Index

A

Abortion, spontaneous, 36, 37, 133–134, 190, 192–193

Acceptable Daily Intakes, 213–214

Agency for Toxic Substances and Disease Registry (ATSDR), 2, 5, 7, 8, 26, 45–47, 65–75, 81–83, 84–85, 94–97, 212–213, 257, 260

biologic markers, 230–231

funding, 65, 85, 92, 93, 95

health assessments, 66, 83, 95, 103–104, 119

priority substances, 8, 104, 106, 108–109, 146–148

states, assistance for, 92–93, 97, 259, 269

Agricultural chemicals, see Nitrates;

Pesticides

Airborne toxins, 8, 9–12

birth defects, 11, 194

cancer, general, 11, 160–162, 168, 173

case-control studies, 168

children, effects on, 162–164, 166, 167

computer technology for assessing, 11, 169

cost of monitoring, 172

cross-sectional studies, 11, 157, 159–161, 163–165, 169, 262

dose-response assessment, 164, 170

exposure assessment, 12, 117, 118, 157–173, 125, 137, 262–264

federal law, 75, 180, 261

historical perspectives, 44

individual studies, 165–167, 160

indoor, 117–118, 157, 169–171, 263

lead, 212, 235

local studies, 163–165

longitudinal studies, 11–12, 157, 158–159, 161–163, 173

lung cancer, 38–39, 40, 41, 42, 160, 181–182, 187

morbidity studies, 11, 157, 156–169

neurotoxic effects, 12, 162, 166, 213, 225

symptomatology, 164–165, 170, 173

volatilization, 15, 18, 117, 140–141, 179, 195, 264

Air conditioning, 170



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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1 Index A Abortion, spontaneous, 36, 37, 133–134, 190, 192–193 Acceptable Daily Intakes, 213–214 Agency for Toxic Substances and Disease Registry (ATSDR), 2, 5, 7, 8, 26, 45–47, 65–75, 81–83, 84–85, 94–97, 212–213, 257, 260 biologic markers, 230–231 funding, 65, 85, 92, 93, 95 health assessments, 66, 83, 95, 103–104, 119 priority substances, 8, 104, 106, 108–109, 146–148 states, assistance for, 92–93, 97, 259, 269 Agricultural chemicals, see Nitrates; Pesticides Airborne toxins, 8, 9–12 birth defects, 11, 194 cancer, general, 11, 160–162, 168, 173 case-control studies, 168 children, effects on, 162–164, 166, 167 computer technology for assessing, 11, 169 cost of monitoring, 172 cross-sectional studies, 11, 157, 159–161, 163–165, 169, 262 dose-response assessment, 164, 170 exposure assessment, 12, 117, 118, 157–173, 125, 137, 262–264 federal law, 75, 180, 261 historical perspectives, 44 individual studies, 165–167, 160 indoor, 117–118, 157, 169–171, 263 lead, 212, 235 local studies, 163–165 longitudinal studies, 11–12, 157, 158–159, 161–163, 173 lung cancer, 38–39, 40, 41, 42, 160, 181–182, 187 morbidity studies, 11, 157, 156–169 neurotoxic effects, 12, 162, 166, 213, 225 symptomatology, 164–165, 170, 173 volatilization, 15, 18, 117, 140–141, 179, 195, 264 Air conditioning, 170

