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FILE NAME: Metalclad (METC) DATE: 1968 Oct DOC#: METC023 DOCUMENT DESCRIPTION: Occupational Health Program of The Western States Asbestos Health Plan THE WESTERN S T A T E S ASBESTOS HEALTH PLAN t OCCUPATIONAL HEALTH PROGRAM WESTERN STATES CONFERENC E OF A S B ESTOS WORKERS ASSOCIATED I NSULATION CONTR ACTORS OF THE WESTERN STATES O C T O B E R 31, 1968 occupational health program FOR THE WESTERN STATES ASBESTOS HEALTH PLAN I r v i n g R. T abershaw , M.D. W. C la rk C o o p er, M.D. J . LeRoy B a lz e r, M.S. Tabershav-Cooper A ssociates 2180 M ilvia S tre e t B erk eley , C a lifo rn ia 94704 tr u s te e s of che W estern S ta te s A sbestos H ealth P la n , m ee tin g in S e a t t l e , W ashington, on O cto b er 31, 1968, approved t h is program and e n te red in to an agreem ent w ith Dr. Tabershaw fo r i ts im plem entation. The T r u s te e s , m eetin g in San F ra n c is c o on March 10, 1969, a u th o r i z e d t h a t c o p ie s be made a v a i l a b l e f o r g e n e r a l d i s t r i b u t i o n . BOARD OF TRUSTEES WESTERN STATES ASBESTOS HEALTH PLAN W estern S ta te s Conference of A sbestos Workers Frank Calegory E arl B. K irkland Don A. B ru n e r Edward T . L ontz A ssociated In su latio n C ontractors of th e W estern S ta te s Donald Bradshaw K enneth M. M cC affree A. D. S c h in n e re r LeLand E. S w eetser OCCUPATIONAL HEALTH PROGRAM FOR THE WESTERN STATES ASBESTOS HEALTH PLAN I, Introduction I I . D is trib u tio n of W estern A sbestos W orkers A. Area Covered B. Local Unions in Area I I I . P resent H ealth A c tiv itie s A. H ealth and W elfare P lans B. E nvironm ental C o n tro l C . Summary IV . Workmen's C om pensation V. Recommended P ro g ram A. M edical P ro g ram - G e n e ra l B. I n d u s tr ia l H ygiene Program - G eneral V I. M edical Exam inations A. C ontent B. Frequency C. S ite D. C o st E. S upervision F. Records V II. I n d u s tr ia l Hygiene V III. R e la tio n sh ip s w ith I n te r e s te d Groups A. T ru ste e s o f H ealth and W elfare P lans B. T ru stees o f L ocal H ealth and W elfare C. C ontractors D. I n s u l a t i n g W orkers E. Physicians F. In d u stria l H ygienists G. O th e rs IX . Summary OSCUPATIONAL HEALTH PRQGRAX for A sbestos W orkers and In s u la tin g C o n trac to rs of the W estern S ta te s I r v i n g R . T a b e rsh a w , M .D ., W. C la r k C o o p e r, M.D.j and J . LeRoy B a lz e r, M .S. O ctober 31, 1968 INTRODUCTION The e s ta b lis h m e n t in 1966 o f a su p p lem en tal H ealth and W elfare Fund fo r O ccupational H ealth and Research by the A ssociated In su la tio n C ontractors of th e W estern S ta te s and th e W estern S ta te s C onference of A sbestos W orkers has made i t p o s s ib le to b eg in a co o rd in ated program to p rev en t o cc u p atio n a l d isease in the in su la tin g tra d e . The need fo r such a program has been in c re a sin g ly a p p a re n t. In su la tin g w orkers a re s u b je c t to a number of s p e c if ic h azard s in th e ir tra d e , th e m ajor ones a r is in g from ln h a la b le d u sts in th e f a b r ic a tio n , a p p lic a tio n , fin is h in g , and te a r in g o u t o f v a rio u s in s u la tin g m a te r ia ls . Knowledge h a s b een s te a d i ly accum ulated as to m ethods of red u cin g exposures to d u sts and to d e te c t d ise a se i n men a lr e a d y a f f e c t e d . Work i n th e t r a d e i s s t a b l e ; b u t f r e q u e n t changes in w ork s i t e and j o b s , m u ltip le em p lo y ers, and a w idely, s c a t t e r e d w ork fo rc e make conventional m edical su rv e illa n c e and in d u s tria l hygiene d i f f ic u lt to apply. A co o rd in ated program is tim ely . A ll in s u la tin g w orkers in th e area r e c e iv e m ed ic al c a re th ro u g h h e a lth and w e lfa re p lan s j o i n t l y su p p o rte d by la b o r and m anagem ent. The in c re a s in g age o f th e w ort f o rc e and r i s i n g c o sts of m edical c a re a r e producing in e v ita b le s tr a in s upon h e a lth , w e lfa re and p ension fu n d s. At th e same tim e, a v a ila b le knowledge on th e p re v e n tio n , d iag n o sis, and treatm en t of a sb e sto s-re la te d d isease is not being ap p lied . L eadership in both em ployer and lab o r groups is concerned n o t only about the p e rso n a l e f f e c ts o f p re v e n ta b le i l l n e s s b u t a ls o ab o u t th e u ltim a te e f f e c ts on in d u stry . They a re th e r e fo r e seek in g e f f e c tiv e and p r a c tic a l means o f developing and ap p ly in g m o d em 'o ccu p atio n al h e a lth p ra c tic e s under th e p a rtic u la r conditions of th e ir trad e. In th e d ev elo p m en t o f th e p r e s e n t p r o p o s a l, we h av e (1 ) rev iew ed a l l c u rre n t H ealth and w e lfa re plains in th e W estern S ta te s , w ith em phasis upon p r e v e n t i v e m e d ic in e an d i n d u s t r i a l h y g ie n e ; (2) c o n s id e r e d t h e basic components of m edical and e n v iro n m en tal s u rv e illa n c e ; (3) made s p e c if ic recom m endations upon su ch m e d ic a l and e n v iro n m e n ta l p ro g ram s; and (A) rev iew ed th e s u i t a b i l i t y and a v a ila b ility of lo c a l m edical and environm ental h e a lth reso u rc es, w ith s p e c ific recom m endations w here a p p ro p ria te . L ocal Unions in Area In Table I I a re lis te d the lo c a ls of the In te rn a tio n a l'A sso c ia tio n of H eat and F r o s t I n s u la to r s and A sb esto s W orkers w ith in th e a re a c o v ered by th e W estern C onference. Members o f th e A sso c ia te d I n s u l a ti o n C o n tr a c to rs o f th e W estern S ta te s do n o t n e g o tia te d ire c tly w ith a l l of the unions in th e W estern C onference. C o n tra c to rs i n C olorado, f o r exam ple, a re in th e Midwest A s s o c ia tio n . TABLE I I L o cal A sbestos Workers* Unions in W estern S ta te s Local Number #5 #7 m #20* #28 #29* #36 #62* #69 #70* #73 #76 1 #82 #97 #135 u _______ H eadquarters Los A ngeles, C a lif. S e a ttle , W ashington San F ran cisco , C a lif. Long Beach, C a lif. D enver, Colorado H unters P o in t, C a lif. P o rtla n d , Oregon B rem erton, W ashington S a l t Lake C ity , Utah Mare I s la n d , C a lif , Phoenix, Arizona A lb u q u e rq u e , N.M. Spokane, W ashington Anchorage, A laska Las V egas, Nevada No. of Men 522 134 427 -- 152 -- 144 -- 94 -- 93 106 66 78 46 H ealth & W elfare P eriodic C o n trib u tio n X-ray 0 ,2 1 /h r. yes 20 no 30C yes -- -- 16C no -- -- 25c no -- -- . 