ATSDR - Annual Report 2000

Table 1. Types of Sites Assessed in Fiscal Year 2000

Type of Site Number of Sites Percentage

Manufacturing 49 32

Government 25 17

Waste Storage or Treatment 23 15

Mining 16 11

Other 19 13

Natural Area 12 8

Waste Recycling 5 3

Residential 1 1

Total 150 100

Following are examples of public health assessments conducted in fiscal year 2000.

Brick Township Autism Public Health Assessment, New Jersey

In February 1998, ATSDR and CDC were contacted by a group of parents of children in Brick Township and by U.S. Senator Robert Torricelli and U.S. Representative Christopher Smith with a request to investigate concerns about the prevalence of autism and other pervasive developmental disorders among children in Brick Township, New Jersey. They also asked that ATSDR assess whether community members may have been exposed to hazardous chemicals in the environment.

In responding to this request, ATSDR and CDC conducted multiple activities and investigations. ATSDR conducted a public health assessment evaluating whether community members may have been exposed to hazardous chemicals in the environment. ATSDR's public health assessment concluded that there was no clear pattern linking the residences of the children who had autism with environmental contaminants. However, there was also no clear pattern for a link between environmental contaminants and the residences during pregnancy of mothers of children who had other pervasive developmental disorders. Total trihalomethane levels in the municipal drinking water supply exceeded 80 parts per billion several times during the study period. There was no clear pattern linking the residences of the mothers (during pregnancy) with location and timing of the high trihalomethane levels. The public health assessment therefore concluded that it appears unlikely that trihalomethane in the municipal drinking water supply was associated with autism incidence in Brick Township. CDC's investigation found that the rates of autism and other pervasive developmental disorders in Brick Township were high compared with prevalence rates reported in previously published studies.

ATSDR and CDC emphasized community involvement and outreach in their Brick Township activities and investigations. The two agencies coordinated their activities and met with the community jointly. Their agencies' reports, informational fliers, and press releases were released to the public at the same time.

This was the first U.S. investigation to fully explore the possible association between autism and environmental contaminants. The results of the Brick Township autism investigation provided valuable information about a disorder which is estimated to be the third most common developmental disability (occurring in as many as one in every 500 children).

Children on Isla de Vieques

U.S. Navy Training Exercises on Vieques, Puerto Rico

Isla de Vieques is a small island south of the main island of Puerto Rico on which the U.S. Navy has a bombing range for conducting training exercises. In May 1999, ATSDR received a petition from a resident of Vieques to evaluate any health effects that might be associated with potential releases of hazardous substances as a result of bombing range activities. Training activities at Vieques had been halted from 1999 until June 2000 in response to a training exercise accident in which a civilian contractor for the Navy was killed.

People who opposed the bombing training conducted on the island established camps on the bombing range to protest the bombings. These camps of protestors included children. In June 2000, an agreement between the Governor of Puerto Rico and the President of the United States resulted in training exercises being resumed with inert bombs. A political referendum is to be held in November 2001 to determine whether the Navy will leave the island in 2003 or resume full-scale training.

ATSDR staff members visited the island several times and met with a variety of community members to determine their specific health concerns. ATSDR has provided environmental health education to resident and non-resident health care providers for the island. During ATSDR's first visit to the island, community activists were camping on the live impact area of the training range. ATSDR expressed concern to various governmental agencies about the potential danger of unexploded ordnance on the site. Eventually, this public health threat was removed with the reinstitution of security at the site. This was accomplished by agreements with local authorities and the federal government.

ATSDR has evaluated sampling information gathered by various environmental agencies. The primary source of drinking water provided by pipeline from the main island of Puerto Rico and the island's backup wells have been determined to be safe. The lay of the land and other geographical aspects of the island limit the possibilities for potential contaminants to reach other parts of the island. A public health assessment on drinking water was released for public comment to the communities of Vieques in February 2001. The assessment was made available in both English and Spanish. The assessment found that the Vieques public water supply is safe to drink.

ATSDR is currently evaluating environmental information related to other potential pathways of exposure to the communities. The potential for transport of contaminants through the air and through the food chain is being evaluated.

Health Consultations

Health consultations provide advice and recommendations on specific, health-related questions concerning actual or potential human exposure to hazardous substances or to other related human health hazards. A health consultation is often needed quickly to evaluate situations and recommend immediate actions to mitigate or prevent harm to human health from exposure to hazardous substances in the environment.

Consultations vary in complexity; either an individual health professional or a team may respond to a question about a site or issue. In some cases, ATSDR prepares more than one health consultation in response to a request for help with an exposure or potential exposure. Health consultation reports may be either written or oral, and they are timely; for example, an oral report might be provided on the day a request reaches ATSDR.

NPL Status of FY 2000 Health Consultations

Figure 3: NPL Status of Fiscal Year 2000 Health Consultations

In fiscal year 2000, ATSDR staff members and state health assessors issued 383 health consultations (82 NPL; 301 non-NPL) for 342 hazardous waste sites in 43 states, Puerto Rico, and the Virgin Islands. Unlike public health assessments, the majority were non-NPL sites, (see Figure 3). Solid waste disposal sites were the main type of hazardous waste sites addressed by these health consultations. Fifty-seven of the health consultations responded to public health concerns about contaminated drinking water, explosive landfill gases, and contaminated surface soil at solid waste disposal sites such as abandoned dumps and both closed and operating municipal landfills.

During fiscal year 2000, ATSDR organized a team of staff members, called the "Strike Team," to provide quick answers to specific requests from other agencies for health consultations. The Strike Team is a multidisciplinary team composed of an environmental health scientist, an industrial hygienist, a toxicologist, a physician, an editor, and regional staff members. The team was established to provide a quick response to site-specific and focused requests on issues that are time-critical. The team strives to provide a response within 3 working days.

The Strike Team prepared 28 written health consultations in fiscal year 2000. The majority of the requests came from EPA. Implementing the Strike Team's recommendations has allowed EPA to

continue remediation activities without relocating residents in some cases
be responsive to residents extremely concerned about the health effects of emissions from a hazardous waste incinerator
incur decreased remediation costs while still acting in the best interest of the public's health.

Following is an example of a site for which ATSDR provided a health consultation in fiscal year 2000.

Metallic Mercury Exposures, Illinois

In July 2000, a private citizen notified the Illinois Department of Public Health (IDPH) and ATSDR that metallic mercury had been found in the basement of a home after the removal of an indoor natural gas meter that was equipped with a mercury pressure regulator (shown on next page). Approximately 1 week before the call, a gas company had removed mercury regulators from that home and from other homes in the neighborhood.

Metallic mercury

ATSDR and EPA determined that many residences in the Chicago area might be contaminated with mercury at levels that could cause acute or long-term health effects in unborn infants and children. In response to concerns about the potential contamination, the Illinois Attorney General's office formed a mercury task force consisting of federal, state, and local health and environmental agencies, along with other interested agencies. The gas companies developed a protocol for identifying, testing, and cleaning affected residences, providing urine testing, relocating residents, reimbursing affected residents for expenses, and providing the opportunity for stress counseling.

About 500,000 residences were potentially affected, including some homes where mercury regulators had been removed more than 10 years previously. ATSDR developed guidance on action levels and on residences that should be prioritized for testing because of possible adverse effects on children and unborn infants. EPA developed clean-up levels that were based on ATSDR recommendations.

Through a cooperative agreement with ATSDR, IDPH evaluated the mercury sampling data after cleanup and issued letters to residents specifying when their homes were safe for occupancy. IDPH also sponsored a "hot line" and developed pamphlets for the public. To date, nearly 1,000 residences have been found to be contaminated, and IDPH has issued more than 700 letters to residents. IDPH is collecting the results of the biologic (urine) testing and results of the original mercury air sample for evaluation and comparison. Data will provide additional information that will help compare residents' exposure with levels of mercury in the environment and identify any exposure-induced, adverse health effects. The Center for Environmental Health in Chicago, a Pediatric Environmental Health Specialty Unit funded by ATSDR, has provided medical information to the task force, the gas companies, local physicians, laboratories, affected residents, and the media.

The training and support that ATSDR provides to Illinois and the other states with which it has cooperative agreements made possible this type of rapid, in-depth response to a potentially widespread public health problem. In this case, federal, state, and local environmental and health agencies joined in partnership with the gas companies in Illinois to contact homeowners whose gas meters had been replaced within the past 10 years and make them aware of the free services available to them to protect their health.

Exposure Investigations

Exposure investigations are conducted to gather and analyze site-specific information to determine whether human populations have been exposed to hazardous substances. Information is obtained through biomedical testing, environmental testing, and exposure-dose reconstruction. Biomedical testing (for example, urine or blood samples) can show current, and sometimes past, exposure to a contaminant. Environmental testing (for contamination of soil, water, or air) is focused on where people live, spend leisure time, or might come into contact with contaminants under investigation. Exposure-dose reconstruction analyses use environmental sampling information and computer models to estimate the contaminant levels that people may have been exposed to. The data and information collected during an exposure investigation help determine whether people have been exposed and, if so, the extent of the exposure. The results of exposure investigations are used to make public health decisions and to recommend appropriate public health actions.

The focus of an exposure investigation is to identify and test residents with the highest potential for exposure. An exposure investigation is not intended to be a study or a complete characterization of a site. Rather, it is a transitional activity designed to provide information that will allow ATSDR to carry out its public health activities more efficiently and effectively. Follow-up activities to exposure investigations may include recommendations for additional sampling, an epidemiologic study, medical evaluations, health education, or more rapid public health action to reduce exposure.

The following criteria are used to determine whether an exposure investigation should be conducted.

Can an exposed population be identified?
Are critical data needed to determine whether a public health hazard exists?
Can the needed information be provided by an exposure investigation?
How would the exposure investigation's results impact public health decisionmaking?

ATSDR conducted 20 exposure investigations in fiscal year 2000. Following are three examples of these investigations.

Village of Tanapag, Saipan

After World War II, about 50 to 60 capacitors that had been used during the war were left in the Village of Tanapag in Saipan, one of the islands in the Commonwealth of the Northern Mariana Islands (CNMI). The abandoned capacitors were scattered throughout the village and were used for a variety of purposes, including boundary markers, headstones, road blocks, and windbreaks.

When the capacitors were removed in the early 1990s, a few were discovered to have leaked fluids containing polycholorinated biphenyls (PCBs). In response to the community's concern about the PCB contamination, the CNMI Department of Public Health (DPH) petitioned ATSDR in 1999 to perform a public health assessment. Community members were concerned for their current safety and wanted to know if their past exposures might cause illness. The Army Corps of Engineers, with oversight from EPA, was responsible for the soil cleanup.

Saipan clinic

At the request of the CNMI Secretary of Health, ATSDR assisted the DPH with the medical evaluation of the residents of Tanapag Village at a satellite clinic. Working with ATSDR were health care providers from the Immigration Health Services of the Health Resources and Services Administration. Between May 8, 2000, and June 9, 2000, the clinic operated 11 hours per day with a staff of 5 health care providers. More than 1,250 individuals were interviewed to obtain exposure and medical histories. Physical exams, blood tests for PCBs, and a general battery of other screening lab tests were also given.

ATSDR staff presented results of the exposure investigation to community members in November, assisted DPH staff with followup on medical examinations, and provided training on PCB exposure and health effects for local health care providers. Seventeen people having total PCB levels above 10 parts per billion were counseled about the health significance of their blood levels; 30 people having abnormal lab values or other health concerns were seen in the clinic by an ATSDR physician. ATSDR also counseled Tanapag residents who had normal PCB lab results, but who still had concerns about environmental contamination. Additionally, information repositories were established in the local library and Tanapag clinic. ATSDR also worked with DPH medical staff to identify data needed to perform a descriptive analysis of disease incidence and mortality in Tanapag.

