Document Z40gxKdMbO7NVz0kpQDJ0N6p8

FILE NAME Brakes BRK DATE 1984 DOC BRK256 DOCUMENT DESCRIPTION US Gov Report - Investigations of Health Hazards in Brake Workers Exposed to Asbestos AOU ETAL PB83-220897 Information is our business INVESTIGATION OF HEALTH HAZARDS IN BRAKE LINING REPAIR AND MAINTENANCE WORKERS OCCUPATIONALLY EXPOSED TO ASBESTOS NIOSH CINCINNATI OH AUG 84 U.S. DEPARTMENT OF COMMERCE National Technical Information Service PB83-220897 _ Investigation of Health Hazards in Brake Lining Repair and Maintenance Workers Occupationally Exposed to Asbestos NIOSH Contract 210-77-0119 Principal Investigator William J. Nicholson Ph.D. S ( ENVIRONMENTAL SCIENCES LABORATORY MOUNT SINAI SCHOOL OF MEDICINE OF THE CITY UNIVERSITY OF NEW YORK > OOOO REPRODUCED BY U.S. DEPARTMENT OF COMMERCE NATIONAL TECHNICAL INFORMATION SERVICE SPRINGFIELD VA 22161 Investigation of Health Hazards in Brake Lining Repair and Maintenance Workers Occupationally Exposed to Asbestos Authors William J. Nicholson Ph.D. Susan M. Daum M.D. William V. Lorimer M.D. Henry Velez M.D. Ruth Lilis M.D. Irving J. Selikoff M.D. Albert Miller M.D. Henry A. Anderson M.D. S. Alf Fischbein M.D. Edwin C. Holstein M.D. William N. Rom M.D. M.P.H. Kenneth D. Rosenman M.D. James D. Todaro M.D. Wei Cheng M.D. Veetai Li B.S. Diane Tarr B.A. \ ENVIRONMENTAL SCIENCES LABORATORY MOUNT SINAI SCHOOL OF MEDICINE OF THE CITY UNIVERSITY OF NEW YORK / = PLerTsat ol REPORT DOCUMENTATION 1. PAGE 4. Title and Subtitle NO. 2 NA Investigation of Health Hazards in Brake Lining Repair and Maintenance Workers Occupationally Exposed to Asbestos 7. Author W.J. Nicholson 9. Performing Organization Address Name and Mt. Sinai School of Medicine of the City University of New York Sponsoring 12. Sponsoring Organization NIOSH Name and 4676 Columbia Parkway Cincinnati Ohio 45226 15. SupplementNaorteys 1. Recipient's PB8 3 5. Report Date No. 220897 6 NA & Performing Organization Rept No. 10. Project Work Unit No. NA 11. or No. Contr Gra anc t t C 210-77-0119 G 13. Reop f o Repr ortt& Period Covered 14 NA 16. AbsLt imir t 2a 00 c wort ds There are several sources of asbestos exposure to garage mechanics automobile repairmen First of course is that the asbestos exposure from the debris of brake or clutch lining wear particularly when the brake or clutch housing are cleaned using a high pressure air hose Second garage mechanics may be at risk from exposures during the use of autobody filler and finally asbestos dust can be disseminated during mixing and application of undercoating materials each of which has contained the fiber in previous years In order to determine the extent of the asbestos risk from garage maintenance work NIOSH has contracted with the Environmental Sciences Laboratory to conduct a clinical examination of garage mechanics The examination was to focus specifically upon those manifestations of asbestos disease such as ray abnormalities and pulmonary function deficits that would elucidate the possible effects from exposure to asbestos in garage employment 7. Decument Analysis a Descriptors asbestos brakes automotive respiratory a identif Eni dedeTr ers ms c COSATI Group Availability Statement AVAILABLE TO THE PUBLIC 239.18 18. Security Class This Report UNCLASSIFIED 28. UNCLASSIFIED Page Sae instructions on Reverse UNCLASSIFIE_D_ t 21. He of Pages 130 130 22. Price OPTIONAL Formerly FORM 272 6-77 Deportment of Commerce ACKNOWLEDGEMENTS This study involved the cooperative effort of a large number of indivi- duals of the Environmental Sciences Laboratory The clinical examina- tions were under the direction of Susan M. Daun M.D. William V. Lorimer M.D. and Henry Velez M.D Other examining physicians inclu- ded Drs Henry A. Anderson Alf Fischbein Edwin C. Holstein Ruth Lilis William V. Rom Kenneth D. Rosenman Irving J. Selikoff and James D. Todaro The pulmonary function laboratory was under the direction of Dr. Albert Miller with assistance from Raphael Warshaw Mark Geiger and Joann Haas Frances Perez Diane Monahan and Blanca Solano were the capable laboratory technicians rays were read by Drs Daum Lilis Selikoff and nan Cheng The organization of the data files and the preparation of the various analyses were performed by Veetai Li and Diane Tarr Mary Bell Valerie Josephson Shirley Levine Veelai Li Amy Manowitz and Diane Tarr conducted the occupational history interviews Scheduling was the responsibility of Ernest Dobbs Selma Annenberg and Sidney Sibel typed this manuscript Without the close cooperation of all of the above this study would not have been possible uw TABLE OF CONTENTS Intro cccd ccu c cet eei eeo e en ee e wee ees eeeaene ane n wwe eree Materials and Methods A a re Study population aes ecee ete e rene be eaeeee Examination locations and protocols ea nc eens cheese Results 2... ccc cece cee nae ee eaee cane ce eneecutenreseecenees ; Occupational histories aren see eee tween wenn ray abnormalities ... ees. ceaen ren eee Age standardization of ray readings Smoking standardization of ray abnormalities Standardized ray abnormalities by work activity Autobody repair and undercoating ..... oe Effect of previous shipyard employment Evidence of malig cccn ccca reneen ernec st eny eees Pulmonary function tests eee eeee Cee ee eee cee Principal spirometric tests cc reece ee eee ene nene Measures of small airway flow ... cece ewer eee enn eens Possible effects from mechanic garage equipment Autobody repair ect ....... oeteerereeres sees Correlations between ray abnormalities and pulmonary function tests e ee Dar eesen re t ce Comparison with other populations ee eeee Physical examination result ees ccm eee en enc nee e ee Laboratory findings ee cetee ee Nickel concentration in welders er pace e ce r ns ts cecee Asbestos exposure data ccc eee ee ere tere reese sees Review of published res 0. ceu ce ceel ce eeet n eee es nonce Measurements in New York City facilities Estimates of study population exposure o- Summary eee ete ences wee e neces rr are rr ar References ee enerc cere rert e e eres ate e eee e eres Appendix ... ccc ... ac near cette t ee estes e esse eeeeeees yee eee eee tee 1 2 2 5 12 12 17 26 28 29 36 38 41 41 41 46 52 59 33 33 65 74 74 86 86 90 93 93 97 100 ii INTRODUCTION Several investigations have indicated that significant asbestos exposure may occur during brake maintenance and repair work Nicholson 1979 Rohl et al 1976 Hickish and Knight 1970 Limited studies have suggested that exposure may be associated with the risk of asbesinduced disease including both pulmonary asbestosis and asbes associated cancer Lorimer et al 1976 Greenberg and Davies 1974 These limited reports do not however indicate whether the risk of associated disease is common or uncommon The question is of importance because over one million workers are regularly or inter- mittently engaged in vehicle maintenance work in the United States at this time Bureau of Labor Statistics 1979 Additionally a large number of other workers were formally engaged in such work in the past and now are either retired or employed otherwise It is estimated that 4,940,000 individuals are currently alive with such current or past employment Nicholson et al 1982 There are several sources of asbestos exposure to garage mechanics and automobile repairmen First of course is that the asbestos exposure from the debris of brake or clutch lining wear particularly when the brake or clutch housing are cleaned using a high pressure air hose Second garage mechanics may be at risk from exposures during the use of autobody filler and finally asbestos dust can be disseminated during mixing and application of undercoating materials each of which has contained the fiber in previous years In order to determine the extent of the asbestos risk from garage maintenance work NIOSH has contracted with the Environmental Sciences Laboratory to conduct a clinical examination of garage mechanics The examination was to focus specifically upon those manifestations of asbestos disease such as ray abnormalities and pulmonary function deficits that would elucidate the possible effects from exposure to asbestos in garage employment MATERIALS AND METHODS STUDY POPULATION The study population for this project consisted of members of the following union groups who routinely performed brake maintenance repair work 1. * Local 259 of were employed the United Automobile in commercial garages Workers UAW whose members in New York New Jersey and Connnecticut Also included were all pensioners maintaining vested rights in a program administered by the Local 2 Local 246 of the Service Employees International Union SEIU employed in New York City municipal garages The unexposed control population for the above brake workers consisted of 1 Local 259 members and pensioners employed currently or previously in parts warehouses New York City and amphibious vehicle con- struction in Stamford Connecticut and Schenectady New York 2 District Council 37 DC 37 Municipal State and Federal Employees Union members employed in New York City as motor vehicle operators or traffic device repairmen The above groups were selected prior to the beginning of the project as the study and control groups for determining the effects of possible asbestos exposure on workers engaged in brake maintenance and repair work The control groups were chosen because of membership in the same union and similar employment circumstances but without brake maintenance work As the study progressed it was found that many of the control population had had exposure to asbestos in other circumstances such as shipyard work and that fewer DC 37 members were participating in the examination than was initially expected Thus in consultation with the project officer it was decided to add to the control groups the rays to be taken in examinations of Local 595 UAW members em- ployed in production maintenance jobs in an automobile body construction facility in Linden New Jersey These workers were to be examined for effects of lead exposure associated with their work in an examination April 7-10 1980. An analysis of their work activities had indicated that their current employment provided only limited opportu- nity for asbestos exposure The decision to include this group was made prior to the April examination In order to reflect the effects of asbestos exposure only those in- dividuals with ten years of employment in a particular trade were considered for examination In the case of the UAW members this con- sisted of all individuals with ten years of union membership For SEIU members who were classified as mechanics in the New York City Civil Service Employees categorization five years of prior automobile maintenance work were required in order to obtain such a status Thus the criteria of five years of union membership identified individuals who had at least ten years of employment in garage work as a mechanic or apprentice Table 1 lists the distribution by seniority date and union affiliation of all individuals who were invited and who participated in the examinations The response was limited by several circumstances One was the dis- tance many individuals had to travel in order to reach an examination site For example both Local 259 and DC 37 Headquarters at which most examinations were held are located in lower Manhattan whereas most study participants lived in Brooklyn or Queens Many lived at even greater distances in Westchester or Nassau County N.Y. or in New Jersey Examination sites were arranged to accomodate as many of the study population as possible but many individuals still lived at considerable distance from a site Another factor was that most shops organized by these unions are relatively small 79 of the population workers in shops employing fewer than 30 members only sixth of whom would have been employed for longer than ten years 259 9Tt < <zt gee garge garge invted 97 construction invited invited invted LS Ste z 28 particpated maintenace invited particpated uy sxzeak seay] OZ Ajpouas 315zauoT 20.0-29.9 197 197 pojyedia ATens 48ze od 5 30.-9 pajypauy pazTWT Total 676 676 Total sopueyom Percentage Percntage T Retires 395 395 43. AQFOUS quowkTda @TauL Aq MVN Percntage YUewoTds STOPFYSA- 15.9 jo U7 ES S O< 26% ve z6 (282) 97 T 82 69 ral < S SIT ey 15 ST (9 (7S) T) 907 9< UBY ( Od SBT 02 OU vsoy sem 10x AQFZO 892 sem BY se AQZO YIP NIGS |yQ-4q qof Jo 20 years Becausof particng years azoqun reflected employedin syy particpang Vsvays poypAury Ce" (6*ST) Jusao1 particpating Vo employment distributions distributions job employment for | 7) S 94 L6T 84 949 G6e seniority seniority syq UP sit s1z9M YQ sTenpa,uy SUOTICPLRXS 6T-0OL 62-02 asequieg Ay peqfyot Jo ct SOAFI savozuoyunfiopuas > 6 viow ase 6<-00< 120 YY Teo] qued.194 DY Jo UE osnvray joUoyQ air The contact with individuals in these shops was by mail with letters from the Union President and Dr. Irving J. Selikoff of Mount Sinai School of Medicine followed by a phone call from Mount Sinai personnel In the larger shops where the program was also described by the Union health and safety representative and attendance encouraged greater participation resulted Finally only one examination was held at each of the sites outside of Manhattan and those unable to attend on a given day could only be accomodated at a clinic in New York City These factors led to a particularly low response of the 264 individuals invited cipated to the examination versus 53.4 at the site in Long Island where large shops of Condec only 23.8 parti- Information was obtained by phone and from the return mailer of the reasons for participation These are tabulated in Table 2. It also was found that of those sent invitations 2.1-5.3 were unde- liverable by the post office EXAMINATION LOCATIONS AND PROTOCOL Examinations were held at approximately monthly intervals from May 1978 through February 1980 at a variety of sites chosen for their conven- ience These to the residence or employment included the union headquarters location of Local of the participants 259 UAW in New York City and Schenectady New York the Community Center Stamford Con- necticut the headquarters of DC 37 State County and Municipal Em- ployees Union in New York City the Paterson Clinic Paterson New Jersey the Mount Sinai Multiphasic Medical School of Medicine Center Hempstead Long Island and New York City For those locations without ray facilities portable units were obtained In each lo- cation spirometry stations were established ment of the Pulmonary Function Laboratory using field survey equip- of Mount Sinai School of Medicine Laboratory examining and interview stations established in the available space in all facilities were easily Appendix 1 is the form used for all examinations The examinations consisted of a complete occupational history with detailed descriptions Table 2 . Reasons given for participation in examinations Do not wish to participate Not interested Too busy at this time Inconvenient time Recent examination Current illness injury or incapacitation Illness or death in family Too far to come or moved away Miscellaneous health reasons : Telephone response 20 - 20 20 Mail response 175 5 of work activities that could affect the health of the individual descriptions of work practices during brake maintenance and repair work and the use of personal protection devices Special care was taken to elicit information on previous exposures to asbestos and other dusts that might be pneumoconiotic The clinical examination tests and procedures consisted of 1. complete medical history 2 current and past uses of medications 3. o 4 5 current and past symptoms physical examination complete blood count including a differential count on individ- uals with an abnormal white cell count 6 20 channel blood chemistry analysis 7 pulmonary function tests including determination of complete volume characteristics 8 14 17 inch full size anterior chest ray All chest rays laboratory results and examination findings were reviewed immediately for conditions that might require urgent attention If such conditions were found the patient was notified and if he wished his personal physician was called The radiographs were subsequently interpreted using the ILO C International Classification of Pneumoconioses Parenchymal changes of 1/0 or greater were con- sidered abnormal as were pleural thickening pleural plaques and pleu- ral calcification Additionally other abnormal disease conditions were noted See Appendix 2. Predicted values for spirometry were based upon the revised analysis by Miller et al 1980 of data of Morris Koski and Johnson 1971 The criteria for individual spirometric abnormalities are listed in Table 3 After interpretation of the rays and review of all laboratory and clinical findings a report and letter were prepared and sent to each participant The two most important parameters for the assessment of health effects from asbestos exposure are the manifestation of small irregular opacities on an interpretable ray and restrictive pulmonary Table 3 Criteria for normality of spirometry FVC FEV1 MMF FEV1 FVC > 80 of predicted > 80 of predicted > 75 of predicted age age age 29 30-59 60 .75 2.70 .65 FVC predicted 0.147 x Height in 0.025 x Age yr - 4.241 FEV predicted 0.094 x Height in 0.032 x Age yr - 1.426 For Blacks the predicted values were 89 of the above MMF predicted 0.044 x Height in - 0.046 x Age yr + 2.806 For Blacks the same values were observed From Miller Thornton Smith and Morris Am J. Ind Med 55-68 1980 function deficits Of the 916 individuals from the four groups listed above who participated in the examinations readable rays were available on 860 individuals and interpretable pulmonary function tests on 883. The 6.1 unsatisfactory rays stemmed from the use of portable ray facilities that did not have processing facilities immediately available In one examination a light leak developed in the ray cassette holder that rendered 30 rays unreadable 24 from SEIU members and 6 from DC 37 members Because of the extensive travel in- volved few with unreadable rays from the examination took advantage of the availability of another ray at a later examination The distributions by union affiliation and work activity of participants with valid rays and pulmonary function tests are shown below in Tables 6 and 7 ray developing facilities were not available for films taken by the portable units and by two of the fixed installations used in this survey The unavailability of a film for review at the time it was taken led to a less than desired quality for the readable rays Both overand -penetrated films present difficulties in the interpretation of the minimal changes seen with low level asbestos exposure Thus a greater degree of inter- and observer variability exists with the interpretation of the films of this survey by the physicians reading the