EFFECTS OF OXIDANT LEVELS ON SELECTED HEALTH
CHARACTERISTICS OF PERSONS IN THE LOS ANGELES BASIN
FIRST ANNUAL REPORT
VOLUME I: DATA COLLECTION
Prepared for the
Coordinating Research Council Environmental Protection Agency
Thirty Rockefeller Plaza Research Triangle Park
New York, New York 10020 North Carolina 27711
under Contract No. CAPM-11-71 under Contract No. 68-02-0349
By
Copley International Corporation
7817 Herschel Avenue
La Jolla, California 92037
April 7, 1973
-------
EFFECTS OF OXIDANT LEVELS ON SELECTED HEALTH
CHARACTERISTICS OF PERSONS IN THE LOS ANGELES BASIN
FIRST ANNUAL REPORT
VOLUME I: DATA COLLECTION
Prepared for the
Coordinating Research Council
Thirty Rockefeller Plaza
New York, New York 10020
under Contract No. CAPM-11-71
Environmental Protection Agency
Research Triangle Park
North Carolina 27711
under Contract No. 68-02-0349
By
Copley International Corporation
7817 Herschel Avenue
Lajolla, California 92037
April 7, 1973
-------
ACKNOWLEDGMENTS
Copley International Corporation gratefully acknowledges the cooperation
of many private citizens of the Los Angeles Basin who gave generously of their
time by participating in the studies described in this report. Without their whole-
hearted cooperation, this report would not have been possible.
Copley International Corporation is grateful to Dr. C. Ray Thompson of
the University of California, Riverside, for the air monitoring facilities descrip-
tions and for other information that he and his staff provided in connection with
the performance of the CHESS studies .
Copley International Corporation is especially grateful to Dr. Robert C.
Chapman of the Environmental Protection Agency for his counsel and assistance
in the conduct of the study.
The work upon which this report is based was performed pursuant to
Contract No. CAPM-11-71 with the Coordinating Research Council and Contract
No. 68-02-0349 with the Environmental Protection Agency.
CONTRIBUTIONS
The overall responsibility of this study was undertaken by Mr. R. David
Flesh, Director, Environmental Economics, Copley International Corporation.
Others who contributed to this report included: Mmes. Marian O. Doscher,
Senior Industrial Economist; Elizabeth M. Roberts, Industrial Economist; and
Linda E. Hanson and Victoria A. Jones, Manuscript Typists.
-i-
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TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS AND CONTRIBUTIONS i
LIST OF TABLES iii
LIST OF FIGURES iv
INTRODUCTION. . 1
OUTLINE OF THE STUDIES 2
Studies Already Undertaken 2
Studies to be Undertaken Soon 7
STUDY LOCATIONS 7
HEALTH DATA COLLECTION UNDERTAKEN 10
Preliminary Tasks 10
Study I - Chronic Respiratory Disease (CRD) 10
Study III - Acute Respiratory Disease (ARD) 15
Study IV - Pulmonary Function in Children (PFT) 17
Study VII - Symptom Variation in Asthmatics 21
AIR MONITORING FACILITIES 26
Equipment 26
Operation 27
CONCLUDING COMMENTS 27
APPENDIX
-11-
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LIST OF TABLES
Table Page
1
2
3
4
5
6
7
8
9
10
11
Kev population characteristics of the study locations
Numbers of School and Family Health Questionnaires
distributed and corresponding response rates
Number of interviews completed by decision of family
Numbers of families who agreed to participate by priority
Number of ARD families chosen to participate, by group ....
Numbers of children tested during the first round of PFT ....
Numbers of children tested during the second round of PFT. . .
Numbers of children tested during the third round of PFT. . . .
Number of asthmatics identified from those who completed
and returned the School and Family Health Questionnaires . . .
Number of interviews completed by decision of candidate ....
Comparison of interview methods used in recruiting
asthmatics
8
14
15
16
17
18
21
21
23
23
24
12 Numbers of asthmatics chosen as panelists and the numbers
of panelists remaining after 19 weeks of participation 25
-111-
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LIST OF FIGURES
Figure
la Schedule of tasks performed - 1972 3
Ib Schedule of tasks performed - 1973 5
2 Los Angeles metropolitan area - urban portion (map) 9
3 Covina 11
4 Garden Grove 12
5 Thousand Oaks 13
6 Sample pulmonary function test report 19
7 Sample pulmonary function test team quality check sheet .... 20
8 Photograph of child participating in pulmonary function test. . . 22
9 Air monitoring shelter 28
10 Particulate sampling devices 29
11 Interior view of shelter 30
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EFFECTS OF OXIDANT LEVELS ON SELECTED HEALTH
CHARACTERISTICS OF PERSONS IN THE LOS ANGELES BASIN
FIRST ANNUAL REPORT
VOLUME I: DATA COLLECTION
INTRODUCTION
In March 1972, Copley International Corporation was awarded contracts
by the Coordinating Research Council (CAPM-11-71 (1-71)) and the Environmental
Protection Agency (68-02-0349) to participate in a coordinated series of epidemio-
logic studies planned for the Los Angeles Basin. These studies form a part of the
Community Health and Environmental Surveillance System (CHESS) program being
conducted in several various sized metropolitan areas across the nation. They
are designed to be performed under standardized procedures to measure simul-
taneously sensitive health and environmental quality indicators in sets of commu-
nities representing exposure gradients to common air pollutants such as oxidants.
The purpose of these studies, and of the CHESS program as a whole, is to permit
an evaluation of existing environmental standards and, in light of new health intel-
ligence obtained, to develop new standards and improved understanding of the
effects of air pollutants on human health.
CIC's primary responsibility under the awarded contracts is to measure
selected health characteristics of persons residing in three communities of the
Los Angeles Basin. Simultaneous measurements of ambient air characteristics
in the same communities is the responsibility of the Statewide Air Pollution
Research Center, University of California, Riverside, under a separate contract
with the Environmental Protection Agency. Additional CIC responsibilities in-
clude critiques of the data collection and analysis procedures designed by the
EPA for the performance of the CHESS studies and of the Federal Intramural
Technical Reports in which the subsequent data analysis performed by the EPA
is described.
This volume covers the progress achieved by CIC in performing its pro-
ject responsibilities during the first contract year. It is divided into five sections:
an outline of the studies already undertaken and those to be undertaken, a descrip-
tion of the study locations, the details of data collection surrounding the studies
already undertaken, a description of the supporting air monitoring facilities, and
concluding comments . Volume II, to be published at a later date, describes the
subsequent data analysis performed by the EPA.
-1-
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OUTLINE OF THE STUDIES
CIC participated in four separate studies during the first year of the awarded
contracts and will participate in three additional studies during the second contract
year. Brief descriptions of the studies, along with statements of the hypotheses to
be tested, are given in the following subsections.
The study numbers were assigned by CIC in connection with the preparation
of a project work plan and time schedule, the latter of which is reproduced below
(Figure 1).
Studies Already Undertaken
Study I - Prevalence of Chronic Respiratory Disease (CRD).
Description: Development of information using School and
Family Health Questionnaires.
Hypothesis: People living in high pollution communities
experience greater prevalence of chronic
respiratory disease than those living in low
pollution communities.
Study III - Incidence of Acute Respiratory Disease (ARD).
Description: Development of information through biweekly
telephone interviews with 275 families per
community.
Hypothesis: Families living in high pollution communities
experience greater incidence of acute respira-
tory disease than those living in low pollution
communities.
Study IV - Pulmonary Function in Children (PFT).
Description: Use of FEVg 75 as indicator measure.
Hypothesis: Children living in high pollution communities
have poorer ventilatory performance than
children living in low pollution communities.
Study VII - Symptom Variation in Asthmatics.
Description: Development of information through comple-
tion of diaries by 75 asthmatics per community.
-2-
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Figure la.
1972
The Effects of Oxidant Levels on Selected Health Characteristics
of Persons in the Los Angeles Basin Area
Schedule of Tasks Performed
Copley International Corporation
JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY
I Study I - Chronic Respiratory Disease Uli 4 • • • • • ::: ' " : ':f:Tfii;::;;;:; .: : H { j : : F i+ : : j [ T • F : : : g
A. Select Schools : j . : j: :::.:::::• :- f: gj .: ] - •• [ • [3
f B. Obtain School Permission - j - - ••• H-- rfEif tt ff tl ' : : ' j: $5 f +
C. Prepare Indexes ana ijupii Lasts • • t ..... 1. .,•.... JTJ4 jj; [ - • [••••[••[]-- • ft iff ' I
D. Prepare Questionnaires and Letters t ; :: j:.:: :' . ra +F 1 " ' ' ' '^ f T "" S ^ ' f
E. Distribute Questionnaires : u ::t:::Hi . • • m .:: :. f i j- j i" j- 'F
inn , MM. mm- m Mli ' "HWmnTM \\l\\W\ \\ ' fntP* M miMIM ttt
H. Edit and Correct Questionnaires : f :: : "JSS: " " ' ^ J ' " "
Study LI - Lower Respiratory Disease if' ' I" ' " [Sffirir r .-.. t f t tt
! I i 1 1 1 1 H ! M ! 1 ! | i ! M M 1 1 1-H-H'l-IH+i+H-hH-H- U ' H 1 1 1 II 1 1 H it t t . ttj .iit| i || .il|-Liitj|Ll.I.|I.[:||. . j: . i J±t+ . T i r j H . ...ft
i::::i:.::| 1 ' : ":i" : : 1 1 :!:il.:i!!!! -H t-hj:T- • fc- •• rf'-rnr •mrrr+rcmmTmy:' -a-nnj TOTWf ITT TFT TIT
j A. Draw Sample : :: : ' ' ' ' '
iiiiiinniminnniiiliiiiiiTTTTTiiiiiiiiiliiiilili[liiilll!l_ | || [1 Lists of names from which Study II samples will be drawn were (
^iiiiiiiiiiiiiii^'iiMiiiiiMiiiiiMiiiiiiiiniiiiiin inf In i rrn^ ^ot^ °t L^e LRD activities are scheduled to be performed during
C. Send Forms to EPA " ' f ' I 1 '1 11 1LLLU ' JLI +H
-44+ HiMIIMMIIMillllMMIHilllllilliilillllllllllllll --• •••]•• r t T • F F -i • ^^ i 'f!
