# 90.15O.3 

# OZONE EXPOSURE 

# AND LUNG FUNCTION 

# IN CHILDREN

# ATTENDING 

# A SOUTHERN

# CALIFORNIA SUMMER CAMP Edward L.

# Avol, Stanley G.

# Trim, David E. 

# L¡ttle, Gharles E.

# Spier, Myra N.

# Smith, Ru.Chuan Peng, 

# William S. 

# Linn,

# Jack D. 

# Hackney Rancho Los

# Amigos Medical Center 

# Downey, California 

# Kenneth B. 

# Gross, 

# James B. 

# D'Arcy

Diane 

# Gibbons General 

# Motors Research 

# Laboratories

Warren, Michigan 

# lanT.T. 

# Higgins University 

# of Michigan 

# AnnArbor, Michigan



# --¿ '

--

- -_ An &Wesrr 

## lvf¡Necsv¡Nr ASSOC¡ATION

a Srxc¡ 1907 

### For Presentation at

### the 83rd 

### Annual Meeting & 

### Exhibition Pittsburgh, Pennsylvania 

### June 24-29,1990

### INTRODUCTION 

### In recentyears' 

### public health'related research has begun-to 

### shift towards 

### multi-hour exposure.protocols as

## a.;;;';äìì;ìi;'J..n"ìiJrot aõiual 

### óublic exposure

### to ambient 

### air 

### ooilurion'. Many 

### in Üt. ãån.rãi-pòit"iqi¡"".may be 

### affected 

### by such..exposure patterns' 

### ôrrildren, 

### for example, 

### t"uïüJ'à'i 

## í"ú;iì;iiv increasáO-iist<

### fromãir poltution bv

### virtue of their tifestyle patterns,

## *hi.;""?i.Ëi;;;1";';;;;;f houis 

### of outdoor èxercise' regardless or 

### air quality, during daylight hours. Several studies have addressed possible effects 

### of multi-hour oxidant e*posu'e2'5' but 

## ,,,.*pi, 

## io'irrilö;J1.il;i"iuig'"ó"ìtv have been stymied 

### by concurrent exposures to other potlutantr, 

### unrurrrr"áiärJ';;;ìt;î protäcols, or

### alack of detailed 

### air monitorins at test sites. 

### \ileinvestigatedmulti.houro,effectsinafieldsettinginvolvingactualambient. exposures, 

### while

### employinË'lüìriu."Jrã;"-:,;å;t 

## r.árlr...nt tãchniques. 

### over a six'weck oeriod. westudied atotat 

### ;f ï93 healthy volunteè-rs, aged 8-17 years' who,atten-dcd a summer õamp 

### in a mountain 

### ro"rtion-íõo'[rn-sãutteast 

### of Loi¡,nãetes. Some volunteers came from extremely 

### o.-polluted 

### ,.giänr'ái ;i,;

## $;;il õó;rì (ros Ànãeres)

### Aif Basin; 

### otlers came 

### from much cleanei areas.

### At the camp, ambient 

### orconcentrationi typically a-pp-roached the primary 

### National Ambient

## ei, qualìiîttanãài¿ tÑnnqs) cðnlinttái¡on 

### oi o'iz ppm 

### (t20 ppb)

### for several hours 

### during

## the;ii;""-;;;;d òãtrv 

### eìeîing, rhen decreased 

### to 

### low.but non-zero levels overnight; 

### particutaie'iË;;iË';;;;".siúible. Tñê investisation's main purpose was to addressthe question: 

## ¡" vã,iiäîápì!üi'üËïtt acute ct'angei 

### in lung 

### function related to low-level 

### multi'hour oxidant 

### air pollution exposureT 

## *tt"?oÈ.ro site was located 

### at pine Springs Ranch, 

### a 

### christian gamp. operatcd 

### by the Sourheasrern 

### California

## c;i;;.;;; ïl-tt'ã 3üinttt-oai Aduentist 

### Church' 

### rhis 316-acre 

### facility is located 

## n.., r¿íirîñàì'õÃ,-isõ-Ën., 

### *utheaitãf ios Angelcs at an 

### altitude 

### of 1570 

### m. The camp rests in 

### "

## tt,irli"Ë'üä;;;í;"1;;;Ñnà"¿ ontwo sidés bv mountain pcaks some 

### T00mhigherinelevation. Vegetationinthegeneralaiãaisdese,tsctu6brushwithoccasional stands

### of pine trees.

## rr,e..*Ëli" óiaisic teãeptot site; no important 

### air pollution sources are nearby.

### The movable biosurveillance 

### facilityó was placed 

## in a central cam-Þ, 

### location and continuous

### air quality 

## r";i;;i;;;ì; ;ðáìil;" to 

### lulã-funõtion testins' was performed at this central site f rom late

## J"".';i;'"';fi..;ly 

## Ai;ilt l98ti. Campersarrivéd on Sundav af ternoon and stayed rhrough the

## f;ìl;;;;; Éìrïá"v ñotn^ing.' 

