United States
Environmental Protection
Agency
Environmental Sciences Research
Laboratory
Research Triangle Park IMC 27711
EPA-600/8-79-008b
April 1979
Research and Development
Plan for Air Pollution
Research in the Texas
Gulf Coast Area
Volume II. Plan for
Health Effects Studies
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RESEARCH REPORTING SERIES
Research reports of the Office of Research and Development. U.S. Environmental
Protection Agency, have been grouped into nine series. These nine broad cate-
gories were established to facilitate further development and application of
environmental technology. Elimination of traditional grouping was consciously
planned to foster technology transfer and a maximum interface in related fields.
The nine series are:
1. Environmental Health Effects Research
2. Environmental Protection Technology
3. Ecological Research
4. Environmental Monitoring
5. Socioeconomic Environmental Studies
6. Scientific and Technical Assessment Reports (STAR)
7. Interagency Energy-Environment Research and Development
8. "Special" Reports
9. Miscellaneous Reports
This report has been assigned to the SPECIAL REPORTS series. This series is
reserved for reports which are intended to meet the technical information needs
of specifically targeted user groups. Reports in this series include Problem Orient-
ed Reports. Research Application Reports, and Executive Summary Documents.
Typical of these reports include state-of-the-art analyses, technology assess-
ments, reports on the results of major research and development efforts, design
manuals, and user manuals.
This document is available to the public through the National Technical Informa-
tion Service. Springfield. Virginia 22161
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EPA-600/8-79-008b
April 1979
PLAN FOR AIR POLLUTION RESEARCH
IN THE TEXAS GULF COAST AREA
Volume II. Plan For Health Effects Studies
by
Donald E. Johnson
R. John Prevost
SOUTHWEST RESEARCH INSTITUTE
3600 Yoakum Boulevard
Houston, Texas 77006
Contract No. 68-02-2955
Project Officer
Basil Dimitriades
Atmospheric Chemistry and Physics Division
Environmental Sciences Research Laboratory
Research Triangle Park, North Carolina 27711
ENVIRONMENTAL SCIENCES RESEARCH LABORATORY
OFFICE OF RESEARCH AND DEVELOPMENT
U.S. ENVIRONMENTAL PROTECTION AGENCY
RESEARCH TRIANGLE PARK, NORTH CAROLINA 27711
-------
DISCLAIMER
This report has been reviewed by the Environmental Sciences Research
Laboratory, U.S. Environmental Protection Agency, and approved for publi-
cation. Approval does not signify that the contents necessarily reflect the
views and policies of the U.S. Environmental Protection Agency, nor does
mention of trade names or commercial products constitute endorsement or
recommendation for use.
ii
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ABSTRACT
In Che study reported here, a plan for air pollution research was
developed for the Texas Gulf Coast Area. This report is Volume II of a five
part series of reports documenting that plan and is specifically directed at
presenting a plan for health effects studies.
A panel of three epidemiologists aided by other support staff developed
the health effects study plans presented in this report. Available aero-
metric, health effects, demographic, and meteorologic data as well as other
inputs resulting from public meetings were reviewed and considered in
development of the plan. Documentation begins with a general assessment of
area populations, air quality, and relevant health effects. Questions are
addressed which must be answered in accomplishing a plan for health effects
studies.
The plan begins with detailed discussion of the general research needs
of the area regarding health effects and presents a set of hypotheses which
need to be addressed with specific studies. The plan culminates with
description of twelve types of studies considered to be most useful in
providing definitive answers. Relative priorities, time sequencing, and
rough cost estimates are provided with the study descriptions.
iii
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CONTENTS
ABSTRACT iii
TABLES vi
STUDY BRIEFS vii
1. INTRODUCTION 1
A. The Study Team 1
B. The Population at Risk 3
C. Air Quality 5
D. Relevant Health Effects 12
2. DEFINITION OF QUESTIONS 14
A. Questions to be Answered 14
B. Health Effects Study Design 15
3. RESEARCH PLAN FOR HEALTH EFFECTS 17
A. Outline of the Plan 17
B. Assessment of TGCA Research Needs 17
C. Hypotheses to be Addressed 24
D. Proposed Health Effects Studies 27
E. Summary of the Plan 46
F. Resources for Performance and Support of
Health Effects Studies 46
REFERENCES 51
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TABLES
Table Page
1 Health Effects Study Organization.
2 Summary of Important Ambient Air Measurements
for the Houston Area 1975-1977 7
3 Hypotheses on Health Effects 25
4 Summary of Research Priorities 47
5 Summary of Air Quality Measurements Required
for Health Effects Studies 48
6 Available Resources for Support of TGCA Health
Effects Studies 49
vi
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STUDY BRIEFS
Brief Page
1 Performance of Maximally Exercising Healthy Persons
in Relation to Texas Gulf Coast Air Pollution Exposure 28
2 Mutagenicity Assay of Air Pollutants in the
Texas Gulf Coast Area 30
3 Evaluation of the Association of Lung Cancer and Air
Pollution in the Texas Gulf Coast Area 32
4 Evaluation of Existing Health Data Collection
Systems in the TGCA '. 34
5 Respiratory Illness and Asthma Attacks in Children
with a History of Asthma Related to Ozone and
Total Suspended Particulate Exposure 35
6 Body Burden Studies in Human and Animal Populations
of the Texas Gulf Coast Area 36
7 Analysis of Mortality and Morbidity Patterns in
the Texas Gulf Coast Area 37
8 Symptom Reporting and Pulmonary Function in Adults
with Emphysema/Chronic Bronchitis Exposed to
Texas Gulf Coast Air Pollution 39
9 Public Opinion and Environmental Pollution in
the Texas Gulf Coast Area 41
10 Cytogenetic Studies in Human Populations of the
Texas Gulf Coast Area 42
11 Study of Reproductive Wastage Due to Air Pollution
in the Texas Gulf Coast Area 43
12 Hazard Assessment of Increased Emissions in the TGCA
Due to Projected Uses of Alternate Fuels,
Particularly Coal 45
vii
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SECTION 1
INTRODUCTION
As part of the Clean Air Act Amendments of 1977, the United States
Congress mandated that the Environmental Protection Agency, in cooperation
with local groups, plan and execute a research program in the Texas Gulf
Coast area to define the air pollution and related health problems. Accord-
ingly, a study has been commissioned by the Agency to develop a plan for a
three-year $3,000,000 program. This study, a joint effort of Radian Corp-
oration and Southwest Research Institute, is aimed at the collection and
review of information on air pollution and related health effects, and the
identification of specific research needs. In particular, the study objective
is to define approaches which would best resolve the identified research
needs.
The research plan developed under this study has been summarized in a
five part series of reports:
Volume I: Plan for Air Quality Studies
Volume II: Plan for Health Effects Studies
Volume III: Summary of Previous Air Quality Studies, and Data
Volume IV: Summary of Previous Health Effects Studies and Data
Volume V: Local Viewpoint on Research Needs
This document is Volume II of that series. It has been prepared following a
review of available aerometric, health effects, demographic, and meteorologic
data. The assessment included input from several different organizations
within the Texas Gulf Coast area. Two public meetings were held in Houston
(October 3, 1978 and January 25, 1979) at which the public was invited to make
presentations about air pollution and possible health effects of these pollu-
tants. Oral presentations and written documents resulting from these meetings
were reviewed and considered in the preparation of this report.
The report is divided into three major sections. Section 1, Introduction,
includes information on the composition of the study team and background infor-
mation regarding area populations, air quality, and relevant health effects.
Section 2 contains a set of questions relevant to the design of pertinent
research approaches. Section 3 presents a plan for health effects.
A. The Health Effects Study Team
The approach taken in accomplishing this health effects design study has
involved the cooperative efforts of three principal groups: a panel of
epidemiologists, a principal project team and support staff, and a set of
consultants and advisors to the panel and principal staff. (See Table 1). It
has been the primary responsibility of the panel of epidemiologists to review
existing health, air quality, and demographic data and to draw specific con-
clusions and recommendations regarding health effects study designs. In
-------
TABLE 1. HEALTH EFFECTS STUDY ORGANIZATION
Panel of Epidemiologists
Dr. P. A. Huffier, Chairperson
Dr. D. I. Hammer, Panelist
Dr. A. H. Holguin, Panelist
Project Team and Support Staff
Dr. D. E. Johnson, Technical Director
R. J. Prevost, Manager, Health Effects
K. T. Kimball, Statistics
Dr. J. G. Dobbins, Demography
Dr. C. W. Eifler, Biostatistics
Dr. D. Reed, Epidemiology
Dr. J. R. Goldsmith, Epidemiology
Health Indicator Advisory Group
Dr. C. R. Shaw, Carcinogenicity
Dr. D. E. Jenkins, Clinical Pulmonary Func.
Dr. T. S. Matney, Mutagenicity
Organization
UT School of Public Health, Houston
Rex Hospital, Raleigh, N.C.
UT School of Public Health, Houston
Southwest Research Institute, Houston
Southwest Research Institute, Houston
Southwest Research Institute, Houston
UT Medical Branch, Galveston
UT Medical Branch, Galveston
California State Health Dept., Berkeley
Ben Gurion University, Israel
M. D. Anderson Tumor Institute, Houston
Baylor College of Medicine, Houston
UT Graduate School of Biomedical
Sciences, Houston
-------
support of the Panel, the project team has provided input to the Panel, and
has worked with them during panel discussions to arrive at the most reason-
able approaches to health effects study designs. The project team and Panel
have also met with a secondary set of medical advisors regarding specific
health indicator parameters (symptomatology, response levels, etc.)* The
project team has assembled this report under the guidance and direction of the
Panel.
The separation of responsibilities between the panel of epidemiologists
and the principal project team is of critical importance to this project.
Specific study designs and priorities recommended in this report are those
proposed by the expert panel of epidemiologists.
B. The Population at Risk
This study is directed toward the population residing in the Texas Gulf
Coast Area (TGCA). This area is a highly industrialized urban area in the
vicinity of Houston, Texas, including adjacent counties and forms the largest
urban and industrial area in the southern United States. As depicted in
Figure 1, the ten county coastal area covers a region from Louisiana to the
far side of Galveston Bay and includes some 9,538 square miles. In 1970, the
population was 2,417,258 persons; one county, Harris, had 70% of this total.
A rapid population growth during the last several decades (38% from 1960-1970)
has produced a rapidly expanding urban environment and a rapidly changing
demographic pattern. This rapid growth has continued since 1970 such that the
population of Harris County had an estimated increase of 24% in 1976 as com-
pared to 1970^ '. Net in-raigration accounted for 68% of that post census
gain. The current TGCA population is estimated to be approximately 3 million
persons and is increasing at 4% or 120,000 persons per annum. The ethnic
distribution of this population, as estimated from the 1970 census is 79%
white (including Spanish), 20% Negro, and less than 1% Other, a category which
includes, but is not limited to, American Indian, Chinese, and Japanese.
Persons of Spanish language or surname comprise 11% of the population.
All parts of the TGCA lie within boundaries of Standard Metropolitan
Statistical Areas (SMSA) as defined by the U.S. Department of Census. The
population of the area is therefore primarily an urban and suburban population
as opposed to a rural population. In 1970, 74% of the TGCA population lived
within the boundaries of six incorporated cities: Houston, Pasadena, Baytown,
Galveston. Beaumont, and Port Arthur. In the health effects resource
document' ', Volume IV of this series, socioeconomic and demographic data
are presented for these cities, including separate statistics for six sub-
regions of the City of Houston. Summary statistics for these areas are
presented on the following page. An important item indicated in the table is
distance from concentrated manufacturing activities associated with ship
channels: the Houston Ship Channel (east Houston to Gulf of Mexico) and the
Beaumont Ship Channel (east Beaumont to Gulf of Mexico). The industrialized
corridors associated with these two ship channels contain a significant amount
of the nation's petrochemical and refining capacity and are potential sources
for associated ambient air pollution.
-------
SAN
JACINTO
Cleveland
Cleveland
_ . Conroe
-------
Urban
Subdivision*
Central Houston
NE Houston
NW Houston
SW Houston
E. Houston
Pasadena
Baytown
Galveston
Beaumont
Port Arthur
1970
Population
160,483
192,485
188,449
279,654
184,335
102,097
43,980
61,809
115,919
57,371
White Under 18
45
55
88
98
90
99
95
70
69
60
34
41
37
30
37
39
39
32
34
34
Median**
Education
(Years)
9.3
10.2
11.0
13.9
10.0
12.
