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Winthrop
Community Health Survey Winthrop
Environmental Health Facts Subcommittee (Winthrop
Airport Hazards Committee) Winthrop
Board of Health AIR
Brian Dumser, PhD, CIH Chair
of the Subcommittee August
18, 1999 Click on
Underlined Elements in the
following table to jump to a section of the report.
Summary
In many communities located close to major airports,
power generation facilities, or other major industries, there is a
strong perception that pollution generating activities at these
facilities result in a direct negative impact on the health of
residents. Statements to this effect have been repeatedly voiced by
representatives of the communities surrounding Logan airport, but,
absent hard data in the existing record, no action has been taken by
responsible authorities to investigate further.
Currently, plans are underway for the construction of additional
facilities Logan airport which will markedly increase operational
capacity and the generation of pollutants.
<XR1> While potent arguments in favor of this expansion are being
presented from an economic standpoint, once again no consideration is
being given to the possible public health impact. In light of the failure to address this issue by
Massport, or by Federal or State regulatory authorities, the Winthrop
Environmental Health Facts Subcommittee, a voluntary group made up of
residents of the Town of Winthrop Massachusetts, elected to address the
question directly. <XR2>
A strong
correlation is known to exist between exposure to petrochemical exhaust
emissions and a variety of respiratory and cardiovascular diseases (1-10).
Logan airport estimates its daily production of such pollutants
at approximately 50,000 pounds per day (11). The Subcommittee undertook
a survey to determine whether a correlation also exists between
frequency and severity of respiratory disease and level of exposure to
these pollutants as determined by location in Winthrop relative to the
airport. Return to Health Study Directory The
results of this survey demonstrate that a clear increase in several
respiratory diseases and disease symptoms exists between areas of the
Town which are adjacent to the airport, and those more distantly located
on Broad Sound. <XR5>In fact, for the most common respiratory diseases, asthma and allergy, disease is
twice as common in the most heavily exposed neighborhood as it is in the
least exposed. <XR3>
Finding
no other likely explanation for this effect, the Subcommittee proposes
that airport activities, most likely the generation of airborne
pollution from the combustion of gasoline and kerosene, are indeed
negatively affecting the health of the residents of Winthrop. The implications of these findings are serious.
While the unique geography and demographics of Winthrop provided
a situation where the effects of airport generated pollution could be
studied in isolation from other pollutant sources, <XR4>
Winthrop is by no
means the only community impacted, nor the community most highly
impacted by airport activity-generated emissions. As sample size
determines the sensitivity of the analysis, only the most frequently
occurring respiratory diseases could be adequately tested.
<XR12> Thus, while the case can be made strongly for asthma and
allergenic disease, effects on other less common serious or
life-threatening respiratory and cardiopulmonary conditions which are
also linked to fuel exhaust exposure remain an unexplored possibility.
Finally, Return to Health Study Directory Summary: State's Follow-Up Duties <XR11> In brief, the study demonstrates
that serious damage is being done to the health of the residents
of Winthrop at current levels of airport activity, and this damage
correlates with location, a measure of exposure to airport
activity-generated pollution. The Subcommittee feels it is incumbent on State regulatory
authorities responsible for the public health to further investigate
this matter, to further define the scope and severity of the problem,
and initiate processes which will return our community to the state of
health enjoyed by the majority of Massachusetts citizens. Return to Health Study Directory Introduction
Winthrop, by contrast, is a stable, mature
residential community without significant pollution sources except for
the airport. Despite this
fact, asthma incidence in Winthrop closely mirrors that in the mainland
communities which abut the airport, and <XR9>
lung cancer rates for females is
50% higher than the statewide average (14).
Some neighborhoods in Winthrop are located within a few hundred
feet of major airport runways, while others are located as much as a
mile and a half away. Residents
report a marked difference in perception of chemical odors from the
airport in relation to location in the Town, indicating that different
levels of exposure occur within the Town resulting from distance from
the airport and wind direction. In
consideration of these facts, this study was conducted to determine
whether any correlation exists between the level of exposure to air
pollutants generated by airport activity and the incidence of and
frequency of symptoms to respiratory disease.
