Why A Community-Based Study?

Since 1980, Environmental Health Coalition (EHC) has worked with residents in the neighborhoods of Barrio Logan, Sherman Heights, Logan Heights and National City. During that time period, residents have consistently and repeatedly told us about the health problems experienced by family members. They wonder aloud about the possible connection to the environmental pollution emitted from neighboring shipyards, metal plating shops, auto body shops, and other businesses well-known to most residents.

In 1995 EHC embarked on an environmental health and justice education project for women in these communities. Over 200 women participated in Salud Ambiental Latinas Tomando Acci�n or SALTA Project and they expressed strong concerns about the impacts of pollution on the health of their families, and particularly their children. The leaders of the program, promotoras de salud ambiental, decided it was time to document those concerns and record the health status of members of their neighborhoods. Thus, this study was initiated by and for the community most at risk.

Target Communities

Survey participants all reside in the communities of Barrio Logan, Logan Heights, Sherman Heights, and National City, all low-income communities of color. 84% of residents in these communities are ethnic minorities and 30% live below the poverty line. These communities were selected because they are disproportionately impacted by environmental pollution from industries such as shipyards, Naval operations, fuel farms, metal plating shops, and chemical supply companies.

There is also a link between the ethnicity and socioeconomic status of a community and the concentration of hazardous materials, the generation of hazardous waste, and the emission of toxic air pollutants. The target communities contain about 1.8% of the County’s population and are approximately 80% Latino. However, 34% of the County’s hazardous materials and 27% of its hazardous waste are stored or generated in these areas.

Studies conducted by major industries in accordance with the California’s Air Toxics "Hot spots" Information and Assessment Act (AB2588) reveal that eight of the top twelve polluters are in or adjacent to the target communities. The 200 county industries inventoried in 1989-91 as part of the screening for this program emitted over 13 million pounds of toxic air contaminants per year; this included 1.4 million pounds from facilities located in the Barrio Logan area and 0.45 million pounds from Naval Air Station, North Island.

Limitations of the Study

As described below, this study is an informal community-based effort that does not conform with standard scientific methods for research. The purpose of the study was to collect data that would inform and enlighten residents, health professionals, regulatory agencies, businesses and elected officials about potential links between pollution and human health. The nature of the study does not establish causal links but rather suggests associations between exposure to toxic chemicals and adverse health effects.

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INTRODUCTION: The Need for a Health Survey

In the spring of 1997, Environmental Health Coalition sponsored a community-based survey to assess the health status of residents in four communities in San Diego County. Health concerns often related to exposure to toxics were documented for over 421 adults and 417 children in Barrio Logan, Logan Heights, Sherman Heights and National City.

The purpose of the survey was to gather information on the prevalence of respiratory illness, asthma, lead poisoning, and cancer. An additional goal was to assess reproductive health, since this is an early and sensitive indicator of environmental health damage. Finally, the survey includes an assessment of residents’ exposure to pollutants in San Diego Bay via swimming and eating bay fish.

Target Communities

These four neighborhoods were chosen because their housing is aging, their residents are low-income people of color, and the mix of land uses - homes, schools, and parks alongside heavy traffic and polluting industries - has made these communities some of the most heavily affected by toxic pollution in the region. These are the neighborhoods closest to downtown and San Diego Bay. The heaviest industries in the region - National Steel & Shipbuilding Company and Southwest Marine shipyards, Monsanto’s Kelco kelp processing plant, and the Naval Station at 32nd Street - are lined up along the bay front less than a quarter mile from the nearest homes. ARCO and Chevron have large tank farm facilities along the waterfront, and immense grain-loading facilities are close by at the 10th Avenue Terminal.

Table 1 compares the volume of hazardous materials stored on site or generated within the target communities to the County as a whole.

TABLE 1: HAZARDOUS MATERIAL STORAGE AND HAZARDOUS WASTE GENERATION IN TARGET COMMUNITIES
Zip Code/Communities	Hazardous Materials (Max.  lbs. on site at any one time)	Hazardous Wastes (lbs. generated per year)
92113 - Barrio Logan,  Logan Heights	69,657,593	40,870,000
92102 - Sherman Heights	973,430	1,098,175
91950 - National City	16,024,201	3,990,661
92136 - Naval Station	143,047,000	3,424,000
92101 - Downtown SD	63,200,000	6,309,000
Total for these 5 zip codes	292,901,000	55,691,836
Total for San Diego County	809,000,000	187,780,000
% of total from 5 zip codes	36%	30%
(This data is from the County Department of Environmental Health, from hazardous materials and waste inventories reported to the County by the facilities themselves. It is current as of spring, 1997. The Hazardous Materials data include solids, liquids, and those gases measured in pounds, but not gases measured in cubic feet.)

