Study of high- and low-current-configuration homes from the 1988 Denver Childhood Cancer Study.

An epidemiological study conducted by Savitz et al. reported that residential wire codes were more strongly associated with childhood cancer than were measured magnetic fields, a peculiar result because wire codes were originally developed to be a surrogate for residential magnetic fields. The primary purpose of the study reported here, known as the Back to Denver (BTD) study, was to obtain data to help in the interpretation of the original results of Savitz et al. The BTD study included 81 homes that had been occupied by case and control subjects of Savitz et al., stratified by wire code as follows: 18 high current configuration (HCC) case homes; 20 HCC control homes; 20 low current configuration (LCC) case homes; and 23 LCC control homes. Analysis of new data acquired in these homes led to the following previously unpublished conclusions. The home-averaged (i.e., mean of fields measured in subjects' bedrooms, family/living rooms, and rooms where meals normally eaten) spot 60 Hz, 180 Hz, and harmonic (i.e., 60-420 Hz) magnetic fields were associated with wire codes. The 180 Hz and harmonic components, but not the 60 Hz component, were associated with case/control status. Measured static magnetic fields were only weakly correlated (rapproximately 0.2) between rooms in homes. The BTD data provide little support for, but are too sparse to definitively test, the 1995 resonance hypothesis proposed by Bowman et al. Case and control homes had similar concentrations of copper in their tap water. Copper concentration was not associated with wire codes nor with the level of electric current carried by a home's water pipe. These results of the BTD study suggest that future case/control studies investigating power frequency magnetic fields might wish to include measurements of 180 Hz or harmonic magnetic fields in order to examine their associations (if any) with disease status.

A richer conceptualization of "exposure" for epidemiological studies of the "EMF mixture".

Controversial laboratory results and the now discredited "wire code paradox" suggest that epidemiologists might miss something if they measured only 60 Hz fields and summarize time series of exposure with only a time integral. This has led to the question of how else the exposure issue could be addressed. This paper proposes a potential answer to this question by borrowing concepts from pharmacology. The paper briefly explores how the limitations of current analysis can lead to poor public policy decisions. The paper then uses a pharmacological analogy to highlight such concepts as "mixture," "ingredient," "dose duration," "dosing schedule," and "windows of biological vulnerability" to guide an epidemiologist in choosing what to measure. The authors point out that any candidate "ingredient" or exposure metric must be associated with wire code or spot measurements if it is to explain previous epidemiological associations. This helps eliminate many "ingredients" and exposure metrics from consideration. The authors then describe how they applied these concepts in the design of a prospective study of miscarriage and EMF exposure.

A case-control pilot study of traffic exposures and early childhood leukemia using a geographic information system.

The scientific debate on risk relationships between proximity to electric and magnetic fields and the development of childhood leukemia has recently focused on the role of other factors that may be strongly correlated with power lines. Proximity to high traffic density, as defined by major roadways or automobile counts, and associated socioeconomic neighborhood characteristics have been suggested as potentially important confounders. For traffic or socioeconomic status (SES) to confound any EMF effect these factors would need to have their own independent impact on leukemia risk. This study was designed to use geographic information system (GIS) technology to empirically examine the relationship between traffic density and socioeconomic indicators to early childhood leukemia in an urban area of California. Ninety cases of childhood leukemia diagnosed under the age of five between 1988 and 1994 among children born in San Diego County were matched by gender and birth date to a total of 349 children also born in the county and not known to have developed any cancer. Case-control differences were assessed via conditional logistic regression. No significant differences were observed for the neighborhood median family income of the birth residences. When comparing neighborhoods with median annual income > or = $56,000 to those with incomes < or = $18,000 the odds ratio was 0.86 (95% confidence interval 0.31, 2.38). Traffic density was measured using a variety of methods, including information on average daily traffic counts and road characteristics. None of the measures of traffic were associated with case status. Neither SES or traffic density near the birth address as assessed with GIS methods are strong enough risk factors for leukemia to be confounders which could totally explain the effect of another variable (such as wire code). Associations with the diagnosis address or with more direct exposure measures may differ from those reported here.

Panel exploring pro and con arguments as to whether EMFs cause childhood brain cancer.

