COOPERATIVE EXTENSION UNIVERSITY OF CALIFORNIA
ENVIRONMENTAL TOXICOLOGY NEWSLETTER

Vol. 12 No. 1 - Mar 1992

FOOD QUALITY

Table of Contents

INTRODUCTION

The publications division of the Division of Agriculture and Natural Resources recently ceased publication and distribution of Cooperative Extension Newsletters, and this is the first issue we have produced and distributed independently. To conserve as much as possible, we have revised the format slightly so that we can fit more information into a smaller area. I hope that you will not notice any change in delivery since publication of the Environmental Toxicology Newsletter will continue to be occasional and at irregular intervals. This issue will focus principally on two issues; food quality and lead.

For the past several months I have been ruminating about the subject of food safety. At a recent meeting a producer of food mentioned that he thought that safety was really an aspect of food quality, and I think his point is valid. Thus the title of this issue is FOOD QUALITY, rather than FOOD SAFETY, although I will write mostly about the safety aspects of ingesting food. I think that it is important to qualify the following commentary as a view from an industrially advanced and affluent nation. In many of the so-called developing countries the food situation is considerably different.

(I was recently in Mexico at a conference at the University of Queretaro, where I learned that in Mexico in 1990 there were over 11 million cases of reportable foodborne illness.)

FOOD QUALITY

What has happened to the food safety issue? Is it still an issue of importance? Has the focus changed? Are people still visibly concerned about it as they were two years ago? Are people eating apples again? These are some of the questions I was pondering during a high altitude flight (yes, inside an airplane so I was only a little hypoxic {lacking oxygen}). During the last couple of months I have been talking about food safety with advisors in California, and other CE colleagues across the US. It appears that food safety issues have been moved to the back burner, although the pan is still uncomfortably warm.

Marciel Pastore (Home Advisor in Napa County) told me that she only receives calls about food safety when stories have appeared in the news media about food safety issues. Walt Bentley (Farm Advisor in Kern County) told me that in his perception, growers are still concerned with producing high quality, safe produce (as they always have been), however they are not so defensive any more about their use of agricultural chemicals; they are beginning to take a proactive approach of public education. Dr. Frank Dost (Extension Toxicologist at Oregon State University, retired) tells me that he thinks the pendulum is swinging back to the center, where people will take a more reasoned approach to food safety in the future. I feel the same way, and hope that we are all correct in our assessments.

The UCD central computer system was recently revamped, and it now contains a Fortune of the Day. Sometimes these fortunes are definitions. One of the fortunes read: Chemicals, n.: Noxious substances from which modern foods are made. I plan to make a slide of this definition for presentations. It goes hand-in-hand with Paracelsus old adage: All substances are poisons, there is none which is not. The right dose differentiates a poison from a remedy. Paracelsus was writing about drugs (also chemicals), and I am always reminded of his wisdom when I read the latest listing of chemicals for the Proposition 65 list. But I digress....

Late in 1989 I prepared a presentation titled Food Safety Issues in the 1990's. To project into the future it seemed necessary to reflect on the past since as we know, history does repeat itself in many ways (at least we seem to make the same mistakes over and over again). Starting with prehistoric times, food safety probably involved two things; getting enough to eat, and not being eaten. In addition, early humans must have learned what could and could not be eaten by trying new foods, and experiencing the results. (Frank Dost claims early toxicologists watched others eat new foods, and waited a day to see if it was all right before trying it themselves. So much for canaries!) If we look at early recorded history it is apparent that food safety, up until medieval times, revolved around proper storage and preparation. Bacterial and fungal contamination of foods were the major causes of food poisoning.

During the early stages of civilization, microbial contamination continued to be a big problem, with an added twist; intentional food poisoning for political gain! Prior to the development of analytical chemistry and forensic toxicology, intentional poisoning was a common risk for the politically powerful. There was no way to know whether it was accidental or intentional food poisoning. In the 17th and 18th centuries, little changed, except that pathologists were now able to identify the post-mortem effects of poisons, and chemistry was flourishing and tests were developed to detect one of the most popular poisons, arsenic.

