RESPIRATORY HEALTH IMPACTS IN THE ENTERTAINMENT INDUSTRY FROM EXPOSURE TO THEATRICAL SMOKES AND FOGS by SUNIL CHARLES VARUGHESE H.B.Sc, The University of Toronto A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in THE FACULTY OF GRADUATE STUDIES School of Occupational and Environmental Hygiene We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA November 2002 © Sunil Charles Varughese, 2002 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department The University of British Columbia Vancouver, Canada DE-6 (2/88) Abstract The potential for respiratory health impacts from exposure to theatrical smokes and fogs (glycol or mineral oil aerosols) in the entertainment industry has raised concern among employees and performers and given rise to compensation claims. One hundred and one entertainment industry workers in British Columbia were studied in live theatre, film production, music concerts and other venues where theatrical smokes and fogs was used on the study day. Sites consisted of a convenience sample and participation was greater than 70%. An American Thoracic Society based questionnaire with additional questions on skin and voice symptoms and exposure history was used to assess chronic effects. Cross-shift spirometry, an acute symptoms questionnaire and exposure monitoring on the study day were used in assessing effects from acute exposure. Monitoring data and histories were used in estimating cumulative exposure to theatrical smokes and fogs over the past 2 years. Compared to controls, the entertainment industry group had reduced FEV1 (p<0.05), and increased dyspnea (p<0.05), work-related chest tightness (p<0.05), work-related sneezing (p<0.05) and work-related nasal symptoms (p<0.05). For the entertainment industry group only, internal multivariable analysis to assess symptom relationships to cumulative exposure over the past 2 years (1000 mg/m3-hrs) showed the following for work-related symptoms (OR, 95% Cf): cough. 1.8 (1.1, 3.1), phlegm 2.4 (1.1, 5.3), wheezing 1.4 (0.9, 2.1), chest tightness 1.2 (0.8, 1.9), nasal symptoms 0.9 (0.7,1.3), and skin rashes 1.2 (0.7, 2.1). Glycol-based theatrical smoke was associated with acute symptoms as follows (OR, 95%CI): cough 2.7 (0.5, 14.5), chest 2.0 (0.6, 6.7), 2 or more nose/throat/voice 2.4 (0.5, 9.7), dryness 4.9 (1.7, 13.8), central nervous system 3.9 (1.4, 11.3), and irritative eye 3.2 (1.0, 10.6). No significant associations were found between cumulative exposure and FVC and FEV1. However, percent FEV1/FVC was significantly associated with cumulative exposure (B=1.17, p<0.05). For cross-shift lung function changes mineral oil-based theatrical smoke was negatively associated with FEV1 (B=-1.35, p=0.1). Overall, the results indicate that exposure to theatrical smokes and fogs is causing non• specific respiratory irritation and increasing the risk for chronic airflow obstruction among BC entertainment industry employees. Table of Contents Abstract ii Table of Contents iii List of Tables v Acknowledgements V1 1 Introduction • 1 2 Background 3 2.1 Historical Use 3 2.2 Current Use 3 2.3 Current Theatrical Smoke Generation Methods 5 3 Literature Review 8 3.1 Previous Studies on Theatrical Smokes and Fogs 10 3.2 Respiratory and Mucous Membrane effects from exposure to Glycols found in Fog Fluid 18 3.3 Allergic Contact Sensitization related to Glycols 21 3.4 Respiratory Health Effects from Inhalation Exposure to Mineral Oil 25 3.5 Respiratory and Mucous Membrane Irritation from Aldehydes 26 4 Objectives 28 5 Methods 29 5.1 Selection of Study Sites 29 5.2 Exposure Monitoring 31 5.2.1 Area Exposure Measurements 31 5.2.2 Personal Exposure Measurements 33 5.3 Health Effects 35 5.3.1 Participation, study design 35 5.3.2 Ethics, informed consent 35 5.3.3 Questionnaires 36 5.3.4 Physiologic testing 37 5.3.5 Comparison data 38 5.3.6 Data management and analysis 39 6 Health Effects Study Results 51 6.1 Participation and Characteristics of Study Participants 51 6.2 Characteristics of Work 53 6.3 Correlations among potential explanatory variables 59 6.4 Respiratory Health Indicators-Entertainment Industry Group vs. Comparison Group 59 6.5 Respiratory Health Indicators in Relation to Theatrical Smoke Exposures: Entertainment Industry Group Only 62 6.6 Dermal Health Indicators 65 6.7 Acute Symptoms 65 6.8 Cross-Shift Lung Function Results 68 7 Discussion 70 7.1 Overview 70 7.2 Interpretation of Chronic Respiratory Symptoms 71 7.3 Interpretation of Lung Function Results 73 7.4 Interpretation of Acute