United States EPA - 600/1 - 80 - 033
Environmental Protection November 1980
Agency
Research and
Development
Status of the Community Health and
Environmental Surveillance System
(CHESS)
Prepared for
United States House of Representatives
Committee on Science and Technology
Prepared by
Office of Health Research
Washington DC 20460
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EPA-600/1-80-033
November 1980
STATUS OF THE
COMMUNITY HEALTH AND ENVIRONMENTAL SURVEILLANCE SYSTEM
(CHESS)
REPORT
TO THE
U.S. HOUSE OF REPRESENTATIVES
COMMITTEE
ON
SCIENCE AND TECHNOLOGY
OFFICE OF RESEARCH AND DEVELOPMENT
U.S. ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, D.C. 20460
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TABLE OF CONTENTS
I. Introduction 1
II. Status of CHESS Data Analyses and Results Obtained 3
A. Validation of the Health Effects Data 3
B. Validation of the Aerometric Data 6
C. Further EPA Review and Analysis of CHESS Data 7
D. Review and Analysis of CHESS Data by Others
(than EPA) 9
E. Results Obtained from Analysis of CHESS Data 9
III. Pressure to Force EPA to Publish
or Not to Publish CHESS Results 11
A. AlSI/Steel Company Actions 11
B. UARG/EPRI/EEI Actions 12
C. NRDC Actions 13
APPENDIX A 15
Table A - CHESS Status 16
Table B - Current Status of CHESS Data Sets 17
Table C - CHESS Data Sets Validated 22
Table D - CHESS Data Sets Published (23) 24
Table E - CHESS Data Sets Provided to University of
North Carolina Under Contract 26
APPENDIX B 28
Current Status of Independent CHESS Analyses 29
APPENDIX C 31
PUBLISHED REPORTS RELATED TO CHESS
A. Pilot Studies (pre-CHESS) 32
B. Reports from CHESS Data Sets 35
C. General Reports Related to CHESS 41
APPENDIX D 44
OTHER REPORTS ON POLLUTANT BURDENS 45
iii
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Status of Community Health and Environmental Surveillance System
(CHESS)
I. Introduction
This report has been prepared in response to a request by the U.S.
House of Representatives' Committee on Science and Technology which
appears in House Report No. 96-959, page 61. The Committee requested
that the Administrator of EPA:
"...immediately (within 90 days) prepare and submit to the Committee
a comprehensive and substantial report on the status of the analysis
of CHESS data and on any results obtained with particular emphasis
on methods used to assure the soundness of any results. The report
should also describe any pressure the Agency has received to force
them to publish or not publish any CHESS results."
From 1969 to 1975 EPA conducted a series of epidemiologic studies
on the health effects of air pollution. These studies, together known
as the Community Health and Environmental Surveillance System (CHESS)
studies, were performed in several cities across the United States.
Several different populations and pollutants were studied. In 1974 EPA
published a monograph on the health effects of sulfur oxides (hereafter
called the CHESS monograph) which reported results from the early years
of the CHESS studies. After unfavorable publicity about the CHESS
studies, subcommittees of the House Committee on Science and Technology
conducted an investigation into the technical adequacy of the CHESS
studies in 1976. In their Investigative Report the subcommittees
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made seventeen recommendations about the analysis and use of those studies and
of CHESS data generally.
In the Environmental Research, Development and Demonstration Authorization
Act (Research Authorization Act) of 1978, Congress directed that the
Administrator of EPA implement the recommendations of the Investigative Report,
unless for any specific recommendation he determines that implementation has
already occurred, that the quality of research would not thereby be enhanced,
or that funding is unavailable (in which case funding is to be sought
2
from Congress). EPA1s implementation of these recommendations is documented
in reports to Congress by the Administrator (EPA Research Outlook, 1978
and 1979) and the EPA Science Advisory Board (Report of the Health
Effects Research Review Group, February, 1979), which are reproduced in
the CHESS addendum (supra, note 1). Among the pertinent recommendations
in the Investigative Report, Recommendation 6(a) directs that unanalyzed CHESS
data be examined by year and that analysis be carried out only on those data
that appear to have a higher degree of validity than the 1969-1971 data
used as a basis of the 1974 CHESS Monograph. Recommendation 6(b) is
that completed analyses be published in traditional scientific peer-
reviewed journals, and not simply in monograph form. Recommendation
3(b) is that EPA not utilize the CHESS monograph as a source of quantitative
data supportive of standards without explicit qualification.
The Investigative Report ("The Environmental Protection Agency's Research Program
with Primary Emphasis on the Community Health and Enviornmental Surveillance System
CHESS): An Investigative Report, November 1976") is available as part of an
addendum to the CHESS monograph. The addendum (EPA 600/1-80-021, April, 1980) was
announced to the public in the Federal Register of April 2, 1980 (45 FR 21702).
That addendum was published pursuant to Recommendation 3(c) of the Investigative
Report, and is being forwarded to the House Committee on Science and Technology
with this report.
2
Section 10 of the Research Authorization Act of 1978, P.L. 95-155, November 8,
1977 (42 U.S.C. §4361b). 9
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II. Status of CHESS Data Analyses and Results Obtained
In implementing the recommendations from the Investigative Report and
in assuring the validity of data analyses and the quality of results obtained
EPA has taken the actions described below. Tables A and D in Appendix A show
respectively the current status of CHESS data sets and publications to
date from those data sets. EPA has recently also discussed these matters
at a public meeting of the Clean Air Scientific Advisory Committee
(CASAC) of the EPA Science Advisory Board (SAB) on August 20-22, 1980,
in Arlington, Virginia. CASAC was established under Section 109(d)(2)
of the Clean Air Act (42 U.S.C. §7409(d)(2)) to provide advice to the
Administrator on such matters.
The status of CHESS data analyses and methods used to assure soundness
of both health effects and aerometric data are described below. Thereafter,
the review and analysis of CHESS data by both EPA and others, and results
obtained, are discussed.
A. Validation of the Health Effects Data
An additional data quality assurance procedure has been applied to
the health questionnaire information. This technique involves additional
checking to confirm that the data on the computer data tape files are
consistent with the original source document responses. The major
advantage of this approach is that any errors introduced into the data
set during the data processing phase can be identified and corrected.
The successful application of this procedure to 61 CHESS data sets
during 1977-1979 required 32 person-years of effort and $140,000 of
computer time by EPA's Health Effects Research Laboratory in Research
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Triangle Park, North Carolina (HERL/RTP) (see Table C in Appendix A).
Since 1976, analysis of CHESS data has been performed only after the
relevant data sets have undergone this additional quality assurance
procedure. A relevant report is:
Chamblee, CP: USE OF STATISTICAL SAMPLING IN VALIDATING HEALTH
EFFECTS DATA. In: Data Validation Conference Proceedings,
EPA Report No. EPA 600/9-79-042, pp. 31-38, September, 1979.
With this validation step alone the remaining CHESS data are of
demonstrably greater reliability than those used as the basis for the
1974 CHESS monograph. EPA has determined that such data, including
those being analyzed under contract at the University of North Carolina
(see II. C., infra), are acceptable for further analysis in accordance
with Recommendation 6(a) of the Investigative Report. Of course, the simple
fact of comparatively greater reliability does not assure that the data or
subsequent analyses are of such reliability as to be useful for standard-
setting or other purposes. Rather, the general overall reliability and
validity of CHESS data and procedures are subject to public and scientific
scrutiny at the time CHESS studies are published in peer-reviewed journals
or are proposed to be included in criteria documents or to be used as a
basis for standards.
Beyond the aforementioned data validation procedures, the validity
of the statistical analysis was carefully reviewed. The Investigative Report
has little criticism and, in fact, some praise for the EPA analysis of the
cross-sectional studies. There was more criticism of the panel data analysis
involving temporal comparison of asthmatic attacks or cardiopulmonary
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symptoms. EPA agreed with this assessment and funded resource grants
which have been successful in developing improved analysis methods for
these studies. Relevant reports are:
Whittemore, AS; Keller, JB: ASTHMA AND AIR POLLUTION: A QUANTITATIVE
THEORY. Energy and Health, Proceedings of SIMS Conference,
Alta, Utah, June, 1978. N. E. Breslow and A. S. Whittemore,
Editors. Philadelphia: SIAM, 1979.
Korn, EL; Whittemore, AS: METHODS FOR ANALYZING PANEL STUDIES OF
ACUTE HEALTH EFFECTS OF AIR POLLUTION. Biometrics 35(4),
December, 1979.
Whittemore, AS; Korn, EL: ASTHMA AND AIR POLLUTION IN THE LOS
ANGELES AREA. A. Jour. Public Health 70(7): 687-696, July,
1980.
