Agency for Toxic


Substances and


Disease Registry


Division of Health Studies 

SERUM DIOXIN LEVELS


IN RESIDENTS OF


CALCASIEU PARISH, LOUISINA


October 2005 

DEPARTMENT OF HEALTH 

& HUMAN SERVICES 

Agency for Toxic Substances 

and Disease Registry 

Atlanta, Georgia 30333 
Additional copies of this report are available from:


National Technical Information Services, Springfield, Virginia


(800) 553-6847 or (703) 605-6244


Request publication number PB2006-100561

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


PUBLIC HEALTH SERVICE


AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY


ATLANTA, GEORGIA


FINAL REPORT 

SERUM DIOXIN LEVELS IN 

RESIDENTS OF CALCASIEU PARISH, LOUISIANA 

October 2005 

Agency for Toxic Substances and Disease Registry


Division of Health Studies


Health Investigations Branch


1600 Clifton Road, E-31


Atlanta, Georgia 30333

DISCLAIMER


The use of the name of a company or product does not constitute endorsement by the


Agency for Toxic Substances and Disease Registry, the Public Health Service, or the


U.S. Department of Health and Human Services. 

2 
CONTENTS


DISCLAIMER ......................................................................................................................... 2


LIST OF TABLES................................................................................................................... 5


LIST OF FIGURES ................................................................................................................. 6


LIST OF APPENDICES ......................................................................................................... 7


ABSTRACT............................................................................................................................. 8


INTRODUCTION ................................................................................................................... 9


BACKGROUND ..................................................................................................................... 9


Dioxin and dioxin-like compounds............................................................................ 9


Reference Levels of Dioxin...................................................................................... 10


Health Effects ............................................................................................................ 10


Previous Studies in Calcasieu Parish ....................................................................... 11


STUDY RATIONALE.......................................................................................................... 12


OBJECTIVES ........................................................................................................................ 12


METHODS............................................................................................................................. 13


Study Design.............................................................................................................. 13


Eligibility Criteria...................................................................................................... 13


Target Area ................................................................................................................ 13


Comparison Area...................................................................................................... 14


Sampling Design ....................................................................................................... 14


Data Collection.......................................................................................................... 14


 Recruitment and Enrollment of Participants .................................................. 14


Informed Consent............................................................................................. 15


Questionnaire ................................................................................................... 15


Laboratory Analysis......................................................................................... 15


Data Management...................................................................................................... 16


Data Analysis............................................................................................................. 16


RESULTS............................................................................................................................... 17


Participation............................................................................................................... 17


Comparison between Parishes.................................................................................. 17


Regression Analyses ................................................................................................. 18


Comparison with Combined Data Set...................................................................... 19


Comparison of Congener Profiles ............................................................................ 19


DISCUSSION ........................................................................................................................ 19


Study Strengths........................................................................................................... 20


Study Limitations ....................................................................................................... 21


3 
CONCLUSIONS.................................................................................................................... 22


RECOMMENDATIONS ...................................................................................................... 22


AUTHORS AND ACKNOWLEDGEMENTS ................................................................... 23


REFERENCES....................................................................................................................... 24


TABLES................................................................................................................................. 28


FIGURES ............................................................................................................................... 32


APPENDICES ....................................................................................................................... 38


4 
LIST OF TABLES


Table 1. Demographic and other characteristics of target and comparison populations.. 29


Table 2. 	Mean (ppt) Serum Dioxin TEQ Levels (SEM) by demographic and other


characteristics for study areas................................................................................ 30


Table 3. 	Mean Serum Dioxin TEQ Levels (ppt) by Age (years) for Calcasieu Parish,


Lafayette Parish, and the Combined Reference Data Set.................................... 31


5 
LIST OF FIGURES


Figure 1. Map of Calcasieu Parish Study Area .................................................................... 33


Figure 2. Frequency of Dioxin TEQ Levels (ppt) in Calcasieu and Lafayette Parishes........ 35


Figure 3. Percent Congener Contribution to Total TEQ in Calcasieu and Lafayette


Parishes ................................................................................................................... 36


Figure 4. Mean Congener Concentration Levels (ppt) in Calcasieu and Lafayette Parishes


and a NCEH Laboratory Comparison Range of Means ...................................... 37


LIST OF APPENDICES


A. Letters of Introduction for Census.................................................................................. 40


6 
Letter to Community Members ...................................................................................... 41


Letter to Community Authorities ................................................................................... 42


 Letter to Physicians ......................................................................................................... 43


B. 	Household Census Scripts and Questionnaire................................................................ 44


C. 	Letters to Persons Eligible for Study.............................................................................. 54


D. 	Eligibility Scripts and Questionnaires............................................................................ 57


Calcasieu - Minor ............................................................................................................. 58


Calcasieu - Adult .............................................................................................................. 63


Lafayette - Minor.............................................................................................................. 68


Lafayette - Adult............................................................................................................... 74


E. 	Informed Consent Documents......................................................................................... 80


 Adult Consent ................................................................................................................... 81


Parental Consent ............................................................................................................... 85


 Youth Assent..................................................................................................................... 90


F. 	Investigation Questionnaire ............................................................................................. 95


G. 	Specimen Preparation and Shipping............................................................................. 126


H. 	Health Education Materials........................................................................................... 132


I. 	 Results Letter.................................................................................................................. 145


J. 	 Specification of the design setup structure, the stratum variable, and the primary


sampling unit for the SUDAAN programming ........................................................ 151


7 
EXECUTIVE SUMMARY 

Calcasieu Parish, Louisiana, contains the Calcasieu Estuary, an area with many 

petrochemical industries that make chlorinated hydrocarbon solvents, vinyl chloride 

monomer, and other petroleum-based chemicals. Several residents of Calcasieu Parish 

expressed concerns about the impact that these chemicals may have on their health. In 

1998, staff from the U.S. Environmental Protection Agency (EPA) Region VI asked the 

Agency for Toxic Substances and Disease Registry (ATSDR) to review the blood dioxin 

results of 11 people and a pooled blood sample from residents of Calcasieu Parish. An 

ATSDR report concluded that three people and the pooled blood sample had levels of 

dioxin-like compounds (hereby referred to as dioxins) above a reference range and 

recommended that the sources of dioxin be identified and measures be implemented to 

reduce exposure (Agency for Toxic Substances and Disease Registry 1998a). In 

December 1998, staff from the ATSDR collected blood from an additional 28 selfselected residents of Mossville, an area in Calcasieu Parish, to measure dioxin. The 

exposure investigation indicated that the mean blood dioxin concentrations of the 28 

participants were above the 95th percentile of a reference population (Agency for Toxic 

Substances and Disease Registry 1999). 

This investigation was conducted to better characterize the nature and extent of 

exposure to dioxin among residents of Calcasieu Parish. Study participants were selected 

from a residential area surrounding the petrochemical industries located near the 

Calcasieu Estuary. People living in Lafayette Parish, Louisiana, comprised the 

comparison group in this investigation. 

Overall, the mean serum dioxin level did not differ between residents of Calcasieu 

Parish and residents of Lafayette Parish. In addition, the mean dioxin levels were similar 

when Calcasieu residents were placed into three areas based on distance to industrial 

areas (industrial corridor, industrial buffer, and outer ring). Dioxin levels increased with 

age in Calcasieu and Lafayette Parishes. Calcasieu Parish residents who reported eating 

locally caught fish, smoking cigarettes, working in an occupation with potential exposure, 

or using pesticides, had dioxin levels similar to those of Lafayette Parish residents who 

reported these activities. Current cigarette smokers in Calcasieu Parish had higher dioxin 

levels than current cigarette smokers in Lafayette Parish. African Americans in Lafayette 

Parish had higher dioxin levels than African Americans in Calcasieu Parish and whites in 

Lafayette Parish. 

We also evaluated the blood samples for congener patterns, or the distribution of 

dioxins in serum. The congener pattern in Calcasieu Parish residents was similar to that 

of Lafayette Parish residents. 

8 
SERUM DIOXIN LEVELS IN


RESIDENTS OF CALCASIEU PARISH, LOUISIANA


Following the discovery of petroleum and gas reserves in the 1920s, Calcasieu 

Parish became a highly industrialized area, containing a large number of petrochemical 

and agrochemical manufacturing and processing plants. These plants produce chemicals 

such as chlorinated hydrocarbon solvents, vinyl chloride monomer, petroleum-based 

chemicals, and commercial feedstock (U.S. Environmental Protection Agency 2003). In 

2000, thirty-one Calcasieu Parish industries reported releases of 14,450,855 pounds of 

environmental contaminants to the Environmental Protection Agency (EPA) Toxic 

Release Inventory. This included 1.27 pounds of dioxin. Chemical, petroleum, and 

solvent recovery industries contributed the greatest amount to the total releases 

(Louisiana Department of Environmental Quality 2000). 

Community members were concerned about the effect of chemical releases on 

their health. Previous review and investigation by the Agency for Toxic Substances and 

Disease Registry (ATSDR) indicated higher than expected levels of dioxin-like 

substances in the blood of some community members. As a followup to these previous 

investigations, ATSDR conducted this study to better characterize the nature and extent 

of human exposure to dioxin and dioxin-like substances throughout Calcasieu Parish. We 

selected study participants from a residential area surrounding petrochemical industries 

located near the Calcasieu Estuary. Residents living in Lafayette Parish, Louisiana, 

comprised the comparison group in this investigation. 

BACKGROUND 

Dioxin and dioxin-like compounds 

Polychlorinated Dibenzo-p-Dioxins (PCDDs) comprise a family of 75 chemically 

related compounds each of which is called a congener. PCDDs share properties with two 

other groups of chemicals, polychlorinated dibenzo furans (PCDFs) and several 

compounds from a group of chemicals called polychlorinated biphenyls (PCBs). 

Together with PCDDs, these compounds are referred to as dioxin-like compounds, or 

dioxins. The term dioxin in this document will be used to describe these three groups of 

dioxins: PCDDs, PCDFs, and PCBs. Although the mono-ortho PCBs have dioxin 

activity, this group was not included in the analysis because calculation of the dioxin 

toxic equivalent (TEQ) for the reference population did not include the mono-ortho 

PCBs. 

Dioxin is found in air, water, and soil. PCDDs and PCDFs are not made on 

purpose, but result from burning fuel, wood, and waste, and from making certain 

products. PCBs are commercial mixtures that are no longer produced in the United 

States, but were used in the past as coolants and lubricants in transformers, capacitors, 

and other electrical equipment. When humans are exposed to dioxin through contact with 

contaminated soil, air, and water, dioxins can enter the body and get stored in fat. 

Individual dioxin congeners are eliminated slowly from the body at different rates. The 

rate of elimination is calculated in “half-lives”—the time it takes for 50% of dioxin to 

leave the body. 

9 
The most toxic form of dioxin is 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8­

TCDD or TCDD). The half-life of TCDD is estimated to be 7 to 12 years (Agency for 

Toxic Substances and Disease Registry 1998b). The toxicity of other dioxins is described 

relative to TCDD by using Toxic Equivalency Factors (TEFs) (van der Berg et al. 1998). 

A person’s dioxin body burden, as measured in blood or other biologic samples, is often 

described as the sum of the concentration of each dioxin congener in parts per trillion 

(ppt) weighted by each congener’s TEF. This sum is called the Toxic Equivalent Quotient 

(TEQ). 

Reference Levels of Dioxin 

All people are exposed to small amounts of dioxins. Dioxin exposure is typically 

higher in urban areas of industrialized countries compared to rural areas. Average 

background TCDD and TEQ human body burden of dioxin and dioxin-like compounds 

measured in blood and adipose tissue have dropped steadily in the United States over the 

past several decades from 50–80 ppt in the 1970s to 30–50 ppt in the 1980s and 10–20 

ppt in the 1990s (Aylward and Hays 2002, Lorber 2002). Levels of TCDD range from 3 

to 7 ppt in the general population and rarely exceed 10 ppt (Agency for Toxic Substances 

and Disease Registry 1998b). 

Few data have been published about reference, or background, levels of dioxin in 

humans. The most current published data about reference levels of dioxin in humans were 

developed from studies conducted in the 1980s and 1990s (Centers for Disease Control 

and Prevention 1987; Needham et al. 1996). As described above, dioxin levels in the 

general population are decreasing. From 1995 through 1998, ATSDR and the National 

Center for Environmental Health (NCEH) of the Centers for Disease Control and 

Prevention (CDC), conducted several dioxin studies in the United States. Reference 

levels of serum dioxin were calculated on the basis of the results from these studies 

among people with no known occupational or accidental exposures to dioxin. The mean, 

median, and 95th percentile blood dioxin toxic equivalent (TEQ) concentrations were 21 

ppt, 19.9 ppt, and 37.5 ppt, respectively. These reference data may not be representative 

of the U.S. or the Calcasieu populations, but represent the best available estimate of 

dioxin levels among unexposed persons (Orloff et al. 2001). 

Health Effects 

Studies show that as the serum dioxin TEQ level increases, the risk for chronic 

health effects increases. The International Agency for Research on Cancer has 

determined that TCDD can cause cancer in humans (International Agency for Research 

on Cancer 1997). EPA and the CDC’s National Institute for Occupational Safety and 

Health consider TCDD a probable human carcinogen and a “cancer promoter” in 

conjunction with certain other chemicals (U.S. Environmental Protection Agency 1994, 

2000; National Institute for Occupational Safety and Health 1984). The Institute of 

Medicine of the National Academy of Sciences reviewed all occupational, environmental, 

and veterans studies on exposure to dioxin in 1996, 1998, and 2000. The 2000 summary 

of findings stated that evidence is sufficient to suggest an association between exposures 

to dioxin and soft-tissue sarcoma, non-Hodgkins lymphoma, and Hodgkins disease 

(Institute of Medicine 2000). The review also stated that limited, but suggestive, 

evidence indicates an association between exposure to dioxin and the respiratory cancers 

(lung, bronchus, larynx, trachea), prostate cancer, multiple myeloma, and acute 

10 
myelogenous leukemia (Institute of Medicine 2000). However, individual dioxin 

resistance and individual health outcomes vary greatly (ATSDR 1998b). 

Dioxin exposure is also linked with several noncancer health effects. The most 

widely accepted health effect from high levels of dioxin exposure is a skin condition 

called chloracne, a severe form of acne. Chronic noncancer health effects linked with 

dioxins include problems of the immune system, developing nervous system, endocrine 

system, and reproductive functions. 

Animal studies have shown increases in the incidence, prevalence, and severity of 

endometriosis. (Wissing 1998). Further animal experiments have implicated dioxin in this 

disease, but small, hospital-based, case-control studies have failed to provide compelling 

evidence for an association of environmental contaminants and endometriosis. (Rier and 

Foster 2002). A women’s health study in Seveso, Italy, reported a doubled, nonsignificant 

risk for endometriosis among women with serum TCDD levels of 100 ppt or higher, but 

the relation between dose and response was not clear (Eskenazi et al. 2002). 

Animal studies have shown the immune system to be one of the most sensitive 

targets of the toxic effects of TCDD. TCDD inhibits immunoglobulin secretion and 

decreases resistance to bacterial, viral, and parasitic infections in exposed animals. 

However, human health studies for immune effects have been inconsistent (Baccarelli et 

al. 2002). 

Recent epidemiologic studies suggest a possible association between dioxin and 

diabetes in human populations (Remillard and Bunce 2002; Longnecker and Daniels 

2001). A study of Air Force veterans exposed to Agent Orange and its contaminant, 

TCDD, suggested an association between dioxin exposure and diabetes mellitus and 

adverse effects on glucose metabolism and insulin production (Henriksen et al. 1997). 

Another study of Air Force veterans whose blood levels were within the range of the 

background population demonstrated an association between diabetes and dioxin levels 

(Longnecker and Michalek 2000). A mortality study among a highly dioxin-exposed 

population in Seveso, Italy, showed excess deaths from diabetes (Pesatori et al. 1998). 

Subtle effects of environmental exposure to dioxins at background in humans are 

largely unknown and poorly understood. Further scientific research is ongoing to study 

subtle changes and various health outcomes from low level and high level dioxin 

exposures. 

Previous Studies in Calcasieu Parish 

In 1998, EPA Region VI held meetings with residents of Calcasieu Parish, 

Louisiana, to discuss ongoing activities in the Calcasieu Estuary. A resident of Calcasieu 

asked EPA to review results from 12 blood samples from Calcasieu Parish residents who 

had been independently analyzed for dioxin. EPA requested that ATSDR, the federal 

agency tasked with studying the human health effects of toxic substances, review the 

blood dioxin results. The samples included 11 individual blood samples and a pooled 

blood sample from 100 patients at a local hospital. Three of the individual blood samples 

and the anonymous pooled blood sample were above the reference for dioxins. The three 

11 
persons with elevated dioxin levels lived in Mossville and Bayou D’Inde. In October 

1998, ATSDR issued a health consultation on the blood dioxin results and recommended 

that the exposure sources of dioxin in the three persons with elevated blood dioxin levels 

be identified and measures be implemented to reduce exposure (ATSDR 1998a). 

In December 1998, ATSDR conducted an exposure investigation in Mossville, 

Louisiana, to determine if other residents of Mossville had been exposed to dioxin. 

ATSDR conducted blood tests for dioxin-like compounds on 28 self-selected residents of 

the community who were 18 years of age or older, who had lived in the designated area 

for at least 5 years, and who had no occupational exposure to dioxin. Older people who 

had been long-term residents in the neighborhood were given preference for participation 

of this exposure study. The mean (54.8 ppt), median (68.3 ppt), and 95th percentile (162.3 

ppt) dioxin TEQ exceeded the mean (21.0 ppt), median (19.9 ppt), and 95th percentile 

(37.5 ppt) dioxin TEQ of the reference population. The participants’ TEQs ranged from 

3.8 ppt to 186 ppt. Age positively correlated with dioxin levels, with the highest 

elevations found in participants more than 45 years old (ATSDR 1999). 

STUDY RATIONALE 

The sampling strategy for participants of the Mossville exposure investigation 

was by convenience biased toward older, potentially more exposed, persons. Further 

investigation was necessary to determine if the dioxin levels found in the exposure 

investigation were representative of Calcasieu Parish residents. Further, because diet is an 

important source of dioxin exposure, it was important to determine if the dioxin levels of 

Calcasieu residents were different than those of others in southern Louisiana who had a 

similar lifestyle and diet. The use of a comparison population stratified by age in this 

study allows analysis of differences in dioxin levels among persons in southern Louisiana 

who have similar dietary and lifestyle habits. Finally, and most importantly, dioxins are 

stored in body fat, increase with age, and are eliminated from the body slowly. Therefore, 

interpreting whether a person’s dioxin level resulted from a recent or a past exposure is 

difficult. High levels of serum dioxin among younger age groups may suggest a more 

recent exposure and the need to identify and mitigate the relevant source(s) of exposure. 

An evaluation of serum dioxin for various age groups was regarded as a means by which 

to assess time of exposure. 

OBJECTIVES 

The primary objectives of this investigation were to determine 

1.	 whether the serum dioxin levels in a sample of Calcasieu residents ages 15 

years and older were elevated relative to a comparison population, and if so, 

2.	 if any pattern of exposure existed among people with elevated serum dioxin. 

A secondary goal of this investigation was to determine if levels of volatile 

organic compounds (VOCs) were elevated in Calcasieu Parish residents. The results of 

the investigation of VOCs will be discussed in a separate document. 

12 
METHODS 

Study Design 

A cross-sectional design was chosen to determine whether the serum dioxin levels 

in Calcasieu Parish residents were different from those in a population with a similar age 

distribution, lifestyle, and diet. The dioxin levels of a population-based random sample of 

Calcasieu Parish residents were compared to those of a similar group of Lafayette Parish 

residents. The evaluation of numerous dioxin congeners also allowed for a cross-sectional 

comparison of the congener profiles between Calcasieu and Lafayette Parishes. 

Eligibility Criteria 

The target group consisted of persons who had resided in Calcasieu Parish for the 

last 5 years and were at least 15 years old. The comparison group consisted of persons 

who had resided in Lafayette Parish for the last 5 years, had never resided in Calcasieu 

Parish, and were at least 15 years old. In addition, study participants had to weigh at least 

95 pounds, could not have lost more than 15 pounds in the last year, were not suffering 

from hemophilia or any other bleeding disorders, and had not had cancer chemotherapy 

in the 4 weeks prior to the date of specimen collection. Women were excluded if they 

were pregnant or had breast-fed a child in the past 6 months. Each study participant was 

asked to complete a questionnaire (Appendix F) and to provide a blood sample to 

measure serum dioxin. 

Target Area 

The target area was chosen to encompass those areas which were in closest 

proximity to EPA’s Toxic Chemical Release Inventory (TRI) sites and had the greatest 

population density. The choice of three areas with increasing distance to industry allowed 

analysis of serum dioxin level in relationship to proximity to industry. The target areas 

were identified and geographically defined by census blocks using 2000 census data and 

Geographic Information System (GIS). We identified three target areas in Calcasieu 

Parish (Figure 1): 

1.	 The Industrial Corridor – an elliptical shaped area measuring 3 by 6 miles and 

encompassing residential areas surrounding petrochemical industries located near 

the Calcasieu estuary. This area included Westlake, Mossville, Sulphur, Lake 

Charles, and surrounding area. 

2.	 The Industrial Buffer – an additional 1.5-mile wide area around the industrial 

corridor. 

3.	 The Outer Ring – the towns of Vinton, Dequincy, and Iowa approximately 6 

miles northwest, west and east of the industrial corridor and still in Calcasieu 

Parish. 

The target areas were further divided into sectors at the request of the community 

study group. The use of the sector design allowed us to ensure that every sector had an 

equal number of participants. The industrial corridor and the industrial buffer were 

divided into four sectors each, for a total of eight sectors. The outer ring was not divided 

13 
and was considered to be one sector (Sector 9). Our goal was to recruit 32 participants 

per sector, 8 participants in each of four age groups: 15–29, 30–44, 45–59, and 60 years 

and older. 

Comparison Area 

In consultation with the Louisiana Office of Public Health and the Calcasieu 

Community Dioxin Study Work Group, we chose Lafayette Parish as the comparison 

population for this study. Lafayette is demographically and geographically similar to 

Calcasieu Parish, but lacks Calcasieu’s chemical (Health Resources and Services 

Administration 2001). Calcasieu and Lafayette Parishes are similar in total population 

(183,577 and 190,503); percentage white (73.6 and 73.4), percentage black (24.0 and 

23.8), percentage under age 18 (27.3 and 27.4), percentage age 65 through 84 (10.3 and 

7.8), percentage age 85 and older (1.0 for both), and percentage of individuals living 

below the poverty level (16.5 and 15.8). Lafayette Parish is more densely populated, with 

682 people per square mile compared to 167 in Calcasieu Parish. The EPA TRI 2000 

ranks Calcasieu Parish 6th out of 64 parishes in Louisiana, with 31 industries reporting 

12,548,645 pounds of total releases, and 2nd in the state for total releases of dioxin. 

Lafayette Parish is ranked 48th in the state with 10 industries reporting 11,907 pounds of 

total releases and no reported dioxin releases. All of Lafayette Parish comprised Sector 

10 (Figure 1). 

Sampling Design 

Sampling was accomplished by multi-stage cluster sampling. Census blocks 

within the 10 sectors were identified by GIS using 2000 Census data. The blocks were 

assigned to only one of the sectors. When a block straddled two or more sectors, that 

block was assigned to the sector that contained most of the block. Blocks within each 

sector were then randomly assigned to a “cluster” of at least 600 persons. Clusters could 

be composed of one or many census blocks, depending upon the population size in each 

block. 

Data Collection 

Recruitment and Enrollment of Participants. One cluster from each of the nine 

Calcasieu sectors and three clusters in the 10th Lafayette sector were randomly selected as 

the sites at which a household enumeration would be conducted and participants selected. 

Residents of the randomly chosen clusters were sent a letter of introduction (Appendix A) 

and brochure (Appendix H), informing them of the study and that someone from the 

National Opinion Research Center (NORC) would come to their house to conduct a 

household listing. Letters were also sent to local authorities and local physicians advising 

them of the household listing (Appendix A). 

The principal investigator and the contractor developed appropriate forms, 

canvasser training, and procedures for canvassing, interviewing, recalling, and reporting 

to insure that appropriate methods were used to make an accurate and complete census. 

During the household listing phase, NORC personnel conducted a door-to-door 

household listing of residents in each of the randomly selected clusters in both target and 

comparison areas (Appendix B). 

When the household census was complete, persons who were considered initially 

eligible were stratified by age and geographic location and contacted by mail to let them 

14 
know about the investigation and that they might be asked to participate in the study 

(Appendix C). Randomly selected initially eligible participants were contacted by 

telephone to explain the investigation, confirm eligibility, and recruit participants. 

Investigators introduced themselves, explained the investigation in general, and requested 

permission to ask eligibility questions. All investigators followed a short script to confirm 

age, gender, and address, and to ascertain eligibility through a series of questions based 

on the eligibility criteria (Appendix D). 

Informed Consent. The consent of each participant was confirmed at the 

beginning of each interview by completion of a participant consent form approved by the 

CDC Human Subjects Institutional Review Board. Participants under 18 years old were 

asked to sign a participant assent form and their parent or guardian was asked to sign a 

parental consent form (Appendix E). 

Questionnaire. The interviewer administered a questionnaire to the participant 

(Appendix F). The first part of the questionnaire reconfirmed eligibility to participate in 

the investigation and to give 60 milliliters (mL) of blood. The second part of the 

questionnaire was comprised of environmental exposures questions. Interviews were 

randomly monitored by supervisory personnel and spot checks were made to ensure 

accuracy in data recording. Contract personnel from NORC administered the 

questionnaire on behalf of ATSDR. 

Laboratory Analysis. A phlebotomist collected a 60 mL venous blood specimen 

(50 mL for dioxin analysis and 10 mL for VOC analysis) from eligible participants 

according to procedures established by CDC. Established documentation and chain-ofcustody methods were used to ensure the integrity of the biologic specimens collected 

and to safeguard against tampering with biologic specimens or records (Appendix G). 

Using high resolution gas chromatography/isotope-dilution high resolution mass 

spectrometry, NCEH laboratory personnel measured PCDDs, PCDFs, and PCBs which 

exhibit dioxin-like properties in serum samples (Patterson et al. 1987; Patterson et al. 

