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Volume 131, Issue No. 4 July/August 2016
Current Issue
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ISSN 0033-3549
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NEPHC Abstracts

Exposure 1

Biomonitoring Data at the US EPA's Office of Pesticide Programs: Applications, Challenges, and Research Needs

  • D. Miller , US Environmental Protection Agency

The US Environmental Protection Agency Office of Pesticides Programs (EPA/OPP) is responsible for protecting public health and the environment from the adverse effects of pesticides. One of OPP's primary roles is to assess the human health risks associated with pesticide exposure. When assessing exposure and risk, OPP has traditionally relied on environmental measurements and general exposure models. However, the availability and scope of biomonitoring data—particularly biomonitoring data collected under the Centers for Disease Control and Prevention (CDC) National Health and Nutrition Examination Survey (NHANES) program—has increased rapidly over the last decade and can be used to characterize the general population's exposure to a broad range of pesticides. Nationally representative biomonitoring data—as contained in NHANES—is the only available data source that represents real-world exposures on a national and subpopulation basis in a statistically meaningful way. While the available biomonitoring data can be extremely useful for informing the risk manager on the extent of exposures and—for some chemicals—allowing valuable comparisons with the results of EPA's traditional environmental measurement–based risk assessment methods, challenges remain with respect to the interpretation of results and their incorporation into routine EPA risk assessment practice. EPA/OPP's presentation will discuss these challenges and future opportunities, and highlight EPA/OPP's current and planned activities involving interpretation of NHANES and other biomonitoring data from a regulatory perspective. In particular, EPA/OPP will present (1) current uses of NHANES biomonitoring and other data in EPA's strategic planning and in policy and regulatory decisions; (2) challenges associated with using biomonitoring information to inform and guide EPA/OPP regulatory decisions; and (3) efforts to increase the future utility of biomonitoring with respect to the assessment and management of risks from pesticides.


Exposure 1

Leveraging Resources to Address Problem Construction and Demolition Debris Sites

  • P. Ruesch , US Environmental Protection Agency

Construction and Demolition (C&D) debris landfills that are not regulated or properly managed may pose a threat to human health and the environment. Several C&D landfills in the Midwest have caused community impacts such as odors, dust, and smoke. These facilities may also experiencing issues such as fires, hydrogen sulfide and/or methane gas emissions, and leachate outbreaks impacting surface and/or groundwater. State, federal, and local environment and health agencies are increasingly called upon to address dust, odor, and other issues near C&D landfills. These nuisance complaints usually indicate more complex problems. With limited authority, resources, and a limited scope on permit and license conditions, it can be a challenge to mitigate such problems. Agencies must be creative and use collaborative approaches to mitigate problems. EPA Region 5, in coordination with ASTDR and local and state authorities, have addressed problems at several C&D landfills in the Midwest. Issues have been mitigated at these facilities by using a coordinated, collaborative approach with local stakeholders, many times in cooperation with the site owner/operator and as well as the local community. In some cases, the agency has utilization of a combination of air, water, solid waste, and Superfund authorities, mechanisms, and resources. The lessons learned from these cases have been documented and are currently being shared in both workshops and guidance documents that are summarized in the presentation.


Exposure 1

Chinese Drywall: Federal and State Efforts and Findings to Date

  • L. Wilder , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

Background: In 2008, residents began contacting the Florida Department of Health concerning health effects they attributed to living in homes constructed with Chinese drywall. Hundreds of residents have since contacted their respective state health agencies and the Consumer Product Safety Commission (CPSC). The CPSC, US Environmental Protection Agency (EPA), and the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry have been working with our state partners to determine the cause of the problem and whether exposure to contaminants may be a health concern. Issue: Residents living in homes containing Chinese drywall consistently report the occurrence of nonspecific symptoms such as eye, nose, and throat irritation, respiratory problems, nosebleeds, and headaches. Residents also report discoloration of copper piping and other metal alloys inside their homes. Both symptoms of irritation and degrading metal have been validated by federal and state employees who toured potentially contaminated homes. CPSC, EPA, Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, and various state health agencies are in the process of testing samples of the potentially contaminated drywall and the indoor and outdoor air around specific residences for sulfur compounds, volatile and semi-volatile compounds, organic acids, polycyclic aromatic hydrocarbons, and pesticides. Results: Evaluation of the results to determine the cause of the problem and possible health implications is ongoing. Lessons Learned: Chinese drywall is an ongoing multifaceted, multistate issue that requires active participation from many state and federal agencies. Coordination among all federal and state agencies is imperative.


Exposure 1

Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Initiative: Construction and Demolition Debris Landfills

  • L. Wilder , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

The number of construction and demolition (C&D) debris landfills is increasing in the United States. In many states, there are no daily cover requirements, air emission controls, or liner requirements. The lack of these engineering controls can lead to air emissions of hydrogen sulfide (H 2 S), methane, and other compounds. The Agency for Toxic Substances and Disease Registry (Centers for Disease Control and Prevention[CDC]/Agency for Toxic Substances and Disease Registry) has been involved in several community health investigations involving H 2 S exposures from C&D landfills. In a number of these investigations, CDC/Agency for Toxic Substances and Disease Registry declared the levels of H 2 S found in the communities' air to be a public health hazard. Other hazards include unrestricted public access, uncontrolled surface and subsurface fires, and groundwater contamination. Once CDC/Agency for Toxic Substances and Disease Registry designates a “public health hazard,” recommendations are made to reduce community exposures. Reducing community exposure can be costly. CDC/Agency for Toxic Substances and Disease Registry has found that many local and state health and environmental agencies are not aware of the exposure and health issues surrounding these landfills until community health concerns arise. Results: To address these issues, CDC/Agency for Toxic Substances and Disease Registry formed a multiagency workgroup whose goal is to increase federal, state, and local awareness of public health, worker health, and environmental health issues associated with C&D landfills. The current focus is on community and worker health issues arising from C&D landfills and guidance on how to either avoid health and environmental problems or take steps to reduce them. CDC/Agency for Toxic Substances and Disease Registry, with input from workgroup participants, is developing a guidance document and working to educate stakeholders on C&D issues.


Exposure 2

Identification and Evaluation of Pediatric Environmental Exposures

  • N. Beaudet , University of Washington

Background: Health care providers and public health officials are increasingly asked to evaluate a child's health risk from long- or short-term exposures to environmental agents. As children (and fetuses) develop and grow, they pass through critical windows of susceptibility and are more vulnerable than adults to environmental toxicants. Issue: PEHSUs (Pediatric Environmental Health Specialty Units) are a network of academically based pediatricians, toxicologists, exposure scientists, and others capable of responding to requests for information and offering advice on prevention, diagnosis, management, and treatment of environmentally related health effects in children. PEHSUs also provide training on pediatric environmental health, including translation of research findings into practice or policy, for health care professionals, public health officials, community groups, and others. Results: The environmental history is an important tool to identify potentially significant environmental exposures. The environmental exposure history is enhanced by environmental measurements to characterize the intensity of suspected pediatric environmental exposures. Case examples from the University of Washington PEHSU will highlight the utility of exposure measurements in the determination of pediatric environmental health risks. Cases include exposure to petrochemicals in contaminated drinking water and soil, and pesticides contamination of grass from aerial spray drift. Lessons Learned: The environmental history is key to identification of exposures of concern, and exposure evaluation is essential for informed risk assessment and risk communication.


Exposure 2

Partnerships to Address School Related Issues in EPA Region 2 (NY, NJ, PR, USVI)

  • M. Galvez , Mount Sinai School of Medicine
  • P. Sheffield , Mount Sinai School of Medicine
  • J. Forman , Mount Sinai School of Medicine
  • L. Graziano , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • M. Maddaloni , U.S. Environmental Protection Agency
  • M. O'Neill , U.S. Environmental Protection Agency

Background: Children spend a significant portion of time in day cares and schools. Careful consideration of potential environmental exposures in both indoor and outdoor settings can ensure a healthy environment where children learn, eat, sleep, and play. Issue: Several concerns have been raised regarding environmental exposures in the day care/school setting. These range from school siting issues related to former industrial or agricultural uses of school buildings and grounds, to concerns about existing environmental chemicals in buildings, including polychlorinated biphenyls in window caulking, to artificial turf fields on school grounds. We describe Region 2 partnerships to address these school-related environmental issues. Results: In the past 10 years, the Region 2 Pediatric Environmental Health Specialty Unit (PEHSU) has been involved in a number of school-based cases encompassing a variety of environmental exposures. The settings include public and private schools for children ranging in age from infancy to adolescence. Detailed discussion of these cases will focus on how partnerships were formed to address environmental exposure concerns. Lessons Learned: Early and frequent communication between PEHSU and regional affiliates can enhance the efficiency and effectiveness of addressing school-related environmental issues.


Exposure 2

Implementing Child Product Chemical Safety Policy—Priorities, Practicalities, and Public Health Practice

  • C. Karr , University of Washington

Background: Potentially hazardous chemicals have been found in children's products, including toys. In response, legislative efforts to improve the safety of children's products and reform regulatory approaches are emerging in several states, nations, and through international agreements. In 2008, Washington State's Children's Safe Products Act required identification of reportable chemicals of concern for child health. The state agencies (health, ecology) sought additional advisement on prioritizing chemicals from the University of Washington Pediatric Environmental Health Specialty Unit. Issue: Data availability and quality regarding chemical toxicity, exposure pathways, presence in child products, and use patterns are variable among chemicals. We reviewed the conceptual framework and public health decision-making process of prioritization development among several jurisdictions to inform the Washington State prioritization process for chemicals of high concern in children's products. Results: We developed a framework designed to provide a uniquely fetal and child-centric lens of exposure-health data sources and expert judgement in evaluating higher versus lower level of concern for chemicals of concern in children's products. Three spheres of risk are considered: the inherent health hazard of the chemical, the individual child's exposure experience to the chemical from its use in a child product, and the population of children's extent of exposure to this chemical in their environments. Lessons Learned: The current regulatory format is inadequately informed regarding the presence and extent of hazardous chemicals in children's products. This makes prioritization for public health action a challenging balancing act. However, approaches to optimizing the opportunity to apply knowledge where it exists and work toward improved information access are possible and ongoing.


Exposure 2

Addressing Environmental Health Issues With Women of Childbearing Age: A Pilot Project Funded by the U.S. Environmental Protection Agency

  • M. Mathias , Ohio Department of Health

Background: Preventable exposure to environmental hazards may lead to adverse outcomes during pregnancy for the woman and fetus. The Ohio Department of Health (ODH) received funding as part of the US Environmental Protection Agency (EPA) grant Building Capacity to Address Environmental Health Issues During Pregnancy. Issue: The main goals of the grant were to (1) increase the capacity of health professionals to screen for environmental health hazards during pregnancy, and (2) ensure that pregnant women have access to information/interventions to reduce their exposure to environmental hazards. The ODH mailed surveys to Ohio ob-gyn and family medicine physicians to learn about their current practice in screening/educating women about environmental hazards. The pilot sites were evaluated to determine their knowledge of environmental hazards and capacity to address these issues with women. The ODH created an environmental risk assessment tool (arsenic, cadmium, carbon monoxide, lead, mercury, mold, pesticides, radon, and tobacco), and the health professional educated the patient on how to avoid/reduce exposure and provided educational materials. For evaluation, surveys were sent to women who participated in the project. Also, a follow-up evaluation of the sites' knowledge and capacity was conducted. Results: A total of 85% of clients reported learning something from filling out the assessment tool and talking with their health professional; and 41% reported changing their behaviors in the home based on the information they received. Pilot site staff reported feeling more confident when educating clients on environmental risks. Lessons Learned: We learned that there was a need for a standardized environmental screening tool and that health professionals wanted more information on environmental risks and where to find educational materials. We also learned that a lack of time is an issue to be considered.


Exposure 3

The National Children's Study: Experience in the Field

  • D. Baker , University of California–Irvine

The National Children's Study (NCS) is a nationwide prospective birth cohort study. The study population will be identified by enrolling pregnant women with a target of 1,000 participants in each of 105 randomly selected locations—mostly counties—using a multistage cluster sample. In fall 2005, the NCS selected 7 representative locations to pilot test the NCS. In 2009, the 7 “Vanguard Centers” began identifying, recruiting, and enrolling participants for the feasibility phase of the NCS. During the pilot phase, study researchers will evaluate the recruitment and sampling methods, as well as all other study methods. The University of California–Irvine is a Vanguard Center and serves Orange County, California. Major activities of the Vanguard Centers have included providing scientific input on the study hypotheses and protocol; conducting geographic-based sampling of neighborhoods (segments) within the locations; conducting community outreach and engagement; negotiating with regional birthing hospitals so data can be collected at the time of delivery; planning the logistics for the field study, including establishing project offices and hiring staff; implementing the neighborhood-based recruitment; and starting data collection in homes, clinics, and birthing hospitals. The study in Orange County will follow women ages 19–49 years from 10,500 dwelling units in 15 segments for 5 years to identify new pregnancies for enrollment in the study. Particular challenges in the county include engagement of a highly diverse population with multiple primary languages and gaining the cooperation of restricted access communities within the randomly selected segments, such as gated communities and locked apartment buildings.


