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1989/90
TASK FORCE ON
ENVIRONMENTAL CANCER
AND HEART AND LUNG DISEASE

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Eleventh Report to Congress
1989-1990
Task 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
National Library of Medicine
Centers for Disease Control
Center for Environmental Health and Injury 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
Department of Defense
Department of Veterans Affairs
Prepared by the Task Force Working Group
Ken Sexton, Chairperson
Printed on Recycled Paper

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Copies of this document may be obtained
through requests to
Office of Health Research (RD-683)
U.S. Environmental Protection Agency
401 M Street, SW
Washington, DC 20460
202-260-5900
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, VA 22161

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TASK FORCE ON
ENVIRONMENTAL CANCER AND HEART AND LUNG! DISEASE
Honorable Thomas Foley
Speaker of the House of Representatives
Washington, D.C. 20510
Dear Mr. Speaker:
As Chairman of the Task Force on Environmental Canner and Heart and Lung
Disease, I am pleased to submit the Eleventh Report to Congress in accordance
with Public law 95-95, Section 402 (b)(5).
The 16 members 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 and four major workshops
on environmental and occupational asthma, the effect of pesticides on human
health, evaluation and effective risk ocmnunicatian, and environmental health
risk education. This report also includes recanaendations from participants
at each of the workshops. Note that these recxxnmendations do not necessarily
reflect the views of the Task Force or its individual members.
The Task Force's activities contribute to improved understanding of
environmentally related disease and serve to identify important research needs
that should receive consideration. 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 hope for
achieving progress in the protection of human health and the environment.
Environmental Protection Agency ¦ National Cancer Institute
National Heart, Lung, and Blood Institute * NationaJ 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 * Department of Veterans Affairs
Agency for Toxic Substances and Disease Registry • National Library of Medicine
Please address your reply to:
William K. Reilly
Administrator
U.S. EnvironmentalProtection Agency
401 M Street, S.W.
Washington, D.c. 20460
APR 2 9 m
Sincerely yours
Enclosure

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TASK FORCK ON
ENVIRONMENTAL CANCER ANI) HEART AND LUNO DISK ASF
Please address vour reply to:
William K. Reilly
Administrator
U.S. Environmental Protection Agency
401 M Street, S.W.
Washington, D.C. 20460
APR 2 9 W
Honorable J. Danforth Quayle
President of the Senate
Washington, D.C. 20510
Dear Mr, President:
As chairman of the Task Force on Environmental Cancer and Heart and lung
Disease, I am pleased to submit the Eleventh Report to Congress in accordance
with Public Law 95-95, Section 402 (b)(5).
The 16 members 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 arri four major workshops
on environmental and occupational asthma, the effect of pesticides on human
health, evaluation and effective risk cxsranunication, and environmental health
risk education. This report also includes recommendations from participants
at each of the workshops. Note that these recommendations do not necessarily
reflect the views of the Task Force or its individual members.
The Task Force's activities contribute to improved understanding of
environmentally related disease and serve to identify inportant research needs
that should receive consideration. 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 hope for
achieving progress in the protection of human health and the environment.
Knvironmenlut Protection Agency • National Cancer Institute
National Heart. Luii£, anil Blood Institute • National institute for Occupational Safety and Health
National Institute of linvironinenial Health Sciences • National Center for Health Statistics
Centers for Disease Control * I'ood and Drug Administration
Department at' fmergy * Consumer Product Safety Commission
Occupational Safety and Health Administration • Department of Agriculture
Department of Defense • Department of Veterans Affairs
Agency tor Toxic Substances and Disease Kegistry • National l ibrary ot Medicine
Sincerely yours,
William i
Chairman
Enclosure

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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 human disease. Its efforts
are directed toward reducing or preventing environmentally related diseases, in particular, cancer and
heart and lung disease.
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 (EPA) and four Public
Health Service organizations: the National Cancer Institute (NCI-National Institutes of Health); the
National Heart, Lung, and Blood Institute (NHLBI-National Institutes of Health); the National
Institute of Environmental Health Sciences (NIEHS-National Institutes of Health); and the National
Institute for Occupational Safety and Health (NIOSH-Centers for Disease Control). Eleven other
members have joined the Task Force by invitation and, accordingly, additional PHS organizations have
become members: the National Center for Health Statistics (NCHS-Centers for Disease Control), the
Center for Environmental Health and Injury Control (CEHIC-Centers for Disease Control), the Food
and Drug Administration (FDA), the Agency for Toxic Substances and Disease Registry (ATSDR), and
the National Library of Medicine (NLM-National Institutes of Health). Non-PHS organizations also
joined: the Department of Energy (DOE), the Consumer Product Safety Commission (CPSC), the
Occupational Safety and Health Administration (OSHA), the Department of Agriculture (USDA), the
Department of Defense (DOD), and the Department of Veterans Affairs (VA).
To meet its reporting requirements to Congress, this report describes the accomplishments of
the Task Force during 1989-1990. Chapter 1 introduces the Task Force. Chapter 2 describes the
substantive activities of the Task Force during 1989-1990. Recommendations of participants at
workshops sponsored by the Task Force are contained in Chapter 3.

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CONTENTS
Page
EXECUTIVE SUMMARY	1
Chapter 1 INTRODUCTION	3
Chapter 2 ACTIVITIES OF THE WORKING GROUP IN 1989-1990	5
Public Education and Communication	5
Evaluation and Effective Risk Communication	5
Environmental Health Risk Education	7
Health Professional Education	8
Environmental and Occupational Asthma	8
TOXNET Information Dissemination	9
Effects of Pesticides on Human Health	9
Chapter 3 RECOMMENDATIONS	11
Public Education and Communication	11
Evaluation and Effective Risk Communication	11
Environmental Health Risk Education	12
Health Professional Education	14
Environmental and Occupational Asthma	14
Effects of Pesticides on Human Health	16
Appendix A Section 402 of Public Law 95-95	A-l
Appendix B Members of the Plenary and Task Force	B-l
Working Group
Appendix C Mission Statement of the New Task Force	C-l
Member: National Library of Medicine
Appendix D Available Publications of the Task Force	D-l
on Environmental Cancer and Heart
and Lung Disease

