CF ASSESSMENT CF A FTFID INVESTIGCTCN
GP SEM23R SPCNT?JNrnjS AECSTICN 3XEES DI T5RES CEBGCN
IN BELKTIQI TO FCSEST 2,4,S-T S??AY PHfdTCZS
by the Epideniclccic Studies Prccrsr
Uterine Branch
Benefits ard Field S tafias Division
CPP/ CIS, Z?A
Faar^ary 27, 157
-------
TABLE CF CCNTEJITS
Page
List of Tables ii
List of Figures iv
Chapter
I Intrcduction 1
II Purpose and Scope • 5
III Methods 8
IV Results 37
V Sunmary and Conclusions 77
Appendix
A Cuesticnnaira: Cragcn Miscarziaga Investigation 30
B Tj'mr- peon Statistics, Jackscn Manorial Ecscital 99
-------
LIST OF TABLES
Table Page
1. Selected Agricultural Statistics for Counties
Including the Study, Central and/or Urban Areas 18
2. Zip Cedes Corresponding to the Study,
Urban, and Central Areas 20
3. Total Acres Treated and Pounds 2,4,5-T Used
in Alsea Basin (1972-1977) 22
4. Applications of 2,4,5-rT by Dav and Jfcnth in the
Alsea Basin (1972-1977) 24
5. Annual Admissions and Births in Hospitals in Study,
Urban, and Control Areas.........*....... 30
6. Number of Hospitalized Spontaneous Abortion Cases for
Study, Urban, and Control Areas 33
7. Number of Hospitalized Spontaneous Abortion Cases for
Study, Urban, and Control Areas, Accumulated
by Month 39
3. Hospitalized Spontaneous Abortion Cases by Study,
Urban, Control Area, and Age Group of Patient.... 40
9. Number and Percent of Spontaneous Abortions According
to Length of Gestation in the Study, Urban and
Control Areas 41
10. Total Number of Births by Months for the
Study, Urban, and Control Areas 42
11. Number of Births Corresponding to the tfonth of
Spontaneous Abortions in l±e Study, Urban and
Control Areas 43
ii
-------
LIST OF TABLES
Table Page
12. Monthly Spontaneous Abortion Index for the
Study/ Urban, and Control Areas '. 44
13. Abortion Index by Period, Area, and Month 47
14. Analysis of Variance of Abortion Irjdex by .
Period, Area, and Month 51
IS. Parameters of the Model "Index =» A + 3 Sin (2J t-0)"
for the various areas.... T 57
16. Study Area Index Corrected for Phase Shifts, Study
minus Control—— 1 month lag 53
17. Study Area Index Corrected for. Phase Shift, Study
minus Urban — 2 month lag 59
IS. Study Area Index Corrected for Phase Shift Study
minus (Urban plus Control) 2 month lag 60
19. Number of Births per Month and Unweighted Abortion
Index for the Study, Urban, and Control Areas $4
20. Cross - Correlation of Corrected Study Area
Index with Spray Data 63
21. Pounds of 2,4,5-T Applied in the Alsea Basin and
Abortion Index for the Study Area by Month and
Period 59
22. Cross-Correlation of Study Area Abortion Index
with Scray Data 70
23. Study and Urban Area Physician Interviews: Estimated
Numbers of Spontaneous Abortions Treated Annually and
Percentages Hospitalized 74
iii
-------
LIST OF FIGuBES
Figure Number Page
1. Oregon.,
2. Study Area in Lane, Lincoln and Sentcn
Counties of Oregon .................... ...................... 10
3. Land Cover in Lincoln, Sen ton, and Lane (Partial)
Counties, Oregon ............................................. 11
4 . Control Area in Malheur County, Oregon. . . . .................. 14
5 . Land Cover in Malheur County, Oregon ........................ 13
6 . Urtan Area in Benton County, Oregon ......................... 17
7. Acres Sprayed with 2,4,5-T in Aisea Basin
Accumulated by Sespective Month, 1972-1977 .................. 25
3. Pounds of 2,4,5-T Sprayed in Alsea Basin
Accumulated by Sespectlve I-tenth, 1972-1977 .................. 26
9. Hospitals in Study and Urban Areas .......................... 28
10 . Hospitals in Control Area ................................... 29
11. Plot of tfcnthly Spontaneous Abortion Index
for the Study, Urtan, and Control Areas ..................... 45
12. Abortion Index for the Studv Area by
Month and Period ...................................... . ..... 48
13. Abortion Index for the Control Area by
Month and Period ..................... ". ...................... 49
14. Abortion Index for the Urban Area cy
Month and Period ............................................. 50
15. Spontaneous Abortion Index, 1972-1977 cor the Study Area
and the Combined Control and Urban Areas. . ................... 55
iv
-------
LIST OP FIOJBES
Figure Number Page
16. Study and Control Areas: a) Combined Urban and Control Index;
b) Study Area Index; c) Urban and Control Index Shifted Bade
Two Months 5£
17. Predicted and Observed Points for the Study Area 61
18. Predicted and Observed Points for the Urban & Control Area 67
19. a) Study Area Abortion Index Corrected for Phase Shifted
Urban Index b) Pounds of 2,4,S-T Sprayed by Month , 65
20. Crcss-Ccrrelaticn of Study Area Abortion Index
with Spray Pattern in Total Pounds 2,4,5-T applied
by Month, 1972-1977 66,
-------
Chapter I
INTRODUCTION
One of the widely used chlorophenoxy herbicides is the chemical
2,4,5-trichlorophenoxy acetic acid, ccmmcnly referred to as 2,4,5-T.
A selective herbicide, 2,4,5-T is especially useful for brush control
on rangeland, along right-of-ways, and in conifer forest habitats.
The parent acid is formulated in a variety of emulsifiable esters
and specific amine salts registered for use in both Canada and Che
United States.
Many studies have been conducted to determine the fate of TCTD in the
environment. Since TCED is reportedly not mobile.in soil, it is not
considered to be a risk in ground 'water. TCTO dees not accumulate
in vegetation (1).
In comparison with other pesticide products, the phenoxy herbicides are
relatively non-toxic to mammals, and 2,4,5-T is classified as moderately
toxic with an acute oral LDS (rat) at 500 mg (acid basis) Ag (2).
However, low levels of TCCD have been shown.to have oncogenic effects
in rodents and related effects in primates. Fetotoxicity and terato-
genicity have been demonstrated at low levels, with the appearance of
cleft palate and kidney anomalies in rats, mice, and hamsters. Embryc-
taxic effects in avian species have also been reported (1).
-------
In July, 1978, Staff of the EPA Offica of Pesticide Programs (QPP) and
Colorado State University epidemiologists met in Oregon with local and
State health officials to begin an investigation into a group of women
living in the vicinity of Alsea who claimed they had experienced
miscarriages because of herbicide spraying in the course of forest
management. The investigation was precipatated in late June, 1978,
when EPA received a letter signed by eight women living in this area
who had experienced 10 miscarriages since 1972. The women claimed
to be surrounded by forest land which has been sprayed for years with
herbicides known to contain dioxin. They also charted their dates of
miscarriage and related dates the forest areas were sprayed. Each of
the women was under a physician's care at the time of miscarriage, and
neither the women nor their doctors could ascertain the reasons for
abortion. The investigators met with four of the women to discuss the
circumstances of their reported exposure and any possible relationship
to their subsequent miscarriages.
Following the visit by E?A and Colorado State University staff, an
extensive health questionnaire (Appendix A) was designed jointly by
OPP's Epicaniologic Studies Programs (ESP's) in Miami, Iowa, South
Carolina and Colorado, in which detailed questions on self and family
pregnancy and medical histories, environmental aspects, diet, occu-
pational and household pesticide usage were included. During the first
week of August, 1973, an epidaniologist from Colorado's ESP admin-
istered the questionnaire to nine women who had experienced 13
confirmed miscarriages frcra toy, 1973 to March, 1978.
-------
During lata August and early September, the health questionnaire and
related data (spray application, vital statistics, etc.) were evaluated
independently by 10 experts in the fields of obstetrics, gynecology,
epidemiology, biostatistics, reproductive endocrinology, and perinatal
medicine. The consensus of the reviewers was that:
1. the spontaneous abortions did appear to follow a seasonal
pattern (two of the reviewers noted the seasonal relationship
but drew no conclusions);
2. Good Samaritan Hospital records for Senton County women
for the years 1975-77 showed numerically higher rates of
spontaneous abortions per live births during Jan., Feb., Mar.,
and Oct., Nov., and.Dec., of each year than curing April
through Sept. (these records were based on stillbirths of
terms greater than 20 weeks). Conversely, 10 of the 13 miscar-
riages reported by the Alsea participants occurred during the
months of April through September (1973-1973);
3. there was a high numerical incidence of March to June
miscarriages (nine of 13) ancng the Alsea participants. However,
there was concern that the reports might comprise a biased
sample (albeit unintended) of all miscarriages that occurred
within the area and years -jnder investigation;
-------
4. a causal relationship between forast herbicide spraying
and reproductive wastage had not been demonstrated from the data
presented. Opinions ranged from ". . .-no evidence of a
causal relationship . . ." ta "I cannot support or refute a
cause and effect relationship ..." Reviewers either stated
or inferred that there was no real evidence of an epidemic
based on the data presented.
An analysis of the data by staff of CPP's Human Effects Monitoring
Branch (EEMB) identified:
1) the possibility of a relationship between time of
spraying and conception and subsequent abortions among
the Alsea women; and
2) the fact that, while State and county records of spontaneous
abortions are given for terns of 20 weeks or greater, 12 of
the 13 miscarriages experienced by the women in Aisea were
for terms of less than 20 weeks.
Eased upon the comments of the reviewers and HEMB staff, OF? undertook
ta develop data on spontaneous abortions of 20 weeks duration or less
in the Study araa and in a comparable control population.
-------
The current study of 6-*/ear spontaneous abortion rates in three Oregon
areas was initiated by the Human Effects Monitoring Branch, Office of
o
Pesticide Programs, in October of 1978. The study was accomplished
under contract to the Epideniologic Studies Program (ESP) projects in
Colorado, Florida and Idaho. Scientists from the Colorado Project,
under the direction of Dr. Eldon Savage, organized and conducted the
field investigations, developed the data including .the spontaneous
abortion index, and prepared much of the report. Idaho project staff
assisted in collection of hospital data in Malheur County. Statistical
analysis and the interpretative narrative were developed by Drs. Robert
Duncan and Thomas Keefe of the Florida and Colorado projects, respect-
ively.