Two groups of epidemiologists were assigned to develop pro and con arguments with regard to a causal explanation for statistical associations sometimes seen between surrogates for occupational and residential electric and magnetic field exposure and brain cancer. The arguments developed were meant to help the Department of Health Services when it prepared its final risk evaluation by a respectful and illuminating review of the possible reasons for concluding either that magnetic fields were or were not likely to be a cause of brain cancer.

The use of electric bed heaters and the risk of clinically recognized spontaneous abortion.

We conducted a prospective cohort study to evaluate the relation of spontaneous abortion and electric bed heater use during the first trimester of pregnancy. Compared with non-users, rates of spontaneous abortion were lower for women who used electric bed heaters. The adjusted odds ratio and 95% confidence interval (CI) for the two major devices used, electric blankets (N = 524) and waterbeds (N = 796), were, respectively, 0.8 (95% CI = 0.5-1.1) and 0.9 (95% CI = 0.7-1.2). An increase of risk with increasing intensity (setting-duration combination) of use was not observed. Users of electric blankets at low settings for most of the night (N = 171) had lower risks of spontaneous abortion than non-users (adjusted odds ratio = 0.5; 95% CI = 0.3-1.0). Twenty women who used electric blankets at a high setting for 1 hour or less had an adjusted odds ratio of 3.0 (95% CI = 1.1-8.3), but we found no spontaneous abortions among the few women (N = 13) who used a high setting for 2 or more hours. We found that exposure rankings of the magnetic field time-weighted average and a rate of change metric did not correspond monotonically to the pattern of spontaneous abortion risks and that electric blankets contribute less to overnight time-weighted average magnetic fields than has been thought.

Maternal periconceptional use of electric bed-heating devices and risk for neural tube defects and orofacial clefts.

Electric and magnetic fields are of concern as risk factors for adverse reproductive outcomes, including congenital anomalies. Among residential exposures to electric and magnetic fields, electric bed-heating devices such as electric blankets may be a substantial source of such exposures, and their use is fairly common. Two population-based case-control studies were analyzed to investigate whether the periconceptional use of electric blankets, bed warmers, or electrically heated waterbeds increased the risk of women to deliver infants or fetuses with neural tube defects (NTDs) or orofacial clefts. We obtained information on bed-heating devices from 538 NTD cases and their 539 controls in one study, and 265 NTD cases and 481 controls and 652 orofacial cleft cases and their 734 controls from another study. Our results revealed a few modestly elevated risks of certain anomaly phenotypes with maternal use of certain bed-heating devices, but risks tended to be imprecise. In general, women who reported more frequent use of a bed-heating device, or longer duration of use, did not appear to have a higher risk for delivering offspring with anomalies than were women who reported less frequent or shorter-duration use.

Examining associations between childhood asthma and traffic flow using a geographic information system.

Using geographic information systems (GIS) and routinely collected data, we explored whether childhood residence near busy roads was associated with asthma in a low-income population in San Diego County, California. We examined the locations of residences of 5,996 children [less than/equal to] 14 years of age who were diagnosed with asthma in 1993 and compared them to a random control series of nonrespiratory diagnoses (n = 2,284). Locations of the children's residences were linked to traffic count data at streets within 550 ft. We also examined the number of medical care visits in 1993 for children with asthma to determine if the number of visits was related to traffic flow. Analysis of the distribution of cases and controls by quintiles and by the 90th, 95th, and 99th percentiles of traffic flow at the highest traffic street, nearest street, and total of all streets within a 550-ft buffer region did not show any significantly elevated odds ratios. However, among cases, those residing near high traffic flows (measured at the nearest street) were more likely than those residing near lower traffic flows to have two or more medical care visits for asthma than to have only one visit for asthma during the year. The results of this exploratory study suggest that higher traffic flows may be related to an increase in repeated medical visits for asthmatic children. Repeated exposure to particulate matter and other air pollutants from traffic exhaust may aggravate asthmatic symptoms in individuals already diagnosed with asthma.

Prevalence of people reporting sensitivities to chemicals in a population-based survey.

