** The public comment period to the EPA ends April 17, 2006 **
From the EPA
Click here for an electronic copy of the NAAQS
The CASAC letter to the EPA
How to comment, from the EPA
EPA's final Ozone Criteria Document
From the CA Air Resources Board (ARB)
California's rationale for PM standards set in 2002
Proposed Identification of Environmental Tobacco Smoke (ETS) as a Toxic Air Contaminant (PDF) Executive Summary, June 2005.
Recent information about ETS Recent Research/Fact Sheets
Analysis of Primary Fine Particle National Ambient Air Quality Standard Metrics, Philip R.S. Johnson and John J. Graham, Journal of Air & Waste Management Association: Volume 56, 206-218, February 2006.
Coarse Particle Fact Sheet (Word) from Environmental Defense
Featured Presenations
Powerpoint Presentation, George Thurston, Sc.D.
Powerpoint Presentation, Melanie Marty, Ph.D
Call Notes
Speakers: John Balbus, MD, MPH, George Thurston, Sc.D., and Melanie Marty, Ph.D.
I. Welcome and Introduction: Susan W. Marmagas, Director of Health Programs, Collaborative on Health and the Environment II. Presentations
1) John Balbus, MD, MPH, Director, Health Program, Environmental Defense Particulate Matter (PM) pollution is the most lethal type of pollution. Premature death estimates range from 50,000-100,000 in the U.S., outnumbering automobile accident deaths.
Basic Info: Particles are classified based on diameter and health considerations. Fine Particles are particles less than 2.5 micron in diameter, and can penetrate deeply in the lungs. The smallest fine particles, less than 1 micron, can go all way through the lungs and make their way into the systematic circulation, potentially contributing to blood vessel damage, leading to atherosclerosis, heart attacks, and other health effects. Larger particles, or Coarse Particles, are between 2.5 and 10 micron in diameter, and are more likely to stay in the lungs, penetrating deeply. If these particles get trapped, inflammation may cause the release of chemicals that can get into the systemic circulation and lead to blood vessel damage, diabetes, children susceptible to heart problems, stunted lung growth, worsening respiratory disease such as asthma, etc.
Major mandate sources of fine particles include power plants, diesel exhaust and roadway pollution. Coarse particle sources come from the burning of coal/fossil fuels, roadway pollution, windblown dusts/soil, etc.
Regulation: The US EPA has two ways of dealing with PM pollution: First, the EPA addresses PM sources with specific rules on a source-by-source basis, examples include the Clean Air Interstate Rule (CAIR), diesel exhaust rules, etc. Second, the EPA uses the National Ambient Air Quality Standards (the NAAQS), a two-part system to control air pollution, which includes deliberation and standard setting, as well as implementation plans. If certain areas do not meet national standards, a state implementation plan for those areas take effect.
The Clean Air Act, the federal law passed in 1970, was designed with a unique mandate that includes three important components: 1) The protection of public health, 2) including the most susceptible subpopulations, 3) with an adequate margin of safety. Basic elements of the act include the NAAQS for PM pollution regulation. The NAAQS are based solely on scientific health considerations, although economics come into play with implementation, and are due for revision every 5 years. Due to the Clean Air Act and the NAAQS, great strides have been made in reducing air pollution in the past several years. The EPA has developed an iterative, intensive, and rigorous process for setting the NAAQS, including:
1) A thorough review of all scientific literature by EPA scientists, resulting in a criteria document, a comprehensive document that is peer reviewed by a panel of experts assembled as a subcommittee for the Clean Air Scientific Advisory Committee (CASAC);
2) Once the CASAC approves the criteria document, the EPA then translates the scientific results of the studies into a risk and policy assessment, resulting in a staff paper that is thoroughly reviewed and approved by the CASAC.
3) Recommendations are then made to the EPA Administrator, who has final say.
The NAAQS proposed by the EPA on December 20th of 2005 fail to fulfill the mandate of the Clean Air Act. Also, the proposed standards provide exemptions to coverage under the Clean Air Act that undermine the scientific integrity of the standard setting process.
In the case of PM pollution, more than 2000 studies were reviewed. It was found that premature deaths from cardiovascular disease occur at levels below the current annual average standard (15ug/m3), and far below the current daily average standard (65ug/m3). Evidence for fine particle pollution is historically stronger than for coarse particle pollution, due to the fact that coarse particles are rarely measured separately from fine particles.