Smaller industries of all kinds are located here too, many right next door to houses. Metal plating shops, chemical suppliers, furniture makers, and auto repair shops are among the businesses with the potential to create health and safety hazards for their neighbors. In fact, within the three zip codes of this study (92113, 92102, 91950) are 460 facilities that have regulated hazardous materials on site. Lot sizes as small as 25 feet exacerbate the problems created by the intermixing of homes with industry. Moreover, as many of the homes were built before 1950, they present lead-poisoning hazards. Additional noise and air pollution sources are the I-5 freeway, the Coronado Bridge, and the surface streets such as Main Street which have heavy diesel truck traffic.

Among the families in our survey group of 188 families, 11 live within 50 feet of a business that generates a hazardous waste, and 123 families (65%) live within 500 feet of such a business. Families are close not only to industrial toxics, but also to major roads. Of the 188 families, 81 (43%) live within 500 feet of I-5, I-94, Harbor Drive, or the Coronado Bridge.

Within a quarter mile of Perkins Elementary School in Barrio Logan, there are 39 businesses that use or store regulated hazardous materials - a total of 834,500 lbs. according to hazardous materials inventories reported by the businesses to the County Department of Environmental Health.

Social and Environmental Justice

This pattern of development is seen across the nation: hazardous and polluting activities are located in neighborhoods whose residents have the least political clout to keep them out. According to a 1987 United Church of Christ study, the location of hazardous waste dump sites correlates more strongly with the racial makeup of the residents than with their economic status. The study estimated that more than half of the nation’s 26 million African Americans, and more than one-third of its Latinos, live in neighborhoods with at least one uncontrolled toxic waste site(1). Put another way, twice as many minorities can be found in communities with a toxic waste facility than in communities without one. Both social justice and health issues are part of the toxic waste picture. Because of this pattern of inequality, the environmental justice movement works to enable affected communities to recognize the threats to their health and safety and create change.

Environmental Health Coalition has worked since its inception in 1980 to reduce the health risks to residents in San Diego’s poor communities of color. Out of this work grew the SALTA (Salud Ambiental, Latinas Tomando Acci�n--Environmental Health, Latinas Taking Action) Project in 1995 - the first application of the promotora peer-education model for social change and community organizing. The promotora model builds on the cultural phenomenon in the Latino community of women forming information and assistance networks. The SALTA project educates promotoras to make individual behavior changes, such as reducing home use of toxic pesticides, while teaching them to identify industrial sources of pollution and the government agencies that regulate them. From the start, promotoras are introduced to the concept of empowerment, both for themselves and the natural networks they relate to daily. In 1997, EHC hired five of the promotoras on a part-time basis to continue organizing their communities. These organizers conducted the health survey reported here.

Community Health Concerns

The survey grew out of community residents’ concerns about the health effects on their families of exposure to environmental pollution in their neighborhoods and the lack of relevant health information on these communities. Residents are particularly concerned about air quality, pollution in the water and fish of San Diego Bay, and lead poisoning. Many residents had told the SALTA promotoras about increased asthma and other respiratory disease among children in their neighborhoods, as well as frequent eye irritation and sometimes sickening odors. Staff at Perkins Elementary School share the perception that neighborhood children are affected by the quality of
the Barrio Logan environment. Pediatric health care providers at Logan Heights Family Health Center, a primary source of health care for many residents, note that asthma is a common patient complaint in their daily practice. However, beyond standard vital statistics collected by the County and personal health information sequestered in medical files, there is little information on the health of people in these neighborhoods.

A telephone survey of 358 residents of the 92113 area conducted in 1994 by San Diego State University’s Social Science Research Laboratory for the Industrial Environmental Association, a San Diego industry association, found that residents of Barrio Logan were especially likely to be concerned about exposure to toxics: 60% rated “exposure to hazardous materials released into the environment by nearby industries” as a moderate/high risk, while 49% rated “a truck carrying chemicals crashing in your community” as a moderate/high risk. (2)

Existing Health and Environmental Information

Before conducting the community survey, EHC examined existing health and environmental information from other sources which is summarized below.

Asthma. Asthma is a chronic abnormality in airway responsiveness, characterized by a marked, reversible narrowing of the airways. The costs of asthma are staggering; by the year 2000 it is estimated that health care costs associated with asthma in the United States will be $14.5 billion.(3)

The national prevalence of asthma in children was estimated at 7.7% according to 1994 data published by the National Center for Health Statistics. A 1993 National Health and Nutrition Examination Survey reported 4% of Mexican American children with asthma.(4) This relatively low rate of asthma for Mexican American children seemed to contradict the information we were receiving from the community. However, all researchers agree that the prevalence and severity of asthma are rising across all age and ethnic groups, with children suffering the most substantial increases. Cases among very young children have increased 160% since 1980, according to a report by the Centers for Disease Control and Prevention released in April 1998. Asthma has become the most prevalent chronic disorder affecting children younger than 17. Poor children and African-American children are more likely than other children to be hospitalized from the disease, and more likely to die from it.(5)

Two other local investigations of asthma among children in or near our target communities took place around the time of our community-based health study. Although these results were not available to us prior to our survey development, both confirm our suspicion that the national “reported” rate of asthma in Mexican American children does not reflect the actual rate of suffering in the local community and that there are many cases of undiagnosed asthma.

