&EPA
            Preliminary Research Findings


         of the El Paso Children's Health Study
                      El Paso
                                    i
                 Children's Health
                     _ Study     i^J
                  Research and Development

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                                    Disclaimer

The information in this document complies with U. S. Environmental Protection Agency
regulations and policies pertaining to the protection of human subjects in research and was
reviewed and approved by the University of North Carolina's Committee for the Protection of
the Rights of Human Subjects and by the EPA Human Subjects Research Review Official.
The collection of data was also reviewed and approved by the White House Office of
Management and Budget to ensure our compliance with the Paperwork Reduction Act. The
information included herein presents preliminary findings of the initial phase of the study and
is approved for publication. Approval does not signify that the contents reflect the view of the
Agency, nor does mention of trade names or commercial products constitute endorsement or
recommendation for use.

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                                          EPA 600/R-02/047
                                          July 2002
     Preliminary Research Findings

of the El Paso Children's Health Study

                Prepared for the
      El Paso Independent School District
                  El Paso, TX
               Principal Investigator
                 Lucas Neas, Sc.D

             Co-principal Investigator
              Melissa Gonzales, Ph.D.
          U. S. Environmental Protection Agency
           Office of Research and Development
National Health and Environmental Effects Research Laboratory
               Human Studies Division
          Epidemiology and Biomarkers Branch
           Research Triangle Park, NC 27711

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[This page is intentionally blank]

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                                  Table of Contents

Title Page
Disclaimer
Executive Summary   	1
Introduction                                                                                   2
Study Overview 	4
Methods      	5
Study Population 	6
Respondent and Demographic Factors   	7
Prevalence of Risk Factors   	8
Unadjusted Prevalence of Respiratory Health Outcomes 	9
Adjusted Prevalence of Respiratory Health Outcomes    	10
Discussion    	11
Pending Publications  	12
Abstracts for Scientific Meetings  	12
Figure 1.  Number of questionnaires distributed, returned, completed, and the final number of	13
          questionnaires suitable for analysis after exclusions; El Paso Independent School
          District, El Paso, Texas, January-February 2001
Figure 2.  Parental education level; 6,825 children in the fourth and fifth grades of elementary	14
          schools in the El Paso Independent School District, El Paso, Texas, January-February
          2001
Figure 3.  Questionnaire responses by child's Hispanic ethnicity status, language of the 	15
          questionnaire, and school district region; 6,825 children in the 4th and 5th grades of
          elementary schools in the El Paso Independent School District, El Paso, Texas,
          January-February 2001

Table 1.   Selected model covariate risk factors associated with respiratory health effects, El  	16
          Paso Children's Health Study, February 2001

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Table 2.   Proportion of two-adult households, Hispanic ethnicity of the child, and questionnaire	17
          respondent's sex and relationship to the child by school district region; 6,825 4th and
          5th grade school children, El Paso Independent School District, El Paso, Texas,
          February 2001
Table 3.   Demographic information by Region and School: 6,825 children in the fourth and 	18
          fifth grades of elementary schools in the El Paso Independent School District, El
          Paso, Texas, January-February 2001
Table 4.   Prevalence of risk factors by school region and elementary school: 6,825 children in 	22
          the fourth and fifth grades of elementary schools in the El Paso Independent School
          District, El Paso, Texas, January-February 2001
Table 5.   Unadjusted prevalence of selected respiratory conditions by school region and 	26
          elementary school: 6,825 children in the fourth and fifth grades of elementary
          schools in the El Paso Independent School District, El Paso, Texas, January-February
          2001
Table 6.   Adjusted prevalence of selected respiratory conditions by school region and 	30
          elementary school: 6,825 children in the fourth and fifth grades of elementary schools
          in the El Paso Independent School District, El Paso, Texas, January-February 2001

Appendix A.         Glossary of Terms 	34
Appendix B.         Exclusions Due to  Severe Illness or Missing Critical Information on   	36
                    Questionnaire by School Region and Elementary School: 7,772 children in
                    the 4th and 5th grades of elementary  schools in the El Paso Independent
                    School District, El  Paso, Texas, January-February 2001
Appendix C.         Analytic Methods	38
Acknowledgments   	39

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Preliminary Research Findings
of the El Paso Children's Health Study
                             Executive Summary
     The El Paso Children's Health Study
was designed to evaluate the possible
association between childhood respiratory
illness and ambient air quality in the El
Paso metropolitan area.  The study was
conducted by researchers of the U.S.
Environmental Protection Agency (EPA),
in cooperation with the El Paso
Independent School District (EPISD), as
part of EPA's Border XXI Program.
     In the spring of 2001, 9,797
respiratory health questionnaires were
distributed to all 4l  and 5th grade students
enrolled in the 54 EPISD elementary
schools, and completed questionnaires
were successfully returned for 7,772
children (80%). After the exclusion of
children with severe chest illnesses,
injuries or operations and children with
missing information on key risk factors,
questionnaires for 6,825 children were
suitable for further analysis.
     This document is an attempt to
provide immediate information back to the
EPISD as a return on their investment in
the El Paso Children's Health Study.
These preliminary research findings
provide a summary of the information
collected during the questionnaire survey
phase of the study across the 54
elementary schools, including the
prevalence of respiratory symptoms and
illness and the prevalence of key risk
factors for respiratory illness. The
information may be useful to EPISD
school health nurses and health educators
in designing local public health programs.
      The El Paso Children's Health Study
was not  designed to provide a direct
comparison between El Paso with the rest
of the United States. Nevertheless, as a
whole, the children in our study do not
appear to have a higher prevalence of a
physician's diagnosis  of asthma, either
lifetime  or in the last year, than observed
in similar studies of schoolchildren in other
U.S. communities.
      The analytic work on the El Paso
Children's Health Study will continue
beyond this document. Analyses of the role
of traffic-related air pollutants in children's
respiratory health will be conducted over
the next two years, with presentations of
preliminary findings at a major
international scientific conference  in 2003
and publication  of scientific papers in peer-
reviewed journals in 2003 and 2004.

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                    Preliminary Research Findings
               of the El Paso Children's Health Study
Introduction

     The El Paso-Ciudad Juarez area is
one of the largest metropolitan areas on the
U.S.-Mexico border.  Sources of air
pollutants include the more than 18 million
vehicles, which annually cross between the
two cities, heavily traveled roads and
interstate freeways, and local industries.
During the winter, weather conditions trap
air pollutants close to ground level where
they concentrate. The main air pollutants
that we are studying (paniculate matter or
soot, and gases such as nitrogen dioxide
and volatile compounds) are produced by
car and truck emissions.  The Texas
Natural Resources Conservation Commission
routinely monitors these air pollutants in El
Paso.  As part of the El Paso Children's
Health Study, these air pollutants have
been measured in the vicinity of El Paso
Independent School District (EPISD)
schools over two consecutive winters.
Preliminary analyses suggest that the
levels of many of these air pollutants
appear to depend on the school's distance
from major roadways.  Highway and
border traffic congestion, combined with
winter weather conditions and  different
levels of air pollutants in different areas of
the city provided the opportunity to study
the health effects of motor vehicle exhaust
in children.
     The El Paso Children's Health Study
evaluated the prevalence of respiratory
illnesses  and symptoms among those 41'
and 5th grade students enrolled in the
EPISD during the spring 2001.  The study
was conducted by researchers of the U.S.
Environmental Protection Agency (EPA),
in cooperation with EPISD.  Fifty-four
/ith
elementary schools participated in the
questionnaire portion of the health survey.
     Immediately following the survey,
children at 20 schools who had written
parental permission had their height,
weight and pulmonary function measured.
These 20 schools were locations where  air
pollution measurements had been collected
over the previous two winter seasons.
Additional air pollution measurements
were also collected at these schools at the
same time pulmonary function was
measured on the children. The full study
will fill important information gaps in our
scientific knowledge  and understanding by
looking at the possible links between
outdoor air pollution and asthma,
bronchitis, other chest illnesses and
symptoms in children.
     These preliminary research findings
provide a summary of the information
collected during the questionnaire survey
phase of the study.  It describes how
prevalent respiratory  symptoms and illness
are among this segment of the student
population. Demographic characteristics
of the students and their families as well as
the prevalence of specific risk factors, or
covariates, known to be associated with
respiratory health status are also described.
The information for each school that
participated in the study is presented in
tables aggregated by EPISD region.
     The information contained in this
public health report provides the EPISD an
in-depth view of the respiratory status of
their students and may be a useful tool for
health professionals, district-wide and at
individual schools, to better understand
respiratory health trends and target

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resources for training and intervention
programs.  The cooperation extended by
the EPISD principals, teachers, staff,
parents and children was excellent
throughout the study. Without such
cooperation, a study of this magnitude
could not have been accomplished to the
high degree of participation and quality
achieved.

