Document 3mox7Rad969x8GMvzdzOnEr3

The Association of Vinyl Chloride Exposures With Morbidity Symptoms Robert Spirtas, Dr. F.H. Anthony J. McMichael, M.D., Ph.D. John Gamble, Fh.D. Mark Van Ert, Ph.D. Occupational Health Studies Group University of North Carolina Chapel Hill, North Carolina Presented To The American Industrial Hygiene Conference Minneapolis, Minnesota June 5, 1975 ucc 006344 THE ASSOCIATION OF VINYL CHLORIDE EXPOSURES WITH MORBIDITY SYMPTOMS Robert Spirtas, Dr. P.H. Anthony J. McMichael, M.D., Ph.D. John Gamble, Ph.D, Mark Van Ert, Ph.D. Abstract A mall-out questionnaire was sent, to all workers In a vinyl chloride polymerization plant and to a sample of rubber workers in an adjoining plant. The questionnaire examined symptoms previously associated with vinyl chloride exposure. Assessment of exposure levels was made by analytical measurement and observation. All individual work histories were examined in order to evaluate symptoms for each job held. The resulting statistical analysis revealed a dose-response type of relation ship between exposure and certain of these symptoms. ucc 006345 Introduction Before its recent implication in the etiology of angiosarcoma, vinyl chloride (VC) had been given a relatively clean bill of health. First synthesized in 1833,VC has come into increased use since World War II in the production of polyvinyl chloride (PVC) resins. Until 1960, no industrial fatalities associated with VC use had been reported. However, two fatalities then occurred, in a PVC polymerization plant--one worker died cleaning out a polymerization vessel, and the other while working in a pit.1 These two deaths underscored the potential seriousness of the acute effects of VC upon the central nervous system. Relatively few effects have been reported as a result of acute 2 exposure to VC. Lehmann and Flury reported that VC was highly narcotic, but had a wide margin between its narcotic and lethal concentrations. Its local irritating effect, however, was described as very slight. It was estimated that VC concentrations of 7-10 percent in air (70,000 100,000 ppm) would be narcotic to humans in a short time. Two cases 3 of VC gassing were reported in Great Britain. A process worker, standing outside a polymerization vessel and washing it with a water stream, suddenly collapsed across the open manhole. Subsequently, he experienced tightness of the chest, nausea, abdominal pain and headache. The second case, a maintenance worker, was overcome while repairing a VC leak. A study of clinical manifestations of 186 male PVC workers identified the presence <>T the "narcotic syndrome", asthenic nervous symptoms, Raynaud's syndrome and iiepaLomennIyJ* However, the absence of a control (unexpoHcd) population, or of comparisons between PVC workers experiencing UCC 006346 2 different exposures, hampered the interpretation of these findings. In studies of VC as a possible anaesthetic agent, using dogs as subjects, incoordinated muscular activity of the extremities and serious cardiac arrythmias were observed.^ Angioneurosis (spasm of peripheral blood vessels) in PVC polymerization workers has also been reported.^ The association of vascular spasm (manifested as Raynaud's phemonenon) with acroosteolysis has been reported by several investigators. ' The pathogenesis of these peripheral vascular manifestations has been variously interpreted as disordered vasomotor control via the hypothalamus, as a q general central nervous system dysfunction, or by localized physico chemical action in conjunction with specific individual susceptibility.^ Overall, the literature of the recent decades has suggested that most of the toxic effects of exposure to VC act via the central nervous system, chat they occur most obviously at very high exposure concentrations, and that both acute and chronic toxic effects occur. A recent cross-sectional health survey of 354 VC workers related the proportion of workers who had experienced acute central nervous system symptoms at work (headache, light-headedness, dizziness, and loss of consciousness) with their duration of employment.