1990; Turner et al. 1997). Serum samples were spiked with 13C12-labelled internal 

standards. The laboratory staff isolated the analytes of interest using a C18 solid phase 

extraction procedure followed by a multicolumn automated cleanup and enrichment 

procedure. Laboratory personnel separated the analytes with a DB-5ms capillary column 

(30m x 0.25 μm film thickness), using a Hewlett-Packard 6890 gas chromatograph. The 

staff quantified the analytes by ID-HRMS, using selected ion monitoring at 10,000 

resolving power with a Micromass Auto Spec ULTIMA or a Finnigan MAT95 mass 

spectrometer in the EI mode. The concentration of each analyte was calculated from an 

individual standard linear calibration curve. Each analytical run included three unknown 

serum samples, a method blank, and a quality control sample. The analyst was blinded to 

the quality control samples. After all data were reviewed using comprehensive quality 

assurance and quality control procedures, the analytical results were reported on both a 

whole-weight and a lipid-adjusted basis, taking fat concentrations into account in 

calculating dioxin levels. Results of this study are reported as TEQs. 

The detection level of each congener is based on the volume of serum that was 

analyzed. Thus, detection levels may be different for each congener and for each 

analytical run. If the serum volume was not sufficient to detect a specific congener, the 

15 
result for that congener is reported as non-detect (ND). The NDs were assigned a value 

equal to the limit of detection divided by two (Hornung and Reed 1990). 

Data Management 

The NORC interviewers wrote down information obtained during the household 

listing and in-person interview phases of the study. To assure 100% data entry 

verification, two separate operators entered the same data into a Computer Assisted Data 

Interview (CADI) system. 

Data Analysis 

Statistical analyses were performed by using SUDAAN (Research Triangle 

Institute, Release 8.0, Research Triangle Park, NC) software. SUDAAN procedures 

produced population weighted estimates for means and standard deviations of several 

variables. The specification of the design setup structure, the stratum variable, and the 

primary sampling unit for the SUDAAN programming are described in Appendix J. 

Demographic characteristics of study participants by parish were compared by 

gender, race, age, length of residency, food consumption patterns, occupation, pesticide 

usage, smoking, and distance from industry using CHI-SQ test. Results are considered 

statistically significant if the p-value is less than or equal to 0.05. Only statistically 

significant differences are noted. 

The student’s t-test was used to compare the weighted mean difference of TEQ 

between the target and comparison areas. T-tests were also used to compare means for the 

study areas by categories of gender, age, race, ate locally caught fish (ever), ate locally 

caught fish (past year), year moved to the parish, occupational exposure to dioxin, usage 

of pesticide, ever smoking, and currently smoking. The t-test was also used to compare 

mean TEQ levels for each parish with the combined reference data set. 

We used the Adjusted Wald test with PROC REGRESS to compare weighted 

mean TEQ levels between the three target areas: industrial corridor, industrial buffer, and 

outer ring. Each of these target areas was also compared with the comparison area (i.e., 

Lafayette Parish). The TEQ levels for Calcasieu and Lafayette Parishes stratified by age 

group were compared with the Combined Reference Data Set using the two sample Z test 

for means. 

Weighted univariate regression analysis was conducted to examine the association 

between log transformed serum dioxin TEQ level (log10 TEQ) and age of the participants, 

year first lived in parish, fish consumption, gender, smoking, race, potential occupational 

exposure, and pesticide usage of the participants independently. Analyses were 

performed using techniques that incorporated sampling weights and design features of the 

study. 

Linear weighted multiple regression analysis was conducted with parish being the 

main exposure variable in the model and Adjusted Wald F tests were used to compare 

means levels among the variables examined in the univariate analysis. We performed all 

regression analyses after adjustment for age, year first lived in parish, fish consumption, 

gender, smoking, race, potential occupational exposure, and pesticide usage of the 

participants. 

16 
Because race remained significant in the final reduced model, stratified univariate 

and multiple regression analysis by race were performed to examine the association 

between the log10 TEQ and all the other covariates. 

RESULTS 

Participation 

Following the random selection of block clusters, 2,239 households in Calcasieu 

Parish and 785 households in Lafayette Parish were identified to be canvassed during the 

household enumeration phase of the investigation. Of these, 1,963 (87.7%) in Calcasieu 

and 565 (72%) in Lafayette were enumerated. From that enumeration, 606 people in 

Calcasieu, and 264 people in Lafayette were found to be eligible for the study. From this 

pool of eligible subjects, 307 (50.7%) people in Calcasieu and 125 (47.3%) people in 

Lafayette agreed to participate in the study. Blood samples were collected from 423 

people—300 in Calcasieu and 123 in Lafayette. Blood samples with quantities sufficient 

for laboratory analysis were available for 415 participants—295 people in Calcasieu and 

120 people in Lafayette. 

Comparison Between Parishes. Questionnaires were completed by 432 

participants. Their ages ranged from 15 through 91 years in Calcasieu Parish and 15 

through 84 years in Lafayette Parish. Participants in the two areas were similar in most 

characteristics. Calcasieu participants had greater potential occupational exposure to 

dioxin and ate locally caught fish. A greater proportion of participants who lived in 

Lafayette had moved into the parish since 1981 (Table 1). 

Dioxin TEQ levels ranged from 2 ppt to 97 ppt in Calcasieu Parish and 2.2 ppt to 

146 ppt in Lafayette Parish (Figure 2). Participants from both parishes had similar mean 

dioxin TEQ levels (Table 2). When the Calcasieu area was divided into three areas 

(industrial corridor, industrial buffer, and outer ring) (Figure 1), the mean dioxin TEQ 

levels among persons in these three areas were similar to each other and to Lafayette 

residents. Dioxin TEQ levels increased with age in both parishes. Mean dioxin TEQ 

levels were similar among persons in both parishes when stratified by age, gender, length 

of residence, fish consumption, occupational exposure, or pesticide usage. African 

Americans in Lafayette Parish showed significantly higher mean dioxin TEQ levels than 

whites in Lafayette Parish and African Americans in Calcasieu Parish. Mean dioxin TEQ 

levels were similar for whites in both parishes. When stratified by past smoking history, 

persons in both parishes had similar mean dioxin TEQ levels. However, current smokers 

in Calcasieu Parish had significantly higher mean dioxin TEQ levels than current 

smokers in Lafayette Parish. Dioxin TEQ levels were similar among persons in both 

Calcasieu and Lafayette Parishes when stratified by consumption of gar, crab, and 

crawfish, locally caught or raised meat, or locally raised fruits, vegetables, and eggs (data 

not shown). The mean dioxin TEQ was significantly higher among Lafayette residents 

compared to that of Calcasieu residents for those who ever ate locally caught catfish 

(23.9 ppt and 19.2 ppt, respectively, p=0.005) and for those who ever ate locally caught 

flounder (30.1 ppt and 21.3 ppt, respectively, p=0.006). 

17 
Regression Analyses. In weighted univariate regression analysis, age of the 

participants and year first lived in parish had a significant impact upon serum dioxin TEQ 

level (log10 TEQ) (P < 0.001). Age of the participants explained 48% of the variation 

independently; year first lived in parish explained 23% of the total variation. Parish did 

not significantly impact log10 TEQ. 

Using weighted multiple regression analysis with parish being the main exposure 

variable in the model, we found no significant difference of log10 TEQ between Calcasieu 

and Lafayette after controlling for age of the participants, year first lived in parish, fish 

consumption, gender, smoking, potential occupational exposure, and pesticide usage by 

the participants. Furthermore, in the final model, we found that age of the participants, 

race, year first lived in parish were significant covariates. The multivariate model 

explained about 52% of the total variation. 

We also conducted separate multivariate analyses for African Americans and 

whites. In the weighted multiple regression analysis among African Americans, the 

difference of log10 TEQ between parishes was significant (i.e., dioxin TEQ higher in 

Lafayette than Calcasieu in the group) after controlling for age of the participants, year 

first lived in parish, fish consumption, gender, smoking, potential occupational exposure, 

and pesticide usage by the participants. Finally, we found that age of participants, year 

first lived in parish, potential occupational exposure, and the interaction between 

occupational exposure and parishes were significant covariates in the final African 

Americans-only model. This model explained about 77% of the total variation in serum 

dioxin TEQ for African Americans. 

In the multivariate analysis for whites only, the difference of log10 TEQ between 

parishes was not statistically significant after controlling for age of the participants, year 

first lived in parish, fish consumption, gender, smoking, potential occupational exposure, 

and pesticide usage by the participants. Moreover, we found that age of the participants, 

year first lived in parish, fish consumption, and potential occupational exposure were 

significant covariates in the final whites-only model. This model explained about 51% of 

the total variation in serum dioxin TEQ for whites. 

Comparison With Combined Data Set. Table 3 presents the mean serum dioxin 

TEQs by age groups for a combined reference data set of unexposed persons from several 

serum dioxin studies in the United States. There was no overall difference between the 

mean serum dioxin TEQs for the Parishes and this combined data set (Table 3). However, 

mean serum TEQs for the youngest age group, age 15–29, were lower in both Calcasieu 

Parish and Lafayette Parish compared to the combined reference data set. In the oldest 

age group available for comparison, age 60–68 years, dioxin TEQ concentrations were 

slightly, but not significantly, higher in the parishes compared to the combined data set. 

Comparison of Congener Profiles. In order to describe a congener profile for 

each parish, the percent of congener contribution to total TEQ is presented in Figure 3. 

The congener profiles between the two parishes were similar, with PCDDs accounting for 

more than 70% of total TEQ. Congener concentrations were also compared to NCEH 

laboratory comparison range of means (Needham et al. 1996) (Figure 4). Congener 

concentrations in the parishes were within most of the available NCEH comparison 

ranges. However, overall concentrations for both parishes were slightly below the lower 

end of the comparison range of means for 123678D, 1234678D, and OCDD. 

18 
Concentrations of co-planar PCBs (3445P, 33445P, 334455P) also appeared to be lower 

in Calcasieu and Lafayette Parish. 

DISCUSSION 

This investigation set out to compare serum dioxin levels of Calcasieu Parish 

residents to those of people who live in a similar parish with a lower amount of industrial 

activity. Results indicated that dioxin levels are similar in both parishes and that both 

parishes have levels similar to a combined data set used to give a “best estimate” of 

dioxin levels among unexposed persons. A few study participants in both Calcasieu 

Parish (maximum serum TEQ value = 97 ppt) and Lafayette Parish (maximum serum 

TEQ value = 146 ppt) had high dioxin levels. However, no overall differences existed 

between the two parishes and the comparison data set. 

This investigation also set out to determine any current exposure to unusual 

sources of dioxin. Analysis of younger persons in Calcasieu, 15–29 years of age, 

compared to Lafayette and the combined data set, indicated that people in Calcasieu 

Parish are not currently being exposed to unusual sources of dioxin. 

This study was not designed to determine the reason why some people in 

Calcasieu and Lafayette Parishes have dioxin TEQ levels higher than the reference range. 

Some factors which might be related to higher dioxin levels include recent weight loss or 

illness, different food consumption patterns, or individual differences in uptake and 

elimination of dioxin. Further study of these factors is necessary to determine their 

relative contribution to serum dioxin levels. 

Analysis showed that African Americans in Lafayette Parish had significantly 

higher dioxin levels than African Americans in Calcasieu Parish or whites in Lafayette 

Parish. The difference in mean serum dioxin TEQ between African Americans in 

Lafayette Parish and African Americans in Calcasieu remained significant after 

controlling for confounders in a multiple regression analysis. Race has not been indicated 

as a predictive factor in serum dioxin levels in other studies, but few studies have 

evaluated this factor. The relationship of race to dioxin level should be further studied. 

Dioxin, a by-product of industrialization, began to increase in the environment in 

the early 1900s and peaked in the 1960s and 1970s. Environmental controls initiated in 

the 1970s have resulted in a decrease in the industrial release of dioxin. However, most 

people are still exposed to some amount of dioxin primarily through eating fish, meat, 

and dairy products. When compared with the NCEH congener-specific reference ranges, 

the Calcasieu and Lafayette residents had lower values for some congeners, particularly 

the coplanar PCBs. The lower values were not unexpected because the congener-specific 

reference ranges used by NCEH were from an earlier period to compare with a fisheating population in the Great Lakes region (Needham et al. 1996). Some of the 

congener-specific reference ranges were higher than levels observed for Calcasieu or 

Lafayette residents possibly because the reference ranges were based on data that may 

have been collected a decade prior to the Calcasieu study. Thus, the differences could 

reflect the reductions in dioxin body burden observed in the general population over time 

(Aylward and Hays 2002, Lorber 2002). Nevertheless, the congener pattern, or profile, 

19 
observed among Calcasieu Parish residents was similar to that observed in Lafayette 

Parish residents. 

Levels of dioxin seen in Calcasieu and Lafayette, even the highest levels, would 

not be considered to result in the most common health effects associated with dioxin 

exposure: chloracne and liver effects. Other health effects associated with dioxin 

exposure have generally been associated with higher levels of dioxin burden. However, 

this study evaluated serum dioxin levels at one point in time; levels of past exposure as 

well as the risk for health effects associated with those exposures are unknown. 

Study Strengths 

This was a scientifically-based study which also benefited from strong community 

input and involvement. The Calcasieu study represented the challenge of developing and 

implementing a study which would withstand scientific scrutiny while simultaneously 

assuring a study which would answer the questions and concerns of the community. To 

ensure community input, the Calcasieu Community Dioxin Study Work Group was 

formed. Approximately 17 Calcasieu Parish community members were in this work 

group which represented different geographic areas and environmental groups within 

Calcasieu Parish. The Community Work Group members met frequently with the 

principal investigator and other study collaborators to assure community involvement in 

the study design, to assist in the development of the protocol for the study, and to stay 

abreast of the progress of the study. Members assisted in the development of the study by 

indicating what they wished to learn from the study, voicing concerns about the study 

design, and problem solving. Members were educated on the advantages and 

disadvantages of different study designs. By working together with the community work 

group, we were able to develop a study which answered the community’s concerns while 

maintaining high scientific standards. 

Another strength of this study was that it employed a population-based sample, an 

unexposed population-based comparison population, and a large sample size which 

allowed stratification by age and proximity to industry. We collected information on the 

participants’ individual characteristics, including age, consumption of locally caught and 

raised food, potential occupational and environmental exposure, geographic location, and 

individual congener data. 

This study also benefited from the strong quality assurance and quality control 

procedures utilized by the NCEH laboratory and the availability of reference comparison 

values for dioxin TEQ and dioxin congener concentrations. Though the combined data 

set reference cannot be considered representative of the U.S. population, it does include 

dioxin data from unexposed persons in different states. These data were available from 

previous ATSDR and NCEH studies and allowed for an external comparison of study 

findings with national data, regardless of the overall lack of difference in mean serum 

dioxin TEQ between the two parishes. 

Study Limitations 

20 
One limitation of the study was that only 50 mL of whole blood was collected for 

dioxin analysis. Although this amount of blood was chosen because it was thought to be 

sufficient for dioxin analysis and would not be a burden on study participants, a larger 

quantity would have provided more serum for analysis and thus lower detection limits 

and fewer nondetects. We estimated the results for nondetects by using a recognized 

method of substituting one half of the detection limit for nondetect results, but fewer 

nondetect levels would have given a more precise determination of each congener level 

and of the TEQ for each study participant. 

Another limitation of the study was that information regarding weight change and 

body mass index (BMI) was not included in the questionnaire. In the body, dioxin is 

found in the blood and in body fat. When weight is stable, a person’s dioxin body burden 

is divided between the blood and the body fat (called partitioning). Total dioxin body 

burden is represented by the dioxin in blood. However, when weight is gained or lost, the 

concentration of dioxin in blood and adipose tissue changes. Current and historical 

information on these parameters may have assisted in the interpretation of the dioxin 

data. 

Finally, we collected self-reported information about consumption of locally 

caught or raised food. Additional questions regarding consumption of all food sources 

would have allowed for more detailed analysis. Measurement of dioxin in these foods 

would also give an indication of the contribution of food on the body burden of dioxin. 

EPA estimates that more than 90% of the dioxin in humans comes from food sources, 

especially meat, fish, and dairy products. This study could not identify strong factors in 

overall food consumption patterns which might have helped to explain the higher dioxin 

levels observed in some participants. 

CONCLUSIONS 

1.	 Overall, people who live in Calcasieu Parish had similar mean serum dioxin TEQ 

levels as people who live in Lafayette Parish. 

2.	 African Americans who live in Lafayette Parish had significantly higher mean 

dioxin TEQ levels when compared to those of whites in Lafayette Parish and 

African Americans in Calcasieu Parish. 

3.	 Dioxin levels in both parishes increased with age and length of residence. 

4.	 Persons in Calcasieu and Lafayette Parishes age 68 years and younger had similar 

mean serum dioxin TEQ to a combined data set developed to give a best estimate 

of dioxin level in persons not unusually exposed to dioxin. 

5.	 Serum dioxin TEQ levels were not elevated among the youngest age group 

evaluated (ages 15 to 29 years) in either Calcasieu Parish or Lafayette Parish 

when compared with external comparison data. Although not conclusive, these 

data suggest no unusual current dioxin exposures among the populations in these 

areas. 

21 
6. The dioxin congener profile in Calcasieu Parish is similar to that in Lafayette 

Parish. 

RECOMMENDATIONS 

1.	 Future studies of dioxin exposure should collect information on body mass index, 

individual weight change, and detailed food consumption patterns. 

2.	 The contribution of race to dioxin level should be further explored in any future 

population-based studies of serum dioxin. 

22 
AUTHORS AND ACKNOWLEDGEMENTS 

Authors: 

Alden Henderson, PhD, MPH 

Roberta Hilsdon 

M. Deborah Millette, MPH 

Curtis Noonan, PhD 

Mohammed Uddin, MD, MPH 

Lee Yang-Wong, MS 

Acknowledgements: 

The Calcasieu Community Dioxin Study Work Group 

Harold Areno Kathy Landry Lee Sherman 

Charlie Atherton Betty Larce Peggie Sullivan 

Dagmar Darjean Lois Booker Malvo Jerome Summers 

Nona Harris Caroline Peters Michael Tritico 

Pat Hartman Debra Ramirez Bobbie White 

Barrett Landry Junus Reado Sr. 

Agency for Toxic Substances and Disease Registry 

Sylvia Allen-Lewis Jennifer Lyke Jason Saunter 

Lafreta Dalton Melissa Massaro Kathy Skipper 

Steve Dearwent Elaine McEachern Judy Smith 

Danielle DeVoney Ketna Mistry Francisco Tomei-Torres 

Yolonda Freeman Ken Orloff Rueben Warren 

John Holland George Pettigrew Lynn Wilder 

Michael Lewin Hana Pohl Greg Zarus 

National Center for Environmental Health, Centers for Disease Control and Prevention 

Charles Dodson Don Patterson 

Larry Needham Wayman Turner 

Louisiana Department of Health and Hospitals, Office of Public Health, Section of 

Epidemiology and Environmental Toxicology 

National Opinion Research Center (NORC) 

23 
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Health Resources and Services Administration. 2001. Community health status report, 

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polychlorinated dibenzofurans. Vol. 69. Lyon, France: WHO International Agency for 

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Longnecker MP, Daniels JL. 2001. Environmental contaminants as etiologic factors for 

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Longnecker MP, Michalek JE. 2000. Serum dioxin level in relation to diabetes mellitus 

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11(1):44–8. 

Lorber M. 2002. A pharmacokinetic model for estimating exposure of Americans to 

dioxin-like compounds in the past, present, and future. Sci Total Environ 288:81–95. 

Louisiana Department of Environmental Quality. 2000. Toxic release inventory. 

Available from: URL: 

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19(4):A367–71. 

26 
T A B L E S


27 
Table 1. Demographic and Other Characteristics of Participants from Calcasieu and Lafayette 

Characteristic 

Sex

 Male

 Female 

Age (years)

 15–29

 30–44

 45–59

 >60

Race

 White

 African-Americans 

Ate Locally Caught Fish (ever) 

Yes

 No 

Ate Locally Caught Fish (past year)

 Yes

 No 

Year Moved to Parish

 1981+

 1961–1980

 1941–1960

 1900–1940 

Occupational Exposure to Dioxin

 Yes

 No

Use Pesticides

 Yes

 No 

Ever Smoked

 Yes

 No 

Currently Smoke 

Yes

 No

Smoked in past 5 years

 Yes

 No 

Parishes 

Calcasieu 

(n=295) 

140


155


 76


 70


 80


 69


263


 28


258


 32


181


 70


113


 96


 70


 16


 68


227


254


 40


180


115


 82


 27


109


 71


Lafayette 

(n=120) 

50


 70


26


 31


 31


 32


108


 10


56


 53


 38


 15


67


 29


 18


 6


 12


108


109


 10


71


 49


27


 11


38


 33


_2 (p-value) 

2.68 (0.11) 

1.93 (0.59) 

0.98 (0.33) 

13.6 (0.00) 

0.18 (0.67) 

11.7 (0.01) 

5.93 (0.02) 

2.66 (0.11) 

2.62 (0.11) 

0.32 (0.57) 

1.56 (0.21) 

28

Table 2. Mean Serum Dioxin TEQ Levels (ppt) by Demographic and Other Characteristics 

Calcasieu Parish Industrial Industrial Outer Calcasieu Parish: 3 Calcasieu Lafayette p-value* 

Corridor Buffer Ring Sections Combined (n=120) 

(n=142) (n=122) (n=31) (n=295) 

 Male Sex

19.7 15.7 19.1 16.7 20.5 0.24 Female 19.3 25.8 15.9 23.0 20.1 0.21 

 15-29 Age (years)

9.6 8.0 9.0 8.4 7.5 0.34 30-44

11.2 15.4 13.4 14.3 14.7 0.91 45-5920.8 19.3 21.9 19.7 19.8 0.96 

>60 

32.7 41.0 25.8 36.9 42.4 0.42 

 White Race

20.2 20.9 16.1 20.2 18.6 0.58 African-Americans 13.3 17.5 14.5 16.9 38.0 0.001 

 Yes Ate Locally Caught Fish (ever)

19.3 19.6 17.1 19.2 20.4 0.46 No 20.4 25.1 18.6 23.2 20.2 0.41 

 Yes Ate Locally Caught Fish (past year)

18.0 20.3 17.1 19.6 18.0 0.52 No 20.1 16.7 17.3 17.7 30.8 0.20 

 1981+ Year Moved to Parish

11.4 18.6 19.0 17.4 16.0 0.60 1961-198019.9 16.4 12.1 16.5 19.1 0.39 1941-196019.0 23.5 22.6 23.6 26.2 0.51 1900-1940 35.5 50.6 33.1 44.9 69.2 0.38 

 Yes Occupational Exposure to Dioxin

22.9 19.6 19.0 20.2 19.5 0.73 No 18.5 20.4 16.6 19.6 20.4 0.65 

 Yes Use Pesticides

20.4 19.7 17.3 19.6 20.5 0.48 No 12.4 22.3 16.8 20.3 19.0 0.88 

 Yes Ever Smoked

18.0 19.5 15.4 18.8 18.8 0.99 No 21.5 22.0 19.7 21.6 22.5 0.79 

 Yes Currently Smoke

16.7 17.3 12.2 16.8 12.9 0.05 No 13.9 12.7 12.8 13.0 17.3 0.62 

Overall mean serum dioxin TEQ (ppt) 19.5 20.1 17.2 19.7 20.3 0.71

 * T test comparing mean serum TEQ levels between Calcasieu Parish and Lafayette Parish. 

29 
Table 3. Mean Serum Dioxin TEQ Levels (ppt) by Age (years) for Calcasieu Parish, 

Lafayette Parish, and the Combined Reference Data Set* 

Age Combined Calcasieu p-value† Lafayette p-value‡

(years) Reference Data Set Parish Parish 

(n=214) (n=295) (n=120) 

15–29 14.3 8.4 0.0001 7.5 0.0001

 30–44 15.4 14.3 0.8575 14.7 0.5958

 45–59 18.5 19.8 0.6745 19.8 0.3007

 60–68 27.5 30.7 0.7980 31.7 0.9064

 >69 -- 46.9 -- 51.3 -­

*

Dioxin 2004, September 2004, Berlin, Germany

 †Z test comparing mean serum TEQ levels between Calcasieu Parish and the Combined 

Reference Data Set

 ‡Z test comparing mean serum TEQ levels between Lafayette Parish and the Combined 

Reference Data Set 

30 
F I G U R E S


31 
32

IndustrialCorridor 

IndustrialBuffer 

Figure 1. Location of Calcasieu and Lafayette Parishes

LOUISIANA 

Lafayette Parish 

Calcasieu Parish

Dequincy 

Iowa 

Vinton 

33
34

Figure 2. Distribution of Serum Dioxin TEQ by Parish

0

10

20

30

40

50

60

70

1 3 5 7 9 11 13 15 17 19 21 Dioxin TEQ (ppt)

Number of People

Calcasieu

Lafayette
2378D

12378D

123478D123678D123789D

1234678D1234679D 

OCDD 2378F

12378F23478F

123478F123678F123789F234678F

1234678F1234789F 

OCDF 3344P 3445P

33445P

334455P 

Figure 3. Congener Contribution to Total TEQ in Calcasieu and Lafayette Parishes 

40% 

35% 

Calcasieu 

30% Lafayette 

25% 

20% 

15% 

10% 

5% 

0% 

Percent of TEQ 

Dioxin-like Congener 

35 
2378D

12378D

123478D123678D123789D

1234678D1234679D

OCDD 

2378F

12378F23478F

123478F123678F123789F234678F

1234678F1234789F 

OCDF 3344P 3445P

33445P

334455P 

Figure 4. Mean Congener Concentration Levels (ppt) in Calcasieu, Lafayette, and a National 

Centers for Environmental Health Laboratory Comparison Range of Means 

1000 

Calcasieu 

Lafayette 

Laboratory - lowest means 

Laboratory - highest means 

100 

10 

1 

Parts Per Trillion 

Dioxin-like Congener 

36 
APPENDICIES


A. Letters of Introduction for Census 

a.	 Community Members 

b.	 Community Authorities 

c.	 Physicians 

B. Household Census Scripts and Questionnaire 

C. Letter to Persons Eligible for Study

 Letter for “Difficult-to-Reach” Eligibles 

D. Eligibility Scripts and Questionnaire 

a.	 Calcasieu Minor 

b.	 Calcasieu Adult 

c.	 Lafayette Minor 

d.	 Lafayette Adult 

E.	 Informed Consent Documents 

a.	 Adult Consent to Be in a Health Study 

b.	 Parental Consent for Your Child age 15 to 17 to be in a Health Study 

c.	 Youth age 15 - 17 Assent to Be in a Health Study 

F.	 Investigation Questionnaire 

G. Dioxin Specimen Preparation and Shipping 

H. Health Education Materials 

a.	 Household Listing Brochure 

b.	 Study Fact Sheet for Eligible Residents 

c.	 Study Fact Sheet for Community Members 

d.	 Health Profession Study Fact Sheet 

I.	 Results Letter to Participants 

Dioxin Fact Sheet 

J.	 Specification of the design setup structure, the stratum variable, and the primary sampling 

unit for the SUDAAN programming 

37 
Appendix A


A Letter of Introduction for Census and A Letter to Community Authorities


38


CalcasieuFINAL.doc, 12/1

Agency for Toxic Substances and Disease Registry


U.S. Department of Health and Human Services


Atlanta, Georgia 30333


December, 2001 

Dear Resident: 

The Agency for Toxic Substances and Disease Registry, also known as ATSDR, is conducting a 

health study in your parish. ATSDR is a federal health agency which is part of the Public Health 

Service. We will be looking at some chemical substances in people living in Calcasieu and 

Lafayette parishes in Louisiana. The chemical substances that we will look at are called dioxins 

and volatile organic compounds. This research will help us learn more about differences in the 

levels of these substances in people who live in the parish. 