rays than with films taken by the same technician with the same equipment and continuously monitored for quality Following the completion of the examinations all rays from all examinations were intermixed masked and identified with a coded number If multiple films of the same individual were taken these were labeled with a single number and designated as A B C etc. These films were read as group individually by three experienced readers who were free to utilize the best P film for the determi- nation of an ray reading Results for the three readers and that of the individual who read the rays following each examination were entered on a code sheet for each participant The results of the four readings were then averaged using the following criteria 10 1 All parenchymal readings within given categories rounded irreg- ular and combined were averaged utilizing the ILO U twelve point scale If the average came exactly half between two values as is possible with an even number of readers the values of the three readers who read the entire group of rays at one time determined whether one averaged up or down 2 If the reading of one individual differed by three units from that of the average of the others all readers read that particular film The readers were told that a disagreement existed on par- enchymal readings but no other information was provided If the subsequent reading brought the outlying interpretation into closer agreement the average of the second readings was utilized If a disagreement of the same magnitude still persisted the ray was interpreted by the entire group of readers and a consensus ob- tained This occurred for fewer than five rays 3 If a disagreement existed among the readers as to whether or not pleural changes existed such films were also read with the specification that a disagreement existed with respect to in- terpretation of the pleura Following a second interpretation a determination was based upon the average of the second reading If an ray was interpreted as normal by two individuals and abnormal by two others the interpretations of the same three readers as before determined the overall classification Approximately 110 rays read early in the sequence were reintroduced into the group at a later time to provide information on reproducibility of the individual readers For this analysis no second readings as described above were used Table 4 shows the distribution of dif- ferences of parenchymal and pleural readings of each of the four read- ers along with the average score of the parenchymal readings for each| individual based on a 12 point scale As can be seen both the interobserver reproducibility and observer comparability of readers is well within similar variations determined by other interpretation groups Rossiter 1972 Glover Bevan Cotes et al 1980 See Table 12 for the results of individual and averaged readings by job category 11 Table 4 The variability and reproducibility of three ray readers participating in this study 4 * Reader 1. 2 3 Subcategory difference Second reading - first reading -3 -2 -1 0 1 2 3 0 4 13 93 1 82 1 0 Standard deviation 0.77 Average score First reading 2.40 Second reading 2.241 0 5 20 66 10 4 0 56 Average Standard deviation 0.83 score First reading 2.67 Second reading 2.55 3 8 13 63 14 5 0 57 Standard deviation 1.01 Average score First reading 2.51 Second reading 2.38 ( ) = Number of films read as 0/0 both times 1 / = 1 = etc. 12 OCCUPATIONAL HISTORIES RESULTS A careful review of all jobs each person held revealed that many examinations participants had previously been employed in a job with potential for significant asbestos exposure This is shown in Table 5 for each union group that participated in the examination or whose rays were utilized for analysis Overall 21.5 of the study participants had an identified or highly probable exposure to asbestos in previous employment or military service The percentages were particularly high in the groups that included men with skills as welders vehicle construction and city maintenance mechanics Here asbestos exposure in shipyards or during the welding and cutting of high temperature equipment insulated with asbestos was identified Of the 234 with identi- fied or possible asbestos exposure and readable rays 87 rays were of men previously employed in shipyards 8.9 of all In order to eliminate any confounding exposure in the analysis of brake work the health effects of individuals with identified and possible exposures to asbestos and other dusts were analyzed separately according to the four broad exposure categories of Table 5 direct occupational asbestos exposure shipyard and heating trades possible asbestos exposure and exposure to other dusts In the direct occupational category were those individuals that insulated pipes worked in asbestos manufactur- ing operations or had similar exposures Among those classified in shipyard or heating trades were those with any shipyard employment or work that involved the repair installation or maintenance of boiler room equipment or equivalent exposures Also included in this cate- gory were a group of men 12 that insulated mufflers with asbestos or installed brake linings on continuous basis during the construction of amphibious vehicles An individual was classified in the category with the highest potential asbestos exposure as ordered above irrespective of the total employ- ment time in that category It should be noted that while every care was utilized in attempting to elicit a past asbestos exposure this may 13 Table 5 The distribution by union affiliation and type of work activity,, of study participants Type of work activity No identified asbestos exposure or garage work Garage employment but no brake work Brake work Union affiliation UAW 259 Maint Const UAW 595 DC 37 14 3.9 70 55.6 85 69.1 28 28.9 82 2 - 23.0 1.6 18 18.6 217 2 - 61.0 1.6 18 18.6 Other dust exposure 7 2.0 3 2.4 18 14.6 1 1.0 Possible asbestos exposure Shipyard heating trades 14 3.9 23 18.3 22 6.2 262 20.6 11 8.9 5 4.1 13 13.4 17 17.5 Direct asbestos exposure - insulation factory work - 4 2 3.3 2.1 Totals 356 126 123 97 Totals with other possible asbestos exposure 36 10.1 372 29.4 20 16.3 32 33.0 SEIU 246 Totals 8 )2.4 22 6.5 205 124 213 63.2 450 7 2.1 22 6.5 61 18.1 4 1.2 36 83 131 10 337 1039 7 25.8 224 21.5 ( ) = Percentage of union members in job category 1 Four men had missing occupational histories and These were excluded from further analysis 2 Ten of these 26 individuals insulated mufflers and 2 continuously installed brakes during amphibious vehicle construction Their other asbestos exposure occurred as part of the job under study These were not included in totals other possible asbestos exposure In subsequent analysis however they were included in the category of shipyard heating trades 14 not have been successful in every instance due to inadequate recall of the worker or because an asbestos exposure may have occurred without his knowledge The large number of workers with identified exposures suggests the possible scope of the problem Such unidentified exposures would however contribute proportionately to the abnormalities found in both the exposed brake workers and unexposed groups under study In the analysis that follows workers will be classified according to their asbestos exposure irrespective of their union affiliation or job classification at recruitment a It is striking that 8.9 of all participants had previous employment in the shipbuilding and ship repair industry As approximately 45 of the study participants were over age 55 many had opportunity for employ- ment in one of the several New York area shipyards that operated during and after World War II Brooklyn Navy Yard the Hoboken yards of Todd and Bethlehem Steel Approximately 4,500,000 men and women were employed in ship construction and repair during World War II Nicholson Perkel and Selikoff 1982 This constituted 9.4 of the agricultural national male work force in 1943 but a much smaller percentage was employed tics 1979 after World War II -0.5 Bureau of Labor StatisThus the finding of such a large number with shipyard employment in this study is understandable and provides an opportunity to evaluate the effects of past short shipyard work as well as that of garage employment Tables 6 and 7 display the distributions by work activity of those for whom interpretable rays are available and for whom valid pulmonary function tests were obtained As can be seen lower percentages of readable rays were available for DC 37 and SEIU 246 members be- cause of the previously mentioned loss of 30 rays The individuals involved however were randomly scattered among the different exposure categories The percentage of individuals with valid pulmonary function tests 96.4 compares favorably with other surveys Again those with missing tests are randomly distributed among all occupational categories 15 Table 6 The distributions and percentages of readable rays by union affiliations and type of work activity Type of work activity Union affiliation UAW 259 Maint Const UAW 595 DC 37 No identified asbestos exposure or garage work 14 100.0 67 95.7 85 100.0 25 100.0 Garage employment but no brake work 81 2 98.8 100.0 - 14 77.8 Brake work 214 2 98.6 100.0 - 18 100.0 Other dust exposure 7 3 100.0 100.0 18 100.0 0 0.0 Possible asbestos exposure 14 100.0 21 91.3 11 9 100.0 81.8 Shipyard heating trades 22 26 100.0 100.0 5 100.0 13 76.5 Direct asbestos exposure - insulation factory work - 4 100.0 1 50.0 Totals 352 98.8 121 96.0 123 100.0 80 87.0 SEIU 246 Totals 8 100.0 202 98.5 19 86.4 116 93.5 187 87.8 421 93.6 7 100.0 35 97.2 20 90.9 57 93.4 77 92.8 123 94.0 4 100.0 302 89.6 9 90.0 983 94.6 ( ) = Percentage of category with readable ray 16 Table 7 The distribution of valid pulmonary function tests by union affiliation and type of work activity,, Type of work activity Union UAW 259 Maint Const affiliation DC 37 SEIU 246 No identified asbestos exposure or garage work Garage employment but no brake work 13 92.9 80 97.6 69 98.6 2 100.0 25 89.2 18 100.0 8 100.0 22 100.0 Brake work 211 97.2 2 00.0 17 94.4 206 96.7 Other dust exposure 7 100.0 67.3 67.3 100.0 100.0 7 100.0 Possible asbestos exposure 14 100.0 23 100.0 11 100.0 20 90.9 Shipyard heating trades 21 95.5 262 100.0 17 100.0 56 91.8 Direct asbestos exposure - insulation factory work - J 4 50.0 100.0 Totals 346 97.2 124 98.4 89 96.7 323 95.8 Totals 115 95.8 122 98.4 436 96.9 17 94.4 68 97.1 120 95.2 5 83.3 883 96.4 ( ) = Percentage of category with valid pulmonary function test 1 Two men with valid pulmonary function tests had missing occupational histories 2 No pulmonary function tests were performed at the Linden New Jersey examination of UAW 595 members 17 RAY ABNORMALITIES Tables Sa and 8b list the averaged readings for the parenchymal ray abnormalities according to the ILO C International Classification of Pneumoconioses for the various asbestos groups established in this survey Seven hundred and ninety of 983 readable rays were classified as having 0/0 or 0/1 readings for parenchymal fibrosis One hundred and seventy were classified in category 1 0-1 and seven were classified as having 1-2 abnormalities Of those with normal pleura 735 of 871 84.5 were also normal for parenchymal changes For those with abnormal pleura the percentage with normal parenchyma was much less Only 64 of 113 56.6 of the readings were categorized as 0/0 or 0/1 Tables 9a and 9b list the pleural abnormalities according to the se- verity extent and thickness of pleural thickening and whether or not calcification or pleural plaques were seen The greatest proportion of pleural abnormalities consisted of pleural thickening 89 of 113 Pleural calcification was seen only infrequently being identified on only 12 rays including eight for which pleural thickening was also noted Fleural plaques were seen on 38 rays including 16 for which pleural thickening was also identified and one with pleural calci- fication The degree of pleural abnormalities was relatively minor Of those with and thickness pleural A thickening 42 had the lowest category of extent Twenty were categorized as either A or 1 The more severe examples of pleural thickening were largely confined to individuals who had either direct asbestos exposure or had previously been employed in shipyards Tables 10 and 11 list the percentages in the different occupational categories according to the type of ray abnormality As can be seen from Table 11 the percentage with any abnormality among those with garage employment is 24.2 compared to 18.8 among individuals with no stated asbestos exposure or garage employment Corresponding percentages for parenchymal abnormalities are 19.0 vs. 15.3 and for pleural abnormalities 8.4 vs. 8.9 respectively for those with garage 18 number AVFaTIOfi z/e YI0M BUA Type 02 work t/z g Suipazosae Z/t exposure identfied garage Soya[eurq Garage work No eg Baineld Other STqeL Avz-x [ewaoN dustexposure [eukysred asbetos heating Fo 420385 , pue categorization Joqum no oul categories 4) ) 0 0 fa) re) 0 I to 0 if 9 T () 0 Normal Normal c 0 0 0 activty i 9 0 9 9 L l ay. -x2 0 t opacitesopacitesUQ daey 0 < Parenchyma Parenchyma oste *yz0m 0 9 UeF P& arenchyma 2/2 2/2 ayeig work 107 9 ras z 0 oO 3 atqz3sOASaqse 4 8 1 il 19 eT 84 00 oTqey . 1) cz Zz 66 Ao f*a t 3"sse yons use OF Sq 1 UF 343 2 UF is 30 Z^' OIt LU <Z LZ = trades 52 27 702 Ot O < 2G 0 z08a,e>A9MOCT ) ' sy IsyWO 0 xay2zy S$ 897 0 00 & satTroFaqed ansodx work 0 factory ansodxs 0 ainsodxe soyeqsy o8er3 267 exposure activty asbetos e.g clasifed of atno indvual in work such activty in other lower categories shipyard _~ Ss (q2z0m Bapexy YK Jo 0 MOT, 0 0 uy indvidual AzoqBy ou TayxIOK person category clasifed category OF e.g. also have On have the ex- 19 </Z AZTAT RIS Z/Z YAO 0Ff Type workwork YuTproa.8 exposure identfied identified employment SofjptTewrug No Jo o/1 98 Bainatd Other 9TqeL Aer-y [Tewmouqy Posibleasbestos TewAqsuzed Shipyard heating Fo AroZa eS Totals pue categorization Aoqun worker ayy asbestos fe) 0 6) ) Abnormal 0 4) 0) 0 ag 0 ) Profusion ) 0 I 6) ra aqt X39 0 0/0 0 0/1 0 1/0 ra) asbestos r4 T t 0) 0 1 opacitesopacites UH oaeq 1/2 re) 2/1 Parenchyma Parenchyma "Yx0% 0 | < UBT ueosad ASYIO p[noa ayeIq t 9 z 17 0 0 t 0 sOySqse szayrzom 6 6 <9 ) < oT! AO -a'y 3'ase 0 ras yous fatqey aTqez 0 03 T ze a9 0 UT 0 VaNnsSOdxa pzed tys exposure exposure z Zz m 2 tl 0 AaeMoy 0 s) Se sy ADO a7[qe0 0 ArOBaqzeo trades Ol < 11 0 10 Z Tt 67 3q3 saFY UT e 0 (720m 0 Jo JOU MOY 1 work sopeay FO P[NOK uy factory such ansodxa ansodx category work activty that category exposure is a indvual category exposure categoris dust the table would shipyard workes e.g in categories shipyard indvidual AzroQeZ given category or other clasifed clasifed clasifed clasified such e.g. work also have Se have ex- yeantg anbeytd AYTaJoe categorycategory 7 FIOM AyT[eurog pleura activity 10 asbestos work 164 rat work Fo employnt (1/0-/0) lq SoUyItTq, wz trades dust exposure PUT Posible heating ZUIXY Vv factory factory Ayogaqes [Tewsouqy eanstd calcifcation with pleural pleural categorization clasifed yon Fo adA^'yT S t (EET t ( <)zt (1)1 z (7)S (8) 0 2z [z} {zle ) 0 0 9 ) 0 0 of 0 Extent Extent and thickness thickness pleural thickening t 860 60 0 0 9 2 9 . < el 3Z 0 0 e T 0 0 Tt {i} r(t]9 0 11 0 3< 0 ( ) a ' e ft) 0 (t)lot 0 9 4 4 Zz ( <}6 0 y 1 2 3 L Ss L@ Zz 8 <@ aL t 99 Sc thickening thickening 8 Oze LZ <s 6L SEL present uoTPENSU) that table pleural given thickenig category also shipyard shipyard20 shipyard Ason workes e.g. , could syerg Zenp aT paTsZuUpT anscdxa o8vze9 ON Syuzg 19430 qtsog paedryg 4I5TG STEROL ON f708a3e2 s3SNpsatrogyea @ 19430 UT activity ZO vansodxsojseq soyaqse oF ou o% dATY Pleural sanodxa califcation califcation califcation oste AzoZaye2d SAVY ptnoa *Zurayot WaTSJou TernayTd UeT& prRom '3'a qypa ASYION Sszaqiom [eaptuTquaszd 2 ayexrq e paed tys 2 (sjanbe,d0 atqey TT )) paTj{seo 2 pur SB egy 2 st oq} Ut voTyetzI[Zo ofAQTZYOE ypA Teqy}O uoszed oT"YOM WITH ewe quesad YIOM exposure SyBIq no exposure a exposureexposureexposure asbestosasbestosin y30q eyz AvYyIO faTqey asbetos= = = UT [ ({ ] )} x,5 TeHoT ByQ ay4 ayy UO vi NS 4 Sap~rAoFjeAxto8a3> [RaNdsTegnbeyd Ct4 (Z) (Zz z re) (1)z (9)s (it (6)91 *Ss3np & 3q30 ut Jo tO according to categorycategory So3seq pleural parenchyma parenchyma abnormalites 0-2 abnormalites acording ) to AQTSRQOF ainsodxaS0Rsqe Abnormal 03 ou 0} Z2 WIOM Ay} OF [emouge Normal sae) activty TeanyTg pleura rac 20 gare work 1c: 85 rAd exposure Brake exposure 6 dust heating 9 L efxapcostuorrey exposure [ewurogy Bad nal 0 Oo o o 0 0. 