12.
10.
11.
.3
,1
,7
,7
10.4
Distance to
Ship Channel
Industry(Miles
1-7
3-13
6-18
6-22
0-6
0-8
0-7
7-10
0-12
0-7
TGCA
*
**
2,497,258
79
37
11.9
Urban subdivisions are defined specifically in Reference 2, Section 3.
Persons 25 years of age and older.
The population statistics and distances to ship channel industrial areas
are of interest to health effects studies. The areas further away from ship
channel industry are potentially less exposed to certain air pollutants
originating from ship channel sources and could possibly serve as comparison
or low exposure areas. Selection of specific areas of possible interest to
health effects studies would be dependent upon the specific study design, the
characteristics of the ambient air pollution exposure of that population.
Some specific study locations of interest to TGCA health effects studies are
presented in Figure 2 and discussed in the following section.
C. Air Quality
Two documents prepared by Radian Corporation^3^) have served this health
effects study as the primary sources of background air quality information.
The later of those two documents, entitled "Aerometric Research Plan",
discusses TGCA ambient air quality. Summary data obtained from that report
are presented in Table 2. The research plan for air contaminants, Volume I
of this series, is an additional source of air quality data. From these doc-
uments and from other data, it has been observed that the air quality of the
TGCA is characterized by relatively high levels of ozone, hydrocarbons and
particulates. Each of these pollutants have exceeded their respective EPA
standards. This table shows data for ten different air monitoring stations
covering 1975 to 1977. The highest ozone and hydrocarbon levels were seen at
the Parkhurst station which is located northeast of the center of town. The
Mae Drive and Clinton stations located east of the center of town near the
ship channel had the next highest ozone and hydrocarbons plus the highest
levels of particulates. Lower levels of particulates and ozone were measured
downtown (MacGregor) and southeast of the city (Fuqua). The Aldine station
located northeast of the city further out of town than the Parkhurst station,
had intermediate levels of the pollutants.
-------
HOUSTON INTER-
CONTINENTAL
AIRPORT
PREVAILING
WINDS
STUDY AREA B
HIGHEST OZONE
STUDY AREA A
HIGHEST TSP
STUDY AREA C
LOW OZONE. TSP
IP CHANNEL
HOUSTON
D
HOBBY
AIRPORT
AIR MONITORING LOCATIONS
GALVESTON
BAY
5 Clinton
6 Crawford
7 MacGregor
8 Fuqua
1 Lang
2 Aldine
3 Parkhurst
4 Mae Drive
SCALE OF MILES
FIGURE 2. Air Monitoring Locations: Harris County, Texas
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TABLE 2. SUMMARY OF IMPORTANT AMBIENT AIR MEASUREMENTS FOR THE HOUSTON
AREA 1975-1977
(All measurements in parts per million, except TSP in micrograms
per cubic meter.)
' Ul
i 1 ;
1 ? : 1
* <
ozorc
Maxlaua 1975
dourly 1976
Average 1977
S'umber of 1975
•lours over 1976
08 ppo 1977
\unber of 1.975
Hours aver 1976
.03 ppn 1977
May-Oct
Only
S'lTROGEN DIOXIDE
"axiaum 1975
Hourly 1976
Average 1977
i l975
A.™>1 19?&
Average 1J77
SON- METHANE
•IYDROCAMON
Highest 1975
6-9 do 1976
Average 1977
SULFUR 3IOXI3E
Maximum 2.975
•Jov-rlv 1975
Aierage 1977
"axiaua 1975
5 icur 19*6
Average 1977
Annual 197!
1
' 0.121
-.
0.256
..
--
0.272
0.270
251
397
103 i 322
213
! 307
88
..
--
-•
..
..
—
..
269
0.13
0.14
G.ll
0.02
a 02
0.02
2.1
i 3.9
6.2
„
—
• -
--
Average 1976 i "
1977
TOTAL SUSPENDED
'AaTICLTATE
vaxlsum 1975
:i Hour 1976
Average 1977
Annual 1975
Geonecric 1976
Mean 1977
•"
149
0.11
0.01
0.01
0.10
0.01
0.01
0.00
0.00
0.00
153
227 1 134
273
57
60
62
1041
64
65
74
Furkhurst
(NR)
0.267
0.286
0.302
242
534
481
221
447
404
0.13
«
0.14
*
—
*
18.6
7.0
IS. 5
_
—
—
—
—
—
—
—
—
150
220
200
63
64
67
a
>
h
a
Ss
x •**
0.288
0.297
0.222
202
279
255
180
232
224
0.21
0.32
0.18
0.03
0.02
a 03
3.9
3.4
6.1
0.20
C.12
0.11
0.13
0.07
0.06
0.00
0.00
0.00
204
198
841
82
90
91
rllnton
(E)
0.307
0.278
0.20S
214
518
224
188
446
213
0.35
0.24
—
*
*
—
6.3
10.1
4.2
0.56
0.63
0.44
0.53
0.43
0.34
*
*
*
_
—
334
—
_
142
Crawford
(CENT)
0.254
0.223
0.309
186
188
119
171
167
105
0.41
0.29
0.13
*
*
*
12.4
7.6
10.3
0.17
0.26
—
0.14
0.19
—
*
*
—
L63
119
629
71
69
76
NacCregor
(CENT)
0.198
0.270
0.254
116
243
170
96
219
129
__
0.12
—
_.
*
—
__
_
—
__
_
—
__
_
—
—
—
—
149
175
252
62
S3
53
u
M
§
1
0.285
0.289
0.281
255
289
281
253
434
129
_
—
—
_
__
—
__
._
—
__
_
x
U
u
a
£
0.222
0.225
0.236
288
311
188
233
257
179
0.10
0.29
0.12
0.01
a 01
0.02
5.4
3.8
2.9
0.21
0.31
| 0.03
__
._
—
_
~
0.12
0.21
0.02
0.00
0.00
0.00
1
205 1 126
228 , 207
240 1203
65 ! 59
60
63
57
64
01
U
a
u
0.160
0.186
0.185
187
205
133
145
152
84
0.09
0.11
0.09
0.01
0.01
0.01
3.1
4.5
6.4
0.02
0.09
0.02
0.01
0.03
0.01
3.00
0.00
0.00
180
185
'81
74
71
89
* Not available at present
Sources: Texas Air Control Board(6)
City of Houston^7)
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Levels of ozone in the Houston area are among the highest in the United
States with only a few cities measuring higher levels. Ozone is not as high
as that seen in Southern California where hourly averages of ozone routinely
exceed 0.2 and even 0.3 ppm; in-the Texas Gulf Coast area it is rare for an
hourly average of 0.3 ppra to occur and hourly averages of 0.2 occur infre-
quently. The composition of photochemical oxidants in the Houston area may
be different from those in Southern California, especially for components that
are involved in eye discomfort. In California, additional oxidants implicated
for eye discomfort and other health effects included peroxyacyl nitrate,
acrolein, peroxy and benzoyl nitrate and aldehydes. Eye discomfort complaints
have not been reported in the Texas Gulf Coast area; this may be due to lower
exposures of these specific eye irritants. Comparison of the air quality of
Houston with that of Southern California is important because much of the
health data relative to oxidants has been collected in California.
The high total suspended particulate matter present in the Texas Gulf
Coast area may be comprised of smaller particles which may be more important
with regard to health effects. Little data are available regarding the per-
centage of respirable particulates present with the total particulates.
Higher levels of particulates are generally seen in urban areas of the north
central and north eastern U.S. as well as in the western U.S. Particulates in
Houston may be of greater concern than other areas because of the chemical
composition of the particulates, especially that of the respirable portion.
A relatively high percentage of the particulate emissions in the Houston area
is from petrochemical sources located along the Houston ship channel. Little
is known regarding the composition of trace inorganic and organic components
present with the particulate matter. These unknown chemicals may be associ-
ated with certain health problems such' as lung cancer, other respiratory
diseases, and cardiovascular diseases.
The Houston area greatly exceeds the standard for non-methane hydro-
carbons. The levels are similar to those seen in other urban areas the size
of Houston. These hydrocarbon levels are relatively high in the Texas Gulf
Coast area, especially relative to oxides of nitrogen. There are significant
point sources of hydrocarbons, especially along the Houston ship channel which
is east of the center of the city of Houston, extending out to and including
the city of Baytown. Data from sources such as the Texas Air Control Board
indicate that the total emissions of hydrocarbons from point sources have
decreased by approximately 40 percent during the last several years; however,
the ambient air levels of total non-methane hydrocarbons have not changed
appreciably over this time period. Since health effects of hydrocarbon
exposures have not been studied, no specific health effects have been attrib-
uted to ambient levels of hydrocarbons. Hydrocarbon composition in Houston
air is described in the referenced Radian reports(3»4,5). xne presence of
aromatic hydrocarbons suggests that there could be some health effects from
these pollutants.
Carbon monoxide levels are below the EPA standard of 9.0 ppm second high-
est eight hour average: approximately 5 and 7 ppm in Houston in 1975 and 1977,
respectively. Point sources accounted for 60% of carbon monoxide in 1973
according to the emissions data.
-------
Currently, sulfur dioxide levels are relatively low in most areas
of the Texas Gulf Coast area with an elevation seen in one area around the
Houston ship channel which apparently is associated with several point sources.
These levels are low as compared to those seen in some other areas of the
United States. Conversion from relatively clean fuels such as natural gas to
petroleum fuels and especially high-sulfur coal could significantly increase
levels of oxides of sulfur. Some industries in Texas have made conversions
to coal at present. If this occurs on a broad scale in Houston, there could
be sharp increases in emissions of S02 and particulates in the ship channel
area and also from electrical power plants located throughout the area.
Oxides of nitrogen are relatively low in the Houston area. Annual
averages for Houston range from 0.01 to 0.03 ppm (standard 0.05 ppm) with
maximum hourly average ranges of 0.12 to 0.41 ppm. The highest levels are
usually seen in the center of Houston. Sources of oxides of nitrogen appear
to be from vehicular traffic and from point sources along the ship channel.
An increase in burning of dirtier fuels such as petroleum and coal could
also lead to significant increases in emissions of oxides of nitrogen. This
change could cause other pollutant problems in that it appears that one of the
uncommon features of the air pollutant composition in the Houston area is the
high total non-methane hydrocarbon to NOX ratio. It is suggested that the
chemical reactions which take place in the atmosphere are NOX limited; thus
significant increases in NOX may have rather profound changes in levels of
other air pollutants such as ozone and other oxidant products.
In the eighth annual report of the Council on Environmental Quality W,
published in 1977, the conditions and trends of air quality for several
metropolitan areas in the United States were discussed. It was pointed out
that only the South Coast Basin of California, the Houston-Calveston area
and the Philadelphia area are likely to be significantly above the ambient
ozone standard in 1990. This discussion suggests that the petrochemical in-
dustries are responsible for most of the oxidant pollution in the Houston-
Galveston area. The report also examines the Pollution Standards Index (PSI)
developed by the Federal Interagency Task Force(9). The PSI index was used to
compare the air quality in 20 major metropolitan areas on a uniform basis.
Comparison of the PSI values indicated that the Los Angeles area had an index
value as the most "unhealthy" area of the United States with nine other cities
having unhealthy ratings of 100 or more, but less than 200, days per year.
The Houston area was one of these nine areas with a PSI rating of 141 as
compared to 318 for Los Angeles.
The Texas Air Control Board presented air quality data for the Houston
area in its Biennial Report covering September 1976 to August 1978(1Q). The
haze problem in Houston was discussed and the need for more information on the
exact nature of haze, the chemical reactions which lead to its formation, the
effects of high humidity, the relative contributions of automotive and indus-
trial emissions, and its potential health effects were presented.
Pertinent meteorology data for the area included in the aerometric
reports (3.4) provided by Radian Corporation are summarized as follows. The
prevailing wind direction in the area is from the south to southeast for every
month of the year except January in which it is from the north to northwest.
-------
The area has warm temperatures with high relative humidities throughout the
year. The area has an annual rainfall of approximately 48 inches and an
annual percentage of possible sunshiny days of 57 percent.
