Environmental
Cancer
and
Heart and Lung
Disease
Ninth Annual Report to Congress
1986
TASK FORCE ON
ENVIRONMENTAL CANCER AND
HEART AND LUNG DISEASE

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Environmental Cancer
and
Heart and Lung Disease
Ninth Annual Report to Congress
1986
Task Force on
Environmental Cancer and Heart and Lung Disease
U.S. Environmental Protection Agency
Public Health Service
National Cancer Institute
National Heart, Lung, and Blood Institute
National Institute for Occupational
Safety and Health
National Institute of Environmental
Health Sciences
National Center for Health Statistics
Centers for Disease Control
Food and Drug Administration
Department of Energy
Consumer Product Safety Commission
Occupational Safety and Health Administration
Department of Agriculture
Veterans Administration
Department of Defense
Prepared by the Task Force Working Group
Scott R. Baker, Chairperson

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(301) 231-5250
When this supply is exhausted, the
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Service
U.S. Department of Commerce
5285 Port Royal Road
Springfield, Virginia 22161

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TASK FORCE ON
ENVIRONMENTAL CANCER AND HEART AND LUNG DISEASE
JAN 25 1988
Please address your reply to:
Lee M. Thomas
Administrator
U.S. Environmental
Protection Agency
401 M Street, S.W.
Washington, DC 20460
Honorable James C. Wright, Jr.
Speaker of the House of Representatives
Washington, DC 20515
Dear Mr. Speaker:
As Chairman of the Task Force on Environmental Cancer and Heart and Lung Disease,
I am pleased to submit the Ninth Annual Report to Congress in accordance with Public Law 95-
95, Section 402(b)(5).
The Task Force sponsors workshops and promotes cooperation among its 15 member agencies
in an effort to identify risks and consolidate scientific research recommendations, with the goal
of reducing dangers posed to human health by environmental pollutants. During 1986, the Task
Force examined Federal risk communication activities, conducted a workshop for the academic-
based occupational medicine physicians and completed a 5-year plan of activities based on analysis
of critical issues.
This report presents three recommendations based on the conclusions of participants in Task
Force activities. The first two recommendations emphasize the need for education and training
of health professionals in regard to hazards that may exist in certain environmental and
occupational settings, and the need for surveillance and collaboration among physicians when
identifying and treating patients who have been exposed to environmental hazards. The third
recommendation relates to enhancing the awareness of primary care physicians about possible
exposures of populations to environmental health issues. Primary health care providers in the
community could be important sources of information about potential health effects of exposure
to environmental pollutants.
The workshops and activities of the Task Force on Environmental Cancer and Heart and
Lung Disease provide guidance and direction to the scientific and regulatory community on the
complex relationship between environmental pollution and human disease. I believe that the
coordination and cooperation of the Task Force agencies continue to result in scientific and
educational advances and in more open communication with health professionals and the general
public.
Environmental Protection Agency • National Cancer Institute
National Heart, Lung, and Blood Institute • National Institute for Occupational Safety and Health
National Institute of Environmental Health Sciences * National Center for Health Statistics
Centers for Disease Control • Food and Drug Administration
Department of Energy • Consumer Product Safety Commission
Occupational Safety and Health Administration • Department of Agriculture
Department of Defense • Veterans Administration
Agency for Toxic Substances and Disease Registry
Sincerely,
Lee M. Thomas
Administrator

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TASK FORCE ON
ENVIRONMENTAL CANCER AND HEART AND LUNG DISEASE
JAN 25 1968
Please address your reply lo:
Lee M. Thomas
Administrator
U.S. Environmental
Protection Agency
401 M Street, S.W.
Washington, DC 20460
Honorable George C. Bush
President of the Senate
Washington, DC 20510
Dear Mr. President:
As Chairman of the Task Force on Environmental Cancer and Heart and Lung Disease,
I am pleased to submit the Ninth Annual Report to Congress in accordance with Public Law 95-
95, Section 402(b)(5).
The Task Force sponsors workshops and promotes cooperation among its 15 member agencies
in an effort to identify risks and consolidate scientific research recommendations, with the goal
of reducing dangers posed to human health by environmental pollutants. During 1986, the Task
Force examined Federal risk communication activities, conducted a workshop for the academic-
based occupational medicine physicians and completed a 5-year plan of activities based on analysis
of critical issues.
This report presents three recommendations based on the conclusions of participants in Task
Force activities. The first two recommendations emphasize the need for education and training
of health professionals in regard to hazards that may exist in certain environmental and
occupational settings, and the need for surveillance and collaboration among physicians when
identifying and treating patients who have been exposed to environmental hazards. The third
recommendation relates to enhancing the awareness of primary care physicians about possible
exposures of populations to environmental health issues. Primary health care providers in the
community could be important sources of information about potential health effects of exposure
to environmental pollutants.
The workshops and activities of the Task Force on Environmental Cancer and Heart and
Lung Disease provide guidance and direction to the scientific and regulatory community on the
complex relationship between environmental pollution and human disease. I believe that the
coordination and cooperation of the Task Force agencies continue to result in scientific and
educational advances and in more open communication with health professionals and the general
public.
Sincerely,
Lee M. Thomas
Administrator
Environmental Protection Agency • National Cancer Institute
National Heart, Lung, and Blood Institute • National Institute for Occupational Safety and Health
National Institute of Environmental Health Sciences • National Center for Health Statistics
Centers for Disease Control • Food and Drug Administration
Department of Energy • Consumer Product Safety Commission
Occupational Safety and Health Administration • Department of Agriculture
Department of Defense • Veterans Administration
Agency for Toxic Substances and Disease Registry

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PREFACE
The Task Force on Environmental Cancer and Heart and Lung
Disease is an interagency group established by Congress to promote
cooperation and coordination and recommend research to determine
and quantify the relationship between environmental factors and hu-
man disease. Its efforts are directed toward reducing or preventing
environmentally related diseases, in particular, cancer and heart and
lung disease. As a result of Task Force consideration and the member
Agencies' approval, recommendations have evolved from the needs
identified by scientists at Task Force-sponsored workshops.
Section 402 of Public Law 95-95, the Clean Air Act Amendments
of 1977, designated the initial members of the Task Force as the U.S.
Environmental Protection Agency (EPAJ and, from the Public Health
Service (PHS) of the Department of Health and Human Services, the
National Cancer Institute (NCI), the National Heart, Lung, and Blood
Institute (NHLBI), the National Institute of Environmental Health Sci-
ences (NIEHS), and the National Institute for Occupational Safety
and Health (NIOSH-Centers for Disease Control). Nine other Govern-
ment organizations have joined the Task Force by invitation: three
PHS Agencies, the National Center for Health Statistics (NCHS), oth-
er components from the Centers for Disease Control (CDC), and the
Food and Drug Administration (FDA); the Department of Energy
(DOE) in 1983; the Consumer Product Safety Commission (CPSC) and
the Department of Agriculture (USDA) in 1984; the Veterans Admin-
istration in 1985; and the Occupational Safety and Health Administra-
tion (OSHA) of the Department of Labor in 1986. The Department of
Defense (DoD) is an observer to the Task Force.
To meet its reporting requirements to Congress, this report de-
scribes the accomplishments of the Task Force during its ninth year,
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1986. Chapter 1 introduces the Task Force and its various subgroups.
Chapter 2 describes the substantive activities of the Task Force dur-
ing its ninth year, and Chapter 3 outlines planned activities for the
tenth year. Recommendations are contained in Chapter 4.
iv

