&EPA
United Slates
Environmental Protection
Agency
Environmental Research
Laboratory
Corvallis OR 97330
EPA 600/5-78 016a
July 1978
Research and Development
Human Health Damages
From Mobile Source
Air Pollution
A Delphi Study
Volume I
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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 en-
vironmental 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 SOCIOECONOMIC ENVIRONMENTAL
STUDIES series This series includes research on environmental management,
economic analysis, ecological impacts, comprehensive planning and fore-
casting, and analysis methodologies. Included are tools for determining varying
impacts of alternative policies; analyses of environmental planning techniques
at the regional, state, and local levels: and approaches to measuring environ-
mental quality perceptions, as well as analysis of ecological and economic im-
pacts of environmental protection measures. Such topics as urban form, industrial
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This document is available to the public through the National Technical Informa-
tion Service, Springfield, Virginia 22161.
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EPA-600/5-78-016a
July 1978
HUMAN HEALTH DAMAGES FROM MOBILE SOURCE AIR POLLUTION:
A DELPHI STUDY - VOLUME I
by
Steve Leung
Eureka Laboratories, Inc.
401 N. 16th Street
Sacramento, California 95814
Elliot Goldstein
University of California
Davis, California 95616
Norman Dal key
University of California
Los Angeles, California 90024
Contract No. 68-01-1889
Project Officer
John Jaksch
Criteria and Assessment Branch
Corvallis Environmental Research Laboratory
Corvallis, Oregon 97330
CORVALLIS ENVIRONMENTAL RESEARCH LABORATORY
OFFICE OF RESEARCH AND DEVELOPMENT
U.S. ENVIRONMENTAL PROTECTION AGENCY
CORVALLIS, OREGON 97330
EPA - RTF LIBRARY
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DISCLAIMER
This report has been reviewed by the Corvallis Environmental Research
Laboratory, U.S. Environmental Protection Agency, and approved for publication,
Approval does not signify that the contents necessarily reflect the views and
policies of the U.S. Environmental Protection Agency and the California Air
Resources Board, nor does mention of trade names or commercial products
constitute endorsement or recommendation for use.
-n -
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FORWORD
Effective regulatory and enforcement actions by the Environmental Protection
Agency would be virtually impossible without sound scientific data on pollu-
tants and their impact on environmental stability and human health. Respon-
sibility for building this data base has been assigned to EPA's Office of
Research and Development and its 15 major field installations, one of which
is the Corvallis Environmental Research Laboratory (CERL).
The primary mission of the Corvallis Laboratory is research on the effects
of environmental pollutants on terrestrial, freshwater, and marine ecosystems;
the behavior, effects and control of pollutants in lake systems; and the de-
velopment of predictive models on the movement of pollutants in the biosphere.
A. F. Bartsch
Director, CERL
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ABSTRACT
During the past year, the California Air Resources Board conducted a survey
of 14 health experts on the human damages from mobile source air pollution.
A variant of the Delphi technique was used in the study to arrive at a consensus
judgment of the experts on the dose-response relationship for photochemical
oxidants, nitrogen dioxide and carbon monoxide. The panel experts were requested
to answer questionnaires to provide dose-response for all three pollutants and
for healthy individuals as well as diseased or sensitive persons. The completed
questionnaires were analyzed and the group consensus were sent to the panel
members. The panel experts were then asked to answer the same questionnaires
again for a second time. The data obtained during the second round represents
the final group consensus.
In the first round survey, there was good agreement among the panel experts
for the health effects of oxidant on all categories of population, while the
data for both carbon monoxide and nitrogen dioxide was much less so. The results
of the second round survey showed improvement in group agreement for all three
pollutants.
This report was submitted by the California Air Resources Board in the fulfill-
ment of Contract No. 68-01-1889 under the sponsorship of the Environmental
Protection Agency. This report covers a period from July 1, 1973 to June 30, 1974
the work was completed as of August 30, 1974.
-TV-
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TABLE OF CONTENTS
Page
Foreword iii
Abstract iv
List of Figures V1'
List of Tables vii
Acknowledgments . xi
1. Executive Summary 1
2. Conclusions 8
3. Recommendations 9
4. Introduction 10
5. Research Methods 11
A. General Description 11
B. Measures of Central Tendency 12
C. Measures of Validity 14
D. Criteria for First Round Result Feedback 17
E. Confidence Limits 19
F. The Questionnaire 20
6. Results 25
7. Discussion 51
A. General Comments 51
B. Dose-Response Model 52
C. Delphi Data vs. Experimental Data 61
References 76
Appendices
A. Questionnaire 84
B. Second Round Survey Dose-Response Curves 131
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FIGURES
Page
Figure 1 Original Distribution 13
Figure 2 Underlying Normal Distribution 14
Figure 3 Change of Group Estimate as a Function of Group Error ... 18
Figure 4 Illustration of Distributions on Range Estimates 19
Figure 5 Comparison of Logit and Probit Density Functions 55
Figure 6 Comparison of Logit and Probit Dose-Response Curves .... 56
Figure,7 Comparison of Logit and Probit -- Least Squares Fit on the
Estimates (X) of Oxidant Dosage Caused Discomfort on
Normal Population 59
Figure 8 Comparison of Logit and Probit -- Least Squares Fit on
the Estimates (X) of Oxidant Dosage Caused Disability
on Normal Population 60
-VI-
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TABLES
Page
Table 1 Final Best Estimates,
Photochemical Oxidant Concentrations (ppm)
Incapacity, Disability and Discomfort in Different
Population Fractions 4
Table 2 Final Best Estimates,
Carbon Monoxide Concentrations (ppm)
Incapacity, Disability and Discomfort in Different
Population Fractions 5
Table 3. Final Best Estimates,
Nitrogen Dioxide Concentrations (ppm)
Incapacity, Disability and Discomfort in Different
Population Fractions 6
Table 4 Population Categories Which May be Affected,
Definition of Conditions for Incapacity, Disability
and Discomfort
Photochemical Oxidant and Nitrogen Dioxide 23
Table 5 Population Categories Which May be Affected,
Definition of Conditions for Incapacity, Disability
and Discomfort
Carbon Monoxide 24
Table 6 Estimates of Effects on 0% of Population by Population
Category,
Photochemical Oxidant Concentrations (ppm),
First Round Survey 27
Table 7 Estimates of Effects on 10% of Population by Population
Category,
Photochemical Oxidant Concentrations (ppm),
First Round Survey 28
Table 8 Estimates of Effects on 50% of Population by Population
Category,
Photochemical Oxidant Concentrations (ppm)
First Round Survey 29
Table 9 Estimates of Effects on 90% of Population by Population
Category,
Photochemical Oxidant Concentrations (ppm),
First Round Survey 30
Table 10 Estimates of Effects on 0% of Population by Population
Category,
Nitrogen Dioxide Concentrations (ppm),
First Round Survey 31
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Page
Table 11 Estimates of Effects on 10% of Population by Population
Category,
Nitrogen Dioxide Concentrations (ppm),
First Round Survey 32
Table 12 Estimates of Effects on 50% of Population by Population
Category,
Nitrogen Dioxide Concentrations (ppm),
First Round Survey 33
Table 13 Estimates of Effects on 90% of Population by Population
Category,
Nitrogen Dioxide Concentrations (ppm),
First Round Survey 34
Table 14 Estimates of Effects on Q% of Population by Population
Category,
Carbon Monoxide Concentrations (ppm),
First Round Survey 35
Table 15 Estimates of Effects on 10% of Population by Population
Category,
Carbon Monoxide Concentrations (ppm),
First Round Survey 36
Table 16 Estimates of Effects on 50% of Population by Population
Category,
Carbon Monoxide Concentrations (ppm),
First Round Survey 37
Table 17 Estimates of Effects on 90% of Population by Population
Category,
Carbon Monoxide Concentrations (ppm),
First Round Survey 38
Table 18 Estimates of Effects on 0% of Population by Population
Category,
Photochemical Oxidant Concentrations (ppm),
Second Round Survey 39
Table 19 Estimates of Effects on 10% of Population by Population
Category,
Photochemical Oxidant Concentrations (ppm),
Second Round Survey 40
Table 20 Estimates of Effects on 50% of Population by Population
Category,
Photochemical Oxidant Concentrations (ppm),
Second Round Survey 41
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Page
Table 21 Estimates of Effects on 90% of Population by Population
Category,
Photochemical Oxidant Concentrations (ppm),
Second Round Survey 42
Table 22 Estimates of Effects on 0% of Population by Population
Category,
Nitrogen Dioxide Concentrations (ppm),
Second Round Survey 43
Table 23 Estimates of Effects on 10% of Population by Population
Category,
Nitrogen Dioxide Concentrations (ppm),
Second Round Survey , 44
Table 24 Estimates of Effects on 50% of Population by Population
Category,
Nitrogen Dioxide Concentrations (ppm),
Second Round Survey 45
Table 25 Estimates of Effects on 90% of Population by Population
Category,
Nitrogen Dioxide Concentrations (ppm),
Second Round Survey 46
Table 26 Estimates of Effects on 0% of Population by Population
Category,
Carbon Monoxide Concentrations (ppm),
Second Round Survey 47
Table 27 Estimates of Effects on 10% of Population by Population
Category,
Carbon Monoxide Concentrations (ppm),
Second Round Survey 48
Table 28 Estimates of Effects on 50% of Population by Population
Category,
Carbon Monoxide Concentrations (ppm),
Second Round Survey 49
Table 29 Estimates of Effects on 90% of Population by Population
Category,
Carbon Monoxide Concentrations (ppm),
Second Round Survey 50
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Table 30 Comparison of Mean for Lower and Upper Limits (Y|_ and Yy)
for 50% Population With the Mean Best Estimates for
10% and 90% Population (XIQ and Xgg, all normalized
to X50) 52
Table 31 Summary of Experimental Data on Oxidant Effects Relevant
to the Delphi Data 62
Table 32 Summary of Experimental Data on Nitrogen Dioxide Effects
Relevant to the Delphi Data 70
Table 33 Summary of Experimental Data on Carbon Monoxide Effects
Relevant to the Delphi Data 73
-x-
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ACKNOWLEDGEMENTS
This study was funded under Contract No. 68-01-1889 from the Environmental
Protection Agency. Assistance in planning program objectives and project
direction was given by Fred Abel, William Watson and John A. Jaksch of the
Environmental Protection Agency's Washington Environmental Research Center,
Resources Analysis Staff.
The Authors are indebted to the staff members of the Air Resources Board.
Appreciation is extended to Robert McMullen and Ben Brewer for their assistance
and advice in statistics, Duane Seibel, John Graham and Susan Poindexter for
their efforts in data processing, Gary Palo and Evan Wong for reviewing the
report and Ruth Sullivan and Betty Verdina for their help in typing. Special
thanks is extended to Laura Storey Dick who has spent many weekends in typing
and editing this final report.
Grateful acknowledgement is made to John R. Kinosian, Chief of the Technical
Services Division, and Albert H. Bockian, Chief of the Research Section for
valuable advice and guidance.
Special thanks is extended to Drs. John R. Goldsmith and T. Timothy Crocker
for their suggestion in setting up the questionnaire and all 14 panel members
for their participation in this study.
This report is dedicated to the memory of Mr. Dale H. Hutchison who, first
conceived of this project, served as Chief of the Air Resources Board's
research program until his death on August 29, 1973. Widely recognized as a
pioneer in the field of air pollution research, his leadership, wisdom and
humor are missed by all.
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SECTION 1
EXECUTIVE SUMMARY
This report discusses the results of a survey among a group of 14 health
experts on the human damages from mobile source air pollution. This survey
includes three major air pollutants, photochemical oxidant, nitrogen dioxide,
and carbon monoxide. The study was supported by the U.S. Environmental
Protection Agency.
The research method used in this study was a variant of the Delphi technique.
This approach uses a panel of experts to arrive at a group consensus on the
dose-response relationship for each of the pollutants. This method improves
the quality of judgments of relatively uncertain issues by experts. The basic
assumption is that the most accurate assessment of a problem where data is
incomplete can be obtained by canvassing a group of experts and accepting the
group consensus.
The Delphi technique involves three steps. Estimates are first obtained
independently from the experts. The panel is then informed of the distribution
of answers on the first round, and is asked to reestimate their answers for
questions with large disagreement. The third step involves the compilation of
the final estimates which include answers of the second round and those in the
first round with good agreement. In this study, these final estimates were
reported in the form of median and interquartile range. Answers from each
round were also reduced and expressed in a S-shaped dose-response curve by
using the logistic distribution model. The accuracy of these group responses
were evaluated by means of the data dispersion and self-confidence ratings.
In arriving at the group estimates, the experts were asked to answer a set of
questionnaires. The questionnaire was designed to allow the experts to
estimate one hour concentrations of oxidant, nitrogen dioxide, or carbon monoxide
which would induce specific functional abnormalities in 14 population categories.
-1-
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These categories are:
Normal
ChiIdren
Old Age
Heart Condition, Mild
Heart Condition, Severe
Hay Fever, Sinusitis
Influenza
Upper Respiratory Infection
Asthma
Acute Viral Bronchitis
Acute Bacterial Pneumonia
Chronic Respiratory Diseases
Mild Chronic Obstructive Lung Disease
Severe Chronic Obstructive Lung Disease
The population varies significantly in their response to a given pollutant
exposure independent of the health status of the group. The questionnaire
considered this variation by querying the concentration at which 90%, 50%,
10%, and 0% of the population would be expected to manifest the stated ab-
normality. In addition to estimating these points, the experts indicated a
range of pollutant concentrations for each dose-response result to allow
limits for each estimate. The experts also estimated the duration in hours
of the abnormalities. Self-ratings were given for each of the answers.
The first round data were analyzed for group agreement with the feed-back
criterion. Those answers with interquartile range greater than one-half of the
median were fed back to the panel members for re-estimation. Using this stringent
criterion, two-thirds of the estimates for oxidant, about 90% of the estimates for
CO, and all of the estimates for NO^ were iterated.
The second criterion used for validity measurment in the study was self-confidence
rating. The rating ranges from 1-10, where 1 meant "the answer is a sheer guess,"
and 10 meant "the panelist knows the answer very well." An average self-rating
-2-
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of 5 or higher was used as the cut-off point for acceptable confidence score.
Based on this self-rating scale, the experts have higher confidence in their
answers for photochemical oxidant and carbon monoxide questionnaires than
those for nitrogen dioxide. The panel members gave an average self-rating
score of 5 or higher in about 50% of their answers for both the photochemical
oxidants and carbon monoxide questionnaires, and only in 25% of their answers
for nitrogen dioxide.
A different criterion was used to evaluate the degree of agreement within the
group on answers in the second round. The estimate is considered to have
good group agreement if its standard deviation is equal to or less than one-
third of the median value. Based on this criterion, good agreement is observed
in 58%, 17% and 8% of answers for the photochemical oxidants, carbon monoxide
and nitrogen dioxide questionnaires, respectively. In comparison with the
first round data, there is a definite improvement in group agreement in the
second round.
The final best estimates of pollutant concentrations causing incapacity,
disability and discomfort for all population categories in different affected
population fractions are summarized in Tables 1-3.
-3-
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TABLE 1: Final Best Estimates, Photochemical Oxidant Concentrations (ppm)
Incapacity, Disability and Discomfort in Different Population Fractions
Population
Category
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory
Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory
Disease
Mild Chronic
Obstructive Disease
Severe Chronic
Obstructive Disease
0%
0.30
0.30
0.32
0.30
0.35
0.27
0.30
0.30
0.30
0.30
0.30
0.35
0.32
0.20
Incapacity
10%
0.77
0.70
0.70
0.60
0.80
0.60
0.62
0.60
0.60
0.75
0.65
0.62
0.80
0.50
50%
1.02
1.00
1.00
0.95
1.00
0.85
0.92
0.80
0.85
0.92
0.82
0.93
1.00
0.75
90%
1.50
1.40
1.40
1.20
1.45
1.00
1.20
1.00
1.20
1.20
1.00
1.45
1.20
1.00
Disabil ity
0%
0.20
0.20
0.20
0.23
0.20
0.20
0.20
0.20
0.20
0.20
0.20
0.20
0.20
0.13
10%
0.41
0.50
0.55
0.52
0.60
0.50
0.50
0.40
0.40
0.50
0.40
0.47
0.50
0.40
50%
0.80
0.70
0.72
0.77
0.80
0.65
0.67
0.60
0.55
0.60
0.60
0.70
0.80
0.55
90%
1.00
1.00
1.00
1.00
1.15
0.80
0.95
0.80
0.80
0.80
0.80
1.05
1.00
0.75
Discomfort
0%
0.10
0.10
0.10
0.15
0.15
0.10
0.10
0.10
0.10
0.10
0.10
0.10
0.10
0.10
10%
0.30
0.30
0.30
0.40
0.40
0.30
0.30
0.30
0.30
0.30
0.30
0.30
0.40
0.20
50%
0.50
0.50
0.50
0.50
0.50
0.40
0.50
0.40
0.40
0.40
0.40
0.50
0.52
0.32
90%
0.80
0.75
0.70
0.75
0.70
0.50
0.70
0.60
0.60
0.55
0.60
0.60
0.60
0.42
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TABLE 2: Final Best Estimates, Carbon Monoxide Concentrations (ppm)
Incapacity, Disability and Discomfort in Different Population Fractions
Population
Category
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory
Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory
Disease
Mild Chronic
Obstructive Disease
Severe Chronic
Obstructive Disease
Incapacity
0%
110.0
100.0
100.0
60.0
77.5
97.5
100.0
100.0
100.0
100.0
97.5
100.0
100.0
92.5
10%
205.0
187.5
180.0
100.0
160.0
170.0
167.5
172.5
162.5
170.0
151.0
150.0
152.5
140.0
50%
262.5
235.0
210.0
180.0
190.0
250.0
225.0
225.0
215.0
200.0
215.0
200.0
205.0
180.0
90%
300.0
300.0
300.0
190.0
215.0
300.0
300.0
300.0
300.0
215.0
300.0
225.0
275.0
205.0
Disability
10%
80.0
60.0
62.5
45.0
50.0
60.0
60.0
60.0
65.0
60.0
60.0
59.0
60.0
60.0
10%
160.0
145.0
240.0
80.0
120.0
130.0
125.0
140.0
120.0
115.0
120.0
110.0
127.5
100.0
50%
182.5
165.0
167.5
122.5
150.0
165.0
170.0
165.0
160.0
150.0
167.5
155.0
155.0
140.0
90%
225.0
200.0
200.0
150.0
170.0
200.0
200.0
197.5
200.0
180.0
200.0
180.0
190.0
170.0
Discomfort
0%
45.0
35.0
32.5
25.0
30.0
40.0
40.0
37.5
40.0
40.0
35.0
39.5
40.0
32.5
10%
100.0
80.0
80.0
55.0
72.5
80.0
80.0
84.0
80.0
77.5
70.0
75.0
65.0
60.0
50%
120.0
105.0
103.5
65.0
110.0
115.0
105.0
110.0
100.0
100.0
105.0
95.0
100.0
90.0
90%
140.0
120.0
130.0
90.0
119.0
135.0
140.0
130.0
131.0
120.0
135.0
125.0
140.0
100.0
I
en
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TABLE 3: Final Best Estimates, Nitrogen Dioxide Concentrations (ppm)
Incapacity, Disability and Discomfort in Different Population Fractions
Population
Category
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory
Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory
Disease
Mild Chronic
Obstructive Disease
Severe Chronic
Obstructive Disease
Incapacity
0%
4.70
4.25
3.85
3.45
3.85
3.50
3.50
4.00
3.75
4.25
3.50
3.75
3.50
3.00
10%
2.50
2.50
2.25
1.90
2.35
2.50
2.25
2.00
2.50
2.10
2.45
2.60
2.35
1.75
50%
8.00
6.50
6.00
6.00
5.50
5.50
4.50
5.00
5.50
5.50
4.50
4.90
4.85
3.60
90%
10.00
8.00
8.00
8.00
8.00
7.00
5.75
6.00
7.00
6.50
6.00
6.00
6.00
4.50
Disability
0%
1.60
1.60
1.50
1.55
1.60
1.70
1.50
1.60
1.50
1.50
1.75
1.75
1.60
1.30
10%
3.75
3.35
3.00
2.90
3.10
3.00
3.00
3.15
3.00
2.75
3.00
3.30
2.90
2.35
50%
4.50
4.25
4.00
4.00
4.15
4.00
3.75
4.00
4.00
4.00
4.00
4.20
3.65
3.05
90%
6.00
5.50
5.00
5.50
6.00
5.50
4.75
5.00
5.00
5.00
5.00
5.00
4.80
3.60
Discomfort
0%
1.00
1.05
1.20
0.75
1.00
1.15
1.00
1.10
1.25
1.00
1.30
1.00
1.00
0.75
10%
2.50
2.20
2.00
2.00
2.00
2.40
2.10
2.45
2.10
1.85
2.10
2.00
1.60
1.50
50%
3.25
3.00
3.00
3.00
3.10
3.50
3.10
3.00
3.15
3.25
3.00
3.20
2.65
2.10
90%
4.90
4.65
4.00
3.50
4.00
4.00
4.00
4.00
4.00
4.00
3.85
3.70
3.55
3.00
CTl
I
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In examining the Delphi data and the available experimental data, it is
observed that these data are comparable to each other. The limited number of
"good agreement" answers in the finalized results, especially in the area
pertaining to the health effects of nitrogen dioxide and carbon monoxide, is
really a reflection of the lack of actual data to form a basis for the
panelists to come to a better group agreement.
Based on the interpretation of data obtained in this study, one may
conclude that Delphi technique is appropriate for formulating group judgments
in the air pollution health effects area. In the absence of experimental
data, use of Delphi techniques to obtain a broad and well-informed opinion
from a group of experts offers an important alternative to air pollution
control agencies for making decisions.
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SECTION 2
CONCLUSIONS
The following conclusions are based on the interpretation of data obtained
in this study.
1. Delphi techniques are appropriate for formulating group judgments in
the air pollution health effects area. In the absence of experimental
data, use of Delphi techniques to obtain a broad and well-informed
opinion from a group of experts offers an important alternative to air
pollution control agencies for making decisions.
2. According to the best estimates of the panel, the oxidant threshold
level in normal individuals for one hour exposure ranges from 0.05 to 0.20
ppm. The threshold concentration is lowered among young and old individuals,
and also those with underlying disease. Those with respiratory and chronic
obstructive diseases are most sensitive to the photochemical oxidants,
and the threshold levels for these population groups range from 0 to 0.20
ppm.
The health effects of nitrogen dioxide on different population groups
follow a similar trend as the oxidant. The threshold level of N02 for
one hour exposure in "normals" ranges 0.50-1.90 ppm. The experts suggest
that individuals with severe heart condition are most sensitive to NOp,
with a threshold concentration range of 0.20-1.45 ppm. Nitrogen dioxide
also has a profound effect on individuals with respiratory and chronic
obstructive diseases. The threshold level for the latter population group
is 0.30-1.65 ppm. Carbon monoxide exerts its effects mainly in impairing
the oxygen carrying capacity of hemoglobin. Individuals with heart conditions
are therefore most susceptible to its effects. The threshold level of CO
for one hour exposure on people with heart condition is 10-50 ppm, while
the threshold level in "normals" is 21-72.5 ppm. Individuals with obstructive
disease are also quite sensitive to the CO effects, with a threshold level
of 17.5-52.5 ppm.
3. Based on the dispersion of data in this study, there is a tremendous lack
of experimental information in the field of air pollution health effects.
This is especially true for nitrogen dioxide and carbon monoxide.
-8-
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SECTION 3
RECOMMENDATIONS
1. A similar study using the Delphi approach, but with separate panels for
each pollutant, should be undertaken. This will help to obtain more
accurate and uniform data.
2. In view of the big gap in the air polltuion health effects knowledge,
governmental and other funding agencies should initiate more intensive
research programs to fill in this gap.
3. If the dose-response estimates contained in the present report are used
in policy deliberations, close attention should be paid to the degree of
group consensus and panelists' confidence in their own answers.
-9-
-------
SECTION 4
INTRODUCTION
In recent years much evidence has accumulated which indicates that ozone,
I C
nitrogen dioxide, and carbon monoxide may be hazardous to health. The
extent of this hazard depends on the toxicity and concentration of the
pollutants, the duration of exposure, and the health status of the individuals
who are exposed. Information for assessing human risk due to air pollution
has been obtained from epidemiological investigations, volunteer studies, and
animal experimentation. Although these studies have yielded valuable data,
the complexity of the problem of air pollution is such that at present the
results do not define dose-response relationships of normal or inordinately
susceptible individuals except for those cases in which the exposures are
above ambient pollutant concentrations. The estimates of the dose-response
relationship in humans must be developed if the public is to be protected
from possible health effects of air pollution.
In May 1973, the California Air Resources Board responded to a request for
proposal by the Environmental Protection Agency entitled "Human Health Damages
from Mobile Source Air Pollution" and submitted a proposal to estimate "rough
order" physical dose-response relationships for mobile source air pollutants.
The purpose of this project is to determine the dose-response relationships
for carbon monoxide, nitrogen dioxide and photochemical oxidants. Such a study
is of importance not only in providing information to protect the public but also
to generate data for estimating the cost benefit of air pollution control-
This proposal was accepted and initiated on July 1, 1973.
A variant of the Delphi techniques was proposed to arrive at a consensus
judgment of a panel of experts on the dose-response relationship for each of
the pollutants. This method improves the quality of judgments of relatively
uncertain issues by experts and allows an improved measure of accuracy and
consistency of judgment. The basic assumption is that the most accurate
assessment of a problem where data is incomplete can be obtained by canvassing
a group of experts and accepting the group consensus.
-10-
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SECTION 5
RESEARCH METHODS
A. GENERAL DESCRIPTION
The Delphi techniques used in this study were generated at the RAND
Corporation to provide a method for the systematic aggregation of expert
judgment. These techniques are most useful where insufficient data
exist to derive meaningful policy. In such cases, these techniques are
used to obtain informed judgmental data in the place of actual experimental
data.
Delphi procedures have been applied to a wide range of studies, including
long-range forecasts of economic and technological developments for
industrial decision-making, estimation of costs for new product develop-
ments, estimation of incidence of various disease states in the total
population, and many others. An assessment of Delphi for this type of
application is found in reference 8.
The basic justification for using the Delphi techniques is the elementary
fact that, given a distribution of estimates from a panel of experts, the
error of the mean of those estimates will be less than, or at worst, equal
to the average error of the individual estimates. Depending on the shape
of the distribution, other measures of central tendency such as the median
g
or geometric mean may be more appropriate than the mean.
The Delphi technique involves three features: (1) Anonymity -- estimates
are elicited independently from each of the panelists; (2) Iteration and
controlled feedback -- for questions with large disagreement on the first
round, the panel is informed of the distribution of answers on the first
round and asked to reestimate their answers; and, (3) Statistical group
response -- rather than asking the group to arrive at a single "concensus,"
the distribution of estimates on the final round is reported in the form of
the median and the interquartile range. This group response assures that
all panelists' judgments are included in the final estimate, and furnishes
a measure of the degree of agreement.
-11-
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A group of 14 physicians and scientists were employed as the expert panel
members for this study. These panel members were queried and their
anonymously submitted answers together with a self-confidence rating of
from 1-10 for each answer were collated, analyzed and returned for a
second iteration. This "feedback" is used by the experts to reestimate answers to
the original questions. Answers from each round were reduced and expressed
in a S-shaped dose-response curve by using the logistic distribution
model. The accuracy of these group responses were evaluated by means of
the data dispersion and self-confidence ratings.
The fourteen panel members are listed below:
Oscar Balchum, M.D.
T. Timothy Crocker, M.D.
Carroll Cross, M.D.
Richard Ehrlich, M.D.
Gustav Freeman, M.D.
Elliot Goldstein, M.D.
Jack Hackney, M.D.
Steve Horvath, Ph.D.
Paul Hoeprich, M.D.
Glen Lillington, M.D.
Homer Peabody, Jr., M.D.
Stanley Rokaw, M.D.
Carl Shy, M.D.
MEASURES OF CENTRAL TENDENCY
In a Delphi exercise, each panelist independently estimates some quantity
of interest -- in the present case the dose required to produce a given
type of impairment in a given percentage of a specified population. The
data are analogous to independent measures of a quantity by a fallible
instrument, e.g., the set of numbers that would be obtained by repeated
measurements of the length of a table with a yardstick. In the theory of
errors applied to such a case, it is assumed that the variant readings
result from random errors which are distributed normally with zero mean.
Thus the mean of the measurements is the best estimate of the actual
length of the table.
When the distribution of responses is highly skewed, as in the present
study, the mean is usually not the most appropriate measure of central
tendency. The data from the present study are in accord with a large
-12-
-------
number of experimental studies in which the distributions tend to be log-
normal. For a theoretical log-normal process, the population is dis-
tributed normally on the logarithm of the independent variable. Let u
and a be the mean and standard deviation of the underlying normal
distribution on the logarithm. For a distribution with u = 0 and a = 1,
the mean of the original distribution is 1.65 times the median. In the
present study, about 90% of the distributions have means greater than
the median, with factors ranging from 1 to about 3. The hypothesis that
the data will fit the model of log-normality appears plausible.
The mean(u)of the underlying normal distribution is the logarithm of the
geometric mean (GM) of the original distribution. For this reason, the
geometric mean is generally taken to be the more appropriate measure of
central tendency for a log-normal distribution. Put another way, if the
theory of errors is applied to the underlying (symmetrical) distribution
on the logarithm of the quantity being measured, the best estimate is the
mean of that distribution. The mean of the underlying distribution corres-
ponds to the geometric mean of the original distribution. The relationship
between the two distributions (for the case u - 0, o = 1) is illustrated
by Figures 1 and 2.
z
o
o.
