Ian Greaves - Academia.edu (original) (raw)

Papers by Ian Greaves

Scandinavian Journal of Work, Environment & Health, Jun 1, 1987

Scandinavian Journal of Work, Environment & Health, 1987

Occupational and Environmental Medicine, 1989

Archives of Environmental Health: An International Journal, 2002

The authors examined the relationship between parent-reported estimates of children&a... more The authors examined the relationship between parent-reported estimates of children's exposure to environmental tobacco smoke (ETS) in the home and children's urinary cotinine levels. Data were collected from a largely ethnic minority, low-income, urban sample of households in which a child had asthma and at least 1 household member smoked. Information about level of household smoking restriction, parental smoking status, and number of cigarettes smoked per day accounted for approximately 45% of the variance in cotinine concentration. Detailed information about the duration of household smoking or children's ETS exposure added no additional significant information. Questionnaires eliciting detailed information about smoking habits and children's ETS exposure may be no better at predicting children's urinary cotinine levels than simpler surveys that inquire about smoking restrictions in the home, parental smoking status, and number of cigarettes smoked at home per day.

Background: Physicians do not always provide appropriate patient care, due in part to inadequacy ... more Background: Physicians do not always provide appropriate patient care, due in part to inadequacy in their education and training. Performance outcomes, such as individuals' examination scores have been linked to future performance as physicians, accentuating the need for high-quality educational institutions. While the medical school accreditation process in the United States assures a uniform standard of quality, approximately one quarter of physicians in training and in practice in the United States graduated from medical schools located outside of the United States or Canada. These graduates of international medical schools (IMGs) have been more likely than domestically educated doctors to practice primary care and treat underserved and minority populations. An increasing proportion of IMGs who seek to enter post-graduate training programs and subsequent licensure in the United States graduated from medical schools located in the Caribbean. The quality of medical education at...

Occupational and Environmental Medicine, 1988

The inhalation of beryllium causes a serious lung disease characterised by pronounced radiographi... more The inhalation of beryllium causes a serious lung disease characterised by pronounced radiographic and functional impairments and occurs in workers engaged in the extraction and manufacture of the metal. This paper describes the beryllium exposure levels and refining processes in a large beryllium factory operating since the 1930s. Lifetime beryllium exposure histories were estimated for the 309 workers present at a health survey conducted in 1977. Beryllium exposure levels in the plant were high for many years, with some estimated exposure levels in excess of 100 jg/m3. As late as 1975, there were exposures to beryllium above 10 jig/m3 in some jobs. After about 1977, the plant was in compliance with the permissible exposure limit of 2 0 jg/m3. The median cumulative exposure in this cohort was 65 gg/m3-years and the median duration of exposure was 17 years. From copyright.

Occupational and Environmental Medicine, 1988

A cross sectional study of 297 white male workers employed in a large beryllium plant was conduct... more A cross sectional study of 297 white male workers employed in a large beryllium plant was conducted to test the hypothesis that long term exposure to beryllium is associated with decrements in pulmonary function. Spirometric measurement of pulmonary function, chest radiographs, and arterial blood gas measurements were collected. After controlling for age, height, and smoking in multivariate regression models, decrements in FVC and FEV, were found to be associated with cumulative exposure to beryllium in the period up until 20 years before the health survey. These decrements were observed in workers who had no radiographic abnormalities. The alveolar-arterial oxygen difference was associated with cumulative exposure in the 10 years immediately before survey, after controlling for age and smoking. These findings suggest that beryllium may have both short and long term pulmonary effects that are distinct from the classic forms of acute and chronic beryllium disease.