In 1997 the San Diego Chapter of the American Lung Association conducted an asthma screening at Burbank and Logan elementary schools - both in our survey area. Children tested were referred by their parents or teachers as possibly having asthma. Out of a total 170 childrentested, 50% were found to have asthma and received follow up care through the Association’s Open Airways Program. Staff who conducted the screening noted an unusual incidence of skin disorders, such as eczema and hives, in the children, which they believed might be due to air pollution. Many of the asthmatic children also appeared to be suffering from allergies, with the pale, pasty faces, runny noses, and dark circles under the eyes that are characteristic of allergy sufferers. Nationally, about 80% of children who have asthma also have allergies, and, in children, the two conditions are closely linked. (6)

From 1991-1994, the parents of nearly 1,000 fourth grade students at Balboa, Chollas, Baker, and Emerson Elementary Schools were surveyed to determine the prevalence of asthma among this student population. Of the 654 Hispanic 9-12 year-olds in the study, 14.4% were categorized as “probable current asthma” and an additional 13.5% had respiratory symptoms indicating “possible asthma”. The probable asthma category was assigned if the child had been diagnosed by a physician as having asthma or had a history of wheezing; the possible asthma category was assigned if the child had at least two of the other common asthma-related symptoms: breathlessness, chest tightness, cough, mucous production, or congestion. A more intensive follow-up with 66 students with probable or possible asthma confirmed the likelihood of a "probable asthma" diagnosis in84.8% of the children. This study also found a significant difference in health insurance coverage among the ethnic groups in the study, with Hispanics among the lowest at 37.2%.(7)

Environmental factors. Although the specific cause of asthma is unknown, chemicals that are potentially implicated in its cause and/or exacerbation include many of the pollutants generated in the target areas from both mobile and industrial sources: ozone, nitrogen oxides, formaldehyde, acetaldehyde, cadmium, hexavalent chromium, nickel and particulate matter. To date, researchers have stopped short of listing ambient air pollution as a known cause of asthma, although it is clearly established that chemical exposures can induce asthma in occupational settings(8). Among other known triggers for asthma attacks are allergens, irritants in the air, respiratory infections, excessive exertion, emotional stress, extreme weather or sudden changes in eather, and certain medications(9). Poverty and lack of access to medical care also play an important role in increasing the toll taken by asthma in low-income, communities of color.

San Diego County is a non-attainment area for the National Ambient Air Quality Standards for ozone, a pollutant implicated in many respiratory problems. According to the US EPA Office of Air Quality Planning and Standards, ozone can irritate the respiratory system, reduce lung function, aggravate asthma, inflame and temporarily damage the lining of the lung, aggravate chronic lung diseases such as emphysema and bronchitis, and reduce the immune system’s ability to fight off bacterial respiratory infections(10).

The County has exceeded the California State standards for fine particulate matter (PM10) since 1988, with the percent of samples that exceeded the state standard ranging from 10% to 36%(11). The State of California has just classified the particulates in diesel exhaust as a toxic air contaminant and whole diesel exhaust is identified as a chemical “known to the State to causecancer” under California’s Safe Drinking Water and Toxic Enforcement Act of 1986. The volume and impact of diesel exhaust in the target community are not known. While its proximity to the ocean may help disperse air pollution, its proximity to multiple localized sources, such as freeways and major surface streets with high truck traffic, could cause high localized levels of pollution. According to the Findings of the Scientific Review Panel on the Report on Diesel Exhaust, “near-source exposures to diesel exhaust may be as much as five times higher than the 1995 population time-weighted average total air exposure.”(12) Studies in Europe have consistently found a positive correlation between the distance of residency from major roadways and the incidence and severity of asthma(13,14,15,16).