The following scientist were instrumental in the successful development
and conduct of the study:
•
Dr. Eldon P. Savage, Director, Colorado ESP, Colorado State
University
Colorado ESP Staff: Drs. Thomas Keefe, Robert Zimmerman and
Richard Hayes; Messrs. William Wheeler, Lawrence Mounce and Jerry
Rench; Ms. Lois Cox and Ms. Barbara Stevens.
Idaho ESP Staff (Dr. Charles Brckopp, Director): Ms. Jill Wyatt
and Ms. Pamela Smith.
Dr. Robert C. Duncan, Director, Florida ESP, School of Medicine,
university of Miami.
HEMB Staff: Drs. Jack Griffith and Charles Miller, Mr. Robert
Heath and Ms. Mary Frankenberry.
This report was organised and edited by:
Jack Griffith, Ph.D.
Robert Heath, M.S.
Mar/ Frankenherry, 3.A.
-------
Chapter II
PURPOSE AND SCOPS
Ike purpose of this study was to assess the rates of spontaneous abor-
tion occurring in a'forested region of Oregon's cn****\ Range, centered
about the Alsea basin, where 2,4,5-T has been casnnnly used in forest
management, and to compare those rates with rates occurring in a compa-
rable control area.
Specific objectives of the study were to test the following hypotheses:
a. whether cr not differences in spontaneous abortion rates exist
between the study and control populations;
b. whether or not seasonal variations in rates exist within the
study and control populations;
c. whether cr net such variations, if they exist, can be as-
sociated with time and concentration of spray applications in
the study area.
The data are liadtad to in-patient records of women hospitalized for
spontaneous abortions of less than 20 weeks tern, based upon: ,
a. the observation that 12 of the 12 miscarriages reported cy the
original nine participants were for terns of less than 20
weeks duration;
-------
b. the assumption that a possible chemical effect -would be most
likely during the first trimester of pregnancy and could
therefore be im&f* in abortion data spanning the entire nine
months of 'tens.
-------
Chapter III
METHODS
The methods used in this study consisted of defining the study area,
developing/confirming a 2,4,5-T use history in that area, researching
U.S. Postal ZIP cede boundaries, selecting a control area, defining an
urban area, abstracting spontaneous abortion data from the hospitals
in the three areas, interviewing area physicians, retrieving county
birth data from Oregon computer tapes, and collecting various descript-
ive data ancillary to the study.
Description of the Study Area
The Study Area comprises approximately 1500 square miles of Oregon's
forested Coastal Range (Figures 1 and 2). It >as selected so as to be
centered around the "Alsea basin", an area of approximately 400 square
miles. The Study area includes the western half of Senton County,
northwestern Lane County and all but the northern and northwestern
reaches of Lincoln County. It is bounded on the west by approximately
70 miles of the Pacific Coast entending from Lincoln City southward to
Florence, and extends inland for distances ranging frcm 10 to 35 miles.
(Exact boundaries conform to U.S. Postal ZIP boundaries.) The Study
area includes all but'the northern and southern reaches of the Siuslaw
National Forest. Interspaced throughout one numerous ccrnmercially owned
and Bureau of Land Management forested acreages (Figure 3). Mcrataia
elevations of approximately 1,000 feet are not 'jncsmmon; cesk elevation
is slightly more than 4,000 .feet.
-------
Figure 1. OREGON
-------
Figure 2.
Study A|"ea in Lane, Lincoln and 3enton Counties of Oregon
STUDY AREA
3O
1C
-------
Figure- 3. Land Cover in Lincoln, Senton, and Lane (partial) Counties Oregon
FOREST
CROP 4/or RANGE
a?
-------
Drainage.is primarily westward; principal rivers include the Siletz,
Alsea, Yaquina and the Siuslaw. Eastern fringes of the area drain
eastward into the Willamette Valley. Maximum runoff is reached gen*-
erally during the winter months as the result of storms off the Pacific
occurring usually as rain. There is little snow accumulation.
The Study area is predominantly rural. The four hospitals in the area
are located in the four largest towns: Newport (pop. 5,200); Lincoln
City (4,200); Toledo (2,800); and Florence (2,250). Each of these hospi-
tals was utilised in the study. With the exception of Philomath
(1,700), all other towns/villages have populations of less than 1,000.
Alsea has a population of 400 (1970 census).
All of the nine women who participated in the first chase of the investi-
gation resided, at the time of pregnancy, in 'rural residences located
within 12 miles of Alsea. All cut one of the women resided in the Alsea
River watershed; the ninth resided southwest of Philomath in the
Corvallis watershed.
Description of the Control Area
After careful review and consultation with staff of the Oregon State
Eealth Department, the Control area was selected in Malheur County,
Oregon. Selection was cased on the following criteria:
1. The area had little or no use of 2,4,5-7.
2. The area is primarily rural, as is the Study araa.
-2
-------
3. Physician practices and hospital facilities were expected to
be similar to those in the Study area.
4. The area bore topographic similarities to the study area,
being of similar elevation and/ although not mountainous, having
rugged terrain (escarpments, rolling hills, arroyos, canyons).
The Control area comprises four contiguous postal ZIP code zones in the
northeastern part of Maiheur County (See Figure 4). The area covers
approximately 1,000 square miles and is bounded on the east and north-
east by the Snake River, which there fontts the Oregon-Idaho boundary.
Several creeks drain the area eastward into the Snake River. Approxi-
mately 90 percent of the area is classified as rangeland, sagebrush
being the dominant vegetation. Cropland accounts for a snail but
important percentage of the area along stream and river courses.
Twenty-one percent of the land in the county is in private ownership,
75 percent is Federal and the remainder (5%) is State, county, or
local governments, (See Figure 5)
The two hospitals in the Control area are located in the two largest
towns: Ontario (pop. 3,200) and Nyssa (pop. 2,900). Both hospitals
were utilised in the survey. The area also includes the tswn of Vale
(1,350) and the villages of Harper and Cairo (pop. less than 2SO).
13
-------
Figure 4. Control Area in Malheur County Oregon
CONTROL AREA'
3O
SCALH
1 ^
-------
5. Land Cover
FOREST
CHOP a/or RANG
-------
Personnel from the Malheur County Cooperative Extension Agent's office
had no specific figures to report on pesticide use in the county;
however, it was stated that there is very/ very little use of 2,4,5-T
in the county/ particularly in the cultivated areas. Personnel from
the area office of the BLM, which has the responsibility for management
of public land within Malheur County/ reported that 2,4,5-T has not
been applied on 3LM lands in the county since 1972 by either 3LM or
ranchers with grazing permits. Additionally, BLM personnel stated that
no pesticides of any kind had been applied to 3LM grazing land since
1968. A sagebrush control program used 2,4-D but not 2,4,5-T in Malheur
County.
Description of the Urban Area
The Urban area is comprised of the tow connecting Postal ZIP zones that
encompass the cities of Corvallis and Albany, Oragcn. 3oth sites are
located in the agricultural non-forested Willamette Valley. The
Corvallis ZIP zone is contiguous with the east-central boundary of the
Study area and the Albany sane connects the Carvaliis zone at its north-
east corner (see Figure 6}. The populations of Corvallis and Albany are
over 37,000 and 21,000 (1970 census).
-------
Figure 6.
Urban Area in Benton County, Oregon
URBAN AREA
3O vni««
SCALE
17
-------
TABLE 1
Selected Agricultural Statistics for Counties Including
the Study, Central and/or Urban Areas
Oregon, 1972 - 1977
All Facts, Number
Land in Farms, Acres
Approximate Land Area, Acres
Percent in Farms
Forest Production, Number
of Farms
Ecrest. Production, Dollars
Crops, Number of Farms
Crops, Dollars
Livestock, Number of Farms
Livestock, Dollars
Malheur
Control
1,357
1,360,195
6,309,760
21.6
5
1,278
935
23,040,153
991
20,063,573
Count' T and
Lincoln
Study
258
47,390
631,104
7.5
38
208,726
59
495,703
214
1,028,121
Area
Lane
Study
1,840
270,587
2,913,230
9.3
153
553,042
900
11,780,769
1,152
9,319,416
Sentcn
Studv &
Crban
575
129,034
427,520
30.2
53
457,313
301
3,317,112
423
2,667,955
tJ.S. Bureau of the Census, Census of Agriculture, 1369 T.ol. 1 area
Report Part 41. Oregon Section 2. County Eata. U.S. Government
Printing Off ice, Washington, D.C. 1972.
-------
Wcmen in both cities use Gccd Samaritan Hospital in Csrvallis for
gynecological and/or cbstetrical care, as do various wcnen thrcughcut
the Study area. All spontaneous abortion records for tanns of less than 20
weeks were obtained from the Hospital, first, to derive additional
data for the Study area., and, second, to permit comparison of seasonal
spontaneous abortion patterns and frequencies in an unsprayed urban
area adjacent to the Study area.
The abortion data for the Urban area are considered to be of limited
utility in this study because of an apparent tendency for first-
trimester abortions to be frequently handled in urban clinical .
facilities of a type that do not exist in the Rural Study and Centre!
areas. The data are useful, however/ in providing a measure of
monthly and seasonal trends on patterns in abortion frequencies.
Research of zip Code Boundaries
To facilitate an identification of the boundaries of the Study area,
T3 cede maps were developed with the cooperation of personnel in
local post offices. The boundaries of the Study area, which coincide
with the zip code delivery routes, remained unchanged curing the study
tine frame of 1972-1977 (See Table 2).
-------
ZIP Codes Corresponding to the Study, Urban,
and" Control Areas
Oregon, 1972 - 1977
Area Zip Codes
Urban 97321, 97320 .
Control 97906, 97913, 97914/97913
Study 97324, 97326, 97341, 97343
97357, 97365, 97366, 97367
97369, 97370, 97376, 97380
97388, 97390, 97391, 97394
97439, 97453, 97480, 97493
-------
Spray Data
In tiie study of the Alsea area women, spray data on the use of 2,4,5-7
were collected and plotted for the iiratediate area referred to as the
"Aisea Basin". This information was supplier! l:y the following major
organizations that used the chemical: USFS-Siuslsw National Forest;
USDI-Sureau of Land Management, Alsea Resources Area; Willamette Indus-
tries, Inc., Pilooath, Oregon; and Starker Forest, Philomath, Oregon.
The supplied data consisted of the date(s) of application, rata of
application, formulation, nurier of acres treated, and the location of
the treated land.
The locations of the sprayed areas were plotted to quarter-section on
township saps. In this manner the perimeter of the "Alsea Basin" could
then he defined as one covering approximately 4CO square miles or
2SS,Cnc acres. Curing the o—/ear period from 1272-1977, a total of 7121
acres was treated with 9015 pounds of 2,4,5-7. The poundage and acreage
varied from year to year (Table 35. The areas treated during this
period represent approximately 33 of the total acreage within the "Alsaa
3asin".