### sìu¿i., were 

### performedfrom Sundav through Friday 

### afternoo"t"åtifv,ïå"îîãi tä

### int.tf.t-e 

### *ittt itiigiout oüseruance 

### of thc sabbath' 

### Generalcampactivitieswerehighlystructufed.Campersandcounselorswereassigncd to aspecific cabin, and 

### .li'iå,ip 

## ãiiliiiË;;-ü;i;i*ã ás acabin 

### group' Acceptance into the study was based 

### upon.îiïfinJn.ti'iã-paiticip.te,.igneà informed-consent' and no health contfaindioations (e.g., 

## .riftäãi,-îütliþãnts tecelueãä tee'st¡irt upon acceptancc 

### into thc studv and an 

### inexpensive';i[ií;r;.h 

## ;;;ï;;;i;ii";. ntot"t or 29

## j subjects

## - 154 bovs and 

## Ì'3ï¿r;il:-ïccllîrïiii ð"äïiiirã-iü.ï-e'.. 

## ïr"" it.iJã i n ca mp morè tha n one week, for a

### total 

### of 305 

### person-weelkiäîrîi,iiñãilãi)lìitàit tñtiãót.ristics aie summarized 

### in Table 

### I' ThelarSestcontingentofsubjects(51%)residedinurbanareasofRiversidcandSan Bernardino counties, which are among the most-or-nãiluted areas in.the 

### unitcd Statcs. ozone levets 

### in thcse areas cxceed rhc NAAQS 

### for ¡00

## ñoiliiitl; ."t; in a

### tvpical 

### vearl' These subjects werc considered-

### t"

## ï;";;ìtùì; riJt-ór pa.st 

### áÀúient

## o. exposure. 

### At their homes' 

### daily peak O, 

### concentratioîsift."li'fti".'Uããnloisiôei.Lf V highdr thän at camp' and seasonal averase concentrarrons 

## r";ü;'üî;ú;;".ir"äi ói 

### rtlJrtói'-Ãnòtitt large contingent of subjects Paper #90'I 50.3 resided in urban san Diego 

### county, rvhefe thc NAAQS is exceeded 

### only 30to 50 h 

### in atypical 

### i'"ï;"äiiñ;;-r,omes, ¿ahv

## iã.[ó, .on..ntrations siould have been 

### similar to or lower than íhose at the camp, and

## r..roí"ìîJåË;'i;¡;;i;.ti";, should have been lower. These subjects' 

# ;çËiqifr ,;fr 

# ¡i',li[{tîitJif.fl i+ffi

# {urlt;t*:il.$;{i*l"ïr''#t";
Screening, which included a

### brief written medical history, spirometry, explanation 

### of 

# ì!ii,,:".lf';:i.iå:','.'r'åf,*r:îË:',T,"ï:ï 

# $::x: 31"'".å*ii'!!:".:'Jyi:tåö:i,:"1,:'Ï ;';íã.v

## ;;;;i"ã) *as

### t.n.ãii;ã"bî;á-bi; 1le"intment, at twentv minute 

### intervals' between 

### öiåö:éStitt (At4 testine) 

### .nã jiOb'-lS¡O h (Þivf

### testins). Fridav afternoon âppointments were between l530-1730 

## lt, to"a'"äi¿- 

## i"t.;f;t;;.; ;itñ'special- activities (camp'wide sports ðãmpetitions, sabbath preparations)' Testing was performed on

### cPI-22i l2-liter rolling seal spirometers interfaced to DEC 

### MNC

## il/23 computers. 

### 'Äìi 

## ;;;ù;; -*ás 

### peiiorred i-n

### a temperature-controllcd climate chamber, 

### maintained., 

## ti;'6,îii'fítfte suU¡ec1seaied and nosè

### clip 

### in place' Up 

### to five maximal forced 

### expiratori*i'iruuåii*eie performeà to obtain thfee 

### in which forced 

### vital capacity (FVC) and 

### 1o...å ËióìiËå-'ål""iJ 

## í"

## t* *t31a (FEV,|) dif fereg 

## -9l-lt* than f ive 

### Dercent. From these 

### Ûtr.i ãiãrpiã¿ 

### r"nàuuer., the 

### following parameters were determined: 

## ä;;ä;-ot;;;rï uãio'.

## i"ï;;;l' '?;11à 

### Lã"ono' íFEVn' 

### with n = 0'75 to 3)' 

### Fvc' the percenrase 

### rario

### of 

### FEvl to 

## Ëîö GÉiliËi,iC-i iCiO.q6),;.at 

### fiow rate (PFR), 

### time to PFR 

### (for ouality assuran., 

### purporåri,"rÏ-ìålíit {rá1ìnitãiátu 

## fto* rate

### dvtrFn), and the forced 

### ;xDiratory flows 

### with

## tu,'í'iz,'îil ltlòr rvc,è-ry"t¡i1e. Four

### function va¡iables considered 

### iâå,å!,iiiå,ì;i oi 

## Ú,.1áre.íãäiiiri--Ïvc,ÞÊi,, nrn-, and MMFR -- are presented here. 

### Symptomandactivitydiarieswerecompletedbyeachclmpglwhile.awaitinghis/her turn to-tåiï.'St.nãardized symptoms questronnatres wcie completed by each subject at every 

