Adjustment for temporal confounders in a reanalysis of a case-control study of beryllium and lung cancer.

OBJECTIVES: To evaluate potential confounding of the association between beryllium and lung cancer in a reanalysis of data from a published case-control study of workers at a beryllium processing facility. METHODS: The association of cumulative and average beryllium exposure with lung cancer among 142 cases and five age-match controls per case was reanalysed using conditional logistic regression. Adjustment was made independently for potential confounders of hire age and birth year. Alternative adjustments to avoid taking the logarithm of zero were explored. RESULTS: Adjustment for either birth cohort or hire age (two highly correlated factors) attenuated lung cancer risk associated with cumulative exposure; however, lung cancer risk was significantly associated with average exposure using a 10-year lag following adjustment. Stratification of analyses by birth cohort found greater lung cancer risk from cumulative and average exposure for workers born before 1900 than for workers born later. The magnitude of the association between lung cancer and average exposure was not reduced by modifying the method used to take the log of exposure. CONCLUSION: In this reanalysis, average, but not cumulative, beryllium exposure was related to lung cancer risk after adjustment for birth cohort. Confounding by birth cohort is likely related to differences in smoking patterns for workers born before 1900 and the tendency for workers hired during the World War II era to have been older at hire.

Occupational and other risk factors for hand-grip strength: the Honolulu-Asia Aging Study.

BACKGROUND: In certain occupations, including farm work, workers are exposed to hazardous substances, some of which are known to be toxic to the nervous system and may adversely affect muscle strength. Measurement of hand-grip strength may be useful for detecting neurotoxic exposure. METHODS: The authors studied 3522 participants of the Honolulu Heart Program and the Honolulu-Asia Aging Study to determine whether occupational exposures to pesticides, solvents, and metals assessed at exam I (1965-68) are associated with hand-grip strength at exam IV (1991-93) and change in hand-grip strength over 25 years. Correlation, analysis of variance and covariance, and linear regression were used to evaluate the associations. RESULTS: At exam IV, participants ranged in age from 71-93 years; mean hand-grip strength was 39.6 kg at exam I and 30.3 kg at exam IV. Over 25 years, the decline in hand-grip strength was an average of 8-9 kg for all exposures. Hand-grip strength was inversely associated with age and glucose but directly associated with cognitive function, BMI, and haemoglobin level. No other exposures were associated with hand-grip strength. CONCLUSION: This study did not provide evidence that occupational exposure to pesticides, solvents, and metals adversely affected hand-grip strength in this population, but confirmed other important associations with hand-grip strength.

Chest radiography in Portland cement workers.

To investigate the prevalence of pneumoconiosis in Portland cement workers, a controlled cross-sectional survey was conducted. Chest radiographs of approximately 2640 Portland cement workers showed prevalence rates of about 1% for rounded and for irregular small opacities and about 2% for pleural abnormalities. After age and smoking adjustment, the overall prevalences were still significantly elevated over controls, but when examined separately by smoking status, the significant increases were confined to smokers. Although statistically significant, the prevalences were only elevated about 1% in cement workers, compared with controls. A statistically significant relationship with exposure was found for pleural abnormalities but not for rounded or irregular small opacities. Thus a weak association exists between pulmonary radiographic abnormalities and employment in US Portland cement plants, and there appears to be a dose-response relationship between exposure and pleural abnormalities.

Ozone-induced respiratory illness during the repair of a portland cement kiln.

OBJECTIVES: Workers at a portland cement plant had experienced acute respiratory and eye irritation when performing maintenance inside a kiln. These episodes were associated with a bleach-like odor, which was only reported during maintenance operations. An industrial hygiene investigation was conducted to determine the cause of the illness. METHODS: While workers replaced refractory brick inside the kiln, air samples were collected for chlorine, sulfur dioxide, inorganic acid, ozone, and dust. After the rebricking was completed and all the workers had exited the kiln, its electrostatic precipitator was reduced to half power and the induced-draft (ID) fan was turned off to recreate conditions present during illness episodes. RESULTS: Chlorine, inorganic acid, and ozone were not detected, and only trace concentrations of sulfur dioxide were detected while workers were inside the kiln. However, when conditions present during previous episodes were recreated, the bleach-like odor was soon evident. Chlorine was not detected, but 0.09 to 0.11 ppm of ozone was measured at the discharge end of the kiln, and 4.5 ppm was measured at the inlet end. Within a half hour after the electrostatic precipitator was turned off and the ID fan was turned on, the ozone concentrations decreased to background levels of 0.02-0.03 ppm. CONCLUSIONS: Somewhat lower ozone exposures may have occurred during previous kiln maintenance operations due to more open access portals, but previous episodes of eye and respiratory irritation were probably caused when ozone, generated by the electrostatic precipitator, back-drafted into the kiln after the ID fan was turned off.