Exposure 3

The Role of CDC in the NCS

  • A. Correa , Centers for Disease Control and Prevention

As one of the lead federal agencies for the National Children's Study (NCS), the Centers for Disease Control and Prevention (CDC) has played a key role in its planning and has been instrumental in providing high-level oversight through representation in and chairing of the Interagency Coordinating Committee (ICC), which oversees broad study issues, promotes interagency collaboration, assures that the mission of the study is maintained over time, and ensures that the study's goals reflect the scientific priorities of the lead agencies. Over the years, CDC scientists have served on scientific workgroups, played a key role in the development of the NCS sample design, and continue to be involved in chartering the research plan and protocol and piloting analysis of environmental biomarker specimens. In the future, CDC's efforts toward achieving its health impact goals are likely to benefit from NCS data on the nature and extent of the health problems facing infants, children, and adolescents; new information regarding the impact of environmental and genetic factors on child health and development; evaluations of exposure-outcome relationships; establishment of reference ranges to evaluate environmental chemical exposures in mothers, infants, and young children; and potential opportunities for assessing the effectiveness of public health efforts to decrease exposure to specific chemicals and known risk factors. In addition, the NCS is likely to benefit from CDC expertise in a wide range of domains, including housing and managing public-use and confidential NCS data sets, laboratory support and storage of environmental and biological samples from NCS participants, development of methods for evaluation of health outcomes for core hypotheses, and development of adjunct studies.


Exposure 3

Overview of the National Children's Study

  • M. Dellarco , National Institutes of Health

The National Children's Study (NCS) will follow approximately 100,000 children from early in pregnancy to adulthood to assess how the full range of environmental exposures, interacting with genetic factors and other exposures, influence the health and development of children. Authorized by Congress in 2000, the study was planned with scientific input from leading federal agencies (National Institutes of Health, Centers for Disease Control and Prevention, and Environmental Protection Agency) and more than 2,500 scientists across the country. The study is guided by core hypotheses to address the priority exposures and outcomes but will also provide both data and samples for addressing future questions. A representative sample of US live births will assure that the exposure outcome relationships identified by the study will apply to all children and that important varied types of exposures will not be missed. Local and regional centers will implement the study in 105 Locations, mostly counties, across the country to assure the necessary community engagement and needed ongoing scientific expertise are available. Data, including interview, examination and samples, will be collected by face-to-face visits both in the home and in the clinical settings and by other methods between the visits. In January and April 2009, 2 and 5 initial Vanguard Centers, respectively, began enrolling participants into the Vanguard phase to pilot test the design elements and full protocol of the study. Following this pilot, with necessary revisions and refinements based on reviews, pilot experience and available resources, current plans are to implement the main study protocol in 3 successive waves beginning in early 2011.


Exposure 3

The NCS Pilot Study: Role of the NCEH Laboratory

  • M. Mortensen , Centers for Disease Control and Prevention

For at least 3 decades, scientists within NCEH's Division of Laboratory Sciences (DLS) have been using a technique known as biomonitoring to determine human exposure to environmental chemicals. Biomonitoring measurements are health-relevant assessments of exposure because they measure the amount of chemicals that actually enters people's bodies. DLS publishes biomonitoring results in the Centers for Disease Control and Prevention (CDC) National Report on Human Exposure to Environmental Chemicals , which reports results on a nationally representative sample of the US population. However, chemicals in urine are measured only in children ages 6 years and older; chemicals in blood or serum are measured only in children aged 12 years and older, with a few exceptions. Concentrations of many of the chemicals were highest in the youngest age groups that were examined. For children ages 5 years and younger, minimal information exists on exposure to priority environmental chemicals, and this lack of information is a major gap in protecting children from harmful exposures. DLS will lend its analytical and biomonitoring expertise to the ongoing pilot study for the National Children's Study (NCS) being conducted by the National Institute of Child Health and Human Development at the National Institutes of Health with a consortium of federal agencies (Environmental Protection Agency, Centers for Disease Control and Prevention, and National Institute of Environmental Health Sciences). Samples of blood, breast milk, and urine from 525 pregnant mothers and from their infants after birth will be analyzed for more than 100 environmental chemicals and nutritional indicators. Samples will be collected from NCS participants enrolled at 7 study centers (the Vanguard Centers). The data from this pilot study will provide important exposure information on young children. Vanguard Centers are currently recruiting and enrolling participants. Sample collection began in the first half of 2009. This presentation will describe benefits of the collaboration between NCEH/DLS and the National Children's Health Study, and provide an overview of the pilot study activities.


Exposure 4

Hazardous Emissions Associated with Air Freshener Use in Indoor Air

  • L. Freed , University of Washington
  • D. Wilson , University of Washington

Air fresheners are designed to mask odors in the home using a complex array of ingredients. These ingredients can be broken down into 5 main categories: highly volatile primary ingredients that have immediate health effects, the secondary products that are caused by the reactions between primary ingredients and constituents in the air, the preservatives that keep the products on the shelves longer, carrier ingredients that allow for the product to be dispersed into the air, and synergistic compounds that combine with other compounds to create a greater health risk than the original compound would have by itself. Primary ingredients include terpenes, such as d-limonene and a-pinene, which are used as fragrances, and aldehydes, namely benzaldehyde and acetaldehyde, which are used as solvents to ensure a homogenized release of product in the air. d-limonene and a-pinene are naturally occurring compounds in essential oils of citrus fruit and pine, but the concentrations found in nature can be as little as 1% of the concentrations found in air fresheners. The terpenes also react with ozone and the hydroxyl radical in air to form aldehydes, especially formaldehyde, at competitive rates with air exchange rates indoors. Formaldehyde and methylisothiazolinone are common preservatives that are used and carrier ingredients include volatile hydrocarbons like benzene. The health effects of these chemicals are well documented and many have been determined to be possible human carcinogens and respiratory irritants. It is clear that the use of these products may pose a threat to human health in both short-term and chronic use.


Exposure 4

Policy Issues in Air Freshener Ingredient Disclosure

  • R. Scott , Alliance for Healthy Homes

Air fresheners, a multibillion dollar product heavily marketed to consumers, including young teenagers, are designed to deliver fragrances and other chemicals into our lungs. Many ingredient chemicals are associated with health problems including asthma attacks, lung damage, and other risks. Air freshener ingredients are virtually unregulated and need not be disclosed. Environmental and healthy housing organizations convinced the Environmental Protection Agency to ask the 7 largest air freshener makers for a significant amount of ingredient information in 2008. Most of the information was withheld from the public under claims of business confidentiality. The Alliance for Healthy Homes and Sierra Club have met with air freshener and fragrance makers and their trade associations in 2008 and 2009 to discuss greater public ingredient disclosure and ingredients of concern. The companies recently released to the public much of the ingredient information they had earlier withheld and are designing a voluntary ingredient disclosure program for an even broader range of household products, including soaps and detergents, floor maintenance products and polishes, and disinfectants. Parties are also discussing possible state and federal legislation to make some form of ingredient disclosure mandatory. Makers of household products are interested in reassuring consumers about the safety of their products. Obstacles still remain for disclosure of all important ingredients. Ingredients most sensitive as trade secrets, such as fragrances, disinfectants, and normal use byproducts, are those for which health concerns are greatest, too.


Exposure 4

Health Effects of Air Freshener and Air Care Products

  • D. Wilson , University of Washington
  • L. Freed , University of Washington

The health effects of air care products in the home can be divided into 5 major categories of impacts: (1) short-term effects such as respiratory irritation, which are the most often reported and most often correlated to air freshener use; (2) time-dose effects where exposure to the same vapor over time produces an apparent adaption (a plateau in respiratory irritation) but continues to damage the body; (3) synergistic effects where multiple related compounds combine together to produce a net effect worse than each of the individual compounds; (4) variable consequences within humans and between humans and rats that make it difficult to compute actual risk based on animal laboratory studies; and (5) emergent impacts through cancers and other causally complex diseases that evolve over long time periods. Data are readily available in the literature to prove the detrimental impact of each of these classes of effects for one or more compounds: short-term effects (formaldehyde); time-dose effects (1-octene); synergistic effects (aldehydes); variable consequences (glutaraldehyde); and emergent impacts (vinyl acetate). These combined effects clearly call for decreasing and discerning use of air care products in the home in order to produce improved indoor air quality and minimize detrimental impacts on human health.


Exposure 5

A Public Health Focus on Infertility: An Emerging Priority

  • M. Macaluso, on behalf of the CDC Infertility Working Group , Centers for Disease Control and Prevention

Background: In 2002, approximately 2 million American women of reproductive age were infertile and 3.3–4.7 million sexually experienced men reported seeking a visit for infertility services. Centers for Disease Control and Prevention (CDC) conducts surveillance and research on the causes of infertility, monitors the safety and efficacy of infertility treatment, and sponsors national prevention programs. An agencywide ad hoc working group was formed in 2007 to coordinate infertility activities at CDC and to evaluate existing gaps in this area. These findings have been published in a white paper (Fertil Steril 2008 Nov 5). Issue: To identify public health concerns and open a discussion about the role of the public health community in addressing infertility. Results: The working group found that, despite ongoing efforts directed at infertility, considerable gaps exist in public health surveillance, research, communication, and program and policy development. For example, evaluating whether the prevalence of infertility has varied over time is limited because of changes in societal and behavioral practices and the introduction of new technological advances in infertility treatment. The proportion of the infertility burden that can be prevented is not known, although there are several known and potential causes of infertility, including environmental and occupational hazards, genetic abnormalities, infectious agents, delayed childbearing, and certain behaviors, diseases, or disorders. Other concerns involve the diagnosis and treatment of infertility. Lessons Learned: Infertility is an emerging public health priority because it is a common disease or disability and considerable gaps exist in the public health community. The working group hopes its work will focus wider attention on infertility as a public health problem, including the area of environmental health.


Exposure 5

A Public Health Focus on Infertility: National Action Plan and Next Steps

  • N. Larsen, on behalf of the CDC's Infertility Working Group , Centers for Disease Control and Prevention and SAIC (contractor)

Background: Infertility is a common disease/disability. In 2002, approximately 2 million American women of reproductive age were infertile and 3.3–4.7 million sexually experienced men reported seeking a visit for infertility services. The Centers for Disease Control and Prevention (CDC) has long been concerned with infertility causes and prevention. An agencywide ad hoc working group formed at CDC in 2007 to coordinate infertility activities found gaps and opportunities in public health surveillance, research, communications, programs, and policy development. To address these concerns, the group published a white paper highlighting infertility as a public health issue (Fertil Steril. 2008 Nov 5) and held a symposium at CDC to review infertility causes, consequences, and potential interventions. Symposium participants requested the group to outline a national action plan on infertility and public health. Issue: To develop a national action plan that addresses gaps in infertility and public health. Results: The public health and infertility national action plan outline incorporates elements from the infertility white paper; suggestions from the symposium; public health principles, including primary, secondary, and tertiary prevention; and the Institute of Medicine's core functions. The plan has 5 essential components: evaluating impact; advancing knowledge; advancing policy; strengthening capacity; and taking action. The completed outline will be sent to interested stakeholders, who be invited to draft the final plan by joining any of 4 plan workgroups on surveillance, research, policy, and communication. Lessons Learned: The national action plan on infertility and public health will address the gaps in surveillance, research, communications, programs, and policy development. The working group hopes its activities focus wider attention on infertility as a public health problem, including the area of environmental health.


Exposure 5

A Public Health Focus on Infertility: Unmet Needs and Opportunities for Action

  • R. Wang , Centers for Disease Control and Prevention

Background: In 2002, approximately 2 million American women of reproductive age were infertile and 3.3–4.7 million sexually experienced men reported seeking a visit for infertility services. Centers for Disease Control and Prevention (CDC) conducts surveillance and research on the causes of infertility, monitors the safety and efficacy of infertility treatment, and sponsors national prevention programs. An agencywide ad hoc working group was formed in 2005 to coordinate infertility activities at CDC and to evaluate for existing gaps in this area. These findings have been published (Fertil Steril 2008 Nov 5). Issue: To identify opportunities for strengthening infertility prevention and management and the roles that the public health community can play in this effort. Results: The working group found that several opportunities exist in public health surveillance, research, communication, and program and policy development. For example, ongoing data collection systems need to be expanded to obtain valid population-based estimates of the prevalence of infertility in women and men and to better understand environmental, sociodemographic, and behavioral correlates of infertility. In-depth research is needed to evaluate similar issues at the population level using surveillance systems. Systems and policies to facilitate the translation of research results into prevention programs need to be developed. Upon the development of infertility prevention and management programs, efforts need to be coordinated to assure that they reach people who need them. Lessons Learned: Several opportunities exist for strengthening infertility prevention and management programs. With the publication of these findings and the roll-out of a national action plan, the working group hopes to focus wider attention on infertility as a public health problem, including the area of environmental health.


