PB82-1C83
Community Health Associated with Arseni" in
Drinking Water in Millard County, Utah
Utah Dept. of Health, Salt Lake City
Prepared for /
Health Effects Research Lab.
Cincinnati, OH
Sep 81
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EPA-600/1-81-064
COMMUNITY HEALTH ASSOCIATED WITH ARSENIC IN
DRINKING HATER IN MILLARD COUNTY, UTAH
by
J. W. Southwlck, A. E. Western, M. M Beck,
T. Whitley, and R. Isaacs
Utah State Department of Health
Division of Environmental Health,
Bureau of Health Statistics, and
State Health Laboratory
150 West North Temple
P.O. Box 2500
Salt Lake City, Jtah 84110
J. Petajan and C. D. Hansen
University of Utah
College of Medicine
Department of Neurology and
Division of Dermatology, LDS Hospital
Grant No. R-8C4 617-01
Project Officer
Daniel G. Greathouse
Field Studies Division
Health Effects Research Laboratory
Cincinnati, Ohio 45268
HEALTH EFFECTS RESEARCH LABORATORY
OFFICE OF RESEARCH AND DEVELOPMENT
U.S. ENVIRONMENTAL PROTECTION AGENCY
CINCINNATI. OHIO 45268
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DISCLAIMER
This report nas been reviewed by the Health Effects Research Laboratory,
U.S. Environmental Protection Agency, and approved for publication. Approval
does not signify that the contents necessarily reflect the views and policies
of the U.S. Environmental Protection Agency, nor does mention of trade names
or commercial products constitute endorsement or recommendation for use.
it
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FOREWORD
The primary mission of the Health Effects Research Laboratory is to
provide the EPA Regulatory Offices with human health assessments for pop-
ulations exposed to environmental contaminants. This information is used
in the Agency's standard setting procedures to ensure that man is pro-
tected from significant adverse health effects.
The objectives of the Investigation reported herein were to assess
the human health implications of consuming drinking water contaminated
with arsenic. The investigation involved comparisons of body burden
levels, physical examination results, and cancer incidence and mortality
rates between a population exposed to 0.18 to 0.21 mg/1 of arsenic in
their drinking water and a comparison population not so exposed. Levels
of arsenic in hair and urine clearly reflect the levels of arsenic in the
drinking water. However, no significant differences were observed between
the health or mortality experiences of the arsenic exposed and comparison
populations.
The results of this study fail to demonstrate significant health
effects associated with exposures to moderate levels of waterborne arsenic.
However, since the study was relatively small (145 exposed and 105 com-
parison participants), these results must be considered as only part of
the evidence necessary for assessing the human health implications of
waterborne arsenic exposure.
James B. Lucas
Acting Director
Health Effects Research Laboratory
ili
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ABST8ACT
This study (evaluates the health effects of arsenic 1n drinking water at
Revels approximately four times the maximum allowed by the National Interim
primary Drinking Water Regulations. Physical examinations of 250 people
Included evaluating dermatologlcal andineurological health, sampling hair and
Urine for arsenic content and testing for anemia. Water consumption estimate)
Were used to estimate arsenic Ingestion.
Study participants came from a homogeneous, stable population with mini-
mum Influence ffan cigarette smo':1ng dye to the predominantly "Mormon" life-
(style of Millard County. Utah where thty resided. The 145 "exposed" partici-
pants came from /t1nckl«y and Peseret wftert drinking water arsenic content ^
averaged 0.18 arid 0.21 mg/1 respectively. A matched control group of 105
participants was selected from neighboring Delta where drinking water arsenic
•veraged 0.02 mg/1.
A clear relationship was shown between the amount of arsenic consumed and
the amount of arsenic present 1n hair and urine samples. Dermatologlcal signs
compatible with arsenic exposure were rare am', when found, were scattered
plngly among both exposed and control participants rather than being clustered
ps multiple signs on Individuals with higher arsenic exposure. Anemia was not
Jfound significantly more often among exposed participants. Nerve conduction
slowing did not correlate significantly with arsenic exposure levels. Typical
Signs and symptoms of arsenic Intoxication were rot found 1n any of the study
participants.
Cancer Incidence and cancer death rates did not suggest an excess of
Icancer 1n the exposed comnunlty. In general, the exposed participants ap-
peared to be as healthy as control participants. No adverse health effects
fcould be confirmed by this study for people exposed to arsenic 1n drinking
water at four times the maximum allowed by current standards.
This report was submitted 1n fulfillment of Grant No. R-804-617-01 by
!the Utah State Department of Health under the sponsorship of the U.S. Environ*
tnental Protection Agency. This report covers a period from Ncwnher 1, 1976
to January 31, 1980, and work was completed as of February 29, 1980.
1v
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CONTENTS
Foreword . 111
Abstract 1v
Acknowledgements vi
Figures v 11
Tables ...... .... viii
1. Introduction 1
2. Methods and Procedures 5
Study design 5
Study subjects 5
Assessment of exposure to environmental arsenic . 13
Assessment of health status 18
Statistical methods 21
3. Results 23
Assessment of exposure to environmental arsenic . 23
Assessment uf health status 28
4. Discussion and Conclusions 49
References 51
Appendices
A. Release form 53
B. Dermatologist's forms and questionnaire 54
C. Neurologist's forms and questionnaire 59
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ACKNOWLEDGMENTS
. The Initial; planning of the study {received considerable support from
pr. Alan 6. Barbour and Dr. Talra Fuku$h1ma of the Disease Control Branch
of the State Division of Health and 1s (gratefully acknowledged.
1 i '
i Many community leaders In West Millard County were Instrumental In
Soliciting excellent community support for this study. Especially heipful
pre Leigh R. Makfleld, Merlin Chrlsterisen and Hlllard Hells Wood of Delta;
Halter Eklns of Hinckley, and 0r1n All tied of Deseret.
To Dr. Kenneth M. Topham and the Mi rd County School District we
fexfend special thanks for making the Dc(lta High School available for
conducting the physical examinations.
A critical review of the findings jof this study by Dr. Joseph L. Lyon
nf the University of Utah Medical Centeir, Department of Family and Community
Medicine, was especially useful 1n improving the presentation of the data and
has sincerely appreciated.
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FIGURES
Number Page
1 Map of West Millard County, Utah, showing the geographic
relationship of the control community (Delta) to the
arsenic exposed communities (Hinckley and Deseret) 7
2 Data card for file of potential participants in the
arsenic study 9
3 Questionnaire to determine eligibility of potential par-
ticipants for the arsenic study 10
4 Water and beverage consumption questionnaire 16
5 Age adjusted cancer incidence for communities of Millard
County, Utah, 1966-1976 (direct method of age adjustment) ... 36
6 Age adjusted cancer death rates in selected Utah cities,
1956-1975 39
7 Age adjusted cerebrovascular death rates in selected Utah
cities, 1956-1975 40
8 Age adjusted cardiovascular death rates in selected Utah
cities, 1956-1975 41
9 Age adjusted arteriosclerosis death rates in selected Utah
cities, 1956-19/5 42
vi i
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TABLES
Number Page
1 Eligible exposed participants (frow Hinckley and Deseret)
showing percent successfully scheduled for physical examina-
tions and the percent actually examined 11
2 Randomly selected control participants (from Delta) showing
percent successfully scheduled for physical examinations
and the percent actually examined 12
3 Age and sex distribution of study participants from control
(Delta) and exposed (Hinckley and Deseret) communities .... 12
4 Number of physical examination participants from each study
community showing number of hair and urine samples received . . 14
5 Percentage of participants who sent in hair samples by age
category, sex, and exposure group 14
6 Arsenic concentration in well water of three study communities . 23
7 Daily sunnier water consumption rates for residents of three
study comunities 24
8 Annual arsenic consumption from drinking water for study
participants from three study communities 25
9 Estimated "total dose" of arsenic from drinking water for
study participants from three study commnities 25
10 Comparison of arsenic in hair of residents of three
communities 26
11 Arsenic levt* in hair compared to estimated annual arsenic
dose 26
!2 Comparison of arsenic in urine of residents of three
communities 27
13 Arsenic levels in urine compared to estimated annual arsenic
dose . 27
14 Specific signs associated with arsenic ingestion as found in
dermatological examinations 28
vi11
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Number Page
15 Four measures of arsenic exposure for the twelve participants
who showed dermatological signs compatible with chronic
arsenic poisoning 29
16 Symptoms recorded by study participants on a "Health
Questionnaire" showing results from the study communities . . 30
17 Nerve conduction velocity values with respect to age,
location and nerves examined 31
18 Study participants judged to have abnormal nerve conduction
(temperature corrected) 32
19 Abnormal nerve conduction velocities (temperature corrected)
by community and age of participants according to nerves
examined 33
20 Neurological and physical findings ..... 34
21 Anemia in study participints from three study conmunities . . 34
22 Characteristics of anemic participants from three communities. 35
23 Age adjusted death rates (per 100,000) for four diseases for
selected Utah Communities, 1956-1975 (indirect method of
age adjustment) 38
24 Age specific death rates (deaths/100,000/year) for Utah and
three Millard County communities, 1956 thru 1975 tor cancer,
cardiovascular disease, cerebrovascular disease, and arterio-
sclerosis, showing numbers of deaths and the average size of
the age groups 43
25 A group analysis comparison of means for health and exposure
indicators in exposed and control communities i 44
26 Chi square test comparing incidence of symptoms in exposed
and control communities 45
27 Health and arsenic exposure indicators used in factor analysis 46
IX
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SECTION 1
INTRODUCTION
BACKGROUND
Arsenic 1s a common mineral widely distributed In the environment. In
various chemical combinations, arsenic 1s notorious primarily for its acute
toxicity (Lisella et al., 1972). Epidemiological evidence has accumulated to
show that arsenic consumed 1n drinking water has been reionsible for specific
signs and symptoms of lllr.ess, and even death (Zaldlver, 1974 and Tseng et al.,
1968). Since 1900. limits or standards have been set to control the amount of
arsenic that can be permitted in food and water (Usella et al., 1372). In
the United States the "Interim Primary Drinking Water Regulations" allcw *
maximum of 0.05 mg. of arsenic per liter of drinking water (Environmental Pro-
tection Agency, 1976). This U.S. Standard 1s uncharged from the U.S. Public
Health Service Standard of 1962.
While several studies suggest that specific signs, symptoms, and medical
problems m«y be associated with too much arsenic in drinking water, they also
show a number of conspicuous disparities in the kinds of signs and symptoms
recorded depending upon where the various episodes were studied.
Tseng, et al., (1968) reported a major episode of waterborne arsenic
poisoning i an area on the southwest coast of Taiwan. The predominant signs,
symptoms, and illnesses reported from this study were hyperpigmentation, kera-
toses, skin cancer, and a circulatory disorder locally known as "blackfoot
disease." The average concentration of arsenic 1n the well waters consumed by
this population was 0.6 mg/Hter. Water frcm the wells was used for more than
45 years. This study showed the prevalence rate of skin cancer to Increase in
direct proportion to the arsenic content of the well water.
In the city of Antofagasta, Chile (Zaldivar, 1974) an investigation was
made Into reported chronic arsenic poisonings. The source of arsenic was the
drinking water supply. The mean concentration of arsenic in this water was
determined to be 0.8 mg/liter. Children (0-15 years of age) were the predomi-
nant patients. Among the signs and symptoms recorded from this population
were weight loss, diarrhea, general debilitation, *norex1a, and scaling of the
skin. Over 80 percent of the affected population had abnormal skin pigmenta-
tion, mar\y had hyperkeratosis of palms and soles. There was a high frequency
of bronchopulmonary disease, especially bronchiectasis. There were also
several cases of Ischemia and myocardial infarction, also mesenteric throm-
bosis.
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Vallee, et al., (1960) reported that polyneuritis and motor-palsies may
be the only manifestations of chronic exposure to arsenic. Heyman, et al.,
(1956) investigated 41 cases of arsenical polyneuropathy. A number of the
cases had more than chronic exposures. For these patients the onset was sud-
den and dramatic. The first signs in those patients with chronic exposure
were weakness, prostration, muscular aching, and personality changes. Cutan-
eous manifestations were recorded after six weeks. Large areas of skin over
the trunk and arms became highly pigmented. Hyperkeratotlc scaling developed
especially over hands and soles. Some of the patients developed white trans-
verse bands on their fingernails (Mee's Lines). The onset of symptoms of
neuropathy wis characterized by the appearance of numbness, tingling, and sen-
sations of "pins and needles" in the feet. Sensory examinations showed a de-
crease in touch, pain, and temperature sensations in their hands, feet, and
lower legs in a symmetrical "stocking-glove" distribution. In more severe
cases other signs and symptoms were recorded.
Tsuchlya (1977) summarized a number of arsenic studies in Japan. He
called attention to abnormal electroniyographlc findings in residents living
near mining and smelting operations where copper and arsenic trloxlde were
produced. Interest has developed in the possible prolongation of nerve con-
duction velocities due to the absorption by the body of certain toxic metallic
1ons.
Mizuta et al.»(1956) and Miyata et al., (1970) [as reported by Tsuchlya
(1972)] studied arsenic poisonings resulting from consumption of contaminated
soy sauce and milk. Anemia was reported as a frequent abnormality exhibited
by the victims.