21c yes -- -- 21c yes 21C yes 20c no 20c no 21C- yes O ther Locals i n Same H & W Plan 6 9 ,7 3 ,7 6 ,1 3 5 82,97 73,76,135 5 ,6 9 ,7 6 ,1 3 5 5 ,6 9 ,7 3 ,1 3 5 7 ,9 7 7,82 5 ,6 9 ,7 3 ,7 6 * S tarred lo c a ls are in U .S. Naval S hipyards which were not in clu d ed in the present review . -5' (2) S e a tt le . W ashington. The I n s u la tio n and A sbestos W orkers W elfare T rust of S e a ttle provides l i f e insurance b e n e fits fo r a c c id e n ta l death and dism emberment, and lo ss o f tim e fo r n o n -o ecu p atlo n al d is e a s e , m edical c a re and h o s p it a l expense b e n e f its to members a n d /o r dep en d en ts o f lo c a l 7 ( S e a ttle and Tacoma), lo c a l 82 (Spokane and B illin g s ) and lo c a l 97 (A nchorage). O ccu p atio n al d ise a se s a re excluded from b e n e fits i f covered by w orkm en's co m p en satio n . D ia g n o stic ch eck -u p ex am in atio n s n o t in c id e n t to or necessary fo r the diagnosis of a sick n ess or accid en tal in ju ry are ex p ressly ex clu d ed , i f paid out of in su ra n c e . The m onthly c o n trib u tio n is 20$. The in s u r a n c e c a r r i e r i s New York L i f e I n s u r a n c e Company. (3 ) San F r a n c is c o . C a l if o r n ia . The H e a lth and W elfare P la n o f lo c a l 16 h a s b e e n I n o p e r a t i o n s i n c e 1951 an d now p r o v i d e s b e n e f i t s f o r a b o u t 440 a c tiv e and 30 r e t i r e d members- M edical c a re , h o s p ita l b e n e f its , and l o s ttim e b e n e fits a re provided through Blue C ro ss; and l i f e in su ran ce coverage is by S tan d ard In s u ra n c e Company of P o r tla n d , O regon. The program i s su p p o rted by a 30c per hour c o n trib u tio n . S ince 1957, th e h e a lth and w elfare fund has p ro v id ed an n u al c h e st film s on a v o lu n ta ry b a s is to a l l members, paying a t f i r s t $10, now $12j to any o f s e v e r a l d e s ig n a t e d r a d i o l o g i s t s f o r th e s e r v ic e ($ 1 6 .5 0 i f two film s a re ta k e n ) . T h is i s s e p a r a te from th e in su ra n c e program, w ith c h e st film fee s being b ille d d ir e c tly to the A d m inistrator o f th e H e a lth and W e lfa re Fund, who a l s o r e c e iv e s t h e f ilm s and i n t e r p r e t a t i o n s . During the f i r s t y ear o f th e program , pulm onary fu n c tio n te s ts w ere perform ed on ab o u t 166 men; th e se w ere d isc o n tin u e d b ecau se o f ex p en se. Over a p e r io d o f 10 y e a r s , n e a r l y 2000 f i l m s h a v e b e e n ta k e n i n 390 men a n d -h a v e provided e x c e lle n t s e r i a l evid en ce"o f changes. Expansion of the program to Include annual screening exam inations is under c o n sid eratio n . (4) D enver. C o lo rad o . L ocal 28 w ith 156 members has had a h e a lth and w e lfa re program sin c e about 1952, I t is fin an ced by a c o n trib u tio n of 16c a n h o u r , w ith C a l i f o r n i a W estern L i f e I n s u r a n c e Company a s th e in s u ra n c e c a r r ie r . I t is a cash indem nity program and does n o t.p e rm it p e rio d ic exam inations, in absence o f i ll n e s s . There have been film s taken on a v o lu n ta ry b a s is by th e lo c a l tu b e rc u lo s is program , b u t union o f f i c ia ls do n o t know th e e x te n t o f p a r t i c i p a t i o n . (5 ) P o rtla n d .. O regon. The H e a lth and W elfare P lan o f lo c a l 36 pro v id es h o s p ita l, m edical and su rg ic a l b e n e fits through a choice e ith e r of d ire c t b e n e fits from th e K aiser F oundation or cash b e n e fits through In te rn a tio n a l H ealth and L ife In su ran ce Co. of P o rtla n d , L ife , a c c id e n ta l death and dismemberment, weekly incom e, d e n ta l b e n e fits and m ajor m ed ical coverage u n d er K a is e r F o u n d a tio n a r e u n d e r w r itte n by B an k ers L i f e Company o f Des M o in e s, Io w a. The f o r e g o in g a r e p a id f o r by a 25$/h o u r c o n t r i b u t i o n . Laboratory, o r o th er expenses involved in p e rio d ic exam inations a re provided u n d e r th e K a is e r p l a n b u t n o t u n d e r th e IHA c o v e ra g e w hich p a y s o n ly f o r necessary x -ra y and la b o ra to ry p rocedures in c id e n t to the d ia g n o sis o r treatm ent of non-occupational in ju rie s or illn e s s . D ental coverage is f o r 50% o f c o v e re d c h a rg e s i n e x c e s s o f a $15 p e r annum d e d u c t i b l e . -7 - M edical S u r v e il la n c e . A ll members a r e p ro te c te d a g a in s t r o u tin e and major m edical expenses fo r them selves and th e ir dependents w ith v a ria tio n s in co m p leten ess. I t i s n o t th e purpose of t h i s re p o rt to compare or evaluate m edical coverage as such. There is in a ll lo cals a consciousness o f the need fo r improved p re v e n tiv e program s. These have been d i f f ic u l t to provide in th e c o n te x t of e x is tin g in su ran ce programs and in the absence o f any one em ployer having a la rg e enough p ro p o rtio n of th e work fo rc e to provide o ccu p atio n al h e a lth se rv ic e s. P e rio d ic c h e st film s , although h ig h ly d e s ira b le , a re not enough in them selves to e s ta b lis h p h y sic a l s ta tu s of th e w orker.. T heir value is fu rth e x reduced when x - r a y s a re tak e n by many d i f f e r e n t r a d i o l o g is ts u sin g d iff e re n t c r i t e r i a , u n re la te d to c li n ic a l h i s t o r ie s , working e x p erien ce, and knowledge o f th e i n s u l a t o r s ' env iro n m en t. P r iv a te p h y sic ia n s se e too few men w ith common w o rk in g e x p e r ie n c e t o d e a l c o n s i s t e n t l y w ith t h e i r problem s arisin g out of asb esto s exposure. WORKMEN'S COMPENSATION A lthough a s e p a r a te stu d y would be re q u ire d to cover workm en's com pensation p ro v is io n s w ith in th e 13 S ta te s o f th e W estern C onference, in f o r m a tio n s u p p li e d i n T a b le XV shows t h e im p o r ta n t v a r i a t i o n s i n th e 14 ju ris d ic tio n s involved ( th ir te e n S ta te s and U nited S tates Government). Equally im portant a re th e in te rp re ta tio n s ap p lied w ith in the v ario u s ju ris d ic tio n s . There a re d iffe re n c es in b e n e fits fo r m edical care, tem porary t o ta l d i s a b i l i t y , perm anent p a r t i a l d is a b ility , perm anent to ta l d is a b ility , and d eath , p ro v isio n s fo r w aiver o f com pensation, subsequent in ju ry funds (in a l l ju ris d ic tio n s except Nevada), p ro v isio n s fo r e x t r a t e r r i t o r i a l i t y , a llo c a tio n of c o s ts to l a s t employer or p ro ra tin g over a l l em ployers considered to be co n trib u to ry to d ise a se . The U .S. D epartm ent o f Labor l a s t y e a r fin an ced a study of the problem s of com pensation in b e r y llio s is and a s b e s to s -re la te d d ise a se . This stu d y , by th e f ir m o f Woodward and F e n d i l l e r i n New York C i t y , h a s n o t y e t been re le a s e d . -9 - RECOKMENDED PROGRAM The needs of th e in s u la tin g in d u stry and i t s w orkers can b e st be met by a c o o rd in a te d o c c u p a tio n a l h e a lth program re sp o n siv e to both management and lab o r through the tru ste e s of the p a rtic ip a tin g h e a lth and w elfare p la n s. In such a program , the M edical A dvisor o f the O ccupational H ealth P lan of th e W estern S ta te s , in conform ity w ith g u id e lin e s approved by th e tr u s te e s , would c o o rd in a te and su p e rv ise m ed ical and in d u s tr ia l hygiene a c tiv itie s as follow s: I . M edical Program A. N eg o tiate w ith ap p ro p riate c lin ic s or p h y sician s in each m ajor a re a to perform p e rio d ic ex am in atio n s on members. B. E stab lish content of such exam inations. C. E sta b lish frequency of such exam inations. D. M ain tain c e n tr a l f i l e of m ed ic al a b s tr a c ts on members. E. M ain tain c e n tr a l f i l e o f d u p lic a te c h e s t film s on members. F. P e rio d ic a lly provide the tr u s te e s , c o n tra c to rs and union members w ith s t a t i s t i c a l e v a lu a tio n o f p h y s ic a l h e a lth s t a t u s o f m em bership, w ith o u t r e v e a lin g in d iv id u a l company o r m em ber's name. G. P ro v id e m edical in fo rm atio n on a s b e s to s -re la te d d iseases and o th e r o ccu p atio n al h e a lth problem s to p a rtic ip a tin g c lin ic s and p h y sician s, p erso n al p h y sic ia n s, ra d io lo g is ts , and p a th o lo g is ts , w ith p a rtic u la r em phasis on d iag n o stic c r i t e r i a and on r e la tiv e hazard o r s a fe ty o f work environm ent. B. Work d i r e c t l y w ith l o c a l r a d i o l o g i s t s and