A , Draw Sample ••riii m : : : 5 ' : i
ttrr 7-H-H-i-i-iTHHl ', ! i 1 1 i 1 Mi M 1 1 1 1 i 1 1 H -Mr+f +H+ +H- +HH+ - •• | IT r |'" ff ' i" ' " f TTTT I I ' M ' 1' f
ii i'iri:':i i!MiM!:iit!iiiii'i -f+fH- M;iMi.MMMi u L pj J-1.J-J -1-4 J—uij-j — Ln~i — ' r H i i T i "n I ' M n rr r r hr "*i r
— -:':i:ii!|..:: ||li|llilll;:ilillll| !IHI [Ill • R - ffi H •- ; ; ; JF" J •;
|fH- !'MIMH-|-H'(i IIMII'lilllllllliiiMllill T+F+H-4W f • ^ • • TT ••• • • [• F'Fff'l ' ' F fl H ^ t
;:Mi!iiiiM!iiiii: ^iiiiinnniiHiHi -H--H-+ IMMI +H ! ^ •• ' ] r i T' ' I L 1 ll 1 1 ' [ i — T"l
iini iiMi.MiiiiHiiuinntinntM'-M-'H'lniMiiiiliinHM •• [ i mrc " ' ' 1" f L" F ' ' ' '^ht 11 4 f
JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY
AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER
^^B^^^^qfflfg^^^^M^P^^^g^^^^ffl
frtttff • n'wTfWffiT rift w TPTrT'TT4H-:-,TiTTi fK Wffflfll TF T ' Iff : t T ffll iitl ffw :
; itf fflf ; if- - - - J - - H n
obtained during Study I. ;fFTi*l: :| 3 : : I::|f:EH
the second contract year . ij ffi cMi' ° ff -r- ' ° J" nr- fe[ : fl H t? T '
[.:::. f :::if:::^ijlli:. S.| S I : : : :: ; ; ;• ; | :
• gi)jiiS^^^-j;|; :;; ; :::::.: | :
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t H B !£:. : i !!{:•!:, :: :: I : : : 4 Si
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1st IllliliPnil 1 ; MMliJilliMill i
B 1O ID ZO 25 B 1O IS 2O 23 B IO 18 ZO ZB S 1O IB ZO 2O B IO IB 2O 29
AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER
-------
Figure la. (continued)
1972
The Effects of Oxidant Levels on Selected Health Characteristics
of Persons in the Los Angeles Basin Area
Schedule of Tasks Performed
Copley International Corporation
JANUARY
SEPTEMBER
OCTOBER
NOVEMBER
Study IV - Pulmonary Function Survey
C. Select and Train Testing Teams
b/lb/73
i/30/73
JANUARY
FEBRUARY
SEPTEMBER
NOVEMBER
DECEMBER
-------
Figure lb.
1973
The Effects of Oxidant Levels on Selected Health Characteristics
of Persons in the Los Angeles Basin Area
Schedule of Tasks to be Performed
TASKS TO BE PERFORMED
SEPTEMBER
Copley International Corporation
OCTOBER NOVEMBER DECEMBER
Study II - Lower Respiratory Disease
Part 1 - Validate Medical Records
A. Draw Sample
B . Copy Medical Records
C. Send Forms to EPA
Part^2 - Diagnosis Customs
A. Draw Sample
B . Obtain AMA Cooperation
C. Mail Questionnaire
D. Reminder Mailing
I
B. Personal Follow-Up
F. Send Responses to EPA
Study in - Acute Respiratory Disease
A. Identify Potential Panelists
B . Map Household Locations
C. EPA Selects Families for Interview
D. Conduct Interviews
E . EPA Selects ARD Families
F. Conduct Bi-Weekly Surveys
G . Edit Interview Surveys
H. Send Forms to EPA
Study IV - Pulmonary Function Surveys
A. Obtain School Permission
B . Notify Parents of P. F . Test
C. Select and Train Testing Teams
D. Prepare Class Lists
E. Conduct Tests
F. Edit Test Forms
G. Send Forms to EPA
SEPTEMBER
NOVEMBER
DECEMBER
-------
Figure Ib. (continued)!
1973
The Effects of Oxidant Levels on Selected Health Characteristics
of Persons in the Los Angeles Basin Area
Schedule of Tasks to be Performed
Copley International Corporation
TASKS TO BE PERFORMED
SEPTEMBER OCTOBER NOVEMBER DECEMBER
. Request ARD Family Cooperation/
Mall Instructions
3/6/74-
AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER
-------
Hypothesis: Susceptible subjects living in high pollution
communities experience greater incidence
or more severe asthma attacks than those
living in low pollution communities .
Studies to be Undertaken Soon
Study II - Prevalence of Lower Respiratory Disease (LRD).
Description: Validation of information obtained from
School and Family Health Questionnaires
by reference to medical records and deter-
mination of diagnostic customs.
Hypothesis: Air pollution is a contributory cause of in-
creased incidence or severity of pneumonia,
croup, bronchitis, and other deep chest
infections among children.
Study V - Incidence of Irritative Symptoms During Acute Episodes.
Description: Development of information through coordi-
nated telephone interviews with ARD families,
Hypothesis: There is a significant increase in irritative
symptoms during elevations of air pollution
levels.
Study VI - Pollutant Burden of Trace Metals.
Description: Collection of hair, tap water, and household
dust from ARD families. Collection of 25
maternal-fetal sets per CHESS community.
Hypothesis: The body burden of trace metals closely
parallels environmental exposure co metals
concentration.
STUDY LOCATIONS
The first step leading to the conduct of the studies was the selection of
communities representative of a pollutant gradient. Tentative communities were
The term "Episodes" is used as an epidemiologic term for CHESS study purposes
and not as indicating critical values for regulatory or health warning purposes.
-7-
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selected in 1971 by the EPA with reference to published information about maxi-
mum oxidant concentrations, climatic variations, and population characteristics.
Evaluations of these communities were then performed by measuring ozone at
temporary sites in the tentative communities. Based on the results of these
evaluations, three communities were chosen as permanent study locations.
They are listed below according to pollutant gradient designation:
High oxidant community: Covina, California.
• Intermediate oxidant community: Garden Grove, California.
• Low oxidant community: Thousand Oaks, California.
In April 1972, an air monitoring station was erected in support of the
CHESS program under the direction of the EPA in each of the selected commu-
nities . The maintenance of these stations in accordance with EPA procedures
is the responsibility of the University of California, Riverside . During the first
month of station operations, daily maximum hourly average concentrations of ozone
were found to meet the national primary photochemical oxidants air quality standard
31 percent of the time in Covina, 46 percent in Garden Grove, and 63 percent in
Thousand Oaks. Based on these further results, the choice of the three commu-
nities as representative of a pollutant gradient appears to be satisfactory.
As can be seen in Figure 2, the three communities form a rough geo-
graphic triangle of the following intercity mileage distances:
Thousand Oaks to Covina: 65 miles
Covina to Garden Grove: 35 miles
• Garden Grove to Thousand Oaks: 75 miles
As mentioned above, population characteristics were also considered by the EPA
in the choice of communities. The comparability of those selected is demonstrated
by the following information taken from Bureau of the Census reports:
Table 1. Key population characteristics of the study locations.
Characteristic
Population
White race (%)
No . of families
No . of persons per family
Median family income ($)
Median age (years)
Median no . of years of
school completed
Covina
30,380
98.1
7,794
3.9
11,958
27.4
12.4
Garden Grove
122,524
97.9
30,817
4.0
11,793
24.9
12.4
Thousand Oaks
36,334
98.4
8,849
4.1
14,071
23.9
12.7
Sources: Bureau of the Census, 1970 General Population Characteristics, Final
Report PC (1)-B6, and 1970 General Social and Economic Character-
istics, Final Report PC (1)-C6.
-8-
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L.OS ANGELES
METROPOLITAN AREA
Thousand Oaks
15 miles
-------
It is noted that Covina has a slightly older population, while Thousand Oaks has
a slightly wealthier population. In general, however, all three communities can
be described as being white, middle-income. It is further noted that the use of
such communities places a constraint on the projection of the project results.
However, such a constraint is justified in the establishment of a baseline against
which any complexities arising from ethnic or income factors can be judged later.
HEALTH DATA COLLECTION UNDERTAKEN
Preliminary Tasks
Initial tasks included a critique of the EPA procedures for the perform-
ance of the CHESS program, and the selection of clusters of elementary schools
within each CHESS community. The review considered the adequacy and internal
consistency of the documents for use in obtaining and processing health data. In
general, the procedures were found adequate to produce the information needed
to satisfy the purpose of the study. However, an additional constraint underlying
most of the procedures was recognized as the method for choosing respondent
families. Because of reliance on elementary schools as the vehicle for contact-
ing potential respondents, the study findings cannot be said to represent the
entire populations of the CHESS communities. Instead, the results will reflect
the effects of oxidants on families having elementary school children. Ample
justification for this constraint would exist if it can be held that such families
or the elementary school children of such families are among the most sensitive
to exposure to oxidants.
An attempt was made to locate the air monitoring station in each CHESS
community centrally with respect to the local school district boundaries and well
away from specific sources of possible air pollution, such as industrial plants
and freeways. Formal requests were made to school district boards of education
for their cooperation and permission to conduct the study in elementary schools
nearby the air monitoring stations. In each case, the school boards were very
cooperative and quickly granted permission allowing the studies to be conducted
in accordance with the schedule of Figure 1. The locations of the air monitoring
stations and the elementary schools used in connection with the following studies
are shown in Figures 3, 4, and 5.
Study I - Chronic Respiratory Disease (CRD)
The purpose of this study is to develop a cross-sectional comparison of
the prevalence of chronic respiratory disease symptoms from information soli-
cited from approximately 1,000 families in each community. Background infor-
mation and an enumeration of pertinent symptoms was solicited by means of
School and Family Health Questionnaires, an example of which is appended to
this report. Estimating an average of two elementary school children per family,
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Figure 3.
COVINA
t
N
/
Arrow
TEMPORARY
MONITORING
STATIONS
Highway
SUNKIST
[MONITORING
STATION
San Bernardino
0 1/4 1/2 3/4
I t 1 1
SCALE IN MILES
Freeway
O
H
Source: University of California, Riverside •
-------
Figure 4.
GARDEN GROVE
to
Katella
Avenue
PARK VIEW
MARK TWAIN
^STANLEY A
B CROSBY
MONITORING
STATION .
VIOLETTE
Garden Grove
T
Westminster
\
Bolsa
Blvd.
Garden
\
TEMPO RARYV
MONITORING
STATION
Grove
Avenue
Source: University of California, Riverside.
-------
Figure 5.
THOUSAND OAKS
MONITORING
STATION
0 1/4 1/2 3/4
I I I 1
SCALE IN MILES
TEMPORARY
MONITORING
STATIONS!
Source: University of California, Riverside.