During the 19th century, toxicologists and chemists became even more skilled at detecting toxicants, and also discovered microbial toxins as a cause of foodborne illness. The development of technology enabled larger scale food processing resulting in better food hygiene, however there were occasional failures resulting in large outbreaks of deadly botulism. Food processing also lead to the addition of chemicals to enhance storage, and sometimes food adulterants were added as well. Enter the 20th Century, in which there have been as many changes in food safety issues as there have been advances in technology. Microbial contamination continued to be a hazard, however we have become better and better at preventing it during processing (we still have plenty at home, however). More food additives were developed and widely used, leading to the Food Drug and Cosmetic Act of 1938 and the establishment of the Food and Drug Administration (FDA). Testing procedures were developed to establish the safety of food additives, and toxicology became an important science to regulators of food and drugs. With each world war the health sciences progressed, and an astounding discovery was made; the activity of a drug may be designed, by studying how the structure of a chemical affects its biological activity. This led to a whole new era in drug manufacture, and the advent of new pesticides as well. In 1958 an amendment to the Food, Drug and Cosmetic Act was added which included the Delaney clause which absolutely proscribed the approval of any food additive which causes cancer in animals or humans.

As the century progressed, chemists became better at finding small quantities of chemicals in foods, down to the part per million level, leading to detection of chemicals in areas of the environment where they had not been found before. This scenario continued on into the 70's where the limits of detection dropped even further. Each decade brought a further 2 to 3 order of magnitude decrease in limits of detection. Human made chemicals, at measurable levels, appeared everywhere we looked. The science of toxicology however has not progressed as rapidly in detecting adverse biological responses.

(We will discuss this further in a future issue).

Late in the 20th Century, developed countries have gone about as far as they can in promoting food safety through proper food processing. Microbial contamination remains the primary cause of foodborne illness, and most of it is related to improper food handling and storage at the consumer level. Now that only a few hundred people die each year from food poisoning, consumers turn their attention to new concerns about the safety of additives and residues in food. The concerns are different because they are concerns about chronic exposure effects, where the link between exposure and disease may be hard to detect. The process of Risk Assessment is born out of statistics, and used to make predictions about potential health effects in humans, on the basis of studies in animals (an extension of the canary paradigm).

Because food safety is such an emotional issue, and because most Americans have grown up with an abundant and relatively nontoxic food supply (I hesitate to call it safe) food safety becomes a lever for promoting change in other social policies. Food safety becomes political, particularly the chronic toxicity aspects of residues in foods. Microbial contamination and improper food storage and handling still account for most outbreaks of foodborne illness. What comes next? Although the regulatory agencies entrusted with maintenance of a wholesome food supply are doing a good job, they are asked to do better with less, and educational programs are developed to help consumers understand the issues, and learn how to keep from poisoning themselves. (An unnamed academic at a prestigious university recently said that you can usually tell when an issue is just about spent because that is when the Federal Government finally gets around to addressing it with educational programs.)

One thing to remember is that residue testing is not really a food safety program. It is a program to insure that drugs and pesticides are being used according to label directions, and in a fashion which will not lead to excessive residues in treated products. The real food safety programs are inherent in the registration process during which the registrant must provide extensive toxicology data about the product, and data about the occurrence of residues in treated produce or animals. This is the real food safety program of our regulatory agencies.

So where are we going from here? Food storage and preparation will continue to be the main causes of foodborne illness; most of it caused by the end consumer. Improper diet will continue to be a major cause of chronic exposure related illness, mostly due to inadequate intake of necessary nutrients and vitamins, and due to over adequate intake of fats. Natural toxicants and environmental contaminants will still be a great concern, but will cause very few outbreaks of illness. Pesticide and drug residues will continue to be of concern, but probably will not be as useful as political tools in the future.