p a th o lo g is ts to improve d if f e r e n tia l d iag n o sis of a s b e s to s -re la te d d ise a se s. I . A dvise t r u s t e e s upon workm en's com pensation a s p e c ts of a sb esto sis and other a sb esto s-re la te d d iseases. J . P rovide h e a lth ed u catio n al m a te ria l fo r d is trib u tio n to c o n tr a c t o r s , lo c a l u n io n s, and members:. K. M a in ta in c lo s e l ia is o n w ith members o f th e m ed ical p ro fe s s io n in te r e s te d in and resp o n sib le fo r th e h e a lth of the in su lato r. L. Keep inform ed on w orldw ide re s e a rc h a s i t p e rta in s to th e d e te c tio n , p rev en tio n and tre a tm e n t o f m edical problem s im portant to in su la tin g w orkers, and tra n s la te th is inform ation in to ap p ro p riate actio n . I I . I n d u s t r i a l H ygiene Program A. Develop m anuals of h y g ien ic p r a c tic e , w ith the h elp of th e organized h e a lth and s a fe ty com m ittees in each a re a , fo r c o n s id e ra tio n by tru s te e s and by lo c a l union le a d e rs and c o n tra c to rs , -11- TABLE V D is trib u tio n of A sbestos W orkers in Five M ajor L o cals Based on Years S in ce E n te rin g Trade Local 10 or le s s 10-20 Over 20 T otal #5 123 (23%) 220 (42%) 183 (35%) 526 (100%) #7 25 (16%) 69 (45%) 60 (39%) 154 (100%) $16 134 (31%) 115 (27%) 178 (42%) 427 (100%) m 29 (22%) . 30 (23%) 74 (56%) 133 (100%) #82 29 (17%) 57 (33%) 85 (50%) 171 (100%) 340 (24%) 491 (35%) .580 (41%) 1411 (100%) S i te and C o sts I t i s im p o rtan t th a t th e ex am in atio n s be done by one p h y sic ia n o r c li n i c in each m ajor a re a , u sin g form s p re s c rib e d by th e O ccupational H ealth F la n . D iscussions w ith re p re s e n ta tiv e c lin ic s in the a re a s have in d ic a te d th a t an exam ination as o u tlin e d would c o st about $50, as of m id-1968. T his would in v o lv e in d iv id u a l n e g o tia tio n and perhaps lo c a l m o d ific a tio n s o f some p a r ts o f th e ex am in atio n . S ch ed u lin g exam inations e v e ry two o r t h r e e y e a r s i n some members w ould r e l e a s e fu n d s f o r s p e c i a l s tu d ie s in d ic a te d fo r o th e rs . H ealth and w e lfa re funds should a p p ro p riate fu n d s e q u iv a le n t to $50 p e r member to co v er th e e x a m in atio n program . S u p e rv isio n . The M edical A dvisor would sup p ly p a r tic ip a tin g c lin ic s w ith s p e c i f i c in f o r m a tio n on th e c u r r e n tl y a c c e p te d c r i t e r i a f o r th e d ia g n o s is of a sb e sto sis and system s fo r c la s s if ic a tio n of ch est roentgenogram s. R e p re se n ta tiv e film s f o r r a d io lo g is ts to review would be c irc u la te d to a p p ris e them o f d ia g n o s tic c r i t e r i a . S im ila rly , p a th o lo g is ts in each a re a would be kept ad v ised of c u rre n t in fo rm a tio n on th e p a th o lo g ic d ia g n o s is o f a s b e s to s is w ith th e aim o f discouraging e ith e r o v er- or under-diagnosis. M edical R e c o rd s. A d u p lic a te c h e s t f ilm and a summary o f each m em ber's m edical reco rd would be kept on f i l e in the o f fic e of th e M edical A dvisor, w ith th e c o n s e n t o f th e man exam ined. The m e d ic a l s t a f f w ould be a v a i l a b l e fo r consultation (or to suggest appropriate co n su ltatio n ) in d iffic u lt diagnostic s itu a tio n s . -13- B. Review and e v a lu a tio n of p e rio d ic r e p o r ts on th e e x te n t o f p a r t i c i p a ti o n by union m em bership, and s t a t i s t i c a l d a ta on fin d in g s (w ithout id e n tif ic a tio n of in d iv id u a ls by name). C. P ro v id in g and a p p ro v in g s p e c i f i c s u g g e s tio n s f o r i n d u s t r i a l hygiene p ra c tic e s . D. S u g g estin g c o n ta c ts w ith lo c a l p a th o lo g is ts , r a d io lo g is ts , in d u s tria l h y g ie n ists, as needed. I II . C ontractors. A. A sso c ia te d I n s u la tio n C o n tra c to rs o f th e W estern S ta te s : 1 . Would be re g a rd e d as s o u rc e o f in fo rm a tio n on g e n e ra l problem s and needs o f the in s u la tin g co n tracto r. 2. Would p e r i o d i c a l l y r e c e iv e in fo r m a tio n on p r e v e n tiv e m edical and in d u stria l hygiene e ffo rts . 3 . Would r e c e i v e s c i e n t i f i c an d e d u c a tio n a l m a t e r i a l on the co n tro l of.hazards in the in su la tin g trad e. 4 . Would b e a p p ris e d in adv an ce o f p a s s i b l e recom m endations fo r in d u s tr ia l hygiene th a t m ight prove unduly expensive or burdensome. 5 . Would b e k e p t a d v ise d on co m p en satio n l e g i s l a t i o n . B, Individual, c o n tra c to rs, in a d d itio n : 1 . Would r e c e iv e i n t e r p r e t a t i o n o f e n v iro n m e n ta l fin d in g s made by lo c a l in d u s tr ia l h y g ie n is ts . 2 . When f e a s i b l e w ould be g iv e n a s s i s t a n c e i n i n d u s t r i a l hygiene su rv ey s, w ith s p e c ific recom m endations. 3 . Would r e c e iv e d e t a i l e d e n v iro n m e n ta l d a ta r e l a t i n g to t h e i r in d iv id u a l work s i t e s (names of c o n tra c to rs , o r i d e n t if i a b l e jo b s would n o t b e made p u b lic w ith o u t w ritte n consent of the co n tracto r in v o lv ed ). IV. In su la tin g W orkers. A. I n te r n a tio n a l Union - There would b e f u l l co o p e ra tio n w ith ed u catio n al and research e ffo rts of the in te rn a tio n a l union, -subject only to re s tric tio n s on c o n fid e n tia lity of inform ation. B. W estern Conference 1 . Wcm-ld ro rp -fu p p e r i o d i c r e p o r t s on th e s t a t u s o f p r e v e n tiv e med i c a l e f f o r t s and i n d u s t r i a l .h y g ie n e p.r r o r t s ~ 2 . Wo u ld r e c e i v e s c i e n t i f i c and e d u c a tio n a l m a t e r i a l on th e c o n tro l of hazards in the tra d e . 3 . Would be k e p t a d v ise d on tre n d s i n co m p e n sa tio n . -1 5 - SUMMARY A fter review of (1) th e m edical and in d u s tr ia l hygiene needs of the in su la tin g in d u stry in th e W estern s ta te s , (2) the d is tr ib u tio n of in su la to rs and c o n tra c to rs , (3) th e c u rre n t h e a lth and w e lfa re p lan s and environm ental c o n tro l e f f o r ts , and (4) a v a ila b le m edical and environm ental re so u rc e s, a re g io n a l o c cu p atio n al h e a lth program is su g g ested , w ith the o b je c tiv e of im proving and c o o rd in a tin g e f f o r ts to c o n tr o l o c c u p a tio n a l d is e a s e and th ereb y le s s e n th e human and economic e f f e c ts of p re v e n ta b le i l l n e s s in the in su latin g trad e: . T. A perm anent M edical A dvisor should be ap p o in ted to work w ith th e W estern C onference of In su la tin g W orkers and the A ssociated In su la tin g C ontractors of the W estern S ta te s, to develop and c a rry out m edical p o lic ie s . I I . The M edical A d v iso r would be re s p o n s ib le to th e T ru ste e s of th e W estern S ta te s O ccu p atio n al H ealth P lan and would work w ith tr u s te e s of lo c a l h e a lth and w e lfa re p lan s in the improvement and im plem entation of p rev e n tiv e h e a lth activ itie s. I I I . The a s b e s to s w orkers and c o n tr a c to r s would s u p p o rt, through lo c a l h e a lth and w e lfa re program s or s p e c ia l assessm en t, p e rio d ic p h y s ic a l exam inations o f a l l members, w ith c o n ten t and frequency based upon recom m endations of th e M edical A d v iso r, IV. Such exam inations should be perform ed in each lo c a l area by a c li n ic o r p h y sic ia n chosen by th e lo c a l h e a lth and w elfare p lan w ith th e advice of th e M edical A dvisor. V. E s tim a te d c o s t o f i n i t i a l and p e r i o d i c e x a m in a tio n i s $50 p e r man p e r annum (a s o f ra id -1 9 6 8 ). V I. A b stracts of p e rio d ic exam inations and d u p lic a te ch est film s would be s e n t to th e M edical A d v iso r's c e n tr a l f i l e . V II. The M edical A d v iso r and h is s t a f f would p rep are, f o r lo c a l d is trib u tio n , h e a lth education m a te ria l. V III. Each lo c a l a re a would be urged to form a h e a lth and s a fe ty com m ittee, w ith la b o r and management re p r e s e n ta tiv e s , to supervise lo c a l environm ental c o n tro ls . ..J t t 151 E valuation and c e n tr a l o f argentea erooaum a ir. the tn sn la tl.