Symptoms 74 7.5 Strengths of the Study 75 7.6 Limitations of the Study 77 7.7 Summary 79 7.8 Comparison of Risks and Recommendations 86 Appendix A :Consent Form and Questionnaires 89 Appendix B: Correlations and T Test results for variables considered in models 128 m List of Tables Table 3-1 Physical-Chemical Properties of Glycols Found in Theatrical Smokes 24 Table 5-1 Description of Multivariable Models 47 Table 6-1 Participation 51 Table 6-2 Demographics 52 Table 6-3 Health History 53 Table 6-4 Set Location on Current Production 54 Table 6-5 Respirator Useage at Work 54 Table 6-6 Job Titles 55 Table 6-7 Work Duration Characteristics for Current Production 56 Table 6-8 Personal Exposure on Sampling Day 57 Table 6-9 Self-reported Exposure Variables for Sampling Day 57 Table 6-10 Calculated Variables for Self-reported Past Smoke Exposure 58 Table 6-11 Chronic Symptoms 60 Table 6-12 Lung Function Results 61 Table 6-13 Odds Ratios for Multivariable Models for Reported Work-Related Respiratory Symptoms 63 Table 6-14 Linear Regression Multivariable Models for Lung Function Results 64 Table 6-15 Odds Ratio for Reported Skin Symptoms 65 Table 6-16 Acute Symptoms Prevalence 66 Table 6-17 Acute Symptoms by Grouping 67 Table 6-18 Odds Ratios for Multivariable Models for Acute Symptoms 67 Table 6-19 Multivariable Cross-Shift Change in Lung Function 69 Table 7-1 Comparison of Findings with Previous Studies 85 IV Acknowledgements I would like to thank the members of my thesis committee Kay Teschke and Mike Brauer. I would especially like to thank my supervisor, Susan Kennedy for her guidance and incredible ability to keep me motivated throughout this whole process. Thanks to Yat Chow for collecting and preparing the exposure data and assisting me with work on the sets. Thanks also goes to Barbara Karlen for technical training and much support throughout the project, and Victor Leung for lab support. A special thanks goes to SHAPE, Linda Kinney, Rob Jackes, Marty Clausen, Ian Pratt, Mark Thompson, Byron Lonneberg, Jason Hartley, Jim Rhodes, Mike Price, Prem Marimathu, Kathy Gilroy- Sereda, all of the study participants, and the many production managers and technical directors who gave permission to conduct our study on their productions. I would also like to thank my friends in BC and in Ontario and my family for their much support and words of encouragement along the way. V 1 Introduction The use of theatrical smokes and fogs which will also be referred to as 'smokes' or 'fogs' has been a concern in the entertainment industry for many years. Compensation claims have been filed by employees in the entertainment industry who have been exposed to theatrical smoke. Although it is difficult to estimate the number of claims filed worldwide, an article in the San Francisco Chronicle referred to 7 worker's compensation claims filed since 1990 with the San Francisco Opera Association claiming throat irritation from exposure to theatrical smokes and fog (Russell 2001). These performers believed that they have suffered adverse respiratory effects from exposure to fogs. The issue of theatrical smokes and fogs is a complex one as they create important visual effects on a production. Two previous studies on theatrical smokes and fogs had found associations between exposure to theatrical smokes and fogs and self-reported nasal, throat, and respiratory symptoms but these studies only focused on Broadway Musicals in New York (Burr, Van Guilder et al. 1994; Moline, Golden et al. 2000). Difficulty exists in generalizing these findings to other production types as exposures in musicals may differ from exposures in movie/television productions and music concerts. Musicals, lasting only a few hours would be expected to have shorter duration exposures to peak levels of theatrical smokes and fogs while movie/television productions and music concerts would be expected to have lower peak exposures over the course of a workday which can range from 10-18 hours. Uncertainty still exists about exposure scenarios in these production types within the entertainment industry. 1 Researchers at the School of Occupational and Environmental Hygiene at the University of British Columbia were approached by Safety and Health in Arts, Production, and Entertainment (SHAPE) about conducting a study investigating the use of theatrical smokes and fogs. SHAPE is a health and safety agency that deals with the entertainment industry in British Columbia and has representatives from both labour and management.