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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1 Alaska, 131 American Petroleum Institute, 46, 65 Analytic studies, 29 Angiosarcoma, 11, 38, 160–161 Animal studies, 46–47, 143 air pollution exposure, 12 ATSDR, 46 biologic markers, 229, 233–234, 238 food-borne toxins, 207, 208 sentinels, 17, 214–215 soil pollution, 17, 204, 214–215 waterborne toxins, congenital defects, 194 Aquifers, see Groundwater Arizona Arsenic, 107, 131, 160, 184, 191, 210–211 Asthma, 171–172, 264 Australia, 14, 189 B Benzopyrene, 119 Beryllium, 164 Biologic markers, 3, 17–19, 47, 116, 120, 121–123, 124, 128, 130, 219–249 animal studies, 229, 233–234, 238 birth defects, 229 blood, 18, 206, 222, 223, 224, 235, 236, 243–244 carcinogens, 18, 232–233, 234, 238 causal inference and, 220, 236–239 children, 224 classification of, 219–220, 246 defined, 17, 219–223 developmental toxins, 162–163 DNA adducts, 163, 222, 223, 232, 230, 236, 239, 241–242 dose response and, 221, 224, 229, 235, 238, 241, 242, 243–244 evaluation issues, 220, 236–239, 247 exposure assessment, general, 17, 239, 241–242 immune system, 220, 223, 233, 236, 241, 242–245 liver, 18, 223–224, 231–232 methodology, general, 236–239, 244–245 models, 239, 248 mutagens, general, 229–230, 234 neurotoxins, 18, 224, 225, 226–229 occupational toxicology, 231–236 PCBs, 18, 224, 230, 232–233 protein adducts, 220, 222, 230, 233–234, 242 reproductive toxicology, 18–19, 229, 233 respiratory disease, 245–246 statistical approaches, 220, 236–239, 247, 248 Superfund sites, 224–225 TCE, 18, 224–225, 229, 230, 236 urine, 224, 225, 235, 236 Birth defects, 36, 38, 133–134, 139, 140 airborne toxins, 11, 194 biologic markers, 229 waterborne toxins, 14–15, 180, 189–197, 265 Birth weight, 20, 190, 198–199, 209–210, 224 Blackfoot disease, 184 Bladder cancer, 13–14, 85, 139, 161, 181, 183–184, 188, 198, 222, 265, 268 Blood biologic markers, 18, 222, 223, 224, 235, 236, 243–244 food-borne toxins, 206 Blood pressure, 18, 184, 224 Body weight at birth, 20, 190, 198–199 children, exposure per unit of, 15, 208, 224 soil-borne toxins, 17 Bone disease, 206 Breast cancer, 14, 185 British Clean Air Act, 44 C Cadmium, 195, 206 California, 10, 37, 78, 94, 107, 110–111, 132–136, 167, 187, 191–193, 198, 214, 259, 266 Canada, 137–138, 159, 164, 182, 213 Cancer and carcinogens, 30, 36–38, 46, 139, 209

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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1 airborne toxins, cancers other than lung, 11, 160–162, 168, 173 angiosarcoma, 11, 38, 160–161 biologic markers, 18, 232–233, 234, 238 bladder, 13–14, 85, 139, 161, 181, 183–184, 188, 198, 222, 265, 268 breast, 14, 185 colon, 181, 183, 232 esophageal, 188–189 food-borne toxins, 207–208 gastric cancer, 187 gender differences, 14, 140–141, 160, 182–183, 185, 187 leukemia, 41, 131–133, 139, 140–141, 168, 185–187, 198 lung, 38–39, 40, 41, 42, 160, 181–182, 187 multinational study, 38–39 rectal, 181 soil-borne toxins, 215 testicular, 215 waterborne toxins, 13–14, 110, 180, 181–189, 198, 265–266 Case-control studies, 48–54 , 121, 132–133 airborne toxins, 168 soil-borne pollutants, 215 waterborne toxins, 13–14, 180, 183–184, 187, 188–189, 191 Causal inference, 29–42, 33, 35–42, 113 biologic markers, 220, 236–239 effect size, 32 legal issues, 43–44 time dimension, 40, 35, 36, 40–41 water pollution, disease and, 180, 186 see also Statistics and statistical approaches Centers for Disease Control, 92, 131 biologic markers, 230-231 National Center for Health Statistics, 169 waterborne toxins, congenital defects, 193–194 Chemical Manufacturers Association, 46, 65 Children, 68, 85, 131–132, 268 airborne toxins, 162–164, 166, 167 biologic markers, 224 birth weight, 20, 190, 198–199 lead poisoning, 162, 166 pesticides, 16 sex ratio, births, 160 soil-borne toxins, 203, 211, 212, 215, 266 waterborne toxins, 185–186, 190 weight, exposure per unit, 15, 208, 224 see also Birth defects Chlorinated hydrocarbons, 196, 215 Chlorination, 13–15, 180, 182, 183–184, 195, 225–226 Chronic disease, general, 25, 46, 47, 106 waterborne toxins and, 180, 194–195 see also specific diseases and organs Chronic obstructive pulmonary disease, 245–246, 268 Cities Hazardous-waste Site Discovery Plan, 77 Classification biologic markers, 219–220, 246 error in, 33, 35, 38, 130, 141, 181, 183, 191, 207, 222–223, 246, 248 Standard Industrial Classification, 140 Clean Air Act, 75, 180, 261 Clean Water Act, 180 Cohort studies, 121 Colon cancer, 181, 183, 232 Colorado, 212 Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA),6, 45, 46, 61–65, 102 Information System (CERCLIS), 62–64, 78, 80, 83–84, 95, 102–103, 258, 259 see also National Priorities List; Superfund sites Computer technology air pollution mortality, 11, 169 data bank analyses, 169, 172 simulations, 47 Confidence intervals, 32, 42 Congressional Research Service, 45 Cost and cost-effectiveness, 62, 257