Factors associated with safe use of agricultural pesticides in Minnesota.

How farmers protect themselves against pesticide exposure has important public health consequences. To obtain insights into pesticide self-protection, this study obtained data on chemically resistant glove and other protective equipment use as they relate to the type of farming practice, demographic characteristics of farmers and their farming operations, farmers' preventive health beliefs and behaviors, and factors related to their health care. Data were obtained by telephone interviews conducted in six rural Minnesota counties. Survey respondents totaled 1, 327 (87% response rate), with 502 reporting pesticide use. Ninety-five percent of the latter respondents believed in the effectiveness of protective equipment and 88 percent believed that pesticide exposures are harmful. Fifty-six percent of the subjects wore chemically resistant gloves and 22 percent wore other protective clothing 75 percent of the time or more when using pesticides. Glove use and certification to use restricted pesticides was less frequent for women. The use of protective equipment in this group of Minnesota farmers was weakly related to being certified to apply restricted pesticides, believing in the effectiveness of protective clothing, believing that smoking causes serious health problems, using crop insecticides, and distance to a health care facility.

Safe handling of agricultural pesticides in Minnesota: results of a county-wide educational intervention.

Safe pesticide handling in a group of Minnesota farmers, aged 40 years and older, was influenced through the use of a multifaceted, countywide educational intervention. Two intervention counties and two control counties were involved in this effort. The intervention consisted of mailed pesticide information to farm households, educational programs on pesticides for county physicians, elementary school training modules on pesticides and the use of safe pesticide handling displays in key business areas by agricultural extension agents. Five hundred eight farmers were identified as pesticide users (186 in the intervention counties and 322 in the control counties). The use of gloves and other protective clothing while handling pesticides increased in the intervention group. Improvement was greater in those who had used protective equipment the least before the intervention. From these results, it appears that a broad-based educational intervention might have a modest impact in how farmers protect themselves when using pesticides.

Task-based noise exposures for farmers involved in grain production.

Few studies have been done examining noise exposures associated with agricultural tasks. This study was conducted to address that research gap by calculating the noise exposures for tasks and equipment associated with grain production and assessing the variability in those exposures. An additional aim of this study was to identify tasks and equipment that could be targeted for intervention strategies as a means toward reducing the total noise exposures of farmers and farm workers. Through the use of personal noise dosimetry and direct observation, over 30,000 one-minute noise exposure measurements and corresponding task and equipment data were collected on 18 farms and compiled into a task-based noise exposure database. Mean noise exposures were calculated for 23 tasks and 18 pieces of equipment. The noise exposures for the tasks and equipment ranged from 78.6 to 99.9 dBA and from 80.8 to 96.2 dBA, respectively, with most of the noise exposures having a large standard deviation and maximum noise exposure level. Most of the variability in the task and equipment noise exposures was attributable to within-farm variations (e.g., work practices, distance from noise sources). Comparisons of the mean noise exposures for the agricultural tasks and equipment revealed that most were not statistically different. Grain production tasks and equipment with high mean noise exposures were identified. However the substantial variability in the noise exposures and the occurrence of intense noise measurements for nearly every task and piece of equipment indicate that targeting a few specific tasks or equipment for intervention strategies would reduce lifetime noise exposure but would not completely eliminate exposure to hazardous noise levels.

Cattle-related injuries and farm management practices on Kentucky beef cattle farms.

