Environmental Epidemiology

303 Pages·1986·24.002 MB·\303

by  Frederick C. Kopfler (Author)

ENVIRONMENTAL
EPIDEMIOLOGY
Frederick C. Kopfler
Gunther F. Craun
Boca Raton London New York
CRC Press is an imprint of the
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First published 1986 by Lewis Publishers, Inc.
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ISBN 13: 978-0-87371-073-2 (hbk)
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Library of Congress Cataloging~in-Publication Data
Environmental epidemiology.
"Proceedings of the Symposium on Exposure
Measurement and Evaluation Methods for Epidemiology,
co-sponsored by the Health Effects Research
Laboratory of the United States Environmental
Protection Agency and the Division of Environmental
Chemistry of the American Chemical Society at the
I 90th National Meeting of the ACS in Chicago,
Illinois, September 8-13, 1985"-P. I.
Includes bibliographies.
l. Health risk assessment -Congresses. 2. Poisons-
Dose-response relationship-Congresses. 3. Biological
monitoring- Congresses. 4. Epidemiology-Congresses.
I. Kopfler, Frederick C. II. Craun, Gunther F.
Ifl. Symposium on Exposure Measurement and Evaluation
Methods for Epidemiology (1985: Chicago, 111.)
IV. Health Effects Research Laboratory (Cincinnati,
Ohio) V. American Chemical Society. Division of
Environmental Chemistry. IV. American Chemical
Society. Meeting (190th : 1985 : Chicago, 111.)
[DNLM: 1. Environmental Exposure-congresses.
2. Environmental Monitoring-congresses. 3. Environ-
mental Pollutants - analysis - congresses.
WA 671 E606 1985]
RA566.27.E58 1986 614.4 86-21316
ISBN 0-87371-073-8
This book is dedicated to
Leland J. McCabe,
whose investigations of the
relationship of illness and disease to waterborne
contaminants during his 35-year federal career
serve as a cornerstone of many of our
current drinking water and bathing-beach water standards.
We are privileged to have worked with him
during the last 15 of these years.
He is both friend and mentor.

