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FILE NAME: Ford (FD) DATE: 1977 maybe DOC#: FD134 DOCUMENT DESCRIPTION: Mt. Sinai Contract Proposal . CWS- 'r.ooi '~ " " ' % c ^+ o W -, i I r ! *vco % f . H ~ ...................... '& 41S ' v i< ic .r a J i b br~s *" JS - "v:. L : \ --Si;* c . s. . -.tv s.-- ........................... ocj. n'-.-.r.: ' bsJcle*. " : ' " - r -: CONTRACT PROPOSAL ' V ' ' ' ' ' ` ` In v e stig a tio n o i H ealth H o ard s la Brake L ining R ep air and M aintenance W orkers O ccupationally Exposed to A sbestos ' ETP No . 2 1 0 -7 7 -0 1 1 9 -0 0 0 0 o . ............... - - fe tv lro m n e n ttO -'Snri^nxms l a b o r a t o r y Mount S in a i School of M edicine 100th S tr e e t and F ilth Avenue Kew Y o rk , Mew F o rk 1 0 0 2 9 --- - COPY OF PROPOSAL G 002971 PRODUCED BY FORD T ib i o f C ontenti P ro p o sa l summary and d a t a s h e e t 1n P r o j e c t summary ............................................................................. : * , " Y T e c h n ic a l p ro p s a l .................................................................................*** i I n t r o d u c t i o n .................................................................................. A . C h a r a c t e r i z a t i o n o f e x p o s u re .........................................- 1 - B . A s s e s s a e n t o f h e a l t h e f f e c t s ................................. .. 2 C. A s b e s to s r e l a t e d c a n c e rs I n b r a k e w o rk e rs ................. 2 S p e c i f i c a l a s o f - t h i s I n v e s t i g a t i o n ........................................ 2 A. D eterm ination of the f e a s ib ility of a m o rtality s tu d y ............................ ....................................................................... 2 B. C lin ic a l in v e s tig a tio n -o f d ise a se in brake workers 2 M ateria ls and aethods ................................................. 3 A. Task I-C h a ra c te riz a tlo n o f brake r e p a ir environm ents B. Task II-F e a s ib illty study fo r retro sp e ctiv e m o r t a l i t y s tu d y ............................... ......................................... 3 C . T ask I l l - M e d i c a l s u rv e y ....................... .................... .. = P re v io u s e x p e r ie n c e o f t h i s .la b o r a to r y ................................ 8 A . M o r t a l i t y - s t u d i e s . -- ...................------------..............................jj B . C l i n i c a l i n v e s t i g a t i o n s ............................... ' .................. 8 C. P revious s tu d ie s of brake re p a ir and m aintenance w o rk e rs .......................................... .................................................. 8 S ignificance of th is research A . D is e a s e among b r a k e r e p a i r w o rk e rs ............................ . 8 O B . E s ta b lis h m e n t o f c l i n i c a l s u r v e i l l a n c e program s . . 8 F a c i l i t i e s a v a i l a b l e ..............................................................................^ O r g a n iz a tio n a l r e s p o n s i b i l i t y ........................................................* S ta te m e n t o f a s s u r a n c e ........................................................................ 1 C o n tr a c t p r i c i n g p r o p o s a l ........................................................................... * C u r r e n t s o u r c e o f s u p p o r t .................................................................... H . E . W. R e p r e s e n ta ti o n s andC e r t i f i c a t i o n s ....................... 1 R e p re sen ta tio n s ...................................................... C e r t i f i c a t i o n s . . ' ............ --................................................................... ' ................................... ! A p p en d ices ............................. ;................... . ILO/UC X - r a y c l a s s i f i c a t i o n s h e e t (m ark s e n s e ; L aboratory exam ination sh e e ts and forms (mark sense) . P h y sical exam ination P ast m edical h i to ry R esp iratio ry questionnaire ' R eprints on lab o rato ry brake re p a ir stu d ies P erso n n el cu rricu lu m v ita e andb ib lio g ra p h ie s . k ` 'Nh; ~ . . * .-qjwL,' . ria z O - v'\*' ` . 002972 PRODUCED BY FORD P roject Sumary .3 Lli-n averie rrs .e b %o c ; is c I bgtk Isb-tSYdi otj j. :;::;3,-;jo s-dT " ` '\ t 1.'. r .- ' r * s e a rc h 'v ili undertake th r e e 'ta s k s to '-e v alu ate th e h e m lth hazards ~-.associated w ith ' th e ' p a i r " and m ainteoanee'-of auto m o b ile'an d tru ck brake jji'jk . Methods TSiSS1' W ith in t h i r t y d a y s o l t h e I s s u a n c e o f a c o n t r a c t f l I M il^ ffiJ rrlro w a B e c t a l ~ y e i 8 i f i l i g i ' J r f f l i t f _ ______ . , ^ . i* t> jr jitad B ed f ro m j j a w n t A w n ^ '^ r th ln 'tf ie 'tr r a k 'e `m a n u fa c tu rin g in d u s t r y , im ragC Ttirt o f g a r i g eS T n d brake x e p a ir o p e ra tio n s , and s ta te and fe d e ra l agencies th a t may have conducted environm ental surveys l a these estab lish m en ts . l^ a r^ b O iS S % 7 e ill be documented and typm eroX 'trafce lin in g s J e i ^ P ^ t ^ i ^ o a ' h m a t e B r l a l ^ h ^ e C ^ H n ^ - t h w / j y ^ ^ ^ s ^ h Bhl i s h e d . D eterm in atio n w ill be made o f th e f e a s i b i l i t y o f id e n tif y in g a cohort of brake lin in g r e p a ir and m aintenance w orkers lo r a jn o rta lU y stu d y . In * tv itta a l'S " w riX "h> 's o a g h tT i a v ln g " s lg n iile w n t em ploym ent l a t h e in d u s t r y y prior-'o 1955/"Through T m ibns~rispresenting b rak e re p a ir and m aintenance workmeuT F o llo w in g a d e te r m in a tio n t h a t a a u f f i c i e n t num ber o f a p p ro p ria te ly exposed in d iv id u a ls can be id e n tif ie d , th e f e a s i b i l i t y of tra c in g and d eterm in in g th e v i t a l s ta tu s o f a sample o f th e p o ssib le cohort w ill be u n d e rta k e n . T h is -task 1X1 h e com pleted w ith in \9Q y d|ym V X tM T .s s B ia o * ef * a - c o n tr a c t j " " ~ A c lin ic a l study w ill be undertaken of 1,200 c u rre n tly o r previously employed b rake r e p a ir w orkers and c o n tro ls to in v e s tig a te th e presence or absence o f c lin ic a l stigm ata of asbestos exposure. P articip an ts in th e c lin