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Current Issue

Volume 131, Issue No. 1 January/February 2016
Current Issue
Full Contents | Past Issues
ISSN 0033-3549

January/February 2016
Public Health Reports

A Message from the Editor
Frederic E. Shaw, MD, JD

Letter to the Editor
Shannon M. Farley, DrPH / Kevin R. Schroth, JD / Christine Johnson Curtis, MBA / Sonia Angell, MD, MPH

Executive Perspective: HRSA’s Transformation of Public Health Training
Mary Beth Bigley, DrPH, MSN, APRN, FAAN

The Shift to High-Impact HIV Prevention by Health Departments in the United States
David W. Purcell, JD, PhD / Eugene McCray, MD / Jonathan Mermin, MD, MPH

A Call for Greater Consideration for the Role of Vaccines in National Strategies to Combat Antibiotic-Resistant Bacteria: Recommendations from the National Vaccine Advisory Committee
National Vaccine Advisory Committee

Overcoming Barriers to Low HPV Vaccine Uptake in the United States: Recommendations from the National Vaccine Advisory Committee
National Vaccine Advisory Committee

Hepatitis A Infections Among Food Handlers in the United States, 1993–2011
Umid M. Sharapov, MD, MSc / Karine Kentenyants, MD, MPH / Justina Groeger, MD, MPH / Henry Roberts, PhD / Scott D. Holmberg, MD, MPH / Melissa G. Collier, MD, MPH

Using a Handheld Device for Patient Data Collection: A Pilot for Medical Countermeasures Surveillance
Matthew F. Daley, MD / Kristin Goddard, MPH / Melissa McClung, MSPH / Arthur Davidson, MD, MSPH / Gretchen Weiss, MPH / Ted Palen, MD, PhD, MSPH / Carsie Nyirenda, MPH / Richard Platt, MD, MSc / Brooke Courtney, JD, MPH / Marsha E. Reichman, PhD

A Tool for Providing Data on Small Areas: Development of Neighborhood Profiles for Santa Clara County, California, 2014
Whitney L. Webber, MS / Pamela Stoddard, PhD / Brianna van Erp, MPH, MPP / Mandeep Baath, MPH / Greg Bazhaw, MRCP / Kate Kelsey, MPH / Douglas Schenk, MA / Roshini Shah, MPH / Bill Shoe, MCRP / Anandi Sujeer, MPH

Integrating Public Health and Deliberative Public Bioethics: Lessons from the Human Genome Project Ethical, Legal, and Social Implications Program
Karen Meagher, PhD / Lisa M. Lee, PhD, MA, MS

Shifting Resources and Focus to Meet the Goals of the National HIV/AIDS Strategy: The Enhanced Comprehensive HIV Prevention Planning Project, 2010–2013
Stephen A. Flores, PhD / David W. Purcell, JD, PhD / Holly H. Fisher, PhD / Lisa Belcher, PhD / James W. Carey, PhD, MPH, MA / Cari Courtenay-Quirk, PhD / Erica Dunbar, MPH / Agatha N. Eke, PhD, MEd / Carla Galindo, MPH, CHES / Marlene Glassman, PhD, MSW / Andrew D. Margolis, MPH / Mary Spink Newman, PhD / Cynthia Prather, PhD / Dale Stratford, PhD / Raekiela D. Taylor, MPH / Jonathan Mermin, MD, MPH / ECHPP Project Team

A Critical Assessment of Officially Reported Chagas Disease Surveillance Data in Mexico
Ellen M. Shelley, MS / Rodolfo Acuna-Soto, MD, PhD / Kacey C. Ernst, PhD / Charles R. Sterling, PhD / Heidi E. Brown, PhD, MPH

Evaluation Framework for HIV Prevention and Care Activities in the Enhanced Comprehensive HIV Prevention Planning Project, 2010–2013
Holly H. Fisher, PhD / Tamika Hoyte, MPH / Stephen A. Flores, PhD / David W. Purcell, JD, PhD / Erica Dunbar, MPH / Dale Stratford, PhD

Systematic Review and Meta-Analysis of Inhaled Toxicants from Waterpipe and Cigarette Smoking
Brian A. Primack, MD, PhD / Mary V. Carroll, RN, BSN / Patricia M. Weiss, MLIS / Alan L. Shinhadeh, ScD / Ariel Shensa, MA / Steven T. Farley, BS / Michael J. Fine, MD, MSc / Thomas Eissenberg, PhD / Smita Nayak, MD

Associations Between Social Determinants of Health and Pregnancy Among Young People: A Systematic Review of Research Published During the Past 25 Years
Sarah B. Maness, PhD, MPH / Eric R. Buhi, PhD, MPH

Exposure to Suicide in the Community: Prevalence and Correlates in One U.S. State
Julie Cerel, PhD / Myfanwy Maple, PhD / Judy van de Venne, PhD / Melinda Moore, PhD / Chris Flaherty, PhD / Margaret Brown, MPH

Needs Assessment for Patients with Sickle Cell Disease in South Carolina, 2012
Alyssa M. Schlenz, PhD / Andrea D. Boan, Phd, MSCR / Daniel T. Lackland, DrPH / Robert J. Adams, MS, MS / Julie Kanter, MD

Evaluating Shared Laboratory Services: Detecting Mycobacterium Tuberculosis Complex and Drug Resistance Using Molecular and Culture-Based Methods
Julie Tans-Kersten, MS, BS-MT(ASCP) / Shou-Yean Grace Lin, MS / Edward Desmond, PhD / David Warshauer, PhD

Evaluating Early Case Capture of Pediatric Cancers in Seven Central Cancer Registries in the United States, 2013
Mary Puckett, PhD / Antonio Neri, MD, MPH / Elizabeth Rohan, PhD, MSW / Castine Clerkin, MS, CTR / J. Michael Underwood, PhD / A. Blythe Ryerson, PhD, MPH / Sherri L. Stewart, PhD

HIV Testing in Publicly Funded Settings, National Health Interview Survey, 2003–2010
Cheryl Tan, MPH / Michelle Van Handel, MPH / Christopher Johnson, MS / Patricia Dietz, DrPH

The Public Health Nurse Workforce in U.S. State and Local Health Departments
Angela J. Beck, PhD, MPH / Matthew L. Boulton, MD, MPH

Agreement Between Self-Reported and Confirmed Cancer Diagnoses in New York City Firefighters and EMS Workers, 2001–2011
Rachel Zeig-Owens, DrPH / Andrea Kablanian, MPH / Mayris P. Webber, DrPH / Yang Liu, MS / Edward Mayerson, MA / Theresa Schwartz, MS / Nadia Jaber, RPA-C / Kerry J. Kelly, MD / David J. Prezant, MD

The Impact of the Affordable Care Act on Funding for Newborn Screening Services
Julia F. Costich, PhD, JD / Andrea L. Durst, DrPH, MS

Prevalence of Diabetes and Health-Related Quality of Life Among Rural-to-Urban Nong Zhuan Fei Migrants in an Urban Area of Northern China, 2013
Shauang Yan, MD / Xincai Hong, MBBS / Haiqiao Yu, MBBS / Zhen Yang, MBBS / Siying Liu, MBBS / Wei Quan, MBBS / Jiankai Xu, PhD / Liying Zhu, MD / Weilun Cheng, MB / Hong Xiao, MD / Heather Kitzman-Ulrich, PhD / Mark J. DeHaven, PhD

Population-Based Estimates of Decreases in Quality-Adjusted Life Expectancy Associated with Unhealthy Body Mass Index
Haomaio Jia, PhD / Mathew M. Zack, MD MPH / William W. Thompson, PhD

Health Department HIV Prevention Programs That Support the National HIV/AIDS Strategy: The Enhanced Comprehensive HIV Prevention Planning Project, 2010–2013
Holly H. Fisher, PhD / Tamika Hoyte, MPH / David W. Purcell, JD, PhD / Michelle Van Handel, MPH / Weston Williams, MHS / Amy Krueger, MPH / Patricia Dietz, DrPH / Dale Stratford, PhD / Janet Heitgerd, PhD / Erica Dunbar, MPH / Choi Wan, PhD / Laurie A. Linley, MPH / Stephen A. Flores, PhD

Law and the Public’s Health: Tax-Exempt Hospitals and Community Health Under the Affordable Care Act: Identifying and Addressing Unmet Legal Needs as Social Determinants of Health
Mary Crossley, JD / Elizabeth Tobin Tyler, JD, MA / Jennifer L. Herbst, JD, MBE, LLM

NCHS Dataline
Sandra S. Smith, MPH

From the Schools and Programs of Public Health: Flipping the Classroom and the Pedagogy: Using Active Learning Principles to Bring Leadership Training in Affirmative Sexuality to Public Health Education
S. Bryn Austin, ScD

From the Schools and Programs of Public Health: Mental Health Training in Schools of Public Health: History, Current Status, and Future Opportunities
Elizabeth Reisinger Walker, PhD, MPH, MAT / Jennie Kwon, BS / Delia L. Lang, PhD, MPH, MA / Richard M. Levinson, PhD, MA / Benjamin G. Druss, MD, MPH

Public Health Reports

More on PubMed Central PubMed Central
Additional volumes and issue numbers (1878-2007) can be
found on PubMed Central.
NEPHC Abstracts


Case Study of Outdoor Wood Boiler Impacts in a Residential Development

  • K. Groetsch , Michigan Department of Community Health

The Northeast States for Coordinated Air Use Management estimated 29,568 outdoor wood boilers (OWBs) sold in Michigan (1990–2005). No statewide restrictions exist on placement or use of OWBs. Some local jurisdictions have established ordinances restricting use or new installation. This presentation describes collaboration between state environmental and health departments along with a local health department to address, using the state public health code, the operation of an existing OWB in a residential development in Michigan. Unlike indoor wood stoves certified by the US Environmental Protection Agency (EPA), most OWBs do not have secondary combustion and are designed to smolder (oxygen-starved fires). Approximate dimensions of OWBs are 6 ft 3 . OWBs produce elevated amounts (100 2 to 1,000 2 micrograms per m 3 ) of fine particulate matter (e.g., PM2.5). PM2.5 penetrates deeply into human lungs, with the smallest-size fractions entering the blood stream. Short-term exposures of vulnerable populations to elevated PM2.5 concentrations have been reported to result in negative health effects, including premature death. Collaboration between state and local officials under the state's public health code resulted in an investigation into the use of an OWB in a residential development. That investigation determined the OWB posed a public health hazard. The public health code was invoked to temporarily [[ OK? ]]prevent the use of the OWB. A court of law determined that no preexisting process exists to address the public health hazards of OWBs in residential developments. State and local governments can successfully collaborate to address health hazards from OWBs. The preventive action of establishing local ordinances restricting use of OWBs is the preferred strategy.



The Chemical Safety Board's Role in the National Infrastructure

  • M. Gomez , US Chemical Safety Board

The US Chemical Safety and Hazard Investigation Board (Chemical Safety Board/CSB) was created under the Clean Air Act Amendments of 1992 to “investigate accidental chemical releases,”conduct research about “potential for accidental releases,” and issue reports and recommendations “to make chemical processing, handling, and storage as safe and free from risk of injury as is possible,” particularly to the Environmental Protection Agency and the Occupational Safety and Health Administration. Congress modeled the CSB after the National Transportation Safety Board, and also directed it to “establish by regulation…requirements for reporting accidental releases into…ambient air.” As the primary federal investigative agency for chemical incidents in fixed facilities, the CSB is part of the national public health infrastructure for chemical risk prevention, especially through its recommendations. Since 1998, the CSB has issued more than 540 recommendations arising from more than 50 incident investigations and several studies. As a nonregulatory agency, however, the CSB is only one small component of a much larger web of chemical hazard prevention efforts. This presentation summarized the nature of the incidents and hazards the CSB has investigated, focusing on its recommendations, their rationale, and their impact.



Sacramento County's Color-Coded Food Safety Rating System—2008 Samuel J. Crumbine Award Recipient

  • A Enriquez , Sacramento County Environmental Management Department

The Sacramento County Environmental Management Department's Environmental Health Division developed and implemented several food safety program enhancements over the course of 6 years. Program reviews prior to the implementation of program enhancements revealed over 40% of facilities with major risk factor violations. Significant efforts were made through food safety education and public disclosure to reduce this percentage and reduce the incidence of foodborne illness within Sacramento County. One of the most visible components of the program included a “Green/Pass, Yellow/Conditional Pass, Red/Closed” food safety rating and placard system to disclose food inspection results to the public. Department staff worked diligently with stakeholders, obtained input from the public, and educated food facility operators. Various outreach methods were used to educate the business community and the public, including print, radio and television media outlets, focus groups, public workshops, stakeholder meetings, and the distribution of educational materials in multiple languages. Program improvements included an initial requirement to post inspection report at food facility (2003–2006), posting of inspection reports and placard results on county Web site ( ), food safety awards of excellence for facilities with exemplary inspection history, a shift to risk-based inspections and increased inspection frequencies for food facilities, added personnel, mandatory food safety education for facilities with poor compliance history, posting of “Green/Pass, Yellow/Conditional Pass, Red/Closed” placards at food facilities for the disclosure of inspection results (commenced January 2007), outreach and education for the food industry and the public, public workshops, compliance assistance bulletins, “How to Get a Green” classes in multiple languages, “How to Get a Green” DVD/instructional video, standardization training and inspection field guide, and development of enforcement policies.



Preliminary Assesment of Cyanotoxin Occurrence in Freshwater Lakes and Reservoirs of the United States

  • K. Loftin , US Geological Survey
  • J. Graham , U. S. Geological Survey
  • M.Meyer , U. S. Geological Survey
  • A. Ziegler , U. S. Geological Survey
  • J. Dietze , U. S. Geological Survey
  • S. Holdsworth , U.S. Environmental Protection Agency

Background/Objectives: Human cyanotoxin poisonings appear to be occurring at greater frequency and are receiving increased attention worldwide. Direct cyanotoxin exposure has been shown to occur through recreational surface water activities (e.g., swimming, wading, water skiing), consumption of raw or inadequately treated drinking water, dermal contact, and aerosol inhalation. Data from the 2007 US Environmental Protection Agency National Lake Assessment (NLA) representing the first national-scale microcystin reconnaissance in the United States will be presented and compared to the 2006 US Geological Survey's Midwestern Cyanotoxin Reconnaissance (MCR). Differences in the role of sample collection technique and location will be highlighted. The co-occurrence of cyanobacterial blooms and taste-and-odor compounds will be discussed as a possible real-time sentinel of potential cyanotoxin exposure. Methods: Cyanotoxins were analyzed by enzyme-linked immunosorbent assays and liquid chromatography/tandem mass spectrometry. Taste-and-odor compounds were measured by gas chromatography/mass spectrometry. Results: Microcystins were detected in 32% of integrated photic zone samples (NLA) and 100% of near shore cyanobacterial bloom samples (MCR) with mean (nondetects excluded) microcystin concentrations of 3.0 µg/L and 880 µg/L, respectively. Anatoxin-a, cylindrospermospins, and saxitoxins also were detected at frequencies ranging from 8% to 30% depending on cyanotoxin class, sample type, and sample location. Cyanotoxins and taste-and-odor compounds co-occurred in 91% of bloom samples (MCR). Conclusions/Implications: Microcystins were the most commonly occurring class of cyanotoxins during these 2 studies and the co-occurrence of other cyantoxin classes may be more common than previously believed. Cyanotoxin concentrations and detection frequencies can vary substantially depending on study design and sample collection techniques and location. Additionally, correlation between cyanobacterial blooms and taste-and-odor compounds may provide a means to reduce the risk of cyanotoxin exposure by the public through education efforts.



Research-Based Approach to Improving NCEH's and ATSDR's Web Presence

  • W. López , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • C. Scheel , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

Background: The many Web pages comprising the National Center for Environmental Health (NCEH) and the Agency for Toxic Substances and Disease Registry (ATSDR) Web sites were lacking content structure and appropriate organization. Issues included nondescriptive labels, no formal information architecture, poor readability, and content duplication. With its vast amount of content, ATSDR's Camp Lejeune Web site is an example of one site that quickly became disorganized. The NCEH/ATSDR eHealth activity migrated the site to a structured, user-friendly template. Another issue was the programmatic organization of the Web sites. Following user research, NCEH/ATSDR began organizing their Web sites based on topic as seen on the redesigned NCEH asthma Web site. Issue: The NCEH and ATSDR legacy Web sites were developed without using a defined process, which resulted in inconsistent formatting and content. After recognizing the need for improvement, the NCEH/ATSDR eHealth activity implemented a research-based approach to the design and development of Web pages. The NCEH/ATSDR eHealth activity also uses analysis tools, such as usability testing, needs analysis, user research, and Web metrics, to tailor the CDC template to meet the audience needs. Results: By implementing tools and processes of Web site development, NCEH/ATSDR now have Web sites that contain user-centered Web pages, content that is organized and labeled in a meaningful way, navigation that allows easier access to the most important and popular information, and tools that make it easier for information sharing with interested parties. Lessons Learned: Invest in user research at the beginning of the process to create a user-centered Web site, research creates a more objective process for improving a Web site, and partnering with our clients is essential to create context around research data.



