Study Results

ATTACHMENT X

Study Results

ATTACHMENT X1

Normal Range Health Assessment Results Letter

NORMAL RANGE HEALTH ASSESSMENT RESULTS LETTER

[DATE]

[ID]

[Name]

[Address]

[City, St. Zip]

Dear [NAME]:

Thank you very much for taking part in the Children’s Health after the Storm (CHATS) study. As promised, we are sending you the results of the laboratory tests on your child’s blood and urine as well as an explanation of these results.

All of your child’s test results are within the range considered as normal. These results are highlighted on the second page of this letter. Please note that the health assessment your child received from the CHATS study nurse should not replace any scheduled visits to your regular doctor or health care provider.

We would also like to take this opportunity to reassure you that the information you and your child provided for the CHATS Study will be kept private and will be used only for research purposes. All published information about the study will be in summary form only; your names will not be in any report with the study’s results.

While we cannot give you medical advice, if you have questions about your results or want a list of local doctors and clinics, please call our lead nurse, [NAME], toll-free at 1-800-xxx-xxxx.

We will check in on you and your child again in several months to see how you are doing and to discuss the next phase of this important survey. We hope we can count on your continued support.

S incerely,

Diane Wagener, PhD.

Project Director

Children’s Health after the Storms

Results of your child’s blood and urine tests:

Test	Your Child’s Measurement	Normal Range
Hemoglobin¹	xxxx	xxxx to xxxx
White Blood Cells²	xxxx	xxxx to xxxx
Platelets ³	xxxx	xxxx to xxxx
Total IgEº	xxxx	xxxx to xxxx
IgE- (Cats)^	xxxx	xxxx to xxxx
IgE (Oak)*	xxxx	xxxx to xxxx
IgE (mold)	xxxx	xxxx to xxxx
Urinary creatinine'	xxxx	xxxx to xxxx

¹ Hemogloblin is the substance in blood that carries oxygen; measurements outside the normal range may be due to anemia or other blood conditions.

² White blood cells are associated with the body’s ability to fight infections; measurements outside the normal range may be due to an infection or the body trying to deal with an infection.

³ Platelets are the cells associated with blood clotting; measurements outside the normal range may be due to prolonged bleeding or other blood conditions.

º ^ *  Total IgE and specific IgEs (such as cats, oak tree, and mold) are substances, often called antibodies, that are part of the body’s reaction to exposures to things such as cats, tree dust and pollen, and mold; measurements higher than the normal range may be linked to allergies of those exposures.

' Urinary creatinine is a natural occurring substance in urine; an elevation in the level maybe associated with kidney problems.

ATTACHMENT X2

Abnormal Range Health Assessment Results Letter

ABNORMAL RANGE HEALTH ASSESSMENT RESULTS LETTER

[DATE]

[ID]

[Name]

[Address]

[City, St. Zip]

Dear [NAME]:

Thank you very much for taking part in the Children’s Health after the Storms (CHATS) study. As promised, we are sending you the results of the laboratory tests on your child’s blood and urine as well as an explanation of these results.

One or more of your child’s test results is outside of the normal range. These results are highlighted on second page of this letter. We suggest that you take this report and discuss the results with your health care provider as soon as possible. Please note that the health assessment your child received from the CHATS study nurse should not replace any scheduled visits to your regular doctor or health care provider

We would also like to take this opportunity to reassure you that the information you and your child provided for the CHATS Study will be kept private and will be used only for research purposes. All published information about the study will be in summary form only; your names will not be in any report with the study’s results.

While we cannot give you medical advice, if you have questions about your report or want a list of local doctors and clinics, please call our lead nurse, [NAME], toll-free at 1-800-xxx-xxxx.

We will check in on you and your child again in several months to see how you are doing and to discuss the next phase of this important study. We hope we can count on your continued support.

