POLYCYCLIC AROMATIC HYDROCARBON
EXPOSURE OF CHILDREN IN LOW-INCOME FAMILIES
by
Jane C. Chuang, Patrick J. Callahan, Christopher W. Lyu,
Ying-Liang Chou, and Ronald G. Menton
Battelle Memorial Institute
Columbus, Ohio 43201-2693
Volume II: Appendices A through F
Cooperative Agreement CR822073
Project Officer
Nancy K. Wilson
National Exposure Research Laboratory
U.S. Environmental Protection Agency
Research Triangle Park, NC 27711
NATIONAL EXPOSURE RESEARCH LABORATORY
OFFICE OF RESEARCH AND DEVELOPMENT
U.S. ENVIRONMENTAL PROTECTION AGENCY
RESEARCH TRIANGLE PARK, NORTH CAROLINA 27711
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An opportunity to contribute to an
important study and receive $75!
You may be qualified to participate in an environmental
study and receive $75 for your participation if you have
a child aged 2 to 5 who stay home with an adult dunng
the day and the child is potty-trained, and you live in a
one-story home (can be duplex or one-story apartment).
To find out if you may participate in the study and receive
$75, please call us as soon as possible at (919) 544-3717.
This is a local call if you call from Durham. You may call
the above numbers collect if it's a long distance call to
you.
If you call us, please tell the receptionist that you have
questions about the environmental study. Our office
hours are 9 to 5, Monday through Friday. Thank you.
ABOUT THE STUDY: The U.S. Environmental Protection Agency is working with Battelle Memorial Institute and
Survey Research Associates of Durham on an important environmental study. The purpose of the study is to develop
methods to measure potential environmental pollutant exposure among children and adults living in cities and rural
areas.
(Please Remove This Flyer After August 4, 1995)
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The Environmental Study *** Telephone Screening Form
SRA #: | | | |
Respondent's Name: (first)
(LAST)
Phone No.
No./Street Name
Respondent is: 1 male 2..
FEMALE
INTERVIEWER CODE: 1 ! !
1. How do you heat your home during the winter time?
2. How many people in your household smoke cigarettes, cigars, or a pipe everyday?
NONE 0 (GO TO 4)
1 1
2 2
3 3
4 4
5 5
RF 7 (GO TO 4)
DK 8 (GO TO 4)
3. On average, what is the total number of cigarettes, cigars, or pipesful of tobacco per day that people
smoke in your home?
| | | CIGARETTES PER DAY (1 PACK = 20)
| ] j CIGARS PER DAY
| | | PIPESFUL OF TOBACCO PER DAY
RF 97
DK 98
4. Are there any children aged 2 to 5 living in this household?
YES 1 «"ASK: How many? (GO TO 5)
NO 2 (GO TO EXIT 1)
RF 7 (GO TO EXIT 1)
DK 8 (GO TO EXIT 1)
EXIT l: Thank you for your willingness to answer our questions. However, our study can only
include families with children aged 2 to 5. Thank you very much for your time.
Goodbye.
SCRl MS
PAGE 1
09/19/95 SRA
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The Environmental Study *** Telephone Screening Form
SRA j |
5. (Do the children/Does the child) aged 2 to 5 go to pre-school or daycare during the day or stay home
with an adult during the day?
GO TO PRE-SCHOOL/DAYCARE 1 ^ASK: How may hours per day (do the children/does
STAY HOME WITH AN ADULT 2 the child) go to pre-school/daycare?
OTHER 3 Houra/Day.
RF 7
DK 8
SPECIFY OTHER:
6. (Are the children/Is the child) aged 2 to 5 already potty-trained (stop using diapers)?
YES l
NO 2 ASK: (Are the children/Is the child) in the process of
RF 7 potty training? 1...YES 2...NO
DK 8
7. The next question is regarding the structure of your home. Is your home (a/an)...[read categories]
One-Story House, oi
One-Story Duplex, 02
Two-Story House, 03
Two-Story Duplex, 04
Trailer/Mobile Home, 05
Apartment, or 06
Any Other Type 07
RF 97
DK 98
SPECIFY OTHER:
8. How long have you and your family lived in your current home?
YEARS MONTHS
9. Are you planning to move out of your current home before July 1, 1995?
YES 1
NO 2
RF 7
DK 8
SCR 1.MS
PAGE 2
09/19/95 SRA
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The Environmental Study *** Telephone Screening Form
10. What was your total household income last year?
| i 11 i
I I l>! I.
[IF RESPONDENT IS HESITANT ABOUT REPORTING INCOME, READ THE FOLLOWING:]
Was it ?
Less than $10,000 1
$10,000 to $20,000 2
$21,000 to $30,000 3
$31,000 to $40,000, or 4
More then $40,000 5
RF 7 (GO TO 12)
DK 8 (GO TO 12)
11. How many people (including yourself) were supported by this income?
NO. OF PEOPLE:
12. Are you receiving any public assistance?
YES 1
NO 2
RF 7
DK 8
INTERVIEW NOTE:
INTERVIEWER CODE: | | |
SCRIMS
PAGE 3
09/19/95 SRA
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APPENDIX B. INFORMED CONSENT FORM
THE ENVIRONMENTAL STUDY
CONSENT FORM PAGE 1 OF 3
CONSENT FORM
The Environmental Study
ABOUT TIIE RESEARCH STUDY
The U.S. Environmental Protection Agency is working with Battelle/Survey Research Associates, Inc.
for an environmental study in the city and rural areas. The goal of this study is to develop a method
to measure the amount of potentially hazardous pollutant in the air we breathe, the soil and dust
around our houses, and the food we eat. About four smoker-households will be selected to participate
in this study. To verify this research study, you may contact Dr. Nancy Wilson, U.S. Environmental
Protection Agency, Research Triangle Park, North Carolina 27711, or call (919) 541-4723.
DO I HAVE TO PARTICIPATE?
Participation in this study is totally voluntary. There will be no costs to you to participate in the
study. All reasonable efforts will be made to protect the confidentiality of information obtained from
this study, in keeping with legal requirements. Your name will be removed from the questionnaire
before we process the data. No names will appear on any reports. Participation will not affect any
government benefits you may receive. You may stop at any time or refuse to answer any questions.
If you can participate, you will be helping provide important information about the potentially
hazardous pollutant exposure to young children living in the city and rural areas.
WHAT DO I NEED TO DO TO PARTICIPATE IN THE STUDY?
The study will be conducted in August or September 1995. It will take 2 days to do the study. It
will take 1 to 2 hours each day for us to meet with you and for us to do the study activities. We will
ask you to collect food and urine samples. We will also ask you to complete a child activity diary
and a food diary. Our study staff will show you how to collect the samples and record the diaries. It
will take you 5 to 15 minutes each time to collect food or urine and to record the diaries. You do not
have to change your daily activities for the study. We will schedule an appointment with you at your
convenience.
Your participation is very important to the success of this study. Your household was selected in a
scientific manner. It is very difficult to replace a household which has been selected for this study.
To thank you for your participation, we will pay you $15 one week before the study begins and $60
after we complete the study. You will receive a total of $75 if you complete the study activities with
us. We will also give you a certificate recognizing your contribution after the completion of this
study. The following is a summary of what we plan to do in each day:
* We will visit you at the scheduled time one week before Day-1 of the study and pay you $15.
The $15 is to make up the costs for any extra food for our food samples. We will also put 4
air tracers in your house to measure the air flow. The tracer is only about 1/4 of the size of a
pencil. They don't need to be watched and don't make noise. They don't cause any risk or
danger to your family. It will take about 15 to 20 minutes for this visit.
CONSENTS. £PA * SMK
B-l
July 19, m5
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THE ENVIRONMENTAL STUDY
CONSENT FORM PAGE 2 OF 3
Day-1 Study Activities
a. Two indoor and 2 to 3 outdoor air monitors will be installed. The size of the monitor
is about the size of a small microwave oven. They do not need to be watched. The
noise that the monitors put out is like a small tan. There is no risk or danger to your
family. They will be plugged into an electric outlet in your house. When the
monitors are running, they use very little electricity (it costs about 60 cents a day to
run the monitors). We will put the indoor monitors in a playpen (we will bring the
playpen) and the outdoor monitors in a dog house (we will bring the dog house).
b. We may put a meteorological monitor (MM) outside your house. The MM is about 10
feet tall. The MM is powered by its own battery and doesn't need to be watched.
The MM does not make noise and there is no risk or danger to your family.
c. Two air tracers will be used to measure the air flow in your home. The tracers are
similar to the ones we plan to put in your house about a week before the study begins.
d. You will be asked to answer questions about your home, your family members, your
daily activities, and heaters used in your home.
e. A Child Activity Diary and a Food Diary will be used to record your child's daily
activities and what you and your child eat in a 24-hour monitoring period. We will
tell you when the 24-hour monitoring period begins and show you how to record the
diaries.
f. Food and urine samples for the 24-hour monitoring period will be collected. We will
give you containers and coolers and show you how to do it.
Day-2 Study Activities
a. Some areas in your house will be vacuumed and we will take some soil samples
around your house.
b. The air monitors, air tracers and the meteorological monitor will be removed.
c. We will pick up the Child Activity Diary, Food Diary, food and urine samples, and
the coolers.
d. You will be asked to answer questions about your and your child's daily activities
during the 24-hour monitoring period.
e. We will pay you $60, ask you to sign a receipt, and present you a certificate to thank
you for your participation.
CONSENTS. EPA " SMK
July 19, 1995
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THE ENVIRONMENTAL STUDY
CONSENT FORM PAGE 3 OF 3
INFORMED CONSENT
I certify that I have read this 3-page consent form, or it has been explained to me, and I understand its
contents. I understand that my participation will involve all of the activities described in this consent
form. My signature below means that I have freely agreed to participate in this study and I have
allowed my child to be included in this study. I understand that i may contact Christopher W. Lyu,
Study Manager, at (919) 544-3717 if I have any additional questions about this study. If I believe that
there is any infringement upon my rights, I may contact the Administrator for the Institutional Review
Board, Charlotte Coley, at (919) 544-3717.
Please Print Your Name Please Print the Child's Name
Your Signature Date
Spouse/Partner's Signature Date
(if applicable)
Study Staff's Signature Date
CONSENTS.EPA * SMK
Juiy 19, 1995
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APPENDIX C. PARTICIPANT INFORMATION BOOKLET
THE ENVIRONMENTAL STUDY
Participant Information Sheets
*1. Child Activity Diary
*2. Food Diary for Adult
*3. Food Diary for Child
*4. Instructions for Adult/Child Urine Sample Collection
Thank you for your participation in this important environmental study.
Your assistance in collecting food and urine samples and completing the
Child Activity Diary and Food Diary are very important to the success of
this study. You should have received $15 payment for preparing extra
foods for our sample collection. After the completion of this study, we
will pay you an additional $60 for your participation.
Our research study staff will show you how to complete the participant
information sheets. If you have questions regarding the study or the
participant information sheets, please feel free to call Frances Patterson
or Christopher Lyu at 544-3717 or 408-0541 for assistance. Once again,
thank you for your participation.
C-l
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Ilouschol
Child Activity Diary
Page 1
FROM:
V. 07/06/95
TO:
TIME —>
OUTDOOR ACTIVITIES
TIME --->
INDOOR ACTIVITIES
•
upAiA2a.wQi Please Record Time and Activities. Use this form to help you answer questions in the next page.
-------
IIouscliol
Child Activity Diary
Page 2
FROM:
V. 09/22/95
TO:
HOURS —>
OUTDOOR ACTIVITIES
HOUR —>
INDOOR ACTIVITIES
I. Total hours spent outside the house?
1. Total hours spent inside the house?
2. About how many hours did your child
play on the_grouiid of the front yard?
2. About how many hours did your child sit or
play on the floor inside the house?
Which Room in the House?
3. About how many hours did your child
play on the ground of the back yard?
