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August 7, 1991, Vol 266, No. 5 >
ARTICLE | August 7, 1991

The Environment and the Lung: Title and subTitle BreakChanging Perspectives FREE

Jonathan M. Samet, MD; Mark J. Utell, MD
[+] Author Affiliations

Reprint requests to New Mexico Tumor Registry, Medical Center, 900 Camino de Salud NE, Albuquerque, NM 87131 (Dr Samet).


JAMA. 1991;266(5):670-675. doi:10.1001/jama.1991.03470050070025
Text Size: A A A
Published online
Article
References

The focus of public health concern and research in regard to environmental lung diseases has changed across the century. Illustrative agents include radon, indoor asbestos, environmental tobacco smoke, acidic aerosols, and oxidant gases. Tremendous progress has been made in understanding and preventing environmental lung diseases. However, we remain concerned about adverse consequences of breathing polluted outdoor and indoor air. In the persistent concerns about adverse effects of polluted air on the lung, a new emphasis is pervasive; the focus has shifted from avoiding clinical disease among highly exposed individuals to protecting the population from an unacceptable burden of risk. The technique of quantitative risk assessment has become increasingly important for characterizing the safety of environmental agents. The resulting emphasis on the final risk projection and attendant uncertainties may overly emphasize gaps in our knowledge.

(JAMA. 1991;266:670-675)