ATSDR is conducting this study in collaboration with the National Opinion Research Center 

(NORC). NORC is a non-profit research center affiliated with the University of Chicago that has 

been conducting research in the public interest for over 50 years. As part of the health study, we 

need to get a list of everyone living in your area. In the next few weeks, a representative of 

NORC will come to your home to ask you the names of the people who live in your home, their 

ages and how long they’ve lived in the parish. Gathering this information is a very important step 

in the study. 

Interviewers from NORC will have identification badges and will not ask to come into your 

home. If you have any questions about the interviewers or what they are doing, you may call 1­

866-835-6672. 

We would very much like your help with this study but giving this information is 

completely voluntary. All information which you give us will be kept confidential. 

ATSDR and NORC recognize that you may have concerns about this study. If you have 

questions about the interviewers, the study, or medical or technical questions about dioxin and 

volatile organic compounds please call NORC toll free at 1-866-835-6672. We welcome the 

opportunity to discuss any concerns with you. 

We have enclosed a brochure about the study. We hope you will help us with this research 

project. Someone will be visiting you soon. 

Sincerely, 

M. Deborah Millette, MPH 

Epidemiologist 

Agency for Toxic Substances and Disease Registry 

39 

CalcasieuFINAL.doc, 12/1 
January 2002 

Dear Community Authority: 

The National Opinion Research Center (NORC) at the University of Chicago is undertaking an 

important study in Calcasieu and Lafayette Parishes on behalf of the Agency for Toxic 

Substances and Disease Registry (ATSDR). The study is designed to determine exposure to 

Dioxin and Volatile Organic Compounds. 

Some households in your area have been selected as part of the sample for this study. During 

January and February, NORC interviewers will contact selected households in your community. 

Interviewers will visit pre-selected households, explain the study to an adult and, after informed 

consent has been obtained, list the individuals who live there. Since residents are frequently 

concerned about security and safety, we wanted to inform your organization of this research 

project and alert you that our interviewers will be present in your community. On other research 

projects we have found that some of those selected to be interviewed may call organizations such 

as yours for information about our presence. 

Be assured that participation in this study by your residents is completely voluntary and that our 

interviewers will adhere to the strictest professional standards. Our interviewers will be wearing 

photo identification badges which state that they are NORC representatives. The interviewers 

are trained professionals who have signed legally binding pledges of confidentiality. 

NORC is one of the oldest and most prestigious social science research organizations in the 

nation. NORC has been conducting nationwide studies for over 59 years, during which we have 

earned a reputation for research that is scientifically sound and socially worthwhile. 

If you have any questions or would like more information on the study or NORC, please call me 

toll-free at 1-866-835-6672. 

Sincerely, 

Official NORC Person 

Official NORC Person’s Title 

40 

CalcasieuFINAL.doc, 12/1 
Dear Doctor, 

The Agency for Toxic Substances and Disease (ATSDR) is conducting a study of chemical 

exposure in your community. ATSDR is a federal health agency which is part of the U.S. Public 

Health Service. We will be looking at several chemical substances, dioxins and volatile organic 

compounds, in people living in Calcasieu and Lafayette parishes, Louisiana. 

Participants will be chosen at random, therefore, the first step in the study will be to complete a 

household listing in selected census blocks in the parish. Since some of the residents may be 

your patients, we wanted to apprise you of the study in case you receive inquiries from your 

patients. We also want to assure you that participation in this study by your patients is 

completely voluntary and that our National Opinion Research Center (NORC) interviewers will 

adhere to the strictest professional standards. 

We will conduct a public meetings in Calcasieu and Lafayette Parishes at the following times 

and places to explain the study. 

Tuesday, January 15th, 2002 at 7:00 PM at the Lake Charles Civic Center, and 

Thursday, January 17th, 2002 at 7:00 PM at the Holiday Inn Holidome, Lafayette 

I am including the advance letter and a brochure which will go to those persons living in census 

blocks selected for study. If you have any questions, or want additional information on the 

study, please do not hesitate to contact me. 

Thank you for your time. 

Sincerely, 

M. Deborah Millette, MPH 

Epidemiologist 

Agency for Toxic Substances and Disease Registry 

Division of Health Studies 

Health Investigations Branch 

404-498-0563 - Direct Line 

888-422-8737- Toll-free line 

41 

CalcasieuFINAL.doc, 12/1 
Appendix B 

Household Census Scripts and Questionnaires 

The questionnaire for both parishes is the same, except that in Lafayette Parish, the subject is 

asked if he/she EVER lived in Calcasieu Parish. For the comparison population “ever living in 

Calcasieu” is a disqualifier. The questionnaire used in Calcasieu Parish is presented here. 

42 

CalcasieuFINAL.doc, 12/1 
Interviewer ID: 

Case ID: [PLACE STICKER HERE] 

Script for Household Listing--Calcasieu Parish 

Hello, my name is (INTERVIEWER’S NAME). I’m here on behalf of the Agency for Toxic 

Substances and Disease Registry. ATSDR is a federal health agency and is part of the Public Health 

Service. ATSDR is conducting a health study in your parish. As part of the health study, we want to 

get a list of everyone living in your area. May I speak to the head of the household or an adult 

member, please? 

YES ∫ WHEN SPEAKING TO ADULT, CONTINUE OR IF ANOTHER PERSON COMES 

TO DOOR, REPEAT INTRODUCTION ABOVE THEN CONTINUE. 

NO ∫ When is a good time to come back and speak with an adult? 

DAY OF WEEK: Mon Tues Wed Thurs Fri Sat Sun 

DATE: ______/_______/__2002__ 

TIME: ______:______ AM/PM 

IF REFUSE, GO TO Q3A. 

ATSDR is conducting a health study in your area to tell us more about exposure to dioxin and 

volatile organic compounds in Calcasieu and Lafayette Parish. 

Q1. A few days ago you should have received a letter from us telling you that we are conducting a 

household listing in your parish and that we would visit you. Did you receive this letter? 

1 Yes ∫ SKIP TO Q2 

2 No 

Q1A.	 The letter explained that we want to get a list of everyone living in your area to see who 

is eligible for the study. Would you like me to read this letter to you? (IF YES, READ 

LETTER AND THEN CONTINUE WITH Q2. IF NO, CONTINUE WITH Q2). 

Q2. To see who should be asked to take part in this testing program, we need to ask a few questions 

about people living in your household. You will be asked mainly about the names, age, 

and gender of people who live in your household. The interview will take about 10 

minutes. 

VERBAL CONSENT 

43 

CalcasieuFINAL.doc, 12/1 
__________________________________________________________ 

Before we start, I want to let you know that your participation is voluntary. You have the right to 

refuse to answer any question at any time. All data will be kept private to the extent permitted by 

law. No data that identifies you or your place of residence will be included in any report. If you 

have questions about the study or about your rights should you decide to participate in the study, I 

have some phone numbers you can call. Would you like these numbers? 

YES ∫ You can call my supervisor at NORC or get more information about the study by calling 

NORC toll-free at 1-866-835-6672. This phone number is included in the letter and 

brochure you received earlier/that I just gave you. 

NO ∫ CONTINUE WITH Q3 

Q3: Do you agree to answer my questions? 

1 Yes ∫ SKIP TO Q4 

2 No 

Q3A. May I ask why you do not wish to participate? 

1 Too busy 

2 Not interested 

3 Confidentiality concerns 

4 Information too personal 

5 Need more information about study 

6 Other (specify):______________________________________________ 

ATTEMPT TO SET AN APPOINTMENT DATE AND TIME FOR FUTURE VISIT. IF 

SUCCESSFUL, RECORD DAY, DATE AND TIME ON PAGE 1 AND CONTINUE. IF 

RESPONDENT STILL REFUSES TO PARTICIPATE, THANK THE RESPONDENT. IF THE 

ADDRESS INFORMATION IS READILY AVAILABLE, FILL IN Q4 AND END VISIT. 

Q4: I would like to confirm that I am at the correct address. What is the 

complete address of this household unit? 

Address Line 1: ___________________________________________________


Line 2 (Apt #, Lot #): _________________________________________________


City __________________________________________


State __________ Zip Code _____________________


Q5: What is the correct telephone number of this household unit? 

Primary telephone number: _____ - _____ - ______ 

Page 44 
Secondary phone number (if avail): _____ - _____ - ______ 

Page 45

n order for us to scientifically select a respondent who may be able to take part in this study, I will need to list all members of your household, 

starting with yourself. 

Q6: THE FOLLOWING QUESTIONS WILL BE REPEATED FOR EACH MEMBER OF THE HOUSEHOLD: 

other persons living in this household? What is your full name?/ What are the names of all the 

his/her 

What is 

age? 

relationship to you? What is his/her 

gender? his/her What is 

5 years? for the last Calcasieu lived in Has he/she 

Last name First name Middle name 

Respondent 1 15-29 

2 30-44 3 45-59 4 60 + 

1 Self 

F M 

NO YES 

Resident #2 Name 1 15-29 

2 30-44 3 45-59 4 60 + 

2 Wife/Husband 3 Son/Daughter 4 Mother/Father 5 Brother/Sister 6 Grandparent 7 Aunt/Uncle 8 Partner 9 Other: ____________ 

F M 

NO YES 

Page 46 
Last name 

this household? What are the names of all the other persons living in 

Middle name 

his/her 

What is 

age? 

relationship to you? What is his/her 

gender? his/her What is 

5 years? for the last Calcasieu lived in Has he/she 

Resident #3 Name 1 15-29 2 Wife/Husband M YES 

2 30-44 3 Son/Daughter
3 45-59
 4 Mother/Father F NO 4 60 + 5 Brother/Sister 

6 Grandparent 7 Aunt/Uncle 8 Partner 9 Other: ____________ 

Resident #4 Name 1 15-29 2 Wife/Husband M YES 

2 30-44 3 Son/Daughter
3 45-59
 4 Mother/Father F NO 4 60 + 5 Brother/Sister 

6 Grandparent 7 Aunt/Uncle 8 Partner 9 Other: ____________ 

Resident #5 Name 1 15-29 2 Wife/Husband 

First name 

M YES 

2 30-44 3 Son/Daughter
3 45-59
 4 Mother/Father F NO 4 60 + 5 Brother/Sister 

6 Grandparent 7 Aunt/Uncle 8 Partner 9 Other: ____________ 

Page 47 
Resident #6 Name 1 15-29 

2 30-44 3 45-59 4 60 + 

2 Wife/Husband 3 Son/Daughter 4 Mother/Father 5 Brother/Sister 6 Grandparent 7 Aunt/Uncle 8 Partner 9 Other: ____________ 

F M 

NO YES 

Resident #7 Name 1 15-29 

2 30-44 3 45-59 4 60 + 

2 Wife/Husband 3 Son/Daughter 4 Mother/Father 5 Brother/Sister 6 Grandparent 7 Aunt/Uncle 8 Partner 9 Other: ____________ 

F M 

NO YES 

Resident #8 Name 1 15-29 

2 30-44 3 45-59 4 60 + 

2 Wife/Husband 3 Son/Daughter 4 Mother/Father 5 Brother/Sister 6 Grandparent 7 Aunt/Uncle 8 Partner 9 Other: ____________ 

F M 

NO YES 

Last name this household? What are the names of all the other persons living in 

First name Middle name 

his/her 

What is 

age? 

relationship to you? What is his/her 

gender? his/her What is 

5 years? for the last Calcasieu lived in Has he/she 

Page 48 
Resident #9 Name 1 15-29 

2 30-44 3 45-59 4 60 + 

2 Wife/Husband 3 Son/Daughter 4 Mother/Father 5 Brother/Sister 6 Grandparent 7 Aunt/Uncle 8 Partner 9 Other: ____________ 

F M 

NO YES 

Resident #10 Name 1 15-29 

2 30-44 3 45-59 4 60 + 

2 Wife/Husband 3 Son/Daughter 4 Mother/Father 5 Brother/Sister 6 Grandparent 7 Aunt/Uncle 8 Partner 9 Other: ____________ 

F M 

NO YES 

W

NTERVIEWER: VERIFY NAME, AGE, AND GENDER OF EACH HOUSEHOLD MEMBER.


HEN FINISHED, PROBE FOR ADDITIONAL HOUSEHOLD MEMBERS: Have we missed anyone?


Please include any children and babies, and any household members who are currently away traveling, in the hospital, or away on business.
Do not include any students currently living away at school or anyone staying here temporarily who has a usual residence somewhere else. WHEN
FINISHED: Thank you for answering these questions and participating in the household listing. Do you have any questions about the study that I
can answer?
YES ∫ ANSWER QUESTIONS
NO ∫ Thank you again for letting me ask you about your household.


Page 49 
________________________________________________________________________ 

________________________________________________________________________ ________________________________________________________________________ COMMENTS: ________________________________________________________________________


Page 50 
Appendix C


Letter to Persons Eligible for Study and Letter for “Difficult-to-Reach” Eligibles


Page 51

A Letter of Introduction to Persons Eligible for the Study


 Target and Comparison Areas


Agency for Toxic Substances and Disease Registry


U.S. Department of Health and Human Services


Atlanta, Georgia 30333


March, 2002 

Dear (Person’s Name): 

The Agency for Toxic Substances and Disease Registry, also known as ATSDR, is conducting a 

health study in your parish. ATSDR is a federal health agency which is part of the Public Health 

Service. We will be looking at some chemical substances called dioxins and volatile organic 

compounds in people living in Calcasieu and Lafayette parishes. This research will help us learn 

more about differences in the levels of these substances in people who live in the parishes. We 

would like your help to do the second part of the health study. 

ATSDR is conducting this study in collaboration with the National Opinion Research Center 

(NORC). NORC is a non-profit research center affiliated with the University of Chicago that has 

been conducting research in the public interest for over 50 years. You may recall that a NORC 

interviewer came to your home recently to get details about the people who live there. They 

asked some questions and noted some facts about you. From that information we randomly 

picked you as someone who can be a part of this study. We will need 400 people to take part in 

the study. Being in the second part of the study is very important. 

People who are in the second part of the study will be asked to come to our local office. While 

there, a trained interviewer will give you a questionnaire and a health professional will draw 

some blood and ask you for a urine sample. The questionnaire asks some questions about your 

occupation, the foods you eat, and some things with which you may have come in contact. It will 

take about 1-2 hours to do the survey, give a urine sample, and have your blood drawn. 

People who take part in the study will be given $50 for their time and transportation. 

This study is free of charge and entirely voluntary. Facts about you will be kept private to the 

extent allowed by law. Your name and records will be kept in a locked file. They will not be 

used in any reports written about this study. 

We hope you will help us with this research project. Someone will be calling you soon to tell you 

more about the study. Please call the study’s toll-free number at 1-866-835-6672 if you have 

questions about the study. We welcome the opportunity to discuss any concerns with you. 

Sincerely, 

M. Deborah Millette, MPH, Epidemiologist, Agency for Toxic Substances and Disease Registry 

Page 52 
Letter for “Difficult-to-Reach” Eligibles


Target and Comparison Areas


Page 53

Dear 

I am writing to you to ask your help with a health study in Calcasieu and Lafayette parishes. 

You recently received a call from the Agency for Toxic Substances and Disease Registry. You 

may have thought that it was a solicitation but we aren’t selling anything nor are we taking a 

survey. We are a federal public health agency of the U. S. Department of Health and Human 

Services. 

We are conducting a study with 400 participants in Calcasieu and Lafayette parishes. We are 

doing this study because several years ago we found that some people in Calcasieu Parish had 

higher than expected levels of a chemical called dioxin in their blood. We are following up on 

this by measuring levels of dioxin in people in Calcasieu and Lafayette parishes. 

In order for this study to give us a scientific answer, we choose people at random. You might 

remember that several months ago someone in your household answered some questions for us 

about the people who live in your home. From that information, your name was 

selected as a person who might be able to be a part of the study. The people who are asked to be 

in the study represent all the people in Calcasieu and Lafayette parishes. The success of the 

study depends on getting the participation of everyone who was chosen to be in the study. 

I understand that we all get calls and letters from telemarketers and solicitors and it=s hard to 

decide what to pay attention to. I would appreciate your help with this study. I=m including 

some press clippings about the study so that you can see that we really are what we say we are. 

Our interviewers will be trying to call you again in the next week. If you have questions or 

would like to speak to me, please call me at 404-498-0563 or toll-free at 1-888-422-8737. 

If you would be willing to answer some questions to see if you are eligible for the study, please 

call 1-866-835-6672. 

Thank you. 

Respectfully, 

M. Deborah Millette, M.P.H. 

Epidemiologist 

Health Investigations Branch 

Division of Health Studies 

Agency for Toxic Substances and Disease Registry 

Page 54 
Appendix D


Eligibility Scripts and Questionnaires for Adults and Minors in Calcasieu and Lafayette


Parishes


Page 55 
Interviewer ID: 

Person ID: 

Script for Eligibility Questionnaire: Minor 

Calcasieu Parish 

Hello, my name is (INTERVIEWER NAME) and I’m calling on behalf of the Agency for Toxic 

Substances and Disease Registry. May I speak with (the parent or Guardian of RESPONDENT), 

please? 

YES  SKIP TO (Q1) 

NO When is a good time to call back and speak with (the parent or Guardian of 

RESPONDENT)? 

DAY OF WEEK: Mon 

Wed 

Fri 

Tues 

Thurs 

Sat 

Sun 

DATE: ______/_______/__2002__ 

TIME: ______:______ AM/PM 

(Q1) A few days ago you and your child should have received a letter from us telling you that we 

are conducting a health study in Calcasieu Parish and that we might call him/her. I am calling to 

see if he/she might be interested in participating in the study. Did you receive this letter? 

Q1_MR 

YES  CONTINUE WITH (Q2) 

NO  NOLET2 The letter explained he/she was selected to participate in a study we are 

conducting in Calcasieu Parish. Would you like me to read this letter to you? (IF YES, 

READ LETTER AND THEN CONTINUE WITH (Q2). IF NO, CONTINUE WITH 

(Q2). 

(Q2) Participation will involve completing a questionnaire and having some blood drawn from 

his/her arm. If he/she decides to participate, it should take about one to two hours of time. Your 

child must be accompanied by a parent or Guardian. We will schedule a time for you to come to 

our office which is convenient for you. He/she will receive $50 for time and travel. Do you have 

any questions? Q2_MR 

ANSWER QUESTIONS. 

Would it be alright with you for me to talk with your child? I will need to ask him/her some 

additional questions to see if he/she is eligible to be in the study. CONSENT 

PARENT GIVES CONSENT  Yes CHILD IS HOME, 

I may also need to talk with you again after 

speaking with your child to schedule a time that is 

Page 56 
convenient for you and your child to participate. 

SKIP TO (Q2A) 

 Yes Child is NOT home, 

reschedule using INTRO 

 No SKIP TO (Q4A) 

(Q2A) CONTINUE SCRIPT WITH MINOR 

Hello (RESPONDENT), my name is (INTERVIEWER NAME) and I’m calling on behalf of the 

Agency for Toxic Substances and Disease Registry. I just talked to your parent/Guardian and 

he/she said I could talk to you about participating in a health study. 

(Q1A) A few days ago you should have received a letter from us telling you that we are 

conducting a health study in Calcasieu Parish and that we might call you. I am calling to see if 

you might be interested in participating in the study. Did you receive this letter? Q1A_MR 

YES  CONTINUE WITH (Q2A) 

NO  The letter explained that you were selected to participate in a study we are conducting in 

Calcasieu Parish. Would you like me to read this letter to you? (IF YES, READ LETTER 

AND THEN CONTINUE WITH (Q2A). IF NO, CONTINUE WITH (Q2A). 

(Q2A) Participation will involve completing a questionnaire and having some blood drawn from 

your arm. If you decide to participate, it should take about one to two hours of time. You must be 

accompanied by a parent or Guardian to the site office. We will schedule a time for you to come 

to our office which is convenient for you and your parent or Guardian. You will receive $50 for 

time and travel. Do you have any questions? Q2A_MR 

(Q3A) I would like to confirm a few things and then ask you some questions to see if you are 

eligible to be in the study. Before we start, I want to let you know that your participation is 

voluntary. You have the right to refuse to answer any question at any time. All data will be kept 

private to the extent permitted by law. We can not tell your parent(s) or Guardian about your 

answers. No data that identifies you or your place of residence will be included in any report. If 

you have questions about the study or your rights if you take part I have a phone number you can 

call. Would you like this numbers? Q3A_MR 

YES  You can call my supervisor or get more information about the study by calling NORC 

toll-free at 1-866-835-6672. 

NO  CONTINUE 

(Q4A) Are you willing to consider participating at this time? Q4A_MR 

MINOR GIVES CONSENT  Yes GO TO ELIGIBILITY 

QUESTIONNAIRE ON NEXT PAGE 

 No SKIP TO (Q4B) 

Q4B. Thank you for your time. May I ask why you do not wish to participate? Q4B_MR 

1 Too busy 

Page 57 
2 Not interested 

3 Confidentiality concerns 

4 Information too personal 

5 Need more information about study 

6 Don’t want to give blood - afraid of needles 

7 Other (specify):_______Q4B_OTH_______________________________ 

__________________________________________________________ 

ELIGIBILITY SCREENER: CALCASIEU PARISH 

1. Last Name S1_LNAME First Name S1_FNAME Middle Initial 

S1_MNAME 

2. Gender S2_GENDER |___| M 

|___| F 

3. Age S3_AGE 

4. Date of Birth S4_DOBMO, S4_DOBDAY, S4_DOBYR

 |___|___| - |___|___| - |___|___|___|___|

 Month Day Year 

5. Address Line 1: S5_ADDR1_______________________________________________ 

Line 2 (Apt #, Lot #): S5_ADDR2_________ _____________________________________ 

City S5_CITY__________________________________________ 

State 

S5_STATE______ 

Zip Code 

S5_ZIP_________ 

___ 

______ 

6.Telephone Number(s) 

Primary telephone number: S6PHONE1_____ - _____ - ______ 

Secondary phone number (if avail): S6PHONE2_____ - _____ - ______

 What type of line is this number? S6_TLINE____ work ____ cell phone ____ other 

Best time to reach respondent: S6_BTIME ___ ___ : ___ ___ am/pm S6_AMPM 

7. Have you lived in Calcasieu Parish for 

the last 5 years? 

S7_5YRS 

YES NO 

INELIG1 

Ineligible. 

Thank you for your 

time. In order to 

participate in this 

Page 58 
investigation you 

must have lived in 

Calcasieu Parish for 

the last 5 years. 

8. How long have you lived in Calcasieu 

Parish? S8_YRS 

______ Years 

9. Do you have hemophilia or any other blood clotting or 

bleeding disorder? 

S9_HEMO 

YES →

Ineligibl 

e 

NO 

10. Have you received chemotherapy in the past 6 weeks? 

S10_CHEMO 

YES →

Ineligibl 

e 

NO 

11. Do you weigh less than 95 pounds? 

S11_WGH 

YES →

Ineligibl 

e 

NO 

12. Have you lost more than 15 lbs. In the last year? 

S12_LOST 

YES →

Ineligibl 

e 

NO 

For Women Only 

13. Are you currently pregnant? 

S13_PREG 

YES →

Ineligibl 

e 

NO 

14. Have you breast fed a child in the last 6 months? 

S14_BFED 

YES →

Ineligibl 

e 

Thank 

you for 

your 

time. In 

order to 

participat 

e in this 

investiga 

tion you 

must be 

eligible 

to give a 

blood 

sample. 

Your 

“Yes” 

answer 

makes 

you 

ineligible 

to give 

blood. 

INELIG2 

NO

 For All Respondents 

15. You are eligible to be in the study. Would Yes No I need more 

you be willing to consider participating in the information. 

tests for dioxin and volatile organic compounds 

by completing a questionnaire and having some Schedule Skip to Schedule 

blood drawn from your arm? S15_INT Appointment Q5 follow-up call. 

INFORM PARENT/GUARDIAN THAT THEY MUST ACCOMPANY MINOR TO THE 

APPOINTMENT. 

Page 59 
______________ _____________________ ______________________ 

______________ _____________________ 

Is R ready to schedule appointment APPTMO 

Thank you very much for your time. 

Appointment scheduled for: 

Date Time Location 

Follow-up call scheduled for:

 Date Time 

Q5. Thank you for your time. May I ask why you do not wish to participate? S16_NOTINT 

1 Too busy 

2 Not interested 

3 Confidentiality concerns 

4 Information too personal 

5 Need more information about study 

6 Don’t want to give blood - afraid of needles 

7 Other (specify):__S16_OTH__________________________________________ 

Page 60 
Interviewer ID: 

Person ID: 

Script for Eligibility Questionnaire: Adult 

Calcasieu Parish 

Hello, my name is (INTERVIEWER NAME) and I’m calling on behalf of the Agency for Toxic 

Substances and Disease Registry. May I speak with (RESPONDENT), please? 

YES  SKIP TO (Q1) 

NO When is a good time to call back and speak with (RESPONDENT)? 

DAY OF WEEK: Mon 

Wed 

Fri 

Tues 

Thurs 

Sat 

Sun 

DATE: ______/_______/__2002__ 

TIME: ______:______ AM/PM 

(Q1) A few days ago you should have received a letter from us telling you that we are 

conducting a health study in Calcasieu Parish and that we might call you. I am calling to see if 

you might be interested in participating in the study. Did you receive this letter? Q1_AD 

YES  CONTINUE WITH (Q2) 

NO  NOLET The letter explained that you were selected to participate in a study we are 

conducting in Calcasieu Parish. Would you like me to read this letter to you? (IF YES, 

READ LETTER AND THEN CONTINUE WITH (Q2). IF NO, CONTINUE WITH 

(Q2). 