To describe the prevalence and correlates of reports about sensitivities to chemicals, questions about chemical sensitivities were added to the 1995 California Behavior Risk Factor Survey (BRFS). The survey was administered by telephone to 4,046 subjects. Of all respondents, 253 (6.3%) reported doctor-diagnosed "environmental illness" or "multiple chemical sensitivity" (MCS) and 643 (15.9%) reported being "allergic or unusually sensitive to everyday chemicals." Sensitivity to more than one type of chemical was described by 11.9% of the total sample population. Logistic regression models were constructed. Hispanic ethnicity was associated with physician-diagnosed MCS (adjusted odds ratio (OR) = 1.82, 95% confidence interval (CI) 1.21-2.73). Female gender was associated with individual self-reports of sensitivity (adjusted OR = 1.63, 95% CI 1.23-2.17). Marital status, employment, education, geographic location, and income were not predictive of reported chemical sensitivities or reported doctor diagnosis. Surprising numbers of people believed they were sensitive to chemicals and made sick by common chemical exposures. The homogeneity of responses across race-ethnicity, geography, education, and marital status is compatible with a physiologic response or with widespread societal apprehensions in regard to chemical exposure.

Childhood asthma along the United States/Mexico border: hospitalizations and air quality in two California counties.

Since the passage of the North American Free Trade Agreement in 1993, there has been an increasing need to monitor environmental health trends that may be related to the rapid industrialization of the United States/Mexico border. We studied two counties on the California/Baja California border to obtain baseline data on trends in childhood asthma hospitalizations and two pollutants that aggravate asthma, ozone and particulate matter (less than 10 microns in diameter), from 1983 to 1994. Hospital discharge records of children 14 years and younger were analyzed, and rates by county, race, and sex were age-adjusted to the 1990 California population. Data on five ozone and particulate matter indices obtained from the California Environmental Protection Agency were used. Imperial County had the highest childhood asthma hospitalization rates in California for non-Hispanic whites and African-Americans, and the second highest for Hispanics. San Diego County had rates below the state average. Over the time period examined, rates in Imperial County increased 59%, while those in San Diego County decreased 9%. Maximum ozone levels increased 64% in Imperial County but decreased 46% in San Diego County. Particulate matter levels were four times higher in Imperial than in San Diego County. High rates of childhood asthma hospitalizations in Imperial County may be partially related to high levels of poverty and worsening air quality conditions produced by increased burdens on the local airshed. Asthma prevalence surveys and binational time-series analyses examining asthma-pollutant relationships are needed.

A prospective study of spontaneous abortion: relation to amount and source of drinking water consumed in early pregnancy.

In 1992, we published four retrospective studies, conducted primarily within a single California county, which found higher spontaneous abortion rates among women who drank more tapwater than bottled water in early pregnancy. The current prospective study extends that investigation to other water systems. Pregnant women from three regions in California were interviewed during their first trimester. Multivariate analyses modeled the amount and type of water consumed at 8 weeks' gestation in each region in relation to spontaneous abortion rate. In Region I, which was within the previous study area, the adjusted odds ratio (OR) comparing high (> or = 6 glasses per day) consumption of cold tapwater with none was 2.17 [95% confidence interval (CI) = 1.22-3.87]. Furthermore, when women with high cold tapwater and no bottled water consumption were compared with those with high bottled water and no cold tapwater consumption, the adjusted odds ratio was 4.58 (95% CI = 1.97-10.64). Conversely, women with high bottled water consumption and no tapwater had a reduced rate of spontaneous abortion compared with those drinking tapwater and no bottled water (adjusted OR = 0.22; 95% CI = 0.09-0.51). Neither tap nor bottled water consumption altered the risk of spontaneous abortion in Regions II and III. Although controlling for age, prior spontaneous abortion, race, gestational age at interview, and weight somewhat strengthened the association in Region I, the distribution of these confounders did not vary appreciably across regions. This study confirms the association between cold tapwater and spontaneous abortion first seen in this county in 1980. If causal, the agent(s) is not ubiquitous but is likely to have been present in Region I for some time.

Pesticide exposures to children from California's Central Valley: results of a pilot study.