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Study Overview

     This document is divided into three
main sections. The first section outlines
the questionnaire study and provides a
descriptive summary of the characteristics
of the study population in terms of their
respiratory health and risk factors.  The
second section provides a review of the
prevalence of covariate risk factors and
demographic information for each  of the
54 participating schools.  The last section
provides both the crude prevalence rates of
respiratory health outcomes (illness and
symptoms) and the adjusted prevalence
rates, which  account for the risk factors
and demographics of each school.  The
definitions of the respiratory health
outcomes, risk factors and demographic
variables used in these analyses are
provided in Appendix A. The results are
explained and interpreted at the end of the
report.
     The El Paso Children's Health Study
complied with EPA regulations and
policies pertaining to the protection of
human subjects in research and was
reviewed and approved by the University
of North Carolina's Committee for the
Protection of the Rights of Human
Subjects and by the EPA Human Subjects
Research Review Official.  The collection
of data was also reviewed and approved by
the White House Office of Management
and Budget to ensure our compliance with
the Paperwork Reduction Act.

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Methods
     All 4th and 5th grade students enrolled
in EPISD schools received a questionnaire
packet from their teacher to take home to
their parents between February and March
2001.  All questionnaire packets contained
an English-language questionnaire, a
Spanish-language questionnaire and a No.
2 pencil. The parents were instructed to
complete the questionnaire in the language
they preferred, seal it inside the provided
envelope, and returned by the child to the
school. The provision of duplicate
questionnaires in both English and Spanish
to all parents was intended to ensure that
all respondents could reply in the language
of their own choice and to permit an
evaluation of any language-related
differences in reporting these health
conditions.
     The questionnaire asked parents
whether the child had experienced asthma,
bronchitis and/or allergies or breathing
problems ever in their lifetime and/or
within the past year.  Information on risk
factors known to be related to respiratory
health effects and demographic
information was also collected.
     Upon receipt of the returned
questionnaire packet, all personal
identifying information was detached from
the remainder of the questionnaire. All
personal identifying information has been
maintained in a secure file separate from
the statistical information in strict
accordance with the Federal Privacy Act.
     The statistical portion of each
questionnaire was scanned into a statistical
database.  Over the past year, this
statistical information has undergone
quality assurance review to identify any
reporting problems and to ensure the
overall quality of the database. A more
detailed discussion of the analytic methods
employed in the production of these
findings is provided in Appendix C.

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Study Population

     During January and February 2001,
9,797 questionnaire packets were
distributed to 4th and 5th grade school
children attending 54 elementary schools
in the EPISD (Figure 1).  By the end of
May, questionnaires were not returned for
1,564 children (16%). No clear pattern
was observed of non-returns by school
region. Questionnaires were returned for a
further 461 children (5%), but their parents
declined to participate in the study.
Completed questionnaires were returned to
the schools by parents for 7,772 children
(80%).
     A small proportion (4%) of the
school children reported severe conditions
including cystic fibrosis, chest injury, chest
operation, heart disease, or the need for
supplemental oxygen for more than two
weeks after birth. Since these conditions
are often associated with severe respiratory
illness and are causally unrelated to
environmental factors, these 274 children
were excluded from the study.
     Any comparison of disease
prevalence across schools requires an
adjustment for selected risk factors that
may also differ across schools. Therefore,
a final 673 children (9%) were excluded
because of missing information on one or
more of these risk factors.  Appendix B
lists the number of questionnaires excluded
by school, region and district-wide because
the child had a severe illness or because
critical information was not reported.
After these exclusions, 6,825
questionnaires were suitable for further
analysis.

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Respondent and Demographic Factors
     In every school region, the child's
biological mother most commonly
completed the questionnaires (Table 2).
Grandparents or other adults completed
less than  10% of the questionnaires
district-wide. Sixty to 70% of the children
lived in households with two adults, but
the percentage of two-parent households
was somewhat lower in EPISD Region 3.
     The study population consisted of
6,825 4th  and 5th grade schoolchildren with
approximately equal proportions of girls
(51%) and boys (49%) and half of whom
were 10 years of age or older (table 4).
The students in this study population were
predominantly of Hispanic ethnicity
(83%). The questionnaire was completed
predominantly in English by both
Hispanics and non-Hispanics respondents
(Figure 2) with the exception of EPISD
Region 3, where significantly more
Spanish-language questionnaires were
returned (62%).  This trend corresponds to
the higher percentage of Hispanics in this
region (98%) as compared to the EPISD as
a whole.
     The median level of parental
education varied considerably across the
school district (Figure 3). Approximately
half of the households in Regions 1, 2 and
3 had a maximum parental education of a
high school degree and/or additional post-
high-school education. College education
was most common in Region 4 (56%,
Range 25-78%) and less common in
Region 3 (17%, Range 5-57%).
Differences in overall parental education
level between Region 3 and the other
Regions is also exemplified by the number
of schools where parents did not have a
high school degree. There were five
schools in Region 3 where 40-50% of the
parents had less than a high school
education. In contrast, only one school in
the  other regions had a 30% rate of less
than high school education. However, it
should be noted that 57% of the parents
from Mesita Elementary School had a
college education.

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Prevalence of Risk Factors
     The prevalence rates of risk factors
associated with respiratory health problems
varied considerably by EPISD region and
elementary school (Table 4). The
distributions of these risk factors are
important since we would expect schools
with a higher prevalence of these risk
factors to have a higher prevalence of
respiratory conditions.
     Genetic factors may predispose
children to respiratory ailments such as
asthma.  Therefore, it is important to
obtain information on the health history
of the child's biological parents  The
average prevalence of a parental history of
respiratory illness was 31% for allergy,
12% for asthma, and 7% for other lung
diseases.
     Similarly, environmental factors may
also be associated with respiratory
ailments. Approximately one-third of the
households in the district had at least one
person who smoked cigarettes indoors.
Prevalence of smoking in more than 40%
of the children's homes was reported for
two elementary schools: Burnet (47%) and
Clardy (41%). A low prevalence of
smoking in the home was found for three
elementary schools: Milam (16%),
Kohlberg (16%), and Polk (17%).
     Across the entire district, 18% of the
parents reported a problem with mold
inside of their home.  The prevalence
rates of indoor mold were less than 10% at
three schools: Rusk (9%), Kohlberg (9%)
and Roberts (9%).  At four schools, 25%
or more of the parents reported a home
mold problem: Milam (27%), Logan
(27%), Schuster (25%), and Putnam
(25%).
     A majority of the households (80%)
had gas stoves, and slightly more than half
had a furry pet (52%) such as a cat, dog,
hamster, mouse or guinea pig.