As mentioned previously, the predominant feature cf the study ares is
the forested Coastal aange. Since the Coastal Ranee extends fron north
err. Ciliforria into Washington, it wss considered r.ecasssry to estahlish
that: 1) topography and vegetation are similar d'.rcucjhout Cregon; ar.C. 2}
forest isanager.ent r-racticas in the Alsea has in are rer:resenc3tive of the
-------
Table 3"
Total Acres Treated and Pounds 2,4,5-T Used in AT sea Basin
Oregon, 1972-1977
Year
1972
1973
1974
1975
1976
1977
Acres Treated
88
28
219
63
468
444
25
469
207
80
287
223
229
90
552
1619
1259
2875
1946
444
90
2480
Treatment
0.5 Ib/A
1.0 Ib/A
2.0 Ibs/A
3.0 Ibs/A
1 Ib/A
2 Ibs/A
1 Ib/A
.3 Ibs/A
1 Ib/A
2 Ibs/A
3 Ibs/A
1 Ib/A
2 Ibs/A
1 Ib/A
2 Ibs/A
3 Ibs/A
Total 2,4,5-T (Ibs.)
44
98
438 ;.
189
769
444
50
494
207
240
447
223
478
270
971
1619
2512
4131
1946
888
270
3104
Total
7,131
S,916
-------
entire forested area. Personal communications with representatives of
the O.S. Barest Service and consnercial tree fara operators substan-
tiated that the ecological characteristics of the Coastal Range were
consistent in the Oregon c-^gt-ai Hange and that the chemical, 2,4,5-7,
is used as a carmen forest management tcol in this region.
The herbicide 2,4,5-T is applied almost exclusively by helicopter at an
average rate of two pounds per acre for control of undesirable vege-
tation such as red aider, vine naple, salmonberry, and Thircbleberry.
Certain weather factors such as wind and precipitation dictate time of
application, but in general the canpound is used in the spring (March,
April, or May) with a second application trade, if needed, in .middle to
late surnner (July and/or August). These seasonal usage patterns are
shewn in Table 4 and Figures 7 and 8.
To avoid contamination of water sources prior to 1973, the general appli-
cation policy was to avoid spraying near hones and provide for a single
swath of 30 to 60 feet en each sice of any major stream. Li September,
1978, the Cregcn Forest Practices Act provided extended guidelines.
These guidelines required that no spraying was to be mace within 500
feet of an inhabited residence nor within 200 feet en either side of a
Class A stream. Class A streams are defined as major streams with fish
and/or ones that are used for domestic water supplies.
Thus, the data from the Alsea basin illustrate a pattern which rray be
considered as representative of the Study area. In general, greater
amounts cf the chemical were acclied curinc the serins than
-------
Table 4
Applications of 2,4,5-7 by Day and Month in the Alsea Basin
Oregon, 1972-1977
Year
1972
1973
1974
1975
1975
1977
Dates Total Days
March 17, 20, 31
April 4
July 31
August 1, 19, 23, ?
May 5,5,10,13,14
August 15
April 26, 27, 29 .
May 4
July 29
August 2
April 9, 16
May 25, 27, 29
July 31
August 20
April 3-10
May 6
March 12-15, 19
March 24 - Aoril 14
3
1
1
4_
9
5
1
6
3
1
1
1
6
2
3
1
1
7
a
1
9
4
22
25
Acres treatment
148
121
48
151
468
444
25
469
- 180
27
48
J2
287
239
• 202
16
95
552
2840
35
2875
534'
19*6
2480
Amount Aoolied (Ibs
296
no
144
219
769
444
50
494
ISO
27
144
96
447
478
282
16
195
971
4096
35
4131
1158
19*6
210*
-------
Figure 7.
Acres Sprayed with 2,4,5-T in AT sea
Basin Accumulated by Respective Month, 1972 through 1977
5—
4-
)
o
1 0
o
2-
1 —
' J ' F ' M ' A ' M ' j ' J ' A ' « ' O ' N '
-------
Figure 8.
Pounds* of 2,4,5-T Sprayed in AT sea
Basin Accumulatsd by Respective Month, 1972 through 1977,
5-1
4-4
•23-
2-4
M ' A ' M
J J
MONTH
A S C N
"Active ingredient
-------
daring the summer treatments. Additionally, the spray program is .not
a month-long operation. Usually it spans only a few days' time. The
duration of the spraying depends on the number of acres to be treated
and on the weather conditions.
Selection of Hospitals and Abstraction of Spontaneous Abortion Data
Spontaneous abortion data were abstracted from all five hospitals
located in the Study and Urban areas (See Figure 9) and from the two
hospitals located in the Control area (See Figure 10). These hospitals
were viewed as the primary source of health care deliver/ for the
respective arass. The seven Oregon hospitals contacted are located
in Corvallis, Lincoln City, NeAroort, Toledo, Florence, Nyssa, and
Ontario. Those hospitals and the number of admissions and live births
that each recorded in 1975 are found in Table 5. All field work was
completed curing November and December, 1978.
Most of the hospitals were reluctant to participate in a record search
with non-hospital personnel because of patient confidentiality. Three
hospitals permitted a complete record search by field epidemiologists,
while at the other four hospitals the data were abstracted by hospital
personnel. Patients' names and addresses, excepting 21? codes, were not
recorded.
For each of the spontaneous abortions the following information was
provided or abstracted: H-ICTA diagnosis cede, age of patient, data of
-------
Figure 9.
Hospitals in Study and Urban Areas
Lincoln/
CJty '*
.JNCOLN
COUNTY
Newport/
Toledo
Florence
x/Corvallis
BENTON
COUNTY /
LANE
COUNTY
23
-------
Figure -10.
Hospitals in Control Area
Ontario
Nyssa
MALHSUR
COUNTY
-------
1SBLZ 5
Annual Admissions and Births in Hospitals in
Study, Drtan, and Control Areas
Creccn 1972 - 1977
Hospital
Lccaticn
Urban Area
Study Area •
Central Area
Hospital
(feme
Good Samaritan
Western Lane
North Lincoln
Pacific Ccinnunities
Ifew Lincoln
Malheur Memorial
Salv Scsary
City
Ccrvallis
Florence
Lincoln City
Newport
Toledo
Nyssa
Ontario
Admissions
1975
7389
802
1367
1159
875
710.
4097.
Births
1975
986
87
^•»
/ /
48
103
110
474
3U
-------
spontaneous abortion, gestation period, and ZIP code of patient's resi-
dence. Chly records of spontaneous abortions that occurred from 1972
through 1977 were sought. This time period coincided with the temporal
miscarriage pattern-of the nine original Alsea women.
Srcra 1972 to 1977, two ICDA texts were used by the hospitals. In 1973
5-ICEA was published and spontaneous abortions were listed by the codes
643.0, 643.1, 643.2, and 643.9. The 643.9 code includes any spontaneous
abortions not listed as induced or spontaneous. Prior to 1973, hospitals
used the 3th revision of ICEA. Spontaneous abortions were coded as
643.0, 643.1, 643.2, and 643.9. The code number 644- was also used for
1972, since this cede approxiirated 5-ICCA code number 643.9.
Physician Interviews
A list of private physicians who practice at each of the five hospitals
in the Study and the Urban areas was compiled front information pro-
vided by the hospitals and by local health officials. From the list,
30% of the physicians were randomly selected for interview. However,
since physicans tended to practice in groups, doctors not randomly
selected were also interviewed whenever available. In the Study area
19 of 27 (70%) of the physicians—all general practitioners—were
contacted. In Gorvallis all eight of the obstetricians/gynecologists
were interviewed as well as 20% (five) of the general practitioners and
10% (two) of the internists.
-------
When possible, interviews were carried cut in the doctor's office.
Each physician was asked to estimate the number of spontaneous
abortion cases of terms less than 20 weeks that he or she had treated
per year during the 1972 to 1977 time period. Each was also asked
to estimate the percentage of those cases which had been hospitalized.
Because of similarities in medical facilities and rural population
distribution in the Control and the Study areas, physician practices
were assumed to be similar in the two areas. Therefore, it was
decided not to conduct physician interviews in the Control area.
Cata Preparation
The data en spontaneous abortions of less than 20 weeks from, the seven
study hospitals were edited, coded, keypunched, and computer edited.
The number of monthly hospitalized spontaneous abortions during 1972-
1977 were tabulated- for each of the three areas. These data were also
tabulated and crcss-tsfaulated according to the several variables of
interest. For example, the data en hospitalized spontaneous abortions
were cress-tabulated according to area (Study, Urban, and Centre!) and
gestation period (less than 4 weeks, 5-3 weeks, 9-13 weeks, 14-17
weeks, and 17-20 weeks).
Birth certificate data for 1972 through 1977 were obtained in the fora
-------
of computer tapes fron the Vital Statistics Section of the Cregcn
State Health Department. These ccncuter tapes were used to obtain the
number of births per month in the Study, Urban, and Control areas for
1972-1977.
The Spontaneous Abortion Index; In order to make comparisons among
areas and among the months of the year, especially within areas, the
data on spontaneous abortions need to take into account the number of
births in the three areas during each of the twelve months. The index
described below is basically the ratio of the number of hospitalized
spontaneous abortions to the number of births corresponding to the
spontaneous abortions, based on the residence 21? Cade of the women
contributing to each event. Thus, the ratio is not a true rate but
rather an index of the hospitalized spontaneous abortion experience of
the women residing in the three areas.
In order to describe the spontaneous abortion index, the following
notation is recuired:
Y. . =« the number of hospitalized spontaneous abortions in the
i=i area (i = 1,2,3...) in the j— month (j = 1,2,...,
12) during 1972-1977;
*'
X^ = the number of births in the i— arsa and in the jJ±!
month during 1972-1977.
-------
An index that has been used in similar studies is sinply the ratio
*ij^ij. TSie inherent problem with such an index is that the'
.numerator involves women of one conception period whereas the
denominator involves women of a different non-overlapping conception
period.
The spontaneous abortion index developed here is 2-^ = ^i.-/cii
where C^ is a five-month moving-average of the X^ . 's which have
been appropriately shifted. In particular, C^= £ w'
-------
Statisticial Procedures
Statistical evaluation of the data is based on the following analyses:
1. Analysis of. variance of the abortion index by area and
monthf deriving a residual error tarm by dividing the data
into two "3-year periods.
2. Frequency table analyses, by chi-square, to test monthly
variation in the emulated number of spontaneous abortions
analyzed as siriole frequencies and as expected monthly
frequencies of spontaneous abortions calculated from the
frequencies of corresponding live births.
3. Tests of cyclic trends including:
(a) A pcwer-spectrun analysis of the abortion index ever
months to test for cyclic trends in the monthly.data.