U)
UJ
cc.
GEOMETRIC MEAN
.5 1.0 1.5 2.0
CONCENTRATION
FIGURE I ORIGINAL DISTRIBUTION
2.5
3.0
-13-
-------
-2-1 01 2
LOG CONCENTRATION
FIGURE 2 UNDERLYING NORMAL DISTRIBUTION
With an exact log-normal distribution, the geometric mean is identical with
the median. For applied exercises where the distributions tend to be
ragged, the median has the additional advantage that it is less influenced
by extreme outlying estimates. In experimental studies, the median has
been more accurate than the mean and slightly more accurate than the
aeometric mean (Unpublished data available on request from N. Dalkey)
Therefore, the median is used as the measure of central tendency or "best
estimate." Since the median is an order statistic, an appropriate measure
of dispersion is the interquartile range, i.e., the range around the median
that contains 50% of the responses. This is the measure of dispersion that
has been used in most applied Delphi studies. Experimental studies have
not identified any specific advantages of this statistic (over other forms
12
of feedback, for example).
C. MEASURES OF VALIDITY
Two indices for analysis of validity are used in this study. They are the
second round dispersion of the estimates, and self-rating on the part of the
-14-
-------
panelists. It might be expected a priori that some relationship exists
between the dispersion and accuracy. If the Delphi procedure were a
sampling process -- i.e., if each estimate were a random sample out of
some distribution of estimates, with the true response at the geometric
mean of that distribution -- then the error of the observed geometric
mean would simply be the sampling error. The sampling error is related
to the standard deviation a of the distribution from which the sample
is drawn by the relationship.
S.E. « o/fi
where n is the number of estimates in the sample. Thus, the greater
a the greater the expected error for a given sample size.
However, the process of estimation in a group is not a random sampling
out of an unbiased distribution (geometric mean = true answer). In
experimental studies with student subjects and general information
questions, the error is about three times the sampling error estimated
from the standard deviation in Figure 6 of reference 9. In their study
using short-range predictions as subject matter, Dal key and Brown found
that the correlation between error and standard deviation was about .67;
however, there is no way to guarantee that the numerical relationship
between error and standard deviation found in that study generalizes to
the present study. The fact that the relationship between error and
standard deviation is substantially the same for short-range predictions
and general information questions, as observed by Dal key and Brown, is
some ground for expecting the generalization to hold.
The experiments indicate that the bias increases on the second round.
The amount of convergence, as indicated by the reduction in standard
deviation, between round one and round two is greater than the decrease
in error. Numerically, a least squares approximation gives Log Error = .60
for round one, and Log Error = 1.2a for round 2. Thus a criterion for
"good" estimates based on the second round distribution must be more
stringent than a criterion based on the first round distribution.
-15-
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One convenient reference point for applying dispersion as a criterion of
validity is afforded by the notion of sufficient agreement discussed in the
next section on result feedback. That notion suggests a cut point at an
initial log error of about .3. Using the relationship Log E = 1.2o, and
rescaling to the original distribution, a criterion of s - 1/3 Md is
arrived at where S is the observed standard deviation, and Md denotes the
median. If the analogy with the short-range prediction data holds, the
expected error for estimates fulfilling this criterion would be less than
33% of the median.
The other internal criterion of validity, namely the self-rating, is
obtained by asking each panelist to rate each of his estimates on a scale
of 1-10, where 1 means "my answer is a sheer guess" and 10 means "I know
the answer very well." In previous experiments, correlations between
individual self-ratings and individual accuracy is not very high, ranging
around .25. However, the correlation between the average self-rating and
the error of the median was -.62 for the short-range prediction study.
The best criterion of validity for the group estimates obtained in this
study is experimental verification. Thus, the finalized data of this
study are subjected to both statistical scrutiny and verification with
available experimental data.
* The cut point of 5 for the group self-ratings was based on taking the
mid-point of the range.
-16-
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D- CRITERIA FOR FIRST ROUND RESULT FEEDBACK
The basic reason for the iteration step is the expectation that the error
of the median will decrease as a result of reestimation. Experimental
8911
studies ' ' have shown that for a majority of the cases, accuracy did
increase between round one and round two. Figure 3 shows the results of
several of these studies concerning the relationship between round one
error, and the change in error between round one and round two. In these
experiments, two rounds of estimates were obtained, the second with
feedback of the medians and quartiles of the first round answers. The
abscissa in Figure 4 is the error of the median for the first round
answers. The ordinate is the change in error between first and second
rounds. Error is defined here as:
F In Md
E = In y—
Md is the median answer and T the true answer. The vertical bars indicate
that the absolute value of the logarithm is taken. Note that E = 0, if
Md = T. A positive value for the change (E of round 1 minus E of round 2)
indicates the median is more accurate on round 2. As the figure shows,
if the initial error is .3 or less, i.e., In f— £.3, indicating
|U| I I
.75 = T- £ 1.35, the effect of iteration is to increase the error on the
average. Thus, for questions where the initial error is expected to be
small, reestimation is likely to be counterproductive. Since the initial
error cannot be measured in practice, the first round standard deviation is
the next best indicator. Using the relationship Log E = .6 (for the first
round), Log E <_ .3 corresponds to S <_ .6 Md where S is the observed standard
deviation. This reference point has been used as a definition of "sufficient
agreement" in several previous Delphi studies, where sufficient agreement is
taken to mean that it is inappropriate to have the group reestimate.
For the present study, the decision was made to impose a more stringent
criterion, primarily on the grounds that the degradation on iteration for
modest initial error is small, and some large errors might be greatly reduced.
The criterion selected was to feedback the first round results for those
with interquartile range greater than one-half of the median.
-17-
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CHANGE OF GROUP ESTIMATE AS A FUNCTION OF GROUP ERROR
CO
LU
O
O
O.
ID
O
DC
CD
O
2
-------
E. CONFIDENCE LIMITS
In addition to estimating the one hour exposure at which a given percentage
of a given population would experience a given impairment, the panelists
were asked to estimate the range within which this estimate might fall.
Specifically, they were asked to estimate an upper limit Y|_ defined as
the dosage at which the panelist felt there was no more than a 5% chance
that the dosage would exceed his estimate and a corresponding lower limit Yy.
The medians of the Y|_'s and the YU'S thus represent the group estimates of
the confidence range. Although the quartiles for these limits were computed,
they were not fed back to prevent overloading the panelists with nine
numbers for each dosage estimate. The medians of the best estimate X and
its upper and lower quartiles were fed back.
It is emphasized that the distribution of responses and the estimated range
should not be confused. Figure 4 schematically shows the relationships
involved. The curves in Figure 4 illustrate the distributions of responses
for Yj_, X and YU, for a given pollutant, a given population type, a given
level of impairment and a given percentage of population. For external
validity tests -- e.g., comparison of the panel estimates with experimental
data, the relevant estimates are the medians of YL, X, and Yy. Thus, if
the experimental data falls well within the estimated range, this is a
positive outcome for the study. If the experimental data falls outside
the estimated range, this is a negative outcome. Inspection of the data
indicate that there is a fairly close relationship between the inter-
quartile ranges on X and the estimated range, with the latter somewhat
wider than the former for oxidant and N02- For CO, Y|_ is generally lower
than 0,25 for X, but YU is generally lower than Qy5 for X.
CO
a: =
LU O
m °-
CO
DISTRIBUTION
OF YL
DISTRIBUTION
OF X
DISTRIBUTION
OF
MEDIANS
•-- QUARTILES
CONCENTRATION
ILLUSTRATION OF DISTRIBUTIONS ON RANGE ESTIMATES
FIGURE -4-
-19-
-------
F. THE QUESTIONNAIRE
The questionnaire was designed to allow a group of experts to estimate
one hour concentrations of oxidant, nitrogen dioxide, or carbon monoxide
which would induce specific functional abnormalities in population
categories of healthy individuals and of ones with underlying disease
states. Because children, adults, and the old age may differ in their
response to air pollutant exposures, the questionnaire querried the
effect of air pollution in normal members of each age group.
The underlying illnesses selected for evaluation were ones that might
be expected to enhance sensitivity to specific air pollutants. Since
oxidant air contaminants (ozone and nitrogen dioxide) primarily impair
2-3
respiratory function, the experts were asked to estimate the dose-
response relationships for population categories of individuals with
asthma, hay fever-sinusitis, influenza, acute viral bronchitis, upper
respiratory infection, acute bacterial pneumonia, mild chronic
obstructive lung disease, severe chronic obstructive lung disease, and
chronic respiratory disease of a noninfectious nature such as pneumo-
coniosis or sarcoidosis. The experts v/ere also asked to estimate
the effect of oxidant and nitrogen dioxide for patients with mild or
severe heart conditions. These categories were included because the
intimate relationship of respiratory to cardiac function suggests that
injury to the former system might reflect itself in an indirect fashion
by decreasing cardiac function.
The deleterious effects of carbon monoxide are due to the formation of
carboxyhemoglobin with a resultant decrease in the oxygen carrying
capacity of the blood. Patients with underlying cardiac disease comprised
the principle population groups of interest as patients with these conditions
may be unusually sensitive to diminshed oxygenation. Estimates of carbon
monoxide toxicity were obtained for the aforementioned respiratory diseases
to determine if in the opinion of the experts these conditions also might
increase sensitivity to carbon monoxide.
-20-
-------
Abnormalities incurred by exposure to each air pollutant were specified
for each population category. In many instances, clinical studies had
shown that exposure to air pollutants might induce or enhance the presence
of the abnormality. With some abnormalities, such as the occurrence of
nasal or sinus drainage in hay fever or sinusitis, this relationship is not
known and therefore it is conceivable that this untoward effect might not
result from pollutant exposure. Dose-response relationships In circum-
stances such as this must be considered problematical, until experimental
data become available.
The abnormalities were arbitrarily divided into categories (discomfort,
disability, and incapacity) in accordance with the probable severity of
the abnormalities for the majority of patients in each population category.
It must be emphasized that these divisions are inexact and that it is likely
that abnormalities such as dyspnea or headache may be discomforting for
some individuals and disabling for others. The virtue of the scale is
that it allows assessments of dose-response which correlate with clinical
parameters of increasing importance. As an example, for the population
category Acute Bacterial Pneumonia, cough was considered discomfort, a
minimal effect, dyspnea was considered disability, a more serious conse-
quence, and acute respiratory failure was considered incapacity, a much more
severe medical disturbance.
Since the biologic effect of a pollutant varies with the duration of exposure
at a fixed concentration, a fixed time period of one hour was chosen in order
to minimize this factor and to allow comparison of individual pollutant
effects. Longer exposure periods might have been chosen, but these would
have increased the difficulty in estimating the dose-response relationship
without improving the precision of the estimate.
The population varies significantly in their response to a given pollutant
exposure independent of the health status of the group. " The questionnaire
considered this intrinsic variation by querying the concentration at which
90%, 50%, 10%, and 0% of the population would be expected to manifest the
stated abnormality. In addition to estimating these points, the experts
indicated a range of pollutant concentrations for each dose-response result
-21-
-------
to allow limits to be calculated for each estimate. The expert also
estimated the duration in hours of the abnormalities. Self-ratings were
given for each set of three answers -- the range Y[_, Yy, and the best
estimate X.
A complete set of the questionnaire for the study is included in Appendix A,
pages 85-131. Definition of each population group, the normal individual
as well as those with underlying disease, and examples of symptoms expected
under each category of abnormalities (discomfort, disability, and incapacity)
are presented in details in the questionnaire of Appendix A and summarized
in Tables 4-5.
-22-
-------
TABLE 4: Population Categories Which May be Affected,
Definition of Conditions for Incapacity, Disability and Discomfort
Photochemical Oxidant and Nitrogen Dioxide
Population
Category
Normal
Children*
Old Age*
Heart Condition,
Mild*
Heart Condition,
Severe*
Hay Fever,
Sinusitis
Influenza
Upper Respi-
ratory
Infection
Asthma
Acute Viral
Bronchitis
Acute Bacterial
Pneumonia
Chronic Respi-
ratory
Diseases*
Mild Chronic
Obstructive
Lung
Disease*
Severe Chronic
Obstructive
Lung Disease*
Definition of Conditions
Incapacity
May precipitate respi-
ratory and cardiac
problems, broncho-
pneumonia
n
Acute respiratory
failure
Pulmonary edema
Angina or myocardial
infarction
Nasal or sinus
drainage and
headache
Superimposed bac-
terial pneumonia
Superimposed bac-
terial infection
Status asthmaticus
Acute respiratory
fai lure
"
3neumonia
Broncho -pneumonia ,
cor pulmonale
M
Disabil ity
Headache
n
Bronchitis
Congestive heart
failure
Pulmonary edema
Nasal or sinus
drainage
Dyspnea
Dyspnea, or need
medication and
rest
Asthmatic attack
Onset or worsening
of dyspnea
n
Respiratory
infection
Exacerbation of
bronchitis, fever
and increased sputum
production and chest
pain
ii
Discomfort
Eye irritation;
non-productive
coughing, chest
tightness
Ii
Dyspnea
II
Worsening congestive
heart failure
Nasal or sinus
discomfort
Increased cough
and pleuritic pain
Worsening symptoms
Dyspnea
Worsening of cough
ti
Dyspnea
II
II
* Please refer to
Appendix A for further explanation.
-23-
-------
TABLE 5: Population Categories Which May be Affected,
Definition of Conditions for Incapacity, Disability and Discomfort
Carbon Monoxide
Population
Category
Normal
Children*
Old Age*
Hay Fever,
Sinusitis
Upper Respiratory
Infection
Asthma
Heart Condition,
Mild*
Heart Condition,
Severe*
Influenza
Acute Viral
Bronchitis
Acute Bacterial
Pneumonia
Chronic Respiratory
Diseases*
Severe Chronic
Obstructive Pul-
monary Disease*
Mild Chronic
Obstructive Pul-
monary Disease*
Definition of Conditions
Incapacity
Coma or convulsions
it
M
II
II
Asthmatic attack,
coma, convulsion
Angina pectoris,
arrythmia, coma or
convulsions
II
Respiratory failure,
coma, convulsions
ii
ti
M
n
it
Disability
Throbbing headache,
confusion, irrita-
bility, dizziness
M
n
n
n
n
Throbbing headache,
confusion, irrita-
bility, dizziness,
and increases in
dyspnea
11
11
11
M
11
M
Throbbing headache,
confusion, irrita-
bility, dizziness
Discomfort
Mild headache,
errors in
cognitive function
ii
ii
n
n
ii
n
n
n
11
M
n
n
M
* Please refer to Appendix A for further explanation.
-24-
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SECTION 6
RESULTS
Basing on the raw data obtained from the second round survey, median estimates,
first and third quartiles, mean and standard deviations for each polulation
fraction were computed. Using the median estimates to fit into the logistic
distribution model (See pages 51-60), dose-response curves for each abnormality
affecting different fraction of various population categories by each pollutant
were plotted. These dose-response curves for the second round are presented in
Appendix B. The raw data and dose-response curves for the first round and raw
data for the second round are not included in this report. Limited copies of
these data are available from the principal investigator upon request.
A summary showing the first round results on the median estimates for discomfort,
disability and incapacity affecting different fraction of various population
categories by each pollutant is given in Tables 6-17. These tables also include
the time duration of each abnormality caused by the pollutant exposure, and the
panelists' self-confidence ratings.
The first round data were analyzed for group agreement with the feedback criterion
outlined in page 17. Those answers with interquartile range greater than one-half
of the median were fed back to the panel members for reestimation. Using the
feedback criterion, good group agreement was observed in 38% of the answers for
the photochemical oxidant questionnaire, 10% for carbon monoxide, and 1% for
nitrogen dioxide. On this stringent criterion, two-thirds of the estimates for
oxidant, about 90% of the estimates for CO, and all of the estimates for N0~ were
iterated. Estimates with good agreement and not iterated in the second round were
identified with asterisk (*) in. Tables 6-17.
The other criterion for validity measurement used in the study was self-confidence
rating. Each panelist was asked to rate each of his estimates on a scale of 1-10,
where 1 meant "the answer is a sheer guess," and 10 meant "the panelist knows the
answer very well." An average self-rating of 5 or higher was used as the cut-
off point for acceptable confidence score. Based on this self-rating system,
panel members put higher confidence in their answers for photochemical oxidant
-25-
-------
and carbon monoxide questionnaires than those for nitrogen dioxide. In about
50% of their answers for both the photochemical oxidants and carbon monoxide
questionnaires, the panel members gave an average self-rating score of 5 or
higher, while they showed the same degree of confidence in about 25% of their
answers for nitrogen dioxide.
The second round results were summarized in Tables 18-29. These tables include
all new estimates from the panelists as well as those first round data with good
group agreement and not required reiteration. This data represents the improved
and finalized data for the study.
A different criterion was used to evaluate the degree of agreement within the
group on answers in the second round. The estimate is considered to have good
group agreement if its standard deviation is equal to or less than one-third of
the median value. Based on this criterion, good agreement is observed in 58%,
17% and 8% of answers for the photochemical oxidants, carbon monoxide and
nitrogen dioxide questionnaires, respectively. Comparing to the first round
data, there is a definite improvement in group agreement in the second round.
It must be noted, however, a different criterion for assessing group agreement
was used in the first round survey.
-26-
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TABLE 6: Estimates of Effects on 0% of Population by Population Category,
Photochemical Oxidant Concentrations (ppm),
First Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
0.22
0.20
0.20
0.20
0.20
0.13
0.13
0.13
0.10
0.15
0.15
0.20
0.20
0.10
X
0.35
0.30
0.32
0.30*
0.35*
0.27
0.30
0.30
0.30
0.30
0.30
0.30*
0.32
0.20
Yu
0.50
0.45
0.42
0.40
0.50
0.40
0.45
0.50
0.50
L0.50
0.42
0.55
0.47
0.35
T
R
6.0
4.0
4.0
4.0
4.0
4.0
5.0
5.0
3.0
4.5
5.0
4.5
4.0
4.5
DISABILITY
Yl
0.10
0.10
0.10
0.10
0.10
0.10
0.10
0.10
0.08
0.10
0.10
0.10
0.08
0.05
X
0.20
0.20
0.20*
0.27
0.23*
0.20
0.20*
0.20*
0.20
0.20
0.20
0.20*
0.20
0.15*
Yu
0.40
0.40
0.30
0.40
0.35
0.35
0.35
0.30
0.35
0.40
0.35
0.40
0.35
0.23
T
R
5.5
4.0
4.5
4.0
4.0
4.0
4.5
5.0
3.5
4.0
5.5
4.5
5.0
5.0
DISCOMFORT
Yl
0.03
0.00
0.00
0.03
0.03
0.00
0.00
0.00
0.00
0.00
0.05
0.00
0.00
0.00
X
0.10
0.10
0.10
0.10
0.10
0.10
0.10*
0.10*
0.10*
0.10*
0.10
0.10*
0.10
0.10*
Yu
0.20
0.20
0.20
0.20
0.20
0.20
0.20
0.20
0.20
0.20
0.20
0.20
0.23
0.20
T
R
6.0
5.5
5.0
4.5
5.0
5.0
5.0
5.0
4.5
4.5
5.0
5.0
5.5
5.0
Yl = Lower Limit Estimate (ppm)
X = Best Estimate (ppm)
Yu = Upper Limit Estimate (ppm)
T = Time Duration of the Effects (hour)
R = Self-Ratings of Panel Member
* = Value with Good Group Agreement (Interquartile Ranges h of Median)
-------
TABLE 7: Estimates of Effects on 10% of Population by Population Category,
Photochemical Oxidant Concentrations (ppm),
First Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
0.55
0.55
0.42
0.40
0.47
0.40
0.40
0.40
0.40
0.42
0.40
0.40
0.40
0.30
X
0.75*
0.75"
0.67
0.60*
0.80
0.60
0.60
0.65
0.60*
0.75*
0.60
0.60
0.80
0.50
Yu
1.10
1.00
0.93
0.80
1.05
0.95
0.90
0.80
0.95
1.00
1.00
1.05
1.05
0.70
T
19
24
24
24
24
14
24
18
24
24
24
24
24
24
R
6.0
4.0 _j
4.0
4.0
4.0
4.5
5.0
5.0
3.5
3.5
4.5
4.0
4.0
5.0
DISABILITY
Yl
0.40
0.35
0.30
0.40
0.35
0.30
0.30
0.23
0.27
0.30
0.30
0.35
0.25
0.15
X
0.50*
0.50*
0.42
0.55
0.60
0.50
0.45
0.40
0.40*
0.45
0.40*
0.50
0.45
0.40
Yu
0.80
0.80
0.70
0.80
0.90
0.70
0.75
0.60
0.65
0.70
0.70
0.80
0.80
0.55
T
7
7
12
18
12
11
11
9
12
12
9
24
24
24
R
6.0
4.5
4.0
4.0
4.0
5.0
5.0
5.0
4.0
4.5
5.5
4.0
5.0
5.5
DISCOMFORT
Yl
0.14
0.20
0.20
0.20
0.20
0.15
0.15
0.10
0.10
0.10
0.15
0.20
0.10
0.10
X
0.30
0.35
0.30*
0.40
0.40*
0.30
0.35*
0.30
0.30
0.30
0.35*
0.30
0.30
0.25
Yu
0.50
0.50
0.50
0.55
0.50
0.43
0.50
0.50
0.50
0.45
0.50
0.45
0.50
0.45
T
4
3
6
24
6
7
9
6
10
11
6
8
9
7
R