PREFACE
The epidemiologic approach is a valuable methodology for assessing the
association of chemical exposure and occurrence of a disease in a human
population, and should be used to supplement data obtained from clinical
and toxicologic research. Epidemiology studies are important in the regula-
tory process because the results are necessary to elucidate the risk of human
chemical exposure incurred by human beings without the uncertainty of
interspecies extrapolation. Because the United States Environmental Pro-
tection Agency (U.S. EPA) is required to develop regulations under six
separate legislative acts, these studies are usually conducted to provide
information for estimation of risk of exposure through a given route or
from a specific source.
Case control and cohort studies can provide a quantitative estimate of
health risk association with various environmental exposures, but it is often
difficult to assess relevant exposures for individuals because retrospective
epidemiologic studies require estimates of past exposure which must be
made in light of current information. While it is important to fully under-
stand the sources, routes, and extent of exposure of individuals to environ-
mental toxicants, obtaining such knowledge about the population included
in an epidemiology study may not be practical and/or achievable in all
cases. Prospective studies can be designed in which exposure measurements
are included as part of the study, but these studies are generally not feasible
because of the high costs of following a cohort for a long period to deter-
mine associations between exposure and an observed health effect.
It is important that the exposure data collected for epidemiologic studies
be relevant and appropriate for both the study design and regulatory needs.
The accurate measure or assessment of exposure is paramount because
random misclassification of exposure for study participants can only bias
the outcome of the study toward one or no association between exposure
and disease. Most epidemiologic studies have assumed that exposure to a
contaminant is an adequate surrogate for the dose. A major limitation of
past studies has been a lack of information on dose, e.g., the amount of the
contaminant or metabolite in body tissue or the amount that interacts with
the target organ or tissue. Biologic markers of cumulative dose would also
assist in improving the sensitivity of epidemiologic studies, and should be
considered, whenever possible, to supplement the data collected on expo-
sure to environmental contaminants.
in
This book contains papers presented at a symposium co-sponsored by the
Health Effects Research Laboratory of the U.S. EPA and the Division of
Environmental Chemistry of the American Chemical Society at the 190th
National Meeting of the ACS in Chicago, Illinois, September 8-13, 1985. It
brings together the thoughts and work of epidemiologists, chemists, and
mathematical modelers. By gaining insight into each other's needs and capa-
bilities, scientists can plan research that will allow the exposure of partici-
pants in epidemiologic studies to be more accurately assessed. It is impor-
tant that chemists, biochemists, and toxicologists fully understand the
capabilities and limitations of epidemiologic studies so that improved inter-
disciplinary studies can be conducted.
Frederick C. Kopfler
Gunther F. Craun
IV
ACKNOWLEDGMENTS
We wish to thank the Division of Environmental Chemistry and the U.S.
EPA for the financial support required to provide the excellent facilities for
the symposium and to help defray the costs of travel and registration for
many of the nonchemist and foreign speakers.
Each paper included in this proceedings has been critically reviewed by at
least two peers. We wish to express our appreciation to the following
reviewers: Julian Andelman, John Bosch, Emile Coleman, Charlotte
Cottrill, Donna Cragle, Peter Farmer, Peter Gann, Roger Giese, Daniel
Greathouse, Jack Griffith, Robert Herrick, Norman Kowal, Pasquale
Lombardo, Charles Mann, Gary Marsh, Patricia Murphy, Michael Pereira,
Paul Skipper, John Stanley, Lance Wallace, and Elaine Zeighami. The
extensive review to ensure high quality and logical validity resulted in
improvement of most of the papers. However, each paper must ultimately
stand on its own merit. Because of the review process, not all presented
papers were accepted for publication.
We also wish to thank Andrea Donoghue, Betsy Kostic, Brana Lobel,
and Kate Schalk of Eastern Research Group for their invaluable assistance
in making travel arrangements, assembling the manuscripts, coordinating
the peer reviews, and editing and producing the camera-ready copy for this
book.
REVIEW/DISCLAIMER STATEMENT
This book has been reviewed by the U.S. Environmental Protection
Agency (EPA), and has been approved for publication as an EPA docu-
ment. Mention of trade names or commercial products does not constitute
endorsement or recommendation for use.
v
FREDERICK C. KOPFLER is presently Chief of the
Chemical and Statistical Support Branch, Toxicology
and Microbiology Division, Health Effects Research
Laboratory, U.S. Environmental Protection Agency,
Cincinnati, Ohio. He obtained his BS in chemistry from
Southeastern Louisiana University in 1960 and
advanced degrees in biochemistry and food science from
Louisiana State University. After completing a National
Research Council-sponsored postdoctoral appointment
in the Pioneering Research Laboratory for Animal Proteins at the U.S.
Department of Agriculture, he was involved in environmental research
with the U.S. Public Health Service and, since its formation in 1970, has
been associated with the U.S. Environmental Protection Agency (EPA).
Dr. Kopfler has worked closely with epidemiologists in designing studies
of the relationship between drinking water chlorination practices and
cancer incidence in consumers, and studies of mineral and trace element
content of drinking water and the occurrence of cardiovascular disease.
His current research areas include isolation of organic contaminants
from water for toxicological testing and the identification of the reaction
products of chlorine with biological chemicals.
VI
GUNTHER F. CRAUN has served in various capacities
over the past twenty years as an environmental engineer
and epidemiologist with the U.S. Public Health Service
and the U.S. Environmental Protection Agency (EPA).
Since 1970, he has been associated with EPA's drinking
water and health research activities. His current
research interests include relationships between drinking
water contaminants and cardiovascular disease, cancer,
and infectious diseases. He received his education in
civil engineering (BS) and sanitary engineering (MS) at Virginia Poly-
technic Institute, and public health (MPH) and epidemiology (MS) at
Harvard University. He is registered as a professional engineer in the
Commonwealth of Virginia.
Mr. Craun has authored and coauthored numerous articles in the
international scientific, public health, and engineering literature. The
American Water Works Association and the New England Water Works
Association have recognized Mr. Craun for his work on waterborne
disease outbreaks and trace metals in the drinking water of the Boston
metropolitan area. The EPA awarded Mr. Craun a meritorious perform-
ance citation for his participation in the Community Water Supply
Study, which identified deficiencies in the nation's public water supplies.
Mr. Craun is a member of the International Association of Milk,
Food, and Environmental Sanitarians Committee on Communicable
Diseases Affecting Man, and from 1977 to 1982 he served as chairman of
the American Water Works Association Committee on the Status of
Waterborne Disease Outbreaks in the United States and Canada. Mr.
Craun served as liaison representative to the National Research Council's
Safe Drinking Water Committee from 1974 to 1977, and as a member of
the World Health Organization Working Group on Sodium Chloride,
and Conductivity in Drinking Water in 1978. He has also served as a
member of the Water Pollution Control Federation Research Committee
and the International Association on Water Pollution Research Study
Group on Virology.
Mr. Craun is currently Coordinator of the Environmental Epidemiol-
ogy Program in EPA's Health Effects Research Laboratory, Cincinnati,
Ohio. In his present capacity, he works with a number of other govern-
ment agencies, including the National Cancer Institute and Oak Ridge
National Laboratory, on epidemiological studies of drinking water con-
taminants. He is also involved in projects with the National Academy of
Sciences and the University of Pittsburgh Center for Environmental Epi-
demiology to identify new research areas and methodologies for environ-
mental epidemiology.
vu