Exposure 6

Microenvironment Exposure Weights Can Be Obtained From a Straightforward Statistical Model of Time-Location Data

  • B. DeCastro , Westat
  • A. Geyh , Johns Hopkins University
  • A.Houseman , Brown University
  • L. Ryan , Commonwealth Scientific and Industrial Research Organisation (Australia)
  • J. Spengler , Harvard University

Collection of time-location data through diaries is a common feature of personal exposure studies and is intended to provide a basis for time-weighted averaging in exposure assessment totaled across microenvironments. Particular difficulties posed by the outcome—multiple nonordered microenvironments—have precluded routine statistical analysis, but such multinomial outcomes may be modeled within a regression framework using the generalized logit model (or discrete choice model). Conveniently, this model predicts the proportions of subjects in each microenvironment at each time interval. These proportions may be construed most usefully as exposure weights in a formulation of total exposure. This report introduces the generalized logit model and demonstrates its application to data from a study of schoolchildren (N = 95, 7–11 years old) in southern California who reported their time-location at 30-minute intervals in structured 24-hour diaries for 4 days per month for 12 months (June 1995–May 1996; N = 171,000). A generalized logit model of the proportion of subjects in each of 5 microenvironments—indoor-home, indoor-school, indoor-other, commuting, outdoors—shows that while subjects spent substantial time indoor-home, there was substantial variation for other microenvironments at all temporal scales. Consistent with a daily academic schedule, indoor-school time predominates at the 30-minute timescale. Yet, at the day and month timescales indoor-other predominates. This suggests that important longer-term exposures among schoolchildren may be missed because nonhome and nonschool microenvironments are not often monitored. The model also found that microenvironment location is most positively correlated with the previous 30-minute interval, tapering through the preceding 3 hours. Also discovered was that children in homes with =5 televisions spent 21% less time outdoors than homes with =2 televisions, while nonwhites spent 21% less time indoor-school than whites.


Exposure 6

Perinatal Exposure to Perchlorate, Thiocyanate, and Nitrate in Mothers and Newborns

  • B. Blount , Centers for Disease Control and Prevention
  • D. Rich , University of Medicine and Dentistry of New Jersey
  • L.Valentin-Blasini , Centers for Disease Control and Prevention
  • S. Lashley , University of Medicine and Dentistry of New Jersey
  • C. Ananth , UMDNJ-Robert Wood Johnson Medical School
  • E. Murphy , New Jersey Department of Environmental Protection

Background/Objectives: Perchlorate is a commonly occurring environmental toxicant that may be transported across the placental barrier by the sodium-iodide symporter (NIS), possibly resulting in both increased perchlorate exposure and decreased iodide uptake by the fetus. Methods: We measured levels of 3 physiologically relevant NIS-inhibitors (perchlorate, nitrate, and thiocyanate) and iodide in maternal and fetal fluids collected during caesarean-section surgeries on 150 US women. Results: Geometric means of perchlorate, thiocyanate and nitrate concentrations in maternal urine (2.90, 947, and 47900 µg/L, respectively) were similar to previously published results, while urinary iodide concentrations (1420 µg/L) were significantly higher (p<0.0001), likely because of prevalent prenatal vitamin use in the study population (74%). Thiocyanate concentrations were higher in the maternal serum, cord serum, and amniotic fluid of smokers compared to women with environmental tobacco smoke exposure and nonsmokers (p-values of 0.0006, 0.0011, and 0.0026, respectively). Perchlorate was detected in most samples: urine (100%), maternal serum (94%), cord serum (67%), and amniotic fluid (97%). Maternal urinary perchlorate concentrations were positively correlated with perchlorate concentrations in amniotic fluid (r = 0.57), indicating that maternal urine perchlorate is an effective biomarker of fetal perchlorate exposure. Maternal serum perchlorate was generally higher than cord serum perchlorate (median ratio 2.4:1 for paired samples), and maternal urine perchlorate was always higher than fetal amniotic fluid perchlorate concentrations (mean ratio 22:1); conversely, iodide levels were typically higher in fetal fluids compared to maternal fluids. Conclusions: We found no evidence of either disproportionate perchlorate accumulation or lack of iodide in the fetal compartment, and no association between cord blood concentrations of these anions and newborn weight, length, and head circumference.


Exposure 6

Chemicals Used in Personal Care Products: Biomonitoring Advances

  • A. Calafat , Centers for Disease Control and Prevention

Background/Objectives: Synthetic chemicals such as phthalates (plasticizers), parabens (preservatives), triclosan (antimicrobial agent), and benzophenone-3 (sunscreen agent) can be used in personal care products, medications, paints, adhesives, and in some medical products. Data on the potential effects of these compounds on human health are limited and, at times, even contradictory, but several of these chemicals have demonstrated toxicity in experimental animals. For the past 10 years, we have developed biomonitoring programs to assess human exposure to several compounds present both as “active” and “inactive” ingredients in personal care products. Methods: We have analyzed biological samples (e.g., urine, serum) collected from the general population using state-of-the-art analytical methods, namely isotope dilution tandem mass spectrometry. Results: The urinary concentrations of monoethyl phthalate (MEP) have been associated with the reported use of personal care products both in men and women. MEP is the primary metabolite of diethyl phthalate, a compound commonly used as a fragrance vehicle in personal care products. The urinary concentrations of the sunscreen agent benzophenone-3 were significantly higher among men than women and among whites compared to blacks. Exposure to triclosan and parabens also follows specific demographic patterns. Conclusions/Implications: Exposure to several these chemicals commonly used in personal care products is prevalent in the general US population. The observed differences by sex, gender, and race/ethnicity probably reflect differences in lifestyle (e.g., use of personal care products containing these compounds). The identification of personal care products as contributors to these chemicals' body burden is an important step in exposure characterization. Further work is needed to identify additional predictors of exposure to these synthetic chemicals.


Exposure 6

Exposure to Acrylamide and Its Metabolite Glycidamide in the General Population

  • H. Vesper , Centers for Disease Control and Prevention

Background/Objectives: The toxicity of acrylamide and its primary metabolite glycidamide in combination with the lifelong exposure of the population to these chemicals raised concerns about their health effects. To aid in the assessment of possible health risks, the extent of the actual acrylamide and resulting glycidamide exposure in the general population needs to be characterized. The aim of this study is to assess human exposure to acrylamide and glycidamide in the general population using hemoglobin adducts of acrylamide and glycidamide as biomarkers of exposure. Methods: The newly released data from the National Health and Nutrition Examination Survey (NHANES) as well as data from other studies reported in the literature were reviewed. Biomarker values observed in the NHANES population were assessed by sex, age groups, race/ethnicity, and smoking status. Results: Consistently across studies, smokers have higher biomarker values than nonsmokers. There is a high variability among individuals but modest differences between NHANES population subgroups and other study populations, which suggests that gender, age, race/ethnicity, and geographical location do not strongly affect acrylamide exposure. Though modest, biomarker levels in nonsmokers differs among country and ethnic groups. NHANES data indicate that secondhand smoke has a small but significant impact on biomarker levels in nonsmokers. Conclusions: The modest differences in biomarker values between population subgroups may result in different health risks for these groups. Therefore, these differences may need to be considered in future risk assessment studies. Further studies are needed to better explain the high among individual variability within subpopulations.


Exposure 7

National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population 1999–2002

  • C. Pfeiffer , Centers for Disease Control and Prevention (CDC)
  • R. Schleicher , Centers for Disease Control and Prevention
  • W.Young , National Association of Chronic Disease Directors
  • J. Jacobellis , National Association of Chronic Disease Directors
  • J. Osterloh , Centers for Disease Control and Prevention
  • R. Jain , Centers for Disease Control and Prevention

Background: The National Health and Nutrition Examination Survey (NHANES) collects unique reference information on biochemical indicators of diet and nutrition representative of the US population; however, the data are not easily accessible for review and interpretation by health officials and professionals. Issue: To improve understanding of the levels of biochemical indicators in the general US population and in selected subpopulations, the Division of Laboratory Sciences (DLS), Centers for Disease Control and Prevention (CDC), set out to generate a comprehensive nutrition report that presents NHANES data by age, sex, and race/ethnicity for all or part of the 4-year period from 1999 through 2002. The National Association of Chronic Disease Directors (NACDD) aimed at translating the nutrition report to a white paper that makes program and nutrition surveillance policy recommendations for public health action to prevent chronic disease. Results: In July 2008, DLS released the National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population 1999–2002 , the first CDC publication that offers reference information on a wide range of biochemical indicators (27) in a single document ( These indicators are representatives of water-soluble vitamins, fat-soluble micronutrients, iron-status indicators, trace elements, and isoflavones and lignans. In August 2008, the NACDD released a white paper that translated and disseminated responses to the observations in the nutrition report and made policy recommendations for federal, state, and local governmental organizations. Lessons Learned: The nutrition report will help scientists assess inadequate or excess intake and will inform analyses on the relation between biochemical indicators and health outcomes. It is expected to be a valuable resource for the nutrition community. Advocacy for adoption of the policy recommendations is underway through the NACDD Legislative and Policy Committee.


Exposure 7

Iodine Status of the U.S. Population, NHANES 2005–2006

  • K. Caldwell , Centers for Disease Control and Prevention
  • A. Makhmudov , Centers for Disease Control and Prevention
  • E.Ely , Centers for Disease Control and Prevention
  • J. Jarrett , Centers for Disease Control and Prevention
  • D. Henahan , Centers for Disease Control and Prevention
  • R. Jones , Centers for Disease Control and Prevention

Background/Objectives: Since 1971, the general US population has been monitored for dietary iodine sufficiency by urinary iodine (UI) measurements through the National Health and Nutrition Examination Survey (NHANES). This report presents the UI concentrations for the population participating in NHANES 2005–2006. Methods: In 2005–2006, approximately 5,000 participants per year were selected to participate in NHANES. Household interviews and physical examinations were performed. Urinary iodine-concentrations assessments were determined on a random subsample of 2,649 participants ages 6 years and older. Results: The median UI concentrations for the general US population in 2005–2006 was 164 µg/L (95% confidence interval [CI]: 154–174). Children had a higher UI concentrations than adolescents and adults. Among all (pregnant and nonpregnant) women of reproductive age, the median UI concentration was 120 µg/L (95% CI: 108–138), 37.1 ± 17.6% of pregnant women had a UI concentrations <100 µg/L, and 10.7 ± 10.4% of pregnant women had a UI level <50 µg/L. Conclusions: These findings affirm the stabilization of the UI concentrations and the adequate iodine nutrition in the general US population since 2000. However, subgroups of the population have medium urinary concentrations either excessive or insufficient with regards to iodine status. Children 6–11 and adults 70 years and older have urinary iodine concentrations in excess of levels determined by the World Health Organization (WHO) to be adequate and may put them at risk of hyperthyroid induced iodine disorders. Women of childbearing age and, in particular, pregnant women have urine iodine levels that are inadequate, thus placing this group at high risk for iodine deficiency disorders.


Exposure 7

CDC's National Biomonitoring Program

  • J. Osterloh , Centers for Disease Control and Prevention
  • M. Mortensen, Centers for Disease Control and Prevention
  • S. Caudill, Centers for Disease Control and Prevention
  • L. Wong, Centers for Disease Control and Prevention
  • J. Hugick, Centers for Disease Control and Prevention
  • S. McClure, Centers for Disease Control and Prevention
  • J. Pirkle, Centers for Disease Control and Prevention
  • E. Sampson, Centers for Disease Control and Prevention

Background: Biomonitoring measures exposures to environmental chemicals in people's biological samples. The Division of Laboratory Sciences (DLS) has fostered the growth of biomonitoring as a tool for the assessment of exposure to environmental chemicals. Issue: What have been the attributes and applications of biomonitoring? Results: Biomonitoring measures exposure in individuals in contrast to traditional procedures that provide an estimated average exposure. Biomonitoring recognizes aggregate exposure from all routes (dermal, inhalational, gastrointestinal), though it does not identify routes by which exposure occurs. The application of biomonitoring can assist in creating case definitions and recognizing unusual prevalence of exposure in epi-investigation; assigning accurate exposure designation in observational research studies; validating intake doses by reverse dosimetry for risk assessment; diagnosing chemically related disease in medicine; and documenting the trends on exposure over time and the effectiveness interventions in preventing exposure. The National Report on Human Exposure to Environmental Chemicals provides reference values for the US population for exposure to more than 200 chemicals. This report has provided interpretive support to epi-investigations, research, and risk assessments, and has helped direct scientists to study levels of chemicals that might act in the human body. The DLS supports about 50 studies annually that investigate the use and application of biomonitoring. The DLS also is collaborating with other agencies and states on the use of biomonitoring in their programs. Lessons Learned: Biomonitoring can be useful in epidemiology, research, risk assessment, and medicine. Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Environmental Protection Agency, state public health laboratories, and other agencies are using biomonitoring in their approaches to understanding the exposure and risks of environmental chemicals.