While working on farms with livestock increases the risk of injury among farm workers in comparison to other commodity farms, few studies have examined the role offarm management practices in association with the risk of cattle-related injury. We examined the farm management practices of Kentucky beef cattle farms in association with self-reported rates of cattle-related injuries among workers. We conducted a mail survey of a random sample of 2,500 members of the Kentucky Cattlemen's Association. Results from 1,149 farm operators who were currently raising beef cattle and provided complete survey response are reported. During the busy season, the principal operator worked 20 hours per week on the beef operation, and among all farm employees, the beef operation required 35 hours per week (median cumulative hours). There were 157 farms that reported a cattle-related injury in the past year among the principal operator or a family member, yielding an annual cattle-related injury rate of 13.7 beef cattle farms per 100 reporting at least one cattle-related injury. The majority of these injuries were associated with transporting cattle, using cattle-related equipment (head gates, chutes, etc.), and performing medical or herd health tasks on the animal. A multivariable logistic regression analysis of cattle-related injuries indicated that the risk of injury increased with increasing herd size, increasing hours devoted to the cattle operation per week by all workers, and the number of different medical tasks or treatments performed on cattle without the presence of a veterinarian. Farms that performed 9 to 13 tasks/treatments without a veterinarian had a two-fold increased risk of a cattle-related injury (OR = 1.98; 95% Cl: 1.08-3.62) in comparison to farms that performed 0 to 4 tasks without a veterinarian. In adjusted analyses, the use of an ATV or Gator for cattle herding was associated with a significantly reduced risk of cattle-related injury (OR = 0.51; 95% CI: 0.30-0.86) in comparison to other herding methods. This study indicates that a substantial proportion of cattle-related injuries are associated with work activities related to handling practices and cattle restraining equipment.

The NIOSH Retrospective Pesticide Reference Database.

For the National Institute for Occupational Safety and Health (NIOSH) case-control study of glioma among non-metropolitan residents, pesticide information was considered critical. Responses to open-ended questions about pesticide exposures had to be grouped for analysis. Our aim was to classify pesticide responses in biologically relevant categories. We built the NIOSH Retrospective Pesticide Reference Database (NIOSH-RPRD) on over 1000 pesticide products and chemicals, particularly those likely to be used in the upper Midwest, using multiple sources. We obtained first and last years of product registration and product pesticide ingredients and their relative weights from the U.S. Environmental Protection Agency's Pesticide Product Information System. We added fields for pesticide class (organophosphate, etc.), carcinogenicity ratings, and evidence regarding endocrine-disrupting activity. Participant data were merged with the database, allowing each product recalled by a respondent to be linked to one or more chemicals, as appropriate. Respondents named 1347 different pesticides (or pesticide-targeted species) used on the farm, at non-farm jobs, or at home. Database usefulness was assessed by comparing numbers of responses naming actual chemicals to total responses linked to those chemicals. Sixty percent of farm pesticide, 59% of non-farm occupational, and 65% of house and garden responses named products, not chemicals. Among farm pesticide users, 182 (46%) reported using a total of 440 pesticides 1 to 40 years (mean 8.5 years) before those pesticides actually were marketed. The NIOSH-RPRD, now available to other investigators, has been a useful tool for us and other researchers to evaluate, group, and correct pesticide responses.

Airborne antibiotic concentrations in a swine feeding operation.

During the past 50 years, it has become common practice in the U.S. to add antibiotics to livestock feed to reduce disease and promote growth. Use of antibiotics in this manner has become the source of increasing controversy because overuse of antibiotics is suspected of leading to resistance in bacteria that cause human diseases. The purpose of this study was to measure airborne antibiotic concentrations in a swine production facility that routinely included antibiotics in feed. Samples were collected in a hog facility that included rooms devoted to farrowing, nursery, and growing operations. Analytical methods were developed to measure concentrations of the antibiotics tylosin and lincomycin in air samples. Tylosin was mixed in the feed in some of the rooms in the facility. While lincomycin was not added during this study, it had been used in this facility in the past and therefore was included in the analytical testing. Inhalable (n = 34), respirable (n = 37), and high-volume (n = 16) dust samples were collected on PVC filters over a two-month period. Tylosin concentrations were above the limit of quantification (LOQ) in 93% of the samples, while lincomycin concentrations were above the LOQ in only 9% of the samples (LOQ = 0.04 ng/sample). The average tylosin concentrations were 3, 18, and 49 ng/m3 in the respirable, inhalable, and high-volume samples, respectively. No occupational or environmental worker exposure criteria currently exist for antibiotics in air. The results of this study may be used to estimate potential swine production worker exposures and to further study the association between these exposures and health effects.

Urinary bromide and breathing zone concentrations of 1-bromopropane from workers exposed to flexible foam spray adhesives.