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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1 airborne toxins, monitoring, 172 remediation, 77, 78 site assessment, 95, 257 see also Funding Court cases, see Litigation Cross-sectional studies, 48–54 , 121 airborne toxins, 11, 157, 159–161, 163–165, 169, 262 biologic markers, 238 waterborne toxins, 194–195, 196 D Data bases and data banks analyses of, 169, 172 community, 97 disease registries, 37, 45–47, 70, 181–182, 188 exposure registries, 8, 75, 97 national site inventory, 6, 8, 76–77, 93, 94, 96, 268–269 NPL, 7, 9, 64, 66, 67–68, 70, 71–74, 75, 77, 79, 80, 81, 83, 93, 95, 103–105, 108–109, 119, 144–146, 187, 211, 258, 259, 260 DDT, 205, 206–207 Demography of groundwater use, 5, 10, 61, 259 minorities, 26, 133, 183, 244 population-based studies, 168–169, 183, 248 proximity to waste sites, 2, 26, 67, 68, 103, 114–116, 137–138, 257 and research methodology, 29, 40, 127 rural areas, 5, 61 urban areas, 77, 160, 172, 179, 185, 212, 262, 267 Denmark, 170 Descriptive studies, 28–29 causal inference and, 113 water pollution, 13, 14, 180 Diary records, 12, 166–167, 170, 173, 264 Dibromochloropropane (DBCP), 110, 133, 187, 191, 233 Dichloroacetic acid, 225, 229 Dichloroethylene, 140, 194 Dioxin, 207–208, 209 Disease occurrence, general, see Chronic diseases; Mortality and morbidity; specific diseases andorgans Disease registries, 37, 45–47, 70, 181–182, 188 Distance factors, see Spatial factors DNA adducts, 163, 222, 223, 230, 232, 236, 239, 241–242 Dose response, 35, 40–41, 64, 120–121, 122–123, 131 airborne toxins, 164, 170 biologic markers, 221, 224, 229, 235, 238, 241, 242, 243–244 food-borne toxins, 206, 208 odors and, 135 waterborne toxins, 184, 194 E Eastern Europe, 27, 197 Ecologic studies, 121, 132–133, 160, 187, 191, 222 Economic issues, see Cost and cost-effectiveness; Funding Effect size, 32 Elderly persons, 68, 166 Emphysema, 245–246 Environmental Defense Fund, 46, 65 Environmental Epidemiology, 27–28 Environmental Protection Agency (EPA), 2, 26, 45, 66, 75, 103 biologic markers, 239 policy, 7, 268 priority substances, 8, 104, 106, 108–109, 146–148 risk assessments, 64, 66, 82, site assessment, 107 site discovery, 76–78, 259, 268 site remediation, 81–83 TCE limits, 18 TEAM, 117, 124, 128 water quality control, 179, 185–186 see also Superfund sites Error of measurement, 11, 32, 33–34, 36–37, 191 confidence intervals, 32, 42 cross-sectional studies, 163 exposure assessment, 127–128, 141, 163

