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Environmental
Cancer
and
Heart and Lung
Disease
Tenth Report to Congress
1987/88
TASiC FORCE ON
ENVIRONMENTAL CANCER AND
HEART AND LUNG DISEASE
•S f

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Environmental Cancer
and
Heart and Lung Disease
Tenth Report to Congress
1987/88
Thsk Force on
Environmental Cancer and Heart and Lung Disease
U.S. Environmental Protection Agency
Public Health Service
National Institutes of Health
National Cancer Institute
National Heart, Lung, and Blood Institute
National Institute of Environmental
Health Sciences
Centers for Disease Control
National Institute for Occupational
Safety and Health
National Center for Health Statistics
Food and Drug Administration
Agency for Tbxic Substances and Disease Registry
Department of Energy
Consumer Product Safety Commission
Occupational Safety and Health Administration
Department of Agriculture
Department of Defense
Veterans Administation
S3 m
283
ill
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o m
co • >
33
o
Prepared by the Ibsk Force Working Group
Ken Sexton, Chairperson

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Copies of this document may be obtained
free of charge through requests to
Office of Health Research (RD-683)
U.S. Environmental Protection Agency
401 M Street, SW
Washington, DC 204B0
(202) 382-5895
When this supply is exhausted, the
document can be purchased from
National Technical Information
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
Please address your reply lo
APR 6 1989
William K. Reilly
Administrator
U.S. Environmental Protection Agency
401 M Street, SW
Washington, DC 20460
Honorable j. Danforth Quayle
President of the Senate
Washington, DC 20510
Dear Mr. President:
As Chairman of the Task Force on Environmental Cancer and Heart and Lung Disease, 1 am
pleased to submit the Tenth Report to Congress in accordance with Public Law 95-95,
Section 402 (b)(5).
The 15 Agencies that constitute the Task Force continue to work together to assess possible
relationships between environmental pollutants and human health. The report describes Task
Force activities, including a major workshop on risk communication and public education, the
publication of the report of its workshop on health professional education, and initiation of
planning for workshops on the effects of pesticides on human health and evaluation of risk
communication programs.
This report includes three recommendations based on the conclusions of participants in the
Workshop on the Role of Government in Health Risk Communication and Public Education.
The recommendations call for sharing of risk information among Agencies, the establishment of a
national research agenda on risk communication, and the development of risk information
specific to community needs. Implicit in these recommendations is the recognition that the goal
of risk communication is to ensure that the public is informed and involved in decisions that
affect their lives and property.
The Task Force's activities contribute to improved understanding of environmentally related
disease and serve to identify important research needs that should receive emphasis. The
collaborative opportunities fostered by the Task Force promote a broadly based and cooperative
Federal approach to environmental health. I believe that such an approach offers the best hope
for achieving progress irr the protection
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

Sincprely,
William K. Reill
William K. Reill
Chairman

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TASK FORCE ON
ENVIRONMENTAL CANCER AND HEART AND LUNG DISEASE
Please address your reply to:
APR 6 1989
William K, Reilly
Administrator
U.S. Environmenta. Protection Agency
401 M Street, SW
Washington, DC 2046C1
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 CanceT and Heart and Lung Disease, 1 am
pleased lo submit the Tenth Report to Congress in accordance with Public Law 95-95,
Section 402 (b)(5).
The 15 Agencies that constitute the Task Force continue to work together to assess possibie
relationships between environmental pollutants and human health. The report describes Task
force activities, including a major workshop on risk communication and public education, the
publication of the report of its workshop on health professional education, and initiation of
planning for workshops on the effects of pesticides on human health and evaluation of risk
communication programs.
This report includes three recommendations based on the conclusions of participants in (he
Workshop on the Role of Government in Health Risk Communication and Public Education.
The recommendations call for sharing of risk information among Agencies, the establishment of a
national research agenda on risk communication, and the development of risk information
specific to community needs. Implicit in these recommendations is the recognition that the goal
of risk communication is to ensure that the public is informed and involved in decisions that
affect their lives and property.
The Task Force's activities contribute to improved understanding of environmentally related
disease and serve to identify important research needs that should receive ennphasis. The
collaborative opportunities fostered by the Task Force promote a broadly based and cooperative
Federal approach to environmental health. I believe that such an approach offers the best hope
for achieving progress in the protection
Environmental Protection Agency • National Cancer Institute
National Heart, Lung, and Blood Institute * National Institute for Occupational Safely 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 Safely and Health Administration • Department of Agriculture
Department of Defense • Veterans Administration
Agency for Toxic Substances and Disease Registry
Sincerely,
William K. Reil
Chairman

