. Perception of Health Threat*;  2  MEDIUM.

5.  Current Activity Level;  2  MEDIUM -  Some Federal surveys, studies;  seme local
    restrictions (e.g.,Baltimore City has restriction on unvented space heaters).
                              ***********
VOLATILE ORGANIC COMPOUNDS (VOCs);

1.  Population Potentially Exposed;  5  (>1,000,000 population)
    The average home contains some 45 aerosol containers, each of which tray
    contain 15 VOCs.  Considering the number of products on the market, the
    workgroup came to the concensus that a large portion of the population was
    potentially exposed.

2.  Health Effects;  1
    Sane toxic effects at lower concentrations.  Primarily irritant effects,
    exacerbating pre-existing diseases.  Discounted carcinongens because there
    are few in the whole group of VOCs.

3.  Public Concern*;  1  LOW.

4.  Agency/Org. Perception of Health Threat*;  2  MEDIUM.

5.  Current Activity Level;  1  LOW - A few Federal regulatory and research activities?
    little local activities.
*  Rankings for Categories (3) Public Concern and (4) Agency/Org. Perception of
   Health Threat  were based on the experience and professional judgement of the
   IAP Workgroup members. .                 .   - ""

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                                JUSTIFICATION -3-
RADCN;

!•  Population Potentially Exposed:  4  (250,001 - 1,000,000 population).
    Limited data are available from Baltimore Study Area.  12 out of 18 samples
    had levels >_ 4 pCi/1.  12.5% of hones in U.S. contain significant amounts
    of radon.

    492,000 hones X .125 » 61,875 hones  X 2.8 people/household - 173,250 people.

    Group felt that this was low due to geological structures found in the
    Baltimore area (ex:  Baltimore Gneiss etc.).  Therefore, the workgroup came
    to a concensus to place this in Category 4.

2.  Health Effects;  3 - Known Carcinogen, lung cancer. (IARC)

3.  Public Concern*;  3  HIGH.

4.  Agency/Organization Perception of Health Threat*;  3  HIGH.

5.  Current Activity Level;  2  MEDIUM - Seme federal research and information
    development/public education activity; little local activity.

PASSIVE SMOKING:

1.  Population Potentially Exposed;  5  (>1,000,000 population)
    Estimate of nonsmokers = 1,296,700;  See Matrix sumaries for calculations.

2.  Health Effects;  2.5 - Potential Carcinogen - lung cancer.  {1937 Surgeon
                                                                General's Report)
3.  Public Concern*;  2  MEDIUM.

4.  Agency/Organization Perception of Health Threat*;  2  MEDIUM.

5.  Current Activity Level;  2  MEDIUM - Some Federal, private business, and
    other organizational activities;  most local restrictions are for safety-
    purposes.  More activity could be done on local basis.
*  Rankings for Categories (3) PubTic*Concern and (4) Agency/Org. Perception of
   Health Threat  were based on the experience and professional judgement of the
   IAP Workgroup members.

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                                 JUSTIFICATION
CHLORDANE:

1.  Population Potentially Exposed;  3  {50,001 - 250,000 population)
    From commercial applicator use, about 106,260 people are potentially exposed.
    (See Summary sheets for calculations.)  Homeowner and nonconmercial applicator
    use will increase the potential population number but will not push the number
    into the next Category.

2.  Health Effects;  2.5 - CAG Group B2 Probable Human Carcinogen (inadequate human
    evidence, sufficient animal evidence);  IARC Group 3 Not a Carcinogen (inadequate
    human evidence, limited animal evidence).

3.  Public Concern*;  1  LOW.

4.  Agency/Organization Perception of Health Threat*;  1  LOW.

5.  Current Activity Level;  1  LOW - Most of activity is Federal/Maryland State
'ity
dnii
    pesticide training of certified applicators required for all pesticides.
                             ************

CHLOROFOBM;

!•  Population Potentially Exposed;  5  (>1,000,000 population)
    1980 Population served by a public water system in the Baltimore Study Area =
    1,591,000  (88%).

2.  Health Effects;  2.5 - CAG Group B2 Probable Human Carcinogen (inadequate human
    evidence, sufficient animal evidence);  IARC Group 2B Probable Human Carcinogen
    (inadequate human evidence, sufficient animal evidence).

3.  Public Concern*;  1  LOW.

4.  Agency/Organization Perception of Health Threat*:  1  LOW.

5.  Current Activity Level;  1  LOW  - EPA is developing chloroform MCL (Maximum
    Contaminant Level);  Baltimore TEAM Study;  Baltimore monitoring for chloroform
    and brcmqform at a few pools/spas.
*  Rankings for Categories (3) Public Concern and (4) Agency/Org,. „Perception of
   Health Threat  were based on the experience and professional" judgement of the
   LAP Workgroup members.

