agency for toxic substances and · final report jasper county, missouri superfund site lead and...

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Agency for ToxicSubstances andDiseaseDivision of Health Studies

FINAL REPORT

Jasper County, Missouri Superfund SiteLead and Cadmium Exposure Study

Missouri Department of HealthDivision of Environmental Health and Epidemiology

Bureau of Environmental Epidemiology

February 1995

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U.S. DEPARTMENT OF HEALTH& HUMVN SERVICESPublic Health ServiceAgency for Toxic Substancesand Disease RegistryAtlanta, Georgia 30333

Additional copies of this report are available from:National Technical Information Service. Sprinsrfield. Vinrim'2

(703) 487-4650Request publication number PB95-'794C'4

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESPUBLIC HEALTH SERVICE

AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRYATLANTA, GEORGIA

JASPER COUNTY, MISSOURI SUPERFUND SITELEAD AND CADMIUM EXPOSURE STUDY

MISSOURI DEPARTMENT OF HEALTHDIVISION OF ENVIRONMENTAL HEALTH AND EPIDEMIOLOGY

BUREAU OF ENVIRONMENTAL EPIDEMIOLOGY

February 1995

This study and final report were partially supported by funds from the ComprehensiveEnvironmental Response, Compensation, and Liability Act trust fund provided to theMissouri Department of Health, under Grant No. H75/ATH790118 from the Agency forToxic Substances and Disease Registry, Public Health Service, U.S. Department of Healthand Human Services.

DISCLAIMER

Mention of the name of any company or product does not constitute endorsement by the Agencyfor Toxic Substances and Disease Registry, the Public Health Service, the U.S. Department ofHealth and Human Services, or the Missouri Department of Health.

11

Adults 15 through 44 Years of Age 18Adults IS through 44 Years of Age Questionnaire

Results 19Adults 15 through 44 Years of Age Multivariate

Analysis 19

DISCUSSION 19Study Limitations 19Study Strengths 21Interpretation 21

CONCLUSIONS 27

RECOMMENDATIONS 29

AUTHORS AND ACKNOWLEDGMENTS 31

REFERENCES 35

TABLES 37

FIGURES 173

ATTACHMENTS 203

APPENDICES 209

IV

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CONTENTS

Page

DISCLAIMER ii

LIST OF TABLES v

LIST OF FIGURES ix

LIST OF ATTACHMENTS xi

LIST OF APPENDICES xiii

ABSTRACT 1

INTRODUCTION 3

Site Background 4

METHODS 5Population Census Phase 5

Mailout 5Census Field Follow-up 6

Data Collection Phase - Participant Selectionand Recruitment 7

Interviews 8Biological Specimens 8Laboratory Specimen Quality Control/Quality Assurance 9Environmental Sampling 9Data Management 10Analytical Approach 11

RESULTS 12Children 6 through 71 Months of Age 12Children 6 through 71 Months of Age Household

Questionnaire Results 14Children 6 through 71 Months of Age Multivariate

Analysis 15Youths 6 through 14 Years of Age 17Youths 6 through 14 Years of Age Household

Questionnaire Results 17Youths 6 through 14 Years of Age Multivariate

Analysis 18

111

Adults 15 through 44 Years of Ape 18Adults 15 through 44 Years of Age Questionnaire

Results 19Adults 15 through 44 Years of Age Multivariate

Analysis 19

DISCUSSION 19Study ^imitations 19Study Strengths 21Interpretation 21

CONCLUSIONS 27

RECOMMENDATIONS 29

AUTHORS AND ACKNOWLEDGMENTS 31

TABLES 37

FIGURES 173

ATTACHMENTS 203

APPENDICES 209

IV

LIST OF TABLESPage

Table 1.—Number of residences determined from census mailout andfield visits and percent response to the census 39

Table 2.—Number and percent of residents determined eligible for thestudy from the census data collection phase, by study group 41

Table 2a.—Eligible study group candidates, sample size, and numberand percent willing to participate in the data collection phase 41

Table 2b.—Eligible control group candidates, sample size, and numberand percent willing to participate in the data collection phase 43

Table 3.—Reasons for candidates not participating in the datacollection phase, by study and candidate group 45

Table 4.—Number and percent of telephone and field attempts to contactcandidates for the data collection phase 47

Table 5.—Demographic characteristics for study and control groups 49

Table 6.—Child questionnaire responses by factors and group 51

Table 7.—Comparison of blood lead, urine cadmium, and environmentaldata by study groups and age classes 57

Table 8.—Child group distribution of blood lead levels by studyand control populations 59

Table 9.—Mean blood lead values compared to child questionnairefactors by group 61

Table 10.—Mean blood lead values compared to child householdquestionnaire factors by group 65

Table 11.—Child group distribution of urine cadmium levels by studyand control populations 69

Table 12.—Child biomedical test percentages and numbers by rangeand group 71

Table 13.—Child household questionnaire responses by group and factor 77

Table 14.—Regression coefficients and level of significance for multiplelinear regression on child group blood lead values with environmentalfactors included in the model 85

Table 15.—Regression coefficients and significance values for stepwisemultiple linear regression on child -oup blood lead values withenvironmental factors in model 87

Table 16.—Regression coefficients and significance values for stepwisemultiple linear regression on child group blood lead values excludingthose children with blood lead levels over t^n micrograms per deciliter 89

Table 17.—Regression coefficients and level of significance for multiplelinear regression on child group blood lead values without environmentalfactors included in the model 91

Table 18.—Regression coefficients and level of significance for multiplelinear regression on child group urine cadmium levels with environmentalfactors included in the model 93

Table 19.—Regression coefficients and level of significance for multiplelinear regression on child group urine cadmium levels without environmentalfactors included in the model 95

Table 20.—Youth questionnaire responses by group and factor 97

Table 21.—Youth group distribution of blood lead levels by study andcontrol populations 103

Table 22.—Mean blood lead values compared to youth questionnaire factorsby group 105

Table 23.—Youth mean lead levels by group and household questionnairefactor 107

Table 24.—Youth group distribution of urine cadmium levels by study andcontrol populations Ill

Table 25.—Youth biological test percentages and numbers by range andgroup 113

Table 26.—Youth household questionnaire by group and factor 121

VI

Table 27.—Regression coefficients and significance values for stepwisemultiple linear regression for youth blood lead values without environmentalfactors included in the model 131

Table 28.—Regression coefficients and significance values for stepwisemultiple linear regression for youth urine cadmium values withoutenvironmental factors included in the model 133

Table 29.—Adult questionnaire responses by group and factor 135

Table 30.—Adult group distribution of blood lead levels by study andcontrol populations 141

Table 31.—Mean blood lead values compared to adult questionnairefactors by group 143

Table 32.—Adult mean blood lead levels by household questionnaire factorsand group 145

Table 33.—Adult group distribution of urine cadmium levels by study andcontrol populations 149

Table 34.—Adult biological test percentages and numbers by range andgroup 151

Table 35.—Adult household questionnaire by factor and group 159

Table 36.—Regression coefficients and significance values for stepwisemultiple linear regression for adult blood lead values without environmentalfactors included in the model 167

Table 37.—Regression coefficients and significance values for stepwisemultiple linear regression for adult urine cadmium values withoutenvironmental factors included in the model 169

Table 38.—Comparison of study and control area participants with areapopulation by selected socio-economic data 171

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LIST OF FIGURES

PageFigure 1.—Correlation Between Blood Lead, Soil, House Age, and Inside Paint 175

Figure 2.—Correlation Between Blood Lead, Soil and Inside Pain, whileControlling for Age of the House 179

Figure Al.—Scatter Plot of Combined Study and Control Groups HouseholdIncome Compared to Blood Lead Levels 183

Figure A2.—Scatter Plot of Combined Study and Control Groups YearHouse Built Compared to Blood Lead Levels 187

Figure A3.—Scatter Plot of Study Group Children Living in Homes BuiltAfter 1960 and Soil Lead Level Compared to Blood Lead Levels 191

Figure A4.—Graph of Cumulative Percentage of Blood Lead Levels in theStudy and Control Groups 195

Figure A5.—Scatter Plot of Study Group Children Who Lived in HomesHaving Undetectable Interior Paint Levels Compared to Blood Lead 199

IX

LIST OF ATTACHMENTS

PageAttachment 1.—Census Flow Chart (Study Area/Control Area 205

XI

LIST OF APPENDICES

Page

Appendix A.—Initial letter to residents of Jasper, Newton and McDonaldCounties Explaining Purpose of Health Study A-l

Appendix B.—Heavy Metal Exposure Assessment Census Form B-l

Appendix C.—Child Questionnaire Age 6-71 Months C-l

Appendix D.—Young Person Questionnaire Ages 6 -14 Years Old D-l

Appendix E.—Teenage and Adult Questionnaire Ages 15-44 Years E-l

Appendix F.—Household Questionnaire F-l

Appendix G.—Participant Consent for Blood and Urine Testing G-l

Appendix H.—Release of Medical Information to Participants' Physician H-l

Appendix I.—Participant Consent to Environmental Sampling In andAround Home 1-1

Appendix J.—Request for Participant Reimbursement J-l

Appendix K.—Biological Tests Used in the Jasper County Lead andCadmium Exposure Study K-l

Xlll

ABSTRACT

One of the largest lead-zinc mining areas in the world since the mid-1800's was the Tri-State Mining District, part of which is located in southwest Missouri. Approximately 240 squaremiles of the district remains today as the Jasper County Superfund Site. The Site ischaracterized by extensive surface land disturbances and waste piles that resulted from mining,milling, and smelting of ore. The major population center of the region is Joplin. To determineif there is a relationship between exposure to mining wastes and elevated blood lead and urinecadmium levels, this study evaluated 391 exposed persons and 271 individuals from an areawhere no mining has occurred. Results of the study found that blood lead levels weresignificantly higher in the exposed group compared to the control group. There was nosignificant difference for cadmium between the two groups. Also, the study determinedenvironmental exposure to the area soil was the most important factor influencing the distributionof blood lead levels between the two groups.

JASPER COUNTY, MISSOURI SUPERFUND SITELEAD AND CADMIUM EXPOSURE STUDY

INTRODUCTION

Lead's toxic effects on humans, especially children, have been extensively documented(ATSDR, 1988). Consistent findings from several recent longitudinal studies indicate adversehealth effects on fetal and child development, including neurobehavioral and growth deficits, anddeficits in IQ scores (Needleman, 1990; Baghurst, 1992). These effects were associated withblood lead levels as low as 10 micrograms per deciliter (/tg/dL).

The Centers for Disease Control and Prevention (CDC) has described childhood leadpoisoning as one of the most common preventable environmental pediatric health problems inthe United States today (CDC, 1991). Enough is known about the sources and pathways of leadexposure for the CDC to establish a national goal to eradicate the problem by the year 2012.The sources for lead exposure include air, food, water, dust, and soil. Throughout humanhistory, lead has been used in paints, glazes, eating utensils, plumbing, drugs, and, recently,gasoline (ATSDR, 1988). In addition, Missouri citizens have been exposed to lead via mining,milling, and smelting. Missouri ranks as the number one lead producing state in the nation (DoeRun, 1987).

This study was conducted to determine if residents living in the Jasper County SuperfundSite area, an old lead mining, milling, and smelting area in southwest Missouri, have blood leadand urine cadmium levels higher than residents living in a comparison area. The objectives ofthis study were:

1. To measure the amounts of lead in blood and cadmium in urine in a studypopulation and compare them to values found in a control population.

2. To determine the level of lead and cadmium contamination in soil, interior housepaint, interior house dust, and water in a study area and compare these withlevels of contamination observed in a control area.

3. To characterize the distributions and deviations from standard reference rangesof selected biological test results in a study population and compare these with acontrol population.

4. To determine the extent to which demographic, environmental, behavioral,occupational, and socio-economic factors are associated with the distribution ofblood lead and urine cadmium levels in the study and control populations.

SITE BACKGROUND

The Jasper County Superfund Site is a portion of the old Tri-State Mining District. From1850 to 1957, it was one of the largest lead-zinc mining areas in the world. Discovery of oredeposits in Jasper and Newton Counties resulted in the establishment of mining camps duringthe pre-Civil War period on Turkey Creek and Center Creek in Jasper County and at Spurgeon,Moseley, and Granby in Newton County. From the 1840s through the Civil War years, over200 widely dispersed primitive log smelting furnaces were operated in this area. These smeltingfurnaces were replaced with Scotch-hearth smelters located at Granby, Moseley and CenterCreek (EPA, 1986). Ore production consisted of mining, crushing, and grinding the rock to astandard size, ore separation, and tailings disposal. Mine production in the Missouri portionreached its peak in 1916 when over 123 million rock-tons were processed to yield approximately304 thousand tons of zinc concentrates and 41 thousand tons of lead concentrates.

The Missouri portion of the Tri-State Mining District has a north-south span ofapproximately 30 miles from Granby north to Neck City. The site is generally characterizedby extensive surface land disturbances and chat piles that resulted from mining, milling, and thesmelting of ore. Disturbed areas are spread over approximately 240 square miles. Communitiesin the area include Joplin, Carterville, Carthage, Diamond, Duenweg, Granby, Oronogo,Ritchey, and Webb City.

Approximately eight million cubic yards of waste milling and mining products arescattered throughout the area. Some areas have been reclaimed for residential and industrialuses by leveling and incorporating the remaining chats with the soil. Open mine shafts, subsidedareas having steep, unstable slopes, and open pits containing deep pools of water existthroughout the region. The general site is primarily uncontrolled and routinely used forrecreational purposes (i.e. fishing, hunting, scuba diving, swimming, ATV usage, etc.). Inaddition, water-quality problems result from artesian flow of mine waters from open shafts,rainwater runoff, and seepage from tailings piles and settling ponds. Chats have been used asrailroad ballast, road materials, and aggregates in asphalt paving and concrete. Sands andsmaller sizes have been used for children's sandboxes and play areas, abrasives, roofinggranules, pipe coatings, and filter sands (Barks, 1976).

In 1989, the Department of Health (DOH) collected 24 soil samples from locationsthroughout the mine tailings area. Sampling was biased toward residential and tailing areas mostlikely to result in high population exposure. Lead levels ranged from 44 to 2,830 parts permillion (ppm) with a mean of 947 ppm. Cadmium levels were 2.7 to 190 ppm and averaged54 ppm. Zinc levels ranged from 345 to 36,300 ppm with a mean of 9,245 ppm. In 1986, theEnvironmental Protection Agency (EPA) collected ten soil samples throughout the site area. Thelead level range was 73 to 7,300 ppm with a mean of 2,501 ppm; cadmium ranged from 5.9 to250 ppm and averaged 80 ppm; and the zinc range was 750 to 39,000 ppm with a mean of11,775 ppm (EPA, 1986).

For comparison, the Leadville, Colorado exposure study found residential soil lead levelsthat ranged from 110 to 12,000 ppm and cadmium levels from 1 to 150 ppm (ATSDR, 1990).A survey of U.S. soils found background soil concentrations for lead ranged from 2 to 200 ppm,

from .01 to .70 ppm, and zinc from 10 to 300 ppm. A U.S. Geologic Survey studyestimated that the average Missouri lead soil concentration ranged from 2.1 to 930 ppm with amean of 44 ppm (USGS, 1984). The same survey estimated cadmium soil levels to be less than1 ppm.

METHODS

This study was conducted in two phases; a census phase and a data collection phase. Allpersons participating in the data collection phase were randomly chosen from eligible personsdetermined in the census.

Population Census Phase

Detailed city and county maps were obtained from the state highway department, localcounty assessors, and other available sources. They were used to determine the exposure andcontrol areas for the study. The exposure area was the Jasper County Superfund Site andincluded portions of Webb City, Joplin Rural Route 3, Joplin Rural Route 7, all of Oronogo,all of Duenweg, and all of Carterville. The control area was chosen to be socio-economicallysimilar, geographically close, but physically outside the Superfund and lead mining area. Itincluded Neosho south of U. S. Highway 86 and all of the city of Goodman.

Mailout

After the exposure and control areas were determined, the DOH contracted with a Joplin-area bulk mailing service. The service maintained an address label data base for each of theareas. The DOH provided all of the printed informational letters, census forms, envelopes, andpostage-paid pre-addressed return envelopes to the mailing service. D 's Addressing and BulkMailing provided all of the labeling and handling, including delivery to the various city postoffices. As a part of the agreement, D 's provided the DOH an extra set of mailing labels.These labels were used on the census forms from responders. When the census was complete,the only labels remaining were those residences not responding. These labels were placed oncensus questionnaire forms and forwarded to field staff for follow-up. Appendix A and B areexamples of the letter and census form used in this phase.

The census form requested the name, age, gender, and length of residence for eachperson living in the household. A 60-day residency requirement was necessary to participatein the second phase. This requirement was established to ensure recent exposure to lead andcadmium contamination in soil, air, or water.

The mailout census to the exposure area took place in January 1991, and to the controlarea in February. The mailing included 6,745 letters to the study area and 6,202 letters to the

control area (Table 1). Approximately 20% of the census forms were returned completed. Themailout volume was, by design, artificially large. Our shotgun approach included all addressesin several areas, especially rural routes, even though only a small portion was used as the studyareas. A good example of this was in the northwest portion of Joplin where the mailout includedapproximately 40 square blocks which was not in the final designated study area. Approximately600 homes from Rural Route 3 received mailout letters, but only about 35 homes were actuallyin fSa study area. By utilizing cross reference directories, local maps, and information f^-rnruiai route mail carriers, approximately 40% of the remaining labels were excluded from i ifollow-up because they were determined to be out of the study area.

Census Field Follow-up

Field follow-up was directed by an on-site coordinator. Investigators were studentsattending the Environmental Health Technology program at Missouri Southern State College,which was under contract to the Department for the service. Follow-up forms were separatedaccording to city or rural route, and then further subdivided according to street. The addressesthat showed only a post office box number were translated, where possible, into street addressesby using water billing records. The local coordinator trained the students in interviewtechniques, purpose and design of the study, confidentiality requirements, and data handlingrequirements. A total of 14 students participated in the data collection on evenings andweekends.

Students worked in pairs to guarantee personal safety. They were required to pick upduty assignments at the Jasper County Health Department, and to return the forms there at theend of each work day. A special mail slot was installed in a secured doorway for formsreturned after normal working hours. This reduced the possibility of misplaced, lost, or missingforms, and helped to insure the confidentiality of the information.

The coordinator documented the results of field activity as "complete", "vacant", "willnot participate", or "not home". All forms were then sent to the DOH central office, except"not home" which were continued in the field process. Each residence was visited at least twotimes, on different days, and at different times. Also, notes were left requesting the residentto call the local coordinator concerning the census.

Field census activity was initiated on March 2, 1991, in the exposure area and ended onJuly 25, 1991, in the control area. Within the study area, 3,343 homes were visited yieldingcompleted census data on 2,340. There were 438 vacant homes, 277 would not participate, andno one could be contacted at 288 homes. For the control area, 1,901 homes were visited withinformation being collected at 1,278, 133 were found vacant, 84 unwilling to participate, and406 could never be contacted (Table 1). A total of 2,808 survey forms were determined to belocated within the study areas and within the proper age classifications (i.e., six months to44 years of age [study n = 1,844, control n = 964]).

The response to the census for the study group was 84%, and the control group 79%.From these survey forms, 8,067 persons (study n = 5,229, control n = 2,838) were determinedeligible for the study data collection phase. Of those eligible, 1,070 were children (692 Study,378 Control); 1,794 were in the youth category (1,165 Study, 629 Control); and 5,203 wereadults (3,372 Study, 1,831 Control) (Table 2; Attachment 1).

Data Collection Phase - Participant Selection and Recruitment

After the census was completed, information on all eligible participants was entered intoa data base file. To be eligible for the study data collection phase, candidates must have beenbetween 6 months and 45 years of age and have lived at the current residence for 60 days ormore. Age groupings were established for 6 months through 71 months (children), 6 through14 years (youth), and 15 through 44 years (adult). A stratified random sample of residents wasselected with over-sampling of young children. The sample size for the study and controlpopulations was 400 each. The populations were stratified to 250 children, 100 youth, and50 adult. To determine the sample size, we used the following formula:

n= EO,(E/Z)2 + pq/N

Where:1. p= percent of attribute (elevated blood lead level) in the universe, expressed as a

decimal, .102. q = l - p3. E= sampling error, expressed as a decimal was 3%4. Z= numerical value of the standard deviation for the 95% confidence level, 1.965. N= size of the universe, 89496. n= size of the sample

The above sample size calculation is used to determine the number of participants neededto be representative of the study area. In addition, if sample size is calculated to determine thenumber of participants needed for each group to detect a difference in elevated blood lead levelsbetween the control and study population of 10% (0% in control and 10% in study) wouldrequire 179 persons per group for an alpha of .05 and a power of .85.

Randomly selected candidates were contacted by telephone, informed of the second studyphase, and invited to participate (Tables 2a and 2b). The participation rate in the data collectionphase for both groups was 34 %. The study adult group was the least likely to participate withonly 23 % volunteering. Table 3 summarizes the reasons for candidates not participating. Ifcandidates did not participate, it was generally because eligible candidates could not be reachedor they refused. Many gave no reason for not participating, especially in both adult groups.Table 4 summarizes our efforts to contact candidates by telephone and field visits. At least threetelephone attempts were made to reach the candidate. At least two field attempts were made tocontact the candidates not reached by telephone.

Interviews

Standard questionnaires (Appendices C, D, and E) were used for each child, youth, oradult selected for the data collection phase and who agreed to participate. A standard householdquestionnaire was used for all group classifications (Appendix F). All interviewers were trainedinitially by ATSDR using a standard interviewer training manual (ATSDR, 1991). Interviewersincluded the study investigators and students from Missouri So, 'hern State College. The studyquestionnaire was answered by the individual in the case of adults and jointly by theparent/guardian with the participant who was under the age of 16 years. All interviewquestionnaires were visually inspected for completeness and consistency at the completion of theindividual's clinic session, and again at the end of each day, by the on-site coordinator. Toensure quality control of interviewing, one of the investigators, along with the clinic coordinator,attended every clinic session, monitored interviews during the session, and visually inspectedthe questionnaire at the end of each clinic session.

Prior to the interview, all participants were requested to provide informed consent beforefurther participation. Parents or guardians provided consent to interviewing and biologicaltesting of minor children under age 18. In addition to parental consent, children aged12 through 17 years were asked to verbally assent to testing. Also, participants were offeredthe opportunity to sign consent forms to have their individual results sent to their privatephysician. Participants received ten dollars for their participation. All consent forms and thequestionnaire were reviewed and approved by the Missouri Department of Health InstitutionalReview Board. Forms used for consent and receipt of payment can be seen in Appendices G,H, and I.

In order to determine if the study participants differed from the non-participants, fourvariables were examined. The distribution of these variables (race, household income, educationlevel and year house built) was compared between the 1990 Census and results from the studyhousehold questionnaire for the study and control areas. The racial distributions between theCensus and study participants were equivalent. Household income and education level weregenerally higher for the study participants than the levels shown in the 1990 Census. Incomelevel averaged $5,000 higher than the Census for the study area households and $8,000 higherfor the control area households. Education levels were about one year higher for both study andcontrol participants compared with the 1990 Census. Study area participants lived in homes ofsimilar age to those indicated on the Census, while the control area participants generally livedin newer homes, by about eight years, than that indicated by the Census.

Biological Specimens

Each participant was asked to provide blood and urine specimens for heavy metalexposure measurement and biological testing. A minimum amount of seven (7) milliliters ofblood was collected for analysis. Duplicate blood samples were collected from some adults forquality control/quality assurance. No duplicates were collected from children. Specimencollection took place during a six-week period from July 15, 1991, through August 31, 1991.

8

All specimen collection for the exposed group was done at the Jasper County HealthDepartment. For the control group, specimen collection was centrally located at the civicauditorium in downtown Neosho. All urine and blood specimen collection containers wereprovided by an ATSDR contract laboratory. Biological tests and expected normal range valuesused in this study can be seen in Appendix J and Appendix K.

Parents/guardians received instructions on urine collection procedures from clinical staff.They were requested to obtain a urine sample from each family participant, including themselvesif appropriate. In the event of initial urine collection failure, participants were provided liquidsto drink and a second collection attempt was made later. For very young children and for totalurine collection failures, urine specimen collection devices were sent home with the participantfor further attempts at collection and return the next day. Participants were then directed to theinterview area, followed by the venous blood sample collection. All phlebotomists used on thisstudy were specialized in pediatric phlebotomy.

Laboratory Specimen Quality Control/Quality Assurance

To ensure the quality control and quality assurance of the biological testing, ATSDRcontracted with Midwest Research Institute (MRI), Kansas City, Missouri, and theEnvironmental Health Laboratory Sciences (EHLS), CDC, to conduct the laboratory analyses.MRI subcontracted locally with Roche Laboratory for the complete blood counts and forphlebotomists. To prevent the contamination of specimens with the analytes of interest, speciallyscreened cadmium and lead free collection materials, including vials, vacutainers, and collectioncups, were sent from the EHLS to the study clinic sites.

To minimize the possibility for specimen loss, each sample was labeled with a uniqueidentification number provided by the EHLS. Each participant's information, including censusform, questionnaire, consent form, etc., was labeled with the same identification number as thebiological specimens. All information was maintained as a medical record for each participantand checked at completion of the participant's clinic session, and then checked again at the endof each daily clinic by the on-site coordinator.

All biological specimens were handled by an on-site coordinator provided by MRIaccording to a protocol established by the EHLS for this study (MRI, 1991). Blood specimensanalyzed locally were transported twice daily to the local laboratory. All other specimens weretransported overnight to the respective laboratories in shipping containers specially provided byEHLS.

Environmental Sampling

This study included environmental sampling for lead and cadmium in drinking water,soil, and house dust. Only lead was analyzed for in the interior house paint sampling. Allenvironmental sampling was done under a standard protocol agreed to by ATSDR, EPA, andDOH (EPA, 1991), and within the financial resource capacity of the EPA. In this agreement,

MI,MMUOJ-\;I.I jaded

EPA committed to sample 100 study households and 25 control households, plus all householdshaving a child with 10 micrograms per deciliter or greater blood lead. Participants were askedto provide consent for environmental sampling at the time of their original interview.

All child households were listed and then randomized using one child participant perhousehold. Initially, ISO households were chosen for environmental sampling in the study groupand 50 households in the control group, to reach a sample group of 100 study and 25 controlhouseholds. This list of households was provided to the EPA for initiation of sampling onSeptember 15, 1991. Information provided to the EPA included name, locating information, andhomeowner consent for property access.

EPA's initial field activities consisted of coordination with the property owners to arrangefor a time to meet to explain the sampling procedure, drop off a water bottle for collection of"first draw" water sample, and arrange for a convenient time for sample collection (i.e., to pickup the water sample and to collect the indoor dust, exterior soil and paint samples). Two fieldcrews were used on the initial sampling, completing an average 16 homes per day. During tmssampling event, the DOH received reports on some participants with elevated blood lead results.Households of these members were sampled during this event rather than waiting for the follow-up sampling event. Replacement households for the elevated cases were provided to the EPAfrom the original list of randomized households.

The first sampling event was completed September 27, 1991. During this first samplingevent, the EPA collected samples from 119 households in the study area and 18 in the controlarea.

A second sampling event occurred from November 18 through November 22, 1991.There were six study and eight control households in this environmental sampling event. A totalof 125 households, including the elevated blood lead households, were used in the study areafor environmental sampling. Of the 125 study area households, 105 (84%) were randomlyselected from 173 non-duplicated eligible households, and 20 (16%) were blood lead elevatedchildren's houses of the 25 households that were eligible for sampling. The control areasampling included 26 child households.

Data Management

All interview questionnaires were visually inspected by the on-site coordinator forcompleteness and consistency at the completion of the individual's clinic session and again at theend of each day. All questionnaire data was entered into a DBase m file and converted into aStatistical Analysis System (SAS) dataset. To insure data entry consistency, a 10% randomsample of all participants was drawn and reviewed by the principal investigator and consultantsfrom the St. Louis University School of Public Health. The questionnaire data was submittedto ATSDR on a standard tape in ASCII *~->rmat. ATSDR merged the questionnaire data with thebiological and environmental test data :rom the submitting laboratories. It was returned toMissouri on a standard tape in the form of a SAS dataset.

10

Data analysis was done jointly by DOH and the St. Louis University School of PublicHealth. The Statistical Package for the Social Sciences (SPSS) and SAS statistical packages wereused in data analysis.

Analytical Approach

For this study, statistical significance was p=.05 and borderline significance was set atp<.10. Significance values indicated the probability pf being correct when rejecting a nullhypothesis of no difference between comparison groups. P-values are for two-tailed tests.Questionnaire data was initially compared between study and control groups using chi-square testfor nominal data and student's t-test for continuous data. Laboratory measurements for bloodlead and urine cadmium were compared using a student's t-test. Biological data was alsoreported as the percent normal, below normal, and above normal and compared between groupsby chi-square. No adjustments were made for multiple comparisons; however, this limitationwas considered in interpreting the results.

Multiple regression analysis was used to evaluate the relationship between a number ofvariables that the literature would suggest is associated with blood lead levels. It washypothesized that the higher the environmental levels of lead and cadmium and the greater thenumber of behavioral factors that contribute to exposure, the higher the blood lead levels andurine cadmium levels. Two modeling techniques were used, a full regression model in whichall relevant variables were entered into the model simultaneously and a stepwise model in whichonly those variables included in the full model that met specified criteria were entered into themodel in a forward step-wise manner. A p-value of .15 was used for variables to enter themodel and a value of .25 was used for variables to be taken out of the model.

Stepwise regression was used for two purposes: 1) to provide a more parsimonious modelthan that provided by the full model; and, 2) in the case of the youth and adult groups, becausethere was an inadequate number of cases to use a full model. It is desirable to have a minimumof five cases per variable in the model (i.e., if there are only 60 cases available, the modelshould not include more than 12 variables).

Variables were selected for the regression model based upon review of the literature andfrom the investigators knowledge of the toxicology of lead poisoning to determine whichdemographic, environmental and behavioral variables have been associated with elevated leadpoisoning. Different factors were used for children than youths or adults, depending upon theirstage of behavioral development. For example, finger sucking behavior is more likely in youngchildren than adults, while adults will be exposed to lead through gun firing and cleaningactivities. For the dichotomous variables, "no" was coded as zero (0) and "yes" was coded asone (1).

Prior to regression analysis, a correlation matrix was constructed to evaluate variablesfor collinearity. None of the variables selected for inclusion was collinear with any othervariable (r2>.64) (Lewis-Beck, 1980).

11

RESULTS

We measured blood lead levels and urine cadmium levels on 695 persons to determineif there was a relationship between exposure to products from mining and smelting operationsand elevated blood lead and urine cadmium levels. Persons were sampled from three groups:children 6 through 71 months of age, youths 6 through 14 years of age, and adults 15 through44 years of age. The 6 through 71 nonths of age group was considered the most at risk of leadpoisoning and, therefore, more persons were recruited into this group. All groups includedpersons from both an area of Missouri where lead mining had taken place over the past century(study) and another area where lead mining had never taken place (control). The demographiccharacteristics of the study and control groups can be seen in Table 5.

The study group included 412 volunteers and the control group 283. Blood lead levelscould only be obtained in 391 study persons and 271 controls because we were unable to collectan adequate amount of blood from the remaining 33 participants. The number of persons inwhich cadmium levels could be obtained was less than for lead because of the difficulty ofobtaining urine samples from small children, particularly those in diapers (study, n = 356;controls, n = 249).

Children 6 through 71 Months of Age

Table 6 presents questionnaire information that was taken on each child in the two studygroups. There were 243 children in the study group and 138 in the control group. In the vastmajority of the cases, the information on the children was obtained from the mother.Approximately half the subjects in both groups were male and 95 % were white. Both study andcontrol groups were of similar age, with mean ages slightly over three years. Only 2% of thechildren breast fed. The children spent approximately 90% of their time at home, and theremainder was divided between baby-sitter, day care, or other location. When the child wasawake, six to seven hours were spent playing on the floor at home. The study children playedon the floor a little more than an hour a day longer than the control children (p = .051).

Most all the children in both groups spent time outdoors playing around their homes orother places in the neighborhood. Approximately 30% of these children also played in yardsother than their own. In general, the children in both groups played in all areas around thehouse, but more often in the back and front yards. The study group spent significantly moretime outdoors, 3.24 hours, compared to the control group, 2.65 hours (p = .017). Only 1.2%of the children in the study group reported playing in or around mine tailings and waste piles.Most parents in both groups reported that the area the children played in was grassy, butapproximately 17% played in areas that were composed of dirt and soil.

Over a third of the children in both groups took food, snacks, or bottles outside whenthey played. Most parents in both groups reported that their children wash their hands beforeeating and sleeping, and were washed after playing with dirt or sand. Ten percent of the studyand 14% of the control children were reported to have used a pacifier in the previous six

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months. Approximately a fifth of all the children sucked their thumb or fingers and chewedtheir fingernails; however, significantly more children in the study group were reported to chewfingernails, 26.7% and 17.4% respectively (p= .051). There was little overlap between childrenin the groups with various hand-to-mouth behaviors. A child that sucked his/her thumb was nomore likely to use a pacifier or chew fingernails. Only 14% of the children in the groupsdemonstrated more than one behavior and only three children had all three behaviors.

Half of the children had a favorite toy or blanket, but only a fifth of the children tookit outside. Most children did not put this into their mouth. Over half the children occasionallyput things in their mouth other than food but only occasionally swallow non-food items.

The parents indicated that most of the children (95%) never put paint chips in theirmouth. Approximately one fifth of the children Lived in households that had a garden in theiryard. Children only occasionally ate vegetables from their garden. Approximately 60% of thechildren ate vegetables grown in other locations. Less than 5% of the children had ever beentreated with herbal medicines.

Table 7 presents the simple bivariate analysis of the biological and environmental data.The environmental data was related to the household, (125 in the study area and 26 in thecontrol area), not to a specific individual. Blood lead levels were almost twice as high in thestudy children compared to the control households with children (p = .001). This correspondedwith significantly higher lead found in dust, paint, and soil in the study area.

