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Occupational and environmental exposure to organochlorine compounds in a coastal British Columbia community Teschke, Kay; Marion, Stephen A.; Jin, Andrew 1996

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    Occupational & Environmental Exposure  to Organochlorine Compounds  in a Coastal British Columbia Community  Final Report of Phase 1  Questionnaire Survey of Three Groups  ?  Native Band Members ?  Pulp, Paper, and Sawmill Employees ?  Other Community Residents                       July 1996  by Kay Teschke, PhD, CIH; Stephen A. Marion, MD, FRCPC; Andrew Jin, MD, MHSc  Department of Health Care and Epidemiology University of British Columbia Vancouver, BC V6T 1Z3 Canada Summary    This report presents the results of the first phase of a study examining the occupational and environmental exposures of residents of a coastal British Columbia community to organochlorine compounds.      Phase 1 involved a questionnaire survey of members of three community groups:  native reserve residents (N=78); pulp, paper, and sawmill employees (N=84); and other community residents (N=80).  They were questioned about their diets, in particular consumption of seafood, game, and wild plants, their occupational histories, their duration of residence in the community, and other personal and demographic factors.  The main purpose was to determine whether their occupations and diets presented differences in organochlorine exposure opportunities.    The results indicated that, as expected, the pulp, paper, and sawmill employees (almost all men) had more potential for occupational exposures, mainly through work in or downstream of the bleach plant in the pulp mill, or work with chlorophenate fungicides in the sawmill.  Other community residents had also held jobs with potential for exposure, though to a lesser extent.  For example, native men were frequently employed in logging and silviculture, where pesticide exposures might occur.    Native reserve residents did not eat more fish and other seafood as expected, however the types of seafood they consumed did differ from other community residents.  They ate more lingcod eggs, herring and herring eggs, eulachon grease, smoked salmon, clams, oysters, and sea urchins, but less trout, red snapper, cod, halibut, sole, flounder, crab, shrimp, and prawns.  How these differences in patterns of seafood consumption would affect potential for organochlorine exposure is unknown because the relative levels of contamination of these species is unknown.    In order to determine whether these differences in occupation and diet have resulted in differing body burdens of organochlorine compounds, and to determine the relative importance of these exposures to dose, we recommend that the next phase of this study proceed.  Phase 2 would involve taking blood samples from a subset of the survey respondents and analyzing the samples for specific organochlorine compounds.  Acknowledgements    Special thanks to Jody Slakov who was the study coordinator and who conducted many of the interviews as well.  Thanks also to Mia Hillis and Joanna Tom who were the study interviewers.    Laurette Bloomquist, Dr. Sue Crawford, and Pam Winquist provided invaluable advice about the diet portion of the survey.  Laurette Bloomquist, Dr. Ray Copes, Steve Hodges, Jack Nickel, Dr. Jay van Oostdam, and Pam Winquist provided helpful comments on the questionnaire during the design stages.  Mike Hagen kindly provided data from the Dioxin and Furan Trend Monitoring Database.    Representatives of the native band, the mill, the unions, and the local health unit were extremely helpful during the organization and process of this study.     Finally, we are extremely grateful to all the band members, pulp and paper mill employees, and other community residents who gave their time to take part in this survey.  We also thank the volunteers who participated in the questionnaire pretesting.      This study was funded in part by grants from the BC Ministry of Health, the BC Ministry of Environment, the Department of Indian Affairs and Northern Development, Environment Canada, the HEAL Project Committee, and Health Canada.  Table of Contents  1.0   Introduction ......................................................................................................................................................1  2.0  Methods .............................................................................................................................................................3     2.1  Population Sampling........................................................................................................................3   2.2  Subject Recruitment..........................................................................................................................4   2.3  Questionnaire Content and Pretesting.........................................................................................4   2.4  Questionnaire Administration.......................................................................................................5   2.5  Ethical Review and Approval........................................................................................................5   2.6  Statistical Methods............................................................................................................................5  3.0  Results 7 ..............................................................................................................................................................   3.1  Characteristics of the Community Members..............................................................................7     3.1.1  Personal and Demographic Characteristics.................................................................7     3.1.2  Activities and Occupations............................................................................................10     3.1.3  Seafood Consumption ....................................................................................................16     3.1.4  Other Wild Food Consumption....................................................................................23     3.1.5  Other Food Consumption..............................................................................................29     3.1.6  Changes in Eating Patterns Since 1980........................................................................29   3.2  Characteristics of Male Participants Only.................................................................................35     