Minority Health Program

Contents

• Executive Summary
  
• Highlights of Activities and Findings to Date
  
• Demographics
  
• Health Studies and Applied Research
  
• Substance-Specific Applied Research
  
• Community Involvement and Risk Communication
  
• Training and Education
  
• Future Directions
  
• American Indian and Alaskan Native Initiative
  
• Hispanic American Initiative
  
• References

Link to DHHS Office of Minority Health
Link to ATSDR's Home Page
Link to NCID Office of Minority and Women's Health

Preventing adverse health effects and environmental injustice in disadvantaged communities and people of color exposed to hazardous substances is a priority for the Agency for Toxic Substances and Disease Registry (ATSDR)

National health statistics document that African Americans, Hispanic Americans, American Indians, and Alaskan Natives suffer disproportionately from preventable morbidity and mortality. Regardless of income, education, or geographic location, these groups of Americans are generally in poorer health than their white counterparts. However, the impact of the environment, particularly toxic and hazardous waste(s), on the health of minority populations has not been adequately investigated and characterized .

This document describes the Agency's Minority Health/Environmental Justice Program, including its findings to date and future directions. Hazardous substances are referred to throughout the document. It should be understood that "hazardous substances" means substances released from hazardous waste sites or other forms of unplanned releases of toxic substances into community environments .

ATSDR established a Minority Health Initiative in 1987 that focused on the demographic characteristics, health perspectives, health communication patterns, and health professional and community health education needs of disadvantaged communities and persons of color. This effort has evolved into the Agency's Minority Health/Environmental Justice Program, which has four goals:

• Demographics: To develop a comprehensive demographic profile of communities living near hazardous waste sites and other sources of hazardous substances.
• Health Studies and Applied Research: To determine the relationship between identified adverse human health outcomes and hazardous substances in disadvantaged communities and persons of color.
• Community Involvement and Risk Communication: To develop and execute environmental risk communication and education programs to mitigate and prevent adverse health effects from hazardous substances in disadvantaged communities and people of color.
• Training and Education: To increase the numbers and racial and ethnic diversity of persons in professional disciplines encompassing environmental public health. This includes assisting with curriculum development in academic institutions, faculty support through research projects, seminars and workshops in toxicology and other disciplines, and short-term training for professionals in disciplines related to identifying and preventing environmental hazards.

Highlights of Activities and Findings to Date

This part of the report describes activities and findings from each of the four areas addressed by ATSDR's Minority Health/Environmental Justice Program .

Demographics

The demographics component of the Minority Health Program was established to 1) develop methods for determining and retrieving validated demographic information about populations residing near hazardous waste sites; 2) identify communities near such sites or areas where persons of color are the predominant population; and 3) develop demographic profiles of such communities to the extent possible .

To date, ATSDR has collaborated with EPA on the following demographic activities:

• Through the application of geographic information system (GIS) techniques, populations were identified within 1-mile radii of EPA's National Priorities List (NPL) Superfund sites located in the contiguous United States. A total of 1,200 sites were examined, and the data for those sites were incorporated into a database containing 1990 census population information for all counties and states in the United States. This database can be used for comparisons at the county and state levels and will support the development of demographic profiles in the Lower Mississippi Delta and other notable regions (see Future Directions).
• For those NPL sites located in EPA's Region IV, spatial and statistical analyses were conducted, and information on the socioeconomic characteristics of the populations residing in those areas was obtained. Analysis showed African Americans and Hispanic Americans were disproportionately represented around NPL sites in Region IV.

Birth Defects in Children of Color, California (1992):The purpose of this study, funded by a grant to the California Birth Defects Program in 1992, is to determine_by use of a population-based, case-control study design_if racial and ethnic differences or both (specifically for Hispanic Americans, African Americans, Filipinos, Chinese, Vietnamese, and other groups) in prevalences of birth defects are related to exposure to environmental contaminants common to hazardous waste sites .

Mercury Exposure Among Members of the Fond du Lac Band of Chippewa Indians in Northern Minnesota (1991):ATSDR and the Indian Health Service conducted an exposure study to determine whether members of the Fond du Lac Band of Chippewa Indians were exposed to mercury as a result of eating locally caught fish that had been shown to have elevated levels of methyl mercury. Blood specimens were collected from 238 participants, who were also interviewed about their fish consumption and other risk factors for mercury exposure. The number of fish meals eaten per week and consumption of fish caught in a contaminated section of the St. Louis River were significantly associated with increased blood mercury levels. The study population did not have excessive exposure to mercury; consumption of fish appeared to be the primary route of exposure .

Mohawk Indian Reservation, New York: Exposure to and Body Burdens of PCBs from Toxic Waste in a Population of Native American Women and Infants (1991-1992):ATSDR awarded a grant to the New York Department of Health to assess the association between maternal exposure to PCBs through ingestion of local fish and game contaminated with hazardous waste and the levels of PCBs in breast milk. Breast milk samples from 53 Mohawk women from the Akwesasne reservation and from 109 women from a control community were collected and analyzed for the presence of total PCBs and PCB congeners. The mean concentration of total PCBs in breast milk was higher among the Mohawk women than the control women. The Mohawk women also had significantly higher levels of 2,5,3'-trichlorobiphenyl compared with the controls. That PCB congener is present in Aroclor 1248, the suspect PCB mixture at the point sources of contamination in the vicinity of Akwesasne. Additional Mohawk women have been recruited for participation in this study and analysis of these supplementary data is ongoing .