### AM/pM resting 

### appoint..ní, ããlurn.titing symptoms since the previous testing. 

### period' Each 

## lË;ü';io;;ä;fio.Ï-.;;;i;i;i;ï;;ili;i;, äiuiv, 

### ã't"¡rine thèir dav's 

### activitics since 

### their AM testing. 

### Air quality sâmples were collected 

### from the.roof 

### of the biosurveillance 

### fàcility' 4'5 m above the ground. 

### continiouJn'onî;;;i;; 

### i;ió;ñtio;(collected as computerized f ive'minute averaged readings) 

## *., r.-.ãiáåïiãt-ãzóñe tO:l lmonitòred 

### in duplicate),-s-ulf ur oxides [SOx]' nitrogen oxides 

### [Nox], 

## .;;i;ï;;;";;ã;iðdi:";äitl-htðiocarbôns [rHC]' wind speed [wS]' 

### wind direction 

### twol, 

### amüiäi'täi"öJiä"itè fii,.ana am'¡ient 

### relativè humiditv [RH].usir-¡!' a DEc MNC I

### l/23 

## computer:-i;;;ii-ï;"' hoùriize-segresated low.-.volume f.ilter 

### t"_TPl1..f?¡fl 

## ;ilOät idir,tÂõ, Z.l ¡¡

### Vlri¡O,ãná a Uac*u.p 

### total f

### ifter) were collected using aconventtonat blower motor tocated on

## i;;i-.fä;t ioãi. 

## riit.t s.*liJsíet. analvsed 

### for collected mass and 

### for particulate sutfate 

### anlnitiäiË i¡V ¡on ct¡roma-tãLrãptry). Poúen sampleswere collected 

## õr.:;;;ï,'i,6.i.ði-tãrtineî;y;'t.;;;á;;;ri tnt nu-.nà pt't testine pcriods, and rorwarded to a commerciál laboratory 

### for analysis. 

### Qualityassuranceguidelineswerestrictlyfollowed.Airqualitymeasu.rementsandlung 

### function testing were

## #;;i;i;i,¡ ai strictly'sepaiate functions, 

### with discrete personnel assigned to each task. 

### n¡i åä"¡t"ii"Jìniirurónicãli¡rations and maintenance were 

### tvpicallv performed each Sunday

## üàtiìîi'iilã;--to âtiiuat

### oi the next week's 

### campers' Spirometer 

### calibrations 

### ,n.r. 

## p"rfor*ãã'óüîiio t.riing every morning and afternoon, using 

### a 3'00 L 

### calibration syringe. A subset 

### of each week's subject population was also monitored to determine

### ventilation rates achieved 

### ¿uring

### typìãìt"ii¡iiãl,ii"'ltiàt. pact¡ ¿ay, p¡oject 

### staff visircd,subjects' camp 

### acriviry sires and 

## ,...oriJiujü'iaiã-iUv 

## *tilt paipat'¡óäl 

### aïd minutevent¡lation rate (bv 

### dircct measure*ent 

### usi,ii ã-ú;gù;i'órtaUte'rÀïiiomêter and non'rebreathing valve)' Paper +90- I50.3Paper *90-150.3 Campers 

### actively participating 

### in camp 

### activities, as

### well asthose passively prescnt 

### or not 

### involved, were studied, 

### in an attempt 

### to

### quantify both the extent 

### of participation and the physical 

### intensity 

### of any given camp 

### activity. Thc BMDP statistical softwares was employed to derive summary statistics and to test some O¡ exposure/lung 

### function response models suggested by previous laboratory exposure 

### studiesãnd/or summer camp studies. 

### First,two-factor analyses

### of variance were performed to determine \¡/hether lung 

### function varied consistently between 

### different days 

### of the rpeek 

### and/or between AM and PM testing,

### without regard to 

### air 

### quality. Then, repeated-measu¡ès analyses 

### of covariance were performed, 

### to test \4,hether 

### function tended 

### to decline on days 

### with higher O. concentrations, averaged over a Ihor 8h period before the function test. Next, regression coelficients were calculated to relate each 

### individual subject's PM FEVr (expressed as change

### from AM FEV.)

### with O, concentration 

### during the preceding 

## lh or'8h period. 

### Finally, the possibility 

### of c'umulativdexposure effects was explored through linear regression analyses which related 

### individual FEY, changes between Monday AM tests and subsequent PM tests,

### with âverage 

### O, concentrationi over 

### the intervening 

### periods. For computational 

### simplicity, the 

### latter

### wire estimated by aweighted sum

### of 8h averages on Mondays, and 24h averages on subsequent days, preceding PMtesting. (Fridays \À,erenot included because 