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Unadjusted Prevalence of Respiratory Health Outcomes
     The crude or unadjusted prevalence
of the children's respiratory conditions
provides a snapshot of the burden of illness
at each school.  The unadjusted prevalence
may be most useful to School Health
Nurses in the allocation of educational
materials and health surveillance to those
elementary schools with the highest
prevalence regardless of the reasons for
this higher prevalence. For these
preliminary findings, we focused our
attention on seven important respiratory
conditions:
    • a physician's diagnosis of allergy
     ever in lifetime,
    • a physician's diagnosis of asthma
     ever in lifetime,
    • a physician's diagnosis of asthma in
     the last year,
    • a physician's diagnosis of bronchitis
     in the last year,
    • a parental report of chronic cough in
     the last year,
    • a parental report of persistent wheeze
     in the last year,
    • a parental report of chronic phlegm
     in the last year.
                /ith
                       th
     Among the 4 and 5  grade school
children in the EPISD, the crude or
unadjusted prevalence of a physician's
diagnosis of asthma at some time in
their life was 11% (table 5).
Recent national surveys have estimated the
lifetime prevalence of asthma as between
11% and 12% for the entire U.S. The
five EPISD elementary schools with the
highest lifetime prevalence of physician-
diagnosed asthma were Nixon (18%),
Clendenin (16%), MacArthur (17%), Dr.
Green (16%), and Western Hills (16%).
     Among the 4th and 5th grade school
children in the EPISD, the unadjusted
prevalence of a physician's diagnosis of
asthma within the past year was 8% For
the entire U.S., surveys have estimated the
prevalence of asthma in the last year at
between 6% and  8%.  The five EPISD
elementary schools with the highest
prevalence of a physician's diagnosis of
asthma in the last year were Whitaker
(12%), Clendenin (12%); Mesita (12%);
Rivera (13%) and Western Hills (13%).
     Only Western Hills and Clendenin
elementary schools were in the top five
EPISD elementary schools for both a
higher prevalence of lifetime physician's
diagnosis of asthma and a higher
prevalence of asthma within the past year.
     The unadjusted prevalence of asthma
at these EPISD elementary schools should
be interpreted with considerable caution.
The El Paso Children's Health Study was
designed to detect patterns of illness across
the entire EPISD that might be related to
air pollution. The El Paso Children's
Health Study was not designed to reliably
detect elevation of illness at individual
elementary schools. The higher unadjusted
prevalence of asthma at these schools may
be due to the prevalence of risk factors,
reporting bias of the respondents,  or
chance.

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Adjusted Prevalence of Respiratory Health Outcomes
     As previously mentioned, a family
history of respiratory ailments and
household environmental risk factors may
influence whether a child has respiratory
health problems. The crude or unadjusted
prevalence of respiratory illness is often
greatly influenced by the proportion of
each risk factor present at each school.  In
order to correct for this, we adjusted the
prevalence of each respiratory condition at
each school to a standard population with
the following characteristics:
   • an equal proportion of boys and girls,
   • 10 years of age,
   • who considered themselves to be
     white Hispanics,
   • life-long residents of El Paso, Texas,
   • from English-speaking, non-
     smoking, two-parent households,
   • the parent with the highest education
     was a high school graduate,
   • no furry pets (dogs, cats, mice,
     hamsters or guinea pigs) in the home,
   • the household had no indoor mold or
     moisture problems,
   • the household did not have a gas
     stove, and
   • whose biological parents had no
     history of asthma, allergy or lung
     disease.

     The model produces adjusted
prevalence rates that more accurately
reflect the differences in the prevalence
rates in the study population that are
unrelated to these risk factors (table 6). In
selecting the composition of a standard
population for the EPISD, we generally
selected the most common characteristics
of the district has a whole, except for
potential  risk factors such as smoking in
the home, furry  pets, and gas stoves.
     The adjusted prevalence of these
selected respiratory conditions among all 4th
and 5th grade schoolchildren varied
considerably across the EPISD (table 6):
     • The adjusted prevalence of a
  physician's diagnosis of asthma ever in
  lifetime was 6% for the EPISD, with three
  schools at or above a 10% prevalence:
  Nixon (10%), Alamo (15%) and Dr. Green
  (12%).
     • The adjusted prevalence of a
  physician's diagnosis of asthma in the
  past year was 4.1% for the EPISD, with
  two schools above 7% prevalence: Houston
  (9%) and Hart (8.7%).
     • The adjusted prevalence of chronic
  cough in the past year was 1.3% for the
  EPISD, with two schools above 3%
  prevalence: Clendenin (3.8%) and
  Roberts (3.1%).
     • The adjusted prevalence of persistent
  wheeze in the past year was 1.4% for the
  EPISD, with one school above 3%
  prevalence: Col dwell (3.3%).
     • The adjusted prevalence of chronic
  phlegm in the past year was 1 2% for the
  EPISD, with two schools above 3%
  prevalence: Col dwell (3.7%) and
  Clendenin (3.4%).
     • The adjusted prevalence of bronchitis
  in the past year was 2.7% for the EPISD,
  with three schools at or above a 5%
  prevalence: Houston (5.0%), Zavala (7.6%),
  and Putnam (5.0%).

     Although the prevalence of these
respiratory  conditions at each school has been
adjusted for school-to-school differences in
the most important risk factors, these results
must still be interpreted with considerable
caution.  The higher adjusted prevalence of
respiratory  illness at any school may be still
due to unintentional  reporting bias on the part
of the respondents or simply chance
variations.
                                                10

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Discussion
     The El Paso Children's Health Study
was not designed to provide an overall
comparison between the El Paso
Independent School District and the U.S.
as a whole. Comparison of our findings
with those of other national surveys may
be problematic due to differences in
sampling and questionnaire wording.
Nevertheless, the children in our study as a
whole do not appear to have a higher
prevalence of either a lifetime history  of a
physician's diagnosis of asthma or a
physician's diagnosis of asthma symptoms
in the last year than the U.S. as a whole.
     Even though the overall prevalence
of asthma was comparable to that of the
entire U.S., public health authorities have
become concerned about the rising
prevalence of asthma among all
communities. We hope that these
preliminary research findings may be
useful in targeting public health education
and surveillance programs to those
elementary schools with a higher
prevalence of asthma and related
respiratory conditions. The Indoor
Environments Division of EPA's  Office of
Radiation and Indoor Air has developed
educational materials discussing
environmental factors related to asthma
exacerbation. EPA's Office of Research
and Development has developed a
comprehensive Research Strategy for
Asthma.  The El Paso Children's Health
Study is an important component of this
EPA research strategy.
     The prevalence of several known risk
factors for asthma and other respiratory
conditions are elevated in the El Paso
Independent School District, particularly
cigarette smoking in the child's home. The
high prevalence of tobacco smoking
among the children's parents could hinder
the success of smoking prevention
programs among the children. Educators
may wish to take this high prevalence of
parental smoking into account in designing
their smoking prevention programs.
     The analytic work on the El Paso
Children's Health Study will continue over
the next several years. A complete analysis
of the role of traffic-related air pollutants
in children's respiratory health will be
conducted during 2002 with a report of
preliminary findings at a major
international scientific conference in
Spring 2003 and several scientific papers
in peer-reviewed journals in 2003 and
2004.
     In conclusion, we are extremely
grateful for the outstanding cooperation  of
the children, parents, teachers, and
administrative staff of the El Paso
Independent School District. Without your
assistance, this study could not have been
conducted.
                                                 11

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Pending Publications

Noble, C.A.; Mukerjee, S.; Gonzales, M.;
     Rodes, C.E.; Lawless, P.A.;
     Natarajan, S.; Myers, E.A.; Norris,
     G.A.; Smith, L.; Ozkaynak, H.; Neas
     L.M. Continuous measurement of
     fine and ultrafine particulate matter,
     criteria pollutants and meteorological
     conditions in El Paso, Texas.
     Environmental Science &
     Technology (submitted).
Abstracts for Scientific Meetings

Gonzales, M.; Neas, L.; Mukerjee, S.;
     Ozkaynak, H. Children's respiratory
     health and exposure to particulate
     matter and co-pollutants in El Paso,
     TX. Presented at the 12th Conference
     of the International Society for
     Environmental Epidemiology,
     Buffalo, NY, August 19-23, 2000.

Norris, G.A.; Mukerjee, S.; Ozkaynak, H.;
     Smith, L.A.; Noble, C.; Rodes, C.E.;
     Gonzales,M.; Neas, L.M.
     Relationship between fine and
     ultrafine particle number and VOC
     concentrations in El Paso, Texas
     (14E2). Presented at 20th Annual
     Conference of the American
     Association for Aerosol Research,
     Portland, OR, October 15-19, 2001.
Noble, C.A.; Rodes, C.E.; Lawless, P.A.;
     Natarajan, S. Myers, E.A.; Mukerjee,
     S.; Norris, G.A.; Ozkaynak, H.A.;
     Gonzales, M.; Neas, L.M.;  Smith,
     L.A. Correlation of fine and ultrafine
     particulate matter with
     meteorological conditions and
     criteria pollutants in El Paso, Texas
     (11PJ10). Presented at 20th Annual
     Conference of the American
     Association for Aerosol Research,
     Portland, OR, October 15-19, 2001.