(Q2) Participation will involve completing a questionnaire and having some blood drawn from 

your arm. If you decide to participate, it should take about one to two, hours of your time. We 

will schedule a time for you to come to our office which is convenient for you. You will receive 

$50 for your time and travel. If you are interested, I will need to ask you some additional 

questions to see if you are eligible to be in the study. Do you have any questions? Q2_AD 

ANSWER QUESTIONS. 

INTERESTED  SKIP TO (Q3) 

NOT INTERESTED  SKIP TO (Q4A) 

(Q3) I would like to confirm a few things and then ask you some questions to see if you are 

eligible to be in the study. Before we start, I want to let you know that your participation is 

voluntary. You have the right to refuse to answer any question at any time. All data will be kept 

private to the extent permitted by law. No data that identifies you or your place of residence will 

be included in any report. If you have questions about the study or your rights if you take part I 

have a phone number you can call. Would you like this number? Q3_AD 

Page 61 
YES  You can call my supervisor or get more information about the study by calling NORC 

toll-free at 1-866-835-6672. 

NO  CONTINUE 

Are you willing to consider participating at this time? Q3A_AD 

YES  GO TO ELIGIBILITY QUESTIONNAIRE ON FOLLOWING PAGE. 

NO  CONTINUE WITH (Q4A) 

Q4A. Thank you for your time. May I ask why you do not wish to participate? Q4A_AD 

1 Too busy 

2 Not interested 

3 Confidentiality concerns 

4 Information too personal 

5 Need more information about study 

6 Don’t want to give blood - afraid of needles 

7 Other (specify):_Q4A_OTH________________________________________ 

Page 62 
ELIGIBILITY SCREENER: CALCASIEU PARISH


1. Last Name S1_LNAME First Name S1_FNAME Middle Initial 

S1_MNAME 

2. Gender S2GENDER |___| M 

|___| F 

3. Age S3_AGE 

4. Date of Birth S4_DOBMO, S4_DOBDAY, S4_DOBYR

 |___|___| - |___|___| - |___|___|___|___|

 Month Day Year 

5. Address Line 1: S5_ADDR1______________________________________________ 

Line 2 (Apt #, Lot #): S5_ADDR2 ______________________________________________ 

City S5_CITY __________________________________________ 

State 

S5_STATE______ 

Zip Code 

S5_ZIP_________ 

____ 

______ 

6.Telephone Number(s) 

Primary telephone number: S6PHONE1_____ - _____ - ______ 

Secondary phone number (if avail): S6PHONE2 _____ - _____ - ______ 

What type of line is this number? S6_TLINE work ____ cell phone ____ other 

Best time to reach respondent: S6_BTIME ___ ___ : ___ ___ am/pm S6_AMPM 

7. Have you lived in Calcasieu Parish for 

the last 5 years? 

S7_5YRS 

YES NO 

INELIG1 

Ineligible. 

Thank you for your 

time. In order to 

participate in this 

investigation you 

must have lived in 

Calcasieu Parish for 

the last 5 years. 

8. How long have you lived in Calcasieu 

Parish? S8_YRS 

______ Years 

Page 63 
9. Do you have hemophilia or any other blood clotting or 

bleeding disorder? 

S9_HEMO 

YES →

Ineligibl 

e 

NO 

10. Have you received chemotherapy in the past 6 weeks? 

S10_CHEMO 

YES →

Ineligibl 

e 

NO 

11. Do you weigh less than 95 pounds? 

S11_WGH 

YES →

Ineligibl 

e 

NO 

12. Have you lost more than 15 lbs. In the last year? 

S12_LOST 

YES →

Ineligibl 

e 

NO 

For Women Only 

13. Are you currently pregnant? 

S13_PREG 

YES →

Ineligibl 

e 

NO 

14. Have you breast fed a child in the last 6 months? 

S14_BFED 

YES →

Ineligibl 

e 

Thank 

you for 

your 

time. In 

order to 

participat 

e in this 

investiga 

tion you 

must be 

eligible 

to give a 

blood 

sample. 

Your 

“Yes” 

answer 

makes 

you 

ineligible 

to give 

blood. 

INELIG2 

NO

 For All Respondents 

15. You are eligible to be in the study. Would Yes No I need more 

you be willing to consider participating in the information. 

tests for dioxin and volatile organic compounds 

by completing a questionnaire and having some Schedule Skip to Schedule 

blood drawn from your arm? S15_INT Appointment Q5 follow-up call. 

Is R ready to schedule appointment APPTMO 

Thank you very much for your time. 

Appointment scheduled for: 

Date Time Location 

Page 64 
______________ _____________________ ______________________ 

______________ _____________________ 

Follow-up call scheduled for:

 Date Time 

Q5. Thank you for your time. May I ask why you do not wish to participate? S16_NOTINT 

1 Too busy 

2 Not interested 

3 Confidentiality concerns 

4 Information too personal 

5 Need more information about study 

6 Don’t want to give blood - afraid of needles 

7 Other (specify):S16_OTH___________________________________________ 

Page 65 
Interviewer ID: 

Person ID: 

Script for Eligibility Questionnaire: Minor 

Lafayette Parish 

Hello, my name is (INTERVIEWER NAME) and I’m calling on behalf of the Agency for Toxic 

Substances and Disease Registry. May I speak with (the parent or Guardian of RESPONDENT), 

please? 

YES  SKIP TO (Q1) 

NO When is a good time to call back and speak with (the parent or Guardian of 

RESPONDENT)? 

DAY OF WEEK: Mon 

Wed 

Fri 

Tues 

Thurs 

Sat 

Sun 

DATE: ______/_______/__2002__ 

TIME: ______:______ AM/PM 

(Q1) A few days ago you and your child should have received a letter from us telling you that we 

are conducting a health study in Lafayette Parish and that we might call him/her. I am calling to 

see if he/she might be interested in participating in the study. Did you receive this letter? Q1_MR 

YES  CONTINUE WITH (Q2) 

NO  NOLET2 The letter explained he/she was selected to participate in a study we are 

conducting in Lafayette Parish. Would you like me to read this letter to you? (IF YES, 

READ LETTER AND THEN CONTINUE WITH (Q2). IF NO, CONTINUE WITH 

(Q2). 

(Q2) Participation will involve completing a questionnaire and having some blood drawn from 

his/her arm. If he/she decides to participate, it should take about one to two hours of time. Your 

child must be accompanied by a parent or Guardian. We will schedule a time for you to come to 

our office which is convenient for you. He/she will receive $50 for time and travel. Do you have 

any questions? Q2_MR 

ANSWER QUESTIONS. 

Would it be alright with you for me to talk with your child? I will need to ask him/her some 

additional questions to see if he/she is eligible to be in the study. CONSENT 

PARENT GIVES CONSENT  Yes CHILD IS HOME, 

I may also need to talk with you again after 

Page 66 
speaking with your child to schedule a time that is 

convenient for you and your child to participate. 

SKIP TO (Q2A) 

 Yes Child is NOT home, 

reschedule using INTRO 

 No SKIP TO (Q4A) 

(Q2A) CONTINUE SCRIPT WITH MINOR 

Hello (RESPONDENT), my name is (INTERVIEWER NAME) and I’m calling on behalf of the 

Agency for Toxic Substances and Disease Registry. I just talked to your parent/Guardian and 

he/she said I could talk to you about participating in a health study. 

(Q1A) A few days ago you should have received a letter from us telling you that we are 

conducting a health study in Lafayette Parish and that we might call you. I am calling to see if 

you might be interested in participating in the study. Did you receive this letter? Q1A_MR 

YES  CONTINUE WITH (Q2A) 

NO  The letter explained that you were selected to participate in a study we are conducting in 

Lafayette Parish. Would you like me to read this letter to you? (IF YES, READ LETTER 

AND THEN CONTINUE WITH (Q2A). IF NO, CONTINUE WITH (Q2A). 

(Q2A) Participation will involve completing a questionnaire and having some blood drawn from 

your arm. If you decide to participate, it should take about one to two hours of time. You must be 

accompanied by a parent or Guardian to the site office. We will schedule a time for you to come 

to our office which is convenient for you and your parent or Guardian. You will receive $50 for 

time and travel. Do you have any questions? Q2A_MR 

(Q3A) I would like to confirm a few things and then ask you some questions to see if you are 

eligible to be in the study. Before we start, I want to let you know that your participation is 

voluntary. You have the right to refuse to answer any question at any time. All data will be kept 

private to the extent permitted by law. We can not tell your parent(s) or Guardian about your 

answers. No data that identifies you or your place of residence will be included in any report. If 

you have questions about the study or your rights if you take part I have a phone number you can 

call. Would you like this numbers? Q3A_MR 

YES  You can call my supervisor or get more information about the study by calling NORC 

toll-free at 1-866-835-6672. 

NO  CONTINUE 

(Q4A) Are you willing to consider participating at this time? Q4A_MR 

MINOR GIVES CONSENT  Yes GO TO ELIGIBILITY 

QUESTIONNAIRE ON NEXT PAGE 

 No SKIP TO (Q4B) 

Q4B. Thank you for your time. May I ask why you do not wish to participate? Q4B_MR 

Page 67 
1 Too busy 

2 Not interested 

3 Confidentiality concerns 

4 Information too personal 

5 Need more information about study 

6 Don’t want to give blood - afraid of needles 

7 Other (specify):____Q4B_OTH_______________________________________ 

__________________________________________________________ 

ELIGIBILITY SCREENER: LAFAYETTE PARISH 

1. Last Name S1_LNAME First Name S1_FNAME Middle Initial 

S1_MNAME 

2. Gender S2_GENDER |___| M 

|___| F 

3. Age S3_AGE 

4. Date of Birth S4_DOBMO, S4_DOBDAY, S4_DOBYR

 |___|___| - |___|___| - |___|___|___|___|

 Month Day Year 

5. Address Line 1: S5_ADDR1_____________________________________________ 

Line 2 (Apt #, Lot #): S5_ADDR2_____________________ ________________________ 

City S5_CITY__________________________________________ 

State 

S5_STATE______ 

Zip Code 

S5_ZIP_________ 

____ 

______ 

6.Telephone Number(s) 

Primary telephone number: S6_PHONE1 _____ - _____ - ______ 

Secondary phone number (if avail): S6_PHONE2_____ - _____ - ______

 What type of line is this number? S6_TLINE work ____ cell phone ____ other 

Best time to reach respondent: S6_BTIME___ ___ : ___ ___ am/pm S6_AMPM 

7. Have you lived in Lafayette Parish for 

the last 5 years? 

S7_5YRS 

YES NO 

Ineligible. 

Thank you for your 

time. In order to 

participate in this 

Page 68 
investigation you 

must have lived in 

Lafayette Parish for 

the last 5 years. 

INELIG1 

8. How long have you lived in Lafayette 

Parish? S8_YRS 

______ Years 

9. Have you ever lived in Calcasieu Parish YES - Ineligible NO 

S8A_EVER Thank you for your 

time. In order to 

participate in this 

investigation you 

may not have ever 

lived in Calcasieu 

Parish. INELIG1 

Page 69 
10. Do you have hemophilia or any other blood clotting or 

bleeding disorder? 

S9_HEMO 

YES →

Ineligibl 

e 

NO 

11. Have you received chemotherapy in the past 6 weeks? 

S10_CHEMO 

YES →

Ineligibl 

e 

NO 

12. Do you weigh less than 95 pounds? 

S11_WGH 

YES →

Ineligibl 

e 

NO 

13. Have you lost more than 15 lbs. In the last year? 

S12_LOST 

YES →

Ineligibl 

e 

NO 

For Women Only 

14. Are you currently pregnant? 

S13_PREG 

YES →

Ineligibl 

e 

NO 

15. Have you breast fed a child in the last 6 months? 

S14_BFED 

YES →

Ineligibl 

e 

Thank 

you for 

your 

time. In 

order to 

participat 

e in this 

investiga 

tion you 

must be 

eligible 

to give a 

blood 

sample. 

Your 

“Yes” 

answer 

makes 

you 

ineligible 

to give 

blood. 

INELIG2 

NO

 For All Respondents 

16. You are eligible to be in the study. Would Yes No I need more 

you be willing to consider participating in the information. 

tests for dioxin and volatile organic compounds 

by completing a questionnaire and having some Schedule Skip to Schedule 

blood drawn from your arm? S15_INT Appointment Q5 follow-up call. 

INFORM PARENT/GUARDIAN THAT THEY MUST ACCOMPANY MINOR TO THE 

APPOINTMENT. 

Page 70 
______________ _____________________ ______________________ 

______________ _____________________ 

Is R ready to schedule appointment APPTMO 

Thank you very much for your time. 

Appointment scheduled for: 

Date Time Location 

Follow-up call scheduled for:

 Date


Time


Q5. Thank you for your time. May I ask why you do not wish to participate? S16_NOINT 

1 Too busy 

2 Not interested 

3 Confidentiality concerns 

4 Information too personal 

5 Need more information about study 

6 Don’t want to give blood - afraid of needles 

7 Other (specify):S16_OTH____________________________________________ 

Page 71 
Interviewer ID: 

Person ID: 

Script for Eligibility Questionnaire: Adult 

Lafayette Parish 

Hello, my name is (INTERVIEWER NAME) and I’m calling on behalf of the Agency for Toxic 

Substances and Disease Registry. May I speak with (RESPONDENT), please? 

YES  SKIP TO (Q1) 

NO When is a good time to call back and speak with (RESPONDENT)? 

DAY OF WEEK: Mon 

Wed 

Fri 

Tues 

Thurs 

Sat 

Sun 

DATE: ______/_______/__2002__ 

TIME: ______:______ AM/PM 

(Q1) A few days ago you should have received a letter from us telling you that we are 

conducting a health study in Lafayette Parish and that we might call you. I am calling to see if 

you might be interested in participating in the study. Did you receive this letter?Q1_AD 

YES  CONTINUE WITH (Q2) 

NO  NOLET The letter explained that you were selected to participate in a study we are 

conducting in Lafayette Parish. Would you like me to read this letter to you? (IF YES, 

READ LETTER AND THEN CONTINUE WITH (Q2). IF NO, CONTINUE WITH 

(Q2). 

(Q2) Participation will involve completing a questionnaire and having some blood drawn from 

your arm. If you decide to participate, it should take about one to two, hours of your time. We 

will schedule a time for you to come to our office which is convenient for you. You will receive 

$50 for your time and travel. If you are interested, I will need to ask you some additional 

questions to see if you are eligible to be in the study. Do you have any questions?Q2_AD 

ANSWER QUESTIONS. 

INTERESTED  SKIP TO (Q3) 

NOT INTERESTED  SKIP TO (Q4A) 

(Q3) I would like to confirm a few things and then ask you some questions to see if you are 

eligible to be in the study. Before we start, I want to let you know that your participation is 

voluntary. You have the right to refuse to answer any question at any time. All data will be kept 

private to the extent permitted by law. No data that identifies you or your place of residence will 

be included in any report. If you have questions about the study or your rights if you take part I 

have a phone number you can call. Would you like this number?Q3_AD 

Page 72 
YES  You can call my supervisor or get more information about the study by calling NORC 

toll-free at 1-866-835-6672. 

NO  CONTINUE 

Are you willing to consider participating at this time? Q3A_AD 

YES  GO TO ELIGIBILITY QUESTIONNAIRE ON FOLLOWING PAGE. 

NO  CONTINUE WITH (Q4A) 

Q4A. Thank you for your time. May I ask why you do not wish to participate? Q4A_AD 

1 Too busy 

2 Not interested 

3 Confidentiality concerns 

4 Information too personal 

5 Need more information about study 

6 Don’t want to give blood - afraid of needles 

7 Other (specify):Q4A_OTH__________________________________________ 

Page 73 
ELIGIBILITY SCREENER: LAFAYETTE PARISH


1. Last Name S1_LNAME First Name S1_FNAME Middle Initial 

S1_MNAME 

2. Gender S2GENDER |___| M 

|___| F 

3. Age S3_AGE 

4. Date of Birth S4_DOBMO, S4_DOBDAY, S4_DOBYR

 |___|___| - |___|___| - |___|___|___|___|

 Month Day Year 

5. Address Line 1: S5_ADDR1______________________________________________ 

Line 2 (Apt #, Lot #): S5_ADDR2 ______________________________________________ 

City S5_CITY __________________________________________ 

State 

S5_STATE______ 

Zip Code 

S5_ZIP_________ 

____ 

______ 

6.Telephone Number(s) 

Primary telephone number: S6PHONE1_____ - _____ - ______ 

Secondary phone number (if avail): S6PHONE2 _____ - _____ - ______ 

What type of line is this number? S6_TLINE work ____ cell phone ____ other 

Best time to reach respondent: S6_BTIME ___ ___ : ___ ___ am/pm S6_AMPM 

7. Have you lived in Lafayette Parish for 

the last 5 years? 

S7_5YRS 

YES NO 

Ineligible. 

Thank you for your 

time. In order to 

participate in this 

investigation you 

must have lived in 

Lafayette Parish for 

the last 5 years. 

INELIG1 

8. How long have you lived in Lafayette 

Parish? S8_YRS 

______ Years 

9. Have you ever lived in Calcasieu Parish 

S8A_EVER 

YES - Ineligible NO 

Thank you for your 

time. In order to 

Page 74 
participate in this 

investigation you 

may not have ever 

lived in Calcasieu 

Parish. INELIG1 

10. Do you have hemophilia or any other blood clotting or 

bleeding disorder? 

S9_HEMO 

YES →

Ineligibl 

e 

NO 

11. Have you received chemotherapy in the past 6 weeks? 

S10_CHEMO 

YES →

Ineligibl 

e 

NO 

12. Do you weigh less than 95 pounds? 

S11_WGH 

YES →

Ineligibl 

e 

NO 

13. Have you lost more than 15 lbs. In the last year? 

S12_LOST 

YES →

Ineligibl 

e 

NO 

For Women Only 

14. Are you currently pregnant? 

S13_PREG 

YES →

Ineligibl 

e 

NO 

15. Have you breast fed a child in the last 6 months? 

S14_BFED 

YES →

Ineligibl 

e 

Thank 

you for 

your 

time. In 

order to 

participat 

e in this 

investiga 

tion you 

must be 

eligible 

to give a 

blood 

sample. 

Your 

“Yes” 

answer 

makes 

you 

ineligible 

to give 

blood. 

INELIG2 

NO 

Page 75 
 For All Respondents 

Yes 

Schedule 

Appointment 

No 

Skip to 

Q5 

I need more 

information. 

Schedule 

follow-up call. 

16. You are eligible to be in the study. Would 

you be willing to consider participating in the 

tests for dioxin and volatile organic compounds 

by completing a questionnaire and having some 

blood drawn from your arm? S15_INT

Is R ready to schedule appointment APPTMO 

Thank you very much for your time. 

Appointment scheduled for: 

Date Time Location 

______________ _____________________ ______________________ 

Follow-up call scheduled for:

 Date Time 

_____________ _____________________ 

Q5. Thank you for your time. May I ask why you do not wish to participate? S16_NOTINT 

1 Too busy 

2 Not interested 

3 Confidentiality concerns 

4 Information too personal 

5 Need more information about study 

6 Don’t want to give blood - afraid of needles 

7 Other (specify):S16_OTH___________________________________________ 

Page 76
Appendix E


Informed Consent Documents


Consent for Adults


Consent for Parent or guardian of Minor


Assent for Minor


Page 77 
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


U.S. PUBLIC HEALTH SERVICE


AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY


ATLANTA, GEORGIA 30333


ADULT CONSENT TO BE IN A HEALTH STUDY 

What We Are Doing 

The Agency for Toxic Substances and Disease Registry (ATSDR) is doing research about 

exposure to some chemicals in a few parishes in Louisiana. Your parish has been chosen for the 

study. The chemicals which we will study are called dioxins and volatile organic compounds 

(VOCs). 

Dioxin is a name given to a family of similar chemicals. Dioxins are found in the air, water, soil 

and food. Dioxins are not made on purpose. They come from burning fuel, wood and waste and 

from making certain products. When dioxins get in the environment, they do not break down 

easily. They do not dissolve in water and they do not evaporate in air. When they get in your 

body they stay for a long time in your blood and body fat. Everyone has some dioxin in their 

blood. 

Volatile Organic Compounds or VOCs are a group of chemicals which go from liquid to gas, 

or evaporate, very quickly. This means that they can get into the air easily. There are many 

individual VOCs. Some common things which have VOCs in them are: gasoline, kerosene, nail 

polish remover, paints, paint thinners, dry cleaner fluid, cleaning products, pesticides, glues, 

permanent markers, and building materials and home furnishings. We are all exposed to VOCs. 

Some health effects from too much VOC exposure include eye and throat irritation, nasal 

congestion, rash, headache, nausea, shortness of breath, and vomiting. 

Why We Are Doing This Study 

The purpose of the study is to find out if there are differences in the levels of dioxin in different 

people’s blood. We will also look at VOC levels in people’s blood to see if there are differences 

in the levels between people. If we find differences, we will look to see if the people with higher 

levels have anything in common. This study will tell us about dioxin and VOC level by age, 

eating habits, where people work, and where people live. We can use those facts with what we 

know about soil, air and water to help learn how people come into contact with dioxin and 

VOCs. 

Why You Are Being Asked to Be in this Study 

You have been chosen for this study because you live in one of the selected areas, you are the 

right age, and you are able to give a blood sample. We are asking you to be in this study to help 

us find out if there are differences in the levels of dioxins and VOCs in people’s blood. 

What We Will Ask You to do 

You are free to join the study or not. If you join the study, you are free to stop at any time. If 

you join the study you will be asked some questions and we will draw some blood from your 

arm. 

What We Will do 

We will ask you some questions to make sure that you can be in the study and that you can give blood. 

Page 78 
1.	 A person trained to draw blood will take 60 ml (about 3_ tablespoons) of blood from a 

vein in your arm. 

2.	 A staff person will ask you questions about where you have lived, worked, and what 

foods you eat. 

How Long it Will Take 

It should take about one hour, but no more than two hours, to complete blood test and questions. 

You will only have to give a blood sample once. 

Contacting You in the Future 

We will send you a letter with your test results. The letter will have a number for you to call if 

you have any questions. If we find any pattern of exposure, we may contact you to ask 

additional questions sometime in the future. If you agree to allow us to contact you, we will 

explain our questions to you in advance and you can decide to consent to answer them or not in 

the same manner that you are doing now. 

What We Will Do with Your Blood 

For this study we will look at your blood for dioxins and VOCs only. We will not test your 

blood for anything else. 

We don’t know enough about the human health effects of dioxin but progress in studying dioxin 

and human health is being made every day. Your blood and the results of the test that we are 

doing on it for this study may be helpful in the future. Because of that, any blood that is left after 

we test it will be stored for future study. If we want to conduct a study which will be meaningful 

to your health, we will contact you to ask for your consent. You will be free to agree or not 

agree to our using your blood in another study. If your blood is used for any analysis which does 

not pertain to your health, such as research on analysis methods, we will remove your name and 

anything that could link the blood to you. If you change your mind about having your blood 

stored, you can contact the Principal Investigator, M. Deborah Millette at 404-498-0563 or 1­

888- 422-8737. 

What the Study Will Tell us 

1.	 The level of dioxin and VOCs that you have in your blood. 

2.	 The level of dioxin and VOCs that other people have in their blood. 

3.	 If there are differences in people’s dioxin levels and VOC levels, and if so, if there are 

any patterns to the differences. 

4.	 What environmental health activities may be needed in the future. 

What the Study Will Not Tell us 

1.	 Where the dioxin or VOCs came from, if they are found 

2.	 Information on chemicals other than dioxin and VOCs. 

3.	 If you will get sick from the level of dioxin and VOCs in your blood 

Risks 

We will try to make you as comfortable as possible but taking your blood may hurt a little. You 

will feel a slight “pinch” when we put the needle in. You may feel some discomfort or see a 

small bruise where the blood was drawn. 

Benefits 

Page 79 
You will receive a copy of your test results and a copy will be sent to your physician if you wish. 

You will receive fact sheets about dioxins and VOCs. You will assist in answering questions 

about the amount of dioxin and VOCs in people’s blood. 

If You Don’t Want to Be in the Study or If You Change Your Mind Later 

You can refuse to take the blood test or answer any survey questions. There is no penalty. You 

may choose to leave this study at any time, even after signing the consent form. 

Privacy 

Your name and test results are kept private to the extent allowed by law. Your name will not be 

used in any reports written about this study. Any reports written about the study will use dioxin 

and VOC levels. All names and test results will be kept in a locked file. 

Payment for Your Time 

You will get a $50 money order after giving a blood sample and answering the questions, to 

repay you for travel and your time for being in the study. 

Contact Person 

If you have any questions, feel that you have been hurt by being in this study, or wish to have 

your blood removed from storage, please contact: 

M. Deborah Millette, Principal Investigator 

Agency for Toxic Substances and Disease Registry


1600 Clifton Road E-31


Atlanta, Georgia 30333


Direct: 404-498-0563


Toll-free: 1-888- 422-8737 Extension 0563


Please leave your name, telephone number, and your question(s). Your call will be returned as 

soon as possible. 

For questions regarding research subjects’ rights, please contact: 

Dr. Robin Wagner, Deputy Associate Administrator for Science, 

Agency for Toxic Substances and Disease Registry 

1600 Clifton Road E-31 

Atlanta, Georgia 30333 

Direct: 404-498-0003 

Toll-free: 1-888-422-8737 Extension 0003 

Page 80 
________________________________________________________ 

_______________________________________________ ____________ 

If you do not understand the study or what we are asking you to do, please ask questions. If you 

have no questions and agree to be in this study, please sign the consent form. 

PARTICIPANT CONSENT 

I agree to be in the health study. I have read and/or been told about what the study is about, the 

study questions, and blood samples. I have been given a chance to ask questions and I feel that 

my questions have been answered. I know that being in this study is my choice and that I can 

leave it at any time. I have been given a copy of this Consent Form. 

Please answer the following questions by initialing your response. Your answers will not 

disqualify you from the study. You may have your blood removed from storage at any time by 

calling the number listed above. If you allow us to contact you in the future, you are not 

agreeing to answer any future questions. You will be able to agree or decline to answer our 

questions at that time. 