### their non-standard 

### activity/testing scheduleswould have made these estimates inaccurate). RESULTS 

### Air Monitoring Ozone levels rose

### gradually throughout each day, displaying a "broad peak" between 1000and 2000 h each day (see 

### Figure 

## l). Daily maxima

### typically occurred 

### in late afternoon (1500-1700 h); subsequently, concentrations 

### gradually declined 

### to non-zero overnight ozone levels 

### of 25-50 ppb, 

### Other gaseous

### criteria pollutants (SOz, CO, THC, NOx) were 

### typically at undetectable or

### trivial levels. Meteorological patterns were quite stable 

### for extended periods during the six weeks 

### of 

### field operations. Each day,

### with sunrise, ambient temperatures 

### quickly rose

### from overnight lows

### of l0-15' C to daytime values 

### of 25-35' 

### C. Relative 

### humidity ranged 

### from 30-45 percent overnight to

### typical daytime values 

### in the 5-20 percent range. (The 

### sixth and

### fìnal week 

### of 

### field sampling 

### did show some

### variation 

### from this summer-long 

### pattern, asthunderclouds passed through the area, bringing a

### brief period 

### of intermittent 

### rain.) Nighttime windsvaried 

### from 2-5

### km/h. Wind speed

### typically inc¡eased to 8-12 

### km/h by 1200 h, then 

### fell to overnight levels by mid afternoon. Particulate loadings were very low, ranging

### from I

### I to 54 ¡¿glm3 TSP collcctcd over 24h sampling; particulate nitrate and sulfate usually accounted 

### for lcssthan twenty percent 

### of this 

### material. Pollen and spores sampling occasionally 

### identified a small amount 

### of 

### potentially :! allergenic material, but counts did not appear to correlate in any systematic way

### with subjects' test performance or reporting 

### of symptoms. Lung Function Table 

### II summarizes statistical results 

### from the

### four key lung

### function tests 

### for all 305 subject-weeks 

### of data, and Figures 

### I and 2 relate mean FEV, and PFR to O1, by camper week. 

### For FVC, 

### FEV., and MMFR, the best 

### overall performance'was observed 

### ãt the Sunday PM screening, despíte the

### factthat subjects were 

### unfamiliar with the procedures. Mean FVC and FEVn showed highly 

### significant downtrends from Mondays through Wednesdays, 

### with partial reveisal on Thursdays and 

### Fridays. Changes 

### from

### AMto PMalso varied consistcntly bctwecn days; changes 

### were negative 

### early 

### in the week, 

### and positive 

### later. MMFR 

### did not vary 

### significantly over 

### time, Mean PFR increased

### significantly from oneday to the next, and was 

### significantly higher 

### in afternoons than 

### in mornings. Regression analyses

### of individual data showed that increases

### in PFR were associated

### with decreases 

### in time to 

### PFR. Individualized regression analyses also showcd an association between increased time to PFR and increased 

### FEV.. However, its magnitude wastoo small to cxplain much 

### of the

### time-variability of FEV,t. Wheri the 

### FEY, analyses were repeated 

### after excluding subjects \rrithsuboptimal performancè Paper #90-t50.3 or 

### higtvariability (those

### with any time to PFR > 0.3 sec or \r,ith any 

### FEV, < 70% 

### of FEVl at 

### their best test session), statistical conclusions were unaltered Morning FEVr levels showed a

### significant positive correlation 

### with O. concentrâtions averaged over the 

### priceding 

### l,8, or 24 h -a t¡end oppositc to that expected. 

### Ãfternoon FEV. measurements showed no relationship to O. concentrations during the preceding Ih,

### th, or 24li pcriods. Morning-to-afternoon FEY,, chanles showed no

### significant relationshiþ 

### with Or lcvel 

### in the hour preceding the PM test, but 

### did show a

### significant negative.relationship 

### wíth Oa a.veragcd over 8h (essentially the entire time betlveen 

### AM and PM tests). 

### The mean 

## of 305 

### individual regression slopcs 

### of FEV, change 

### (AMto PM) versus ambient Ot level v/as not 

### significantly 

### different from zero, and ihe

### distribution of individual slope valueis was nearly symmetrical around zero. Inspection 

### of individual data showed that extreme slopes resulted 

### from single "outlying" data points 

### -- unusually large positive or l_egative F.EV.1 9¡a¡-C9s^on the day

### with the affected subject's highest

### or lorvest O, exposure. 

