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(information, we identified an increased risk with older paternal age \(O\
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(a decreased risk among children in whom allergic rashes were diagnosed \(\
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( disease profiles. The second analysis was )Tj
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(diagnosis. )Tj
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( reference of 0.08 \265g/L )Tj
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(\(95% CI 0.07)Tj
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-0.0457 Tc 0.1857 Tw 1 0 0 1 141.36 390.48 Tm
(0.09\). We also found levels of arsenic in urine samples ranging from )Tj
-0.0576 Tc 0 Tw -69.12 -13.92 Td
(nonde)Tj
-0.048 Tc 0.168 Tw (tectable to 1180.40 \265g/L. Normal urine levels of arsenic are lower th\
an 50 \265g/L; a level )Tj
-0.0365 Tc 0.1885 Tw 0 -13.68 TD
(>200 \265g/L is considered abnormal and may be associated with health ef\
fects. Both tungsten and )Tj
-0.0171 Tc 0.2057 Tw 0 -13.92 TD
(arsenic were identified in tap water samples community)Tj
0.084 Tc 0 Tw 267.84 0 Td
(-)Tj
0.0255 Tc 0.0945 Tw 4.32 0 Td
(wide. Six addition)Tj
-0.036 Tc 0.236 Tw 87.6 0 Td
(al metals \(antimony, )Tj
-0.0207 Tc 0.1207 Tw -359.76 -13.68 Td
(barium, cesium, cobalt, molybdenum and uranium\) were either slightly el\
evated above the )Tj
-0.0344 Tc 0.1887 Tw T*
(population geometric mean or else had more than 10% of their results abo\
ve the 95)Tj
/TT0 7.92 Tf
-0.0809 Tc 0 Tw 399.12 5.52 Td
(th)Tj
/TT0 12 Tf
-0.0276 Tc 0.0276 Tw 6 -5.52 Td
( percentile )Tj
-0.0172 Tc 0.1372 Tw -405.12 -13.68 Td
(level of the reference population or health)Tj
0.084 Tc 0 Tw 200.88 0 Td
(-)Tj
-0.036 Tc 0.156 Tw 4.32 0 Td
(based va)Tj
-0.0564 Tc 0.3204 Tw 41.76 0 Td
(lue. Although individual homes had )Tj
-0.0276 Tc 0.1876 Tw -246.96 -13.92 Td
(environmental samples with detectable levels of these metals, they were \
not elevated )Tj
0.0587 Tc 0 Tw 0 -13.68 TD
(community)Tj
0.084 Tc 54.24 0 Td
(-)Tj
0.0624 Tc 0.0576 Tw 1 0 0 1 130.56 280.08 Tm
(wide. )Tj
0 Tc 0.12 Tw ( )Tj
-0.015 Tc 0.135 Tw -22.32 -13.92 Td
(Our cross)Tj
0.084 Tc 0 Tw (-)Tj
-0.0249 Tc 0.1929 Tw (sectional analysis also identified five nonpersistent pesticides \(out o\
f 31 )Tj
-0.0136 Tc 0.1336 Tw -36 -13.68 Td
(nonpersistent pesticides or metab)Tj
-0.0206 Tc 0.1406 Tw 159.36 0 Td
(olites analyzed\) that were each above their respective 95)Tj
/TT0 7.92 Tf
-0.0809 Tc 0 Tw 271.2 5.52 Td
(th)Tj
/TT0 12 Tf
0 Tc 0.12 Tw 6 -5.52 Td
( )Tj
-0.0343 Tc 0.2057 Tw -436.56 -13.92 Td
(percentile national reference value in more than 10% of the Churchill Co\
unty urine samples. )Tj
-0.0215 Tc 0.1175 Tw T*
(These pesticides include two organophosphate pesticide metabolites, two \
chlorinated phenol )Tj
0.002 Tc 0.118 Tw 0 -13.92 TD
(pesticides, a)Tj
-0.0236 Tc 0.1436 Tw 58.56 0 Td
(nd a fungicide. We also identified an aromatic hydrocarbon pesticide tha\
t was )Tj
-0.0231 Tc 0.1964 Tw -58.56 -13.68 Td
(slightly higher than the reference. We did not find community)Tj
0.084 Tc 0 Tw 297.36 0 Td
(-)Tj
-0.0203 Tc 0.1003 Tw (wide elevations of any of these )Tj
-0.0167 Tc 0.2327 Tw -297.36 -13.92 Td
(nonpersistent pesticides in environmental samples. )Tj
0 Tc 0.12 Tw 246.72 0 Td
( )Tj
-0.0176 Tc 0.1376 Tw -210.72 -13.68 Td
(Among 11 persistent pesticides a)Tj