There were no significant differences in the amount of lead found in the analysis of waterin the two areas. Although there were no differences in urine cadmium levels, the levels ofcadmium in the dust and soil samples were significantly higher in the study area. There wereno significant differences in cadmium levels in water.

Table 8 indicates the child group blood lead levels distribution. The range was less thanone to 40.5 /ig/dL for the study group and less than one to 9.5 ^g/dL for controls.Table 9 presents blood lead levels for various factors that might be associated with thedistribution of lead levels. Lead levels in both groups were slightly higher in males than femalesbut the differences did not reach levels of statistical significance. There were no statisticallysignificant differences in the lead levels of the children playing outdoors compared to thosestaying inside. In both groups, children who played in grassy areas had significantly loweraverage blood lead levels than those children who played in dirt areas. This was also reflectedin the higher average lead levels in the children who played in dirt. Children in both groupswho took food outside had higher levels of blood lead, but this only reached statisticalsignificance in the study group. Children in the control group that used a pacifier had higherblood lead levels that were of borderline statistical significance. Children in the study groupwho ate vegetables from a home garden had higher blood lead levels than those who never atefrom these gardens; however, the difference was only of borderline significance.

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We also looked at the correlation between the age of the house and the blood lead andurine cadmium levels (data not shown in tables). The age of the house was significantly relatedto blood lead, (r = .32, p < .001) but not to urine cadmium levels (r = .05, p = .473). Theyear the house was built also significantly related to the amount of cadmium in dust samples(r = .289, p < .001) and to the soil cadmium and lead levels (r = .346, p < .001), and(r = .546, p < .001) respectively. The highest correlation was between the amount of lead inpaint samples and the year the house was built, (r = .570, p < .001).

Table 10 presents results in a manner similar to Table 9 but for household information.Children living in a rented home had significantly higher blood lead levels than those living inowner occupied houses. In the study group, homes with copper water pipes had children withsignificantly higher blood leau levels than those not having copper pipes. Blood lead levels inchildren who lived in households that included a person who repaired auto radiators had higherlead levels.

The distribution for child urine cadmium levels can be seen in Table 11. Over 90% ofvalues in both study groups were below 0.20 micrograms per gram.

Table 12 presents the results of the blood chemistry analysis and the immune functiondata. As expected from the mean results presented in Table 7, significantly more children inthe study group had elevated blood lead levels compared to controls, 13.8% compared to 0%,p <.001. More children in the study group had low mean corpuscular hemoglobin levelscompared to the control group (p = .018), as were the results for percent monocytes(p = .022). Slightly more children in the study group had lower urea nitrogen levels, andslightly more children in the control group had elevated levels. For the immunological data,there was a different distribution of mature T-cells, primarily due to the larger number ofchildren in the control group with elevated levels. Significantly more children in the controlgroup had low percent natural killer cells.

Children 6 through 71 Months of Age Household Questionnaire Results

Table 13 presents the results of the household questionnaire. Only one questionnaire wasadministered per household. Approximately 9% of all homes had lead water pipes and 16%copper water pipes. Slightly more homes in the study group had people who smoke cigarettesin the house, 48% compared to 38%, (p = .048). More study homes had cats and dogs thatwent in and out of the house. All other variables were equally distributed between the study andcontrol groups.

Sixteen children lived in mobile homes. The average blood lead and urine cadmiumlevels were not significantly different in this group compared to those children not living inmobile homes. Lead was 5.15 pg/dL compared to 5.29 /xg/dL and cadmium was .065 /tg/g and.074 /xg/g respectively. In the mobile homes the content of lead in the water was higher6.89 fjLg/L compared to water in other housing, 2.33 ^g/L; however, this was not statisticallysignificant, (p = .378).

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There was no difference in the presence of a smoker in the house and the year the housewas built between the two groups. The education level of the head of the household wassignificantly higher in non-smoking homes, 13.8 years compared to 12.5 years (p <.001), aswas the household income level (p < .001).

Children 6 through 71 Months of Age Multivariate Analysis

A multivariate linear regression model was used to evaluate the relationship betweenenvironmental factors and blood lead levels. Table 14 shows the regression coefficients forblood lead, after all variables had been entered into the model, for each of the variables alongwith their levels of statistical significance. Because environmental sampling for lead in dust,soil, water, and paint was done on only some of the participants, regression analysis was basedon only the 163 individuals in which data was available on all factors. Individuals selected forenvironmental sampling were biased toward those who had a high blood lead level.Approximately 16% of the environmental samples came from homes with elevated blood leadlevels and the remaining samples were randomly selected.

The only statistically significant variables in the full model were the amount of lead foundin the soil samples taken from the individual's yards, whether the house had lead water pipes,and the household income. The only other factors that were even close to being significant werewhether the children took food outside with them, whether they played in a grassy area, and thehead of household's education.

In addition to this model, we ran a stepwise regression model using those variables listedin Table 14. A stepwise model limits variables that get into the model to specific statisticalcriteria. For this model, a p-value of 0. IS was used for variables to enter the model and a valueof 0.25 was used for variables to be taken out of the model. This results in a considerablystreamlined model, but not one so restrictive that only statistically significant variables enter themodel. All statistically significant variables remain in the model and variables suggestive of arelationship were also in the model. Results of this analysis were presented in Table 15. Soillead levels, household income, presence of lead water pipes in the home, and head of householdeducation level were statistically significant while the year the house was built, age, and whetherthe child took food outside were of borderline significance.

The full stepwise model explains 35 % of the variance in blood lead levels. Soil leadalone explains 25 % of this variance. Therefore, the other six variables combined only explain10% of the variance.

Table 7 showed that the mean value for lead paint was significantly different between thestudy and control groups. In order to determine the contribution of interior paint to the bloodlead levels as compared to soil, we calculated the correlation coefficients between blood lead,soil lead, paint lead, and the age of the house. Age of house was included in the model becauseof the significant correlation between paint lead and soil lead, and the assumption that olderhouses would more likely have both interior and exterior lead paint. The paint lead

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jgdRd

measurements were taken from inside the house, and, therefore, should not contribute to the soillead levels. Figure 1 shows the correlation coefficients between these various factors. The yearthe house was built was statistically correlated with both paint and soil levels. The correlationbetween inside lead paint levels and soil was probably indirect through age of the house, whichreflected the probability of exterior lead paint. Diagram A of Figure 2 presents this correlationdiagram with the partial correlation's controlling for the age of the house for both the controland study group combined. The correlation between paint and blood lead was decreased vilethe correlation between soil lead and blood lead remains relatively constant. This relationsiuppersists for the study group alone (Diagram B) but there was no correlation between any of thesemeasures in the control group alone (Diagram C).

In order to determine the possible effect this might have, we repeated the multipleregression on only those children's households which were not randomly selected forenvironmental sampling (Table 16). Only the soil and dust lead levels and whether they rentedtheir house were statistically significant. The only major difference between the two models isthat dust lead levels were significant after these households were removed from the model.Because all households not randomly selected had children with blood lead levels greater thanor equal to ^ 10 ng/dL, this suggests that dust plays a more important role in children withlower blood lead levels than in children with higher blood lead levels. Soil lead, however,remained the most important variable in both models.

Table 17 presents a full regression model without the environmental data. This modelincludes all 339 children with blood lead levels, more than twice the number of children thanwhen environmental factors were in the model. This was because only a sample of homes werechosen for environmental assessment. The variable indicating exposure status was highlysignificant in this model but did not reach statistical significance in the model with environmentalfactors. This was due in part to the significant correlation between blood lead and soil lead andlead in interior paint, r = .27 and .23 respectively. Exposure status is a proxy for elevated soillead because soil lead levels in the exposure group are six times higher than the control group.The other significant factors included having played in a grassy area, taking food outside, headof household education level, household income, and year the house was built. These factorswere similar to those in the regression model with the environmental factors included.

A similar multivariate analysis was done for cadmium (Table 18). The only significantvariables in the model were the amount of cadmium in the water, whether they played outside,and whether the child took food outside to eat. After all variables were entered, 22.4% of thevariance was explained by the model but almost half, 10.3%, was explained by the cadmiumlevels in the water. The stepwise model resulted in the same three variables, cadmium in water,playing outside, and taking food outside as statistically significant. No other variables were evenof borderline significance, and, therefore, did not enter the model.

Table 19 presents the model of cadmium without the environmental variables. In thismodel, only having played outdoors and taking food outdoors was statistically significant withhousehold income of borderline significance.

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Youths 6 through 14 Years of Age

Table 20 presents questionnaire information that was taken on each person 6 through14 years of age. There were 117 persons in the study group and 95 controls. Significantlymore mothers answered the questionnaires for the respondents in the control group comparedto the study group. In the control group, 6.3 % of the respondents reported never spending timeoutside compared to only 0.9% of the study group (p = .027). This was also reflected inspending time in various locations outside the house. Significantly more respondents in the studygroup reported playing near mine tailings or slag piles. Significantly more study participantsreported playing on sidewalks or streets and also more reported playing in ground that was dirtand playing in sandboxes. More participants in the study group reported taking food outsidewhen they played.

As indicated in Table 7, the mean blood lead levels were significantly higher in the studygroup, 3.61 ng/dL compared to the controls, 2.46 ng/dL (p < .05). Urine cadmium levels wereslightly higher in the study group, .114 /tg/g, compared to the controls, .087 /xg/g, but this wasof only borderline significance (p = .067).

Table 21 presents the blood lead distributions for the study and control groups. Table22 presents mean blood lead levels for the groups by various factors on the individualquestionnaire. Blood lead levels were significantly higher in the youth study group whoindicated that they played in dirt (p = .056) and for those who say they played in sand(p = .059). It was also significantly higher in the 20 youth who indicated that soil was hauledin for their garden and in those who ate root vegetables from the garden. The only significantdifference in the control group was that youth who did not wash after having played in dirt hadhigher blood lead levels than those who washed (p = .043).

Table 23 presents blood lead results by the household questionnaire. In the study group,the only significant factor was that youths who lived in homes with lead water pipes hadsignificantly higher blood lead levels (p = .038). Control youths that lived in air conditionedhomes had lower blood lead levels than those living in non-air conditioned homes (p=.056).

The urine cadmium distributions for the youth study groups can be seen in Table 24.Over 90% of all results are below 0.30 /ig/g. Table 25 presents the results of the bloodchemistry analysis and the immune function data. Although the mean blood lead levels werehigher in the study group than the controls, the only persons with an elevated lead level werein the control group. All other persons' levels were within normal limits.

Youths 6 through 14 Years of Age Household Questionnaire Results

Table 26 presents household questionnaire results on this group. More persons in thestudy group lived in mobile homes, 6.8% compared to 1.1 %. More persons in the study grouphad lead water pipes compared to control, and more study participants used natural gas, but lessstudy participants had recently painted the inside of their homes. Significantly more persons in

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the control group prepared, served or stored food in clay, homemade, or foreign made material.None of the households in either group had a household member that worked in mining or amine related occupation. The responses to the other questions on the household questionnairewere unremarkable.

Youths 6 through 14 Years of Age Multivariate Analysis

Because of the small number of persons whose homes had environmental values on soil,dust, and water, it was necessary to limit the regression analysis to a stepwise approach andexclude the environmental data. Table 27 presents the stepwise regression results on blood leadafter the environmental factors had been removed. Five variables remained in the model andall were statistically significant: year the house was built, exposure status, sucked thumb, malegender, and household income. For cadmium, four variables remained in the model: age,household income, having a vegetable garden, and exposure status; however, only age wasstatistically significant (Table 28).

Adults 15 through 44 Years of Age

Table 29 presents questionnaire information similar to that presented for the other twoage groups. There were 52 persons in the study group and 50 persons in the control group.Half of the study group and 44% of the control group were males. Almost half of both groupsreported being exposed to smoking in their workplace. Similar numbers of persons in the studyand control groups currently smoked cigarettes, 34.6% and 28.0% respectively. Approximately13% of the total group reported chewing tobacco and 8% used snuff. Almost all persons,approximately 87 % , reported using alcoholic beverages sometime in their life and 59 % currentlyused it. Only one person in the study group reported working in a mining related job in the last90 days.

Table 7 presents the results of the blood lead and urine cadmium levels. Mean bloodlead levels were slightly higher in the study group, 3.44 /xg/dL compared to the control group,2.22 ng/dL. There were no differences in the cadmium levels.

The blood lead distributions for the adult groups can be seen in Table 30. The high leadlevel (33 /xg/dL) found in the study group was probably due to occupational exposure. We alsoanalyzed the blood lead data (Table 31) similarly to that reported in Table 9. Among the studygroup, mean blood lead levels were significantly higher in the 25 males, 5.20 (±6.13) ftg/dLcompared to the 26 females, 1.97 (±.941) /ig/dL, p = .015. None of the other variablesapproached levels of statistical significance. Cadmium levels were higher in current cigarettesmokers, .659 (±.493) compared to past smokers. .340 (±.316), p = .046. This was also truefor those who had smoked at least 100 cigarettes in their life (n = 31) and those who did not(n = 20), .515 (±.446) pg/g and .272 (±.365) /xg/g respectively (no data table). None of theother comparisons approached statistical significance.

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Among the control group, lead levels were also higher for the 21 males compared to the28 females, 2.88 (±1.25) /ig/dL compared to 1.73 (±1.23), p = .002. Blood lead levels werehigher in the 25 persons who had ever smoked 100 cigarettes compared to the 24 persons whohad not, 2.85 (±1.29) and 1.56 (±.770) /tg/dL respectively. Persons working in auto bodyrepair (n = 11) had higher lead levels than 38 persons who did not, 3.03 (±1.62) and1.99 (±1.19) /tg/dL respectively (p = .024). None of the other analysis resulted in statisticalsignificance.

Table 32 presents the mean blood lead results divided into factors from the householdquestionnaire. The only significant difference was in the control group where blood lead levelswere significantly higher in persons who lived in non-air conditioned homes.

The urine cadmium distributions for the adult study groups can be seen in Table 33.Approximately 12% of the study group results are above one jig/g. Table 34 presents the resultsof the biological test data. Only one person had an elevated blood lead level, and he was in thestudy group. Significantly more persons in the control group had low suppressor/cytotoxic T-cell than the study group. Twenty percent of the study group had B-cells as a percent oflymphocytes that were low compared to only 2% in the control group (p = .005). The studygroup had more high natural killer cells, and the control group had more low natural killer cells.None of the other parameters differed significantly between the two groups.

Adults 15 through 44 Years of Age Household Questionnaire Results

Table 35 presents household questionnaire results on this group. As reported for theyounger age groups, more persons in the study group lived in mobile homes, 15.4% comparedto 2.0%. Less than 2% of the households in either group had a household member that workedin mining or a mine related occupation. The responses to the other questions on the householdquestionnaire were unremarkable.

Adults 15 through 44 Years of Age Multivariate Analysis

There were inadequate data available on the environmental sampling for a multivariateanalysis to be performed. Environmental data was taken on only six homes in each of the twogroups. Tables 36 and 37 present the multiple regression analysis for lead and cadmiumrespectively after the environmental data was removed. Three variables remained in the modelfor lead; male gender, presently smoking cigarettes, and year house was built. Only age andthe presence of a smoker in the household was included in the model for cadmium.

DISCUSSION

Study Limitations

Because of the large number of statistical comparisons calculated for this study, it islikely that some comparisons reached statistical significance by chance. If a p-value of .05 is

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used, it is possible that for every 100 comparisons, five will reach statistical significance bychance alone. It is, therefore, important to not only look at individual statistically significantdifferences, but also at other factors that might increase confidence in the results, such as theconsistency of data across similar variables, biological plausibility, and clinical relevance.

On average, only 34% of eligible persons participated in the study. This participationrate limits our anility tc generalize the results to eligible persons in the study and control areas.Comparison of particip its with census information indicated that the persons volunteering forthe tiidy were of a higher socio-economic status than the general populations of the areas.Since the socio-economic levels of the study participants were somewhat higher than the generalpopulations, the true blood lead levels of the areas in question may be slightly higher than thoseshown in this study (Table 38). This effect may be stronger in the control area since theparticipants had slightly newer hones than non-participants, also. However, these differentialswere not strong enough to affect tne overall conclusion of the study (i.e., that the study area'sresidents had higher blood lead levels than the control area's residents).

In order to recruit the required number of participating children, it was necessary to testmore than one child in approximately 24% of the households. For this reason, environmentalsample results (i.e. soil, paint, etc.) were the same for all children in the same household. Anassumption of multiple regression is that each of the independent variables are independent ofeach other. Since the same environmental data was used for more than one child, thisassumption was violated. More weight would be given to households with more than one childincluded in the sample. There is no adequate methodological means of dealing with thisproblem. It is possible to use the number of households and not the number of participants todetermine the degrees of freedom for the statistical analysis. We evaluated all of the resultsusing this criteria and found that it did not change statistical significance.

This does not, however, remove the problem of double-counting but does add a moreconservative interpretation of significance. There is no way of adequately removing double-counting from the regression analysis. Given the size of the study area, the universe ofcandidates eb'gible for the study did not allow us to limit the study participants to one child perhousehold.

Another potential problem with the study was that approximately 16% of theenvironmental samples were not randomly taken. All households with children having elevatedblood lead levels received environmental sampling in order to provide them with counseling asto preventive measures. Because we did not want to lose this data, particularly since it was inthe children of most concern, we included all children in the analysis. This biased theenvironmental sampling toward children with elevated blood lead levels. In order to evaluatethe impact that this bias might have on the study results, we performed a multiple regressionanalysis using only children from the randomly selected households (Table 16). The slightdifference (dust lead in Table 16) between the two analyses suggests that the inclusion ofchildren from the non-randomly selected households did not affect the interpretation of results.

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Study Strengths

Strengths of this study included using a control community similar in socio-economicstatus as the study group to provide a background value for exposures, using the CDClaboratories for precise blood lead and cadmium measurements, using a standard questionnaire,and including environmental sampling of participant's households at approximately the same timeas biological sampling. The control area was selected based on socio-economic status comparingpoverty rate, education level, occupation, unemployment rate, and income. It was alsodetermined prior to initiation of the study that the comparison area was out of the mining districtand far enough removed from the lead and cadmium wastes of the Jasper County Superfund Sitethat no local exposure would be related to the Site.

The study investigators, in cooperation with ATSDR, developed and followed strict datacollection methods to control for interviewer bias. The same interviewers worked both studyareas and were given a standardized training course. The interviewers were monitored by aninvestigator during the census period and during the clinic sessions. Use of the standardizedquestionnaire tool allowed for control of confounders, such as housing characteristics, personalbehavior, hobbies, and occupations.

This study is one of the first to conduct biomarker testing of exposure while at the sametime collecting environmental samples on residences of the study members. By incorporatingthis into the study, a better picture of exposure to heavy metals could be ascertained rather thanusing only proxy measures, such as age of housing, distance to an exposure source, etc.

Interpretation

The primary objective of this study was to determine if blood lead levels and urinecadmium levels were higher in a study population of persons living in an old lead mining,milling, and smelting area in southwest Missouri compared to an area that had never had anylead mining related activities. Secondary, but related, objectives included measuring lead andcadmium in a variety of environmental media and comparing this between the study and controlpopulations. We also characterized the distribution of various biological tests in the twopopulations in relation to standard reference ranges. Finally, we determined how variousenvironmental, behavioral, occupational, and socio-economic factors influence exposure to leadand cadmium in order to recommend preventive measures to reduce this exposure.

The evidence was convincing that exposure to lead was significantly different betweenthe study and control populations. Mean blood lead levels were almost twice as high in childrenliving in the study area compared to those in the control area (Table 7). This resulted in 13.8%of the study children with blood lead levels over 10 /ig/dL, the level set by the CDC asrequiring intervention (CDC, 1991). None of the children in the control area had elevatedlevels. Youths and adults also had significantly higher mean blood lead levels; however, theonly two youths with levels above 10 ig/dL were in the control group. One adult in the studygroup had a level exceeding the CDC standard, but this was probably occupation related.

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Environmental samples for dust, soil, and water lead and cadmium, and indoor paint leadlevels, were taken from a random sample of 105 homes in the study area and 26 homes in thecontrol area (Table 7). In addition, environmental testing was done in 20 of the 25 householdsin which children had blood lead levels 10 /ig/dL or higher. Some members moved prior to theenvironmental sampling, so their households could not be sampled. It was necessary to performenvironmental sampling in the homes of children with elevated blood lead levels in order toprovide them with information on preventive steps to decrease exposure. The soil lead level inthe study area was over six times higher than in the control area. Lead in dust and paintsamples were also significantly higher in the study area. Cadmium levels in dust and soil - sretwo to four times higher in the study group; however, as noted above, the urine cadmium levelswere not significantly different between the groups.

A major objective of this study was to determine if there was a relationship betweenexposure to soil lead related to past mining operations and blood lead levels. Soil lead derivesfrom a number of sources: naturally occurring, lead paint, leaded gasoline, mine tailings, andlead smelting. It was assumed that soil lead in the control area resulted from that naturallyoccurring in the area, lead paint, and leaded gasoline. Soil from the study area would probablyinclude contributions from these sources in approximately the same proportions as in the controlarea, plus additional lead from mine tailings and past smelting operations.

Correlation analysis, however, indicate hat measurements taken on paint samples insidehomes were correlated with soil samples. Because the paint lead samples were taken inside thehouses, there should have been little if any relationship between these levels and soil lead levels.One possible explanation for this relationship was that lead paint inside the nouse was relatedto the age of the house and that the age of house was related to soil lead. In older homes, notonly was the inside painted with lead paint, but also the outside.

This significant correlation between the age of the house and paint suggests that the ageof house reflects the amount of lead paint used inside the house. By analogy, it also reflects theamount of lead-based paint used on the outside the house. This could not be directly determinedfrom this study because paint measurements were not made on the outside of the houses.

The mean house age interval for the study group was 1940-49 and for the control group1950-59. The age of house correlated with soil lead levels, r = .56. This relationship mightbe due to older homes having higher levels of lead in outside paint, which contributes to the soillevels. Because the contribution of outside lead paint to the soil levels might be differentbetween the two areas, we evaluated the relationship between blood lead levels and soil levelsadjusting for the age of the house. Figure 1 showed the correlational relationship between 'oillead and blood lead in the study and control groups as a biserial correlation, that is, a correla, nnot adjusted for age of house. Figure 2 showed the partial correlation after adjusting for houseage.

The correlation between soil and blood lead was not changed after adjusting for age ofhouse in the study group but was reduced in the control group indicating that age of the house

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contributes minimally to the relationship between blood lead levels and soil lead levels in thestudy group but decreases the relationship in the control group. This was consistent with theassumption that soil lead was the major contributor to blood lead levels independent of the ageof the house.

The correlation between lead paint and blood lead was also substantially reduced aftercontrolling for age of house while the correlation between soil lead and blood lead was virtuallyunchanged. This was related to the fact that the strong relationship between lead paint and bloodlead was spurious, that is, it was indirect because both lead paint and soil lead were related tothe age of the house. This supports the argument that soil lead was the primary determinant ofblood lead levels in the study area and that no single factor was dominant in the control group.

The importance of soil lead can be further seen in the stepwise regression model(Table 15). Soil lead was the dominant factor in predicting blood lead levels. It alone explains25 % of the variance in blood lead levels out of 35 % explained by the whole model. No otherenvironmental lead media had enough predictive power to enter the model.

Multiple regression analysis indicated a relationship between the presence of lead waterpipes and lower blood lead levels. It is not clear what this relationship indicates particularlysince the blood lead levels on average were not significantly different for children living inhomes with and without lead water pipes (Table 10).

The study area's blood lead levels were significantly higher than the control area afteradjustment for all behavioral, demographic, and socio-economic variables with the exception ofthe environmental variables. After the environmental variables were entered, the differencesdisappeared implying that the environmental differences between the study and control areasaccounted for the differences in blood lead levels.

Having shown the importance of soil lead in predicting blood lead, we examined otherfactors that were related to blood lead levels. Since the socio-economic levels of the studyparticipants were somewhat higher than the general population's of the areas, the true blood leadlevels of the areas in question may be slightly higher than those shown in this study. This effectmay be stronger in the control area since the participants had slightly newer homes than non-participants. These differences, however, were not strong enough to affect the overall studyconclusion.

Males had higher mean blood lead levels than females, which was consistent in all agegroups, but only reached statistical significance in adults. We have seen similar findings inother blood lead analyses conducted in Missouri (Phillips, 1992). In these evaluations, malestended to spend more hours outdoors than females. Also, they tended to participate in morerisky exposure behavior (i.e., soil contact, auto body work, hobbies, etc.) than did females.

Blood lead levels were higher in control children who never go outside. Also, childrenwho used a pacifier had higher blood lead levels only in the control group, but not in the study

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group. However, children in the control group who played inside were still exposed to dust leadwhich is currently considered a significant exposure source. This was further substantiated bythe fact that children who played on grassy surfaces had lower blood lead levels than those whoplayed on other surfaces, particularly dirt. Again, this can be attributed to the impact of thehigh soil lead levels overwhelming other risk factors.

A multiple regression analysis was calculated on blood lead levels using only thosebehavior factors that might be related to contact with soil. Of the 15 factors, only four weresignificantly related to blood lead levels. Children who played on a grassy surface had lowerblood lead levels; children who took food outside or played on concrete or asphalt surfaces hadhigher blood lead levels. Children who washed before going to sleep had higher blood leadlevels. This was probably related to children who played outside and get dirty were more likelyto need to wash before going to bed.

A battery of biological tests were performed for each person where adequate samples ofblood and urine were collected. In children, six measures were found to be significantlydifferent between the study and control groups: lead, mean corpuscular hemoglobin, ureanitrogen, monocytes percent, all mature T-cells, and natural killer cells. Children in the studyarea had higher mean blood lead levels than children in the control area. More children in thestudy area had low levels of mean corpuscular hemoglobin than children in the control area.More children in the study area had low blood urea nitrogen levels than children in the controlarea.

In youths, only one measure, B-cells, was found to be significantly different between thetwo groups. Three measures were found to be significantly different between the adult groups;suppressor/cytotoxic T-cells, B-cells, and natural killer cells.

As this study was not designed to collect and analyze clinical medical (orneurobehavioral) information, it is impossible to assign a causal relationship to lead for any ofthe measures (i.e. monocytes percent, all mature T-cells, natural killer cells, etc.) found to besignificantly different between the study and control groups. In addition, the differences weresmall and probably not of clinical significance. Because of the study design, no standard patternbetween the populations, and the inconsistencies seen in these results, we attempted to draw nospecial conclusions between lead and cadmium exposure and these biological findings.

The toxic effects of lead exposure on neuropsychological development in childhood havebeen evaluated extensively (ATSDR, 1988). Lead is ubiquitous in the environment and readilycrosses the placenta during pregnancy. Young children are vulnerable to the effects of leadbecause they absorb a larger amount per unit of body weight than adults, ingest more becauseof hand-to-mouth activity, and retain a larger fraction of the absorbed lead than do adults(Ziegler, 1978). The nutritional well-being and socio-economic status of the child may also playa role in lead toxicity (ATSDR, 1988).

24

Our study findings are similar to other studies by finding blood lead levels associatedwith personal behavioral factors, such as play area, cleanliness, etc. Our findings indicate low-level exposures are occurring in children who are exposed to the contaminate^ soil at the JasperCounty Superfund Site. Our findings further indicate that elimination of soil exposure throughplaying in vegetated areas will help to prevent elevated blood lead.

For many of our study group, the exposure has been for their entire lifetime. Our studydid not assess neurobehavioral outcomes. Because longitudinal studies are finding a link todevelopmental deficits at low-level lead exposures, further research is needed to evaluate apossible relationship between the blood lead findings, soil lead results, child development, andneurobehavioral performance.

25

CONCLUSIONS

This study evaluated an exposed and a control population for exposure to lead andcadmium mining wastes. The evaluation covered four specific objectives and found:

1. The blood lead values were significantly higher in the study group compared tothe control group. There was no significant difference for urine cadmiumbetween the two groups.

2. Levels of lead and cadmium in various environmental media (soil, dust, interiorpaint) were significantly higher in the study area as compared to the control area.

3. There were very few significant differences in the biological tests between thestudy and control groups.

4. Environmental exposure to soil was the most important factor influencing thedistribution of the childhood blood lead levels between the two groups.

27

RECOMMENDATIONS

1. Study results found elevated blood lead levels due to exposure to soils at the JasperCounty Superfund Site. We, therefore, recommend that exposure to the leadcontaminated soil in the study area be reduced.

2. Adverse neurobehavioral outcomes are considered to be the health problems of concerndue to blood lead poisoning. This study did not attempt to evaluate the neurobehavioraloutcomes, such as school achievement or IQ scores from standardized tests administeredin local school systems. We recommend a study be initiated to evaluate neurobehavioraloutcomes based on these school records.

3. For future similar epidemiological studies, we recommend environmental soil and dustsamples for lead be speciated to determine the percent of the contribution from thevarious sources of environmental lead.

29

AUTHORS and ACKNOWLEDGMENTS

Authors:Patrick E. Phillips, DVM, MSPH1

R. Gilegoiy Evans, PhD, MPH2

Daryl W. Roberts, MEd1

Anthony D. Moehr, BS3

Sandra E. Stewart, BS1

Ana-Maria Murgueytio, MD, MPH2

Wayne F. Schramm, MA1

Affiliations

1. Missouri Department of Health, Jefferson City, Missouri2. St. Louis University School of Public Health, St. Louis, Missouri3. Jasper County Health Department, Webb City, Missouri

Acknowledgments

Jasper CountyDanny Hensley- Presiding CommissionerLloyd Burgi- CommissionerAnna Ruth Crampton- CommissionerEarl Campbell- Former CommissionerCity of Joplin, Missouri

Jasper County Health DepartmentBill Gory

Newton County Health DepartmentCity of Neosho, Missouri

McDonald County Health DepartmentCity of Goodman, Missouri

Missouri Southern State College, Joplin, MissouriDr. Wayne Adams

Midwest Research Institute, Kansas City, MissouriKay TurmanJohn Stanley, PhD

Freeman Hospital, Joplin, Missouri

31

Agency for Toxic Substances and Disease Registry, Region Vn OfficeDenise Jondan-Izaguirre, Senior Regional RepresentativeDavid Parker

Environmental Protection Agency, Region VII OfficeGlen CurtisRobert MorbyDavid WagonerBUI RiceMorris Kay

Agency for Toxic Substances and Disease Registry, Atlanta, GeorgiaSara SarasuaFred Stallings, MDJeffrey Lybarger, MD, MPHDan Harper

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

Charles DodsonPatricia MuellerRobert VogtDaniel Pascal

St. Louis University School of Public Health, St. Louis, MissouriFernando SerranoNancy Yolanda SerranoPatricio Murgueytio, MD, MPHJim Kimmey, MD, MPH

University of Missouri, Columbia, MissouriTom Clevenger, PhD

Census Takers and InterviewersMonty BreckenridgeJanine NeffTisha Elaine WeberRichard TaffnerLeigh Ann AndersonAmy TillmanRayna BroadwayRoxane WeldonLarry MeachamWendy Conrow

32

Randy MillsKerri ColeDerick TillmanMichiko Bienda JonesJoseph JohnsonChirstiana Vanlook

Clerical SupportDonna ElliottJudy EhrhardtPatricia Weaver

The investigators would especially like to acknowledge and thank the citizens for theirparticipation and assistance as the study was developed and implemented.

33

'"•""""-'!'''•' P"" **"!'"•'

34

REFERENCES

Agency for Toxic Substances and Disease Registry (ATSDR), United States Department ofHealth and Human Services, 1988. The Nature and Extent of Lead Poisoning in Children in theUnited Stastes: A Report to Congress. Atlanta, Georgia.

Agency for Toxic Substances and Disease Registry (ATSDR), United States Department ofHealth and Human Services, 1991. Multi-state Heavy Metal Exposure Study QuestionnaireTraining and Coding Manual. Atlanta, Georgia.

Barks, J. (1977). Effects of Abandoned Lead and Zinc Mines and Tailings Piles on WaterQuality in the Joplin, Missouri Area. United States Geological Survey, Water ResourcesInvestigation, No.77-75.

Baghurst, P., McMichael, A., Wigg, N., Vimpani, G., Robertson, E., Roberts, R., and Tong,S. (1992). Environmental exposure to lead and children's intelligence at the age of seven years:The Port Pine Cohort Study. N. Engl. J. Med. 327:1279-1284.

Centers for Disease Control and Prevention (CDC), United States Department of Health andHuman Services, 1991. Preventing Lead Poisoning in Children. Atlanta, Georgia.

Colorado Department of Health, 1990. Leadville Metals Exposure Study. Denver, Colorado.

Fulton, M., Roab, G., Thomson, G., Laxen, D., Hunter, R., and Hepburn, W. (1987).Influence of blood lead on the ability and attainment of children in Edinburgh. Lancet 1:1221-1226.

Lewis-Beck, 1980. Applied Regression: An Introduction. Beverly Hills, CA: Sage UniversityPress).

Midwest Research Institute (MRI), 1992. Multistate Lead and Cadmium Exposure Study withthe States of Missouri, Kansas, and Illinois: Summary Report. Kansas City, Missouri.

Moehr, A.D., Roberts, D.W., Phillips, P.E., and Evans, R.G. (1994). Childhood leadpoisoning near abandoned lead mining and smelting areas: a case study of two affectedhouseholds. J. Environ. Health 56(3):20-23.

Needleman, H., Gunnoe, C., and Barrett, P. (1979). Deficits in psychological and classroomperformance of children with elevated dentine lead levels. N. Engl. J. Med. 300:689-695.

Needleman, H., Schell, A., Bellinger, D., Leviton, A., and Allred, E. (1990). The long-termeffects of childhood exposure to low levels of lead: An 11-year follow-up report. N. Engl. J.Med. 322:83-88.

35

Phillips, P.E., Roberts, D.W., (1992). Evaluation of Lead Exposure in the Glover, MissouriArea: Report to the Missouri Department of Natural Resurces. Jefferson City, Missouri.

United States Environmental Protection Agency (EPA), 1986. Final Report for the Tri-StateMining Area Joplin, Missouri. Region VIE Kansas City, Kansas.