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Passive Sacking;  Justification for Ratings of

  1.  Public Education.
                                                                   Appendix I5a
                                                                      2/6/87
      a.  Cost - HIGH.  A considerable amount of effort and resources would be
          required by government and/or nongovernment agencies.

      b.  Time^rame - SHORT/COMTNUOUS.  Fstablishing a public education program
          could be done in less than 2 years.  After it is established, it would
          be an ongoing program.

      c.  Legal Considerations - Minimal.  To establish a public education program
          would not require any legal effort.

      d.  Acceptability - HIGH.  Majority of people in Maryland are nonsrookers
          (71%).  See the Passive Smoking Background Document.

      e.  Political Sensitivity - LOW.  Little or no political implications.

      f.  Other Considerations - Agencies must be able and available to respond to
          inquiries.

  2.  Smoking Policies in Government and Nongovernment Buildings.
      a^Cost -ICW.Would require little or no expenditure of resources.

      b.  Timeframe -  SHORT.  Once the jurisdiction has committed to smoking
          policies,  the policies can be established and implemented very quickly
          (e.g., Executive Order).

      c.  Legal Considerations -  MEDIUM.  May involve union contract negotiations.

      d.  Acceptability -  HIGH. Majority of people in Maryland are nonsmckers.
          See the Passive Smoking Background Document for smoking policies presently
          in place in government agencies.

      e.  Political Sensitivity -  LOW.   Little or no political sensitivity.

      f.  Other Considerations -  Expect a vocal minority to object to smoking
          policies.
      Increased Qif<
	nent of Building Codes and Standards/Existing Smoking
Regulations.
a.  Cost -  HIGH.  Agencies must dedicate increased numbers of personnel
    to raise level of enforcement.

"h.  Tameframe - SHORT/COWTINUCUS.  The enforcement program is an established
    program.  To increase the level of effort within that enforcement program
    could be done in less than 2 years.  Once the increased level of enforcement
    was in place, this would be an ongoing effort.

c.  Legal Considerations - Minimal.  This would involve enforcing existing
    regulations.

d.  Acceptability -  HIGH.  Majority of people in Maryland are nonsmokers.
    See Passive Smoking Background Document for description of existing
    snoking regulations.

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                                                                Passive Smoking -2-
        Political Sensitivity -
        budget requirements.
                             MEDIUM.  Moderately sensitive issue due to increased
4.
^.  Other Considerations -  Expect a vocal minority concerning the passive
    smoking issue.

Passage of New State or Local Laws on Smoking Restrictions.
a.  Cost - HIGH.  Long-term effort to overcome political and legal
    considerations could be expected to lead to significant costs.

H.  Time^rarne - LONS.  Efforts in the last 5 years have been unsuccessful
    and met with considerable resistance and opposition.  Gaining and
    generating support for passage will likely take many more years.
    Approach is being changed to generate efforts on a local level (rather
    than on the state level).

c.  Legal Considerations -  HIGH.  Requires new legislation on state or local level.
    d.
    e.
    f.
    Acceptability -  HIGH.  Majority of people in Maryland are nonsmdkers
    (71%).  See the Passive Shaking Background Document for a description of
    present restrictions/prohibitions in public places.

    Political Sensitivity -  HIGH.  Very sensitive issue due to opposition
    from strong tobacco lobby in Maryland.

    Other Considerations -  Difficult enforcement of restrictions;  expect a
    vocal minority.
5.
Smoking Cessation  (Clinics, Self-Help Sessions, etc.).
a.  Cost -  LOW.  A low cost to organizations to sponsor cessation activities
    due to their commitments to weilness programs.  TTie cost to individuals
    ranges from $35 - $450/person.  Employee may lose some working hours if
    he/she goes to the clinic during working hours; however, ultimately
    employee absenteeism and sicktime would decrease, thus further reducing
    the cost.

    For the American Lung Association population, it has been shown that
    57% of people are able to stop smdking at the end of a smdking clinic;
    one year after a smdking clinic, 36% of people have stopped smoking.

b.  Timeframe -  SHOOT.  Most of the sessions to quit smoking are short-term.
    Cessation clinics oenerally run 5-7 weeks.  Hypnosis may consist of
    1-3 sessions.  Employee turnover would ultimately make this a continuous
    c.  Legal Considerations - Minimal.

    d.  Acceptability -  HIGH.  Majority of people in Maryland are nonsnckers.
        In addition, smokers (who would like to quit) would be favorable of this
        program.

    e.  Political Sensitivity - LOW.  No political implications.

    f.  Other Considerations -

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                                                               Passive Stacking  -3-

6.  Health Insurance to Cover Cessation Methods  (Clinicsi Self-Help Sessions, etc.)
    a.  Oast -  MEDIUM.   Costs would be increased for agencies/companies with SORB
        slight increase for individuals.  Some Jnsvirance companies do provide
        discounts to individuals  (that do not strike) and ccnpanies (with smoking
        policies in place).

    b.  Timeframe -  MEDIUM.  Timeframe is difficult to estinate, but could take
        2-5 years to establish (if not longer).

    c.  Legal Considerations  - Minimal.

    *.  Acceptability -   MEDIUM.  This option would be very acceptable
        if the employer bears the full cost;  it would be less aceptable if costs
        were scared by employer/employee.

    e.  Political Sensitivity -  MEDIUM.  Government agencies that implement this
        program would require increased budget for their agencies.

    f.  Other Considerations  -  In the event, that insurance companies would not
        cover cessation methods voluntarily, legislation would be necessary to
        mandate coverage by the insurance company.