One question that most extension people will ask is, Where should we go from here? In Extension we are often asked to defend particular practices, or advocate a particular technology. I do not think that it is our role to defend traditional growing practices, growers, or regulators. I think that our advocacy should be limited to promoting science-based decision making processes, which means we have to incorporate the process into our daily lives. This does not mean that we abandon our own points of view, it means that we acknowledge our personal bias and how it affects our decision making processes. It also means recognizing when our own choices are not based on science. In this way, we can promote communication.

Communicating concepts of risks of low level chemical exposure (such as residues of drugs and pesticides) first requires listening to what people want to know, and why they are concerned. Listen first, then explain. One of the goals of risk communication as outlined in the National Academy of Sciences report titled Improving Risk Communication is to communicate information that will allow people to make informed decisions. It does not mean that they choose what we want, or what we would choose. It simply means they are able to make an informed decision. Involving the general public in making decisions about acceptable risks is essential. As CE educators we can assist in this process by promoting communication and offering the best science-based information available.

A VOICE FROM THE PAST

Some of the stacks of papers I have been collecting have started to turn to peat, so it was time to go through them and see what was salvageable. I came across a paper from the first issue of Regulatory Toxicology and Pharmacology in 1981. The article was written by John Frawley from Hercules Incorporated (a chemical company) and the title is The 1980s - A Decade of Change. The article is written from the perspective of an industry toxicologist, and it contains some jewels, which in retrospect should cause us to ponder just what has been accomplished during the 1980s. Presented below are some of the statements which I find most interesting and educational, and which may be of interest to you.

(In reference to the regulatory climate of the 1970s): "Certain sincerely motivated and dedicated individuals wanted to achieve a 100% safe environment, free of any risk from chemicals which cause cancer, interfere with normal reproduction and genetics, or accelerate senilic or other changes in a single living human being or in any other creature on earth. There should be no provision for trace exposure to a carcinogen because that might permit a little bit of cancer.

This `zero risk' concept was thrust upon the regulatory agencies in the seventies by the involvement in the regulatory process of many individuals untrained in the scientific process, especially lawyers, who were called upon to help draft regulations for new laws passed by Congress.

Prior to the seventies we used such language as `safe beyond a reasonable doubt,' the language of the food additives amendment to the Food, Drug, and Cosmetic Act. We knew that absolute safety was a fantasy, an unachievable goal, and we tried to reduce risks to an ever-diminishing level. Maybe we were somewhat cavalier, but if we had to resort to statistical analysis of tumor incidence at a maximum tolerated dose of a chemical in comparison with the control, we generally concluded that we did not have a toxicological effect worth pursuing. Rather than devote a great professional effort to repeating the study, or to reducing exposure to a minimum, we generally considered it more productive to move on to examining other chemicals for more significant health hazards.

This is the tragedy of the NCI bioassay program. Originally it was designed and intended to be a screening program to detect tumorigens, under the most extreme testing conditions. It was not intended to be a definitive safety evaluation. If a chemical gave a positive response under these extreme conditions, it was intended that more extensive and definitive studies be conducted, including lower doses, metabolic rates, other species, etc., to permit evaluation of the health hazard.

Unfortunately our hysteria over cancer and the Delaney philosophy the `zero risk' philosophy have prevented the regulatory agencies from this type of rational action. They are forced to act on the basis of preliminary, screening data from NCI or any organization. They find it politically unacceptable to wait for definitive research, or as the cliches go: `we cannot gamble with public health...... chemicals have no constitutional rights, they are guilty until proven innocent' the `zero risk' philosophy.

Fortunately, there is now growing recognition of the fact that there is no such thing as absolute safety and that the demands for `zero risk,' as per the Delaney philosophy, are incompatible with other needs of society. However, with this increased realization that the terms safe and hazardous are not white and black situations, but are judgments which were made previously by toxicologists, there is a growing sentiment that the public should play a role in deciding how safe is safe.