Lead. Childhood lead poisoning is a major, preventable environmental health problem. The Centers for Disease Control and Prevention (CDC) considers blood lead levels of 10 or more micrograms of lead per deciliter of blood (mg/dL) as "elevated" since levels as low as 10 mg/dL are associated with harmful effects on children's learning and behavior. A 1997 CDC report showed elevated lead levels in children to vary significantly by the age of housing: 13% of Mexican American children living in pre-1946 housing tested positive, while only 2.3% of Mexican American children living in housing built between 1946 and 1973 and 1.6% of those living in pre-1973 housing tested positive.(17)

There is ample reason to be concerned about the lead exposure of community children. The survey communities have a very high proportion of housing built before 1950, much of which is not well maintained to prevent lead hazards. The neighborhoods are also intersected by freeways, and are close to Mexico, where leaded gasoline is still available. Within the neighborhoods there are sites where lead is used now, such as radiator shops, or was used in the past, such as foundries. An additional source of lead may be dust from sites formerly used as burn dumps. Furthermore, children of Latino heritage are more likely to be served food cooked or stored in lead-glazed clay pottery from Mexico, a frequent source of elevated lead levels. San Diego County’s Childhood Lead Poisoning Prevention Program tracks cases of lead-poisoned children; of the approximately 570 total cases that they managed from January 1, 1992 through December 31, 1997, 81% have been Latino children(18).

In July 1998 EHC conducted two finger-stick blood screening events in the National City and Sherman Heights neighborhoods. Those tests showed that 12% of the children tested had blood lead levels greater than 10 mg/dL.

Birth Defects. The California Birth Defects Monitoring Program in 1991 found that, compared to babies born elsewhere in California, babies in San Diego County suffer a “markedly higher” incidence of birth defects including spine and brain formation defects, cleft palate, and missing kidney. Overall incidence of birth defects in San Diego County was 38 per 1,000 live births, compared to 29.6 per 1,000 births for the state as a whole. In San Diego, children with African-American or Latino mothers had higher rates of birth defects than children of white mothers. In other parts of California, the rates were similar for blacks, whites, and Latinos. Follow-up studies were recommended but not funded, leaving questions about causes and trends unanswered(19).

School Attendance Data. School attendance figures for the 1996-1997 school year were obtained from San Diego Unified School District. Public schools in the survey area (Barrio Logan, Logan Heights, and Sherman Heights are within SDUSD, National City is not) do not have unusual levels of absenteeism due to illness. However, the relationship between health and school attendance is not simple; parents may send children to school sick because they lack child care for them to stay home, or children may be sent home sick after arriving at school and are being counted as present. For this reason it is difficult to draw conclusions about children’s health from school attendance figures.

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SURVEY PROTOCOL:
An Informal Survey to Empower the Community

Face-to-face interviews were held with 188 women in the four target communities during May and June of 1997. Each woman was asked a standard set of questions about her health and that of her spouse, children, and other family members living in the home during the previous six months (November 1996 to May 1997). Each woman was also asked several questions regarding her reproductive history and health. Demographic information was collected and is summarized in Table 2 below.

The surveyors were five women who received training in environmental health issues and community organizing as participants in Environmental Health Coalition’s SALTA project (Salud Ambiental, Latinas Tomando Acci&emdash;n), and were subsequently hired by EHC as part-time organizers. While not professional surveyors, the women were provided with training on surveying techniques and methods. Each of these women surveyed 40 women from among her friends and neighbors, a number of whom had also been SALTA participants. All respondents were Spanish-speaking, Latina women with children, many of whom had some knowledge of EHC’s work in the community.

Survey Limitations and Strengths

The lack of a randomized survey population, the fact that many survey respondents were familiar with EHC, and the small size of the control group all detract from the validity of the survey as an objective study of the survey communities. While these methods would likely be regarded as flaws in formal academic research, they are the typical conditions under which community surveys are done. Both community organizers and residents were empowered by this opportunity to corroborate the anecdotal health concerns expressed by friends and neighbors with quantifiable data. Sharing their family health histories with caring and trusted members of thecommunity gave the survey participants confidence that the information would not fall on deaf ears.

While the survey participants are not representative of the entire community, they are probably healthier than a random sample of residents would be. Those surveyed were mothers of intact families with relatively young, employed adults and school-age children, along with some extended family members. Many have lived in the community for several years. Not included in the survey were young, unmarried mothers, elderly people living alone, women too isolated or sick to have participated in SALTA, homeless residents of the community, and very recent immigrants. If anything, this survey probably presents a rosier health picture than is the reality among all residents of the community.

Rather than attempting to construct a statistically valid portrait of community health indicators, the value of this more qualitative survey is in pointing out areas where further attention is warranted.

Survey Development

The questionnaire was developed by a survey team comprised of community members, EHC staff, and health professionals. The team included Shanna Holland, a graduate student in public health and social work at San Diego State University, one of the surveyors; Maria Miramontes, a community resident and SALTA promotora; Maria Moya, the SALTA Project Director; Joy Williams, EHC's Community Assistance Director; Diane Takvorian, EHC’s Executive Director; Dr. Ruth Heifetz, a physician specialist in occupational and environmental health; and Beatriz Barraza-RoppŽ, a health educator with expertise in the Latina peer education model. Dr. Anthony Horner of UCSD was solicited for help with questions on asthma symptoms, to assess if undiagnosed asthma might be present; his suggestions were incorporated with modifications. A draft of the survey was pilot tested on 10 families in Chula Vista during April of 1997. A copy of the survey in Spanish with an English translation is included in the Appendix.