-------
as shown in Figure 2, the questionnaires were distributed through a cluster of
elementary schools having an enrollment of approximately 2,000 students in each
community. The distribution took place during the last week of April 1972 .
Table 2. Numbers of School and Family Health Questionnaires distributed and
corresponding- response rates.
Community
Covina
Garden Grove
Thousand Oaks
No. of
Schools
Used
5
5
3
Enrollment
as of
Jan. 1972
2,148
2,147
1,950
No. of
Que stionnaire s
Distributed
1,395
1,456
1,219
Total
Response
Rate*
87%
85
88
*Includes questionnaires completed by families and returned to schools plus
telephone interviews completed with non-respondent families.
The number of questionnaires distributed and the percentage returned to each
school is given in Table A of the Appendix.
In Garden Grove and Thousand Oaks the questionnaires were sent home
with the youngest child of each family having one or more children enrolled in the
eight schools used. This was possible, since CIC was able to identify the young-
est children from the records of each school. However, this procedure could not
be used in Covina, since CIC was not granted access to enrollment information.,
Consequently, in Covina the questionnaires were sent home with all children in
attendance during the week of the distribution. The parents of these children
were asked simply to return all duplicate questionnaires to the schools.
In accordance with the data collection procedure, telephone interviews
were conducted with 100 families having children enrolled in the Garden Grove
schools and a like number of families having children enrolled in the Thousand
Oaks schools. The families were selected from those who did not return the
questionnaires. The results of these interviews increased the response rates
from 82 percent and 83 percent, respectively, to those shown above. The re-
sponse rate for the Covina schools had to be estimated.
Editing and coding of returned questionnaires was undertaken in May
1972. The processing was divided into five subtasks in order to permit the
editors to change activities periodically. This procedure has the advantage of
insuring control of the work and minimizing error due to constant repetition of
the same task. The subtasks included:
• CRD-LRD numbering
• Editing
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• ARD and asthma candidate numbering
• Listing of doctors' names and assigning doctor numbers
• Preparing callback lists of non-respondents
The study was concluded, as scheduled, by the end of June.
Study III - Acute Respiratory Disease (ARD)
The purpose of this study is to correlate the incidence of acute respiratory
disease with environmental quality. Panels of at least 275 families residing within
a two-mile radius of the air monitoring station were recruited to provide the nec-
essary data. The initial selection of candidate families was made from those who
completed and returned the School and Family Health Questionnaires during
Study I. Final selection by the EPA was based on consideration of such factors as:
• Location of residence
• Presence of children under 12
• Presence of a working telephone
• Length of residence
• Intention to move
• Presence of parents
Recruitment was done by home interviews which were conducted from
mid-August through mid-September 1972. An example of the home interview
form is appended. At the end of this period, the numbers of interviews shown
in Table 3 had been completed.
Table 3. Number of interviews completed by decision of family.
Community
Covina
Garden Grove
Thousand Oaks
Agreed to
Participate
352
374
310
Refused to
Participate*
59
105
48
Total
411
479
358
Acceptance
Rate
85%
78
87
*Category includes a few families in each community who were deemed by CIC
to be ineligible to participate because: (1) they planned to move from their
communities within eight months, (2) they were unable to communicate in the
English language, or (3) their telephones had been removed.
The number of families who agreed to participate may be divided into
four priority categories defined as:
• la, 2a - Both parents or substitute parents and preschool
siblings reside in the home.
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• la, 2b - Both parents or substitute parents and elementary
school siblings reside in the home.
• la, 2c - Both parents or substitute parents and high school
or college aged siblings reside in the home.
• la, 2d - Both parents or substitute parents but no siblings
reside in the home .
The numbers of families in each of these categories are given in Table 4:
Table 4. Numbers of families who agreed to participate by priority category.
Community
Covina
Garden Grove
Thousand Oaks
la, 2a
163
163
143
la, 2b
162
159
145
la, 2c
27
52
21
la, 2d,
0
0
1
Total
352
374
310
Interviewing was continued in the order of priority categories until at least
275 la, 2a and la, 2b families in each community agreed to participate. The dif-
ferences among the totals were primarily a function of (1) the distances between
houses and (2), particularly in Thousand Oaks, the variability of the terrain.
The relatively high number of Garden Grove families who refused to par-
ticipate suggested the existence of a problem and prompted the CIC home inter-
view team leader to investigate. Indeed, a problem was uncovered. One parent,
believed to have a child enrolled in Parkview School, was offended by the questions
in the School and Family Health Questionnaire concerned with the presence of
phlegm. Apparently, this parent was successful in arousing neighborhood anti-
pathy to the CHESS program of sufficient duration to affect participation in the
ARD study.
Biweekly telephone interviewing of ARD families began in November 1972.
The following table shows the number of families chosen to participate by group
designation in each of the CIC CHESS communities. It is noted that only families
with both parents or substitute parents and preschool siblings in the home (priority
category la, 2a) and families with both parents or substitute parents and elemen-
tary school siblings in the home (priority category la, 2b) were chosen. An
example of the ARD telephone survey form is appended.
-16-
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Table 5. Number of ARD families chosen to participate, by group.
Community Group A* Group B* Total
Covina 163 162 325
Garden Grove 154 157 311
Thousand Oaks 146 142 288
*Groups A and B were chosen at random by the EPA from each community to
permit telephoning of half of the families during the first of two successive
weeks and the remaining half of the families during the second of two succes-
sive weeks.
To date, the cooperation of the ARD families has been excellent. Many
have taken time to contact the CIC project office to relate things that they feel
may be important. Attrition has been minimal. After nine biweekly periods,
over 95 percent of both Group A and Group B families are continuing to participate.
Study IV - Pulmonary Function in Children (PFT)
This study is to correlate the ventilatory performance of elementary school
children with environmental quality. Performance is evaluated by measuring forced
expiratory volume occurring within 0.75 seconds (FEVg 75) using a volume cylinder
type spirometer.
Concurrent with Study I, CIC clerical personnel prepared class lists and
pulmonary function test report sheets in Garden Grove and Thousand Oaks. In
early May 1972, class lists (including only the names of children) were provided
by the Covina school district, thus relieving the necessity of asking Covina chil-
dren for their names at the times of the testing. CIC clerical personnel immed-
iately prepared test report sheets and letters to parents from these lists. The
letters were used for purposes of obtaining parental consent.
An intensive training session for pulmonary function team members was
held in mid-May by the EPA project officer. Pulmonary function testing in the
schools began the day following the training session.
An original plan to use members of local units of Parent-Teacher Associa-
tions as testing teams was abandoned when it became clear that it was not possible
to obtain a sufficient number of volunteers so late in the school year. Instead, 14
professional field interviewers were employed by CIC to serve in this capacity.
Four of these people with appropriate experience were assigned as team leaders.
The remaining ten were assigned as team members and alternates. Testing was
conducted by four 3-member teams whose membership remained constant through-
out the testing period. The numbers of children tested in each community are
summarized in Table 6.
-17-
-------
Table 6. Numbers of children tested during the first round of PFT.
Community
Covina
Garden Grove
Thousand Oaks
Enrollment
as of
May 1972
2,148
2,225
1,963
No. of
Children
Tested
1,941
1,971
1,773
Percent of
Children
Tested
90%
89
90
The numbers of children tested at each school is given in Table A of the Appendix.
Thus, from mid-May through early June 1972 approximately 5, 700 kinder-
garten through sixth grade children were tested in 13 elementary schools. By the
end of the first week, it was found that three teams could easily test all children in
a single school of up to 600 enrollment in a single day. The volume of information
obtained can be envisioned from a projection of the sample pulmonary function test
report shown in Figure 6. Columns 6 through 16 are completed at the time of the
tests.
In November 1972 and February 1973, CIC conducted second and third
rounds of pulmonary function testing. During each of these rounds approximately
5, 500 kindergarten through sixth grade children were tested in the same schools.
Although enrollments in these schools ranged from 329 to 707 children, the use
of three 3-member teams proved adequate to complete the tests on a schedule of
one school per day.
Professional field interviewers were again employed by CIC to serve as
pulmonary function team members . Most of these individuals had served in this
capacity during the initial round of testing. As in the first round, the member-
ship of the teams remained constant throughout the testing periods and the spriro-
meters were rotated among teams to eliminate systematic variations in the results
Periodic quality checks were made to identify unusual results for immediate
investigation. A sample quality check is shown in Figure 7.
The numbers of children tested in each community are summarized in
Tables 7 and 8.
-18-
-------
Subject: CRC - EPA Contract Reports (2)
r
From:
Jeannette Gore
Informational Services Division
YOM - Room 339
L_
"1
J
DATE OF MESSAGE
August 3! , 1973
DATE OF REPLY
INSTRUCTIONS
Use routing symbols whenever pos-
sible.
SENDER:
Forward original and one copy.
Conserve space.
RECEIVER:
Reply below the message, keep
one copy, return one copy.
-FOLD-
-FOLD—
USE BRIEF. INFORMAL LANGUAGE
Enclosed are two (2) copies of the report, "The Capacity of the Soil as a Natural Sink for
Carbon Monoxide," for possible EPA number assignment. The report was prepared for CRC and
EPA, and was submitted to NTIS by CRC.
Also_enclosed are two (2) copies of the report, "Effects of Oxidant Levejs on Selected
Health Characteristics of Persons in the Los Angeles~Basin , First AnnuaT Report - Vo I ume I :
Data Collection," for possible EPA number assignment. This report was prepared for CRC
and EPA and was submitted to NTIS by CRC. - - -
If EPA numbers are assigned to these reports, please notify me.
assigned, please return these copies to me.
Thank you.
If numbers are not
_j
2. TO BE RETURNED TO ORIGINATOR
OPTIONAL FORM 27
OCTOBER 1962
GSA FPMR (41 CFR) 101 - 11.6
-------
Figure 6. SAMPLE
PULMONARY FUNCTION TEST REPORT
Mo.
(1.2)
10,
Team
(9,10)
Day
(3, A)
3.0
Machine
(11,12)
3-
Yr.
(5.6)
Page J_ of 3_
Hr.
(7,8)
03,
City
(13,14)
0
Area
(15)
Ol
School
(16,17)
Grade
(18)
03
Class
(19)
READOLLT
I. 00
3- ol
SYMPTOM CODE
1 - No Respiratory symptoms
2 - Cough, Cold, Sore Throat
3 - Asthma
4 - Both 2 and 3 Positive
NAME (LAST, FIRST)
(20-51)
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(63,64)
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(65)
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(66)
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55.5
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4,
SYMPTOMS
(70)
/
1
a.