4. Time Spent In Other Outdoor Activiti
[List other activities]
3. liow many hours of nap time?
Which Room in the House?
4. How many hours of night sleep?
Which Room in the House?
5. Time Spent In Other Indoor Activities:
[List other activities]
Did your.child do any of the following tilings outside the ho
Did your child do any of the following things inside the house?
YES
NO
Please check YES or NO for each questio
YES
NO
Please check YES or NO for each question.
1. Slicking thumb, fingers, or toe?
1. Sucking thumb, fingers, or toe?
2. Eating and playing outside the house?
2. Eating and playing on the floor?
3. Putting toys in the mouth?
3. Putting toys in the mouth?
4. Eating dirt or sand?
4. Washing hands before eating?
5. Walking barefoot in the yard?
5. Washing hands after playing outside?
6. Playing with a cat or dog?
6. Washing hands before going to bed?
7. Digging in the yard?
7. Walking barefoot inside the house?
8. Going somewhere away from home?
8. Playing with a cat or dog?
epaiAia.wQi Please answer the questions the best you can. If you don't know how to do it, our staff will help you.
-------
Household
CHILD
Solid and Liquid Food Diary
From
To
What Did Your Child Eat or Drink?
INSTRUCTIONS
BREAKFAST
LUNCH
DINNER
SNACKS
1.
2.
4.
5.
6.
General Instructions
Collect the same amount of food or liquid
child ate or drank during the 24-hour peri
Record what your child ate or drank on th
form.
Food Collection Instructions
Put the SAME amount of solid foods you
ate into the plastic container with GREE
labels.
Put the SAME amount of liquid foods yo
child drank into the plastic jar with GREE
labels.
Please separate solid foods and liquid foo
If your child eats cereals and milk, please
separate cereals and milk.
Please remove uneatable parts from the fo
samples (such as paper wrap or bones).
If your child eats out or if you order carry
for your child, please buy extra foods.
Close the container and jar tightly and put
them back into the cooler immediately aft
each food sample collection.
DO NOT put your foods into your child's
food container or jar.
l-:PA2A2a.\VQl
22-Sep-95
-------
Household
ADULT
Solid and Liquid Food Diary
From
To
What Did Your Child Eat or Drink?
INSTRUCTIONS
BREAKFAST
LUNCH
DINNER
SNACKS
1.
2.
2.
4.
5.
6.
7.
General Instructions
Collect the same amount of food or liquid
child ate or drank during the 24-hour peri
Record what your child ate or drank on th
form.
Food Collection Instructions
Put the SAME amount of solid foods you
ate into the plastic container with GREE
labels.
Put the SAME amount of liquid foods yo
child drank into the plastic jar with GREE
labels.
Please separate solid foods and liquid foo
If your child eats cereals and milk, please
separate cereals and milk.
Please remove uneatable parts from the fo
samples (such as paper wrap or bones).
If your child eats out or if you order carry
for your child, please buy extra foods.
Close the container and jar tightly and put
them back into the cooler immediately aft
each food sample collection.
DO NOT put your foods into your child's
food container or jar.
EI'A2A2a.\VQl
22-Sep-95
-------
Household:
INSTRUCTIONS FOR URINE SAMPLE COLLECTION
Container
Number
ifiiiaiiiii
^ ^ V;V> - ,
DATE
TIME
1
2 - 3 HOURS AFTER LUNCH
2
2 - 3 HOURS AFTER DINNER OR
BEFORE GO TO BED
3
FIRST TI-irNG IN THE MORNING
AFTER (YOU/THE CHILD) GET UP
4
2 -3 HOURS AFTER BREAKFAST
...../ .*v A.S>.
: s-.*.v--'N*-'••••••.vN;.;.*.*;v.v.,.t->.y.?A\\v.v.vo.vsv>.s\sv\v\s^svxvN\v>.v.VAsv.-;':v;y;vXS-.svX-Xsv.\v!'
The containers with ORANGE labels are for ADUL
The containers with GREEN labels are for CHILD.
Please use the right container for each sample.
DO NOT mix adult urine sample with child sample.
The containers are numbered 1 through 4.
Always close the cap TIGHTLY after each collecti
Sit the container in an upright position in the cooler.
* First check the container's number and label to see if you get the right one for the urine sample collection.
* Use the bonnet to catch the urine at the time of collection. IMMEDIATELY pour the urine into the right container
filling it between the black mark and the red mark.
* CLOSE the cap of the container TIGHTLY and put the container in the Ziploc bag.
* Put the container in an upright position in the cooler immediately after each collection.
* After each collection, the bonnet should be rinsed with clear water only. DO NOT USE any soap or detergent to
clean the bonnet or urine container.
Questions?
If you have questions regarding foods or urine sample collection or about the study, please call
Christopher or Frances at 544-3717 or 544-3718. Thank you for your participation in this important study.
El'AUlUn.WQl
22-Scp-95
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APPENDIX D. HOUSE OBSERVATION SURVEY
The Environmental Study
Pre-Monitoring Questionnaire
House Observation Survey
HOUSEHOLD ID LJ
PRE-Q3.EPA
D-l
-------
THE ENVIRONMENTAL STUDY
HOUSE OBSERVATION SURVEY
TABLE OF CONTENTS
PAGE
INTERVIEW INFORMATION 1
SECTION A - HOUSE INTERIOR
HOUSE FLOOR PLAN 2
SECTION B - HOUSE EXTERIOR
QUESTION B1 3
SECTION C - HOUSE LOCATION & SURROUNDING AREA
QUESTION CI 6
LOCATION & SURROUNDINGS OF THE HOUSE/SKETCH 8
-------
INTERVIEW INFORMATION
HOUSEHOLD ID I 1
i i
RECORD:
SUBRECORD:
VERSION:
i i
INTERVIEWER
ID #
DATE
TIME STARTED
TIME ENDED
RESULTS
ae
INCOMPLETE,
SPECIFY
REASON)
01
AM /'
AM /
MM DD YY
PM
PM
COMPLETE ... 1
INCOMPLETE . 2
02
AM /
AM /
MM DD YY
PM
PM
COMPLETE ... 1
INCOMPLETE . 2
03
AM
! 1 1 Li
AM
MM DD YY
PM
PM
COMPLETE ... 1
INCOMPLETE . 2
I !
04
AM /
AM /
MM DD YY
PM
PM
COMPLETE ... 1
INCOMPLETE . 2
01
02
03
REASONS FOR NONCOMPLETION:
04
PACE 1
03/22/95
-------
A HOUSE FLOOR PLAIN
SECTION A
SKETCH THE INTERIOR OF THE HOUSE AND MARK AREAS SAMPLED WITH AN "X.' USu A COMPASS TO
DETERMINE THE DIRECTIONS OF THE HOUSE AND MARK THE DIRECTIONS ON THIS SKETCH.
PAGE 2
09/22/35
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Bl. TYPE OF LIVING STRUCTURE:
B2. BUILDING MATERIALS - ROOF:
B3. BUILDING MATERIALS - SIDING'
B4. BUILDING FOUNDATION:
B5 IS THERE A FRONT PORCH/
BALCONY''
ONE-STORY HOUSE
ONE-STORY DUPLEX . . .
TWO-STORY HOUSE . . .
TWO-STORY DUPLEX .
TRAILER/MOBILE HOME
APARTMENT
OTHER (SPECIFY)
REFUSED
DK
[SPECIFY OTHER4
METAL
WOOD SHINGLES OR PLYWOOD
ASPHALT SHINGLES
OTHER (SPECIFY)
[SPECIFY:].
VINYL SIDING ONLY
BRICK ONLY
BEADED SIDING
BLOCK
WOOD
BRICK AND VINYL/BEADED SIDING
BLOCK AND VINYL/BEADED SIDING
OTHER (SPECIFY)
[SPECIFY:].
BLOCKS
SLAB
CRAWL SPACE . .
BASEMENT
OTHER (SPECIFY)
[SPECIFY:].
YES
NO
PACK 3
-------
SECTION B
HOUSE EXTERIOR
B6. IS THERE A DECK OR PORCH/ YES 1 ' '
BALCONY IN THE BACK OF THE NO 2
HOUSE'?
B7. IS THERE A CONCRETE (OR PAVED) YES I 1 '
DRIVEWAY? NO 2
[IF NO, SPECIFY J — '
B8. IS THERE A CONCRETE (OR PAVED) YES 1 ' >
WALKWAY FROM THE DRIVEWAY NO 2
TO THE HOUSE?
[IF NO, SPECIFY'-! —— ' '
B9. CONDITION OF EXTERIOR STRUCTURE:
YES NO
a. WELL MAINTAINED 1 2 ' '
b. PEELING PAINT I 2 ' '
c. SIDING IN DISREPAIR I 2 ' >
d. PARTS OF SIDING OR ROOFING LYING IN I 2 f }
YARD
e. GENERALLY DETERIORATED I 2 < >
BIO. DESCRIBE THE .AREA OUTSIDE IN YARD > 50% COVERED WITH LAWN, TREES, ETC. ..1 < '
FRONT OF THE HOUSE (>=MORE YARD > 50% BARE DIRT/MUD 2
THAN): YARD > 50% PAVED 3
OTHER (SPECIFY) 4
( )
(SPECIFY: ] 1—1
311. DESCRIBE THE AREA OUTSIDE IN YARD > 50% COVERED WITH LAWN, TREES, ETC. ..1 ' >
3ACK AND ON THE SIDES OF THE YARD > 50% BARE DIRT/MUD 2
HOUSE (>=MORE THAN): YARD > 50% PAVED 3
OTHER (SPECIFY) 4
(SPECIFY:) —— — ' '
l'ACli -I
99/72/99
-------
SECTION n
HOUSE EXTERIOR
B12. IS THERE ANY ODOR OUTSIDE? IF YES, DESCRIBE IT.
YES NO
a. FRONT OF HOUSE 1 2 < i
b BACK OF HOUSE 1 2 t >
c. SIDE OF HOUSE 1 2 i i
[DESCRIPTION.! L_1 ' '
B13. IS THERE STANDING WATER OR YES 1 < >
ANY DISCHARGE INTO THE YARD? NO 2
(SUCH AS DISCOLORED WATER/
MUD, ETC. FROM INDUSTRIAL,
SEWAGE, OR HOUSEHOLD WASTE)
(IF YES, CAN YOU SEE WHERE ITS COMING FROM:)
— ( )
B14. IS THERE EVIDENCE THAT RUBBISH YES I ' '
BURNING IS DONE ON THE NO 2
PROPERTY?