As described previously., validation of 61 data sets has been completed.
Four data sets not to be validated involve "episode" studies. They are
New York City (1971-72), the Southeast area (Birmingham and Charlotte,
1971-72), Chattanooga (1971-72), and California (1973). There are three
major considerations underlying the decision that these data sets not
be validated or subject to full analysis:
(1) As the initial episode studies were analyzed (New York City
and Birmingham-Charlotte, 1970-71), concern for a systematic
reporting bias in the study respondents became evident, opening
any conclusions to serious question.
(2) Although the studies were designed to take advantage of opportunities
to study episodes of high air pollution, in retrospect when
the air quality data were more carefully examined there were
frequently only marginal exposure differences between the time
periods studied.
(3) The data from these studies are the most difficult, logistically,
to retrieve and validate.
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B. Validation of the Aerometric Data
The aerometric data from the early CHESS studies in the 1974 monograph
were also criticized in the Investigative Report. One of the major limitations
identified was the difficulty in estimating prior air pollution exposures of
the study participants, because the monitoring data base over time was
either very short or nonexistent. The later CHESS studies necessarily
benefit from the availability of a longer historical record of pollution
exposure information.
The Investigative Report further included statements regarding possible
correction procedures that might be employed to ascertain more valid
aerometric estimates than those provided by the original CHESS monitoring
efforts. These statements included references to the use of aerometric
data from local or state air monitoring systems where they existed side
by side with the CHESS monitoring stations. Other statements were made
in the Report to the effect that more valid estimates of certain air
pollutant levels monitored by the CHESS system could be obtained by correcting
original reported values upward to revised levels likely to have existed,
taking into account estimated maximum likely error ranges for such measurements.
Personnel from the EPA Environmental Monitoring and Support Laboratory
in Research Triangle Park, North Carolina (EMSL/RTP) performed validation
of aerometry data for the study locations and years associated with the
health data sets validated as described above (in II. A.). This aerometry
validation, completed in 1978, consisted of inspecting for consistency
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both data collection records and previously discarded air quality measurements
(those not meeting pre-specified criteria established for determination
o
of acceptable quality aerometric data ).
Although some deletions or omissions have been identified in the
aerometry data, these data gaps are believed by EPA's EMSL/RTP and
HERL/RTP to be few and are therefore believed to exert little effect
upon long-term data averages (quarterly, annual, etc.) needed for analysis
of health effects associated with long-term exposures (acute respiratory
disease, chronic respiratory disease, lower respiratory disease, and
pulmonary function studies). These deletions or omissions are believed
to be significant enough to cast doubts upon the reliability of results
from analyzing health data sets based on short-term (daily, weekly,
monthly) exposures (asthma and cardiopulmonary panels and episode
studies).
Finally; efforts have been made to correct many of the deficiencies
in collection and analysis of aerometry data associated with the early
CHESS studies. The utilization of the Community Health Air Monitoring
Program (CHAMP) system with automated data collection capabilities, for
example, permitted more extensive aerometric data validation with the
later data sets (post-CHESS).
C. Further EPA Review and Analysis of CHESS Data
Subsequent to release of the Investigative Report in 1976, each of the
previously unpublished CHESS data sets underwent critical examination by EPA,
3
The criteria for acceptable quality aerometric data as well as descriptions
.of monitoring methods are contained in a January, 1976, EPA publication,
Community Health and Environmental Surveillance System Air Pollution
Monitoring Handbook: Monitoring Methods (EPA 600/1-76-011).
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involving each point discussed above, before any further analysis was
initiated. In addition, once analysis has been initiated, critical
examination continues both by EPA and by contractors hired to perform
the analyses. Analysis of one data set, Chattanooga PFT 1973-74, was
cancelled after completion of initial validation procedures because of an
uncorrectable data coding problem.
EPA entered into a contract with Dr. Carl Shy at the University of
North Carolina (UNC) School of Public Health in 1977 to produce reports
on 36 CHESS data sets. All the data sets provided to Dr. Shy had been
revalidated through the procedures discussed above. (One data set,
Chattanooga PFT 1973-1974, was subsequently found to contain coding
errors serious enough to warrant its removal from inclusion, as mentioned
in the preceding paragraph, bringing the total number of data sets to be
analyzed by Dr. Shy to 35.) The contract calls for delivery 36 months
from its effective date, September 1, 1977, of 12-21 manuscripts of
quality suitable for publication at a cost to EPA of approximately
$590,000 over the three-year period. Dr. Shy has requested an extension
of the contract period at no additional cost to EPA. The sets provided
to UNC are identified in Tables B & E in Appendix A of this report. To
date, Dr. Shy has forwarded five analyses to EPA for preliminary (pre-
publication) review.
4
It should be noted that a three-person non-EPA peer review panel recruited
by the UNC group reviews all planned publications of the Shy analyses.
(See the Report of the Health Effects Research Review Group, republished
in the CHESS addendum at p. 206, supra, note 1.) Further, as discussed
at the CASAC meeting of August 20-22, 1980, any such analyses will be
cited in air quality criteria documents prepared by EPA pursuant to
Section 108 (a) (2) of the Clean Air Act (42 U.S.C. §7408 (a) (2)) only
if they conform to guidelines approved by CASAC.
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D. Review and Analysis of CHESS Data by Others (Outside EPA)
Numerous requests for copies of the CHESS reports and data files
have been received and honored by EPA under the Freedom of Information
Act or otherwise. Copies of computer tapes containing the data files
provided to requestors have been coded in the interest of confidentiality.
A list of the 13 individuals and organizations who have made such requests
appears in Appendix B.
E. Results Obtained from Analysis of CHESS Data
Appendix C contains a list of published reports which relate to
CHESS and to the CHESS data. With one exception, no results from analyses
of the validated data sets have yet been published by EPA or its contractor.
The single exception mentioned above is a report by Drs. Shy and
Love given at a meeting of the Air Pollution Control Association (APCA)
in Hawaii in 1979 and subsequently published in proceedings of that
meeting. (See Appendix C, I. B. 25.) The results of that study were
derived from initial CHESS analyses performed on the Chattanooga acute
respiratory disease (ARD) 1971-72 and 1972-73 data sets under the EPA
contract with Dr. Shy.
The study results were included in the July, 1979, Second External
Review Draft of the EPA NO Criteria Document. As part of public comments
on the NO document draft and in subsequent meetings with EPA, the
x
Utility Air Regulatory Group (UARG), the Electric Power Research Institute
(EPRI), and the Edison Electric Institute (EEl) commented on the Chattanooga
ARD 1972-73 study. [That study was one of several conducted in the
CHESS program to follow-up earlier (1968) studies in Chattanooga which
were performed by Shy and which in part formed the basis for the 1970 National
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Ambient Air Quality Standard (NAAQS) for NO .] UARG, EPRI, EEI, and
their statistical consultants, Roth and Associates, questioned the
validity and interpretation of both the 1968 Shy Chattanooga studies and
the 1972-73 Chattanooga ARD study, as well as British indoor pollution
studies. Roth and Associates were unable to duplicate the Shy and Love
(1979) results, despite use of the same statistical analyses of data
from copies of the 1971-72 and 1972-73 Chattanooga ARD data sets on
computer tapes obtained from EPA. Roth noted problems ascertaining the
criteria employed by Shy and Love to exclude subjects from analyses or
to assign subjects to study groups according to demographic characteristics,
Roth and Associates representatives met in Chapel Hill, North
Carolina, with Shy's group at the UNC School of Public Health in June,
1980. The two groups compared the contents of their data analysis files
as a first step toward identifying sources of discrepancies in their
results. Data handling errors were discovered which had occurred in
transferring data from EPA's validated data files to the working analysis
files of Shy's group. Other potential problems were noted with the UNC
analyses concerning assessment of possible confounding effects due to
racial, socioeconomic, or other factors. The UNC group agreed (1) to
correct the aforementioned errors in data handling, (2) to reexamine
their assessment of confounding factors or co-variables in reanalyzing
the 1972-73 Chattanooga ARD data, and (3) to provide clear documentation
of criteria employed for exclusion or classification of subjects and of
other considerations in performing the reanalysis. In the meantime,
discussion of the published Shy and Love (1979) analyses has been deleted
10
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from a revised NO criteria document draft. These developments were
X
also discussed publicly at the August, 1980, meeting of the Clean Air
Scientific Advisory Committee (CASAC).