^ Although a dose- response relationship wsb implied in the report, this relationship could be partly or wholly explained by differences between the several employmentduration categories either in age or in duration of opportunity to experience these acute symptoms. Methods In 1974, a mall questionnaire survey was conducted on a population of VC polymerization workers, seeking information about the frequency of occurrence of job-related symptoms. In an attempt to avoid some of the shortcomings of earlier studies, these self-reported symptoms were related. ucc 006347 3 by the respondent, to the specific type of job he was engaged in within the polymerization plant, and to the calendar year of their occurrence. (See Appendix 1.) Further, equivalent information was collected, in identical fashion, from a sample of rubber workers in the adjoining plant. (See Appendix 2.) Firstly, these two aspects of the study allowed internal comparisons between polymerization workers in different jobs and at different time-periods (i.e., different exposure situations), and secondly, an external (in the sense of vinyl chloride exposure) comparison of polymerization workers with rubber workers. In this way, the frequency of self-reported symptoms could be more meaningfully interpreted. The validity of self-reported work history information has been tested in another study being done on the workers in this plant and found to be acceptable- information was sought on the frequency of eight symptoms. The first four (dizziness or light-headedness, passing out, nausea or "sick feeling", and headache) were symptoms of central nervous system disturbance, similar to those examined in the above-mentioned study.^ The next two sought symptom information for peripheral neurovascular and neuromuscular disturb ance ("pins and needles", and muscle weakness). The seventh symptom referred to local irritation (of eyes, nose, and throat), and the eighth symptom referred to the generalized asthenia ("run-down" feeling) originally 4 reported by Suciu et al. (Jueallonnaires were mailed to all workers involved in the vinyl chloride plant, and to a sample of the workers in the adjoining rubber plant. This latter population consisted predominantly of rubber workers, with a small minority (five percent) of polyvinyl chloride (PVC) fabrication workers. The statistical sampling procedure for choosing which rubber workers to include in the study entailed taking a systematic l-in~12 sample with a random starting place from an alphabetical listing, thereby assuring a representative sample of the rubber plant workers. The response rate for ucc 006348 4 current vinyl chloride workers was 200/298 (67%) while the rate for the current rubber plant workers was 89/212 (42%). This difference in response rates may be due to the adverse publicity on vinyl chloride exposure. However, the respondents had no knowledge of which exposure category they worked in. Thus, some of the vinyl chloride workers will serve essentially as "controls" on other vinyl chloride workers. Because of the way exposure categories subdivide the population, any potentially confounding effect of other chemicals should be accounted for. Thus, if rubber workers, for example, got more headaches because of solvent exposure, the effect would be to lessen the chances of a dose-response pattern (as defined in the study) emerging. In order to evaluate the exposure experiences of each worker, the individual jobs reported on the questionnaire were grouped into 12 categories (see Figure 1). The principles and procedures- of regrouping production-oriented categories into health-oriented categories has been recently described.