well developed in fetuses or babies—human fetuses have only 20-50% of the DNA repair enzyme activity of adults; if this hypothesis is true, this population may be particularly sensitive to carcinogens (Kimmel and Buelke-Sam 1994). Much greater absorption of lead through the gastrointestinal tract in children (30%) than adults (6%) has been demonstrated (Ross et al. 1992).

The normal decline of many physiologic functions (such as immunologic responses) with aging might make the elderly more susceptible to various pollutants. Increased mortality due to both pulmonary and cardiovascular disease has been documented when pollution (for example, with particles and CO) has been only slightly increased, even when the levels of pollution remained within EPA guidelines (see earlier discussion in this chapter). However, there are substantial uncertainties about whether the correlations between measured pollution indicators (PM, CO, etc.) and mortality reflect cause and effect.

Some behavior patterns of children result in their receiving greater doses of pollutants than adults who experience the same environment. Running and playing outdoors lead to higher breathing rates and hence potentially greater intake of airborne pollutants; this might also affect adults who are working hard or who exercise regularly. Young children engage in a high degree of hand-to-mouth behavior; videotapes have documented about 40 hand-to-mouth actions per hour among young children (Ross et al. 1992). Thus, contaminated dirt and dust might enter children's systems to a greater degree than adults.

Sensitive populations can include those whose health is already compromised. For example, asthmatics respond to SO2 at lower concentrations than nonasthmatics (see section on Acidic Aerosols and Gases). African-Americans are more likely than whites to have hypertension and kidney disease and therefore could be more susceptible to pollutants, such as lead, which adversely affect the circulatory and renal systems (see section on Lead). Similarly, some people may be much more sensitive to the effects of some chemical exposures because of pre-existing conditions brought on by exposures to other agents (possibly including other chemicals). For example, people who have experienced a hepatitis B virus infection appear to be at greatly increased risk of cancer due to aflatoxin B exposure, compared with those who have not had hepatitis B infection.

Variability in diet can be fairly extreme (e.g., vegan diets, which excludes all animal products, versus average American fare), resulting in substantial differences in the intakes of some pollutants (NRC 1993). Vegans, for example, should have substantially lower exposure to PCDDs and PCDFs, since the majority of the intake of these materials in the average American diet comes from their presence in animal fats. In addition, dietary deficiencies may also play a role in increasing the variability of uptake of certain pollutants. For example, iron deficiency can result in higher uptake of lead in the diet, while calcium deficiency might affect lead excretion (as observed in animal models) (ATSDR 1997b).

It has been observed that at high enough exposures, some chemicals or exposure situations alter the toxic effects of other chemicals or exposure situa-



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