UNITED STATES DEPARTMENT OF THE INTERIOR 

GEOLOGICAL SURVEY

BIBLIOGRAPHY OF RECENT PAPERS IN THE BIOMEDICAL

LITERATURE ON THE HEALTH IMPACTS 

OF GEOLOGIC PROCESSES AND MATERIALS

Compiled by

Nicklya M. Harris 

Robert B. Finkelman

U.S. Geological Survey Open-File Report 99-521

This report is preliminary and has not been reviewed for conformity with U.S. Geological 

Survey editorial standards and stratagraphic nomenclature
Introduction

This report contains abstracts describing recent research in the biomedical literature that 

deals with human health problems caused by geologic materials and processes. This 

report is intended to serve two purposes. The first purpose is to use the abstracts to 

illustrate the range of health issues caused by geologic materials and processes. The 

second purpose is to provide a sense of the relative level of interest of the biomedical 

community in these issues.

This report is not intended to be a comprehensive literature search, but rather to provide a 

recent snapshot of biomedical research on selected environmental health issues. The 

report also complements and augments a similar literature review (Gross and Finkelman, 

1999? U.S. Geological Survey Open-File Report 99-9) that focused exclusively on the 

health impacts of coal and coal use.

Search Methods

The source of the abstracts on human health issues was the MEDLINE database. It is 

readily accessed through the internet. The address of PubMed, the search vehicle used, is 

http://www.ncbi.nih.gov/PubMed. The order of investigation was to enter the phrases 'human 

health1 into the search database, and then enter other combinations such as human health 

and mercury, human health and air pollution, human health and emissions, etc. We 

grouped the abstracts into 5 main categories: human health impacts of dust, volcanic 

emissions, arsenic, trace elements, and coal. The search was constrained to the past 10 

years except for the health impacts of volcanic emissions for which we looked back over 

the past 15 years. Most of the studies deal with exposure to natural materials, however, 

we have included a few abstracts that discuss occupational and household exposure that 

we felt were relevant.

Comments

We found 30 abstracts dealing with health impacts of dust. The concerns were primarily 

with quartz and asbestos. About one-third of the abstracts were concerned with problems 

in the U.S. There were 21 abstracts on the health impacts of volcanic emissions. About 

half were concerned with U.S. volcanoes (Mt. St. Helens, Alaska, and Hawaii). There 

were 13 abstracts on arsenic with about half dealing with arsenic exposure in the U.S. We 

found 16 abstracts discussing health impacts of trace elements other than arsenic with 

about half concerned with situations in the U.S.
Int J Biometeorol 1999 Apr;42(4):217-25

Characteristics of rural dust events shown to impact on asthma 

severity in Brisbane, Australia.

Rutherford S, Clark E, McTainsh G, Simpson R, Mitchell C

School of Public Health, Griffith University, Logan, Australia.

Wind erosion in arid inland Australia leads to dust plumes which can pass over populated coastal

areas in Eastern Australia, such as Brisbane. Such events can lead to concerns about respiratory

health problems because they significantly increase the fine particle component of atmospheric

aerosols. This paper examines the participate characteristics of 11 dust events in Brisbane and

associations with daily diary records (peak expiratory flow, symptoms) of people with asthma, and

hospital emergency attendances for asthma during a number of seasons between 1992 and

1994. These dust events are frequently, but not always, characterised by higher participate levels

and higher ratios of fine to coarse particulates. The results indicate that a

number of dust events were significantly associated with changes in asthma severity, but general

relationships could not be determined. Given that the phenomenon of wind-blown dust is not

isolated to the Australian continent, these findings raise important questions about the effects of

wind-blown dust in other parts of the world.

PMID: 10232068, Ul: 99248840

Allergy 1999 Apr;54(4):320-9

Association of ambient air-pollution levels with acute asthma 

exacerbation among children in Singapore.

Chew FT, Goh DY, Ooi BC, Saharom R, Hui JK, Lee BW 

Department of Paediatrics, National University of Singapore. 

[Medline record in process]

BACKGROUND: Air-pollution levels have been shown to be associated with increased morbidity 

of respiratory diseases. METHODS: Data for ambient air-pollutant levels, meteoroiogic factors, 

and hospitalization or emergency room (ER) visits for acute asthma in Singapore children over a 

5-year period (1990-4) were obtained and analyzed for associations by time-series 

methods. RESULTS: Throughout this period, the annual mean and 24-h mean levels for sulfur 

dioxide (SO2), nitrogen dioxide(NO2), and total suspended partides (TSP) and maximum 1-h 

dairy average for ozone were generally within the air-quality guidelines established by the World 

Health Organization (WHO). However, positive correlation between levels of each of these 

pollutants and daily ER visits for asthma was observed in children aged 3-12 years, but not 

among adolescents and young adults (13-21 years old). The association with SO2 and TSP 

persisted after standardization for meteoroiogic and temporal variables. An adjusted increase in 

2.9 ER visits for every 20 microg/m3 increase in atmospheric SO2 levels, lagged by 1 day, 

was observed on days when levels were above 68 rnicrog/m3. With TSP, an adjusted increase of 

5.80 ER visits for every 20 microg/rn3 increase in its daily atmospheric levels, lagged by 1 day, 

was observed on days with levels above 73 microg/m3. Similar results were also obtained after 

controlling for autocorrelation by time-series analysis. CONCLUSIONS: These associations were 

observed even though the overall levels of all pollutants were generally within the air-quality 

guidelines established by the WHO. These findings suggest that asthmatic children are 

susceptible to increased levels of air pollutants, particularly SO2 and TSP, although the ambient 

levels are generally within "acceptable" ranges. 

PMID: 10371090, Ul: 99297500
J Aerosol Med 1999 Spring;12(1):37-44

Health effects of sulfur-related environmental air pollution: the 

pulmonary surfactant system is not disturbed by exposure to acidic 

sulfate and neutral sulfite aerosols.

Griese M, Winzinger G, Schams A, Josten M, Ziesenis A, Maier K

Lung Research Group, Ludwig-Maximilians-Universrty, Munich, Germany, griese@pk-i.med.unimuenchen.de

The goal of this study was to assess the impact of long-term exposure to environmental sulfurrelated aerosols on the biochemical and biophysical properties of lung surfactant. Eight Beagle 

dogs were housed under clean air conditions for 450 days, followed by an exposure period of 400 

days to 0.36 mg/m3 of suffite (16.5 h/d) and to 5.66 mg/m3 of suifate (6 h/d) equivalent to a 

pulmonary hydrogen burden of 15 mumd/m3. Other dogs kept in clean air for the whole study 

period were additional controls. Serial bronchoaiveolar lavages (BALs) were analyzed for total 

phospholipid concentration, content and ratio of a surfactant-rich large aggregate (LA) fraction 

and a small aggregate (SA) fraction, in vitro surface area cycling of Las into SAs as a measure of 

alveolar extracellular pulmonary surfactant aggregate metabolism, and surface activity of native 

and lipid-extracted LA. No significant changes over time and no differences between the clean air 

period and the exposure period were observed. Thus, long-term environmental exposure of dogs 

to the sulfur-related air pollution tested does not lead to alterations in the amount, extracellular 

metabolism, or surface-active properties of pulmonary surfactant 

PMID: 10351128, Ul: 99225811

Environ Health Perspect 1999 Jun;107(Suppl 3):451-460

Molecular Epidemiologic Research on the Effects of Environmental 

Pollutants on the Fetus.

Perera FP, Jedrychowski W, Rauh V, Whyatt RM

Joseph L. Mailman School of Public Health at Columbia University, New York, New York USA. 

Evidence shows that fetuses and infants are more affected than adults by a variety of 

environmental toxicants because of differential exposure, physiologic immaturity, and a longer 

lifetime over which disease initiated in early life can develop, in this article we review data on the 

effects of (italic)in utero(/italic) exposure to common environmental contaminants, including 

polycydic aromatic hydrocarbons (PAH), particulate matter and environmental tobacco smoke 

(ETS). We then summarize results from our molecular epidemidogic study to assess risks from 

(italic)in utero(/italic) exposures to ambient air pollution and ETS. This research study, conducted 

in Poland, used biomarkers to measure the internal and bioeffective dose of toxicants and 

individual susceptibility factors. The study included 160 mothers and 160 newboms. Ambient air 

pollution was significantly associated ((italic)p(/italic) (3/4) 0.05) with the amount of PAH bound to 

DNA (PAH-DNA adducts) in both maternal and infant cord white blood cells (WBC). Newborns 

with elevated PAH-DNA adducts (greater than the median) had significantly decreased birth 

weight ((italic)p (/italic)- 0.05), birth length ((itafic)p (/italic)= 0.02), and head circumference 

((itaJic)p (/italic)= 0.0005) compared to the newboms with lower adducts ((itaiic)n (/ttalic)= 135). 

Maternal and infant cotinine levels were increased by active and passive cigarette smoke 

exposure of the mother ((italic)p (/italic)(3/4) 0.01). An inverse correlation was seen between 

newborn plasma cotinine (nanograms per milliliter) and birth weight ((itaiic)p (/italic)= 0.0001) and 

length ((italic)p (/italic)= 0.003). Adducts were elevated in placenta] tissue and WBC of newboms 

who were heterozygous or homozygous for the cytochrome P4501A1 (italic)Msp(/itaiic)l(italic) 

(/italic)restriction fragment length polymorphism (RFLP) compared to newboms without the RFLP. 

Levels of PAH-DNA and cotinine were higher in newboms than mothers. These results document 

that there is significant transplacentaJ transfer of PAH and ETS constituents from mother to fetus; 

that PAH-DNA adduct levels in maternal and newborn WBC were increased with environmental 

exposure to PAH from ambient pollution; and that the fetus is more sensitive to genetic damage 

than the mother. The study also provided the first molecular evidence that transplacental PAH 

exposure to the fetus is compromising fetal development. If confirmed, these findings could
have significant public health implications since a number of studies have found that reduction of 

head circumference at birth correlates with lower intelligence quotient as well as poorer cognitive 

functioning and school performance in childhood. 

PMID: 10346993

Sci Total Environ 1999 Mar 9;227(2-3): 145-54

Airborne lead and participate levels in Semarang, Indonesia and 

potential health impacts.

Browne DR, Husni A, Risk MJ

School of Geography and Geology, McMaster University, Hamilton, Ontario, Canada. 

Spatial and temporal variation in airborne lead and total suspended particulates was examined in 

the city of Semarang, Indonesia, and surrounding area. Both airborne lead and TSP varied 

significantly with the type of urban development. Mean urban airborne lead levels were 0.35 

microgram/m3 in the highway zone, 0.95 microgram/m3 in the residential zone, and 0.99 

microgram/m3 in the commercial zone. Airborne lead levels in the industrial zone were 

significantly higher than all other areas, with a mean of 8.41 micrograms/m3. Airborne lead 

concentrations of this magnitude have not been reported in Indonesia previously. Mean TSP 

levels ranged from 115.5 micrograms/m3 to 165.8 micrograms/m3 in urban areas. Increased 

levels of TSP were associated with areas adjacent to major transportation routes. On a seasonal 

basis, TSP levels were significantly lower during the rainy season, while mean airborne lead 

levels did not show a significant seasonal trend. Observed ambient pollution levels were 

translated into potential heath impacts based on previously established relationships. Increased 

levels of TSP pollution near major roads was estimated to result in a 1.6% increase in mortality 

for all causes of death and a 7.9% increase in mortality due to respiratory disease. Estimated 

child blood lead levels indicated possible lead toxicity among Semarang children. 

PMID: 10231980, Ul: 99248762

Eur Respir J 1999 Feb;13(2):266-73

Fine participate air pollution, resuspended road dust and respiratory 

health among symptomatic children.

Tiittanen P, Timonen KL, Ruuskanen J, Mirme A, Pekkanen J

Unit of Environmental Epidemiology, Division of Environmental Health, National Public Health 

Institute, Kuopio, Finland.

The short-term association of paniculate air pollution with peak expiratory flow rate (PEF) and 

respiratory symptoms was examined. Forty-nine children with chronic respiratory symptoms aged 

8-13 yrs were followed daily for six weeks in spring, 1995, in Kuopio, Finland. Daily 

concentrations of paniculate material with a 50% cut-off aerodynamic diameter < or = 10 

microm and < or = 2.5 microm (PM10 and PM2.5, respectively), black carbon, and the number 

concentrations of particles from 0.01-10 microm diameter were measured. During the study 

period, PM10 were mainly resuspended soil and street dust, and the concentration was estimated 

using aluminum content of PM10 samples. No consistent effect of particles was found as 

the associations varied by lag. Of the lags examined, only 1-day lagged PM2.5 was statistically 

significantly associated with morning PEF (beta=-1.06, SE=0.52 (per interquartile increase in 

pollutant)). Evening PEF was significantly associated with the 1-day lagged number of particles in 

the size range 0.1-1.0 microm (beta=-1.56, SE=0.72). One-day lagged PM10, PM2.5-10, PM2.5 

and resuspended PM10, and 4-day average of PM2.5 were significantly associated with 

increased risk of cough. Given the short duration of the study, separating the effects of different 

types of particles was difficult. The present study demonstrates the highly variable size and 

number distribution and chemical composition of particles in Finland, and underlines the 

importance of measuring the size and chemical composition of particles to determine which types 

of particles are associated with health effects. 

PMID: 10065666, Ul: 99163549
Proc Natl Acad Sci U S A. 1999 Mar 30;96(7):3396-403.

Long-range transport of mineral dust in the global atmosphere: 

impact of african dust on the environment of the southeastern United 

States.

Prospero JM

University of Miami, Rosenstiel School of Marine and Atmospheric Science, 4600 Rickenbacker 

Causeway, Miami, FL 33149, USA.

Soil dust is a major constituent of airborne particles in the global atmosphere. Dust plumes 

frequently cover huge areas of the earth; they are one of the most prominent and commonly 

visible features in satellite imagery. Dust is believed to play a role in many taogeochemical 

processes, but the importance of dust in these processes is not well understood because of the 

dearth of information about the global distribution of dust and its physical, chemical, and 

mineralogical properties. This paper describes some features of the large-scale distribution of 

dust and identifies some of the geological characteristics of important source areas. The transport 

of dust from North Africa is presented as an example of possible long-range dust effects, and the 

impact of African dust on environmental processes in the western North Atlantic and the 

southeastern United States is assessed. Dust transported over long distances usually has a mass 

median diameter <10 &mgnm. Small wind-borne soil particles show signs of extensive 

weathering; consequently, the physical and chemical properties of the particles will greatly 

depend on the weathering history in the source region and on the subsequent modifications that 

occur during transit in the atmosphere (typically a period of a week or more). To fully understand 

the role of dust in the environment and in human health, mineralogists will have to work closely 

with scientists in other disciplines to characterize the properties of mineral particles as an

ensemble and as individual particles especially with regard to surface characteristics. 

PMID: 10097049, Ul: 99199196

Epidemic! Prev 1998 Oct-Dec;22(4):221-5

The mortality due to pulmonary silicosis in the Tuscany region in the 

last decade demonstrates that the health effects of work exposure to 

silica are still marked

Epidemid Prev. 1998Oct-Dec;22(4):221-5. Italian.

Merler E, Barchielli A, Sorso B, Giovannetti L, Cardini CE

U.O. di Epidemidogia, Centra per lo Studio e ia Prevenzione Oncoiogica, Azienda Ospedaliera

Careggi, Firenze.

An analysis of death certificates from 1987 to 1996 among residents of the Tuscany Region

identified 1518 deaths from pneumoconiosis, the large majority from silicosis, a disease explained

by occupational exposure to silica dust. A dozen of deaths are from asbestosis, occurred at

younger ages and are concentrated in a restricted area where a cement-asbestos factory was

active. Deaths from pneumoconiosis occurred mainly among males, and the rates of the disease

are decreasing only in the latest years. About 10% of deaths from silicosis are among subjects

dying before 65 years of age. Mortality rates are very high in several areas of the Region,

approximating those from lung cancer and ischaemic heart disease. For the above reasons the

disease is still of concern from the point of view of public health and actions are suggested to

obtain a description of prevalence and incidence of the disease.

PMID: 10052260; Ul: 99161412

Occup Environ Med 1998 Nov;55(11):779-85

Crystalline silica and risk of lung cancer in the potteries.

Cherry NM, Burgess GL, Turner S, McDonald JC

Centre for Occupational Health, Stopford Building, University of Manchester, UK.
OBJECTIVE: To evaluate crystalline silica as a human carcinogen. METHODS: A cohort of 5115 

men, bom 1916-45 and employed in the pottery, refractory, and sandstone industries of Stokeon-Trent was identified from occupations subject to health surveillance by the local Silicosis 

Medical Board (now the Department of Social Security). Detailed occupational and smoking 

histories, and records of small parenchyma! opacities on periodic radiographs were extracted 

from medical records. An exposure matrix was derived from some 1400 personal or static dust 

samples and tested against the presence of small parenchymal opacities in a subcohort of 1080 

men employed for at least 10 years, who had started working in the industry before 1960. 