6.0
5.5
5.0
4.5
4.5
5.0
5.0
5.0
3.5
4.5
5.0
5.0
5.0
5.0
00
Yl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects
Self-Ratings of Panel Member
Value with Good Group Agreement
(hour)
(Interquartile Ranges % of Median)
-------
TABLE 8: Estimates of Effects on 50% of Population by Population Category,
Photochemical Oxidant Concentrations (ppm),
First Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
0.75
0.75
0.80
0.65
0.75
0.55
0.70
0.60
0.60
0.65
0.60
0.80
0.75
0.50
X
1.10*
0.95
1.00*
0.95
1.00
0.80
0.90
0.90
0.85*
0.92"
0.85
1.05
1.10
0.65
Yu
1.40
1.30
1.30
1.35
1.50
1.10
1.15
1.20
1.20
1.30
1.10
1.40
1.50
0.80
T
13
24
24
24
24
12
24
18
24
24
24
24
24
24
R
5.5
4.0
4.0
4.5
4.0
5.0
5.0
5.0
5.0
4.5
5.0
5.0
4.0
5.0
DISABILITY
Yl
0.50
0.50
0.47
0.50
0.45
0.45
0.45
0.45
0.40
0.35
0.40
0.45
0.50
0.35
X
0.80
0.70*
0.75*
0.75
0.75
0.70
0.65
0.70
0.60*
0.60
0.60
0.70*
0.80
0.55
Yu
1.15
1.15
1.00
1.05
1.15
0.95
0.85
0.95
0.80
0.85
0.75
1.00
1.20
0.75
T
7
7
12
18
14
11
11
9
12
12
9
24
24
24
R
5.5
4.5
4.0
4.0
4.0
4.5
5.0
5.0
4.5
4.0
5.0
4.0
5.0
5.0
DISCOMFORT
Yl
0.35
0.35
0.30
0.35
0.35
0.25
0.30
0.30
0.20
0.25
0.25
0.30
0.30
0.20
X
0.60*
0.60*
0.50
0.50
0.50*
0.40
0.50
0.45
0.40
0.45
0.40
0.50*
0.50
0.40
Yu
0.80
0.75
0.65
0.70
0.65
0.65
0.70
0.65
0.75
0.70
0.70
0.60
0.75
0.55
T
4
4
6
24
6
7
9
6
10
11
6
8
10
10
R
6.0
4.0
4.5
4.5
4.5
5.0
5.0
5.0
5.0
4.0
5.0
5.0
5.0
5.0
Yl = Lower Limit Estimate (ppm)
X = Best Estimate (ppm)
Yu = Upper Limit Estimate (ppm)
T = Time Duration of the Effects (hour)
R = Self-Ratings of Panel Member
* = Value with Good Group Agreement (Interquartile Ranged H of Median)
-------
TABLE 9: Estimates of Effects on 90% of Population by Population Category,
Photochemical Oxidant Concentrations (ppm),
First Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
1.15
1.10
1.00
1.00
1.00
0.75
0.80
0.80
0.95
0.90
0.80
1.00
1.00
0.60
X
1.50*
1.40"
1.40*
1.20
1.45*
1.00
1.20
1.10
1.25
1.20*
1.00*
1.45*
1.35
l.OQ
Yu
1.80
1.60
1.65
1.85
2.00
1.30
1.45
1.50
1.75
1.65
1.40
1.80
1.85
1.35
T
20
24
24
24
24
12
24
18
24
24
36
24
24
24
R
4.0
3.5
5.0
4.5
4.0
4.5
5.0
5.0
5.0
5.0
5.0
5.0
4.5
5.5
DISABILITY
Yl
0.80
0.70
0.70
0.80
0.75
0.55
0.80
0.70
0.55
0.50
0.60
0.75
0.60
0.45
X
1.00*
1.00*
1.00*
1.00*
1.15*
0.80
0.95
0.95
0.80*
0.80*
0.80
1.05
0.95*
0.60
Yu
1.40
1.20
1.40
1.40
1.65
1.10
1.10
1.20
1.05
1.05
1.00
1.40
1.35
0.80
T
7
7
12
18
24
11
9
9
12
12
9
24
24
24
R
4.5
4.0
5.0
3.5
4.0
4.5
5.0
6.0
4.5
4.5
5.5
5.0
5.0
6.0
DISCOMFORT
Yl
0.45
0.55
0.40
0.50
0.45
0.30
0.50
0.32
0,30
0.30
0.40
0.40
0.40
0.25
X
0.80*
0.75*
0.70*
0.75*
0.70*
0.55
0.70
0.55
0.60*
0.55*
0.60
0.60*
0.60*
0.45
Yu
1.00
1.00
0.95
1.00
0.90
0.75
0.95
0.85
0.85
0.85
0.80
0.85
0.95
0.65
T
4
4
6
24
6
8
9
6
10
11
6
9
10
10
R
6.0
4.5
5.0
4.0
4.5
5.5
5.0
5.5
5.0
4.5
5.0
5.0
5.0
5.5
I
GJ
o
Yl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects (hour)
Self-Ratings of Panel Member
Value with Good Group Agreement (Interquartile Ranges ^ of Median)
-------
TABLE 10: Estimates of Effects on 0% of Population by Population Category,
Nitrogen Dioxide Concentrations (ppm),
First Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
1.35
1.00
1.00
1.00
1.00
1.75
0.90
1.20
0.901
1.00
1.50
0.65
1.00
0.55
X
2.25
2.00
2.25
1.75
2.00
2.50
2.00
2.10
2.00
2.00
2.35
2.25
2.15
1.50
Yu
3.00
3.00
3.00
2.75
3.25
3.25
3.00
3.50
3.35
2.90
3.25
3.10
3.50
2.55
T
R
6.0
4.5
4.0
4.0
5.0
3.5
3.2
3.0
3.0
3.0
3.5
4.0
3.5
3.0
DISABILITY
Yl
1.00
0.75
0.50
0.50
0.50
0.85
0.50
0.45
0.45
0.45
0.75
0.50
0.50
0.45
X
1.85
1.25
1.25
1.10
1.15
1.65
1.10
1.30
1.10
1.00
1.40
1.25
1.65
1.00
Yu
2.50
2.00
2.75
2.10
2.50
2.50
2.50
2.65
2.10
2.00
2.65
2.50
2.90
2.05
i
R
5.0
3.5
4.0
4.0
5.0
4.5
3.5
3.5
3.5
4.5
4.5
3.5
3.5
3.5
DISCOMFORT
Yl
0.20
0.20
0.20
0.15
0.20
0.25
0.20
0.20
0.40
0.35
0.20
0.20
0.25
0.15
X
0.80
0.50
0.55
0.80
0.75
1.00
1.00
0.75
1.00
1.00
1.00
0.75
1.00
0.55
Yu
1.75
1.50
1.50
1.25
1.65
1.75
2.00
1.75
1.80
1.55
2.00
1.75
1.90
1.50
I
R
5.5
4.5
5.0
4.0
5.0
5.0
4.5
4.0
4.0
4.0
4.5
4.5
4.5
3.5
I
CO
Yl = Lower Limit Estimate (ppm)
X = Best Estimate (ppm)
Yu = Upper Limit Estimate (ppm)
T = Time Duration of the Effects (hour)
R = Self -Ratings of Pane1, Member
* = Value with Good Group Agreement (Interquartile Ranged
of Median)
-------
TABLE 11: Estimates of Effects on 10% of Population by Population Category,
Nitrogen Dioxide Concentrations (ppm),
First Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
2.45
2.10
2.10
2.00
2.00
3.00
2.50
2.30
2.55
1.80
2.30
2.35
2.05
1.80
X
4.00
3.80
4.00
3.75
3.85
4.25
3.25
4.00
3.75
2.85
3.75
3.65
4. 00-*
3.50
Yu
5.55
4.90
5.50
5.00
5.10
5.25
4.50
5.00
4.55
4.75
5.00
4.95
5.25
4,75
T
12
12
24
24
24
12
24
24
24
24
24
24
24
24
R
5.5
5.0
4.5
3.5
5.0
3.0
4.5
4.0
4.0
4.5
3.5
4.0
4.0
4.0
DISABILITY
Yl
1.80
1.15
1.00
1.50
1.75
2.00
1.45
1.50
1.30
1,45
1.65
1.40
1.50
1.40
X
3.00
2.50
3.00
2.70
3.00
3,00
2.65
3.00
2.25
2.05
2.75
2.50
2.85
2.40
Yu
4.50
3.75
4.55
4.15
4.25
4.35
4.00
4.40
3.80
3.00
4.20
4.00
4.60
4.00
T
6
6
18
24
24
8
12
11
12
12
12
24
21
21
R
4.5
3.0
4.5
3.5
5.0
3.0
3.0
3.5
4.5
^4.5
3.0
4.0
4.0
4.0
DISCOMFORT
Yl
1.00
0.75
0.50
0.85
0.50
1.00
1.00
1.00
0,90
1.00
1.00
1.00
1.00
1.00
X
2.00
1.75
1.75
2.00
1.75
2.50
2.20
2.00
1.80
1.70
2.25
2.00
2.00
1.60
Yu
3.00
3.00
3.00
3.25
3.25
3.75
3.25
3.00
3.10
2.90
3.75
3.00
3.25
2.80
T
5
4
7
12
7
6
6
5
10
10
7
8
6
10
R
6.0
5.0
5.0
4.0
5.0
3.5
5.0
3.5
4.0
3.5
3.5
4,0
4.0
4.0
CO
PO
I
rl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects
Self-Ratings of Panel Member
Value with Good Group Agreement
(hour)
(Interquartile Ranges h of Median)
-------
TABLE 12: Estimates of Effects on 50% of Population by Population Category,
Nitrogen Dioxide Concentrations (ppm),
First Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
3.90
2.80
3.75
3.30
3.00
2.80
3.55
3.50
3.50
3.50
3.55
3.15
3.30
3.00
A
5.75
5.00
5.00
5.00
4.65
4.75
4.75
5.00
4.75
4.35
4.75
4.40
5.00
4.50
Yu
8.00
6.15
7.10
5.90
6.30
6.30
5.50
7.70
5.75
5.25
5.95
5.75
6.20
5.75
1
12
12
24
24
24
12
24
24
24
24
24
24
24
24
R
5.5
5.0
4.5
3.5
5.0
3.0
4.5
3.5
4.0
4.0
3.5
4.0
4.0
4.0
DISABILITY
Yi
3.30
2.20
2.00
2.45
2.00
2.75
2.00
2.20
1.75
1.50
2.20
1.50
2.15
1.65
X
4.50
3.50
4.10
3.85
4.35
4.50
3.00
4.25
3.00
2.70
3.50
2.80
4.00
3.00
Tu
5.25
4.50
5.75
5.25
5.65
5.55
4.75
5.30
5.00
4.10
5.00
5.00
5.35
4.75
T
6
6
18
24
24
8
12
11
12
12
12
24
21
21
R
5.0
3.5
4.5
3.5
5.0
3.0
3.5
3.5
4.5
4.0
3.5
4.0
4.0
4.0
DISCOMFORT
Yl
1.90
1.50
1.00
1.75
1.50
2.30
1.75
1.75
1.10
1.25
1.75
1.00
1.50
1.25
X
3.75
2.75
2.50
2.70
2.75
3.25
13.00
2.50
2.00
2.10
2.75
2.25
2.25
2.00
Yu
4.25
3.50
3.25
3.50
3.50
4.10
4.25
4.25
3.25
3.55
4.00
3.25
3.75
3.35
T
3
4
7
12
10
6
7
5
10
10
8
8
8
10
R
6.0
5.0
5.5
4.0
5.5
3.5
5.0
3.5
4.0
3.5
3.5
4.5
4.0
4.0
I
GO
CO
Yl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects
Self-Ratings of Panel Member
Value with Good Group Agreement
(hour)
(Interquartile Ranges Jj of Median)
-------
TABLE 13: Estimates of Effects on 90% of Population by Population Category,
Nitrogen Dioxide Concentrations (ppm),
First Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
5.00
3.50
4.00
4.50
r 4.25
4.75
4.50
5.25
4.75
5.25
4.50
4.75
4. DO
4.00
X
6.25
6.25
6.00
6.50
6.50
5.75
6.00
6.50
6.00
6.50
5.75
6.00
6.00
5.50
Yu
9.00
7.50
9.00
7.50
7.75
7.00
7.50
8.00
7.H5
7.25
8.00
7.50
8.50
7.25
T
12
12
24
24
24
12
24
24
24
r 24
24
24
24
24
R
5.5
5.0
4.5
4.0
5.5
4.0
5.0
4.0
4.5
4.5
4.5
4.0
4.0
4.0
DISABILITY
Yl
4.00
3.00
2.50
2.75
3.50
3.00
2.75
4.50
3.00
1.85
2.50
2.50
2.60
2.15
X
5.50
5.00
5.00
5.00
5.00
5.00
4.50
5.00
4.00
3.00
4.50
4.25
5.00
3.85
Yu
7.00
6.75
6.25
6.00
5.25
6.75
5.50
6.00
5.50
4.95
6.25
5.50
6.50
5.55
T
6
6
18
24
24
8
12
11
12
12
12
24
21
21
R
5.0
5.0
4.0
3.5
5.0
4.5
4.5
4.0
4.5
4.5
4.5
4.0
4.0
4.0
DISCOMFORT
Yl
3.50
2.30
2.00
2.25
2.50
2.80
2.30
2.50
2.30
1.45
2.05
1.75
1.75
1.60
X
4.75
3.50
3.50
3.60
4.25
4.75
4.00
3.00
3.25
3.00
3.50
3.00
2.75
2.75
Yu
5.75
4.25
4.75
4.75
5.00
5.60
5.00
4.80
4.10
4.50
4.75
4.70
4.90
4.40
T
3
4
7
21
10
6
7
5
10
10
10
8
8
10
R
6.5
5.5
5.0
3.5
5.0
5.0
5.0
4.0
4.5
4.0
4.0
4.0
4.0
4.0
Yl = Lower Limit Estimate (ppm)
X = Best Estimate (ppm)
Yu = Upper Limit Estimate (ppm)
T = Time Duration of the Effects (hour)
R = Self-Ratings of Panel Member
* = Value with Good Group Agreement (Interquartile Ranged % of Median)
-------
TABLE 14: Estimates of Effects on 0% of Population by Population Category,
Carbon Monoxide Concentrations
First Round Survey
POPULATION CATEGORY
Normal
Children
Old Aqe
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
60.0
60.0
60.0
40.0
45.0
60.0
60.0
56.0
55.0
60.0
60.0
60.0
55.0
39.0
X
80.0
90.0
90.0
55.0
75.0
90.0
100.0
100.0
100.0
95.0
100.0
90.0
100.0
80.0
Yu
130.0
145.0
145.0
70.0
100.0
135.0
145.0
145.0
152.5
130.0
152.5
152.5
145.0
126.0
T
R
5.0
5.5
5.0
4.5
5.0
4.5
4.5
5.0
5.0
4.5
4.5
4.5
5.0
5.0
DISABILITY
Yl
40.0
40.0
45.0
25.0
35.0
40.0
40.0
35.0
35.0
30.0
25.0
30.0
30.0
20.0
X
60.0
60.0
60.0
40.0
55.0
60.0
55.0
55.0
55.0
50.0
50.0
55.0
55.0
35.0
Yu
80.0
90.0
90.0
60.0
90.0
80.0
80.0
80.0
80.0
80.0
80.0
80.0
80.0
52.5
T
R
5.5
5.5
4.5
4.0
4.5
4.5
4.5
4.5
5.0
4.0
4.5
4.0
4.5
3.5
DISCOMFORT
Yl
20.0
14.5
16.0
10.0
22.0
20.0
17.5
10.0
16.5
10.0
10.0
15.0
10.0
7.5
X
35.0
28.0
32.5
20.0
33.5
35.0
32.5
27.5
30.0
21.0
22.5
28.5
20.0
18.5
Yu
55.0
45.0
65.0
42.5
60.0
55.0
55.0
45.0
57.5
43.5
45.0
35.0
40.0
30.0
T
R
6.0
6.0
4.5
3.5
4.0
5.0
5.0
5.0
5.0
4.0
5.0
4.0
4.0
3.5
CO
CJ1
Yl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects
Self-Ratings of Panel Member
Value with Good Group Agreement
(hour)
[Interquartile Range £ h of Median)
-------
TABLE 15: Estimates of Effects on 10% of Population by Population Category,
Carbon Monoxide Concentrations (ppm),
First Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
160.0
155.0
150.0
55.0
120.0
160.0
150.0
150.0
150.0
130.0
150.0
150.0
145.0
97.0
X
200.0
190.0
177.5
100.0*
155.0*
190.0
180.0
182.5
175.0
160.0
184.0
175.0
175.0
145.0
Yu
222.5
227.5
200.0
140.0
195.0
232.5
230.0
235.0
220.0
220.0
232.5
212.5
210. OJ
198.0
T
12
12
12
24
12
12
12
12
12
12
18
12
12
24
R
5.5
5.0
5.5
4.5
5.0
4.0
4.0
4.5
4.5
4.5
4.0
4.5
5.0
5.0
DISABILITY
Yl
100.0
80.0
90.0
54.0
90.0
90.0
90.0
90.0
75.0
60.0
70.0
80.0
90.0
50.0
X
132.5
125.0
125.0
80.0
120.0
135.0
135.0*
130.0
120.0*
110.0
125.0
120.0*
130.0
100.0
Yu
177.5
176.0
172.5
120.0
160.0
170.0
180.0
180.0
170.0
145.0
170.0
160.0
175.0
130.0
T
7
7
7
16
12
7
7
7
7
9
9
11
11
13
R
5.5
5.0
4.5
5.0
4.5
3.5
3.5
4.0
4.0
4.0
3.5
4.0
4.5
4.5
DISCOMFORT
Yl
55.0
44.0
49.0
33.0
45.0
55.0
55.0
40.0
40.0
32.5
40.0
39.0
30.0
25.0
X
75.0
75.0
75.0
60.0
85.0
75.0
75.0
65.0
70.0
60.0
70.0
75.0
60.0
40.0
Yu
100.0
95.0
106.0
82.0
111.0
100.0
100.0
90.0
95.0
82.0
100.0
100.0
90.0
65.0
T
3
3
4
5
5
3
4
4
4
5
5
6
6
6
R
6.0
5.0
4.0
4.5
4.5
3.5
4.0
4.5
4.5
4.0
3.5
3.5
4.5
4.5
o\
I
Yl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects
Self-Ratings of Panel Member
Value with Good Group Agreement
(hour)
(Interquartile Range ^ h of Median)
-------
TABLE 16: Estimates of Effects on 50% of Population by Population Category,
Carbon Monoxide Concentrations (ppm)
First Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
210.0
192.5
180. 0
104.0
155.0
185.0
190.0
190.0
187.5
170.0
190.0
190.0
190.0
145.0
X
260.0
235.0
210.0
161.0*
180.0*
230.0
220.0
235.0
220.0
210.0
220.0
230.0
230.0
180.0
Yu
287.5
272.5
285.0
205.0
205.0
300.0
270.0
295.0
^247.5
225.0
270.0
265.0
265.0
200.0
T
18
12
12
24
12
12
12
17
12
18
18
18
18
24
R
6.5
6.0
6.0
5.0
6.0
5.5
5.0
5.5
5.5
5.5
4.5
5.0
5.0
6.0
DISABILITY
Yl
140.0
125.0
125.0
77.5
100.0
125.0
122.5
125.0
123.5
110.0
122.5
125.0
135.0
84.5
X
170.0
165.0*
165.0
122.5
152.5
180.0*
175.0*
172.5*
155.0
155.0
175.0
160.0
170.0
150,0
Yu
200.0
200.0
190.0
175.0
172.5
200.0
200.0
200.0
190.0
200.0
200.0
196.5
197.5
188.0
T
7
7
7
22
12
7
7
10
7
9
9
11
11
13
R
6.0
5.5
5.0
5.5
5.0
5.0
4.5
4.5
4.5
4.5
4.5
4.5
5.0
5.5
DISCOMFORT
Yl
87.5
73.5
71.0
57.5
65.0
83.5
72.5
65.0
65.0
55.0
60.0
62.5
50.0
45.0
X
120.0
112.5
102.5
80.0
102.5
120.0
110.0
100.0
95.0
90.0
90.0
100.0
85.0
70.0
Yu
135.0
138.5
140.0
105.0
140.0
145.0
135.0
130.0
124.5
120.0
130.0
132.5
127.5
97.5
T
3
3
4
5
6
3
4
5
4
5
5
6
6
6
R
6.5
5.0
3.5
5.5
4.5
5.5
5.0
5.0
5.0
4.0
4.5
4.0
4.5
5.0
I
u>
Yl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects
Self-Ratings of Panel Member
Value with Good Group Agreement
(hour)
(Interquartile Range ^ 4 of Median)
-------
TABLE 17: Estimates of Effects on 90% of Population by Population Category,
Carbon Monoxide Concentrations (ppm),
First Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
235.0
225.0
215.0
130.0
185.0
215.0
210.0
227.5
210.0
210.0
210.0
195.0
200.0
170.0
X
275.0
275.0
250.0
172.5
200.0
260.0
250.0
262.5
237.5
225.0
225.0
215.0
245.0
225.0
Yu
325.0
325.0
300.0
215.0
235.0
300.0
285.0
322.5
272.5
^5.0
260.0
282.5
282.5
295.0
T
16
12
12
25
12
12
12
16
12
18
18
18
18
24
R
7.0
7,0
6.5
5.0
6.0
6.5
5.5
5.5
5.5
5.5
5.0
5.0
5.0
16.0
DISABILITY
Yl
160.0
165.0
150.0
100.0
140.0
150.0
140.0
160.0
140.0
140.0
140.0
141.5
140.0
104.0
X
190.0
190.0
175.0
150.0
165.0
175.0
175.0
187.5
170.0
170.0
175.0
166.0
170.0
170.0
Yu
235.0
235.0
200.0
200.0
190.0
215.0
230.0
200.0
200.0
200.0
200.0
200.0
215.0
185.0
T
10
10
10
24
12
10
10
8
10
9
9
11
11
18
R
7.0
7.0
5.0
5.5
5.0
5.5
4.5
4.0
4.5
4.5
4.5
4.5
5.0
5.5
DISCOMFORT
Yl
114.0
98.0
98.0
75.0
91.0
114.0
109.0
97.5
95.0
84.5
87.5
95.5
87.5
65.0
X
135.0*
125.0*
127.5
95.0
129.0
135.0*
140.0*
130.0*
115.0
112.5
120.0
137.5
120.0
100.0
Yu
155.0
152.5
157.5
120.0
170.0
158.5
182.5
157.5
141.0
140.0
148.5
162.5
152.5
135.0
T
4
4
5
5
6
r 5
5
5
5
5
5
6
6
6
R
6.5
5.5
5.0
5.5
5.0
5.0
4.0
4.0
4.5
4.5
4.0
4.5
5.0
5.5
CO
CO
Yl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects (hour)
Self-Ratings of Panel Member
Value with Good Group Agreement (Interquartile Ranges h of Median)
-------
TABLE 18: Estimates of Effects on 0% of Population Category,
Photochemical Oxidant Concentrations (ppm)
Second Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
0.17
0.20
0.20
0.20
0.20
0.13
0.13
0.13
0.10
0.15
0.15
0.20
0.20
0.10
X.
0.30
0.30
0,32*
0.30
0.35
0.27
0.30
0.30
0.30
0.30
0.30
0.30
0.32
0.20
Yu
0.50
0.45
0.42
0.40
0.50
0.40
0.45
0.50
0.50
0.50
0.42
0.55
0.47
0.35
T
R
DISABILITY
Yl
0.10
0.10
0.10
0.10
0.10
0.10
0.10
0.10
0.08
0.10
0.10
0.10
0.08
0.05
X
0.20
0.20
0.20
0.23
0.23
0.20
0.20
0.20
0.20
0.20
0.20
0.20
0.20
0.13
Yu
0.35
0.40
0.30
ro~.35
0.35
0.35
0.35
0.30
0.35
0.40
0.35
0.40
0.35
0.23
T
R
DISCOMFORT
Yl
i 0.05
0.00
0.03
0.05
0.03
0.00
0.00
0.03
0.00
0.00
0.05
0.00
0.00
0.00
X
0.10
0.10
0.10
0.15
0.15
0.10
0.10
0.10
0.10
0.10
0.10
0.10
0.10
0.10
Yu
0.20
0.20
0.20
Ho. 25
0.25
0.20
0.20
0.20
0.20
0.20
0.20
0.20
0.23
0.20
T
R
I
GO
Yl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects (hour)
Self-Ratings of Panel Member
Value with Good Group Agreement (Standard Diviation ^- 1/3 of Median for estimates iterated on second round,
or Interquartile Range ^ ^ of Median for estimates not iterated)
-------
TABLE 19: Estimates of Effects on 10% of Population by Population Category,
Photochemical Oxidant Concentrations (ppm),
Second Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
0.55
0.55
0.40
0.40
0.47
0.40
0.40
0.40
0.40
0.42
0.40
0.40
0.50
0.30
X
0.75
0.75
0.70*
0.60
0.80*
0.60*
0.62*
0.60*
0.60
0.75
0.65*
0.62
0.80*
0.50*
Yu
1.10
1.00
1.00
0.80
1.05
0.93
0.92
0.95
0.90
1.00
1.00
1.00
1.02
0.75
T
19
24
24
24
24
22
36
24
24
24
24
48
48
48
R
DISABILITY
Yl
0.40
0.35
0.30
0.30
0.30
0.25
0.30
0.20
0.27
0.30
0.30
0.27
0.30
0.20
X
0.50
0.50
0.55*
0.52*
0.60*
0.50*
0.50*
0.40*
0.40
0.50*
0.40*
(0.47
0.50
0.40*
Yu
0.80
0.80
0.85
0.80
0.88
0.75
0.72
0.65
0.65
0.70
0.70
0.67
0.80
0.60
T
12
7
24
24
20
21
21
14
12
17
15
24
24
30
R
DISCOMFORT
Yl
0.13
0.15
0.20
0.20
0.20
0.10
0.15
0.10
0.15
0.10
0.15
0.13
0.20
0.10
X
0.30*
0.30*
0.30
0.40*
0.40
0.30*
0.35
0.30*
0.30*
0.30*
0.35
0.30*
0.40*
0.20
Yu
0.40
0.42
0.50
0.55
0.50
0.40
0.50
0.50
0.50
0.50
0.50
0.42
0.60
0.38
T
8
7
6
24
6
12
12
8
12
12
12
14
14
18
R
o
I
Yl = Lower Limit Estimate (ppm)
X = Best Estimate (ppm)
Yu = Upper Limit Estimate (ppm)
T = Time Duration of the Effects (hour)
R = Self-Ratings of Panel Member
* = Value with Good Group Agreement (Standard Diviation ^ 1/3 of Median for estimates iterated on second round,
or Interquartile Ranged h of Median for estimates not iterated).
-------
TABLE 20: Estimates of Effects on 50% of Population by Population Category,
Photochemical Oxidant Concentrations (ppm),
Second Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Respiratory Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
0.75
0.67
0.80
0.60
0.65
0.60
0.62
0.60
0.60
0.65
0.60
0.65
0.72
0.45
X
1.10
1.00*
1.00
0.95*
1.00*
0.85*
0.92*
0.80
0.85
0.92
0.82*
0.93*
1.00*
0.75*
Yu
1.40
1.25
1-30
1.27
1.40
1.25
1.22
1.20
1.20
1.30
1.15
1.20
1.38
0.98
T
24
24
24
48
24
22
36
24
24
24
30
48
48
48
R
DISABILITY
Yl
0.50
0.50
0.47
0.50
0.42
0.40
0.40
0.40
0.40
0.40
0.40
0.45
0.50
0.35
X
0.80*
0.70
0.75
0.77*
0.80*
0.65*
0.67*
0.60*
0.60
0.60*
0.60*
0.70
0.80*
0.55*
Yu
1.05
1.15
1.00
1.05
1.20
0.95
T.95
0.95
0.80
0.90
0.80
1.00
1.15
0.77
T
10
12
24
24
20
21
22
17
12
17
10
24
24
30
R
DISCOMFORT
Yl
0.35
0.35
0.30
0.27
0.35
0.20
0.27
0.23
0.20
0.20
0.20
0.30
0.30
0.15
X
0.60
0-60
0.50
0.50*
0.50
0.40*
0.50*
0.40
0.40*
0.40
0.40*
0.50
0.52*
0.32
Yu
0.80
0.75
0.65
0.80
0.65
0.60
0.70
0.60
0.60
0.67
0.60
0.60
0.80
0.50
T
4
6
12
24
6
12
16
11
12
12
12
8
14
18
R
Yl = Lower Limit Estimate (ppm)
X = Best Estimate (ppm)
Yu = Upper Limit Estimate (ppm)
T = Time Duration of the Effects (hour)
R = Self-Ratings of Panel Member
* = Value with Good Group Agreement (Standard Diviation^ 1/3 of Median for estimates iterated on second round,
or Interquartile Range ^ h of Median for estimates not iterated).
-------
TABLE 21: Estimates of Effects on 90% of Population by Population Category,
Photochemical Oxidant Concentrations (ppm),
Second Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
1.15
1.10
1.00
1.00
1.00
0.80
0.80
0.80
0.80
0.90
0.80
1.00
0.88
0.60
X
1.50
1.40
1.40
1.20
1.45
1.00*
1.20*
1.00*
1.20*
1.20
1.00
1.45*
1.20*
1.00*
Yu
1.80
1.60
1.65
1.85
2.00
1.38
1.60
1.40
1.60
1.65
1.40
1.80
1.60
1.32
T
20
24
24
24
24
24
33
24
36
24
36
24
48
48
R
DISABILITY
Yl
0.80
0.70
0.70
0.80
0.75
0.60
0.60
0.60
0.55
0.50
0.60
0.70
0.60
0.45
X
1.00
1.00
1.00
1.00
1.15
0.80*
0.95*
0.80*
0.80
0.80
0.80*
1.05*
0.95
0.75*
Yu
1.40
1.20
1.40
1.40
1.65
1.05
1.20
1.13
1.05
1.05
1.02
1.35
1.35
0.95
T
7
7
12
18
24
21
F21
r 18
12
12
20
24
24
30
R
DISCOMFORT
Yl
0.45
0.55
0.40
0.50
0.45
0.30
0.50
0.35
0.30
0.30
0.35
0.40
0.40
0.23
X
0.80
0.75
0.70
0.75
0.70
0.50*
0.70*
0.60*
0.60
L0.55
0.60*1
0.60
0.60
0.42*
Yu
1.00
1.00
0.95
1.00
0.90
0.75
0.95
0.80
0.85
0.85
0.80
0.85
0.95
0.65
T
4
4
6
24
6
12
9
11
12
8
12
9
11
21
R
I
-t>
ro
Yl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects (hour)
Self-Ratings of Panel Member
Value with Good Group Agreement (Standard Diviation ^ 1/3 of Median for estimates iterated on second round,
or Interquartile Range ^ % of Median for estimates not iterated).
-------
TABLE 22: Estimates of Effects on 0% of Population by Population Category,
Nitrogen Dioxide Concentrations (ppm),
Second Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
1.50
1.55
1.50
1.35
1.50
1.50
1.50
1.35
1.50
1.35
1.35
1.45
1.55
1.00
X
2.50
2.50
2.25
1.90
2.35
2.50
2.25
2.00
2.50
2.10
2.45*
2.60
2.35
1.75*
Yu
3.50
3.45
3.30
2.85
3.50
3.60
3.40
3.50
3.50
3.40
3.45
4.00
3.50
3.00
T
R
DISABILITY
Yl
1.00
1.00
1.00
0.60
1.00
1.10
1.00
1.00
1.00
0.80
1.00
1.05
1.00
0.65
X
1.60
1.60
1.50
1.55
1.60
1.70
1.50
1.60
1.50*
1.50*
1.75
1.75
1.60
1.30*
Yu
2.60
2.65
2.50
2.40
2.85
2.75
2.55
F2.70
2.60
2.55
2.80
2.95
2.90
2.45
T
R
DISCOMFORT
Yl
0.50
0.50
0.50
0.20
0.45
0.50
0.50
0.65
0.70
0.50
0.60
0.50
0.45
0.30
X
1.00
1.05
1.20
0.75
1.00
1.15
1.00
1.10
1.25
1.00
1.30
1.00
1.00
0.75
Yu
1.90
1.80
2.35
1.45
1.85
2.00
2.00
1.75
2.00
1.85
2.00
1.90
1.70
1.65
T
R
CO
I
Yl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects (hour)
Self-Ratings of Panel Member
Value with Good Group Agreement (Standard Diviation^ 1/3 of Median for estimates iterated on second round,
or Interquartile Range ^ h of Median for estimates not iterated).
-------
TABLE 23: Estimates of Effects on 10% of Population by Population Category,
Nitrogen Dioxide Concentrations (ppm),
Second Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
3.25
3.00
3.00
2.35
2.85
2.95 "
2.75
2.60
3.00
3.00
2.60
2.90
2.05
1.85
X
4.70
4.25
3.85
3.45
3.85
3.50
3.50
4.00
3.75
4.25
3.50
3.75
4.00
3.00
Yu
8.00
6.00
5.45
4.70
5.00
4.85
4.85
5.00
5.00
5.25
4.90
5.00
5.25
4.25
T
19
20
24
30
24
19
24
24
24
24
27
36
30
33
R
DISABILITY
Yl
2.90
2.20
2.00
1.85
2.15
2.00
1.80
1.85
1.85
1.50
2.00
2.50
1.85
1.40
X
3.75
3.35
3.00
2.90
3.10
3.00
3.00*
3.15
3.00*
2.75
3.00
3.30
2.90
2.35
Yu
5.00
4.75
4.00
4.10
4.25
4.25
4.20
4.10
4.00
4.00
4.25
4.20
4.30
3.65
T
10
10
19
22
19
12
16
11
16
16
17
24
24
24
R
DISCOMFORT
Yl
1.60
1.50
1.50
1.20
1.20
1.50
1.45
1.25
1.15
1.00
1.25
1.15
1.00
0.85
X
2.50
2.20
2.00
2.00
2.00
2.40
2.10
2.45
2.10*
1.85
2.10
2.00
1.60
1.50
Yu
3.25
3.05
3.00
2.95
3.20
3.50
3.20
3.50
3.20
2.85
3.25
3.10
3.15
2.50
T
9
8
8
16
9
9
9
8
8
11
11
11
11
12
R
-b
-to
Yl = Lower Limit Estimate (ppm)
X = Best Estimate (ppm)
Yu = Upper Limit Estimate (ppm)
T = Time Duration of the Effects (hour)
R = Self-Ratings of Panel Member
* = Value with Good Group Agreement (Standard Diviation 6 1/3 of Median for estimates iterated on second round,
or Interquartile Range £ h of Median for estimates not iterated).
-------
TABLE 24: Estimates of Effects on 50% of Population Category,
Nitrogen Dioxide Concentrations (ppm),
Second Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
4.30
4.00
4.00
4.00
3.75
3.80
3.25
3.00
4.00
3.75
3.10
3.50
3.25
2.50
X
8.00
6.50
6.00
6.00
5.50
5.50
4.50
5.00
5.50
5.50
4.50
4.90
4.85
3.60
Yu
11.50
10.00
8.00
8.00
8.00
8.00
7.60
7.50
8.00
8.00
7.60
8.00
7.10
5.00
T
20
22
24
31
24
22
24
24
24
25
27
36
30
33
R
DISABILITY
Yl
3.25
3.05
2.80
3.00
3.25
3.00
2.70
2.40
3.00
2.75
2.50
3.00
2.40
1.85
X
4.50
4.25
4.00
4.00
4.15
4.00
3.75
4.00
4.00*
4.00
4.00
4.20
3.65
3.05
Yu
7.60
6.20
5.90
5.00
6.00
6.20
4.90
5.50
5.00
5.00
5.50
6.00
5.00
4.40
T
11
11
19
22
20
14
16
14
16
16
18
24
24
24
R
DISCOMFORT
Yl
2.15
2.15
2.20
2.00
2.35
2.35
2.30
2.00
2.35
2.25
2.00
2.25
1.85
1.30
X
3.25
3.00
3.00
3.00
3.10
3.50
3.10*
3.00
3.15*
3.25
3.00*
3.20
2.65
2.10
Yu
4.60
4.25
4.05
4.00
4.60
4.65
4.40
4.30
r4.25
4.00
4.50
4.25
3.90
3.65
T
9
9
10
16
9
9
11
9
10
11
12
11
11
12
R
Yl = Lower Limit Estimate (ppm)
X = Best Estimate (ppm)
Yu = Upper Limit Estimate (ppm)
T = Time Duration of the Effects (hour)
R = Self-Ratings of Panel Member
* = Value with Good Group Agreement (Standard Diviationi1/3 of Median for estimates iterated on second round.
or Interquartile Range ^ % of Median for estimates not iterated).
