Through this multisectoral, integrated approach, ATSDR is increasing the capacity of the agency and its partners--particularly communities--to prevent exposure to hazardous substances and to respond more effectively at the local level to health threats should they arise. ATSDR is continuing to integrate health promotion into its environmental health activities through training, research, partnerships, and program development, and is providing leadership to others to do the same.

For more information, contact Maureen Lichtveld, MD, MPH, ATSDR Division of Toxicology and Environmental Medicine 1600 Clifton Rd, NE, MS E33, Atlanta, GA 30333; telephone (404) 639-6204; fax (404) 639-6207.

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Study Indicates Childhood Lead Exposure May Result
in Health Effects 20 Years Later

Research--both in science and communications--is the foundation upon which all health promotion activities should be based. ATSDR's research on lead is one example of building the knowledge base that health professionals will use to educate and motivate people to adopt preventive and more healthy behaviors concerning lead.

Results of a study of adults 19 to 29 years old exposed as children to lead from a mining and smelting facility indicate that there may be health effects 20 years after exposure to lead during childhood, according to Agency for Toxic Substances and Disease Registry (ATSDR) researchers.

The lead-exposed group performed more poorly on neurologic and neurobehavioral tests and reported more trouble conceiving children and having more medical conditions than a control group, said Lynette Stokes, PhD, MPH, an ATSDR epidemiologist and the study's principal investigator.

"We know that exposure to lead is associated with adverse health effects; in this study we add to our knowledge about the long-term effects," said Dr. Stokes. "Our study showed that if you were exposed to lead between 9 months and 9 years of age, neurologic and reproductive effects were observable 20 years later. The study was designed to find subtle effects in the function of the central and peripheral nervous system that were still present many years after exposure. These subtle effects were still observable."

The lead-exposed group consisted of 917 people who were 9 months to 9 years of age and living in Idaho's Silver Valley during the period January 1, 1974 to December 31, 1975. All of the 917 residents were traced to their current addresses or telephone numbers. Silver Valley is the location of the Bunker Hill mining and smelting facility, which was opened in 1886, closed in 1981, and declared a Superfund hazardous waste site in 1983. Soils measured for lead in 1986 and 1987 in many surrounding communities had lead levels greater than 1,500 parts per million. During the period being studied, the facility operated without a device for reducing air emissions.

A 1974 public health survey showed widespread lead poisoning among Silver Valley children; average blood lead levels were 55 micrograms of lead per deciliter of blood (µg/dL). The highest child blood lead levels measured were 164 µg/dL in 1974 and 136 µg/dL in 1975; 10 µg/dL or less is the current recommended blood lead safety standard for children. Lead-contaminated air, soils, and dusts in homes, schools, and the community were all identified as contributors to the children's elevated blood lead levels.

Lead has been shown to affect primarily the peripheral and central nervous systems, blood cells, and metabolism of vitamin D and calcium. Reproductive effects have been reported and speech and hearing problems are not uncommon in lead-exposed children.

In the current study, ATSDR researchers gathered health data in two phases from the lead-exposed group and a control group of Spokane, Washington, residents. The study included use of (1) a telephone medical history questionnaire [917 lead-exposed participants, 754 controls], and (2) neurobehavioral and kidney biomarker tests on a random selection of people from Phase I [281 lead-exposed participants, 287 controls]. Past lead exposure was investigated through (1) assessment of length of Silver Valley residence for the lead-exposed group, and (2) in Phase II, measurement of bone lead concentration in both the lead-exposed and control groups by K X-ray fluorescence. Bone lead concentration is an indication of past lead exposure because lead circulating in the blood gets stored in bone.

Compared with the control group, the lead-exposed group

• had a significantly higher prevalence of neuropsychiatric symptoms (4.4 symptoms compared with 2.7; the largest differences in the proportions of reported symptoms between the two groups were for difficulty reading and concentrating and problems remembering);

• had a significantly higher prevalence of difficulty conceiving children, which increased with duration of residence in the Silver Valley;

• reported a significantly higher number of medical conditions, including anemia, anxiety, history of high blood pressure, urinary tract conditions, ulcers, arthritis, poor circulation, and history of dialysis among family members; and

• had a significantly higher average tibial bone lead concentration (4.6 µg lead/g bone mineral with a range of not detected to 37.0 µg/g compared with 0.60 µg/g with a range of not detected to 17.4 µg/g).

Among crude mean scores, each central and some of the peripheral neurobehavioral tests showed a modest dose-response relation with increasing bone lead concentration, suggesting that severity of dysfunction increases with higher bone lead concentration.