Mossville, Louisiana

Residents of the community of Mossville in Calcasieu Parish, Louisiana, expressed concern over potential health effects from exposure to chemical releases from chemical manufacturing plants in their neighborhood. Calcasieu Parish has a large number of chemical manufacturing plants which produce petroleum-based chemicals and chemicals such as chlorinated hydrocarbon solvents and polyvinyl chloride. Chemical wastes from some of these operations are burned in hazardous waste incinerators operated by industries in the area. Mossville is located across the road from a large vinyl chloride monomer plant. Several flares at this facility intermittently burn unidentified waste materials. Residents reported that black soot from these flares was deposited on vegetation on their property.

Mossville, Louisiana

To document their concerns, a community member provided ATSDR with blood dioxin test results that indicated that some residents had elevated blood dioxin levels. In response to these preliminary findings, ATSDR conducted an exposure investigation. Blood samples were collected from 28 residents of the community, and the samples were analyzed for chlorinated dibenzodioxins (CDDs), chlorinated dibenzofurans (CDFs), and polychlorinated biphenyls (PCBs). A limited investigation of environmental contamination was also conducted: four surface soil samples and two chicken eggs were collected and analyzed for CDDS and CDFs. A breast milk sample from one resident was also analyzed.

The exposure investigation concluded that blood dioxin concentrations measured in the study participants were elevated, but were at levels that were unlikely to be associated with known clinical health effects such as chloracne (an acnelike skin condition) or elevated liver enzyme levels. The average concentration of dioxin in blood samples from the exposure investigation participants was at the upper end of the reference range averages. The reference range was from studies conducted in the 1980s. Thus, the current reference range could be lower. Four of 28 residents had blood dioxin concentrations that exceeded the reference range means by twofold or threefold. Dioxin concentrations in three surface soil samples and two chicken eggs were not at levels of health concern. The concentration of dioxin in a breast milk sample was not elevated.

The source of the increased dioxin exposure in residents of Mossville could not be initially determined. ATSDR plans to work with federal and state agencies and the community to implement further investigations to identify possible sources of dioxin exposure in Mossville. ATSDR facilitated access to an Association of Occupational and Environmental Clinics (AOEC) environmental medical expert in dioxin to review medical information for the 28 exposure investigation participants, determine the next clinical steps for these people, and provide them with education and information about their exposure status.

Anniston, Alabama

The Monsanto Company produced PCBs at a plant in Anniston, Alabama, from 1935 to the 1970s. Hazardous wastes, including PCBs, were disposed of in two unlined landfill areas adjacent to the production facility. Investigations documented the presence of PCB contamination in sediment samples from off-site drainage ditches and in soil samples from private residences east and north of the facility. These findings led to the remediation of off-site contaminated areas and property buyouts for some homeowners.

Subsequent investigations detected elevated blood levels of PCBs in some residents living in the community surrounding the facility or other neighborhoods in Anniston. The source and exposure pathways by which residents had been exposed to PCBs had not been defined. Furthermore, it was uncertain whether significant exposures were still occurring. ATSDR conducted an exposure investigation to address these question.

Before conducting the exposure investigation, staff from ATSDR and the Alabama Department of Public Health (ADPH) met with community representatives to explain the exposure investigation and solicit their input. In March 2000, ATSDR staff members met with families who lived within a half-mile radius of the site and invited them to participate in the exposure investigation. To be eligible for the investigation, at least one family member had to be a child between 1 and 7 years old. ATSDR staff members and representatives of the community group, CAP, went door-to-door in the designated neighborhoods to invite eligible families to participate. A total of 18 families participated in the exposure investigation. Environmental samples were collected from the homes of these families. The concentration of PCBs was determined in blood serum samples from 37 children (16 years old or less) and 43 adults.

The exposure investigation concluded that 5 of the 43 adults tested had elevated (higher than 20 parts per billion) blood PCB levels. Blood PCB levels were not elevated in the 37 children tested. PCB concentrations in excess of 1 part per billion were detected in surface soil samples from 4 homes and in house dust samples from 2 homes. Blood PCB levels were not correlated with soil or house dust PCB levels.

The exposure investigation showed a strong correlation between blood PCB level and length of residency. This, along with the absence of elevated blood PCB levels in younger residents of the community, suggests that past exposures to environmental PCB contamination exceeded current exposures.

The findings of this study are consistent with studies conducted by the EPA that have documented that elevated levels of PCBs remain in off-site soils and sediments. Because the future use of these areas cannot be predicted, ATSDR recommended that the areas be remediated to prevent the potential for further exposure.

Emergency response

Responding to Spills and Other Emergency Events

ATSDR emergency response staff members provide health-related technical support to federal, state, and local responders during emergencies involving the uncontrolled release of hazardous substances. As resources permit, they also do time-critical consultations. ATSDR emergency response coordinators have immediate access to various experts including chemists, toxicologists, environmental scientists, and medical professionals. Site-specific consultation teams can be convened to provide support 24 hours a day, usually within 30 minutes.

During fiscal year 2000, ATSDR emergency response staff members received a total of 613 requests for assistance or consultation from EPA regional offices, other federal agencies, state and local agencies, and private citizens. Of these, 59 were acute events for which ATSDR provided information. ATSDR also made an on-site response to one of these acute events. During these emergencies, ATSDR assisted first responders in addressing the public health needs of more than 500,000 people who were potentially affected by these accidental spills or releases. In response to these requests, ATSDR provided protocols for treatment of people who were exposed to hazardous substances, evaluated the health implications of spills, and provided action levels to protect workers and the public. About one-third of the requests for assistance in acute events were made by EPA.

For example, ATSDR responded to an EPA request in July 2000 for on-site assistance with a spill of an unidentified substance into the Guaynabo River in San Juan, Puerto Rico. An unknown amount of a substance had been released into the river, which is the drinking water supply source for approximately 250,000 residents of metropolitan San Juan. The contaminant passed through a treatment plant and into the homes of residents. The treatment plant was shut down for decontamination, a 7-day process, and Commonwealth officials provided residents with alternative water supplies. The concentration of the contaminant was below levels of health concern in all of the analytical results reviewed; however, the concentration was sufficient for the average person to detect an objectionable odor. The possibility of additional contaminants could not be eliminated, and further analysis was being conducted by multiple agencies, including the Puerto Rico Department of Health, the U.S. EPA Caribbean Field Office, and the Puerto Rico Department of Environmental Quality.

EPA Region 2 requested that ATSDR provide on-site assistance in coordinating the environmental and public health aspect of the contamination of the city's water supply. ATSDR reviewed environmental data and evaluated the public health significance of the contaminants. ATSDR also met with Commonwealth and EPA officials to coordinate activities and facilitated arrangements through EPA and the Centers for Disease Control and Prevention's National Center for Environmental Health for rapid turnaround in the analysis of water samples.

In addition to assisting federal and other agencies with response to spills, releases, and other acute events involving hazardous substances, ATSDR emergency response personnel routinely participate in regional and local training in which response to such spills is simulated. In fiscal year 2000, ATSDR participated in 26 local drills, usually providing compound-specific information on toxicity, human health effects, fate and transport, and worker health and safety.

One such exercise ATSDR participated in was a Congressionally mandated, full-field exercise called "Top Official" or TOPOFF. TOPOFF consisted of two simulations of terrorist attacks that were timed to occur simultaneouslyone involving a biological agent in a major city and the other involving a chemical agent in a smaller city. In addition, a third full-field exercise involving a radiological release took place in Washington, D.C. The objective of the exercises was to test the Federal Response Plan response to such incidents and to evaluate failures of the systems. ATSDR dispatched emergency response coordinators to the biological and chemical incidents and also provided information for the response to the radiological incident.

Chapter Two: Evaluating Relationships Between Hazardous Substances and Health: Toxicologic Research

A second major goal of ATSDR is to evaluate relationships between hazardous substances in the environment and adverse human health outcomes. To help achieve that goal, ATSDR has a toxicologic research program that is filling many of the data gaps about how hazardous substances affect human health. ATSDR also helps provide information about the relationship between hazardous substances and health outcomes by developing toxicological profiles that summarize information about many of the most hazardous substances found at Superfund sites.

Identification and Ranking of Hazardous Substances

The Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) Priority List of Hazardous Substances contains the names of 275 substances found at NPL sites and believed to pose the most significant potential threat to human health. This list helps form ATSDR priorities on many issues. The Superfund Amendments and Reauthorization Act of 1986 (SARA) requires ATSDR, in cooperation with EPA, to compile this priority list, which is drawn from all hazardous substances known to exist at NPL sites. The ranking of substances on the priority list is based on three criteria: (1) frequency of occurrence at NPL sites, (2) toxicity, and (3) potential for human exposure.

Asbestos fibers

To ensure that the priority list is current, ATSDR periodically reexamines its information database (HazDat) of all hazardous substances known to exist at NPL sites. In early fiscal year 2000, the 1999 CERCLA Priority List of Hazardous Substances was published. Its availability was announced in the Federal Register on October 21, 1999 (64 FR 56792). The top substance on the 1999 Priority List of Hazardous Substances was arsenic, followed by lead and mercury (see Table 2).

TABLE 2. Top 10 Substances on the 1999 Priority List

1999 Priority List
*Rank*	*Name*
1	Arsenic
2	Lead
3	Mercury
4	Vinyl chloride
5	Benzene
6	Polychlorinated biphenyls
7	Cadmium
8	Benzo(a)pyrene
9	Polyaromatic hydrocarbons
10	Benzo(b)fluoranthene

Along with the publication of the revised priority list in October 1999, ATSDR also published an updated Completed Exposure Pathway Site Count Report. A completed exposure pathway (CEP) is an exposure pathway that links a contaminant source to a receptor population. The CEP ranking is based on a site frequency count, and thus lists the number of sites at which a substance has been found in a completed exposure pathway. The substance found in a completed exposure pathway at the most sites was lead, followed by trichloroethylene and arsenic (see Table 3).

Table 3. Substances Found Most Frequently at Sites with a Completed Exposure Pathway (CEP)

Number of sites with substance in a CEP

Substance All Sites NPL Sites

Lead 298 206

Trichloroethylene 277 239

Arsenic 215 147

Tetrachloroethylene 206 167

Benzene 149 116

Cadmium 148 105

Chromium 146 102

PCBs 130 96

1,1,1-trichloroethane 116 97

Zinc 116 75

Preparation of Toxicological Profiles

CERCLA, as amended, requires ATSDR to prepare toxicological profiles for each hazardous substance on the CERCLA Priority List of Hazardous Substances. These profiles summarize the current scientific literature and interpret available toxicological and epidemiologic information to determine levels of significant human exposure regarding the substances.

ATSDR also provides toxicological profiles at the request of the Department of Defense (DOD) and the Department of Energy (DOE). Thirty toxicological profiles were under development as finals or drafts for public comment during fiscal year 2000. These profiles covered CERCLA substances and non-CERCLA substances identified by DOD and DOE (See Appendix B for a list of toxicological profiles completed in 2000). The toxicological profile for total petroleum hydrocarbons was released as a final profile in fiscal year 2000, thus completing the list of 25 substances submitted by DOD for profile development. The final toxicological profiles for uranium and ionizing radiation were released during fiscal year 2000; they were prepared at the request of DOE. The following toxicological profiles were under development as public comment drafts during fiscal year 2000: americium, cesium, cobalt, iodine, and strontium. These profiles will be released for public comment in fiscal year 2001. Toxicological profiles developed in fiscal year 2000 featured new sections on child health issues, which are being added to all new profiles.

In fiscal year 2000, 137 toxicological profiles were available on CD-ROM. During the year, ATSDR continued a quality control project to update and complete the process of placing all public health statements of final toxicological profiles on the agency's Internet site.

Fact Sheets (called ToxFAQs), containing material drawn from ATSDR public health statements, have also been developed. ATSDR now has a total of 150 fact sheets in print and posted on the Internet in HTML and PDF format.

ATSDR's Substance-Specific Applied Research Program

ATSDR is working to determine the relationships between adverse human health outcomes and hazardous substances through its Substance-Specific Applied Research Program. CERCLA requires that for each hazardous substance listed, ATSDR, in consultation with EPA and other public health agencies and programs, assess whether adequate information is available on the health effects of the substance. Furthermore, the law requires that ATSDR, in cooperation with the National Toxicology Program, initiate a research effort designed to determine the health effects of those substances for which adequate information is not available (or under development).