3.2.1  Characteristics of Men in the Community Overall ..................................................35     3.2.2  Personal and Demographic Characteristics...............................................................58     3.2.3  Activities and Occupations among Male Participants.............................................58     3.2.4  Seafood Consumption among Male Participants .....................................................59     3.2.5  Other Wild Food Consumption among Male Participants.....................................60     3.2.6  Other Food Consumption among Male Participants...............................................60     3.2.7  Changes in Eating Patterns Since 1980 among Male Participants ........................61  4.0   Conclusions.....................................................................................................................................................62  5.0   References........................................................................................................................................................64  List of Tables  Table 1:  Survey participation ............................................................................................................................8  Table 2:  Personal and demographic characteristics of survey participants............................................9 Table 3:  Organochlorine exposure history of survey participants....................................................11-12 Table 4:  Occupational history of survey participants..........................................................................13-15 Table 5:  Fish intake of survey participants in 1980...............................................................................17-18 Table 6:  Smoked fish intake of survey participants in 1980......................................................................19 Table 7:  Shellfish intake of survey participants in 1980.......................................................................20-21 Table 8:  Other seafood intake of survey participants in 1980 ..................................................................22 Table 9:  Wild game intake of survey participants in 1980..................................................................24-25 Table 10:  Smoked wild game intake of survey participants in 1980.........................................................26 Table 11:  Wild plant intake of survey participants in 1980...................................................................27-28 Table 12:  Other food intake of survey participants in 1980..................................................................30-33 Table 13:  Changes in food intake of survey participants ............................................................................34  Table 2(M):  Personal and demographic characteristics of male survey participants................................36 Table 3(M):  Organochlorine exposure history of male survey participants..........................................37-38 Table 4(M):  Occupational history of male survey participants................................................................39-41 Table 5(M):  Fish intake of male survey participants in 1980.....................................................................42-43 Table 6(M):  Smoked fish intake of male survey participants in 1980............................................................44 Table 7(M):  Shellfish intake of male survey participants in 1980.............................................................45-46 Table 8(M):  Other seafood intake of male survey participants in 1980 ........................................................47 Table 9(M):  Wild game intake of male survey participants in 1980........................................................48-49 Table 10(M):  Smoked wild game intake of male survey participants in 1980...............................................50 Table 11(M):  Wild plant intake of male survey participants in 1980.........................................................51-52 Table 12(M):  Other food intake of male survey participants in 1980........................................................53-56 Table 13(M):  Changes in food intake of male survey participants ..................................................................57         1 1.0   Introduction    In British Columbia, many economically important industrial activities1 may contribute to increased human exposure to persistent organochlorine compounds2. Human exposure to these pollutants could occur in industrial workplaces, from environmental dispersion into water, air and soil, or through food-chain bioaccumulation [Beck et al, 1989; Fait et al, 1989; Rottluff et al, 1990; Svensson et al, 1991; Sweeney et al, 1990].    We studied a Census Agglomeration community with a population of about 18,000 people (according to the 1991 census). It is located on the coastal mainland of British Columbia about 120 km northwest of Vancouver. The community's largest single employer is an integrated forest products manufacturer which operates a large pulp, paper, and lumber mill with about 1,400 employees. In past years, the mill has produced chlorine-bleached pulp and paper as well as lumber treated with chlorophenates. The mill produces its own steam, much of it from the combustion of wood waste and waste-water sludge. There are logging and silviculture activities outside the city limits. The community has active local commercial, sport, and native fisheries. The latter is conducted by members of an native band (748 registered members as of 31 December 1993) which has a reserve (population 559 persons as of 31 December 1993) bordering on the municipality. Because of the variety of ways in which community residents might have been exposed to persistent organochlorine compounds and to organochlorine pesticides, and because of the generous cooperation of the area's business, labour, municipal and native community leaders, this community is an excellent place to study human exposure to these chemical compounds.     The overall purpose of this study is to determine whether or not persons with occupational history or dietary habits suggestive of potentially increased exposure to persistent organochlorine compounds have increased concentrations of these compounds or their metabolites in their blood. The study is being conducted in two main phases.    Phase 1 was conducted in 1995, and consisted of a questionnaire survey of the demographic characteristics, residential history, occupational history and dietary habits of the community's residents.                                             