Control Group

The pilot surveys from Chula Vista were used as a control group, along with those of 10 families from the survey group whose residences were beyond the boundaries of the four neighborhoods. Although this group is small and the survey is not attempting to present a case-control study, it is nevertheless useful to be able to compare the survey group with a similar group outside of the survey’s geographic boundaries. The control families were similar to the survey families in many respects (see Table 2). One environmental difference is that, although the ambient air quality in Chula Vista is not ideal, it is generally considered better than many areas of the county.

Survey Population

The survey was conducted in four communities: Barrio Logan, Sherman Heights, Logan Heights, and National City. Each is an older neighborhood that is now a low-income, mostly Latino community. Barrio Logan and National City are directly adjacent to San Diego Bay and the industries that ring the bay. Both these communities started out as residential neighborhoods but became mixed industrial-residential areas over the past several decades. Sherman Heights and Logan Heights are slightly further inland.

The 188 women interviewed reported on the health of a total of 838 individuals - 421 adults and 417 children. In each case, the women were the mothers of the children in the household. The percentage of families in the survey from each of the target communities was as follows:

31% Barrio Logan 21% National City
40% Sherman Heights 8% Logan Heights

Adults in the survey group ranged in age from 18 to 83, with an average age of 34. Half the adults have lived in the community for eight years or fewer, half for more than eight years. The longest time in the community was 38 years.

As the study did not include questions about where the people lived before they moved here, no conclusions can be drawn about the previous environmental exposures of survey participants. Our personal knowledge of the survey group is that most of the adults immigrated to this country from Mexico or Central America; however, many have lived in other San Diego neighborhoods before moving to one of the survey communities.

Children’s ages ranged from less than one year to 16 years, with an average of eight years. The number of children per household ranged from one to six, with an average of two. On average, the children had spent 80% of their lives in the survey communities.

  
Medical Care

Altogether, more than a third of the families do not have regular medical care. A total of 9% of the families reported having no source of medical care. Another 27% reported that they seek health care from emergency, not routine, health care providers.

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RESULTS:
Children and Adults Experience Respiratory Problems

This study was a community-based effort to collect data that would inform and enlighten residents, health professionals, regulatory agencies and elected officials about potential links between pollution and human health. The results presented here are not intended to demonstrate causal links but rather suggest associations between exposure to toxic chemicals and adverse health effects which may require further investigation or action.

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Children’s Health

A major focus of the survey was to look at the health of the children living in the target communities. It is well established that children are more susceptible to damage from   environmental pollutants. A combination of factors contribute to this situation: immature and developing nervous, immune, respiratory, and reproductive systems, behavioral patterns which may bring children into contact with pollutants, higher rates of respiration, and greater body surface to weight enhance children's intake of toxins.

The target communities have a high proportion of young people.

Respiratory Health

Both diagnosed asthma and possible asthma symptoms were assessed (see Table 3). A total of 7.7% of survey children up to age 16 were reported by their mothers as having physician-diagnosed asthma. This rate is the same as the current national rate, but higher than the reported rate of 4.4% for Mexican American children. One community, Barrio Logan, had a significantly higher rate of 10.5%. National City children had a lower rate, 4.7%.

The levels of diagnosed asthma may be assumed to under-represent actual rates of asthma in a survey population in which more than a third of the families do not have regular access to health care. Furthermore, the diagnosis of asthma itself is not entirely standardized. For these reasons, we also asked about respiratory symptoms that might indicate the presence of asthma.

Mothers were asked if their children had reported any of three symptoms that are descriptive of asthma: frequent cough without a cold, difficulty breathing, or cough with chest pressure. The results are striking in their consistency: the survey group as a whole had much higher rates of all three symptoms than did the control group, and the Barrio Logan and Logan Heights groups had consistently higher rates than did the other neighborhood groups. The survey children were also much more likely to have two or three of the symptoms, compared to the comparison group. None of the comparison group children had more than one of these symptoms.

Table 4 presents a cross-tabulation of children with one, two, or three respiratory symptoms vs. those with diagnosed asthma. There is a statistically significant correlation between symptoms and asthma (p < .00001), providing a measure of validation for these questions as indicators of asthma. Just as important, substantial numbers of children who were not diagnosed with asthma had symptoms that may indicate they do have asthma. A total of 26% of the non-diagnosed children had one or more of the symptoms, and 12% had two or three symptoms. Each of the three symptoms correlates significantly with a diagnosis of asthma (p<.0001), but "difficulty breathing" correlates most strongly with diagnosed asthma; 14% of non-diagnosed children reported this symptom.