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4-
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/
\
[/
FEV.75
(71-74)
5.<^3
/. 86
5.7-3
5-46
3,o8
3.4<^
/.
-------
Covina
Figure 7.
PULMONARY FUNCTION TEST - TEAM QUALITY CHECK
(Eleventh Day - Round One)
Rowland School
June 1972
o
1
Grade
K
1
2
3
4
5
6
Team 1
n I
28 30
25 33
25 34
35 60
33 62
x
.33
.42
.29
.27
.90
x
1.08
1.33
1.37
1.72
1.90
Team 2
n I
27 31
26 33
25 41
33 57
33 66
x
.91
.18
.45
.52
.31
x
1.18
1.27
1.65
1.74
2.00
Team 3
n
29
23
27
28
26
31
Zx
28.58
28.34
35.09
40.80
39.03
57.20
x
0.99
1.23
1.29
1.45
1.50
1.84
Team 4
n Zx
30 27.74
27 39 . 50
27 41.38
34 65.36
x
0.92
1.46
1.53
1.92
n = number of children tested in each classroom.
Z x = sum of the maximum FEVg 75 readings for all children tested in each classroom.
x = Tx/n = mean maximum FEVg 75 reading for all children tested in each classroom.
-------
Table 7. Numbers of children tested during the second round of PFT.
Community
Covina
Garden Grove
Thousand Oaks
Enrollment
as of
Sept. 1972
2,218
2,048
1,817
No. of
Children
Tested
2,000
1,836
1,613
Percent of
Children
Tested
90%
90
89
Table 8. Numbers of children tested during the third round of PFT.
Enrollment No. of Percent of
as of Children Children
Community Jan. 1973 Tested Tested
Covina 2,252 1,990 oo7o
Garden Grove 2,071 1,849 89
Thousand Oaks 1,824 1,616 89
The enrollments and numbers of children tested at each school are given in Table B
of the Appendix.
In general, the principals, teachers, and other personnel of the schools
used for this study were very cooperative. Virtually all of the children tested
seemed to enjoy the experience of making the numbers on the digital meter read
as high as possible (see Figure 8). Competition for the highest reading evolved
(without prompting) in all but the lowest classes.
Study VII - Symptom Variation in Asthmatics
The purpose of the asthma panel study is to correlate the frequency and
severity of asthma attacks with environmental quality. Approximately 75 asth-
matics were recruited in each of the CHESS communities. This was done by
home interviews which were conducted from mid-July through mid-August 1972.
An example of the home interview form is appended.
As in the ARD study, initial lists of candidates were developed for each
community from responses to the questionnaires distributed in Study I. The
numbers of candidates included on these lists are given in Table 9.
-21-
-------
Figure 8
Seven-year-old Weathersfield School second-grader Jill Berube takes a deep
breath and then blows into the wind machine as Copley International Corporation
research, Mrs. Vivian Picker of Garden Grove, watches. Thousand Oaks
News-Chronicle photo by Bob Pool.
-22-
-------
Table 9. Number of asthmatics identified from those who completed and returned
the School and Family Health Questionnaires.
Number of Asthmatics
Identified From No. of Families
Community Questionnaire Responses Involved
Covina 112 85
Garden Grove 144 114
Thousand Oaks 96 73
In addition, CIC obtained names from the referrals of those on the lists and
from house-to-house interviews conducted throughout each CHESS community. At
the end of the home interview period, the following numbers of interviews had been
completed.
Table 10. Number of interviews completed by decision of candidate.
Community
Covina
Garden Grove
Thousand Oaks
Agreed to
Participate
144
175
118
Refused to
Participate*
25
36
16
Total
169
211
134
Acceptable
Rate
85%
83
87
*Category includes a few families in each community who were deemed by CIC
to be ineligible to participate because: (1) they planned to move from their
communities within eight months, (2) they did not have telephones, or (3) they
were under two years of age.
Of those who agreed to participate, 130 candidates in Covina, 156 in
Garden Grove, and 113 in Thousand Oaks stated that they had suffered asthma
attacks (including symptoms of both shortness of breath and wheezing) within
the past 12 months and gave the names of doctors who had treated them for this
disease. The remainder of those who agreed to participate stated that they had
not suffered asthma attacks within the past 12 months and/or had not been treated
by doctors practicing in the Los Angeles Basin.
At the end of the home interview period, the productivity of the methods
employed by CIC to locate asthmatics were estimated and compared. The methods
differed only to the extent that the persons whose names were taken from the
School and Family Health Questionnaires were known to be asthmatics, whereas
the persons contacted during the house-to-house canvassing were not. Because
of this difference, it was felt that a proper measure of productivity should be
based on the number of persons who agreed to participate rather than the number
of interviews completed. Table 11 gives the comparison:
-23-
-------
Table 11. Comparison of interview methods used in recruiting asthmatics .
Method Employed
to Locate
Asthmatics
No. of
Asthmatics
Who Agreed
to Participate
No. of
Interviewer
Days Expended
Productivity of Method
(No. Who Agreed Per
Interviewer Day)
Covina
Interview persons whose
names were taken from
the School and Family
Health Questionnaires
and their referrals*
110
19.0
5.8
Interview persons by
house-to-house
canvassing
Garden Grove
Interview persons whose
names were taken from
the School and Family
Health Questionnaires
and their referrals*
Interview persons by
house-to-house
canvassing
Thousand Oaks
Interview persons whose
names were taken from
the School and Family
Health Questionnaires
and their referrals*
Interview persons by
house-to-house
canvassing
34
10.0
133
42
25.5
9.0
112
24.5
5.5
3.4
5.2
4.7
4.6
1.1
"In this comparison, referrals were combined with persons whose names were taken
from the School and Family Health Questionnaires since both were known, or at least
thought to be, asthmatics.
-------
Thus, house-to-house canvassing was found to be 59 percent as productive
as interviewing persons known to be asthmatics in Covina, 90 percent as produc-
tive in Garden Grove, and 24 percent as productive in Thousand Oaks. Again,
the differences were primarily a function of (1) the distances between houses and
(2) the variability of the terrain.
CIC considers the location of asthmatics by house-to-house canvassing
as necessary to supplement the names taken from the School and Family Health
Questionnaires and recommends its use in urban communities where meteorolo-
gical and topographical conditions are not extreme. Indeed, the fact that only
2.2 percent of a given population can be expected to have asthma in varying
degrees of severity should not be taken as prima facie evidence that the method
could not be productive. For example, the Bureau of the Census lists 3.11 per-
sons per household for the nation as a whole.^ Based on CIC's experience in the
Los Angeles Basin, it is estimated that a single interviewer can contact at least
30 households or 93 persons per day. Besides interviewing an average of two
asthmatics (2.2 x 93 =2.0) per day, numerous referrals could be obtained.
Other methods of obtaining names of asthmatics were considered but were
not implemented due to legal restrictions. These methods included soliciting
names from hospitals, allergy treatment centers, private practioners, and phar-
macists .
Of those who agreed to participate, the numbers of asthmatics selected
by the EPA to serve as panelists is shown in Table 12.
Table 12. Numbers of asthmatics chosen as panelists and the numbers of
panelists remaining after 19 weeks of participation.
Community
Covina
Garden Grove
Thousand Oaks
No. of
Asthmatics Chosen
As Panelists
73
76
78
No . of Panelists
Remaining
56
55
65
Percent of
Panelists
Remaining
77%
72
83
Asthma symptoms were recorded by the panelists on special diaries mailed to
them each week by CIC . Completed diaries were returned to CIC for editing.
An example diary is appended.
2Bureau of the Census, 1970 General Population Characteristics, Final Report
-25-
-------
Completion of the diaries began in late October 1972. Twenty-one percent
of the first week's diaries that were returned to CIC contained one or more errors.
This percentage gradually declined to about 6 percent of the nineteenth week's
diaries, which was the final week of the contract year. The percentage of usable
diaries after any necessary callbacks have been completed has risen from 75 per-
cent to 99 percent of the number of remaining panelists.
The attrition of participants has been greater among asthma panelists than
ARD families. This is believed to be partly a matter of the self-administration
technique employed for asthma data collection and partly due to the propensity of
individuals to avoid having to discuss this chronic problem. The technique is
recognized among market research organizations as being generally less produc-
tive than an interviewer administration technique such as that adopted for Study III.
AIR MONITORING FACILITIES
Air monitoring in support of the CHESS program in the Los Angeles Basin
is the responsibility of the University of California, Riverside, and not of CIC.
Nevertheless, it is felt that at least a brief description of the facilities used for
this purpose is necessary in order for this volume to present a complete overview
of data collection. The information provided below was prepared by UCR.
Equipment
Air monitoring shelters and equipment were furnished by EPA and are
identical at all sites. The shelters are air conditioned, prefabricated aluminum
structures enclosed by chain link fences. Photographs of the exterior of a typical
shelter are given in Figures 9 and 10. On the outside of the shelter are mounted
the following measuring devices:
Hi Vol particulate sampler
Total and respirable particulate sampler (EPA design)
Dustfall bucket
• Air intake manifold for samplers inside the shelter
In the interior of the 10' x 12' shelter are the following instruments:
• Bubbler box (for 24 hr. SO2 and NO2)
Sulfur dioxide analyzer
Ozone analyzer
• PANalyzer (UCR design)
Nitrogen oxides analyzer
Strip chart recorders
' Data set
-26-
-------
• Combustible gas alarm system
• Acoustic coupler for transmitting data to the EPA, National
Environmental Research Center, Research Triangle Park,
North Carolina
' Business telephone
A photograph of the interior of a typical shelter is given in Figure 11.
Operation
The air monitoring stations are serviced daily by UCR personnel. Pre-
filled bubblers and pre-weighed particulate filters are shipped to California and
returned to the EPA for analysis. All gas flow meters are calibrated at the
National Environmental Research Center. For quality control purposes, periodic
calibrations of continuous analyzers are performed at the stations by EPA personnel.
The outputs of the ozone and SC>2 analyzers are recorded on magnetic tape
by the data set. The nitrogen oxides analyzers have three outputs: NO, NO2, and
NOX. They too are recorded on tape . Current plans call for the installation of
continuous CO, total hydrocarbons, and PAN monitoring instruments. All outputs
except PAN will also be recorded on tape. Real time data can be obtained either
from the display console at the National Environmental Research Center or by
viewing the digital readouts at the stations. Data can be read from the magnetic
tape only at North Carolina. PAN data will be taken manually from a strip chart
recorder.
CONCLUDING COMMENTS
Study I (CRD) was completed during the first contract year. Studies III
(ARD), IV (PFT), and VII (Symptom Variation in Asthmatics) will continue into
the second contract year. Studies II (LRD), V (Incidence of Irritative Symptoms
During Acute Episodes), and VI (Pollutant Burden of Trace Metals) will be under-
taken during the second contract year.