Exposure 7

Emerging Techniques in Inorganic Measurements

  • C. Verdon , Centers for Disease Control and Prevention
  • K. Caldwell , Centers for Disease Control and Prevention
  • R.Jones , Centers for Disease Control and Prevention

Background: Recent years have seen rising demand for elemental analysis of human biological samples and a dramatic increase in the number of sophisticated laboratory tests capable of “simultaneously” measuring a greater number of inorganic (“metal”) elements in their various chemical forms—that is, elemental “species.” This is in contrast to techniques that measure an element after a high energy decomposition to its atomic state that strips it of its molecular identity (a “total” measurement). Different species of the same element often have dramatically differing toxicological profiles; therefore, as new analytical methods emerge—largely driven by advances in laboratory instrumentation and techniques—increasingly sophisticated hypotheses can be tested that relate health and disease to the presence of one or another elemental species in human specimens. Issue: Biomonitoring activities concerned with elemental analysis of human urine or blood have been dominated by laboratory technologies—most commonly, inductively coupled plasma mass spectrometry (ICP-MS)—that measure the “total” element concentration but that leave out valuable information concerning the species composition of the element. Results: Online separation technologies such as liquid (LC) or gas chromatography (GC) have been added as hyphenated techniques that accomplish time-resolved separation of elemental species followed by ICP-MS detection. These yield rich information on species composition of the sample and permit better-informed judgment in assigning health risk due to exposure to the element. More recently, refinements in techniques using LC- or GC-ICP-MS include the utilization of isotopically enriched species for the application of isotope dilution methods. Lessons Learned: Questions can be formulated asking what elemental species occur in water, food, and air; how are they transformed upon entering the body; and what differential effects these elemental species have on human health.


Exposure 8

The Results of State and Federal Efforts to Control Illicit Methamphetamine Production and Use

  • N. Melnikova , Agency for Toxic Substances and Disease Registry
  • J. Wu, Agency for Toxic Substances and Disease Registry

Background: Methamphetamine (meth) is an addictive narcotic that affects the central nervous system. It is easily made in small illegal labs where its production endangers the makers, neighbors, and the environment. Approximately 13 million Americans ages 12 or older reported using meth at least once during their lifetime (NSDUH, 2007). Methods: The retrospective 2001–2008 data from 18 states participating in the Agency for Toxic Substances and Disease Registry's (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry) Hazardous Substances Emergency Events Surveillance (HSEES) system was used to evaluate the trends in illegal meth labs in response to the serious state and federal collaborative efforts to quell the meth lab problem in the United States. Results: Of the 66,588 HSEES events reported from 2001–2008, 3.6% (n = 2373) were meth related. Reported events dropped from 3.3% in 2001 to 1.3% in 2008 with the peak of 5.8% in 2003. Percent of events occurring in residential areas increased from 62.0% in 2001 to 79.0% in 2008. There was a 7-fold decrease in transportation-related meth events (from 13.8% to 1.9%) during this period. Percentage of events with injuries declined from 36.6% in 2001 to 11.4% in 2008. Police officers were first responders on the scene in 66% of all meth events. The percentage of injuries among police officers decreased from 50% in 2001 to 35% in 2008. Percent of victims among general public increased from 29% in 2001 to 47.1% in 2008. Conclusions: The state and federal public awareness campaigns, enhancing precursor chemical restrictions, combined with law enforcement pressure resulted in reduction of domestic methamphetamine events and related injuries. However, additional efforts should be done to eliminate the problem.


Exposure 8

Agricultural Chemical Releases and Associated Public Health Consequences in Selected States

  • P. Ruckart , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • L. Saw , Utah Department of Health
  • J.Shumway , Utah Department of Health

Background: Agricultural chemicals are toxic by nature, but when used appropriately they can aid in pest management, increase crop production, and reduce the spread of disease. However, misuse and unintentional releases can occur. We examined agricultural chemical releases and associated injuries using data from the Hazardous Substances Emergency Events Surveillance (HSEES) system and describe prevention outreach activities conducted by one participating state. Methods: We analyzed data from 17 states participating in HSEES during 2003–2007 for releases involving agricultural chemicals where only one chemical was released. We presented descriptive statistics for contributing factors, industries involved in the releases, categories of victims, types of adverse health effects, severity and disposition of the victims, evacuations, and in-place sheltering. Results: There were 1,753 releases of a single agricultural chemical during 2003–2007 (4% of all events in this time period). Human error was the most frequent primary (root) contributing factor, and improper filling, loading, or packing was the most frequent secondary contributing factor. There were 487 victims in 217 events (12% of all agricultural-related events). Employees and members of the general public were those most likely to be injured. The most frequently reported injuries/symptoms were respiratory irritation and gastrointestinal problems. Most victims were treated at a hospital, but not admitted. Thirteen victims died. Pesticide NOS was the most frequently released individual substance. Agriculture, forestry, fishing and hunting, and transportation/warehousing were the industries most frequently involved in the releases. Conclusions: Proper storage of chemicals, customized educational trainings, and use of integrated pest management (IPM) are likely to minimize agricultural releases and associated public health consequences.


Exposure 8

Using HSEES Data to Reduce Firefighter Injuries in New York State

  • W. Welles , New York State Department of Health
  • R. Wilburn , New York State Department of Health
  • J.Ehrlich , New York State Department of Health

Background: The Hazardous Substances Emergency Events Surveillance (HSEES) program at the New York State Department of Health collects information about acute hazardous materials (hazmat) incidents and associated injuries. HSEES data from 2000 to 2008 include 9,875 hazmat incidents of which 89 resulted in injuries to 413 firefighters. Issue: Responders are not caught unaware by the incident and are trained to protect themselves; therefore, their injuries lead to several questions. Why are firefighters injured? What hazmat incidents pose the greatest risk of firefighter injuries? What are the most common firefighter injuries? What lessons learned can help a firefighter protect himself or herself? Results: Of the 413 injured firefighters, 362 wore firefighter turnout gear: 106 without a respirator, 126 with a respirator, and 130 with respirator use unknown. Hazmat incidents involving multiple chemicals resulted in 60% of the injured firefighters and, therefore, pose a greater risk for firefighters than single chemical incidents. The 4 categories associated with the highest number of injured firefighters were retail trade, utility and sanitary services, private residences, and durable goods manufacture. The most frequently reported symptom among injured firefighters was respiratory irritation (52%). Lessons Learned: Firefighters need reminders to protect themselves from exposure to hazardous materials. Early recognition of hazmat incidents needs to improve. “Prevention is more important than correction” in hazmat incidents. Hazmat training of firefighters varies widely. Firefighters remember stories about “what went wrong” and of lessons learned, which helps improve their future responses and may reduce injuries.


Exposure 9

Biomonitoring: The Advocacy Perspective

  • D. Gratale , Trust for America's Health

Background: For more than 30 years, the Environmental Health Laboratory of the National Center for Environmental Health has been performing biomonitoring, which measures exposure to environmental chemicals in people's bodies. Issue: What have been the advocacy tactics and techniques used to educate and influence key stakeholders on Capitol Hill—congressional staff and members—about biomonitoring? Results: Biomonitoring helps provide information that public health officials can use to determine which population groups are at high risk for exposure to environmental chemicals and adverse health effects, assess public health interventions, and monitor exposure trends. Biomonitoring can help inform policy decisions, ranging from contributing to the science used to support the ban of certain phthalates used in children's toys to assessing the exposure of Nevada schoolchildren to mercury after a student brought liquid mercury to school. Providing policy makers with concrete examples of the applications of biomonitoring is a useful advocacy technique. Describing biomonitoring efforts in particular states, highlighting what could be accomplished with greater resources, and demonstrating support from other coalition partners are also effective advocacy tactics used to educate congressional staffers about the benefits of biomonitoring, especially during appropriations discussions. Future biomonitoring advocacy should continue to highlight concrete examples of biomonitoring accomplishments and articulate what could be achieved with additional support and resources. Lessons Learned: Federal and state health agencies are using biomonitoring to help understand the exposure to environmental chemicals. Examples of specific accomplishments stemming from biomonitoring, and particularly state-specific examples, are helpful in the advocacy environment when discussing authorizing and appropriations legislation.


Exposure 10

Naturally Occurring Asbestos (NOA) in Context

  • M. Harper , Centers for Disease Control and Prevention

Asbestos occurs naturally through geologic processes and can be found throughout much of the world. It is clear that mining of asbestos, the manufacture of asbestos products, and their use is associated with disease. What is less clear is whether significant disease would have occurred in the absence of mining or other significant disturbance of rocks and soils in those areas where asbestos is found naturally. In addition to asbestos there are minerals that are fibrous, but not generally classified as asbestos. While exposure to some of these may also lead to an enhanced risk of disease similar to that caused by asbestos, this has not been shown for all. The risk of disease with any of these materials is related to the production of airborne fibers of dimensions compatible with inhalation. Amphiboles may also form prismatic crystals or fragments of similar dimensions to asbestos known as cleavage fragments. The toxic potential of these other “elongated mineral particles” is often unclear. They are commonly encountered in certain rocks and soils that may be mined or quarried or built upon or tilled. The widespread presence of asbestos and non-asbestiform amphibole crystals and cleavage fragments in rocks leads to exposures of miners and construction workers and farmers, as well as the local population around mining and construction sites. Exposures may also be unrelated to work. Many government agencies within the United States are involved in the issues of “naturally occurring asbestos” (NOA), including the National Institute for Occupational Safety and Health (NIOSH). While NIOSH research efforts are directed to understanding and preventing asbestos exposure of workers, the research results also have bearing on the environmental issues of NOA.


Exposure 10

Methods for Controlling Naturally Occurring Asbestos at Construction Projects to Protect Public Health

  • J. Yetman , Fairfax County Virginia Health Department

Naturally occurring asbestiform deposits were identified at a construction project in 1987. A biopsy of construction worker “rashes” identified asbestos. The deposits are in the Piney Branch Complex, which contains actinolite and tremolite minerals. This complex underlies approximately 7,000 acres or 10.9 square miles of Fairfax County, Virginia. Undisturbed areas have at least 3 feet of overburden of plastic clays and do not represent a health hazard. When disturbed during construction, there is a potential to release respirable fibers. The regulatory approach to protect public health is to control dust from construction projects in these potential asbestos areas. The Environmental Health Division protects public health by enforcing fugitive dust control; air monitoring; and spoils disposal at prior approved sites and disturbed areas capped with 6 inches of clean fill or equivalent. Details and maps can be found at, search word Asbestos. The source of this asbestos has been a basis for a regulatory problem rather than recognition of the fact that asbestos, whether in the ground or in manufactured products, is still asbestos. Since the NESHAP National Emission Standards for Hazardous Air Pollutants) regulations do not specifically mention "naturally occurring" asbestos, this source of asbestos is unregulated. This does not diminish the potential health hazard. The presence of asbestos, confirmed by appropriate laboratory analysis, should be dealt with as a hazardous material regardless of its origin or the working circumstances. However, since this “material” is not covered by a federal or Virginia regulations, the enforcement or control it is not mandated. As a consequence, recent budget limitations have resulted in the program's being defunded as of June 30, 2009.


Exposure 11

State Smoke-Free laws: Effectively Protecting Employees and the Public from Secondhand Smoke Exposure

  • M. Tynan , Centers for Disease Control and Prevention

Secondhand smoke (SHS) contains more than 50 carcinogens and causes 46,000 heart disease and 3,400 lung cancer deaths each year. Additionally, the Institute of Medicine released a report in October 2009 on SHS cardiovascular effects. This report concluded that secondhand smoke causes heart attacks, even brief secondhand smoke exposure could trigger a heart attack; and smoke-free laws prevent heart attacks and save lives. In 2006, the Surgeon General concluded that there is no risk-free level of exposure to SHS and that eliminating smoking from all indoor areas is the only way to fully protect nonsmokers from the adverse health effects of SHS exposure. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings are ineffective in providing protections against SHS. Private worksites, restaurants, and bars are common locations where employees and patrons are likely to be exposed to SHS. A Healthy People 2010 objective calls for establishing smoke-free laws in all 50 states and DC. This presentation will (1) examine the extent to which states have passed laws that provide adequate protection against SHS in worksites, restaurants, and bars; and (2) discuss the air quality improvements and health benefits of these laws. As of October 1, 2009, 21 states and DC have adopted statewide smoke-free laws that prohibit smoking in all 3 of these locations. While the number of states that have enacted smoke-free laws has increased substantially in the past decade, over half of the states still offer either inadequate or no protection from SHS in public places. Smoke-free laws are an evidence-based policy approach that has been proven to reduce exposure to SHS, improve indoor air quality, and encourage smokers to quit.


Exposure 11

Women at Risk for Higher Second-hand Smoke (SHS) Exposure During Pregnancy: Who Are They?