ATSDR used several mechanisms to fill priority data needs in fiscal year 2000. These included industry testing through EPA, private-sector voluntarism, and academic-based research conducted through the Minority Health Professions Foundation. Additional research needs are being addressed through other agency programs including ATSDR's Great Lakes Human Health Effects Research Program and an interagency agreement with the National Toxicology Program. Significant progress has been made in filling the priority data needs. Through fiscal year 2000, ATSDR has identified 201 priority data needs for the top 50 hazardous substances. A total of 117 priority data needs are being addressed via the mechanisms that ATSDR has implemented. In addition, 53 priority data needs have been filled. Data obtained from the research program are used to update ATSDR toxicological profiles and to develop health-guidance values for hazardous substances evaluated in ATSDR's public health assessments conducted at waste sites. Currently, ATSDR is expanding its Substance-Specific Applied Research Program by identifying priority data needs for an additional 10 priority hazardous substances, bringing the total number of substances with a research agenda to 60.

Industry Testing Through EPA

The Toxic Substances Control Act of 1976 (TSCA) authorizes EPA to ensure that chemicals are safe for their intended use. EPA places some of this responsibility on chemical manufacturers and processors by requiring them to conduct toxicologic testing. Costs of conducting this research are borne completely by the industries.

Substances with Some Research Needs to Be Addressed by Industry Testing:

Benzene
Chloroethane
Hydrogen cyanide
Methylene chloride
Sodium cyanide
Tetrachloroethylene
Toluene
Trichloroethylene

During fiscal year 2000, ATSDR and EPA finalized information to support development of a TSCA test rule for eight substances that ATSDR previously had identified as having research needs. A test rule is the legally enforceable document that describes (1) EPA's authority to require testing, (2) the specific testing required, (3) why it is required, and (4) who should conduct the testing. The proposed test rule will address substance-specific research needs identified in ATSDR's priority data needs documents. In a recent meeting between officials of EPA and ATSDR, EPA identified the ATSDR test rule as its top priority for fiscal year 2001. Publication of the proposed test rule is expected in the spring of 2001.

Private Sector Voluntarism

ATSDR encourages industry to voluntarily conduct needed research into the toxicity of priority chemicals. During fiscal year 2000, ATSDR had Memoranda of Understanding in place with three private-sector organizationsGeneral Electric Company (GE), Halogenated Solvents Industry Alliance, Incorporated (HSIA), and the American Chemistry Council (ACC), formerly called the Chemical Manufacturers Association,to address about 10 research needs for 5 substances.

Methylene Chloride

During fiscal year 2000, ATSDR reviewed and accepted the conclusions of an HSIA study covering the immunotoxicity of methylene chloride, a substance found in at least 842 NPL sites. The data from the study indicated that inhalation exposure to methylene chloride at a concentration of 5,187 parts per million did not result in any sign of immunotoxicity. This study addresses an important research need for methylene chloride, that is, to determine whether the immune system is a susceptible target organ for this chemical via inhalation exposure. As a next step, HSIA plans to use physiologically based pharmacokinetic modeling, a state-of-the-art technique, to estimate oral intakes of methylene chloride-contaminated environmental media that would not produce human immunotoxicity. This research is being conducted because ATSDR has identified ingestion of contaminated media as the most common exposure route for methylene chloride at hazardous waste sites.

Substances with Some Research Needs Being Addressed by Private-Sector Voluntarism:

ethylene chloride
Polychlorinated biphenyls
Tetrachloroethylene
Trichloroethylene
Vinyl chloride

Trichloroethylene

During fiscal year 2000, ATSDR signed a third agreement with HSIA that covers a developmental toxicity study on trichloroethylene, a substance found in at least 932 NPL sites. This study addresses an important research need for trichloroethylene, that is, to determine whether the development of the young is affected by breathing this chemical. HSIA has completed the study, and it is currently undergoing outside peer review.

Vinyl Chloride

During fiscal year 1996, ATSDR entered into an agreement with the American Chemistry Council covering a study on reproductive and developmental toxicity for vinyl chloride, a substance found in at least 544 NPL sites. Vinyl chloride ranks fourth on the agency's Priority List of Hazardous Substances. This study addresses two important research needs for vinyl chloride, that is, to determine whether the reproductive system and the development of the young are targets of this chemical via inhalation exposure. During fiscal year 2000, ATSDR reviewed and accepted the conclusions of this study. The study indicated that exposure to vinyl chloride through two consecutive generations did not affect reproductive performance and fertility at any of the concentrations used in the study up to 1,100 parts per million (ppm). However, there were significant effects on the liver, including increased liver weights and hypertrophy in the parental rats.

Similarly, no developmental toxicity was reported at any of the concentrations up to 1,100 ppm. Maternal toxicity noted as increased kidney weights relative to the day-20 gestation weights was reported at 100 ppm; and at 1,100 ppm maternal toxicity included increases in both liver and kidney weights relative to the day-20 gestation weights.

Research Program of the Minority Health Professions Foundation

The Minority Health Professions Foundation's Environmental Health and Toxicology Research Program is a partnership that involves minority health-professions schools located throughout the nation. A major component of the Substance-Specific Applied Research Program (SSARP), the program is ATSDR's primary mechanism for filling gaps in knowledge about the effects of hazardous substances.

Laboratory research

Some examples of significant new fiscal year 2000 findings from the program include

Children may be exposed to polyaromatic hydrocarbons (PAHs) in utero through their mother's inhalation of PAHs. PAHs are a neurotoxin.
Long-term exposure to PAHs results in elevated enzyme activity that may contribute to the formation of harmful toxic reactive metabolites and symptoms in target organs.
Specific combinations of metals accumulate to a greater extent in inner city soil than in soil in outlying areas. These data will be useful in the development of profiles on the interaction of metals in the environment.

New research findings from this program are incorporated into the updated toxicological profiles and result in filling priority data needs and fulfilling the agency's congressional mandate to assure the initiation of research when available information is inadequate. In addition to being the agency's primary mechanism to address data gaps for hazardous substances, the Environmental Health and Toxicology Research Program is the only university-based research program that supports the agency's efforts to address environmental justice concerns.

Mixtures Assessment and Research Program

Superfund sites rarely contain only one hazardous substance. Frequently, multiple chemicals are found at NPL sites. Therefore people who are exposed to contaminants from waste sites are often exposed to mixtures of hazardous substances.

The principal aim of ATSDR's Mixtures Assessment and Research Program is to develop methods for assessing the joint toxicity of exposure to multiple chemicals that are most frequently found at hazardous waste sites. The program seeks to identify pertinent mixtures, assess joint toxicity, and conduct experimental testing to fill research needs.

During fiscal year 2000, identification and ranking of chemical mixtures that are found in completed exposure pathways has progressed. A list of binary mixtures has been identified, and work is being conducted to identify higher order mixtures (such as 3- and 5-component mixtures). On May 3031, 2000, ATSDR convened an international review panel of outside expert scientists to review three draft documents. The 2-day discussions focused on ATSDR's Guidance Manual for the Assessment of Joint Toxic Action of Chemical Mixtures, its Guidance for Preparation of Interaction Profiles, and the Interaction Profile for Chlorinated Dibenzo-p-Dioxins, Hexachlorobenzene, p,p'-DDT, and Methylmercury. Overall, the panel was very supportive of the mixtures program and commended ATSDR scientists for their work to address and characterize the health effects of chemical mixtures.

Also during fiscal year 2000, ATSDR continued its support of experimental research to enhance the understanding of the underlying mechanisms of toxicity following exposure to chemical mixtures. Many of the key research findings during the year were presented in seven separate presentations at national and international toxicology meetings. One of the papers was recognized as the best paper presented in the Risk Assessment speciality section at the annual meeting of the Society of Toxicology held in Philadelphia, Pennsylvania, March 1923, 2000.

Computational Toxicology Program

As a part of the development of the SSARP, ATSDR has incorporated the use of state-of-the-art computational toxicology methods such as physiologically based pharmacokinetic (PBPK) modeling, structure-activity-relationship (SAR) techniques, and benchmark dose (BMD) models to aid in interpreting and assessing short, intermediate, and long-term health effects associated with exposure to hazardous substances. PBPK, BMD, and SAR are computer-based mathematical models used to predict the action of chemicals on the body in the absence of little or no experimental data. The alternative to mathematical models is often costly
experimental work that can take months to years to complete.

The computational toxicology laboratory has been used to provide critical toxicological information that supports agencywide programs and activities. Following are highlights of some of the major projects and activities conducted during fiscal year 2000.

New minimum risk levels (MRLs) for methylene chloride were derived by developing and using a PBPK model.
A minimum risk level for manganese was derived by applying BMD modeling technology to the data set.
A pharmacokinetic model for aluminum was developed that provided convincing evidence that using aluminum compounds in childhood vaccines is safe. Both CDC and the World Health Organization used the ATSDR assessment to recommend continued use of aluminum in childhood vaccines. Aluminum is used in certain vaccines to increase immunologic response and thus make the vaccine more effective.
Development of safe fish consumption levels for women and children who eat fish containing dioxins.
SAR analyses of a styrene-acrylonitrile trimer were critical in a multiagency decision to pursue reproductive toxicology testing of this compound found in the drinking water in Toms River, New Jersey.
Development and utilization of a PBPK model for PCBs to determine route-specific sources contributing to high serum PCB levels in Anniston, Alabama. The model simulations indicated that high PCB soil levels were an important exposure route.

Great Lakes Human Health Effects Research Program

The Great Lakes Human Health Effects Research Program is intended to build on, and amplify, the results of past and ongoing fish-consumption research in the Great Lakes basin, using existing structures and institutions already involved in human health research. This ATSDR-supported research program studies known at-risk populations to further define the human health consequences of exposure to persistent toxic substances identified in the Great Lakes basin.

During fiscal year 2000, significant research findings were reported. Those findings include the following.

The relationship between prenatal exposure to PCBs and performance on the Fagan Test of Infant Intelligence (FTII) was assessed in infants at 6 months and again at 12 months. The results indicated a significant relationship between exposure to PCBs and poor performance on the FTII. No significant relationship was found between exposure to DDE or methyl mercury on any tests of the FTII.
PCBs and DDE were markedly elevated in a cohort of adults who consumed fish. Exposure to PCBs, but not to DDE, was associated with lower scores on several measures of memory and learning.

Chapter Three: Evaluating Relationships Between Hazardous Substances and Health: Conducting Health Studies

ATSDR conducts and supports health studies to evaluate the relationship between exposure to hazardous substances and adverse health effects. Many of these studies have focused on seven priority health conditions ATSDR identified as the health conditions considered to be most sensitive to exposures to hazardous substances. These are birth defects and reproductive disorders, cancer, immune function disorders, kidney dysfunction, liver dysfunction, lung disease, and neurotoxic disorders. ATSDR also conducts studies to evaluate how people become exposed to hazardous substances.

Pediatric neurobehavioral testing

In 2000, ATSDR completed five health studies. Of these, two had findings related to exposure to hazardous substances, and two had health-related findings. One study had findings related to both exposure and health. ATSDR also continued several surveillance activities in fiscal year 2000, including its surveillance of hazardous spills and releases in a number of states. Following are some of the findings from studies and surveillance activities completed in fiscal year 2000.

The Kalamazoo River Angler's survey demonstrated that people who ate fish from that river had significantly higher residue levels of total PCBs and DDE than people who did not eat the fish. This finding is consistent with other studies performed under the Great Lakes Research Program.
In the Coeur d' Alene Basin of Idaho, about 15% of children under 6 years of age were identified with blood lead levels higher than 10 micrograms per deciliter, the level of health concern. The basin area is contaminated with lead from a century of mining activities.
A study of exposure to toluene diisocyanate from a foam manufacturing facility in North Carolina identified children with clinical evaluations and symptoms consistent with asthma in numbers greater than expected for a community of similar size.

One additional activity of significance initiated during fiscal year 2000 was the medical evaluation of people exposed to asbestos-contaminated vermiculite in Libby, Montana. More than 6,000 people were provided medical testing, including spirometry (which measures the breathing capacity of the lungs) and chest x-rays (which can identify changes in the lungs and the lining of the lungs that may be the result of asbestos exposure).