S incerely,

Diane Wagener, PhD

Project Director

Children’s Health after the Storms

Results of your child’s blood and urine tests:

Test	Your Child’s Measurement	Normal Range
Hemoglobin¹	xxxx	xxxx to xxxx
White Blood Cells²	xxxx	xxxx to xxxx
Platelets ³	xxxx	xxxx to xxxx
Total IgEº	xxxx	xxxx to xxxx
IgE- (Cats)^	xxxx	xxxx to xxxx
IgE (Oak)*	xxxx	xxxx to xxxx
IgE (mold)	xxxx	xxxx to xxxx
Urinary creatinine'	xxxx	xxxx to xxxx

¹ Hemogloblin is the substance in blood that carries oxygen; measurements outside the normal range may be due to anemia or other blood conditions.

² White blood cells are associated with the body’s ability to fight infections; measurements outside the normal range may be due to an infection or the body trying to deal with an infection.

³ Platelets are the cells associated with blood clotting; measurements outside the normal range may be due to prolonged bleeding or other blood conditions.

º ^ *  Total IgE and specific IgEs (such as cats, oak tree, and mold) are substances, often called antibodies, that are part of the body’s reaction to exposures to things such as cats, tree dust and pollen, and mold; measurements higher than the normal range may be linked to allergies of those exposures.

' Urinary creatinine is a natural occurring substance in urine; an elevation in the level maybe associated with kidney problems.

ATTACHMENT X3

Session 2 Health Assessment Results

Session 2 Health Assessment Results

Child’s Name: Date:

Type of Assessment (check one): Baseline 6 month

Below are the results from your child’s health assessment. These are given to you for your personal records. These tests do not substitute for a visit to your own doctor or other health professional. We encourage you to share all of these results with your child’s doctor/healthcare provider especially if any of the results are outside the normal limits. We encourage you to let your child’s physician/healthcare provider know about any results that are outside the normal limits. If you or the child’s physician/healthcare provider has questions about these results, they can contact the CHATS Lead Nurse at xxx-xxx-xxxx.

1. Your child’s weight is: ______lbs

Within normal limits: ______ Outside normal limits: ______

2. Your child’s skin examination for evidence of allergic reaction is:

Within normal limits: ______ Outside normal limits: ______

3. Your child’s spirometry result (indication of lung function) is:

Within normal limits: ______ Outside normal limits: ______

4. Your child’s exhaled nitrous oxide results (indication of inflammation of the breathing system) is:

Within normal limits: ______ Outside normal limits: ______

Nurse’s Printed Name:

Nurse’s Signature:

ATTACHMENT X4

Extreme Value Health Assessment Results Letter

EXTREME VALUE HEALTH ASSESSMENT RESULTS LETTER

[DATE]

[ID]

[Name]

[Address]

[City, St. Zip]

Dear [NAME]:

Thank you very much for taking part in the Children’s Health after the Storm (CHATS) study.

As we promised, we are providing the results of your child’s laboratory tests. One or more of your child’s test results is outside of the normal range and may pose a serious health risk to your child. The result is outlined below in this letter.

We suggest that you take this report right away and discuss the results with your health care provider. Please note that the health assessment your child received from the CHATS study nurse should not replace any scheduled visits to your regular doctor or health care provider

Test Child’s value Normal Range

Xxxx xxxx xxx

While we cannot give you medical advice, if you have questions about your report or want a list of local doctors and clinics, please call our lead nurse, [NAME], toll-free at 1-800-xxx-xxxx.

We would also like to take this opportunity to reassure you that the information you and your child provided for the study will be kept private and will be used only for research purposes. Your names will not be in any report with the study’s results.

We will check in on you and your child again in several months to see how you are doing and to discuss the next phase of this important study. We hope we can count on your continued support.

S incerely,

Diane Wagener, PhD.

Project Director

Children’s Health after the Storms

ATTACHMENT X5

Normal Range Environmental Test Results Letter

ENVIRONMENTAL TEST RESULTS LETTER

Low Ambient/Normal Cotinine

[DATE]

[ID]

[Name]

[Address]

[City, St. Zip]

Dear [NAME]:

Thank you very much for taking part in the Children’s Health after the Storm (CHATS) study. As promised, we are sending you information about the air samples we took in and outside your home.