East Cleveland Health and Development Initiative

  • M. Halko , Cuyahoga County Board of Health
  • Domenica McClintock , Cuyahoga County Board of Health
  • H.Stark , Cuyahoga County Board of Health

The Cuyahoga County Board of Health (CCBH) has joined efforts with local government, a school district, a local hospital, developers, planners, stakeholders, grassroots organizations, community members, and other identified partners to establish the Health and Development (H&D) Committee in a suburb of Cleveland, Ohio (East Cleveland). This small urban community is dealing with educational, economic, housing, and health challenges. The focus of the committee's work is to facilitate the inclusion of health considerations into land use and brownfield redevelopment by promoting environmental and policy changes within East Cleveland. It is intended that these changes will positively impact the built and natural environments and in turn, improve population health and reduce health inequities. The East Cleveland Action Model, with the priority areas of nutrition, physical activity, land, and environment and safety, provides the framework for maintaining a collaborative, outcome-driven process for monitoring health and social impacts. It is this framework that has allowed the CCBH, H&D Committee and county-level partners to clearly identify expansion opportunities. County-level partnerships and efforts have emerged from successful pilot efforts in East Cleveland; hence, CCBH is expanding the community level revitalization efforts in East Cleveland, while broadening county-level healthy land use policy efforts to support the long-term sustainability of local efforts.



Characterization of Post-Katrina Indoor Allergen Exposures Among New Orleans Children With Asthma

  • L. White , Tulane University
  • F. Grimsley , Tulane University
  • H.Mitchell , Rho, Inc
  • J. El-Dahr , Tulane University
  • P. Chulada , National Institutes of Health
  • R. Chon , SRA International

Background: Following Hurricane Katrina, the extensive flooding that resulted from levee breaches damaged over 80% of the homes in New Orleans. The flood waters soaked homes for extended periods of time. The extreme dampness that remained stimulated copious amounts of mold growth. The question of the impact of mold on children with asthma arose. Objectives: Identify post-Katrina New Orleans environment for mold, and other indoor typical asthma allergens, and examine their relationship skin sensitivities in children with asthma in the post-Katrina New Orleans area. Methods: The homes of families with children with moderate-to-severe asthma participating in the Head-off Environmental Asthma in Louisiana (HEAL) study underwent comprehensive environmental evaluations that consisted of a visual inspection, humidity measurements, a caregiver interview (residential history, home environmental factors), indoor and outdoor air sampling (total fungal spores, pollen), and indoor dust collection from the child's bedroom. Dusts were analyzed for roach, mouse, dust mite, endotoxins, ß-D-glucans, and mold. Air samples were analyzed for mold (total fungal spores and some genus categorizations) and pollen. Results: Children skin sensitivities are presented in accompanying poster. Dwelling types were detached houses (68%), duplex/triplex/row houses (22%), apartments (8%), Federal Emergency Management Agency (FEMA) trailers (5%), and other (3%). Detectable bedroom dust allergens were Alternaria (94%), roach (19%), mouse (58%), and dust mites (58%). Air samples showed the predominant mold species in homes were basidiospores (97.8%), Cladosporium (96.2%), ascospores (91.2%), Penicillium aspergillus (77.5%), and Curvularia (75.8%). Conclusions: For some mold species, a correlation between mold levels and frequency of sensitization were observed; however, this relationship did not hold for several other species. Overall, these data suggest that children living in post-Katrina New Orleans have relatively high rates of sensitivity to certain mold and asthma allergens that could contribute to asthma symptoms.



Promising Strategies for Addressing the Intersection of Violence, Healthy Eating and Physical Activity

  • A. Lyles , Prevention Institute

Background: In efforts to promote healthy eating and active living, many communities are finding that violence is increasingly impeding the effectiveness of their efforts. Yet these same communities are at higher risk for chronic diseases, such as heart disease, diabetes, and high blood pressure. In the face of violence and safety concerns, residents face limitations in their ability to eat better and move more. Potential environmental solutions provide safe shared spaces and activities, such as joint use agreements and walking clubs. Best practices of preventing violence can inform and strengthen chronic disease prevention initiatives in communities impacted by violence. Methods: We conducted a literature review on the intersection of violence, food, and activity. Key informant interviews were conducted with advocates and practitioners working in chronic disease prevention from 8 urban/peri-urban California communities. The sample represents primarily Latino and African American communities. We also vetted promising strategies with key leaders and experts in the field. Results: Violence is the primary community concern, and negatively affects eating and activity in many ways: (1) women avoid trips to grocery stores, impacting the family's health; (2) overeating serves as a coping mechanism; (3) communities perceived as violent are not seen as viable markets for healthy foods; and (4) perception of violence will limit physical activity despite availability of parks and open spaces. Conclusions: Given the intersection between violence and chronic disease, communities are faced with the challenge of collectively addressing these complex issues. Prevention strategies should be designed to be comprehensive and collaborative using an equity lens. Learning Objectives: ( 1) Gain knowledge about the current strategies around preventing violence and identify promising strategies to address both chronic disease and violence. (2) Explain the intersection between violence and chronic disease and have the tools for further action based on data sources, case studies, and best/promising strategies.



Application of a PBPK Model to Estimate Chloroform Exposures in Humans

  • D. Moffett , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • D. Fowler , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • C.Welsh , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • R. Rogers , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • M. Ray , University of Georgia
  • S. Ritger , University of Georgia
  • D. Keys , University of Georgia
  • J. Fischer , University of Georgia

Development and application of human physiologically based pharmacokinetic (PBPK) models for estimating solvent exposures represents a promising avenue for advancing exposure assessment science. Exposures to trihalomethanes are a public health issue; of particular concern is chloroform, likely to be carcinogenic to humans by all routes of exposure under high-exposure conditions that lead to cytotoxicity and regenerative hyperplasia in susceptible tissues. In addition to chloroform exposure from drinking water, inhalation of chloroform from air while showering and dermal absorption from showering or swimming in chlorinated pools constitute additional sources of exposure. Research focused on the development of a generic PBPK model structure for simulation of 3 routes of exposure (oral ingestion, dermal absorption, inhalation) to chloroform resulted in coded Berkeley Madonna simulation software. The model consists of blood, rapidly and slowly perfused tissue, fat, liver, kidney, and skin compartments. Previously published human PBPK models were slightly modified to conform to our model structure, while chemical specific parameters for chloroform were retained. Model simulation runs can demonstrate differential exposure parameters and can be examined in a temporal perspective for multiple exposure pathways. Further, the model can estimate chloroform exposures necessary to achieve body burdens associated with adverse health effects. This provides a benchmark for helping interpret the level of concern for community exposures to chloroform. This work is supported by a contract with Eastern Research Group (contract no. 0133.19.011/1). This poster presents the application of the PBPK chloroform model to a site-specific exposure to potable water for which an intervention of bottled water had been affected based on traditional exposure assessment. PBPK modeling estimates demonstrate that intervention with bottled water would not significantly reduce exposure to individuals exposed dermally and especially by inhalation. PBPK modeling estimates may have important applications for combined exposure pathways and for difficult exposure scenarios, such as fetal exposures.



State Smoke-Free Laws: Evidence of Effectiveness and Status

  • M. Tynan, Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

In 2006, the Surgeon General concluded that there is no risk-free level of exposure to secondhand smoke (SHS) and that eliminating smoking from all indoor areas is the only way to fully protect individuals from SHS exposure. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings are ineffective in eliminating exposure to 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 scientific evidence on the effectiveness of smoke-free laws and (2) examine the extent to which states have enacted smoke-free laws that prohibit smoking in worksites, restaurants, and bars. Smoke-free laws are an evidence-based policy approach that has been proven to reduce exposure to SHS and encourage smokers to quit. Emerging evidence indicates that policies that prohibit smoking in all indoor areas impact morbidity and mortality by reducing heart attacks. The status of smoke-free laws was identified using CDC's State Tobacco Activities Tracking and Evaluation (STATE) System database. As of December 1, 2009, 21 states and DC have adopted comprehensive smoke-free laws that prohibit smoking in public places such as worksites, restaurants, and bars. While the number of states that have enacted smoke-free laws has increased substantially in the past decade, over half the states still offer either inadequate or no protection from SHS in public places. Despite the progress that has been made over the last decade in implementing comprehensive statewide smoke-free laws, significant regional disparities still exist in smoke-free policy coverage.



Federal Regional Response Team Draft Guidance on the Use of Poison Control Centers in Region 6

  • P. Young , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

The Regional Response Team (RRT) has partnered with poison centers during response to hazardous materials incidents in Region 6. As one of 13 RRTs in the country, the Region 6 RRT is responsible for preparedness planning and training to ensure effective response to the release of hazardous substances. The Region 6 RRT has developed guidance on the utilization of poison centers with protocols so environmental response agencies can quickly and efficiently access the expertise, resources, and services provided by poison centers. Poison control centers (PCCs) (or poison centers) have historically been unrecognized in the preparedness and response community as a major player in the role of protecting the health of our population during hazardous materials incidents or terrorist events.



Healthy Environments Through Land Use Policy: Experiences from LA County Department of Public Health

  • J. Armbruster , Los Angeles County Department of Public Health
  • L. Franco , Los Angeles County Department of Public Health
  • G.Haberman , Los Angeles County Department of Public Health
  • P. Simon , Los Angeles County Department of Public Health

Background: Los Angeles County has 88 cities and many unincorporated areas. The average weight of county adults has steadily increased, along with increases in rates of obesity and diabetes. Although regular physical activity is one of the most effective ways to prevent these conditions, half of adults in the county do not get recommended levels of exercise. Issue: Land use strategies can increase physical activity and prevent chronic conditions. The Department of Public Health (DPH) implemented the following land use strategies to improve health: (1) Award 5 grants to create built environment change that facilitates physical activity. Grantees focus on policy change in a local jurisdiction along with a physical project. Examples include developing/implementing bike/pedestrian master plans. (2) Award technical assistance grant to provide grantees with expert guidance. (3) Provide input into city/community plans, including health data, comment letters, and oral testimony. (4) Host workshops that increase capacity to improve health via built environment change. Results: The first year of the 3-year grant has been completed and grantees have laid the groundwork for community input and policy language development. DPH participated in the development of a new city health element and submitted comment letters and oral testimony on city/community plans. DPH offered trainings to DPH staff and city partners to increase capacity for collaboration. Lessons Learned: DPH's experience in land use policy highlights the value of partnerships between health departments and planners. These nontraditional partners have different yet complementary skill sets, and increased collaboration can help both sectors reach their goals.



A 21st Century Transportation Agenda for Health, Equity, and Environmental Quality

  • L. Cohen , Prevention Institute
  • J. Srikantharajah , Prevention Institute
  • M.Aboelata , Prevention Institute

Today's transportation system must become more than a means of simply moving people and goods. It must reflect a new vision for thriving communities that supports equity, opportunity, healthy people, and a healthy planet. This session will present a vision for a 21st century transportation agenda in which active transportation such as walking and bicycling are normal modes of travel rather than “alternative” modes; where traffic injuries and harmful vehicle emissions are not acceptable side effects of mobility; and where the most vulnerable communities are prioritized in community planning and development activities. Research is increasingly showing that transportation policies and practices are key determinants of health through influence on air quality, physical activity, safety, and economic opportunity. Public health is tasked with supporting and promoting population health yet has had a difficult time participating in transportation policy and the broader community design process that has tremendous influences on health. With the upcoming authorization of a new multiyear, billion-dollar federal transportation bill comes the opportunity to turn the tide to build multisectoral partnerships and integrate health as a priority in transportation policies. The recent federal recovery and reinvestment package also includes substantial opportunities to influence how transportation systems are planned and built in ways that protect health and enhance community well-being. This session will introduce cross-cutting strategies and policy opportunities to create an equitable multimodal transportation system that emphasizes health, safety, and the environment. The session will highlight the importance of collaboration and the potential for convergence across fields.



The Pediatric Environmental Health Toolkit: From Pilot Study to Multi-Media Training Programs to Clinical Use

  • M. Miller , University of California–San Francisco

Background: A variety of analyses identified a need for clinical tools to enable pediatric health care providers to provide routine guidance to patients on environmental health. The Pediatric Environmental Health Toolkit was developed to satisfy this need, along with training programs to provide guidance on use and basics on environmental health. Issue: The toolkit was developed in phases over 6 years with goals to optimize its acceptance by pediatric health care providers and gain widespread use in the clinical setting. Major steps included a strategic process of developing materials with a team of experts, pilot testing with clinicians running training programs, encouraging use in medical education, developing an online CE course, and a wide dissemination strategy. An important goal was to obtain endorsement from the influential American Academy of Pediatrics (AAP). All major phases underwent extensive evaluation. Results: Major goals of the toolkit development process have been achieved, including AAP endorsement, successful pilot testing at 17 diverse practices in California and Massachusetts, development of a train-the-trainer program conducted at major medical centers in 5 states, creation and launch of an online CE course in collaboration with the Agency for Toxic Substances and Disease Registry (ATSDR) ( ), dissemination of thousands of copies to providers, and inroads into institutionalization in provider organizations. Evaluation results for both the pilot test and trainings were consistent—participation in toolkit activities was associated with improved knowledge of environmental health topics and confidence in discussing environmental health issues with patients. Lessons Learned: Careful planning, a strategic approach, and ongoing alliance and partner building have been critical to the successful acceptance and distribution of the toolkit. Making environmental health clinical tools accessible and easy to use are critical to success. The toolkit materials are available without charge at



Using the Social Ecological Model to Influence Water and Sanitation Behaviors

  • R. Goldberger , Alaska Native Tribal Health Consortium
  • T. Ritter , Alaska Native Tribal Health Consortium
  • J.Dobson , Alaska Native Tribal Health Consortium

Background: Providing modern water service in Alaska native villages has been a cornerstone of Alaskan public health effort since 1957. To date, approximately 70% of villages have been provided modern water service. It was assumed that village residents would immediately begin using water service once provided. Data show that it takes approximately 14 years for a village to fully adapt to utilizing the water service. Issue: Alaska natives suffer from some of the highest rates of water-related disease ever documented. To reduce rates of infections, a formative approach to influencing water and sanitation practices is underway. Our efforts are focused in 4 villages receiving water service for the first time. The approach is based on principles of the social ecological model and seeks to influence behaviors at the individual, environmental, and policy levels. We also employ an adaptation of the National Patient Safety Foundation's “Ask Me 3” technique for communicating health behavior messages. Results: The project is funded by the Centers for Disease Control and Prevention (CDC) Healthy People and Healthy Communities Through Improved Environmental Health Services Program. We are in the second year of a 3-year project. Final results will be available fall 2010. Lessons Learned: Preliminary indications are that water use interventions should be specific and targeted. Cultural tailoring of messages appears to be essential when communicating sensitive information with indigenous populations. A formative approach is critical to developing successful water use interventions.



Housing Policy for Older and Disabled People: The Missing Piece

  • E. Smith, Concrete Change

Typical community planning documents call for creating housing types suitable for older and disabled people. While that is an essential component, it misses the fact that most older people want to remain in their existing home, and it fails to acknowledge that disability, regardless of the age of onset, usually strikes nondisabled people living in inaccessible homes. The presenter will give evidence that adequate housing policy requires a second component, beyond special housing types designated for older or disabled people—i.e., ensuring that all new houses offer a basic level of disability access. The presenter will briefly review current home construction policy, demonstrating that it permits nearly all new single-family houses—the housing type in which the majority of the population lives—to be built without any access features. The presenter will highlight 7 specific negative health outcomes resulting from this current norm of house construction. The presenter will then define visitability as an alternative to inaccessible houses, clarifying its similarities to and differences from universal design. Next, the presenter will discuss several existing visitability-type policies that have brought about thousands of new houses with basic disability access in several locales, creating houses sold on the open market as opposed to especially constructed for older people or people with disabilities. Additionally, recent research will be discussed that challenges typical ways of assessing the need for accessible houses and demonstrates the high likelihood that a new house will have a resident with severe mobility impairment at some point in the lifetime of the house.



