is given to issues related to toxic air pollutants and pesticide exposure of children. We do not deal with voluntary behavioral exposures, such as smoking, or with subjects, such as radiation, that have been dealt with in recent NRC reports.
This report considers the needs for research in environmental epidemiology in general, extends the assessment of information on the health effects of exposures from hazardous wastes started in the first volume up to the middle 1990s, and includes selected reports in the gray literature. Most of the gray literature examined here comes from state-generated studies or, if they are available to the public, analyses conducted by researchers for use in legal proceedings. Some of these contain critical information on subjects of interest to the committee. Also, as part of our review of the gray literature, we consider recent reports from the World Bank and the Pan American Health Organization regarding the health consequences of environmental contamination in central Europe, Central America, and China. The committee recognized its obligation to subject such studies to its own peer-review. Thus, at least two committee members, expert in the relevant field of a study but not authors of the study, examined each of the reports from the gray literature that are cited in this report.
The decision to include gray literature arises because the committee found in preparing its first report that reports from a substantial number of relevant studies had not appeared in the conventional peer-reviewed literature. As discussed in more detail in chapter 7 of this volume, the committee solicited certain key reports from selected states on the epidemiologic study of hazardous-waste exposures. The committee then reviewed these to see how well they met its criteria for acceptable gray literature. The criteria are that a report be about an epidemiologic study involving a community or residential population, that it have some sort of peer-review or other evidence of quality control, that the authors tried to collect exposure data, and that it have been published since 1980.
The first report of the committee considered findings in the published literature about hazardous waste in relation to the legislative mandates of the Environmental Protection Agency (EPA) and the Agency for Toxic Substances Disease Registry (ATSDR). The committee concluded that, as a practical consequence of these mandates, EPA and ATSDR tend to focus chiefly on the general estimation of exposure from and management of hazardous-waste sites and only indirectly consider potential public health implications of exposures from such sites. As this committee and the US General Accounting Office (GAO, 1991) have observed, this is because inadequate resources have been devoted to characterizing human health risks possibly associated with exposure to hazardous wastes. Of more than $4 billion spent annually on the Superfund Program, less than