Fort Hall Indian Reservation Cohort Study, Idaho (1991): ATSDR conducted an investigation in 1991 to describe mortality and selected morbidity among a cohort of Native American first responders following a warehouse fire in April of 1980. Twenty-six first responders were identified. Followup was conducted by reviewing tribal enrollment records, death certificates, interviews, and Indian Health Service clinic records. At the end of the study period, 25 (96.2%) of the first responders were alive. None of the cohort members had a medical history of any type of cancer. The cause of death for the one decedent was cardiac arrhythmia. The major limitations of this investigation included the small sample size and the possibility of an incomplete cohort .

Respiratory and Renal Disease Study, Fort Hall, Idaho (1993): ATSDR is providing technical assistance to the Shoshone-Bannock Tribe in Fort Hall, Idaho, in evaluating possible health effects associated with air pollution from two nearby phosphate plants. The phosphate plants have emitted high levels of particulates, fluoride, radionuclides, cadmium, and chromium for the past 40 years. Data collection was completed in spring 1993; 239 residents from the target community and 289 from the comparison community participated. Biomedical testing was conducted on 222 participants. Investigators are comparing the prevalence of selected diseases, biomarkers of exposure (urine levels of several metals), and biomarkers of effect (pulmonary function tests and renal biomarker panel) in the target and comparison populations .

Mercury Exposure, Florida (1991):ATSDR funded a grant to the Florida Department of Health and Rehabilitative Services (HRS) to conduct a cross-sectional study of subclinical effects of human mercury exposure, which will involve screening Everglades residents, including a minority population, using hair methyl mercury levels. Persons with hair methyl mercury levels greater than 10 parts per million will be examined further (that is, nerve conduction velocity, visual evoked response, visual fields, and neurobehavioral testing) .

Socorro, New Mexico: Soil-Related Lead Poisoning (1990-1991): The New Mexico Department of Health, under an ATSDR grant, conducted blood lead screening and a follow-up study of lead exposure among residents living near an abandoned smelter site, where soil lead levels up to 24,800 ppm had been documented in a slag pile. Follow-up testing was conducted to determine whether blood lead levels dropped after an emergency cleanup of the site. The data are currently undergoing peer review and have not been released to the public .

Texarkana, Texas: Site-Specific Surveillance Project at the Koppers Company, Inc., NPL Site (1990-1991):The Texas Department of Health began surveillance for adverse health outcomes among residents living near the Koppers site, an abandoned creosote wood treatment facility. Soil and groundwater contamination from polycyclic aromatic hydrocarbons (PAHs) was present over the entire site. The first year of collected data showed that residents living on or near the site reported a higher prevalence of skin rashes than those in the comparison area (27.9% compared with 4.9%). Even after adjustment for the belief that health problems were related to chemicals in or near home, target area residents were still 2.9 times more likely to report skin rashes. Target area women who reported having problems becoming pregnant had fewer pregnancies (an average of 1.3 compared with 3.4) than women in the comparison area who reported having the same problem (p<0.04). During the second year, the rate of skin rashes in the target area was 8.5 times higher (standardized morbidity ratio, 95% CI 5.9-11.9) than expected on the basis of 1990 National Health Interview Survey rates. Increased risk for rashes was associated with digging in residential yards, having contact with neighborhood soil, and wading or having contact with Wagner Creek. Most rashes (94%) were associated with itching or burning. The target area residents did not appear to have higher rates of adverse pregnancy outcomes or cancer than residents of the comparison area. The investigators recommended protective clothing and thorough skin washing for residents having contact with on-site soil; they recommended complete avoidance of soil contact for women of childbearing age .

Puyallup Indian Reservation Mortality Analyses, Washington (1991): The purpose of this mortality analysis, which included ATSDR technical assistance, was conducted at the request of the Puyallup Nation to evaluate cancer mortality among Puyallup members residing near the Commencement Bay Superfund site. The assessment found that heart disease was the primary cause of death among registered members of the Puyallup Tribe from 1984 to 1989 .

Pago Pago, American Samoa: Biological Indicators of Exposure to Heavy Metals in Fish Consumers_Inner Harbor (1992):ATSDR and the American Samoa government conducted a cross-sectional exposure study to determine whether fish caught from a harbor contaminated with heavy metals presented a health hazard to residents of the island. The 207 participants provided blood and urine specimens and were interviewed concerning fish consumption, occupation, and other risk factors for metals exposure. Residents of the island with the contaminated harbor had higher blood mercury levels than residents of a comparison island. Fish consumption was associated with higher mercury and arsenic blood levels in the entire study population. The study concluded that although few of the residents continue to consume fish caught from the contaminated harbor, fish consumption among the study population is associated with elevated levels of mercury and arsenic .

Lake Coeur d'Alene, Idaho (1989):The Idaho State Health Department and the Indian Health Service asked the Agency for Toxic Substances and Disease Registry to determine whether the consumption of fish captured from Lake Coeur d'Alene and the Coeur d'Alene River, as well as from the adjacent Chain Lakes, could substantially increase lead and cadmium levels in human blood and urine. The goal of the study was to characterize fish and duck acquisition and consumption patterns of people living around Lake Coeur d'Alene and to determine the association between fish and duck consumption and lead or cadmium levels. The lead and cadmium levels among participants residing near Lake Coeur d'Alene were within the expected range and are not of any known clinical significance. There was no statistically significant association between fish or duck consumption and blood lead levels .