[IF YES, DESCRIBE^ J ' '
B15. IS GARBAGE DUMPED IN THE YES 1 ' '
YARD'' NO 2
[EF YES, DESCRIBE^ ' '
B16. IS GARBAGE STORED IN YES 1 ' '
CONTAINERS IN THE YARD? NO 2
[IF NO, DESCRIBE WHAT HOW j_ — ' '
B17. ARE THERE ANIMALS LIVING IN YES 1 < 1
THE YARD? NO 2
[IF YES, DESCRIBE.] — ' '
B18. IS THERE ANIMAL FOOD AND/OR YES 1 ' '
DROPPINGS AROUND THE YARD? NO 2
[IF YES, DESCRIBE^ — ' '
I'ACE 5 0f22/iS
-------
SECTION C
HOUSE LOCATION & SURROUNDING AREA
Ci. DISTANCE TO STREET: FRONT OF HOUSE: I I 1 I 't I I I rw
BACK OF HOUSE: Mil FT I 1 I IN ' '
[MOT APPLICABLE=9i>(i OR 96|
LEFT SIDE OF HOUSE: MM FT I 1 1 IN ' '
RIGHT SIDE OF HOUSE: I 1 I I FT LJ I IN ' >
C2. TRAFFIC CONDITIONS AT TIME OF LIGHT (LESS THAN 1 CAR'S MIN) 1 ' 1
OBSERVATION. MODERATE (1-4 CARS/5 MIN) 2
HEAVY (5 CARS OR MORE/5 MIN) 3
[SPECIFY # OF CARS/MINUTE: 1 I—I—1 ' 1
[TIME OF OBSERVATION:] I I I : I I 1 AM/PM ' >
C3. FRONT ENTRANCE OF BUILDING: AT STREET LEVEL 1 ' '
BELOW STREET LEVEL 2
ABOVE STREET LEVEI 3
C4. ARE THERE STAIRS AT THE FRONT YES 1 1 1
ENTRANCE1 NO 2
C5. SURROUNDING AREA: RESIDENTIAL ! ' >
RECREATIONAL 2
COMMERCIAL 3
INDUSTRIAL 4
WOODED 5
MIXED (SPECIFY) 6
[SPECIFY:] —— ' '
l'ACIL 6 09/22/95
-------
SECTION C HOUSE LOCATION & SURROUNDING AREA
C6. HOUSE SURROUNDING AREA:
YES NO
a. CONSTRUCTION SITE 1 2
b. DEMOLITION SITE 1 2
c. VACANT/LITTER/DUMP SITE I 2
d. UNINHABITED BUILDINGS 1 2
e. ADJACENT HOMES IN POOR CONDITION' I 2
f. PUBLIC HOUSING PROJECT I 2
g. FARM OR AGRICULTURAL AREA I 2
h. LAGOON OR DRAINAGE DITCH 1 2
i. POWER LINES 1 2
j. MANUFACTURING FACILITIES 1 2
k. INDUSTRIAL STORAGE FACILITIES 1 2
1. IRRIGATION DITCHES/CANALS 1 2
m. GARBAGE DUMPS 1 2
n. STANDING WATER I 2
o. RAILROAD/RAILROAD STATION 1 2
pace 7
0!>/7r/95
-------
SECTION C
HOUSE LOCATION &. SURROUNDING AREA
LOCATION & SURROUNDINGS OF THE HOUSE
SKETCH THE LOCATION AND SURROUNDINGS OF THE HOUSE. MEASURE THE APPROXIMATE DIMENSIONS OF THE
HOUSE AND THE SIZE OF THE YARD (FRONT AND BACK).
PAGE S
03/22/93
-------
House Location & Surrounding Area ID: FNA4
ImsI
Pathway soil sampling location
Location of the Mel Static:
ig»>. :
W'-ri--;'.
^ North 4-—
liisl
-e-
—15'1" —
pif
ceiling
height
7W
iliiil
front porch
¦
43M0"
mm
WHtfiS
'9 sl«ps
19'10"
I
TPS
/
£5®
5 step
¦¦ street
14*9" to street
House Floor Plan ID: PNA4
|~j"l CATS samplers
Q PFT source lubes
[HD House Dust/HVS3 Sampling Ar
|IM| Indoor Morutoi
OM Outdoor Monitor
Sampling Dates: 2/16-17,'V4
OIvI
NOTE: Wood floor
storage
bedroom U2
~W
bath
kitchen
& dining 121
area
Q>
bedroom#!
HD
#2
ur
living area
HmI
HD
#1
front porch
-doormat
(entryway soil)
-------
House Location & Surrounding Area
ID: PSB4
f:pS Pathway soil sampbiig location
North 4-
-e-
concrete walkway
10 steps
street
14*10" P;
ll§®iltSiI
ceiling height
8!2"
stxeet
} : '.:
House Floor Plan ED: PSB4
HI CATS samplers
PFT source tubes
[HD House Dust/HVS3 Sainpli»g Area
IM Indoor Monitor
QM Outdoor Monitor
Sampling Dates: 2/16-17/94
I
3)
bedroom #2
Tm|T]
living aiea
HD
~w
\b>
bedroomtfl
closft
0
"1.
bath
kitchen
JL
OM
-------
House Location & Surrounding Area
ID: SNA4
i£pS' Pathway soil sampling bcation
Location of the Mel Station
house
jEffi.j-ji¦vti&r'&Lsr,,'jasi,N"
limm
(3 steps)
?PS > *
ImsI
North
[down hill to the house]
ceiling height: 9
276"
125'
front porch
PS \9 steps)
nnpaved street (grsveD
un; laved
str «t (gravel)
.ditch
WIJTSp.'V.''
ii|
iefectxic,^
|pOWBI.
station';
House floor Han ID: SNA4
m CATS samplers
Q PFT source tviies
House Dust/HVS3 Sampling Area
| IM| Indoor Monitor
qj^I Outdoor Monitor
House Temperature:82.4 F (8/14/95); 86.6 F (8/15/95)
CATS Start Time: #3642 ( 11:17 am, S/14J95)
#4442 ( 11:20 am, 8/14195)
CATS End Time #3642 ( 1:26 pm, 8/15195)
#4448 ( 1:24 pin, 8/15195)
bath
6
dining area, Kitchen
v2)
\
bed room #2
Pl#4448
bed room #3
/
/
bed room ti\
0
HD *3642
--
living area
QMSm
\
0
-------
House Location & Surrounding Area ID: SNB4
tfPS Pathway soil sampling location
40'
n'6
r 62"~
f PS 41'4" to street
North
\
V ;
3---
r;. ¦
ceiling height: 8
House Floor Ran ID: SNB4
[~f| CATS samplers
0 PFT source lubes
|HDj House Dust/HVS3 Sampling Area
Ml Indoor Monitor
OlY] Outdoor Monitor
House Temperature:88.2® F (8/15/95), 86.6°F (8716/95)
CATS Start Time: #2470(9:48 am,8/15/95)
# 42 ( 9:50 am,8/15/95)
CATS ZndTime: #2470(10:08 am, 8/16/95)
# 42 (10:14 am, 8/16/95)
OM
side door |
[5 steps] .
kitchen
bath room
#2470.
TU
'laundry
©
bed room # 2
closet area
IM
or
m
©
iHD
living area
_Q_
bed ruum #3
r-"
bedroom# 1
front porch
[5 steps]
-------
House Location & Surrounding Area
ID: SNC4
*PS- Pathway soil sampling location
North
-99 -
ceiling hei^il: 8 9
driveway
|_T10'lj— 226"
[9 steps to garage]
p\— w
%-m
f- ^
Is" "1
^street*
stxeet
House Floor Plan ID: SNC4
HI CATS samplers
0 PFT source tubes
|_HD" House Dust/HVS3 Sampling Area
Indoor Monitor
IM
Qjyj Outdoor Monitor
Hoiise Temperature: 87 4 F (8/15/95), 85.8 F (8/16/95)
CATS Start Time: #3805 CI 1:04 am,8/15/95)
# £20 (l 1:07 am,8/15/95)
CATS End Time: #3805(12:21 pm, 8/16/95)
# 420 (12:22 pro, 8/16/95)
back r
porch
[4 steps]
1 [5 steps at porch]
I [4 steps at street]
IM
OM
kitchen
bath
bed room #2
bed room #1
HD
-------
House Location & Surrounding Area
ID: SND4
Pathway soil sampling location
ft*®?*
y
zf
North
84' to fence
(PS
s:?s
ir.
28"
28'
[concrete slab under deck]
&
126"
ceiling height 8'
House has a full basement.
40'
front
carport
20' .
63'
14'8"
59' to street porch
CPS
paved
. driveway
House Floor Plan ID: SND4
m CATS samplers
Q PFT source tubes
|HDV House Dust/HVS3 Sampling Area
Indoor Monitor
IM
QM Outdoor Monitor
House Temperature: 78.0 F (8/15)95); 73.6 F (8/16)95)
CATS Start Time: #4269 G:10 pm, 8/15/95)
#6252 0:14 pm, 8/15/95)
CATS End Time: #4269(4:16 pm, 8/16/95)
#6252(4:17 pm, 8/16/95)
<2>,
bed room #1
bath room
closet
J J -
IM
0
dining area
HD*2
kitchen
12
#6252
bed room
Wl
closet
bed room #3
rryj#4269
1 H HD#!
living area fjj
porch
car port
[This house has a full basement.]
-------
House Location & Surrounding Area ID: SNE4
Pathway soil sampling location
34*6"
48*10"
2711"
ceiling height 7*11"
18*10"
'front porch•
I
39' to street
6'4"
PS
North
-j— 10*4" -)
T~
/
screen
porch
r~;
—14
*ps- r.
paved •
driveway'.'
House floor Flan ID: SNE4
|T1 CATS samplers
Q PFT source hies
|jHD. House Dust/HVS3 Sampling Area
| IM| Indoor Monitor
Outdoor Monitor
House Temperature: 162 F (8/17/95); 77.4°F (8/18/95)
CATS Start Time: #1940 (9:15 am, 8/17/95)
#1588 (9:13 »m, 8/17/95)
CATS End Time: #1940 (10:14 Am, 8/18/95)
#1583 (10:16 am, 8/18/95)
den area
bedroom #2
bedroom m
1/2 bath
bath room
bedroom #3
kitchen
y
LB #1588
"hd
CD
dining area
living area
IM
side
j door
/
front door
-------
House Location & Surrounding Area
ED: SNH4
0>S- Pathway soil sampling location
Location of the Met Station
North
IPS
ra
58'
24'
31'
"'6"
i—i
ceiling height: 8
— 4'g"
I front porch
1
Iff
54'
78' to street 6'n" (5 steps)
1 •
ps
[
[street is unpsved gravel] ;
House Floor Plan ID: SNH4
|T| CATS samplers
0 PFT source tubes
j- House Dust/HVS3 Sampling Area
Indoor Monitor
IM
OM Outdoor Monitor
House Temperature: 742 F (8/19/95), 78.6 F (8/20/95)
CATS Start Time: # 819 (2:28 pm, 8/19/95)
#1672 (2:29 pro, 8/19/95)
CATS End Time: # 819 (2:09 pm, 8/20/95)
#1672 (2:10 pm, 8/20/95)
closet
back door
bath m
bedroom
m
kitchen
dining
area
o
JJ] #1672
bed room
#4
bed room
W1
bedroom
#3
Irving area
front po
-------
House Location & Surrounding Area
ID: SNT4
$>S Pathway soil sampling location
Location of the Met Station
North
teet
parkng
lot
?PS'
CPS ftont door (6 steps)
ceiling height: T9
¦ 436"
(ilteps) (Tsteps)j
60T' —I
: PS
House Floor Flan H); SNI4
|T| CATS samplers
3 PFT source tiiaes
?HD House Du«t/HVS3 Sampling Area
Indoor Monitor
1M
OIvl Outdoor Monitor
House Temperature: 73.6 F ($121195), 75 4 F (8/22/95)
CATS Start Time: #4287 (9:35 am, 8/21195)
#3772 (9:36 am, 8/21/95)
CATS Eiid Time: #4287 (10:14 am, 8/22)95)
#3772 (10:16 am, 8/22/95)
front
-g*"~L
bedroom
m
3
bath
bed
#1
room
#4
IM
#4287
living area
bed room #1
urn t> t #2
HD
m.
JH-
#3772 HD
bed room
kitchen
#2
den area
-l^-i
~j~ n
closet i bath #2
dining area
utility room
V™
OM
back
-------
House Location & Surrounding Area
ID: SNJ4
Pathway soil sampling location
North
h,. 4f|W'-
f"' ¦' r"
SSlsl3
ceiling height
-159 -
Ki'rJKI
,}fj;
fe^1
46*9"
f •' -w#
f«^pr
hC.
ceiling height
76" 4
(1 step in shaded area)'
front
(1 step) ,;pS
gravel driveway to mam road
about D.l mile to main rood
-..^r
• ; s b ur-»^w. • >-; r. p m : •
House floor Flan ID: SNJ4
[T1 CATS samplers
Q PFT source tubes
*IDf. House DustiHVS3 Sampling Area
fcWc'-iT3"
Indoor Monitor
IM
OM Outdoor Monitor
House Temperature: 76.0 F (8/21)95), 85.4 F (8/22/95)
CATS St*rt Time: #2516( 11:00am, 8/21)95)
# 574 (11:01am, 2121195)
CATS End Tune: #2516( 11:54am, 8/22/95)
U 574 (11:55 #m, 8/22/95)
bedroom
bed room #2
back door
I7*~L_
OM
area
kitchen dining ^oedroom
"*G- "•
mr/J
' #574
.' HD m
IHD*2
living area
dwiareq .
front door
(The shaded area is 1 step higher.)