-.r tr -,-- Vf. Clark C o o p e r Occupational Health in esid en e,. i t the School o f Public H ealth, 'IsiY sr sity s i C a lifo r n ia , gsrfcslcy J . LeHoy 3 a 1 2 e r ' In d u str ia l Hygiene Ingm eerirH :, School of Public Health, U niversity of C aliforn ia, Berkeley ! C\ >__ u I t has beer, recogn ized fo r a numoer o f years t e a l in s u la t in g vtorsers r.z.ve ar, increased r is k o f a s b e s t o s is (le a t h a r t and Sanderson, 1552; (larr, 13o4; S e l i k c f f *: a i . , 1=55; Ahlman, 1=45; Keane and liv e n , iS S s; F e r r is , lyoT; a ls ir .f o ld e t a l . , 1557; and o th e r s) ar.c a lso th at they e x h ib it a higher than expcctad in c id e n c e or lung cancer and other m alignar.siez ( e .g ., S e l i k o f f , 1564, and Dunn and. H eir, i ? 6 5 ) . During the past three y e a r s, we have had an o p p o rtu n ity to study in t e n s iv e ly both the h e a lth s ta tu s ana the work p r a c tic e s and environ m ental exposures o f sen engaged, in the in s u la tin g trade ir. the Ian F ra n cisco area. M ed ical fir.air.gs w i l l be rep o rted su b seq u en tly ir. g r e a te r d e t a i l . In the p resen t rep ort, p e r t in e n t data w i l l be summarised to v e r i f y the magni tu ie o f the problem ar.d to in d ic a te the p r o b a b ility o f such epidem ialo g ic s tu d ie s answering current major q u estio n s relevant :c a s b e s to s as a h ea lth hazard. Se w i l l then turn to the p r a c t ic a l problems o f d e r e n o in g en viron m en tal c o n d itio n s in the tra d e and appropriate measures to c o r r e c t th en . S tu d ie s D irected ^ow'.ri the InsI'l s t i r . r Markers Although in io r m -tic a i s b ein g c o l l e c t e d on more than 1 ,8 3 0 members o f the In te r n a tio n a l A ssn e ia tic r . o f Heat and F ro st I n s u la t o r s and A sbestos 'Sorkera who work in C a lifo r n ia , W ashington, Oregon, se a p o r tio n s o f Levada, Arizona and Montana, the p r e se n t report w i l l be lim it e d to th ose in 5an F ra n cisco and a d ja cen t a r e a s. L ocal 16 of the union, whose o f f i c i a l t e r r i t o r y t h is i s , has approxim ately 4C0 a c tiv e embers (See map). I t s j u r is d ic t io n , however, d oes n ot cover 3tlp y srd a operated by the U .c . Navy where th ere are s n a i l lo c a l unions hut where union membership i s not o b lig a t o r y . The l a t t e r employ about 110 in s u la to r s in the San Francisco ares. L o ca l 16 m s organized in 1911. Like o th e r lo c a l unions in the a sb e sto s tr a c e , i t .has been ch a r a c te r ize ! by s t a b i l i t y , e x c e l l e n t pay, pride in craftszauiahip," and a stro n g f a t h e r - t o - 3or. t r a d it io n - There has been a l i b e r a l p e n sio n p lan sin c e 1956 as w e ll as a h e a lth ar.d w elfare program which p rovid es com prehensive m ed ical care by p h y sic ia n s and h o s p iia io chosen by the in d iv id u a l members. Both th ese program are j o i n t l y sponsored and c o n t r o lle d by union ana management. The l o c a l i s the c o l l e c t i v e b a r g a in in g u n it fo r in s u la t in g workers employed by p rivate in d u str y w ith in i t s j u r i s d i c t i o n . Members may work f o r any one o f the se v e n major in su la tin g c o n tr a c to r s in the area , or may be a s s ig n e d by the union fo r work by o th er con tractors as n eed ed , Thuc, one man u s u a lly works f o r many employero over a p eriod o f y ears and union records provide the only referen ce p oin t for a study that has c o n tin u ity . S e le c t io n of Croup fo r Study IniOria&ticn wag cU tcincd ur.ion r eco rd s o s o i l eeii wko were rccentc--C o f the I c e d St ary tim e during the p erio d January 1 , 1946, through December 31, 1965. In form ation jn deaths, la p s e s , w ithdraw als, r e tir e m e n ts , t r a n s f e r s , new members, retu rn s to a c t i v i t y and tr a n sfe r s ir, or out viere c o lle c t e d and u sed to develop a p ictu re o f the work fo r c e a v a ila b le fo r study. There were 161 a c tiv e in s u la t o r s as o f January 1, 1946; 433 en tered during the period u n til 1 2 /3 1 /6 5 , w h ile 214 l e f t the p o p u la tio n fo r v a rio u s r e a so n s. Thus, 594 in d iv ic u a is were a c t iv e member3 at some time or a n o th er during the 20-y e a r p erio d , n t h a c tiv e ncr.aorzh.ip ran gin g from 161 in 1946 te 310 i s 1506 ( f a c ie 1 , Table 1 ! A c tiv e liesbern ae o f Jossuary 1 1946 161 < _ ,, '_ E atarsd o December 31. 1965 433 Total la Population 5S4 l e s s Those Who L e ft 214 V Act life Members as o f December 31, 1965 380 ( Chart 1 Chart i B u n ra riies tha tm e of e n te r ic s H i in su ln - ttng trade of the 554 nsa a v a ila b le fo r stu d y. G il/ .51 (15 *) s ta r te d before '936; so t h is i s the maxi <^U(U>*M*****rbt*t)11*t,,)wr*ltMIIit* triM, mum number tha c o u li p o c sio ly hove r sa c k tc 3C years o f o b serv a tio n by 1955. A ctu a lly , only 72 in d i v id u a ls w ith t h is such exposure -were observed. The in flu x of craftsm en during world War 1 ship b u ild in g r a is e d new a eth ers to the p oin t that a t o t a l of 250, or 15 56, had joined p r ie r ta 1*46, Thus, n e a r ly o n e -h a lf could have hid 20 or so r s years of ooa erv a tia n by 1566 and 250 of those under ob serv a tio n had passed 20 y ears sin e s jo in in g the trade. These fig u r e s ere important in in terp retin g current fin d in g s , p a r tic u la r ly v;ith respect to j s a lig r a n d e s 'w ith long In te n t p erio d s. A ll men w ith 30 years sin c e jo in in g the trade hate worked in the sh ip yard s, the m ajority having worked there f o r 5 or more y e a r s. Of these w ith over 20 years in the trade, le a s then 1 have never wcried in th s s h ip y a r d s. Only when one coicb to nen who have jo in e d the trade sin c e 1945 0 we enccuntar s ig n if ic a n t numbers w ith :io shipyard ex p erien ce. tuu Evidences of A e b e s tts is it, the Group There has been a program of voluntary annual chest roentgenogram s for a l l a c t iv e end r e t i r e d members s in c e 1557. P iln s have been taken by any one of se v e r a l r a d io lo g is t e s e le c t e d by the A dm inistrator o f the h e a lth end Welfare Plan who kept f ilm s and in t e r p r e t a t io n s in a c e n t r a l f i l e . * Approximately 1,500 film s , taken over a 10-yeax p eriod , have been rein terp reted , without p rio r knowledge of work h is t o r ie s , symptoms, or o th e r in form ation . ?ilm s with d e fin ite or d o u b tfu l changes have been in d ep en d en tly review ed by a r a d io lo g ic co n su lta n t who i s p a r t i c ip a tin g l a the U1CC-USPHS a s b e s t o e ls c l a o s i i l e a t i o n p r o j e c t . o r purposes of the p r e s e n t r e p o rt, n e g a tiv e film s were th ose w ith no evidence of