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CONTENTS
EXECUTIVE
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Appendix A
Appendix B
Appendix C
Page
SUMMARY	vii
INTRODUCTION	1
ACTIVITIES OF THE WORKING GROUP
IN 1986	5
Long-Term Planning	5
Health Professional Education	6
Public Education and Communication	9
PLANNED ACTIVITIES OF THE WORKING
GROUP IN 1987	11
Health Effects of Pesticide Exposure	11
Health Professional Education	12
Public Education and Communication	13
Environmental Dictionary	13
Cost-Effectiveness Methodologies in Research
Planning	14
RECOMMENDATIONS	15
Health Professional Education	15
SECTION 402 OF PUBLIC LAW 95-95	21
MEMBERS OF THE TASK FORCE,
WORKING GROUP, AND PROJECT GROUPS	25
SELECTED PUBLICATIONS FROM THE
TASK FORCE ON ENVIRONMENTAL
CANCER AND HEART AND LUNG DISEASE	35
v

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EXECUTIVE SUMMARY
The Task Force reports yearly on its activities to Congress. Dur-
ing its ninth year, the Task Force's activities were focused in the fol-
lowing areas:
•	Long-term planning
•	Health professional education
•	Public education and communication.
Based on the findings and conclusions developed by scientists,
physicians, and educators participating in meetings sponsored by the
Task Force, the following recommendations for research are offered
to the Congress for its consideration:
1.	Academic medical centers should be encouraged to teach their
medical students to take an occupational and environmental his-
tory from their patients on a routine basis.
2.	For specific exposures, all primary care physicians who see pa-
tients presenting with occupational and environmental exposures
should be encouraged to work collaboratively to gather in-depth
data on exposure and adverse sequelae, including derivation of
exposure-dose relationships.
3.	State and local health entities should be urged to encourage pri-
mary care physicians to be knowledgeable about which popula-
tions in specific geographic areas may be exposed to environmental
hazards and may need information on potential risks to their
health.
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The Interagency Education Program Liaison Group published the
Report of the Special Grand Rounds: Women at Work. Ad hoc editor-
ial committees prepared the reports of the workshops on airborne pol-
lutants and respiratory cancer (published in Environmental Health
Perspectives, volume 70, 1986) and environmental toxicity and the ag-
ing processes (published by Alan R. Liss, 1987).
The Long-Range Planning Committee developed a 5-year plan of
activities that was adopted by the Working Group. Activities are
planned in the areas of public education and communication, health
professional education, environmental epidemiology, and several spe-
cific scientific issues. Information gathering and needs assessment
were begun for those activities slated for the first year of the plan.
The Interagency Education Program Liaison Group sponsored a
workshop, The Community as Patient, to focus on the role of aca-
demic-based occupational medicine physicians in reducing risks asso-
ciated with hazardous substances in the community. The meeting in-
cluded presentation of case studies and development of recommenda-
tions for research and education.
The Project Group on Public Education and Communication
planned and held a workshop to examine Federal risk communication
activities. Participants included Government policymakers, program
administrators, and public health professionals from Federal, state,
and local government, as well as experts in risk communication from
academia, citizens' and environmental groups, media, business, and
industry.
In 1987, the Task Force will sponsor the following activities. A
workshop on the health effects of pesticide exposure will focus on
nonoccupational exposure and will consider the relationship between
pesticide exposure and observed health effects.
The Interagency Education Liaison Group will work with the Na-
tional Library of Medicine to disseminate information on the
TOXNET data base to primary care physicians. A brochure specifi-
cally tailored to physicians' information needs will be developed, and
an exhibit will be designed to demonstrate the use of TOXNET at
meetings of selected physician groups.
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The Interagency Education Program Liaison Group also is
planning a meeting, in cooperation with NHLBI, to promote commu-
nication linkages between pulmonary medicine grantees and practi-
tioners of family medicine. Discussions will include means to prevent
or reduce the incidence of environmentally or occupationally related
asthma.
The Project Group on Public Education and Communication will
complete its activities related to the Workshop on the Role of Govern-
ment in Health Risk Communication. The report of that Workshop
and an inventory of Federal risk communication programs will be
prepared for publication. The Group will initiate planning of its next
activity, a workshop on evaluation of health risk communication
programs. Information gathered on programs having evaluations and
on evaluation methodologies will be used to develop generic evalua-
tion criteria.
The Working Group will conduct a feasibility study to determine
the need for an environmental dictionary. Such a reference document
would define selected environmental terms (chemicals, diseases, and
concepts) and include lists of referral organizations and experts.
The Working Group will also initiate an effort to ascertain the
extent to which cost-effectiveness is considered in planning health re-
search programs. Depending on the preliminary information collected
from Task Force member Agencies, the Working Group may proceed
with a bibliographic compilation of methodologies and a workshop
effort.
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Chapter 1
INTRODUCTION
The Task Force on Environmental Cancer and Heart and Lung
Disease was established by Congress in the Clean Air Act Amend-
ments of 1977 (P.L. 95-95)* to address the environmental disease
problem in a broad and coordinated fashion. Congress chose the
mechanism of an interagency task force to ensure continued commu-
nication between the U.S. Environmental Protection Agency (EPA),
the major regulatory Agency dealing with health and environmental
hazards; Agencies conducting health research, particularly the Public
Health Service (PHS) Agencies within the Department of Health and
Human Services (DHHS); and other Agencies as appropriate. The
Task Force is mandated to determine and quantify the relationship
between environmental pollution and human disease, in particular,
cancer and heart and lung disease, and to recommend research,
strategies, and other measures to reduce or eliminate the risk of these
diseases and prevent or reduce their incidence.
The legislation stipulated that the EPA Administrator or a person
designated by the Administrator chair the Task Force and also named
the other original members from PHS as the National Cancer Institute
(NCI), the National Heart, Lung, and Blood Institute (NHLBI), the Na-
tional Institute for Occupational Safety and Health (NIOSH-Centers
for Disease Control), and the National Institute of Environmental
Health Sciences (NIEHS). The law also specified the involvement of
other Agencies with interests in environmental health and, according-
ly, the National Center for Health Statistics (NCHS), other compo-
nents of the Centers for Disease Control (CDC), the Pood and Drug
*See Appendix A for full text of Section 402 (P.L. 95-95).
1