  • G. DeLorenze , Kaiser Permanente
  • J. Yang , Sequoia Foundation
  • M.Pearl , Sequoia Foundation
  • M. Kharrazi , California Department of Public Health

Background/Objectives: Nonsmoking women can be exposed to SHS throughout pregnancy. How this exposure varies in different subpopulations is not well understood. We will quantify the amount of SHS exposure during each trimester of pregnancy via cotinine concentrations distributed across mothers' demographic and behavioral characteristics. Methods: The study sample includes 522 nonsmoking women (46 African Americans, 211 whites, and 265 Hispanics) from the Project Baby's Breath Study who gave birth between March 2001 and February 2003 in San Diego County, California. Urine specimens obtained in early pregnancy (median of 5–6 weeks' gestation), maternal serum specimens collected at 15–19 weeks' gestation, and umbilical cord blood serum/plasma specimens collected at delivery were assayed for concentrations of cotinine, a major nicotine metabolite. Demographics and perceived SHS exposure data were obtained at delivery from either of 2 survey forms. Geometric mean cotinine levels (ng/ml) were compared across subpopulations. Change in log10 cotinine concentrations as predicted by mother's characteristics, was estimated by multivariable linear regression. Results: Exposure to SHS decreased with each succeeding trimester. Univariate analysis revealed that black race, younger age (<20), Medicaid payment for prenatal care, living with smokers during pregnancy, and father who smoked during all 3 trimesters were associated with higher median cotinine concentrations in each trimester. Multivariate regression analysis indicated that = 12 years' education and living with smokers/having friends who smoked predicted higher mean cotinine concentrations in all 3 trimesters. Hispanic race and older age were associated with lower cotinine levels. Conclusions/Implications: The findings indicate that interventions are needed to target specific subpopulations (e.g., mothers with 12 years' education; those living with smokers) in order to reduce maternal prenatal exposure to SHS.


Exposure 11

Secondhand Smoke Exposure Among Nonsmokers in New York

  • K. Aldous , New York State Department of Health

Background: Exposure to secondhand smoke (SHS) has been linked to numerous health consequences, including heart disease and lung cancer. Several state and municipalities have enacted smoke-free air laws and often the effectiveness of these prohibitions has been determined by population-based telephone surveys that measure self-reported SHS exposure. Measurement of the biomarker cotinine in serum or saliva is a more accurate assessment of SHS exposure. Method: Nicotine, a component of tobacco smoke, is rapidly metabolized by the body to cotinine, which has a half-life of ~20 hours, making it an appropriate biomarker for exposure studies. Cotinine can be reliably measured in blood, saliva, and urine using sensitive detection by mass spectrometry. The characteristics and performance of the analytical procedure that is used for both serum and saliva cotinine measurement will be explained. The method was applied to a study that was part of the New York City (NYC) Health and Nutrition Examination Survey conducted in 2003–2004 that measured serum cotinine from 1,767 participants. Results : The smoking prevalence in NYC was lower than found nationally; the proportion of nonsmoking adults in NYC with elevated cotinine concentrations was greater than the national average overall (56.7% vs. 44.9%, p<0.05). The highest cotinine concentrations among nonsmokers were in adults ages 20–39 years, males, and Asian Americans. Conclusions: Although NYC enacted comprehensive smoke-free workplace legislation in 2003, data suggest that exposure to SHS remains a significant health issue, especially among certain groups. The impact of high population density in the urban area may explain the elevated SHS exposure measured in this study.


Exposure 11

Exposure of the U.S. Population to Secondhand Smoke Assessed Through the Use of Biomarkers

  • J. Bernert , Centers for Disease Control and Prevention
  • R. Jain , Centers for Disease Control and Prevention
  • C.Sosnoff , Centers for Disease Control and Prevention
  • Y. Xia , Centers for Disease Control and Prevention

The exposure of nonsmokers to secondhand smoke (SHS) is a significant public health problem. The 2006 Surgeon General's Report on Involuntary Exposure to Tobacco Smoke found that SHS causes premature death and disease in both children and adult nonsmokers, and concluded that no level of exposure is risk free. The use of biomarkers is essential to evaluate exposures within the population. Methods: Two specific biomarkers for tobacco exposure have been used in the National Health and Nutrition Examination Survey (NHANES): serum cotinine, the primary proximate metabolite of nicotine, and more recently the tobacco-specific nitrosamine NNAL. Both have been measured by sensitive and specific liquid chromatography/tandem mass spectrometry methods. Results: An initial evaluation of the noninstitutionalized US population in Phase 1 of NHANES III (1988–1991) found that serum cotinine was detectable in 92% of the population, including 88% of nonsmokers. Continued analyses in the remainder of NHANES III and in subsequent NHANES have documented a substantial decline of more than 70% in exposure levels over the ensuing years, reflecting the concomitant and extensive public health effort to reduce such exposures. However, this decline has largely stabilized in recent years, and a significant number of people continue to be exposed to SHS. In the most recent NHANES, conducted during 2007–2008, we have also begun analyzing urinary NNAL, a tobacco-specific nitrosamine. We have found excellent correspondence between these 2 biomarkers, and have documented that this known pulmonary carcinogen may be measured in many nonsmokers exposed to SHS, further emphasizing the potential risks associated with such exposures. Conclusion: Continued monitoring of both of these markers is important in documenting future efforts to ultimately eliminate the risk of exposure to SHS in the population.


Exposure 12

State Environmental Public Health Policy

  • D. Farquhar , National Conference of State Legislatures
  • S. Hendrick , National Conference of State Legislatures

Environmental public health continued to move forward in state legislatures, in spite of the budget crises, with 158 bills being enacted in 41 states. In every state some bill related to environmental health was introduced, totaling 1,333 bills in the 50 states (DC and the territories were not included in this research). No single issue dominated the environmental health agenda in 2009, but some states were more active than others. New York saw 251 bills introduced, but as of August, none have passed. Indiana only introduced 24 bills related to environmental health, but passed 7 of them. Montana introduced 17 bills, enacting 6 of them.


Exposure 12

Understanding Emerging State Chemical Policies and Green Chemistry Initiatives

  • S. Hendrick , National Conference of State Legislatures

Many states regulate chemicals beyond the scope of federal law. Concerns about the health effects of hazardous chemicals have led to state laws targeting substances in products such as toys, jewelry, and cosmetics. Recent federal inaction has prompted some state policy makers to take an aggressive and comprehensive approach to regulating chemicals by requiring a review all chemicals and a listing of those that are particularly hazardous. California and Maine recently passed legislation that requires state agencies to identify chemicals of concern, prioritize which chemicals pose the greatest risk to public health, and regulate the use of those chemicals in consumer products. Connecticut, Washington, and Minnesota have enacted similar legislation. Some states are establishing an interstate chemical clearinghouse to share information on regulated chemicals with other states and the public. Also, several states are pushing green chemistry initiatives that aim to foster use and development of new chemicals and chemical products that reduce or eliminate the use or generation of hazardous substances. This session will explore existing state frameworks for chemical regulation and emerging state approaches to chemical policy. Learn if your state is incorporating these innovative green chemistry and chemical assessment and management policies and what factors contribute to their adoption. Discover what opportunities exist for environmental health professionals and advocates to participate in the emerging national conversation on chemical regulation.


Exposure 12

Protecting Ecosystems and People Through Chemicals Policy: Lessons from the EU

  • M. Schwarzman , University of California–Berkeley

Background: The lack of a well-functioning US chemicals policy has resulted in widespread human and ecosystem exposure to both legacy and “emerging” chemical contaminants, most of whose associated risks are still poorly understood. With the institution of the REACH regulation (for Registration, Evaluation, Authorisation and Restriction of Chemicals), the European Union (EU) is leading the development of chemicals policies that are more protective of human health and the environment Issue: Over the next decade, the REACH regulation will make hazard information available for over 10,000 chemicals in commerce and will provide a mechanism for regulating chemicals of highest concern. Its approach differs fundamentally from current US chemicals policies and merits understanding from a public environmental health perspective. Results: REACH departs from existing chemicals policies in several ways: (1) Equivalent data are required for new and existing chemicals, with a “no data; no market” provision; (2) chemicals in products are subject to regulation; (3) bi-directional communication is established in supply chains; and (4) burden of proof of safety for chemicals of high concern is shifted to producers. With the implementation of REACH, the EU is shifting from a “presumption of innocence” approach to a more precautionary one. Furthermore, by controlling access to European markets, REACH has set what may become a de facto global standard. Lessons Learned: The widening gulf between US and European chemicals policy presents both an opportunity and an imperative for the United States to retool its own approach, drawing on data and models developed in the EU. Doing so has the potential to improve human health and the environment through reduced chemical contamination, safer workplaces, and a chemicals market oriented toward producing safe materials.


Exposure 12

California's Green Chemistry Initiative: Toward a Comprehensive Public Health Model of Chemicals Policy

  • M. Wilson , University of California–Berkeley

Background: Like other highly populated US states, California faces mounting problems caused by human and ecosystem exposures to chemical pollutants. A total of 75% of the state's legacy hazardous waste sites have breached their containment and are leaking directly into groundwater, posing what the state calls a “major threat to human health or the environment.” In 2004, there were an estimated 207,000 cases of occupational disease attributable to chemical exposures, with direct and indirect costs totaling $1.4 billion. Issue: With global chemical production expected to double in 24 years—far outpacing population growth—a deep re-visioning is called for in chemical and product policy. In recognition of this inevitability, and building on years of work by government, nongovernmental organizations, labor, and business leaders throughout the United States in pollution prevention, toxics use reduction, green chemistry, and chemicals policy, the state of California launched its Green Chemistry Initiative (GCI) in 2008. Results: Two laws enacted in 2008 (AB 1879 and SB 509) will implement initial elements of the GCI, building a toxics information clearinghouse and calling on California Environmental Protection Agency to develop a process to identify and prioritize chemicals of concern, and to take action on those of greatest concern, with the goal of “launch[ing] a new chemicals framework and a quantum shift in environmental protection.” Lessons Learned: The GCI faces a formidable set of scientific, technical and policy-related challenges that have opened new research questions at the intersection of chemicals policy, environmental health sciences, and green chemistry. Addressing these questions is essential to inform the policy process as California and other US states, as well as the federal government, take on the challenge of chemicals policy.


Exposure 13

Continental-Scale Variation in Soil Geochemistry: Implications for Human Exposure

  • L. Woodruff , US Geological Survey
  • D. Smith , U.S. Geological Survey
  • W.Cannon , U.S. Geological Survey
  • R. Garrett , Geological Survey of Canada

In 2004, the US Geological Survey and the Geological Survey of Canada collected soil samples from 221 sites along 2 transects across Canada and the United States as a pilot study to refine sampling and analytical protocols for a soil geochemical survey of North America. A north-south transect extended from northern Manitoba to the United States–Mexico border near El Paso, Texas. A west-east transect followed the 38th parallel from just north of San Francisco, California, to the Virginia shore. The 2 transects crossed a wide diversity of soil parent materials, soil ages, climatic conditions, landforms, land covers, and land uses. Sample sites were selected randomly at approximately 40 km intervals. At each site, soils from the A and C horizons and from a depth of 0 to 5 cm were collected. All samples were analyzed for 44 major and trace elements as well as inorganic and total carbon contents. The data reveal coherent, continental- to regional-scale geochemical patterns primarily controlled by natural processes involving soil parent materials, soil age, and climate. Spatial distribution of elements of environmental concern, such as arsenic, cobalt, chromium, mercury, lead, selenium, and tungsten, is highly variable along the transects and is primarily influenced by natural soil-forming factors and occasionally by human activities. Anthropogenic influence on soil chemistry may, in some cases, be recognized by comparing surface soil concentrations with concentrations in deeper soils at individual sites. The effects of soil geochemistry on human health are dependent on element concentrations, soil characteristics, bioavailability, and pathways from soils into the body.


Exposure 13

Bacillus anthracis in N. American soils: Two Long-Range Transects and Within Post-Katrina New Orleans

  • D. Griffin , US Geological Survey

Soil samples were collected along a north-south transect extending from within Canada, to the United States–Mexico border in Texas (104 samples), a group of sites within New Orleans following Hurricane Katrina in 2005 (19 samples), and a Gulf Coast transect extending from Louisiana to Florida, in 2007 (38 samples). Samples were collected from the top few centimeters of soil and were screened for the presence of total Bacillus species and Bacillus anthracis using a multiplex-polymerase chain reaction (PCR) assay. The prevalence rate of Bacillus sp./ B. anthracis in the north–south transect and the 2005 New Orleans post-Katrina sample set were 20/5% and 26/26%, respectively. Prevalence of Bacillus sp. in the 2007 Gulf Coast sample set was 63/0%, and Bacillus anthracis was not detected in any of these samples. Individual transect-set data indicate a positive relation between occurrences of species, and soil moisture or soil constituents (i.e., zinc and copper content). The 2005 New Orleans post-Katrina data indicated that B. anthracis is readily detectable in Gulf Coast soils following flood events. The data also indicated that occurrence as it relates to soil chemistry may be confounded by flood-induced dissemination of germinated cells and the mixing of soil constituents for short temporal periods following an event.