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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1 misclassification, 33, 35, 38, 130, 141, 181, 183, 191, 207, 222–223, 246, 248 recall bias, 11, 12, 33, 135, 164–165, 263–264, 268 Esophageal cancer, 188–189 Ethical issues, 29, 247–248 Evaluation issues, 2, 42 biologic markers, 220, 236–239, 247 exposure assessment, 8–10, 20, 257–258 site assessment, 7–8, 20, 96, 257–258 Europe, 207 Eastern Europe, 27, 197 Experimental methods, 45, 46–47 biologic markers, 237 see also Animal studies Exposure assessment, 8–10, 19, 61, 101–148, 259–264 airborne toxins, 12, 117, 118, 157–173, 125, 137, 262–264 biologic markers, 17, 239, 241–242 body weight, exposure per unit, 15, 208, 224 causal inference, 29–42, 33, 35–42, 43–44, 113, 220, 236–239 defined, 101, 219, 220, 239 disease, general, and, 29–34, 40–41 error in, 127–128, 141, 163 evaluation issues, 8–10, 20, 257–258 federal activities, 26, 64–65, 75–78 ground water toxins, 107, 110–111, 112–113, 116, 117, 125, 130–134, 142, 143, 259 health risk assessments, 4, 30, 35, 66, 83, 95, 103–104, 119 historical perspectives, 102–103 local actions, 131–143 methodology, general, 102, 117, 119–144 models, 65, 86, 118–119, 123, 124, 128–129, 134 multiple exposures, 39, 102, 114, 116, 157–158, 160, 208, 213, 232, 246, 267 PCBs, 16 potential exposures, 4, 8, 7, 76–78 registries, 8, 75, 97 risk assessment, 4, 30, 35, 45, 64, 66, 82, 86 routes of exposures, general, 117–119, 203 sentinel health events, 85, 97, 268 statistics on, limitations of, 126–131 surrogate measures, 120, 124, 131–142 time factors, 102, 116, 132, 134 waterborne toxins, 131–134, 135, 139–142 F Federal Emergency Management Agency, 70 Federal government, 21, 60, 62–86, 96–98, 258–259 exposure assessment, 26, 64–65, 75–78 local actions, cooperation with, 8 regulations, 1, 2, 5–8, 26, 60, 180 remediation programs, 62, 63–64, 80–83 site assessment, 62–63, 65–75, 79–80, 84, 93–95, 107 states, cooperation with, 7, 8, 69–70, 75, 78, 85, 92–93, 97, 259, 268, 269 technical assistance, 7, 8, 268, 269 see also Agency for Toxic Substances and Disease Registry; Environmental Protection Agency; Laws, specific federal; Superfund sites; other specific agencies Federal Register, 83 Federal Water Pollution Control Act, 179, 180 Finland, 163, 171 Fish consumption, 15, 16, 19, 203, 204–208, 214, 267 Follow-up studies, 161–162 Food-borne toxins animal studies, 207, 208 blood, 206 carcinogens, 207–208 contaminants in, general, 15–17, 27, 203, 204–208, 213–214, 266–267 dose-response assessment, 206, 208 fish, 15, 16, 19, 203, 204–208, 214, 267 Hispanics, 133

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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1 international efforts, 213–214 malnutrition, 189 meat, 16, 207 milk, 207 neurotoxic effects, 205, 208, 209 pesticides, 214 reproductive toxicology, 205, 208, 209 see also Fish consumption Food and Drug Administration, 213–214 Formaldehyde, 170–171, 243–244 Funding, 5–6, 19, 61, 93 ATSDR, 65, 85, 92, 93, 95 research, 8, 85–86, 93–94, 97, 257 site discovery and assessment, general, 76–77, 95, 257, 268 site-specific, 87–91 state-level, 85, 92–93 see also Superfund G Gastric cancer, 187 Gender differences cancer, 14, 140–141, 160, 182–183, 185, 187 kidney disease, 195 sex ratio, births, 160 see also Men; Women Genotoxicity COPD, 245–246 DNA adducts, 163, 222, 223, 230, 232, 236, 239, 241–242 mutagens, general, 229–230, 234 protein adducts, 220, 222, 230, 233–234, 242 see also Birth defects; Reproductive toxicology Geographic factors, 121 air pollution-related mortality, 11 see also Rural areas Government role, see Federal government; Local action; Regulations; State-level actions Great Lakes, 16 Groundwater toxins, 5, 8, 9, 10, 13, 41, 118, 179, 184–199, 267 demographic factors, 5, 10, 61, 259 exposure assessment, 107, 110–111, 112–113, 116, 117, 125, 130–134, 142, 143, 259 federal law, 75, 180 pesticides, 16, 46, 110, 206–208, 214 remediation, 20, 81 reproductive toxicology, 14 rural areas, 5, 61 state-level actions, 92, 110–113, 259 see also Water pollution Guidelines on Studies in Environmental Epidemiology, 27 H Halogenated hydrocarbons, 13 Hazard Ranking System, 79, 80 Health risk assessments, 4, 30, 35, 114, 119–120, 142 ATSDR, 66, 83, 95, 103–104, 119 EPA, 64, 66, 82, 239 Heart diseases and disorders, 15, 20, 139, 140, 191, 192, 193–193, 194, 265 Hispanics, 133 Historical perspectives, 25–26, 27–28 biologic markers, 220 context of study, 44–45 diary studies, 166 exposure assessment, 102–103 site assessment, 69, 102–103 vinyl chloride, 160–161 waterborne toxins, 179–180 see also Retrospective studies Hospital-based studies, 168–169, 171 I Illinois, 188 Immune system and immunology asthma, 171–172, 264 biologic markers, 220, 223, 233, 236, 241, 242–245 waterborne toxins, 15, 199 India, 159 Individual studies, 120, 121, 128, 131–142 airborne toxins, 165–167, 160

