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 inquire repeatedly over time to the same company regarding the claim of a single health-related symptom; and (4) inquiries received at one CCP company might not relate to that company’s products, since some sample CCP forms submitted were those of manufacturers.

The letter further explained that most of the information they receive is anecdotal and inconsistent in terms of type, quantity, and quality of information, including the circumstances of product use. Most often the inquiry is received indirectly from merchants, printers, brokers, etc. The yearly average of health-based inquiries is stated to include claims from companies alleging health symptoms and may or may not have included the regular inquiries. Furthermore, some inquiries do not state the number of workers affected and are thus treated as a single inquiry. Some of the inquiries result from odors associated with CCP. Also, some inquiries result from news articles and may have no temporal relationship with actual exposure. For the years 1987 to 1996, the yearly average (±standard deviation) for health-based inquiries for all U.S. CCP manufacturers was 113 (±4) for 960,115 (±6,473) tons of paper sold—or approximately 1 inquiry per 10,000 tons of CCP sold (equivalent to less than 1 inquiry per 1 billion 8.5- X 11-in. sheets). The information was examined for trends by the companies. They found an increasing volume of CCP sold during the period 1987-1992, with a corresponding increasing rate of inquiries followed by an apparent sharp decrease in health inquiries over the last 5 years (1992-1996) (see Figure 4-1). CCP manufacturers have provided no descriptive details (such as conditions of work or volume of CCP used) for the health complaints that led to the reported inquiries.


 * Figure 4-1. Production of CCP and number of inquiries per year for all U.S. manufacturers from 1987 to 1996. (Source: Graves et al. [2000]. Reprinted with permission. Copyright by Academic Press.)

The cross-sectional studies reviewed in this section were conducted to evaluate either the potential health effects of indoor air contaminants in general or those of CCP specifically. Both types of studies are summarized in Table 4-3. In both cases, the information about