Arsenic has been associated with diseases of the cardiovascular system
1n a number of epidemiological studies. Early in 1901, Reynolds examined 500
patients suffering from arsenical poisoning. Cardiac and hepatic signs and
symptoms were recognized in approximately 25 percent of the patients. Thir-
teen deaths were attributed to congestive heart failure. Later Borgono and
Greiber (1972) and Zaldivar (1974) reported on dermatological manifestations
and deaths especially omong children. Over 70 percent of the cases were chil-
dren 0 to 15 years of age. Deaths were reported due to thrombosis of mesen-
teric and brain arteries, narrowing of coronary arteries, and/or n\yocardial
Infarction.
An association of arsenic and cancer has also been reported in some of
the studies. Rosset (1958) reported keratoses associated with carcinomas of
the internal organs. Sommers and McManus (1953) reported a study where cancer
of skin and internal organs were associated with arsenical poisoning. How-
ever, conclusive evidence for such a relationship is not available.
Not all studies of people with arsenic exposure from drinking water
showed evidence of health effects. Morton et al., (1976) expressed disap-
pointment to have found no association between drinking water arsenic levels
of approximately 0.100 mg/1 in Lane County, Oregon and skin cancer Incidence.
Dermatologists of that area seldom saw arsenical keratosis or hyperplgmenta-
tion despite their awareness of the widespread potential exposure to arsenic.
Goldsmith et al. (1972) evaluated the health significance of 0.100 to 1.000
2
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ng/1 of arsenic In drinking water In Lassen County, California. They conclud-
ed that although arsenic levels 1n drinking water above 0,05 mg/1 Increased
arsenic levels 1n the hair, they could find no evidence of any specific ill-
ness associated with elevated arsenic levels.
It 1s evident from the literature that cutaneour lesions (hyperplmenta-
tion, keratoses, and some skin cancers) are the more consistent signs of
chronic arsenic exposure. With reference to these studies the National Acad-
emy of Science (Arsenic 1977) observed, "It should be noted that many studies
of populations 'at risk' have failed to evaluate cutaneous changes adequately.
Proper examinations of the skin of people subjected to chronic low-dose arse-
nic exposure have the potential of providing valuable Information related to
dose and duration of exposure necessary to cause changes 1n given populations.
In a word, these benign skin lesions may be regarded as sensitive Indexes of
exposure to an agent that has potentially ser?ous consequences."
Since exposure to arsenic In drinking water has produced such varied re-
sults, continued research and study are necessary in order to more accurately
assess the health impact of arsenic on the residents of a community where the
drinking water contains a level of arsenic that exceeds the maximum permitted
by the National Standards (Fowler, 1977).
Since an adequate animal model for arsenic Intoxication studies has not
been found, there is a need for studies to be performed on populations that
are Inadvertently exposed to arsenic in their drinking water (National Academy
of Science, 1977). The residents of Hinckley and Deseret, (Millard County,
Utah) are among those Inadvertently exposed populations. The Hinckley com-
munity's drinking water supply contains a level of arsenic (mean ¦ 0.180 mg/
liter) approximately four times the maximum limit permitted by the National
Standards. Deseret residents have only private wells which contain arsenic
1n the range of 0.053 to 0.750 mg/1iter. (Only residents of Deseret with
wells exceeding 0.150 mg/1 were Included 1n this study.)
This West Millard County area and its residents provided an excellent
opportunity to study the health effects of drinking water containing concen-
trations of arsenic which exceed the National Standard. The drinking water
in Hinckley and Deseret exceeded the level of arsenic permitted by the Stand-
ard while arsenic 1n the water supply of Delta was well within the limits of
the Standard (mean * 0.019 mg/1). The residents of all three conrnunlties are
part of the same stable, homogenous, predominantly "Mormon" population. The
study of these communities was undertaken 1n 1976 by the Utah State Division
of Health under a grar.t from the United States Environmental Protection
Agency.
OBJECTIVE
The objective of this study was to test the following hypothesis:
A population which consumes drinking water containing levels
of arsenic which exceed National Drinking Water Standards by
approximately four to eight times will show more signs and symptoms
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of chronic arsenic poisoning than a matched control population
which consumes drinking water with minimal arsenic content.
4
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SECTION 2
METHODS AND PROCEDURES
STUDY DESIGN
This study was designed to test the hypothesis and evaluate the health
effects of consuming arsenic in drinking water by the following methods:
1. Assessment of environmental exposure to arsenic.
a. Environmental sampling 1n each community to document arsenic
exposure potential from drinking water and airborne particulates.
b. Estimating drinking water's contribution to arsenic consumption
by obtaining answers to a water consumption questionnaire from each
study participant.
c. Measuring levels of arsenic In hair and urine samples of
participants from each community to show levels of arsenic uptake
from the environment.
2. Assessment of health status.
a. Examining participants for dermatologlcal signs of chronic
arsenic poisoning, such as hyperpigmentatlon, keratoses, vascular
changes, and skin cancers.
b. Determining nerve conduction velocities and performing
neurological examinations on participants.
c. Measuring hematocrits to Identify anemia among participants,
d. Evaluating coronunity death rates and cancer Incidences.
STUDY SUBJECTS
Description of Study Communities
The West Millard County, Utah, area 1s located near the center of a large
desert valley. The land slopes to the southwest; however, the valley is so
large 1t makes the land appear flat. The area is rural with agriculture, the
primary source of livelihood.
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The inhabitants of the area are over 95 percent Caucasian. The early
Mormon settlers of the area were predominantly English with a small number
from Scandinavia. In the 1860s and 1870s, they settled 1n Deseret. As their
numbers Increased, they moved out to form other communities. Including
Hinckley, and later Delta. Many of the families 1n these stable conmun1t1es
are related to each other.
The drinking water supply for the area comes from deep wells. Two com-
munities, Hinckley and Delta, have developed public drinking water systems.
The residents of smaller surrounding communities, such as Deseret, obtain
their drinking water from individual wells located near the family home.
Arsenic content of groundwater in this area tends to increase toward the
southwest (See Figure 1). Delta, the larger of the three study communities
(population = 1610), 1s situated in the northeast of Millard County and Its
drinking water wells contain very little arsenic (less than 0.025 mg/1).
Hinckley (population = 400), which 1s west-southwest of Delta, discovered
arsenic levels of approximately 0.180 mg/1 in water from Its new culinary
well which was completed 1n 1968. Prior to 1968 Hinckley residents consumed
water from private wells. Of the five private wells available for testing in
Hinckley during the study, the average concentration of arsenic was 0.178 mg/1
(range 0.100 - 0.250). Private wells serving families of Deseret (population
- 210) ranged from 0.053 to 0.750 mg/1 with the higher concentrations of
arsenic tending to be found in wells toward the southwest.
Selection of Exposed Participants
Exposed participants were selected from residents of the Hinckley and
Deseret areas where their drinking water was tested and known to contain at
least 0.150 mg/1 of arsenic. Males and females, five years of age or older
and current residents of the arsenic exposed communities for a minimum of five
years, ware selected as exposed participants. The majority of the eligible
participants had lived in their comnunitles most of their lives. All quali-
fied Individuals were Included in the study, except for a few who (because of
apparent antipathy toward government) refused the invitation to participate.
Selection of Control Participants
Control participants were selected from the residents of Delta where the
drinking water supply contains less than 0.025 mg of arsenic per liter of
water. Residents of Delta who had lived part of their lives 1n Hinckley,
Deseret,or surrounding areas where the drinking water contained a level of
arsenic that exceeded the National Standard of 0.05 mg / liter of water were
not selected as control participants.
Control participants were screened for exposure to arsenic through use of
arsenic-containing pesticides or other arsenic-containing chemicals. No con-
trol participants were found to have this type of arsenic exposure.
The age and sex distribution of the control population was made to re-
flect the age and sex distribution of the exposed population (see Tables 1 and
21. Since the eligible control population was larger than the exposed
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Gunnison Bend
Reservoir /"
DELTA
HINCKIEY
OASIS
DESERET
F16. 1. Map of West Millard County, Utah, showing the geographic
relationship of the control coonunlty (Delta) to the
arsenic exposed cowwunltles (Hinckley and Deseret).
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population, control candidates were grouped by age categories and a number
was given to each. Control participants were ther. chosen by random number se-
lection from within age categories.
Recruitment of Participants
After obtaining cooperation of community leaders, public meetings were
held 1n Hinckley and Deseret to explain the need for a study of arsenic health
effects and to solicit support. People attending the meetings voted to
support the study.
A card file (Figure 2) of families living 1n all three study communities
was prepared from various sources Including the telephone directories, school,
and church records.
Participants were recruited by families. Families listed In the carl
file were visited by study representatives and those willing to participate
were recruited Into the study. Information required to determine el1g1b1,1ty
to participate 1n the study was obtained through the administration of a >r1ef
questionnaire entitled "Household Census and Water Survey" (Figure 3). PtofJle
meeting the eligibility criteria outlined above were selected to participate
1n the study.
A few families and Individuals from the exposed conrntun1t1es (33 total
people) were antagonistic toward the study and refused to participate due to
antipathy toward government. We could not determine how many of these 33
people would have met the eligibility criteria had they been willing to parti-
cipate 1n the study. Table 1 shows that of the 223 persons determined to be
eligible for the exposed group, we were successful 1n scheduling 83 percent,
for physical examinations. Although all adults over 30 years old were sched-
uled for physical examinations, we encountered reluctance when we tried to
schedule some young adults and youth. A few persons 1n all age groups failed
to keep their appointments for physical examinations. S1xty-f1ve percent of
the eligible exposed group were actually evaluated by physical examination.
Table 2 shows similar Information for the control group. Of the 226 se-
lected, 69 percent were successfully scheduled for physical examinations. As
with the exposed group, some did not keep their appointments. Forty-six per-
cent of the selected control group were actually evaluated by physical exami-
nation.
Table 3 shows the final distribution of study participants. The match
between control and exposed groups remained quite close. Our concern ror bal-
ance within the study population was directed toward balance between exposure
groups. We wanted the control population to mirror the age and sex distribu-
tion of the exposed population. We attempted to analyze possible Imbalances
1n our study population using a multlway frequency table analysis from BMDP
(Brown, 1979). This analysis for balance showed that the available exposed
population was not perfectly balanced across age categories, but balance was
achieved between exposure groups.
The test showed that there were significantly more (P * .005) total
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HOUSEHOLO CENSUS AND OATA CAM) - ARSENIC STUOV
MHE-HEAO Of HOUSEHOLD PMOW
AOURESS
CITY ZIP COOE
nw
SEX
MU OI
•irth
NO T1
SCSOOL
GRADE
CLASS
MINKINC UATEB-RESIDCNCE
INVO0MTION
Main Source of Mljr'* Drinking
U»»*r
AAAi f Inul Sflnrrs
—k..
Town* I CltlM of Fwlljr lNld«act
(Beginning with friimt)
Town-City Tear
Kaaarka
tt/M/77
FIG. 2. Data card for file of potential participants 1n the arsenic study.
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HOUSEHOLD CENSUS AND HATER USE SURVEY - ARSENIC STUOY 24 28 294
Oat*.
Head of Household.
Address.
fn—intty,
Faarily Census and Residence Date:
Zip Code
of
Fenlly
Sex
Date of
Birth
Have you
Alaays
Lived In
This
Coaunity?
Yes No
II
IF NO Expliia
Residue! 1m
ThiS COMMlt)
.urrent
Nh Yrs
amity
"Total
Nu Yrs
Residence Outside This
Tom or City
«y
¦ Any
History
of
Arsenic
useT
X_l
J-L
J-L
J-L
J-L
J-L
Meter Source Data:
Where does the Tap Mter 1e your hose com froa?
D COMunlty (Public) Supply D Private Hell
O Other
Hon Long Have You Used Mater Fran This Source?
~ Less than One Year
1~~] 1 to S yrs Years
~ S yrs w (tore Years
Additional Information:
FI6. 3. Questionnaire to determine eligibility of potential participants for the arsenic study.
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participants In the age category 13-20. Nonetheless, this characteristic was
not significantly different between exposure groups. That 1s, the control
population mirrored the age (and sex) patterns of ».he exposed population even
though ther* were significantly fewer control participants (° .005). So
significant differences between control and exposured participants were found
for age categories ("P"s ranging from .944 to .103) or sex {¥ - .*04).
Table 1. Eligible exposed participants (from Hinckley and Deseret) showing
percent successfully scheduled for physical examinations and the percent
actually examined.
Age Total number Percent Percent
Group eligible scheduled examined
Male
Female
Male
Female
Male
finale
7-12
24
14
421
43%
42%
43%
13-20
28
27
683
78%
43%
52%
21-30
8
7
88%
86%
63%
57%
31-40
11
14
1003
100%
82%
79%
41-50
12
13
loot
100%
50%
100%
51-60
14
13
1003
100%
79%
100%
61-70
10
11
100%
100%
80%
82%
71+
8
10
100%
100%
75%
80%
Totals
115
108
79%
86%
58%
72%
Grand Total
223
83%
65%
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libit 2. Randor'y selected control participant! {fro* Oelta) showing
percent successfully scheduled for physical examinations and the percent
cUiilly examined.