United States Environmental Protection Agency (EPA), 1991. Sampling Protocol for the JasperCounty Blood Lead and Cadmium Exposure Study. Region VJJ, Kansas City, Kansas.United States Geological Survey (USGS), United States Department of the Interior, 1984."Geochemical Survey of Missouri: Geography of Soil Geochemistry of Missouri AgriculturalSoils." Geological Survey Professional Paper 954-H, I. Washington, D., C.

Ziegler, E., Edwards, B., Jensen, R., Mahaffey, K., Fomon, S. (1978). Absorption andretention of lead by infants. Rediatar. Res. 12:29-34.

36

AUTHORS and ACKNOWLEDGMENTS

Authors:Patrick E. Phillips, DVM, MSPH1

R. Gregory Evans, PhD, MPH2

Daryl W. Roberts, MEd1

Anthony D. Moehr, BS3

Sandra E. Stewart, BS1

Ana-Maria Murgueytio, MD, MPH2

Wayne F. Schramm, MA1

Affiliations

1. Missouri Department of Health, Jefferson City, Missouri2. St. Louis University School of Public Health, St. Louis, Missouri3. Jasper County Health Department, Webb City, Missouri

Acknowledgments

Jasper CountyDanny Hensley- Presiding CommissionerLloyd Burgi- CommissionerAnna Ruth Crampton- CommissionerEarl Campbell- Former CommissionerCity of Joplin, Missouri

Jasper County Health DepartmentBill Gory

Newton County Health DepartmentCity of Neosho, Missouri

McDonald County Health DepartmentCity of Goodman, Missouri

Missouri Southern State College, Joplin, MissouriDr. Wayne Adams

Midwest Research Institute, Kansas City, MissouriKay TurmanJohn Stanley, PhD

Freeman Hospital, Joplin, Missouri

31

Agency for Toxic Substances and Disease Registry, Region Vn OfficeDenise Jordan-Izaguirre, Senior Regional RepresentativeDavid Parker

Environmental Protection Agency, Region VII OfficeGlen CurtisRobert MorbyDavid WagonerBUI RiceMorris Kay

Agency for Toxic Substances and Disease Registry, Atlanta, GeorgiaSara SarasuaFred Stallings, MDJeffrey Lybarger, MD, MPHDan Harper

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

Charles DodsonPatricia MuellerRobert VogtDaniel Pascal

St. Louis University School of Public Health, St. Louis, MissouriFernando SerranoNancy Yolanda SerranoPatrick) Murgueytio, MD, MPHJim Kimmey, MD, MPH

University of Missouri, Columbia, MissouriTom Clevenger, PhD

Census Takers and InterviewersMonty BreckenridgeJanine NeffTisha Elaine WeberRichard TaffnerLeigh Ann AndersonAmy TillmanRayna BroadwayRoxane WeldonLarry MeachamWendy Conrow

32

Randy MillsKerri ColeDerick TillmanMichiko Brenda JonesJoseph JohnsonChirstiana Vanlook

Clerical SupportDonna ElliottJudy EhrhardtPatricia Weaver

The investigators would especially like to acknowledge and thank the citizens for theirparticipation and assistance as the study was developed and implemented.

33

REFERENCES

for Toxic Substances and Disease Registry (ATSDR), United States Department off and Human Services, 1988. The Nature and Extent of Lead Poisoning in Children in the

United Stastes: A Report to Congress. Atlanta, Georgia.

Agency for Toxic Substances and Disease Registry (ATSDR), United States Department ofHealth and Human Services, 1991. Multi-state Heavy Metal Exposure Study QuestionnaireTraining and Coding Manual. Atlanta, Georgia.

Barks, J. (1977). Effects of Abandoned Lead and Zinc Mines and Tailings Piles on WaterQuality in the Joplin, Missouri Area. United States Geological Survey, Water ResourcesInvestigation, No. 77-75.

Baghurst, P., McMichael, A., Wigg, N., Vimpani, G., Robertson, E., Roberts, R., and Tong,S. (1992). Environmental exposure to lead and children's intelligence at the age of seven years:The Port Pine Cohort Study. N. Engl. J. Med. 327:1279-1284.

Centers for Disease Control and Prevention (CDC), United States Department of Health andHuman Services, 1991. Preventing Lead Poisoning hi Children. Atlanta, Georgia.

Colorado Department of Health, 1990. Leadville Metals Exposure Study. Denver, Colorado.

Fulton, M., Roab, G., Thomson, G., Laxen, D., Hunter, R., and Hepburn, W. (1987).Influence of blood lead on the ability and attainment of children in Edinburgh. Lancet 1:1221-1226.

Lewis-Beck, 1980. Applied Regression: An Introduction. Beverly Hills, CA: Sage UniversityPress).

Midwest Research Institute (MRI), 1992. Multistate Lead and Cadmium Exposure Study withthe States of Missouri, Kansas, and Illinois: Summary Report. Kansas City, Missouri.

Moehr, A.D., Roberts, D.W., Phillips, P.E., and Evans, R.G. (1994). Childhood leadpoisoning near abandoned lead mining and smelting areas: a case study of two affectedhouseholds. J. Environ. Health 56(3):20-23.

Needleman, H., Gunnoe, C., and Barrett, P. (1979). Deficits in psychological and classroomperformance of children with elevated dentine lead levels. N. Engl. J. Med. 300:689-695.

Needleman, H., Schell, A., Bellinger, D., Leviton, A., and Allred, E. (1990). The long-termeffects of childhood exposure to low levels of lead: An 11-year follow-up report. N. Engl. J.Med. 322:83-88.

35

Phillips, P.E., Roberts, D.W., (1992). Evaluation of Lead Exposure in the Glover, MissouriArea: Report to the Missouri Department of Natural Resurces. Jefferson City, Missouri.

United States Environmental Protection Agency (EPA), 1986. Final Report for the Tri-StateMining Area Joplin, Missouri. Region Vn Kansas City, Kansas.

United States Environmental Protection Agency (EPA), 1991. Sampling Protocol for the JasperCounty Blood Lead and Cadmium Exposure Study. Region VTJ, Kansas City, Kansas.United States Geological Survey (USGS), United States Department of the Interior, 1984."Geochemical Survey of Missouri: Geography of Soil Geochemistry of Missouri AgriculturalSoils." Geological Survey Professional Paper 954-H, I. Washington, D., C.

Ziegler, E., Edwards, B., Jensen, R., Mahaffey, K., Fomon, S. (1978). Absorption andretention of lead by infants. Rediatar. Res. 12:29-34.

36

TABLES

37

Table 1.—Number of residences determined from census mailout and field visitsand percent response to the census, Jasper County Lead and Cadmium ExposureStudy, Missouri 1991.

Mahout Response

TOTAL MAILOUT LETTERS

ReturnedResidents Exceeded Age 44Outside of Study AreaPotential Participants

TOTAL MAILOTTT RESPONSE

Field Visit Response

Residents Exceeded Age 44Refused ParticipationOutside of Study AreaVacant (inc. businesses)Not HomePotential Participants1

Study Area

6745

324614331

1269

827277

2133438288

1513

TOT AT, FTF.T.D VISIT RESPONSE 5476

Control Area Total

6202 12947

201 525699 1313351 682

1251

66584

3050133406613

4951

2520

1492361

5183571694

2126

10427

TOTAL No. of Homes in Area i

Percent response •*399884%

245379%

645182%

Data base Completed Surveys

1 . Field visit potential participants

2. Total number of homes in area44 + Not home

3. Percent response =(Residents Exceeded Age 44 +

1844 964 2808

= Completed surveys - Mailed potential participants

= Potential participants + Residents exceeded age

Participants) / (Total number of homes in area - vacant)

39

Table 2.—Number and percent of residents determined eligible for the study fromthe census data collection phase, by study group, Jasper County Lead and CadmiumExposure Study, Missouri 1991.

Group

Children

Youth

Adults

Total Eligible

Study (%)

692

1165

3372

5229

(13%)

(22%)

(65%)

(100%)

Control (%)

378

629

1831

2838

(13%)

(22%)

(65%)

(100%)

TOTAL (%)

1070

1794

5203

8067

(13%)

(22%)

(65%)

(100%)

Table 2a.—Eligible study group candidates, sample size, and number and percent willingto participate in the data collection phase, Jasper County Lead and Cadmium ExposureStudy, Missouri 1991.

Study Group

Children

Youth

Adults

TOTAL

Eligible Members

692

1165

3372

5259

Sample Size (%)'

667 (96%)

327 (28%)

229 (7%)

1223 (23%)

Participants (%Y

243 (36%)

117 (36%)

52 (23%)

412 (34%)

1. Sample size percent = sample size / eligible members.2. Participants percent = participant members / sample size.

41

Table 2b.—Eligible control group candidates, sample size, and number and percentwilling to participate in the data collection phase, Jasper County Lead and CadmiumExposure Study, Missouri 1991.

Control Group

Children

Youth

Adults

TOTAL

Eligible Members

378

629

1831

2838

Sample Size (%)'

369 (98%)

296 (47%)

163 (9%)

828 (29%)

Participants (%Y

138 (37%)

95 (32%)

50 (31%)

283 (34%)

1. Sample size percent = sample size / eligible members.2. Participants percent = participant members / sample size.

43

Table 3.—Reasons for candidates not participating in the data collection phase, by study andcandidate group, Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

Child <EligiblSampleAcceptRefuse

iroup Response to Recruitment> Candidate*))Size

ed Participationd Participation

Reasons for Refusal

Unable to contactCandidate movedRefusedNot interestedChange in group classFilled the groupScheduled, did not showNo exact reason given

Study Group692667243424

Study Group (n— 424)

28%7%

21%5%6%0%

12%20%

Control Group378369138231

Control Group (n— 231)

14%8%

34%3%4%0%

18%20%

Youth Group Response to RecruitmentEligible CandidatesSample SizeAccepted ParticipationRefused ParticipationReasons for Refusal



Study Group (n=210)

30%7%

16%0%3%8%9%

27%


201Control Group (n=201)

19%5%

21%3%1%0%9%

41%

Adult Group Response to RecruitmentEligible CandidatesSample SizeAccepted ParticipationRefused ParticipationReasons for Refusal



177Study Group (n = 177)

23%3%

20%3%1%0%9%

41%


113Control Group (n=113)

15%6%

26%3%0%0%

14%36%

45

Table 4.—Number and percent of telephone and field attempts to contact candidatesfor the data collection phase, Jasper County Lead and Cadmium Exposure Study,Missouri 1991.

ContactMethod

PhoneAttempts

One Call

Two Calls

Three Calls

Four Calls

Five orMore Calls

SUBTOTAL

FieldAttempts

One Visit

Two Visits

Three orMore Visits

SUBTOTAL

TOTALATTEMPTS

TOTAL

666

309

168

84

79

1,306

275

112

4

391

1,697

StudyNumber

401

163

90

52

32

738

179

91

1

271

1,009

GroupPercent

60%

53%

54%

62%

41%

57%

65%

81%

25%

69%

59%

ControlNumber

265

146

78

32

47

568

96

21

3

120

688

GroupPercent

40%

47%

46%

38%

59%

43%

35%

19%

75%

31%

41%

47

Table 5.—Demographic Characteristics for Study and Control Groups, Jasper CountyLead and Cadmium Exposure Study, Missouri 1991.

CharacteristicStudy Group

Number PercentControl Group

Number PercentSex

MaleFemale

207205

50.249.8

140143

49.550.5

Age6-71 months6-14 years15-44 years

24311752

59.028.412.6

1389550

48.833.617.6

RaceWhiteBlackAsian/PacificIslander

Am Indian/Alaska Native

3963

1

9

96.80.70

0.20

2.20

2743

0

5

97.21.10

0.00

1.80Income/year

<$15,000$15,000-24,999> $25, 000

91106200

22.926.750.4

4871

151

17.826.355.9

Education1

< 12th GradeHigh SchoolGraduate

Technical schoolSome College ormore

5

21011

179

1.20

51.92.70

44.2

2

1306

145

0.07

45.92.10

51.2Year Home Built

<19301930-19591960-1991

9477

134

30.825.243.9

2577

141

10.331.758.0

1. Education level of the head of the household.

49

Table 6.—Child questionnaire responses by factors and group, Jasper County Leadand Cadmium Exposure Study, Missouri 1991.

FACTORPerson answering question

MotherFatherGrandparentOther person

Subject lived in this house (yrs)

GenderMaleFemale

RaceWhiteBlackAsian or Pacific IslanderAmerican Indian/ Alaska nativeRefusedDon't know

Hispanic originYesNoRefusedDon't know

Age (yrs)

Does child breast feed? ( < 3yrs old)YesNoNot applicable (child S 3yrs old)

Where does child spend time (in a 24 hour period)?Baby-sitter (his)Commercial day care (hrs)Other location (hrs)Home (hrs)

STUDYMean ± SDn = 243

86.8%9.9%0.4%2.9%

2.31 ±1.71

50.2%49.8%

95.9%0.8%0.0%2.9%0.0%0.4%

4.9%94.7%0.0%0.4%

3.38 ±1.58

2.1%55.1%42.8%

3.82% ±8.71.77% ±5.44.84% ±7.789.1% ±12.8

CONTROLMean ± SDn = 138

86.2%8.0%2.2%3.6%

2.41 ±1.52

44.9%55.1%

94.9%2.2%0.0%2.2%0.0%0.7%

4.3%94.2%0.0%1.4%

3.18 ±1.78

2.2%47.1%50.7%

3.86% ±9.02.22% ±6.05.27% ±9.688.1% ±14.3

p-value1

.375

.301

.322

NC

.523

.264

.312

Average hours child spends asleep 10.14 ±1.85 10.24 ±1.76 .598

Hours child spends playing onthe floor indoors at home

7.15 ±10.95 5.68 ±3.17 .051

51

Table 6.—Continued.

FACTORDoes child play outdoors around house or inneighborhood?

YesNoIf yes, how many hours?

Does child play in any of the following areas aroundthe house?

Back yard?YesNo

Front yard?YesNo

Side yard?YesNo

Other?YesNo

Where does child play other than own yard?Neighbor's yard

YesNo

PlaygroundYesNo

Near creek or ditchYesNo

Near tailings or slag pilesYesNo

Sidewalks or streetsYesNo

ParkYesNo

Only plays at homeYesNo

OtherYesNo


92.4%7.8%3.24 ±2.54

66.3%33.7%

47.7%52.3%

32.9%67.1%

3.3%96.7%

33.3%66.7%

5.8%74.2%

2.9%97.1%

1.2%98.2%

7.4%92.6%

15.2%84.8%

20.6%79.4%

28.0%72.0%


89.9%10.1%2.65 ±2.16

60.1%39.9%

48.6%51.4%

25.4%74.6%

3.6%96.4%

28.3%71.7%

4.3%75.7%

7.2%92.8%

0.0%100.0%

1.4%98.6%

19.6%80.4%

23.2%76.8%

24.6%75.4%

p-value1

.438

.017

.232

.879

.122

.864

.306

.552

.047

NC

.012

.273

.550

.479

52


FACTORIf the ground where the child plays:

f^nmAvunsayYeaNo

Concrete or asphaltYesNo

Dirt or soilYesNo

SandboxYesNo

OtherYesNo

Does child take food, snacks, bottle, etc. outside toplay?

YesNo

Are child's hands washed before eating?YesNoDon't know

Are child's hands washed before sleeping?YesNoDon't know

Are child's hands washed after playing with dirt orsand?

YesNoDon't know

How many times per week is child given a bath orshower?

Has child used a pacifier in the past 6 months?YesNo

Does child suck thumb or fingers?YesNo


80.7%19.3%

11.1%88.9%

15.6%84.4%

10.3%89.7%

9.1%90.9%

37.0%63.0%

86.8%12.3%0.8%

90.9%8.6%0.4%

95.1%3.7%1.2%

7.57 ±3.33

10.3%89.7%

20.6%79.4%


80.4%19.6%

12.3%87.7%

18.8%81.2%

8.0%92.0%

3.6%96.4%

39.1%60.9%

89.1%10.9%0.0%

89.9%10.1%0.0%

88.4%8.7%2.9%

6.49 ±2.91

14.5%85.5%

21.0%79.0%

p-value1

.953

.722

.421

.458

.047

.686

.059

.671

.057

.002

.221

.920

53


FACTORDoe* child chew on fingernails?

YesNoDon't know

Does child have a favorite blanket or toy?YesNo

Does child carry it with them during the day?YesNoDon't know

Does child often put this in their mouth?YesNoDon't know

Frequency child puts things other than food in theirmouth?

A lotOnce in a whileAlmost neverNever

Frequency child puts mouth on furniture or windowsill?

A lotOnce in a whileAlmost neverNever

Frequency child swallows things other than food?A lotOnce in a whileAlmost neverNever

Frequency child puts paint chips in their mouth?A lotOnce in a whileAlmost neverNeverDon't know


26.7%73.3560.0%

46.1%53.9%

19.3%80.2%0.4%

12.8%86.8%0.4%

21.4%34.2%29.6%14.8%

9.1%23.0%19.3%48.6%

0.0%7.8%25.9%66.3%

0.0%1.6%1.6%96.3%0.4%

CuNTkuLMean ± SDn = 138

17.4%81.9%0.7%

50.0%50.0%

21.7%78.3%0.0%

15.2%84.8%0.0%

21.7%37.7%19.6%21.0%

13.0%30.4%13.0%43.5%

0.7%10.1%22.5%66.7%

0.7%2.9%2.2%94.2%0.0%

p-value1

.051

.462

.650

.607

.126

.125

.433

.531

54


FACTOR


CONTROLMean ± SDn =•• 138 p-value1

Does household have « vegetable garden in the yard?Yes 21.0%No 79.0%

Has soil been hauled in and placedon the garden?

Yes 10.3%No 89.7%Don't know 0.0%

How often does child eat vegetablesgrown in the garden?

Once a week or more 8.2%Less than once per week 82.7%Never 9.1%

How often does child eat leafy green vegetables grownin the garden?

Once a week or more 1.6%Less than once per week 88.9 %Never 9.5%

How often does child eat rootvegetables grown in the garden?

Once a week or more 2.5 %Less than once per week 89.3%Never 8.2%

How often does child eat vegetables grown elsewhere inthe local area?

Once a week or more 36.2%Less than once per week 30.5%Never 33.3%

How often does child eat leafy green vegetables grownelsewhere in the local area?

Once a week or more 21.4%Less than once a week 46.1 %Never 32.5%Don't know 0.0%

How often does child eat root vegetables grownelsewhere in the local area?

Once a week or more 13.6%Less than once a week 44.0%Never 41.6%Don't know 0.8%

23.9%76.1%

9.4%89.9%0.7%

11.6%81.9%6.5%

2.2%84.8%13.0%

8.0%83.3%8.7%

34.8%18.8%46.4%

11.6%58.0%29.7%0.7%

10.9%54.3%34.8%0.0%

.508

.401

.416

.510

.041

.014

.027

.199

55


FACTORHas child ever been treated with traditional or herbalmedicines?

YesNoDon't know


2.9%96.7%0.4%


5.1%94.9%0.0%

p-valuel

.417

1. P-values are for proportions from chi-square analysis and for intervaldata from t-test.

NC-Not calculated because less than five subjects expected per cell.

56

Tableand

Teste

7. — Comparison of blood lead, urine cadmium, and environmental data by study groupsage classes, Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

i Variable Study GroupMean ±SD (n)

Control Group Mean±SD (n) p-valuel

Environmental

Lead Dust2

Lead Water3

Lead Paint*

Lead Soil2

Cadmium Dust2

Cadmium Water3

Cadmium Soil2

608 ±1551 (125)

2.62 ±3.60 (125)

1.38 ±1.65 (121)

599 ±735 (125)

8.60 ±5.87 (125)

1.51 ±10.9 (125)

11.1 ±8.04(125)

209 .±408 (26)

2.12 ±0.42(26)

0.412 ±0.23 (26)

91.1 ±112 (26)

4.85 ±3.55 (26)

0.225 ±0.05 (26)

2.59 ±2.99 (26)

.006

.438

.001

.001

.001

.505

.001

Children 6 through 71 Months of Age

Blood Lead5

Urine Cadmium6

6.25 ±4.86 (225)

0.07 ±0.07 (193)

3.59 ±1.88 (128)

0.08 ±0.09 (112)

.001

.758

Youth 6 through 14 Years of Age

Blood Lead

Urine Cadmium

3.61 ±1.97 (115)

0.114 ±0.121 (112)

2.46 ±2.24 (94)

0.087 ±0.084 (90)

<.001

.067

Adult 15 through 44 Years of Age

Blood Lead

Urine Cadmium

3.44 ±4.59 (51)

0.419 ±0.429 (51)

2.22 ±1.35 (49)

0.309 ±0.539 (47)

.052

.264

1. P-values from t-test.2. Parts per million.3. Parts per billion.4. Milligrams per square centimeter.5. Micrograms per deciliter.6. Micrograms per gram.

57

Table 8.—Child group distribution of blood lead levels by study and control populations,Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

Blood Lead Level(mi xograms/deciliter)

0.1-1.5

1.6-3.0

3.1-4.5

4.6-6.0

6.1-7.5

7.6-9.0

9.1-10.5

10.6-12.0

12.1-13.5

13.6-15.0

15.1-16.5

16.6-18.0

18.1-19.5

19.6-21.0

21.1-22.5

22.6-24.0

24.1-25.5

39.1-40.5

TOTAL

Study GroupNumber (Cum. %)

8 (3.6)

41 (21.8)

54 (45.8)

41 (64.0)

20 (72.9)

16 (80.0)

20 (88.9)

6 (91.6)

2 (92.4)

5 (94.7)

2 (95.6)

2 (96.4)

2 (97.3)

1 (97.8)

2 (98.7)

1 (991.)

1 (99.6)

1 (100.0)

225

Control GroupNumber (Cum. %)

12 (9.4)

51 (49.2)

32 (74.2)

18 (88.3)

7 (93.8)

7 (99.2)

[<10/xg/dL] = 1 (100.0)

,

128

59


S T U D Y C O N T R O LFACTOR Mean ±SD (n) Mean ±SD (n)Ate child's hands washed after playing with dirtor sand?

Yes 6.23 ±4.87 (214) 3.51 ±1.75 (114)No 6.41 ±5.08 (9) 3.04 ±2.07 (10)p-value .914 .424

Has child used a pacifier in the past 6 months?Yes 6.56 ±5.14(23) 4.71 ±2.73 (18)No 6.23 ±4.83 (201) 3.40 ±1.64 (110)p-value .757 .064

Does child suck thumb or fingers?Yes 5.84 ±4.10 (48) 3.00 ±1.87 (26)No 6.38 ±5.04 (176) 3.74 ±1.86 (102)p-value .501 .074

Does child chew on fingernails?Yes 6.49 ±4.84 (62) 3.07 ±1.14 (22)No 6.17 ±4.87(162) 3.66 ±1.96 (102)p-value .662 .064

Does child have a favorite blanket or toy that iscarried with them during the day?

Yes 5.75 ±3.14(44) 3.35 ±1.90 (26)No 6.13 ±4.82(58) 3.81 ±1.75 (105)p-value .655 .315

Does child often put this in their mouth?Yes 6.08 ±4.75 (29) 3.86 ±1.97 (20)No 5.90 ±3.% (73) 3.52 ±1.75 (44)p-value .844 .487

Has soil been hauled in and placed on thehousehold garden?

Yes 4.70 ±2.57 (21) 3.57 ±2.56 (12)No 6.44 ±5.02 (23) 3.45 ±1.56 (19)p-value .161 .878

How often does child eat vegetables grown in thegarden?

Once a week or more 6.89 ±5.37 (19) 3.30 ±1.33 (15)Never 4.48 ±2.36 (18) 3.57 ±2.36 (9)p-value .087 NC

62

Table 9.—Mean blood lead1 values compared to child questionnaire factors bygroup, Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

FACTORSTUDYMean ±SD (n)

CONTROLMean ±SD (n)

SexMaleFemalep-value2

Does child play outdoors around house or inneighborhood?

YesNop-value

Is the ground where the child plays:Grassy

YesNop-value

Concrete or asphaltYesNop-value

Dirt or soilYesNop-value

SandboxYesNop-value

Does child take food, snacks, bottle, etc. outsideto play?

YesNop-value

Are child's hands washed before eating?YesNop-value

Are child's hands washed before sleeping?YesNop-value

6.77 ±5.26(112)5.72 ±4.38 (113).106

6.13 ±4.95(208)5.14 ±3.55(17).457

5.92 ±4.68 (182)9.02 ±5.94 (26).016

5.85 ±3.95 (22)6.36 ±5.06 (186).646

7.57 ±5.06 (35)6.05 ±4.90 (173).098

7.62 ±4.60 (23)6.15 ±4.97(185).179

7.37 ±6.13 (87)5.55 ±3.72(121).015

6.11 ±4.89(196)7.02 ±4.66 (28).356

6.39 ±5.00 (206)4.64 ±2.44(19).133

3.79 ±1.62(59)3.42 ±2.07 (69).263

3.50 ±1.82(117)4.57 ±2.29(11).071

3.29 ±1.71 (104)5.17 ±1.88(13)<.001

3.16 ±1.71 (15)3.55 ±1.88(102).449

4.31 ±2.01 (26)3.26 ±1.70(91).010

3.53 ±2.09(11)3.49 ±1.80(106).946

3.80 ±1.93 (50)3.72 ±1.17(67).118

3.67 ±1.95(113)2.98 ±1.10(15).051

3.63 ±1.91 (114)3.23 ±1.56(14).454

61


STUDY CON1KULMean ±SD (n) Mean ±SD (n)

How often does child eat leafy green vegetablesgrown in the garden?

Once a week or more 6.27 ±1.71 (4) 2.57 ±0.57 (3)Never 6.46 ±5.51 (20) 3.64 ±1.98 (18)p-value NC NC

How often does child eat root vegetables grown inthe garden?

Once a week or more 7.11 ±2.20 (6) 3.43 ±2.00 (11)

Never 6.40 ±5.69 (18) 3.48 ±1.76 (11)

p-value NC .956

1. Blood lead values are in micrograms per deciliter.2. P-values are from t-test.NC-Statistical significance not calculated if number of subjects was less than 10 in any cell.

63

Table 10.—Mean blood lead1 values compared to child household questionnaire factors bygroup, Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

FACTORSTUDY

Mean ±SD (n)CONTROLMean ±SD (n)

I» soctarior of bom* woodYwNop-value*

b home rented or ownedRentOwnedp-value

Doei home hive lead waterpipe*

YeaNop-value

Does home have copperwater pipes

Ye.Nop-value

House been refinishedin liit year

YesNop-value

Ii air conditioningu«ed in home

YesNop-value

Painted pictures withartist paints

Ye.Nop-value

Painted or refinishedfurniture

YesNop-value

Cast lead into anythingYesNop-value

6.46 ±5 Ot5.93 ±4.13.432

7.63 ±4.225.67 ±4.99.006

6.40 ±5.286.26 ±5.25.909

8.58 ±5.925.51 ±4.61.002

6.00 ±3.986.42 ±5.48.493

6.03 ±4.797.54 ±5.09.102

5.57 ±3.686.33 ±4.98.463

5.31 ±4.416.44 ±4.93.180

7.50 ±1.606.22 ±4.88NC

(137)(86)

(66)(159)

(21)(163)

(46)(138)

(?7)(124)

(193)(32)

(25)(200)

(40)(185)

(3)(222)

3.64 ±1.843.53 ±1.93.748

4.53 ±1.853.30 ±1.80.002

3.13 ±1.663.63 ±1.89.412

3.58 ±2.233. 56 ±1.79.982

3.75 ±1.963.41 ±1.80.320

3.50 ±1.884.18 ±1.79.162

3.35 ±1.993.63 ±1.86.532

3.90 ±2.243.50 ±1.76.309

3.07 ±0.343.62 ±1.91NC

(72)(56)

(30)(98)

(11)(81)

(16)(76)

(64)(63)

(111)(17)

(20)(108)

(29)(99)

(4)(123)

65


Factor

Worked with soldering inelectronic*

YMNop-vaiue

Soldered pipe* or roeulYMNop-value2

Repaired auto ndiitonYesNop-vilue

Worked on *uto bodief or•uto maintenance

YesNop-vilue

Made potteryYe«Nop-vilue

Casting or smelting leadYesNop-value

Battery manufactureYesNop-value

Paint, glaze, and inkYesNop-value

Other lead related activityYesNop-value

Food or drink prepared,served or stored in clay,homemade, or foreign madematerial

YesNop-value

StudyMean+. SD

5.14 ±4.086.50 ±5.01.114

7.56 ±6.466.23 ±4.82NC

7.53 ±3.946.13 ±4.93.220

6.22 ± 3.966.26 ± 5.65.947

3.906.25 ±4.86NC

6.26 ±2.066.25 ±4.90NC

4.91 ±2.496.31 ±4.94.375

8.07 ±9.676.21 ±4.76NC

5.74 ±2.216.25 ±4.96.744

6.83 ±6.416.24 ±4.80.710

(n)

(39)(183)

(8)C14)

(20)(204)

(114)(111)

(1)(224)

(4)(220)

(10)(214)

(4)(221)

(10)(213)

(10)(212)

ControlMean±SD

2.80 ±1.713.61 ±1.82.128

2.88 ±1.213.62 ±1.90NC

4.96 ±1.933.48 ±1.82.012

3.67 ±1.983.50 ±1.77.596

2.703.60 ±1.88NC

3.59 ±1.88NC

3.59 ±1.88NC

4.703.58 ±1.88NC

1.94 ±0.523.68 ±1.88NC

2.65 ±1.323.63 ±1.90NC

(n)

(13)(113)

(5)(123)

(ID(116)

(67)(61)

(1)(127)

(0)(128)

(0)(128)

(1)(127)

(7)(121)

(6)(121)

66


Factor Study ControlMean +. SD (n) Mean +. SD (n)

Food or drink Moredin copp«r/p«wttr container*

Yei 4.50 ±1.42 (6) 4.70 (1)No 6.29 ±4.91 (219) 3.58 ±1.88 (127)p-valua NC NC

Food or drink itored in openoriginal can

Yei 6.90 ±4.58 (30) 3.60 ±2.08 (26)No 6.14 ±4.90 (195) 3.59 ±1.83 (102)p-value7 .427 .974

1. Blood lead values are in micrograms per deciliter.2. P-values are from t-test.NC-Significance levels not calculated if number of subjects was less than

10 in any cell.

67

Table 11.—Child group distribution of urine cadmium levels by study andcontrol populations, Jasper County Lead and Cadmium Study, Missouri 1991.