RESULTS: Standardised mortality ratios (SMRs) calculated against mortalities for Stoke-onTrent, with 95% confidence intervals (95% CIs), were raised for all causes (1.15 (1.05 to 1.26)), 

lung cancer (1.28 (0.99 to 1.62)) and non-malignant respiratory disease (2.04 (1.55 to 2.65)). 

Average concentration and duration of exposure to silica were, taken together, significantly 

related to the presence of small opacities (> or = 1/0). In a nested case-referent analysis of 52 

cases of lung cancer and 197 matched referents, conditional logistic regression gave a 

significantly increased odds ratio (OR) for average silica concentration (micrograrns/mS.lOO), 

after adjustment for smoking, of 1.66 (1.14 to 2.41) but not for duration of exposure nor, in 

consequence, for cumulative exposure. CONCLUSION: The association between risk of lung 

cancer and quantitative estimates of silica exposure supports the SMR analysis and implies that 

crystalline silica may well be a human carcinogen. 

PMID: 9924456, Ul: 99123531

Rev Mat Respir. 1998 Oct;15(5):615-21. French.

[Asbestos-associated occupational lung diseases. Role of the 

pneumology unit in screening and compensation].

Bignon J, Housset B, Brochard P, Pa'ron JC

Service de Pneumologie et de Pathologie Professionnelle, CHI Creteil.

The application of new decrees concerning the protection of individuals against sanitary risks

linked to the various possible expositions to asbestos dusts is leading to a growing involvement of

pulmonologists in diagnosis procedures not only for active workers regularly examined via the

occupational medicine healthcare system, but also for those who are no longer, the unemployed

or retired previously exposed to asbestos fibres. The present chapter presents and comments the

revised guidelines about the compensation procedures for occupational diseases, and provides

useful recommendations for establishing the records leading to their medical assessment. It

emphasises the importance of a dose cooperation between pulmonologists and radiologists in

order to avoid radiation overdosing, which could increase the risk of lung cancer, as much as

possible.

PMID: 9834988; Ul: 99052053

Am J Ind Med. 1998 Dec;34(6):547-58.

Surveillance of respirable crystalline silica dust using OSHA 

compliance data (1979-1995).

Linch KD, Miller WE, AKhouse RB, Grace DW, Hale JM

National Institute for Occupational Safety and Health, Division of Respiratory Disease Studies, 

Morgantown, WV 26505-2888, USA.

BACKGROUND: The objective of this work was to estimate the percentage of workers by industry 

that are exposed to defined concentrations of respirable crystalline silica dust. METHODS: An 

algorithm was used to estimate the percentage of total workers exposed to crystalline silica in 

1993 at concentrations of at least 1, 2, 5, and 10 times the National Institute for Occupational 

Safety and Health (NIOSH) Recommended Exposure Limit (REL) of 0.05 mg/m3. Respirable 

crystalline silica air sampling data from regulatory compliance inspections performed by the 

Occupational Safety and Health Administration (OSHA), for the years 1979-1995, and recorded in 

the integrated Management Information System (IMIS) were used to estimate exposures. 

Therefore, this work does not include industries such as mining and agriculture that are not 

covered by OSHA. The estimates are stratified by Standard Industrial Classification (SIC) codes.
RESULTS: This work found that some of the highest respirabie crystalline silica dust 

concentrations occurred in construction (masonry, heavy construction, and painting), iron and 

steel foundries (casting), and in metal services (sandblasting, grinding, or buffing of metal parts). 

It was found that 1.8% (13,800 workers) of the workers in SIC 174-Masonry, Stonework, Tile 

Setting, and Plastering-were exposed to at least 10 times the NIOSH REL For SIC 162-Heavy 

Construction, Except Highway and Street Construction-this number is 1.3% (6,300 workers). SIC 

172-Painting and Paper Hanging-wfiich includes construction workers involved in sandblasting 

was found to have 1.9% (3,000 workers) exposed to at least 10 times the NIOSH REL. The 

industry that was found to have the highest percentage of workers (6%) exposed to at least the 

NIOSH REL was the cut stone and stone products industry. CONCLUSION: Not enough is being 

done to control exposure to respirabie crystalline silica. Engineering controls should be 

instituted in the industries indicated by this work. 

PMID: 9816412; Ul: 99033200.

J Occup Environ Med. 1998 Oct;40(10):855-61.

Occupational risk factors for cancer of the gastric cardia. Analysis of 

death certificates from 24 US states.

Cocco P, Ward MH, Dosemeci M

Institute of Occupational Medicine, University of Cagliari, Italy.

We evaluated the risk of gastric cardia cancer by occupation and industry in a case-control study 

using information from death certificates for 24 US states in 1984-1992. One thousand fifty-six 

cases of gastric cardia cancer were identified among men aged 20 years or more, including 1,023 

whites and 33 blacks. Controls were 5,280 subjects who died of nonmaJignant diseases, 5:1 

matched to cases by geographic region, race, gender, and 5-year age group. Among white men, 

occupations with elevated risk included financial managers (odds ratio [OR] = 6.1; 95% 

confidence interval [Cl], 1.3-28.8), janitors and cleaners (OR = 1.7; 95% Cl, 1.0-2.9), production 

inspectors (OR = 3.2; 95% Cl, 1.5-6.9), and truck drivers (OR = 1.5; 95% Cl, 1.0-2.2). Industries 

with elevated risk included pulp and paper mills (OR = 2.0; 95% Cl, 1.0-37), newspaper 

publishing and printing (OR = 2.6; 95% Cl, 1.0-6.3), industrial and miscellaneous chemicals (OR 

* 2.0; 95% Cl, 1.0-3.9), water supply and irrigation (OR = 5.6; 95% Cl, 1.6-19.9). Among black 

men, risks were nonsignificant^ increased for subjects employed in railroads (3 cases, 2 controls) 

and for carpenters (3 cases, 0 controls). We created job-exposure matrices for asbestos, 

inorganic dust, metal dust, lead, poiycydic aromatic hydrocarbons, nitrogen oxides, nitrosamines, 

sulfuric acid, fertilizers, herbicides, other pesticides, and wood dust. Among white men, a 

consistent pattern of risk increase by level and probability of exposure was observed only for 

sulfuric acid mists, with a twofold excess (95% Cl, 0.6-7.3) associated with high probability of high 

intensity exposure. A significant 30% increase in risk was observed for those subjects with a high 

probability of exposure (all levels combined) to lead, and a 60% increase was observed for 

subjects with high-level exposure to lead (all probabilities combined). However, crosstabulation of 

gastric cardia cancer risk by probability and level of exposure to lead did not show consistent 

trends. Asbestos exposure also showed an overall 50% increase but no consistent trends among 

white men. None of the 12 occupational hazards showed an association with risk for black men. 

PMID: 9800169; Ul: 99016551.

Environ Health Perspect. 1998 Nov; 106(11)^538-43.

Major issues in miner health.

Joyce S

As recently as the last few decades, thousands of miners died in explosions, roof collapses, fires,

and floods each year, and lung disease caused by inhaling mineral dusts was ubiquitous. Miners

worked virtually unprotected, and were often treated as expendable bodies fulfilling critical roles

in this important industry, which in the United States comprises about 5% of the gross domestic

product.

PMID: 9799195; Ul: 99016029.
Am J Ind Med. 1998 Oct;34(4):318-24.

Polymorphisms in the promoter of the tumor necrosis factor-alpha 

gene in coal miners.

Zhai R, Jetten M, Schins RP, Franssen H, Bonm PJ

Department of Health Risk Analysis and Toxicology, Maastricht University, The Netherlands. 

Tumor necrosis factor-alpha (TNF) is recognized as a central mediator of mineral dust-induced 

lung fibrosis, and genetic polymorphisms of the TNF promoter have been reported to influence 

levels of TNF production. To assess whether polymorphisms within the TNF promoter gene are 

associated with susceptibility to coal workers' pneumoconiosis (CWP), the DNA of 78 coal miners 

was typed for G-to-A transitions at positions -238 and -308. Our results show that frequency of 

A-308 genotype (T2) is significantly overpresented in coal miners with CWP (50%), as compared 

with miners without CWP (25%) and controls (29%). After correction for cumulative dust exposure 

and smoking, the A-308 transition genotype is still associated with the presence of CWP (OR = 

3.0, 95% Cl = 1.0-9.0). Both A-238 and A-308 transition genotypes were related to TNF release 

from endotoxin-stimulated blood monocytes; only the A-238 transition and not the A-308 

transition was associated to coal dust-induced TNF release. In summary, this study shows that 

the A-308 transition is related to CWP, but this relation is not paralleled by a different TNF release 

in this genotype. A larger number of patients coupled to frequent TNF release are required to 

evaluate genotype screening to estimate individual health risks for effects of coal mine dust 

exposure. 

PMID: 9750937; Ul: 98423511.

J Taxied Environ Health. 1998 Sep 11;55(1):31-44.

Environmental particulate-mediated cytokine production in lung 

epithelial ceils (A549): role of preexisting inflammation and oxidant 

stress.

Stringer B, Kobzik L

Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, 

USA.

Epidemidogic data show that air pollution participates cause adverse pulmonary health effects, 

especially in individuals with preexisting lung disease. We sought to model in vitro preexisting 

lung inflammation in order to investigate the hypothesis that "primed" lung epithelial ceils will 

exhibit enhanced phlogistic responses [e.g., interteukin-8 (IL-8) production] to particuiate air 

pollution. Exposure of tumor necrosis factor alpha (TNF-aJpha) primed or control A549 cells to the 

air pollution participates, residual oil fly ash (ROFA), and the known pathogenic dust alphaquartz, but not inert T1O2, caused increased IL-8 production in primed cells compared to normal 

ceils in a concentration-dependent manner (particle concentration range 0-200 microg/ml). 

We hypothesized that oxidant mechanisms may be involved in the cellular response to 

participates. Addition of the antioxidant N-acetylcysteine (MAC, 1.0 mM) decreased ROFA and 

alpha-quartz-mediated IL-8 production by approximately 50% in normal and TNF-aipha-primed 

A549 cells. In addition, exposure of A549 cells to ROFA caused a substantial (and NAC 

inhibitable) increase in oxidant levels as measured by fluorometry (DCFH oxidation). These data 

suggest that (1) lung epithelial ceils primed by inflammatory mediators can show enhanced 

cytokine production after exposure to air pollution particulates, and (2) oxidant stress is a key 

mechanism for this response. 

PMID: 9747602; Ul: 98418374.

Ann Occup Hyg. 1998 Jui;42(5):287-94. Review.

The quartz hazard: a variable entity.

Donaldson K, Borm PJ

Department of Biological Sciences, Napier University, Edinburgh, U.K.

An IARC Working Group recently classified crystalline silica (quartz) into lARC's Group 1, i.e. a

carcinogen. This classification is based on evidence of carcinogenicity in experimental animals
and in humans. However, the evaluation stated that in making the overall evaluation, the Working 

Group noted that cartinogenitity to humans was not detected in ail industrial circumstances 

studied and that carcinogenicity may be dependent on inherent characteristics of the crystalline 

silica or on external factors affecting its biological activity. The present review seeks to put the 

apparently conflicting findings of cancer incidence in quartz-exposed industries into a unifying 

thesis, based on mechanistic studies. These mechanistic studies have enabled the events 

leading from deposition of quartz to silicosis and cancer to be partially elucidated and have 

demonstrated that the biological effects of quartz can be understood in terms of surface reactivity. 

We particularly emphasise the ability of quartz to generate free radicals and cause oxidative 

stress and the fact that this could be modified by a range of substances that affect the quartz 

surface; some of these modifying substances could originate from other minerals. We therefore 

propose that the hazard posed by quartz is not a constant entity, but one that may vary 

dramatically depen ding on the origin of the silica sample or its contact with other 

chemicals/minerals within its complex constitution. The mechanistic data described here could 

assist in the interpretation of epidemiological studies and pose further hypotheses that could be 

tested in order to help resolve the quartz carrinogenesis anomaly. The data suggest that quartz 

cannot be death with as a single hazard entity, as is the case with most other chemicals. 

PMID: 9729916; Ul: 98399615.

[Evaluation of health hazards of asbestos containing wastes in the 

mining industry and prospects of their utilization].

Dueva LA, et al.

Med Tr Prom Ekol. 1997;(9):9-13. Russian.

Dueva LA, Elovskaia LT, KovaJevskaia EV

Nil meditsiny truda RAMN, Moskva.

The study covered asbestos-containing waste at a major mining enrichment enterprise-

"Uralasbesf JSC. A set of methods were used to associate natural human compensatory

mechanisms with experimental models simplifying possible routes of asbestos influence on

humans and proved no toxic features of the dust studied. The results help to manage removal

and storage of asbestos-containing waste, to use it for production of various building materials.

However, variable asbestos (free and fixed) content of the waste and admixtures of chromium,

nickel and other elements in it prevent from utilisation of asbestos waste at other enterprises and

necessitate further hygienic evaluation.

PMID: 9440947; Ul: 97478726.

J Expo Anal Environ Epidemiol. 1997 Jul-$ep;7(3):385-95. Review.

The link between silica dust levels, risk assessments, and 

regulations.

Goldsmith DF

Public Health institute, Berkeley, California 94704, USA. davegdd@pubiichealth.org 

improvements in workplace health among silica exposed workers followed demonstrations of the 

severity of the risk of silicosis and means of controlling high dust levels on the job. Current 

ambient environmental analyses include either an adoption of air quality goals for reducing 

emissions of criteria pollutants or the conduct of risk assessments to determine if regulatory 

procedures are needed. Although silica has been regulated as a workplace hazard for most of the 

20th century, only recently has it been considered for ambient control, and most of the thrust for 

this action has evolved from environmental regulatory work in California, where both state 

initiative (Proposition 65) and legislative law (Air Toxics Hot Spots Information and Assessment 

Act; Assembly Bill number 2588) have required risk assessments for silica dust emissions as 

carcinogens. 

PMID: 9246600; Ul: 97389418.
Mil Med 1997 Jan; 162(1): 1-13. Review.

Al Eskan disease: Persian Gulf syndrome.

Korenyi-Both AL, Korenyi-Both AL, Juncer DJ

Office of the State Surgeon, Pennsylvania National Guard, Department of Military and Veteran's 

Affairs, Commonwealth of Pennsylvania 17003-5003, USA.

This article examines the potential relationship between Al Eskan disease and the Persian Gulf 

syndrome. At Eskan disease, reported in Military Medicine in 1992, is a novel and previously 

unreported condition triggered by the exceptionally fine sand dust of the Central and Eastern 

Saudi Arabian peninsula. We repeat our study of the pathogenesis of Al Eskan disease to include 

the ultrastructural and microanalytical study of the sand, aerobidogica) studies of the Kingdom of 

Saudi Arabia, and the etiology, symptoms, and prevalence of the disease. We conclude that 

immunodepression resulting from the continued presence of sand particles less than 1 micron in 

diameter in the lungs and bodies of Persian Gulf veterans explains not only the symptoms of the 

hyperegic lung condition of phase I and the symptoms of phase II of Al Eskan disease, but also 

provides an important due to a common factor in most cases of Persian Gulf illnesses. We 

include a discussion of most of the commonly suspected agents in the Persian Gulf syndrome. In 

this case, we conclude that each of these factors, such as oil well fires, old-world .diseases, or 

depleted uranium, are probably adjuvant or contributing causes. The only common exposure that 

would lead to recognition of the Persian Gulf syndrome as a single medical condition, rather than 

a catch-all phrase for unrelated conditions, appears to be exposure to the ubiquitous, fine sand of 

the area, and a resulting immunosuppression that is aggravated by opportunistic infections and 

other nonmicrobial ailments. 

PMID: 9002695; Ul: 97156267.

Przegl Lek. 1996;53(8):631-3. Polish.

[Consequences of exposure to asbestos dust].

Kotela I, Laskowicz K, Plezia B

Przychodni Przyzakladowej Etemit w Szczucinie.

Mesotheliomas of pleura are neoplasms that rarely occur. Their etiology is connected with

occupational exposure as well as environmental contact with asbestos dust. In this work, two

cases of mesotheliomas of pleura are presented: first one with occupational exposure, the other

one with environmental exposure. An increased number of mesothelioma diseases has been

emphasised and endangerment of inhabitants health living closely to asbestos processing factory

as well.

PMID: 8999467; Ul: 97127903.

Med Pr. 1996;47(4):393-9. Review. Polish.

[Refractory ceramic fibers, kinds, health effects after exposure, 

TLVs].

Wozniak H, Wiecek E

Zakiadu Aerozdi Instytutu Medycyny Pracy, Lodzi.