In addition to gathering LRD information by means of the School and
Family Health Questionnaires, Study II will be undertaken to validate the medical
history of young children and to compare physicians' diagnostic patterns among
the study communities. In the first part of the study, a sample of 200 children
in each CHESS community will be selected by the EPA on the basis of information
contained in completed and returned questionnaires. The names of these children
and their physicians will be sent to Copley International Corporation. CIC will
then contact the physicians and obtain permission to transcribe the medical records
of these children onto validation forms supplied by the EPA. Medical students will
be hired to perform the copy work. The completed validation forms will be re -
viewed for errors and unclear entries and then forwarded to the EPA.
-27-
-------
Air monitoring shelter.
1. Particulate samplers .
2. Air intake manifold.
Source: University of California, Riverside,
-28-
-------
Figure 10. Particulate sampling devices.
1. T/RSP particulate sampler.
2. Hi Vol particulate sampler.
3. DustfaU bucket.
Source: University of California, Riverside,
-29-
-------
Figure 11. Interior view of shelter.
1. Air intake manifold.
2. Data set.
3. Combustible gas alarm.
4. Strip chart recorder.
5. Ozone analyzer .
6. Nitrogen oxides analyzer.
Bubbler box (not shown).
Sulfur dioxide analyzer (not shown).
PANalyzer (not shown).
Source: University of California, Riverside,
-30-
-------
The second part of the study is to survey 100 doctors in each community.
In each case the doctors will be asked to define the symptoms of bronchitis as
they diagnose it. This procedure will be used to establish the diagnostic customs
in each community. The results of the survey will be sent to the EPA.
The basic strategy of Study V is to survey health characteristics of a known
sector of the population just after a marked short-term elevation in air pollution.
The results of the exposure to the acute episode will be compared to the results of
other surveys conducted with the same sample during periods of low or normal air
pollution. The sample will be drawn up in advance from ARD study rosters, and
the normal ARD telephone interviewers will be briefed on the conduct of the acute
episode survey. Actual initiation of the survey will be controlled by EPA declara-
tion of an acute episode. All interviewing will be carried out on the day following
the EPA alert.
Under Study VI, specimens of hair, vacuum cleaner dust, and tap water
will be collected from a sample of ARD families in the CHESS communities. The
tap water and dust samples will be collected by personal visits to the homes after
appointments have been scheduled. Hair samples will be collected by participants
during a normal haircut and mailed to CIC.
CIC will arrange with local hospital departments of obstetrics to collect
25 maternal-fetal sets in each community. In doing so, CIC will assist the
hospitals in selecting suitable patients and eliciting their cooperation. CIC will
supply the hospitals with Mother's and Hospital Information questionnaires for
completion after deliveries and prenumbered labels and containers for tissue
collection. CIC will arrange for the preparation and transportation of the 25
tissue sets from each community to the EPA.
The first of two special tasks to be undertaken during the second contract
year involves the preparation of magnetic cassette tapes to instruct interviewers
in speaking to classes of elementary school children preparatory to pulmonary
function testing, recruiting and administering the diaries of asthma panelists,
and eliciting cooperation of expectant mothers in preparation for the collection
of maternal-fetal sets. The second specific task involves editing the EPA pro-
cedures used in the collection and analysis of CHESS program data. Emphasis
here will be directed at uniformity of terminology and general clarity of the
statements of purpose and step-by-step instructions. Printing of a limited num-
ber of the edited procedures will follow EPA approval of any revisions made by
CIC.
-31-
-------
APPENDIX
-32-
-------
Table A.
NUMBERS OF SCHOOL AND FAMILY HEALTH QUESTIONNAIRES DISTRIBUTED
(STUDY I-CRD) AND NUMBERS OF CHILDREN TESTED (STUDY IV-PFT),
PER SCHOOL, IN EACH CHESS COMMUNITY
Covina
Totals
2,148
Name of School
Crosby*
Mark Twain**
Parkview
Stanley
Violette
Totals
Enrollment
as of
Jan. 1972
2,147
.Name of School
Glenwood*
Meadows
Weathersfield
Totals
Enrollment
as of
Jan. 1972
621
753
576
1,950
No. of
Questionnaires
Distributed
217
258
295
393
232
1,395
Garden
No. of
Questionnaires
Distributed
434
263
294
294
271
1,456
Percent of
Questionnaires
Returned
91%
87
93
79
87
87%
Grove
Percent of
Questionnaires
Returned
81%
87
78
81
86
82%
Enrollment
as of
May 1972
334
397
454
606
357
2,148
Enrollment
as of
May 1972
507
384
509
426
399
2,225
Thousand Oaks
No. of
Questionnaires
Distributed
396
468
355
1,219
Percent of
Questionnaires
Returned
82%
84
82
8 W
oo/o
Enrollment
as of
May 1972
641
750
572
1,963
1,941
90%
No. of
Children
Tested
1st Round
475
287
465
387
357
1,971
Percent of
Children
Tested
1st Round
94%
75
91
91
90
89%
No . of Percent of
Children Children
Tested Tested
1st Round 1st Round
559
690
524
1,773
87%
92
92_
90%
*Site of air monitoring unit maintained by University of California, Riverside.
**This school has several special education classes which were not tested.
-------
Table B.
NUMBER OF CHILDREN TESTED (STUDY IV - PFT).
PER SCHOOL, IN EACH CHESS COMMUNITY
Covina
Name of School
Cienega
Griswold
Manzanita
Rowland
Sunkist*
Totals
Enrollment
as of
Sept. 1972
527
408
309
598
376
No. of
Children
Tested
2nd Round
498
349
282
536
335
2,218
2,000
Percent of
Children
Tested
2nd Round
94.5%
85.5
91.3
89.6
89.1
90.2%
Enrollment
as of
Jan. 1973
518
418
329
611
376
No. of
Children
Tested
3rd Round
470
350
299
530
341
Percent of
Children
Tested
3rd Round
2,252
1,990
Garden Grove
Name of School
Crosby*
Mark Twain**
Parkview
Stanley
Violette
Enrollment
as of
Sept. 1972
447
352
469
366
414
No. of
Children
Tested
2nd Round
434
271
438
317
376
Percent of
Children
Tested
2nd Round
97 . 1%
77.0
93.4
86.6
90.8
Enrollment
as of
Jan. 1973
456
371
484
354
406
No. of
Children
Tested
3rd Round
399
297
455
326
372
Percent of
Children
Tested
3rd Round
87.5%
80.1
94.0
92.1
91.6
Totals
2,048
1,836
89.6%
2,071
1,849
89.3%
Thousand Oaks
Name of School
Glenwood*
Meadows
Weathersfield
Enrollment
as of
Sept. 1972
574
691
552
No. of
Children
Tested
2nd Round
503
648
462
Percent of
Children
Tested
2nd Round
87.6%
93.8
83.7
Enrollment
as of
Jan. 1973
566
707
551
No. of
Children
Tested
3rd Round
513
657
446
Percent of
Children
Tested
3rd Round
90.6%
92.9
80.9
Totals
1,817
1,613
1,824
1,616
*Site of air monitoring unit maintained by University of California, Riverside.
"This school has several special education classes which were not tested.
-------
OMB 158-R0019
EXPIRES 8/31/73
044630
SCHOOL AND FAMILY HEALTH QUESTIONNAIRE
NAME OF HEAD OF HOUSEHOLD-
STREET-
FIRST NAME LAST NAME
(9-28)
(24-49)
CITY ZIP CODE
(50-64) (65-69)
TELEPHONE
(70-76) (77-78)
THE INFORMATION REQUESTED IN THIS QUESTIONNAIRE
WILL BE HELD IN STRICT CONFIDENCE. RESULTS WILL BE
SUMMARIZED FOR GROUPS OF PERSONS. NO INFORMATION
ON INDIVIDUAL RESPONSES WILL BE RELEASED.
-35-
DC 9639 «•"<» K*mma-nn OPTICAL SCABBM OOWCUTiai « OT~. «. »»
-------
INSTRUCTIONS FOR ANSWERING SCHOOL AND FAMILY HEALTH QUESTIONNAIRE
1. READ QUESTIONS CAREFULLY BEFORE ANSWERING.
2. SELECT TH,E ANSWERS WHICH SEEM MOST APPROPRIATE, AND BLACKEN COMPLETELY
THOSE BOXES WHICH CORRESPOND WITH THEM. (SEE ILLUSTRATION BELOW.)
DO YOU USUALLY COUGH DURING THE DAY OR NIGHT
IN WINTER? (DO NOT COUNT AN OCCASIONAL COUGH.)
MOTHER (OR
FEMALE GUARDIAN)
1 H
YES NO
FATHER (OR
MALE GUARDIAN)
1 1
YES NO
3. USE A SOFT LEAD PENCIL DO NOT USE INK.
4. ANY REMARKS CAN BE WRITTEN ON THE BACK OF THE PAGES.
ERASE ANY MISTAKES COMPLETELY.
-36-
DC 9640
-------
[ HEALTH QUESTIONS ABOUT THE FATHER AND MOTHER
NOTE: THE QUESTIONS IN THIS SECTION ARE TO BE ANSWERED FOR BOTH PARENTS BY THE MOTHER
OR FEMALE GUARDIAN. ANSWER THE QUESTIONS IN THIS SECTION ONLY FOR PARENTS (OR
GUARDIANS) LIVING IN THE HOME.
1. DO YOU USUALLY COUGH FIRST THING IN THE MORNING IN WINTER? (COUNT TWO OR MORE
COUGHS UPON ARISING, OR WHEN YOU FIRST GO OUT OF DOORS, OR WHEN YOU SMOKE THE
FIRST CIGARETTE OF THE DAY IF YOU ARE A SMOKER. DO NOT COUNT CLEARING OF
THROAT.)
IF YOU ANSWERED "YES" TO QUESTION 1 PLEASE ANSWER QUESTION 2 .
2. DO YOU COUGH LIKE THIS ON MOST DAYS OR NIGHTS FOR AS MUCH AS THREE MONTHS EACH YEAR?
3. DO YOU USUALLY COUGH DURING THE DAY OR NIGHT IN WINTER? (DO NOT COUNT AN
OCCASIONAL COUGH).
IF YOU ANSWERED "YES" TO QUESTION 3 PLEASE ANSWER QUESTION 4.
