A Systematic Review of Home-Based Environmental Interventions in Improving Asthma Morbidity
- D. Crocker, Centers for Disease Control and Prevention
- G. Dumitru, Centers for Disease Control and Prevention
- S. Kinyota, Centers for Disease Control and Prevention
- C. Ligon, Centers for Disease Control and Prevention
- D. Hopkins, Centers for Disease Control and Prevention
Background: Interventions that target a wide variety of asthma triggers through home visits may be beneficial in improving asthma outcomes. CDC scientists and the Task Force on Community Preventive Services systematically reviewed the evidence of effectiveness of home-based multi-trigger multi-component environmental interventions in improving asthma-related morbidity.
Methods: We sought English language studies that evaluated interventions with at least one home visit, included more than one intervention component directed towards reducing multiple environmental asthma triggers, and met Community Guide criteria for study quality and execution.
Results: Twenty-three studies met our inclusion criteria. In the 20 studies targeting children, asthma symptom days were reduced by 0.8 days/2weeks (Range: –2.3 to –0.6 days/2 weeks) equivalent to 21 symptom days/year; school days missed due to asthma were reduced by 12.3 days per year (Range: –31.2 to –3.4) , and the number of asthma acute care visits were reduced by 0.57 visits per year ( Interquartile interval: –1.71 to –0.33 ). Only three studies reported outcomes among adults with asthma and found inconsistent results.
Conclusions: Findings from this review indicate that home-based multi-trigger, multi-component, environmental interventions are effective in reducing symptom days, school days missed, and acute asthma visits in children with asthma. We cannot draw any conclusions on the effectiveness of this intervention in adults due to inconsistent results and the small number of studies Additional studies are needed to evaluate the effectiveness of this intervention in adults and determine the individual contributions of the various intervention components.
Planning a Nation-wide Toxicology Registry: ACMT's Toxicology Investigators Consortium (ToxIC)
- P. Wax , University of Texas–Southwestern
Background: Recently, the American College of Medical Toxicology (ACMT) has established the ACMT Toxicology Investigators Consortium, known as the ACMT ToxIC Network. This new network of medical toxicologists has been constituted to enable the nationwide collection of important toxicological data from patients at the bedside. Issues: As the specialty of medical toxicology (med tox) has grown considerably in recent years, an increasing number of med tox–trained physicians are caring for patients at the bedside—both in the inpatient and outpatient setting. We have determined that at least 45 distinct medical toxicology groups see patients at the bedside across the United States. The aggregate numbers of patients seen in the past year by these centers exceeded 14,000. Individual site census varied from 10 to more than 1,000 per year. At present much poison exposure data, including some environmental and occupational exposures, are captured by poison control centers and entered into the National Poison Data System. Poison center data are collected over the telephone from the public and other health care providers and are limited by the fact that they does not collect a complete data set of bedside observations. The ToxIC network is designed to collect data at the bedside. The intent of the ToxIC registry is to enhance current toxicosurveillance efforts by creating a general registry of toxicological encounters collected by medical toxicologists at the bedside. In addition encounters with specific chemical agents could be tracked prospectively by this national network of medical toxicologists. Results: Medical toxicologists have formed a nationwide network of toxicology centers where patients are seen at the bedside. Collecting patient data on these toxic exposures could greatly enhance our understanding of a large number of current toxicological problems. Lessons Learned: Identifying appropriate funding sources will be critical to the success of the toxicosurveillance system.
Criteria for a Health Community: Environmental Justice and Sustainability
- Y. Anderson , North Carolina Central University
- M. Lamberth , North Carolina Central University
- J.Bang , Department of Environmental, Earth and Geospatial Sciences, North Carolina Central University
- S. DeLauder , North Carolina Central University
Background: Within a well-defined area of Durham, North Carolina, residential dwellings are interspersed with businesses. The community is impacted by chemical facilities, several brownfields sites, underground storage tanks, and former landfills and dumpsites. North Carolina Central University has partnered with organizations in the Durham community on several projects to address exposure to environmental hazards and projects to assist the community with laying the groundwork for redevelopment that meets the goals of environmental justice and sustainability. Issue: Identification and prioritization of hazards in environmental justice (EJ) communities often requires input from a diverse group of stakeholders (community residents, public health professionals, local and state government officials, academics, industry) with varying expertise and interest. Multiple factors must be considered when trying to achieve environmental justice and sustainability in communities. As we continue to create healthy communities, issues at the intersection of environmental justice and sustainability need to be closely aligned. Results: The process in Durham included visual identification of hazards, geographic information system (GIS) mapping, engaging stakeholders in the community as well as local and state government, and convening community visioning sessions. Each of these activities provides critical information for linking sustainability with environmental concerns in EJ communities. The desired outcome is building a critical mass of stakeholders that will address issues at the intersection of EJ and sustainability and that will ultimately impact public policy. Lessons Learned: Environmental justice and sustainability are not incompatible goals for disproportionately impacted communities. The involvement of the community in decision making ensures that realistic targets can be projected while implementing projects. The involvement of stakeholders from diverse constituencies will strengthen the outcome.