600 0 69 60 60 0 2 abnormality thickenig 2 (1) e{T3t 0 ie) ) 0 {tle (12 1 2 z 0 o 1 0 C1 0 00 3 ) T4 0 0 o 6) 00 s4eq sinodxs sinodxs Pleural aey califcation califcation 2 califcaton2 2aey pynos usazTs you e prnoa -B-a ot FAC 3 ARES: (Ze {tis o 00 00 3< 0 0 1 Aayiom szayr0om 1 Te(ENPaAtpu syee@xq predrys 1) SUOTAPS 0 ) 0 LT 9 It fe) 0 0 T 0 1 pue 2s e eya Yons atqeq ( aq} UF Ayrayou pue pleural pleural 07 $8 St 9 9 6 <l z SEL y3t4 ASsYIO vosxzad MoT YAOm califcation YAM w wotqesz1p of given ywasdno pleural an given thickenig SyeIq ofyrom exposure se clasifed that categoryalso asbetos shipyard workers asbestosasbestos in shipyard exposureexposure would e.g. could YIOA paTzT Ao YAM could SyeIq Jsnp aT Fo asbeto S[eq0y opr ON ayxTIag uotzernsuy) oasnodza parsdyg sSerey qtsog za01g adfkt cy 2430 y30q = == [ ({ ] j} ze ou zsyQo atqeq ut ayy, 243 auqL roMer 10 Lr 22 aqQuay AS20ZazeD rar Les Parenchymal Parenchymal Reading Ll cer 6 86 UT sotq[ewru AQTR9" Aci~-y OT yo YA0OM P14RL OF osequazodOther pue zsquny Z asbestos garage work 0 garge Tt Brake work work I asbetos asbestos factory factory T %S 0 0 - 0- .0 - fa) - 6) - t 48 70) 0- z category 0 work 81.2 % %Z E % Ges 30 29 2 3.4 % 5.0 % 0.5 % i 202 LY 06%8'y = | | | L 75.8 % 15.1 15.1 8=4E'9 0.7 % 5.0 % 17 % 1 Z9PT L 537 #9 YG"9 0 75.0 % 14.7 % %6 0 0.9 % 4.3 % 5.2 % 1 4B" fh) - %S O 076.0 6 1g 15.2 LI 41 91 0.7 % 9% 2 6 % et%8 6 Z 35 oct %e et 17.1 exposure exposure Loy RBS 8%0 SL 0 %092 81@ <4s3 89 6L %z9 77 Ged 28 9 983 yazom 9.1 1 ainsodxe(410M exposure 64.2 yAon 55.6 % 10 14.6 9.8 0.8 123 soyaqse 0.2 work % % 5 1.1 on 74.8 % 130 6.5 4.8 43971G STEROL Ae) Url xraqumy Ai08a 6 ZO0Z ces SIt tty Sse ^'d <Z1 86 ze9 parenchymlorZaqei3to/pue 20 T/T] 1/0change 20 asbestos asbestos asbestos workasbetos Teinstd Avi-X :pue Aue24 IT work x0 [euAyoal jo O/Ted10/pue AWTtq.e work exposure [eanstd exposure 17.1 of asbestos Auy heating asbetos TewAyousredtradesexposure 21.1 work pleural parenchymal LET 47 greater 8 Any %6 parenchymal pleural 21 and or parenchymal parenchymal pleural 6 eI S1 pleural and thickening thickening thickening 4381 11 40 92 252 40 g 46 %2 %8 42 ge Ott 62 Sz TOT ZA by 252 ZZ TE SE 8x2 SZ 46 93 ZL S 5.7 45 1 -1 2S" 42 -1 45 ST SY 5.7 Il 6 oe 8 ci 61 te SZ -1 -1 Ell iT EST LZ 42 81 25.2 %L %S -1 43 I< zol 61 97 02 BL 81 9 LT gL 07 97 KE EE 2ST ainsodxa dinsodxa sapezy (Y20H t Binsodxe AZTATI sojaqse YIOM yom YIOM aXeAQG Yroa eansodxa soyeqs 3urqvoy AroqIe; soy se uot paediug STISsog 3e{nsur) Oe payzeqs a8er3 asers oY syeag ysnp SL YIM oN 306 pry 29430 yosaTG UqoL 24 employment compared to those with no such employment or no stated asbestos exposure The minimal overall differences between these two groups are more manifest in parenchymal abnormalities there being little difference in the percentages of pleural abnormalities On the other hand significant differences exist in the percentages of pleural abnormalities among those employed in work having direct asbestos exposure or shipyard employment and those only employed in garage work or having no asbestos exposure We will thus utilize both parenchymal and pleural abnormalities to characterize the various exposed groups 3 Other criteria could have been utilized for the determination of an abnormal ray For example we could have required that all four readers read an ray as abnormal before it would be so categorized or that an averaged reading of 1/1 be required for the establishment of parenchymal fibrosis or that pleural plaques not constitute an abnor- mality To ities would investigate whether more stringent criteria for abnormal- have altered the analysis the overall results were cal- culated with the criteria for abnormality being an ray categorized as 1/1 or greater and the presence of pleural thickening of calcifica- tion plaques were not considered abnormal These data are shown in the last column of Table 11 and demonstrate the identical trends that were present in the data with less stringent criteria for abnormal- ities Table 12 shows the distribution of abnormal rays for each reader according to work category While different percentages of abnormal rays were obtained by the various readers the trends according to work activity were highly consistent Those engaged in brake work had a higher percentage of abnormalities compared to those who did not and those with other asbestos exposures had the greatest percentage of abnormalities according to all four readers Thus the overall ray results are relatively independent of the individual readers and independent of the criteria for abnormality established 25 Zz Sl 8 92 $'IZ Le $ 9% 6 7Z ROL Table (186/Z1z) (186/59) (186/097) (186/497) Percentage 3snp 62ZX 982abnormalites ets abnormalites teal (S </9) L&%(S </6) so category PTqtsog Ysqse job job ez category 89Ecategory gee(11/9@) geE(14/92) *saepax , Heavy exposure no brake (eet exposure Shipyard Shipyard Posible paeAdrys exposure Shipyard Posible Posible /4) jo exposure 4203985 18.8Azo3aye. ( 101/421 ) et Aavoy ) (6/9) 4/9 ) 4/123 4/123 yoy ( 24/7 ) 16.8 STQeL 34/202 got 31.7 &q Savzeg(( ) (9L1/6Z) 4/9 5.6 42/12 542//1122 912( 17/76 36.8 64/20 of 19.3 (12/01) ( ) 47/123 ) 27.6 4/9 47/123 eSZ 3.8 aywag ( 8 < 8t 8 91 Lcre 61 < S. anamnsodxs (207/8<) (Z0/#E) (Z0%/9) (Z0/6) (Z02/L<) rapesay pogezaySutprsa I z 4 26 Age standarization of ray readings Inasmuch as the prevalence of ray abnormalities reflects various assaults to the lung separate from that under study that accrue overtime it is necessary to consider age in comparisons of groups exposed to asbestos in different circumstances Any age effect can in part be due to unknown exposures to various dusts including asbestos the opportunities for which increase with time Additionally any related changes progress with time and the manifestation of rela- tively minor exposures early in life can be significant in later years As discussed previously a selection criteria for the exposed and control groups resulted in study populations that had similar age distributions However to more accurately take into account any age effect ized to the the overall percentages age distribution of of ray abnormalities were standard- all 983 individuals for whom readable rays were available using equation 1 A standardized percentage stdstd was calculated N,, 1 Pstd = = PN,,9 83 Where P. is the percentage of abnormal rays in the ith age category of the group of interest and NT the number of all 983 individuals in the ith age group For a group having an age cell with no data insulation other standardization was based on those cells with with with data data std NT = NT 1/983 avail i / yt yT i N all i avail i 2 Where P. again equals the percentage of abnormal rays in the ith age category of the group of interest and N. the number of all 983 individuals in the ith age category P is the percentage of abnormal rays among all 983 individuals in the ith age category These over all standardized percentages are shown in Table 13 The difference between the individuals performing brake work and those with no identi- fied asbestos exposure remains while the percentage of abnormalities in those employed in a garage but not engaged in brake repair work 27 PpazieuysPercntage 2O0l SC 1O l y Table c'24 S$ 9 9 9 o 1 69% $ # F + - a8y Percentage - abnormalites abnormalites acording work activity by 9 72 2 Sz 9TQeT standardized 40 40-49 50-59 Totals percntage (6/12) 60-69 (2/92) activity (S </8) work < oe 40-49 '4 50-59 9 OF 6 22 70 Totals Se 4 by(6/4) percentage 929M Aq t Sher 7/47 ~X oremployment Qi< 11.9 11.9 8 7/47 0 </E4) 15.7 (2/2) 26.7 26.7 0'0 34.4 < 34.4 ( </T) OO 30.8 0 09 24.2 oot (1/1) 24.3 - STQ#pes2 YOM ( brake 25.0 9 i (2/8 9E 0.0 (s/8) 9/389/38 7Td8/35 ) (6/ <) 2/7 ) ( 21/9 <'ce( </T) 18.6 wous 705 24.5 19/107 worket 19/107 10.7 Body 38y 6S-0S 6/54 0.0 ( 0.0(86/6) 38/15 83/8/1154 TL( 71.4 (21/2) 0.0 0.0 9613/32 30.6 (S/2) 38.6 38.6 <g6 6 work exposure 1(i9/L) Lst 2/11(1/0) ( 0 0( )(1/2) 1/3 1/3 0028/35 a 20.3 IIE ( 2/12 32.0 asbestos JO exposure , woTyngtzisp 0.0 ( 39.6 60.0 , trades e'y 6 TT 20.0 20.0 Tit 0 017/42 40.5 60.0 0"0 4/123 35.8 30.8 30.8 30.8 /9T) asbetos YA0M : (z04 aBe Sopeiq 943 factory BOYSIQe 34.9 ) quawioy10.4 16.9 12/9 248/93 YIOM 14/134 dua 36/213 104/372 ya0om 4ysnp 14/34the all indviduals indivduals rays avilabe paztreuys distrbuion readble readble the oy distribution whom ( Az03e3 1.6 were avilabe t 28 decreases to somewhat below the level of those unexposed otherwise The percentages of abnormalities among those with other asbestos expo- sure remain significantly different from those unexposed If we consider the percentage of ray abnormalities a manifestation of a normal distribution with a variance reflected by the number of abuormal rays the respective standard deviations in the final column of Table 13 are calculated While the percentage of abnormal rays in each of the job categories of Table 13 has a large uncertainty associated with it because of the limited number of individuals in a work activity other than brake work the pattern of observed percentages yields a remarkable consistency The two groups with no identified asbestos exposure garage controls and garage workers with no brake or body work have the lowest percentages of abnormalities the various activities with probable asbestos exposure have the highest percentages and brake workers are intermediate Individuals with other dust exposure appear to be unaffected by such materials This is probably the result of the relatively short exposure times or the marginal exposure circumstances The other dusts included coal 23 men silica 9 men and other dusts 3 men Five of the other dust exposures were for longer than ten years One of the five had an abnormal ray The average exposure of the other 30 was 3.2 years In subsequent analysis these 35 individuals will be characterized by their garage or garage employment One notable feature of Table 13 is the high percentage of abnormal rays among the 32 individuals who worked for some time in auto body repair See subsequent sections on auto body repair and undercoating work Smoking standardization of ray abnormalities Smoking has been identified as exacerbating the malignant effects of asbestos Death rates from asbestosis among 20+ cigarette smokers are 2.8 times greater than among nonsmokers and Seidman 1979 and both parenchymal and pleural Hammond Selikoff ray abnormalities have been reported as more common among current and smokers than nonsmokers Weiss 1971 Rossiter and Harries 1979 Weiss Levin and 29 Goodman 1981 An effect of smoking on the prevalence of ray abnormalities was also found in this study with both parenchymal and pleural abnormalities found more among smokers than nonsmokers and more frequently among current smokers than smokers The age standardized data for the overall ray readings are shown in Table 14a Table 14b lists the percentage distribution of smoking histories ac- cording to job category As the unexposed group contains 25 more current smokers than the other exposure groups the ray results where possible should be standardized for cigarette smoking as well as for age This can be done for major work categories but is unreliable for most subcategories because of the absence of data in some smoking- age cells The standardization procedure follows that of age standard- ization and utilizes the overall smoking histories of the study group 31.6 were smokers 42.4 smokers and 26.0 nonsmokers Standardized ray abnormalities by work activity Table 15 lists the age and smoking standardized percentages of ray abnormalities among those with no identified asbestos exposure those engaged in brake maintenance and repair and those with probable asbestos exposure including auto body repair work The overall percentage of abnormal rays among individuals with probable asbestos exposure differs significantly from those unexposed 0.005 two sided The differenc ies particularly significant 0.0002 for pleural abnor- malities This occurs because pleural abnormalities often appear from relatively low asbestos exposures and can exceed parenchymal abnormalities in prevalence at long times from onset of exposure See Anderson et al 1976 e.g. As many of the individuals in this probably exposed category worked during World War II in shipyards we are observing effects in this group after 35 years from onset of exposure Table 16 lists the age and smoking standardized percentages of abnormalities according to garage activity and union There is relatively little difference between the percentages of abnormal ray for the auto workers of UAW Local 259 while a large and significant p < 0.05 30 Table 14a Age standardized percentage of ray abnormalities according to smoking history all exposure categories Smoking History Abnormality Smokers smokers Nonsmokers Smoking standardized Pleural 14.0 11.2 9.1 11.5 Parenchymal 26.3 16.0 13.9 18.8 Any 32.6 22.9 20.4 . 25.3 Table 14b Percentages of distribution of smoking histories according to job category Smokers smokers Nonsmokers No exposure including mechanic garage work 39.1 39.1 21.7 Brake work Probable asbestos exposure 29.1 31.8 43.1 42.0 27.8 26.1 31 Table 15 The age and smoking standardized percentages of ray abnormalities according to exposure category Exposure category Pleural No identified asbestos exposure 8.4 1.6 garage work 10.4 2.3 Garage work but no brake work 6.6 2.2 Brake work Probable asbestos exposure including body work 7.2 19.8 2.7 Parenchymal 15.8 - 2.1 17.0 - 2.8 14.4 - 3.5 19.3 19.9 2.7 Any 20.1 2.5 21.9 -3.2 17.8 - 3.9 24.4 2.5 32.5 - 3.5 32 Table 16 Age and smoking smoking standardized percentages,,percentapergcentages,, es,, of ray abnormalities for different groups of garage workers according to work activity Work activity Brake work UAW 259 19.8 - 3.0 No brake work 17.3 Percentage of participants with other asbestos exposure 15.1 UAW 595 . Group DC 37 SEIU 28.9 - 4.0 21.7 4.4 18.7 4.7 16.3 25.8 ; Overall 24.4 2.5 20.1 - 2.5 21.5 1 Standardized to age and smoking distribution of all 983 men for whom readable rays were available No identified asbestos exposure . : 3 Does not include 12 individuals with asbestos amphibious vehicle construction exposure during 33 difference exists between those employed in city garages and all other groups combined This can be attributed to the greater grinding and finishing of brake lining material that the city workers do The work in commercial garages is virtually exclusively on automobiles in which brake shoes are simply removed and replaced Asbestos exposures large- ly occur through the air blowing of residual dust in the drum housing Many of the city workers on the other hand repair truck brakes and here machining of the lining may be required to obtain a proper fit This additonal exposure can be significant Rohl Langer Wolff and Weisman 1976 found machining of new brake short term asbestos concentrations during linings to range from 24 ml to 72 ml the Tables 17a and 17b show the percentages of individuals with ray abnormalities according to years of garage employment and years since onset of garage work As can be seen there is an increasing percent- age of rays according to either variable However to some extent this would be a reflection of the previously discussed age effect seen in both the exposed and unexposed populations analyzed in this study In order to take into account age the standardized percentages of abnormal rays were calculated for the age decades 40 through 69 years for those employed more than or less than 30 years and more than or less than 30 years from onset of employment Individuals in each of these three age decades were included in both the 30+ years and year groups So difficulties with empty cells was avoided However the small numbers in each age cell prevented any smoking standardization The results show that those employed for more than 30 years or with 30 or more years from onset of exposure have the greater percentage of abnormal rays The differences between the age standardized abnor- malities in the group with 30 or more years of employment and those with no asbestos or garage exposure or those with less than 30 years of garage employment achieve a sided level of significance of 0.05 An analysis by the estimated number of does not indicate any trend Table 18 brake jobs per week however The estimates are necessarily uncertain because of poor recall and the analysis did not consider either duration of work or time from onset of employment 34 Table 17a Percentage of individuals with ray abnormalities according to years of garage work Garage work 20 Years of garage employment 20-29 30-39 40+ Totals Brake work 13.8 13/94 No brake work 27.0 3/48 Total 18.3 26/142 20.0 34/170 16.7 6/36 19.4 40/206 Age standardized 30 Brake work 19.4 - 3.0 28.8 34/18 16.7 2/12 27.7 36/130 45.2 14/31 0.0 0/3 41.2 14/34 30+ 23.0 95/413 21.2 21/99 24.2 116/512 28.7 -4.2 Table 17b Percentage of individuals with ray abnormalities according to years since onset of garage work Years since onset Garage work 20 20-29 30-39 40+ Totals Brake work 13.2 10/76 No brake work 22.5 9/40 Totals 16.4 19/116 20.3 30/148 21.2 7/33 20.4 37/181 Age standardized > 30 Brake work 21.2 - 3.6 24.4 33/135 11.1 2/18 22.9 35/153 40.7 22/54 37.5 3/8 40.3 25/62 30+ 25.3 - 3.5 23.0 95/413 21.2 21/99 24.2 116/512 35 PpezTuyspesquaored $'9Z 0Ez 827 Age 98T y' <Z of Age ase SuypscoeAq STeVOL ya10m sAva- +02 Bt axerq sTqeL Temzrouge yo 1-4 times FO Asvenbsry than s eQu arzSg 3yQ OF work O%> Standardized Standrized readbleayeig 23.6 9E%17.8 Zz Cost/ov)> T <Czzat/zy) Ste 36.5 Z1z(6/TZ) D <Z percentage,, SLENPTAU 19/107 19/107 ( 38/15 )( 31/85 35.7 2/5 ( 96/406 2.2 23.1 86S9e7/52 ) 14/60 ) Cxe/ot) 15/42 ) 1/3 0.0 23.1 <86 ITB Fo cy 1/1 9.1 ( 35.3 (8z/et) 66.7 6 .7 100 100 31.8 31.8 31.8 DOFANGTS BLT eTQyea 0/1 0.0( 25.6(y7/TI} 22.9 2 .9 0.0 0.0 21/9 21/9 TP |a8e whom sAer-y 24.9 ayy azam ( 19/18 ) 47/192 47/192 ( )39/120 8 4/12 ) 17/505 17/50 02 distribution distribution all Al indivduals al were available 9-7 x80m saqy yom ayeazq yI0mM | qupeax Auy on TEIOL z 36 Among those members of Local 259 of the UAW who were examined 27 had been examined previously Lorimer 1976 Table 19 shows the comparison of the two sets of readings for these individuals Of the 27 pairs of rays read ten received identical readings The 1979/1980 reading was one subcategory higher than that of 1974 in seven in six it was one subcategory less One reading was two subcategories higher in 1979-80 and three were two subcategories lower Thus the overall readings were very similar between the two periods of time and there was no evidence for any progression of fibrosis among the small group of individuals examined in two periods of time Auto body repair and undercoating work The highest percentage of ray abnormalities in any group observed in this study was riods of time among men employed in auto body shops for varying 38.6 versus 24.5 for brake workers and 18.6 pefor garage workers who did no brake work While relatively few men were in the category the percentage of abnormalities was significantly higher than garage workers who did no brake repair 0.05 sided The average time of employment of the group in body shops was 13.3 years Of those employed more than 20 years 5 of 7 71 had abnormal rays In past years asbestos was commonly used as a reinforcing agent in plastic auto body fillers used for dent patching Extensive dust exposure was common as the material was sanded smooth The extent of asbestos exposure is unknown because no fiber counts are available from such operations Fortunately with the increased awareness of asbestos hazards and with the introduction of the occupational asbestos stand- ard most manufacturers removed asbestos from their formulations In a current 1981 analysis of six compounds used in shops employing UAW 259 members no asbestos was identified However while current a bes- tos risks no longer exist in these shops at least to our knowledge persons exposed previously should be made aware of their asbestos exposure the risk associated with it the synergistic effect of cigar- ette smoking and the desirability of appropriate medical surveillance 37 Table 19 Comparison of ray readings of garage employees 1974-1979 1974 reading 0/0 0/1 1/0 1/1 1/2 0/1 1979/1980 Reading 0/1 1/0 1/1 6 2 0 0 5 4 4 1 0 0 0 0 0 3 0 0 0 0 0 1 1/2 0 0 0 1 0 38 Automobile undercoating materials also contained asbestos as forcement fiber and disease had been suggested in individuals a rein- engaged principally in undercoating work Thirteen men were identified in this study with significant periods of undercoating work Of the group three had abnormal rays but two of the three also work in body shops Thus we have insufficient data to evaluate a risk from this activity in this population Parenthetically numerous other men re- ported having occasionally one to two times per year applied under- coating materials These individuals were not segregated in any analy- sis In all cases where undercoating was done mixed compounds were utilized It would be expected that the