(b) Adjustment of the abortion index data to account for
phase differences between the Study area and the Ccn-
trol and Urban areas.
(c) Fit of a sine-rfave model to the abortion index data.
(d) Cyclic analysis cf the raw abortion data (unadjusted
fcr births).
•5C
-------
(e) Examination of birth- data frcni Miami, Florida (Jackson
Memorial Hospital, 1976-77) fc_ cyclic behavior.
(f) A test for cyclic trends after recalculating the
abortion index by raw mincers of births as the
denominator rather than the five—tenth moving average.
4. Cress-correlation analyses between Study area abortion
indices and spray patterns.
(a) Crcss-correlaticn analyses, parametric and non-carnaetric,
between the Study area abortion index and the monthly
spray pattern cf 2,4,5^1 in pounds sprayed' per month.
(b) Crcss-correlaticn analysis with the monthly spray pat-
tern aftar adjusting- the abortion index data for dif-
ferences in cyclic trends.
(c) Cross-correlation analyses of Study araa abortion index
and spray patterns for the periccs 1972-74 and 1975-77.
5. Evaluation of physician interview data.
-------
Chapter F7
RESULTS
The annual numbers of hospitalized spontaneous abortion oases in the
three areas appear in Table 6. There was a total of 477 cases: 138
in the Study area, 1Q9 in the Control area and ISO in the Urban.
Table 7 depicts these cases accumulated by month of the year for the
1972 to 1977 tine period. The same cases are also represented accord-
ing to the age of the patient in Table 8. Table 9 presents, for each
area, the cases by weeks-of-term categories for those cases (456) for
which term was
As mentioned previously, the number of births in these three areas
needs to be taken into account in any coirpariscns rrace among the
areas with respect to the number of spontaneous abortions. Table 10
presents the nurr-ber of births per calendar month for the Study, Crban
and Control areas; the five-month moving average of the number of
births corresponding to the month of spontaneous abortion is given in
Table 11 for each area, where the weights were obtained from the
tabulation of spontaneous abortions according to length of gestation
(Table 9).
Table 12 presents the monthly spontaneous abortion index for each of
the three areas in the study; the monthly spontaneous abortion index
for these areas is also displayed graphically in Figure 11. An
obvious feature of this graph is the elevated ir.cex of the Study area
for the month of June.
37
-------
TABLE 6
Number of Hospitalized Spontaneous Abortion Cases for Study,
Ocean, and Control Areas
Oregon, 1972 - 1977
Year
1972
1973
1974
1975
1976
1977
Total
Study Area
37
34
23
31
33
30
ia a
Urban Area
44
40
38
19
20
19
180
Control Area
9
19
27
27
3
19
109
-------
Month
January
February
March
April
May .
June
July
August
Septsnber
Octcfaer
Msvenfcer
Secsmcer
Total
Drfaan, and Gsntrol Areas,
Oregon, 1972
Study Area
10
17
18
11
IS
24
20
17
9
15
16
15
133
Accumulated by Month
- 1977
Urban Area
25
17
15
16
17
15
5
11
17
19
7
16
130
W«.«»«M^ f
Control Area
12
4
7
14
9
6
7
10
11
7
3
14
109
39
-------
TAELZ 8
Hospitalized Spontaneous Abortion Cases by Study, Crban,
Control Area, and Age Group of Patient
Oregonf 1972 - 1977
Age
Group
10-14
15-19
20-24
22-29
30-34
35-39
40-44
45-49
Total
Study
Area
3
33
59
44
13
9
6
_±_
138
Percent
1.6
20.2
36.7
23.4
9.6
4.3
3.2
0.5
100.0
Urban
Area
0
12
63
62
26
7
5
g_
130
Percent
0
6,7
37.3
34.4
14.4
3.9
2.3
g_
10.0
Control
Area
0
14
38
.24
21
9
3
o •
109
Percent
0
12.8
34.9
22.0
19.3
3.3
2.3
0__
100.1
-------
TABLE 9
Number and Percent of Spontaneous Abortions According to
Isngth of Gestation in the Study, Crban, and Control Areas
Oregon, 1972 - 1977
Study
Gestation Period Area.
. 1. 13-20 weeks 8
(4.6%)
2. 14 -17 weeks 24
(13.3%)
3. 10 - 13 weeks 63
(39.1%)
4. 5-9 weeks 62
(35.6%)
5. 4 weeks or less 12
(6.9%)
ictal 174
.Grban
Area
12
(6.7%)
15
(3.3%)
83
(46.1%)
60
(33.3%)
10
(5.6%)
130
Control
Area
7
(6,8%)
14
(13.7%)
43
(47.1%)
23
(27.5%)
5
(4.9%>
102
Overall,
27
(5.9%)
53
(11.6%)
199
(43.6%)
150
(32.9%)
27
(5.9%)
456
-------
TABLE 10
Number of Births by Months for the Study,
Urban, and Control Areas
Oregon 1372 - 1977
Study Area
January
February
March
April
May
June
July
August
Sept enter
October
Jtoveirber
Dacenfcer
Six-Year Total
194
138
202
189
201
228
203
212
204
170
172
181
2344
Urban Area
338
353
344
335
357
373
315 •
351
242
343
337
327
4120
Control Area
124
124
126
131
155
145
156
131
154
136
155
129
1666
-------
TABLE 11
Numoer or s:
Month
. January
February
Mat*
April
.May
June
July
August
September
Cctccer
Jtovenfcer
Cecendber
Total
urtns uarrespcnaing tc
in the Study, Otban
Oregon?
Study Area
208.3
206.8
191.8
177.8
177.9
184.0
189.7
193.0
195.6
196.7
208.7
213.4
2344
3 cne nanrn or spcnt^ns
, and Cbntrol Areas
1972 - 1977
Urban Area
338.3
345.0
341.5
340.4
334.8
334.3
342.0
345.7
342.5
346.9
358.1
350.7
4120
x:us Accrticns
Gsntrol Area
146.3
142.6
145.6
143.6
142.3
130.5
126.5
125.4
129.0
138.7
147.3
148.1
1666
Based en five-racnth moving average.
-------
TSBLZ 12
Monthly Spontaneous Abortion Index for the Study, Crban, and
Control Areas
Oregon, 1972 - 1977
Month
January
February
March
April .
May
June
July
August
Septenfcer
October
November
Cecamcer
Average
Study Area
43.1
82.2
93.3
61.9
89.9
130.4
105.4
38.1
46.0
76.2
76.7
70.3
80.3
Urban Area
73.9
49.3
43.9
47.0
50.3
44.9
14.6
31.3
49.6
54.3
19.6
45.6
•43.8
'Control Area
32.0
28.1
48.1
97.5
63.2
46.0 •
55.3
79.3
35.3
50.5
54.3
94.5
65.4
Average
63.0
53.2
61.9
63.3
63.0
73.8
53.4
66.6
60.3
60.5
50.2
70.1
63.3
The spontaneous abortion index is defined as the ratio of the nurcber of
hospitalised spontaneous abortions to the corresponding number of live
births based on a five-ncnth moving average, and is expressed as
abortions/1,000 births.
-------
JOO —
ao-
60-1
20-
Figure 11. Plot of Monthly Spontaneous Abortion Index
for the Study, Urban, and Control areas
Oregon, 1972-1977
140-7 . m—v**s^STUDY AREA
URBAN AREA
CONTROL AREA
iv\
120-i
i i 1 1 I I I 1 i 1 i
JFMAMJJASON
45
-------
Statistical Analyses
In order to arrange the data in such a way that proper error terras
for hypothesis tests could be calculated and to see whether seasonal
spontaneous abortion patterns were consistent over tine, the data
were gathered into two 3-year periods as shown in Table 13. The
plots of these data are shown in Figures 12, 13, and 14.
From the graphical representations it is seen that the time
(seasonal) patterns within each area are remarkably similar for the
two periods.
The analysis-of variance appropriate for the data in Table 13 is
given in Table 14. Although the three-year tiae periods could have
been viewed as a blocking factor, it was decided to test the various
interaction tarsss for possible significance, dearly, the only
significant variation is among the three arsas.
The mean values for the three areas are: Study area = 80.3? Crian
area = 43.3; and Control area = 65.4 (see Table 12). By the New
Cuncan's Multiple Pange Test, all three means are significantly
different from each other (p<.05, two tailed).
From Table 13 and Figure 14 it is seen that there is a decrease in the
overall Abortion Index fcr the Urban area curing Period II. Analysis
showed that this decrease is significant (p<.OOQ2). The nsan
-------
TABLE 13
Average
abortion Index" by Period, Area, and Month
Oregon, 1972-1977
January
February
March
April
'May
June
July
August
September
October
Novesnfaer
Dacssnber
•
Study
Area
48
77
94
45
112
98
95
76
81
71
105
34
PERIOD I
(1972 - 3 -
. Urban
Area
95
58
59
76
54
72
29
52
76
63
22
57
4)
Control
Area
63
28
14
34
34
46
63
96
140
29
63
95
Study
Area
48
87
94
79
67
163
116
104
31
81
48
56
PERIOD n
(1975 - 6 -
Urban
Area
53
41
29
18
43
18
0
12
23
46
17
34
7) '
Control
Area
96
28
82
111
42
'46
47
64
31
72
41
95
80.5
59.4
67.9
81.2
28.3
62.9
Ssspitalizsd spontaneous sborticns/1,000 live births adjusted for
gestaticnal age distribu5.cn of observed abortions. The ccmcuted
monthly births for the six-year interval were divided equally between
the two periods.
-------
figure 12 Abortion Index for the Study Area By Month and Period
X
01
-a •
c
o
100
160
140
120
100
00
60
20
U.*M4M-*ini«M *4 J*M«»***»%*htir«
F M A M
J J A S 0 N D
Aontlt
-------
Figure 13 Abortion Index for the Control Area Dy Month and Period
16ft,
X
01
-a
c
o
O
140
120
100
00
60
40
20
I
J
MAM
•* •.•
J J
Month
SON 0
-------
Figure 14 Abortion Index for the Urban Area Qy Month, and Period
120
101
X
%
c
o
o
60
20
0
MJ JA SO ND
Month
-------
TABLE 14
Analysis of Variance of Abortion Index by Period, Area, and Month
(See Table 13)
.Source of
Variation
Periods
Areas
Months
Periods x Areas
Periods x Months
Areas x Months
Ncn-additivity
Residual
Degrees of
Freedom
1
2
11
2 '
11
22
1
21
Sum of
Squares
2,485.13
16,475.53
3,377.82
3,498.08
7,749.38
25,156.81
0.34
12,738.58
Mean
Square
2,485.13
8,237.76
. 307.07
1,749.04
704.49
1,143.49
0.34
606.60
F-Satio
4.10
13.58*
<1
2.88
1.16
1.89
<1
EX.0002
-------
abortion index of the Urban area for Period I is 59.4. When this is
compared to the six-year mean for the Study area (30.8) and that for the
Control area (65.4) using the New Cancan's Multiple Range Test it is
found that both the Urban area and the Control area differ from the
Study area (p<.05, two tailed), but not from each other. This seems
a acre conservative analysis since the reason for the precipitous
decrease of the abortion index during Period II is presently unknown.