The CASAC clearly recommended lowering the annual and daily standards; nonetheless, the EPA is leaving the annual at 15ug/m3. This standard neither protects public health nor provides a margin of safety for the public, and includes an unprecedented exemption for agriculture and mining industries, whose course particle emissions are fully exempted. Also, regions that have less than 100,000 people will not be monitored at all because they are considered rural.
The NAAQS that have been proposed by the EPA are unexpected, coming from an EPA administrator who was touted for bringing a science background to his position. The CASAC, consisting of 22 leading experts, reached a consensus opinion that standards should be lowered substantially, and the EPA administrator failed to follow the committee’s recommendations. There will be opportunities to provide feedback to the EPA at three upcoming concurrent meetings held in Philadelphia, San Francisco, and Chicago on March 8th.
2) George Thurston, Sc.D., Associate Professor of Environmental Medicine, Nelson Institute of Environmental Medicine, NYU School of Medicine Background/history (Slides 2, 3 & 4): In the late 1990’s, there were merely a few dozen epidemiological studies indicating an association between fine particle pollution and cardiac mortality and morbidity. The bulk of deaths were due to cardiac failure, although asthma was shown to be a consequence of PM pollution in several epidemiological studies. At that time, the biological mechanisms were unknown.
People most effected by ambient air pollution (Slide 5) are older adults, people who may have preexisting conditions or diseases, people with inadequate healthcare or who lack healthcare altogether, as well as children. Asthma is generally considered a children’s disease, but adults may be affected as well. Studies have shown that healthy adults who run on ozone alert days may be threatening lung health. For example, when measuring lung function before and after a run, researchers found that although lung function generally increases after a run on a low pollution day, a high pollution day caused lung function to remain the same or decrease. In addition to the ozone, there is also a PM inflammatory factor at play, which can exacerbate asthma even in healthy adults.
Mechanism (Slide 6, 8-12, 19): Smaller particles are deposited deepest in the lungs and stay longer, while larger particles are deposited in the upper airways and can be cleared out.
We have learned much about the underlying mechanisms of PM effects on the pulmonary system in the last few years. Some of the PM effects on the pulmonary system are:
1. Altered Lung Function: Scientists use a spirometer to measure the ability to breathe in and out. Scientists can also measure lung function decline through the diffusing capacity, a measure of oxygen transfer from the lungs to the blood. Diffusing capacity decreases with increasing PM exposure.
2. Lung Injury: Scientists can study fluids as the lungs and measure inflammation. PM exposure also causes lung inflammation; measured using concentrated ambient air Particles (CAPS) that can elicit responses. CAPS are measured from the alveolar fluids that are collected, and the inflammation impacts assessed.
3. Exacerbation of Pulmonary Disease: Studies show that nitric oxide (NO) is an indication of pulmonary inflammation, responsible for asthma attacks, and that NO levels increase with increasing PM pollution. Many children try to control pulmonary inflammation with medication. Air pollution and high NO levels work against the medication.
4. Altered Pulmonary Immune Defense: Air pollution can make people more likely to catch influenza, etc. because the body’s defenses go down. Altered immune defense can also make someone more susceptible to air pollution. PM pollution can also depress the body’s ability to inactivate bacteria, knocking down the ability to fight disease.
Transition metals: Metals cause oxidative stress in the body, potentially leading to many problems such as tissue inflammation, aging, cancer, and arthritis. Acidic sulfates originating from power plant emissions combine with particles that contain transition metals and enhance metal solubility, leading to increased bioavailability of metals, which leads to increased oxidative stress. Our bodies have only been exposed to these particles over the last couple of hundred years, and have not evolved good coping mechanisms, which explains why particles can be so damaging.
A plausible biological pathway for PM to increase mortality and morbidity has been shown. There is now coherence between the epidemiologic and toxicological data. As a result, we would expect health-based standards to become more stringent.
Recent epidemiologic analysis from the American Cancer Society (ACS) cohort study (slide 26): Graphs show the continuum of effect as concentration goes up, and vice versa. A relative risk of 1 would mean that the effect remains the same. If there were no effect of air pollution, there would be a horizontal line on 1, but when pollution levels decrease below average, the relative risk decreases. When the pollution levels are above average, the relative risk increases. For the first time, this analysis showed that lung cancer risk increases with increasing air pollution. The lung cancer risk of living in a city like New York or Washington D.C. is roughly the same as the risk of a nonsmoker living with a smoker.
Short-term studies (slide 29) show that an association exists between particles and mortality below the mean concentration, 15ug/m3. Multi-city studies with narrow confidence bands show effects below 15, which suggests that the annual standard should be below 15ug/m3.