spraying of such material would not lead to the release of high concentrations of resirable asbestos fibers However the grinding underfoot of dry sprayed material on shop floors could release the encapsulated fibers Effect of previous shipyard employment Of the 983 individuals with readable rays 87 had been previously employed for some period of time in a shipyard generally during World War II Overall 39.1 of the rays of this group were abnormal On an age standardized basis 28.6 were abnormal compared to 20.5 for all groups unexposed to asbestos control group garage workers with no brake or body work exposure and those exposed only to other dusts Because of the relatively small number of cases the difference between these percentages is not significant at 0.05 level Tables 20 and 21 show the number and percentages of abnormal rays according to years of shipyard employment and time since onset of shipyard work To the extent possible age standardized percentages have been calculated for each exposure category although with the small numbers in a given time cell the procedure has large statistical uncertainties The average time of employment of all 87 individuals in shipyard work was five years As few 15 worked longer than ten years the data in Table 20 on the trend according to shipyard employment are unstable because of the small numbers in longer term employment categories In Table 21 however a significant thand with years since onset of shipyard employment is seen On an age standardized basis 37.9 of those with more 39 Table 20 Number and percentage of ray abnormalities according to years of shipyard employment Parenchymal reading Years of shipyard employment 0-4.9 5-9.9 10-14.9 15-19.9 Totals Normal pleura 0 31 14 4 4 53 1 3 4 0 2 9 2 1 0 0 0 - Abnormal pleura 0 7 1 4 1 13 1 8 2 0 0 10 2 1 0 0 0 1 Any abnormality 20 39.2 Age standardized percentage of abnormality 27.2 7 33.3 24.7 4 50.0 45.5 3 42.9 37.1 34 39.1 28.6 40 Table 21 The number and percentage of ray abnormalities according to years from onset of shipyard employment Parenchymal abnormality 0 1 2 < 10 Years since onset of employment 10-19.9 20-29.9 20-29.9 30-39.9 Normal pleura 3 3 12 33 0 0 2 7 0 0 0 1 40+ Totals 2 53 0 9 0 1 Abnormal pleura 0 0 0 2 9 2 13 1 0 0 0 9 1 10 2 0 0 0 1 0 1 Any abnormality Age standardized percentage of abnormality 0 0.0 - 0 0.0 - 4 25.0 19.2 27 45.0 3 60.0 34 39.1 36.6 47.6 37.9 28.6 * Age standardized percentage of those 30 or more years from onset of shipyard employment 41 than 30 years from onset of shipyard employment had abnormal rays This percentage is different from that of unexposed individuals at a 0.02 sided level of significance It is possible to compare the results of the prevalence of abnormal rays among different shipyard populations 30 years or more from onset of employment The finding here of 17 more ray abnormalities compared to controls among former shipyard workers employed for an average of five years is in agreement with studies of the effects of term shipyard employment In a study of ship repair workers employed for more than 20 years 87 of the rays of those 30 or more years from onset of employment were abnormal Selikoff Nicholson and Lilis 1980 The percentages of abnormal rays in the two groups are approximately in the ratio of the periods of employment Evidence of malignancy In any ray screening of a population of this size it would not be unexpected that a chest malignancy would be identified Such was the case with one individual in this study He was referred to the chest service at Mount Sinai Hospital for follow diagnosis His bronchogenic carcinoma was not operable and while alive two years later was in poor condition Parenthetically at examination his CEA level was 1.3 nanogram and his sputum analysis showed moderate atypia but no malignant cells present PULMONARY FUNCTION TESTS Principal spirometric tests Tables 22 23 24 and 25 show the mean values of forced vital capacity as a percent of that predicted 100 x PFVC the forced expiratory volume in TVC the 1 second as a percent of forced expiratory volume forced vital in 1 second capacity 100 x FEV / as a percent of that predicted tween 25 100 x FEV PFEV and 75 of forced and vital the maximal midexpiratory flow becapacity as a percent of that pre- 42 Pez; Sutyowsprzepurys Zed" S6 Forced work (62) 9 exposure employment brakewith body 97%96 withAvy including including work (29) FO including including employent AlcS Al FTqeL & 6 2 posible 2FLpossible asbetos se gof asbestos exposure oj heating Aqtorde ZuTpr0s5 exposure [rapa asbetos exepxpoossuurere psoig mean indivduals to the smoking ; smoking 31.6 Ex smokers categorization activity categorycategory lower exposure exposure asbestos 9 percent percent acording capacity to and that history category 96 94.1 ( 94.7 1.9 ( < <} (Z) 99.2 7 2% 2 ( 2.4 96.4 86.0 92.1 Ess 92.1 42 93.6 ( 98.5 1.2 181 (1) 4.6 15 93.0 ( 92.8 FL96 2FE 96 6SIT 94.9 ( 94.7 2.2 26 99.8 ( 93.0 ( 94.3 2.0 56 10.5 alqysod sanodxs gapeaz (yzom ansodx distrbuionmeaningful of distribution distributionsmokers all with valid pulmonary KkzojaeF pulmonary pulmonary ) theother dsusutcshdust sOmokners person indvidual clasifed given given Smoking ou Jou aT a ey Smoking standrized,, standardized,, standardized,, standrized,, UT 95.7 4804 UT 95.7 AzoZaqu 1.2 sye2q uopzuNy 91.3 91.3wats SB @ 1.5- UF Azeuow{nd 0.7 96.9 pTeA 92.9 TENpFAuy 2.4 YIFA (%o9z uoszadBy we UQ 03 96.1 1.6- [Te JO Aey. 96.1 Yone 3 srayou-n Ss} 95.8 -1.5 3 WoTANQIYS|p( AYTIOR%y"Zy 19.1 19.1 2 ay} FO UF ostr * SuTHYows02 ay} JO srayou-xqayy YIOM AaMoT prtnos JO OF S*a STENPAUT AroJaqzed AroSa]eI x0179 *yzOM $%9 OF test function TE B category ainsodxa szayo0m category test Fo ayerg would notwouldcategory 0 ray se brake worker worker low categories low higher _ table no Bart] pardAtys yans ~m MOT UT OU 82g pPeZTazupeysSuTYOUS 6LLOF8 7O1F6' to category and smoking Smoking 4 = (St) (6%) Curent smokers (2S) smokers smokers Non work 6 8 quadizadSuTprode e@ garge IFE'9L 76.5 1.4 o'Ts7'82 - ( 80.1 saBy & Se SeTIOZa3eD TSYsIY p{nom staSnmdorkiizendg,, standrized,,staundorsiizead,,asyYIOp0uvyusayrroFze2 0.9 e BYyQ soyaqse se Garage (JAg/ Axio3stypuodas Aga Garge x employment suo SutTyous 75.7 0.8 <@ UT QOOT) pue employment = 1.3 body work 75.6 1.3 employment L1EL including work XY 92 3.3 ZL 74.7 74.7 43 ( <8) - ( (i) 60FZ 94 79.074.7 (15 79.0 . e uO 1.0 a+r o3 74.9 "SUNP 78.4 * aqtry 0.4 axrnsodxa 75.7 78.4 1.9 943 2A94G30 aaey UT etqey oumtoa Ajtoeds>sz03aqe5 AzojeatdxTeqTA gol 03 poszoj pasiog jo SOjaqse identifed and posible 74.3 1.1 7 8 (19) 76.2 ( 78.4 6 [Te Jo sToyus ey, aAamoT OSTe 76.2 0.6 prnod 04 1.0 ) uotgnqraysip exposure 1.9 T'1LFE"yZ 1.7 76.4 18 1.0 Posible asbestos 75.4 0.7 aAnsodxa szayioa exposure 12.8 srayous-xg standr e1qIsodansodxs soy8q1se.6 sozaainqssoedxa 2 ansodx predtys indviduals offactory factory mean YI0% pur of category meanigful function = few category in category to Standardized smoking distrbution distrbution of valid pulmonary test UOTIZBaXeD 31.6 smokers with est Standrized Ex smokers % Smokers categorization smokers that 75.5 *8'a 75.7 1.2 ( ) 76.4 B@ ) 0.7 (20H ayy "HIOM Suryous saperzq 12.8 YOM azqyQ0 72.7 12.8 9Y3 FO BART syeIq UT FO OF ou se Butqeay Aaj S%OIE JOU sAPY yons function function PTNOK a_qeq function function pulmonary p[Nnoa azgqrq ( ind af ) have category ayy would have no 313 Table ; ZuT yous pesyotperd TGyarpgee employent work SS'IOFF9T"*6S0OTL 91.8 <316Fe8Z0OT L<F8LO 97.6 standrized,,Smoking yey)Aroysty 29 97.6 jO Sutyous AZO3STY 9 6 9 work 1F9L6 <F9 16 asbestos asbestos (GIL) 98.1 : = employment work (18T) 97.9 O'7FL Smoking history TOL ot (ZS) (81) (ZE) (2) 47 42 = 128 (92) 108.0 181 - a ey standrized,, standrized,, smokers VyeIg UT 102.6 102.6 SB 102.6 ( 1.6 WsAT3 97.6 1.9 e 0.8 UT |YA 105.2 including [eNPTALU quaoradpue SuTXoOUS e& <1F0'gOl Azosaqzvose 9% ) 9T92L pUodes 2.5 auc ogoyr UT Jutpz03s5e ( BUNTOA 56 ) (*higd/ UOTIeAdxa 10.3 Aas) to smokingsmokers distrbuionactivty distrbuion 26.0 pulmonary functio test paoszog EC ebmpolodymeynt work T 9 95.9 1TO2L eFE'6 96.9 1SE5I Posible Posible asbestos exposure 98.8 exposure 24 (92) 99.3 (Z) Shipyard 8Ship6yard heating 1tra6des 96.7 35 09F386 102.4 = amsodxa 135.1 ( ( standard sojaqse ButTqvoy ATOZICT few indivduals the category category To meanigful valid Standrized Standardized the category be all T(he Sexmpookseurres categorizatn categorizationcatEegoxry work activty such such smokers indvidual 105.2 ( ( ) e 97.6 3.4 TTe ue -atJaqZO osTe ( Jey 102.8 1.3 ( YSNs 102.8 ST 101.7 2.0 *MIom 10.7 3.5 12.5 32 03 103.1 1.81.8 uvali UI 103.1 0} TaMOT ce 101.3 5.1 2 * FO Yom Yyons Axo8azed pavdtys ayy Fo OY AsYyO SaTqeq '%QLE atqey TOIT OF UT Jo function e FO BAY ay3 pulmonary pulmonary function === YOU 343 UT UT category would given classified givengiven classified a would worker worker have have 3 yPezt 9 8 8 Sutyougpreugs SEF" Ss <FS forced expiratoy flow A3r2ed> (61) (92) (06) (7) work $ 9 < 9 Curent smokers Teqta CIKW/SNH staed PFSIOTOF X Ai03stu Garge LCLO01) Sutyows pus Due Garge Se including 2.9 Yor asbestos 469 83.6 5.5 or work 78.0 5.9 employment < 9 78.9 employment zE'SL 82.3 peqatped91qeL AsoSaqnowsozaq yeqy qol yo MoT} 09 quazed ' identifed and posible 76.2 4.1 asbestos exposure 81.5 7.1 Posible heating trades 72.8 5.3 AzrojZetdxs Burpadsese Table 25 75 (9 <) Smoking Smoking - 9 S smokers F6 FZ H0T 92.3 5.8 ($9) 78.3 6.3 8'> 98.4 2.6 z68 71.3 9.4 (8S) 89.2 4.8 1 ) 82.6 8.6 FZ9/ 92.8 5.7 = (1) "3893 < <2I ( ( ( 27.9 90 {Te jo (2) 1.5 6.536 69%F0L 10.1 12 23 104.9 UT - OU BABY 3ou *arqez oTqe2 PN ayy 942 p[nom ur Smoking standrized standardized Arosazedsyerq standrized e 95.1uaTs Se Bw 95.1ut 80.5 Uy patysepo 93.6 TeNpATU 93.6uosad80.0 Ue 80.0 03 ev 89.0 Jey ortS{NP yons st atqeyAsyjJo 87.0 AJYTADE aqQ 20 ut 89.6 123. 1 soyeqs few @Tqtsodal soqeaanssoedx Butzeay pulmeoinnasryodxaAr0,De5 ( ArtoZazeDainsodx to PpecstoF exposure , of mean (Yt0m 123.3 03 Sapezy FO YAomM AasoT PTROD ayq Jo oy -2'a of be ay] individuals category pue 10213 04 UI Fo %qTE YIOM & the meanigful sroyY40m Standrized Standardized Standardized category smoking activty Non smokers valid pulmonary functiotest Uorqetigsa with pulmonary , Smokers 31.6 smokers have no categorization categorization smokers ofwork activty meaningful activty such function pulmonary = fu=nction function given given category category brake Jo 94vIq Jayjo se would have YOHs 46 dicted 100 x PMMF according to job category and smoking history The prediction equations used were those of Miller et al 1980 See Table 3 The distribution of these parameters is shown in Tables 26 27 28 29. With the exception of auto body workers and garage workers who do not work with brakes there are no differences between the means or in the distributions of the three principal spirometric test results PFVC FEV PFEV including those with FEV1 ) possible past for all exposure other groups to asbestos of workers While there are some differences between the various job categories in smoking category subgroups these are largely the result of statistical varia- tions The more stable smoking standardized data show virtually identical results for the unexposed control population brake workers and individuals exposed or possibly exposed to asbestos These data are shown in Table 30. This might be anticipated as only marginal differencweerse seen in the individuals in different work percentage of ray abnormalities among categories As forced vital capacity is usually a less sensitive determination of asbestos changes than the presence of ray abnormalities and forced expiratory volume in one second relates to exposures other than asbestos the absence of a definite trend among the groups with varying asbestos exposure is not unexpected sec section on measures of small airway disease for a discussion of PMMF Measures of small airway disease As was seen in Tables 22-24 with the exception of mechanic garage workers and those men engaged in auto body work no differences existed in the means of the spirometric test results between the three major occupational groups studied those unexposed to asbestos or to garage work those engaged in brake work and those with a probable asbestos exposure However in the case of PMMF Table 25 individuals with an identified asbestos exposure had a lower smoking standardized mean compared to those in the other two categories although not at a 0.05 level of significance The unexposed control group had the highest mean values followed closely by mechanics engaged in brake work Those with identified and possible exposure to asbestos had interme- 47 Table 26 The distribution of forced vital capacity as a percentage of that predicted 100 x PFVC by job category and smoking history - Job category 60 100 x FVCP 60-79.9 60-79.9 80-99.9 80-99.9 100+ No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work Smokers 0 0.0 2 5.6 5 11.1 7 19.4 1 0.8 20 15.6 0 0.0 0 0.0 29 64.4 23 63.9 67 52.3 11 91.7 11 24.4 4 11.1 40 31.3 1 8.3 No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work 0 0.0 2 6.7 2 1.1 1 6.7 4 8.5 9 20.9 21 11.5 1 6.7 27 57.5 16 37.2 75 41.2 10 66.7 16 34.0 16 37.2 84 46.2 3 20.0 No identified asbestos exposure or garage work Garage employment but no brake work Brake work kody work ( ) = Percentage Nonsmokers 0 ** 0.0 3 12.0 0 0.0 4 13.8 2 1.7 7 5.9 O 0.0 0 0.0 11 44.0 16 55.2 59 50.0 4 80.0 11 44.0 9 31.0 50 42.4 1 20.0 48 Table 27 The distribution of forced expiratory volume in one second as a percentage of forced vital capacity 100 x FEV1 according to job category and smoking history Job category No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work No identified asbestos exposure or garage work Garage employment but no brake work Brake work - Body work No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work ( ) = percentage 55 100 ^ FEV1 55-64.9 65-74.9 75-84.9 85+ Smokers 0 7 0.0 15.6 0 0.0 4 11.1 4 3.1 11 8.6 1 8.3 0 0.0 12 26.7 10 27.8 42 32.8 25.3 25.0 17 37.8 9 20.0 18 50.0 4 11.1 53 41.4 18 14.1 8 66.7 0 0.0 Smokers 3 6.4 3 7.0 1 0.6 1 6.7 3 6.4 2 4.7 9 5.0 0 0.0 8 17.0 14 32.6 35 29.2 6 40.0 23 48.9 10 21.3 18 41.9 6 = 14.0 99 54.4 38 20.9 6 40.0 2 13.3 Nonsmokers 0 0.0 1 4.0 2 6.9 2 6.9 0 0.0 0 0.0 U 0.0 1 20.0 2 8.0 5 17.2 26 22.0 0 0.0 19 76.0 15 51.7 64 54.2 3 60.0 3 12.0 5 17.2 28 23.7 20.0 20.0 49 Table 28 The distribution of forced expiratory volume in one second that predicted 100 x PFEV by job category and smoking history Job category 60 100 ^ FEV1 PFEV FEV1 1 60-79.9 80-99.9 100+ No identified asbestos exposure or garage work Smokers 0 0.0 11.191 11.191 Garage employment but no brake work I 2.8 6 16.7 Brake work 2 1.6 14 8.6 Body work 1 8.3 0 0.0 19 42.2 20 55.6 57 44.5 7 58.3 21 46.7 9 25.0 58 45.3 4 33.3 No identified asbestos exposure or garage work Ex smokers 2 2 4.3 4.3 Garage employment but no brake work 4 9.3 3 7.0 Brake work 2 1.1 9 5.0 Body work 1 6.7 1 6.7 Nonsmokers No identified asbestos exposure or garage work 0 0.0 0 0.0 Garage employment but no brake work ~ 1 3.5 1 ( 3.5 Brake work 1 0.9 4 3.4 Body work 0 0.0 .) 0.0 ) percent 15 31.9 17 9.5 41 22.5 6 40.0 28 59.6 19 44.2 130 71.4 7 46.7 7 28.0 9 31.0 29 24.6 3 60.0 18 72.0 18 62.1 84 71.2 2 40.0 50 Table 29 The distribution of forced expiratory flow between 25 and 75 of forced vital capacity as a percent of that predicted 100 x PMMF according to job category and smoking history 100 x MMF PMMF Job category 60 60-74.9 60-74.9 75-89.9 90-104.9 105+ No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work Smokers 10 9 25.6 23.1 3 7.7 9 30.0 9 30.0 - 4 13.3 37 * 33.6 16 14.6 19 17.3 2 18.2 3 27.3 2 18.2 5 12.8 12 30.8 10.0 10.0 16.7 16.7 14 12.7 24 = 21.8 9.1 9.1 3 27.2 No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work ( ) = percentage Smokers 7 16.7 5 11.9 12 36.4 5 15.2 14 9.3 17 11.3 4 36.4 1 9.1 Nonsmokers 0 0.0 3 15.8 3 12.5 5 20.8 1 1.1 11 12.2 1 25.0 25.0 25.0 7 16.7 5 15.2 33 22.0 5 45.5 1 5.3 5 20.8 16 17.8 25.0 25.0 5 11.9 3 9.1 31 20.7 0 0.0 18 42.9 8 24.2 51 36.7 1 9.1 1 5.3 6 25.0 21 23.3 0.0 0.0 14 73.7 5 20.8 41 45.6 25.0 25.0 51 Table 30 Smoking standardized,, means and percentages of abnormal pulmonary function tests by job category category No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work Definite and possible asbestos exposure Mean value 100 x PFVC 95.7 - 1.2 91.3 1.5 96.9 0.7 92.9 - 2.4 96.1 - 1.1 abnormal 10.2 - 2.9 23.2 - 4.7 10.9 - 1.6 5.7 - 4.0 13.1 - 2.6 No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work Definite and possible asbestos exposure 100 ^ FEV PFEV 102.6 - 1.6 97.6 - 1.9 , 105.2 -0.8 97.6 -3.4 102.8 - 1.3 7.2 - 3.2 14.9 - 4.9 7.1 1.3 8.3 - 4.8 8.7 - 2.1 No identified asbestos exposure or garage work 100 x PMMF 95.1 - 3.5 31.6 -5.4 5.4 Garage employment but no brake work 80.5 -3.6 49.5 7.5 Brake work 93.6 - 1.6 27.5 - 2.8 Body work 80.0 -8.8 46.6 - 13.5 Definite and possible asbestos exposure 89.0 - 2.8 43.9 -5.2 1 Standardized to the smoking distribution of all with valid pulmonary function test Smokers 31.6 smokers 42.4 Nonsmokers 26.0 FEV PYTV 2 Abnormal is less than 80 for 100 x PFVC and 100 x and less than 75 for 100 x PHMF 52 diate values and those mechanic garage workers the lowest values The difference between the mechanic and mechanic garage workers is significant at the 0.001 sided level See section on possible health effects of mechanic garage employment The same difference wag seen in auto body repair workers but because of the smaller number of individuals it did not achieve significance at the 0.05 level 0.12 Possible effects from mechanic garage employment For the principal three spirometric tests as well as for MMF PMMF individuals with garage employment but who did not engage in brake maintenance work had significantly lower means and a greater percent- age of abnormal pulmonary function results than either controls brake workers or those with possible exposure to asbestos otherwise We . investigated whether this may be the result of the greater percentage of blacks and Hispanics employed in this category compared to other job activities coupled with improper pulmonary function standards for these groups Table 31 shows the percentage of individuals in the various job categories according to their race As can be seen among those with garage employment but no brake work more than 40 were black or Hispanic compared to 28 of those with no identified asbestos exposure and 16 of those who worked in brake maintenance and repair To the extent possible we took into account the known differences between black and white populations in the predicted standards for forced vital capacity and forced expiratory volume in one second black normals were 89 of those of whites For MMF the same prediction parameters were used for blacks and whites as there appears little racial difference in flow rates Schoenberg