Ceramic fibres are amorphous or crystalline synthetic mineral fibres which are characterised by 

refractory properties (i.e. stability in temperature above 1000 degrees C). In general, ceramic 

fibres are produced from aluminium oxide, silicon oxide and other metal oxides and less 

frequently from non-oxide materials such as silicon carbide, silicon nitride and boron nitride. In 

Poland, the production of ceramic fibres was begun in the Refractory Materials Plant, Skawina, 

during mid-eighties. The production capacity accounts for about 600 tons annually. It is estimated 

that approximately 3000 persons are exposed to the effect of ceramic fibres in Poland. During the 

production of ceramic fibres, concentrations of respiral fibres in the air at work places range from 

0.07 to 0.27 f/cm3; during the manufacture of ceramic fibre products from 0.23 to 0.71 f/cm3 and 

during the application of ceramic fibre products from 0.07 to 1.67 f/cm3. As published data depict, 

fibres longer than 5 microns are most common in the work environment, and the proportion of 

fibres with diameters below 1 micron accounts for 40-50%. Bearing in mind the present situation 

in Poland, namely combined exposure to asbestos (during removal of worn out heat-insulating
materials) and ceramic fibres (during installation of new insulation), as well as in view of own 

investigations and literature data which evidence a strong carcinogenic effect of certain fibres, the 

following MAC values have been adopted: Dusts of refractory ceramic fibres: total dust-2 mg/m3; 

respirabie fibres-1 f/cm3 (L > 5 microns; D < 3 microns; L: D < 3:1) Dusts of reflactory ceramic 

fibres mixed with asbestos: total dust-1 mg/m3; respirabie fibres-1 f/m3. Dusts of refractory 

ceramic fibres mixed with other man-made mineral fibres (MMMF): total dust-2 mg/m3; respirabie 

fibres-1 f/m3. According to the IARC, ceramic fibres have been included into group 2B-suspected 

human carcinogen. 

PMID: 8847986; Ul: 96405600.

Toxicology. 1995 Apr 12;98(1-3):47-55.

Effect of heavy metal ions on the release of reactive oxygen 

intermediates by bovine alveolar macrophages.

Schluter T, Berg I, Dorger M, Gercken G

Department of Biochemistry and Molecular Biology, University of Hamburg, Germany. 

Short-term incubations of bovine alveolar macrophages (BAM) with metal-containing dusts induce 

the release of reactive oxygen intermediates (ROI). Incubations of BAM (90 min) with dissolved 

metal compounds (0.1-100 microM) combined with quartz dusts were performed to investigate 

the effects of single elements on BAM stimulation. As(lll), as well as the calcium antagonists, 

Ni(ll) and Ce(lll), inhibited the secretion of superoxide anions (O2-) and hydrogen peroxide 

(H2O2). O2-concentrations were lowered by Mn(il) and Fe(ll). Increased ROI concentrations 

were observed with V(IV) (O2- and H2O2) and Fe(UI) (O2-). The addition of Cd(ll), Cr(lll) and 

V(V) showed no effect on the dust-induced respiratory burst.

The influence of insoluble heavy metal compounds on ROI secretion by BAM were studied with 

metal oxide-coated silica particles. In most cases the release of ROi was not affected by the 

chemical modification of the particle surface. Coating with CuO markedly lowered the 

concentrations of O2- and H2O2, whereas vanadium(IV) oxide considerably increased both 

ROIs. Although most of the investigated metal compounds did not alter ROI secretion our present 

results with V(IV) and Fe(lll) confirm our recent statistical evaluation of the effects of heavy metalcontaining dusts on ROI secretion (Berg et al., 1993, J. Toxicol. Environ. Health 39, 341). 

PMID: 7740553; Ul: 95259072.

Przegl Epidemiol. 1995;49(4):407-16. Polish.

[Assessment of lung cancer risk due to environmental asbestos dust 

exposure in the general population].

Szeszenta-Dabrowska N, Szymczak W, Wilczynska U 

Zespol Srodowiskowych Zarozen Zdrowia Instytutu Medycyny Pracy w Lodzi. 

Assessment of lung cancer risk due to environmental asbestos dust exposure in the general 

population was based on the model of risk extrapolation from the occupational (in asbestoscement plant) to the environmental concentrations. 24-h determinations of asbestos fibre 

concentrations in the air varied considerably, from 0.4 f/l to 4.6 f/l. The lung cancer risk due to 

environmental exposure of the general population to asbestos dust has been estimated to be 22 

cases p.a. This seems to be very low, considering that the total number of deaths from lung 

cancer in Poland in 1992 was about 17.5 thousand. The environmental asbestos exposures and 

their health effects are limited mainly to the areas located in the vicinity of asbestos plants and 

are attributable primarily to improper utilization of the plant wastes (for example as the surface of 

local roads and sports grounds at schools) and their unathorized disposal. The incidence of 

pleural mesothelioma among the inhabitants of those areas seems to be endemic. The endemic 

character of pleural mesothelioma occurrence has been recently revealed in the vicinity of one of 

major Polish asbestos and cement plant. 

PMID: 8868201; Ul: 97021841.

10
Med Pr. 1995;46(2): 179-87. Review. Polish.

Amorphous silica. Types, health effects of exposure, NDS].

WozniakH.WiecekE

Z Zakladu Aerozoli, Instytutu Medycyny Pracy im. prof, dra med. Jerzego Nofera w Lodzi. 

Maximum allowable concentration (MAC) values for amorphous silica dust have not been 

identified in the Polish legal regulations up-to-date. In this work the authors review values of 

allowable (recommended) amorphous silica dust concentrations in other countries. Data on other 

types of amorphous silica (natural and synthetic) used in industry as well as data on health 

effects of exposure to these types of dust are presented. The work encompasses 42 entries in the 

references and one Table which includes the following proposed MAC values: Non-cateinate 

diatomaceous earth (diatomrte) and synthetic silica: Total dust-10 mg/m3 Respirable dust-2 

mg/m3 Calcinate diatomaceous earth (diatomrte) and fused silica (vitreous silica): Total dust-2 

mg/m3 Respirable dust-1 mg/m3. 

PMID: 7637638; Ul: 95364699.

Ann Occup Hyg. 1994 Aug;38(4):477-87, 409-10.

The assessment of exposure in terms of fibres.

GibbsGW

The membrane filter (MF) method for evaluating asbestos fibre concentrations was introduced in 

the 1960s. Before that time the midget impinger (Ml) was used in North America, while the long 

running (LRTP) and regular thermal pretipitator (TP) were used in the U.K. All studies from which 

estimates of long-term health risks can be derived (i.e. those with individual cumulative lifetime 

exposure estimates) were based on the now obsolete methods. The reliability of converting these 

indices of exposure to MF equivalent concentrations was reviewed, it was concluded that no 

overall single factor could be derived for the Quebec mining and milling industry. However, it has 

been possible to derive conversion factors at the individual mill and work area level. Applying 

these in one Quebec mortality study analysis based on ail jobs held by persons in the cohort gave 

an overall MF/MI ratio of 3.6. An examination of the confidence intervals surrounding the Quebec 

data, ratios derived for other chrysolite mines by other investigators, and measurements of fibre 

concentrations in the 1970s suggest that this was probably not unreasonable. Side-by-side and 

other measurements were used to convert Ml concentrations in the U.S. textile industry to 

MF fibre concentrations. While conversions involve considerable uncertainty, independent 

measurements of fibres in the lung tissues of workers from the U.S. textile plant and Quebec mills 

show that in lungs the ratios of the concentrations of chrysotile to those of tremdite are quite 

consistent with the ratio of assessed exposures to these fibres in the two industries. There is an 

apparently higher risk of mesothelioma in one Quebec mining area (Thetford Mines) than in 

another (Asbestos). A high concentration of fibrous tremdite has been found in the lungs of 

workers in Thetford. A method of evaluating the extent to which mesothelioma risk in the 

chrysotile mining industry might be explained by tremdite exposures was proposed. The slope 

of the lung cancer dose-response relationship for the textile industry is approximately 50 times 

that for the mining and milling industry. Available data on the length distributions of fibres from 

Quebec mines and mills (up to 5% > 5 microns) and the Charleston textile plant (up to 21% > 5 

microns) and some marginal indication of longer fibres in tissues from Charleston workers 

suggest that further work specifically addressing differences in the size distributions of long fibres 

in these industries is 

PMID: 7978969; Ul: 95069680.

Environ Health Perspect. 1994 May;102(5):478-82.

Characterization of air contaminants formed by the interaction of lava 

and sea water.

Kullman GJ, Jones WG, Comwell RJ, Parker JE

Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health,

Morgantown, WV 26505 USA.

11
We made environmental measurements to characterize contaminants generated when basaltic 

lava from Hawaii's Kilauea volcano enters sea water. This interaction of lava with sea water 

produces large clouds of mist (LAZE). Island winds occasionally directed the LAZE toward the 

adjacent village of Kalapana and the Hawaii Vdcanos National Park, creating health concerns. 

Environmental samples were taken to measure airborne concentrations of respirable dust 

crystalline silica and other mineral compounds, fibers, trace metals, inorganic acids, and organic 

and inorganic gases. The LAZE contained quantifiable concentrations of hydrochloric acid (HCI) 

and hydrofluoric acid (HF); HCI was predominant HCI and HF concentrations were highest in 

dense plumes of LAZE near the sea. The HCI concentration at this sampling location averaged 

7.1 ppm; this exceeds the current occupational exposure ceiling of 5 ppm. HF was detected in 

nearly half the samples, but all concentrations were <1 ppm Sulfur dioxide was detected in one of 

four short-term indicator tube samples at approximately 1.5 ppm. Airborne participates were 

composed largely of chloride salts (predominantly sodium chloride). Crystalline silica 

concentrations were below detectable limits, less than approximately 0.03 mg/m3 of air. Settled 

dust samples showed a predominance of glass flakes and glass fibers. Airborne fibers were 

detected at quantifiable levels in 1 of 11 samples. These fibers were composed largely of 

hydrated calcium sulfate. These findings suggest that individuals should avoid concentrated 

plumes of LAZE near its origin to prevent over exposure to inorganic acids, specifically HCI. 

PMID: 8593853; Ul: 96115314.

Environ Health Perspect 1990 Aug;88:277-86

Human occupational and nonoccupational exposure to fibers.

Esmen MA, Erdal S

Graduate School of Public Health, University of Pittsburgh, PA 15261.

Human exposure to fibers in occupational and nonoccupational environments has been a health 

concern for nearly a century. In this review, selected results from the literature are presented to 

highlight the availability, limitations, and interpretive difficulties associated with the past and 

current human fiber exposure data sets. In the traditionally defined asbestos fibers, large 

amounts of the data available suffer from the diversity of sample collection and analysis methods. 

Two simple generalizations suggest that occupational exposures are several orders of magnitude 

higher than that of environmental exposures; and currently extant data and the current routine 

measurement practices present significant difficulties in the consistent interpretation of the data 

with respect to health effects. The data on the human exposures to man-made vitreous fibers are 

much more complete than the data on asbestos exposure, while exposure data on other manmade fibrous materials are lacking. The human exposure data to many minerals which, at times, 

exist in fibrous habit, are very scanty, and in view of the biological activity of some of these 

fibers, this lack may be of significant concern. 

PMID: 2272324; Ul: 91106377.

Int J Health Sen/. 1986;16(2):253-63.

Asbestos and health in the Third World: the case of Brazil.

BemnanDM

Almost all of the asbestos used in Brazil is mined by an enterprise wholly owned by two European 

multinational companies, which also produce and market over two-thirds (by weight of asbestos) 

of the products made from asbestos. About 80 percent of the asbestos used in Brazil is finally 

consumed in the form of asbestos cement: for roof tiles and roofing panels, wall-board, and 

domestic and industrial water tanks. A survey of consumer literature and advertising printed by 

Eternrt, S.A., and Brasilit, SA, disclosed no mention of a potential danger from exposure to 

asbestos dust, and no recommendations for cutting down exposure to that dust. The situation at 

smaller, Brazilian-owned firms is reputed to be disastrous from the standpoint of workers' 

exposure to asbestos dust at the point of production. At a large asbestos-cement manufacturing 

plant owned by Etemit, however, exposure to asbestos dust (according to company records) 

seemed to be kept under 2.0 fibers per cc., the present standard for the United States. 

PMID: 2939030; Ul: 86194866.

12
Environ Health Perspect. 1985 Oct;62:319-28.

Health implications of environmental exposure to asbestos.

McDonald JC

The health impact of environmental pollution resulting from the industrial use of asbestos can be 

assessed in three ways. First, there are the direct epidemioiogical surveys. These indicate that 

domestic exposure has been responsible for cases of mesothelioma and possibly lung cancer 

and radiological changes in family contacts of asbestos workers. Exposure in the neighborhood of 

crocidolite mines and factories has also resulted in cases of mesothelioma but no similar 

evidence exists for chrysotile or amosrte. Neither air nor water pollution has been directly 

incriminated as a cause of either respiratory or digestive malignancies. Second, a few attempts 

have been made to extrapolate from exposure response findings in industrial cohorts. For 

several reasons, even for lung cancer, this approach is dubious: the observed gradients have a 

100-fold range in slope; the equivalences of dust, fiber and gravimetric measures are largely 

guesswork; and the carcinogenic potential of mineral fibers, particularly for the pleura, varies 

enormously with fiber type and/or dimensions. No adequate exposure-response observations 

have been made for mesothelioma. A third approach makes use of the differing incidence of 

mesothelioma in men and women. Data from several countries indicate that until the 1950s (i.e., 

30-40 years after significant industrial use of asbestos began), the rates were similar in both 

sexes. Since then, the incidence in males has risen steeply-in the U.S. and U.K. at about 10% 

per annum. In females, on the other hand, there has been little or no convincing increase. These 

data suggest that the "background" level of mesothelioma in both sexes is and has been about 2 

per million per annum and that-as at least some mesothelioma cases in females are directly or 

indirectly attributable to occupational exposure-there is little room left for arty contribution from 

the general environment. It is recommended that mesothelioma surveillance, backed by 

appropriate epidemioiogical inquiries, offers an effective method of monitoring the health impact 

of asbestos air pollution. 

PMID: 4085437; Ul: 86108190

Ann Acad Med Singapore. 1984 Apr; 13(2 Suppl):345-52.

Mineral fibres and cancer.

McDonald JC

A synthesis is presented of the salient findings to date from laboratory and epidemioiogical 

research, on the health effects of asbestos and other natural and man-made mineral fibres. 

Experimental evidence suggests that all mineral fibres are capable of causing fibrosis and 

malignancy, with chrysotile at least as pathogenic as other fibres. However, penetration, retention 

and phagocytosis are affected by size and shape and reactivity and durability by physicochemical properties. Thus it is not surprising that in man the results of exposure vary considerably 

with fibre type and industrial process. A considerable body of evidence suggests that chrysotile 

has seldom, if ever, caused peritoneal mesothelioma and that the great majority of pleura! 

mesotheliomas are also attributable to croddoiite or amosite. Without more reliable information 

on intensity and duration of exposure by fibre type, the epidemioiogical evidence on this point 

cannot be wholly conclusive. There are stronger grounds from a limited number of cohort studies 

for believing that in relation to estimated exposure, the risk of lung cancer has been 

much higher in textile plants than in fibre production or in the manufacture of friction products, 

with asbestos-cement plants somewhere in between. The data on man-made fibre production 

remains equivocal. It is concluded that attempts to regulate asbestos without regard for fibre type, 

although perhaps adequate for lung cancer and fibrosis, may do little to reduce the risk 

of mesothelioma. The search for safe fibre substitutes for asbestos will remain difficult until the 

parameters of pathogenicity are better understood. 

PMID: 6093677; Ul: 85045368.

13
Epidemic* 1999 Feb;9(1):27-31

Asthma-like disease in the children living in the neighborhood of Mt. 

Sakurajima.

Uda H, Akiba S, Matano H, Shinkura R

Department of Public Health, Faculty of Medicine, Kagoshima University, Japan. 

We conducted self-administered questionnaire surveys of school children living in the vicinity of 

Mt. Sakurajima using ATS-DLD questionnaire. In this paper, we report the results of analysis 

comparing the proportion of children with asthma-like disease in the area exposed to the volcanic 

ash and gases released by Mt. Sakurajima and control areas. Asthma-like disease 

was ascertained using ATS-DLD questionnaire and the definition proposed by the study group 

established by Environmental Protection Agency in Japan. The proportion of children with 

asthma-like disease was not different between the exposed and control groups. The odds ratio of 

asthma-like disease comparing the exposed and control groups was 1.1 and its 95% 

confidence interval was 0.7-1.8 (P = 0.583). When the exposed area was divided into Tarumizu 

city. Sakurajima town and Kagoshima city, none of them showed an elevated proportion of 

children with asthma-like disease when compared with the control area. In the entire study 

population including both the exposed and control groups, the proportion of children with 

asthma-like disease was 6 and 3% in boys and girls, respectively. These values were quite 

similar to those obtained from a survey of 45,674 school children in western districts in Japan in 

1992. In conclusion, the present study indicates that the proportion of children with asthma-like 

disease is not elevated in the exposed area. Further investigations are necessary to 

confirm our conclusions. 