Methods
The Town was divided into 10 neighborhoods, primarily
on the basis of natural topography, containing between 1,000
and 2,500 residents each. Two
neighborhoods were selected as likely
representing areas of highest (#1, Court Road, and #2, Cottage
Park), and lowest (#5, Winthrop Beach, and #6, Winthrop Highlands)
exposure. A questionnaire
was devised, consisting of 30 questions to obtain information on the
incidence of diagnosed asthma, allergies, chronic bronchitis, chronic
sinusitis, and emphysema, and on the frequency of symptoms experienced.
Standard demographic information was also obtained on gender,
age, and the duration of residence in the neighborhood.
A smoking history was obtained, and information on the frequency
of perception of odors caused by airport-related activities.
Responses to questions on diagnosed disease incidence were
yes/no, followed by a question on time since onset.
Responses to questions on symptom frequency included none and
either 4 or 5 frequency ranges.
Interviews were conducted by volunteers from the
community who were trained in requirements for objective data
collection, chain-of-custody, and anonymity requirements.
Interviews were conducted 4 weekday evenings per week, between
the hours of 6:30 and 8:30 PM. Team
leaders assigned streets to the interviewers.
Every residence in the neighborhood was approached, one time
only, until the entire neighborhood was canvassed.
All residences, single and multiple family dwellings and
apartment complexes were sampled, with the exception of mechanically
ventilated buildings. No
commercial establishments were encountered in the zones polled. In this
manner, a random sample of residents was polled which averaged
approximately 18% of the population of the selected neighborhood.
The only exception to this was neighborhood 5, the last area
sampled. Activity was continued in this area, progressing from north
to south, until the desired quota of 500 interviews each in low and high
exposure areas was obtained. Each
questionnaire was identified only by neighborhood, and no names or
addresses were collected. The
questionnaires were collected each evening and held centrally.
Following data entry, the database was screened to
exclude unsuitable responses. Corrections
were made to the database where possible, for example intelligible but
non-numerical responses. Questionnaires
with critical data missing or internally contradictory responses were
excluded. Data was also
discarded for individuals residing in the identified zone for less than
one year, or who were not in residence for at least four days per week.
All such changes were recorded.
Of the 1000 questionnaires obtained, 838 were admissible, 430
from the high-exposure zone (Area 1 - 172;
Area 2 - 258) and 408 from the low-exposure zone (Area 5 - 197;
Area 6 - 211).
In light of the seriousness of the effects on human
health, and the truncated timetable presented by airport expansion
activities, simplified exploratory statistical analyses were first
carried out by excluding from the data all individuals not smoke-free
for the past five years. Data
from high exposure (areas 1 and 2) and low exposure (areas 5 and 6)
zones were pooled, and symptom frequency compared by chi-squared
contingency analysis. The
results of this analysis formed the basis for an earlier report which
was presented by the Caucus on Air Transportation to representatives of
the state government July 1, 1999.
While that approach provided a convincing and
statistically significant demonstration of the differential effect of
location on disease incidence, the dataset contains more information
which can be accessed by more sophisticated analyses.
To this end, the Subcommittee contracted the services of an
epidemiological analytical firm, John Snow Inc., to further analyze the
data. SAS software was
employed to re-incorporate smokers into the study, correcting for
smoking history, age and sex by means of the Mantel-Haenszel Test.
Additional statistical analyses were performed with Epi Info V6
(15). Further, it was noted
that while low-exposure zones 5 and 6 were essentially equivalent, high
exposure zones 1 and 2 showed a differential from one another which was
consistent with position relative to the airport.
Contingency analysis was thus carried out for each of these zones
separately, compared to the joined low-exposure population 5 and 6.
The complete set of statistical analyses, identification and
criteria for data exclusion, complete and amended datasets, and original
survey questionnaires are on file with the Winthrop Board of Health.