Noble, C.A.; Rodes, C.E.; Ozkaynak,
     H.A.; Mukerjee,  S.; Gonzales, M.;
     Neas, L.M. Continuous measurement
     of ultrafine particulate matter in El
     Paso, Texas, USA,  during winter
     1999. Presented at the 13th
     Conference of the International
     Society for Environmental
     Epidemiology, Garmisch-
     Partenkirchen, Germany, September
     2-5,2001.

Gonzales, M; Walsh, D.;  Rhoney,  S.; Neas
     L.M.  Low Prevalence of Asthma
     and Wheeze Among Hispanic
     Children Along the United States -
     Mexico Border.  Presented at the 98th
     International Conference of the
     American Thoracic Society,  Atlanta,
     GA, May 19-22,  2002.
                                                12

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Figure 1.  Number of questionnaires distributed, returned, completed and the final number of
questionnaires suitable for analysis after exclusions; El Paso Independent School District, El
Paso, Texas, January-February, 2001.
              Distributed
               n = 9,797
               Returned
               n = 8,233
              Completed
               n = 7,772
            Final Data Base
               n = 6,825
                                                      Exclusions:
                                               Severe Illness a  n = 274
                                               Missing Data b  n = 673
     a  Severe  illness  includes cystic  fibrosis  (n =  4),  chest  injury (n  = 27),
        chest operation (n = 59), heart disease (n =  130) or the need for  supplemental
        oxygen for more than two weeks after birth (n = 86).

     b  Data were missing on severe illness or child's sex, age, race or ethnicity.
                                               13

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Figure 2. Parental education level; 6,825 children in the 4th and 5th grades of elementary
schools in the El Paso Independent School District, El Paso, Texas, January-February 2001.
     Completed College
              30%
                   21%
     Some Post-High School
Did Not Complete High School
         18%
                                                   23%
        Completed High School
                                       14

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Figure 3.  Questionnaire responses by child's Hispanic ethnicity status, language of the
questionnaire, and school district region; 6,825 children in the 4th and 5th grades of
elementary schools in the El Paso Independent School District, El Paso, Texas, January-
February 2001.
              Region 1
    50%
                        21%
                        29%
  Region 2
                                          49%
                                                           17%
            34%
            Region 3
   36%
                 2%
                       62%
Region 4
                                          36%
                                                            37%
                                                    27%
                  Hispanic - Spanish Questionnaire
                  Hispanic - English Questionnaire
                  Non-Hispanic - English Questionnaire
                                          15

-------
Table 1.  Selected model covariate risk factors associated with respiratory health
effects, El Paso Children's Health Study, February 2001.
Demographic Information
      Single parent family
      Parental education level
      Child's  age
      Child's  sex
      Life-long resident of El Paso
Parental Medical History
      Parental history of asthma
      Parental history of other lung disease
      Parental history of allergy
Household Characteristics
      Cigarette smoking in the home
      Home mold or moisture problem
      Furry pet  (dog, cat, pet mouse or other rodent)
      Gas stove
                                           16

-------
Table 2.  Proportion of two-adult households, Hispanic  ethnicity  of  the  child,  and
questionnaire respondent's sex and relationship  to the child  by school  district region;
6,825 4th and  5th grade  school  children, El Paso Independent  School District, El Paso,
Texas, February 2001.
          Two Adult    Hispanic       Female
Region   Household    Ethnicity     Respondent
                             Respondent's Relationship
                                     to Child
             70%
79%
84%
Biological Parent           88%
Grandparent                2%
Adoptive/Legal Guardian     6%
Other Adult                 1%
             70%
81%
85%
Biological Parent           90%
Grandparent                2%
Adoptive/Legal Guardian     6%
Other Adult                 1%
             59%
98%
86%
Biological Parent           82%
Grandparent                3%
Adoptive/Legal Guardian    10%
Other Adult                 1%
             73
-------
Table 3. Demographic Information by Region and School: 6,825 children in the 4th and 5th grades of elementary schools in the El Paso
                                             Parental Education Level
Hispanic, Spanish Questionnaire and
     Lifetime El Paso Resident
Elementary
School
District
Region 1
Bradley
Burnet
Collins
Crosby
Dowell
Fannin
Lee
Newman
Nixon
Park
Schuster
Stanton
Wainwright
Whitaker
Single-Parent
Household
32%
31%
22%
29%
23%
40%
32%
33%
39%
28%
18%
26%
34%
31%
43%
34%
No High
School
18%
17%
7%
18%
9%
21%
24%
17%
27%
18%
1%
7%
22%
31%
27%
13%
High
School
22%
24%
32%
28%
21%
24%
25%
21%
32%
26%
12%
16%
33%
29%
23%
21%
Post-High
School
21%
22%
24%
27%
31%
20%
22%
26%
18%
19%
24%
20%
17%
22%
29%
15%
College
34%
31%
34%
20%
34%
30%
26%
32%
18%
29%
58%
53%
20%
15%
13%
47%
Hispanic
83%
79%
70%
92%
76%
84%
82%
76%
95%
87%
45%
67%
84%
95%
92%
62%
Spanish
Questionnaire
37%
30%
23%
48%
15%
22%
32%
26%
53%
29%
7%
13%
38%
35%
62%
17%
Lifetime
Resident
59%
63%
62%
52%
67%
69%
71%
66%
68%
69%
38%
63%
72%
73%
49%
61%
                                                                18

-------
Table 3. Demographic Information by Region and School: 6,825 children in the 4th and 5th grades of elementary schools in the El Paso
                                             Parental Education Level
Hispanic, Spanish Questionnaire and
     Lifetime El Paso Resident
Elementary
School
District
Region 2
Alta Vista
Bliss
Bonham
Cielo Vista
Clendenin
Coldwell
Crockett
Hawkins
Hillside
Houston
Hughey
Logan
MacArthur
Milam
Rusk
Travis
Single-Parent
Household
32%
30%
36%
21%
25%
21%
36%
26%
31%
37%
29%
42%
37%
16%
40%
16%
34%
31%
No High
School
18%
14%
23%
7%
7%
0%
17%
20%
16%
24%
9%
26%
10%
7%
6%
3%
23%
20%
High
School
22%
23%
21%
20%
22%
14%
19%
22%
31%
24%
27%
32%
27%
26%
18%
11%
26%
30%
Post-High
School
21%
23%
24%
22%
38%
13%
27%
26%
27%
20%
27%
20%
24%
21%
24%
14%
23%
17%
College
34%
35%
25%
49%
31%
70%
31%
28%
21%
21%
33%
15%
36%
43%
46%
68%
23%
27%
Hispanic
83%
81%
95%
46%
91%
76%
94%
95%
96%
100%
92%
98%
84%
44%
92%
30%
99%
69%
Spanish
Questionnaire
37%
32%
51%
16%
29%
19%
39%
37%
43%
46%
34%
51%
27%
14%
19%
3%
52%
37%
Lifetime
Resident
59%
56%
75%
22%
60%
63%
70%
70%
65%
64%
73%
63%
67%
18%
65%
5%
68%
40%
                                                                19

-------
Table 3. Demographic Information by Region and School: 6,825 children in the 4th and 5th grades of elementary schools in the El Paso
                                             Parental Education Level
Hispanic, Spanish Questionnaire and
     Lifetime El Paso Resident
Elementary
School
District
Region 3
Alamo
Beall
Burleson
Clardy
Cooley
Douglass
Hart
Lamar
Mesita
Moreno
Roosevelt
Vilas
Zavala
Single-Parent
Household
32%
41%
53%
40%
51%
38%
39%
56%
44%
35%
34%
38%
43%
35%
32%
No High
School
18%
33%
33%
45%
37%
25%
32%
50%
41%
31%
4%
19%
43%
33%
40%
High
School
22%
24%
32%
23%
25%
25%
20%
20%
23%
29%
13%
24%
21%
26%
24%
Post-High
School
21%
20%
14%
15%
21%
25%
24%
16%
17%
20%
22%
16%
20%
23%
22%
College
34%
17%
11%
9%
13%
17%
18%
5%
11%
17%
57%
35%
8%
14%
7%
Hispanic
83%
98%
100%
100%
99%
100%
97%
99%
99%
98%
86%
96%
99%
98%
100%
Spanish
Questionnaire
37%
62%
74%
76%
58%
51%
54%
78%
71%
58%
28%
31%
82%
73%
72%
Lifetime
Resident
59%
62%
68%
57%
66%
79%
53%
57%
61%
66%
70%
70%
58%
51%
48%
                                                                20

