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

Practice 1

An Idiopathic Environmental Illness-like Syndrome in Children: Diagnostic and Management Dilemmas

  • A. Woolf , Children's Hospital, Boston
  • M. Hopkins , University of Texas

Background: Idiopathic environmental illness (IEI) syndrome is a controversial condition described in adults, although many clinicians doubt the authenticity of the diagnosis. Patients develop a broad constellation of symptoms and signs that are provoked by a range of chemicals. Often the condition is heralded by an acute inadvertent exposure to a chemical in the workplace. The condition is not well described in children. Objective: We describe here cases of IEI seen in a Pediatric Environmental Health Center (PEHC), a clinic dedicated to the treatment of children whose illnesses may be related to environmental exposures. Methods: All medical records of patients referred to the PEHC between 1997 and 2009 were reviewed for the listing of a diagnosis of “multiple chemical sensitivities” or “idiopathic environmental illness.” Patients whose symptoms seemed related predominately to a single environment, such as an indoor air quality problem at home or in a school, or were readily explained by a single known illness, such as sinusitis, were excluded. We defined IEI as follows: patients whose symptoms were involved >1 body system, whose family connected them to exposures to multiple chemicals or precipitants, and whose symptoms occurred in several environments. Charts were reviewed for the patient's age and gender, symptoms and signs, environmental triggers, diagnostic testing, and descriptions of managements pursued by the family. Results: Thirteen patients met the definition of IEI syndrome in children: 9 males, 4 females. Mean age at presentation was 10.8 years old (range 3.5–21.75 years). Precipitants included paints, fumes, ammonia, cleansers, perfumes, lawn chemicals, pesticides, foods, preservatives, food dyes, carpets, tobacco smoke, wood stoves, polyester, molds, toothpaste, detergents, shampoos, and solvents. Symptoms included detecting objectionable odors (15), bronchospasm (5), rash (5), cough or shortness of breath (6), fatigue or weakness (8), dizziness (8), abdominal pain (8), and behavioral changes (3). Normal or negative diagnostic studies included complete blood count, liver and renal function, immunoglobulins, skin testing, Radioallergosorbent t ests, sweat tests, and pulmonary function tests. Therapies included dietary restrictions (9), dietary supplements/herbs (7), home modifications or relocation (6), home schooling (6), social isolation (5), homeopathy (5), counseling (2), chelation (1), and sublingual extracts (1). Conclusion: There are children whose illnesses, as well as their history of exposures to chemicals, resemble that of the entity known as “idiopathic environmental illness” in adults. Like the adult condition, the circumstances surrounding the illness described by these children and their families were varied. Management must be individualized according to the family's needs.


Practice 1

America's Children and the Environment: Development of New Children's Environmental Health Indicators

  • D. Axelrad , US Environmental Protection Agency
  • J. Sturza , U.S. Environmental Protection Agency
  • G.Miller , U.S. Environmental Protection Agency
  • O. Nweke , U.S. Environmental Protection Agency
  • D. Cantor Paster , U.S. Environmental Protection Agency

Background: Children's environmental health indicators are useful for tracking status and trends in critical environmental contaminants and related childhood health effects. America's Children and the Environment is a US Environmental Protection Agency (EPA) compilation of children's environmental health indicators, presenting information on trends in environmental contaminants in air, water, food, and soil; contaminants measured in the bodies of mothers and children; and childhood diseases that may be influenced by environmental factors. Examples include children living in counties in which air quality standards were exceeded; children's blood lead levels; and children with asthma. EPA is currently preparing a third edition of America's Children and the Environment , with updates to the indicators previously published and several new indicators. Issue: Our understanding of how environmental contaminants may affect children's health has grown substantially, and several new data sets have become available. Examples of new topics under consideration for America's Children and the Environment include environmental contaminants in indoor dust; body burdens of phthalates and brominated flame retardants; and adverse birth outcomes. Selection of new indicators requires consideration of the importance of the topic to children's environmental health; suitability of available data; and ability to summarize key data in a technically appropriate and understandable indicator. Results: We identified several topics of interest in children's environmental health that were not included in the 2003 edition of America's Children and the Environment . We reviewed the literature and evaluated the availability of data for developing indicators to address those topics. We selected a subset of candidate topics for further development, and are currently examining indicator options for each topic. Lessons Learned: For several children's environmental health topics of interest, suitable data are available for indicator development.


Practice 1

Accuracy of Lead Level Measurement Using Oral Fluid

  • L. Gardner , Emory University
  • R. Geller , Emory University
  • R.Hannigan , University of Massachusetts
  • Y. Sun , Georgia Department of Community Health
  • A. Mangla , Georgia Department of Community Health

Background/Objectives: There were approximately 240,000 children with lead poisoning in the United States in 2008. Associated deficits are well known. Current screening practices take time and require blood draws. Oral fluid can be used in vitro to measure lead, but has not been tested in a clinical setting. This study compares oral fluid and blood lead levels in a clinical setting. Methods: Oral fluid samples were collected on 500 children ages 6 months to 5 years in a primary care clinic. Children having routine blood lead levels drawn were eligible. Blood lead levels were measured by standard methodology, and oral fluid lead levels were measured using mass spectroscopy. Oral fluid samples from 50 children were gathered twice to provide internal controls, but counted once. Data analysis used Pearson correlations, scatter plots, and linear regression. The mean absolute difference between the sample groups was determined to test the hypothesis that group means are equal. Results: A total of 500 patients agreed to enroll; 474 patients had both blood and oral fluid samples available for analysis; 26 did not have blood available. Of the 474 patients, 455 had blood levels <4mcg/dL; 446 had oral fluid levels <4mcg/dL; 19 had blood levels =4mcg/dL; and 28 had oral fluid levels =4mcg/dL (92% correlation). Using a cutoff of 4mcg/dL gives a sensitivity of 96% and a specificity of 99%. Internal controls suggested no variations, p<0.05. Conclusion/Implications: Oral fluid appears to be a reliable medium to use when screening children for lead exposure at levels =4mcg/dL. Oral fluid lead levels =4 mcg/dL should be confirmed by venous blood sample. The convenience of oral fluid lead screening should improve our screening success by reducing parental refusal and eliminating inability to obtain an adequate sample.


Practice 1

Building Global Children's Environmental Health Capacity: Partnership in Vietnam

  • C. Karr , University of Washington
  • N. Beaudet , University of Washington
  • Q.Nguyen , Thomas Jefferson Medical School
  • Q. Kieu , Project Vietnam
  • M. Keifer , University of Washington

Background: Economic pressures, rapid industrialization, and an ineffective regulatory system place children in lower-income countries at increased risk for significant environmental exposures. The North American Pediatric Environmental Health Specialty Unit (PEHSU) network has initiated global health partnerships to support the capacity of pediatric health professionals in developing nations. Issue: In 2008–2009 the North American PEHSU partnered with the University of Washington's Fogarty International Collaborative Center for Healthy Work and Environment Program and Project Vietnam to investigate children's environmental health (CEH) capacity in Vietnam. The project sought to identify and engage regional leaders in pediatric medicine and environmental health and identify priority issues and current practices. Results: The PEHSU network model was presented and discussed at a national environmental and occupational health conference in Vietnam in October 2008. Focused formal introductory trainings on core CEH topics were provided at 6 children's hospitals/pediatric departments in Vietnam in March 2009. Informal meetings with administrative and academic leaders in each of these institutions were held to explore priorities and experience. During trainings, surveys regarding environmental hazards knowledge, attitudes, and beliefs of pediatric health care providers who care for children in Vietnam were collected from 141 pediatricians. Formal survey results and general impressions will be discussed. Lessons Learned: In Vietnam, pediatric health care providers endorse environmental hazards in child health as an important topic but general awareness and training experience of these topics is very limited. There is no current structural focus on children's environmental health among environmental health initiatives in Vietnam and there has been no integration of these topics into routine training or practice for pediatric providers.