Discussion. Whether or not the symptomatic children have the reactive airway responses of “real” asthma, they seem to be having an unusual degree of breathing difficulty. In addition, local, national, and international studies have consistently reported that at least 50% of children and adults presenting asthma-like symptoms will be diagnosed with asthma upon medical follow-up(5, 6, 20, 21, 22). Further, symptomatic but undiagnosed asthmatic children are likely to have greater lung function impairment than their diagnosed counterparts(20).

The survey children were not more likely to be living in a household with a smoker compared to comparison families, or to the US population in general (17% of adults in the survey smoke, as compared to 25% for the nation and 19% for California.) Moreover, the majority of Barrio Logan children in our survey live in the Mercado Apartments, which are relatively new housing units with low levels of typical household asthma triggers such as dust mites or cockroach allergen. Given these lower levels of household triggers, ambient air quality is one factor that remains a plausible contributor to the respiratory problems apparently experienced by these children.

Eye and Nose Irritation

People exposed to ambient air pollution commonly complain of eye and nose irritation. These
symptoms were mentioned frequently by members of the survey communities. Skin rash is another symptom that is sometimes mentioned as an early indicator of environmental pollution affecting human health. Accordingly, the survey included one question each about skin rash and eye or nose irritation within the previous six months.

Discussion. The incidence of skin rash among children in the survey group is not high compared tothe control group. However, the nose/eye irritation results are striking. All survey communities reported higher levels of this symptom than did the control group, with especially high levels in the Barrio Logan and Logan Heights neighborhoods. The group as a whole had almost twice the percentage of reports of this symptom among children as the control group. Swimming in San Diego Bay correlated positively with eye/nose irritation.

Gastrointestinal Symptoms and Headache

The survey included three questions about gastrointestinal symptoms &endash; vomiting, nausea, or stomachache -- experienced in the previous six months, and one on headaches. Results of the gastrointestinal symptoms were also analyzed to measure the numbers of children who had two or three of these symptoms.

Discussion. The results show dramatically higher levels of symptoms of gastrointestinal illness in the survey group. This finding is significant but cannot be clearly attributed to environmental
factors. The Perkins Elementary school nurse has regularly sent children home who were sickened by odors in the vicinity of the school; however, this does not explain the high levels seen in the other children. Further investigation is warranted to verify this finding and determine why these children seem to be experiencing more stomach sickness.

The incidence of headache is significant since headache is not common in children.
Pollutants or odors in the air may contribute to the incidence of headaches, but no conclusions can be drawn without further investigation.

Lead Poisoning

A primary step in combating childhood lead poisoning is to make certain that all at-risk
children receive blood lead tests. For this reason, the survey asked mothers if their children had been tested, at what age, and with what result.

Discussion. These results indicate that lead poisoning incidence in the survey neighborhoods is higher than national levels for Mexican-American children, as reported in the 1997 CDC study cited above. CDC found overall percentages for elevated blood lead levels of 4% for Mexican-American children. However, the survey result of 15% is close to the percentage of lead poisoning CDC found in Mexican-American children living in pre-1946 housing, which was 13%.

The rate of screening within our survey group was more than double the national rate of
screening; a 1994 national survey showed that about 24% of young children had received blood lead screening(23). Awareness of and testing for lead poisoning is probably higher among the survey communities because the SALTA program included a lead education unit, which encouraged screening for children. However, the rate of screening is still well below the CDC guidelines of universal screening for all young children.

Children’s Exposure to Pollutants in San Diego Bay

Twenty-two years after the federal Clean Water Act (1976) was passed, San Diego Bay is
neither fishable nor swimmable. A 1989 County of San Diego study found bay fish to be contaminated with metals, pesticides, and radioactive isotopes(24). As a result, signs were posted around the bay advising certain populations (such as pregnant women) to limit their fish consumption. The portions of the bay near the large shipyards and Naval Station are particularly polluted with heavy-metal hot spots(25), yet these are exactly the places where children have easy swimming access to the bay, at Crosby Street Park in Barrio Logan and Tidelands Park in National City.

The survey asked two questions about children’s exposure to the bay: whether the children
ever swim in the bay, and whether they ever eat fish from the bay. A total of 17% of children were reported by their mothers to swim in the bay, while 5% were said to eat the fish at least
occasionally. Differences among neighborhood groups were not significant on either question.

Discussion. In children, swimming in the bay correlated positively with eye/nose irritation, but not with symptoms of gastrointestinal illness. 

On these two questions, it may be speculated that children of SALTA participants would be
less likely to either swim in the bay or eat the fish, since the topic of bay pollution was
covered in the SALTA curriculum. If this is the case, it would mean that an even higher number of children are exposed to bay pollutants than would be expected based on these survey results.

Cancer

One childhood cancer was identified, a case of leukemia. With this small sample size it is
not possible to state whether one case among 417 children is more than the rate in the general US population. Currently in the United States, one child in 600 develops a cancer by the age of 10.