Some examples of ongoing studies in fiscal year 2000 include an evaluation of childhood brain cancer at Toms River, New Jersey; an investigation of childhood leukemia and birth defects among children exposed to contaminated drinking water at Camp Lejeune, North Carolina; and a study examining whether neurotoxic effects and asthma are related to hydrogen sulfide exposure in Dakota City, Nebraska.

The health studies activity continues to be a program that provides services to communities and expands the knowledge base for public health decisions and program development. Following are summaries of two health studies ATSDR completed in fiscal year 2000.

Glenola, North Carolina

A manufacturing facility in Glenola, North Carolina, released diisocyanates and other substances during the production of polyurethane foam. The plant was closed by state order in 1997. ATSDR undertook an investigation to identify children with asthma who lived near the facility during the period of highest emissions of diisocyanates. Parents of children who lived in the area were interviewed by telephone, and the parents confirmed potential exposure for 204 children; 118 of the children had respiratory symptoms and were offered a clinical evaluation by specialists in childhood asthma. A di agnosis of asthma was made for 28 of the 55 children in the study who were evaluated; asthma was considered possible for another 10 children. The two specialists provided recommendations for medical care as appropriate. The information collected was most consistent with a high prevalence of asthma among the community's children. Two children had antibodies to diisocyanates, adding to the evidence for human exposure in the community.

Testing lung capacity

The children with asthma received early diagnosis and referral, along with appropriate recommendations for medical care and followup. Findings were shared with the community and the state health department. ATSDR is also providing information to local health care providers on current guidelines for diagnosis and management of childhood asthma.

Kidney Biomarker Study

In 1993 and 1994, ATSDR included a panel of kidney biomarkers in three studies of communities living near military bases that had been included on the NPL. These test results served as the baseline values for the follow-up study of 526 participants. For most of the children and adolescents who participated, measured elevations in the kidney biomarkers had reverted to normal at followup. For persons over age 20, about 50% of the elevations in these biomarkers reverted to normal at followup.

The presence or absence of elevated biomarkers at baseline among generally healthy participants was not associated with the development of early indicators of kidney disease at followup. However, participants who had selected health conditions at baseline (diabetesand to a lesser extentheart disease, hypertension, gout, and urinary tract disease) and elevated biomarkers were more likely to show early indicators of kidney disease (elevated serum creatinine, elevated serum cystatin C, and decreased creatinine clearance) at followup. This longitudinal study confirmed the utility of four urinary kidney biomarker tests as markers of preclinical organ dysfunction among adults with certain pre-existing medical conditions.

Medical Testing Program for People Exposed to Asbestos-Contaminated Vermiculite, Libby, Montana

During fiscal year 2000, ATSDR initiated a program to screen for asbestos-related illness among residents of Libby, Montana, who may have been exposed to asbestos contained in a mineral mined in Libby for many years. Vermiculite, a natural mineral used to make insulation materials and garden soil additives, was mined in Libby, Montana, from the 1920s until 1990. The vermiculite ore mined at Libby has been shown to be contaminated with asbestos. The vermiculite ore was surface mined, milled, heated to expand its volume, and shipped throughout the nation, and used as play and fill material locally. Many people were potentially exposed to the asbestos in the vermiculite.

In response to public health concerns about cases of asbestos-related illnesses in Libby, ATSDR instituted a medical screening program for the residents and former residents of the town. Those who participated in the screening included former miners, household members who may have been exposed to dust on the clothing of mine workers, people who played in the vermiculite during childhood, and former Libby residents exposed to the airborne emissions of dust from vermiculite processing. EPA, the Montana Department of Health and Human Services, the Lincoln County Environmental Health Department, and the Montana Department of Environmental Health assisted ATSDR with the screening program.

Chest x-ray

ATSDR used multiple communication strategies and methods to reach the general public in Libby. These included mailing flyers, putting up posters, handing out reminder cards, sponsoring open houses and public availability sessions, making presentations at Community Advisory Group meetings, and setting up displays at local health fairs and events, such as the July 4 celebration. ATSDR staff members also conducted face-to-face outreach in the community, gave interviews on local radio stations, and ran announcements on the local cable television station.

Community participation in the medical testing program was very high. More than 6,000 Libby residentstwice as many as ATSDR had projectedparticipated in the testing program. Testing began in early July 2000 and consisted of spirometry, chest x-rays, and an exposure and health questionnaire. More than 90% of the scheduled interviews were kept. Testing at the clinic was conducted through November 2000. About 5% of those tested were immediately referred for a follow-up examination because of health conditions found as a result of the chest x-ray or spirometry test. ATSDR has worked with the DHHS Region 8 Office to facilitate needed medical services in the community. The Health Resources and Services Administration (HRSA) provided a grant for a nurse to work with residents and designated the community as being medically underserved. The National Cancer Institute is sharing information with the community on clinical trials and current therapies that are available to treat asbestos-related illnesses.

Participants have been notified of their test results. An interim report is being prepared that will assist the community in applying for grants for support of clinical services for people in need. Once completed, the information will also be used to assist in planning future testing, assisting EPA to identify ways in which people may become exposed, and assisting clinical research about the illnesses for the benefit of people with asbestos-related illnesses and their physicians.

ATSDR is also assisting EPA in evaluating the public health impact of the many sites where vermiculite was shipped for processing across the country. Vermiculite from Libby was transported to plants in 30 states. Altogether, there are about 300 potential sites where some vermiculite operations were located. ATSDR is helping to prioritize sites on the basis of potential public health impact.

What illnesses are associated with asbestos exposure?

Asbestosis

Asbestosis is a serious, progressive, long-term disease of the lungs. It is not cancer. It is caused by inhaling asbestos fibers that irritate lung tissues and cause the tissues to scar. The scarring makes it hard for lungs to do their job getting oxygen into the blood. Symptoms of asbestosis include shortness of breath and a dry crackling sound in the lungs while inhaling. The chance of getting asbestosis is very small for those who do not work with asbestos. There is no effective treatment for asbestosis; however, symptoms of the disease can be managed under the care of a physician. The disease, if severe, can cause disability and death.

Lung Cancer

Lung cancer causes the largest number of deaths related to asbestos exposure. People who work in occupations involving the mining, milling, manufacturing, and use of asbestos and its products are more likely to get lung cancer than the general population. The most common symptoms of lung cancer are coughing and a change in breathing. Other symptoms include shortness of breath, persistent chest pain, hoarseness, and anemia. People who develop these symptoms do not necessarily have lung cancer, but should consult a physician for advice. People who have been exposed to asbestos and are also exposed to some other cancer-causing product, such as cigarette smoke, have a greater risk of developing lung cancer than people who have been exposed only to asbestos.

Mesothelioma
esothelioma is a relatively rare form of cancer that is found in the thin lining (membrane) of the lungs, chest, abdomen, and heart. Several hundred cases are diagnosed each year in the United States, and most cases are linked with exposure to asbestos. About 2% of all miners and textile workers who work with asbestos, and 10% of all workers who were involved in the manufacture of asbestos-containing gas masks, develop mesothelioma. This disease may not show up until many years (generally 2040+) after asbestos exposure.

Hazardous Substances Emergency Events Surveillance: Analysis of 5 Years of Data

Since 1990, ATSDR has maintained an active, state-based Hazardous Substances Emergency Events Surveillance (HSEES) system to describe the public health consequences associated with the release of hazardous substances. The HSEES program collects data on the public health impact of hazardous substance releases and promotes the prevention of these impacts in 16 participating states (see Figure 1). In fiscal year 2000, an analysis was conducted looking at 5 years of data from HSEES.

Figure 1. States participating in HSEES in FY 2000

There were 24,359 events reported to the HSEES during 19931997. Fixed-facility events represented 80% of all events, and transportation-related events represented 20%. The number of events reported increased every year, partially due to improved reporting. The largest percentage of fixed-facility industry-related events involved releases from aboveground storage areas and from a vessel used for processing, piping, material loading and unloading sites. The most frequent causal factors were equipment failure and operator error.

The frequency of both transportation-related and fixed-facility events was highest from April through August, with a peak occurring in May, coinciding with the high demand for agricultural chemicals. Both fixed-facility and transportation-related events occurred more frequently on week days than on weekends. The majority of fixed-facility events and transportation events occurred between the hours of 6 am and 6 pm, peaking at 10 am.

Eighty-one percent of transportation-related events occur during ground transport, 13% during rail transport, and 6%, combined, for other types of transport. Analysis showed that although the railroad events are not as common as other types of events, they have a greater potential for harm because large volumes of chemicals are carried by rail through residential areas at times of the day when people are more likely to be at home. Eleven percent (n=2,676) of events had an official evacuation ordered ranging from 1 to more than 10,000 persons evacuated. Fifty percent of the evacuations involved 20 or fewer persons, and only 2% involved 1,000 or more persons.

A total of 9,869 decontaminations were performed at HSEES events on 2,162 employees on scene (406 at a hospital), 5,637 first responders on scene (259 at a hospital), and 992 members of the general public (413 at a medical facility). There were 8,397 victims resulting from spills or releases at fixed facilities and 1,216 victims from spills or releases that occurred while hazardous substances were being transported. For both transportation and fixed-facility events, the population group most often injured was "employees and students" (55.9%), followed by "the general public" (35%) and "first responders" (9%).

First responders, however, are the group most often injured in methamphetamine production-related events as reported in Morbidity and Mortality Weekly Report (November 17, 2000). Of the first-responder group, professional firefighters, police, and volunteer firefighters were the most frequent victims of spills or releases that occurred at fixed facilities, and police officers were the most frequent victims of such events that occurred while hazardous materials were being transported.

Acids, ammonia, chlorine, and pesticides are more frequently represented among events involving victims than among total events, indicating a greater potential for harm. These chemicals have been specifically targeted for prevention activities. Respiratory irritation, eye irritation, gastrointestinal irritation, vomiting, headache, dizziness and other central nervous system effects, skin irritation, physical injury, and chemical burns were the most commonly reported effects. A total of 110 deaths were reported. Motor vehicle collisions were likely responsible for 47 of the 110 deaths. Events where explosions were reported were responsible for 25% (n=16) of the 63 remaining deaths. Almost 21% of the 63 deaths were in a farming-related industry.

States have used their data from the HSEES program to prevent spills and to prevent injuries to first responders or users of chemicals that frequently cause injury. Several instructors have updated training courses on the basis of a recent article published in the Morbidity and Mortality Weekly Report. The article reported data on injuries that first responders have suffered from illicit methamphetamine drug labs.

Childhood Cancer Registry Workshop

ATSDR sponsored a 3-day expert panel workshop that discussed what data is needed to better identify any possible links between childhood cancer and children's exposure to hazardous substances in the environment. The workshop, "Workshop on Environmental Exposures Among Children with Cancer: Current Technologies, Methodological Challenges, and Community Concerns," was held January 2527, 2000. It was convened to identify and prioritize feasible strategies for obtaining data to measure or estimate environmental exposures among children with cancer. Having such data would facilitate research into the possible links of exposure and pediatric cancer. Many experts attended the workshop, including representatives of the National Institutes of Health and the National Cancer Institute, which was developing a childhood cancer registry, the Child Cancer Network.

Examples of the panel's recommendations to the National Cancer Institute included the following.

Collect data for at least two points of residential history: (1) residence at time of diagnosis and (2) residence at birth, so that potential prenatal exposures and later exposures can be explored.
Ensure that appropriate diagnostic groupings of cases are used in cancer causation research activities (for example, data collection and data analysis) to reflect current knowledge of the multi-faceted distinctiveness of cancer as a diagnostic category.
Provide improved, published assessments of existing exposure databases that facilitate more efficient determinations of their applicability and validity.

Soil Pica Workshop

ATSDR invited 10 expert panelists to a workshop to assess the current state of science on soil pica behavioran issue that is relevant to the agency's ongoing work at many sites where people may be exposed to contaminated soils. The 2-day workshop focused on addressing three key issues: the prevalence of soil pica behavior, soil ingestion rates for people who exhibit this behavior, and means for identifying people with this behavior. Common themes discussed throughout the workshop included the need for clear definitions of key terms, the lack of extensive research on the distribution of soil ingestion rates, and the need for additional research to fill data gaps.

