Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page R1
--> Environmental Epidemiology Volume 2 Use of the Gray Literature and Other Data in Environmental Epidemiology Committee on Environmental Epidemiologyand Commission on Life Sciences National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1997
OCR for page R2
--> 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
OCR for page R3
--> 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.
OCR for page R4
--> 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
OCR for page R5
--> 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-
OCR for page R6
--> 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
OCR for page R7
--> Contents Chapter 1 Environmental Epidemiology: The Context 1 Introduction 2 Definition of Environmental Epidemiology 3 Purview of This Report 3 Structure of This Report 5 Special Issues for the Study of Environmental Epidemiology 5 The Role of Public-Health Departments in Environmental Epidemiology Research 7 Conclusions 9 References 10 Chapter 2 Environmental-Epidemiology Studies: Their Design and Conduct 12 Origins of Epidemiology 12 Types of Studies in Environmental Epidemiology 13 Special Considerations 19 Causal Inference in Epidemiology 22 References 24 Chapter 3 Exposure Assessment in Environmental Epidemiology 26 Principal Concepts That Underlie the Content of This Chapter 28 Concept and Method in Exposure Assessment 28
OCR for page R8
--> 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
OCR for page R9
--> Robust Methods 144 Modeling Exposure 145 Conclusions 149 References 150 Chapter 7 Review of the Gray Literature from State Reports 154 Introduction 154 Review of Gray Literature 155 State Studies of Reproductive End Points 162 Reports From Other Countries 170 References 171 Chapter 8 Major Conclusions and Recommendations 173 Conclusions and Recommendations Concerning The Grey Literature 174 Conclusions and Recommendations on Methodologic Issues 176 Index 181
OCR for page R10
--> 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.