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EXECUTIVE SUMMARY
The Task Force on Environmental Cancer and Heart and Lung Disease reports periodically to
Congress. During 1989-1990, the Task Force held two major workshops on environmental and
occupational asthma and environmental health risk education, in addition, the Task Force supported
the publication of proceedings from the Environmental and Occupational Asthma Workshop, as well
as the proceedings of two other workshops, held prior to 1989: the Workshop on Evaluation and
Effective Risk Communication and the Workshop on Effects of Pesticides on Human Health.
The recommendations developed at the workshops and offered to Congress for its consideration,
are summarized in Chapter 3 of this report. These recommendations do not necessarily reflect the
views of the Task Force, its individual member agencies, or all the workshop participants.
The Workshop on Environmental Health Risk Education: The Workshop on Environmental Health
Risk Education was held in September 1990 in Arlington, Virginia, to explore concepts, curricula, and
strategies for integrating environmental health risk education into the U.S. school system. The purpose
of environmental health risk education is to help the learner understand society's impact on the
environment and the effects of the environment on the health and safety of the individual. The
workshop brought together 90 educators, state and federal government representatives, environmental
and health decision-makers, students, and representatives from professional associations, public interest
groups, acadcmia, and industry. Through presentations and discussion, participants examined three
areas: the need for and approaches to environmental health risk education, identifying and overcoming
barriers to incorporation by the educational system, and developing networks for dissemination and
implementation.
The Workshop on Environmental and Occupational Asthma: This workshop was held from
November 28 to December 1,1989, to address concerns associated with an illness of growing national
and international importance; more than 10 million Americans suffer from asthma. At the Workshop,
working groups of scientists reported on the current state of knowledge in epidemiology and
surveiliance, clinical assessment, patient management, and assessment of impairment. The Workshop
also identified research gaps and recommended priorities in each of these areas, which are outlined in
the Workshop's proceedings (Merchant, 1990).1 Finally, the working groups pinpointed several
strategies for achieving the goal of enhancing the skills of the primary care physician in the recognition,
treatment, reporting, and prevention of occupational and environmental asthma. Each strategy involves
improving communication concerning asthma to reach the primary care provider directly through the
medical literature and educational programs, and/or indirectly through the media and the physician's
patients. Recommendations and conclusions were developed by participants at the workshop and
published as a supplemental issue of Chest in November 1990.
The Workshop on Evaluation and Effective Risk Communication'. The Workshop on Evaluation
and Effective Risk Communication was held in June 1988 to provide practical guidance on planning
and evaluation as part of implementing environmental and health risk communication programs.
Participants included government policy makers, program administrators, risk communicators, scientists.
'Merchant, James A., ed. 1990. Environmental and Occupational Asthma. Chest. 98(5): 145S-
252S. Supplemental Issue.
1

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and public health professionals from federal, state, and local government, as well as representatives
from acidemia, citizens' groups, the media, business, and industry. At the workshop, participants
discussed the need to: evaluate environmental and health risk communication programs; develop
rationales to support evaluation strategies; design and implement an evaluation strategy; use the results
of an evaluation; and determine resources that can be used for evaluation. Successful case studies in
the health communication and environmental communication fields were presented. The proceedings
for this workshop have been published by EPA2 and will be distributed to environmental policy makers
and risk communications specialists in government, academia, and risk communications.
The Workshop on Effects of Pesticides on Human Health: In response to the concerns of several
Task Force members and to public concern about pesticides, the Task Force sponsored a workshop on
this topic in May 1988. At the workshop, working groups of scientists assessed several toxicological
endpoints of pesticide exposure and examined the actual human exposure to pesticides through all
media. The proceedings were published in 1990 by EPA.3
2Fisher et al. 1991, U.S. EPA Center for Environmental Research Information. EPA/600/9-90/054.
3EPA/600/9-90/016 and are available from the National Technical Information Service (Accession
No. PB90-188723/AS).

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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 Amendments of 1977 (P.L. 95-95)4 to address the environmental disease
problem in a broad and coordinated fashion. Congress chose the mechanism 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; federal organizations
conducting health research, particularly the Public Health Service (PHS) within the Department of
Health and Human Services (DHHS); and other federal organizations as appropriate. The Task Force
is mandated to recommend a comprehensive research program 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-National Institutes of Health); the National Heart, Lung, and Blood
Institute (NHLBI-National Institutes of Health); the National Institute for Occupational Safety and
Health (NIOSH-Centers for Disease Control); and the National Institute of Environmental Health
Sciences (NIEHS-National Institutes of Health). The law also specified the involvement of other
government organizations with interest in environmental health and, accordingly, additional PHS
organizations have become members: the National Center for Health Statistics (NCHS-Centers for
Disease Control), the Center for Environmental Health and Injury Control (CEHIC-Centers for
Disease Control), the Food and Drug Administration (FDA), the Agency for Toxic Substances and
Disease Registry (ATSDR), and the National Library of Medicine (NLM-National Institutes of Health).
Non-PHS organizations also joined: the Department of Energy (DOE), the Consumer Product Safety
Commission (CPSC), the Occupational Safety and Health Administration (OSHA), the Department
of Agriculture (USDA), the Department of Defense (DOD), and the Department of Veterans Affairs
(DVA). The addition of these members, by vote of the Task Force, has increased the opportunities
to promote and formalize interaction and cooperation.
The Task Force organization in 1989-1990 included a Plenary, a Working Group, and two ad
hoc subgroups: the Interagency Group on Public Education and Communication and the Interagency
Education Program Liaison Group. The Plenary consists of organization heads and representatives of
Departmental Secretaries, who in turn designate the Working Group representatives. The Working
Group meets three times a year to discuss environmentally related health problems of national
significance that are common to members. To address these problems, the Working Group identifies
topics for consideration and sponsors workshops, symposia, and various ad hoc committees of relevant
experts, who deliberate and provide research and other recommendations to the Task Force. The
members of the Plenary and Working Group are listed in Appendix B.
4See Appendix A for full text of Section 402 (P.L. 95-95).
3

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The Task Force workshops bring together experts in scientific subject areas to identity research
needs. The workshop reports are published in the peer-reviewed literature or in government
publications and are available to the entire scientific community. The research needs identified by the
workshops are submitted to the Task Force for consideration. Some of the research needs are
considered by members in their research planning, and some of these may ultimately become
recommendations of the Task Force to Congress.
The Task Force serves to stimulate cooperation among federal organizations and scientific
communities concerned with environmental health research. Its members have the opportunity to
integrate regulatory and research perspectives on the kinds of scientific information needed to provide
an improved basis for protection of human health and the environment. The Task Force provides an
open, freely accessible forum for the exchange of ideas and information, which benefits all of its
members.
The Task Force is mandated to report to Congress on its activities. During 1989-1990, the Task
Force's activities focused on the following areas:
¦	Public education and communication
¦	Health professional education
¦	Effects of pesticides on human health
These activities, described in Chapter 2, were directed by subcommittees composed of both
Task Force members and scientists from academia, research institutions, industry, and government.
The recommendations to Congress that originated from the Task Force activities are presented in
Chapter 3. Task Force publications are presented in Appendix D. In 1991, the Task Force will
continue its efforts in public education and communication, and health professional education, and will
consider other subjects for future activities.
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Chapter 2
ACTIVITIES OF THE WORKING GROUP IN 1989-1990
The Task Force Working Group met periodically to exchange information, 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 Interagency Group on
Public Education and Communication completed its report from the Workshop on Evaluation and
Effective Risk Communication and held a Workshop on Environmental Health Risk Education. The
Interagency Education Program Liaison Group (IEPLG) held the Workshop on Environmental and
Occupational Asthma. The Task Force sponsored efforts to complete the proceedings from the
Workshop on the Effects of Pesticides on Human Health.
PUBLIC EDUCATION AND COMMUNICATION
The role of the Task Force's Interagency Group on Public Education and Communication is
to enhance the collaboration, sharing of information, and coordination of risk communication and
education efforts of member organizations and other federal organizations. The Interagency Group
directed two activities in 1989-1990.
Evaluation and Effective Risk Communication
The Workshop on Evaluation and Effective Risk Communication was held in June 1988 to
provide practical guidance on planning and evaluation as part of implementing environmental and
health risk communication programs. Participants included government policy makers, program
administrators, risk communicators, scientists, and public health professionals from federal, state, and
local government, as well as representatives from academia, citizens' groups, the media, business, and
industry. The proceedings for this workshop have been published by EPA (Fisher et al., 1991)3 and
will be distributed to environmental policy makers and risk communications specialists in government,
academia, and industiy.
The workshop was a natural sequel to the Task Force's first risk communication activity ~ a
January 1987 workshop on the Role of Government in Health Risk Communication and Public
Education. Participants at the 1987 workshop emphasized the importance of incorporating measures
of effectiveness into the planning of risk communication programs.
3Fisher, Ann, Maria Pavlova, and Vincent Covello. 1991. Evaluation and Effective Risk
Communication: Workshop Proceedings. U.S. EPA Center for Environmental Research Information.
EPA/600/9-90/054.
5