Ruling out other pollutants (slide 30): If other pollutants, such as ozone, NO2, CO, and SO2 were responsible for PM effects, there would be an upward slope of relative risk with increasing pollution, but instead there is a horizontal line with surrounding scatter, indicating that other pollutants are not responsible for PM effects. Other studies suggest that coarse particles may be associated with acute health effects (slide 31).
Benefits analysis (slide 32-36): Slide 32 and 33 shows a graph taken from the EPA staff paper, showing analysis from a study in St. Louis. Essentially, these graphs show that lowering the short-term standard will not be beneficial (i.e. show significant decreases in mortality and morbidity) if the long-term is not lowered below a certain threshold, unless the short-term is lowered to 25ug/m3.
Slides 34-36 shows the analysis by the EPA of numbers of deaths in 5 cities that would occur at various standards: 15/65, 15/40 (close to what the administrator is proposing), and 12/25. It’s not until we get down to 12/25ug/m3 that we see a decrease in numbers of deaths. Again, with a higher long-term standard of 15 ug/m3, few places can meet the short-term standard of 35ug/m3, which is why the long-term standard needs to be lowered to see a real reduction, although lowering the short-term to 25ug/m3 may show some benefit.
Implications (Slide 37): New toxicological research has shown numerous effects and plausible pathways that support the epidemiological data, supporting new standards lower than those proposed by the EPA administrator. Without lowering the long-term standard, we will not see health benefits, and will be ignoring the great amount of research that has been done in the last few years.
3) Melanie Marty, Ph.D., Chief, Air Toxicology and Epidemiology Section, Cal/EPA’s Office of Environmental Health Hazard Assessment (OEHHA), presenting PowerPoint slides created by Bart Ostro, Ph.D., Chief, Air Pollution Epidemiology Unit, OEHHA
In 2002, the California Air Resources Board (ARB) promulgated new standards (slides 1,2). Unlike the current EPA proposal, CA included a PM 10 as well as a PM 2.5 standard, although there is still no coarse standard yet. CA reduced the annual average from 30 – 20ug/m3, compared to EPA’s 50ug/m3. In 2001, the CA ARB determined to add an annual average standard of 12ug/ m3, compared to the EPA’s 15ug/m3.
Several studies were taken into account for this decision (slides 3-5): the Harvard 6-Cities Study, the American Cancer Society Study, and the Adventist Health Study, which have examined the effects of long-term exposure to PM10 and PM2.5 on mortality. A large number of individuals were followed for a longtime, and associations were found between PM 2.5 exposure and cardiac mortality, lung cancer, and a significant reduction in life expectancy. If taking into account the most and least polluted cities, the average decline in life expectancy was 1.5 years.
The evidence from these studies is consistent and coherent (slide 6), linking PM pollution to many problems, including the worsening of asthma, work loss, respiratory problems, hospitalization, lung function decrement, increased emergency room visits, etc.
Long-term exposure also affects morbidity in kids (slide 7), causing bronchitis, chronic coughs, etc. Although the jury is still out, PM exposure during pregnancy may lead to low birth weight, premature birth, birth defects, etc. A Southern California Children’s Health Study that took place over a 4-year period (now 8 years) showed an association between PM 2.5, PM 10, coarse particles, acid vapors, NO2, and reduced lung growth in kids. It is difficult to pin-point which pollutant is the worst actor.
The rationale for the standard (slide 8-11): CA focused on the mortality studies because they provided the most robust data. Because there is a linear exposure response for the PM effects, particularly mortality, the assumption can be made that effects will occur throughout a range of concentrations. In order to pick a number, they had to intuit that occurrences of these effects were more likely to occur at the upper end of the distribution, and therefore identified the mean as the minimum effect level. They wanted a standard below the mean to provide for an adequate margin of safety. Note that morbidity effects occur in the same range as mortality effects, so even though CA chose to focus on mortality data, public health would still be protected from morbidity. Also, it was thought that focusing on attaining an adequate annual standard would force the short-term averages, especially the peaks, down. The PM 10 was kept as a backstop.
Under the assumption that most PM 10 effects occur above the mean, the PM 10 standard was set for below the mean, indicated by the red line. The squares represent the range of concentration in a given study, and the diamonds represent the study mean concentration for PM 10.
Again, the red line represents where CA chose to put the PM 2.5 standard, at 12ug/m3. Although 15ug/m3 was considered because it is the national standard, but CA did not think it provided an adequate margin of safety.