None of the results of biomarker tests to determine differences in kidney function between the lead-exposed and control groups were significantly different. From the test results, it is not clear whether the lead-exposed group suffered kidney damage in the past or will in the future from the mobilization of lead from bone, said the ATSDR researchers in the study's report. The scientific literature suggests that more sensitive biomarkers for kidney damage from heavy metal exposure need to be developed. Also, clinical symptoms and evidence of reduced kidney function do not usually become apparent until 50% to 75% of the kidney's nephrons have been destroyed.

ATSDR researchers hope to evaluate the group again in the future to determine if identified problems persist or new problems such as kidney disease develop. ATSDR is currently determining if members of the lead-exposed group are eligible for ATSDR's medical monitoring program. When certain criteria are met, the medical monitoring program provides screening for known exposure-related health effects and referrals to specialists for further evaluation.

Dr. Stokes presented the study's neurobehavioral results at the 6th Meeting of the International Neurotoxicology Association in Hungary on June 30, 1997, and at the 9th meeting of the International Society for Environmental Epidemiology in Taiwan on August 18, 1997.

For more information, contact Lynette D. Stokes, PhD, MPH, at ATSDR, Division of Health Studies, 1600 Clifton Rd, NE, MS E31; telephone (404) 639-6203; fax (404) 639-6219; e-mail LXS4@CDC.GOV.

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Agencies Are Sharing Strategies for More Effective Response to Methyl Parathion Health Threat

Two key characteristics of health promotion are collaboration and capacity building among various groups to protect the public from an imminent health threat. ATSDR and its partners' collaborative response to the misuse of methyl parathion is one example of these facets of health promotion.

Agencies responding to illegal, indoor use of the pesticide methyl parathion are sharing their strategies nationwide to help increase the effectiveness of future responses to this health threat.

Methyl parathion, commonly known as "cotton poison," is a synthetic pesticide related to nerve gas that by law can be used only in open fields. It can cause a range of symptoms, including headache, nausea, dizziness, convulsions, and unconsciousness, and can even result in death of humans and their pets.

"One of the things we're trying to do is to provide others who are going to have methyl parathion as an issue with strategies that are applicable and useful, that clearly define how to deal with methyl parathion issues," said Leslie Campbell, MS, an environmental health scientist in the Division of Toxicology and Environmental Medicine (DHEP), Agency for Toxic Substances and Disease Registry (ATSDR).

During the past 3 years, at least 40 federal, state, and local health and environmental agencies have worked together to respond to illegal methyl parathion spraying of homes, day care centers, and other businesses in 9 states (see sidebar "Recent Incidents of Illegal, Indoor Use of Methyl Parathion" for states and dates).

As of mid-July 1997, approximately 4,500 premises have been reported sprayed with methyl parathion; 18,000 people have been affected, including 10,000 children; and 2,300 people have been relocated until their homes can be cleaned up. The U.S. Environmental Protection Agency (EPA) estimates that the cost of this problem as of July 1997 is $200 million. Incidents of indoor methyl parathion use continue to be reported, the most recent in Texas City, Texas, in May 1997.

"This is no longer a localized public health issue, and therefore it requires a response that is very nationwide in scope," said Maureen Lichtveld, MD, MPH, DHEP director.

ATSDR, EPA, and state and local health and environmental agencies are working together at the community level to respond to the incidents. Collectively, their efforts include testing homes and businesses for methyl parathion; conducting biomedical tests to determine levels of methyl parathion exposure; providing health professionals and the public with information about how to properly respond to or prevent this problem; and in some cases of imminent public health threat, cleaning up methyl parathion from contaminated buildings. The agencies are sharing nationally the expertise they brought to bear on the problem and the lessons they learned through this effort.

"The problem called not only for a multi-organizational emergency response, but providing people with the skills and knowledge to make healthful decisions and working side-by-side with the community to intervene effectively," said Dr. Lichtveld. This response called for multilevel, multidimensional support of the community through scientific expertise and health education and promotion.

"One of our biggest challenges, you can imagine, has to do with the area of communications with the affected community," said Don Rigger, MBA, BS, an EPA Region IV environmental scientist who responded to methyl parathion incidents in Mississippi. "We established a center, a communications coordination center, manned by ATSDR, EPA, and state health people, and that's our focal point for the community. We have availability sessions where people come in and hear about what's going on."