How to Strengthen Partnerships of Local, State and Federal Resources
- A. Ansari , Centers for Disease Control and Prevention
- J. Buzzell , Centers for Disease Control and Prevention
- L.Evans , Centers for Disease Control and Prevention
In June 2008, the Centers for Disease Control and Prevention (CDC) and the Conference of Radiation Control Program Directors (CRCPD) sponsored the Roundtable on Communication and Teamwork: Keys to Successful Radiological Response. This roundtable brought together experts in the fields of health physics, hospital preparedness, epidemiology, public health preparedness, risk communication, psychology, and emergency medicine to address the following key concerns: insufficient awareness and understanding of mutual responsibilities for preparing and responding to radiological incidents, the need for strengthening communications and improving working relationships among the participating organizations, and the need for increased awareness of emerging roles and responsibilities regarding radiological events. Participating in the roundtable were representatives from the Association of State and Territorial Health Officials (ASTHO), CDC, CRCPD, the Council of State and Territorial Epidemiologists (CSTE), and the National Association of County and City Health Officials (NACCHO). The need to raise radiological emergency preparedness to the same level of importance as other disasters was the main theme of the roundtable. Other common observations included the following: awareness of the need to develop consistent radiological capabilities, the need to coordinate and build relationships among participating agencies, and the need for funding specifically allocated for radiological emergency preparedness. The main desired outcome of this roundtable is to develop and engage new ideas to address the issues described above. Holding this roundtable at a broad-scope public health conference will allow for new perspectives on these issues from scientists/stakeholders that may have never been approached otherwise.
Environmental Public Health: Emerging Leaders in Sustainability
- A. Houghton , Adele Houghton Consulting, LLC
- J. McLeod , Cuyahoga County Board of Health
Environmental health and sustainability are natural allies. In many cases, the environmental hazards targeted by sustainability initiatives contribute to chronic public health disease burdens such as asthma, obesity, and cancer. The environmental health community is uniquely positioned to advocate for policies and initiatives that improve the health of the community as well as the environment. Pockets of these initiatives are evident across the country where environmental public health (EPH) departments have taken the lead in promoting healthy food programs, beneficial use and recycling programs, climate change adaptation and mitigation programs, and zero-waste programs, to name a few. Currently, the greatest challenge for EPH departments engaging in local sustainability initiatives is a gap in information about lessons learned from similar initiatives across the country. This roundtable will gather examples of local and regional sustainability programs and initiatives from conference attendees. The roundtable host will use existing case studies to guide the conversation. However, the goal of the session will be to start closing the gap in information about what is happening at the local level around sustainability through spirited discussion. The information gathered at the roundtable will be incorporated into a Web site developed by the CDC's Environmental Public Health Leadership Institute EPH Sustainability alumni group, which includes case studies, educational materials, links, and resources highlighting EPH sustainability initiatives across the country. The level of interest in EPH departments to engage in sustainability initiatives has outstripped available educational offerings and published case study information. This roundtable will help bolster current momentum around sustainability initiatives by generating new case studies and lessons learned and expanding the number of EPH professionals engaged in sustainability at the local level.
Biomonitoring—Is Your State Doing It?