4. DO YOU COUGH LIKE THIS ON MOST DAYS OR NIGHTS FOR AS MUCH AS THREE MONTHS EACH YEAR?
5. DO YOU USUALLY BRING UP PHLEGM (THICK FLUID) FROM YOUR CHEST FIRST THING IN THE
MORNING IN WINTER? (COUNT PHLEGM WHETHER SWALLOWED OR EXPELLED, UPON ARISING,
OR WHEN YOU FIRST GO OUT OF DOORS, OR WHEN YOU SMOKE THE FIRST CIGARETTE OF THE
DAY IF YOU ARE A SMOKER.) (DO NOT COUNT PHLEGM FROM THE NOSE.)
IF YOU ANSWERED "YES" TO QUESTION 5 PLEASE ANSWER QUESTION 6.
6. DO YOU BRING UP PHLEGM LIKE THIS ON MOST DAYS OR NIGHTS FOR AS MUCH AS THREE MONTHS
EACH YEAR?
7. DO YOU USUALLY BRING UP PHLEGM FROM YOUR CHEST DURING THE DAY OR NIGHT IN WINTER?
IF YOU ANSWERED "YES" TO QUESTION 7 PLEASE ANSWER ffOESTIOM 8. 1
8. DO YOU BRING UP PHLEGM LIKE THIS ON MOST DAYS OR NIGHTS FOR AS MUCH AS THREE MONTHS
EACH YEAR?
9. IN THE PAST THREE YEARS, HAVE YOU HAD A PERIOD OF COUGH AND PHLEGM LASTING FOR
THREE WEEKS OR MORE? (ALL PERSONS SHOULD ANSWER THIS QUESTION.) IF YOU USUALLY
HAVE COUGH OR PHLEGM, THE QUESTION REFERS TO PERIODS OF MORE THAN USUAL COUGH
OR PHLEGM.
Nfl
-37- YES, 1 PERIOD
YES, 2 OR MORE PERIODS
4 d M: ": t
3, -n ~! rf «
Oi '-I (N! rOi J
OJ *-i CMJ m, J
l_l 'J ~J v- 1
jj n n !"; ~
Oi M CNJj CO] «*
^ | w U ^
MOTHER (OR
FEMALE GUARDIAN)
fl 1
YES NO
D fl
YES NO
fl D
YES NO
fl fl
YES NO
D D
YES NO
-
fl fl
YES NO
D fl
YES NO
fl D
YES NO
D
Q
n ""i ^ '"• 1
LO. ID, I*" CO' 01 j
oV ul r-, to1 crj
"j ^.' "^J 'J J
"^ *^j J i-J _
11 n q n £\
mi U3J r- co en
u J J J J
FATHER (OR
MALE GUARDIAN)
fl D
YES NO
fl Q
YES NO
D D
YES NO
fl fl
YES NO
fl D
YES NO
- - -. . ."Ofti.
fl fl
YES NO
fl D
YES NO
.-':.••*.",:» ~ - •-,;";
fl fl
YES NO
D
D
fl
DC 9641
-------
DO NOT MARK ii p
IN THIS SPACE '** ""
0123456789 0123456789
0123456789 0123456789
0^23456789 2i5u2SuZ5u
0 i\ 2 3 4 5 6 7 8 9 0 t\ 2 3 4 5 6 7 8 9
Y N Y N
l_, U ij U
10 DO YOU GET SHORT OF BREATH WALKING ON LEVEL GROUND AT AN ORDINARY PAHF?
11. DO YOU SMOKE A PIPE OR CIGAR?
12 HAVE YOU EVER SMOKED AS MANY AS FIVE PACKS OF CIGARETTES THAT IS AS MANY AS 100
CIGARETTES, DURING YOUR ENTIRE LIFE?
13 DO YOU NowsMOKFrifiARFTTES?
14. IF YOU ARE A CURRENT OR AN EX-CIGARETTE SMOKER, HOW MANY CIGARETTES DO (DID)
YOU SMOKE PER DAY?
1ESS THAN 1/2 PACK PER DAY (1-5 CIGARETTES PER DAY)
ABOUT V, PACK PFR DAY (6-14 CIGARETTES PER DAY)
ARDIIT 1 PARK PFR DAY (15-?5 niRARFTTFS PFR DAY)
ABOUT 1% PACKS PER DAY (7R-34 CIRARFTTFS PER DAY)
AROIIT 7 PACKS PFR DAY (3R OR MORF CIGARETTES PER DAY)
15. IF YOU ARE A CURRENT OR AN EX-CIGARETTE SMOKER, HOW OLD WERE YOU WHEN YOU FIRST
STARTED SMOKING?
16. IF YOU ARE AN EX-CIGARETTE SMOKER, HOW OLD WERE YOU WHEN YOU LAST GAVE UPSMOKING?
17. AT YOUR JOB ARE YOU NOW OR HAVE YOU BEEN FREQUENTLY EXPOSED TO IRRITATING SMOKE,
DUST OR FIIMFS?
IF YOU ANSWERED "NO" TO QUESTION 17 SKIP THE NEXT 2 QUESTIONS BELOW.
18. WHAT KIND OF IRRITANT WERE YOU EXPOSED TO: (FOR EXAMPLE: COAL OUST, CUTTING OILS,
ASBESTOS, MINE DUST, SMELTER FUMES, RAW COTTON DUST, FOUNDRY DUST)
19. HOW LONG WERE YOU EXPOSED?
LESS THAN 1 YEAR
1 TO 5 YEARS
6T010YEARS ~38~
MORE THAN 10 YEARS
41"' •! ' ;
--! IN; oij *3
?i 71 7] "1 1
il -! IM| mi «J
1 ul Lj —
n n n n
o! >-i rvjl ml *
u u t-1 u
•3 -d T! "3 -
i T! -3 -a -
3313'
MOTHER (OR
FEMALE GUARDIAN)
0 B
YES NO
i n
YES NO
1 1
YES NO
1 1
YES NO
I
I!
n
n
1
n
m
YEARS
YEARS
B P
YES NO
|
' I
n
[i
-i ~\ ""••'
LO! u3' i^>- x :'••
-'I'! "
m1 UJ (^i cC" :•
J ' t.J V ' ' 1
! ^i 4 ^^ ^ f"Ti'
u"> (£>\ r~[ CO1 CT
0 0 O •! J
In n ri n n
in LD I--! Mi 01
L.I (J iJ L- U
•i n <•- r> n n
mi o> r^ co' 01
J Li '_ J (J LJ
] in uw r^ ool ffil
i I.' J J L-' ij
FATHER (OR
MALE GUARDIAN)
D D
YES NO
3 D
YES NO
f| fi
[1 u
YES NO
1 1
YES NO
i
fi
1
•D
a
on
YEARS
m
YEARS
1 11
YES NO
0
!!
DC 9642
-------
n QUESTIONS ABOUT THE HEALTH OF
WRITE AT THE HEAD OF EACH COLUMN THE
NAME OF EACH CHILD 12 YEARS OF AGE OR
YOUNGER.
THEN, IN EACH CHILD'S COLUMN MARK ONE
BOX TO ANSWER EACH OF THE FOLLOWING
QUESTIONS.
1. HAS YOUR CHILD BEEN TREATED BY A
DOCTOR FOR PNEUMONIA DURING THE
LAST THREE YEARS?
2. HAS YOUR CHILD BEEN TREATED BY A
DOCTOR FOR AN ATTACK OF CROUP
DURING THE LAST THREE YEARS?
3. HAS YOUR CHILD BEEN TREATED BY A
DOCTOR FOR AN ATTACK OF BRONCHITIS
DURING THE LAST THREE YEARS?
4. HAS YOUR CHILD BEEN TREATED BY A
DOCTOR DURING THE PAST THREE YEARS
FOR ANY CHEST INFECTION OTHER THAN
THE ABOVE THREE?
5. HAS YOUR CHILD BEEN IN THE HOSPITAL
FOR ONE OF THE ILLNESSES MENTIONED
IN QUESTIONS 1,2, OR 3 ABOVE DURING
THE LAST THREE YEARS?
6. WHAT IS THE FULL NAME AND ADDRESS
OF THE DOCTOR WHO TAKES CARE OF
YOUR CHILD OR, IF YOU TAKE YOUR CHILD
TO A CLINIC FOR MEDICAL CARE, WHAT IS
THE NAME AND ADDRESS OF THE CLINIC?
CHILDREN 12 YEARS OR YOUNGER
DO NOT MARK
IN THIS SPACE
0123456
n K H H * H H
0123456
"•n'nnnnmmrinn •innnnin'l1
2i222SSZScl i tH mJ tM •a-'d •?) mJ
nnnnnnnnnn nri'"lBrlr]l~lrlrirl
0 1 2 3 456 78 9 9 H ^J I "D ^ ^ 'j ^U ^
2i232SS222 ca-drd0dtlld'frjcd^I
0 1 2 3 45678 9 (3*-]r3r34l3l9fa0dCLl
HHWHHWWHW- -H u u u u • u LJ juw
7890123456789 q -I <•
7890|1i234g6789 "lt!r
3 -3 r
NAME OF
1st CHILD
fl NO
fl YES, ONCE
0 YES, TWICE
0 YES, MORE
THAN TWICE
0 NO
0 YES, ONCE
0 YES, TWICE
0 YES, MORE
THAN TWICE
0 NO
0 YES, ONCE
0 YES, TWICE
0 YES, MORE
THAN TWICE
0 NO
0 YES, ONCE
0 YES, TWICE
fl YES, MORE
THAN TWICE
fl NO
| YES, ONCE
| YES, TWICE
0 YES, MORE
THAN TWICE
-39-
NAME OF
2nd CHILD
0 NO
0 YES, ONCE
0 YES, TWICE
0 YES, MORE
THAN TWICE
fl NO
0 YES, ONCE
0 YES, TWICE
0 YES, MORE
THAN TWICE
fl NO
0 YES, ONCE
0 YES, TWICE
0 YES, MORE
THAN TWICE
0 NO
0 YES, ONCE
fl YES, TWICE
0 YES, MORE
THAN TWICE
0 NO
0 YES, ONCE
0 YES, TWICE
0 YES, MORE
THAN TWICE
NAME OF
3rd CHILD
fl NO
0 YES, ONCE
0 YES, TWICE
0 YES, MORE
THAN TWICE
0 NO
0 YES, ONCE
0 YES, TWICE
0 YES, MORE
THAN TWICE
0 NO
0 YES, ONCE
0 YES, TWICE
0 YES, MORE
THAN TWICE
0 NO
fl YES, ONCE
0 YES, TWICE
0 YES, MORE
THAN TWICE
0 NU
fl YES, ONCE
0 YES, TWICE
fl YES, MORE
THAN TWICE
jjsiiiii
NAME OF
4th CHILD
fl NO
fl YES, ONCE
0 YES, TWICE
0 YES, MORE
THAN TWICE
fl NO
fl YES, ONCE
fl YES, TWICE
0 YES, MORE
THAN TWICE
Q NO
0 YES, ONCE
fl YES, TWICE
fl YES, MORE
THAN TWICE
0 NO
fl YES, ONCE
0 YES, TWICE
0 YES, MORE
THAN TWICE
fl NO
fl YES, ONCE
0 YES, TWICE
fl YES, MORE
THAN TWICE
DC 9643
roiuin, OPTICAL SCANNING CORPORATION Q .