The panelists defined soil pica as the recurrent ingestion of unusually high amounts of soil (that is, on the order of 1,0005,000 milligrams per day). Groups at risk of soil pica include children aged 6 years and younger and developmentally delayed individuals. The panelists agreed that soil pica clearly exists, but the prevalence at a given soil ingestion rate has not been adequately characterized. Nonetheless, noting that soil ingestion is normal behavior among children, the panelists unanimously agreed that ATSDR should continue to evaluate the public health implications of all types of soil soil ingestion, including soil pica.

Chapter Four: Preventing Health Effects Related to Hazardous Substances

ATSDR achieves its goal of preventing or reducing the harmful health effects of exposure to hazardous substances by drawing on its resources in health education, risk communication, environmental medicine, and health promotion to assist communities. The types of services provided include training local physicians about the health concerns associated with contaminants to which their patients may be exposed, providing communities with information and education about the health effects of hazardous substances and providing clinical evaluations and screenings such as testing for lead exposure. ATSDR also conducts health education and promotion activities that have a nationwide focus, such as its case study program for environmental health.

These activities are conducted with the assistance of numerous partners with whom the agency has cooperative agreementsstates, American Indian tribal nations or groups, and national organizations. In fiscal year 2000 ATSDR was in the first year of a new 5-year agreement with 10 national organizations (up from 5 under the previous agreement). ATSDR also expanded its network of pediatric environmental health specialty units in fiscal year 2000 (eight are now in operation). In fiscal year 2000, ATSDR, in cooperation with its partners, performed health education and promotion activities at approximately 300 sites.

Pediatric Environmental Health Specialty Units Program

The Pediatric Environmental Health Specialty Unit (PEHSU) Program was designed to promote children's health by encouraging medical specialists with environmental expertise to work collaboratively with pediatricians to develop pediatric environmental medical expertise and to improve the ability of parents and locally practicing health-care providers to access this expertise. Starting in 1998, three pilot units were established in Seattle, Boston, and New York City. These units focused on conducting activities in the areas of medical education and training, telephone clinical consultation and outreach, and clinical evaluation of children who may have been exposed to hazardous substances in the environment.

From this modest beginning, in fiscal year 2000 the PEHSU Program has grown to include

a national network of eight operating units, including a University of California unit operating in Irvine and San Francisco
(see Figure 1.)
the addition of EPA as a partner in six of the units
an increasing international interest in
establishing similar units
the continuing and increasing interest and demand for these services from governmental agencies at all levels and from the public
opportunities to collaborate with additional partners, such as NIEHS/EPA/CDC Centers for Children's Environmental Health and Disease Prevention Research
an impact on the field of pediatric environmental health as a potential medical subspecialty
the development of a body of published articles, curricula, and educational materials.

Figure 1. Location of FY2000 Pediatric Environmental Health Specialty Units

Map showing location of Location of FY2000 Pediatric Environmental Health Specialty Units

The number of PEHSU activities has increased since the units were established. In fiscal year 1998, 123 children were evaluated in PEHSU clinics; by fiscal year 2000, 929 children were evaluated. In fiscal year 1998, the units received a total of 14,534 consultation calls from health-care providers and the public; by fiscal year 2000, the number had grown to 30,643. The number of health professionals reached with education or training was 672 in fiscal year 1998. In fiscal year 2000, the number of health professionals reached was more than 8,580.

The Cook County PEHSU took an active role in ATSDR's response to potentially widespread mercury contamination in Chicago area homes, mentioned previously in Chapter One. On July 20, 2000, a suburban Chicago homeowner discovered elemental mercury in his basement after the removal of an indoor natural gas meter that was equipped with a mercury pressure regulator. The homeowner contacted the local gas company, the EPA, and the Illinois Poison Center for health and clean-up information. The Poison Center referred the family to the Cook County PEHSU. The family, which included an 8-week-old infant, was evaluated. Shortly after that two other families were evaluated: a second family with two small children and a third family with a preteen son. These families had potential exposures and health concerns similar to those of the first family.

The director of the Cook County PEHSU met with city officials and helped develop a plan to address the community health concerns. A local health center was used to coordinate the collection of medical and exposure histories and urine specimens. The PEHSU developed a screening tool to assist local hospitals and clinics in determining individual mercury exposure and the appropriate medical followup.

By September 2000, it was recognized that more than 500,000 homes scattered over northeastern Illinois were potentially affected. Throughout this time, the PEHSU worked closely with the Illinois Department of Public Health, ATSDR, and EPA. Because of already existing working relationships, the PEHSU and these agencies were able to share information and coordinate efforts to effectively address public health concerns. The PEHSU director participated in seven televison interviews, a radio interview, and two newspaper reports. The Illinois Department of Public Health established a telephone hotline to refer health-related questions to the PEHSU.

Health Education Activities for Communities

ATSDR's health education activities are designed to assist communities in understanding, preventing, or mitigating adverse health effects associated with exposure to hazardous substances. These activities include providing information and training to health-care providers and providing information to enable people in communities to prevent or reduce their exposure to hazardous substances.

For example, ATSDR coordinated a one-day training program in fiscal year 2000 for employees of the Memphis (Tennessee) Shelby County Health Department (MSCHD). The program included information on ATSDR's public health assessment and review of cancer incidence. Approximately 15 health department staff members participated in the training. The purpose of the training was to build capacity within the MSCHD to respond to environmental health concerns related to the Memphis Defense Depot.

Exam at a Pediatric Environmental Health Specialty Unit

ATSDR is also working with a community located next to an old sanitary landfill in Juncos, Puerto Rico. ATSDR has been active in assessing the needs of the residents and providing health education for the community. During fiscal year 2000, ATSDR health educators participated in two public availability sessions, talked to the residents about ATSDR's role, explained the public health assessment process, and explained the process of an exposure investigation.

Culturally sensitive health education materials were developed to better inform the community on the status of the health evaluation process. These materials included a site-specific fact sheet, Juncos Landfill, Juncos, Puerto Rico, in English and Spanish and a flier that explained the purpose of ATSDR's visit to the community as part of the process of conducting an exposure investigation. ATSDR translated various materials for the community into Spanish, including consent forms, fact sheets, and letters explaining the purpose of ATSDR's visit in November 1999 to conduct an exposure investigation.

Educating Health Professionals Nationwide

ATSDR works through a variety of mechanisms to provide health education and information to health professionals nationally. Activities may include Grand Rounds presentations, off-site seminars and workshops, newsletters, fact sheets, satellite broadcasts, and Web-based training. ATSDR often enters into partnerships with other organizations in these efforts, including national organizations, local universities, and professional societies. Currently, ATSDR health education activities have been focused on implementing a national strategy to provide environmental health training for nurses and other frontline health care providers, and expanding partnerships in environmental health expertise.

Distance Learning Program

ATSDR, working with CDC's Public Health Practice Program Office, developed two Public Health Training Network courses in fiscal year 2000GIS in Public Health: Using Mapping and Spatial Analysis Technologies for Health Protection and Environmental Health: A Nursing Opportunity. Nearly 2,000 public health professionals viewed each course.

Environmental Health: A Nursing Opportunity, a 2½-hour program, was broadcast live on August 10, 2000. The program focused on environmental health and the integration of environmental health into nursing and other health care professional practice. The program provided specific tools (for example, the Taking an Exposure History case study in an environmental medicine template) and demonstrated how to implement the tools in actual practice. Nurses, nurse practitioners, physicians, educators, and other health professionals assisted in program presentation.

Environmental Health a Nursing Opportunity

The live program was broadcast in 48 states in the United States, with a total of 561 registered downlink sites. There were also sites registered in Canada. The highest number of sites registered in a single state was 48 (Florida). Twenty-one states had 10 or more registered downlink sites. A total of 2,163 participants registered to view the live program. California had the most registrants (248); other states where participation was particularly high included Wisconsin (224) and Florida (170). Continuing education credits (CMEs, CNEs, and CEUs) were awarded to participants who completed the course evaluation and examination. To date, approximately 200 requests have been received for videotapes of the program.

Developing GIS data

The GIS program, GIS in Public Health: Using Mapping and Spatial Analysis Technologies for Health Protection, provided an introduction to the application of GIS technology and the use of health data in the decision-making and resource allocation process. It focused on the opportunities that GIS offers that are useful in public health, such as mapping the locations where cases of a specific disease have been found or in evaluating the adequacy of existing health resources. It was intended to familiarize health professionals with the ways that GIS can be used in public health. The 1,945 registered participants included environmental health professionals, health resource planners, health assessors, and health care providers.

Health Promotion Activities at Sites

Health promotion supports three key goals: prevention (proactive actions to prevent the adverse effects of hazardous substances), intervention (actions to diminish or eliminate adverse consequences of exposure to hazardous substances), and capacity building (actions to strengthen existing public health infrastructures to enhance environmental health services for affected communities). Following are two examples of sites where ATSDR conducted health promotion activities in fiscal year 2000.

Health Promotion Activities in Libby, Montana

One of the sites at which ATSDR conducted health promotion activities in fiscal year 2000 was in Libby, Montana. ATSDR, in cooperation with the Association of Occupational and Environmental Clinics through the National Jewish Medical and Research Center in Denver, Colorado, developed a training program for health care providers in Libby and Kalispell, Montana. The training was held on September 18 and 19, 2000. It was developed with the assistance of pulmonologists from the center and a Spokane physician.

Grand rounds were held at the hospital in Kalispell on September 18; 48 physicians, nurses, and physician assistants attended. The objectives of the presentation were to review the epidemiology and pathogenesis of nonmalignant lung disease from exposure to tremolite asbestos, and to discuss the clinical manifestations and diagnosis of nonmalignant asbestos-related lung diseases.

Evening training sessions were held in Libby on September 18 and in Kalispell on September 19. The session in Libby was attended by 14 physicians, nurses, and physician assistants; the Kalispell session was attended by 26 participants. The objectives of the evening presentations were to review the purpose of screening evaluations for asbestos-related lung diseases and discuss appropriate diagnostic followup of screening abnormalities, to identify practical approaches to medical management, and to generate a dialogue about education and risk communication strategies for patients with asbestos-related diseases. The presentations included didactic and interactive case-based discussions.

ATSDR has also been active in trying to assist the community in improving its access to needed medical care.

Health Promotion Activities in Ottawa County, Oklahoma

ATSDR worked with Ottawa County public health officials to create a Lead Poisoning Prevention Program to address concerns of residents living near the Tar Creek Superfund site. The site is inside Oklahoma's portion of the Pitcher Field mining region, an area that has had extensive lead and zinc mining. Tar Creek has been on the National Priorities List since September 1983. Children who live or play near mine tailings piles may ingest or inhale lead-contaminated dust. These piles have also been used by riders of off-road vehicles, and houses have been built on the tailings.

The prevention program has three goals. The first goal is to develop community-relevant health education and outreach strategies that will update and inform Ottawa County residents regarding the lead poisoning problem in the Tar Creek Superfund site and surrounding areas. The second goal is to continually monitor blood lead levels in Ottawa County children through the creation of a multipurpose database that facilitates tracking, information sharing, and the measurement of community impact. The third goal is to determine the incidence of Ottawa County children with learning disabilities from visual and/or cognitive deficits that represent barriers to education.

The program used a mobile education and blood-testing unit that visited Head Start centers and kindergartens in Ottawa County's seven school districts during the 19992000 school year. The program screened 127 children enrolled in Head Start and 122 kindergarten children. In addition, 600 blood level screenings of children and pregnant women were performed through the county's Women, Infants, and Children (WIC) clinics. A database was created to track blood lead levels and interventions and to provide information to EPA for pathway analysis and, when necessary, cleanup. Additionally, parents of children identified with elevated blood lead levels received referrals and educational materials. Fifty children had blood lead levels that were above the level of health concern, 10 micrograms per deciliter; these children are being rechecked every 3 months.