Practice 2

An Overview of NASA Public Health Projects Using Remote Sensing

  • S. Estes , National Aeronautics and Space Administration/USRA
  • J. Haynes , NASA

Health providers/researchers need environmental data to study and understand the geographic, environmental, and meteorological differences in disease. Satellite remote sensing of the environment offers a unique vantage point that can fill in the gaps of environmental, spatial, and temporal data for tracking disease. The field of geospatial health remains in its infancy, and this program will demonstrate the need for collaborations between multidisciplinary research groups to develop the full potential. Relevance/Significance: Satellite earth observations present a unique vantage point of the earth's environment from space that offers a wealth of health applications for the imaginative investigator. The presentation will present research results of the remote sensing environmental observations of earth and health applications that can contribute to tracking/surveillance networks. Approach/Methodology: The National Aeronautics and Space Administration (NASA) has used satellite remote sensing of the environment to provide a method for bridging gaps of environmental, spatial, and temporal data for tracking disease. This overview will provide an overview of projects that NASA is currently conducting with the Centers for Disease Control and Prevention (CDC), academia, and other governmental/state agencies. Conclusions and Recommendations : This presentation provides a venue where the results of both research and practice using remote sensing when applied to public health and the environment will be showcased. This presentation will be the introduction of ongoing projects that will include such topics as their impact and implications and how these types of projects are relevant to the community.


Practice 2

Estimating Particle Sulfate Concentrations Using MISR Aerosol Properties

  • Y. Liu , Emory University

Understanding the spatial distribution of fine particle sulfate (SO 4 ) concentrations is important for optimizing emission control strategies and assessing the population health impact due to exposure to SO 4 . Aerosol remote sensors aboard polar orbit satellites may help expand the sparse ground monitoring networks into regions currently not covered. We developed a Generalized Additive Model (GAM) using Multiangle Imaging SpectroRadiometer fractional AODs scaled by Graphic Environment Operating System (GEOS)-Chem aerosol profiles to predict ground-level SO 4 concentrations. This advanced spatial statistical model is able to explain 70% of the variability in SO 4 concentrations measured at the surface, and the predicted spatial surface of annual average SO 4 concentrations are consistent with contours interpolated from ground measurements. Comparisons with alternative models demonstrate significant advantages of using model-scaled lower-air fractional AODs instead of their corresponding column values. The nonlinear association between SO 4 concentrations and fractional AODs makes the GAM a more suitable model structure than conventional linear regressions.


Practice 2

Integration of Dust Prediction Systems and Vegetation Phenology to Track Pollen for Asthma Alerts in Public Health

  • J. Luvall , National Aeronautics and Space Administration

Initial efforts to develop a deterministic model for predicting and simulating pollen release and downwind concentration to study dependencies of phenology on meteorology will be discussed. The development of a real-time, rapid-response pollen release and transport system as a component of the New Mexico Environmental Public Health Tracking System (EPHTS), is based on meteorological models, National Aeronautics and Space Administration (NASA) earth science results (ESR), and an in situ network of phenology cameras. The plan is to detect pollen release verified using ground based atmospheric pollen sampling within a few hours using daily Moderate Resolution Imaging Spectroradiometer data in nearly real-time from Direct Broadcast, similar to the MODIS Rapid Response System for fire detection. As MODIS winds down, the National Polar-orbiting Operational Environment Satellite Systems- Visible Infrared Imaging Radiometer Suite sensor will assume daily vegetation monitoring tasks. Also, advancements in geostationary satellites will allow 1 km vegetation indices at 15–30 minute intervals. The pollen module in EPHTS will be used to (1) support public health decisions for asthma and allergy alerts in New Mexico, Texas, and Oklahoma; (2) augment the Centers for Disease Control and Prevention (CDC) Environmental Public Health Tracking Network (EPHTN); and (3) extend surveillance services to local health care providers subscribing to the Syndrome Reporting Information System (SYRIS). Previous studies in NASA's public health applications portfolio provide the infrastructure for this effort. The team is confident that NASA and National Oceanic and Atmospheric Administration (NOAA) ESR data, combined into a verified and validated dust model, will yield groundbreaking results using the modified dust model to transport pollen. The growing ESR/health infrastructure is based on results from a rapid prototype scoping effort for pollen detection and simulation carried out by the principal investigators.


Practice 3

International Pediatric Environmental Health Leadership Institute

  • R. Etzel , International Pediatric Association
  • J. Pronczuk , World Health Organization
  • J. Schaller , International Pediatric Association

Background: Environmental health is a neglected issue in most pediatric training programs, yet it is a fundamental and cross-cutting area of major importance to global child health. Issue: With funding from the US Environmental Protection Agency (EPA), the International Pediatric Association, and the World Health Organization (WHO) launched an International Pediatric Environmental Health Leadership Institute to train pediatricians about children's environmental health and improve their capacities for leadership and advocacy regarding the prevention of pediatric diseases linked to environmental factors. In collaboration with the National Pediatric Societies of Haiti, India, and Kenya, the institute gave 3 days of onsite training in each of these countries to pediatricians and other health workers. The training offered a standard curriculum using the second edition of the American Academy of Pediatrics book Pediatric Environmental Health and specific modules taken from the WHO Training Package for Health Care Providers, a series of peer-reviewed annotated PowerPoint presentations on key topics in children's environmental health. The pediatricians who attended the workshops were required to present a seminar about children's environmental health at their home hospital; record, file, and analyze the pediatric environmental history forms from children with illnesses from environmental contaminants; and propose a community project on an environmental health problem. Results: The institute trained 189 professionals and established links between those involved in patient care and those in charge of policy making and public health in these 3 countries. It also facilitated networking and exchange of ideas among clinicians on prevention and treatment of childhood illnesses linked to the environment. Lessons Learned: Training alone is probably insufficient for achieving practice change; clinicians need to incorporate knowledge into daily patient care and become active in community environmental health work.


Practice 3

Integrating Environmental Health Into Pediatric Healthcare

  • L. McCurdy , National Environmental Education Foundation

Background: Health professionals are often not fully equipped with the knowledge to understand environmental health hazards within their communities and be able to diagnose, treat, and prevent resulting health conditions. Issue: The National Environmental Education Foundation (NEEF) Healthcare Provider Initiative employs a multipronged strategy involving a wide range of stakeholders to advance environmental knowledge among health professionals in order to improve public health, with a special emphasis on children and other populations disproportionately impacted by environmental health disparities. Through curriculum development, trainings, generation of national agendas, and strategic partnerships, NEEF facilitates the integration of environmental health into health care provider education and practice. Our scientifically based, peer-reviewed tools include Environmental Management of Pediatric Asthma: Guidelines for Healthcare Providers , Pediatric Environmental History Forms, and a wide range of other environmental health resources. Our signature program, Faculty Champions Initiative, aims to build health professionals' capacity to address environmental health issues. Faculty members from medical and nursing schools serve as leaders in integrating environmental health into their academic institutions in a sustainable manner by training other faculty members, colleagues, and students; providing expertise to their institutions and communities; and serving as models for how to integrate environmental health into health professionals' education. Results: NEEF's tools and resources have been well accepted by the health professional community and have been integrated into curriculum and clinical practice through the Faculty Champions Initiative and other efforts. Lessons Learned: NEEF's strategy to integrate environmental health into health care has demonstrated success and its Faculty Champions Initiative proved itself to be a successful replicable model. Larger-scale application of this strategy is needed to achieve national success.