Figure 12 is noteworthy for two reasons. First, there is striking
similarity in the patterns, especially the "shoulders" on the curves
following the peaks for each period. Second, the peak for the second
period corresponding to a greatly increased pesticide usage is
higher than that for the first period.
Frequency liable Analyses
Ctaifotm Hypothesis i Since the adjusted numbers of births used for the
denaoinators in calculating indices appear sensibly flat (see Table 11)
monthly variations in' the cumulated number of spontaneous abortions
were analyzed as staple frequencies (see Table 7).
Older the hypothesis that monthly accumulated spontaneous abortions
were uniformly distributed throughout the year, chi-scuare analyses
were performed for each area. The urban area showed a significant
variation among .Tenths due to a high number cf spontaneous abortions in
Eecsmber and lew numbers in July and November. The other two'areas did
sir
-------
not shew significant variation among months, but in the Study area the
north of June had a significant contribution to the overall chi-square
value. Further, in each area, various months showed large
contributions to the overall chi-square.
Expected Frequencies Based on Live Births; When the expected monthly
frequencies of spontaneous abortions were calculated from the
frequencies of corresponding live births from Table 11, the chi-square
analyses were virtually the sane as when based on the actual number
of spontaneous abortions.
Cyclic Trends
Spectral Analysis^ The Analyses of Variance and the chi-square
analyses, together with a close study of Figure 11, strongly suggested
the possibility of cyclic trends in the data.
Fower-spectrun analysis of the abortion index over months showed that
for each area there was only one cycle of significance and it had a
period of about four months in each area.
Adjustment For Cyclic Trends; The importance of indentifying cyclic
trends is two-fold. First, their presence might have some biological
meaning relevant to this study. Second, a month-to-mcnth comparison
between the Study area and the Control areas should take into account
chase differences which might be related to fertility patterns or some
ether as-yet-urJocwn phenonenona.
-------
The need for this type of adjustment is shewn Li Figure 15. Since the
Study area and the combined Urban and Control areas seem to be almost
exactly 180° cut of phase, any month-by-mcnth differences could be
falsely amplified. Clearly, if the Control data are shifted back in
time as shewn in Figure 16, monthly differences could• possibly reflect
excess abortions in the Study area if they exist.
The Sine Wave Model; Since the pcwer-spectrun analysis identified
only one frequency for each set of data, it was decided to fit the
simplest cyclic model:
Index = A + 3 Sin (|£ t - D) where t is in months. Table 15 shews
quite clearly that this model adequately represents the data in the
Urban and Control areas. Because of the peak in the Study area data
around June and July, the model does not fit the Study area as well.
The phase difference between the Study and the Urban and Control
areas is on the order of two months.
Tables 16, 17, and 18 shew the Study area data adjusted for the Control
and the Urban area and for both areas combined. Figures 17 and 13 shew
the'sine wave models fitted to the abortion index data for the Study
area and the Control and Urban Areas.
-------
i FIGURE 16y SPONTANEOUS ABORTION INDEX. 1972 - 77 FOR THE STUDY AREA AND THE ,
"*" ""* I COMBINED CONTROL AND URBAN AREAS. '
fl30.-
ui
in
.El
DO,.
00
I 60~
140 r
|30|i
I I I
- STUDY ARiA . I
w "'*'"""" "
, - URBAN AND CONTROL!
I I
J ip M
A M J J
Muntli
A S O N . D
-------
FIGURE 16:
•I-
70-.
x-
Q i 60^"
50s-
40 r-
30 -
STUDY AND CONTROL AREAS: (a) COMBINED URBAN AND CONTROL INDEX,
(b) STUDY AREA INDEX (c) URBAN AND CONTROL INDEX SHIFTED BACK
TWO MONTHS
(a) CONTROL AND URBAN AREA
f
M
M
N
140
120
»
* J«a
a*
30-,
60
40
SO'
70
a
50
40
30
(b) STUDY AREA
x
HI
a
I > > I
M
M J
(ci URBAN AND CONTROL AREA
WITH 2-MONTH PHASE SHIFT
j i i_t . i
J I
N
M A M J J
-F
-------
IS
Parameters of the Model "Index » A +• B Sin ( t - D) "
For the Various Areas T
A (Mean)
B (Amplitude)
T (Period in Months)
0 (Siase Shift in Months)
Adequacy of the Model
(Correlation)
Study
83.1
IS. 6
3.6
1.1
0.49
Urban
43.4
IS .2
4.1
3.1
0.78*
Control
65.5
24.7
4.1
2.2
.92**
Urban -t-
Gsntrol
S6.0
15.6 -
4.0.
2.8
.84**
* 0.05
-------
TRBLS 16
Study Area Index Corrected for Phase Shifts
Study minus Ccntrol — 1 ncnth lag
Study
48.1 (J)
32.2 (F)
'93.8 (M)
61.9 (A)
89.9 (M)
130.4 (J)
105.4 (J)
38.1 (A)
46.0 (S)
76.2 (0)
76.7 (N)
70.3 (D)
Control
28.1 (F)
48.1 (M)
97.5 (A)
63.2 (M)
46.0 (J)
55.3 (J)
79.3 (A)
85.3 (S)
50.5 (0)
54.3 (N)
94.5 (D)
82.0 (J)
Difference
20.0
34.1
-3.7
-1.3
43.9
75.1
25.6
2.8
-4.5
21.9
-17.3
-11.7
53
-------
TABLE 17
Study Area Index Corrected for Phase Shift
Study minus Urban — 2 month lac
Study
48.1 (J)
82.2 (F)
93.3 (M)
61.9 (A)
89.9 (M)
130.4 (J)
105.4 -(J)
88.1 (A)
46.0 (S)
76.2 (0)
76.7 (N)
"70.3 (D)
Urban
43.9 (M)
47.0 (A)
50.8 (M)
44.9 (J)
14.6 (J)
31.3 (A)
49.6 (S)
54.8 (0)
19.6 (N)
45.6 (D)
73.9 (J)
49.3 (F)
Difference /
4.2
3S.2
43.0
17.0
75.3
98.6
55.8
33.3
26.4
30.6
2.3
21.0
59
-------
TABLE 13
Study Area Index Corrected for Phase Shift
Study minus (Urban plus Control) — 2 month lag
Study
48.1 (J)
82.2 (F)
93.8 (M)
61.9 (A)
89.9 (M)
130.4 (J)
105.4 (J)
88.1 (A)
46.0 (S)
76.2 (0)
76.7 (N)
70.3 (D)
Orban + Control
46.0 (M)
72.3 (A)
S7.0 (M)
45. 5 (J)
35.0 (J)
55.8 (A)
67.5 (S)
52.7 (0)
37.0 (N)
70.1 (D)
78.0 (J)
53.3 (P)
Difference
2.1
9.9
36.3
16.4
54.9'
74.6
37.9
35.4
9.0
6.1
-1.3
12.0
50
-------
130
120
110
100
oo
BO
70
GO
1
FIGURE 17 PREDICTED AND OBSERVED POINTS FOR THE STUDY AREA
STUDY AREA
Sin* W«va Modal
M
M
J
Maiuli
O
N
Q
-------
FIGURE 10 PREDICTED AND OBSERVED POINTS FOR THE URBAN + CONTROL AREAS
a\
30
-------
Cyclic Analysis of the Numbers o£ Abortions; The raw numbers of
abortions shewed the same time behavior as did the indices. In order
to find seme rationale for cyclic variation in spontaneous abortions,
a physician beard-certified in obstetrics and gynecology was
consulted. Ss was aware that births might show sane high frequency
cyclic behavior superimposed on a yearly cycle. The data for 1976-77
for Jackson Material Hsspital in Miami, Florida are shown in
Appendix B. A plot of these data suggests cycles of two-months
duration. Plots of the Oregon birth data in this report suggest
cycles of fao-to-threo months duration. Clearly, these patterns need
investigation since they might be viewed as "noise" in the data and
thus obscure important relationships.
Sirole Number of Births as the Denominator for the Abortion Index; In
order to see if any unanticipated algebraic relationships involved in
computing the denominator for the index could be causing a problem,
the raw numbers of births were used to compute abortion indices. The
results of the analyses did not change from the above. Table 19 shows
the distribution of births by month and the computed indices.
Cross-Gii-alaticn Between Study Arsa Abortion Indices and Spray
Pattern
Cross-Correlation Analysis: A cross-correlation was computed between
the abortion index for the Study area and the monthly pattern of
spraying 2,4,5-T in pounds sprayed cy month ('jao riiMUi'a ID}. This
-------
TRBLE 19
Number of Births per Month and Unweighted Abortion Index
for the Study, Urban, and Control Areas
Oregon 1972 - 1977
Month
January
February
March
.April
May
June
July
August
September
October
Ncvenfcer
Cacsnrer
Total/Average
Study Area
194
183
202
139
201
228
203
212
204
170
172
181
2344
51.5
90.5
39.1
58.2
79.6
105.3
98.5
80.2
44.1
88.2
93.0
82.9
80.1
Urban
338
353
344
335
357
378
315
351
342
343
337
327
4120
Area
74.0
48.1
43.6
47.3
47.6
39.7
15.9
31.3
49.7
55.4
20.3
43.9
43.6
Control Area
124
124
126
131
1S5
145
156
131
154
136
155
129
1666
96.8
32.3
55.6
100.9
58.1
41.4
44.9
76.3
71.4
51.5
51.6
108.5
65.3
-------
FIGURE 10 (a) STUDY AREA ABORTION INDEX CORRECTED FOR PHASE-SHIFTED
URBAN INDEX; (l>) POUNDS OF 2,46-T SPRAYED BY MONTH
ui
100
(CORRECTED ,
INDEX
U)
r
10 —
6 -i
|4 -
. 2.4.6-T
I (POUNDS! '3 -
' X 1.000
1 0 .J
•»—.-^T.
/ *Y
(bl
I
J
I
F
MAM
I
A
.1
S
I
O
-
N 0|
-------
FIGURE 20 CROSS-CORRELATION OF STUDY AREA ABORTION INDEX WITH
1 SPRAY PATTERN IN TOTAL POUNDS OF 2,4,5-T APPLIED SY
' MONTH, 1972-77. .