Prehospital and Disaster Medicine, 1996

Occupational and Environmental Medicine, 1989

Relations between pulmonary symptoms and exposure to respirable dust and sulphur dioxide (S02) we... more Relations between pulmonary symptoms and exposure to respirable dust and sulphur dioxide (S02) were evaluated for 145 silicon carbide (SiC) production workers with an average of 13-9 (range 3-41) years of experience in this industry. Eight hour time weighted average exposures to S02 were 1.5 ppm or less with momentary peaks up to 4 ppm. Cumulative SO2 exposure averaged 1-94 (range 0O02-19 5) ppm-years. Low level respirable dust exposures also occurred (0-63 ± 026 mg/m3). After adjusting for age and current smoking status in multiple logistic regression models, highly significant, positive, dose dependent relations were found between cumulative and average exposure to SO2, and symptoms of usual and chronic phlegm, usual and chronic wheeze, and mild exertional dyspnoea. Mild and moderate dyspnoea were also associated with most recent exposure to SO2. Cough was not associated with SO2. No pulmonary symptoms were associated with exposure to respirable dust nor were any symptoms attributable to an interaction between dust and SO2. Cigarette smoking was strongly associated with cough, phlegm, and wheezing, but not dyspnoea. A greater than additive (synergistic) effect between smoking and exposure to SO2 was present for most symptoms. These findings suggest that long term, variable exposure to S02 at 1 5 ppm or less was associated with significantly raised rates of phlegm, wheezing, and mild dyspnoea in SiC production workers, and that current threshold limits for SO2 may not adequately protect workers in this industry.

Environmental Research, 2007

As part of an assessment of schoolchildren's environmental exposures and health, a probability sa... more As part of an assessment of schoolchildren's environmental exposures and health, a probability sample of 136 children from diverse racial/ethnic backgrounds was drawn from grades 2-5 of two inner-urban Minneapolis schools (Whittier, Lyndale). Questionnaires were administered to a parent/guardian; blood samples for IgE and lung function tests were obtained. Overall adjusted rates for lifetime asthma (15.4%; 95%CI 9.3-21.5%), asthma in the last 12 months (13.6%; 7.8-19.4%), and current asthma medication use (10.5%; 5.3-15.7%) were higher than reported US national rates. Adjusted rates for lifetime physician-diagnosed asthma differed significantly among racial/ethnic groups (Po0.01): African-Americans (25.9%), White/Others (25.8%), Hispanics (9.3%), Somalis (1.8%), Asians (0%). Corresponding rates for atopy (total IgE4100 IU/mL or an allergen-specific IgE40.35 IU/mL) were: African-Americans (66.6%), White/Others (100%), Hispanics (77.2%), Somalis (78.1%), Asians (81.8%). Lung function (FEV 1 , FVC) was analyzed by linear regression using log-transformed data: significant race-specific differences in lung function were found relative to White/Others (Po0.001 for each racial/ethnic group): African-Americans (FEV 1 À16.5%, FVC À16.9%), Somalis (À22.7%, À26.8%), Hispanics (À12.2%, À11.4%) and Asians (À11.1%, À12.4%). Females had significantly lower FEV 1 (À8.8%) and FVC (À11.0%) than males. An unexplained, significant difference in children's lung function was found between the two schools. A history of physician-diagnosed asthma was not associated with decreased lung function. Factors other than poverty, inner-urban living, and IgE levels (atopy) need to be considered in the development of childhood asthma.

Environmental Health Perspectives, 2003

The School Health Initiative: Environment, Learning, and Disease (SHIELD) study used a probabilit... more The School Health Initiative: Environment, Learning, and Disease (SHIELD) study used a probability sample of children (second through fifth grades) from two low-income and racially mixed neighborhoods of Minneapolis, Minnesota, to assess childhood environmental health. Children were eligible to participate in SHIELD regardless of whether they or their families spoke a foreign language, their household had a telephone, or they were enrolled in a special education program. The overall enrollment rate in year 1 was 57%, with a substantial disparity between children from English-speaking (42%) versus non-English-speaking (71%) families. At the end of year 1, 85% were retained in the study. A relatively high percentage of children provided the two requested blood (82%) and urine (86%) samples in year 1, and 90% provided a valid spirometry sample. Eighty-two percent provided both requested volatile organic chemical badge samples, and both time-activity logs were obtained from 66%. However, only 32% provided both peak flow measurements. All percentages increased for those participating in the second year of the study. Results indicate that a school-based research design makes it feasible and practical to conduct probability-based assessments of children's environmental health in economically disadvantaged and ethnically diverse neighborhoods. There is an ongoing need, however, to improve understanding of the cultural, economic, psychologic, and social determinants of study participation among this population.