You may store my blood for future study. I may You may contact me in the future if you have 

choose to remove my blood from storage at any time. additional questions. At that time I will be asked 

my consent again. 

YES____________ NO_____________ 

YES____________ NO_____________ 

Participant Name (Print) 

Participant’s Signature Date 

I would like a copy of my test results to be sent to my doctor:


Name: ______________________________Telephone Number:____________


Address:_____________________________________________________________


Page 81 
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


U.S. PUBLIC HEALTH SERVICE


AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY


ATLANTA, GEORGIA 30333


PARENTAL CONSENT FOR YOUR CHILD TO BE IN A HEALTH STUDY 

What We Are Doing 

The Agency for Toxic Substances and Disease Registry (ATSDR) is doing research about 

exposure to some chemicals in a few parishes in Louisiana. Your parish has been chosen for the 

study. The chemicals which we will study are called dioxins and volatile organic compounds 

(VOCs). 

Dioxin is a name given to a family of similar chemicals. Dioxins are found in the air, water, soil 

and food. Dioxins are not made on purpose. They come from burning fuel, wood and waste and 

from making certain products. When dioxins get in the environment, they do not break down 

easily. They do not dissolve in water and they do not evaporate in air. When they get in your 

body they stay for a long time in your blood and body fat. Everyone has some dioxin in their 

blood. 

Volatile Organic Compounds or VOCs are a group of chemicals which go from liquid to gas, 

or evaporate, very quickly. This means that they can get into the air easily. There are many 

individual VOCs. Some common things which have VOCs in them are: gasoline, kerosene, nail 

polish remover, paints, paint thinners, dry cleaner fluid, cleaning products, pesticides, glues, 

permanent markers, and building materials and home furnishings. We are all exposed to VOCs. 

Some health effects from too much VOC exposure include eye and throat irritation, nasal 

congestion, rash, headache, nausea, shortness of breath, and vomiting. 

Why We Are Doing this Study 

The purpose of the study is to find out if there are differences in the levels of dioxin in different 

people’s blood. We will also look at VOC levels in people’s blood to see if there are differences 

in the levels between people. If we find differences, we will look to see if the people with higher 

levels have anything in common. This study will tell us about dioxin and VOC level by age, 

eating habits, where people work, and where people live. We can use those facts with what we 

know about soil, air and water to help learn how people come into contact with dioxin and 

VOCs. 

Why Your Child Is Being Asked to Be in this Study 

Your child has been chosen for this study because he/she lives in one of the selected areas, is the 

right age, and is able to give a blood sample. We are asking your child to be in this study to help 

us find out if there are differences in the levels of dioxins and VOCs in people’s blood. 

What We Will Ask You and Your Child to do 

Your are free to allow your child to join the study or not. If he/she joins the study, he/she is free 

to stop at any time. 

If you allow your child to join the study he/she will be asked some and we will draw some blood 

from his/her arm. Before we ask your child any questions, we will ask you to leave the room. 

We cannot tell you anything about the answers your child gives. 

Page 82 
What We Will do 

We will ask your child some questions to make sure that he/she can be in the study and that 

he/she can give blood. 

1.	 A person trained to draw blood will take 60 ml (about 3_ tablespoons) of blood from a 

vein in his/her arm. 

2.	 A staff person will ask him/her questions about where he/she has lived, worked, and what 

foods he/she eats. 

How Long it Will Take 

It should take about one hour, but no more than two hours, to complete the blood test and 

questions. He/She will only have to give a blood sample once. Depending on what we find, we 

may contact you or your child to ask additional questions sometime in the future. 

Contacting You and Your Child in the Future 

We will send you and your child letters with their test results. The letter will have a number for 

you or your child to call if you have any questions. If we find any pattern of exposure, we may 

contact you and your child to ask additional questions sometime in the future. If you agree to 

allow us to contact you and your child, we will explain our questions to you in advance and you 

can decide to consent to answer them or not in the same manner that you are doing now. 

What We Will Do with Your Child’s Blood 

For this study we will look at your child’s blood for dioxins and VOCs only. We will not test 

your child’s blood for anything else. 

We don’t know enough about the human health effects of dioxin but progress in studying dioxin 

and human health is being made every day. Your child’s blood and the results of the test that we 

are doing on it for this study may be helpful in the future. Because of that, any blood that is left 

after we test it will be stored for future study. If we want to conduct a study which will be 

meaningful to your child’s health, we will contact you to ask for your consent. You will be free 

to agree or not agree to our using your child’s blood in another study. If your child’s blood is 

used for any analysis which does not pertain to his/her health, such as research on analysis 

methods, we will remove his/her name and anything that could link the blood to him/her. If you 

change your mind about having your child’s blood stored, you can contact the Principal 

Investigator, M. Deborah Millette at 404-498-0563 or 1-888- 422-8737. 

The Study Will Tell Us: 

1.	 The level of dioxin and VOCs that your child has in his/her blood. 

2.	 The level of dioxin and VOCs that other people have in their blood. 

3.	 If there are differences in people’s dioxin levels and VOC levels, and if so, if there are 

any patterns to the differences. 

4.	 What environmental health activities may be needed in the future. 

The Study Will Not Tell Us: 

1.	 Where the dioxin or VOCs came from, if they are found. 

2.	 Information on chemicals other than dioxin and VOCs. 

Page 83 
3. If your child will get sick from the level of dioxin and VOCs in his/her blood. 

Risks 

We will try to make your child as comfortable as possible but taking his/her blood may hurt a 

little. He/She will feel a slight “pinch” when we put the needle in. He/She may feel some 

discomfort or see a small bruise where the blood was drawn. 

Benefits 

You and your child will receive a copy of his/her test results and a copy will be sent to his/her 

physician if you wish. You and your child will receive fact sheets about dioxins and VOCs. Your 

child will assist in answering questions about the amount of dioxin and VOCs in people’s blood. 

If You Don’t Want Your Child to Be in the Study or If You or Your Child Change Your 

Minds Later 

You can refuse to allow your child give a blood sample or answer any survey questions. Your 

child can refuse to take the blood test or answer any survey questions. Your child may choose 

to leave this study at any time, even after you sign the consent form. If you withdraw your 

consent, your child will leave the study. There is no penalty. 

Privacy 

Your child’s name and test results are kept private, to the extent allowed by law. His/Her name 

will not be used in any reports written about this study. Any reports written about the study 

will only use dioxin and VOC levels. All names and test results will be kept in a locked file. 

Payment for Your Child’s Time 

Your child will get a $50 money order after giving a blood sample and answering the questions, 

to repay him/her for travel and his/her time for being in the study. 

Contact Person 

If you have any questions, or feel that your child has been hurt by being in this study, or wish to 

have your child’s blood removed from storage, please contact: 

M. Deborah Millette, Principal Investigator 

Agency for Toxic Substances and Disease Registry


1600 Clifton Road E-31


Atlanta, Georgia 30333


Direct: 404-498-0563


Toll-free: 1-888- 422-8737 Extension 0563


Please leave your name, telephone number, and your question(s). Your call will be returned as 

soon as possible. 

For questions regarding research subjects’ rights, please contact: 

Dr. Robin Wagner, Deputy Associate Administrator for Science, 

Agency for Toxic Substances and Disease Registry 

1600 Clifton Road E-31 

Atlanta, Georgia 30333 

Direct: 404-498-0003 

Page 84 
Toll-free: 1-888-422-8737 Extension 0003 

Page 85

________________________________________________________ 

_______________________________________________________ 

____________________________________________________ ____________ 

If you do not understand the study or what we are asking you and you child to do, please ask 

questions. If you have no questions and agree to allow your child to be in this study, please sign 

the consent form. 

PARENTAL CONSENT FOR YOUR CHILD TO BE IN A HEALTH STUDY 

I agree to allow my child to be in the health study. I have read and/or been told about what the 

study is about, the study questions, and blood samples. I have been given a chance to ask 

questions and I feel that my questions have been answered. I know that allowing my child to be 

in this study is my choice and my child can leave it at any time at his/her request or at my 

request. I have been given a copy of this Consent Form. 

Please answer the following questions by initialing your response. Your answers will not 

disqualify you from the study. You may have your child’s blood removed from storage at any 

time by calling the number listed above. If you allow us to contact you and your child in the 

future, you are not agreeing to answer any future questions. You will be able to agree or decline 

to answer our questions at that time. 

You may store my child’s blood for future study. I You may contact me and my child in the future if 

may choose to remove my child’s blood from storage have additional questions. At that time my child a 

at any time. will be asked for our consent again. 

YES____________ NO_____________ 

YES____________ NO_____________ 

Child’s Name (Print) 

Parent or Guardian’s Name (Print) 

Parent or Guardian’s Signature Date 

I would like a copy of my child’s test results to be sent to his/her doctor: 

Name: ______________________________________


Telephone Number:____________


Address:_____________________________________________________________


U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

U.S. PUBLIC HEALTH SERVICE 

Page 86 
AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY


ATLANTA, GEORGIA 30333


YOUTH ASSENT TO BE IN A HEALTH STUDY


What We Are Doing? 

The Agency for Toxic Substances and Disease Registry (ATSDR) is doing research about 

exposure to some chemicals in a few parishes in Louisiana. Your parish has been chosen for the 

study. The chemicals which we will study are called dioxins and volatile organic compounds 

(VOCs). 

Dioxin is a name given to a family of similar chemicals. Dioxins are found in the air, water, soil 

and food. Dioxins are not made on purpose. They come from burning fuel, wood and waste and 

from making certain products. When dioxins get in the environment, they do not break down 

easily. They do not dissolve in water and they do not evaporate in air. When they get in your 

body they stay for a long time in your blood and body fat. Everyone has some dioxin in their 

blood. 

Volatile Organic Compounds or VOCs are a group of chemicals which go from liquid to gas, 

or evaporate, very quickly. This means that they can get into the air easily. There are many 

individual VOCs. Some common things which have VOCs in them are: gasoline, kerosene, nail 

polish remover, paints, paint thinners, dry cleaner fluid, cleaning products, pesticides, glues, 

permanent markers, and building materials and home furnishings. We are all exposed to VOCs. 

Some health effects from too much VOC exposure include eye and throat irritation, nasal 

congestion, rash, headache, nausea, shortness of breath, and vomiting. 

Why We Are Doing This Study 

We are trying to find out if there are differences in the levels of dioxin in different people’s 

blood. We will also look at VOC levels in people’s blood to see if there are differences in the 

levels between people. If we find differences, we will look to see if the people with higher levels 

have anything in common. This study will tell us about dioxin and VOC level by age, eating 

habits, where people work, and where people live. We can use those facts with what we know 

about soil, air and water to help learn how people come into contact with dioxin and VOCs. 

Why You Are Being Asked to Be in this Study 

You have been chosen for this study because you live in one of the selected areas, you are the 

right age, and you are able to give a blood sample. We are asking you to be in this study to help 

us find out if there are differences in the levels of dioxins and VOCs in peoples’ blood. 

What We Will Ask You to Do: 

You are free to join the study or not. If you join the study, you are free to stop at any time. 

If you join the study you will be asked some questions and we will draw some blood from your 

arm. 

What We Will Do: 

We will ask you some questions to make sure that you can be in the study and that you can give 

blood. 

1. A person trained to draw blood will take 60 ml (about 3 _ tablespoons) of blood from a 

Page 87 
vein in your arm. 

2.	 A staff person will ask you questions about where you have lived, worked, and what 

foods you eat. Before we ask you these questions we will ask your parent(s) or guardian 

to leave the room (unless you prefer to have them stay with you). We cannot tell your 

parent(s) or guardian about your answers. 

How Long it Will Take 

It should take about one hour, but no more than two hours, to complete the blood test and 

questions. You will only have to give a blood sample once. Depending on what we find, we 

may contact you to answer additional questions sometime in the future. 

Contacting You in the Future 

We will send you a letter with your test results. The letter will have a number for you to call if 

you have any questions. If we find any pattern of exposure, we may contact you to ask 

additional questions sometime in the future. If you agree to allow us to contact you, we will 

explain our questions to you in advance and you can decide to consent to answer them or not in 

the same manner that you are doing now. 

What We Will Do with Your Blood 

For this study we will look at your blood for dioxins and VOCs only. We will not test your 

blood for anything else. 

We don’t know enough about the human health effects of dioxin but progress in studying dioxin 

and human health is being made every day. Your blood and the results of the test that we are 

doing on it for this study may be helpful in the future. Because of that, any blood that is left after 

we test it will be stored for future study. If we want to conduct a study, which will be 

meaningful to your health, we will contact you to ask for your consent. You will be free to agree 

or not agree to our using your blood in another study. If your blood is used for any analysis 

which does not pertain to your health, such as research on analysis methods, we will remove 

your name and anything that could link the blood to you. If you change your mind about having 

your blood stored, you can contact the Principal Investigator, M. Deborah Millette at 404-498­

0563 or 1-888- 422-8737. 

What the Study Will Tell us 

1.	 The level of dioxin and VOCs that you have in your blood. 

2.	 The level of dioxin and VOCs that other people have in their blood. 

3.	 If there are differences in people’s dioxin levels and VOC levels, and if so, if there are 

any patterns to the differences. 

4.	 What environmental health activities may be needed in the future. 

What the Study Will Not Tell Us 

1.	 Where the dioxin or VOCs came from, if they are found 

2.	 Information on chemicals other than dioxin and VOCs. 

3.	 If you will get sick from the level of dioxin and VOCs in your blood 

Risks 

We will try to make you as comfortable as possible but taking your blood may hurt a little. You 

will feel a slight “pinch” when we put the needle in. You may feel some discomfort or see a 

small bruise where the blood was drawn. 

Page 88 
Benefits 

You and your parent(s) will both receive a copy of your test results. You will receive fact sheets 

about dioxins and VOCs. You will assist in answering questions about the amount of dioxin and 

VOCs in people’s blood. 

If You Don’t Want to Be in the Study or If You Change Your Mind Later 

You can refuse to take the blood test or answer any survey questions. There is no penalty. You 

may choose to leave this study at any time, even after signing the consent form. If your parent(s) 

decides to withdraw their consent, you will leave the study. 

Privacy 

Your name and test results are kept private, to the extent allowed by law. Your name will not be 

used in any reports written about this study. Any reports written about the study will only use 

dioxin and VOC levels. All names and test results will be kept in a locked file. 

Payment for Your Time 

You will get a $50 money order after giving a blood sample and answering the questions, to 

repay you for travel and your time for being in the study. 

Contact Person 

If you have any questions, feel that you have been hurt by being in this study, or wish to have 

your blood removed from storage, please contact: 

M. Deborah Millette, Principal Investigator 

Agency for Toxic Substances and Disease Registry, 1600 Clifton Road , Atlanta, Georgia 30333 

Direct: 404-498-0563 

Toll-free: 1-888- 422-8737 Extension 0563 

Please leave your name, telephone number, and your question(s). Your call will be returned as 

soon as possible. 

For questions regarding research subjects’ rights, please contact: 

Dr. Robin Wagner, Deputy Associate Administrator for Science, 

Agency for Toxic Substances and Disease Registry, 1600 Clifton Road, Atlanta, Georgia 30333 

Direct: 404-498-0003 

Toll-free: 1-888-422-8737 Extension 0003 

Page 89 
________________________________________________________ 

____________________________________________ ____________ 

If you do not understand the study or what we are asking you to do, please ask questions. If you 

have no questions and agree to be in this study, please sign the consent form. 

YOUTH ASSENT TO BE IN A HEALTH STUDY 

I agree to be in the health study. I have read and/or been told about what the study is about, the 

study questions, and blood samples. I have been given a chance to ask questions and I feel that 

my questions have been answered. I know that being in this study is my choice and that I can 

leave it at any time. I understand that my parent(s) can withdraw consent for me to participate in 

this study at any time. I have been given a copy of this Assent Form. 

Please answer the following questions by initialing your response. Your answers will not 

disqualify you from the study. You may have your blood removed from storage at any time by 

calling the number listed above. If you allow us to contact you in the future, you are not 

agreeing to answer any future questions. You will be able to agree or decline to answer our 

questions at that time. 

You may store my blood for future study. I may You may contact me in the future if you have 

choose to remove my blood from storage at any time. additional questions. At that time I will be asked 

my consent again. 

YES____________ NO_____________ 

YES____________ NO_____________ 

Participant Name (Print) 

Participant’s Signature Date 

Page 90 
Appendix F


Study Questionnaire


The questionnaire for Lafayette Parish is included. It includes one more question than the version 

used in Calcasieu Parish. That question is, “Have you ever lived in Calcasieu Parish”. 

Page 91 
The Louisiana Calcasieu and


Lafayette Parishes Dioxin and


Volatile Organic Compounds


Exposure Investigation 

Investigation Questionnaire 

Lafayette Parish, Louisiana 

a. 

c. 

U.S. Department of Health and Human Services 

b. U.S. Public Health Service 

Agency for Toxic Substances and Disease Registry 

d. Atlanta, Georgia 30333 

Respondent ID: PERSONID Interviewer ID: 

Interview Date: / / Interview Time: Begin 

End 

: am/pm

: am/pm

 QUEX Status: Blood Draw ID: 

Page 92 
1. RESPONDENT INFORMATION 

First I’m going to ask you some questions about 

yourself. 

79.What is your name? 

Last: Q1_LNAME 

First: Q1_FNAME	 Middle: Q1_MNAME 

80.Date of Birth ____/____/____ Q2DOB_MO/Q2DOB_DY/Q2DOB_YR 

81.Age (years) ___________ Q3_AGE (If <15 years, ineligible, GO TO END) 

82.What is your Race (circle all that apply)? 

1. White Q4_RACE1	 6. Native Hawaiian,Pacific IslanderQ4_RACE6 

2. 	Black, African American Q4_RACE2 1. Other Specify Q4_RACE7 

RACEOTH _____________ 

3. American Indian, Alaska Native Q4_RACE3	 8. Don’t Know 

4. Asian Q4_RACE4	 9. Refused 

5. Hispanic/Latino Q4_RACE5 

83.What is your home address? 

Address Line 1: Q5_ADDR1 

Line 2 (Apt/Lot #): Q5_ADDR2 

City: Q5_CITY 

State: Q5_STATE Zip code: Q5_ZIP 

84.What is your telephone number(s)? 

Q6_HMPH - Home: ( ) 

Q6_WKPH - Work: ( ) 

Q6_CELL - Cell: ( ) 

Q6_OTHPH - Other: ( ) 

Page 93 
2. ELIGIBILITY 

Now I’m going to ask you some questions to confirm 

your eligibility to give blood. 

YES NO 

DON’T 

KNOW REFUSED 

IF YES, DON’T 

KNOW OR 

REFUSED R IS 

85.Do you have hemophilia or any other 

blood clotting or bleeding 

disorder? Q7 

1 2 3 4 

NOT ELIGIBLE 

FOR BLOOD 

DRAW: 

86.Have you received chemotherapy in 1 2 3 4 Thank you. Your 

the past 6 months? Q8 answer makes you 

87.Do you weigh less than 95 pounds? Q9 1 2 3 4 ineligible to give a 

blood sample.

88.Have you lost more than 15 pounds in 

the last year? Q10 1 2 3 4 However, you will 

be able to 

89.WOMEN: Are you currently pregnant? 

Q11 1 2 3 4 complete the 

questionnaire. 

90.WOMEN: Have you breastfed a child in 

the last 6 months? Q12 

1 2 3 4 

When we finish 

with the survey, I 

will take you to the 

check out area. 

YE 

S 

NO IF R answers “YES” to Q13 and “NO” to 

Q14: 

Thank you. Based on your answer you may 

not be able to give a blood sample. We will 

complete the questionnaire and then take your 

blood pressure to see if you are eligible to give 

a blood sample. 

91.Have you ever been told by a physician 

that you have high blood 

pressure? Q13 

1 2 

(Go to Q15) 

92.Are you being treated for this condition 

with medications? Q14 

1 2 

93.When did you move to Lafayette Parish? 

Q15_MTH, Q15_DAY, Q15_YR 

/ /

 mm dd yyyy 



IF DATE IS AFTER 1997, R IS NOT ELIGIBLE FOR 

BLOOD DRAW: 

Thank you. You must have lived in Lafayette Parish 

for at least 5 years. Your answer makes you 

ineligible to give a blood sample. However, you will 

be able to complete the questionnaire. When we 

finish with the survey, I will take you to the check out 

area. 

94.Have you ever lived in Calcasieu Parish? Q16 

Page 94 
ο YES  ο NO 

95.Have you lived at another address in Lafayette Parish? Q17 

ο YES  ο NO ➨ GO TO Q18 

If “Yes”, R IS NOT ELIGIBLE FOR BLOOD 

DRAW:Thank you. You must never have lived in 

Calcasieu Parish. Your answer makes you ineligible 

to give a blood sample. However, you will be able to 

complete the questionnaire. When we finish with the 

survey, I will take you to the check out area. 

If you ever lived at another address in Lafayette Parish, please give the other address(es) and the dates 

you lived there: 

17A. What was the first address? 

To 

What dates did you live at the most recent From: Q17A_BM, Q17A_BY : Q17A_EM, 17A_EY

address? mm yyyy mm yyyy 

Address Line 1: Q17A_AD1 

Line 2 (Apt/Lot #): Q17A_AD2 

City: Q17A_CTY State: Q17A_ST 

Zip code: Q17A_ZIP Telephone: Q17A_PH 

17B. Was there another address? ο YES ο NO  (GO TO Q18) Q17B 

To 

What dates did you live at the next most From: Q17B_BM, Q17B_BY : Q17B_EM, 17B_EY

recent address? mm yyyy mm yyyy 

Address Line 1: Q17B_AD1 

Line 2 (Apt/Lot #): Q17B_AD2 

City: Q17B_CTY State: Q17B_ST 

Zip code: Q17B_ZIP Telephone: Q17B_PH 

17C. Was there another address? ο YES ο NO  (GO TO Q18) Q17C 

To 

What dates did you live at the next most From: Q17C_BM,Q17C_BY : Q17C_EM, 17C_EY

recent address? mm yyyy mm yyyy 

Address Line 1: Q17C_AD1 

Line 2 (Apt/Lot #): Q17C_AD2 

City: Q17C_CTY State: Q17C_ST 

Zip code: Q17C_ZIP Telephone: Q17C_PH 

17D. Was there another address? ο YES ο NO  (GO TO Q18) Q17D 

To 

What dates did you live at the next most From: Q17D_BM,Q17D_BY : Q17D_EM, 17D_EY

recent address? mm yyyy mm yyyy 

Address Line 1: Q17D_AD1 

Line 2 (Apt/Lot #): Q17D_AD2 

City: Q17D_CTY State: Q17D_ST 

Page 95 
Zip code: Q17D_ZIP Telephone: Q17D_PH 

Page 96

17E. Was there another address? ο YES ο NO  (GO TO Q18) Q17E 

To 

What dates did you live at the next most From: Q17E_BM, Q17E_BY : Q17E_EM, 17E_EY

recent address? mm yyyy mm yyyy 

Address Line 1: Q17E_AD1 

Line 2 (Apt/Lot #): Q17E_AD2 

City: Q17E_CTY State: Q17E_ST 

Zip code: Q17E_ZIP Telephone: Q17E_PH 

Page 97 
Case ID: Lab ID: 

3. SMOKING HISTORY 

Next I’m going to ask you some questions about your 

smoking history. 

YES NO DON’T KNOW REFUSED 

96.Have you ever smoked 

cigarettes? Q18 

1 2

(GO TO Q22) 

3 4 

97.Have you smoked cigarettes in 

the past 5 years? Q19 

1 2

(GO TO Q22) 

3 4 

98.Do you currently smoke? Q20 1 2

(GO TO Q22)

 3

(GO TO Q22)

 4

(GO TO Q21) (GO TO Q22)

Check ineligible 

smoker on case label 

99.How many cigarettes do you smoke a day? Q21 

1. Up to _ pack 

2. Up to 1 pack 

3. Up to 1 _ pack 

4. Up to 2 packs 

5. Over 2 packs 

Page 98 
4. OCCUPATION 

Next I’m going to ask you some questions about your 

job. Please base your answers on your current job, or if 

retired or unemployed, your last job. 

100.A. What is the name of the company for which you work(ed)? 

Q22A Q22VER 

If Homemaker or never worked, please check one of the following: Q22A1 

ο Homemaker with past employment experience  GO TO Q23 

ο Homemaker who has never worked  GO TO Q35 

ο Never worked  SKIP TO Q35 

B.	 What kind of business or industry is this, that is, what do they make or do at the place 

where you work? 

Q22B 

C.	 What do you actually do on the job, what are some of your main duties? 

Q22C 

D.	 How many years have you been doing this job? 

Q22D	 # Years 

E. How many hours a week do you usually work on this job? 

Q22E	 # Hours 

Page 99 
5. DIOXIN EXPOSURE 

Next I’m going to ask you some questions about dioxin 

exposure throughout your employment history. 

101.Have you EVER been employed: Q23_1 

In the manufacture, formulation, or commercial application of the 

herbicide 2, 4-D, 2,4,5-T or related compounds. Example: Agent 

Orange, Agricorn D, D50, Lawn-keep, Pantgard, Weed-B-Gon .................... 

ο YES ο NO 

(GO TO Q24) 

ο DK 

(Most recent job with exposure) 

A. What is the name of the company for which you worked? 

Q23A1 Q23A1VER 

B.	 In what City and State was the company located? 

City: Q23B1CTY State: Q23B1ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q23C1 

D.	 How many years had you been doing this job? 

Q23D1	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q24 

(Next most recent job with exposure) Q23_2 

Page 100 
102.Have you EVER been employed: Q24_1 

In the manufacture or formulation of hexachlorophene? 

Example: Phisohex, Septisol, Septpfen, Dermadex ............................. 

ο YES ο NO 

(GO TO Q25) 

ο DK 

(If Yes  Most recent job with exposure) 

A. What is the name of the company for which you worked? 

Q24A1 Q24A1VER 

B.	 In what City and State was the company located? 

City: Q24B1CTY State: Q24B1ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q24C1 

D.	 How many years had you been doing this job? 

Q24D1	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

(Next most recent job with exposure) Q24_2 

A.	 What is the name of the company for which you worked? 

Q24A2 Q24A2VER 

B.	 In what City and State was the company located? 

City: Q24B2CTY State: Q24B2ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q24C2 

D.	 How many years had you been doing this job? 

Q24D2	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

If Yes Insert extra job pages here Q24_3 

Page 101 
103.Have you EVER been employed: Q25_1 

In direct handling, transportation, or disposal of phenolic or pesticide 

hazardous waste? Example: Insecticide, Karbofos, 

Kill-A-Mite, Melathion, Parathion ................................................................. 