ATSDR's Health Education and Promotion Partnerships with National Organizations

ATSDR has worked with a variety of national organizations since 1989, and conducts many public health education and promotion activities through collaborative projects and partnerships with national organizations of health professionals. These activities build capacity by increasing knowledge of environmental medicine and public health issues for members of the participating organizations and by helping members address the public health concerns of the people and communities they serve. In fiscal year 2000, ATSDR reached more than 80,000 health professionals through its funding of the following 10 national organizations.

American Academy of Pediatrics (AAP)
American Association of Occupational Health Nurses (AAOHN)
American College of Medical Toxicologists (ACMT)
American College of Preventive Medicine (ACPM)
Association of Occupational and Environmental Clinics (AOEC)
Association of State and Territorial Health Officials (ASTHO)
Migrant Clinicians Network (MCN)
National Alliance for Hispanic Health
National Association of County and City Health Officials (NACCHO)
National Environmental Health Association (NEHA).

For example, ATSDR's collaboration with the Migrant Clinicians Network (MCN) has led to the completion of an extensive mapping project of more than 1,500 membersincluding nurses, physicians, health educators, outreach workers, and directors of migrant health clinicsto identify and prioritize environmental health issues and health education needs on a regional basis. This needs assessment and mapping effort will enable MCN to effectively target its environmental health educational messages and activities.

ATSDR's work with the National Association of County and City Health Officials (NACCHO) resulted in training for 30 local health officials and community members in June 2000. This training will enable local health departments to be more effective partners with state and federal agencies and more effective advocates for community health concerns. In fiscal year 2000, NACCHO published Community Revitalization and Public Health. This document is considered to be a landmark in defining public health issues, roles, and relationships in the Brownfields redevelopment process, and more than 1,250 copies have been distributed to local and state health departments and federal agencies.

ATSDR has also developed health education and promotion partnerships with Tribal Nations. American Indian and Alaskan Native populations exposed to hazardous substances from waste sites, accidental spills, and other sources of environmental pollution are sometimes at greater risk than the general population for adverse health effects. As a federal agency, ATSDR works directly with American Indian and Alaskan Native populations to prevent dangerous environmental exposures that can result in negative health outcomes or diminished quality of life.

In 1999, ATSDR initiated a cooperative agreement program with four tribal colleges and universities to build programs for environmental public health. Under this agreement, ATSDR provides technical assistance in environmental health science and toxicology. The four participants in the program are the College of Menominee Nation, Dine College, Northwest Indian College, and Turtle Mountain Community College. The program is designed to help tribal colleges and universities develop environmental health curricula. For example, through the program Dine College plans to offer an associate of science in public health degree program to increase the number of Navajo health professionals. The program will have an environmental public health track.

Risk Communication and Research Activities

Health risk communication is an emerging area of emphasis and importance at ATSDR and in parts of the broader public health community. Over the past decade, health risk communication has played an integral part in ATSDR's comprehensive efforts to prevent or mitigate adverse human health outcomes related to hazardous substance exposure. Effective risk communication involves more than merely explaining a health or environmental risk to the public. ATSDR has been working with its health-care partners to develop effective and relevant health communication strategies and messages. Messages are tailored for targeted audience needs (for example, cultural-, age- or sex-specific).

Communications Training Activities

An interactive health risk communications training course was held in Pachuca, Mexico, the capital of the state of Hidalgo, from May 31, 2000, to June 2, 2000. The course objectives included enabling participants to (1) identify the elements that affect health risk perception; (2) describe the stages in health risk communication planning, implementation, and evaluation; and (3) write a plan for a specific target audience. Techniques such as role playing, creation of materials, and values clarification were used. Workshop evaluations revealed that participants thought the program content was useful for their work, the materials were effective, and their expectations were met.

Approximately 2,000 people who live in the communities nearby benefitted from the workshop. Because the participants work with communities in other parts of Mexico, the potential benefit of the workshop was even greater. Benefits included improved interagency coordination and improved ability to deal with environmental health problems. The workshop also opened a door to future collaboration between ATSDR and the state of Hidalgo.

Communication Strategies and Message Development for Targeted Audiences

The purpose of this project was to (1) develop environmental education relationships with schools that are near toxic waste sites; (2) educate and empower children and teachers within the Kids for Saving Earth (KSE) network to better understand the earth's environmental problems and to provide them with action-oriented, noncontroversial, and engaging educational materials and activities; and (3) inform children about the role of government agencies in environmental programs. In fiscal year 2000, KSE designed a poster and worksheets to teach youngsters about how to deal with the consequences of toxic waste sites. Children's artwork was included in the designs. KSE sent packets of environmental information to 4,000 schools nationwide, encouraging students to become members of the organization and to use the KSE Web site.

KSE and ATSDR are currently working together to expand last year's outreach program to educators and children. KSE will adapt the educational materials so that they are culturally relevant for a Spanish-speaking audience by translating them and inserting appropriate artwork. The materials will be pretested with members of the target audience. Each culturally appropriate set of materials will be mailed to 7,000 schools. Web-site materials will also be created and placed on KSE's Web page, on the Web page of ATSDR's Office of Children's Health, and on CDC's new children's and Spanish language Web pages.

Appendix A: Sites at Which ATSDR Conducted Activities in FY 2000

HA = public health assessment
HC = health consultation
HE = health education
HS = health study
EI = exposure investigation
ER = emergency response

The following list shows the sites at which ATSDR conducted public health activities in FY 2000, specifically public health assessments, health consultations, health education and promotion, health studies, and emergency response activities. Consultations that are not site specific are not listed. The listing uses these abbreviations:

Alabama
Alabama Methyl Parathion Sites HE
Alabama Plating Company HE
American Brass Inc. HA, HE
Anniston Army Depot HE
Anniston PCB Site
(Monsanto Co.) EI, HA, HC, HE Capitol City Plume HE
Ciba Geigy HE
Hartzog Farm HC
Marshall Space Flight Center HE
Olin Chemical-McIntosh HE
Perdido Groundwater HE
Redwing Carrier HE
Stauffer Chemicals HE
T.H. Agriculture & Nutrition HE
Triana/Tennessee River HE
Redstone Arsenal HE
Wadsworth Brookview HE

Alaska
Alaska Pulp Corp. HA, HE
Arctic Surplus HE
Cape Thompson/Pt. Hope HE
Dutch Harbor HE
Ketchikan Pulp HE
Kodiak HE
Standard Steel and Metals HE
U.S. DOT FAA Umiat Airstrip Staging HE

Arizona
ASARCO Mining HA
Brush Wellman Inc. HC
Franklin Elementary School HA, HE
Klondyke Tailings HA, HE
Litchfield Airport Area HA
Lynx Creek HE
Mountain Pressure Treating HE
Nineteenth Avenue Landfill HC, HE
Phoenix Goodyear Airport HE
Tucson International Airport Area HA, HC, HE
Tucson laboratory accident ER
Union Hills Area HC
Vulture Mill Site HA

Arkansas
Ashgrove Cement HE
Great Lakes Chemical Corp. HA
Gurley Pit HE
Helena Chemical Company HC, HE
Koppers Industries HE
Magcobar Mines HE
Mercury Issue—Saline River Basin HE
Methyl Parathion—W. Jacksonville HE
Mountain Pine Pressure Treatment Plt. HE
Red River Aluminum HE
Rixie Iron & Metal HE
Robbins/Sykes HE
South 8^th St., W. Memphis HE
Sykes Flooring Products HC
Texarkana Air Quality HC
Texarkana (Pleasant Hills Community) HE
Vertac HE

California
Abex/Remco HE
Alameda Naval Air Station HE
Bernal Property HC
Burbank elementary school HE
Chevron fire ER
Chrome Crankshaft HC, HA
Conoco Service Station
Soil Contamination HC Del Amo HC, HE
Chrome Crankshaft/Suva School HE
Florence Griffith Joyner School HE
Fort Ord HE
Frank Street Dump HC (2)
J&S Chrome Plating HA, HC
Koppers Co., Inc. (Oroville Plant) HA
Lawrence Livermore Laboratory
(U.S. DOE) HC, HE
Lockheed Propulsion Co. HA
March Air Force Base HA
Mather Air Force Base HA
McFarland Study Area HA
McMinn Avenue HE
Mission Valley EI
Molycorp Inc. HC, HE
Montrose Chemical Corp. HC
New River HE
Pasadena TCE exposure incident ER
Purity Oil Sales, Inc. HC
Santa Susana Field Lab HE
Shasta County mercury spill ER
Sierra Army Depot HE
Sunnyvale residential mercury spill ER
Torrance, chemical reaction ER

Colorado
ASARCO Globe Plant HE
Air Force Plant PJKS HA
Cripple Creek & Victor Gold Mining HC,HA
Denver, pesticide exposure incident ER
Pueblo Chemical Depot HE
Rocky Flats Plant (DOE) HE
Vasquez Blvd. and I-70 HE
Victor Mine HE

Connecticut
Barkhamsted_New Hartford Landfill HC
Bristol Radium Sites HE
Coppola Metals HC, HE
Mallory Hat Factory HC
Millbrook Condos HC, HE
New Haven School ER
New Haven Radium Sites HE
Old Southington Landfill HC (2), HE
Raymark Industries, Inc. HC, HE
Remington Park HC
Scovil Industrial Landfill HA, HE
Thomaston Radium Sites HE
University of Connecticut
Landfill/waste pits HC (2), HE
Upjohn Company
Fine Chemicals Division HA, HE
Waterbury Clock Factory HE
Yaworski Landfill HA
Yaworski Waste Lagoon HA

Delaware
Standard Chlorine HE
District of Columbia Glover Bridge Site HC
HUD Building fire ER
Transformer fire ER
Washington Naval Shipyard HE

Florida
5th & Cleveland Incinerator Site HC
Alaric Incorporated HA, HE
Anclote Florida Power Plant HA
Brown's Dump HA, HC, HE
Calloway & Son Drum Service HA, HE
Doeboy Dump HC
Gulf Coast Lead Co. EI
Holiday Utilities HC
J & J Signs EI, HC
Landia Chemical Co. HA, EI, HE
Material Exchange Corp. Landfill HC, HE
Orlando residential mercury spill ER
Orland Airport spill ER
Precision Fabricating and Cleaning Co. HC
Queens 41 Auto HE
Sanford Gasification Plant HA, HE
Solitron Devices Inc. HA
Solitron Microwave HE
Southern Solvents, Inc. Site HA, HC, HE
Stauffer Chemical Co. (Tarpon Springs) HC
Tower Chemical Co. HC
Trans Circuit Inc. HA, HE
Tuttle Elementary School HC
Tyndall Air Force Base HA
Whiting Field Naval Air Station HA

Georgia
Allied Universal Corp. HE
Arivec Chemicals Inc. HA
Athens Clarke County Landfill HC
Atlanta Steel HE
Brunswick HE
Camilla Wood Preserving Company HA
Coastal Plain Treating Co. HC
Hydrofluoric acid spill ER
Lawrenceville, train derailment ER
Newtown Community HA
Marine Corps Logistics Base HA, HE
Mindis Corporation HE
Montezuma Abandoned Landfill HE
Newtown Community HE
Oakwood Mobile Home Park HE
Richmond County Health
Intervention Project HE
Savannah River Site HE
Seminole Road Landfill HC
Terry Creek Dredge Spoil Area/
Hercules Outfall HC
T.H. Agriculture & Nutrition (Albany) HA
Tri-State Steel Drum Co. Inc HA, HE
U.S. Army Corps of Engineers Airstrip HA
Young Refining Corporation HA
Woolfolk Chemical Works, Inc. HC, HE

Guam
Naval Air Station Agana HE
Idaho
Blackbird Mine EI, HE
Bunker Hill Mining
& Metallurgical HC (3), HE
Coeur d'Alene River Basin HC (3), HS
Eastern Michaud Flats Contamination HC, HE
Idaho National Engineering Laboratory HE