Columbia, Mississippi: Study of Disease and Symptom Prevalence, Newsom Brothers NPL Site (1988):The Mississippi State Department of Health, with technical assistance from ATSDR, conducted a survey of symptom and disease prevalence among residents living within mile of an abandoned chemical manufacturing plant that was contaminated with several volatile organic chemicals, and among residents of a community not located near the site. Residents 12 years of age and older who lived in the target area reported more constitutional symptoms and memory loss than those in the comparison community. Constitutional symptoms were numbness, tingling or prickling, rash, watery or burning eyes, wheezing, chest pain, and dizziness. However, although it is possible that a toxicologic effect led to increased symptoms in the target area, no environmental exposure pathways were known to explain this finding. Further analyses of the study data supported the presence of recall bias. ATSDR is providing community health education and exploring other services for the community .

Use of Azogue (Metallic Mercury) in Santeria Practices of Residents of Hartford, Connecticut (1994):ATSDR collaborated with the Hispanic Health Council of Hartford and the Connecticut Department of Health Services (CTDHS) in a project investigating the use of metallic mercury during spiritual rituals. Azogue is the term used by the Hispanic community when referring to metallic mercury. Santeria is the product of the syncretism of the worship of the Yoruban deity called the Oricha and the cult of the saints characteristic of Spanish Catholicism .

The Hispanic Health Council of Hartford recently submitted its findings from the santeria investigation. There is some evidence of mercury use inside homes; a limited number of persons have been identified who actually use azogue. The CTDHS, in cooperation with the Hispanic Health Council of Hartford and ATSDR, designed and implemented an educational program describing the health risks associated with ritualistic use of azogue in Santeria. The Hispanic Health Council, which has existed in Hartford since 1978, and similar organizations help gain access to Hispanic communities to assist state and local health departments in addressing cultural concerns with appropriate sensitivity and consideration of ethical issues .

Phelps-Dodge Corporation Douglas Reduction Works (1994): The Phelps-Dodge site is a 120-acre former copper-smelting operation just outside Douglas, Cochise County, Arizona. The town of Douglas is along the U.S. and Mexican border in Cochise County. Past emissions from the smelter included arsenic, benzene, lead, sulfur dioxide, inhalable particulate matter, and other heavy metals. Lead contamination in off-site soil (Douglas) averaged more than 250 mg/kg; lead levels were measured at about 350 mg/kg in Pirtleville, a small Mexican-American neighborhood closest to the site. According to 1990 U.S. Census data, Douglas has a population that is 83% Hispanic .

ATSDR personnel completed a site review and update for the Phelps-Dodge Smelter site in 1992. Health professions and community health education were recommended. ATSDR also implemented an education program for physicians and staff at the Cochise County Health Department in Douglas in the same year. The Agency has encouraged state officials to apply for funds to implement blood lead screening for Douglas children. In addition, the Arizona Department of Health Services has received funding from ATSDR to study lung cancer mortality in smelter towns in the state. Researchers will include the Douglas area in the study; ATSDR will provide technical assistance as needed .

Southern Wood Piedmont Company, Augusta, Georgia (1993): The Southern Wood Piedmont Site is a former wood-treating facility in Augusta, Georgia. Citizens have several concerns about past exposures to wood-treating chemicals, current air quality, past arsenic exposures from drinking contaminated private well water, chemical hazards of ditches in residential areas, adequacy of environmental data, ongoing exposures to toxic substances in ditches, odors during remediation, skin disorders and other illnesses, the effect contamination may have on children, and the effect of flooding on the transport of contamination from the Southern Wood Piedmont site .

ATSDR has begun a community health investigation to evaluate the health concerns of the community living near the site and to assess whether these health concerns may be linked to exposure to hazardous substances. Representatives of the Agency reviewed more than 500 medical records in the summer of 1994. Community health education has been initiated through public meetings and community assistance panel meetings .

West Dallas Lead\RSR Smelter, West Dallas, Texas (1992): The RSR Smelter was in operation from 1936 to 1984 in West Dallas, Texas. The concerned residents are primarily of Hispanic-American and African-American descent. In 1991, residents petitioned ATSDR to evaluate the public health impact of lead-contaminated soil in the community surrounding the RSR Smelter. Also in 1991, an EPA investigation found lead in soil in the community at levels greater than 500 ppm. EPA is currently remediating lead-contaminated soil in the community surrounding RSR. A public health consultation was released by ATSDR, and a health professions education program was conducted in 1992. A public health assessment of the site is planned .

In March 1993, the Dallas Department of Health and Human Resources (DHHS) applied for a grant to conduct a study of lead exposure in children in the West Dallas area. The study, conducted in cooperation with EPA Region VI and ATSDR, is currently underway .

Kingsley Park, Buffalo, New York (1994):The Kingsley Park-Diarsenol Company Site is on the grounds of the former Diarsenol Company pharmaceutical manufacturing plant in the City of Buffalo, Erie County, New York. The soil on and off site was contaminated with arsenic and lead. An African-American community is potentially impacted by the site. Remediation of the site and bordering yards was completed in December 1991. The Kingsley Park-Diarsenol Company Petitioned Public Health Assessment is currently being prepared for final release. ATSDR has determined that community health education activities, currently provided by the state of New York, are appropriate for the Kingsley Park Community, as well as programs to assess biological indicators of exposure (blood lead levels). ATSDR will implement a public health education program to advise local public health professionals and the medical community of the nature and possible consequences of exposure to contaminants at the Kingsley Park\Diarsenol Company site. ATSDR will conduct a health statistics review of relevant health outcome data when they become available, and the Agency will evaluate any additional information it receives about the site to determine if further public health actions are appropriate .

