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Good morning, Madam Chairman and members of the Subcommittee. I am Dr. Henry Falk, and I am the Assistant Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR). I am pleased to be meeting with you today to share with you the results of our agency's ongoing work in Anniston, Alabama.

We join you in your concerns about the health and well being of children and families in Anniston and across the country. We also share your desire to address the concerns expressed about illnesses and diseases that might be linked to environmental factors. In fact, ATSDR was created to address these types of concerns.

Congress created ATSDR in 1980 through the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), more commonly known as Superfund. The Superfund legislation created ATSDR to be the principal public health agency to evaluate the human health effects related to exposure to hazardous substances from waste sites and other locations with uncontrolled releases of hazardous substances into the environment. ATSDR was charged with evaluating public health concerns and advising the U.S. Environmental Protection Agency (EPA) and state health and environmental agencies on any actions needed to clean up hazardous waste sites and protect the public's health.

ATSDR works in close collaboration and partnership with EPA; other federal agencies; local, state, and tribal governments; health care providers; and affected communities. As an agency of the U.S. Department of Health and Human Services (DHHS), ATSDR has made a difference to all of these partners by providing new information to assist in remedial decision-making and evaluation. Our work includes answering the health questions of persons who live in communities near affected sites, recommending preventive measures to protect public health, and providing diagnosis and treatment information to local health care providers. ATSDR administers public health activities through partnerships; public health assessment and consultation activities; exposure investigations; health studies and health registry activities; development of toxicological profiles and attendant research; emergency response; health education and health promotion; and community involvement.

Today, I will summarize our health activities in Anniston and also report on some of the activities of our partners.

Anniston Health Issues: In response to community members' concerns about polychlorinated biphenyls (PCBs) in Anniston, ATSDR is working with EPA Region 4, the Alabama Department of Public Health, and the Alabama Department of Environmental Management to identify environmental contaminants in selected areas of west Anniston. Investigations, both past and ongoing, have determined that PCBs are present in the soil at numerous residential and commercial properties in Anniston. In more recent investigations, EPA is further assessing the contamination by sampling for other contaminants, including metals such as lead.

The earliest health work was done by the Alabama Department of Public Health with both technical and financial support from ATSDR. In 1995 that department released a report indicating the likelihood of human exposure to PCBs for residents living next to a site where PCBs were produced in the past. The ensuing investigation found that approximately 25 percent of the people tested had elevated levels of PCBs in their blood. The department's health assessment released last year determined that people living near the Solutia plant were at risk. The results showed that there was both a current and past public health hazard for children if they were exposed to PCBs in soil at specific homes where the soil had not been remediated.

ATSDR Research on PCBs: ATSDR has published extensive up-to-date information on PCBs in its Toxicological Profile for Polychlorinated Biphenyls, which was revised in November 2000. An ATSDR paper on the public health implications of PCBs published in September of 1999 reported the following potential health effects associated with exposure to PCBs:

• Reproductive function may be disrupted by exposure to PCBs.
• Neurobehavioral and developmental deficits occur in newborns who were exposed to PCBs in utero, and these deficits may continue through school-age.
• Other systemic effects are associated with elevated serum levels of PCBs.
• PCB exposure is associated with increased cancer risk.

Additional research conducted under the Great Lakes research program has further demonstrated that:

• Children born to mothers who consumed more than the median number (116) of fish meals before their pregnancy were significantly more likely to have low birth weight.
• Maternal serum PCB concentration was significantly associated with fish consumption and low birth weight.
• Infants who had been exposed prenatally to the most highly chlorinated PCBs had poorer performance on the habituation and autonomic tests of the Neonatal Assessment Scale when tested 24-48 hours after birth than did infants who were not exposed.
• 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.
• 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.

ATSDR Health Consultation Activities Related to PCB Exposures: In 2000, ATSDR released a draft consultation of our evaluation of PCB soil and air data provided by EPA and information provided by an Anniston attorney on the biological blood sampling data of 3,000 individuals. The consultation reported the following findings:

• PCB levels in some residential soils posed a public health hazard.
• About half of the persons tested had detectable levels (greater than 3 parts per billion for this consultation) of PCB in their blood.
• Approximately 15 percent of the persons tested showed blood PCB levels that indicated elevated environmental exposure, or levels greater than 20 parts per billion.
• Air data were not sufficient to make a health judgment.

At the request of residents, ATSDR conducted a health consultation to evaluate water quality in two private wells in Anniston. The health consultation found that all substances of concern in the well water samples were below levels of health concern.

Last year ATSDR released a final report on an exposure investigation conducted to address community concerns about ongoing exposure. A primary interest in the investigation was evaluating exposures to children. The report concluded that:

• Five of 43 adults tested had blood PCB levels that indicated elevated environmental exposure.
• None of the children tested (37) had blood PCB levels indicating elevated environmental exposure.
• Blood PCB levels were not correlated with soil or house dust PCB levels.

ATSDR Health Consultation Activities Related to Lead Exposure: In 2001, ATSDR released two health consultations related to lead contamination in Anniston. The first found elevated levels of lead for west Anniston properties. The second consultation evaluated lead levels at a softball park about 5 miles from Anniston. The health consultation found that lead levels at the park were below levels of health concern.