-------
House Location & Surrounding Area
ID: SNL4
(£5. Pathway soil sampling location
Msl Location of the Met Station
-0 ^ North
ImsI
29'
1 stoiy apartment
ceiling height: 710"
front porch
r
parkmglot
PS
to street
House Moor Plan ID: SNL4
m CATS samplers
@ PFT source tubes
|HD> House Dust
-------
House Location & Surrounding Area
ID: SSF4
Pathway soil sampling location
house
North
„4>< /i ^
¦-J***?:,,
h. ¦ 150
**#'..
t-O
k'-':
H
54'
578"
(back door 9 steps)
j
J 13^"
8'4"H j
ceiling height: 9'
22'4" to street
front poreh
. 28'6"
rps
(1 step at porch &. 3 steps at street)
R?E!52:
T.'iTstwer
House Floor Flan ID: SSF4
|H CATS samplers
Q PFT source tubes
{HD' House Dust/HVS3 Sampling Area
fi",
Indoor Monitor
IM
QM Outdoor Monitor
House Temperature: 76.8 F (2/17/95), 80.8 F (8/18/95)
CATS Stirl Time: ^844( 11:15 am, 8/17/P5 )
#5086 ( 11:17 am, 8/17/95)
CATS End Time: ( 12 20 pm, 8/18/95)
#1086 ( 12:21 pm, 8/18/9 5)
OM
kitchen
bath
U J
laundry
^#6086 <2
\
den area
back door
Q
bed room U2
©
PHD
living area
n !
:44
A
IM
bed room til
iiont porch
-------
House Location & Surrounding Area
ID: SSG4
Pathway soil sampling location
North
his
J side door j&
ceiling height: 711
» -m
I®#
front porch
62 to street
ii5 i (4steps) at
House Floor Plan ID: SSG4
FT] CATS samplers
0 PFT source tubes
|HD; House D\st/HVS3 Sampling Area
IM
Indoor Monitor
OM Outdoor Monitor
House Temperature:87.0 F (8/17/95), 76.2 F (8/18/95)
CATS Start Time: #2070 ( 2:08 pm, 8/17/95)
#7134 (2:10 pm, 8/17/95)
CATS End Time: #2070 ( 3:24 pm, 8/18/95)
#7134(3:23 pm, 8/18/95)
OM
3
bed room
#1
bed room
#2
My
]#7134
bath
/
utihtj
kitchen
a
&
side door
bed room
#3
m
J2.
bed room #4
-J] #2070
closet
closet \
;HD 0
living area
front porch
-------
House Location & Surrounding Area ID: SSK4
£PS Pathway soil sampling location
North
Hp:|—w —
to fence
1
deck
„ outside
storage
\
/
ceiling height: 8'
front screened
porch
1
5'4"
26'
i PS
18'
731 to street
House Floor Plan ID: SSK4
[T1 CATS samplers
Q PFT source tubes
[hD ' House Dust/HVS3 Sampling Area
Indoor Monitor
Qjyfl Outdoor Monitor
IM
House Temp^tuw: 79 6°F (8/21/95),79.4 F (2/22/95)
CATS Start Time: #4614(2:05 pm , 8/21/95)
H 71 (2;06 pm , 8/21/95)
CATS End Time: #4614 ( 2:52 pm, 8/22/95)
H 71 ( 2:53 pm, 8/22/95)
deck
OM
r
y
bath
bed room
m
O
bath
2>
kitchen
IM
dining area
v-.
utility
bed room #2
#71
\
tw.d room
m
-------
House Location & Surrounding Area
ID: SSM4
North
Pathway soil sampling location
94' to property line
H
ceding height: 76
front porch
(5 steps)
CPS
1D1' to unpaved road
(gravel)
1
House Floor Flan ID: SSM4
[T| CATS samplers
0 PFT source tubes
|HDs House DustlHVS3 Sampling Area
Indoor Monitor
Outdoor Monitor
IM
OM
House Temperature: 75.6 F (8/23/95); 77.8 F (8/2495)
CATS Start Time: #5073 (10:46 am, 8/23/95)
#9961 (10:47 am, 8/23/95)
CATS End Time: #5073 (12:10 pm, 8/24/95)
#9961 (12:11 pm, 8/24/95)
OM
back door
l"V I
3
bedroom
m
bath
~#9961
bedroom
#2
a
kitchen
c
dining area
©
IM living area
,-,#5073
;.HD
\
front pore
i
-------
House Location & Surrounding Area
ID: \VNA4 («f: SNL4)
Pathway soil sampling location
IHsl Location of the Met Station
-0 ^ North
ImsI
29'
1 story apartment
ceiling height: 7'10
front porch
parking lot
WW*'
82'
to street
House Floor Ran ID: WNA4 («f:SNL4)
m CATS samplers
Q PFT source tubes
[JhD- House Dust/HVS3 Sampling Area
Indoor Monitor
IM
OM Outdoor Monitor
House Temperature: 69F (1/31/95), 71 F (2/1/95)
CATS Start Time: #1409 (9 am, 1/31,95)
#2720(9:01 am, 1/31/95)
CATS End Time: #\409 (11 am, 2/1/95)
#2720 (11:01 am, 2/1/95)
OM
kitchen
I storage
dining area |
/ pantry
utility
bath
#1409
CD
living area
lHD
\l
bed room #1
IM
X
f2"|ff2720
bed room #3
r\ "
close'
bed room #2
front porch
-------
House Location & Surrounding Area
ID: WNB4
^ES; Pathway soil sampling location
O
Norlh
back do or
J (5 steps)
ceiling height: 6'11
front door CPS
(2 steps)
y
dirt driveway
100' to property line
264' to street
House Floor Plan ID: WNB4
[T| CATS samplers
0 PFT source lubes
House Dust/HVS3 Sampling Area
IM
Indoor Monitor
QM Outdoor Monitor
House Temperature: 76 F (1/31/95), 76 F (2/1/95)
CATS Start Time: #8132 (3 pm, \B\i9S)
#2285 (3:01 pm, 1/31/95)
CATS End Time: #8132 (3;10 pm, 2/1/95)
#2285(3:11 pm, 2/1/95)
OM
3)
bedroom #2
"Tir
#8132
IM
" /
\
bath
3® bedroom
#1
living area
HD r
kitchen
#2285
-------
House Location & Surrounding Area
ID: WNC4 (ref: SNI4)
qgjSi Pathway soil sampling location
Location of the Met Station
North
; front door (6 steps)
paiK
lot
ceiling height: 79"
TmsI
R
s«-
K
70'
43'6"
(5 steps) C^steps)
602"
X"
r-;-
J/i
S?
h;1-:
House floor Flan ID: WNC4 (ref:SNI4)
[T| CATS samplers
Q PFT source tubes
p4D i House Dnst/HVS3 Sampling Area
IM
Indoor Monitor
Qjyj Outdoor Monitor
House Temperature: 66°F (2/2/95), 57°F (2/3/95)
CATS Start Time: #876 (9 am, 2/2/95)
#1314 (9D\ am, 2/2/95)
CATS E»d Time: #876 (11:05 am, 2/3/95)
#1314(11:06 am, 2/3/95)
front
bedroom
tn,
bath
#1^
bed
room
m
/
IM
living area
bed room #1
bed room
to.
|_£J
#1314
den area
b
- [ijuzis
¦HD
kitchen
dining area
(T) 1
^ /
closet | bath #2
utility room
l\^ J
OM
back
-------
House Location & Surrounding Area
IP'S. Pathway soil sampling location
ID: WND4
North
gravel
driveway I
front door
";PS (3 steps)
106' to street
storage'
back door
(4 steps)
163' to property line
ceiling height: 73
251' to property linefl
House Floor Plan ID: WND4
HI CATS samplers
0 PFT source tubes
^Hp • House Dust/HVS3 Sampling Area
Indoor Monitor
IM
QM Outdoor Monitor
House Temperature: 76 F (2/2/95), 76 F (2/3/95)
CATS start Time: #4800 (11:20 an, 2/2/95)
#10303 (11:21 am, 2/2/95)
CATS End Time: #4800 (2:50 pm, 2/3/95)
#10303 (2:51 pm, 2/3/95)
front door
living area
2]#10303
bedroom #3
bedroom #2
__ V.
IM
closet
utility
—or
dining area
kitchen
back door
/f\
bath
storage
bedroom
#1
OM
-------
House Location & Surrounding Area ID: WNE4 (ref:SNA4)
CPS' Pathway sdA sampling location
Location of the Met Station
U-^P.
f ¦
F *
North
[down hill to the house]
(3 steps)
house
/- \- 14'
back door
ceiling height: 9'
226"
125'
front porch
VPS \9 steps)
nnpavied street (gravel)
nr.; isved
str et (gravel)
.ditch
mm
I'aliictiic!/
[\power,
1st at ion
House Iloor Plan ID: WNE4 (ref:SNA4)
[X] CATS samplers
Q PFT source tubes
[HD House Dust/HVS3 Sampling Area
Indoor Monitor
Qjyj] Outdoor Monitor
IM
House Temperature:72°F (2/4/95); 72 F (2/5/95)
CATS Start Time: #762 (9:10 am, 2/4/95)
#282(9 .11 am, 2/4/95)
CATS End Time: #762 (11:10 am, 2/5/95)
#282(11:11 am, 2/5/95)
bath
dining area kitcheri
Q
X
bad loom ¥2
f
[2
#282
bed room Wi
/
U} £
#762/
bed room #1
a)
HD
living area
OM
-------
House Location & Surrounding Area
ED: WNF4
(PS Pathway soil sampling location
NOTE:
js Carspaikd
the backyitd}
itrs 8t
£v';
I;
£".:
fev'
tv-i
i
r
tim.
ill: 39T
llii#
¦ i
back door
—166
nyfT <3 steps)
height: 7
front porch
(3 steps)
street
House Floor Plan ID: WNF4
m CATS samplers
3 PFT soxuce tubes
THD. House DustJHVS3 Sampling Area
1M
Indoor Monitor
|OP/H Outdoor Monitor
House Temperature 56* F (2/6/95), 58° F (2/7/93)
CATS Start Time: #828 (9:25 am, 2/6/95)
#2838 (9:30 am, 2/6/95)
CATS End Time: #828 (11:00 am, 2/7/55)
#2838(11:01 am, 2/7/95)
OM
backdoor
wx:
entryway
kitchen
living
area
nr
#2838
bath (J
XT^ ~~
ted room #2
(P
bed room til
,HD ^222
JD
IM
front porch
-------
House Location & Surrounding Area
ID: WNG4
CPS Pathway soil sampling location
driveway
garage 122 8
% back door
b
celling height: 7 9
front porch
[up hill to the house]
(1 step) ps
street
House Floor Plan ID: WNG4
in CATS samplers
Q PFT source tubes
|HD' House Dust/HVS3 Sampling Area
Indoor Monitor
IM
OM Outdoor Monitor
House Temperature: 78°F (2II6!95), 78 F (2/7)95)
CATS St*rt Tune: #11220 (2 pm, 216195)
#8943 (2:05 pm, 2/6*95)
CATS End Time: #11220 (3:00 pm, 2A/95)
#8943 (3:01 pm,2/7J95)
back door M
front porch
IM
living area
(hardwood floor)
kitchen
dining area
:hd
#2
HD
bedroom #1
-------
House Location & Surrounding Area ID: WNH4
;FS Pathway soil sampling local ion
North
ft J
i~'.r
•'• • f i"
#Sv
73'
back door (2 steps)
ceiling height: T10
=:ii
..tr.v
mi
nr
p*p,s7rs-r-
bl^
314"
porch IPS
(7 steps)
street
House Floor Ran ID: WNH4
[T| CATS samplers
Q PFT source tubes
" House Dust/HVS3 Sampling Area
Indoor Monitor
IM
QM Outdoor Monitor
House Temperature: 63 F (2/8®5);73 F (2/9/95)
CATS Start Time: # 464 (1Q:CI am, 2JS/95)
#3975 (10:41 am, 2/8A>5)
CATS End Time: # 464 (11 am, 2/9/95)
*3975 (11 01 am, 219195)
*YJ®hd*
kitcher.