REFERENCES

1 +
National Research Council, Committee on the Institutional Means for Assessment of Risks to Public Health. Risk Assessment in the Federal Government: Managing the Process . Washington, DC: National Academy Press; 1983;.
2 +
Lowrance WW. Of Acceptable Risk: Science and the Determination of Safety . Los Altos, Calif: William Kaufmann Inc; 1976;.
3 +
Utell MJ, Samet JM.  Environmentally mediated disorders of the respiratory tract. Med Clin North Am . 1990;;74:291-306.
4 +
Lave LB.  The role of quantitative risk assessment in environmental regulations.  In: Hoel DG, Merrill RA, Perera FP, eds. Risk Quantitation and Regulatory Policy . New York, NY: Cold Spring Harbor Laboratory; 1985;:3-9.
5 +
Ames BN, Magaw R, Gold LS.  Ranking possible carcinogenic hazards. Science . 1987;;236:271-280.
6 +
Graham JD, Green LC, Roberts MJ. In Search of Safety: Chemicals and Cancer Risk . Cambridge, Mass: Harvard University Press; 1988;.
7 +
Nero AV Jr.  Radon and its decay products in indoor air: an overview.  In: Nazaroff WW, Nero AV Jr, eds. Radon and Its Decay Products in Indoor Air . New York, NY: John Wiley & Sons Inc; 1988;:1-51.
8 +
Samet JM.  Radon and lung cancer. J Natl Cancer Inst . 1989;;81:745-757.
9 +
Harting FH, Hesse W.  Der Lungenkrebs, die Bergkrankheit in den Schneeberger Gruben. Vierteljahresschr Gerichtl Med Oeff Sanitaetswes . 1879;;31:102-132,313-337.
10 +
Morgan MV, Samet JM.  Radon daughter exposures of New Mexico U miners, 1967-1982. Health Phys . 1986;;50:656-662.
11 +
Lubin JH, Boice JD.  Estimating radon-induced lung cancer in the U.S. Health Phys . 1989;;57:417-427.
12 +
Puskin JS, Nelson CB.  EPA's perspective on risks from residential radon exposure. J Air Pollut Control Assoc . 1989;;39:915-920.
13 +
National Research Council, Committee on the Biological Effects of Ionizing Radiations. Health Risks of Radon and Other Internally Deposited Alpha-Emitters: BEIR IV . Washington, DC: National Academy Press; 1988;.
14 +
National Research Council, Panel on Dosimetric Assumptions Affecting the Application of Radon Risk Estimates. Comparative Dosimetry of Radon in Mines and Homes . Washington, DC: National Academy Press; 1991;.
15 +
Abelson PH.  Uncertainties about health effects of radon. Science . (October 19) , 1990;;250:352.
16 +
Samet JM, Stolwijk J, Rose SL.  Summary: international workshop on residential Rn epidemiology. Health Phys . 1991;;60:223-227.
17 +
Lubin JH, Samet JM, Weinberg C.  Design issues in epidemiologic studies of indoor exposure to radon and risk of lung cancer. Health Phys . 1990;;59:807-817.
18 +
Lubin JH.  Methods for the analysis of radonexposed populations. Yale J Biol Med . 1988;;61:195-214.
19 +
Selikoff IJ, Greenberg M.  A landmark case in asbestosis. JAMA . 1991;;265:898-901.
20 +
Murray R.  Asbestos: a chronology of its origins and health effects. Br J Ind Med . 1990;;47:361-365.
21 +
National Research Council, Committee on Nonoccupational Health Risks of Asbestiform Fibers. Asbestiform Fibers: Nonoccupational Health Risks . Washington, DC: National Academy Press; 1984;.
22 +
US Consumer Product Safety Commission.A Report by the Chronic Hazard Advisory Panel on Asbestos . Washington, DC: US Consumer Product Safety Commission Directorate for Health Sciences; 1983;.
23 +
Mossman BT, Bignon J, Corn M, Seaton A, Gee JBL.  Asbestos: scientific developments and implications for public policy. Science . 1990;;247:294-301.
24 +
Corn M, Crump K, Farrar DB, Lee RJ, McFee DR.  Airborne concentrations of asbestos in 71 school buildings. Regul Toxicol Pharmacol . 1991;;13:99-114.
25 +
Smoking and Health: Report of the Advisory Committee to the Surgeon General . Washington, DC: US Dept of Health, Education, and Welfare; 1964;. DHEW publication (PHS) 1103.
26 +
Reducing the Health Consequences of Smoking: 25 Years of Progress: A Report of the Surgeon General . Washington, DC: US Dept of Health and Human Services; 1989;. DHHS publication (CDC) 89-8411.
27 +
Cameron P, Kostin JS, Zaks JM, et al.  The health of smokers' and nonsmokers' children. J Allergy . 1969;;43:336-341.
28 +
Harlap S, Davies AM.  Infant admissions to hospital and maternal smoking. Lancet . 1974;;1:529-532.
29 +
Tager IB, Weiss ST, Rosner B, et al.  Effect of parental cigarette smoking on the pulmonary function of children. Am J Epidemiol . 1979;;110:15-26.
30 +