ο YES ο NO 

(GO TO Q26) 

ο DK 

(If Yes  Most recent job with exposure) 

A. What is the name of the company for which you worked? 

Q25A1 Q25A1VER 

B.	 In what City and State was the company located? 

City: Q25B1CTY State: Q25B1ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q25C1 

D.	 How many years had you been doing this job? 

Q25D1	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

(Next most recent job with exposure) Q25_2 

Page 102 
104.Have you EVER been employed: Q26_1 

In the lawn care industry? .................................................... ο YES ο NO 

(GO TO Q27) 

ο DK 

(If Yes  Most recent job with exposure) 

A. What is the name of the company for which you worked? 

Q26A1 Q26A1VER 

B.	 In what City and State was the company located? 

City: Q26B1CTY State: Q26B1ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q26C1 

D.	 How many years had you been doing this job? 

Q26D1	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

(Next most recent job with exposure) Q26_2 

A.	 What is the name of the company for which you worked? 

Q26A2 Q26A2VER 

B.	 In what City and State was the company located? 

City: Q26B2CTY State: Q26B2ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q26C2 

D.	 How many years had you been doing this job? 

Q26D2	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

If Yes Insert extra job pages here Q26_3 

Page 103 
105.Have you EVER been employed: Q27_1 

In sod production?.................................................................. ο YES ο NO 

(GO TO Q28) 

ο DK 

(If Yes  Most recent job with exposure) 

A. What is the name of the company for which you worked? 

Q27A1 Q27A1VER 

B.	 In what City and State was the company located? 

City: Q27B1CTY State: Q27B1ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q27C1 

D.	 How many years had you been doing this job? 

Q27D1	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

(Next most recent job with exposure) Q24_2 

A.	 What is the name of the company for which you worked? 

Q27A2 Q27A2VER 

B.	 In what City and State was the company located? 

City: Q27B2CTY State: Q27B2ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q27C2 

D.	 How many years had you been doing this job? 

Q27D2	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

If Yes Insert extra job pages here Q27_3 

Page 104 
106.Have you EVER been employed: Q28_1 

In crop management? ............................................................ ο YES ο NO 

(GO TO Q29) 

ο DK 

(If Yes  Most recent job with exposure) 

A. What is the name of the company for which you worked? 

Q28A1 Q28A1VER 

B.	 In what City and State was the company located? 

City: Q28B1CTY State: Q28B1ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q28C1 

D.	 How many years had you been doing this job? 

Q28D1	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

(Next most recent job with exposure) Q28_2 

Page 105 

107.Have you EVER been employed: Q29_1 

In forestry brush control and hardwood eradication? ................ ο YES ο NO 

(GO TO Q30) 

ο DK 

(If Yes  Most recent job with exposure) 

A. What is the name of the company for which you worked? 

Q29A1 Q29A1VER 

B.	 In what City and State was the company located? 

City: Q29B1CTY State: Q29B1ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q29C1 

D.	 How many years had you been doing this job? 

Q29D1	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

(Next most recent job with exposure) Q29_2 

Page 107 
108.Have you EVER been employed: Q30_1 

In highway and railroad right-of-way clearance? ......................... ο YES ο NO 

(GO TO Q31) 

ο DK 

(If Yes  Most recent job with exposure) 

A. What is the name of the company for which you worked? 

Q30A1 Q30A1VER 

B.	 In what City and State was the company located? 

City: Q30B1CTY State: Q30B1ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q30C1 

D.	 How many years had you been doing this job? 

Q30D1	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

(Next most recent job with exposure) Q30_2 

Page 108 
109.Have you EVER been employed: Q31_1 

In chemical warehouse operations?.................................... ο YES ο NO 

(GO TO Q32) 

ο DK 

(If Yes  Most recent job with exposure) 

A. What is the name of the company for which you worked? 

Q31A1 Q31A1VER 

B.	 In what City and State was the company located? 

City: Q31B1CTY State: Q31B1ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q31C1 

D.	 How many years had you been doing this job? 

Q31D1	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

(Next most recent job with exposure) Q31_2 

A.	 What is the name of the company for which you worked? 

Q31A2 Q31A2VER 

B.	 In what City and State was the company located? 

City: Q31B2CTY State: Q31B2ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q31C2 

D.	 How many years had you been doing this job? 

Q31D2	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

If Yes Insert extra job pages here Q31_3 

There were 3 job iterations in this series. Only 2 iterations are listed here to establish the naming pattern and 

minimize document size. The last variable in series is Q31_4. Please see the data layout included with the 9/26/03 

data file delivery for a complete listing of all variables included in the loop. 

Page 109 
110.Have you EVER been employed: Q32_1 

In papermill pond management? ............................................. ο YES ο NO 

(GO TO Q33) 

ο DK 

(If Yes  Most recent job with exposure) 

A. What is the name of the company for which you worked? 

Q32A1 Q32A1VER 

B.	 In what City and State was the company located? 

City: Q32B1CTY State: Q32B1ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q32C1 

D.	 How many years had you been doing this job? 

Q32D1	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

(Next most recent job with exposure) Q32_2 

Page 110 
111.Have you EVER been employed: Q33_1 

In the use of pentachlorophenol? 

Example: Fungifen, Liroprem, Lauxton, 

Permasan, Woodtreat .......................................................... 

ο YES ο NO 

(GO TO Q34) 

ο DK 

(If Yes  Most recent job with exposure) 

A. What is the name of the company for which you worked? 

Q33A1 Q33A1VER 

B.	 In what City and State was the company located? 

City: Q33B1CTY State: Q33B1ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q33C1 

D.	 How many years had you been doing this job? 

Q33D1	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

(Next most recent job with exposure) Q33_2 

Page 111 
112.Have you EVER been employed: Q34_1 

As a hazardous waste worker?........................................... ο YES ο NO 

(GO TO Q35) 

ο DK 

(If Yes  Most recent job with exposure) 

A. What is the name of the company for which you worked? 

Q34A1 Q34A1VER 

B.	 In what City and State was the company located? 

City: Q34B1CTY State: Q34B1ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q34C1 

D.	 How many years had you been doing this job? 

Q34D1	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

(Next most recent job with exposure) Q34_2 

A.	 What is the name of the company for which you worked? 

Q34A2 Q34A2VER 

B.	 In what City and State was the company located? 

City: Q34B2CTY State: Q34B2ST 

C.	 What did you actually do on the job, what were some of your main duties? 

Q34C2 

D.	 How many years had you been doing this job? 

Q34D2	 # Years 

Did you do this work for another company? ο YES ο NO  GO TO Q25 

If Yes Insert extra job pages here Q34_3 

There were 4 job iterations in this series. Only 2 iterations are listed here to establish the naming pattern and 

minimize document size. The last variable in series is Q34_5. Please see the data layout included with the 9/26/03 

data file delivery for a complete listing of all variables included in the loop. 

Page 112 
6. HOME ENVIRONMENT 

Now I’m going to ask you a few questions about your 

home. 

113.Are pesticides, herbicides, fungicides, and germicides (bug or weed killers; flea and tick sprays, 

collars, powders, or shampoos) used in your home, garden, or on pets? Q35 

1. YES 

2. NO 

3. DON’T KNOW 

114.Where does your drinking and cooking water come from? Circle all that apply. 

1. Private well Q36_1 

2. City water Q36_2 

3. Local spring Q36_3 

4. Other Source : Q36_4 Specify Q36OTH__________________ 

5. Don’t know 

7. FOOD HISTORY 

The following questions ask for information about the 

foods that you eat. For each food, I will ask you if you 

have ever eaten this food, and if you have eaten this 

food in the past year. 

115.Have you ever eaten locally caught fish or shellfish (fish 

caught in Lafayette Parish)? Q37 

A. Do you know where the fish was caught? Q37A 

YES 

1 

1 

NO 

2

(GO TO Q54) 

2 

(GO TO 

Q37B) 

DK 

3 

3 

REFUSE 

D 

4 

4 

Please give names and/or locations of fishing areas. 

(Interviewer show participant the map of Lafayette Parish. Ask the participant to show 

areas in which fish they have eaten have been caught. Record each response the 

participant gives.) 

1) Map area # Q37_1 

Name Q37_1NM 

2) Map area # Q37_2 

Name Q37_2NM 

3) Map area # Q37_3 

Name Q37_3NM 

4) Map area # Q37_4 

Name Q37_4NM 

37B. Have you eaten locally caught fish in the past year? Q37B 1 2 3 4 

Page 113 
REFUSE 

YES NO DK D 

116.Have you ever eaten locally caught catfish? Q38 

Q38A A. Have you eaten locally caught catfish in the past year? 

117.Have you ever eaten locally caught gar? Q39 

Q39A A. Have you eaten locally caught gar in the past year? 

118.Have you ever eaten locally caught redfish? Q40 

Q40A A. Have you eaten locally caught redfish in the past year? 

119.Have you ever eaten locally caught perch? Q41 

Q41A A. Have you eaten locally caught perch in the past year? 

1 

1 

1 

1 

1 

1 

1 

1 

2

(GO TO 

Q39) 

2 

2

(GO TO 

Q40) 

2 

2

(GO TO 

Q41) 

2 

2

(GO TO 

Q42) 

2 

3 

3 

3 

3 

3 

3 

3 

3 

4 

4 

4 

4 

4 

4 

4 

4 

120.Have you ever eaten locally caught bass? Q42 

Q42A A. Have you eaten locally caught bass in the past year? 

1 

1 

2

(GO TO 

Q43) 

2 

3 

3 

4 

4 

121.Have you ever eaten locally caught flounder? Q43 

Q43A A. Have you eaten locally caught flounder in the past year? 

1 

1 

2

(GO TO 

Q44) 

2 

3 

3 

4 

4 

122.Have you ever eaten locally caught trout? Q44 

Q44A A. Have you eaten locally caught trout in the past year? 

1 

1 

2 

(GO TO 

Q45) 

2 

3 

3 

4 

4 

123.Have you ever eaten locally caught drum? Q45 

Q45A A. Have you eaten locally caught drum in the past year? 

1 

1 

2 

(GO TO 

Q46) 

2 

3 

3 

4 

4 

124.Have you ever eaten locally caught shrimp? Q46 

Q46 A. Have you eaten locally caught fish in the past year? 

1 

1 

2 

(GO TO 

Q47) 

2 

3 

3 

4 

4 

125.Have you ever eaten locally caught crawfish? Q47 

Q47A A. Have you eaten locally caught crawfish in the past year? 

1 

1 

2 

(GO TO 

Q48) 

2 

3 

3 

4 

4 

126.Have you ever eaten locally caught crab? Q48 

Q48A A. Have you eaten locally caught crab in the past year? 

1 

1 

2 

(GO TO 

Q49) 

2 

3 

3 

4 

4 

127.Have you ever eaten locally caught oysters? Q49 

Q49A A. Have you eaten locally caught oysters in the past year? 

1 

1 

2 

(GO TO 

Q50) 

2 

3 

3 

4 

4 

128.Have you ever eaten locally caught mussels? Q50 1 2 

(GO TO 

Q51) 

3 4 

Page 114 
Q50A A. Have you eaten locally caught mussels in the past year? 1 2 3 4


Page 115

REFUSE 

YES NO DK D 

129.Have you ever eaten locally caught clams? Q51 

Q51A A. Have you eaten locally caught clams in the past year? 

1 

1 

2 

(GO TO 

Q52) 

2 

3 

3 

4 

4 

130.Have you ever eaten locally caught seafood gumbo? Q52 

Q52A A. Have you eaten locally caught seafood gumbo in the past 

1 

1 

2 

(GO TO 

Q53) 

2 

3 

3 

4 

4 

year? 

131.Have you ever eaten other locally caught fish? Q53 

Q53A A. Have you eaten other locally caught fish in the past year? 

1 

1 

2 

(GO TO 

Q54) 

2 

3 

3 

4 

4 

Specify fish Q53OTH_____________________________ 

132.Have you ever eaten vegetables or fruits grown in Lafayette 

Parish? Q54 

Q54A A. Have you eaten vegetables or fruits grown in Lafayette 

1 

1 

2 

(GO TO 

Q55) 

2 

3 

3 

4 

4 

Parish in the past year? 

133.Have you ever eaten beef, poultry, or other meat raised in 

Lafayette Parish? Q55 

Q55A A. Have you eaten beef, poultry, or other meat grown in 

1 

1 

2 

(GO TO 

Q65) 

2 

3 

3 

4 

4 

Lafayette Parish in the past year? 

134.Have you ever eaten locally raised chickens? Q56 

Q56A A. Have you eaten locally raised chickens in the past year? 

1 

1 

2 

(GO TO 

Q57) 

2 

3 

3 

4 

4 

135.Have you ever eaten locally raised pigs? Q57 

Q57A A. Have you eaten locally raised pigs in the past year? 

1 

1 

2 

(GO TO 

Q58) 

2 

3 

3 

4 

4 

136.Have you ever eaten locally raised ducks? Q58 

Q58A A. Have you eaten locally raised ducks in the past year? 

1 

1 

2 

(GO TO 

Q59) 

2 

3 

3 

4 

4 

137.Have you ever eaten locally raised rabbits? Q59 

Q59A A. Have you eaten locally raised rabbits in the past year? 

1 

1 

2 

(GO TO 

Q60) 

2 

3 

3 

4 

4 

138.Have you ever eaten locally raised cows? Q60 

Q60A A. Have you eaten locally raised cows in the past year? 

1 

1 

2 

(GO TO 

Q61) 

2 

3 

3 

4 

4 

139.Have you ever eaten locally raised geese? Q61 

Q61A A. Have you eaten locally raised geese in the past year? 

140.Have you ever eaten locally raised turkey? Q62 

1 

1 

1 

2 

(GO TO 

Q62) 

2 

2 

(GO TO 

Q63) 

3 

3 

3 

4 

4 

4 

Page 116 
Q62A A. Have you eaten locally raised turkey in the past year? 1 2 3 4


Page 117

REFUSE 

YES NO DK D 

141.Have you ever eaten locally raised turtles? Q63 1 2 

(GO TO 

3 4 

Q64) 

Q63A A. Have you eaten locally raised turtles in the past year? 1 2 3 4 

142.Have you ever eaten other locally raised meat? Q64 1 2 

(GO TO 

3 4 

Q65) 

A. Have you eaten other locally raised meat in the past year? 1 2 3 4 

Specify meat Q64OTH___________________________ 

Q64A 

143.Have you ever eaten game caught in Lafayette Parish? Q65 1 2 

(GO TO 

3 4 

Q78) 

A. Have you eaten game caught in Lafayette Parish in the 1 2 3 4 

Q65A past year? 

144.Have you ever eaten locally caught rabbit? Q66 1 2 

(GO TO 

3 4 

Q67) 

Q66A A. Have you eaten locally caught rabbit in the past year? 1 2 3 4 

145.Have you ever eaten locally caught deer? Q67 1 2 

(GO TO 

3 4 

Q68) 

Q67A A. Have you eaten locally caught deer in the past year? 1 2 3 4 

146.Have you ever eaten locally caught raccoon? Q68 1 2 

(GO TO 

3 4 

Q69) 

Q68A A. Have you eaten locally caught raccoon in the past year? 1 2 3 4 

147.Have you ever eaten locally caught squirrel? Q69 1 2 

(GO TO 

3 4 

Q70) 

Q69A A. Have you eaten locally caught squirrel in the past year? 1 2 3 4 

148.Have you ever eaten locally caught duck? Q70 1 2 

(GO TO 

3 4 

Q71) 

Q70A A. Have you eaten locally caught duck in the past year? 1 2 3 4 

149.Have you ever eaten locally caught turtle? Q71 1 2

(GO TO 

3 4 

Q72) 

Q71A A. Have you eaten locally caught turtle in the past year? 1 2 3 4 

150.Have you ever eaten locally caught alligator? Q72 1 2 

(GO TO 

3 4 

Q73) 

Q72A A. Have you eaten locally caught alligator in the past year? 1 2 3 4 

151.Have you ever eaten locally caught nutria? Q73 1 2 

(GO TO 

3 4 

Q74) 

Q73A A. Have you eaten locally caught nutria in the past year? 1 2 3 4 

152.Have you ever eaten locally caught armadillo? Q74 1 2 

(GO TO 

3 4 

Q75) 

Q74A A. Have you eaten locally caught armadillo in the past year? 1 2 3 4 

Page 118 
153.Have you ever eaten locally caught wild geese? Q75 1 2 

(GO TO 

3 4 

Q76) 

Q75A A. Have you eaten locally caught wild geese in the past year? 1 2 3 4 

Page 119 
REFUSE 

YES NO DK D 

154.Have you ever eaten locally caught opossum? Q76 1 2 

(GO TO 

3 4 

Q77) 

Q76A A. Have you eaten locally caught opossum in the past year? 1 2 3 4 

155.Have you ever eaten other locally caught game? Q77 1 2 

(GO TO 

3 4 

Q78) 

A. Have you eaten other locally caught game in the past year? 1 2 3 4 

Specify meat Q77OTH___________________________ 

Q77A 

156.Have you ever eaten eggs raised in Lafayette Parish? Q78 1 2 

(GO TO 

3 4 

Q79) 

A. Have you eaten eggs raised in Lafayette Parish in the 1 2 3 4 

Q78A past year? 

Page 120 
8. VOLATILE ORGANIC COMPOUND EXPOSURE 

Finally, I’m going to ask you some questions concerning 

exposure to volatile organic compounds. 

YES NO DK REFUSED 

157.Have you picked up dry cleaning in the last 24 hours? Q79 1 2 3 4 

158.Have you pumped gasoline in the last 24 hours? Q80 1 2 3 4 

159.Have you smoked a cigarette, cigar, or pipe today? Q81 1 Check 

ineligible 

smoker on 

case label 

2 3 4 

The next questions concern possible sources of 

chemical exposure. I am going to read a list of common 

household items. For each of these I will ask you five 

questions: 

A. B. C. D. E. 

IN THE LAST DID YOU DURING THIS DID YOU DURING THE 

THREE DAYS BREATHE THE TIME BREATHE USE OF THIS 

(TODAY, FUMES FROM ALTOGETHER, FUMES FROM PRODUCT DID 

YESTERDAY, OR THIS PRODUCT HAVE YOU THIS PRODUCT YOU WEAR A 

THE DAY BEFORE OR HAVE IT ON BREATHED FUMES OR HAVE IT ON PROTECTIVE 

YESTERDAY) HAVE YOUR SKIN FROM THIS YOUR SKIN MASK? 

YOU EITHER TODAY? PRODUCT OR HAD WHILE YOU 

BREATHED FUMES IT ON YOUR SKIN WERE 

FROM THIS FOR LONGER WORKING AT 

PRODUCT OR HAD THAN 30 YOUR JOB? 

IT ON YOUR SKIN? MINUTES. 

(IWER: IF NO, 

SKIP QUESTIONS 

B-E AND GO TO 

NEXT 

PRODUCT). 

Product 

160.Diesel fuel or 1. Yes Q82A 1. Yes Q82B 1. Yes Q82C 1. Yes Q82D 1. Yes Q84E 

kerosene 2. No (Go to next 2. No 2. No 2. No 2. No 

product) 

3. DK 

4. Refused 

3. DK 

4. Refused 

3. DK 

4. Refused 

3. DK 

4. Refused 

3. DK 

4. Refused 

161.Gasoline 1. Yes Q83A 1. Yes Q83B 1. Yes Q83C 1. Yes Q83D 1. Yes Q83E 

2. No (Go to next 2. No 2. No 2. No 2. No 

product) 

3. DK 

4. Refused 

3. DK 

4. Refused 

3. DK 

4. Refused 

3. DK 

4. Refused 

3. DK 

4. Refused 

162.Paint thinner, 1. Yes Q84A 1. Yes Q84B 1. Yes Q84C 1. Yes Q84D 1. Yes Q84E 

brush 2. No (Go to next 2. No 2. No 2. No 2. No 

cleaner, 

furniture 

stripper, 

product) 

3. DK 

4. Refused 

3. DK 

4. Refused 

3. DK 

4. Refused 

3. DK 

4. Refused 

3. DK 

4. Refused 

benzene, 

carbon 

tetrachloride 

Page 121 
A. B. C. D. E. 

IN THE LAST DID YOU DURING THIS DID YOU DURING THE 

THREE DAYS BREATHE THE TIME BREATHE USE OF THIS 

(TODAY, FUMES FROM ALTOGETHER, FUMES FROM PRODUCT DID 

YESTERDAY, OR THIS PRODUCT HAVE YOU THIS PRODUCT YOU WEAR A 

THE DAY BEFORE OR HAVE IT ON BREATHED FUMES OR HAVE IT ON PROTECTIVE 

YESTERDAY) HAVE 

YOU EITHER 

YOUR SKIN 

TODAY? 

FROM THIS 

PRODUCT OR HAD 

YOUR SKIN 

WHILE YOU 

MASK? 

BREATHED FUMES IT ON YOUR SKIN WERE 

FROM THIS FOR LONGER WORKING AT 

PRODUCT OR HAD THAN 30 YOUR JOB? 

IT ON YOUR SKIN? MINUTES. 

(IWER: IF NO, 

SKIP QUESTIONS 

B-E AND GO TO 

NEXT 

Product 

PRODUCT). 

163.Varnish, lacquer, 

wood stain, 

or wet paint 

1. Yes Q85A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q85B 

2. No 

3. DK 

4. Refused 

1. Yes Q85C 

2. No 

3. DK 

4. Refused 

1. Yes Q85D 

2. No 

3. DK 

4. Refused 

1. Yes Q85E 

2. No 

3. DK 

4. Refused 

164.Model glue or 

other 

adhesives 

1. Yes Q86A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q86B 

2. No 

3. DK 

4. Refused 

1. Yes Q86C 

2. No 

3. DK 

4. Refused 

1. Yes Q86D 

2. No 

3. DK 

4. Refused 

1. Yes Q86E 

2. No 

3. DK 

4. Refused 

165.Bug or insect 

spray 

1. Yes Q87A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q87B 

2. No 

3. DK 

4. Refused 

1. Yes Q87C 

2. No 

3. DK 

4. Refused 

1. Yes Q87D 

2. No 

3. DK 

4. Refused 

1. Yes Q87E 

2. No 

3. DK 

4. Refused 

166.Weed killer 1. Yes Q88A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q88B 

2. No 

3. DK 

4. Refused 

1. Yes Q88C 

2. No 

3. DK 

4. Refused 

1. Yes Q88D 

2. No 

3. DK 

4. Refused 

1. Yes Q88E 

2. No 

3. DK 

4. Refused 

167.Solid toilet bowl 

deodorizers 

1. Yes Q89A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q89B 

2. No 

3. DK 

4. Refused 

1. Yes Q89C 

2. No 

3. DK 

4. Refused 

1. Yes Q89D 

2. No 

3. DK 

4. Refused 

1. Yes Q89E 

2. No 

3. DK 

4. Refused 

168.Air freshener or 

room 

deodorizer 

1. Yes Q90A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q90B 

2. No 

3. DK 

4. Refused 

1. Yes Q90C 

2. No 

3. DK 

4. Refused 

1. Yes Q90D 

2. No 

3. DK 

4. Refused 

1. Yes Q90E 

2. No 

3. DK 

4. Refused 

169.Pressure treated 

lumber/wood 

products 

1. Yes Q91A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q91B 

2. No 

3. DK 

4. Refused 

1. Yes Q91C 

2. No 

3. DK 

4. Refused 

1. Yes Q91D 

2. No 

3. DK 

4. Refused 

1. Yes Q91E 

2. No 

3. DK 

4. Refused 

170.Fingernail polish 

or nail polish 

remover 

1. Yes Q92A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q92B 

2. No 

3. DK 

4. Refused 

1. Yes Q92C 

2. No 

3. DK 

4. Refused 

1. Yes Q92D 

2. No 

3. DK 

4. Refused 

1. Yes Q92E 

2. No 

3. DK 

4. Refused 

Page 122 
A. B. C. D. E. 

IN THE LAST DID YOU DURING THIS DID YOU DURING THE 

THREE DAYS BREATHE THE TIME BREATHE USE OF THIS 

(TODAY, FUMES FROM ALTOGETHER, FUMES FROM PRODUCT DID 

YESTERDAY, OR THIS PRODUCT HAVE YOU THIS PRODUCT YOU WEAR A 

THE DAY BEFORE OR HAVE IT ON BREATHED FUMES OR HAVE IT ON PROTECTIVE 

YESTERDAY) HAVE 

YOU EITHER 

YOUR SKIN 

TODAY? 

FROM THIS 

PRODUCT OR HAD 

YOUR SKIN 

WHILE YOU 

MASK? 

BREATHED FUMES IT ON YOUR SKIN WERE 

FROM THIS FOR LONGER WORKING AT 

PRODUCT OR HAD THAN 30 YOUR JOB? 

IT ON YOUR SKIN? MINUTES. 

(IWER: IF NO, 

SKIP QUESTIONS 

B-E AND GO TO 

NEXT 

Product 

PRODUCT). 

171.Dry-cleaning 

liquid or spot 

remover 

1. Yes Q93A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q93B 

2. No 

3. DK 

4. Refused 

1. Yes Q93C 

2. No 

3. DK 

4. Refused 

1. Yes Q93D 

2. No 

3. DK 

4. Refused 

1. Yes Q93E 

2. No 

3. DK 

4. Refused 

172.Hair Dyes 1. Yes Q94A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q94B 

2. No 

3. DK 

4. Refused 

1. Yes Q94C 

2. No 

3. DK 

4. Refused 

1. Yes Q94D 

2. No 

3. DK 

4. Refused 

1. Yes Q94E 

2. No 

3. DK 

4. Refused 

173.Cutting or 

sanding 

wood 

1. Yes Q95A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q95B 

2. No 

3. DK 

4. Refused 

1. Yes Q95C 

2. No 

3. DK 

4. Refused 

1. Yes Q95D 

2. No 

3. DK 

4. Refused 

1. Yes Q95E 

2. No 

3. DK 

4. Refused 

174.Household 

bleach 

1. Yes Q96A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q96B 

2. No 

3. DK 

4. Refused 

1. Yes Q96C 

2. No 

3. DK 

4. Refused 

1. Yes Q96D 

2. No 

3. DK 

4. Refused 

1. Yes Q96E 

2. No 

3. DK 

4. Refused 

175.Cleaners with 

bleach 

1. Yes Q97A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q97B 

2. No 

3. DK 

4. Refused 

1. Yes Q97C 

2. No 

3. DK 

4. Refused 

1. Yes Q97D 

2. No 

3. DK 

4. Refused 

1. Yes Q97E 

2. No 

3. DK 

4. Refused 

176.Oven cleaners 1. Yes Q98A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q98B 

2. No 

3. DK 

4. Refused 

1. Yes Q98C 

2. No 

3. DK 

4. Refused 

1. Yes Q98D 

2. No 

3. DK 

4. Refused 

1. Yes Q98E 

2. No 

3. DK 

4. Refused 

177.Rug cleaners 1. Yes Q99A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q99B 

2. No 

3. DK 

4. Refused 

1. Yes Q99C 

2. No 

3. DK 

4. Refused 

1. Yes Q99D 

2. No 

3. DK 

4. Refused 

1. Yes Q99E 

2. No 

3. DK 

4. Refused 

178.Drain cleaner 1. Yes Q100A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q100B 

2. No 

3. DK 

4. Refused 

1. Yes Q100C 

2. No 

3. DK 

4. Refused 

1. Yes Q100D 

2. No 

3. DK 

4. Refused 

1. Yes Q100E 

2. No 

3. DK 

4. Refused 

Page 123 
A. B. C. D. E. 