Southwire Company, Carrollton, Georgia (1994):The Southwire Company and the Southwire Company Copper Division are in Carroll County, Georgia, within the city limits of Carrollton. Southwire is a manufacturer of electrical wire and cable; the Copper Division is a secondary copper refinery. A largely African-American community is potentially impacted by the site. Area residents have expressed a variety of concerns about the impact of Southwire on public health. ATSDR is currently conducting a public health assessment of the site; the Agency has also been in contact with community members, including African Americans, to gather community health concerns .

South Valley National Priorities List (NPL) Site, Albuquerque, New Mexico (1993):The South Valley National Priorities List Site is located within a 1-square-mile mixed industrial and Hispanic-American residential area of southwest Albuquerque, New Mexico, known as San Jose. Groundwater and vadose zone soils are the primary contaminated media at this site, and volatile organic compounds are the major contaminants. ATSDR's 1989 public health assessment indicated risk to human health resulting from possible exposure to contaminated groundwater via residential use of private wells for bathing and irrigation. The 1993 site review and update concurs with many recommendations made by the 1993 San Jose Task Force Report entitled "Residents' Perceptions of Health Concerns and Environmental Degradation of the San Jose Community of Albuquerque, New Mexico." Some of the recommendations include conducting health monitoring of households within plumes of contamination, organizing a well monitoring and sampling database for wells located within defined plumes of contamination, and establishing a broad-based community education and public information program. In addition, ATSDR has recommended that local environmental agencies investigate areas not directly related to the Superfund site that may pose a risk to residents because of exposure to environmental contaminants or physical hazards .

Frontera Creek, Humacao, Puerto Rico (1994):Industrial development of the Frontera Creek area began in 1970; environmental concerns first surfaced in 1977 with reports of an alleged connection between the deaths of 30 cows and exposure to the creek. An investigation by the Puerto Rico Environmental Quality Board concluded that lindane discharged into the Frontera Creek by one of the industries in the area could have been the cause of the deaths. Ciudad Cristiana, a residential development of about 480 homes near the Frontera Creek area industries, opened in 1979. Approximately 1,000 people may have lived in the Ciudad Cristiana area, which is in Humacao, a city with a 1986 estimated population of 50,800. The community is primarily Hispanic (Puerto Rican). A public health assessment is currently being developed for this site .

Substance-Specific Applied Research

Minority Health Professions Foundation Applied Research

The Minority Health Professions Foundation (MHPF) comprises 11 Historically Black Colleges and Universities with medical programs and has established as its primary mission to research the persistent health problems that disproportionately affect poor and minority citizens. These efforts include the development of environmental health professionals from minority and disadvantaged backgrounds. The purposes of the ATSDR-MHPF cooperative agreement, which is administered by the Research Implementation Branch of the Division of Toxicology, are these:

• initiate research to fill data needs identified by ATSDR for priority hazardous substances, and
• enhance existing disciplinary capacities to conduct research in environmental health at MHPF member institutions.

Research activities conducted by the MHPF provided information that addressed 8 of the 117 priority data needs ATSDR identified for the 38 priority hazardous substances. Additional data needs for ATSDR priority hazardous substances will also be addressed. Research at MHPF institutions is related to broad areas of toxicology and environmental health science. Some MHPF member institutions are conducting health studies of minority groups exposed to hazardous substances on ATSDR's priority list .

The following institutions have received awards to conduct studies:

College of Pharmacy, Florida A&M University, Tallahassee

"Effects of Lead on Glucocorticoid-Regulated Enzyme Activity in Cultured Hepatocytes, Lymphocytes, and Neuroblastoma Cells"

"Mechanisms of Lead and Cadmium Toxicity" (3 subprojects)

This institution is conducting research on ATSDR data needs to build upon existing capabilities in molecular toxicology. Funded studies include investigations of the subcellular mechanism(s) of the toxic action of lead and cadmium. This work will add to the information base necessary for developing methods to prevent or mitigate adverse human health effects related to exposure to these substances .

Martin Luther King, Jr./Charles R. Drew

University of Medicine & Science, Los Angeles, California

"Inner City Environmental Lead Exposure and Hypertension"

Charles R. Drew is investigating the relationship between lead exposure and hypertension in three subpopulations: African-American males and females and Hispanic females. The intent is to determine if elevations in blood pressure are associated with environmental or occupational exposure to lead, and if this effect in males can be reversed by removing lead from the body using chelation therapy with 2,3-dimercaptosuccinic acid (DMSA). The research will also characterize blood lead levels in a sample population of African-American and Hispanic women of child-bearing age to determine if the combination of lead exposure (resulting in elevated tissue lead levels) and hypertension during pregnancy results in a greater risk of adverse fetal outcomes .

Meharry Medical College, Nashville, Tennessee

"Acute and Subchronic Inhalation and Oral Toxicity Testing of Benzo-a-pyrene and Fluoranthene"

The School of Medicine has established a core environmental health research laboratory to be shared by faculty and students. The unit includes faculty currently conducting environmental health research and will build upon those endeavors. Substance-specific research in the unit consists of acute and subchronic toxicity studies of the effects of polycyclic aromatic hydrocarbons (PAHs) from oral and inhalation exposures. The subchronic study includes preliminary screening tests for possible toxic effects on the nervous and reproductive systems .

Morehouse School of Medicine, Atlanta, Georgia

"A Longitudinal Study of Lead Poisoning from Maternal-Infant Relationship Through Early Childhood"

Morehouse is estimating the prevalence of lead exposure in African-American children living in Atlanta's inner-city neighborhoods, which have a high density of older homes. The researchers will measure the levels of lead in the environmental media in and around these homes to determine potential sources of lead exposure of persons with elevated blood lead levels. They will also conduct a feasibility study in which the blood of pregnant women and their newborns will be analyzed for lead levels. Over a 3- to 5-year period, the researchers will examine the cause-and-effect relationship of lead exposure on the cognitive and behavioral development of children exposed to lead in utero .