Return to Health Study Directory
Results
Results Table 1: Frequency of Odor Perception Table
1. Frequency
of Odor Perception %
Response on Scale 0 - 100 (Days/Year)
Return to Health Study Directory
Results Table 2: Area 1 vs. Low Exposure Areas 5+6 Table
2. Relative
Risk High
Exposure Area 1 vs Pooled Low Exposure Zone (Areas 5 + 6) Total
Sample Size - 580
Results Table 3: Area 2 vs. Areas 5+6 Table
3. Relative
Risk High
Exposure Area 2 vs Pooled Low Exposure Zone (Areas 5 + 6) Total
Sample Size - 666
** Relative Risk is the
proportionate increase (or decrease) in disease incidence in the high
exposure area compared to the low exposure area, adjusted for influences
due to the age, sex and smoking history as estimated by the Mantel-Haenszel
procedure.
** p value is the likelihood
that the values obtained in the high and low exposure zones come from
the same population and differences are due simply to random variation. Return to Health Study Directory
The results clearly show that a differential increase in respiratory disease occurs from the low exposure zones (area 5 and 6) through the moderately exposed area 2 to the highly exposed Court Road area 1. The statistical significance is absent for the infrequent conditions chronic bronchitis and emphysema, though a positive trend is still evident. Chronic sinusitis shows a strong correlation with the most highly exposed area. <XR16>For the more common diseases, allergies and asthma, statistical significance of the correlation with location is extremely strong for the most highly exposed area 1; while less strong for the more moderately exposed area 2, the trend is well maintained. (Ed. Note. Slight change made to preceding sentence 11-11-01.)
Results Table 4: Disease Incidence; Clinically Diagnosed, Self-Reported Table
4. Disease
Incidence; Clinically Diagnosed, Self-Reported Most
Likely Estimate, 95% Confidence Limits
Return to Health Study Directory
Results Table 5: Predicted Excess Disease in High Exposure Areas Table
5. Predicted
Excess Disease in High Exposure Areas
Results Table 6: Frequency of Respiratory Symptoms Table
6. Frequency
of Respiratory Symptoms %
Response in Scale 0 - 100
Go To Discussion: Symptom Frequency; Table 6,7 Referral Return to Health Study Directory
Results Table 7: Percent of Respondents Symptomatic At Any Level (Irritation and Lung Function) Table
7. Percent
of Respondents Symptomatic At Any Level Restricted
Lung Function (Inhaler Use, Asthma Attack, Wheezing) and Bronchonasal
Irritation (Cough, Rhinitis)
Go To Discussion: Symptom Frequency; Table 6,7 Referral Return to Health Study Directory Discussion: Spatial Location Influence Discussion The primary goal of this study was to determine
whether spatial location relative to Logan airport, as a determinant of
chemical exposure, has an influence on respiratory disease in the Town
of Winthrop. While the
exact component or mixture of components responsible for the effect is
as yet unclear, it has been well established in the literature that
exposure to pyrolysis products of fossil fuels correlates strongly with
both incidence of and symptomatic response for several important
respiratory diseases. In the majority of urban settings, multiple sources of such
pollutants make it difficult or impossible to identify the impact of
individual polluters. Winthrop,
a residential community occupying a peninsula in Massachusetts Bay, has
no major local petrochemical pollution sources with the exception of
Logan airport. While
generalized airborne pollution from nearby Boston and its suburbs no
doubt contributes to the burden, such effects are sufficiently distant
as to be well-mixed, affecting the Town equally.
Logan airport by contrast approaches within a few hundred yards
of portions of the Town. Residents
report a very distinct geographical pattern of odor perception of burned
and unburned kerosene (Jet Fuel A) and burning rubber from airplane
tires. Other neighborhoods
within the Town are more remote and less plagued by this problem.