et al 1978 However data on these standards are relatively limited and they may not be fully accurate For Hispanics we used the same criteria as for whites Table 32 shows the overall spirometric data according to race As can be seen the means for PFVC and FEV PFEV for the black are generally lower than the white population in all smoking population categories The smoking standardized difference is significant at the 0.01 level sided for PFVC On the other hand the data for the Hispanic 53 Table 31 The distribution and percentages by race accordintgo the work activity of study participants who had valid pulmonary function tests Race Type of work activity No identified asbestos exposure or garage work Garage employment but no brake work Brake work Body work Identified and possible asbestos exposure Totals White Black 89 76.1 63 58.9 19 16.2 40 37.4 356 83.4 24 75.0 177 88.9 709 86.3 56 13.1 6 18.7 19 9.5 140 17.0 Hispanic 9 7.7 4 3.7 15 3.5 2 6.3 3 1.5 33 4.0 54 Table 32 The means of spirometric tests by race Race White Black1 | Hispanic Current smokers 93.0 222 91.2 53 96.9 9 Smoking history smokers 100 x PFVC 97.4 300 89.9 51 94.4 17 Nonsmokers 99.6 187 96.5 36 81.6 7 Smoking standardized 96.6 92.0 91.9 White Black,, Hispanic 96.2 220 98.4 53 105.0 9 100 FEV,PFEV 104.9 300 110.0 186 100.4 51 106.8 36 101.7 17 95.3 7 103.5 101.4 101.1 White Black Hispanic 77.5 197 83.5 44 95.9 100 x MMF PMMF 92.7 248 102.9 144 89.8 40 95.5 24 94.1 113.3 5 90.6 89.3 99.7 PFEV 1 PFVC and for blacks were 0.89 that for whites 2 Standardized to the smoking distribution of all with valid pulmonary function Lests Smokers 31.6 smokers 42.4 Nonsmokers 26.0 55 population is similar to that of whites with the exception of the nonsmoking group which is comprised of only six individuals Thus the use of the same prediction function for Hispanics as for whites would appear to be a correct procedure but the prediction correction for blacks remains in question Table 33 depicts the means of PFVC and whites by smoking history and job category FEV and PFEV Table for blacks and 34 the smoking standardized means by race and job category Too few Hispanics were available for this analysis As can be seen the deficits for those categorized as garage employees but who do no brake repair or mainten- ance work exist for both racial groups However it is particularly notable for the blacks where the means of PFVC and FEV PFEV1 for brake garage workers are 10 lower than for blacks employed in other jobs The pulmonary function deficits in this group largely account for the lower values seen for blacks overall in Table 32 and suggest that proper normal spirometry parameters were used The origin of these deficits is not clear The group is largely comprised of car jockeys auto polishers and new car preparation men There was considerable movement of individuals among these jobs and often a person would do all three They are employed in the same facilities as the brake workers Also included are a small group of skilled mechanics who would perform difficult mechanical or electrical repairs parts department personnel and a few men in DC 37 who were dispatchers working out of the repair area Table 35 lists the spiro- metric data for the three groups in commercial garages compared to those engaged in brake work those exposed to asbestos otherwise or the unexposed control group As can be seen the deficits are associ- ated with the group working as car jockeys or car preparation men and those employed in auto body shops The differences in the smoking standardized means for PFVC and FEV vehicle preparation men and mechanics PIEV , between the car jockeyincluding those who do brake work are significant at 0.01 sided 56 aWNd/W X spirometric standrized acording means race 96 OOT tests category "88 T'L4968 9CF6C6 621F9 identfied 1.3 LC+L <OT - activtywork T 96.2 Ad d/ asbestos garage work "Agr x 6 0 1.7 926" OF 940 86 SOT 66 1 <42S6 19FT06 Garage employment employment oot but brake work . paztreuqys Sutpi0dce O 0 QA* d/OAT <1F296 LF@96 80S" T<Fe' <'79'S6 C9F8? 2#0S6 S*9FL8 identifed O0T L6 6 2.5 A}Ttzoe -2.0 YOK - yuowfTduosanodxa FHAoOM 4.5 VyeIG YAOM yion ov adky on aduzey4NG oyeIAg Apog yom PAaTYUopTSOJaqSE dansodxaa8e18 quawsoy93.9 ao dws 6 .1 - ysom OU on a3vze4ANG ayeay Apoy 57 Table 34 Pulmonary function results of garage workers who do not repair brakes according to work activity and smoking history Pulmonary function parameter Current Smoker smokers smokers Mechanical Parts Department PFVC FEV PFEV MMF / PMMF 88.8 3.4 98.8 4.3 106.1 14.7 105.3 1.4 110.7 6.5 80.7 7.5 95.2 100.1 12.1 Auto body repair work PFVC FEV PFEV1 MMF PMMF 93.0 2.8 95.9 5.5 82.3 8.8 92.8 96.9 15 71.4 11 92.9 4.5 100.6 6.5 91.3 New vehicle preparation jockey polisher PFVC FEV PFEV1 MMF PMMF 83.6 4.7 87.0 5.2 10.6 88.5 3.1 93.7 4.0 81.0 8.2 96.9 6.6 108.3 6.9 15.3 58 Table 35 Smoking standardized pulmonary function results of . garage workers who do not repair brakes compared to other groups Job category ; PFVC No identified asbestos exposure or garage work , Brake work 102.6 96.9 Parts department Body work 97.5 92.9 Vehicle preparation car jockeys car polishers Definite and possible asbestos exposure 89.1 2.6 96.1 FEF PFEV 102.6 105.2 104.2 3.5 97.6 95.4 102.8 MMF / PMMF 95.1 . 93.6 90.9 80.0 82.9 89.0 1 Standardized to the ary function test smokers 26.0 smoking distribution of all with valid pulmonSmokers 31.6 smokers 42.4 Non- To the extent that occupational factors may be associated with these deficits the possibility exists that greater exposure to automobile exhaust among individuals in this group has contributed to these find- ings A greater exposure could arise if the mechanics generally worked on cars with engines off or if on with exhaust hoses attached That auto exhaust may be contributory is suggested by the data of Ayers et al 1973 who have observed significant pulmonary deficits among bridge and tunnel workers who are heavily exposed to automobile exhaust during the course of their work in the bridges and tunnels in and around New York City There deficits in forced vital capacity of % for nonsmokers and 13 for smokers compared to a normal population smoking not specified were seen Greater deficits were seen for various measures of airway flow The association of automobile exhaust with the deficits in pulmonary function among a limited group of garage workers is of course only suggestive For a definitive association to be demonstrated it is necessary that a detailed study be made of the work activities and the exposures of this group of workers in order to determine if they do have significantly more exposure to auto exbaust than do garage mechanics Auto body repair Workers who were engaged in auto body repair had mean values for the various spirometric tests that were considerably lower than those of garage mechanics unexposed controls and even the groups exposed to asbestos otherwise Because of the few individuals in this group the differences between the auto body workers and garage mechanics only achieve sided statistical significance for PFEV to asbestos and other dusts which could primarily affect In FVC addition the auto body shop workers are exposed to solvents from paints and fillers and welding fumes The manifestations of disease seen in both the rays and the pulmonary function tests in the limited populations observed in this study warrant further definiation Similarly an industrial hygiene survey of the materials to which auto body repairmen are ex- posed is also necessary 60 Correlations between ray abnormalities and pulmonary function tests Table 36 lists three pulmonary function results accordintgo the ray reading of the individuals Two criteria were utilized for ray abnormality a 1/0 or greater parenchymal reading and any pleural change including the presence of diaphragmatic plaques and a 1/1 or greater parenchymal reading and pleural thickening or calcification The presence only of a diaphramatic plaque was not considered abnormal in the latter criterion The results show that in general those with abnormal rays have lower pulmonary function than those with normal rays This is evident for smokers and smokers The pulmonary function means for the nonsmokers however are the same for those with abnormal rays as for those with normal rays This is to be ex- pected as minimal asbestos effects can be seen on ray before signi- ficant deficits in FVC occur However even minimal asbestos effects can be exacerbated by smoking leading to the deficits seen in Table 36. The data of Table 36 are consistent with the previous discussed data suggesting a greater percentage of ray abnormalities among " current and previous smokers compared to nonsmokers Also as ex- pected the pulmonary deficits in those with abnormal rays are great- er when the criteria for abnormality is more stringent Comparisons with other populations Table 37 provides a comparison between pulmonary function results measured in this study and those determined in a study of the general population of Michigan Miller et al 1980 For this comparison the mechanic garage workers are excluded because of factors that may be unique to that group The studies overlapped considerably in time and the same technical personnel were used in each The field dates for the Michigan survey were February 1978 through December 1979 and for this study May 1978 through February 1980. The purpose of the Michigan survey was to measure levels of polybrominated biphenyls in blood and adipose tissue and to evaluate other health indicators The group was chosen by a random selection process using Michigan phone numbers Predicted values utilized the regression equations for the data of 61 Spirometric parameter x 100 Table 36 The means reading of spirometric values according to ray and smoking history using two criteria for ray abnormality ray reading Normal 1/0 Pl.Th. Abnormal or Pqs Normal Abnormal 1/1 or Pl.Th PFVC FEV PFEV1 MMF PMMF 92.7 176 97.2 175 80.3 152 Smokers 91.6 84 94.0 83 76.1 73 94.0 213 96.8 212 80.7 190 89.2 43 89.0 42 69.5 35 PFVC FEV PFEV MMF PMMF 97.2 264 105.2 264 92.4 216 92.4 81 98.7 81 89.4 62 PFVC 98.5 173 Nonsmokers 98.3 48 FEV PFEV1 MMF / PMMF 108.8 172 110.2 48 101.0 127 105.3 37 ( ) = Number in category 98.1 299 104.1 299 91.6 243 90.1 43 96.1 43 91.3 34 99.8 191 108.5 190 101.9 144 99.2 24 108.6 24 107.6 17 62 Table 37 A with comparison of spirometric results in this cohort with those observed in the general population of Michigan * Smoking history Observation group This study excluding mechanic garage workers Michigan general population Blacks Whites Whites Smokers smokers Nonsmokers 100 x PFVC 96.5 96.5 2.3 98.2 94.3 98.6 101.1 94.7 97.3 99.2 Smokers smokers Nonsmokers 100 ^ FEV1 PFEV 104.1 95.5 102.4 _ 104.8 106.7 110.2 96.1 101.6 105.8 Smokers smokers Nonsmokers 100 x PMMF 90.2 90.8 98.9 76.5 95.5 106.6 2.6 80.5 88.2 97.6 * Predicted values were obtained from the data of Morris et al 63 Morris et al 1971 As can be seen the data for the whites in this study compare very favorably with Michigan white males Had the mechanic garage workers been included mean values from % to % lower would have been obtained c.f. Table 30 A variety of different research groups have produced regression equations for pulmonary function parameters on the basis of measurements on normal populations The equations of Kory et al 1961 Cherniak and Raber 1972 and Morris Koski and Johnson 1971 particularly have gained widespread acceptance for comparative purposes The populations utilized and the criteria for acceptable data are shown in Table 38 for these three studies along with five others that have also established regression equations for normal populations and this study As can be seen only two of these research groups included only nonsmokers in the study group A third included individuals who smoked for less than six months and one included individuals who were smokers of less than pack years of cigarettes In some cases averages of best efforts were utilized in others values for all parameters were taken from the flow volume curve of the best effort as determined by forced vital capacity Of most importance a considerable diversity exists in the age distributions of the study populations selected Values for FVC and FEV increase until about age 25 then remain relatively unchanged until about age 35 and thereafter declining steadily with age Because of this complexity regression equations based upon a wide range of ages and utilizing only a single linear term to account for age can be significantly in error The errors are such as to produce overestimates of pulmonary functions for young and older groups and underesti mates for those in the middle years see e.g. Schoenberg et al 1978 As the population in this study is largely between the ages of 40 and 70 most regression equations are likely to understate the values for these parameters Additionally lower predicted values will clearly be obtained from populations that include smokers or from studies that include averages of several the maximal ones The use of standards expiratory efforts rather from such populations can than lead to underestimates of effect from agents in the workplace that can affect pulmonary function 64 for TablesevralsevralO) ; $1 403 yeas critea studies criteria . criteria spirometry normal Buy] of normal subjects pou = - = MOF =k M4 ------ OZ la Add Number of Smoking GOZ Aay . number We qaoyg ~Ovaqxy ua, ge] $150} MoTZ Raber UOPQITAg 15-79 Jtoja Son{Ba 6mo After - Best al smokers Ao cigs 39 cigs > ja < soy xvy - smokers smokers 3 . Ysay JO 4 OTH jo < - smokers 5 Best z < al aoqun 25-79. 8290UWS-ON Any efort After gt SAS 335 < [waoes 20-74 Ffqey Keller yBouusyqSuIyF 0760 OUS UOKov) Best effort huy 2 Bestefort >(sa)4-y JO 25-74 al STUNPAyTpuzszaquny 092% Bue OCE smokers see VN c2t Oot vo8e AO} study avy 26-70 78-02 6L-ST Non smokers 3 Best efort 01-92 BTENPTA} AL JO (20S) Jdquny poasqput ZT OZ8 82T BOY SCOT 9oT 641 91 aqey {Uo TU ADL TON Tu 4pnis Y qe WS yw y oO yo spszay yvpUN29y wopnuy Aaoy sneisgy sj}Ato4 Sty 74), 65 In this study valid pulmonary function tests exist for 163 nonsmokers in other than the mechanic garage group The previous discussion has indicated their pulmonary function parameters FVC FEV and MMF compare favorably with the group studied by Morris Koski and Johnson It is instructive to utilize the regression equations from the above studies of normal populations to obtain other comparative data The various regression equations utilized are shown in Table 39 and the percent ratios of observed to predicted spirometry parameters are listed in Table 43. As can be seen the values obtained for PFVC and FEV PFEV1 are in excess of 1.00 for all regression equations This is the result of the inclusion of smokers among comparative groups the use of averages of several efforts or the underprediction result- ing from the broad age distributions utilized for the regression equa- tions High values of FEV PFEV result in part from an extrapolated origin of expiration c.f. Table 39 The values for PMMF FEF ~ PFEF 50 and 75 PFEF75 PFEF75 are less than tions of Cherniak and Knudson This is 1.00 for the the result of prediction equa- their use of the maximum flow value obtained in any effort rather than the flow in the effort with maximum FVC It is generally found that lower flow rates are obtained during the achievement of a maximal FVC The Morris Koski and Johnson equations would appear to give the best comparison for FVC and MMF because a large proportion above age 30 only nonsmokers were studied of and their population the best effort was was utilized The very complicated equation of Schoenberg which was developed to properly take account of age is limited by the relatively few individuals over age 30 and the use of averages of efforts Regression equations for the various spirometric parameters obtained from data on the 163 white nonsmokers tested in this survey are listed in Table 41. Because only three individuals were under age 30 only the linear dependence on age could be established PHYSICAL EXAMINATION RESULTS Table 42 lists the number and percentage of abnormalities found on physical examination according to job category and organ system The only 66 Table 39 The parameters in regression equations for the prediction of spirometric functions in nine studies Study x Ht in Morris et al Miller et al Cherniak & Raber Knudson et al Ferris et al Kory et al Bass Higgens & Keller FVC 0.148 0.147 0.12102 0.1651 0.11684 0.13208 0.159 0.15748 x Age yrs Constant -0.025 -0.026 -0.01357 -0.029 -0.027 -0.022 -0.023 -0.024 -4.241 -4.053 -3.18373 -5.459 -2.79 -3.60 -5.72 -5.38 Morriest al Miller et al Cherniak & Raber Knudson & Keller Ferris et al Kory et al Higgens & Keller FEV1 0.092 0.094 . 0.09107 0.13208 0.07366 0.09398 0.11684 -0.032 -0.032 -0.0232 -0.027 -0.028 -0.028 -0.028 -1.260 -1.426 -1.50723 -4.203 -0.70 -1.59 -3.18 Morris et al Miller et al Cherniak & Raber Knudson et al Higgens & Keller Cherniak & Raber Knudson et al Higgens & Keller Michigan Cherniak & Raber Knudson et al Michigan MMF 0.047 0.044 0.05948 0.1143 0.05588 FEF50 FEF50 0.06526 0.06526 0.069 0.069 0.0635 0.10255 FEF75 0.0903 0.044 0.0497 -0.045 -0.046 -0.037 -0.031 -0.044 -0.044 +2.513 +2.806 +2.61187 -1.864 +1.89 -0.03049 -0.03049 -0.015 -0.037 -0.0252 +2.40337 -5.4 +1.577 -1.1121 -0.01987 -0.012 -0.02895 +2.72554 +2.72554 -4.143 0.03562 67 yi spirometric spirometric acording acording = determined in dgC/*4Aoador ) 99 9es S2T $28 0s Miler . AOJ . O 2 6 1.1 t% 1907.32 107.3 (o0g% . 1.1 O T8 99T 106.0 106.0 Feris MilerKnudsonFerris Kory Feris OF Kory Higens Kory STqEL Jo MichganSchoenbrgMichgan Michigan Ens By Sy JO COTx). 