^ Industrial hygiene analytic sampling results are present in Tables 1, 2, and 3. Table 1 contains data taken by company personnel before major changes were made in controlling levels of vinyl chloride exposure, and should be representative of the relative levels that workers were exposed to during their earlier work history. Table 2 contains company data taken during the installation of environmental controls. Table 3 contains data taken by University of North Carolina personnel in 1975, after major environmental controls had been installed. By comparing these three tables it can be seen that the absolute levels of vinyl chloride have decreased, yet the gradient of exposure between job categories appears to have remained the same. ucc 006349 5 Based on these sampling results, and on general industrial hygiene evaluation of the plant operations, it was possible to create a further grouping of the jobs in Figure 1 into three categories representing high, low, and essentially no exposure to VC. Figure 1 illustrates this grouping in the context of a flow diagram of the vinyl chloride manufacturing process. Results Since the symptoms under consideration are all transitory and reversible, an acute effects model has been employed. Thus, each reported person-job held, rather than each person, is treated as the unit of observation. Each person has been able to contribute to the analysis his experience in more than one job (the average is approximately three jobs/ person, and often a person has experienced jobs in more than one O.T. group). By treating the job as the unit of observation, there is a tendency to dampen the effect of individual variability in symptom experience since workers are often acting, in effect, as their own controls. Any differences found with this type of model can then be more easily ascribed to real differences in environmental exposure. Tables 4-1 through 4-8 present the basic data used in the analysis. Limiting the statistical analysis to white males (who make up 95 percent of the plant population) was necessary in order to provide adequate cell sixes. In Tables 4-1 through 4-8, the categories of response are labelled 0, 1,2 and 'I to correspond with the questionnaire replies as to frequency of symptoms: never, once, occasionally and often. By examining Tables 4-1 through 4-8 it can be seen that a certain type of pattern is evident for many of the symptoms. This pattern is most evident for Table 4-1 (corresponding to symptom 1). For the 255 high exposure group jobs recorded on individuals' questionnaires, 94 (37 percent) ucc 006350 6 were reportedly associated with an episode of dizziness or light-headedness at least once. The comparable figures for the low exposure group were 28 out of 236 jobs (12 percent) and the values for the rubber worker jobs were 21 out of 214 jobs (10 percent). The purpose of presenting these tables is to describe the patterns of response for each symptom. A measure of the importance of these results is given in the following statistical analysis, which employs a weighting scheme with values 0, 1, 2 and 3 respectively. (For example, if a person answered "occasionally" to the frequency of a given symptom, this response was treated as twice as important as an answer of "once".) Using the Occupational Title Grouping in Figure 1, a series of statistical analyses were performed to determine the relationship of the questionnaire responses of these grpups of workers to their relative exposures to VC. The differential exposures to VC between the three study groups account for only one of the many possible hazards. Thus, the controls in this study must be viewed as "internal controls" who may be exposed to other chemical exposures. However, the consistency and strength of the results of this study in conjunction with similar results from previous studies, tend to confirm the suspicion that the causative agent in this study is vinyl chloride. Since questionnaire answers are recorded in categories rather than a continuum, it was therefore appropriate to use statistical analysis techniques designed for categorical data. The procedure used in this analysis was the Categorical Linear Data Model. 