Practice 3

From Advancing Science to Improving Prevention

  • P. Sutton , University of California–San Francisco
  • T. Woodruff , University of California - San Francisco

Background: A rapidly expanding body of research has implicated prenatal exposure to chemicals that are widely dispersed in our environment with adverse reproductive, developmental, child, adult, and intergenerational health impacts. As the critical importance of prenatal exposures is increasingly revealed, so is the need for interdisciplinary teams of health scientists and clinicians to find a common purpose in taking timely action to prevent adverse prenatal environmental exposures. Methods: In 2008 the From Advancing Science to Ensuring Prevention (FASTEP) Alliance was formed by the University of California–San Francisco Program on Reproductive Health and the Environment to increase capacity to connect, educate, and mobilize networks of reproductive and pediatric health physicians, nurses, midwives, and other clinicians, and their patients, health-affected populations, consumers, workers, and others impacted by the lifecycle of reproductive toxicants. FASTEP has 3 interrelated objectives: (1) Improve clinical practice; (2) advance public health policy; and (3) develop a practical application of an ecological model of heath—strive to consider the physical and social context in which prenatal exposures occur when developing recommendations for advancing reproductive and developmental health outcomes. Results: To meet its objectives FASTEP has undertaken projects on healthy food systems, protecting workers from reproductive hazards , a brochure titled “Toxic Matters,” and Navigating the Scientific Evidence to Improve Prevention, a peer-reviewed transparent methodology to efficiently vet, frame, and synthesize the scientific evidence evaluating the environment and reproductive health that is consistent with preventing harmful exposures. This presentation will describe the results of these collaborative efforts to transform emerging scientific discoveries about the role of the environment on reproductive health outcomes into healthy pregnancies, healthy children, and the health of future generations.


Practice 5

Developing a Public and Friendly Environmental Public Health Tracking Network

  • A. Charleston , Centers for Disease Control and Prevention

The Environmental Public Health Tracking Network (Tracking Network) is a component of the Public Health Information Network (PHIN) that provides information from a nationwide network of integrated health and environmental data to drive public health action. The program is a collaborative effort, with local, state, and national partners working together to establish a standardized approach to provide information to both the general public and public health professionals. Tasked with being a resource for both the public health professional and the general public, the Tracking Network developed both secure and public portals to address the needs of both users. The secure portal provides public health experts the ability to work with tools and appropriate access to data. The public portal was slightly more complicated since the user was not presumed to be a public health or environmental health expert. The program could not assume that the public user had an understanding of public health and environmental impacts and had to provide appropriate interpretations of the data. The Tracking Program conducted market research to establish a tool that was user friendly and provided easily digestible information. This research served as the foundation for the development of a highly user-friendly Web-based interface.


Practice 5

Selection and Refinement of Integrated Environmental Health Data for Internet Queries

  • M. Bekkedal , Wisconsin Division of Public Health
  • M. Werner , Wisconsin Division of Public Health
  • H.Anderson , Wisconsin Division of Public Health

Background: Local health departments often use summarized environmental health surveillance data to conduct planning activities, identify priorities, and develop policies at the community level. Implementation of Internet-based data queries facilitates broad access to data that can be used for these applications. Issue: Until very recently, the availability of most environmental health data reflected the division between health and environmental resources, and integrated environmental health data were often difficult to obtain. A primary objective of Wisconsin's Environmental Public Health Tracking (EPHT) portals is to provide an electronic data query resource where relevant environmental health data have been carefully selected for environmental health relevance. Results: Two examples of data refinement demonstrate the advantages of the Wisconsin portals. The program has developed County Environmental Health Profiles that integrate data and information into a single document. It is on the public portal as a static document and on the secure portal as a dynamic, customizable product. Additionally, the program has included air toxics data on its portals. The data are condensed to include only contaminants most relevant for the priority topic area of cancer. Additionally, the data are organized so users can identify localized risk estimates that provide the public health context for these environmental data. Lessons Learned: Data refinement is important to ensure utility of the EPHT portals. There are numerous data query systems available for environmental and health data, but EPHT portals provide data integration and refinement to promote application to environmental public health objectives.


Practice 6

Creating a Holistic Approach for Children's Environmental Health in West Michigan

  • M. Hultin , Michigan Department of Environmental Quality
  • M. Suero , U.S. Environmental Protection Agency
  • C.Boyd , Sustainable Research Group
  • R. Wahl , Michigan Department of Community Health
  • M. Davis-Poeder , Kent County Health Department

Background: As a result of US Environmental Protection Agency (EPA) interest and technical support, an initiative was created to enhance collaboration and expand efforts among children's health partners in West Michigan. Collaboratively, stakeholders decided to focus on urban Grand Rapids. The resulting Greater Grand Rapids Children's Environmental Health Initiative (GRCEHI) includes numerous partners such as local, county, state, and federal agencies and nonprofit organizations. Issue: The overall goal of the GRCEHI is to achieve a holistic approach to children's environmental health through promotion and realization of healthier home environments. The group consists of core members from agencies dealing with various aspects of children's environmental health. A workgroup formed to address key environmental indicators. Results: The GRCEHI successfully earned funding for its work, receiving grants from US EPA Community for a Renewed Environment and US Centers for Disease Control and Prevention Environmental Public Health Capacity Building. The GRCEHI conducts outreach/education events and distributes materials from a variety of stakeholder groups participating in the initiative. Health care workers in the community now use a coordinated assessment document to review environmental health indicators in homes and deliver resource referrals. Lessons Learned: The benefit of bringing together enthusiastic stakeholders to champion the issue of children's environmental health is that most members have a unique area of expertise. It is difficult to bring the diverse interests together and unite behind a common cause. Bringing a variety of unique groups together can foster difficulties understanding one another, but simultaneously achieves improved results for community awareness and engagement in issues.


Practice 6

EPA Lessons Learned: West Michigan Children's Environmental Health (CEH) Initiative

  • M. Suero , US Environmental Protection Agency
  • E. Master , US Environmental Protection Agency
  • R.Hood , West Michigan Environmental Action Council
  • P. Haan , Healthy Homes Coalition
  • K. Meyerson , Asthma Network of West Michigan
  • M. Davis-Poeder , Kent County Health Department

Background: US Environmental Protection Agency (EPA) Region 5 (R5) participated in a very successful children's environmental health (CEH) pilot project (2006–2008), in West Michigan (WM), focusing existing CEH resources, primarily technical assistance and capacity building, from the voluntary programs related to indoor environmental quality. The goal was to achieve a more holistic approach to CEH through the promotion and realization of healthier homes, child care facilities, school environments, and communities. Regional expectations were to achieve some early hazard or risk reductions through an approach that would be both sustainable by the community and replicable for the region in other areas. Presentation focuses on EPA's role and lessons learned. Issue: R5 carried out this geographically focused pilot on CEH to discern whether a more coordinated, focused approach would result in better leveraging resources of both internal and external resources and partners. Results: Capacity for CEH was increased among various key stakeholders, such as decision makers for school and low-income housing maintenance and health care providers. Hazard reductions were achieved, primarily in schools, with the removal of hazardous chemicals and installation of diesel emissions reduction devices on school buses. Community entities also successfully competed for additional funding to continue work on making home environments healthier and safer. Lessons Learned: Bundling activities through healthy homes and healthy schools approaches and focusing these opportunities on key influential, stakeholders led to greater impacts than what would have been achieved through more traditional program-by-program approaches. R5's presence and resources, including participation as an active partner in the community, were essential. Participation of state agencies and other federal agencies was crucial. Elements that are critical to ensure the success of a US EPA geographically focused community CEH project will also be shared.