Exposure 13

The North American Soil Geochemical Landscapes Project: Providing Data for Exposure Assessment

  • D. Smith , US Geological Survey
  • L. Woodruff , U.S. Geological Survey

Background/Objectives: A detailed knowledge of the concentration of chemicals in soil is required for calculation of human exposure to those chemicals via a soil pathway. At present, agencies involved with human and environmental health have no common understanding of soil geochemical background variation for North America and the processes that control this variation. Methods: The North American Soil Geochemical Landscapes Project, a tri-national initiative among the United States, Canada, and Mexico, was established to (1) develop a continental-scale design and protocols for generating soil geochemical data and (2) provide baseline soil geochemical data that are useful for a wide range of applications and disciplines, including public health. The project is based on low-density sample collection over a spatially balanced array of 13,496 sites for the continent (1 sample site per 1,600 km 2 ). Samples collected at each site include material from a depth of 0–5 cm and the soil A and C horizons. Each sample is analyzed for more than 40 elements. Results: The results of this 10-year project will provide improved documentation of the natural variability of potentially toxic elements such as mercury, arsenic, and lead in soil. The observed variability is the result of several parameters such as soil parent material, climate, and human activities. Conclusions: Concentrations of potentially toxic elements in soil commonly vary by 1–2 orders of magnitude. Understanding this variation is critical in terms of understanding human exposure and for understanding soil pollution on a national scale. We must understand the range of baseline concentrations if we are to recognize and understand changes in the chemical composition of soil.


Exposure 14

Quality of Water from Private Wells in the United States, 1991–2004

  • L. DeSimone , US Geological Survey
  • P. Hamilton , U.S. Geological Survey
  • R.Gilliom , U.S. Geological Survey

More than 40 million people, or 15% of the US population, rely on privately owned, household wells for drinking water. These wells are not regulated under the Safe Drinking Water Act, and well testing is up to the homeowner. The water quality of about 2,100 private wells from 30 regionally extensive aquifers in the United States was evaluated as part of the National Water-Quality Assessment Program of the US Geological Survey (USGS) from 1991 to 2004. As many as 219 properties and contaminants were measured, in samples collected prior to any treatment, and concentrations were compared to human-health benchmarks (US EPA maximum contaminant levels and USGS health-based screening levels). Overall, 23% of the sampled wells had 1 or more contaminant at a concentration above a human-health benchmark. The contaminants most often above benchmarks (1 to 7% of wells) were primarily naturally occurring, and included radon, arsenic, uranium, and nitrate. Anthropogenic contaminants (pesticides and volatile organic compounds [VOCs]) were detected in more than half the sampled wells, but were above benchmarks in <1% of wells. Microbial contaminants were detected as many as one-third of 400 sampled wells. Regional patterns were apparent. Mixtures of contaminants individually above benchmarks were uncommon (4% of wells), but mixtures of contaminants at concentrations below but approaching benchmarks were found in most wells (73%). Mixtures are of concern because of the potential for synergistic effects and the lack of health benchmarks for mixtures. These findings underscore the importance of homeowner education and well testing, and indicate the vulnerability of private well water to contamination. More information is needed on the numbers and distribution of people consuming water from private wells to better understand the potential health risks associated with contaminants in private well water.


Exposure 14

Polonium-210 in Groundwater in Churchill County, Nevada

  • R. Seiler , US Geological Survey

Background/Objectives: Polonium-210 (210Po) is a toxic alpha emitter that is rarely found in groundwater at activities exceeding 1 picocurie per liter (pCi/L). Its discovery at concentrations exceeding the US drinking water standard for adjusted gross alpha activity (15 pCi/L) in numerous domestic wells at the location of a cancer cluster in Churchill County in northern Nevada led to an investigation of the geochemical processes responsible for mobilizing it. Methods: In 2007–2009, water samples were collected from 63 public-supply and domestic wells and analyzed for major ions, trace elements, stable isotopes, and a suite of radionuclides. 210Po was analyzed by alpha spectrometry. Results: 210Po activities in the wells ranged from less than 0.1 to 170 pCi/L. Public-supply wells all have very low 210Po activity and only domestic wells have activities >1 pCi/L. 210Po is associated with high pH (>8.5) sulfate-reducing waters. Repeat measurements indicate its levels are stable for periods much longer than its half-life of 138.4 days. 210Po is effectively removed from drinking water by household reverse-osmosis systems. Conclusions/Implications: 210Po is a human carcinogen and its presence in drinking water is a cause for concern because of its known biological effects. Its temporal stability indicates it has a natural source and that exposure to 210Po has occurred since the wells were drilled. Concentrations exceeding 15 pCi/L have been reported in fewer than 100 wells from only 4 states in the United States. It will be present in the environment wherever uranium and radon are present, however, and its rarity could be an artifact of limited sampling and unsuitable monitoring methods. USGS is now evaluating the need for a national reconnaissance of its occurrence in groundwater.


Exposure 14

Exposure to Fluoride, Arsenic and Uranium from Well Water in Idaho

  • K. Elgethun , Idaho Division of Public Health
  • J. Vannoy , Idaho Division of Public Health
  • J.Fromm , Idaho Department of Environmental Quality

Background: Many parts of Idaho have groundwater with naturally occurring fluoride, arsenic, and uranium above their respective US Environmental Protection Agency (EPA) maximum contaminant levels (MCLs). Fluoride can cause abnormal bone growth and stained teeth. Arsenic is a Class A carcinogen. Uranium is a potential kidney toxicant. Issue: Private wells that serve fewer than 15 connections or 25 individuals are not subject to EPA drinking water standards. Thousands of wells in rural Idaho fall into this category. Transient wells serving schools are also exempt from fluoride and uranium standards. Irrigation wells are completely exempt despite the fact that crops can take up significant amounts of all 3 contaminants. Drinking water is the primary exposure pathway. However, foods raised using fluoride-, arsenic-, or uranium-containing water may contribute appreciably to exposure. Soils irrigated with these waters can increase in contamination over time. We evaluated the relative contribution of fluoride-, arsenic-, and uranium-affected produce to residents' total exposure in addition to water ingestion alone. Results: Fluoride concentrations in MCL-exceeding Idaho drinking water wells average around 7 mg/L (MCL = 4 mg/L; Max = 22 mg/L). Arsenic concentrations in MCL-exceeding wells average around 20 µg/L (MCL = 10 µg/L; Max = 1460 µg/L). Uranium concentrations in MCL-exceeding wells average around 70 µg/L (MCL = 30 µg/L; Max = 110 µg/L). Root vegetables can concentrate uranium and arsenic in their edible portions. Leafy greens can concentrate all 3 contaminants in their edible portions. Concentrations in these crops can add an additional ~5-20% to the total oral dose when compared to water ingestion alone. Soil ingestion was not considered but may also be a significant pathway for children. Lessons Learned: Promoting private well testing for fluoride, arsenic, and uranium and preventing exposure are important public health services. Crop uptake and subsequent food ingestion should be considered when calculating total oral dose for water contaminants and when educating the public.


Exposure 14

Presenting New Jersey Private Well Water Data to the Public

  • B. Goun , New Jersey Department of Health and Senior Services
  • J. Fagliano , New Jersey Department of Health and Senior Services
  • R.Opiekun , New Jersey Department of Health and Senior Services
  • P. Cohn , New Jersey Department Health and Senior Services
  • J. Louis , New Jersey Department Environmental Protection
  • J. Shevlin , New Jersey Department Environmental Protection

Background: In New Jersey, private wells provide drinking water to approximately 15% of the state's 8.5 million people. Unlike community water systems that are routinely monitored by water suppliers for numerous volatile organic compounds, inorganics, and radiologicals, private well owners are not required to routinely conduct water monitoring. However, under the New Jersey Private Well Testing Act, an owner must test a residential well as part of the sale of their property. Issue: In an effort to assist all residents with information regarding drinking water quality, the New Jersey Environmental Public Health Tracking (EPHT) Project has added private well water quality monitoring data to its public portal. Results: Data collected from over 51,000 private wells tested throughout New Jersey between 2002 and 2007 show geographic variation in the percentage of tested wells that exceeded arsenic and/or nitrate standards. In New Jersey's 10 counties in the Piedmont region, 12% of private wells tested exceeded the state maximum contaminant level (MCL) of 5 micrograms per liter (ug/L) for arsenic. The highest concentration found was 254 ug/l. Exceedances were most frequent in Mercer, Hunterdon, and Somerset counties (20%, 18%, and 17%, respectively). Statewide, 2.7% of private wells tested exceeded the MCL of 10 mg/l for nitrate. The highest concentration found was 153 mg/l. Cumberland and Salem counties had much higher rates of MCL exceedance for nitrate (11% and 9%, respectively). Implications: By providing private well data in conjunction with data from community water systems, New Jersey EPHT can provide more comprehensive water quality data for public health officials, state and local governments, communities, and interested citizens.


Exposure 14

Perfluorinated Aqueous Film Forming Foams (AFFF) in Municipal Wells Near Fire Fighting Training Sites

  • J. Kelly , Minnesota Department of Health
  • V. Yingling , Minnesota Department of Health

Background: Aqueous film forming foams (AFFFs) containing perfluorinated chemicals (PFCs), have been used since the 1960s to extinguish petroleum fires. PFCs, including perfluoro-octanoic acid (PFOA), perfluorooctane sulfonate (PFOS), and perfluorohexane sulfonate (PFHxS) have been detected in groundwater at large firefighting training locations (military bases, airports, fire training schools). These findings have raised concern about potential contamination of drinking water near other fire training sites. Methods: The Minnesota Pollution Control Agency (MPCA) surveyed fire departments, major airports, refineries, and fire training academies on the types and volume of firefighting foams used and the location and frequency of training. The MPCA and the Minnesota Department of Health (MDH) evaluated the survey results and developed a prioritized list of sites for further investigation. MDH focused on sites near municipal water supply wells. Fifteen cities were identified as being at risk based on proximity of the wells to training areas, well capture zone and groundwater flow direction, vulnerability to contamination, depth and construction of the wells, volume of AFFF used, and frequency of training. Seventy-two city wells were sampled in March–April, 2009. Results: PFCs were detected in wells in 7 cities; none exceeded state drinking water limits. The highest concentrations were detected in Cottage Grove, Minnesota, where the results are confounded by the presence of a larger, industrial waste-related PFC groundwater plume. In general, the concentrations of PFCs detected were below 0.1 parts per billion. Conclusions: Firefighting training sites where PFC-bearing AFFFs are repeatedly used may pose a risk to drinking water supplies. However, sampling to date in Minnesota indicates PFCs concentrations in community wells near smaller fire training sites are below levels of health concern.


Exposure 15

How to Reach the Masses: Lessons Learned in Faith-Based Environmental Health Outreach

  • N. Graves , University of North Carolina–Chapel Hill

As the faith community becomes increasingly involved in health initiatives, educators must be prepared to provide meaningful information in an appropriate format, especially for vulnerable populations disproportionately affected by environmental health issues. African American audiences, in particular, have been shown to be responsive to health interventions through faith-based community outreach (Campbell, 2007). For this reason, the Community Outreach and Education Core (COEC) in the UNC-Chapel Hill Center for Environmental Health and Susceptibility (CEHS) has partnered with traditional African American churches to provide important environmental health information for at-risk communities in North Carolina. The COEC translates CEHS research into knowledge that can improve public health and educates the public about genetic and environmental factors in disease. Since fall 2007, over 400 adult and youth church members have learned about risks for environmentally related disease and actions to reduce those risks. Workshop evaluation results indicate increased knowledge among participants following workshops and, in some cases, an intention to change behavior. Preliminary (nonvalidated) results of follow-up surveys indicate that adult participants took some of the recommended actions to reduce their disease risk. Lessons learned in the COEC's faith-based outreach include the following: (1) Start small (with one key environmental health issue), and build from that foundation. (2) Maintain ongoing relationships with the faith-based community and its leadership. (3) Some churches are more sophisticated than others in recruitment and in supporting health-related initiatives. (4) Look for opportunities to bring together diverse churches that are proximate. (5) Evaluating the success of outreach efforts in these informal educational settings can be challenging.


Exposure 15

A Methodology to Examine Environmental Health Disparities in Philadelphia

  • S. Márquez , The University of the Sciences
  • A. Oluyomi , MD Anderson Cancer Center

Although significant advances in environmental health have been made in Philadelphia with regard to lead safe housing and reducing childhood lead poisoning, a critical need that remains is addressing environmental justice, eliminating health disparities associated with other environmental exposures, and identifying populations that are disproportionately impacted and particularly vulnerable to environmental exposures. This paper provides an overview of a methodology to collect, analyze, and summarize data on environmental exposures in relation to community health center service areas for agenda setting and examining health disparities in relationship to spatial environmental data (such as permitted discharges, Superfund sites, brownfields, age and condition of housing). Particular attention is given to how spatial analysis and the geographic information system (GIS) can be used to address environmental justice and health disparities issues in setting public health agendas and developing community-based intervention strategies. Spatial analysis and GIS can play an important role in evaluating and assessing aggregate health impacts, including lifestyle factors, social determinants, and environment factors; neighborhood and community attributes; and housing and land use attributes linked to disparities in health outcomes; and it provides a useful tool for raising awareness and building partnerships to communicate with the public about disproportionate impacts and environmental justice issues. Since environmental health issues receive less-than-sufficient attention in the evaluation and prioritization of addressing health disparities and intervention strategies, this basic screening methodology is useful for evaluating disproportionate impacts and health disparities issues, with environmental public health as an integral part of the process.