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PREFACE
The Tksk 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 en-
vironmentally related diseases, in particular, cancer and heart and lung
disease, As a result of Task Force consideration and the member Agen-
cies' approval, recommendations have evolved from the needs identi-
fied 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 as the U.S. Environmental Pro-
tection Agency (EPA); and from the Public Health Service (PHS) of the
Department of Health and Human Services, the National Cancer Insti-
tute (NCI), the National Heart, Lung, and Blood Institute (NHLBI), the
National Institute of Environmental Health Sciences (NIEHSJ, and the
National Institute for Occupational Safety and Health (NIOSH-Cen-
ters for Disease Control). Ten other Government organizations have
joined the Tksk Force by invitation: four PHS Agencies, the National
Center for Health Statistics (NCHS-Centers for Disease Control), other
components from the Centers for Disease Control (CDC), the Food and
Drug Administration (FDA), and the Agency for Toxic Substances and
Disease Registry (ATSDR); the Department of Energy (DOE) in 1983;
the Consumer Product Safety Commission (CPSC) and the Department
of Agriculture (USDA) in 1984; the Veterans Administration in 1985;
and the Occupational Safety and Health Administration (OSHA) of the
Department of Labor in 1980. The Department of Defense (DoD) is an
observer to the Thsk Force.
iii

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To meet its reporting requirements to Congress, this report de-
scribes the accomplishments of the Task Force during 1987/88. Chapter
1 introduces the Task Force and its various subgroups. Chapter 2 de-
scribes the substantive activities of the Task Force during 1987/88. Rec-
ommendations are contained in Chapter 3.
iv

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CONTENTS
Page
EXECUTIVE SUMMARY	vii
Chapter 1	INTRODUCTION	1
Chapter 2	ACTIVITIES OF THE WORKING GROUP	5
IN 1987/88
Public Education and Communication	5
Health Professional Education	7
Effects of Pesticides on Human Health	9
Environmental Epidemiology	10
Chapter 3	RECOMMENDATIONS	11
Risk Communication and Public Education 11
Appendix A SECTION 402 OF PUBLIC LAW 95-95	17
Appendix B MEMBERS OF THE TASK FORCE,
WORKING GROUP, AND AD HOC
GROUPS	21
Appendix C MISSION STATEMENT OF THE NEW TASK
FORCE MEMBER AGENCY: AGENCY FOR
TOXIC SUBSTANCES AND DISEASE
REGISTRY	31
Appendix D SELECTED PUBLICATIONS FROM THE
TASK FORCE ON ENVIRONMENTAL
CANCER AND HEART AND LUNG DISEASE 37
v

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EXECUTIVE SUMMARY
The Tbsk Force on Environmental Cancer and Heart and Lung
Disease reports yearly to Congress. During 1987/88, the Tksk Force sup-
ported a major workshop on risk communication and public education,
published the report of its 1986 health professional education workshop,
and began planning a major workshop on the effects of pesticide on hu-
man health.
The following recommendations, offered to Congress for its consid-
eration, are based on the conclusions and findings developed by partic-
ipants at the Workshop on the Role of Government in Health Risk Com-
munication and Public Education:
1.	Ongoing mechanisms and networks are needed for sharing
information among Agencies about risks, risk assessment,
risk management, and risk communication,
2.	A national agenda should he established for research on
risk communication that identifies gaps and sets
priorities,
3.	Risk information should be specifically tailored in both
content and form to the needs of the target public group
in particular communities.
The Workshop participants recognized the need for Government
Agencies to engage in risk communication so that the public can partic-
ipate in an informed manner in decisions that affect their lives and prop-
erty. The participants also urged a systematic research approach to the
study of risk communication. As recommended by the Workshop, the
Tbsk Force's Project Group on Public Education and Communication
vii

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was renamed the Interagency Group on Public Education and Commu-
nication and expanded to include representatives of all Tksk Force mem-
ber Agencies. An editorial committee prepared the proceedings of the
Workshop for publication (Plenum Press, in press].
Recognizing that a recurring theme of the January 1987 Workshop
related to the importance of incorporating measures of effectiveness
into the planning of risk communication programs, the Interagency
Group initiated the planning of a workshop on evaluation. A planning
committee defined the workshop objective: to provide practical guidance
on planning and evaluation as part of implementing environmental and
health risk communication programs. In preparation for the June 1988
workshop, papers were commissioned on evaluation methodology and
research and the application of methods and theory to programs. The
recommendations from that workshop will be included in the Task
Force's Eleventh Report to Congress.
Another Tksk Force standing committee, the Interagency Education
Program Liaison Group (IEPLG), published the Report of the Workshop
on the Community as Patient. The report includes recommendations for
research and education and implementation strategies relevant to the
role of academic occupational and environmental medicine physicians
in reducing risks associated with hazardous substances in the commu-
nity. Some of the recommendations developed by the Workshop partic-
ipants were presented in the Tksk Force's Ninth Annual Report to Con-
gress and were used by the Agency for Toxic Substances and Disease
Registry in designing its mandated health education program.
The IEPLG also initiated the planning of a workshop to examine
possible environmental and occupational factors that may be associated
with asthma. In cooperation with the National Heart, Lung, and Blood
Institute and the National Institute for Occupational Safety and Health,
the IEPLG established a workshop steering committee and held an ini-
tial planning meeting to define goals and develop a plan for the work-
shop.
In cooperation with the Agency for Toxic Substances and Disease
Registry, the IEPLG began designing an activity to disseminate informa-
tion about the National Library of Medicine's TOXNET data system to
health professionals. The target audience for this information dissemi-
nation project will be primary care practitioners of family, preventive,
and internal medicine, and the intent is to reach them through the 1988
meetings of their specialty organizations.
viii