### Variation in dâily PM Or level near the time 

### of testing (the best predictor 

### of responise 

### in prior camp and laboratory studies) could not be associated 

### with variation 

### in FEV,,, 

### in this study group. Upper and lower quartiles were compared to test the possibility 

### of a reactive subgroup 

### of subjects (Table 

## III). The quartiles 

### did not 

### differ substantially 

### in age, size, sex 

### ratio, or propo¡tion 

### of individuals residing 

### in high- and low-O, communities. Younger age and male sexappeared to associate 

### with more variable lung func-tion, i.e.

### with increased 

### probability of falling into either extreme 

### quartilc. These results r¡/ereessentially the samewhether 

### lh or Eh O, values were used 

### in the analyses. Regression analyses 

### relating 

### individual FEVo changes acrossthe camping week 

### with average Ot exposure levels over the sametime intervâls (Table 

### IV) yielded some evidence 

### for a cumulatíve 

### effect over the 

### interval Monday morning-\Yednesday afternoon 

### (during which mean 

### FEVr changes were

### significantly negative regardless 

### of air quality variations). The negative correlation between FEV,| change and O, concentration was

### significant (P

## - 0.039), but explained lessthan 2%

### of the FEV,, 

### variationl Exercise Measurements Most subjects' physical 

### activity was 

### roughly comparable

### tothat 

### in other studies 

### of active campers, but less persisten^t 

### and/or less intense than 

### in our previous ambient exposure studies

### with controlled exercisev. However, 

### in this study, exercise/exposure periods were appreci-ably longer (several 

### hours'duration) than 

### in our previous studies 

### (typically involving l-2 h

### of exercise/exposure), DISCUSSION Possibly the most important result 

### f¡om the lung 

### function testing is the demonstration of consistent time-dependent changes, apparently indepèndent of air 

### quality-.in particular, the decline in FEV,' during the early days of testing. (The change 

### in PFR 

### with time may be

### partly explained by a learning effect--subjects 

### initiating the maneuver more 

### forcefully after rnore experience--but the change in FEV,, cannot beexplained 

### in that 

### way,) A 

### qualitatively sjmilar pattern 

### of FEV,' change was observéd by Raizenne et al. in astudy of Canadian campCrss. Our find-ings would'seem to represent a reai

### effect 

### of repeated spirometric testing on r'espiratory mechanics, not an 

### artifact of the specific experimental circumstances, Ozone exposurçs,in this study were

### similar toor higher than lcvels observed in eastern summer camp

### studies<-', The 

### air monitoring data suggest

### that no 

### pollutant other than Or should have 

### affected lung 

### function 

### in this

### study,At iñe same time, these results show thaï relationshìps.betweer.r O, and lung

### function,

## if they existed at 

### all in this experimental setting, were smaller in magnituile and/or lessconsistent than thc aforementioned time-dependent lung 

### function variation.Paper #90- I50.3 The contrast 

### in findings between this study and previous eastern camp studies suggests 

### that 

### (i) our Los Angeles 

### arealubjects \¡,ere less reactive to-O3 th-an eastern campers, or that 

## iiij sò¡ílettt¡ne other than O, was at least 

### partly responsible for-effects seen 

### in eastern studies. Þrâvious "ror-k 

### in our laboråtory does suggest'decreased 

### reactivity to Or 

### in Lo¡ Angeles area residents 

### during summe¡, perhaps 

### cauiéd 

### by repeated 

### ambient 

### exþosures'". However, 

### liiå""à-t.¿ respo-nse due

### to'p;ior a;nbient exposure

### ii unlikely to-expla_in ourfindings, because 

### ãuisu¡jects väried 

### widcly in terms

### of O, levels at 

### their places 

### of residence, and residence had nã o¡uiôus 

### influence on 

### iung function iesults. Our subjects may have been 

### unlsual 

### in that most 

### of them came 

### from relìgious, 

### highly health-conscious

### families, but 

### thatfactor would 

### nàïi¡ietV influence 

### their sensítivity to-Or. Other consistcnt differences between our subjects and eastern campers are not obvious at present' Eastern camp studies 