Exposure 15

Advancing the Consideration of Vulnerability Factors in Environmental Justice Analysis for Decision Making

  • O. Nweke , US Environmental Protection Agency
  • P. Grevatt , U.S. Environmental Protection Agency
  • H.Case , U.S. Environmental Protection Agency
  • C. Lee , U.S. Environmental Protection Agency
  • D. Payne-Sturges , U.S. Environmental Protection Agency
  • H. Zenick , U.S. Environmental Protection Agency
  • W. Sanders , U.S Environmental Protection Agency

Research suggests that minority and low income population groups systematically experience higher levels of environmental exposures and related health impacts compared to the general population or other population groups. Disparities in the health impacts of environmental hazards derive from unequal distribution of one or more factors like biological and psychosocial factors across population groups. These factors may operate at both the community and individual levels, and in ways that directly or indirectly affect the vulnerability of groups in the population, such as through increased susceptibility to and/or increased exposure to environmental hazards. Therefore, it is important to elucidate how these factors contribute to vulnerability. Such knowledge is valuable to facilitate consideration of vulnerability in assessments to determine whether or not minority and low-income populations experience differential environmental health impacts. The Environmental Protection Agency's Office of Environmental Justice has initiated a project to lay the scientific foundation for developing tools and analytical frameworks that incorporate the concept of vulnerability in assessments of environmental health disparities. Objectives include the following: (1) identify community-level factors (e.g., inadequate social capital, psychosocial stress) that are prevalent among minority and low-income populations that may affect vulnerability to environmental hazards; (2) elucidate how these factors contribute to differential burdens of susceptibility, environmental exposure, and health impacts; and (3) identify data sources and needs, frameworks, and methods for incorporating these concepts in disproportionate impact analysis. This effort will provide the scientific support for the incorporation of the concept of vulnerability in environmental justice analysis, and also illuminate opportunities to adapt existing risk assessment tools and frameworks for environmental justice analysis.


Exposure 16

Respiratory Health Following a Decrease in Hydrogen Sulfide Gas Emissions: Dakota City, Nebraska

  • C. Cusack , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • S. Foster , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • J.Sapp , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • J. Wu , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

Objective: A 10-month health investigation compared concentrations of hydrogen sulfide (H 2 S) in ambient and indoor air with the prevalence of respiratory conditions among Dakota City, Nebraska, residents after a known source of contamination was mitigated. This study determined if covering the wastewater lagoons resulted in measurable decreases in the concentration of H 2 S emissions and related decreases in the number of hospital visits for acute respiratory illnesses. Methods: Ambient and indoor air monitoring stations collected H 2 S emissions data near the wastewater lagoons and in surrounding areas of Dakota City. Air monitoring and hospital discharge data were evaluated to determine if there was an overall decrease in visits for respiratory-related disease reported on days on or following high concentrations of H 2 S. Results: Covering the wastewater lagoons resulted in a decrease in the ambient and indoor levels of H 2 S. Additionally, there was a decrease in the number of emergency room and unscheduled outpatient visits for asthma and “all respiratory” conditions. Conclusions: The number of hospital visits did not increase on the day of or the day immediately following high H 2 S levels. However, the overall decrease in hospital visits for asthma and “all respiratory” conditions suggests a relationship between the covering of the wastewater lagoons and the subsequent decrease in H 2 S levels. The findings are consistent with the hypothesis that a reduction in the exposure to H 2 S has positive health benefits.


Exposure 16

Is Vapor Intrusion Lurking Around Your Town's Former Friendly Neighborhood Drycleaner?

  • J. George , Tennessee Department of Health

Background: Exposure to tetrachloroethylene (perc), the most common dry cleaner chemical, is a known health concern. Data from Tennessee's Dry Cleaner Environmental Response Program (DCERP) suggests that 10% of drycleaners investigated showed evidence of perc vapor intrusion. Vapor intrusion is an unwelcome guest at former dry cleaner sites or any site undergoing environmental investigation and slated for redevelopment or reuse. Issue: Dry cleaners are located everywhere. Because of their locations, a chemical released from a dry cleaner to the environment can impact a number of people. Vapor intrusion can affect residential and/or other retail and commercial properties that lie adjacent to dry cleaners. Groundwater, soil, and even soil gas are routinely investigated. What about indoor air? The Tennessee Department of Health (TDH) along with other state and federal agencies, suggests indoor air needs to be routinely evaluated. Results: The DCERP program is currently assessing 55 sites across the state. DCERP asks TDH's Environmental Epidemiology Program (EEP) to evaluate about 5 sites each year for health concerns due to vapor intrusion. These sites have indoor air concentrations of perc and trichloroethylene above health comparison values. Many are being converted to another use (brownfield redevelopment), and are near sensitive populations (day care facilities, homes, assisted living centers, churches) or other residential or commercial establishments. Lessons Learned: With the increasing focus on perc and trichloroethylene toxicity by regulatory agencies, the health comparison values or screening values for these compounds continue to be set lower and lower. Evaluations considering factors such as the current levels of indoor air contaminants, the future use of the site, and the effect the impacted media has on those adjacent to the site should be performed to assess site reuse.


Exposure 16

Environmental Health Surveillance Data Meets the Public Health Assessment Process

  • E Hom , California Department of Public Health
  • M. Underwood , California Department of Public Health
  • R.Orozco , California Department of Public Health
  • J. Roberts , California Department of Public Health

Background: The California Department of Public Health houses several programs funded by the Centers for Disease Control and Prevention (CDC) that often work in isolation from each other. Two of these programs, the Site Assessment Section (SAS), which evaluates the exposure and health impacts from hazardous waste sites, and the California Environmental Health Tracking Program (CEHTP), which is establishing a statewide network of environmental and health data, recently collaborated to expand the health outcome data used in the public health assessment process. Issue: Together, SAS and CEHTP identified various types of environmental health surveillance data to analyze for the communities located near a former secondary smelter that had released toxic air emissions in the past and had deposited hazardous waste on the site. Then SAS evaluated wide variety of health outcomes that may have been negatively impacted by exposure to the pollutants from the smelter. Results: Working with CEHTP resulted in a more comprehensive investigation into the possible health effects of the smelter. For example, standard risk assessment techniques would not have involved looking at preterm birth. However, even after controlling for several known risk factors for preterm birth, this investigation identified preterm birth as possibly associated with exposure to the smelter pollutants. Lessons Learned: This case study illustrates how examining a broad spectrum of environmental health surveillance data can help identify important negative health impacts from a contaminated site and inform communities about their performance on specific health indicators. However, significant limitations include that that exposure is often very crudely classified and sometimes health surveillance data are only available for only very short periods of time.


Exposure 16

Stakeholders and Vapor Intrusion

  • L. Siegel , Center for Public Environmental Oversight

More than many other environmental activities, vapor intrusion response requires the active cooperation of impacted communities. However, the inherent complexity of the investigation means that agencies and other must make an extra effort to educate homeowners, school staff, and other affected people. Furthermore, policies should be developed to address residents concerns over property values, not just because it is fair, but because fear of lost wealth discourages cooperation. As more communities develop experience with vapor intrusion, they are developing consensus positions in support of real-time sampling, blanket mitigation, and source remediation as the ultimate solution. A growing number of communities are insisting upon long-term management programs—particularly at school sites—to ensure that mitigation systems remain protective. However, even the best practices will not win community support unless agencies and responsible parties make a conscious effort to develop trust.


Exposure 17

Lead Bullet Fragments in Venison from Rifle-Killed Deer: Potential for Human Dietary Exposure

  • W. Hunt , The Peregrine Fund
  • R. Watson , The Peregrine Fund
  • J. Oaks , Washington State University
  • C. Parish , The Peregrine Fund
  • K. Burnham , The Peregrine Fund
  • R. Tucker , Washington State University

Background/Objectives: Published studies show retention of lead ammunition residues in the tissues of hunter-killed animals and elevated blood lead concentrations in subsistence hunter populations. A 2008 study by the Centers for Disease Control and Prevention (CDC) reported significantly higher blood lead concentrations in consumers of game meat. We investigated the incidence and bioavailability of lead bullet fragments in a sample of 30 deer shot by hunters with standard lead-core, copper-jacketed bullets under normal hunting conditions. Results: All carcasses showed metal fragments and widespread fragment dispersion in radiographs before being taken to commercial butchers. Fluoroscopy revealed metal fragments in the resultant ground meat packages of 24 (80%) of the 30 deer; 32% of 234 ground meat packages contained at least one fragment. Fragments were identified as lead by ICP in 93% of 27 samples. Isotope ratios of lead in meat matched the ratios of bullets, and differed from background lead in bone. We fed fragment-containing venison to 4 pigs to test bioavailability; 4 controls received venison without fragments from the same deer. Mean blood lead concentrations in pigs peaked at 2.29 µg/dL (maximum 3.8 µg/dL) 2 days following ingestion of fragment-containing venison, significantly higher than the 0.63 µg/dL averaged by controls. Conclusions: We concluded that people risk exposure to bioavailable lead from bullet fragments when they eat venison from deer killed with standard lead-based rifle bullets and processed under normal procedures. The extent to which lead bullet fragment ingestion is harmful to humans is unknown, but in consideration of the 10 million hunters in the United States, their families, and low-income beneficiaries of venison donations, we urge the investigation of bone lead concentrations in long-term consumers of venison.


Exposure 17

Elevated Blood Lead Levels Negatively Impacts Kindergarten Reading Readiness

  • P. McLaine , Johns Hopkins University
  • A. Navas-Acien , Johns Hopkins University
  • P. Simon , Rhode Island Department of Health
  • M. Diener-West , Johns Hopkins University
  • J. Agnew , Johns Hopkins University

Background and Objective: Despite decreases in blood lead levels in the US population, many children living in urban areas continue to be affected by early and ongoing exposures to lead. Lead exposure effects on IQ are well known, and the detrimental impact of lead exposure on reading and math school progress has been described. Our objective was to evaluate the relationship between blood lead levels and kindergarten reading readiness, an earlier marker of school performance, in a diverse urban school population. Methods: Kindergarten reading readiness test scores and school administrative data for 3,652 children attending public school kindergarten in Providence, Rhode Island, were linked to State Health Department records of blood lead testing using individual identifiers. Children having at least one blood lead test and reading readiness test scores in both the fall and spring were included (N = 3,407). A total of 59% were Hispanic and 36% spoke Spanish as their first language. On average, each child had 3 available blood lead tests. For each child, the geometric mean blood lead level was estimated. Results: The median geometric mean blood lead level was 4.2µg/dL (IQR 2.9–6.0). After adjustment for sex, race, age, child language, and free/reduced lunch status, children whose blood lead levels were 5–9 and =10ug/dL were 1.43 and 2.49 times more likely to score below national benchmark standards for reading readiness in the fall (OR: 1.43; 95% CI: 1.22, 1.68)(OR: 2.49; 95% CI: 1.84, 3.35) compared to children whose blood lead levels were 0–4ug/dL. On average, the fall reading readiness score was decreased by 5 and 10 points for children with blood lead concentrations in the 5–9 and 10+ug/dL categories respectively, compared to children with blood leads 0–4ug/dL (-4.5 points [95% CI: -6.1, -2.8]) (-10.1 points [95% CI: -13.3, -7.0]). Conclusions: Elevated lead exposure may contribute to decreased reading readiness at kindergarten entry. Additional lead exposure remediation and educational programs during or before kindergarten could reduce the gap in reading readiness before children begin basic primary school education.


Exposure 17

Methodological and Regulatory Issues Surrounding the Health Evaluation of Lead in Synthetic Turf

  • S. Gerstenberger , University of Nevada–Las Vegas
  • K. Gleason , New York State Department of Health
  • G.Pulliam , New Jersey Department of Health and Senior Services
  • J. Fagliano , New Jersey Department of Health and Senior Services
  • D. Moffett, PhD , Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention
  • G. Ulirsch, PhD , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

Background: In 2007, the New Jersey Department of Health and Senior Services (NJDHSS) and the Agency for Toxic Substances and Disease Registry (Centers for Disease Control and Prevention [CDC]/Agency for Toxic Substances and Disease Registry) evaluated a synthetic turf recreational field in Newark, New Jersey. Lead was detected in turf fibers and fiber-derived dust at concentrations exceeding federal and New Jersey hazard criteria for lead in dust and soil. Therefore, the field was closed as a prudent public health response. Issue: Public health professionals across the country soon began to evaluate synthetic turf for the presence of lead. In June 2008, CDC issued a health alert recommending testing of older fields and guidelines to reduce the potential for children's exposure to lead. In July 2008, the Consumer Product Safety Commission released an analysis of lead in synthetic turf concluding that synthetic fields are safe to install and play on. Results: Data collected from recreational fields and day care centers in the United States (New Jersey, New York, and Nevada) and Korea have verified the widespread issue regarding elevated lead concentrations in some synthetic turf fibers. Lessons Learned: Standardized approaches for sampling synthetic turf and interpreting the results to assess potential lead hazards are lacking. Furthermore, an in-depth understanding of the exposure and health risk implications of lead in turf is needed, especially given its presence in day care centers. As a result, the CDC/Agency for Toxic Substances and Disease Registry, NJDHSS, New York State Department of Health, and the University of Nevada–Las Vegas have collaborated to (1) increase awareness of potential lead exposure from synthetic turf; (2) identify assessment uncertainties; (3) recommend that regulatory agencies, with input from other interested parties, systematically address these uncertainties; and (4) recommend an interim standardized approach for sampling, interpreting results, and taking health-protective actions.