PMID: 10098350, Ul: 99198423

Aust N Z J Public Health 1997 Dec;21(7):773-8

The Mount Ruapehu eruption, 1996: a review of potential health 

effects.

Weinstein P, Patel A

Ministry of Health, Wellington, New Zealand.

Literature search and consultation with New Zealand experts were used to review the potential

health effects of explosive volcanic eruptions, and possibilities for their control, in the context of

the 1996 eruption and possible future eruptions of Mount Ruapehu. Humans may be exposed to

several types of hazardous ejecta during and after volcanic eruptions. Such exposure

may cause health effects that could require surveillance and control, but health effects in New

Zealand are unlikely to be detectable while eruptions remain small and infrequent. The existing

health surveillance systems in New Zealand are adequate to monitor and help control the

possible health effects of volcanic eruptions.

PMID: 10098350

Environ Health Perspect. 1994 May;102(5):478-82.

Characterization of air contaminants formed by the interaction of lava 

and sea water.

Kullman GJ, Jones WG, Cornwell RJ, Parker JE

Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health,

Morgantown, VW 26505 USA.

We made environmental measurements to characterize contaminants generated when basaltic

lava from Hawaii's Kilauea volcano enters sea water. This interaction of lava with sea water

produces large clouds of mist (LAZE). Island winds occasionally directed the LAZE toward the

adjacent village of Kalapana and the Hawaii Vdcanos National Park, creating health concerns.

Environmental samples were taken to measure airborne concentrations of respirable dust,

crystalline silica and other mineral compounds, fibers, trace metals, inorganic acids, and organic

and inorganic gases. The LAZE contained quantifiable concentrations of hydrochloric add (HCI)

14
and hydrofluoric acid (HF); HCI was predominant. HCI and HF concentrations were highest in 

dense plumes of LAZE near the sea. The HCI concentration at this sampling location averaged 

7.1 ppm; this exceeds the current occupational exposure ceiling of 5 ppm. HF was detected in 

nearly half the samples, but all concentrations were <1 ppm Sulfur dioxide was detected in one of 

four short-term indicator tube samples at approximately 1.5 ppm. Airborne participates were 

composed largely of chloride salts (predominantly sodium chloride). Crystalline silica 

concentrations were below detectable limits, less than approximately 0.03 mg/m3 of air. Settled 

dust samples showed a predominance of glass flakes and glass fibers. Airborne fibers were 

detected at quantifiable levels in 1 of 11 samples. These fibers were composed largely of 

hydrated calcium sulfate. These findings suggest that individuals should avoid concentrated 

plumes of LAZE near its origin to prevent over exposure to inorganic acids, specifically HCI 

PMID: 8593853; Ul: 96115314.

Bull Pan Am Health Organ 1996 Sep;30(3):218-26

Public health surveillance after a volcanic eruption: lessons from 

Cerro Negro, Nicaragua, 1992.

MaJilay J, Real MG, Ramirez Vanegas A, Noji E, Sinks T

Division of Environmental Hazards and Health Effects, National Center for Environmental Health, 

Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

The eruption of the Cerro Negro volcano near Leon, Nicaragua, on 9 April 1992 distributed an 

estimated 1.7 million tons of ash over a 200 square kilometer area. An assessment was 

conducted to evaluate the health effects on approximately 300,000 residents, using routine data 

obtained by the national epidemiologic surveillance system. It was found that rates of visits to 

health care facilities for acute diarrheal and respiratory illnesses increased in two study 

communities, one within and one near the disaster zone. Specifically, visits for acute diarrhea 

were nearly 6 times more numerous than before the eruption in both communities, while visits for 

acute respiratory diseases were 3.6 times more frequent in Malpaisillo (the community near the 

disaster zone) and 6.0 times more frequent in Telica (the community within it). Most of the visits 

were for infants and children less than 5 years old. Increased diarrheal disease morbidity, which 

commonly occurs after volcanic eruptions, demands detailed investigation of the type and quality 

of water supplies following heavy ashfall. Ash-related respiratory problems should be 

further examined to determine the spectrum of such diseases and the timing of illness onsets 

among infants and other special population subgroups. Data collected on health conditions before 

and after an eruption by passive surveillance can be used to detect eruption-related morbidity. 

Systems already in place, such as Nicaragua's national epidemiologic surveillance system, 

can be modified or extended so as to increase their sensitivity to new cases and hence their 

ability to provide appropriate notification to medical relief agencies. 

PMID: 8897722, Ul: 97053109

Environ Health Perspect 1996 Mar;104(3):290-7

Partlculate air pollution and respiratory disease in Anchorage, Alaska.

Gordian ME, Ozkaynak H, Xue J, Morris SS, Spengler JD

Department of Health and Human Services, Municipality of Anchorage, AK 99519-6650, USA. 

This paper examines the associations between average daily particuiate matter less than 10 

microns in diameter (PM10) and temperature with daily outpatient visits for respiratory Disease 

including asthma, bronchitis, and upper respiratory illness in Anchorage, Alaska, where there are 

few industrial sources of air pollution. In Anchorage, PM10 is composed primarily of earth 

crustal material and volcanic ash. Carbon monoxide is measured only during the winter months. 

The number of outpatients visits for respiratory diagnoses during the period 1 May 1992 to 1 

March 1994 were derived from medical insurance claims for state and municipal employees and 

their dependents covered by Aetna insurance. The data were filtered to reduce seasonal trends 

and serial autocorrelation and adjusted for day of the week. The results show that an increase of 

10 micrograms/m3 in PM10 resulted in a 3-6% increase in visits for asthma and a 1-3% increase 

in visits for upper respiratory diseases. Winter CO concentrations were significantly associated 

with bronchitis and upper respiratory illness, but not with asthma. Winter CO was highly

15
correlated with automobile exhaust emissions. These findings are consistent with the results of 

previous studies of particulate pollution in other urban areas and provide evidence that the coarse 

fraction of PM10 may affect the health of working people. 

PMID: 10098350

Hawaii Med J 1996 Mar55(3):48-54

Emergency department visits and hospitalizations for respiratory 

disease on the island of Hawaii, 1981 to 1991.

Mannino DM, Ruben S, Hdschuh FC, Hdschuh TC, WHson MD, Hdschuh T

National Center for Environmental Health, Centers for Disease Control and Prevention (CDC),

Atlanta, Georgia, USA.

This study examined trends in and patterns of emergency department visits and hospitalizations

for respiratory disease on the island of Hawaii from 1981 to 1991. We found that emergency

department visit rates and hospitalization rates for both asthma and COPD for 1987 to 1991

increased in all regions of the island in comparison with such rates for 1981 to 1986. Rates of

emergency department visits and hospitalizations for chronic obstructive pulmonary disease or

COPD, but not asthma, were significantly higher in the high-exposure Kona side of the island

than in the intermittent-exposure Hilo side of the island during 1983 and 1988 to 1990. We also

found that during the weeks that winds were from the west, blowing volcanic air pollution

toward Hilo, emergency department visits for asthma increased 15%. Some of the results of our

study support the hypothesis that volcanic air pollution affects respiratory health on the island of

Hawaii, while other results do not. Any future studies should include measurements of air

pollutant levels.

PMID: 8882554, Ul: 97036907

World Health Stat Q 1996;49(3-4):204-8

The effects of volcanoes on health: preparedness in Mexico.

Zeballos JL, Meli R, Vilchis A, Barrios L 

Pan American Health Organization, Mexico.

The article reviews the most important aspects of volcanic eruptions and presents a summary of 

the harmful materials they emit The main health effects can be classified as either physical 

(trauma, respiratory diseases, etc.) or psychological (depression, anxiety, nightmares, neurosis, 

etc.). Popocatepetl, the most famous active volcano in Mexico, lies on the borders of the States 

of Mexico, Puebla and MoreJos. In 1993, seismic activity intensified, as did as the emission of 

fumaroles, followed in December 1994 by moderate tremors and strong emissions of gases and 

ash. In 1996, a number of seismic events led to an unexpected explosion. A daily emission of 

8,000 to 15,000 tonnes of sulfur dioxide has been measured. Popocatepetl is located in a densely 

populated region of Mexico. A complex network to monitor the volcano using sophisticated 

equipment has been set up, including visual surveillance, seismic, geochemical and geodesic 

monitoring. An early warning system(SINAPROC/CENAPRED) has been developed to keep the 

population permanently informed. The warning system uses colour codes: green for normal, 

yellow for alert, and red for warning and evacuation. An emergency plan has been prepared, 

including evacuation and preparation for medical centres and hospitals in the region, as well as 

intense public information campaigns. 

PMID: 10098350

Arch Environ Hearth 1994 Sep-Oct;49(5):39&401

Evaluating a fluorosis hazard after a volcanic eruption.

Rubin CH, Noji EK, Seligman PJ, Holtz JL, Grande J, Vrttani F

Epidemic Intelligence Service, Epidemiology Program Office, Atlanta, Georgia.

The August 1991 eruption of Mt. Hudson (Chile) deposited ash across southern Argentina and

contributed to the deaths of thousands of grazing sheep. Early ash analysis revealed high levels

of fluoride, a potential ash constituent toxic to humans and animals. In order to evaluate fluorosis

as the cause of sheep deaths and to examine the possibility that similar ash and airborne

16
toxins could also have an effect on the human population, we conducted an investigation that 

included health provider interviews, hospital record review, physical examination of sheep, 

determination of sheep urine fluoride levels, and complete constituent analysis of ash samples 

collected at proscribed distances from the volcano. Ash deposited farthest from the volcano 

had highest fluoride levels; all fluoride measurements were normal after rainfall. There were no 

signs or symptoms of fluorosis observed in sheep or humans. Sheep deaths resulted from 

physical, rather than chemical properties of the ash. 

PMID: 7944572, Ul: 95031257

Prehospital Disaster Med 1994 Jan-Mar 9(1): 58-66

In the shadow of El Chichon: an overview of the medical impact of the 

28 March to 4 April 1982 eruptions of the Mexican volcano.

Nania JM, Rodriguez Garcia M, Fruchter JS, Olsen KB, Hooper PR

Deaconess Medical Center, Department of Emergency Medicine, Spokane, Wash., USA.

PMID: 10155492, Ul: 96021875

Arch Environ Health 1990 Nov-Dec;45(6):367-73

Health effects of volcanic ash: a repeat study.

Yano E, Yokoyama Y, Higashi H, Nishii S, Maeda K, Koizumi A 

Department of PubRc Health, Teikyo University School of Medicine, Tokyo, Japan. 

The Mount Sakurajima volcano in Kyushu, Japan, is proximal to a large residential area, and it 

emits an enormous amount of volcanic ash during frequent eruptions. In our previous study, we 

investigated, for the first time, respiratory effects of chronic exposure to volcanic ash. The study 

demonstrated a low prevalence of respiratory symptoms, even in the area of highest exposure; 

only a slight excess prevalence of symptoms appeared to be associated with exposure to 

volcanic ash. To confirm the findings of our previous study, the prevalence study of chronic 

respiratory symptoms for residents was repeated in Kanoya and Tashiro, which are located 25 

and 50 km, respectively, from the crater of Mt. Sakurajima. The concentration of suspended 

participate matter in Kanoya frequently exceeded the national environmental quality standards 

and, during summer and winter, was 2-3 times higher than that found in Tashiro. Women who 

were 30-59 y of age and who had resided in Kanoya or Tashiro for more than 3 y completed a 

modified ATS-DLD questionnaire. The prevalence of nonspecific respiratory disease was low, 

i.e., 6.5% in Kanoya and 6.2% in Tashiro; similar prevalences were found in women who had 

never smoked. When we restricted the analysis to individuals without a history of occupational 

exposure to dusts and who had no exposure to passive smoking, there was a slightly higher 

prevalence of nonspecific respiratory disease in Kanoya than Tashiro, but the difference 

was not significant. Eye symptoms were equally prevalent in the two areas. 

PMID: 2270957, Ul: 91103610

Lancet 1990 Jul 21;336(8708):176

Health hazards of volcanic gases.

Baxter PJ, Tedesco D, Mieie G, Baubron JC, Cliff K

Publication Types:

Letter

PMID: 1973489, Ul: 90318177

Res Nurs Health 1986 Dec;9(4):331~40

Status of natural disaster victims' health and recovery 1 and 3 years 

later.

Murphy SA

Bereaved, property loss, and control groups (N = 155) studied 11 months following the 1980 

volcanic eruption of Mt. St. Helens were recontacted 35 months postdisaster to test the 

hypotheses that the greater the loss experienced, the higher the stress, and the poorer the

17
health. In general, the hypotheses were supported. Even though mental distress decreased 

between the two data collection periods, the mental health of the bereaved group remained 

poorer than both the property loss and control groups. At 3 years postdisaster, only 4% of the 

study participants reported complete recovery from disaster loss. Findings are compared with 

those of other recent disasters and clinical and theoretical implications are discussed. 

PMID: 3643610, Ul: 87119152

Am J Public Health 1986 Mar;76(3 Suppl):66-75

Evaluation of physical health effects due to volcanic hazards: human 

studies.

Buist AS, Bernstein RS, Johnson LR, Vollmer WM 

PMID: 3946729, Ul: 86127866

Immediate public health concerns and actions in volcanic eruptions: 

lessons from the Mount St. Helens eruptions, May 18-October 18,1980. 

Bernstein RS, Baxter PJ, Falk H, Ing R, Foster L, Frost F

A comprehensive epidemiological evaluation of mortality and short-term morbidity associated with 

explosive volcanic activity was carried out by the Centers for Disease Control in collaboration with 

affected state and local health departments, clinicians, and private institutions. Following the May 

18, 1980 eruption of Mount St. Helens, a series of public health actions were rapidly instituted to 

develop accurate information about volcanic hazards and to recommend methods for prevention 

or control of adverse effects on safety and health. These public health actions included: 

establishing a system of active surveillance of cause-specific emergency room (ER) visits and 

hospital admissions in affected and unaffected communities for comparison; assessing the 

causes of death and factors associated with survival or death among persons located near the 

crater; analyzing the mineralogy and toxicology of sedimented ash and the airborne concentration 

of resuspended dusts; investigating reported excesses of ash-related adverse respiratory effects 

by epidemiological methods such as cross-sectional and case-control studies; and controlling 

rumors and disseminating accurate, timely information about volcanic hazards and recommended 

preventive or control measures by means of press briefings and health bulletins. Surveillance and 

observational studies indicated that: excess in morbidity were limited to transient increases in ER 

visits and hospital admissions for traumatic injuries and respiratory problems (but not for 

communicable disease or mental health problems) which were associated in time, place, and 

person with exposures to volcanic ash; excessive mortality due to suffocation (76 per cent), 

thermal injuries (12 per cent), or trauma (12 per cent) by ash and other volcanic hazards was 

directly proportional to the degree of environmental damage that is, it was more pronounced 

among those persons (48/65, or about 74 per cent) who, at the time of the eruption, were 

residing, camping, or sightseeing (despite restrictions) or working (with permission) doser to the 

crater in areas affected by the explosive blast, pyrodastic and mud flows, and heavy ashfall; and 

de novo appearance of ash-related asthma was not observed, but transient excesses in adverse 

respiratory effects occurred in two high-risk groups-hypersusceptibtes (with preexisting asthma 

or chronic bronchitis) and heavily exposed workers. Laboratory and field studies indicated that 

volcanic ash had mild to moderate fibrogenic potential, consisting of greater than 90 per cent (by 

count) respirable size particles which contained 4-7 per cent (by weight) crystalline free silica 

(SiO2). 

PMID: 3946727, Ul: 86127860

Am J Public Health 1986 Mar;76(3 Suppl):59-65

Evaluation of physical health effects due to volcanic hazards: the use 

of experimental systems to estimate the pulmonary toxicity of 

volcanic ash.

Martin TR, Wehner AP, Butler J

Shortly after Mount St. Helens erupted in 1980, a number of laboratories began to investigate the 

effects of volcanic ash in a variety of experimental systems in attempts to predict effects that 

might occult in the lungs of humans exposed to volcanic ash. The published results are

18
remarkably consistent, despite the use of non-uniform ash samples and variability in the 

experimental approaches used. The data indicate that volcanic ash, even in high concentrations, 

causes little toxicity to lung cells in vitro and in vivo, as compared with effects of free crystalline 

silica, which is known to be highly fibrogenic. Volcanic ash does not appear to be entirely inert, 

however, possibly because of low concentrations of free crystalline silica in the ash. The 

published experimental studies suggest that inhaled volcanic ash is not likely to be harmful to the 

lungs of healthy humans, but the potential effects of volcanic ash in patients with pre-existing lung 

diseases are more difficult to ascertain from these studies. 