12 (This procedure makes use of the cell proportions In a weighted least squares analysis of com plex contingency tables.) ucc 006351 The first set of analyses examined which of the symptoms, if any, exhibited a significant dose-response type of relationship with presumed VC exposure. A dose-response pattern was deemed to exist if the (weighted) symptom response rate for O.T. Group 1 was significantly* greater than for O.T. Group 2 and, in addition, the response rate for O.T. Group 2 was greater than for O.T. Group 3. This takes account of both the direction and magnitude of the respective differences. It was next decided to determine the importance of age at time of exposure to each job as a possible confounding variable. The study population was subdivided by age at exposure into 36 and 37 at time of entry into job. For those symptoms where adjustment by age produced a better fitting model (in the statistical sense), the adjustment for age was made in Table 5. Only the statistical models for symptoms 1, 7, and 8 were enhanced by age adjustment. In each of these three cases age was not a significant variable in its own right, but its inclusion resulted in a better fitting model. (The direction of the difference in age groups for all three of these symptoms indicated that younger people tended to exhibit these symptoms more frequently than older people, although this difference was not statistically significant.) This may be due to a possible adaptation by older workers or to self-selection by the more sensitive workers. The results presented in Table 5 show a clear dose-response relation ship for symptoms 1, 3, 4, 5, and 8. This means that in addition to there being a significant difference in the response rate for all VC workers when compared with rubber workers, there is a further difference between * Significance here is defined as : probability of a Type 1 error (a) .05. ucc 006352 VC workers when they are categorized into high and low exposure groups. For symptoms 2 and 7, the direction of the response gradient was of a nature to indicate a dose-response pattern but the magnitude of the differences was not quite great enough to meet the criteria for statistical significance. These two symptoms have consequently been labelled as "Borderline". Symptom 6 (muscle weakness) did not exhibit a dose-response gradient and was consequently omitted from Table 5. Preliminary attempts at utilizing information on smoking, length of service and calendar period of exposure have yielded little to date. Further work is being done in these areas. In summary, there appears to be a dose-response relationship between certain acute symptoms (predominantly neurological) and level of vinyl chloride exposure. ucc 006353 FLOW DIAGRAM VINYL CHLORIDE POLYMERIZATION - POLYVINYL CHLORIDE PLANT Figure 1 High (N=226) Low (N-245) Control (N-227) Liquid Monomer V.C. Polymerize mix with copolymer (10) Service & Utility (06) Trucking, Loading (11) Maintenance (07) ( ) Denotes O.T. from Table 1. ucc 006354 Table 1 VC EXPOSURE INDEX COMPANY DATA GRAB SAMPLE - GAS CHROMATOGRAPH PRIOR TO 1974 O.T. 01 03 04 05 08 06 06 02 07 ? DESCRIPTION Tank Farm Operators Reactor Operators High Pressure H^O Stripper Operators Relief Operators Supply Men Service & Utility Janitors Maintenance Pilot Plant Janitor EXPOSURE INDEX H H H H H M M M M 09 Centrifuge Operators 09 Dryer Operators 09 Bagger Operators 11 Truck Operators L L L L (L) Low 0-50 ppm (M) Medium 50 - 200 ppm (H) High 200 & Above UCC 006355 ).T. 01 04 03 08 06 03 11 08 09 09 11 07 OTG High High High Low High High Low Low Low Low Low High Table 2 EXPOSURE DATA FOR VC AND PVC WORKERS IN A VC AND PVC PLANT COMPANY DATA Second Quarter 1974 VINYL CHLORIDE MONOMER EXPOSURE WORKERS 3 6 10 9 36 HIGH EXPOSURE most readings - 20-30 ppm MAXIMUM READING Tank Farm Attendant High Pressure Water Cleaner MEDIUM EXPOSURE most readings - 10-20 ppm Reactor Operator - Bldg. 2 Relief Operator - Bldg. 2 Service Utility < 40 > 50 > 50 50 > 50 . A OOJ o V LOW EXPOSURE moat readings - 0-10 ppm 4 Reactor Operator - Bldg. 1 12 Shipping Operator 3 Relief Operator - Bldg. 1 12 Centifuge Operators Dryer Operators 8 Baggers 9 Truckers 48 Maintenance < 20 < 20 < 10 < 10 > 50 ucc 006356 \ v .. .. ,. .. .