Other health promotion-related activities in Mississippi and other states have included (1) educating local health professionals to increase understanding and awareness of how to diagnose and treat people with potential methyl parathion exposures and how to answer health-related questions and concerns; (2) assisting the community in dealing with the adverse psychological and social effects of exposure and relocation, including training social workers to help affected communities cope with methyl parathion exposure issues; (3) answering calls from area physicians and advising the local health department about how to test and interpret test results for methyl parathion, and (4) educating the community about how to prevent and reduce exposure to methyl parathion and how to control roaches and other insects more safely.

Through these efforts and others, the agencies collectively were able to (1) stop current violators of pesticide regulations; (2) remove the population at risk, including the most vulnerable segment--children--from exposure; (3) test more than 1,300 people for exposure, which not only helped protect the health of those tested, but helped direct the intervention efforts and continues to be pivotal in public health decisionmaking; (4) reach agreement with the manufacturer of methyl parathion to modify the product and packaging to reduce the potential for its misuse; (5) more effectively use resources through collaboration; and (6) enhance the ability to respond to similar problems at a national level.

During emergency responses to recent methyl parathion incidents, the agencies were not able to answer the following questions about methyl parathion exposures: (1) What is the predictive value of p-nitrophenol measured in the urine as it relates to methyl parathion exposure or environmental wipe samples? (2) What is the best and most consistent way to conduct environmental sampling? (3) What health education plan and communication strategy are appropriate for people who remain in their homes and for people who are relocated?

To help involved agencies decide the best strategies to use in the future, ATSDR convened a panel of experts from universities and government agencies on April 24-25, 1997, to discuss key issues of science, public health practice, and risk management related to indoor misuse of methyl parathion. Agencies are now sharing the panel's report, "ATSDR Methyl Parathion Expert Panel Report," with Mississippi, Louisiana, Tennessee, Arkansas, Illinois, and Texas local and state health departments and other partners who are or may be faced with a methyl parathion health threat.

The report contains recommendations on the following methyl parathion issues: (1) environmental fate and biomonitoring, (2) correlation of environmental and biological data, (3) appropriateness of criteria for relocating building residents and decontaminating buildings, (5) clinical evaluation, (6) protocol and practice standards for diagnostic and laboratory evaluations, and (7) health education and risk communication strategies.

The agencies are basing their responses to methyl parathion incidents on their past experiences and the panel's recommendations and hope that by sharing this information everyone involved can more effectively prevent or respond to indoor spraying of methyl parathion.

For more information, or to obtain the "ATSDR Methyl Parathion Expert Panel Report," contact Leslie Campbell, ATSDR, DHEP, 1600 Clifton Rd, NE, MS E33, Atlanta, GA 30333; telephone (404) 639-6205; fax (404) 639-6208; e-mail lca2@cdc.gov.

Recent Incidents of Illegal, Indoor Use of Methyl Parathion

Date				Location


November 1994			Lorain, Ohio

April 1995			Detroit, Michigan

November 1996			Pascagoula and a 5-county area of Mississippi
 
				Mobile, Alabama

December 1996			New Orleans and other areas of Louisiana

February 1997			Expanded areas of Mississippi 
				Memphis, Tennessee
				Memphis City, Arkansas

April 1997			Chicago, Illinois

May 1997			Texas City, Texas

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From the Tribes

The pinnacle of health promotion is community action. The St. Regis Mohawk Tribe is one example of a community taking action to ensure and promote environmental and public health.

St. Regis Mohawk Respond to Pollution
by Developing Own Environmental Expertise

Lawrence Swamp, BA

The small Mohawk community of Akwesasne, located on the banks of the St. Lawrence River in northern New York, is facing serious environmental threats caused by pollution from upstream industries. The St. Regis Mohawk tribe is responding by developing its own expertise to improve the environment and the tribe's health in ways that promote cultural lifestyles that respect, preserve, and enhance the environment.

The Problem

General Motors (GM), the Aluminum Company of America (ALCOA), and Reynolds Metal Company, Inc. have built production plants next to the reservation. Over the years, these facilities have generated hazardous waste that includes, collectively, polychlorinated biphenyls (PCBs), cyanide, polynuclear aromatic hydrocarbons, fluoride, arsenic, and dibenzofurans. The US Environmental Protection Agency (EPA) has placed the GM and Reynolds Metal Company, Inc. sites on the National Priority List of Superfund sites. ALCOA is working under New York State Department of Environmental Conservation and EPA orders to investigate and clean up on-site and some surrounding area contamination.

Out of concern about safe drinking water, the tribe started its Environment Division. The Environment Division's goal is to prevent disease and injury, while promoting lifestyles that respect, protect, and enhance the environment. In 1977, under the sponsorship of the Indian Health Service, the tribe hired an environmental health technician to be responsible for the community's water safety.