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For the June 1988 Evaluation Workshop, two papers were commissioned to provide background
information for discussions:
¦	A Guide to Evaluation Research Theory and Practice
¦	Evaluation for Risk Communicators
At the workshop, participants discussed the need to: evaluate environmental and health risk
communication programs; develop rationales to support evaluation strategies; design and implement
an evaluation strategy; use the results of an evaluation; and determine resources that can be used for
evaluation. Successful case studies in the health communication and environmental communication
fields were presented. Specific objectives of the workshop were to improve the understanding of
evaluation problems and tasks; to survey principles and methods of evaluation relevant to risk
communication; to illustrate practical risk communication evaluation through successful examples; to
provide some guidance for planning and coordinating evaluations of risk communication activities; and
to identify future needs and derive recommendations for improving risk communication.
In the context of the workshop, risk communication was defined as any purposeful exchange
of information about health or environmental risks between interested parties. Evaluation, also in this
context, is any purposeful effort to determine the effectiveness of risk communication programs.
Evaluation encompasses a wide range of activities, from the diagnosis of risk communication problems
to measuring and analyzing program effects and outcomes. Key questions included: How can agencies
that communicate with the public about risk learn whether they are communicating effectively? Are
their messages appropriate and clear to the intended audience? Are their messages reaching that
audience?
The workshop participants agreed that evaluation is critical to risk communication; evaluation
is the only way to determine whether risk communication is achieving (or has achieved) its objectives.
Evaluation, in other words, provides essential planning and program information, program direction,
and demonstration of program accomplishments. At each stage in the risk communication process,
evaluation results in information that is critical to program effectiveness.
One major reason for evaluating risk communication activities is the simple shortage of
resources to conduct a shotgun approach. Even though a multiple-channel, multiple-hit risk
communication strategy is probably essential, managers need to be able to choose those messages and
channels that use their limited resources most effectively.
Having examined the reasons for and steps involved in evaluation, the workshop participants
then turned to the problems associated with evaluation as well as a number of case studies. Three of
these problems are the value-laden nature of evaluation, the lack of resources for evaluation, and the
debated usefulness of evaluation. Evaluation is value-laden because many stakeholders (e.g.,
government agencies, unions, scientists, industry) are interested in the conduct and effectiveness of any
risk communication program, and they have varying and often conflicting needs and perspectives.
Resources are often required by more urgent tasks, especially if evaluation has not been planned in
advance. Finally, the evaluation process has been criticized because direct and immediate changes in
risk communication policies and programs have not resulted from it.
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Environmental Health Risk Education
The Workshop on Environmental Health Risk Education was held in September 1990 in
Arlington, Virginia, to explore concepts, curricula, and strategies for integrating environmental health
risk education into the U.S. school system. The purpose of environmental health risk education is to
help the learner understand society's impact on the environment and the effects of the environment
on the health and safety of the individual. Environmental health risk education also offers a valuable
opportunity to make science more relevant and dynamic. It can develop in today's students and
tomorrow's adults both the knowledge and critical thinking skills that will empower them to make
important personal and social choices in an increasingly technological society.
The workshop brought together 90 educators, state and federal government representatives,
environmental and health decision-makers, students, and representatives from professional associations,
public interest groups, academia, and industry. Through presentations and discussion, participants
examined three areas: the need for and approaches to environmental health risk education, identifying
and overcoming barriers to incorporation by the educational system, and developing networks for
dissemination and implementation.
Participants agreed that there is a need for environmental health risk education. Such
education can help prevent environmentally related diseases by educating the public so that it can make
informed decisions about both individual and societal environmental risks. Such education can also
support and enhance the broader national educational goals of science literacy and the development
of critical thinking. Resource materials, demonstration projects, and teacher training programs are
necessary to promote the integration of environmental health risk education into the school systems
in the U.S. TTiese should be developed through collaboration and linkages with environmental, health,
and science education networks.
Three workshop products are being developed for dissemination:
¦	An executive summary of the workshop, including conclusions and recommendations.
¦	A proceedings of the workshop, which will include the executive summary, the four
commissioned papers prepared for the workshop, the panelists' presentations, the
opening and closing speeches, edited transcripts of the discussion sessions, and post-
meeting comments.
¦	A resource manual, which includes descriptions of various programs, curricula,
classroom materials, dissemination networks, and other resources useful for developing
and implementing environmental health risk education programs.
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HEALTH PROFESSIONAL EDUCATION
The Task Force's Interagency Education Program Liaison Group (IEPLG) continued its efforts
to increase awareness of environmental health issues among health professionals by utilizing multi-
agency planning and participation in two projects.
Environmental and Occupational Asthma
The Workshop on Environmental and Occupational Asthma was held November 28 to
December 1, 1989, to address concerns associated with an illness of growing national and international
importance. More than 10 million Americans suffer from asthma.
The goals of the workshop were designed by the program committee to summarize the current
state of knowledge about environmental and occupational asthma, to develop strategies to transmit
essential knowledge to primary care providers, and to identify research priorities. These goals were as
follows:
¦	To provide a workable definition of occupational asthma and identify respiratory
hazards resulting from environmental as well as occupational exposures.
¦	To relate the current knowledge to needed skills and behaviors within the practice
patterns of physicians, particularly primary care and other first contact providers.
¦	To> provide and evaluate mechanisms for reinforcing physicians' skills and behavior in
regard to preventing, treating, and reporting environmental and occupational asthma.
¦	To recommend surveillance mechanisms for recognition of environmental and
occupational asthma.
¦	To suggest further measures in the areas of clinical assessment, epidemiology,
management, control, and prevention, necessary to identify and protect individuals at
risk.
¦	To identify research gaps and recommend new research initiatives.
At the Workshop, each scientist was assigned to one of four working groups: epidemiology and
surveillance, clinical assessment, patient management, and assessment of impairment. In these groups,
scientists reported and summarized the current state of knowledge concerning these topics, identified
research gaps, and recommended priorities in each of these areas. The working groups also pinpointed
several strategies for achieving the goal of enhancing the skills of the primary care physician in the
recognition, treatment, reporting, and prevention of occupational and environmental asthma. The
priorities for management of environmental and occupational asthma, and the research gaps and
recommendations of the working groups are summarized in Chapter 3. They are presented in detail
in the Workshop Proceedings, which were published as a supplemental issue of Chest in November 1990
8