-------
Table 3. Demographic Information by Region and School: 6,825 children in the 4th and 5th grades of elementary schools in the El Paso
                                             Parental Education Level
Hispanic, Spanish Questionnaire and
     Lifetime El Paso Resident
Elementary
School
District
Region 4
Dr. Green
Johnson
Kohlberg
Lindbergh
Polk
Putnam
Rivera
Roberts
Rosa Guerrero
Western Hills
White
Single-Parent
Household
32%
27%
30%
41%
15%
25%
21%
28%
22%
43%
31%
23%
14%
No High
School
18%
9%
5%
22%
2%
5%
2%
13%
9%
29%
5%
1%
5%
High
School
22%
14%
10%
26%
6%
13%
6%
20%
7%
23%
15%
13%
12%
Post-High
School
21%
18%
16%
24%
16%
22%
14%
23%
20%
17%
22%
9%
18%
College
34%
56%
66%
24%
75%
58%
78%
38%
61%
25%
55%
75%
63%
Hispanic
83%
72%
69%
89%
58%
62%
47%
85%
68%
92%
77%
75%
64%
Spanish
Questionnaire
37%
22%
25%
48%
11%
13%
8%
33%
18%
40%
18%
18%
14%
Lifetime
Resident
59%
56%
51%
54%
43%
61%
50%
56%
54%
64%
57%
62%
64%
                                                                21

-------
Table 4.  Prevalence of risk factors by school region and elementary school: 6,825 children in the 4th and 5th grades of elementary
schools in the El Paso Independent School District, El Paso, Texas, January - February, 2001.
                      Parental History of Respiratory Illness
Home Environment
Elementary
School
District
Region 1
Bradley
Burnet
Collins
Crosby
Dowell
Fannin
Lee
Newman
Nixon
Park
Schuster
Stanton
Wainwright
Whitaker
Lung
Disease
7%
7%
5%
5%
8%
14%
3%
7%
6%
6%
7%
8%
13%
7%
3%
4%
Asthma
12%
13%
14%
14%
15%
16%
13%
12%
7%
13%
18%
11%
22%
6%
8%
16%
Allergy
31%
33%
40%
32%
35%
40%
36%
35%
17%
30%
44%
44%
30%
19%
21%
41%
Cigarette Smoking in
the Home
32%
35%
34%
47%
38%
34%
28%
38%
34%
40%
27%
28%
33%
34%
40%
32%
Mold
Problem
18%
19%
23%
11%
18%
21%
21%
21%
15%
16%
18%
23%
25%
20%
17%
19%
Gas Stove
80%
83%
98%
86%
80%
82%
67%
88%
91%
85%
93%
74%
83%
86%
70%
85%
Furry Pet
52%
59%
64%
54%
69%
63%
53%
68%
53%
67%
64%
64%
56%
61%
30%
51%
                                                                22

-------
Table 4.  Prevalence of risk factors by school region and elementary school: 6,825 children in the 4th and 5th grades of elementary
schools in the El Paso Independent School District, El Paso, Texas, January - February, 2001.
                      Parental History of Respiratory Illness
Home Environment
Elementary
School
District
Region 2
Alta Vista
Bliss
Bonham
Cielo Vista
Clendenin
Coldwell
Crockett
Hawkins
Hillside
Houston
Hughey
Logan
MacArthur
Milam
Rusk
Travis
Lung
Disease
7%
8%
7%
9%
5%
6%
9%
9%
9%
7%
8%
5%
10%
6%
10%
5%
7%
10%
Asthma
12%
13%
11%
17%
16%
8%
15%
11%
13%
6%
15%
10%
15%
17%
21%
8%
8%
10%
Allergy
31%
34%
28%
47%
42%
30%
43%
31%
32%
24%
35%
15%
32%
45%
44%
41%
23%
27%
Cigarette Smoking in
the Home
32%
30%
34%
28%
33%
25%
34%
33%
32%
30%
34%
36%
24%
39%
24%
16%
32%
28%
Mold
Problem
18%
19%
16%
18%
24%
17%
21%
20%
18%
14%
24%
12%
22%
27%
24%
27%
9%
14%
Gas Stove
80%
80%
91%
94%
60%
46%
69%
82%
89%
79%
88%
86%
82%
95%
47%
95%
91%
81%
Furry Pet
52%
55%
52%
59%
60%
60%
45%
50%
52%
50%
53%
51%
60%
66%
50%
70%
58%
41%
                                                                23

-------
Table 4.  Prevalence of risk factors by school region and elementary school: 6,825 children in the 4th and 5th grades of elementary
schools in the El Paso Independent School District, El Paso, Texas, January - February, 2001.
                      Parental History of Respiratory Illness
Home Environment
Elementary
School
District
Region 3
Alamo
Beall
Burleson
Clardy
Cooley
Douglass
Hart
Lamar
Mesita
Moreno
Roosevelt
Vilas
Zavala
Lung
Disease
7%
7%
5%
6%
8%
6%
5%
6%
6%
7%
7%
4%
10%
11%
5%
Asthma
12%
8%
5%
4%
12%
9%
7%
5%
10%
5%
13%
12%
10%
11%
6%
Allergy
31%
18%
14%
11%
22%
27%
18%
10%
14%
21%
41%
23%
9%
19%
10%
Cigarette Smoking in
the Home
32%
37%
40%
34%
37%
41%
30%
39%
40%
39%
30%
34%
39%
38%
40%
Mold
Problem
18%
16%
19%
19%
15%
15%
18%
12%
16%
13%
20%
20%
16%
12%
16%
Gas Stove
80%
85%
89%
90%
92%
91%
90%
84%
86%
86%
62%
76%
84%
85%
83%
Furry Pet
52%
35%
26%
34%
33%
48%
45%
17%
34%
31%
49%
43%
24%
35%
41%
                                                                24

-------
Table 4.  Prevalence of risk factors by school region and elementary school: 6,825 children in the 4th and 5th grades of elementary
schools in the El Paso Independent School District, El Paso, Texas, January - February, 2001.
                      Parental History of Respiratory Illness
Home Environment
Elementary
School
District
Region 4
Dr. Green
Johnson
Kohlberg
Lindbergh
Polk
Putnam
Rivera
Roberts
Rosa Guerrero
Western Hills
White
Lung
Disease
7%
6%
4%
6%
7%
5%
6%
7%
9%
3%
7%
5%
5%
Asthma
12%
15%
14%
8%
17%
10%
17%
16%
19%
12%
11%
21%
16%
Allergy
31%
42%
38%
29%
47%
45%
53%
33%
48%
23%
40%
50%
50%
Cigarette Smoking in
the Home
32%
25%
30%
34%
16%
21%
17%
29%
21%
33%
24%
26%
29%
Mold
Problem
18%
16%
15%
12%
9%
17%
16%
25%
23%
9%
18%
15%
17%
Gas Stove
80%
69%
42%
55%
89%
78%
69%
60%
63%
89%
89%
49%
74%
Furry Pet
52%
59%
54%
30%
66%
75%
71%
60%
60%
31%
63%
62%
77%
                                                                25

-------
Table 5. Unadjusted prevalence of selected respiratory conditions by school region and elementary school: 6,825 children in the 4th
and 5th grades of elementary schools in the El Paso Independent School District, El Paso, Texas, January - February, 2001.
                              Ever in Lifetime
Respiratory Symptoms in the Last Year
Elementary
School
District
Region 1
Bradley
Burnet
Collins
Crosby
Dowell
Fannin
Lee
Newman
Nixon
Park
Schuster
Stanton
Wainwright
Whitaker
Physician
Allergy
31%
34%
35%
35%
39%
36%
29%
38%
25%
33%
34%
39%
30%
35%
27%
36%
Diagnosis
Asthma
11%
11%
11%
11%
10%
12%
11%
9%
7%
11%
18%
11%
8%
10%
7%
14%
Asthma
8%
8%
8%
10%
10%
10%
7%
10%
6%
10%
8%
5%
6%
8%
8%
12%
Bronchitis
7%
6%
5%
4%
12%
6%
4%
7%
4%
5%
5%
10%
3%
6%
3%
10%
Chronic
Cough
4%
3%
3%
3%
2%
5%
3%
3%
2%
3%
3%
5%
0%
4%
1%
4%
Persistent
Wheeze
4%
4%
5%
1%
4%
4%
1%
4%
5%
1%
7%
7%
5%
5%
1%
4%
Chronic
Phlegm
3%
3%
2%
3%
4%
6%
1%
2%
2%
3%
1%
4%
5%
4%
1%
3%
                                                                26