*9* T>: .il matter Percent Percent
6r»"P selected scheduled exwlned
Kale Fawale Hale Female Walt Feile
7-1*
24
18
25*
22*
25*
11*
!3-20
30
29
57*
621
20t
<5*
21-30
11
9
73*
71*
36*
67*
31-40
14
19
86*
95*
57*
68*
41-50
16
12
loot
92*
44*
58*
51-60
9
13
100*
77*
89*
69*
61-70
9
8
89*
100*
67*
75*
71*
3
2
100S
100*
67*
100*
Totals
116
110
681
71*
41*
53*
Grand Total
226
69*
46*
Table 3. Age and sex distribution of study participants inm control (Delta)
and exposed (Hinckley and Deseret) co*mun1t1es.
ftoes
Control
Exposed
Hale
*
Female
*
Hale
i
Female
*
7-12
6
12.8
2
3.5
10
14 9
6
7.7
13-20
6
12.8
13
22.4
12
1/.9
14
17.9
21-30
4
8.5
6
10.3
5
7.5
4
5.1
31-40
8
17.0
13
22.4
9
13.4
11
14.1
41-50
7
14.9
7
12.1
6
9.0
13
16.7
51-60
8
17.0
9
15.5
11
16.4
13
16.7
61-70
6
12.8
6
10.3
8
11.9
9
11.5
71+
2
4.3
2
3.5
6
9.0
8
10.3
Totals
47
44.8
58
55.2
67
46.2
78
53.8
Grand Total 105 145
12
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ASSESSMENT OF EXPOSURE TO ENVIRONMENTAL ARSENIC
Environmental Sampling for Arsenic
Monthly drinking water samples were obtained from the Hinckley community
drinking water well (May 1976 - May 1977). The purpose was to assess possi-
ble seasonal variation 1n arsenic content of Hinckley water, and to compute
a better averaae arsenic content value. Delta community drinking water was
sampled similarly during the same time >«er1od and tested for arsenic content.
Some months e*ch of the three Delta wells were sampled Individually, while on
other months a mixed sample from the Delta water system was taken.
The families 1n Deseret had no community water system, so Individual
private wells were sampled and tested to evaluate arsenic levels. Prior to
selecting Deseret residents for participation 1n the arsenic study* each po-
tential participant's home drinking water well was sampled and tested for
arsenic content.
An air monitoring station was established near Delta to measure total
suspended particulates on a dally basis for a year (July 1977 - June 1978).
Each week the filter with the heaylest particulate load was set aside for
arsenic content analysis. The purpose was to obtain an estimate of the amount
of airborne arsenic 1n that dry desert region on the chance that airborne
arsenic might confound the study.
Collecting Hair and Urine Samples
Early 1n the study (May, 1977) 119 hair and 153 urine samples were col-
lected from school-age children to document arsenic body-burden differences
between Hinckley and Delta. Bottles for urine and envelopes for hair were
delivered to cooperating families by study representatives. Participants
were Instructed to collect a first morning void of urine and to take hair
samples from hair growing closest to the skin. There was some evidence that
our collection Instructions were not consistently followed. Resulting hair
and urine samples were picked up from families and delivered to the laboratory
for analysis.
Later (August, 1978), as part of the physical examination, 185 hair and
234 urine samples were obtained. Each participant 1n the physical examina-
tion was given a urine sample bottle. Most produced a urine sample at that
time. No attempt was made to account for possible diurnal variation 1n urine
concentrations. A few took the sample bottle home with them, but generally
did not return with a urine sample. Table 4 shows the number of participants
from each study connunlty and the number of urine and hair samples received.
Each participant 1n the physical examination was given a self-addressed,
postage-paid envelope with his name on 1t. Each was Instructed to place a
quantity of hair from their next haircut in the envelope and mail It to the
address on the envelope (the study headquarters). Hair samples began arriv-
ing at the office almost immediately after the physical examination and con-
tinued for several months. Almost 75 percent of the participants sent 1n
hair samples, which was considered an excellent return. Most of the people
13
-------
*teho failed to s^fed hair samples were from the control community. fjMe 5
shows the age and sex distribution of participants who sent In halt -ai^es.
Tablv 4. Number of physical examination participants from each study
tomnunlty showing number of hair and urine samples received.
rnnm,m1f„ Number of Number of samples collect
uomnuruty mrttHmnte Urine Hair
Control (Delta)
105
99
68
Exposed communities
145
135
117
Hinckley
102
95
80
Deseret
43
40
37
-flital
230
234
185
Table 5. Percentage of participants who sent in hair samples by age category,
sex, and exposure group.
Age Category Control Group Exposed Group
Hale
Female
Male
Female
7-12
67%
100%
30%
50%
13-20
33%
62%
83%
64%
21-30
75%
50%
80%
100%
31-40
63%
46%
78%
64%
41-50
57%
86%
83%
85%
51-60
86%
89%
82%
85%
61-70
67%
67%
88%
89%
70*
100%
50%
100%
78%
% of Total
I of Grand Total
64%
65%
66%
85*
77%
81%
14
-------
laboratory Methods for Arsenic Determinations
Analyses for arsenic 1n water, urilne, and hair samples, and on the air
!sample filters were done by the Utah State 01 vision of Health, Bureau of
!Laboratories. The water was analyzed by the automated sodium borohydrate
linethod using a tube furnace.
- After specific gravity iras Tnenurffr TWMcyTurTrie sample, a 25 ml all-
iquot was withdrawn for ashing. The samples were ashed using a mixture of
.nitric, perchloric, and sulphuric ac1d£. The ash was dissolved 1n water,
|diluted, and analyzed with the auto>nated hydride method. Urinary arsenic
levels were not adjusted for specific gravity.
Hair samples were washed with resJdue-free detergent, rinsed thoroughly
;w1th distilled water and dried at room temperature overnight. A portion (0.1
to 1.0 g) was weighed and ashed using a mixture of nitric, perchloric, and
isulphurlc acids. The ash was dissolved In water and diluted to 100 ml. The
jsamples were analyzed using the automated hydride method.
'«• fkifr volume air simples were colltcted on 8 x TO Inch glass fiber fi"It£Pi
¦The filters were cut Into strips 3/4 x 8 Inches which are equal to 1/12 of
ithe entire sample. The strips were heated In 3 N nitric acid for 30 minutes.
jAfter cooling, the solution was decanttd into Phillips beakers. Distilled
iwater was added to the beakers containing the strips and placed 1n the ultra-
¦sonic vibrator to allow the nitric acid trapped 1n filter to diffuse Into the
(water. These washings were added to the first decanted solution. Concen-
trated sulfuric acid was added to the combined solutions. The resulting solu-
tion was evaporated to fumes of sulfuric acid. After cooling, distilled water
was added to dissolve the ash and dilute the material to 25 ml. The resulting
samples were analyzed by the automated borohydrlde method.
In general, the following control procedures were followed for every
20 samples:
1. At least one blank.
2. Four or more standards ranging from 5 to 40 yg/Hter arsenic.
3. At least one "spiked" sample.
4. At least two duplicate samples.
5. Unused glass fiber filters were cut the same way as the high volume
filters and run for controls. (0.3 ug of arsenic average on unused
8"xl0" filters.)
Estimating Arsenic Exposure from Drinking Water
When study participants reported 1*or their physical examination, they
were asked to complete a "Water and Beverage Consumption Questionnaire"
i(£*gure 4). As they filled out the questionnaire an assistant showed him or
ttenIap-eigiLL ounce w*tar glass- and asMri for the various
<
15
-------
REPLICATION QUESTIONNAIRE
MILLARD COUNTY ARSENIC STUDY
UATEP AND BEVERAGE CONSUMPTION QUESTIONNAIRE
24 28 295
Date
Name
Water Consumption
Considering all the sources of your drinking water (Including home, work,
school, etc.); please estimate how many 8 oz. glasses of plain water you
drink In a typical 24 hour day (summer and winter) from each water source.
Sunwer Winter
1.
2.
3.
4.
5.
Hinckley public water supply
Delta public water supply
Private well at hone
Private well other than at home
Location
8 oz. glasses
8 oz. glasses
ft oz. glasses I
8 oz. glasses
Other water sources
Explain
8 oz. glasses
Beverages Consumed
Please estimate how many 8 oz. glasses of the following beverages you c! -ink
1n a typical 24 hour day (summer and winter).
Beverages made with home tap water: Sumner Winter
6. Flavored drinks (Kool Aid, etc.) 8 oz. glasses
7. Fruit Juice from Concentrate 8 oz. glasses
8. Home canned juices 8 oz. glasses
9. Postum, Pero, etc. 8 oz. glasses
10. Coffee or Tea (made at home) 8 oz. glasses
11. Other beverages with home tap water 8 oz. glasses
Explain
FIG. 4. Water and beverage consumption questionnaire.
16
-------
24 28 295
MILLARD COUNTY ARSENIC STUDY-WATER AND BEVERAGE CONSUMPTION QUESTIONNAIRE (Continued)
Beverages r«Qu1rlng no addition of tip water: Suwtr Winter
12.
Carbonated Soft Drinks
8
02.
glasses
13.
Non-Carbonated Soft Drinks
8
oz.
glasses
14.
Coaaarclal Fruit ft Vegetable Juices
8
oz.
glasses
{V-8, Tow to Juice, Pineapple,
•tc.)
15.
Milk
8
02.
glasses
16.
Beer
8
02.
glasses
17.
Mine
8
01.
glasses
18.
Coffee (from restaurant or other
source away from home)
8
OZ.
glasses
19.
Other beverages
8
oz.
glasses
Explain
FIG. 4. Water and beverage consumption questionnaire
(continued).
-------
times of day th^t one might consume water or beverages (such as morning upon.
rFsIng, at noonjfor lunch, etc.). The|quest1onna1re Included places for sum-
mer and winter water consumption, community sources of water, various types
of beverages including those made with!home tap water and those not requiring
addition of taplwater.
^ Consumption of arsenic from well water was estimated from participant
pant^daily we'll water consumption*estimates were tabulated separately for
summer and winter. For the purposes of calculating an annual arsenic dose,
the daily summer consumption estimate was applied to four months (126 days)
while the daily iwinter consumption estimate was applied to eight months (239
days). The total estimated quantity of water consumed during a year (in
liters) was then multiplied by the number of milligrams of arsenic per liter
of the applicable well water, to derive ti.e estimated annual dose of arsenic
from well water (in milligrams). A crijde estimated "Total Dose" was calcu-
lated also based on the annual dose tirjies the number of years each partici-
pant had lived in the community.
assessment w health status
Physical Examination Facility and Routine
Participants in the physical examination were given an appointment during
the week of August 7, 1978. They were scheduled from 10 AM through 9 PM de-
pending on their availability and work schedule.
The physical examinations were conducted in several rooms of the Delta
High School. Typically as participants arrived they were received by study
representatives who helped each of theif fill out several forms Including an
informed consent form, a water and beverage consumption questionnaire, a
health questionnaire, and a patient's personal history questionnaire. (See
Figure 4 and Appendices A, B, and C.)
After completing the forms, the participants were taken to various sta-
tions vor urine samples, hematocrit determinations, neurological examinations,
and dermatological examinations. Upon completion of the physical examination,
each participant's folder of examination papers was checked. The participant
was then given a self-addressed, postage-paid envelope for a hair sample to
toe collected and mailed later.
'DERMATOLOGICAL EXAMINATIONS
Dermatological examinations were carried out on 249 of the 250 individ-
uals who came for physical examinations. Of the individuals examined, 43
;(17.3X) were from Deseret; 101 (40.6%) were from Hinckley; and 105 (42.2X)
Were from Delta.
The examinations were carried out on a blind basis. The dermatologist
had no knowledge of the community in which any individual resided. Body
it*«as examined included face, back, abdomen, arms, legs, hands, and feet. N©
Attempt was, marietta examine the. chest, ithigh* or genital areas unless questill-
able (lesions werie indicated by the study participants. Notations were made or
" la
-------
fthe Individualeye and hair color asjan Indication of the susceptibility toj
jactlnic damage and skin cancer.
Participants were examined for specific signs of arsenic toxicity, in-
cluding palmar «nd plantar (palms and soles) keratoses, diffuse palmar and
plantar hyperkeratoses, and skin tumors 1n non-sun exposed areas. All such
Minors were recorded except for obviously benign lesions such as seborrheic
keratoses ana wins. Any mstoiagicirty^vinfwwTTgnurt caere xnrivrt
previously removed were noted. The location (I.e., sun-exposed vs palmar/
plantar) and frequency of all keratoses and tumors were recorded. Any diffus*
non-sun exposed hyperplgmentatlon was recorded, as were Nee's lines 1n nails.
(Arterial Insufficiency was noted to assess any tendency toward "blackfoot
[disease" described for the Taiwan arsealc episode (Tseng, et al., 1968).
1 ' :
! Following the dermatologlcal examination, the previously completed
j"Health Questionnaire" (Appendix B) was reviewed by the dermatologist with
(the participant to clarify any positive responses and the relative frequency
jof viral or bacterial Infections.
jNftiroloqical -Examinations
! :
| All participants 47 years of age and younger were examined by the neu-
rology team. Otder participants were excluded because neuropathies Incident
to age were expected to be conmon. We focused on younger participants, In
jwhom neuropathy was not generally expected, to see If an excess of neuropathy
Icould be associated with high arsenic Ingestion. In all, 150 participants
(received neurological examinations (Delta 67, Hinckley 53, and Oeseret 30).
lEach participant failed out a "Patient's Personal History" prior to examina-
tion (see Appendix C for copy of forms used with neurological examinations).