Practice 6

Environmental Health Indicators Work Group of West Michigan

  • C. Boyd , Sustainable Research Group
  • R. Wahl , Michigan Department of Community Health
  • M.Hultin , Michigan Department of Environmental Quality
  • M. Suero , U.S. Environmental Protection Agency
  • J. Taylor-Morgan , Michigan Department of Environmental Quality
  • M. White , U.S. Environmental Protection Agency

Background: The Greater Grand Rapids Children's Environmental Health Initiative (GRCEHI) is a multi-stakeholder collaborative to address children's environmental health in urban communities of the Greater Grand Rapids Metropolitan Area of West Michigan. Within the GRCEHI, the Environmental Health Indicators Work Group serves to analyze and report out environmental health data for the targeted communities in order to support compelling arguments for effective resource allocation, and measure program successes. Primary concerns are lead, mercury, radon, carbon monoxide, asthma, and indoor and outdoor air quality. Issue: Environmental health indicators are simplified numeric values used to determine the status of health risks and outcomes derived from environmental exposures. Indicators are useful for (1) benchmarking and tracking trends over time and a wide range of geographic scales, (2) determining progress against a specific health goal, and (3) determining how subsets of the population are doing compared to the whole population (e.g., children, minorities). Indicators are particularly useful when clearly measurable links between health effect and causative agent are not available. The utility of indicators can, however, be undermined by data quality issues and availability at incompatible scales—for example, the use of national statistics to make inferences about local conditions. Also, aggregated data may mask the true nature of environmental health concerns at a finer spatial-temporal resolution. Results: The workgroup has (1) developed a publicly available resource library of identified data sets specific to the region; (2) developed an “indicator matrix” to manage and rank data for quality objectives; (3) provided geographic information system (GIS) maps to make the data more graphically visual; (4) vetted fact sheets and informational material for use in outreach/educational activities; and (5) provided expert input to initiatives such as Health Kent 2010. Data were obtained from both peer-reviewed literature and published health statistics and through direct public dialogue with affected communities.


Practice 7

Air Quality Indicators for EPHT: Why, What and How

  • F. Dimmick , US Environmental Protection Agency
  • R. Vaidyanathan , Centers for Disease Control and Prevention
  • S.Anderson , New Jersey Department of Environmental Protection
  • S. Stone , U.S. Environmental Protection Agency
  • E. Hall , U.S. Environmental Protection Agency
  • M. Round , Massachusetts Department of Public Health

This presentation highlights efforts of the air quality team within the Centers for Disease Control and Prevention (CDC) Environmental Public Health Tracking (EPHT) content workgroup to develop air quality indicators for use in the CDC and state EPHT portals. The presentation describes the results of the team's efforts to develop nationally consistent air quality health tracking indicators and measures. The presentation begins with a description of the specific purpose/goals of developing air indicators for EPHT. The presentation addresses the technical and communication aspects of using Environmental Protection Agency (EPA) air quality data for the indicators on CDC's national EPHT portal. The presentation discusses how EPA data were obtained and transferred to CDC and then the key aspects of calculating the indicators, including use of metadata. The presentation outlines the development and potential uses of EPA's statistical predictions of air quality (including developing indicators for counties without air quality monitors). The presentation shows the resulting Web site pages, including data displays and supporting text. The presentation includes a series of “screen shots” to show the specific approach to air indicator displays on the CDC EPHT portal, with on-the-fly data generation. The presentation will also describe how state EPHT portals addressed the air quality data (with “screen shots”). The air quality team identified a number of challenges to overcome when public health portals present air quality information important to their state environmental partners. The presentation finishes with a summary of the lessons learned and implications of the project. The presentation includes the team's conclusions, recommendations for potential future activities, and thoughts on the relevance to various communities. Although this work was reviewed by EPA and approved for publication, it may not necessarily reflect official agency policy.


Practice 7

A Comparison of Annual Average PM2.5 Monitored and Modeled Concentrations

  • A. Vaidyanathan , Centers for Disease Control and Prevention
  • S. Kegler , Centers for Disease Control and Prevention

Objectives: The Environmental Public Health Tracking Network provides county-level annual PM2.5 (particulate matter) averages based on US Environmental Protection Agency (EPA) Air Quality System (AQS) data for counties where monitoring data are available. Hierarchical Bayesian modeled (HBM) PM2.5 concentration estimates available from the US EPA provide an alternative basis for such averages, and provide comprehensive geographic coverage. The specific objective of this presentation is to explore factors that might explain differences between the annual averages based on these 2 data sources. Methods: The HBM-estimated PM2.5 daily concentrations were generated across a 36 × 36 km grid covering the conterminous United States for the year 2005. The grid cells constitute the smallest spatial unit of analysis for this study. Each AQS monitor was assigned to its surrounding grid cell for purposes of comparing the HBM- and AQS-based annual PM2.5 averages. Candidate factors for characterizing differences between the HBM- and AQS-based averages include US Census region, monitor sampling frequency, and various indices describing monitor setting. An initial descriptive analysis provides guidance in subsequent multivariate analyses from which formal statistical inferences may be drawn. Results: Observed differences between the HBM- and AQS-based annual averages range between -7.1 µg/m 3 and +3.4 µg/m 3 . Approximately one-third of the absolute differences exceeded 1 µg/ m 3 . Out of the 903 monitors considered simultaneously, 92 showed annual average PM2.5 concentrations above 15 µg/m 3 (the current National Ambient Air Quality Standards annual standard) and surrounding HBM-based annual average concentrations below 15 µg/m 3 . Geographic variations are also evident in the differences. Conclusions: While the mean overall difference between HBM- and AQS-based annual PM2.5 averages is relatively small, data users may need to be aware of systematic variations in the differences. These differences take on additional importance when they coincide with monitors having annual average concentrations close to the NAAQS PM2.5 annual standard.