IN THE LAST DID YOU DURING THIS DID YOU DURING THE 

THREE DAYS BREATHE THE TIME BREATHE USE OF THIS 

(TODAY, FUMES FROM ALTOGETHER, FUMES FROM PRODUCT DID 

YESTERDAY, OR THIS PRODUCT HAVE YOU THIS PRODUCT YOU WEAR A 

THE DAY BEFORE OR HAVE IT ON BREATHED FUMES OR HAVE IT ON PROTECTIVE 

YESTERDAY) HAVE 

YOU EITHER 

YOUR SKIN 

TODAY? 

FROM THIS 

PRODUCT OR HAD 

YOUR SKIN 

WHILE YOU 

MASK? 

BREATHED FUMES IT ON YOUR SKIN WERE 

FROM THIS FOR LONGER WORKING AT 

PRODUCT OR HAD THAN 30 YOUR JOB? 

IT ON YOUR SKIN? MINUTES. 

(IWER: IF NO, 

SKIP QUESTIONS 

B-E AND GO TO 

NEXT 

Product 

PRODUCT). 

179.Stain repellent 1. Yes Q101A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q101B 

2. No 

3. DK 

4. Refused 

1. Yes Q101C 

2. No 

3. DK 

4. Refused 

1. Yes Q101D 

2. No 

3. DK 

4. Refused 

1. Yes Q101 

2. No 

3. DK 

4. Refused 

180.VCR cleaner 1. Yes Q102A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q102B 

2. No 

3. DK 

4. Refused 

1. Yes Q102C 

2. No 

3. DK 

4. Refused 

1. Yes Q102D 

2. No 

3. DK 

4. Refused 

1. Yes Q102E 

2. No 

3. DK 

4. Refused 

181.Video disk 

cleaner 

1. Yes Q103A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q103B 

2. No 

3. DK 

4. Refused 

1. Yes Q103C 

2. No 

3. DK 

4. Refused 

1. Yes Q103D 

2. No 

3. DK 

4. Refused 

1. Yes Q103E 

2. No 

3. DK 

4. Refused 

182.Tape recorder 

cleaner 

1. Yes Q104A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q104B 

2. No 

3. DK 

4. Refused 

1. Yes Q104C 

2. No 

3. DK 

4. Refused 

1. Yes Q104D 

2. No 

3. DK 

4. Refused 

1. Yes Q104E 

2. No 

3. DK 

4. Refused 

183.Typewriter 

correction 

fluid 

1. Yes Q105A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q105B 

2. No 

3. DK 

4. Refused 

1. Yes Q105C 

2. No 

3. DK 

4. Refused 

1. Yes Q105D 

2. No 

3. DK 

4. Refused 

1. Yes Q105E 

2. No 

3. DK 

4. Refused 

184.Paint primer 1. Yes Q106A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q106B 

2. No 

3. DK 

4. Refused 

1. Yes Q106C 

2. No 

3. DK 

4. Refused 

1. Yes Q106D 

2. No 

3. DK 

4. Refused 

1. Yes Q106E 

2. No 

3. DK 

4. Refused 

185.Rust remover 1. Yes Q107A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q107B 

2. No 

3. DK 

4. Refused 

1. Yes Q107C 

2. No 

3. DK 

4. Refused 

1. Yes Q107D 

2. No 

3. DK 

4. Refused 

1. Yes Q107E 

2. No 

3. DK 

4. Refused 

186.Spray paint 1. Yes Q108A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q108B 

2. No 

3. DK 

4. Refused 

1. Yes Q108C 

2. No 

3. DK 

4. Refused 

1. Yes Q108D 

2. No 

3. DK 

4. Refused 

1. Yes Q108E 

2. No 

3. DK 

4. Refused 

Page 124 
Product 

A. 

IN THE LAST 

THREE DAYS 

(TODAY, 

YESTERDAY, OR 

THE DAY BEFORE 

YESTERDAY) HAVE 

YOU EITHER 

BREATHED FUMES 

FROM THIS 

PRODUCT OR HAD 

IT ON YOUR SKIN? 

(IWER: IF NO, 

SKIP QUESTIONS 

B-E AND GO TO 

NEXT 

PRODUCT). 

B. 

DID YOU 

BREATHE THE 

FUMES FROM 

THIS PRODUCT 

OR HAVE IT ON 

YOUR SKIN 

TODAY? 

C. 

DURING THIS 

TIME 

ALTOGETHER, 

HAVE YOU 

BREATHED FUMES 

FROM THIS 

PRODUCT OR HAD 

IT ON YOUR SKIN 

FOR LONGER 

THAN 30 

MINUTES. 

D. 

DID YOU 

BREATHE 

FUMES FROM 

THIS PRODUCT 

OR HAVE IT ON 

YOUR SKIN 

WHILE YOU 

WERE 

WORKING AT 

YOUR JOB? 

E. 

DURING THE 

USE OF THIS 

PRODUCT DID 

YOU WEAR A 

PROTECTIVE 

MASK? 

187.Spray shoe 

polish 

1. Yes Q109A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q109B 

2. No 

3. DK 

4. Refused 

1. Yes Q109C 

2. No 

3. DK 

4. Refused 

1. Yes Q109D 

2. No 

3. DK 

4. Refused 

1. Yes Q109E 

2. No 

3. DK 

4. Refused 

188.Water repellent 1. Yes Q110A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q110B 

2. No 

3. DK 

4. Refused 

1. Yes Q110C 

2. No 

3. DK 

4. Refused 

1. Yes Q110D 

2. No 

3. DK 

4. Refused 

1. Yes Q110E 

2. No 

3. DK 

4. Refused 

189.Suede protector 1. Yes Q111A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q111B 

2. No 

3. DK 

4. Refused 

1. Yes Q111C 

2. No 

3. DK 

4. Refused 

1. Yes Q111D 

2. No 

3. DK 

4. Refused 

1. Yes Q111E 

2. No 

3. DK 

4. Refused 

190.Degummers 1. Yes Q112A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q112B 

2. No 

3. DK 

4. Refused 

1. Yes Q112C 

2. No 

3. DK 

4. Refused 

1. Yes Q112D 

2. No 

3. DK 

4. Refused 

1. Yes Q112E 

2. No 

3. DK 

4. Refused 

191.Tire cleaner 1. Yes Q113A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q113B 

2. No 

3. DK 

4. Refused 

1. Yes Q113C 

2. No 

3. DK 

4. Refused 

1. Yes Q113D 

2. No 

3. DK 

4. Refused 

1. Yes Q113E 

2. No 

3. DK 

4. Refused 

192.Door spray 

lubricant 

1. Yes Q114A 

2. No (Go to next 

product) 

3. DK 

4. Refused 

1. Yes Q114B 

2. No 

3. DK 

4. Refused 

1. Yes Q114C 

2. No 

3. DK 

4. Refused 

1. Yes Q114D 

2. No 

3. DK 

4. Refused 

1. Yes Q114E 

2. No 

3. DK 

4. Refused 

Page 125 
9. CONTACT INFORMATION 

193.In case we want to contact you again, keeping in mind that people move, we would like to get a little more 

information to help us locate you in the future. In case you move to another residence could we have the 

names and addresses of two people who live outside of your household who would always know how to 

find you? Q115 

1. YES 

2. NO  GO TO END 

3. DON’T KNOW 

4. REFUSED 

194.Contact #1 Information 

First Name: Q116_FNA What is Contact #1 relationship to you? 

Last Name: Q116_LNA Q116REL 

Address Line 1: Q116_AD1 1. Parent 

Line2apt#: Q116_AD2 2. Grandparent 

City: Q116_CTY 3. Friend 

State: Q116_ST 4. Neighbor 

Zip code: Q116_ZIP 5. Coworker 

Telephone ( ) Q116_PH 6. Other specify Q116OTH ___________ 

195.Contact #2 Information 

First Name: Q117_FNA What is Contact #2 relationship to you? 

Last Name: Q117_LNA Q117REL 

Address Line 1: Q117_AD1 1. Parent 

Line2apt#: Q117_AD2 2. Grandparent 

City: Q114_CTY 3. Friend 

State: Q117_ST 4. Neighbor 

Zip code: Q117_ZIP 5. Coworker 

Telephone ( ) Q117_PH 6. Other specify Q117OTH____________ 

End of survey. 

126

IWER: Please thank respondent for their participation and 

move them to the blood draw area for the next phase of the study. 

127

APPENDIX G


Dioxin Specimen Preparation and Shipping


128

WHOLE BLOOD COLLECTION AND PROCESSING FOR DIOXIN 

TUBE METHOD 

NOTE: UNIVERSAL PRECAUTIONS SHOULD BE OBSERVED AT ALL TIMES WHEN 

COLLECTING AND HANDLING BODILY FLUIDS AS OUTLINED BY CDC. REFER TO MMWR 

VOLUME 36/NO. 2S. 

A. COLLECTION PROCEDURE 

1. Materials needed per participant. 

-Gauze sponges 

-Alcohol wipe 

-Bandaid 

-10 mL non-siliconized red top tubes (Each tube of whole blood will yield approximately 4 

to 5 mls of serum 

-19g or 21g 3/4" butterfly assembly with multiple sample luer adapter 

-Preprinted labels 

-Tourniquet 

-Vacutainer holder 

2. Venipuncture procedure. 

-Locate a suitable table and chair for blood collecting and lay out blood collection supplies. 

-Locate the puncture site. Hold with 2 fingers on one side of the "alcohol wipe" so that only 

the other side touches the puncture site. Wipe the area in a circular motion beginning with a 

narrow radius and moving outward so as not to cross over the area already cleaned. Repeat 

with a second alcohol wipe. 

-Locate vein and cleanse in manner previously described, then apply the tourniquet. If it is 

necessary to feel the vein again, do so; but after you feel it, cleanse with alcohol prep again, 

and dry with a sterile gauze square. 

-Fix the vein by pressing down on the vein about 1 inch below the proposed point of entry 

into the skin and pull the skin taut. 

-Approach the vein in the same direction the vein is running, holding the needle so that a 15o 

angle with the examinee's arm. 

-With bevel facing up, push the needle (either butterfly or regular needle) firmly and 

deliberately into the vein. Tape the needle in place to allow both hands to be free for 

collecting the tubes of blood. Activate the vacuum collection tube. If the needle is in the 

vein, blood will flow freely into the tube. If no blood enters the tube, probe for the vein until 

entry is indicated by blood flowing into the tube. 

-For collection, loosen the tourniquet immediately after blood flow is established and release 

129

entirely as the last tube fills. Collect the red top tubes and label with the appropriate label. 

Place the tubes upright in a rack and allow to clot. 

-After the last tube has filled, withdraw the needle with a swift backward motion. When the 

needle is out of the arm, press gauze firmly on the puncture. Heavy pressure as the needle is 

being withdrawn should be avoided because it may cause the sharp point of the needle to cut 

the vein. 

-Have the examinee raise his arm (not bend it) and continue to hold the gauze in place for 

several minutes. This will help prevent hematomas and bruising. 

-Report to the physician any reaction experienced by the participant during the venipuncture 

procedure. 

-Label all tubes with the preprinted labels provided, and use a ballpoint pen to add the date 

collected and your initials to the label. 

-Place a bandaid on the subject's arm. 

B. SERUM PROCESSING PROCEDURE 

1. Materials and Equipment Needed per Participant 

-Disposable pipet


-30 mL (1 oz.) glass bottle for SERUM DIOXIN with Teflon-lined screw cap


-7 ml glass vial with white screw cap for SERUM LIPIDS


-Preprinted labels


-Centrifuge


-Freezer (-20oC) or dry ice


2. Processing 

-After the blood has been allowed to clot at room temperature for 20- 30 minutes, centrifuge the 

red-top tubes for 15 minutes at the rpm necessary to attain a force of 1000 g. To calculate the 

number of rpm necessary to attain 1000 g, use the following formula: 

rpm = 9450//r, 

where r is the distance in centimeters from the center of rotation to the bottom of a test tube 

when it is extended in the centrifuge head. 

Example: for r = 16, rpm = approximately 2400. 

-Using preprinted labels for each participant, label each of the containers as follows: 

Priority Size/Type Container Container Label 

130

1. 30 mL glass bottle	 SERUM DIOXIN 

2.	 7 mL glass vial SERUM LIPIDS 

-Use a ballpoint pen to add the date collected and your initials to the labels 

on all containers. 

-To maximize the amount of serum recovered from all of the red top 

tubes, do the following: 

1.	 Using a disposable pipet, transfer all of the serum that is free of red 

cells from each red top tube to the 30 mL glass bottle. 

2.	 Any remaining serum left in the red top tubes that may have become 

mixed with red cells should be transferred to a clean 10 mL red top 

tube. Extra tubes are provided for this purpose. 

3.	 Centrifuge for 10 minutes and transfer the clear serum to the glass 

bottle containing the serum originally harvested. Prepare a lipid 

aliquot from this serum by adding about 2-3 mls to the 7 ml glass vial 

with the white screw cap. Recap both bottles and freeze. Place 

upright in a -20oC (or lower) freezer and store at the same temperature 

until shipment to the CDC on dry ice. 

131

SHIPPING INSTRUCTIONS


1.	 Place the glass bottles in the boxes that are provided. Place each box inside a ziplock bag and seal the bag. 

2.	 Place the bagged specimen boxes inside the styrofoam shipping container. Add 

10-15 lbs of dry ice to the shipper and place extra packing material around the 

specimens (newspaper, paper towels, etc.) 

3.	 Prepare a Federal Express airbill for shipping and mark the appropriate boxes 

including the one for dry ice shipment and overnight delivery. Place a dry ice 

sticker on the outside of the shipping box. 

Shipping address: 

Charles Dodson TEL: (770) 488-4305 FAX: (770) 488-4541 

Centers for Disease Control 

Building 17 Loading Dock 

4770 Buford Highway NE 

Atlanta GA 30341 

4. Please phone or fax to the above numbers to inform the day the package is 

shipped. Ship only on Monday - Thursday to insure that the package will arrive 

during a regular work day and not over a weekend day. 

132

APPENDIX H


Health Education Materials


133

Household Listing Brochure 

Exposure Investigation of Dioxins and Volatile Organic Compounds 

in Calcasieu and Lafayette Parishes, Louisiana 

Several years ago, some citizens from Calcasieu Parish, Louisiana, were found to have higherthan-expected levels of chemicals called dioxins in their blood. To follow up on that finding, the 

Agency for Toxic Substances and Disease Registry (ATSDR), a public health agency of the U.S. 

Department of Health and Human Services, is planning an investigation to determine the amount 

of dioxins and other chemicals, called volatile organic compounds (VOCs), present in people 

who live in Calcasieu and Lafayette parishes. 

ATSDR wants to find out if there is any difference between the two parishes in the amounts of 

these chemicals in people’s blood. If differences are found, ATSDR will look at the people with 

higher levels to see if they have anything in common that might cause the differences. This 

exposure investigation also will give ATSDR scientists information on the amount of dioxins 

and VOCs among area residents, as well as their ages, eating habits, place of work, and place of 

residence. ATSDR will examine this information to find out if residents of these areas are 

exposed to unusual levels of dioxins and VOCs and how people may be exposed to them. 

The First Step —A Household Listing 

ATSDR has hired the National Opinion Research Center (NORC) to visit households in 

communities in Calcasieu and Lafayette parishes to make a list of everyone who lives in those 

areas. NORC researchers will make a door-to-door survey of households in these neighborhoods 

during January and February, 2002. You will be asked to give the names and ages of those who 

live in your household. Your help in answering these questions is very important to the success 

of this exposure investigation. 

The Second Step — The Study 

Some of the residents of Calcasieu and Lafayette parishes who are identified in the household 

listing will be contacted again by NORC in April or May, 2002. These residents will be invited 

to take part in an interview and asked to give a blood and urine sample for testing. 

If you have any questions, please call the NORC toll-free number at 1 (816) 835-6672. 

Questions and Answers About the Exposure Investigation 

What is ATSDR? 

The Agency for Toxic Substances and Disease Registry (ATSDR) is a public health agency in 

the U.S. Department of Health and Human Services. ATSDR headquarters are in Atlanta, 

Georgia. The agency’s mission is to serve the public by using the best science, taking responsive 

134

public health actions, and providing trusted health information to prevent harmful exposures and 

disease related to toxic substances. 

What is NORC?Who is Conducting this Census?

 NORC is a non-profit research center affiliated with the University of Chicago that conducts 

research in the public interest for government agencies, colleges and universities, foundations, 

non-profit organizations, and private corporations. ATSDR has hired the National Opinion 

Research Center (NORC) at the University of Chicago to do a door-to-door survey of households 

in your community to gather information from residents for the household listing. 

What are dioxins? A group of chemicals commonly called dioxins are a family of similar 

chemicals. Dioxins are found in the air, water, and soil. They are not made on purpose, but result 

from burning fuel, wood, and waste, and from making certain products. When they get into the 

soil, air, and water, they can enter your body and stay in your blood and body fat for a long time. 

What are volatile organic compounds (VOCs)? What are Volatile Organic Compounds 

(VOCs)VOCs is the name of a group of similar chemicals that change from liquid into gas 

(evaporate) very quickly. This means that they get into the air easily. Some common things that 

have VOCs in them are gasoline, kerosene, nail polish remover, paints, paint thinners, dry 

cleaning fluid, cleaning products, pesticides, glues, permanent markers, building materials, and 

home furnishings. Almost everyone is exposed to VOCs. 

Why do you need to know how many people live here? 

ATSDR will select a research sample for the investigation from household members in your 

community. ATSDR wants to be sure that this study represents people of all ages in your 

community. 

Why should I answer the questions? 

Answering the questions for the household listing will only take a few minutes of your time, and 

your answers will help find answers to some important questions about exposure to dioxins and 

VOCs in your community. 

135

What if I don’t want to answer the questions? 

Answering the questions for the household listing is voluntary, and you may refuse if you wish. 

We hope you will take part, because for the study to be complete, all of the households in your 

area need to be on the listing. 

Will my answers be kept private? 

Yes, your answers will be private. All information you give is solely for the use of ATSDR for 

this investigation. The Privacy Law, a special federal law, protects you answers. This law 

requires all federal agencies to maintain the privacy of citizens. No information that would 

identify any individual may be released. The law also requires that ATSDR protects your privacy 

in the ways personal information is collected and handled. 

Will I be called later? 

You may or may not be asked to take part in the second part of the investigation. A group of 

residents, picked at random from the household listing, will be called in April or May and invited 

to take part in the interview and testing. 

If I answer the questions in the first part of the study, do I have to take part in the second 

part? 

No. Your participation is up to you, but by participating you will help to determine if people in 

Calcasieu and Lafayette parishes are being exposed to unusual levels of dioxins and VOCs. 

136

Study Fact Sheet for Eligible Residents 

The 2002 Dioxin Study 

The Louisiana Calcasieu and Lafayette Parishes Dioxins and Volatile Organic Compounds 

Exposure Investigation 

Several years ago, some citizens from Calcasieu Parish, Louisiana, were found to have higher-thanexpected levels of dioxins in their blood. To follow up on that finding, the Agency for Toxic 

Substances and Disease Registry (ATSDR), a public health agency of the U.S. Department of 

Health and Human Services, is doing a study to find out the amount of dioxins in people who live in 

Calcasieu parish. As part of the study, we will also look at the amount of volatile organic 

compounds (VOCs) in selected parish residents. 

Purpose of the Study 

We are doing this study to see if people in Calcasieu Parish are being exposed to unusual levels of 

dioxins or volatile organic compounds. In order to find out, we will compare the dioxin and volatile 

organic compound levels of people in Calcasieu Parish with those of people in Lafayette Parish. If 

we find differences in the levels, we will look to see if there are any patterns to the differences. 

The results of the study will tell us if people in Calcasieu Parish are being exposed to unusual levels 

of dioxins and VOCs. 

Who can participate? 

Participants must be: 

1. 15 years old or older 

1. Have lived in their parish for the last 5 years. 

2. Residents of Lafayette Parish may never have lived in Calcasieu Parish. 

3. Participants must be able to have blood drawn. 

We will choose 288 participants in Calcasieu Parish and 112 participants in Lafayette Parish 

to be in the study. 

How the study is being conducted 

Step 1 - We made a list of everyone who could be in the study. Your name was selected as a 

person who might be able to participate in the study. 

Step 2 – We will call people to ask them a few more questions. Those people who are still able 

to participate will be asked to join the study. 

Each participant will be asked to answer questions about their job, the food they eat, and contact 

with various substances. We will collect a blood sample (about 4 tablespoons). This will take 

about one, but no more than two, hours. We will give you $50.00 for your time and travel. 

Why should I participate if I’m asked? 

Study participants are scientifically selected to represent many people in the parish. When 

137

we have a good sample of people, it is not necessary to test everyone in order to draw conclusions 

about the parish. If you are asked to be in the study, your participation will make our results 

stronger. 

What is dioxin? 

Dioxin is not one chemical, but a family of 75 similar compounds. The toxicity of each of the 

compounds is different. Dioxins are found in the air, water, and soil. They are not made on purpose, 

but result from burning fuel, wood, and waste, and from making certain products. When they get 

into the soil, air, and water, they enter the body and are stored in fat. Dioxin leaves the body very 

slowly. The time it takes for one-half of the most toxic type of dioxin to leave your body is 

estimated to be seven to twelve years. Everyone has some dioxin in his or her body. 

The best-known health effect from high levels of dioxin exposure is a skin problem. This 

skin problem is called chloracne, a severe form of acne. Other health effects linked with dioxins are 

problems of the immune system, developing nervous system, endocrine system, and reproductive 

functions. Dioxin exposure is linked with several types of cancer. 

What are Volatile Organic Compounds (VOCs) 

VOCs are a group of similar chemicals that evaporate very quickly and get into the air easily. 

Some common things that have VOCs in them are gasoline, kerosene, nail polish remover, paints, 

paint thinners, dry cleaning fluid, cleaning products, pesticides, glues, permanent markers, building 

materials, and home furnishings. Everyone is exposed to VOCs. 

The health effects of different VOCs vary. Some VOCs linked with health problems are 

benzene, vinyl chloride, and ethylene dichloride (EDC). High levels of VOCs can cause dizziness, 

headache, and sleepiness. They can also cause confusion, nausea, difficulty in speaking and 

walking, unconsciousness, and death. Breathing VOCs for long periods of time can result in liver, 

kidney and nerve damage, immune reactions, various blood disorders, liver cancer and leukemia. 

The Agency for Toxic Substances and Disease Registry 

The Agency for Toxic Substances and Disease Registry (ATSDR) is an agency of the U.S. 

Department of Health and Human Services. ATSDR is headquartered in Atlanta, Georgia. The 

agency’s mission is to serve the public by using the best science, taking responsive public health 

actions, and providing trusted health information to help prevent harmful exposures and disease 

related to toxic substances. 

For more information about this study, please contact: 

M. Deborah Millette, Epidemiologist 

The Agency for Toxic Substances and Disease Registry, Division of Health Studies, Health 

Investigations Branch, 1600 Clifton Road E-31, Atlanta, Georgia 30333 

Direct Line: 404-498-0563 

Toll-free number 888-422-8737 

Website: http://www.atsdr.cdc.gov 

138

The 2002 Dioxin Study 

Fact Sheet for Community Members 

The Louisiana Calcasieu and Lafayette Parishes Dioxins and


 Volatile Organic Compounds Exposure Investigation


Several years ago, some citizens of Calcasieu Parish, Louisiana, were found to have higher-thanexpected levels of dioxins in their blood. To follow up on that finding, the Agency for Toxic 

Substances and Disease Registry (ATSDR), a public health agency of the U.S. Department of 

Health and Human Services, is conducting an investigation to determine the amount of dioxins 

present in people who live in Calcasieu parish. As part of the study, we will look at the amount 

of volatile organic compounds (VOCs) present in selected parish residents. 

What are dioxins? 

Dioxin is not one chemical, but a family of 75 similar compounds. The toxicity of each of the


compounds is different. Dioxins are found in the air, water, and soil. They are not made on


purpose, but result from burning fuel, wood, and waste, and from certain manufacturing


processes. When they get into the soil, air, and water, they enter the body and are stored in fat.


Dioxin leaves the body very slowly. The time it takes for one-half of the most toxic type of


dioxin to leave a person=s body is estimated to be seven to twelve years. Everyone has some


dioxin in his or her body.


The most familiar health effect from high levels of dioxin exposure is a skin condition called


chloracne, a severe form of acne. Other health effects linked with dioxins are problems of the


immune system, developing nervous system, endocrine system, and reproductive functions.


Dioxin exposure is also linked with several types of cancer.


What are Volatile Organic Compounds (VOCs)?


VOCs are a group of similar chemicals that evaporate very quickly and get into the air easily.


Some common things that have VOCs in them are gasoline, kerosene, nail polish remover,


paints, paint thinners, dry cleaning fluid, cleaning products, pesticides, glues, permanent


markers, building materials, and home furnishings. Everyone is exposed to VOCs.


The health effects of different VOCs vary. Some VOCs associated with adverse health effects


are: Benzene, Tetrachloroethylene (TCE), Vinyl Chloride, Ethylene Dichloride (EDC), and


Carbon Tetrachloride. High levels of VOCs can cause dizziness, headache, sleepiness, confusion,


nausea, difficulty in speaking and walking, unconsciousness, and death. Breathing VOCs for


long periods of time can result in liver damage, kidney damage, immune reactions, nerve


damage, liver cancer, various blood disorders, and leukemia.