III. Pressure to Force EPA to Publish or Not to Publish CHESS Results
Since the release of the 1976 Investigative Report on CHESS and enactment
of the Research Authorization Act of 1978, industrial and environmental interest
groups have taken actions which could be construed as exerting pressure
on EPA to publish or not to publish CHESS data. The smelting industry,
for instance, has long criticized the CHESS studies. Many groups have also
submitted written comments concerning CHESS during reviews of the various draft
NO, criteria documents, and the first external review draft of a revised
criteria document for particulate matter and sulfur oxides (PM/SO ) which was
released in April, 1980. Three main interest groups or coalitions, however,
can be identified as having recently exerted pressures to affect EPA's publi-
cation or possible use of CHESS studies: (1) the American Iron and Steel
Institute (AISl) and member steel companies; (2) the Utility Air Regulatory
Group (UARG) and associated organizations such as the Electric Power Research
Institute (EPRl) and the Edison Electric Institute (EEl); and, to a lesser
extent, (3) the Natural Resources Defense Council (NRDC).
A. AlSI/Steel Company Actions
AISI and member steel companies have brought a succession of legal
actions against EPA in federal district court in Pittsburgh in connection with
EPA's current review and revision of the criteria document for particulate matter
under Section 108 of the Clean Air Act (42 U.S.C. § 7408). Some of these actions
11
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have involved, directly or indirectly, the analysis and possible future regulatory
use of CHESS studies. These and related AISI actions include:
(1) The taking of 41 depositions on CHESS and other subjects from EPA
staff members, Drs. Carl Shy and Gory Love at UNC, and other scientists
as part of discovery proceedings connected with AISI vs. Costle,
No. 78-92 (W. D. Pa.). In connection with the 2 1/2 years of
litigation, AISI has demanded the deletion of any reference to CHESS
analyses from the revised PM/SO criteria document now in preparation,
X
and assurances that CHESS analyses would not be used in considering
revision of the primary (health) National Ambient Air Quality
Standard for particulate matter. The lawsuit recently was settled,
without terms affecting EPA's analysis or possible use of CHESS.
(2) The meeting of AISI representatives and attorneys with Dr. Stephen
Gage, EPA Assistant Administrator for Research and Development,
and other ORD officials to discuss CHESS-related issues in
December, 1979. The meeting followed EPA's refusal to terminate
Dr. Shy's contract, as requested by AISI in a letter to the
Administrator of April 18, 1979. AISI attorneys repeated
demands that all CHESS results be excluded from consideration
in the PM/SO document and that the Shy contract be terminated.
x 3
(3) The initiation by AISI and member steel companies in February, 1980,
of further legal proceedings against EPA seeking (1) the
suspension of Dr. Shy's contract, and all other epidemiologic
research funded by EPA; (2) suspension of EPA's analysis of
any CHESS data; and (3) a prohibition against EPA's use of any
CHESS data in current EPA regulatory activities, pending
12
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court-supervised "implementation" of Recommendations 3, 6, and
10 of the Investigative Report. AISI vs. Costle, No. 80-218
(W. D. Pa.)
B. UARG/EPRI/EEI Actions
Without resort to the courts, several electric industry groups have
brought to the attention of EPA new information and constructive criticism
regarding various CHESS studies. The utility interest groups and their
statistical consultants, Roth and Associates, have had meetings and communications
concerning CHESS both with EPA officials and with Drs. Shy and Love at UNC.
They have discussed the 1972-73 Chattanooga ARD study (see II. E. above) and
other CHESS studies concerning NO , PM, and SO . Recently, UARG submitted
X X
comments to EPA on the April, 1980, PM/SO criteria document draft, including
X
substantive analyses of CHESS. EPA has also sought advice from the
Science Advisory Board (SAB) Clean Air Scientific Advisory Committee
(CASAC) concerning UARG's CHESS information, and the possible use of CHESS
data for standard setting purposes.
C. NRDC Actions
Actions which have been taken by NRDC relative to publishing and
using CHESS data are:
(1) Telephone conversations between NRDC representatives and EPA
officials in which NRDC said that important information could
be derived from certain CHESS studies (including some unpublished
analyses) concerning PM/SO health effects and that the CHESS
X
studies should not be universally excluded from the document
in response to the AISI lawsuit.
13
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(2) A petition filed by NRDC with the Administrator of EPA requesting
that a criteria document be prepared reviewing scientific
evidence for setting a fine particle standard. Several CHESS
studies were cited as examples of scientific evidence supporting
the NRDC petition.
(3) Concerns expressed regarding the propriety of EPA meeting with
industry groups to receive new information on CHESS. In a
November, 1979, public meeting attended by NRDC, EPA had
offered to meet with any party at any time to discuss new
information related to CHESS. In response to NRDC's recently
expressed concerns, EPA has agreed to inform NRDC of any
future CHESS-related meetings with other parties so that NRDC
may attend if it so desires.
14
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APPENDIX A
15
AWBERG LIBRARY u.o. tr>V
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Table A
CHESS STATUS
Summary:
Total Data Sets 83
Data Sets Published 23*
Total Publications Related to CHESS (see Appendix C) 57*
Data Sets Validated 61
Data Sets Provided to the University of North Carolina for Analysis. . 36t
Data Sets Not Planned to be Analyzed or Published 27
*Total includes data sets "published" in 1974 CHESS Monograph and other
EPA technical publications as well as some in peer-reviewed publications
or journals.
tDiscovery of coding errors in one data set has reduced the number of data
sets to be analyzed to 35, as discussed in Section II. C. of this report.
16
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Table B (see Key, p. 19)
CURRENT STATUS OF CHESS DATA SETS
New York
1 CRD 1970
2 CRD 1972
a,b
c.d.f
3 LRD 1972b)C)d
4 PFT 1970-71a'b
5 PFT 1971-72C'd
6 PFT 1972-73C'd)f
7 PFT 1973-74C'd'f
8 PFT 1974-75C'd>f
9 ARD 1970-71a'b
10 ARD 1971-72C'd'f
11 ARD 1972-73C>d>f
12 Asthma 1970-71*
13 Asthma 1971-72C'8'8
14 Asthma 1972-73C>e'g
15 Asthma 1973-74°>d'e>8
16 Asthma 1974-75°ğd>e'8
17 Cardiopulmonary 1970-71'
18 Cardiopulmonary 1971-72
19 Cardiopulmonary 1972-73C'e'8
20 Cardiopulmonary 1973-74°ğd'e>8
21 Cardiopulmonary 1974-75C'd>e>g
22 (NJ) CRD 1971
23 (NJ) LRD 1971
c,f
c,f
24 Episodes 1970-71
25 Episodes 1971-72*
Utah
26 CRD 1970
a,b,c
,a,b,c
27 LRD 1970
28 PFT 1971-72C>d)f
29 PFT 1972-73C'd>f
30 PFT 1973-74C)d'f
31 PFT 1974-75C)d>f
32 ARD 1971-72C)d)f
33 ARD 1972-73C)d)f
34 Asthma 19713
35 Asthma 1971-72C>e>g
36 Asthma 1972-73C>e'8
37 Asthma l973-74Cjd>e>g
38 Asthma 1974-75°>d'e>8
39 Cardiopulmonary 1971-72C>e'g
40 Cardiopulmonary 1972-73C'e'g
41 Cardiopulmonary 1973-74°)d'e'8
42 Cardiopulmonary 1974-75°>d'e'8
17
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Table B (continued)
Birmingham-Charlotte (Southeast)
43 CRD 1971
44 LRD 1971
c,f
b,c
45 PFT 1971-72b'C
46 PFT 1972-73C'd'f
47 PFT 1973-74C'd>f
48 PFT 1974-75C)d'f
49 ARD 1970-71C>d>f
50 ARD 1971-72C'd>f
51 ARD 1972-73C'd>f
52 Asthma 1971-72C'e>g
53 Asthma 1972-73C>e'g
54 Asthma 1973-74°ğd'e'g
55 Asthma 1974-75C'd>e'8
56 Episodes 1970-71b
57 Episodes 1971-72h
Chattanooga
58 CRD 1971
59 LRD 1971
60 CRD 1973
c,f
c,f
c.d.f
61 LRD 1973C>d>f
62 PFT 1971-725
63 PFT 1972-73C>d'f
64 PFT 1973-74C>d'h
65 ARD 1971-72b'C>d'f
66 ARD 1972-73b'C>d'f
67 Asthma 1972-73b'C
68 Episodes 1971-72h
California
69 CRD 1971C'd'f
70 LRD 1971C'd'f
71 PFT 1972C'd'f
72 PFT 1972-73C'd'f
73 PFT 1973-74Cjd>f
74 PFT 1974-75C>d>f
75 ARD 1972-73C'd>f
76 Asthma 1972-73b)C'e
77 Asthma 1973-74b'C'd'e
78 Asthma 1974-75b)C'd>e
^_ c,d,e,g
79 Cardiopulmonary 1973-74
80 Cardiopulmonai
81 Episodes 1973*
80 Cardiopulmonary 1974-75C'd'e'8
Montana-Idaho
82 CRD 1970
83 LRD 1970
a,b
a,b
18
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Table B (Key)
a Published in 1974 CHESS Monograph
b Published elsewhere
c Additional questionnaire quality assurance has been performed
d More extensive air monitoring data base has been applied for exposure
assessment
e Improved methodological development of statistical analysis has
been applied
f Additional analyses still in progress by UNC
g No additional analyses have been initiated to date
h No analyses are warranted because of poor data set quality
A very brief description of each CHESS health indicator follows:
Chronic respiratory disease (CRD). Adult chronic respiratory
disease prevalence was estimated by a self-administered questionnaire
adapted from that used by the British Medical Research Council. The
questionnaire inquired whether the subject coughed and produced phlegm
for at least three months of the previous year. These studies compared
CRD prevalence in otherwise similar communities selected for their air
pollution gradient. The CRD community rates can be adjusted for important
covariates such as age, race, cigarette smoking, socio-economic status,
and occupational exposure to dust or fumes.