- D. Lee , California Department of Public Health
- M. Lipsett , California Department of Public Health
- McNeelSandy , California Department of Public Health
- Welling Robbie , California Department of Public Health
- D. Rupali , California Department of Public Health
The value of biomonitoring has been well established by the national biomonitoring program conducted by the Centers for Disease Control and Prevention. Unfortunately, state-specific data are not available from the national program, and various states have initiated their own biomonitoring programs. California is the first state to have a legislatively mandated biomonitoring program intended to determine levels of environmental chemicals in a representative sample of Californians, establish trends in the levels of chemicals over time, and assess the effectiveness of public health efforts and regulatory programs to reduce exposures of Californians to specific chemicals. Existing fiscal constraints prevent full implementation of a statewide program. However, California is proceeding with defining chemicals to include in the program, conducting public integration activities, building laboratory capabilities, defining a results communication framework, exploring the availability of existing biospecimen repositories, and carrying out targeted community biomonitoring investigations in collaboration with public health partners such as environmental health tracking. Through this roundtable, California will invite other state public health staff to share their experiences in establishing and implementing state biomonitoring programs. Examples of topics to be discussed include chemical selection, target populations, results communication, public participation, and collaborations. Improving the interpretation, use, and communication of biomonitoring data remains a particular area of interest. The roundtable will facilitate sharing of experiential knowledge and resources, thus promoting shared development of cross-disciplinary approaches, methods, and tools.
An Exploratory Study of Mercury Release Data With Biomarkers of Neurodevelopmental Disorders in Children
- S. Faber , The Children's Institute
- A. Michanowicz , University of Pittsburgh
- C.Lawson , University of Pittsburgh
- K. Ferrer , University of Pittsburgh
- C. Volz , University of Pittsburgh
Background/Objectives: Exposure to heavy metals has been associated with the development of neurodevelopmental disorders (NDs). The plasma zinc/serum copper ratio (Zn/Cu) reflects the health of the metalloprotein system responsible for the detoxification of heavy metals in humans. Low ratios suggest that the metalloprotein system is not efficiently managing these exposures. We sought to explore the relationship between a proxy measure for mercury exposure and clinical ND biomarkers in a sample of children with NDs in southwestern Pennsylvania. Methods: A convenience sample of 183 children with NDs, ages 3–18 with intakes 2005–2008 comprised the study population. Zn/Cu and percent CD4-percent CD8 ratio (CD4/CD8), percent CD8 (%CD8), and percent natural killer cells (%NK) drawn at initial clinical evaluation were used as biomarkers of NDs. The children's intake domicile locations were geo-referenced using ArcView GIS 9.3. Mercury air emissions in pounds per year (2006) from area point sources were procured from the Environmental Protection Agency (EPA) Toxic Release Inventory database. Inverse distance weighting (IDW) was used to estimate mercury exposure based on emissions data. Emission rates corresponding to the domiciles of each patient were determined and correlated with study biomarkers. Results: No interesting correlations were observed for CD4/CD8, %CD8, and %NK and mercury emissions. However Zn/Cu showed a -0.116 Pearson correlation coefficient (p = 0.13) with IDW mercury emissions. Furthermore, scattergram analysis indicates a cluster of children (9) with high (>200 pounds/year) IDW mercury emissions and low Zn/Cu, while there were no children in the same emissions category with Zn/Cu over 0.73 (Zn/Cu range 0.24–1.24). A 2 sample t-test revealed a significant difference in Zn/Cu between the high- and low-exposure groups (p = 0.02). Environmental Public Health Implications: A subset of children with NDs in western Pennsylvania may exhaust metalloprotein functioning upon reaching a high threshold of mercury exposure, leading to the dropping of their Zn/Cu ratios.
Development of a Multi-State/Agency, Collaborative, Confined Animal Feeding Operation Bio-monitoring Study; Can we do it?
- G. Carlson , Missouri Department of Health and Senior Services
A number of studies with various methodologies have associated adverse human health conditions with living near some types of confined animal feeding operations (CAFOs). Some studies have estimated exposure through ambient air monitoring. Some have drawn conclusions associating illness with proximity based on self-reported information. Others have based conclusions on analysis of water quality but without verification that the CAFO actually impacted the water supply in question. Because of the rural characteristics of CAFO locations, none of these studies were based on a large enough sample to yield robust statistical conclusions. Finally, none of these studies verified exposure or the occurrence of illness related to the CAFO based on medical verification or biomonitoring. This roundtable discussion will solicit ideas from attendees about how to develop a multistate/agency collaborative biomonitoring study that will be able to draw valid conclusions about exposure to emissions from CAFOs. If a study design can be identified, further discussion will attempt to elicit partners willing/able to become involved in such a study and to identify resources to carry out such a study.