CAR-Null Mice Demonstrate Sensitivity to Parathion

  • L. Mota , Clemson University
  • W. Baldwin , Clemson University

The constitutive androstane receptor (CAR) is a key regulator of several Phase I–III detoxification genes. Parathion is one of the 2 most potent environmentally relevant activators of CAR based on our transactivation assays. Therefore, animal studies were conducted to determine if CAR was activated by parathion in vivo. Male and female, wild-type, and CAR-null mice were treated i.p. with 100 ?l of 10% DMSO/corn oil, 3mg/kg/day TCPOBOP, or parathion at either 5 or 20 mg/kg/day for 2 consecutive days. CAR-null mice showed greater sensitivity to parathion compared to wild-type mice as determined by the formation of tears, lethargy, and perturbation in gross motor skills. Parathion did not induce Cyp2b expression as determined by Q-PCR or Western blots, indicating that it is not a CAR activator in vivo due to its short half-life. However, untreated CAR-null mice demonstrated lower expression of Cyp2b10 and Cyp2c29 compared to wild-type mice, indicating that CAR is important to the basal regulation of some CYPs. Parathion incubation of microsomes from untreated wild-type and CAR-null mice revealed differential metabolism between the genotypes. The paraoxon/p-nitrophenol ratio demonstrated that parathion was preferentially metabolized to paraoxon in the CAR-null male mice, while the formation of p-nitrophenol was much greater in the CAR-null mice. Interestingly, the formation of both paraoxon and p-nitrophenol was faster in female wild-type mice than female CAR-null mice, indicating that female wild-type mice show a slightly different strategy for protecting themselves from parathion. Because we are importing a greater percentage of our vegetable and fruit crops from Central and South America, places that still use parathion, we may be placing individuals that show repressed CAR expression, such as newborn children, at increased risk.



What Size Asbestos Fibers Are the Most Important for Predicting Human Risk of Lung Cancer and Asbestosis?

  • L. Stayner , University of Illinois–Chicago
  • E. Kuempel , Centers for Disease Control and Prevention
  • S.Gilbert , Centers for Disease Control and Prevention
  • M. Hein , Centers for Disease Control and Prevention
  • J. Dement , Duke University

Background: Evidence from toxicologic studies indicates that risk of respiratory diseases varies with asbestos fiber length and width. However, there is a total lack of epidemiologic evidence concerning this question. Methods: Data were obtained from a cohort mortality study of 3,072 workers from an asbestos textile plant that was recently updated for vital status through 2001. A previously developed job exposure matrix based on phase contrast microscopy (PCM) was modified to provide fiber size–specific exposure estimates using data from a reanalysis of samples by transmission electron microscopy (TEM). Cox proportional hazards models were fit using alternative exposure metrics for single and multiple combinations of fiber length and diameter. Results: TEM-based cumulative exposure estimates were found to provide stronger predictions of asbestosis and lung cancer mortality than PCM-based estimates. Cumulative exposures based on individual fiber size–specific categories were all found to be highly statistically significant predictors of lung cancer and asbestosis. Both lung cancer and asbestosis were most strongly associated with exposure to thin fibers (<0.25 µm). Longer (>10 µm) fibers were found to be the strongest predictors of lung cancer, but an inconsistent pattern with fiber length was observed for asbestosis. Cumulative exposures were highly correlated across all fiber sizes categories in this cohort (0.28–0.99, p-values < 0.0001), which complicates the interpretation of the study findings. Conclusions: Asbestos fiber dimension appears to be an important determinant of respiratory disease risk. Current PCM-based methods may underestimate asbestos exposures to the thinnest fibers, which were the strongest predictor of lung cancer or asbestosis mortality in this study. Additional studies are needed of other asbestos cohorts to further elucidate the role of fiber dimension and type.



Who Has Carbon Monoxide Alarms in Mecklenburg County?

  • S. Saha , Centers for Disease Control and Prevention
  • S. Iqbal , Centers for Disease Control and Prevention
  • F.Yip , Centers for Disease Control and Prevention
  • J. Clower , Centers for Disease Control and Prevention
  • T. Nurmagambetov , Centers for Disease Control and Prevention

Background: Unintentional carbon monoxide (CO) poisoning causes almost 450 deaths and more than 20,000 emergency department visits each year. As the majority of these CO poisoning cases occur in residential settings, use of CO alarms could potentially prevent many of these adverse events. To date, little is known about rates of compliance and factors associated with CO alarm use. Objectives: Identification of socioeconomic factors that are associated with the adoption of CO alarms in Mecklenburg County, North Carolina, where ordinances in 2002 and 2004 mandate the installation of residential CO alarms. Methods: In early 2009, a household survey was conducted in Mecklenburg County, North Carolina, to investigate presence of residential CO alarms using a stratified random sampling strategy. Information on socioeconomic and demographic factors and use of CO alarms was collected. Multivariate logistic regression was used to identify factors associated with CO alarm use. Results: Among the 216 households surveyed, 144 (67%) of the households reported to have at least one CO alarm in their house. Families with higher income were more likely to install alarms. Those who rent their homes were less likely to have CO alarms (OR: 0.41; 95% CI: 0.14–0.87) than homeowners. Those who were aware of the CO alarm ordinances were 10 times (95% CI: 3.35–15.9) more likely to have a CO alarm than those who were not aware of the law. Conclusion: A total of 2 out of 3 households interviewed in Mecklenburg County had a CO alarm in their home. Those who were aware of the CO ordinance were more likely to have a CO detector. Lower-income families are less likely to have CO alarms, which make them more vulnerable to unintentional CO poisoning.



A Sustainability Evaluation of Water and Sanitation Interventions After Hurricane Mitch, 7 Year Review

  • R. Sabogal , Centers for Disease Control and Prevention
  • E. Medlin , Centers for Disease Control and Prevention
  • R.Gelting , Centers for Disease Control and Prevention

Background/Objectives: The American Red Cross (ARC) and the Centers for Disease Control and Prevention (CDC) collaborated on a sustainability evaluation of ARC-water and sanitation interventions in Central America after Hurricane Mitch in 1998. Periodic evaluations of the sustainability of post-hurricane interventions were conducted following the final implementation of all interventions in 2002. This paper presents results from 2009. The evaluation examined the continued functioning of ARC-provided water, sanitation, and hygiene education interventions. Methods: The sustainability evaluation includes 4 components: (1) a cross-sectional household survey, inspection of water and sanitation facilities, and evaluation of hygiene behaviors; (2) qualitative water sampling of community water sources and stored household water; (3) a survey conducted with the community water committee; and (4) an infrastructure inspection of the water system. US Agency for International Development (AID) indicators were used as the basis for measuring the performance indicators: households with year-round access to an improved water source; households with access to a sanitation facility; households with appropriate hand-washing behavior; and population using hygienic sanitation facilities. Results: Since project initiation in 2000, 74% of households had year-round access to an improved water source, a 106% increase; 95% of households had access to a sanitation facility, an 86% increase; 51% of respondents demonstrated appropriate hand-washing technique, a 155% increase; and 76% of respondents were using a hygienic sanitation facility, a 230% increase. Conclusions/Implications: The ARC post–Hurricane Mitch water and sanitation interventions were sustainable on a regional basis after 7 years. Physical infrastructure interventions were generally more sustainable than hygiene behavior interventions. Sustainability of water and sanitation systems was more likely in communities with active water committees.



Children's Health Issues and Chemicals Policy Reform

  • M. Marty , US Environmental Protection Agency

Increasing concern regarding the adverse health impacts of exposure to environmental chemicals is pushing efforts to reform US policy on chemicals management. There is widespread concern that the Toxic Substances Control Act (TSCA) has not adequately protected children from prenatal or postnatal exposure to chemicals in everyday use. A number of issues arise with respect to the unique characteristics of infants and children that must be addressed in any policy reform. In 2001, the US Environmental Protection Agency (EPA) worked with industry stakeholders to develop a voluntary program to increase information on chemical hazards to children, the Voluntary Children's Chemical Evaluation Program (VCCEP). This pilot project failed to produce additional information adequate to evaluate risks to children. US EPA is currently expanding its evaluation of chemicals on the TSCA list to prioritize them for potential further action, but there is still inadequate information to assess risks to children. Additional steps must be taken to include information relevant to perinatal exposures and risks to the developing child to adequately prioritize chemical hazards. Potential exposure through unique children's exposure pathways (e.g., transplacental, breast milk, hand to mouth) must be incorporated into any assessment plan. Prioritization must include toxicity data, structure-activity analyses, and toxicity pathway screens that adequately account for developmental toxicity. Research to best approach these problems must be accelerated. Increased collaboration among government agencies, researchers, industry, and nongovernmental organizations (NGOs) is needed to adequately assess risks to children from environmental chemical exposures. Legislation and policy changes are needed to reduce exposures of children to the thousands of chemicals in their environments.



Polychloriated Biphenyls in Breast Milk: Application of a PBPK Model for Site Specific Evaluations

  • C. Welsh , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • D. Fowler , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • D.Moffett , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • D. Farrer , Oregon Department of Human Services
  • M Poulsen , State of Oregon Department of Environmental Quality
  • D. Davoli , U.S. Environmental Protection Agency

Background: A mechanism to predict breast milk polychloriated biphenyl (PCB) concentrations, based on a mother's PCB exposure, is desirable for risk assessors and public health practitioners. This poster describes data from comparisons of a 3-compartment physiologically based pharmacokinetic (PBPK) model, and a one-compartment pharmacokinetic model for estimating breast milk PCB concentrations. Methods: The PBPK model was modified from a recently described PBPK model; the one-compartment pharmacokinetic model was previously used for traditional risk assessment (RA). Model runs considered (1) milk and blood PCB levels associated with specific fish-eating exposures; (2) the dose of PCBs associated with a given PCB concentration in milk or blood; and (3) reductions in blood and milk PCB levels that result from dietary interventions to reduce exposures. Results: A variety of model applications illustrate the capabilities for assessing temporal and media-specific PCB exposures. Model simulations indicate that PCB levels in milk are highest initially, and are reduced over a 6-month nursing period. Modeled data suggest that early-life interventions can have a significant effect on PCB levels in breast milk. Simulation results from the PBPK and the RA models indicate the 2 models produce estimates that compared favorably. Conclusions: Both models facilitate the evaluation of multiple site-specific exposure scenarios and permit a focused analysis of critical exposure questions. The PBPK model aids the evaluation of exposures on a temporal basis. A clarified view of exposures and related risks will also inform risk mitigation/remediation decisions at known hazardous waste and spill sites.



Challenges with EPA's AQS System: Extraction, Management and Usability for Environmental Epidemiology Research

  • T. Delcour , Tulane University
  • L. White , Tulane University
  • A.Shankar , Tulane University
  • E. Langlois , Tulane University

Environmental monitoring data are an important data source for the Environmental Public Health Tracking Network (EPHTN). The Environmental Protection Agency (EPA) Air Quality System (AQS) collects national ambient air monitoring data for criteria pollutants. EPA collects AQS data for compliance purposes; using this same data for EPHTN linkages with health outcome data requires several time-consuming steps. The objective is to identify issues for using AQS data from national databases for linkages with health outcome data for EPHTN. As the network advances to linking environmental and health indicators, quality control and standardization of data also increase. Sources of EPA-monitored PM2.5 values (particulate matter) were compared for ease of use and accessibility. While EPA has standards for the collection and analysis of air monitoring samples for compliance purposes, EPHTN has other requirements that were examined, including selection of appropriate data source, efficient methods for downloading and compiling data, regional or state differences in sampling frequencies, and nonsystematically missing data. An algorithm was developed as a means of intercalating missing PM2.5 values that can be employed by those without the capability for advanced modeling. A protocol of how to use the algorithm in various missing data scenarios was created. The sampling frequency for PM2.5, missing data, location of monitors relative to population density, and data quality varied across states and regions. For environmental epidemiology research, EPA's Data Mart is an effective way to extract AQS data. The amount of missing data varied drastically along with the adherence to sampling frequency methods. Calculating missing PM2.5 values can be conducted with straightforward statistical methods.



Development of an Operational Forecasting System for Harmful Algal Blooms

  • R. Stumpf , National Oceanic and Atmospheric Administration
  • M. Tomlinson , National Oceanic and Atmospheric Administration
  • T.Wynne , National Oceanic and Atmospheric Administration

The National Oceanic and Atmospheric Administration (NOAA) has developed operational and demonstrational forecasts of harmful algal blooms (HABs) and their impacts. These include forecasts involving Karenia brevis along the eastern and western coasts of the Gulf of Mexico, and toxic cyanobacteria (cyanoHABs) in Lake Erie. Both of these types of HABs pose public safety concerns for recreational users, as well as for shellfish ( K. brevis ) and drinking water (cyanoHABs). Nowcasts and forecasts involve a combination of strategies. K. brevis is capable of producing aerosols, and poses a particular risk when these aerosols reach the shore. CyanoHABs pose a risk when they concentrate near the surface. Identifying when and where a problem may result involve a combination of models and observations. Both species produce blooms that can be observed visually or from satellite, so ocean color imagery is an integral part of the detection system. Heuristic models that incorporate additional environmental data are used to identify and constrain the bloom field, and also to generate the forecasts. This includes models based on winds to indicate when a bloom may be near the surface. Forecasts also include transport models (that may be coupled with numerical circulation models), and also models pertaining to the ecological conditions that indicate likelihood of harmful events or conditions. Creating a heuristic strategy leads to standard operating procedures (SOPs) that are necessary for consistent forecasts. The products are distributed in several ways, including an analysis for public health and environmental managers and Web sites and hotlines for the public.



Overview of Public Health Issues Related to Construction and Demolition Debris Landfills

  • M. Colledge , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

Background: Hydrogen sulfide emissions from construction and demolition (C&D) debris landfills can pose a serious threat to human health and the environment. The production of hydrogen sulfide occurs in C&D landfills through the anaerobic breakdown of calcium sulfate, which comprises approximately 90% of gypsum drywall. Currently, there are an estimated 3,600 C&D landfills operating in the United States. Since C&D landfills are not regulated by federal laws, environmental control requirements vary depending on the applicable state regulations. There is currently no federal ambient air quality standard for hydrogen sulfide, and 18 states are without hydrogen sulfide ambient air standards. Issue: While odor complaints have been generally been considered to be a nuisance issue, there is an increasing awareness of the health effects of exposure to hydrogen sulfide. Air samples around C&D landfills have detected hydrogen sulfide concentrations that exceed the Agency for Toxic Substances and Disease Registry (ATSDR) minimal risk levels (MRLs) of 70 ppb (parts per billion) for acute exposures and 20 ppb for intermediate exposures and US Environmental Protection Agency (EPA)s reference concentration (RfC) of 1.4 ppb. At some landfills, concentrations have exceeded those identified to be associated with adverse health effects, including neurological, respiratory, and ocular effects. Also, surface and subsurface landfill fires are not uncommon and can result in fire and explosion hazards and particulate exposures for the surrounding community. Results: It is important that government entities understand the potential human health risks from ambient exposures to C&D landfill emissions. To do this, ATSDR has created a national C&D workgroup to increase awareness of these issues with federal, state, and local partners across the country.



Presentation of Sparse and Sensitive Health Effects Data: Optimizing Data Utility and Protecting Confidentiality

  • H. Strosnider , Centers for Disease Control and Prevention
  • S. Kegler , Centers for Disease Control and Prevention
  • N.Jones , Centers for Disease Control and Prevention

The Environmental Public Health Tracking Network (Tracking Network) is a Web-based information system incorporating standardized electronic health and environmental data and measures. The Tracking Network aims to balance the dissemination of data with the need to maintain data quality standards and protect sensitive information. Spatial variability in environmental hazards commonly requires analysis of environmental health data covering small areas. However, for certain health outcomes, the number of cases for a selected place, time, and group of people is often small. A number of data protection and stability-related methods are utilized in the Tracking Network. The Tracking Network currently employs data aggregation, data suppression, spatial smoothing, and statistical stability assessment methods. Data are aggregated across place, time, and populations to balance utility and protection of confidentiality. Non-zero counts less than 6 are suppressed for counties with a total population less than 100,000. To prevent reverse calculation of suppressed data, selected non-zero counts above this threshold are also suppressed using complementary suppression software. Spatially smoothed rates and proportions are presented to clarify spatial patterns. Rates and proportions are routinely evaluated for statistical stability, and any measure with a relative standard error (RSE) greater than or equal to 30% is flagged as unstable. Single method approaches to data protection such as simple numerator rules may not provide for optimal release of sensitive data. The combination of several approaches has enabled the Tracking Program to provide more comprehensive geographic coverage for health effect measures while protecting sensitive information. When presenting health and environmental data, supporting information is needed to aid interpretation of the data. Continued evaluation of available methods and development of new methods are needed to display data which link health with the environment.



Interactive Animations to Aid Community Understanding of Environmental Exposures and Toxicokinetic Principles

  • D. Moffett , Centers for Disease Control and Prevention
  • D. Fowler , Centers for Disease Control and Prevention
  • C. Welsh , Centers for Disease Control and Prevention
  • J. Arthur Archer , Centers for Disease Control and Prevention
  • A. Eckert , Centers for Disease Control and Prevention
  • D. Higgins , Centers for Disease Control and Prevention
  • J. Hulsey , Centers for Disease Control and Prevention

Background: There is a clear need for educational materials that help explain complicated issues of environmental exposures to members of communities affected by environmental contaminants. In particular, a means to help explain toxicological principles is a specific need. This poster describes an animated interactive tool that is designed to convey environmental exposure and toxicokinetic principles to community members and public health professionals. Issues: Work focused on building an interface for chloroform exposures for a varied audience. Animations depicting humans and human organ systems were constructed to illustrate ingestion, inhalation, and dermal exposures. Initial work focused on developing a prototype and used shaded 2-dimensional figures and organ systems. Current work is proceeding to develop 3-dimensional figures and organ systems. Results: The interactive interface contains illustrations of contaminant distribution and disposition, an ability to illustrate varying exposure levels from low to high, and permits the use of numerous pop-ups, including depictions of detailed mechanistic and metabolic events. Running text permits a standalone/continuous loop presentation. Ongoing work is focused on adding audio narrative descriptions of the events/action on the videoscreen.