ic a l survey w ill be sought through unions rep resen tin g brake repa and m aintenance workmen. The fin d in g s w i l l be r e la te d to d u ratio n of employment, ty p e o f employment, freq u en cy , r e g u la r ity o r in te rm itte n cy of brake r e p a ir w ork, d u ra tio n from onset o f e m p lo ^ e n t^ .J is to r y o f o th e r p o te n tia l asb esto s exposure w ill be so u g h t. I com parison.c i fin d in g s* w iV ^ 'im cto tB k en 'rv rl-ttr-tb o se -present-A n-other -asbestos-exposed (afecsto s m in ers'M a ' ^ l e n s ' / ssb esto s'T affto ry 'w o rk ers', fam ily -co n tact . o f -m sbesti w x & ^ ;- * S ito 5 w a tlo B w orkers}. ^ r S t -examinatlocs w lt-b e com pleted w ith in ^n year of th e I s s u ance o f m c o n tra c t. l * ^ - - ''-- ^ ` ` ' R ationale - B ecause few p eo p le a r e a v a ila b le in any one b rak e r e p a i r or f a c i l i t y th e p a rtic ip a n ts in both th e m o rta lity study and the survey w ill be sought through v ^ ious In th is , *e have been assured of the clin ical C o u n t e d Ticipal B n p lo y ees, th e ^ r a n s p o r ta tld n * W r k e r s , W o rk ers, u d th e A m erican F e d e r a tio n o f G overnm ent E m p lo y . TM PTM cedures fo r th e conduct o f both th e m o rta lity study and c lin ic a l survey have been developed in numerous e a r lie r s tu d ie s by th is L aboratory of groups o f wortanen . . -<i-\ 002973 >Q PRODUCED BY FORD *33-28-2199 T aciu ti iT The conduct o f th e p h y sic a l exam inations d escrib ed above w ill be u n d e rta k e n in v a rio u s f i e l d s t a t i o n s .e s t a b l i s h e d n e a r th e employment s l e w . z:':~. o i.c r o u p e -o f.-b rak e .re p a ir^ . and m a in te n a n c e w o r k e r s . T h e s e would 7.; > ~i n c l u d e .u n io n , h a l l i :-w u n icip al b u i l d i n g s , `'o r . l o c a l 'i* i d ical f a c i l i t i e s . A ll.'tiav e been s u c c e s s f u lly u t i l i z e d by t h i s 'J la b o ra to rr i n p rev io u s sim ilar stu d ies. . ~ O ther . 2r>z J .>. L 1c s--o--c--a-u----z--; *CT 1 c ir.r ' L u rin g th e p a s t tw o 'y e a rs ', o v e r 6 ,0 0 0 i n d iv i d u a ls h a v e -b e e n exam ined Vi l o r t h e p r e v a le n c e o 1 d i s e a s e r e l a t e d t o o c c u p a t io n a l l a c t o r s . The .g e o g ra p h ic a l s e t t i n g s h av e -ranged I r o n Los A n g e le s, C a lif o r n ia , to . B a le V e rte * V e w Io u n d la ttd ? ' 'C u r r e n t l y , " tw e n ty -fo u r g ro u p s o l i n d i v i d u a l s are under surv eillan ce in tro s p e c tiv e or xetrospectiverprospective ' m o rta lity s tu d ie s . T e n 'o i "these are u n d e r.th e d ire c tio n o l th e .. .p rin c ip al in v e stig a to r on th is p ro p o sal. - r ... ; r . Zxt i cef r : s ' ` -,; vj:: ; *</, W-* y Vj 3 - - ZZ 24... . ' : bVw.VJJi "Z'*1* - a 'z ' : .*? r.- * *\ ^ i r r r . a : i:*.-: " t d s t t O -- ` * >--** . { * * . . ' pc ix i ' ..z. . 2,,>.*:J " ~ ^ ' ** T . - o ^ . * - v - ` IX--/ :* : ' - ............ . c- -jJ *; ... , ' " I ' 5 ;rr' \ r . . : ` ; ? :L. . z L ' . n i::: _*v . *: /oui;. J.-T* . i .r<*;re c ^q- - = 30*'r e * " L ii# " i 1; ..--..-.i l i e t O u ,, n .v o S a tA r .. r^r^c . * i / rc s*. j;: - - , k- : " -m ...j; ' ' . ' . '.+r. , i . \ .. 10. >..? .v *.* `o i*.*; \ j j. hsii-oZctic*.- cz> X*:.. * . - C . * V " lu -"'s "*.*^*J ** VJ/X..' ? rs az oX^l X '*r. sX'V-^S oi: : s.*i? 3od ;ix " r ^ q X r i n ,zq s.'T . " *cl ` "xr ' l-Jv<rn(L? L<> r.jhTJ -:C|`J-I aoi : u o : - i s v j!^. p.d 'l r.i-- -iv-'-j:? s 'i r c J>& --.;ac /rae,ri 37,-.:; 37, ...jt;.. ^ ' , i c i nitimtf i o s i . - i s n o K ' 1. i;, r . o i .. n - -i-JaHnSV /lo x d s J tt-.Rrss-tT f.+ , *sov.oJ.;aa Xcq.'siaM bn.';''iviVJ. ; ' i 1- - ' r.'S l o r.c i : 70 ` c-'i .:.-.o ;ra -rA 3/i'r bnu . , ./ ^ .c V , . u /.. iir.r - K u Ja v u l u ' i o t iri.t used l u fo u h n ,... c,;i -io l 1-- . ; O a i / } -M ? 3 i i i u l ': T o i r t ; * a w j i v ..... i - n i t- j-.c .% :> i - i ,-'. : ' ' ' . J.-J.TT-1"!CW 1'.' ?.qi^T" "t"- i' u 1 002974 Q PRODUCED BY FORD *.-'--r-T-.-->" YY c Y x ` " >07 533-28-2139 ' .In v e s tlg a fo f t c i f H e lth H az ard s "Brake TdaiTTgTteplr wnd 'H a ln t n a n c e Worker - 'O c c u p a tio n a lly -Erposod t o A Bb e e t o a -- - -- C i KFP 2 1 0 -7 7 -0 1 1 9 -0 0 5 0 " . . .' . . . . . . . 31CC3 TO - T echnl cal Pro p o ta i s rtlsi T-,i.*b : v i t a l BC l e s -y a o ii^ V '- r tf s a d o / f i l c z i ts S In tro d u c tio n .' s fiiE 'n i insdow m IcTasir - r r r --5 - ~ ` - - l - C ' ~ ` - - f f -- * i -- - - '*R---c--e- n*t.i*-n--v--e--s-t ig-*a--t-i-o--n--s--'-"-h--a--v--e---`.-d--o---n--oxuttrra t^eadd .th a t . a -i j ^ i l-i c a n t . a s b e s to s "^ E x p o su re Bay p c c u r. d u r in g b r a k e n a in t u r n i mad ^ r a k e r e p a i r w o rk . ( l ) idi*f r n t i m i te d s t u d i e s have WiqBjBSEgPjythat su c h jy __ . __ .__ e3f i * * A* n o t known hew evw r; '#tieK r~ su ch ' `d i s e a s e i s common o r u n common s i n c e a p p r o p r ia t e 'l a r g e s c a l e I n v e s t i g a t i o n s have n o t been made.'' The q u e s tio n l a o f im p o rta n c e i n view o f t h e f a c t t h a t approxim ately 900,000 w orkers are re g u la rly o r in te r m itte n tly engaged in such work in th e U n ite d S t a t e s - a t ^ th is tim e -(3 ) f r e s p o n s i b l e f o r th e more th a n 130 m illio n cars and tru c k s re q u irin g brake m aintenance (4> .A d d itio n a lly , e .la rg e number o f o th e r w orkers w ere fo rm erly engaged in such work .in th e p ast and a r e now e i t h e r r e t i r e d o r o th e r w is e em p lo y ed ;, t h e i r num ber i s not..k n o w n . A u tom obile p r o d u c tio n expan d ed r a p i d l y a f t e r .World War IX ( a p p ro x im a te ly 30,000,000 ca rs and tru c k s were in use d u rin g 1945)(41, and w ith i t , th e re was a concom itant sh a rp in c re a s e In t.he'num ber o f b rak e m aintenance em ployees. T h is .group o f w o rk e rs i s now r e a c h in g t h e . p e r i o d o f h ig h r i s k from a s b e s to s . r e la te d d is e a s e s (25 o r more y e a rs from, o n se t o f ex p o su re (5)1 . c 0i , C O C h aracterizatio n of exposure . : r "= s u r " .