In response to community concerns that children in Anniston could be exposed to lead, ATSDR and a local group, Community Against Pollution (CAP), facilitated a screening program in spring 2001. The program focused on children less than 6 years old who lived in areas of Anniston known to have contaminated soil. Four of the 410 children screened were found to have blood lead levels equal to or greater than current guidelines of 10 micrograms per deciliter (μg/dL). Close to 25 percent of the children screened had blood lead levels of 5.0 μg/dL to 9.9 μg/dL. These findings provide evidence that children are being exposed to lead. Because of the limited number of sampling results, this project did not provide a complete picture of blood lead levels in Anniston. Collectively, however, the data indicate that blood lead levels in children in Anniston are similar to those reported for other areas of the state and nation.

As a result of this program, CAP acquired additional funding from several sources to conduct ongoing monthly health education classes in the community. These classes emphasize the importance of continued screening and provide information that community members can use to reduce the potential for exposure to lead.

The collaborative efforts demonstrated through the success of the screening program have fostered communication among the Anniston community, local physicians, and local, state, and federal health agencies. The project provides evidence that community-based research can result in a successful outcome for everyone involved.

PCB Expert Workshop: In early January of this year, ATSDR held a panel session in Atlanta entitled Exploring Opportunities for PCB-Related Health Studies in Anniston, Alabama. The purpose of the session was to gather input from nationally recognized PCB experts on issues related to the options of conducting health study activities in Anniston. The seven experts on the panel came from different universities throughout the United States, including the University of Alabama at Birmingham and Harvard University. Among the issues discussed at the session were research needs, community needs, and methods for reaching a better understanding of exposure in the Anniston community. Community members, as well as state and federal health and environmental officials, attended as audience observers. A summary report of the meeting will be available in May.

Pediatric Environmental Medical Support: In 2000, the Southeast Pediatric Environmental Health Specialty Unit (PEHSU), which is based at Emory University in Atlanta and is supported by ATSDR and EPA, became involved in Anniston to provide information and support to local pediatricians. While in Anniston, it became clear that there was concern among community members for the health and well-being of the children. In particular, concerns were voiced regarding the number of children who had difficulties with development, learning, and behavior. The big question voiced by community residents was what role pollution played in this picture.

A series of meetings was held over the course of a year between the PEHSU representatives and the leaders in the community. These meetings focused on finding a solution to help the children, rather than on what may or may not be the cause. On December 4, 2001, a day-long working conference was held in Anniston. Leaders from all sectors of the community attended the conference. Participants included the mayor and representatives from community action groups, business, education, and health care--all committed to the well-being of the children of Anniston.

Conference attendees produced a list of concepts and ideas for future discussion, including the following:

• An inventory of existing agencies to identify resources in the area that would be needed to meet the needs of children with learning and developmental problems.
• A program to enhance existing services for children with learning and developmental disabilities; additional services could also be considered to better meet the needs of as many children as possible. This program could improve the likelihood of a positive outcome and success in life for the children of Anniston.
• A process for documenting learning and developmental disabilities in Anniston and evaluating the success of intervention services.

A Steering Committee was established to explore these suggestions. The committee has met twice and has scheduled a community-wide meeting for April 30, 2002, to update the entire community on the progress to date and generate the next set of steps.

Health Care Needs: ATSDR has neither the legislative authority nor the resources to provide medical care in any of the communities in which we work. Moreover, frequently we find that "Superfund" communities lack the necessary medical care resources. We can and do call on our Pediatric Environmental Health Specialty Units to provide medical care referrals. We offer specialized training to local physicians on diagnosis and treatment related to exposure to specific chemicals. We also work to identify other programs in the U.S. Department of Health and Human Services that may offer assistance and resources to these communities.

Future Activities in Anniston: ATSDR--in cooperation with EPA, state and local agencies, and the community--is continuing a number of activities, including:

• A health consultation reviewing air data near the site for January 2000-January 2001;
• A review of available blood lead data for Calhoun County over the past 5 years;
• A final version of the health consultation entitled Evaluation of Soil, Blood, & Air Data from Anniston, Alabama;
• Collecting samples of locally grown vegetables, which will be tested for the presence of PCBs and lead;
• A health consultation that will evaluate fish consumption as a potential PCB exposure pathway;
• Assisting as appropriate in the Protocol for Assessing Community Health Excellence in Environmental Health (PACE-EH, funded by the National Center for Environmental Health, Centers for Disease Control and Prevention), under the direction of the Calhoun County Health Department. This community-based process will provide a better understanding of the environmental health concerns of the community.

We have been intensively involved in the Anniston community for the past three years, and will continue our work for the foreseeable future. In close cooperation with our partners in the community, in the state, in other federal agencies, and in academia, we remain committed to protecting and promoting the health of Anniston's citizens.

Madam Chairman, this concludes my testimony. I will be happy to answer any questions you or the other subcommittee members may have.

This page last updated on May 16, 2002

Contact Name: Joanne Cox/ vzc6@cdc.gov

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