Cancer Epidemiology, Biomarkers & Prevention, 2011

Background: People exposed to secondhand tobacco smoke (SHS) inhale the lung carcinogen 4-(methyl... more Background: People exposed to secondhand tobacco smoke (SHS) inhale the lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) which is metabolized to NNAL and its glucuroniders. These urinary metabolites, termed total NNAL, can be quantified. A related compound, iso-NNAL, has been proposed as a biomarker for exposure to smoke constituent residues on surfaces (thirdhand tobacco smoke). There is limited information in the literature on levels of total NNAL in children exposed to SHS. Methods: We recruited 79 parent–child dyads from homes where the enrolled parent was a cigarette smoker and visited their homes. Parents were asked questions, home ambient air quality was evaluated, and children provided urine samples. Urine was analyzed for total NNAL, total cotinine, total nicotine, and iso-NNAL. Results: Ninety percent of the children had detectable total NNAL in urine; total nicotine and total cotinine were also detected in most samples. There were significant positive ...

American Journal of Respiratory and Critical Care Medicine, 2009

American Journal of Public Health, 1987

Journal of Exposure Science & Environmental Epidemiology, 2000

The School Health Initiative: Environment, Learning, Disease (SHIELD) study is a novel school-bas... more The School Health Initiative: Environment, Learning, Disease (SHIELD) study is a novel school-based investigation of children's environmental health in economically disadvantaged urban neighborhoods of Minneapolis. This article describes the study design and summarizes lessons learned about recruiting and monitoring this historically understudied population. The SHIELD study focused on measuring children's exposures to multiple environmental stressors [ volatile organic chemicals (VOCs) , environmental tobacco smoke, allergens, bioaerosols, metals, pesticides, polychlorinated biphenyls (PCB) , phthalates ] and exploring related effects on respiratory health (e.g., lung function) and learning outcomes (e.g., standardized test scores, academic achievement). It involved intensive exposure monitoring, including environmental measurements inside and outside the children's schools and inside their homes, personal measurements with passive dosimeters worn by the children, and biological marker measurements in blood and urine. The SHIELD participants comprised a stratified random sample of 153``index'' children and 51 of their siblings enrolled in grades 2 ± 5 at two adjacent elementary schools. The Minneapolis Public Schools (MPS) assisted with identifying, contacting, recruiting, and monitoring this population, which traditionally is difficult to study because families / children are highly mobile, speak a diversity of languages, frequently do not have a telephone, endure economic hardships, often do not trust researchers, and have a spectrum of unconventional lifestyles and living arrangements. Using a school-based approach, the overall SHIELD enrollment (response) rate was 56.7%, with a wide disparity between English-speaking (41.7%) and non-English-speaking (71.0%) families / children. Most children remained involved in the study through both monitoring sessions and exhibited an acceptable degree of compliance with study protocols, including providing blood and urine samples. Results indicate that it is both practical and affordable to conduct probability-based exposure studies in this population, but that it is also important to improve our understanding of factors (e.g., cultural, economic, psychological, social) affecting the willingness of families / children to participate in such studies, with special emphasis on developing cost-effective recruitment methods.

The American review of respiratory disease, 1987

Endotoxin exposure has been implicated in the etiology of lung disease in cotton workers. We inve... more Endotoxin exposure has been implicated in the etiology of lung disease in cotton workers. We investigated this potential relationship in 443 cotton workers from 2 factories in Shanghai and 439 control subjects from a nearby silk mill. A respiratory questionnaire was administered and pre- and postshift forced expiratory volume (FVC) and flow in one second (FEV1) were determined for each worker. Multiple area air samples were analyzed for total elutriated dust concentration (range: 0.15 to 2.5 mg/m3) and endotoxin (range: 0.002 to 0.55 microgram U.S. Reference Endotoxin/m3). The cotton worker population was stratified by current and cumulative dust or endotoxin exposure. Groups were compared for FEV1, FVC, FEV1/FVC%, % change in FEV1 over the shift (delta FEV1%), and prevalences of chronic bronchitis and byssinosis, and linear and logistic regression models were constructed. No dose-response relationships were demonstrated comparing dust concentration to any pulmonary function or symp...

American Journal of Public Health, 1983

Byssinosis, a lung disease caused by cotton dust, has been the subject of recent controversy. Deb... more Byssinosis, a lung disease caused by cotton dust, has been the subject of recent controversy. Debates over the nature of the disease, possible interactions with cigarette smoking, and the proposed reevaluation of the cotton dust standard by the Occupational Safety and Health Administration have tended to overlook the plight of affected workers and to obscure the most effective means for preventing the disease. The present lack of definitive information is no reason for inaction, nor for depriving disabled workers of adequate financial compensation. In this respect, byssinosis is no different from other public health hazards for which action must often be taken on the basis of incomplete evidence.