A benefits assessment done by the CA ARB showed that lowering the proposed annual average PM 10 standard would prevent 6500 premature deaths/year, thousands of hospitalizations for cardio-pulmonary problems (including asthma), and 389,000 lower respiratory symptoms for kids 7-14 years-old, representing missed school days.
III. Discussion
Q. Dr. Ronald Sass, with the Allergy & Asthma Diagnostic Treatment Center, asked what the second most important type of pollution would be, assuming that particle pollution is the most important. He also wondered if there exists a good website that can estimate how many years may be shaved off of your life, depending on where you live.
A. George Thurston emphasized that different types of pollution will be important to different groups of people. For example, in the city center, traffic pollutants would be important, and SO2 emissions from power plants are important in particle pollution. In general, people mostly worry about particle and ozone pollution.
John Balbus commented that ranking pollution types is difficult, because in many cases one source can have several different types of emissions.
Kevin Stewart, with the American Lung Association (ALA), suggested the US PIRG reports as a good source for this type of information.
Q. Tony Delucia, formerly the National Chair of the American Lung Association, asked about how many areas would become non-attained with a more stringent standard like 12 or 13 ug/m3.
John Balbus answered that he could provide Tony with an EPA analysis of how many areas would be non-attainable with different standards. The analysis shows that, 7-10 years from now, there would be very few additional non-attainment areas with the current standard, and hundreds more with a more stringent standard.
Q. Neil Gendel, Project Director of the Healthy Children Organizing Project, asked about the relationship between in-door and outdoor pollution.
A. Melanie Marty commented that in some respects, indoor air might be worse than outdoor air, but in terms of fine particles, indoor air is not considered worse because, at least in places like California where the weather is nice, PM in outdoor air contributes to indoor air pollution due to good weather and open windows, etc.
Q. Unknown Speaker asked about the rationale for coarse particle standard rollback in rural areas, versus fine particles.
A. John Balbus responded that a mere handful of studies have investigated course particles (PM 2.5 to PM 10) particularly, and those that have been done took place in urban areas, though they did show respiratory effects, increased morbidity, and premature mortality. One rural study was done in the Coachella Valley, but the EPA uses two other, non-applicable studies to defend the rollback - one from the volcanic ash of Mt. Saint Helens, and the other from a dust storm in Spokane, Washington. They claim that there is not enough evidence to support or refute effects of coarse particles, and therefore cannot set a standard for anything but urban-types particles, assuming that urban-types particles do not occur in rural areas of less than 100,000 people. The reality is the agriculture and mining are not clean processes.
Melanie Marty added that in Coachella valley, PM 10 and less are dominated by crustal material, and the standard that was chosen is out of whack with the studies. Also, transitional elements certainly occur in dirt, which would make rural areas harmful as well. Crystal and silica can be a serious health hazard to those exposed (i.e. miners getting silicosis at surprisingly low levels). Crystal and silica make up about 12% of earth’s crust, and are therefore crustal in origin.
Polly Hoppin thanked participants for comments and speakers for their informative presentations, and mentioned that she and Susan will be following up with participants through email about the future directions of the CHE Asthma Working Group.
Participant List
Ellen Alkon, M.D., M.P.H.
Director, Public Health Education in Medicine
241 N. Figueroa Street, Room 143
Los Angeles, CA 90012
213-250-8623
ealkon@dhs.co.la.ca.us
John Balbus, MD, MPH
Director, Health Program
Environmental Defense
1875 Connecticute Avenue, NW, Suite 600, Washington, DC 20009
202-387-3500
jbalbus@environmentaldefense.org
Vanessa Briggs, MBA
Executive Director, Health Promotion Council
Phila. Allies Against Asthma, Project Director
215-731-6150
Phil Brown, Ph.D.
Professor of Sociology and Environmental Studies
Brown University
Box 1916, Providence, RI 02912
401-863-2633
phil_brown@brown.edu
Doug Brugge
Associate Professor
Public Health & Family Medicine, Tufts University School of Medicine
136 Harrison Avenue
Boston, MA 02111
617-636-0326
dbrugge@aol.com
Sandy Buchanan
Executive Director
Ohio Citizen Action
614 W. Superior Avenue, Suite 1200
Cleveland, OH 44113
216-861-5200
sbuchanan@ohiocitizen.org
Lynn Carroll, Ph.D.