Texas Southern University, School of Pharmacy, Houston

"Studies of Neurobehavioral Toxicity of Lead"

"The Interaction and Speciation of Heavy Metals with Organic Acids in Simulated Toxic Waste Site Soil"

"Assessment of Organic Solvents-Induced Neurotoxicity in Rats after Acute and Subchronic Exposures"

A Minority Center for Environmental Health Research has been established as part of this institution's overall proposal to enhance capabilities for conducting research in neurotoxicology, environmental fate, and molecular toxicology. Three functions are being accomplished through the center: oversight of data needs research, enhancement of the existing program for a bachelor of science degree in environmental health through the purchase of additional equipment, and creation of a Summer Environmental Research Institute for undergraduate students to participate in ongoing research projects. Investigators at this institution propose to conduct the following studies: laboratory investigation of the environmental fate of arsenic, cadmium, chromium, lead, mercury, nickel, selenium, and zinc ionic species; mechanisms of neurotoxic effects of toluene and trichloroethylene; and an investigation of the correlation between neurochemical changes and learning behavior to elucidate possible mechanisms of lead neurotoxicity .

Tuskegee University, School of Veterinary Medicine, Tuskegee, Alabama

"Multigenerational Studies of the Toxic Effects of Mercury and Zinc in Rats and Mice"

Tuskegee has an established environmental health program in its curriculum. Investigators are studying the reproductive effects of mercury in multiple generations of animals and the acute and subchronic toxic effects of zinc. The latter study will include screening for possible reproductive effects .

Xavier University, College of Pharmacy, New Orleans

"Developmental Toxicity of Benzene in Two Species of Fish"

"Multimedia Study of Lead, Cadmium, Zinc, and Benzene in an Urban Environment"

"Neurotoxicity of Subchronically Administered Zinc"

Xavier is conducting several studies to address ATSDR data needs while strengthening its research and educational program in environmental toxicology. Research investigations include studies on the developmental effects of benzene in rodents following oral administration and a comparison developmental study of the effects of benzene exposure on the life cycle of two fish species. These studies will not only address a data need but also provide information on the correlation across species. Evaluation of the neurotoxicity associated with acute and subchronic oral exposure to zinc will also be addressed by Xavier scientists .

Great Lakes Applied Research

The ATSDR Great Lakes Human Health Effects Research Program is investigating and characterizing the association between the consumption of contaminated Great Lakes fish and short- and long-term potential health effects. The program has six objectives:

(1)build upon and extend the results of past and ongoing research;

(2)develop information databases or research methodology that will provide long-term benefits to human health effects research efforts in the Great Lakes basin;

(3)provide direction for future health effects research;

(4)provide health information to state and local health officials, the concerned public, and their health care professionals;

(5)in concert with state and local health officials, increase public awareness of the potential health implications of toxic pollution in the Great Lakes basin; and

(6)coordinate as necessary with relevant Public Health Service (PHS) research programs and activities, including those of the Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and the Indian Health Service (IHS), as well as the U.S. Environmental Protection Agency and state and local health departments, to ameliorate adverse public health impacts of persistent toxic substances in the Great Lakes basin .

To achieve these objectives, ATSDR has developed a Great Lakes Health Effects Research Strategy. The goal is to identify human populations residing in the Great Lakes basin who may be at greater risk of exposure to chemical contaminants present in one or more of the Great Lakes and to help prevent adverse health effects. This strategy is built upon the five traditional elements of disease prevention: identification, evaluation, control, dissemination, and infrastructure .

For fiscal year 1992, ATSDR funded nine research grants to study the potential adverse human health effects of consumption of contaminated Great Lakes fish. These studies include eight epidemiologic investigations in presumed susceptible populations, that is, American Indians, Alaskan Natives, sport fishers, the urban poor, pregnant women, and the nursing infants and fetuses of mothers who consume contaminated Great Lakes fish. The ninth study focuses on developing more sensitive methods to detect persistent Great Lakes contaminants, such as polychlorinated biphenyls (PCBs), dioxins, alkylated lead, mirex, and methyl mercury in human biologic tissues and fluids. The 10 grants funded by ATSDR for fiscal year 1993 include continuation awards for the nine research proposals funded in 1992 and one new award that established an interlaboratory-based, quality assurance/quality control program for the ATSDR research program .

Of the 10 funded awards, three grants focus on minority populations in the Great Lakes basin:

New York State Department of Health

"PCB and Dichlorodiphenyl Dichloroethene (DDE) Exposure among Native American Men from Contaminated Great Lakes Fish and Wildlife"

Epidemiologic study in the Mohawk Indian Tribe, an established cohort of American Indians, will investigate the association between the consumption of locally caught fish and wildlife and body burdens of PCBs (67 congeners) and DDE in men who live along the St. Lawrence River and its tributaries. The investigator will also examine residential and occupational exposure to these contaminants .

University of Illinois at Chicago

"Great Lakes Fish as a Source of Maternal and Fetal Exposure to Chlorinated Hydrocarbons: A New Cohort of African-American Women"

Epidemiologic study in a new cohort of pregnant African-American women who regularly consume contaminated Great Lakes fish. Analysis of body burden (PCBs, dichlorodiphenyl dichloroethane, and dieldrin) will be conducted to identify populations at risk of adverse health effects. The children of these women will also be studied to determine their exposure to Great Lakes contaminants via maternal exposure. This cohort will be selected from persons who live adjacent to Lake Michigan .