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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1 diary records, 12, 166–167, 170, 173, 264 waterborne toxins, 181 Indoor air pollution, 117–118, 157, 169–171, 263 Institute of Medicine, 16, 20–21 International Labor Organization, 27 International perspectives, 27–28 air pollution, symptoms, 12 Europe, 27, 197, 207 food-borne toxins, 212, 213–214 smoking and cancer, 38–39 see also Foreign countries; specific countries Iowa, 181–182, 183 Israel, 163 Itai-Itai byo, 206 J Japan, 16, 205, 206 K Kidney disease, 195, 236 L Laws, specific federal British Clean Air Act, 44 Clean Air Act, 75, 180, 261 Clean Water Act, 180 Federal Water Pollution Control Act, 179, 180 Resource Conservation and Recovery Act, 75, 103, 258 Safe Drinking Water Act, 75, 261 Superfund Amendment and Reauthorization Act, 46, 62, 65-66, 80 Toxic Substances Control Act, 45, 261 see also Comprehensive Environmental Response, Compensation, and Liability Act Lead, 123, 162, 166, 195, 208, 211–213, 222, 235, 267 Legal issues, 27, 197–198, 247–248, 265 see also Litigation Legislation, 5, 6, 26, 44–45, 47, 60, 269 state-level, 60, 86 see Laws, specific federal Leukemia, 41, 131–133, 139, 140–141, 168, 185–187, 198 Lipophilic toxins, 16, 214, 267 Litigation, 2–3, 27, 42–44, 46, 47, 65, 197–198, 248, 265 Liver and liver diseases, 15, 139, 141–142 angiosarcoma, 11, 38, 160–161 biologic markers, 18, 223–224, 231–232 soil-borne toxins, 215 waterborne toxins, 184, 185, 195–196, 199 Local actions, 2, 8, 69 airborne toxins, morbidity studies, 163–165 exposure assessment, specific sites, 131–143 Longitudinal studies, 143 air pollution, 11–12, 157, 158–159, 161–163, 173 prospective studies, 121, 137–138, 161, 162, 238 time series analysis, 29, 173 waterborne toxins, 181 see also Retrospective studies Love Canal, 17, 44, 138, 162, 184–185, 190–191, 196–197, 198–199, 214, 266 Lung cancer, 38–39, 40, 41, 42, 160, 181–182, 187 Lymphoma, 185, 198, 241 M Massachusetts, 18, 41, 131–132, 137, 185–186, 188, 189–190, 224 Mathematical models, 128–129 Maximum Contaminant Levels, 18, 111 Meat, 16, 207 Memory, 208 Men, 181–182, 233 see also Gender differences Mercury, 16, 203, 205, 236 Meta-analyses, 4–5, 39, 42, 97, 198, 261, 262, 266