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Administration (FDA), the Department of Energy (DOE), the Consum-
er Product Safety Commission (CPSC), the Department of Agriculture
(USDA), and the Veterans Administration (VA) have become mem-
bers. The Department of Defense (DoD) is an observer to the Task
Force. The addition of these other Agencies and Departments, by vote
of the Task Force, has increased the opportunities to promote and
formalize interaction and cooperation.
The Task Force organization in 1986, shown in Figure 1, included
a Plenary, a Working Group, three standing committees, and various
ad hoc subgroups. The Plenary consists of Agency heads and repre-
sentatives of Departmental Secretaries, who in turn designate the
Working Group representatives. The Working Group meets approxi-
mately every 12 weeks to discuss environmentally related health
problems of national significance that are common to member
Agencies. To address these problems, the Working Group identifies
research needs through workshops, symposia, project groups,
subcommittees, and various ad hoc committees. The members of the
Plenary, Working Group, and subgroups are listed in Appendix B.
TASK FORGE ON ENVIRONMENTAL GANGER AND
HEART AND LUNG DISEASE
ZAD HOC GROUPS /
IN 1686 /
WORKING GROUP
PLENARY
PROJECT GROUP ON
PUBLIC EDUCATION
AND COMMUNICATION
INTERAGENCY
EDUCATION PROGRAM
LIAISON GROUP
PROJECT GROUP ON
QUALITY ASSURANCE
IN ANALYTICAL
METHODOLOGY
Figure 1. Task Force Organization (1986)
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The Task Force workshops bring together experts in specific sub-
ject areas to identify research needs. The workshop reports are pub-
lished in the peer-reviewed literature and are available to the entire
scientific community. The research needs identified by the workshops
are submitted to the Working Group, which then conveys the research
needs to the Plenary members for their consideration. Some of the re-
search needs are considered by member Agencies in their research
planning, and some of these may ultimately become recommendations
of the Task Force to Congress.
The Task Force serves to coordinate research and stimulate coop-
eration among Federal Agencies and scientific communities con-
cerned with environmental health. Its members have the opportunity
to integrate regulatory and research perspectives on the kinds of sci-
entific information needed to provide an improved basis for protec-
tion of human health and the environment. The Task Force provides
an open, freely accessible forum for the exchange of ideas and infor-
mation, which benefits all of its members.
The Task Force is mandated to report to Congress yearly on its
activities. During its ninth year (1980), the Task Force's activities
were focused in the following areas:
•	Long-term planning
•	Health professional education
•	Public education and communication.
These activities, described in Chapter 2, were directed by subcommittees
of both the Task Force and scientific workshops, involving scientists
from academia, research institutions, industry, and Government.
Chapter 3 describes activities planned for 1987 in the areas of health
effects of pesticide exposure, health professional education, public
education and communication, environmental epidemiology, and cost-
effectiveness methodologies in research planning. The recommenda-
tions to Congress that originated from the year's Task Force activities
are presented in Chapter 4.
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Chapter 2
ACTIVITIES OF THE WORKING GROUP IN 1086
The Task Force Working Group met approximately every 12 weeks
to exchange information, discuss environmental health issues of com-
mon interest, and initiate and direct activities of its subcommittees.
The Working Group completed its first long-term planning effort
and approved a 5-year plan, recognizing the need for flexibility in im-
plementing the plan. Project groups and subcommittees established by
the Working Group directed other activities. The Interagency Educa-
tion Program Liaison Group (IEPLG) completed and published the
Report of the Special Grand Rounds: Women at Work. The IEPLG
also continued to focus on the role of the health professional in
environmental health issues. The Project Group on Public Education
and Communication initiated planning for a major workshop on
health risk communication. Ad hoc editorial committees prepared the
reports of the workshops on airborne pollutants and respiratory can-
cer and environmental toxicity and the aging processes. (See Appen-
dix C for availability.)
Long-Term Planning
The framework for the planning process was based on the Task
Force goals to (1) develop comprehensive risk reduction/prevention
strategies for selected critical issues and (2) identify methodologies for
enhancing coordination among Agencies and the societal sectors
served by these Agencies. The Working Group identified broad areas
of environmental concern, and the planning subcommittee focused on
more specific issues within these areas. The subcommittee rated each
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issue according to a set of evaluation criteria, and experts were asked
to comment on the need and timeliness of the activities proposed to
address the issues. Issue papers were prepared that described for each
activity its objectives, history or background, anticipated accomplish-
ments, and relationship to other activities. The 5-year plan of activities
that was adopted by the Working Group is shown in Table 1.
During 1986, information gathering and needs assessment
activities were begun for the FY87 activities. In addition to the
activities listed in the plan, another activity—a workshop on the
health effects of pesticide exposure—was suggested as a potential
high-priority effort. After discussion with staff in the EPA Office of
Pesticide Programs, USDA, NCHS, NIOSH, and FDA, the Working
Group agreed to incorporate this activity into the long-term plan.
The plan will be evaluated and revised each year to ensure rele-
vance and to shaipen the focus on specific gaps in scientific knowledge.
In 1987 the subcommittee will recommend activities for FY92 to the
Working Group.
Health Professional Education
The Community as Patient Workshop, a product of the Task
Force's Interagency Education Program Liaison Group, focused on
the role of academic-based occupational medicine physicians in re-
ducing risks associated with hazardous substances in the community.
The theme of the Workshop was the diagnosis and treatment of the
health needs of the community.
The Workshop's objective, to define the community outreach role
of the academic occupational medicine physician, was accomplished
through a needs assessment process. Numerous health professionals,
Federal Agencies, and professional organizations were contacted to
develop an inventory of recommendations. The Workshop partici-
pants ranked these recommendations in terms of their importance to
the community outreach role of the occupational medicine physician.
The highest ranked recommendations, categorized as either research
or education, served as the basis for the Workshop discussions. The
full report of the Workshop (see Appendix C for availability) ad-
dresses strategies for implementation of the recommendations.
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Tbble 1
Long-Range Plan of Activities
Adopted in 1986 (Tentative)
FY87
•	Public Education and Communication Workshop
•	Indoor Air Pollution Workshop
•	Education of Health Professionals: Conference on Occupational and Environmental
Asthma
•	Education of Health Professionals: Dissemination of Information on TOXNET
•	Survey of Cost'Effectiveness Methodologies
•	Workshop on the Health Effects of Pesticide Exposure
FY88
•	Public Education and Communication: Workshop on Evaluation and Planning of
Health and Environmental Communication Programs
•	Education of Health Professionals: Conference for Office-Based Nonacademic
Physicians
•	Environmental Epidemiology: Workshop on High-Risk Occupational Exposures
•	Education of Health Professionals: Conference on Linkage of Professionals and
Science Writers
•	Workshop on Cost-Effectiveness Methodologies (continued)
•	Data Compilation: Environmental Epidemiology Dictionary
•	Workshop on the Health Effects of Pesticide Exposure [continued)
FY80
•	Education of Health Professionals: Conference on Linkage of Professionals and
Science Writers (continued)
•	Environmental Epidemiology: Workshop on Nonoccupational Exposures
•	Workshop on Cost-Effectiveness Methodologies (continued)
•	Data Compilation: Environmental Epidemiology Dictionary (continued)
FYflO
•	Environmental Epidemiology: Workshop on Measurement or Workshop on
Standardized Questionnaire Development
•	Workshop on Susceptible Populations
•	Data Compilation: Environmental Epidemiology Dictionary (continued)
•	Data Compilation: Directory of Data Bases
FY94
•	Environmental Epidemiology: Workshop on Measurement or Workshop on
Standardized Questionnaire Development (continued)
•	Data Compilation: Directory of Data Bases (continued)
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The Workshop also included the presentation of case studies.
One described the response of Seattle, Washington, to an environmental
emergency involving the identification of polynuclear aromatic hydro-
carbon contamination in a popular park that was formerly the site of
a coal gasification plant. Benzo(a)pyrene, a carcinogen, was found in
soil samples at high concentrations, which resulted in the temporary
closing of the park. The case study set a framework for addressing
numerous issues that arise when communities are faced with real or
perceived environmental/occupational hazards. These issues include:
•	Identification of the hazard
•	Assessment of the health consequences of the hazard
•	Communication of information about such hazards to the
public
•	Definition of the role of individuals and Agencies in the
evaluation
•	Evaluation of the effectiveness of actions taken in response
to the hazard.
The other case study described a community education outreach
effort in New Jersey. The Environmental and Occupational Health In-
formation Program, based at Rutgers University, provides information
to the public and health professionals so that decisions related to
environmental problems can be made more effectively. A unique fea-