1  e.g., production of chlorine-bleached pulp and paper, wood treatment with chlorinated   antisapstain fungicides, silviculture, agriculture, and electrical utilities 2  i.e., polychlorinated dibenzo-para-dioxins (dioxins), polychlorinated dibenzofurans (PCDFs),   polychlorinated biphenyls (PCBs), and certain organochlorine pesticides, including tetra- and  pentachlorophenates, 2,4-D, DDT, heptachlor, chlordane, dieldrin, hexachlorobenzene and   hexachlorocyclohexane   2 In Phase 1, we hypothesized that occupational history or dietary habits suggestive of exposure to the chemical compounds of interest might be more prevalent or greater in magnitude in two subgroups of the population: pulp, paper and lumber mill employees, who might come into contact with these chemicals at work; and native persons, who might consume more locally harvested fish and other seafood.     Phase 2 of the study has not yet been carried out. If funded, it would consist of collecting blood specimens from some or all of the questionnaire survey participants, and analyzing the blood specimens for the organochlorine compounds of interest.     The results for Phase 1 of the study are reported here.     3 2.0  Methods  2.1  Population Sampling    The survey's target population consisted of residents of the Census Agglomeration community with birthdates between 1 January 1930 and 31 December 1969 inclusive (i.e., aged 25 to 64 years as of 1 January 1995).  The minimum age would allow about 7 years of employment in a potentially exposed job (approximately one biological half-life for many dioxins and furans [Poiger and Schlatter, 1986]), and the maximum age would be the last year of employment prior to retirement. To ensure sufficient representation of pulp, paper and lumber mill employees (who make up approximately 11% of the population in the target age range) and native persons (about 3% of the target population), we randomly selected persons for the survey in three separate groups.    We selected the first group, pulp, paper and lumber mill employees, from a seniority list of all unionized production, maintenance and service workers currently employed by the mill. One hundred names were initially selected. One person who was no longer an employee was excluded, so a replacement was randomly selected.     We selected the second group, native reserve residents, from a list of names, birthdates and addresses of current members of the native band. We limited the selection to persons with a listed birthdate in the eligible range, and with an address on the band's reserve. We randomly selected the names of 100 persons. One person's correct birthdate was outside the eligible range and so this person was excluded, but no replacement was selected. Had any person selected in this group been a current employee of the pulp/paper/lumber mill, he or she would not have been excluded, but this possibility never occurred.     We selected the third group, other residents of the survey area, from a July 1991 provincial voters list. Within the list, persons were grouped by gender and 5-year age categories. We limited the selection to persons in the age categories corresponding to the eligible age range, and with a listed postal code within the Census Agglomeration but not on the native reserve. We randomly selected the names of 100 persons initially. We excluded one person whose correct birthdate was outside the eligible range and 21 persons who were no longer residents of the Census Agglomeration. We replaced these excluded individuals with others randomly selected in supplemental draws. Any persons selected in this group who were current employees of the pulp/paper/lumber mill were also excluded and replaced; this occurred an unrecorded number of times. Persons of native heritage, persons with Indian Status as defined under the Indian Act of Canada, and members of the local native band were eligible to be in this   4 group, but only if they were not residents of the reserve.   2.2  Subject Recruitment    We mailed each randomly selected person an introductory letter and then contacted individuals by telephone or in person to confirm their eligibility, to explain the study further, and to request participation. Participation was strictly voluntary. No financial reward was offered or given to any survey participant.  2.3  Questionnaire Content and Pretesting    The occupational and residential history sections of the questionnaire were adapted from one used by the US National Cancer Institute (NCI) [Wolf et al, 1987]. Questions were added to query exposures to specific organochlorines known to be associated with work in the forest industry, farming, and other professions.     The diet portion of the questionnaire was mainly directed at the consumption of local fish, shell fish, other seafoods, game meat, and wild fruits. The list of items was originally developed by Pam Winquist of Health Canada in consultation with Laurette Bloomquist from the Sliammon Native Band. Questions about smoking and consumption of other food items, including meats, dairy products, and cereals were adapted from another US NCI Questionnaire [Block, 1989] in consultation with Dr. Sue Crawford, a nutritionist with experience in dietary survey design.     Questions about specific food items asked respondents to report the frequency and quantity consumed during the year 1980. This year was selected to be representative of past consumption, since persistent organochlorines such as dioxins and furans have extremely long biological half-lives and therefore take years to accumulate in the tissues [Poiger and Schlatter, 1986]. We used this style of questioning because we believed that it was the most expeditious way to obtain information about respondents' long-term average intake of specific foods over the past 25 years or more. To aid recall of that era of a person's life, we began by asking respondents to recall who would normally have prepared each of their meals in that era, and to recall a typical meal. Strategies for improving past dietary recall were developed based on literature information [Friedenreich et al, 1992; Friedenreich et al, 1991; McKeown-Eyssen et al, 1986; Sobell et al, 1989; Krall et all, 1988] in consultation with Dr. Crawford.     