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(Merchant, 1990)6. Copies of the proceedings were also distributed to 250 members of the Association
of Occupational and Environmental Clinicians, who are providing feedback on the findings and
recommendations. In the future, it is hoped that a followup workshop will be held in which participants
will develop an implementation plan for the recommendations made at the 1989 workshop.
TOXNET Information Dissemination
With the growing awareness of toxic contamination and the potential link between disease and
a wide range of environmental factors, the public increasingly expects health care practitioners to
diagnose and treat environmentally and occupationally related disease. The National Library of
Medicine's (NLM's) Toxicology Data Network (TOXNET) is a computerized system of toxicologically
oriented data banks targeted for health care workers in occupational and environmental related fields,
including primary care practitioners of family, preventive, and internal medicine. TOXNET enables
users to obtain health effects information about chemical exposure; e.g., symptoms, animal test data,
environmental monitoring data, routes of exposure, risk assessment, regulatory information, etc. In
cooperation with NLM, ATSDR, and other federal organizations, the IEPLG has disseminated
information about TOXNET to health professionals. The TOXNET family of data banks currently
includes the Hazardous Substances Data Bank, the Registry of Toxic Effects of Chemical Substances,
the Chemical Carcinogenesis Research Information System, the Integrated Risk Information System,
the Environmental Mutagen Information Center Backfile (EMICBACK), the Environmental Teratology
Information Center Backfile (ETICBACK), the Developmental and Reproductive Toxicology file, and
the Toxic Chemical Release Inventory (TR1987 and TR1988).
The Task Force's TOXNET information dissemination activities have been stopped temporarily
due to a lack of funding.
EFFECTS OF PESTICIDES ON HUMAN HEALTH
In response to the concerns of several Task Force members and to public concern about
pesticides, the Task Force sponsored a Workshop on Effects of Pesticides on Human Health in May
1988. The Workshop focused on chronic, low-level exposures to pesticides. At the Workshop, working
groups of scientists addressed several toxicological endpoints: carcinogenicity, developmental toxicity,
reproductive toxicity, neurotoxicity, and immunotoxicity. Another working group specifically addressed
exposure to pesticides through all media and the relationship of exposure to chronic health effects. The
working groups considered 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?
6Merchant, James A., ed. 1990. Environmental and Occupational Asthma. Chest. 98(5): 145S-
252S. Supplemental Issue.
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?
Proceedings from the Workshop were published in 1990 (Baker and Wilkinson, 1990).7
'Baker, Scott R. and Chris F. Wilkinson, eds. 1990. The Effects of Pesticides on Human Health:
Proceedings of a Workshop. EPA/600/9-90/016. National Technical Information Service No. PB90-
188723/AS. Also published as the Effects of Pesticides on Human Health in Advances in Modern
Environmental Toxicology, Vol XVIII. Princeton, N J.: Princeton Scientific Publishing Company, Inc.,
1990.
10

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Chapter 3
RECOMMENDATIONS
The recommendations in this chapter were developed at workshops sponsored by the Task
Force on Environmental Cancer and Heart and Lung Disease. Each workshop employed its own
approach to discussing topics and formulating conclusions and recommendations. It is important to
note that these recommendations do not necessarily reflect the views of the Task Force, its individual
members, or all individual participants at each workshop.
PUBLIC EDUCATION AND COMMUNICATION
Evaluation and Effective Risk Communication
in the course of the workshop, the most crucial needs for researching risk communication were
identified and, on the basis of these needs, four short-term and three long-term recommendations were
developed.
Short-term Recommendations:
Recommendation 1. Agencies should be encouraged to use evaluation methods that are
appropriate to the scale and importance of the risk communication effort. Small-scale efforts
may require only quick and easy evaluation methods. In contrast, more-resource-intensive,
statistically reliable methods may be appropriate for large-scale efforts.
Recommendation 2. Agencies should be encouraged to integrate results from evaluation
research into program planning and decision making. Mechanisms are needed to permit
federal agencies to share the results of evaluation research.
Recommendation 3, Agencies should develop guidelines to help managers choose evaluation
methods. Workshops or other training mechanisms are needed to build the skills required to
design and implement evaluation strategies.
Recommendation 4. Agencies should be encouraged to evaluate risk communication programs
so that mid-course corrections can be made and program impact can be assessed.
Long-term Recommendations:
Recommendation 1. At this time, several evaluation methods are often used together. Relatively
little is known about the incremental gain in evaluation information associated with using or
adding another method. Agencies should support research aimed at measuring effectiveness
of risk communication as well as the cost-effectiveness of alternative evaluation approaches.
Some of the questions that need to be answered include: How can we evaluate whether risk
communication is effective in changing behavior? How much does the behavior change as a
11