Practice 7

Methodologies for Environmental Public Health Tracking of Air Pollution Effects

  • F. Yip , Centers for Disease Control and Prevention
  • T. Matte , New York City Department of Health and Mental Hygiene
  • A.Cohen , Health Effects Institute
  • A. Vaidynathan , Centers for Disease Control and Prevention
  • P. Garbe , Centers for Disease Control and Prevention
  • J. Qualters , Centers for Disease Control and Prevention

Background: The Centers for Disease Control and Prevention (CDC) established the Environmental Public Health Tracking (EPHT) program to support state and local projects to compile, link, analyze, and disseminate environmental and health data to engaging stakeholders and guide actions to improve public health. Issue: Approaches to assess the public health burden attributable to air pollutants, such as PM2.5 (particulate matter), is complex. A workshop of governmental officials and researchers from the United States, Canada, and Europe was set up in 2008 to discuss key methodological issues to further the development of indicators of health effects of air pollution suitable for public health tracking using prior methodological work and experience in air quality health impact assessment. Workshop participants were asked to produce recommendations on (1) using state-level data and analyses; (2) using published external concentration response function estimates for health effects; and (3) communicating findings to the stakeholders. Results: Workgroup discussions identified key recommendations for the EPHT program, including the following: (1) future progress will likely require addressing local sources and providing timely and locally relevant health impact data to promote the engagement of local stakeholders; (2) local estimates alone are unlikely to support robust health impact assessment, and “borrowing strength” from other published evidence is important; (3) efforts to track air quality health impacts should be developed incrementally; and (4) it is important to develop a communication strategy that is coordinated among the agencies and that identifies the most appropriate health impact metrics and methods of communicating uncertainty. Lessons Learned: Future advances in public health protection will require an improved understanding of local pollution exposures and sources and their impact on health. Thus, developing an approach to provide local stakeholders timely, understandable, and locally relevant data on air pollution health impacts will be important in guiding actions to improve public health.


Practice 8

Addressing Community Concerns and Generating Hypotheses Using Environmental and Health Tracking Data

  • S. Condon , Massachusetts Department of Public Health
  • F. Medaglia , Massachusetts Department of Public Health

Background: With readily available Environmental Public Health Tracking (EPHT) data in Massachusetts, local boards of health, researchers, and community groups are better equipped to address community environmental and health concerns—particularly in relation to smart growth development proposals and environmental impact assessments. Data sets currently available on the EPHT network include cancer incidence by county, community, and census tract; asthma and myocardial infarction hospitalization by county; childhood blood lead levels by census tract, community, and county; and school-based pediatric asthma prevalence by community and school. Issue: Stakeholders such as academic researchers and state and local health departments have access to readily available EPHT data and tools Standardized incidence ratios calculator, geographic information system [GIS]) to answer questions and generate and test hypotheses. Results: Examples of using EPHT data and tools to aid local health in timely decision making and in more readily addressing community cancer concerns will be shared. Lessons Learned: Use of tracking data such as environmental and health outcome data can aid local boards of health, researchers, and community groups to map trends and determine the likelihood that health outcomes may or may not be associated with environmental exposures. EPHT data are limited by the quality and quantity of data available. Although communities seek answers in real time, the application of tracking data may lag several years behind.


Practice 8

The Utility of the National Environmental Public Health Tracking Network for Informing Public Health

  • E. Hummelman , Centers for Disease Control and Prevention

The National Environmental Public Health Tracking Network (NEPHTN) was created in response to a report by the Pew Environmental Health Commission that found “a gap in critical knowledge that hinders our national efforts to reduce or eliminate diseases that might be prevented by better managing environmental factors.” The NEPHTN is a Web-based, secure, distributed information system of standardized electronic health and environmental data and measures. It provides nationally consistent data and measures from 16 grantee states, New York City, and various national partners focusing on asthma, acute myocardial infarction, birth defects, carbon monoxide poisoning, childhood lead poisoning, air and water quality, and cancer. Public and secure users can discover and explore data and contextual information that informs them of potential hazardous exposures and geographic and temporal trends in health outcomes. As secure users, public health agencies can perform in-depth analyses of health and environmental data for the purposes of identifying populations at risk, quantifying harmful environmental risks, understanding the relationship between health and environment, guiding public health actions, and informing policy. Secure users can also share tools and methods, contributing to a broader knowledge base and consensus within the scientific community on appropriate methodologies for examining the relationship between health and the environment. The NEPHTN can provide important information on the health status of communities, identify areas and populations most at risk from environmental hazards, and inform public health practice and policy. Analysis of data from the NEPHTN can provide valuable information on changes or trends in levels of pollutants, population exposure, occurrence of noninfectious health effects, and enable public health practitioners to examine the possible relationships among them.


Practice 9

Developing Distance Learning for Pediatric Health Professionals

  • K. Jenkins , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

Background: Training health professionals through Web-based technology is increasing. This session will demonstrate an efficient and effective process to meet the challenges of planning and delivering pediatric health professional education on environmental health topics. This session will examine the following: (1) Providing on-demand access to distance learning environmental health content for the pediatric health professional workforce. (2) Timely filling of environmental health training gaps for pediatric health professionals. (3) Designing distance learning programs matching technology to needs of pediatric health professionals. Issues/Objectives: At the end of the session participants should be able to identify methods and processes used to develop effective distance learning courses; describe critical components in the design and implementation of distance learning materials; and describe guidelines for the development of successful distance programs. Results: Distance education provides several advantages to pediatric health professionals. This session will demonstrate a process that is both efficient and effective in improving the quality of online instruction. Lessons Learned: Developing a distance learning course is more than merely transferring existing content and curriculum into a distance learning module. Different teaching methods are used for distance learning, such as making learning an interactive process. Strong program management skills are needed to keep design and implementation processes moving and meet timelines.


Practice 9

Promoting Public Health by Revitalizing Environmental Health Fellowship Programs

  • J. Moran , Arkansas Department of Health

Background: State public health laboratories (PHLs) are concomitantly experiencing staff shortages with increasing workloads and budget shortfalls. It is imperative that PHLs promote public health and begin introducing new scientists to PHL science if these challenges are to be met with success. Issue: The Arkansas Public Health Laboratory (ADH-PHL) is actively promoting public health through the Environmental Health (EH) Fellowship Program sponsored by APHL and the Centers for Disease Control and Prevention (CDC). ADH-PHL uses this program to train new scientists in public health laboratory science, fill staffing shortages, and advance science and technology. Results: The EH Fellowship Program at ADH-PHL has seen great success after receiving awards in 2006 and 2008. Aggressive advertising and recruitment has placed 2 training fellows to serve as Laboratory Response Network–Chemistry (LRN-C) chemists in Arkansas while working to promote public health through research projects spanning public health, preparedness, personalized medicine, and biomonitoring topics. The LRN-C training platform is used to teach LC-MS/MS, ICP-MS, and GC-MS technology , as well as standard laboratory procedures. After fellows qualify for LRN-C methods, they work with lead scientists at ADH-PHL, CDC, University of Arkansas for Medical Sciences, and the National Center for Toxicological Research to develop, present, and publish their specific research. These projects have been published in top journals, provided critical data for grant applications, and continued to see national and international attention from PHLs, private industry, and regulatory agencies. These training fellows are also vital for Arkansas's maintaining a high degree of response readiness. Lessons Learned: If used properly, the EH Fellowship Program can provide additional means for PHLs to promote public health laboratory science, advance public health technology, and fill staffing shortages.