-------
Table 5. Unadjusted prevalence of selected respiratory conditions by school region and elementary school: 6,825 children in the  4th
and 5th grades of elementary schools in the El Paso Independent School District, El Paso, Texas, January - February, 2001.
                              Ever in Lifetime
Respiratory Symptoms in the Last Year
Elementary
School
District
Region 2
Alta Vista
Bliss
Bonham
Cielo Vista
Clendenin
Coldwell
Crockett
Hawkins
Hillside
Houston
Hughey
Logan
MacArthur
Milam
Rusk
Travis
Physician
Allergy
31%
31%
25%
27%
38%
40%
42%
34%
29%
34%
34%
20%
26%
35%
36%
14%
30%
25%
Diagnosis
Asthma
11%
10%
4%
9%
15%
13%
16%
11%
9%
4%
14%
11%
9%
14%
17%
8%
5%
9%
Asthma
8%
8%
3%
7%
7%
10%
12%
9%
7%
6%
12%
11%
6%
11%
10%
8%
5%
6%
Bronchitis
7%
7%
5%
8%
5%
13%
6%
10%
4%
3%
12%
9%
8%
8%
12%
8%
4%
6%
Chronic
Cough
4%
5%
7%
6%
5%
2%
9%
5%
3%
1%
6%
5%
3%
5%
8%
3%
6%
0%
Persistent
Wheeze
4%
5%
4%
3%
4%
5%
9%
9%
4%
4%
4%
5%
5%
6%
0%
0%
6%
5%
Chronic
Phlegm
3%
4%
5%
4%
4%
2%
9%
8%
4%
0%
4%
5%
1%
3%
4%
5%
5%
1%
                                                                27

-------
Table 5. Unadjusted prevalence of selected respiratory conditions by school region and elementary school: 6,825 children in the  4th
and 5th grades of elementary schools in the El Paso Independent School District, El Paso, Texas, January - February, 2001.
                              Ever in Lifetime
Respiratory Symptoms in the Last Year
Elementary
School
District
Region 3
Alamo
Beall
Burleson
Clardy
Cooley
Douglass
Hart
Lamar
Mesita
Moreno
Roosevelt
Vilas
Zavala
Physician
Allergy
31%
23%
18%
18%
25%
29%
20%
15%
18%
23%
44%
30%
15%
21%
12%
Diagnosis
Asthma
11%
7%
14%
5%
4%
5%
9%
3%
7%
8%
12%
9%
6%
7%
7%
Asthma
8%
6%
7%
2%
6%
5%
7%
1%
10%
5%
12%
7%
5%
7%
7%
Bronchitis
7%
5%
2%
2%
6%
5%
4%
3%
5%
3%
14%
4%
2%
7%
9%
Chronic
Cough
4%
3%
4%
0%
2%
4%
4%
1%
3%
4%
4%
1%
2%
1%
2%
Persistent
Wheeze
4%
3%
2%
4%
3%
2%
5%
0%
3%
6%
3%
5%
1%
1%
2%
Chronic
Phlegm
3%
2%
2%
2%
4%
1%
3%
2%
1%
3%
3%
1%
1%
5%
1%
                                                                28

-------
Table 5. Unadjusted prevalence of selected respiratory conditions by school region and elementary school: 6,825 children in the  4th
and 5th grades of elementary schools in the El Paso Independent School District, El Paso, Texas, January - February, 2001.
                              Ever in Lifetime
Respiratory Symptoms in the Last Year
Elementary
School
District
Region 4
Dr. Green
Johnson
Kohlberg
Lindbergh
Polk
Putnam
Rivera
Roberts
Rosa Guerrero
Western Hills
White
Physician
Allergy
31%
35%
31%
26%
39%
41%
39%
38%
42%
20%
37%
41%
37%
Diagnosis
Asthma
11%
13%
16%
9%
15%
11%
14%
12%
14%
8%
14%
16%
14%
Asthma
8%
9%
7%
8%
9%
9%
7%
10%
13%
6%
11%
13%
9%
Bronchitis
7%
11%
10%
8%
11%
11%
11%
13%
15%
4%
7%
15%
13%
Chronic
Cough
4%
4%
4%
4%
4%
4%
4%
5%
2%
6%
4%
4%
2%
Persistent
Wheeze
4%
5%
4%
5%
5%
5%
7%
8%
5%
3%
3%
7%
6%
Chronic
Phlegm
3%
3%
6%
4%
2%
3%
2%
6%
1%
5%
3%
3%
2%
                                                                29

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Table 6. Adjusted prevalence of selected respiratory conditions by school region and elementary school: 6,825 children in the
4th and 5th grades of elementary schools in the El Paso Independent School District, El Paso, Texas, January - February,
2001.
                             Ever in Lifetime
Respiratory Symptoms in the Last Year
Elementary
School
District
Region 1
Bradley
Burnet
Collins
Crosby
Dowell
Fannin
Lee
Newman
Nixon
Park
Schuster
Stanton
Wainwright
Whitaker
Physician
Allergy
23%
25%
22%
32%
28%
25%
18%
30%
22%
26%
23%
23%
22%
33%
25%
21%
Diagnosis
Asthma
6%
6%
4%
8%
6%
5%
6%
6%
6%
6%
10%
6%
4%
8%
5%
6%
Asthma
4.1%
4.2%
2.7%
4.9%
4.7%
3.1%
3.4%
4.8%
4.9%
5.3%
3.4%
2.5%
3.1%
5.4%
5.5%
4.6%
Bronchitis
2.7%
2.2%
1.5%
1.4%
4.0%
2.1%
1.7%
2.6%
2.3%
1.2%
1.2%
3.4%
0.5%
2.7%
1.5%
3.3%
Chronic
Cough
1.3%
1.0%
0.9%
0.5%
0.7%
1.2%
1.0%
0.9%
1.1%
1.1%
0.6%
1.4%
0.0%
2.1%
0.6%
1.5%
Persistent
Wheeze
1.4%
1.4%
1.4%
0.6%
1.2%
1.5%
0.5%
1.2%
2.3%
0.3%
1.8%
1.7%
1.6%
2.6%
0.6%
0.8%
Chronic
Phlegm
1.2%
1.2%
0.7%
0.7%
1.8%
2.1%
0.5%
0.7%
1.4%
1.3%
0.2%
1.3%
1.8%
2.3%
0.6%
1.1%
                                                                30

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Table 6. Adjusted prevalence of selected respiratory conditions by school region and elementary school: 6,825 children in the
4th and 5th grades of elementary schools in the El Paso Independent School District, El Paso, Texas, January - February,
2001.
                             Ever in Lifetime
Respiratory Symptoms in the Last Year
Elementary
School
District
Region 2
Alta Vista
Bliss
Bonham
Cielo Vista
Clendenin
Coldwell
Crockett
Hawkins
Hillside
Houston
Hughey
Logan
MacArthur
Milam
Rusk
Travis
Physician
Allergy
23%
23%
19%
18%
25%
31%
26%
27%
23%
26%
24%
19%
17%
26%
24%
9%
26%
22%
Diagnosis
Asthma
6%
6%
3%
5%
7%
8%
9%
7%
5%
4%
8%
9%
5%
8%
9%
3%
3%
4%
Asthma
4.1%
4.3%
0.9%
3.5%
2.9%
5.0%
5.5%
5.0%
3.8%
4.8%
5.7%
9.0%
3.0%
5.6%
4.4%
3.2%
3.7%
3.2%
Bronchitis
2.7%
2.9%
2.4%
2.8%
1.8%
4.2%
2. 1%
3.8%
1.4%
1.6%
4.6%
5.0%
3.2%
3.1%
4.2%
1.0%
1.5%
3.3%
Chronic
Cough
1.3%
1.7%
2.8%
2.0%
1.1%
0.5%
3.8%
2.2%
1.3%
0.8%
1.3%
2.1%
1.2%
1.3%
2.0%
0.0%
2.9%
0.0%
Persistent
Wheeze
1.4%
1.7%
1.4%
0.8%
1.0%
1.8%
2.8%
3.3%
1.3%
2.3%
1.3%
2.3%
1.5%
1.9%
0.0%
0.0%
2.6%
1.3%
Chronic
Phlegm
1.2%
1.6%
2.2%
2.0%
1.1%
0.6%
3.4%
3.7%
1.6%
0.0%
1.4%
1.9%
0.2%
0.4%
1.3%
1.2%
2.7%
0.0%
                                                                31