-------
12 YEARS OR YOUNGER CONTINUE ON
PLEASE CHECK BOX BELOW IF THERE ARE
MORE THAN 8 CHILDREN 12 YEARS OF AGE
OR YOUNGER.
1. HAS YOUR CHILD BEEN TREATED BY A
DOCTOR FOR PNEUMONIA DURING THE
LAST THREE YEARS?
2. HAS YOUR CHILD BEEN TREATED BY A
DOCTOR FOR AN ATTACK OF CROUP
DURING THE LAST THREE YEARS?
3. HAS YOUR CHILD BEEN TREATED BY A
DOCTOR FOR AN ATTACK OF BRONCHITIS
DURING THE LAST THREE YEARS?
4. HAS YOUR CHILD BEEN TREATED BY A
DOCTOR DURING THE PAST THREE YEARS
FOR ANY CHEST INFECTION OTHER THAN
THE ABOVE THREE?
5. HAS YOUR CHILD BEEN IN THE HOSPITAL
FOR ONE OF THE ILLNESSES MENTIONED
IN QUESTIONS 1, 2, OR 3 ABOVE DURING
THE LAST THREE YEARS?
6. WHAT IS THE FULL NAME AND ADDRESS
OF THE DOCTOR WHO TAKES CARE OF
YOUR CHILD OR, IF YOU TAKE YOUR CHILD
TO A CLINIC FOR MEDICAL CARE, WHAT IS
THE NAME AND ADDRESS OF THE CLINIC?
DO NOT MARK
IN THIS SPACE
0123456
01 23456
NAME OF
5th CHILD
1 NO
[j YES, ONCE
[j YES, TWICE
0 YES, MORE
THAN TWICE
[j NO
[| YES, ONCE
| YES, TWICE
fl YES, MORE
THAN TWICE
fl NO
fl YES, ONCE
| YES, TWICE
fl YES, MORE
THAN TWICE
fl NO
fl YES, ONCE
| YES, TWICE
| YES, MORE
THAN TWICE
I NO
[1 VCQ ONCE
| YES, TWICE
| YES, MORE
THAN TWICE
-40-
01234
01234
01234
01234
78901234
78901234
NAME OF
6th CHILD
1 NO
fl YES, ONCE
| YES, TWICE
fl YES, MORE
THAN TWICE
i! NO
[i YES, ONCE
fl YES, TWICE
| YES, MORE
THAN TWICE
D NO
fl YES, ONCE
fl YES, TWICE
fl YES, MORE
THAN TWICE
Q NO
| YES, ONCE
fl YES, TWICE
fl YES, MORE
THAN TWICE
| NO
DYFS ONfE
D YES, TWICE
D YES, MORE
THAN TWICE
56789 4 ~ '
56789 o — <•
56789 o - c-
56789 o r
56789 o -' <•
56789 4 -
O ^ '
NAME OF
7th CHILD
fl NO
| YES, ONCE
fl YES, TWICE
fl YES, MORE
THAN TWICE
D NO
f] YES, ONCE
[| YES, TWICE
|] YES, MORE
THAN TWICE
1 NO
[] YES, ONCE
| YES, TWICE
| YES, MORE
THAN TWICE
D NO
fl YES, ONCE
[] YES, TWICE
| YES, MORE
THAN TWICE
| NO
fl YFS nwrF
[j YES, TWICE
|] YES, MORE
THAN TWICE
m *j- u-> av r- cc! cnj
• ~' ' '" H
-j r^l -d- in, u";1 i^-1 OD< frij
g fr, cj- LO U| r- CD i CT> i
vl m' J ""> ^ ^ CD en;
ji rn' -J ^' u> f^ O?1 cni
jm-3-LnLOr^-ccc^
M m1 <£ r-, co- en;
NAME OF
8th CHILD
y NO
0 YES, ONCE
j] YES, TWICE
fj YES, MORE
THAN TWICE
i NO
| YES, ONCE
fl YES, TWICE
j] YES, MORE
THAN TWICE
fl NO
fl YES, ONCE
fl YES, TWICE
fl YES, MORE
THAN TWICE
1 NO
fl YES, ONCE
[] YES, TWICE
fl YES, MORE
THAN TWICE
fl NO
DVPQ HMPF
| YES, TWICE
fl YES, MORE
THAN TWICE
DC 9644
-------
HI GENERAL QUESTIONS ABOUT THE HOUSEHOLD
1. WHAT EDUCATIONAL LEVEL HAS BEEN COMPLETED BY THE HEAD OF THE HOUSEHOLD?
(MARK ONE BOX ONLY)
ELEMENTARY SCHOOL
PART OF HIGH SCHOOL
HIGH SCHOOL GRADUATE
PART OF COLLEGE
COLLEGE GRADUATE
GRADUATE SCHOOL INCLUDING
ADVANCED AND PROFESSIONAL DEGREES
TRADE,TECHNICAL, OR BUSINESS
SCHOOL BEYOND HIGH SCHOOL
4—i ,N 01! «r «| ic r- i
L, L. U U -J . -J t-
5 *-'• c\j; rl •!? i^f <£; f^'
i -3 *3 'j •£! "i I "3 •?! ^
idc3<3i'3i3^csl^
g I I -5 I 3 'il mJ
2. WHAT IS THE RACE OF THE FAMILY?
INDIAN
MEXICAN AMERICAN OR SPANISH AMERICAN
NEGRO
ORIENTAL
WHITE
OTHER, INCLUDING MIXED
3. HOW LONG HAS THE FAMILY LIVED IN YOUR PRESENT CITY OR TOWN?
LESS THAN 1 YEAR U
1 YEAR D
2 YEARS 1
n
3 YEARS U
4 YEARS I
5 YEARS U
6 YEARS 1
7 YEARS 1
n
8 YEARS U
9 YEARS fl
10 YEARS U
11 YEARS 1
12 YEARS 1
OR MORE
4. HOW MANY ROOMS ARE THERE IN YOUR LIVING QUARTERS? (00 NOT COUNT BATHROOMS,
PORCHES, BALCONIES, FOYERS. HALLS OR HALF ROOMS. MARK ONE BOX ONLY).
5.
ONE U FOUR U
TWO D FIVE 1
THREE 1 SIX D
DO YOU PLAN TO MOVF WITHIN THF NFXT YFAR'
SEVEN U
EIGHT 11
NINEOR D
MORE
P B
YES
NO
6. DO YOU ORDINARILY USE A GAS STOVE FOR COOKING IN YOUR HOME?_
YES
NO
7. DO YOU USE A GAS SPACE HEATER IN YOUR HOME?.
-41-
YES-
NO
DC 9645
-------
IV CENSUS OF HOUSEHOLD
044630
(WRITE IN THE COLUMN BELOW THE FIRST AND MIDDLE NAME
OF EACH PERSON LIVING IN THE HOUSEHOLD. WRITE LAST NAME
FOR PERSONS WHOSE LAST NAME IS DIFFERENT FROM THAT ON
THE COVER OF THE QUESTIONNAIRE.)
NAME
(9-31)
01
g
02
03
04
05 '
06
07
08
09
10
11
12
13
14
15
MARK THE APPROPRIATE BOX OR BOXES FOR EACH PERSON
(36-37)
AGE
YEAR OF AGE IN YEARS
BIRTH AT LAST
BIRTHDAY
r^
i i
i i
i i
I !
I !
I I
I I
! I
I I
I I
I I
rz:
i i
LZZI
(38)
SEX
MALE FEMALE
1 2
0 1
1 2
1 I
1 2
1] P
d b
1 2
3 i
1 2
I 2
1 2
I I
1 2
' ii
1 2
1 2
1 2
: 11
1 2
1 2
1 2
0 I
U U
1 2
(39) (79-80
POSITION IN HOUSEHOLD
FATHER MOTHER
OR OR
MALE FEMALE CHILD OTHER
GUARDIAN GUARDIAN
i i i i m
I 234
I i i n m
1 234
n n r' n i — i
u II y 11 M
1 234
fl 1 Ij fj [05]
1 234
;' is ii i1 (MI
1 234
1 234
Ei !i i 11 [Ml
1 234
;! i i [ [oal
1 234
'•' n n n i — i
11 ;; o Qo]
1 234
I 234
II H n (! ryi
1. 234
'\ P " ii p!3l
'-• -. lj L_- 1
1 234
;; H ~i H | 1
1 2 34
I 234
!; 8 1 1 m
-42-
DC9646
-------
~< U -^ w ,SJ
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u u y u LJ w LJ M
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H H H H H ~ •? H
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DC 9647
oNMiTU OPTICAL SCANNING CORPORATION c "-1
-------
REPORT OF ARD PANEL INTERVIEW
CITY
FAMILY NAME
ADDRESS
TELEPHONE
RACE
FAMILY NUMBER
ZIP
u u
? 9
5 5
5 S
U U
g 5
n n
JJ LL.
5
u
r
i
L
I
L,
c
1. DO YOU HAVE DEFINITE PLANS TO MOVE FROM
THIS CITY OR A DISTANCE GREATER THAN 5 MILES
IN THE NEXT YEAR ?
2. WILL YOUR FAMILY PARTICIPATE IN
THIS STUDY ?
IF THE ANSWER IS NO TO QUESTION 1 AND YES TO
QUESTION 2, ASK QUESTION 3 AND 4.
3. WHAT IS THE APPROPRIATE TIME OF DAY FOR
YOU TO BE CALLED ON THE PHONE?
LIST PHONE ONLY IF DIFFERENT FROM ABOVE.
YES
YES
NO
NO
AM
PM to
AM
PM to
AM
. PM phone
AM
.PM phone.
ARE THERE ANYDAYS (MONDAY-FRIDAY)
DURING WHICH YOU CANNOT BE REACHED AT
HOME BY PHONE? (THIS QUESTION
REFERS TO THE MOTHER OR HER
EQUIVALENT)
IF YES, MARK DAY(S) YOU
CANNOT BE REACHED.
