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Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
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Environmental Epidemiology

Volume 2

Use of the Gray Literature and Other Data in Environmental Epidemiology

Committee on Environmental Epidemiology

and

Commission on Life Sciences

National Research Council


NATIONAL ACADEMY PRESS
Washington, D.C.
1997

Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
×

NATIONAL ACADEMY PRESS
2101 Constitution Ave., NW Washington, DC 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

International Standard Book Number 0-309-05737-X

Library of Congress Catalog Card Number 91-28051

Cover photograph: LES MOORE/UNIPHOTO

Copyright 1997 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
×

COMMITTEE ON ENVIRONMENTAL EPIDEMIOLOGY

ANTHONY B. MILLER (Chairman),

University of Toronto, Toronto, ON, Canada

DAVID BATES,

University of British Columbia, Vancouver, BC, Canada

THOMAS CHALMERS,

Department of Veterans Affairs and Harvard School of Public Health (deceased December 1995)

JOHN FROINES,

UCLA School of Public Health, Los Angeles, CA

DAVID HOEL,

Medical University of South Carolina, Charleston, SC

JAMES MELIUS,

New York State Department of Health, Albany, NY

JOEL SCHWARTZ,

Harvard University School of Public Health, Cambridge, MA

LYNN GOLDMAN,

US Environmental Protection Agency, was a member of the committee until February 1994

Special Advisers

ROBERT MORRIS,

Medical College of Wisconsin, Milwaukee, WI

PAUL SCHULTE,

National Institute for Occupational Safety and Health, Cincinnati, OH

DIANE WAGENER,

National Center for Health Statistics, Hyattsville, MD

Staff

DEVRA LEE DAVIS,

Scholar in Residence until June 1993

LINDA MILLER POORE, Research Associate

AMY REDMON, Editor

NORMAN GROSSBLATT, Editor

PAULETTE ADAMS, Project Assistant

The Committee on Environmental Epidemiology (listed above) prepared the original version of this report. The Commission on Life Sciences of the National Research Council, whose membership is shown on the next page, completed the report. All members of the Committee on Environmental Epidemiology agreed to the present content of the report.

Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
×

COMMISSION ON LIFE SCIENCES

THOMAS D. POLLARD (Chairman),

Johns Hopkins Medical School, Baltimore, MD

FREDERICK R. ANDERSON,

Cadwalader, Wickersham & Taft, Washington DC

JOHN C. BAILAR III,

University of Chicago, Chicago, IL

PAUL BERG,

Stanford University, Palo Alto, CA

JOHN E. BURRIS,

Marine Biological Laboratories, Woods Hole, MA

SHARON L. DUNWOODY,

University of Wisconsin, Madison, WI

URSULA W. GOODENOUGH,

Washington University, St. Louis, MO

HENRY W. HEIKKENEN,

University of Northern Colorado, Greeley, CO

HANS J. KENDE,

Michigan State University, East Lansing, MI

SUSAN E. LEEMAN,

Boston University, Boston, MA

THOMAS E. LOVEJOY,

Smithsonian Institution, Washington, DC

DONALD R. MATTISON,

University of Pittsburgh, Pittsburgh, PA

JOSEPH E. MURRAY,

Wellesley Hills, MA

EDWARD E. PENHOET,

Chiron Corporation, Emeryville, CA

EMIL A. PFITZER,

Research Institute for Fragrance Materials, Inc., Hackensack, NJ

MALCOLM C. PIKE,

USC School of Medicine, Los Angeles, CA

HENRY PITOT III,

University of Wisconsin, Madison, WI

JONATHAN M. SAMET,

Johns Hopkins University, Baltimore, MD

CHARLES F. STEVENS,

The Salk Institute for Biological Studies, La Jolla, CA

JOHN L. VANDEBERG,

Southwestern Foundation for Biomedical Research, San Antonio, TX

National Research Council Staff

PAUL GILMAN, Executive Director

ALVIN G. LAZEN, Associate Executive Director

SOLVEIG M. PADILLA, Administrative Assistant

Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
×

Preface

VOLUME 1 OF Environmental Epidemiology was published in 1991 and has helped to define a field that seeks to clarify the relationship between exposure to physical, biologic, and chemical agents in the environment and human health. That report examined and evaluated the published scientific literature on health effects that could be linked with exposure to hazardous-waste sites and presented recommendations about filling major data gaps in order to advance the field.