Government and Stakeholder Collaboration to Prevent and Control Obesity in California

  • E. Abramsohn , California Department of Public Health
  • K. Tharp , California Department of Public Health
  • N.Kohatsu , California Department of Public Health

Background: The California Department of Public Health (CDPH) has a 5-year cooperative agreement with the Centers for Disease Control and Prevention to implement environmental and policy interventions. The program aims to prevent and control obesity in California guided by the California Obesity Prevention Plan (COPP); to reduce the adverse impact of obesity-related chronic conditions and diseases; and to decrease obesity-related health inequities. Issue: CDPH is responsible for engaging stakeholders to enhance the current California Obesity Prevention Plan with specific details for implementing the strategies already identified within the plan. The strategies and their action steps will guide development of state functions related to infrastructure, management, implementation, training and technical assistance, and evaluation. The plan will also help strengthen statewide food and physical activity environmental change efforts by encouraging partnerships between private and public organizations. Additional details will be added to guide evaluation of the COPP implementation process, as well as the intermediate and long-term outcomes. Results: To gather input on the details for implementation and evaluation, multiple forums for stakeholders are underway, including listening sessions, workgroups, roundtables, key informant interviews, focus groups, and online surveys. Each forum includes a systematic process to prioritize policy and environmental change strategies and to collect feedback. Lessons Learned: The process of soliciting feedback from stakeholders via multiple mechanisms will yield a complete and prioritized list of action steps for implementing and evaluating the COPP. The end result will be an expanded document with details for each sector (private and public) to implement action steps promoting environments that encourage healthy eating and physical activity.



Installing “10-year” Smoke Alarms in Fire Safety Programs: Do They Really Last 10 Years?

  • J. Wilson , National Center for Healthy Housing
  • J. Akoto , National Center for Healthy Housing
  • S.Dixon , National Center for Healthy Housing
  • D. Jacobs , National Center for Healthy Housing
  • M. Ballesteros , Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention began funding a Smoke Alarm Installation and Fire Safety Education (SAIFE) program in 1998. This program involves the installation of lithium-powered “10-year” smoke alarms in homes at high risk for fires and injuries. This study aimed to (1) determine among original SAIFE homes if the lithium-powered alarms were still present and functional 8–10 years after installation and (2) understand factors related to smoke alarm presence and functionality. Data on a total of 384 homes and 601 smoke alarms in 5 states were collected and analyzed. Only one-third of alarms were still functional; 37% of installed alarms were missing; and 30% of alarms were present, but not functioning. Alarms were less likely to be functioning if they were installed in the kitchen and if homes had a different resident at follow-up. Of the 351 alarms that were present and had a battery at the time of the evaluation, only 21% contained lithium-powered batteries. Of these, 78% were still functioning. Programs that install lithium-powered alarms should use units that have sealed-in batteries and “hush” buttons. Additionally, education should be given on smoke maintenance that includes a message that batteries in these alarms should not be replaced. Lithium-powered smoke alarms should last up to 10 years if maintained properly.



Five Mile Creek—A Brownfield Success Story

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

Five Mile Creek—despite its name—is a 28-mile waterway flowing through 9 cities and 14 communities in Jefferson County, Alabama. Its watershed drains 78 square miles. The abundance of coal, iron, and limestone deposits, along with a plentiful supply of fresh water, made the region a center for iron and steel manufacturing, coal mining, and coke production. By the early 20th century, acid mine drainage and other industrial contaminants had made Five Mile Creek—dubbed “Creosote Creek” because of its chemical odor and slick sheen—one of the most polluted waterways in Alabama. Two local leaders, Wendy Jackson of the Freshwater Land Trust and William Hewitt, Fire Chief of Tarrant, Alabama, joined forces to secure lands to reduce health and environmental hazards. Because of the groundbreaking partnerships, robust industry contributions, and dedication of hundreds of volunteers, the Five Mile Creek Greenway Partnership secured over $4.2 million in resources to revitalize the watershed and its surrounding communities. Today, residents can now enjoy a 29-mile long blueway and the greenspace that embraces it. A vibrant partnership, with strong community participation, is working to transform a blighted watershed into an attractive destination for running, hiking, horseback riding, canoeing, and kayaking during all the seasons of the year—affording residents and visitors opportunities of proven benefit to physical and mental health. Brownfields redevelopment is helping to establish the framework for a 28-mile greenway system—a “string of green pearls.” This case study from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry's “Leading Change for Healthy Communities and Land Reuse” may be particularly helpful to groups looking to form intergovernmental partnerships over broad areas, developers, or planners who want to create recreational greenspaces.



Safe & Healthy Homes (SHH): Embarking on Lead Poisoning Primary Prevention

  • H. Binns , Northwestern University
  • L. Targos , Metropolitan Tenants Organization
  • J.Pinkwater , Illinois Chapter American Academy of Pediatrics
  • M. Kahssai , Metropolitan Tenants Organization
  • P. Vasquez , Northwestern University
  • J. Bartlett , Metropolitan Tenants Organization

Background: New primary prevention strategies are needed to prevent lead exposures. Motivating parents to be concerned and knowledgeable about lead will be a first step. Issue: The Safe & Health Homes (SHH) Project, a partnership of a medical center, a community-based tenants' rights agency, and a state pediatric organization, aims to demonstrate lead poisoning primary prevention. The project initially focused on educational outreach to parents recruited by faxes from medical offices and has expanded to include callers to a housing concerns hotline. Home-specific information (e.g., age, past inspection) and lead information are mailed to participants; phone education is provided. Other services include lead education group sessions, home visits, and referrals for lead inspection. Results: Over 12 months, SHH materials have been mailed to 1,394 parents from 16 medical offices and 1,394 hotline callers. A total of 97% live in a home built <1978 (76% <1930); 88% rent; 10% live in buildings previously inspected for lead (86% had lead hazards). A total of 687 parents (34% of those requesting) completed a call; 57% remembered the mailing; 53% reported paint damage at home; 17% reported recent renovation; 47% live in Section 8 housing; 27% have landlord problems; 17% were interested in a home inspection and 23% in a home visit. Among those called, 31% with landlord problems versus 13% without (p<0.01) were interested in a lead inspection. Remembering the mailed materials did not influence caller interest in home inspection. SHH staff members reported that willingness to proceed to an inspection was influenced by cultural factors and perceived risks for their children. Lessons Learned: Multiple strategies are needed to reach diverse families. Perceptions of risks and tenant–landlord relationships have important influence on interest in lead-related preventive services.



Protecting Public Health During the Midwest Floods

  • S. Casteel , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

Background/Objectives: Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry developed and implemented an action plan to protect public health during the 2007 Coffeyville, Kansas, flood and oil spill and the 2008 Iowa floods. Methods/Issues: CDC/Agency for Toxic Substances and Disease Registry conducted the following activities to protect public health: partnered with the federal, state, and local health and environmental officials to incorporate the public health action plan into the incident response; partnered with local health and city officials to develop accurate, simple health and safety information; developed health education materials specifically for children; developed “plain language” health education materials for Amish and Mennonite communities; facilitated community meetings; facilitated procurement of personal protective equipment (PPE) for residents; and evaluated the human health significance of environmental data. Results: Residents and children were educated about health and safety precautions to follow prior to retuning to flooded properties. Conclusions/Lessons Learned: Education activities minimized injuries and hazardous environmental exposures. Emergency responders should deploy public health staff onsite at the inception of the event; incorporate public health activities into the disaster response from the inception of the event; utilize partnerships to assure accurate and consistent health messages are provided, and to minimize duplication of efforts; hold “one-stop-shopping” meetings for health, environment, Federal Emergency Management Agency (FEMA) and other assistance groups so residents can talk to representatives of all groups at one meeting; partner with local officials to develop a public health action plan, and have local partners provide health messages to the public as trusted community members; and use child-friendly materials to teach children about flood hazards.



Rainwater Harvesting System With GIS-Aided Resources Conservation Planning

  • Y. Chiu , Jin Wen University of Science and Technology
  • C. Hu , Louisiana State University
  • Y.Chiu , Louisiana State University

Background: In recent years, the water demand around the world has increased significantly while freshwater sources have become limited and, in some areas, depleted. With limited resources, there is a growing awareness to utilize water in more sustainable manners. Rainwater harvesting system (RWHS) is an obvious option if weather permits. But the barrier of broad RWHS implementation often is its initial cost and uncertain cost effectiveness. Objectives: The RWHS was often evaluated only on its water saving; other associated benefits such as energy and treatment savings were often overlooked. This study proposed a comprehensive model incorporating spatial technologies, hydraulic simulation, and economic feasibility to assess the cost effectiveness and planning of the RWHS in the urban water–energy conservation scheme. Method: Several hillside communities around Taipei, Taiwan, were used as case study. Data collected for this study includes rainfall depth and pattern, typical catchment area on buildings, potable water demand, RWHS size and cost, and water–energy coefficient. The cost-benefit analysis was performed to evaluate the water and/or energy savings under various rainfall depth and water demand. Additionally, marginal analysis was applied to identify the optimal RWHS size in these hill communities. Results: Simulation results indicate that with the current utility rate, implementing RWHS was cost effective for most of the studied communities when both water and energy saving were considered. The locations and optimum system size to achieve maximum saving were also identified. Implications: With successful demonstration, the study approach could be utilized as an effective tool to support decision making in urban resource conservation. The nonmonetary benefits of RWHS such as emergency water supply, reducing stormwater runoff, and land erosion should be taken into consideration during planning.



Disasters and Health and Healthcare Disparities

  • J. Davis , University of South Carolina
  • S. Wilson , University of South Carolina
  • A.Brock-Martin , University of South Carolina
  • S. Glover , University of South Carolina
  • E. Svendsen , South Carolina Department of Health and Environmental Control

Background/Objectives: Limited research has shown that the poor and medically underserved are disproportionately affected by a disaster. There is a paucity of information on what the combined effects of a disaster and living in an area with existing health or health care disparities has on a community's health, access to health resources, and quality of life during the disaster recovery phase. Methods: We conducted a systematic literature review with the following search terms: disaster; health disparities; health care disparities; medically underserved; and rural. Using the combination of these search terms we performed individual inquiries on several widely accepted public health electronic search indices. Results: Extensive research has been published on disasters, health disparities, health care disparities, and medically underserved populations individually, but few studies addressed these topics collectively. We reviewed 12 articles that met the inclusion criteria; however, only 7 pertained to disasters in medically underserved populations. There were no relevant long-term studies addressing the effects of a disaster on a community with preexisting medical underservice issues or subsequent amplified health care disparities post-disaster. Conclusions/Implications: We observe a critical gap in the current literature examining how disaster-affected communities address the escalating burden of chronic disease in the midst of ongoing health care disparities long after the initial response efforts have ceased. Longitudinal assessment and long-term follow-up are especially necessary because the delayed health effects following a disaster, especially for a technological disaster, may not appear until many years later. Future disaster epidemiology studies should account for differences in health status and access before and after the disaster to better address the interaction between disparities in health and health care and adverse health outcomes in disaster populations.



Chemical risks Associated With Consumption of Shellfish Harvested on Oakland Bay, Washington

  • E. Diaz , Washington State Department of Health
  • L. O'garro , Washington State Department of Health

Oakland Bay is located in South Puget Sound, Washington. It is one of the most productive commercial shellfish growing areas in the country and is known worldwide for its Manila clams ( Tapes philippinarum ). In addition, Pacific oysters ( Crassostrea gigas ), Kumamoto oysters ( Crassostrea sikamea ), and mussels ( Mytilus edulis ) are also grown in the area. Historical and current industrial use of Oakland Bay has resulted in sediment contamination in Shelton Harbor and surrounding areas. Recent sediment sampling has shown dioxins/furans contamination. Given the health and economic importance of shellfish in Oakland Bay to the nation, it is critical to test shellfish for dioxins/furans. The Department of Health conducted this study to assess chemical risks associated with consumption of shellfish harvested in Oakland Bay. Four consumption scenarios were used to calculate shellfish average daily intakes and compared with World Health Organization (WHO) and Agency for Toxic Substances and Disease Registry (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry) values. Exposure to dioxins at the levels detected in shellfish from Oakland Bay is not likely to produce harmful noncancer or cancer health effects for the average US population or the Squaxin Island Tribe; and contaminant intake associated with the various consumption rates did not exceed Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry minimal risk level (MRL) toxic equivalents (TEQ) of 1 pg /kg/day and the WHO daily intake established at 1–4 pg TEQ/Kg/day.



Summary of Results of the Duwamish Valley Regional Modeling and Health Risk Assessment, Seattle, Washington

  • G. Palcisko , Washington State University
  • E. Diaz , Washington State Department of Health
  • L.O'garro , Washington State Department of Health

The Duwamish Valley is an industrialized area in south Seattle. Residents from 2 communities in the area, Georgetown and South Park, asked the Washington State Department of Health to conduct an assessment of the impacts that air pollution may have on their health. The objectives of this study were to identify which air pollutants are key contributors to acute and/or chronic health risk, what sources are the key contributors to acute and/or chronic health risk, and to what degree are different geographic areas of south Seattle impacted by air emissions in the Duwamish Valley. The Air Toxics Hotspots Analysis and Reporting Program developed by the California Environmental Protection Agency was the primary tool used to model air emissions from multiple sources (e.g., stationary and mobile emissions) in south Seattle. Air emission sources in the Duwamish Valley include point, mobile, and wood stove sources. The dispersion and ground level impact of these emissions were then modeled using local meteorological and terrain conditions. Noncancer hazards and cancer risks were calculated based on modeled ground level pollutant concentrations at many locations throughout the project area. Modeling results indicated diesel soot and wood smoke are the main contaminants that raise the pollution levels in the area and increase potential health risks for residents. Diesel soot presents the biggest health threat. Potential health risks are higher for people who live near major pollution sources. This study reaffirms findings of an earlier Puget Sound air toxic evaluation conducted in Seattle by the Puget Sound Clean Air Agency in 2003, and is consistent with those of National Air Toxics, Portland Air Toxics Assessment, South Coast, California Air Toxics Resources Board, and Vancouver Metro.



Children's Consumer Products

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

State lawmakers have been the first to react to the spike in children's consumer product safety recalls. An array of legislation aimed at shoring up consumer product safety standards and enforcement has been approved in state legislatures across the nation since 2006. These bills generally focused on lowering the permissible lead content in children's products, banning the sale of recalled products, and regulating potentially harmful substances found in some children's products



Marine Mammals as Sentinels of Ocean and Human Health: A Baseline Study of Algal Toxins on the US West Coast

  • E. Frame , National Oceanic and Atmospheric Administration
  • H. Wiedenhoft , National Oceanic and Atmospheric Administration
  • F. Gulland , The Marine Mammal Center
  • K. Lefebvre , National Oceanic and Atmospheric Administration

Background: Blooms of toxic algae have increased in range and frequency over recent decades. Global climate change and ocean warming have the potential to further this trend, resulting in an increased risk of human exposure to algal toxins. The US coastline is quite vast and the full extent of toxin prevalence cannot be addressed with direct measurement. Marine mammals provide an elegant solution. They feed at the top of the food chain and are affected by the same algal toxins that cause human illness and death, making them ideal sentinels in terms of potential algal toxin exposure. Issue: We are currently involved in a project to determine baseline levels of algal toxins in marine mammal species along the US West Coast, with a focus on how global climate change might impact the spatial and temporal range of algal toxin exposure. We are first focusing on domoic acid (DA), the causative agent of amnesic shellfish poisoning (ASP), an emerging illness that was not recognized until it was responsible for several human deaths in 1987. Domoic acid poisoning has been relatively common in California marine mammals since the late 1990s; however, the first documented case in an Alaskan marine mammal occurred in 2008. Results: Domoic acid levels found in a wide range of marine mammal species from locations along the US coast from Alaska to California representing current exposure patterns will be presented. Lessons Learned: The baseline toxin levels we record in this study tell us where and when toxin is currently present in the coastal environment and can be used as a reference to judge any potential increase in the frequency or geographic extent of toxic events.