1.3 122.7 - T't = = = 9 2 = JNK 108.4 - 1.2 0S8 90T al Coots)et 111.3 - 1.3 < l 111.2 - = = = = = = e t E l se se Aga O'OT TIT BY0T L60T <82T 760T Stit ZIT ajwoaypdsBOTIa T'l T'l Tle Z'1 Clg Z'l ol < T <C Ts aul, (OTx) = = = F = = DAad/DAB T0T 20T <SOT 680T L7ezt 7BOT Z6T Set CTIT Aaqey , -*[B "Te y T@ (Te TB Ja Je 32 38 3D ABT Te TAWA 39 YP Apnyg spia0y ASTIN YAeqpusyo uospnuy spi294 K10y sug susty Bzequaoyg us8yU TW DO Table 41 Prediction equations determined for various spirometric parameters from 163 nonsmoking whites in this study Parameters FVC FEV MMF FEF 50 FEF 75 Regression equation 0.0136 x Ht - 0.0267 x Age - 3.29 0.0858 x Ht - 0.0270 x Age - 0.792 0.0159 x Ht - 0.0289 x Age + 4.017 - 0.0033 x Ht - 0.0259 x Age + 6.124 0.0060 x Ht - 0.0196 x Age + 2.093 the R 0.43 0.43 0.09 0.04 0.12 No mechanical garage workers are included However there were no other exclusions based on health information.or job 69 Cyanosi503 examined (7) (7T) (9z) (et) exposure (1) ( <) (se) (OT) work (8) (90T) 59qSY Cyanosis extremites extremites extremites 9 9 8.7 8.7 10 8T 9.6 12 8 o @S Go Joints (ot) (ZE) {s7) (9%) 8.4 8.4 ) (28) 8.1 9 (TT) (62) punoj Kazoseo ayeag Skin 0 9 zz 9 8 OOT 9S 11.5 11.5 ) $6T 18.4 23 $ 6 10.0 Gof sefipmacuqe 2 a8eiey 02 ay yO Thyroid (7) (6) (ez) (S$) 0.0 0.0 ) (Sz) 1.6 2 (8) (6S) Thyroid Lymphatics Lymphatics 1 8 vst O 11.2 11.2 ) 2 02 0.0 0 2 92 8 9% 87 Sufpiose 18.7 =PEWeL zaqunu PetsTIVpt Gastroineal,, pue 26 Dry (e) (6) (ct) (6) 17.3 17.3 ) (Iz) 9.3 10 (6) (7) 37 yIFA 9 Gastrointesinal,, Gastrointestinal,, Gastrointesinal,, Gastrointesinal,, 0 8 11.5 11.5 ) C stT 24.2 8 $*T de 11 uofFyepwxs ON 257 sejuid STeNpAuF Abdominal TeoysdAu Fo uosiedt syL Number . wegsd^'s abAnormralitgy oe TeUWOP as=quny peuexa Number sopaeydus indvuals us3i9 BqUpoL UtAS saky yznoy prozAy 352UD FPA ( Auy GY, ) 70 circumstance in which a statistically significant greater percentage of abnormalities is found is for abnormal lymph glands among the popu- lation serving as an unexposed control With the numbeorf subcate- gories established in Table 42 such a finding would be expected on the basis of chance alone We attribute no significance to it Table 43 shows the number and percentage of individuals with rales or finger clubbing according to their ray reading A greater percentage of individuals with abnormal rays have dry rales than do individuals with normal rays The numbers however are so small that the data do not achieve significance There was no correlation of finger clubbing with ray findings Overall rales were observed in 4.8 of the entire study group and clubbing in 2.6 compared to 25.2 with abnormal rays for 13.1 if more stringent ray reading criteria were utilized c.f. Table 11 Thus in contrast to earlier data from Great Britain British Occupational Hygiene Committee 1968 it would appear that the presence of ray abnormalities is a considerably more sensitive parameter than rales or restrictive pulmonary function deficits for the categorization of asbestos disease This has also been seen in several other asbestos groups including shipyard workers to be published and chemical or oil refinery maintenance employees Lilis et al 1980 Data for the blood pressures are shown in Table 44 according to age job category and race As can be seen the systolic and diastolic blood pressures of the blacks are significantly above those of the whites Systolic pressures increase from 5 to 7 percent per decade and diastolic from 2 to 3 percent each decade with the rates of increase being greater for blacks than whites The analyses of the age standardized blood pressures according to smoking history or job category are shown in Table 45. White cigarette smokers appear to have somewhat lower blood pressures but this could be artifactual as it is not reflected in blacks No significant differences are seen in the analysis of blood pressures according to work activity 71 Table 43 The number and percentage ofindividuals with rales and finger clubbing according to ray reading Rales present Clubbing present Both rales and clubbing present* ray reading Normal Abnormal 30 4.3 17 6.9 16 2.6 6 2.7 3 0.5 1 0.5 The cases with both rales and clubbing in the separate categories as well are included 72 (T) (9) (OT) (2T) ( <) Systolic Systolic Black presure pressure 9 % T'S 123.4 3.8 123.4 126.6 1.9 20 0 0ZT ZEZT 78ZT 128.0 128.0136.8 1.4 137.0 -3.0 3.0 B T 131.8 -2.5 2.5 + 134.0 . 134.0 134.0 -3.3 3.3 7 98 S3aANseid (Z)( <2()82) 152.2152.2 - 166.5 166.5 -6.8 6.8 12 standardized standardized < 135.4< 135.4 - 0.6 143.2 143.2 143.2 1.6 1.6 OS T T standrized dinsead poTq 9Y BoOBY yYoutg = F F F = ade DT Diastolic 8 Diastolic Diastolic Diastolic pressure F + pus I;[oysep 29 presure eTqPL soe. O'LET TET O'FET 76.2 76.2 - 1.8 Diastolic 75.5 75.5 -presure presure 0 68 ) pue fq ( <T)(49) ( <T8)3.1 83.1 - 90.4 90.4 -2.6 2.6 41 OT BE 6 TT 7 85.8 85.8 - 0.8 93.3 93.3 -2.2 2.2 28 7 O0 [oysds Age F F 89.3 89.3 - 2.1 93.5 93.5 -5.0 5.0 12 + ayy standrized standrized O'8ZT 84.6 84.6 - 0.4 89.0 89.0 -1.1 1.1 768 948 pezTavus 6% 6 6% 6S 69 aay - - - - - 0% OF OV OS O09 +02 asy peztaurs 62 6 6<7 6S 69 -~-~ - 02 0 0<% 0S 09 +04 ady 73 Table 45 Age standardized systolic and diastolic blood pressures accordintgo race smoking histaondrjy ob category Race Smoking history White Black Smokers smokers Nonsmokers Smokers smokers Nonsmokers 131.5 - 1.3 137.3 - 1.0 135.6 1.4 140.8 - 143.4 - 141.7 - 3.8 Diastolic 82.9 - 0.8 88.5 - 2.1 85.3 - 0.6 90.0 - 1.6 84.8 - 0.7 86.3 - 2.3 Job category White Black No identified exposure Garage work but no brakes Systolic 140.1 - 2.5 .150.4 - 5.3 136.1 - 2.7 139.4 - 4.0 Brake work 134.5 - 1.0 140.5 - 2.7 Asbestos exposure 135.5 1.4 . 149.6 - 5.2 No identified exposure Diastolic 85.1 - 1.2 89.9 - 3.6 Garage work but no brakes 85.5 1.3 87.8 - 1.5 Brake work Asbestos exposure 84.4 - 0.6 84.4 - 0.6 87.0 - 1.9 94.9 - 2.4 74 LABORATORY FINDINGS The data on the blood analyses CBC and SMA are shown in Tables 46 and 47. No unusual findings are present for any parameter The means of the various parameters according to job category are listed in Table 48 and do not show anything remarkable Tables 49 and 50 show the results of the analysis of sputum specimens for abnormal cytology and the blood analysis for carcinogenic embryonic antigen CEA They show no find- ings suggestive of neoplasia most values are within the normal range Further there is no difference in the distribution of either parameter for the different job categories MRC RESPIRATORY SYMPTOMS The principal results of the respiratory symptoms questionnaire are shown in Tables 51 52 and 53. Tables 51 and 52 show the expected correlation with cigarette smoking In Table 53 the smoking stand- ardized percentages of chronic bronchitis and shortness of breath categories are listed for different job categories NICKEL CONCENTRATIONS IN WELDERS As part of a study to assess effects on welders plasma nickel concen- trations were measured in twelve welders in the control group engaged in amphibious vehicle construction The results are shown in Table 54 and indicate that the particular group within this study had higher nickel concentrations than a group of 62 welders in a large shipyard and ten times the concentration of hospital controls While no physiological effects can be associated with such concentrations the toxic and potentially carcinogenic effects of nickel would suggest identification of the exposure source and implementation of abatement measures 75 Table 46 The distribution of blood count values CBC Analysis Range See headings .. .. for concentration unit Individuals within range Number Percentage White blood cell count thousands 13.9-11.3 < 3.00 3.00 G 4.99 5.00 - 6.99 7.00 - 8.99 9.00 -10.99 11.00 1 70 342 308 124 39 0.1 7.9 38.7 34.9 14.0 3.1 Red blood cell count millions < 4.25 4.25 - 4.74 4.75 - 5.24 5.25 - 5.74 , 5.75 - 6.24 > 6.25 S 130 462 . 228 34 12 4.3-6.3 2.0 14.7 52.3 25.8 3.8 1.4 13.0 13.0 - 13.9 14.0 - 14.9 15.0 16.0 - 15.9 16.9 17.0 - 17.9 > 18.0 Hemoglobin gm 12 54 237 335 186 54 6 12.9-18.12.29-18.2 1.4 6.1 26.8 37.9 21.0 6.1 0.7 37.5 37.5-39.9 37.5-39.9 40.0 -42.4 42.5-44.9 42.5-44.9 45.0 -47.4 47.5 -49.9 50.0 -52.4 52.5 Hematocrit percent 4 13 92 245 308 154 53 15 38.9-54.9 0.5 1.4 10.4 27.7 34.8 17.4 6.0 1.7 ] = Laboratory normal rance 76 Table 47 The distribution of concentrations of various blood components SMA Analysis Range See headings for ~ concentration unit Within range Number Percentage Glucose mg 65-125 < 80 80 - 99 100 - 119 120 - 139 140 - 159 160 46 415 294 61 25 47 nitrogen dl 8-25 < 10 10 - 14 15 - 19 20 - 24 > 25 44 250 420 150 22 5.0 46.8 33.2 6.9 2.8 3.5 5.0 28.2 47.4 16.9 2.5 Creatinine mg 0.7-1.5 < 0.80 0.80 - 0.99 1.00 - 1.19 1.20 - 1.39 1.40 - 1.59 > 1.60 5 113 339 315 : 89 22 0.6 12.8 38.4 35.6 10.0 2.5 Sodium meq 135-145 < 138 138 - 139 140 - 141 142 - 143 144 - 145 146 - 147 > 148 14 102 234 237 125 76 98 Potassium meg 3.5-5.0 < 3.00 3.00 - 3.49 3.50 - 3.99 4.00 - 4.49 4.50 - 4.99 > 5.00 5 38 222 . 451 . 209 56 1.6 11.5 26.4 26.7 14.1 8.6 11.1 0.6 4.3 25.2 39.8 23.7 6.2 Table 47 continued 2 Range See headings for concentration unit Within range Number Percentage Chloride meq 95-107 < 100 100.0 - 102.4 102.5 - 104.9 105.0 1 107.4 107.5 ~ 109.9 > 110.0 50 215 212 229 88 92 Carbon dioxide meg 24-32 < 25.0 25.0 - 27.4 27.5 - 29.9 30.0 - 32.4 > 32.5 39 238 310 244 55 Uric acid mg 3.5-9.0 24 4.0 6.0 8.0 8.0 9.9> 9.910.0 376 392 88 6 Calcium mg 8.5-10.5 9.0 1.0 9.0 > 9.9 10.9 10.9 11.0 11.0 16 510 340 17 Inorganic phosphate mg 12.0-4.5 < 2.00 2.50 3.00 3.50 - 2 2.00 2.49 2.99 3.49 3.99 4.00 16 134 15.1 15.1 37.4 331 280 37.4 37.4 31.6 10.4 92 10.4 33 Total protein dl 6.0-8.5 < 6.50 6.50 - 6.90 7.00 - 7.49 7.50 -7.99 -7.99 8.00 - 8.49 8.50 26 197 401 197 55 7 2.9 2.9 2.3 22.3 45.445. 45.4 45.4 22.3 22.3 0.8 0.8 Table 47 continued Range . See headings for concentration unit Within Within range Number Percentage Albumin dl 3.0-5.5 3.50 - 3.99 4.00 - 4.49 4.50 - 4.99 5.00 - 5.49 18 439 398 29 2.0 49.7 45.0 3.3 Cholesterol mg 140-330 < 150 150 - 174 175 - 199 200 - 249 250 - 299 300 13 66 162 443 178 24 1.5 7.4 18.3 50.0 20.1 2.7 Creatine phosphokinase U 0-225 < 50 50 - 74 75 - 99 100 - 149 150 - 199 200 - 249 250 - 299 $ 300 52 162 196 258 104 49 22 43 5.9 18.3 22.1 29.0 11.7 5.6 2.5 4.9 719 oT O 0 O800 c O6 t <100 O 2 070 O c O z 06090 <O0 <0O00 020 O 972 c0 0 T ? 6 0 9 70 O'o bib pue + + + += ++F++ +++ + ++ + >++= F BTQyso5 einsodx 3 asqyutjag soq s cs7^'Ot*s fest es#oet $9TCUT TeT Table COT687oT 9^'2668CGara eye ZS7% <C0ckd 10z 602 6TLT LTt @ SUOFIEWZGS &208a 382 qof puw os ey sajowusdSuypricz28 fiTqIeL alu unos po[q ouedwos jo POTQ soenTeA snoyaB uUs U ay} identifed identifed so o 10 B T 2 O TO O z 020 0 f'0 TO UO020 0 cO O 2O O 10 O 6 T 1070 g T 709 O 0 2L 9 identified identified + + + + Garage Garage Garage employment employment employment employment = + + + + + % + + exposure . garage -0.20 0.20 09 670T Zot7.14 7.14 T2 4TSOT 882 0.19 0.19 0.19 627% Ly9 <2z7.40 7.40 ote <*2z-0.09 -0.01 1.18 -0.5 0.01 $0 O0 0 16.2 0.01 t 07 $ 015.7 1.18 9 0 C0 C o t -0.2 1.15 t+ -0.3 0.3 + + F 143.5 143.5 + + + -0.4 + + = 143.4 143.4 + -0.2 Yalow4.24 142.1103.6 3yHvIQ 0.3 28.1 -0.12 0.12 c sOIT dest 28.5 6.42 6.42 ZSOT $ 8e -0.14 0.14 6E%17) 2C228.8 6.43 $6T S22 -0.17 0.58 yaom 72.5 19.6168.9 v8e203 -2.8 2.8 22.7 4.41 -3.6 0.03 90 O Z0 O 22.2 Ott 270% 971s -0.03 0.03 + + 222.7 c o c 0 222.2 222.2 F 0.57 0.57 = + -0.03 0.03 + + + 0.59 0.59 che -1.9 aes -0.01 22.5 -5.6 5.6 9 94 6 01 a ST 17 .7 13 .8 177.7 9 fOT 1 82 -3.6 8 ? ord 0$ 7 177.9 133.1 17 .9 17 .9 9 6T Lez -2.0 *Ado> orp peenaqepe aevydso esvuaopAyasvuTHoUdy ayedsoy FUND VUNOD 4adUsied Pod VpaO udtoayu UR BPTXOTp LOnB Ag podey1599 BUPTIGAD syur3sou, puortg arzuy4 pPonrylyy yUPQyg Opon VUE, vseurg wo2} pwoasy FSEUICY ePTIOUD uoyrzeg PStTaOnR enpILeG poqo8sgupTenyge[O3U2D9 tSyQiPaayC suyreiy Ad9S $085 o3ryory auTIWs95 80 66T-St (0'0) 0 Table Table 49 0(0 90) if(1'0) distribution ( The {uwdistribution acording T acording T category i category (v< 0) = 99 6 /wsouen)6-6 3 cytology Spu< tum S cytology 41 cytology 9 (t' <) 82 (ee) ~~ Category =6(<96) (796) ( < (0 (< YA > LOT 26) etl $6) 617 96) HQT <28 garage 67 brakes work ra < T 9 0 21 (9) ($T) (ZT) ) 0.0 , work repair with FTqPL work c ot 34.0 3 ( 6 (<$61) 3 ( < <Z) 419 0.2 = Identifed ) Identifed posible @ ( (Ove) (2 32 a4 ) 37.2 ) 1 ) 96.3 0.5 yo ~ s = = ou (0Sy) ) 0.4 (9 (9 (7 T Lt %Z 06 143 ( 6 ) 823 ersjdhpJo Totals ) aTqtsod percentages IO atyse[dqow atypia considerd 20 eqpd^'qe atypia normal ASoTORAD no normal etdqe sagequoiad atypia considerd considerd dysplasi ajerpoyzepneoy dysplasi sayeig OF ST = JewsroN pity patyrzuapy soq se sozqse gor on aserey ou ere axe1q ( PIO] ) fy 7oc y 81 66I-Sl 0 (0 0) t Table 0 (0 0) 6 distribution distrbution /w2 = 6 distrbuionYY) ouew)6S according acording to cytology smoking results Sputum Sputum cytology cytology 9 ( %) Category (2 <6) 3 4 Category 1 2 6S < Slz 6) pue Azodayeo smokers smokers Suryous Nonsmokers ASOTYAD Nonsmokers 03 ) 22.6 1.1 36.7 39.5 22.6 ( < 04 . cz 24.8 ZI 2.8 34.0 umyndssutpz0doe waQNdS z (87) (6 OL 64 6) (O2 ve) Jo 146 77 percntages 41.0 37.3 37.3 19.7 19.7 ( 1.8 Regular dysplasi BuTyoug SIBYOUS xS19xOyUws SADYOWSUN I (1'0) conetr< aions 82 (ee) < ( <96) 93.2 93.2 0.8 0.3 LL 97.8 97.3 941 (ELE) 0.0 822 3 96.3 96.3 0.4 etsdsp 0.4 40 ABoTOYADaTyserdyaw ao etd^'je sagequ ciad Tewsi0onN azeynsay erdAye pripn ajer poy = STRIO] ( ) T 7* < y 83 Table 52 The number and percentage of individuals reporting symptoms of chronic bronchitis MRC accordintgo smoking category Chronic bronchitis Yes No Totals Smoking category Smokers smokers smokers 80 29.1 195 70.9 275 34 9.5 325 90.5 359 21 9.5 199 90.5 220 84 pez number reporting number symptos reporting Category Category garage or garage smoking standraized standraized percentage acording Non Bt/L ($2) L7/2(9 20/68 Ex 12/56 Os/s (0 OT) L/T7/28 Gargeasbetos 9S/7zT(T9Z) 19.4 ) 98T/0% 20/186 ) (9 TT) cT/t 7.4 eg repair sADHoOWS-xXq eTder . Garge Identifed posible posible (R62) 92T/0% 40.6 28/69 10/88 ) 11.4 10/8 (904) zt/s 10.0 body Auto pue suoqdus Ao ) a8equoiad percntage1 yAOn sanodxa qnq YafA pue aInsodxa yom suzy k108.e) edvATs RAO yao ayedez soyxeAg Lpoq = psTIUopT gor oN soqase |VsBAavy ou advary29281q soqjase o3ny ( ) 85 Tabl5e4 Nickel concentrations in the plasma of amphibious vehicle construction welders compared to other groups Group Vehicle welders Shipyard welders Hospital controls No. of individuals 12 62 15 ' Plasma nickel concentrations liter Median Range Mean SD 11.8 2.5 0.7 5.4 te 14.3 0.5 - 15.3 - 0.5 2.6 10.8 - 3.2 3.1 - 3.3 1.0 0.7 ASBESTOS EXPOSURE DATA REVIEW OF PUBLISHED RESULTS Review of fiber concentration data for brake work A variety of measurements have been made of asbestos air concentrations during brake lining repair and maintenance activities in the United States and Great Britain These include both term sampling over a working day to obtain information on weighted average exposures to workers and short sampling to document the concentrations during various work practices The largest set of samples of brake maintenance work is that obtained by NIOSH during the years 1975 through 1976 where 283 samples were taken in five brake repair facilities including 152 over a one week period in one facility documenting both term weighted average TWA exposures and asbestos concentrations in specific brake repair activities NIOSH 1972-1976 Unfortunately no documentation exists as to the number of brake jobs performed in a facility or by workmen during sampling periods or on the work practices utilized during the repair and maintenance work Table 55 summarizes the data on weighted exposures over a sampling period for men changing lining material punching out rivets riveting linings to shoes and working in the parts department Table 56 lists general area samples taken during the course of a day These data demonstrate that iu general the term asbestos exposures of garage employees are below 0.5 ml However during the air blowing of drums punching out of rivets and riveting asbestos concentrations can be considerably higher Further area samples taken distant from the location of brake repair show widespread dissemination of airborne asbestos with concentrations up to 1.3 ml found to be present More limited date are available from industry sources In Great Bri- tain lickish and Knight 1570 of the Ford Motor Company Lave provid- ed information on both long and short sampling during different 87 Number Number 60 0 repair and maintenace work 92 0 Te T OT'O 2 0 Garge poyied Sojsqye (Tw SUJUT B197619761976 ; BxeIG YAOM 1976 . FO D A S[CpAo SJPOAF uBR STeyjoq ss OueojzyPTWeL Suf[dues E ) JIUpUPY] 89T~S0"O 2 rama) 4700 0.4 0.2-0.3 LePr-T2e JRO Z2SL-SE0 Szazg Te'T 9TO~-<0 SuTUpY zo (eRep pues poysFTqndu JTruoszdaprdz A Suysry9 SuPysung SuPsepTday Jo wasq~Juoy soTdues A fo T@ S Punching Punching out Zz Zz T S t | 9/61-ST) FO satdurs 9T TZ <% @ 9T TT T eT Z HSOIN A (9267) 5 (9261) (Sl6T) 1.21 (2L61) <swory B V @ 9 @ @ Vv @ a 88 Number Garge Boucjrvu (Tu/sroqt)SoOJsqepofaed SUFUT AZutdwes OxvVIq YAOM 1976 jo B 9 =8TIPL Bupldues C ) pur wore aredsz F wiej-Fuoz F1972 From From , Jo 2eqUnN seTdurs aSvas9 repair repair maintenace maintenace maintenance average , 18 teay 7<T-<0 T0-TO 400 0.04 T0O 6*0-90 Ceaup poystrqndu [Tersuy | 8T 9 T T T a *9/61-Z2) O& 66 % T T HSOIN (9261) (9461) (9261) ($261) (9461) (261) V 9 a 4 4 wor 89 cirumstanceIO sucop total sampling ayeaq Asbetos fibers conetraions conetraions Staic SAPIG samples is TT samples yonz3 Range *TIUy yonag DEAIOS fibers Meansfeq C Static BOUCITFEM9YvIQ 3Snp cloud byuNap SUyANp Jc Personal LS sSuoftSuzMOTG soyeqsy cleaning 3TqeL eajuso Ate yo Jeqyjy BSufAToOu Jequny Personal Staicwoysads so0yArzos guy[ducs Static samples Sta ic wisj-Suc7 FromSut Tdurs car sz 89 O 60 L oT brake Z9E-TL T-8e "0 60 L Z z 9 I weighted average above samples ae2 Hickish , E. asnp L. dyxvIq Knight Ann apts oT3219 , ze. 97325 pnojys L. Knight KnightKnight An fq fq uo changes 800 <8 TST" " CT vehicles 800 0.68 serviced SaTdurs truck incl omy T 9 . oA0de truck JO service cleaning OO B8rzvaP 1.83 nearby nearby aTduvs pozyston 17-21 bays , Hyg BF4uAqS 1970 swo2z brake repair activities These are shown in Table 57. The work prac- tices sampled by Hickish and Knight appeared typical of those of past years with the drum dust being removed by air blowing During the full course of brake service air concentrations of from 0.4 to 3.6 ml were found More recent information has been supplied by Manhattan Marsh 1979 These show that during the course of well ~ controlled brake repair work with exhaust ventilation utilized asbestos exposures of 0.02 to 0.3 ml may occur during the course of a brake job Short asbestos concentrations during specific work activities have been measured by several groups in both automotive and truck servicing These are shown in Table 58 They demonstrate that short asbestos concentrations during brake maintenance work can be high However because they comprise only a portion of the work involved in brake maintenance the TWA concentrations are generally much lower Clearly reduction of these peak exposures by engineering controls or by work practices can significantly reduce THA exposures Two sets of data on the time course of asbestos concentrations exist The measurements of total dust by Lee indicate that after air blowing short dust concentrations are high but fall within minutes to lower values The data on fiber counts by Rohl4 indicate that measurable concentrations of asbestos persists in the workplace for as long as 15 minutes after air blowing as far as 75 feet away These data coupled with the previous information on asbestos concentrations in general garage areas indicate that a general level background contamination of asbestos can exist throughout a garage where brake repair is conducted MEASUREMENTS IN NEW YORK CITY FACILITIES 1979 During 1979 NIOSHI