- t , R e ce n tly ,' m in e ra lo g ic a l and in d u s t r ia l hygiene stu d y o f d u sts in brake r e p a ir work has dem onstrated th a t: 1 . Dust le v e ls . ___ __ a s s o c ia te d w ith b ra k e r e p a ir and . b ^ V m ^ i n l S ^ ^ ^ w k i r ^ l j u i t e d S t a t e s , G re a t B ri t a i n and Swi t z e r . land have dem onstrated th a t th ese .^.5 B u c a l e T w l s ^ ^ 'p e r s Y t ^ o f "15=30 T atriites "1 f t e f 'c e s s a t l o n - a f - w o r k -and may be fo u n d n o t o n ly " i n th e im m ed iate v i c i n i t y o f th e workman, b u t fo r varying d ista n e e s" a b b u t-th e w orkplaceT- D ea su ra b le 'le v e ls have been /bi: v o n c fo u n d up t o .75 f e e t from th e . w o rk s ite ., w ith in g a r a g e s and m a in te n an c e .^shops, , - -r.'-jc,; S3n r.;::-Jnlam .hni '..v q 9 t -' -G ::X . ?*' c- '.z--- ' . ^ - sec-jo _dr'->t i o sic-x -i o u i Cri; . U s c i --..-',, o ' ,X . ,, A s b e s to s c o n t e n t . - ' 3d f f ' w a f s '.'b r v ib r..' 'h o ' gr.*> , - f r ' 'Vkgfttw r - . f y t , ,7- r i ,, n *J* ' ' ' = C `2 C. C * ** : *' ~ ____ ' ____ _____ - estsyT C T ^s^S em onstratei^ . rill-th a a g h -1 jn in fcT-j: *5 . i/.A -fi:'..i r_i-r-t u a1l l.y **a l i c h_r_y_s_o^t1i l_e ^ -oa r-.1 l4-.mt eyr i ti t +r^a o i fco+ssta-e^-4r i 't e ^" mm iinneerrfatllOofgfiicCaall 'a a a i y j as h av e 'd e m o n s tra te d t h a t t h i s i s u n f o r t u n a t e l y n o t s o . (1 ,6 -9 ) e '.lr.irf n l s ' T s a X b l o -r. \ - : : ~ ^ 2 ___ . ' cu 3 . T iber s iz e . " ' - ' !-- ' n' " T 'J O li.-: i c r.;.- ' T f f i-.' -, r-. *'" r ~ _ r--- i ari." *a r . i u r . i l s d ii . *. .**S- -' ^.v7rAiiiV m ass E i g n S T ^ H c ^ O B i g p S t ^ r ; . < . ' V ' . "-'-V- J . r.'4 002975 T h erefo re, Q PRODUCED BY FORD I ez-& z-LU E-IOJTOW e-jru: -*^a e ^ tb*F,^er*vnt *>efrrwd -to to i a*i:i above ir e l a t e t o o n tii.iiv - -- n i m e - r r h e r * -- i u s ^ p t i d r - i i t * * * ; ir * - 1 O . v T i ^ a x t c O i o r t . -. A' .. -------------------------- '-Tr l - ' r'-- -- - 3. A ssessm ent of h e a lth e f p f e 9 r*'* r o ts -rF ''2lnrfr>T - o -5- I n as a n a ly s is o f th e h e a lth e x p e rien c e o f 90 ln d iv id u alrH im p lp y ed prad o m in an tly as g e n e ra l m echanics in g arag e r e p a i r s , 4 t^ r a * f<iuad th a t1 -a s i g n i f i c a n t number had d e c e a s e d v i t a l c a p a c i t i e s fZ T ifx i'r/x -ra y c h a n g e s ' c h a r a c t e r i * t l c ' " a s b e s t o s 'e x p o s u re ^ p a re n c h y m a l a t i b r o s i s - 20% i l e u r a f - t h i ck e n in g o V 'c a ^ c i r i c a t l 'o n 'r- % )7t5) ^ Aa w ith " o th e r a s b e s to s ' ex p o su res, th e ^ d e g re e 'o f abnorm ality stro n g ly c o rre la te d w ith onset of .v e h ic u la r m a in te n a n c e work ; J 3 h l l e 't h i s p r e l i m i n a r y c l i n i c a l ' su rv ey was H a l t e d l a scope and was g g f g g a Q ^ ^ B a i i tfartlT^ l t a r e s u l t s suggest t h a t .a s b e s to s d is e a s e I s " lik e ly W ^b e p re s e n t among g arage, w orkers ' !S 'A sbestos r e la te d c a n c e rs 'in b ra k e w orkers' Xi**-'-`-1-' 'ic~ z I n a d d i tio n t o a T h ijla x -a n rriifesT"at53ii"l C a s b e s to s e x p o su re among g ara g e " . n p lo y e e s , t o n c e r J J H s% 'an ciattsi h 'a i ? i tlie s e e x p o s u re s n ay h av e l e d t o an '."`J I n c r e a s e d m o r t a l i t y fro m a s b e s to s r e l a t e d d i s e a s e s . ' I n o th e r c irc u m s ta n c e s , `r e l a t i v e l y low e x p o s u re s to ' a s b e s to s h a v e b e e n c a u s a l l y r e l a t e d to c a se s o f M esotheliom a tl0 -1 2 -)an d ex c ess "bronchogenic' carcinom a "(13) . A sb e s to sia , and ' ' ex c ess g a s t r o i n t e s t i n a l ca n ce r may a ls o be found in groups o f in d iv id u a ls ^ exposed to d u st C on cen tratio n s s u f f ic ie n t to produce th e x -ra y changes d e s c r ib e d p r e v io u s ly ( 5 ) . 'A s a s b e s t o s - r e l a t e d c a n c e rs u s u a l l y do n o t o a p p e a r f o r 2 5 , 3 0 , 40 o r more y e a r s from f i r s t e x p o s u re , we a r e o n ly now reach in g a p erio d where s ig n if ic a n t n u m b e rs- in d iv id u a ls may be a t r is k from asb esto s d ise ase asso c ia te d w ith brake w ork. A lready, however, th e re ' a r e lsdSJfctwif r e j2 j iil s 3n i Tiies6thdXlbBu~M Jtong-wuch A a d l v l d u n l s - t ( l l , 1 4 ) I I . S p e c ific alms o f t'.J s in v e s tig a tio n ; T h is r e s e a r c h w ill u n d e rta k e two p r in c i p a l ta s k s to e v a lu a te th e h e a lth hazards a s so c ia te d w ith r e p a ir and m aintenance of. autom obile and tru c k brake lin in g s , a m o rta lity f e a s ib ili ty stu d y 'an d a c lin ic a l survey o f b rak e w orkers. A dd itio n ally , a thorough' c h a ra c te riz a tio n o f th e brake T ep alr environm ent w ill be done using existing d ata: V ' . : ; - ,0;- - - > -- ------- - - a--.tv:::-: GC-e.r- --.l : i : -y.c e . : A . D e te r m in a tio n o f th e f e a s i b i l i t y o f a m o r t a l i t y s tu d y `s "'n ' " ,, A d e t e r m i n a t i o n v i l l b e madVrb f " th o `i e h s i b i l l t y o f I d e n t i f y i n g a c o h o rt ` o f brake lin in g re p a ir and m aintenance workers fo r a m o rta lity study to d e te rm in e i f J g r a n i i r 'i S t e s t o r d e a t h MteCMj among s u c h e m p lo y e e s. In o r d e r t o t o ..hi* , i n d i v i d u a l s w i l l b e s o u g h t h a i i g " i i g n i x'ic s a it .employm ent i n th e In d u stry p r io r to 1955. T h e. a v a ila b ility o f such in d iv id u a ls w ill be ", d eterm in ed from a' rev iew o f -r e c o rd s o f u nions r e p r e s e n tin g b rake r e p a ir ' r-v^ w orkm en.' B i t h t h e Bete r m in a ti o n " t h a t ' s u f f i c i e n t n u m b e r a p p r o p r ia te ly : e x p o s e d I n d i v i d u a l s ''c a n b e 1i B e n t i r i e d . ^ 't h e 'f e 'a s i b i l i t y ' o f t r a c i n g and d eterm in in g v i - t a l 's t a t u s '- o f `a s a m p l e 'b f 'i p o s s i b l e c o h o r t w l 11:ibe la n d e r ta k e n . ,-x )<W2!-'s.:.. j - t l s / s . '--'J 'tc la u ' 3r.n.- hsTml-rinocob-.evsn I'fJ?t-tj.fjkM- "'.T'/-,*.";. .. B. C lin ic a l in v e stig a tio n of d ise ase in brake workers ~ ~ A clin ic a l study w ill be undertaken o f - ?.i\. Jr.;:?, -- - " p r * 3 va c T&r7"'jtb s enee "o :"clIV , ( .) jpre i r l a x s ly --gwpigyea--' e s tig a te ' tho e x p o su re . The fin d in g s 'lo cj'ni ... ; "-,. st | ' ; ' 2 .