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In response to the concerns of several Federal Agencies and the
public, the Task Force initiated the planning of a major workshop to ex-
amine the chronic effects of pesticides on human health. A planning
committee composed of Federal and extramural scientists met several
times to structure the workshop process. Working groups of scientists
began drafting papers to assess several toxicological endpoints of pesti-
cide exposure (carcinogenicity, developmental toxicity, reproductive tox-
icity, neurotoxicity, and immunotoxicity) and to examine the actual hu-
man exposure to pesticides through all media. The workshop was sched-
uled for May 1988, and its findings, conclusions, and recommendations
will be presented in the Task Force's Eleventh Report to Congress.
The Long-Range Planning Committee reviewed and revised planned
activities, and the Working Group undertook a feasibility study for a pro-
posed activity in environmental epidemiology.
ix

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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 prob-
lem in a broad and coordinated fashion. Congress chose the mecha-
nism of an interagency Task Force to ensure continued communication
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 Tksk Force
is mandated to determine and quantify the relationship between envi-
ronmental 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 interest in environmental health and, accordingly, the
National Center for Health Statistics (NCHS-Centers for Disease Con-
trol), other components of the Centers for Disease Control (CDC), the
Food and Drug Administration (FDA), the Department of Energy (DOE),
the Consumer Product Safety Commission (CPSC), the Department of
Agriculture (USDA), the Veterans Administration (VA), and the Agency
•See Appendix A for full text of Section 402 (P.L. 95-95).
1

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for Toxic Substances and Disease Registry (ATSDR) 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 in-
teraction and cooperation.
The Task Force organization in 1987/88, shown in Figure 1, includ-
ed a Plenary, a Working Group, and various ad hoc subgroups charged
with conducting specific activities. The Plenary consists of Agency
heads and representatives of Departmental Secretaries, who in turn des-
ignate the Working Group representatives. The Working Group meets
quarterly 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 work-
shops, symposia, and various ad hoc committees. The members of the
Plenary, Working Group, and the subgroups are listed in Appendix B.
TASK FORCE ON ENVIRONMENTAL CANCER AND
HEART AND LUNG DISEASE
•PLANNING COMMITTEE
FOB THE WORKSHOP ON
THE EFFECTS OF J
PESTICIDES ON /
HUMAN HEALTH /
WORKING GROUP
PLENARY
INTERAGENCY
EDUCATION PROGRAM
UAISON GROUP
INTERAGENCY GROUP ON
PUBLIC EDUCATION
AND COMMUNICATION
LONG-TERM
PLANNING COMMITTEE
' Ad hoc committee nslabliahed for platiniriR !hi- workshop.
Figure 1. Ttask Force Organization (1987/88)
2

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The Tksk Force workshops bring together the experts in specific
subject areas to identify research needs. The workshop reports are pub-
lished in the peer-reviewed literature and are available to the entire sci-
entific 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 research
needs are considered by member Agencies in their research planning,
and some of these may ultimately become recommendations of the Tksk
Force to Congress.
The T&sk Force serves to coordinate research and stimulate cooper-
ation among Federal Agencies and scientific communities concerned
with environmental health. Its members have the opportunity to inte-
grate regulatory and research perspectives on the kinds of scientific in-
formation needed to provide an improved basis for protection of human
health and the environment. The T&sk Force provides an open, freely ac-
cessible forum for the exchange of ideas and information, which bene-
fits all of its members.
The T&sk Force is mandated to report to Congress yearly on its ac-
tivities. During its tenth year (1987/88), the Tbsk Force's activities were
focused in the following areas:
•	Long-term planning
•	Public education and communication
•	Health professional education
•	Effects of pesticides on human health
•	Environmental epidemiology.
These activities, described in Chapter 2, were directed by subcommit-
tees of both the Task Force and scientific workshops, involving scientists
from academia, research institutions, industry, and Government. The
recommendations to Congress that originated from the year's Tksk Force
activities are presented in Chapter 3. In 1988, the Tksk Force will contin-
ue its efforts in the areas of effects of pesticides on human health, pub-
lic education and communication, and health professional education; de-
velop reports on these activities; and consider other subjects for future
activities.
3

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Chapter 2
ACTIVITIES OF THE WORKING GROUP IN 1987/88
The Task Force Working Group met quarterly to exchange infor-
mation, discuss environmental health issues of common interest, and
initiate and direct activities of its subcommittees. The Working Group
reviewed and revised its long-term plan of activities. The Project Group
on Public Education and Communication held the Workshop on the Role
of Government in Health Risk Communication and Public Education
and, as recommended by that Workshop, became the Interagency Group
on Public Education and Communication. An editorial committee pre-
pared the proceedings of the workshop for publication, and the Intera-
gency Group initiated planning for a workshop on evaluation of health
risk communication programs. The Interagency Education Program Liai-
son Group (IEPLGJ completed and published the Report of the Workshop
on Community as Patient and initiated planning of additional activities
to focus on the role of the health professional in environmental health
issues. A planning committee began work in preparation for a major
workshop on the effects of pesticides on human health. The Working
Group considered the results of a feasibility study on preparing an en-
vironmental epidemiology reference document.
Public Education and Communication
In keeping with the Task Force's emphasis on education as a
means of reducing or preventing disease, the Project Group on Public
Education and Communication was established to focus on communi-
cating information about environmental factors and human disease to
the general public. A recommendation of the Project Group's January
1987 Workshop on the Role of Government in Health Risk Communica-
tion and Public Education was that the Group be renamed the Interagen-
cy Group on Public Education and Communication and be expanded to
include representatives of all Tksk Force Agencies. The role of the Inter-
5