Hirayama T.  Nonsmoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan. BMJ . 1981;;282:183-185.
31 +
Trichopoulos D, Kalandidi A, Sparros L, et al.  Lung cancer and passive smoking. Int J Cancer . 1981;;27:1-4.
32 +
IARC 1986:IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans: Tobacco Smoking . Lyons, France: World Health Organization, International Agency for Research on Cancer; 1986;;38.
33 +
National Research Council. Environmental Tobacco Smoke: Measuring and Assessing Health Effects . Washington, DC: US Dept of Health and Human Services, National Academy Press; 1986;.
34 +
The Health Consequences of Involuntary Smoking: A Report of the Surgeon General . Rockville, Md; US Dept of Health and Human Services; 1986;. DHHS publication (CDC) 87-8398.
35 +
Lee PN. Misclassification of Smoking Habits and Passive Smoking . Berlin, Germany: Springer Verlag; 1988;.
36 +
Rylander R.  Environmental tobacco smoke and lung cancer. N Engl J Med . 1990;;323:834.
37 +
Wu AH, Samet JM.  Environmental tobacco smoke: exposure-response relationships in epidemiologic studies. Risk Analysis . 1990;;10:39-48.
38 +
Repace JL, Lowrey AH.  Risk assessment methodologies for passive smoking-induced lung cancer. Risk Analysis . 1990;;10:27-37.
39 +
Spengler JD, Brauer M, Koutrakis P.  Acid air and health. Environ Sci Technol . 1990;;24:946-956.
40 +
Shrenk HH, Heimann H, Clayton GD, et al.  Air Pollution  in Donora, Pa: Epidemiology of the Unusual Smog Episode of October 1948: Preliminary Report . Washington, DC: Public Health Service; 1949;. Public Health Bulletin 306.
41 +
Logan WPD.  Mortality in the London fog incident. Lancet . 1953;;1:336-338.
42 +
Mazumdar S, Schimmel H, Higgins ITT.  Relation of daily mortality to air pollution: analysis of 14 London winters, 1958/1959-1971/1972. Arch Environ Health . 1982;;37:213-220.
43 +
Thurston GD, Ito K, Lippman M, Hayes C.  Reexamination of London, England, mortality in relation to exposure to acidic aerosols during 1963-1972 winters. Environ Health Perspect . 1989;;79:73-82.
44 +
Bates DV, Sizto R.  Hospital admissions and air pollutants in Southern Ontario: the acid summer haze effect. Environ Res . 1987;;43:317-331.
45 +
Ware JH, Ferris BG Jr, Dockery DW, Spengler JD, Stram DO, Speizer FE.  Effects of ambient sulfur oxides and suspended particles on respiratory health of preadolescent children. Am Rev Respir Dis . 1986;;133:834-842.
46 +
Sheppard D, Wong WS, Uehara CF.  Lower threshold and greater bronchomotor responsiveness of asthmatic subjects to sulfur dioxide. Am Rev Respir Dis . 1980;;122:873-878.
47 +
Bauer MA, Utell MJ, Morrow PE, Speers DM, Gibb FR.  Inhalation of 0.30 ppm nitrogen dioxide potentiates exercise-induced bronchospasm in asthmatics. Am Rev Respir Dis . 1986;;134:1203-1208.
48 +
Koenig JQ, Covert DS, Pierson WE.  Effects of inhalation of acidic compounds on pulmonary function in allergic adolescent subjects. Environ Health Perspect . 1989;;79:173-178.
49 +
Lipfert FW, Morris SC, Wyzga RE.  Acid aerosols: the next criteria air pollutant? Environ Sci Technol . 1989;;23:1316-1322.
50 +
National Research Council, Subcommittee on Nitrogen Oxides, Committee on Medical and Biological Effects of Environmental Pollutants. Nitrogen Oxides . Washington, DC: National Academy Press; 1976;.
51 +
Lippmann M:  Health effects of ozone: a critical review. J Air Pollut Control Assoc . 1989;;39:672-695.
52 +
Samet JM, Utell MJ.  The risk of nitrogen dioxide: what have we learned from epidemiological and clinical studies? Toxicol Ind Health . 1990;;6:247-262.
53 +
Spengler JD, Duffy CP, Letz R, et al.  Nitrogen dioxide inside and outside 137 homes and implications for ambient air quality standards and health effects research. Environ Sci Technol . 1983;;17:164-168.
54 +
Morrow PE.  Toxicological data on NO2: an overview. J Toxicol Environ Health . 1984;; 13:205-227.
55 +
Frampton MW, Smeglin AM, Roberts NJ Jr, Finkelstein JM, Morrow PE, Utell MJ.  Nitrogen dioxide exposure in vivo and human alveolar macrophage inactivation of human influenza virus in vitro. Environ Res . 1989;;48:179-192.
56 +
Samet JM, Lambert WE, Skipper BJ, et al.  A study of respiratory illnesses in infants and NO2 exposure. Arch Environ Health . In press.
57 +
National Research Council, Committee on Risk Perception and Communication. Improving Risk Communication . Washington, DC: National Academy Press; 1989;.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