In 1980, the community-based Freedom School was founded in Akwesasne to meet the cultural needs of Mohawk youth. The school was located near the GM property. Children soon began complaining of headaches, nausea, and eye irritation. Though pollution from surrounding industries was suspected to be the symptoms' cause, the symptoms were not conclusively traced to the pollutants. Worried about the well-being of their children, parents formed a group called Mohawks Agree on Safe Health (MASH) to ensure that the community had access to needed health services.

MASH was also determined to learn what effect the pollution was having not only on human health, but on the entire ecosystem of the St. Lawrence River. New York State wildlife pathologist Ward Stone's tests on small animals such as shrews, frogs, ducks, and snapping turtles revealed levels of toxic PCBs in the animals' fat so high that most of the samples could have been considered hazardous waste.

In 1987, three studies were initiated to examine the effects of pollution on human health, wildlife, and fish in Akwesasne. The studies were part of a risk assessment study co-sponsored by the New York State Department of Health and GM. One human health study revealed significant levels of PCBs in breast milk. To reduce exposure to PCBs, the tribe issued an advisory recommending that nursing and pregnant women not eat fish from the St. Lawrence River.

In 1994, the tribe entered into a 5-year cooperative agreement with the Agency for Toxic Substances and Disease Registry to conduct community and health professional environmental health education in response to these problems.

The Tribe's View and Response

Probably the biggest dividing point between the tribe and industries has been the incompatibility of two models of economic development. Industry's model is based on resource extraction, pollution, and profit; the tribe's, on spiritual, social, and cultural relationships with the natural world. Tribal members believe that they have a responsibility to future generations to preserve the environment, and this view has driven their response to pollution of their environment and its consequences on the ecosystem and their health.

"I have always been taught that we as human beings have a responsibility to ensure that environmental damages are stopped and ecosystems are restored," said Mary Fadden, DVM, PhD, the division's natural resource damage assessment coordinator and environmental toxicologist. "I hope that our children and grandchildren will know this generation was thinking of their welfare, and I hope they will realize that we tried our best and worked our hardest to ensure that environmental problems were properly cleaned up."

While studies were being conducted, the tribe increased efforts to develop its own environmental expertise by securing funding and hiring additional staff for the Environment Division. A lawyer was hired to seek funding for air and water quality programs, and through negotiations with EPA, the programs were created.

Soon after, the tribe began to develop its own air and water quality standards. These standards are known as Applicable or Relevant and Appropriate Standards, and are developed for the specific needs of the reservation. These standards are based on existing, enforceable EPA and other tribal environmental standards. Eventually, the Environmental Division was able to do its own environmental sampling, monitoring, and assessments based on these standards.

The tribe has also

• developed the General Assistance Program to measure the tribe's overall environmental capabilities and to help assess the community's environmental needs. Under this program, the tribe has produced a comprehensive, reservationwide environmental assessment and management strategy; developed procedures to assess environmental impacts of proposed development projects; begun development of a data management system; begun work on an environmental regulatory/enforcement framework; and developed an Iroquois environmental newsletter for all Indian Nations in EPA's Region II.

• embarked on other environmental activities unrelated to the GM cleanup, specifically natural resource protection, recycling and solid waste management, and monitoring and regulation of reservation gas stations.

• through its Air Quality Program, established a Tribe/State "high-volume" air sampling station; networked with other agencies to increase awareness of air pollution's effects on the reservation; created an outline for tribal air quality regulations; and developed a work plan for toxicant monitoring.

• collected extensive background data through a number of studies and sampling efforts for establishing water quality standards for the tribe.

• started studies to look at disease trends and find out what populations within the tribe are more susceptible to the adverse effects of environmental contaminants.

Key to the tribe's success has been its ability to work with other organizations with related concerns, such as the New York State Department of Environmental Conservation, which provided technical support and services related to data collection and analysis. Research institutions, including St. Lawrence, Clarkson, Syracuse, Cornell, and SUNY Albany universities, all contributed expertise toward improvement of the Akwesasne environment.

For more information, contact the St. Regis Environment Division at Box 8A, Rt. 37, St. Regis Mohawk Tribe, Hogansburg, NY 13655; telephone (518) 358-6211; fax (518) 358-6252; email lcswamp@slic.com.

Lawrence Swamp, Mohawk, is an Environmental Health Specialist in the St. Regis Mohawk Tribe's Environment Division.

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This page last updated on October 24, 2003
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