Length of Time in the Community

In general, an adverse health condition that is linked to environmental pollution might be
expected to become worse the longer one has been exposed to it. However, no consistent
relationship emerged in this survey between the percentage of people’s lives spent in the
community and their health, as measured by the various symptoms. In fact, a slightly negative
association was found with children: the longer they had been in the community, adjusting for age, the fewer symptoms of illness they had. This may indicate a “survivor bias,” that is, families who were strongly affected by environmental pollution may have left the community.

Summary: Key findings concerning children's health

• Respiratory illness and associated symptoms among children were the most striking findings of the study and include:
  

  • Survey children reported nearly twice the number of symptoms of respiratory illness than the control group.
  • 12% of all survey children not previously diagnosed with asthma reported at least two symptoms of respiratory illness that may indicate undiagnosed asthma. 7.7% of all survey children had physician-diagnosed asthma. This indicates that up to 20% of children may be asthmatic.
  • Children living within the Barrio Logan area reported more physician-diagnosed asthma than children in the other survey areas or the control group: 10.5% reported physician-diagnosed asthma compared to the national average of 7.7% and the national average for Mexican American children of 4.4%.
  • 27% of all survey children reported nose and eye irritation compared to 15% of the control group.

• Survey children reported more than double the incidence of gastrointestinal symptoms and headache than the control group.
• 50% of all survey children have had a blood test to assess possible lead poisoning. 12% of those tested had positive results.
• 17% of survey children swim in San Diego Bay raising concerns about that source of exposure to pollution.
  

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Adult Health

While children are at increased risk of adverse health effects resulting from exposure to
environmental pollutants, adults are in no way immune to these risks. Other high risk groups
include the elderly, those with preexisting heart or lung disease, and asthmatics. Moderately
exercising healthy adults can experience 15 to over 20 percent reductions in lung function from exposure to low levels of ozone over several hours(10).

Respiratory Health

Adults were asked the same set of questions about their own respiratory health as about
the children’s health.

Discussion. The patterns mirror those of the children, with overall higher rates of respiratory
symptoms and more people with two or three symptoms, compared to the comparison group. As with the children, adults in Barrio Logan and Logan heights experience more of every kind of respiratory symptom. Only diagnosed adult asthma did not follow the general pattern: comparison group adults had higher levels than survey adults.

Skin and Eye Symptoms

Adults were asked the same set of questions about skin rash and eye/nose irritation as
were asked about their children.

Discussion. As with the children, eye and nose irritation levels are strikingly higher in the
survey communities than in the control group. Barrio Logan and Logan Heights adults reported the highest levels, consistent with their children. Skin rash was less of a problem with survey adults than control group adults.

Headache and Gastrointestinal Symptoms

Forty-five percent of adults in the survey group experienced headache and nausea, compared
to 16% of adults in the control group. Of survey adults, 18% reported stomach aches and 9%
reported vomiting. Respective numbers for the control groups are 19% and 7%.

Discussion. While the survey adults do not show the consistently elevated levels of
gastrointestinal symptoms seen in the children, the very high rates of headache and nausea suggest these adults are affected by some aspect of their environment or have additional stresses in their lives not experienced by the control group adults.

Reproductive Health

Survey women were asked a number of questions related to their reproductive health. Areas
covered included difficulty becoming pregnant, miscarriages, low birth weights, and birth defects. Women were also asked whether any of their children had died, a question that produced information necessary in calculating the total number of pregnancies that occurred in the survey group and the infant mortality rate. Using the calculated total pregnancies as the denominator, the miscarriage rate was determined. Subtracting miscarriages from total pregnancies to derive the number of live births, the rate for low birth weight and birth defect rate were calculated. Table 10 shows the results, along with corresponding national data.

Discussion. As a whole, reported average rates of miscarriage, birth defects, and low birth weight among the survey group were below the national average for these rates. However, the rates for miscarriage and low birth weight are significantly higher than the national average in Logan Heights and the rate for birth defects was higher in National City.

National birth data in 1993 show a rate of 5.8% low birth weight among Mexican American
women (26); the same year, a study of Hispanic women in San Diego County noted low birth weight in 5.2% of births (27). Among our survey group, the average was slightly higher than both these rates, matching the overall national rate at 7%.

Difficulty getting pregnant is another measure of reproductive health that can be affected
by exposure to various types of environmental pollutants, which can affect the fertility of either men or women. The survey group responses were well below the national infertility rate of
approximately 17% (couples who have had unprotected sex for two years without a pregnancy).

The recruitment process for this survey (SALTA members and their friends, family, and
neighbors) undoubtedly skewed the results for these questions by excluding very young, unmarried, or childless women.

Nonetheless, the Logan Heights group stands out with consistently higher rates of negative
outcomes on all of the reproductive health questions. The small size of this group makes it
difficult to draw any conclusions beyond the need to study the situation further, however.