-.-w-xh' Table 3 Vinyl Chloride Sampling Results Chemical Plant (Buildings I & XI) and Rubber Plant (3-24 to 3-26-75) O.T. Location Vinyl Chloride Levels (ppm) as Detected by:* Mi ran V.C. Indicator Tube Grab Sample by G.C. Charcoal Tube Remarks Building I 03,04 Reactor Room Operator's Desk Desk Cluster (4 tubes) Mezzanine General Room Typical Peak 15+2 15+5 21+2 15+2 93+2 20 -- -- 5-6 "" 4-5 11.7 7.0,11.7, 10.9,7.4 47.4 11.7 05 Stripper Area Operator's Desk (PVC 4 Copolymer Side) 33+5 24 General Area 24-32 -- 7 -- 20.0 -- 08 Relief Area Operator's Desk -- 3 General Area 28-36 -- -- -- 1.43 -- 09 Second Floor Spray Driers General Room 3 -- -- -- 09 Bagging Area Lines 4,6,7, 9-16+3 -- -- --- -- 09 Bulk Drying Area (Rotary Driers) Panel Board Area 1.5 Bagger: Line 13 3.5 3 -- -- -- 6.1 -- UCC 006357 Table 3 -- continued O.T. 02 02 Location Vinyl Chloride Levels (ppm) as Detected by:* Mi ran V.C. Indicator Tube Grab Sample by G.C. Charcoal Tube Remarks Transfer Pump House No Pumping of V.C. -- Pumping of V.C. Purification Room -- 8 20 5.8 300(1) -- 26.1 Building II 03 Reactor Room Operator -- -- 05 Stripper Level Operator -- -- 08 Relief Area Operator -- 07 Maintenance Pipe Fitter --- -- Rubber Plant 10 Film and Sheeting Mezzanine Area 1.8-4.0 -- Banbury Mill #4 Area 3.2-6.5 10<2> 12 General Room Not " Detectable -- -- -- -- -- -- 5.2 8.8 5.0 5.9 -- 5.0 Personnel Personnel Personnel Personnel (1) Air-Supplied Respirator Required. (2) Not taken in breathing zone. UCC 006358 Footnote to Table 3 `Definitions for V.C. Analytical Techniques Charcoal Tube Samples: gases and vapors adsorbed to activated charcoal and subsequently analyzed by gas chromatography by OHSG laboratory personnel. Reflect time weighted averages. Grab Samples: gases and vapors drawn into sampling bottles, bottles sealed, and contents analyzed by injecting portion of contents into gas sampling port of AID portable gas chromatograph. Data obtained in field low due to V.C. loss from sampling bottles. Miran Infra-Red Analyzer: continuous monitoring of V.C. by the direct reading instrument. Lower detectable limit of Instrument: 0.8-1.0 ppm. Area samples minimum of 10 minutes. Indicator Tubes: Gastec indicator tubes with range of 0.5-14.0 ppm. Easy to read and correlates well with other methods (i.e., charcoal tubes and Miran). UCC 006359 Table 4-1 EXPOSURE CATEGORY BY FREQUENCY OF DIZZINESS, LIGHT-HEADEDNESS Count (Row Percent) O.T. Never High Exposure 161 (63.1) Low Exposure 208 (88.1) Rubber Worker Column Total 193 (90.2) 562 (79.7) Once 8 (3.1) 1 (0.4) 5 (2.3) 14 (2.0) Occasionally 72 (28.2) 25 (10.6) 14 ( 6.5) 111 (15.7) Often 14 (5.5) Row Total 255 (100.0) 2 (0.8) 236' (100.0) 2 (0.9) 18 (2.6) 214 (100.0) 705 (100.0) UCC 006360 Table 4-2 EXPOSURE CATEGORY BY FREQUENCY OF PASSING OUT Count (Row Percent) O.T. Never High Exposure 244 (95.7) Low Exposure 231 (97.9) Rubber Worker Column Total 212 (99.1) 687 (97.4) Once 8 (3.1) 3 (1.3) 2 (0.9) 13 (1.8) Occasionally 2 (0.8) 2 (0.8) 0 (0.0) 4 (0.6) Often 1 (0.4) Row Total 225 (100.0) 0 (0.0) 236 (100.0) 0 (0.0) 1 (0.1) 214 (100.0) 705 (100.0) UCC 006361 Table 4-3 EXPOSURE CATEGORY BY FREQUENCY OF NAUSEA, "SICK" FEELING Count (Row Percent) O.T. Never High Exposure 193 (75.7) Low Exposure 212 (89.8) Rubber Worker Column Total 190 (88.8) 595 (84.4) Once 5 (2.0) 0 (0.0) 3 (1.4) 8 (1.1) Occasionally 42 (16.5) 20 ( 8.5) 16 ( 7.5) 78 (11.1) Often 15 (5.9) Row Total 255 (100.0) 4 (1.7) 236 (100.0) 5 (2.3) 24 (3.4) 214 (100.0) 705 (100.0) UCC Q06362 Table 4-4 exposure Category by frequency of HEADACHE Count (Row Percent) O.T. Never High Exposure 187 (73.3) Low Exposure 194 (82.2) Rubber Worker Column Total 183 (85.5) 564 (80.0) Once 3 (1.2) 0 (0.0) 0 (0.0) 3 (0.4) Occasionally 42 (16.5) 30 (12.7) 25 (11.7) 97 (13.8) Often 23 (9.0) Row Total 255 (100.0) 12 (5.1) 236 (100.0) 6 (2.8) 41 (5.8) 214 (100.0) 705 (100.0) UCC 006363 Table 4-5 exposure Category by frequency of "PINS AND NEEDLES" IN ARMS OR LEGS Count (Row Percent) Q.T. Never