¦ All subjects were examined by a neurologist 1n a room separate from that
jused for electrodlagnostic tests. Light touch, pain, and temperature sensa-
tions were tested. An aestheslometer (a modified Von Frey hair device) was
msed to measure thresholds to touch over the dorsum of fingers and toes. A
2 g force was taken as the lowest threshold for touch. A plnwheel was used
over the feet and legs for detection of hypalgesla and sensory level. Cooled
;a1um1num discs and wooden discs (1 cm2) were used for evaluation of tempera-
ture sense 1n hands and feet. The numier of correct responses 1n six trials
was determined. Position sense was evaluated at the great toe. The number of
jcorrect responses out of ten were determined for 10° changes In position.
Vibratory sense was evaluated by application of a 128 Hz tuning fork over the
medial malleolus while the examiner palpated the lateral malleolus, vibratory
sense was rated as normal or decreased in comparison to that of the examiner.
Deep tendon (stretch) reflexes were rated on an 0 to ~~ scale with 2 being
normal, 1 just perceptible, 3+ unsustained clonus and 4+ sustained clonus.
The general appearance of the hands and feet with respect to the degree of
jsweatlng, color, muscle mass, and skin temperature was also recorded.
Vital statistics for each subject, blood pressure (left arm, sitting
position) and a systemic review using i standard. National Board of Internal .
Medicine form were also obtair«d (see Appendix C). Participants wen examined
further 1f the medical history and neurological examination suggested the
-------
•presence of 1nvq|vement of the nervous system.
Electrodlagnostlc studies were performed using a TE-4 electro«\yograph.
AH results were recorded on photographic paper for future reference. Median,
plnar and sural sensory nerves were studied 1n the right limbs.
^ Motor nerves were evaluated by applying a short duration (< 0.2 msec)
pupramaxlwal square wave ptf+se to a end d+steV point tm the nerve
({above the elbow, and at the wrist for median and ulnar nerves; at the knee and
ankle for peroneal nerve) while recording froir a small Intrinsic hand or foot
|miscle. The time to first negative deflection of the evoked muscle action po-
tential was recorded. Distal latency was subtracted from proximal latency and
jthe difference divided Into the dlstande between the two points of stimulation.
Latencies, amplitude and wave form measurements were recorded.
Sensory nerve conduction was evaluated by stimulating median and ulnar
digital nerves while recording the nerve action potential at the wrist. The
Conduction distance was usually 13 cm. The sural nerve was stimulated at the
lateral malleolus and recorded proximaTly 15 cm from the point of stimulation.
Temperatures were recorded by means of a skin (2 mm) thermistor using a
Yellowsprlngs Telethermometer at the base of the first and fourth fingers and
at the lateral malleolus.
Data were recorded on the reporting forms (Appendix C). Means and stan-
dard deviations for conduction velocities were then calculated for each nerve,
geographic location, and age group.
hematocrit Determinations
Blood was drawn by finger prick method. The first drop was discarded and
the subsequent blood collected 1n a hematocrit tube. The tubes were centri-
fuged and the hematocrit readings made.
The criteria used to evaluate anemia was taken from the "Biology Data
Book" (1974). The normal range for females 14 years of age and older is 37 to
47 percent and for males 40 to 54 percent. Single values were given for those
under 14 years orf age. People whose hematocrit readings were below the listed
values or ranges were considered anemic.
Community Death Rates and Cancer Incidences
A retrospective epidemiological study was conducted to examine the pos-
sible association of arsenic consumption with cancer and vascular diseases 1n
the West Millard County communities.
a. Cancer Incidence: Using Tumor* Registry data, age adjusted cancer in-
cidence rates were calculate for Millard County and several communities in
Millard County. All types of cancers were included, including reported skin
Cancers. Skin cancer reporting depended on individual physicians since they
yw>r» not required to report them. All forms of skin cancer could be Included*
¦trot just the types associated with arsqnic. Onty seven percent of all cancers
2ft
-------
County were sktn cancers.
The direct method of age adjustment was used. Age specific Incidence
rates for the standard population (Utah) were not readily available to enablei
use of the indirect Method of age adjustment. An age adjusted Incidence rate:
s also calculated for the residents Of Millard County population. This was ;
for purposes of comparison to Indicate whether county residents were in-'
A in ****
^ p¥fpw mi ivtt? wr
b. Death Kates: Using vital statistic records of the State of Utah, age
djusted rates for cancer and three vascular diseases were calculate for 43 •
omnunlties In t|tah; Including Hinckley, Delta, and Fillmore In Millard County,
hese rates were calculated to make a qomparison for the death rates of the
111 lard County communities un>r study^ All cancer-caused deaths were Included
(In the study.
I ! i
; Since the study communities had small populations and age specific death
rates for Utah were available, the Indirect method of age adjustment was used
In calculating death rates. An average of the 1960 and 1970 census data for
O&Qf the 43 cities was used to calculatede*th rates for the years 1956
through 1976. Since no 1960 census population breakdown data were available
for Hinckley, thp 1960 percentage of age distribution for Millard County was
Applied to the Hinckley population to Estimate a 1960 age distribution for the
Residents of Hinckley. This estimate Was averaged with the 1970 age distribu-
tion data and the resulting figures weHe used to calculate the age adjusted
death rates for Hinckley.
1 ;
| In order to check the method for estimating Hinckley's 1960 age distribu-
tion, the 1970 age distribution was estimated by the same method. The 1970
estimate was compared to actual 1970 consus data. The 1970 estimate had a
Aarger population in the 65 year old arid older age groups than the 1970 census
bata. If the saine bias were introduced because of estimating the 1960 age
distribution, the age adjusted death rajtes for Hinckley would be slightly
power than they Should be.
Statistical methods
Data collected In this study were summarized with various univariate, bi-
Varlate, and multivariate statistics. Data were keypunched on an Entrex 600/40
>nd a computer tape was generated and sent to the State of Utah's main frame
computer, an Itel AS/5. This 4 megabytp computer operates under IBM/s MVS
Operating system software.
The data were analyzed using the statistical software package SAS, sup-
plied by the SAS Institute, Raleigh, North Carolina. Also used was a program
called ECTA based on a procedure by Leo< Goodman, University of Chicago,
Illinois.
, The following procedures were used? 1) analysis of variance, 2) cluster
analysis, 3) correlation analysis, 4) discriminant analysis, 5) factor analy-
sis. 6) chi-square analysis of 2-way contingency tables, 7) log linear analyst!
«f£inult1-way contingency tables, 8) regression analysis (least souares).
-------
analysis of leans and standard deviations using t-tests and F-tests, 10)
canonical correlations analysis, and 11) simple descriptive statistics includ-
ing computer-printer plots (histograms: and scattergrams).
-------
SECTION 3
RESISTS
jftSSESSMENT OF EXPOSURE TO ENVIRONMENTAC ARSENIC
Irsenlc In Drlnk'lng Water
Monthly water samples taken from Hinckley and Delta (May 1976-May 1977)
'showed arsenic concentrations averaging 0.180 mg/1 for Hinckley and 0.019 mg/1
for Delta (see Thble 6).
Table 6. Arsenic concentration In well water of three study communltles.
Comnunlty
Nunfcer of
samples
Mean
Arsenic content
pzn
Range
Oelta*
Hinckley**
Deseret***
23
12
27
0.019
0.180
0.210
0.006 - 0.032
0.150 - 0.220
0.053 - 0.750
*Samples froq Delta's three public wells sometimes Individually and
sometimes as mixed by distribution system.
~~Samples from Hinckley's single public well.
~~~Single samples from 27 private welts In Oeseret.
Deseret well waters averaged higher In arsenic content than did
Hinckley's or Delta's. Families 1n Deseret whose wells tested less than
0.150 mg/1 were not Included In this study. Mean arsenic 1n well water of
deseret participants was 0.270 mg/1.
I :
Arsenic In Ambient Air ¦
Ambient air monitoring (July 1977^June 1978) showed an average of 0.005
kig/M3 for arsenic (Range 0.001 to 0.01! ug/M3). These figures are biased to-
Jjprd overestimating the amount of arserlc 1n ambient air because arsenic
2h
-------
fanaTyses were cfcducted only for the ttyys with greater total suspended par-
'ITculates In amfflent air. Nonetheless^ the amount of arsenic found was
extremely low. We concluded that the imount of arsenic 1n the dry desert
dust that became airborne particulates!was not sufficient to materially bias
iInterpretation of arsenic exposure via;drinking water.
i
Arsenic Exposure Estimates
i Water consumption data from participants 1n the physical examination was
'tabulated for eich community (see Tabl* 7). The consumption patterns were
jslmllar for each community. Individuals with similar work tended to have
islmllar water consumption rates. Highest consumption of water was associated
jw1th farmers and others who worked outfof-doors 1n the area's hot (90°-105°F)
desert environment. A few participants estimated their water consumption at
imore than eight liters per day 1n the Summer.
Compared with "Dally Fluid Intake" as discussed 1n the National Interim
Drinking Water Regulations, (Environmental Protection Agency, 1976), these
^participants reported higher than average fluid Intake levels. This should
ia«t be unexpected given the area's -desert environment. *»
Table 7. Daily summer water consumption rates for residents of three
study communities.
Number
Community
of participants
Mean
Range
Standard deviation
Delta
105
2.7
0.5 - 12.0
1.9
Hinckley
102
2.9
0.3 - 13.0
2.0
Deseret
43
2.4
O
00
1
CO
o
1.4
Estimates of arsenic consumed by each study participant showed a wide
range (see Table 8) within each community depending on the water consumption
(levels of each participant. Nonetheless, the mean arsenic consumption level
iwas lowest 1n Delta (control) and highest 1n Deseret.
i The product of length of time exposed and the estimated arsenic consump-
tion rate was cailculated as "Total Dosa." Table 9 shows "Total Dose" esti-
mates for Delta were substantially below those of Hinckley and Deseret, al-
though some overlap was evident.
Arsenic In Hair
Initial sampling of school-age children and their parents 1n 1977 showed
Hinckley residents averaged more arsenic In hair (0.82 i»g/g) than 1n Delta
residents (0.32 t»g/g).
" ""¦ Sampling 1n 1978 as part of the physical examination showed a similar
^ i N
-------
Table 8. Ainual arsenic consumption from drinking water for study
Dartlcloanu from three study caanunltles.
Number of
participants
Arsenic consumption (mg)
Community
Hei?T
Median
Delta (contml)!
"Exposed"
Hinckley
Deseret
W5
145
102
43
152.4
j135.5
I
1192.5
-4 -T39
12 - 853
12 - 853
14 - 736
TT
119
115
148
Table 9. Estimated "total dose" 0f arsenic from drinking water for
study participants from three study communities.
Number of
"Total arsenic dose""
Range
Comnunlty
Hear.
Ian
Delta (control)
105
716
32
- 8,052
443
"Exposed"
145
4^079
161
- 23,884
2,797
Hinckley
102
4,222
265
- 23,884
2,875
Deseret
j
43
3*743
161
- 14,250
2,419
pattern. Table 10 shows Deseret residents to average somewhat less arsenic
1n hair than Hinckley residents but mofc than Delta residents. These arsenic
1n hair data wert transformed to their Hogs and a Duncan's Multiple Range
test was perfornfed. The results showed that Hinckley and Deseret did not
differ from each other significantly bit both were significantly different
from Delta.
A "t"-test comparing Hinckley and Deseret (exposed) hair arsenic levels
with Delta's (control) showed the difference to be statistically significant
at P ¦ < 0.0001.
When conmunlty of residence was ignored and hair arsenic levels were con*
pared to estimated annual arsenic consumption, a dose-response relationship
was clearly evident. Table 11 shows ttyat those with the lower estimated
annual doses, also had lower hair arseilc levels. The greater the annual dos*
of arsenic the Higher was the arsenic level 1n hair, except 1n the over 300 mf
«£-arsen1c per year category, which wa$ not significantly different from the.. ^
Other categories.
*5
-------
Table 10. Con^arlson of arsenic In hh1r of residents of three communities.
Number of hrsenlc concentration (uq/g)
Conmunlty
samples
Arlthnfctlc Mean
Ranqe Median
;0elta (control)
68
|
01.32
0.10 - 3.10 0.20
"Exposed"
117
1.17
0.10 - 4.70 0.80
Hinckley
80
1.21
0.10 - 4.60 0.90
Deseret
37
1.09
0.10 - 4.70 0.65
Table 11.
Arsenic
level 1n hair compiared to estimated annual arsenic dose.
N
Annual dose
(mq)
Ha4r ars«nic
geometric mean
(uq/q)
Grouping*
5
0 -
9
0.12
A
55
10 -
29
0.21
A
46
30 -
99
0.46
A
69
100 -
299
0.83
B
10
300+
0.47
AB
*Means with the same letter not significantly different at P = .01 (Duncan's
Multiple Range Test).
Arsenic In Urine
Initial sampling of school-age chrtldren and their parents 1n 1977 showed
Hinckley residents averaged more arsenic 1n their urine (0.098 mg/1) than did
Delta residents (0.009 mg/1).