University of Wisconsin-Superior, Lake Superior Research Institute

"An Assessment of a Human Population at Risk: The Impact of Consuming Contaminated Great Lakes Fish on Native American Communities"

Epidemiologic study to investigate fish consumption, body burden of PCBs and mercury, and neuropsychological status in the Red Cliff Indian Tribe, which comprises five communities of American Indians. The cooking practices of these individuals will be investigated to determine if cooking reduces the levels of Great Lakes contaminants in their food. Animal neurotoxicity testing is proposed as a model. The individuals selected for this study live along Grand Portage, Minnesota; Keweenaw Bay and Bay Mills, Michigan; and Bad River, Wisconsin .

CommunityInvolvement and Risk Communication

Two sites where community health education and risk communication are currently underway are the Escambia Wood Treatment Site in Florida and the Chattanooga Creek Site in Tennessee .

The Escambia Wood Treating Siteconsists of 26 acres in a mixed residential and commercial section of north-central Pensacola, Florida. A plant that treated wooden utility poles and foundation pilings with creosote and pentachlorophenol (PCP) operated on the site from 1943 to 1982. Phase 1 of the community health education activities has been completed at the Escambia Wood Treatment Site; a local registered nurse provided community health education activities for area residents. Educational sessions were conducted on the following topics: diseases of the skin, basic toxicology, pathways of exposure, and health issues of hazardous chemicals. Technical resources were provided by the Florida Department of Health and Rehabilitative Services .

The Chattanooga Creek Sitebegins at the Georgia border; the creek flows through mixed industrial and residential Chattanooga, Tennessee, neighborhoods until it meets the Tennessee River. Currently, 42 sites in the vicinity of Chattanooga Creek are known or suspected to be hazardous waste sites. Thirteen of the sites are state Superfund sites. ATSDR's actions in the area include providing environmental health education to health care providers at the local health center and other clinics to assist them in assessing possible adverse health outcomes associated with exposure to hazardous substances at the sites. Environmental health education for the community is intended to assist residents in mitigating exposure to tar deposits in the area and to hazardous substances in Chattanooga Creek surface water, sediments, and fish .

Training and Education

Health Professions Education in American Indian and Alaskan Native Communities

In FY 1992, ATSDR activities directed to the needs of health professionals serving American Indians and Alaskan Natives included participation in three conferences: "Circles of Strength: Healthier Indian Communities by the Year 2000," the Indian Health Service health promotion and disease prevention conference_the "National Tribal Conference on Environmental Management," and "Toxic Substances and Navajo Health_Workshops for the People"

In FY 1993, Nez Perce Environmental Restoration and Waste Management was funded through a cooperative agreement. One of the activities being conducted is the development of the Patient Handbook on Toxic Waste: What are the Risks? This project will help tribal and other local health care providers disseminate educational materials on the potential health effects, prevention, medical surveillance, screening, and methods of diagnosis and treatment of injury or disease related to hazardous waste exposure. The overriding goal of the project is to provide health care providers with a means of educating their patients who have health concerns related to hazardous waste exposure_in a way that is easily understood by the public. The goal of the project is a public informed about the relative risks of exposure to radioactive and other hazardous waste and equipped to make informed decisions about their behavior and medical treatment options, based on the knowledge they gain from the handbook .

Health Professions Education in Special Populations of Asian Ancestry

In FY 1993, Minnesota and Wisconsin, two recipients of ATSDR State Cooperative Agreements, independently recognized the need in their states for special community outreach to Asian populations living near Superfund sites_the Sheboygan River and Harbor Site in Wisconsin and the Waite Parke Wells Site (St. Cloud) in Minnesota. These populations were believed to be at risk of exposure to toxic contaminants because of their traditional high levels of subsistence fishing and their methods of preparing fish .

The Wisconsin project cooperated with a number of other state and local agencies, and used a local Sheboygan community college to reach residents speaking the Hmong language. The Wisconsin group presented a "Fish Class" that demonstrated safe levels of fish consumption and methods of preparation. Wisconsin also developed a local map, in English and Hmong, showing contaminated lakes and rivers and the types of fish that were safe and unsafe to eat .

The Minnesota project developed fact sheets on safe fish consumption_in English, Laotian, Vietnamese, Hmong, and Cambodian_for use in the St. Cloud and Twin Cities metropolitan area. A poster was developed for display in health agencies serving these populations. The Minnesota group also developed a fact sheet on PCBs and health effects and made two presentations reaching approximately 50 health professionals who serve Asian populations .

Minority Health Professions Foundation (MHPF)

In collaboration with CDC, ATSDR has funded a cooperative agreement with the MHPF for the past 5 years. The ultimate goal of the cooperative agreement is to provide better-trained minority physicians, pharmacists, veterinarians, dentists, and other health professionals, thereby enhancing health programs that will improve the health status of minority groups. The following activities are being funded:

Scientific Exchange/Lecture Series

This activity provides resources to institutions to send individuals or teams to visit CDC and

ATSDR to learn about research project opportunities and priorities. This program also supports faculty travel to Atlanta to participate in various seminars. Scientists from CDC and ATSDR also visit the institutions to consult with them on collaborative projects .

During FY 1994, representatives from Howard University's Schools of Medicine, Dentistry, and Pharmacy, along with Charles R. Drew University's School of Medicine visited ATSDR to discuss future projects .

Symposium on Career Opportunities in Environmental and Public Health and the Biomedical Sciences

This activity exposes high school and college students to careers in public health and the biomedical and environmental health sciences. Approximately 1,300 students participate annually in the symposium. Evaluations of the program show that students are becoming increasingly familiar with and interested in environmental health science careers (i.e., pharmacology and toxicology) .