-0.4S
•.5-
-
-
Mcnths Shift in Spray Data
-------
analysis shewed that the abortion index for the Study area was
significantly correlated (p<.01) with the spray pattern after a lag
of two (r=.70) to three (r=.76) ncnths (see Figure 20).
Tb avoid problems with a ncn-noraal distribution of the spray data,
a Spearman rank correlation corrected for ties was computed. The two-
month lag was not quite significant (r=.46), but the three-tnonth lag
was (r=O.S8, p<.05).
Cross-Correlation Between the adjusted Study Area Index and the Spray
Pattern
Haioval of the Cyclic Trend; The differences shewn in Tables 16, 17,
and 18 new appear to be free of cyclic trends. This is shown in
/
-------
TABLE 20
Cross - Correlation of Corrected Study Area Index with
Spray Cata
0
Study vs. Orban -.08
Study vs. Central -0.27
Study vs. Orban +• 0.09
Control
Lag (months)
1234
0.33 0.89* 0.56 0.04
0.24 0.84* 0.48 -0.15
0.38 0.83* 0.54 0.17
* p<.01
-------
TABLE 21
Pounds of 2,4,5-T Applied in the Alsea Basin and Abortion Index
Ebr the Study Area by Month and Period
Cregca, 1972-1977
January
February
March
April
May
June
July
August
Septsnfcer
October
itovenfcer
December
PERIOD
(1972 - 3
Abortion
Index
43
77 •
94
45
112
98
95
76
61
71
105
34
I
- 4)
Founds
2,4,5-T
0
0
296
290
471
0
238
365
0
0
0
0
PERIOD
(1975 -
Abortion
Index
48
87
94
79
67
163
116
104
31
81
48
56
II
6-7)
Pounds
2,4,5-^T
0
0-
2131
5574
317
0
16
195
0
0
0
0
-------
TABLE 22
Cross-Correlation of Study Area Abortion Index with Spray Eata
Period I
Period II
Lag
0 1
0.19 -0.06 0
0.32 -0.24 0
(months)
2 3
.27 0.31
.31 0.66**
4
0.00
0.00
Scearaian Sank Correlation corrected for ties
0.01
-------
abortion Index/Spray Pattern Cress-Correlation Analyses for Periods
I and n -
Table 21 shows the pounds of 2,4,5-T used by month and the abortion
index by month for Periods I and II (1972-74 and 1975-77). Cross-
correlation analyses were completed between the abortion indices for
each period and the respective monthly patterns of spraying 2,4,5^1 in
pounds sprayed by month in the "Alsea Basin." Sines the spray data
are clearly not approximately normally distributed, a Speannan Rank
Correlation corrected for ties was done to find the cross-correlation
between spray patterns and the abortion index in the Study. Area.
Ihe results are shown in Table 22. These correlations show the same
pattern as these for the six-year aggregate of data (see Table 20),
although the correlation does not reach significance for the Period I
data.
Physician Interviews
Table 23 lists the physicians' estimates of the number of spontaneous
abortion cases of tents less than 20 weeks treated per year (1972-77)
and the percentage that were hospitalized.
Cf the 19 doctors contacted at the fcur hospitals in the Study area,
four refused to provide estimates and four indicated they did not
handle such cases. The remaining 11 physicians provided positive
-------
responses on number of cases handled and/or percentage hospitalized.
Assuming that the four who refused to respond do handle such cases,
79% (IS of 19) of the physicians contacted have treated spontaneous
abortions during the study period.
Prom the physician interviews, it is estimated that approximately
70% of the spontaneous abortion cases are hospitalized among these
treated by physicians practicing at one of the Study area's four
hospitals. . Ihe.percentage is calculated by weighting the individual
hospitalized percentage estimates by the respective number of cases
treated by each responding physician. .
It is concluded, therefore, that the abortion data presented for the
Study area are, indeed, representative of that area. It is further
assumed that because of the aforementioned medical/population
similarities between the Study and the Cdntrol areas, a similar
representative percentage of spontaneous abortions are hospitalized in
the Cantrol area.
The percentage of spontaneous abortion cases hospitalized in the Crban
area is estimated to be approximately 30%. (The estimate is adjusted
for general practitioners not selected for interview). The percentage
is clearly less than that for the Study area, apparently cue to these
cases treated at the clinic and medical center facilities not
available in the Study area. Ihe data are considered to be reflective
72
-------
of seasonal spontaneous abortion patterns; however, Urban area index
•values are undoubtedly biased downward relative to those for the Study
and Control areas.
73
-------
TABLE 23
Study and Urban Area Physician Interviews: Estimated'Numbers
of Spontaneous Abortions Treated Annually and Percentages
Annual Mean Number
Ssspital
Pacific Communities-
Newccrte, OR
(9 Physicians)
Western Lane Hospital
Florence, CR
(6 Physicians)
New Lincoln Ssspital
Toledo, OR
(4 Physicians)
.Contacted
Physician
A
B
d-
. D2
t?
P
G
H
I
J4
X
L
M
N
Type of
Patients
G?
G?
G?
G?
G?
G?
G?
G?
G?, Surgery
G?
G?
G?
G?
G?
of Spontaneous
Abortion Cases,
1972 - 1977
*
0
0
10.0
0
1.5
<1.5
6
1.5
15
7.1
*
0
0.3
Percent
Haspitalized
75-80
—
—
95
—
20-30
Chkncwn
25
95
75
50
—
—
100
74
-------
TABLE 23 (Continued)
Hospital
Jferth Lincoln Hospital
Lincoln City, OR
(8 Physicians)
Contacted
Physician
0
P
Q
R
S
Gccd Samaritan Scspital T
GorTalliSf OR
U5
V6
w
X
Y
z
AA
33
CC
CD
Type of
Patients
G?
G?
G?
G?
G?
G?
G?
G?
G?
Internist
OB/G2N
CB/G2N
OB/G2N
CB/G2N
Annual Mean Number
of Spontaneous
Abortion Cases,
1972 - 1977
5.0
. 5.0
*
*
*
5.0
1
3.9
*
0
50.0
50.0
50.0
50.0
Percent
Bsspitalized
30
80
—
—
—
30
50
30
—
—
10
10
10
10
Internist 0 —
G?
11
0
-------
TABLE 23 (Continued)
Contacted
Hospital Physician
Good Samaritan Hospital EE
Gorvallis, CR
(continued) FF
GG
EH
Annual Mean Number
of Spontaneous
Type of Abortion Cases, Percent
Patients 1972 - 1977 Sospitalized
CB/G2N
OE/GXN
OB/GZN
CB/G2N
50.0
0
50.0
50.0
10
1C
10
Perused to release data.
^•Physician C has practiced in the immunity since January 1973.
rhysician D has practicsd in the connunity since 1975.
^Physician E has practicsd in the ccrrmunity since 1977.
Physician J has practiced in the cammnity since 1976.
^Physician 0 has not taken any ccstetric cases in past three years.
s I
Physician V has practiced for 14 months.
-------
Chapter V
AND COKZI35ICNS
Tlie objectives of the study were to test the following hypotheses:
(a) whether or not differences Li spontaneous abortion rates
exist between the study and central population;
(b) whether or not seasonal variations in rates exist within
the study and control populations;
(c) whether or not such variations, if they exist, can be
associated with time and concentration of spray applications
in the Study area.
Hie statistical analyses of the spontaneous abortion and spray data
presented herein to test these hypotheses have demonstrated that:
1* The 1972-77 abortion rate index for the Study area is
significantly higher than those for either the Control or
the Urban area.
2. There is a statistically significant seasonal cycle in the
abortion index in each of the areas with a period of about
4 months. In particular, there is an outstanding peak in
June in the Study area.
77
-------
3. There is a statistically significant cross-ccrrelaticn
between the Study area spontaneous abortion index and
spray patterns in tents of pounds applied by months in the
Alsea basin, 1972-77, after a lag time of 2 or 3 months.
The results based on the six-year aggregate of abortion and spray data
are confirmed and enhanced by the analysis of the two 3-year
aggregates. The cyclic tine patterns are consistent over time
periods; the Study area shews an elevated abortion index over the
Control and the Urban areas; and there is a peak in the abortion index
which correlates positively with the spray pattern in the Alsea basin
after a lag tins of 2 to 3 months.
For all its csnplexity, however, this analysis is a correlational
analysis, and correlation dees not necessarily mean causation.
73
-------
REFERENCES
1, Rebuttable Presumption Against Registration and Continued
Registration of Pesticide Products Containing 2,4,5-T.
Environmental Protection Agene/, Office of Pesticide Programs,
Washington, D.C., Federal Register [6560-01] Vol. 43, No. 78 -
Friday, April 21, 1978.
2. Farm Chemicals Handbook - 1978. R. L. Meister, Jr. (ed.),
Meister Pufal. Co., WiUoughby, Chio, pp. 250-251, 1978.
-------
ao
AFSESDIX A
QUESTIONNAIRE: Orsccn Miscarriaae Investiaatian
NAME DATE
ADDRESS
Prior addresses:
. Fran 19 to 19
CTT? COUNTY JTATc
• From 19 to 13_
CITY CuUiHTY STATE
Fran 19 to 19
cTTT
Family Physician:
NAME
ADDRESS PHONE
Data of Last Cainnleta Physicial Examination
-------
DATA
I'lcauu 1 I at lilt!iicii iluriiiK |»ruttnai)cy>
(CJly. C.iiinly, Staia)
Imllr.ii u | Ivu lilriliu
(|!lVi! lliltli)
(1) l'ii II TIM in
(2\ I'fi.-m.'il urti
•>l 1 1 1 l> 1 II Ii:i/S|>oul aiiiiouu
iilnii i lini:i C|\lvii ilaii:)
lu 1 rill ui:li;lil Oh. , a/.)
Any ltd Hi ild'ciUii. HUM I till
iliil Ir li!ii«:y , iir ittliur
<-i>ll|li.'ll 1 I'il 1 liii|iil 1 I lUtMlL Y
(Aiiiiuc:|- Ijn, Yt::i (ili:uc. r ll>a)
411' Illlltlllll-lll \
\at
, — — .,
2nd
3rd
4 lih
5th
t
-------
I'llKCMAIIGY DATA
rain11 tun-1)
I'm 1 1 uuli 1 t'l lisi, did you
<:)(|u:rli:n<:>: ii|ioitlnu durJii|{
|ii i:|;iumi:y V
I'm' ml iii:arr la^uii ami
.••I 1 1 Mil ft li:», unu iliaru a
(no); |iurltid ol Illitutia
ami i>|ioi I lii|;, or wau
ml HI'III r lii|)<: liudili:!)?
l)i:l(;lil i:lil i-|jil40try (III).