Urine Cadmium Level(micrograms per gram)

0.01-0.10

0.11-0.20

0.21-0.30

0.31-0.40

0.41-0.50

0.51-0.60

0.61-0.70

0.71-0.80

TOTAL


167(86.5)

15 (94.3)

8 (98.4)

2 (99.5)

1 (100.0)

193

Control GroupNumber (Cum %)

•96 (86.7)

11 (95.5)

2 (97.3)

1 (98.2)

1 (99.1)

1 (100.0)

112

69

Table 12- Child Biomedical Test Percentages and Numbers by Range and Group, Jasper County Lead and Cadmium Exposure Study, Missouri 1991

FactorLow

StudyNormal High Total Low

ControlNormal High

P-Value1

TotalBlood Tests

Cadmium(micrograms/gram Creatinine)

Lead-

CBC--Basophils count(thousands/cubic mi l l imete r )

CBC--Basophils (percent)

CBC--(iranulocytes count(thousands/cubic mi l l imeter)

CBC--Granulocyles (percent)

CBC-Hemoglobin (gram/deciliter)

CBC-Hematocrit (percent)

CBC--Mean Corpuscular Hemoglobin(picograms)

CBC-Mean Corpuscular HemoglobinConcentration (percent)

CBC-Mean Corpuscular Volume(fluoroliter)

Normal Ranges Not Available for Child

0.0(0)

0.0(0)

0.0(0)

4.6(9)

66.0(130)

10.6(23)

57.6(125)

9.2(20)

0.0(0)

35.0(76)

86.2(194)

99.0(190)

98.5(197)

95.4(185)

34.0(67)

89.4(194)

42.4(92)

90.8(197)

99.5(216)

65.0(141)

13.8(31)

1.0(2)

1.5(3)

0.0(0)

0.0(0)

0.0(0)

0.0(0)

0.0(0)

0.5(1)

0.0(0)

*

(225)

*

(192)

*

(200)

*(194)

*(197)

*

(217)

*

(217)

*

(217)

*

(217)

*

(217)

0.0(0)

0.0(0)

0.0(0)

4.5(5)

66.4(75)

7.8(9)

60.0(69)

4.4(5)

0.0(0)

39.1(45)

100.0(128)

100.0( 1 1 1 )

99.1( 1 1 1 )

95.5(107)

33.6(38)

92.2(106)

40.0(46)

93.0(107)

99.1(114)

60.9(70)

0.0(0)

0.0(0)

0.9(1)

0.0(0)

0.0(0)

0.0(0)

0.0(0)

2.6(3)

0.9(1)

0.0(0)

*

(128)

*

(111)

*

(112)

*

(112)

*

(113)

*

(115)

*

(115)

*

(115)

*

(115)

*(115)

<.00l

NC

NC

0.944

0.945

0.415

0.673

0.018

NC

0.459

Table 12 cont- Child Biomedical Test Percentages and Numbers by Range and Group, Jasper County Lead and Cadmium Exposure Study, Missouri 1991

Factor

CBC-Platelet count(thousands/cubic millimeter)

CBC-Red Blood Cells(millions/cubic millimeter)

CBC-White Blood Cells(thousands/cubic mil l imeter)

CBC- Lymphocytes (percent)

CBC-Lymphocytes count(thousands/cubic millimeter)

CBC-Monocytes (percent)

CBC-Monocytes count(thousands/cubic millimeter)

CBC-Eosinophil (percent)

CBC-Eosinophil count(thousands/cubic millimeter)

CBC--Platelet Distribution Width(fluoroliter)

StudyLow Normal High

0.5(1)

14.3(31)

2.3(5)

10.7(23)

0.0(0)

8.9(19)

0.0(0)

0.0(0)

0.0(0)

11.1(24)

87.1(189)

85.3(185)

83.0(180)

46.3(100)

87.7(171)

89.7(191)

98.0(191)

96.2(204)

94.3(183)

87.6(190)

12.4(27)

0.5(1)

14.8(32)

43.1(93)

12.3(24)

1.4(3)

2.1(4)

3.8(8)

5.7(11)

1.4(3)

Total

*

(217)

*

(217)

*

(217)

*

(216)

*

(195)

*

(213)

*

(195)

*

(212)

*

(194)

*

(217)

ControlLow Normal High

0.9(1)

13.0(15)

3.5(4)

3.5(4)

0.0(0)

1.8(2)

0.0(0)

0.0(0)

0.0(0)

14.8(17)

90.4(104)

87.0(100)

81.7(94)

48.3(55)

85.0(96)

94.7(108)

98.2( H I )

97.4(111)

93.8(106)

83.5(%)

8.7(10)

0.0(0)

14.8(17)

48.3(55)

15.0(17)

3.5(4)

1.8(2)

2.6(3)

6.2(7)

1.7(2)

P- Value1

Total

*(115)

*(115)

*(115)

*(114)

*

(113)

*(114)

+

(113)

*

(114)

*

(113)

*(115)

0.535

0.726

0.821

0.076

0.496

0.022

NC

0.586

0.850

0.591

Table 12 cont- Child Biomedical Test Percentages and Numbers by Range and Group, Jasper County Lead and Cadmium Exposure Study. Missouri 1991

FactorLow

StudyNormal High Total Low

ControlNormal High

P-Value1

Total

CBC-Red Cell Distribution Width(percent)

Chem--Urea Nitrogen(milligrams/deciliter)

Chcm-Creatinine(mill igrams/decil i ter)

Chem— Alanine Aminotransferase(International Uni ts / l i ter)

Chem-Albumin (grams/deciliter)-JOJ

Chem--Reticulocyte Count (percent)

Chcm-Scrum electrolytes-sodium(milliequivalent/liter)

Chem-Scrum electrolytes-potassium(milliequivalent/liler)

Chem-Serum electrolytes-chloride(milliequivalent/liter)

Chem-Aspartate aminotransferase-AST(International Units/liter)

42.6(92)

3.8(8)

13.2(28)

0.0(0)

0.5(1)

2.4(5)

1.9(4)

2.4(5)

0.0(0)

0.0(0)

53.2(115)

96.2(204)

86.8(184)

100.0(211)

99.5(211)

89.9(187)

98.1(208)

97.6(207)

96.7(205)

100.0(212)

4.2(9)

0.0(0)

0.0(0)

0.0(0)

0.0(0)

7.7(16)

0.0(0)

0.0(0)

3.3(7)

0.0(0)

*

(216)

*(212)

*(212)

*(211)

*(212)

*(208)

if

(212)

*

(212)

*

(212)

*

(212)

37.4(43)

0.9(1)

19.7(23)

0.0(0)

0.0(0)

4.3(5)

0.0(0)

0.9(1)

0.0(0)

0.0(0)

57.4(66)

96.6(113)

80.3(94)

98.3(115)

100.0(117)

88.0(103)

99.2(116)

99.2(116)

97.4(114)

98.3(114)

5.2(6)

2.6(3)

0.0(0)

1.7(2)

0.0(0)

7.7(9)

0.9(1)

0.0(0)

2.6(3)

1.7(2)

*(115)

*

(117)

*

(117)

*

(117)

*

(117)

* •

(117)

*

(117)

*

(117)

*

(117)

*

(116)

0.632

0.020

0.122

NC

NC

0.644

NC

0.329

0.709

NC

Table 12 cont- Child Biomedical Test Percentages and Numbers by Range and Group, Jasper County Lead and Cadmium Exposure Study, Missouri 1991

Factor

Immunoglobulins-Gamma G(milligrams/deciliter)

Immunoglobulins-Gamma A(milligrams/deciliter)

Immunoglr' Gamma M(milligrams/deciliter)

Helper-T Cells(percent of lymphocytes)

Suppressor/Cytotoxic T-Cells(percent of lymphocytes)

All mature T-Cells(percent of lymphocytes)

B-Cells (percent of lymphocytes)

Natural Killer Cells(percent of lymphocytes)

Urine TestsChem--Total Protein (grams/deciliter)

Low

3.7(8)

0.5(1)

0.5( I )

4.1(9)

5.4(12)

5.4(12)

1.8(4)

0.9(2)

0.0(0)

Normal

95.4(207)

91.7(199)

96.3(209)

93.2(206)

92.8(205)

93.7(207)

94.1(208)

97.3(215)

100.0(116)

StudyHigh

0.9(2)

7.8(17)

3.2(7)

2.7(6)

1.8(4)

0.9(2)

4.1(9)

1.8(4)

0.0(0)

Total

*

(217)

*

(217)

*

(217)

*

(221)

*

(221)

*

(221)

*

(221)

*

(221)

*

(116)

Low

3.4(4)

2.5(3)

0.0(0)

5.8(7)

3.3(4)

3.3(4)

3.3(4)

8.3(10)

0.0(0)

ControlNormal High

95.8(113)

89.0(105)

98.3(116)

91.7( 1 1 1 )

95.9(116)

91.7( H I )

88.4(107)

9J- . i*(110)

98.0(212)

0.9(1)

8.5(10)

1.7(2)

2.5(3)

0.8(1)

5.0(6)

8.3(10)

0.8(1)

0.0(0)

Total

*(118)

*(118)

*

(118)

*

(121)

*

(121)

*

(121)

*

(121)

*

(121)

*

(212)

P-Value1

0.988

0.238

0.537

0.769

0.509

0.043

0.174

0.002

NC

Table 12 com- Child Biomedical Test Percentages and Numbers by Range and Group, Jasper County Lead and Cadmium Exposure Study, Missouri 1991

Factor

Chein--Gamma-Glutomyllransferase(International Units/l i ter)

UA-Red Blood Cells(number of cells/high powered field)

UA-White Blood Cells(number of cells/high powered field)

UA--Urobi l inogen (mi l l i g rams /dec i l i t e r )

Creatinine (grams/24 hours)

Alanine aminopeptidase (AAP)(micrograms/liter)

Gamma glutamyltransferase (GOT)(micrograms/liter)

N-acetyl-B-D-glucosaminidase (NAG)(micrograms/liter)

UA-Specific Gravi ty

UA-pH

Low

0.010)

0.0(0)

0.0(0)

0.0(0)

50.0(89)

5.9( 1 2 )

7.4(15)

0.0(0)

0.0(0)

0.0

(0)

StudyNormal High

100.0(210)

97.1(34)

93.7(149)

98.5(192)

48.9(87)

72.3(146)

91.6(185)

99.0(204)

100.0(195)

95.4

(185)

0.0(0)

2.9(1)

6.3(10)

1.5(3)

1.1(2)

21.8(44)

1.0(2)

1.0(2)

0.0(0)

4.6

(9)

Total

*

(210)

*

(35)

*

(159)

*

(195)

*

(178)

*

(202)

*

(202)

*

(206)

*

(195)

*

(194)

Low

0.0(0)

0.0(0)

0.0(0)

0.0(0)

55.8(63)

9.7(10)

11.7(12)

0.0(0)

0.0(0)

0.0

(0)

ControlNormal High

99.2(116)

95.0(19)

92.1(81)

100.0( 1 1 1 )

44.2(50)

72.8(75)

87.4(90)

100.0(H4)

100.0(111)

95.5

(106)

0.9(1)

5.0(1)

8.0(7)

0.0(0)

0.0(0)

17.5(18)

1.0(1)

0.0(0)

0.0(0)

4.5

(5)

Total

*

(117)

*

(20)

*

(88)

*

(111)

*

(113)

*

(103)

*

(103)

*

(114)

*

(111)

*

(111)

P-Value1

NC

NC

0.621

NC

0.364

0.374

0.470

NC

NC

.957

Table 12 com.- Child Biochemical Test Percentages and Numbers by Range and Group, Jasper County Lead and Cadmium Exposure Study, Missouri 1991

Factor

Urine Tests (Cunt.)

UA--Bacieria

UA--Bilirubin

UA-Blood

UA-Casts (Hya l ine)

UA-Crysials

UA-Epithelial cells

UA--Glucose

UA-Ketones

UA-Leukocyte esterase

UA-Nitrate

UA--Protein

Normal

0.0(0)

99.5(194)

98.5(190)

72.0(139)

70.8( 1 3 1 )

98.5(192)

96.9(189)

94.9(185

99.5(194

93.8(182)

StudyNot Normal

100.0

(17)

0.5(1)

1.6(3)

no data

28.0(54)

29.2(54)

1.5(3)

3.1(6)

5.1(10)

0.5(1)

6.2(12)

Total

*

(17)

*(195)

*(193)

*(193)

*

(185)

*(195)

*

(195)

*

(195)

*

(195)

*

(194)

Normal

18.2

(2)

100.0(111)

98.2(109)

66.7(74)

68.0(70)

100.0( H I )

100.0(111)

92.8(103)

99.1(110)

95.5(106)

ControlNot Normal

81.8

(9)

0.0(0)

1.8(2)

no data

33.3(37)

32.0(33)

0.0(0)

0.0(0)

7.2(8)

0.9(1)

4.5(5)

Total

*

(11)

*

(111)

*

(111)

*(111)

*

(103)

*

(111)

*

(111)

*

(111)

*

(HI)

*

(111)

P-Value1

0.068

NC

NC

0.326

0.614

0.189

0.062

0.457

NC

0.538

1. Percentages are indicated in first line and Numbers are shown in parenthesis.• Percentages may not equal 100%2. p value form chi-square analysisNC- significance not calculated if expected number is less than five

Table 13.—Child household questionnaire responses by group and factor, Jasper County

FACTOR

Wb*n wu houM built1900-19091910-19191920-19291930-19391940-19491950-19591960-19691970-19791980-19891990-PretentDon't know

Exterior of home i«:Wood

Ye*NoDon't know

BrickYetNoDon't know

BlockYe*NoDon't know

Vinyl or metal tidingYe*NoDon't know

Other type tidingYe.NoDon't know

I* your houie a mobile home?Ye*NoDon't know

It houie rented or owned?RentedOwned

Doe* your home have:Lead water pipe*

Ye*NoDon't know

Plaitic water pipe*Ye*NoDon't know

STUDY(n=243)

10.3*4.1%7.0*5.8*7.8*3.7*1.8*8.6*20.6%0.8%23.5%

60.1%38.7%1.2%

11.1%87.7*12%

2.1%96.7%1.2%

17.7*81.1%1.2%

13.2%85.6%1.2%

6.6%92.2%1.2%

29.6%70.4%

9.1%72.0%18.9%

59.3%21.8%18.9%

(JUNIKUL(n=138)

2.2*0.0«8.2*10.9*5.1%10.1*10.1%26.1%15.2%1.4%16.7%

58.0%42.0%0.0%

16.7%83.3%0.0*

0.0%100.0%0.0%

26.1%73.9%0.0%

18.1%81.9%0.0%

1.4%98.6%0.0%

23.2%76.8%

9.4%63.0%27.5*

39.1%33.3%27.6%

p-value1

<.001

.364

.137

NC

.071

.193

NC

.174

.135

.002

77


FACTOR

Q^lvmtzod MM! witw pipwYMNoDon't know

Copper water pipe*YMNoDon't know

Iron water pipesYeaNoDon't know

Other type of water pipesYesNoDon't know

What type water is used for drinking?Private wellPublic waterBottled waterLocal spring/brookCisternOtherDon't know

What type water is used for cooking?Private wellPublic waterBottled waterLocal spring/brookCisternOtherDon't know

What fuel is used for house heating?Bottled or tank gasNatural gasElectricityFuel oil or keroseneCoal or cokeWoodOtherDon't know

What fuel is used for water heating?Bottled or tank gasNatural gasElectricityFuel oil or keroseneCoal or cokeWoodOtherDon't know

STUDY(n=243)

21.8*59.3%18.9%

19.8%61.3%18.9%

2.1%79.0%18.Q%

12.8%68.3%18.9*

5.8%90.5%1.6%0.0%0.0%1.9%0.4%

5.8%93.0*0.0*0.0%0.0%0.8*0.4*

3.7*71.6%18.5*0.0*0.0*2.5*2.9*0.8*

1.6*70.4*26.7*0.0*0.0*0.0*0.0*1.2*

CONTROL(n=138)

18.1%54.3%27 .5ft

14.5%58.0%27.5*

8.7%63.8*27.5*

18.1%54.3%27.5%

2.2%96.4%0.7%0.0%0.0%0.7%0.0%

2.2%97.1%0.0%0.0%0.0%0.7%0.0%

0.0%70.3%21.0%0.0%0.0*3.6%5.1*0.0*

0.0%70.3%29.7%0.0*0.0*0.0%0.0*0.0*

p-valuel

.141

.106

<.001

.024

NC

NC

NC

NC

78


FACTOR

Wlut feel » used for cooking?Bottled or tank gasNatural gaaElectricityFuel oil or known*Coal or coinWoodOtherDon't know

Hat house been refiniihed in theliit yeir?

YetNoDon't know

Ii «ir conditioning uied in thehome?

Ye.No

Ii there i houiehold member that worked in:Mining

YesNo

Underground miningYesNo

Surface miningYesNo

Mine nullingYesNo

Mine transportationYesNo

Mine clerical/administrationYesNo

Smelter/smeltingYesNo

Other mining jobsYesNo

Lead mining jobYesNo

Zinc mining jobYesNo

Silver mining jobYesNo

STUDY(n=243)

2.1%51.0%46.5%0.0%0.0%0.0%0.4%0.0%

44.0%54.3%1.6%

86.0%14.0%

2.5%97.5%

0.0%100%

0.4%99.6%

0.4%99.6%

1.2%98.8%

0.4%99.6%

0.4%99.6%

1.2%98.8%

0.4%99.6%

1.2%98.8%

0.8%99.2*

CONTROL(n=138)

0.0%40.6%58.0%0.0%0.0%0.0%0.0%0.0%

49.8%50.0%0.7%

87.0%13.0%

1.4%98.6%

1.4%98.6%

1.4%98.6%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

p-vaiue'

NC

.494

.796

NC

NC

NC

NC

NC

NC

NC

NC

NC

NC

NC

79


FACTOR

Molybdenum mining jobYetNo

Cod mining jobYe*No

Limestone mining jobYeiNo

Clay mining jobYesNo

Other mining jobYetNo

Wear mining clothing homeAlwaysSometime*Never

The household member does not shower after mining relatedjob

AlwaysSometimesNever

Has a household member done any of the following in the last90 days:

Painted with artists paintsYesNo

Painted/refinished furnitureYesNo

Painted inside or outside of home or buildingYesNo

Worked with stained glassYesNo

Cast lead into anythingYesNoDon't know

Soldering in electronicsYesNoDon't know

Soldering pipes/metal sheetsYesNoDon't know

STUDY(n=243)

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

1.2%97.5%1.2%

1.6%97.5%0.8%

10.7%89.3%

18.5%81.5%

38.3%61.7%

0.4%99.6%

1.2%98.8%0.0%

16.9%81.1%2.1%

3.7%94.2%2.1%

UUIMTKUL(11=138)

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

1.4%98.6%0.0%

1.4%98.6%0.0%

15.2%84.4%

23.9%76.1%

34.1%65.9%

0.0%100%

3.6%94.9%1.4%

10.1%87.4%1.4%

5.1%94.9%0.0%

p-valuel

NC

NC

NC

NC

NC

NC

NC

.198

.209

.412

NC

NC

.173

.198

80


FACTOR

Repaired automobile ndiatonYMNoDon't know

Automobile maintenance/auto bodyYMNo

Worked in aewage treatment plantYeaNoDon't know

Made potteryYeaNo

Ride* bike/ATV in the local areaYeaNo

WeldingYeaNo

Viiited indoor firearm target rangeYeaNoDon't know

Cleaned or repaired firearmiYeaNo

Wire/cable cutting or iplicingYeaNoDon't know

Catting or imelting leadYeaNo

Plaitict manufacturingYeaNo

Battery manufacturingYeaNo

Pipe machiningYetNoDon't know

Electroplating with lead solutionsYeiNo

Refining gasolineYeiNo

Paint, glaze or ink manufactureYeiNo

Rubber manufacturingYeiNo

STUDY(n=243)

8.6%90.9%0.4%

50.2%49.8%

0.0%99.6%0.9%

0.0%100%

11.5%88.5%

9.5%89.7%

1.6%97.9%0.4%

7.8%92.2%

21.4%76.5%2.1%

2.1%97.9%

2.9%97.1%

4.5%95.1%

2.1%95.9%2.1%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

CUNIKUL(n=138)

8.0%91.3%0.7%

50.0%50.0%

2.2%97.8%0.0%

0.0%100%

10.1%89.9%

8.7%91.3%

1.4%98.6%0.0%

10.1%89.9%

19.6%80.4%0.0%

0.0%100%

0.0%100%

0.0%100%

0.0%97.8%2.2%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

p-value'

.199

.969

NC

NC

.679

.544

NC

.437

.206

NC

NC

NC

NC

NC

NC

NC

NC

81


STUDY(n=243)

CONTROL(n=138)

p-value1

Scnp metaj recoveryYM 4.5*No 94.2*Don't know 1.2*

Other lead related work/activityYM 4.5*No 93.8*Don't know 1.6*

Other cadmium work/activityYei 0.4*No 94.7*Don't know 4.9*

Food or drink prepared, aerved, or stored in clay, homemade,or foreign made material

Yea 4.5*No 94.2*Don't know 1.2%

5.8*94.2*0.0*

5.1*94.9*0.0*

0.0*98.6*1.4*

4.3*94.0%0.7%

.369

.310

NC

.891

Food or drink stored in open original canYeaNo

Store food in copper or pewterYeaNo

Anyone smoke in the homeYeaNo

Anyone smoke cigarettes in the homeYesNo

14.4*85.6*

2.5*97.5*

48.6*51.4*

48.1%51.9%

20.3%79.7%

0.7*99.3%

42.8*57.2*

37.7*62.3%

.137

NC

.274

.048

Anyone smoke cigars in the homeYes 0.0%No 100%

Anyone smoke pipes in the homeYes 0.8%No 99.2%

Do dogs and cats go in and out of the house?Yes 40.7%No 59.3%

Have you used mining or smelting material around the houseor yard?

Yes 25.1%No 69.1%Don't know 5.8%

0.0%100%

6.5%93.5%

31.2%68.8%

17.4%74.6%8.0*

NC

.001

.063

.184

82


FACTOR STUDY(11=243)

CUNTKUL

(n=138)p-value1

Tn» hifOMt yetr of education completed by the held ofhouMhold

No Kfaool 0.0%Etanenury 1.2%High school 50.7%Technicsj or tr»de ichool 2.6%Junior or community collage 2.5%Four ye«r college or university 33.7 %Graduate school 6.8%Don't know 1.5%

ToUl household income$4999 or less 8.5%$5000-9999 7.0%$10,000-14,999 7.5%$15,000-19,999 13.6%$20,000-24,999 13.8%$25,000-29,999 13.1%$30,000-34,999 10.0%$35,000-39,999 8.0%$40,000 or more 15.0%Refused 0.7%Don't know 2.7%

0.0%0.4%47.7%2.9%11.6%26.5%10.6%0.4%

3.9%2.8%11.3%11.0%15.2%10.2%15.9%12.0%13.1%1.8%2.8%

1. P-values for chi-square test.NC-Significance levels not calculated if number of subjects was less than

5 expected in a cell.

<.ooi

.004

83

Table 14.—Regression coefficients and level of significance for multiple linear regression onchild group blood lead values with environmental factors included in the model, JasperCounty Lead and Cadmium Exposure Study, Missouri 1991.

Variable (n = 163) Regression Coefficient1'2 p-value3

Exposure Group .867 .406Age .278 .323Male .901 .206SoU Lead .003 .000Dust Lead .00035 .153Lead Water -.051 .625Lead Paint .055 .857Eat home grown vegetables once perweek or more 1.322 .315Plays Outdoors 2.551 .202Usually Plays in Dirt .289 .789Usually Plays in Grass -1.808 .111Wash Before Eating -.296 .791Wash Before Sleeping 1.201 .297Takes Food Outside 1.280 .095Sucks Thumb -1.161 .205Uses Pacifier -.121 .921Chews Fingernails .266 .750Wood House Exterior -.288 .760Lead Water Pipes -3.591 .019House Recently Painted -.245 .734Head of Household Education .807 .109Household Income -.472 .010Smoker in Household -.878 .238Rents House .238 .804Year House Built -.203 .250Intercept 3.766 .222

1. Regression coefficients are for full regression model with all variables entered on stepone. Model includes all variables indicated in literature as related to elevated blood levels.

2. R2 = .403. P-values are for significance of regression coefficient with all variables in the model.

85

Table 15.—Regression coefficients and significance values for stepwise multiple linearregression on child group blood lead values with environmental factors in model, JasperCounty Lead and Cadmium Exposure Study, Missouri 1991.

Regression(n = 175) Coefficient1'2 p-value3

Soil Lead Level .004 < .001Household Income -.562 < .001Lead Water Pipes -3.620 ' .011Head of Household Education .104 .037Year House Built -.262 .088Age .366 .102Take Food Outside 1.025 .129Intercept 5.468 <.001

1. Stepwise regression using all variables included in TABLE 14 with a valueof 0.15 for variables to enter the model and a value of 0.25 used forvariables to be taken out of the model.

2. R2 = .35.3. P-values are for significance of regression coefficient with all variables

in the model.

87

Table 16.—Regression coefficients and significance values for stepwise multiple linearregression on child group blood lead values excluding those children with blood lead levelsover (en micrograms per deciliter, Jasper County Lead and Cadmium Exposure Study,Missouri 1991.

RegressionVariable (n=151) Coefficient1-2 p-value3

Soil Lead Level .001 < .001Household Income -.144 .107Dust Lead Level .001 .001Head of Household Education -.143 .126Rent House .993 .035Lead Water Pipes -1.051 .156Vegetable Garden .994 .105Intercept 5.957 <.001



in the model.

89

Table 17.—Regression coefficients and level of significance for multiple linearregression on child group blood lead values without environmental factors includedin the model, Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

Variable (n = 339)Exposure GroupAgeMale

Regression Coefficient1*3

1.925-.063.722

p-value3

<.001.709.083

Eat home grown vegetables onceor more a week .453 .534Plays Outdoors 1.668 .122Usually Plays in Dirt .461 .439Usually Plays in Grass -2.123 .003Wash Before Eating -.147 .709Wash Before Sleeping 1.118 .120Takes Food Outside .999 .028Sucks Thumb -.714 .178Uses Pacifier .346 .632Chews Fingernails .444 .188Wood House Exterior .307 .482Lead Water Pipes -.604 .436House Recently Painted -.201 .640Head of Household Education

.051 .025Household Income -.296 .005Smoker in Household -.308 .486Rents House .724 .167Year House Built -.388 < .001Intercept 5.774 <.001

1. Regression coefficients are for full regression model with all variables entered on step oneexcept environmental variables were not included to determine the contribution ofdemographic and behavioral factors.

2. R2 = .27.3. P-values are for significance of regression coefficient with all variables in the model.

91

Table 18.—Regression coefficients and level of significance for multiple linear regression onchild group urine cadmium levels with environmental factors included in the model, JasperCounty Lead and Cadmium Exposure Study, Missouri 1991.

Regression Coefficient xVariable (n=148) 1,000^ p-value3

Exposure Group -7.6:3 331Age -1.645 .570Male -8.824; .269Cadmium Dust .692 .346Cadmium Water 3.180 < .001Cadmium Soil .214 .736Eat home grown vegetables onceor more a week -2.647 .870Plays Outdoors -40.697 .037Usually Plays in Dirt -.568 .964Puts Things in Mouth -.288 .955Wash Before Eating .0146 .201Wash Before Sleeping .0173 .187Takes Food Outside .0197 .018Head of Household Education

.082 .886Household Income -1.547 .412Smoker in Household 2.914 .733Year House Built -.123 .941Intercept 76.55 .022

1. Stepwise regression using all variables included in TABLE 14 with a value of0.15 for variables to enter the model and a value of 0.25 used for variablesto be taken out of the model.

2. R2 = .21.3. P-values are for significance of regression coefficient with all variables in

the model.

93

Table 16.—Regression coefficients and significance values for stepwise multiple linearregression on child group blood lead values excluding those children with blood lead levelsover ten micrograms per deciliter, Jasper County Lead and Cadmium Exposure Study,Missouri 1991.

RegressionVariable (n=151) Coefficient1'2 p-value3

Soil Lead Level .001 < .001Household Income -.144 .107Dust Lead Level .001 .001Head of Household Education -. 143 .126Rent House .993 .035Lead Water Pipes -1.051 .156Vegetable Garden .994 .105Intercept 5.957 < .001



in the model.

89

Table 17.—Regression coefficients and level of significance for multiple linearregression on child group blood lead values without environmental factors includedin the model, Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

Variable (n = 339) Regression Coefficient1-2 p-value3

Exposure Group O25 <U01Age -.063 .709Male .722 .083Eat home grown vegetables onceor more a week .453 .534Plays Outdoors 1.668 .122Usually Plays in Dirt .461 .439Usually Plays in Grass -2.123 .003Wash Before Eating -.147 .709Wash Before Sleeping 1.118 .120Takes Food Outside .999 .028Sucks Thumb -.714 .178Uses Pacifier .346 .632Chews Fingernails .444 .188Wood House Exterior .307 .482Lead Water Pipes -.604 .436House Recently Painted -.201 .640Head of Household Education

.051 .025Household Income -.296 .005Smoker in Household -.308 .486Rents House .724 .167Year House Built -.388 < .001Intercept 5.774 <.001


2. R2 = .27.3. P-values are for significance of regression coefficient with all variables in the model.

91

Table 18.—Regression coefficients and level of significance for multiple linear regression onchild group urine cadmium levels with environmental factors included in the model, JasperCounty Lead and Cadmium Exposure Study, Missouri 1991.

Regression Coefficient xVariable (n=148) l.OOO1-* p-value3

Exposure Group -7.624 " 331Age -1.645 .570Male -8.824- .269Cadmium Dust .692 .346Cadmium Water 3.180 < .001Cadmium Soil .214 .736Eat home grown vegetables onceor more a week -2.647 .870Plays Outdoors -40.697 .037Usually Plays in Dirt -.568 .964Puts Things in Mouth -.288 .955Wash Before Eating .0146 .201Wash Before Sleeping .0173 .187Takes Food Outside .0197 .018Head of Household Education

.082 .886Household Income -1.547 .412Smoker in Household 2.914 .733Year House Built -.123 .941Intercept 76.55 .022

1. Stepwise regression using all variables included in TABLE 14 with a value of0.15 for variables to enter the model and a value of 0.25 used for variablesto be taken out of the model.

2. R2 = .21.3. P-values are for significance of regression coefficient with all variables in

the model.

93

Table 19.—Regression coefficients and level of significance for multiple linear regressionon child group urine cadmium levels without environmental factors included in the model,Jaspejr County Lead and Cadmium Exposure Study, Missouri 1991.

RegressionVariable (n=291) Coefficient p-value3

x 1,000U

Exposure Group -4.80 .639Age 3.241 .364Male 1.418 .879Eat home grown vegetables onceor more a week 3.020 .853Plays Outdoors -45.897 .021Usually Plays in Dirt -1.650 .901Puts Things in Mouth -7.710 .321Wash Before Eating 18.710 .214Wash Before Sleeping 20.035 .210Takes Food Outside 22.991 .021Head of Household Education

.759 .245Household Income -4.048 .068Smoker in Household -4.309 .668Year House Built -.791 .696Intercept 88.848 .015


2. R2 = .07.3. P-values are for significance of regression coefficient with all

variables in the model.

95

Table 20.—Youth questionnaire responses by group and factor, Jasper County Lead andCadmium Exposure Study, Missouri 1991.

FACTORPerson aniwering quMtiom

MotherFatherGrandparentOthw relativeOther penon

Subject lived in thif houie (yrs)

GenderMaleFemale

RaceWhiteBlackAiian or Pacific blanderAmerican Indian/ Alaska nativeRefutedDon't know

Hispanic originYesNo

Age (yrs)

Highest year of educationNo schoolingElementaryHigh schoolDon't know

Use tobacco productsYesNo

Use cigarettesYesNoNumber of cigarettes per day

Use cigarsYesNoNumber of cigars per day

Use pipesYesNoNumber of bowls per day

STUDY(n = 117)

66.7X14.5 *1.7*0.9%16.2%

6.05 ±4.1

50.4%49.6%

94.9%0.9%0.9%1.7%0.0%1.7%

6.0%94.0%

10.82 ±2.62

10.3%86.4%2.6%0.9%

1.7%92.3%

0.0%100%.009 ±.09

0.0%100%0.0%

0.0%100%0.0

UUWTKUl-(n = 95)

78.9%15.8%2.1%0.0%3.2%

5.36 ±3.63

58.9%41.1%

98.9%0.0%0.0%1.1%0.0%0.0%

4.2%95.8%

10.54 ±2.82

11.6%87.3%1.1%0.0%

3.2%95.8%

0.0%100%.04 ± .32

0.0%100%0.0%

0.0%100%0.0

p-value1

.030

.201

.215

NC

.562

.825

.420

.330

NC

NC

97


FACTORHoun per day spent in the following activities:

SchoolBaby-fitterCommercial day careAnother locationHomeSleeping

Play or spend time outdoorsYe.NoHoun per day spent outdoorsFront yard?

YesNoDon't know

Side yard?YesNoDon't know

Back yard?YesNoDon't know

Other?YesNoDon't know

Where does person spend time other than own yard?Neighbor's yard

YesNoDon't know

PlaygroundYesNoDon't know

Creek or ditchYesNoDon't know

Near tailings or slag pilesYesNoDon't know

Sidewalks or streetsYesNoDon't know

ParkYesNoDon't know

STUDY(n = 117)

2.M±1.870.19 ±0.820.14 ±0.81224 ±2.6318.5 ±2.78922 ±1.08

99.1%0.9%4.63 ±2.87

59.8%39.3%0.9%

50.4%48.7%0.9%

65.0%34.2%0.9%

13.7%85.5%0.9%

53.0%46.2%0.9%

13.7%85.5%0.9%

13.7%85.5%0.9%

9.4%89.7%0.9%

23.1%76.1%0.8%

18.8%80.3%0.9%

CONTROL(n = 95)

1.04 ±1.240.08 ±0.530.24 ±1.062.92 ±3.7519.7 ±3.839.12 ±1.10

93.7%6.3%4.16 ±2.88

53.7%40.0%6.3%

40.0%53.7%6.3%

60.0%33.7%6.3%

5.3%88.4%6.3%

46.3%47.4%6.3%

7.4%86.3%6.3%

6.3%87.4%6.3%

0.0%93.7%6.3%

13.7%80.0%6.3%

3.2%90.5%6.3%

p-value1

.526

.028

.078

.044

.084

.014

.073

.036

.023

.001

.026

<.001

98


FACTOROnly pUyi it horn*

YeiNoDon't know

OtherYeiNoDon't know

If the ground where the penon plays:Grassy

Ye.NoDon't know

Concrete or itphiltYesNoDon't know

Dirt or toilYetNoDon't know

SindboxYetNoDon't know

OtherYeiNoDon't know

Doet penon uke food or snicks outside to play?YeiNoDon't know

Are person's hands/face washed before eating?YetNoDon't know

Are person's hands/face washed before deeping?Ye*No

Does child suck thumb or fingers?Ye.No

Doei child chew on fingernails?YesNo

STUDY(n = 117)

3.4%95.7%0.9%

25.6%73.5%0.9%

79.5%19.7%0.9%

22.2%76.9%0.9%

23.1%76.1%0.9%

5.1%94.0%0.9%

8.5%90.6%0.9%

57.3%41.9%0.8%

75.2%23.9%0.9%

67.5%32.5%

7.7%92.3%

53.0%46.2%

CONTROL(n = 95)

15.8%77.9%6.3%

15.8%77.9%6.3%

78.9%14.7%6.3%

20.0%73.7%6.3%

15.8%77.9%6.3%

1.1%92.6%6.3%

3.2%90.5%6.3%

38.9%54.7%6.4%

86.3%12.6%1.1%

75.8%24.2%

10.5%89.5%

44.2%55.8%

p-valuel

.026

.065

.084

.045

.024

.027

.006

.112

.186

.472

.272

99


FACTORDoe* person pin other things intheir mouth?

YetNo

Frequency rwtllowi things other than food?A lotOnce in a whileAlmost neverNever

Doei household hive i vegetable garden in the yard?YesNo

Hti toil been hauled in ind placed on the garden?YesNoDon't know

How often does person eat vegetables grown in the gtrden?Once t week or moreLess than once per weekNever

How often does person eat leafy green vegetables grown in thegarden?

Once a week or moreLess than once per weekNever

How often does person eat root vegetables grown in thegarden?

Once a week or moreLess than once per weekNever

How often does person eat vegetables grown elsewhere in thelocal area?

Once t week or moreLess than once per weekNever

How often does person eat leafy vegetables grown elsewhere inthe local area?

Once i week or moreLess than once per weekNeverDon't know

STUDY(n = 117)

53.8%46.2%

0.9%6.8%17.9%73.5%

31.6%68.4%

17.1%14.5%68.4%

13.7%6.8%79.5%

6.0%0.9%93.2%

6.0%2.6%91.5%

39.3%24.8%35.9%

26.5%12.8%59.8%0.9%

CONTROL(n = 95)

41.1%58.9%

0.0%5.3%11.6%83.2%

35.8%64.2%

17.9%17.9%64.2%

25.3%5.3%69.5%

1.1%1.1%97.9%

4.2%0.0%95.8%

38.9%18.9%42.1%

15.8%17.9%66.3%0.0%

p-value1

.063

.423

.522

.768

.098

NC

.240

.514

.184

100


FACTORHow often doe* penon eat root vegetable* grown elsewhere inthe local mi?