increased lin e a r or nodular shadows, nor th ick en ed , d isto r te d , or c a lc ifie d pleura or pericardium. D e fin ite changes c o n s is te n t w ith a e h e a to a ie included in creased lin e a r markings or d e fin ite ev id en ce o f th ick en ed , d is t o r t e d , or c a l c i f i e d p le u r a , Where fin d in g s were equivocal in clu d in g minor p le u r a l changes such a s obscured co stop h ren ic angles or questionable p a r ie ta l ( thick en in g, changes were c a lle d d o u b tfu l. \ E xcluding a l l men who d ied or were l o s t from the union by tr e n s fc r or 1savin;; ths rede p r io r to i n s t i t u t i o n o f th e x -ra y program in 1558. th ere were 480 e l i g i b l e fo r film s . Cf th e s e , 386 took advantage o f the o p p o rtu n ity to the e x te n t of having had at le a s t one film . Table 2 illu s t r a t e s the p a r tic ip a tio n and d is tr ib u tio n of those with d e fin ite roettgcr.o- graphic changes, grouped by p eriod o f e n te r in g tr a d e . P leu ral changes predominated over parenchym al. In clu d in g in d iv id u a ls i s when there was evid en ce fo r both ty p e s o f change, 41. or 4 %, had d e f in it e parenchymal and 75, or 55 %, b a i etirrite pleural aencrmnlitire, . 153 Period of Humber Dumber "umber w ith Cafi.n its Chong?9 E ntering A vailable Having C o n sisten t w ith A sbeotcais ( Trade for Piiaa Pilm (s) Dumber 5 \ 1906-10 0 0 0 n nrrf 1911-15 2 - 2 2 1005. ( 1916-20 S 5 1921-25 7 3 5 IOCS 2 67& 1926-30 19 13 6 62S 1531-35 17 13 _6 48* 1935-40 49 41 17 415 1541-45 117 101 33 33S 154-6-50 61 47 12 25S 1951-55 69 57 5 9* 1956-60 74 55 2 4% ' 1561-65 57 49 1 2 T otal 4S0 386 93 245 C a lc ifie d p le u r a l p la q u es wars c e a o n str sb le in 17 in d iv id u a ls , a l l o f when bad b ts s in the trade fo r 20 yea rs or s o r e . Hire o f the }o In d iv id u a ls examined who had Joined the trade p rio r to 1936 showed d e f in it e c a l c i f i c a t i o n , i s w i l l ha p oin ted out in a n a ly ses of m o r ta lity , four deaths iro n cor pulmonale a sso c ia te d w ith pulmonary f ib r o s is were reported over the 20-y e a r p erio d ir o n 1S4& to 1963. M ortality Analysis 'o have been 72 icnown deaths in th e group o f 594 men during the p eriod 1?46 - 1565. Death d fic & t e a have been obtained fo r 6 4 . S able 3 su n n a r ise s cu rren t inform ation on causes of death f o r the e n t ir e group and fo r the 25A in d iv id u a ls in when 20 yea rs or co re had elap sed sin ce th e ir jo in in g the trade, e ith e r at the estab lish m en t of the 1546 cohort or subsequent to th a t d a t e , i l l o f the 14 deaths ir o n lu n g cancer occurred in th ose w ith 20 y ears or ncre sin ce jo in in g the tra d e. Expected r a te s were based on C a lifo rn ia norm ality r a te s fo r sh ite c e l e s , th e 1545-50-51 r a te s b ein g a p p lie d f o r the y e a r s 1946 - 55, and 1955-60-61 r a te s fo r the y ea rs 1956 through 1965. Observed lu n g can cer d eath s were 7 ,S 7 t in e s ex p ected . Two of the deaths fr e n tu n ers o f the r e s p ir a to r y tr a c t were due to p le u r a l x e e o t h e lio r a , So p e r ito n e a l xeso th elio m a have been rep o rted . Two x a lig n a n c le s o f the g a s t r o - in t e s t ln a l tr a c t (one of stomach and one o f c o lo n ) have occu rred . Pour deaths ir o n cor pulmonale and pulmonary f i b r o s i s were in clu d ed in the c a r d io v a sc u la r re n a l ca teg o ry in men w ith 45, 41, 27, and 21 years in the trade resp ectiv ely . Table 3; A n a ly sis o f Deaths in Study Croup (January 1, 1946 through December 31, 1965) Cauoe o f Death T o ta l-P o p u la tio n -In 250 Men w ith Over of 594 20 fe a r s in Trade c M alignant neoplasms ( i 40-205) D igontivi system ( 1 5 0 - 1 5 9 ) Observed 18 2 Observed 16 1 Expected 2.54 R e sp irato ry system ( 16 0 - 1 6 4 ) O t h e r t U n s p e c i f i e d 14+ 14+ 1 .78 2 1 M ajor C ard io v ascu lar Renal D isease (330-334) Y lo lest Deaths (800-889) 3 0 ++ 11 18+v 6 19.09 A ll other, ceuoes Hot Known 5 4 -8 . 5 - ,' 1 72 : 49 ' 35.13 " -- 1 t b l ! C I e e ; i i _ r .& t , c n o f l i S t L I C E , " t i l E d i t i o n , V("nC, Dene v c , `,5 5 - 154 - # ` ^ S -a sin ? h i s t o r i e s are inadequate on stony a t the e a r ly deaths; and ncxr.ir.,-.rui ar.alyoie r ^ lita c to th ia - i l l so p o s s ib le only w ith p ro sp e c tiv e o b aervation a. The p o s s i b i l i t y c l u se fu l uata i s enhanced by the r e l a t i v e l y lo-* smoking ra te lo r th ese cu rren tly w or'in ;;. In t.te h a lf of t ' ; cu rren t p op u la tio n ao fa r in terv iew ed on th is : Table A; SeTer Smoked C igarette f Shopped Sacking {at l e a s t one year) C urrently Smoke C ig a rettes 16 is s 43 s f ie t ie r th is i s the r e s u lt ,,r a c tiv e campaigns a^siaa: cig a rstee sr.ektns in th is not know. I f the p a ttern pe r a io t s , p r o c c e c tlv e stu d ieo on the ir .t e r r v itt ic r .3 se r ar.d n a li n a a c ie s should be c f g r e a t in t e r e s t d^**'`**5 e next decade. pee, te at .n smekir.- The fo r e g o in g data confirm th a t in eu la tin r-w o rk ers in San F rancisco resen: l a lew fork and lutw J ersey and in the U nited Cir.5c.0s in th e ir r is k e f hot! lung ca n c e r . Vhat are the p r o sp ects o f b e tte r d e fin in g e t io lo g ic f a c t o r s . r isk through environmental studies? lia r werkera I.r.'ironnental Studies G en eral. The in s u la tin g worker, or la r g e r , handles a v a r ie ty o f in s u la t in g m a teria ls, des crib ed below, in Jobs th 3 t range ir o n commercial and major in d u s t r ia l con stru ction , to a a r ir .e c o n s tr u c tio n and r e p a ir . V.oat in s u la t o r s are tra in ed and q u a lifie d in a l l phases o f t.ccir c r a f t and fo r a i l m a t e r ia ls . Some s p e c i a l i s e , but over the years a g r e a t v a r ie ty o f je e s i s the r u le . We have found i t co n ven ien t to c l a s s i f y Jobs under two major h eadings: (1 ) lig h t and heavy in d u s t r ia l c o n str u c tio n , which in c lu d e s cov erin g p ip e s and ducts ir. o f f ic e end fa cto ry co n str u c tio n as w e ll as a p p lic a tio n s of in s u la iir .3 m a teria ls to b o ile r s , tracking towers and steam tu rb in es; and ( 2 ) n a rin e con stru ctio n and r e p a ir , which in v o lv e s a p p lica tio n of in s u la t in g m a teria ls to p ip e s , ducta and b o ile r s in sh ip s, but because o f the to r s r ig id s p e c i f i c a t i o n of m a te r ia ls and t h e ir use in predom inantly con fin ed sp aces ant s p e c ia l d i f f i c u l t i e s in v e n t ila t io n deserves to be regarded se p a r a te ly . The in o u la t o r `3 jeh when working w ith a sb e sto s co n ta in in g m a te r ia ls car. bp d ivid ed in to 5 g e n e r a l o p era tio n s; (1 ) th e p r fa b r ic a tio n o f n a t e r ia ls (10 If o f h is t i n e ) , m which m olccd pipe c o v erin g or b lo ck s are cut and shaped to f i t , u ain g e ith e r hand or power t o o ls . (2 ) A p p lic a tio n {about 40 h o f h ia tim e) in clu d es f i t t i n g , hammering in to place, carving, an d /or a tta c h in g m a te r ia ls by w ire or g lu e . O ) F in ish in g OO > of h is tim e) where insu la tin g c& teriola are coated with aabestoa containing ceneat, r esin s, asb estos, or cotton c l o t h , or petroleum -based s e a l e r s . ( 4 ) Tearing out <10 & o f h is t in e ) where old in su la tio n i s removed or unusable n a t e r ia ls are taken, o ff p rior to r c inoue.t io n . ( 5 ) Ulxing (5 of h ia tim e) in which a s b e s to s f i b e r s , fib r o u s g la s s , n in e r a l wool and cc c e n te are mined in v a r io u s com binations in b u ck ets or trou gh s or In a u te n n tlc m ixing m achines. ( 6) General work o ccu p ies the rem aining 5 % o f h ie tim e and in c lu d e s clea n in g .u p o f o ld in s u la tio n , tr a n s p o r tin g m a te r ia ls and moving equipm ent. The fo r e g o in g arc averages b,t3ed on tim ing cany workers during many jo b s u s in g a s b e s to s co n ta in in g m a te r ia ls . O bviously, they vary from s it u a t io n to s it u a t io n ; new c o n s tr u c tio n fo r example would n ot in v o lv e touring o u t. At p r e se n t, l e s s than h a lf the l a g g e r 'o time io sp en t w ith work i n v o l v i n g the usa of asb eotoo m a te r ia ls; our cu rren t e stim a te i s 45 Tabic 5 ; The I n s u la to r 's Job R rcfabrication A pplication 10 % 40 ji Pinirihing ' ' .............. -V ~ 30 T e a r i n g Cut o r R e p la c in g S ork ' 10 % 55 - r.,,,,1 ft-tir..