ture of the program is an advisory committee composed of repre-
sentatives from industry, labor, and local, state, and Federal government.
The program includes an Information Resource Center, accessible
through a toll-free number, to provide information on a proactive ba-
sis and make referrals to other organizations. Other components of
the program provide information to workers, local government and
voluntary groups, schools, small industries, and physicians.
The IEPLG will publish the report of this Workshop, to include
the case study presentations, discussion highlights, and recommenda-
tions, in 1987.
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Public Education and Communication
In keeping with the Task Force emphasis on education as a
means of reducing or preventing disease, the Project Group on Public
Education and Communication focuses on improving communication
of information about environmental factors and human disease to the
general public. As Federal organizations institutionalize risk assess-
ment and risk management into their deliberative processes, commu-
nication of health risk assessment concepts to the public becomes in-
creasingly important.
The Project Group planned a workshop, scheduled for January
1987, to explore existing Federal risk communication activities, iden-
tify gaps in research and practice that need to be addressed, and de-
velop effective strategies for interprogram and inter-Agency coopera-
tion in risk communication activities. The participants included Gov-
ernment policymakers, program administrators, and public health pro-
fessionals from Federal, state, and local governments, as well as ex-
perts in risk communication from the academic community, citizens'
and environmental groups, media, business, and industry.
In preparation for the Workshop, the Project Group compiled an
inventory of Federal Agency programs in risk communication. The in-
ventory, which includes a directory of key Federal Agency offices
that are involved in risk communication, will be published as a Work-
shop product.
The Workshop planning committee developed an agenda combin-
ing plenary sessions and small group discussions. Segments of the
program included:
• Overview of Federal risk communication activities and their
effect on state and local activities
—	Information from the inventory of Federal programs
—	Case examples of Federal, state, and local risk communica-
tion programs
—	A panel representing the perspectives of citizens, media,
and industry
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• Fundamentals of the risk communication process and the
techniques that can be used to communicate risk
—	Analysis of risk assessment data as the basis for risk com-
munication
—	Perceptions of risk by the public
—	Identification of target audiences
—	Presentation of scientific information in a form understand-
able by the general public
—	Evaluation of public response to risk communication
programs.
Participants were assigned to small groups and asked to identify
the key problems that impede risk communication, formulate recom-
mendations to address these problems, and suggest specific mecha-
nisms or actions to implement the recommendations. A panel of Fed-
eral Agency representatives discussed the policy implications of the
recommendations.
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Chapter 3
PLANNED ACTIVITIES OF THE WORKING GROUP
IN 1987
After initial information gathering, the Task Force made the fol-
lowing changes in activities planned for FY87 (see Table 1): the inr
door air pollution workshop focusing on allergens and pathogens was
moved to 1989 and replaced with a workshop on the health effects of
pesticides, and the environmental epidemiology dictionary project will
begin in 1987 rather than in 1988. Additional activities in public edu-
cation and risk communication will be incorporated into the plan.
Health Effects of Pesticide Exposure
Several Task Force Agencies have responsibilities for managing
the use of pesticides and reducing their deleterious health effects.
While many groups and organizations have examined the effects of
pesticides on the environment, many information gaps exist, particu-
larly with regard to linking exposure to disease. Recognizing the need
for exposure data in developing more realistic risk assessments, the
Tbsk Force will initiate the planning of a workshop on the health ef-
fects of pesticide exposure. The workshop will have a consumer-user
orientation and focus on nonoccupational exposures. The objectives
will be to identify gaps in knowledge, achieve scientific consensus on
future research and policy needs, and produce a report including re-
search recommendations.
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Health Professional Education
TOXNET
To further Task Force efforts to provide information to health
professionals on environmental and occupational health issues, the
IEPLG will work with the National Library of Medicine (NLM) to
disseminate information on the TOXNET data base. TOXNET, sup-
ported by NLM, CDC, EPA, and the Agency for Toxic Substances
and Disease Registry (ATSDR-CDC), was developed in partial re-
sponse to the Superfund legislation requirement that an inventory of
literature on the health effects of toxic substances be compiled and
maintained. The information in TOXNET could be useful to primary
care physicians in the diagnosis and treatment of environmentally and
occupationally related diseases. Therefore, the target groups for this
information dissemination project will be primary care practitioners
of family, preventive, and internal medicine. The IEPLG will develop
a brochure on TOXNET that is specifically tailored to the informational
needs of primary care practitioners. In addition, an exhibit will be de-
signed for display at the annual meetings of selected physician
groups. The exhibit will demonstrate how to use TOXNET. This ac-
tivity will include an evaluation of the effectiveness of targeting mes-
sages to physician groups.
Occupational and Environmental Asthma
The Division of Lung Diseases, NHLBI, has awarded grants to
improve the teaching of prevention in pulmonary medicine. This net-
work of grantees in participating medical schools has concentrated
heavily on occupational and environmental insults and their preven-
tion. The'IEPLG is planning a meeting to promote communication
linkages between pulmonary medicine grantees and practitioners of
family medicine. This meeting will serve as a forum for the communi-
cation of new research findings in pulmonary medicine to primary
care practitioners. The focus will be the prevention or reduced inci-
dence of environmentally and* occupationally related pulmonary dis-
ease. A report of the meeting will be prepared.
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Public Education and Communication
The Role of Government in Health Risk Communication and
Public Education
As described in Chapter 2, the Workshop on the Role of Govern-
ment in Health Risk Communication was held in January 1987. Fol-
lowing the Workshop, the Project Group on Public Education and
Communication will prepare and publish a report, which will include
recommendations for stimulating Agency cooperation in risk commu-
nication, recommendations for research needed to reduce the limita-
tions and uncertainties of risk assessment data, and recommendations
on methods to improve risk communication. The report will also in-
clude an assessment of the needs of risk communicators and experts
to more effectively plan, develop, implement, and evaluate risk com-
munication programs. In addition, the Project Group will complete an
inventory of existing Federal health risk communication programs,
with particular emphasis on what risk communicators and experts are
doing to address the key questions and problems raised during the
Workshop, including a directory of key Federal Agency offices that
are responsible for and involved in risk communication programs.
Evaluation of Health Risk Communication Programs
The Project Group on Public Education and Communication has
recognized the importance of incorporating measures of program ef-
fectiveness into programs and evaluating health risk communication
programs. A workshop on evaluation is being planned and tentatively
scheduled for late spring 1988. The objectives will be to gather and
present information on risk communication evaluations done in the
past and use this information to develop generic evaluation criteria.
Case studies will be used to illustrate evaluation techniques. The ini-
tial activity will be for Project Group members to identify case
studies on risk communication that are being evaluated within their
Agencies.
Environmental Dictionary
Before beginning the compilation of an environmental dictionary,
the Working Group planned to conduct a feasibility study to deter-
mine the need for such a product, the scope and orientation of the
entries, and interest on the part of physician groups, environmental
groups, and commercial publishers. The results of the study will be
presented to an advisory committee, which will then determine how
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to proceed with the activity. It is expected that the publication will
serve as a desk reference on environmental terms and will have a
clinical-chemical orientation. The document will include lists of refer-
ral organizations and experts.
Cost-Effectiveness Methodologies in Research Planning
Task Force member Agencies will be surveyed to ascertain the
extent to which cost-effectiveness is considered in planning health re-
search programs. Efforts to reduce budget deficits and the escalation
of health care delivery costs have stimulated increased attention to
the economic efficiency of current and future approaches to improv-
ing health. Increased attention to cost-effectiveness might provide a
means of increasing the utility of research recommendations, includ-
ing the Task Force's recommendations.
Possible Task Force efforts in this area may include a bibliographic
compilation on current methodologies and their use, a workshop in-
volving Agency personnel who conduct studies of cost-effectiveness,
and a symposium involving participants from Government, academia,
and industry, with the proceedings to be published.
14