closet 12]#3975
bed room #3
bed room #2 ' , HD
living area
fronl porch
IM
OM
-------
House Location & Surrounding Area
ID: WNI4
(JS Pathway £01] sampling location
illlp
North
\J\r
bock door
(5 steps)
ceiling height: s
I (ps front door
1 j (2 steps)
street v~
House Floor Plan ID: WNI4
[J] CATS samplers
Q PFT source tubes
; HD House Dust/HVS3 Sampling Area
IM
Indoor Monitor
OM Outdoor Monitor
House Temperature: 70°F (2/9/95);63 F (2/10/95)
CATS Stilt Tim«: #6901 (9:20 am, 2/9/95)
#10804 (9:21 am, 2/9/95)
CATS End Time: #6901 (8:55 am , 2/10/95)
#10804 (8:56 am, 2/10/95)
OM
kitchen
dining area \
closet
A
1
back door
bath room
den , /
;HD
0 #10804
_G2
IM
l#6901
\o
living area
flL
/
bed room #1
r
\ bed room #2
8
front pore*
-------
APPENDIX E. PRE-MOMTORING QUESTIONNAIRE
The Environmental Study
Pre-Monitoring Questionnaire
HOUSEHOLD ID LJ
FRE-Q2.EPA
E-l
-------
The Environmental Study
Prc-Monitoring Questionnaire
THE ENVIRONMENTAL STUDY
PRE-MONITORING QUESTIONNAIRE
TABLE OF CONTENTS
PAGE
INTERVIEW INFORMATION
HOUSEHOLD IDENTIFICATION INFORMATION 0
SECTION A CHARACTERISTICS OF THE HOUSE 1
QUESTIONS A1 - A19
SECTION B HOUSEHOLD INFORMATION 4
QUESTIONS B1 - B44
SECTION C CHILD ACTIVITY INFORMATION 9
QUESTIONS CI - C24
SECTION D FOOD CONSUMPTION INFORMATION 12
QUESTIONS D1 - D6
CONCLUDING STATEMENT 19
(SCHEDULE NEXT VISIT)
-------
The Environmental Study
Pre-Monitoring Questionnaire
HOUSEHOLD IDENTIFICATION INFORMATION
RECORD THE FOLLOWING INFORMATION FROM THE SCREENING QUESTIONNAIRE. VERIFY RESPONDENT'S NAME. ADDRESS.
AND TELEPHONE NUMBER LiEFORE THE INTERVIEW.
(1) NAME:
(2) ADDRESS:
(3) CITY, STATE, ZIP:
(4) TELEPHONE NUMBER:
NO PHONE 99
l'AGE 0
03/22/9 5
-------
The Environment'*! Study
Pre-MonitOring Questionnaire
INTERVIEW INFORMATION
HOUSEHOLD ID: I I
RECORD:
SUBRECORD:
VERSION:
i >
INTERVIEWER
ID #
date
TIME STARTED
TIME ENDED
RESULTS
(IF INCOMPLETE,
SPECIFY REASON)
01
MM DD YY
AM / PM
LJ ! : U_J
AM ! PM
COMPLETE 1
INCOMPLETE 2
02
03
04
MM DD YY
AM / PM
LU : L±
AM / PM
COMPLETE . .
INCOMPLETE
t i
i i
l l
MM DD YY
AM / PM
AM / PM
COMPLETE . .
INCOMPLETE
MM DD YY
AM / PM
AM / PM
COMPLETE . .
INCOMPLETE
REASONS FOR NONCOMPLETION:
01
02
03
04
RESPONDENT'S COOPERATION WAS:
VERY GOOD I ' '
GOOD 2
FAIR 3
POOR 4
THE OVERALL QUALITY OF THIS
INTERVIEW WAS:
HIGH QUALITY I ' '
GENERALLY RELIABLE 2
QUESTIONABLE (SPECIFY BELOW). . . 3
UNSATISFACTORY (SPECIFY BELOW). . . 4
REASON(S) FOR THE UNRELIABLE OR QUESTIONABLE QUALITY OF THE INTERVIEW:
09C2/95
-------
The 'Environmental Study
Pre-Monitoring Questionnaire
HOUSEHOLD IDENTIFICATION INFORMATION
RECORD THE FOLLOWING INFORMATION FROM THE SCREENING QUESTIONNAIRE. VERIFY RESPONDENT'S NAME, ADDRESS.
AND TELEPHONE NUMBER BEFORE THE INTERVIEW.
(1) NAME:
(2) ADDRESS:
(3) CITY, STATE, ZIP:
(4) TELEPHONE NUMBER:
NO PHONE 99
I'A a e o
09/22/9S
-------
The Environmental Study
!'rc-,\joniiorui" questionnaire
SECTION A
CHARACTERISTICS OF THE HOUSE
In this interview wc will be discussing a number of topics including your home, your family, and foods you usually eat.
I'd like to be«in by asking some questions about the house.
Al. How eld is the house? | i I j ' >
YEARS
(DK - 998)
A2. Do you own or rent this house? (IF RENT, ASK Own 1 ' '
NAME AND PHONE NUMBER OF OWNER OR Ren! 2
LANDLORD) Qlh..r 3
DK 8
[SPECIFY OTHER:] L ' '
NAME OF OWNER/LANDLORD:
TELEPHONE NUMBER:
I'aCE t aom/31
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The Environmental Study
Prc-Monilorin® Questionnaire
{USE HOUSE FLOOR PLAN TO IDENTIFY EACH ROOM. ASK A3 FOR ALL ROOMS. THEN ASK A4-A7 FOR EACH ROOM.]
A3. A4. A5. A6. A7.
Would you tell me what
rooms
Is there carpet in
How old is the
In the past 3 months, was
In the past week, was the
you have in the house?
the (ROOM)?
carpet in the
the carpet tn the (ROOM)
carpet in the (ROOM)
(ROOM)?
steam- or dry-cleaned?
vacuumed?
ROOM
Yes No
DK=98
Yes No DK
Yes No DK
I 2
! 1 1
1 2 8
1 2 8
Months
1
1 2
I 1 !
1 2 8
1 2 8
MOtUftS
1 2
1 1 1
1 2 8
1 2 8
Months
1 2
1 I 1
I 2 8
1 2 8
MonLls
1 ! 1
I 2
1 2 8
I 2 8
Months
! !
I 2
1 2 S
1 2 8
' Months
I 1
1 2
1 1 1
1 2 8
I 2 8
Months
i
f
1 2
I 1 1
1 2 3
1 2 8
Months
AS,
!i i )
Is there a fireplace in this house?
11 i t
YES 1
NO (CO TO A12) 2
DK . (ASK TO CHECK THE HOUSE) ... 8
A9. During the cold weather in the past year, did you YES 1
use the fireplace? NO (GO TO Alt) 2
DK (GOTO All) 8
A10. On the average, about how many times per week
or month did vou use it?
Times Per
t >
WEEK .
MONTH
DK . . .
PAGE 2
0mf35
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The Environmental Stuiiv
Pre-Monitoring Questionnaire
All. When was the fireplace last used?
(DK = 98 98 98)
JL
MM DD YY
I )
A12. Is your house located within a quarter mile of
any major freeway or industrial or incineration
plants that produce lots of smoke or a strange
smell?
YES 1 i i
NO 2
DK 8
[IF YES. SPECIFY:
A13. What type of sewage system is used ir. your
home?
MUNICIPAL 1
SEPTIC TANK 2
CESSPOOL 3
OTHER 4
DK S
( i
(SPECIFY OTHER:]
( I
A14. Did you ever see sewage in the yard'.' YES 1
NO (GO TO Alb) 2
DK (GO TO A16) 8
A15. About how many times per (day/week/month/or | j | p^r ' '
year) did this happen (sewage in the yard)?
DAY 1
WEEK 2
MONTH 3
YEAR 4
DK 8
A16. About what time during a day do you think that
there is the most traffic near your house?
H.ACE j
03/22/9 S
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The Environmental Study
Prc-Monitoring Questionnaire
SECTION B
HOUSEHOLD INFORMATION
Next I would like to a.sk you some questions about the members of your household. [ASK B1 - B5. IF B2 = NO, SKIP TO
B5]
Bl. B2. B3. B4. B 5.
Would you tell me the first name
of everyone living in this
household, their ages, and their
relationships to you? Let's start
with you.
[CLARIFY SEX IF
NECESSARY]
Does anyone in
the household
regularly smoke
cigarettes,
cigars, or a
pipe in the
house? Would
you teil me
who they are?
[NO — > B5]
On average, what is the
total number of cigarettes,
cigars, or pipesful of
tobacco per day that
(PEOPLE) smoke in the
house?
Where do
(PEOPLE)
usually smoke
in the house?
Who in your
household stays
home most of the
day?
l'EOPLE/NA
ME
AGE
RELATIONS
HIP
YES NO
CICS / C1CAKS/D PIPES/
DAY AY DAY
WHEKE SMOKE
NOT
HOME HOME
PERSON #1
1 1 1
SE
LF
1
¦1
1 2
i 1 1! 1 II I i
~
1 2
PERSON HI
1 1 1
1 2
1 II 1 II ! i 1
~
i 2
PERSON H3
1 1 1
1 2
1 M II II 1 1
~
i 2
PERSON #4
I 1 1
|
1 2
1 M 1 1 1 1 1 1
~
1 2
PERSON #5
| | |
1 2
II 1
~
1 2
PERSON
1 1 1
1 2
1 1 1 1 1 1 1 1 1
~
L 2
PERSON #7
1 1 !
1 2
1 1 1 1 1 1 1 1 1
~
1 2
PERSON #8
1 ! 1
I 2
1111111*1
~
1 2
PAGE 4
09/22/35
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The
Prc-Moiutoruig Questionnaire
PERSON H9
1 ! 1
1 2
M : 1 11 1 1 1
~
1 2
PERSON #10
1 1 !
i
i
1 2
1 1 1 II 1 1 1 !
~
1 2
f )
( I
The next few questions are about the employment of your household members.
B6. Are you currently employed?
YES
NO .
(GO TO BIO)
B7. Who do you work for? [IF SELF-
EMPLOYED, GO TO B91
i i
B8. What does the (company/person) do?
B9. What kind of work do you do?
BIO. Is anyone else living in the household employed'.'
YES 1
NO ;go to BiS) 2
;Ir YF.S. SPECIFY WHO:]
PAIMUE 5
03/22/31
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The Environmental Sludy
Pre-Monitoruig Questionnaire
Bil. Who does (he/she) work for? [IF SELF-
EMPLOYED, CO TO BI3]
B12. What does the (company/person) do?
B13. What kind of work does (he/she) do?
B14. Is anyone else living in the household employed? YES
NO (GO TD BI8)
[IF YES. SPECIFY WHO:]
i>-\c;e 6
09/22/95
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The Environmental Stuily
Prc-Monitoring Questionnaire
B15. Who does (he/she) work for? [IF SELF-
EMPLOYED, GO TO BI7]
B16. What does the (company/person) do?