The 1978 physical examination sanpUng of urine showed a similar pattern
but with somewhat higher average concentrations. Part of the reason for the
apparently higher concentrations compared to 1977 was the laboratory's manner
of reporting of extremely low urinary arsenic levels. Part of the time the
laboratory reported the lowest levels as "less than 0.010 mg/l,H but subse-
quently reported the lowest levels as "less than 0.040 mg/1." In analysis of
d4ta these samples were handled as being 0.010 and 0.040 mq/1 respectively
^6
-------
L_ Table 12 sjfews Deseret to have thi highest average arsen1c-1n-ur1ne con:
centratlons. These urinary arsenic data were transformed to logs and tested
with the Duncan's Multiple Range Test.[ The results showed that as with hair
arsenic, Hinckley and Deseret did not differ from each other significantly,
but both were significantly different from Oelta. A "t"-test showed the two
exposed conminltles to have more a.~senjc 1n urine than Delta at the
r» < 0.0001 level of significance.
jTable 12. Comparison of arsenic In uHne of residents of three conminltles.
' Number of ! Arsenic concentration".,
Cownunlty i samples ""Xrltywetlc mean Range Median
CTU
Delta (control) 99 10.048 0.010-0.220 0.040
i ! •
"Exposed" 135 i0.185 0.025 - 0.660 0.158
^trrdrley f 95 *0.175 0.025-0.580 6.>50>-~
Deseret 40 ,0.211 0.030 - 0.660 0.160
Table 13 shows a strong dose-response relationship between estimated
annual dose of arsenic and arsenic 1n urine. The higher the estimated arsenic
dose per year, ihe higher the average tevel of arsenic found 1n urine samples,
Table 13. Arseilc levels 1n urine compared to estimated annual arsenic dose.
N
Annual
(mg)
dose
Urine arsenic
geometric
Dean (mq/1)
Grouping*
10
0 -
9
.034
A
73
1o -
29
.044
A
63
30 -
99
.089
B
76
100 -
299
.152
C
12
300+
.302
0
•Means with the same letter not significantly different at P = 01 (Duncan's
Multiple Range Test).
b
-------
ASSESSMENT OF HEALTH STATUS
ftermatoloqical Findings
Results of the dermatological examination are shown in Table 14. The
finding of signs suggestive of arsenic toxicity was rare, with only 12 of 249
Jjartlcl pants having any signs associated with arsenic ingestion. The fact
jowrt no participant had more -than one jrtgn (i.e. ptymentatton and muttlpte
cancers) suggests that the findings may have been incidental and not related
{to arsenic.
Table 14. Specific signs associated with arsenic ingestion as found 1n
dermatological: examinations.
" - 1 , »
Signs of atretic ingestion
Control
Exposed
Palmar & plantar keratosis
1
2
diffuse palmar or plantar hyperkeratosis
2
5 *'
Tumors (nonsun-exposed)
0
0
Diffuse pigmentation (nonsun-exposed)
0
1
Arterial insufficiency
0
1
Mee's lines in nails
0
0
Total
3
9
Percent
2.86%
6.25%
These twelve participants were not clustered among the more heavily ex-
posed participants, as might be expected 1f high level arsenic exposure were
responsible for the findings (see Table 15). For each indicator of exposure,
;the twelve tended to rail on either side of the mean for their respective
jcommunity. The ages of the twelve averaged 57.5 years (range 26-82). Half o1
the twelve were females, half were males. The signs of arsenic ingestion
given in Tuble 14, were regressed against annual arsenic dose and the log of
annual dose, but no significant associations were found.
The "Health Questionnaire" (Appendix B) used by the dermatologist con-
tained symptoms reported in* the literature for populations exposed to high
levels of arsenic. Table 16 displays the participants' responses. No mean-
ingful differences were seen in the number of individuals experiencing symp-
toms associated with arsenic toxicity fn the exposed communities compared to
the control.
38
-------
[Table 15. Four treasures of arsenic exposure for the twelve participants who
Showed dermatological signs compatible With chronic arsenic poisoning.
participant's
jcomnunl ty
Sign
H*lr
arsenic
tyg/g)
Urinary
arsenic
(mg/1)
"Yearly
Dose"
(mg)
"Total
Dose"
(mg)
Age
1
Delta
t
Palmer & planter
keratosis
0.1
0.025
20
1240
78
Del ta
Diffuse palmer
hyperkeratosis
0.6
0.070
135
6885
54
delta
t
i
Diffuse palmer
hyperkeratosis
0.4
0.050
12
240
59
kfecklay
Diffuse mlW palmer
hyperkeratosis
1.9
0.380
150
3900
26
Hinckley
Diffuse mild plantar
hyperkeratosis
0.6
0.095
12
336
51
Hinckley
Diffuse palmer
hyperkeratosis
3.0
0.420
117
7956
68
Hinckley
Diffuse pigmentation
0.1
0.130
79
4898
62
^1nekley
Arterial insufficiency 1.2
0.060
83
5700
82
(Deseret
Palmer & plantar
keratosis
0.2
0.180
61
4148
72
beseret
Palmer & plantar
keratosis
_
570
14250
73
Deseret
Diffuse plantar
hyperkeratosis
0.4
0.160
604
7248
32
Deseret
Diffuse palmer
hyperkeratosis
0.270
162
810
33
19
-------
¦fable 16. Symptoms recorded by study participants on a "Health Questionnaire'.^
Showing results from the study communltiles.
L- Symptoms
[Control
Exposeo
Fatigue and malaise
17.1*
11.1*
i
hrthrltls
11.4*
9.0*
Sweating of hards & feet
6.7*
5.6*
bacterial infection
3.8*
2.8*
herpes simplex
9.5*
13.9*
Headache
15.2*
15.3*
joTzzlness, trouble with balance
21.0*
13.9*
tough or hoarseness
3.8*
6.9*
Paresthesia
2.9*
4.2*
Extended sun exposure
14.3*
13.2*
Any type of cancer
5.7*
7.6*
Abdominal pain or diarrhea
7.6*
6.3*
Neurological Findings
Nerve conduction data are presented in Table 17 according to age group,
community, and nerve examined. The mean values for conduction velocity for
ar\y given nerve did not vary significantly with respect to age or community.
However, some participants in each conmunlty and age group had below normal
conduction velocities. For sensory nerves, velocities below 37 m/s were con-
sidered abnormal provided nerve temperature was above 30°C.
Sensory nerve conduction was observed to be primarily affected, with the
sural nerve most often Involved. Participants with low foot temperature ex-
plaining the slow conduction were also indicated. In such cases velocities
were corrected according to the factor 1.8 m/s/degree. For example, a sural
velocity of 32 nVs at 28°C could be corrected to 35.6 m/s at 30°C. The cor-
rected velocity remains below normal. Thjs is an estimated value which will
intry somewhat from participant to participant because the nerve temperature
30
-------
Tab1e 17. Nerve conduction velocity* values with respect to age, location and nerves examined.
Comvnlty/Age
Ulnar bo tor
Median motor
Ulnar sensory
Median sensory
Peroneal
Sural
Delta
Ages 7-12
58
11 (N« 2)
61 t
4 (N- 8)
51
i 3 (N- 8)
51
t
6 (N- 8)
53
t
4 (»• 8)
46
i
4 (N- 8)
Ages 13-20
66
~
9 (N- 9)
66 *
10 (N-19)
50
t 5 (N«18)
50
~
4 (N-19)
53
~
5 (N-19)
42
t
3 (N-19)
Ages 21-30
65
t
7 (N- 4)
62 t
4 (N-10)
49
i 4 (N» 7)
45
~
4 (N-10)
51
t
5 (N-10)
39
t
3 (N-10)
Ages 31-40
63
~
4 (N- 4)
63 ±
4 (N-21)
51
t 5 (N-17)
47
t
5 (N*21)
52
~
4 (N-21)
43
t
3 (N>20)
Ages 41-47
60
~
9 (N- 4)
57 ~
6 (H- 9)
45
i 7 (N- 8)
46
~
8 (N- 9)
54
~
6 (V 9)
44
~
4 (»¦ 8)
Hinckley
Ages 7-12
67
~
3 (N- 3)
59 t
7 (H- 6)
52
i 6 (N« 5)
48
~
4 (N- 6)
55
1
6 (N- 6)
45
t
5 (N- 5)
Ages 13-20
65
~
11 (N-10)
59 i
7 (N-20)
47
t 7 (N*16)
48
~
7 (N-20)
54
~
11 (N-20)
43
t
4 (N-19)
Ages 21-30
67
t
1 (»' 2)
64 t
3 (N- 4)
46
i 8 (N« 4)
50
~
7 (N- 4)
52
1
7 (N- 4)
42
+
7 (N- 4)
Ages 31-40
62
~
6 (N- 2)
63 i
4 (N'13)
48
i 5 (N-10)
46
1
6 (N-13)
47
1
6 (N-13)
42
~
3 (N-13)
Ages 41-47
6?
1
2 (N- 3)
60 ~
4 (N» 9)
48
i 7 (N» 5)
44
t
7 (N- 9)
49
~
7 (N- 8)
42
+
6 (N- 8)
Deseret
Ages 7-1?
64
~
8 (N- 8)
62 ~
8 (N-10)
46
t 9 (N- 9)
47
~
3 (N- 9)
58
~
9 (N-10)
44
1
3 (N-10)
Ages 13-20
52
~
11 (N- 3)
63 t
3 (N» 6)
50
t 9 (N- 6)
47
t
7 (*- 6)
50
1
5 (N- 6)
43
~
6 (N- 6)
Ages 21-30
67
1
2 (N- 2)
67 •
5 (N- 5)
46
* « («* 3)
48
1
6 (N- 5)
58
~
10 (N- 5)
43
~
4 (N- 5)
Ages 31-40
67
~
7 (N- 5)
57 ~
10 (N- 7)
49
*- 3 (N- /)
47
~
11 (»• 7)
53
1
4 (»• 7)
41
t
5 (N- ;)
Ages 41-47
(N- 0)
60 ;
1 (N- 2)
51
t 8 (N- 21
45
~
2 (»¦ 2)
50
t
3 (N- 2)
44
±
4 (»- 2)
~All values In Meters per second
-------
•Varies along 1t^ course depending uponjthe shape of the leg. Taking such
participants Into consideration, six exposed and six controls were found to
have slowing of sural nerve conduction'{Table 18). In Hinckley, five partlci*
pants had other nerves with abnormal conduction, as did three in Deseret and
(two in Delta.
iutfgetf ta have abnormal new conduction
(temperature corrected).
Participant
age range
Number of
participants
Nerve with
abnormal conduction
Communl ty
Delta (controls)
13-20
21-30
31-40
31-40
41-47
2 Sural
3 Sural
1 Sural
1 Median Sensory
1 Median and Ulnar Sensory
8 {= 11.9% of 67 participants)
Hinckley 13-20 1 Ulnar Sensory
13-20 1 Median and Ulnar Sensory
21-30 1 Sural
31-40 1 Sural
31-40 1 Median Sensory
31-40 1 Peroneal
41-47 2 Sural
41-47 _J Median Sensory & Peroneal
9 (= 17.OX of 53 participants)
Deseret
7-12
13-20
31-40
31-40
1
1
1
1
T
Sural
Ulnar Sensory
Sural
Median Sensory
and Median Motor
13.3% of 30 participants)
Exposed (Hinckley and Deseret)
13 (=» 15.756 of 83 participants)
The data can be viewed from the standpoint of number of nerves with abnormal
conduction. More nerves were involved In exposed participants; median motor
and peroneal nerves in addition to the median sensory, ulnar sensory, and
sural which were also seen 1n control participants (Table 19).
- — Participants with nerve conduction slowing were found in all three
¦frtwmujnities- The number of participants involved was small but the data
-------
Hhrilcate a sltgJjfly increased proportion of participants with slowing of
wrve conduction anong the exposed participants. Actual nerve conduction
velocities were regressed against annual arsenic dose and the log of annua
¦fose, but no significant associations «|ere found.
^•ble 19. Abnormal nerve conduction velocities (temperature corrected) by
Tfowwnlty and agp of participants according to nerves examined.
lonmui
Age
range
Nerved with abnormal
Median Median
conduction-
Ulnar
nlty
TurTT
Peroneal
Delta 7-12
0
: 0
0
0
0
13-20
2*
! 0
0
0
0
21-30
3
0
0
0
0
31-40
1
0
1
0
0
41-47
0
; o
1
1
0
IflJlaT Del fa (control J
6/55-9.2*
; o*
2/57-3.0*
1/58*1.7*
0*
Hinckley 7-12
0
0
0
0
0
13-20
0
0
1
2
0
21-30
1*
0
0
0
0
31-40
1
0
1
0
1
41-47
2
0
1
0
1
total Hinckley
4/49-8.2*
0*
3/52-5.8*
2/40-5.0*
2/51-
¦3.91
Peseret 7-12
0
0
0
1
0
13-20
1
0
0
0
0
21-30
0
0
0
0
0
31-40
1
i
1
0
0
41-47
0
0
0
0
0
iTotal Deseret
2/30-6.7*
1/30-3.3* 1/29-3.4*
1/27-3.7*
0*
jrotal Exposed
6/79-7.6*
N
CVI
GO
.2* 4/81-4.9*
3/67-4.5*
2/81-
2.51
1 (Hinckley and Deseret)
*0ne with nerve temperature less than 30°C.
Neurological and physical findings are summarized 1n Table 20. No trends
Were noted for any particular neurological finding or geographical location,
jln general, typical signs and symptoms of arsenic intoxication were not pre-
sent in any of the participants examined, but slight impairment of sensation
33
-------
*1n the feet was found 1n two oartlclDants of each community.
! liable 20. Neuroloalral iand physical findings.