Illinois
A & F Material Reclaiming, Inc. HC
Action Wrecking Inc. HC
Amoco Chemicals (Joliet Landfill) HC
Barrie Park Former Manufact. Gas Plant HC
Belleville/Metropolitan HC
Bohn Heat HA
Chicago clinic mercury spill ER
Chicago Copper and Chemical Company HC
Chicago metro methyl parathion site HC, HE
Chicago mercury spill ER
Cross Brothers Pail
Recycling (Pembroke) HC, HE
Depue/New Jersey Zinc/Mobil
Chem. Corp. HA
Edwards W.E. HC
Evergreen Manor Contamination Plume HA
Flora fire ER
Former Creosote Forest Products HC
Gulf Mobile and Ohio Railyard EI, HE
Ilada Waste Company HC
Illinois Beach Park HA
Indian Refinery—
Texaco Lawrenceville HA, HE
Joliet Army Ammunition Plant
(Manufacturing Area) HA
Joliet Army Ammunition
Plant (Lap Area) HA
Koppers Inc. Forest Products Group HA
LaSalle Electric Utilities HE
Lindsay Light HC
Matthiessen & Hegler Zinc Co. HE
Metro Disposal System Incorporated HC
Mobil Oil Accidental Release HE
New Jersey Zinc/Mobil Chemical HE
Nicor mercury spill ER
Nike Missile Site HE
Nordic Acres Groundwater HE
Oak Park Manufacturing HE
Ottawa Radiation Areas HE
Pagel's Pit HC
Parsons Casket Hardware Company HA
Peoria State Hospital HC
Peru mercury spill ER
Pfizer Inc. HA
Riverdale Chemical HC
Rust-oleum Corp., Evanston Facility HC
Savanna Army Depot Activity HA
Smith Douglas, Inc. HE
Tesla High School Mercury spill ER
Thomas Garage Service HC
U.S. Army Fort Sheridan HC
U.S. DOE Argonne National Lab (317) HA
U.S. DOE Argonne National Lab (318) HA
Yeoman Creek Landfill HC

Indiana
Bloomington mercury spill ER
Bowman School EI
Conrail Rail Yard (Elkhart) HC, HE
Frank Foundries Corporation HC, HE
Gary school mercury spill ER
Hoosier Wood Treating HC
Keil Chemical HE
Main Street Well Field HC
Vickers Warehouse Site HA

Iowa
3rd Avenue Mercury EI
Bernstein Salvage Site HC
Clinton Coal and Gas HE
Coggon Creamery HC
Cresco mercury spill ER
Dubuque Municipal Landfill HC
Electro-Coatings, Inc. HA
Former Diller Battery HC
Iowa Army Ammunition Plant HA

Kansas
57^th and North Broadway HE
Container Recycling, Inc., Kansas City HC
Chemical Commodities, Inc. HA
Fort Riley HA

Kentucky
Bellevue Park HC
LLD Site HC
National Electric Coil HE
Paducah Gaseous Diffusion Plant HE
Rubbertown Plant HE

Louisiana
Agriculture Street Landfill HC (3), HE
Calcasieu Estuary HC, EI, HE
Central Wood Preserving Co. HA, HE
Devil's Swamp Lake HC
D.L. Mud, Inc. HE
Eunice train derailment ER
Grand Bois HE
Highway 71/72 Refinery HA, HE
Lincoln Creosote HA
Maurin Wood Preserving HC
Mossville HE
New Orleans Methyl Parathion Sites HE
Norco Community Industry Panel HE
PAB Oil HE
Renner Creosoting HC
Ruston Foundry HA, HE
Thompson Hayward HE
Texaco Inc. Shreveport Works HC
Union Creosoting (Union Post Co.) HC

Maine
Portland, biohazard spill ER
Waldeborough School Mercury Spill ER

Maryland
68th Street Dump/Industrial
Enterprises HA, HE
Andrews Air Force Base HC
Brandywine Defense Reutilization and
Marketing Office HC
Central Chemical (Hagerstown) HA
Fort George G. Meade HA
Industrial Enterprises HA
Prince Georges County arsenic removal ER
Spectron, Inc. HE

Massachusett
Allied Auto Body HE
Alphagary Corporation HC
Atlas Tack Corp. HA
Baird & McGuire HE
Borne strychnine incident ER
Boston Edison HE
Coastal Oil HE
Fort Devens HA, HE
GE — Housatonic River HA (4), HC (2), HE
Glen Street Neighborhood HA
Hatchery Road HA, HE
Jamesbury Corp. HC
Laidlaw (Plainville) Sanitary Landfill HE
Marshall Farms Inc. HC
Materials Technology Laboratory
(U.S. Army) HC
MBTA Railyard HE
Merrimack Valley HE
Modern Electroplating HE
Morse Cutting Tools HA
New Bedford Harbor HE
Nuclear Metals HE
Nyanza Chemical Waste HE
Otis Air National Guard HC, HE
Paint Shop Pond HE
Rocco's Disposal (Sutton Brook) HE
Rock Avenue Landfill HA
Salem Power Plant HE
Seaver Street HE
Somerville/Tufts Admin. Bldg. HE
Teledyne Rodney Metals HE
Wells G and H, Woburn HE

Michigan
Bear Archery Disposal Property HC
City of Hillsdale Property HC
Closed Hamlin Road Landfill East HC
Closed Hamlin Road Landfill West HC
Florida Gas HC
Gratiot Avenue Trailer Park HC
Hartford School Athletic Field HC
Johnson Iron Industries HC (2)
Joy Road Dump/Holiday Park HC
Kalamazoo River HS
Kellogg Property HC
Lafarge Corporation, Alpena Plant HA
LFPR, Inc. HC
Melvindale Allen Road HC
Miller Middle School mercury spill ER
Nagel Residence Site HC
Par Don Manufacturing HC
Old Charcoal Iron Property HC
Old Smokestack Property HC
Portage Metal Finishing Co. HC
SER Plating Company HC
Velsicol Chemical Michigan HE
Ward Bakery HC
West Beitz Creek Fill Area HA

Minnesota
2303 Kennedy Street HC
Agate Lake Scrapyard HC
Aitkin Municipal Wellfield HC
American Linen (Ameripride) HA
Ashland Refinery HE
Baytown Township Ground
Water Plume HC, HE
Co-operative Plating HE
Faribault Municipal Well Field HE
FMC Corp. (Fridley Plant) HE
Hawkins Chemical Co. HE
Hidden Lakes Development HC, HE
Interplastic Corp. HC, HE
Kennedy Street Building HE
Naval Industrial Reserve Ordinance Plant HE
New Brighton/Arden Hills/TCAAP
(U.S. Army) HC
Nutting Truck & Caster Co. HC
Pigs Eye Landfill HC, HE
Rochester freon spill ER
St. Louis River/ U.S. Steel HE
St. Regis Paper HE
Waite Park Wells HC
Western Mineral Products HE

Missouri
Amoco Oil Co. HA, HC (3), HE
Big River Mine Tailings/St. Joe Mine HE
Bonne Terre HE
Cafo Farms HE
Defiance Dump Sites HC
Doe Run Lead Co. Tailings HE
Elvins Mine Tailings HE
Federal Mine Tailings HE
Former Hulett Lagoon HE
Hayden Creek Tailings HE
Hubert Wheeler State School HC
Leadwood Mine Tailings HE
Madison County Mine Tailings HE
Missouri Electric Works HC (2), HE
National Mine Tailings HE
Newton County Wells EI, HC
Newton County Mine Tailings HE
Pools Prairie HA, HE
Quality Plating HC
Quail Run Mobile Manor HC
S & S Landfill HC, HE
St. Louis mercury spill ER

Mississippi
Jackson County Pesticide Sites HE
Picayune Wood Treating Site HC

Montana
Alberton Train Derailment HE
Burlington Northern — Livingston HE
Libby Asbestos Site HC (2), HE
Lockwood Solvents Site HC (2)
Milltown Reservoir Sediments HC (2)
Mouat Industries HE

Nebraska
Omaha Lead HC
Dakota City/ S. Sioux Hydrogen Sulfide HE

Nevada
Nye County, hydrogen sulfide exposure ER
Nevada Test Site HE

New Hampshire
Cardinal Landfill HA, HC, HE
Concord, landfill fire ER
Gendron Junkyard HE
Johns Manville/Nashua River HE
J. P. Stevens Textile HC (3)
Messer Street Manufactured
Gas Plant HA, HC, HE
Mohawk Tannery HE
Savage Municipal Water Supply HE
Surrette America Battery HC (4), HE

New Jersey
Atlantic State Cast Iron Pipe HA
Borough of Hawthorne HE
Brick Township Investigation HA, HE
Burlington Co. Res Recovery Complex HC
Chemical Insectide Corp. HE
Chemical Leaman Tank Lines HE
Chemsol, Inc. HC
Ciba-Geigy Corp. HA, HE
Cinnaminson Ground
Water Contamination HA, HE
Combe Fill North Landfill HC
Cornell Dubilier
Electronics Inc. HA,HC (2), HE
Dover Township Municipal Landfill HE
Dover Township Public Water Supply HC, HE
Emmell’s Septic Landfill HA, HC, HE
Federal Creosote HA, HE
Fort Dix (Landfill Site) HA
Franklin Burn HE
Glen Ridge Radium Site HC (2)
Hawthorne Municipal Wells HA
Horseshoe Road HC, HE
Iceland Coin Laundry
and Dry Cleaning HA, HE
Lightman Drum Company HA, HE Martin Aaron, Inc. HA, HE
McGuire Air Force Base #1 HC
Mercury Trading Inc. HC
Middlesex Sampling HE
Monroe Township Groundwater
Contamination Site HC (2)
Reich Farms HE
Rhodia Inc. HE
Rhone-Poulenc Chemical Co. HE
Route 561 Dump HA, HE
United States Avenue Burn HA, HE
Vineland Chemical HE

New Mexico
Fort Wingate Depot Activity HC
Fruit Avenue Plume HA
Los Alamos wildfire ER
Los Alamos Scientific Laboratory HE
North Railroad Avenue Plume HE
Soccorro tire fire ER

New York
102nd Street Landfill HE
3M/ Dynacolor/GE HE
Abby Street Hickory Wood Subdivision HC, HE
Alco Aggregate HE
Anitec Image Corp HA
APCO/Woodstock Brownfield HE
Barker Chemical HC, HE
Brookfield Avenue Landfill HA
Circuitron Corp. HC
Fort Edwards, tank car ammonia spill ER
Fresh Kills Landfill HA
Fulton Avenue HA
Goldisc Recordings, Inc. HC
Griffiss Air Force Base HE
Hamburg Nike HE
Hickory Woods HE
Hillcrest Cancer Cluster, Broome County HE
Hiteman Leather HA, HE
Hooker (102nd Street) HC
Hooker-Ruco HE
Hudson River PCBs EI, HE
Huntington Town Landfill HA
Jones Chemical HE
Lehigh Valley Railroad HA
Little Valley HA
Love Canal HE
Mohonk Road Industrial Plant HE
NYC hospital ER
Old Ithaca Dump HE
Pelham Bay Landfill HA, HE Peter Cooper Corporation (Markhams) HA
Peter Cooper Corporation (Gowanda) HA
Plattsburgh Air Force Base HA
Prima Asphalt HE
Sealand Restoration HE
Shenandoah Rd. Groundwater HE
Sidney Landfill HA
St. Regis Mohawk Reservation HC
Seneca Army Depot HA, HE
Southside High School HE
Stanton Cleaners Area
Groundwater HA, HE
Tri-Cities Barrell HE
Village of Liberty Water Supply-Elm St HA
Waterford HS

North Carolina
Aberdeen Pesticide Dumps HA
Barber Orchard HC (2), EI
Benfield Industries HE
Camp Lejeune HE
Cartrette Field HC
Davis Park Road TCE HE
Geigy Chemical Corp.
(Aberdeen Plant) HA
Georgia-Pacific Corp.
Hardwood Sawmill HA, HE
Marshallberg mercury spill ER
North Belmont PCE HC, HE
Parmele train derailment ER
Paw Creek Bulk Petroleum Terminal HC
Scottland cottonseed fire ER
Trinity American HE, HS