<C.'ipct - lS t S g | T .' i'iV: - .He'S' e 002976 " "T Q PRODUCED BY FORD I -- - ei-8-C 2 - 3 --A- W illiam J . H icholson 533-28-2199 caaJft r iz i1: i d ne : e.r2Ciif- i i . - . c r::v.'. c ,. r , l t t d tx> d u r a t i o n erf i .' . reemgpil^oTymOe^ntt. .r HH iissttoo rr yy oo rf ^oStne r p o tue nndt iear tla' kaesnb(e s to s tEh oxspeo-spu rree swe ni ltl ibne ostohuegr h t. A com parison c l fin d in g - , a n d 'm ille rs , -asbestos factory W r W '.w orkers , fa m ily c o n ta c t .or as - woryexa a re a v a ila b le f o r comparison * * * t h i s T i l T^ 1*3*aai-w T>"t flai ir noted above w ill'b e taken in to account, es . iMBTim'Tirrr-T" !______^ ___j SClinnrc>e tf*hh#e* lIoonnga--- ~W l1 1 i t w ill be possi- tarm b e * ^ ? * r ,nc e a o i iiv elv h e a lth experience of brake rep air b le to some e x te n t to p r e d ic t th e l i k e l y ne sim ilax those and b r a k e m a in te n a n c e w o rk e rs whose e x p e r ie n c e n a s 0,5 _ who a r e s tu d i e d . - ' - - - '. -. ... . ' in. M aterials and methods A. t ,c V1C T1 -- CWhICa-LrOaWcWtWer.i.z-a-t.-i--o--n of W.a k e reoa--i--r--'-envi,,ronment 1^ ^ ayyy?-,.cy , ,, r i - a a ^ y * i a r " 5 ? * a ,iu f a c tu r e d and th e m a te r ia ls u sed 1. c x te n d in 9 in " 1930 8 ~ i rriTr,eVf ' T r ~ r igr'**-- n r*tll'r g , ~c`d ~b rg ta ! . . --n o ' in lo ro a tio n 111 b . W = 1 S ' 'd `J' - ' h i S f S i l L " S - t . n . I t / . *2 * " " ! ! ~ U r ,, L u t i ,, 11 b. * . * . document use of m a teria ls in p ast y ea rs. "2 . 002977 ............. w i l l ' be'' rev iew ed ' to o b ta in in fo rm atio n 3. A ll av a ila b le lite r a tu r e w o rk e rs. The v a rio u s - on th e asb esto s exposures o f brake rep ^ u tilix ed . m '; s c ie r.tific iite r a iu r c ab stractin g ^ r f b ra k= U n a d d i t i o n , d a t a w i l l *>e 9 _'ia t e fed eral agencies th a t \-j C;. _ - . " ' i n s t a l l a t i o n ^ r e p a i r o r r e m o v a l.... ^ . . . . - * -* ^ fo r r e t r o s p e c t i v e T ^ r t a U t y s t u dy 1. u p s f individualso^nd co h o rt study 0 r.n:-,u r ~ i- e ra . I t is e stim a ted th a t a c -_^ f pm olovees. i 'focus Thus , th e searcii PRODUCED BY FORD 1 d I r.oi.zr.zzK .1 m aiZlir. eei;-s!:-E --4 -- C- W illia o J . m cnoisoH 533 -28-2199 a . 'She International Association o f M a c h in is ts -- c! S t a t e , Ccorrfcy,; and Municipal Employees . ? :d .'^ T ra n s p o rta tio n W orkers-'^ ' '"- r t M e r n j : - - r x - - T r a n s p o r t W orkers ' ' 7 77' " . '-'-tS'. -American r e d e r a tio n o f ^Government t o p l a y e ^ - - ^ - - . ; ^ Jin t h i s ~ in v es^g a o n f'"v e 'vi a lre ad y b e e n ' u re d the' coopera tio n o f th e f i r s t th re e m entioned u n io n s. - Indeed, each o f these have c o o p e ra te d w ith 'ns on o u r e a r lie r - s tu d y o f v a rio u s a s p e c ts o f th e problem s a sso c ia te d w ith a sb e sto s exposure d u rin g brake ' r e p a ir (see S e c tio n IV and a ls o l e t t e r from Sheldon S am uels). A d d i t i o n a l l y , : em p lo y ers o f i n d i v i d u a l s who would do b ra k e m aintenance work would be c o n ta c te d . These w o u ld .in c lu d e : a f^ ~ ^ ^ ^ r ' a g a ^ j r s s a g i C * e ~ - ;____ j t. s . . ....... c . TSSTCCTnientauto p o o l o p e r a t i o n s ----------- ----z--Ziz;.. ' d . M unicipal garages e . Large ta x i and auto .fle e t o p erato rs . .. tio n whose m e te r s m a d e _ ^ g e ^ J o ^ u s ^ ^ k ^ ^ H l o ^ e l y * *:<v^u . .... . * * ' -1 w ould h a v e b a c o n j f i r s t * * * ^f a ^ ^ ^ ^ t r t o i - r e l a b e d t tL s w e e t. r e a c h i n g a p e r i o d o f ^ ^ ^ j L ^ S e c r e e - o f e x c e s s m o r t a l i t y w i l l m ils-e n a th e E x p ectatio n '* * * -* !* * 9 d continu0US- be le s s than th a t i n s u l a t i o n ( 5) , w ould ' ^ t h a t V S i r l t l a ^ c o h o r t! p e rh a p s 2000 o r more i n d i v i d u a l s , require th a t a fa irly larg in d iv id u als to be sought fo r inclusion b e ld e t l f ^ ot f WS a l l h a v e b eg u n g a ra g e em ploym ent w ith b ra k e in su c h a c o h o r t 55 L d J i d e a n y / v i l l h av e had a t l e a s t f i v e y e a r s . work p r io r to 195^ rk enviionm entS w ill be ch a racterize d o f such em pioim ent. T h t ^ coinpleton o f Task I to in d u sio n in a ^ y.j-i.' r.':: p o t e n t i a l c o h o r t . 7^ J _7 Tl * * > - ~___n-i c _nf -the g ro u p so i d e n t i f i e d w i l l be Approximate y a f e a s i b i l i t y o f 'conducting a re tro sp e c - traced to ^ ,, h o r t o b serv atio n p erio d beginning V*-,*i i ic. t i v e - p r o s p e c t i v e s t u d y - -Y.'.OiCD'ST som etim e I n t h e -^>est ^ _ sta tu s of theindividuals.and - *c- -w/': ViJ- . d u c t in g su c h a . s t u d y .7 - tr a c in g ^ ille s ta b lis h the v ita l . -- . - - ~y<t*v o f con-- d e t e r m i n e ^ e ^ i b U i t y o f con ' . - ^ " - r e c o r d s 7t o - b e 's o u g h t '.from a v a r i o u s c o o p e r a tin g u n io n 2 . and" in d u s try so u rces w ill- in c lu d e s : r . .-r& -*'.1';.- t o r'v jl-lc- sjlzzi sen io rity ' l i s t s - ' -- -^WV7*.1 "; - - ; . - ai 'rsL 002978 PRODUOE D BY FORD I S: a : 0 o teic-fcs-u^ 533-28-2X 99' : .Q.-v * %-**3 <*> pi. n o r.-i-V -w ; -t ;.'F- '. Qniofj an a Company n e w s l e t t e r * '- ''- " - ; " ' ''r W N v T 'V ' X=>--aor.-w; -ii'- . a.-;w t , : . r j ; . ; c ;: r... i - . --X ( '' Ih e a a v i l i b e p e ru se d t o d eterm in e d I f In fo rm a tio n can be o b ta in e d on 'S : * ' e, d. Hame ' : = ( | | S o c ia l S e c u rity -n u m b e r ^ =r _s -_- D ate o f b i r t h >- r -- 1- r -* -- r _ Sex . v.t? }-' ' Engiloyment h i s t o r y , in c lu d in g , I f p o s s ib le In fo rm a tio n on work l o c a t i o n s an a jo b a c t i v i t i e s . - -; - C onsideration w ill be given to th e se le c tio n of th e most appro p r ia te com parison group fo r c a lc u la tio n o f expected m o rta lity by cause. O ften lo c a l and s ta te ra te s a re u n a v a ila b le o r un s t a b l e f o r l e s s common c a u s e s o f d e a th . On th e o t h e r h an d , n a t i o n a l r a t e s may n o t s e rv e as an a c c u r a te r e p r e s e n t a t i o n o f th e general pop u latio n death ra te s in the region o f in te r e s t. Z t i s a n tic ip a i.e d - je h C~; y r ma r i ^ r c b e cb ace x i> ed _ v ith in d iv id n ^ 'iL ii^ n g ^ i n ^ ^ M ^ s t j f t e ^ tg J e W P ^ to c .'