made measurement at three New York City facilities employing workers who attended examinations in this survey These were the repair shops of the Departments of Sanitation Transpolation and Police The results are shown in Table 59. They are similar to those 91 Activy (Tu Activity uoT3. UBD. STFGOWoIHe Air blowing fromblowing GUPANp SOPFIAOLY Brushing drums GrindgGrinding BOULVTRWgc Grindg linings SUoTPJejIDeTIeL BYCAG suyinp porexhaust Sojsaye BONA Bevling fo pue Riveting Aqewuns Sweping cleanig ~ wo NIOSH Knight 1972-76 ml ml Om wo e le samples samples aT 0.45-14W .O 5W 4 Nn Zz . Marsh Marsh 8 1979 1979 0-20 0.2-0.4 0.2-0.4 VT-B%S*TZ-70 OZL-E 02-6T 9E-7's | Rohl Rohl Rohl et 1976 1976 39 1976 Rohl Rohl et , 1976 23.7-2.0 9L6T 9161 9/61 1.9-2.0 1.9-2.0 6461 Te Te *T@ 1.9-2.0 33 38 2.4-3.6 2.4-3.6 UsIeH THON [HOY TYyoY 33 yO SNYXSssneyxs pue BauypMyoTqwAoslnzp sunap Zupsnagywsonrpj swnap pBuzuayyS3UTT poos r0d TSOAUOgP SUTIAFY SuzdonsSuypUBIaTo 92 Table 59 Long and short sampling of brake lining repair and maintenance work in New York City garage facilities Activity Sampling time fiber concentration Sample TWA rl Brake change After finishing Wet brushing of Area sample Area sample job dust Department of Sanitation 136 190 10 395 390 0.33 0.12 0.54 0.06 0.05 Department of Transporation Brake mechanic 1 Brake mechanic 2 Brake mechanic 3 Wet brushing of dust mechanics 1,2,3 150 196 175 194 135 3 3 9 0.15 0.30 0.31 0.26 0.24 2.62 2.22 0.87 0.21 0.21 0.23 0.23 0.28 0.28 ; Brake mechanic 1 Brake mechanic 2 Brake mechanic 3 Dry brushing of dust Police Department 129 68 124 177 47 12 21 0.20 0.21 0.34 0.08 0.03 0.81 0.61 0.20 0.20 0.19 0.19 93 discussed previously TWA exposures during a full brake job averaged about 0.20 ml During either wet or dry brushing of brake dust concentrations could exceed 2 ml ESTIMATES OF STUDY POPULATION EXPOSURE TWA exposures during automobile brake maintenance ranged generally be- tween 0.2 to 0.7 ml if brushing or air blowing of brake dust occurred Prior to 1950 riveted brake linings were used and somewhat higher concentrations may have occurred Table 60 lists the distribution of brake jobs per week done by U.A.W. Local 259 members The average is about one every two days for those who do brake work If the exposure during the 1-2 hours required for a job is 1 ml an approximate TWA exposure would be 1 ml 1.5 or about 0.1 ml General garage exposure from other jobs would add slightly to this but the upper limit of the average exposure for the commercial garage mechanics examined in this study would be 0.2 ml For the S.E.I.U. Local 246 mechanics employed by the City higher average exposures would have occurred from the riveting drilling and grinding that was done on large truck brake assemblies However these high exposure work acti- vities would only require a few minutes of work As with commercial garage workers few City employees worked on a brake job as often as daily Thus even with the intermittently higher exposures experienced by S.E.I.U. members the average exposure for the group over time is unlikely to exceed 0.5 ml SUMMARY The clinical examination of garage employees engaged in the repair and maintenance of vehicles indicate the following results 1 A greater prevalence of ray abnormalities is found among garage mechanics who repaired brakes than among blue collar controls or garage workers who do not engage in brake or auto body work The age standardized percentage of abnormalities is significantly gleator 0.05 in those with 30 or wire years of employment jo AtoNuyxsIq ory oujeox0g now 1-4 week 9T z LZ -OOT Jo sdous JO AQuoNbyxz SOABWTSTruosan 09 66% azqunay udu 8TICL TRI0T Jo mM sqof VA UT o7e1q no brake work % parts : Lt sjaed @20W yquo/T 470M (939 uoTtAngy24stq sopuryou yquow/c- Jo 20 yaoa/ Teuosad zequny ouop Acp/T 7-1 usyQ O7yUAQG ssaz oubuyzsu) STBROL T 95 compared to workers with lesser service The increased prevalence in commercial garage workers exposed on average to less than 0.2 ml was not statistically significant while a significant excess is seen in workers who had occasion to grind and machine brake linings prior to installation on larger vehicles The prevalence of ray abnormalities is in accord with estimates of asbestos exposure in the different circumstances The prevalence of ray abnormalities among workers in auto body shops was particularly high and although the number of such individuals was limited also achieved a level of significance at 0.05 The higher percentage of abnormalities in this group can be attributed to the past sanding of auto body fillers containing asbestos Individuals who had previous employment in shipyards averaging five years in duration also had a greater percentage of abnormal rays The percentage age standardized percentage was significantly greater in those whose shipyard employment began 30 or more years previously The pulmonary function results of garage mechanics engaged in brake work are no different from garage workers and other general population controls As the major spirometric tests are less sensitive measures of asbestos exposure than rays this finding is in accord with the low exposures of the groups under study Car jockeys new vehicle preparation men and auto body shop work- ers have significantly FEV and MMF compared lation controls reduced pulmonary function to other garage workers and tests FVC general popu- The auto body shop employees had exposure to asbestos and 3 Var- iety of solvents The causal exposure among the car vehicle preparation men is uncertain The role of automobile exhaust should be investigated 96 Pulmonary function deficits correlated with ray abnormalities Greater percentages of ray abnormalities and pulmonary function deficits were seen among current and former smokers than among smokers No unusual physical examination of laboratory findings were identified As in other studies a high prevalence of hypertension was observed among blacks which was not correlated with any job category A small group of welderisn amphibious vehicle construction showed significantly elevated plasma concentrations of nickel 97 REFERENCES Anderson H.A. Lilis I.J. Household 311-323 1976 R. Daum S.M. Fischbein A.S. and asbestos neoplastic risk Ann N.Y. Selikoff Acad Sci Ayres S.M. Evans R. Licht D. Griesbach J. Reimold F. Ferrand E. and Criscitiello A. Health effects of expsoure to high concentra- tions of automotive emissions Arch Envir Health 168-178 1973 Bass H. The flow volume loop normal standards and abnormalities in chronic obstructive pulmonary - diseaCs hee st 171-176 1973 British Occupational Hygiene Society Hygiene asbestos dust Ann Occup Hyg 47-69 standard for chrysotile Bureau of 1909-1978 ton D.C. Labor Statistics Employment and BLS Bulletin 1312-11 Government 1979 earnings United States Printing Office Washing- Cherniak R.M. and Raber tion using an automated 38-46 1972 M.F. Normal standards for ventilatory funcwedge spirometer Am Rev. Respir Dis Ferris B.D. Anderson D.O. and Zickmantel screening tests of pulmonary function Amer 1965 R. Prediction values for Rev. Resp Dis 252-261 Glover J.R. Bevan Lowe C. McDermott dust in North Wales C. Cotes J. Elwood P. Hodges N. Kell R. M. and Oldham P. Effects of exposure to slate Brit J. Indus Med 152-162 1980 Greenberg M. and Davies T.A. Brit J. Indus Med 91-104 1974 Mesothelioma Register 1967-1968 Hammond cigarette 1979 E.C. Selikoff I.J. and smoking and death rates Seidman Ann N.Y. H. Asbestos exposure Acad Sci 473-490 Hickish D.E. and Knight K.L. Exposure to maintenance Ann Occup Hyg 17-21 1970 asbestos during brake Higgins M.W. and Keller J.B. Seven measures of ventilatory lung function Population values and a comparison of their ability to discriminate between persons with and without chronic respiratory symptoms and disease Tecumset Michigan Am Rev. Respir Dis 258-272 1973 Knight M.L. and Hickish D.E. Investigations into alternative forms of control for dust generated during the cleaning of brake assemblies and drums Ann Occ Hyg 37-39 1970 98 wy Knudson R.J. mal expiratory effects of age Slatin R.C. Lebowitz M.D. and Burrows B. The maxivolume curve Normal standards variability and Am Rev. Respir Dis 587-600 1976 Kory R.C. Callahan R. Boren Administration Cooperative Clinical Spiromety in Normal Man H.G. and Snyer J.D. The Veterans Study of Pulmonary Function I. Am J. Med 243-258 1961 Lee G.L. Removing dust from brake assemblies during servicing - alternative cleaning methods Ann Occ Hyg 33-36 1970 Lilis R. Daum S. Anderson H. Andrews G. and Selikoff I.J. Asbestosis among maintenance workers in the chemical industry and in oil refinery workers In J.C. Wagner and W. Davis eds Biological Effects of Mineral Fibres ' IARC Scientific Pub No. 30 Lyon pp 795-810 1980 Lorimer W.V. Rohl A.N. Miller A. .J Asbestos exposure of brake repair Mt. Sinai J. Med 207-218 1976 Nicholson workers in W.J. and Selikoff the United States Marsh J. | Unpublished data Personal Communication 1979 of Manhattan Corporation Miller A. Thornton J.C. Smith H. and Morris J.F. Spirometric abnormality in a normal male reference population further analysis of the 1971 Oregon study Am J. Indus Med 55-68 1980 Morris healthy J.R. Koski A. and nonsmoking adults Johnson L.D. Spirometric standards for Am Rev. Respr Dis 57-67 1971 National Institute for Occupational Safety and Health 1972-1976 Personal Communication Ralph Zumwalde - -" National Institute for Occupational Safety and Health Industrial Hygiene Survey Report of the New York City Sanitation Traffic and Police Brake Servicing Facilities Queens New York Cinciunati Ohio May 12 1979 Nicholson W.J. Perkel G. and to asbestos population at risk Am J. Ind Med 259-311 1982 Selikoff I.J. Occupational exposure and projected mortality - 1980-2030 - Rohl sure A.N. Langer A.M. Wolff M.S. and during brake lining maintenance 110-128 1976 Weisman Il and repair Asbestos Envir expoRes Rossiter C.E. and Harries Study survey of the sample Indus Med 281-291 1979 P.G. U.K. Naval Dockyards Asbestosis population aged 50-59 years Brit J. Rossiter C.E. Initial repeatability trials of Classification of the radiographic appearances Brit J. Industr Med 407-419 1972 the Cincinnati c^> pneumoconiones 99 Schoenberg J.B. Beck G.J. and Bouhuys A. Growth and decay of pulmonary function in healthy blacks and whites Respir Physiol 367-393 1978 Selikoff I.J. Nicholson W.J. and Lilis R. Radiological evidence of asbestos disease among ship repair workers Amer J. Indus Med 9-22 1980 Weiss W. Levin R. and Goodman L. Pleural plaques and cigarette smoking in asbestos workers J. Occup Med 427-430 1981 Weiss W. Cigarette smoking asbestos and pulmonary fibrosis Rev. Respir Dis 223-227 1971 Amer 100 APPENDIX I -. Name 101 BRAKE REPAIR AND MAINTENANCE WORKERS SURVEY Date No. Union Local : Address Telephone Street Carage Facility City Date of Birth State Age ZIF Sex Name of Physician optional . Address URINE Albumin Albumin ce Protein ENVIRONMENTAL SCIENOIS LABORATO ENVIRONMENTAL ENVIRONMENTAL ENVIRONMENTAL SCIENOIS SCIENOIS LABORATO LABORATO MORN MORN MORN MORN MOUNT SCHOOL OF MEDICINE OF THE CITYCITY UNIVERSITY OF NEW YORK AE a owen He ST RENE Ua aad OTROS ABN TY AY ABE OT Oe Oem een 8 Mee ace OA verke yIuoay V. , V. V. V. svanodxi V.V. V. sae SUDAUON V. aovuo V. V.= V. ANOLSIN V. V. V. V. V. V. AVNOTEYIDO wuOM V.HOLAID aNy nor TAVUH TULYosSud) wOoTrL 1 POTdIY O1/aoug 3anqoudsiunvare } 1 iv ON 10 20 M ESVUO NVI MWuosrs WAHL 2J9O -- TNAO WOlNLOUILS3S0 7S LIRA SROTADUd . NOLAVISEDdUOA JO =| senc yo fem -Je ouay adh, opus, ce}e {| pourOL ng o | A = 3] : es Se . ra 4 1 ' va . . ; 10) GlavouG wTyjuod eens oem orem yyy . ~~ GozyaTSY co chalet - | me e {mee ame rf Ren TuNopyedansw 2 12 ; f Last First Year first exposed to asbestos occupationally Year last exposed to asbestos occupationally Total number of years -subtract -subtract -subtract and months exposed to asbestos exposent # yrs dising period not exposenet xpHosOent Dates employed as Garage forker ] YR orclutch orclutch Work Dates performing brake Work D Datas performing undercosting | | i| | 11 123 115 6 6 6to 6 to to to i dus | 27 25 25 | <3 1 } j { ^' | f | Jes Exposed to other dusts 1-30 Yes 3 If F29 Silica Year first exposed Year last exposed Total number of years and months exposed rd Coal . Year first exposed Year last exposed Total amber of years and months exposed Total years underground Year first exposed Your last exposed Total number of years and months exposed stor stor to becoming a garage Forte did mediate family work withwith asbestos any member of your No 2-7 : : Nes who and employed as from from AM - Lenplaegt=a | 4 / An } c nat <0 Geant coe bi a ite i ; Yi { Reproduced best copy Reproduced from available GD 34 34 36 36 fi, to | ... bey ta (1 /AY ; las 175 RESPIRATORY QUESTIONNAIZE Last First Middle initial I am now like you going to ask you some questions to answer YES or NO whenever mainly about possible your chest I would COUGH . Do you usually cough first thing in the morning on getting up Count a cough with first smoke or on first going out of doors Exclude clearing throat or a single cough 1 - No 2 - Yes 2 Do you usually cough during the day or at night Ignore an occasional cough 1 No 2 - Yes 3 12 yes Do you cough like this on most days or nights for as much as three months each year No 2 - Yes Have you 1 2 been coughing like this - less than two years - more than two years PHLEC Do you usually bring up any phlegm morning on getting up Count phiegs with first smoke Exclude phlegm from the nose Count swallowed phlegn from your chest first or on first going out i No thing in the of doors 2 - Yes 5 Do you usually bring up any phlegm from your chest during the day or at night 1 No 2 - Yes 6 . + If yes Do you bring up phlegm like this on most days or nights for as much as three months each year 1 - No 2 - Yes Have you 2 2 done so for - less than - more than two two years years What color is your sputum or phlegm 1 - whitish 2 3 - yellow and green - grey and black 4 - brown Column Number * For night shift employees 12 ] ] 15 15 16 17 17 18 19 Use of air hoses to blow out brake shoes Which years done did you bevel or machine shoes Which years done What current dust removal practice is used during brake or clutch jobs at your garage When did this begin What was done before Did you do undercoating work or were you near such work CONTIUED Describe ercnma mee HISTORY ot RESPIRATORS RESPIRATORS Do you wear a respirator 1 = No 2 = Yes What type is it mainly 1 - Filter OCUPATINL 2 Cartridge 3 Air Supply Do you wear it usually 1 Usually 2 Occasionally 3 Infrequently Do you eat at your work site - No 2 - Yes : - . : (ie | Do you smoke at your work site 1 No 2 - Yes 3 - Nonsmoker Do you change your clothes before going home 1 No 2 - Yes Temas T T rene syns Ryn vores etek te a- Does your employer launder them 1 - No 2- furnish Yes work clothes and Do you have separate work clothes 1 - No ?- lockers Yes for street and Do you shower before going home 1 - No 2 - Yes ne eemeeaal 189 17 yes attacks was your breathing absolutely normal between 1 - No 2 - Yes WEATHER 18 Does the weather Only record affect your chest YES if adverse weather causes chest symptoms definitely and regularly 19 - If yes Does the weather pake you short of breath . Type of weather 1 - heat 2 - cold 3 - dampness - 4 - dryness 5 - any extreme NASAL CATARRH 20 Do you usually have a stuffy nose or catarrah at the back of your nose in the winter No 2 Yes 35 35 tw nm wy ~ 3939 39 39 40 40 21 Do you have this in the summer PHYSICIAN COMBIENT Nasal catarrh : 1 bas no relation to chest condition 2 - aggravates cough tion from chest and phlegm produc- as described above 3 4 5 is * cause of cough and phleg is a separate entity - no cough phlegm are produced by patient cannot be specified an~ CHEST ILLNESSES 22. During the past three years have you had any chest kept you from your usual activities for as much as illness a week which has . 23 If yes Did you bring up more phlegm than usual in any of these illnesses y 44 44 45 45 24 : How many illnesses like this have you had in the past three years 46 46 25 Do you have a heart condition for which you are under a doctor's care 1 - No - Yes ---- f -------- If YES specify conditions and drug therapy TOPACCO SMOKING 103 26 Do you now smoke cigarettes 27 If NO Have you ever smoked cigarettes 1 - No 2 Yes 28 How old were you when you started smoking regularly 29 29 How old were you when you last gave up smoking cigarettes uw ws nad years List year Derson last stopped smoking rt 30 How much did you smoke on the average 31. did you inhale the cigarette smoke What did you mostly smoke Type 1 2 - filter + filter Size 1 - regular 2 ~ king size 3 - 100 millimeter Do you smoke a pipe 1 - No If NO Have you ever smoked a pipe 1 - No How many pipefuls & day did you smoke Do you smoke cigars 1 - No If NO Have you ever smoked cigars 1 No How many cigars a did you smoke 2 - Yes 2 Yes 2 Yes 2 Yes Do you chew tobacco 1 ~ No 2 Yes NAME } | I] a wr? First _ | NUMBER MI MI AGE DATE OF BIRTH TUTL TUL TUL TUTL | 05 TUL | 11 | on + last examined by a physician month & year { { | T 343 4%. acute illness not hospitalized other than trauma ) acute illness hospitalized other than trauma 3 trauma not hospitalized . trauma hospitalized 3 follow acute illness 6 follow chronic illness 7 routine check 8 occupational surveillance program exam supplied by employer 3. employment physical - soe ee +", 1 was your last chest ray month 1 ii | year | { 22 Result = normal 2 = 2bnormal 3 = doesn't know PHYSICIAN | 25 | Code 0001 if never bad chest ray Y _ 27 27 ~ - Have you ever been hospitalized hospitalized 1. No 2. Yes Describe below TATE HOSPITAL REASON Have release forms been signed 1 = No = Yes 28 Have you ever been told by a doctor that you had any of the following conditions Vascular ren 01 Heart murmur 02 03 Angina Heart Attack GE 05 06 Any are other under heart condation for which you the care of a doctor specify High blood pressure Claudication Pulmonary piiai Pulmonary Pun lmonari y b 07 Pneumonia 08 Pleurisy 09 Asthma 10 Bronchitis 11. 12 Emphysema Bronchiectasis 13. Pulmonary tuberculosis 14 Silicosis 15 Asbestosis 16 Other Pulmonary specify Gastrointestinal 17. 18 19 20 21 22 23 24 25 Gastric ulcer - told by H.D. " " - UGIS . " - Hemorrhage Hemorrhage Duodenal ulcer - told by M. ... et UGIS " - Hemorrhage Bleeding from ulcer Other GI bleeding Hiatus hernia 26 27 28 29 Hepatitis Jaundice Gall bladder disease Liver disease 30 31 32 Enlarged liver Cirrhosis - alcoholic ... - Other 33 Ulcerative colitis 34 Diverticulitis 35. Other GI specify Genitourina Genitourina 36 Nephritis 37 38 Kidney disease indicate Urinary infection type 39 Kidney stones 40 41 Prostate enlargement Blood in urine not caused by above 42 Protein in urine not caused by above conditions 43 Other genitourinary Skin 44 Psoriasis 45 Eczena 46 Other Blood skin specify 47. Acute Anemia er 48 Chronic Anemia 49 Low white blood count 50 52 Problems with blood clotting or bleeding Sickle cell 52 Thales 53 Other Blood specify Eve 54 Require glasses 55 Glaucoma 56 Cataracts 57 Weak or lazy eye 58 Optic neuritis 59 Other Eye specify Ear Nose and Throat 60 Chronic Sinusitis 61 62 Impaired hearing Nasal allergies Reproduced from best available copy (o) 63 Nasal polyps 64 Laryngeal polyps 65 Tonsilectory 66. Other ENT specify ervous System 67 Seizure disorder .. 