The combination of high temperature and high humidities in the TGCA will
probably impact health effects studies. It is known that biological response
parameters such as performance, pulmonary function, symptomatology and tox-
icity in experimental animals are significantly impacted by elevated temp-
eratures and humidities. In general elevated temperature and humidity have
been associated with increased toxicity. Health effects of air pollutants
such as oxidants and particulates have been studied in geographic areas with
lower temperatures and lower humidities. The high humidities will affect
aerosol formation, transformation and transport. These interactions may be
involved in health effects.
Certain conclusions regarding requirements for air monitoring requirements
to support health effects studies, can be outlined. Continuous monitoring
of some of the criteria pollutants has been underway in the TGCA since about
1973 with little or no air monitoring data prior to this time. Presently,
there is continuous monitoring of criteria pollutants by the City of Houston,
the Texas Air Control Board and the Environmental Protection Agency. These
data would be available and applicable to projected health effects studies
provided air monitoring stations were located sufficiently close to study
populations. There are several special research efforts on air monitoring
that would be useful for health effects studies. Two of these are: (.1) The
Houston Area Oxidants Study (HAOS) sponsored by the Houston Chamber of
Commerce, and (2) The Houston Air Pollution Study (HAPS) sponsored by the
EPA.
An extensive air monitoring effort was performed as part of the HAOS
effort during the summer of 1977 which provides data to characterize the
ambient air in and around the Houston area. Of particular importance are the
data for total and respirable suspended particulates and detailed monitoring
of individual hydrocarbons. Other measurements included aeroallergens, indi-
vidual aldehydes, ozone, PAN and other oxidants. Most of this data will be
available in a final report in the early part of 1979.
The HAPS program was performed by several EPA contractors to examine
aerosols in the Houston area during the summer of 1978. This study included
measurements of the quantities of respirable particulates and total particu-
lates as well as detailed chemical characterizations of the organic material
associated with the respirable particulates. Some effort has also been
planned for measurement of organics not associated with particulate matter
through the use of absorbent systems. The analytical methodologies involve
gas chromatography combined with mass spectrometry to identify trace organics.
Final reports for these studies are scheduled for late 1979.
Even though the criteria pollutants are being monitored at a number of
stations in the area on a continuous basis, it is likely that future epidem-
iology studies will require additional air monitoring stations. These stations
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should be located as close to study populations as possible and monitoring
both indoors and outdoors near residences may be needed. There is a need to
more precisely quantitate the ambient air exposure of individuals. One
approach would be through the use of personal air monitoring devices which
could be worn by individuals. This approach has not been utilized more
because of the large costs involved ($100 plus per monitor) and the generally
poor accuracy of the devices. Nonetheless, there is a possibility that with
newer technology personal monitors could be utilized for measurements of
total particulates and oxidants/ozone to aid in the health effects effort in
the TGCA. A pilot study could be done with 20 to 30 selected participants
fitted with personal monitors to measure total and respirable suspended par-
ticulates and either ozone or total oxidants. The persons would wear these
monitors for an 8 to 12-hour exposure period to obtain an integrated time
exposure of the two pollutants. This data would then be compared with data
from fixed station monitors to determine possible differences. There is a
psosibility that real exposures to particulates and ozone of persons that
stay indoors at home might be significantly less than that of ambient air
exposures because of the reduction of these pollutants going from outdoors to
indoors. This is especially true for air conditioned houses in which filters
are somewhat effective in reducing particulate matter and ozone.
For health studies related to oxidants/ozone, it is probable that
detailed continuous measurements of the following will be needed: ozone,
total oxidants, oxides of nitrogen, sulfur dioxide, PAN, aeroallergens, temp-
erature and humidity. Monitoring should be accomplished for the duration of
the health study and, in general, needs to accurately describe exposures of
participants with monitoring at stations very close to the participants'
residences and with combinations of monitoring of individuals and indoor and
outdoor monitoring.
For epidemiology studies aimed at aerosols, continuous monitoring for
total suspended particulates and respirable particulates would be needed
to describe the exposures to participants both indoors as well as outdoors.
Size fractionation measurements of particulate matter and detailed chemical
characterization of aerosols for both inorganic and trace organic material
would be needed on an intermittent basis. The inorganic measurements would
include parameters such as trace metals, fluorides, asbestos, nitrates,
sulfates, sulfuric acid, and perhaps others. Trace organic measurements
should provide the identities and approximate levels of organics that are
toxic to man, particularly for those organisms with carcinogenic, mutagenic
and teratogenic properties. It might be possible to fractionate the organics
and then utilize tissue culture procedures for examination of toxicity to pro-
vide a selection of those fractions with the highest toxicity for detailed
chemical characterization. The difficulties and costs of these types of
measurements would preclude their conduct on a broad scale. Selected samples
for peak levels of total particulates should be analyzed.
Retrospective epidemiology studies will require estimates of both
previous and current air pollution levels to approximate exposures. Estimates
for past exposures could be developed from industrial emissions and production
data. These estimates of emissions of various types of materials could be
utilized to approximate air quality data historically.
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D. Relevant Health Effects
A critical assessment of all the relevant literature for health effects
of air pollutants is beyond the scope of this effort. Three recent reviews
of the health effects of air pollutants have been published for criteria
pollutants. Two of these review articles are Health Effects of Exposure to
Low Levels of Regulated Air Pollutants by Ferris^1) and Effects of Air
Pollution written by Shy, Goldsmith, Hackney, Lebowitz and Menzell^'. Each
has rather extensive bibliographies plus an assessment of the data for health
effects on the criteria pollutants with some idscussion of pollutants associ-
ated with aerosols that may be involved in health effects.
A recent review and assessment of the literature for health effects and
exposures to sulfur dioxide and particulates in children was published by
EPA^13). This report pointed out the advantages of using children in environ-
mental health studies:
• They are not generally exposed to occupational exposures or tobacco
smoking,
• They are less likely to have experienced several different air
pollutant exposures related to residential mobility, and
• Acute morbidity would be least likely to be confounded with
symptoms of chronic disease.
Attention has also been directed toward those epidemiology studies per-
formed in the Texas Gulf Coast area and to other selected references which
report on health effect indicators that may be useful for application in the
area. There have been few environmental epidemiology studies performed in the
TGCA. Dr. Daniel E. Jenkins of the Baylor School of Medicine conducted a
study(14) which collected information regarding the prevalence of respiratory
symptoms and abnormal pulmonary function among elementary, junior and senior
high school students in two areas of Houston, one with relatively high air
pollution near the Houston ship channel and the other with relatively low air
pollution in the south central portion of the city. The study indicated a
higher prevalence of upper respiratory tract symptoms in the high air pollu-
tion versus low pollution area with no differences seen for pulmonary function.
The primary air monitoring index was for total suspended particulates as
measured by the City of Houston. The monitoring effort was carried out during
October-December 1976. A summary brief for this study is provided in Section 4
of the resource document for health effects^). A recent study(15) conducted
in two Los Angeles communities produced conflicting results: pulmonary
function was lower in the high pollution community but respiratory symptoms
were reported more frequently by residents of the low pollution community.
A study(16) of selected trace metals in several populations was performed
by Southwest Research Institute in 1972 to 1973 in the Houston area in city
policemen working downtown, in persons working in covered parking garages and
in females living close to major expressways. These three population groups
were compared with matched control groups. The results showed that for
certain metals such as lead, there were significantly higher levels in blood
and hair of persons working in parking garages and on downtown streets. No
differences were seen for females near freeways as compared with a control
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group of females. A summary brief for this EPA sponsored study is provided
in Section 4 of the resource document for health effects^).
A health effects study' ' was performed as part of the Houston Area
Oxidant Study (HAOS) during the summer and fall of 1977 in which health
information was collected on persons suffering from allergic asthma, chronic
bronchitis and/or pulmonary emphysema. These persons were monitored for
prevalence of nasal and respiratory symptoms and a portion were monitored for
pulmonary function responses. The data from these health indicators were com-
pared with a broad spectrum of air monitoring data which included ozone, total
oxidants, oxides of nitrogen, aeroallergens, total non-methane hydrocarbons,
total suspended particulates, total respirable particulates, PAN, formaldehyde,
total aldehydes and individual hydrocarbons. The results of this study are
to be included in a final report due in February 1979. This effort has sig-
nificant relevance to the planning document because of its emphasis on a por-
tion of the population believed to be more sensitive to respiratory irritants
and on exposure to ozone and total oxidants. A summary brief for this study
is provided in Section A of the resource document for health effects' '.
A report by the Texas Department of Health and the University of Texas
Cancer Center, M.D. Anderson Hospital and Tumor Institute entitled, Impact of
Cancer on Texas, published in 1978^8) is important relative to the incidence
of certain types of cancer in the Texas Gulf Coast area. This report points
out that lung cancer is significantly above the national average in Harris
and Galveston Counties and that other forms of cancer such as bladder and
liver are higher than the national average. The report concludes that lung
cancer is a major public health problem in the state, especially in the Texas
Gulf Coast area, with deaths due to lung cancer increasing some 53 percent
from 1969 to 1976. Currently, one in four cancer deaths in the state of Texas
is due to lung cancer and men account for 79 percent of these.
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SECTION 2
DEFINITION OF QUESTIONS
A. Questions to be Answered
Throughout this assessment of research needs consideration has been given
to three basic concepts: (1) exposures, (2) populations at risk, and (3) re-
sponses. It is the identification of a specific set of these components which
defines a research approach. Some important aspects of each of these compo-
nents which must be considered are listed as follows:
Exposures
• What: criteria and noncriteria pollutants
• What: physical, chemical and biological characteristics
• When: current, past, and future; short/long
• Where: ambient, work place, home, transportation, public buildings
Populations at risk
• Healthy populations and specially sensitive subsets
• Numbers and locations
• Demographic characteristics
Responses
• Recognition of a spectrum of biological responses
• Sensory-visual, smell, test
• Mortality
• Aggravation of existing diseases
• Contribution to formation of diseases
To better organize the review of available data and accomplish the devel-
opment of study approaches to resolve the research needs in the Texas Gulf
Coast area, a set of questions has been formulated which addresses these three
basic concepts. The questions were formulated following the study of available
aerometric and meteorological data and information about specific health
effects studies in the TGCA and a review of possible health problems which
appear to be related to exposure to air pollutants. The questions have been
structured under three separate headings: (1) Exposures, (2) Populations at
risk, and (3) Biological responses.
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Exposures
1. What are the air pollutant exposures (current, past and future) to the
populations at risk?
2. What will be the effect on air pollutant levels of conversion by a major
portion of industry in the TGCA from the burning of relatively clean
fuels to dirtier fuels such as coal?
Populations at Risk
1. What populations are at risk to adverse levels of air pollutants?
2. Are there portions of these populations which are more sensitive to air
pollutants?
3. What are the approximate numbers and locations of these specially
sensitive populations?
Responses
1. What are the health effects responses to the criteria pollutants in this
area? Noncriteria pollutants? Current, past and future?
2. What are the important health indicators for evaluation of effects of air
pollutants? (Mortality, pulmonary alteration, symptomatology, sensory
perception, reproductive changes, behavior, opinions, cancer or cardio-
vascular effects).
B. Health Effects Study Design
To design a specific health effects study requires the determination of
a very specific set of the three major components discussed in the previous
section. Three questions must be answered in development of a set of appro-
priate studies for an area such as the TGCA. These are:
1. What are the logical groupings of the three components which form
appropriate and reasonable research approaches?
2. What is the relative importance of the need for information from these
groupings?
3. What is the logical sequence for interrelated approaches?
Proper consideration of these questions leads to the development of appropriate
specific study designs, and the assignment of priorities regarding effort and
time.
To address these questions in development of specific research approaches,
the full range of population responses must be considered. These range from
death, in the worst case,, to simple psychological stress at the opposite end.
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In order of diminishing importance, some of the possible responses are listed
below:
• Mortality (cancer, violent deaths, infant mortality, fetal loss)
• Morbidity (chronic obstructive lung disease, birth defects)
• Symptoms (respiratory symptoms, eye or skin irritation)
• Discomfort (headache, general aches and pains)
• Diminished performance (work activities, athletic ability)
• Psychological stress (attitude, concern, odors, visibility)
The ordering of responses in the preceeding list is not always dimin-
ishing in the strictest sense, but serves to demonstrate various levels or
kinds of response to air pollution. Psychological stress, for example, can
possibly lead to serious distress or even death by accident or suicide, but
generally it can be expected to occur at the nuisance or diminished perform-
ance level. For a given air pollutant, the population at risk generally
increases as the severity of response diminishes.