' j Community
^ Findings r— j HlncETgr Peserelrr
Cold feet '
3
2
0
i
Cramps
I
8
6
2
I
Sweating
0
4
2
Decreased reflextes
3
0
0
pecreased sensation
2
2
2
fcarpal turwel syndrome
0
o
1
hematocrit Findings
Table 21 shpws results of hematocrit testing. The percentage of partici-
pants with anemlp tended to be higher 1ti the exposed conmunltles; however, two
pf the four anenrlcs 1n Deseret came from one family (mother and son, age 7).
Another son of the same family (who at 2 years old, was too young for this
Study) was subsequently found to have anemia also. Two other sons (ages 14
fend 9) were study participants, but did not show anemia.
Table 21. Anemia In study participants from three study conmunltles.
Anemia
, Communlty
Number tested
Number
Percent
i Control (Delta)
100
5
5.0
Exposed
137
10
7.3
Hinckley
95
6
6.3
Deseret
42
4
9.5
If a fanrilfal tendency toward anemia existed 1n this Deseret family, the
34_
-------
percentage of arfcmla for Deseret could jbe somewhat biased toward the high s1
-------
350
300
25C
?o:
1ST
133
5' -
e
£
_ ?
ntu
FIG. 5. Age adjusted cancer Incidence for communities of Millard
County, Utah, 1966-1976 (direct method of age adjustment).
36
-------
*f cancer (196641976) than did Delta. (The highest Incidence was found foi
jFTllmore, the Mallard County seat fooMlatlon 1,411).
[Cowmnlty Death 'Rates
Table 23 shows age adjusted deathjrates (Indirect adjustment method) for
Jcancer, cerebrovascular, cardlovasculai, and arteriosclerosis for 43 Utah cow*
nuniLies iui un jinii inciifSi rTyim w " y snuw y>BpTi>lbtTjr uic icisuui
jshlp of the various community death ra^es to each other.
I
Canceit—Compared to 42 other-Utah comnunltles (see Figure 6),
Hinckley had the highest cancer death rate (138 per 100,000). Delta's cancer
death rate was among the higher of theie Utah comnunltles. The Hinckley can-
cer deaths were lof specific Interest because of the community's arsenic expo-
sure. For the 31 years (1956-1976) foi which the rate was calculated, 14 can*
jeer deaths were reported for Hinckley.: The types of cancer were the same
|types most frequently reported for Utah: lung, breast, large Intestine, pros-
Itate, stomach, leukemia, kidney, uterui, bone, and connective tissue. There
{was no unusual
-------
Table 23. *)» adjusted death rates (per 100,000} for four dlsNHi for selected Utah
Conwnltles, 1956-1975 (Indirect Method of age adjustment).
CEREBRO-
CARDIO-
ARTER1
COUNTY
CITY
COOE
CANCER
VASCULAR
VASCULAR
SCLERA
beaver
01
BEAVER
01
135
123
274
38
MILFORD
02
123
70
263
25
BO* ELDER
02
BRISHAH CITY
01
80
73
176
21
TREMNTOR
02
85
36
194
16
GARLAND
04
106
80
171
7
CACHE
03
LOGAN
01
73
75
153
12
SMI WIELD
02
95
79
173
19
HYRW
10
87
46
171
11
MELLSVILLE
11
116
76
205
9
CARBON
04
DRAGERTON
01
91
39
138
10
HELPER
02
122
32
258
9
PRICE
03
124
58
233
10
WELLINGTON
05
70
69
206
11
DAVIS
06
BOUNTIFUL
01
105
63
217
14
CLEARFIELD
03
95
127
157
6
LATTON
06
99
55
223
27
GRAND
10
MOAB
01
129
73
214
14
I BOW
11
CEDAR CITV
01
95
68
200
2
PARAMAN
04
71
45
254
14
JUAB
12
NEPHI
01
61
81
196
41
EUREKA
02
130
95
295
24
MILLARD
14
DELTA
01
116
82
170
22
FILLNORE
02
90
82
177
24
HINCKLEY
03
138
54
138
36
SAN JUAN
19
BUNDING
01
106
68
134
8
KWTICILLO
02
64
55
119
37
SANPETE
20
EPHRAIN
01
95
76
218
10
MNTI
02
83
81
187
8
GUNNISON
04
109
46
257
16
NT. PLEASANT
07
84
73
236
17
TOOELE
23
GRANTSVILIE
01
116
48
329
9
TOOELE
02
119
50
251
9
UTAH
25
AMERICAN FORK
01
114
87
187
13
LEX1
02
104
76
216
15
FAYSON
04
113
76
216
28
PLEASANT GROVE
05
73
79
185
26
PROVO
06
54
50
141
11
SPANISH FORK
07
105
80
224
14
SPRINGVILLE
OB
98
78
196
18
WASATCH
26
279
14
HEBER
01
80
79
WASHINGTON
27
173
ST. GE0R6E
01
75
49
17
ENTERPRISE
03
6i
69
115
6
HURRICANE
04
it
•4
210
10
-------
OOOOOOOOOOdOOdO'-OO o oo do
eowmr. cm cooc or commitics
FIG. 6. Age adjusted cancer death rates In selected Utah cities, 1956 - 1975L
V 9
-------
~0 <
30 •
20 1
10 •
00
90
80
70
60 •
50 •
40
30 •
20 •
10 •
0 ¦
Ran* 32.19 - 124.84
Mnh 69.42
Sttndtrd Deviation 19.74
a
5
coukty, cm cooc of cowmiities
adjusted cerebrovascular death rates In selected Utah cities.
-------
320
100
280
260
240
220
200
180
160
140
120
100
«0
60
40
20
0
Nnn
Standard Deviation
114.61 ¦ 329.06
203.91
47.22
38©3Si8o3®2S3SS88S83S8S:=8SSS8SS8S3&833SSSS
coumr*, cm axe or cqmimities
; adjusted cardiovascular death rates 1n selefted Utah cities, IS
-------
Range 2,14 - 41.39
Mean 16.46
Standard Deviation 9.33
45
40
35 ,
£ 30.
8 20.
I
X
3
5
I
| 15-
i io.
ooooooo«-oooooo«-oooooooooooooo<
«-OMONi-NONONNOOOONOMi-ON«-eMNMOMN(
cowin. cm code of tmmiizn
FIG. 9. Age adjusted arteriosclerosis death rates in selected Utah cities, 1956 - 1$75.
-------
Tabl# 24. Age specific dMtli rates (d»itlrt/100,000/yMr) for Utah
and three Klllard County coawnltlM. 1966 thru 197$ for
cancer, cardiovascular d1«*as*, MMtowrticulir disease,
and arteriosclerosis, staring maters of deaths and the
av*rag* slz* of tha age group*.
Caannity
Characteristics
*FT
91 ty
"WW
y
CAHCtt
Stata
Flllaore
Dalta
HI neklay
CARDIOVASCULAR
Stata
Filter*
Dalta
Hinckley
CEREBROVASCULAR
Stat*
FHIaora
Delta
Hinckley
ARTERIOSCLEROSIS
Stata
Flllnora
Delta
Hinckley
m GROUP SIZE
Stat*
Fillbore
Delta
Hinckley
7 (158)
0
0
0
1 (25)
0
0
0
i m)
0
0
0
6 (274)
14 CD
119,004
157
202
40
4 (18)
0.5 (23)
0
0
0
0.07 (3)
0
0
0
1224,417
347
400
108
6 (223)
0
22 (D
0
1 (34)
0
0
0
1 (36)
0
0
0
0.2 (7)
0
0
0
75,607
202
224
57
19 (875)
S 21
0
18 (840)
17 o;
30 (2)
0
149 (4749)
196 (13)
189 (11)
390 (6)
275 (8788)
392
344
325
4 (201)
52
(1651)
0
60
<4i
0
34
(2
0
0
0.5
0
0
0
(21)
13 (406)
227,502
293
330
79
159,613
332
291
77
558
706
986
1053 (8)
2079 (28587)
1638 58
1599 (47)
1316 (10)
797 (10965)
1017 (36)
1088 (32)
789 (6)
202 (2781)
311 11)
272 (8)
395 (3)
68,759
177
147
38
shows the variables considered and thatj the health Indicator Incidences did
0ot differ significantly between exposed ana central conmunltles, thus we were
kinable to reject the null hypothesis.
}
j Fytor Analysis --Twenty-*nine s» ected th and exposure Indi-
cators were subjected to a factor analysis (Sail, 19/9«). Pearson product-
foment correlation co-efficients were ijsed. Five of the indicators were
.transferred to their natural logs because of their non-normal distribution, to
imake them more '"normal." Table 27 shows the 29 indicators.
i
|
! Figure 10 shows 11 factors developed by the factor analysis \using
^'Equamax" rotatibn method). The factors are ranked 1n order of the amount of
i 'Variability explained with the basic Information they contain. Variables
¦within each factor ar* mniroH of the variable's Importance to the
*3
-------
Table 25. A group analysis comparison of Mam for health and exposure
Indicators In exposed and control conminlties.
Variable
t Test
sla. level
Control
number
Control
mean ft std. dev.
Exposed
mean S std. dev.
Exposed
nuftfeer
Urine arsenic
P <.0001*
99
48.U30.7
185.3H24.3**
135
Annual dose
P <.0001*
105
24.2±22.1
152.4±130.8**
145
Total dose
P <.0001*
105
716 ±1112
4079 ±3807**
145
Hair arsenic
P <.0001*
68
.32*.49
1.17 ±1.09**
117
Urine/hair ratio
N.S. (.45)*
66
269±219
448 1581**
111
Aqe
N.S. (.44)
105
38.7*19.3
40.6 ±21.5
145
Years 1n conminlty
N.S. (.«)
105
26.2±15.4
28.0 *17,6
145
Ulnar motor d.1.***
M.S. (.04)
24
2.29±0.31
2.53 10.59**
38
Ulnar motor v.****
N.S. (.88)
23
63.8±8.2
64.1 ±8.5
38
Median motor d.1.
N.S. (.43)
67
2.98±0.46
3.05 *0.55
82
Median Motor v.
N.S. (.13)
67
62.6±6.8
61.0 ±6.5
82
Ulnar sensory d.1.
N.S. (.18)
58
2.63*0.33
2.73±0.45
67
Ulnar sensory v.
N.S. (.06)
58
50.2±5.„
48.H6.6
67
Median sensory v.
U.S. (.30)
67
47,8±5.4
46.8±6.4
81
Peroneal d.1.
N.S. (.88)
67
3.99±0.90
3.97-0.92
81
Peroneal v.
N.S. (.68)
67
52.3±4.6
52.7±8.4**
81
Sural v.
N.S. (.7?)
65
42.5±3.8
42.7±4.4
79
iematocrit
N.S. (.48)
100
43.5±3.6
43.2±3.6
137
* These t-test significance levels were computed using log-transforwed data due to
non-norwality of the variable,
** Indicates the standard deviation is significantly different between groups by
It or less, using untransforwd data.
***d.l. « Distal latency for nerve.
**** v. * Velocity for nerve conduction.
If actor.
The factor that explained the most variability in the data set, "Factor
1," could be called the "exposure factor" as expressed by the interrelation-
ships of estimated annual and total doses of arsenic, by living in exposed or
control communities and by the amount af arsenic found in hair and urine
samples. The significant correlation", among these exposure variables takes on
added importance since none of the health indicators correlated with this
exposure factor.
"Factor 2" could be called the "age factor" since years in community are
jitited to age.
44
-------
Tablf 26. Chi square test Comparing Incidence of symptoms
In exposed and rhntrol communities.
Chi square j Control Exposed
Variable5
sig.
level
i percent S
no.
percent I
"no.
1
Abnormal Dermatology
U.S.
(P-.22)
I "
2.9%
3
6.3%
9
Palmer/Plantar !
Keratosis
N.S.
(P-.76)
1.0%
1
1.4%
2
Diffuse Palmer/Plantar
Hyperkeratosis
N.S.
(P-.46)
1.9$
2
3.5%
5
Any type Cancer;
N.S.
(P=.61)
4.8%
5
3.5%
5
"R&mbness i Tingling
N.S.
(P».8DT
¦ Tl.«%
12
TO.4%
15
Touch & Temperature
Sense
N.S.
(P-.13)
1.0%
1
4.2%
6
Reduced Energy
N.S.
(P=.70)
10.5%
11
9.0%
13
Nerve Conduction
Slowing
N.S.
(P-.51)
11.9%
8
15.7%
13
Anemia
N.S.
(P-.47)
5.0%
5
7.3%
10
Sex * Female
N.S.
(P-.82)
55.2%
58
53.8%
78
"Factor 3" primarily contained a siex/arsen1c-in-ha1r relationship. Women
tended to have less arsenic in their hair than men.
"Factor 4" was a composite factor showing a relationship between sex,
induced energy ljevel, and some neurological measurements. This factor indi-
cated women reported more "reduced energy levels" than men. Women had higher
median sensory, nerve velocity and lower distal latency for the median motor
nerve.