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Table 6. Adjusted prevalence of selected respiratory conditions by school region and elementary school: 6,825 children in the
4th and 5th grades of elementary schools in the El Paso Independent School District, El Paso, Texas, January - February,
2001.
                             Ever in Lifetime
Respiratory Symptoms in the Last Year
Elementary
School
District
Region 3
Alamo
Beall
Burleson
Clardy
Cooley
Douglass
Hart
Lamar
Mesita
Moreno
Roosevelt
Vilas
Zavala
Physician
Allergy
23%
19%
17%
16%
20%
23%
14%
15%
18%
23%
32%
24%
13%
17%
11%
Diagnosis
Asthma
6%
5%
15%
4%
3%
3%
9%
4%
6%
6%
6%
6%
4%
4%
4%
Asthma
4.1%
3.9%
6.7%
1.6%
4.0%
3.1%
4.6%
1.3%
8.7%
3.6%
4.6%
3.2%
3.6%
3.2%
2.7%
Bronchitis
2.7%
2.3%
0.0%
0.6%
2.7%
1.6%
2.1%
2.3%
2.9%
0.8%
4.3%
2.0%
0.9%
3.1%
7.6%
Chronic
Cough
1.3%
1.1%
2.5%
0.0%
0.9%
0.9%
1.6%
0.0%
1.6%
2.1%
1.0%
0.6%
1.2%
0.5%
1.0%
Persistent
Wheeze
1.4%
1.1%
0.9%
2.3%
1.0%
0.8%
2.0%
0.0%
0.9%
2.2%
0.7%
2.2%
0.0%
0.5%
1.6%
Chronic
Phlegm
1.2%
0.9%
0.9%
1.0%
1.5%
0.3%
0.7%
1.7%
0.4%
1.6%
0.2%
0.0%
0.3%
2.9%
0.9%
                                                                32

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Table 6. Adjusted prevalence of selected respiratory conditions by school region and elementary school: 6,825 children in the
4th and 5th grades of elementary schools in the El Paso Independent School District, El Paso, Texas, January - February,
2001.
                             Ever in Lifetime
Respiratory Symptoms in the Last Year
Elementary
School
District
Region 4
Dr. Green
Johnson
Kohlberg
Lindbergh
Polk
Putnam
Rivera
Roberts
Rosa Guerrero
Western Hills
White
Physician Diagnosis
Allergy
23%
24%
20%
19%
25%
28%
24%
33%
26%
14%
27%
28%
23%
Asthma
6%
7%
12%
6%
7%
6%
7%
7%
7%
5%
8%
8%
6%
Asthma
4.1%
4.0%
3
4
3
3
3
5
4
3
5
4
3
.9%
.4%
.6%
.8%
.1%
.2%
.9%
.3%
.1%
.6%
.7%
Bronchitis
2.7%
3.5%
2.9%
4.1%
3.2%
3.4%
3.2%
5.0%
4.3%
2.4%
2.6%
4.2%
4.0%
Chronic
Cough
1.3%
1.3%
i
2
1
1
1
1
0
3
1
1
0
.3%
.0%
.1%
.0%
.0%
.7%
.5%
.1%
.3%
.2%
.7%
Persistent
Wheeze
1.4%
1.5%
1.3%
1.6%
1.4%
1.3%
1.5%
2.9%
1.3%
1.1%
0.9%
1.8%
1.7%
Chronic
Phlegm
1.2%
1.2%
2.1%
1.8%
0.8%
1.0%
0.8%
2.4%
0.2%
2.3%
1.1%
1.0%
0.5%
                                                                 33

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                                  Appendix A
Demographics

    Hispanic

    Non-Hispanic

    Spanish language

    Relation to child

    Maximum education


    No High School

    High School

    Post-High School

    College
    Glossary of Terms




Child is Spanish/Hispanic/Latino

Child is not Spanish/Hispanic/Latino

Spanish language questionnaire was completed and returned

Relationship of the questionnaire respondent to the child

Highest grade or education level completed by the respondent
or other primary adult in the household.

Did not graduate from high school

High School Graduate

Some post-high school education

College graduate
Respiratory Health Outcomes (Illness and Symptoms)

    Lifetime Allergy
    Lifetime Asthma

    Asthma in last year

    Bronchitis

    Chronic Cough

    Persistent Wheeze

    Chronic Phlegm
Diagnosis of allergies by a medical professional ever in
lifetime

Diagnosis of asthma by a medical professional ever in lifetime

Asthma symptoms within the last year

Bronchitis within the last year

Chronic morning cough without a cold in the last year

Persistent wheeze without a cold in the last year

Chronic chest congestion or phlegm without a cold in the last
year
                                          34

-------
Risk Factors

    Parental allergy


    Parental asthma


    Parental lung disease



    El Paso life

    Furry pet

    Gas stove

    Mold problem

    Cigarette smoking in
    the home
                             Appendix A, continued
Diagnosis of allergies or hayfever in either the biological
mother or biological father

Diagnosis of asthma or reactive airways disease in either the
biological mother or biological father

Diagnosis of chronic bronchitis, emphysema, or chronic
obstructive lung disease in either the biological mother or
biological father

Lifetime resident of El Paso

Furry pets in the home (dog, cat, mouse or hamster)

Gas stove used for cooking

Evidence of mold or water damage in the home

One or more person who lives in the child's household smokes
inside the child's home
                                               35

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                                 Appendix B
Exclusions Due to Severe Illness or Missing Critical Information on Questionnaire By
School Region and Elementary School; 7,772 children in the 4th  and 5th  grades of
elementary schools in the El Paso Independent School District, El Paso, Texas, January-
February 2001.
                        Number of Children Excluded
Elementary School
District
Region 1
Bradley
Burnet
Collins
Crosby
Dowell
Fannin
Lee
Newman
Nixon
Park
Schuster
Stanton
Wainwright
Region 2
Alta Vista
Bliss
Bonham
Cielo Vista
Clendenin
Coldwell
Crockett
Hawkins
Hillside
Houston
Hughey
Logan
Mac Arthur
Milam
Rusk
Travis
Severe Illness
274
68
8
4
6
4
2
6
5
10
1
5
1
14
2
66
7
8
O
0
6
O
7
5
6
2
7
1
1
1
O
6
Missing Data
673
167
15
11
7
12
12
15
24
7
16
11
7
16
14
140
17
17
5
0
8
7
12
4
10
7
6
6
6
7
19
9
i Cl VCll I
Excluded
12%
11%
12%
14%
8%
11%
14%
11%
11%
10%
8%
10%
10%
16%
14%
10%
15%
13%
11%
0%
10%
7%
10%
10%
9%
9%
8%
5%
8%
15%
12%
14%
i1 iiiai
Number
6825
1648
152
79
137
115
72
151
201
144
190
133
64
124
86
1659
116
138
55
63
117
121
157
70
139
81
147
118
78
37
141
81
                                        36