7.  Increased Excise Tax to Support Smoking Cessation Activities'.
    a.  Cost -  LCW.  Majority of population in Maryland are nonsmokers and would
        be unaffected by the tax.  This program would require minimal effort
        and  resources by government agencies and other organizations.

    b.  Timeframe - MEDIUM.  This "program-could he done in 3 - 5 years.

    c.  Legal Considerations - HIGH.  This effort would require new legislation.

    d.  Acceptability -  HIGH.  Majority "of people in Maryland are nonsmokers.

    e.  Political Sensitivity - HIGH.   Raising taxes is a highly sensitive issue.

    f.  Other Considerations •>- More effective with young people.  See the Passive
        Smoking Background Document, Section III.C. for a discussion of Excise Tax
        effects.

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         Radon;   Justification for Ratings of Potential Programs.        Appendix #5b
                                                                          2/11/87
1.  Public Education.

    a.  Cost -  HIGH.  Considerable amount of effort and resources would be
        required by government and/or nongovernment agencies.

    b.  Timeframe -  SHOOT/CONTINUOUS.  To establish a public education program
        would take less than  2 years.  After the program has been established,
        it would be an ongoing program.

    c.  Legal Considerations  - Minimal.

    d.  Acceptability -  HIGH.  The entire Maryland population may be potentially
        exposed.

    e.  Political Sensitivity -  LOW.  Little or no political implications.

    f.  Other Considerations  -  Education would include both awareness of potential
        problem and mitigation where problems are found.  It would also require
        agencies to respond to inquiries.

2.  Education of Elected and Government Officials.

    a.  Cost - LOW.  Training/seminars are not expensive, less than $100/person.

    b.  Timeframe -  SHORT.  Time needed for training would <2 years,  Many current
        seminars are available.  See the Radon Background Information Document for
        activities available.

    c.  Legal Considerations - Minimal.

    d.  Acceptability -  HIGH.  Acceptable by all groups.

    e.  Political Sensitivity -  LOW.  No political implications.

    f.  Other Considerations -  Educating elected and government officials may
        result in resource support of studies,  surveys,  and/or public education.

3.  state or LocalFunded Survey of Homes.

    a.  Cost - HIGH.   Statewide survey could cost between $750,000 - $1,000,000.
        Local survey would cost less.

    b.  Timeframe - MEDIUM.  Survey would take 2-3 years.

    c.  Legal Considerations - Minimal.

    d.  Acceptability -  HIGH.  Majority of popultion would be very interested  in
        the results;   participation would be voluntary.

    e.  Political Sensitivity -  LOW.  No political implications.

    f.  Other Considerations -  Must obtain cooperative  release of test results
        from citizens and deal with the issue of confidentiality of the data.

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                                                                       Radon  -2-
4.  State or Local Funded Testing in Schools.
    a.  Oost -  MEDIUM.  Agencies most ocmiat time and resources to establish
        and run the program.

    b.  Timeframe -  SHORT.  Survey would take <2 years.

    c.  Legal Considerations - Minimal.  Public done in.

    d.  Acceptability -  HIGH.  Constituencies would be interested in the results
        because of the health implications to children.

    e.  Political Sensitivity -  MEDIUM.  This could be a potentially sensitive
        issue, if a problem is found in the schools, because people will want
        the government to mitigate the problem (which takes money, etc.).
        This issue is similar to the asbestos issue (asbestos in schools).

    f.  other Considerations -

5.  Free Radon Testing for Citizens.	
    a~iCost -  HIGH.  Testing devices, analyses, etc. would be costly.  The cost
        would range from $25 - $50/house, depending on the number and type of
        monitors.

    b.  Timeframe -  SHORT.  Once the resurces are committed, implementation of
        the program would take <2 years.  Program would then be ongoing.

    c.   Legal Considerations - Minimal,  Given that this would be a voluntary
        program,  a release or cooperative agreement would be needed.   May
        still have liability for inaccurate results.

    d.   Acceptability -  HIGH.  This would be a 'no cost service1.

    e.   Political Sensitivity    LOW.   There are very little implications when
        providing free testing for citizens (voluntary).

    f.   Other Considerations -  Confidentiality of data issue; agencies must be
        prepared to follow up testing with information and advice on mitigation.
        Infrastructure must be in place for agencies/organizations to be responsive
        to problem houses quickly so that demand and public reaction do not build
        up to cause panic.

6.  Epidemiological Study.
    a.   Cost - HIGH,  this would require a great deal of effort and resources.

    b.   Timeframe -  LONG.  3+ years.

    c.   Legal Considerations - Minimal.

    d.   Acceptability -  HIGH.  Majority of people would be interested in the
        results.

    e.   Political Sensitivity -  LOW.   No political implications. Some people
        may question spending this large amount of money for limited usefulness.

    f.   Other Considerations -  An epidemiological study would indicate the extent
        of adverse health effects from radon in the area.

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