1-Bromopropane (1-BP) has been marketed as an alternative for ozone depleting solvents and suspect carcinogens and is in aerosol products, adhesives and solvents used for metal, precision and electronics cleaning. Toxicity of 1-BP is poorly understood, but it may be a neurologic, reproductive and hematologic toxin. Sparse exposure information prompted this exposure assessment study using air sampling, and measurement of urinary metabolites. Mercapturic acid conjugates are excreted in urine from 1-BP metabolism involving removal of bromide (Br) from the propyl group. One research objective was to evaluate the utility of urinary Br analysis for assessing 1-BP exposure using a relatively inexpensive, commercially available method. Complete 48 h urine specimens were obtained from 30 workers on two consecutive days at two facilities using 1-BP adhesives to construct polyurethane foam seat cushions and from seven unexposed control subjects. All of the workers' urine was collected into composite samples representing three daily time intervals (at work; after work but before bedtime; and upon wake-up) and analyzed for Br ion by inductively coupled plasma-mass spectrometry. Full-shift breathing zone samples were collected for 1-BP on Anasorb carbon molecular sieve sorbent tubes and analyzed by gas chromatography-flame ionization detection via NIOSH method 1025. Geometric mean (GM) breathing zone concentrations of 1-BP were 92 parts per million (p.p.m.) for adhesive sprayers and 11 p.p.m. for other jobs. For sprayers, urinary Br concentrations ranged from 77 to 542 milligrams per gram of creatinine [mg (g-cr)(-1)] at work; from 58 to 308 mg (g-cr)(-1) after work; and from 46 to 672 mg (g-cr)(-1) in wake-up samples. Pre-week urinary Br concentrations for sprayers were substantially higher than for the non-sprayers and controls, with GMs of 102, 31 and 3.8 mg (g-cr)(-1), respectively. An association of 48 h urinary Br concentration with 1-BP exposure was statistically significant (r(2) = 0.89) for all jobs combined. This study demonstrates that urinary elimination is an important excretion pathway for 1-BP metabolism, and Br may be a useful biomarker of exposure.

Tractor overturn concerns in Iowa: perspectives from the Keokuk county rural health study.

Agriculture remains one of the most hazardous industries in the U.S., with tractor overturns producing the greatest number of agricultural machinery-related fatalities. Rollover protective structures (ROPS) and seatbelts effectively reduce tractor overturn deaths. However, a large proportion of tractors in use in American agriculture are older tractors without ROPS and seatbelts. This article describes the tractor-related responses from participants in a population-based study conducted in Keokuk County, Iowa. This study was designed to measure rural and agricultural adverse health and injury outcomes and their respective risk factors. Questionnaires were partially developed from well-documented national surveys. Questions about agricultural machinery use, presence of safety equipment on the machinery, work practices, and attitudes about farm safety were included. Study participants on farms who owned tractors had an average of 3.1 tractors with an average age of 27 years. Only 39% of the 665 tractors had ROPS. Tractor age was associated with the presence of ROPS; 84% of tractors manufactured after 1984 were ROPS-equipped, whereas only 3% of tractors manufactured before 1960 were ROPS-equipped. ROPS-equipped tractors were significantly more common on larger farms and households with higher income. Only 4% of the farmers reported that their tractors had seatbelts and they wore them when operating their tractors. The results of this study support the findings of other studies, which indicate that many older tractors without ROPS and seatbelts remain in use in American agriculture. Until a dramatic reduction in the number of tractors in the U.S. operated without ROPS and seatbelts is achieved, the annual incidence of 120 to 130 deaths associated with tractor overturns will persist.

Exposure of commercial pesticide applicators to the herbicide alachlor.

Presented in this paper are the results of a pilot study to estimate the alachlor inhalation (2-chloro-2',6'-diethyl-N-[methoxymethyl] acetanilide) and skin exposures of commercial pesticide applicators, who apply a variety of herbicides and insecticides to crop land. Twenty applicators and seven hauler-mixers participated in the study. Inhalation exposures ranged from 0.32 to 6.4 micrograms/m3, with a geometric mean of 1.6 micrograms/m3. Alachlor deposition on clothing patches was highly variable, ranging from < 0.01 to 32.0 micrograms/cm2. The thigh patches generally received more deposition than patches in other areas. Surface-wipe and hand- and glove-wash samples also indicated that the hands frequently were exposed; alachlor concentrations in postshift handwash samples ranged from 3 to 324 micrograms/sample. The results of the study indicate that commercial pesticide applicators encounter substantial exposures to alachlor and that proper precautions for reducing exposures are not always followed. Practical steps, in particular the use of good work practices, may be taken to reduce exposures in this population.