Hid your dorl.or itill
you llial your uul|;lu~
I'^'llll Uil:l l:Xrt!!lli I VliY
hlil your dor.lor ludlcutu
Iliiil you luid hi|',li lilood
|U't::ltiUI i: ilm lll|;
|>l i:|'OIOIi: y /
(Mil your doctor ludlcati:
llial you li.nl klilutiy
Inl t:t: I (mi iloi In);
I'.i-iil al Ion)
lut
.
2nd
3rd
•
Alh
•
Stlt
-------
CY IUTA
CONTINUED
I'KltfNANCIKS
hid liu |>ri::i<:r llu: any
mi:i| Iciil: luuu Tor uuiylit
run! ml , lil|;li lil oo.l
l>i ciiiiiu i!, in: Icliluuy
lul i;i:l tohiiV • 1 1: yuu
|i|i:a:iu ij|U!f. I f y
iiu:il leal I ant).
hlil you hiivi: any
i i:ti|il i al »ry Inlect louu
ilur lii|( |>n-|;iinnr.y '/
(UCi:l, !i ill |!i!lll al' Illll)
Ikiil yini n:a: any of Iliu
1 ol loulitji n>i:«j Iral loa
|n lor l.a 111: iliu In);
l>r>!|'tiiiiiii:yY 1 1 y«:u.
lu.llriilt: liow nfiiMi.
1. Ui/il com i.n.-t:|'l Iveu
2. Iliirmmtiiti
'1. Anr iitau:ii:aiil u
/I. Aul III l:ll aiuliit::i
'i. A:i|.ll III
(>. Aul ll> lot li:u (fiiiuclfy)
/. MI:I:|>|II|; |i||lti
II. V/llamhiii
'•. Tl'aui|iil 1 1 ^1:1 :l
(ti|ii:t: 1 1 y)
O. Oilier mi:ill c.al Inua
(:i|»:i: 1 <:y)
Itlt
•
2,1,1
•
3rd
4th
•
Sell
•
-------
I'liKCIlAUCY DATA
IHil /mi iiiut iiiiy of lite
1 nl luuliiK iM'lor |i't:|iiiiiiii:t!? (Hpuclfy
kluil, iiiiuiiinl ti, I'ruqiiuitcy
ami uliiui)
1 . T.il.,n:cti
2. Ali:ulntl
1. Miirl luiiiia
A. "ill i«r,!*" (t:occaluu,
I.SII. «:!.:.)
Hiil you j.ulli:r any (iltyulcnl
lu)inli:ii liming |trti|;iiui)cy?
(H yuii. iihnu klml. wooku
-------
IMIKCNAIIOY DATA
PUKtiHANClBS
Ultal liiuiuulinlil <:lii!mli:u1 u
((•iilulu, i;
-------
PREGNANCY OUTCOME OF SIS7Z3S
For each of your sisters, please list pregnancy outcomes.
Total number of pregnancies
City of _ Present Full Spontan. Induced
Residence Acre term Premature Abortions Abortions
1.
Z.
3.
4.
5.
-------
MEDICAL HISTORY
A. SUBJECT'S:
Have you had any of the following diseases or disorders in you
lifetime?
NO YES If yes, xhen/hcw long?
1. Measles:
Regular
Gernan
2. Infectious heptatitis
3. Pneumonia, other
respiratory infections
4. Allergies (asthma, hay
fever, drug reactions)
3« 31 cod disorders, anemia
S. Heart disease
7. High blood pressure
8. Kidney disease; cystic
nephritis, etc.
9. Diabetes
1Q. Thyroid disorders
11. Stomach disorders, ulcar
12. Small bcwel disorders,
ileitis
13. Large bowel disorders,
colitis .
14. Nervous system disease,
central, peripheral
15. Ep i 1epsy
15. Muscle system disorders,
paralysis
17. Skeletal (bone)
di sorders
13. Skin disease
19. V.O.
EQ. Congenital dafec-s
21. Mental illness
22. Other (Please List)
-------
MEDICAL HISTORY (CONTINUED)
3. Subject's hosoitall rations, excluding pregnancies;
APPROXIMATE LENGTH OF
OATS PLACE REASON STAY
C. HBSTRUAL INFORMATION:
1. Are ycur menstrual periods regular? Mo, Yes.
2. Would you character!zs your menstrual period as (check-one):
a. Probably light
b. Probably average _____
c.' Probably heavy
a. SUSJECTS FAMILY
1. Did subject's father, or father's brother(s) or sistar(s) suffer
from any congenital dafact? Mo. Yas. Not sura.
If yes, plaasa list:
Father '
His brothers)
His s1 starts)
2. Did sufajsct's mother, or Bather's brother(s) or sistar(s) suffer
from any canganital defact? Mo, Yes. Mot sure.
If yes, please list:
tether .
Her brother(s)
Her sistar(s)
-------
MEDICAL HISTORY (CONTINUED)
3. Mother's pregnancies; Total number •
How many wera ful1 term ?
How many miscarriages ?
If known, during which week(s) of pregnancy
. Did any of subject's brothers suffer from any congenital defect?
Mo, ___ Yes, Not sure.
If yes, list type of defect:
5. Major illnesses or diseases of brothers:
5. Did any of subject's sisters suffer from any congenital' defect?
N° sure.
If yes, list type of defect:
7. Major illnesses or diseases of sisters;
-------
KHVT IUINHI2HTA1. ASlMJCTJi
I'ltliCNANCIKS
llnw 111. my niMi::i Ju (wail) your
i t::i|ili:itt:• |t|iu:u of uitik
I nun I In: ncai uiii arua ajuayud
ulili lu:ili l<: 1 ilu:i iliirlnj; g|M:i:ll:y ilurluf;
Will I'll |M <-|;ililllC ll!!l. )
llliiii hi (uii:i) I In! tmiircu
ni yuiir Uiilisi' :iii|i|>ly?
(Mini Ir l|ili; , »ji:ll, 1 ypt:)
llcli: y>lll l:Vi:r ilWill'ti «>l it
rlniu|;c In I In: I aiil «.: ol
y.iui u.iicr ilurliij; iir
:,iuiii ill 1 t:T lif.l'li It: lilt:
.i|i|> 1 iirat Inn?
Ui:li: ymil IVIIllt.-ll ii
ll<>U'-i:i, Mi:i:;i, .-ill rnl):i
i-V/
liitlli (•: lili! V/.i:i
-------
litlVI IMttlMUNTAI, ASI'UOTS
Illil ynii Imvu ly uvur Iteuu touted for (icutlcJdu
II yuu, d«> you know uhoa
? My uliam
H» you kitou llut rtiinilt«? (Hut)
11 nol , ilo you know wliuri: Iliuy may liu
Ha,
Yes.
Hot aure.
-------
FOOD SUPPLY AND DIET
A. What percantage of your meat and poultry products ara raised
locally? %.
3. What percantage of your fruits and vegetables are raised
locally? _%.
C. Does your nrilk come from local ccws? Mo, Yes.
ScmeCi).
0. Do you have a home garden? Mo, Yes.
£. Do you aat game taken from local forest areas that have been
treated with herbicides? No, Yes. Kind?
Approximate number of meals per year
-------
93
HOUSEHOLD ?£STICID£ USAGc
1. Has a commercial applicator treated your res i denes 'far pests within
the past five (5) years? _ Yes, _ No, _ Unknown.
2. Has your residence ever been treated for termites? Mo, Yes,
_____ Unknown.
3. Within the past five (5) years has your household used no-past strips?
N°» Unknown.
4. Within the past five (5) years has your household usad any c-f the
following pesticides on pets?
Insecticide Collar _ Yes, _ No, _ MA
Insecticide Sharnpoo _ Yes, _ No, _ HA
Insecticide Powder _ Yes, _____ No, _ NA
Other _________-________________-— ____________________
5. Within the past five (5) years have you used moth balls, crystals,
•flakes, or aerosols? Yes . No, Unknown;
o. Within the past five (5) years have pesticides been usad :n the:
House _____ Yes, _____ No.
Garden _ Yes, _ No, _ NA.
Yard _ Yes, _ No, _ NA..
7. Are any pesticides stored on the premises? _ Yes, _ No,
_____ Unknown.
3. Within the pasz five (2) years have you used any disinfectants?
_ Yes, _ No, _ Unknown.
-------
i j
i i
! i
i
1 i
1
1
I
i
1
i
: L i £ t
r r - - r
1
L n _ n i~
L L r
the
F.I- 1-
r
_
h
r
i 1
r r r i" r
i
- r - - r
- r- r r t-
- - L r r
- u i- L L
i i ; i i
•
1
: j: :
\
-
. _ - -
— — —
_ _ _
i
i !
L
_ j_. j_
— — i—
• ' !
!
—
—
i
'
—
—
—
—
—
;
— 1
I
—
i
P
j
i
t
c
L
t
_L_LL-L
_J_I_L_L
- "
\- -
— r-
- h
—
_
~
-
- h
—
—
—
—
^ "
M. i
1
—
—
—
—
i
<
i j
r*
r r
L _
h h
r r
"* r*
—
-
—
—
—
—
^^
"
—
—
—
—
—
—
—
\
—
•
i
•— i
i ~
V.
\ "
~ i
~T
ITaat are naaes of gll pesti-
cides used by the household i:
the past five years and the
saaes of all nos-usec pestiri'
currently stored cz the pre=i
Also, show E?A registration
nuaber if known.
O ^ ^ K
«<* ir - ^
^*^ t5 K tt
C 0
C £35
COMMERCIAL
! Who used this
[HOUSEHOLD FPAT) - MALE j specific T»ftP72-
IHOUSEHCLD HEAD - FEMALE i cide?
(OTHER ADULT->18 xrrs old 1
CHILD -<1S
•rrs old 1
ILIOUZSI Is rhis pesticide in liquid cr
! SOLID ! solid fcr^? (Aerosols sre liauids
'
Hov sany ounces of this pesticide have y
cr any »esber of your household used in
the oast 12 aonths?
How sissy ounces of this pesticide are
currently stored on the premises?
HOUSE
LAWK
where on the nre-
— -ses has this
pesticide been
YARD (other than lavajiused in the oast
VEGETABLE GARDEN 5 years.
FLOWER BED
OTHER
How sany tiaas has this pesticide been
used in the sast 12 souths?
BOOTS
GLOVES
MASK
WASH HAKDS
j What rrse of precautions ars
taken vhen using this
oesticide?
.AREA OFF-LIMITS TO CHILDREN & PETS !
OTHER
1
t
NONE .1
YES
NO
NOT STORED
YES
NO
NOT STORED
Is this pesticide stored
under lock and key?