We thus conducted a survey to determine if there existed a
correlation between spatial location and odor perception, as an index of
chemical exposure, and both frequency of diagnosed respiratory disease,
and prevalence of symptoms to that disease as an indicator of negative
health impact. Return to Health Study Directory Discussion: Odor Perception/Exposure Level - MassPort Model Odor
Perception / Exposure Level A central component of the argument put forward in
this report is that spatial location within the Town of Winthrop
relative to the airport is an adequate determinant of exposure to
airport-activity generated pollutants.
While anecdotal reports regarding the perception of fuel and
burnt rubber odors from residents support the contention, and epicenters
of the sampled neighborhoods are approximately 0.4 miles (area 1), 0.8
miles (area 2) and 1.5 miles (areas 5 and 6) from runways, direct
correlation of location/exposure level is lacking.
Actual pollutant concentration in these areas is unknown, as no
monitoring is carried out. In lieu of direct measurement, Massport carries out
mathematical dispersion modeling of
several important components of fuel and fuel exhaust (Carbon Monoxide,
Nitrogen Dioxide, Volatile Organic Compounds, and Particles of diameter
10 �m. or less). Three
sites in the Massport projection grid correspond very closely to the
areas sampled in this study. Exact
matches are found for area 1 (Court Road) and area 2 (Cottage Park),
areas in close proximity to the airport.
In addition, area 6 forms its northern border with the Massport
projection area Revere Beach. <XR13>
Although Logan
carries out no air pollution monitoring in the surrounding communities,(16).
Massport�s model predicts uniform particulate concentrations at
all three sites, and an increase in combustion gases of approximately
10% at the Court Road site, with equivalent concentrations at both
Cottage Park and Revere Beach. Concentrations
of Volatile Organic Compounds, which comprise the fraction responsible
for the noticeable odor, show a wider latitude of dispersion.
Concentrations at Court Road are approximately double that
predicted at Revere Beach. The
difference in concentration between Court Road (area 1) and Cottage Park
(area 2) varies from about 20% (highest peak value in 1 hour) to about
90% (highest peak value in 24 hours). Return to Health Study Directory
Direct evidence of
this differential local concentration was sought in the survey.
Frequency of perception of fuel and rubber odors was sampled in
each neighborhood, and the responses converted to an approximately
linear scale from 0 (never) to 100 (two or more times per week).
Results (Table
1) were consistent with spatial location, with mean scores ranging
from approximately 30 in zones 5 and 6 to 60 and 69 in zones 2 and 1.
Median scores were 0 (never) in zone 5, 12 (once per month) in
zone 6, 50 (once per week) in zone 2 and 100 (two or more times per
week) in zone 1. While it
is clear that only direct monitoring can establish actual and relative
concentrations of these pollutants, sufficient information has been
presented here to justify the classifications of low (areas 5 and 6),
moderate (area 2) and high exposure (area 1).
Disease
Incidence.
Discussion: Disease Incidence Table 3,4 Referral <XR10> Tables
3 and 4 show that a very clear increase in diagnosed disease exists
in the neighborhoods in close proximity to the airport relative to the
more remote locations. Further,
while areas 1 and 2 are contiguous, the epicenter of area 2 is
approximately twice the distance from the airport as that of area 1.
Relative risks were calculated, controlling for possible
confounding variables of sex, age and smoking history.
In fact, all four neighborhoods are demographically very similar,
and little effect of these variables was noted.
Estimates of the reliability of the predicted
relative risks, as indicated by the p values, are influenced both
by the magnitude of the difference and
the frequency of the disease in the population.
<XR17>For the three most prevalent conditions, allergy, asthma, and
chronic sinusitis, the existence of a clear increase in frequency with
position closer to the airport is striking.
Further, the size of the difference is also impressive.
For allergy and asthma, the most highly exposed population
experiences a two-fold increase in disease incidence compared to the
least exposed neighborhoods. Return to Health Study Directory As mentioned above,
these incident rates (Table 4) are a reasonable estimate of the level of
diagnosed disease in the sample group, although they should not be
compared to other studies which are primarily based on hospitalization
rate or mortality. The rates presented here are consistent throughout the
population under study, and appropriate for analysis of
spatially-located differences in disease rate among the subgroups of
that population. They do however include historical cases, and well-controlled
or other asymptomatic conditions which would not appear for example in
the Massachusetts Disease Registry.
