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Exploratory Analysis of Respiratory Illness Among Persons Living Near a landfill.

Abstract

Residents living near one of the largest landfills in the United States expressed longstanding concern about respiratory health within their community. As a result, the authors evaluated the severity and frequency of respiratory symptoms occurring in the past 12 months among self-identified residents with asthma, severe breathing, or respiratory conditions. A telephone survey was performed over a 30-day data collection period to characterize respiratory illness among residents living in two communities on Staten Island.

Responses were received from 541 residents of the landfill community and 289 residents the north-shore community, over 7 miles from the landfill. In addition, 449 persons living elsewhere on Staten Island responded voluntarily. The proportion of respondents who reported having asthma was higher among north-shore residents. Reports from respondents who lived adjacent to the landfill and those who lived in the north-shore community differed primarily with respect to two measures: odors (rotten eggs and garbage) and eye, nose, and throat irritation,

In spite of longstanding community health concerns about the landfill, the respiratory health of Staten Island residents had never been investigated in relation to the landfill. The results of this assessment indicate that a fairly large number of Staten Island residents experience respiratory-related symptoms and conditions. It was concluded that further investigation of respiratory illness among this population is warranted.

Editor's note:

This special report was prepared by employees of the federal government, therefore, it is exempt from copyright protection under Title 17 of the U.S. Code.

Introduction

Fresh Kills Municipal Landfill (FKML), established on Staten Island in 1948, is one of the oldest and largest landfills in the United States. It is owned and operated by the New York City Department of Sanitation (NYCDOS). Covering more than 2,200 acres, FKML receives approximately 14,000 tons of refuse per day and operates 24 hours a day, six days a week [1,2]. The landfill has long been a source of health concerns within the local community NYCDOS has received hundreds of odor complaints from residents living near the landfill. An occupational study reported a higher percentage of work-related dermatologic, neurologic, hearing, and respiratory symptoms among workers at FKML than among other New York City sanitation workers [3].

Staten Island lies within the New York City metropolitan area, which is a nonattainment area for national ambient air quality standards for ozone, particulate matter, and carbon monoxide [4]. Respiratory health investigations elsewhere have demonstrated that ozone and particulate matter are associated with exacerbations of asthma [5,6]. Therefore, when considering the possible contribution of landfill emissions to high levels of asthma symptoms on Staten Island, one should take into account the impacts of other air pollution sources in the area.

To decrease landfill emissions, NYCDOS proposed to install and operate a landfill gas collection system and associated flare. Installation of this system during the summer of 1997 was expected to reduce the air emissions of methane and nonmethane organic compounds (NMOC) that normally occur at municipal landfills [7]. It was determined that respiratory health concerns should be evaluated prior to scheduled flaring activities, which could potentially change the ambient air conditions in surrounding communities.

The objective of this investigation was to evaluate the severity and frequency of current respiratory symptoms among self-identified residents with asthma, severe breathing, or respiratory conditions in two Staten Island communities. The investigation used a creative method for quickly capturing community experiences of and perceptions about the frequency and severity of odors and respiratory illness. This method was not meant to serve as a purely random sampling that would generate population estimates of the prevalence of respiratory conditions on Staten Island.

Methods

Selection of the Communities

Two communities with similar geography income, and demographics were identified. The first community was adjacent to the landfill, and the second was on the other side of the island (the north shore). The landfill community sat just east of the landfill site, which generally was downwind. According to the 1990 census, approximately 16,000 people resided in the area. Forty-nine percent were male, and 51 percent were female. Eighty-five percent were white, two percent were black, and 13 percent belonged to other races. The median household income was $47,000 [8]. Approximately 14,000 people resided in the north-shore community, located on the northeast corner of the island more than 7 miles from the landfill. Forty-eight percent were male, 52 percent were female, 76 percent were white, 15 percent were black, and nine percent belonged to other races. The median household income was $42,000 [8].

Community Outreach

During April 1997, each street in the selected communities was canvased, addresses of residences were recorded, and a listing of households was developed. A letter was sent to each address, asking residents who met the eligibility criteria to call a toll-free number and answer a brief questionnaire. The eligibility criteria specified residents eight to 65 years of age, who suffered from asthma, severe breathing, or respiratory problems. To encourage participation, a follow-up postcard and a flyer from the Office of the Staten Island Borough President were mailed two weeks after the initial letter. Also, all households with listed telephone numbers were identified. One week prior to the end of the data collection, over 7,000 households in the selected communities were contacted by telephone and encouraged to participate. Additional outreach efforts during the 30-day data collection period included meetings with physicians of the county medical society; solicitation flyers in offices, clinics, pharmacies, and h ospitals; and public meetings at local libraries.