Application of a pilot study to the development of an industrial hygiene sampling strategy.

An industrial hygiene pilot study was conducted to estimate the concentrations of respirable dust likely to be encountered during the personal sampling phase of a large-scale morbidity study of the portland cement industry. An analysis of the pilot study data showed little variability in exposure for subjects working in the same job in the same area of the same plant. Thus, one could estimate mean exposure by sampling several subjects rather than sampling the same subject several times. It was concluded that for statistical considerations, the best approach would be to sample four jobs per area and six subjects per job. Practical considerations required one more often to select six jobs with two subjects per job, however. Overall, the collection of fewer samples was required during the morbidity study than was anticipated originally. In turn, the reduction in the number of samples to be collected resulted in a savings of time and resources.

Estimating historical exposures of workers in a beryllium manufacturing plant.

BACKGROUND: Beryllium is known to be toxic to the lungs, causing beryllium lung disease and associated with increased lung cancer risk. Airborne beryllium exposures have been monitored since the 1940s. This study describes methods used to measure airborne beryllium concentrations and how historical measurements from a beryllium manufacturing plant were used to estimate workers' exposures in a lung cancer case-control study. METHODS: Airborne beryllium concentrations had been measured using all-glass impingers, high-volume air filters, and personal respirable and total dust samplers. To provide consistency in exposure estimates over time, measurements collected by the other monitoring methods were converted to approximate the most frequently used high-volume, time-weighted average measurements. Because industrial hygiene measurements were not collected in every year for all jobs throughout the duration of the case-control study, exposure estimates had to be extrapolated from the existing measurements over time and across jobs. RESULTS: Over 7,000 historical measurements were available to estimate beryllium exposures of workers over time. Average exposures between jobs varied considerably and exposures for all jobs decreased dramatically between the 1940s and 1970s due to major plant production changes. CONCLUSIONS: Although error in the exposure metrics for the cases and controls likely occurred due to limitations of the exposure assessment data, the exposure estimates for each job over time provided a reasonable, objective mechanism for categorizing workers by the relative exposures they were likely to have encountered during their tenure. Published 2001 Wiley-Liss, Inc.

Prevalence of radiographic appearance of pneumoconiosis in an unexposed blue collar population.

Blue collar employees currently working in environments free from exposure to respiratory hazards were examined with chest radiography and a standard occupational history questionnaire. Workers who had worked for a total of 5 yr or more in previous jobs with possible hazardous respiratory exposures were excluded. Each radiograph was read independently by 3 NIOSH-certified "B" readers. For small opacities, the median profusion was accepted as a summary reading. The 1,422 readable films represented a population of 50.6% males, 49.4% females, 52.5% whites, 44.2% blacks, 47.0% current smokers, and 38.5% nonsmokers. The mean age was 33.8 yr, with a range from 16 to 70 yr. Small opacities of profusion greater than or equal to 1/0 were identified in only 3 (0.21%) of the radiographs--2 with small rounded opacities and 1 with small irregular opacities. Small irregular opacities of profusion category greater than or equal to 0/1 were statistically associated with age, gender, and pack-years of smoking. The results suggest that using the median of 3 independent readings should rarely result in interpretation of chest radiographs as "positive" for pneumoconiosis in active workers who have not had significant dust exposure.

Historical respirable quartz exposures of industrial sand workers: 1946-1996.