Scandinavian Journal of Work, Environment & Health, Jun 1, 1987

Scandinavian Journal of Work, Environment & Health, 1987

Occupational and Environmental Medicine, 1989

Archives of Environmental Health: An International Journal, 2002

The authors examined the relationship between parent-reported estimates of children&a... more The authors examined the relationship between parent-reported estimates of children's exposure to environmental tobacco smoke (ETS) in the home and children's urinary cotinine levels. Data were collected from a largely ethnic minority, low-income, urban sample of households in which a child had asthma and at least 1 household member smoked. Information about level of household smoking restriction, parental smoking status, and number of cigarettes smoked per day accounted for approximately 45% of the variance in cotinine concentration. Detailed information about the duration of household smoking or children's ETS exposure added no additional significant information. Questionnaires eliciting detailed information about smoking habits and children's ETS exposure may be no better at predicting children's urinary cotinine levels than simpler surveys that inquire about smoking restrictions in the home, parental smoking status, and number of cigarettes smoked at home per day.

Background: Physicians do not always provide appropriate patient care, due in part to inadequacy ... more Background: Physicians do not always provide appropriate patient care, due in part to inadequacy in their education and training. Performance outcomes, such as individuals' examination scores have been linked to future performance as physicians, accentuating the need for high-quality educational institutions. While the medical school accreditation process in the United States assures a uniform standard of quality, approximately one quarter of physicians in training and in practice in the United States graduated from medical schools located outside of the United States or Canada. These graduates of international medical schools (IMGs) have been more likely than domestically educated doctors to practice primary care and treat underserved and minority populations. An increasing proportion of IMGs who seek to enter post-graduate training programs and subsequent licensure in the United States graduated from medical schools located in the Caribbean. The quality of medical education at...

Occupational and Environmental Medicine, 1988

The inhalation of beryllium causes a serious lung disease characterised by pronounced radiographi... more The inhalation of beryllium causes a serious lung disease characterised by pronounced radiographic and functional impairments and occurs in workers engaged in the extraction and manufacture of the metal. This paper describes the beryllium exposure levels and refining processes in a large beryllium factory operating since the 1930s. Lifetime beryllium exposure histories were estimated for the 309 workers present at a health survey conducted in 1977. Beryllium exposure levels in the plant were high for many years, with some estimated exposure levels in excess of 100 jg/m3. As late as 1975, there were exposures to beryllium above 10 jig/m3 in some jobs. After about 1977, the plant was in compliance with the permissible exposure limit of 2 0 jg/m3. The median cumulative exposure in this cohort was 65 gg/m3-years and the median duration of exposure was 17 years. From copyright.

Occupational and Environmental Medicine, 1988

A cross sectional study of 297 white male workers employed in a large beryllium plant was conduct... more A cross sectional study of 297 white male workers employed in a large beryllium plant was conducted to test the hypothesis that long term exposure to beryllium is associated with decrements in pulmonary function. Spirometric measurement of pulmonary function, chest radiographs, and arterial blood gas measurements were collected. After controlling for age, height, and smoking in multivariate regression models, decrements in FVC and FEV, were found to be associated with cumulative exposure to beryllium in the period up until 20 years before the health survey. These decrements were observed in workers who had no radiographic abnormalities. The alveolar-arterial oxygen difference was associated with cumulative exposure in the 10 years immediately before survey, after controlling for age and smoking. These findings suggest that beryllium may have both short and long term pulmonary effects that are distinct from the classic forms of acute and chronic beryllium disease.