Data Collection

Data were collected from April 29 through May 28, 1997. During that time, residents called a toll-free number and completed a short questionnaire. If more than one person in the household reported a physician diagnosis of asthma or gave a self-report of severe respiratory or breathing problems, the interviewer completed a separate questionnaire for each eligible respondent. If a participant was younger than 18 years of age, the interviewer was required to speak to an adult. Several interviewers, located in Chicago, were available to administer the questionnaire and simultaneously record data with a computerized data collection instrument. The telephone lines were open seven days a week.

The questionnaire was designed to collect information on demographics, residential history, pre-existing health conditions, and environmental conditions within the past 12 months. Questions referring to respiratory health were drafted based on previously used questionnaires [9-11]. Self-reports of asthma and other respiratory conditions were not verified. Because of the history of complaints by residents, respondents also were asked to comment on the odors in their neighborhood [12,13]. The final questions addressed the outside air in the respondents' neighborhoods.

Statistical Analyses

Descriptive analyses of population demographics were performed for all respondents: the landfill community the north-shore community, and respondents from outside the targeted areas. Descriptive analyses of questionnaire responses focused only on respondents from the landfill community and the north-shore community. Because the sample consisted of respondents who voluntarily chose to call into the telephone lines, those who participated might have had different traits than those who chose not to participate (i.e., might have been more apt to have symptoms they wanted to report). Without a probability sample, the authors concluded that analyses based on statistical inference would not be appropriate. Therefore, only descriptive analyses were performed.

Results

Characteristics of Respondents

The household listing identified 12,195 households in the two selected communities. Letters to 340 (2.8 percent) of these households were returned as unusable to the Agency for Toxic Substancs and Disease Registry (ATSDR): 151 were returned because of incomplete addresses, 127 because of vacant residences, 47 because of unknown addresses, nine because they went unclaimed, and six because there was no forwarding address. The telephone center received 1,355 calls. Of these, 1,279 resulted in interviews; 63 respondents gave their names and addresses but did not continue with the interview, and 13 were excluded because they were outside the age range. A total of 541 calls (42.3 percent) came from the landfill community and 289 (22.6 percent) came from the north-shore community In addition, 449 callers (35.1 percent) did not live in the targeted areas but had heard of the project and volunteered answers to the questionnaire.

Table 1 gives the demographic distribution of the respondents. Almost half of the respondents from the selected communities were 25 through 44 years of age. A higher percentage of these respondents were female.

Respondents were predominantly white; however proportionately more blacks responded from the north-shore community than from the landfill community. This might reflect the higher percentage of black residents in the north-shore community

Respiratory-Related Symptoms and Conditions

The percentages of self-reported conditions in the two communities were compared. A diagnosis of asthma was reported by 46 percent of respondents from the landfill community and by 60 percent of respondents from the north shore. Chronic bronchitis was reported by approximately 30 percent of respondents from both communities. Reports of emphysema and congestive heart failure were consistent across both communities, approximately three percent and one percent for congestive heart failure. Reports of coronary heart disease were slightly higher among respondents from the landfill community (2.9 percent) than among respondents from the north-shore community (1.7 percent).

The severity and frequency of respiratory-related symptoms were compared between the two communities (Table 2). Approximately 70 percent of respondents from the selected communities reported being awakened at night by an attack of coughing. Almost half of the respondents reported bringing up phlegm upon getting up or first thing in the morning. Over 70 percent reported that they had experienced wheezing or whistling in the chest at any time in the past 12 months, with a slightly higher percentage among respondents from the north-shore community. Almost half reported an attack of shortness of breath when not doing anything strenuous.

Most respondents with asthma lived on Staten Island at the time of asthma diagnosis (79 percent of the landfill community and 84 percent of the north-shore community). The mean age when asthma was diagnosed was similar for both communities, approximately 22 years. Use of medications prescribed for asthma or respiratory symptoms was approximately 60 percent among respondents (Table 2).

Respondents also were questioned about the frequency with which they sought urgent care and hospitalization for asthma or respiratory symptoms (Table 2). Almost one-quarter of respondents had sought urgent care or had visited an emergency room one or more times in the previous 12 months. Very few respondents from the selected communities had been hospitalized for respiratory-related conditions in the previous 12 months.