Lower respiratory disease (LRD). The questionnaire ascertained
retrospective information from mothers concerning the number of pneumonia,
croup and bronchitis episodes experienced by their children under age 12
19
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Table B (continued)
during the previous three years. These illness rates were compared
across communities. The LRD rates can be adjusted for major covariables
of age, sex, and socioeconoraic status.
Acute respiratory disease (ARD). Telephone interviewers made
biweekly calls to mothers of families enrolled in the study to inquire
whether any family member had developed upper or lower respiratory
illness in the preceding two weeks, and, if so, whether a doctor had
been consulted and how many days of restricted activity had eventuated.
The major response variables were the number of respiratory illnesses
per 100 person-weeks exposure (the attack rate) and the severity score,
which reflected physician visits, fever, and restricted activity. These
studies were performed for about 40 weeks. Rates for each type of
family member may be compared across communities. Adjustment to the ARD
rates can be made for age, race, cigarette smoking, and socioeconomic
status.
Pulmonary function tests (PFT). The ventilatory function of elementary
school children was measured using a peak flow meter three times each
year, once each in the fall, winter, and spring. Major covariates were
age and height. The average rates, appropriately adjusted, were compared
across communities.
Asthma panel studies. Selected asthmatic subjects kept daily
diaries of their asthma attack experience. The daily fluctuations in
the panel's illness experience was compared to daily fluctuations in air
pollutant and meteorologic variables such as sulfur dioxide, nitrogen
20
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Table B (continued)
dioxide, particulates, ozone, sulfates, nitrates, temperature, and
humidity. The time series analyses can be performed by various techniques
which can appropriately resolve the inherent analysis complications,
such as frequent changes in panel composition and daily dependence of
the response variable.
Adult (cardiopulmonary) panel studies. Cardiopulmonary symptoms
were reported daily by a panel of adult subjects. Daily symptom rates
for these panels were compared with daily fluctuations in the levels of
the same pollutant and meteorologic variables listed above with the
asthma studies. Appropriate time series analyses, similar to those used
in the asthma studies, can be performed.
Episode studies. Minor irritation symptoms such as eye irritation,
chest and throat discomfort, etc., were reported by volunteer panelists
during time periods of elevated air pollution and during "control"
periods of normal pollution levels. Differences in reported symptom
rates between time periods were tested for significance by nonparametric
methods.
21
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Table C
CHESS DATA SETS VALIDATED
(For definitions of terms, see Key, Table B)
Study Areas
1. CRD Chattanooga 1971
2. LRD Chattanooga 1971
3. ARD Chattanooga 1971-72
4. ARD Chattanooga 1972-73
5. ARD Southeast 1970-71
6. ARD Utah 1972-73
7. PFT Utah 1971-72
8. PFT Utah 1972-73
9. PFT Utah 1973-74
10. PFT Utah 1974-75
11. Asthma California 1972-73
12. Asthma New York 1971-72
13. Asthma Utah 1971-72
14. Asthma Southeast 1971-72
15. Adult Cardiopulmonary New York 1973-74
16. Adult Cardiopulmonary Utah 1973-74
17. ARD Utah 1971-72
18. CRD California 1971
19. LRD California 1971
20. ARD California 1972-73
21. ARD Southeast 1971-72
22. CRD New Jersey 1971
23. LRD New York 1971
24. PFT California 1974-75
25. CRD Southeast 1971
26. Asthma California 1973-74
27. Asthma California 1974-75
28. PFT California 1972-73
29. Asthma Utah 1973-74
30. Asthma New York 1972-73
31. PFT California 1972
32. ARD New York 1971-72
33. Asthma New York 1973-74
34. CRD New York 1972
35. Asthma Utah 1974-75
36. Asthma Southeast 1972-73
37. Asthma Utah 1972-73
38. PFT California 1973-74
39. CRD Chattanooga 1973
40. LRD Chattanooga 1973
Completed
09/06/77
09/06/77
09/06/77
09/06/77
04/22/77
11/01/77
09/29/77
06/15/77
11/23/77
10/17/77
05/16/77
02/09/77
11/23/74
11/10/77
03/30/77
04/08/77
12/12/77
12/23/77
12/23/77
01/30/77
03/31/78
03/20/78
03/20/78
03/31/78
05/08/78
05/10/78
05/10/78
05/18/78
05/22/78
05/22/78
05/31/78
06/09/78
06/14/78
06/27/78
07/05/78
07/12/78
07/13/78
07/26/78
08/17/78
08/17/78
22
-------
Table C (continued)
CHESS DATA SETS VALIDATED
Study Areas
41. PFT Southeast 1972-73
42. PFT Chattanooga 1972-73
43. PFT Southeast 1973-74
44. ARD Southeast 1972-73
45. ARD New York 1972-73
46. Adult Cardiopulmonary California 1974-75
47. Adult Cardiopulmonary New York 1972-73
48. Adult Cardiopulmonary New York 1974-75
49. Asthma Chattanooga 1972-73
50. Asthma Southeast 1973-74
51. PFT New York 1973-74
52. PFT New York 1974-75
53. Asthma New York 1974-75
54. PFT Southeast 1974/75
55. Asthma Southeast 1974-75
56. Adult Cardiopulmonary California 1973-74
57. Adult Cardiopulmonary Utah 1972-73
58. Adult Cardiopulmonary Utah 1974-75
59. PFT Chattanooga 1973-74
60. PFT New York 1972-73
61. Adult Cardiopulmonary Utah 1971-72
Completed
08/22/78
08/22/78
08/22/78
08/25/78
08/25/78
09/15/78
09/15/78
09/15/78
09/18/78
09/18/78
10/06/78
10/06/78
10/19/78
11/06/78
11/07/78
12/08/78
12/08/78
03/01/79
04/24/79
06/12/79
05/01/79
23
-------
Table D
CHESS DATA SETS PUBLISHED (23)
(For definitions of terms, see Key; Table B)
Stud}
Study # From Table B
Publication
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17-
18.
19.
20.
21.
22.
23.
New York CRD 1970
Utah CRD 1970
Montana-Idaho CRD 1970
Utah LRD 1970
Montana-Idaho LRD 1970
New York LRD 1972
New York ARD 1970-71
New York Asthma 1970-71
Utah Asthma 1971
New York Adult 1970-71
New York Adult 1971-72
New York PFT 1970-71
Southeast PFT 1971-72
New York Episodes 1970-71
Southeast Episodes 1970-71
Chattanooga PFT 1971-72
Southeast LRD
Chattanooga Asthma 1972-73
Chattanooga ARD 1971-72
Chattanooga ARD 1972-73
California Asthma 1972-73
California Asthma 1973-74
California Asthma 1974-75
(1.)
(26.)
(82.)
(27.)
(83.)
(3.)
(9.)
(12.)
(34.)
(17.)
(18.)
(4.)
(45.)
(24.)
(56.)
(62.)
(44.)
(67.)
(65.)
(66.)
(76.)
(77.)
(78.)
I,
I,
I,
I
I
II
I,
I
I
I
III
I,
II
IV
IV
VI
VII
XIII
IX
IX
X
X
X
V
V
V
V
V
Publications
I. Health Consequences of Sulfur Oxides: A report from CHESS,
1970-1971, EPA-650/1-74-004, May, 1974.
II. Clinical Implications of Air Pollution Research, Proceedings of
American Medical Association, Air Pollution Medical Research
Conference, 1976.
24
-------
Table D (continued)
III. Environmental Research, Volume 11, 1976.
IV- Journal of the Air Pollution Control Association, Volume 23,
1973.
V. Archives of Environmental Health, Volume 27, 1973.
VI. EPA Technical Report.
VII. Respiratory Disease in Children Exposed to Sulfur Oxides and
Particulates. EPA 600/1-77-043, September, 1977.