Prehospital and Disaster Medicine, 1996

Occupational and Environmental Medicine, 1989

Relations between pulmonary symptoms and exposure to respirable dust and sulphur dioxide (S02) we... more Relations between pulmonary symptoms and exposure to respirable dust and sulphur dioxide (S02) were evaluated for 145 silicon carbide (SiC) production workers with an average of 13-9 (range 3-41) years of experience in this industry. Eight hour time weighted average exposures to S02 were 1.5 ppm or less with momentary peaks up to 4 ppm. Cumulative SO2 exposure averaged 1-94 (range 0O02-19 5) ppm-years. Low level respirable dust exposures also occurred (0-63 ± 026 mg/m3). After adjusting for age and current smoking status in multiple logistic regression models, highly significant, positive, dose dependent relations were found between cumulative and average exposure to SO2, and symptoms of usual and chronic phlegm, usual and chronic wheeze, and mild exertional dyspnoea. Mild and moderate dyspnoea were also associated with most recent exposure to SO2. Cough was not associated with SO2. No pulmonary symptoms were associated with exposure to respirable dust nor were any symptoms attributable to an interaction between dust and SO2. Cigarette smoking was strongly associated with cough, phlegm, and wheezing, but not dyspnoea. A greater than additive (synergistic) effect between smoking and exposure to SO2 was present for most symptoms. These findings suggest that long term, variable exposure to S02 at 1 5 ppm or less was associated with significantly raised rates of phlegm, wheezing, and mild dyspnoea in SiC production workers, and that current threshold limits for SO2 may not adequately protect workers in this industry.

Environmental Research, 2007

As part of an assessment of schoolchildren's environmental exposures and health, a probability sa... more As part of an assessment of schoolchildren's environmental exposures and health, a probability sample of 136 children from diverse racial/ethnic backgrounds was drawn from grades 2-5 of two inner-urban Minneapolis schools (Whittier, Lyndale). Questionnaires were administered to a parent/guardian; blood samples for IgE and lung function tests were obtained. Overall adjusted rates for lifetime asthma (15.4%; 95%CI 9.3-21.5%), asthma in the last 12 months (13.6%; 7.8-19.4%), and current asthma medication use (10.5%; 5.3-15.7%) were higher than reported US national rates. Adjusted rates for lifetime physician-diagnosed asthma differed significantly among racial/ethnic groups (Po0.01): African-Americans (25.9%), White/Others (25.8%), Hispanics (9.3%), Somalis (1.8%), Asians (0%). Corresponding rates for atopy (total IgE4100 IU/mL or an allergen-specific IgE40.35 IU/mL) were: African-Americans (66.6%), White/Others (100%), Hispanics (77.2%), Somalis (78.1%), Asians (81.8%). Lung function (FEV 1 , FVC) was analyzed by linear regression using log-transformed data: significant race-specific differences in lung function were found relative to White/Others (Po0.001 for each racial/ethnic group): African-Americans (FEV 1 À16.5%, FVC À16.9%), Somalis (À22.7%, À26.8%), Hispanics (À12.2%, À11.4%) and Asians (À11.1%, À12.4%). Females had significantly lower FEV 1 (À8.8%) and FVC (À11.0%) than males. An unexplained, significant difference in children's lung function was found between the two schools. A history of physician-diagnosed asthma was not associated with decreased lung function. Factors other than poverty, inner-urban living, and IgE levels (atopy) need to be considered in the development of childhood asthma.

Environmental Health Perspectives, 2003

The School Health Initiative: Environment, Learning, and Disease (SHIELD) study used a probabilit... more The School Health Initiative: Environment, Learning, and Disease (SHIELD) study used a probability sample of children (second through fifth grades) from two low-income and racially mixed neighborhoods of Minneapolis, Minnesota, to assess childhood environmental health. Children were eligible to participate in SHIELD regardless of whether they or their families spoke a foreign language, their household had a telephone, or they were enrolled in a special education program. The overall enrollment rate in year 1 was 57%, with a substantial disparity between children from English-speaking (42%) versus non-English-speaking (71%) families. At the end of year 1, 85% were retained in the study. A relatively high percentage of children provided the two requested blood (82%) and urine (86%) samples in year 1, and 90% provided a valid spirometry sample. Eighty-two percent provided both requested volatile organic chemical badge samples, and both time-activity logs were obtained from 66%. However, only 32% provided both peak flow measurements. All percentages increased for those participating in the second year of the study. Results indicate that a school-based research design makes it feasible and practical to conduct probability-based assessments of children's environmental health in economically disadvantaged and ethnically diverse neighborhoods. There is an ongoing need, however, to improve understanding of the cultural, economic, psychologic, and social determinants of study participation among this population.