-------
TABLE 25: Estimates of Effects on 90% of Population by Population Category,
Nitrogen Dioxide Concentrations (ppm),
Second Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
6.00
5.50
4.50
5.00
5.00
4.50
4.25
4.00
4.75
4.35
4.00
4.50
4.00
3.25
X
10.00
8.00
8.00
8.00
8.00
7.00
5.75
6.00
7.00
6.50
6.00
6.00
6.00
4.50
Yu
13.50
11.50
10.00
10.00
10.50
10.00
9.50
8.50
10.00
9.00
9.50
9.50
9.00
6.40
T
19
24
24
31
24
22
24
24
24
32
33
36
30
33
R
DISABILITY
Yl
4.00
3.70
3.05
3.40
4.00
3.75
3.50
3.50
4.00
3.50
3.25
4.00
3.00
2.50
X
6.00
5.50
5.00
5.50
6.00
5.50
4.75
5.00
5.00
5.00
5.00
5.00
4.80
3.60
Yu
10.00
9.50
8.00
7.50
8.50
8.00
8.00
8.00
8.00
7.50
8.00
7.00
6.10
5.05
T
10
11
22
22
22
14
16
14
16
16
20
24
24
24
R
DISCOMFORT
Yl
3.50
3.20
3.00
2.40
3.00
2.85
2.70
3.00
3.00
3.00
2.50
2.65
2.60
2.00
X
4.90
4.65
4.00
3.50
4.00
4.00
4.00
4.00
4.00
4.00
3.85
3.70
3.55
3.00*
Yu
6.00
5.65
4.85
4.50
5.00
5.15
5.40
5.00
5.50
4.85
5.00
4.80
4.60
4.00
T
8
10
11
17
10
9
11
9
11
12
13
12
12
12
R
I
-C.
Yl = Lower Limit Estimate (ppm)
X = Best Estimate (ppm)
Yu = Upper Limit Estimate (ppm)
T = Time Duration of the Effects (hour)
R = Self-Ratings of Panel Member
* = Value with Good Group Agreement (Standard Diviation ^ 1/3 of Median for estimates iterated on second round,
or Interquartile Range ^ ^ of Median for estimates not iterated).
-------
TABLE 26: Estimates of Effects on 0% of Population by Population Category,
Carbon Monoxide Concentrations (ppm),
Second Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
80.0
72.5
65.0
40.0
50.0
67.5
65.5
67.5
67.5
62.5
62.5
65.0
65.0
60.0
X
110.0
100.0
100.0
60.0*
77.5
97.5
100.0
100.0
100.0
100.0
97.5
100.0
100.0
92.5*
Yu
150.0
150.0
142.5
90.0
112.5
135.0
142.5
140.0
145.0
142.5
141.0
140.0
142.5
120.0
T
R
DISABILITY
Yl
40.0
40.0
40.0
30.0
32.5
30.0
40.0
40.0
40.0
35.0
35.0
32.5
32.5
30.0
X
80.0
60.0
62.5
45.0
50.0
60.0
60.0
60.0
65.0
60.0
60.0
59.0
60.0
60.0
Yu
109.0
100.0
96.5
L72.5
85.0
100.0
90.0
97.5
100.0
90.0
85.0
85.0
85.0
82.5
T
R
DISCOMFORT
Yl
21.0
20.0
17.5
12.5
10.0
20.0
20.0
20.0
20.0
15.0
20.0
19.5
20.0
17.5
X
45.0
35.0
32.5
25.0
30.0
40.0
40.0
37.5
40.0
40.0
35.0
39.5
40.0
32.5
Yu
72.5
55.0
60.0
47.5
50.0
60.0
62.5
60.0
60.0
52.5
60.0
59.5
60.0
52.5
T
R
Yl = Lower Limit Estimate (ppm)
X = Best Estimate (ppm)
Yu = Upper Limit Estimate (ppm)
T = Time Duration of the Effects (hour)
R = Self-Ratings of Panel Member
* = Value with Good Group Agreement (Standard Diviation ^ 1/3 of Median for estimates iterated on second round,
or Interquartile Range ^ % of Median for estimates not iterated).
-------
TABLE 27: Estimates of Effects on 10% of Population by Population Category,
Carbon Monoxide Concentrations (ppm),
Second Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
177.5
146.0
150.0
55.0
120.0
137.5
130.0
132.5
115.0
125. Oj
115.0
100.0
117.5
100.0
X
205.0
187.5
180.0
100.0
155.0
170.0
167.5
172.5
162.5
170.0
151.0
150.0
152.5
140.0
Yu
250.0
237.5
210.0
140.0
195.0
225.0
200.0
232.5
192.5
200.0
198.0
199.0
200.0
175,0
T
20
21
22
22
12
22
24
24
24
24
24
24
24
24
R
DISABILITY
Yl
125.0
105.0
105.0
57.5
80.0
110.0
90.0
105.0
75.0
77.5
80.0
80.0
95.0
72.5
X
160.0
145.0
140.0
80.0
120.0
130.0
135.0
140.0
120.0
115.0
120.0
120.0
127.5
100.0
Yu
196.5
197.5
175.0
115.0
157.5
160.0
180.0
174.0
170.0
159.5
155.0
160.0
157.5
145.0
T
12
12
14
17
17
12
12
13
15
14
12
13
13
19
R
DISCOMFORT
Yl
60.0
50.0
50.0
30.0
50.0
60.0
50.0
53.5
51.0
42.5
45.0
44.0
40.0
32.5
X
100.0
80.0*
80.0*
55.0
72.5*
80.0*
80.0*
84.0*
80.0*
77.5*
70.0
75.0*
65.0
60.0
Yu
127.5
101.5
105.0
80.0
102.5
108.5
108.0
114.0
113.0
100.0
102.5
97.5
100.0
92.5
T
7
8
10
1Z
11
10
11
12
10
10
11
11
11
12
R
CO
I
Yl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects (hour)
Self-Ratings of Panel Member
Value with Good Group Agreement (Standard Diviation ^. 1/3 of Median for estimates iterated on second round,
or Interquartile Range ^ *s of Median for estimates not iterated).
-------
TABLE 28: Estimates of Effects on 50% of Population by Population Category,
Carbon Monoxide Concentrations (ppm)
Second Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
200.0
190.0
170.0
104.0
155.0
195.0
185.0
195.0
180.0
165.0
180.0
160.0
165.0
140.0
X
262.5
235.0
210.0
161-0
180.0
250.0
225.0
225.0
215.0
200.0
215.0
200.0
205.0
180.0
Yu
300.0
300.0
300.0
2Q5.0
205.0
300.0
300.0
287.5
300.0
240.0
300.0
250.0
255.0
200.0
T
20
20
22
24
12
22
24
24
24
24
24
24
24
24
R
DISABILITY
Yl
150.0
125.0
125.0
90.0
120.0
125.0
122.5
125.0
122.5
110.0
127.5
112.5
122.5
100.0
X
182.5
165.0
167.5
122.5
150.0
180.0
175.0
172.5
160.0
150.0
167.5
155.0
155.0
140.0*
Yu
230.0
200.0
200.0
166.0
185.0
200.0
200.0
200.0
200.0
200.0
200.0
197.5
197.5
180.0
T
12
10
12
17
17
12
12
12
15
15
15
13
15
19
R
DISCOMFORT
Yl
85.0
80.0
71.0
40.0
80.0
80.0
75.0
80.0
80.0
65.0
80.0
60.0
70.0
60.0
X
120.0*
105.0*
103 . 5*
65.0
110.0*
115.0*
105.0
110.0*
100.0
100.0*
105.0
95.0*
100.0
90.0
Yu
155.0
137.5
139.0
100.0
140.0
140.0
137.5
136.5
140.0
123.0
131.0
120.0
125.0
115.0
T
7
8
10
11
11
11
12
11
11
10
12
12
12
12
R
IO
I
Yl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects (hour)
Self-Ratings of Panel Member
Value with Good Group Agreement (Standard Diviation^ 1/3 of Median for estimates iterated on second round,
or Interquartile Range ^ ^ of Median for estimates not iterated).
-------
TABLE 29: Estimates of Effects on 90% of Population by Population Category,
Carbon Monoxide Concentrations (ppm),
Second Round Survey
POPULATION CATEGORY
Normal
Children
Old Age
Heart Condition, Severe
Heart Condition, Mild
Hay Fever, Sinusitis
Upper Respiratory Infection
Asthma
Viral Bronchitis
Bacterial Pneumonia
Influenza
Chronic Respiratory Disease
.Mild Chronic Obstructive Disease
Severe Chronic Obstructive Disease
INCAPACITY
Yl
250.0
205.0
200.0
145.0
175.0
235.0
200.0
200.0
200.0
192.5
205.0
200.0
200.0
167.5
X
300.0
300.0
300.0
190.0
215.0
300.0
300.0
300.0
300.0
215.0
300.0
225.0
275.0
205.0
Yu
400.0
375.0
375.0
245.0
255.0
375.0
355.0
350.0
350.0
275.0
355.0
300.0
325.0
262.5
T
20
20
22
24
22
22
24
24
24
24
24
24
24
24
R
DISABILITY
Yl
177.5
165.0
165.0
109.0
142.5
172.5
160.0
152.5
150.0
150.0
155.0
152.5
155.0
121.0
X
225.0
200.0
200.0
150.0
170.0
200.0
200.0
197.5
200.0
180.0
200.0
180.0
190.0
170.0
Yu
290.0
245.0
250.0
200.0
200.0
257.5
252.5
242.5
250.0
205.0
250.0
200.0
225.0
200.0
T
12
12
14
21
16
12
14
15
13
15
15
15
15
20
R
DISCOMFORT
Yl
114.0
98.0
91.0
65.0
92.5
114.0
109.0
97.5
97.5
90.0
100.0
97.5
102.5
70.0
X
135.0
125.0
130.0*
90.0
119.0*
135.0
140.0
130.0
131.0
120.0*
135.0*
125.0*
140.0*
100.0
Yu
155.0
152.5
165.0
120.0
160.0
158.5
182.5
157.5
157.0
140.0
160.0
159.5
160.0
140.0
T
7
6
10
11
11
6
6
6
11
10
12
12
12
12
R
en
o
Yl
X
Yu
T
R
*
Lower Limit Estimate (ppm)
Best Estimate (ppm)
Upper Limit Estimate (ppm)
Time Duration of the Effects (hour)
Self-Ratings of Panel Member
Value with Good Group Agreement (Standard Diviation^ 1/3 of Median for estimates iterated on second round,
or Interquartile Range ^ ^ of Median for estimates not iterated).
-------
SECTION 7
DISCUSSION
A. GENERAL COMMENTS
Due to the voluminous quantity of data generated from this study, dis-
cussions in this report will be mostly restricted to the finalized results
which include data obtained in the second round and those from the first
round that do not require reiteration.
Based on the criterion given under the method section, the second round
estimates are classified as "good agreement" or not. Judging by the
numbers of "good agreement" answers, it might seem that the Delphi approach
does not work out very well in this study. However, if one examines closely
the distribution of answers for each pollutant, population group and
condition, and compares these answers with available experimental data, one
will conclude that Delphi procedures are appropriate for arriving at group
estimates. As it is discussed below under Section C, the Delphi data are
generally comparable with available experimental data. The limited number
of "good agreement" answers in the finalized results, especially in the area
pertaining to the health effects of nitrogen dioxide and carbon monoxide, is
really a reflection of the lack of actual data to form a basis for the
panelists to come to a better group agreement, rather than a deficiency of
the Delphi techniques. This comment, however, should be taken with a certain
amount of caution. Although the panel members participating in the study
are considered experts in the field of air pollution health effects, their
degree of knowledge and philosophy vary. These differences may explain
some of the variability of answers in areas where there is a lack of
experimental data.
In spite of the fact that the dispersion is wide on a large portion of the
estimates, these estimates turn out to have a reasonable form of consistency.
The panelists were asked to estimate both the concentrations at which 10%
and 90% of a given population would experience a given impairment, and the
concentrations at which they were 5% and 90% certain that a given fraction
of the population would experience the impairment. The two estimates are
-51-
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not logically dependent; however, because of the lack of information in
this task situation, it seems unlikely that a sharp discrimination could
be made between the two types of estimates. This would suggest that a
fair amount of redundancy exists in the data if the panelists are being
consistent. One simple hypothesis to test the existence of redundancy
is that the 10% and 90% estimates on population are similar to the 5%
and 95% estimates of certainty for the 50% estimate on population.
The hypothesis was tested on a subset of the data, namely, the 27 cases
Normal, Children, and Severe Heart Condition, for the three levels of
impairment and the three pollutants. In each of the 27 cases, the 5% and
95% confidence limits for the 50% population estimate, and the 10% and 90%
population estimates were divided by the 50% population estimate to rake
the various cases comparable—in effect, normalizing the Y|_, YJJ, XJQ and
X estimates to the X estimates.
Table 30 displays the mean normalized Y^ and Yy estimates and the mean
normalized X^Q and Xgg estimates for the 27 cases. The similarity between
mean Y|_ and X^Q and Yy and Xgg is striking. Inspection of individual esti-
mate indicates that in many of the 27 cases, the Y[_ and XJQ or Yy and Xgg
are in fact, identical. In summary, the answers put forth by the panelists,
especially in area where no experimental data exist, are not just random
estimates.
TABLE 30: Comparison of Mean for Lower and Upper Limits (Y|_ and
for 50% Population with the Mean Best Estimates for 10%
and 90% Population (XIQ and Xgg, All Normalized to X5Q)
YL .67 .70 X1Q
Y 1.29 1.25 X
B. DOSE-RESPONSE MODELS
A glance at the data suggests that the dose-response relationship expressed
in the median estimates is S-shaped. A number of models are available to
represent this type of relationship. The model used in the present study
-52-
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is the threshold or susceptibility level model. This approach assumes
that each individual is characterized by a susceptibility level (reaction
threshold) which has some distribution in the population. A first
thought might be that the distribution is normal. However, there is a
fixed lower bound to the dosage, namely zero; a frequently encountered
distribution for quantities with fixed lower bound is the log-normal.
In the log-normal case, the population is distributed normally on the
logarithm of the quantity.
Assuming log normality for the distribution of susceptibility, the density
of individuals whose threshold is concentration {c) x one hour (for a
given pollutant, a given degree of impairment, and a given population type)
would be expressed by:
B 0 (z)
c where z = A + B (In c)
0(z) is the normal density function with mean 0 and standard deviation
= 1, and A, B are constants computed by least squares. Since the panel
was asked to estimate the dosage for given fractions of the population,
a more convenient form for computation is the cumulative distribution,
where F is the fraction of the population affected,
F = •/"!«, 0 (*)dx
This model is often referred to as the PROBIT model.
Although the PROBIT model is intuitively clear, it has the drawback that
computation is cumbersome, especially if curve fitting is to be carried
out for a large number of cases, since there is no elementary closed form
for the inverse of the cumulative distribution function.
Another model is the logistic (LOGIT) model. The LOGIT model can be
thought of as an extension of the familiar accretion rate type of relation-
ship where the fractional increase in the number of individuals affected is
-53-
-------
is proportional to the number remaining (unaffected) and the fractional
increase in dosage. In differential notation
When this expression is integrated we obtain
In F
1-F
= A1 + B'ln c
Since F and c are obtainable directly from the estimates, it is straight-
forward to compute the constants A' and B' by least squares. In fitting
the dose-response curves, three points are computed. Each point is
derived with the following expression: A' + B'ln c
A1 + B1 In c
e A1 + B1 In c
when F is the affected population fraction,
Although the LOGIT and PROBIT models are based on quite different assumptions,
they generate very similar dose-response relationships. This is difficult
to demonstrate analytically.* However, the similarity can be shown graph-
ically.
Figure 5 shows the density distributions for the LOGIT and PROBIT analysis,
where the curves are fitted to the points F = .95, c = 1 and F = .5, c = .5.
Figure 6 shows the cumulative (dose-responsive) curves generated by the
density functions of Figure 5. In both figures the solid line is the
LOGIT analysis. The dashed line in Figure 5 is the PROBIT case. The
* Birmbaum reports that Haley has demonstrated that l{4>(x) - x(!-7x} 1 <0.01
for all x> where $ is the normal density function and x is the logistic
function in "Statistical Theories of Mental Test Scores" by F. M. Lord,
M. R. Norick. Addison-Wesley Publ. Co., 1968. Pages 399-407.
-54-
-------
df
dc
2.8 --
2.4
2.0
1.6
1.2
.8
.4
0
LOGIT DENSITY
PROBIT DENSITY
.1 .2 .3 .4 .5 .6 .7 .8
OXIDANT DOSAGE (ppm x hr)
.9 1.0 I.I 1.2
COMPARISON OF LOGIT AND PROBIT
DENSITY FUNCTIONS
FIGURE -5-
-55-
-------
o
<
o:
o
I—
<
Q-
o
Q.
L06IT
O PROBIT
FITTED POINTS
4 .5 .6 .7 .8 .9
OXIDANT DOSAGE (ppm x hr.)
1.3
COMPARISON OF LOGIT AND PROBIT
DOSE-RESPONSE CURVES
FIGURE -6-
-56-
-------
PROBIT case in Figure 6 is shown by the circled dots. The PROBIT curve
is not drawn in because it is almost indistinguishable from the LOGIT
curve.
As can be seen from the figures, the LOGIT density distribution differs
somewhat from the PROBIT distribution, especially in the vicinity of the
peaks, where the LOGIT distribution has a higher peak. However, the
differences tend to wash out when the cumulative distributions are
calculated.
For those who prefer the susceptibility model as a basis for the dose-
response relationship, the LOGIT analysis can be interpreted as a
convenient approximation, where the log-normal density distribution of
thresholds is replaced by the "near log-normal" density distribution of
the LOGIT function. Of course, some researchers may find the assumptions
of the LOGIT analysis more persuasive.
One question remains. Although the two models are highly similar when
fitted exactly to two points, serious discrepancies might arise when the
two models are approximated by least squares to more than two points. To
check this possibility, Figure 7 shows the least squares fit of the LOGIT
and PROBIT models to the case Oxidant, Normal, Discomfort, X, where the
LOGIT model gives a very good fit to the panel estimated points (crosses
in Figure 7). Figure 8 shows the least squares fit to the case Oxidant,
Normal, Disability, X, where the LOGIT model does not give a particularly
good fit. As the figures indicate, the least squares computation generates
about the same dose-response curve for the two models in each case.
In the present analysis, only three data points are being fitted for each
dose-response curve, namely the median estimates of dose for IQ%, 50:-',
and 90% of population affected. It might appear that the data imposes
very little restriction on the model to be employed, and that, in fact,
any S-shaped curve with two undetermined constants would fit the data
equally well. This is not quite the case. The underlying phenomena
-57-
-------
dictate that the dose-response curve fall to zero at least in the vicinity
of zero, and that it approach 1 asymptomatically with increasing dose. If
a relationship of the type
F - e<* + !>
is postulated, as c--> °°, b/c —> 0, and a must be 0 in order for F --> 1.
Hence, there is in reality only one constant to be determined by the data.
This formula gives a poor fit to the data, as the dashed curve in Figure 7
illustrates.
Another widely used S-curve is the so-called Gomperz curve
kc
F = k ab
or in logarithmic form
In F = In k + (In a)bc
The process constraints (F = 0 when c = 0, F = 1 when c = °°) imply that
k = 1, a < 1 and b < 1. Strictly speaking, the Gomperz curve cannot
fulfill the constraints, since F = a at c = 0; however, if a is a very small
number this may not be serious.
In fact, the Gomperz curve does appear to fit the data fairly well, at
least for the cases Normal, Disability, X for each of the three pollutants.
4040
For CO, the least squares a = 1/e , a very small number indeed! Hence,
the fact that the LOGIT anlaysis gives a good fit to most of the data
cannot be interpreted as a confirmation of the susceptability model. The
principal advantages of the LOGIT analysis are that the underlying model
is relatively clear and curve-fitting is computationally convenient.
-58-
-------
o
<
cc
o
I—
<:
a.
o
a.
1.0
.9
.8
.7
.6
.5
.4
.3
.2
O PROBIT
+ POINTS FITTED
e o-t t/c
* i
I I
-P-
.1 .2 .3 4 .5 .6
H
.8 .9
1.0
OXIDANT DOSAGE (ppm x hr.)
COMPARISON OF LOGIT AND PROBIT
LEAST SQUARES FIT ON THE ESTIMATES (x) OF
OXIDANT DOSAGE CAUSED DISCOMFORT ON
NORMAL POPULATION.
FIGURE-7-
-59-
-------
o
cc
o
Q_
.0 -
.9 -
.8 •
.7 •
.5 •
.3-
.2-
.1
0
^-t-O
<
/
/
r
•
/
/
-i
-X1
^r
^r
h
— LOGIT
0 PROBIT
+ POINT
S FITTED
•
*^*t5
»
D .1 .2 .3 .4 .5 .6 .7 .8 .9 1.0 I.I 1.2 1.3
OXIDANT DOSAGE ( ppm x hr.)
COMPARISON OF LOGIT AND PROBIT
LEAST SQUARES FIT ON THE ESTIMATES (x) OF OXIDANT
DOSAGE CAUSED DISABILITY ON NORMAL POPULATION
FIGURE -8-
-60-
-------
C. DELPHI DATA vs. EXPERIMENTAL DATA
Oxidant
The conditions that were queried in regard to the effects of photochemical
oxidant were discomfort as manifested by eye irritation, non-productive
coughing or chest tightness, disability as manifested by headache, and
incapacity due to respiratory or cardiac abnormalities or bronchopneumonia.
1 19 20-23
Eye irritation, ' non-productive cough and chest tightness or soreness
are the earliest manifestations of exposure to photochemical oxidant.
1 23
Headache due to the irritative properties of ozone ' is likely to be a
more significant manifestation as this symptom often diminishes ability
to concentrate. Respiratory and cardiac problems as well as broncho-
pneumonia are potentially incapacitating complications of oxidant exposure.
Experimental data on oxidant effects relevant to this study are summarized
in Table 31.
Analysis of the estimates for each category of response in normal children,
adults, and the elderly indicates consistency in the answers of the panel.
This agreement of opinion was most apparent in the estimates for the 10
or 50% dose-response rate. Less agreement was found in the experts'
estimates as to the upper and lower levels of human sensitivity to oxidants.
According to the experts, a one hour exposure to 1.50 ppm of oxidant would
cause incapacity in 90% of normal adults, 1.02 ppm would cause incapacity
in 50%, .77 ppm would incapacitate 10%, and 0.30 ppm or less would not
incapacitate anyone (Table 6-9). Slightly lower levels would incapacitate
the more sensitive group such as the children or the elderly. Disability
due to headache was predicted to occur in 90% of normal adults after a one
hour exposure to 1.00 ppm of oxidant, in 50% after exposure to 0.80 ppm,
in 10% after exposure to 0.41 and in none who were exposed to 0.20 ppm
or less; the predictions for discomfort were 0.80 ppm, 0.50 ppm, 0.30 ppm
and 0.10 ppm. Again slightly lower values were predicted for the dose-
response relationships of disability and discomfort in children and the
elderly.
-61-
-------
TABLE 31 : Summary of Experimental Data on Oxidant Effects
Relevant to the Delphi Data
Concentration
(ppm)
0.37-0.70
>.30
1
0.37-0.7
1.0-2.0
0.38-1.59
0.8-1.7
0.5
0.25
Exposure
Time
2 hrs.
--
--
2 hrs.
--
--
--
--
Subjects
Human
Human
Human
Human
Human
Mice
Human
Human
Human
Effects
Cough, nasopharyngeal
irritation, substernal
soreness, chest tightness;
symptoms accentuated with
excercise
Eye irritation due to some
photochemical products
Dyspnea, headache in most
subjects
Dyspnea, headache in 50%
of subjects
Incapacitating illness
Presence of silicosis did
not affect murine ability
to resist bacterial challenge;
this is contrary to accepted
clinical assumption
Pulmonary congestion
Edema formation
Less than 6% of asthmatic may
have attacks precipitated
when oxidant concentration
>.25 ppm
Reference
20, 21, 22
19
23
20, 21
30, 31
42
26
47, 48
50
-62-
-------
The consistency of the expert opinion probably reflects the extensive
literature which is available in regard to these dose-response relation-
ships. Numerous investigators have studied the affect of similar exposures
? ? 0 ? R 9fi ^ 1
in volunteers, ' ' accidental poisonings and in experimental animal
32-35
models. Exposure to 0.37 ppm of ozone produces the same symptoms in
20
some volunteers. Eye irritation, a very sensitive indicator of photo-
19
chemical smog, is often due to photochemical products rather than ozone.
This abnormality can be present when oxidant concentrations are less than
0.3 ppm. The similarity of these experimental results with the estimates
provided by the panel of experts is obvious.
Although headache occurs secondary to oxidant exposure, dyspnea is more
frequent and as such this symptom would have been a slightly better index
of disability. Most volunteers develop dyspnea and headache when exposed
23
to 1.0 ppm of ozone. These symptoms occur in less than 50% of volunteers
20 21 22
who are exposed to 0.7 or 0.37 ppm of ozone. Data concerning the
threshold value for these symptoms has not been reported. The experimental
results closely approximate the estimates of the experts.
Data concerning the dose-response relationship for illness such as respiratory
infection are derived from accidental exposure and as such are fragmentary
as well as imprecise. The few reports that are available suggest that
short term exposure to 1.0 to 2.0 ppm of oxidant will cause incapacitating
illness. ' Whether lesser exposures can also induce illness is unknown.
The opinion of the experts was that a one hour exposure to 1.50 ppm of
oxidant would result in incapacity in 90% of normal adults, an estimate
that is consistent with these data. The estimates for illness in 50% of
normal adults (1.02 ppm) and in 10% of normal .adults (0.77 ppm) are also
in accord with experimental data, as these levels of exposure will
20 21 22
undoubtedly produce dyspnea, cough and ventilatory disturbances. ' '
The panel did not agree very well on the estimate that exposure to 0.30 ppm
would not be incapacitating. This value would appear to be valid however
since numerous volunteers have been subjected to higher concentrations of
oxidant without incurring illness. Results from tests in sensitive animal
32 33
models also fail to show abnormalities at these exposure levels. '
-63-
-------
Volunteer or accidental toxicity data for these dose-response relationships
for children and the elderly are not available. Experiments with young
animals have shown an increased susceptibility to the acute toxic effects
of ozone. Although experiments with "old" animals have not been reported,
it seems likely that the age-related decrease in cardio-pulmonary function
would enhance susceptibility to oxidant induced injury. Therefore, even
though the estimates for the dose-response relationship for these groups
cannot be evaluated objectively, they seem reasonable.
There was general agreement by the experts that patients who were compromised
by either a viral or bacterial illness would have enhanced susceptibility
to oxidant induced abnormalities. Good agreement was observed on the
estimates by the experts of the dose-response relationship for discomfort,
disability, and incapacity in 10%, 50% and 90% of individuals with acute
viral bronchitis and influenza. According to the experts, cough (discomfort),
dyspnea (disability), bacterial pneumonia or acute respiratory failure
(incapacity) would result in children and elderly from exposure to levels
of photochemical oxidant that were less than the levels necessary to
produce discomfort, disability, or incapacitation in healthy adults. The
two infections of the lower respiratory tract were affected to a similar
degree with 90% of infected individuals experiencing increased dyspnea
at 0.80 ppm of oxidant and increased cough at 0.60 ppm. Ten percent of
the infected population would be incapacitated from either superimposed
bacterial pneumonia (influenza) or acute respiratory failure (viral
bronchitis) by exposure to 0.65 or 0.60 ppm of oxidant. Exposure to 0.30
ppm of oxidant would cause discomfort as manifested by cough or with
influenza cough and pleuritic pain. The estimates by the experts also
showed statistical agreement regarding increased sensitivity to oxidant
exposure for the 10%, 50%, and 90% population categories in individuals
with upper respiratory infections. The concentrations of oxidant
necessary to produce adverse effects of discomfort, disability and
incapacity were slightly higher than those necessary to produce the same
effect in patients with influenza or viral bronchitis. Although the
estimates of the levels of oxidant which would cause increases in dis-
-64-
-------
comfort, disability and incapacity for the various population categories
with bacterial pneumonia were usually not statistically significant, the
trend parallelled the estimated values for influenza. None of the estimates
for these disease states showed good group agreement in the 0% population
category. Hence, it would appear that the experts agreed that exposure
to 0.30 ppm or higher of oxidant would be harmful to some individuals with
acute infection but they could not agree on the lower limit of oxidant
sensitivity. The conclusion that oxidant exposure would enhance symptoms
or worsen already present dysfunction is consistent with a large body of
evidence indicating an additive interaction of oxidant exposure and
2 3 32 35
infection. ' ' The estimates for concentrations of oxidant which
would cause discomfort, disability and incapacity are quantitatively similar
20 21
to ones which cause cough and dyspnea in normal individuals, ' depress
TO 'JJ 00
resistance to bacterial infection in murine models ' ' and result in
33 39 40
murine pneumonia. * ' The conclusion that already infected individuals
will have enhanced susceptibility to ozone induced abnormalities is also
supported by data obtained in volunteers in which stress such as exercise
41
significantly increased sensitivity to oxidant damage.
According to the experts, patients with chronic lung disease would mani-
fest increased sensitivity to photochemical oxidants if their underlying
illness involved infection. Althought the dose-response estimates did
not always have good group agreement, the overall trend for the expert
opinion indicates that patients with chronic respiratory illnesses of a
non-infectious nature such as a pneumoconiosis or sarcoidosis are not
inordinately sensitive to photochemical oxidants. The only experimental
data which bear on this point consist of murine experiments in which mice
with silicosis were exposed to atmospheres of photochemical oxidant
42
42
(0.38 - 1.59 ppm) during a bacterial challenge. The presence of
silicosis did not affect murine ability to resist the bacterial challenge.