PMID: 3080911, Ul: 86127865

Am J Public Health 1986 Mar;76<3 Suppl):53-8

Evaluation of physical health effects due to volcanic hazards: 

crystalline silica in Mount St. Helens volcanic ash.

Doliberg DD, Bdyard ML, Smith DL

This investigation has shown that crystalline silica has been identified as being present in the 

Mount St. Helens volcanic ash at levels of 3 to 7 per cent by weight. This identification has been 

established using X-ray powder diffraction, infrared spectrophotometry, visible 

spectrophotometry, electron microscopy, and Laser Raman spectrophotometry. Quantitative 

analysis by IR, XRD, and visible spectrophotometry requires a preliminary phosphoric acid 

digestion of the ash sample to remove the plagioclase silicate material which interferes with the 

determination by these methods. Electron microscopic analysis as well as Laser Raman 

spectrophotometric analysts of the untreated ash confirms the presence of silica and at levels 

found by the XRD and IR analysis of the treated samples. An interiaboratory study of volcanic ash 

samples by 15 laboratories confirms the presence and levels of crystalline silica. Although several 

problems with applying the digestion procedure were observed in this hastily organized supply, all 

laboratories employing the digestion procedure reported the presence of crystalline silica. These 

results unequivocally put to rest the question of the presence of silica in the volcanic ash from 

eruptions of Mount St. Helens in 1980. 

PMID: 3004241, Ul: 86127864

Lab Invest 1983 Jan;48(1):5-12

Health effects of Mount St. Helens volcanic dust.

Craighead JE, Adier KB, Butier GB, Emerson RJ, Mossman BT, Woodworth CD 

PMID: 6823090, Ul: 83113385

Lancet 1982 Jul 17;2(8290): 150-1

Volcanic gases and health: Masaya Volcano, Nicaragua.

Baxter PJ, Stoiber RE, Williams SN 

PMID: 6123853, Ul: 82218765

JAMA 1981 Dec4;246(22):2585-9

Mount St Helens eruptions, May 18 to June 12,1980. An overview of 

the acute health impact.

Baxter PJ, Ing R, Falk H, French J, Stein GF, Bernstein RS, Merchant JA, Allard J 

Thirty-five known deaths were caused by the landslide and lateral blast of the May 18 eruption of 

Mount St Helens and at least 23 persons are missing. In 18 of 23 cases that reached autopsy, 

asphyxiation from ash inhalation was the cause of death. A rapidly established hospital 

surveillance system detected increases in the number of emergency room (ER) visits and 

admissions for asthma and bronchitis in communities with the heaviest ashfaii after the May 18 

eruption and the eruptions on May 25 and June 12. There were also increases in the number of 

ER visits for ash-related eye complaints in some areas, laboratory studies indicated that the May 

18 ash was not acutely toxic, but the respirable portion contained 3% to 7% of crystalline free 

silica, a potential pneumoconiosis hazard to certain heavily exposed occupational groups.

19
Continuing volcanic activity of Mount St Helens and future eruption of other volcanoes in the 

Cascade Range may pose a variety of health hazards, including blast, ashfalls, flooding, damage 

to public utilities, and possible psychosocial effects. 

PMID: 7029020, Ul: 82055845

N Z Med J 1997 Mar 28;110(1040):90-1

Under the volcano: fire, ash and asthma?

Bradshaw L, Fishwick D, Kemp T, Lewis S, Rains N, Slater T, Pearce N, Crane J 

Department of Medicine, Wellington School of Medicine.

AIMS: To investigate the prevalence of respiratory symptoms in known asthmatics, following 

exposure to airborne volcanic ash particles caused by the eruptions of Mount Ruapehu, New 

Zealand, commencing September 1995. METHOD: A one page postal questionnaire was sent to 

1392 previously identified asthmatics 2 months after the first major eruption. RESULTS: Two 

hundred and thirty seven subjects had moved from the area, died or gone overseas since the 

original contact 4 years previously; therefore the target population was 1155 subjects of whom 

361 lived in the exposed area and 794 in the nonexposed areas. The response rates were 246 

(68.1%) in the exposed group and 477 (60.1%) in the nonexposed group making a total of 723 

individuals. The prevalence of nocturnal shortness of breath in the last two months was 29.3% in 

the exposed group and 24.7% in the nonexposed (OR = 1.26, 95% Cl; 0.83-1.78). Similarly 

30.9% of the exposed group had an asthma attack in the last 2 months compared to 31.9% of the 

nonexposed group (OR = 0.96, 95% Cl; 0.69-1.33). Finally, 48.4% of the exposed group 

used asthma medication in the 2 months following the eruption in comparison to 53% of the 

nonexposed group (OR = 0.83, 95%, Cl; 0.61-1.12). CONCLUSIONS: The study showed no 

association between living in an area exposed to volcanic ash particles and either asthma 

symptoms or the use of asthma medication. There was a small but nonsignificant increase in 

nocturnal shortness of breath in the exposed group. 

PMID: 9137309, Ul: 97283175

Arch Environ Health 1986 Mar-Apr41(2):94-9

Chronic pulmonary effects of volcanic ash: an eptdemiologic study.

Yano Er Yokoyama Y, Nishii S

The chronic pulmonary effects of exposure to volcanic ash were investigated by conducting a

cross-sectional epidemiologicai study of 2,006 women between 30 and 59 yr of age who lived in

three areas subjected to different levels of airborne ash. In the three areas prevalences of chronic

bronchitis and other respiratory symptoms were so low that volcanic ash did not seem to be

a major cause of respiratory disease. In the highly exposed area, however, 9.9% of the women

experienced symptoms of one or more respiratory diseases, while 6.4% of the women in the

medium- and 5.4% of the women in the low-exposure area had these symptoms. Prevalences of

each disease and symptom increased as total suspended particulate level increased, suggestive

of an association of mild respiratory symptoms with volcanic ash.

PMID: 3718009, Ul: 86240999

Am J Public Health 1986 Mar;76(3 Suppl):39-44

The development of a multidisciplinary plan for evaluation of the 

long-term health effects of the Mount St. Helens eruptions.

Buist AS, Martin TR, Shore JH, Butler J, Lybarger JA 

PMID: 3946728, Ul: 86127862

20
Lancet 1997 Nov 15;360(9089): 1435-8

Global assessment of El Nine's disaster burden.

Bouma MJ, Kovats RS, Goubet SA, Cox JST Haines A

Department of infectious and Tropical Diseases, London School of Hygiene and Tropical 

Medicine, UK.

BACKGROUND: Natural disasters have profound effects on health and require medical 

intervention as part of relief operations. The world's populations are becoming increasingly 

vulnerable to extreme weather events, which are responsible for most natural disasters. The El 

Nino Southern Oscillation (ENSO) is the most prominent global climate system associated with 

year-to-year weather variability and extreme events. We have estimated the burden on human 

health of natural disasters associated with ENSO. METHODS: We used time-series regression 

analysis of the relation between El Nino years and the annual rates of persons affected by natural 

disasters per 1000 population during 1964-93, globally and also by region and disaster type. 

Correlations between sea-surface temperature (SST) anomalies (index of ENSO) and the rates of 

persons affected by natural disasters per 1000 population were determined globally, by region 

and by disaster type. FINDINGS: The rate of persons affected by natural disasters worldwide is 

strongly associated with ENSO; rates are greater during the first El Nino year (p = 0.05) and the 

following year (p = 0.01) than in the pre-Nino year. The correlation between rates of persons 

affected by natural disasters and SST anomalies in the Eastern Pacific (a key ENSO indicator) is 

highest in the last quarter of the previous year (r = 0.53, p < 0.01). These associations are 

strongest in South Asia, the region where more than 50% of all disaster victims live. Worldwide, 

rates of persons affected by drought/famine (half of all disaster victims) and by volcanic 

eruptions show significant associations with the ENSO cyde, being highest in the post-Nino year 

and El Nino year, respectively, and being significantly associated with SST anomalies. 

INTERPRETATION: The strong relation between ENSO and populations affected by natural 

disasters can be described as a "natural disaster cyde". Determining the phase in this cyde, 

using SST from the Eastern Equatorial Pacific, could benefit disaster preparedness on a global 

scale, for South Asia in particular, and for all populations affected by drought/famine and volcanic 

disasters. 

PMID: 9371167, Ul: 98038505

Environ Health Perspect 1977 Aug;19:139-43

Arsenic levels in Oregon waters.

Stoner JC, Whanger PD, Weswig PH

The arsenic content of well water in certain areas of Oregon can range up to 30 to 40 times the 

U.S.P.H.S. Drinking Water Standard of 1962, where concentrations in excess of 50 ppb are 

grounds for rejection. The elevated arsenic levels in water are postulated to be due to volcanic 

deposits. Wells in central Lane County, Oregon, that are known to contain arsenic rich water 

are in an area underlain by a particular group of sedimentary and volcanic rocks, which geologists 

have named the Fischer formation. The arsenic levels in water from wells ranged from no 

detectable amounts to 2,000 ppb. In general the deeper wells contained higher arsenic water. 

The high arsenic waters are characterized by the small amounts of calcium and magnesium in 

relation to that of sodium, a high content of boron, and a high pH. Water from some hot springs in 

other areas of Oregon was found to range as high as 900 ppb arsenic. Arsenic blood levels 

ranged from 32 ppb for people living in areas where water is low in arsenic to 250 ppb for those 

living in areas where water is known to contain high levels of arsenic. Some health problems 

associated with consumption of arsenic-rich water are discussed. 

PMID: 908291, Ul: 78003235

21
Environ Health Perspect 1999 May;107(5):359-65

Drinking water arsenic in Utah: A cohort mortality study.

Lewis DR, Southwick JW, Ouellet-HeUstrom R, Rench J, Calderon RL

U.S. Environmental Protection Agency, National Health and Environmental Effects Research 

Laboratory, Human Studies Division, Research Triangle Park, NC 27711 USA. 

The association of drinking water arsenic and mortality outcome was investigated in a cohort of 

residents from Millard County, Utah. Median drinking water arsenic concentrations for selected 

study towns ranged from 14 to 166 ppb and were from public and private samples collected and 

analyzed under the auspices of the State of Utah Department of Environmental Quality, Division 

of Drinking Water. Cohort members were assembled using historical documents of the Church of 

Jesus Christ of Latter-day Saints. Standard mortality ratios (SMRs) were calculated. Using 

residence history and median drinking water arsenic concentration, a matrix for cumulative 

arsenic exposure was created. Without regard to specific exposure levels, statistically significant 

findings include increased mortality from hypertensive heart disease [SMR = 2.20; 95% 

confidence interval (Cl), 1.36-3.36], nephritis and nephrosis (SMR - 1.72; Cl, 1.13-2.50), and 

prostate cancer (SMR = 1.45; Cl, 1.07-1. 91) among cohort males. Among cohort females, 

statistically significant increased mortality was found for hypertensive heart disease (SMR = 

1.73; Cl, 1.11-2.58) and for the category of ail other heart disease, which includes pulmonary 

heart disease, pericarditis, and other diseases of the pericardium (SMR = 1.43; ci, 1.11-1.80). 

SMR analysis by low, medium, and high arsenic exposure groups hinted at a dose relationship for 

prostate cancer. Although the SMRs by exposure category were elevated for hypertensive heart 

disease for both males and females, the increases were not sequential from low to high groups. 

Because the relationship between health effects and exposure to drinking water arsenic is not 

well established in U.S. populations, further evaluation of effects in low-exposure populations is 

warranted. 

PMID: 10210691, Ul: 99228656

Bid Trace Bern Res 1999 Mar;67(3): 197-204

Trace elements in coai: environmental and health significance.

Finketman RB

US Geological Survey, Reston, VA 20192, USA.

Trace elements can have profound adverse effects on the health of people burning coal in homes 

or living near coai deposits, coal mines, and coal-burning power plants. Trace elements such as 

arsenic emitted from coal-burning power plants in Europe and Asia have been shown to cause 

severe hearth problems. Perhaps the most widespread health problems are caused by domestic 

coai combustion in developing countries where millions of people suffer from fluorosis and 

thousands from arsenism. Better knowledge of coal quality characteristics may help to reduce 

some of these health problems. For example, information on concentrations and distributions of 

potentially toxic elements in coal may help delineate areas of a coal deposit to be avoided. 

Information on the modes of occurrence of these elements and the textural relations of the 

minerals in coal may help to predict the behavior of the potentially toxic trace metals during coal 

cleaning, combustion, weathering, and leaching. 

PMID: 10201327, Ul: 99215510

Int J Occup Environ Health 1998 Oct-Dec;4(4):217-30

Human exposures to arsenic from consumption of well water in 

West Bengal, India.

Subramanian KS, Kosnett MJ

Product Safety Laboratory, Health Canada, Ottawa, Ontario, Canada. s_k_subramanian@hcsc.gc.ca

The authors visited the State of West Bengal, India, in August 1996, as consultants to the World

Health Organization (WHO). The general mandate of the mission was to formulate

recommendations to the Government of India regarding its efforts to assist the Government of

22
West Bengal in remedying health problems arising from the presence of arsenic in groundwater in 

excess of the WHO guideline limit of 0.05 mg/L in eight districts of the State. The authors held 

discussions with Government of India and Government of West Bengal officials, as well as 

scientists, engineers, and physicians studying the analytic, medical, engineering, and 

hydrogeologic facets of the problem. They conducted field visits to arsenic-affected villages; 

inspected health centers, including the laboratories conducting the analytic and dinical studies; 

and interviewed and examined local lay people, including many arsenic-poisoned patients. 

This overview of the arsenic contamination problem in West Bengal is based upon a review of the 

scientific literature and government reports and the authors direct firsthand assessment. The 

authors hope that their recommendations will assist in the development of a comprehensive 

infrastructure and plan of action, which are necessary to control the epidemic of chronic arsenic 

poisoning now afflicting West Bengal. 

PMID: 9876630, Ul: 99093910

Cad Saude Publica 1998; 14 Suppl 3:193-8

Lung cancer and arsenic exposure in drinking water: a 

case-control study in northern Chile.

Ferreccio C, Gonzalez Psych C, Milosavjlevic Stat V, Marshall Gredis G, Sancha AM 

Grupo para el Desarrollo de la Investigation en Salud (GREDIS). Casilta 52750, Correo Central, 

Santiago, Chile.

In some Chilean cities, levels of arsenic (As) in drinking water reached 800 (g/L between 1950 

and 1970, while current levels are 40 (g/L. To evaluate the causal role of this exposure in lung 

and bladder cancers, we conducted a case-control study in Regions I, II, and III of the country. 

From 1994 to 1996, cases diagnosed as lung cancer and two hospital controls were entered in 

the study; one control was a patient with a cancer, while the other was a patient without cancer, 

both conditions unrelated to As. Controls were matched with cases by age and sex. A standard 

survey containing questions about residence, employment, health history, was administered to 

study subjects. Data on As concentrations in water were obtained from records of the municipal 

water companies. A total of 151 lung cancer cases and 419 controls (167 with cancer and 242 

without cancer) were enrolled. Median level of lifetime As exposure was significantly higher 

among cases, with a dear dose-response relationship between mean As exposure levels, with an 

OR (95% Cl) of: 1, 1.7 (0.5-5.1), 3.9 (1.2-13.4), 5.5 (2.2-13.5), and 9.0 (3.6-22) for strata one to 

five respectively. This study provides new evidence that As in drinking water can cause internal 

cancers and gives an estimate of the form of this relationship. 

PMID: 9819479, Ul: 99051501

WMJ 1998 Oct;97(9):46-8

Never on a Saturday (or a Sunday): the case against using 

weekend urine specimens to assess arsenic exposure.

Knobeioch L, Korthof S, Anderson H 

Wisconsin Department of Health and Family Services, USA.

The Wisconsin Department of Health and Family Services Bureau of Public Health recently 

investigated two cases of suspected arsenic poisoning. These cases involved four adults whose 

urinary arsenic levels ranged from 340 to 1485 ug/L (normal 0-30 ug/L). These findings were 

initially interpreted as evidence of an ongoing exposure to a toxic form of arsenic, however followup investigations determined that all of the urine specimens had been collected on a weekend 

and that each of these individuals had consumed fish within 48-hours of urine collection. Most of 

the fish was consumed at "Friday night fish fries" which are a popular tradition at many local 

restaurants. Urine samples collected after these individuals eliminated fish from their diets 

contained normal arsenic levels. This report suggests the need for laboratories to differentiate 

non-toxic forms of arsenic that are present in fish and seafood products from other species of 

this element Until more specific analytical methods become available, patients should be 

instructed to omit fish and seafood from their diets for several days prior to collecting urine for 

arsenic analysis. In addition, elevated urinary arsenic levels should be interpreted cautiously and

23
exposure to toxic forms should be confirmed before a diagnosis of arsenic poisoning is

entertained.