- ? !a te r lila 'lpd b esto s co n ta in in g in s u la t io n m a te r ia ls era introduced lr.to C a lifo r n ia in the e a r ly 1920*3 , V ' ;h Canadian c h r y o o iile b ein g - f i d l a s c a t proa-acta. A lte r th e United Ota tec 3uv? m s t , --c-t p o s i t s aaoestoe In the n id ~J930's , a o a ite grad u ally became the predominant type of a sb esto s u e o i. I t was u se batil t0 " ttJca Qaoal':a b la n k ets and In carta m a t Ion. 1th ck ry n n tile i s th i C s s r .u f acture of raid ed ir.nulati.cn m a te r ia ls (ila g a esia and A a f c c s t c o I . 1'jirinc eor.a true t i e r ar.c. r ep a ir crea ted the r a j or decani lo r t h i s type of in s u la tio n during the e a r ly 1940' a. The use o f ea 03i t e as t i e predominant a30*atca f i b - r used con tin u ed u n t i l aocn a lt a r 196.0 whan c h r y a o tila was rein tro d u ced in to none rold ed p rod u cts. (Chart 2) The use o f pare c n c s ite Chart 2 8c111i***U**l<\o*fuY4toQ >rwafati'i I id *cca I'&itott St***, b lan k ets h&a now n e a r ly cea sed . Tocay, molded I n s u la tio n m a te r ia ls , w hies co n ta in 10 - 15 T> by weight o f a s b e s to s , say have pure th r y a o tila , pure aaioaite, or a n ix cure o f the two. Tie 55 - 50 % is u s u a lly calcium s i l i c a t e , cade by em ir.* amorphous diatD saceo'As earth viith lir.e ar.i cunr.r. w ith h ere. This heating ia not s u ffic ie n t to convert the diatonaceoua earth to c n a t o b a i i t e . C r o c id o lite and onrhophyllite are not uoed in i r s u lr t ic f n a te r ia ls in our area. Only about 40 % of the in s u la tin g e a t e n a id new being used are asbe3tsc containing; fibrous glass i s w idely used, accounting fo r 15 to JC a of in s u la tin g n a t e r ie l a p p lied in San F ra n cisco . The g la ss aoat w idely used ha3 a fib e r d ian etsr greater than 4 n icro n s, but acne s p e c ia lity m aterials are in the 1 to 2 m icros range. Other m a te r ia ls, which occupy about 10 * of the average in s u la t o r *3 t i n e , in clu d e the use o f fea r g la s s , cork , rubber, p o ly sty ren e and p ciyu reth an es. He a ls o kaa p o t e n t ia l derm atologic and in h a la tio n problems a s s o c ia te d w ith s o lv e n t s , a d h esiv es, ar.d coating m aterials. Environmental Surveys The dust exposures a s s o c ia te d w ith variou s phases o f the trade were sppra.i,ecd u sin g sam ples c o lle c t e d by m idget in p in g er and by membrane f i l t e r . For the a id g e t ispir-ger cou n ts, m ethods-used were those deecribcd ir. Public H ealth S e r v ic e B u lle t in Bo. 217, w ith 95 e t h y l a lc o h o l as the sam pling medium. campling tim es ranged fr o a 10 m inutes to 30 m inutes r e p r e se n tin g a maximum sample volume o f 3 cubic f e e t . U illip o r e type AA. f i l t e r s fo r the s t a t e d pore s ic e 0 ,S a ic r o n wore used in f i l t e r h o ld ers, 37 m illim eters- in diam eter w ith ar. approximate su rfa ce area o f 650 square m i l m e te r s . These ere used w ith e it h e r C a se lla or 4SA b a tte r y operated p erso n a l sam plers, w ith sam pling r&tco of 1 ,8 - 2 ,2 l i t e r s p er m inute. The p erso n a l sam plers were worn by I n s u la to r s , w hile a t woo;, , over p erio d s ranging fr o a 30 m inutes to 2 h ou rs. F ibers were counted by a n o d if ic i technique ( or the US"HE, ia which e oegaAt was c u t frctt the f i l t e r and p laced fa c e up over a crop c f 50 % dim ethyl p h th a la te end 50 v d ie t h y l or.ylate, and a cover o l i ? a p p lie d . The counting f i e l d was d efin ed by a g r a tic u le tiding phase c o n tr a s t i llu a in a t io n w ith a 4 m illim eter (4}x phase co n tra st o b je c tiv e } . Fibers d efin ed ao p a r tic le o having a 3:1 or g rea ter length to id th r a t io ere counted and p ie c e d in the fo llo w in g c a te g o r ie s : le a n thnn 3 ,5 micrcr.o ir. .cmeter ar.d le a s than 5 cic r o n a in le n g th ; le a s than 3 .5 m icrons ir, diam eter ar.d more than 5 microns in len g th ; more than 3 ,5 m icrons in diam eter nr.d l e s s than 5 m icrons m len gth ; tr,d mere than 3,5 r; crons ir. diam eter one more man 5 m cror.t i.c le n g th , The 'J 5 m erer Ctij: 'JTtZX X t o t a l a i 397 s i i j e t ir^ in g er and H' aecarsne f i l t e r sam ples c c llu it c a in broatking e c - c K ilo antedates c o n ta in in g m a teria ls wer# in use arc numnarisod in J sclo o 6 ar.d 7 , Tabla 6; Ir.?inCT Ou*i Concept r a tio n s by lob C l a s s i f i c a t i o n Jo b C ls s .iiin tlo n * L lj-.U ; 8 H e a v y I n d u s t r l a l Suckbsr of S sep l* * y.t&n f K ia -c j j K a r u . c C a iit tr u c '.is it in K c r u r i i S a n p lc s * K -n ^ t P re fa b ric A tio n A p p lic a tio n n ix lr-c F ir-ish io s T c .c in j O ut C e n tra l 11 24 17 n 17 u i.l 2 .4 4 .4 1 .4 4 .3 0 .7 7 0 .8 -1 4 .3 0 .4 -7 .5 0 .9 -9 .8 0 .2 -3 .9 1 .0 -8 .6 0 .2 -1 .F 4 1 .2 19 1 .4 15 1 .3 20 1.fi 1 15 I > 1_________________________ 9 .1 i.4 -2 8 .8 1 . 4 --3 , 9 1 .3 -2 9 .3 0 .1 -6 .2 4 H C 3 .c 0 .5 -l.S Table ?t iOiotwit m i a rim eanetsmTSoss w jo* cusiiriuriw Jab C l. litr c ie n 9 t* tft6 rie atlo ' A p p lie s H U tlt 7 c ln i Out G enTl 1.1 ( S t * n 4 ftu I n e u s t x l s l s t 5 p l t filsrW tc Ml l n th > v> JUflf* j..i K * r i * * c n 5 r u t : .*> *5\ii j >.***.r o f 1 S4k.plC( -i *3 '('ir'* /*- ^11 > V. M 20 .1 4. 1 .8 -1 5 .4 7 7 0 .4 J.W 16 3 .1 2 .0 3 . 2 - i a . i r Zl 8.2 w r- 1 7 4 ,1 2 .1 0 .1 -1 3 .4 P 19 1 1 .2 io 19 0 . 0 .6 ft.l-6 .1 U 0 .8 0.4 l 23 .8 2.4 1 .2 -4 3 .3 It 3 1 .3 1 0 .3 t I.fc 1 . 0 o -u .o i* C.J 0 .2 t4A{ 3 .3 -1 0 5 . 0 ,1 -4 7 0 .7-120 .3 -1 .3 1 .4 -1 2 6 0 -2 .3 V a r ia tio n s in t s s t e r ia la , Jobs, in d iv id u a l' s work h a b it s , o th er c o n str u c tio n a c t i v i t i e s nearby, teaperaturea, hum idity, a ir covenent, com plicated the strategy for environmental a p F r a in o l. Sacplea were i a a o s t s it u a t io n s d e lib e r a t e ly taken under c o n d itio n s where the h ig h e s t dust c o n c e n tr a tio n s r e p r e se n ta tiv e of a p a r t ic u la r Job ere being developed, tiidgot ia p in g er samples were taken during the course of the c o lle c t io n of the aeabrane f i l t e r sample fo r the sane can end o p era tio n . Cocparioon o f t h is data did not y ie ld uaerul c o r r e l a t i o n s betw een the cou n ts obtained by nsidgot ie p ia g e r and embrace f i l t e r . _ ^ r^ c J tr d s r o f r in 'te r e a tlih a t - t i i '^-weig h t rejBoCjm aeS^^^ i <v *twS-JT**cti-u'i" br - rirc> o 'fro1 oV-t. ). , iTrwould -net "have - b--e e n 'e s e----e e d e a--r ^ y c n . . . fo>t rm . a nan w o r k ic*r!~~U**S>*~je^S*r~?j b' _' IT' Mmr r d jag jrr ^rSt^i=T e.