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agency Group is to enhance the collaboration, sharing of information,
and coordination of risk communication and education efforts of mem-
ber Agencies and other Federal Agencies. The Interagency Group de-
veloped a proposed plan of activities through 1990.
Role of Government in Health Risk Communication
and Public Education
The Workshop on the Role of Government in Health Risk Commu-
nication and Public Education was held in January 1987 to explore ex-
isting Federal risk communication activities, identify gaps in research
and practice that need to be addressed, and develop effective strategies
for interprogram and inter-Agency cooperation in risk communication
activities. The participants included Government policy makers, pro-
gram administrators, risk communicators, scientists, and public health
professionals from Federal, State, and local government, as well as rep-
resentatives from academia, citizens' groups, the media, business, and
industry.
The Workshop participants agreed on the importance of risk com-
munication by Government Agencies, recognizing that the goal should
be to produce an informed public who are involved in decisions that af-
fect their lives and their property. Risk communication programs need
to include guidelines on which to base the definition of objectives and
the development of standards and measures for evaluating risk commu-
nication programs and performances. To address these needs, the partic-
ipants discussed a broad and diverse set of risk communication princi-
ples and guidelines for use by Federal Agencies. An overriding theme
of discussion was that risk communication must be understood as a two-
way interactive process based on mutual respect and trust.
An editorial committee prepared the proceedings of the Workshop for
publication (see Appendix D for availability). The proceedings include:
•	Overview of the principles and guidelines for improving risk
communication
•	Perspectives on Government risk communication programs and
descriptions of programs
•	Case studies of Government risk communication programs,
including the Newark dioxin case, the BKK Corporation landfill
6

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case, a phosphorus release in Ohio, and notification of workers
exposed to 2-naphthylamine
• Descriptions of various aspects of the risk communication process.
Appendixes include an inventory of Government risk communication
programs and manuals on risk communication for Government commu-
nicators and for plant managers.
Evaluation of Health Risk Communication Programs
The importance of incorporating measures of effectiveness into
the planning of risk communication programs was a recurring theme
of the January 1987 Workshop on the Role of Government in Health
Risk Communication and Public Education. Therefore, the Interagen-
cy Group on Public Education and Communication decided that a
workshop on evaluation would be a useful sequel to its first risk com-
munication activity. A planning committee defined the workshop ob-
jective: to provide practical guidance on planning and evaluation as
part of implementing environmental and health risk communication
programs. In preparation for the June 1988 Workshop on Evaluation
and Effective Risk Communication, papers were commissioned on
evaluation methodology and research and the application of methods
and theory to programs.
Health Professional Education
The Task Force's Interagency Education Program Liaison Group
continued its efforts to increase awareness of environmental health is-
sues among health professionals by utilizing multi-Agency planning
and participation. The report of the 1986 Workshop on the Commu-
nity as Patient was published (see Appendix D for availability). The
report includes recommendations for research and education and im-
plementation strategies relevant to the role of academic occupational
and environmental medicine physicians in reducing risks associated
with hazardous substances in the community. Case studies, describing
the management of a community impact of an environmental hazard
and a community educational outreach effort, are also presented. As
a special aid for health professionals, the report provides two sample
occupational/environmental history forms and urges their use in clin-
ical practice.
7

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The Agency for Toxic Substances and Disease Registry was guided
by the recommendations contained in the Task Force's Ninth Report
in developing its newly mandated (Superfund Amendments and Re-
authorization Act of 1986) Health Education Program. Specifically,
ATSDR program personnel believed that an integrated network of
academically based environmental and occupational medical clinics
could best address the Tbsk Force's proposed recommendations. Such
a network was created in 1987 by ATSDR in part to examine the long-
term implications and utility of the proposed recommendations.
This program outcome provides one small but vivid example of
compliance with the Congressional intent by stimulating cooperation
between EPA and the Public Health Service to implement comprehen-
sive strategies to reduce or prevent exposure to hazardous substances
that may produce environmentally related disease or illness.
Environmental and Occupational Asthma
In cooperation with NHLBI and NIOSH, the IEPLG established
a steering committee, composed of clinicians and researchers, to de-
velop a plan for a Workshop on Environmental and Occupational
Asthma. The steering committee defined the following general goals
for the workshop:
•	Define environmental and occupational asthma and identify
respiratory hazards resulting from environmental as well as
occupational exposures
•	Relate the current knowledge to needed skills and behaviors
within the practice patterns of physicians, particularly primary
care and other first contact providers (what do primary care
physicians need to know?)
•	Provide mechanisms for reinforcing physicians' skills and
behaviors in regard to preventing, treating, and reporting of
environmental and occupational asthma
•	Provide surveillance mechanisms for the recognition of
environmental and occupational asthma
•	Suggest further needs and efforts, such as clinical assessment,
epidemiology, management, control, and prevention, necessary to
identify and protect individuals at risk
8