PMID: 9810258, Ul: 99027953

Cancer Causes Control 1997 May;8(3):292-308

Drinking water and cancer.

Cantor KP

Occupational Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National 

Cancer Institute, Bethesda, Maryland 20892, USA.

Epidemidogic evidence on the relation between contaminants in drinking water and cancer is 

reviewed. The reviewed studies cover exposure to: disinfection byproducts; nitrate; arsenic and 

other metals; voiatiles and contaminants from hazardous waste sites; asbestiform fibers; 

radionuciides; and fiuoride. Most investigations are ecologic, with some confirmation of elevated 

risk from individual-based studies. In the case of waterborne arsenic, and possibly chlorination 

byproducts, there is a consistent but small body of epidemiologic evidence of an association with 

one or more types of cancer. Nitrate in groundwater has increased greatly over the years, and the 

demonstration of endogenous nitrosation among highly exposed subjects raises concern of 

elevated cancer risk. However, the epidemioiogic data are not yet sufficient to draw a conclusion. 

There is a diversity of studies among populations exposed to water contaminated with pesticides, 

volatile organics, or mixtures from hazardous waste sites. Studies of asbestiform fibers and 

radionuciides in water are not conclusive, but there are suggested elevations of several cancer 

sites in highly exposed populations. There is no suggestion that fiuoride in drinking water is linked 

with elevated risk of cancer. As topics for epidemioiogic evaluation, drinking water contaminants 

pose methodologic problems common to studies designed to detect relatively small elevations in 

risk, with the added challenge of assessing exposures for many years in the past Nevertheless, 

epidemioiogic assessment is valuable and dearly warranted, given the potential public health 

impact of small risk elevations among very large exposed populations, and the limitations of 

toxicologic experiments in assessing carcinogenic risk of complex mixtures or of compounds for 

which appropriate animal models are not available 

PMID: 9498894, Ui: 98141142

Sci Total Environ 1997 Dec 3;208(1-2):89-95

Arsenic intake by the adult population in Bombay city.

Tripathi RM, Raghunath R, Krishnamoorthy TM

Environmental Assessment Division, Bhabha Atomic Research Centre, Bombay, India Hydride 

generator atomic absorption spectrophotometry (HG-AAS) is employed for the determination of 

arsenic in air, duplicate diet and body fluids. The detection limit for arsenic is 0.02 ppb. The 

reliability of the analysis is assessed through analysis of Standard Reference Materials (SRMs) of 

soil and fish tissue obtained from IAEA. The concentration of arsenic in atmospheric air 

particulates collected from different suburbs showed geometric means in the range of 1.9-5.6 

ng/m3. The total intake of arsenic through air and duplicate diet is approximately 10 

micrograms/day for the adult population of Bombay (Mumbai) City. The dietary intake through 

food is the major contributor to the total intake. The turnover time of arsenic in Wood is estimated 

to be approximately 33 days based on the observed mean concentration of arsenic in blood of 1 

microgranVdi. The daily intake of arsenic by the adult population of Bombay is much lower than 

the WHO recommended value of 140 micrograms. 

PMID: 9496652, Ul: 98157737

Cent Eur J Public Health 1996 Dec;4(4):246-9

Model of multiple exposure to contaminants in monitoring the 

environmental impact on population health.

KlimentV

National Institute of Public Health, Prague, Czech Republic.

24
The model study is focused on possibilities of comprehensive evaluation of the multiple exposure 

of humans to selected inorganic contaminants (arsenic, cadmium, lead, zinc) monitored within the 

subsystems of the monitoring the environmental impact on population health (inhalation and 

ingestion exposure from air, drinking water and foodstuffs and biological monitoring). The mean 

daily intake of contaminants of average adults is assessed using the monitoring and literature 

data. The exposure balance showed that the total intake of individual contaminants studied did 

not exceed the limit values given by the exposure standards (acceptable daily intake). The 

highest value of exposure reaching 28% of the limit was reported for cadmium. The prevailing 

pathway of exposure is ingestion of foodstuffs: more than 95% in ail contaminants under study, 

information on the intake of contaminants is used as input in a linear muiticompartmental model 

describing their kinetics and retention in the human organism. The results of the model 

computation are compared with the laboratory data obtained in the biological monitoring of adult 

urine. The model and monitoring sets of results were found to conform well for cadmium and zinc. 

For arsenic and lead the model values are roughly one order of magnitude lower than the 

monitored ones which should be considered as acceptable for the model studies of this type. The 

model study of contaminant monitoring data processing and evaluation suggests further 

applications of health risk assessment representing one of the basic outputs of monitoring the 

environmental impact on population health. 

PMID: 8997533, Ul: 97151551

Published erratum appears in Science 1996 Nov 29:274(5292): 1451

India's spreading health crisis draws global arsenic experts.

Bagla P, Kaiser J

Comment in: Science 1996 Nov 22;274(5291):1287

PMID: 8927976, Ul: 97017485

Wis Med J 1996 Feb; 95(2): 100-4

Health effects of ingesting arsenic-contaminated groundwater.

Haupert TA, Wiersma JH, Goidring JM

Department of Natural and Applied Science, University of Wisconsin, Green Bay, USA. 

Approximately 4% of private drinking water wells in central Outagamie and Winnebago counties 

contain naturally occurring arsenic at concentrations exceeding the present Environmental 

Protection Agency (EPA) standard of 50 parts per billion (ppb). This cross-sectional study 

assessed health status via a self-administered survey. Questions concerned water consumption 

and resulting neurological, gastrointestinal, and dermatoiogrcal symptoms. Participants were 

recruited through a public information campaign recommending water testing through local health 

departments; the survey was distributed at the time the water sample was submitted. Participants 

were unaware of their arsenic water concentration before completing the survey. Surveys from 

637 families-64% of all surveys distributed-representing 1,836 individuals were completed. Of 

those respondents, 452 (25%) consumed between 5 and 50 micrograms of arsenic per day 

through water consumption; 47 (3%) consumed more than 50 micrograms of arsenic per day. 

This sample size had 80% power to detect a two-fold difference in the prevalence of the health 

effects studied. At this power level, no significant associations between arsenic intake, estimated 

through drinking water consumption and water arsenic concentrations, and the health effects 

studied were established. 

PMID: 8819705, Ul: 96416914

Br J Cancer 1995 Jan;71(1):109-14

Multiple risk factors associated with arsenic-induced skin 

cancer: effects of chronic liver disease and malnutritional 

status.

Hsueh YM, Cheng GS, Wu MM, Yu HS, Kuo TL, Chen CJ

Department of Public Health School of Medicine, Taipei Medical College, Taiwan, Republic of

China.

25
In order to evaluate the prevalence and multiple risk factors of arsenic-induced skin cancer 

among residents in Taiwanese villages in which chronic arseniasis is hyperendemic, a total of 

1571 subjects aged 30 or more years were recruited between September 1988 and March 1989. 

All of them were interviewed personally by a public health nurse using a structured questionnaire, 

and 1081 interviewed study subjects, including 468 men and 613 women, participated in physical 

examination, giving a participation rate of 68.8%. The overall prevalence of skin cancer was as 

high as 6.1%, showing an increase with age in both men and women. There was a significant 

dose-response relation between skin cancer prevalence and chronic arsenic exposure as indexed 

by duration of residence in the endemic area, duration of consumption of high-arsenic artesian 

well water, average arsenic exposure in parts per million (p.p.m.) and cumulative arsenic 

exposure in p.p.m.-years. Chronic carriers of hepatitis 6 surface antigen with liver dysfunction 

had an increased prevalence of skin cancer. Undernourishment, indexed by a high consumption 

of dried sweet potato as a staple food, was also significantly associated with an increased 

prevalence of arsenic-induced skin cancer. All these risk factors remained statistically significant 

in the multiple logistic regression analysis. Consistent with animal experiments, the findings imply 

that liver function and nutritional status may affect the metabolism of inorganic arsenic and the 

development of subsequent skin cancers. 

PMID: 7819025, Ul: 95118778

J Air Waste Manage Assoc 1991 Jun;41(6):827-31

Ambient air arsenic levels along the Texas-Mexico border.

Shields J

University of Texas School of Public Health, San Antonio.

The Texas-Mexico border region is one of the most rapidly developing areas in the state. 

Unprecedented economic and demographic growth is placing stress on a system already 

overburdened with air, water, waste, and public health problems. This paper reports the results of 

an initial survey of the past and present ambient air levels of arsenic along the Texas side of the 

border. Ambient air arsenic levels have increased over time, exhibit seasonal variations, and are 

higher in specific areas when compared to the rest of the state. Five of the 20 areas in Texas 

having the highest 24-hour levels of arsenic are found along the border, in areas where 

emissions have been significantly reduced at the source, arsenic levels remained high in the 

environment for over two years. This provides a potential continuum for human exposure. The 

results of this study emphasize the need for bi-national development and implementation of air 

quality control programs along the Texas-Mexico border. 

PMID: 1910749, Ul: 92000607

Am J Public Health 1983 Dec;73( 12): 1366-9

Lead concentrations in inner-city soils as a factor in the child lead 

problem.

Mielke HW, Anderson JC, Berry KJ, Mielke PW, Chaney RL, Leech M

Soil samples were randomly collected from 422 vegetable gardens in a study area centered in 

downtown Baltimore, Maryland, and having a radius of 48.28 km (30 miles). The levels of lead, 

four other metals (cadmium, copper, nickel, and zinc), and pH were measured for each location. 

The application of multi-response permutation procedures, which are compatible with mapping 

techniques, reveals that lead (as well as cadmium, copper, nickel, and zinc) is concentrated and 

ubiquitous within the soils of the inner-city area of Metropolitan Baltimore. The probability values 

that the concentration of metals occurred by chance alone vary from about 10(-15) to 10(-23) 

depending on the metal considered. Our findings pose environmental and public health issues, 

especially to children living within the inner-city. 

PMID: 6638229, Ul: 84049832

26
Sci Total Environ 1998 Nov 10;223(2-3):81-6

Lead, nickel and vanadium in seafood: an exposure assessment for 

Kuwaiti consumers.

Bu-Olayan AH, al-Yakoob S

Chemistry Department, Faculty of Science, Kuwait University, Safat, Kuwait.

Human exposure to lead (Pb), nickel (Ni) and vanadium (V) through the Ingestion of six species

of fish and two species of shrimp in Kuwait are determined. The study on seafood consumed by

the Kuwaiti residents was analyzed by conducting a survey in five districts of the country, namely,

Kuwait city (Capital), Farwaniya, Jahra, Hawaly and Ahmedi. Samples consisting of fish and

shrimp were purchased from the local fish market during November 1995 and June 1996. Based

on the survey, three major factors were investigated: (i) Pb, Ni and V concentration in the fish of

locally consumed fish and shrimp; (ii) daily dietary intake of these elements in humans through

consumption of seafood; and (iii) characterizing potential health risks associated with the

estimated daily intakes. The risk associated with Pb, Ni and V in seafood was estimated based on

a Hazard Index (HI). Although the highest HI (using the 95th percentiles of the daily intake of the

element as the dose of concern) was observed for zobaidy, hamoor and shrimp, ft is always < 1.

This indicated that no serious health threats are associated with oil-related elements in fish and

shrimp.

PMID: 9861729, Ul: 99078722

Toxicology. 1995 Apr 12;98(1-3):47-55.

Effect of heavy metal ions on the release of reactive oxygen 

intermediates by bovine alveolar macrophages.

Schluter T, Berg I, Dorger M, Gercken G

Department of Biochemistry and Molecular Biology, University of Hamburg, Germany. 

Short-term incubations of bovine alveolar macrophages (BAM) with metal-containing dusts induce 

the release of reactive oxygen intermediates (ROI). Incubations of BAM (90 min) with dissolved 

metal compounds (0.1-100 microM) combined with quartz dusts were performed to investigate 

the effects of single elements on BAM stimulation. As(lll), as well as the calcium antagonists, 

Ni(II) and Ce(lll), inhibited the secretion of superoxide anions (O2-) and hydrogen peroxide 

(H2O2). O2-concentrations were lowered by Mn(ll) and Fe(ll). Increased ROI concentrations 

were observed with V(IV) (O2- and H2O2) and Fe(lll) (O2-). The addition of Cd(ll), Cr(III) and 

V(V) showed no effect on the dust-induced respiratory burst.

The influence of insoluble heavy metal compounds on ROI secretion by BAM were studied with 

metal oxide-coated silica particles. In most cases the release of ROI was not affected by the 

chemical modification of the particle surface. Coating with CuO markedly lowered the 

concentrations of O2- and H2O2, whereas vanadium(IV) oxide considerably increased both 

ROIs. Although most of the investigated metal compounds did not alter ROI secretion our present 

results with V(IV) and Fe(lll) confirm our recent statistical evaluation of the effects of heavy metalcontaining dusts on ROI secretion (Berg et al., 1993, J. Toxicol. Environ. Health 39, 341). 

PMID: 7740553; Ul: 95259072.

Rev Environ Health 1996 Oct-Dec;11(4):191-203

Assessment of potential health risks associated with ingesting heavy 

metals in fish collected from a hazardous-waste contaminated 

wetland in Louisiana, USA.

Tchounwou PB, Abdelghani AA, Pramar YV, Heyer LR, Steward CM

Department of Basic Pharmaceutical Sciences, Xavier University College of Pharmacy, New

Orleans, Louisiana 70125, USA.

Significant adverse effects on environmental quality, ecosystem integrity, and human health have

often been associated with improper disposal of hazardous materials. This study ascertains the

levels of eight heavy metals in various fish species that were collected from a local hazardous27
waste-contaminated wet-land and estimates the potential health risk that may be associated with 

consuming such fish. We examined a total of 53 fish samples representing 12 different species. 

The respective mean concentrations (ng/g) of arsenic, cadmium, chromium, copper, iron, lead, 

mercury, and nickel found in edible tissues were as follows: 72.5 +7-103.1, 55.4 +/- 34.6, 97.4 +7- 

111.7, 177.3+7-328.3, 2711.0 +7-4469.6, 26.0+7- 119.0, 32.7+7-75.3, and81.5+7- 178.9. Fora 

10-kg child eating 6.5 g of fish per day, the computed combined hazard index was 0.475 ; for 70- 

kg adults with a daily consumption of 6.5 g (general population), 30 g (sport fishermen), and 140 

g (subsistence fishermen), the respective computed hazard indices were 0.068, 0.313, and 1.462. 

The results indicate that subsistence fishermen had the highest risk for systemic effects, with an 

exposure exceeding the Environmental Protection Agency (ERA) Reference Dose value. In a 10- 

kg child, such excess exposure would be reached-even with such single metals as arsenic and 

mercury-when applying the EPA-approved maximum fish consumption rate of 54 g/day to the 

general population. The cancer risk for arsenic, the only metal with an established cancer potency 

factor from oral exposure, varied from 8 x 10(-6) to 253 x 10(-6), indicating an exposure 

exceeding the widely accepted risk level of 1 x 10(-6) (one excess cancer per 10(6) population). 

PMID: 9085435, Ul: 97239774

Regul Taxied Pharmacd 1997 Aug;26(1 Pt 2):S23-34

Urinary chromium as a biological marker of environmental exposure: 

what are the limitations?

Paustenbach DJ, Panko JM, Fredrick MM, Firtley BL, Proctor DM 

McLaren/Hart Inc.-ChemRisk, 1135 Atlantic Avenue, AJameda, California 94501, USA. 

Public concern has mounted recently about environmental exposures to chromium in soil, tap 

water, and ambient air. In response, agencies charged with protecting public health have 

attempted to study exposure by monitoring urinary chromium levels among potentially exposed 

populations. While urinary biomonitoring of occupational^ exposed workers has been 

successfully used to assess high-level inhalation exposures in the workplace, evaluating low-level 

environmental exposures has been problematic. Due to these problems, before an extensive 

biological monitoring study is conducted of those exposed to low levels of environmental 

chromium, several issues must be resolved. First, exposures to chromium must occur at the 

same time as sampling, because the biological half-life of chromium in urine is very short (less 

than 2 days). Second, reduced bioavailabiiity and bioaccessibility via the oral and dermal routes 

of exposure limit the capacity of urinary monitoring to measure environmental exposures (e.g., 

systemic dose is too small to be measured). Third, the dose of chromium must be sufficient such 

that it may be reliably measured above background levels in urine (range of 0.2 to 2 &mgr;g/liter) 

and above the analytical limit of detection (0.2 &mgr,g/liter). Fourth, the inter- and intrapersonal 

variability in background levels of urinary chromium is known to be significant and influenced by 

food and beverage intake, smoking, and exercise. Thus, the role of each factor must be carefully 

understood. Finally, it is imperative to have developed a complete understanding of the dinical 

significance of elevated urinary chromium levels before a study is performed, because higher 

than background levels, in and of themselves, are not indicative of a significant health concern. 