B17. What kind of work does (he/she) do?
Now I am going to ask you .some questions about the daily activities of your household.
BIS. B19.
What do you use to cook or heat food?
Appliance
How often
ft Times
do you use (APPLIANCE)?
Per
Day Week Month Don't Know
1
I 1 1
12 3 S
2
i I 1
12 3 8
3
I I 1
12 3 8
B20. How do you heat your home during the winter time?
B21. How often do you clean the house?
Times Per
DAY 1
WEEK 2
MONTH 3
YEAR 4
DI< 8
B22. When you clean the house, do you usually...?
Yes No PK
a. Vacuum the house 1 2 8
b. Wst-mop the Moor 1 2 8
c. Sweep the floor and entrance I 2 8
PACE 7
09/72/95
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The Environmental Stuily
Prc-Moniloring Questionnaire
B23. What are the sources of drinking water for the household?
< i
B24. Do you filter your drinking water?
YES
NO .
DK .
B25. What are the sources of water for cooking and
bathin"?
COOKING:
BATHING:
( i
( i
B26. Do you have any pets?
YES 1 ' i
NO (GO TO B29) 2
B27. What kind of pets do you have
B28. Do you keep your pets inside the house or outside
the house?
Inside 1
Outside 2
Other 3
(SPECIFY OTHER:]
B29. Do you or others in your household often walk
barefoot INSIDE the house?
YES
NO .
1 ' '
7
[IF YES. WHC:|.
B30. Do you or others in your household often walk
barefoot OUTSIDE the house?
YES
NO .
[IF YES. WHO:]
B31. Does anyone in your household frequently work or
play in the yard that would involve contact with soil?
YES
NO .
[IF YES. WHO:] .
I l
I'ACF. 8
-------
The Environmental Study
Pre-Monitoring Questionnaire
B32. Does anyone in your household change automobile
oil in the driveway (or garage)'.'
YES
NO (GOTOB35)
1 ' '
7
IF YES. WHO:] .
B33. How often (does/do) (PEOPLE IN B32) change oil
in the driveway (or garage)?
I 1 1 Times Per
MONTH 1
YEAR 2
DK 8
B34. How (do/does) (they/you/he/she) dispose of" tht
automobile oil?
~
B35. How do you dispo.se of your garbage?
t )
B36. What months of the year do you usually close all of the exterior doors and windows because of heating or air
conditioning? [READ EACH MONTH:]
Yes
a. January .
b. February .
c. March . .
d. April . . .
e. May . . .
f. June . . .
g. July ....
h. August . .
i. September
j. October .
k. November
1. December
No
2
2
2
2
2
2
2
2
9
2
2
?
I'.ACF. ')
03I22J3S
-------
The Environmental Study
Prc-Monitoring Questionnaire
SECTION C
CHILD ACTIVITY INFORMATION
Now I am {join}; to ask you some questions about (CHILD'S NAME)'s daily activities during the last month. Please take
a moment to think about what (CHILD'S NAME) did inside the house and outside the house during this past January...
CI. On the average, about how many hours a day, I 1 I
including nap time, did (CHILD'S NAME) HOURS/DAY
sleep? [WE NEED AN AVERAGE OF
JANUARY/31 DAYS]
C2. On the average, about how many hours a day |__| ]
did (he/she) stay outside the house (including HOURS/DAY
playing, shopping with mom, etc.)? [WE NEED
AN AVERAGE OF JANUARY/31 DAYS]
C3. On the average, about how many hours a day
did (he/she) stay inside the house''
[YOU MAY USE 24 - C2 = C31
HOUP.S/DAY
C4. Where did (he/she) usually play outside the j i
house? ' "
C5. Could you give me an estimate of about how
many hours |
outside the h
C5 < = C2]
many hours per day (he/she) walked barefoot HOURS/DAY
outside the house? [WHAT % OF C2 IS C5.
C6. Could you give me an estimate of about how
many hours per day (he/she) ate or drank
outside the house (such as taking a baby bottle
or eating snacks when he/she played outside)?
[WHAT % OF C2 IS C6. C6 < = C2]
i i
HOURS/DAY
CI. When (CHILD'S NAME) was outside the
house, about how many how
,(he/she) sit or play on the gi
OF C2 IS CI. C7 < = C2]
i i
house, about how many hours per day did HOURS/DAY
(he/she) sit or play on the ground'.' [WHAT %
i'ACK 10
-------
The Environmental Study
Pre-Monitorfing Questionnaire
C8. Where did (he/she) usually play inside the
house?
C9. Could you «ive, me an estimate of" about how [ [ [ ( >
many hours per day (he/she) walked barefoot HOURs.TDaY
inside the house? [WHAT % OF C3 IS C9. C9
<= C3]
CIO. When (CHILD'S NAME) was inside the house, [ [ j
about how many hours per day did (he/she) sit HOURS/DAY
or play on the floor? [WHAT % OF C3 IS CIO.
CIO < = C3]
Cll. Did you ever see (him/her) eat dirt or sand? YES 1
NO 2
DK 8
C12. Did you ever see (him/her) eat snow? YES 1 ' '
NO 2
DK S
C13. Did (CHILD'S NAME) use a pacifier? YES 1
NO 2
DK 8
CI4.
C15.
Did (he/she) suck (his/her)...?
Yes No
Don't Know
How often did (he/she) suck (his/her) (SUCK IN CI4)? Would
you say...?
Rarely/
Most of the Time Sometimes Almost Never DK
a. Thumb 1
2
8
1 2 3 8
b. Fingers I
1
8
! 2 3 8
c. Toe I
2
8
I 2 3 8
TAGIL 11
03/22/95
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The Environmental Study
Pre-Monilorui» Questionnaire
C16. Did you ever see (CHILD'S NAME) chew
(his/her) finger nails or toe nails'?
YES 1
NO 2
DK 8
C17. How many tunes did you cut (his/her) finder
nails and/or toe nails in the past January?
Times
i i
C18. How often did (CHILD'S NAME) put toys in
(his/her) mouth? Would you say...?
Most of the time 1
Sometimes, or 2
Rarely or almost never 3
DK 8
C19. Did (he/she) put any things other than toys or
foods in (his/her) mouth?
YES
NO .
DK .
1
(CO TO C21) 2
! )
C20. What did (he/she) put in (his/her) mouth'5
C21. In the past January, how often were (CHILD'S
NAME)'s hands washed before eating meals?
Would you say...?
C22. How often were (his/her) hands washed before
eating snacks? Would you say...?
C23. How often were (his/her) hands washed after
playing outside the house? Would you say...?
C24. How often were (his/her) hands washed before
going to bed? Would you say...'?
Most of the time 1
Sometimes, or 2
Rarely or almost never 3
DK 8
Most of the time 1
Sometimes, or 2
Rarely or almost never 3
DK 8
Most of the time 1
Sometimes, or 2
Rarely or almost never 3
DK 8
Most of the time 1
Sometimes, or 2
Rarely or almost never 3
DK 8
i >
PAGE 12
OS/21/95
-------
The Environmental Shuty
Prc-Moniloring Qucsiionnnire
SECTION D
FOOD CONSUMPTION INFORMATION
Now I'd like to ask you some questions about you and (CHILD'S NAMJEl's usual eating habits over the past year. I'll
read a list of food and beverage items and ask you how often, on average, you and your child ate or drank each of the
following items. If you're not sure about an answer, please give your best yuess. You may answer in per day, per week,
or per month. For example, once per day, twice per week, or 3 times per month.
Dl. D2.
FOOD
[Lsss lhan once per
month = Ra rely /N eve r = 001
How Often Did You Eat?
How Often Did (CHILD'S NAME) Eat?
WRITE tt OF TIMES, THEN CIRCLE
THE NUMBER FOR DAY, WEEK, OR
MONTH
WRITE tt OF TIMES, THEN CIRCLE
THE NUMBER FOR DAY, WEEK, OR
MONTH
tt times
(00 = rarely/n
ever)
day week month DK
tt times
(00 = rarely/ne
ver)
day week month DK
A. Apples, applesauce, pears
1 i 1
12 3 8
1 1 1
12 3 8
B. Cantaloupe (in season)
i 1 1
12 3 8
1 ; !
12 3 8
C. Oranges
1 1 1
12 3 8
1 ! 1
12 3 8
D. Orange juice or
grapefruit juice
1 1 1
12 3 8
1 1 I
12 3 8
E. Grapefruit
1 1 1
L 2 3 8
1 I I
12 3 8
F. Other fruit juices,
fortified fruit drinks
1 1 1
12 3 8
L^J
12 3 8
G. Beans such as baked
beans, pintos, kidneys,
limas, or in chili
1 ! I
12 3 8
1 ! 1
12 3 8
i
Txrnrrr
05/22/35
-------
The Environmental Shitly
Prc-Mo»»itorii»g Questionnaire
Dl. D2.
FOOD
(Less than once per
month = Rarely/Never=00]
How Often Did You Eat?
How Often Did (CHILD'S NAME) Eat?
WRITE If OF TIMES, THEN CIRCLE
THE NUMBER FOR DAY, WEEK, OR
MONTH
WRITE it OF TIMES, THEN CIRCLE
THE NUMBER FOR DAY, WEEK, OR
MONTH
# times
(00 = rarely/n
ever)
day week month DK
# times
(00 = rarely/ne
ver)
day week month DK
H. Tomatoes, tomato juice
1 1 1
12 3 8
1 1 1
12 3 8
I. Broccoli
1 1 1
12 3 8
1 1 1
12 3 8
J. Spinach
I 1 1
12 3 8
1 1 1
— - — j
12 3 8
K. Mustard greens, turnip
greens, collards
1 1 1
" "
12 3 8
1 ^
12 3 8
L. Cole slaw, cabbage,
sauerkraut
1 1 1
12 3 8
1 i
12 3 8
M. Carrots, or mixed
vegetables containing
carrots
L I !
12 3 8
1 I i
12 3 8
N. Green salad
[ I 1
12 3 8
i 1 1
12 3 8
O. Salad dressing,
mayonnaise (including on
sandwiches)
m
12 3 8
1 1 1
12 3 8
P. French fries and tried
potatoes
L_l 1
12 3 8
! 1 1
12 3 8
Q. Sweet potatoes, yams
I 1 1
12 3 8
1 1 1
12 3 8
PACE 14
09/2 2/55
-------
The Environmental .Sliitly
Pro-Monitoring Questionnaire
Dl. D2.
FOOD
[Less than once per
monlh = RarDiy/Never=OG]
How Often Did You Eat?
How Often Did (CHILD'S NAME) Eat?
WRITE tf OF TIMES, THEN CIRCLE
THE NUMBER FOR DAY, WEEK, OR
MONTH
WRITE # OF TIMES, THEN CIRCLE
THE NUMBER FOR DAY, WEEK, OR
MONTH
it times
(00 = rarely/n
ever)
day week month DK
# times
(00 = rare!y/ne
ver)
day week month DK
R. Other potatoes, including
boiled, baked, potato
salad, mashed
1 1 1
12 3 8
LU
12 3 8
S. Rice
1 i 1
12 3 8
1 1 1
t
12 3 8
T. Hamburgers,
cheeseburgers, meatloaf
1 1 :
12 3 8
I ! !
12 3 8
U. Beef (steaks or roasts)
1 1 !
12 3 8
1 1 i
12 3 8
V. Beef stew or pot pie with
carrots, other vegetables
UJ
12 3 8
[ 1 1
12 3 8
W. Liver, including chicken
livers
1 1 1
12 3 8
1 1 1
12 3 8
X. Pork, including chops,
roasts
LU
12 3 3
1 I 1
12 3 8
Y. Fried chicken
1 1 1
12 3 8
1 1 1
12 3 8
Z. Chicken or turkey,
baked, roasted, stewed or
broiled
12 3 8
LLJ
12 3 8
AA. Fried fish or fish
sandwich
1 1 1
12 3 8
1 ! 1
12 3 8
FACE 15
09/22/95
-------
The Environmental Stmlv
Prc-Monitorinj Questionnaire
Dl. D2.
