Fresh Kills - Teamwork Leads to Better Understanding of Potential Landfill Health Effects

The Agency for Toxic Substances and Disease Registry (ATSDR) is working with its partners to better understand the potential health effects of large landfill air emissions. 

In 1991, members of the Staten Island community and then New York (NY) congresswoman Susan Molinari petitioned ATSDR with concerns about health effects, including respiratory problems, possibly associated with the Fresh Kills Landfill. ATSDR coordinated a joint response by several of its divisions and offices, the New York State Department of Health (NYDOH) , and the New York City Department of Health (NYCDOH). 

Opened in 1948, the Fresh Kills complex covers approximately 2,200 acres and operates 24 hours a day, 6 days a week. More than 500 people work on site, and the 1990 census shows that approximately 75,000 people live within 1 mile of the site. It receives about 10,000 tons of solid waste per day. 

In 1996, NYCDOH reported that the overall incidence of cancer was not elevated among persons residing within 1 mile of the landfill. However, on Staten Island as a whole, there was a slight-to-moderate increase in the prevalence of lung cancer and, to a lesser extent, cancers of the colon, bladder, pharynx, and larynx.⁽¹⁾ In addition, NYDOH reported in 1997 that the prevalence of work-related dermatologic, neurologic, hearing, respiratory, and other symptoms (i.e., "sore and itching throats") was higher among employees at the landfill than among off-site sanitation employees in similar job positions.⁽²⁾

ATSDR evaluated air quality data on the area obtained from the New York Department of Environmental Conservation (NYDEC) monitoring network⁽³⁾ and found that there were no landfill-related contaminants at levels of public health concern.⁽⁴⁾ ATSDR also evaluated emissions data from a US Environmental Protection Agency (EPA) study.⁽⁵⁾ Because NYDEC and EPA had sampled for and identified different emissions, ATSDR recommended gathering additional environmental and epidemiologic data.⁽⁴⁾

Because of community concerns, ATSDR evaluated the severity and frequency of respiratory symptoms among residents in two Staten Island communities, one near the landfill and another 7 miles away. In response to physicians' concerns, ATSDR also evaluated whether residents' respiratory symptoms had worsened, improved, or stayed the same since moving (or returning) to Staten Island. 

ATSDR sent letters explaining the study and criteria for participating in the study to 12,000 households in the two communities. To participate, residents had to be 8 to 65 years of age and had to have severe respiratory problems. Eligible residents were invited to participate in a toll-free telephone interview. The interview included questions on demographics, residence, odors, pollution, respiratory symptoms, and health conditions. 

To prepare the community for the study, and to increase participation, the ATSDR site team developed a multiphase community outreach approach that included the following activities: 

• produced two continuing medical education courses, which were offered through the Richmond County (NY) Medical Society; 
• held a press conference and released a joint press release with then Congresswoman Molinari announcing ATSDR's study;
• held poster sessions in libraries and met with local community boards to educate community members about ATSDR and its activities on Staten Island and to encourage participation in the study; 
• distributed flyers and posters about the study through local physicians and pharmacies; and
• called 7,000 residences to invite eligible persons to participate. 

In the summer of 1997, ATSDR conducted a 6-week study of asthmatic Staten Island residents to determine whether acute changes in respiratory morbidity and daily indicators of landfill emissions were associated. A total of 151 persons aged 1565 years who had asthma and who resided near the landfill volunteered to participate. 

Participants were asked to fill out a diary covering daily symptoms, peak flow (lung capacity measured by spirometer), activity, and odor recognition. Concurrently, ATSDR sampled the air of several residential locations for four air pollutants that can contribute to respiratory ailments: ozone, particulate matter less than 10 microns, particulate matter less than 2.5 microns, and hydrogen sulfide (H₂S), which was collected as an indicator of landfill emissions. During the study period, daily pollen and fungi counts were collected by the New Jersey Medical School in Newark,New Jersey and meteorological data were collected from three existing sources: (1) the Newark International Airport, (2) the Fresh Kills Landfill, and (3) Susan Wagner High School located on Staten Island. These stations reported wind direction, wind speed, temperature, barometric pressure, precipitation, cloud cover, and relative humidity. 

Participation in the study was excellent, with 148 (98%) of the 151 residents initially enrolled in the study completing the daily diaries. A total of 102 (69%) participants were female, 46 (31%) were male, and the majority were 30-49 years of age. In the summer of 1999, ATSDR plans to release a draft of the respiratory health investigation, which will determine if respiratory morbidity (e.g., wheeze, peak flow, etc.) was significantly associated with indicators of landfill emissions (e.g., measures of hydrogen sulfide or odor recognition), while controlling for other determinants of air quality on Staten Island. 