Practice 9

Canadian Nurses Environmental Health Collaboration from Coast to Coast to Coast

  • H. Swirsky , Mount Sinai Hospital
  • F. Hanley , Dawson College
  • A.Chircop , Dalhousie University

Background: Reinforcing previously held positions about the importance of environmental health and nursing, the Canadian Nurses Association (CNA) board of directors chose environmental health as a core theme in celebrating their centennial. In June 2007 a project was launched to increase nurses' awareness of the importance of integrating environmental health into all domains of nursing practice, education, research, and policy. The CNA funded the process to establish an Environmental Health Reference Group and invited nursing representation from every region in Canada. These nurses would bring their expertise to the table to develop accessible tools for nurses to support them as they began the process of this integration. The main objectives of this presentation are to share experiences and outcomes of the CNA Environmental Health Reference Group and to increase nurses' awareness of environmental health issues; become familiar with the tools developed by the group to support environmental health in practice, education, research, and policy; and suggest ways in which nurses can find ways to reduce their own environmental footprint. Methods of the reference group included monthly national teleconferences, e-mail discussions, and a 2-day workshop to set priorities, develop workbooks, and draft environmental health principles. Results: A background paper, video, and educational module for each of the 3 main components in the area of environmental health principles, greening the health system, and climate change were developed. Lessons Learned: This group learned the importance of establishing a permanent workgroup to sustain the initiatives developed by the reference group. The group has now formed a permanent structure affiliated with the CNA to continue to develop the links between nursing practice and environmental health.


Practice 10

Poisoned Fruit: The Rising Consumption and Waning Regulation of Imported Produce

  • P. Woodall , Food and Water Watch

A study of 50 fruit and vegetable products that are commonly eaten as well as grown in America, such as fresh apples, frozen broccoli, fresh tomatoes, orange juice, and frozen potatoes, found that imports made up one out of 10 fresh fruits and one out of 9 fresh vegetables Americans ate in 1993; but by 2007 the import consumption share doubled to more than one out of 5 fresh fruits and fresh vegetables. The share of imported canned or frozen produce tripled, from 5.2% of frozen packages or cans in 1993 to 15.9% in 2007. The share of imported fruit juice (orange, apple, and grape) grew from about a third of American consumption in 1993 to about half of consumption in 2007. On average, each American consumed 20 pounds of imported fresh fruit, 31 pounds of imported fresh vegetables, and 24 pounds of imported processed produce and drank 3 gallons of imported juice in 2007. Imported produce was more than 3 times more likely to contain the illness-causing bacteria Salmonella and Shigella than domestic produce, according to the latest Food and Drug Administration (FDA) survey of imported and domestic produce. Imported fruit is 4 times more likely to have illegal levels of pesticides and imported vegetables are twice as likely to have illegal levels of pesticide residues as domestic fruits and vegetables. But while over the past 15 years Americans' consumption of imported fresh fruits and vegetables doubled, border inspection has not kept pace with rising imports and the federal government inspects less than 1% of imported produce.


Practice 10

National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan

  • T. Ali , National Institute for Biotechnology and Genetic Engineering, Pakistan
  • Qaiser Mahmood Khan , National Institute for Biotechnology and Genetic Engineering (NIBGE) Faisalabad, Pakistan.

Over the last few decades pesticide use has increased on crops to meet the demands of rapidly growing population. The situation is worse in developing and underdeveloped countries. Pakistan is an agricultural country where cotton is the major cash crop. Bahawalpur is a major cotton-growing area in Pakistan, and cotton picking is carried out by women, who are exposed to a variety of pesticides and their residues during the harvest season, which is 3–4 months long, without using any protective measure. Peripheral blood was obtained from 69 exposed and 69 unexposed females. It was used to test the genotoxicity of pesticide exposure using micronucleus assay in cultured lymphocytes. The subjects in the 2 groups were of similar average age (37.72 ± 13 for the exposed and 37.52 ± 13.47 for unexposed), with the exposed group (23.97±13.76 years of exposure) involved in cotton picking from September to December every year. Samples were taken twice—first before the picking season (July), and then when the picking is nearly finished (December) and subjects got maximum exposure. A significantly higher binucleated lymphocyte micronucleus (BNMN) frequency was found for the exposed females as compared to the control group in the first (12.77±3.85 vs. 4.58 ± 3.3) and follow-up sampling (16.31 ± 4.21 vs. 4.34 ± 3.42). Increase in BNMN frequency in follow-up sampling indicate an increase in DNA damage with an increase in pesticide exposure. Age and years of exposure has positive correlation with micronucleus assay. Results from the present study indicate that occupational exposure to pesticide mixtures while cotton picking results in cytogenetic damage in exposed females, with more damage in harvest season.


Practice 10

Building Capacity for Community Participation in Local Lead Coalitions

  • K. Korfmacher , University of Rochester

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.


Practice 11

Decision Points in Response to a Small Area Cancer Inquiry Using Multifarious Data Sources

  • L. Harduar Morano , Florida Department of Health
  • S. Watkins , Florida Department of Health

Background: The Florida Department of Health (FDOH) was recently involved in a well-publicized cancer inquiry concerning a small underserved historically black community (n˜300). Drinking water in this community was contaminated by trichloroethylene, a carcinogenic solvent. In addition, there were concerns of airborne exposure to carcinogenic beryllium dust. Issue: Cancer concerns related to environmental pollutants are routinely brought to the attention of health department officials. These concerns tend to be highly volatile and often involve local media and politicians and may be accompanied by a lack of trust in government. This situation was compounded by the fact that residents were not immediately informed of the groundwater contamination. Public health practice and experience with these sites highlights the importance of acknowledging the community's concerns as well as the need to educate them about the limitations of epidemiologic studies as early as possible in the process. Response to these inquires requires a thorough understanding of the data and should identify and explain all assumptions and conclusions in a format that the community can understand. Results: This presentation outlined the steps/factors considered by FDOH in its response to the contamination and possible adverse health outcomes. The temporal span of the inquiry required the use of the Florida cancer registry as well as the evaluation of Florida death certificates, both electronic and microfiche. In addition, identification of historical location variables (e.g., ZIP codes) was required for use in data extraction. These location variables were not always readily available. Conclusion: Decision points, including a discussion of various data sources, limitations of the data sources and the environmental sampling data, determination of appropriate statistical methods, and methods of data presentation, were discussed.


Practice 11

The Use of Multiple Geospatial Algorithms to Identify a Cluster of a Rare Cancer in Pennsylvania

  • V. Seaman , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
  • B. Lewis , Agency for Toxic Substances and Disease Registry
  • S.Dearwent , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

Background/Objectives: Polycythemia vera (PV) is a rare blood cancer with an unknown etiology reportable to state cancer registries since 2001 and with a national rate of 0.9 cases/100,000 persons/year. In 2006 the Pennsylvania Department of Health (PADOH) asked the Agency for Toxic Substances and Disease Registry (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry) to help investigate a suspected PV cluster in a 3-county region of northeast Pennsylvania. Methods: Eligible participants included tricounty residents reported to the state cancer registry and self-reported cases with a medical diagnosis of PV from 2001 to 2005. The PV diagnosis was validated using a newly discovered biomarker (JAK2 V617F) and existing medical records. Spatial relationships were evaluated by standardized rate ratios (SRRs) based on ZIP codes and census tracts, buffering, inverse distance weighting (IDW), the SatScan statistic, and a hybrid method that included aspects of both the SRR and SatScan analyses. Results: Of 62 participants (38 registry, 24 nonregistry), 33 were confirmed to have PV. The SRRs for ZIP codes and census tracts were not in good agreement, and the buffering, IDW, and Sat Scan analyses all identified different potential cluster areas. The hybrid method resulted in a single statistically significant cluster area (p<0.001) which contained 15 of the 33 confirmed cases. Conclusions/Implications: Geospatial applications are often used to identify and visualize disease incidence; however, the accuracy of existing data sets and the inherent limitations of arbitrary population-based reference systems can compromise their usefulness. We used a rigorous case definition, aggressive case finding, and a variety of geospatial cluster-analysis tools to identify the first reported cluster of this rare cancer that was not possible using conventional methods.