VIII. Environmental Research, Vol. 17, 1978.
IX. Recent Evidence on the Human Health Effects of Nitrogen Dioxide,
In: Nitrogen Oxides and Their Effects on Health
Ann Arbor Science, 1980.
X. Amer. Jour. Pub. Health. 70(7), 1980.
25
-------
Table E
CHESS DATA SETS PROVIDED TO THE UNIVERSITY OF NORTH CAROLINA UNDER CONTRACT
ACUTE RESPIRATORY DISEASE SURVEYS
1. New York
2. New York
3. Salt Lake Basin
4. Salt Lake Basin
5. Chattanooga
6. Chattanooga
7. Southeast
8. Southeast
9. Southeast
10. Utah
1971-
1971-
1971-
1972-
1971-
1972-
1970-
1971-
1972-
1972-
1972
1973
1972
1973
1972
1973
1971
1972
1973
1973
PULMONARY FUNCTION STUDIES
11. Salt Lake Basin
12. Salt Lake Basin
13. Salt Lake Basin
14. Salt Lake Basin
15. Los Angeles Basin
16. Los Angeles Basin
17. Los Angeles Basin
18. Los Angeles Basin
19. Chattanooga
20. Chattanooga
21. New York
22. New York
23. New York
1971-
1972-
1973-
1974-
1972
1972-
1973-
1974-
1972-
1973-
1972-
1973-
1974-
1972
1973
1974
1975
1973
1974
1975
1973
1974*
1973
1974
1975
*Data set subsequently withdrawn and deleted from analysis program due to
discovery of coding errors in the field.
26
-------
Table E (continued)
PULMONARY FUNCTION STUDIES
24. Southeast 1972-1973
25. Southeast 1973-1974
26. Southeast 1974-1975
CHRONIC RESPIRATORY DISEASE SURVEYS
27. Chattanooga 1971 (1)
28. Chattanooga 1973
29. Los Angeles Basin 1971
30. Southeast 1971
31. New York 1972
32. New Jersey 1971
LOWER RESPIRATORY DISEASE SURVEYS
33. Chattanooga 1971
34. Chattanooga 1973
35. Los Angeles Basin 1971
36. New Jersey 1971
27
-------
APPENDIX B
28
-------
Current Status of Independent CHESS Analyses
Requestor
Kennecott Copper Corporation
(Analyzed by A. D. Little,
Inc.)
Date Provided
1974
Dr. Donald R. McNeil 1975
Department of Statistics
Princeton University
Dr. Neil Roth1 1975
Office of Program Evaluation
Office of Planning and
Management, EPA
Mr. John Waite 1975
Cryptanalytic Computer
Sciences, Inc.
Mr. Ralph Mitchell 1973
Battelle Columbus
Mr. John Viren 1975
Greenfield, Attaway, and
Tyler, Inc. 1977
Dr. John Goldsmith 1976
California State Dept. of Health
Dr. Edward Faeder 1976
So. California Edison, Inc.
Specific Study
*Utah Asthma 1971
Utah CRD
Utah LRD
New York Asthma 1970-71
New York Adult 1970-71
New York CRD 1970
New York PFT 1970
(Same as above)
(Same as above)
New York Asthma 1970-71
Utah Asthma 1971
New York ARD 1970-71
*New York Asthma 1970-71
*New York Asthma 1971-72
New York CRD 1970
California Asthma,
1972-73
*California Asthma,
1972-73
*Report or draft report on reanalyses prepared by requestors. Note that
data sets with dates before 1972 were among those discussed in 1974 CHESS
monograph.
TNow of Roth and Associates, statistical consultants to the Utility Air
Regulatory Group, the Electric Power Research Institute, and the Edison
Electric Institute.
29
-------
Current Status of Independent CHESS Analyses (continued)
Requestor
Dr. Alice Whittemore
Stanford University
Dr. Robert Mendelsohn
Yale University
Date Provided
1978
1976
Dr. Lyman Olsen
Utah State Dept. of Health
1976
Reed, Smith, Shaw & McClay, for 1979
American Iron & Steel Institute
Hunton and Williams, for
Utility Air Regulatory
Group
1979
Specific Study
California Asthma, 1972-73
California Asthma, 1973-74
California Asthma, 1974-75
New York CRD 1970
New York PFT 1970-71
New York Asthma 1970-71
New York Adult 1970-71
Utah CRD 1970
Utah LRD 1970
Chattanooga CRD 1971
Chattanooga LRD 1971
Chattanooga ARD 1972-73
Utah Asthma 1970-71
Utah CRD 1970
Utah LRD 1970
All Available Data Sets
All Available Data Sets
*Report or draft report on reanalyses prepared by requestors. Note that
data sets with dates before 1972 were among those discussed in 1974 CHESS
monograph.
30
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APPENDIX C
31
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PUBLISHED REPORTS RELATED TO CHESS
A. Pilot Studies (pre-CHESS)
1. Pearlman, ME; Finklea, JF; Creason, JP; Shy, CM; Young, MM; Horton,
RJM: NITROGEN DIOXIDE AND LOWER RESPIRATORY ILLNESS. Pediatrics
47:391-398, February, 1971.
2. Shy, CM; Creason, JP; Pearlman, ME; McClain, KE; Benson, FB;
Young, MM: THE CHATTANOOGA SCHOOL CHILDREN STUDY: EFFECTS
OF COMMUNITY EXPOSURE TO NITROGEN DIOXIDE. I. METHODS,
DESCRIPTION OF POLLUTANT EXPOSURE, AND RESULTS OF VENTILATORY
FUNCTION TESTING. J. Air Pol. Control Assoc. 20(8): 539-545,
August, 1970.
3. Shy, CM; Creason, JP; Pearlman, ME; McClain, KE; Benson, FB;
Young, MM: THE CHATTANOOGA SCHOOL CHILDREN STUDY: EFFECTS
OF COMMUNITY EXPOSURE TO NITROGEN DIOXIDE. II. INCIDENCE
OF ACUTE RESPIRATORY ILLNESS. J. Air Pol. Control Assoc.
20(9): 582-588, September, 1970.
4. Cohen, AA; Bromberg, SM; Buechley, RW; Heiderscheit, LT; Shy,
CM: ASTHMA AND AIR POLLUTION FROM A COAL-FUELED POWER
PLANT. Am. J. Public Health 62(9): 1181-1188, September, 1972.
5. Hauser, TR; Shy, CM: POSITION PAPER: NO MEASUREMENT. Environ-
X
mental Science and Technology 6(10): 890-894, October, 1972.
32
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6. Shy, CM; Nelson, CJ; Benson, FB; Riggan, WB; Newill, VA; Chapman,
RS: VENTILATORY FUNCTION IN SCHOOL CHILDREN: 1967-1968
TESTING IN CINCINNATI NEIGHBORHOODS. In: Health Consequences
of Sulfur Oxides: A Report from CHESS, 1970-1971. EPA
Report No. EPA-65/1-74-4, pp. 6-3 - 6-14. Research Triangle
Park, N. C., EPA, May, 1974 (Available from NTIS as PB-234 92/AS)
7. Finklea, JF; Goldberg, J; Hasselblad, V; Shy, CM; Hayes, CG:
PREVALENCE OF CHRONIC RESPIRATORY DISEASE SYMPTOMS IN
MILITARY RECRUITS: CHICAGO INDUCTION CENTER. 1969-1970.
In: Health Consequences of Sulfur Oxides: A Report from
CHESS. 1970-1971. EPA Report No. 65/1-74-4, pp. 4-23 - 4-36.
Research Triangle Park, N. C., EPA, May, 1974 (Available
from NTIS as PB-234 92/AS).
8. Finklea, JF; French, JG; Lowrimore, GR; Goldberg, J; Shy, CM;
Nelson, WC: PROSPECTIVE SURVEYS OF ACUTE RESPIRATORY
DISEASE IN VOLUNTEER FAMILIES: CHICAGO NURSERY SCHOOL
STUDY, 1969-1970. In: Health Consequences of Sulfur
Oxides: A Report from CHESS, 1970-1971. EPA Report No.
EPA-65/1-74-4, pp. 4-37+. Research Triangle Park, N. C.,
EPA, May, 1974 (Available from NTIS as PB-234 92/AS).
9. Hinton, DO; English, TD; Parr, BF; Hasselblad, V; Dickerson,
RC; French, JG: HUMAN EXPOSURE TO AIR POLLUTANTS IN THE
CHICAGO-NORTHWEST INDIANA METROPOLITAN REGION, 1950-1971.