This public participation is welcome and I believe beneficial for all involved. However, it necessarily involves education and understanding, which slow the process of decision making and the ability to act. It sometimes is reduced to a standstill if the public is represented by individuals who have antiestablishment motives. But realistically, the question usually evolves from `how safe is safe?' to `how safe can we afford?' The cost of removing an ever-diminishing doubt of safety increases geometrically; and by cost, I refer not only to financial commitments, but to social benefits which are delayed or denied. At some point with every decision a degree of risk must be accepted.

Now this brings us to what is going to be the fad of the eighties-risk assessment.

This is an attempt to quantify the probability of injury or illness which may be associated with a decision to permit a specific exposure to a chemical. It is predicated on the assumption that society generally accepts certain degrees of risk associated with natural phenomena lightning, tornadoes, tidal waves, sun radiation, etc., and that risks from chemical exposures which are no greater than these background risks are generally acceptable to the public. No effort has been made to obtain a public vote on this concept and I am not at all certain how such a vote would turn out. In reality, risk assessment is merely a device for regulators to communicate to the public in a reassuring manner- so they can say that the risk of injury from exposure to a specific chemical is no greater than being struck by lightning. Everyone can relate to this analogy and it seems to have a reassuring effect.

Whether or not the assessment of risk is correct is another matter. How do you arrive at such an estimate of the probability of injury? In the case of chemicals for which we cannot establish a threshold, like some direct carcinogens, there is no biological method for predicting or extrapolating the potential effect from a dosage several orders of magnitude below a dosage level already demonstrated to produce `no measurable effects.' A small fraction of a dose which causes `no measurable effect' also should cause `no measurable effect.' But maybe biology fails us, because it is theoretically possible that an effect may exist and biology cannot measure it. In desperation we turn to the experts on probabilities and find a solution because statisticians rush in where biologists fear to tread. In statistical analysis, numbers are impersonal and are treated the same whether they are probabilities for winning at roulette or for developing a liver tumor. Fortunately, statistics can extrapolate from a `no measurable effect' level to a `less than no measurable effect' level, even though it has no biological basis and is indeed contrary to biological concepts. This is the current fad and it appears that we will spend the first several years of the eighties not debating the concept, but trying to decide which of many statistical methods is the best for extrapolation.

I am pessimistic that we will ever find any way to make this type of risk assessment a useful procedure. At the same time, I am optimistic that we will return to the positive approach of safety evaluation, in which we accept, for most toxic responses, the concept of a threshold below which no risk is involved. I believe that biological rather than statistical evaluation of the significance of effects needs to be restored, but I also believe that the public should share in this process. That sharing should not be a public debate or even public involvement in each and every decision, but participation in establishing the principles which guide the decision maker, principles based on biological observations rather than hypothetical risks.

This movement toward risk assessment and hopefully beyond it will be one of the major changes for the eighties and will affect not only the evaluation of our laboratory data, but also the type of data which we collect and the way we perform our experiments.

(In reference to Good Laboratory Practices (GLPs) which are regulatory requirements for record keeping of studies used for registering drugs and pesticides): I know of no other profession, no other occupation, no other business that has allowed itself to become so dominated by government and stripped of its integrity and pride. We are guilty until proven innocent, which is merely an extension of the same philosophy that has been adopted for years concerning chemicals. I have heard some people complacently say that the auditing/validation of toxicological studies is really not different from an outside accounting firm auditing of a company financial report. Yes, it is quite different. An accounting firm will come into a corporation or university periodically to inspect accounting procedures and practices and spot-check specific items. If these are being performed in accordance with good accounting principles, they will so certify. They do not audit and validate every contract, every bank transaction, every purchase order, every small transaction.

No, only the toxicologist and the toxicology laboratory are subject to this type of in-depth scrutiny, distrust, and regulatory overkill. More `zero risk.