Youth Education and Outreach on Environmental Health Factors for Breast Cancer

  • T. Greene , JSI Research & Training Institute, Inc.
  • C. Battye , Lawrence High School for Health and Human Services
  • D.Davilla-Colon , Lawrence High School for Health and Human Services

Issue: Breast cancer is the leading cause of cancer death among Hispanic women. Reducing exposure to suspected environmental health risk factors is particularly important for younger women, given the development of the disease. Previous research also indicates that Hispanic youth are effective health promoters who can assist family members overcome cultural and linguistic barriers to screening and care. Background: Lawrence, Massachusetts, whose population is 64% Hispanic, is the pilot site of a risk communication initiative developing youth leadership to address breast cancer. Components include in-school curricula and afterschool programs. Objectives are to increase knowledge about risk factors for breast cancer, including environmental connections, dietary factors, physical activity, and the role of genetics. Approach: A newly launched Health Promotion Club engages 26 girls and boys in designing and conducting peer and community outreach activities. Youth conduct outreach on these topics to peers as well as promote early detection and treatment to their family members. Led by the JSI Center for Environmental Health Studies and supported by the Susan G. Komen for the Cure Massachusetts Affiliate, partners include the Lawrence High School for Health and Human Services and Lawrence community health and service organizations. Results and Lessons Learned: Messages and materials have been distributed in outreach activities targeting more than 3,000 youth. Content is now integrated into health and environmental courses and student homeroom activities for 500 youth, with documented learning gains. Despite the uncertain and developing state of knowledge about environmental health contributors to breast cancer, risk communication that furthers Hispanic youth leadership development in this area holds great promise.



Estimating the Probability of Elevated Arsenic Concentrations in Pennsylvania Groundwater

  • E. Gross , US Geological Survey

Almost 2.2 million Pennsylvanians drink groundwater from privately owned wells that is not regularly tested for contaminants with links to cancer, such as arsenic. Data for these contaminants are not widely available because statewide testing for arsenic to determine where groundwater concentrations exceed the health-based standard of 10 parts per billion would be prohibitively expensive. To avoid possible health risks, areas in Pennsylvania with potential for elevated arsenic concentrations need to be defined. The goal of this study is to utilize available arsenic concentrations for groundwater and explanatory data to define areas of Pennsylvania with the highest predicted probability for elevated concentrations of arsenic in groundwater (> 4 parts per billion). A logistic regression model is used to calculate and map predictive probabilities for arsenic concentrations across the state. The model utilizes a dependent variable of arsenic concentrations and explanatory spatial variables that were (1) anthropogenic, such as land cover or population density, or (2) natural, such as geologic setting or precipitation amounts. Explanatory data for each well with a measured arsenic concentration are processed and extracted with a geographic information system (GIS) and analyzed using logistic regression. The study (1) maps the probability of elevated arsenic concentrations in Pennsylvania groundwaters, and (2) evaluates the relation of arsenic concentrations to anthropogenic and natural variables. The model can be used to predict probabilities of elevated arsenic concentrations in areas of sparse data. The most important variables for predicting elevated arsenic concentrations will be identified. Resulting probability maps can be used by health officials to direct resources toward testing and education programs in areas with the highest predicted probabilities of elevated arsenic concentrations.



MN Experience using cPAH Potency Equivalence: “Fingerprinting” of PAHs in Sediments

  • C. Herbrandson , Minnesota Department of Health
  • R. Messing , Minnesota Department of Health

Background: Analyses of carcinogenic polycyclic aromatic hydrocarbons (cPAHs) at contaminated sites has typically been limited to 7 “Environmental Protection Agency (EPA) list” cPAHs. The Minnesota Department of Health (MDH) recommends that the California Office of Environmental Health Hazard Assessment (OEHHA) potency equivalence factors (PEFs) of 25 “extended list” cPAHs be used to characterize cPAH cancer risk at sites. The extended list includes a number of cPAHs, found in the environment, that are more potent carcinogens than benzo[a]pyrene. cPAH analyses were conducted on St. Louis River sediments associated with a steel plant, Duluth Minnesota, and analyses of cPAHs on the EPA list and on the extended list were compared. Analytical Methods: EPA Method 8270C SIM was used to analyze extended list cPAHs. Results: Numerous potent cPAHs were found in site sediments, including 4 dibenzopyrenes and 7,12-dimethylbenzanthracene. Dibenzo[a,l]pyrene is the largest contributor to the B[a]P potency equivalence (B[a]P PEQ). Evaluation of the extended list of cPAHs at this site suggests carcinogenic risk is 4 times greater than the risk calculated using the EPA list cPAHs alone. Noncarcinogenic PAHs (nPAHs) and cPAHs on the EPA list and on the extended list showed consistent “fingerprints,” or relative concentrations, across the site. Conclusions: Analyses of cPAHs only from the EPA list underestimates the cancer risk from PAHs found in sediments. Once a site-specific fingerprint of the extended cPAH list is established, cPAH risk from site samples can be estimated from analyses of a smaller number of PAHs. MDH and the Minnesota Pollution Control Agency are in the process of evaluating cPAH data from additional sources.



Heavy Metals in Urban Community Gardens: Analysis of Risk to Gardeners in West Philadelphia

  • J. Hirsch , University of Pennsylvania

Background/Objectives: Urban gardens build community, reclaim and beautify urban space, and help people access fresh, locally produced food. However, pursuit of these positive goals may entail serious health hazards for urban populations if contamination exists. We must explore the extent to which urban gardens may be significantly contaminated with toxic metals, and plan gardens to avoid such exposure. Elevated heavy metal levels in urban soils are a potential source for levels of those metals in the blood of residents via hand-to-mouth ingestion, skin absorption, and dust inhalation. This research investigates whether heavy metals contaminate urban community gardens in West Philadelphia. Methods: I collected 225 soil samples from 7 Urban Tree Connection (UTC) gardens, following Environmental Protection Agency (EPA) and Pennsylvania Department of Environmental Protection (PA DEP) standards. I performed X-ray fluorescence screening to determine initial heavy metal concentration. Selected samples sent to an EPA-certified lab to determine more precise heavy metal concentrations. I mapped samples in ArcGIS to investigate spatial patterns and historic records of garden locations to reconstruct land use history. Results: Of 225 samples tested, 115 (69%) showed detectable levels of lead (Pb). However, only 2 samples exceeded the acceptable limit of 400 ppm (parts per million). While only 79 samples (35%) showed detectable mercury (Hg) levels, 62 exceeded the Pennsylvania standard of 66 ppm, and 32 were over 3 times the acceptable limit (198 ppm). Results from an EPA-certified lab supported the 2 Pb concentrations but contradicted the Hg findings, with no samples having more than 1.5 ppm Hg. Conclusions/Implications: Policy makers and community organizations must institute effective garden-remediation techniques to reduce exposure to heavy metals and develop standard procedures for the testing urban agricultural sites.



Identification of the Point of Departure for a Chronic Oral Minimal Risk Level for Cadmium

  • L. Ingerman , SRC, Inc.
  • G. Diamond , SRC, Inc.

Kidney dysfunction is one of the most sensitive toxicity targets of chronic environmental exposure to cadmium (Cd). Increases in the excretion of biomarkers of renal dysfunction (e.g., low molecular weight [LMW] proteins) are sensitive biomarkers of impaired kidney function. A 10% increase in the prevalence of abnormal biomarker levels is generally considered to be indicative of Cd-associated renal dysfunction in exposed populations. Points of departure (PODs) for deriving a minimal risk level (MRL) for Cd by 3 approaches were compared: (1) lowest adverse effect level (LOAEL) for LMW proteinuria among studies of Cd-exposed populations, (2) lowest benchmark dose (BMD) from independent analyses of kidney dysfunction data from 5 studies of Cd-exposed populations, or (3) meta-analysis of dose-response functions from 11 data sets for indices of kidney dysfunction and Cd exposure. Approach 1: The range of LOAELs for increased prevalence of LMW proteinuria was 0.5-10 µg Cd/g creatinine; the lowest LOAEL was associated with a doubling the probability of LMW proteinuria. Approach 2: The range of BMDLs (lower 95% confidence interval of BMD) for a 10% prevalence of LMW proteinuria was 0.7–12.0 µg Cd/g creatinine. Approach 3: Internal doses corresponding to a 10% excess risk of LMW proteinuria (UCD-10) were estimated for 5 groupings of the data sets. The 95% lower confidence limit on the lowest UCD-10 estimated from studies of Cd-exposed Europeans was 0.5 µg Cd/g creatinine. The PODs estimated using these 3 approaches was similar and the POD from the third approach was selected as the basis of the MRL; there is higher confidence in this approach because it is based on whole-dose response curves from several studies rather than data from a single study.



Review of Soil Lead Near Hazardous Waste Sites and Blood Lead Levels in the People Living Near Them

  • D. Jackson , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • H. Zahran , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • G.Zarus , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

Background: Flaking paint, past leaded gasoline use, and smelter and mining operations have contributed to lead in soils. Leaded paint in older homes and lead-contaminated soil are the leading sources of lead exposure for children in the United States. Objectives: Evaluate the soil lead contribution to blood lead levels. Methods: We evaluated data from Agency for Toxic Substances and Disease Registry (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry) reports published between 1985 and 2005 on Superfund or similar locations where soil and blood lead data were collected. Data from 127 reports at 77 locations represented 22,805 people (65% children) in 30 states. We used maximum blood lead levels (BLLs) for the analysis because median or mean values were mostly unavailable in Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry's HazDat database. The mean BLLs were highly correlated with the maximum BLLs (Spearman correlation p- value=0.0001). Results: One hundred reports had a maximum BLL =10 µg/dL and 27 reports were <10 µg/dL. There was no statistically significant difference between the median of the maximum soil lead levels where the maximum BLLs were =10µg/dL (27,988 parts per million [ppm]; 95% CI: 16,000–33,100) and BLLs <10µg/dL (25,500 ppm; 95% CI: 12,669–48,000). There is no statistically significant correlation between the maximum BLLs and maximum soil lead levels for both children and adults (Spearman correlation coefficient r = 0.04; p-value = 0.6283; n = 127 events). Conclusions: While we did not find a statistically significant association between soil lead levels and BLLs for these sites, we cannot conclude with certainty that the lead-contaminated soils did not present an exposure hazard given the study limitations. More work is needed to standardize the capture of meaningful information (i.e., exposure factors) in exposure databases.



Building Capacity for Community Participation in Local Lead Coalitions

  • K. Korfmacher , University of Rochester Medical Center

Despite populationwide decreases in childhood lead poisoning rates, rates remain high in upstate New York. Diverse stakeholders in Rochester came together in 2000 to form the Coalition to Prevent Lead Poisoning (CPLP), whose goal is ending lead poisoning in the community by 2010. Through years of developing a coalition, the CPLP successfully promoted community awareness, direct action, and local policy change. These efforts culminated in passage of a local lead law in 2005 that is considered a national model. Lead poisoning rates in Rochester declined 72% from 2000 to 2008. However, other communities in upstate New York have not benefited from such focused attention to this issue. In 2008, CPLP and the University of Rochester undertook a project to leverage Rochester's experience in local lead poisoning prevention to foster lead coalitions in 3 counties in upstate New York. Given the limited experience with community-based primary prevention efforts in each of these counties, their communities benefited greatly from Rochester's experience. The University of Rochester partnered with local community groups in these 3 upstate counties to draft a needs assessment. The local groups participated in lead coalitions in their counties and conducted direct action projects to reduce lead poisoning in their communities. The CPLP assisted each local coalition with technical support, speakers, and strategic advice. University of Rochester staff integrated the local coalitions' experiences into project reports to guide the local partners' future actions. We analyze the challenges and successes of peer-to-peer technical and strategic advice for developing capacity among community organizations to contribute to local coalitions and highlight lessons learned for promoting and supporting local coalitions elsewhere.



Center for Environmental Analysis Global Pediatric Asthma Program

  • J. Kraemer , Southeast Missouri State University
  • H. Duschell , Southeast Missouri State University

Pediatric asthma is the most serious chronic health problem facing children in the United States. There are numerous treatment and prevention options available; there has been limited success with most interventions. A global asthma intervention program focused on education, medication, and the environment is needed. This research utilized 3 distinct strategic goals: (1) improving health care provider knowledge about environmental asthma triggers; (2) improving patient/patient family knowledge about environmental asthma triggers; and (3) assessing patient homes and developing a home environmental trigger action plan specific to each participant. This research used a standard case (N = 100) – control (N = 200) methodology. In-home assessments require the completion of 4 specific activities: Asthma Ready Homes™: IMPACT Asthma Kids CD©, assess and survey the home, completion of a questionnaire and home assessment, and perform basic indoor air quality measurements (e.g., carbon monoxide [CO], carbon dioxide [CO 2 ], relative humidity and temperature). All the activities are based on the EPR3 Guidelines. The case group received all 4 specific activities. The control group received an educational package only. Program effectiveness was based on (1) the number of emergency room (ER) visits/physician visits over a one-year period for each group, and (2) improved behaviors by patient families after receiving the in-home environmental trigger action plan. The health care provider education program was assessed using a pretest–posttest design, and a significant increase in knowledge was measured. This evidence-based program has been successful in reducing ER visits and unscheduled health care visits due to asthma onset. The overall goal of this study was to determine if a global environmental pediatric asthma trigger intervention program would decrease the number of emergency room visits/admissions or physician visits due to asthma.



Skills, Competencies and Future Challenges for Environmental Health Practitioners and Administrators

  • S. LaFollette , University of Illinois–Springfield

Background: Using competencies defined by Environmental Health Competency Guidelines Project, we surveyed environmental health practitioners (EHPs) and administrators in local, state, or federal agencies on EHPs' abilities to complete each competency and the importance of each competency in their work. The survey also asked for their assessment of traits and characteristics of an effective EHP, their evaluation of educational criteria for National Environmental Health Science and Protection Accreditation Council (EHAC) accreditation of academic environmental health programs, and the most significant challenges facing the field. Method: The targeted survey was distributed to readily available e-mail lists of EHPs and administrators. Results: After 2 weeks, 33 administrators and 91 EHPs completed the survey. Both groups were in general agreement regarding the importance of the competencies, with no statistically significant differences between the 2 groups on any competency. The perception of skills of EHPs to complete the competency was not as uniform. The EHPs ranked their own skills and competencies higher than did the administrators of their workforce, significantly so on a number of competencies. Ratings of the traits and characteristics needed to be an effective EHP were similar across the 2 groups. Both groups ranked issues facing the profession similarly, with water quality, new pathogens, and vector control ranked highest. Other issues identified included climate change and ecological issues; food availability and safety; and water availability, quality, and conservation. Conclusions: Competencies needed and future challenges identified in this study fall within accreditation criteria promulgated by EHAC.



REACHing To Healthier Anishnaabek: Promoting Healthy Native Communities in Michigan

  • S. Laing , Michigan Public Health Institute
  • C. Edgerly , Inter-Tribal Council of Michigan, Inc.
  • T.Anthony , Michigan Public Health Institute

Michigan's American Indians experiences rates of chronic disease morbidity and mortality that far exceed state and national averages. Numerous factors contribute to the serious burden of chronic disease. Behavior Risk Factor Survey (2007) data for American Indians estimate much higher rates of obesity, smoking, and diabetes among the American Indian population compared to rates for Michigan overall. The communities in which Michigan's American Indians live, work, and play have many social and environmental barriers to a healthy way of life, including lack of access to high quality, culturally competent health care; rural communities where people cannot safely walk to gathering places, worksites, schools, or stores; and social norms that support the abuse of commercial tobacco. Racial and Ethnic Approaches to Community Health Across the U.S. (REACH US) is a national, multilevel program that strives to eliminate racial and ethnic disparities in health. As a grantee of REACH US, the Inter-Tribal Council of Michigan (ITCM) coordinates the REACHing to Healthier Anishinaabek program in 3 tribal communities. The 4 primary strategies of the ITCM REACH program are consciousness raising, community development, health promotion, and policy, systems, and environmental change. ITCM provides funds to each REACH tribe to employ a full-time coordinator at the tribal health center to facilitate the development and implementation of tribe-specific community action plans (CAPs). Intervention strategies are based upon best practices and then tailored to the unique community and culture using evaluation data and input from community members. Evaluation data suggest the ITCM REACH program is a promising approach for improving community health.



Cancer Mapping With webDMAP in Utah

  • A. Stroup , University of Utah
  • S. LeFevre , Utah Department of Health
  • J.Harrell , University of Utah
  • P. McNeally , University of Utah
  • C. Tiwari , University of North Texas
  • K. Beyer , University of Iowa

webDMAP is a Web-enabled geographic information system (GIS) tool designed to generate smoothed rates on a grid of points. Interpolation on the grid results in a spatial surface of rates. This spatial surface is useful for epidemiologic exploration of disease patterns and for presenting rates to the public without risk of inappropriate disclosure. The Utah Cancer Registry (UCR) and partners implemented and tested the webDMAP tool in collaboration with developers at the University of Iowa. Utah's urban, rural, and frontier population patterns offered a unique opportunity to evaluate the performance of webDMAP. The UCR used georeferenced cancer data from 1996 to 2005. Although other cancers were evaluated, the results presented here focus on female breast and male prostate cancers. Sex and 5-year age group (20 and older) specific strata and populations for each US 2000 Census Block Group centroid in Utah were generated. Two grid types, a uniform 5-kilometer (intra-point distance) grid and a “densified” grid were used. The densified grid was generated so that each grid point represents 10,000 person-years. Indirect age-adjusted rates were calculated for points of these 2 grids. Maps 1–4 present the spatial surface for the 2 cancer sites for each grid type. Results showed an area of concern in Iron County for both cancers. This finding was confirmed using traditional cluster investigation techniques. webDMAP performed well for the Utah population structure. It was useful in conducting public health surveillance activities and for generating publicly consumable disease-rate maps.