In preparing volume 2, the Committee on Environmental Epidemiology set out to address important issues that were introduced in volume 1, such as the use of biomarkers and principles for drawing inferences from epidemiologic studies. The effects of exposure to an environmental agent can be hard to detect. The populations that have been exposed to the agent at a specific site are often small and the amount of exposure hard to determine. Only small changes in incidence of a disease may have occurred—so small as to make it difficult to determine clearly whether an association exists between the environmental exposure and the effect observed. Yet it is of great public-health importance to know if effects are occurring. Large numbers of people at many different sites may be exposed to the same environmental agent. Small effects detected in a small population could mean that a larger number exposed in the total population are at risk. Volume 2 continues the discussion of environmental epidemiology by examining ways to improve the chances of detecting an effect if one is occurring. Thus, the report focuses on improving how we measure exposure and how we apply the standard methods of epidemiologic research. The committee also examines the so-called gray litera-

Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
×

ture—reports that have not been published in journals after peer-review but may contain valuable clues about possible hazards to human health. These gray literature reports are often from state and local public-health groups and have usually been reviewed locally.

The committee that prepared volume 1 also prepared the bulk of the report that follows. In particular, it did the long and arduous work of reviewing a collection of gray-literature reports to determine how useful these might be in helping to understand the effects of environmental exposure. They also prepared the original versions of all other chapters. Unfortunately, long delays occurred in the latter stages of the study process, and the original committee could not complete the report. Responsibility for completion was then assumed by the Commission on Life Sciences of the National Research Council, the oversight body for the Committee on Environmental Epidemiology. Thus, though the original committee deserves the gratitude of the scientific community for initiating the preparation of this report and for its initial work, the Commission takes responsibility on behalf of the National Research Council for the contents of the report along with the original committee. Special thanks are due to those members of the Commission—John Bailar, Malcolm Pike, and Jonathan Samet—who played the central role on behalf of the Commission.

We acknowledge the efforts of and thank the Committee on Environmental Epidemiology and the staff of that committee. Their names are listed in the front of this report. We also thank the Agency for Toxic Substances and Disease Registry, sponsor of the study, for its support.

THOMAS D. POLLARD, CHAIRMAN

COMMISSION ON LIFE SCIENCES

Page viii Cite
Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
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Exposure-Data Needs for Epidemiology Studies

 

31

   

Issues in Exposure Assessment

 

42

   

The Need for Improvement in Exposure Assessment

 

44

   

Air-Pollution Studies and Exposure Assessment

 

47

   

Exposure Assessment at Hazardous-Waste Sites

 

49

   

Assessment of Past Exposure

 

49

   

Complex Mixtures

 

50

   

Indexes of Exposure

 

51

   

Subjective Symptoms and Exposure Assessment

 

54

   

Use of Biologic Markers of Exposure

 

56

   

Dosimetric Modeling

 

58

   

Training in Environmental-Exposure Assessment

 

60

   

Conclusions

 

60

   

References

 

62

Chapter 4

 

Researching a Broad Range of Health Outcomes

 

68

   

Respiratory Outcomes

 

69

   

Neurologic Outcomes

 

73

   

Reproductive and Developmental Outcomes

 

76

   

Hepatic and Renal Outcomes

 

80

   

Immunologic Effects

 

80

   

Biologic Markers in Environmental Epidemiology

 

81

   

Susceptible Populations

 

84

   

Recommendations

 

85

   

References

 

87

Chapter 5

 

Data Systems and Opportunities for Advances

 

94

   

Introduction

 

94

   

Data-Collection Systems: What They Measure

 

96

   

Bridging Environment and Health

 

107

   

Monitoring of Environmental-health Effects

 

112

   

Confidentiality and Needs for Personal Identifiers

 

120

   

Data Gaps, Resource Constraints, and Research Opportunities

 

123

   

References

 

127

Chapter 6

 

Opportunities for Methodologic Advances in Data Analysis

 

130

   

Introduction

 

131

   

Analysis of Discrete Outcomes

 

132

   

Analysis of Correlated Data

 

133

   

Analysis of Data When the Shape of the Dose Response Relation Is Unknown

 

142

Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
×
Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
×

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is interim president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth Shine is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and of advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing service to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both academies and the Institute of Medicine. Dr. Bruce Alberts and Dr. William A. Wulf are chairman and interim vice chairman, respectively, of the National Research Council.

Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
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Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
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Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
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Page viii Cite
Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
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Suggested Citation:"Front Matter." National Research Council. 1997. Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology. Washington, DC: The National Academies Press. doi: 10.17226/5804.
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Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology Get This Book
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Determining the health risks to humans of exposure to toxic substances in the environment is made difficult by problems such as measuring the degree to which people have been exposed and determining causation—whether observed health effects are due to exposure to a suspected toxicant. Building on the well-received first volume, Environmental Epidemiology: Hazardous Wastes and Public Health, this second volume continues the examination of ways to address these difficulties. It describes effective epidemiological methods for analyzing data and focuses on errors that may occur in the course of analyses.

The book also investigates the utility of the gray literature in helping to identify the often elusive causative agent behind reported health effects. Although gray literature studies are often based on a study group that is quite small, use inadequate measures of exposure, and are not published, many of the reports from about 20 states that were examined by the committee were judged to be publishable with some additional work. The committee makes recommendations to improve the utility of the gray literature by enhancing quality and availability.

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