We tested particles in the air, nitrogen dioxide which is toxic gas, and smoke from tobacco. The U.S. Environmental Protection Agency has set National Air Quality Standards for nitrogen dioxide and particles in the air to protect public health, including health of children and people who have asthma. The levels of nitrogen dioxide and particles in the air in your home were below the Standards. This is good and means that appliances in your home such as gas ranges and ovens, gas water heaters, gas clothes dryers and any fireplaces are properly vented. It also means that any exhausts from cars or lawn mowers outside are not polluting the air inside your home. On the next page, we list the amount of nitrogen dioxide in your home and compare it against your community’s measurement and to the national standard. We also provided some website addresses and a brochure to help you lower the levels in your home even more.

It is important to understand that the amounts of these pollutants are estimates from measurements taken in your home over seven days. They do not fully describe your true exposure in your home and also outside of the home. Air pollutant amounts typically change on a daily basis. We have enclosed some information on air pollution, including specific information on these pollutants, where they tend to come from, and what you can do to decrease exposures for you and your child.

The U.S. Environmental Protection Agency does not have quality standards for exposure to tobacco smoke. However, the Environmental Protection Agency and Centers for Disease Control and Prevention encourage people not to smoke in the home and car because exposures can cause ear infections, more frequent and severe asthma attacks, coughing, shortness of breath, bronchitis, and pneumonia in children. On the next page, we also list the amount of cotinine in your child’s urine. The only way a child can have cotinine in the urine is if they are exposed to tobacco smoke. Although there are no government standards, we do have data on the levels of cotinine in children throughout the United States. Your child was within the normal range.

We would also like to take this opportunity to reassure you that the information you and your child provided for the CHATS study will be kept private and will be used only for research purposes. Your names will not be in any report with the study’s results.

If you have questions about your report, please call me toll-free at 1-800-xxx-xxxx. We will check in on you and your child again in several months to see how you are doing and to discuss the next phase of this important Study. We hope we can count on your continued support.

S incerely,

Diane Wagener, PhD.

Project Director

Children’s Health after the Storms

Reports from in and outdoor air samples (lower is better):

Pollutant	Your Household’s Measurement	Your Community’s Measurement	National Standard
PM10	xxxxx	xxxxx	xxxxx
Nitrogen Dioxide	Xxxxx	xxxxx	xxxxx
Tobacco Smoke	Xxxx	Not measured	None

Report of cotinine in the urine (lower is better)

Your Child’s Measurement Measurements in 90% of Children

Ages 3-11 Years Ages 12-19 Years

Less than 1.22 ng/mL Less than 1.16 ng/mL

List of websites:

ATTACHMENT X6

Abnormal Range #1 Environmental Test Results Letter

High Ambient/High Cotinine

ABNORMAL RANGE ENVIRONMENTAL TEST RESULTS LETTER

High Ambient/High Cotinine

[DATE]

[ID]

[Name]

[Address]

[City, St. Zip]

Dear [NAME]:

Thank you very much for taking part in the Children’s Health after the Storm (CHATS) study. As promised, we are sending you information about the air samples we took in and outside your home.

We tested particles in the air, nitrogen dioxide which is toxic gas, and smoke from tobacco. The U.S. Environmental Protection Agency has set National Air Quality Standards for nitrogen dioxide and particles in the air to protect public health, including health of children and people who have asthma. At least one of the levels of nitrogen dioxide and particles in the air in your home were above the Standards. This is means that appliances in your home such as gas ranges and ovens, gas water heaters, gas clothes dryers and any fireplaces are not properly vented. It also means that any exhaust from cars or lawn mowers outside may also be contributing to the air pollution inside your home. Poorly vented homes can lead to health problems. On the next page, we list the amount of nitrogen dioxide in your home and compare it against your community’s measurement and to the national standard. We also provided some website addresses and a brochure to help you lower the levels in your home.

It is important to understand that the amounts of these pollutants are estimates from measurements taken in your home over seven days. They do not fully describe your true exposure in your home and also outside of the home. Air pollutant amounts typically change on a daily basis. We have enclosed some information on air pollution, including specific information on these pollutants, where they tend to come from, and what you can do to decrease exposures for you and your child.