### differed appreciably 

### from ours 

### in environmental factors other than 

### air quality, inèluding lower attitudè 

### (¡equiiing less

### ventilation 

### for a given 

### work rate), higher 

### reiative-úumidity (increasing heat stress_at aypical daytime.temperatures), and more 

### iiãquenrtàin (giving riõeìo more dènse vegetation, ànd thus to a

### different, perhaps heavier, 

### buiàen 

### of aeròãttergins).That thesefactõrs 

### influenced response

### to O, seems 

### unlikely, but ðannot Ue 

### ruled

### out] Oí more concern isthe 

### possibility that other pollütants exacerbate the response to Ot. 

### Acid aerosol coexisting 

### with O, has been suggested as 

### a 

### cp¡tributor to respiratory dysfuncLion, onthe basis of su-mmer resþiratory 

### morbidity statisticsrras we,ll assummer camp 

### fínãincs3. Some animal studies also indicate 

### ihat acids enhance the respiratory 

### toxicity of O.12. -But 

### c6ntr9lled human exposure studies, using much 

### the Same response measures as r-u'¡¡¡¡¡.r camp studies, 

### tend 

### to iefute the hypothesis 

### that acid contributes

### to respiratory áVitunòtion.'Several investigators have found 

### iittle effect of exposure to

### sulfuric acid alone, 

### ai¿ flit-fe added 

### effect of expiosure to Or plus sulf 

### uric acid ascompared to Or alone, in healthy 

### ádult volunteersl3. 

### In younger asthniatics, 

### only sligh.t, 

### lungfunction clianges have been 

### iJpoite¿ 

## in exposures 

### to sulfu¡ic acid aeiosol- 

### alonera. On the other hand, contròlled 

### eibirimental eiposutes 

### might have underestimated the 

### possibility o-f.

### Otlacid interactions, because they \r'ere

### of shorter 

### duration than 

### typical summer-camp amb¡ent exposures. Specific on-site monitoring 

### of acid aerosols u,as not available here nor 

### in some 

### of the eastern 

## itudies. However, elevãted

### acid concentrations 

### often accompany.elevated 03 concentrations 

### at eastern camp

### sites. 

### In our study, 

### acid concentrations should have been consistently near zero, since párticulate, NO", and SO, levels were consistently low. We

### therefore conclude 

### that time-dependent 

### effects unrelated 

### to air quality may 

### confound the interpretation 

### of air pollutioñ effects as

### studied 

### in summer camps 

### or other 

### arbient-e*po.ure séttings 

### involving iepeated lung 

### function measurements. Past findings 

### need

.. 