It should be noted that this apparent lack of interaction between the
presence of a pneumoconiosis and susceptibility to infection is contrary
to the accepted clinical assumption that such an interrelationship does
exist.43'44
-65-
-------
The experts uniformly considered photochemical oxidant exposure as a
precipitating cause of dyspnea (discomfort), exacerbation of bronchitis
(disability) and bronchopneumonia (incapacity) in patients with chronic
obstructive lung disease. Except for the 0% population category, good
agreement among the experts was shown in almost all of the dose-response
estimates. Respiratory abnormalities would be exacerbated in 90% or more
of patients with mild chronic respiratory disease by exposure for one hour
to higher concentrations of photochemical oxidant 0.6 ppm or more. At
these levels of exposure patients with mild chronic respiratory disease
tolerated photochemical oxidant less well than comparably aged healthy
adults. The experts were also in agreement that this difference in
sensitivity would not exist at the lower levels of exposure. Comparison
of the predictions for discomfort, disability, and incapacitation of 10%
of the population shows that patients with mild chronic respiratory disease
can withstand the same or slightly higher levels of exposure as well as
healthy adults. Discomfort, disability and incapacity were markedly increased
in patients with severe chronic respiratory disease by exposure to photo-
chemical oxidant. The dose-response estimates uniformly indicated a 25 to
40% increase in sensitivity to photochemical oxidants for all segments of
this population category. The threshold level at which a minimal effect
defined in this case as dyspnea, might be expected was in the range of 0.20
to 0.30 ppm. The few studies which have been performed in individuals with
severe chronic respiratory disease are in agreement with the conclusion
that this population group is most susceptible to the deleterious effects
43 44
of photochemical oxidant. ' Experimental evidence which has been
1 32 33 37-40 45
previously cited ' ' ' ' further supports the experts' contention
that the presence of severe underlying lung disease, hypoxia, and infection
provides a uniquely susceptible substrate for oxidant induced damage.
The experts' estimates of the dose-response relationship for discomfort,
disability and incapacity of 10,50, and 90% of individuals with mild or
severe heart conditions tended to agree in most instances. According to
the experts 20% or more of patients with mild heart disease were likely
to develop discomfort due to dyspnea after exposure to 0.40 ppm or more
-66-
-------
of oxidant. More serious disability (congestive heart failure) was predicted
after exposure to 0,60 ppm or greater. Pulmonary edema could be anticipated
in some patients who were exposed to 0.8 ppm or greater and the lower
threshold for effect (0% population} was estimated to be 0.35 ppm. The
predicted oxidant concentrations which would cause discomfort (dyspnea)
were slightly higher than concentrations that were estimated to cause the
same effect in the elderly. The fact that slightly higher concentrations of
oxidant were estimated to be necessary to cause disability or incapacitation
in patients with mild heart disease than in the elderly can be attributed
to differences in the medical conditions which were queried in regard to
these conditions. Much more severe conditions, heart failure or pulmonary
edema, were chosen for these responses because they represent the major
consequences of oxidant exposure in patients with heart disease. The
experts predicted discomfort (worsening of congestive heart failure),
disability (pulmonary edema), and incapacitation (angina or myocardial
infarction) in 10% of this population group for exposure levels which
exceeded 0.40 pprn, 0.52, and 0.60.
The experts' opinions were probably based at least in part on the edemag-
enic properties of ozone. Edema formation with resultant pulmonary
congestion, bronchoconstricticn, hypoxia and secondary infection is the
ige
26
1 27 28
major cause of toxicity in humans. ' ' In normals pulmonary congestion
due to ozone induced edema occurs after exposure to 0.8 to 1.7 ppm.
"urnerous experimental studies have demonstrated edema formation after
47 48
exposure to as little as 0.5 ppm of ozone. ' The estirate that some
individuals already compromised by heart failure might develop pulmonary
edema after exposure to 0.52 ppm of ozone agrees with these data. Neither
epidemiological nor experimental data bearing on the relationship of oxidant
exposure to angina pectoris or rnyocerdial infarctions has been reported.
However, the increased sensitivity to ozone during exercise suggests that
under normal circumstances individuals with severe coronary disease may
be stressed sufficiently by exposure to oxidant to infarct compromised
tissues.
-67-
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Excellent agreement among the experts existed in the dose-response estimates
for 10, 50, and 90% of individuals with allergic conditions (asthma, hay
fever or sinusitis). According to the experts concentrations of 0.6
to 1.0 ppm of oxidant would incapacitate asthmatic patients (status
asthmaticus) or patients with hay fever, or sinus.itis (nasal or sinus
drainage and headache), concentrations of 0.4 to 0.8 ppm would cause dis-
ability (asthmatic attack, nasal or sinus drainage) and concentrations of
0.3 to 0.6 ppm would cause discomfort (dyspnea, nasal or sinus discomfort).
As was the case with most of the disease categories, the threshold estimates
below which no effect would occur were unreliable.
This finding of good agreement among the experts for most of the dose-
response estimates as regards asthma is not surprising since data exist
from human and non-human investigations proving that bronchoconstriction
1 2 20 32 39
is a very sensitive index of oxidant exposure. ' ' ' ' The uniform
occurrence of ozone induced bronchoconstriction is the basis for the general
belief that oxidant exposure precipitates respiratory abnormalities in
asthmatic individuals, Data proving this association, however, are meager.
This is in part due to the understandable reluctance of investigators
to expose patients with asthma to oxidant atmospheres. The one published
epidemiological study indicates that a rather small proportion (less
than 6%) of asthmatics may have attacks precipitated when oxidant concen-
50
trations exceed 0.25 ppm. Data from experiments with guinea pigs
confirm the likelihood of this relationship, as animals that were exposed
to ozone prior to inhaling acetylcholine manifested immediate respiratory
51 52
embarrassment similar to anaphylaxis. '
Neither human nor non-human data exists interrelating hay fever or sinusitis
to oxidant exposure. In this disease state, it would appear that the
uniformity of expert opinion represented an extrapolation from the
assumptions made for asthmatic patients. Whether this explanation is true
or not can only be tested by asking the experts the reasons for their
virtually identical estimates.
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Nitrogen Dioxide
In contradistinction to the uniformity of opinion concerning the dose-
response relationships for oxidant exposures, almost all of the estimates
for nitrogen dioxide lacked significance. Group agreement did not occur
for any values among the normal adult, child, or elderly population groups.
This is not surprising since few human studies of the effect of acute
exposure to nitrogen dioxide have been performed, and these have usually
tested respiratory function rather than clinical response. ' ~ Experi-
mental data from these and other relevant studies are summarized in Table 32.
Nakamura had 15 healthy persons inhale 6 to 40 ppm of nitrogen dioxide for
five minutes and found that airway resistance increased by 24 percent
53
just after termination of inhalation. Suzuki and Ishikawa had 10 healthy
persons inhale 0.7 to 2.0 ppm of nitrogen dioxide for 10 minutes and found
that the effective compliance, expiratory and inspiratory resistances did
not change immediately after inhalation was discontinued, but did change
54
at 10 minutes post inhalation. According to these data the inspiratory
resistance rose by 50 percent on the average, the expiratory resistance
rose by 15 percent (average), and the effective compliance decreased by
approximately 10 percent. In a similar kind of human experiment Abe
observed a post inhalation increase in expiratory and inspiratory flow
resistance in healthy adults who were exposed for 10 minutes to 4.0 to
cc
5.0 ppm of nitrogen dioxide. These abnormalities were quite marked.
At 30 minutes after exposure the expiratory resistance was increased by
77 percent and the inspiratory resistance by 92 percent. These investi-
gators did not mention patient symptomatology either during or following
exposure to nitrogen dioxide. Hence, any prediction as to discomfort,
disability, or incapacity in "normals" is of necessity conjectural. The
lack of information in regard to nitrogen dioxide induced symptoms un-
doubtedly accounts for the difference in group agreement between oxidant
and nitrogen dioxide dose-response relationships.
Some group agreement occurred in certain estimates for infections such
as viral bronchitis, upper respiratory infections and influenza. The
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TABLE 32: Summary of Experimental Data on Nitrogen Dioxide
Effects Relevant to the Delphi Data
Concentration
(ppm)
6-40
0.7-2.0
4-5
25 or
higher
150-200
> 200
3.5
4-5
Exposure
Time
5 minutes
10 minutes
10 minutes
< 1 hour
--
--
2 hours
1 hour
Subjects
Human
Human
Human
Human
Human
Human
Mice
Human
Effects
Increase in airway resistance
by 24%
Expiratory resistance in-
creased by 15%; inspiratory
resistance increased by 50%
30 minutes after exposure,
expiratory resistance in-
creased by 77%, and inspira-
tory resistance by 92%
Bronchiolitis and
pneumonitis
Fatal pulmonary fibrosis
Acute pulmonary edema and
death
Increased incidence of
bacterial pneumonia and
death
Decrease in arterial partial
pressure of 03; increase in
alveolar-arterial 02
pressure gradient
Reference
53
54
55
2, 58
1, 2
1, 2, 59
60
56, 57
-70-
-------
experts predicted that one hour exposures to 3.0 ppm of nitrogen
dioxide would cause disability (dyspnea) in 10% of individuals with
viral bronchitis and that exposure to 4.0 ppm would cause disability
in 50%. The threshold level for this effect in 0% of the population
was estimated to be 1.5 ppm. Discomfort due to cough was predicted in
10% of individuals with viral bronchitis following exposure to 2.1 ppm
of nitrogen dioxide and in 50% following exposure to 3,5 ppm. Similarly
trustworthy estimates in regard to upper respiratory infections were
3.0 ppm for disability in 10% of the population and 3.1 ppm for discomfort
(cough) in 50%. A threshold value of 2.45 ppm was agreed upon for incapa-
city (acute respiratory failure) in influenza and 3.0 ppm for discomfort
in 50% of patients with influenza. Acute exposure to nitrogen dioxide
is an uncommon occupational hazard of workers manufacturing nitric acid,
of farmers (exposed to silage--silo fillers' disease), and of electric arc
workers. Although there is a considerable body of information indicating
that exposure to nitrogen dioxide enhances susceptibility to infection,
it is difficult to use extrapolations from these data as a comparison for
the Delphi predictions. Exposure to 25 ppm or higher for periods of less
p r n
than one hour has resulted in bronchiolitis and pneumonitis. ' Comparably
1 2
short periods of exposure to 150-200 ppm causes fatal pulmonary fibrosis. '
1 2 59
Higher exposures are associated with acute pulmonary edema and death. ' '
Because these exposures were accidental in nature, the values cited are at
best crude estimates of concentration and duration. Experimental studies
have confirmed the cause and effect relationship between exposure to nitrogen
dioxide and diminished pulmonary resistance to infection. " Exposure of
mice to fixed concentrations of 3.5 ppm of nitrogen dioxide for two hours
prior to infection with virulent Klebsiellal organisms results in a
significantly increased incidence of bacterial pneumonia and death.
Further studies with this murine model have demonstrated that the nitrogen
dioxide induced impairment in bacterial resistance is due to injury to
the alveolar macrophage system. According to these experimental data
the threshold level for the antibacterial defect is 7.0 ppm for a 4-hour
exposure and 2.3 ppm for a 17 hour exposure. Exposure to nitrogen dioxide
concentrations of 5 ppm or more for 24 hours has been shown to enhance the
rn
susceptibility of non-human primates to influenza infection. These
-71-
-------
studies are in accordance with the opinion of the experts that exposure
to nitrogen dioxide enhances pulmonary susceptibility to infection.
However, the evidence is too fragmentary to allow quantisation of the
dose-response relationship.
Good group agreement was found in the expert estimates of the threshold
level for incapacity and disability in 0% of patients with severe
chronic obstructive pulmonary disease. Evidence for the validity of
these estimates (1.75 ppm - incapacity; 1.30 ppm - disability) has
recently been presented by Von Nieding and associates. ' These
investigators showed that a one hour exposure to 4 or 5 ppm of nitrogen
dioxide would significantly decrease the arterial partial pressure of
oxygen and significantly increase the alveolar-arterial oxygen pressure
gradient. Confirmation of these data would indicate that the experts'
seemingly low estimates of 1.30 or 1.75 ppm were realistic predictions
for populations with severe chronic obstructive pulmonary disease. There
was little agreement among the experts on the estimates for the various
percentages of patients with mild or severe heart disease, asthma, hay
fever or sinusitis. This lack of agreement by the experts can be attributed
to a paucity of information concerning the dose-response relationship for
these population categories.
Carbon Monoxide
Unlike the problem involved with oxidants in which secondary disease such
as infection is often the principle complication, carbon monoxide exerts
its toxic effect directly by combining with hemoglobin to form carboxy-
hemoglobin. The high affinity of carbon monoxide for the hemoglobin molecule,
210 times greater than oxygen, results in physiological loss of the oxygen
carrying capacity of the blood. In addition to reducing the oxygen carrying
capacity of the blood, carboxyhemoglobin interferes with the release of
oxygen by the hemoglobin molecule. ' Hypoxia of varying severity is a
direct consequence of these two effects. Functional impairment and tissue
injury parallel the extent of exposure as this duration determines the
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-------
degree of hypoxia. Experimental data on CO effects relevant to this study
is summarized in Table 33.
TABLE 33: Summary of Experimental Data on Carbon Monoxide Effects
Releant to the Delphi Data
Concentration
(ppm)
1000
500
100
53
50
50-100
Exposure
Time
--
1 hour
.5-2 hours
1.5 hours
2 hours
4 hours
Subjects
Human
Human
Human
Human
Human
Human
Effects
Vomiting, coma, death
Mild to throbbing headache
Increased COHb from 1% to
5-10%; interference with
higher integrative function
Shortened mean time to angina
Shortened mean time to angina
Shortened mean time to angina
Reference
65
65
66-68
69
70
71
Because carbon monoxide toxicity is a common medical problem, much research
has been performed in patients with clinical illness as well as volunteers.
In normal individuals, the toxic effects of carbon monoxide as a result
65
of acute, high level exposure are the following: Concentrations over
1000 ppm typically cause vomiting, coma, and death. Exposure to 500 ppm
for one hour will produce a blood concentration of 20% carboxyhemoglobin
and cause mild or throbbing headaches. Exposure to 100 ppm increases the
blood carboxyhemoglobin level from 11% (normal) to 5-10%. Interference with
higher integrative functions such as vigilance, coordination, and psychomotor
fifi CO
function has been observed at these levels of carboxyhemoglobin. '
Whether similar impairments of mentation occur at lesser levels of exposure
such as 50 ppm (carboxyhemoglobin of less than 5%) is uncertain.
The dose-response estimates of the experts reflect this information. Good
group agreement is present for the 10%, 50%, and 90% segments of almost
-73-
-------
every population category, normal as well as abnormal, in regard to the
presence of discomfort (mild headache, errors in cognitive function) at
exposure levels of .approximately 100 ppm. More precisely, one hour exposures
to carbon monoxide levels of 80 ppm will cause discomfort in 10% of children
and the elderly, levels of 103-120 ppm will cause discomfort in 50% of
children, adults and the elderly and levels of 130 or 140 will cause dis-
comfort in 90% of adults and the elderly. These values are virtually
r /" CG
identical to the previously cited results in volunteers. ~ There is
no group agreement on the estimates for the threshold level. The absence
of agreement may reflect the discordance in results of dose-response
testing which has been reported by different investigators. It is of
interest that the common value even though not agreed upon by the group is
very similar to the federal standard of 35 ppm for one hour.
With one exception the dose-response estimates in regard to the presence
of disability were non-uniform. Disability was defined as a throbbing
headache, confusion, irritability or dizziness. The average estimate
tended to be between 100 and 200 ppm. Similarly, with three exceptions
which will be subsequently discussed, the estimates for incapacity did
not show agreement.
The only population categories with some consensus regarding concen-
trations of carbon monoxide likely to cause incapacity or disability
were severe heart disease and severe chronic pulmonary disease. The
experts predicted the occurrence of angina pectoris, arrythmia, coma
or convulsions in 50% of individuals with severe heart disease following
a one hour exposure to 180 ppm of carbon monoxide. Good agreement also
occurred in the prediction that the threshold level for a 0% result in
this population category was 60 ppm. Both of these estimates are much
below those for all other patient categories. The uniformity in these
estimates as opposed to the lack of group consensus for most of the other
patient categories can be attributed to the widespread knowledge of
Aronow's studies in which angina pectoris and arrythmia's were induced
in patients with cardiac conditions who were exposed to 50 or 100 ppm
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-------
of carbon monoxide. ' ' The group consensus in regard to the threshold
for incapacity for 0% population with severe chronic obstructive pulmonary
disease can be attributed to a uniform opinion that at least some of these
patients are so sensitive to any additional stress that any increase in
hypoxia will result in respiratory failure.
-75-
-------
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Induced Angina Pectoris. Ann. Int. Med. 79:392-395, 1973.
71. Anderson, E.W., R.J. Andelman, J.M. Strauch, N.J. Fortuin, and
J.H. Knelson. Effects of Low-Level Carbon Monoxide Exposure on Onset
and Duration of Angina Pectoris: A Study in Ten Patients With Ischemic
Heart Disease. Ann. Intern. Med. 79-46-50, 1973.
-83-
-------
APPENDIX A
QUESTIONNAIRES
CONTENTS
Page
I. PHOTOCHEMICAL OXIDANT
A. Normal 87
B. Children 88
C. Old Age 89
D. Heart Condition, Mild 90
E. Heart Condition, Severe 91
F. Hay Fever, Sinusitis 92
G. Influenza 93
H. Upper Respiratory Infection 94
I. Asthma 95
J. Acute Viral Bronchitis 96
K. Acute Bacterial Pneumonia 97
L. Chronic Respiratory Disease 98
M. Mild Chronic Obstructive Lung Disease 99
N. Severe Chronic Obstructive Lung Disease 100
II. NITROGEN DIOXIDE
A. Normal 102
B. Children 103
C. Old Age 104
D. Heart Condition, Mild 105
E. Heart Condition, Severe 106
F. Hay Fever, Sinusitis 107
G. Influenza 108
H. Upper Respiratory Infection 109
I. Asthma 110
J. Acute Viral Bronchitis Ill
K. Acute Bacterial Pneumonia 112
L. Chronic Respiratory Disease 113
M. Mild Chronic Obstructive Lung Disease 114
N. Severe Chronic Obstructive Lung Disease 115
III. CARBON MONOXIDE
A. Normal 117
B. Children 118
C. Old Age 119
D. Heart Condition, Mild 120
E. Heart Condition, Severe 121
F. Hay Fever, Sinusitis 122
G. Influenza 123
H. Upper Respiratory Infection 124
I. Asthma 125
J. Acute Viral Bronchitis 126
K. Acute Bacterial Pneumonia 127
L. Chronic Respiratory Disease 128
M. Mild Chronic Obstructive Lung Disease 129
N. Severe Chronic Obstructive Lung Disease 130
-85-
-------
QUESTIONNAIRES FOR PROJECT
"HUMAN HEALTH DAMAGES FROM MOBILE SOURCE AIR POLLUTION"
PHOTOCHEMICAL OXIDANT
The following questions apply to all population categories included in this study.
Please use the attached sheets for your answers. The answers should be marked on
the graphs and in boxes of appropriate column provided for each question.
(1) Please indicate by an X the pollutant concentrations which if present for one
hour cause 90% of the stated population to suffer incapacity*, disability* and
discomfort*. Indicate by a Y on both sides of your X, the range of pollution
concentrations which will produce the indicated health responses for 90% of
this population; by that we mean the lower limit Y^_, as the concentration at
which you feel there is only a 5% chance the true answer would be below this
estimate and the upper limit, Y.., as the concentration at which you feel there
is only a 5% chance the true answer would exceed your estimate. In instances
in which a health response occurs, write down the average duration of discomfort
(hrs.), disability (hrs.), and incapacity (hrs.) in the boxes under Column (1)
on the right. Indicate your degree of assurance concerning your answer in
Column (2). Use a scale 1-10 where 10 means "I know the answer very well" and
1 means, "my answer is a sheer guess". Considerations to take into account in
making this judgment are, how good is the information concerning this item; how
well can it be estimated, etc. If you believe that the response will occur at
concentrations higher than those given in the scale, write these estimates in
the space above the graphs.
(2) Please indicate by an X the pollutant concentrations which if present for one
hour cause 50% of the stated population to suffer incapacity*, disability* and
discomfort*. Indicate by a Y on both sides of your X, the range of pollution
concentrations which will produce the indicated health responses for 50% of
this population; by that we mean the lower limit YL, as the concentration at
which you feel there is only a 5% chance the true answer would be below this
estimate and the upper limit, Yy, as the concentration at which you feel there
is only a 5% chance the true answer would exceed your estimate. In instances
in which a health response occurs, write down the average duration of discomfort
(hrs.), disability (hrs.), and incapacity (hrs.) in the boxes under Column (1)
on the right. Indicate your degree of assurance concerning your answer in
Column (2). Use a scale 1-10 where 10 means "I know the answer very well" and
1 means, "my answer is a sheer guess". Considerations to take into account in
making this judgment are, how good is the information concerning this item; how
well can it be estimated, etc. If you believe that the response will occur at
concentrations higher than those given in the scale, write these estimates in
the space above the graphs.
(3) Please indicate by an X the pollutant concentrations which if present for one
hour cause 10% of the stated population to suffer incapacity*, disability* and
discomfort*. Indicate by a Y on both sides of your X, the range of pollution
concentrations which will produce the indicated health responses for 10% of
this population; by that we mean the lower limit Y|_, as the concentration at
which you feel there is only a 5% chance the true answer would be below this
estimate and the upper limit, Yy, as the concentration at which you feel there
is only a 5% chance the true answer would exceed your estimate. In instances
in which a health response occurs, write down the average duration of discomfort
(hrs.), disability (hrs.), and incapacity (hrs.) in the boxes under Column (1)
on the right. Indicate your degree of assurance concerning your answer in
Column (2). Use a scale 1-10 where 10 means "I know the answer very well" and
1 means, "my answer is a sheer guess". Considerations to take into account in
making this judgment are, how good is the information concerning this item; how
well can it be estimated, etc. If yoi: believe that the response will occur at
concentrations higher than those given in the scale, write these estimates in
the space above the graphs.
(4) Please indicate by an X the pollutant concentrations which if present for one
hour cause 0% of the stated population to suffer incapacity*, disability* and
discomfort*. Indicate by a Y on both sides of your X, the range of pollution
concentrations which will produce the indicated health responses for 0% of
this population; by that we mean the lower limit YL, as the concentration at
which you feel there is only a 5% chance the true answer would be below this
estimate and the upper limit, Yy, as the concentration at which you feel there
is only a 5% chance the true answer would exceed your estimate. Indicate your
degree of assurance concerning your answer in Column (2). Use a scale 1-10
where 10 means "I know the answer very well" and 1 means, "my answer is a sheer
guess". Considerations to take into account in making this judgment are, how
good is the information concerning this item; how well can it be estimated, etc.
-86-
-------
POLLUTANT: PHOTOCHEMICAL OXIDANT
POPULATION CATEGORY:
NORMAL
(1)
INCAPACITY
DISABILITY
DISCOMFORT
DEFINITION OF CONDITIONS:
* Incapacity = may precipitate
respiratory ar.d carci;
problems, bror.cho-
pneumonia
* Disability = headache
* Discomfort = eye irritation, non-
productive coughing,
chest tightness
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
1.8 20
(2)
INCAPACITY
DISABILITY
DISCOMFORT
I I
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1.8
1 2
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1 2
_J I
1.8 2.0
INCAPACITY
DISABILITY
DISCOMFORT
W
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
-87-
1.8 2.0
INCAPACITY
DISABILITY
DISCOMFORT
-------
POLLUTANT: PHOTOCHEMICAL OXIDANT
POPULATION CATEGORY:
CHILDREN"
" Children - healthy children of less than
10 years of age.
(1)
INCAPACITY
DISABILITY
DISCOMFORT
DEFINITION OF CONDITIONS:
' Incapacity =• may precipitate
respiratory and cnrJi:
problems, broncho-
pneumonia
* Disability = headache
* Discomfort = eye irritation, non-
productive coughing,
chest tightness
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1 2
INCAPACITY
DISABILITY
DISCOMFORT
(2) 50$
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1.8
1 2
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
nuroMervDT
1C#
1 2
i i i > i i i i i i
I i i t i t i i > i
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
CO
INCAPACITY
DISABILITY
DISCOMFORT
&
' 2
0.2 0.4 0.6 .0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1.8 2.0
INCAPACITY
DISABILITY
DISCOMFORT
-------
POLLUTANT: PHOTOCHEMICAL OXIDANT
POPULATION CATEGORY:
OLD AGE"
** Old age - patients who have no proven
underlining disease but who on an
epidemiologic basis are likely to have
senile emphysema and arteriosclerotic
cardiovascular disease (ASCVD).
DEFINITION OF CONDITIONS:
* Incapacity = acute respiratory failure
• Disability = bronchitis
* Discomfort = hyspnea
(1)
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
i 2
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
' 7
1 1 1 1 1 1 1 1 1 f
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
co
INCAPACITY
DISABILITY
DISCOMFORT
05*
' 2
ifiiiifiii
i i i i i 1 1 i • 1
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1.8 2.0
INCAPACITY
DISABILITY
DISCOMFORT
-89-
-------
POLLUTANT: PHOTOCHEMICAL OXIDANT
POPULATION CATEGORY:
HEART CONDITION, MILD"
•' Heart condition due to any etiology such
as arteriosclerotic cardiovascular disease
(ASCVD), rheumatic heart disease, hyper-
tension, ASCVD without evidence of
congestive heart failure.
DEFINITION OF CONDITIONS:
* Incapacity = pulmonary edema
* Disability = congestive heart
failure
* Discomfort = dyspnea
(1)
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
50#
i i i i i i i i i i
i i t i i i t i i i
i i i i i i i i i t
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
' 2
1 1 1 1 1 1 1 1 1 |
1 1 1 I 1 * 1 1 1 1
INCAPACITY
DISABILITY
DISCOMFORT
CO
INCAPACITY
DISABILITY
DISCOMFORT
0*
i o
i ii ii tii ' j
iiitiiii|i
i i i i i i i i . |
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-90-
-------
POLLUTANT: PHOTOCHEMICAL OXIDANT
POPULATION CATEGORY:
HEART CONDITION, SEVERE"
** Heart condition due to any etiology such as
arteriosclerotic cardiovascular disease
(ASCVD), hypertension, rheumatic heart
disease with clinical evidence of heart
failure.
DEFINITION OF CONDITIONS:
* Incapacity - angina or a inyor:ir>!i:
infarctior.
' Disability - pulmonary cvieirm
* Discomfort = worsening •.-or.fOL-i i vo
heart failure
(1)
INCAPACITY
DISABILITY
DISCOMFORT
9C#
t i i i i i i i i i '
i i i i i i i i i i
i i i i i i i i i i
INCAPACITY
DISABILITY
DISCOMFOR1
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (.PPM)
(2)
INCAPACITY
DISABILITY
50$
' 2
» 1 » 1 1 1 1 t 1 f
1 1 I 1 1 1 1 1 1 1
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DKCOMFOBT
1C$
1 2
i i i I i i i i < i
INCAPACITY
DISABILITY
DISCOMFORT
CO
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.3 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
-91-
INCAPACITY
DISABILITY
DISCOMFORT
-------
POLLUTANT: PHOTOCHEMICAL OXIDANT
POPULATION CATEGORY:
HAY FEVER, SINUSITIS
DEFINITION OF CONDITIONS:
* Incapacity = nasal or Sinus drainage
and headache
* Disability - nasal or sinus drainage
• Discomfort = nasal or sinus discoml'ort
(1)
INCAPACITY
DISABILITY
DISCOMFORT
1 2
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
j i
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
1 2
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
1 2
INCAPACITY
DISABILITY
DISCOMFORT
1 2
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0-8 1-0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-92-
-------
POLLUTANTS PHOTOCHEMICAL OXIDANT
POPULATION CATEGORY:
INFLUENZA
DEFINITION OF CONDITIONS:
* Incapacity = superimposed bacterial
pneumonia
• Disability = dyspnea
• Discomfort = increased cough ar.d
pleuritic pain
(1)
INCAPACITY
DISABILITY
DISCOMFORT
1 2
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 O.B 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
(2)
INCAPACITY
DISABILITY
DISCOMFORT
1 2
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 06 O.B 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
1 2
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
(4)
INCAPACITY
DISABILITY
DISCOMFORT
1 2
j i i
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
-93-
-------
POLLUTANT: PHOTOCHEMICAL OXIDANT
POPULATION CATEGORY:
UPPER RESPIRATORY INFECTION
DEFINITION OF CONDITIONS:
' Incapacity = secondary bacterial
infection
' Disability = need medication and rest
' Discomfort = worsening symptonc
(1)
INCAPACITY
DISABILITY
DISCOMFORT
0.7 0.4 06 0.8 1.0 1.2 1.4 1.6 1.8 20
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
1 2
IINLACACI 1 T
DISCOM FORT
<3)
1 N C A P AC 1 T Y
CO
INCAPACITY
DISABILITY
nurOMPOHT
i i i i i i i i i i
i i i i i i i i t i
0.2 0.4 0.6 0.8 1.0 1.2 J.4 V6 1.8 20
CONCENTRATION (PPM)
i i i i i t i i i i
iiitiiiiii
i i i i i i i i i i
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
0#
i i i i i i i > i i
t i i i t i i i i i
i i i i i i i > i i
i
i
2
2
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
-94-
1.8 2.0
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
-------
POLLUTANT-. PHOTOCHEMICAL OXIDANT
POPULATION CATEGORY-'
ASTHMA
DEFINITION OF CONDITIONS:
* Incapacity = status asthmat i i-'
* Disability = asthmatic attack
* Discomfort .-. dyspnea
(1)
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
I 2
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
I I
I I I I 1 I J
_J I
i i
1 2
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISARIl ITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
CO
INCAPACITY
DISABILITY
nicrOMFORT
a*;
' 2
I 1 1 I I I I I 1 i
0.2 0.4 0.6 0.8 10 1.3 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-95.