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result of risk communication? How can we evaluate the impact on ultimate risk management
decisions? Are these decisions better as a result of the risk communication? (For example,
are citizens making decisions that are appropriate to their own preferences and circumstances?)
Recommendation 2. Agencies should sponsor forums for public and expert debate of issues
related to the appropriateness of motivational and persuasive messages within risk
communication programs. Guidelines are needed on ethical issues related to using persuasive
messages to help foster an informed public.
Recommendation 3. Agencies should support the development of a guidebook for practitioners
on how to apply evaluation techniques. This guidebook would establish an evaluation
framework, with suggestions for how to make the decisions necessary for tailoring an evaluation
program to the scope and importance of a risk communication activity, as well as how to
recognize the limitations of alternative methods. The guidebook should include case studies
demonstrating the value and importance of evaluation research in risk communication.
Environmental Health Risk Education
A preliminary survey of student attitudes and perceptions about environmental health risk was
conducted in preparation for the Workshop. It indicated that students are poorly informed about many
environmental health risk issues. While the students surveyed generally took personal responsibility
for environmental problems, they lacked the tools they needed to act constructively in addressing these
problems.
The workshop participants identified several scientific, institutional, and perceptual barriers to
implementing environmental health risk education. These include the inherent limitations and
uncertainties in the environmental health science database and the resultant discomfort with science
among many teachers and students; the current tack of adequate science instruction in schools; and the
lack of broad understanding among the public of the critical importance of environmental health issues.
The Committee recognized that effective public education is dependent upon improved scientific
methods and data for risk assessment by the scientific community. They also recommended that
collaborative partnerships be developed among various sectors to improve understanding of the need
for environmental health risk education and to facilitate its integration into school systems.
Following the Workshop on Environmental Health Risk Education, a committee of participants,
including educators, environmental and health decision-makers, and representatives from federal and
state government, professional associations and public interest groups, academia, and industry
developed conclusions and recommendations based on the information and ideas presented and
discussed at the workshop. The Committee agreed that there is a clear need for environmental health
risk education. Environmental health risk education helps the learner understand society's impact on
the environment and the effects of the environment on the health and safety of the individual. It
provides the scientific understanding, knowledge, and critical thinking skills, and the understanding of
policy and social issues, that will enable today's students and tomorrow's adults to make important
personal and social choices concerning environmental health risks.
The Committee emphasized the importance of including both teachers and scientists in the
development of environmental health risk education materials and programs, and urged that special
efforts be made to make materials relevant to inner city students and minorities. The Committee
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stressed that environmental health risk education should be grounded in the scientific method, and that
health risk information should be based exclusively on peer-reviewed scientific data. The Committee
recommended that environmental health risk education should avoid endorsing any particular policy.
The Committee made two recommendations based on the rationale that follows. All
environmental health risk education is important in preventing environmentally related diseases. At
present, the public's lack of understanding of how environmental health risks are evaluated results in
their inability to critically evaluate environmental health risk information, which often leads to decisions
and "solutions" to problems that have little scientific basis. Environmental health risk education will
help provide students and thus ultimately the public, with the critical thinking skills and knowledge
essential for making better decisions regarding both individual and societal environmental health risks.
The recommendations, presented below, represent the views of the committee and do not necessarily
reflect the view of the Task force, its individual members, or all workshop participants.
Recommendation 1. Environmental health risk education can support and enhance educational
goals of science literacy and the development of critical thinking, and should be integrated into
curricula of grades 1-12 in U.S. schools. Areas that should be covered in an environmental
health risk education program include: scientific methods for investigating environmental
health risk issues and problems; methods for assessing the quality of scientific investigation; a
working knowledge of the fundamental concepts of risk assessment and management; an
understanding of the relationship of exposure to risk and how the toxicity and risks of specific
substances are determined; and the application of critical thinking to decisions regarding
environmental health risks.
Recommendation 2. The U.S. Environmental Protection Agency and the Interagency Task Force
on Environmental Cancer and Heart and Lung Disease should establish a network of
government agencies; professional, educational, and scientific associations; public interest and
parent groups; academia; industry; and the media to facilitate the integration of environmental
health risk education into school curricula. Utilizing this and existing environmental, health,
and education networks, resource materials, and demonstration projects for environmental
health risk education should be developed and disseminated.
Networks and partnerships will be important to the development and dissemination of
environmental health risk education programs and materials for several reasons. First, environmental
health risk issues and solutions are influenced by and affect many different sectors of our society.
Opportunities should be created for each of these sectors to have a voice in developing these programs.
Second, development and dissemination of environmental health risk education is a substantial,
multidisciplinary effort that will require broad-based support to succeed. The exchange of materials
and methods between networking organizations expands access to resources and prevents costly
duplication of effort. Collaborative partnerships among schools, local community officials, and
nongovernmental organizations will help to improve community understanding of the need for
environmental health risk education. This will help reduce environmental health risks. Because control
of education in the United States rests with the states and localities, networking and partnerships are
particularly important for the dissemination and the integration of environmental health risk education.
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HEALTH PROFESSIONAL EDUCATION
Environmental and Occupational Asthma
To develop recommendations, the participants were assigned to four working groups:
epidemiology and surveillance, clinical assessment, patient management, and assessment of impairment.
Each working group was asked to make recommendations for research, education, and implementation
strategies. The working groups identified the priorities for management of environmental and
occupational asthma, and identified research gaps and made recommendations, which are stated below.
These recommendations reflect the views of the working groups; they do not necessarily reflect the
views of the Task Force, its individual members, or all workshop participants.
Priorities for Management of Environmental and Occupational Asthma
Recommendation J. A single definition for occupational and environmental asthma is not
necessary, as different criteria for case definitions are appropriate to different uses.
Recommendation 2. Exposures to industrial emissions resulting in occupational and
environmental asthma are both varied and prevalent. It is important for the practicing
physician to have a general understanding of the importance of dose-response, and especially
the importance of high exposures arising from spills of chemicals such as isocyanates in the
manifestations of asthma, but also that control of exposures to the level of permissible exposure
limits in no way assures that asthma will be controlled in all patients.
Recommendation 3. Data presented at this Workshop provide the single best-documented study
of the importance of environmental exposures which can result in epidemic community asthma.
The recurring outbreak of environmental asthma in Barcelona, Spain, which included asthma
deaths arising from community exposure to soy bean dust, provides compelling new information
on the potential importance of industrial point sources in the etiology of asthma.
Recommendation 4. The importance of the occupational history in the assessment of
occupational and environmental asthma cannot be stressed strongly enough. The practicing
physician must take a thorough occupational and environmental history and account for
potential exposures in the home, the workplace, and the community. The pattern of asthma
(immediate, late, dual, and recurrent) associated with these exposures must be recorded.
Asthma with exposures to a wide range of nonspecific stimuli including solvents, permanent
press fabrics, detergents, cigarette smoking, diesel exhaust, and cold air are all important in
both the diagnosis and management of this disease.
Recommendation 5. It is now clear from several exposures including isocyanates and western
red cedar, that early diagnosis of occupational asthma and removal from further exposure is
critically important to prevention of serious sequelae of asthma which may include death. The
physician is responsible to provide the patient and his or her employer explicit written
restrictions from irritant exposures. If it is not possible to prevent asthma through
environmental control or job transfer, the physician is responsible for recommending alternate
employment.
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Recommendation 6. Physicians should understand state workers' compensations laws and
procedures in order that their occupational asthma patients' rights and privileges not be
compromised.
Recommendation 7. Assessment of impairment from occupational asthma involves evaluation
of a number of clinical and physiologic parameters. These include assessment of the duration
and frequency of asthma symptoms, the degree of limitation of activities, the frequency of
asthma exacerbations, the amount of medication needed to maintain asthma under optimal
control, the severity of asthma as perceived by the patient, measurement of FEV, before and
following bronchodilation, and measurement of bronchial responsiveness to pharmacologic
agents (histamine or methacholine). Evaluation of these parameters is best done by physicians
experienced in this area. The AMA Guides for the evaluation of asthma are not appropriate
for assessment of occupational asthma and should be revised.
Research Gaps and Recommendations
The research gaps and recommendations of each working group are summarized below by
group.
Epidemiology and Surveillance
Recommendation 1: Methods need to be developed to assess as accurately as possible the
prevalence and incidence of asthma and asthma-like syndromes among workers in selected
industries. Methods should be explored to better document this exposure through the use of
biological markers of sensitivity.
Recommendation 2: The effects of duration and level of exposure, and the effect of cigarette
smoking, atopy, family history, and duration of symptoms should be determined in relation to
asthma severity and outcome in selected populations.
Recommendation 3: Studies are needed to improve and standardize environmental assessment
and monitoring relevant to the onset of occupational/environmental asthma in order to
understand environmental exposure risk factors.
Recommendation 4: Models of occupational/environmental asthma surveillance are needed and
optimal screening methods/early markers of occupational/environmental asthma need to be
defined and validated.
Recommendation 5: Population-based studies in cohorts of children are needed to determine
the prevalence of asthma and asthma-like syndromes; the proportion of these conditions related
to environmental exposures; the proportion of children with asthma whose disease is
exacerbated by exposure to specific and general environmental agents; and the difference in risk
factors and in the prevalence, incidence, and severity of asthma in different racial, ethnic, and
geographical groups.
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Clinical Assessment
Recommendation 6: Studies are needed to carefully evaluate host factors and environmental