### to be ¡eexamined 

### in thñ light, and 

### fúture studiès need 

### to be designed so

### that time'related effects and exposure-related effects can be distinguished 

### in subsequent analyses. ACKNOWLEDGMENTS Thc authors 

### thank Elder Stephen Blue

### of the Southeastern 

### California Conference 

### of Seventh-Dat Adventists, Camp Ranger 

### Rishard Gore, and the 

### cntjre 

### staff_of Pine Springs Ranch

### for their cooperaiion and assistance

### with this project. We

### thank L'H. Wightman' J-E. Hãm¿t, J,C. Solomori, and the entire 

### staff of the Ranðho-Los Amigos Env-ironmental Health Seivicé 

### for 

### technicaliupport. Wethank Dr. M.P. Jones

### of the 

### University of Iowa and Dr. D.\Y' Dockery 

### of Harvard 

### Uiiversity for statistical advice relevant to 

### this project' Paper #90- I50.3 REFERENCES 

### l. P.J.A. Rombout, P.J. 

### Lioy, and B.D. Goldstein, nRationale 

### for an eight-hour ozone standard," JAPCA 36:913 (1986). 2. L.J. Folinsbee, lV.F. McDonnell, 

### and D.H. Horstman, "Pulmonary 

### function and symptom responses 

### after 6.6-hour exposure 

### to 0.12 ppm ozone 

### with moderate exercise" JAPCA:38:28 (l 988). 3. M. Lippmann, P.J. 

### Lioy, G. 

### Leikauf et al., "Effects 

### of ozone on the pulmonary 

### function of children," 

### Adv Mod 

### EnvironToxicol 5:423 (1983). 4. M.E. Raizenne, R.T. Burnett, B. Stern et al., "Acute lung 

### function responses to ambient acid aerosol exposures 

### in children,n 

### Environ Heal Persoectives 79:179 (1989). 5. D.M. Spektor, 

### M. Lippmann, P.J. 

### Lioy et al., "Effects 

### of ambient ozore on rcspiratory 

### function 

### in active normal 

### children,n Am Rev Resoir 

### Dis 137:313 (1988). 6. E.L.

### Avol, L.H.\Yightman, W.S. 

### Linn et al., 

### "A movable 

### laboratory

### for controlled 

### clinical studies 

### of air pollution exposure," JAPCA 29:743 (1979),

8. BMDP Statistical Software; Dixon, W.J., 

### Ed.i University 

### of California Press, Los Angeles, 1981, pp. 237-50, 359-88. 9. E.L. 

### Avol, W.S. 

### Linn, D.A. Shamoo et al., "Short-term respiratory effects 

### of photochemical oxidant exposure 

### in exercising 

### children," JAPCA 37:158 (1987). 10. W.S. 

### Linn, E.L. 

### Avol, D.A. Shamoo et al., "Repeated laboratory exposures

### of volunteer Los Angeles 

### residents: 

### An apparent seasonal

### variation 

### in response," 

### leåilQ!-lld-ugl-H.çel 4:505 ( r988). 

### ll.D.V.BatesandR.Sizto,"AirpollutionandhospitaladmissionsinSouthernOntario: The acid summer haze

### effect" Environ Res 4t:317 (1987). 12.J.A. Graham, "Review, discussion, and summary: 

### Toxicology (Symposium onthe health effects 

### of acid aerosols)" 

### Environ Heal Persoectives 

### 79:l9l (1989). 13. S.M. Horvath, L.J. Folinsbee, and J.F. Bedi, "Combined 

### effect 

### of ozone and 

### sulfuric acid on pulmonary 

### function 

### in man," Am 

### Ind Hve Assoc J 4E:94 (1987). 14.J.Q. Koenig, W.E, Pierson, and M. Horike, "Effects 

### of inhaled 

### sulfuric acid on pulmonary 

### function 

### in adolescent asthmatics," Am Rev Resoir 

### Dis 128:221 (1983). 7.Aerometric Data Division,

### TABLE 

## I SUBJECT characteristics by week, mean

## i s'd' 

### -leell geek

### 2 Ueek

### 3 geek

### 4 geek

### 5 Heek ó Paper #90-150.3

TotsI 

### ?7 157 

### 24 144 14.3 

### r 1.3 11.5

### r 1.9 

### 1ó5r6 150r12 57

### r 13 42 r'13 Paper +*90-150.3 

### TABLE 

## III COMPARISON 

### of subjects 

### v/ith highest and lowest



### individual regression sloPcs*. Lower

## Ouartile Upper

## Ouartile All Subiects subi ects boys, 

### no. 21 ?9 

### girts, 

### m. 21 24 age,

### ylr 9.1 

### r 0.7 11'4 

### r 1.'l holght,

### cmr 138

### t I 149

### t 9 uelght. 

### kg 32

### t 6 42

### t 13 rBoys and girLs cqÍbined. 

## ?o 20 37 

## 28 27 24 11.0

### r

## O.E 11.0

## t 1.4 11'ó 

### r 1.4 

## 14ór6 149r11 152r10 

## 37rg 41t12 41r11

2559

## t744 2230

## t 662 4374

## t t690 2732 

### x t003 

## 25t3t747 2t92t666 4402tt687 27ll

## t 1007 24gg

## t745 2185

## t677 4377

## t t757 2722

## t 1058 2488 

## r

## ?38 2l1l

## t 67l 4471

## t 1695 2736

## t t059 2473 

## il752 2162

## t 6'16 4397

## t 1808 2732

## * t056 247t 

## i¡753 2t53

## t 674 4483

## t 1744 2706

## t 1057 2469

## t756 2l4l

## t672 4422 

### r.

## l8t0 2643 

## ! t053 248r

## ir76l 2158

## t672 455E

## * 

## l78l 2704

## t 1081 2476

## t774 2154

## *.687 4489 

## * l80E 2687

## f 1068 2495

## t77l ?l75

## r.684 4588

## t t630 272t

## t t078 Measure *Percentage studied in: Week I Week 2 Week 3 Week 4 Week 5 Week 6 Percentage of: Boys 

### Girls Percentage 

### living in O, 

### pollution level: Low Intermediate High Age, 

### yr, mean

## t s.d. Height, cm, mean

## t s.d 

## tt.2!2.0 lr.5 + 1.9 26 9 I 23 2t 20

58 42