-------
POLLUTANT: PHOTOCHEMICAL OXIDABT
POPULATION CATEGORY:
ACUTE VIRIAL BRONCHITIS
DEFINITION OF CONDITIONS:
' Incapacity = acute respiratory
failure
* Disability = dyspnea
* Discomfort = cough
(1)
INCAPACITY
DISABILITY
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
' Z
i i i i i i I i i i
I i i i i i I > i j
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1.8 2.0
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
nKCOMFOOT
l i i i i t I i i i 12
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1.8 2.0
INCAPACITY
DISABILITY
DISCOMFOR
CO
INCAPACITY
DISABILITY
nurOMFOBT
<$,
1 2
i i t i t i i i i f
i i i i t i i i i I
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1.8 2.0
INCAPACITY
DISABILITY
DISCOMFOR
-96-
-------
POLLUTANT! PHOTOCHEMICAL OXIDANT
POPULATION CATEGORY:
ACUTE BACTERIAL PNEUMONIA
DEFINITION OF CONDITIONS:
* Incapacity = acute respiratory
failure
• Disability = dyspnea
* Discomfort = cough
(1)
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1.8 2.0
1 2
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
l i
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1.8
1 2
INCAPACITY
DISABILITY
OlSCOMfORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1.8 2.0
1 2
INCAPACITY
DISABILITY
DISCOMFORT
CO
INCAPACITY
DISABILITY
DISCOMFORT
1 2
1 1 1 1 1 1 1 1 1 1
1 t 1 1 1 1 1 1 1 |
0.2 0.4 0.6 O.i 1-0 1.2 1.4 (.6
CONCENTRATION (PPM)
1.8 2.0
INCAPACITY
DISABILITY
DISCOMFORT
-97-
-------
POLLUTANT:
POPULATION CATEGORY:
CRRONIC RESPIRATORY DISEASES"
•* Chronic respiratory diseases of a non-
infectioue nature such as pneumoconiosis,
or sarcoidoeis.
OXIDANT
DEFINITION OF CONDITIONS:
' Incapacity = pneumonia
* Disability = respiratory infection
* Discomfort = dyspnea
(1)
INCAPACITY
DISABIUTY
DISCOMFORT
J ' '
1 2
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
(2)
INCAPACITY
DISABILITY
DISCOMFORT
1 2
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
(3)
INCAPACITY
DISABILITY
DISCOMFORT
I I
1 2
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
(it) OS
INCAPACITY
DISABILITY
DISCOMFORT
1 2
1 I 1 1 1 1 1 1 f 1
Illltlflfl
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
-98-
-------
POLLUTANT: PHOTOCHEMICAL OXIDANT
POPULATION CATEGORY:
MILD CHRONIC OBSTRUCTIVE LUMG DISEASE"
*" Patients with mild chronic obstructive
pulmonary disease are defined as individuals
who expectorates purulent sputum for periods
of at least three months during each year.
DEFINITION OF CONDITIONS:
' Incapacity = broncho-pneumonia,
cor pulmonale
' Disability = exacerbation of
bronchitis, fever aiui
increased sputum pro-
duction and chest pair;
' Discomfort = dyspnea
(1)
INCAPACITY
DISABILITY
DISCOMFORT
90*
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1 2
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
50&
' *
i i * i i i i t » i
i i i i i i i i i i
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
i.a 2.0
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
CONCENTRATION (PPM)
1.8 2.0
INCAPACITY
DISABILITY
DISCOMFORT
U)
INCAPACITY
DISABILITY
IKrOMFOfiT
c#
' 2
1 1 1 t 1 1 1 1 [ 1
i i i I i 1 I i i |
0.2 0.4 0.6 .0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-99-
-------
POLLUTANT: PHOTOCHEMICAL .OXIDANT
POPULATION CATEGORY:
SEVERE CHRONIC OBSTRUCTIVE LUNG DISEASE'
** Patients with severe chronic obstructive
pulmonary disease are defined as individuals
who in addition to expectorating purulent
sputum for periods of at least three months
during each year, also, have a diminished FEV
and persistent hypoxeraia with arterial blood ,
oxygen tensions of <60 mm hg.
DEFINITION OF CONDITIONS:
* Incapacity = broncho-pneumonia.
cor pultnor.ale
Disability = exacerbation of bror.-
chitis, fever ar.d
increased sputum
production and chest pair
Discomfort = dyspnea
(1)
INCAPACITY
DISABILITY
DISCOMFORT
1 2
(2)
INCAPACITY
DISABILITY
DISCOMFORT
1 1 1 1 1 1 1 1 1 1
1 1 1 1 f 1 1 1 I 1
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
50*;
' 2
i i i i i < I i i i
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
(3)
INCAPACITY
DISABIUTY
rmrnMsnoT
1 2
LI 1 1 1 1 t 1 11
i i i i i i i i i i
i | i i i i i t i i
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
CO
INCAPACITY
DISABILITY
DISCOMFORT
a*
' 2
1 1 t 1 1 1 t 1 1 1
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
CONCENTRATION (PPM)
-100-
INCAPACITY
DISABILITY
DISCOMFORT
-------
QUESTIONNAIRES FOR PROJECT
"HUMAN HEALTH DAMAGES FROM MOBILE SOURCE AIR POLLUTION"
NITROGEN DIOXIDE
The following questions apply to all population categories included in this study.
Please use the attached sheets for your answers. The answers should be marked on
the graphs and in boxes of appropriate column provided for wach question.
(1) Please indicate by an X the pollutant concentrations which if present for one
hour cause 90% of the stated population to suffer incapacity*, disability* and
discomfort*. Indicate by a Y on both sides of your X, the range of pollution
concentrations which will produce the indicated health responses for 90K of
this population; by that we mean the lower limit Y|_, as the concentration at
which you feel there is only a 5% chance the true answer would be below this
estimate and the upper limit, Y.., as the concentration at which you feel there
is only a 5% chance the true answer would exceed your estimate. In instances
in which a health response occurs, write down the average duration of discomfort
(hrs.), disability (hrs.), and incapacity (hrs.) in the boxes under Column (1)
on the right. Indicate your degree of assurance concerning your answer in
Column (2). Lfse a scale 1-10 where 10 means "I know the answer very well" and
1 means, "my answer is a sheer guess". Considerations to take into account in
making this judgment are, how good is the information concerning this item; how
well can it be estimated, etc. If you believe that the response will occur at
concentrations higher than those given in the scale, write these estimates in
the space above the graphs.
(2) Please indicate by an X the pollutant concentrations which if present for one
hour cause 50% of the stated population to suffer incapacity*, disability* and
discomfort*. Indicate by a Y on both sides of your X, the range of pollution
concentrations which will produce the indicated health responses for 50% of
this population; by that we mean the lower limit Y|_, as the concentration at
which you feel there is only a 5% chance the true answer would be below this
estimate and the upper limit, Yy, as the concentration at which you feel there
is only a 5% chance the true answer would exceed your estimate. In instances
in which a health response occurs, write down the average duration of discomfort
(hrs.), disability (hrs.), and incapacity (hrs.) in the boxes under Column (1)
on the right. Indicate your degree of assurance concerning your answer in
Column (2). Use a scale 1-10 where 10 means "I know the answer very well" and
1 means, "my answer is a sheer guess". Considerations to take into account in
making this judgment are, how good is the information concerning this item; how
well can it be estimated, etc. If you believe that the response will occur at
concentrations higher than those given in the scale, write these estimates in
the space above the graphs.
(3) Please indicate by an X the pollutant concentrations which if present for one
hour cause 10% of the stated population to suffer incapacity*, disability* and
discomfort*. Indicate by a Y on both sides of your X, the range of pollution
concentrations which will produce the indicated health responses for 10% of
this population; by that we mean the lower limit Y^, as the concentration at
which you feel there is only a 5% chance the true answer would be below this
estimate and the upper limit, YJJ, as the concentration at which you feel there
is only a 5% chance the true answer would exceed your estimate. In instances
in which a health response occurs, write down the average duration of discomfort
(hrs.), disability (hrs.), and incapacity (hrs,) in the boxes under Column (1)
on the right. Indicate your degree of assurance concerning your answer in
Column (2). Use a scale 1-10 where 10 means "I know the answer very well" and
1 means, "my answer is a sheer guess". Considerations to take into account in
making this judgment are, how good is the information concerning this item; how
well can it be estimated, etc. If you believe that the response will occur at
concentrations higher than those given in the scale, write these estimates in
the space above the graphs.
(4) Please indicate by an X the pollutant concentrations which if present for one
hour cause 0% of the stated population to suffer incapacity*, disability* and
discomfort*. Indicate by a Y on both sides of your X, the range of pollution
concentrations which will produce the indicated health responses for 0% of
this population; by that we mean the lower limit YL, as the concentration at
which you feel there is only a 5% chance the true answer would be below this
estimate and the upper limit, YU, as the concentration at which you feel there
is only a 5% chance the true answer would exceed your estimate. Indicate your
degree of assurance concerning your answer in Column (2). Use a scale 1-10
where 10 means "I know the answer very well" and 1 means, "my answer is a sheer
guess". Considerations to take into account in making this judgment are, how
good is the information concerning this item; how well can it be estimated, etc.
-101-
-------
POLLUTANT: NITROGEN DIOXIDE
POPULATION CATEGORY:
NORMAL
(1)
INCAPACITY
DISABILITY
DISCOMFORT
DEFINITION OF CONDITIONS:
* Incapacity = may precipi :.;He
respiratory rm>i .••\i--i;
problems, bronrl.o-
pneumonia
' Disability = headache
" Discomfort - eye irritation, non-
productive cough in;;,
chest tightness
123
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
50^
INCAPACITY
DISABILITY
DISCOMFORT
1234
CONCENTRATION (PPM)
i i
INCAPACITY
DISABILITY
DISCOMFORT
OJ
INCAPACITY
DISABILITY
n i <:r r»M enDT
1U/6
1 2
i i t i i i i i i i
i i i i i i i i i t
i
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
co ax,
INCAPACITY
DISABILITY
DISCOMFORT
1 2 3
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-102-
-------
POLLUTANT: NITHCGEN DIOXIDE
POPULATION CATEGORY:
CHILDREN"
'* Children - healthy children of less than
10 years of age.
(1)
INCAPACITY
DISABILITY
DISCOMFORT
DEFINITION OF CONDITIONS:
" Incapacity = may precipitate
respiratory :»:..;
cardiac rrobl c::..- .
bror.c:'.o-pneu:;.o:;::
' Disability = headache
" Discomfort - eye i rri: :>.'. iov., ::o::-
prociuc ti ve :'O'.;.t:.i :v .
chesc tit-::-.r.e^s
1234
CONCENTRATION (PPM)
i 2
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
50$
1234
CONCENTRATION (PPM)
1 2
INCAPACITY
OISARII ITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
1234
CONCENTRATION (PPM)
1 2
INCAPACITY
DISABILITY
DISCOMFORT
CO
INCAPACITY
DISABILITY
DISCOMFORT
1 2 3
CONCENTRATION (PPM]
INCAPACITY
DISABILITY
DIS.COMFORT
-103-
-------
POLLUTANT: NITROGEN DIOXIDE
POPULATION CATEGORY:
OLD AGE"
'* Old age - patients who have no proven
underlining disease but who on an
epidemiologic basis are likely to have
senile emphysema and arteriosclerotic
cardiovascular disease (ASCVD).
DEFINITION OF CONDITIONS:
* Incapacity = acute respiratory
failure
* Disability = bronchitis
Discomfort = dyspnea
(1)
INCAPACITY
DISABILITY
DISCOMFORT
1 , • , . ' 2
1 i i i i i i i t I
i i i i i i i i i I
INCAPACITY
DISABILITY
DISCOMFOR1
1234
CONCENTRATION (PPM)
(2)
INCAPACITY
DISABILITY
1 2
1 1 1 1 1 1 1 1 1 I
1 I 1 1 1 1 1 1 | 1
234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
1 2
234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
C*)
INCAPACITY
DISABILITY
DISCOMFORT
, . , . ' 1
1 1 1 1 1 1 1 1 1 f
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-104-
-------
POLLUTANT: NITROGEN DIOXIDE
POPULATION CATEGORY:
HEART CONDITION, MILD"
** Heart condition due to any etiology such as
arteriosclerotic cardiovascular disease
(ASCVD), rheumatic heart disease, hyper-
tension, ASCVD without evidence of
congestive heart failure.
DEFINITION OF CONDITIONS:
* Incaper1. t.y pulmonary eHc«!,''.
Disability = cor.geetive ::«vir'.
i'ail-.ire
Discomfort - dyspnea
(1)
INCAPACITY
DISABILITY
DISCOMFORT
1734
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
50*;
' 2
1 1 1 1 1 1 I 1 | |
1 1 1 1 1 t 1 1 1 1
1234
CONCENTRATION ( PPM)
I 2 3
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
ni srnMFOQT
, , , , , 1 2
1 1 1 1 1 1 1 1 | |
1 1 1 1 1 1 1 » | f
I INCAPACITY
DISABILITY
DISCOMFORT
CO
INCAPACITY
DISABILITY
DISCOMFORT
CONCENTRATION (PPM)
-105-
1 2
INCAPACITY
DISABILITY
DISCOMFORT
-------
POLLUTANT: NITROGEN DIOXIDE
POPULATION CATEGORY:
HEART CONDITION, SEVERE"
** Heart condition due to any etiology such
as arteriosclerotic cardiovascular disease
(ASCVD), hypertension, rheumatic heart
disease with clinical evidence of heart
failure.
DEFINITION OF CONDITIONS:
' Incapacity = angina or a
myocardial infarction
Disability = pulmonary edema
Discomfrot = worsening congestive
heart failure
(1)
INCAPACITY
DISABILITY
ni<;roMFOBT
9<#
i i i i i i i i i , 1 2
1 1 1 I I I 1 i ! 1
1 I I I I I 1 1 1 1
INCAPACITY
DISABILITY
DISCOMFOR1
1234
CONCENTRATION (PPM)
(2)
INCAPACITY
DISABILITY
DISCOMFORT
1234
CONCENTRATION (PPM)
t I
i 2
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
I J_
INCAPACITY
DISABILITY
DISCOMFORT
CONCENTRATION (PPM)
CO
INCAPACITY
DISABILITY
DISCOMFORT
I I
113
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-106-
-------
POLLUTANT: NITROGEN DIOXIDE
POPULATION CATEGORY:
HAY FEVER, SINUSITIS
(1)
INCAPACITY
DISABILITY
DISCOMFORT
• Disabilit
' Di scorn for
90&
i i i i i i i i i i
1 1 1 1 1 1 I 1 ! 1
1 1 t 1 t 1 1 1 1 1
DEFINITION OF CONDITIONS'-
• Incapacity = nasal or si.:1/.;!-
drainage nr.ci r.eariar:
nasal or piiv.is
drainage
nasal or sir.us
discomfort
1234
CONCENTRATION (PPM)
i 2
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
I I I I
234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
1234
CONCENTRATION (PPM)
i 2
INCAPACITY
DISABILITY
DISCOMFORT
CO
INCAPACITY
DISABILITY
DISCOMFORT
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-107-
-------
POLLUTANT: NITROGEN DIOXIDE,
POPULATION CATEGORY:
INFLUENZA
DEFINITION OF CONDITIONS:
* Incapacity =
bacterial pneumonia
* Disability = dyspnea
' Discomfort = increased coup:: ar.d
pleuritic pain
(1)
INCAPACITY
DISABILITY
DISCOMFORT
f 1 1 1 1 1 1
1 1
234
CONCENTRATION (PPM)
1 2
1 1
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
1 1 1 1
1 1 t
1 2
I I
1234
CONCENTRATION (PPM)
(3) 10#
INCAPACITY
DISABILITY
DISCOMFORT
1*
t 1
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
1 2
INCAPACITY
DISABILITY
DISCOMFORT
(t)
INCAPACITY
DISABILITY
DISCOMFORT
1 1
1 1
1 1
1 1
1234
CONCENTRATION (PPM)
-108-
1 2
INCAPACITY
DISABILITY
DISCOMFORT
-------
POLLUTANT: NITROGEN DIOXIDE
POPULATION CATEGORY:
UPPER RESPIRATORY INFECTION
DEFINITION OF CONDITIONS:
' Incapacity = secondary bactennl
infection
' Disability = need medication ?.;•..:
rest
* Discomfort = worsening sy.7.pto::.=
(1)
INCAPACITY
DISABILITY
DISCOMFORT
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
I I
1234
CONCENTRATION (PPM)
i 2
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
1 2 3
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
Cl)
INCAPACITY
DISABILITY
DISCOMFORT
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-109-
-------
POLLUTANT: NITROGEN DIOXIDE
POPULATION CATEGORY:
ASTHMA
DEFINITION OF CONDITIONS:
* Incapacity = status astiimaticus
' Disability = asthmatic attack
* Discomfort = dyspnea
(1)
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
I i (
1234
CONCENTRATION (PPM)
i i i
i * i
1234
CONCENTRATION (PPM)
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
1 2
1
1
1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 ( 1 t
INCAPACITY
DISABILITY
DISCOMFORT
1 2
INCAPACITY
DISABILITY
DISCOMFORT
Co
INCAPACITY
DISABILITY
DISCOMFORT
1234
CONCENTRATION (PPM)
1 2
INCAPACITY
DISABILITY
DISCOMFORT
-110-
-------
POLLUTANT: NITROGEN DIOXIDE
POPULATION CATEGORY:
ACUTE VIRIAL BRONCHITIS
DEFINITION OF CONPITIONS:
* Incapacity = acute respiratory
failure
• Disability = dyspnea
* Discomfort = cough
(1)
INCAPACITY
DISABILITY
DISCOMFORT
1 1
1234
CONCENTRATION (PPM)
1 1
1 t 1
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
1 I
1 1 1 1
I i
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
1 1 1 1 1 t 1
OS
23
CONCENTRATION (PPM)
t I 1 1 1 L t
1234
CONCENTRATION (PPM)
-111-
INCAPACITY
DISABILITY
DISCOMFORT
i i
1 1 1 1 1 1 I 1 1 1
1 1 1 1 1 1 I 1 1 1
INCAPACITY
DISABILITY
DISCOMFORT
-------
POLLUTANT: NITROGEN DIOXIDE
POPULATION CATEGORY:
ACUTE BACTERIAL PNEUMONIA
DEFINITION OF CONDITIONS:
* Incapacity - acute respiratory
T;i i ! '.i rn
" Disability •: dy.st'iioii
' Discomfort - cou£h
(1)
INCAPACITY
DISABILITY
DISCOMFORT
I I I
I 1 I
J I I I
1234
CONCENTRATION (PPM)
1 i
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
(5)
INCAPACITY
DISABILITY
DISCOMFORT
I I
I I
1234
CONCENTRATION (PPM)
I I 1
I i
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
j i
1 2
1734
CONCENTRATION (PPM)
-112-
INCAPACITY
DISABILITY
DISCOMFORT
-------
POLLUTANT: NITROGEN DIOXIDE
POPULATION CATEGORY:
CHRONIC RESPIRATORY DISEASES"
** Chronic respiratory diseases of a non-
infectious nature such as pneuraoconiosis,
or sarcoidodis.
DEFINITION OF CONDITIONS:
' Incapacity = pneumonia
' Disability = respiratory inj'pcrio:
' Discomfort - dvscr.ea
(1)
INCAPACITY
DISABILITY
DISCOMFORT
1234
CONCENTRATION (PPM)
i 2
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
5C$
' 2
t i i i i i i i i i
(3)
INCAPACITY
DISABILITY
DISCOMFORT
1234
CONCENTRATION (PPM)
I 2
INCAPACITY
DISARILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
_» i ( i_
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-113-
-------
POLLUTANT: NITROGEN DIOXIDE
POPULATION CATEGORY:
MILD CHROMIC OBSTRUCTIVE LUNG DISEASE"
** Patients with mild chronic obstructive
pulmonary disease are defined as individuals
who expectorates purulent sputum for periods
of at least three months during each year.
DEFINITION OF CONDITIONS:
* Incapacity = broncho-pneumonia,
cor pulmonale
4 Disability = exacerbation of
bronchitis, fever and
increased sputum
production and chest
pain
* Discomfort = dyspnea
(1)
INCAPACITY
DISABILITY
DISCOMFORT
90&
!,,,.'»
i i t i i i i i i t
t i i t i i t i i i
1234
CONCENTRATION (PPM)
(234
CONCENTRATION (PPM)
234
CONCENTRATION (PPM)
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
n i cr r>AA CODY
' 2
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 f
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
t , , ' 2
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 J
INCAPACITY
DISABILITY
DISCOMFORT
CO
INCAPACITY
DISABILITY
DISCOMFORT
0#
1 ?
i i i i i iii i f *
t i i i i i i i i i
i i i i i i i i i ,
INCAPACITY
DISABILITY
DISCOMFORT
-114-
-------
POLLUTANT: NITROGEN DIOXIDE
POPULATION CATEGORY:
SEVERE CHRONIC OBSTRUCTIVE LUNG DISEASE"
"* Patients with severe chronic obstructive
pulmonary disease are defined as individuals
who in addition to expectorating purulent
sputum for periods of at least three months
during each year, also, have a diminished FEV
and persistent hypoxemia with arterial blood
oxygen tensions of < 60 mm hg.
DEFINITION OF CONDITIONS:
' Incapacity = bror.cho-pr.er,:::on;. ''•,
cor pulmonnlp
' Disability = exacerbii: io:i o:'
bronchitis, fever
and increnr-oc SYII;<-.;
product! or. =ir.d cher
pair.
• Discomfort = dyspnea
(1)
INCAPACITY
DISABILITY
DISCOMFORT
9056
2 3
CONCENTRATION {PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
n i crriM COOT
nc#
i i i i i i 1 i ( i
i i 1 t i i t i i i
1 i i 1 i i 1 i i i
1 2
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
CO
INCAPACITY
DISABILITY
DISCOMFORT
1 2
1234
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-115-
-------
QUESTIONNAIRES FOR PROJECT
"HUMAN HEALTH DAMAGES FROM MOBILE SOURCE AIR POLLUTION"
CARBON MONOXIDE
The following questions apply to all population categories included in this study.
Please use the attached sheets for your answers. The answers should be marked on
the graphs and in boxes of appropriate column provided for each question.
(1) Please indicate by an X the pollutant concentrations which if present for
one hour cause 90% of the stated population to suffer incapacity*, disability*
and discomfort*. Indicate by a Y on both sides of your X, the range of
pollution concentrations which will produce the indicated health responses
for 90% of this population; by that we mean the lower limit Y[_, as the concen-
tration at which you feel there is only a 5% chance the true answer would be
below this estimate and the upper limit, Yy, as the concentration at which you
feel there is only a 5% chance the true answer would exceed your estimate. In
instances in which a health response occurs, write down the average duration
of discomfort (hrs.), disability (hrs.), and incapacity (hrs.) in the boxes
under Column (1) on the right. Indicate your degree of assurance concerning
your answer in Column (2). Use a scale 1-10 where 10 means "I know the answer
very well" and 1 means, "my answer is a sheer guess". Considerations to take
into account in making this judgment are, how good is the information concern-
ing this item; how well can it be estimated, etc. If you believe that the
response will occur at concentrations higher than those given in the scale,
write these estimates in the space above the graphs.
(2) Please indicate by an X the pollutant concentrations which if present for one
hour cause 50% of the stated population to suffer incapacity*, disability* and
discomfort*. Indicate by a Y on both sides of your X, the range of pollution
concentrations which will produce the indicated health responses for 50% of
this population; by that we mean the lower limit Y|_, as the concentration at
which you feel there is only a 5% chance the true answer would be below this
estimate and the upper limit, Yy, as the concentration at which you feel there
is only a 5% chance the true answer would exceed your estimate. In instances
in which a health response occurs, write down the average duration of discomfort
(hrs.), disability (hrs.), and incapacity (hrs.) in the boxes under Column (1)
on the right. Indicate your degree of assurance concerning your answer in
Column (2). Use a scale 1-10 where 10 means "I know the answer very well" and
1 means, "my answer is a sheer guess". Considerations to take into account in
making this judgment are, how good is the information concerning this item; how
well can it be estimated, etc. If you believe that the response will occur at
concentrations higher than those given in the scale, write these estimates in
the space above the graphs.
(3) Please indicate by an X the pollutant concentrations which if present for one
hour cause 10% of the stated population to suffer incapacity*, disability* and
discomfort*. Indicate by a Y on both sides of your X, the range of pollution
concentrations which will produce the indicated health responses for 10% of
this population; by that we mean the lower limit YL, as the concentration at
which you feel there is only a 5% chance the true answer would be below this
estimate and the upper limit, Yy, as the concentration at which you feel there
is only a 5% chance the true answer would exceed your estimate. In instances
in which a health response occurs, write down the average duration of discomfort
(hrs.), disability (hrs.), and incapacity (hrs.) in the boxes under Column (1)
on the right. Indicate your degree of assurance concerning your answer in
Column (2). Use a scale 1-10 where 10 means "I know the answer very well" and
1 means, "my answer is a sheer guess". Considerations to take into account in
making this judgment are, how good is the information concerning this item; how
well can it be estimated, etc. If you believe that the response will occur at
concentrations higher than those given in the scale, write these estimates in
the space above the graphs.
(4) Please indicate by an X the pollutant concentrations which if present for one
hour cause 0% of the stated population to suffer incapacity*, disability* and
discomfort*. Indicate by a Y on both sides of your X, the range of pollution
concentrations which will produce the indicated health responses for 0% of
this population; by that we mean the lower limit YL, as the concentration at
which you feel there is only a 5% chance the true answer would be below this
estimate and the upper limit, Y(j, as the concentration at which you feel there
is only a 5% chance the true answer would exceed your estimate. Indicate your
degree of assurance concerning your answer in Column (2). Use a scale 1-10
where 10 means "I know the answer very well" and 1 means, "my answer is a sheer
guess". Considerations to take into account in making this judgment are, how
good is the information concerning this item; how well can it be estimated, etc.
-116-
-------
POLLUTANT: CARBON MONOXIDE
POPULATION CATEGORY:
NORMAL
DEFINITION OF CONDITIONS:
' Incapacity = coma or convulsion
* Disability = throbbing headacr.e,
confusion, irritabii
di zziness
* Discomfort = mild headac'-.e, c-rro:
in cognitive :'^:x;':.c
(1)
INCAPACITY
DISABILITY
DISCOMFORT
9056
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
1 2
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
1 I 1 1 1 1
1 1 1
20 40 60 BO 100 120 140 160 180 200
CONCENTRATION (PPM)
1 2
INCAPACITY
DISABILITY
DISCOMFORT
(3) 10*
INCAPACITY
DISABILITY
DISCOMFORT
i i
20 40 60 SO 100 120 140 160 ISO 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
U)
INCAPACITY
DISABILITY
DISCOMFORT
' 2
1 1 1 1 1 1 1 1 J /
20 40 CO 80 100 120 140 160 180 200
CONCENTRATION (PPM)
-117-
INCAPAC1TY
DISABILITY
DISCOMFORT
-------
POLLUTANT: CAKBON MONOXIDE
POPULATION CATEGORY:
CHILDREN"
" Children - healthy children of lees
than 10 years of age.
DEFINITION OF CONDITIONS:
* Incapacity - coma or oonvul;--\ ov.::
" Disability - tiirobbir,e-; i'.r.-uia,-: ,-.
COnl'usiOr!, irri', :u>,;
dizziness
* Discoml'ort - mild headache, error:
in cognitive functioi
(1)
INCAPACITY
OISABIUTY
DISCOMFORT
9056
' 2
I i D i t \ i i I I
I i i i 1 t i i I 1
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
(2)
INCAPACITY
DISABILITY
50£
1 2
t 1 1 1 1 1 1 I 1 t
1 1 1 1 1 1, 1 I 1 1
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
30 40 60 80 100 120 140 16O 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
I 2
20 40 60 60 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-118-
-------
POLLUTANT: CARBON MONOXIDE
POPULATION CATEGORY:
OLD AGE"
DEFINITION OF CONDITIONS:
* Incapacity = coma or convulsions
" Disability = throbbing headache,
cor1.: usi or., irri tabil •
** Old Age - patients who have no proven
underlining disease but who on an epidemiologic
basis are likely to have senile emphysema and
arteriosclerotic cardiovascular disease (ASCVD). • Discomfort = mild headache, errors
in cognitive ''ur.c t i or.
(1)
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 ISO 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
50&
i i i fl i i i i i I
1 1 1 4 1 1 1 f t 1
1 1 1 1 1 1 1 1 1 I
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
ni ^r r*M COOT
10$
, , , , 1 2
i i i i i i i i i i
i t i p i i i i i i
INCAPACITY
DISABILITY
DISCOMFORT
U)
INCAPACITY
DISABILITY
nuroMFORT
0#
, . . . » 2
1 1 1 1 1 1 1 1 1 1
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
-119-
INCAPACITY
DISABILITY
DISCOMFORT
-------
POLLUTANT: CARBON MONOXIDE
POPULATION CATEGORY:
HEART CONDITION, MILD"
** Heart condition due to any etiology such
aE arteriosclerotic cardiovascular disease
(ASCVD), rheumatic heart disease, hyper-
tension, ASCVD without evidence of
congestive heart failure.