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•	Identify research gaps and recommend new research initiatives.
TOXNET Information Dissemination
In cooperation with ATSDR and other Federal Agencies, the
IEPLG began planning an effort to disseminate information about the
National Library of Medicine's Toxicology Data Network (TOXNET]
to health professionals. TOXNET is a computerized on-line system of
toxicologically oriented data banks operated by the National Library
of Medicine. TOXNET's three data banks—the Hazardous Substances
Data Bank, the Registry of Toxic Effects of Chemical Substances, and
the Chemical Carcinogenesis Research Information System—permit
efficient access to valuable data on potentially toxic or otherwise haz-
ardous substances. With the growing awareness of toxic contamina-
tion and the potential link between disease and a wide range of en-
vironmental factors, the public increasingly will expect health care
practitioners to diagnose and treat environmentally and occupational-
ly related disease. TOXNET enables users to obtain data on known
chemicals and identify unknown chemicals based upon their physical
characteristics (e.g., physical form, color, odor, etc.). The target audi-
ence for the information dissemination activity will be primary care
practitioners of family, preventive, and internal medicine.
Effects of Pesticides on Human Health
In response to the concerns of several Tksk Force Agencies and
to public concern about pesticides, the Working Group undertook the
planning of a workshop to assess the effects of pesticides on human
health. With a focus on chronic, low-level exposures to pesticides,
working groups of scientists were established to address several toxi-
cological endpoints; carcinogenicity, developmental toxicity, reproduc-
tive toxicity, neurotoxicity, and immunotoxicity. Another working
group specifically addressed exposure to pesticides through all media
and the relationship of exposure to the chronic health effects. The
working groups were to consider the following questions in developing
their papers:
•	What is the potential of pesticide chemicals to cause adverse
health effects?
•	Is there evidence that at current levels of exposure, human health
is being compromised?
9

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•	Are testing and toxicological risk assessments adequate to detect
the kinds of effects that might occur?
•	How can the capability to monitor for potential adverse effects
of pesticides be improved?
•	What are the major gaps in our current understanding of the
science and what are the needs for future research?
The working groups papers will form the basis for discussions at the
workshop, scheduled for May 1988.
Environmental Epidemiology
The Working Group conducted a feasibility study to determine the
need for an environmental epidemiology reference document for phy-
sicians. Three options were considered: (1) definitions of epidemio-
logic terms relevant to environmental study; (2) practical guidelines
for clinicians on how to do office-based epidemiology; and (3) a desk
reference for physicians with information on the most important expo-
sures and referrals. The feasibility study included the identification of
existing, publicly available, computerized data bases on environmental
health and risk assessment. Approximately 70 relevant data bases
were identified, as well as several related generic data bases. In ad-
dition, literature searches were conducted to identify epidemiologic
and environmental glossaries and relevant publications. It was noted
that the International Programme on Chemical Safety is in the pro-
cess of compiling internationally agreed on definitions for the terms
most frequently used in toxicological and epidemiological studies. In
view of existing and planned information resources, the Working
Group decided not to proceed with this activity.
10

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Chapter 3
RECOMMENDATIONS
The Task Force on Environmental Cancer and Heart and Lung
Disease recommends strategies and other measures that might help in
the determination and quantification of relationships between environ-
mental pollution and human disease and in preventing or reducing the
incidence of environmentally related disease. The findings and conclu-
sions developed by participants in scientific meetings sponsored by the
T&sk Force are considered in the formulation of recommendations. Ac-
cordingly, the recommendations stated in this report are a summary of
the conclusions developed by participants in those meetings. These
recommendations do not necessarily reflect the unanimity of views
of the Tksk Force member Agencies.
Risk Communication and Public Education
At the Workshop on the Role of Government in Health Risk Com-
munication and Public Education, educators, communications practi-
tioners, representatives of Federal, State, and local government, the
media, industry, academia, and private interest groups developed rec-
ommendations, guidelines, and strategies for improving the communi-
cation of risk information to the public. The goal of risk communica-
tion should be to assure that the public is informed and involved in
the decision-making process in a thoughtful, solution-oriented manner.
Workshop participants emphasized that risk communication must be
understood as a two-way interactive process based on mutual respect
and trust.
The Workshop participants also urged that risk communication be
recognized as an essential component of the risk management process.
The satisfactory resolution of risk situations requires a credible risk as-
sessment, well documented and fairly executed risk management that
11

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addresses the issues that concern the affected population, and an open,
interactive way to communicate with the affected population. Risk as-
sessors and risk managers need to be aware of the intricacies of risk
communication, and the entire risk management process must take
into account the need for communicating with the public, decision-
makers, and all interested parties.
Recommendation h Coordination and Collaboration, Ongoing
mechanisms and networks are needed for sharing information
among Agencies about risks, risk assessment, risk management,
and risk communication.
Government Agencies are major sources of information on risks,
and it is important to sustain trust in their credibility as sources of in-
formation. Government Agencies have different mandates, which ne-
cessitates cooperation in risk assessment and risk communication. En-
hancing coordination and collaboration among Agencies can reduce
the possibility of confusion.
Coordination within and between Agencies, including Agencies at
the Federal, State, and local level, is critical to effective efforts at risk
communication. Efforts should be devoted to building stronger bridges
among agencies and organizations. Interagency and intra-agency com-
munications should be more coordinated as a matter of routine.
Recommendation 2: Research Agenda. A national agenda should
be established for research on risk communication that identifies
gaps and sets priorities.
Many of the current principles and guidelines for risk communi-
cation are based on experience and observation, not on systematic re-
search. Although some related research has been conducted, the num-
ber of studies that focus specifically on risk communication is small.
There have been only limited efforts to develop or exploit contribu-
tions from the relevant social science disciplines and evaluate existing
risk communication programs.
Research is needed on factors that enhance or diminish the effec-
tiveness of risk communication, including basic and applied research
on psychological, sociological/political, anthropological, and economic
processes, risk comparisons, legal and ethical issues, and processes of
mediation, negotiation, and public involvement.
12