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Chapter 4
RECOMMENDATIONS
The Task Force on Environmental Cancer and Heart and Lung
Disease recommends strategies and other measures that might help in
determining and quantifying relationships between environmental pol-
lution and human disease and in preventing or reducing the incidence
of environmentally related disease. The findings and conclusions de-
veloped by scientists who participate in consensus-building meetings
sponsored by the Task Force are considered in the formulation of rec-
ommendations. Accordingly, the recommendations stated in this re-
port are a summary of the conclusions developed by scientists in
those meetings. These recommendations do not necessarily reflect the
views of the Task Force member Agencies.
Health Professional Education
Physicians and educators at the Workshop on The Community as
Patient developed recommendations and strategies for education and
research to contribute to the determination of the relationship be-
tween environmental and occupational factors and human disease.
They were specifically concerned with the role of the academic-based
occupational medicine physician in communities faced with environmental
threats, There was overall agreement on the need for national, state,
and local programs to enhance health professional education on occu-
pational and environmental health hazards in the community. The full
report of the Workshop includes recommendations for both research
and education and discusses strategies for implementation of these
recommendations.
15

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Recommendation 1: Training. Academic medical centers
should be encouraged to teach their medical students to take
an occupational and environmental history from their pa-
tients on a routine basis.
In general, physicians do not take occupational factors into ac-
count when evaluating their patients' health problems, and they prob-
ably afford less attention to environmental factors. Medical histories
often are incomplete with respect to hazards that may be encountered
in the home (indoor pollution] and workplace hazards that may be
transmitted to the home, e.g., on the clothing of workers. For various
reasons—lack of awareness, unavailability of appropriate forms-
physicians do not ask questions to elicit information about their pa-
tients' work and home environments,
Such information is needed for the diagnosis, treatment, and pre-
vention of occupationally and environmentally related disease. The
national health promotion/disease prevention strategy, set forth in the
DHHS 1990 Objectives for the Nation, recognizes this need: by 1990,
at least 70 percent of primary health care providers should routinely
elicit occupational health exposures as part of the patient history, and
at least 70 percent of all primary care physicians should be able to
identify the principal health consequences of exposure to major
categories of environmental threats.*
Medical schools should incorporate practical instruction on how
to take occupational and environmental histories into the basic curric-
ulum. The taking of these histories and the interpretation of the infor-
mation in establishing diagnoses should be emphasized as essential to
good medical practice.
Recommendation 2; Surveillance and Collaboration. For
specific exposures, all primary care physicians who see pa-
tients presenting with occupational and environmental expo-
sures should be encouraged to work collaboratively to gather
in-depth data on exposure and adverse sequelae, including
derivation of exposure-dose relationships.
Surveillance is the first step in preventing disease. Physicians,
particularly occupational medicine physicians, are in the position to
collect information about exposures and the occurrence of disease.
*U.S. Department of Health and Human Services. 10flO. Promoting Health/Preventing
Disease: Objectives for the Nation, pp. 35, 42.
16