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                           Appendix B, continued.
Exclusions Due to Severe Illness or Missing Critical Information on Questionnaire By
School Region and Elementary School; 7,772 children in the 4th and  5th grades of
elementary schools in the El Paso Independent School District, El Paso, Texas, January-
February 2001.
Elementary School
District
Region 3
Alamo
Beall
Burleson
Clardy
Cooley
Douglass
Hart
Lamar
Mesita
Moreno
Roosevelt
Vilas
Z aval a
Region 4
Dr. Green
Johnson
Kohlberg
Lindbergh
Polk
Putnam
Rivera
Roberts
Rosa Guerrero
Western Hills
Whitaker
White
_1_ ^ U111ILS\^1 \S1 ^_/«««J
Severe Illness
274
5
6
5
10
12
4
O
6
6
O
5
3
6
66
5
7
10
8
5
4
5
4
5
6
2
5
IU1 \^BB -L^A\^1UU\^U
Missing Data
673
10
18
17
15
20
17
14
19
6
11
25
11
8
175
11
22
20
17
12
12
11
15
18
12
7
18
Percent
Excluded
12%
17%
14%
14%
12%
15%
15%
11%
14%
7%
14%
13%
11%
13%
10%
10%
14%
8%
10%
7%
11%
11%
8%
10%
14%
6%
10%
Final
Number
6825
1519
57
124
111
164
148
102
117
132
138
74
169
101
82
1999
134
143
295
208
214
120
114
186
174
92
86
174
                                             37

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                                    Appendix C
                                 Analytic Methods
     Epidemiology  is  an  observational
science that relies on the collection of data
on a large numbers of study participants in
order  to  draw meaningful   conclusions
regarding   the  prevalence   of   health
outcomes. As with experimental science, a
baseline,  or  background,  level of  risk
factors must be established so as to be able
to observe real  differences. In the current
analysis, the first step in this process was
to exclude children with  severe  illness.
Also  excluded  were  questionnaires  that
were missing important information about
the child, the child's health status. Simple,
or crude  prevalence  rates of  respiratory
illness  were  then  estimated  for  each
school.  However, these prevalence rates
did not account for  the influence of risk
factors, which  were present in differing
proportions at each school.  To correct for
this, we adjusted the prevalence rates of all
respiratory health outcomes and symptoms
using  a  specialized statistical  technique
known as a fixed-effects logistic regression
model.  This  multivariate model produced
prevalence rates at each school  that were
adjusted for:
   •  the  child's age, sex,  and ethnicity
      (equal proportion of boys and girls
      who are  10 years old  and white
      Hispanics);
   •  the duration of child's residency in
      El  Paso,  TX   (life-time El  Paso
      resident);
   •  the questionnaire language (English-
      speaking household  as reflected in
      the language the questionnaire was
      completed);
   •  the number of primary adults in the
      household (two-parent household);
   •  indoor  cigarette smoking  in the
      home (non-smoking households);
   •  mold/moisture problem in the home
      (no mold problem);
   •  furry pets in the home such as a dog,
      cat, mouse,  hamster or guinea pig
      (no furry pets);
   •  maximum parental  education  level
      (high school graduate);
   •  biological   parents'   history   of
      asthma, allergy or lung disease (no
      parental history  of these ailments);
      and
   •  Gas stove in  the  home (no gas
      stove).

The adjustment of the prevalence for these
risk  factors  allows  for a  more  precise
comparison    of   the  prevalence   of
respiratory   health  outcomes  between
schools.
                                           38

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Acknowledgements
                          El Paso Independent School District
Dr. Gilberto Anzaldua, Superintendent
Hector Martinez, Associate Superintendent, Operations
Linda Holman, Associate Superintendent., Curriculum, Instruction & Assessment
Nicholas Corona, Executive Director, Facilities Maintenance and Construction
Adolfo Rincones, Executive Director, Curriculum, Instruction and Assessment
Luis Villalobos, Executive Director, Communications and Business Partnerships
Robert LaGrone, Evaluator, Research and Evaluation
Judith Hunter, Assistant Director for Health Services
Elementary School Principals
Elementary School Nurses
Fourth and Fifth Grade Schoolteachers
Region Associate Superintendents


              United States Environmental Protection Agency ~  Region 6
Darrin Swartz-Larson, Director, El Paso Border Office
Allyson Siwik, El Paso Border Office
Maria Vasquez, El Paso Border Office
Kuenja Chung, Office of Air
                   Texas Natural Resource Conservation Commission

Archie Clouse, Director, El Paso Office
Victor Valenzuela, El Paso Office


                         Other Individuals and Organizations

Jesus (Chuy) Reynoso, Program Manager, Air Quality Program, El Paso City-County Health and
Environmental District
Rosalba Rojas, Mexican Ministry of Health
Jennifer Slotnick, National Network for Environmental Management Studies Fellowship
Jose Barrios, Hispanic Association of Colleges & Universities National Internship
Cammie Chaumont, National Network for Environmental Management Studies Fellowship
Griselle Ortiz, Hispanic Association of Colleges & Universities National Internship

                             US EPA El Paso Study Team

Debra Walsh, Scott Rhoney, Ed Hudgens, Suzanne McMaster, James Scott, Cara Carty,
Erik Svendsen, and Gina Terrill
Special Thanks to Laurance N. Nickey, MD
                                              39

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                     Quality Assurance/Quality Control

                          El Paso Children's Health Study

                                      Page 1 of2

       The study  "Health Effects of Particulate Matter and Co-Pollutants in Children Living in
El Paso, Texas" was conducted by the Epidemiology and Biomarkers Branch (EBB), Human
Studies Division (HSD), National Health and Environmental Effects Research
Laboratory (NHEERL), Office of Research and Development (ORD), U.S. Environmental
Protection Agency, Research Triangle Park, NC, in compliance with NHEERL QA Guidelines.
This project was conducted in two separate phases: phase 1) questionnaire distribution to all
students in 4th and 5th grades in the El Paso Independent School District, and phase 2) in selected
schools air monitoring was conducted as well as health measurements collected from children
with parental consent. This report describes the preliminary research findings from phase 1 of
this project.
Date of Approval

March 1, 1995



Decembers, 1999
January 11,2000
Item
Multiple Project Assurance issued from the Office for Protection from
Research Risk to the Institutional Review Board of the University of North
Carolina's Committee on the Protection of Rights of Human Subject.

Institutional Review Board Approval received from the University of
North Carolina's Committee on the Protection of Rights of Human
Subjects. This approval included:
       Questionnaire - Spanish and English
•      Selection of schools
•      Parental Informed Consent
•      Student/Subject Assent Form
       Incentatives to class rooms for participation
•      Thank you gifts to students for participation

Recommended Operating Procedure for School-Based Questionnaire
Distribution, Collection, and Processing
•      Contact with the school district
       Informational meetings at the schools
•      Preparation of the questionnaire packets for the classrooms
       Distribution of the questionnaire packets
•      Collecting the questionnaire packets
       Questionnaire handling and storage
•      Statistical portion of each questionnaire to be scanned twice and
       the two electronic versions compared to  ensure accurate scanning

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October 11,2000
 Quality Assurance/Quality Control

      El Paso Children's Health Study

                  Page 2 of2

OMB Information Collection Request  2080-0065
•      Study Protocol and Respondent Burden
•      English Questionnaire
•      Spanish Questionnaire
•      Spirometric Examination
November 13, 2000   Renewal of Institutional Review Board Approval from the University of
                    North Carolina's Committee on the Protection of Rights of Human
                    Subjects.
January 5, 2001
January 5, 2001
March 16, 2001
Approval of Quality Assurance Project Plan entitled "El Paso Children's
Health Study" - Specific quality control activities and data quality
objectives as described in the document included:
•      Accountability of the questionnaires would be 100% or an
       explanation for those missing
•      One percent of the questionnaires will be manually compared to a
       printed version of the scanned data to ensure that the electronic
       version of the data corresponds to the physical record
•      Electronic version of questionnaire data will be reviewed to ensure
       the data is internally consistent and agrees with historical data and
       with scientific knowledge

Approval of Data Management Plan entitled "El Paso Children's Health
Study"
       Completed questionnaires sent to home office for key entry and
       scanning
       Questionnaires scanner using high-speed scanner
•      Verification of scanned data by manually checking one percent

IRP-NHEERL-H-HSD/EBB/LMN/01-001-000 -Health Effects of
Particulate Matter and Co-Pollutants in Children Living in El Paso, Texas
       The Director of Quality Assurance for NHEERL has concluded the conduct of this
project was in compliance with EPA quality requirements.

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