Practice 12

Environmental Antecedents and Contributing Factors: Preliminary Data From the EHS-Net Foodborne Outbreak Study

  • C. Monteilh , Centers for Disease Control and Prevention and TKCIS (contractor)
  • K. Delea , Centers for Disease Control and Prevention

Background: Daily, 40% of the population eats at least one meal away from home. The majority of reported foodborne illness outbreaks (FIOs) originate in food service establishments. However, there has been no systematic examination of contributing factors (CF) and environmental antecedents to FIOs in food service. The Environmental Health Specialist Network (EHS-Net)—a collaborative project of the Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration, the US Department of Agriculture, the US Environmental Protection Agency, and 9 state health agencies—established the EHS-Net Foodborne Outbreak Study to address this issue. Issue: Grounded in the systems approach, this longitudinal study collects and assesses data from a number of outbreaks in order to improve understanding of CF and antecedents associated with outbreaks. During FIO investigations in food service establishments, study Environmental Health Specialists conducted environmental assessments—collecting data on the organization and operation of the kitchen (e.g., language barriers), makeup and knowledge of the workforce (e.g., staff training), workload (e.g., busiest day), and service (e.g., consumer access to unpackaged food)—and uploaded the data to the CDC. Results: In the pilot phase, 2006–2008, participating states reported 244 FIOs. Preliminary results indicate that knowledge of both CF (e.g., barehanded handling of ready-to-eat foods) and environmental antecedents (e.g., glove policy, glove supply, and training) is necessary to understand the context in which FIOs occur. Lessons Learned: Environmental antecedents and CF complement an FIO investigation. Expansion beyond the 9 pilot states will allow for examination of the strength of associations among CF, environmental antecedents, and pathogens.


Practice 12

The Impact of Local Environmental Public Health Capacity on Foodborne Illness Morbidity in Maryland

  • J. Zablotsky , US Department of Agriculture
  • B. Resnick , Johns Hopkins University
  • M.Fox , Johns Hopkins University
  • J. McGready , Johns Hopkins University
  • T. Burke , Johns Hopkins University

Background: Over the past several years, the safety and security of our food supply has been challenged as never before. Yet, despite the headlines, food service facilities (FSF) and workers remain the most common sources of food contamination. In Maryland, the food supply is protected by county-level Food Protection Programs located within environmental public health (EPH) divisions—whose responsibility it is to perform regular inspections of FSF and other preventive activities. Consequently, the goal of this research was to determine the effectiveness of these activities in preventing county-level foodborne illness. Methods: Using a cross-sectional study design, univariate and multivariate negative binomial regression was performed. The key independent variables were measures of EPH division capacity and services, measured via a written survey. The key dependent variables were county-level foodborne illness incidence data from Maryland's Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention (CDC) FoodNet database. Results: In univariate and multivariate analyses, local EPH divisions with higher capacity—measured as larger Food Protection Program workforce size, budget, and greater employee experience—had lower rates of foodborne illness. Counties with better performance measures, such as high FSF inspection compliance rates, had a lower incidence of foodborne illness. Finally, county-level regulatory mandates, such as the requirement for certified food manager programs, were shown to be effective in reducing rates of foodborne illness. Conclusions: Although these findings must be considered with caution due to the small sample size of 22 counties, the nearly universal protective effect local EPH division capacity had on the burden of foodborne illness is striking, and the findings provide new insight and evidence for future research and, ultimately, legislative and organizational enhancements to food safety system infrastructure.


Practice 13

Determination of Cr(VI) in Air Monitoring Filters by HPLC-ICP-MS After Ultrasonic Extraction

  • R. Wolf , US Geological Survey
  • S. Machemer , U.S. Environmental Protection Agency
  • T.Hosick , U.S. Environmental Protection Agency
  • M. Colledge , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry

Background/Objectives: Most chromium (Cr) found in the environment occurs in 2 valence states: hexavalent, Cr(VI), and trivalent, Cr(III). Although trivalent chromium is an essential trace element, the hexavalent form is a known respiratory carcinogen. The 8-hour exposure limit established by Occupational Safety and Health Administration (OSHA) is 5 µg/m³ air. The objective of the study was to determine if the chromium present in air monitoring filters from an ore-processing site was in the hexavalent form, which poses a health risk. Methods: Air samples were collected on quartz air filters pretreated with 1N sodium hydroxide and stored at 4ºC prior to analysis. Filter subsamples were extracted for 3 hours in a 10 mM sodium bicarbonate buffer solution (pH 9) in an ultrasonic bath. Filtered sample extracts were analyzed using reversed-phase ion-pairing high performance liquid chromatography (HPLC) and inductively coupled plasma mass spectrometry (ICP-MS) for both trivalent and hexavalent chromium. Separate subsamples of each filter were also acid digested for total chromium analysis. Results: Total chromium values range: 8–250 µg per filter or 0.003–0.13 µg/m 3 of air. Results for hexavalent chromium were below the practical quantitation limit (PQL) of 0.9 µg per filter (or 0.001 µg/ m 3 air) for all samples. Reference material BCR 545 (hexavalent chromium in welding dust, IRMM, Belgium), used for method validation and quality control purposes, showed an average recovery of 100% of the certified hexavalent chromium value. Conclusions/Implications: The results of this study show that there is no detectable hexavalent chromium in the particulates sampled from this ore-processing site and consequently no health risks due to the presence of hexavalent chromium.


Practice 13

Application of an Integrated Testing Strategy to the US EPA Endocrine Disruptor Screening Program

  • C. Willett , People for the Ethical Treatment of Animals
  • K. Sullivan , Physicians Committee for Responsible Medicine
  • J.Brown , People for the Ethical Treatment of Animals

The current version of the proposed US Environmental Protection Agency (EPA) Endocrine Disruptor Screening Program is organized into 2 tiered batteries of tests. The first tier consists of in vivo and in vitro screens intended to identify chemicals capable of interacting with the estrogen, androgen, and thyroid endocrine systems; and the second tier consists of animal-intensive developmental and reproductive screens in several species. Some still undefined set of positive results in the Tier 1 battery will trigger Tier 2 testing. The proposed Tier 1 screening battery has been criticized for its cost, the low specificity of some of the animal assays, and the large numbers of animals consumed per chemical. Using highly conservative estimates, the Tier 1 battery will use a minimum of 518 to 536 animals and cost between $324,000 and more than $938,000 per chemical. We present an alternative testing strategy that would save animals and resources and result in more efficient screening and characterization of the endocrine-disrupting potential of manufactured chemicals. The preliminary tier includes physical and chemical data, existing toxicological data, and in vitro and (Q)SAR methods that are either validated or nearly validated. The results of this alternative Tier 1 can be used in a weight-of-evidence approach to (1) identify priority chemicals and (2) design an integrated, chemical-specific strategy for further screening or testing. Such a strategy would greatly reduce the use of animal testing for both Tier 1 and Tier 2, while maintaining a high level of sensitivity for identification and classification of endocrine disrupting chemicals.