-0.0234 Tc 0.1777 Tw (nalyzed, we found only DDE \(geometric mean=447.07 )Tj
-0.0303 Tc 0.1983 Tw -36 -13.92 Td
(ng/g of lipid, 95% CI 355.09)Tj
0.084 Tc 0 Tw (-)Tj
-0.0474 Tc 0.0714 Tw (562.87\) to be above the )Tj
/TT1 12 Tf
-0.0218 Tc 0.1418 Tw 258 0 Td
(National Exposure Report)Tj
/TT0 12 Tf
-0.0349 Tc -0.0051 Tw 126 0 Td
( reference of )Tj
-0.0133 Tc 0.1333 Tw -384 -13.68 Td
(260.00 ng/g of lipid \(95% CI 234.0)Tj
0.084 Tc 0 Tw 169.44 0 Td
(-)Tj
-0.0392 Tc 0.1392 Tw 1 0 0 1 245.76 142.08 Tm
(289.0\). We did not find elevated levels of DDT or DDE in )Tj
-0.0166 Tc 0.1366 Tw -173.52 -13.92 Td
(environmental samples, )Tj
-0.0366 Tc 0.2046 Tw (but levels in humans can reflect historical exposure because these )Tj
-0.0482 Tc 0.206 Tw 0 -13.68 TD
(chemicals are stored in body fat. We also found a geometric mean level o\
f 10.46 ng/g of lipid of )Tj
-0.0341 Tc 0.1941 Tw 0 -13.92 TD
(hexachlorobenzene in our Churchill County study population compared with\
 the national level )Tj
0.042 Tc -0.402 Tw 456.96 0 Td
(of )Tj
-0.0217 Tc 0.1074 Tw -456.96 -13.68 Td
(less than the detection limit. However, the )Tj
/TT1 12 Tf
-0.0218 Tc 0.1418 Tw 205.68 0 Td
(National Exposure Report)Tj
/TT0 12 Tf
-0.0413 Tc 0.2813 Tw 126 0 Td
( used an instrument )Tj
EMC 
ET

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( )Tj
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( )Tj
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(-)Tj
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(February 6, 2003)Tj
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(National Center for Environmental Health)Tj
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( )Tj
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(Division of Environmental Hazards and Health)Tj
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( Effects)Tj
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( )Tj
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(EXECUTIVE SUMMARY)Tj
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(Background)Tj
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(As part of its response to the elevated number of children in Churchill \
County in whom )Tj
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(acute lymphocytic leukemia \(ALL\) had been diagnosed, the Nevada State \
Health Division )Tj
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(\(NSHD\) requested techn)Tj
-0.0317 Tc 0.1757 Tw 118.56 0 Td
(ical assistance from the Centers for Disease Control and Prevention )Tj
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(\(CDC\). The purpose of the subsequent collaborative investigation was t\
o conduct a cross)Tj
0.084 Tc 0 Tw (-)Tj
-0.0186 Tc 0.0731 Tw T*
(sectional exposure assessment to identify contaminants unique to the Chu\
rchill County )Tj
-0.054 Tc 0.174 Tw 0 -13.68 TD
(community. We )Tj
-0.0094 Tc 0.1294 Tw 80.16 0 Td
(examined exposures to certain chemical contaminants known or suspected t\
o )Tj
-0.0233 Tc 0.1433 Tw -80.16 -13.92 Td
(cause cancer in humans, associated previously with clusters of childhood\
 leukemia, thought to be )Tj
-0.0212 Tc 0.1584 Tw T*
(present in the local environment, or because we had the analytic capacit\
y to do so.)Tj
0 Tc 0.12 Tw 394.8 0 Td
( )Tj
EMC 
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( )Tj
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(Methods)Tj
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( )Tj
EMC 