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Recommendation 3: Targeting and Transmitting Risk Information.
Risk information should be specifically tailored in both content
and form to the needs of the target public groups in particular
communities.
An important area of research relevant to risk communication is
how to tailor messages to the specific community. The public is not a
single monolithic entity, and no single risk message is appropriate for
all audiences. The most effective information is designed for specific
audiences and takes into account the characteristics of the community.
The risk communicator should study the history and dynamics of the
community and develop a profile that identifies how that community
has traditionally solved problems.
The news media play an important role in transmitting risk infor-
mation to the public, and the risk communicator should consider the
media and other channels of communication in developing the commu-
nity profile. These other channels include direct advertising, public
meetings, one-on-one contacts or counseling, health professionals, and
community networks. The selection of the most effective channel or
combination of channels should be based primarily on the community
characteristics and content of the information.
13

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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
Clean 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;
17

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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."
18

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

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Appendix B
TASK FORGE ON ENVIRONMENTAL
CANCER AND HEART AND LUNG DISEASE
PLENARY AND ALTERNATES
1987/88
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
Vincent T. DeVita,
Director, NCI
Manning Feinleib,
Director, NCHS
Jean French,
Science Advisor,
Office of the Director,
CDC/NIOSH
John A. Gr on vail,
Chief Medical Director, VA
Suzanne S. Hurd,
Director, Division
of Lung Diseases,
NHLBI
Claude Lenfant,
Director, NHLBI
James O. Mason,
Director, CDC, and
Administrator, ATSDR
21

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J. Donald Millar,
Director, CDC/NIOSH
David P. Rail,
Director, NIEHS
Ken Sexton,
Director, Office of
Health Research,
Office of Research and
Development, EPA,
Working Group Chairperson
William Tallent,
Assistant Administrator,
Agriculture 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
22

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WORKING GROUP MEMBERS
1987/88
Scott R. Baker,
Special Assistant to the Assistant Administrator,
Office of Research and Development, EPA
Chairperson
and
Ken Sexton,
Director, Office of Health Research,
Office of Research and Development, EPA
Chairperson
Richard H. Adamson,
Director, Division of
Cancer Etiology, NCI
Max Lum,
Medical Education
Specialist, ATSDR
Nathaniel Barr,
Office of Health and
Environmental Research
Office of Energy Research,
DOE
Zakir H. Bengali,
Division of Lung
Diseases, NHLBI
James R. Fouts,
Senior Scientific Advisor
to the Director, NIEHS
Jean French,
Office of the Director,
Science Advisor,
CDC/NIOSH
Kailash C. Gupta,
Director, HSHL, CPSC
Jeffrey A. Lybarger,
Chief, Epidemiology
and Medicine Branch,
ATSDR
Richard M. Parry, Jr.,
Assistant to the
Administrator,
Agriculture Research
Service, USDA
Maria Pavlova,
National Expert on
Toxicology,
EPA - Region II
Michael Peterson,
Senior Policy Analyst,
Office of the Assistant
Secretary of Defense
(Health Affairs), DoD
23

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A. Richey Sharrett,
Chief, Social and
Environmental Epidemiology
Branch, Division of
Epidemiology and Clinical
Applications, NHLBI
Barclay M. Shepard,
Director, Agent Orange
Project Officer
Karen Skinner,
Special Assistant to the
Commissioner, FDA
Diane Wagener,
Division of Epidemiology
and Health Promotion,
NCHS
Ralph Yodaiken
Director, Office of
Occupational Medicine,
OSHA
24

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INTERAGENCY EDUCATION PROGRAM
LIAISON GROUP
1987/88
Max Lum,
Medical Education Specialist, ATSDR
Chairperson
E. Joseph Bangiolo,
Office of Cancer
Communications, NCI
Paul W. Bergman,
Pesticide Use and Impact
Assessment Extension
Service, LJSDA
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
fames R. Secrest,
Chief, Multidisciplinary
Resource Development Branch,
Division of Medicine, HRSA
Ralph Yodaiken,
Director, Office of
Occupational Medicine,
OSHA
25