In this document, the general approach to definition of specific health
effects studies has been to first, determine specific or general environ-
mental exposures, second, determine important potential health effects re-
lated to the exposures and, third, define appropriate populations at risk to
be studied. These questions will now be addressed directly in an assessment
of the TGCA research needs and the development of a research plan for health
effects.
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Section 3
RESEARCH PLAN FOR HEALTH EFFECTS
A. Outline of the Plan
A reserach plan for health effects is presented in this section.
Research needs are first addressed by taking a comprehensive look at important
types and areas of study which would provide needed answers to area problems.
After the assessment of research needs, a listing of important hypotheses is
made. These hypotheses follow directly from the research needs and address
the important questions which need to be answered for the TGCA. Brief des-
criptions of important health effect study designs are then presented which
are considered by the panel of epidemiologists to be most useful in providing
definitive answers. For each of the study briefs, priority, time schedule,
and sequencing (where appropriate) are addressed. Approximate estimates of
the level of effort are given for each study design. A summary of the research
plan is then provided to give an overall look at the magnitude and types of
studies suggested as high, intermediate, and low priority items. Finally,
resources available to perform and support such health effects studies are
discussed.
B. Assessment of TGCA Research Needs
The review and assessment of relevant aerometric and health data indi-
cated that there are two primary air pollutants that need to be examined.
These are photochemical oxidants and suspended particulates. Sulfur dioxide
is not of primary concern but some efforts may be needed, because of possible
future alterations in levels of this pollutant. For each of these two major
air pollutants, a discussion of the assessment of important health effects,
including both short term (acute) and long term (chronic) effects is presented
in the following section.
1. Photochemical Oxidants
This air pollutant is significantly elevated in the Texas Gulf Coast
area. It appears that elevations will be prevalent for at least the next five
years. The levels seen are in violation of the former EPA standard (.08 ppm)
for more than 100 days per year. The data base for establishment of a dose-
response relationship between ozone and other oxidants and selected health
indicators is not adequate. In addition, little information for this relation-
ship is available for the TGCA. As discussed earlier, this area apparently
has significant differences in the composition and concentration of oxidants
and other air pollutants versus the Los Angeles area where most of the health
data were collected. The high humidities and temperatures seen in the TGCA
may also affect the dose-response relationship. High humidity combined with
elevated temperatures will alter pulmonary function measurements. Also, animal
toxicity data clearly show increased toxicity to toxic chemicals with elevated
temperature and humidity.
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A study should be directed at a vigorously exercising population
such as cross-country runners or other types of long distance runners, high
school and college track (for runs of 220 yards- and above), long distance
swimmers in outdoor pools, etc. These vigorously exercising individuals should
be examined for evidence of decrements in performance resulting from acute
exposures to air pollutants, and for other health effects parameters such as
prevalence of certain symptoms, pulmonary function and other physiologic meas-
urements and chromosomal changes. A maximally exercising population represents
a population at risk that has a relatively higher pollution exposure than the
general population. Persons exercising at 60-80% of their aerobic capacity for
15 to 60 minutes are exposed to as much as 10 times the quantities of air
pollutants as sedentary persons. Exercising populations in the TGCA meeting
these criteria are present in cross country runners, long distance swimmers
(outdoors), long distance runners (training and competitve), track (for the
longer races), and bicycling. There is,therefore, a significant population
at risk in the study area that is exposed to significantly higher dosages of
air pollutants for short time periods.
There is evidence that vigorously exercising persons are at greater
risk to exposures of air pollutants currently encountered in ambient air. The
primary reason is that for short time periods (usually less than one hour),
much larger volumes of air are inhaled thus a higher exposure to air pollutants
such as oxidants is encountered.
A study of performance of cross country runners relative to daily
level of air pollutants was performed in the Southern California area by
Wayne, et alU9). They found a significant correlation (>0.8) between oxidant
levels one hour prior to the race and the percent of team members whose per-
formance did not improve. No relationship was seen between performance and
carbon monoxide, nitrogen dioxide nor weather parameters. DeLucia and
Adamst20' examined healthy males in a chamber study for effects of ozone with
different levels of exercise. They utilized one hour exposures of 0.15 and 0.3
ppm of ozone with the subject at rest and exercised at 25%, 45% and 65% of
maximum oxygen uptake. They found altered ventilatory patterns and decreased
pulmonary function for maximally exercising persons at levels of ozone of 0.15
and 0.3 ppm. Folinsbee, et al{21) concluded that the effects of ozone are most
severe immediately after exercise and that heat stress may modify the overall
effect of ozone on pulmonary function. These authors studied the effects of
2 hour exposures to ozone (O.Sppm) to non-smoking healthy males undergoing
exercise. From these reports it appears that performance symptomatology and
certain pulmonary function parameters are useful indicators of effects of air
pollutants.
An RFP issued from the Environmental Protection Agency at Research
Triangle Park on cross-country runners in the Texas Gulf Coast area was aimed
at studying performance, symptomatology and lung function for home meets.
This three year study would provide for an assessment of possible health
effects for short term exposures (approximately 15 minutes) to air pollutants.
High school cross country meets are held on weekends from September through
the first of December in the TGCA. The highest hourly values for ozone occur
from May through October in the TGCA. Other pollutants such as oxides of
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nitrogen and aerosols are higher during episodes of air stagnation which are
more frequent in the summer and fall. The proposed runners study would over-
lap the end of the expected highest ozone levels. The study should be directed
at an assessment of not only ozone, but daily levels of oxides of nitrogen,
sulfur dioxide, particulates (total and respirable), and aeroallergens. For an
effective assessment of exposures and health responses, a range of air pollutant
values is needed. This range should be present in the proposed design.
One of the problems associated with exposures to photochemical oxi-
dants is the question of adaptability of persons to these exposures. The
study by Hackney et al.* ' compared four Los Angeles residents with four
Canadians who were not accustomed to Los Angeles smog. Each of these persons
spent between two and one half and three hours breathing initially clean air
and then air with 0.37 ppm of ozone. The blood and lung function of the
participants were continually examined for changes. Differences were seen
for both groups of people, that is, changes from clean air to ozone exposure;
however, the participants from the Los Angeles area showed fewer alterations
on the average. It was conlcuded that the differences noted were a result of
adaptation to exposure to ozone. Animal studies have indicated that exposure
to ozone results in an increase in antioxidant enzyme activity and a prolif-
eration of cells in small airways and air sacs or alveoli of the lungs. This
may be an important aspect of exposure to photochemical oxidants.
The effects of ozone and other oxidants on reproduction needs to be
considered. This could be accomplished by a prospective environmental epidem-
iology effort in which a group of pregnant females living in an area with rel-
atively high oxidant levels versus a control area with low oxidant levels are
followed over a period of time to include the term of pregnancy and monitored
for parameters such as birth defects, fetal loss, fetal size, etc.
Another approach for study of the oxidant situation would include
panels in which portions of the populations with some type of disease state
are monitored for prevalence of symptoms and measurement of pulmonary fun'ction
over a time period to coincide with the times of expected high oxidants. This
is similar to efforts carried out under the HAOS study and other efforts
carried out by the Environmental Protection Agency. The panelists would be
monitored for health effect indicators such as symptomatology and measurement
of pulmonary responses using conventional pulmonary function parameters and
perhaps including measurement of small airways resistance. Sensitive popu-
lations that could be studied include persons suffering from asthma, bronchitis,
emphysema and cardiovascular diseases. Epidemiologic studies have been con-
ducted to evaluate the acute effects of short term exposures to oxidants for
persons with asthma, bronchitis and emphysema. Asthmatic children represent an
important group of people that are more responsive to respiratory irritants
and they have fewer confounding variables than adults. Symptom reporting plus
medical, demographic, socioeconomic and personal information will be collected
for the children. Pulmonary function measurements may not be useful because
asthmatic children have rather variable responses because of their disease and
it might be impossible to quantify any small difference, if any, due to daily
fluctuations in air pollutants. Adult panels probably should be restricted to
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persons with bronchitis and/or emphysema. Asthma in adults is a quite dif-
ferent disease from bronchitis and emphysema. Cigarette smoking is a very
concentrated type of air pollution which exerts significant effects, both
chronic and acute. An attempt to detect differences due to daily changes in
air pollution with wide daily variabilities in exposure to cigarette smoke is
difficult and perhaps impossible. It may be, however, that air pollutants
are additional factors which aggravate the effects of substances such as
cigarette smoke, asbestos, etc. Where possible, nonsmokers should be studied
separately from smokers and exsmokers. However, persons with bronchitis and
emphysema are likely to be predominantly current and exsmokers, thus exsmokers
and nonsmokers could be studied together.
Hyperreactivity measurements may be useful in future studies of
respiratory reactions to pollutants. Hyperreactive participants could be iso-
lated during the data analysis and analyzed separately. Hyperreactivity can
be measured directly by provocative inhalation of histamine, mecholyl, or car-
bachol (Golden et al.^3))p These latter measurement techniques are sensitive
in detecting alterations in pulmonary changes.
2. Aerosols (Suspended Particulates)
The air pollution situation in the Texas Gulf Coast area is charact-
erized by relatively high levels of total suspended particulates and haze is
commonly observed which may be associated with respirable aerosols. Studies
should be performed to examine possible health effects related to these aero-
sols, both chronic and acute effects for populations in and around the ship
channel area versus a control population in perhaps the western or north-
western part of Houston.
Populations should be monitored for pulmonary function and sympto-
matology for prevalence of upper and lower respiratory diseases and chronic
respiratory diseases. An area near the Houston ship channel could be selected
for relatively high exposuies to aerosols (as indicated by high suspended
particulate measurements) and another area (west or northwest of the city) with
relatively lower levels of aerosols. The area near the ship channel would also
have relatively high ozone levels although not the highest in the TGCA. Few
measurements are available regarding the respirable portion of particulates
for these proposed study areas. As was discussed under the oxidants section,
panel studies of persons with asthma, bronchitis and emphysema (children and
adults) could be examined for symptomatology (acute effects-short term expos-
ures) and susceptibility to infections (upper and lower respiratory diseases).
The latter type study is directed at longer exposures, that is, several months
or years. Upper and lower respiratory diseases occur primarily in the winter
months while air stagnation episodes usually do not occur in the winter in
Houston. The incidence of upper and 1 ower respiratory diseases in children
is much higher than in adults.
Other health effect indicators would be mortality and morbidity of
cancer of the lung, bladder and liver plus chronic lung diseases such as
emphysema and bronchitis. This type of study will have to include rather de-
tailed collection of information regarding the personal habits of the
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population to include key elements such as. smoking, occupational exposures
and previous residences.
Tobacco smoking, especially cigarettes, has been clearly shown to
be inv-jlved in the etiology of lung cancer, bronchitis and emphysema. Certain
occupational exposures have also been implicated in these diseases. Obviously
to quantify a possible relationship of these diseases with air pollution in
the TGCA will require a very careful accounting for tobacco smoking and occu-
pational exposures. As discussed earlier, Harris County and some of the
surrounding counties have a rather higher incidence of lung cancer. The
question is the high incidence related to exposures to unknown chemicals from
the petrochemical industries in the area. Since lung cancer has a long la-
tency period (20-30 years), the exposures of the population at risk have
occurred for time periods for which little or no monitoring information is
available, thus rough estimates must be determined.
These studies could be supplemented by measurement of body burdens
via examination of human autopsy tissue from different geographic areas, that
is, a control area and a high exposure area. Information about occupation,
smoking, brief medical history and previous residences will need to be col-
lected from the accidental death cases. The body burden measurements would
be made for certain organics and trace metals as an index of exposure. There
is also a possibility that animals could be utilized for body burden efforts
because of the much shorter life spans of the animals.
Sulfur dioxide is currently not an air pollution problem in the
Houston area, but it could become a major air pollutant if dirtier fuels are
utilized in industry, particularly coal. It is recommended that, if possible,
a background health effects study be conducted relative to sulfur dioxide if
it can be associated with a study of particulates. This information could be
utilized for comparison with future studies. One area of the Texas Gulf Coast
area which has a significantly higher level of S02 is in the vicinity of the
Houston ship channel.