'This brings us to the very practical and critical area of decision making which I think will describe the eighties -- How will we spend our resources in the toxicology laboratory? We have reached the point when technology assessment is essential. We must apply greater selectivity to our choice of investigations or we will lose ground in our quest for lower risk. We cannot afford to spend a half-million dollars and two years of time to determine whether or not a chemical is a carcinogen, mutagen, or teratogen. We cannot afford to double and redouble the number of animals we use in our studies, merely to reduce the chance of a false-negative assay. We cannot afford to devote more time on the `form' rather than the `substance' of our toxicological studies. We cannot afford the distrust and the adversary atmosphere that have divided the profession. We cannot continue to divert an unreasonable amount of our resources trying to reduce risk to zero for one chemical at the expense of needed investigations on other chemicals. We must reduce to a minimum those studies which can be predicted to contribute nothing to a safety decision, regardless of the experimental outcome.

That is, I think, our challenge for the eighties: To effect change so that our resources are dedicated to significant health and environmental problems. We must assess our technology, select the best procedures and methods, and apply them with the wisdom of Job to the most rewarding problems."

Reference: Excerpts extracted from Regulatory Toxicology and Pharmacology 1, 3-7 (1981). The paper was originally presented at the International Conference on Procedure & Methods for Assessment of Environmental Quality, sponsored by the International Academy of Environmental Safety, June 29-July 2, 1980.

LEAD

Late last year a lawsuit was filed against a number of makers of ceramicware for noncompliance with Proposition 65. The reason for the noncompliance was that lead is often used in glazes and paints, and this lead can leach out under certain conditions and enter food. Considerable media attention was focussed on this, and it provided a good opportunity for public education about the hazards of lead in ceramicware and lead from other sources. Lead is an ancient hazard and it continues to be a hazard to this day. Lead toxicity is a significant toxicologic problem in the United States and throughout industrialized and developing countries. Lead is an element and as such it is not degraded in the environment. It is particularly hazardous to children, before and after birth. It accumulates in body tissues, especially bone, and has a long half-life so that elimination takes a long time. The most significant site of toxicity is the central nervous system, and it can cause irreparable damage. In a few words, lead is a real problem.

The contribution of lead in ceramicware to human exposure depends on many factors. Most commercial ceramicware purchased within the last 10 years will not contribute significant amounts of lead to the diet unless chipped, cracked or scratched. Areas on ceramicware which do not routinely come into contact with food (plate rims, outside areas of cups, etc.) may be colored with glazes which contain amounts of lead which are not permitted on food surfaces. The FDA has established Action Levels (levels above which they will take regulatory action) for lead in ceramicware, and these levels were recently revised by FDA with the following note:

"Please note that the two new categories in the revised policy, cups/mugs and pitchers, designate articles previously classified as small and large hollow-ware, that are now separated from the hollow-ware category and addressed individually.... because they are used to hold hot acidic beverages or to store acidic beverages for extended periods of time."

Flatware 3 ppm
Small hollow-ware 2 ppm
Large hollow-ware 1 ppm
Cups and mugs 0.5 ppm
Pitchers 0.5 ppm

Last year Allison Beale (Environmental Toxicology and Water Advisor for Sacramento, etc.), Scott Wetzlich (Environmental Toxicology Extension Staff Research Associate), and I modified the FDA Quick Color Test (QCT) for lead. We call it the University of California Quick Lead Test (UCQLT), and kits are available through the UCD Toxicology Extension Office for UCCE advisors. Allison has applied the tests on a large scale in her counties (more than 3000 tests), and has found an average of 12.2% testing positive. Valerie Mellano, Environmental Issues Advisor in San Diego has tested 120 pieces of ceramicware and found more than 60% of the Mexican pieces positive. Imported ceramicware is of special concern, especially if it has not been imported for retail sale (personally purchased abroad or shipped as a gift). Allison has found that some ceramicware available through retail sales outlets also have high levels of leachable lead. There are cases on record of whole families who have suffered severe lead poisoning from the use of such items. Our greatest concern is the possible contribution of such items to the lead intake of minority children, and the subtle detrimental effects such exposure may have. The application of the UCQLT to communities and populations at risk provides a possibility for education about more serious lead risks (lead based paint), and also to prevent continued intake of low levels from an unsuspected source.