-irpri, ;y5nigrs.baff-rr^5?q7 h a sh est0 8 ." r7rke7fccfVthe.t,,,$306t..men work l e e s ..than h a lf .o f th e ir -tim e wi t h thl6~7B&tcrigr~ ieotiId ^ b gJan ^ ad d c'ip B e fe tT ' f n c t c ^ y i g l r e B 3. .andT-t I i k - i l C tUff/tt i i r m r n -- n TTTTT T 1 p1 t-- f H * -5 % *ry*_* I; 2 m I ; i 5- ?! ; ** --- \ t> U * * -t I --i--i ~T" 1 TTTTTTT n rm rf t iWm-'h s *i is imt s ----------! ' tr? ? 5* -4------1 m A 1 * ir ~ 4- " m H rj f-- H /I 0!. r <r >*1 P ut m- o 4H sr3 ta t tra> 4-I ( P1 t oft <9 tH-* 1 P- >P1 1* /) n >> H c1 i** i* < > iV*' oo p cya n f s M t ao ti o + Oca i*- O ipr ti rft Gft aO? tr *. t t P* *T? P Atr h 0JD i>t:r *A O.+ p *O1 O Ca S O <1` o n i(9 thi* Ata flL n pP` Pa n tn *T 4+ n rm >1 tKr *9 P- p . H- & 3 2o (S g or # r Ou V, (ft I* tit I*Cl M t fdt f.+- IU* o\ :lar i|U: tv rl PI P>* I * It I rtursjir^- fM i --r r r m T r i tt F m if h i -- ^--i 4-H f-H I-- M I--f H : I :+* t t l \ 4. **f l !< 4 m r> Si t; si i* "1 aunuitms <* i -- t t t t t t t i ------ r y r n " p r r n t ? , L \\ !-- ! - sr .I I ; nir I I--f--> ) n I li I t-- 4i-- i I fi }< t i ? 'r i I* ft : t *t+4 a J - 153 Tie c le a r c u t ev id en ce o f pneum oconiosis and in c r e so c d lu n g cancer m ke i t obvious *'.1 *, ..-.t-.: workers nave hod ex p osu res tn a t cannot bo t o le r a t e d . S etro o ^ cctiv e n a z ly a is ax th io t ir e cannot d iffe r e n tia te e ffa c to o f ( l) peak ourgee as contrasted with tim e-weighted evcragos tr.d (2 i tr.a p o s s i b i l i t y th a t e x p o s u r e s , p a r t ic u la r ly in marine c o n str u c tio n ars h i .peer in the period proceed in g and during World War II than ccey are r.sr-r, * ha.-e so evidence, htviever, to support the l a t t e r p o in t, ? - r r is ox a l , hare rep orted corp orative studied ion s m Tc* England shipyards 1^ 15*0 and 5 u s is g s im ila r in s tru ss s ta tio n s which in d ic a te no s ig n if ic a n t r e d u c tio n in average duot couuta, which had not been found to he ctrcescively high in 140. Theca iir .c ir .53 su g g est th a t a prudent cource would hs to lower -.r.rcsholi star.dards and imprevs p r e se n t work p r a c t ic e s . In d u strial hvricoe Su ccessfu l red u ction o f s over erne s t o l exposures n e c e s s it a t e s as centime, t ie a of .r.duatriti hygiene c e a s u r e s , watch mu3t he taker, s e r io u s ly and f o r c e f u lly im p le m e n ti. '.lethoij to co n sid er in c lu d e ; ( 1 / s u c a t it u t in g l e s s hazardous m a te r ia ls ; (2) er.cLcci" c e r ta in work ' areas; O ) providing lo c a l exhaust v e n tila tio n ; ( 4 ) requiring personal raspir.t-.cry protec tio n ; (5 i changing work h a b its and im proving g e n e r a l housekeeping. These p om in n i l ha taken up in tu rn . S u b s titu tio n o f m a t e r ia ls , p a r tic u la r ly fib ro u s g l a s s , has been going er. fe r mr.;; y ears, alth ou gh not fo r h e a lth r e a s o n s, la marine ar.d heavy in d u s tr ia l wotk, th ere i s , hev.ever, r.o s u it a o le s u n s t it u t e fo r a sb e sto s in s u la tin g .p r o u u o ts , which have a c tu a lly beer. in e r t cmmylused in our ares in r e c e n t y ea rs because of the in c r e a se in heavy in d u stria l cor.otruttitn. U nless i t could be shown th a t a so e e to s cannot be used s a f e ly , abandoning i t or pr0r .ib i-.is5 i t would be 0 d r a s t ic recom m endation. l a our o p in io n , e f f o r t s to uoe i t a a fe ly have r.oc yet been vigorously tr ie d . Enclosing operations e n tir e ly or p a rtia lly is appropriate for p refab n eotien ci fittin g s and b lc c k o . Kuds and cem ents should be nixed in e n c lo se d booths or autom atic miners ar.d c a r r ie d to work B ite s in c o n ta in e r s th a t would p reven t ev a p o ra tio n . Local e x c e s s t v e n t i l a t i o n a t a p p lic a tio n e l t e c i s im p ra ctica l i s co o t s it u a t io n s . Large power b o ile r and steers g e n e r a to r o p era tio n s cou ld , however, use lo c a l exhaust s y s te m sir.ee there work o fte n remains in one l o c a t io n fo r many hotC3 or weeks. U ltim a te ly , i t w i l l probably a found p r a c tic a l, even e s s e n t ia l, to v e n tila te core e n e r g e tic a lly in aarir.c construction arc re p a ir , not only to prevent in to le r a b le dust concentration:; but a ls o to am eliorate extreme tem perature and hum idity c o n d itio n s under which work i s being p e r fo r a e c , The tech n ica l problems to 0 t h is can be s o lv e d . P erso n a l r e s p ir a to r y p r o t e c t io n i s an iep o rta n t ad ju n ct to o th er neaaurca. Present aasko are not worn r e g u la r ly , even when provided, because they are h o t, ur.ccm fenable, in crease the e f f o r t of b r e a th in g , and in t e r f e r e w ith c o c r u n ic a tio n . ii&ny f i l t e r c a t c r is la , d esp ite t h i s high r e s is t a n c e , do c o t ad eq u ately f i l t e r out fib r o u s n a t e r ia lo , Research leading to the development o f b e t t e r - f i t t i n g , lo w -r e s ia ta n c e , f ib e r - r e moving ca sk s i s im p erative. In some s i t u a t i o n s , the in s u l a t i n g worker nay have to depend upon a su p p lied a ir system; but be cruet o f the need fo r hose and compressor, i t s u sefu ln ess i s U n ite d . Personal a ir supplied r e s p ir a t o r s w ith t h e ir own power u n its would be none v e r s a t ile and could be uDed for acre p a r t ic u la r ly dusty e x p o su res such as te a r ih ? out aboard s h ip . Xn&amuch as f i t t i n g and m aintenance of masks i s r e c o g n iz e d as e s s e n t ia l i f p erso n a l r e sp ir a to r y p r o te c tio n lo to be e f f e c t i v e , the independent nature o f many I n s u la to r s ' work cakes i t unrewarding to think 1a c o n v e n tio n a l term s. The id e a or e f f i c i e n t but cheep th --cwawey nook ic being explored by some. , Changing work p r a c t ic e s o f f e r s great p o t e n t ia l, exam ples Include in crea sed uoe of properly design ed prenolded and cu t f i t t i n g s , the use of w ater oprayo to wet n o t o r ia l before cutting, the en clo sed m ixing o f aude, the use o f I n d u s tr ia l vacuum system s fo r c lea n in g up ar.d when tearing out. I t i s b e l i e v e d t h a t a c o m b i n a t i o n of a l l the f o r e g o i n g , p r o p e r l y p l a n n e d ur.c t a i l c r e d t o m e e t the d i f f e r e n t r e q u i r e m e n t s o f th e many s n i v a r i e d j o b s the i m s u l c t c r meet do, c o u ld throughout construction s it e s . _ ' B C U S S iO -- j j a i l e r s o i ir.ctcence o; a a 3 W i i a and live nearly o-Txiiu r u t io betrtce- ohaervfca deatha i - o s can cer o f the lu n g and p leu ra o.-.d th s career expected ere In gen eral agreement w ith oonsr s tu d ie s c f m -u ia tin g workers. Thus, S e lik a ff et a l . fourd $,U tir.es the expected numcer o i r e s p ir a to r y cancer d eath s end X ieir.feld e t a l . , 8,4 tin e a , q u ite sim ila r to our fin d in g 7 ,5 t i r o s . Cur p o c u la t ic s as exposed to both c h r y s o ti.lt ana. am oaitu. th ere i s ao evid en ce th at they have e v e r aca *>igr.if le a n t c r o c im o lits exp osu re. P rosp ective stu d ie scay d evelop p a tte r n s th a t r e la t e to the changing usage o i c n r y s o t ils tins m o o ite ; but th-: us of v a r io u s c c s a in a tio n s o i ty p e3 and the v a ria b le la te n c y o f tunors na.ee i t unii.ee ly th a t th ese causative fa cto rs can ever be s a tis fa c to r ily separated. Tbs r e l a t i v e l y la rg e c e n te r o i c u r r e n tly employed in s u la tin g workers who have r.sver smoked c ig a r e t t e s or who have q u it io r at le& ot 1 year provide an e x tr e s u iy v a lu a b le population fo r p r o sp e c tiv e study r e la t in g to the I n te r a c tio n between a sb e sto s and c ig a r e tte smoking ( S e l i k o f f , 15&7). E x is t in g d u st le v e l , whether measured by m idget impinge ; or f i b e r counts from membrane ~J f i l t e r s , were not as h igh ae had been a n t ic ip a te d . The tim e-w eighted a v erages were w ith in jJ th e p r e se n t th resh o ld l i a i t v a lu e o f 5 m illio n p a r t ic le s per cubic f o o t , even fo r mcn'rnrkT.'Et^ f u llt im e n i l .' a s b e s to s . Ir. r e a l i t y , most men work le s s than h a l f of t h is w ith sue.