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Collaborative efforts are needed to identify occupations or environmental
insults that are likely to involve risks of disease.
The collaboration of occupational medicine physicians, who see
patients with common workplace exposures, will serve to increase
the information base on exposure and the development of occupation-
al disease. This information will also be helpful in determining the
points of transition from clinical normality to abnormality.
In addition, the benefits of combining clinical practice and
epidemiologic inquiry are becoming increasingly evident. Clinical
considerations related to the identification of disease in individuals
comprising a population having a specific exposure are essential to
epidemiologic study. Epidemiologic studies provide important infor-
mation to clinicians for their decisions on individual patient care in
matters relating to diagnosis, treatment, and prognosis.
Recommendation 3: Identification of Populations Likely lb
Be Exposed. State and local health entities should be urged
to encourage primary care physicians to be knowledgeable
about which populations in specific geographic areas may be
exposed to environmental hazards and may need information
on potential risks to their health.
Groups at risk may include those who live near hazardous waste
sites. The identification of these and other groups could be useful for
further clinical workups so as to establish possible linkages between
exposure and adverse health effects. Anecdotal data indicate that
many physicians are unaware of environmental hazards in their prac-
tice areas. Those who are aware of environmental problems may not
know what health risks may be associated with such hazards. This
lack of awareness and information adversely affects the physicians'
ability to take care of patients. Continuing medical education programs
could stimulate physicians to be alert to the possibility of high-risk
groups in the community and expand physicians' sensitivity to report-
ing responsibilities.
17

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Appendix A
SECTION 402 OF PUBLIC LAW 95-95

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Appendix A
SECTION 402 OF PUBLIC LAW 95-95
Glean Air Act Amendments of 1977
"INTERAGENCY COOPERATION ON PREVENTION OF
ENVIRONMENTAL CANCER AND HEART AND LUNG DISEASE
Sec. 402(a) Not later than three months after the date of enactment of
this section, there shall be established a Task Force on Environmental
Cancer and Heart and Lung Disease (hereinafter referred to as the
Task Force'). The Task Force shall include representatives of the
Environmental Protection Agency, the National Cancer Institute, the
National Heart, Lung, and Blood Institute, the National Institute (for)
Occupational Safety and Health, and the National Institute (of)
Environmental Health Sciences, and shall be chaired by the Adminis-
trator (or his delegate).
(b) The Task Force shall—
(1)	recommend a comprehensive research program to deter-
mine and quantify the relationship between environmental
pollution and human cancer and heart and lung disease;
(2)	recommend comprehensive strategies to reduce or eliminate
the risks of cancer or such other diseases associated with
environmental pollution;
(3)	recommend research and such other measures as may be
appropriate to prevent or reduce the incidence of
environmentally related cancer and heart and lung dis-
eases;
21

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(4)	coordinate research by, and stimulate cooperation between,
the Environmental Protection Agency, the Department of
Health, Education, and Welfare, and such other Agencies
as may be appropriate to prevent environmentally related
cancer and heart and lung diseases; and
(5)	report to Congress, not later than one year after the date of
enactment of this section and annually thereafter, on the
problems and progress in carrying out this section."
22

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Appendix B
TASK FORCE ON ENVIRONMENTAL
CANCER AND HEART AND LUNG DISEASE

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Appendix B
TASK FORCE ON ENVIRONMENTAL
CANCER AND HEART AND LUNG DISEASE
PLENARY AND ALTERNATES
1986
Lee M. Thomas,
Administrator,
U.S. Environmental Protection Agency
Chairperson
Richard H. Adamson,
Director, Division of
Cancer Etiology, NCI
Scott R. Baker,
Special Assistant to
the Assistant Administrator,
Office of Research
and Development,
EPA, Working Group
Chairperson
Charles DeLisi,
Associate Director,
Office of Energy Research,
DOE
Vincent T. DeVita,
Director, NCI
Manning Feinleib,
Director, NCHS
Jean French,
Science Advisor,
Office of the Director,
CDC/NIOSH
John A. Gronvall,
Chief Medical Director, VA
Suzanne S. Hurd,
Director, Division
of Lung Diseases,
NHLBI
25

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Claude Lenfant,
Director, NHLBI
James O. Mason,
Director, CDC
J. Donald Millar,
Director, CDC/NIOSH
David P. Rail,
Director, NIEHS
William Tallent,
Assistant Administrator,
Agricultural Research
Service, USDA
J.W. Thiessen,
Deputy Associate Director,
Office of Energy Research,
DOE
Andrew Ulsamer,
Acting Associate Executive
Director for Health Sciences,
CPSC
Ralph Yodaiken,
Director, Office of
Occupational Medicine, OSHA
Frank E. Young,
Commissioner, FDA
26

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WORKING GROUP MEMBERS
1986
Scott R. Baker,
Special Assistant to the Assistant Administrator,
Office of Research and Development, EPA
Chairperson
Richard H. Adamson,
Director, Division of
Cancer Etiology, NCI
Nathaniel Barr,
Office of Health and
Environmental Research,
Office of Energy Research,
DOE
Lois Ann Beaver,
Staff Scientist, Office
of Science Coordination,
Office of the
Commissioner, FDA
Zakir H. Bengali,
Division of Lung
Diseases, NHLBI
Bruce Cohen,
Office of Analysis
and Epidemiology, NCHS
James R. Fouts,
Senior Scientific Advisor
to the Director, NIEHS
Jean French,
Science Advisor,
Office of the Director,
CDC/NIOSH
Kailash C. Gupta,
Deputy Director HSHL,
CPSC
John R. Herbold,
Senior Policy Analyst,
Office of the Assistant
Secretary of Defense
(Health Affairs], DoD
Max Lum,
Medical Education
Specialist, Division of
Medicine, Bureau of Health
Professions, HRSA
Richard M. Parry, Jr.,
Assistant to the
Administrator,
Agricultural Research
Service, USDA
Maria Pavlova,
National Expert on Toxicology
EPA—Region II
A. Richey Sharrett,
Chief, Social and
Environmental Epidemiology
Branch, Division of
Epidemiology and Clinical
Applications, NHLBI
27

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Barclay M. Shepard,	Ralph Yodaiken,
Director, Agent Orange	Director, Office of
Project Office, VA	Occupational Medicine,
OSHA
28

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INTERAGENCY EDUCATION PROGRAM
LIAISON GROUP
1986
Max Lum,
Medical Education Specialist,
Division of Medicine,
Bureau of Health Professions, HRSA
Chairperson
E. Joseph Bangiolo,
Office of Cancer
Communications, NCI
Lois Ann Beaver,
Staff Scientist,
Office of Science
Coordination, Office
of the Commissioner, FDA
Paul W. Bergman,
Pesticide Use and Impact
Assessment Extension
Service, USDA
Lee Gigliotti,
Acting Chief, Health
Promotion Sciences
Branch, Division of
Cancer Prevention and
Control, NCI
Sydney Parker,
Chief, Prevention, Education,
and Manpower Branch,
Division of Lung Diseases,
NHLBI
James R, Secrest,
Chief, Multidisciplinary
Resource Development Branch,
Division of Medicine, HRSA
Alan D. Stevens (Retired 1986),
Director, Division of
Training and Manpower
Development, CDC/NIOSH
Ralph Yodaiken,
Director, Office of
Occupational Medicine,
OSHA
29