A battery of rapid biological test procedures to include the Ames
test could be used as a type of sentinel system. This would provide for an
indication of mutagenetic activity of air pollutants. The system should be
operational for several years.
In the proposed studies, it may he necessary to consider the sources
of drinking water in the exposed populations. The city of Houston and neigh-
boring communities receive their drinking water generally from two sources,
one from underground water which is relatively low in organics and the second
from surface water from Lake Houston which tends to have higher levels of
organics (trihalomethanes and pesticides). There are research efforts cur-
rently underway to monitor toxic organics in water from these two sources and
this data should be considered in the design of population studies.
An interesting approach for studying the possible relationship of
ambient air pollutants to cancer is through the use of biological test systems,
The long latency period in the development of cancer makes it rather difficult
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to define a relationship of exposure to air pollutants and development of
cancer. Thus monitoring of human populations for cancer is observing effects
from a cause perhaps some 20 years previous. A .more rapid monitoring system
would be advantageous. Such a system has Been proposed by a number of invest-
igators and has recently been described in a publication by Commoner^).
Techniques are described using a battery of cell culture procedures to test
particulate matter and urine samples from experimental animals and humans
exposed to toxic organic compounds. Dr. T.S. Matney of the University of Texas
Graduate School of Biomedical Sciences and a member of the health indicator
advisory group of this study has proposed the utilization of a series of bio-
logical test procedures including the Ames test. Consideration should be given
to use of a battery of tests employing bacteria, plants, animals and human
tissue. These studies would involve exposure of specific biological systems
to particulates and other pollutants and determination of the specific muta-
geneticity, carcinogenicity and teratogenicity of the subject pollutants.
Dr. Matney has utilized these screening procedures to examine particulate
matter present in Houston's ambient air and he found that on certain days,
particularly when there was an inversion with a high aerosol level, particulate
matter tended to be positive in the screens, but on other days the particulates
were negative. Studies could be performed in which particulate matter from
several areas was examined using a battery of mutagenic tests on perhaps a
daily or weekly basis to determine the presence or absence of potentially
carcinogenic materials in the Houston area. Studies could also be performed
in which populations were examined for presence of mutagenic materials in
their urine samples. These test systems would determine those populations at
risk, that is, those with a relatively high exposure to the toxic organics.
The test systems might also be utilized to detect those persons most sensitive
to these toxic materials. These approaches could add very important pieces
of data relative to whether the high particulates and organics present with
these particulates may be associated withthe contribution to lung cancer in the
area.
In vitro systems have been shown to be positive for substances with
known carcinogenic activity in animal studies and to a much lesser extent in
people. These tests have also shown negatives which agreed with available
data. The tests are often utilized to screen potentially toxic substances for
carcinogenic activity. A common scenario is that if the substance is positive
in the in vitro tests, then toxicity studies in several animal species would
be performed; if negative, the substance would be presumed to be non-carcino-
genic and vice versa. The in vitro tests are reported to provide a high degree
of accuracy for not reporting "false negatives". An important point for
in vitro tests for health effects is to utilize the results of a battery of
such tests in combination with epidemiology results to draw conclusions.
Another possibility for the high incidence of lung cancer in the
Texas Gulf Coast area is that these elevations may have been associated with
exposure to asbestos in the Houston- Galveston area from shipbuilding carried
on in the 1940's. To examine this possibility, a case control study could be
performed aimed at identifying occupational exposures, specifically employment
in shipyard or related activities, smoking history, current and past
22
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residences, and other personal and demographic information. Other types of
occupational exposures which may have contributed to these types of cancers
include exposures to grain and cotton dust and exposures to pesticides in
these operations. A retrospective study would also collect incidence informa-
tion for other types of diseases in addition to cancer, especially lung
diseases. Selection of proper control groups for this study will be extremely
important. This can be accomplished several ways such as through random digit
dialing or house-to-house surveys.
The panel considers that a systematic review should be accomplished
to determine the specific characteristics of existing mortality data systems
in the area and to evaluate whether or not a coordinated system would be
useful for definition of health problems potentially related to air pollution
exposures. A system currently exists for mortality but it lacks many specific
characteristics that could make it significantly more useful for application
to air pollution studies. An improved system would include information re-
garding multiple causes of death, migration history, occupation and smoking
histories, location of work and work history. Such a system would be useful
to describe present conditions in the area especially for future situations
when there will be significant changes in the demographic characteristics of
the population and in the air pollutants in the area.
3. General
A well-defined opinion survey performed in the TGCA would provide
considerable benefits for the Environmental Protection Agency with minimum
funds. It could provide information relative to the general population's
opinions on their assessment of air pollution in the area, what they think
should be done, if anything, about the situation and what they would be
willing to do to improve the situation. The survey would collect information
regarding opinions for different socioeconomic groups, ethnic groups, dif-
ferent occupations, urban versus rural comparisons and comparisons between the
Texas Gulf Coast area and other geographic areas of the United States. Ath-
letes, who represent healthy population, would be surveyed to determine their
opinions regarding the effects of air pollution on performance and symptoms
such as coughing or headaches after athletic performance. Also, opinions
regarding the perception of illnesses within the various groups cited above
would be tabulated. Because of the potential usefulness of this information
in the design of other portions of a more comprehensive health effects research
plan, the opinion survey should be performed as near the beginning of the over-
all program as possible.
Consideration should be given for the utilization of time series
statistical approaches in the examination of data relative to effects of air
pollutants on populations. This approach can be used to account for auto-
correlation among variables and has been recognized by other investigations as
one that potentially can be very useful in the evaluation of effects of air
pollutants on people. Autocorrelation is a problem with air variables during
episodes of air pollution and for daily health measures which relate strongly
from one day to the next.
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Chamber studies are important. However, there are enough current
chambers in use and it would be wasteful to build another in this area.
Population studies should receive high priority because they will help define
issues and answer those questions described earlier. One difficulty for any
population study for the TGCA is the rapidly changing demographic character-
istics of the population. The area is rapidly growing due largely to an
influx of new people. This must be considered in the design of population
studies.
Air monitoring for several of the health studies should include
measurement of the aeroallergens to include ragweed, grass pollen and molds.
Air monitoring should also include the measurement of asbestos and fiberglass
materials which are related to certain types of cancer.
C. Hypotheses to be Investigated
To be most effective, a health effects research program with limited
funding must focus its resources. One very useful technique is to identify
hypotheses (unproven statements) which could be tested by experimentation or
analysis. Resources should be focused on the testing of those hypotheses
which will most contribute to a better understanding of the problem.
Important hypotheses resulting from the assessment of research needs are
presented in Table 3. Specific study designs addressing one or more of these
hypotheses have been developed, and are presented after the listing of
hypotheses.
Hypotheses regarding design of an associated air pollution monitoring
program for the TCCA are presented in Volume I of this series of reports.
24
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TABLE 3. HYPOTHESES ON HEALTH EFFECTS
1. Exposures to air pollution levels experienced in some areas of the TGCA
causes increased respiratory symptoms and performance decrements in some
maximally stressed or exercising healthy persons.
2. The levels of oxidants and suspended particulates experienced in
areas of the TGCA can produce an increased frequency of respiratory
illnesses and asthma attacks in children with active asthma.
3. The levels of oxidants and suspended particulates experienced in some
areas of the TGCA can produce increased frequency of respiratory symptoms
in adults with chronic obstructive respiratory disease.
4. Specific components of suspended particulates from selected areas of the
Texas Gulf Coast are genetically active and will produce mutations in
mutagenic assay systems.
5. Available bacterial and mammalian mutagenicity test systems can be used
effectively in air pollution studies, specifically for characterization
of genetic activity of particulates, vapor phase organics and photo-
chemical oxidants.
6. Human and animal cytogenetic techniques can be used effectively in
population monitoring for air pollution studies in groups selected from
areas within the TGCA experiencing sharp contrasts with respect to ozone,
particulate and hydrocarbon exposures.
7. Residential or occupational exposures are associated with the excesses of
lung cancer noted in several counties (Calveston, Harris, Jefferson, and
Orange) in the Texas Gulf Coast area.
8. Past levels of suspended particulates and specific characteristics of
suspended particulates (size, amount of hydrocarbon, composition and
genetic activity estimated from present exposures) are associated with
cancer patterns described for selected Texas Gulf Coast counties.
9. Body burdens of hydrocarbons in animals and humans resident in areas of
high and low pollution relate to hydrocarbon levels found in local air
or water sources and relate to incidence of cancer in areas of the TGCA.
10. Chromosomal aberration responses to environmental exposures, specifically
exposure to ozone and hydrocarbons, can be measured and specifically
related to differences in air pollution experienced in areas of the TGCA
with respectively higher and lower exposures.
11. Recent mortality and morbidity patterns in the Texas Gulf Coast area,
particularly cancer, fetal and infant mortality and chronic obstructive
lung disease, can be related to air pollution levels.
25
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TABLE 3. HYPOTHESES ON HEALTH EFFECTS (Continued)
12. Specific maternal or paternal environmental exposures can he identified
for women experiencing early fetal loss (spontaneous abortions prior to
12 weeks).
13. Number and type of chromosomal anomalies present in abortus material from
spontaneous abortions prior to 12 weeks can be related to environmental
exposures.
26
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D. Proposed Health Effects Studies
The hypotheses described in the previous section can be investigated by
collecting appropriate data, and analyzing and interpreting those data with
respect to the hypothesis in question. Data collection can involve existing
daca or data resulting from specific information collected in the field such
as clinical testing, biological sampling, questionnaire information, or other
observations. Data analysis can be accomplished by statistical analysis,
correlation analysis, case studies, mathematical modeling, or other methods.
Brief descriptions have been developed for twelve studies which are
thought to be of the types which will be most productive for addressing air
pollution related health effects questions in the TGCA. These designs are
broad and will require the definition of more detailed experimental plans and
protocol before execution. Concepts could be added to each of these designs
to enhance the usefulness of the results; on the contrary, many of these study
briefs could be subdivided into smaller studies. Priorities have been assigned
based on the necessity of addressing the specific health issues and the prob-
ability of contribution to a better understanding of air related health effects.
A rationale is also presented to document some of the reasons used to justify
each priority listed. The study designs, as presented, represent the opinions
of this study team regarding the set of studies which would most likely yield
definitive and useful answers to TGCA air related health effects questions.
27
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STUDY BRIEF 1.
Performance of Maximally Exercising Healthy Persons in Relation to Texas Gulf
Coast Air Pollution Exposure
AMBIENT EXPOSURES
Ozone; hydrocarbons; total suspended particulates; oxides of nitrogen
OBJECTIVE
To determine if exposure to air pollutants in the Texas Gulf Coast Area is
associated with increased symptoms and performance decrements in maximally
exercising healthy persons.
BACKGROUND
Earlier studies in the Los Angeles basin have shown increased symptoms (eye
irritation, cough, chest discomfort) reported by healthy student nurses and
decreased performance by high school cross-country track runners to be
related to increased levels of photochemical oxidants. These studies have not
been replicated despite the need for more studies of the effects of various
levels of ozone on healthy stressed adults. There is concern that the photo-
chemical oxidant mix in the Texas Gulf Coast area may be different from that
of Los Angeles. Ozone does not cause eye discomfort although it does cause
cough and chest discomfort. Maximally exercising healthy persons engaging in
aerobic work (running) take in considerably larger doses of ambient air than
sedentary persons.
DESIGN
Approximately twenty high school cross-country teams and track teams partici-
pating in meets in the Texas Gulf Coast area will be studied for a three-year
period. The high school cross-country season is in the fall and the track
season is in the spring (April-May). Monthly ozone levels in the TGCA
are comparable for the fall (cross-country season) and the spring (track season).
The cross-country season usually comprises ten leets. For each runner at each
meet, pulse rate and pulmonary function will be determined pre- and post-race
and symptom reporting will be determined post-race; race times will be measured
for each runner at each meet. Methodologic aspects of this study will be re-
fined during pre-season meet pilot studies. Ambient air pollutants will be
measured at meet sites intermittently the day before and the day of each race
and continuously at various stations in the area. Race performance times, pre-
and post-race pulse and pulmonary function determinations and post-race symptom
reporting will be related to ambient pollutant levels and distance of event
(220, 440, 880, 1 miles or 3 miles) since distance will enhance dose or exposure.