One* « week or moreLeu than once per weekNeverDon't know

Hn pertoo hid or done my of the following in the lait 90d»yi:

Received traditional medication!YetNo

Piinted with artiitf paintiYeiNo

Painted/refiniihed furnitureYeiNoDon't know

Painted home or buildingYeiNo

Worked with ttained glassYeiNo

Cast lead into fishing linkenYeaNo

Soldering in electronicsYetNoDon't know

Soldering pipet/metal sheetsYeiNo

Repaired automobile radiatorsYeiNo

Automobile maintenanceYeiNo

Made potteryYeiNo

Rides • bike in the local areaYeiNo

WeldingYeiNo

Viiited indoor firearm targetrange

YeiNo

STUDY(n = 117)

12.0*13.7*74.4*0.0*

6.8*93.2*

15.4%84.6 X

1.7*98.3*0.0%

7.7%92.3%

0.9*99.1%

0.9*99.1%

4.3%94.9%0.9%

0.9%99.1%

1.7*98.3%

7.7%92.3*

3.4%96.6*

18.8%81.2%

0.9%99.1%

3.4%96.6%

CONTROL(n=95)

21.1%9.5*69.5*0.0*

3.2%96.8%

7.4%92.6%

3.2%95.8%1.1%

15.8%84.2*

0.0%100%

0.0%100%

2.1%97.9%0.0%

1.1%98.9%

2.1%97.9%

4.2%95.8%

1.1%98.9%

21.1%78.9*

1.1*98.9*

0.0%100%

p-value1

.160

NC

.071

NC

.064

NC

NC

NC

NC

NC

NC

NC

.682

NC

NC

101


FACTORCleaned or repaired firetnni

YetNoDon't know

STUDY(a = 117)

5.1*74.4*20.5*

CONTROL(n = 95)

3.2*96.8*0.0*

p-value1

<.001

1. P-values are for proportions from chi-square analysis and for irterval datafrom t-test.

NC-Not calculated because less than five subjects expected.

102

Table :popu

Bl(mic

>1. — Youth group distribution of blood lead levels by study and controlations, Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

ood Lead Levelrograms/deciliter)

0.1-1.5

1.6-3.0

3.1-4.5

4.6-6.0

6.1-7.5

7.6-9.0

9.1-10.0

>.10.0

TOTAL


13 (11.3)

43 (48.7)

23 (68.7)

23 (88.7)

8 (95.7)

4 (99.1)

1 (100.0)

115


26 (27.7)

50 (80.9)

12 (93.6)

3 (96.8)

1 (97.9)

1 (98.9)

1 (100.0)

94

103

Table 22.—Mean blood lead1 values compared to youth questionnaire factors by group,Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

FACSex

MaleFernp-va]

Is theGras

Ye

DOR

deue2

pound where the child plays:7

Nop-value

Concrete or asphaltYesNop-value

Din or soilYesNop-value

STUDYMean ±SD (n)

3.92 ±1.91 (57)3.30 ±1.99(58).089

•

3.54 ±1.92(92)3.98 ±2.15(22).346

3.28 ±1.53 (24)3.72 ±2.07 (90).328

4.27 ±1.97(26)3.43 ±1.94(88).056


2.89 ±2.71 (56)1.82 ±1.02(38).024

2.59 ±2.46 (75)1.98 ±0.98 (13).389

2.05 ±1.00(19)2.62 ±2.55 (69).346

3.31 ±2.36 (14)2.34 ±2.28 (74).150

Does child take food, snacks, bottle, etc. outsideto play?

YesNop-value

Are child's hands washed before eating?YesNop-value

Are child's hands washed before sleeping?YesNop-value

Are child's hands washed after playing with dinor sand?

YesNop-value

Does child suck thumb or fingers?YesNop-value

3.65 ±2.00 (65)3.59 ±1.94(49).882

3.63 ±1.97(86)3.33 ±1.74(28).463

3.42 ±1.93(78)3.99 ±2.02 (37).149

3.62 ±2.02 (106)3.54 ±1.41 (8)NC

4.06 ±1.50(9)3.57 ±2.01 (106)NC

2.09 ±1.09(36)2.78 ±2.84 (52).174

2.38 ±2.31 (81)2.97 ±1.89(12).403

2.53 ±2.39 (72)2.19 ±1.70(22).527

2.28 ±2.11 (82)3.68 ±2.82 (12).043

4.57 ±5.51 (9)2.23 ±1.47(85)NC

105


STUDY CONTROLFACTOR Mean ±SD (n) Mean ±SD (n)Does child chew on fingernails?

Yes 3.63 ±1.84(60) 2.25 ±1.35 (42)No 3.55 ±2.12 (54) 2.63 ±2.77 (52)p-value .819 .423

Has soil been hauled in and placed on thegarden?

Yes 3.96 ±1.92(20) 2.24 ±1.08 (17)No 2.74 ±1.32(17) 3.63 ±4.28 (17)p-value .033 .209

How often does child eat vegetables grown in thegarden?

Once a week or more 2.96 ±1.30 (16) 3.26 ±3.68 (24)Never 3.73 ±1.55 (13) 1.82 ±0.27 (5)p-value .155 NC

1. Blood lead values are in micrograms per deciliter.2. P-values are from t-test.NC-Significance levels not calculated if number of subjects was

less than ten in any cell

106

Table 23.—Youth mean lead1 levels by group and household questionnairefactor, Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

Factor

Is extenor of home wood

YetNop-value

It home rented or ownedRentOwnedp-vilue

Does home hive leadwater pipei

YeiNop-vtlue

Doet home hive copperwtter pipei

YetNop-value

House been refiniihedin last year

YeiNop-value

If air conditioninguted in home

YeiNop-value

Painted pictureswith artist paints

YeiNop-value

Painted or refmishedfurniture

YetNop-vilue

Cast lead into anythingYe.Nop-value

StudyControlMean ± SD

321 ±1.953.83 ±1.83.117

3.92 ±1.773.51 ±2.01.358

4.77 ±1.833.47 ±1.84.038

3.10 ±1.553.88 ±1.99.053

3.83 ±1.983.42 ±1.95.268

3.55 ±1.923.89 ±2.23.516

3.96 ±2.033.51 ±1.95.300

2.73 ±1.533.74 ±2.00.057

3.35 ±1.063.61 ±1.98NC

(n)

(60)(S3)

05)(90)

(10)(85)

(33)(62)

(52)(63)

(98)(17)

(27)(87)

(16)(99)

<2)(113)

Mean ± SD

2.54 ±2.602.34 ±1.69.675

3.70 ±4.362.15 ±1.22.154

3.75 ±2.132.33 ±2.22NC

1.88 ±0.962.56 ±2.39.322

2.32 ±1.602.58 ±2.74.571

2.06 ±1.174.36 ±4.40.056

2. 19 ±1.292.49 ±2.35.663

2.21 ±1.712.52 ±2.37.583

1.40 ±2.46 ±2.25NC

(n)

(53)(41)

(18)(74)

(7)(73)

(13)(67)

(47)(47)

(78)(16)

(12)(82)

(21)(73)

(I)(93)

107


Factor

Worked with soldering inelectronics

YetNop-v«lue

Soldered pipei or meulYeiNop-value

Repaired auto radiator*Ye«Nop-value

Worked on auto bodies orauto maintenance

YeiNop-vtlue

Made potteryYetNop-value

Casting or smelting leadYetNop-value

Battery manufactureYesNop-value

Paint, glaze, and inkYetNop-v«lue

Other lead related activityYetNop-value

Food or drink prepared, served orstored in clay, homemade, orforeign made material

YesNop-value

StudyMean ±SD

3.07 ±1.613.77 ±2.02.150

3.60 ±3.293.60 ±1.94NC

3.48 ±1.543.61 ±2.00NC

3.39 ±1.883.84 ±2.04.220

4.10 ±2.263.51 ±1.97NC

4.103.60 ±1.97NC

2.303.61 ±1.97NC

3.60 ±1.96NC

3.10 ±1.433.67 ±2.00NC

5.23 ±2.533.56 ±1.92NC

(n)

(20)(92)

(3)(112)

(8)(107)

(61)(54)

(2)(113)

(1)(114)

(1)(114)

(0)(115)

(4)(107)

(3)(109)

ControlMean±SD

2.51 ±1.772.43 ±2.35.893

2.25 ±0.572.46 ±2.29NC

2.33 ±1.312.46 ±2.29NC

2.78 ±2.731.94 ±0.94.075

2.45 ±2.24NC

1.402.46 ±2.25NC

2.45 ±2.24NC

4.10 ±1.552.42 ±2.26NC

1.34 ±0.212.57 ±2.34NC

2.08 ±1.162.51 ±2.36.549

(n)

(16)(77)

(4)(90)

(6)(88)

(57)(37)

(0)(94)

(1)(93)

(0)(94)

(2)(91)

(7)(84)

(11)(82)

108


Factor Study ControlMean±SD (n) Mean ± SD (n)

Food or drink ttored incopper/pewtar container*

Y«t 4.70 (1) 3.00 (1)No 3.59 ±1.97 (114) 2.45 ±2.25 (93)p-vtlue NC NC

Food or drink ttored in openoriginal c*n

Yei 3.86 ±1.88 (18) 1.70 ±1.38 (7)No 3.55 ±1.98 (97) 2.51 ±2.29 (87)p-vilue NC NC

1. Blood lead values are in micrograms per deciliter.NC-Significance levels not calculated if number of subjects was less than ten in any cell.

109

Table 24.—Youth group distribution of urine cadmium levels by study andcontrol populations, Jasper County Lead and Cadmium Study, Missouri 1991.


0.01-0.10

0.11-0.20

0.21-0.30

0.31-0.40

0.41-0.50

0.51-0.60

0.61-0.70

TOTAL


77 (68.8)

17 (83.9)

9 (92.0)

4 (95.5)

3 (98.2)

1 (99.1)

1 (100.0)

112


73 (81.1)

8 (90.0)

6 (96.7)

1 (97.8)

2 (100.0)

90

111

Table 25- Youth Biological TestStudy, Missouri 1991

Percentages and Numbers by Range and Group, Jasper County Lead and Cadmium Exposure

Factor

Blood Tests

Cadmium

(micrograms/gram Creatinine)

Lead2

CBC- -Basophils count

(thousands/cubic millimeter)

CBC- -Basoplii] s (percent)

CBC- -Granulocytes count


CBC- -Granulocytes (percent)

CBC- -Hemoglobin (gram/deciliter)

CBC- -Hematocrit (percent)

CBC- -Mean Corpuscular Hemoglobin

(picograms)


Concentration (percent)

Study

Low Normal High Total

Control


P-Value1

normal ranges not available for youth

0.0(0)

0.0

(0)

0.0(0)

0.0(0)

17.3

(19)

0.0(0)

23 .7

(27)

1.8

(2)

0.0

(0)

100.0

(115)

100.0

(109)

100.0

(113)

99.1

(108)

81 .8

(90)

99. 1

(113)

76 .3

(87)

91 .2

(104)

100.0

(114)

0.0 *

(0) (115)

0.0 *

(0) (109)

0.0 *

(0) (113)

0.9 *

(1) (109)

0.9 *

(1) (110)

0.9 *

(1) (114)

0.0 *

(0) (114)

7.0 *

(8) (114)

0.0 *

(0) (114)

0.0(0)

0.0(0)

0.0(0)

1 .1(1)

22.6

(21)

1 . 1

(1)

18.1

(17)

1 .1

(1)

0.0(0)

97.9

(92)

100.0

(93)

97.8

(90)

98.9

(91)

76.3

(71)

97.9

(92)

80 .9

(76)

96 .8

(91)

100.0

(94)

2.1(2)

0.0(0)

2.2(2)

0.0(0)

1.1

(1)

1.1

(1)

1.1

(1)

2.1(2)

0.0(0)

*

(94)

*

(93)

*

(92)

*

(92)

*

(93)

*

(94)

*

(94)

*

(94)

*

(94)

0.116

NC

NC

NC

0.630

NC

0.348

0.234

NC

Table 25 ronr.- Yoni-h Riological Test Percentages and Numbers by Range and Group, Jasper County Lead and CadmiumExposure Study, Missouri 1991

Factor

Blood Tests

CBC- -Mean Corpuscular Volume

(f luoroliter)

CBC- -Platelet count


CBC--Red Blood Cells(millions/cubic millimeter)

CBC--White Blood Cells(thousands/cubic millimeter)

CBC- - Lymphocytes (percent)

CBC- - Lymphocytes count


CBC- -Monocytes (percent)

CBC- -Monocytes count


CBC- -Eosinophil (percent)

Study


11.4

(13)

0.0(0)

5 . 3(6)

9.7

(11)

6.2

<7)

0.0(0)

2 .7(3)

0.0(0)

0.0

(0)

87.7

(100)

97.4

(111)

94 .7(108)

86 .8(99)

87.6(99)

100.0(109)

96.5(109)

100.0(109)

95.6(108)

0.9 *

(1) (114)

2.6 *(3) (114)

0.0 *(0) (114)

3.5 *(4) (114)

6.2 *(7) (113)

0.0 *(0) (109)

0.9 *

(1) (113)

0.0 *(0) (109)

4.4 *(5) (113)

Control


12 .8(12)

2.1(2)

4 .3(4)

6 .4(6)

2.2(2)

0.0(0)

1 . 1

(1)

0.0(0)

0.0(0)

87.2

(82)

95.7

(90)

94 .7

(89)

90.4

(85)

91.4

(85)

100.0

(93)

98.9

(92)

100.0

(93)

94.6

(88)

0.0

(0)

2.1(2)

1.1(1)

3.2(3)

6.5(6)

0.0(0)

0.0(c;

0.0(0)

5.4(5)

*

194)

*(94)

*

(94)

*

(94)

*

(93)

*

03)

*

(93)

*

(93)

*

(93)

P-Valuel

0.636

NC

0.516

0.683

0.368

NC

NC

NC

0.752

Table 25 cont.- Youth Biological TestExposure Study, Missouri 1991

Percentages and Numbers by Range and Group, Jasper County Lead and Cadmium

Factor

CBC- -Eosinophil count(thousands/cubic millimeter)

CBC- -Platelet Distribution Width

( f luoroliter)

CBC--Red Cell Distribution Width(percent)

Chem--Uiea Nitrogen(milligrams/decil iter)

Chem--Creatinine(mil lig rams /decil iter)

Chem- -Alanine Aminotransf erase(International Units/liter)

Chem- -Albumin (grams/deciliter)

Chem- -Reticulocyte Count (percent)

Chem- -Serum electrolytes-sodium

(milliequivalent/liter)

Study


0.0(0)

4 .4(5)

56 . 1

(64)

2. 6(3)

0 . 0

(0)

0 . 0

(0)

0.0(0)

0.9(1)

1 .8

(2)

93.6

(102)

92. 1

(105)

43.9

(50)

97.4

(111)

100 .0

(114)

98.2

(111)

100 .0

(114)

90.9

(100)

98.2

(112)

6.4 *

(7) (109)

3.5 *

(4) (114)

0.0 *

(0) (114)

0.0 *

(0) (114)

0.0 *

(0) (114)

1.8 *

(2) (113)

0.0 *

(0) (114)

8.2 *

(9) (110)

0.0 *

(0) (114)

Control


0.0(0)

9.6(9)

54 .3

(51)

0 . 0

(0)

1. 1

(1)

0.0(0)

0.0(0)

3 .2(3)

0.0(0)

96.8(90)

85.1(80)

45.7(43)

100 . 0

(91)

98.9(90)

100.0(92)

100.0(92)

90.3(84)

100.0(92)

3.2(3)

5.3(5)

0.0(0)

0.0(0)

0.0(0)

0.0(0)

0.0(0)

6.5(6)

0.0(0)

*(93)

*

(94)

*

(94)

*

(91)

*

(91)

*

(92)

*

(92)

*

(93)

*

(92)

P-Value1

0.297

0.255

0.786

NC

NC

NC

NC

0.454

NC

Table 2b cone.- Youth biological rest Percentages and Numbers by Kange and uroup. Jasper County Lead and CadmiumExposure Study, Missouri 1991

Factor

Chem- -Serum elect rolytes- potassium

(mi lliequivalent /liter)

Chem- -Serum electrolytes-chloride

(milliequivalent/liter)

Chem- -Aspart it e aminotrannferase- -AST

( Internal lonal Units/liter)

Immunoglobul ins -Gamma G

(mill igtams/deciliter)

Immunoglobul ins-Gamma A

(mil igrams/deci liter)

Immunoglobul ins-Gamma M(milligrams/deciliter)


Suppressor/Cytotoxic T-Cells

(percent of lymphocytes)


Study


0.0(0)

0 .0(0)

0.0(0)

8 .7(10)

4 .4

(5)

4 .4

(5)

10.4

(12)

2.6(3)

5.2(6)

99. 1(113)

99.1(113)

100.0(113)

90 .4(104)

80. 9(93)

93 . 9(108)

88 .7(102)

90.4(104)

90.4(104)

0.9 *(1) (114)

0.9 *(1) (114)

0.0 *(0) (113)

0.9 *(1) (115)

14 .8 *(17) (115)

1.7 *(2) (115)

0.8 *

(1) (115)

7.0 *(8) (115)

4.4 *

(5) (115)

Control


0.0(0)

0.0(0)

0.0(0)

13.0(12)

7.6(7)

2 .2(2)

6 .4

(6)

1.1

(1)

7.5(7)

98.9

(91)

97.8

(90)

100.0

(92)

85.9

(79)

82.6

(76)

94 .6

(87)

90 .4

(85)

94 .7

(89)

89.4

(84)

1.1 *

(1) (92)

2.2 *

(2) (92)

0.0 *

(0) (92)

1.1 *

(1) (92)

9.8 *

(9) (92)

t

3.3 *

(3) (92)

3.2 *

(3) (94)

4.3 *

(4) (94)

3.2 *

(3) (94)

P-Value1

NC

NC

NC

0.590

0.373

0.547

0.292

0.496

0.741

Table 25 cont.- Youth Biological Test Percentages and Numbers by Range and Group, Jasper County Lead and CadmiumExposure Study, Missouri 1991

Factor


Natural Killer Cells


Ur.ine__IestS

Cliem- -Total Protein (grams/deciliter)

Chem- -Gamma -Gl utomyl trans £ erase(International Units/liter)

*-* UA--Red Blood Cells-J (number of cells/high powered field)

UA- -White Blood Cells(number of cells/high powered field)

UA- -Urobilinogen (milligrams/deciliter)


Alanine aminopeptidase (AAP)

(micrograms/liter)

Study


7.0(8)

0. 9

(1)

0 . 0(0)

0 .0(0)

0.0(0)

0.0(0)

0.0(0)

19.4(20)

4 .6(5)

93 .0(107)

91.3(105)

99. 1(113)

100 .0(113)

84 .2(16)

87.4(90)

100.0(115)

66.0(68)

73.1(79)

0.0 *(0) (115)

7.8 *(9) (115)

0.9 *(1) (114)

0.0 *(0) (113)

15.8 *(3) (19)

12.6 *(13) (103)

0.0 *(0) (115)

14.6 *(15) (103)

22.2 *(24) (108)

Control


1.1

(1)

3 .2(3)

0. 0

(0)

0.0(0)

0.0(0)

0.0(0)

0.0(0)

20.7(19)

3.5(3)

95.7(90)

84 .0(79)

100 .0(92)

100.0(92)

89.5(17)

94 .7(71)

97.9(91)

69.6(64)

69.0(60)

3.2

(3)

12.8(12)

0.0" (0)

0.0(0)

10.5(2)

5.3 «(4)

2.1(2)

9.8(9)

27.6(24)

*

(94)

*

(94)

*

(92)

*

(92)

*

(19)

*

(75)

*

(93)

*

(92)

*

(87)

P-Value1

0.019

0.221

NC

NC

NC

0.102

NC

0.598

0.655

Table 25 cont.- Youth Biological Test Percentages and Numbers by Ranqe and Group, Jasper County Lead and CadmiumExposure Study, Missouri 1991

Factor

Low

Study

Normal High Total Low

Control

Normal High Total

P-Value*

Gamma glutaniyltransferase (GGT)

(micrograms/liter)

N-acetyl-B-D-glucosaminidase (NAG)

(micrograms/liter)

4.6

(5)

0.0

(0)

94 .4

(102)

100.0

(116)

0.9

(1)

0.0

(0)

(108)

[116)

3.5

(3)

0.0

(0)

92.0(80)

97 .8(90)

4.6

(4)

2.2(2)

(67)

(92)

0.255

NC

UA--Specific Gravity 0.0

(0)

99. 1

U 14 )

0.9(1) (115)

0. 0(0)

100 .0(93)

0.0(0) (93)

NC

UA--pH 0.0(0)

97.4(112)

2.6(3) (115)

0 .0(0)

96 .8(90)

3.2(3) (93)

NC

oo

Table 25 cont.- Youth Biological Test Percentages and Numbers byMissouri 1991

Group, Jasper County Lead and Cadmium Exposure Study,

Factor

Urine Tests (Cont.l

UA- -Bacteria

UA- -Bilirubin

UA- -Blood

UA-Casts (Hyaline)

UA- -Crystals

UA- -Epithelial cells

UA- -Glucose

UA- - Ketones

UA- -Leukocyte esterase

UA--Nitrate

UA- - Protein

Normal

9. 1(2)

99. 1(114)

98. 3(113)

100.0

(1)

62 .6<72)

60.0

(63)

98.3

(113)

92.2

(106)

93 .9(108)

99. 1(114)

90.4(104)

StudyNot Normal

90.9(20)

0.9

(1)

1.7(2)

0 .0

(0)

37.4

(43)

40 .0

(42)

1 .7

(2)

7.8

<9)

6 .1(7)

0.9

(1)

9.6

(11)

Total

*

(22)

*

(115)

*

(115)

*

(1)

+

(115)

*

(105)

*

(115)

*

(115)

*

(115)

*

(115)

*

(115)

ControlNormal Not Normal

27.3(3)

100.0(93)

94.6(88)

66.7(2)

72.0(67)

65.0(52J

100.0(93)

93 .5(SI)

96.8(90)

100.0(93)

90.3(84)

72.7(8)

0.0(0)

5.4(5)

33.3"(1)

28.0(26)

35.0(28)

0.0(0)

6.5(6)

3.2(3)

0.0(0)

9.7

(9)

Total

*

(11)

*

(93)

*

(93)

*

(3)

*

(93)

*

(80)

*

(93)

It

(93)

*

(93)

*

(93)

»

(93)

p-value1

0.170

NC

0.148

NC

0.151

0.487

NC

0.703

0.338

NC

0.978

1. Percentages are indicated in the first line and numbers are shown in parenthesis.* Percentages may not equal 100%

2. p-values from chi-square analysis.NC- significance values not calculated if expected number is less than five.

Table ^6.—Youth household questionnaire by group and factor, Jasper County Leadand Cadmium Exposure Study, Missouri 1991.

FactorYear house built

< 1900-19091910-19191920-192919:10-193919< 0-19491950-195919^0-19691970-19791980-19891990-presentDon't Know

Is exterior of home:Wood

VesNoDon' Know

BrickYesNoDon't Know

BlockYesNoDon't Know

Vinyl metal sidingYesNoDon't Know

Made of other materialsYesNoDon't Know

Is home a mobile homeYesNoDon't Know

Is home rented or ownedRantOwnedOther

Studyn = 117

14.5%0.9%8.5%4.3%4.3%9.4%3.4%14.5%17.1%0.0%23.1%

52.1%46.2%1.7%

10.3%88.0%1.7%

0.9%97.4%1.7%

25.6%72.6%1.7%

18.8%79.5%1.7%

6.8%91.5%1.7%

22.2%77.8%0.0%

Controln=95

6.3%1.1%1.1%5.3%5.3%18.9%10.5%22.1%10.5%0.0%18.9%

55.8%44.2%0.0%

11.6%88.4%0.0%

1.1%98.9%0.0%

27.4%72.6%0.0%

26.3%73.7%0.0%

1.1%98.9%0.0%

18.9%78.9%2.1%

p-valuel

.015

.407

.425

NC

.431

.203

.048

.253

121


FactorDoes home have:

Lead water pipesYesNoDon't Know

Plastic water pipesYesNoDon't Know

Galvanized steel water pipesYesNoDon't Know

Copper water pipesYesNoDon't Know

Iron water pipesYesNoDon't Know

Other water pipesYesNoDon't Know

Type of water used for drinkingPrivate wellPublic waterBottledLocal spring or brookCisternOtherDon't Know

Type water used for cookingPrivate wellPublic waterBottledLocal spring or brookCisternOtherDon't Know

Studyn = 117

8.5%74.4%17.1%

62.4%20.5%17.1%

22.2%60.7%17.1%

28.2%54.7%17.1%

6.0%76.9%17.1%

11.1%70.9%17.9%

3.4%92.3%0.0%0.0%0.0%1.7%0.9%

3.4%95.7%0.0%o.c%0.0%0.0%0.9%

Controln=95

7.4%77.9%14.7%

50.5%34.7%14.7%

25.3%60.0%14.7%

13.7%71.6%14.7%

15.8%69.5%14.7%

11.6%73.7%14.7%

1.1%96.8%0.0%0.0%0.0%2.1%0.0%

1.1%96.8%0.0%0.0%0.0%2.1%0.0%

p-value

.835

.066

.822

.021

.066

.821

NC

NC

122


FactorStudy

n = 117Controln=95 p-value1

What type of fuel isused for house heating

Bottled or tank gasNatural gasElectricityFuel oil or keroseneCoal or cokeWoodOther

What type of fuel isused for water heating


What type of fuel isused for cooking


House been refinished in last yearYesNo

Is air conditioning used in homeYesNo

Household member worked in:Mining

YesNo

Underground miningYesNo

Surface mining

YesNo

3.4%76.9%12.0%0.0%0.0%3.4%4.3%

2.6%71.8%25.6%0.0%0.0%0.0%0.0%

2.6%56.4%41.0%0.0%0.0%0.0%0.0%

45.3%54.7%

84.6%15.4%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%74.7%17.9%0.0%0.0%3.2%4.2%

0.0%70.5%29.5%0.0%0.0%0.0%0.0%

0.0%34.7%65.3%0.0%0.0%0.0%0.0%

50.5%49.5%

83.2%16.8%

0.0%100.0%

0.0%100.0%

0.0%100.0%

.336

.255

.001

.448

.773

NC

NC

NC

123


FactorMine milling

YesNo

Mine transportationYesNo

Mine smelterYesNo

Other mining jobsYesNo

Lead mining jobYesNo

Zinc mining jobYesNo

Silver mining jobYesNo

Molybdenum mining jobYesNo

Coal mining jobYesNo

Limestone mining jobYesNo

Clay mining jobYesNo

Other mining job

YesNo

Wear mining related job workclothing home


Does not shower after miningrelated job


Studyn = 117

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%0.0%

0.0%100.0%0.0%

Controln= 95

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%

0.0%100.0%0.0%.

0.0%100.0%0.0%

p-value

NC

NC

NC

NC

NC

NC

NC

NC

NC

NC

NC

NC

NC

NC

124


FactorPainted pictures with artist paints

YesNoDon't Know

Painted or refinishcd furnitureYesNo

Painted inside or outside of homeor building

YesNo


Cast lead into anythingYesNo


YesNoDon't Know

Soldered pipes or metalYesNo

Repaired auto radiatorsYesNo


YesNo

Worked at sewage treatment plantYesNo

Made potteryYesNo

Studyn = 117

23.1%76.1%0.9%

14.5%85.5%

25.6%74.4%

0.0%100.0%

2.6%97.4%

18.8%78.6%2.6%

3.4%96.6%

6.8%93.2%

53.0%47.0%

1.7%98.3%

1.7%98.3%

Controln=95

12.6%87.4%0.0%

22.1%77.9%

40.0%60.0%

0.0%100.0%

1.1%98.9%

16.8%82.1%1.1%

4.2%95.8%

7.4%92.6%

61.1%38.9%

6.3%93.7%

0.0%100.0%

p- value

.093

.152

.025

NC

NC

.661

NC

.880

.238

.080

NC

125


FactorRidden * dirt bike, mountain bikeor ATV in local area

YesNo

Did weldingYesNoDon't Know

Cleaned or repaired firearmsYesNo

Visited indoor firing rangeYesNo

Wire cable cutting or splicingYesNo

Casting or smelting leadYesNo

Plastic manufactureYesNo

Battery manufactureYesNo

Pipe machiningYesNo

Studyn = 117

17.1%82.996

9.4%90.6%0.0%

11.1%88.9%

4.3%95.7%

29.1%70.9%

0.0%100.0%

0.0%100.0%

0.0%100.0%

2.6%97.4%

Controln=95

20.0%80.0%

9.5%89.5%1.1%

15.8%84.2%

0.0%100.0%

35.8%63.2%

0.0%100.0%

0.0%100.0%

0.0%100.0%

1.1%96.8%

p-value

.587

.538

.317

NC

.294

NC

NC

NC

NC

Electroplating with leadYesNo

Refining gasolineYesNo

100.0%

100.0

100.0%

100.0%

NC

NC

126


FactorStudy

n = 117Controln= 95 p-value1

Paint, glaze, and inkYesNo

Rubber manufactureYesNo

Scrap metal recoveryYesNoDon't Know

Other lead related activityYesNoDon't Know

Other cadmium related activityYesNoDon't Know


YesNoDon't Know

Food in copper, pewter dishesYesNo

Food or drink stored in openoriginal can

YesNo

Anyone smoke in homeYesNo

Number of persons that smokein home

100.0%

100.0%

5.1%94.9%0.0%

3.4%93.2%3.4%

0.0%95.7%4.3%

2.6%94.9%2.6%

100.0%

15.4%84.6%

52.1%47.9%

1.10 +1.50

100.0%

100.0%

5.3%93.7%1.1%

8.4%88.4%3.2%

2.1%96.8%1.1%

100.0%

7.4%92.6%

53.7%46.3%

0.91 ±1.08

NC

NC

.537

.292

NC

12.6%86.3%1.1% .013

NC

.071

.822

127


FactorStudy

n = 117Controln= 95 p-value

Smoke cigarettes in homeYesNoDon't Know

Number cigarettes per day in home

Smoke cigars in homeYesNo

Don't Know

Number cigars day in home

Smoke pipes in homeYesNo

Number pipe bowls/day in home

Dogs or cats that go in and out ofhouse

YesNo

Used mining or smelting materialaround house or yard

YesNoDon't Know

Highest year of educationcompleted by head of household

Elementary schoolHigh schoolTechnical or trade schoolJunior collegeFour year college or univ.Attended graduate school

51.3%0.9%

7.9%

9.81 ±14.42

2.6%49.6%47.8%

0.03 ±0.37

100.0%0.034 ±0.37

58.1%41.9%

35.0%61.5%3.4%

1.7%52.1%3.4%1.7%33.3%7.7%

51.6%2.1%46.3% .738

10.64 ±14.05

1.1%52.6%46.3%

0.00 ±0.00

.684

100.0% NC0.021 ±0.20

47.4%52.6%

26.3%72.6%1.1%

1.1%43.2%1.1%11.2%30.5%12.6%

.118

.174

.120

128


FactorTotal gross household income

$4,999 or less$5,000 to $9,999$10,000 to $14,999$15,000 to $19,999$20,000 to $24,999$25,000 to $29,999$30,000 to $34,999$35,000 to $39,999$40,000 or moreRefused to answerDon't Know

Studyn = 117

12.0566.0%5.1%12.8%12.0%10.3%11.1%11.115.4%1.7%2.6%

Controln= 95 p- value

4.2%3.2%8.4%7.4%15.8%10.5%18.9%10.5%17.9%3.2%0.0% .232

1. P-values for chi-square test.NC-Significance values not calculated if less than five expected in any cell.

129

Table 27.—Regression coefficients and significance values for stepwise multiple linearregression for youth blood lead values without environmental factors included in themodel, Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

Variable (n = 169)Year House BuiltExposure GroupSucks ThumbMale GenderHousehold IncomeIntercept

Regression Coefficient1"2

-.301.9701.50.832

-.1424.320

p-value3

<.001.001.002.004.021

<.001

1. Stepwise regression using all variables included in TABLE 14,except environmental factors, with a value of 0.15 forvariables to enter the model and a value of 0.25 used forvariables to be taken out of the model.

2. R2 = .29.3. P-values are for significance of regression coefficient with

all variables in the model.

131

Table 28.—Regression coefficients and significance values for stepwise multiplelinear regression for youth urine cadmium values without environmental factorsincluded in the model, Jasper County Lead and Cadmium Exposure Study,Missouri 1991.

Variable (n=195)AgeHousehold IncomeEat Vegetables fromGardenExposure GroupIntercept

Regression Coefficient1 a

.007-.006

.015

.022

.006

p-value3

.010

.062

.117

.134

.884

1. Stepwise regression using all variables included in TABLE 14, exceptenvironmental factors, with a value of 0.15 for variables to enter themodel and a value of 0.25 used for variables to be taken out of the model.



133

Table 29.—Adult questionnaire responses by group and factor, Jasper County Lead andCadmium Exposure Study, Missouri, 1991.