The route of exposure, valence of chromium to which people were exposed, exposure time, and 

duration must all be understood before the biological data can be implemented. We have 

conducted a total of nine human exposure studies over the past 3 years in an attempt to 

understand the kinetics of chromium and the impact on urinary, red blood cell (RBC), and plasma 

biomonitoring programs. The results of these studies are described here and our 

recommendations are offered for how to design and implement a urinary chromium biomonitoring 

study. In our view, given some evidence that the dose of hexavalent chromium [Cr(VI)] is 

sufficient to be measurable above background concentrations of total chromium [Cr(lll) and 

Cr(VI)J, duplicated measurements of chromium in plasma and RBCs are, in most cases, a more 

definitive gauge of environmental exposure than urinary biomonitoring. Copyright 1997 Academic 

Press. 

PMID: 9380834, Ul: 98025736

28
J Air Waste Manag Assoc 1997 Aug;47(8):905-10

Airborne hexavalent chromium in southwestern Ontario.

BellRW, HipfnerJC

Ontario Ministry of Environment and Energy, Science and Technology Branch, Toronto, Canada. 

This study reports the first field measurements of airborne hexavaJent chromium (Cr(vi)) in 

southwestern Ontario. Hexavalent chromium was identified as an inhalation carcinogen and an 

air toxic of concern during the 1991-93 Windsor Air Quality Study. The results of that study 

indicated that approximately 20% of the routinely monitored ambient airborne chromium (Cr) was 

in the hexavaJent form. In addition, the range of carcinogenic health risks attributable to airborne 

Cr(vi) was determined to be between 1.4 x 10(-5) and 3.0 x 10(-4) for people living in the Windsor 

area. During the summer of 1993, analyses of concurrent indoor and outdoor 24-hour air quality 

samples taken at 33 residences in Hamilton resulted in geometric mean Cr(vi) concentrations of 

0.20 ng/m3 and 0.55 ng/m3, respectively, and little or no relationship between the indoor and 

outdoor sample sets. During the summer of 1994, an airborne Cr(vi) size-fraction study was 

conducted in Hamilton, the results of which suggested that the majority of the Cr(vi) was in the 

inhalabie fraction. 

PMID: 9269134, Ul: 97414441

Rev Environ Health 1996 Oct-Dec;11(4): 179-89

Health risks from exposure to metals in household dusts.

Lemus R, Abdelghani AA, Akers TG, Homer WE

Department of Environmental Health Sciences, Tuiane University School of Public Health and

Tropical Medicine, New Orleans, Louisiana 70112, USA

The levels of arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), iron (Fe), lead (Pb),

mercury (Hg), and nickel (Ni) were determined in a total of 315 indoor and outdoor dust samples

collected from 53 households in Louisiana. Inductively coupled plasma analysis revealed that in

many samples, the metal content exceeded the United States Environmental Protection

Agency (EPA) Risk-Based Concentration (RBC) guidelines. For example, the number of dust

samples above the EPA-RBC included 64 for Cd, 52 for Hg, 43 for As, 4 for Fe, 4 for Cu, 3 for Cr,

and 2 for Ni. One-hundred fifty-two samples exceeded the street-dust level for Pb published by

the U.S. Agency for Toxic Substances and Disease Registry. The results of this study

indicate that exposure to indoor and/or outdoor dust presents a potential health risk for Louisiana

residents.

PMID: 9085434, Ul: 97239773

J Cardiovasc Risk 1996 Feb;3(1): 18-25

Trace elements and cardiovascular diseases.

Houtman JP

Intel-university Reactor Institute, Detff, The Netherlands.

The relation between trace elements and human health has been scarcely studied. With respect

to cardiovascular diseases and hypertension attention has mostly focused on arsenic, cobalt

copper, chromium, fluorine, manganese, vanadium, zinc, selenium, silicon, cadmium, and lead.

Environmental contamination can influence organ concentrations through long-term, low-level

effects. This article reviews the present knowledge obtained by epidemiological, biochemical and

ceil biological studies. Attention is paid to interpretation problems due to the complexity of

biochemical interactions with proteins of various sorts which determine metabolic processes and

to the occurrence of detoxification mechanisms in which trace elements interact. This

can also lead to strong variations in individual vulnerability. In general, the elements selenium,

copper, zinc, chromium, and manganese seem to counteract the development of cardiovascular

diseases, whereas cadmium and may be lead seem to stimulate it. Effects of arsenic, silicon and

fluorine are unclear and for cobalt absent. The intensity of these effects on public health is difficult

to measure, but is as yet probably limited except in extra-ordinary situations.

PMID: 8783027, Ul: 96377179

29
J Toxjcd Environ Health 1993 Dec;40(4):555-83

Designing a biological monitoring program to assess community 

exposure to chromium: conclusions of an expert panel.

Anderson RA, Cotton T, Doull J, Marks JG, Smith RG, Bruce GM, Rnley BL, Paustenbach DJ 

Industrial Health Foundation, Pittsburgh, Pennsylvania.

The possible benefits of biological monitoring of large groups of people potentially exposed to 

environmental contaminants has become an area of much interest in recent years. Because 

chromite-ore processing residue has been found in some soils in northern New Jersey, urinary 

chromium monitoring of people in the community was evaluated as a potentially useful tool. In an 

attempt to identify those who could be exposed and to quantify the magnitude of exposure to the 

chromium in these soils, the New Jersey Department of Health (NJDOH) initiated a public health 

screening project. In 1992, the NJDOH proposed to evaluate over 4000 people who lived or 

worked near these sites. Volunteers were administered a questionnaire and were given 

a limited physical examination, and a single spot urine sample was collected. Because of the 

difficulties in using urinary chromium to assess low-level exposure and the potential implications 

of any regulatory decisions that could be based on the results of this project, a panel of experts 

was convened to evaluate the protocol. The panel consisted of five scientists and physicians with 

expertise in toxicology, dermatology, epidemiology, biological monitoring, and analytical 

chemistry. Like a World Health Organization group, the panel concluded that although urine 

biomonitoring can be useful in evaluating high levels of exposure to chromium, it is not reliable for 

assessing low-level exposure similar to that which may have occurred in northern New Jersey. 

The panel also noted that when urinary biomonitoring is to be used to assess the public's 

possible exposure, a large number of precautions must be taken to ensure the accuracy and 

usefulness of the results. The single most important recommendation was to collect a second, 

and perhaps a third, spot urine (or 24-h urine) sample before concluding that a person may be 

routinely overexposed. These suggestions are applicable to designing a biomonitoring program 

for nearly any environmental contaminant to which a community may be exposed. A review of 

scientific literature associated with biological monitoring of chromium is provided. 

PMID: 8277519, Ul: 94104035

Environ Res 1998 Feb; 76(2): 114-9

Incidence of heavy metal contamination in water supplies in northern 

Mexico.

Wyatt CJ, Fimbres C, Romo L, Mendez RO, Grijalva M

Centre de Investigation en Alimentation y Desarroilo, Hermosiilo, Sonora, Mexico. 

Contaminants in drinking water present public health risks. The objective of this study was to 

analyze water samples taken from wells or storage tanks, direct sources for domestic water in 

Northern Mexico, for the presence of lead (Pb), copper (Cu), cadmium (Cd), arsenic (As), and 

mercury (Hg). The samples were analyzed by atomic absorption coupled with a hydride generator 

or a graphite furnace. High levels of Pb (0.05-0.12 ppm) were found in Hermosiilo, Guaymas, and 

Nacozari. Forty-three percent of the samples in Sonora exceeded the action level (0.015 ppm) 

established by the EPA for Pb. For As, 8.92% exceeded the limit with a range of 0.002-0.305 

ppm. Several studies have indicated a possible link between As and fluoride (F) in drinking water. 

This study showed a positive correlation between F and As (r = 0.53, P = 0.01, and n = 116). One 

location in Hermosiilo had 7.36 ppm of F and 0.117 ppm of As, 3.5 times the recommended F 

levels in drinking water and 2 times higher than the level permitted for As. Hg contamination was 

found in 42% of the samples. Based on the results of this study, it appears that As, Hg, and Pb 

contamination in the drinking water for some areas of the state of Sonora is a major concern. 

PMID: 9515066, Ul: 98190510

Public Health 1996 May; 110(3): 175-7

Copper in drinking water-an investigation into possible health effects.

Fewtrell L, Kay D, Jones F, Baker A, Mowat A

Centre for Research into Environment and Health, Crewe, Cheshire, UK.

30
A study was carried out to examine the possible relationship between levels of copper in drinking 

water and the incidence of specified childhood liver complaints presenting at a major UK 

paediatric liver unit. Public drinking water supplies were generally found to have levels of copper 

which were well below the EC standard of 3,000 micrograms/l. In private supplies, a slightly 

greater number of samples were found to exceed the prescribed concentration; in one instance a 

value of 26,000 micrograms/l was recorded. Data describing infant patients reporting to Kings 

College Hospital, London with specified liver complaints were examined. Where the address of 

patients could be determined (220 out of 240 cases), all patients were found to live in areas 

served by public drinking water supplies and were, thus, unlikely to have experienced elevated 

drinking water copper concentrations. 

PMID: 8668764, Ul: 96268015

Environ Health Perspect 1999 Jun;107(6):441-446

Daily Intake of Copper from Drinking Water among Young Children in 

Sweden.

Pettersson R, Rasmussen F

Department of Pediatrics, Central Hospital, Skovde, Sweden. 

[Record supplied by publisher]

Copper is an essential trace element that may cause intoxication if intake becomes excessive. 

Young children are at risk of intoxication because of high consumption of drinking water and 

immature copper metabolism. The aims of this prospective study were to estimate concentrations 

of copper in drinking water, volumes of drinking water consumed by children, and children's daily 

intake of copper. Concentrations of copper In unflushed drinking water were analyzed for 1,178 

children living in Uppsala and Malmo, Sweden, and concentrations and amounts of copper 

consumed from drinking water were estimated for 430 of these children, 9-21 months of age. The 

study children were from Swedish families, were not enrolled in publicly provided day care, and 

were not breast-fed more than three times a day. In the initial population, the 10th percentile for 

copper concentration in unflushed drinking water was 0.17 mg/L, the median was 0.72 mg/L, and 

the 90th percentile was 2.11 mg/L. In the subpopulation of 430 children, the 10th percentile for 

daily intake of copper from drinking water was 0.03 mg/L, the median was 0.32 mg/L, and the 

90th percentile was 1.07 mg/L- The median daily intake of copper from drinking water was higher 

in Uppsala, at 0.46 mg, than in Malmo, at 0.26 mg. For groups of children whose families took 

part in a later prospective diary study, the copper concentration in consumed water could, to 

some extent, be predicted from the concentration of copper in unflushed drinking water. The 

lowest concentrations of copper in drinking water were found in households with old water-pipe 

systems and in those living in detached houses. A large proportion of the young children satisfied 

their daily requirement of copper solely from drinking water. About 10% of the children had a 

copper intake above the level recommended by the World Health Organization. 

PMID: 10339444

Cent Eur J Public Health 1998 Nov;6(4):274-9

Air pollution by participate matter in the industrialized city of Leoben, 

Austria.

Wippel R, Kock M, Kosmus W, Pichler-Semmelrock FP, Marth E 

Institute for Analytical Chemistry, University of Graz, Austria.

At seven sites in Leoben, Austria, aerosol particles were sampled in two size fractions by a 

dichotomous sampler using virtual impaction: the fine fraction (alveolar aerosol) with an 

aerodynamic diameter dac < 2.5 microns (PM2.5), and the coarse fraction (tracheobronchial 

aerosol) with an dac between 2.5 and 10 microns. It is believed that these particles are able to 

reach the lower regions of the human respiratory tract, and thus be responsible for most of the 

adverse health effects associated with suspended participate pollution. A second sampling 

procedure was made collecting the PM2.5 fraction and after leaching with nitric acid, lead, zinc, 

cadmium, copper, chromium and vanadium were determined with an inductively coupled plasma 

mass spectrometer (ICP-MS). For one sample point a third sampling was carried out and both

31
fractions were subsequently leached with water and dilute hydrochloric acid. Pb, Zn, Mn, Fe, Cd, 

Ni, Cu, Rb, Sr, Mo, Cs, Ba and Tl were determined by ICP-MS. 

PMID: 9919376, Ul: 99118020

Sci Total Environ 1999 Mar 9;227(2-3):249-56

Monitoring of mercury pollution in Tanzania: relation 

between head hair mercury and health.

Harada M, Nakachi S, Cheu T, Hamada H, Ono Y, Tsuda T, Yanagida K, Kizaki T, Ohno H 

Institute of Molecular Embryology and Genetics, Kumamoto University School of Medicine, 

Japan.

Through 1996 into 1997, a spot investigation on mercury contamination was conducted three 

times in Tanzania, especially around the Lake victoria. A total of 150 goldminers, 103 fishermen 

and their families, and 19 residents of Mwanza City volunteered for the current study. A high total 

mercury level of 46.3 ppm (near to 50 ppm, a critical level of Minamata disease) and over in the 

head hair was observed in six goldminers (highest value, 953 ppm), four fishermen and their 

families (highest value, 416 ppm), and four Mwanza people (highest value, 474 ppm). With the 

exception of these 14 subjects, however, each mean total mercury level was well within the 

normal range (below 10 ppm). Out of the goldminers examined, 14 cases were diagnosed as a 

mild form of inorganic-mercury poisoning according to their clinical symptoms (such as 

polyneuropathy mercurialis, neuroasthemia, or tremor mercurialis) and the low ratio of 

methylmercury to total mercury, whereas neither inorganic-mercury poisoning nor methylmercury 

poisoning (Minamata disease) was noted in the fishermen and their familiesor in the Mwanza 

people. In addition, some subjects who showed a high total mercury level made habitual use of 

toilet soap containing much mercury. The findings obtained suggest that the mercury pollution in 

Tanzania is not very serious, however, it should be observed continuously. 

PMID: 10231987, Ul: 99248769

Environ Health Perspect 1999 May;107(5):343-7

Neuropsychological and stress evaluation of a residential 

mercury exposure.

Fiedler N, Udasin I, Gochfeld M, Buckler G, Kelly-McNeil K, Kjpen H 

UMDNJ-Robert Wood Johnson Medical School, Piscataway, New Jersey 08855 USA. 

Residents of a former factory building converted to apartments were exposed to mercury over a 

2-year period. The neurobehavioral and emotional health effects of this exposure and subsequent 

evacuation are presented. Urine mercury levels were measured before (urinel) and 3-10 weeks 

after evacuation (urine2) of the building, when neurobehavioral and psychological measures were 

also completed. Performance on neurobehavioral and psychologic measures were compared 

between subjects above and below the median for urinel (>=19 microg/g creatinine) and were 

correlated with urinel mercury levels. The high urine mercury group made more errors on a test 

of fine motor function and 84% of the residents reported clinically significant elevations in somatic 

and psychologic symptoms. Although subdinical tremor from mercury exposure may have 

affected subtle hand-eye coordination, other tests of motor function were not affected. Therefore, 

the observation of reduced hand-eye coordination may be due to chance. Significant levels of 

psychosocial stress were more closely associated with the evacuation necessitated by mercury 

exposure rather than a direct effect of mercury exposure. 

PMID: 10210689, Ul: 99228654

Alaska Med 1998 Oct-Dec;40(4):75-7, 89

Regional health assessment relating to mercury content of 

fish caught in the Yukon-Kuskokwim Delta rivers system.

Duffy LK, Rodgers T, Patton M

Department of Chemistry and Biochemistry, University of Alaska Fairbanks 99775, USA.

32
Seven species of fish were surveyed for muscle tissue mercury content across a broad area of 

western Alaska. Total mercury levels were determined by cold vapor atomic fluorescence 

spectroscopy in 66 fish sampled during 1997. Methylmercury in sampled fish amounted to 97 to 

100% of total mercury values. Using mercury consumption risk levels derived from U.S. 

Environmental Protection Agency hazard assessment models, mean total mercury was 

determined to be above the human critical value of 0.2 g/g (ppm) in 29% of the fish species, and 

62% of the fish species contained mercury exceeding the wildlife critical value for piscivorous 

mammals. Overall, 24% of the fish exceed the critical value for human consumption and 58% the 

wildlife critical value. Similarly 31% of sites sampled exceeded the human consumption critical 

value. Based on the mean of ail fish sampled and a small number of river otters, a 

biomagnification factor of 12 was calculated for the Yukon-Kuskokwim Delta Region of Alaska. 

PMID: 10202403, Ul: 99218681

Drug Chem Toxicol 1999 Feb;22(1): 129-42

Mercury. Top of the hit parade for eight years.

Nickle RA

Agency for Toxic Substances and Disease Registry, Atlanta, Georgia 30333, USA. 