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PROJECT GROUP ON QUALITY ASSURANCE
IN ANALYTICAL METHODOLOGY
1986
Lois Ann Beaver,
Staff Scientist,
Office of Science Coordination,
Office of the Commissioner, FDA
Chairperson
Stanley M. Blacker,
Director, Quality
Assurance and Special
Studies Staff, EPA
Douglas W, Bristol,
Toxicology Research and
Testing Program, NIEHS
Harry S. Hertz,
Director, Center for
Analytical Chemistry, NBS
William Horwitz,
Acting Director,
Science Policy Staff, FDA
Eric J. Sampson,
Acting Director, Clinical
Chemistry Division, CDC
30

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PROJECT GROUP ON PUBLIC EDUCATION
AND COMMUNICATION*
1986
Maria Pavlova,
National Expert on Toxicology,
EPA—Region II
Chairperson
Frederick Allen,
Associate Director,
Policy Analysis, EPA
Donald Barnes,
Science Advisor, Office of
Pesticides and Toxic
Substances, EPA
Alexander Cohen,
Deputy Director, Division of
Biomedical and Behavioral
Science, CDC/NIOSH
Vincent Covello,
Director for Risk Assessment
and Risk Management Research,
National Science Foundation
Thomas W. Devine,
Director, Office of Policy,
Budget and Program
Management, EPA
Susan Diehl,
Risk Assessment Coordinator,
Office of the Regional
Administrator, EPA—Region IV
Ann Fisher,
Senior Economist,
Office of Policy Analysis, EPA
James R. Fouts,
Senior Scientific Advisor
to the Director, NIEHS
Jean French,
Science Advisor,
Office of the Director,
CDC/NIOSH
John Herbold,
Senior Policy Analyst,
Office of the Assistant
Secretary of Defense
(Health Affairs), DoD
Michael D. Hogan,
Special Assistant for Risk
Assessment, Biometry and
Risk Assessment Program,
NIEHS
Edward A. Klein,
Director, TSCA Assistance Office,
Office of Toxic Substances, EPA
'Became the Interagency Group on Public Education and Communication in
January 1987.
31

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Christine Krutszch,
Public Affairs Specialist,
Office of Prevention,
Education, and Control, NHLBI
Stanley L. Laskowski,
Deputy Regional
Administrator, EPA
James Marshall,
Director, Office of Internal
Affairs, EPA—Region II
David McCallum,
Senior Fellow, Institute for
Health Policy Analysis,
Georgetown University School
of Medicine
Sanford Miller,
Director, Center for Food
Safety and Applied Nutrition,
FDA
Kim Mortensen,
Public Health Advisor,
CDC/ATSDR
Richard M. Parry, Jr.,
Assistant to the Administrator,
Agricultural Research Service,
USD A
Peter Preuss,
Director, Office of Health and
Environmental Assessment,
Office of Research and
Development, EPA
Rose Mary Romano,
Chief, Information Projects Branch,
Office of Cancer Communications,
NCI
Robert J. Scheuplein,
Deputy Director, Office of the
Director, Toxicological
Services, FDA
Barclay M- Shepard,
Director, Agent Orange
Project Office, VA
Karen Skinner,
Special Assistant to the
Director for Science Policy,
Safety and Applied Nutrition,
FDA
Frank Tooper,
Assistant to the Assistant
Secretary for Nuclear Energy,
Office of Nuclear Energy, DOE
Andrew Ulsamer,
Director, Health Services,
CPSC
Michael White,
Associate Director, NHLBI
Jeannette Wiltse,
Air Toxics Coordinator, Office
of Air and Radiation, Office
of Research and Development
EPA
32

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Appendix C
SELECTED PUBLICATIONS FROM THE TASK FORCE
ON ENVIRONMENTAL CANCER AND
HEART AND LUNG DISEASE

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Appendix C
SELECTED PUBLICATIONS FROM THE TASK FORCE
ON ENVIRONMENTAL CANCER AND
HEART AND LUNG DISEASE
The following publications represent some of the contributions to the
study of environmental disease, its causes, treatment, and prevention,
made by Task Force-sponsored workshops, symposia, conferences,
and research reports.
1.	
Environmental Cancer and Heart and Lung Disease, Annual Reports
to Congress, 1978-1985. (Available from Technical Resources, Inc.,
and NTIS.)
Eighth Annual Report. 1985. NTIS Accession No. PB87 184412;
paper copy $13.95; microfiche $6.50.
Seventh Annual Report. 1984. NTIS Accession No. PB85 236842;
paper copy $10.00; microfiche $4.50.
Sixth Annual Report. 1983. NTIS Accession No. PB84 219187;
paper copy $11.50; microfiche $4.50.
Fifth Annual Report. 1982. NTIS Accession No. PB83 155762;
paper copy $16.00; microfiche $4.50.
Fourth Annual Report. 1981. NTIS Accession No. PB82 200429;
paper copy $12,00; microfiche $4.00.
Third Annual Report. 1980. NTIS Accession No. PB81 174716;
paper copy $11.00; microfiche $3.50.
Second Annual Report. 1979. Available from Technical
Resources, Inc.
First Annual Report. 1978. Available from Technical Resources,
Inc.
35

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These annual reports describe the activities and accomplishments of
the Task Force for the preceding year. Summaries of the various Task
Force Project Group activities are also given, with emphasis on major
workshops and reports undertaken during the year. Recommendations
for research needed to elucidate environment-disease relationships are
presented.
	2	
Environmental Health-Related Information, A Bibliographic Guide to
Federal Sources for the Health Professional. 1984. (Available only
from NTIS; NTIS Accession No. PB84 22981; paper $25.00; micro-
fiche $4.50.)
This annotated bibliography contains selected materials on occupa-
tional and environmental health available from Federal organizations.
It includes audiovisual presentations as well as publications related to
the diagnosis, treatment, prevention, and limitation of environmentally
related disease. The book is organized by categories chosen to guide
the user to the desired materials as efficiently as possible. Appendixes
provide information on NCI Cancer Centers, Educational Resource
Centers supported by NIOSH, Federally funded clearinghouses for
environmental health issues, and accredited residencies in preventive
and occupational medicine.
	3	
Exposure Assessment: Problems and Prospects, Journal of Toxicolo-
gy—Clinical Toxicology, Vol. 21, Nos. 1 and 2, 1983-84. Special Sym-
posium Issue.
Experts from Government, academia, and clinical research institu-
tions presented papers describing various models and approaches cur-
rently used to assess human exposure to toxic substances. These pa-
pers cover the various settings and purposes for which exposure de-
terminations are undertaken. Each paper is followed by references
and the discussion that took place at the symposium.
	4	
Summary of the Workshop on Exposure to Environmental Agents,
Their Metabolism, and Mechanisms of Toxicity: Research Needs.
36