Exposure 18

Urinary Cadmium and Association with Bone Density in Men and Women Over 20 Years: NHANES III, 1988–1994

  • R. Jeffries Birch , Westat
  • K. Mahaffey , Westat
  • R.Clickner , Westat

Background: Urinary cadmium (UCd) concentrations reflect long-term exposure to cadmium. Under conditions of high environmental exposures and in occupational settings, exposure to cadmium has been associated with overt bone disease, specifically reduced bone mineral concentrations. Environmental cadmium exposures in recent decades in the United States are substantially lower than those previously identified as impairing bone structure. Utilizing urinary cadmium concentrations and bone density measurements using dual energy X-ray absorptiometry (DXA) reported during the National Health and Nutrition Examination Survey III (NHANES III) (1988–1994), we investigated the relationship between bone density and urinary cadmium excretion among adults over 20 years of age. Methods: Low bone mass was defined as a T-score of < -1 on bone density of total hip region and osteoporosis was defined as a T-score of < -2.5. UCd was categorized into 4 groups, <0.05µg/g creatinine, 0.5–1.0 µg/g creatinine, 1.0–2.0 µg/g creatinine, and 2.0 or greater µg/g creatinine. Logistic regression analyses were carried out on 4 population stratifications based on gender and age, 2 demographic factors known to be associated with bone density. Additionally, analyses were adjusted for race/ethnicity, body mass index, smoking status, age, and menopause status for women. Results: Statistically significant odds ratios were found showing an association between UCd and low bone density and osteoporosis for men =50 years and between urinary cadmium and osteoporosis for women =50 years. UCd was not a significant predictor for either low bone mass or osteoporosis for men or women <50 years. Conclusions: These data indicate that even at exposures currently present in the United States decreases in bone density may be associated with increasing urinary cadmium over the range of exposures present in the United States within the past decade.


Exposure 18

Blood Mercury Levels Among Consumers of Locally Caught Fish, Cheyenne River Sioux Tribe Reservation

  • C. Martin , Centers for Disease Control and Prevention

Background: Cheyenne River Sioux Tribe Reservation Tribe (CRST) residents regularly consume locally caught fish despite consumption advisories due to elevated mercury (Hg) in surface waters and fish. This study aimed to quantify Hg exposure among tribal residents who consumed at least 2 weekly servings of locally caught fish. Methods: Participants completed a questionnaire designed to collect demographic data, the average number of servings of all fish and locally caught fish consumed per week during the preceding month, locations where fish were caught, and types of fish consumed. Blood specimens were collected to quantify Hg levels. Results: The 79 participants, ages 18 to 60 years, were 99% American Indian and 52% female. Most (75%) had total blood Hg less than the limit of detection (LOD) (geometric mean: 0.31 µg/L, 95% CI: 0.27 to 0.36; range: less than LOD to 4.1 µg/L) and all were below 20 µg/L, the reference level associated with elevated Hg exposure among adults. Only 11% had levels greater than 2003–2004 National Health and Nutrition Examination Survey (NHANES) 50th percentile (0.80 µg/L). A correlation between blood total Hg concentrations and the average number of weekly servings of locally caught fish eaten in the preceding month was observed (Spearman correlation = 0.23, p = 0.046). Conclusions: Selection and recall bias, as well as seasonal timing of the study, may have impacted the results. Blood Hg concentrations increased with increasing consumption of locally caught fish. However, all participants had Hg concentrations below those demonstrated to impact health and similar to the US population.


Exposure 18

Alaska's Statewide Hair Mercury Biomonitoring Program: Results to Action

  • L. Verbrugge , Alaska Department of Health and Social Services
  • R. Kossover , Alaska Department of Health and Social Services
  • S.Wenzel , Alaska Department of Health and Social Services

Background: In Alaska most mercury exposure occurs through consumption of fish and marine mammals. Many Alaskans have high consumption rates of these foods, so an accurate assessment of mercury exposure is essential for the development of optimal consumption advice. In July 2002, the Alaska Division of Public Health (ADPH) began a statewide hair mercury biomonitoring program to address this need. Methods: Confidential hair mercury testing is offered free of charge to all women of childbearing age (15–45 years old) in Alaska. Samples are submitted to ADPH through a participant's health care provider, and the Alaska Public Health Lab analyzes them using a direct mercury analyzer. Results are reported back to the provider, with a copy for the patient. Follow-up investigations are performed for women whose hair mercury level exceeds 5 parts per million (ppm). Results: Through June 30, 2009 hair samples from 751 women who lived in 89 communities were analyzed. The median hair mercury concentration was 0.47 ppm; the maximum concentration was 7.82 ppm. Follow-up investigations were conducted for 4 women; consumption of marine mammals and/or pike was identified as their probable source of mercury exposure. Implications: In October 2007 ADPH released its first fish consumption guidance that recommended limiting consumption of a few fish species due to mercury content. The reassuringly low hair mercury concentrations observed in the biomonitoring program enabled public health officials to strike an Alaska-specific risk/benefit balance for fish consumption advice. Program results also guide targeted surveillance needs; EPHP is now studying exposures through pike consumption in western Alaska.


Exposure 19

Volatile Organic Compounds (VOCs) Levels in Blood in the U.S. Population, 2003–2004

  • H. Zahran , Centers for Disease Control and Prevention
  • D. Jackson , Centers for Disease Control and Prevention
  • B.Blount , Centers for Disease Control and Prevention

Background: Exposure to volatile organic compounds (VOCs) is ubiquitous. Chronic exposure to high levels of some VOCs can lead to cancer and neurocognitive dysfunction. To better understand the prevalence and magnitude of VOC exposure, Centers for Disease Control and Prevention (CDC) measures VOCs in human blood as part of the National Health and Nutrition Examination Survey (NHANES). Objectives: The purpose of this study is to quantify blood concentrations of 33 VOCs and identify the demographic and lifestyle factors associated with VOC blood concentrations. Methods: A total of 33 VOCs in whole blood were measured among a one-half subsample of persons 20 to 59 years who participated in the NHANES 2003–2004 survey (n = 1,482). Results: A total of 19 of the 33 VOCs tested were not measurable in the blood. A 60% or higher proportion of the survey participants had detectable concentrations for 7 VOCs: bromodichloromethane (73.4%), chloroform (92.1%), benzene (58.4%), ethylbenzene (69.0%), MTBE (80.3%), toluene (95.6%), and m-/p-xylene (98.4%). Another 7 VOCs (2,5 dimethylfuran, tetrachloroethene, bromoform, dibromochloromethane, 1,4 dichlorobenzene, o-xylene, and styrene) had detection frequencies ranging from 16.8% to 40.2%. Smokers had higher levels of benzene, toluene, ethyl benzene, and m-/p-xylene than nonsmokers. Higher fuels-related VOC blood levels were found in men and persons ages 50–59 years. Men had a higher concentration of MTBE, and heavy drinkers had a higher concentration of benzene and toluene. Blood concentrations of bromodichloromethane, ethyl benzene, and m-/p-Xylene decreased significantly with increasing body mass index (BMI). Conclusions: Although the associations differed by VOC, age, sex, and lifestyles were associated with VOC blood concentrations. This study shows that it is important to continue to monitor VOCs to determine the need for strategies to reduce exposures in the general population.


Exposure 19

Proportionate Cancer Mortality in Methylmethacrylate-Exposed Healthcare Workers

  • J. Diaz , Louisiana State University

Background/Objectives: Methylmethacrylate (MMA) is a volatile liquid that is mixed with plasticizers to make custom-fitted dentures, hearing aids, and joint prostheses—health care products in increasing demand by an aging population. Chronic MMA exposures have been associated with gastrointestinal (GI) cancer in animals and colorectal cancer in manufacturing workers. A proportionate cancer mortality investigation was conducted to determine cancer death differences in orthopedic surgeons performing total joint replacements (TJRs) (MMA-exposed cases) and general surgeons not performing TJRs (unexposed controls). Methods: The American Colleges of Orthopedic Surgeons and General Surgeons provided the names, addresses, and birth and death dates of 468 white male orthopedic surgeons and 1,890 white male general surgeons who died during 1991–1999 (Power = 98%, a = 0.05). Decedent data were submitted to the National Death Index for matching with cause of death on death certificates. Results: Orthopedic surgeons died of cancer more often (Z = 2.960,p = 0.003) and at younger (t = 5.53, p<0.000) ages (mean = 69.4 years) than general surgeons (mean = 79.2 years). Orthopedic surgeons died of GI (Z = 1.997, p = 0.046) and lymphoproliferative (Z = 2.148, p = 0.032) cancers more often than general surgeons. Other cancer deaths were similar in both groups. Conclusions/Implications: Orthopedic surgeons are chronically exposed to MMA and are proportionately more likely to die from cancer, especially GI and lymphoproliferative cancers, than general surgeons. Chronic MMA exposures have been linked to GI cancers in other occupations, and MMA plasticizers have been associated with lymphoproliferative malignancies. MMA-exposed health care workers may be at significantly increased risks of untimely deaths from specific malignancies that can be effectively screened for during prolonged latency periods.


Exposure 19

Persistence, Patience and Partnerships: Studying Cancer Risks in TCE-Exposed Workers at the View-Master Factory

  • S. Joshi , Oregon Department of Human Services
  • J. Douglas , Oregon Department of Human Services

Background: In 1998, workers at the View-Master plant in Beaverton, Oregon, learned that the factory's drinking and manufacturing water supply was contaminated with the solvent trichloroethylene (TCE) at levels more than 300 times above the safe drinking water standard. It is estimated that as many as 25,000 employees drank this contaminated water between 1951 and 1998. Since the discovery, the Oregon Public Health Division (OPHD) has worked with exposed workers to study and communicate the health risks from exposure to TCE. Issue: TCE was once widely used in occupational settings, and has emerged as an important environmental contaminant that impacts communities throughout the United States. Exposure to TCE has been linked to a broad range of health effects, including cancer; however, there is ongoing debate about the strength of the epidemiological evidence on TCE's carcinogenicity. The View-Master workers present a unique opportunity to study the cancer risks from TCE exposure, with implications for advancing environmental health research and public health policy. Results: Since 1998, OPHD has worked collaboratively with former View-Master workers and Mattel Corporation on data collection, exposure assessments, and outreach efforts. Some successes include the formation of the View-Master Community Advisory Group, medical screenings sponsored by Mattel, the establishment of the View-Master Science Advisory Panel, and several preliminary studies to support the development of a strong case-control study design by OPHD. Despite these successes, securing funding for in-depth health studies and expanded outreach remains a challenge. Lessons Learned: In the past decade, the partnership between OPHD and the View-Master workers and other stakeholders has evolved to include a community participatory approach to studying the health risks and outcomes in exposed workers. This approach can advance the current understanding of the health risks from TCE exposure, and support actions to reduce the public health burden from this contaminant.


Exposure 19

The Use of PBPK Models to Predict the Metabolism of Perchloroethylene in Children

  • B. McPhail , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • J. Wilson , Centers for Disease Control and Prevention/Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry/DTEM/OD

Human studies often rely on adult data in order to determine human effects from environmental compounds; however, exposures (i.e., oral, dermal, inhalation) to xenobiotics occur at every age. It is unethical to perform toxicological studies on children, but many believe that ”windows of vulnerability” occur during development. Perchloroethylene (perc) is a volatile organic compound (VOC) commonly used in the dry cleaning industry and often found in drinking water. Acute exposure to perc has been shown to cause central system (CNS) depression, while chronic exposures have caused hepatotoxicity, nephrotoxicity, and cancer. The aim of the current project was to develop a physiologically based pharmacokinetic (PBPK) model to simulate inhalation and oral exposures of PERC at different ages. PBPK models are computer simulations that use mathematical equations to describe the absorption, distribution, metabolism, and elimination of a compound in the body. In the current project, simulations were performed in male and female neonates (0 year old), infants (1 year old), young children (3 years old), older children (8 years old), adolescents (16 years old), and adults in order to determine the effect of age on perc metabolism and exposure. As a result, children 0–3 years old were shown to have slightly higher concentrations of perc in the blood, which decreased with age and through adulthood. Consequently, metabolite formation was shown to increase with age. The adults had the highest area under the curve (AUC) for metabolites when compared to the young. PBPK models have been used in risk assessment for various compounds and are capable of predicting the risk of a wide range of compounds at different ages.







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