The questionnaire was sent for review to the study funding contributors and representatives of the study participants. Comments were received from Laurette Bloomquist (Health and Social   5 Development Co-ordinator, Sliammon Indian Band), Dr. Ray Copes (Medical Specialist, BC Ministry of Health), Steve Hodges (Environmental Technologist, MacMillan Bloedel), Jack Nickel (EARP Coordinator, Health Canada), Dr. Jay van Oostdam (Toxicologist, BC Ministry of Environment), and Pam Winquist (Nutritionist, Health Canada).    The questionnaire was pretested in three groups: a convenience sample of 2 individuals from the Vancouver area to check the duration and feasibility of the diet sections of the questionnaire; a convenience sample of 10 individuals from the Vancouver area during the interviewers' training period; and 7 native band members and 7 community residents selected at random from the populations of interest. Changes to the questionnaire were made in response to each of these pretests. A copy of the final questionnaire is attached as an appendix.  2.4  Questionnaire Administration    The questionnaire was administered in person, in a face-to-face interview by one of three interviewers. All interviews were conducted in English. Interviewers showed respondents standard printed lists of chemical names to help them recall exposures to certain chlorinated organic chemicals. Interviewers showed respondents standard-sized vessels (bowl: 400 mL, plastic foodsaver container: 400 mL, plastic foodsaver lid: 20 mL, drinking glass: 250 mL, tablespoon: 15 mL) to help them estimate sizes of food servings. The weights and heights of study participants were measured at the interview sites.  2.5  Ethical Review and Approval    Before the start of the survey, our proposed research methods received ethical review and approval from the University of British Columbia Behavioural Sciences Screening Committee for Research and Other Studies Involving Human Subjects.    2.6  Statistical Methods     For purposes of statistical analysis, we considered our three groups (mill employees, reserve residents, and other community residents) to be a single stratified random sample with three strata and oversampling of the two smaller strata (mill employees and reserve residents). For each stratum, the sampling fraction was the number of participants divided by the size of the sampling frame. For the stratum of other community residents, the size of the sampling frame was estimated from Census data [Statistics Canada, 1992], because the list of voters was from 1991 and contained the names of many ineligible persons. For each stratum, we calculated a "stratum weight" equal to the size of the sampling   6 frame divided by the number of participants in each stratum (Table 1). These weights were used to calculate weighted averages describing characteristics of community members over all three strata combined.     However, the main purpose of the study was to compare characteristics between the three groups. For this, we used simple unweighted data. For dichotomous (yes/no) variables, we used ?2 or two-tailed Fisher exact tests for both two-group and three-group comparisons, testing null hypotheses of no association between group membership and a particular variable. For discrete ordinal scale variables and continuous interval-ratio variables we used nonparametric Wilcoxon rank sum tests for two-group comparisons, and nonparametric Kruskal-Wallis tests for three-group comparisons, testing null hypotheses of no difference among the groups in their respective distributions of a particular variable.    Frequency tabulations, calculation of summary statistics and group comparisons were performed using the statistical software package SAS?, Release 6.04 for Personal Computers (SAS Institute Inc., Cary, NC, USA).     7 3.0  Results    Table 1 describes the participation in the study by each of the three groups. In every case the participation ratio (defined as the number of participants divided by the number of eligible persons randomly selected) was high: 84.0% among mill employees; 78.8% among reserve residents; and 79.2% among other residents of the community. The sizes of the eligible study populations (i.e., the sampling frames) and the stratum weights are listed.     Table 1 also indicates the age and gender compositions of the groups. The study participants in each group appear to have ages and proportions of females similar to members of their sampling frames and/or those randomly selected.  The only exception is that more men in the "other community residents" group refused to participate, resulting in a slightly higher proportion of women participants than in the eligible population.   3.1  Characteristics of the Community Members    3.1.1  Personal and Demographic Characteristics    Table 2 describes the personal and demographic characteristics of all the community members combined and each of the three groups separately (mill employees, reserve residents, and other members of the community). The most outstanding difference between the groups is that among the participating mill employees, 98.8% were men, but in the other two groups approximately one-half were men and one-half were women. Because of this disparity in gender composition, in this table and those which follow (Tables 3 to 13), we make no statistical comparisons between mill employees and the other groups. The p-values in Tables 2 through 13 refer to comparisons between reserve residents and other residents of the community.  Results for males only, comparing all three study groups, are described in Section 3.2.    The "All" column of Table 2 indicates that most women in the community had children, and most of these had breast-fed their infants. The average height was 5 feet 7 inches, and the average body mass index was 26.2, slightly higher than the range considered most healthy (20 to 25). Although most community members had smoked cigarettes at one time, only 22% do now. More than three-quarters of the community have lived in houses using wood stoves for heating between 1970 and 1995, for an average of 13 years.  About 20% burned driftwood.  The average duration of continuous residence in the community was 24 years.   8   9   10   In the comparisons of the native reserve residents to other residents of the community, we observed reserve residents to have the following demographic differences from the "other" group (p < 0.05).  They ?  were younger (mean age of 40.9 years vs. 45.8 years in "other" group), ?  had a higher proportion of women who were mothers (95% vs. 75%) ?  were shorter (mean of 65.6 inches vs. 67.2), ?  had a lower proportion of current cigarette smokers (8% vs. 23%), and ?  had a longer duration of residence in the survey area (mean of 30.4 years vs. 23.6).    