33
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In: Health Consequences of Sulfur Oxides: A Report from
CHESS, 1970-1971. EPA Report No. EPA-65/1-74-4, pp.
4-3 - 4-22. Research Triangle Park, N. C., EPA, May, 1974
(Available from NTIS as PB-234 92/AS).
10. Hayes, CG; Hammer, DI; Shy, CM; Hasselblad, V; Sharp, CR;
Creason, JP; McClain, KE: PREVALENCE OF CHRONIC RESPIRATORY
DISEASE SYMPTOMS IN ADULTS: 1970 SURVEY OF FIVE ROCKY
MOUNTAIN COMMUNITIES. In: Health Consequences of Sulfur
Oxides: A Report from CHESS, 1970-1971. EPA Report No.
EPA-65/1-74-4, pp. 3-19 - 3-34. Research Triangle Park, N. C,
EPA, May, 1974 (Available from NTIS as PB-234 92/AS).
11. Finklea, JF; Hammer, DI; House, DE; Sharp, CR; Nelson, WC;
Lowrimore, GR: FREQUENCY OF ACUTE LOWER RESPIRATORY
DISEASE IN CHILDREN: RETROSPECTIVE SURVEY OF FIVE ROCKY
MOUNTAIN COMMUNITIES, 1967-1970. In: Health Consequences
of Sulfur Oxides: A Report from CHESS, 1970-1971. EPA
Report No. EPA-65/1-74-4, pp. 3-35 - 3-54. Research
Triangle Park, N. C., EPA, May, 1974 (Available from NTIS
as PB-234 92/AS).
12. English, TD; Sune, JM; Hammer, DI; Truppi, LA; Culver, WE;
Dickerson, RC; Riggan, WB: HUMAN EXPOSURE TO AIR POLLUTANTS
IN FIVE ROCKY MOUNTAIN COMMUNITIES, 1940-1970. In:
Health Consequences of Sulfur Oxides: A Report from
CHESS, 1970-1971. EPA Report No. EPA-65/1-74-4, pp.
3-3 - 3-17. Research Triangle Park, N. C., EPA, May, 1974
(Available from NTIS as PB-234 92/AS).
34
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B. Reports from CHESS Data Sets
1. Chapman, RS; Shy, CM; Finklea, JF; House, DE; Goldberg, HE;
Hayes, CG: CHRONIC RESPIRATORY DISEASE IN MILITARY INDUCTEES
AND PARENTS OF SCHOOLCHILDREN. Arch. Environ. Health
27(3): 138-142, September, 1973.
2. French, JG; Lowrimore, G; Nelson, WC; Finklea, JF; English, T;
Hertz, M: THE EFFECT OF SULFUR DIOXIDE AND SUSPENDED
SULFATES ON ACUTE RESPIRATORY DISEASE. Arch. Environ.
Health 27(3): 129-133, September, 1973.
3. Shy, CM; Hasselblad, V; Burton, RM; Nelson, CJ; Cohen, AA: AIR
POLLUTION EFFECTS ON VENTILATORY FUNCTION OF U. S. SCHOOL-
CHILDREN. Arch. Environ. Health 27(3): 124-128, September,
1973.
4. Hammer, DI; Miller, FJ; Stead, AG; Hayes, CG: AIR POLLUTION
AND CHILDHOOD LOWER RESPIRATORY DISEASE. I. EXPOSURE TO
SULFUR OXIDES AND PARTICULATE MATTER IN NEW YORK, 1972.
Clinical Implications of Air Pollution Research. AMA Air
Pollution Medical Research Conference, December 5-6, 1974.
Publishing Sciences Group, Inc., pp. 321-337, 1976.
5. Chapman, RS; Hasselblad, V; Hayes, CG; Williams, JVR; Hammer,
DI: AIR POLLUTION AND CHILDHOOD VENTILATORY FUNCTION. I.
EXPOSURE TO PARTICULATE MATTER IN TWO SOUTHEASTERN CITIES,
1971-1972. Clinical Implications of Air Pollution Research.
AMA Air Pollution Medical Research Conference, December
5-6, 1974. Publishing Sciences Group, Inc., pp. 285-303,
1976.
35
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6. Stebbings, JH; Hayes, CG: PANEL STUDIES OF ACUTE HEALTH EFFECTS
OF AIR POLLUTION. I. CARDIOPULMONARY SYMPTOMS IN ADULTS,
NEW YORK, 1971-1972. Environmental Research 11: 89-111,
1976.
7. Stebbings, JH: PANEL STUDIES OF ACUTE HEALTH EFFECTS OF AIR
POLLUTION. II. A METHODOLOGIC STUDY OF LINEAR REGRESSION
ANALYSIS OF ASTHMA PANEL DATA. Environmental Research 17:
10-32, 1978.
8. Nelson, CJ; Shy; CM; English, T; Sharp, CR; Andleman, R; Truppi,
L; VanBruggen, J: FAMILY SURVEYS OF IRRITATION SYMPTOMS
DURING ACUTE AIR POLLUTION EXPOSURES. J. Air Pol. Control
Assoc. 23(2): 81-86, February, 1973.
9. Cohen, AA; Nelson, CJ; Bromberg, SM; Pravda, M; Ferrand, EF;
Leon, G: SYMPTOM REPORTING DURING RECENT PUBLICIZED AND
UNPUBLICIZED AIR POLLUTION EPISODES. Am. J. Public Health
64(5): 442-449, May, 1974.
*10. Hammer, DI: RESPIRATORY DISEASE IN CHILDREN EXPOSED TO SULFUR
OXIDES AND PARTICULATES. EPA Report No. EPA-600/1-77-043,
September, 1977.
11. Hasselblad, V: LUNG FUNCTION IN SCHOOL CHILDREN: 1971-1972
CHATTANOOGA STUDY. EPA Report No. EPA-600/1-77-002,
January. 1977.
* Originally published as a Harvard University Ph.D. dissertation,
prior to application of data validation procedures. Now
being reexamined using validated data sets, as discussed at the
August, 1980, CASAC meeting.
36
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12. Decker, CE; Royal, TM: NITROGEN DIOXIDE TRENDS IN SELECTED
CHATTANOOGA COMMUNITIES. EPA Report No. EPA-600/1-76-034,
October, 1976.
13. House, DE; Finklea, JF; Shy, DM; Calafiore, DC; Riggan, WB;
Southwick, JW; Olsen, LJ: PREVALENCE OF CHRONIC RESPIRATORY
DISEASE SYMPTOMS IN ADULTS: 1970 SURVEY OF SALT LAKE
BASIN COMMUNITIES. In: Health Consequences of Sulfur
Oxides: A Report from CHESS, 1970-1971. EPA Report No.
EPA-65/1-74-4, pp. 2-41 - 2-54. Research Triangle Park,
N. C., EPA, May, 1974 (Available from NTIS as PB-234 92/AS).
14. Goldberg, HE; Finklea, JF; Nelson, CJ; Steen, WB; Chapman, RS;
Swanson, DH; Cohen, AA: PREVALENCE OF CHRONIC RESPIRATORY
DISEASE SYMPTOMS IN ADULTS: 1970 SURVEY OF NEW YORK
COMMUNITIES. In: Health Consequences of Sulfur Oxides:
A Report from CHESS, 1970-1971. EPA Report No. EPA-65/1-74-4,
pp. 5-33 - 5-48. Research Triangle Park, N. C., EPA, May,
1974 (Available from NTIS as PB-234 92/AS).
15. Nelson, WC; Finklea, JF; House, DE; Calafiore, DC; Hertz, MB;
Swanson, DH: FREQUENCY OF ACUTE LOWER RESPIRATORY DISEASE
IN CHILDREN: RETROSPECTIVE SURVEY OF SALT LAKE BASIN
COMMUNITIES. 1967-1970. In: Health Consequences of
Sulfur Oxides: A Report from CHESS, 1970-1971. EPA Report
No. EPA-65/1-74-4, pp. 2-55 - 2-74. Research Triangle Park,
N. C., EPA, May-. 1974 (Available from NTIS as PB-234 92/AS).
37
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16. Love, GJ; Cohen, AA; Finklea, JF; French, JG; Lowrimore, GR;
Nelson, WC; Ramsey, PB: PROSPECTIVE SURVEYS OF ACUTE
RESPIRATORY DISEASE IN VOLUNTEER FAMILIES: 1970-1971 NEW
YORK STUDIES. In: Health Consequences of Sulfur Oxides:
A Report from CHESS, 1970-1971. EPA Report No. EPA-65/1-74-4,
pp. 5-7 - 5-49. Research Triangle Park, N. C., EPA, May,
1974 (Available from NTIS as PB-234 92/AS).