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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1 Methodology air pollution research, 10–12 analytic studies, 29 biologic markers, 236–239, 244–245 causal inference, 29–42 cohort studies, 121 demographic factors, 29, 40, 127 descriptive studies, 13, 14, 28–29, 113, 180 ecologic studies, 121, 132–133, 160, 187, 191, 222 experimental methods, 45, 46–47, 237 exposure measurement, 102, 117, 119–144 follow-up studies, 161–162 misclassification, 33, 35, 38, 130, 141, 181, 183, 191, 207, 222–223, 246, 248 for policy decisions, 7–8, 268–269 population-based studies, 168–169, 183, 248 prevalence studies, 29 problems, general, 29, 126–131 prospective studies, 121, 137–138, 161, 162, 238 retrospective studies, 42, 48–54, 101, 134–135, 184–187, 238 sampling, 81–82, 126, 127, 128 site assessment, 8, 96–97, 259–260, 269 standards, 27–28, 39, 70 of study, 2, 26 see also Animal studies; Case-control studies; Cross-sectional studies; Longitudinal studies; Statistics and statistical approaches Michigan, 44, 205 Milk, 207 Minamata disease, 205 Minorities, 26, 133, 183, 244 Mixed chemical exposure, see Multiple exposures Models biologic markers, 239, 248 computer simulations, 47 exposure, indoor air pollution, 118 mathematical, 128–129 site discovery and assessment, 81, 94 toxicokinetic, 123 see also Animal studies Montana, 211 Motor functions, 16, 197, 225 Mortality and morbidity, 35, 137–138 air pollution-related, 11, 157, 156–169 disease occurrence, general, 4, 29, 31, 33, 36, 40–41 disease registries, 37, 45–47, 70, 181–182, 188 historical perspectives, 25 sentinel health events, 85, 97, 268 water pollution-related, general, 14, 181–189 Multiple exposures, 39, 102, 114, 116, 157–158, 160, 208, 213, 232, 246, 267 Multivariate analysis, 182 N National Cancer Institute, 13–14, 188 National Center for Health Statistics, 169 National Health and Nutrition Survey, 164 National Institute for Environmental Health Sciences (NIEHS), 8, 70, 85, 86, 209–210, 269 National Priorities List (NPL), 7, 9, 64, 66–68, 70, 71–74, 75, 77, 79, 80, 81, 83, 93, 95, 103–105, 108–109, 119, 144–146, 187, 211, 258, 259, 260 National Research Council, 2, 20, 117, 124, 129, 203, 215, 219 Neurotoxic effects, 20, 104, 106, 123 airborne toxins, 12, 162, 166, 213, 225 biologic markers, 18, 224, 225, 226–229 food-borne toxins, 205, 208, 209 lead, 162, 166, 213 memory, 208 motor functions, 16, 197, 225 PCBs, 16, 209–210

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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1 waterborne toxins, 14, 15, 18, 189, 197, 199 New Jersey, 14, 41, 128, 165, 185, 186–187 New York, 69–70, 86–87, 138, 185 Love Canal, 17, 44, 138, 162, 184–185, 190–191, 196–197, 198–199, 214, 266 Nicaragua, 197 Nitrates, 14, 85, 179, 268 Nonconventional pollutants (NCPs), 10 Nonpoint source pollution, 107, 110–111, 260 see also Nitrates; Pesticides North Carolina, 14, 188, 210, 213, 265 O Occupational toxicology, 169–171, 137–138, 141, 160 biologic markers, 231–236 dioxin, 207–208 International Labor Organization, 27 lead, 213 PCBs, 209 Standard Industrial Classification, 140 Odors, 134–135, 141 Office of Technology Assessment (OTA), 9, 45, 76, 77, 103, 258 Ouch-ouch disease, 206 Ozone, 164 P Peer review, 15, 198 Pennsylvania, 139, 142 Personal studies, see Individual studies Pesticides, 16, 46, 110, 179, 195, 203, 204, 205, 206–208, 209, 214, 233–234, 261 Poland, 241 Polychlorinated biphenyls (PCBs), 16–17, 204–205, 207, 208–210 biologic markers, 18, 224, 230, 232–233 neurotoxic effects, 16, 209–210 Population factors, see Demography; Public opinion Population-based studies, 168–169, 183, 248 Potential exposures, 4, 7, 8, 76–78 Prevalence studies, 29 Priority substances, 8, 104, 106, 108–109, 146–148 Private sector ATSDR funding, 92 research standards, 70 Prospective studies, 121, 137–138, 161, 162 biologic markers, 238 Protein adducts, 220, 222, 230, 233–234, 242 Public health advisories, 70, 71–74, 205, 213 Public Health Service, 179 Public opinion, 1, 29, 60–61, 256 recall bias, 11, 12, 33, 135, 164–165, 263–264, 268 R Racial factors, 183 see also Minorities Radioactive pollutants, 181–182 Recall bias, 11, 12, 33, 135, 164–165, 263–264, 268 Rectal cancer, 181 Regulations, 1, 2, 5–8, 26, 60, 180 see also Standards Remediation programs, 6, 8, 31, 97 cost of, 77, 78 federal, 62, 63–64, 80–83 groundwater contamination, 20, 81 site closure, 8, 92 state actions, 86, 92 Reproductive toxicology, 35, 36, 41, 68, 133–134 abortion, spontaneous, 36, 37, 133–134, 190, 192–193 biologic markers, 18–19, 229, 233 birth weight, 20, 190, 198–199, 209–210, 224 food- and soil-borne toxins, 205, 208, 209 mercury, 16, 205