Practice 13

Developing Greener Technology for Cotinine Biomonitoring Programs

  • L. Pack , Association of Public Health Laboratories
  • S. Owen , Arkansas Public Health Laboratory, Arkansas Department of Health
  • C.Baker , Arkansas Public Health Laboratory; Arkansas Department of Health
  • J. Stevens , Gilson, Inc.
  • J. Moran , Arkansas Public Health Laboratory; Arkansas Department of Health

Background: Cotinine, a nicotine metabolite, is a marker used to assess human exposure to tobacco products. Laboratory methods for cotinine typically require solid-phase extraction (SPE) and Liquid chromatography-mass spectrometry analysis. The goal of this study is to improve SPE using greener technology by incorporating a 96-well plate, reducing reagents, and eliminating dichloromethane (DCM). Method: SPE is performed on a Gilson 215 SPE 4-probe system using Strata X-C 33µm polymeric strong cation cartridges (60mg/3ml). Sample aliquots (1 ml) are mixed with 500µl internal standard (D3-cotinine, 5.0ng/ml) spiking solution and 10µl formic acid. Prior to loading samples, SPE cartridges are conditioned with 2 ml methanol and 2 ml 50mM ammonium acetate (NH4OAc, pH 6.0). Loaded cartridges are washed with 2 ml NH4OAc and eluted using three 600µl aliquots of ammonium hydroxide/methanol (5%/95%). All aliquots are combined, evaporated to dryness, and reconstituted in 100µl of water. Standards, quality control material, and patient samples are processed identically and analyzed using LC-MS/MS. Results: SPE is conducive for 96-well plate formatting, capable of processing 25 samples in 60 minutes. Overall reagent use is reduced by 73% and DCM is eliminated. SPE provides high recoveries (>75%) and low limits of detection (MDL < 0.049 ng/ml). Accuracy measurements show < 3% error, and relative standard deviations (6% to 36%) are adequate for both serum and urine quality controls (1.0–1000ng/ml). This method provides nearly identical results when compared to values obtained by laboratories using standard methods provided by Centers for Disease Control and Prevention (r2 = 1.000). Conclusion: A greener, 96-well plate SPE format has been developed for cotinine by reducing reagent use and eliminating DCM. Accuracy, precision, and sensitivity measurements meet or exceed current technology.


Practice 13

Shifted Health Effects in Animals Exposed to Psychological Stress and Toxicants

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

In 1995, at the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry's Psychological Effects of Hazardous Substances workshop, the question of biologically based interactions between psychological stress and hazardous substance exposure was posited. (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, 2000) Since that time, there has been a growing body of research on what are the interactions between psychological stress and exposure to toxicants. First, there is a great body of research on the role of psychological stress alone in a wide range of physical disorders (especially of the cardiovascular system). (Chida and Hamer, 2008) There are now several studies showing complex and unpredictable effects of stress and concurrent toxicant exposure. For example, a 2004 paper by DA Cory-Slechta et al. shows more health effects in female offspring of dams exposed to Pb and stress, whereas male offspring were affected by just the Pb exposure alone. This group of researchers postulates a common pathway of effect of both stress and Pb exposure on the mesocorticolimbic dopamine/glutamate systems. There is a need to continue this line of research for more stressed human populations (low socioeconomic status, minority, female, etc.), which may show shifted health effects from exposure to toxicants on top of their already heightened allostatic load.


Practice 14

Pesticides and National Strategies for Health Care Providers in the Educational and Practice Settings

  • A. Liebman , Migrant Clinicians Network
  • H. Murphy-Robinson , University of Washington
  • M.Keifer , University of Washington

In 2003 the Environmental Protection Agency (EPA) funded 2 very important initiatives to address pesticide education nationally among both practicing clinicians as well as students in health professions schools. The impetus behind these 2 efforts was evidence showing that neither students nor practicing clinicians had effective training in managing pesticide exposure and prevention. A 1994 survey of 126 medical schools found that only 2 schools had dedicated environmental/occupational (E/O) health courses, 50 schools reported no training in history taking about environment, the average time devoted among schools with programs was 7 hours in 4 years, and only 68% of schools reported having faculty with expertise in E/O health. In 2000 the Migrant Clinicians Network conducted a needs assessment among clinicians working with underserved populations that found that 83% of the 164 clinicians surveyed have limited education and training in occupational and environmental health. Despite this finding, the assessment showed that the same clinicians believe these issues are important, and they desire more training, technical assistance, and resources to meet the occupational and environmental medicine needs of their patients. The presentation will discuss some of the exciting results after 5 years of this initiative. The discussion will focus on some of the challenges and barriers faced as well as the lessons learned from the successes of the program. Participants will have the opportunity to discuss the future of environmental/occupational training for students and practicing clinicians looking at key areas to target for success.


Practice 14

Research to Practice Adaptation: Lessons Learned in Translating an Effective Asthma Home Visiting Program to Public Health Practice

  • P. McLaine , Johns Hopkins University
  • K. Scott , Baltimore City Health Department
  • M.Shea , Baltimore City Health Department

Background: Currently, federal, state, and local public health agencies are interested in seeing translation of effective research programs into practical public health programs. However, all research projects are based in part on local conditions and the collection of locally important data, which may not be initially apparent to replicators. Issue: Baltimore City Health Department has begun a 3-year initiative to translate the Seattle-King County asthma home visiting program to a public health program serving 250 schoolchildren with persistent asthma. Our 6 adaptations to the proposed research program resulted in additional changes in approach that had not been originally anticipated. Results: We will describe several practical issues affecting our translational work and discuss how we approached resolution for our practice setting. These issues include the following: (1) Use of data collection tools developed for research purposes. (2) Need for additional tools to easily and systematically translate findings into action and track what is done for evaluation purposes. (3) Need for field staff to have a wide range of knowledge and standardized training. (4) Explaining the importance of translation research to Institutional Review Boards. (5) Combining the environmental and medical approaches. (6) Identifying resources to address the 6 adaptations to the research program. Lessons Learned: Replication requires a practical understanding of how successful research efforts were carried out. Experience in the field with research staff is useful to better understand the importance of their environment to the research design and to the planned replication.


Practice 14

Development of a Model of Environmental Translational Research for Cancer Prevention

  • C. Orenstein , Cornell University
  • C. Batman-Mize , Cornell University
  • N.Brown , Cornell University
  • S. Snedeker , Cornell University
  • H. Stone , Cornell University

Background: Cornell's program on Breast Cancer and Environmental Risk Factors (BCERF) was founded in 1996 to address concerns of New York State residents about the possible role of environmental risk factors in increased breast cancer incidence. Issue: From the start, BCERF has taken an innovative approach to public health communication, embracing the traditional translational research model of converting basic research into information resources tailored to various audiences, while expanding on this model to involve target audiences in the translation, dissemination, and evaluation of cancer prevention programming. This expansive translational model includes a rigorous critical evaluation and interpretation of the existing science on emerging risk factors as part of the translational research process. The BCERF model makes use of risk perception research to evaluate the attitudes and understandings of target populations and draws on the recommendations of advisory boards in the development and evaluation of cancer prevention programming. Results: Our presentation describes projects and products that exemplify the BCERF model, emphasizing processes such as critical evaluation, stakeholder participation, and the employment of risk communication principles. Examples include regional cancer and environment forums hosted by the program, as well as BCERF's translational research and outreach efforts tailored to populations with exposures of concern, such as young women and environmental estrogens; firefighters and mammary carcinogens; and the teaching community, which has unexplained elevated breast cancer rates. Lessons Learned: We will discuss successes as well as general and specific challenges to developing translational research outreach and education with these audiences, including large information gaps, complex and uncertain science, and access to the populations.



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