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INTERAGENCY GROUP ON PUBLIC EDUCATION
AND COMMUNICATION*
1987/88
Maria Pavlova,
National Expert on Toxicology,
EPA - Region II
Chairperson
Frederick Allen,
Associate Director
Office of 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
Ann Fisher,
Senior Economist,
Office of Policy Analysis, EPA
Jean French,
Science Advisor,
Office of the Director,
CDC/NIOSH
Michael D. Hogan,
Special Assistant for Risk
Assessment, Biometry and
Risk Assessment Program,
NIEHS
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
Edward A. Klein,
Director, TSCA Assistance Office,
Office of Toxic Substances, EPA
Christine Krutszch,
Public Affairs Specialist,
Office of Prevention,
Education, and Control,
NHLBI
Stanley L. Laskowski,
Deputy Regional
Administrator, EPA — Region IV
Max Lum,
Medical Education Specialist,
ATSDR
'Became the Interagency Group on Public Education and Communication in
January 1967,
26

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James Marshall,
Director, Office of Internal
Affairs, EPA — Region II
David McCallum,
Senior Fellow, Institute for
Health Policy Analysis,
Georgetown University School
of Medicine
Richard M. Parry, Jr.,
Assistant to the Administrator,
Agricultural Research Service,
USDA
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
Karen Skinner,
Special Assistant to the
Commissioner, 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
27

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Appendix C
MISSION STATEMENT OF THE
NEW TASK FORCE MEMBER AGENCY:
AGENCY FOR TOXIC SUBSTANCES
AND DISEASE REGISTRY

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Appendix C
AGENCY FOR TOXIC SUBSTANCES
AND DISEASE REGISTRY
MISSION
The mission of ATSDR is to prevent or mitigate adverse human
health effects and diminished quality of life resulting from expo-
sure to hazardous substances in the environment.
LEGISLATIVE AUTHORITY
The Agency for Toxic Substances and Disease Registry (ATSDR) is
part of the Public Health Service (PHS) and is based in Atlanta,
Georgia. It was created by Congress to implement the health-related
sections of laws that protect the public from hazardous wastes and
environmental spills of hazardous substances. ATSDR derives its
authority from three separate acts of Congress.
1. The Comprehensive Environmental Response, Compensation, and
Liability Act of 1980 (CERCLA), commonly known as the "Super-
fund" Act, provided Congressional mandate to remove or clean up
abandoned and inactive hazardous waste sites and to provide Feder-
al assistance in toxic emergencies. Congress made the Environmen-
tal Protection Agency (EPA) the lead agency in implementing
CERCLA and created ATSDR to implement the health-related sec-
tions of the Act.
31

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2.	In 1984, amendments to the Resource Conservation and Recovery
Act of 1976 (RCRAJ, which provides for the management of legit-
imate hazardous waste storage or destruction facilities, charged
the ATSDR to conduct health assessments at these sites, when re-
quested by EPA, States, or individuals, and to assist EPA in deter-
mining which substances should be regulated and the levels at
which they may pose a threat to human health.
3.	In 1986, amendments to CERCLA, known as the Superfund Amend-
ments and Reauthorization Act of 1986 (SARA], broadened ATSDR's
responsibilities in the areas of health assessments, toxicological
data bases, information dissemination, and medical education.
ORGANIZATION
ATSDR's three Offices are the Office of the Associate Administrator
(OAA), the Office of External Affairs (OEA), and the Office of Health As-
sessment (OHAJ. The OAA is responsible for the Agency's planning and
budget and develops overall policy. OEA is responsible for developing ex-
posure and disease registries, planning and conducting research, producing
toxicological profiles, responding to legislation, developing agreements and
contracts, providing liaison with EPA and technical assistance to State
and local agencies, maintaining the list of areas closed or restricted be-
cause of contamination, and coordinating the activities of ATSDR's region-
al staff—those persons responsible for coordinating ATSDR programs
within 10 regions across the United States. OHA provides emergency re-
sponse to toxic and environmental disasters, gives health consultations in
public health emergencies, makes health assessments of hazardous waste
sites, provides technical assistance to agencies and organizations, and es-
timates health risks to humans from exposure to hazardous substances.
The program areas in which ATSDR operates are as follows:
• Health Assessments—to evaluate data and information on the re-
lease of hazardous substances into the environment in order to: as-
sess any current or future impact on public health, develop health
advisories or other health recommendations, and identify studies or
actions needed to evaluate and mitigate or prevent human health
effects.
32

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Toxicological Profiles—to summarize and interpret available data
on the health effects of hazardous substances and to initiate toxico-
logical and health effects research, where needed.
Emergency Response—to provide health-related support in public
health emergencies, including public health advisories, involving ex-
posure to hazardous substances.
Exposure and Disease Registries—to establish and maintain a reg-
istry of serious diseases and illnesses in persons exposed to toxic
substances as a result of environmental exposure and a registry of
persons exposed to hazardous substances.
Health Effects Research—to expand knowledge of the relationship
between exposure to hazardous substances and adverse human
health effects through epidemiological, toxicological, laboratory, and
other studies on hazardous substances.
Health Education—to develop and disseminate, to physicians and
other health care providers, materials on the health effects of toxic
substances.
Literature Inventory/Dissemination—to establish and maintain,
through the National Library of Medicine (NLM), a publicly acces-
sible inventory on hazardous substances.
Worker Health and Safety—to assist in occupational safety and
health service and research programs for protecting workers at Su-
perfund sites and workers who respond to emergency releases of
hazardous substances.
List of Areas Closed to the Public—to maintain a nationwide list
of sites closed or restricted to the public because of contamination
by hazardous substances.
33