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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1 sex ratio, 160 sperm, 16, 19, 205, 220, 233–234 waterborne toxins, 14, 185, 189–195 see also Birth defects Research, general, 28–30, 269 funding, 8, 85–86, 93–94, 97, 257 recommendations, 8, 26–27, 28–30 state-level, 93 tabular list of studies, 48–54 see also Methodology Resource Conservation and Recovery Act, 75, 103, 258 Respiratory disease, 264, 268 asthma, 171–172, 264 biologic markers, 245–246 emphysema, 245–246 see also Lung cancer Retrospective studies, 42, 101 biologic markers, 238 odors as surrogates, 134–135 specific sites, 48–54 waterborne toxins, 184–197 Risk assessment, 4, 30, 35, 45, 64, 66, 82, 123, 142 ATSDR, 66, 83, 95, 103–104, 119 EPA, 64, 66, 82, 239 state-level, 86 see also Biologic markers Rural areas, groundwater, 5, 61 S Safe Drinking Water Act, 75, 261 Sampling, 81–82, 126, 127, 128 Saudi Arabia, 188–189 Sex differences, see Gender differences Sick building syndrome, see Indoor air pollution Site assessment, 7–8, 20, 62–63, 65–75, 79–80, 84, 94–95, 103–106, 120, 261–262, 268, 269 cost of, 95, 257 detection of toxins, 213–215 evaluation issues, general, 7–8, 20, 96, 257–258 federal government, general, 62–63, 65–75, 79–80, 84, 93–95, 107 funding, 76–77, 95, 257, 268 historical perspectives, 69, 102–103 methodology, general, 8, 96–97, 259–260, 269 NPL, 7, 9, 64, 66, 67–68, 70, 71–74, 75, 77, 79, 80, 81, 83, 93, 95, 103–105, 108–109, 119, 144–146, 187, 211, 258, 259, 260 specific sites, 48–54, 69, 70, 71–74, 131–142 state actions, 69–70, 76, 86, 92, 268 Site closure, 8, 92 Site discovery, 7, 258–259 EPA, 76–78, 259, 268 funding, 76–77, 95, 257, 268 models, 81, 94 national inventory, 6, 8, 76–77, 93, 94, 96, 268–269 state-level, 86, 92 Skin diseases, 104, 106 Smoking, 38–39, 40, 41, 42, 182, 187, 232–233 Soil pollution, 8, 15–17, 143–144, 184–185, 203–215, 266–267 animal studies, 17, 204, 214–215 cancer, 215 case-control studies, 215 children and, 203, 211, 212, 215, 266 liver disease, 215 reproductive toxicology, 205, 208, 209 volatile organic compounds, 118, 195 Spatial factors population proximate to waste sites, 2, 26, 67, 68, 103, 114–116, 137–138, 257 sampling, 126, 127 Sperm, 16, 19, 205, 220, 233–234 Standard Industrial Classification, 140 Standards Acceptable Daily Intakes, 213–214 biologic markers, 244 Maximum Contaminant Levels, 18, 111 research methodology, 27–28, 39, 70 site sampling, 81–82, 268 TCE limits, 18 State-level actions, 21, 47, 55, 60, 86–93, 258–259