17. Shy, CM; Hasselblad, V; Finklea, JF; Burton, RM; Pravada, M;
Chapman, RS; Cohen, AA: VENTILATORY FUNCTION IN SCHOOL
CHILDREN: 1970-1971. NEW YORK STUDIES. In: Health
Consequences of Sulfur Oxides: A Report from CHESS,
1970-1971. EPA Report No. EPA-65/1-74-4, pp. 5-109 -
5-119. Research Triangle Park, N. C., EPA, May, 1974
(Available from NTIS as PB-234 92/AS).
18. Finklea, JF; Calafiore, DC; Nelson, CJ; Riggan, WB; Hayes, CG:
AGGRAVATION OF ASTHMA BY AIR POLLUTANTS: 1971 SALT LAKE
BASIN STUDIES. In: Health Consequences of Sulfur Oxides:
A Report from CHESS, 1970-1971. EPA Report No. EPA-65/1-74-4,
pp. 2-75+. Research Triangle Park, N. C., EPA, May, 1974
(Available from NTIS as PB-234 92/AS).
19. Finklea, JF; Farmer, JH; Love, GJ; Calafiore, DC; Sovocool, GW:
AGGRAVATION OF ASTHMA BY AIR POLLUTANTS: 1970-1971 NEW
YORK STUDIES. In: Health Consequences of Sulfur Oxides:
A Report from CHESS, 1970-1971. EPA Report No. EPA-65/1-74-4,
pp. 5-71 - 5-84. Research Triangle Park, N. C., EPA, May,
1974 (Available from NTIS as PB-234 92/AS).
38
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20. Goldberg, HE; Cohen, AA; Finklea, JF; Farmer, JH; Benson, FB;
Love, GJ: FREQUENCY AND SEVERITY OF CARDIOPULMONARY
SYMPTOMS IN ADULT PANELS: 1970-1971 NEW YORK STUDIES.
In: Health Consequences of Sulfur Oxides: A Report from
CHESS, 1970-1971. EPA Report No. EPA-65/1-74-4, pp.
5-85 - 5-108. Research Triangle Park, N. C., May, 1974
(Available from NTIS as PB-234 92/AS).
21. Hertz, MB; Truppi, LA; English, TD; Sovocool, GW; Burton, RM;
Heiderscheit, LT; Hinton, DO: HUMAN EXPOSURE TO AIR
POLLUTANTS IN SALT LAKE BASIN COMMUNITIES. 1940-1971.
In: Health Consequences of Sulfur Oxides: A Report from
CHESS, 1970-1971. EPA Report No. EPA-65/1-74-4, pp.
2-3 - 2-39. Research Triangle Park, N. C., EPA, May, 1974
(Available from NTIS as PB-234 92/AS).
22. English, TD; Steen, WB; Ireson, RG; Ramsey, PB; Burton, RM;
Heiderscheit, LT: HUMAN EXPOSURE TO AIR POLLUTION IN
SELECTED NEW YORK METROPOLITAN COMMUNITIES, 1944-1971.
In: Health Consequences of Sulfur Oxides: A Report from
CHESS, 1970-1971. EPA Report No. EPA 65/1-74-4, pp.
5-3 - 5-32. Research Triangle Park, N. C., EPA, May, 1974
(Available from NTIS as PB-234 92/AS).
23. Finklea, JF; Shy, CM; Love, GJ; Hayes, CG; Nelson, WC; Chapman,
RS; House, DE: HEALTH CONSEQUENCES OF SULFUR OXIDES:
SUMMARY AND CONCLUSIONS BASED UPON CHESS STUDIES OF 1970-1971,
39
-------
In: Health Consequences of Sulfur Oxides: A Report from
CHESS, 1970-1971. EPA Report No. EPA-65/1-74-4, pp.
7-3 - 7-24. Research Triangle Park, N. C., EPA, May, 1974
(Available from NTIS as PB-234 92/AS).
24. Shy, CM; Riggan, WB; French, JG; Nelson, WC; Dickerson, RC;
Benson, FB; Finklea, JF; Colucci, AV; Hammer, DI; Newill,
VA: AN OVERVIEW OF CHESS. In: Health Consequences of
Sulfur Oxides: A Report from CHESS, 1970-1971. EPA
Report No. EPA-65/1-74-4, pp. 1-3 - 1-9. Research Triangle
Park, N. C., EPA, May. 1974 (Available from NTIS as PB-234 92/AS)
*25. Shy, CM; Love, GJ; RECENT EVIDENCE ON THE HUMAN HEALTH EFFECTS
OF NITROGEN DIOXIDE. In: Nitrogen Oxides and Their
Effects on Health. S. D. Lee, Ed. Ann Arbor: Ann Arbor
Science, pp. 291-305, 1980.
T26. Whittemore, AS; Korn, EL: ASTHMA AND AIR POLLUTION IN THE
LOS ANGELES AREA. Amer. Jour. Pub. Health. 70(7):
687-696, July 1980.
*Proceedings of the Air Pollution Control Association Meeting in Hawaii, 1979.
TDiscussed in context of demonstrating statistical validation procedures (see
page 3 of this report).
40
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C. General Reports Related To CHESS
1. Shy, CM; Finklea, JF; Calafiore, DC; Benson, F; Nelson, WC;
Newill, VA: A PROGRAM OF COMMUNITY HEALTH AND ENVIRONMENTAL
SURVEILLANCE STUDIES (CHESS)- Determination of_ Air Quality,
pp. 41-48. New York: Plenum Press, 1972.
2. Finklea, JF; Cranmer, MF; Hammer, DI; McCabe, LF; Newill, VA;
Shy, CM: HEALTH INTELLIGENCE FOR ENVIRONMENTAL PROTECTION:
A DEMANDING CHALLENGE. Proc. 6th Berkeley Symp. on Mathematical
Statistics and Probability, July 19-22, 1971. Vol. 6, pp. 11-19,
Berkeley: University of California Press, 1972.
3. Riggan, WB; Hammer, DI; Finklea, JF; Hasselblad, V; Sharp, CR;
Burton, RM; Shy, CM: CHESS--A COMMUNITY HEALTH AND ENVIRON-
MENTAL SURVEILLANCE SYSTEM. Proc. 6th Berkeley Symp. on
Mathematical Statistics and Probability, July 19-22, 1971.
Vol. 6, pp. 125-133. Berkeley: University of California
Press, 1972.
4. Nelson, WC; Hasselblad, V; Lowrimore, GR: STATISTICAL ASPECTS
OF COMMUNITY HEALTH AND ENVIRONMENTAL SURVEILLANCE SYSTEM.
Proc. 6th Berkeley Symp. on Mathematical Statistics and
Probability, July 19-22, 1971. Vol. 6, pp. 125-133. Berkeley:
University of California Press, 1972.
5. Hasselblad, V; Nelson, WC; Lowrimore, GR: ANALYSIS OF HEALTH
EFFECTS DATASOME RESULTS AND PROBLEMS. Statistical and
Mathematical Aspects of Pollution Problems, pp. 275-282. New
York: Marcal Dekker, Inc., 1974.
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6. Shy, CM; Finklea, JF: AIR POLLUTION AFFECTS COMMUNITY HEALTH.
Environmental Science and Technology, 7: 204-208, March,
1973.
7. French, JG: EFFECTS OF SUSPENDED SULFATES ON HUMAN HEALTH.
Environ. Health Perspect. 1: 35-37, 1975.
8. Love, GJ; Shy, CM; Calafiore, DC; Benson, FB; Finklea, JF: THE
STRATEGY FOR DETERMINING THE EFFECTS OF ENVIRONMENTAL
POLLUTION ON HUMAN HEALTH. Environ. Letter 3(1): 13-2,
1972.
9. Burton, RM; Kozel, WM; Penely, RL; Ward, GH; Chapman, RS:
APPLICATION AND EVALUATION OF PORTABLE FIELD INSTRUMENTS
FOR MEASURING FORCED EXPIRATORY VOLUME OF CHILDREN AND
ADULTS IN ENVIRONMENTAL HEALTH SURVEYS. Environ. Health
Perspect. 8: 123-131, 1974.
10. Finklea, JF; Shy, CM; Moran, JB; Nelson, WC; Larson, RI; Akland,
GG: THE ROLE OF ENVIRONMENTAL HEALTH ASSESSMENT IN THE
CONTROL OF AIR POLLUTION. Advances ^in. Environmental Science
and Technology, Volume 7, pp. 315-389. New York: Wiley, 1977.
11. Nelson, WC: AIR POLLUTION RISK ASSESSMENT: CAN WE QUANTIFY
THE UNCERTAINTY? N. E. Breslow and A. S. Whittemore, Editors,
Energy and Health. Proceedings of SIMS Conference, Alta, Utah,
June, 1978. Philadelphia: SIAM, 1979.