"Factor 5" encompassed correlations between neurological measurements as
did "Factor 10."
i "Factor 6" contained the relationship between sural nerve velocity and
designation of nerve slowing. It Indicated that the lower the sural nerve
JieTocity became, the more likely the neurologist was to judge the Individual-
is
-------
Tjible 27. Health and arsenic exposure Indicators used 1n factor analysis,
Test
Indicator
Units
^General
[Exposure
Dermatologic exam
[Questionnaire
iNeurological exam
Hematocrit
Age
"SWUc ' '
Urine arsenic*
Hair arse.ilc*
Annual dose*;
Years In conrninity
Total dose*
Urine/hair ratio*
Cortmuni ty
Arterial insufficiency
Palmer/plantar keratosis
Diffuse pal mtr/plantar
hyperkeratosis
Hyperpigmentatlon
Any type cancer
Numbness & tingling
Reduced touch & temperature
sense
Reduced energy level
Ulnar motor distal latency
Ulnar motor velocity
Median motor distal latency
Median motor velocity
Ulnar sensory velocity
Median sensory velocity
Peroneal distal latency
Peroneal velocity
Sural velocity
Nerve slowing
Hematocri t
Anemia
years
maTe/femaTe
mg/liter
iig/gram
milligrams
years
mil 11 grams
ratio
exposed/contri
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
yes/no
seconds
meters/second
seconds
meters/second
meters/second
meters/second
seconds
meters/second
meters/second
yes/no
*
yes/no
* Transformed to natural log.
i*
-------
¦MK,H>r I
1. Annual dose
2. Community
-3r Urine arsenic
?7~ToUT^ose"
5. Hair arsenic
factor 4
1. Median sensory velocity
2. Median motor distal latency
3. Reduced energy level
4. Sex
factor f
1. Anemia
2. Hematocrit
3. Hyperplgmentatlon
Factor 10
1. Ulnar motor velocity
2. Median motor velocity
Figure 10. Factors developed by factor analysis ("EquamaxH rotation).
is having nerve slowing. Half of the aerve slowing observed was associated
Hth the sural nerve.
"Factor 7* contained hematocrit, anemia, and hyperplgmentatlon variables
he relationship between anemia and hyperplgmentatlon resulted from the fact
.hat the only person 1n the study with hyperplgmentatlon also had anemia.
"Factor 8" and "Factor 11" dealt with abnormalities of the extremities.
*
47
i-actpr z
Years 1n comnunlty
Age
Factor 3
Ur1ne/ha1r ratio
Hair arsenic
Sax
Fact&r S Factor 6
Peroneal distal latency Sural velocity
Ulnar sensory velocity Nerve slowing
Peroneal velocity
i-actpr 8
Arterial Insufficiency
Redujced touch i temp,
sehse
Factor 9
Diffuse palmer/
planter hyper-
keratosis
Any type cancer
Factor 11
Numbness & tingling
-------
factor 8" Implied that 1f the dermatologist saw arterial Insufficiency 1n_._
the extremities, the participant was aipre likely to have claimed to have had
"reduced sense of touch or temperature* sensations 1n feet or hands." "Factor!
11" simply represented participant claims to have had persistent or unusual
numbness, tingling or sensations of 'pflns and needles' 1n feet or hands.
The relatlbnshlp 1n "Factor 9" 1nid
found diffuse palmer/plantar hyperKe1
to have answered "yes" to the question
Icated that 1f the dermatologist
sratwesr tfiFTffrtrctpjFTrwa^ Tncre TTfceTy
"have you ever had any type cancer?"
All of the: relationships seen In Factors 2 through 11 could occur 1n any
community of people without arsenic ensure. Indeed this factor analysis
Indicated arsenic exposure was Independent of these health Indicators.
Discriminant Analysis
For discriminant analysts, the classification criterion was determined
by a general square distance measure (Goodnight, 1979b). Two groups were
considered: the arsenic exposed participants (Hinckley and Deseret residents)
-¦W control participants (Delta residents). Health problems upon which the*®"
discrimination Was based were: Nerve conduction slowing as determined by the
neurologist (see Table 18), dermatological signs compatible with chronic
arsenic polsonlhg as determined by the dermatologist (see Table 15), and
anemia (see Tables 21 and 22). When there were missing values, observations
were deleted. This meant that only participants under age 48, who received
the neurological examinations, were considered 1n this analysis. There were
141 observations, 79 exposed and 62 controls.
The discriminant analysis misclasslfled 49.6% of the participants. Of
the 79 exposed participants only 15 (19.0%) were classified as exposed based
on the health Indicators. Of the 62 control participants, 6 (9.7%) were
misclasslfled as exposed.
Since almost half (70/141) of the participants were misclasslfled by the
discriminant analysis, the analysis Implies that the health problems were not
sufficiently related to arsenic exposure 1n this study population to permit
discrimination (differentiation) between exposed and control participants.
Canonical Correlation Analysis
In order to avoid any bias from using commun1ty-of-residence as the
definition of exposure to arsenic, a canonical correlation (Goodnight, 1979a)
was performed without using community-pf-residence data. As 1n the discrimi-
nant analysis, nerve conduction slowing, arsen1c-l1ke dermatological signs
and anemia were used as the set of hejailth-problem-1nd1 eating (dependent)
variables. Arsenic levels 1n hair and; urine, estimated annual arsenic dose,
years-1n-commun1ty, and sex were used hs the set of explanatory (Independent)
variables.
No significant canonical correlation was found, Indicating no evidence
ef-a relationship between health problems and arsenic exposure.
-------
SECTION 4
DISCUSSION ANl| CONCLUSIONS
i
This study :had a relatively small'study population, but compensating for
small size (froni a statistical standpoint) was the fact that we were dealing
with a homogenoiis, stable population with minimum Influence from cigarette
smoking due to the predominantly "Mormdn" Hfe-style. Me had a distinct por-
tion of the study population with a significantly higher exposure to arsenic
from drinking water. The study result^ showed consistency and logic within
[themselves. For] example, 1n the facto# analysis, the data were sufficient to
{develop several Internally consistent factors that gave confidence 1n the
jdaicrlptlve abHHty of the data set. * *""*
¦ This study showed a clear relationship between the amount of arsenic con-
sumed 1n drinking water and the amount of arsenic 1n scalp hair (n«185, r-.47,
P«<.0001) and ursine (n-234, r*.70, ^0001)» This relationship was expected
Is 1 nee the IngeHfon of an element obvldusly will result 1n its excretion.
Arsenic levels found In hair and urine isamples were simply considered tools to
evaluate arsenic exposure.
Our stu
-------
younger age groups arid most conmon in people over 70 years of age. Indeed
people seemed to live to "ripe-old" ages in these study communities.
Our hypothesis that arsenic consumption at the levels found 1n Hinckley
and Deseret drinking water would result 1n signs and symptoms of chronic
arsenic poisoning, was not confirmed by this study. Residents of Hinckley
and Deseret appeared to be as healthy as Delta residents. When community of
residence was ignored and health indicators were compared with measures of
arsenic exposure, the participants with higher arsenic exposure did not show
evidence of health problems any more than did participants with lower arsenic
exposure.
After reviewing these data compared to published data, we wondered why
the various episodes ascribed to arsenic exposure differed so much in signs
and symptoms of illness. Assuming arsenic was an indisputable exposure
factor 1n these episodes, what confidence do we have that some other toxic
exposure factor may not have also been present to produce some of the signs
and symptoms unique to the various episodes? For example, why "blackfoot
disease" in Taiwan but not in Chile? Why were children the predominant
patients in Chile? Is 1t possible that factors such as dietary habits or
malnutrition might influence the expression of various signs and symptoms of
arsenic intoxication?
One aspect of these arsenic episodes that has not been adequately
assessed is the species of arsenic present 1p the implicated waters. Since
As+3 is known to be much more toxic than As4*5, the species of arsenic in
water may explain why Hinckley water may not produce toxicity, while arsenic
in water elsewhere might. The species of arsenic in Hinckley water was deter-
mined to be predominantly (86t) As+5 by Dr. Kurt Irgolic of Texas A & M Uni-
versity, College Station, Texas (Personal communication, 13 February 1980).
The present drinking water standards, promulgated in the National Interim
Primary Drinking Water Regulations, has a "Maximum Contaminant Level" of
0.05 mg/1 for arsenic. This standard is based on the assumption that at an
average water Intake of two liters per day, arsenic intake from water would
not exceed 100 yg per day (36.5 rag/year).
In this study, no adverse health effects were found for exposed people
consuming an average of more than 150 mg of arsenic from well water per year.
This indicates the amount of arsenic consumed from water by the exposed popu-
lation of this study was four times (150/36.5 = 4.1) the maximum allowed by
the current standard without evidence of adverse health effects.
50
-------
REFERENCES
' i
Biology Data, Book. 1974. 2nd Ed. [Federation of American Societies
for Experimental Biology Vol. jlll, p. 1850.
Borgono, J. tf. and R. Grelber. 19^2. Epidemiological study of
arsenlclsm 1n the city of Ant^fagasta. Trace substance 1n
Envlrortnental Health-V 1972. jA symposium, C. D. Hemphill,
Ed., University of Missouri, (jolumbla, Missouri, pp. 13-24.
Brown, M. 1979. Multlway Frequency Tables - The Log-Linear Model.
BJttP BJ<*»d1ca1 JComputer 'Progrws P-Series 1979. Univ.
Calif. Press, pp. 297-332.
Brown, M. and J. Benedettl. 1979. 1 Two Frequency Tables - Measures
of Association. In: BMDP B1dmed1ca1 Computer Programs
P-Senie* 1979. Univ. Calif. Ijress. pp. 245-277.
Env1 ronmental Protection Agency. 1976. National Interim Primary
Drinking Water Regulations. U.S. Govt. Printing Office,
Wash. B.C. EPA-570/9-76-003. i 159 pp.
Fowler, B. A. 1977. International Conference on Environmental
Arsenic: An Overview. Env1rc|n. Health Perspectives.
19:239-242.
Goldsmith, M. D., J. Thorn and G. Gentry. 1972. Evaluation of health
Implications of elevated arsenic 1n well water. Water Research 6
1133-11136.
Goodnight, J. H. 1979a. CANCORR Procedure. Pages 139-142. in
SAS Useffc Guide. SAS Institute Inc. Raleigh, N.C.
Goodnight, J!. H. 1979i. DISCRIM Procedure. Pages 183-190. in
SAS User's Guide. SAS Institute Inc. Raleigh, N.C.
Goodnight, J. H. 1979e. T-test Procedure. Pages 425-426. in
SAS User's Guide. SAS Institute Inc. Raleigh, N.C.
Heyman, A., 0. B. Pfelffer, Jr., R. W. Wlllett, and H. M. Taylor.
1956. Peripheral neuropathy caused by arsenical Intoxication.
New England J. of Med. 254(9):401-409.
-------
Llssella, F. , K. R. Long, and H. G. Scott. 1972. Health aspects
of arsenicals in the environment. J. Environ. Health.
34(5):5T1-518.
Mlyata, K., S. Kosho, and T. Nagal. 1970. Clinical observations
on chronic arsenic poisoning. Sakal Iho 88:4 (not seen)
Mlzuta, N., et al. 1956. An outbreak of acute arsenic poisoning
caused by arsenic contaminated soy sauce: a clinical report
of 200 cases. Japan. J. Int. Med. 45:867 (not seen)
Morton, W., G. Starr, D. Pohl, J. Stoner, S. Wagner, and P. Weswlg.
1976. Skin cancer and water arsenic 1n Lane County, Oregon.
Cancer 37:2523-2532.
National Academy of Science. 1977. Medical and biologic effects
of environmental pollutants - Arsenic. National Academy of
Sciences, Washington, D.C. 332 pp.
Reynolds, E. S. 1901. An account of the epidemic outbreak of
arsenical poisoning occurring 1n beer-drinkers in the north
of England and the midland counties 1n 1900. Lancet 1:166-170.
Rosset, M. 1958. Arsenical keratosis associated with carcinomas
of the internal organs. Canadian Med. Assoc. J. 78:416-419.
Sail, J. P. 1979a. FACTOR Procedure. Pages 203-210. in
SAS User's Guide. SAS Institute Inc. Raleigh, N.C.
Sail, J. P. 1979fc, FREQ Procedure. Pages 215-220. in SAS User's
Guide. SAS Institute Inc. Raleigh, N.C.
Sonners, S. C.. R. G. McManas. 1953. Multiple arsenical cancers of
skin and internal organs. Cancer 6:347-359.
Tseng, W. P., M. H. Chu, J. M. Fong, C. S. Lin and S. Yeh. 1968.
Prevalence of skin cancer in an endemic area of chronic
arsenicism 1n Taiwan, J. National Cancer Inst. 40(3):453-463.
Tsuchiya, K. 1977. Various effects of arsenic in Japan depending
on type of exposure. Environ. Health Perspectives, Vol. 19:35-42.
Vallee, B. L., D. D. Ulmer, and W. I. C. Meeker. 1960. Arsenic
toxicology and biochemistry. A.M.A. Arch, of Ind. Health,
21:56/132-75/151.
Zaldivar, R. 1974. Arsenic contamination of drinking water and
foodstuffs causing chronic poisoning. Beitr. Path. Bd. 151:384-400.
52
-------
APPENDIX A
MILLARD COUNTY ARSENIC STUDY
RELEASE
I do hereby authorize Information obtained through physical
examinations and special clinical studies to be released to the
Millard County Arsenic Study conducted by the Bureau of Environmental
Epidemiology of the Utah State Division of Health. I understand
that Information accumulated by this study will not be used in any
way which endangers my right to privacy.
I also request that any Important health problems discovered
through my medical examination be brought to the attention of my
family physician.
M.D.
Physician's Name
Physician's Address
Signed
53
-------
APPENDIX B
24 28 296
MILLARD COUNTY ARSENIC STUD*
HEALTH QUESTIONNAIRE
0»t* , Number
Have you recently had , . . Yes No
1. Any unusual weight loss. Q Q
2. Trouble with your energy level that has made your
dally activities harder.