The U.S. Environmental Protection Agency does not have quality standards for exposure to tobacco smoke. However, the Environmental Protection Agency and Centers for Disease Control and Prevention encourage people not to smoke in the home and car because exposures can cause ear infections, more frequent and severe asthma attacks, coughing, shortness of breath, bronchitis, and pneumonia in children. On the next page, we also list the amount of cotinine in your child’s urine. The only way a child can have cotinine in the urine is if they are exposed to tobacco smoke. Although there are no government standards, we do have data on the levels of cotinine in children throughout the United States. Your child’s level of cotinine was among the highest 10% of children their age. The Centers for Disease Control and Prevention encourages you to try to identify where the child is being exposed to tobacco smoke and minimize that exposure.

We would also like to take this opportunity to reassure you that the information you and your child provided for the CHATS study will be kept private and will be used only for research purposes. Your names will not be in any report with the study’s results.

If you have questions about your report, please call me toll-free at 1-800-xxx-xxxx. We will check in on you and your child again in several months to see how you are doing and to discuss the next phase of this important Study. We hope we can count on your continued support.

S incerely,

Diane Wagener, PhD.

Project Director

Children’s Health after the Storms

Reports from in and outdoor air samples (lower is better):

Pollutant	Your Household’s Measurement	Your Community’s Measurement	National Standard
PM10	Xxxxx	xxxxx	xxxx
Nitrogen Dioxide	xxxxx	xxxxx	xxxxx
Tobacco Smoke	xxxxx	Not measured	None

Report of cotinine in the urine (lower is better)

Your Child’s Measurement Measurements in 90% of Children

Ages 3-11 Years Ages 12-19 Years

Less than 1.22 ng/mL Less than 1.16 ng/mL

List of websites:

ATTACHMENT X7

Abnormal Range #2 Environmental Test Results Letter

High Ambient/Normal Cotinine

ABNORMAL RANGE ENVIRONMENTAL TEST RESULTS LETTER

High Ambient/Normal Cotinine

[DATE]

[ID]

[Name]

[Address]

[City, St. Zip]

Dear [NAME]:

Thank you very much for taking part in the Children’s Health after the Storm (CHATS) study. As promised, we are sending you information about the air samples we took in and outside your home.

We tested particles in the air, nitrogen dioxide which is toxic gas, and smoke from tobacco. The U.S. Environmental Protection Agency has set National Air Quality Standards for nitrogen dioxide and particles in the air to protect public health, including health of children and people who have asthma. At least one of the levels of nitrogen dioxide and particles in the air in your home were above the Standards. This is means that appliances in your home such as gas ranges and ovens, gas water heaters, gas clothes dryers and any fireplaces are not properly vented. It also means that any exhaust from cars or lawn mowers outside may also be contributing to the air pollution inside your home. Poorly vented homes can lead to health problems. On the next page, we list the amount of nitrogen dioxide in your home and compare it against your community’s measurement and to the national standard. We also provided some website addresses and a brochure to help you lower the levels in your home.

It is important to understand that the amounts of these pollutants are estimates from measurements taken in your home over days. They do not fully describe your true exposure in your home and also outside of the home. Air pollutant amounts typically change on a daily basis. We have enclosed some information on air pollution, including specific information on these pollutants, where they tend to come from, and what you can do to decrease exposures for you and your child.

The U.S. Environmental Protection Agency does not have quality standards for exposure to tobacco smoke. However, the Environmental Protection Agency and Centers for Disease Control and Prevention encourage people not to smoke in the home and car because exposures can cause ear infections, more frequent and severe asthma attacks, coughing, shortness of breath, bronchitis, and pneumonia in children. On the next page, we also list the amount of cotinine in your child’s urine. The only way a child can have cotinine in the urine is if they are exposed to tobacco smoke. Although there are no government standards, we do have data on the levels of cotinine in children throughout the United States. Your child’s level of cotinine was within the normal range.

We would also like to take this opportunity to reassure you that the information you and your child provided for the CHATS study will be kept private and will be used only for research purposes. Your names will not be in any report with the study’s results.