Complete test kits are available through the Environmental Toxicology Extension Office at UCD. Call Sandy Ogletree, ETX Extension Administrative Assistant for further information (916- 752-2936). For additional information about the use of these kits, contact Allison Beale in Sacramento (916-366-2013).

*******
Lead Astray

The "Newsweek" article I just read,
has filled me with a fear,
That my home may harbour hidden lead,
and harm those I hold dear;

My wife, my kids, my dog, her pups,
may be victims, one and all,
I suspect my pipes, my plates, and cups,
or the paint upon my wall;

I find the culprit is my paint,
and so removing it's a must,
It seems I must invoke a saint,
to find a contractor to trust;

The EPA, Department of Health,
HUD won't get involved;
Would it cost them too much of their wealth,
to make sure this problem's solved?

So I fear for kids everywhere,
the IQ points they've lost,
Due to lack of funds for their care,
Truly that's the biggest cost.

Ralph Lucanie RPh, CSPI
Hudson Valley Poison Center
*******

TOXICOLOGICAL TIDBITS

1. In the past, lead-based inks had been used on bread wrappers, leading us to recommend that such bags not be reused "inside-out." In late October of 1991, the FDA was told by the American Baker's Association that no such inks have been used for bread wrappers since the beginning of 1991, and that stocks should have been used up within 6-9 months. (Good News!)

(Source, Food Chemical News, Nov. 25, 1991)

2. A report in Science magazine recently stated that UDMH (unsymmetrical dimethylhydrazine, a breakdown product of Alar) is not as potent as a carcinogen as the EPA estimated during the Alar controversy; it is only half the potency originally estimated.

3. The FDA in collaboration with the Bureau of Alcohol, Tobacco and Firearms (BATF) has been expected to set an action level for lead in wine at 300 ppb (0.3 ppm), however it is likely that the level will be lower. Only a very few of the US wines tested have exceeded this level. (Stay tuned, this should be interesting!)

(Source, Food Chemical News, September 16, 1991)

4. Fumonisin is a mycotoxin produced by Fusarium moniliforme in corn. For many years it was known that moldy corn produced a very characteristic poisoning in horses known as Moldy Corn Poisoning (who said toxicologists aren't creative?) The mycotoxin responsible for this syndrome (a characteristic lesion in the central nervous system) was identified not long ago (within the last four years). The November issue of J. Agricultural and Food Chemistry contained an article in which fumonisins B1 and B2 were detected in corn-based products from 5 countries. The human health significance in not known at this time, however the authors noted that almost all samples from a coastal area of South Carolina contained fumonisins B1 and B2, and that the area has the highest risk for esophageal cancer in the US.

(Source, Food Chemical News, December 9, 1991)

5. Vets take note! Dr. Gerald B. Guest, Director of the FDA Center for Veterinary Medicine (CVM) has clarified the CVM extra-label use policy in a statement made to veal producers. The extra- label criteria "pertain only to veterinarians." Non-veterinarian producers cannot decide to use drugs in a fashion other than as labeled because they do not have the training. In addition, and this applies to veterinarians; "The extra-label use of drugs for production purposes (such as improving rate of gain, feed efficiency, milk production, or for routine disease prevention) is not allowed. CVM's policy does not provide for the extra-label use of drugs in animal feeds; a drug may not be mixed into feed for any use or level not specifically permitted by the label, even if ordered by a veterinarian."

Waste Management Educational Materials

We recently received a package of materials from the Institute of Food and Agricultural Sciences at the University of Florida called "Enviroshopping -- Shopping with Concern for the Environment." The package includes materials for use with a variety of audiences (videotape, lesson plans, etc.). The focus of the materials is consumer awareness in relation to packaging and recycling. If you would like to evaluate or utilize these materials, please call Sandy Ogletree (916)-752-2936.