-, m a te r ia ls , f i b e r co u n ts vers on the average betw een 2 and 10 f ih e r s / c c . N e v e r th e le ss, there was e v i dence, a s p oin ted out above, f o r both a s b e s t o s is and e x c e s s iv e tucor in c id e n c e . The poGoible e x p la n a tio n s are ( l ) exposures in th e p a s t were such h ig h er; (2 ) the peak dust an; f ib e r cou n ts are more im portant than the a v e r a g es; 0 5 there are o th e r substance presen t in in s u la t in g m a te r ia ls which augment the a sb e sto s e f f e c t ; and ( 4 ) our -prtBer.t p erm iscirle l e v e l s are too high; and (55 th e sh ip y a rd exposures during the period 19^0 to 1545, b ein g tr g e ly em osite and continued a t r a th e r h ig h le v e l s over s e v e r a l y e a r s, may be major c o n tr iutors to the present s itu a tio n . In our o p in io n , in the absence o f any evid en ce th a t work p r a c tic e s have changed s u f f i c i e n t l y to b la s e p r e se n t a s b e s t o s is on extrem e c o n d itio n s in the p a st and u n c e r ta in ty ^s to l e v e l s n e c e ssa r y to reduce cancer r a t e s , we th in k i t i s prudent th a t in s u la tin g workers not be per m itte d tc work under any c o n d itio n s t h a t exceed 5 nppcf by m idget ia p in g sr a and that } in d u s t r i a l hygiene and p erso n a l p r o t e c t iv e equipment be geared toward th e s e o b je c tiv e s'. Due to the changing work s i t e s and r e l a t i v e l y independent nature o f the in c u la tir .g workers, p r o v id in g adequate in d u s t r ia l h ygien e i e d i f f i c u l t . Our exp erien ce s u g g e s ts that at l e a s t in the U nited S ta te s j o i n t union-management programs w i l l be n ecessa ry fo r the education of workers and c o n tr a c to r s and fo r the e f f e c t i v e im plem entation of r u le s f o r s a tis f a c t o r y work p r a c tic e s. A m ed ical program to m ain tain a p p ro p ria te su rv eilla r.ee over in s u la tin g workero should in clu d e p e r io d ic c h e st f ilm s end e s tim a te s o f pulmonary fu n c tio n , the l a t t e r fo r comparative p u rp o ses, and to d e te c t o th er r e s p ir a t o r y d isea se upon which even minor a sb e sto a ie would be d is a s t r o u s , The e f f e c t i v e e a r ly d e t e c t io n o f lung cancer as a d isco u ra g in g problem at p r e s e n ts I t i e our c o n v ic tio n th a t sputum c y to lo g ic study needs much fu r th e r a p p lic a tio n end study than i t has h e r e -to -fa r r e c e iv e d . Su-mary The working environment and h e a lth s t a t u e o f in s u la tin g workers in the an t'rar.cisco area and ir. s e v e r a l other m etro p o lita n a r e a s o f tho Western U nited S ta te s were studied during the p e r io d 1555 - 67 . The i n s t a l l a t i o n o f in s u la tin g m a te r ia ls in th ese a reas ic dor.s by embers o f a o in g le in t e r n a t io n a l u n ion w ith a s ta b le membership now numbering approxim ately , >,00 men. Thsir. job -assignments can be c l a s s i f i e d as heavy* a n d 'lig h t in d u s t r ia l nr.d marine c o n s tr u c tio n and r e p a ir , liayor in s u la t in g ms t e n n i s used are e so e sto c co n ta in in g (45 &); <1.1 n r ia e i r e s a cn eeiv es, r.oioe, and h ea t e '.pcaurea. iVerfc p a tte r n s have been analyse and she# th a t 2 0 3 ; t e e r.ovr i s the trade save performed In a l l m ajor job c la a o lf ic a t io n o and have need a l l b a sic m a te r ia ls . Oust acr.scr.tration s re stu d ied by midget imptr.gcr and aenbrana f i l t e r sam p lin g. She former in d ic a te d t i n e - w e ig - ^ d aversfjeo in nearly o i l vtsrs s itu a tic r o be lew the present thrcehald H a s t value o f 5 m illio n p a r tic le o per cubic fo o t. i'cverth^l-aa, tbar? ore recatsonographic char.ee0 c o n s is te n t w ith aese at.oaia in 25 51 o f the membership, ranging frem ncr.e in men ur.icr 10 y ears i a the trade to over 50 % lr. thooc w ish over 30 years ia the t r a c e . Tho in cid en ce o f coacer of the lung or.d pleura during the p erio d 15io to ',555 m men w ith over 20 years Jin cc J o in in g th e trade won 7 ,5 t i n e s exp ected . Two deaths iron p leu ral m esotheliom a occurred in 7953 and 3554 in aer. with 3 and so years e ir c c Joining the trade. Recommendations are in c lu d e s f o r improved in d u s tr ia l h y g ien e, r e la t in g so v.orh p r a c tic e s and r e sp ir a to r y p r o te c tio n , fo r n o d ic a l s u r v e illa n c e , in c lu d in g p e r io d ic sputum a tu c ie s . Fare e f a study supporteli by Crcr.t UI-C0432 frea xne D iv is io n of Urtar. and In d u str ia i Health, F u c ile Health S e r v ic e , S ep a risen e e f H ealth, Hdueation. &r.d a lia r e ; and ty Cenerai Research Supp:cort Crar.t l-S G l-r R -C S iii fr e n th K aticoai lr .3 t it u t e s o i H ealth 10 th Scasai c f Public Heait U niversity of C a lifo rn ia . se r x e le y , C a lifo rn ia . R ef r e n c e s: A h 1 a a n , K.: A sb e sto se s Among in s u la t io n orkerc sr. Finland. F riesein ga o th e t e t a in te r n a tio n a l Congress or, O ccupational H ealth. Vienna, 1$66, ,;p. 23"-2 0 , - A h 1 a a r k , A .E .J ., Bruce, H .L .T ., ysxroa, A ,i'.; S ilic o s is - e n d oth er Rnsuhccomcsea in Sweden, pp. 353-357. 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A Stuuy o f R a d io lo g ic a l and P a th o lo g ic a l F eatu res o f tOO Cases with a Considera t io n of H p id eciology, B r i t . Sed. J . , 7 :10S-1C74, 7556. - K e e n e , end Savon, O c su o a tie sa l Haaaras o f Pipe I n s u la t o r s . Areh. R nviron. H ealth , 7 3 :7 7 1 -7 6 4 , 73, - K 1 i n X 1 d , I., l e s s i t e , J . , Kooyaaa, 0 .: m o r ta lity E xperience ir. a Group o f A sbestos 'A'oricers. Aren, in v ir o n . H ealth , 1 5 :1 7 7 -1 6 0 , 1567. - L e a t c o r t G .i,, ant Sanderson, J . 7 . : iO=e O boervations oa A s b e s t c s is . Ann. Cccup. H yg., 6 :5-74, 75b3. - l i c h e n , J .: M alignancies in A sbestos icrS icrs. Arch. Environ. H ealth, 13:19-t>27, H-66. - L i n d e k e n , C .l,, Pelrocls, P h illip s , .a ,, Taylor, R.D.: Surface C o llectio n H fficiency o f Large- Fore liembrane P i l t e r o . H ealth P h y s ic s , 1 0 ;7 , 1S. - H a r r , b'. y . ; A sbestos hxponurc During Laval V e sse l Overhaul. Amur. I n d u s tr . Hyg. Assn. 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P resen ted at the Environm ental E p id cn iology S e ssio n o f the 55th Annual M eeting of the American P u b lic H ealth A sso c ia tio n in Miami Roach, F lo rid a ,- October 25, 1567. *- Subcommittee cn Duct P rocedures in A ir A n a ly sis, 7935-30* lu s t Procedures ir. Air A nalysis: The Sampling and A n a ly sis of I n d u s tr ia l D u sts, Amer. Pub. Kealtr. A ss. Tearbock. - Subcommittee on 5tanc.ard Methods. T ra n sa ctio n s o f F i f t h Annual M eeting of the N a tio n a l Canfetcr.ce of GovernnenlsJ. In d u str ia l H y g ien ia t3 . Washington, 1942.