Maternal Residential Proximity to Traffic and Adverse Birth Outcomes: 4 Utah Counties, 2000–2006

  • R. Calanan , Centers for Disease Control and Prevention
  • S. LeFevre , Utah Department of Health
  • R.Rolfs , University of Utah
  • D. Bensyl , Centers for Disease Control and Prevention
  • M. Friedrichs , Utah Department of Health

Air-pollutant exposure has been associated with adverse pregnancy outcomes. Higher residential background concentrations of air pollutants have been reported to increase risks for adverse birth outcomes, but effects of exposure to motor vehicle exhaust pollutants have not been well studied. We conducted a cross-sectional study using 2000–2006 birth record data from 4 counties in Utah (Davis, Salt Lake, Utah, and Weber). Live, singleton births with 22–44 weeks' gestation and weighing 500–5,000 grams were included. Multivariable logistic regression models were used to evaluate associations between a surrogate measure of exposure to motor vehicle exhaust pollutants (distance-weighted traffic density) and full-term low birth weight (LBW; =37 weeks completed gestation and <2,500 grams) and preterm birth (<37 weeks completed gestation). We identified 3,725 (1.7%) LBW infants among 221,426 full-term births and 18,471 (7.7%) preterm infants among 239,897 total births. Using no exposure as the reference, the highest quintile of exposure (distance-weighted traffic density =5,441) was not associated with risk for full-term LBW (adjusted odds ratio [aOR]: 1.05; 95% confidence interval [CI]: 0.96–1.15) or preterm birth (aOR: 1.02; CI: 0.97–1.06) after adjustment for maternal education level, marital status, tobacco use during pregnancy, and parity. The associations between exposure to motor vehicle exhaust pollutants and birth outcomes are subject to substantial confounding by such risk factors as smoking during pregnancy. These results do not support implementation of public health intervention related to pregnant women's residential proximity to high traffic density roads.



Recreational Spaces and “Green Health”

  • V. Lowerson , University of California–Irvine
  • A. Hipp , Washington University in St. Louis
  • D.Graham , University of Minnesota - Twin Cities

Recreational spaces provide a multitude of health benefits. Much research on recreational space focuses on parks. Parks have been shown to promote physical health by affording places for people to move, play, and exercise. They offer opportunities for social health benefits, providing spaces for gathering and community events facilitating social cohesion. They also provide places for stress relief and other mental health benefits. Last, parks and recreational spaces also improve environmental health for individuals and for the ecosystem. Researchers began by developing a theoretical framework for assessing park space for its multitiered benefits based on Robert Merton's theory of manifest and latent function. Our goal was to include in our measure constructs and questions that could tap into the transdisciplinary health outcomes associated with recreational space, both intended and unintended. Because our target audience includes community advocates and policy makers, we wanted to turn this into a usable audit tool. In creating our instrument, we drew on existing measures and ideas from the active living research literature. From the theoretical discussion of the multitiered health benefits of recreational spaces, we outlined an environmental audit instrument to assess health-relevant features of recreational spaces. The assessment tool will provide measures of physical, social, and psychological health as well as an overall measure of “green health”—our composite measure of a park's relationship to both human and environmental health. These indices can be utilized by researchers, community activists, and policy makers.



Use of the National Poison Data System for National Public Health Toxic Exposure and Illness Surveillance

  • C. Martin , Centers for Disease Control and Prevention
  • A. Wolkin , Centers for Disease Control and Prevention
  • C.Cooper , TKC Integration Services
  • A. Bronstein , American Association of Poison Control Centers

Background: The National Poison Data System (NPDS) is a real-time surveillance system for human exposures and associated illnesses that provides tools to analyze aggregate case data from the 61 US poison centers (PCs). Our objectives are to describe events of public health (PH) significance detected by NPDS and how the system can identify possible cases during an outbreak. Methods: After NPDS identifies anomalies in PC calls reporting signs and symptoms, American Association of Poison Control Centers and Centers for Disease Control and Prevention (CDC) scientists classify their public health (PH) significance. During an outbreak, potential cases are identified on the basis of signs and symptoms, demographic characteristics, and/or particular exposures. Cases can be tracked spatially and temporally. Using descriptive statistics, we analyzed events of PH importance in 2008. Results: In 2008, NPDS identified 17 events of PH significance due to exposures from school outbreaks (3), chemical accidents (2), food poisoning (3), construction dust (2), mold (1), narcotic overdose (1), nutritional supplement (1), possible tuberculosis outbreak (1), carbon monoxide (CO) (2), and aflatoxin (1). During a multiple-state selenosis outbreak from March 11 to June 4, 2008, NPDS identified 170 persons in 8 states exposed to an improperly formulated nutritional supplement. To monitor the impact of power outages following Hurricane Ike in 2008, NPDS identified 97 calls to PCs in Texas, Kentucky, and Louisiana regarding unintentional CO exposures. Evaluation of a nationwide Salmonella outbreak revealed 1,427 calls from 50 states reporting exposure to contaminated peanut products from January through February, 2009. Conclusions: NPDS has demonstrated utility for detecting illness clusters of potential public health significance and tracking spatial and temporal illness trends during public health events. Information learned from NPDS is shared with appropriate federal, state, and local public health partners and PCs to enhance situational awareness.



Developing the Future Environmental Health Workforce

  • J. Neistadt , National Association of Local Boards of Health
  • T. Murphy , The University of Findlay

According to a number of published reports, we are facing a workforce shortage crisis in environmental public health. The cited reasons for this shortage are numerous; they include but are not limited to lack of adequate number of graduates from environmental health academic programs, competition from private sector employers for those graduates, low pay in the public sector, lack of established career path for employees in the public sector, high retirement in the public sector, lack of job satisfaction in the public sector due to low pay, and overwork. As professionals in a crisis, we must act quickly to stem the tide of the workforce shortage. To do so will ensure an adequate workforce to maintain and improve public health; not to act is unthinkable. We must “think outside of the box” and come up with new ideas, concepts, and procedures to increase the number of competent employees in our profession. Our old ideas of recruiting, retention, and promotion no longer work and have not worked for a number of years. We must look at improving worker conditions and pay and benefit packages, we must look at career paths for our employees, we must look at marketing programs that speak to the great works performed by our programs and our employees, we must look at new ways to recruit from academic programs, we must look at new ways to recruit high school students into academic programs, and we must maintain high standards for our profession through accredited academic programs and third party certifications of our profession.



Environmental Factors and the Modifying Effect of Cigarette Smoke Associated With Asthma Severity Among Adults in New England

  • K. Nguyen , Connecticut Department of Public Health

Asthma is a cause of serious morbidity and mortality among adults in the United States. Data from the Asthma Regional Council indicated that the current asthma prevalence for New England adults (9.7%) is significantly higher than the current asthma prevalence for the rest of the United States (8.1%). Previous studies suggest that some environmental factors play a major role in the development asthma in children. However, the effect of environmental factors and the potential modifying effect of smoking on the exacerbation of asthma among adults are unknown. Pooled data for adults from Connecticut, Massachusetts, Maine, New Hampshire, and Vermont were analyzed using the 2006–2007 Call-Back Behavior Risk Factor Surveillance Survey (BRFSS). Using a weighted multinomial logistic regression model, the effect of environmental factors and the potential modifying effect of smoking on asthma severity, categorized as mild intermittent and mild persistent, moderate persistent, and severe persistent asthma, was tested. The authors found that current smokers who were exposed to wood stoves (OR: 3.1, 95% CI: 1.2, 8.1), pets (OR: 5.5, 95% CI: 1.3, 24.4), and mold (OR: 2.9, 95% CI: 1.1, 8.0) were significantly more likely to have severe asthma as compared to those who did not report these exposures. Among former smokers and nonsmokers, those who had been exposed to environmental tobacco smoke were more likely to have greater severity of asthma than those who were not exposed [(OR: 2.2, 95% CI: 1.0, 4.6) and (OR: 4.2, 95% CI: 1.4, 12.7), respectively]. These data suggest that the effect of environmental factors on asthma severity may be modified by smoking status, even after controlling for sociodemographic factors. Targeting smokers with asthma and making modifications to the environment may be important for reducing asthma severity among a high-risk population.



Analytical Method for Assessing Formaldehyde Exposure in Humans

  • M. Ospina , Centers for Disease Control and Prevention
  • A. Barry , Centers for Disease Control and Prevention
  • A.Costin , Centers for Disease Control and Prevention
  • H. Vesper , Centers for Disease Control and Prevention

Background: Aldehydes are molecules reactive toward proteins and other biomolecules. The reaction products of aldehydes with hemoglobin (hemoglobin adducts) are useful biomarkers for exposure assessments and the assessment of human health risks. Formaldehyde is an important environmental chemical. It can be found in furniture, carpets, particle board, fabric, paint, cooking fumes, wood-burning stoves, fireplaces, and cigarette smoke. The aim of this study was to develop an analytical method to assess human exposure to formaldehyde by measuring hemoglobin adducts as biomarkers of exposure. Methods: A proteomics approach was used for the analysis of hemoglobin adducts of formaldehyde. Hemoglobin isolated from red blood cell samples (1 mg) was digested with trypsin and the resulting formaldehyde modified peptides were analyzed by liquid chromatography-tandem mass spectrometry. Results: Of the peptides obtained with the trypsin digestion, the heptapeptide with the formaldehyde adduct at the N-terminal valine of the alpha chain of hemoglobin was used as biomarker. Linear calibration curves from 0-90 nmol/L and accuracy in the range of 94–110% were obtained. Limits of detection were 2 nmol/L. The mean concentration for 40 hemoglobin samples analyzed by this method was 1.94 nmol/g hemoglobin with values ranging from 1.37–2.63 nmol/g hemoglobin. Conclusions: The method appears to be suitable for measuring formaldehyde exposure in humans.



Estimation of the Lung Cancer Risk from Indoor Exposure to Radon in Bulgaria

  • Z. Paskalev , Balkan Academy of Science, Bulgaria
  • D. Apostolova , Medical University - Sofia, Bulgaria

Radon is a lung cancer–causing radioactive gas. The average indoor radon concentration varies between 5 and 25 Bq/m 3 . The aim of this study is the estimate the lung cancer risk from indoor exposure to radon in Bulgaria. The National Center of Radiobiology and Radiation Protection in Sofia, Bulgaria, has conducted a nationwide survey of radon in homes. The results show that average concentration of radon in Bulgarian homes is about 12–15 Bq/m 3 . However, the survey also found a very wide range of radon levels, from 2–3 Bq/m 3 to 40–50 Bq/m 3 . The average effective dose rate received by a person as a result of radon inhalation and its short-living progenies in indoor air in Bulgarian building is estimated to be 75 mGy/h (with wide range from 57 mGy/h to 93 mGy/h). The average annual effective dose is estimated of 1.18 mGy/h. Using the conversion dose coefficient for radon, recommended by the International Commission on Radiological Protection 0.017 mSv/y for 1 Bq/m 3 , we estimated the annual effective dose, received by a person, living in buildings 7,000 hours per year (with radon concentration in indoor air 15 Bq/m 3 ) to be 0.26 mSv/y. If the radon concentration in Bulgarian homes is 40 Bq/m 3 , our estimated give that the annual effective dose to be 0.68 mSv/y. In Bulgaria, the new lung cancer cases for male ages 50–74 is 3,160. The all Bulgarian male population in this age group is 805,166. Using the risk conversion coefficient, recommendation by IRCP is 4.8.10(-2) /Sv for men 20–74 years old. Our estimation of the cancer lung risk from indoor exposure to radon to be for nonsmokers 26.3 lung cases per year for male Bulgarian population.



Policy Change Is a Catalyst for Increasing Active Travel to School and Reducing Barriers

  • M. Pedroso , Safe Routes to School National Partnership
  • R. Ping , Safe Routes to School National Partnership

Safe Routes to School (SRTS) practitioners around the country are launching and managing programs with limited or nonexistent local, state, or federal funding, and are often subject to state or local policy limitations and barriers. The important but limited federal SRTS funding program can only potentially support up to 7% of the nation's elementary and middle schools at its current funding level for FY 2005–2009. More funding is needed from federal, state, and local sources. In addition, some state and local policies can build a supportive environment for Safe Routes to School, such as complete streets policies that pair road improvements with accommodations for bicyclists and pedestrians or directing a portion of traffic fines to Safe Routes to School efforts. On the contrary, some state and local policies can work against practitioners, such as those that determine where schools are located, or school wellness policies that do not adequately address physical activity. Legislation or new policies can be implemented that would assist and sustain local SRTS programs. The Safe Routes to School National Partnership and its partners at the national, regional, and state level are working to increase funding, change existing policies, and create new policies through advocacy, legislation, and collaboration. The partnership's State Network Project convenes leaders in health, transportation, education, and other fields to collaborate on policy change in 9 states and the District of Columbia. The project works to ensure the success of the state SRTS program, reduces barriers through policy change, and secures new revenue streams. The full report, titled Safe Routes to School State Network Project Final Report 2007-2009 , is available at



Bringing Science to End Users: Natural Disaster Scenarios to Increase Resiliency

  • S. Perry , US Geological Survey
  • G. Plumlee , U.S. Geological Survey
  • D.Cox , U.S. Geological Survey
  • L. Jones , U.S. Geological Survey

Background: The US Geological Survey Multi-Hazards Demonstration Project (MHDP) has a mission to reduce destruction from natural disasters and to improve resiliency. MHDP provides science for decision making and response by uniting hundreds of partners, from public and private sectors, to create cross-disciplinary scenarios and to communicate the results through diverse and novel methods. Issue: Larger, less frequent natural disasters have catastrophic consequences when they strike societies that are not prepared. Yet such disasters are outside the experience, planning, and training of most safety professionals and citizens; and recovery from these disasters is a complex, interdependent process with physical, social, ecologic, economic, and institutional dimensions. Results: In 2008, MHDP completed the ShakeOut Earthquake Scenario, a study depicting a major earthquake on the southern San Andreas Fault, California, and its regional consequences over time, by considering the geology, engineering, public safety and health, sociology, and economics of the disaster. Similarly, in 2009, MHDP began the ARk Storm Scenario, to identify and then communicate the costs and consequences of a massive, but plausible, West Coast storm. Lessons Learned: The ShakeOut Earthquake Scenario launched the largest earthquake preparedness event in US history (5.4 million participants) and increased earthquake readiness by inspiring improvements to awareness, mitigation, training, policies, and procedures. It also identified important, needed research (including research in environmental public health). We anticipate similar value and influence from the ARk Storm Scenario, and invite participation from attendees of this conference.



MRSA Surveillance in the Environment: Methods, Validation and Implications

  • A. Peterson , Johns Hopkins University
  • M. Davis , Johns Hopkins University
  • G.Awantang , Johns Hopkins University
  • B. Limbago , Centers for Disease Control and Prevention
  • E. Silbergeld , Johns Hopkins University

Background: Culture-based surveillance methods have demonstrated methicillin-resistant Staphylococcus aureus (MRSA) persistence and transmission in the hospital environment. Rising community MRSA infection frequency and severity shows the importance of community transmission to the overall MRSA landscape. Recent studies have found MRSA transmission among humans and companion or farm animals, especially emerging zoonotic MRSA associated with industrial agriculture. Surveillance in the European Union (EU) for zoonotic MRSA has focused on sampling of dust inside intensive production swine barns. The objective of this study was to develop a sampling, isolation, and identification protocol for MRSA from the environment; assess correlation between animal and environmental MRSA rates; and validate it in less intense exposure settings. Methods: Nasal and proximal environmental swabs were taken from horse and cattle farms in the mid-Atlantic region. Data were collected at the animal and farm level. Samples were double enriched in broth and plated onto MRSA selective chromagenic agar. Phenotypic colonies was subcultured, DNA extracted, and MRSA confirmed by polymerase chain reaction (PCR). Independence of environmental and animal samples was tested using chi-square. Results: MRSA was detected from both animal and environmental swabs. Fourteen unique animal-environment pairs were identified, 7 from the negative farms and 7 from the positive farm. Of these pairs, 11/14 (78%) were correlated (both negative or both positive), ?2 = 4.38 (p = 0.04). Conclusions: Similar to EU findings, correlation between nasal carriage in animals and MRSA in local environments was significant. In our study this held even in low-intensity settings, suggesting surveillance could be conducted around farms without animal sampling, reducing time and economic cost while providing methods to extend the characterization of farm and surrounding environments. Further expansion of this study could lead to more efficient sampling designs for future surveillance.