- ^ n n s y ljr a n li^ 7Hew l K f-y W s ta te s good -data are *Trvai l a b l e ^ehil 11 Cs'1TBtg ti lr .e s s w i l l b e s t u d i e d . A d d i t i o n a l l y , we v i l i consider th e u sefu ln ess o f review ing p ath o lo g ical m a teria l and m edical reco rd s to a s c e rta in th e ex iste n ce of unusual causes o f d eath , such as m esotheliom a, in th is population. I t i s u n lik e ly th a t inform ation e x is ts in a v a ila b le reco rd s on r a c e , smoking h is t o r y , o r o th e r employment o f an in d iv id u a l. I n t h i s p ro p o se d r e s e a r c h we w i l l i n v e s t i g a t e an a l t e r n a t i v e stu d y d e sig n , th a t o f a p ro sp e c tiv e m o rta lity stu d y d a tin g from th e tim e of id e n tific a tio n o f a co h o rt. Here, such fa c to rs as smoking and s p e c if ic employment h is to r y can be o b ta in ed and r e la te d to subsequent m o rta lity experience. C. Task I I I - M edical Survey 1. A p ro to co l w ill be developed to study th e h ealth e ffe c ts of occu p a tio n a l ex posure to a s b e s to s in b rake r e p a ir work th ro u g h th e c l i n i c a l e x a m in a tio n o f a p p r o x im a te ly 1200 i n d i v i d u a l s . As d e s c rib e d p re v io u s ly , m ost b rak e shops g e n e ra lly employ few men, " and th u s s e le c tio n o f such a number o f in d iv id u a ls fo r examina tio n w ill In g e n e ra l, be done through th e unions re p re se n tin g w o rk ers employed in b ra k e m ain ten an ce in r e p a i r . Members o f th e p r e v i o u s l y d e s c r ib e d u n io n s -?(see s e c t i o n I I I -5) -h av e- a s s u r e d us ' - th a t th e i r members w i l l p a r ti c ip a te in th e p lanned c l i n i c a l survey. T hey w i l l a l s o make a v a l l t t o l e t o -us l i s t s o f r e t i r e d members who have been employed in t h i s w ork. Trom th e s e l i s t s , i t i s f e a s ib le -to s e le c t a .s u f f i c i e n t number o f in d iv id u a ls to in s u r e that-'jf t o t a l T" t h i s , i t a p p e a r s p o s s i b l e 'Xif** " in c iu d e7 * * fo r e x a m p le p ^ 3 0 '- r e t i r * d w o rk e rs , 300. i n d i v i d u a l s w ith 20 y e a rs o r more from o n se t o f exposure t o a s b e sto s in th is tra d e , 300 who had from te n t o n in e te e n y e a r s ' from o n s e t O f w o rk , 200 w ith one to n in e y e a rs sin c e o n se t, and 300 autom obile m echanics who w ould h av e s i m i l a r tim e s from o n s e t o f g a ra g e w ork b u t would n o t have been exposed to a s b e s to s d u s t -during b rak e re p a ir work. R e c o rd s w i l l W TeepC o f t h e - t o t a l num ber a v a i a l b l e from th e s o u rc e s . u til is e d , so th a t d a ta on th e samp le s ir e in r e la tio n of th e to ta l 002979 PRODUCED BY FORD eeis-B s-cM ':'" 533-28-2199 /M ftO Xl'M T/ 13b6^a c lin e dLs ; r ;. ii-Crr. o rf The f in a l s t a t i s t i c a l design o f any proposed study w ill be d e v e lo p e d i n c o o p e r a tio n w ith O r. . C u y le r Hammond, "Vice P re s id e n t f o r Epidem iology and S t a t i s t i c s o f th e American Cancer **5 . . s.'w i i:c 11 , zr i ' , v . ;-5. . :n.-r.-. -.1 :-rZ ,T- " .. I t i s a n tic ip a te d th a t param eters se le c te d fo r study in the c lin ic a l exam ination v i l l in c lu d e: - . - ''r - -}<v; i.T.-: Com plete o c c u p a tio n a l h is to r y .. c -... b . A sbestos exposure h isto ry - , ........... ... C. . Com plete m edical h is to ry _ ; . .. d . D e ta ile d h is t o r y o f work r e p a i r - and b ra k e m aintenance work Smoking h i s t o r y ' - . f . S p e c ific symptoms: e x e r tio n a l dyspnea, cough, sputum , o th e r c h e s t -symptoms ; ... . ; ' g . H istory o f previous ch est x -ray findings h . Use o f in d u s t r ia l hygiene p re c a u tio n s , in c lu d in g vacuuming, v e t c le a n in g , re s p ira to rs , and period o f u se. i . P h y sical exam ination, v ith p a rtic u la r referen ce to ch est, abdomen, clu b b in g , oro-pharynx, cy a n o sis. j . C l i n i c a l b io c h e m ic a l t e s t s (SKA 12) k . . CBC .* - .- . . -- l . U rine .... - . , m. Carcinom a em bryonic a n tig e n - - ^ n . P o ste ro -a n te rio r ch e st x -ra y w ith l a t e r a l and oblique film s made where in d ic a te d . F u ll s i z e 14 x 17 film s w i l l be u se d . o . Pulm onary fu n c tio n s tu d ie s , in c lu d in g v e n tila to ry te s ts I t i s a n tic ip a te d t h a t a p ro to c o l to be su g g ested would be s im ila r to those u tiliz e d in o th er c lin ic a l fie ld stu d ies by th is labora to r y . Appendix I in c lu d e s form s p re v io u s ly u sed in such examina t i o n s by t h i s la b o r a to r y . R esponses a r e re c o rd e d on mark sense form s f o r ra p id e n try in to com puter sy stem s, w ith th e p rep aratio n o f rep o rts and the an aly sis of d a ta . .. ' The p ro to co l to b e designed w ill be subm itted to th e p ro ject .o f f ic e r fo r review and approval b efo re proceeding w ith the study. \ r r j l>t .. r.i r , v G u id e l in e s t o b e p ro m u lg a te d by NIOSH f o r th e c o n d u c t o f pulm onary fu n ctio n te s ts w ill, be .fo llo w e d .'. Our c u rre n t procedures' + mre to re c o rd f u l l flow -volum e cu rv es on a l l maximal b rea th in g e f f o r t s o f an in d iv id u a l.- . The pulm onary fu n c tio n t e s t s continue -i u n t i l th e b e s t f u l l flow -volum e curve i s reproduced to w ith in 5*. T h is .u s u a lly in v o lv e s a minimum o f th r e e e f f o r ts ^ b u t can c o n tin u e ' .-v.<. r r . f o r f i v e -or m o re. V a r io u s p a r a m e te r s from th e d i f f e r e n t e f f o r t s ' -OCW i 5 - . J 1 a r e a l s o s t o r e d 'i n t h e sem ory o f a n1 SRL. . ' ":* These in clu d e ;* r. j_- rnc:i c.-.i -.h7. .- r.: sc : OJ s*-c* . .. a . Forced v ita l capacity / d i.v .j- ' ./ir,-'';.:' b . : 1 - s e c . f o r c e d e x p i r a t o r y volume^.ad f.vr.r. jo n r.cn? t i d i i l - i v 3 - s e c fo r a e d .e x p ir a to r y volum e _rv,r ic n ciir.Ij-d .if - e x p ir a to r y flo w - a h rs .ia .'C 002980 R PRODUCED BY FORD ~ *e--& .2 " -fi =U" .. '. " V" ' ' ... . . U M lW . 'M u W iW , " 533-28-2199 . - r - i i o a C '^ r ir v : Y .: .