John S. Neuberger

Health problems in Galena, Kansas: A heavy metal mining Superfund site

Health problems at a heavy metal mining Superfund site were surveyed using prevalence information from 1980-85. Current environmental exposures include lead and cadmium in drinking water, mine wastes, and surface soils. Age- and sex-specific illness rates in whites in an exposed town (Galena) were compared with similar rates in two control towns. Multivariate analyses of morbidity data examined statistically significant risk factors for relevant illness in the three towns. Mortality rates for 1980-85 for white residents of Galena and for the U.S. were compared using univariate analysis. Among residents of the three towns who had lived there at least 5 years prior to 1980, there was either a statistically significant or borderline excess reported prevalence in Galena of chronic kidney disease (females aged greater than or equal to 65), heart disease (females aged greater than or equal to 45), skin cancer (males aged 45-64), and anemia (females aged 45-64). Multivariate analyses revealed statistically significant associations of stroke, chronic kidney disease, hypertension, heart disease, skin cancer, and anemia with variables related to Galena exposure. Personal physicians were contacted to confirm the information provided by the subjects; validity was good for all reported illnesses except chronic kidney disease. A statistically significant excess of deaths from hypertensive disease (females aged greater than or equal to 65), ischemic heart disease (males and females aged greater than or equal to 65), and stroke (females aged greater than or equal to 65) was found in residents of Galena City. This study confirms that environmental agents in Galena are associated with, and may have contributed to, the causation of several chronic diseases in residents of this community. Further studies are recommended.

Residential radon exposure and lung cancer: risk in nonsmokers.

Lung cancer is a disease that is almost entirely caused by smoking; hence, it is almost totally preventable. Yet there are a small percentage of cases, perhaps as many as 5 to 15%, where there are other causes. Risk factors identified for this other group include passive smoking, occupational exposure to certain chemicals and ionizing radiation, diet, and family history of cancer. In the United States cigarette smoking is on the decline among adults, occupational exposures are being reduced, and people are being made more aware of appropriate diets. These changes are gradually resulting in a reduced risk for this disease. Lung cancer in the U.S. may, therefore, eventually become largely a disease of the past. It remains important, however, to continue to study the cause(s) of lung cancer in non-smokers, particularly never smokers. Because of our interest in the effects of residential radon exposure on the development of lung cancer in non-smokers, we conducted a critical review of the scientific literature to evaluate this issue in detail. Strict criteria were utilized in selecting studies, which included being published in a peer reviewed journal, including non-smokers in the studied populations, having at least 100 cases, and being of case-control design. A total of 12 individual studies were found that met the criteria, with 10 providing some information on non-smokers. Most of these studies did not find any significant association between radon and lung cancer in non-smokers. Furthermore, data were not presented in sufficient detail for non-smokers in a number of studies. Based on the most recent findings, there is some evidence that radon may contribute to lung cancer risk in current smokers in high residential radon environments. The situation regarding the risk of lung cancer from radon in non-smokers (ex and never) is unclear, possibly because of both the relatively limited sample size of non-smokers and methodological limitations in most of the individual studies. A summary of these studies is provided concerning the state of knowledge of the lung cancer risk from radon, methodological problems with the residential studies, the need for the provision of additional data on non-smokers from researchers, and recommendations for future research in non-smokers.

Residential radon exposure and lung cancer : evidence of an urban factor in Iowa

An ecological study of lung cancer, cigarette smoking, and radon exposure was conducted in 20 Iowa counties. County-based lung cancer incidence data for white female residents of Iowa were stratified according to radon level and smoking status. Cancer incidence data for the period 1973-1990 were obtained from the State Health Registry of Iowa. Smoking level was determined from a randomly mailed survey. Radon level was determined according to an EPA supported charcoal canister survey. Within low smoking counties, rates for all lung cancer and small cell carcinoma were significantly lower (p < 0.05) in the high radon counties relative to the medium and low radon counties. However, within high smoking counties, rates for all lung cancer, adenocarcinoma, and small cell carcinoma were significantly higher (p < 0.05) in the high radon counties relative to the low radon counties. Variations in socioeconomic data for these counties, available through the 1980 and 1990 census, did not explain these results. Lung cancer rates also were significantly increased in urban counties even after holding smoking status constant. Multivariate analyses revealed significant interactions between smoking, urbanization, radon levels, and lung cancer. The results of this hypothesis generating study will be tested in a case/control study now ongoing in Iowa. Analysis will need to include separate evaluations by smoking status, radon level, and residence in urban or rural areas for the major morphologic types of lung cancer.

Spatial variation of residential radon concentrations: The Iowa radon lung cancer study

Homeowners and researchers frequently estimate the radon concentrations in various areas of the home from a single radon measurement often performed in the homes basement. This study describes the spatial variation of radon concentrations both between floors and between rooms on the same floor. The geometric mean basement and first floor radon concentrations for one-story homes were 13.8% and 9.0% higher, respectively, as compared to their counterparts in two-story homes. The median first floor/basement ratio of radon concentrations for one-story homes was 0.60. The median ratios between first floor/basement and second floor/basement for two-story homes were 0.51 and 0.62, respectively. The mean coefficient of variation for detectors placed on the same floor was 9.5%, which was only 2.6% higher than the mean coefficient of variation found for collocated (duplicate) quality control detectors. The wide individual variations noted in radon concentrations serve as a reminder of the importance of performing multiple radon measurements in various parts of the home when estimating home radon concentrations.