CONSUMER CONFIDENCE IN FOOD SAFETY IS RETURNING

Consumer confidence in food safety has been restored after a sharp downturn following the alar and Chilean grape incidents of 1989, according to a new study by the Food Marketing Institute (FMI). The study also showed that individuals are relying increasingly on manufacturers and retailers for food safety assurances. Shoppers are less likely to rely on their own judgement about product safety, according to FMI's Consumer Attitudes and the Supermarket 1991. Although consumers rated themselves as the first choice for judgements about food safety, the level dropped from 45 percent in 1988 to 39 percent this year, while consumer reliance on manufacturers increased from 19 percent to 23 percent. The number one concern about food safety is spoilage, according to the survey, but there is less concern now than there has been over the last two years. Consumers' second major concern is the use of pesticides, insecticides, and herbicides, followed by improper packaging. Four in ten of those surveyed avoid products over issues related to the ethical treatment of animals, and three in 10 refuse to buy products that are not recyclable or have unnecessary packaging. In terms of nutrition, consumers eating less red meat increased just one percentage point from 33 to 34 percent. Consumers eating less fat increased just one percentage point, from 33 to 34 percent. Consumers eating less fat increased from 22 to 25 percent over the two year period, while those eating less salt declined from 13 percent to 10 percent. Reduced consumption of cholesterol remained unchanged at 12 percent. Consumers are eating fewer meals in restaurants this year and are turning to microwave products and their supermarkets' prepared food departments, the study showed.

Reference: The University of Georgia Veterinary Newsletter (VM 2640). Reprinted from AMI Newsletter, Vol. 24, No. 23, June 7, 1991 as stated in NEWS, Livestock Conservation Institution, July 1991.

BEHAVIORAL RISK FACTOR SURVEY OF VIETNAMESE -- CALIFORNIA, 1991

Since 1975, an estimated 979,700 refugees from Vietnam and other Southeast Asian countries have immigrated to the United States. Although public health agencies have reported extensively on the occurrence of infectious diseases in these populations, the prevalence of risk factors for noninfectious health concerns (e.g., heart disease, cancer, and unintentional injuries) have not been well defined. To characterize risk factors for selected noninfectious diseases and injuries among the estimated 280,200 Vietnamese who have relocated to California, the University of California, San Francisco, and the California Department of Health Services developed a Vietnamese-language version of CDC's Behavioral Risk Factor Surveillance System (BRFSS) for use in a computer-assisted telephone interviewing (CATI) system. This report summarizes findings from the 1991 survey and compares them with data for the general California or U.S. population.

The questionnaire included 96 questions covering 10 target areas: sociodemographics, acculturation, nutrition, exercise, tobacco use, alcohol consumption, hypertension, cholesterol, safety-belt use, and cancer screening.

Of 1705 eligible persons who were contacted, 1011 (59%) agreed to participate. The average age of respondents was 39.8 (standard deviation {SD}: 13.3) years. Most (55%) respondents were men; 30% of respondents were unmarried. The average year of immigration was 1981 (SD: 4.4 years). Less than half (45%) had completed high school; 80% reported fewer than 4 years of college. Nearly half (43%) had no health insurance; 28% lived in households with incomes below the poverty level. Most (77%) reported limited or no English fluency.

When compared with the total population of California or the United States, prevalence rates for several behavioral risk factors were higher for Vietnamese who had resettled in the United States (Table 1), including rates of smoking (men), no exercise (both sexes), never having had cholesterol checked (both sexes), not knowing cholesterol level (women), never having had recommended breast and cervical cancer screening tests (women), and never having had rectal exams (both sexes). However, rates of alcohol consumption and hypertension (both sexes) and safety- belt nonuse (men) were lower than for the total population of California.