Is this pesticide stored •''•
its original container?
KIT CHEN- uNDER SIXKJ
KITCHEN-OTHER "where on the sren-'se:
i
!"TTTT7 RCD>! is this oesticids
GARAGE
SHED
BACK PORCH
SASEIETT
Q'T'- .'pv
NCT STORED
stored?
1
-------
OCCUPATIONAL HISTORY OF SUBJECT
Please list any employment:
Employer • Describe Beginning and ending
(location) Tyce of Business Job Title Dates
Oo you launder your husband's work clothes with family wash?
Yes Mo
OCCUPATIONAL HISTORY OF HUSBAND
Luployer Describe Beginning and ending
(location) Type of Business Job Title Datas
1.
Z.
6.
-------
THESE QUESTIONS REFER TO HUSBAND'S OCCUPATION:
Was This Job Was Protective Did He Inhale Did Chemical Solvents,
Considered Equipment or Chemical Solvents Oils, Ousts, etc. Get-
Oangercus Clothing Available Oust OP Other Fumes? on His Skin/Clothes?
0)
Yes
No
If yes,
why?
(2)
Yes
No
If yes,
why?
(2)
Yes
No
if y~
why?
(*)
Yes
No
If yes,
why?
(2)
Yes
No
if yes,
whv?
Yes
No
If yes, what
was it?
Yes
No
If yes, what
was it?
Yes
No
If yes, what
was it?
Yes
No
If yes, what
was it?
Yes
No
If yes, what
was it?
Yes
No
If yes, list if
known:
Yes
No
If yesTlist if
known:
Yes
No
If yes, list if
known:
Yes
No
If yes, list if
known:
Yas
NO
If yes, 1 ist if
known:
Yes
No '
If yes, 1
if known:
Yes
No
If yes, 1
if known:
Yes
No
If yesTl
if known:
Yes
No
if yesTl
if known:
•
Yes
No
If yes, 1
if known:
ist
ist
ist
ist
;st
-------
THESE QUESTIONS RE?3 TO HUSBAND'S OCCUPATION CONTINUED:
Was This Job Was Protective Did He Inhale Did Chemical Solvents
Considered Equipment or Chemical Solvents Oils, Ousts, etc. Get
Dangerous Clothing Available Oust or Other Fumes? on His Skin/Clothes?
(S)
Yes
Mo
If y«7
why? .
Yes
No
If yes, what
was it?
Yes
No
If yes, list if
known:
Yes
No
If yes, list
if known:
1. Did your husband serve in Vietnam?
servica.
No, Yes,
Months of
_ MO,
1. If ves, was he directly involved with spraying af Acent Qrar.ca ___
Yes. .
2. Was he otherwise exposed to Agent Orange during his military activities?
_____ None; _____ Some; _____ Often.
4. Has your husband aver had a spenn examination? .Me, Yes.
If yes, were abnormalities suspected? No, Yes.
No, Yes (specify),
5. Has your husband ever had V.O.? _____
_____ No kncwl edge.
5. Has your husband ever used marijuana?
No knowledge.
Y2S,
7. Has your husband ever used "cries" such as csccaine, LOS, etc?
*No, Yes, Mo knowledge.
-------
EDUCATIONAL BACKGROUND
Old you graduate from high school? No, Yes, Class of 19
If not, what was the highest grade completed? .
Did you graduate from college? No, Yes.
degree1s . and year1s .
If riot, did you attend college? No, Yes, Years.
•
Did your husband graduate from high school? _____ ,'lo, _ Yes,
Class of 19 _.
If not, what was the highest grade he completed? .
Did your husband graduate frcra college? No, Yes.
List degree1 s and year1 s .
If not, did your husband attend collage? No, Yes, Years.
-------
A S '« ?• ?. 5 C .«. S 7 A 7 I S :
JacJiscs Msssrial Hs spiral
1S77-1S73
APPENDIX 3
.
V±=issicr.s
75— 77
77-73
Cacai Oeliverias
7S-77
OCT.. IKCV.
234 1:52
£73 15*2
«,„ L.
•
SI 4
3*3
ea«
JAil.
•
570
55?
SiS
F33.
461
-••«
MA?..
SSS
CIS
* 53T~
451
Jt ,
JJJ^V
532
«.-.n
jrxz
503
_
-p-rv
574
<•><:
rwC.
555
«a-»
fT-S-
£1 &
„__
---~~ ,.-, .,—_
5730
-
S - ' 1 '
»-'Va--
SSaff
• 77-7B
•S-V va-a
e., JJ
S~ ^«4..-,v
~s-77
77—73
r=tal Live =:
• ' 75—77
'. ?riva-a
< Staff
r» \ 77-72
?riva-a
Staff
Wacisal livs
Sir^-.s
75-77
rrivata
Staff
77 -73
?riva-a
Staff
Casa^aar? 5-sc
liv» Birtris
/ 3— / /
?riva;«
Staff
77-73
?riva=a
S-'f f
Jr^lti Pracr.a
75-77
77~ "3
i=w =•-• tj: •«•
\ S3
1
isie
1 13
1515
1=70
\ 5
1554
1
i
'.423
\ 7
1425
1472
1 3
i435
1
1
1 95
1 5
i E5
1 53
1 3
1 95
1
1 4
1 12
1
1
i 42
i 55
1
1
1
m .
344
545
! 14
1531
i --
39
1
isss
1 30
1253
1543
1 14
1525
1
1
1507
1 21
1435
1452
1 4
•444
1
1
1 51
1 5
1 72
I 50
i 5
1 55
!
1 5
! 11
l
1
1 71
.1 "2
1
i
i
7± i ti 1 i- id . 1 ?- 1 •:•?!•?.•> 1 'T 1 11 1 •»«?•
*~i \e.i A ld«* 107 Un li«i |«<-»^ 1 STS | sri | smi
=43^ i 1 I 1 1 II
5111 II 1 1 1
524 1 1 11 III
till II!
*S 1 S-J 1 i.t I SS |.d« 1 iS 71 1 -P- | 7.1 1 -Ifl
55 1 1 1 ! 1 .III
III! I I I 1 1
1 55H '^4? !«'•» 4f« '<=i i«~ !s<" Is-s 1 «ai l-'s-JS-J
I 34 1 23 1 22 1 14 1 17 i 22 . 1 22 1 IS I 11 ! ••-7 :
1525 UC9 U35 1395 'S57 i45 '4?= |aa-} 1 ?4= 1 *=ss
I;-;? i ! 1 1 ! 1 I 1 1
1 « 1 i 1 1 1 1 i i '
Is-so 1' I | I'll II !
1 1 1 ! 1 i i 1 1 t • :
1 III I.I 1 ! . i 1 . :
1454 1370 1422 1217 i252 1250 i4l5 "475 1 432 i S14C
1 24 I 21 1 24 \ 12 i 15 i 12 1 15 ! 14 1 14 i 220
1440 1345 1255 13C4 !272 1273 U57 1451 1455 i 4sr.;
Ii47 ( 1 1 1 ! 1 1 1 i
1 5 ! 1 1 j 1 ' 1 1 | 1
Ic-;? 1 ! 1 II. 1 i i
III! II II 1 .
1 • } 1 1 1 i 1 ! i
1 55 1 72 ! 55 i 52 1102 1 77 1C 5 '105 1 1C5 ' 1122
1 10 ! 12 1 S i 1 1 S i 13 4121 5 ! 37
I =5 1 50 ! 50 i 51 1 54 1 57 HC1 1 1C 2 i 10" i 1025
1 55 i ! 1 II i ! ! i
i 3 1 | 1 1 i 1 ! 1 '
1 s; 1 i j 1 i I . ! ; !
till 1 1 1 1 . i i
Iri5|4|5 15! 2!4i"! 5 • 57.
i 5 ' t i ! 1 s 1 1 . ! !
i I.I! i ! ! ' ; <
1 1 I 1 i l ! i !
1 52 i 43 ! 54 : 73 | 57 i 51 1 52 1 71 : '.-. • 721
1 si 1 1 1 1 ! i '. ! . '
1 1 ! 1 II l !
1 1 1 1 1 1 i i 1
till i 1 ! ' •
oo
-------
APPENDIX 3 - Continued
^isr '
ccr.
• 10
3
5
*
7
. _-w..
'>r~— —
Wtt
5
-OS
«*— — */ 1 Aw C *
1
4 1 14
7'
7CCAL 7C?. ii.--1
?rivar« 0
Staff 1 .10
C/S 1
?r:.va;s 0 i
Staff 0
77—73 5
VXGIX^l i I
Private 1 0
Staff 4
C/S 1
Privazs Q
Staff 1 1
^-scrtis.-s i
76-77 | i\
77—73 1 ij
~ P *icr .-.cc~ !
Casarsar. Saczlsr. !
75-77 ,' Si
"7-73 i c:
Casaraar. Ssctisr.s
75—77 I 03"
?T'-'TV ! 5X3
?a-aat i 3S
77-7= i iCi2
?ri=ary i = 5
Sas-aai ! 27
C 3 0
7 SI 4
1
. Q i 01 -0
1 Ot 2
« i 2! 5
i
0 ( 0! 0
72!;
i
n 01 0
•j 21 • 0
1
2s \ 25 i 22
45! 211 21
1 1
! 1
72 j 521 32
ssl S5| 33
! 1
• 57 ! 321 57
! 21 ! 23 1 27
i e= ! e-« as
i "3 ! 2~! =C
i 23 ' "'ll 25
C
3
0
1
•n
=c
/ i
1 15
i
1
1
0 0 I 0
6 215
!
1 C 1 Q
0 Oil
1
! 1
1 !
!
1 1
1 • .
1
1 1
1 44 1 25 12?
1 " 1 i
I !
1 1 1
1 30 1 55 1 30
1 ! !
! i 1
! *5 1 52 C.S2
i 72 ! Sj 172
i 25 ! 22 i 3G '
1 ! • 1
1 ~" I i
I 1 1
G G 1 .0 j 1
1
7 • 41 12 1 2 ! 72
! I 1 1
G 0001 1
0 01 0 ! 1 1 5
1 1
!
i 1 t
i
1 i !
1
i I ' '
i l ! .
50 24 43 25 I 411
I i ' i 1
II! 1
1 -1 i ' 1 '.
57 | • 52 i 52 i 53"' i ?C£
i 1 ...... •- -••• •
i 1 I 1 •!•••••
! 77 1 1C7 I 1C4 -i 105 i li'2'5 '
! 51 i 74 i 75 i rC 1 7r =
! 2= j 22 I 25 ;25 1 ' J-C
1 . ! i ! 1
! 1 1 i •
1 1 1 1 1
100
------- |