28
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STUDY BRIEF 1. (Continued)
PRIORITY
High: Ozone is one of the major concerns in the TGCA. Results from a study
of healthy stressed or maximally exercising adults may be more generalizable
to the area population.
DURATION AND ESTIMATED COST
3 years; $ 750,000.
29
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STUDY BRIEF 2.
Mutagenicity Assay of Air Pollutants in the Texas Gulf Coast Area
AMBIENT EXPOSURES
Total suspended particulates, respirable particulates, ozone, hydrocarbons and
vapor phase organics
OBJECTIVES
1. To determine the genetic activity of particulates from selected areas of
the Texas Gulf Coast.
2. To characterize the chemical composition of particulates.
3. To evaluate the available bacterial and mammalian mutagenicity test systems
for utility in air pollution studies, specifically for characterization
of genetic activity of particulates, vapor phase organics and photochemical
oxidants.
4. To evaluate human and animal cytogenetic techniques for utility in pop-
ulation monitoring for air pollution studies in groups selected from
areas within the TGCA experiencing sharp contrasts with respect to ozone,
particulate and hydrocarbon exposures.
BACKGROUND
With the increased concern for chronic health effects of air pollution, especially
the possibility of cancer and reproductive wastage, it is important to determine
che presence of genetically active compounds in the air mixture and to identify
che specific constituents of the air which produce these effects.
DESIGN
Particulate sampling would be done at anticipated peak times in several con-
trasting areas under varying climatic conditions. These samples would be
analyzed for mutagenicity in a bacterial test system using a repair capable
strain and selected mammalian cell test systems. Particle size would be
accounted for in the sampling methods to obtain a separate sample for respirable
particulates. Particulate samples would be analyzed for chemical composition.
Air samples from both high and low oxidant (ozone) areas would be analyzed for
genetic activity in both bacterial and mammalian cell test systems. Efforts
would be directed at identifying both the test system(s) most sensitive to air
samples containing mixtures of fairly low levels of ozone and hydrocarbons
(particulates) that occur in the ambient air and the system(s) which gives the
most specific response to a given pollutant. Important developmental work in
this area is being conducted by the Smithville Environmental Carcinogenesis
Center of the University of Texas System Cancer Center.
30
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STUDY BRIEF 2. (Continued)
PRIORITY
High: Technology to conduct these studies currently exists and is being used
in air pollution studies. Cancer mortality rates, especially lung cancer,
apparently are very high in several counties of the TGCA. Difficulty in identi-
fying exposures of 20-30 years earlier that may be related to cancer patterns
today makes short term assays like this very important adjunct to environmental
cancer studies.
DURATION AND ESTIMATED COST
18 months; $150,000 - $200,000
31
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STUDY BRIEF 3
Evaluation of the Association of Lung Cancer and Air Pollution in the Texas
Gulf Coast Area
AMBIENT EXPOSURES
Suspended particulates (1940 to present)
OBJECTIVES
1. To evaluate the association of past levels of suspended particulates and
specific characteristics of suspended particulates (size, amount of
hydrocarbon, composition and genetic activity estimated from present
exposures) to the cancer patterns described for selected Texas Gulf Coast
counties.
2. To identify specific residential or occupational exposures associated
with the excesses of lung cancer noted in several counties (Galveston,
Harris, Jefferson and Orange) in the Texas Gulf Coast area.
3. To determine if any differences exist in the histopathologic distribu-
tion for lung cancer cases observed in these counties which may be
related to specific environmental exposures.
4. To determine if smoking patterns differ for residents of Texas Gulf Coast
Area counties from other Texas or U.S. counties.
BACKGROUND
Although several cancer sites may be identified from morbidity and mortality
analyses to be in excess or increasing in the Texas Gulf Coast area, the excess
for lung cancer is already fairly well documented for several counties. The
continued high frequency for this site would facilitate the conduct of incident
(newly diagnosed) observational cohort or case-comparison studies in these
selected counties. Because the highest rates of lung cancer mortality have
been observed for Galveston, Orange and Jefferson counties, initial field
studies should be pursued in these areas. The annual number of newly diagnosed
cases for Galveston County is approximately 150 and 300 cases a year for Orange
and Jefferson Counties.
DESIGN
The focus of the cancer investigations should be on lung cancer in the apparent
high risk counties, specifically counties with a single industry and a fairly
non-mobile population. Newly diagnosed cases of lung cancer over two to three
year interval would be reported by participating physicians in the counties and
the cases interviewed for exposure histories (specifically occupational, resi-
dential and smoking). Both a population and a hospital control (two for each
case) would be selected and interviewed in the same manner as the cases.
Pathology reports and specimens would be obtained and reviewed using a standard-
ized protocol for the histopathologic classification. Environmental analyses
would be conducted for regions within the county to include characterization
32
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STUDY BRIEF 3 (Continued)
of particulate exposures and estimation of past exposures (from 1940 to present)
using emissions inventories and production data for industries located within
the counties. Background information regarding smoking patterns would be
obtained from existing sources or studies conducted in other parts of the state
or U.S. if available for comparable time period or obtained directly. Data
regarding the histopathologic classification of lung cancer cases are available
for case series by various means of ascertainment (autopsy, surgical, diag-
nostic and screening).
PRIORITY
High: Three of the most highly industrialized counties in the TGCA (Orange,
Jefferson and Galveston) have excessive lung cancer mortality rates. Industry
in these areas is largely chemical and petrochemical and the populations are
fairly stable by contrast with Houston. The ability to examine and classify
tissue by histopathology will allow comparison with non-industrialized areas
and may provide a specific pathologic marker for environmental effects.
Mutagenicity assays of current air samples will identify biologic activity of
present pollutants. Information regarding mutagenicity will also be utilized
when extrapolating backwards from present levels of pollution to estimate levels
and characteristics of exposures 20-30 years earlier.
DURATION AND ESTIMATED COST
3 years; $600,000.
33
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STUDY BRIEF 4
Evaluation of Existing Health Data Collection Systems in the TGCA
AMBIENT EXPOSURES
General
OBJECTIVE
To evaluate existing health data collection systems and identify specific
information needed for air pollution studies that might be incorporated
into these systems to facilitate more efficient and timely population
monitoring.
BACKGROUND
Several existing data collection systems are available at the state and local
level that could be utilized to evaluate mortality and morbidity patterns in
a specific and coordinated fashion. Some efforts in this area are already
underway for cancer incidence with the Texas State Cancer Information System
(Texas State Department of Health Resources), the Texas Health Atlas
(University of Texas School of Public Health) and the Environmental Epidemiology
data system of the Lawrence Berkeley Laboratory (University of California).
In addition the availability of the National Health Examination Survey tapes
for morbidity information at the University of Texas School of Public Health
presents an additional data source that should be evaluated for inclusions in
some coordinated system.
DESIGN
The available data collection and information systems in the TGCA will be
reviewed for inclusion of specific content related to air pollution health
effects. Potential sources of available data will be identified as well as
a mechanism(s) to coordinate methods of data collection and analysis.
PRIORITY
High: There is need for background data (incidence, prevalence, disability)
to assess impact of conditions associated with air pollution and to design
and conduct more specific studies. Review of descriptive data will generate
additional hypotheses to be tested.
DURATION AND ESTIMATED COST
1 year; $150,000.
34
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STUDY BRIEF 5.
Respiratory Illnesses and Asthma Attacks in Children with a History of Asthma
Related to Ozone and Total Suspended Particulate Exposure
AMBIENT EXPOSURES
Suspended particulates, ozone, and other pollutants
OBJECTIVE
To determine if children with active asthma exposed to oxidant/total suspended
particulate air pollution report an increased frequency of acute respiratory
illnesses and asthma attacks than similar children not so exposed.
BACKGROUND
Asthma in children is different than adult asthma and quite heterogeneous.
Asthma prevalence in the general population ranges from 2 to 5 percent.
Relatively few studies of air pollution and asthmatic children have been done,
yet children (and adults) so afflicted are affected markedly by air pollution
with both an increased frequency of asthma attacks and an increased frequency
of acute respiratory diseases.
DESIGN
Children with a history of active asthma from an area with higher/lower oxidant
total suspended particulate exposure will be recruited. Initial health
questionnaire and quarterly pulmonary function tests will be accomplished.
Participants will be followed for one/two year(s) with weekly or biweekly
questionnaires on the frequency of acute upper and lower respiratory disease
attacks. The frequency of asthma attacks, the use of asthma medications, the
frequency of physician attended illness, the frequency of Emergency Department
visits and the frequency of hospitalizations for asthma will be monitored.
This study permits distinction between medically attended and medically un-
attended respiratory illnesses and asthma attacks and should be considered a
pilot project representing a major contribution to the study of air pollution
and chronic respiratory disease in children.
PRIORITY
High to Intermediate: The association of air pollutants with the increased
risk of acute respiratory disease, especially among children, is an important
issue and an issue which will become even more important with a possible
increase in S02 emissions.
DURATION AND ESTIMATED COST
2 years; $350,000.
35
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STUDY BRIEF 6.
Body Burden Studies in Human and Animal Populations of the Texas Gulf Coast Area
AMBIENT EXPOSURES
Air pollutants shown to be genetically active through mutagenetic assay
OBJECTIVES
To determine the body burden of hydrocarbons in animals and humans resident
ir. areas of high and low pollution using autopsy data
BACKGROUND
Measureirent of pollutants in body burdens (blood, urine, hair, feces, soft
tissue, bone) has been utilized to estimate exposures and accumulation. This
approach has been very useful in describing relatively longer term exposures
to various air pollutants. Exposures of hydrocarbons to marine organisms via
body burden measurements has been performed for several years but the approach
has not been applied to animal or people studies. Analytical techniques are
available for these measurements, especially the high boiling aromatic compounds.
DESIGN
Hunan body burden studies would be designed to complement the mutagenicity assay
of air samples in areas with the greatest contrast for the compounds identified
to be genetically active. The extent of absorption and degree of exposure to
hydrocarbons experienced by longterm residents in these areas would be assessed
by analyzing the amount stored in body fat using available autopsy material.
An animal model using domestic animals (pets) may be more efficient for these
analyses since domestic animals have a shorter life span and more restricted
range.
PRIORITY
Intermediate: This study is sequential to mutagenetic assay. Useful in
assessing lifetime exposure to hydrocarbons among longterm residents since
exposure to some of these compounds is associated with increased cancer rates.
DURATION AND ESTIMATED COST
18 months; $150,000 - $200,000.
36
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STUDY BRIEF 7.
Analysis of Mortality and Morbidity Patterns in the Texas Gulf Coast Area
AMBIENT EXPOSURES
General
OBJECTIVES
1. To determine background rates (mortality, incidence, prevalence), time
trends and environmental and demographic correlates of cancer, chronic
obstructive lung disease and reproductive wastage in the TGCA.
2. To analyze recent mortality and morbidity patterns in the Texas Gulf
Coast area with particular reference to cancer, fetal and infant
mortality and chronic obstructive lung disease.
BACKGROUND
Excesses of cancer, specifically lung cancer, have been noted for several
counties in the Texas Gulf Coast area. The persistence of these trends in
the counties noted (Galveston, Harris, Orange and Jefferson) and the possible
environmental and demographic factors associated with these rates have not
been adequately documented.
DESIGN
This study would include detailed analytic studies of cancer and reproductive
wastage in the Texas Gulf Coast area. Chronic obstructive lung disease would
be included in these analyses to evaluate both acute and chronic effects.
Information regarding background rates, time trends and environmental and
demographic associations would be obtained. Such information is essential for
the development of specific case-control prevalence, panel or prospective
studies to test hypotheses generated from the descriptive studies. All counties
in the designated Texas Gulf Coast area would be included in the morbidity and
mortality analyses (cancer, reproductive wastage, chronic obstructive lung
disease). Specific urban industrialized and non-industrialized areas within
the Texas Gulf Coast area would be selected for studies of acute morbidity of
chronic obstructive lung disease and related diagnoses, utilizing hospital
discharge diagnostic summaries,outpatient visits or insurance data for several
days for each month throughout a 12 month period. Mortality, demographic and
air quality data available for all U.S. Counties from the Lawrence Berkeley
Laboratory would be analyzed by county and when possible by census tract for
the TGCA. The availability of data from the Houston Influenza Watch program
at Baylor would facilitate an evaluation of the variation in viral disease
patterns with variations in air pollution. School absenteeism and the use of
a "sentinel class" for illness reporting will be considered in conjunction
with the analysis of data provided by the Influenza Watch program. Data tapes
from the National Center for Health Statistics (Health Examination Survey)
will be analyzed for Texas and the TGCA to identify prevalence of selected
acute and chronic conditions by geographic area or population group.