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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1 ATSDR assistance, 92–93, 97, 259, 269 federal cooperation with, 7, 8, 69–70, 75, 78, 85, 92–93, 97, 259, 268, 269 funding, 85, 92–93 groundwater contamination, 92, 110–113, 259 health departments, information from, 2 legislation, 60, 86 NPL sites, 103 regulations, 2, 5–8, 60 remediation efforts, 86, 92 research, 93 risk assessment, 86 site assessment, 69–70, 76, 86, 92, 268 see also Demography; specific states Statistics and statistical approaches, 42, 256 biologic markers, 220, 236–239, 247, 248 confidence intervals, 32, 42 disease registries, 37, 45–47, 70, 181–182, 188 effect size, 32 exposure data, limitations, 126–131 exposure registries, 8, 75, 97 multivariate, 182 national site inventory, 6, 8, 76–77, 93, 94, 96, 268–269 number of sites, 9 power, 36 recall bias, 11, 12, 33, 135, 164–165, 263–264, 268 significance assessment, 2, 32–34, 38–39, 43, 185 volume of waste generated, 1–2, 26, 60, 102 see also Error of measurement Superfund Amendment and Reauthorization Act (SARA), 46, 62, 65–66, 80 Superfund sites, 1, 5, 6, 10, 13, 15, 19, 61–86 , 92 air pollution, 161 biologic markers, 224–225 lead, 212–213 legislation for, 45, 46 National Priority List (NPL), 7, 9, 64, 66, 67–68, 70, 71–74, 75, 77, 79, 80, 81, 83, 93, 95, 103–105, 108–109, 119, 144–146, 187, 211, 258, 259, 260 population proximate to, 2, 26, 67, 68, 103, 114–116, 137–138, 257 remediation, 80–83 site discovery funding, 77 torts, 43 Surface water, 8, 20–21, 179, 180, 182 see also Water pollution Surrogate measures, 120, 124, 131–142 Sweden, 160 Symptomatology, 4, 31, 70, 130, 137, 263 airborne toxins, 164–165, 170, 173 diary records, 12, 166–167, 170, 173, 264 nonspecific, 135–136 recall bias, 11, 12, 33, 135, 164–165, 263–264, 268 T Taiwan, 184, 208, 224 Taxonomy, see Classification Technical assistance, 7, 8, 268, 269 Tennessee, 18, 141, 214 Testicular cancer, 215 Tetrachlorethane, 166, 188 Time factors causation and, 40, 35, 36, 40–41 exposure assessment, 102, 116, 132, 134 see also Longitudinal studies; Retrospective studies Time series analysis, 29, 173 Torts, see Litigation Total Diet Study, 214 Total Exposure Assessment Methodology, 117, 124, 128 Toxic Substances Control Act, 45, 261 Toxicokinetics, 123 Trichloroethane (TCA), 133–134, 181 Trichloroethylene (TCE), water pollutant, 13, 14–15, 18, 118, 139–140, 142, 194, 197, 265, 266

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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1 biologic markers, 18, 224–225, 229, 230, 236 Trihalomethanes (THMs), 13, 180, 181–184, 184, 265 U United Kingdom, 41, 44, 159 United Nations Environmental Program, 27 Urban areas, 77, 160, 172, 179, 185, 212, 262, 267 Urine, 224, 225, 235, 236 Utah, 167, 168, 172 V Vietnam, 215, 233 Vinyl chloride, 11, 38, 160–161, 205 Volatile organic compounds (VOCs), 13, 14–15, 18, 118–119, 123, 128, 131–134, 140–142, 158, 179, 196, 263 see also specific compounds Volatilization, 15, 18, 117, 140–141, 179, 195, 264 W Water pollutants, 9–10, 13–15, 19, 125, 158, 179–199, 264–266 animal studies, 194 birth defects, 14–15, 180, 189–197, 265 cancer, 13–14, 110, 180, 181–189, 198, 265–266 case-control studies, 13–14, 180, 183–184, 187, 188–189, 191 causal inference, 180, 186 CDC, 193–194 children and, 185–186, 190 chlorination, 13–15, 180, 182, 183–184, 195, 225–226 chronic diseases, general, 180, 194–195 cross-sectional studies, 194–195, 196 demographic factors, 5, 10, 61, 259 descriptive studies, 13, 14, 180 dose-response assessment, 184, 194 EPA, 179, 185–186 exposure analysis, 131–134, 135, 139–142 fish, bioaccumulation, 15, 16 immune system, 15, 199 individual studies, 181 liver disease, 184, 185, 195–196, 199 morbidity and mortality, general, 14, 181–189 neurotoxic effects, 14, 15, 18, 189, 197, 199 reproductive toxicology, 14, 185, 189–195 TCE, 13, 14–15, 18, 118, 139, 140, 139–140, 142, 194, 197, 224–225, 229, 230, 236, 265, 266 volatilization, 15, 18, 117, 140–141, 179, 195, 264 see also Groundwater; Surface water Weight, see Body weight Women cancer, 14, 140–141, 183 kidney disease, 195 see also Gender differences World Health Organization, 27, 212