Graduate Environmental Toxicology Curricula Development and Enhancements

Florida A&M University (FAMU) is the first College of Pharmacy at a Historically Black College and University to offer a Ph.D. in Environmental Toxicology. ATSDR provides funding for curricula development for this program. This program enhances the academic and research infrastructure of minority heath institutions that train graduate toxicologists. ATSDR staff members chosen to serve as adjunct professors for the program will begin teaching this year .

Minority Physician Training

Through the Morehouse School of Medicine in Atlanta, environmental health seminars for minority physicians are conducted at the regional and national meetings of the National Medical Association (NMA). Approximately 10 seminars are conducted to educate the physicians about ATSDR's Environmental Health Case Study activities and about detection of environmentally related illnesses .

In addition to the projects listed here, the MHPF has been awarded funds to conduct the following activities:

Health Education at HBCU Nursing Schools for Improving Community Outreach

The Division of Health Education extended its health professional education activities to include minority nursing schools. A Train-the-Trainer course was developed by nurses at Howard University School of Nursing. ATSDR presented its course, "Clues To Unraveling the Association Between Illness and Environmental Exposure" to the Howard University nurses. This course describes how to (1) evaluate the relationship between exposures to hazardous substances and health effects and respond to client and community concerns; (2) identify environmentally caused illness by taking an exposure history; (3) conduct client evaluation and develop an intervention and referral plan for clients, family members, and the community; (4) describe environmental health-related follow-up activities at toxic waste sites; (5) discuss basic concepts of health risk communication; (6) identify and use environmental health information resources in public health nursing; and (7) evaluate the impact of direct client service. After the Howard University nurses have been trained, they will conduct a needs assessment for the other nursing schools, particularly those in the Delta Region, to determine a mechanism for establishing a core curriculum and implementing a training component for a Train-the-Trainer program .

National Library of Medicine (TOXNET Training) at HBCUs

Through the National Library of Medicine, ATSDR will provide initial Environmental Information Access training to a number of the HBCUs in the Environmental Information Outreach Network that serves the Mississippi Delta area. This project will support development of the environmental hazard profile for the Mississippi Delta project .

Training Hispanic Graduate Students in the Development of Public Health Assessments of Hazardous Waste Sites

The proposed project, which is part of ATSDR's Hispanic Initiative, is designed to train Hispanic environmental health scientists in evaluating potential adverse health effects in minority populations, specifically those of Hispanic-American background, who may be exposed to hazardous wastes. This project targets students from schools of public health with historically Hispanic enrollments and will initiate the Hispanic-American activities element of the ATSDR Minority Health Initiative. The interns will work on a specific health assessment, consultation, or related project assigned by ATSDR. Potential projects could include developing a public health assessment or portions thereof, developing a health consultation, data gathering in the community, and communication of public health assessment results .

Mississippi Delta Project

Since 1987, ATSDR has sought to document the public health implications of hazardous waste sites and other sources of exposure to environmental toxicants in disadvantaged communities. To date, ATSDR's efforts in minority health have not been concentrated on any one geographic area of the country. Rather, the Agency has pursued the four goals of its Minority Health Program in minority communities around individual waste sites across the nation. This approach has provided ATSDR with valuable data and insight about the environmental hazards faced by minority populations. However, reducing the disparity in health and improving quality of life among disadvantaged groups and among ethnic and racial populations requires a more concentrated effort by the public and private sectors than can possibly be accomplished using a site-by-site approach .

Moreover, by focusing on a region with demonstrated minority health disparities and identified environmental hazards, it is possible to develop the data and experience necessary to shape public health interventions within that region. ATSDR, in collaboration with CDC and other federal and state agencies and academic institutions in the region, proposes such a concentrated effort be undertaken in the Mississippi Delta Region. (See also, the ATSDR Delta Project for additional information.)

Project description For purposes of this project, the Mississippi Delta Region is defined as a 219-county strip along the Mississippi River in Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee. The region is populated by approximately 8.3 million people, including a large number of African Americans .

Currently, there is no comprehensive database of the sources of pollution present in this area. However, from ATSDR activities, we know that environmental hazards in the Delta area cover the entire spectrum of sources of pollution_from mercury contamination in some states' surface waters to pesticide problems in the agricultural areas of several states along the Mississippi Delta .

State health department officials have expressed concerns to ATSDR staff about problems associated with the presence of hazardous substances in the general environment. The range of concerns include problems with pesticides, groundwater contaminants, and biota containing toxic substances. From 1980 to 1983, the CDC/ATSDR Associate Director for Minority Health worked at the Mississippi Department of Health. During that period, citizens in Mississippi expressed strong concerns about adverse environmental health outcomes in minority communities. These types of concerns about specific environmental hazards have been reported to ATSDR and CDC by all the states in the Delta Region .

Within the 219 counties, at least 40 hazardous waste sites are on EPA's National Priorities List (NPL). The NPL is a listing of the most hazardous waste sites nationwide. In addition, 1,491 sites are on EPA's overall list of uncontrolled hazardous waste sites. Furthermore, ATSDR has received petitions from citizens living in the area to conduct public health assessments. Undoubtedly, there are many undocumented toxic and hazardous waste sites throughout the region .

The goal of the Delta Project is to prevent or mitigate adverse health effects and reduced quality of life in disadvantaged populations living in communities impacted by identified environmental hazards in the Mississippi Delta Region. This goal will be pursued jointly with CDC and other federal agencies, state and local health departments, local community groups, and institutions of higher education, particularly those that serve large minority populations. The federal agencies cooperating in the Mississippi Delta Project are EPA, the National Institute of Environmental Health Sciences, the National Institute for Occupational Safety and Health/CDC, the National Center for Environmental Health/CDC, and ATSDR .