FOOD
[Less than once per
month = Rare!y/Never=OG|
How Often Did You Eat?
How Often Did (CHILD'S NAME) Eat?
WRITE rt OF TIMES, THEN CIRCLE
THE NUM3ER FOR DAY, WEEK, OR
MONTH
WRITE if OF TIMES, THEN CIRCLE
THE NUMBER FOR DAY, WEEK, OR
MONTH
# times
(00 = rarely In
ever)
day week month DK
it times
(00 = rare!y/ne
ver)
day week month DK
BB. Other fish, broiled or
baked
I 1 1
12 3 8
1 1 1
12 3 8
CC. Spaghetti, lasagna, other
pasta with tomato sauce
I 1 1
12 3 8
! 1 1
1 2 3 S
DD. Hot dogs
1 1 1
12 3 8
1 1 1
12 3 8
EE. Ham, lunch meats
1 1 1
12 3 8
1 1 1
12 3 8
FF. Vegetable soup, vegetable
beef, minestrone, tomato
soup
1 1 1
12 3 8
12 3 8
GG. White bread (including
sandwiches), bagels,
crackers, etc.
1 1 1
12 3 8
1 1 I
12 3 8
HH. Dark bread, including
whole wheat, rye,
pumpernickel
1 1 !
12 3 8
1 1 !
12 3 8
II. Corn bread, corn
muffins, corn tortillas
1 1 !
12 3 8
u-j
12 3 8
JJ. Salty snacks (such as
chips, popcorn, pretzels)
1 ! 1
12 3 8
1 1 1
12 3 8
PAGE 16
OS/2 2/95
-------
The Environmental Stmiy
Prc-Monitoiing Questionnaire
Di. D2.
FOOD
[Less than once per
month = Rarely/Ncvir=00]
How Often Did You Eat?
How Often Did (CHILD'S NAME) Eat?
WRITE tt OF TIMES, THEN CIRCLE
THE NUMBER FOR DAY, WEEK, OR
MONTH
WRITE tt OF TIMES, THEN CIRCLE
THE NUMBER FOR DAY, WEEK, OR
MONTH
ft times
(00 = rare!y/n
ever)
day week month DK
tt times
(00= rarely/ne
ver)
day week month DK
KK. Peanuts, peanut butter
1 1 1
1 2 3 8
1 i I
12 3 8
LL. Margarine on bread or
rolls
L^J
12 3 8
1 i i
12 3 8
MM Butter on bread or roils
LXJ
12 3 8
LU
12 3 8
NN. High Fiber, bran or
granola cereals, shredded
wheat
1 1 1
12 3 8
1 1 1
12 3 8
OO. Highly fortified cereals,
such as Product 19,
Total, or Most
! 1 1
1 2 3 8
! I 1
12 3 8
PP. Other cold cereals, such
as Com Flakes, Rice
Knspies, Cheerios
1 1 1
12 3 8
! I I
12 3 8
QQ. Cooked cereals
1 1 1
12 3 8
1 1 i
12 3 8
RR- Eggs
i 1 1
12 3 8
1 1 1
12 3 8
SS. Bacon
I 1 1
12 3 8
1 1 i
12 3 8
TT. Sausage
1 1 1
12 3 8
1 1 1
12 3 8
PAC.'E 17
09/22/95
-------
The Environment:!! Study
Prc-Monitorin( Questionnaire
Dl. D2.
FOOD
(Less than once per
month = Rarely/Never^ 00;
How Often Did You Eat?
How Often Did (CHILD'S NAME) Eat?
WRITE # OF TIMES, THEN CIRCLE
THE NUMBER FOR DAY, WEEK, OR
MONTH
WRITE # OF TIMES, THEN CIRCLE
THE NUMBER FOR DAY, WEEK, OR
MONTH
tf times
(00 = rarely/n
ever)
day week month DK
tt times
(00 = rarely/ne
ver)
day week month DK
UU. Ice cream
1 ! I
12 3 8
! ! 1
12 3 8
VV. Doughnuts, cookies,
cakes, pastry
1 1 1
12 3 8
1 1 1
12 3 8
WW Pies
i 1 1
12 3 8
1 1 1
12 3 8
XX. Chocolate candy
1 1 1
12 3 8
1 1 1
12 3 8
YY. Cheeses and cheese
spreads, not including
cottage cheese
1 1 1
12 3 8
1 1 1
12 3 8
ZZ. Whole milk and
beverages with whole
milk (including on cereal)
i I 1
1 2 3 S
L^j
12 3 8
AA 2% milk and beverages
A. with 2% milk (including
on cereal)
1 i i
L 2 3 S
1 1 1
12 3 8
BBB Skim milk, 1 % milk or
buttermilk (including on
cereal)
1 2 3 S
12 3 8
CC Regular soft drinks (not
C. diet)
LiJ
12 3 8
1 1 1
12 3 8
PACE 18
OS/21/35
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The Environmental .Sfuily
P re-Monitoring Questionnaire
Dl. D2.
FOOD
(Less lhan once per
month = Rarely/Never= 00|
How Often Did You Eat?
How Often Did (CHILD'S NAME) Eat?
WRITE £ OF TIMES, THEN CIRCLE
THE NUMBER FOR DAY, WEEK, OR
MONTH
WRITE # OF TIMES, THEN CIRCLE
THE NUMBER FOR DAY, WEEK, OR
MONTH
ft times
(00 = rarely/n
ever)
day week month DK
# times
(00 = rarely/ne
ver)
day week month DK
DD Beer
D.
I ! 1
12 3 8
EEE Wine
1 1 I
12 3 8
FFF Liquor
12 3 8
GG Milk or cream in coffee
G. or tea
12 3 8
12 3 8
HH Sugar in coffee or tea, or
H. on cereal
1 1 1
12 3 8
L_U
12 3 8
PACE 19
09/22/SS
-------
Tbc Envjronuirntnl .Study
Pre-Monitoriiig Questionnaire
D3.
Now I would like to ask you how often in the past year you used any of the following methods to cook or heat
food.
METHOD
ii times
(00 = never in past
year)
day week month year DK
a. Barbecue (grill, broil, or roast)
I ! |
1 2 3 4 8
b. Deep-fry
1 1 1
1 2 3 4 8
c. Fry
1 1 1
1 2 3 4 8
d. Stir-fry (or saute)
1 1 1
1 2 3 4 8
e. Microwave
1 1 1
1 2 3 4 8
f. Steam
1 1 1
1
1 2 3 4 8
g. Bake
i i ;
1 2 3 4 8
h. Stew (slow cooking, or
siminer)
i i i
12 3 4 8
i. Boil
! 1 1
1 2 3 4 8
j. Other
(SPFPIFY rtTHFR j
1 i i
1 2 3 4 8
(
D4. What kinds of fat did you usually use in cooking (to deep-fry, fry, or stir-fry) in the past year?
Did you use...?
a. Vegetable oil . .
b. Com oil
c. Peanut oil . . . .
d. Butter
e. Margarine . . . .
f. Bacon fat . . . .
g. Lard/fatback . . .
h. Other
[SPECIFY OTHER;;
Yes No Don't Know
2 8
2 8
2 8
2 8
2 8
2 8
2 8
2 8
PAGE 20
03/:2/95
-------
Tlic Environment,!) Study
Pre-Monitoring Questionnaire
D5. D6.
How often did you eat the following
carry-outs in the past year?
foods
from
restaurants or
How often did (CHILD'S NAME) eat the
following foods from restaurants or carry-outs in
the past year?
FOOD
tf times
(00 = never in
past year)
day
week
month
year
DK
# times
(00 = never in
past year)
day week
month
I
year DK
a. Fried chicken
! 1 !
i
7
3
4
8
! I I
1 2
3
4 8
b. Burgers
1 1 1
2
3
4
8
1 1 1
1 2
3
4 8
c. Pizza
1 1 1
i
2
. 3
4
8
1 1 1
I 2
3
4 8
d. Chinese food
I 1 1
I
2
3
4
8
1 1 I
1 2
3
4 8
e. Mexican food
111
1
2
3
4
8
1 1 1
1 2
o
J
4 8
f. Fried fish
1 1 1
1
2
3
4
8
1 1 1
1 2
3
4 8
g. Barbecue
! 1 1
1
2
3
4
8
1 1 1
I 2
3
4 8
pace 21
0S/22/9J
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Tile Environmental Study
P re-Monitoring Questionnaire
CONCLUDING STATEMENT
Thank you very much tor your time, (Mr./Mrs./Ms.) (RESPONDENT'S LAST NAME). That concludes our interview
for today. We really appreciate your willingness to answer our questions and to participate in this important study.
You've been very helpful. Is there anything else you think we should know that has not been asked?
SCHEDULE AN APPOINTMENT WITH THE RESPONDENT FOR THE NEXT DAY'S VISIT.
Now I would like to schedule a time for us to come back to visit you tomorrow. When will be convenient for you
tomorrow?
DATE:
/
TIME:
AM I PM
Thank you again For taking part in this important study. We'll see you tomorrow around (TIME). (EXTEND HAND)
COMMENTS?
! I
COMPLETE INTERVIEW INFORMATION ON THE FRONT PAGE OF THIS QUESTIONNAIRE.
REVIEW THE ENTIRE QUESTIONNAIRE FOR MISSING INFORMATION OR APPARENT ERRORS AS SOON
AS POSSIBLE.
PACE 22
OS/2 2/95
-------
APPENDIX F. POST-MONITORING QUESTIONNAIRE
The Environmental Study
Post-Monitoring Questionnaire
HOUSEHOLD ID LJ
POST-Q2.EPA
F-l
-------
INTERVIEW INFORMATION
HOUSEHOLD ID I I
i i
RECORD:
1 !
SUBRECORD:
VERSION:
i )
INTERVIEWER
ID ft
DATE
TIME STARTED
TIME ENDED
RESULTS
(IF INCOMPLETE,
SPECIFY REASON)
01
1 1 1
II II 1 li 1 1
1 1 1 • 1 ' AM/PM
1 ' ! • 1 1 1 A M / PM
COMPLETE 1
INCOMPLETE ... 2
MM DD YY
02
1 I 1
1 1 II 1 II 1 1
| 1 1 • 1 I ! AM / PM
1 ! ! • 1 1 1 AM / PM
COMPLETE 1
INCOMPLETE ... 2
MM DD YY
03
1 I 1
1 1 II 1 II M
COMPLETE I
INCOMPLETE ... 2
1 1 !
MM DD YY
04
1 1 1
1 1 II MM 1
1 1 1 • 1 1 1 AM / PM
1 1 1 ' 1 1 1 AM / PM
COMPLETE 1
INCOMPLETE ... 2
MM DD YY
REASONS FOR NONCOMPLETION:
01
02
03
04
i >
i i
RESPONDENT'S COOPERATION WAS:
VERY GOOD 1
GOOD 2
FAIR 3
POOR 4
THE OVERALL QUALITY OF THIS
INTERVIEW WAS:
HIGH QUALITY I
GENERALLY RELIABLE 2
QUESTIONABLE (SPECIFY BELOW). . . 3
UNSATISFACTORY (specify below). . . 4
REASON(S) FOR THE UNRELIABLE OR QUESTIONABLE QUALITY OF THE INTERVIEW:
09/22/9 5
-------
Tl.e Eiivirou.uentnl Study Post-Mouitorim; Questioimaire
I would like to ask you some questions about what you and (CHILD'S NAME) did during the 24-hour period, that is from
to . First,
1. Did you or (CHILD'S NAME) do anything during the 24-nour period that brought you or (him/her) near any of
the following materials, places, or activities?
a. freshly applied paint
b. food being fried, grilled, or barbecued . . .
c. burning of mhbish, garbage, or yard waste
d. other open flames, including harbecus
flames, Fires
e. glues or other adhesives
f. solvents, fumes, or odorous chemicals . .
g. floor wax, furniture wax, or shoe polish .
h. gasoline- or diesel-powered equipment othe
than automobiles, including lawn mowers
i. household cleaning agents, such as scouring
powders or ammonia
j. excessive dust in the air . . . .
k. stain or spot removers
1. gas station or auto repair shop
m. pump any gasoline or around where anyone
was pumping gasoline
n. using a gas range/oven or in the home when
it was used
o. using a microwave oven . .
p. freshly applied insecticides
q. freshly applied herbicides (in farm fields or
gardens)
r. . roofing tar or road tar
s. changing automobile oil
ADULT
YES NO
2
2
2
CHILD
YES NO
I 2
IF YES. WHERE
I'ACE 1
09/22/95
-------
The Eiiviroiiineiihd Study
Post-.YIoiiitoriiig Questionnaire
[ASK 2-4 FOR ADULT FIRST. THEN ASK 2-4 FOR CHILD.]