FACTORPerson answering the questionnaire

Self

GenderMaleFemale

RaceWhiteBlackAtian or Pacific IslanderAmerican Indian/ Alaska nativeRefusedDon't know

Hispanic originYesNoRefusedDon't know

Age (yri)

Highest year of educationElementaryHigh schoolUniversity or collegeGraduateTechnical or trade schoolJunior or community college

Is smoking allowed in your work place?YesNo

Smoked 100 or more cigarettes in lifetimeYetNoAverage cigarettes per day

Currently use cigarettesYesNo

Average cigarettes per dayAge you first smoked cigarettesAverage years smoked cigarettes

Smoked 50 or more cigars in lifetimeYesNoAverage cigars per week

STUDY(n = 52)

100%

50.0%50.0%

100%0.0%0.0%0.0%0.0%0.0%

1.9%97.1%0.0%0.0%

32.38 ±8.6

0.0%53.8%36.5%5.8%1.9%1.9%

46.2%53.8%

61.5%38.5%19.06 ±19.91

34.6%65.4%

16.88 ±12.916.56 ±8.5512.21 ±7.29

9.6%90.4%2.0 ±1.05

CONTROL(n = 50)

100%

44.0%56.0%

96.0%0.0%0.0%2.0%0.0%2.0%

2.0%98.0%0.0%0.0%

32.38 ±9.15

2.0%44.0%28.0%10.0%0.0%14.0%

44.0%56.0%

50.0%50.0%57.88 ±196.3

28.0%72.0%

18.28 ±7.8617.48 ±6.1910.28 ±9.41

8.0%92.0%3.25 ±1.70

p-value1

.548

.346

.978

.708

.827

.240

.270

.471

.724

.485

.385

.773

.271

135


FACTORCurrency uie cigan

YeiMo

Avenge cigin per we*Yean unce last smokt ganAge you fint smoked c.^inAvenge yean imoked cigan

Smoked SO or more pipe bowls in lifetime .YesNoAverage pipe bowls per week

Currently uie pipe*YesNo

Use chewing tobacco 20 or more times in lifetimeYetNo

Currently use chewing tobaccoYetNo

Years since last chewed tobaccoAge you first chewed tobaccoAverage years chewed tobacco

Use muff 20 or more times in lifetimeYesNoAverage lifetime pouches per week

Currently use snuff tobaccoYesNo

Age you first snuff tobaccoAverage years snuffed tobacco

Has person ever drank alcoholic beveragesYesNo

Currently drinks alcoholic beveragesYesNo

Years since last drank alcoholAverage age when first drankAverage (current) drinks per week

STUDY(n = 52)

0.0%100%

0.02.75 ±2.8736.-* ±35.149.60 ±9.94

1.9*98.1%2.0 ±0

0.0%100%

15.4%84.6%

1.9%98.1%

4.5 ±2.8817.25 ±5.828.0 ±5.55

9.6%90.4%2.75 ±2.5

1.9%98.1%

20.6 ±4.0324.4 ±42.06

88.5%11.5%

57.7%42.3%

11.36 ±24.4820.0 ±20.858.55 ±23.82

CONTROL(n = 50)

2.0*98.0*

1.0 ±7.8612.66 ±8.7318.0 ±37.366.25 ±4.19

4.0%96.0%8.5 ±2.1

0.0%100%

10.0%90.0%

4.0%96.0%

8.33 ±5.7713.8 ±3.276.8 ±3.58

6.0%94.0%1.66 ±0.57

4.0%96.0%

16.66 ±3.215.33 ±5.85

86.0%14.0%

60.0%40.0%

6.3 ±11.5216.02 ±8.061.58 ±4.66

p-value1

JOS

.081

.338

.552

.535

NC

.415

NC

.210iS6

.677

.497

.714

.535

.204

.478

.709

.812

.183

.206

.043

136


FACTORHour* per w«*k spent in the following activities:

SchoolWorkAnother locationHome

Has person worked in mine relitedjob in the Itit 90 days?

YetNo

Hit person done any of the following in the lait 90 days:Painted with artists paints

YeiNo

Ptinted/refinished furnitureYesNo

Painted home or buildingYesNo


Cast lead into fishing sinkersYetNo

Soldering in electronicsYesNoDon't know

Soldering pipes/metal sheetsYesNo

Repaired automobile radiatorsYesNo

Automobile maintenanceYesNo

Worked in sewage treatment plan!YesNo

Made potteryYesNo

Rides bike/ATV in the local areaYetNo

WeldingYesNo

STUDY(n = 52)

2.50 ±6.9234.88 ±21.2518.65 ±1933112.01 ±29.67

1.9%98.1%

15.4%84.6%

9.6%90.4%

23.1%76.9%

0.0%100%

5.8%94.2%

9.6%90.4%0.9%

0.0%100%

3.8%96.2%

17.3%82.7%

0.0%100%

1.9%98.1%

11.5%88.5%

11.5%88.5%

CONTROL(n = 50)

2.68 ±8.4928.52 ±21.3114.36 ±17.68122.44 ±28.95

0.0%100%

10.0%90.0%

16.0%84%

24.0%76.0%

0.0%100%

2.0%98.0%

14.0%86.0%0.0%

4.0%96.0%

0.0%100%

22.0%78.0%

2.0%98.2%

0.0%100%

8.0%92.0%

16.0%84.0%

p-valuel

.134

NC

.415

.333

.912

NC

.327

.492

NC

NC

.550

NC

NC

.548

.513

137


FACTORVUited indoor firearm target rang*

YetNo

Hat p«non done any of the following in the last 90 days:Cleaned or repaired firearm

Ye*No

Wire/cable cutting or splicingYeiNoDon't know

Catting or smelting leadYetNo

Plaitici manufacturingYeiNo

Battery manufacturingYesNo

Pipe machiningYetNo

Electroplating with lead solutioniYetNo

Refining gasolineYesNo

Paint, gltze or ink manufactureYesNo

Rubber manufacturingYesNo

Scrap metal recoveryYesNo

Other lead related work/activityYetNo

Other cadmium work/activityYesNoDon't Know

STUDY(n = 52)

0.0*100%

9.6%90.4%

13.5%84.6%1.9%

3.8%96.2%

1.9%98.1%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

5.8%94.2%

3.8%96.2%

0.0%98.1%1.9%

CONTROL(n = 50)

2.0%98.0%

8.0%92.0%

24.0%-6.0%0.0%

2.0%98.0%

0.0%100%

0.0%100%

2.0%98.0%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

4.0%96.0%

2.0%98.0%

0.0%100%0.0%

p-value1

NC

.773

.257

NC

NC

NC

NC

NC

NC

NC

NC

.679

.581

NC

138


FACTORHai peffon done any of the following in the last 30 daya:

Painted house or building inside) and outYe»No

Painted or refinithed furnitureYMNo

STUDY(n = 52)

15.4%84.6%

3.8%96.2% . '

CON(n =

•"'• 12.0*88.0%

16.0%84.0%

TROL -SO) p-value1

:XTDOM the person have a vegetable garden in the yard?

YM ' 26.0%No 73.1%

DOM person frequently till, pltnt, or work in the garden?YM 13.5%No 86.5%

Hit toil been hauled in and placed on the gtrden?YM 9.6%No 89.5%

How often do you eat vegetable* from your own garden?Once or more per week 19.2%Leu than once per week 0.0 %Never 84.8%

How often do you eat leafy green vegetables?One* or more per week 3.8%Lest than once per week 1.9%Never 94.2%

How often do you eat root vegetables?One* or more per week 3.8%Leu than once per week 3.8 %Never 92.3%

How often do you eat vegetables grown elsewhere in the localarea?

Once or more per week 46.2 %Leu than once per week 25.0 %Never 26.9%Don't know 1.9%

How often do you eat leafy green vegetables grown elsewherein the local area?

Once or more per week 32.7%Less than once per week 11.5 %Never 55.8%

60.0%

10.0%90.0%

16.0%84.0%

20.0%4.0%76.0%

2.0%2.0%96.0%

6.0%2.0%92.0%

42.0%22.0%36.0%0.0%

32.0%16.0%52.0%

. . .,161

.587

.340

.340

.858

.764

.340

.340

139


STUDY CONTROLFACTOR (n = 52) (n = 50) p-value1

How often do you eat root vegetables grownelsewhere in the local area?

Once or more per week 1.9% 18.0%Less than once per week 23.1% . 18.0%Never 75.0% 64.0% .340

Have you ever been treated with traditional orherbal medicines?

Yes 11.5% 6.0%No 88.5% 94.0% .324

Are you pregnant?Yes 1.9% 4.0%No 48.1% 50.0%Not applicable 50.0% 44.0%Don't know 0.0% 2.0% .653

Are you now taking birth control pills?Yes 13.5% 6.0%No 34.6% 48.0%Not applicable 51.9% 46.0% .254

1. P-values are for proportions from chi-square analysis and forinterval data from t-test.

NC-Significance not calculated if less than five expected in anycell.

140

Table 30.—Adult group distribution of blood lead levels by study and controlpopulations, Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

Blood Lead Level(micrograms/deciliter)

0.1-1.5

1.6-3.0

3.1-4.5

4.6-6.0

6.1-7.5

7.6-9.0

9.1-10.5

31.6-33.0

TOTAL


13(25.5)

19(62.7)

9 (80.4)

3 (86.3)

4(94.1)

1 (96.1)

1 (98.0)

1 (100.0)

51


17(34.7)

21(77.6)

8 (93.9)

1 (95.9)

2 (100.0)

49

141

,,i.min,ui«i., p,,B is,,,,,.,., jaded papAoaj

142

Table 31.—Mean blood lead1 values compared to adult questionnaire factors by group,Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

FACTORGender

MaleFemalep-value2

STUDYMean ±SD (n)

5.20 ±6.13(25)1.97 ±0.94(26).015


2.88 ±1.25(21)1.72 ±1.23 (28).002

Is smoking allowed in your work place?Yes 3.36 ±2.32 (23) 2.26 ±1.38 (22)No 3.71 ±5.89(28) 2.19 ±1.36 (27)p-value .790 .850

Smoked 100 or more cigarettes in lifetimeYes 4.34 ±5.68 (31) 2.86 ±1.50 (25)No 2.18 ±1.20(20) 1.56 ±0.77 (24)p-value .087 < .001

Currently use cigarettesYes 5.57 ±7.11 (18) 2.95 ±1.35 (14)No 2.88 ±2.13 (13) 2.74 ±1.73 (11)p-value .198 .732

Use chewing tobacco 20 or more times in lifetimeYes 5.13 ±2.20 (8) 3.26 ±1.13 (5)No 3.26 ±4.88 (43) 2.10 ±1.34 (44)p-value NC NC

Has person ever drank alcoholic beveragesYes 3.75 ±5.64 (30) 2.36 ±1.34 (43)No 3.27 ±2.46 (15) 1.25 ±0.48 (6)p-value .759 NC

Has person done any of the following in the last90 days:

Painted with artists paintsYes 1.80 ±0.96 (8) 1.80 ±0.52 (5)No 3.88 ±4.93 (43) 2.27 ±1.41 (44)P-value NC NC

Painted or refinished furnitureYes 3.16 ±1.33 (5) 2.06 ±0.97 (8)No 3.60 ±4.83 (46) 2.25 ±1.42 (41)p-value NC NC

Painted home or buildingYes 5.41 ±8.69(12) 2.29 ±1.59 (12)No 2.98+2.14(39) 2.20 ±1.29 (37)P-value .358 .841

143


FACTORSoldering in electronics

YesNop-value

Automobile n^. ntenanceYesNop-value

WeldingYesNop-value

STUDYMean ±SD (n)

3.62 ±2.05 (5)3.55 ±4.80 (46)NC

4.31 ±2.24 "(9)3.39 ±4.97 (42)NC

5.02 ±2.52 (6)3.36 ±4.79 (45)NC


2.00 ±0.79 (7)2.26 ±1.43(42)NC

3.03 ±1.62(11)1.99 ±1.19(38).024

2.61 ±1.26(8)2.15 ±1.37(41)NC

Wire/cable cutting or splicingYes 4.50 ±1.97 (6) 2.78 ±1.71 (12)No 3.41 ±4.90 (44) 2.04 ±1.19 (37)p-value NC .099

Does the person have a vegetable garden in theyard?

Yes 2.19 ±1.60(13) 2.09 ±0.92 (20)No 4.02 ±5.18(38) 2.31 ±1.60 (29)p-value .220 .575

Does person frequently till, plant, or work in thegarden?

Yes 2.15 ±1.47 (6) 2.16 ±0.72 (5)No 2.23 ±1.81 (7) 2.07 ±0.99(15)p-value NC NC

How often do you eat vegetables grown elsewherein the local area?

Once or more per week 3.38 ±2.12 (24) 2.48 ±1.35 (21)Never 5.01 ±8.61 (13) 2.26 ±1.53 (17)P-value .514 .637

1. Blood lead values are in micrograms per deciliter.2. P-values are from t-test.NC-Significance values not calculated if less than 10 expected in

any cell.

144

Table 32.—Adult mean blood1 lead levels by household questionnaire factorsand group, Jasper County Lead and Cadmium Exposure Study, Missouri 1991.

Factor

li exterior of home woodYesNop-value1

Is home rented or ownedRentOwnedp-value

Does home have lead waterYesNop-value

Does home have copperwater pipes

YesNop-value

House been refinishedin last year

YesNo 4.24 ±5.93p-value

Is air conditioningused -in home

YesNop-value

Painted pictureswith artist paints

YesNop value

Painted orrefinished furniture

YesNop value

Cast lead into anythingYesNop-value

StudyMean±SD

2.70 ±1.334.43 ±6.37.195

3.24 ±2.103.60 ±4.89NC

2.49 ±2.303.98 ±5.41.403

3.03 ±2.293.96 ±5.83.558

2.64 ±1.38(29).223

3.46 ±4.844.25 ±1.96NC

1.94 ±1.104.04 ±5.13.167

2.73 ±1.253.70 ±4.97NC

4.01 ±3.313.49 ±4.76.796

(n)

(26)(25)

(7)(44)

(10)(34)

(15)(29)

(22)2.44 ±1.61

(45)(6)

(12)(39)

(8)(43)

(6)(45)

ControlMean±.SD

2.09 ±1.332.41 ±1.39.427

2.00 ±1.162.30 ±1.42.487

3.43 ±1.562.28 ±1.36.171

2.51 ±1.862.31 ±1.23.712

2.01 ±1.04(24).271

2.07 ±1.145.80 ±0.99NC

1.60 ±0.672.30 ±1.40NC

1.89 ±0.842.34 ±1.48.310

3.802.18 ±1.34

(n)

(29)(20)

(14)(35)

(3)(38)

(10)(31)

(25)

(47)(2)

(6)(43)

(13)(36)

(1)(48)

145


Factor

Worked with soldering inelectronic!

Ye*Nop-value

Soldered pipei or meulYetNop-value1

Repaired auto radiatonYe.Nop-vilue

Worked on tuto bodies orauto maintenance

YesNop-vtlue

Made poneryYesNop-value

Catting or smelting leadYetNop-value

Battery manufactureYetNop-value

Paint, glaze, and inkYetNop-value

Other lead related activityYetNop-value


YesNop-value

StudyMean +. SD

2.57 ±1.793.74 ±4.94NC

5.103.52 ±4.63NC

3.56 ±2.183.55 ±4.80NC

2.84 ±2.004.29 ±6.22.265

1.703.59 ±4.63

14.6 ±16.082.86 ±1.80.335

2.303.57 ±4.64

3.55 ±4.59

4.20 ±2.003.49 ±4.77.803

4.50 ±2.133.57 ±4.80.744

(n)

(7)(43)

(1)(50)

(5)(46)

(26)(25)

(1)(50)

(3)(48)

(1)(50)

(0)(51)

(3)(47)

(3)(46)

ControlMean±SD

2.03 ±0.642.31 ±1.50.384

3.102.23 ±1.36NC

2.60 ±0.422.20 ±1.38NC

2.33 ±1.432.10 ±1.28.555

2.22 ±1.35

3.802.18 ±1.34

2.22 ±1.35

2.22 ±1.35

1.85 ±0.212.23 ±1.38.696

3.50 ±2.752.13 ±1.22.482

(n)

(ii)07)

(1)(47)

a)(47)

05)04)

(0)(49)

(1)(48)

(0)(49)

(0)(49)

C)(47)

(3)(46)

146


Factor Study ControlMeanj^SD (n) Mean ±. SD (n)

Food or drink stored in copper/pewter containers

Ye. (0) (0)No 3.55 ±4.59 (51) 2.22 ±1.35 (49)p-value NC NC

Food or drink stored in openoriginal can

Yes 1.70 ±0.29 (4) 2.05 ±0.97 (9)No 3.71 ±4.75 (47) 2.26 ±1.43 (40)p-value: NC NC

1. Blood lead values are in micrograms per deciliter.2. P-values are from t-test.NC-Significance not calculated if expected number is less than

10 in any cell.

147

Table 33.—Adult group distribution of urine cadmium levels by study and controlpopulations, Jasper County Lead and Cadmium Study, Missouri 1991.


0.01-0.10

0.11-0.20

0.21-0.30

0.31-0.40

0.41-0.50

0.51-0.60

0.61-0.70

0.71-0.80

0.81-0.90

0.91-1.00

1.01-1.10

1.11-1.20

1.21-1.30

1.31-1.40

1.41-1.50

1.51-1.60

1.61-1.70

TOTAL


14 (27.5)

10 (47.1)

3 (52.9)

6 (64.7)

2 (68.6)

2 (72.5)

2 (76.5)

2 (80.4)

1 (82.4)

3 (88.2)

1 (90.2)

2 (94.1)

1 (96.1)

1 (98.0)

1 (100.0)

49

Control GroupNumber (Cum. %)

18 (38.3)

10 (59.6)

5 (70.2)

3 (76.6)

5 (87.2)

2 (91.5)

1 (93.6)

1 (95.7)

1 (97.9)

1 (100.0)

47

149

Table 34- Adult Biological Test Percentages and Numbers by Range and Group,Missouri 1991

Jasper County Lead and Cadmium Exposure ;».. ;dy.

Factor

Blood TestsCadmium

(micrograms/gram Creatinine)

Lead2

CBC- -Basophils count(thousands/cubic m i l l i m e t e r )

CBC- -Basophils (percent)

CBC- -Granulocytes count(thousands/cubic millimeter)

CBC- -Granulocytes (percent)

CBC- -Hemoglobin (gram/deciliter)

CBC--Hematocrit (percent)


(picograms)


Concentration (percent)

Low

100.0(51)

0 .0(0)

0 .0

(0)

0.0

(0)

0.0(0)

2.3

(1)

4 .0

(2)

14 .0

(7)

4 .0

(2)

0.0(0)

Study

Normal

0.0(0)

98 .0(50)

100 .0(44)

100 .0

(45)

97.7(43)

95.5(42)

90.0(45)

82.0(41)

74 .0(37)

100.0(50)

High

0.0(0)

2.0(1)

0.0(0)

0.0

(0)

2.3

(1)

2.3

(1)

6.0(3)

4 .0(2)

22.0

(11)

0.0(0)

Total

*

(51)

*

(51)

*

(44)

*

(45)

*

(44)

*

(44)

*

(50)

*•

(50)

*

(50)

*

(48)

Control •

Low Normal

97.9(46)

0.0(0)

0.0(0)

0.0(0)

0.0(0)

0.0(0)

2.1

(1)

10.4(5)

2.1

(1)

0.0(0)

2.1

(1)

100.0(49)

100 .0(48)

93 .8(45)

100 .0(48)

97.9(47)

89.6(43)

79.2(38)

62.5(30)

100.0(48)

High Total

0.0(0)

0.0(0)

0.0(0)

6.3(3)

0.0(0)

2.1

U)

8.3(4)

10.4

(5)

35.4(17)

0.0(0)

*

(47)

*

(49)

*

(48)

*

(48)

*

(48)

*

(48)

*

(48)

*

(48)

*

(48)

*

(48)

p-value1

0.295

NC

NC

NC

NC

NC

NC

0.429

0.315

NC

Table 34 cont- Adult Biological Test Percentages and Numbers by Range and Group,Study, Missouri 1991

Jasper County Lead and Cadmium Exposure

to

Factor

CBC- -Mean Corpuscular Volume

(f luoroliter)

CBC- -Platelet count


CBC- -Red Blood Cells(millions/cubic millimeter)

CBC --White Blood Cells(thousands/cubic millimeter)

CBC- -Lymphocytes (percent)

CBC- -Lymphocytes count(thousands/cubic millimeter)

CBC--Monocytes (percent)

CBC--Monocytes count(thousands/cubic millimeter)

CBC--Eosinophil (percent)

CBC--Eosinophil count(thousands/cubic millimeter)

Low

6.0(3)

0.0(0)

12 .0

(6)

0.0(0)

14 .3(7)

0.0(0)

8.3(4)

0 .0(0)

0.0

(0)

0.0(0)

Study

Normal

94.0(47)

100.0(50)

88.0(44)

86 .0(43)

83 .7(41)

100.0(44)

91.7(44)

100.0(44)

100.0

(47)

100.0

(44)

High Total

0.0 *

(0) (50)

0.0 *

(0) (50)

0.0 *

(0) (50)

14 .0 *

(7) (50)

2.0 *

(1) (49)

0.0 *

(0) (44)

0.0 *

(0) (48)

0.0 *

(0) (44)

0.0 *

(0) (47)

0.0 *

(0) (44)

Control

Low Normal

2.1

(1)

0.0(0)

12.5

(6)

0.0(0)

6.3(3)

0.0(0)

2. 1

(1)

0.0(0)

0.0(0)

0.0(0)

97.9

(47)

97. 9

(47)

87.5 •

(42)

91.7

(44)

93.8

(45)

100.0

(48)

97.9

(47)

100.0

(48)

100.0

(48)

100.0

(48)

p-value1

High Total

0.0(0)

2.1(1)

0.0(0)

8.3(4)

0.0(0)

0*0(0)

0.0(0)

0.0(0)

0.0(0)

0.0(0)

* NC V

(48)

* NC

(48)

* 0.940

(48)

* 0.374

(48)

* 0.250

(48)

* NC

(48)

* NC

(48)

* NC

(48)

* NC ;•

(48) .;

* NC '

(48)



Factor

CBC--Platelet Distribution Width

(f luoroliter)

CBC--Red Cell Distribution Width

(percent)

Chem- -Urea Nitrog'en(milligrams/deciliter)

Chem- -Creatinine(milligrams/deciliter)

Chem- -Alanine Aminotransf erase

(International Units/liter)

Chem- -Albumin (grams/deciliter)

Chem- -Reticulocyte Count (percent)

Chem- -Serum electrolytes-sodium(mil liequiva lent/liter)

Chem- -Serum electrolytes-potassium(mi lliequivalent /liter)

Low

6 .0(3)

44 .0(22)

1 .9

(1)

0 . 0

(0)

0.0(0)

0.0(0)

4 . 1(2)

3 . 9(2)

1.9

(1)

Study

Normal

94 .0(47)

56.0(28)

98. 1(51)

100.0(52)

100.0(52)

100.0(52)

81.6(40)

96.2(50)

98.1(51)

High

0.0(0)

0.0(0)

0.0(0)

0.0

(0)

0.0(0)

0.0(0)

14 .3(7)

0.0(0)

0.0(0)

Total

*(50)

it

(50)

*

(52)

*

(52)

*

(52)

*

(52)

*

(49)

*

(52)

*

(52)

Control

Low Normal

4 .2(2)

41 .7

(20)

4 .0(2)

0.0(0)

0.0(0)

0.0(0)

2.0

(1)

0.0(0)

2.0

(1)

87.5(42)

56.3(27)

96 .0(48)

100 .0

(50)

98.0

(49)

100.0

(50)

82.0

(41)

98.0

(49)

98.0

(49)

p-value1

High Total

8.3(4)

2.1(1)

0.0(0)

0.0(0)

2.0

(1)

0.0(0)

16.0

(3)

2.0

(1)

0.0(0)

*

(48)

*

(48)

*

(50)

*

(50)

*

(50)

*

(50)

*

(50)

*(50)

*

(50)

0.304

0.585

NC

NC

NC

NC

0.818

NC

NC



Factor

Chem- -Serum electrolytes-chloride

(milliequiva lent/liter)

Chem- -Aspartate aminotransf erase- -AST


Immunoglobul ins-Gamma G

(mill i grams /dec i liter)

Immunoglobul ins -Gamma A(mil ig rams /deciliter)

Immunoglobul ins-Gamma M

<->» (milligrams/deciliter)


Suppressor/Cytotoxic T-Cells




Low

0.0(0)

0 .0(0)

0 . 0

(0)

3 .9(2)

0.0

(0)

0 .0(0)

0 .0(0)

4 .0(2)

20.0(10)

Study

Normal

98. 1

(51)

100.0(52)

100.0(52)

88.5(46)

92 .3

(48)

88 . 0

(44)

92.0

(46)

90.0

(45)

80.0

(40)

High Total

1.9 *

(1) (52)

0.0 *

(0) (52)

0.0 *(0) (52)

7.7 *(4) (52)

7.7 *(4) (52)

12.0 *(6) (50)

8.0 *

(4) (50)

6.0 *(3) (50)

0.0 *(0) (50)

Control

Low Normal

0.0(0)

0.0(0)

2 .0

(1)

4 . 1

(2)

0.0(0)

0.0(0)

12 .2(6)

0 .0(0)

2.0

(1)

98.0

(49)

100.0

(50)

98 .0-(48)

87.8(43)

89. B(44)

87 . 8

(43)

77.6

(38)

89.8

(44)

91.8

(45)

p-value1

High Total

2.0(r

0.0(0)

0.0(0)

8.2(4)

10.2

(5)

12.2

(6)

10.2

(5)

10.2

(5)

6.1(3,

*

(50)

*

(50)

*

(49)

*

(49)

(49)

*

(49)

*(49)

*

(49)

*

(49)

NC

NC

NC

0.994

0.658

0.970

0.032

0.286

0.005


Jasper County Lead and Cadmium Expu. i.e

LH

Factor

Natural Killer Cells


Urine_Iest_sChem- -Total Protein (grams/deciliter)

Chem- -Gamma-Glutomyltransf erase


UA--Red Blood Cells

(number of cells/high powered field)

UA- -White Blood Cells(number of cells/high powered field)

UA- -Urobilinogen (milligrams/deciliter)


Alanine aminopept idase (AAP)

(micrograms/liter)

Gamma glutamyl transferase (GGT)

(micrograms/liter)

Low

0.0

(0)

0.0

(0)

0.0

(0)

0.0

(0)

0.0

(0)

0.0

(0)

8.2

(4)

3.9

(2)

3 .9

(2)

Study

Normal

94 .0

(47)

100 .0

(52)

94 . 1

(48)

75.0

(9)

86.7

(39)

100.0

(49)

65.3

(32)

80 .4

(41)

92.2

(47)

High Total

6.0 *

(3) (50)

0.0 *

(0) (52)

5.9 *

(3) (51)

25.0 *

(3) (12)

13.3 *

(6) (45)

0.0 *

(0) (49)

26.5 *

(13) (49)

15.7 *

(8) (51)

3.9 *

(2) (51)

Control

Low Norma 1

8 .2

(4)

0.0

(0)

0 .0

(0)

0 .0

(0)

0.0

(0)

0.0

(0)

18.0

(9)

4 .4

(2)

4 .4

(2)

91.8

(45)

98 .0

(49)

86 .0'

(43)

93 .8

(15)

85.7

(36)

100.0

(49)

60.0

(30)

80.4

(37)

93.5

(43)

p-value1

High Total

0.0(0)

2.0(1)

14 .0

(7)

6.3

(1)

14.3

(6)

0.0

(0)

22.0

(11)

15.2

(7)

2.2

(1)

*

(49)

*

(50)

*

(50)

*

(16)

*

(42)

*

(49)

*

(50)

*

(46)

*

(46)

NC

NC

0.172

0.161

0.898

NC

0.342

0.993

NC

Table 34 cont- Adult Biological Test Percentages and Numbers by Range and Group, Jasper County Lead and Cadmium ExposureStudy, Missouri 1991

Factor

Low

Study

Normal High Total Low

Control

Normal

p-value1-

High Total

N-acetyl-B-D-glucosaminidase (NAG)

(micrograms/1iter)

UA--Specific Gravity

UA--pH

0.0(0)

0.0(0)

0. 0(0)

94 . 1(48)

98.0(48)

100.0(49)

5.9(3)

2.0

(1)

0.0(0)

(51)

(49)

(49)

0.0

(0)

0.0(0)

0.0

(0)

94 .0(47)

100.0(49)

100 .0(49)

6.0(3)

0.0

(0)

0.0

(0)

(50)

*

(49)

t

(49)

NC

NC

NC

Table 34 cont.- Adult Biochemical Test Percentages and Numbers by Range

Study, Missouri 1991and Group, Jasper County Lead and Cadmium Exposure

Factor

Urine Tests (Cont.)

UA- -Bacteria

UA- -Bilirubin

UA- -Blood

UA-Casts (Hyaline)

UA- -Crystals

UA- -Epithelial cells

UA- -Glucose

UA- -Ketones

UA- -Leukocyte esterase

UA--Nitrate

UA- -Protein

Study

Normal Not Normal

7.7

(1)

95.9(47)

89. 8(44)

0.0

(0)

60.4

(29)

44 .4

(20)

95. 9(47)

87. 8(43)

85.7(42)

93 .9(46)

91 .8(45)

92.3(12)

4 .1(2)

10.2(5)

100 . 0

(1)

39.6(19)

55.6(25)

4 .1

(2)

12 .2(6)

14.3(7)

6 .1(3)

8.2(4)

Total

*

(13)

*

(49)

*

(49)

*

(1)

*

(48)

*

(45)

*

(49)

*

(49)

*

(49)

*

(49)

*

(49)

ControlNormal Not Normal

0.0(0)

100.0(49)

93 .9(46)

0.0(0)

73.5(36)

40.9(18)

100.0(49)

93 .9(46)

93.9(46)

100.0(49)

93 .9(46)

100.0

(11)

0.0(0)

6 .1(3)

0.0(o')

26 .5(13)

59. 1(26)

0.0(0)

6 .1(3)

6 .1(3)

0 .0(0)

6 .1(3)

Total

*

(11)

*

(49)

*

(49)

*

(0)

*

(49)

*

(44)

*

(49)

*

(49)

*

(49)

*

(49)

*

(49)

p-value^-

NC

NC

0.461

NC

0. 172

0.736

NC

0.294

0.182

NC

NC

1. Percentages are indicated in first line and Numbers are shown in parenthesis.• Percentages may not equal 1001

2. p-values from chi-square analysis

(inn vfliiji-.<.>

158

Table 35.—Adult household questionnaire by factor and group, Jasper County Leadand Cadmium Exposure Study, Missouri 1991.

Factor

Year houM built< 1900-19091910-19191920-19291920-19391940-19491950-19591960-19691970-19791980-19891990-presentDon't Know

It exterior of home:Wood

YesNo

BrickYeiNo

BlockYesNo

Vinyl/mtul tidingYeiNo

It home • mobile homeYesNo

h home rented or ownedRentOwned

Doet home have:Lead water pipe'

YeiNoDon't Know

Plastic water pipesYesNoDon't Know

Galvanized steel water pipesYesNoDon't Know

Copper water pipesYesNoDon't Know

Studyn = 52

9.6%7.7%9.6%9.6%7.7%9.6%3.8%17.3*9.6%

15.4%

51.9*48.1*

13.5*86.5*

100.0%

13.5*86.5*

15.4%84.6*

13.5*86.5*

19.2*67.3%13.5*

63.5%23.1*13.5*

32.7%53.8%13.5%

28.8%57.7%13.5*

Controln = 50

2.0%0.0%4.0%4.0%8.0%14.0%22.0%20.0%14.0%

12.0%

60.0%40.0%

16.0%84.0%

100.0%

22.0%78.0%

2.0%98.0%

28.0%72.0%

6.0%76.0%18.0%

60.0%22.0%18.0%

24.0%58.0%18.0%

20.0%62.0%18.0%

•p- value1

.058

.411

.717

NC

.258

.017

.069

.128

.819

.579

.541

159


Factor

Iron water pipesYetNoDon't Know

Does home have other water pipe*YetNoDon't Know

Type water used for drinkingPrivate wellPublic waterBottledLocal spring or brookCitternOther

Type water used for cookingPrivate wellPublic waterBottledLocal spring or brookCisternOther

Which fuel used for house heatingBottled or tank gasNatural gasElectricityFuel oil or keroseneCoal or cokeWoodOther

Which fuel used for water heatingBottled or tank gasNatural gasElectricityFuel oil or keroseneCoai or cokeWoodOther

Which fuel used for cookingBottJed or tank gitNatural gasElectricityFuel oil or keroseneCoal or cokeWoodOther

Studyn = 52

7.7*78.8*13.5*

3.8*82.7*13.5%

3.8*94.2*1.9*0.0*0.0*0.0*

3.8%96.2*0.0%0.0%0.0*0.0*

0.0%75.0*13.5*0.0*0.0%7.7*3.8*

0.0%69.2*30.8*0.0%0.0%0.0%0.0*

0.0%46.2%53.8%0.0%0.0%0.0%0.0%

Controln = 50

10.0%72.0*18.0*

12.0%70.0*18.0*

0.0%98.0%0.0%0.0%0.0%2.0*

0.0%98.0*0.0%0.0*0.0*2.0%

2.0%68.0%30.0%0.0%0.0%0.0%0.0%

2.0%56.0%42.0*0.0*0.0%0.0%0.0%

2.0%38.0%60.0%0.0*0.0%0.0*0.0%

p-valuel

.723

.219

NC

NC

.036

.267

.446

160


Factor

House been refiniibed in latt yearYMNo

Ii «ir conditioning uied in homeYefNo

Houiehold member worked in:Mining

YeiNoDon't Know

Underground miningYe»No

Surface miningYe»No

Mine millingYesNo

Mine transportationYeaNoMine imelterYe«No

Other mining jobtYetNo

LeW mining jobYetNo

Zinc mining jobYetNo

Silver mining jobYetNo

Molybdenum mining jobYetNo

Coal mining jobYesNo

Limestone mining jobYetNo

Clay mining jobYetNo

Studyn = 52

442%55.S*

88.5%11.5%

1.9%96.2%1.9%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

1.9%98.1%

0.0%100%

1.9%98.1%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

Controln = 50

52.0%43.0%

96.0*4.0%

2.0%98.0%0.0%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

2.0%98.0%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

0.0%100%

p-value1

.432

.156

.615

NC

NC

NC

NC

NC

NC

NC

NC

NC

NC

NC

NC

NC

161


FactorStudyn = 52

Controln =50 p-value1

Household member worked in:Other mining job

Ye*No

Wear mining related job workclothing home

Alw«y«Sometime!Never

Does not shower after miningrelated job

AlwaysSometime!Never

HII member done any of thefollowing in the [act 90 days:

Painted pictures with artist paintiYe»No

Painted or refinished furnitureYesNo

Painted inside or outside of homeor building

YetNo


Cast lead into anythingYesNo


YesNoDon't Know

Soldered pipes or metalYe.NoDon't Know

Repaired auto radiatorsYesNo


YesNo

Worked at sewage treat; nlantYesNo

0.0%100%

0.0%98.1%1.9%

0.0%98.1%1.9%

23.1%76.9%

17.3%82.7%

38.5%61.5%

1.9%98.1%

11.5%88.5%

13.5%84.6%1.9%

1.9%98.1%0.0%

9.6%90.4%

50.0%50.0%

0.0%100%

0.0%100*

2.0%98.0%0.0%

2.0%98.0%0.0%

12.0%88.0%

26.0%74.0%

38.0%62.0%

0.0%100%

2.0%98.0%

22.0%76.0%2.0%

2.0%96.0%2.0%

4.0%96.0%

50.0%50.0%

4.0%96.0%

NC

NC

.367

.142

.285

.961

NC

.056

.524

.590

.262

.100

NC

162


Factor

Hti member done any of thefollowing in the lait 90 diyt:

Mide potteryYeiNo

Ridden a dirt bike, mounuin bikeor ATV in local area

YeiNo

Did weldingYe>NoDon't Know

Cleaned or repaired firearmsYeiNo

Vitited indoor firing rangeYeiNo

Wire/cable cutting or splicingYe«NoDon't Know

Carting or smelting leadYe.No

Plastic manufactureYeiNo

Battery manufactureYetNo

Pipe machiningYesNo

Electroplating with leadYeaNo

Refining gasolineYetNo

Paint, glaze, and inkYeiNo

Rubber manufactureYesNo

Scrap metal recoveryYesNo

Other lead related activityYesNoDon't Know

Studyn = 52

1.9*98.1*

17.3*82.7*

15.4%82.7*1.9*

13.5*86.5*

1.9*98.1*

19.2*78.8*1.9*

5.8*94.2*

1.9*98.1*

1.9*98.1*

0.0*100*

0.0*98.1*

0.0*100*

0.0%100%

0.0*100%

5.8*94.2*

5.8*92.3*1.9*

Controln =50

0.0*100%

14.0*86.0*

28.0*72.0*0.0*

18.0*82.0%

2.0%98.0*

42.0*58.0*0.0*

2.0*98.0*

0.0*100.0%

0.0*100.0*

0.0*96.0*

0.0*100*

0.0*100*

0.0*100*

0.0*100%

4.0%96.0%

4.0%96.0*0.0*

p-value1

NC

.646

.200

.528

NC

.031

NC

NC

NC

NC

NC

NC

NC

NC

.679

.559

163


Factor

Other cadmium related ActivityYeiNoDon't Know

Food or drink prepared, served orrtored in clay, homemade, orforeign made material

YetNo

Food in copper, pewter dittiesYetNo

Food or drink ttored in openoriginal can

YetNo

Anyone tmoke in homeYetNo

Number of pertont that smokein home

Smoke cigarette! in homeYetNo

Number cigarettes/day in home

Smoke cigars in homeYetNo

Number cigtrs/day in home

Smoke pipes in homeYetNo

Number pipe bowls/day in home

Oogt or ctit that go in and out ofhouse

YetNo

Studyn = 52

1.9*96.2%1.9*

5.8*90.4*

0.0*100%

7.7*92.3*

50.0*50.0*

1.25 ±2.35

50.0%50.0*

28.23 ±138.26

3.8*96.2%

0.01 ±0.13

0.0*100*

0.00 ±0.00

40.4*59.6*

Controln ^50

0.0KO*0.0*

6.0%94.0*

0.0*100*

18.0*82.0*

56.0*44.0%

0.86 ±1.03

56.0%44.0*

28.86 ±40.57

0.0*100%

0.0 ±0.0

0.0%98.0%

0.04 ±0.28

50.0%50.0%

p-value1

NC

.375

NC

.118

.543

.543

NC

NC

.329

164


Factor n = 52 n = 50 p-value1

U§*d mining or imehing miterUl•round houM or yard

Yet 30.8* 14.0%No 65.4* 78.0*Don't Know 3.8* 6.0* .169

1. P-values for chi-square test.NC-Significance levels not calculated if number of subjects was

less than five expected in a cell.

