NCEH in
Partnership With
Washington
The National Center for Environmental Health (NCEH) is part of the
Centers for Disease Control and Prevention (CDC). NCEH’s work
focuses on three program areas: identifying environmental hazards,
measuring exposure to environmental chemicals, and preventing
health effects that result from environmental hazards. NCEH has
approximately 450 employees and a budget for 2004 of approximately
$189 million; its mission is to promote health and quality of life
by preventing or controlling diseases and deaths that result from
interactions between people and their environment.
NCEH and partners in Washington collaborate on a variety of
environmental health projects throughout the state. In fiscal
years 2001–2004, NCEH awarded more than $3.4 million in
direct funds and services to Washington for various projects.
These projects include activities related to asthma, the use of
global positioning systems (GPS) to characterize children’s
exposure to pesticides, and lead poisoning prevention. In
addition, Washington benefits from national-level prevention and
response activities conducted by NCEH or NCEH-funded partners.
Identifying Environmental Hazards
NCEH identifies, investigates, and tracks environmental hazards
and their effects on people’s health. Following are examples of
such activities that NCEH conducted or supported in Washington.
Asthma
- Controlling Asthma from a
Public Health Perspective—NCEH is funding the Washington
State Department of Health (WDOH) to develop asthma-control
plans that include disease tracking, intervention, and
occupational components. Funding began in fiscal year 2002 and
continues through fiscal year 2004.
- Replication and
Implementation of Scientifically Proven Asthma Interventions—NCEH
is funding grantees to implement scientifically evaluated asthma
interventions that decrease acute-care visits and
hospitalizations and increase compliance with asthma-care plans.
The Washington State Chapter of the Asthma and Allergy
Foundation of America is a grantee for the Asthma Care
Training for Kids (ACT) intervention. ACT’s goals are to
increase asthma-control compliance behaviors and decrease
emergency department visits and number of days spent in the
hospital. Funding began in fiscal year 2001 and continued
through fiscal year 2003.
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Environmental Public Health Tracking
- Infrastructure Enhancement
and Data Linkage Demonstration Project for the National
Environmental Public Health Tracking (EPHT) Network—NCEH is
funding a cooperative agreement with WDOH to develop a
blueprint for EPHT, enhance existing surveillance systems for
exposure and health effects, and conduct projects aimed at
demonstrating data linkage to show the value of electronic
reporting and the usefulness of linked data for policy. WDOH
developed the Washington Environmental Public Health Tracking
Network (WEPHTN) to carry out these objectives. WDOH is
enhancing the Washington Electronic Disease Surveillance
System’s electronic reporting of birth defects, developing
population-based exposure data, and enhancing environmental
monitoring and data analysis of persistent toxicants such as
polychlorinated biphenyls and mercury. WDOH also is expanding
the state’s electronic hospital reporting to include illness
related to pesticide exposure and is partnering with the state
education system and the Office of the Superintendent of Public
Instructions to develop a prototype data system for school-based
environmental monitoring and illness surveillance.
WDOH also is implementing an application to directly and
securely access and analyze fish tissue contamination, fish
consumption, human population, and birth defects data from
original data sources. Assessment of fish tissue sampling led to
a statewide consumption advisory on the basis of mercury
concentrations in bass tissue. WDOH is using geographic
information system tools to prepare maps that will be used to
develop the fish contamination application. WDOH plans to
develop a georeferenced database of target populations, develop
and deploy methods for estimating fish consumption, evaluate the
feasibility and usefulness of fish-contamination-related
environmental indicators, and develop and implement electronic
reporting of birth defects from sentinel hospitals. Funding
began in fiscal year 2003 and continues through fiscal year
2005.
Health Studies
- An Assessment of
Environmental Contamination from Chemicals Used and Produced
during Methamphetamine Manufacture—This pilot study will
address chemical environmental hazards associated with the
clandestine manufacture of methamphetamine in private homes.
NCEH is assessing chemicals that may persist in these homes and
residents’ possible exposures to those chemicals. A convenience
sample will be used for a cross-sectional exposure assessment.
The pilot study began in fiscal year 2003 and continues through
fiscal year 2005.
In March 2004, a project-planning meeting was held in Seattle
with Washington state health officials, the principal
investigator, and a project co-investigator to discuss the
logistic framework of the study and to visit several field
sites.
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Measuring Exposure to Environmental Chemicals
NCEH measures environmental chemicals in people to determine how
to protect people and improve their health. Following are examples
of such activities that NCEH conducted or supported in Washington.
Funding
- Antiterrorism Funding to
Increase State Chemical Laboratory Capacity—In fiscal year
2003, CDC provided more than $930,000 to Washington to
help the state expand its chemical laboratory capacity to
prepare for and respond to chemical-terrorism incidents and
other chemical emergencies. This program expansion will allow
full participation of chemical-terrorism response laboratories
in the Laboratory Response Network. NCEH has begun to fund
laboratory development and the purchase of state-of-the-art
equipment in Washington’s state public health laboratory in
support of developing a network of chemical laboratories and of
transferring technology to measure chemical agents.
- Biomonitoring Planning
Grant—In fiscal years 2001 and 2002, NCEH awarded grants to
WDOH to develop a plan for implementing a biomonitoring
program for the state. In this way, WDOH could make decisions
about which environmental chemicals within its borders were of
health concern and could make plans to measure levels of those
chemicals in the Washington population.
Studies
- Use of GPS to Characterize
Children’s Exposure to Pesticides—In collaboration with the
University of Washington, NCEH examined childhood
activity patterns and their relation to exposures. Children were
fitted with GPS and their activities at home and school were
evaluated. Urine samples also were collected from the children.
The NCEH laboratory analyzed the urine samples for presence of
the pesticide methamidaphos. These data are being evaluated.
Services
- Helping State Public Health
Laboratories Respond to Chemical Terrorism—NCEH is working
with Washington’s public health laboratory to prepare
state laboratory scientists to measure chemical terrorism agents
or their metabolites in people’s blood or urine. NCEH is
transferring analytic methods for measuring chemical terrorism
agents (including cyanide-based compounds and other chemicals)
to Washington. In addition, NCEH has instituted a
proficiency-testing program to measure the compatibility of the
state’s analytic results with results from the NCEH laboratory.
- Blood Lead Laboratory
Reference System (BLLRS)—Three laboratories in Washington
participate in NCEH’s standardization program to improve the
overall quality of laboratory measurements of blood lead levels.
This program helps laboratories nationwide evaluate their
performance on these critical laboratory tests. NCEH provides
BLLRS materials to the laboratories four times a year without
charge.
- Newborn Screening
Quality-Assurance Program—NCEH provided proficiency-testing
services and dried-blood-spot, quality-control materials to
monitor and help assure the quality of screening program
operations for newborns in Washington. The importance of
accurate screening tests for genetic metabolic diseases cannot
be overestimated. Testing of blood spots collected from newborns
is mandated by law in almost every state to promote early
intervention that can prevent mental retardation, severe
illness, and premature death.
- Lipid Standardization
Program (LSP)—NCEH provides two lipid research laboratories
in Washington with accuracy-based standardization support
for analytic measurement. These laboratories are involved in one
or more ongoing lipid-metabolism longitudinal studies or
clinical trials that investigate risk factors and complications
associated with cardiovascular disease. The LSP, supported by
NCEH’s Lipid Reference Laboratory, provides quarterly analytic
performance challenges and statistical assessment reports that
allow program participants to monitor performance over time and
thus ensure the accuracy and comparability of study results and
findings.
- Cholesterol Reference
Method Laboratory Network (CRMLN)—Working with manufacturers
of in-vitro diagnostic products is the most effective means to
improve and standardize these measurements in clinical
laboratories and to achieve the National Cholesterol Education
Program’s goals for laboratory performance. NCEH established
CRMLN to help manufacturers calibrate diagnostic products used
for lipid and lipoprotein testing. The Northwest Lipid
Research Laboratories of the University of Washington
Department of Medicine and Pacific Biometrics Research
Foundation are two of three U.S. laboratories in CRMLN.
These laboratories use CDC reference methods or designated
comparison methods that are closely linked to CDC reference
methods. This ensures that diagnostic products are properly
calibrated and traceable to the accuracy base maintained at CDC.
More than 95% of participants in proficiency-testing surveys of
the College of American Pathologists have been certified through
CRMLN.
- Diabetes Autoantibody
Standardization Program (DASP)—In 2000, in collaboration
with the Immunology of Diabetes Society, NCEH established DASP
to improve autoantibody measurements worldwide. Fifty-five
laboratories from 17 countries participate in DASP; three of
these laboratories are in Washington.
Biochemical analyses of Type 1 diabetes autoantibodies are
crucial for predicting disease onset. These analyses provide the
most sensitive and meaningful measures for accurately targeting
program interventions and thus are central to efforts to prevent
and delay onset of diabetes.
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Preventing Health Effects That Result
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 conducted or supported in Washington.
- Lead Poisoning Prevention—The
Washington Childhood Lead Poisoning Prevention Program (WA
CLPPP) received NCEH funding from 1995 to June 2003. In
2001, the program screened 3,487 children under 6 years of age
for lead; 32 of these children had elevated blood lead levels.
Using NCEH funding, WA CLPPP established several mechanisms to
ensure proper monitoring and tracking of childhood lead
poisoning cases: state screening guidelines, a law requiring
reporting of all blood lead levels to the state, and a
comprehensive surveillance system that tracks childhood lead
poisoning cases and monitors case-management activities.
- Building Environmental
Public Health Capacity—NCEH funds two projects in Washington
to support the building of environmental public health capacity.
NCEH funds Island County to improve public understanding
of environmental health, to assess and prioritize environmental
health needs based on data, and to develop solutions for
environmental health issues. NCEH funds the University of
Washington School of Public Health and Community Medicine to
develop a training module that will help local and state public
agencies integrate the 10 essential services of environmental
health into their practices.
- Public Health Inspections
of Cruise Ships—NCEH established the model Vessel Sanitation
Program in 1975 to combine cooperation of the cruise ship
industry with CDC’s ability to aggressively protect the health
of travelers. The program helps the industry develop and
implement comprehensive sanitation programs that minimize risks
for gastrointestinal diseases. Every vessel that has a foreign
itinerary and carries 13 or more passengers is subject to two
unannounced inspections each year. In 2003, the Vessel
Sanitation Program conducted two inspections of cruise vessels
that have stops in Washington.
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Resources
NCEH develops materials that public health professionals,
medical-care providers, emergency responders, decision makers, and
the public can use to identify and track environmental hazards
that threaten human health and to prevent or mitigate exposure to
those hazards. NCEH’s resources cover a range of environmental
public health issues, including air pollution and respiratory
health (e.g., asthma, carbon monoxide poisoning, and mold
exposures), biomonitoring to determine whether selected chemicals
in the environment get into people and how much, childhood lead
poisoning, emergency preparedness for and response to chemicals
and radiation, environmental health services, environmental public
health tracking, international emergency and refugee health,
laboratory sciences as applied to environmental health, radiation
studies, safe disposal of chemical weapons, specific health
studies, vessel sanitation, and veterans’ health.
For more information about NCEH programs, activities, and
publications as well as other resources, contact the NCEH Health
Line toll-free at 1-888-232-6789, e-mail NCEHinfo@cdc.gov, or
visit the NCEH Web site at
www.cdc.gov/nceh.
June 2004
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