3.1.2  Activities and Occupations with Potential for Exposures to Organochlorines     Table 3 describes the participants' exposures to certain activities likely to involve organochlorine compounds.  The "All" column indicated that, as would be expected, the most common activities involving potential exposure were employment in pulp and paper production (19% of community members) and in sawmills (18%), but farming was also common (12%).  Very few individuals recalled applying organochlorine pesticides or herbicides, using polychlorinated biphenyls (PCBs), or working at an incinerator.    Study participants listed 1286 jobs, for an average of 5.3 jobs each. The individual job descriptions were grouped into 22 different categories, listed in Table 4.  Most of the job groups refer to jobs in the pulp and paper mill, the lumber mill, or either ("forest products mill"). These jobs groups were the most specific, and they had been held by 2 to 8% of the community members.  Some jobs were grouped based on "industry" ? logging, silviculture, agriculture, other wood products manufacturing, construction, and transportation ? these were held by 5 to 17% of community members. The remaining jobs, held by few people, were categorized in one of two broad groups. "Occupations with exposures to chemicals other than organochlorines" included welders, printers, etc.; 52% of community members had held jobs of this type.  Office and service jobs were grouped as "occupations unlikely to have exposures"; 81% of community members had held jobs of this type.      In the comparisons of the native reserve residents to other residents of the community, we observed reserve residents to have the following occupational differences (p < 0.05): ?  less employment in pulp/paper mill maintenance jobs; ?  less employment as pulp/paper machine operators;  ?  less employment in maintenance jobs involving multiple areas within a forest products mill; ?  more employment in logging; ?  less employment in farming or agriculture/horticulture/landscaping;   11   12   13   14   15   16 ?  less employment in driver/transportation/vehicle service jobs; and ?  less employment in jobs with exposures to chemicals other than organochlorines.    3.1.3  Seafood Consumption    Tables 5 to 8 describe the answers to the seafood portion of diet questionnaire, with Table 5 outlining fish consumption, Table 6 smoked fish consumption, Table 7 shellfish consumption, and Table 8 consumption of other types of seafood, all in the year 1980.  Almost all community members ate fish (96%); the most popular types, salmon, lingcod, and red snapper, were eaten 7 to 24 times a year on average (Table 5).  Some fish were rarely eaten (less than once a year on average):  lingcod roe; tommy cod; herring; smelt; perch; and eulachon.      Somewhat fewer people ate smoked fish (72%, Table 6). Almost all the smoked fish consumed was salmon, eaten 7 times a year on average.  No one reported eating the following fish smoked: red snapper; lingcod; tommy cod; halibut; sole or flounder; herring; smelt; or perch.    Shellfish were eaten by 74% of community members (Table 7).  The most frequently consumed types were prawns, shrimp, butter clams, Dungeness crab meat, oysters, and native clams (eaten 2 to 6 times per year).  No one reported eating sea prunes. Horse clams, geoduck, mussels, and limpets were eaten less than once a year on average.    Few community members ate other seafood (16%, Table 8).  The most frequently reported were seaweed and octopus or squid, but both of these were consumed less than once a year.  No one reported eating seal or sea lion fat or organ meat, or seagull meat.    In Tables 5 through 8, compared to participants in the "other" group, participating native reserve residents were slightly less likely to include fish in their diet (87% versus 96%, p=0.04), and no more or less likely to include smoked fish, shellfish or other seafood in their diet. Compared to participants in the "other" group, we observed participating native reserve residents to have the following differences (p < 0.05) in the types of fish and seafood they consumed. Reserve residents ate  ?  more lingcod eggs, ?  more herring and herring eggs, ?  more eulachon grease, ?  more smoked salmon, ?  more butter clams, Japanese (Manila) clams and native clams,  ?  more oysters,   17   18   19   20   21   22   23 ?  more Mesikw sea urchins, ?  less trout, ?  less red snapper, ?  less grey/black/Alaska cod, ?  less halibut, ?  less sole/flounder, ?  less unspecified other fish, ?  less Dungeness crab meat, and ?  less shrimp and prawns.    3.1.4  Other Wild Food Consumption    Tables 9 to 11 describe consumption of other types of wild foods in the year 1980, with Table 9 describing wild game consumption, Table 10 smoked wild game consumption, and Table 11 wild plant consumption.  Although many community members ate game (47%, Table 9), almost none ate it smoked (1%, Table 10).  The most frequently eaten types of game were deer and moose, both eaten about 11 times per year on average.  Most other types of game were eaten once a year or less often.  No one reported eating organ meat from bears, or mountain goats, or eating beaver or porcupine.    Most community members ate wild plants (83%, Table 11).  The most frequently eaten were blackberries and huckleberries (eaten 3 to 13 times a year).  Most other wild plant foods were eaten less than once a year, and no one reported eating roots.    In Tables 9, 10, and 11, compared to participants in the "other" group, native reserve residents were more likely to include wild game in their diet (76% versus 44%, p<0.0005), but they were no more or less likely to have eaten smoked wild game or wild plants. In their pattern of wild game and plant consumption, native reserve residents were ?  more likely to include deer meat in their diet (76% vs 35%), but on average consumed it less   often and in smaller quantities,  ?  more deer liver/organs, ?  more huckleberries, ?  more salmonberries and salmonberry shoots,  ?  more thimbleberries,  ?  more blackberries, and  ?  more crabapples.    24   25   26   27   28   29   3.1.5  Other Food Consumption    Table 12 reports on consumption of various other foods, typically store bought, in 1980.  The food items selected for this portion of the survey were mainly fat containing and therefore had the potential to be contaminated with organochlorine compounds.      