Environmental Health Perspectives on Climate Change

  • D. Ratnapradipa , Southern Illinois University
  • J. Schoof , Southern Illinois University
  • Wendi Middleton , Southern Illinois University

Background: Studies have shown that climate variability and change impact the physical environment. Foodborne, vector-borne, airborne, and waterborne diseases are all dependent on local/regional environmental factors. As global and regional climates change, public understanding of the relationship between environmental factors and potential human health issues will become increasingly important. Issue: This presentation seeks to summarize the basic relationships between human health and climate and to introduce climate modeling as a means of exploring potential direct and indirect human health risks. For example, changes in climate will likely impact the range of vectors associated with several vector-borne diseases, increase heat stress due to more frequent or more extreme temperatures, and impact air quality, food supply, water quality, pest control, vector control (including mosquitoes), and tropical disease. While these impacts are generally explored at the macro level, climate variation and change may be locally/regionally variable, requiring development of region-specific strategies to protect human health. Results: (1) Rapid introduction of clean energy solutions will have positive human health impacts. (2) There is a need to reevaluate regional responses to human health issues in the context of climate change. (3) Climate change impacts must be considered in the context of other influences on human health. Conclusions/Implications: Although climate projections are most reliable at large scales (global), human health impacts from climate change have a distinct regional signature that depends heavily on the local environment, health education, infrastructure, and preparedness.



Bring Your Own Bag to the Garden Market—A Sustainable Worksite Campaign

  • B. Rentz , Centers for Disease Control and Prevention

In an effort to facilitate the consumption of fruits and vegetables by workers at the Centers for Disease Control and Prevention (CDC), garden markets offering low-cost produce were introduced. This was initially done under CDC's Healthier Worksite Initiative. With the launch of CDC's Go Green, Get Healthy (GGGH) initiative, an environmental component was added to these garden markets. In the Bring Your Own Bag (BYOB) campaign, the agency has emphasized the need to reduce the use of plastic bags at the garden markets and promote more environmentally friendly alternatives. The BYOB campaign encourages shoppers to bring a reusable bag to the market by offering a punch card for a discount after multiple visits. This program is designed to increase awareness of the detrimental environmental effects of plastic bags, create a habit of using an environmentally safe bag choice, and encourage repeat visits to the garden market. Issue: CDC seeks to actively engage its workers to make choices in favor of personal and environmental health. Sustainable practices must be integrated into individuals' lifestyle and carried out as part of their daily activities. Establishing healthy habits takes time and repeated effort. Results: The BYOB campaign has started to show a reduction in the number of plastic bags used by the vendor and an increase in the number of reusable bags brought to the market. Additionally, this program demonstrates an effective use of repeat visit punch cards within a worksite health promotion initiative that can be used in other organizations to modify behaviors and make their workforce greener and healthier.



Break the Cycle of Environmental Health Disparities

  • I. Rubin , Emory University
  • R. Geller , Emory University
  • M.Marcus , Emory University
  • J. Nodvin , Emory University

Break the Cycle is a collaborative interdisciplinary research and training program with university faculty who mentor students in academic tracks that focus on the environmental impact on children's health. The target populations are communities where the environmental hazards are related to circumstances of social and economic disadvantage. Each student was required to develop a project that focuses on reducing or preventing environmental health–related illnesses and disorders for children who live in these communities. At the end of the project period the students present their studies and findings in a symposium; the reports of their studies reviewed and compiled in a scientific journal that will be available for distribution and dissemination. Our budget allows us to provide student stipends and professor oversight, develop and put on a conference, provide travel funds, and have a nationally known keynote speaker.



Using the PEHSU Model for Building Children's Environmental Health Global Networks: Chile

  • I. Rubin , Emory University
  • M. Berger , U.S. Environmental Protection Agency
  • H.Frumkin , Centers for Disease Control and Prevention
  • R. Geller , Emory University
  • H. Molina , Pontificia Universidad Católica de Chili
  • E. Paris , Pontificia Universidad Católica de Chile

Background: Children from all over the world suffer from exposure to environmental pollution, which has deep consequences for their health. This is an ongoing challenge worldwide, independent of the country's developmental status. The average US physician receives only 6 hours of environmental health teaching in medical school. The US Institute of Medicine has declared a national need to increase training in environmental medicine. Methods: Pediatric Environmental Health Specialty Units (PEHSUs)are a source of medical information and advice on environmental conditions that influence children's health. They are easy to organize and should be replicable internationally. They include experts in many disciplines: pediatrics, neurodevelopment, occupational medicine, immunology, toxicology, nursing, and social work. They offer community education and outreach, training for health professionals, consultation, and referral. Training materials have been developed and efforts started and underway in Vietnam, Kenya, India, and Haiti. Publications have appeared in Pediatric Clinics of North America (Paulson and Gitterman, editors, 2007). Governmental activities related to children's environmental health include the G8 environmental ministers discussing health care education and capacity building, 2009, and the Korean Ministry of Environment establishing 11 centers in 2009. The World Health Organization (WHO) has an article in preparation for 2010 about establishing similar centers in other countries. A meeting sponsored by the International Network of Children's Health, Environment and Safety (INCHES) will be held in India in 2010. Discussion: PEHSUs can build health care professionals' capacity through training, form collaborative relationships between medical professionals, environment, and health ministries, and enlist others to become active in the field. The talents of existing North American PEHSUs have been valuable and accessible in developing this expertise worldwide.



Typology of Park Users: Using Cluster Analysis to Categorize Urban Park Users

  • C. Rutt , Centers for Disease Control and Prevention
  • K. Mumford , University of Minnesota
  • L.Biazzo , Centers for Disease Control and Prevention
  • C. Andrews , Centers for Disease Control and Prevention

Background: Current research has examined the attributes and behaviors of park users, access to parks, and park characteristics. This study employs cluster analysis to identify subgroups of park users in Atlanta, Georgia. Methods: A total of 2,930 intercept surveys were collected from 12 parks. Park users were asked to provide demographic information, travel behaviors, frequency of park use, residential location, activities they engaged in at the park, and the percent of weekly physical activity they received in the park. Results: The sample was 54.5% male, 60.1% white, 31.4% African American, 5.6% Hispanic, and on average were 40 + 13 years [ [??] ]old. Four clusters were identified: 19% of the sample was in cluster 1, 23% in cluster 2, 37% in cluster 3, and 13% in cluster 4. The first cluster included whites, males, people who lived closer to the park, used nonmotorized travel, went more frequently, got more physical activity in the park, and engaged in more vigorous activities. The second cluster included white women who lived near the park, went more frequently, used nonmotorized transportation, and reported moderate activities. Individuals in cluster 3 were female, African American, lived further from the park, used motorized transportation, and engaged in sedentary or child care activities. Cluster 4 included males, Hispanics, people who lived farther, used motorized transportation, went less frequently, and engaged in organized and nonorganized sports. Conclusion: The results of this study could be used to inform the development of new parks, modifications to current parks, and enhance outreach to subgroups to increase park use and physical activity.



Case Study Analyses of a Framework for Determining a Mutagenic Mode of Carcinogenic Action

  • K. Salinas , SRC, Inc.
  • M. Anatra-Cordone , SRC, Inc.
  • P. McClure , SRC, Inc.
  • P. McGinnis , SRC, Inc.

The Environmental Protection Agency (EPA) draft Framework for Determining a Mutagenic Mode of Action (MOA) for Carcinogenicity was developed in response to, and as an extension of, EPA's Guidelines for Carcinogen Risk Assessment and Supplemental Guidance for Assessing Susceptibility from Early-Life Exposure to Carcinogens. The identification of a MOA(s) for carcinogenicity permits chemical-specific interpretation and quantification of cancer risk, including adjustments to cancer risks when exposures occur in children. Current EPA guidelines encourage risk assessors to evaluate the carcinogenic potential of a chemical using a weight-of-evidence approach. The mutagenic MOA framework may be applied to chemicals identified as carcinogens to determine if mutation is a key event in cancer development. This research employs case studies for 6 chemicals (2-napthylamine, 3,3'-dimethylbenzidine, acrylamide, benzo[a]pyrene, biphenyl, and naphthalene) to evaluate the effectiveness of the framework for determination of a mutagenic MOA, and to aid in the identification of its strengths and weaknesses.



Characterizing Risk to Populations Near Contaminated Lands

  • R. Schafer , American Association for the Advancement of Science/US Environmental Protection Agency Fellow

Objective: This study reports on the process for revising the Contaminated Lands Indicator in the Environmental Protection Agency (EPA) report on America's Children and the Environment, 2010 edition. This type of risk indicator can inform communities, establish means for site comparison, and help to set priorities for policy makers. Issue: A surrogate indicator using proximity to Superfund sites (within one mile) has been employed in previous editions. Primary concerns are (1) the potential for undercounting from the latitude/longitude point identifying each site, (2) the potential for overcounting because sites where exposure pathways have been broken are not distinguished from other Superfund sites, and (3) the incompleteness of an indicator based on only Superfund sites. The process for developing the new indicator, its current status, and how it attempts to address these concerns are presented. In addition, because the burden of risk is greater for more vulnerable individuals, the new indicator will be overlaid with income information in an attempt to use socioeconomic data to capture a broader picture of the multiple factors influencing health near contaminated lands. Results: The developing indicator is a substantial improvement. A number of remaining challenges are considered, particularly the use of agency performance measures to identify sites where exposure pathways have been broken. In addition, whether the indicator addresses community concerns and anticipates future needs is discussed. Lessons Learned: Several recommendations are put forth in developing future versions of this indicator, including steps toward developing a nationwide inventory of contaminated lands, means for categorizing sites other than performance measures, and the need for including site-specific information and health consequences that may be unrelated to direct exposure.



Methods to Incorporate Hospital Discharge and Air Monitoring Data Into an EPHT

  • A. Shankar , Tulane University
  • L. Langlois , Tulane University
  • L.White , Tulane University

Background: It is well known that poor air quality can adversely impact persons with chronic respiratory and cardiac diseases. One of the goals of the Environmental Public Health Tracking Network is to characterize the health burden attributable to air pollution exposure. To address this need, Tulane CAEPH set out to design and validate methods that link trends in air quality and health outcomes, specifically the analysis of spatial and temporal trends of air quality and cardiorespiratory health outcomes. In partnership with the Missouri Department of Health and Senior Services, we are using Missouri's hospital discharge data to develop statistical methods for linking and analyzing hospital discharge and air quality data. Air monitoring data are downloaded from the Environmental Protection Agency (EPA) Air Quality System Data Mart. Issue: There is no standard procedure to deal with spatial and temporal gaps resulting from the spatial location and sampling frequency of the EPA air monitors. Results: A comprehensive method to combine ambient air data and hospitalization data is presented. The method consists of a series of procedures that involve interpolation of missing PM2.5 (particulate matter) values as well as linking health data with the nearest air quality monitor. The interpolation method is then applied to link PM2.5 data collected from 27 monitors in Missouri for the period starting January 2001 to December 2005 with hospitalization data for asthma, c hronic obstructive pulmonary disease ( COPD), and myocardial infarctions for the same period. Methods to be evaluated include time-series, Poisson regression, and case-crossover analyses. Lessons Learned: Spatial and temporal gaps make it difficult to link and analyze air quality and hospitalization data. We have developed a standardized procedure to combine ambient air data and hospitalization data.



The First Puerto Rico Children's Environmental Health Conference: Lessons Learned and Best Practices

  • R. Stephenson , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • M. Feliciano-Hernandez , Puerto Rico Department of Health
  • D.Perez , Pediatric Environmental Health Specialty Unit (PEHSU)
  • L. Graziano , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • A. Pomales , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • M. Watters , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Region II, in collaboration with the Puerto Rico Department of Health (PRDOH) and the Pediatric Environmental Health Specialty Unit (PEHSU) sponsored the inaugural Puerto Rico Children's Environmental Health Conference in June, 2009. This event was the first of its kind for Puerto Rico and perhaps the Caribbean as a whole. The primary objectives for the conference were to (1) provide knowledge to health care professionals on the evaluation, diagnosis, treatment, and prevention of childhood diseases of toxic environmental origin, (2) increase the knowledge of pediatric health care providers, parents, and community members about environmental threats to children's health, and (3) develop strategies for public health officials to collaborate with regional partners and connect with communities that share a diverse ethnic and socioeconomic background. The conference planning committee developed the theme, objectives, and agenda for the conference and invited public health experts in various environmental health fields as speakers. Participants were asked to complete initial post-conference and follow-up evaluations. The conference received favorable ratings on the content of the presentations, the facilities, professional applicability, illustrative materials, and organization (approval range: 97.4%–100%). Many attendees found that the conference provided valuable information and was beneficial for their career/professional development (46.3% and 31.7%, respectively). While this response may seem low for established annual conferences, it is quite promising for a first-time event. Most follow-up respondents (70%) reported they have used the knowledge they gained from the conference in their day-to-day work activities and shared the information with others. The planning staff demonstrated best practices and learned important lessons in fostering agency partnerships, addressing language barriers, maximizing the use of limited funding, effective avenues for publicity, timing of events, and follow-up.



Engaging Community Members Living Near an Historic Asbestos Site in Pennsylvania

  • L. Werner , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • B. Allerton , Pennsylvania Department of Health
  • M.White , The Commonwealth Medical College
  • C. Lloyd , Pennsylvania Department of Health
  • S. Doan , Agency for Toxic Substances and Disease Registry
  • A. Pomales , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

The Borit asbestos site in Ambler, Pennsylvania, poses a potential public health hazard. Environmental cleanup and health education activities are in progress. The site includes multiple neighborhoods and local jurisdictions. Sustained and creative efforts are in progress to reach different stakeholder and health professional groups. Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry and the Pennsylvania Department of Health (PADOH) participate in monthly meetings of the Borit Community Advisory Group (CAG). Health agencies are reaching out with written materials and unique events to engage stakeholders, including (1) Four health professional grand rounds on asbestos toxicity. Health agencies visited local doctor's offices in 2009, and shared eye-catching posters to display with health protective messages for patients who may have been exposed to asbestos. (2) Fact sheets describing health effects, exposure risk, and health consultation results. (3) An open house in West Ambler attended by more than 75 residents. With support from the American Legion, the West Ambler Civic Association, and local grocery stores, the event included an update on the site, information on health promotion and local healthy home resources, and a dance performance by children from the community. (4) Earth Day neighborhood cleanup and EPA command post open house held in conjunction with Whitpain Township. Agency staff shared information and worked alongside residents. The agencies are working to maintain a positive focus on the big picture of health in the Ambler and West Ambler communities without losing focus on issues specific to the site cleanup. Face-to-face interactions among agency staff, community groups, and residents have established trust, improved participation, engaged the community, and connected an underserved community with organizations with whom they can partner and improve the community's health and overall quality of life.



Massachusetts Department of Public Health Statewide Surveillance of Health Concerns and Toxic Algae Blooms Project

  • S. Condon , Massachusetts Department of Public Health
  • M. Celona , Massachusetts Department of Public Health
  • V. Yandell , Massachusetts Department of Public Health

Massachusetts experiences harmful algal blooms (HABs) in both marine and freshwater environments. In marine waters, explosive growth of the dinoflagellate Alexandrium commonly causes harmful algal blooms (HABs) known as red tide. Alexandrium produces a neurotoxin that can accumulate in filter-feeding shellfish, which if ingested can lead to paralytic shellfish poisoning. HABs in freshwater bodies occur when cyanobacteria experience explosive growth. Some cyanobacteria produce toxins that can cause illness in humans and animals if ingested. Exposure to cyanobacteria themselves can cause dermal and inhalation reactions. The Massachusetts Department of Public Health (MDPH) has implemented the Statewide Surveillance of Health Concerns and Toxic Algae Blooms Project. As part of the project, MDPH has entered into a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to conduct enhanced surveillance of HABs and human and animal-related illnesses and to identify environmental factors related to HABs. Specific objectives of the project include collecting information on health effects resulting from exposure to HABs, collecting environmental data at water bodies with HABs, entering these data into CDC's Harmful Algal Bloom-related Illness Surveillance System (HABISS), and analyzing and interpreting it. MDPH has identified and is working with several stakeholders, including environmental agencies, local health departments, hospital emergency rooms, veterinarians, watershed groups, and lake associations. Results of the 2009 season will be discussed, including data collection practices. Environmental data are collected by MDPH staff and a contractor. Health data are collected by collaborating with the Regional Center for Poison Control and Prevention, hospital emergency departments, and veterinarians.