- > r ! p o t e Ji a t p ^ i t o r y - f l o v - t ^ O ^ ^ o f l r S C : s-rfT .V ' t e l i o c l d s i , t r o r c a d - e x p ir a to r y lw-,23-=75--'. 1c :r.2Z - - /.t r iisH 3.i b - ' ^ . ^ d e x p i r a t o r y t i m e 'i r .o v r d r - r i.- ie -r .r .^ tt s o rr.i," VSS.--J l o r - t c l .V -'i-O w v -u ' . >'&i3r.->; a l \~ c 3 c -jr t x l r c e o s ! tE xcai an In s p e c tio n -o f th* flow-volum e .curves o f an in d iv id u a l, tiie b e s t e f f o r t is - e le c te d and-tha.above num erical.param eters re c o rd e d . The flow -volum e curves continue^fco se rv e as a * ii - p e r m a n e n t:r* c o rd o f - a l l e f f o r t s -of a n ' i n d i v i d u a l . ;V.C r!3Zt-p - - f c '- o e v r i r t i . e s c ~ `"i t4 . 1 t r i p a r t i t e -m e e tin g '-to d is c u s s -th e -p ro ^ cfc-* r U ; i e a rra n g e d and w ill be composed o f re p re s e n ta tiv e s o f th e o rg a n iz a tio n s l i s t e d i n s e c t i o n X II B. ' ; . . .*r I t `.-ttr- i : 5. A ll w orkers w ill b e examined in appropr ia te 'f ie ld s ta tio n s to be s e t up i n t h e New York-New J e r s e y - C o n n e c tic u t- P e n n s y lv a n ia - a r e a .- Our ex p erien ce in d ic a te s th a t th e f a c i l i t i e s w ill be - i c e n te re d i n Onion ex am in atio n h a l l s ; community f a c i l i t i e s ; o r ' m edical f a c i l i t i e s as physician c lin ic s , h o s p ita l o u tp a tie n t d ep artm en ts. The u t i l i z a t i o n o f such f ie l d s ta tio n s w ill f a c i l i t a t e th e attendance o f th e .w orkers, since .tra v e l w ill be k e p t to a minimum. S u ita b le x -ra y equipm ent w i l l b e c o o rd in a te d . E ach i n d i v i d u a l p a r t i c i p a n t i n t h e 's tu d y v i l i b e p r o v id e d w ith an ..inform ed con sen t form and an a ssu ra n ce -th at a l l info rm atio n in -th e i n v e s t i g a t i o n v i l i b e h e ld d n a c c o r d an ce w ith th e p r iv a c y a c t {PL 9 3 - 7 5 9 ) . . - -v i: .-.1 . * ... ' .. O . The exam ination w ill b e .conducted ac co rd in g to p ro ced u res prom ul g a te d i n 42 CFR P a r t 8 5 a , O c to b e r 1 4 , 1 976. '" O c c u p a tio n a l S a f e ty and H e a lth I n v e s ti g a ti o n s o f P la c e s o f Employment" and o th e r a p p r o p r ia t e g u i d e l i n e s o f NIOSH. .....................; As p a r t o f th e p r o t o c o l to b e .s u b m itte d t o NIOSH, c r i t e r i a w i l l be e s ta b lis h e d by which an in d iv id u a l w ill rec eiv e ra p id n o tif i c a tio n o f a b n o rm a litie s in -the la b o ra to ry t e s t , -c lin ic a l examina t i o n , x - r a y and p u lm o n ary f u n c ti o n t e s t s , -Upon d e te r m in in g such . a b n o r m a litie s , th e in d iv id u a l p a r t i c i p a n t .-will r e c e iv e n o t i f ic a ' tio n and, in ad d itio n , a rep o rt w ill be subm itted to h is physician i f he so req u ests. . . . . 1-'> ~ t,. : . - r -. . 6. Each in d iv id u a l p a r tic ip a n ts ' occu p atio n al h is to ry , p a s t m edical h is to ry , p h y sic al exam ination and lab o rato ry d ata w ill be thorough- 2 ly review ed by a p h y sician using a c ce p ta b le m edical stan d ard s. A ll ,..--,-w i c h e s t trim s w i l l . b e r e a d .in d e p e n d e n tly by. th re e ^ e x p e rie n c e d x -ra y a-.-T . - --.'v:',.- .- r e a d e r s and c a t e g o r i s e d b y .'th e . ILO U/C .c a te g o r y .{see A ppendix I I 1"* b elo w ). The film s w i l l th e n be -re in te rp reted ,- e a c h o f th e th re e -read ers w ill p a r tic ip a te , to g e th e r w ith an "ad d itio n al experienced ciiSL-. 733 ; r e a d e r . . P aren c h y m al f i b r o s i s , p l e u r a l , f i b r o s i s , p l e u r a l c a l c i f i - "]- `v t . . c a t i o n , n e o p la sm , n o n - a s b e s to s .d is .e a a e w iH .JO X Jb e r e c o r d e d , o r ~lzr' . . i.tow - - th e ir a b s e n c e n o t e d . ::.-.The - q u a lity .o f th e f i l m , w i l l a l s o b e e v a lu a te d . a-.* a re p o rt w ill be generated, supplying th e re s u lts o f a ll findings t o th e i n d i v i d u a l an d t o any p h y s ic ia n d e s ig n a te d b y him . No O t .t- t , i r i r r e s u l t s , - h o w ev er, c o n c e r n in g -any in d i v i d u a l man w i l l b e made a v a i l a b l e t o e i t h e r t h e _ in d F v id u a l',s em p lo y er o r t o -the u n io n c o n c e rn e d . sa/.s^P u ll c o n f id e n tia lity , o f r e s u lts ; w ill,, h e ..m aintained. S t a t i s t i c a l -r.ir'-wjvtr.-.s-i r r r . l - r e s u l t s - . o f jth e ifin d in ss :-* * illy ..-h o w e v e r,;b e made a v a i l a b l e t o i e :- r - tiir i- .- r 'jz rf.- i n t e r e s t e d in d u s tr y "and la b o r g ^ o u p s^ ", - ....... oTisJfcrcw a o c k c s rc iz m sA crd bits i n -. --.j..- .. : --n''' " 002981 Q PRODUCED BY FORD -r-. 533-28-2199 7 . The ShA-12 .an d -CBCs w i l l b e a n a ly z e d . i a _ t h e C h e m is try D ep a rt m en t o f H ount~SB*i-*C1`09l-^ o i-ito d ic ij ad th e b lo o d f o r c a r c in o g e n ic em bryonic -a n tig e n - w i ll h e exam ined a t t h e Hoffman L aRoche L a b o ra to ry l a N u tle y , New J e r s e y . E ach o f t h e s e has b e e n ap prov ed -under t h e P r o f i c i e n c y T e s tin g P ro g ram o f CDC o r -th e C o lle g e , o f jA m e rie a n IP a th o lo g y .'. s z z s i s-.ff; f'-zo c t \r r iir .s : o v rc t ? ~ .'. = - - ' 3 . r i =nT fe fV - - Mnn-t-Viiy -prog r e s s r e p o r t s , t e c h n i c a l .--q u a rte rly - r e p o r t s , a n d a f i n a l re p o rt w ill be subm itted in accordance w ith the requirem ents of ? h e proposed -c o n tra c t,'* * d escrib ed i n -the -Request fo r P ro p o sal. " Ksj?-> *,3 c-z it'.'- i: .t P re v io u s e x p e r ie n c e o f t h i s l a b o r a t o r y 3S.2 r: .A. M o r t a l i t y s t u d i e s -u ad . I :A . , - r - Numerous m o rta lity s tu d ie s o f - d i f f e r e n t groups--of w orkers have been ' .