YES
NO
MON
TUE
WED
THU
FRI
NAME OF INTERVIEWER
DATE OF INTERVIEW
-44-
DO NOT MARK
IN THIS COLUMN
p v 5 .i 4 y t;
H H H H H R H
a I, & a 6 f, Q
n n n q n n n
0 l ? j 4 r) 6
b y u p u u u
n n n n n n n
11 y 5 y
a. s s
9 9 i1 g S 9 S 5
U U U P U U U I.
pynntlDn"
-------
5. WHAT DOCTOR (S) TREAT (S) YOUR FAMILY ?
FAMILY MEMBER AGE SEX DOCTOR
-45-
-------
ARD TELEPHONE QUESTIONNAIRE
1892
NAME: PHONE:
ADDRESS:
CENSUS LIST
Has there
been
any new
illness?
© ®
0 ®
® ®
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Fever?
© ®
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® ®
®®
© ®
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© ®
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® ®
© ®
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Respiratory Illness
Lower-
chest cold
croup
bronchitis
pneumonia
asthma
© ®
© ®
© ®
© ®
© ®
®®
®®
® ®
® ®
® ®
© ®
®®
®®
© ®
© ®
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Upper-
head cold
linus
sore throat
runny nose
© ®
© ®
© ®
© ®
®®
®®
® ©
© ®
® ®
0®,
0®
© ®
®@
® ®
© ®
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NUMBER:
PERIOD:
REMARKS:
How many days were normal
activities restricted?
®©®@®®®@®®
®o®®®®®@®®
®®®®®©©@®®
Q) ^D (^ ^D (^ ^D (^ {$ ^D ^D
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(Q) GD ^D ^D (5) (^ ^s) ^D ^D ^D
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®©©®@©©@®©
®®®®®©©®@®
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Was
doctor
con-
sulted?
© ®
0®
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© ®
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0 ®
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Did
doctor
say ear
was in-
fected?
© ®
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NCS Tr.ins-Optic F1483-54321
II II II II I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
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ASTHMA PANEL QUESTIONNAIRE
OMB 158-R0019
(Card 1)
1. I.D. #
COL (1-8)
2. Asthma Subject's Name
COL (9-40) (Last)
3. Subject's Address.
COL (41-63) (House Number)
(First)
(Street)
(Initial)
(City)
4. Subject's Telephone Number
COL (64-70)
5. Other Code # .
COL (71-78)
(State)
(Zip)
COL (79-80)[O
6. If respondent is other than asthma subject, enter:
(Respondent's Name)
7a. Subject plans to move within the year
7b. If yes, when?_
and where?
8a. Subject agrees to participate in panel
8b. If no, enter reason for refusal
9. Interviewer's Name.
10. Date of Interview II I I
Mo. Day Yr.
(Relationship to subject)
Yes
No
Yes
No
-47-
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Pac
(Card 2)
1. IDENTIFYING INFORMATION
1. Birth Date
(Month) (Day) (Year)
COL (9-14)
Enter two numbers each for the month, day,
and year on the lines above. For example:
For birthdate June 5, 1950, enter
06 05 50.
COL (15)
2. Sex:
Male
1 D
Female
2 D
II. HEALTH HISTORY
1 . How old were you when your asthma
first began?
2. About how many asthma attacks have you
had within the past year?
3. When you have an asthma attack do you
usually have'
a. Shortness of breath?
b. Wheezing in the chest?
c. Fever?
d. Increased sputum or phlegm production?
3. Race or ethnic group COL (16)
1 Q Indian
2 Q Mexican-American or
Spanish-American
3 Q Black
4 Q Oriental
5 Q White
6 | I Other
(Please specify)
COL (17-18)
(Enter age in years)
COL (19-21)
(Enter number of attacks)
1 O Yes 2 Q No COL (22)
1 n Yes 2 Q No COL (23)
1 O Yes 2 Q No COL (24)
1 d Yes 2 Q No COL (25)
-48-
-------
Page 2
4a.
4b.
5.
6.
7.
8.
9.
10.
Do you use medicine (pills, liquid, inhaler
or suppositories) when you have, or are
about to have, an asthma attack?
If yes, please specify medicine(s) used.
Do your asthma attacks ever get severe
enough to keep you from your normal
activities or from sleeping at night?
Do you have asthma attacks in:
Winter (Jan -Feb -Mar )
Spring (Apr -May-June)
Summer (Jul -Aug -Sept ) . . ...
Fall (Oct -Nov -Dec ) . . .
At your job are there fumes or dusts that
tend to bring on asthma attacks?
Do you tend to get asthma attacks:
a. When it gets unusually cold outside? ... •
b. When you get respiratory infections,
like colds? . .
c. When you get upset? ... ....
d. When you eat certain foods? ...
e. When you are near certain animals? . ...
Do you have hay fever?
What is the name and address of the doctor
who has been treating you for your
asthma?
1 Q Yes 2 Q No COL (26)
1 Q Yes 2 Q No COL (27)
1 Q Yes 2 Q No COL (28)
1 n Yes 2 Q No COL (29)
1 Q] Yes 2 Q No COL (30)
1 rj Yes 2 Q No COL (31 )
1 Q] Yes 2 n No COL (32)
1 Q Yes 2 n No COL (33)
i
1 QJ Yes 2 Q No COL (34)
1 Q Yes 2 [J No COL (35)
1 [J Yes 2 Q No COL (36)
1 Q] Yes 2 n No COL (37)
1 Q Yes 2 Q] No COL (38)
roi n9-4-n
-49-
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Page 3
11 Have you smoked a total of more than 100
cigarettes during your entire life?
Do you smoke cigarettes now?
If you are a current or an ex-cigarette
smoker, how many cigarettes do (did)
you smoke each day? (Check only 1
answer).
Less than '/z pack per day
(1—5 cigarettes).
About Vz pack per day
(6—14 cigarettes) . .
About 1 pack per day
(15—25 cigarettes)
About T/2 packs per day
(26-34 cigarettes)
About 2 or more packs per day
(35 or more cigarettes).
How many years have you smoked cigarettes
(if you now smoke) or did you smoke (if
you are an ex-smoker)?
If you are an ex-cigarette smoker, when
did you last give up smoking?
Within the past 6 months
More than 6 months ago
1 Q Yes
Yes
2 d No
2 Q No
COL (42)
COL (43)
COL (44)
2 a
4 a
COL (45-46)
(Years)
COL (47)
2 d
12. Do you currently smoke cigars or a pipe?
1 CH Yes
2 No
COL (48)
13. How many other people in your home
smoke? (cigarettes, cigars or a pipe)
COL (49)
-50-
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Page 4
III. GENERAL HISTORY
1 . How many rooms are there in your
living quarters? (Do not count
bathrooms, porches, balconies,
foyers, halls, or ha If rooms.)
2. How many people live in your
household?
3. What educational level did the
head of your household complete?
1
2
3
4
5
01
02
03
04
05
06
2
3
4
5
6
7
Q One 6 G
D Two 7 G
G Three 8 G
G Four 9 G
G Five
G One 07 G
G Two 08 G
G Three 09 G
G Four 10 G
G Five 11 G
G Six 12 G
G Elementary school
G Part °f high school
G High school graduate
G Part of college
G College graduate
G Graduate school
n Other
Six COL (50)
Seven
Eight
Nine or
more
Seven COL (51 -52)
Eight
Nine
Ten
Eleven
Twelve or
more
COL (53)
(Please specify)
COL (79-80) 0 2
-51-
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NAME
I. PLEASE ANSWER FOR EACH DAY OF THE WEEK:
I.D. NUMBER
WEEK
1. DID YOU HAVE AN
ASTHMA EPISODE TODAY?
2. WERE YOU OUT OF YOUR
HOME NEIGHBORHOOD
ALL DAY TODAY
(24 HOURS)?
SUNDAY
©NO
©YES, ONE
OYES, TWO
OR MORE
©NO
OYES
MONDAY
©NO
O YES, ONE
O YES, TWO
OR MORE
©NO
OYES
TUESDAY
©NO
© YES, ONE
© YES, TWO
OR MORE
©NO
©YES
WEDNESDAY
©NO
OYES, ONE
OYES, TWO
OR MORE
©NO
OYES
THURSDAY
ONO
O YES, ONE
© YES, TWO
OR MORE
©NO
©YES
FRIDAY
©NO
© YES, ONE
O YES, TWO
OR MORE
©NO
OYES
SATURDAY
©NO
O YES, ONE
O YES, TWO
OR MORE
O NO
OYES
II. IF YOU DID HAVE AN ASTHMA EPISODE, PLEASE ANSWER THE QUESTIONS BELOW:
3. AT WHAT TIME DID THE
FIRST EPISODE BEGIN?
4. WERE YOU IN YOUR
HOME NEIGHBORHOOD
WHEN THE FIRST EPISODE
BEGAN?
5. WAS THE EPISODE (OR
EPISODES) SEVERE
ENOUGH TO KEEP YOU
FROM YOUR NORMAL
ACTIVITY OR FROM
SLEEPING AT NIGHT?
SUNDAY
©MIDNIGHT
TO 6 A.M.
©6 A.M. TO
NOON
©NOON TO
6 P.M.
OB P.M. TO
MIDNIGHT
©NO
©YES
©NO
©YES
MONDAY
©MIDNIGHT
TO 6 A.M.
©6 A.M. TO
NOON
ONOON TO
6 P.M.
Qe P.M. TO
MIDNIGHT
ONO
OYES
©NO
OYES
TUESDAY
OMIDNIGHT
TO 6A.M.
©6A.M. TO
NOON
©NOON TO
6 P.M.
Qe P.M. TO
MIDNIGHT
©NO
©YES
©NO
OYES
WEDNESDAY
OMIDNIGHT
TO 6 A.M.
©6 A.M. TO
NOON
ONOON TO
6 P.M.
Qe P.M. TO
MIDNIGHT
ONO
©YES
©NO
©YES
THURSDAY
©MIDNIGHT
TO 6 A.M.
©6 A.M. TO
NOON
©NOON TO
6 P.M.
©6 P.M. TO
MIDNIGHT
©NO
©YES
©NO
©YES
FRIDAY
©MIDNIGHT
TO 6 A.M.
©6 A.M. TO
NOON
ONOON TO
6 P.M.
Qs P.M. TO
MIDNIGHT
©NO
©YES
©NO
©YES
SATURDAY
©MIDNIGHT
TO 6 A.M.
©6A.M. TO
NOON
©NOON TO
6 P.M.
©6 P.M. TO
MIDNIGHT
©NO
©YES
©NO
©YES
OMB
158-R0019
Expires
8/31/73
1990
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jns-Optic F1240
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