2. 3. 4.
PEOPLE
Did (PEOPLE)
take any vitamins,
medications, or
drugs during the
24-hour period?
Yes No
[IF YES1 What kind of vitamins,
medications, or drugs did
(PEOPLE) take?
Name
How much did (PEOPLE) take?
Amount
(ADULT/YOU)
1 2
a.
a.
b.
b.
c.
c.
(CHILD'S NAME)
1 2
a.
a.
b.
b.
c.
6.
Did you use your (heating system/heaters)
during the 24-hour period?
YES 1 [RECORD HEATER & ASK Qx 6]
NO,. 2 [GO TO 7]
When did you use the (HEATING SYSTEM/HEATERS)?
HEATING SYSTEM/HEATERS
TIME (FROM)
TIME (TO)
a.
b.
7. Did anyone smoke cigarettes, cigars, or a pipe inside your
house during the 24-hour period?
8. About how many cigarettes, cigars, or pipesful of tobacco were
smoked in the house during the 24-hour period?
[COLLECT CIGARETTE BUTTS]
9. Did you cook in the house during the 24-hour period?
10. About how many hours did you cook in the house during the
24-hour period?
11. What (appliance) did you use to cook in the house during the
24-hour period?
YES 1
NO (GO TO 9) 2
CIGARETTES CIGARS PIPES
YES 1 ' ;
NO ... . (GO TO 12) 2
I 1 I HOURS I i I MINUTES ' '
! I
PAGE 2
-------
Tue Environmental Study
Post-Monitoring (Questionnaire
12. Did you cook outside the house during the 24-hour period? YES 1 ' '
NO .... (GO TO 16) 2
13. Where did ycu cook outside the house during the 24-hour
period? ' '
14. About how many hours did you cook outside the house during | | | HOurs 1 I I MINUTES ' '
the 24-hour period?
15. What (appliance) did you use to cook outside the house during
the 24-hour period?
[ASK 16-20 FOR ADULT FIRST. THEN ASK 16-20 FOR THE CHILD. CHECK CHILD ACTIVITY DIARY]
16. 17. 18. 19. 20.
PEOPLE
Did
(PEOPLE)
go anywhere
outside the
house during
the 24-hour
period?
Ye.s Nn
[IF YES] Where did (PEOPLE)
go? (Did you/CHILD'S NAME
go anywhere else during the 24-
hour period?)
[COMPARE 17 TO I AND CHILD
ACTIVITY DIARY FOR
POSSIBLE DISCREPANCY.]
Where
Did (PEOPLE) go by
car, by bus, by truck,
or by foot?
Car Bus Truck Tout
What (were/was)
(PEOPLE) doing
(at/in) (WHERE)?
Activity
About how
many hours
did (PEOPLE)
spend (at/in)
(WHERE)?
Honrs Miiis
(ADULT/
YOU)
1 2
a.
12 3 4
12 3 4
12 3 4
12 3 4
a.
1 1 II i 1
b.
b.
11 1! 11
c.
c.
II II I!
d.
d.
1 Ml 1 1
(CHILD/
NAME)
1 2
a.
12 3 4
12 3 4
12 3 4
12 3 4
a.
1 1 11 1 I
b.
b.
I Ml, 1
c.
c.
II II 1 1
d.
d.
II II 11
[INTERVIEWER: ADD THE TOTAL ft OF HOURS SPENT OUTSIDE THE HOUSE AND RECORD BELOW]
ADULT CHILD
TOTAL TIME SPENT OUTSIDE = 20a. 20c.
TOTAL TLV1E SPENT INSIDE = 20b. 20d.
TOTAL = 24 24
[CHECK CHILD'S HOURS HERE AND HOURS ON THE CHILD ACTIVITY DIARY]
PAGE 3
09/22/9S
-------
The Environment^] Study
Post-Monitoring Questionnaire
21. Did you work in the yard or do work that YES 1 < >
involved contact with dirt or soil during the 24- NO 2
hour period?
22. Did you sweep or vacuum the floor or rugs inside YES 1 1 1
your house during the 24-hour period? NO 2
23. Did you walk barefoot inside the house during the YES 1 ' >
24-hour period? • NO 2
DK 8
24. Did you walk barefoot outside the house during YES 1 ' '
the 24-hour period? NO 2
DK 8
25. About how many hours, including nap time, did | 1 j Hqurs 1 1
you sleep during the 24-hour period?
26. How often did (CHILD'S NAME) suck (his/her) Most of the time during the day, ... 1 ' '
thumb, fingers, or toe during the 24-hour period? Sometimes, or 2
Would you say...? Only once or twice 3
[CHECK DIARY #1] DID NOT SUCK 4
DK 8
27. Did you see (CHILD'S NAME) chew (his/her) YES 1 ' '
finger or toe nails during the 24-hour period? NO 2
DK 8
28. Did you cut (his/her) finger nails or toe nails in YES 1 1 '
the past two weeks? NO 2
DK 8
29. How often did (he/she) put toys in (his/her) mouth Most of the time during the day, ... 1 11
during the 24-hour period? Would you say...? Sometimes, or 2
[CHECK DIARY #31 Only once or twice 3
DID NOT PUT TOYS IN MOUTH . 4
DK 8
PAGE 4
OS/32/9 S
-------
The Environmental Study
Post-Moaitoriup Questiniuj.iire
30. Did you see (CHILD'S NAME) put any things YES 1 < >
other than food or toys in (his/her) mouth during NO (GO TO 32) 2
the 24-hour period? DK (CO TO 32) 8
31. What did (he/she) put in (his/her) mouth? t i
32. How often were (CHILD'S NAME)'a hands Every time before eating meals, ... 1 '
washed before eating meals during the 24-hour Most of the time, 2
period? Would you say...? [CHECK DIARY #4] Sometimes, or 3
Rarely/Almost never 4
DK 8
33. How often were (his/her) hands washed before Every time before eating snacks, ... 1 '
eating snacks during the 24-hour period? Would Most of the time, 2
you say...? Sometimes, or 3
[CHECK DIARY #4] Rarely/Almost never 4
DK 8
34. How often were (his/her) hands washed after Every time after playing outside, ... 1 '
playing outside during the 24-hour period? Would Most of the time 2
you say...? Sometimes, or 3
[CHECK DIARY #5] Rarely/Almost never 4
DID NOT PLAY OUTSIDE 5
DK 8
Now I would like to ask you some questions about your opinions on this study.
35. When you think about all of the study activities over the past two days, was there anything that particularly bothered
36. Do you feel that any of the following activities was too much of a burden, too confusing, or caused too much
you or that you feet was too difficult for you and your child to do?
inconvenience to you and your family? [READ LIST:]
YES NO IF YES, WHY?
b. Collecting food samples
e. Conducting air sampling outside your home . . .
f. Completing our interviews with you
I'AGE 5
09/22/9 S
-------
The Euviroiiweutal Study
Post-Moiiitoriug Questionnaire
37. Would it be a problem to you if we gave you a check
instead of cash for your participation in this study?
38. Would you be willing to participate in this study if the
payment for your participation was $50?
YES 1
NO 2
YES 1
NO 2
CONCLUDING STATEMENT
Thank you very much for your time, (Mr./Mrs./Ms.) (RESPONDENT'S LAST NAME). That concludes our interview
for today. We really appreciate your willingness to answer our questions and to participate in this important study.
You've been very helpful. Is there anything else you think we should know that has not been asked? Thank you again
for taking part in this important study.
COLLECT THE CHILD ACTIVITY DIARY AND FOOD DIARY AND REVIEW THE DIARIES WITH THE
RESPONDENT. CORRECT THE INFORMATION IN THE DIARIES IF NECESSARY. PICK UP FOOD AND URINE
SAMPLES AS WELL AS COOLERS. CHECK THE SAMPLES AND LABELS. VERIFY THE LABELS WITH THE
RESPONDENT. COMPLETE THE CHECKLIST. PAY THE RESPONDENT $60 AND ASK FOR A RECEIPT.
COMMENTS?
COMPLETE INTERVIEW INFORMATION ON THE FRONT PAGE OF THIS QUESTIONNAIRE.
REVIEW THE ENTIRE QUESTIONNAIRE FOR MISSING INFORMATION OR APPARENT ERRORS AS SOON AS
POSSIBLE.
PAGE 6
09/22/95
-------
HERL-RTP-0-578 TECHNICAL REPORT DATA
1. REPORT NO.
600/R-98/163b
2
3.RECIPIENTS ACCESSION NO.
4. TITLE AND SUBTITLE
Polycyclic Aromatic Hydrocarbon Exposure of Children in Low-
Income Families
Vuliune II: Appendices A through F
5.REPORT DATE
6 .PERFORMING ORGANIZATION CODE
7. AUTHOR(S)
Jane C. Chuang et al.
8.PERFORMING ORGANIZATION
REPORT NO.
9. PERFORMING ORGANIZATION NAME AND ADDRESS
Battelle Memorial Institute
505 King Avenue
Columbus, Ohio 43201
10.PROGRAM ELEMENT NO.
Projects E0608 and E0460
11. CONTRACT/GRANT NO.
Cooperative Agreement CR822073
and Contract 68-D4-0023
12. SPONSORING AGENCY NAME AND ADDRESS
National Exposure Research Laboratory
U. S. Environmental Protection Agency
Research Triangle Park, NC 27711
13 .TYPE OF REPORT AND PERIOD
COVERED
Published Report, 12/93-12/97
14. SPONSORING AGENCY CODE
EPA/600/09
15. SUPPLEMENTARY NOTES
16. ABSTRACT
In four small studies, tlie exposures of preschool children lo polycyclic aromatic hydrocarbons (PAH) Uirough dietary
ingestion, nondietary ingestion, and inhalation were examined. Data were combined to estimate PAH exposures and
potential doses for children in 24 families. In air, indoor PAH levels were higher than those outdoors, and in smokers'
homes compared to nonsmokers' homes. Outdoor air PAH levels were higher in inner city compared to rural areas. The
relative concentrations of PAH in dust and soil were house dust > entry way dust > pathway soil. The PAH
concentrations in adults' food were higher than those in children's food. However, children's potential daily doses of PAH
were higher than those of adults in the same households. Inhalation was an important pathway for children's exposure to
total PAH, but dietary and nondietary ingestion were more important for exposure to B2 PAH (probable human carcino-
gens). Statistical analysis suggested that inner city children have higher exposure to B2 PAH than do rural children.
17. KEY WORDS AND DOCUMENT ANALYSIS
a. DESCRIPTORS
b. IDENTIFIERS/ OPEN ENDED
TERMS
c.COSATI
18. DISTRIBUTION STATEMENT
19. SECURITY CLASS (This
Report)
Unclassified
21.NO. OF PAGES
20. SECURITY CLASS (This Page)
Unclassified
22. PRICE
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