- c o n d u c te d by v a r io u s members o f t h e E n v iro n m e n ta l S c ie n c e s L a b o r a to ry . - T hese s t u d i e s a r e l i s t e d i n T a b l e . I . - I n ea ch we h av e h a d th e c o o p e ra - - - t i o n o f th e u n io n s r e p r e s e n tin g th e workman and o f te n o f th e company - b y whom tb e y w ere em p lo y ed . - ' - ' ' B. C lin ic a l in v e s tig a tio n s A v a rie ty o f c lin ic a l -surveys have been undertaken in v e stig a tin g . th e h e a lth hazards in d if f e r e n t in d u s trie s . These are d e ta ile d in T ab le I I . In many o f th e s e su rv e y s ve re c e iv e d th e c o o p e ra tio n o f b o th th e union and management in v o lv e d . The su rv ey s were h e ld in such lo c a tio n s a s a m u n ic ip a l c e n te r , union h a l l , company m edrc a l f a c i l i t y , p r i v a t e m e d ic a l `c l i n i c , h o t e l , l o c a l h o s p i t a l . In a l l . c a s e s , n e c e s s a ry eq u ip m en t, s u p p lie s and p e rso n n e l w ere r e a d ily moved to the exam ination s ite in q u estio n , C. P re v io u s s tu d ie s o f b rake r e p a ir gad m aintenance workers^ T h is la b o ra to ry has conducted two p re v io u s s tu d ie s o f b rak e w orkers and th e environm ent of b rak e r e p a ir and m aintenance. Appendix I I I includes copies of th ree published a r tic le s describ in g th is research. V. S ig n if ic a n c e o f t h i s r e s e a rc h .z ` -:* . "A. 'p i s e a s e among b r a k e r e p a i r w o rk e rs ............ - - -j" O b je c tiv a c l i n i c a l and m o r t a l i t y e x p e r ie n c e among b r a k e r e p a i r J- - .en b z s k z m a in te n a n c e -- r-k er* w i l l b e a n a ly z e d b o d e te r m in e w h e th e r . . s ti g m a t a o f a s b e s t o s d i s e a s e i s - p r e s e n t among t h e s e w o rk e rs . The ~ r e s u l t s w i l l b e compared w ith th o se among w orkers m o th e r a s b e sto s *> - ; . r e x p o s e d g r o u p s , t a k i n g i n t o a c c o u n t s u c h -im p o r ta n t v a r ia b l e s as d u r a - : t i o n o f e x p o s u re , -d u ra tio n from u n s e t o f e x p o s u re , i n t e n s i t y o f expo : s u r e , sm oking h a b i t s . -The d a t a - w ill- h a v e p r e d i c t i v e v a lu e in co n - i p sid e rin g the ex ten t of asb esto s d ise ase ris k vrm qw oxK ers in th is '-tra d e .'- - ` ;'V ' ' r ' -' 1' .V 2." / ' E s ta b lis h m e n t o f d l l n i c a l ' s u r v e i l l a n c e p ro g ram s ^ " ' ' ` " { J JT. 1 i n a i y s l s ' t f W ia a ii* g s - i * r e l a t i o n to^known -d isease risk a m o n g r>* n f ': I ' t e th e r a s b e 's to s -e x p b 's e d -w o rk ers/, w i l l a llo w a p p r o p r i a - a re ti o n s to be made p r o p r i t f o r -p ro sp e c tiv e m e d ica l_ s u r v e i l l a n c e _ o f ^ ' b rak e r e p a ir and brake m aintenance w orkers. - 'VW'3*' ~`:r -*V "_____" .'1 . - 'I' 002982 w _ V35 PRODUCED BY FORD .. T ab le 1 O ccop*tional C ohorts thider S u rv e illa n c e C U ortallty Studies) ; A sbestos Z. . -- " r . r K .T . - K J , I n s u la to r s .. z. z 1,250 O .S. - Canada In s u la to rs k r J 1 17,800 t TInarco A s b e s to s ' l e c t o r i w o rk e rs j. . C L J 1 : 1,000 4 ; ; v: " C narco f a m ily . ~ F i 7 -- ~ r. A sb e s to s m in e r s ; Q u eb ec, C anada :L r r , 500 r i 1,200 ^ P a te r s o n n e ig h b o rh o o d ? z. U 7 R 1 > > > 6,000 fa c to ry w orkers - K an v ille, K J . 690 - f a c t o r y w o rk e rs - W aukegan, I l l i n o i s '. _ _ . . 1 , 6 0 0 . Y' 1 ... -- . "/ TZ ZZ -- "-- . 7 S ty re n e ; r P roduction and p o ly m erizatio n w orkers 500 V inyl ch lo rid e . P olym erization workers . 1,200 O th e rs -, : P ainters . - : - 1 - . " .. . T -.125,000 Titanium dioxide w orkers " . P rin ters - ; - tT z - - 950 r 65,000 R o o fe rs =. ~ - 7 -6,000 A brasive soap workers 215 Wood t r e a t m e n t w o rk e rs 300 Tunnel and caisso n w orkers - 1,000 Ceram ic t i l e w orkers T ric h lo ro e th y le n e - H .Y .C. 1,450 450 N itrosam ines 350 R e fin ery employees E l e c t r i c a l w o rk e rs ex p o se d t o PCB r. . r ?.. I; 7 -- ^ - ~ )_ _ n *3* i z x " c* z. - z -- " u. n - * - - 1,350 I 5.0 : : - r -- ,7_ . r~ " r -- h: ' s --. i -- ?' . 002983 PRODUCED BY FORD PRODUCED BY FORD f . iV .fv 1 i ' ' 1 Q K> CO 00 . \ 'i -lt - I H .Vj.v f \ O in iip 1. A lliiert tu B f a c t o r y w o r k o r a J I'.-I r t i 1 l u l l o f f a c t o r y U o r k o t B 1litu i 1h t l m t II II II II W o rk ers It II II II U n io n 1 II II II A. r .'i i n t ih |( T r n d c u H " 5. I'v e t o u t L ie w o r k e r s fi. T l f u n Iiim d i o x i d e p i g m e n t l>U n i i w o r k e r 7. l.u iid b i t r n o r a % * Il II M ^j|lctm dnr y le ad m olter w orker !). , Hrnku muJ u t cn n n co and r e p o i r I Tnlilo II C lin ic a l F ie ld S tu d ie s 1975-76 D ates c it* 1 Humber '\y Bx.'im1noil Prulll era 1975 1975-76 1975 1975 1976 1976 1975-76 1975 1975 1975 1975 1975 1975 1976 1976 1975 P a te rso n , M.J. P n ta r s o n , N..7. - ^ t . T oledo, Ohio S t. L o u is , Mo. H ash v llle, Tcnn. K n o x v llla-C liattn u o o n n Hew York C ity , H.Y,, T o le d o , Olilo A* S t. L ouis, tin. J r. T o lo d o , Oliio " 1 ^ S t . L o u is , Mo. . . 1 Brooklyn Hsvy Y ard ., B ronx, N .Y .(3 rd Avi E l) 110 C. ) 7< a> iW ' 95 260 90 no 05; ' er* 302 ' 1 o 270 - ;Y u 206 ' r1t 25 .1 10 9 A sbestos :> c.' o {" -j o Afilifctitifii .fertpoauru QJ ^ i) h *' ft Aubuui >t> li Cl Aiilieiuos >. c1, AuIihuI iih t 1 AiiImiiiI oh k Aiihoiil iifci 1' S o lv n n tn , unbent ni t. Mixed dk|iiiiiiiruu 3 a T ( Litil 1lifat d lu x ld o 'r 0 duiib. ii()x V* >14 PVC`uxL-ruiiluii, o il uVr Blllvciltll Iv o " T ith n tix n dluxIduM. d u u t, Sil* ^ iii | ' I.' l 14 n\ Leiirf fittuf-to ,r. Hold . fuMdu ii* In d ia n a p o lis, Ilid. lo s Aiifjolea, C a lifj , I - Hew York C ity , H .y T tsJfi IB l I. 166 d o |. !. : 65 Anlmaton, carbon tniniuxide, lead r\ o ; , r f t t V : '* r--\Shu5,^ - \1-r' i-J: : ; t( 'V ; , ;t li. ; t mmm w,, ......... tar fSfci' I 4 i>x ` .. I C . Pates CP c 7i .Q u r~ |i*4 Ir51975 1976 1976 -^ v`,} *\Vt>*. 'v ; : t *V V-* r_ '. \* u' .i-. k-f<;*|.r.if. Ii J \ 1,-` * 1 .'{P/ 'S, v *. 1 i; . <* >.,' . * . ,< : ' `J . in . i! rti. 16. '1'' .` *1 1177 . IMuor I t i s ' worker r | ,`- '1 9 7 5 ` ' . .`lyri'iinj'rtiinufncruvinji, polymer- liiiiLJtiii'mid oxtru alu ii workers * , / (*> ^ > ... 