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

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Appendix D
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, 1978-1986, (Available from EPA Office of Health Re-
Rearch and NTIS.)
Ninth Annual Report. 1986.
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 EPA Office of Health
Research.
37

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First Annual Report, 1978. Available from EPA Office of Health
Research.
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; microfiche
$4.50.)
This annotated bibliography contains selected materials on occupational
and environmental health available from Federal organizations. It in-
cludes audiovisual presentations as well as publications related to the
diagnosis, treatment, prevention, and limitation of environmentally re-
lated disease. The bobk is organized by categories chosen to guide the
user to the desired materials as efficiently as possible. Appendixes pro-
vide information on NCI Cancer Centers, Educational Resource Cen-
ters supported by NIOSH, Federally funded clearinghouses for environ-
mental and occupational health issues, and accredited residencies in
preventive and occupational medicine.
3	
Exposure Assessment: Problems and Prospects, Journal of Tbxicology—
Clinical Toxicology, Vol. 21, Nos. 1 and 2,1983-84. Special Symposium
Issue.
Experts from government, academia, and clinical research institutions
presented papers describing various models and approaches currently
used to assess human exposure to toxic substances. These papers cover
the various settings and purposes for which exposure determinations
are undertaken. Each paper is followed by references and the discussion
that took place at the symposium.
38

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4.
Summary of the Workshop on Exposure to Environmental Agents, Their
Metabolism, and Mechanisms of Toxicity; Research Needs. August
1981. (NTIS Accession No. PB82 212895; paper $13.50; microfiche
$4.00.)
This summary presents the full text and rationale of 72 research recom-
mendations 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, exposure
quantification and monitoring, metabolism, and disease processes. Both
short- and long-term needs are identified in a balanced 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 models in
animals and humans.
	6	
Legal and Administrative Impediments to the Conduct of Epidemiologic
Research. 1984.
This study was conducted to determine whether significant modifications
or relaxation in impediments to data access and record linkage have oc-
curred since the Task Force recommendation on this issue in its Fourth
Annual Report to Congress. Recent literature was reviewed, and Federal
epidemiologists involved with these issues were interviewed.
	7	
Quarterly Calendar.
To facilitate information dissemination within a 3-month time frame, the
Tksk Force Calendar announces meetings, conferences, symposia,
39

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courses, public hearings, and workshops that pertain to environmental
pollution and disease.
	8	
Workshop on Environmental Education Needs of Health Professionals.
1979.
The summary report of this workshop identifies the needs of health pro-
fessionals in environmental education and develops action plans to en-
hance their capability to prevent environment-related disease.
	9	
Recommendations on 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 en-
vironmentally 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, statistics,
and risk assessment; clinical research; and basic and animal research.
There is an extensive list of references at the end of the report.
1	1	
Report of the Seminar on Laboratory Quality Assurance, A Management
Approach. 1984.
This report summarizes the presentations given at a 2-day seminar
sponsored by the Task Force Project Group on Quality Assurance in
40

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Analytical Methodology. Scientists and laboratory managers discussed
the difficulties involved in producing reliable and compatible labora-
tory data. A problem-solving technique was used to elicit possible so-
lutions to the successful application of quality assurance at the mana-
gerial level.
1	2	
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
Toxicology, 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 chemicals.
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.
1	3	
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 contribution
of radon, environmental fibers, formaldehyde, organic particles, pas-
sive smoking, and metals to the incidence of respiratory cancer. Each
of these airborne pollutants is discussed in the context of its inter-
action with cigarette smoke and the risk of exposure to human popu-
lations. Data gaps and uncertainties are identified, and recommenda-
tions 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
41

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from the toxicological perspective. The report will also include recom-
mendations for future research.
15	
Report of the Special Grand Rounds: Women at Work. 1986. (NTIS Ac-
cession 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.
16	_
Report of the Workshop on the Community as Patient. 1987.
The report includes 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 recom-
mendations for research and education are also presented.
17.		
Effective Risk Communication: The Role and Responsibility of Govern-
ment and Non-Government Organizations. In press. New York: Plenum
Press.
The report includes an overview of the principles and guidelines for
improving risk communication, descriptions of Government risk com-
munication programs and case studies, and manuals on risk commu-
nication for Government communicators and plant managers. Future
directions for research in risk communication are highlighted.
42
~u. S. GOVERNMENT PRINTING OFFICE: 1989/648-163/87099

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To obtain ordering information on any of the selected publications,
please complete the card below and return to
Office of Health Research (RD-683)
U.S. Environmental Protection Agency
401 M Street, SW
Washington, DC 20460
(202) 382-5895
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: 	
2345	6789
10 11	12	13	14	15	16	17
43

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v»m'
y ; ' . • „
..
U.tS. Environmental Protection Agency
Public Health Service
National Institutes of Health
National Cancer Institute
National Heart, Lung, and Blood Institute
National Institute of Environmental
Health Sciences
Centers for Disease Control
National Institute for Occupational
Safety and Health
National Center for Health Statistics
Food and Drug Administration
Agency for Toxic Substances and Disease Registry
Department of Energy
Consumer Product Safety Commission
Occupational Safety and Health Administration
Department of Agriculture
c
Department of Defense
Veterans Administration
CERI-89-104
i
*

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