165

(inn v3<'ii>.-.> jaded papAo

166

Table 36.—Regression coefficients and significance values for stepwisemultiple linear regression for adult blood lead values without environmentalfactors included in the model, Jasper County Lead and Cadmium ExposureStudy, Missouri 1991.

Variable (n = 99)

Male Gender

Presently SmokingCigarettes

Year House Built

Intercept

Regression Coefficient1'2

2.06

2.04

-.300

2.77

p-value3

.002

.003

.036

.001

1. Stepwise regression using all variables included in TABLE 14, exceptenvironmental factors, with a value of 0.15 for variables to enter themodel and a value of 0.25 used for variables to be taken out of the model.



167

Table 37.—Regression coefficients and significance values for stepwisemultiple linear regression for adult urine cadmium values withoutenvironmental factors included in the model, Jasper County Lead andCadmium Exposure Study, Missouri 1991.

Variable (n = 97)

Age

Person in household thatsmokes

Intercept

Regression Coefficient1'2

.012

.165

-.096

p-value3

.037

.092

.629

1. Stepwise regression using all variables included in TABLE 14,except environmental factors, with a value of 0.15 forvariables to enter the model and a value of 0.25 used forvariables to be taken out of the model.



169

Table 38.—Comparison of study and control area participants with area populationby selected socio-economic data, Jasper County Lead and Cadmium Exposure Study,Missouri 1991.

Socio-economicFactor

Percent MinorityRace

Mean EducationLevel (years)

Median Income,(household)

Median YearHouse Built

Study Participants1

Study Area

3.1%

13.1

$25,000

1955

Control Area

2.9%

13.4

$27,100

1970

1990 Census2

Study Area

3.2%

12.2

$20,500

1962

Control Area

3.9%

12.3

$18,800

1961

1. Source: Study survey.2. Source: 1990 Census from U.S. Bureau of the Census.

171

FIGURES

173

Figure 1.—Correlation Between Blood Lead, Soil,House Age, and Inside Paint

175

Figure 1- Correlation Between. Blood Lead, Soil, House fcg«, ft-xul InsidePaint, Jasper County Blood Lead and Cadmium Study, tlissouri, 1991

,31

.62

.33

.56

Diagram 3Study Group

Pb 3

.47

.56

Pb 3- Blood LeadS- SoilK\- House?- Paint

Diagram A.Children

Pb B

.50

S P

56

03

.62

Diagram CControl Group

Pb 3

.21

.32

177

Figure 2.—Correlation Between Blood Lead, Soil, and Inside PaintWhile Controlling for Age of the House

179

Figure 2- Correlation Bettreen Blood Lead, Soil, and Inside Paint,ffkilt Controlling ior *g* o± th« House,

Jasper County Blood Lead and Cadmium Study, Missouri, 1991

Diagram \- All ChildrenPb B

.19 .43

P-.017 p-.OOO

.30 .000

Diagram 3- Study Group

Pb 3

.18

p=.052

Diagram C- Control Group

Pb 3

.14

p=.470

.27 p=.004 .10 pa.600

Pb 3- Blood Lead

?- Paint

S- Soil

181

Figure Al.—Scatter Plot of Combined Study and Control GroupsHousehold Income Compared to Blood Lead Levels

183

pun \3<>|<>.>.i JSded

184

50i

40 j

0330

8 20-CQ :

10-!

oo

Figure A1

Jasper County StudyCombined Study and Control Groups

0 10 20 30 40 50

Household Incomecorrelation coefficient = .21

income is in $1,000

Figure A2.—Scatter Plot of Combined Study and Control Groups YearHouse Built Compared to Blood Lead Levels

187

50

40

T3

Q) 30

8 20DQ

10oovo

01880 1900

Figure A2Jasper County Study

Combined Study and Control Groups

1920 1940 1960

Year House Built

correlation coefficient = .29

1980 2000

Figure A3.—Scatter Plot of Study Group Children Living in Homes BuiltAfter 1960 and Soil Lead Level Compared to Blood Lead Levels

191

03CD

12-i

10-

•o 6-oo 4,

CQ ^;

2\

Figure A3

Jasper County StudyStudy Group Only

0.10 200 400 600 800 1000 1200

Soil Leadcorrelation coefficient = .31

only children living in homes built after 1960

Figure A4.—Graph of Cumulative Percentage of Blood Lead Levelsin the Study and Control Groups

195

cCDOCD

CL(D

VO• J

o

100

80 ^

60

40 ^

20

0•c5>

Figure A4

Jasper County StudyCombined Study and Control Groups

GROUP

Control

Study

•<*

Blood Lead

Figure A5.—Scatter Plot of Study Group Children Who Lived in HomesHaving Undetectable Interior Paint Levels Compared to Blood Lead

199

30

03 20(D

o 10

Figure A5

Jasper County StudyStudy Group Only

0 200 400 600 800 1000

Soil Lead

correlation coefficient = ..48

only children living in homes with undetectable interior paint levels

V*,(,M.,

202

ATTACHMENTS

203

Attachment 1.—Census Flow Chart (Study and Control Areas)

205

Census Flow ChartStudy Area / Control Area

Field Visits5476/4951

tToo Old827/665

t

Vacant436 / 133

t

Relu277

PotentialParticipant1513/613

K)O-J

Potential Participants1844/964 Homes

5229 / 2838 Persons

Total Participants412/283

APPENDICES

209

Appendix A.—Initial letter to residents of Jasper, Newton and McDonaldCounties Explaining Purpose of Health Study

A-l

MISSOURI DEPARTMENT OF John AshcroftGovernor

John R. Bogey, Ph.D.Director

P.O. Box 570. Jefferson City. MO 65102 « 314-751-6400 • FAX 314-751-6010

Dear Resident:

As you may have heard, the Missouri Department of Health willconduct a health study of people living in parts of Jasper, Newton,and McDonald Counties. We believe you live in one of the areasselected to be studied and therefore, would like to tell you about thestudy.

The purposes of the study are twofold: (1) To determine ifpeople have elevated levels of lead and cadmium in their bodies dueto living in the historic mining area, and (2) To determine if anypeople with elevated levels are experiencing adverse health effects,as compared to a non-exposed (control) group.

One of our first steps in the study is to develop a list ofpotential study participants. We have enclosed a short "census"form and return envelope for your use. Please complete the form andsend it back to us, even if you or other members of your household

'may later decide not to participate in the study. Each studyparticipant will receive a cash award of ten dollars and will be keptadvised of the study results as they become available.

If you have any questions about the study or about completingthe form, please call me or Stephen Meek at (314) 751-6102 or(800) 392-7245 or Bill Gory of the Jasper County Health Departmentat 673.-342.1. We sincerely appreciate your cooperation.

YOULS trul

DarylChiefBureau of Environmental Epidemiology

DWR:PEP:SLM:de

®A-3

AN tQUAi OPPOnTUNiTY/AWTJMAIIVE ACTION EMPLOYER - S«tvic« cxovKMO on a nonaocnrrwjtixv Offltt

Appendix B.—Heavy Metal Exposure Assessment Census Form

B-l

MISSOURI DEPARTMENT OF HEALTHHEAVY METAL EXPOSURE ASSESSMENT

CENSUS FORM

Residential Address(Street, RR, Box #)

City Telephone Home ( ).Zip

Work ( ).

Mailing Address

NAME DATE OF BIRTH AGE SEX

A. Persons 6 months • 5 years old (List by age, oldest first)

1.

2.

3.

4.

B. Persons 6 - 1 4 years old

1.

2.

3.

4.

C. Persons 1 5 - 4 4 years old

1.

2.

3.

4.

Has everyone listed above lived at this address longer than 60 days? YES NO

If no, whom?

MO 580-9012 (1-91)

B-3

Appendix C.—Child Questionnaire Age 6-71 Months

C-l

200 CHILD QUESTIONNAIREACE 6-71 MONTHS

HOUSE ID .

PERSON ID

QUESTIONS ABOUT THE CHILD 6-71 MONTHS OLD (LESS THAN 6 YEARS OLD) SHOULDBE ANSWERED BY THE PARENT OR LEGAL GUARDIAN OP THE CHILD.

Child\a full legal nun*:.

C-3

(001-004) HOUSE ID

(005-012) PERSON ID

Now I need to ask a. number of questions about (CHILD'S NAME).

(013) 201. Who is answering these questions?1 » Child's mother2 • •" :ild's father3 » .Id's grandparent4 » Id's other relative5 - er

202. How long has (subject's name) been living in this home?

Years Months(014-015) (016-117)

IF LESS THAN 90 DAYS, OBTAIN PREVIOUS ADDRESS.

Address:

203. What is (CHILD'S NAME) date of birth?(018-023) (MO/DA/YR) / /

88 - REFUSED99 - DON'T KNOW

204. Is (CHILD'S NAME) a boy or girl?(024) 1 - Male

2 - Female

205. Which of the following best describes HIS/HER racialbackground?

(025) 1 =» White2 « Black3 - Asian or Pacific Islander4 - American Indian/Alaska native8 =« REFUSED9 » DON'T KNOW

206. Is thj.3 child Hispanic or of Spanish origin or descent?(026) 1 * Yes

2 * No8 =» REFUSED9 =• DON'T KNOW

PERSON ID

IF CHILD LESS THAN 3 3TEARS OLD:(027) 207. Does this child breast feed?

YesNoNot applicable, over 3 years oldREFUSEDDOH'T KNOW

208. In the last 90 day*, where does (CHILD'S NAME) usually spend HIS/HSRtime each 24 hour period? (approximate number of hours)(99 - DON'T KNOW)

Babysitter(outsideo f home)

Day Care(commercialfacility)

OtherLocation

Home Total(24 hrs)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

(028-029) (030-031)

(038-039) (040-041)

(048-049) (050-051)

(058-059) (060-061)

(068-065) (070-071)

(078-079) (080-081)

(086-089) (090-091)

(032-033) (034 035) (036-037)

(042-043) (044 045) (046-047)

(052-053) (054-055) (056-057)

(062-063) (064-065) (066-067)

(072-073) (074-075) (076H377)

(082-083) (084-085) (086-087)

(092-093) (094-095) (096 097)

209. How many hours, on average, does CHILD spend sleeping?(098-099) (99 - DON'T KNOW)

210. How many hours during the day do you think (CHILD'S NAME) usuallyspends playing on the floor when indoors in this home?

(100-101) Hours (99 - DON'T KNOW)

C-5

PERSON ID -

(102) 211. Does (CHILD'S NAME) play outdoors around the house or in theneighborhood?

1 - Yes2 - No (CO TO QUESTION 217)9 - DON'T KNOW (CO TO QUESTION 217)

212. IF YES, then how many hours a day on the average does(CHILD'S NAME) play outdoors?

(103-104) Hours 99 - DON'T KNOW

213. Where doe* (CHILD'S NAME) uiiually play when outdoorsaround the house? CIRCLE OKE

(105) 1 - Back yard 7 - Other (specify)2 - Front yard 9 - DON'T KNOW3 - Side yard

214. Where does (CHILD'S NAME) usually play outdoors (in thelast 90 days) when he/she is not playing in your own homeyard? CIRCLE ONE

(106-107) 01 - Neighbor's yard02 » Playground03 - Near or around creek or ditch04 » On or near tailings or slag pile*05 • On sidewalks or streets06 • Park07 • Only plays at home08 - Other (SPECIFY)99 - DON'T KNOW

215. Is the ground where (CHILD'S NAKE) usually plays mainlygrassy, concrete/asphalt, plain dirt or soil, ]usc asandbox, or some other stuff? CIRCLE ONE

(108) 1 • Grassy2 * Concrete/asphalt3 - Dirt/soil4 • Sandbox7 - Other (SPECIFY)_9 - DON'T KNOW

216. Does (CHILD'S NAKE) often take food, snacks, candy or abottle or pacifier with him/her outside to play?

(109) 1 - Yes2 - No9 - DON'T KNOW

C-6

PERSON ID -

217. Are (CHILD'S NAME) hand* or face usually washed before eating?(110) 1 • Yes

2 - No9 - DON'T KNOW

218. Are (CHILD'S NAME) hands or face usually washed before going to. sleep?(111) 1 - Yes

2 • No9 • DON'T KNOW

219. Are (CHILD'S NAME) hands or face usually washed after playing withdirt or sand?

(112) 1 - Yes2 - No9 - DON'T KNOW

220. How many times IB (CHILD'S NAME) bathed or given a shower?

(113-114) per week (99 - DON'T KNOW)

221. Has (CHILD'S NAME) used a pacifier in the last 6 months?(115) 1 - Yes


222. Doee (CHILD'S NAME) aucJc HIS/HER thumb or fingers?(116) 1 - Yes

2 • No9 - DON'T KNOW

223. Does (CHILD'S NAME) chew on HIS/HER fingernails?(117) 1 m f»n

2 - No9 » DON'T KNOW

224. Does (CHILD'S NAME) have a favorite blanket or toy?(118) 1 - Yes

2 - No (CO TO QUESTION 227)9 - DON'T KNOW

225. Does (CHILD'S NAME) carry thxa around during the day?(119) 1 . Yes


226. Does (CHILD'S NAME) often put this in HIS/HER mouth?C20) 1 - Yea


C-7

PERSON :: -

227. Many children put some things other than food into their mouths. Wouliyou say that (CHILD'S NAME):

(121) 1 • Doe* this a lot2 • Juat once in a while3 » Almost never4 - Never9 • DON'T KNOW

228. Does (CHILD'S NAME) put HIS/HER mouth on furniture or on the window3111?

(122 ) 1 * Does this a lot2 - Juat once in a while3 » Almost never4 » Never9 - DON'T KNOW

229. Sometimes children swallow things other than food. Would you say t.H.(CHILD'S NAME) swallows things other than food?

(123) 1 - C F»S this a lot2 * Ju.it once in a le3 - Almost never4 » Never9 - DON'T KNOW

If yes, specify items swallowed. —

230. Does (CHILD'S NAME) ever put paint chips in HIS/HER mouth?

(124) 1 - Does this a lot2 - Just once in a while3 - Almost never4 • Naver9 - DON'T KNOW

231. Does your household have a vegetable garden in your yard?

(125) 1 - Yes2 - No (CO TO 236)9 - DON'T KNOW (GO TO 236)

232. Has soil been hauled in and placed on your garden?

(126) 1 - Yea2 - No9 - DON'T KNOW

IF YES, SPECIFY FROM WHERE?

08

PERSON ID

233. How oftan does (CHILD'S NAME) jeat vegetables grown inyour garden?

(127) 1 » Once a week or more2 • Leas than once per week3 - Never (GO TO 236)9 - DON'T KNOW (CO TO 236)

234. How often does (CHILD'S NAME) eat leafy greenvegetables, (such as lettuce or spinach) grown inyour garden?

(128) 1 » Once a week or more2 » Less than once per week3 • Never9 - DON'T KNOW

235. How often does (CHILD'S NAME) eat root vegetables,(such as beets or turnips) grown in your garden?

(129) 1 • Once a week or more2 • Less than once per week3 - Never9 - DON'T KNOW

236. How often does (CHILD'S NAME) eat vegetables grown elsewhere in thelocal area? (e.g. NEIGHBOR'S GARDEN OR LOCAL FARMERS MARKET)

(130) 1 - Once a week or more2 • Less than once per week3 - Never (GO TO 239)9 - DON'T KNOW (GO TO 239)

23*7. How often does he/she eat leafy green vegetables, (suchas lettuce or spinach) grown elsewhere in the area?

(131) 1 - Once a week or more2 • Less than once per week3 • Never9 - DON'T KNOW

238. How often does he/she eat root vegetables, (such as beeror turnips) grown elsewhere in the area?

(132) 1 • Once a week or more2 » Less than once per week3 - Never9 - DON'T KNOW

C-9

PERSON ID -

239. Haa SUBJECT ever been treated <*ith traditional, folk or herbal medications?(133) 1 = Xes

2 = No9 = DON'T XMOW

IF YES, What waa th« oMd<cin« c«ll«d7

END: Thia complete* the queationnaire. Do you have any question* or commentsabout it?

Thank you for your time.

C-10

Appendix D.—Young Person Questionnaire Ages 6 -14 Years Old

D-l

PERSON ID

YOUNG PERSON QUESTIONNAIREAGES 6-14 YEARS OLD

HOUSE ID .

PERSON ID

QUESTIONS ABOUT THE CHILD 6-14 YEARS OLD MUST BE ANSWERED BY THE PARENT OR LEGALGUARDIAN OF THE CHILD.

Child's full/legal name.

D-3

(001-004) HC-SE ID

(005-012) PERSON ID -

I need to ask a number of questions about (CHILD'S NAME).

301. Who is answering these questions?(013) 1 • child's mother

2 • child's father3 - child'» grandparent4 - child's other relative5 - other

302. How long has (SUBJECT'S NAME) been living in this home?

Years Months(014-015) (016-017)

IF LESS THAN 90 DAYS, OBTAIN PREVIOUS ADDRESS (12 MONTH PERIOD)

Address: —————

303. What is (CHILD'S NAME) date of birth?(018-023) (MO/DA/YR) / /

ENTER 88 FOR REFUSEDENTER 99 FOR DON'T KNOW

304. Is (NAME) a boy or girl?(024) 1 - Male

2 - Female

i305. Which of the following best describes HIS/HER racial background?(025) l - white

2 - Black3 « Asian or Pacifi alander4 • American Indian/ .aska native8 - REFUSED9 - DON'T KNOW

306. Is he/she Hispanic or of Spanish origin or descent?( 0 2 6 ) 1 - Yes

2 - No8 - REFUSED9 - DON'T KNOW

D-A

PERSON ID

307. What is the highest year of •education (CHILD'S NAME) has completed?(027-029) (circle one)

No Schooling 000Elementary School 001 002 003 004 005

006 007 008High School (GED » 012) 009 010 Oil 012REFUSED TO ANSWER 068DON'T KNOW 099

IF CHILD IS 12 YEARS OR OLDER ASK 308 ON SMOKING, OTHERWISE, GO TO 309

308. Does (CHILD'S NAME) smoke or use tobacco products?

(030)

(031)

(034)

(037)

(040)

2 • NO (GO TO 309)8 * REFUSED (GO TO 309)9 - DON'T KNOW (GO TO 309)

Does he/she smoke/us* TOBACCO PRODUCT?(Circle responses)

a. Cigarettes

b. Cigars

c. Pipes

d. Smokeless' tobacco

Yes No Don't IF YES, HOW MANY:know

1 2 9 _ _ _ _ _ _ Cigarettes p e r day, total(032-033) (1 pack-20)

1 2 9 Cigars p e r day, total(035-036)

1 2 9 Pipe bowls p e r day, total(038-039)

Times per day, total(041-042)

D-5

PERSON ZD

309. In the last 90 days, where does (CHILD'S NAME) usually spend HIS/HERtime each 24 hour period? (approximate number of hours)(99 - DON'T KNOW)

School Babysitter Day Care Other Home Total(outside (commercial Location (24 h)of home) facility)

Monday(04.-044} (045-046) (047-048) (049-050) (051-052) , -.5-054)

Tuesday _____(055-056) (057-058) (059-060) (061-062) (063-064) (065-066)

Wednesday ______(067-068) (O69-070) (071-072) (073-074) (075-076) (077-078)

Thursday _____^ ______(079-080) (081-082) (083-084) (085-086) (087-088) (089-090)

Friday __^ _^_^_(091-092) (093-094) (095-096) (097-098) (099-100) (101-102)

Saturday ___^__(103-104) (105-106) (107-108) (109-110) (111-112) (113-114)

Sunday(115-116) ril7-118) (119-120) (121-122) (123-124) (125-126)

310. How many hours a day does (CHILD'S NAME) spend sleeping?(127) (99 - DON'T KNOW)

311. Does (CHILD'S NAME) play or spend time outdoors around thehouse or in the neighborhood?

(128) 1 - Yes2 - No (GO TO QUESTION 317)9 - DON'T KNOW (CO TO QUESTION 317)

312. If yes, then how many hours a day on theaverage does (CHILD'S NAME) play or spend timeoutdoors?

(129-130) Hours 99 - DON'T KNOW

D-6

PERSON ID

313. Where does (CHILD'S NAME) usually play whanoutdoor* around the house?

(131) 1 - Back yard2 - Front yard3 - Side yard

7 - Other (specify)9 - DON'T KNOW

314. Where does (CHILD'S NAME) usually playoutdoors (in the last 90 days) when he/she isnot playing in your own home yard?

(132-133) 010203040506070899

Neighbor's yardPlaygroundNear or around creek or ditchOn or near tailings or slag pileiOn sidewalks or streetsParkOnly plays at homeOther (SPECIFY)DON'T KNOW

315. Is the ground where (CHILD'S NAME) usuallyplays mainly grassy, concrete/asphalt, plaindirt or soil, just a sandbox, or some otherstuff?

(134) GrassyConcrete/asphaltDirt/soilSandboxOther (SPECIFY)DON'T KNOW

(135)

316. Does (CHILD'S NAME) often take food or a drinkwith him/her outside to play?

1 - Yes2 - No9 « DON'T KNOW

D-7

' Does (NAME) usually wash HIS/HER hanas or face before earing?(136) 1 - Yes

2 * No9 - DON'T KNOW

318. Does (NAME) usually wash HIS/HER hands or face before going tosleep?

(137) 1 « yes2 - No9 - DON'T KNOW

319. Does (NAME) usually wash HIS/HER hands or face after playingor working with dirt or sand?

(138) 1 « Yes2 - No9 - DON'T KNOW

320. Does (NAME) suck HIS/HER thumb or fingers?

(139) 1 - Yes2 - No9 - DON'T KNOW

321. Does (CHILD'S NAME) chew on HIS/HER fingernails?

(140) 1 - Yes2 * No9 » DON'T KNOW

322. Does (CHILD'S NAME) put things other than food in HIS/HERmouth?

(141) 1 - Yes2 - No9 - DON'T KNOW

IF YES, SPECIFY

323. Sometimes children swallow things other than food. Would yousay that (CHILD'S NAME) swallows things other than food:

(142) 1 - Does this a lot2 « Just once in a while3 » Almost never4 » Never9 - DON'T KNOW

IF YES, SPECIFY

D-8

PERSOM ID

324. Does your household have a vegetable garden in your yard?

(143) 1 - Yes2 - No (CO TO 329)9 • DON'T KNOW (GO TO 329)


(144) 1 • Yes2 « No9 - DON'T KNOW

If YES, SPECIFY FROM WHERE?

326. How often does (CHILD'S NAME) eat vegetables grown inyour garden?

(145)1 - Once a week or more2 - Less than once per week3 - Never (GO TO 329)9 - DON'T KNOW (GO TO 329)

327. How often does (CHILD'S NAME) eat leafy greenvegetables, (such as lettuce or spinach) grown inyour garden?

(146)1 - Once a week or more2 - Less than once per week3 - Never9 - DON'T KNOW

328. How often does (CHILD'S NAME) eat rootvegetables, (such as beets or turnips) grown inyour garden?

(147)1 • Once a week or more2 » Less than once per week3 - Never9 - DON'T KNOW

D-9

PERSON 1J -

329. How often doe* (CHILD'S NAME) eat vegetables grown elsewhere in thelocal area? (e.g. NEIGHBOR'S GARDEN OR LOCAL FARMERS MARKET)

(148)1 - Once a week or more2 » Leu than once per week3 • Never (GO TO 332)9 - DON'T KNOW (GO TO 332)

330. How often does he/she eat leafy green vegetables, (suchas lettuce or spinach) grown elsewhere in the area?

(149)1 - Once a week or more2 • Less than once per, week3 - Never9 - DON'T KNOW

331. How often does he/she eat root vegetables, (such asbeets or turnips) grown elsewhere in the area?

(150)1 - Once a week or more2 » Lass than once per week3 - Never9 - DON'T KNOW

332. Has SUBJECT ever been treated with traditional, folk or herbalmedications?

(151) 1 - Yes2 - No9 - DON'T KNOW

IF YES, What was the medicine called?

D-10

PERSON ID -

My last question* are about (CHILD'S NAME'S) activities.

333. In the last 90 day, has (CHILD'S NAME) participated in any of thefollowing activities? (Circle all that apply.)

(152) a. Painted pictures with artists paints?(not children's paints)

(153) b. Painted, stained or refinishedfurniture?

(154} c. Painted the inside or outside of ahome or building?

(155) d. Worked with stained glass?

(156) e. Cast lead into fishing sinkers.bullets or anything else?

(157) f. Worked with soldering in electronics?

(158) g. Worked on soldering pipesor sheets of metal?

(159) h. Repaired auto radiators?

(160) i. Worked on auto bodies or automaintenance?

(161) j. Made pottery?

(162) k. Ridden a dirt bike, mountain bike,or ATV in the local area?

(163) 1. Welded?

(164) m. Visited indoor firearm target ranges?

(165) n. Cleaned or repaired firearms

This completes the questionnaire. Do youabout it?

Yes

1

1

1

1

1

1

1

1

1

1

1

1

1

1

have any questions

No

2

2

2

2

2

2

2

2

2

2

2

2

2

2

or

Don'tknow

9

9

9

9

9

9

9

9

9

9

9

9

9

9

comments


D-ll

J9d9d

D-12

Appendix E.—Teenage and Adult Questionnaire Ages 15-44 Years

E-l

PERSON 10

TEENAGE AND ADOLT QUESTIONNAIREACES IS - 44 YEARS

QUESTIONS ABOUT THE YOUNG ADULT AGED 15-16 MUST BE ANSWERED WITH THE PARENT ORGUARDIAN PRESENT.

400. QUESTIONS FOR SELECTED PERSON AGE 15 - 44.

HOUSE ID

PERSON ID -

What La your full/legal name?

E-3

(-•"' -CO4) HO'JJE ID

(-05-012) ?IRSON 13 -

401. WHO IS ANSWERING TKESS QUESTIONS?(013) 1 - self

2 • subject'! toother3 - subject's father4 - subject's grandparent5 • subject's other relative6 - Other

401a. IT SELF IS ANSWERING, IS ANY OTHER FAMILY ."-EMBERPRESENT?

(014) 1 - yes2 - no

402. How long have you (SUBJECT'S NAME) bean living in this home?

Years Months(015-016) (017-11B)

IF LESS THAN 90 DAYS, OBTAIN PREVIOUS ADDRESS.

Address:

403. What i3 the your date of birth? / /.(019-024) (MONTH / DAY / YEAR)"

ENTER 88 - REFUSEDENTER 99 - DON'T KNOW

404. SUBJECT'S GENDER(circle one)

(025) 1 - Male 2 - Female

405. What is your race or ethnic group? (READ THE LIST)(026) 1 = White

3 = Asian or Pacific Islander4 = A.T.er^can Indian/Alaska native5 = REFUSED9 = DON • T KNOW

406. Are you Hispanic or of Spanish origin or descent?(027) 1 « Vea

2 - No3 - REF'JSED9 - DON'T KNOW

E-4

?z?.so:< 1

•;07. Wnaz is the highest year oS education you hava cor-rl^(023-020)

N'o SchoolingSleaar.tary School

High School (CCD - 012)Technical or Trad* SchoolJunior or Community CollegeFour year College or UniversityGraduate School (or higher)REFUSED 70 ANSWERDOM'T KNOW

(circle one)000001 002 003 004 COS006 007 COS009 010 Oil 012T13 T14J13 J14013 014 015 016017088099

E-5

TO3ACCO/ALCOHOL

The next: question* concern tobacco and alcohol consumption.

408. ?.re you exposed to people smoking at your workplace in your ir.T.iiiit.work, area?

(031) 1 • ye«2 - no8 - REFUSED TO ANSWER9 - DON'T KNOW

•409. Have you smoked at least 100 cigarettes during your entire life?(1 PACK - 20 CIGARETTES)

(032) 1 - yes2 - no (CO TO QUESTION 410)8 - REFUSED TO ANSWER9 - DON'T KNOW

409.1 Do you smoke cigarettes now?(033) 1 . yes (GO TO QUESTION 409.1.1)

2 - no (GO TO QUESTION 409.2)8 - REFUSED TO ANSWER (GO TO 409.2)9 - DON'T KNOW

409.1.1 On the average, how many cigarettes a day ryou now smoke?

(034-036) (NOW GO TO QUESTION 409.3)

409.2 How long has it been since you smoked cigarettes?(037-028) years

00 « under 1 year88 » refused99 - DON'T KNOW

409.3 On the average of the entire tijne you smoked, he- -jr.ycigarettes did you smoke per day?

(039-040) cigarettes per day88 « REFUSED99 - DON'T KNOW

409.4 About how old were you when you first started sr.o>::..-.::cigarettes regularly?

(Q41-G42) years old88 = REFUSED99 - DON'T K1JOW

409.5 For hou many years WERE YOU/HAVE YOU EIIN a sncV-sr, "including the time you may have stayed off cigar = '_t -- i ?