However, they do represent negative impacts on the health of the
community, and to place these figures in a more human context,
predictions on the effects of this differential are presented in Table
4. This estimates that, in
areas 1 and 2, contiguous neighborhoods with a combined population of
about 3200 people, there are 220 individuals with asthma, 435 with
allergies, and 131 with chronic sinusitis whose condition is correlated
with their location relative to Logan airport.
Discussion: Symptom Frequency - Table 6,7 Referral Symptom
frequency
In contrast to the clear differences demonstrated for
disease incidence, symptom frequency presents a much more complex
picture. Table
6 illustrates symptom frequency for the five diseases sampled in
each zone, as mean values within an approximately linear scale from 0 to
100. Results are highly
variable, and overall scores low due to the high percentage in each
group of asymptomatic respondents. It is probable that the sample size
employed is insufficient to adequately characterize differences in the
much smaller symptomatic subset, and the results should be regarded as
inconclusive. The results
reinforce rather than contradict data presented on disease incidence
distribution however. If
the responses are recast as binary elements (Table
7). Symptomatic vs
Asymptomatic, grouped by functional pathology) a differential of
approximately 50% again emerges between the pooled high exposure and low
exposure zones. Return
to Health Study Directory Health Study References References:
1
Abbey DE, Ostro BE, Petersen F, Burchette RJ.
Chronic respiratory symptoms associated with estimated long-term
ambient concentrations of fine particulates less than 2.5 microns in
aerodynamic diameter (PM2.5) and other air pollutants.
J Expo Anal Environ Epidemiol 1995 5: (2) 137-159
2
Bhatia R, Lopipero P, SmithAH
Diesel Exhaust Exposure and Lung Cancer.
Epidemiology 1997: 8 : 364
3
Brunekreef B, Janssen
NAH, de Hartog J, Harssema
H, Knape M, van Vliet P Air
Pollution from Truck Traffic and Lung Function in Children Living
near Motorways. Epidemiology 1997; 8 : 298
4
Dockery DW, Pope CA III, Xiphing X, Spengler JD, Ware JH, Fay ME,
Ferris BG, Speizer FE. An association between air pollution and mortality in six US
cities. New England Journal
of Medicine, 1993 329: (24)
1753-1760
5
Duhme H, Weiland SK, Keil
U, Kraemer K, Schmid M, Stender
M, Chambless L The
Association between Self-Reported Symptoms of Asthma and Allergic
Rhinitis and Self-Reported Traffic Density on Street of Residence in
Adolescents. Epidemiology
1996;7:578�582
6
LoomisD, Castillejos M, Gold DR, McDonnell W, Borja-Aburto VH Air
Pollution and Infant Mortality in Mexico City.
Epidemiology 1999; 10: 118
7
Moolgavkar SH, Luebeck EG, Anderson EL
Air Pollution and Hospital Admissions for Respiratory Causes in
Minneapolis-St. Paul and Birmingham
Epidemiology 1997: 8: 364
8
Schwartz J Air Pollution and Hospital Admissions for
Cardiovascular Disease in Tucson. Epidemiology 1997; 8 : 371
9
Sheppard L, Levy D, Norris G,
Larson TV, Koenig JQ
Effects of Ambient Air Pollution on Nonelderly Asthma Hospital
Admissions in Seattle, Washington, 1987-1994 Epidemiology 1999; 10: 225
10
Verhoeff A, Hoek G, Schwartz J, van
Wijnen JH Air
Pollution and Daily Mortality in Amsterdam
Epidemiology 1996; 7: 225 �230
11
Logan Airside Improvements Planning Project Volume IV 1999 EOEA
#10458
12
Boston Neighborhood Health Status Report: The Health of South
Boston. Boston Department
of Health and Hospitals, Division of Public Health, Office of Research
and Health Statistics. November
1994
13
The Health of Boston 1998. Boston
Public Health Commission, Office of Research, Health Assessment and Data
Systems, Boston Massachusetts 1998
14
Massachusetts Community Information Health Profile, Massachusetts
Department of Public Health, Bureau of Health Statistics and Evaluation,
Boston Masachusetts.