3. Any swelling of the joints, or swelling or redness
of the hands or feet.
4. Darkening of certain skin areas. Q Q
5. Thickening of skin areas, either scaly masses
or warty forms.
6. Persistent or unusual numbness, tingling, or
sensations of "pins and needles" In feet or hands.
8. Discoloration of urine.
9. Episodes of fainting, sores 1n the mouth, and
awareness of Increased salivation.
10. Any unusual coldness or discoloration of fingers
or tots.
o o
o o
o o
o o
o o
7. Excessive sweating of the hands arid feet. 0 Q
o o
o o
o
Have you ever had . . .
11. History of anemia. Q Q
12. Any unusual colicky abdominal pain, vomiting or diarrhea. Q Q
13. Frequent bolls or other skin Infections. Q Q
14. Any frequent cold sores or fever blisters. o o
15. Severe or frequent headaches. Q Q
16. Feelings of dizziness or trouble with your balance. Q Q
17. Any unexplained cough or hoarseness. Q Q
18. Reduced sense of touch or temperature sensations
11. your feet or hands.
19. Extended exposure to the sun either through sun
bathing or working 1n the sun without your
shirt (4 hours a day for 4 months out of the year).
20. Any type of cancer. Q Q
21. Substantial exposure to pesticides. List most
heavily used; Including any arsenical pesticides:
o o
o o
o o
u
-------
APPENDIX B-l
24 2B 297
OCmftTOLOSIC CHART 1
Mot*:
label with a any lesion
biopsied or referred to
pintle Ian.
Papilloma
Flat plpented nevi
Raised pigmented nevl
Telangiectasia
Keratoses
Area of other noteworthy
lesions should be noted and
labelled.
ic
-------
APPENDIX B-2
OCRmtOLOKIC
REWRKS:
&
-------
APPENDIX B-3 24 28 297
MILLARD COUNTY ARSENIC STUDY
DERMATOLOGIST'S EXAM1 NATION R*M
tote Case Number
Name
6»wwal Appearance
Color of:
Eyes: [ ] Brvwn [ ] Blue [ ] Blue 6reen [ J 6ree«
Hair: [ ] Black [ ] Oark Brawn [ ] Light Brown
[ ] Red [ ] Blond
Skin: Plantation 1n non-sun exposed areas
[ J light Caucasian [ ] Oriental
[ ] Medlta Caucasian [ ] Negro
[ ] Dark Caucasian
Hue: [ ] Pale [ ] Normal [ ] Ruddy
Amount of Scalp hair:
[ ] Normal [ ] Overabundant [ ] Scant
Sfcln Examination
Skin Lesions:
I. Active Keratosis: (Enter niaber of lesions)
Scilp Arms
Head and Neck Dorsal hands
Trunk (back) Palms and Soles
Other
*7
-------
APPENDIX B-4 24 28 297
MILLARD COUNTY ARSENIC STUDY - DERMATOLOGIST'S EXAMINATION FORM (Continued)
Skin Lesions: (continued)
2. Tunors: (Enter number of lesions)
Scalp Anns
Head and Neck Dorsal hands _
Trunk (Buck) Pains and Soles
Other
Probable tuner type: (List)
3. Hyperplgmentatlon: (1 - 4+)
Trunk Extremities
4. Hyperkeratosis: (Palms arte' Soles)
Describe
5. Vascular changes - extremities
Describe
6. Nail changes:
Describe
7. Other abnormalities:
Describe
-2-
58
-------
APPENDIX C
NO.
NAME:
AGE;
DATE:
SEX:
NERVES
ULNAR (MOTOR)
P. LAT.
0. LAT.
it
DISTANCE
VELOCITY
AWDUMTIOfc
P 0
TEMP.
ULNAR (SENSORY)
MEDIAN (MOTOR)
MEDIAN (SENSORY)
PERONEAL
SURAL
SENSORY
TOES
POS.
¥16 (0-4)
AESTH.
PAIN
TEttP.
*
/10
s
cn
/6
FINGERS
/10
,
9
CD
/6
AUTONOMIC
TOES
COLOR
SWEAT
TEMP.
FtKGERS
COMMENTS
RIGHT
LEFT
*0
-------
APPENDIX C-l
PATIENT'S PERSONAL HISTORY
htait No.
CmMmiM
toad: fefarmatfcm ccntM tan «i not ta rvtaaaad nayi
Htm
«yonh*«
• wthcriad w to 4e to.
LsiNnn rM Mtfii
Amtmi
Ckt khi
M.
¦a
Km.
ftMM.
flMM
OttNfMit*
1 lUmH. 1
¦uui ^
1 1
«u
Mull Hm»
R4#m
laaMMi Cm
pMy kani
imU*.
M
r
h«w lo Notify .
. fhnm Nwin .
Out Ull FfcjrtocgJ
FmIji or fteCtfiMg W>)Klw .
FAMILY KBVTOAY
1 1 *"**
> Piriml
HmM
Aflist Dtotfc
Fattei
Mother
•reiNn/Smelt* fOt* Jr*/
M|F
M|F
M I F
M F
H P
H«**>4/»*
%om(V*m0*mt* fOdr **/
M
F
M
F
M
F
M
F
M
t
•Amy mm* mmt* may *r m*4 for «MMr mm op women, p*—r cttk mx fm me* *u+m. S
Do yo« know of aay btoorf t«Uim who has or had: (Grcfe and rtftaUoiuhip)
UMjr 4
PttfONAL MAftfTt (Cteh)
Ym N
Ym N
Ym n
Ym
V«
D* y«M
D»r*»««MN)r
HtR I tot*
D» r* Imi
F*« ~ ClpnO F«f »•» ftM'
MlMriu^iWcWhipH^
I ill ll IP
toy ~ 1 luaii pa
rO im.pm49fO 4«Lf«ri«Q
tor ~ 4 fctnlM p« to* ~
tn
-------
APPENDIX C-2
MKMCATKMt:
Ai* you pmnOy utla| a»y of iht (Cncfel
v«
N*
Ttia«i*atA
v«
?•»
%*** Minm r*
Vm
N»
Vn
Hm
Mmm
Vh
PI*
Mm
v«
M»
Vm»M*
v«
M»
AMliNn
*•
M»
iaiiw—i
Y«
M»
•MfMMlHk
Y«
M»
Vm
PI*
Q>w4^w< M
WrtM ia tfci mm m4 jtmt of my oparaUaw *Mck y«a kM kid
Mm my «Mdi ifn m liwitr
WrtM (n til* an of aiy dimrn jroa hm had «Mdi hhmhJ l«|inlialmi
Moat BBMM«ktch yon kmM (not (tqautnf he^ltaliiation)
-------
APPENDIX C-3
To be ansowred by WOMEN only (Circle)
No
Art you Mdl baring rtpitai
IMfttflly IMSimMl p«ilo4ft*
\m
No
Mate yoo ra
f M Wanting Hi«nn yowi
*k.»'
Mm
No
Do you km
*«y iMiy Ma
i4h>| with your p«tedt'
WkM4
Mm
No
Do yoo fatl 1
ikootoi Mi «n
itM MM yaw gtnad'
Mm
No
Art you mo
on m km ro
• mt tAia tfe* toA contsol piV*
•Wh"
Mm
No
Nwi you tut
t bad • ¦¦can
ww«'
Mm
No
Hm you m
t hot i ductal
ft from Dm Mgpte ot yomt kmil'
•Wn'
Mm
No
Do y«u itfal
•fty Hart tfN c
aactr mi ot iht cami*
ImI mi .
Ho* fMfty diMmi bom dm
Mo» aany thBbirtfu
Ho* Miay pctMlwn
Date of lui p»ro4 _
Any eMfinM o( pnp+*y
To be answered by men and women (CtrcW)
Do yoo (wfn»Hy bat* ami* MkImi1 (If yti.
Do they caoat hmuI mvWi1
Yat
No
Mm
No
Mm
No
Mm
No
Mm
No
Vtt
No
Mm
No
wi»« tba Mwiint
Do ifcty ««r oo mm w4t of tht toad'
Do thry yoo n night from inf4
Do tbty (Mbtei tight hn km#1
Do ihty hurt mow m tto bock ot the hood m4 atd1
Dott Mpinn rtbm Unm*
Y«f No
Hm you *vtr fatatad'
Vm
No
Hih yoo mt M a coowtnuo'
Mm No
Sptlh of diicjntui
Vm
No
Doubfc waaon'
Vtt No
Sptlh of wtafcatia of an arm or lag*
Ym
No
taaim emi*
Vtt No
Ringing hi can4
Yai
No
Vtt No
Ov you fwqwtwtty Pu«t kmAatiMit*
Mm
No
Do you ftipwity km a ant* Mag«t4
Vtt No
L>o you frequently bm tfoublt ewaHowieg^
Mm
No
Do yoo fn^atatfy boat waaata mi
Vo» No
l>o you frequently h*»t boantntn*
vomiting*
Have you ever had thonneti of breath^ (Circle)
Vtt No
Doing your uiuaJ work*'
v«
No
WhKh cawtei yoo io cough,
Vtt No
Climbing a fUghi of uam'>
Mm
No
Acto«pnftio4 by wfcaostng*
Vtt No
WhKh you ai wight*
Mm
No
Ha»t yoo ntr nnnhnri btoo4'
Vtt No
Do you ha«c a cfcronic cough*
Mm
No
Do you rough up *nuch ^otu«'
Hivf you ever had chett pain or tightness in the chest which \
npm
when (Circle)
Vtt No
When e»eiting yourwlf
Mm
No
ftaiinui town tfte arm*
Vtt No
When walking agawni a wind*
Mm
No
Duapptan if you mO
Vtt No
When *dk«ig up a hUP
Vt«
No
Occvn oarty ai reiC
Mm No
After a btavy atal1
Vn
No
Vkm wafting (nt4
Mm No
WHen uptet or tinted*
Vna
No
«>tn walking in coM eoadwt*
Vtt No
Faipital«om
If you hm cfceti |
Y« No
Do you tfeop on more 0u» «m pittow'
Have you recently had pain in Jit stomach wtuch (Circk)
Mm No
Ocvurt 1 - 2 born* aflar • aaeaT
Mm No
It l>rought oo by cstMg fn*4 foo*. gaaiy foo**
V«s No
Awaken* you at algfrO
Mm No
li iikwad by aaUcM madirabom*
Mm No
li i«ki*ad with aift or noting*
r«a No
Occwi «Mi mM| ot tmmo*o*y aftaa'
Mm No
U rebevnd by a homo* ¦anwar
Loea o(
(2
-------
APPENDIX C-4
if you h—« kW i t>»n» tm kumt >«Hi ¦mi *» Mwlt: (On*)
R«fM M«fl
(Ordt)
*• Ti
*• ti
Ml ClIMf
you rtem+y M. (Qfdi)
9« N* Ciwifi m 141 m ^>r
Vm PI*
Vm N* V(MMIW«
Vm N* Fl**iluw*fl
To fct wwirii toy MLW naly Hvm yen rm
im M* Lm «f «Ml KMrttjf* Fa km
Vm K* TmmmIii^m(i4|
Vm K» rinrinp 1mm fmf
V« M* Nnwi (mptw*)*
Vm N« Nm
M:
-------
TECHNICAL REPORT DATA
(Pirate rend Instructions on the reverse before completing)
REP?W-?D0/l-81-064 2 ORD Report
3. RtCIPIlNT-S ACCESSIONNO,
m 108174
TITLE AND SUBTITLE
Community Health Associate^ With Arsenic In Prinkinp,
Jater in Millard County, Utah
S. *£PORT DATE
September 1981
6. PERFORMING ORGANIZATION CODE
AUTHORIS)
[. W. Southwick, A. E. Western, M. M. Beck, J. Whitley,
t. Isaacs
¦. PERFORMING O^SANIZATION REPORT NO.
•ERFORMING ORGANIZATION NAME ANO.ADORE8S
Itah State Department of Health
division of Environmental Health
50 West North Temple
'.0. Box 2500
Salt Lake City, Utah 84110
10. PROGRAM ELEMENT NO.
60C1C
ii. contrIct/grant no.
R804617
. SPONSORING AGENCY NAME AND ADDRESS
lealth Effects Research Laboratory
>ffice of Research and Development
I.S. Environmental Protection Agency
Cincinnati, Ohio 45268
13. TYPE OF REPORT AND PERIOD COVERED
Final ll/l/7h i-« W^WAfl
1«. SPONSORING AGENCY Cosed participants. Nerve conduction slowing did not correlate significantly with
rsenic exposure levels. Typical signs and symptoms of arsenic intoxication were not
ound in any of the study participants.
KEY WORDS AND DOCUMENT ANALYSIS
DESCRIPTORS
b. IHE NTIF IE RS/OPEN ENDED TERMS
c. COSATi l-icld/Croup
ody burden, hair, urine; dermatological
ffects; neurologic effects; arsenic expo-
ure; drinking water; ground water; southei
'tah
Epidemiology
Body Burden
n Human Health Effects
Arsenic
68G
DISTRIBUTION STATEMENT
:elease to public
19 SECURITY CLASS (This Report
nnrlflslif i f
31
20 SECURITY CLASS (Thli page)
22. PRICE
t 22)0*1 (*•». 4-77) previous ioitionhobio.ete
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