Results of the summer 1997 air monitoring program were released for public comment during July 1998. This report, "Fresh Kills Air Monitoring Program Draft Report," presents information concerning ambient concentrations of selected air pollutants in residential areas next to Fresh Kills Municipal Landfill from July 20, 1997, through September 6, 1997. The Fresh Kills Air Monitoring Program Draft Report does not discuss how levels of air pollution might relate to health because health analysis of this study is ongoing and results will not be released until the summer of 1999. 

The primary results of the air monitoring program as listed in the draft report are summarized as follows: (1) Ambient air concentrations of ozone were measured at five monitoring locations. None of the 1-hour average concentrations measured exceeded the National Ambient Air Quality Standard (NAAQS) for ozone (0.120 ppm).⁽²⁾ Two size fractions of particulate matter were measured at the same five locations. The magnitude and size distribution of airborne particulate matter varied little from monitoring location to monitoring location. The levels of particulate matter measured were always lower than their corresponding NAAQS.⁽³⁾ An analysis of the H₂S measurements by location strongly suggested that the primary source of hydrogen sulfide was the Fresh Kills Municipal Landfill and its surrounding wetlands. The concentrations of hydrogen sulfide measured were below levels that have been associated with human illness. Hydrogen sulfide can be detected as an odor at very low levels and was used as an indicator for landfill emissions⁽⁴⁾. 

Daily average pollen counts showed weeds to be the predominant source of pollen near the landfill, followed by grasses, then trees. None of the pollen counts or fungi counts measured during the study period exceeded the levels considered "very high" by the National Allergy Bureau. 

A review of the literature has shown H₂S to be associated with eye irritation, sore throat, coughing, shortness of breath, fluid in the lungs, and, possibly, behavioral changes. At extremely high levels, greater than 500,000 ppb, H₂S can be fatal. The acute- duration inhalation minimum risk level (MRL) for H₂S is 500 ppb and the intermediate-duration MRL is 90 ppb, according to a draft ATSDR toxicological profile for H₂S that has been released for public comment.⁽⁶⁾ The levels of H₂S measured in the residential area adjacent to the Fresh Kills landfill are much lower than the MRLs, indicating that no health effects are anticipated based on the previous and present study findings. 

ATSDR anticipates releasing a draft public health assessment of the Fresh Kills Landfill for peer review during the fall of 1999. The results of the respiratory health investigation is planned for publication in the summer of 1999. 

ATSDR is maintaining community interest and participation by producing and sending a newsletter to local residents and visiting local community boards about every 6 months. The first newsletter was sent to more than 1,400 residents in March 1998, and the mailing list grew to nearly 1,800 residents for the September 1998 issue. 

ATSDR still has a large amount of landfill study data to evaluate, but it has gained an important entry into the community through partnerships with local residents, New York health agencies, environmental regulatory agencies, and local and federal legislators. 

For more information, contact Doug Gouzie, PhD, at (800) 447-1544 or dag6@cdc.gov.

References

1. New York City Department of Health. Staten Island Cancer Incidence Study. New York: New York City Department of Health; 1996 Mar.
2. Gelberg KH. Health study of New York City Department of Sanitation landfill employees. J Occup Environ Med 1997 39:110310.
3. New York Department of Environmental Conservation. Ambient air quality characterization of Fresh Kills Landfill, 1994 preliminary report. New York: New York Department of Environmental Conservation; 1995 Feb. 
4. Agency for Toxic Substances and Disease Registry. Health consultation for the Fresh Kills Landfill, Staten Island, Richmond County, New York. Atlanta: US Department of Health and Human Services; 1998 Jan 20. 
5. US Environmental Protection Agency. Determination of landfill gas composition and pollutant emission rates at Fresh Kills Landfill. Radian Corporation. Atlanta: US Environmental Protection Agency; 1995 Nov. Report No. EPA 902-R-95-0016.
6. Agency for Toxic Substances and Disease Registry. Toxicological profile for hydrogen sulfide [draft for public comment]. Atlanta: US Department of Health and Human Services; 1997 Sept.

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ATSDR Issues First Health Education/Community Involvement Consultation

The Agency for Toxic Substances and Disease Registry (ATSDR) has completed an innovative public health effort - a collaborative health education/communityinvolvement consultation. 