Speciation of Arsenic, Selenium, and Chromium in Wildfire Ashes and Soils by HPLC-ICP-MS

  • R. Wolf , US Geological Survey
  • S. Morman , U. S. Geological Survey
  • G.Plumlee , U. S. Geological Survey
  • P. Hageman , U. S. Geological Survey

Background/Objectives: Soil and ash samples collected from residential areas burned by wildfires in California showed significant levels of potentially toxic metals were present, including chromium, arsenic, and selenium. The highly oxidizing environment of a wildfire has the potential to convert any chromium present to the more toxic hexavalent form, Cr(VI), a known carcinogen. The primary objective of the study was to determine if the chromium in fire-impacted soils and ash samples from the 2007 California wildfires contained hexavalent chromium, as well as which species of arsenic and selenium were present. Methods: Fire ash samples were leached with de-ionized water or simulated lung fluid to mimic interactions with natural precipitation and inhalation of ash particles. Filtered leachates were analyzed using reversed-phase ion-pairing high performance liquid chromatography (HPLC) and inductively coupled plasma mass spectrometry (ICP-MS) for Cr+3, Cr+6, As+3, As+5, Se+4, and Se+6 using the same chromatographic conditions. Results: In the water leachates, selenium levels were less than 0.032 µg/g for both Se+4 and Se+6, while arsenic, as As+5, was significant (3.6 µg/g) in one soil sample. Chromium was higher in samples from burned residential areas and ranged from 0.03 to 0.48 µg/g, with >90% of the chromium present in the hexavalent form. Hexavalent chromium also predominated in the simulated lung fluid extracts, with concentrations as high as 80 µg/L in the leachate (3.2 µg/g ash). Conclusions/Implications: The results indicate that hexavalent chromium may be present in significant levels in ash and soil samples from residential areas burned by wildfires. This could pose a potential health risk due to inhalation of soil and ash particles containing hexavalent chromium. Additional studies, including air monitoring to determine the levels of ash per cubic meter of air, are needed in order to further assess potential exposure to hexavalent chromium by fire fighters, restoration crews, and the public.



Assessment of Indoor Environmental Factors among Persons With Asthma—2006 Behavioral Risk Factor Surveillance System (BRFSS) Adult Asthma Call-back Survey (ACS)

  • H. Zahran , National Institute for Biotechnology and Genetic Engineering, Pakistan
  • C. Bailey , Centers for Disease Control and Prevention
  • J. Moorman , Centers for Disease Control and Prevention

Background: Asthma attacks can be exacerbated by indoor and outdoor air pollutants. Indoor air allergens or irritants, also known as environmental triggers, believed to pose the most risk for asthma attacks include mold, secondhand smoke, dust mites, cockroach droppings, pet dander and fur, and fumes from indoor wood or kerosene use. Objectives: To assess the association between having active asthma and indoor environmental triggers to determine the need for strategies to reduce exposures inside the home. Methods: The 2006 Behavioral Risk Factor Surveillance System (BRFSS) Adult Asthma Call-back Survey (ACS) data from 25 states were used to examine the association between having active asthma and indoor environmental factors. Results: Of the 10,790 respondents who ever had asthma, 71% met the criteria for active asthma. Although the associations differed by sex and state, having active asthma was significantly associated with actions taken to reduce environmental triggers and indoor air allergens and irritants. After adjusting for sex, age, and race/ethnicity, the association remained significant. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were the following: seeing or smelling mold in the past 30 days (1.64 [1.17–2.31]); smoke inside the home in past week (1.60 [1.12–2.30]); current smoker (1.63 [1.22–2.18]); using an air cleaner or purifier inside the home regularly (1.41 [1.07–1.86]); using a mattress cover (1.47 [1.11–1.93]); and using pillow cover (1.58 [1.18–2.13]) to control dust mites. Conclusions: The significant association between active asthma, environmental triggers, and actions taken to reduce environmental triggers indicates the need for continued behavioral monitoring and targeted outreach. Changing habits and reducing allergen or irritant sources may be important steps in managing and controlling asthma.



Describing Threats to Asthma Control in the Home Environment for Children With Asthma—A Comparison of Two Methods

  • E. Wasilevich , Michigan Department of Community Health
  • A. Rafferty , Michigan Department of Community Health
  • C.Fussman , Michigan Department of Community Health
  • S. Lyon-Callo , Michigan Department of Community Health

Background: Asthma is a chronic inflammatory disease of the lungs characterized by wheezing, coughing, difficulty breathing, and chest tightness. Triggers in the home environment can cause or worsen asthma symptoms. Avoidance of asthma triggers and behaviors to reduce exposure in the home environment are important to achieving asthma control. Methods: Respondents to the Michigan Behavioral Risk Factor Surveillance System (BRFSS) who reported that a randomly selected child in their household had ever been diagnosed with asthma were asked to participate in a follow-up interview. Those who agreed were called back and administered an asthma survey, including 17 home environment items. Using 2005–2007 data, we assigned points to the 17 items and summed them to generate a home environment score (HES), describing the level of risk for children with current asthma. We compared 2 approaches to assigning points—one unweighted and one weighted by the relative potential hazard of each item. The distributions of HES scores by the 2 methods were compared and median scores were calculated by demographic characteristics and asthma symptom frequency. Results: The prevalence of pediatric asthma in Michigan was 9.5% (95% CI: 8.0–11.2) in 2007. The most common potential hazard for this population was carpeting in the child's bedroom. The unweighted HES-1 score was normally distributed, and the weighted HES-2 was left-skewed, due to the weight given to recent smoking in the home. There were no significant differences in median HES (1 or 2) between groups according to demographic characteristics or asthma symptom frequency. Conclusions: The 2 methods resulted in different distributions of the prevalence of home environment risk. Preliminary findings do not suggest that either HES is more favorable in characterizing of environmental hazard.



Influence of Training and Previous Experience on the Self-Efficacy of Environmentalists

  • L. McCormick , University of Alabama–Birmingham
  • M. Poole , University of Alabama - Birmingham
  • Z.Kazzi , University of Alabama - Birmingham
  • V. Yeager , University of Alabama - Birmingham

Objectives: Due to Hurricanes Katrina and Rita, there is a unique opportunity to explore the relationship between public health environmentalists' training and their disaster response roles. This study has 3 major objectives. The first objective examines the effects of preparedness training on the environmentalists' perceptions and attitudes regarding the effectiveness of their response to the recent hurricanes. The second objective examines differences between each environmentalist's job role and subsequent response role and any complications that arise from these differences. Finally, this study identifies environmentalists' training needs related to preparing for and responding to such events. Methods: The South Central Center for Public Health Preparedness developed a survey consisting of 33 questions targeting perceived self-efficacy and performance for the public health response to Hurricane Katrina. This survey was administered in 2006 to Alabama public health professionals. Results: Environmentalists with prior experience in responding to natural disasters were more confident in their ability to perform their response role during Hurricanes Katrina or Rita (p = 0.087). Three specific training areas were found to be highly correlated with environmentalists' response to Hurricanes Katrina or Rita: Interagency roles and responsibilities during disaster response (0.96), department-/area-specific emergency response plan training (0.91), and other training (0.95). Environmentalists' primary response roles during Hurricanes Katrina or Rita response efforts were shelter assistance (42%) and environmental issues (15%). Training in environmental health issues (30%) and job-appropriate response protocols were identified as the most useful.



Field Evaluation for Testing Correlation Between Lead Concentration in Household Dust and Soil Lead Values

  • D. Morrison-Ibrahim , Indiana University Purdue University - Indianapolis
  • G. Filippelli , Indiana University Purdue University - Indianapolis
  • Q.Lin , Indiana University Purdue University - Indianapolis
  • R. Buehrer , Indiana University Purdue University - Indianapolis

Lead (Pb) exposure continues to be a public health threat, even after the removal of new Pb sources from the product stream. It is suggested that Pb-saturated soils and the resuspension of fine materials from these soils during dry seasons play a major role in Pb exposure to urban children. Past research has shown that Pb-contaminated house dust is a significant contributor to elevated blood lead levels (BLLs) in children and that the Pb in house dust comes from a variety of sources including Pb-based paint, legacy of leaded gasoline, and industry sources. Extensive surface soil sampling was conducted in the WESCO Community located in Marion County, Indiana, in 2008 with simultaneous testing of household furnace filters from 7 homes in the same area bimonthly during the same year. Primary findings suggest a relationship between the Pb concentrations found in the soil and Pb concentrations found in the filters, with certain seasons having a higher correlation between soil and filter than others. This research adds to the base of scientific knowledge that Pb in soil can be a significant contributor to elevated BLLs in children and that with the current warming trend there poses a risk that longer and drier summers will only add to this burden of Pb in children.



International Geographic Variations in Breast Cancer Incidence and Its Possible Association With Dietary Fat Consumption

  • Y. Wei , Mercer University
  • T. Nguyen , Mercer University

Background/Objectives: Accumulating evidence has indicated that environmental factors could play important roles in breast cancer development. This study is to assess geographic variations in the time trends of breast cancer incidence in North American and Asian countries and to determine if dietary intake is associated with breast cancer incidence. Methods: Time trends of breast cancer incidence and the association with dietary intake were assessed by analyzing ecological data. Age-adjusted incidence rates of female breast cancer were obtained from the Surveillance, Epidemiology, and End Result Program of the US National Cancer Institute and the International Agency for Research on Cancer. Data regarding dietary intake was from Food and Agriculture Organization of the United Nations. Pearson's correlation was used to analyze the association between dietary intake and the incidence of breast cancer. Results: Difference in the time trends of breast cancer incidence was observed between North American and Asian countries. The rates for the United States started going up from 1980, peaked in 1998, and tended to drop off. However, for Japan and Hong Kong, China, the incidence rates have been continually rising over the years. The time trend of breast cancer incidence for Japan was positively correlated with animal fat consumption (r = 0.756; P = 0.000). The incidence rates were also found to be positively associated with animal fat consumption when analyzing all the available data for 30 countries in North America and Asia (r = 0.484; P = 0.007). Conclusion/Implications: This study demonstrates that dietary fat consumption could contribute largely to the international geographic variations in breast cancer incidence, and suggests the need for increasing awareness of the potential impact of diet on breast cancer.



Barriers to Community–Institutional Partnerships in Environmental Health: Trust Is Not Enough

  • M. Feinberg , For A Better Bronx
  • A. Blank , Albert Einstein College of Medicine
  • A.Strelnick , Montefiore Medical Center

Background: In 2001, South Bronx Clean Air Coalition, later known as For A Better Bronx (FABB), began work with Montefiore Medical Center, Albert Einstein College of Medicine and Lehman College, on the first of 3 National Institute of Environmental Health Sciences (NIEHS) Environmental Justice, Community-Based Participatory Research grants, with Montefiore as the principal investigator (PI) on all. This abstract explains how negative financial dynamics between grantee PI and partners can impair the work of community–academic partnerships. Issue: At NIEHS, Environmental Protection Agency (EPA) and National Institute for Occupational Safety and Health (NIOSH) EJ and CBPR grantee meetings, otherwise valuable discussions on how to enhance capacity and power of community partners yielded few concrete recommendations to NIEHS and other granting agencies. Our partnership explored such issues and possible recommendations. Results: Community and subcontracting partners are critical to grant implementation, yet institutional bureaucratic obstacles create unintended difficulties for them. Long delays finalizing subcontracts mean initial grant payments can be months late, while payment on midyear invoices is often tardy. Delays result in payroll problems and untimely expense reimbursements, especially difficult for a low-budget community organization. FABB was also uncomfortable with budgets being decided by PI alone. Lessons Learned: For effective CBPR partnerships, trust is critical, yet finances can strain them. Our partnership now includes FABB in grant-budgeting decisions, an improvement we suggest. We recommend each award incorporate a memorandum mandating timely contracts and payments to community organizations and other partners, and democratic decision making. Compliance can be monitored by partnerships and external auditors or by the granting agency. We suggest further discussion on how the RFA and grant-making process, including reconsideration of allowable institutional indirect budgets, can help build community capacity to respond to government RFAs, and lead these partnerships.



Miscellaneous Chemicals Associated With Work-Related Asthma—California, Massachusetts, Michigan, and New Jersey, 1993–2002

  • J. Mazurek , Centers for Disease Control and Prevention
  • M. Filios , Centers for Disease Control and Prevention
  • J.Wood , Centers for Disease Control and Prevention
  • K. Rosenman , Michigan State University
  • M. Reilly , Michigan State University
  • D. Schill , New Jersey Department of Health and Senior Services

Cases of work-related asthma (WRA) are sentinel health events that indicate the need for preventive intervention. We describe miscellaneous chemicals associated with WRA cases identified by state-based occupational disease surveillance systems. We examined WRA cases reported from 1993–2002 in 4 states: California, Massachusetts, Michigan, and New Jersey. A single case of WRA may be associated with up to 3 putative agents. Agents were coded and grouped using the Association of Occupational and Environmental Clinics (AOEC) exposure coding scheme. Overall, 4,133 WRA cases reported 401 different agents. The most frequently reported agent group was miscellaneous chemicals (801 cases; 19.4%). The miscellaneous chemicals group included nonspecific chemicals (50.4%), glues (11.4%), pesticides (11.2%), perfume (8.1%), photo developing chemicals (2.2%), printing chemicals (2.2%), odors (1.9%) hair products (1.4%), lubricants (1.4%), fire extinguisher discharge (1.2%), and cosmetics (1.2%). Of the WRA cases associated with miscellaneous chemicals, 61.0% cases were classified as asthma caused by workplace exposure to sensitizers or irritants (new-onset asthma) and 25.3% as preexisting asthma exacerbated by workplace exposures (work-aggravated asthma); 13.6% had insufficient data to classify asthma. Occupations most frequently associated with reported exposure to miscellaneous chemicals were assemblers, nurses, secretaries, laborers, clerks, and elementary school teachers. The identification of workplace exposures that trigger asthma improves the ability to eliminate and/or control these exposures and, consequently, improves worker prognoses. The results presented here can be used to direct future research regarding respiratory hazards in the workplace and can inform public health interventions to reduce workplace risks.



Dose Response Assessment Methods to Inform Environmental Policy: An Application of Bayesian Hierarchical Models

  • J. Lam , Johns Hopkins University
  • M. Fox , Johns Hopkins University
  • T.Burke , Johns Hopkins University
  • F. Dominici , Harvard University

Currently, the extrapolation of evidence from both human and nonhuman data to model human dose-response relationships in risk assessment includes using results from one or several similar studies with incorporation of uncertainty factors (i.e., 10) intended to reflect unknown aspects of the process. This deterministic approach has been criticized as obscuring the true uncertainty inherent within the risk estimates and limiting policy makers' ability to make adequately informed decisions. Bayesian methods have been identified as an alternative approach able to handle the unique uncertainties within dose-response assessment, such as combining data from various types of studies, incorporating diverse sources of information (e.g., expert opinion), and accounting for and quantifying the various sources of uncertainty that surround the model and the final dose-response estimate. This dissertation work aims to (1) develop a Bayesian hierarchical model for application to dose-response modeling, incorporating both animal and human data; (2) develop a statistical program in R/WinBUGS to perform computations of the Bayesian model; (3) demonstrate the risk assessment application using trihalomethanes, specifically chloroform, as case examples;( 4) compare results from the Bayesian model to the Environmental Protection Agency (EPA) current deterministic protocol for dose-response assessment; and (5) explore the public health implication and other consequences of using standards generated from the Bayesian method as compared to that derived from the EPA's current dose-response assessment protocols.



Human Exposure to Dioxin-Like Compounds in Fish, Eggs and Soil

  • L. Dykema , Michigan Department of Community Health
  • K. Groetsch , Michigan Department of Community Health

Background/Objectives: Polychlorinated dibenzo-p-dioxins and polychlorinated furans (dioxin-like compounds, or DLCs) are found in the Tittabawassee River downstream of the city of Midland. Frequent flooding carries DLC-contaminated sediments onto upland soils of riparian properties. DLCs are lipophilic, persistent, and bioacumulative compounds. People can be exposed to DLCs while living on contaminated property and eating home-produced animal products. Methods: We present DLC data for soil, fish fillet, chicken egg, and human serum sampling for a property in the Tittabawassee River floodplain. We used the 2005 World Health Organization (WHO) toxic equivalency factors to calculate total dioxin toxic equivalents (TEQs). Results: DLC levels measured in soil from a property in the floodplain of the Tittabawassee River are elevated above the state of Michigan cleanup criterion and are consistent with the congener profile for the Tittabawassee River contamination. DLC levels measured in chicken eggs are elevated. Congener profiles of DLC contamination found in the eggs closely parallels that of flood plain soils. DLC serum levels for 5 people living on contaminated property and eating contaminated eggs are elevated above human background levels. Congeners that predominate in soil and egg profiles are elevated above background in serum of these 5 people. Conclusions/Implications: DLC contamination in Tittabawassee River floodplain soils is bioavailable and accumulates in chicken eggs. People who live on DLC-contaminated soil and eat home-produced eggs exhibit elevated levels of DLCs in their blood serum.





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