National Research Council, Committee on the Institutional Means for Assessment of Risks to Public Health. Risk Assessment in the Federal Government: Managing the Process . Washington, DC: National Academy Press; 1983;.
2 +
Lowrance WW. Of Acceptable Risk: Science and the Determination of Safety . Los Altos, Calif: William Kaufmann Inc; 1976;.
3 +
Utell MJ, Samet JM.  Environmentally mediated disorders of the respiratory tract. Med Clin North Am . 1990;;74:291-306.
4 +
Lave LB.  The role of quantitative risk assessment in environmental regulations.  In: Hoel DG, Merrill RA, Perera FP, eds. Risk Quantitation and Regulatory Policy . New York, NY: Cold Spring Harbor Laboratory; 1985;:3-9.
5 +
Ames BN, Magaw R, Gold LS.  Ranking possible carcinogenic hazards. Science . 1987;;236:271-280.
6 +
Graham JD, Green LC, Roberts MJ. In Search of Safety: Chemicals and Cancer Risk . Cambridge, Mass: Harvard University Press; 1988;.
7 +
Nero AV Jr.  Radon and its decay products in indoor air: an overview.  In: Nazaroff WW, Nero AV Jr, eds. Radon and Its Decay Products in Indoor Air . New York, NY: John Wiley & Sons Inc; 1988;:1-51.
8 +
Samet JM.  Radon and lung cancer. J Natl Cancer Inst . 1989;;81:745-757.
9 +
Harting FH, Hesse W.  Der Lungenkrebs, die Bergkrankheit in den Schneeberger Gruben. Vierteljahresschr Gerichtl Med Oeff Sanitaetswes . 1879;;31:102-132,313-337.
10 +
Morgan MV, Samet JM.  Radon daughter exposures of New Mexico U miners, 1967-1982. Health Phys . 1986;;50:656-662.
11 +
Lubin JH, Boice JD.  Estimating radon-induced lung cancer in the U.S. Health Phys . 1989;;57:417-427.
12 +
Puskin JS, Nelson CB.  EPA's perspective on risks from residential radon exposure. J Air Pollut Control Assoc . 1989;;39:915-920.
13 +
National Research Council, Committee on the Biological Effects of Ionizing Radiations. Health Risks of Radon and Other Internally Deposited Alpha-Emitters: BEIR IV . Washington, DC: National Academy Press; 1988;.
14 +
National Research Council, Panel on Dosimetric Assumptions Affecting the Application of Radon Risk Estimates. Comparative Dosimetry of Radon in Mines and Homes . Washington, DC: National Academy Press; 1991;.
15 +
Abelson PH.  Uncertainties about health effects of radon. Science . (October 19) , 1990;;250:352.
16 +
Samet JM, Stolwijk J, Rose SL.  Summary: international workshop on residential Rn epidemiology. Health Phys . 1991;;60:223-227.
17 +
Lubin JH, Samet JM, Weinberg C.  Design issues in epidemiologic studies of indoor exposure to radon and risk of lung cancer. Health Phys . 1990;;59:807-817.
18 +
Lubin JH.  Methods for the analysis of radonexposed populations. Yale J Biol Med . 1988;;61:195-214.
19 +
Selikoff IJ, Greenberg M.  A landmark case in asbestosis. JAMA . 1991;;265:898-901.
20 +
Murray R.  Asbestos: a chronology of its origins and health effects. Br J Ind Med . 1990;;47:361-365.
21 +
National Research Council, Committee on Nonoccupational Health Risks of Asbestiform Fibers. Asbestiform Fibers: Nonoccupational Health Risks . Washington, DC: National Academy Press; 1984;.
22 +
US Consumer Product Safety Commission.A Report by the Chronic Hazard Advisory Panel on Asbestos . Washington, DC: US Consumer Product Safety Commission Directorate for Health Sciences; 1983;.
23 +
Mossman BT, Bignon J, Corn M, Seaton A, Gee JBL.  Asbestos: scientific developments and implications for public policy. Science . 1990;;247:294-301.
24 +
Corn M, Crump K, Farrar DB, Lee RJ, McFee DR.  Airborne concentrations of asbestos in 71 school buildings. Regul Toxicol Pharmacol . 1991;;13:99-114.
25 +
Smoking and Health: Report of the Advisory Committee to the Surgeon General . Washington, DC: US Dept of Health, Education, and Welfare; 1964;. DHEW publication (PHS) 1103.
26 +
Reducing the Health Consequences of Smoking: 25 Years of Progress: A Report of the Surgeon General . Washington, DC: US Dept of Health and Human Services; 1989;. DHHS publication (CDC) 89-8411.
27 +
Cameron P, Kostin JS, Zaks JM, et al.  The health of smokers' and nonsmokers' children. J Allergy . 1969;;43:336-341.
28 +
Harlap S, Davies AM.  Infant admissions to hospital and maternal smoking. Lancet . 1974;;1:529-532.
29 +
Tager IB, Weiss ST, Rosner B, et al.  Effect of parental cigarette smoking on the pulmonary function of children. Am J Epidemiol . 1979;;110:15-26.
30 +
Hirayama T.  Nonsmoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan. BMJ . 1981;;282:183-185.