In 1997, more than 40 areas of exposed asbestos were discovered at the Valley Forge National Historical Park (VFNHP) near Philadelphia. Concentrations of chrysotile and amosite asbestos in soil samples were as high as 70%. The asbestos was mainly confined to several old quarries, but erosion had spread it into adjoining land, streams, and the Schuylkill River. 

Asbestos has been linked to asbestosis, i.e., a slow buildup of scar-like tissue in the lungs and lung membranes; lung cancer; and mesothelioma, i.e., cancer of the thin membrane that surrounds the lung and other internal organs. 

There was concern that park employees (from 77 to 95 employees, depending on the season) and visitors (almost 7 million a year) may be at exposure risk through inhalation of airborne asbestos fibers. ATSDR, the US Environmental Protection Agency (EPA), the National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention, and the National Park Service (NPS) began collaborating on emergency remediation plans and actions. 

The highest asbestos concentrations found in park air were 0.002 and 0.003 fibers per cubic centimeter (f/cm³). All other samples were below the limit of detection (<0.0019 f/cm³ to <0.0035 f/cm³). Actual concentrations could have been much lower because small sample volumes prevented a lower level of detection. The highest asbestos levels measured were in the upper range of background levels typically found in urban areas. These levels are not expected to pose a significant public health threat.⁽¹⁾

In addition to requesting assistance from several governmental agencies in sampling for and remediating asbestos and preventing asbestos exposure, NPS asked ATSDR to provide a consultation on the health education and outreach needs and concerns of park employees regarding asbestos. This request included providing specific recommendations for health education and community involvement activities. 

ATSDR's Health Education Branch (HEB) of the Division of Toxicology and Environmental Medicine (DHEP) and the Community Involvement Branch (CIB) of the Division of Health Assessment and Consultation (DHAC) collaborated to provide this new, cross-cutting type of consultation. 

In September 1997, ATSDR conducted a health education and community involvement assessment to identify employees' (1) health concerns; (2) health practices (e.g., how they obtain information about environmental and health concerns); (3) health behaviors (e.g., smoking); (4) health conditions (e.g., asthma or asbestosis); and (5) information sources (e.g., the employee newsletter for remediation updates and other site-related news). 

Seventy-four of the available 77 park employees were interviewed to evaluate their exposures and assess their health education and community involvement needs. The interviews were conducted by representatives from ATSDR, the Pennsylvania Department of Health, and the Montgomery County Health Department. The interviews contained questions that provided both quantitative and qualitative data. Because results were not being generalized to a larger population, the data were analyzed using descriptive rather than inferential statistics. 

The resulting consultation report contains background information, actions conducted through 1997, assessment results, and recommendations for further health education and community involvement actions.⁽²⁾

Three interwoven themes emerged from the data analysis. First, employees had differing interpretations of exposure mechanisms and the ways by which asbestos causes adverse health effects. Second, employees were uncertain about the level of asbestos contamination they were bringing on their clothes and shoes into park work areas and housing units. Third, employees were fearful of the potential health effects resulting from asbestos exposure. 

The incidence of tobacco use among employees was high (45%). The interviews, however, did not include questions about whether employees were aware of the compounding effects of smoking on asbestos-related disease. 

Recommendations provided in the consultation report included the following:

• Initiate health education efforts to address employees' health concerns and their actual and perceived risks associated with asbestos exposure, including the adverse health effects of smoking, the risk for cancer associated with smoking and asbestos exposure, and work practices that reduce risk for exposure. 

• Provide information about the employees' non-asbestos related health concerns, e.g., exposure to lead and radon and infection resulting in Lyme disease.

• Provide updates to employees, the community, local agencies, and the media about the progress of asbestos removal in the park and on other asbestos-related concerns. The interview results indicated that the park employees primarily obtain information through internal memos, the safety officer, meetings, other employees, e-mail, and newspapers. Updated information could be communicated to the community and the media through periodic telephone calls, meetings, press releases, or local newspaper advertisements. 

• Ask VFNHP to consider conducting, with assistance from ATSDR, an outcome evaluation within a 6-month-to-1-year time frame to determine whether implementation of these recommendations resulted in any behavior change among park employees. 

These efforts included the following: 

• ATSDR provided VFNHP with information for initiating health education and community involvement activities (i.e., about remediative efforts), and for addressing health concerns through different channels (e.g., internal memos, brochures, and large posters) in places where employees tend to congregate or work. 