The likelihood of having had a Papanicolaou smear was lower for women who had fewer than 4 years of college, women who were unmarried, and women who were more recent immigrants. Similarly, the likelihood of having had a breast examination was lower for women who were unmarried, were more recent immigrants, or had no health insurance. Failure to have had a mammogram was associated with more recent immigration and income below the poverty level. Men were less likely to have had a rectal exam if they were more recent immigrants and less likely to have had a stool occult blood test if they were more recent immigrants or had limited English fluency.

Editorial Note: Persons of Vietnamese origin are the most rapidly increasing segment of the Asian/Pacific Islander ethnic group in the United States. Of the more than 600,000 Vietnamese living in the United States, nearly half (46%) reside in California.

The findings in this report indicate that the behavioral risk- factor profiles of the Vietnamese in California differ markedly from those of the total population in that state. In particular, the high prevalence rate of cigarette smoking for men and the low prevalence rates of use of cancer screening tests for both sexes are consistent with previous findings. Moreover, based on a study of cancer patterns in Los Angeles County, proportional incidence ratios (PIRs) for cancers of the lung and rectum were higher for Vietnamese men than for all other racial/ethnic groups but lower for cancers of the colon and prostate. Among Vietnamese women, PIRs were higher for cancer of the cervix but lower for cancers of the colon, rectum, breast, and lung. Because these data indicate that Vietnamese in California are at higher risk for some chronic diseases, ethnically tailored health promotion programs are needed to reduce these risks and lower barriers to preventive services. In addition, cancer screening programs should target more recent immigrants who are least likely to have received recommended cancer screening tests.

The findings in this report have at least three limitations. First, all prevalence estimates were based on self-reports that were not independently validated. Second, because the CATI methodology excluded potential respondents without telephones, certain information biases might have been introduced. Finally, although these findings can be generalized to all Vietnamese living in California, they may not represent valid estimates of the behavioral risk factors for Vietnamese who reside in other states.

Although ethnic populations may be at higher risk for certain behaviors and health outcomes, national and state health risk- factor surveys often do not sufficiently sample ethnic populations to ensure reliable statistical estimates. Because of these limitations in reliable baseline data, national health objectives for the year 2000 could not be established for Asian/Pacific Islanders and certain other ethnic populations. However, the rapid evolution of the demographic composition of the U.S. population impels the collection of such ethnicity- specific risk-factor data. The standard CDC BRFSS methodology is one such approach that can be adapted to survey an ethnic community by using a culturally appropriate and native-language instrument.

Reference: MMWR, Vol. 41/No. 5, February 7, 1992.

PESTICIDE ILLNESSES DROP IN CALIFORNIA WORKERS

A report released August 30 by the California Department of Pesticide Regulation quotes figures made available by James W. Wells, CDPR interim director. "From 1982 through 1988, there were an average of 349 cases per year associated with exposures to field residues," Wells said, "In 1989, there were only 162 such cases," and added that preliminary data in 1990 showed a similar drop. "While it is too early to draw firm conclusions, we are certainly pleased by this trend."

The report pointed out CDPR increased the re-entry interval for several pesticides in 1988 and 1989. Also, in 1989, 45% of the cases of possible or confirmed pesticide exposure (782 cases) were caused by exposure to disinfectants and other antimicrobials, which under CDPR's current tracking system are viewed as pesticides.

Eleven deaths in 1989 were attributed to pesticides. Four were suicides. Another four individuals died when they ignored warning signs and irritant gas and entered structures being fumigated. Two trespassers died in rail cars being fumigated. One occupational death resulted from use of liquid nitrogen during termite fumigation.

The report did note that illnesses occurring outside the working environment may be under-reported.

Reference: Kansas Pesticide Newsletter, Vol. 14/No. 11, November 15, 1991 (from: Ag Consultant, Fall 1991).

Arthur L. Craigmill, Ph.D.
Environmental Toxicology
University of California
Davis CA 95616-8588
(530)752-2936