What is the purpose of this study? 

The purpose of this study is to see if people in Calcasieu Parish are being exposed to unusual 

levels of dioxins or volatile organic compounds. In order to determine that, we will compare the 

139

dioxin and volatile organic compound levels of people in Calcasieu Parish with those of people


in Lafayette Parish. If we find differences in the levels, we will look to see if there are any


patterns to the differences. The results of the study will tell us if people in Calcasieu Parish are


being exposed to unusual levels of dioxins and VOCs.


Who can participate?


We will choose 288 participants from Calcasieu Parish and 112 participants from Lafayette


Parish who must meet the following requirements to be in the study.


_ Participants must be at least 15 years old. 

_ Participants must have lived in either Calcasieu or LaFayette Parish for the last 5 years 

(residents of Lafayette Parish must never have lived in Calcasieu Parish). 

_ Participants must be able to provide a blood sample. 

How is the study being conducted?


The first step in the study process compiling a list of possible participants is complete. Your


name was selected as a person who might be qualified to participate.


Next, some of the people on the list will be called to confirm that they meet the requirements


listed above, and to ask their participation in the study. Each participant will be asked questions


about their occupation, food consumption, and exposure to various substances.


At the appropriate time, an appointment will be made for collecting a blood sample (about 4


tablespoons) specimen. This will take about one to two hours. Participants will receive $50.00


for their time and transportation costs.


Why should I participate if I’m asked?


If you are asked to be in the study, your participation will make our results stronger. Study


participants are scientifically selected to represent many people in the parish. When we have a


scientific representation of people, it is not necessary to test everyone in order to draw health


conclusions about the parish and achieve the study=s objective.


The Agency for Toxic Substances and Disease Registry


The Agency for Toxic Substances and Disease Registry (ATSDR), located in Atlanta, is an


agency of the U.S. Department of Health and Human Services. The agency’s mission is to serve


the public by using the best science, taking responsive public health actions, and providing


trusted health information to help prevent harmful exposures and disease related to toxic


substances. More information about ATSDR and its public health activities can be found at


www.atsdr.cdc.gov.


For more information about the 2002 dioxin study, please contact: 

M. Deborah Millette, Epidemiologist 

Agency for Toxic Substances and Disease Registry 

Division of Health Studies 

Health Investigations Branch 

140

1600 Clifton Road, MS E-31


Atlanta, Georgia 30333


Phone: (404) 498-0563, (404) 498-0563 (toll free)


Dmillette@cdc.gov


141

Health Profession Study Fact Sheet 

The 2002 Dioxin Study 

The Louisiana Calcasieu and Lafayette Parishes Dioxins and Volatile Organic Compounds 

Exposure Investigation 

Several years ago, some citizens from Calcasieu Parish, Louisiana, were found to have higher-thanexpected levels of dioxins in their blood. To follow up on that finding, the Agency for Toxic 

Substances and Disease Registry (ATSDR), a public health agency of the U.S. Department of 

Health and Human Services, is conducting an investigation to determine the amount of dioxins 

present in people who live in Calcasieu parish. As part of the study, we will also look at the amount 

of volatile organic compounds (VOCs) present in selected parish residents. 

Objectives of the Study 

The primary objective of this investigation is to better characterize the nature and extent of human 

exposure to dioxin-like compounds throughout Calcasieu Parish by comparing citizens’ blood 

dioxin levels with a comparison population in Lafayette Parish. A secondary objective of the 

investigation will be to determine if citizens’ blood volatile organic compound (VOC) levels are 

elevated compared with the comparison population. 

Eligibility 

Participants must be 15 years old or older and have lived in their parish for at least 5 years. 

Residents of Lafayette Parish may never have lived in Calcasieu Parish. Participants must be 

medically eligible to have 60 ml. of blood drawn for testing purposes. 

Methods 

A household listing will be conducted in selected areas in each parish. 288 participants in Calcasieu 

Parish and 112 participants in Lafayette Parish, will be chosen at random from persons determined 

to be eligible from the household listing. Each participant will be asked to take part in an interview 

consisting of questions about their occupation, food consumption, and exposure to various 

substances. A 60ml. blood sample will be collected in order to conduct biological testing for 

dioxins and VOCs. 

Chlorinated Dibenzo-p-Dioxins (CDDs) 

CDDs are a family of 75 chemically related compounds commonly known as chlorinated dioxins. 

Dioxins are found in the air, water, and soil. They are not made on purpose, but result from burning 

fuel, wood, and waste, and from making certain products. When they get into the soil, air, and 

water, they enter the body and are stored in fat. The half-life of 2,3,7,8-TCDD, the most toxic form 

of dioxin, is estimated to be seven to twelve years. 

Volatile Organic Compounds (VOCs) 

142

VOCs are a group of similar chemicals that evaporate very quickly and get into the air easily. Some 

common things that have VOCs in them are gasoline, kerosene, nail polish remover, paints, paint 

thinners, dry cleaning fluid, cleaning products, pesticides, glues, permanent markers, building 

materials, and home furnishings. Almost everyone is exposed to VOCs. 

Health effects 

Health effects from acute high levels of dioxin exposure include skin lesions, such as chloracne and 

patchy darkening of the skin, altered liver function (transient elevation of liver enzymes that 

improves over time), and sub-clinical peripheral neuropathy (occurring shortly after acute exposure) 

that also disappears over time. Long-term exposure is associated with impairment of the immune 

system, developing nervous system, endocrine system, and reproductive functions. Chronic exposure 

of animals to dioxins has resulted in several types of cancer. The Environmental Protection Agency 

and the National Institute for Occupational Safety and Health consider 2,3,7,8-TCDD (the most toxic 

dioxin) a probable human carcinogen, and a cancer promoter when present with certain other 

chemicals. Cancer effects of dioxins were extensively studied with some associations in multiple 

sites, but concomitant exposure to other chemicals cannot be ruled out. Data from studies suggest a 

possible relationship between soft-tissue sarcoma and non-Hodgkin’s lymphoma. Statistically 

significant increases in the risk of all cancers were found in highly exposed workers with longer 

latency periods. 

Health effects of VOCs vary. Some VOCs associated with adverse health effects are: Benzene, 

Tetrachloroethylene (PCE), Vinyl Chloride, Ethylene Dichloride (EDC), and Carbon 

Tetrachloride. High levels of VOCs (acute exposure) can cause dizziness, headache, sleepiness, 

confusion, nausea, difficulty in speaking and walking, unconsciousness, and death. Breathing 

VOCs for long periods of time can result in liver damage, kidney damage, immune reactions, 

nerve damage, liver cancer, various blood disorders, and leukemia. The health conditions 

associated with a known exposure to VOCs in drinking water or with living near contaminated 

sites include several types of adverse birth outcomes, stroke, and several general illnesses. 

The Agency for Toxic Substances and Disease Registry 

The Agency for Toxic Substances and Disease Registry (ATSDR) is an agency of the U.S. 

Department of Health and Human Services. ATSDR is headquartered in Atlanta, Georgia. The 

agency’s mission is to serve the public by using the best science, taking responsive public health 

actions, and providing trusted health information to help prevent harmful exposures and disease 

related to toxic substances. 

For more information about this study, please contact: 

M. Deborah Millette, Epidemiologist


The Agency for Toxic Substances and Disease Registry


Division of Health Studies


Health Investigations Branch


1600 Clifton Road E-31


Atlanta, Georgia 30333


143

Direct Line: 404-498-0563 

Toll-free number 888-422-8737 

Website: http://www.atsdr.cdc.gov 

144

APPENDIX I


RESULTS LETTER TO PARTICIPANTS AND DIOXIN FACT SHEET


145

ATSDR LETTERHEAD


NAME Date Blood Sample Taken _________ 

ADDRESS Dioxin TEQ (ppt) ________________ 

We are sending this letter to thank you for participating in the 2002 Dioxin Study and to tell you 

about your dioxin result. We are also giving you information to help you understand what this 

result means. 

Percent of People with a Lower dioxin TEQ 

Age group 25th 50th 75th 90th 95th 

15 – 29 years 2.8 5.3 9.6 11.6 11.7 

30 – 44 years 8.2 13.6 18.5 22 30.4 

45 – 59 years 10.8 18.4 27.4 31.9 32.4 

60 year and older 23.7 35.8 45.5 77.8 113 

What your results mean 

The dioxin TEQ numbers in the table are from people in Lafayette Parish who do not live near 

areas that make or store dioxins. There is very little information about what the “usual” amount 

of dioxin is in a person. Studies like this one help us to find out what that amount might be. 

Several years ago scientists at the Agency for Toxic Substances and Disease Registry and the 

Centers for Disease Control and Prevention, National Center for Environmental Health tried to 

determine what level of dioxin is seen in people who are not exposed to extra sources of dioxin. 

They looked at dioxin levels of people in different parts of the United States between 1995 and 

1997. In that group of people, the average dioxin TEQ was 21 ppt and 95% of the people had 

dioxin TEQ levels that were less than 35.5 ppt. These results are not broken out into age groups. 

Not Reported means that the level of dioxins in your blood sample may be lower 

than the level that can be measured. It can also mean that we did not have enough 

blood to test or that there was a lab error in testing your blood. 

ppt means “parts per trillion.” One part per trillion is a very small amount. This is 

like putting one drop of ink in enough water to fill a string of railroad tank cars ten 

miles long. It is also one second in 32,000 years. 

TEQ means “Toxic EQuivalent.” Dioxins are a family of over 72 chemicals. Each 

member of the family is called a “congener” and may have a different strengh or 

“toxicity”. When you add the strength of each congener you get the TEQ. This 

number lets us look at the toxicity of all the dioxins with just one number. 

Percentiles tell you the amount of dioxin TEQ that 25%, 50%, 75%, 90% or 95% 

of the people tested in Lafayette Parish have in their blood. To find your 

percentile, first find your age group and then move to the right to find the dioxin 

TEQ that is the closest to your TEQ. The percentile tells you the percent of people 

in Lafayette Parrish who have a similar TEQs or a TEQ that is lower than yours. 

If we look at Calcasieu and Lafayette residents and these results, 88% of the people in Calcasieu 

and Lafayette Parishes have dioxin TEQs below 35.5 ppt. Most of the people with dioxin levels 

higher than this level are older – more than 90% were over 55 years old. We know that dioxin 

builds up in the body over time and that most of the dioxin in our bodies comes from food that 

we eat. It is possible that the diet of the people with dioxin TEQs above 35.5 ppt was higher in 

dioxins. It is also possible that they may have been exposed to an additional source of dioxin. 

Because most of the participants with higher levels are older, it is also possible that exposure to 

dioxin occurred sometime in the past. 

All of us have dioxin in our bodies, some have more, and others have less. We know that the 

amount of dioxin in the body may increase as we get older. This is one reason why older people 

have more dioxin in their blood than younger people. This is also why we looked at dioxin levels 

146

by age. We also know that the dioxin in our bodies comes mostly from food sources, with meat, 

fish, and dairy products providing the greatest amount. 

There is no “cure” for dioxin in your body, but it does leave the body very slowly. If you take in 

less dioxin than the amount of dioxin that leaves your body, the level of dioxin in your body will 

gradually decrease. In the next months, we will be looking at the data we have gathered to see if 

we can find out why some people have higher dioxin levels. It is important to remember that the 

dioxin TEQ levels that people in Calcasieu and Lafayette Parishes that are in this study are not 

associated with health problems. 

If you asked us, we will send your test results to your doctor. If you have any health questions or 

concerns, we suggest that you talk to your doctor. Your doctor can talk to us if he/she has any 

questions about your dioxin level. 

We know that you may have more questions about dioxin and its health effects. We have 

attached a Dioxin fact sheet and a Health Effects of Dioxin “question and answer” sheet for your 

information. If you have any questions about your dioxin test results or any other questions about 

this study, please contact us: 

M. Deborah Millette, MPH at (404) 498-0563 or 1-888-422-8737, extension 0563. 

Mohammed S. Uddin, MD at (404) 498-0587 or 1-888-422-8737, extension 0587 

Thank you again for your participation in the study. 

Respectfully, 

M. Deborah Millette, Epidemiologist 

Principal Investigator 

Health Investigations Branch 

Division of Health Studies 

Agency for Toxic Substances and Disease Registry 

1600 Clifton Road E-31 

Atlanta, Georgia 30333 

147

Frequently Asked Questions about Dioxin Health Effects 

Question: Will I get sick if I have dioxins in my body? 

Answer: Most people in the United States have a small amount of dioxin in their body – 

usually in the low parts-per-trillion (ppt). Studies tell us that people do not seem to get 

sick from these low levels. We do know that as the dioxin level goes up, the chance of 

getting sick from dioxin also goes up. Exposure to high levels of dioxin can affect your 

skin, liver, and nerves. However, people may react differently to the same level of dioxin 

- some of them may get sick and others may not 

Question: What is a “high” dioxin level? 

Answer: Here are some examples of high level dioxin exposures. 

Seveso, Italy: In 1976, an explosion in a plant in Seveso released dioxins into the air. Some 

people who were exposed got chloracne - a rash on the face and neck that looks like acne. The 

rash can occur after a few days of exposure to high levels of dioxin. The people in Seveso who 

had chloracne had dioxin blood levels from 828 ppt to 56,000 ppt. People without this condition 

had dioxin blood levels from 1,770 ppt to 10,400 ppt. Studies conducted many years after the 

accident showed that more people in Seveso died from heart disease, lung disease, and diabetes 

than people who lived in other places. Also, more people in Seveso got cancer. Studies are now 

being done to find out if these health problems were due to dioxin. 

Operation Ranch Hand: From 1962 to 1971, soldiers in the U. S. Air Force sprayed chemicals 

to kill plants and trees in Vietnam. These chemicals had dioxin in them. The highest level of 

dioxins in a group of people that were highly exposed to dioxins was 618 ppt. Studies of health 

effects in this group show that there may be more diabetes in this group than in soldiers who 

were not exposed to dioxin. 

Times Beach Missouri: In 1971 and 1972, oil that had dioxins was sprayed on dirt roads in 

Times Beach to keep the dust down. Dioxin levels in the fat of 39 people who lived in Times 

Beach were from 2.8 ppt to 750 ppt. Studies on this group of people have not found any health 

effects. Fat was used in this study because there were no laboratory methods to measure dioxin 

in blood. Dioxin levels in fat are usually higher than levels in blood. 

Question: How do the dioxin levels of people living in Calcasieu and Lafayette Parishes 

compare with other people who were exposed to dioxin? 

Answer: The highest levels of dioxin of people who live in Calcasieu and Lafayette 

Parishes are lower than highest levels of the people in Seveso and of the soldiers in 

Operation Ranch Hand. 

Question: What are the most common health effects after a short exposure to a high level of 

dioxin? 

Answer: The most common health effects from short exposures are chloracne (an acnelike skin rash), liver changes (liver swelling and dull pain), and peripheral neuropathy 

(weakness, numbness, burning, tickling, pricking or tingling and pain in the arms, hands, 

148

legs and/or feet). 

Question: What other health effects are related to dioxin exposures? 

Answer: While there many studies on people with high exposure levels, there are few 

studies on people with low exposure levels. Every two years, the Institute of Medicine 

reviews dioxin studies. The latest review said that exposure to dioxin may be related to 

soft-tissue sarcoma, non-Hodgkin’s lymphoma, Hodgkin’s disease, and chloracne. The 

Institute also said that there was little data that dioxins may also cause other health 

effects. 

Question: How likely are dioxins to cause cancer? 

Answer: The International Agency for Research on Cancer (IARC), The World Health 

Organization (WHO), and The U.S. Department of Health and Human Services (DHHS) 

have said that one form of dioxin, 2,3,7,8-TCDD, can cause cancer in humans. 

Question: Would you expect any adverse health effects to occur at the dioxin levels seen in 

Calcasieu and Lafayette Parishes? 

Answer: We don’t know much about the health effects of dioxin at levels people have in 

these parishes. Based on what we know now about dioxins, we do not believe that the 

dioxin levels of people who live in Calcasieu and Lafayette Parishes will cause the health 

effects that were seen in the Ranch Hand and Seveso studies. 

For more information, contact: 

M. Deborah Millette, M.P.H. at (404) 498-0563 or 1-888-422-8737, extension 0563 

Mohammed S. Uddin, M.D. at (404) 498-0587 or 1-888-422-8737, extension 0587 

References: 

1.	 NRS/NRC. 2000. Veterans and Agent Orange: Update 2000. National Academy of 

Science / Institute of Medicine . Washington, DC: National Academy Press, 115-117. 

2.	 ATSDR. 1998. Toxicological profile for Chlorinated Dibenzo-p-Dioxins (update). U.S. 

Department of Health and Human Services, PublicHealth Service, Agency for Toxic 

Substances and Disease Registry. Atlanta, GA. 

3.	 Schecter, A, ed. Dioxin and Health. New York and London: Plenum Press, 1994. 

You can find more information about dioxin at the Agency for Toxic Substances and Disease 

Registry, Tox FAQs. Internet site: http://www.atsdr.cdc.gov/tfacts104. 

149

APPENDIX J 

Specification of the design setup structure, the stratum variable, and the primary sampling 

unit for the SUDAAN programming 

150

Specification of the design setup structure, the stratum variable, and the primary sampling 

unit for the SUDAAN programming 

This study follows a sample design involving a complex two-stage sampling process to draw a 

representative sample to make population based inferences. The first stage stratification variable 

was sector with nine sectors in Calcasieu Parish, Louisiana (target area), and a tenth sector for 

Lafayette Parish, Louisiana (control area) (Figure 1). Within each of the 10 sectors in both 

Calcasieu Parish and Lafayette Parish, a set of clusters of census blocks found in those areas 

were formed. The list of census blocks was randomly sorted and sequentially divided so that 

each formed cluster contained at least 600 people. One of these clusters was then randomly 

selected from each sector (stratum) in Calcasieu Parish and three clusters were selected from 

Lafayette Parish (Table 1). 

Using age as the second-stage stratification variable, four age groups were formed for all 

residents in the sampled Primary Sampling Units (PSU); 15 to 29, 30 to 44, 45 to 59, and over 60 

years of age. In the second stage, the sampling plan was to obtain eight people from each of the 

four age groups for the nine sectors in Calcasieu Parish, and 32 people from each of the four age 

groups in the single Lafayette Parish sector. 

After the screeners completed the work, we had a list of 1816 potentially eligible people from 

which to draw the final study sample. Replicates of 9 people were formed by randomly selecting 

one person from each sector within an age group. Once a sector was depleted of people, no 

further replicates for the given age group were formed. 

In light of the study design, the selection of the final participants was complex beyond that which 

can be easily and fully captured by SUDAAN (version 8.0, Research Triangle Institute), survey 

data analysis software. Three features of this phase complicate analysis of the data (Dr. 

Kalsbeek, University of Carolina, Chapel Hill, personal communication, 2003 Jun 19). These 

complicating features are 1) Selection of one cluster of census blocks in each of the nine 

Calcasieu sectors, 2) Selection of the post-screening sample by age and sector from the eligible 

persons in all selected sample PSUs combined, and 3) Composition of the replicates is selective, 

which means ending replicate construction when sectors are depleted of eligible people. 

Thus, the sample design specified for this analysis would have to be a reasonable proxy of what 

was actually done, rather than the sample design as actually implemented. For example, because 

a minimum of two clusters for analysis is needed per stratum, we dealt with the first 

complicating feature by using the census block as the PSU; each cluster consisted of a random 

sample of blocks in Calcasieu Parish. We used the selected 3 Lafayette Parish clusters to be the 

analysis PSU for the tenth sector. Use of proxy specification for samples is not unusual in 

practice, but the question always remains as to how good a proxy can be found. 

Three optional design setups were considered to deal with the other complicating features in 

running SUDAAN to account for the sample design. In addition to these three setups, some 

variations for each option also was considered. The analysis design, the PSU, and the secondary 

sampling unit (SSU) for each setup option is shown in Table 2. We then compared analysis 

results under these options based on the analysis of serum total dioxin level (TEQ) by parish and 

by age group. Details of each option follow. 

Option 1: 

151

The first setup we considered assumes WOR (without replacement) selection in the first stage 

and WOR selection in the second stage, thus necessitating accounting for the stage-specific 

sampling fractions. In this proxy setup, the numerator of the first stage sampling fraction is the 

number of selected census blocks in each sector for sectors 1 through 9 in Calcasieu Parish, and 

the number of clusters selected for sector 10 in Lafayette Parish; the denominator is the total 

number of census blocks in each sector in Calcasieu Parish and the total number of clusters in 

Lafayette Parish. The numerator of the second stage sampling fraction is the number of selected 

eligible people in each selected census block in each age stratum; the denominator is the total 

number of eligible people in the age group within the PSU at the formation of replicates. 

Stratification was considered to be by sector in the first stage and by age in the second stage. 

Table 4 shows the result of the mean and median of TEQ by parish in each age group. A 

statistically significant difference in TEQ between parishes for each age group was not observed. 

Mean and median estimates under this option were somewhat different from the un-weighted 

analysis done in SAS, as were standard errors for the means. 

SUDAAN under this setup option detected many strata or clusters at a given stage of the design 

with a single subunit. To resolve this problem, the “missunit” option was specified in which the 

variance contribution for that stratum or that cluster is computed using the deviation from the 

overall mean of that sampling stage. 

Option 1A: 

To reduce the many single subunit problems, a variation to option 1 was developed to further 

collapse the original selected census blocks, thereby creating a modified proxy PSU in each of 

sectors one through nine. This will create more than one respondent for most of the modified 

proxy PSU within a given stage. We used GIS to delineate all the originally selected census 

blocks, and examined the number of people in each age group within each block to collapse the 

blocks so that they were close enough geographically, and the total number of people in each 

block was sufficient to calculate the variance. 

The denominator of the stage sampling fraction in each sector was computed as the total number 

of blocks divided by the average number of census blocks per modified proxy PSU in the sector. 

We also modified the denominator of the second stage sampling fraction to equal the number of 

eligible people in each age group according to the modified proxy PSU. 

Table 5 shows the results of the same analyses as is shown in table 4. The changes in standard 

error from Option 1 to Option 1A, which are very minimal, are within the second decimal place. 

The minor modification made in the specified PSU for analysis had minimal effect on results. 

Option 2: 

A second considered proxy design specified WOR selection for the first stage and WR (with 

replacement) selection for the second stage. Stratification in the first and second stages is once 

again assumed to be by sector and by age, respectively. We also specified the original selected 

census blocks as PSU, and person as the second stage stratification unit. 

Table 6 shows the results of the same comparative analysis of TEQ by parish in each age group. 

Comparing these results with those from Option 1, we did not observe significant changes in 

standard error and the weighted point estimates of the means and median were identical under 

both options as expected. 

152

As with Option 1, SUDAAN programming for this design showed that there were many strata or 

clusters at a given stage of the design with only one specified sampling subunit, thus creating the 

need for the “missunit” remedy as before. To reduce the many single subunit problems, a 

variation similar to the variation developed for Option 1 was developed for Option 2. 

Option 2A: 

As in Option 1A, we further collapsed the census blocks to form a modified proxy PSU. This 

variation in Option 2 showed generally modest change in standard error as before (Table 7). 

Option 3: 

Lastly, we considered a proxy design where with replacement (WR) selection of PSUs is 

assumed using the original selected census block as the PSU. Under this option, only univariate 

stratification (by sector) needed to be assumed for PSU selection. Table 8 also showed very 

similar results as all the previous options; although, as expected, the estimated standard errors of 

means TEQ were generally higher (i.e. more conservative) than comparable results under the 

other options. 

Adopted approach: 

To draw population-based inference from the data in this study, we need to consider using the 

probability sampling weight and also to account for the 2 stage design in the analysis. With this 

complex design, we accommodated the analysis by considering proxy designs in running 

SUDAAN. We evaluated several plausible options to accommodate the two-stage design using 

the probability sampling weight and showed that the standard errors of estimates were not 

substantially different as shown by the TEQ analyses we ran. Although Option 1 is the one that 

perhaps comes closer to the actual sample design, Option 3 produced results very similar to 

Option 1, which generally estimates precision conservatively, yet was very simple and practical 

to implement. Therefore, we decided to implement Option 3, using SUDAAN for all analyses in 

the final report, and recommended that it be used for comparable analysis for this data. 

153

Table 1. Original selection of census blocks to compile one cluster of about 600 people in 

the 9 sectors of Calcasieu Parish, and three clusters of census blocks in Lafayette Parish 

Sector Population 

Total Number of 

Census Blocks 

Total Clusters of 

Census Blocks 

Number of People 

in Selected Cluster 

2 9675 191 15 629 

3 5312 116 8 621 

6 2597 42 4 675 

7 1803 25 2 692 

1 11435 168 19 647 

4 48789 1040 15 621 

5 13367 320 21 607 

8 6658 70 7 683 

9 9303 323 16 698 

10 190000 265 1818 

154

Table 2. Specifications of optional proxy design setups for SUDAAN programming 

Option First Stage 

Selection 

Second Stage 

Selection 

Primary 

Calcasieu 

Sampling 

Unit 

Primary 

Lafayette 

Sampling 

Unit 

Secondary 

Sampling 

Unit 

1 Without 

replacement 

Without 

replacement Census block Census block 

cluster 

People in four 

age strata 

1A Without 

replacement 

Without 

replacement 

Census block 

collapsed 

further 

Census block 

cluster 

People in four 

age strata 

2 Without 

replacement 

With 

replacement Census block Census block 

Cluster 

People in four 

age strata 

2A Without 

replacement 

With 

replacement 

Census block 

collapsed 

further 

Census Block 

cluster 

People in four 

age strata 

3 With 

replacement 

With 

replacement Census block Census block 

cluster 

People in four 

age strata 

155

Table 3. Un-weighted analysis of Dioxin TEQ level (ppt) for Calcasieu and Lafayette 

Parishes by age groups 

Total Dioxin Level (TEQ) 

Age Group Parish Respondents Mean (SE) Median 

15-29 Calcasieu 76 8.13(0.76) 6.88 

Lafayette 26 7.48(0.70) 6.47 

30-44 Calcasieu 70 12.91(0.94) 10.42 

Lafayette 31 14.46(1.25) 14.04 

45-59 Calcasieu 79 20.08(1.05) 19.33 

Lafayette 31 19.79(1.75) 18.62 

60+ Calcasieu 70 36.98(2.61) 33.27 

Lafayette 32 43.32(5.33) 36.00 

156