(fj43-C-:4) years88 - REFUSED99 - DON'T KNOW

E-6

PiSsoN ::> -

c:c?.?.s

410. Have you smoked at laast 50 cig?rs during your entirs l_f-2?(C45) 1 - yes

2 - no (GO TO QUESTION 411)8 - REFUSED TO ANSWER9 m DOM'T KNOW

410.1 Do you smoke cigar• now?(046) 1 - yes

2 - no (CO TO QUESTION 410.2)8 - R2FUSED TO ANSWER (CO TO 410.2)9 • DON'T KNOW

410.1.1 On the average, how many cigars a weekdo you now smoke?

(047-048) (NOW CO TO QUESTION 410.3)

410.2 How long ha* it been since you smoked cigars?

(049-050) __ year*00 • under 1 year88 • REFUSED99 - DON'T KNOW

410.3 On the average of the er.tire time you smoked, how -ar.ycigar* did you smoke per week?

(051-C52) cigars per week88 - REFUSED99 - DON'T KNOW

410.4 About how old were you when you first started smcVcir.gcigars regularly?

(053-054) years old88 - REFUSED99 - DON'T KNOW

410.5 For how many years WERE YOU/HAVE YOU 3EEN a cicirsmoker, not including the time you nay have stayed c:icigars?

(055-055) years88 - REFUSED99 - DON'T KNOW

E-7

PERSON 10 -

PIPES

•ill. Have you smoked at least 50 oipes during ycur er.tirs Iif£?(C57) i . yea

2 - no {(30 TO QrTSTIOH 412)8 - REFUSED TO ANSWER9 - DON'T KNOW

411.1 Do you smoke pipes now?(058) 1 - -.-*• (GO TO QUESTION 411.1.1)

2 - J (GO TO QUESTION 411.2)8 - REFUSED TO ANSWER (GO TO 411.2)9 - DON'T KNOW

411.1.1 On the average, how many pipes do you nowsmoke per week?


411.2 How long has it been since you smoked pipes?

(061-062) years00 • under 1 year88 - REFUSED99 - DON'T KNOW

411.3 On the average of the entire time you smoked, how r.2r.-_.pipes did you smoke per week?

(063-06-1) pipes per week88 » REFUSED99 - DON'T KNOW

411.4 About how old were you when you first started srr.ckir.gpipes regularly?

(065-066) years old88 • REFUSED99 - DON'T KNOW

411.5 For how many years KEP.E YOU/HAVE YOU 3E~N a pipe r-.:'--not including the time you may have stayed of; pitt-s?

(067-C63) years83 - REFUSED99 - DON'T KNOW

E-f

(G69)

(070)

(071-072)

(073-074)

(075-076)

CKIWINC T03ACCO

412. Have you used chewing tobacco at least 20 cr nora ti-r : .your entire life?1 • yea2 • no (CO TO QUISTION 413)8 " REFUSED TO ANSWER9 - DON'T KNOW

412.1 Do you chaw tobacco now?1 - yea2 - no (GO TO QUESTION 412.2)8 • REFUSED TO ANSWER (CO TO 412.2)9 - DON'T KNOW -

412.1.1 On the average, how many plu-», twist-j, c:pouchea do you chew a week?

(NOW CO TO QUESTION 412.3)

412.2 How long has it been lince you chewed tobacco?

yeara00 - under 1 year88 - REFUSED99 - DON'T KNOW

412.3 On the average of the entire ti.ne you chewed ~~'.:ic*how many pluga/twiita/or pouches did you chew - •-.;..

per week88 - REFUSED99 - DON'T KNOW

(077-078)

(079-GBO)

412.4 About how old were you when you first started cr.tobacco regularly?

years old88 - REFUSED99 • DON'T KNOW

412.5 For how many yeara HAVE YOU/DID YOU chew tcbacca,including the time you may have stayed off chew:..tobacco?

yeara88 - REFUSED99 - DON'T KNOW

E-9

PERSON 13 -

SNUFF

413. Have you used snuff at least 20 or more times during y;-_rentire life?

(081) 1 - yes2 - no (CO TO QUESTION 414)8 - REFUSED TO ANSWER9 - DON'T KNOW

413.1 Do you use snuff now?(082) 1 - yes (CO TO QUESTION 413.1.1)

2 - no (CO TO QUESTION 413.2)8 - REFUSED TO ANSWER (CO TO 413.2)9 - DON'T KNOW

413.1.1 On the average, how many cans/tins/or ".of snuff do you use a week?


413.2 How long has it been since you used anuff?

(085-086) years00 - under 1 year88 - REFUSED99 - DON'T KNOW

413.3 On the average of the entire time you used snuff,how many cans/tins/or pouches did you use a we = /.?

(087-088) per week"S£D

> - : - KNOW

413.4 About how old were you when you first started Uji.anuff regularly?

(039-090) years old88 - REFUSED99 - DON'T KNOW

413.5 For how many years HAVE YOU/DID YOU use sr.uff, r.vincluding the time you may have stayed off sr.uff?

(091-092) years88 - REFUSED99 - DON'T KNOW

E-10

PERSON ID -

ALCOHOL

Now i have a few questions on alcohol consumption.

414. Did you ever drink alcoholic beverages?(093) 1 - Ye*

2 - No (CO TO QUESTION 415)8 • REFUSED9 - DON'T KNOW

414.1 Do you presently drink alcoholic beverages?(094) 1 • Yes (GO TO QUESTION 414.1.2)

2 - No8 - REFUSED TO ANSWER (CO TO QUESTION 415)9 - DON'T KNOW (CO TO QUESTION 415)

414.1.1 How old were you when you quit?(095-096)

88 - REFUSED TO ANSWER99 - DON'T KNOW

414.1.2 How old were you when you began drinking alcc.w.clbeverages?

(097-098)88 - REFUSED TO ANSWER99 - DON'T KNOW

414.1.3 On the average, how many drinks a week do you '.-.3.(1 DRINK • 1 BEER, 1 SHOT LIQUOR OR MOONSHINE, 1CLASS WINE OR WINE COOLER)

(099-100)88 - REFUSED TO ANSWER99 - DON'T KNOWLESS THAN I/week - 00

E-ll

•115. Now z would like to know where you spend your time each 24 hour period,between school, home, work, or gone other location, in the last 90 days,(approximate number of. hour*; 99 - DON'T KNOW)

Monday

School work: Other Bon* TotalLocation (24hr)

"(101-102) (103-104) (105-106) (107-108) (109-110)

Tuesday(111-112) (113-114) (lli-116) (117-118) (119-120)

Wednesday _____(121-122) (123-124) (125-126) (127-128) (129-130)

Thursday(131-132) (133-134) (135-136) (137-138) (139-140)

Friday __^__(141-142) (143-144) (145-146) (147-148) (149-150)

Saturday(151-152) (153-154) (155-156) (157-158) (159-160)

Sunday(161-162) (163-164) (165-166) (167-168) (169-170)

E-12

PERSON 13 -

The next sec of questions are about activities and jobs you may have.

(171)

(172)(173)(174)(175)

(176)(177)(178)

(179)(180)(181)(182)(183)(184)(185)(186)

416.

417.

In the last 90 days have you worked as a miner or in a miningrelated job such as mine material handling or transportation?

1 - Yes2 - No (CO TO 423)9 - DON'T KNOW (GO TO 423)

What type of mine work did you do in the last 90 days?(Circle all that apply.)

Yes No DON'T KNOWa. Undergroundb. Surface*c. Hillingd. Transportation/

handlinge. Clerical/Admin.f. Smelterg. Other

If OTHER, specify:

111

1111

222

2222

999

9999

418. What type of mine did you work in the last 90 days?(Circle all that apply.)

a. Leadb. Zincc. Silverd. Molybdenume. Coalf. Limestoneg. Clayh. Other

IF OTHER. SPECIFY:

Yes11111111

No22222222

Don't99999999

know

419. What is the name of the place where you work (have worked)?

420. How long have you worked (did you work) there, in years andmonths?

Years(187-188)

Months(189-190)

421. Do (did) you change out of your work clothes and leave them atwork?

(191) 1 - Always2 • Sometimes3 - Never9 - DON'T KNOW

422. Do (did) you shower at work before coming home?(192) 1 - Always

2 » Sometimes3 - Never9 - DON'T KNOW

E-13

PERSON ID

423.

(193)

(194)

(195)

(196)

(197)

(198)

(199)

(200)

(201)

(202)

(203)

(204)

(205)

(206)

(207)

(208)

(209)

(210)

(211)

(212)

(213)

(214)

In the last 90 days, have you done any of thefollowing activities? (Circle all that apply)

Yes No Don'tknow

a. Painted pictures with artistspaints? (not children's paints) 12 9

b.

c.

d.

e.

f .

9-

h.

i.

j-

k.

1.

m.

n.

0.

P-

q-r .

a.

t.

u .

V .

Painted, stained or -^finishedfurniture? 1 2

Painted the inside or outside ofa home or building? 1 2

Worked with stained glass? 1 2

Cast lead into fishing sinkers,bullets or anything else? 1 2

Worked with soldering inelectronics? 1 2

Worked on soldering pipesor sheets of metal? | X>

Repaired radiators? 1 2

Worked on auto bodies orauto maintenance? 1 2

Worked at a sewage treatmentplant? 1 2

Made pottery? 1 2

Ridden a dirt bike, mountain bike,or ATV in the local area? 1 2

Welding? 1 2

Visited indoor firearmtarget ranges? 1 2

Cleaned or repaired firearms? 1 2

Wire or cable cuttingor splicing? 1 2

Casting or smelting lead? 1 2

Plastics manufacture? 1 2

Battery manufacture? 1 2

Pipe machining? 1 2

Electroplating with lead•olu- tons? 1 2

Refi. ,ng gasoline? 1 2

9

9

9

9

9

9

9

9

9

9

9

9

9

9

9

9

9

9

9

9

E-14

PIP.SON ID

(215)

(216)

(217)

(218)

w.

X.

y-zl.

SPE(

Paine, glaze, and inkmanufacture?

Rubber manufacture?

Scrap metal recovery?

Other lead related jobor activity?

nrr

i

1

1

1

2

2

2

2

9

9

9

9

(219) z2. Other cadmium related jobor activity

SPECIFY

424.

(220)

(221)

Have you done any of the following activities in the lastmonth?

Yea Noa. Painted a house or building

inaide or out? 1 2b. Painted or refiniahed furniture? 1 2

E-15

ID

OCCUPATIONS. Now I'd like to ask about your two roost recent jobs, starting with the present.

(Unemployed or retired or housewife should be entered as a job.)

a. What type of industry is/was this?b. What is/was your job title and a description of what you do?c. When did you work there?

a. TYPE OF INDUSTRY b. TITt- 6 C. TIKEDESCRIPTION FROM (MO/YR) TO (MO/YR)

25.1 _

! zz mzmizi (230-233) (234-23?)(222-225)

ZZHHI^IZZ^nZ ~ (246-249) (250-253)

(238-241)

254-257) 426. What is the job title you have had moat of the time youhave worked in the last 90 days?

258-261) 427. ' What is the job title you have had moat of the time youhave worked in the last year?

E-16

428. Does your household have a garden in your yard?(VEGETABLE OR FLOWER)

(262) 1 - Yes2 - No (CO TO 434)9 - DON'T KNOW (CO TO 434)

429. IF YES, Do you frequently till, plant or work the gardenyourself?

(263) 1 - Ye»2 - Mo9 - DON'T KJIOW


(264) 1 - Yee2 - No9 - DON'T KNOWIF YES. Specify from where

431. How often do you eat vegetables grown in your garden?

(265) 1 - Once a week or more2 » Less than once per week3 - Never (CO TO 434)9 - DON'T KNOW (CO TO 434)

432. How often do you eat leafy green vegetables,(such as lettuce or spinach) grown in yourgarden?

(266) 1 - Once a week or more2 - Leas than once per week3 • Never9 - DON'T KNOW

433. How often do you eat root vegetables, (such asbeets or turnips) grown in your garden?

(267) 1 • Once a week or more2 • Leas than once per week3 • Never9 - DON'T KNOW

E-17

434.

(268)

(269)

(270)

How often do you eat vegetables grown elsewhere in the local area?(e.g. NEIGHBOR'S GARDEN OR LOCAL r.-JvXTR'S X^JCvET)

1 - Once a week or rore2 • Less than once per week3 • Never (GO TO 437)9 - DON'T KNOW (GO TO 437)

435. How often do you eat leafy green vegetables, (such aslettuce or spinach) grown elsewhere in the area?

1 - Once a week or more2 - Less than once per weelc3 - Never9 - DON'T KNOW

436. How often do you eat root vegetables, (such as beets orturnips) grown elsewhere in the area?

1 - Once a week or more2 • Leas than once per week3 - Never9 - DON'T KNOW

437. Have you ever been treated with traditional, folk, or herbalmedications?

(271) 1 - yes2 - No9 - DON'T KNOW

IF YES, What was the medicine called?

E-18

--?.SG:J :a -

MEN: GO TO END

FOR WOKEN ONLY:

Now I have a couple question* on pregnancy ir.d birth rsntral pills. : askions because thoy can affect the results of the oloci taota w* will

b« doiiig.these cjuestions

433. Ar« you prwgnant?(272) 1 - Y*« (CO TO END)

2 - No7 • Not applicable (male cub j act)8 - REFUSED9 - OON'T KNOW

439. Are you taking birth control pills?(273) 1 - Y««

2 - No7 • Not applicable (male subject or 438 answered YES)8 • REFUSED9 - OON'T KNOW

END:

This completes the questionnaire. Do you have any questions or commentsabout it?


E-19

100 HOUSEHOLD QUESTIDNKr.IrE

TEE FOLLOWING QUESTIONS MUST BE ANSWERED EJf PARENT OR LEGAL GUARDIAN IF THESUBJECT IS AGED 14 OR YOUNGER.

rirst, I would like to ask you cone questions about the home you/SUBJECT lives(WHERE SUBJECT LIVES MOST OF THE TIME IN THE LAST 90 DAYS)

(Circle applicable answer.)

(011-012) 101. What year was this house built? (OLDEST PART)

000102030405

<1900-19091910-19191920-19291930-19391940-19491950-1959

06 - 1960-1969.07 « 1970-197908 - 1980-198909 » 1990-present99 - DON'T KNOW

(012)

(014)

(015)

102. What type of exterior does your/SUBJECT'S home have?

104.

woodbrickblockmobile homevinyl/metal sidingOther

1234569 - DON'T KNOW

103. Is the home you/SUBJECT live in rented or owned?rentownotherREFUSEDDON'T KNOW

What type of water pipes does the home contain?leadplasticgalvanized steelcopperironmixed (specify)Other (specify)DON'T KNOW

F-3

105. What type of water does vour/SUBJECT'S houser.ald normally us*for:

Drinking Cooking(016) (017)

Private w«ll waterPublic water

(city or district)Bottled:-ocal spring or brook'.ist -n.the

2345

DON*. KNOW

234569

106. Which fuel do you us* most for: (Circl* on* per column)

Gas—-bottl*d or tankGas—pipes (natural gas)ElectricityFuel oil or keroseneCoal or cokeWoodOtherDON'T KNOW

HouseHeating(018)

12345679

WaterHeating(019)

12345679

Cooking(020)

12345679

(021)

(022-025)

(026)

107. Has any part of your house been repainted, sanded, or chemically o:heat stripped, or otherwise refinished within the last year?

1 - Yes2 - No9 - DON'T KNOW

IF YES, Approximately when was this most recently done?

"(MONTH / YEAR) (ENTER 99 IF DON'T KNOW MONTH)

108. Do you use air conditioning in your/SUBJECT'S home?

129

YesNoDON'T KNOW

F-A

HOCSEHOLO ACTIVITIES/OCCUPATIONS

Mow I'd Ilk* •to ask you mam* questions about the work and bobbins of allpersons living in this boa*. (All. household members included)

(027) 109. Have any members of the household worked in mining or a miningrelated job such a* mine material handling or transportationin the last 90 days?

1 - Yes2 - No (GO TO 114)9 • DON'T KNOW (CO TO 114)

110. What type of mining or mine related work have householdmembers done in the last 90 days? (Circle all thatapply.)

Yes No Don'tknow

(028) a . Underground 1 2 9(029) b . Surface 1 2 9(030) c . Milling 1 2 9(031) d. Transportation/

handling 1 2 9(031) e . Clerical/Admin. 1 2 9(032) f . Smelter 1 2 9(033) g . Other 1 2 9

IF OTHER, SPECIFY:

111. What type of mine or mine materials have householdmembers worked with in the last 90 days? (Circle allthat apply.)

Yes No Don'tknow

(034) a . Lead 1 2 9(035) b . Zinc 1 2 9(036) c . Silver 1 2 9(037) d . Molybdenum 1 2 9(038) e . Coal 1 2 9(039) f . Limestone 1 2 9(040) g . clay 1 2 9(041) h . Other 1 2 9

IF OTHER, SPECIFY:

F-5

any household m«n^«r(«) ti-.tt warx.« Lr. & tr. n* =rm r.in; r«I»r«d job w«»r EIS/HTR wori: slcrr.in; nan* jifwording?

(042) 1 • Always2 - Sora«tim««3 - N«v«r9 • DON'T KNOW

113. Does any household member (•) that works in a mine ormining related job eoae home from work withoutshowering?

(045) 1 - Xlways2 - Sometimes3 - Never9 » DON'T 10JOW

F-6

lif. ID

Next I have some questions about a number of activities you or other household members may Ho or may have doneIn the last three months. These Include things you may have dune (or work, hobbien, or choree and at home or other |i|.i'»

114.In the last 90 days, have any members ofyour household:

(Circle all that apply)

IHa. IF YlfS:

'Was thla done athome, work, orelsewhere?

1 140. IF HORK/OTIIEIl:

Here I IIOBO clolhnnworn homo?

nlil he/nhoboforo coming IHMIIOV

Yes

•*!

a. Painted pictureswith artlata paints? 1(not children's paints)

b. Painted, stained orrefinlehed furniture? 1

c. Painted the inside oroutside of a home orbuilding?

d. Work with stainedglass?

e. Cast lead Into fishingsinkers, bullets oranything else?

f. Worked with solderingin electronics? 1

g. Soldering pipes orsheets of metal?

h. Repaired autoradiators?

No Don ' tknow

2 9(044)

2 9(048)

2 9(052)

2 9(056)

2 9(060)

2 9(064)

2 9(066)

2 9(072)

HOME WORK/ BOTH Don'tOTHER know

3 4 5 9(045)

3 4 5 9(049)

3 4 5 9(053)

3 4 5 9(057)

3 4 5 9(061)

3 4 5 9(065)

3 4 5 9(069)

3 4 5 9(073)

Yen No Don'tknow

1 2 9(O46)

1 2 9(050)

1 2 9(054)

1 2 9(058)

1 2 9(062)

1 2 9(066)

1 2 9(070)

1 2 9(074)

Yen Mo l>»n ' ikii««'

1 2 9(047)

1 2 9(051)

1 2 9(055)

1 2 9(059)

1 2 9(063)

1 2 9(067)

1 2 9(071)

1 2 9(075)

MOD si: in

14. (Continued)n the last 90 days, haveour household:(Circle all that apply)

. Worked on auto bodiesor auto maintenance? 1(includes mechanics)

i. Worked at a sewagetreatment plant?

;. Made pottery?

1. Ridden a dirt bike,mountain bike or ATVIn the local area?

n. Welding?

it. Cleaned or repairedfirearms?

o. Visited Indoor firearmtarget ranges?

p. Wire/cable cuttingor splicing?

q. Casting or smeltinglead?

any

Yes

1

1

1

1

1

1

1

1

1

members of

No Don ' tknow

2 9(076)

2 9(080)

2 9(084)

2 9(088)

2 9(092)

2 9(096)

2 9(100)

2 9(104)

2 9(108)

114a. IF YtS:

Was this done athome, work, orelsewhere?

HOME WORK/ DOTH Don'taniEK k"°w

3 4 5 9(077)

3 4 5 9(081)

3 4 5 9(005)

3 4 5 9(089)

3 4 5 9(093)

3 4 5 9(097)

3 4 5 9(101)

3 4 5 9(105)

3 4 5 9(109)

1140. IF WORK/OTHER:

Were those clothesworn home?

Yes No Don'tknow

1 2 9(078)

1 2 9(002)

1 2 9(O86)

1 2 9(090)

1 2 9(094)

1 2 9(098|

1 2 9(102)

1 2 9(106)

1 2 9(110)

Did he/she showerbefore coming home?

Yea

1

1

1

1

1

1

1

1

1

No Don ' tknow

2 9(079)

2 9(083)

2 9(007)

2 9(091)

2 9(095)

2 9(099)

2 9(103)

2 9(107)

2 9(111)

HOUSE in

z l

z2

4 . (Cont inued)the last 9O daya, have

ur household!(Circle a l l that apply)

any members of 114a

Hashome

. IF YL3:

this done at, work, or

1141).

HereWO Ml

IF WORK/OTHER 1

those clotheahome?

Did he/ehe showeibefore coming home?

elsewhere?

P la s t i c s m a n u f a c t u r e ?

B a t t e r y m a n u f a c t u r e ?

Pipe m a c h i n i n g ?

Elec t rop la t ing wi thlead solut ions?

R e f i n i n g gasoline?

P a i n t , g laze , andInk m a n u f a c t u r e ?

Rubber m a n u f a c t u r e ?

Scrap meta l recovery?

Other lead relatedjob or ac t iv i ty?

SPECIFY

Other cadmium relatedjob or activity?

Yea No Don ' tknow

1 2 9( 1 1 2 )

1 2 9( 1 1 6 )

1 2 9( 1 2 0 )

1 2 9( 1 2 4 )

1 2 9( 1 2 8 )

1 2 9(132)

1 2 9(136)

1 2 9( 1 4 0 )

1 2 9( 1 4 4 )

1 2 9(148)

HOME

3

3

3

3

3

3

3

3

3

3

WORK/ UOTM Don ' tOTHER know

4 5 9(113)

4 5 9(117)

4 5 9(121)

4 5 9(125)

4 5 9(129)

4 5 9(133)

4 5 9(137)

4 5 9(141)

4 5 9(145)

4 5 9(149)

Yes

1

1

1

1

1

1

1

1

1

1

No Don' tknow

2 9(114)

2 9(118)

2 9( 1 2 2 )

2 9(126)

2 9(130)

2 9(134)

2 9(138)

2 9( 1 4 2 )

2 9(146 )

2 9(150)

Yea No Don ' tknew

1 2 9(115)

1 2 9(119)

1 2 9( 1 2 3 )

1 2 9(127)

1 2 9(131)

1 2 9(135)

1 2 9(139)

1 2 9(143)

1 2 9( 1 4 7 )

1 2 9(151)

SPECIFY

Now I'd like to ack you *oa« <ru«stioc* abou'i yaur disc, ud foodprcp&ration:

li£. Wh«n food or drinks are prepared, Berv»c, or srored, are they ofter.placed in clay pottery or ceramic di«he» which were homemade or maaein another country?

(152) 1 • *••2 - No9 • DON'T KNOW

116. When food or drinki are prepared, «erved, or stored, are they oftenplaced in copper or pewter dishes or containers?

(153) 1 -2 - No9 - DON'T KNOW

117. When food or drinks are stored or put away, are they sometimesstored in the original can after being opened?

(154) 1 - *es2 - No9 « DON'T KNOW

F-10

Now ~ have a few other questions e u your household.

118L Does anyone smoke in your/SUBJECT'S hone?

(155) 1 " *••2 • NO (CO TO 121)9 - DON'T KNOW

(158)

119. Row many people arooke in this home? (including reguiiviaitora/babyaitrera)

(number of people)(99 - DON'T KNOW)

120. Doea anyone amoke TOBACCO PRODUCT in your/SUBJECT' a home?

(Circle reaponaea)

IT YES, How many:Yea No Don'tknow

a.Cigarertes 1

(161)

(164)

b. Cigars

c. Pipes

1

1

2

2

9

9

Cigarettes per day(159-160) in the house?

(1 pack-20)

Cigars per dav in(162-163) the house?

Pipe bowls per day(165-166) in the house?

121.

(167)

Do you have any dogs or cats that go in and out of the house?

1 - Yea2 - No9 - DON'T KNOW

If yea, specify number

122.

(16S)

Has anyone ever used any materials from mines or smelters, such aschat or slag, or lead indusrry material in or around your house oryard?

1 - Yes2 » No9 - DON'T KNOW

17 YES, SPECIFY WHAT MATERIALS AND HOW THEY WERE USED:

F-ll

123. What is tnfc highest year of education zr.ii was conrleted sy

(169-171)

the head of -.w.is household? (RESPONDEDOF HOUSEHOLD IS)

M-ST DECIDE WHO HEAD

(circle one)

No SchoolingElementary School

High School (GED-012)Technical or Trade schoolJunior r Corn-unitFour y j.r CollegeAttended GraduateREFUSED TO ANSWERDON'T KNOW

CollegeUniversity

.hool (or higher)

000001 002 003 004 005006 007 008009 010 Oil 012T13 T14J13 J14C13 014 015 016017088099

(172) 124. What is your total, gross household income before taxes?

01 -$4,999 or less02 -55,000 to 59,99903 -510,000 to 514,99904 -515,000 to 519,99905 -520,000 to 524,99906 -525,000 to 529,999

07 -530,000 to 534,99908 -535,000 to 539,99909 -540,000 or more88 - REFUSED TO ANSWER99 - DON'T KNOW

Now we have a set of questions to ask about (SUBJECT'S NAME)

IF PARTICIPANT IS 6 - 71 MONTHS OF AGE, THEN GO TO SECTION 200.

IF PARTICIPANT IS 6 - 14 YEARS OF AGB, GO TO SECTION 300

IF PARTICIPANT IS 15 YEARS OF AGE OR OLDER, GO TO SECTION 400

F-12

Appendix G.—Participant Consent for Blood and Urine Testing

G-l

MISSOURI DEPARTMENT OF HEALTH

Participant Consentfor Blood and I Irine Testinn

,a Missouri DepJ rtment of Health, in cooperation with the Jasper County Health Department and the federal Agency forToxic Substances and Disease Registry, is conducting a survey of possible exposure to lead and cadmium amongrandomly selected residents of Jasper, Newton, and McDonald counties. My participation will help determine if I have hadexposure that caured me to have high lead or cadmium levels.

The survey has thiee parts: a questionnaire, a blood test for exposure to lead, and a urine test for exposure to cadmium.The questionnaire has been or will be completed by myself or another person in my household.This part of the su vey is for the blood and urine testing (described below) on:

(_J Myse f (_) My child/ward

a. A btocd sample of approximately 15 ml (7 ml for children less than 6 years old) will be taken with a needle from avein ir the arm. There is little risk associated with this procedure. Temporary discomfort and a small bruise mayoccur at the site where the needle enters the skin.

b. A urinj sample will be taken in a specimen cup or other container. Instructions will be provided to help me/mychild/ward use the cup or container correctly.

c. Before the sampling begins, blood pressure and pulse will be checked.

Participation: I understand that my household's participation will take thirty minutes or more. There will be no physicalexamination. There will be no provision for injury compensation or medical treatment as a result of my participation. Iunderstand that I Can stop our participation at any time. If I choose not to participate or to stop there will be no penalty.Benefits received from the Missouri Department of Health in terms of health services or cash compensation will not beaffected by my decision not to participate or to stop.

Results: As a result of my/my child's/ward's participation in this survey I/my child/ward will receive a blood test lor lead and aurine test for cadmium. Other routine laboratory tests on the blood and urine samples will also be run. There will be nocharge to me for any of these tests. The Missouri Department of Health will send me a letter with the test results and will

?fer us tor medical evaluation, and possible additional testing, if indicated by our results.

"Confidentiality: I understand that the Missouri Department of Health and the Jasper County Health Department will takeevery reasonable precaution to keep our records confidential. Any information shared with federal agencies will be kept inaccordance with the federal Privacy Act of 1974. Any reports of this survey will not identify specific individuals by name,social security number, etc., and will only give group information.

Participant consent: I have read the description of this survey. All of my questions have been satisfactorily answered. I/mychild\vard. , voluntarily agree to participate. I further understand that I/my child/ward will be

Printed Namepaid $10.00 for participating.

Participant/guardian name (print) Sgnature

Date: Witness:

For the participant who is a mipor aaed 16 years or older

I agree with the consent given by my parent/guardian. Check, initial, or signature of minor

Assent bv the Minor Child:

We are doing a survey and would Oke to take a small amount of blood by inserting a very small needle into your arm. Therewill be some discomfort. It may leave a bruise or mark, but that will go away soon. We would also like you to take a small cupinto the bathroom and urinate into it. This is to see if you have some chemicals in you.

If vou have any questions, please contact:

Tony Moehr, Jasper County Health Department, Telephone: (417) 673-2479 or (417) 673-3421Patrick E. Phillips, DVM, Missouri Department of Health, Telephone: (800) 392-7245 or (314) 751-6102

G-3

Appendix H.—Release of Medical Information to Participants' Physician

H-l

>£''£&• MISSOURI DEPARTMENT OF John Ashcrofl• - Governor

John R. Bagby. Ph.D.Director

P O. Box fe70. Jefleraon City. MO 65102 • 31d-751-6400 • FAX 314-751-<iO 10

RELEASE OF MEDICAL INFORMATION

TO PARTICIPANT'S PHYSICIAN

TRI-STATE BLOOD LEAD

AND CADMIUM EXPOSURE STUDY

I understand that medical information about me has been and/or will

be collected during the lead/cadmium exposure study. I request that this

information be released to my physician to assist him/her in providing any

necessary medical advice and care.

Participant Phvsician

Printed Name Name (Please print)

Signature Street

Date City State Zip

MO 580-9012 (6-91)

® H-3" ve»0 *»•» AN IQUAl CPPWJNTVAfFHTMAnvt ACTON tVPlOYtfl - Swvicw cxow3«i on o I'm'OiciirTwxjiorv ban

Appendix I.—Participant Consent to Environmental Sampling In and Around Home

1-1

MISSOURI DEPARTMENT OF HEALTH

Participant Consent toEnvironmental Sampling In and Around Home

I understand that the health department's lead and cadmium exposure

study will include some environmental sampling in and around the homes

of some of the participants. The sampling will include drinking water,

household dust, interior paint, and yard soil. The samples will be taken by

representatives or contractors of the U.S. Environmental Protection

Agency (EPA) and these representatives/contractors will carry and show

identification.

If my home is selected for environmental sampling, I will allow

reasonable access to properly identified representatives/contractors. I

understand there will be no cost to me for this sampling and that I will be

notified of the results. Prior to any sampling I will be contacted by phone

for the arrangement of a convenient date and time.

Printed Name

Today's Date

Daytime Phone

Nighttime Phone

Signature

Address

Directions to home

1-3

Appendix J.~Request for Participant Reimbursement

J-l

i,' .1 MISSOURI DEPARTMENT OF John Asrtcroft- — Governor

John 8. Bagby. Ph.D.Director

P.O. Box 570. Jefferson Citv. MO 65102 « 3M-751-<MOO • FAX 3 U-751-6010

REQUEST FOR PARTICIPANT REIMBURSEMENT

TRI-STATE BLOOD LEAD AND

CADMIUM EXPOSURE STUDY

I understand that I will be paid $10.00 by mailed check for agreeing

to participate in the lead/cadmium exposure study and that this will be

the only monetary reimbursement or incentive I will receive. My name and

mailing address are:

Printed Name Street

Signature City State Zip

Date

MO 580-9012 (6-91) J-3B»cvc»a Poo«r AN £CUAj. OPPOnrUN/rV/AWflMAnvE ACTION EMPIOVEU - S»«nc»i sxov>a»o on a nonaBcnrrwxjiorv Dam

Appendix K.—Biological Tests Used in the Jasper County Leadand Cadmium Exposure Study

K-l

Biological Tests Used in the Jasper County Lead and CadmiumExposure Study, Missouri 1991

Name and Type of Lab TestBlood Tests Normal Range of Results

Cadmium Adults normal:2.6-<2.8(micrograms/gram Creatinine)

Lead (micrograms/deciliter) Less than 10

CBC-Basophils count 0-0.3(thousand/cubic millimeters)

CBC-Basophils (percent) 0.0-2.5

CBC-Granulocytes count 1.5-10(thousand/cubic millimeter)

CBC-Hemoglobin (gram/deciliter) 12-16

CBC-Hematocrit (percent/ 37-47

CBC-Mean Corpuscular Hemoglobin (picograms) 27-31

CBC-Mean Corpuscular Hemoglobin 32-36Concentration (percent)

CBC-Mean Corpulscular Volume 81-99(fluoroliter)

CBC-Platelet count 150-450(thousands/cubic milliliter)

CBC-Red Blood Cells 4.2-5.4(millions/cubic milliliter)

CBC-whice Blood Cells 4.8-10.8(thousands/cubic millilicer,'

CBC-Lymphocytes (percent) 20.5-51.1

CBC-Lymphociytes count 0.6-6.0(thousands/cubic milliliter)

CBC-Monocytes (percent) 1.7-9.3

CBC-Monocytes count 0-1.0(thousands/cubic milliliter)

K-3

Name and Type of Lab TestBlood Tests Normal Range of Results

CBC-Eosinophil (percent)

CBC-Eosinophil count(thousands/cubic milliliter

CBC-Platelet Distribution Width(fluoroliter)

CBC-Red Cell Distribution Width(percent)

Chem-Urea Nitrogen(milligrams/deciliter)

Chem-Greatinine (miligrams/deciliter)

Chem-Alanine Aminotranrferase(Interational Units/liter)

Chem-Albumin (grams/decilieter)

Chem-Reticulocyte Count (percent)

Chem-Serum electrolytes-sodium(milliequivalent/liter)

Chem-Serum el :trolytes-potassium(milliequivaient/liter)

Chem-Serum electrolytes-chloride(milliequivalent/liter)

Chem-Aspartate aminutran*erase-AST(International Units/liter)

Immunologlobulins-Gamma G(milligrams/deciliter)

0-10

0-0.7

7.4-10.4

12.5-14.5

7-26

0.5-1.5

0-50

3.5-5.5

0.5-1.5

135-148

3.5-5.5

94-109

Under 1 year:1-5 years:6-10 years:over 10 years:

4-6 months:7-24 months:2-5 years:6-8 years:

9-11 years:12-16 years:Adult:

0-1100-750-600-50

80-500270-1000470-1500690-1500770-1600700-1600560-1800

K-4

Name and Type of Lab TestBlood Tests

Immumoglobulins-Gamma A(milligrams/deciliter)

Normal Range of Results

Immumoglobulins-Gamma M(milligrams/deciliter)

4-6 months:7-24 months:2-5 years:6-8 years :9-11 years:12-16 yearsAdult:

4-6 months :7-24 months:2-5 years :6-8 years :9-11 years:12-16 years;Adult :

3-428-8516-14057-20052-26052-19085-390

23-9627-19043-20053-19048-29047-31045-250

Helper-T Cells(percent of lymphocytes

Suppressor/Cytotoxic T-Cells(percent of lymphocytes)


B-Cells(percent of lymphocytes)

Natural Killer Cells(percent of lymphocytes)

Chem-Total Protein (grams/deciliter)

Chem-Gamma-Glutomytranferase(International Units/liter)

UA-Specific Gravity

UA-pH

UA-Bacteria

UA-Bilirbin

35 -58

15-34

57-80

9-26

2-16

under 2 yearsover 2 years:

5.7-8 .26.0-8.5

Male: 0-65Female: 0-45

1.001-1.035

5.0-8.0

l=negative (normal)2=positive


K-5

Name and Type of Lab TestBlood Tests

UA-Blood

UA-Casts (Hyaline)

UA-Crystals

UA-Epithelial cells

UA-Glucose

UA-Ketones

UA-Leukocyte Esterase

UA-Nitrite

UA-Protein

Normal Range of Results

l=negative (normal)2-positive

l»negative (normal)2=positive








UA-Red bolld cells 0-5(number of cells/high powered field)

UA-whice blood cells 0-5(number of cells/high povered field)

UA-Urobilinogen (milligrams/deciliter; 0.2-1.0

Creacinine Male:(grams/24 hours) Female

Alanine aminopeptidase (AAP) 1.80-8.91(micrograms/liter)

Gamma glutamytransferase (GGT) 5.19-83.51(micrograms/liter)

N-acetyl-Beta-D-gluccr-minid^se ;NA' i 0.17-3.50

0.6-2.50.6-1.5

K-6

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