15
Dean AG, Dean JA, Coulombier D, Brendel KA, Smith DC, Burton AH,
Dicker, RC, Sullivan K, Fagan, RF, Arner, TG.
Epi Info Version 6: a word processing, database and statistics
program for public health on IBM-compatible microcomputers.
Centers for Disease Control and Prevention, Atlanta, Georgia,
USA, 1996
16
<XR14>
Beychok MR. Error Propagation in Air Dispersion Modeling.
Newport Beach CA
People Who Conducted The Survey Winthrop
Environmental Health Facts Subcommittee Members
of the Subcommittee Conducting the Survey
Barbara
Bishop Madeline
Burke Brian
Dumser Eleanor
Casey Greg
Curci John
Dowd Arthur
Flavin, Sr. Barbara
Corbett Flavin Connie
Mara John
Marcy Harvey
Maibor Bob
Massa Kathleen
Mccauley Ellie
Olivolo Judith
Silck Claire
Sweeney Winthrop Health Study Questionnaire Response Sheet
1.
Sex:
0 Male
1 Female.
2.
Age:
0 1
2 3
4 5
3 Current Residence: 0 1 2 3 4 5 6 7 8 9
C
Number of years:
0 1
2 3
4 5
6 7
8 9
C
Former Residence:
0 1
2 3
4 5
6 7
8 9
C
Number of years:
0 1
2 3
4 5
6 7
8 9
C
Former Residence
0 1
2 3
4 5
6 7
8 9
C
Number of years:
0 1
2 3
4 5
6 7
8 9
9 Smoking 0 Yes 1 No
10 Packs per day 0 - Less than 1 1 - 1 2 - 1 � 3 - 2 4 - More than 2
11 Quit 0 Yes 1 No
12 Smoke-Free 0 1 2 3 4 5 6 7 8 9
13 Days/Week Away 0 1 2 3 4 5 6 7
14 Local employment 0 Yes 1 No
15 Allergies 0 Yes 1 No
16 How Long? 0 Less than 1 year 1 1-5 years 2 6-10 years 3 More than 10 years
17 Asthma 0 Yes 1 No
18 How Long? 0 Less than 1 year 1 1-5 years 2 6-10 years 3 More than 10 years
19 Chronic Bronchitis 0 Yes 1 No
20 How Long? 0 Less than 1 year 1 1-5 years 2 6-10 years 3 More than 10 years
21 Emphysema 0 Yes 1 No
22 How Long? 0 Less than 1 year 1 1-5 years 2 6-10 years 3 More than 10 years
23 Sinusitis 0 Yes 1 No
24 How Long? 0 Less than 1 year 1 1-5 years 2 6-10 years 3 More than 10 years
25 Inhaler Use 0 Once a month 1 Once a week 2 2 or more times per week 3 Once a day 4 2 or 3 times a day 5 More than 3 times a day
26 Asthma Attack 0 Once a month 1 Once a week 2 2 or more times per week 3 Once a day 4 2 or 3 times a day 5 More than 3 times a day
27 Wheezing or Shortness of Breath? 0 Once a month 1 Once a week 2 2 or more times per week 3 Once a day 4 2 or 3 times a day 5 More than 3 times a day
28 Coughing Spells? 0 Once a year 1 Once a month 2 2 or more times per month 3 Once a week 4 More than once a week
29 Runny Nose, Tearing Eyes, Sinus Headache? 0 Once a year 1 Once a month 2 2 or more times per month 3 Once a week 4 More than once a week
30 Exhaust, Chemical or Fuel Odors? 0 Once a year 1 Once a month 2 2 or more times per month 3 Once a week
4
More than once a week
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