conditions leading to sensitization and to clinical asthma.
Recommendation 7; The genetic bases of host risk factors for the development and pathogenesis
of occupational/environmental asthma should be explored.
Recommendation 8: Because antigens are important triggers of asthma through IgE antibody-
mediated mechanisms and may, in some cases, be the sole factor, research in this area is
important.
Recommendation 9: More information is needed to evaluate the relationship between clinical
asthma and nonspecific airway hyperresponsiveness.
Patient Management
Recommendation 10: The effect of demographic and exposure conditions on the natural history
of occupational/environmental asthma should be analyzed.
Recommendation 11: The most effective educational strategies for enhancing the current
involvement of practicing physicians in recognizing, treating, and preventing
occupational/environmental asthma need to be identified.
Assessment of Impairment
Recommendation 12: The relationship between occupational/environmental asthma severity at
the time of diagnosis (and baseline airway responsiveness) and long-term disease severity need
to be defined.
Recommendation 13: All clinical parameters in occupational/environmental asthma need to be
validated, including the clinically based severity scoring system to evaluate asthma impairment.
Recommendation 14: The relationship between impairment and disability (including physiologic,
psychological, and sociological issues) needs to be defined for occupational/environmental
asthma.
EFFECTS OF PESTICIDES ON HUMAN HEALTH
Pesticides are developed specifically for their ability to interact and interfere with a variety of
biological targets in the pests at which they are directed. Because of the fundamental similarities of
organisms at the subcellular level, selectivity is often difficult to achieve and unanticipated pesticide
actions leading to a number of adverse health effects may result.
Some occupational exposure to pesticides is unavoidable, even with strict adherence to good
agricultural practices and proper application procedures. Members of the general population are
exposed mainly through pesticide residues in food and water or through homeowner use of pesticides.
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Despite the availability of extremely sensitive analytical chemical capabilities, national data on human
(especially general population) exposure to pesticides are scarce and are frequently limiting in attempts
to estimate potential adverse health impacts.
Although some data are available on the occurrence of acute pesticide poisonings and mortality,
there is almost no information available on the incidence of adverse chronic health effects in humans.
Few epidemiological studies have been conducted in this area due, in part, to difficulties in identifying
and quantifying exposures to different pesticides over time and the existence of many confounding
factors. With the exception of the requirements in the State of California, there are no state, regional,
or federal taws that require the reporting of suspected pesticide-related illnesses.
Following the workshop, a committee of working group chairpersons developed
recommendations, which are included in the workshop proceedings. These recommendations, which
follow, do not necessarily reflect the views of the Task Force, its individual members, or all workshop
participants.
Recommendation 1: Immediate attention should be given to establishing a more comprehensive
national database to provide information on current levels and trends of human exposure to
pesticides. Methods should be developed for measuring internal (blood and/or tissue)
concentrations appropriate for risk assessment. Although a major goal should be to provide
information on baseline exposure of the general population, attention should also be focused
on potentially high risk populations (workers, etc.) where exposures might be more easily linked
with adverse health outcomes.
Recommendation 2: Given the heterogeneous nature of the potential chronic health effects of
pesticides, there is an urgent need for additional research to determine the mechanisms by
which chronic toxicity occurs, the most appropriate endpoints for identifying and measuring
specific types of toxicity, and methods by which the results of animal studies can be
extrapolated to humans. Potential adverse chronic health outcomes requiring attention include,
but should not be restricted to, cancer, reproductive impairment (male and female),
developmental effects (i.e., effects on the developing embryo), immunotoxicity (including
hypersensitivity and asthma-type reactions), and chronic neurological and neurobehavioral
deficits.
Recommendation 3: Regulatory policy toward pesticides should strive to incorporate as much
mechanistic information as possible in order to encourage basic research in this field.
Recommendation 4: There is a need for a more balanced level of concern and for a more
equitable distribution of resources to identify and study all types of toxic effects. In recent
years, there has been a tendency to focus attention and resources on cancer at the exclusion
of other endpoints of toxicity.
Recommendation 5: Although some information on proprietary products must remain
confidential, compromise mechanisms should be sought to make the total existing database
(including industrial data) on chronic health effects of pesticides more readily available to the
scientific community.
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Recommendation 6: More epidemiological studies should be conducted on potential chronic
adverse health effects in humans, especially in populations of workers with known exposures
to specific pesticides. Such studies should be carefully designed around clinical or other
measurements based on toxicity endpoints or target organs established in animal studies.
Recommendation 7: Procedures should be developed whereby groups at potentially high risk to
certain pesticides can be identified and protected. Such groups might include workers, pregnant
women, infants, those with genetic predispositions or compromised immune systems, or those
receiving drug therapy.
Recommendation 8: More concerted efforts should be made at state, regional, and national
levels to establish a system that would require the reporting of all suspected acute and chronic
pesticide-related health effects. This would ultimately result in the development of a
comprehensive national database.
Recommendation 9: Our knowledge base concerning the potential adverse health effects of
naturally occurring components of food is small relative to that of pesticides. More research
should be conducted to identify naturally occurring food constituents and to characterize their
potential for causing adverse health effects in humans.
Recommendation 10: The extent of regulatory efforts directed toward identifying, measuring,
and controlling pesticide residues in food must be considered in the context of the relative
magnitude of the health risks of such residues versus the much greater risks associated with
food-borne disease and naturally occurring food constituents.
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Appendix A
SECTION 402 OF PUBUC 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 Administrator (or his delegate).
(b) The Task Force shall:
(1)	recommend a comprehensive research program to determine and quantify the
relationship between environmental pollution and human cancer and heart and lung
disease;
(2)	recommend comprehensive strategies to reduce or eliminate the risk 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 diseases;
(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."
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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
1989/90
William Reilly,
Administrator,
U.S. Environmental Protection Agency
Chairperson
Richard H. Adamson, Ph.D.
Director, Division of Cancer Etiology
National Cancer Institute
Samuel Broder, M.D.
Director
National Cancer Institute
Manning Feinleib, M.D., M.P.H.
Director
National Center for Health Statistics
James W. Holsinger, M.D., Ph.D.
Chief Medical Director
Veterans Administration
Suzanne S. Hurd, Ph.D.
Director, Division of Lung Diseases
National Heart, Lung, and Blood Institute
Claude Lenfant, M.D.
Director
National Heart, Lung, and Blood Institute
Henry Kissman, Ph.D.
Associate Director
Specialized Information Services
National Library of Medicine
J. Donald Millar, M.D.
Director
National Institute for Occupational
Safety and Health
David Hoel, Ph.D.
Acting Director
National Institute of Environmental
Health Sciences
William L. Roper, M.D.
Director, CDC, and Administrator, Agency
for Toxic Substances and Disease Registry
Ken Sexton, Sc.D.
Director
Office of Health Research
Office of Research and Development
Environmental Protection Agency
Working Group Chairperson
William Tallent, Ph.D.
Assistant Administrator
Agriculture Research Service
Department of Agriculture
Andrew G. Ulsamer, Ph.D.
Associate Executive
Director for Health Sciences
Consumer Product Safety Commission
Robert W. Wood, Ph.D.
Deputy Associate Director
Office of Energy Research
Department of Energy
Ralph Yodaiken, M.D., M.P.H.
Senior Medical Advisor
Occupational Safety and Health
Administration
David Kessler, M.D.
Commissioner
Pood and Drug Administration
Enrique Mendez, Jr., M.D.
Assistant Secretary of Defense for
Health Affairs
Department of Defense
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WORKING GROUP MEMBERS
Chairperson
Ken Sexton, Sc.D.
Director, Office of Health
Research (RD-683)
U.S. Environmental Protection Agency
401 M Street, S.W., Room 3100
Washington, D.C. 20460
(202) 260-5900; FTS 8-260-5900
Environmental Protection Agency
Maria Pavlova, M.D., Ph.D.
National Expert on Toxicology/
Medical Officer
Region II
Environmental Protection Agency
National Cancer Institute
Richard H. Adamson, Ph.D.
Director
Division of Cancer Etiology
National Cancer Institute
Thomas Cameron, D.V.M. (A)
Special Assistant for Environmental
Cancer
Division of Cancer Etiology
National Cancer Institute
National Heart, Lung, and Blood Institute
Suzanne S. Hurd, Ph.D.
Director, Division of Lung Diseases
National Heart, Lung and Blood Institute
James Kiley, Ph.D. (A)
Chief, Airways Disease Branch
Division of Lung Diseases
National Heart, Lung and Blood Institute
A. Richey Sharrett, M.D., Dr.P.H.
Chief, Social and Environmental
Epidemiology Branch, DECA
National Heart, Lung, and Blood Institute
National Institute for Occupational
Safety and Health, CDC
Richard Lemen, M.S.
Director
National Institute for Occupational Safety
and Health, Washington Office
National Institute of Environmental
Health Sciences
James R. Fouts, Ph.D.
Senior Scientific Advisor to the Director
National Institute of Environmental
Health Sciences
William Sheridan Ph.D. (A)
Geneticist
National Institute of Environmental
Health Sciences
Kathryn Mahaffey, Ph.D. (A)
Research Chemist
Office of the Senior Scientific
Advisor to the Director
National Institute of Environmental
Health Sciences
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National Center for Health Statistics, CDC
Diane Wagener, Ph.D.
Chief of the Environmental Studies Branch
Office of Analysis and Epidemiology
National Center for Health Statistics
Olivia Carter-Pokras, M.H.S.
Division of Health Examination Statistics
National Center for Health Statistics
Center for Environmental Health and Injury
Control, CDC
Ruth Etzel, M.D., Ph.D.
Medical Epidemiologist
Division of Environmental Hazards and
Health Effects
Center for Environmental Health and
Injury Control
Maiy White, Sc.D. (A)
Epidemiologist
Division of Environmental Hazards and
Health Effects
Center for Environmental Health and
Injury Control
Food and Drug Administration
John Hathcock, Ph.D.
Chief, Experimental Nutrition Branch
Food and Drug Administration
Department of Energy
Nathaniel Barr, Ph.D. (A)
Office of Health and Environmental
Research
Office of Energy Research
Department of Energy
James Beat), Ph.D.
Office of Health and Environmental
Research
Office of Energy Research
Department of Energy
Consumer Product Safety Commission
Kailash C. Gupta, D.V.M., Ph.D.
Consumer Product Safety Commission
Occupational Safety and Health
Administration
Ralph Yodaiken, M.D., M.P.H.
Senior Medical Advisor
Occupational Safety and Health
Administration
Department of Agriculture
Richard M. Parry, Jr., Ph.D.
Deputy Assistant Administrator
Agricultural Research Service
Department of Agriculture
Department of Defense
Michael Peterson, D.V.M., M.P.H., Dr. P.H.
Senior Polity Analyst
Office of the Assistant Secretary of Defense
Department of Defense
Department of Veterans Affairs
Ann E. Medinger, M.D.
Director of the Pulmonary Function
Laboratory
Veterans Administration Medical Center
Department of Veterans Affairs
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Agency for Toxic Substances and Disease
Registry
Max Lum, Ed.D. (A)
Director, Division of Health Education
Agency for Toxic Substances and Disease
Registry
Jeffrey A. Lybarger, M.D.
Director, Division of Health Studies
Agency for Toxic Substances and Disease
Registry
National Library of Medicine
Henry Kissman, Ph.D.
Associate Director
Specialized Information Services
National Library of Medicine
(A) = Alternate
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Appendix C
MISSION STATEMENT OF THE NEW TASK FORCE MEMBER AGENCY:
NATIONAL LIBRARY OF MEDICINE