Some of these foods were eaten by community members daily or nearly so:  bread; margarine and cooking oil; 2% milk; and milk or cream in coffee or tea. Many other items were eaten at least once a week: hamburger meat; beef steaks or roasts; ham or lunch meats; French fries; potato chips; other potatoes; rolls, bagels, or crackers; muffins, cakes, or cookies; butter or lard; high fibre cereals; cold cereals; eggs; bacon; cheese; whole milk; ice cream; and canned evaporated milk.  Only one item was eaten by community members less than once a month on average: chicken or beef liver.    In the comparisons of the native reserve residents to other residents of the community, we observed reserve residents to have the following differences in other food consumption patterns for these other foods (p < 0.05): ?  more hamburger meat;  ?  more pork chops/roasts;  ?  more fried chicken;  ?  more hotdogs; ?  more margarine/cooking oil; ?  less beef steaks/roasts;  ?  less roasted/stewed/boiled chicken/turkey; ?  less high fibre cereals; ?  less cold cereals; ?  less potato chips; ?  less potatoes (other than chips or French fries); ?  less bread;  ?  less rolls/bagels/crackers; ?  less cottage cheese; ?  less other cheese; and  ?  less 2% milk.    3.1.6  Changes in Eating Patterns Since 1980    Table 13 indicates the participants' reported changes in consumption of various food groups   30   31   32   33   34   35 since 1980.  More than 50% of community residents did not report changes in consumption of "other" seafood, wild game, wild plants, potatoes, breads and cereals, butter or margarine, or dairy products.  Among those who did report changes in eating habits, there was a trend toward less consumption of fish, meat, potatoes, butter or margarine, bacon and eggs, and dairy products.  Only "other" seafood showed a trend toward greater consumption since 1980.    In the comparisons of the native reserve residents to other residents of the community, natives differed in their changes in food intake in every food category except wild game. For the categories fish, shellfish, other seafood, wild plants, meat, potatoes, bread/cereals, butter/margarine, bacon/eggs, and dairy products, the proportion who had not changed their intake since 1980 was larger in the reserve group than in the "other" group.  For most of these food groups, more than 80% of the native participants had not changed their eating habits.  3.2  Characteristics of Male Participants Only    Tables 2(M) to 13(M) describe the results for male participants only in parallel with those described above in Tables 3 to 13 for all participants. Because in this restricted subsample of participants there is no disparity in gender composition, the reported p-values in Tables 2(M) through 13(M) indicate comparisons among male participants in all three groups: mill employees; reserve residents; and other residents of the community.     3.2.1  Characteristics of Men in the Community Overall    Although no statistical tests were performed, a comparison of the "All" column in Table 2 to the "All Males" column in Table 2(M) indicates that the men were somewhat older, taller, heavier (as indicated by body mass index), and smoked more compared to the community-wide averages.      Tables 3(M) and 4(M), compared to the community averages reported in Tables 3 and 4, indicate that men in the community had more jobs in pulp/paper/lumber milling, logging, silviculture, agriculture, construction, and transportation, as well as more occupations with exposures to chemicals other than organochlorines. Fewer men had held jobs unlikely to have had exposures.      Seafood and wild food consumption among male community members, as reported in Tables 5(M) to 11(M), was very similar to the community averages reported in tables 5 to 11.  The only exceptions were that men ate less sole or flounder, less crab, no crab marrow, less other shellfish, and less seaweed.  There were some differences in other food consumption patterns as indicated in Table 12(M) compared to   36   37   38   39   40   41   42   43   44   45   46   47   48   49   50   51   52   53   54   55   56   57   58 Table 12.  Men in the community tended to eat more of the following foods: beef steak or roast; ham or lunch meats; French fries; potato chips; butter and lard; eggs; bacon; sausage; all forms of milk; and ice cream.  They also had somewhat fewer changes in their diets since 1980 than the community as a whole (comparing tables 13(M) and 13).      Statistical tests were performed to look for differences among males in the three groups:  male mill employees; male native reserve residents; and other male community residents.  The results for each of the elements of the survey are described below, first examining the native reserve residents, then the mill employees.    3.2.2  Personal and Demographic Characteristics of Male Participants     In Table 2(M), compared to participants in the two other groups, we observed participating male native reserve residents to have the following personal and demographic characteristics that were different (p < 0.05). They had ?  the shortest height (mean of 67.7 inches vs. 69.8 in mill employees and 70.6 in the "other" group) but no difference in over/underweight as measured by body mass index, and  ?  the longest duration of residence in the survey area (mean of 33.0 years vs. 26.8 in mill employees and 25.4 in "other" group).    Table 2(M) indicates that participating male pulp/paper/lumber mill employees were very similar to other community residents not employed by the mill.     3.2.3  Activities and Occupations of Male Participants    In Tables 3(M) and 4(M), the comparisons of the male native reserve residents to the other two groups showed reserve residents to have the following occupational differences (p < 0.05): ?  the least employment in any pulp/paper mill job; ?  the least employment in wood treatment jobs;  ?  the least employment in maintenance jobs involving multiple areas within a forest products   mill; ?  the least employment in farming or agriculture/horticulture/landscaping; ?  the least employment in driver/transportation/vehicle service jobs;  ?  the least employment in jobs with exposures to chemicals other than organochlorines; ?  the most employment in logging; and  ?  the most employment in silviculture.   59    In Table 3(M) and 4(M), compared to participants in the two other groups, we observed participating male pulp/paper/lumber mill employees to have the following differences in their activities and employment (p < 0.05). They had  ?  the most years of, and most recent employment in all pulp, paper, and sawmill jobs production except the boom area, ?  the most exposure to pulp slimicides and wood preservation treatment, ?  