69 Stroke Parkinson's Disease 70 Psychiatric illness 71 Other Nervous Musculoskeletal specify 72. Rheumatoid arthritis 73 Other arthritis 74 75 76 77 Back injury Degenerative disc disease Yes Neurologic involvement Bone lesions 78. Other Musculoskeletal specify General and Metabolic 79 Thyroid disease or goiter 80 Diabetes $ 82 83 Gout Night seats Fever 84 Other specify Cancer 85 Skin 86 Throat 87 85 Lung Storach 89 B2 90 Rectum 91. Prostate 92 Breast 93 Cervix 94 95. Uterine Other CA specify . Currently B= , inactive condition number D= not under physician's care year diagnosed Active under of physician care | rmeaaed iqis { 11 | 15 | I 19 23 i : 27 { 131 | 35 | i! * Col 39 i 143 1-5 as above punch E in col 6 Other } Col 47 51 55 59 63 67 71 75 7 11 1-5 as above rT 1| ! fas 19 | 23 | : 27 | 31| i 35 ! ia 39 | 43 i 147 | i} 151 punch & in col 6 ALCOROL 2 Tyde 1 . Beer 2. Wine 3 Whisky Quantity . 3 cans week quarts pints week approx 10 shots = 1 pint 1 no alcohol intake 2 6 cans < 1 ct < 1/2 pint 3 6-24 cans 1-4 quarts 2-2 pants week 4 > 24 cans > 6 quaris 2 pints quaris 5 alcoholic < year 6 alcoholic 1-5 years 1 alcoholic > five years 55 | MEDICATION ARE YOU CURRENTLY TAKING ANY OF THE FOLLOWING MEDICATIONS 1= 2 Not taking any medication Currently taking medication medication 56 | 01 - Diuretics water pills 02 - High Blood Pressure meds 03 - Nitroglycerine 04 - Digitalis other 05 - Other cardiac 06 - Antihyperlipidemics 07 " Anticoagulants blood thinner 08 - TB medication 09 - Long antibiotics 10 - Short antibiotics 11 - Stercids - oral 12 - Steroids - topical 13 - dilators 14 - Insulan 15 - Oral diabetes meds 16 - Thyroid meds 17 - Gout medication 18 - Tranquilizers 19 - depressants 20 - psychotics 21 + Sleeping pills daily 22 - Eave you ever had radiotherapy 23 - convulsants 24 - inflammatories 25 - Lanatives 26 - Antahistimines 27 - Decongestants - 28 - Analgerics 29 - Antacids 30 - Other specify List medications currently being taken by number : | 5577 59 61 63 6363 57 69 71 72 72 75 77 77 79 PHYSICAL EXAMINATION ese ! { L. | 234 . f " Height 11 in re o- . led wi *. _: he Toa oan > aot f Cessure! H a . Weight Middle initial | 13 | 27 | - Number JS JS 1 - male Sex 2 - female 1616 Pulse rate |||||| 23 | Regularity 1 = normal 7 2 = irregular 3 = other | 26 j ODOLE EARANCE oo ceca cece venaae seeeeees eevee ven cecescneeseeeee 3 w developed well nourished 2 = obese 3 under Ight 4 = appears chronically ill 5 = pale 6 = other 28 fi CYANOSIS 29 CYANOSIS 29 ... . PUTER etre terete errs s sere ererer eres ceses eases lips fingers eeeera | 1 = absent 2= tongue 3< toes 29 ~ EXTREMITIES clubbing nails . 1 No 2 Yes normal 1 1 other = 2 characterize _ s > | 30 31 arkle edema 1 = No 2 = Yes 32 JOINTS 1 = normal 2 = abnormal If abnormal Joint code 1 = PIP 2 = DIP 3 = Wrist 4 = Elbow 5 = Shoulder 6 = Knee 7 = Ankle 8 = More than 3 . = 9 other descriptive code 1 = swelling 2 = rudness heat 3 = deformity 4 = crepitations 5 = associated with hx of trauma 6 * other 33 | , joint description 34 [| | 34 } | 34 |{ 37 37 | | I T Reproduced from best available copy 5 1 = normal 2 = abnormality present . . If abnormal 1 = seborria 2 = acne valgaris 3 = psoriasis 4 = other describe T 44 . EYES Pupils normal abnormal Specify No Sclera icteric corr teers Yes etter espe eter easvans Conjunctiva normal injected pale other seessseesecese Describe other 46 47 48 MOUTH normal gingival abnormality ot ccch eere te rtr e ees 49 - Describe other THYROID t cress etesseeeeeseeeereneseeeeeseeseseresssetrersecsseerseeeses 1 = normal 2 = enlarged 3 = nodular LYMPHADENOPATHY list locations 1 = normal 2 = cervical 3 = supraclavicular = axillary 5 = inguinal 6 = more than 3 sites 7 - other | I | | 51 CHEST INSPECTION +. ec ee ce ess i aaa | 1 = normal 2 = dullness right 3 = dullness left 4 = increased AP diameter 5 = flaring of costal margins 1 CHEST PERCUSSION .. ccc eee nee cence nec ene e cece ecco tent eteeeas 156 156 1 = normal 2 dullness right 3 = dullness left 4 K resonant right 5 = resonant 6 = resonant 7 * other left bilateral Describe other AUSCULTATION .. ... meses ccc nc ac ee ea tanner sees nace ancseasee 57 1 = normal breath sounds 6 = wheezing and diffuse 2 = decreased - right 3 = decreased - left 7 = lenghtening of respiratory phase 8 = moist rales 4 = decreased bilaterally 9 = other 5 = wheezing and rhonchi in a localized area Describe other 1 = none 2 = RAAL 3 = RPAL 4 = RMAL 5 = Base 6 = LAAL 7 - LPAL 8 = Base 0 diffuse more than 3 CARDIAC PALPATION AND PERCUSSION ccccncceccocscceceecerceucs 63 1 = normal 2 = heart palpable in epigastrum 3 1 heart enlarged by percussion 4 = left ventrical heave 5 " right ventricular heave 6 = displaces P.M.I. HEART SOUNDS .... ccc cee cece e cna c ences sence ween ter cebastrentes se 1 = normal _ 2 = murmur 3 = distant heart sounds Describe other = pII II 53 6 = other ASDOMEN Inspection Masses Abdominal tenderness to palpation 69 1 = none 2 = RUG 3 = FLQ 4 = Epigastric 5 - umbilical 6 - LUQ 7 * LLQ 8 = other Describe other 1-7 PALPABLE LIVER not palpable palpable * " 7e ee7""t * amer ane tee | If palpable span on clavicular line ~ in cm be eeeeeeeeceeece dd Liver tenderness No Yes tte ccs esse ese ce es re ace eee neers Liver consistency a a . normal irregular nodular increased firmness other ---- 71 73 74 PALPABLE SPLEEN not palpable palpable --.---++.s.-seee0- eaaeee If palpable two dimensions by percussion cm Ze PALPABLE KIDNEYS not palpable palpable palpable left left right eet eee ben eas ABDOMINAL MASSES BY PALIATION none present eee en enne Location size and consistency 7% 76 ~ |7 | 72 NEUROLOGICAL EXAMINATION Deep tendon reflexes normal hyperactive decreased absent ie Specify abnormality ankle 1] biceps 12 knee 13 wrist 14 NOTOR cect cece cece sc ce ees rane cet a teaser tence esse ves tepessererenene normal decreased strength Indicate muscle group wrist drop teleky sign extensor weakness Babinski other involved TRcE cc c cM eceO er cR tw e sce none outstretched intention face other hands eeeece ee ee eeeee asec eecene peewee ecercee Describe other 15 18 | | 18 Col 1-9 as above punch kK in col 10 emerge ee, Oe et ee ne Sr em re me ee eee ra won 118 SENSORY pin Arms 1 = absent = present 20 Legs 1 - absent 2 = present OTHER NEUROLOGIC 1 = none 2 present describe EXAMINER'S CODE ete [ [ | 2 Selikoff Anderson 3 =5 4 =10 Daum Fischbein Holstein Lilis Loriner Rom Rosenmann Todaro | 23 23 twee et pe te ee oe 8 wren pee wee . . - HUMAN RESEARCH CONSENT FORM I. PROJECT DESCRIPTION 1. Investigation of Health Hazards in Brake Lining Repair and Maintenance Workers Occupationally Exposed to Asbestos . NIOSH 210-77-0119-0000 2. Investigators Irving J. Selikoff M.D. and William J. Nicholson Ph.D. Purpose To identify any human health hazards associated with brake repair and maintenance II CONSENT TO PARTICIPATE I > age hereby voluntarily agree to cooperate in the above named study and to undergo the tests listed in Attachment A. The study has been discussed with me and I have been given a copy of this document I understand that 1 The procedures and tests to be followed are as stated in AttachmenAt no procedures are experimental 2. Attendant discomforts and risks are as noted in Attachment A and except as noted are minimal and provision has been made for any Decessary medical care and I have been told what to do if I have any reaction 3 Benefits are as indicated in the Purpose statement above Part I Item 3 4 If alternative procedure advantageous to me are available they are specified in Attachment A and if they become available during the project the procedure most advantageious for me will be indicated and used or an explanation will be given to me as to use of any other procedure 5. My inquiries will be answered by the project directors or other personnel invovled in the project Telephone 212-650-5823 212-650-5823 6 I am free to terminate my consent and to discontinue participation in the project at any time without prejudice to myself 7. My identity and my relationship to any information 1 disclosed by me in completing any project questionnaire and 2 reported by me or derived from me during my participation in the above named project shall be kept confidential and will be disclosed to others without my written consent that such information will except as required by law and except be used for statistical and research purposes in such a manner that no individual can be identified I understand that that can endanger if any information is the health and safety found out concerning me of others this infor- mation will be given to the proper authority 8 If any of my medical records are required for purposes of this project a separate written consent for release of the records will be requested from me me ee pee se eeer meeee our cena pueyaen sone 8 = RL oh ee eR es wee - seo . . 1. 9. There will be questions that I will be asked to answer and my inquifies concerning the questions will be answered by Dr. Selikotf or Dr. Nicholson 212-650-5823 10 A report of any significant information from the study that specifically concerns me including medical information will be furnished by the project officer or his designated representative to me or to my designated physician upon completion of the study or earlier if appropriate SIGNATURE Subject'Subjsect's Name Date Will r 11. INVESTIGATOR LU Nichol n, r Associate Professor fy 2 ie SigSniatgurneature L, III CONSENT FOR MAINTENANCE OF RECORDS I hereby give consent for Mount Sinai School of Medicine to maintain all records of this examination They will be completely confidential as information will be released to any physician I designate upon my Titten request and authorization at any time in the future - above and SIGNATURE Subject Name Date IV REQUEST AND AUTHORIZATION FOR RELEASE OF INFORMATION I the Project addresses I named study DO NOT WISH ' hereby request and authorize Director to inform the following physicians whose names and have entered below of any significant findings from the above concerning me DO NOT LEAVE BLANK WRITE NO WHERE YOU TO GIVE A NAME AND ADDRESS . 1. My personal physician Dr. Street 2. Other physician Dr. Street City . State City State wee en Ope eg ae Soe tr gee ... ... ee re - pe = ra a ~ weet tee my SPN ee a eee ATTACHMENT A Investigation of Health Hazards in Brake Lining Repairs Maintenance Workers Occupationally Exposed to Asbestos NIOSH 210-77-0119-0000 and The procedures and tests which involve human subjects in conduct of this project are as follows Blood tests Urine analysis Sputum cytology Chest ray Pulmonary function tests Physical examination Each of the above provides important information the evaluation of health status There is minor disconfort associated with the drawing of blood from the arm The sputum cytology involves coughing up phlegta from the throat into a container which is provided The pulmonary function test involves a maximum breathing effort Rights under the Privacy Act of 1974 Title 5 United States Code Section 55 e2 3 The information required to be given to me under the Privacy Act of 1974 is as follows 1 Authority for collecting information is the Occupational Safety and Health Act of 1970 2 The principal purpose of this study is as stated in Section I Item 3 1 3 Routine use of this information is in developing criteria and programs for a safe and healthy place of employment 4 I do not have to furnish any information I do not wish to Nothing whether happens to me as a result of my not providing all or in part of that requested except that information I may be terminated from the project 5 LOR 4 SWRMUIOD OP poquats | 5 SCIENCES SCIENCES SCIENCES SCIENCES ENVIRONMETAL THE OF MEDICINE | MEDICNE SCIENS SIP uN Namo sp IVS Sing SMOIEUJy =S Comentreqainy Saz2 aShu}oote g a5zqiz 77o> wears g Clasifcton ILO Radiographs { Radiographs Pneumoconioses 4 of Radiogrphs MAN aA aug JO 5 AMOLVUd!Date ALIO SHONIS BHL YO ANIDOSW AO TGOHS 4 1 TVINRPGUANE IVMS asu LNOW Plcoat Tg Lig OPACITES OPACITIEOSPACITIES Zones Tyre Profusin i! j gouvd hag yn . sf / JO VAVNS prnquea>Wertnjory a Sf L sydorpey sez YWVINOJTUs SBLIOVN - / JO vonsnjory 4 , e ! TIVNS o ENV aS MO}oyise) taweZ . co QIAGNoY SVILDVIO [BuO fMnmprg o / oY TIVYWS f ay 5 UBIWT [48D an oh ott Yad Mat ee ee eee te Check veived ee we re 1.11 o ea Meas Poa BM a vt HROy wow Me oa Cy j z i a 7 u : ASOD wo paonsday o x 5 aQeae a ! [8aq Internationale des des Radiographies Radiographies Radiographies 4 ' PLEURAL 1 a & ag RY vy ; t 6 2 pw a 7 a pu beojaitry f rauce! baa er a = aa Pe A Fe) a) cSy{Lailo- evod-ui vb Kea it oft ctorisy adh 2A 3 S ags FrBEco wea Nera, PL / ara in ts ywoan-9! Get t { orb}4 Sa + r _ 7 bed } pee eee yee 4d 39 380 paungs S1uGisp ,U0j50D) TUNG Aya fouNse WIA Enwuds WGI IUar0}29 MWOoswnad Ayeuoge aysuo 28s043-es7UY puaesjco quioahuoy pyoeutmays sIu;nos0qQNy spoSargny saedo Buroyiubes ainsodue (p01lajeo SUOIDUAS uisLe2un Lovel pr {A9}49%) pratingeSuap O.umud zaueo Lovel paunlS qduAy Beicnhnbituonisd eyng eunajyd Aus sapou fit2015 jewsCOM 40 FS Uf Bun, YON jo EDI )12) 20 940 Adi 40 a745 Nd pag Kp 390 icus ayy pou WY as FAI PU 14 IAL JO Yes 26 sey] puns jo puss so Ul] Bun] NIUE Ga Ba UN) Luo BY) OU 40 a1IUOag sn0 je) Omer Cae. das a up wap Bichnitions 0M ma Q0ad ALI 47 334 BAUER 2.00 Agee xe the afected . . Category smal rounited opicties are 1 4290( predominat 4amO} SONd Nate nodules S2UOT -- -- 01-001 small rounded opalities 2/2 small 303 Category ta smalt rounded opacities are PUT clasfied acording parsaye padncsqy priz2ye RU opsties aholt dipius Ayman M Apius m a4q1 aNn ut fanIatda samed JIWEID Iregular Profusionfi Penge prinago zonescategory of the based of 4818hKyatides KuedALysUan sauar profusion conetraion in ye mid opacites Ayensn jewsou Ayensa profuse profusiont (unr UAE,ETL Arveaynd sforqiew:s2uryivat J21yOwUeIuEnTmopPasdatuetip Combined 4wousnyord) Ssodacsaqunysdunyiewurqsew EBBEaMt RL Categoryof^'uties standrrounde whiricehgular opaciirteegsular dimenso mdimeensnions normal FeUpNGs) symyuad wherae iauiou paps asnyosd (RWIOU prusay 312 the rounde smal iregular the rounde rounde rounde inusmber diTvihdede tinhtealyy intalyobbsceureduopbsceurred 1 EL tude was d the separtely separtelyand HeaUE pe 9.1uyapweu2ine IndaA Surpozan2FurpazEs khpwoypbrsIuNU VaswNY SaevdyC ikourh opaertis of ITP the are VANE ovnTane8 Wanye ywasys On FOF spucktiesaINEdAszaVcdE site than those such - opacity . Pagpoe SoucredY banIed saiprtespuckties spuckties sauzcdo sIETY sanideo senaeCngry) Category equivalent zone vw oy pomnodpoanespa sPrpynod PrynseypounosPapunsPopunos Sretodes wortnjosd sepnBaus ndseyndacs , sartder dehned the A or abreviatus in mAyoadUY YLYs DUYyIp MIE.Gorge Cane " anrrea should be sua.it whetheruper yoVUE) -- KsDar Other Costphrenic Right pouews sav0d Sawer Obliteration the thickenigthickenig .asoyt dsentpucrs CawdairAvtarActa diaphragmdiaphragm robe lower lumut standard film Za diaphragm provide partofany ape, apraryapray aprat>pag ayayy (Was ay SWIM EP . 2324) ae WE WO] aie ose IUYE RAGE O) OF Juny ayy dis dA te ee Ue Fury pe PUT Pre Kany vey Haz WUEWuil yorq 5 ing MYL Wars AL a1RUH InOge InoYye 9505 Inge ad OF Combined dn Large yy ures Large aan qeus Wry yews yews - + ~ ~ y 4 qT 4 ai 219 - - - aseOyqual(us UI y ays SUL > t' Ap ayy aie AM ui LM waye Care { rounded zones which spaci ies ay2 spaciies 1y2es LM . Fury kayh Jo ing ayy aie 01-01 "p MEL ase 4/0 standard profusion standard Js smal Category | Category opscitcs PIP Category define the mid opacities FYE JO . Ivar er Sunt te ur ve Bony June weg) may yorg ing JQ JUL vs9y 30 EBEM EBEM Pre dee oy ase iregular opacities small Category ir egular of^'uties iregularare ve of^'uties ... line iregular Gua sit 15 15 egarse blotchy opacities for Aroe unded When bath rounded profusioprnofusion ikourh all U Category A opacity WLYOI hoas A vod Category greatest DME Jo aur parieg site piu sedu Myb Category one the equivalent snare 82 Jy sep Category Cane Cane snare Category snare stynBseynd leter . den dost der nd 3ye vor well well let er IIT = - > dehned te Jo du thickenig ews rus [UE yews inte --- thickening 41 YE saup counphrenic thickening - + angle angle & Obliteraon counphrenic we counphrenic Obliteration the counphrenic provided Costophrenic Cliorwaedro and diaphragm 5 thick Width Width | | IQS sey Right Ig) i t' Grade Grade provided we mm b over. about about Sinm b asesment shrent dolinutely opacities opacities were diameter larger whose qdabreviatusu aya recorded recorded JEL)the widest about entegnty inarkings markings Ju up to to ayt slisided slisided prey profusiont concentration category few normal The egy recorded a Each 1 recorded ga number lung markings markings opacities cannot cannot Wye canot canot is trea, yond divided provent provent provent This between lant lant record profusion optional optional feiture feiture Som several at lant ee we Ot numerous than numerous combined numerous exceds thosethe combined combined exceds excedsthe should should ad ---- ---- op septrately thickenig septrately over septrately from thickening thickening -- - ' yy 3 yy t z op Lumim thich widest partly of the ly) 10 3 tala normal markings markings markings usually are used can roughly IHN IO ty gu ZI] - three zones upper three three jo fur separately clasifcationclasification clasifcation clasification opacities opacities tum such whose opacites the tum combined combined category whose de combined24 equivalent right right upper equivalent Ue equivalent whether eens indicate whether the --ind-icate- VELTE ------- - suo otohtheerr . sarEH - - SaBmaeert U ft 2 ( 3onH 9 SWS, UOQN WOE UY Lag lowerlower WY lower LROQE MOTE 928 ..pooTdmsp9Id 928928 928 visble Atal NaI. 928 THe 1, | into thre thre |saq into into MS Fo lower- lower- + att Tia 24d the combined hihi greatest greatest fe excednot yoyo wel defined DOU DEN JH 10 IUD sau . - 6 apes), . lu 17 . CT we (ay labusgTProer 1spey UUOe "twy> WM NT Ue ge a Ne Ot nos 10 WOG1)inedWIT -/0 offairs BL Tt KTwe not . ny my - prade than 1 v4 The lefines that ) of n\ ot projection projection ; iA { t . ' ' ' ,1 1 i| } : |. : i L. pepneyeornjorgs H 4j ' . why wag Pleuralshagines ! , Cirade t why LELE | GradeGrade more ii H the whole leftfamilie or equivalent WeNECplro wiunylen orequivalent equ4ivalent Siyu1 Ut "cd 3ety eiaeL ang pannedwag \ geeswryrte . a oneone o catrifcation . . . .