12. Whittemore, AS; Keller, JB: ASTHMA AND AIR POLLUTION: A
QUANTITATIVE THEORY. N. E. Breslow and A. S. Whittemore, Editors,
Energy and Health. Proceedings of SIMS Conference, Alta, Utah,
June, 1978. Philadelphia: SIAM, 1979.
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13. Korn, EL; Whittemore, AS: METHODS FOR ANALYZING PANEL STUDIES
OF ACUTE HEALTH EFFECTS OF AIR POLLUTION. Biometrics
35(4), December, 1979.
14. Heiderscheit, LT; Hertz, MB: AN ASSESSMENT OF THE CHESS SULFATE
AND NITRATE DATA DURING THE PERIOD RETA PERFORMED THE
CHEMICAL ANALYSIS. EPA Report No. EPA-600/1-77-004,
January, 1977.
15. Hasselblad, V; Creason, JP; Nelson, WC: REGRESSION USING
"HOCKEY STICK" FUNCTIONS. EPA Report No. EPA-600/1-76-024,
June, 1976.
16. Hasselblad, V: COMPARISON OF METHODS FOR THE ANALYSIS OF PANEL
STUDIES. EPA Report No. EPA 600/1-78-043, June, 1978.
17. Nelson, WC; Knelson, JH; Hasselblad, V: AIR POLLUTANT HEALTH
EFFECTS ESTIMATION MODEL. In: Environmental Modeling and
Simulation. EPA Report No. EPA 600/9-76-016, pp. 191-195,
1976.
18. Chapman, LD; Akland, GG; Finklea, JF; Larson, RI; Mount, TD;
Nelson, WC: ELECTRICITY DEMAND: PROJECT INDEPENDENCE AND
THE CLEAN AIR ACT. ORNL Report No. ORNL-NSF-EP-89, 1975.
19. Chamblee, CP: USE OF STATISTICAL SAMPLING IN VALIDATING HEALTH
EFFECTS DATA. In: Data Validation Conference Preceedings.
EPA Report No. EPA 600/9-79-042, pp. 31-38. Research
Triangle Park, N. C., EPA, September, 1979.
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APPENDIX D
44
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OTHER REPORTS ON POLLUTANT BURDENS
1. Finklea, JF; Hammer, DI; Hinners, TA; Pinkerton, C: HUMAN
POLLUTANT BURDENS. In: G. Mamantov and W. D. Shults
(eds.), Determination of Air Quality, pp. 49-56. New York:
Plenum, 1972.
2. Colucci, AV; Hammer, DI; Williams, ME; Hinners, TA; Pinkerton,
C; Kent, JL; Love, GJ: POLLUTANT BURDENS AND BIOLOGICAL
RESPONSE. Arch. Environ. Health 27: 151-154, September,
1973.
3. Hammer, DI; Colucci, AV; Hasselblad, V; Williams, ME; Pinkerton,
C: CADMIUM AND LEAD IN AUTOPSY TISSUES. J. Occup. Med.
15(12): 956-963, December, 1973.
4. Finklea, JF; Hammer, DI; Bridbord, K; Newill, VA: POLLUTANT
BURDENS IN HUMANS: A MEASURE OF ENVIRONMENTAL QUALITY.
In: W. A. Thomas (ed.). Environmental Science Research,
Vol. J^: Indicators of Environmental Quality, pp. 83-91.
New York: Plenum, 1972.
5. Hammer, DI; Finklea, JF; Hendricks, RH; Hinners, TA; Riggan,
WB; Shy, CM: TRACE METALS IN HUMAN HAIR AS A SIMPLE
EPIDEMIOLOGICAL MONITOR OF ENVIRONMENTAL EXPOSURE. Proc.
5th Univ. of Missouri Conf. on Trace Substances in Environ.
Health, June 29-July 1, 1971. pp. 25-38. Columbia: Uni-
versity of Missouri Press, 1972.
45
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6. Creason, JP; Hinners, TA; Bumgarner, JE; Pinkerton, C: TRACE
ELEMENTS IN HAIR, AS RELATED TO EXPOSURE IN METROPOLITAN
NEW YORK. Clinical Chemistry 21: 603-610, 1975.
7. Hammer, DI; Finklea, JF; Hendricks, RH; Shy, CM; Horton, RJM:
HAIR TRACE METAL LEVELS AND ENVIRONMENTAL EXPOSURE. Am.
J. of Epidemiology 93(2): 84-92, 1971.
8. Creason, JP; Svendsgaard, DJ; Bumgarner, J; Pinkerton, C;
Hinners, T: MATERNAL-FETAL TISSUE LEVELS OF 16 TRACE
ELEMENTS IN 8 SELECTED CONTINENTAL UNITED STATES COMMUNITIES.
Proc., 10th Univ. of Missouri Conf. on Trace Substances
in Environ. Health, 1976. pp. 53-62. Columbia:
University of Missouri Press, 1976.
9. Hammer, DI; Finklea, JF; Hendricks, RH; Shy, CM; Horton, RJM:
TRACE METAL CONCENTRATIONS IN HUMAN HAIR. In: Helena
Valley, Montana, Area Environmental Pollution Study. EPA
Office of Air Programs Publication No. AP-91. Chapter 8,
pp. 125+. Research Triangle Park, N. C., EPA,^ January,
1972 (Available from NTIS as PB-27 00 126).
10. Creason, JP; Svendsgaard, DJ; Bumgarner, JE; Pinkerton, C;
Hinners, TA: MATERNAL-FETAL TISSUE LEVELS OF 16 TRACE
ELEMENTS IN 8 COMMUNITIES. EPA Report No. EPA-600/1-78-033,
May, 1978.
11. Creason, JP; Hinners, TA; Bumgarner, JE; Pinkerton, C: HUMAN
SCALP HAIR: AN ENVIRONMENTAL EXPOSURE INDEX FOR TRACE
ELEMENTS. 1. FIFTEEN TRACE ELEMENTS IN NEW YORK, N.Y.
(1971-1972). EPA Report No. EPA-600/l-78-037a, May, 1978.
46
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12. Creason, JP; Hinners, TA; Bumgarner, JE; Pinkerton, C: HUMAN
SCALP HAIR: AN ENVIRONMENTAL EXPOSURE INDEX FOR TRACE
ELEMENTS. II. SEVENTEEN TRACE ELEMENTS IN FOUR NEW JERSEY
COMMUNITIES (1972). EPA Report No. EPA-600/l-78-037b,
June, 1978.
13. Creason, JP; Hinners, TA; Bumgarner, JE; Pinkerton, C: HUMAN
SCALP HAIR: AN ENVIRONMENTAL EXPOSURE INDEX FOR TRACE
ELEMENTS. III. SEVENTEEN TRACE ELEMENTS IN BIRMINGHAM,
ALABAMA AND CHARLOTTE, NORTH CAROLINA (1972). EPA Report
No. EPA-600/l-78-037c, July, 1978.
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TECHNICAL REPORT DATA
(Please read Instructions on the reverse before completing)
1. REPORT NO. 2. 3. RECIF
EPA-600/1-80-033
4. TITLE AND SUBTITLE 5. REPO
Status of the Community Health and Environmental Novei
Surveillance System (CHESS) 6. PERF
7. AUTHOR(S) 8. PERF
Roberta Cahill RD-683
9. PERFORMING ORGANIZATION NAME AND ADDRESS 10. PRO
SAME AS BELOW 11. CON
12. SPONSORING AGENCY NAME AND ADDRESS 13. TYP
Offi'pp nf Rp.sparrh and Devel opment
U.S. Environmental Protection Agency
Washington, D.C. 20460
'lENT'S ACCESSION NO.
RT DATE
nber 1980
ORMING ORGANIZATION CODE
ORMING ORGANIZATION REPORT NO.
GRAM ELEMENT NO.
TRACT/GRANT NO.
E OF REPORT AND PERIOD COVERED
MSORING AGENCY CODE
15. SUPPLEMENTARY NOTES
16. ABSTRACT
This report has been prepared in response to a request by the U.S.
House of Representatives Committee on Science and Technology which
appears in House Report No. 96-957, page 61.
17. KEY WORDS AND DOCUMENT ANALYSIS
a. DESCRIPTORS b. I DENTI F I E RS/OPEN EN DE
18. DISTRIBUTION STATEMENT 19. SECURITY CLASS (This l
RFT.F.AqTC TO PTTRT.Tn Unclassified
20. SECURITY CLASS (This ;
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D TERMS c. COSATI F'ield/Group
Report) 21. NO. OF PAGES
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Jage) 22. PRICE
EPA Form 2220-1 (Rev. 4-77) PREVIOUS EDITION IS OBSOLETE
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