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August 1981. (NTIS Accession No. PB82 212895; paper $13.50; micro-
fiche $4.00.)
This summary presents the full text and rationale of 72 research rec-
ommendations developed through a consensus of scientific experts.
The document is a compilation of research needs for environmental
cancer and heart and lung disease in areas such as epidemiology, ex-
posure quantification and monitoring, metabolism, and disease
processes. Both short- and long-term needs are identified in a bal-
anced focus on basic and applied environmental disease research.
	5	
Position Papers from the Workshop on Exposure to Environmental
Agents, Their Metabolism, and Mechanisms of Toxicity. Published as
a Special Issue of the Journal of Environmental Science and Health,
Vol. 17A, No. 4, July 1982.
A wide range of topics was covered in this publication, including initi-
ation/promotion concepts of carcinogenesis, toxicologic interactions
and pathogenesis of lung and heart disease, and total exposure mod-
els in animals and humans.
	6	
Legal and Administrative Impediments to the Conduct of Epidemiologic
Research. 1984.
This study was conducted to determine whether significant modifica-
tions or relaxation in impediments to data access and record linkage
have occurred since the Task Force recommendation on this issue in
its Fourth Annual Report to Congress. Recent literature was re-
viewed, and Federal epidemiologists involved with these issues were
interviewed.
	7	
Quarterly Calendar.
To facilitate information dissemination within a 3-month timeframe,
the Task Force Calendar announces meetings, conferences, symposia,
courses, public hearings, and workshops that pertain to environmental
pollution and disease.
37

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8.
Workshop on Environmental Education Needs of Health Profession-
als. 1979.
The summary report of this workshop identifies the needs of health
professionals in environmental education and develops action plans
to enhance their capability to prevent environment-related disease.
9	
Recommendations of Environmental and Occupational Education of
Health Professionals. 1980.
These recommendations outline a strategy through which health pro-
fessionals can more effectively prevent environment-related disease.
Included in the strategy are the establishment of an Interagency Edu-
cation Program Liaison Group and specific recommendations address-
ing curricula, faculty, students, continuing education, and research
components.
1	0	
Report of the Workshop on Environmentally Related Nononcogenic
Lung Disease, Environmental Research, Vol. 38, No. 2, 1985.
This report is intended to reflect the current state of knowledge on
environmentally related nononcogenic lung disease. It contains 45 re-
search recommendations and supporting rationales that resulted from
a week-long workshop. Sessions were held on epidemiology, statis-
tics, and risk assessment; clinical research; and basic and animal re-
search. There is an extensive list of references at the end of the re-
port.
1	1	
Report of the Seminar on Laboratory Quality Assurance, A Manage-
ment Approach. 1984.
This report summarizes the presentations given at a 2-day seminar
sponsored by the Task Force Project Group on Quality Assurance in
Analytical Methodology. Scientists and laboratory managers dis-
cussed the difficulties involved in producing reliable and compatible
38

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laboratory data. A problem-solving technique was used to elicit possi-
ble solutions to the successful application of quality assurance at the
managerial level.
12	.	
Strategies for Determining the Mechanisms of Toxicity. Prepared by
the Subcommittee on Metabolism of the Project Group on Exposure
and Metabolic Mechanisms, Journal of Toxicology—Clinical Toxicol-
ogy, Vol. 23, No. 1, 1985.
The report poses a series of questions for developing strategies for
the use of mechanistic approaches to studying the toxicity of chemi-
cals. The questions are discussed for toxicities relevant to environmental
cancer and heart and lung disease. The report is intended to provide
guiding principles on how pharmacokinetic and metabolism studies
should be used in toxicity experiments.
13	.	
Report of the Workshop on the Contribution of Airborne Pollutants to
Respiratory Cancer, Environmental Health Perspectives, Vol. 70, 1986.
The report includes an overview and papers describing the contribu-
tion of radon, environmental fibers, formaldehyde, organic particles,
passive smoking, and metals to the incidence of respiratory cancer.
Each of these airborne pollutants is discussed in the context of its in-
teraction with cigarette smoke and the risk of exposure to human
populations. Data gaps and uncertainties are identified, and recom-
mendations are suggested for research to reduce these uncertainties.
14	.	
Report of the Workshop on Environmental Toxicity and the Aging
Process. 1987. New York: Alan R. Liss, Inc.
As an effort to provide impetus to a multidisciplinary approach to the
study of interactions between factors in the environment and human
aging processes, two commissioned papers were prepared. One paper
addresses the issues from the gerontological perspective and the other
from the toxicological perspective. The report also includes recom-
mendations for future research.
39

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15.
Report of the Special Grand Rounds: Women at Work. 1986. (NTIS
Accession No. PB87 184263; paper copy $13.95; microfiche $6.50.)
The report is a compilation of presentations on women's occupational
health issues. These include an overview discussion of possible health
effects associated with exposure to video display terminals and toxic
substances in the workplace, and an annotated listing of educational
resources.
IB	
Report of the Workshop on The Community as Patient. In prepara-
tion.
The report will include two case studies illustrating various roles of
health professionals in responding to environmental health concerns
of the community. The highlights of the Workshop discussions and
recommendations for research and education will also be presented.
40

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To obtain ordering information on any of the selected publications,
please complete the card below and return to
Technical Resources, Inc.
3202 Monroe Street
Suite 300
Rockville, Maryland 20852
Attention: Brooke Joseph
A limited number of free copies of these publications is available.
Name __		„„Title 	
Affiliation 	
Street 	City 	
State 	Zip 	
Please circle the item number of the publication(s) you wish to receive.
1	Years:			
2	3	4	5	6	7	8
9 10 11 12 13 14 15 16

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U.S. Environmental Protection Agency
Public Health Service
National Cancer Institute
National Heart, Lung, and Blood Institute
National Institute for Occupational
Safety and Health
National Institute of Environmental
Health Sciences
National Center for Health Statistics
Centers for Disease Control
Food and Drug Administration
Department of Energy
Consumer Product Safety Commission
Occupational Safety and Health Administration
Department of Agriculture
Veterans Administration
Department of Defense

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