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Appendix C
NATIONAL LIBRARY OF MEDICINE
MISSION
The mission of NLM is to assist the advancement of medical and related sciences and to aid
the dissemination and exchange of scientific and other information important to the progress of
medicine and to the public health.
LEGISLATIVE AUTHORITY
The legislation authorizing the National Library of Medicine as a civilian agency is Public
Law 84-941, signed by President Eisenhower on August 3, 1956. There have been minor
amendments since. The NLM's authority should now be cited as Section 465B of 42 U.S. Code
286, as amended by P.L 100-202.
ORGANIZATION
The National Library of Medicine is the world's largest research library in a single scientific
and professional field. The Library collects materials exhaustively in all major areas of the health
sciences and to a lesser degree in such areas as chemistry, physics, botany, and zoology. The
collections today stand at 4.6 million items - books, journals, technical reports, manuscripts,
microfilms, and pictorial materials. Housed within the Library is one of the world's finest medical
history collections of old (pre-1914) and rare medical texts, manuscripts, and incunabula.
The Library's extensive collections and information services may be used by health
professionals and health-science students. Books and journals may be consulted in the reading
room; they may also be requested on interlibrary loan. Medical audiovisual materials may be
viewed in the Library's Learning Resource Center and may be borrowed on interlibrary loan.
NLM serves as a national resource for all U.S. health science libraries. Lending and other
services are provided through a Regional Medical Library Network consisting of 4,000 "basic unit"
libraries (mostly at hospitals), 125 Resource libraries (covering all geographic regions of the U.S.),
and the NLM itself as a national resource for the entire Network. Some 2 million interlibrary loan
requests are filled each year within this Network.
MEDLARS
The Library's computer-based Medical Literature Analysis and Retrieval System
(MEDLARS) was established to achieve rapid bibliographic access to NLM's vast store of
biomedical information. Historically, it was a pioneering effort to use the merging computer
technology of the early 1960s for the production of bibliographic publications and for conducting
individualized searches of the literature for health professionals. MEDLARS continues to be used
for preparing and photocomposing bibliographic publications. Index Medicusto—the monthly
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subject/author guide to articles in nearly 3,000 journals—is the most well known of these but dozens
of other specialized medical bibliographies are produced as well. (A complete list of NLM
publications is available.) Today, through communications networks, MEDLARS search services
are available online to individuals and institutions throughout the world.
Over the years of its evolution, MEDLARS has come to represent a family of databases of
which the MEDLINE database is the most well known. Essentially Index Medicus online,
MEDLINE enables individuals and organizations with computer terminals to query the NLM
computer's store of journal article references on specific topics. MEDLINE currently contains six
million references going back to 1966.
Besides MEDLINE, which became operational in 1971, NLM now has some 40 other
databases - for cataloguing and serials information, toxicological and chemical data, information on
audiovisual materials, and information on cancer and other specialized areas of health and disease.
All of the MEDLARS databases are available through NLM's online network of more than
40,000 institutions and individuals in the United States. They performed some 4.8 million searches
in 1990. User fees are charged by NLM to recover the full costs of providing access to the system.
The availability of the user-friendly microcomputer-based access software, GRATEFUL MED®,
has resulted in an upsurge of individual health professionals joining the NLM network. Access to
the MEDLINE database is also available through four commercial networks and on CD-ROM from
several private companies.
Research and Development
Much of the Library's research and development is carried out by the Lister Hill National
Center for Biomedical Communications. Named after the late Senator from Alabama, the Center
explores the uses of computer, communication, and audiovisual technologies to improve the
organization, dissemination, and utilization of biomedical information. The Center was established
in 1968 and reorganized in 1983 to include the functions of NLM's National Medical Audiovisual
Center.
The Lister Hill Center played a lead role in developing the MEDLARS online retrieval
system in the late sixties and since then has conducted a number of valuable communications
experiments using NASA satellites, microwave and cable television, and computer-assisted
instruction. Currently the Center is investigating the potential of optical videodisc technology for
document preservation, storage, and retrieval, and also has under way several projects that combine
videodisc technology with microcomputers to develop innovative health-science teaching materials.
Computer-based "Expert" systems that will make available to practitioners the knowledge of highly
trained specialists have been devised in several medical fields. "The Learning Center," a facility that
makes available for on-site review the latest hardware and software in health sciences education,
has been opened within the Lister Hill Center.
The Library's newest component, the National Center for Biotechnology Information has
assumed a leadership role in developing information services for biotechnology—the task of storing
and making accessible the staggering amounts of data about the human gene resulting from genetic
research at the NIH and laboratories around the nation.
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Toxicology Information Program
The Toxicology Information Program (TIP) was established at NLM in 1967 to provide
national access to information on toxicology. The program is charged with setting up computerized
databases of information from the literature of toxicology and from the files of both governmental
and nongovernmental collaborating organizations.
Among the databases developed by TIP are TOXLINE® (Toxicology Information Online)
and CHEMLINE®, a chemical dictionary file. More recently, TIP implemented the TOXNET®
(Toxicology Data Network) system of toxicologically oriented data banks, including the HSDB®
(Hazardous Substances Data Bank), useful in chemical emergency response and other applications.
TIP also supports the Toxicology Information Response Center, which provides reference services
to the scientific community.
Grant Programs
The extramural (grant) programs of the National Library of Medicine were originally
authorized by the Medical Library Assistance Act of 1965 (Public Law 89-291) to provide better
health information services through grant support to the Nation's medical libraries. The Act, since
extended by Congress, offers assistance for library resources, research in biomedical
communications, biomedical publications, and the Regional Medical Libraries. Since 1965, the
biomedical library network has been strengthened by grants from NLM's Extramural Programs to
more than 1,000 institutions.
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Appendix D
AVAILABLE PUBLICATIONS FROM THE TASK FORCE
ON ENVIRONMENTAL CANCER AND
HEART AND LUNG DISEASE