31 +
Trichopoulos D, Kalandidi A, Sparros L, et al.  Lung cancer and passive smoking. Int J Cancer . 1981;;27:1-4.
32 +
IARC 1986:IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans: Tobacco Smoking . Lyons, France: World Health Organization, International Agency for Research on Cancer; 1986;;38.
33 +
National Research Council. Environmental Tobacco Smoke: Measuring and Assessing Health Effects . Washington, DC: US Dept of Health and Human Services, National Academy Press; 1986;.
34 +
The Health Consequences of Involuntary Smoking: A Report of the Surgeon General . Rockville, Md; US Dept of Health and Human Services; 1986;. DHHS publication (CDC) 87-8398.
35 +
Lee PN. Misclassification of Smoking Habits and Passive Smoking . Berlin, Germany: Springer Verlag; 1988;.
36 +
Rylander R.  Environmental tobacco smoke and lung cancer. N Engl J Med . 1990;;323:834.
37 +
Wu AH, Samet JM.  Environmental tobacco smoke: exposure-response relationships in epidemiologic studies. Risk Analysis . 1990;;10:39-48.
38 +
Repace JL, Lowrey AH.  Risk assessment methodologies for passive smoking-induced lung cancer. Risk Analysis . 1990;;10:27-37.
39 +
Spengler JD, Brauer M, Koutrakis P.  Acid air and health. Environ Sci Technol . 1990;;24:946-956.
40 +
Shrenk HH, Heimann H, Clayton GD, et al.  Air Pollution  in Donora, Pa: Epidemiology of the Unusual Smog Episode of October 1948: Preliminary Report . Washington, DC: Public Health Service; 1949;. Public Health Bulletin 306.
41 +
Logan WPD.  Mortality in the London fog incident. Lancet . 1953;;1:336-338.
42 +
Mazumdar S, Schimmel H, Higgins ITT.  Relation of daily mortality to air pollution: analysis of 14 London winters, 1958/1959-1971/1972. Arch Environ Health . 1982;;37:213-220.
43 +
Thurston GD, Ito K, Lippman M, Hayes C.  Reexamination of London, England, mortality in relation to exposure to acidic aerosols during 1963-1972 winters. Environ Health Perspect . 1989;;79:73-82.
44 +
Bates DV, Sizto R.  Hospital admissions and air pollutants in Southern Ontario: the acid summer haze effect. Environ Res . 1987;;43:317-331.
45 +
Ware JH, Ferris BG Jr, Dockery DW, Spengler JD, Stram DO, Speizer FE.  Effects of ambient sulfur oxides and suspended particles on respiratory health of preadolescent children. Am Rev Respir Dis . 1986;;133:834-842.
46 +
Sheppard D, Wong WS, Uehara CF.  Lower threshold and greater bronchomotor responsiveness of asthmatic subjects to sulfur dioxide. Am Rev Respir Dis . 1980;;122:873-878.
47 +
Bauer MA, Utell MJ, Morrow PE, Speers DM, Gibb FR.  Inhalation of 0.30 ppm nitrogen dioxide potentiates exercise-induced bronchospasm in asthmatics. Am Rev Respir Dis . 1986;;134:1203-1208.
48 +
Koenig JQ, Covert DS, Pierson WE.  Effects of inhalation of acidic compounds on pulmonary function in allergic adolescent subjects. Environ Health Perspect . 1989;;79:173-178.
49 +
Lipfert FW, Morris SC, Wyzga RE.  Acid aerosols: the next criteria air pollutant? Environ Sci Technol . 1989;;23:1316-1322.
50 +
National Research Council, Subcommittee on Nitrogen Oxides, Committee on Medical and Biological Effects of Environmental Pollutants. Nitrogen Oxides . Washington, DC: National Academy Press; 1976;.
51 +
Lippmann M:  Health effects of ozone: a critical review. J Air Pollut Control Assoc . 1989;;39:672-695.
52 +
Samet JM, Utell MJ.  The risk of nitrogen dioxide: what have we learned from epidemiological and clinical studies? Toxicol Ind Health . 1990;;6:247-262.
53 +
Spengler JD, Duffy CP, Letz R, et al.  Nitrogen dioxide inside and outside 137 homes and implications for ambient air quality standards and health effects research. Environ Sci Technol . 1983;;17:164-168.
54 +
Morrow PE.  Toxicological data on NO2: an overview. J Toxicol Environ Health . 1984;; 13:205-227.
55 +
Frampton MW, Smeglin AM, Roberts NJ Jr, Finkelstein JM, Morrow PE, Utell MJ.  Nitrogen dioxide exposure in vivo and human alveolar macrophage inactivation of human influenza virus in vitro. Environ Res . 1989;;48:179-192.
56 +
Samet JM, Lambert WE, Skipper BJ, et al.  A study of respiratory illnesses in infants and NO2 exposure. Arch Environ Health . In press.
57 +
National Research Council, Committee on Risk Perception and Communication. Improving Risk Communication . Washington, DC: National Academy Press; 1989;.

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