Odor and Environmental Conditions

As shown in Figure 1, of the six selected odors, the odor of garbage was reported most frequently. Almost 90 percent of the landfill community respondents reported the odor of rotten eggs in their area. The odors next most frequently reported by respondents of the landfill community were gasoline or petroleum and burning matches. In the north-shore community, gasoline or petroleum and rotten eggs were, after garbage, the most frequently reported odors. Overall, a higher percentage of odors was reported in the landfill community.

Over 83 percent of respondents from the landfill community and 61 percent from the north-shore community reported irritation of the eyes, nose, and throat. When respondents were questioned about the frequency of this irritation, a higher percentage from the landfill community reported irritation on a daily basis (26 percent) or a few times a week (38 percent). Conversely, a higher percentage of respondents from the north-shore community reported irritation as occurring a few times a month (46 percent).

Discussion

Asthma is not a reportable health condition, and no registries exist of people on Staten Island with asthma or other respiratory conditions. Using a variety of outreach activities, the investigators were able to identify, in just one month, several hundred persons who reported asthma and other respiratory conditions. From this investigation, it appeared that a fairly large number of residents in the selected communities were experiencing respiratory-related symptoms and were willing to participate in a health investigation. It is not known how many other residents who had asthma or respiratory problems did not choose to participate.

A greater percentage of calls were received from residents living in the landfill community. Because similar outreach activities were used in both communities, this difference might have been a result of greater interest among residents who resided in close proximity to the landfill. The proportion of respondents who reported asthma, however, was higher in the north-shore community. This result suggests that people with less serious respiratory conditions may have tended not to call if they lived further from the landfill. Women were more likely than men to call in. In general, women of all races suffer greater asthma mortality and morbidity than do men [14].

Reports from respondents in communities near and further from the landfill differed primarily on two measures: the landfill community reported a higher percentage of certain odors (rotten eggs and garbage) and a higher proportion of eye, nose, and throat irritations. The odors and irritation were consistent with what would be expected in a community that is in close proximity to an active municipal landfill. The irritation may result from strong ambient odors--or it may indicate greater perceived risk among this group. Although odor perception is a highly subjective measure, it may have a general negative impact on quality of life and perception of health. Future research into populations living near landfills and hazardous waste sites should consider the potential effects of odorous compounds on communities.

Because of the descriptive nature of the investigation, the occurrence of symptoms could not be linked to potential landfill emissions. The results do, however, provide insight into the occurrence of asthma and respiratory-related symptoms in this study population and can assist with the formulation of future research questions. The findings indicate a need for--and a community interest in--follow-up investigations. Such investigations should consider the association between environmental conditions (such as noticeable odors) and acute changes in respiratory outcomes.

Acknowledgements: The authors express their gratitude to the Staten Island residents who participated in this assessment. This work was accomplished in cooperation with John Hawley and Alice Stark, from the New York State Department of Health, and Nancy Jeffery and Lori Stevenson, from the New York City Department of Health. Special thanks for contributions are due to Arthur Block, Loretta Bush, Debra Gable, Douglas Gouzie, Germano Pereira, and Brian vonGunten, of ATSDR, and Nicholas Dmytryszyn, of the Staten Island Borough Hall. The authors also would like to acknowledge Myron Schultz for assistance with the manuscript. This work was funded and conducted by ATSDR.

Corresponding Author: Sherri Berger, Agency for Toxic Substances and Disease Registry Division of Health Studies.

Did you know...

"One out of every 20 deaths in a typical large American city has been linked to outdoor air pollution."

Source: American Lung Association and Harvard University Medical School

REFERENCES

(1.) Sulfita J.M., C.P. Gerba R.K. Ham, A.C. Palisamo W.L. Rathje, and J.A. Robinson (1992), "The World's Largest Landfill: A Multidisciplinary Investigation," Environmental Science and Technology, 26(8):1486-1495.

(2.) Division of Health Assessment and Consultation (1996), "Health Consultation: Fresh Kills Municipal Landfill: March 15, 1996," Atlanta, Ga.: Agency for Toxic Substances and Disease Registry.

(3.) Gelberg, K. (1997), "Health Study of New York City Department of Sanitation Landfill Employees," Journal of Occupational and Environmental Medicine, 39(11):1103-1110.

(4.) U.S. Environmental Protection Agency (1996), Fact Sheet: EPA's Proposal on the Particulate Matter Standard, Research Triangle Park, N.C.: November 29, 1996.