High Exposure 219 (85.9) Low Exposure 216 (91.5) Rubber Worker Column Total 201 (93.9) 636 (90.2) Once 2 (0.8) 0 (0.0) 1 (0.5) 3 (0.4) Occasionally 21 ( 8.2) 12 ( 5.1) 7 < 3-3) 40 ( 5.7) Often Row Total 13 (5.1) 255 (100.0) 8 (3.4) 236 (100.0) 5 (2.3) 26 (3.7) 214 (100.0) 705 (100.0) UCC 006364 Table 4-6 EXPOSURE 'CATEGORY BY FREQUENCY OF MUSCLE WEAKNESS Count (Row Percent) O.T. Never High Exposure 221 (86.7) Low Exposure 224 (94.9) Rubber Worker Column Total 194 (90.7) 639 (90.6) Once 6 (2.4) 0 (0.0) 2 (0.9) 8 (1.1) Occasionally 19 (7.5) 11 (4.7) 13 (6.1) 43 (6.1) Often 9 (3.5) Row Total 255 (100.0) 1 (0.4) 236 (100.0) 5 (2.3) 15 (2.1) 214 (100.0) 705 (100.0) VJCC 00&3$5 Table 4-7 EXPOSURE CATEGORY BY FREQUENCY OF IRRITATION OF EYES, NOSE OR THROAT Count (Row Percent) O.T. Never High Exposure 166 (65.1) Low Exposure 158 (66.9) Rubber Worker Column Total 159 (74.3) 483 (68.5) Once 2 (0.8) 1 (0.4) 0 (0.0) 3 (0.4) Occasionally 49 (19.2) 47 (19.9) 43 (20.1) 139 (19.7) Often Row Total 38 255 (14.9) (100.0) 30 236 (12.7) (100.0) 12 214 ( 5.6) (100.0) 80 705 (11.3) (100.0) UCC 006366 Table 4-8 EXPOSURE CATEGORY BY FREQUENCY OF GENERAL FATIGUE, "RUN-DOWN" FEELING Count (Row Percent) O.T. Never High Exposure 177 (69.4) Low Exposure 181 (76.7) Rubber Worker Column Total 171 (79.9) 529 (75.0) Once 1 (0.4) 0 (0.0) 2 (0.9) 3 (0.4) Occasionally 39 (15.3) 29 (12.3) 28 (13.1) 96 (13.6) Often Row Total 38 255 (14.9) (100.0) 26 236 (11.0) (100.0) 13 (6.1) 214 (100.0) 77 705 (10.9) (100.0) UCC 006367 Table 5 RESULTS OF STATISTICAL ANALYSIS OF EIGHT SYMPTOMS S.YMPTQM 1. Dizzyness. Lightheadedness 2. Passing Out 3. Nausea. "Sick" Feeling 4. Headache 5. "Pins and Needles" in Arms and Legs 6. Muscle Weakness 7. Irritation of Eyes. Nose, or Throat 8. General Fatigue. "Run Down" Feeling Dose-Response Pattern Yes Borderline Yes Yes Yes No Borderline Yes UCC 006368 Acknowledgment We are indebted to Mr. Earl Arp for his help in obtaining environ mental samples and for discussions concerning the industrial hygiene aspects of the paper, to Professor Lawrence Kupper for his review of the statistical methodology, to the data processing and laboratory staffs of OHSG for their steadfast efforts in our behalf and to Mrs. Wanda Dodson for manuscript preparation. Address all correspondence to: Robert Splrtas Department of Biostatistics Occupational Health Studies Group University of North Carolina NCNB Plaza, Suite 32 Chapel Hill, North Carolina 27514 U.S.A. ucc 006369 REFERENCES X. Danziger, H. "Accidental Poisoning by Vinyl Chloride: Report of Two Cases." Canadian Med. Assoc. J. 82:828, 1960. 2. Lehamann, K.B., Flury, F. "Toxicology and Hygiene of Industrial Solvents." Williams and Wilkins, Baltimore, 1943. 3. Annual Report of the Chief Inspector of Factories for the Year 1951. London: HMSO Cmd. 8772, March, 1953. 4. Suciu, I., Drejman, J., Valaski, M. "Contributions to the Study of Affections Caused by Vinyl Chloride." Mediclna Interne, 15:967, 1963. 5. Oster, R. H., Carr, C. J., Krantz, J.C., Sauerwald, M. J. Anesthesia XXIV. "Chemical Contribution of Hydrocarbons and Cardiac Auto mat icity." _J:_Pharm::_and_^x2er_:__Thera. 97:1, 1949. 6. Filatova, V.S., Gronsberg, E.S'. "Hygienic Working Conditions in Polyvinyl Chloride Tar Plants." Glgi Saint, 38-42, January, 1957. 7. Wilson, R.E., McCormick, W.E., Tatum, C.F., et al. "Occupational Acroosteolysis." JAMA 201:577-581. 1967. 8. Dlnman, B.D., Cook, W.A., et al. "Occupational Acroosteolysis. 1. An Epidemiological Study." Arch. Environ. Health. 22:61, 1971. 9. Filatova, V.S., Gronsberg, E.S. Cited in: Anghelescu, F., et al. "Clinico-Pathogenic Considerations of Raynaud's Phenomenon in Workers of the PVC Industry." Medicine Interna, 21:473-482, 1969. 10. Lilis, R. et al. "Prevalence of disease among vinyl chloride and polyvinyl chloride workers." Paper presented to New York Academy of Sciences Conference on Vinyl Chloride, New York, May, 1974. 11. Gamble, J.F., Splrtas, R., and Longley, M.Y. "Job Classification and Use of Complete Work Histories in Epidemiological Studies", paper presented at the American Industrial Health Conference, April 16, 1975, San Francisco, California. 