Cancer

Survey respondents reported two adult cancers in women: one breast, one cervical, and no
cancer among men.

Discussion. Given the relatively young age of survey adults (35 average), this is not surprising. At Logan Heights Family Health Center, diagnostic and treatment services for women with cancer, and the related funding for these services, has increased over the past several years. This increase is related to expanded governmental interest in this area. Over time, this may provide additional information about cancer in our target communities.

Occupational Health

Adults in the community reported working at many types of jobs that expose them to
hazardous materials. Information on occupation was obtained for 85% of the men and 35% of the women in the survey. The occupations listed include mechanic, gardener, housekeeper, cafeteria worker, assembly line worker, hotel maid, construction, warehouse worker, painter, and junk yard worker. A total of 43% of employed adults reported they are exposed to toxics at work.

Discussion. These responses provide qualitative information on the occupations of survey adults employed outside the home. In addition, the responses indicated that almost half of these workers believe they are exposed to toxics on the job. This certainly seems plausible given the nature of the jobs listed, and, in fact, may be a low number. However, we did not ask them to name the toxics they are exposed to, or cross-tabulate the job type with the toxics questions to verify the information.

Exposure to Bay Pollution

Approximately 12% of adults reported swimming in San Diego Bay at least occasionally; a
total of 6% report eating bay fish.

Discussion. Unlike the case with children, swimming in the bay did not have a significant
correlation with eye/nose irritation in adults. Without more specific information on when and how often the swimmers went into the bay, this cannot be interpreted further.

Summary of Key Findings: Adult Health

• Rates of adult respiratory symptoms were higher than that of the control group with 17.6% reporting 2 or 3 symptoms compared to 9.3% in the control group.
• Eye/nose irritation trends also follow those of the children; higher than comparison
  adults and more in Barrio Logan and Logan Heights.
• Incidence of gastrointestinal illness does not seem to be excessive. More survey adults
  suffer headaches than the comparison group; this finding is difficult to interpret and may or may not be linked to environmental factors.
• In regard to reproductive health, women from Logan Heights were well above national
  averages for rates of low birth weight, miscarriage, and birth defects. Considering the small sample size and the selection bias in regard to the reproductive questions, there is a need for expanded study in these communities.
• Cancer incidence does not appear to be excessive in the survey group, compared to national rates; however, our group of adults is on average younger than the general US adult population.
• The survey confirmed that some adults are exposed to bay pollution via swimming in the
  water and eating the fish.
• The results suggest that many adults work at occupations that expose them to various
  hazardous materials on the job .
  

Additional Comments of Participants

Participants had the opportunity to expand on their responses in several instances. While
these responses were not evaluated, they do provide insight into the concerns and perceptions of community members.

One open ended questions was: "Do you think contamination affects your health and that of
your family? If yes, in what way?" Of the 188 participants, 72 answered this question.
Forty-six respondents listed concerns about respiratory problems and foul odors. Fifteen felt
pollution hurt their health in every way, while 8 felt childhood development was being damaged. Skin and eye irritations, water pollution and general industrial activities were also listed as concerns by respondents.

Of 32 reasons given why an adult's health was rated as fair or poor, a few specific
diseases such as cancer, diabetes, epilepsy, and kidney problems were listed. Most, however, listed more general concerns: frequent sickness (12); persistent cough (7); headache (6); trouble breathing (3); and depression, stress, and skin allergies (1 each).

Survey participants were asked if they were exposed to chemicals in the workplace and if
they had ever become sick at work. Of 35 comments, 11 identified a type of chemical exposure: solvents (4); unspecified toxic chemicals (3); pesticides (2); soldering fumes (1); and chlorine bleach (1). Symptoms identified included headaches (9); skin/eye irritation (7); cough/chest pressure/runny nose (5); dizziness (3 -- including one who fainted); and generally feeling sick or nauseous (4). One person attributed her child's birth defects and another attributed kidney problems to workplace exposure of toxic chemicals.

Reasons given for a child's health being rated as fair or poor were: frequently sick (7);
asthma (6); headaches (5); skin/eye irritation (4) lead poisoning and cough (3 each); nervousness and stomach ache (2 each); and tooth aches (1). One child's health was extremely poor, the child having undergone many operations.

Mothers were asked if changes in the child's health had occurred since moving to the area.
The major change reported was an increase in skin and eye irritations (12). Other changes
included increased headaches (5); increased general illness and stomach aches (4 each); had developed respiratory problems (6); diagnosed with asthma (5); had developed learning problems or were hyperactive (5); and one child had been lead poisoned.

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RECOMMENDATIONS:
Action Needed to Ensure Toxic-Free Neighborhoods

As a result of the findings and conclusions of this study, EHC recommends the following: