Rural Health Activities

• Comprehensive Assessment of Rural Health in Iowa (CARHI)—NCEH is funding and providing technical oversight to a 2- to 3-year cooperative surveillance activity that is generating baseline health data for selected rural communities in Iowa. With input from a CARHI committee of stakeholders, the Iowa Department of Public Health (IDPH) is linking environmental and health data from a rural community to allow investigation of health effects possibly associated with the environment, such as effects associated with agricultural exposures.
  
  The CARHI committee is developing a tool and process for collecting data and a CARHI database. The committee also is recruiting communities and health care practitioners to participate in the CARHI project.
  
  Public health officials will use CARHI data to monitor communities’ health, identify existing or emerging health problems that warrant further investigation, enhance or guide environmental sampling, conduct comprehensive health studies, or target important public health programs such as smoking cessation and safe farming practices.
   
• Assessment of the Off-Farm Transport of Waste-Associated Chemical and Microbial Constituents Present on Swine-Feeding Operations—NCEH worked with IDPH and Iowa State University to conduct a study to determine whether antibiotics, resistant bacteria, and other constituents found in swine manure are traveling from agricultural fields to nearby soil and water systems.
  Researchers analyzed soil and water samples from an experimental agricultural field both before and after the application of swine manure. Initial tests for bacteria and antibiotic resistance proved inconclusive, prompting the development of new laboratory methods. The final results, based on the new laboratory methods, are pending.
  

Funding

• Antiterrorism Funding to Increase State Chemical Laboratory Capacity—In fiscal year 2003, CDC provided $765,932 to Iowa to assist the state in expanding its chemical laboratory capacity to prepare and respond to chemical terrorism incidents and other chemical emergencies. This program expansion will allow for full participation of chemical terrorism response laboratories in the Laboratory Response Network.
   
• Biomonitoring Planning Grant—In fiscal year 2001, NCEH awarded a grant to Iowa to develop a plan for implementing a biomonitoring program for the state. In this way, the state could make decisions about which environmental chemicals within its borders were of health concern and could make plans for measuring levels of those chemicals in the Iowa population.
  

• Assessing Pesticide Exposure Among Farm Families—NCEH is collaborating with Iowa and CDC’s National Institute for Occupational Safety and Health to investigate the relation between farm-home pesticide use and exposure of farm families to pesticides. NCEH provided confirmatory analyses of concentrations of pesticide metabolites in urine samples obtained from these farm families.
   
• Keokuk Rural Health Study—With the University of Iowa, NCEH investigated the relation between health effects and exposure to pesticides in people living in a rural area of the state. The laboratory measured detectable levels of 29 pesticides in the serum of 100 study participants. University of Iowa investigators are conducting further data analyses.
   
• Age-Related Eye Disease Study (AREDS)—Age-related macular degeneration (AMD) and cataracts are the leading causes of blindness in the United States. The prevalence of both diseases increases dramatically after age 60, but the importance of other risk factors in the development or progression of these diseases is unclear. The National Eye Institute is conducting AREDS, a 10-year, multicenter study (one center is in Iowa) to investigate the natural history of these diseases and the role of various risk factors in their development and progression. The study is examining the effects of nutritional supplementation on preventing and controlling these diseases through a randomized, placebo-controlled clinical trial of 4,757 participants aged 55–80 years. NCEH measured serum samples for levels of carotenoids; lipids; zinc; copper; and vitamins A, E, and C. Study results showed no statistically significant effect of treatment in reducing risk for the progression of age-related lens opacities. For those participants with no AMD, there was no statistically significant difference between treatment groups for at least moderate visual acuity loss. Further, no statistically significant serious adverse effect was associated with treatment.
  

• Blood Lead Laboratory Reference System (BLLRS)—BLLRS is a CDC standardization program designed to improve the overall quality of laboratory measurements of lead in blood. In Iowa, four laboratories participate in BLLRS. This program allows these laboratories to evaluate their performance on laboratory tests. CDC provides BLLRS materials free of charge to these laboratories four times a year.
   
• Lipid Standardization Program (LSP)—NCEH provides standardization support to one lipid research laboratory in Iowa that is involved in epidemiologic studies and clinical trials investigating risk factors and complications associated with cardiovascular disease. LSP, supported by CDC’s Lipid Reference Laboratory (the cornerstone of the National Reference System for Cholesterol to which these lipid measurements are traceable), provides quarterly analytical performance challenges and statistical assessment reports to allow program participants to monitor performance, thus ensuring the accuracy and comparability of study results and findings.

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Preventing Health Effects From Environmental Hazards

NCEH promotes safe environmental public health practices to minimize exposure to environmental hazards and prevent adverse health effects. Following are examples of such activities that NCEH has conducted or supported in Iowa.

• Childhood Lead-Poisoning Prevention—The IDPH Childhood Lead-Poisoning Prevention Program has received NCEH funding since 1992. These funds have enabled Iowa to operate a comprehensive lead program including screening, case management, education, and outreach. Forty-two percent of Iowa’s housing units were built before 1950, so the risk for lead poisoning for young children living in those units is high. In Iowa, the number of children younger than 6 years of age who have been screened for lead has increased 46% from 1997 to 2001—from 25,239 to 36,841, respectively. In addition to more children being tested, the number of children younger than 6 years of age with elevated blood lead levels has decreased 56%—from 9,644 in 1997 to 4,259 in 2001. Through emphasis on screening and use of geographical information systems to target resources to highest risk counties, Iowa has made great strides toward the national goal of eliminating childhood lead poisoning by 2010.
   
• Building Communities of Excellence Through Environmental Health Capacity-Building—In 2001, NCEH established a 3-year cooperative agreement with IDPH. Through implementation of 26 mini-grants, 30 counties have been able to purchase equipment, develop plans and tools, and establish education and marketing programs that have given them greater capacity to carry out the core functions and essential services of environmental health. Model environmental health program templates for wastewater, water quality, food safety, and nuisance programs were created by Iowa’s environmental health work group, which represents local, state, and academic interests. An environmental health resource manual specific to environmental health programs in Iowa has been created and will provide information on environmental health programs relevant to both practitioners and the public. Through training programs developed with this funding, 250 public health practitioners have gained a better understanding of the application of the core functions, essential services, and core competencies that has enabled them to identify needed improvements within state and local public health programming. The Iowa Community Health Needs Assessment and Health Improvement Plan reporting tool allows all 99 counties to report in a consistent manner their public health priorities and plans identified through their local assessment and policy development efforts.
   
• The National Mass Fatalities Institute—CDC funds the National Mass Fatalities Institute, located on the Kirkwood Community College campus in Cedar Rapids. The physical and emotional well-being of survivors and responders; protection of the public health; preservation of evidence; and fulfillment of public expectations demand a timely, efficient, and effective mass-fatalities incident response. The National Mass Fatalities Institute is the only comprehensive training program for mass fatalities response currently available through government or nonprofit agencies. The institute was established to help communities, businesses, industries, government, and disaster response agencies effectively plan for, respond to, and recover from a mass fatalities incident.
  
  Mass fatalities incidents are clearly complex, intense, and demanding events that necessitate collaboration, coordination, and cooperation among many agencies and organizations at all public and governmental levels. A community’s ability to respond to and recover from a mass fatalities incident is dependent on the efficiency and effectiveness of the mass fatalities response.