BACKGROUND: Besides a clear relationship to silicosis, crystalline silica-quartz-has been associated with lung cancer, nonmalignant renal disease, and auto-immune disease. To study diseases associated with crystalline silica further, NIOSH conducted a cohort mortality study of workers from 18 silica sand plants, which had quarry, crushing, and bagging operations to produce industrial sand. Twelve of these plants also had grinding mills to produce fine silica powder. The historical crystalline silica exposures of workers at these plants were estimated to facilitate exposure-response analyses in the epidemiologic study. METHODS: NIOSH obtained personal respirable dust measurement records from Mine Safety and Health Administration (MSHA) compliance inspections at all 18 plants and from the archives of seven plants which had collected samples. These samples had been analyzed for quartz content by x-ray diffraction. Although no personal samples were available before 1974, impinger dust measurements were reported for 19 silica sand plants in 1946; these data were converted and used to estimate exposures prior to 1974. Statistical modeling of the samples was used to estimate quartz exposure concentrations for workers in plant-job-year categories from the 1930s when mortality follow-up of the cohort began until 1988 when follow-up stopped. RESULTS: Between 1974 and 1996, there were 4,269 respirable dust samples collected at these 18 plants. The geometric mean quartz concentration was 25.9 microg/m(3) (GSD = 10.9) with a range from less than 1 to 11,700 microg/m(3). Samples below 1 microg/m(3) were given a value of 0.5 microg/m(3). Over one-third of the samples -37%) exceeded the MSHA permissible exposure limit value for quartz (PEL = 10 mg/m(3)/(%quartz + 2)) and half (51%) of the samples exceeded the NIOSH recommended exposure limit (REL=50 microg/m(3)). The samples were collected from workers performing 143 jobs within the 18 plants, but too few samples were collected from many of the jobs to make accurate estimates. Therefore, samples were combined into 10 categories of jobs performing similar tasks or located within the same plant area. CONCLUSIONS: The quartz concentrations varied significantly by plant, job, and year. Quartz concentrations decreased over time, with measurements collected in the 1970s significantly greater than those collected later. The modeled exposure estimates improve upon duration of employment as an estimate of cumulative exposure and reduce exposure misclassification due to variation in quartz levels between plants, jobs, and over time. Am. J. Ind. Med. 38:389-398, 2000. Published 2000 Wiley-Liss, Inc.

Biological monitoring of commercial pesticide applicators for urine metabolites of the herbicide alachlor.

Alachlor (2-chloro-2',6'-diethyl-N-[methoxymethyl] acetanilide), the active ingredient in several trade name herbicides, is absorbed through the skin and readily excreted in the urine as conjugated metabolites. This paper presents the results of a study to measure alachlor metabolites in the urine of commercial pesticide applicators who were applying alachlor to corn and soybean crops under normal work conditions. Three spot urine samples, collected at the beginning and end of the work shift and the morning after the exposure survey, were collected from 20 applicators, 7 hauler-mixers, and 8 controls. Each sample was analyzed using both a competitive, solid-phase, enzyme-linked immunoassay (ELISA) and a high-performance liquid chromatography (HPLC) technique. Although the urine metabolite concentrations measured by ELISA were consistently higher than the respective HPLC measurements, a high correlation (r = 0.90) was observed between the ELISA and HPLC measurements. The controls, with little exposure to alachlor, had metabolite levels below or near the lower limits of detection for each analysis technique. Similar urine metabolite concentrations were observed for the applicators and hauler-mixers, suggesting similar work exposures. The average postexposure urine concentrations were not correlated with the amount of alachlor handled and applied, suggesting that other factors, such as work practices, are greater determinants of absorbed doses of alachlor.

Lung cancer case-control study of beryllium workers.

BACKGROUND: Cohort mortality studies have found elevated lung cancer mortality among beryllium-exposed workers, but none evaluated the association between beryllium exposure level and lung cancer risk. A nested case-control study of lung cancer within a beryllium processing plant was conducted to investigate the relationship between level of beryllium exposure and lung cancer. METHODS: Lung cancer cases were identified by mortality follow-up through 1992 of a cohort of male workers at a beryllium alloy production plant. Each of 142 lung cancer cases was age-race-matched to five controls. Calendar-time-specific beryllium exposure estimates were made for every job in the plant and were used to estimate workers' cumulative, average, and maximum exposures. The potential confounding effects of smoking were also evaluated. RESULTS: Lung cancer cases had shorter tenures and lower lifetime cumulative beryllium exposures than controls, but higher average and maximum exposures. However, after applying a 10- and 20-year lag, exposure metrics were higher for cases. Odds ratios in analyses lagged 20 years were significantly elevated for those with higher exposure compared to the lowest exposure category. Significant positive trends were seen with the log of the exposure metrics. Smoking did not appear to confound exposure-response analyses. CONCLUSION: Increased lung cancer among workers with higher lagged beryllium exposures and lack of evidence for confounding by cigarette smoking, provide further evidence that beryllium is a human lung carcinogen. Published 2001 Wiley-Liss, Inc.