25 24 

### 5l 10.8

## r 2.1 149

## r 13 152

## r 13 r50

## t 12 14 20 

### l2 t6 

### l6 

## ))

59 4t

JJ 20 47 

### l5

t7 

### l6 l5 20 

### l7

52 48

28 

### 2l 5l 

### TABLE 

## II LUNG function results (mean

## I s'd')

### for 305 subjects; results 

### of analyses

### of variance comparing across days and times' 

## Dav Time FVC

## (mL) FEVl(d) PFR

## (mlls) MMFR 

### lmlls) Sun.+ 

## p.m, 2596

## t763 2272

## t649 4450

## t 1589 2853

## r 967 

### Mon. a.m. p.m. 

## Tue. a.m. p.m, 

### Wed. a.m. p.m, 

## Thu. a.m. p.m. 

## Fri, a,m. p,m. P (day)* P (time) P (interaction) 

# 0.0003 0.170 

# 0.0000 0.331 

# 0.295 0.077 +Slopes dctermined by regression 

### of FEV,, change, a.m. to p.m., on O, concentration (average 

### for 

### I h period 

### prior to p.m. test). Lower 

### quartile consists 

### of the 250lo (76 subjects) whose FEVt changes most negatively 

### with increasing Or; uÞper 

### quartile is the 2590 whose 

### FEV, changes most 

### positively

### with increasing Or. *Proportions 

### of upper- and lower-quartile subjects 

### differed significantly bctween weeks (P = 0.013 by chi-square test).

0.0000 0.32t 0,0056 0.0000

0.391 0.0026 

### rsunday p.m, (screening) data not included 

### in analyses

### of variance' +Huynh.Feldt adjustments were applied 

### in calculating Pvalues, when data 

### distributions did not

## iit assumptions underlying conventional analysis of variânce' Pvalues < 0'00005 tabulated as 0.0000.

### w*- '!ìLÌì: .r:l

Paper +90- I50.3 

### TABLE 

## IY REGRESSION analyses 

### relating FEV,, changcs 

### with average 

### O, levels overvarious intervals. Time 

## Interval. Mean 

## FEV, Mean fO¡L Mon. a.m.

## thru: Chanee.

## mL oob Monday

## p.m. -38 75 Tuesday 

## p.m. -56 66 Wednesday

## p.m. -78 64 Thursday 

## p.m. -75 63 In terceot. mL -7 +7 +28 +16 Slooe.



### mL/oob -0.41 -0.97

- 1.68 -1.46 

## ¡P

-.049 .396 

### -.067 .24t
-.1 l

## I .039 

### -.093

. 104 Paper +90- I50.3 LEGENDS FOR FIGURES 

### FIGURE 

## I FEV' and 

### hourly O, as

### functions 

### of time, mean

## t ISE; open symbols indicate Sunday screening data. 

### FIGURE

## 2 PFR and 

### hourly O, as

### functions 

### of time, mean 

## ! ISE; open symbols indicate Sunday screening data.

NOTE 

### TO EDITORS 

### Under

### the new federal 

### copyright law, publicat¡on 

### rights to this paper are 

### retained by

### the author(s).

l0or

## (-)

T 

### 1I

# V]L I ti.. ' ll

WEEKJ: 4E SUBJECTS ÀGE 10-12, SÍART 7-10-66 oJ

### (-) Paper #9ù-150.3

WEEK 2: 5J SUBJECTS AGE 10- 12, STAR] 7-3-68

wEÊK 4: 47 SUBJECTS AGE 10- I2, START7- I7-8E WEEK 1: 45 SUBJECTS AGE8-9, START 6-26-88 

### Paper #9û-15ù.3

WEEX 2: 53 SUBJECTS AGE 10- I2, STARI 7-J-88

WEEK 4t 47 SUBJECIS ACE I0- I2. START7- I7-EE

WEEK6: 51 SUBJÊCÌS AGE l3t, SfARf 7-31-88 FEV1 (.--.) 0J(-) FEVt (o-*.) ML
2200

21 00

2000

1900 PP8

120

EO 40
0 PFR (. MLilS

PFR (..-.- o ) ML,/S

PFR(...o)

### r) 03

### (-)

PP8
160
120 80
40
0

or

## (-)

ì60
120
80
40
0 PFR(o--...) MLlS 160 1800 120
r700 EO
I600 40 

### 1500 0

PFR (' 4200

4000

J800

MLlS

4400

4200

4000 c) 

### .)8 ! m I 

### ñ



# r r --{ 

## 'rã ø z o J J 

## ó ú, U 

## ù F d 

### È z O t-- dFz U O o u z a N O FEV1 (...-o) 03 (-) PPB r60
120
80
40
0 FEV]

### (.-. o J 

# ) 6 d UJ À Ø 

### ¡- 

### ú À 

## z k É F 

### u z o u z o N 

### o or

## (-)

wEE( J: 48 SUBJECTS AGE 10-12. START 7-10-84

WEEX 5:6l SUBJECIS AGE 10-12, STARI 7-24-88 

### o c E


### = 

## ñ

= ! m t) *, T 

## r o E Ð --l 

## r

= 

# - - r -t 

## r Ð 

# 'Ø E 

### r F Ø m 

# - O 

### z .U 160
120
80
40
0SU

or

## (-) FEV1 (. --.o ) 03

### (-) FEVl (.--.) ML 

# I ilMrv+rYï 2200

2ì 00

2000

1900 2200

21 00

2000

1900 PPB r60
120
80
40
0 Su SU

WEEK5: 61 SUBJECTS aGE 10- I2, START 7-24-88 IVEEK6: 51 SUEJECTS AGE 1J+, START 7_J1_6E o.

### {-) PP8
160
120

EO
40
0 

# iiijiji 'l

ir

FIGURE 1 2200

21 00

2000 PPB

r60
120

EO 4Ô 3200

3100 :i 

# ì 

# i

ì 

## I ä M L,/S

4800

4600 PP8

r60 r20

EO 40 1900 0 fu Fr Su Mo lu DAY (ANII HOUR)

### 0F l^IEEK FEV,, 

### and 

### hour'ly ozone 

### as 

### functjons 

## of time, mean:i one standard 

### error; opeft

### synbols 

### indìcate Sunday 

### screening data, I2 4400 0Su Mô TU Th Fr So DAY (AND HOUR) OF I,JEEK FIGURE

## 2 Peak

### flow rate and 

### hour'ly ozone 

### as 

### functjons 

## of time, mean

### + one



### standard

## error; open

### synbols

### jndicate Sunday 

### screening dat,al 13 rh WEEK 1: a5 SUBJECfS aGE E-9, SÌÀRT 6-26-88

T .a 

### l'

## .l 

# tl
T ï



## Ì.. IT .1, I