Database Manager
TEDX, Inc. (The Endocrine Disruption Exchange)
211 Grand Avenue, Suite V
Paonia, CO 81428
970-527-4082
tedx@tds.net
Marie Chan
IAQ Steering Committee Member for Novato Unified School District
IAQ Steering Committee, Marin County, CA
9 Pioneer Court
Novato, CA 94945-2119
415-892-4655
my.ch@comcast.net
Anthony J. DeLucia, Ph.D.
Board of Directors
Kingsport Tomorrow
214 Commerce Street, Suite 103
Kingsport, TN 37614-0575
423-246-2017
delucia@mail.etsu.edu
Steffi Domike, M.F.A.
Coordinator
Collaborative on Health and the Environment of Pennsylvania
c/o PennFuture, 425 6th Avenue, Suite 2770
Pittsburgh, PA 15219
412-258-6687
che-penn@comcast.net
Adrienne Fitch-Frankel, MALD
Executive Director / Attorney
CalCOSH Legal Services Support Project
353 Vallejo Street
San Francisco, CA 94133
510-302-1043
calcoshlegal@worksafe-cosh.org
Bindi Gandhi, M.A.
Addressing Health Disparities in Asthma Health Educator/Policy Specialist
California Department of Health Services, Environmental Health Investigations Branch
850 Marina Bay Parkway, Building P, 3rd Floor
Richmond, CA 94804-6403
510-620-3605
BGandhi@dhs.ca.gov
Meleah Geertsma, J.D., M.P.H.
Staff Attorney and Public Health Specialist
Environmental Law and Policy Center
35 East Wacker Drive #1300
Chicago, IL 60601
312-673-6500
mgeertsma@elpc.org
Neil Gendel
Project Director
Healthy Children Organizing Project, Consumer Action
221 Main Street, Suite 480
San Francisco, CA 94103
415-777-9648
neil.gendel@consumer-action.org
Michael Green, M.A., MPP
Executive Director
Center for Environmental Health
528 61st Street, Suite A
Oakland, CA 94609
510-594-9864 ext. 101
mgreen@cehca.org
Elina Green, MPH
Project Manager
Long Beach Alliance for Children with Asthma
2651 Elm Avenue, Suite 100
Long Beach, CA 90806
562-427-4249
egreen@memorialcare.org
Steve Heilig, M.P.H.
Director of Public Health & Education
San Francisco Medical Society and Collaborative on Health and the Environment
1003 A O’Reilly
San Francisco, CA 94129
415-561-0850
heilig@sfms.org
Bonnie Holmes-Gen,
Assistant Vice President, Government Relations
American Lung Association of California
921 11th Street, Suite 700
Sacramento, CA 95814
916-442-4446
bhgen@alac.org
Polly Hoppin, Sc.D.
Program Director
University of Massachusetts, Lowell
1 University Avenue
Lowell, MA 01854
978-934-4941
phoppin@envhealth.net
Janice J. Kim, M.D., M.P.H.
Office of Environmental Health Hazard Assessment, Air Toxicology and Epidemiology Section
1515 Clay Street, 16th Floor
Oakland, CA 94612
510-622-3198
jkim@oehha.ca.gov
Barbara Kwetz
Director, Bureau of Waste Prevention, Planning & Evaluation Division
Massachusetts Department of Environmental Protection
One Winter Street
Boston, MA 02420
617-292-5882
Barbara.Kwetz@state.ma.us
Amy D. Kyle, Ph.D., M.P.H.
Research Scientist and Lecturer
School of Public Health, University of California Berkeley, Environmental Health Sciences Division
SPH EHS, 140 Warren Hall MC 7360
University of California, Berkeley
Berkeley, CA 94720
510-642-8847
adkyle@berkeley.edu
Michael Lerner, Ph.D.
President, Commonweal
P.O. Box 316
Bolinas, CA 94924
415-868-0970
mlerner108@aol.com
Kate Lorenzen
Regional Asthma Management and Prevention (RAMP) Initiative
180 Grand Avenue, Suite 750
Oakland, CA 94612
510-302-3316
kate@rampasthma.org
Rebecca Love
Associate, Health & Environment Programs National Environmental Education & Training Foundation
1707 H Street, NW Suite 900
Washington, DC 20006
202-261-6475
Rebecca@neetf.org
Shan Magnuson
Asthma Project Director
Sonoma County Asthma Coalition, American Lung Association - Redwood Empire Branch
115 Talbot Avenue
Santa Rosa, CA 95404
707-527-5864
smagnuson@alac.org
Susan West Marmagas, M.P.H.