the most exposure to farming and agriculture/horticulture/landscaping, ?  the least employment in silviculture, and  ?  the least employment in logging.    3.2.4  Seafood Consumption among Male Participants    In Tables 5(M) through 8(M), compared to participants in the two other groups, male native reserve residents were the most likely to include smoked fish in their diet (85% versus 61% for mill employees and 75% for "other", p=0.022), and no more or less likely to include fish or shellfish in their diet. Compared to participants in the two other groups, we observed participating male native reserve residents to have the following differences (p < 0.05) in the types of fish and seafood they consumed. Male reserve residents ate  ?  the most lingcod eggs, ?  the most herring and herring eggs, ?  the most eulachon grease, ?  the most smoked salmon, ?  the most butter clams,  ?  the most Japanese (Manila) clams,  ?  the most oysters, ?  the most Mesikw and Ap'ten sea urchins, ?  the most Dungeness crab meat, ?  the most seagull eggs, ?  the most unspecified other shellfish, ?  the least trout, ?  the least sole or flounder, ?  the least prawns, and ?  the least octopus or squid.    In Tables 5(M) through 8(M), compared to participants in the two other groups, participating male pulp/paper/lumber mill employees were the most likely to include "other seafood" in their diet   60 (28% versus 15% for male reserve residents and 6% for "other", p=0.014). Also, compared to participants in the two other groups, we observed participating male pulp/paper/lumber mill employees to have the following differences (p < 0.05) in the types of fish and seafood they consumed. Male pulp/paper/lumber mill employees ate  ?  the most sole or flounder, ?  the least smoked salmon, and  ?  the most native clams.    3.2.5  Other Wild Food Consumption among Male Participants    In Tables 9(M) to 11(M), compared to participants in the other two groups, participating male native reserve residents were the most likely to include wild game (78% versus 60% among mill employees and 47% in the "other" group, p=0.024) and smoked wild game in their diet (8% versus 0% among mill employees and 3% in the "other" group, p=0.031), but no more or less likely to include wild plants in their diet. For individual wild food items, male native reserve residents ate  ?   the least moose meat ?  the most salmonberries and salmonberry shoots, and  ?  the most elderberries, thimbleberries, and crabapples.    In Tables 9(M) through 11(M), compared to participants in the other two groups, the only differences (p < 0.05) in the pattern of wild food intake by participating male pulp/paper/lumber mill employees were that they ate ?  the most wild rabbit meat, and  ?  the least huckleberries and blackberries.    3.2.6  Other Food Consumption among Male Participants    In Table 12(M) describing consumption of various other foods, compared to the other two groups, male native reserve residents ate ?  the most hamburger meat, ?  the most hotdogs, ?  the most beef/chicken liver, ?  the least beef steaks/roasts,  ?  the least roasted/stewed/boiled chicken/turkey, ?  the least high fibre cold cereals, ?  the least bread,   61 ?  the least cheese,  ?  the least 2% milk, and  ?  the least yogurt.    In Table 12(M), compared to participants in the other two groups, the only differences (p < 0.05) in the pattern of other food intake by participating male pulp/paper/lumber mill employees were that they ate ?  the least chicken and beef liver, ?  the least potato chips and other potatoes, ?  the most cottage cheese, and ?  the least ice cream.    3.2.7  Changes in Eating Patterns Since 1980 among Male Participants    In Table 13(M), describing changes in food consumption since 1980, for every food category, the proportion who had not changed their intake was largest in the male native reserve residents, and second largest in the mill employee group. The difference was statistically significant (p < 0.05) for all food categories except shellfish, wild game, and wild plants.     62 4.0   Conclusions    From the limited data available, study participants appeared to be similar to persons randomly selected and to persons in the target populations. We see no evidence of selection bias, at least in terms of age and gender. Also, the participation ratios are sufficiently high that even if volunteer biases did occur, the effect on survey results was probably small.    On the basis of recalled history, men currently employed at the pulp, paper and lumber mill definitely have had more opportunities for occupational exposure to organochlorine compounds than have men who are not currently employed at the mill. However, even among men who are not currently employed at the mill, a history suggestive of exposure to organochlorines is not uncommon. We did not see evidence of any lifestyle differences that might protect men employed at the mill from this potential occupational hazard. Men who currently work at the mill don't smoke cigarettes any less, aren't any less exposed to wood smoke, haven't any fewer years of residence in the area, and don't eat any less seafood than do men who are not currently employed at the mill. For a few types of seafood, men employed at the mill eat even more than men not employed at the mill.     Although we observed no overall increase in fish and seafood consumption among native reserve residents (compared to other residents of the community), we definitely saw differences in the types of fish and seafood preferred by members of this culture. Reserve residents also on the average have more years of residence in the area than do other community residents. On the other hand, reserve residents smoke cigarettes less and have had fewer opportunities for occupational exposure to organochlorine compounds.     From our observations of people's patterns of seafood consumption, we cannot yet make any statement about the amount of risk of dietary organochlorine exposure experienced by members of any of the three population groups that we surveyed. Of the seafood reported consumed, we do not know what proportion was harvested locally. We asked about this in the questionnaire interviews, but many respondents answered "unknown", or gave vague, ambiguous, or otherwise difficult to interpret responses. It is possible that there was a problem in the way we posed the question, but it is also likely that in many cases, study participants would not know where their fish was harvested.     