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Appendix D
AVAILABLE 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.
t. Environmental Cancer and Heart and Lung Disease, Reports to Congress, 1978-1990. (Available
from EPA Office of Health Research and NTIS where indicated.)
Eleventh Report to Congress. 1989-1990.
Tenth Report to Congress. 1987-1988.
Ninth Annual Report. 1986.
Eighth Annual Report. 1985. NTIS Accession No. PB87 184412; paper copy $17.00;
microfiche $8.00.
Seventh Annual Report. 1984. NTIS Accession No. PB85 236842; paper copy $17.00;
microfiche $8.00.
Sixth Annual Report. 1983. NTIS Accession No. PB84 219187; paper copy $17.00; microfiche
$8.00.
Fifth Annual Report. 1982. NTIS Accession No. PB83 155762; paper copy $23.00; microfiche
$8.00.
Fourth Annual Report. 1981. NTIS Accession No. PB82 200429; paper copy $23.00;
microfiche $8.00.
Third Annual Report. 1980. NTIS Accession No. PB81 174716; paper copy $23.00; microfiche
$8.00.
These 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. Fisher, Ann, Maria Paulova, and Vincent Covello. 1991. Evaluation and Effective Risk
Communication: Workshop Proceeding
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3. Merchant, James A., ed. 1990. Environmental and Occupational Asthma. Chest. 98(5): 145S-
252S. Supplemental Issue.
This workshop focused on providing a workable definition of occupational/environmental
asthma, relating and providing current knowledge to skills needed in the first contact health
care provider community to allow better prevention/treatment/reporting of
occupational/environmental asthma, and reviewed the current knowledge/identified research
gaps in the areas of clinical assessment, epidemiology, management, control, and prevention
of asthma. This proceedings document includes papers from all the presentors, as well as the
conclusions and recommendations of the workgroups, and the introductory and summary
remarks.
4. Baker, Scott R. and Chris F. Wilkinson, eds. 1990. The Effects of Pesticides an Human Health:
Proceedings of a Workshop. EPA/100/9-90/016. National Technical Information Service No.
PB90-188723/AS. The Effects of Pesticides on Human Health. 1990. (NTIS Accession No. PB90
188723; paper copy $45.00; microfiche $15.00.) Also published as the Effects of Pesticides an
Human Health in Advances in Modern Environmental Toxicology, Vol. XVIII. Princenton, NJ.:
Princenton Scientific Publishing Company, Inc. 1990.
This report presents results of the workshop which focused on the potential chronic health
effects of pesticides. Working groups were held on topics of exposure, neurotoxicity,
carcinogenicity, immuno-toxicity, reproductive effects, and developmental effects. This
proceedings document includes papers from presenters and the conclusions and
recommendations of the work groups.
5. Effective Risk Communication: The Role and Responsibility of Government and Non-
Government Organizations. 1989. Contemporary Issues of Risk Analysis, Vol. 4. New York:
Plenum Press.
The report includes an overview of the principles and guidelines for improving risk
communication, descriptions of government risk communication programs and case studies, and
manuals on risk communication for government communicators and plant managers. Future
directions for research in risk communication are highlighted.
6. Report of the Workshop on Environmental Toxicity and the Aging Process. 1987. Progress in
Clinical and Biological Research, Volume 228. New York: Alan R. Liss, Inc.
As an effort to provide impetus to a multidisciplinaiy 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 will also include recommendations for future
research.
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7. Report of the Special Grand Rounds Women at Work. 1986. (NTIS Accession No. PB87
184263; paper copy $17.00; microfiche $8.00.)
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.
8. Report of the Workshop on the Contribution of Airborne Pollutants to Respiratory Cancer.
1986. Environmental Health Perspectives. Vol. 70.
The report includes an overview and papers describing the contribution 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
interaction with cigarette smoke and the risk of exposure to human populations. Data gaps and
uncertainties are identified, and recommendations are suggested for research to reduce these
uncertainties.
9. Report of the Workshop on Environmentally Related Nononcogenic Lung Disease. 1985.
Environmental Research. 38(2).
This report is intended to reflect the current state of knowledge on environmentally related
nononcogenic lung disease. It contains 45 research recommendation 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.
10. Strategies for Determining the Mechanisms of Toxicity. 1985. Prepared by the Subcommittee
on Metabolism of the Project Group on Exposure and Metabolic Mechanisms. Journal of
Toxicology - Clinical Toxicology. 23(1).
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.
11. Environmental Health-Related Information, A Bibliographic Guide to Federal Sources for the
Health Professional. 1984. (NTIS Accession No. PB84 229681; paper $39.00; microfiche $8.00.)
This annotated bibliography contains selected materials on occupational 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,
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Educational Resource Centers supported by NIOSH, federally funded clearinghouses for
environmental and occupational health issues, and accredited residencies in preventive and
occupational medicine.
12. Exposure Assessment: Problems and Prospects. 1983-84. Journal of Toxicology - Clinical
Toxicology. 21(1) and 21(2). 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.
13.	Position Papers from the Workshop on Exposure to Environmental Agents, Their Metabolism,
and Mechanisms of Toxicity. July 1982. Published as a Special Issue of the Journal of
Environmental Science and Health. 17A(4).
A wide range of topics was covered in this publication, including: initiation/promotion concepts
of carcinogenesis, toxicologic interactions and pathogenesis of lung and heart disease, and total
exposure models in animals and humans.
14.	Summary of the Workshop on Exposure to Environmental Agents, Their Metabolism, and
Mechanisms of Toxicity: Research Needs. August 1981. (NTTS Accession No. PB82 212895;
paper $23.00; microfiche $8.00.)
This summary presents the full text and rationale of 72 research recommendations 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.
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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
National Library of Medicine
Centers for Disease Control
Center for Environmental Health and Injury 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
Department of Defense
Department of Veterans Affairs
EPA/600/R-92/113

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