Occupational Hazards?

Carbonless copy paper, photocopiers and computers expose users to respiratory ailments and headache pain, according to a recent study. But some dispute that the hazards exist.

Common office tasks such as writing or carbonless copy pa per, photocopying and using a computer recently have come under scrutiny as work-site health risks by the U.S. government and a top university.

Physicians from Johns Hopkins University in Baltimore report that these everyday tasks cause workers to suffer from headaches, eye problems and chronic respiratory symptoms.

In a study published in the December 1999 edition of the American Journal of Epidemiology, Drs. Maritta Jaakola and Jouni J.K. Jaakola point to carbonless copy paper as the main culprit. Chemicals used in the paper's coating reportedly make some users ill. Complaints range from skin and mucous membrane irritation to multiple chemical sensitivity syndrome.

Bank receipts, estimates and credit-card receipts often are printed on carbonless copy paper, which is also known as NCR--no carbon required. Chemicals in the coating include formaldehyde and odorless kerosene.

The doctors, who are with the Johns Hopkins School of Hygiene and Public Health, revealed in their report that the chemicals and solvents in carbonless copy paper are inhaled and absorbed by the eyes, which come in contact with the chemicals via a worker's fingers. The paper suggests that workers reduce their exposure.

The study also warned that photocopiers emit chemicals that could cause nasal irritation and that computer use could lead to increased frequency of headaches and fatigue. The findings were based on a study of 2,700 office workers in Finland.

Carbonless copy paper also has moved onto the radar of the National Institute of Occupational Safety and Health as a possible new work-site health concern. The institute will release a paper on the subject in the fall.

But according to Paul Schulte, director of education and information at the institute, it's difficult to determine how many workers are affected by it. "Millions use it. It's easier to track usage through how many tons of this paper are produced," Schulte said.

Appleton Paper of Appleton, Wis., the largest U.S. maker of carbonless copy paper, generates 800,000 tons annually, said Bill Vandenbrandt, a company spokesman.

Manufactured since 1954, carbonless copy paper is still just a small part of the paper industry, however. Its use has been declining for the past six to seven years because of the wide use of laser printers and e-commerce, the company said.

But even after manufacturing the product for 45 years, Appleton workers have not reported any major health problems, only minor irritations. "The experience of our employees wouldn't support the allegations and complaints others have made," Vandenbrandt said. The paper manufacturer is confident that its product is safe and is committed to product evaluations and extensive testing using human volunteers.

Schulte said the health concerns first came up in 1987 at the institute, but not enough information was available. "Right now we're assessing the health effects and how severe they are," he said.

Experts like Dr. Robert McCunney, director of occupational and environmental medicine at Massachusetts Institute of Technology and president of the American College of Occupational and Environmental Medicines, have reviewed institute's study and say the substance is a minor irritant. "I don't think it's a big work-site hazard; any substance can cause a problem," McCunney said. "But there have been rare cases of allergic reactions."

At the center of the carbonless copy paper controversy is Brenda Smith, 51, a former Bell Atlantic customer-service representative. Smith is waging what she calls an education campaign to make known the dangers of carbonless copy paper. "Insurance carriers are going to suffer greatly. It's not fair for people not to be aware of this problem. We want a warning on the product," she said.

Smith was exposed to the product for the last 10 years of her 25-year career at Bell Atlantic. She began experiencing headaches, eye irritation, fatigue and respiratory problems about the same time she began using carbonless copy paper. After finding no relief from regular physicians, she located a doctor who specialized in environmental illness and who discovered chemical levels in her blood that were eight times the level that is considered to be normal. Through the physician and newspaper articles that documented Smith's story, other Bell Atlantic employees who used the product contacted Smith to tell her that they had similar health problems. Smith claims that she eventually was fired from her job as a customer-service representative because she lost her voice, which she attributes to her exposure to carbonless copy paper.

Smith has been involved in several lawsuits concerning her health reactions to the product, but most recently she has joined other members of the Carbonless Copy Paper Injury and Information Network in filing a suit against 22 paper manufacturers under California's Proposition 65. Proposition 65 requires manufacturers to make public any agent that can cause cancer, birth defects or other reproductive harm. After a suit is filed, the companies have 60 days to provide warnings on the product, eliminate the hazard or develop alternatives. If nothing happens, a private enforcer--most likely the person who filed the initial suit--may go ahead with the lawsuit, said Lana Beckett, managing editor of Prop 65 News.

So far, Travelers Property Casualty Group, the fourth-largest workers' compensation writer, hasn't had any claims regarding carbonless copy paper, said Dr. Adam Seidner, the company's national medical director. To qualify as workers' comp claims, these ailments must be diagnosed by a physician and documentation must be submitted that identifies how the symptoms are causally related to the work site, Seidner said. "Is it one of many irritants that are combining to cause the problem or is it the whole host of things, including poor ventilation and rubber bands?" he said.

Workers' comp writer CNA said it hadn't become an issue. Liberty Mutual said it was looking into the matter.