(1)
INCAPACITY
DISABILITY
DISCOMFORT
..,,.' 3
| 1 1 1 t 1 1 1 t f
1 1 1 1 t I 1 1 1 |
DEFINITION OF CONDITIONS:
" Incapacity = angina pectoris,
arrythmia, coma or
convulsions
* Disability = throbbing headache,
confusion, irritability,
dizziness, and increase
in dyspnea
' Discomfort = mild headache, errors
in cognitive function
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160
CONCENTRATION (PPM)
180 200
(2)
INCAPACITY
DISABILITY
5C#
i i i i i i i i i i
i i i 1 r i l t i i
I i i i i i t i < i
20 40 60 80 .00 120 140 160
CONCENTRATION (PPM)
180 200
INCAPACITY
DISABILITY
DISCOMFORT
(3) 1C*
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 ISO 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
1 2
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 10 100 120 140 180 180 200
CONCENTRATION (PPM)
-120-
INCAPACITY
DISABILITY
DISCOMFORT
-------
POLLUTANT: CARBON MONOXIDE
POPULATION CATEGORY:
HEART CONDITION, SEVERE"
** Heart condition due to any etiology such
as arteriosclerotic cardiovascular disease
(ASCVD), hypertension, rheumatic heart
disease with clinical evidence of heart
failure.
DEFINITION OF CONDITIONS:
' Incapacity = congestive heart fail "
* Disability = congestive heart i';v.'•.,
' Discomfort = milri headache, errors
in cognitive function
(1)
INCAPACITY
DISABILITY
DISCOMFORT
90*
.,,,.'*
t i i i i t i i i i
i i i i i i i i i i
i
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(2) 5056
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
1 2
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 f
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
mcroMcnpT
' 2
I I I I 1 1 1 1 1 1
1 k 1 1 1 I 1 1 t t
20 40 60 80 100 120 140 160 ISO 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
CO
INCAPACITY
DISABILITY
nicrOMFOBT
1
i i j i i i i i i i
i i i i i i i i i •
2
20 40 80 80 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-121-
-------
POLLUTANT: CABBON MONOXIDE
POPULATION CATEGORY: DEFINITION OF CONDITIONS:
HAY FEVER. SINUSITIS • Incapacity = coma or convulsions
* Disability = throbbing headache,
confusion, irritabil:'
dizziness
* Discomfort = mild headache, errors
in cognitive function
(1)
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 10O 120 140 160 180 200
CONCENTRATION (PPM)
'*
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
(3)
INCAPACITY
DISABILITY
DISCOMFORT
I I
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
-122-
INCAPACITY
DISABILITY
DISCOMFORT
-------
POLLUTANT: CARBON MONOXIDE
POPULATION CATEGORY:
INFLUENZA
(1)
INCAPACITY
DISABILITY
DISCOMFORT
J 1_
1 1
DEFINITION OF CONDITIONS:
Incapacity = respiratory f-»i U.i't.-,
cor.a, coi:v.;",aiO!.ii
' Disability ; throbbi:^ r-.e.-i.iar.:?,
confusion. : IT: --i'c . 1
dizziness, ir.creni-T
dyspnea
Discomfort ••• ir.ild heaa;:c:.o, '.•:•:• z:•
i!'. cognitive :'•:::-:' •
_i i i i i p
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
1 1
J 2
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
036
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
-123-
-------
POLLUTANT1. CARBON MONOXIDE
POPULATION CATEGORY: DEFINITION OF CONDITIONS:
UPPER RESPIRATORY INFECTION
* Incapacity = coma or convulsions
Disability = throbbing headache,
confusion, irritability
dizziness
' Discomfort = mild headache, errors
in cognitive function
(1)
INCAPACITY
DISABIUTY
DISCOMFORT
90%
1 2
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 ISO 200
CONCENTRATION (PPM)
(2)
INCAPACITY
DISABIUTY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
_J I
1 2
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
CO
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
20 40 63 60 100 120 140 160 180 200
CONCENTRATION (PPM)
-124-
-------
POLLUTANT: CARBON MONOXIDE
POPULATION CATEGORY:
ASTHMA
DEFINITION OF CONDITIONS:
* Incapacity = coma or convulsions
" Disability = throbbing headache,
confusion, irritability,
" Discomfort = mild headache, errors
in cognitive function
(1)
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
1 1 1 1 1 1 1 1 II
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
' 2
i i i * i i i i i i
i i i t i i i i i i
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160
CONCENTRATION (PPM)
180 200
(3)
INCAPACITY
DISABILITY
1 1 ( 1 1 1 I i I 1
30 40 60 (0 100 120 140 160 ISO 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
at,
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 SO 100 120 140 160 180 200
CONCENTRATION (PPM)
1 2
INCAPACITY
DISABILITY
DISCOMFORT
-125-
-------
POLLUTANT: CARBON MONOXIDE
POPULATION CATEGORY:
ACUTE VIRIA.L BRONCHITIS
(1)
INCAPACITY
DISABILITY
DISCOMFORT
DEFINITION OF CONDITIONS:
* Incapacity = without respiratory-
failure, coma,
convulsions
" Disability = throbbing headache,
confusion, irritabili*.
dizziness, increase ir
dyspnea
* Discomfort = mild headache, errors
in cognitive function
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
DISCOMFORT
i i t i
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
1 2
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 130 140 160 180 200
CONCENTRATION (PPM)
CO
INCAPACITY
DISABILITY
DISCOMFORT
1 2
i i i i
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
-126-
-------
POLLUTANT: CARBON MONOXIDE
POPULATION CATEGORY:
ACUTE BACTERIAL PNEUHONIA
(1)
INCAPACITY
DISABILITY
DISCOMFORT
DEFINITION OF CONDITIONS:
" Incapacity = respiratory failure,
coma, convulsions
' Disability = throbbing headacr.e,
confusion, irrilat: I-.:
dizziness, increase i::
dyspnea
' Discomfort = mild headache, errors
in congr.itive function
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
(2)
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 10O 120 140 160 180 200
CONCENTRATION (PPM)
(3)
INCAPACITY
DISABILITY
DISCOMFORT
i t
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
U)
INCAPACITY
DISABILITY
DISCOMFORT
1 2
i i i i i
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 160 200
CONCENTRATION (PPM)
-127-
-------
POLLUTANT: CARBON MONOXIDE
POPULATION CATEGORY:
CHRONIC RESPIRATORY DISEASES"
'* Chronic respiratory diseases of a non-
infectious nature such as pneumoconiosis,
or sarcoidosis.
(1)
INCAPACITY
OISABIUTY
DISCOMFORT
90&
1 2
t < 1 t I 1 t t I |
1 1 I 1 1 1 1 I 1 |
DEFINITION OF CONDITIONS:
' Incapacity = respiratory failure,
coma, cor.vv;lsio::t
* Disability = throbbing headao:>p,
confusion, i rri I :ibi I \ '
dizziness, and ircrea:
in dyspnea
* Discomfort = mild headache, errors
in cognitive function
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
(2)
INCAPACITY
DISABILITY
5(#
' 2
i i i i i i t i i 1
i i i i i i i i i f
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
20 40 60 80 100 120 140 160 ISO 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
ni<;rnMpr>BT
1C$
, . 1 2
1 1 1 1 1 1 1 I 1 1
1 1 1 1 1 1 t 1 1 t
INCAPACITY
DISABILITY
DISCOMFORT
(k)
INCAPACITY
DISABILITY
DISCOMFORT
at
1 2
i i i i i i i i i |
i i i i t i I i i f
i i i i i I I , i |
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
-128-
INCAPACITY
DISABILITY
DISCOMFORT
-------
POLLUTANT: CABBON MONOXIDE
POPULATION CATEGORY:
MILD CHRONIC OBSTRUCTIVE PUmONARY DISEASE"
*' Patients with raild chronic obstructive
pulmonary disease are defined as individuals
who expectorates purulent sputum for periods
of at least three months during each year.
DEFINITION OF CONDITIONS:
* incapacity --- coma or convulsions
* Disability = throbbing :.endac.-:p.
confusion, irritacili-
dizziness
" Discomfort = mild headache, errors
in cognitive t'unrtior
(1)
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
1 2
INCAPACITY
DISABILITY
DISCOMFORT
(2)
INCAPACITY
DISABILITY
, ' 2
i i i i i I i i i i
i i i i i i i i i i
20 40 60 80 100 120 140 160
CONCENTRATION (PPM)
180 200
INCAPACITY
DISABILITY
DISCOMFORT
(3)
INCAPACITY
DISABILITY
DISCOMFORT
10#
1 1
1 1 1 1 1 1 1 1 1 1
20 40 60 SO 100 120 140 16O 180 700
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-129-
-------
POLLUTANT: CAHBQN MONOXIDE
POPULATION CATEGORY:
SEVERE CHRONIC OBSTRUCTIVE PUmOMARY DISEASE"
** Patients with severe chronic obstructive
pulmonary disease are defined as individuals
who in addition to expectorating purulent
sputum for periods of at least three months
during each year, also, have a diminished FEV
and persistent hypoxemia with arterial blood
oxygen tensions of < 60 mm hg.
(1)
INCAPACITY
DISABILITY
DISCOMFORT
90$
I 1 i i I i I I f i
1 I I I I i I I I 1
1 i i I 1 i i i 1 1
1
DEFINITION OF CONDITIONS:
• Incapacity = respiratory failure,
coma, convulsions
• Disability = throbbing headache,
confusion, irritabili t.v,
dizziness, and increase
in dyspnea
* Discomfort = mild headache, errors
in cognitive function
INCAPACITY
DISABILITY
DISCOMFORT
20 40 60 80 100 120 140 160
CONCENTRATION (PPM)
180 200
(2)
INCAPACITY
DISABILITY
50£
i i i i i i i i i i
i i i i i i i i i i
i i i i i i i i » f
20 40 60 80 100 130 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
(?) 1C*
INCAPACITY
DISABILITY
DISCOMFORT
_J f
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
1 2
INCAPACITY
DISABILITY
DISCOMFORT
CO
INCAPACITY
DISABILITY
DISCOMFORT
1 2
i fill ill it
i i i l l i 1 i i i
i i i i i 1(111
20 40 60 80 100 120 140 160 180 200
CONCENTRATION (PPM)
INCAPACITY
DISABILITY
DISCOMFORT
-130-
-------
APPENDIX B
SECOND ROUND SURVEY DOSE-RESPONSE CURVES
-131-
-------
TABLE OF CONTENTS
Graph
I. OXIDAiiT
A. Normal ••• 1-3
B. Children 4-6
C. Old Age 7-9
D. Heart Condition, Kil<5 10-12
E. Heart Condition, Severe ,... 13-15
F. Kay Fever, Sinusitis 16-18
G. Influenza 19-21
H. Upper Respiratory Infection ,. 22-24
T.. Asthma 25-2?
J. Acute Viral Bronchitis 28-30
K. Acute Bacterial Pneumonia • 31-33
L. Chronic Re.-.piratory Diseases 34-36
M. Mild Chronic Obstructive Lung Disease 37-39
N. Severe Chronic Obstructive Lung Disease 40-42
II. NITROGEN DIOXIDE
A. Normal ^3-^5
B. Children 46-48
C. Old Age ^9-51
D. Heart Conditions, Mild , 52-5^
E. Heart Condition, Severe 55-57
F. Hay Fever, Sinusitis ., 58-60
G. Influenza , 61-63
H. Upper Respiratory Infection 64-66
I. Asthma 67-69
J. Acute Viral Bronchitis 70-72
K. Acute Bacterial Pneumonia 73~75
L. Chron:c Respiratory Diseases 76-7°
11. Mild Chronic Obstructive Lung Disease 79-81
N. Severe Chronic Obstructive Lung Disease 82-84
III. CARBON MONOXIDE
A. Normal §5-87
B. Chil dren 88-yO
C. Old At;(, , 91-93
D. Heart Condition, Mild 94-96
E. Heart Condition, Severe 97-99
F. Hay Fever, Sinusitis 100-102
G. Influenza 103-105
H. Upper Respiratory Infection 106-108
I. Asthma 109-111
J. Acute Viral Bronchitis 112-114
K. Acute Bacterial Pneumonia 115-117
L. Chronic Respiratory Diseases „ 118-120
M. Mild Chronic Obstructive Lung Disease 121-123
N. Severe Chronic Obstructive Lung Disease 124-126
-132-
-------
OXIDflNT
NQRMflL
INCflPflCITY =
- may precipitate
respiratory and
cardiac problems,
hot>neuinonia
-es
.50
.75 1.00
DQSflGE
i r
i.25 1.50
PPM X HR
1.75
2.00
-------
QXIDRNT
NGRMRL
DISRBILITY = headache
CURVE fl
YL 2.865
X 1.691
YU .030
.25
.50
.75 1.00
DGSflGE
1.25 1.50
PPM X HR
1.75
2.00
2.86
-------
QXIDRNT
NQRMRL
DISCOMFORT =
eye irritation,
non-productive
coughing, chest
tightness
CURVE R
YL 4.585
X 3.165
YD 2.002
.25
.50
I i
.76 1.00
DGSflGE
1.26 1.60
PPM X HR
1.76
2.00
2.26
2.6C
-------
GXIDflNT
CHILDREN
INCflPflCITY = may precipitate
respiratory and
cardiac problems,
bronchppneumonia
CURVE H
YL 1.810
.25
.50
T r
.75 l.OQ
DGSflGE
i r
1.26 I.50
PPM X HR
1.7S
2.00
2.SC
-------
GXIDRNT
CHILDREN
DISRBILITY = headache
-25
.50
.75 1.00
DGSflGE
1.25 I.50
PPM X HR
1.15
2.00
-------
CO
CO
QXIDRNT
-26
.60
CHILDREN
DISCOMFORT =
eye irritation,
non-productive
coughing, chest
tightness
.76 1.DQ
DOSflGE
1.26 I.SO
PPM X HR
1.76
2.QQ
2.26
-------
QXIDflNT
OLD flGE
lINLHi HLi I F - acute respiratory
failure
-SO
I 7
.75 1.00
DGSflGE
T I
1.26 1.50
PPM X HR
1.75
2.DO
2.26
2.50
-------
QXIDflNT
OLD flGE
DISABILITY =
bronchitis
&QO
.50
.75 1-DO
DOSflGE
T T
1.25 1.5Q
PPM X HR
1.75
2.UQ
-------
GXIDRNT
OLD flGE
DISCOMFORT =
dyspnea
CURVE fl
YL 7.807
X 3.842
YU 2.302
.76 1.00
DOSflGE
1.26 l.SQ
PPM X HR
1.75
2.00
2.26
-------
QXIDflNT
HEflRT COND. MILD
INCflPflCITY = pulmonary edema
-75 I.00
DGSflGE
1.26 1-GQ
PPM X HR
1.16
2.QQ
-------
OXIDfllST
HERRT
MILD
DISflSILITY = congestive heart
failure
CURVE fl
YL 3.685
X 1-332
YU -1.294
I I
.76 i.OQ
DGSflGE
1.26 1.60
PPM X HR
1.76
2.00
-------
OXIDflNT
HEflRT CCJND. MILD
DISCOMFORT = dyspnea
-65
/ / CURVE
/ / YL 5
7 /
/ / YU 3
/ / GRflPH 12
t/
.50 .75 1.00 1. 25 1.50 1 ."7S
fl B
.959 5.170
.077 7.747
.052 7.448
ROUND 2
2.00 2.55
DGSflGE
PPM X HR
-------
GXIDRNT
HEflRT CQND. SEV
INCRPRCITY = ar.gi.na ,r a
myocardinT infarction
-SO
.75 1.QQ
DGSflGE
1.2G 1.5Q
PPM X HR
-------
GXIDRNT
HEflRT CQND. SEV
DISflBILITY - pulmonary edema
.€5
.50
.75 1.00
DQSflGE
1.26 I-GO
PPM X HR
1.7S
2.00
2.50
-------
GXIDflNT
HEflRT CQND. SEV
DISCOMFORT =
worsening congestive
heart failure
ca
Of
Lu
CJ
LU
CJ
cr
CM
-26
/ / CURVE
J L YL 5
/ / X 4
' / YU 2
,/ GRflPH 15
0 .75 1.00 1.26 1-50
fl
.554
.300
.094
1.76
B
4.613
6.800
8.557
ROUND 2
i
8.00 e.i
DGSflGE
PPM X HR
-------
CO
QXIDflNT
HflY FEVER. SINUS
IMCHi HuITY = nasal or sinus
drainage and headache
CURVE fl
YL 3-454
X 1.849
YU -1-620
.65
.so
.75 l.QQ
DGSflGE
i r
1.25 l.SQ
PPM X HR
1.75
2.00
-------
QXIDflNT
-65
.60
HflY FEVER. SINUS
75 I.00
DGSflGE
DISABILITY - nasal or sinus
drainage
CURVE fl
YL 4.699
X 4.179
YU 1-198
SRPPH 17
B
5.010
9.308
12.383
ROUND
5 1.60
PPM X HR
1.16
2.00
-------
OXIDfiNT
HflY FEVER. SINUS
DISCOMFORT = nasal or sinus
discomfort
CURVE fl
YL 6.669
X 8.025
YU 3.887
.50
.75 i.00
DQSflGE
1.25 1.GO
PPM X HR
1.16
2.00
2. S6
-------
OXIDflNT
INFLUENZfl
IINLHr HL-I i « = superimposed
bacterial nneumonia
CURVE fl
YL 3.454
X 2.135
YU -2.054
-65
-GO
i I
-76 I. CO
DQSflGE
PPM X HR
1.16
8.QQ
-------
QXIDRNT
INFLUENZfl
DISABILITY = dyspnea
Of
UJ
U_
U_
cr
CJ
o:
ct:
CiI
CURVE fl
YL 5.507
X 3.454
YU 2.119
B
6.279
6.279
11-353
GRflPH 20
ROUND
-GO
—I T~
.75 I.00
DQSflGE
i
I. 50
PPM X HR
1.75
2.00
-------
CD
^
Lu
U_
U_
-------
GXIDflNT
UP RESP INFECT
XNCflPflClTY = superimposed
bacterial infection
&QQ
-es
-SO
.75 I.00
DGSflGE
1.85
PPM X HR
1.75
2.QQ
-------
QXIDflNT
UP RESF INFECT
DISflBILITY= dyspnea, or need
medication and rest
en
en
CURVE fl
YL 5.507
X 2.606
YU .565
.SO
-75 l.QQ
DGSflGE
1.26 I.GO
PPM X HR
1.76
S.QQ
-------
GXIDflNT
UP RESP INFECT
DISCOMFORT = worsening symptoms
a •
tug
a3:
/ / CURVE
/ / YL 5
I* *H
II X 3
/ YU 2
/ GRflPH 24
/
-60 .75 1. 00 1.86 1.5Q
R B
.091 4.046
.842 5.114
.683 8.004
ROUND 2
1.75 C.QQ 2.26
DQSflGE
PPM X HR
-------
GXIDflNT
flSTHMfl
INCflPflCITY = status asthmaticus
en
—I
CURVE fl
YL 3.454
X 2.094
YU -.725
o.
&QQ
.60
.75 1.00
DOSflGE
1.25 I.GO
PPM X HR
2.QQ
2.25
-------
GXIDflNT
flSTHMfl
DISPBILITY = asthmatic attack
en
CO
•es
.50
.76 I.QQ
DOSflGE
1.60
PPM X HR
1.76
2.00
-------
QXIDflNT
flSTHNfl
DISCOMFORT = dyspnea
UJ
u_
u_
CL
CJ
cc.
CM
o.
£00
CURVE fl
YL 5.H41
X 5.507
YU H.374
B
3.385
6.279
9.196
GRflPH 27
ROUND
-GO
.76 1.00
DOSflGE
6 1-5Q
PPM X HR
1.76
.00
-------
QXIDRNT
VIRRL BRONCHITIS
-es
.50
.75 1.00
DOSflGE
INCflPflCITY - acute
respiratory failure
CURVE fl
YL 3.454
X 1-038
YU -1-393
1.26 1.50
PPM X HR
1.76
2.00
2.86
-------
OXIDflNT
.50
VJRRL BRONCHITIS
75 I.00
DGSflGE
DISRBIL1TY = onsc: or
v/orser.ir.^ ''^f dyspnea
CURVE fl
YL 5.915
X 3.663
YU 1.837
B
6.173
6.326
9.109
GRflPH 29
ROUND
6 1.60
PPM X HR
1.76
8.00
2.26
-------
QXIDflNT
VIRflL BRONCHITIS
DISCOMFORT = worsening of cough
.66
.60
.75 1.00
DGSflGE
CURVE fl
YL 8-812
X 5.507
YU 4.059
B
5.690
6.279
8.683
ROUND
1.25 1.50
PPM X HR
1.76
2.00
2.2S
-------
QXIDflNT
BflCT- FNEUMONIfl
INCflPflCITY - acute respiratory
failure
&00
.60
-76 I.00
DOSflGE
r
1.26 1.60
PPM X HR
1.75
2.00
2.26
-------
LU
t
en
CJ
-------
QXIDflNT
BflCT. PNEUMONIfl
DISCOMFORT = worsening of cough
CJ>
cc
O
a:
a:
u.
o
CM
O.
O
CURVE fl
YL 7.318
X 6.563
YU 3.455
B
4.205
7.244
8.252
GRRPH 33
ROUND
&QQ
-7S 1.00
DQSflGE
5 l.SQ
PPM X HR
1.7G
2.00
-------
OXIDflNT
CHRONIC RESP DIS
IfCflPflCITY = Pneumonia
en
.65
r
.75 I.00
DOSflGE
I.5
PPM X HR
1.16
8.00
-------
GXIDflNT
CHRONIC RESP DIS
DISABILITY = respiratory
infection
-ee
.75 1.00
DOSflGE
L.5
PPM X HR
1.76
2.QQ
-------
OXIDflNT
CHRONIC RESP DIS
DISCOMFORT = dyspnea
CURVE H
YL 5.023
X 4.73H
YU 3.201
&QQ
.25
.60
.75 1.GO
DQSflGE
T T
1.25 l.SQ
PPM X HR
1.76
2.00
-------
OXIDflNT
CHRN OB5T LUNG
.26
.60
T r
.76 l.OQ
DOSflGE
iNCRPfCITY = broncho-pneumonia,
cor pulmonale
1.50
PPM X HR
1.76
e.QQ
-------
QXIDflNT
&QQ
M CHRN 00ST LUNG
DISABILITY
= exacerbation of
bronchitis, fever
and increased sputum
production and chest
pain
.75 I.00
DOSflGE
1.26 1.60
PPM X HR
1.76
2.00
2.26
-------
QXIDflNT
H CHRN GBST LUNG
DISCOMFORT = dyspnea
CURVE fl
YL 7.807
X 7.307
YU 2.451
.75 I.00
DGSflGE
T T
PPM X HR
-------
QXIDPNT
5 CHRN OBST LUNG
INCnPnCIT i = broncho-pneumonia,
cor pulmonale
.75 I.00
DOSflGE
1.26 1-60
PPM X HR
-------
QXIDflMT
S CHRN OBST LUNG
-GO
76 I.QQ
DGSflGE
DISABILITY = exacerbation of
bronchitis, fever
and increased sputum
production and chest
pain
CURVE fl
YL 5.959
X 4.198
YU 2.619
B
5.170
6.990
9.540
GRflPH 41
ROUND
£ 1.6
PPM X HR
1.7G
2.QQ
8.25
-------
OXIDPNT
S CHRN OSST LUNG
DISCQhFQRT
= dyspnea
o
Of
0
LU
tJ
or
CM
O.
CURVE P
YL 9.968
X 6.97H
YU 5.706
B
5.275
5.785
8.185
GRflPH 42
ROUND
-65
.SO
.75 I.00
DQSflGE
6 1.50
PPM X HR
1.76
I.OQ
-------
co
CJ
LU
U_
u_
(X
CJ
en
o.
o
NITROGEN DIOXIDE
1.60
?.DQ
M.&O
NCRMflL
IriUni nUlT» = may precipitate
respiratory and
cardiac problems,
broncho-pneuinor.ia
DOSflGE
/ /CURVE
/ * /
/ / YL -
/ / X "
/ YU
y
^^^ GRflPH H3
7.50 9. GO 10.50 18.00
fl
10.555 7
10.897 5
18.996 7
ROUND
13.50
B
.150
-513
.999
2
15.00
PPM X HR
-------
NITROGEN DIOXIDE
NQRMRL
DISABILITY =
headache
UJ
U.
U_
CE
i?'
CJ
cc
Of
U.
-------
NITROGEN DIOXIDE
NdRftflL
1.50
3.00
•4.60 6.00
DGSflGE
= eye irritation,
non-produc t ive
coughing, chest
tightness
fl
b
5.504
6.426
7.125
7.GO 9.00
PPM X HR
10.50
18.00
13.50
-------
CJ
LU
U-
co
cc
cz.
o.
o
NITROGEN DIOXIDE
CHILDREN
—r
i.eo
INCPPflCITV =
may precipitate
respiratory and
cardiac problems,
ncho-pneumonia
3.CQ
/ /
/ * /
/ /
/ /
is
50 6.00 ?. so 9.00
DQSflGE PPM X HR
' CURVE fl
x YL -10-
X -12.
YU -13.
GRflPH 46
10.60 18.00
B
116 7.244
028 6.685
278 6.094
ROUND 2
13.60 16 .Ot
-------
NITROGEN DIOXIDE
CHILDREN
DISABILITY - headache
YL -8.855
-12.811 8.859
-11.698 6.229
1.50
3.00
M.SO 6.00
DGSflGE
7.60
9.00
PPM X HR
10. 50
12.00
13.60
-------
NITROGEN DIOXIDE
CHILDREN
DISCOMFORT =
1.CO
3.00
.CO 6.DO
DGSfiGE
eye irritation,
non-productive
coughing, chest
tightness
-H.509
B
5-795
5.815
7.114
C 9.CO
PPM X HR
10 .GO
18.00
I
13.GO
-------
NITROGEN DIOXIDE
OLD flGE
iNCflPflCITY = acute respiratory
failure
V?
o
UJ
a:
2:"
CJ
cc
CU
l.SO
3.00
M.6Q 6.QQ
OOSflGE
7.SO
9.00
PPM X HR
10.60
18.QQ
13.50
-------
NITROGEN DIOXIDE
QLD PGE
DISRBILITY = bronchitis
I.SO
3.GQ
'•4.EO 6.00
DOSflGE
7.EQ 9.00
PPM X HR
10.60
12.00
13.60
-------
W7RQGEN DIOXIDE
OLD fiGE
DISCOMFORT
= ayspnea
CURVE
fl
-4.827
-6.652
B
6.317
6.279
8.962
1.60 £.20
DQSflGE
13.50
-------
NITROGEN DIOXIDE
HEflRT CQND. MILD
INCRPRCITY = Pulmonary edema
CJ
LU
CC
cr
a;
cu
O.
I.SO
3.CG
1.SQ 6.00
DGSflGE
7.6Q 9.OQ
PPM X HR
10.60
12.00
13.60
-------
NITROGEN DIOXIDE
HEflRT CGND. MILD
DISflSILITY =
congestive
heart failure
I.CO 6.00
DGSflSE
7.GO 9.00
PPM X HR
10. GO
12.QQ
13.60
16
-------
NITROGEN DIOXIDE
HEflRT CQND. MILD
DISCOMFORT = dyspnea
CURVE
YL
X
YU
fl
-3.182
-6.631
-12.478
B
4.471
6.195
8.708
GRRPH 54
ROUND
6.QQ
DQSflGE
7 .SO 9.00
PPM X HR
10.SO
18.00
13.50
-------
NITRQSEN DIOXIDE
HERftT COND. SEV
= angina or a
myocardial infarction
-10-897 5.513
DQSflGE
7.50 9.DO
PPM X HR
10.60
12.00
13.60
-------
NITRQGEh DIOXIDE
HEflRT D3ND. SEV
DISflBlLITY = pulmonary edema
OL
cr
u_
cv
o.
o
CURVE
YL
fl
-6.338
-9.511
YU
B
6.473
6.866
-11.753 7.002
GRflPH 56
ROUND
3.CQ
1 r
Q 6.QQ
DQSflGE
—i r
7.SO 9.DO
PPM X MR
10.60
12.DO
1—
13.50
16.
-------
Kf
Lu
u_
u_
g?'
cc
a:
Lv_
•
C3
CM
MITffQGEW DIOXIDE
HEflRT D3ND. SEV
DISCONFGRT
l.CQ
3.QQ
DQSflGE
worsening
congestive heart
failure
CURVE
YL
YU
fl
-3-442
-7.467
-12.936
B
5.898
7.358
9.770
GRflPH 57
ROUND
7. GO
9. CO
.00
PPM X HR
-------
NITRGGEN DIOXIDE
HflY FEVER. S1MUS
INCPPRCITY = nasal or sir.us
drainage and headache
1.60
3.00
/ / / CURVE.
I" /* / * YL -13
1 / X -10
/ / YU -11
/ /
^ 9/ GRRPH 58
•^^'
M.GQ 6.00 7.EQ 9.0Q 10.60
fl B
.42H 10-271
.052 6.150
.504 5.790
ROUND 2
le.QQ 13.60
OQSflGE
PPM X HR
-------
NITRQGEN DIOXIDE
HflY FEVER. SINUS
S.QQ
DOSflGE
D1SR5ILITV = nasal or sinus
drainage
YL
fl
-7.057
YU
-12.238
B
6.800
-10.116 7.244
6.861
GRflPH 59
ROUND
7.5Q
9.00
FPM X HR
10 .so
is.oo
13.60
16.
-------
WTRCSEN DIQXIDE
HflY FEVER. SINUS
DISCOMFORT = nasal
1.5Q 6.00
DOSflGE
CURVE
YL
R
-5.000
-9.367
YU
-15.639
or sinus
discomfort
B
6.502
7.996
10.594
GRflPH 60
ROUND
7.50 9.CO
PPM X HR
10.60
18.00
13.50
-------
DIOXIDE
INFLUENT
= superimposed
bacterial pneumonia
&00
3.GQ
6.QQ
DQSflGE
i r
7.SO 9.00
PPM X HR
10.50
13.50
-------
NITROGEN DIOXIDE
INFLUENJR
DISPBlLlTY = worsening dyspnea
I. GO
3.0Q
t.GQ 6.QQ
DOSfiGE
7.60
PPM X
9.QQ
13.60
-------
NITROGEN DIOXIDE
INFLUEMZfl
DISCOMFORT - increased cough and
pleuritic pain
&
O
IU
u_
en
CE
CM
O.