37
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STUDY BRIEF 7. (Continued)
PRIORITY
Intermediate: This study is sequential to evaluation of existing data
collection systems. It would be useful to determine specific background
rates which may relate specifically to air pollution.
DURATION AND ESTIMATED COST
2 years; $400,000.
38
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STUDY BRIEF 8.
Symptom Reporting and Pulmonary Function in Adults with Emphysema/Chronic
Bronchitis Exposed to Texas Gulf Coast Air Pollution
AMBIENT EXPOSURES
Ozone, particulates, and other pollutants
OBJECTIVES
Ic determine if adults with chronic bronchitis or emphysem? exposed to oxidants
and suspended particulate air pollution report an increased frequency of
synptoms on days with higher pollution.
BACKGROUND
Studies of air pollution episodes in Donora, Pa. and London, England have shown
that persons with chronic lung disease (asthma, emphysema, bronchitis) were much
more affected by high pollutant levels when compared to healthy adults. Exposure
response relationships for lower levels of ambient pollutants are not yet
completely delineated. Furthermore, current pollutant exposures probably differ
from the historical air pollution episodes. It is important to know what effects
current pollutant levels have upon persons with chronic bronchitis and emphysema
because they represent about 7% of the adult population. Response to air
pollutants has been shown to be different among asthmatics compared to persons
with extremely impaired respiratory function, i.e. chronic bronchitis and
emphysema.
DESIGN
A group of 200-250 adults (age approximately 40-60 years) with a history of
chronic obstructive lung disease, excluding asthmatics, will be monitored for
an eight month period for symptoms and pulmonary function testing. Panelists
will be recruited from an area in the TGCA with relatively high levels of
ozone (Northeast). Diagnosis of illness should be confirmed by clinical exam-
ination. Current smokers should be excluded from the panel. Symptoms should be
recorded daily and collected bi-weekly. Pulmonary function tests will be
performed twice weekly with a two week interval of daily tests. Health indicators
will be examined relative to daily levels of several air pollutants (as a minimum
ozone, total oxidants, PAN, N02, TSP, RSP, S02t and aeroallergens).
PRIORITY
Intermediate - Low: Results may not be unambiguous. Numerous studies of re-
spiratory symptoms and pulmonary function of healthy and chronically ill persons
have been done and the results have been inconsistent. In many instances the
reporting of symptoms is not related to decrements in pulmonary functioning or
to levels of air pollutants, but may be due to other differences between
39
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STUDY BRIEF 8. (Continued)
persons from the high and low pollution areas being compared.
DURATION AND ESTIMATED COST
1 year; 5350,000.
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STUDY BRIEF 9.
Public Opinion and Environmental Pollution in the Texas Gulf Coast Area
AMBIENT EXPOSURES
Criteria and noncriteria pollutants
OBJECTIVES
To systematically study public opinion regarding possible immediate and longer-
term effects of environmental pollution on their health and well being.
BACKGROUND
Public opinion is a major determinant of public policy yet its systematic study
with regard to environmental pollution is usually ignored; infrequent, earlier
studies have shown that people readily perceive and complain about nuisance
and annoyance aspects of ambient pollution, e.g., alterations in visibility,
odors, soiling and acute irritation symptoms; much less is known about their
concern and awareness of the possible long-term effects of pollution exposure;
little is known about the general population's opinion and knowledge regarding
the major sources and effects of environmental pollution in a given area; current
concerns about limited energy, alternative energy sources, and population growth
would be well served by systematic, thoughtful, representative surveys of public
opinion areas with varying growth and pollution.
DESIGN
Approximately 5,000 families would be surveyed once in a house-to-house survey
using an appropriately designed questionnaire administered by specially trained
interviewers during a six-month period; sampling parameters will include pert-
inent, representative socioeconomic, demographic, occupational and geographic
characteristics; questionnaire information would include environmental opinions
regarding sources, health effects and economic costs, age, sex, race/ethnic
group, education, occupation, socioeconomic status, number of persons in house-
hold, cigarette smoking habit, prevalence of chronic illness, duration of resi-
dence in area and previous area of residence; the survey results will provide
useful scientific information as well as one reasonable basis for determining
public policy.
PRIORITY
Intermediate - Low: How pollution problem and nuisance aspects of pollution
are perceived by residents of TGCA is important to know, but not as important
as determination of specific health effects.
DURATION AND ESTIMATED COST
6 months; $50,000.
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STUDY BRIEF 10.
Cytogenetic Studies in Human Populations of the Texas Gulf Coast Area
AMBIENT EXPOSURES
Air pollutants shown to be genetically active through mutagenetic assay
OBJECTIVES
To determine the specificity of type, number and timing of chromosomal aberration
responses to environmental exposures, specifically exposure to ozone and hydro-
carbons.
BACKGROUND
Human cytogenetic monitoring has been utilized in radiation studies and in pop-
ulations highly exposed to cytotoxic agents (patients on chemotherapy or persons
occupationally exposed to chemical mutagens). Results have not been consistent
and appear to be highly dependent on technique (both handling of specimens and
scoring procedures) as well as the high proportion of nonspecific responses
reflected as simple or transient chromosomal breaks. If complex anomalies,
specifically decentrics,which appear to be the most objective response, are
utilized and standardized protocols are followed, this technique may be extremely
useful in population monitoring and should be evaluated.
DESIGN
Human cytogenetic studies should be designed to complement the mutagenicity
assay of air samples in areas with the sharpest contrast for the compounds
identified to be genetically active. A cross-section of long-term residents
(all ages) in areas of high and low pollution would be examined to identify the
number and type of chromosomal aberrations in circulating lymphocytes by age.
The resulting age distributions of complex chromosomal breaks or anomalies could
be compared for the two or more areas.
PRIORITY
LOW- This study is sequential to mutagenicity assay. Technologic and method-
ologic problems still to be overcome before this technique can be successfully
utilized in field studies of low level exposures.
DURATION AND ESTIMATED COST
18 months; $200,000.
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STUDY BRIEF 11.
Study of Reproductive Wastage Due to Air Pollution in the Texas Gulf Coast Area
AMBIENT EXPOSURES
Photochemical oxidants, hydrocarbons
OBJECTIVES
1. To determine if specific chromosomal anomalies are associated with
environmental exposures.
2. To identify numbers and types of chromosomal anomalies present in abortus
material from spontaneous abortions of less than 12 weeks gestation.
3. To determine if early fetal loss (spontaneous abortion prior to 12 weeks)
is associated with specific maternal or paternal environmental exposures.
4. To determine if the distribution of chromosomal anomalies identified in
the TGCA case series differs from that observed in other areas of the United
States where studies of this type are underway.
BACKGROUND
The association of chromosomal anomalies with spontaneous abortion and the
association of specific anomalies with environmental exposures provide a
potential population monitoring mechanism for a more specific evaluation of
causal mechanisms in reproductive wastage.
DESIGN
A series of approximately 3,000 women in the Houston area planning to become
pregnant would be recruited through the obstetrical gynecologic services of
participating hospitals or private practices. Women enrolled in the study would
be interviewed to determine residence, smoking, employment, husband's employment
and other aspects of environmental exposure; and would be instructed how to
detect and report early signs of pregnancy. They would be tested for pregnancy
as soon as possible. Resulting pregnancies would be monitored. Specimens would
be obtained by or from women experiencing spontaneous abortions. Cytogenetic
analyses would be performed on the specimens obtained. It is estimated that
1500 pregnancies would result from a sample of 3000 women over a two-year period.
If all the fetal losses of less than 12 weeks gestation that can be detected are
ascertained, approximately 450 fetal losses would be identified and available
for study. The rate of chromosomal anomaly for spontaneous abortions has been
observed to be extremely high (50-60%) and even higher in spontaneous abortions
of short gestation. A study of this type would require at least 3 years to
conduct and would entail extensive laboratory costs as well as costs associated
with field activities (recruitment, interviewing and followup of study sample).
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STUDY BRIEF 11 (Continued)
PRIORITY
Low This study is sequential to mortality and morbidity analyses. The study
approach would be much more specific in terms of evaluating exposure effects
on the developing fetus than the statistical treatment of historical data.
However, this type of study requires fairly sophisticated cytogenetics support
and, as a study approach, is just now being evaluated in New York City (Columbia
University).
DURATION' AND ESTIMATED COST
3 years; $600,000.
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STUDY BRIEF 12.
Hazard Assessment of Increased Emissions in the TGCA due to Projected Uses
of Alternate Fuels, Particularly Coal
AMBIENT EXPOSURES
Sulfur Dioxide, Particulates, Oxides of Nitorgen
BACKGROUND
Relatively clean fuels such as natural gas and low-sulfur petroleum are the
predominant energy source at present in the TGCA. Accordingly, sulfur dioxide
levels are relatively low in all areas of the TGCA; exceptions to this are
several areas associated with specific point sources. There is concern
regarding possible increases in emission of certain pollutants such as sulfur
dioxide, particulates, oxides of nitrogen, and possibly others due to the
possibility of conversion to coal, especially high-sulfur coal. If broad
scale conversion to coal occurs in the TGCA, there could be sharply increased
emissions of these pollutants in the ship channel industrial areas and also
from the electrical power plants located throughout the area. These increases
could sharply impact the ambient levels.
DESIGN
This is a paper study to analyze the possible impact of increased use of
alternative energy sources. It would involve projections of the energy
requirements and the specific energy sources for these requirements over the
next ten years. An assessment of existing and projected control technologies
would accompany the projections of energy consumption. Analyses would be
made regarding the expected levels of pollutants such as sulfur dioxide,
particulates, and oxides of nitrogen, the populations exposed to these levels,
and the populations most-at-risk to determine the degree of severity of this
problem.
PRIORITY
Low: Plans to convert to alternative sources are presently uncertain in the
TGCA. Large scale use of alternative energy sources does not present a
significant air pollution problem at present. Any such problems may not occur
at all or may be avoided for many years into the future.
DURATION AND ESTIMATED COST
1 year; $150,000 - $200,000.
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E. Summary of the Plan
The study briefs presented in the previous section collectively form the
basis of an integrated research plan for health effects. Taken as presented
the preliminary cost estimates total to a sum greater than the three million
dollars budgeted for air pollution and health effects during the current three
year TGCA program. Though all of the studies presented are considered impor-
tant, the assignment of priorities has been made to better focus on those
studies considered most important and most probable to produce tangible
results. A summary of these priorities and estimated costs is presented in
Table 4.
Air quality measurements would be required to support the health effects
studies outlined here. A summary of the general types of air quality measure-
ments needed for this support is presented in Table 5. The frequency of
measurements is divided into three categories: hourly, 24 hour and inter-
mittent. The hourly and 24-hour samples should be available on a daily basis.
The intermittent samples (or analyses) should be accomplished at intermittent
intervals during a given period of study.
The research plan for air contaminants presented in Volume I (5) of this
series presents objectives which differ from the specific needs for support
of health effects studies, but there are considerable interactions in the
proposed studies. The following proposed projects from Volume 1 have applic-
ability to understanding possible health effects in the TGCA: 1.3, 1.6, 1.7,
1.8, 1.9, 1.10, 1.11, 1.13, 1.15, 1.16, 1.19, 1.24, 1.29, 2.3, 2.4, 2.5, 2.15,
2.17, 2.18, 2.23, 2.24, 2.27, 3.3.
Those efforts directed at the characterization and identification of
sources and transport of aerosols are very important to the health effects
needs. The plans proposed in Volume I also include an effort to identify
compounds with known or suspected carcinogenic and mutagenic activity present
in ambient air of the TGCA.
F. Resources for Performance and Support of Health Effects Studies in
the TGCA
The types of health effects studies considered and recommended in this
report require extensive capabilities for proper performance. This spectrum
of capabilities includes population recruitment and sampling, biological,
microbiological, chemical, and clinical laboratories, air monitoring, statist-
ical and computational facilities, access to existing data sources, and others.