Cancer Epidemiology, Biomarkers & Prevention, 2011

Background: People exposed to secondhand tobacco smoke (SHS) inhale the lung carcinogen 4-(methyl... more Background: People exposed to secondhand tobacco smoke (SHS) inhale the lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) which is metabolized to NNAL and its glucuroniders. These urinary metabolites, termed total NNAL, can be quantified. A related compound, iso-NNAL, has been proposed as a biomarker for exposure to smoke constituent residues on surfaces (thirdhand tobacco smoke). There is limited information in the literature on levels of total NNAL in children exposed to SHS. Methods: We recruited 79 parent–child dyads from homes where the enrolled parent was a cigarette smoker and visited their homes. Parents were asked questions, home ambient air quality was evaluated, and children provided urine samples. Urine was analyzed for total NNAL, total cotinine, total nicotine, and iso-NNAL. Results: Ninety percent of the children had detectable total NNAL in urine; total nicotine and total cotinine were also detected in most samples. There were significant positive ...

American Journal of Respiratory and Critical Care Medicine, 2009

American Journal of Public Health, 1987

Journal of Exposure Science & Environmental Epidemiology, 2000

The School Health Initiative: Environment, Learning, Disease (SHIELD) study is a novel school-bas... more The School Health Initiative: Environment, Learning, Disease (SHIELD) study is a novel school-based investigation of children's environmental health in economically disadvantaged urban neighborhoods of Minneapolis. This article describes the study design and summarizes lessons learned about recruiting and monitoring this historically understudied population. The SHIELD study focused on measuring children's exposures to multiple environmental stressors [ volatile organic chemicals (VOCs) , environmental tobacco smoke, allergens, bioaerosols, metals, pesticides, polychlorinated biphenyls (PCB) , phthalates ] and exploring related effects on respiratory health (e.g., lung function) and learning outcomes (e.g., standardized test scores, academic achievement). It involved intensive exposure monitoring, including environmental measurements inside and outside the children's schools and inside their homes, personal measurements with passive dosimeters worn by the children, and biological marker measurements in blood and urine. The SHIELD participants comprised a stratified random sample of 153``index'' children and 51 of their siblings enrolled in grades 2 ± 5 at two adjacent elementary schools. The Minneapolis Public Schools (MPS) assisted with identifying, contacting, recruiting, and monitoring this population, which traditionally is difficult to study because families / children are highly mobile, speak a diversity of languages, frequently do not have a telephone, endure economic hardships, often do not trust researchers, and have a spectrum of unconventional lifestyles and living arrangements. Using a school-based approach, the overall SHIELD enrollment (response) rate was 56.7%, with a wide disparity between English-speaking (41.7%) and non-English-speaking (71.0%) families / children. Most children remained involved in the study through both monitoring sessions and exhibited an acceptable degree of compliance with study protocols, including providing blood and urine samples. Results indicate that it is both practical and affordable to conduct probability-based exposure studies in this population, but that it is also important to improve our understanding of factors (e.g., cultural, economic, psychological, social) affecting the willingness of families / children to participate in such studies, with special emphasis on developing cost-effective recruitment methods.

The American review of respiratory disease, 1987

Endotoxin exposure has been implicated in the etiology of lung disease in cotton workers. We inve... more Endotoxin exposure has been implicated in the etiology of lung disease in cotton workers. We investigated this potential relationship in 443 cotton workers from 2 factories in Shanghai and 439 control subjects from a nearby silk mill. A respiratory questionnaire was administered and pre- and postshift forced expiratory volume (FVC) and flow in one second (FEV1) were determined for each worker. Multiple area air samples were analyzed for total elutriated dust concentration (range: 0.15 to 2.5 mg/m3) and endotoxin (range: 0.002 to 0.55 microgram U.S. Reference Endotoxin/m3). The cotton worker population was stratified by current and cumulative dust or endotoxin exposure. Groups were compared for FEV1, FVC, FEV1/FVC%, % change in FEV1 over the shift (delta FEV1%), and prevalences of chronic bronchitis and byssinosis, and linear and logistic regression models were constructed. No dose-response relationships were demonstrated comparing dust concentration to any pulmonary function or symp...

American Journal of Public Health, 1983

Byssinosis, a lung disease caused by cotton dust, has been the subject of recent controversy. Deb... more Byssinosis, a lung disease caused by cotton dust, has been the subject of recent controversy. Debates over the nature of the disease, possible interactions with cigarette smoking, and the proposed reevaluation of the cotton dust standard by the Occupational Safety and Health Administration have tended to overlook the plight of affected workers and to obscure the most effective means for preventing the disease. The present lack of definitive information is no reason for inaction, nor for depriving disabled workers of adequate financial compensation. In this respect, byssinosis is no different from other public health hazards for which action must often be taken on the basis of incomplete evidence.