North Dakota
Bismarck, chemical reaction ER

Ohio
Baker Woods Creosoting HCEagle Picher HA
Elano Corp. HE
Fayette Tubing HE
Feed Materials Production Center HA
Geauga Industries HC
Kirby Tire Company HA, HC (2), HE
Maple Heights chemical reaction ER
Marion County HC
Nease Chemical HC
North Sanitary Landfill HA, HC
Old Delaware City Landfill HC
Old Tiffin City Landfill HE
Rickenbacker Air National Guard (USAF) HA
Tiffin Landfill HC (2)
Skinner Landfill HE
Van Wert Mercury Site HC (2)
Windham Alloys HC
Winton Ridge Landfill HC
Wright-Patterson Air Force Base HA, HC
Van Wert Mercury Site HE

Oklahoma
Tar Creek HE Tulsa Fuel and Manufacturing HA

Oregon
Oregon State Penitentiary HETaylor Lumber and Treating, Inc. HC (2)

Pennsylvania
Air Products HEAltoona Westerly Sewage Treatment Plant HC
Bartonsville trailer incident ER
Bizzarro Junkyard HC
Callery Chemical Company HA
Clements Landfill HC
Fischer & Porter Co. HC
Hamburg Field
Landis Lane Site HC
Lefever Dump HC, HE
Marjol Operation HC, HE
Mercer Spring & Wire HC
Nine Mile Run Slag Area HC (2), HE
Old Wilmington Road
Groundwater Contamination HA
Precision National Corp. HC (3), HE
Roxboro Dioxin Site HC
Safety Light Site HC (3)
Skippack Township (North Penn - 8) HE
So. Philadelphia Subsurface
Petrol. Plume HE
St. Mary’s Borough Landfill HE
Tamaqua fire ER
Tollbrothers HC
Tri-County Landfill HC, HE
U.S. Army Keystone Ordnance HE
Warwick Township Real Estate HC, HE
Wilkes-Barre Steam Heat Building HC

Puerto Rico
Caugas spill ERGuaynabo River spill ER
Juncos Landfill EI, HE
M/V Sergio Zakariadze ER
Scorpio Recycling HC
Union Carbide Grafito HC
Vieques HE

Rhode Island
Central Landfill HCCentredale Manor Restoration Project HE
Davisville Naval Construction
Battalion Center HE
H & H Rack, Inc. HC
M. Earl Adams Co. HC
R & R Jewelry Inc. HC

South Carolina
Aqua-Tech Environmental Inc. HA, HEArkwright Dump HC, HE
Big Creek Landfill HC
Columbia Organic Chemicals Inc. HC
Davisville Naval Construction
Battallion Center HA
International Minerals and Chemicals HC
Palmetto Recycling, Inc. HC
Sangamo Weston/Hartwell PCB EI, HE
Sarratt Property HC
Savannah River Site HE
Shuron Textron, Inc. HE

Tennessee
Arnold Engineering Development Center (U.S. Air Force) HA
Chemet Co. HA
Flura Corporation HC (2)
Jersey Miniere Zinc Co. HA Harpeth River Site HC (2)
H. O. Forgy & Son Inc. HC
Knoxville perc spill ER
Memphis Defense Depot HA
Memphis, glycol spill ER
Memphis/Shelby County
Methyl Parathion HE
Nashville, residential mercury spill ER
Oak Ridge National Laboratory HE
Tennessee River HC
Tullahoma, residential mercury spill ER

Texas
Air Force Plant #4 (General Dynamics) HCAlcoa (Point Comfort)/Lavaca Bay HC, HE
Brownsville Furfural spill ER
Corpus Christi Landfills HE
City of Perryton Well No. 2 HA
Dallas water supply chemical spill ER
Doyle Transformers Site HC
East Texas Lakes HE
Garland Creosoting Co. HA
Galveston chemical exposure ER
Hart Creosoting Company HA
Holly Street Power Plant HA
J & J Plastics HE
Kelly Air Force Base HC (2), HE
La Costex Refinery HC
Many Diversified Interests, Inc. HA, HE
Melton Kelly Property HC
Newell Recycling HC
State Road 114 Groundwater Plume HA
Star Lake Canal Site - Port Neches HA
Tessman Road HE
Texas City Methyl Parathion Sites HE
Tex-Tin Corp. HC
Upper Galveston Bay HC

Utah
Clandestine drug production labs HEEureka Mills HE
Former Miller Floral &
Green House Site HE
Intermountain Waste Oil Refinery HE
International Smelting and Refining HA, HE
Jacobs Smelter Site HA, HE
Ogden Rail Yard HE
Petrochem Recycling Corp.
/Ekotek Plant HC
Staker Paving Asphalt Production HE

Vermont
Downtown Burlington Air Quality HCLakeside Community sites HE
Pownal Tannery HA, HE

Virginia
Abex Corp. HC, EIBedford mercury exposure ER
Former Nansemond Ordnance Depot HA
Naval Amphibious Base Little Creek HC
Norfolk Naval Shipyard HC
Oldover Corp. HC

Virgin Islands
Anguilla Landfill HC, ERBovoni Dump HC

Washington
Able Pest Control HEBainbridge Island Landfill HE
Bangor Ordnance Disposal (U.S. Navy) HA
Bangor Naval Submarine Base HA, HE
Basin Oil HE
Bertrand Creek Area Properties HA, HE
B & L Wood Waste HE
Burlington Northern HE
Cascade Pole HE
CENEX - Quincy HE
Chemcentral HC, HE
Cleancare Corporation HC, HE
Everett Landfill HE
Hamilton Road HE
Hanford Site HE
Holman Cement HE
Inland Empire Plating HC, HE
International Airport HE
Interstate Coatings HE
Kah Tai Lagoon HE
Kitsap County,
Bainbridge Island Dump HC
Klickitat Valley Sawmill HE
Lewis County Central Maint. Shop HE
Lynnwood Plating Inc. HC
Long Painting Company HC, HE
Malarkey Asphalt HE
Midnite Mine HA, HE
Mt. Pleasant Landfill HE
Northwest Cooperage HE
Oeser Company HE
Palermo Wellfield HE
Paradis Road HE
Port Hadlock Detachment (U.S. Navy) HA
Procoat International HE
Rayonier Inc. Mt. Pleasant Landfill HC (2)
Rayonier Inc. 13th & M St. Landfill HC Rayonier Mill HA, HE
Sisco Landfill HC
Skyline Public Water System HE
South Park/Georgetown HC, HE
Spokane River Sediments HE
Sylvan Way Land Company- Sand Pit HC (2)
Toxgon Corporation Seattle HC
U.S. Department of Interior,
Kabba-Texas Mine HC
Washougal Compressor Station HE
Western Farm Service, Harrington HC
Wilder Landfill HE
Wolph’s Second Hand Store HC, HE
Y Road Landfill HE

West Virginia
Fairmont Cullet Pile Site HCFike Chemical, Inc. HC
Heizer Creek HC (2)
Manilla Creek HC
Midwest Steel HC
Poca Drum Dump HC
Sharon Steel HE
South Charleston Municipal Landfill HC
Vienna Tetrachloroethene HA

Wisconsin
American Quality Fibers HEAshland NSP Lakefront HE
Badger Army Ammunition HE
Boerke Landfill HE
Coliseum Office Park HC
County A Road Sludge Disposal HA, HC
Fox River PCB Releases HE
Freedom MTBE Plume HE
Hartland Chemical Company HC (2)
Hydrite Chemical HE
Lincoln Creek Groundwater Plume EI
Madison Kipp Corp. HE
Miller Compressing Company, Inc. HC
Model Road Illegal Drug Laboratory HC
Modern Sewer Service HC
National Auto Wrecking HC
Newton Creek/Hog Island HE
P&G School Bus Service HC
Weisenberger Tie and Lumber Co. HC
Western Wisconsin Ready Mix HC

Wyoming
F.E. Warren Air Force Base HA
North Casper PCE HE

Appendix B: Toxicological Profiles Prepared in FY 2000

Under Development
Aldrin/Dieldrin (Update)
Beryllium (Update)
Creosote (Update)
DDT/DDE/DDD (Update)
Di(2-ethylhexyl) phthalate
Hexachlorobenzene (Update)
Methoxychlor (Update)
Perchlorates

CERCLA

Public Comment Draft
Asbestos (Update)
Arsenic (Update)
Benzidine (Update)
Chromium (Update)
1,2-Dichloroethane (Update)
Di-n-butyl phthalate (Update)
Endosulfan (Update)
Ethion
Manganese (Update)
Methylene chloride (Update)
Methyl parathion (Update)
Pentachlorophenol (Update)
Polychlorinated biphenyls (Update)
Toluene (Update)

U.S. Department of Defense

Final Toxicological Profiles
Total petroleum hydrocarbons

U.S. Department of Energy

Final Toxicological Profile
Uranium (Update)
Ionizing radiation

Under Development
Americium
Cesium
Cobalt (Update)
Iodine
Strontium

Appendix C: ATSDR Resources on the Internet

ATSDR has many documents on its Internet site that provide information about specific sites, substances, agency programs, and activities. These include full public health assessments for a number of sites, easy-to-read fact sheets on toxic substances (ToxFAQs), and case studies for health care professionals. ATSDR's Internet address is www.atsdr.cdc.gov

Some of the resources available on the Web site are listed below.

1999 CERCLA Priority List of Hazardous Substances A Primer on Health Risk Communication Principles and Practices
Alaska Native Subsistence and Dietary Contaminants Program
An Evaluation Primer on Health Risk Communication Programs and Outcomes
ATSDR Cancer Policy Framework
ATSDR National Alerts Toxic Substances
ATSDR Public Health Advisories
ATSDR Public Health Assessments
ATSDR Science Page
ATSDR Statement of Values
ATSDR's Most Frequently Asked Questions
Case Studies in Environmental Medicine
Community Involvement Pages
Community Matters: About ATSDR
Community Matters: Exposure
Community Matters: Find Out About Sites in Your Community
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Community Matters: Search for a Specific Chemical
Community Matters: The ATSDR Ombudsman
Community Matters: What You Can Expect from ATSDR
Congressional Testimony: Medical Monitoring at Hanford Nuclear Facility
Congressional Testimony: The Scientific Aspects of Mercury
Dioxin and Dioxin-Like Compounds in the Soil, Part 1, ATSDR Interim Policy
Guideline
GATHER interactive map server
Great Lakes Human Health Effects Research Program
Hazardous Substances and Public Health Newsletter
Hazardous Substances Emergency Events Surveillance (HSEES) Annual Report 1997
HazDat Site Activity Query Map
Malathion: Chemical Technical Summary for Public Health and Public Safety Professionals
Methyl Parathion Expert Panel Report
Mississippi Delta Project
Organizational Chart of ATSDR
Public Health Concerns at Department of Energy Sites
Public Health Implications of Dioxins
Public Health Implications of Exposure to Polychlorinated Biphenyls (PCBs)
Public Health Statements on various hazardous substances
Report of the Expert Panel Workshop on Psychological Responses to Hazardous
Substances
Substances Most Frequently Found in Completed Exposure Pathways -1999
The Toxicologic Hazard of Superfund Hazardous Waste Sites
Top 20 Hazardous Substances_ATSDR/EPA Priority List 1999
ToxFAQs

This page last updated on September 11, 2001

Contact Name: Maria Gosa/ mjg4@cdc.gov

Table 1. Types of Sites Assessed in Fiscal Year 2000
Type of Site	Number of Sites	Percentage
Manufacturing	49	32
Government	25	17
Waste Storage or Treatment	23	15
Mining	16	11
Other	19	13
Natural Area	12	8
Waste Recycling	5	3
Residential	1	1
Total	150	100

Substance	All Sites	NPL Sites
Lead	298	206
Trichloroethylene	277	239
Arsenic	215	147
Tetrachloroethylene	206	167
Benzene	149	116
Cadmium	148	105
Chromium	146	102
PCBs	130	96
1,1,1-trichloroethane	116	97
Zinc	116	75

The Agency for Toxic Substances and Disease Registry FY 2000 Annual Report

Table of Contents

TABLE 2. Top 10 Substances on the 1999 Priority List

Number of sites with substance in a CEP