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-0.0261 Tc 0.1461 Tw -8.88 -16.8 Td
(We conducted a cross)Tj
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-60.24 -308.64 Td
(-)Tj
-0.0254 Tc 0.0854 Tw (sectional exposure assessment that included the families of )Tj
-0.0322 Tc 0.2076 Tw -140.88 -13.92 Td
(children already enrolled in an NSHD leukemia investigation and comparis\
on families that we )Tj
-0.0227 Tc 0.1907 Tw T*
(identified through random digit dialing. The study population included 1\
4 i)Tj
-0.0138 Tc 0.2138 Tw 360.72 0 Td
(ll children who )Tj
-0.0331 Tc 0.1874 Tw -360.72 -13.92 Td
(resided in Churchill County before diagnosis of their ALL or acute myelo\
cytic leukemia. Case )Tj
-0.0203 Tc 0.167 Tw T*
(families included parents and siblings, as well as other care)Tj
0.084 Tc 0 Tw 284.64 0 Td
(-)Tj
-0.0404 Tc 0.1604 Tw 3.84 0 Td
(taking adults in the home. Each case )Tj
-0.038 Tc 0.1923 Tw -288.48 -13.92 Td
(child was matched with four comparison children )Tj
-0.0446 Tc 0.1989 Tw 240.96 0 Td
(by sex and age; the matched comparison )Tj
-0.0327 Tc 0.1827 Tw -240.96 -13.68 Td
(parents also were enrolled. A total of 205 participants visited a CDC cl\
inic site in Fallon, )Tj
-0.0217 Tc 0.1854 Tw 0 -13.92 TD
(Nevada. Clinic staff collected extensive questionnaire information and b\
iologic samples \(i.e., )Tj
-0.032 Tc 0.104 Tw 0 -13.68 TD
(blood, urine, and cheek swab )Tj
-0.0261 Tc 0.1727 Tw 142.8 0 Td
(samples\). Environmental samples \(i.e., indoor air, play yard soil, )Tj
-0.0363 Tc 0.1723 Tw -142.8 -13.92 Td
(household dust, and tap water\) were collected from current homes and pr\
evious homes for all )Tj
-0.0246 Tc 0.1646 Tw T*
(case families. Environmental samples were also collected from current ho\
mes for comparison )Tj
-0.058 Tc 0 Tw 0 -13.92 TD
(famili)Tj
-0.0375 Tc 0.2314 Tw (es and previous homes for one randomly selected matched comparison famil\
y for each )Tj
-0.0267 Tc 0.1836 Tw 0 -13.68 TD
(case family. Biologic and environmental samples were tested for heavy me\
tals, persistent and )Tj
-0.0182 Tc 0.1382 Tw T*
(nonpersistent pesticides, polychlorinated biphenyls \(PCBs\), and volati\
le organic)Tj
-0.0147 Tc 0.0147 Tw 384.72 0 Td
( compounds )Tj
-0.026 Tc 0.178 Tw -384.72 -13.92 Td
(\(VOCs\). We also tested the biologic samples for evidence of previous v\
iral infections. We also )Tj
-0.0275 Tc 0.1875 Tw T*
(tested environmental samples for radon and radionuclides.)Tj
0 Tc 0.12 Tw 280.08 0 Td
( )Tj
-0.0199 Tc 0.1056 Tw -244.08 -13.92 Td
(Considerable efforts were taken to ensure the quality of the analyses we\
 conducted. We )Tj
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(conve)Tj
-0.0177 Tc 0.1377 Tw 28.56 0 Td
(ned statistical and genetic advisory groups to provide external peer rev\
iew and comment. )Tj
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(In addition, a multi)Tj
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(-)Tj
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(agency panel was formed to review all environmental results using a secu\
re )Tj
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(electronic site for data presentation. We also hosted dedicated weekly )Tj
0.0021 Tc 0.1979 Tw 337.44 0 Td
(conference calls to )Tj
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(facilitate communication among state and federal partners. )Tj
0 Tc 0.12 Tw ( )Tj
EMC 
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