The Agency for Toxic Substances and Disease Registry (ATSDR) is the lead agency within the 

U.S. Department of Hearth and Human Services (HHS) for providing support to the federal 

response to releases of hazardous substances in the environment. Since the Comprehensive 

Environmental Response .Compensation and Liability Act was passed and amended, ATSDR 

has represented HHS on the National Response Team (NRT). The NRT role, and the 

subsequently established National Response .System, are described in the National Contingency 

Plan for Oil and Hazardous Substances Releases (Title 40 Code of Federal Regulations, Section 

300). As part of the National Response System, ATSDR can be called when a hazardous 

substance is released. Consistently, one of the most common substances ATSDR is called about 

is mercury, usually elemental mercury. This presentation will provide some background statistics 

on these calls and some general response options. Several specific cases that have occurred in 

the last few years will be reviewed. These reviews will deal less with remedial options than with 

describing common issues that arose, issues unique to the specific case, arid the impact of that 

case on the community. A brief discussion of risk communication issues and ATSDR's response 

to those issues concludes the presentation. 

PMID: 10189574, Ul: 99205572

Borm PJAnn Occup Hyg. 1997 Dec;41(6):659-76. Review.

Toxicity and occupational health hazards of coal fly ash (CFA). A 

review of data and comparison to coal mine dust.

Department of Health Risk Analysis & Toxicology, University of Maastricht, The Netherlands. 

Coal fly ashes (CFA) are complex particles of a variable composition, which is mainly dependent 

on the combustion process, the source of coal and the precipitation technique. Toxic constituents 

in these particles are considered to be metals, polycyclic aromatic hydrocarbons and silica. The 

purpose of this review was to study the in vitro and in vivo data on coal fly ash and relate the 

studied endpoints to the role of (crystalline) silica, considering its recent classification as a human 

carcinogen. For most of the effects coal mine dust was chosen as a reference, since it contains 

up to 10% of crystalline silica (alpha-quartz) and is well studied both in vivo and in vitro. Most 

studies on fly ash toxicity were not designed to elucidate the effect of its silica-content nor did 

they include coal mine dust as a reference. Taking this into account, both in vitro and in vivo 

experimental studies show lower toxicity, inflammatory potential and fibrogenicity of CFA 

compared to silica and coal mine dust. Although in vitro and in vivo studies suggest genotoxic 

effects of fly ash, the data are limited and do not clarify the role of silica. Epidemiotogical studies 

in fly ash exposed working populations have found no evidence for effects commonly seen in coal

33
workers {pneumoconiosis, emphysema) with the exception of airway obstruction at high 

exposure. In conclusion, the available data suggest that the hazard of coal fly ash is not to be 

assessed by merely adding the hazards of individual components. A doser investigation of 

'matrix1 effects on silica's toxicity in general seems an obligatory step in future risk assessment on 

fly ashes and other particles that incorporate silica as a component. 

PMID: 9375525; Ul: 98043154.Borm PJ

Isr J Med Sci. 1992 Aug-Sep;28(8-9):509-12. Review.

Occupational and environmental exposures and nonspecific lung 

disease--a review of selected studies.

SaricM

Institute for Medical Research and Occupational Health, University of Zagreb, Croatia.

Selected studies show that nonspecific lung diseases are a major occupational and

environmental health hazard. Exposure to mineral dusts (such as cement and brown coal) and

organic dusts (cotton, hemp and flour) as well as manganese and gaseous irritants causes

significant upper respiratory tract injury. Possible additive effects of mixed exposures, combined

exposure to dusts and gaseous irritants of the upper respiratory tract, individual susceptibility, and

mechanisms of nonspecific respiratory effects of exposures are considered. Interpretation of the

results is difficult due to uncontrolled confounding. Measures for preventing lung impairments

include exposure reduction and preemployment examination of workers.

PMID: 1428803; Ul: 93053533.

Nurs Stand 1999 Mar 17-23;13(26):39-41

Pneumoconiosis: a study of its effect on miners' health in South 

Wales 1900-1980.

Howells G, Rees C

University of Wales NHS Healthcare Trust, Cardiff.

Since its discovery in the late 19th century, pneumoconiosis has shaped the lives of thousands of

miners. In some ways it became inextricably linked to the South Wales coal field and was a major

public health threat to the men who worked in those mines. The disease was caused by the

conditions of work and worsened the situation of many who were already living in poverty. This

historical research account traces the miners1 plight and touches on some of the public health

issues raised by the disease.

PMID: 10347463, Ul: 99276811

Am J Ind Med. 1998 Oct;34(4):318-24.

Polymorphisms in the promoter of the tumor necrosis factor-alpha 

gene in coal miners.

Zhal R, Jetten M, Schins RP, Franssen H, Borm PJ

Department of Health Risk Analysis and Toxicology, Maastricht University, The Netherlands. 

Tumor necrosis factor-alpha (TNF) is recognized as a central mediator of mineral dust-induced 

lung fibrosis, and genetic polymorphisms of the TNF promoter have been reported to influence 

levels of TNF production. To assess whether polymorphisms within the TNF promoter gene are 

associated with susceptibility to coal workers' pneumoconiosis (CWP), the DMA of 78 coal miners 

was typed for G-to-A transitions at positions -238 and -308. Our results show that frequency of 

A-308 genotype (T2) is significantly overpresented in coal miners with CWP (50%), as compared 

with miners without CWP (25%) and controls (29%). After correction for cumulative dust exposure 

and smoking, the A-308 transition genotype is still associated with the presence of CWP (OR = 

3.0, 95% CI » 1.0-9.0). Both A-238 and A-308 transition genotypes were related to TNF release 

from endotoxin-stimulated Wood monocytes; only the A-238 transition and not the A-308 

transition was associated to coal dust-induced TNF release. In summary, this study shows that 

the A-308 transition i$ related to CWP, but this relation is not paralleled by a different TNF release 

in this genotype. A larger number of patients coupled to frequent TNF release are required to

34
evaluate genotype screening to estimate individual health risks for effects of coal mine dust

exposure.

PMID: 9750937; Ul: 98423511.

Bid Trace Elem Res 1999 Man67(3): 197-204

Trace elements in coal: environmental and health significance.

Finkelman RB

US Geological Survey, Reston, VA 20192, USA.

Trace elements can have profound adverse effects on the health of people burning coal in homes

or living near coal deposits, coal mines, and coal-burning power plants. Trace elements such as

arsenic emitted from coal-burning power plants in Europe and Asia have been shown to cause

severe health problems. Perhaps the most widespread health problems are caused by domestic

coal combustion in developing countries where millions of people suffer from fluorosis and

thousands from arsenism. Better knowledge of coal quality characteristics may help to reduce

some of these health problems. For example, information on concentrations and distributions of

potentially toxic elements in coal may help delineate areas of a coal deposit to be

avoided. Information on the modes of occurrence of these elements and the textural relations of

the minerals in coal may help to predict the behavior of the potentially toxic trace metals during

coal cleaning, combustion, weathering, and leaching.

PMID: 10201327, Ul: 99215510

Proc Matt Acad Sci U S A1999 Mar 30;96(7):3427-31

Health impacts of domestic coal use in China.

Finkelman RB, Belkin HE, Zheng B

U.S. Geological Survey, Mail Stop 956, Reston, VA 20192, USA. rbf@usgs.gov

Domestic coal combustion has had profound adverse effects on the health of millions of people

worldwide. In China alone several hundred million people commonly bum raw coal in unvented

stoves that permeate their homes with high levels of toxic metals and organic compounds. At

least 3,000 people in Guizhou Province in southwest China are suffering from severe arsenic

poisoning. The primary source of the arsenic appears to be consumption of chill peppers dried

over fires fueled with high-arsenic coal. Coal samples in the region were found to contain up to

35,000 ppm arsenic. Chili peppers dried over high-arsenic coal fires adsorb 500 ppm arsenic on

average. More than 10 million people in Guizhou Province and surrounding

PMID: 10097053, Ul: 99199200

Am Ind Hyg Assoc J 1999 Jan-Feb;60(1):105-10

Assessment of coke oven emissions exposure among coking 

workers.

Chen ML, Mao IF, Wu MT, Chen JR, Ho CK, Smith TJ, Wypij D, Christian! DC 

Department of Public Health, College of Medicine, National Yang-Ming University, Taipei, Taiwan. 

Coking workers are regularly exposed to coke oven emissions, which consist primarily of 

polycyclic aromatic hydrocarbons and volatile organic compounds. This study measured the 

workers' exposure to the benzene soluble fraction of total particulates (BSF). The study 

population consisted of 88 coking workers as an exposure group and 59 referents. Personal 

breathing-zone samples of BSF and total particulates were taken from all study subjects for 3 

consecutive days. The highest BSF concentrations were found among the topside oven workers 

(geometric mean; range) (microgram/m3): lidman (515; 72-18, 181), tar chaser (432; 51-4334), 

and larry car operator (185; 55-649). The lowest was 7 micrograms/m3 in the referents. Among 

the samples at the topside oven 84% exceeded the Occupational Safety and Health 

Administration standard (150 micrograms/m3 BSF). The percentage of BSF in total particulates 

varied across job classifications, ranging from 0.3% in wharfmen to 24% in tar chasers. Area 

sampling indicated that the BSF concentration at the topside area was sixtyfotd higher than that 

at the administrative area, which was approximately 2 km from the coke oven plant areas suffer

35
from dental and skeletal fluorosis. The excess fluorine is caused by eating corn dried over 

burning briquettes made from high-fluorine coals and high-fluorine day binders. Polycyctic a 

romatic hydrocarbons formed during coal combustion are believed to cause or contribute to the 

high incidence of esophageal and lung cancers in parts of China. Domestic coal combustion also 

has caused selenium poisoning and possibly mercury poisoning. Better knowledge of coal quality 

parameters may help to reduce some of these health problems. For example, information on 

concentrations and distributions of potentially toxic elements in coal may help delineate areas of a 

coal deposit to be avoided. Information on the modes of occurrence of these elements and the 

textural relations of the minerals and macerals in coal may help predict the behavior of the 

potentiallylmpact of air pollution on prevalence of rhinitis in Istanbul. 

PMID: 10028622, Ul: 99152976

Arch Environ Health 1999 Jan-Feb;54(1):48-51

Impact of air pollution on prevalence of rhinitis in Istanbul.

Keles N, Ilicali OC, Deger K

Istanbul University, Istanbul School of Medicine, Department of Ear, Nose and Throat, Turkey. 

The effects of air pollution on health are of concern worldwide. There are several pollutants of 

concern, among which are sulfur dioxide, total suspended particulates, nitrogen dioxide, carbon 

monoxide, and volatile organic chemicals. In several studies, researchers investigated the effects 

of those pollutants on lung and nasal functions, although in very few studies has nasal function 

been addressed. We evaluated the effects of air pollution on the prevalence of rhinitis in a 

metropolitan of Turkey, Istanbul. Until 1994, coal was used for both domestic heating and 

industrial processes in the city. Consequently, sulfur dioxide and total suspended particulate 

concentrations in the ambient air exceeded limits of air-quality standards, in recent years, 

especially during the early 1990s, hazardous air pollution levels were reached in Istanbul. In this 

study, we evaluated the incidence of rhinitis before and after installation of a natural-gas network 

in a polluted area of the city. In 1994, 62.5% of the individuals studied suffered from rhinitis, 

compared with 51% of the sample in 1996 (p < .05). Age, gender, smoking status, heating 

source, nor household crowding significantly affected this outcome. The findings strengthened the 

role of pollutant levels as risk factors for rhinitis. 

PMID: 10025416, Ul: 99148283

Int J Occup Environ Health 1996 Jul;2(3): 172-176

Occupational and Environmental Risk Factors for Asthma in Rural 

Communities in China.

Xu X, Niu T, Christian! DC, Weiss ST, Chen C, Zhou Y, Fang 2, Jiang Z, Liang W, Zhang F 

Department of Environmental Health, Harvard School of Public Health, 655 Huntington Avenue, 

Boston, MA 02115, USA.

Respiratory allergens such as dust, gases/fumes, and hay smoke, which are frequently present in 

agricultural settings, can cause or aggravate asthma. The purpose of this study was to examine 

the relationships between occupational and environmental exposures and asthma in Chinese 

rural communities. The study population consisted of 28,946 people 15 years old or older, living 

in rural areas of Anhui province, China. A modified Mandarin translation of the ATS-DLD 

questionnaire was administered by trained interviewers to request information about exposures to 

specific occupational/environmental agents and respiratory disorders. In Huaining, the prevalence 

of wheezing was 3.8% for men; 2.1% for women; the prevalence of asthma was 1.6% for men; 

1.8% for women. In Zongyang, the prevatence of wheezing was 2.7% for men; 1.9% for women; 

the prevalence of asthma was 1.7% for men; 1.2% for women. With control for potential 

confounders such as gender, age, residential area, education level, and smoking status, the 

pooled adjusted odds ratios (ORs) of wheezing and asthma for the group exposed to wood/hay 

smoke were 1.36 (95% Cl: 1.14-1.61) and 1.27 (95% Cl: 1.02-1.58), respectively. For coal-stove 

users, the pooled adjusted ORs were 1.47 (95% Cl: 1.09-1.98) for wheezing and 1.51 (95% Cl: 

1.05-2.17) for asthma. After stratification of the subjects by dust type, the estimated ORs for 

wheezing were 1.58 (95% Cl: 1.02-2.44) among the group exposed to inorganic dust and 3.03 

(95% Cl: 1.25-7.33) among the group exposed to metal dust. Asthma was not shown to be

36
significantly associated with any specific dust type. Findings of the present study are consistent 

with previously reported adverse respiratory health effects related to occupational/environmental 

exposures to wood/hay smoke and dust, and indicate the need for further occupational disease 

surveillance in rural communities. 

PMID: 9933871

Sangyo Ika Daigaku Zasshi 1998 Dec 1;20(4):353-60

Pneumoconiosis problem among the Vietnamese coal mine workers.

Nguyen AL, Matsuda S

National Institute of Labour Protection, Hanoi, Vietnam.

In this report, the authors present the pneumoconiosis problem among Vietnamese coal mine 

workers. As coal is one of the most important products for export, its production has been 

intensified recently. With the strong incentive for rapid economic development health problems of 

miners tend to take second place. As shown in the present report, miners' working conditions 

are very bad, and health protection measures are riot sufficiently implemented, it is apparent that 

official statistics underestimate the actual situation because of the inadequacy of the reporting 

system. Because the financial barrier to establishing a sufficient reporting system for 

pneumoconiosis is enormous, an epidemioiogic study is the most effective way to assess the 

actual situation, it is also useful to conduct epidemioiogic studies as part of an international 

collaborative project, in order to transfer necessary knowledge and epidemioiogic skills from the 

developed countries to Vietnam. 

PMID: 9883486, Ul: 99099938

G Ital Med Lav Ergon 1997 Oct-Dec; 19(4): 152-63

The toxicology and prevention of the risks of occupational exposure 

to aromatic polycyciic hydrocarbons. III. The effects: epidemiological 

evidence, early effects. Individual hypersusceptibility. Health 

surveillance

Porru S, Assennato G, Bergamaschi E, Carta P, Foa V, Fomi A, Gabbani G, Mastrangelo G, 

Sartorelli P Cattedra di Medicina del Lavoro, Universita di Brescia.

Adverse effects following occupational exposure to polycydic aromatic hydrocarbons (PAH) are 

mainly carcinogenic. The available epidemiological data suggest that some substances and 

industrial processes, in which PAH exposure is frequent, are classified as carcinogenic to 

humans: primary aluminium industry, cola gasification, coke production, iron and steel foundry, 

coal tar, pitch, creosote, untreated mineral oils, asphalt, soot. The target organs are mainly lung, 

bladder, skin. Other relevant effects are skin lesions such as folliculitis. The studies on early 

biological effects (chromosomal aberrations, sister chromatid exchanges, micronudei) have 

shown contradictory results, mainly because of differences in exposure intensity. The metabolic 

polymorphism may account for a higher susceptibility to lung and bladder cancer following 

exposure to risk factors; the role of PAH occupational exposure is however to be examined, and 

the use of indicators of genetic susceptibility is currently limited to research programs. Health 

surveillance for PAH exposed workers is funded on the Italian laws (DPR 303/56 and D.Lgs. 

626/94) and it is mainly dedicated to prevention of carcinogenic effects. Preventive examinations 

should consider PAH target organs (skin, lung, bladder, larynx) and look for early signs and 

symptoms. Particular attention will be paid to life habits such as tobacco smoking or diseases 

which could represent condition of susceptibility. Periodical examinations (every six months) will 

similarly evaluate PAH target organs. Health surveillance is also programmed for formerly 

exposed workers and the institution of exposure and cancer registries is mandatory. On the basis 

of the current scientific data, it is not advisable the use of tumor markers or cytogenetic tests at 

the individual level as well as the screening of asymptomatic PAH exposed workers for early 

diagnosis of lung or bladder cancer, information and formation activities will be part of medical 

examinations and will be included in specific programs in cooperation with other company 

functions. 

PMID: 9775009, Ul: 98448135

37