In response to concerns about pesticide use and evidence that contaminants may accumulate in house dust, the California Department of Health Services (DHS) conducted a pilot study of pesticide contamination in rural children's home environments. House dust samples for pesticide analysis were collected from eleven homes, five of which had at least one farmworker (FW) resident. Handwipe samples were collected from one child at each residence (ages 1-3 years). Ten of 33 pesticides tested in house dust were detected. Excluding non-detects, concentrations for diazinon ranged from 0.7-169 ppm in four FW homes and 0.2-2.5 ppm in three non-farmworker (NFW) homes (overall median = 1 ppm), suggesting a difference between FW and NFW homes. Chlorpyrifos ranged from 0.2-33 ppm in three FW homes and < 1 ppm in two NFW homes (overall median < 0.5 ppm). All other pesticides were detected at < 2 ppm at four or fewer homes. The sources of these compounds could not be determined. Co-located samples were considerably different in concentration and loading, indicating intra-household variation. Of nine compounds tested, diazinon and chlorpyrifos were found on the hands of two or three FW children (20-220 ng/hand). Dust ingestion scenarios show child exposures could exceed the United States Environmental Protection Agency Office of Pesticide Program diazinon chronic reference dose (9 x 10(5) mg/kg/day). The results suggested that pesticide residues are present in the home environment of some California children and are likely to contribute to exposures. Additional research is feasible and needed to assess the magnitude and distribution of these risks.

Magnesium in drinking water and ischemic heart disease.

The associations found in the general populations of a number of different countries are suggestive and warrant an integrated program of laboratory and epidemiologic research to reject or confirm the magnesium-IHD hypothesis. Singling out this particular risk factor has two justifications. First, as would be the case with any epidemiologic risk factor for IHD whose attributable risk was large enough to be detectable through epidemiology, applying that attributable risk to the vast annual morbidity and mortality from IHD would translate into tens of thousands of lives benefited and millions of dollars in hospital costs avoided per year. Second, this particular risk factor could conceivably be eliminated by an inexpensive supplementation program. For example, a low-sodium, higher-magnesium and -potassium table salt has been recommended and used in Finland for many years, during a period when the prevalence of hypertension in population surveys was said to decrease (117). Interventions which do not require behavioral change have always been the most cost-effective in public health. We therefore urge funding agencies to give priority to studies determining whether there are unforeseen adverse effects of magnesium for some population subgroups and whether the apparent benefit derived from low doses of magnesium in the development of IHD or IHD death is real. Furthermore, researchers should determine which chemical form of magnesium is best absorbed and most effective. We need to better understand the interrelation of various water and food constituents, as well as individual risk factors, in the pathogenesis of IHD. Susceptible individuals who are at higher risk of being depleted of magnesium need to be identified, and potential untoward effects of magnesium should be studied. Future research must provide better answers about low level waterborne magnesium before recommendations to the public can be made.

The four county study of childhood cancer: clusters in context.

Observations of childhood 'cancer clusters' in small communities in central California prompted us to examine the distribution of childhood cancer in communities throughout the region to see if the overall cancer rate or the distribution of 'cancer clusters' was unusual for agricultural towns where pesticide exposure might be elevated. The distribution of rates was evaluated using a variety of methods: comparison of rates to the regional average, evaluation of the empirical observed versus expected Poisson distribution of events, and multivariate modelling using Poisson regression. These analyses suggest that there were no previously undiscovered communities with excess rates, although the index community which prompted the initial investigation does stand out as unusual. We discuss the impact of a range of forces of morbidity on the likelihood of 'cancer clusters' and the distributions of observed and expected numbers of cancers in a population of locales.

Drinking water source and reproductive outcomes in Sprague-Dawley rats.

As part of our work on the influence of water source on reproductive outcome, Sprague-Dawley rats were randomized to tap water, bottled water, or deionized water treatment groups, utilizing 160 animals per treatment; animals received the water prior to and during pregnancy. Rats were shipped in four batches (A-D). Batch effects were seen for several reproductive parameters. Because the tap water supply was interrupted by an earthquake resulting in an unbalanced design, primary analyses utilized only batches C and D, which included most of the tap water-treated rats. A treatment effect with respect to resorption frequency was seen that was marginally significant using a fixed-effects analysis of variance (P = 0.053), but not when batch was entered as a random effect (P = 0.36). The data were modeled by logistic regression, controlling for batch, litter size, and batch-treatment interaction. The odds ratio comparing tap to bottled water was 1.8 (95% CI 1.0 to 3.3, P = 0.05), which was similar to the epidemiologic result that prompted this study. The magnitude of this association varied by batch, and the difference in resorption frequency was within the range of variation seen for control animals. Although these findings do not justify public health action at this time, further investigation is warranted.