Consistent with the principles of preventing adverse health impacts from environmental hazards, the objectives of the Delta Project are these:

1) Identify key environmental hazards that may affect the health and quality of life of people who live in or around communities thought to be at risk. This effort may result in the development and implementation of appropriate public health actions, based on demonstrated need, including actions recommended to prevent or reduce current exposures to toxic substances .

2) Evaluate (in association with state and local health agencies and academic institutions in the Delta Region) the public health impact on high-risk populations of exposure to the key environmental hazards identified as being of potential harm to human health .

3) Increase the awareness of health care providers who practice in the Delta Region about the adverse environmental health impact of key environmental hazards .

4) Enhance the ability of state and local health departments and academic institutions to address environmental public health issues associated with minority health .

5) Through collaborative effort with the EPA, increase the awareness of the importance of environmental public health among students at Headstart Centers, other preschools, and primary- through college-level institutions in the Delta Region .

A critical first step of the Delta Project is conduct of a needs assessment, which is being carried out in cooperation with the Minority Health Professions Foundation (MHPF). The recipient of funds for the project is the Institute on Health Care for the Poor and Underserved at Meharry Medical School, Nashville, Tennessee. A steering committee will be established to provide guidance to the project. The committee will include representatives from ATSDR, CDC/ATSDR Office of the Associate Administrator for Minority Health, MHPF and its member institutions, HBCUs, state health departments, and other federal agencies .

The purpose of this collaboration is to develop a plan of action that initiates a scientific investigation and a campaign to educate Delta Region residents about environmental hazards. The HBCUs in the Delta Region have educated a large number of the African-American professionals who teach, practice health care, and assume leadership roles in many of the Delta Region minority communities. These professionals have the credibility needed to ensure the success of the project and are strongly committed to supporting HBCUs in the region .

The purposes of the needs assessment are these:

• develop an environmental profile of the key environmental hazards believed to be of consequence to the public health of communities in the region;
• develop a demographic profile of the communities located near a subset of impacted sites in the Delta Region;
• complete a profile on key HBCUs, state and local health departments, local health care centers, health environmental agencies, and health providers who can serve as collaborators or resources for the project;
• convene a strategy workshop to present the results of the demographic characterization activity. The workshop will initiate the development of a longer-term action plan based on the findings of the needs assessment.

Future Directions

American Indian and Alaskan Native Initiative

At least 57 NPL sites and an unknown number of other hazardous waste sites are located on or near American Indian or Alaskan Native lands or have American Indian or Alaskan Native interest. The presence of mercury, uranium, nitrates, dioxins, PCBs, and other contaminants in the environment of American Indians and Alaskan Natives poses a threat both to health and to traditional lifestyles. This problem will continue because reservations are increasingly the targets of siting proposals for solid waste, industrial sludge, and nuclear waste. Although recognition that the health of American Indians and Alaskan Natives may be adversely affected by hazardous substances has led to a memorandum of understanding with the Indian Health Service (IHS), it is critical that health professional education be conducted to increase awareness of environmental health factors and to reduce obstacles to prevention, recognition, and treatment of environmentally related disease .

Tribal governments and state governments are recognized as partners in these efforts. ATSDR recognizes its obligation to build knowledge and capacity within tribal governments. Through this initiative, funding will be made available for federally recognized Indian tribes through a new tribal cooperative agreement program .

ATSDR proposes to develop a cooperative agreement to fund a capacity-building environmental health education program that will address one or both of the following: a) the design of a model for American Indians and Alaskan Native tribal governments for physician and community environmental health education, or b) the development of an environmental health education program related to hazardous wastes. The availability of funds for a competitive cooperative agreement program has been announced .

Hispanic American Initiative

ATSDR in collaboration with Hispanic-American organizations is exploring opportunities to conduct a needs assessment in Hispanic-American communities living near hazardous waste sites and other areas of pollution. The proposed needs assessment would be similar to the one currently being planned as part of the Mississippi Delta Region Project. ATSDR's efforts are still in the developmental stage .

The Agency will continue its internship program to train Hispanic graduate students in the development of public health assessments of hazardous waste sites.

References

1. U.S. Department of Health and Human Services. Public Health Service. Report of the Secretary's Task Force on Black and Minority Health, 1985 .

2. Sexton K, Olden K, and Johnson BL. Environmental justice: The central role of research in establishing a credible scientific foundation for informed decision making. Toxicol Ind Health 1993;9:685-727 .

3. Johnson BL, Williams R, Harris C. Proceedings of the National Minority Health Conference: Focus on Environmental Contamination. Princeton, NJ: Princeton Scientific Publishing, 1992 .

4. Commission for Racial Justice, United Church of Christ (UCC). Toxic Wastes and Race in the United States: A National Report on the Racial and Socioeconomic Characteristics of Communities with Hazardous Waste Sites. New York: United Church of Christ, 1987.

ATSDR Contact Persons:

For more information on the Office of Urban Affairs and the ATSDR Minority Health Program, please contact:

Rueben C. Warren, DDS, MPH, DrPH
Associate Administrator for Urban Affairs
Agency for Toxic Substances and Disease Registry
1600 Clifton Road, N.E. (E-28)
Atlanta, Georgia 30329-4027

Telephone: +1 404 498 0111
FAX: +1 404 498 0087
E-Mail: RWarren@cdc.gov