3 1975 r ^ r/' 1 . fr KUjcI.I c-i*ii'c n n1 iic itu to r man.t.ii-d.'p ' *11 9>6 .. fai*.tur lu (4 workers \ *; { - , | ; o.1 :: uA:i1uriiluti m inersami m ille r s *' a 1976 ' C a r n a l t tt|t v n rk e r* ..... \%j ^>\ o #| tJ * * 1976'. : i j I IMIU tilkM ^ 1976 " lum inelli comminer -, } 5 M 1j //1 r: -i o:* 13 .. : 1m t leu f^ fln u rnnQu in atru d lors'" -9 7 6 111. i ,<y / . -- 1,- I*', ' V' s'f/ . .; :i -i * r.! 1.976 I-, n 002985 PRODUCED BY .FORD o ii ttOmbor Bxitw t n u o f t ni* ^ HUTTBB * ` Wc^oj^'-' C rotoni orini " L ' i c to td fi, Count, '' C ro to n C onni' * ! a" ii> n.H< g <' 'to! h ' j 'f e nPJ'V-U'i. , . Kanina fcttj 'Vf. ' ** . . i *k ; *l* e* H nneii.' pen'n.' ?; --; ti-i * INr 1`*^ h-. tU '1 0 CT /* a & ,V 53:' a f'A ttlie u n ia ,' r i 'C ilm{ > r < U *-.*11 .1' 9iy1. tt* i<t. o Bto. b ' r! g. ^StyPt'fert! moilnmi-tri,- , ;; t :.l S im ivm itn F o rt K d(raN ,itf.Y . I * \ - I . .. ' ^ illuni lu I Iiiiuti'iiu r . ** r % . ! * ron. `i* nIT* I323 `Pi y'nltlnr Inn tiiil - .1 / <: r O. <*I ? b*' i.l*!jidttrjiiyJM i B o lo V e tt ,-M e u o u n d la n d ?. 490 ?. iXiiiiJi iia w H u d so n , -h.'V' '* , *t 1- C Crdnd .fldpidn, lc h . B rnx, t/.Y t !, ' *-v tr g > >i fri r* 65 *O4 G arn i Li IIIy iln atn il `t> 1 .0 4 0 o h V iiiytrinnln.il t-J i, . ir 8 lil jiliwryla i .r. ` .l e ; 4 ? ; O *r *: j . 5 . .V t o 7< l-' ` T' <n t'I N ovarle, H . J . 0' r l M iU;Voahhli a 1! li; Tr f d t o f t i r p -, .1 .1 O *- n Y / i f L'i'i* -aa - . -s -1 *1111 an J . Xicholaon 33-28-2199 o V I. " ^ a c u i t i e s A vailable f ny^r n" e n t^1 Sciences-L a b ir a to r y oi^thew 'un SinaT chobf.'.ck Uedivine i a ,f,* l l t .i.e s a v a lria b le -fo r t-h e =In ve s tig atio. n" wo*f s*U**n**ifrca**i ddilsseeaassee .asaaoonage r ^ ^ ia oe o ip a t<io a a lly '?x*p'o*s*id* ^e roVtipoSs--=- AkddAdi it<iro**n amllyv,;- aJn *t e n__s irv-Le vl_a*b__o_r a':t o r y c 'a p a. b i l i t y i , ! r i ! *B ,1 ,* ia o i - o n t e n l a a t l o n - i n a i r , W ater and t i s s u e a m p l e . . c lin ic a l d ata to be c o lle c te d In a survey such as proposed here la _ thC i t y U a i v e r s i t y * New York co m p u ter system th ro u g h a n ' - ' I E I 5100 te r m in a l housed w ith in t h e l a b o r a t o r y . JTie l a r g e CUNY IB3J System 370 Computer h a s'b e e n programmed to g e n e ra te in d iv id u a l r e p o rts on c l in ic a l iin d in g s o b ta in e d d u rin g ex a a in a tlo n s , and s ta n d a rd s t a t i s t i c a l program s are av ailab le lo r the an aly sis of th e o v erall r e s u lts . VII O rganizational R esponsibility I>r. T rillla a J . N icholson w ill a e rv e 'e s p rin c ip a l in v e s tig a to r f o r th is . proposed re s e a rc h and w ill be d ir e c tly re s p o n s ib le fo r th e conduct o f th e f e a s ib ili ty o f a m o rta lity s tu d y . D r. Ruth L ili s w ill have d ire c t r e s p o n s ib ility f o r th e conduct o f th e c l i i i c a l e x a a in a tio n . As d ire c to r o f th e E nvironm ental S cien ces L a b o ra to ry , ?Dr. Irv in g S e lik o ff .w ill m ain tain d o s e c o n ta c t tr itii t h i s p ro p o se d r e s e a r c h '^and h as o v e r a l l r e s p o n s i b i l i t y *o r a c tiv i tie s o f th e E nvironm ental S ciences L aboratory and th e D iv isio n o f E nvironm ental M edicine. -All re s e a rc h p erso n n el are in th is D iv isio n and th e re are no are as o f ^divided r e s p o n s ib ility . ' Statem ent o f A ssurance ' The in v e s tig a tio n s encompassed by th is a p p lic a tio n have been o r w ill be ~ approved by th e com m ittee o f a s s o c ia te s o f t h e in v e s tig a to r (s ) in accordance w ith th is I n s t i t u t i o n ^ assu ran ce on c lin ic a l rese arch dated O ctober 4, 1971. The u n d ersig n ed ag rees to ac ce p t r e s p o n s ib ility fo r th e s c i e n t i f i c and te c h n ic a l conduct of the p ro je c t and fo r p ro v isio n o f req u ired pro g ress r e p o r ts i f a g ra n t i s .awarded as th e r e s u l t o f t h i s a p p lic a tio n . PRODUCED BY FORD R eferen ces - '1 . R ohl, A .N ., L anger, A .M ., W o lff, M .S ., end Weisman, J^b esto s " exposure during brake lin in g m aintenance and r e p a ir. B a r. Res 12-110-128 4 J ; (1876). ' --' . - v: V .V ., R ohl, A J M i l l e r , A. , K icholson, W J . end S e lik o ff, I .J . '.'.:A 3 b esto s *P3 u r in b ra k e r e p a i r w o rk e rs i n th e U n ite d S t a t e s , . o f Med. 43:20.7-218 (May-June 1976) s o : e:-. * :c .. - ... : . - lit. Sinai '-3. D ep artm en t o f C o s a e r c e , .1972 County B u s in e ss P a t t e r n s , and C ensus o f P o p u latio n 1970 O ccupation by In d u s try . ` i 4 . A utom otive News Almanac 1 9 7 5 . r c . l ~ ' n; 5 . S e l i k o f f , I . J . , Hammond, E .C . and S eidm an, H. C an cer r i s k o f i n s u l a t i o n w orkers in th e U nited S ta te s . B io lo g ical e ffe c ts of a sb esto s, 1973. Lyon, In te rn a tio n a l Agency fo r R esearch on C ancer, 209-216. 6 . R ohl, A .N ., Langer, A JI., K lim e n tid is, R ., W olff, M .S., and S e lik o ff, I .J . A sbestos content of dust encountered in brake m aintenance and r e p a ir. P ro c . Royal Soc. Med. 7 0 :32-36 (J a n . 1 9 7 7 ). 7 . Ja c k o , II.G . and DuCharme, R .T . B rake E m issio n s: E m ission M easurem ents from B rake and C lu tc h L in in g s from S e le c te d M obile S o u rc e s, EPA R e p o rt 68-04-0020, 1973. 8 . H lck ish , D .E . and K night, K.L. Exposure to asb esto s d u rin g brake m aintenance. Ann .Occup .H yg. 1 3 :1 7 -2 1 , 1 9 7 0 . B. Lynch, J .R . Brake lin in g decom position p ro d u cts. J .A lr P o ll. C ont.A ss. 18:824-826 (1968). 1 0 . McDonald, A .D ., H a rp e r, A ., E lA tta r , O.A. and McDonald, J , C . Epidem iology o f prim ary m alignant m so th lia l tum ours in Canada. 1 1 . Newhouse, M.L. and Thompson, H. M esotheliom a o f p le u ra and p e rlto n e u n fo llo w in g ex p o su re to a s b e s to s i n th e London a r e a . B r i t . J . In d . Med. 22:261-269 (1965). . 12 . A n d e rso n , H .A ., L i l l s , R ., Daum, S U . , F is c h b e in , A. S . and S e l i k o f f , I J . , H o usehold c o n t a c t a s b e s to s n e o p l a s t i c r i s k . A nn. NY A ca d . S e i . 271^311-323 . .. 'O lay 1976) . * "L^ ' 1 3V...:`- id g e , J . R . A sb e s to s r e l a t e d d is e a s e i n B a r r o w - in - F u r n e s s . E n v .R e s . 1 1 :2 4 4 -2 4 7 tl9 7 6 ) . . r -- --T- - 14 . G reenberg, U. and Lloyd D avies, T-A. M esotheliom a R e g iste r 1967-1968. B r it. J . In d . Med. 31:91-104 (1 9 7 4 ). ,' . 1 5 . N ic h o ls o n , 1 U . C ase S tu d y 1 : A a s b e s to s -T h e TLV A p p ro a ch . 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