A listing of some of the principal resources available for application to
these types of health studies is presented in Table 6.
46
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Table 4. Summary of Research Priorities
Study
Brief Short Title
1 Maximally Exercising
2 Mutagenicity Studies
3 Lung Cancer Study
4 Health Data System
5 Respiratory Illness
6 Body Burden Studies
7 Mortality and Morbidity
8 Adult Symptom Reporting
9 Public Opinion
10 Cytogenetic Studies
11 Reproductive Wastage
12 Hazard Assessment
Ambient Exposures
03, HC, TSP, NOX
TSP, RSP, 03, HC
Suspended Particulates
General
TSP, RSP, 03
Organics, HC
General
03, TSP, RSP
Criteria Pollutants
Organics, HC
03, TOX, HC
S02, TSP, NOX
Priority
Estimated Cost
1
1
1
1
1-2
2
2
2-3
2-3
3
3
3
$750,000
200,000
600,000
150,000
350,000
150,000
400,000
350,000
50,000
200,000
600,000
200,000
Total - High Priority
Intermediate Priority
Low Priority
Total for all Priorities
*1 = High Priority
2 = Intermediate Priority
3 = Low Priority
$1,700,000
900,000
1,400,000
$4,000,000
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TABLE 5. SUMMARY OF AIR QUALITY MEASUREMENTS REQUIRED FOR HEALTH EFFECTS
STUDIES
Air Quality Parameter
Ozone
TOX
Oxides of Nitrogen
S02
PAN
TSP
RSP
Aeroallergens
Size Fractionation of Particulates
Chemical Analyses of Particulates*
Mutagenic Assay of Particulates**
Individual hydrocarbons with emphasis
on aldehydes, benzene, and toluene
Frequency of Measurements
Hourly
Hourly
Hourly
Hourly
Hourly
24-hr sample
24-hr sample
24-hr sample
Intermittently
Intermittently
Intermittently
Intermittently
*Chemical analysis for the following compounds:
Sulfate
Nitrates
Fluorides
Asbestos
Lead
Cadmium
Arsenic
Mercury
High molecular weight polynuclear aromatics
(such as benzo-a-pyrene)
**Mutagenic assay utilizing a battery of tests:
Ames test (both repair capable and repair deficient strains)
Chemical mutagenesis and carcinogenesis tests (plants, animals, human
tissue)
Chemical teratogenesis tests (animals)
48
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TABLE 6. AVAILABLE RESOURCES FOR SUPPORT OF TGCA HEALTH EFFECTS STUDIES
Organizacion
Baylor College of Medicine,
Houston
Beaumont Chamber of Commerce
Department of Health, City
of Houston
EPA Regional and District Offices
Galveston Chamber of Commerce
Gulf Universities Research
Consortium, Galveston
Houston Allergy Clinic
Houston Chamber of Commerce
Houston-Galveston Area Council
Houston Independent School District
Lamar University, Beaumont
Lawrence Berkeley Laboratory,
University of California, Berkeley
Radian Corporation, Austin
Research Statistics, Inc., Houston
Type of Support
Pulmonary physiology, spirometry
laboratory, virus watch program
Population, health, and economic
data
Health statistics, air pollution
monitoring, air pollution data
from previous years
Air pollution data, previous
support of air/health studies
Population, health, and economic
data
Population estimates, economic,
demographic, and environmental
data
Resident allergists, allergy
patients
Population and economic data,
previous support of air/health
studies
Transportation and air quality
control strategies, population
estimates, health statistics
Students, attendance and other
records, previous support of air
and health studies
Environmental sciences dept.
Mortality, demographic and air
quality data for U.S. counties
Air monitoring, environmental
engineering
Statistical and epidemiologic
consultation
49
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TABLE 6. AVAILABLE RESOURCES FOR SUPPORT
(Cont.)
Rice University, Houston
San Jacinto Lung Association,
Houston
South East Texas Regional Planning
Commission, Beaumont
Southwest Center for Urban Research
Center for Health Planning, Houston
Southwest Research Institute, Houston
Texas Air Control Board
Texas Southern University,
Houston
Texas State Department of Human
Resources
University of Houston
UT Health Sciences Center at Houston,
School of Public Health, Graduate
School of Biomedical Sciences
UT Medical Branch, Galveston
UT System Cancer Center, Houston
UT Carcinogenesis Center,
Smithville
OF TGCA HEALTH EFFECTS STUDIES
Environmental Sciences Dept.
Previous support of air/health
studies
Population estimates, health
statistics
Health statistics, health plan-
ning data
Conduction of air/health studies
and air pollution monitoring
Air pollution data, previous
support of air/health studies
Environmental and health related
departments
Mortality and morbidity data
Environmental and health related
departments
Resident epidemiologists, bio-
statisticians, toxicologists,
environmental health faculty,
community medicine, clinical
faculty
Cancer Center, Departments of
PM and CH
Health statistics, environmental
mutagenesis and carcinogenesis
laboratories
50
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REFERENCES
1. Houston Chamber of Commerce, Research Division: Population, Households
and Dwelling Units in Harris County Census Tracts, Jan. 1, 1976.
2. Johnson, D.E., Prevost, R.J., A Research Plan for Air Pollution and
Related Health Effects in the Texas Gulf Coast Area, Volume IV, Resource
Document: Health Effects, Southwest Research Institute Report for
Project 01-5397, EPA Contract 68-02-2955, January 1979.
3. Lambeth, B.W., Maxey, B.J., and Stadig, W.P.: Gulf Coast Planning Study
Resource Document (Draft Final Report), Radian Corporation Report for
Project 200-355, EPA Contract 68-02-2955, September 1978.
4. Lambeth, B.W., Jones, D., and Tannahill, G.: Texas Gulf Coast Planning
Study, Technical Note on Aerometric Research Plan for Texas Gulf'Coast
Area, Radian Corporation Report for Project 200-355, EPA Contract
68-02-2955, December 1978.
5. Tannahill, G., Lambeth, B.W., et al: A Research Plan for Air Pollution
and Related Health Effects in the Texas Gulf Coast Area, Volume I,
Research Plan, Origin, Transformation, and Fate of Air Contaminants,
Radian Corporation Report for Project 200-355, EPA Contract 68-02-2955,
January 1979.
6. Texas Air Control Board, Continuous Air Monitoring Network Data
Summaries (Annual). Austin, Texas, 1975, 1976, 1977.
7. City of Houston, Air Pollution Control Program Reports (Annual and
Quarterly), Houston, Texas, 1975, 1976, 1977.
8. Council on Environmental Quality, Environmental Quality - 1977: Eighth
Annual Report, U.S. Government Printing Office, Washington, D.C., 1977.
9. Federal Interagency Task Force on Air Quality Indicators: Council on
Environmental Quality, U.S. Environmental Protection Agency and U.S.
Department of Commerce, A Recommended Air Pollution Index, Washington,
D.C., Government Printing Office, 1976.
10. Texas Air Control Board: Biennial Report, September 1, 1976-
August 31, 1978.
11. Ferris, B.G.: Health Effects of Exposure to Low Levels of Regulated Air
Pollutants: A Critical Review, JAPCA. 28: 482-497, 1978.
12. Shy, C.M., Goldsmith, J.R., Hackney, J.D., Lebowitz, M.O., and Menzell,
D.B.: Health Effects of Air Pollution, American Thoracic Society News,
4: 22-63, 1978.
13. Hammer, D.I.: Respiratory Diseases in Children Exposed to Sulfur Oxides
and Particulates, Environmental Health Effects Research Series Report
EPA-600/1-77-043, 1977.
51
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REFERENCES (Continued)
14. Jenkins, D.E., Hsu, H.K., et al: An Attempt to Evaluate Health Effects
of Local Air Pollution in Children, Presentation before the American
Medical Association's course on Air Pollution and Health Effects in
Houston, Texas, May, 1977.
15. Detels, R., Rokaw, S.N., Coulson, A.H., et al: The UCLA Population
Studies of Chronic Obstructive Respiratory Disease: I. Methodology and
Comparison of Lung Function in Areas of High and Low Pollution, Am. J.
of Epidemiology, 109:33-58, 1979.
16. Johnson, D.E., Tillery, J.B., et al: Development of Analytical
Techniques to Measure Human Exposure to Fuel Additives, Southwest
Research Institute Report for Project 01-3451, EPA Contract 68-02-0595,
1974.
17. Johnson, D.E., Prevost, R.J., et al: Study of Health Effects of Air
Pollution in Persons with Chronic Obstructive Pulmonary Disease in
Houston, Texas, Southwest Research Institute Report for Project 01-4902,
Houston Chamber of Commerce Contract HE-2, 1979.
18. Texas Department of Health and University of Texas System Cancer Center:
Impact of Cancer on Texas, 1978.
19. Wayne, W.S., Wehrle, P.P., Carroll, R.E.: Oxidant Air Pollution and
Athletic Performance, JAMA, 199:901, 1967.
20. DeLucia, J.J., and Admas, W.C.: Effect of 03 Inhalation During Exercise
on Pulmonary Function and Blood Chemistry, J. Appl. Physiol., 43:75,
1977.
21. Folinsbee, L.J., Horvath, S.M., Raven, P.B., et al: Influence of Exer-
cise and Heat Stress on Pulmonary Function During Ozone Exposure, J.Appl.
Physiol.; Respirat.Environ.Exercise Physiol., 43(3): 409-413, 1977.
22. Hackney, J.D., Linn, W.S., Karuza, S.K., Buckley, R.D., Law, D.C., Bates,
D.V., Hazucha, M., Pengella, L.D. and Silverman, F.: Health Effects of
Ozone Exposure in Canadians versus Southern Californians, American
Review of Respiratory Disease, June 1975.
23. Golden, J.A., Nadel, J.A., and Boushay, H.A.: Bronchial Hyperirrita-
bility in Healthy Subjects After Exposure to Ozone, Am. Review of
Respiratory Disease. 118(2): 287-294, 1978.
24. Commoner, B.: Carcinogens in the Environment, Chemtech, pp. 76-82,
February 1977.
52
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TECHNICAL REPORT DATA
(Please read Instructions on the reverse before completing)
1 REPORT NO
EPA-600/8-79-008b
3. RECIPIENT'S ACCESSIOI»NO.
4 TITLE AND SUBTITLE
IN
PLAN FOR AIR POLLUTION RESEARCH
THE TEXAS GULF COAST AREA
Volume II. Plan For Health Effects Studies
5 REPORT DATE
April 1979
6. PERFORMING ORGANIZATION CODE
7. AUTHOR(S)
D. Johnson and R. Prevost
8. PERFORMING ORGANIZATION REPORT NO,
9 PERFORMING ORGANIZATION NAME AND ADDRESS
Southwest Research Institute
3600 Yoakum Boulevard
Houston, TX 77006
10. PROGRAM ELEMENT NO.
1AA603 AH-12 (FY-79)
11. CONTRACT/GRANT NO.
68-02-2955
12 SPONSORING AGENCY NAME AND ADDRESS
Environmental Sciences Research Laboratory - RTP, NC
Office of Research and Development
U. S. Environmental Protection Agency
Research Triangle Park. NC 27711
13. TYPE OF REPORT AND PERIOD COVERED
Final
14. SPONSORING AGENCY CODE
EPA/600/09
15. SUPPLEMENTARY NOTES
16 ABSTRACT
In response to Congressional mandates, the U. S. Environmental Protection
Agency will conduct an extensive study of air pollution related problems in the
Texas Gulf Coast Area. As an initial effort, EPA awarded a contract to review the
existing technical information and record the local viewpoint on air pollution
problems in the area, define research needs, and design experimental studies
addressed to these needs. Results are presented in 5 volumes. Volume II describes
and discusses a research plan for health effects studies.
7.
KEY WORDS AND DOCUMENT ANALYSIS
DESCRIPTORS
b.lDENTIFIERS/OPEN ENDED TERMS C. COSATI Field/Group
* Air pollution
* Planning
Texas Gulf Coast
Research
Health
13B
05A
14F
06N
8 DISTRIBUTION STATEMENT
RELEASE TO PUBLIC
19. SECURITY CLASS (ThisReport)
UNCLASSIFIED
21. NO. OF PAGES
61
20. SECURITY CLASS (Thispage)
UNCLASSIFIED
22. PRICE
EPA Form 2220-1 (9-73)
53
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