(5.) American Thoracic Society (1996), "Health Effects of Outdoor Pollution," American Journal of Respiratory and Critical Care Medicine, 153(1);3-50.

(6.) Dockery, D.W, and C.A. Pope (1994), "Acute Respiratory Effects of Particulate Air Pollution," Annual Review of Public Health, 15:107-132.

(7.) U.S. Environmental Protection Agency (1991), Air Emissions from Municipal Solid Waste Landfills--Background Information for Proposed Standards and Guidelines, Research Triangle Park, N.C., March 3-18, 1991.

(8.) Bureau of the Census (1992), 1990 Census of Population and Housing, Summary Tape File 3A, Washington, D.C.

(9.) Shy, C.M., B.A. Boehlecke, P.M. Briggs, P.A. Bromberg, D. Degnan, R.B. Devlin, D.L. Fox, M.J. Hazucah, S. Mukerjee, D. Rothenbacher, R.K. Stevens, and D.D. Wallace (1995), "Do Waste Incinerators Induce Adverse Respiratory Effects? An Air Quality and Epidemiological Study of Six Communities," Environmental Health Perspectives, 103(7-8):714-724.

(10.) American Thoracic Society (1978), "Recommended Respiratory Disease Questionnaire for Use with Adults and Children in Epidemiological Research," American Review of Respiratory Disease, 118:1-120.

(11.) Abramson, M.J., M.J. Hensley, N.A. Saunders, and J.H. Wlodarczyk (1991), "Evaluation of a New Asthma Questionnaire," Journal of Asthma, 28(2):129-139.

(12.) Shim, C., and M.H. Williams (1986), "Effects of Odor on Asthma," American Journal of Medicine, 80:18-22.

(13.) Shusterman, D. (1992), "Critical Review: The Health Significance of Environmental Air Pollution," Archives of Environmental Health, 47(l):76-87.

(14.) U.S. Department of Health and Human Services (1996), Healthy People 2000: Midcourse Review and 1995 Revisions, Publication Number 9601062, Rockville, Md.: U.S. Government Printing Office.
 Demographic Characteristics of Respondents
Characteristic Landfill Community North-Shore Community
 (n = 541) (n = 289)
 Number % Number %
Age
 7-17 84 15.5 58 20.1
 18-24 18 3.3 11 3.8
 25-44 245 45.3 131 45.3
 45-65 194 35.9 89 30.8
Gender
 Male 214 39.6 82 28.4
 Female 327 60.4 207 71.6
Race
 Black 10 1.8 36 12.5
 White 481 88.9 219 75.8
 Other 48 8.9 33 11.5
 Not given 2 0.4 1 0.2
Current Smoker 81 15.0 44 15.2
Characteristic Outside Study Area
 (n = 449)
 Number %
Age
 7-17 109 24.3
 18-24 37 8.2
 25-44 172 38.3
 45-65 131 29.2
Gender
 Male 156 34.7
 Female 293 65.3
Race
 Black 338 8.5
 White 365 81.3
 Other 45 10.0
 Not given 1 0.2
Current Smoker 44 10.0
 Respiratory-Related Characteristics of Respondents
 (Within Past 12 Months)
Characteristic Landfill Community
 (n = 541)
 Number %
Reported physician diagnosis of asthma 250 46.2
Taking prescribed medication for asthma 308 56.9
or respiratory-related condition
Woken at night by an attack of coughing 370 68.4
Bring up phlegm first thing in the morning 262 48.4
Had wheezing at any time 379 70.1
Had shortness of breath when not 226 41.8
doing anything strenuous
Sought urgent care one or more times for 128 23.7
asthima or respiratory-related condition
Hospitalized one or more times for asthma 35 6.5
or respiratory-related conditions
Characteristic North-Shore Community
 (n = 289)
 Number %
Reported physician diagnosis of asthma 174 60.2
Taking prescribed medication for asthma 182 63.0
or respiratory-related condition
Woken at night by an attack of coughing 214 74.0
Bring up phlegm first thing in the morning 144 49.8
Had wheezing at any time 223 77.2
Had shortness of breath when not 124 42.9
doing anything strenuous
Sought urgent care one or more times for 79 27.3
asthima or respiratory-related condition
Hospitalized one or more times for asthma 16 5.5
or respiratory-related conditions
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Article Details
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Author:White, Mary C.
Publication:Journal of Environmental Health
Article Type:Statistical Data Included
Geographic Code:1USA
Date:Jan 1, 2000
Words:3203
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