Cardiovascular effect of bans on smoking in public places.

months from within Helena’s ZIP code and 18 cases per 6 months from outside Helena. During the 6 months that the smoking ban was in effect and all but 2 businesses complied, 24 cases of AMI from Helena and 18 cases not from Helena were reported. Sixty-two percent of patients with AMIs were former or never smokers. In Helena, the ban resulted in 16 fewer cases of AMI (95% confidence interval [CI] 31.7 to 0.3). The annualized incidence rate decreased from 170 to 102 cases/100,000 person-years, then returned to baseline, a 40% transitory decrease. Outside Helena, the incidence rate was 118 cases/100,000 personyears before the ban and 172 cases/100,000 person-years during the ban, an increase of 46%. Advantages: Besides being the first such study, this was also the only study to report data from before and during a smoking ban and after the ban’s suspension. Limitations: Limitations included a small population and thus a small number of events, the inclusion of secondary diagnosis of AMI, a change in definition of AMI during the study period, a brief observation period, the nearness of the comparator community (which could allow misclassification on “exposure”), and a failure to measure change in exposure or define the duration of observation after the suspension of the ban. Conclusion: A 6-month ban on public smoking in Helena resulted in a reversible 40% decrease in incident AMIs in a small community compared with adjacent communities.

Brain Cancer in a Residential Area Bordering on an Oil Refinery

Both in response to community concerns about brain cancer related to an oil refinery and in order to more fully understand the etiology of primary site brain cancer (glioma), a highly focused cancer cluster investigation was conducted. The components included: (1) a literature review of occupational exposures in the petroleum refining and petrochemical industries, (2) comparisons between observed and expected cases, (3) comparisons between mean age at diagnosis and median survival time and (4) interviews concerning exposures of cases. Evidence from the literature review revealed little, if any, effect of petroleum refinery or petrochemical exposure on the risk for brain cancer. There was no statistically significant increase in the number of brain cancer cases in the community (observed = 12, expected = 9.46, standardized mortality ratio = 1.27). There was no statistically significant decrease in mean age at diagnosis or median survival time among those most exposed. Reports of exposure from the case interviews were highest for eating processed meats (98.5%), dental X-rays (96.6%), dog ownership (91.2%) and swimming (80.3%). There were no major occupational exposures identified. It seems unlikely that petrochemicals are involved in any significant way in the etiology of most brain cancers (gliomas). A follow-up case-control study should focus primarily on those risk factors mentioned frequently by the cases.

Lung cancer excess in an abandoned lead-zinc mining and smelting area

Analysis of cancer mortality in whites has revealed a significant excess in both males and females in an old lead/zinc mining and smelting area. This area consists of three rural contiguous counties: Cherokee County, Kansas, Jasper County, Missouri, and Ottawa County, Oklahoma. The lung cancer excess has persisted for at least 28 years for males and 5 years for females. A pilot case/control study is underway in Cherokee County to assess the influence of cigarette smoking, occupation, and residence on the lung cancer excess. Analysis will incorporate the histologic findings. From an environmental perspective, there are numerous mine tailings containing lead, zinc, cadmium, sulfur, germanium, and other chemicals. Considerable dust is airborne. Numerous openings (sink holes and bore holes) connect the old mines with the surface. Radium 226 has been detected in the untreated groundwater.

Cancer of the esophagus: A model of causation

Cancer of the esophagus has shown peculiar worldwide geographic clustering; it has also occurred in excess among individuals in lower socioeconomic census tracts of certain cities. These facts have prompted inquiry into its etiology. Emphasis has been given to environmental effects, particularly mechanical and/or irritating processes, dietary deficiency, and a variety of carcinogens. Immunological susceptibility has been considered, although only infrequently. Overall, primary genetic factors have received short shrift in epidemiological investigations of this disease. An hypothesis of stress related cancer in concert with genotypic susceptibility is presented.

Indoor smoking ordinances in workplaces and public places in Kansas.

INTRODUCTION The purpose of this study was to investigate the preferences of elected city officials regarding the need for a statewide clean indoor air law and to analyze the content of local smoking ordinances. METHODS A survey of elected officials in 57 larger Kansas cities obtained information on the perceived need for statewide legislation, venues to be covered, and motivating factors. Clean indoor air ordinances from all Kansas cities were analyzed by venue. RESULTS The survey response rate was 190 out of 377 (50.4%) for elected officials. Over 70% of the respondents favored or strongly favored greater restrictions on indoor smoking. Sixty percent favored statewide legislation. Among these, over 80% favored restrictions in health care facilities, theaters, indoor sports arenas (including bowling alleys), restaurants, shopping malls, lobbies, enclosed spaces in outdoor arenas, and hotel/motel rooms. Officials who had never smoked favored a more restrictive approach. Employee and public health concerns were cited as influential by 76%-79% of respondents. Thirty-eight ordinances, covering over half of the states population, were examined. They varied considerably in their exemptions. DISCUSSION Officials attitudes toward smoking regulations were associated with their smoking status. The examination of existing ordinances revealed a piecemeal approach to smoking regulations.