12. Grizzle, J.E., Starmer, C.F., and Koch, G.G. "Analysis of Categorical Data by Linear Models", Biometrics. 25:489-504, 1969. ucc 006370 Appendices 1 and 2 Supplementary Questionnaire Included In UNO Questionniare NOTE: Appendix 1 Is an example of the supplement sent to all chemical workers. Appendix 2 is an example of the supplement sent to a sample of the rubber workers. ucc 006371 S'r?PLTTLIH~UY QLTSTlC^iUI'j;: CHSlICyLG (PdlS.Th) DIVISION Tii-2 company h3s provided the imlva??icy with the names of all persons who have worked in the chemicals division (i.e. depts. 093, 83(j or 733). Hecent evidence suggests that some chan Leals involved in PVC manufacture nay he health hazards. We would therefore like to ask you about' your health experiences during your employment in that area. 1. Clock Card Humber .............................................................. 2. List the main tvnes of job that you have done in the chemicals division: 0225 Dept. Mo. (Kvimple: 093 a. ..cm 'Oii. c. .0.11. d. .0.11. e. .au. Tyoe of job Time period 3. If you experienced any illness or adverse health effects that might have been related to working in any of these above Jobs, please describe the svantoms. For each symptom that you experienced, record an answer in Columns A and B. Symptom A. In which one of the above lobs did this symptom occur moat? (Circle ona letter to identify the job, as listed by you in Question 2.) Dizziness, lighthsadednees-- b Passing out ab d Nausea, ''sick" feeling @ b e Headache 0@ Q) e. "Pins and needles" in am3 or legs ab d Muscle weakness ab d. Irritation of eyes, nose or throat General fatigue, "run-down" fouling eb Q Q0 Ot -IS.'S. symptom". ."/-..ytl..1, cdc bcdc B. How often did. the symptom occur? Once Occasionally often (D 3 23 3 2 23 23 2 2 A. Ci' you undic/'.mc ir.^dicaL examination Cor any of these symptoms, please describe, m the n-vo-3** side of this page, tlu; CoLlowln'z: medical tests carried out, diagnosis or explanation given to you, type of treatment, any known or suspected ucc 006372 SUPPLEMENTARY QUEST ICMLMRE: OTUCT types of SYMPTOMS 0132 3 J con." evidence wi.tuin Appendix 2 the ?VC-manui.a:-.i.uring industry has emphasized the potential ..onlth hazards or exposure to chemicals in the work environment. In order to conduct an initial survey of adverse health effects duo to chemical exposure, we are asking a sample of workers to answer these extra questions, in addition to the main questionnaire. 1. Clock Card Number 2. List the main types of jobs that you have done while employed in the work areas that you recorded on page 5 of the main questionnaire: Dept. No. Type of job Time period (Example: 115 a. .//.I. b. .Li?*,.. e.g. Warm-up millman e.g. 1954-59 ) .... fotew $. .CiffA &<?. fe m........ /.m...................... :.a ...CiUv.pAMiV.^Ui................ ..o-.-.z^.... e. ./.$J... .... 7jAs . .................................7/.r. P.U...9. d. e. 3. If you experienced any illness or adverse health effects that might have been related to working in any of these above jobs, please describe the symntoms. For each symptom that you experienced, record aa answer in Columns A and B. 3ymptom A. In which one of the above lobs did this symptom occur most? (Circle one letter to identify the job, as listed by you in Question 2.) Dizziness, lightheadadness Passing out Nausea, "sick" feeling Headache "Pins and needles" in arms or legs a 6 a b (5 bc b 6) d d d d bcd e e e Muscle weakness a b <S) d e Irritation of eyes, nose or throat Q (b) B. How often did the symptom occur? Once Occasionally Often 1 & 3. 1 2 3- 23 1 2 ' l 23 1 63 I General fatigue, "run-down" feeling G d:' Oil'.nr symptom: bcd bcd 23 23 4. II you underwent radical examination for any of these symptoms, please describe, on the reverse side of this page, tha following: medical tests carried out, diagnosis or exp Lunat Lon given to you, type of treatment, any known or suspected ucc 006373