• ATSDR reviewed press releases and provided information to the press through interviews to assist VFNHP in providing updates on remediation efforts, findings, and actions conducted. 

• ATSDR sent VFNHP information packets containing sample press releases, fact sheets, and communication plans to help VFNHP conduct employee and community outreach activities.

• The collaborative efforts of DHEP and DHAC resulted in a consultation that was initiated before the phase of site investigation and assessment had progressed or been completed. Moreover, the consultation was conducted before all sampling and assessment of the site had been completed. Consequently, this consultation serves as a powerful reminder that ATSDR's health consultations warrant early participation in decision making by HEB and CIB. 

• Some of the expected benefits of conducting this new health education and community involvement consultation at an early stage are (1) stakeholders'         (i.e., employees') empowerment by allowing them to voice their concerns; (2) increased, earlier opportunities for communication and collaboration among all participants; and (3) promotion of effective health risk communication at an early stage, which may result in increasing the awareness and knowledge of target audiences and enabling them to better protect their health and decrease their anxiety, fear, and anger about the site hazard. 

ATSDR is conducting an evaluative case study to determine the mechanisms by which stakeholders benefitted from the assessment and the significance of integrating NIOSH, EPA, CDC, and ATSDR environmental and exposure data with that from ATSDR's health education and community involvement consultation. 

For more information, contact Donna Orti (e-mail dlo1@cdc.gov)at (800) 447-1544.

References

1. Agency for Toxic Substances and Disease Registry. Ambient air/Schuylkill River health consultation. Atlanta: US Department of Health and Human Services; 1998, Jan.

2. Agency for Toxic Substances and Disease Registry. Valley Forge National Historical Park health education/community involvement consultation. Atlanta: US Department of Health and Human Services; 1998, Feb.
 

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Children and the Environment

• The Agency for Toxic Substances and Disease Registry (ATSDR) and the US Environmental Protection Agency's Office of Solid Waste and Emergency Response have signed a memorandum of understanding to share responsibility for protecting children from the adverse health effects of hazardous substances from waste sites and emergency releases.

• ATSDR expanded its process for creating toxicological profiles to address the effects of toxic substances in hazardous wastes on the sensitive developing immune, nervous, and reproductive systems of children. The profiles provide toxicologic and adverse health effects information for use by health professionals. ATSDR also publishes a series of easy-to-read toxicological fact sheets in both English and Spanish, which are available to the public by calling the ATSDR toll-free number, 1-800-447-1544, or through the agency's Internet site at under "ToxFAQs." ATSDR is developing additional fact sheets on the special risks to children.

• ATSDR expanded its support of pediatric environmental health specialty units (PEHSU) from two to three locations: Harborview Medical Center, University of Washington, WA; Occupational and Environmental Health Center, Cambridge Hospital, MA; and, most recently, Mount Sinai School of Medicine, NY.

• Training is occurring at the Cambridge Hospital location with two cross-training curriculum modules, "Developmental Factors Related to Children and Environmental Toxic Exposures" and "Pediatric Environmental/ Occupational History." Grand rounds have been given for both Environmental/Occupational Medicine and Pediatric Toxicology residents. Training in pediatric environmental topics have been offered to physicians and residents by means of lectures, grand rounds, journal articles, and curriculum, including a course entitled, "Introduction to Occupational and Environmental Medicine."

• Telephone consultations have taken place at all units (30% of phone consultations at the Harborview PEHSU concerned specific questions on pediatric environmental exposures). During the month of July 1998, a total of 7,212 calls concerning exposures to environmental hazards were made to Harborview, with 2,995 of those calls concerning pediatric exposure; an additional 4,121 information gathering calls were made, with 215 concerning pediatric exposure to environmental hazards.

• A regional needs assessment survey was conducted in Washington, Wyoming, Alaska, Montana, and Idaho by the Harborview. This survey also served as an outreach tool to announce the development of the PEHSU and included a Rolodex card with contact and Web Page information.

• ATSDR and the Centers for Disease Control and Prevention (CDC) are funding a study entitled "Children's Risk Perceptions as a Key Determinant in Communications Planning." The study will assess children's and parents' risk perceptions and knowledge of environmental toxins, such as polychlorinated biphenyl (PCBs), benzene, mercury, and lead. A post-study questionnaire will be administered to assess changes in knowledge, perceived risk of environmental toxins, and the individual's behavioral intent.

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This page last updated on October 28, 2003
Contact Name: Wilma López/ WLópez@cdc.gov