Director of Health Programs
Collaborative on Health and the Environment
P.O. Box 501
Merrifield, VA 22116-0501
703-204-4702
susan@healthandenvironment.org
Melanie Marty, Ph.D.
Chief, Air Toxicology and Epidemiology Section, Cal/EPA’s Office of Environmental Health Hazard Assessment (OEHHA)
1515 Clay St., 16th Floor
Oakland, CA 94612
mmarty@oehha.ca.gov
Leyla Erk McCurdy
Senior Director, Health and Environment Programs
National Environmental Education & Training Foundation
1707 H Street NW, Suite 900
Washington, DC 20006-3915
202-833-2933
mccurdy@neetf.org
Stephanie Moen
CAFA - Project Director
Tulare County Asthma Coalition
869 Cherry Street
Tulare, CA 93274
559-685-3494
smoen@tdhs.org
Laura Moller-Leon
310-764-0955
lmoller@inmed.org
Rachel Morello-Frosch, Ph.D, M.P.H.
Assistant Professor
Center for Environmental Studies and Department of Community Health, School of Medicine, Brown University
135 Angell Street, Box 1943
Providence, RI 02612
401-863-9429
Rachel_Morello-Frosch@Brown.edu
Leo Petrilli
306 Partington Avenue, Apartment 105
Windsor, Ontario N9B 2B5
519-253-4223
leovan7052@yahoo.ca
Cindy Purinton
Cindy.Purinton@chw.edu
Ronald H. Saff, M.D.
Allergy & Asthma Diagnostic Treatment Center
2300 Centerville Road
Tallahassee, FL 32308
850-386-6680
ronsaff@aol.com
Ted Schettler, M.D., M.P.H.
Science Director
Science and Environmental Health Network
39 Bromfield Street, #2
Newburyport, MA 01950
978-462-4092
tschettler@igc.org
Derek Shendell, D.Env., MPH
Assistant Professor, Environmental Public Health Sciences/ Prevention Sciences track
Institute of Public Health, College of Health and Human Sciences, Georgia State University
P.O.Box 3995
Atlanta, GA 30302-3995
404-651-4262
alhdgs@langate.gsu.edu
Kevin M. Stewart
Director of Environmental Health
American Lung Association of Pennsylvania
630 Janet Avenue
Lancaster, PA 17601-4584
717-397-5203
kstewart@alapa.org
George Thurston, Sc.D.
Associate Professor of Environmental Medicine, Nelson Institute of Environmental Medicine, NYU School of Medicine
Thurston@env.med.nyu.edu
Diana Vanek
Outreach Coordinator
Center for Environmental Health Sciences, SB 385, Department of Biomedical and Pharmaceutical Sciences, University of Montana
32 Campus Drive, Skaggs 155
Missoula, MT 59812
406-243-4030
diana.vanek@umontana.edu
Julia Varshavsky
Program Associate
Collaborative on Health and the Environment and Commonweal
P.O. Box 316
Bolinas, CA 94924
415-868-0970 / 805-443-8410c
julia@healthandenvironment.org
Maricela Velásquez
Community Health Worker
CMC-Asthma Education & Management Program
1925 East Dakota Avenue, Suite 120A
Fresno, CA 93726
559-459-1585
mvelasqu@communitymedical.org
Robert L. Wahl, D.V.M., M.S.
Environmental Epidemiologist
Division of Environmental and Occupational Epidemiology, Michigan Department of Community Health
3423 N. Martin Luther King Jr. Blvd.
Lansing, MI 48906
517-335-9151
wahlr@Michigan.gov
Dona Wininsky,
ALA/WI
dwininsky@sbcglobal.net
Nikki Woolverton, M.P.H.
Illinois Asthma Program, Illinois Department of Public Health
535 W. Jefferson Street
Springfield, IL 62761
217-782-3300
NWOOLVER@idph.state.il.us
Carolyn Wysocki, M.A., M.H.S.A.
President
Ecological Health Organization, Inc. (ECHO)
531 Toll Gate Road
Berlin, CT 06037
860-828-4200
sagecarol@comcast.net
Wig Zamore,
Somerville, MA
617-625-5630
wigzamore@rcn.com
Jeanne Zborowski, Ph.D.
Senior Research Specialist
University of Pittsburgh, Graduate School of Public Health
Department of Epidemiology
130 DeSoto Street, 510 Parran Hall
Pittsburgh, PA 15261