Survey respondents reported consumption of a surprisingly wide variety of seafood types. Environment Canada has an ongoing program to monitor levels of dioxins and furans in the tissues of marine organisms in coastal British Columbia waters ("Dioxin and Furan Trend Monitoring Database"), however, as the program's name implies, its purpose is to monitor changes in dioxin and furan levels   63 over time, within species. The program therefore measures levels only in a small number of indicator species of marine life. Of the fish and seafood consumed by survey respondents, the only types being monitored near our survey community were: oysters, Dungeness crab muscle (crab "meat"), and Dungeness crab hepatopancreas (crab "marrow") [personal communication, Mike Hagen, Industrial Programs, Pollution Abatement, Environment Protection, Environment Canada, North Vancouver, BC]. There has never been a comprehensive survey of organochlorine levels in all comestible species of marine life harvested in the waters around our survey community. Therefore, with respect to local residents' potential dietary exposure to organochlorines, the importance of these two food items relative to other types of fish and seafood is simply unknown.    As for patterns of intake of wild game meat, smoked wild game, wild plants and various other foods, we did observe some differences between the groups, but we don't know the implications of these differences for the respondents' organochlorine exposure, again because there has never been a comprehensive survey of organochlorine levels in these foodstuffs in our survey community. Conducting such a survey of animals and plants, both wild and domesticated, terrestrial and marine, would be a highly ambitious and costly proposition. Instead, the matter could be addressed by measuring organochlorine levels in the blood of our survey respondents (i.e., by pursuing Phase 2 of this study). We could then test hypotheses of association between the presence of organochlorines in peoples' blood and their recalled intake of specific types or categories of food. If such associations were found, we could then also derive quantitative exposure-dose relationships between amount of food intake and blood levels of organochlorines. We could also determine the relative contributions of food, occupation, hobbies, and personal or demographic factors to peoples' total organochlorine body burden.    We conclude that there are sufficient differences in organochlorine exposure opportunities among the pulp, paper and lumber mill employees and the native reserve residents that Phase 2 of the study should proceed, and that both of these two groups should be retained in Phase 2. The group "other residents of the community" should also be retained as a control group because there are no widely accepted population reference values for the organochlorine exposure biomarkers that we propose to measure in Phase 2, and based on previous measurements in the BC population [Teschke et al, 1992a; Teschke et al, 1992b], we cannot assume that the level of exposure in the control group will be negligibly small.    The only person who should be excluded from Phase 2 of the study is the woman in the mill employee group. Because she is unique in this regard, there are no other study participants with whom she could be grouped for comparison purposes. Unless she expresses strong personal feelings that she wants to have the Phase 2 blood tests, there is not much reason to collect a blood specimen from her.   64 5.0   References  Beck H, Eckhart K, Mathar W, Wittkowski R. Levels of PCDDs and PCDFs in adipose tissue of occupationally exposed workers. 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Factors influencing accuracy of dietary recall. Nutrition Research 1988;8:829-841  McKeown-Eyssen GE, Yeung KS, Bright-See E. Assessment of past diet in epidemiologic studies. Am J Epidemiol  1986;124:94-103  Mullen MD, Pochini CM, McCrindle S, Romkes, Safe SH, Safe LM. High resolution PCB analysis, synthesis, and chromatographic properties of all 209 PCB congeners. Environ Sci Technol 1984;18:468  Patterson DG, Hampton L, Lapeza CR, Belser WT, Green V, Alexander L, Needham LL. High-resolution gas chromatographic/high resolution mass spectrometric analysis of human serum on a whole-weight and lipid basis for 2,3,7,8-tetrachlorodibenzo-p-dioxin. Anal Chem 1987;59:2000-2005  Patterson DG, Turner WE, Isaacs SG, Alexander LR. A method performance evaluation and lessons learned after analyzing more than 5,000 human adipose tissue , serum, and breast milk samples for polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs). Chemosphere 1990;20:829-836  Phillips DL. Chlorinated hydrocarbon levels in human serum: effects of fasting and feeding. Arch Environ Contam Toxicol 1989;18:495-500  Poiger HC, Schlatter C. Pharmacokinetics of 2,3,7,8-TCDD in man. Chemosphere 1986;15:1489-1494  Rottluff W, Teschke K, Hertzman C, Kelly S, Bert J. Sources of dioxins and furans in British Columbia. Can J Pub Health 1990;81:94-100  Sobell J, Block G, Koslowe P, Tobin J, Andres R. Validation of a retrospective questionnaire assessing diet 10-15 years ago. Am J Epidemiol 1989;130:173-187  Statistics Canada, 1992. Profile of Census Divisions and Subdivisions in British Columbia - Part A. 1992 November. Catalogue No. 95-384. Ottawa (ON): ?1992, Minister of Industry, Science and Technology, Canada.   Svensson B-G, Nilsson A, Hansson M, Rappe C, Akesson B, Skerfving S. Exposures to dioxins and dibenzofurans through the consumption of fish. New Engl J Med 1991;324:8-12   65  Sweeney MH, Fingerhut MA, Patterson DG, Connally LB, Piacitelli LA, Morris JA, Griefe AL, Hornung RW, Marlow DA, Dugle JE, Halperin WE, Needham LL. Comparison of serum levels of 2,3,7,8-TCDD in TCP production workers and in an unexposed comparison group. Chemosphere 1990;20:993-1000  Teschke K, Kelly SJ, Wiens M, Hertzman C, Dimich-Ward H, Ward JEH, Van Oostdam JC. Chlorinated dibenzo-p-dioxins and dibenzofurans in the adipose tissue of British Columbia residents. Victoria: B.C. Ministry of Environment, Lands and Parks, March 1992, ENV035982.592. 35 pp.                          Teschke K, Kelly SJ, Wiens M, Hertzman C, Dimich-Ward H, Ward JEH, Van Oostdam JC. Organochlorine pesticides and polychlorinated biphenyls in the adipose tissue of British Columbia residents. Victoria: B.C. Ministry of Environment, Lands and Parks, November 1992, ENV126733.393. 68 pp.   Wolf KM, Poitrowski ZH, Engel JD, Bekeris LG, Palaicios E, Fisher KA. Malignant mesothelioma with occupational and environmental asbestos exposure in an Illinois community hospital. Arch Intern Med 1987;147:2145-2149.   

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