O
CURVE
YL
YU
fl
-3.716
-7.626
-13.427
B
6.083
7,175
9.385
GRflPH 63
ROUND
1.50
3.0Q
T
4.60 g.GQ
DQSfiGE
7.GO 9.QQ
PPM X HR
10. GO
1—
18.00
!—
13.60
-------
o
CO
LU
cc i
CC
ct:
o
CM
j
NITROGEN DIOXIDE
l.SQ
3.00
UP RESP INFECT
INCflPflCITY =
secondary bacterial
infection
fl
YL -12.022
YU
-13.295
-12.301
GRflPH 64
B
9.916
8.852
6.299
ROUND
! I
M.5Q G.GO
DGSflGE
—T r
7.SO 9.DO
PPM X HR
10.GO
I
13.£0
-------
NITROGEN DIOXIDE
UP RESF INFECT
DISflBlLlTY = need medication and
rest
l.SQ
fl
-6.144
YU
B
6.504
-12.678 9.560
-10.638 6.253
GRflPH 65
ROUND
3. DO
<4.SQ 6.GO
DOSflGE
7.5Q
9.00
ID.50
PPM X HR
L3.GQ
-------
NITROGEN DIOXIDE
UP RESP INFECT
DI5CQMFQRT = worsening symptoms
o.
o
(X.-
O
CO
Ss
UJ
u_
li-
CC
o
-------
NITROGEN DIOXIDE
flSTHMfl
iNCflPflCITY = status asthmaticu
cus
a
- UJ
•£)
cr
o3:
O i
C\)
I.S
3.00
.SO G.QQ
DQSfiGE
g.nn
PPM X HF<
IQ.SQ
12.QQ
13.SO
-------
NITROGEN DIOXIDE
flSTHMfl
DISflBlLlTY = asthmatic attack
o
O
ay
CJ
UJ ,
U-
u_
CL
LJ
cn
o - J
1.50
3.CO
B
6.816
9.507
6.542
M.GQ C.QG
DQSflGE
7.r,n
PPM X HR
IQ .eo
12 .CO
I
13.50
-------
NITROGEN DIOXIDE
RSTHMfl
DISCOMFORT = dyspnea
Qiao
l.SQ
3.QQ
1 T
M.EQ S.QQ
DGSflGE
CURVE
YL
YU
-3.365
-10.002
-17.605
B
5.010
8.875
12.224
GRflPH 69
ROUND
7 .'.'•} 9.CQ
PPM X HR
IQ .
12.aa
13 .CO
-------
NITROGEN DIOXIDE
VIRRL BRONCHITIS
INCRPFCITY = acute respiratory
failure
~> ;.
rs~ r n
1.50
3.00
4.SO S.CQ
DOSfiGE
7.5Q
PPM
3.QQ
HR
IQ.EO
12.QD
-------
NITROGEN DIOXIDE
VIRflL BRONCHITIS
DISflBILITY= dyspnea
to
a?
IV) UJ
s fc
cc
o3:
ex
u_
o"
CM
I.S
3.QQ
I
5.03
DQSffGE
-5.765
B
5.579
-11.679 8.557
-10.290 6.083
GRflPH 71
ROUND
7.50 9.00
PPfl X HR
10.50
I
12.oa
T
L3.SO
-------
NITROGEN DIOXIDE
VIRflL BRONCHITIS
DISCOMFORT" cough
I.GO
3.DQ
5.00
CURVE
YL
-2.960
-7.284
-11.661
B
4.243
6.671
8-108
ROUND
'i r
0 9.00
PPM X HK
T
IQ.SO
12.00
i
13.GO
-------
NITROGEN DIOXIDE
BflCT. PNEUMQNIfl
INCflPflCITY
= acute respiratory
failure
so
i?'
X
ce:
U_
-------
NITROGEN DIOXIDE
BflCT. PNEUMGNIfl
DISfl0lLITY= dyspnea
-4.347
-9.613
B
4.884
7.196
-11.358 6.800
GRflPH 74
ROUND
I.SO
3.00
•4.GO 6.00
DQSflGE
I I
7.50 9.00
PPM X HR
10.60
12.00
13.60
-------
NITROGEN DIOXIDE
BflCT. PNEUMGNIfl
DISCOMFORT =
= CGURH
ro
o
l.SO
3. DO
<4.SO 6.00
DOSflGE
i r
7.50 9.00
PPM X HR
10.50
18.00
13.50
-------
NITROGEN DIOXIDE
CHRONIC RESP DIS
INCflPflCITY =
pneumonia
PO
O
co
(O
UJ
u_
OC
cc
CM
I.CO
3.GO
i I
M.SQ C.OQ
DQSflGE
I T
7.SQ 9.QQ
PPM X HR
10.GO
12.GO
1
13.50
-------
NITROGEN DIOXIDE
CHRONIC RESP DIS
DISflBILITY = mild respiratory
infection
o
UD
B
9.196
10.486
8.174
fr.OO
DQSflGEL
7. 50
9.QQ
PPM- X HR
10.50
13.50
-------
NITROGEN DIOXIDE
CHRONIC RESP DIS
DISCOMFORT = dyspnea
no
I—•
o
CURVE
fl
-3.008
-6.895
B
4.687
6.536
9.433
I.EQ
3.QQ
6-.QQ
DQSflGEL
7.SQ 9.QQ
PPK X HR
10.50
-------
DIOXIDE
M CHRN QBST LUNG
INCflPflCITV = troncho-pneuir.or.ia,
cor pulraonale
o.
a
o
00
u
u
u
§?'
&
CURVE
R
YL -9.269
YU
B
8.132
-12.382 8.034
-13.080 6.853
GRRPH 79
ROUND
l.SQ
3.QQ
DQSflSE-
—i r
7.50 9.00
PPMX HR
10.50
-------
NITROGEN DIOXIDE
o_
M CHRN QBST LUNG
DISR0ILITY = exacerbation of
bronchitis, fever and
increased sputum
production and chest
pain
CURVE
YL
fl
-7.830
B
9.072
YU
-11.390 8.699
-20.300 12.489
GRflPH 80
ROUND
7 rn
»
-------
NITROGEN DIOXIDE
M CHRN G0ST LUNG
DISCOMFORT =
dyspnea
INJ
H-'
OJ
CURVE fl
YL -2.3H3
-H.869
YU -15-522
B
H.H76
5.387
11.542
GRflPH 81
ROUND
G.QQ
DQSflGE
( -|~
7.50 9.on
PPM X HR
io.no
-------
NITROGEN DIOXIDE
o
CO
2s
I— '
LJ
LU
U_
U_
-------
ro
i—'
en
0_
07
LU
Uu
U_
CE
o
CE
o
OJ
NITROGEN DIQXIDS
S CHRN QBST LUNG
DISflBILITY = exacerbation of
bronchitis, fever
and increased sputum
production and chest
pain
CURVE fl
YL
-4.717
B
7.575
YU
-10.982 10.136
-19.683 13.433
GRRPH 83
ROUND
—i—
12.00
1.50
3.GO
•I. SO
DG5RSE
7.SO
r
.00
PPM X HR
10 .GO
13 .GO
-------
NITROGEN DIOXIDE
S CHRN 00ST LUNG
DISCOMFORT = dyspnea
o
o
LJ
LU
U_
Lu
a:
§?'
LJ
a:
Q
OJ
_J
O _'
o .
3.0Q
M.C3 6.UQ
DQSflGE
—T
7.GQ
CURVE fl B
YL -1.358 5.136
X -4.745 6.338
YU -9.973 8.317
GRflPH 84
ROUND
g.oo
PPM X HR
12. 00
13 .GO
-------
CflRBQN NQNQXIDE
NQRMHL
INCRPflClTV = coma or convulsions
UJ
u_
-------
so
»
S;
CJ
LU
U_
U_
LJ
or
a:
o
CXI
CflRBQN MONOXIDE
DISflBlLlTY= throbbing headache,
confusion, irritability,
dizziness
CURVE
YL
YU
fl
-62.702
-66.298
-60.936
B
12.525
12.670
11.155
GRflPH 86
ROUND
o
&.OQ
60.00
100.00 160.03 2QQ.OQ
DQSflGE
2SQ.ro
I
300.00
PPM X HR
I
35Q.OO
MOQ.OQ
M5Q.OO
-------
0-,
CflRBQN
NORHflL
50,00
100.00
ISO .CO
DdSflGE
2CO.OQ
1
2rjC.cn
PPM
DISCQMFQRT = mild headache, errors
in cognitive function
CURVE
YL
-33.852
YU
-62.258
-73.384
B
7.699
13.030
14.650
GRflPH 87
ROUND
300.00
HR
350 .CO
1
MCO.CQ
1
-------
CflRBQN MONOXIDE
CHILDREN
INCflPflCITY = coma or convulsions
o
o
(D
u_
CE
o=C
CT
I
ICQ.CO
1GO.CQ
DQSflGE
PPH X HR
-------
CPRBQN NQNGXIDE
CHILDREN
DISflBILITY =
10Q.DO
ISO.CO 200.DO
DQSflGE
throbbing headache,
confusion,
irritability,
dizziness
CURVE
YL
YU
fl
-46.469
-69.171
-86.763
6
9.556
13.492
16.182
GRflPH 89
ROUND
LO.CO
PPM X
300.00
—i—
350.00
.00
-------
CflRBGN MQNQXIDE
CHILDREN
DISCOMFORT = mild headache, errors
in cognitive function
PS
a:
CJ
a:
o
CM
O
O I
&CG
CURVE
YL
YU
fl
-26.636
-48.073
-51-216
B
6.204
10.433
10.581
GRflPH 90
ROUND
60 .GO 100 .CO 1GQ.CQ 800.00
DOSRGE
ZGn.no 300.00
FPn X HR
360 .00
400.00
l!Ga.OQ
-------
CflRBON IWGXIDE
OLD RGE
INCflPfiCITY = coma or convulsions
C3
to
Sg-
rxs UJ
CE
o
CM
0
6Q.QO 100.00 ISO.00 200.CO
DQSflGE
T r
260.00 300.00
PPM X HR
350.00
r
MOO.00
T
MSO.OO
-------
CD
U-
U_
CC
I?"
t—4
I
UL-
o"
CM
O
O
CflRBQN IW3XIDE
GO.CO
OLD flGE
ICO.Cn ^QO.CjQ
DOSflSE
DISflBILITY =
fl
-46.469
throbbing headache,
confusion,
irritability,
dizziness
-63.085
-64.294
B
9.556
12-320
12.067
ROUND 2
.l?3 30Q
PPN X HK
350
aa .co
-------
LJ
LJ
cc
ct:
o
CJ
CflRBON MONOXIDE
OLD flGE
DISCOMFORT = mild headache, errors
in cognitive function
CURVE
YL
B
-30.730 7.267
-41.853
YU
9.040
-46.716 9.538
GRflPH 93
ROUND
60.00 100.00 15Q.OQ EOQ.OO
DOSflGE
2GQ-00 30Q.00
PPM X HR
35Q.OO
MGQ.OQ
-------
CRRBON MGNGXIDE
HEflRT CQND. MILD
INCflPflCITY = angina pectoris,
arrythmia, coma or
convulsions
20Q.CO
DOSRGE
-73.467
B
14.620
14.742
17.953
PPH X HR
MoQ.U
1
M5Q.CQ
-------
IN3
ro
O
SO
Sg
CJ
LU
U_
o3:
LJ
cc
a:
O.J
O I
CflRBQIM
HEflRT CQND. MILD DISRBILITY =
throbbing headache,
confusion,
irritability,
dizziness, and
increase in dyspnea
CURVE fl
B
YL
-33.994 7.218
YU
-61.191
-91.828
12.292
17.684
GRflPH 95
ROUND
1QQ.DQ
200. CO
DOSflGE
— i - 1
esQ.ro 300 .00
PPtf X HR
sso.ca
MOQ.DQ
-------
CJ
vo
a -
tug
PO L
^ LU
a h_
U_
CE
LJJ
GC
ct:
CM
o -J
MONOXIDE
HEflRT COND. HILD
DISCOf1FORT= mild headache, errors
in cognitive function
•7.0 .CO
1
100.00
CURVE fl
YL -27.933
YU
-35.215
-H5.736
B
6.536
7.676
9.368
GRRPH 96
ROUND
—I 1—
ISO.CO 800.00
DQSflGE
—i r
c?J,CO 3CO.
PPM X HR
350.00
1
400.CO
-------
o.
o
CO
so
CC
--I
a:
o»
O i
CflRBQIM
HEflRT CQND. SEV
rrr: n
i- t. J -C-^J
INCfllflCITY = angina pectoris,
arrythmia, coma or
convulsions
B
-26.195 5.534
-27.904 5-564
YU -39.124 7.381
GRflPH 97
ROUND
DQSRSE
PPM X HR
.00
-------
CflRBON MONOXIDE
HEflRT COND. SEV
DISPBILITY = throbbing headache,
confusion,
irritability,
dizziness, and
increase in dyspnea
fl
-28.788
6.521
6.708
7.668
ICQ .co
ICQ -co ?.r.Q.CQ
DQSflGE
gsn.ro srn.
PPM X HR
350.00
MCQ.CG
»ieo
-------
CflRBGN MONOXIDE
HEflRT COND. SEV DISCOMFORT = idld headache, errors
in cognitive function
(X
<£ i
o
CM
I i
100.00 io3.n c:
DQSflGE
CURVE
fl
YL -20.885
YU
-49.596
B
5.562
-36.463 8.626
10.802
GRflPH 99
ROUND
PPM X HR
i
3CO.GO
MGO.CQ
-------
CflRBON MONOXIDE
HflY FEVER. SINUS INCflPflCITY = coma or convulsions
o_
UJ
cc
Q
CVI
t
,. - ...
O -'—•
I
10Q.CQ
r;.y
DOSflGE
£•30-C") 2CO.CO
PPM X HR
EC
-------
(D
U_
cr
CJ
cc
tr.
u_
o'
CJ.
o
0-00
CflRBQN HQNQXIDE
GO .00
1DQ.CO
HflY FEVER. SINUS
DISflBlLlTY = throbbing headache,
confusion,
irritability,
dizziness
CURVE fl
YL -44.996
X -51.733
YU -48.958
B
9.196
10.162
9.223
GRflPH 101
ROUND
* • .1 i >--\
<_ .'j» j
PPM X HR
-------
CflRBQN MONOXIDE
HflY FEVER. SINUS
CO
DISCOMFORT = mild headache, errors
in cognitive function
CURVE
YL
B
-30.046 6.822
YU
-37.414
-54.624
7.999
11.152
GRflPH 102
ROUND 2
eo.DQ
—i ; i—
lOa.CQ IcG-CO SC3.GQ
DGSflGE
—i 1 1—
250-CT 2CQ.DO SCO.DO
PPM X HR
-------
o.
o
o
so
lUg
u
UJ
«t
1?'
U>
Cu
cc
o
CM
o.
o
&-.:
CflRSON MONOXIDE
INFLUENZfl
ICQ.DO
leo.ci c:
DOSflGE
INCflPflCITY = respiratory failure,
coma, convulsions
CURVE fl
YL -35.128
-34.326
YU
-39.925
GRflPH 103
B
6.905
6.399
7.102
ROUND
?CQ.OQ
PPM X HR
3SQ.CQ
—i—
MCQ.CO
MS3.CO
-------
CflRBQM MQNQXIDE
INFLUENZfl
DI5P0ILITY
ro
CO
o
O
e?
a_-i
tl?
CJ
UJ
u_
u_
cc
:zo-
o*
CJ
CE
Of
u_
Q"
c»
o_
o i
6-j'j
= throbbing headache,
confusion,
irritability,
dizziness, increase
in dyspnea
1CD.C3
- -
DQSflGE
T T
CCD.n SOO.DO
PPM X HR
3SQ.CO
-------
CflRBQN MONOXIDE
INFLUENZfl
DISCGNFGRT = mild headache, errors
in cognitive function
LJ
UJ
U_
u_
CC
o
cc
ct:
o
CM
CURVE fl
YL -22.040
X -30.240
YU -47.795
B
5.168
6.570
9.834
GRflPH 105
ROUND
"D3SflGE"3"°
2.-H .CQ
PPH X HR
SCO-DO
-------
CflRBQN nOMQXIDE
UP RESP INFECT
INCflPflCITY =
= coma or convulsions
o
00
rvj
c>
LJ
Co UJ
U_
(X
LJ
cc
ct
u_
o"
C\l
o.
T ^r~—^^—i 1—
60.00 100.00 160.00 200.00
DQSflGE
-46.067
YU
-HO.757
B
8.982
-40.818 7.540
7.246
GRflPH 106
ROUND
250.00 300.00
PPM X HR
360.00
100.00
450 .03
-------
o
to
ro f %
CJ V—•*
<-U
U_
U_
CC
LJ
GC
o
OJ
CflRBQN
UP RESF INFECT
DISPBILITY
= throttling headache,
confusion,
irritability,
dizziness
CURVE
B
YL -36.184 7.526
-46.105 9.062
YU -50.686 9.576
GRflPH 107
ROUND 2
o
I
50.00
1QQ.CX)
T
153 .CT
DOSflGE
PPM X HR
26Q.OQ
TIQ.OO
-------
CPRBON MONOXIDE
so
o
UJ
CC
o
a:
o"
UP RESF INFECT
DISCOMFORT = mild headache, errors
in cognitive function
CURVE
YL
YU
fl
-25.651
-36.577
-H8.990
B
5-977
7.851
9.980
GRflPH 108
ROUND
,
a '
&00
60.00 IOQ.DQ 1GQ.DO 800.00
DQSflGE
.DO 300.00
PPM X HR
350.00
400.00
450.00
-------
CflRBON MONOXIDE
RSTHMfl
INCPPflCITY = asthmatic attack,
coma or convulsions
o
&
U_
Lu
CC
CC
-43.772 8.495
-43,045 7.937
YU -60.734 10.738
DQSRGE
PPM X HR
-------
MONOXIDE
flSTHNfl
DISflBILITY =
•*» LJ
ro UJ
U_
u_
cr
8?
O
GC
oc
u_
o'
o_ ,
o :
6-CD
50.00 IQQ.DO 150.DO 200.00
DOSRGE
- throbbing headache,
confusion,
irritability,
dizziness
CURVE
YL
YU
R
-56-996
-65.230
-69.775
B
11.768
12.762
13.125
GRflPH 110
ROUND
250 -CT 300.00
PPM X HR
350.00
400.00
460.00
-------
ro
-fc>
U)
o.
a
UJ
I—
LJ
uU
L_
LL.
CC
(O
a:
ct:
CflRBQN IWIGXIDE
flSTHMfl
DISCQMFQRT = mild headache, errors
in cognitive function
CURVE fl
YL -30-409
YU
-46.106
-75.795
B
7.049
9.881
15.507
GRflPH 111
ROUND
50.00 103.CO ICQ.CO £03-CO
DQSRGE
PPM X HR
350.DO
4r~f>
oU .
-------
o
so
Ss'
UJ
u_
u.
cc
o
CE
o
ex
Q
0~f
•6 en
CflRBQN HGNQXIDE
VIRflL BRONCHITIS
INCflPflCITY = respiratory failure,
coma, convulsions
-35.760
YU
-38.525
-38.228
B
7.041
7.150
6.818
GRflPH 112
ROUND
ica.ca
.
PPH X HR
5SQ.C3
-------
CflRSGN MONOXIDE
VIRflL BRONCHITIS
DISflBILITY
CD
s3 f 1
.*» CJ
01 LaJ
CE
O?
i—-4
I—
cr
o'
CM
O.
O
= throbbing headache,
confusion,
irritability,
dizziness, increase
in dyspnea
CURVE fl B
YL -35.798 7.530
X -43.245 8.557
YU -56.040 10.557
GRflPH 113
ROUND
—-r~—- 1 -= r
60.00 lOQ.OQ IGQ.
lOQ.OQ IGQ.OO SQQ.OO
DQSflGE
—I 1 1 1 1—
260.00 300.00 350.00 400.00 HSO.OO
PPM X HR
-------
DTOQM MONOXIDE
VIRflL BRONCHITIS
DISCOMFORT = mild headache, errors
in cognitive function
CO
83-
i—— -
CJ
uu
UL.
Lu
cr
U-
o
OJ
CURVE
-41.050
YU
B
YL -27.743 6.455
8.884
-63.642 12.966
GRflPH 114
ROUND
_
o
o .
1.C3
1CJ.C1
.El SCO.00
OQSflGE
FPM X HR
350.CO
MOD.DO
MGQ.CO
-------
CflRBGN PfGNQXIDE
BflCT. PNEUiMQNIfl
INCPPflCITY = respiratory failure,
coma, convulsions
no
a
5 I
UJ
Uu I
LL. \
C I
g?1
i—^
h-
LJ
Ou
o:
J
CJ
O--J
CURVE R
YU
B
1GQ.CG
SGQ.CO
D35HGE
PPM X MR
-50.179 9.907
-93.962 17.836
-74.892 13.703
GRflPH 115
ROUND
350 .DQ
MQ3.CO
MGQ.CO
-------
o -
CflRBON MONOXIDE
BflCT. PNEUNONIfl
DISflBILITY =
= throbbing headache,
confusion,
irritability,
dizziness, increase
in dyspnea
CURVE
YL
B
-31.153 6.647
YU
-48.316
-75.386
9.697
14.411
GRflPH 116
ROUND
ISO.00
DGSflGE
£00.00
PPM X HR
350.CQ
•JCQ.OD
-------
CflRBON MONOXIDE
BflCT. PNEUMONIfl
DISCOMFORT = mild headache, errors
in cognitive function
s§-
I— •
CJ
vo LU
cr
LJ
CC
o
CVI
CURVE fl
YL
-24.113
YU
-61.423
B
5.823
-45.625 9.960
12.833
GRflPH 117
ROUND
.GO
100 .co
n SOD .DO
DQSflGE
PPM X HR
350.
1
MCQ.CO
-------
c*—•
o -
a .
to \
a
uj£
o~i
ro { ,
on t—•>
o
UJ
UL.
u_
a:
Z2l
o^:
n_>
cc
Q±
U-
o"
CJ
o_
a
CPRBON MONOXIDE
CHRONIC RESP DIS
INCflPRCITY = respiratory failure,
coma, convulsions
CURVE fl
YL -30.370
YU
-53.669
-58.704
B
6.083
10.239
10.661
GRflPH 118
ROUND
3 .CO
IOQ.OO
1GD.CO
DQSflGE
25Q.CO 203.00
PPM X HR
i
MSQ.OQ
-------
ro
un
CflRBON MONOXIDE
CHRONIC RESF DI6
DISABILITY =
Sgl
t— • I
o j
UJ
CJ
(X
8"
CURVE fl
YL
-35.5H8
-42.256
YU -62.152
throbbing headache,
confusion,
irritability,
dizziness, and
increase in dypsnea
B
7.514
8.487
11-956
GRflPH
ROUND
DQSflGE"
1 1—
•» SCO .DO 3S3 -CO
PPM X HR
-------
CflREON flONOMDE
ro
en
IN)
UJ
• i
cc
2
cut
o
a;
a:
o"
CJ
o
CHRONIC RESP DIS
rr> r"\
>. ; v-I * V.' -«J
DISCOMFORT = mild headache, errors
in cognitive function
CURVE
YL
-22.570
YU
-39.212
-42.626
B
5-435
8.587
8.856
GRflPH 120
ROUND
rco.00
PPM X HR
^ J'
i
MCD.CQ
-------
CflRBQM MONOXIDE
M CHRM QBST LUNG
INCflPflCITY = respiratory failure,
coma or convulsions
o
CO
a_-J
r>o ., -.
en <— '
U_
U_
CC
LJ
CC
o"
CM
o.
O
50.00
1GQ.CO
-40.741
YU
-50.154
B
8.057
-39.668 7.453
9.051
GRflPH 121
ROUND
DOSflGE
*-. r -^
J .'- .1
sr.a -oo
.-i
GO.CO
PPM X HR
-------
CflRBQM MQMQXIDE
M CHRN QBST LUNG
oQO
DISflBILITY = throbbing headache,
confusion, irritability,
dizziness
CURVE
fl
YL -43.082 8.972
YU
-55.582 11-015
-63.205 12.030
GRRPH 122
ROUND
GQ.CG
ICQ.00
DQSflGE
£00-CD
.CO 50Q.OQ
PPM X HR
IcQ.OQ
-------
CflRBGN MONOXIDE
N CHRN QBST LUNG
ro
en
cn
FQ.DQ
I
1GQ.CQ
DOSflGE'1'
DISCOMFORT = mild headache, errors
in cognitive function
CURVE
YL
YU
R
-19.332
-26.065
-45.179
4.615
5.699
9.342
GRflPH 123
ROUND
rm.co
PPM X HR
250.CO
-------
CflRBQN MONOXIDE
S CHRM Q0ST LUNG
INCRPflCITY = respiratory failure,
coma, convulsions
3-1
H
j
°J
y?l
a j
u- !
^ i
*• \
S?l
o
cc
C£
Q
CM
»i
CURVE
YL -40.404
-57.436
-55.758
YU
B
8.264
11.147
10.433
GRflPH 124
ROUND
PPM X MR
3SQ.CO
l»QQ.CO
-------
CflRBQN MONOXIDE
S CHRN Q0ST LUNG
DISABILITY
ro
tn
SO .00
1G3.DQ ICu.DO 2C3.C3
DQSflGE
throbbing heaaache,
confusion, irritabil-
ity, dizziness, and
increase in dyspnea
CURVE
YL
YU
-38.301
-39.583
-67.772
B
8.397
8.088
13.144
GRflPH 125
ROUND
PPM X HR
-------
in
00
CPRBQM hQMQXIDE
Ss
UJ
u.
u_
CL
CL
CC
U_
S CHRM GEST LUNG
i 1 1—
GO .00 !Cr).OQ 160.00 800.00
DQSRGE
DISCOMFORT = mild headache,
errors in cognitive
function
CURVE
YL
B
-20.169 5.117
-33.944 7.715
YU
-50.196
10.594
GRflPH 126
ROUND
eco.ra 300.00
PPM X HR
350.00
MOD.00
MSO.OQ
-------
TECHNICAL REPORT DATA
:'l'!etisc rciti.1 luatntelioiis on the rcrersc before e
1. REPORT NO.
EPA-600/5-78-016a
12.
4. TITLE AMD SUBTITLE
Human Health Damages From Mobile Source Air
Pollution: A Delphi Study - Volume I.
7. AUTHORisisteve Leung Elliot Goldstein
Eureka Lab., Inc. Univ. Cal.
Sac.. CA 95814 Davis. CA 95616
Norman Dal key
Univ. Cal.
L.A., CA 9002
8. PERFORMING ORGANIZATION REPORT NO
3. RECIPIENT'S ACCESSI ON- NO.
5. REPORT DATE
July 1978
6. PERFORMING ORGANIZATION CODE
9. PERFORMING ORGANIZATION N.AMII AND AODR ESS
Contractor: California Air Resources Board
1709 llth Street
Sacramento, CA 95814
Subcontractor: Eureka Laboratories, Inc.
401 N. 16th Street, Sac. CA
10. PROGRAM ELEMENT NO.
11. CONTRACT/GRANT NO.
95814
IPA Contract No. 68-01-1889
12. SPONSORING AGENCY NAME AND ADDRESS
Corvallis Environmental Research Laboratory
Office of Research and Development
U.S. Environmental Protection Agency
Corvallis, Oregon 97330
13. TYPE OF REPORT AND PERIOD COVERED
Final Report
14. SPONSORING AGENCY CODE
EPA/600/02
15. SUPPLEMENTARY NOTES
^.ABSTRACT During the'past year, the California Air Resources
4 health experts on the human damages froir. mobile source
of
Board conducted a survey
air pollution.
A variant of the Delphi technique was used in the study to arrive at a consensus
judgment of the exports on the dose-response relationship for nhotochorical oxiciants,
nitrogen dioxide and carbon rcnoxide. The panel experts were reouested to answer nues-|
tionnaires to provide dose-response for all three pollutants ant! for healthy individua
as well as diseased cr sensitive persons. The completed questionnaires were analyzed
and the group consensus v/ere sent to the panel renters. The panel experts vcre then
asked to"answer the sarr.e questionnaires again for a second tine. The data obtained dur
the second round represents the final group consensus.
In the first round survey, there vas good agreement among the panel expert? for tf
health effects of oxidant on all categories of population, while the data for hot'i cart
monoxide and nitrogen dioxide vas much less so. The results of the second round surve
shov/ed improvement in group agreement for all three pollutants.
This report was submitted"by the California Air Resources Board in the fulfillment
of Contract l!o. 68-01-1889 under the sponsorship of the Lnvironncntal Protection Agenc
This report covers a period fror. July 1, 1973 to June 30, 1974 and work war- completed
as of August 30, 1974.
KEY WORDS AND DOCUMENT ANALYSIS
DESCRIPTORS
Air Pollutions
Delphi Study
Dose-Response
Health L'ffects
b.IDENTIFIERS/OPEN ENDED TERMS c. COSATI 1
B. DISTRIBUTION STATEMENT
19. SECURITY CLASS (This Report)
unclassified
21. NO. OF PAGES
272
Unlimited
20. SECURITY CLASS (This page)
unclass ified
22. PRICE
EPA Form 2220-1 (9-73)
0 U.S. GOVERNMENT PRINTING OFFICE: 1978-797.669/227 REGION 10
259
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