If you have questions about your report, please call me toll-free at 1-800-xxx-xxxx. We will check in on you and your child again in several months to see how you are doing and to discuss the next phase of this important Study. We hope we can count on your continued support.

S incerely,

Diane Wagener, PhD.

Project Director

Children’s Health after the Storms

Reports from in and outdoor air samples (lower is better):

Pollutant	Your Household’s Measurement	Your Community’s Measurement	National Standard
PM10	Xxxxx	xxxxx	xxxx
Nitrogen Dioxide	xxxxx	xxxxx	xxxxx
Tobacco Smoke	xxxxx	Not measured	None

Report of cotinine in the urine (lower is better)

Your Child’s Measurement Measurements in 90% of Children

Ages 3-11 Years Ages 12-19 Years

Less than 1.22 ng/mL Less than 1.16 ng/mL

List of websites:

ATTACHMENT X8

Abnormal Range #3 Environmental Test Results Letter

Normal Ambient/High Cotinine

ABNORMAL RANGE ENVIRONMENTAL TEST RESULTS LETTER

Normal Ambient/High Cotinine

[DATE]

[ID]

[Name]

[Address]

[City, St. Zip]

Dear [NAME]:

Thank you very much for taking part in the Children’s Health after the Storm (CHATS) study. As promised, we are sending you information about the air samples we took in and outside your home.

We tested particles in the air, nitrogen dioxide which is toxic gas, and smoke from tobacco. The U.S. Environmental Protection Agency has set National Air Quality Standards for nitrogen dioxide and particles in the air to protect public health, including health of children and people who have asthma. The levels of nitrogen dioxide and particles in the air in your home were below the Standards. This is good and means that appliances in your home such as gas ranges and ovens, gas water heaters, gas clothes dryers and any fireplaces are properly vented. It also means that any exhausts from cars or lawn mowers outside are not polluting the air inside your home. On the next page, we list the amount of nitrogen dioxide in your home and compare it against your community’s measurement and to the national standard. We also provided some website addresses and a brochure to help you lower the levels in your home even more.

It is important to understand that the amounts of these pollutants are estimates from measurements taken in your home over seven days. They do not fully describe your true exposure in your home and also outside of the home. Air pollutant amounts typically change on a daily basis. We have enclosed some information on air pollution, including specific information on these pollutants, where they tend to come from, and what you can do to decrease exposures for you and your child.

The U.S. Environmental Protection Agency does not have quality standards for exposure to tobacco smoke. However, the Environmental Protection Agency and Centers for Disease Control and Prevention encourage people not to smoke in the home and car because exposures can cause ear infections, more frequent and severe asthma attacks, coughing, shortness of breath, bronchitis, and pneumonia in children. On the next page, we also list the amount of cotinine in your child’s urine. The only way a child can have cotinine in the urine is if they are exposed to tobacco smoke. Although there are no government standards, we do have data on the levels of cotinine in children throughout the United States. Your child’s level of cotinine was among the highest 10% of children their age. The Centers for Disease Control and Prevention encourages you to try to identify where the child is being exposed to tobacco smoke and minimize that exposure.

We would also like to take this opportunity to reassure you that the information you and your child provided for the CHATS study will be kept private and will be used only for research purposes. Your names will not be in any report with the study’s results.

If you have questions about your report, please call me toll-free at 1-800-xxx-xxxx. We will check in on you and your child again in several months to see how you are doing and to discuss the next phase of this important Study. We hope we can count on your continued support.

S incerely,

Diane Wagener, PhD.

Project Director

Children’s Health after the Storms

Reports from in and outdoor air samples (lower is better):

Pollutant	Your Household’s Measurement	Your Community’s Measurement	National Standard
PM10	Xxxxx	xxxxx	xxxx
Nitrogen Dioxide	xxxxx	xxxxx	xxxxx
Tobacco Smoke	xxxxx	Not measured	None

Report of cotinine in the urine (lower is better)

Your Child’s Measurement Measurements in 90% of Children

Ages 3-11 Years Ages 12-19 Years

Less than 1.22 ng/mL Less than 1.16 ng/mL

List of websites:

Study Results X-1